UNITED STATESGENERALACCOUNTINGOFFICE WASHINGTON, DC 20548 HUMAN RESOURCES DIVISION B-146858 TEE 2 5 5977 The Honorable The Asslstant Secretary of Defense (HA) Dear Dr Smith We recently completed a survey of Department of Defense (DOD) medical facllltles In the Unrted States and Europe As part of that survey, we dlstrlbuted questlonnalres to physlcrans assigned to seven mllltary hospitals to obtain their opinions concerning condltlons whrch may be influencing the quality of medical care A total of 293 physlclans responded to the questlonnalre, representing about 70 per- cent of the questronnalres distributed Because many areas En the questlonnalre responses may be of interest to you , we are enclosing all the responses with the thought that this information could be useful In DOD's day-to-day management and evaluation of a valuable resource--physicians. One questlon (Number 41) concerns physician retention The answers to this ques- tion might be of particular Interest to you since it highlights rea- sons why physlclans plan to leave the military service An area of particular interest to us was the physlclan assrstant (PA) programs of the Army, Navy, and Air Force We believe that work now being done for the Air Force, which 1s aimed at assessing the appropriate role of these health care providers In Arr Force medical facllrtles,could be beneflclal to the entlre DOD hospital system PHYSICIAN ASSISTANTS Responses to questnon 21, part 2, lndlcate that physlclans are substantially dlssatlsfxed with the adequacy of PA staffing levels. In addltlon, comments from offlclals at some mllltary hospitals which had PAS and from mllrtary offlclals In Washlngton, D.C., were compll- mentary of the PAS' work They stated that if more PAS were avallable, PAS could absorb mole of the physlclans' workloads As you know, in fiscal year 1977, monies for the direct funding of PA training programs were eliminated from the budget The services' response to this action dlffered substantially. The Army xnstlated a 5 ., m B-146858 pilot program m late fiscal year 1977 which placed greater reliance on lndlvrduals tramed in clvrllan schools The Navy 1s planning to phase out PA tralnmg by the end of fiscal year 1978. The Air Force lnltlally trained registered nurses to undertake PA responslbllrtles, m accordance with a recommendation made In the budget declslon. Graduates of this program were desrgnated as Primary Care Nurse Practltroners. In evaluating their work performance, however, Air Force offlclals observed that nurses In the program generally were having dlfflculty assummg a role of diagnosing medlcal problems and mltlatmg health care dellvery As a result, the Al-r Force ended this program in November 1976 and decided to continue its PA training program by reallocatmg funds from other programs. We recently learned that the Air Force is sponsoring a RAND Corporation study to determine the most appropriate mix of physlclans and physlclan extenders-- PAS and Primary Care Nurse Practitioners--m Air Force medical facllltles We understand that the study's prellml- nary findings suggest that physlclan extenders can adequately do a large portxon of the work now done by physlclans m general medlcal clinics, and accordingly, more of them may be needed In the Air Force health care system The A1.r Force is now testing RAND's recommended staffing mix at sxx Air Force cllnlcs, and final conclusions are expected in 1978. The prellmmary results of the EUND study largely reflect the comments and oplnlons we received regardLng the value of these health care providers. However, the comments and oplnlons we received cov- ered a cross section of physicians from the Army and Navy as well as the Air Force One shortcommg of the FUND study seems to be that Its scope 1s llmlted to the Air Force health care system. Our survey showed that all three services believed PAS could do much of the work now done by physlclans Accordingly, we belleve the benefits that may accrue to the Air Force as a result of the RAND study might also be applicable to the Army and Navy hosprtal system Some of the benefits which we belleve may accrue Include --Achlevlng cost savings as a result of maklng greater use of physlclan assistants In health care roles normally assumed by physlclans --Allevlatlng the current shortage of General MedIcal Officers. --Dlmlnlshlng the frequent complarnts from physlclans that they spend too much time treating routine ailments and not enough time practlclng In their specialty area We are aware that certain differences among the health care systems of the three services In both a peacetime and moblllzatlon status might -2- 1 ** ‘ir 4 h B-146858 * llmlt the direct application of the RAND study flndlngs to the Army and Navy, Examples of such differences include --Army and Navy hospitals tend to be larger than Air Force hospitals. --The Navy needs to provide care on ships at sea as well as at land-based facllltles. In light of the prellmlnary flndlngs, we believe that you should examine the scope of the BAND study to determlne whether the final results can be directly applied to the Army and Navy If you decide they cannot, you may want to consider broadening the scope of the study to determlne the optimum mix of physlclans and physician extenders in the different hospital settings of all three services. By using the Air Force's work , you may be able to greatly Increase the appll- cabrllty and value of the RAND study flndlngs. If the results of the RAND study can be applied to the Army and Navy, you may wish to consider provldlng training In a single trlservlce facility, since this could be more cost-effective than lndlvldual tralnlng facllltres 1n each service In an April 23, 1976, "Pomt Paper," the Surgeons General dlscussed this tralnlng approach We appreciate the cooperation and assistance given by DOD per- sonnel during our survey We will be glad to discuss any questions with you or your representatives Smcerely yours, Thomas P McCormick Asslstant Dlrector Enclosure -3-
Physician Questionnaire Results
Published by the Government Accountability Office on 1977-02-25.
Below is a raw (and likely hideous) rendition of the original report. (PDF)