Military Personnel: Additional Actions Needed to Address Gaps in Military Physician Specialties
Highlights
What GAO Found
The Department of Defense (DOD) has experienced gaps between its physician authorizations (i.e., funded positions) and end strengths (i.e., number of physicians). Its overall approach to address these gaps focuses on the individual service components relying on the scholarship program, University, and other programs to recruit and retain physicians. However, this approach does not include targeted and coordinated strategies to address key physician shortages. All of the components experienced gaps in a number of specialties; several of these were below 80 percent of authorized levels (see figure) and are in what are considered critically short wartime specialties. Until the services develop and implement strategies to alleviate these gaps, they could be at risk of not being able to provide medical care to servicemembers during wartime.
Number of Military Physician Specialties That Were Below Authorizations, Fiscal Year 2015
About 95 percent of scholarship- and University-enrolled medical students with reported qualification data met the services' or the University's minimum academic acceptance criteria in fiscal years 2011-2016. However, the services and the University generally did not consistently track performance data, such as licensing exam scores, specialty, and board certification. Further, the Army and the University used their available data to inform their programs, but the Navy and the Air Force did not. Until all the services track such data, the department will not have key information needed to continually improve programs.
The reported cost to the Army, Navy, and Air Force to educate the services' scholarship medical students has fluctuated over the past 6 years, ranging from $44 million to $59 million annually for each service. The costs to educate University medical students are not known. According to University officials, they were unable to determine the costs to educate medical students because their programs share resources. Developing a reliable method to accurately determine shared costs would enable DOD to gauge medical school costs and provide opportunities to enhance overall cost-effectiveness.
Why GAO Did This Study
Because of nationwide shortages and other challenges, DOD offers programs and incentives to attract and retain more than 16,000 military physicians. DOD's scholarship program, managed by the services, and its University (DOD's sponsored medical school), are the department's two primary programs for creating a pipeline of future military physicians.
Senate Report 114-255 included a provision for GAO to review the recruitment, accession, and retention of military health care professionals. GAO assessed the extent to which DOD (1) has experienced gaps between its military physician authorizations and end strengths, and has an approach to address key gaps; (2) has enrolled students who meet minimum qualifications, and tracked data to evaluate their performance; and (3) knows the costs of educating scholarship and University medical students. GAO compared authorizations to end strengths by specialty, analyzed student data and scholarship and University costs, and interviewed DOD and service officials.
Recommendations
GAO is making ten recommendations, including that the services develop targeted and coordinated strategies to alleviate military physician gaps; the services improve the tracking of medical student data, and the Navy and the Air Force use the data to continually improve their programs; and the University develop a method to accurately determine the costs to educate medical students. DOD did not provide comments on a draft of this report.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Defense | The Secretary of the Army should develop targeted strategies for using its recruitment, training, and retention programs collectively to address key military physician gaps in a coordinated manner, and metrics that would monitor the effectiveness of its programs collectively in reducing gaps. (Recommendation 1) |
Army concurred with this recommendation. In fiscal year 2019 DOD and the Army took several actions, including creating a 6-year health professions officer retention bonus for critically short physician specialties; increased the number of Armed Forces Health Professions Scholarship Program scholarships to help decrease the overall physician shortfalls; and added a recruiting mission using Financial Assistance Program scholarships to help decrease the physician shortfall in critical specialties. Lastly, the Army has monitored its recruitment and retention efforts and plans to continue to monitor its efforts annually. As these actions meet the intent of our recommendation, we consider this recommendation to be implemented.
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| Department of Defense | The Secretary of the Navy should develop targeted strategies for using its recruitment, training, and retention programs collectively to address key military physician gaps in a coordinated manner, and metrics that would monitor the effectiveness of its programs collectively in reducing gaps. (Recommendation 2) |
Navy concurred with this recommendation. In October 2019, Navy officials stated that several steps have been taken, including exploring policy changes that would assist in meeting requirements. According to Navy officials, a working group was formed to address recruitment and retention of all critical specialties and finalized a report August 2018. In November 2023, the Navy reported it will continue monitoring recruitment and retention data and DOD reported it estimates this recommendation will be fully implemented by December 2023. In November 2023, we requested additional information about the status of this recommendation. We will continue to monitor DOD's actions to implement this recommendation.
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| Department of Defense | The Secretary of the Air Force should develop targeted strategies for using its recruitment, training, and retention programs collectively to address key military physician gaps in a coordinated manner, and metrics that would monitor the effectiveness of its programs collectively in reducing gaps. (Recommendation 3) |
Air Force concurred with this recommendation. To address this recommendation, the DOD and the Air Force took several actions in fiscal year 2019, including DOD creating a 6-year health professions officer retention bonus for critically short physician specialties and Air Force developing a sustainable process for improved marketing of key specialties to students and increasing the number of Armed Forces Health Professions Scholarships. In 2021, Air Force reported that they are continuing to monitor and recruit to needed specialties. As these actions meet the intent of our recommendation, we consider this recommendation to be implemented as of February 2022.
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| Department of Defense | The Secretary of the Army should track complete, accurate, and accessible information on the qualifications, performance, and progress of Army Armed Forces Health Professions Scholarship Program (AFHPSP) medical students. (Recommendation 4) |
Army partially concurred with our recommendation. In July 2018, the Army issued a memorandum requiring quarterly review of key data fields and requirements for completeness and accuracy of data. Further, retraining of data entry technicians have been performed and records are now to be routinely reviewed by the program manager for accuracy. As this action meets the intent of our recommendation, we consider this recommendation to be implemented.
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| Department of Defense | The Secretary of the Navy should track complete, accurate, and accessible information on the qualifications, performance, and progress of Navy AFHPSP medical students. (Recommendation 5) |
Navy concurred with this recommendation. In November 2018, the Navy changed its Navy Standard Integrated Personnel System (NSIPS) to allow tracking of qualification data fields. In fiscal year 2019, the Navy updated its Navy Standard Integrated Personnel System (NSIPS) to allow tracking of qualification data fields. Moreover, the Navy expanded the capability of other automated systems to capture performance data. In fiscal year 2021, Navy reported that they have completed the creation of routine reporting and reported that these efforts allows the Navy to pull data, including qualification and performance data for routine and ad hoc reports. As these actions meet the intent of our recommendation, we consider this recommendation to be implemented as of February 2022.
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| Department of Defense | The Secretary of the Air Force should track complete, accurate, and accessible information on the qualifications, performance, and progress of Air Force AFHPSP medical students. (Recommendation 6) |
Air Force concurred with this recommendation. In August 2018, the Air Force updated guidance to emphasize the requirement for accurate and complete reporting of qualification data of AFHPSP medical students. The Air Force explored using a secure a tri-service database to track students' performance across the continuum of learning. However, in November 2023, the Air Force noted that as of April 2021, efforts to track students' performance in a department-wide system have been unsuccessful. In November 2023, DOD reported it estimates this recommendation will be fully implemented by April 2024. We will continue to monitor DOD's actions to implement this recommendation.
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| Department of Defense | The President of Uniformed Services University of the Health Sciences (USUHS) should track complete, accurate, and accessible information on the performance and progress of USUHS medical students. (Recommendation 7) |
Uniformed Services University of the Health Sciences concurred with our recommendation. In April 2021, the University reported that it is in the process of redesigning its Student Information System. The University noted that modifications such as changing quarter to semester credits and developing a system to assign clinical rotations throughout the academic year across the country are being developed. In November 2023, DOD reported it estimates this recommendation will be fully implemented by September 2028. We will continue to monitor DOD's actions to implement this recommendation.
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| Department of Defense | The Secretary of the Navy should use information on medical student performance to evaluate Navy accession programs. (Recommendation 8) |
Navy concurred with this recommendation. In October 2019, the Navy reported that the Navy Standard Integrated Personnel System (NSIPS) now contains qualification data of AFHPSP medical students and also has some performance data of these students as they compete their post graduate training. NPSIS is capable of being queried and this data, according to the Navy, can be used to evaluate its accession programs. In April 2021, Navy reported that it is using NSIPS to do information queries and data pulls on performance measures. In November 2023, DOD reported it estimates this recommendation will be fully implemented by April 2024. We will continue to monitor DOD's actions to implement this recommendation.
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| Department of Defense | The Secretary of the Air Force should use information on medical student performance to evaluate Air Force accession programs. (Recommendation 9) |
Air Force concurred with our recommendation. In October 2019, the Air Force reported it plans to annually track and analyze information regarding its AFHPSP medical students and it is in the process of performing its annual review. While the steps Air Force reported demonstrate progress toward fully implementing our recommendation, we believe that this recommendation should remain open until more progress is made. In November 2023, DOD reported it estimates this recommendation will be fully implemented by April 2024. We will continue to monitor DOD's actions to implement this recommendation.
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| Department of Defense | The Assistant Secretary of Health Affairs should require that the President of USUHS develop a reliable method to accurately determine the cost to educate its medical students. (Recommendation 10) |
Uniformed Services University of the Health Sciences concurred with our recommendation. In response to our recommendation, the University contracted with the Institute for Defense Analyses to determine the costs to educate University medical students. In its October 2019 final draft report, the Institute for Defense Analyses estimated the cost to educate medical students that attend the University. As this action meets the intent of our recommendation, we consider this recommendation to be implemented.
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