Will There Be Enough Trained Medical Personnel in Case of War?

HRD-81-67: Published: Jun 24, 1981. Publicly Released: Jun 24, 1981.

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The military services medical departments have missions to: (1) provide peacetime care to eligible beneficiaries; and (2) maintain readiness to meet wartime contingencies. Pursuant to a congressional request, GAO reviewed the extent to which wartime military medical personnel shortages exist, what is being done or can be done to overcome the shortages, and how well available personnel are trained for wartime missions.

An analysis of Department of Defense (DOD) data shows that the number and types of medical personnel in the active duty and reserve forces fall far short of the total projected personnel requirements for the current, most demanding wartime scenarios. DOD projections show that shortages of physicians, nurses, and enlisted medical personnel would be most severe, reduce capacity to deliver wartime care, and begin to occur soon after mobilization. Shortages of surgical personnel would be especially critical. Some other enlisted specialty shortages would also be critical because no pretrained pool exists in the civilian sector. To plan effectively for wartime contingencies, DOD planners need data not only on total medical personnel requirements, but also on what portion of those requirements DOD can actually use in its own military hospitals. It has made little progress toward implementing plans and initiatives to increase its capabilities in these personnel shortage areas. DOD medical readiness planning has focused on long-range goals and objectives to address anticipated changes in threat, personnel, and other factors in future years. Federal mobilization planners believe that the civilian sector has enough medical personnel to augment most military mobilization needs. Selective Service System (SSS) planners have not determined the rate at which medical personnel could be brought into the military if mobilization occurred. Other alternatives are available to DOD in planning to overcome shortages of medical personnel after mobilization.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of Defense should make prearrangements for interservice assignments.

    Agency Affected: Department of Defense

  2. Status: Closed - Implemented

    Comments: DOD is entering into agreements with the American Medical Association and the American Nurses Association to obtain health care providers' names, addresses, and specialty information. During mobilization, DOD would use this information to contact physicians and nurses needed by the services. These agreements, however, do not include personnel to fill shortage positions at predesignated hospitals.

    Recommendation: The Secretary of Defense should obtain advance agreements with civilian medical personnel to fill key hospital shortages.

    Agency Affected: Department of Defense

  3. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of Defense should make arrangements to use those Public Health Service (PHS) officers the Secretary of Health and Human Services (HHS) determines could be committed to DOD.

    Agency Affected: Department of Defense

  4. Status: Closed - Not Implemented

    Comments: DOD failed to implement any new procedures to standardize field unit personnel training at military hospitals. GAO believes that certain in-hospital skills should be emphasized to prepare medical personnel adequately for wartime roles.

    Recommendation: The Secretary of Defense should require the Army to provide needed clinical skills training programs to field personnel on loan to hospitals.

    Agency Affected: Department of Defense

  5. Status: Closed - Implemented

    Comments: In August 1982, DOD began to require the military to submit time-phased personnel requirements data in conjunction with their annual program objective memoranda (POM) submissions.

    Recommendation: The Secretary of Defense should direct the services to periodically report their requirements estimates to DOD medical mobilization planners for developing overall medical mobilization plans.

    Agency Affected: Department of Defense

  6. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of Defense should identify and implement specific initiatives to recruit and retain nurses while continuing its initiatives to recruit and retain physicians.

    Agency Affected: Department of Defense

  7. Status: Closed - Implemented

    Comments: Although DOD increased the emphasis on training overall, requirements for field unit personnel have not been standardized.

    Recommendation: The Secretary of Defense should require the Army to establish firm criteria for the frequency and duration of in-hospital training to be given to field unit personnel.

    Agency Affected: Department of Defense

  8. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of Defense should direct the services to develop a consistent and systematic method to estimate the rate at which reserve medical personnel can be expected to report for duty after mobilization.

    Agency Affected: Department of Defense

  9. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of Defense should require the Army to increase in-hospital training programs for field unit personnel located within short distances of military hospitals.

    Agency Affected: Department of Defense

  10. Status: Closed - Implemented

    Comments: The Secretary of Defense issued a DOD instruction in August 1982, which can be interpreted to mean that the services should consider the availability and constraints of all types of facilities in mobilization planning. However, the instruction does not specifically state that constraints in medical facilities be considered in developing medical personnel requirements.

    Recommendation: The Secretary of Defense should direct the services to develop consistent estimates of near-term medical personnel requirements based on total needs and needs as constrained by available military facilities. The estimates of constrained personnel requirements should be developed together with complete assessments of the availability of other medical resources, such as hospital beds, equipment, and logistic support.

    Agency Affected: Department of Defense

  11. Status: Closed - Implemented

    Comments: DOD asked the services to conduct feasibility studies involving preassignment of physicians in critical specialties and nurses from the active reserve and Individual Ready Reserves to early deploying units. DOD does not have any preassignment plans for enlisted personnel in military unique specialties.

    Recommendation: The Secretary of Defense should develop specific plans to meet the early postmobilization requirements of DOD for: (1) surgeons and other surgical personnel in-theater; and (2) medical personnel in military-unique specialties.

    Agency Affected: Department of Defense

  12. Status: Closed - Implemented

    Comments: The Army took certain steps to improve combat readiness. However, the Army does not have an in-hospital training policy which requires hands-on training in all needed clinical tasks.

    Recommendation: The Secretary of Defense should require the Army to structure in-hospital training programs to provide exposure to the full range of needed skills.

    Agency Affected: Department of Defense

  13. Status: Closed - Implemented

    Comments: DOD implemented only two of the three specific elements needed to comply with this recommendation. Also, DOD did not take the necessary action to identify additional alternatives to overcome postmobilization medical personnel shortages.

    Recommendation: The Secretary of Defense should plan for near term contingencies by evaluating alternatives for overcoming postmobilization medical personnel shortages, which would occur before Selective Service inductees report and are trained for military duty.

    Agency Affected: Department of Defense

  14. Status: Closed - Implemented

    Comments: Since the report was issued, the Army has placed greater emphasis on the training of medical personnel. However, the Army has not taken any action, during this time, to develop a system which monitors the extent and quality of training being provided to medical personnel.

    Recommendation: The Secretary of Defense should require the Army to develop a system for monitoring both clinical and combat-related training to ensure that they are given a high priority and are effectively accomplished.

    Agency Affected: Department of Defense

  15. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of Defense should require the Army to provide guidance to unit and hospital commanders giving increased priority to medical readiness training.

    Agency Affected: Department of Defense

  16. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of Defense should ascertain the extent to which courses, such as the recently developed triservice Combat Casualty Care Course, should be expanded to provide training to medical personnel not now eligible and ensure that such training is provided to all appropriate categories of military medical personnel.

    Agency Affected: Department of Defense

  17. Status: Closed - Not Implemented

    Comments: Although DOD prepared a draft proposal, the Department has not submitted the proposal to Congress. DOD officials are opposed to submitting this proposal because they feel the initiatives DOD has underway will correct the shortages, and single out one group for a draft.

    Recommendation: The Secretary of Defense and the Director, SSS, should submit a proposal for a postmobilization draft of medical personnel to Congress as soon as possible.

    Agency Affected: Department of Defense

  18. Status: Closed - Not Implemented

    Comments: This recommendation is virtually identical to another recommendation in this report.

    Recommendation: The Secretary of Defense and the Director, SSS, should submit a proposal for a postmobilization draft of medical personnel to Congress as soon as possible.

    Agency Affected: Selective Service System

  19. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary of Defense should evaluate the applicability of the GAO recommendations regarding the Army's medical personnel training programs to the programs of the other services and, where appropriate, ensure that the other services take steps to implement them.

    Agency Affected: Department of Defense

  20. Status: Closed - Implemented

    Comments: DOD had a standby legislative proposal in draft form since the early 1980's. DOD has never obtained formal comments from the Director, SSS, on the proposal.

    Recommendation: The Secretary of Defense and the Director, SSS, should jointly develop provisions to be included in a standby legislative proposal for a postmobilization draft of medical personnel.

    Agency Affected: Department of Defense

  21. Status: Closed - Not Implemented

    Comments: This recommendation is virtually identical to another recommendation in this report.

    Recommendation: The Secretary of Defense and the Director, SSS, should jointly develop provisions to be included in a standby legislative proposal for a postmobilization draft of medical personnel.

    Agency Affected: Selective Service System

  22. Status: Closed - Implemented

    Comments: HHS began implementing this recommendation through its participation in the Emergency Mobilization Preparedness Board (EMPB) and the National Disaster Medical System. It participated in an EMPB task force in assessing the availability of civilian physicians. In July and August 1986, HHS began assessing the availability of PHS uniformed physicians.

    Recommendation: The Secretary of Health and Human Services should ascertain the extent to which: (1) civilian medical personnel will be required and available in the civilian sector during mobilization; and (2) DOD can rely on civilian medical personnel as it plans its mobilization efforts.

    Agency Affected: Department of Health and Human Services

 

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