As Memorial Day nears, let us now cast our eyes downward
in remembrance of a fallen comrade, who once cared for
so many, yet asked so little in return:

U.S. Military Medicine: 1775-2001, may she rest in peace.

Since 2001, U.S. military medicine has devolved into a rotten,
stinking corpse of its former, glorious self.  It did not die a
natural death: it was murdered in cold blood.  

--Note that this is not a partisan political issue: although the
massive cutbacks began under George H.W. Bush at the end of the Cold
War, they accelerated under Clinton, who, in dereliction of his duty
as Commander in Chief, neglected to forsee or plan for the coming
global war with radical jihadists, and fund and staff the Military
Medical System (MMS)  accordingly; the final coup de grace was
delivered by the Bush administration which, despite its crowing about
"supporting our troops and veterans", has systematically gutted and
outsourced U.S. military medicine to the point of frank mission
failure, to the permanent detriment of hundreds of troops, their
family members, and retirees.

Additional causes of death on the MMS death certificate include, but
are not limited to, the following:

--Anesthesiologist physicians have been replaced by green
nurse anesthetists (CRNAs), fresh out of training.  Who would you want
watching over you during the "Valley of the Shadow of Death" which is
general anesthesia: a nurse with 2 years of special training, or an
M.D. with 4 years of training *after* 4 years of medical school?
In the military, you no longer have a choice.  Even when
anesthesiologist M.D.s are assigned to military hospitals, they are
increasingly being ordered only to act as "consultants" to the CRNAs,
on call to help (try to) resuscitate patients when incorrect
anesthetic plans formulated by inexperienced nurses for increasingly
sick patients go awry.

--Nurses have been put in command of physicians, in order
to champion "nurse empowerment" over physician control
of what used to be called medical care (now "Health Care").
Because nurses get paid more in the military than in the
civilian world, and get rapid opportunities to slide into 
"clipboard-carrying" command roles, they stay in the military to make
rank.  Physicians who are even *once* micromanaged by having their
physician medical judgments challenged by a nurse, whose only
qualification is the rank on her shoulders, flee the system
demoralized and embittered (like myself).

--Dozens of Military Treatment Facilities (MTFs) have been
shuttered or gutted, leaving major "Medical Centers", such
as Andrews AFB and Lackland AFB hospitals mere shells of their former
selves.  Every day at Malcolm Grow "Medical Center" from 2001 onward, 
some section reported via e-mail that it was not "mission capable" due
to short staffing, infrastructure problems, computer issues, or all of
the above.  When these preventable disasters shut down major areas of
the hospital, like Radiology, Pharmacy, or the Operating Room, quality
medical care simply cannot be provided.  Period.  I say "preventable"
because the one missing piece of the puzzle is leadership with the
guts to demand more funding and personnel to do the job, or else said
leadership would threaten to shut down the hospital (or at least the
ICUs and ORs) until higher HQ coughs up adequate funds and humans to
provide "Excellence in All We Do", rather than dangerous mediocrity.
Sadly, such courage in defense of patient safety does not look good on
one's Officer Performance Report, and will *not* put you at the top of
the stack for promotion (as I found out).

--Sheer lack of planning and leadership from 1997 onward has led
to a shocking shortage of specialist physicians in uniform, including 
especially anesthesiologists and orthopedic surgeons.  The few
remaining active duty docs are routinely pulled away from patient
care in the States to be shipped overseas, leaving major 
"Medical Centers" unable to care for the garrison troops, our
honored retirees, and their dependents.  Whenever you see
that a military clinic is "minimally manned", think where the
missing "men" went to: the civilian world (like myself), Iraq,
and, soon, Iran.

--The shortage of docs (due to intentional neutralization of the
Medical Corps by the Nursing Corps, as well as short-sighted penny
pinching by M.D. Surgeons General) has led to the bulk of day-to-day
primary care being provided by LESS trained PAs, nurse practitioners
(NPs), and, soon, housekeepers who watch "Gray's Anatomy" on TV.
Here's a quick tip for retirees: if the MTF near your house offers to
enroll you in the "Gold Team" (run by PAs and NPs), keep complaining
until you get enrolled in the "Silver Team" or Family Practice, which
are still staffed by M.D.s.  Oh, and if they offer to empanel you in
the new TRICARE "Diamond Team", watch out!  This is the pilot military
medical initiative which does away with inefficient face-to-face
office visits; you simply log on to the TRICARE website, input your
symptoms, and allegedly-sophisticated computer heuristics determine
which prescriptions should be mailed to your house within 3 business
days...DANGER, Will Robinson!

--Competent, highly trained active duty docs are being replaced
pell-mell with less competent, less-educated contract physicians, who
cost the U.S. taxpayer 3 times as much for 40 hours of work per week
as an active duty M.D. costs for 60-80 hours per week (given that the
contractors usually don't take call: that would bust the MTF budget).
Think about it: in general, what kind of civilian docs would accept
the bureaucratic red tape, micromanagement by nurses, and lack of
support staff which define military medicine in 2006: the best docs,
or the worst?  I will make one exception for an excellent former
colleague of mine, who left the USAF after 12 years, resigned his
commission as a senior LtCol, and came back to the same hospital to
make 3 times as much money for half the hours of work, without the
danger of a no-expenses-paid trip to the desert...I tip my hat to him,
and wish him well.  

--Finally, for Memorial Day Weekend, which traditionally kicks off the
"101 Critical Days of Summer"  initiative in the military, put the
following in your Daily Planner:

Note to self: do not get sick or injured, because the Military Medical
System which used to be there for me is now dead...murdered by
incompetent mismanagement at the highest levels, and buried in a
shallow grave of intentional neglect and short-sighted cutbacks,
forgotten.  Goddess help our brave troops at home and overseas, who
have no other options.

Signed,

Major Lee D. Pressed, for

R. Carlton Jones, M.D.
ex-LtCol, USAF, MC
ex-Medical Director of Anesthesia, Travis AFB, CA
ex-Asst. Chief Anesthesiologist/Director of QA, Andrews AFB, MD
Harvard 1985, USU 1990, WHMC Residency 1994
Diplomate, American Board of Anesthesiology
e-mail: webmaster_AT_medicalcorpse_D0T_com
http://www.medicalcorpse.com

_Nemo Me Impune Lacessit_

P.S.  AFAIK, there is no "Diamond Team" initiative...yet...give them a
few months, after a few hundred more experienced LtCol and Major M.D.s
flee the corrupt military medical system as I did...