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)

                                  UNITED STATESGENERALACCOUNTINGOFFICE
                                             WASHINGTON,     DC   20548


              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


                    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

             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


                   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

                             --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