Military Medicine Is in Trouble:

Complete Reassessment Needed

HRD-79-107: Published: Aug 16, 1979. Publicly Released: Aug 16, 1979.

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Since the end of the draft in 1973, the military's direct medical care system has experienced a gap between the number of military physicians it has available and the number needed to provide medical care, seriously impairing the system's ability to meet peacetime medical needs efficiently and effectively. Hospital operations have been hampered by the lack of physicians as has the ability of active-duty members to obtain medical care.

The military service medical departments project substandard professional staffing levels past 1984, with no foreseeable increase in the supply of military physicians. Department of Defense (DOD) data showed widespread closings and reductions of medical services in fiscal year 1978 due to the shortage affecting all beneficiaries. GAO visited seven military hospitals and found services closing and reopening, depending on physician availability; patients sent elsewhere or moved long distances for specialized services; greater dependence on civilian services; longer waits by patients; occasional denial of services; and temporary assignments of physicians to short-handed nonmedical functions. GAO recognizes the physician shortage but sees additional reasons for the system's shortcomings, including shortages among other medical service personnel. GAO surveyed beneficiaries living within 30 miles of military hospitals and found that most families of retired members had tried to obtain medical care during an 8-month period; about one-third of them could not do so. GAO estimated that, in the survey period, 104,000 active-duty members and 157,000 retirees failed to obtain care. A follow-up questionnaire from GAO showed that most patients sought medical care elsewhere because of physician shortages or long waits for appointments; they compared civilian care favorably to that of military hospitals and experienced only slight difficulty in paying for these services.

Matter for Congressional Consideration

  1. Status: Closed - Not Implemented

    Comments: Congress has taken actions to address the problems discussed in the report. Congress amended U.S. Code title 10, section 1087, in 1982 to allow for sizing of military hospitals and clinics based on: life-cycle-cost-effectiveness; staff availability; realistic workload projections; and teaching and training requirements. This action was recommended in HRD-81-24.

    Matter: Congress should clarify and formally recognize policies regarding: (1) who the military's direct medical care system will serve in peacetime; and (2) how and to what extent beneficiaries in the direct care system as a result of the policies adopted would receive the assistance needed to obtain medical care from other sources. Congress should reevaluate the role and structure of the military medical care system and direct DOD to establish a structure that will improve its ability to serve beneficiaries in peacetime. Congress should also consider other alternatives discussed in this report as well as others that may be presented from other sources.

Recommendation for Executive Action

  1. Status: Closed - Not Implemented

    Comments: Most of the deficiencies that this recommendation was designed to correct were caused by a shortage of medical personnel. Since that time, DOD has reduced the physician shortages. Scheduled work in the quality assurance area should examine the emergency room issues involved in this recommendation.

    Recommendation: The Secretary of Defense should improve the environment in which military physicians practice medicine to the extent practicable by: (1) reducing or eliminating emergency room duties for specialists, particularly those who do not have routine exposure to general medical practices; (2) reducing physicians' nonmedical duties; and (3) increasing the length of physicians' assignments at specific hospitals.

    Agency Affected: Department of Defense


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