ALL OF MARYLAND'S POLS ARE GLOBAL CORPORATE WALL STREET CLINTON/OBAMA NEO-LIBERALS OR BUSH/JOHNS HOPKINS NEO-CONSERVATIVES---GET RID OF GLOBAL POLS!
For those not knowing SS Disability, where Wall Street global corporate neo-liberals and Republicans are now sending VETS has long been gutted of funding, low in quality care, and is really no more than Medicaid for All. This is to what Clinton/Obama neo-liberals posing progressive in supporting VETs and Social Security are doing to our health care over these few decades.
'Sarbanes Unveils Fast-Track for Disabled Veterans to Receive Social Security Benefits'
Remember the talk on SS Disability being imploded with citizens that should not be in this program and how it pulls from our SS TRUST? Well, here are Maryland's global corporate I'LL DO ANYTHING FOR GLOBAL WALL STREET AND THE GLOBAL CORPORATE TRIBUNAL RULE pols------
Below you see two of the biggest privatization of all that is public pols moving Veterans from a VA with all the benefits already paid through DOD into our SS Disability to drain the SS TRUST. They are not helping VETS----as SSI is a lower tier of care than military benefits and VA health care-----but the media poses progressive-----these pols are fighting to protect our VETERANS!
'The changes are based on legislation authored and introduced by Congressman Sarbanes called the called the BRAVE Act and will affect Social Security disability applications for veterans receiving 100 percent disability ratings from the Department of Veterans Affairs (VA)'.
Disabled VETS being moved from VA care into what is widely known to be a lower quality of care with SS Disability. It brings the lowest wages if Disabled find work------
No one poses progressive better than Sarbanes-----AND DO WE HAVE A SOCIAL DEMOCRATIC CHALLENGER FOR SARBANES AND CUMMINGS?
FOR IMMEDIATE RELEASE
Feb 19, 2014
Sarbanes Unveils Fast-Track for Disabled Veterans to Receive Social Security Benefits
Updated process ensures disabled veterans have speedy access to the benefits they’ve earned
BALTIMORE – U.S. Congressman John Sarbanes was joined today by Congressmen Elijah Cummings and C.A. Dutch Ruppersberger (all D-Md.) and Social Security Administration (SSA) Acting Commissioner Carolyn Colvin to unveil new claims processing protocols that will fast track Social Security benefits for disabled veterans.
The changes are based on legislation authored and introduced by Congressman Sarbanes called the called the BRAVE Act and will affect Social Security disability applications for veterans receiving 100 percent disability ratings from the Department of Veterans Affairs (VA).
“No one wants to put America’s veterans through a bureaucratic runaround,” said Congressman Sarbanes. “As the baby boomer generation ages and more veterans of the wars in Iraq and Afghanistan need care, this common sense change will help reduce backlogs and cut through unnecessary red tape so that our most disabled veterans receive the benefits they’ve earned.”
“The men and women who fight for us overseas, who put their lives on the line, and spend weeks and months away from their families to ensure our safety deserve the very best when they return home. This change in protocol is more than just a smart policy choice – it’s one more way we can support disabled veterans, and give them the treatment they’ve earned,” said Congressman Cummings
OH, REALLY REPRESENTATIVE CUMMINGS, SARBANES, AND RUPPERSBERGER?????
“Our disabled veterans have given their best to our Country and should not be held hostage to bureaucratic red tape when trying to access their benefits. I applaud these new Social Security Administration protocols that will shorten the process to get our veterans their well-earned benefits,” said Congressman Ruppersberger.
“Our veterans have sacrificed so much for our country and it is only right that we ensure they have timely access to the disability benefits they may be eligible for and deserve,” said Acting Commissioner Colvin. “Social Security worked with Veterans Affairs to identify those veterans with disabilities who have a high probability of also meeting our definition of disability. I am proud of our collaboration and happy to announce this new service for America’s vets.”
In 2007, a veteran-constituent contacted Congressman Sarbanes for help with his application for Social Security benefits. This veteran had already received a 100 percent disability rating from the VA, but had been waiting for years to be approved for disability benefits at the SSA, which required a completely separate application process. Congressman Sarbanes introduced the BRAVE Act to streamline the two rating processes, making it easier for disabled veterans to access their Social Security benefits.
Working directly with Acting Commissioner Carolyn Colvin, Congressman Sarbanes today announced that new administrative protocols have been developed that will fast-track disabled veteran claims in a similar manner as envisioned in the BRAVE Act. These changes will take effect in mid-March.
Here is Maryland openly moving towards privatization by pushing VETs into private clinics which as everyone knows in Baltimore are a lower tiered access to health care---------mostly preventative care only. Maryland was the worst in the nation in how it treats its VETs these several years and now will simply send them to private health clinics as they eliminate the Federal VA structures------most Federal funding for VA has already been moved into this outsourced system rife with fraud and this will create the conditions for that to grow.
'in the area's extensive network of private clinics, according to a formal solicitation'.
Health & Human Services
Maryland VA Outsourcing to Private Doctors
by Tribune News Service | July 31, 2014
By John Fritze and Matthew Hay Brown
The medical system charged with caring for Maryland's veterans is seeking help from private physicians in the Baltimore region to address a primary-care backlog that has become one of the worst in the nation, federal officials said Monday.
With Central Maryland's veterans waiting months to schedule an initial visit with a primary-care doctor, the Veterans Affairs Maryland Health Care System is hoping to tap into whatever reserve capacity is available in the area's extensive network of private clinics, according to a formal solicitation.
While the agency's move is unusual, it comes as lawmakers in Congress unveiled a bipartisan agreement Monday to spend $10 billion to expand access to medical care outside the traditional VA system for veterans who live more than 40 miles from a medical center or face long wait times.
"We want to make sure veterans have good access" to primary care, said Dr. Amit Khosla, deputy director of the managed-care clinical center for the VA system in Maryland. "We want to be proactive."
An audit released last month found that veterans in Maryland were waiting an average of 80 days to see a primary-care doctor for an initial visit, the fourth-longest wait in the nation. By comparison, wait times averaged 64 days in Atlanta, 60 days in Dallas and 59 days in Boston.
Khosla said the average wait in Maryland has since fallen to just under 76 days.
Veterans at a town hall meeting in Arbutus on Monday evening had mixed reactions to enlisting more private physicians to help with the VA caseload.
"That could help," said Robert Cisna, an 86-year-old Navy veteran from Arbutus. "The only thing I would be concerned about is the treatment that the veterans get. Some of these private doctors are going to get very, very rich."
The meeting was hosted by the American Legion, which is traveling the country to solicit veterans' concerns on the quality of care at their local VA medical centers.
Verna Jones, the legion's national director for veterans affairs and rehabilitation, said "purchased care is sometimes necessary," but "the VA should provide health care services for veterans."
"We are not an advocate of outsourcing VA health care," she said.
"We believe the VA health care system is a system worth saving. ... We don't want to tear it down. We want to build it up."
Lawmakers and the Obama administration have been scrambling to address problems at the agency after it acknowledged long wait times -- and attempts by some employees to cover them up.
The scandal led to the ouster of VA Secretary Eric Shinseki in May. His likely replacement, Robert McDonald, is expected to be confirmed by the Senate on Tuesday.
It's not clear how much room is available at private primary-care clinics in the region, many of which already are overwhelmed. But Dr. Peter Beilenson, founder and CEO of Evergreen Health, said he was prepared to handle as many as 50 veterans a day in his network of four clinics located in the Interstate 95 corridor.
EVERGREEN IS A NON-PROFIT CREATED WITH JOHNS HOPKINS TO CAPTURE ALL OF THE CITIZENS BEING PUSHED OUT OF REAL QUALITY HEALTH CARE.
Beilenson, a former health official in Baltimore and Howard County, said his company would respond to the VA's request.
"We have the capacity to [offer] people same-day service," Beilenson said. "We want to be able to serve those who served the country."
Christopher J. Hardwick, a spokesman at the University of Maryland School of Medicine, said the Association of American Medical Colleges recently sent a request for medical schools willing to help the agency. The Maryland school, Hardwick said, "responded that we are willing to help with this request in any capacity and we have shared this response with the VA leadership."
The agency published its request for proposals late last week. Responses are due Aug. 11.
The wait times in Maryland prompted a June 17 visit from acting Secretary Sloan Gibson to the Baltimore VA Medical Center. At the time he pledged to spend $500,000 -- a 40 percent increase -- to help veterans facing delays seek private care.
The VA provides care for 55,000 patients in the state and by many other measures the agency has performed well. Patients already in the system wait an average of four days for a primary-care appointment, five days for an appointment with a specialist and about 21/2 days to see a mental health professional.
Veterans made more than 693,000 outpatient visits at Maryland VA facilities last year.
At American Legion Post 109 in Arbutus, 64-year-old Navy veteran Alan Hottinger spoke of waiting three months to secure a wellness appointment this month, not getting enough notice to get time off from work, and being told the next opening would be in another three months.
Others spoke of hours-long stays in waiting rooms, difficulties getting prescriptions filled and other problems.
Jones, of the legion's national headquarters, said she would take the veterans' concerns to a meeting Tuesday with the director of the Maryland VA Medical System.
Legion officials will move Wednesday from Arbutus to the Community Living Rehab Center -- at 3900 Loch Raven Blvd. in Baltimore -- where they will operate through Friday to help veterans and family members affected by long wait times for care and to assist with benefits claims.
Lawmakers in Washington, meanwhile, unveiled a $17 billion proposal intended to shorten the time it takes to deliver care to veterans. Supporters say the House and Senate should be able to pass the legislation before Congress leaves for its August recess at the end of the week.
The agreement includes $10 billion in emergency funds to allow veterans to rely on outside doctors if they live more than 40 miles from a VA facility or are told they must wait more than 14 days for an appointment. An additional $5 billion would be used to hire doctors, nurses and other medical staff at VA facilities themselves.
"We have a VA that is in crisis today," said Rep. Jeff Miller, a Florida Republican who is the chairman of the House Committee on Veterans' Affairs. "This agreement will go a long way to helping resolve the crisis... helping to get veterans off of waiting lists is extremely important."
Sen. Bernie Sanders, the Vermont independent who chairs the Senate Committee on Veterans' Affairs, also backs the measure.
The proposal includes an independent committee to review VA operations and, in particular, to monitor how many veterans leave the VA system for private doctors.
"Funding for veterans' needs must be considered a cost of war," Sanders said.
As with all the posing that happens in Baltimore politics with all our pols claiming to be progressive Democrats with the media painting them as progressive Democrats------from Congressional pols Cardin, Cummings, Sarbanes, and Mikulski and now Mikulski's Senate seat challengers Donna Edwards and Van Hollen-----every one of them are Clinton/Obama neo-liberals......every Baltimore City Hall pol/Baltimore Maryland Assembly pol-----mayor and city council have passed all these deregulations and privatizations of our VA and VETS-----BAltimore has the worst record for housing for VETS even as media tries to pretend something is being done. This is because Baltimore has global pols working to end public military----end public US military benefits-----grab VET housing in subprime mortgage frauds-----end GI bill access to quality higher education ------
BALTIMORE POLS WORKING FOR WALL STREET AS PLAYERS AND NOT AS POLITICIANS WORKING FOR VOTERS IN THEIR DISTRICTS HAVE TO GO!
Baltimore VA office worst in nation for processing disability claimsOffice that handles claims for Maryland is slowest and makes most mistakes
Robert Fearing, who served in the Air Force for 20 years, with… (Barbara Haddock Taylor,…)
January 26, 2014|By Yvonne Wenger, The Baltimore Sun
The Baltimore office of the U.S. Department of Veterans Affairs is the slowest in the country in processing disability claims for servicemen and servicewomen — averaging about a year — and makes more mistakes than any other office.
The failures locally are a symptom of a national breakdown: Across the country, more than 900,000 veterans wait an average of nine months for the agency to determine whether they qualify for disability benefits, according to the VA.
Even as the VA says it is working to fix problems in Baltimore and nationwide, Paul Rieckhoff, founder of Iraq and Afghanistan Veterans of America, calls the situation "shameful."
"You have to think about that young veteran in Baltimore who has just come back from his third or fourth tour," he said. "They are stuck in limbo, and our veterans deserve better than that."
Officials with the VA acknowledge as much. A spokeswoman for the agency called the delays "unacceptable" and said the VA is focused on clearing its backlog and getting veterans the benefits that they have earned and deserve.
Yet meanwhile, the delays continue.
Robert Fearing, a combat veteran of the Iraq war and a Bronze Star recipient, has been hospitalized three times for paranoia and anxiety caused by post-traumatic stress disorder since he filed his disability claim with the Baltimore office 21/2 years ago. He's still waiting for his benefits.
"I have gone through war fighting the enemy and now I need to fight my own government for the benefits I deserve," said Fearing, who was an Aberdeen resident when he filed his claim but now lives in Stafford, Va. "It is absolutely frustrating and despicable."
Fearing said the base where he was stationed, about 50 miles north of Baghdad, was attacked by mortar rounds more than 150 times in the six months he served there from 2004 to 2005.
The trauma left him with paranoia, a belief that he's being investigated and followed, a feeling "you can't shake out of your head," said Fearing, 44, who is married and has two daughters at home. Fearing, who retired from the Air Force in 2007 after serving for 20 years, earned a master's degree while he was in the military to further his career in counterintelligence. But he said the work now triggers debilitating anxiety and he is seeking an early retirement from his government job.
"The real issue with it is, I want someone to acknowledge the fact that I've got it. I've had to acknowledge it and I have to live with it. What more do they need? Me to be hospitalized again?" he said.
The backlog, lag time and error rates at the VA have been the focus of congressional hearings, a cause for outrage by military advocacy groups and the subject of repeated media investigations. Yet the situation has grown significantly worse.
The VA has acknowledged that the problems at the Baltimore office, which serves all of Maryland, are severe enough to warrant additional training and quality checks.
Nationally, the VA processed more than twice as many claims in 2012 as it did in 2001, but it has been unable to keep up with demand. A recent report by the Government Accountability Office shows that the agency completed 6 percent more claims from 2009 to 2011, but the caseload grew by 29 percent in the same period.
For three consecutive years, the VA has processed more than a million disability claims, which is more than double the number processed in 2001.
And claims are expected to continue to increase as the country transitions from a decade at war.
Disability compensation, which can range from about $125 to $3,000 in monthly payments, is available to veterans who sustain an injury or worsen an existing condition while on duty. The VA is experiencing a historic level of claims from Iraq and Afghanistan veterans, whose disabilities tend to be more complex than cases in the past. Outside of petitioning the help of veterans advocates, elected officials and lawyers to pressure the VA, veterans have virtually no recourse available while they wait.
Rieckhoff said it is shocking that the problem has grown worse over more than a decade at war.
"This is an unacceptable situation," Rieckhoff said.
IT IS NOT SHOCKING-----CLINTON/BUSH/OBAMA AND CONGRESS PASSED LAWS AND DEFUNDED THE VETERAN'S ADMINISTRATION JUST FOR THIS TO HAPPEN AS VETS FROM IRAQ AND AFGHANISTAN CAME HOME.
"Veterans are angry and they should be. … Baltimore is one of the worst areas, but this is national problem that the president has failed to conquer."
The average number of days that veterans across the U.S. wait for an initial decision jumped from 166 days to 262 days, or nearly nine months, over the past two years. The VA's stated goal by 2015 is to process all claims within 125 days, but as it stands now about 70 percent of claims are older than that.
Veterans who contest the agency's decision can wait years on top of the time it takes to initially process a claim. If claims are eventually awarded, the benefits are retroactive.
In Baltimore, the average wait time for an initial decision is almost 12 months.
Obama and Clinton neo-liberals joined Republicans in using the Affordable Care Act to attack US Constitutional rights of citizens to refusing treatment no matter what the health issue. First, they created this best practices being built by the health industry corporations that will make refusing any health protocol grounds for dismissal from a policy or will end with costs added to make the patient unable to refuse.
IT IS THE HEALTH INDUSTRY PROTOCOL OR NOTHING SAY CLINTON/OBAMA NEO-LIBERALS AND REPUBLICANS.
As important you see below global pols are using our SS Disability to super-size this forced protocol and look at who it targets----MENTAL HEALTH and with the Veterans that is a huge area of treatment---from PTSS to drug addiction. The article below shows where SS Disability can now force treatment on main stream disabled AND veterans.
THIS MUST BE REVERSED.
Think as well how this tied to the global corporate gun control policy that will take the right to own guns away for what is a very broad and vaguely written mental health clause----and this will be the mechanism. Now, as a progressive I want gun control but I do not want yet another avenue of denying rights other people have taken from citizens having different struggles in their lives.
THESE KINDS OF POLICIES ARE AIMED AT FORMER MILITARY COMMONLY COMING HOME WITH MENTAL HEALTH ISSUES AND THESE POLICIES WILL KEEP PEOPLE FROM SEEKING THE HELP THEY NEED FOR FEAR OF LOSING US CONSTITUTIONAL RIGHTS.
Being Denied Disability for Failing to Take Medication or Follow Treatment
If you don't take prescribed medications or other treatment, Social Security can deny you disability benefits.
by: Aaron Hotfelder
If you're applying for disability benefits but not complying with the medical treatment prescribed by your doctor, Social Security may be able to deny your claim for "treatment non-compliance." This is because Social Security can find that you would be able to work if you took the medicine, had the surgery, or otherwise followed the treatment recommended by your doctor. While there are some exceptions to this rule, it is important to follow your physician's prescribed course of treatment to the extent possible so that you can avoid this matter entirely.
Denial of Disability Benefits for Non-Compliance
If you fail to follow prescribed treatment, take prescribed medication, or undergo recommended surgery, this may prevent you from getting Social Security or SSI disability benefits, but only when the following four criteria are met.
- Your impairment prevents you from doing any substantial gainful activity (SGA).
- Your impairment has lasted or will last at least 12 months, or can be expected to end in death.
- Your treating doctor has prescribed treatment that would clearly restore your ability to perform full-time work.
- You have refused to follow your treating doctor's prescribed treatment.
Also note that the treatment or medication your doctor has prescribed must be clearly expected to restore your ability to do full-time work. It literally must be able to make the difference between whether or not you can work. For this reason, a minor deviation from your doctor's prescribed treatment is usually not a sufficient basis for Social Security to deny your claim.
Possible Justifications for Failing to Follow Treatment
If Social Security determines that you meet the four criteria above, the agency can deny your disability claim unless you can show that you were justified in failing to follow treatment. Here are several situations in which your failure to follow treatment will not be held against you.
- The prescribed medical treatment violates your religious beliefs. To use this excuse, Social Security will require you to state your religious affiliation and provide evidence that you are a member of that church. In addition, you must show that the medical treatment in question goes against the teachings of your church, which can usually be done by obtaining a statement from a church authority. (Note: Because it is well established that medical treatment violates the beliefs of Christian Scientists, members of that religion do not need to provide evidence on this point.)
- The treatment prescribed by your treating physician conflicts with the advice of another treating source. If you have more than one treating source, sometimes your doctors will disagree on, for example, whether you should undergo a particular surgery. This is generally considered good cause for refusing treatment.
- You cannot afford the prescribed treatment or medication, and there are no free or low-cost clinics reasonably available to you. Disability claimants are often unable to afford medications or treatments prescribed by their doctors. Social Security will not find this excuse compelling unless you show that you've exhausted all your options, including free and subsidized clinics, charitable care, and public assistance programs. If you don't have health insurance, Social Security will want to see that you've applied for Medicaid in an effort to obtain treatment.
- The prescribed treatment involves the amputation of one of your extremities.
- You have a very extreme fear of surgery. This justification is rarely accepted by Social Security, but you may have a chance if your fear is well documented by a mental health professionals.
- The doctor prescribed an unusually risky surgery. To work as an excuse, the level of surgical risk must be above and beyond the ordinary, unavoidable risk of undergoing surgery. Operations such as open-heart surgeries, organ transplants, and experimental procedures are often extremely risky, and refusing to undergo such a surgery will likely not harm your disability case.
- You have a mental illness, and failure to follow treatment is a symptom of the disease. This argument will be much more persuasive coming from your treating mental health provider. Ask him or her to give an opinion to Social Security on this point if non-compliance with medical treatment is an issue in your case.
If Social Security denied your claim for failing to follow prescribed treatment, talk to an attorney about your chances of winning on appeal. You can arrange a free consultation with a disability lawyer here. If Social Security denied your claim because you haven't had any treatment at all, read our article about getting disability benefits when you haven't had consistent medical treatment.
For those remembering, two decades ago Wall Street called the job classification best to be hired as NURSING and VOILA, American citizens all headed for nursing degrees. For these same decades US citizens with these degrees are largely unemployed for the reasons stated below----there was a flood of nursing staff from all over the world into the US labor market led by a very, very, very neo-conservative Johns Hopkins and this global human capital trafficing corporation. Think now what is happening with the shortage of US doctors and the expanded need for doctors and VOILA----we have yet another sector of health industry filled with foreign staff---this time doctors while US citizens cannot even get a decent education or funding to enter strong higher education. The only way today after Obama and Clinton neo-liberals in Congress 'reformed' Federal student loans, grants for US citizens to become doctors is if you have the money to pay the soaring costs. Unless you are a foreign medical student----then Wells Fargo and Johns Hopkins fully funds with grants your medical training. See how you create a completely immigrant workforce in not only the low-wage jobs but the high-skilled jobs? This has gone on through Clinton/Bush/Obama----Obama super-sized it with Trans Pacific Trade Pact and a market-based immigration reform designed to install International Economic Zone policy. This is why Baltimore's health industry is filled with immigrant employees. These are the same employees of the growing national medical chains positioned to handle this climbing Medicaid for All that is taking all US citizens to the lowest level of care. This is to where our Veteran's benefits will be taken with SS Disability. So, as with labor unions having strong health benefit packages losing those and falling into these lower tiers of health care-----now so is VETERAN's losing their strong health benefits tied to a VA that was the best in the world.
Many foreign health employees are perfectly able and trained to do a good job----we are not against immigrant workers coming to America to find jobs. Many are not trained to the standards of US professional degrees and they are finding themselves in these national medical chains. At the same time, foreign health care employees have no connection to HIPPOCRATIC OATH, US RULE OF LAW, US CONSTITUTIONAL RIGHTS, THE BILL OF RIGHTS----all heavily covered in our US health care system. Our VETERANS signed on for quality care-----and a national medical chain filled with foreign staff will have no connection to that ideal. We have American citizens needing and ready for these jobs and we must move away from importing labor until American citizens are fully employed. WE WILL PROTECT ALL IMMIGRANT LABOR WORKING IN THE US UNDER THE SAME US LABOR LAWS ----BUT WILL SLOW THE MOVEMENT FROM OVERSEAS GLOBAL LABOR FORCES AIMED AT INTERNATIONAL ECONOMIC ZONES IN THE US.
THIS IS THE TIERING OF US HEALTH CARE-----AND OVER 80% OF AMERICANS ARE FALLING INTO GUTTED OF FUNDING MEDICAID FOR ALL.
'We argue that the demand-driven U.S. nurse shortage represents a strong migratory “pull” factor for nurses throughout the world, which has stimulated the growth of for-profit organizations to serve as brokers to ease the way for nurses to emigrate. This is occurring, however, in the absence of a careful examination of the implications for nurse recruits and the impact on the health care delivery systems that both send and receive them'.
Imported Care: Recruiting Foreign Nurses To U.S. Health Care Facilities
As U.S. health care facilities struggle to fill current registered nurse staffing vacancies, a more critical nurse undersupply is predicted over the next twenty years. In response, many institutions are doubling their efforts to attract and retain nurses. To that end, foreign nurses are increasingly being sought, creating a lucrative business for new recruiting agencies both at home and abroad. This paper examines past and current foreign nurse use as a response to nurse shortages and its implications for domestic and global nurse workforce policies.
Importing nurses is likely to remain a viable and lucrative strategy for plugging holes in the U.S. nurse workforce.
Within the first two decades of the twenty-first century, the U.S. population is projected to grow at least 18 percent, and the population age sixty-five and older will increase at three times that rate1. Meeting the demand for registered nurses (RNs) that an aging population will require will be a challenge. The U.S. Department of Health and Human Services (HHS) estimated that the United States was weathering a shortfall of 111,000 full-time-equivalent (FTE) RNs in 2000 and projected that this figure will grow to 275,000 by 2010.2 That imbalance will nearly triple in the subsequent decade, reaching a shortfall of 800,000 FTE RNs by 2020.
This looming crisis has spurred public- and private-sector health care leaders to advocate for serious and creative solutions to bolster RN supply. U.S. health care facilities, which confront the nursing shortage twenty-four hours a day, are adopting a host of strategies to attract nurses to fill current nursing vacancies and to stave off future shortfalls.3 Among these strategies is the recruitment and employment of foreign nurses. This is not a new phenomenon; U.S. health care institutions have done it for more than fifty years. What differs today, however, is the marked expansion of organized international nurse recruitment; the growth of private, for-profit agencies to do this work; and an increasing number of countries sending nurses abroad. Many of these countries are poorly positioned to surrender large numbers of qualified nursing staff.4 The consequences for these sending countries have become the focal point of growing international debate that is rising to the highest policy-making levels, although with little resolution.5 Overshadowed by that debate, the consequences for nurse migrants and their workplaces, for quality of care and patient outcomes, and for workforce planning efforts have received little attention. Meanwhile, the United States, while not the world’s largest recruiter of foreign nurses, is recruiting greater numbers than it ever did in the past and is poised to greatly increase those efforts.6
We argue that the demand-driven U.S. nurse shortage represents a strong migratory “pull” factor for nurses throughout the world, which has stimulated the growth of for-profit organizations to serve as brokers to ease the way for nurses to emigrate. This is occurring, however, in the absence of a careful examination of the implications for nurse recruits and the impact on the health care delivery systems that both send and receive them.
The Foreign Nurse Pool: Then And Now
During the past fifty years the United States has regularly imported nurses to ease its nurse shortages.7 Although the proportion of foreign nurses has never exceeded 5 percent of the U.S. nurse workforce, that figure is now slowly rising.8
The Philippines has dominated the nurse migration pipeline to the United States and to other recruiting countries.9 Indeed, until the mid-1980s Filipino nurses represented 75 percent of all foreign nurses in the U.S. nurse workforce.10 Their representation dropped to 43 percent by 2000 as more countries began sending nurses abroad.11
After slowing in the second half of the 1990s, nurse migration to the United States increased, with the Philippines still leading the way for an even larger group of countries. In 1995 nearly 10,000 foreign nurses received their U.S. RN licenses, representing almost 10 percent of all newly licensed RNs in that year.12 By 1998 that proportion fell by nearly half, as the number of new foreign nurses entering the U.S. workforce fell more steeply than the number of new U.S. RNs (Exhibit 1⇓). After 1998 the foreign nurse proportion steadily grew, topping 14 percent in 2003. The growth since 2001 is particularly noteworthy because it occurred as the number of U.S.-trained RNs rose, reversing declines since 1995.
EXHIBIT 1 Percentage Of Newly Licensed Registered Nurses (RNs) In The United States Who Are Foreign Educated, 1995–2003
Filipino nurses represented more than half of the foreign graduates taking the U.S. licensure exam in 2001 (Exhibit 2⇓). Together, nurses from Canada, the United Kingdom, India, Korea, and Nigeria contributed about half that rate. The remainder were from thirty-five countries that were not found among the 1997 cohort.13
EXHIBIT 2 Percentage Of First-Time, Foreign-Trained Registered Nurse (RN) Candidates For U.S. Licensure Examination, By Top Six Exporting Countries, 1997–2001
Upon coming to the United States, foreign nurses are employed in an increasingly diverse array of settings (Exhibit 3⇓). Like their U.S. counterparts, the percentage of foreign nurses working in hospitals has steadily declined over the past decade, from 79.9 percent to 71.5 percent, as organizational and financing reforms have encouraged movement of patient care out of hospitals. At the same time, their numbers in public/community health and ambulatory settings have grown, also mirroring those of U.S.-trained nurses. Unlike domestic nurses, however, foreign nurse representation in nursing homes has risen from 7.4 percent to 9.3 percent.14
View this table:
EXHIBIT 3 Distribution Of U.S.-Trained And Foreign-Trained Nurses, By Setting, 1992 And 2000
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The Impact Of Migration: Home And Abroad
Nurses are enticed to leave their home countries by promises of better pay and working conditions; improved learning and practice opportunities; and free travel, licensure, and room and board.15 Primarily female, nurses often have opportunities for wages unequaled in their own countries and thus become the means for substantial remittances. In 2004 the U.S. Department of Labor reported median annual earnings for RNs in 2002 as $48,090; in hospitals and nursing homes where foreign nurses worked, earnings averaged $49,190 and $43,850, respectively.16 These figures contrast sharply with the $2,000–$2,400 annual salaries paid to nurses in the Philippines in 2002.17
Shifting the nurse supply.
As the United States and other developed countries look to international nurse recruits to balance their national nurse supply and demand, however, sending countries are increasingly questioning the impact on their own health care systems. In perhaps the most striking example, the Wall Street Journal noted that the growing number of Filipino nurses migrating abroad is creating a domestic shortage and beginning to strain the Philippines’ health care system rather than providing an economic benefit as it had in previous years.18 A growing number of other countries are facing a situation similar to that of the Philippines. New offshore recruiting initiatives by developed countries have targeted English-speaking nurses from sub-Saharan Africa, Southeast Asia, and the Caribbean. Experienced nurses, especially those with specialty skills in surgical, neonatal, or critical care nursing, are in particularly high demand.
While the United States has only recently begun active nurse recruitment in South Africa, former Commonwealth countries such as the United Kingdom and Australia have already drawn large numbers of nurses from this area of the world. Between 1998 and 2002 the United Kingdom alone recruited 5,259 nurses from South Africa, along with 1,166 from Nigeria, 1,128 from Zimbabwe, and 449 from Ghana.19 The accelerated recruitment of experienced African nurses is straining an already fragile health care infrastructure in many African countries, which have been battered by AIDS and deprived of resources because of economic and political upheaval.20 Sixteen African countries have an average of 100 nurses per 100,000 population; ten countries average fifty nurses per 100,000; nine report twenty per 100,000; and three have fewer than ten nurses per 100,000.21 In stark contrast, U.S. and U.K. ratios are 782 and 847 per 100,000, respectively.22 In 2000 more than double the number of new nursing graduates in Ghana left that country for positions abroad.23 In response, the Ghanaian government is now begging recruiting nations to cease taking its nurses.24
The loss of qualified nurses places considerable economic pressure on exporting African countries.25 In 1998 the United Nations Conference for Trade and Development estimated that every professional, ages 25–35, who migrated from South Africa represented an annual loss of $184,000 for that country.26 Receiving countries obtain the financial benefit of the migrant’s professional education and training, while sending countries bear these costs. The loss of valuable workers has been so costly that the South African Nursing Council has proposed an export tariff on nurses leaving to work abroad.27
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Nurses’ Technical And Cultural Competence
A key concern related to foreign nurses is whether they provide high-quality services to U.S. patients. Rosemary Stevens has argued that when discussing quality in an international context, one must distinguish between people’s ability to perform specific tasks and their ability to communicate effectively with patients and other professionals to provide culturally appropriate care.28
The Commission on Graduates of Foreign Nursing Schools (CGFNS) was established in 1977 to ensure foreign nurses’ technical and cultural competence prior to employment in U.S. health care institutions. Modeled after the Educational Commission for Foreign Medical Graduates (ECFMG), CGFNS verifies foreign nurses’ credentials and educational qualifications and identifies those at risk for failing the U.S. nurse licensure exam (NCLEX-RN) prior to immigration.29 A qualifying examination that assesses nursing proficiency and English language comprehension earns nurses a CGFNS certificate and eligibility for nonimmigrant occupational preference visas.30
Foreign nurses must supply evidence that they completed prescribed amounts of didactic and clinical instruction as “first-level nurses.” Defined by the International Council of Nurses (ICN), this is a measure of technical competence regardless of national background.31 The final step in the process is passing the NCLEX-RN. Passing nurse licensing and English proficiency tests remains the marker for establishing competence among foreign nurses. No studies to date have determined whether foreign nurses’ cultural orientation and technical competence produce differences in patient outcomes when compared with their domestic counterparts.
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Crisis And Opportunity
In April 2002 the Workforce Commission for Hospitals and Health Systems, convened by the American Hospital Association (AHA), issued its recommendations to health care leaders for confronting the current nurse shortage and averting the predicted shortfall. Flexible staffing options and improved working conditions, methods to simplify work and improve nurses’ quality of life, and fostering more meaningful work were prominent among the strategies offered.32 The AHA has also advocated for federal legislative initiatives that are targeted at building and maintaining the U.S. nursing workforce.33
These responses have yet to dampen the strong demand for foreign nurse labor. Hospitals and nursing homes are independently recruiting nurses overseas as well as hiring recruitment agencies to secure nurses on their behalf. Because of the profitability of this latter strategy, new recruitment agencies are cropping up both within the United States and in other recruiting countries. Many U.S.-based agencies also have offices in sending countries to facilitate the process.
.In recent years recruitment agencies have been placing foreign nurses in larger numbers in states that attracted both large and small numbers of nurses in the past. In 1992 California and New York were home to nearly half of all foreign nurses in the United States. By 2000 their shares of foreign nurses had declined to 38 percent, while the combined shares of the next most frequent locations—Florida, Illinois, Michigan, New Jersey, and Texas—rose to equal them. More than half of the remaining states saw increases in their shares of foreign nurses.34
Venkat Neni’s Global Healthcare Recruiters provides a good example of the marketing allure of foreign nurses in states that previously did not typically recruit or employ international nurses. A physician in India before immigrating to the United States, Neni founded his Wisconsin-based agency in 2002. In less than a year he successfully supplied 145 nurses from India to Milwaukee’s Columbia St. Mary’s and Oshkosh’s Mercy Medical Center. In November 2002 he and executives from Covenant Healthcare System in Milwaukee traveled to India and hired another 100 nurses. In an interview with the Milwaukee Journal Sentinel, Neni shared his goal to recruit an additional 500 nurses to Wisconsin by 2004, estimating profits to exceed $5 million.35 Neni’s earnings pale in comparison with those of more established firms.36
On average, hospitals pay recruiting agencies $5,000–$10,000 per nurse.37 In return, nurses contract to work from two to three years in the hiring institution. In the Covenant Healthcare System example, Global Healthcare agreed to fully refund the recruiting fee to the hospital if a nurse recruit failed to continue working past three months. The hospital was partially repaid if nurses fell short of their three-year commitment.
The hiring facilities.
Although hospitals agree that the initial cost of recruiting foreign nurses is higher than that of hiring domestic nurses, many feel that they save money in the long run because of reduced turnover and the agency’s assurance of full or partial remuneration if recruited nurses fail their contractual obligations. Recruiting abroad may also be less costly than raising salaries, increasing benefits, and providing other economic incentives needed to retain domestic nurses. Under the terms and conditions of hiring foreign nurses from recruiting agencies, therefore, hospitals enter into a relatively risk-free arrangement that provides further incentive for procuring staff abroad. Strategies for such recruitment at one facility are described in a 2003 AHA report on workplace innovations.38
The advantages of recruiting foreign nurses have had particular appeal for long-term care facilities. Since 1989 nursing homes have secured foreign nurses through an “attestation” process stipulated in the Immigration Nursing Relief Act (INRA).39 In recent years recruitment agencies have capitalized on the crisis in long-term care staffing, partnering with nursing home operators to provide nurses from several countries.40 Long-term care institutions will likely continue to look abroad to fill nearly 14,000 staff RN and 25,100 licensed practical nurse (LPN) vacancies.41
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Implications For The Future
The current U.S. nurse shortage and the profitability in recruiting foreign nurses to fill nurse vacancies will undoubtedly increase the interest in, and pressure for, additional means to increase foreign nurse recruitment. Changes in immigration policy, recruitment practices, and licensure requirements will also permit a greater flow of foreign nurses to U.S. health care facilities. For example, the cost of immigration, initially shouldered by migrating nurses, is now transferred to the facilities themselves. The NCLEX-RN examination is being offered overseas, beginning in 2004, in an effort to facilitate the licensure process.42 Recruitment agencies are now routinely based in the Philippines, India, and other key locations to aid nurses’ access to information, English language classes, and exam preparation courses. Newer recruitment strategies now offer U.S.-based master’s-level education to foreign nurses as a further incentive for migration.43 A recent San Francisco Chronicle article reported that as many as 3,000 physicians in the Philippines had begun training to become nurses for export to the United States because of the much higher salaries they could earn.44
Although foreign-trained nurses now account for around 5 percent of the total U.S. nursing workforce, they represent a growing percentage of newly licensed nurses. Moreover, growth in the domestic production of nurses since 2002 did not diminish interest in foreign recruitment among employers. Indeed, Peter Buerhaus and his colleagues note sizable growth in the number of foreign-born nurses in the United States during this period.45 And while interest in foreign nurses accelerates during nurse shortages, it also appears to endure beyond shortage cycles. In 1988, during the last major U.S. nurse shortage, there were 3.7 foreign-trained nurses in the United States per 100 U.S.-trained nurses. In 1996, a time of record domestic nurse production and a slowdown in hospitals’ demand for nurses because of industrywide workforce restructuring, the ratio rose to 5.1.46 Consequently, if nurse vacancies continue in health care facilities, and domestic production falls short of the demand, then foreign nurses are likely to remain a viable and increasingly lucrative strategy for plugging holes in the U.S. nurse workforce.
Ethics of recruiting.
Increased international recruitment requires that several policy issues be explicitly addressed. The international debate over the responsibilities of recruiting nations toward countries whose nurses are being recruited, many of which are developing countries, has produced a range of proposals—from ethical recruitment guidelines and codes of practice to financial compensation for sending countries.47 The British National Health Service and the ICN, for example, have both issued ethical guidelines for foreign nurse recruitment.48 Others have voiced concern about the long-term viability and ethics of foreign nurse recruitment in the face of a global nurse shortage.49
To date, the ethical guidelines have had only a modest short-term impact on recruiting practices, and the compensation proposals continue to be debated without resolution. If the United States maintains its role as a major nurse recruiter, then it should join this international dialogue. This dialogue should not be focused solely on recruitment practices but should place equal emphasis on strategies to reform work environments to improve nurse retention and reduce avoidable demand.
.Little is known about whether the quality of nursing care differs between foreign- and U.S.-trained nurses. While the certification process assures competency in educational training and language, differential quality of clinical care has not been assessed. Quality of care could be affected by, among other things, poor orientation and training of new foreign nurses who are assimilating into the U.S. health care system. The development and evaluation of more comprehensive orientation and training activities are warranted and have been recommended by the AHA.50 An assessment of the quality of care and patient outcomes is likewise needed and should include an appraisal of the cultural competence foreign nurses bring to patient care.51
Workforce strategy issues.
Finally, U.S. workforce planning efforts require the development of systems that monitor the inflow of foreign nurses, their countries of origin, the settings where they work, and their impact on the nurse shortage. Increasing demand for foreign nurses in the face of greater domestic production is a signal that domestic efforts are insufficient to keep up with demand. A broader-based workforce strategy that balances foreign nurse recruitment, domestic production, and concerted retention efforts is needed to ensure that the nursing care needs of the public will be met.
There really is no shortage-------the US has systematically defunded pathways to medical school----made medical school too expense for most to consider in the US-------and it is done to bring the swing of employment in health care to that of foreign workers in high-skilled jobs. US medical school doctors are being shifted to global health systems and health tourism for the world's wealthy------and the bottom tier of all the rest of US citizens are falling into this far less quality of care with preventative care access only.
THIS IS THIRD WORLD HEALTH CARE AND IT IS AFFORDABLE CARE ACT AND THE SENATE'S IMMIGRATION BILL TEAMED WITH TRANS PACIFIC TRADE PACT AND INTERNATIONAL ECONOMIC ZONE POLICIES.
Medicaid patients have always struggled with quality care but as long as protections in going to emergency rooms at hospitals was in place---they knew they could seek quality care. Then that access slowed and is now ending with Affordable Care Act and all Medicaid is slipping into this lower tiered health care. Now VETS are heading there with SS Disability patients and soon to follow------labor union members as they loss their strong health benefit policies.
THIS IS A MANUFACTURED HEALTH STAFFING CRISIS AND IT IS KEEPING HIGH UNEMPLOYMENT FOR AMERICANS WHO COULD EASILY ATTAIN THESE DEGREES.
To Your Health
U.S. faces 90,000 doctor shortage by 2025, medical school association warns
By Lenny Bernstein March 3, 2015
(Merritt Hawkins)The United States faces a shortage of as many as 90,000 physicians by 2025, including a critical need for specialists to treat an aging population that will increasingly live with chronic disease, the association that represents medical schools and teaching hospitals reported Tuesday.
The nation's shortage of primary care physicians has received considerable attention in recent years, but the Association of American Medical Colleges report predicts that the greatest shortfall, on a percentage basis, will be in the demand for surgeons — especially those who treat diseases more common to older people, such as cancer.
[How long you’ll wait for a doctor’s appointment in 15 U.S. cities]
In addition to the growing and aging population, full implementation of the Affordable Care Act in all 50 states would increase demand for doctors as more people are covered by insurance. But Obamacare's impact will be small — just 2 percent of the projected growth in demand, the organization said. The supply of doctors also will grow but not nearly as quickly as the need, officials said.
"An increasingly older, sicker population, as well as people living longer with chronic diseases, such as cancer, is the reason for the increased demand," Darrell G. Kirch, the AAMC's president and chief executive, told reporters during a telephone news briefing.
Under numerous scenarios, demand for doctors will outstrip supply, the Association of American Medical Colleges reported Tuesday. (AAMC)The organization called on Congress to raise the federal cap on slots for medical residents at teaching hospitals by 3,000 annually, at a cost it estimated would be about $1 billion per year. The government provides its $40,000 share of the cost of training each U.S. physician — estimated at about $152,000 annually — via the Medicare program. Currently, those hospitals train 27,000 to 29,000 doctors each year.
In 2013, there were about 767,000 doctors practicing in the United States, according to the report.
Policymakers have debated the doctor shortage for years, with some arguing that certain types of doctors are clustered in cities and affluent areas, leaving rural and poor Americans critically underserved. The government runs programs to encourage doctors, especially primary care physicians, to practice in shortage areas. Some states help doctors pay off their medical school debt, which can run into six figures, if they agree to practice in underserved parts of the country.
In a 2013 paper in the journal Health Affairs, Linda Green, a mathematician who studies the health care system, argued that the projected shortage of primary care doctors may not occur. The move toward larger practices, which enable physicians to share support staff and office space, can allow them to take on more patients. And the increasing use of physician assistants and nurse practitioners will have the same effect, she wrote.
[Once again, U.S. has most expensive, least effective health care system]
The new AAMC report actually predicts a smaller shortage than a similar report written five years ago. In 2010, the organization said the nation would face a shortfall of 130,600 physicians by 2025. But revised population projections by the U.S. Census and a small increase in the number of doctors have brought the predicted shortfall down, according to the report.
Under a better-case scenario, the doctor shortage 10 years from now would be 46,100, the report notes. That would reflect growth in the number of advanced practice nurses and physician assistants. If the shortage is 90,400, the country would need 31,100 primary care physicians and 63,700 non-primary care doctors — including oncologists, neurologists, psychiatrists and others — to meet the demand.
The AAMC represents all 141 U.S. medical schools and 17 in Canada, as well as 400 major teaching hospitals and health systems, including 51 Department of Veterans Affairs medical centers.
The health policy in Affordable Care Act that ties all health policies to Primary doctor visits is designed to create this 'emergency' need to flood the US economy with doctors from around the world. Creating this category 'primary care' being paid less than other medical pathways moved this shortfall. Knowing a shortfall in primary care exists as ACA super-sizes the ties to primary care fuels outsourcing overseas. We used to have a medical structure where GPs----General Practitioners----were the majority of medical degrees----they are adequate for most care----but Affordable Care Act are making it hard for doctors that are not specialized to be with the strongest health systems----as it shows below, the subset of doctors that used to be the front-line primary care doctors are being eliminated. GMOs are the majority of military doctors and for VETS used to dealing with GMOs----being moved to lower tiered coverage will see a loss in plain vanilla family doctoring.
I AM ALL FOR NURSE PRACTITIONERS------BUT WE NEED TO KEEP OUR QUALITY STANDARDS IN HEALTH CARE HIGH AS A DEVELOPED NATION.
'A medical practitioner is a type of doctor.
The population of this type of medical practitioner is declining, however. Currently the United States Navy has many of these general practitioners, known as General Medical Officers or GMOs, in active practice. The GMO is an inherent concept to all military medical branches. GMOs are the gatekeepers of medicine in that they hold the purse strings and decide upon the merit of specialist consultation. The US now holds a different definition for the term "general practitioner". The two terms "general practitioner" and "family practice" were synonymous prior to 1970. At that time both terms (if used within the US) referred to someone who completed medical school and the one-year required internship, and then worked as a general family doctor'.
For those not knowing, Walter Reed and the US military are filled with General Practitioners GPs who have strong skills with less time in the medical process. This is the kind of doctor our VETS are used to when they go to the VA hospitals. This category of doctor is dying with the VA hospitals and it is breaking the pathway to affordable health care and leading to this tiered primary care as preventative care only access. The US Military funded much of American medical training and we are seeing that source of granted pathway to medical doctor disappearing as well. THIS IS THE DOCTOR'S SHORTAGE----
So, while Johns Hopkins is overseas identifying citizens in third world nations to train for medical careers in the US-----US citizens are losing that pathway to quality medical degree programs. Don't worry, the pathway will exist in Ivy League university medical schools for a small percentage tied to global health care systems and health tourism for the world's rich!
THIS IS WHAT EXPANDED AND IMPROVED MEDICARE FOR ALL ADDRESSES----IT REVERSES THIS DISMANTLING OF QUALITY HEALTH CARE ACCESS AND STRENGTHENS IT WITH EVERYONE IN AND NO ONE OUT----KEEPING OUR STRONG PROFESSIONAL TRAINING IN UNIVERSITIES.
This article talks about the British military doctor but the process is the same in the US-----and both UK and US military are under privatization attacks.
The military doctor
Authors: Jo Stephenson
Publication date: 06 Jan 2010
Jo Stephenson looks at a career in the armed forces and asks how recent events in Iraq and Afghanistan have affected the profession
Consultant anaesthetist Gavin McCallum was on a mission to pick up casualties in Iraq when he was shot.
He was in a helicopter with another doctor, an operating department practitioner, and some paratroopers, responding to one of the bloodiest incidents of the second Gulf War, when the craft was attacked.
“We came under sustained small arms and rocket propelled grenade fire,” he says. “Five people in the helicopter were seriously injured and I was clipped by a round.”
Shot in the calf, his first priority was to treat those who’d been gravely hurt. “It was a flesh wound,” he explains. “All I could see were two holes in my trousers with smoke coming out—then it was sore. But it didn’t stop me functioning. It was a high adrenaline situation.”
You might imagine tales like this would deter doctors from joining the armed forces. But contrary to expectations, recent and ongoing conflicts have led to increased interest in military medicine, according to the Royal Air Force (RAF), the Royal Navy, and the army.
Doctors are attracted by the chance to practise in challenging environments and the variety of military medicine and life.
Senior military medics say there is often a surge in interest from healthcare professionals in the light of high profile conflicts because doctors see that they are needed.
The experience of being injured while serving with the RAF Reserves didn’t put Wing Commander McCallum off. After two operations on his leg he went back to the NHS but continued with the Reserves as clinical director of his squadron and helped to train other military medics, joining the RAF regulars this year.
“A lot of the work is damage control on seriously ill people,” he says. “It is work you don’t do in the NHS. You wouldn’t see as much trauma in any other circumstances.”
Recruitment, roles, and training vary for doctors entering different forces and there are also roles in reservist organisations—the RAF Reserves, the Territorial Army, and the Royal Navy Reserves.
Most doctors enter the regular forces through cadetships and are sponsored through part of their medical degree.
Cadetships are managed by individual forces but are generally worth about £15 000 (€16 500;$24 000) a year for three years, plus tuition fees, in return for six years’ service after doctors have completed foundation year 1. A smaller number of doctors join at a later stage in their training or when they are fully qualified.
Medical cadets start specialist training one to three years after their NHS peers, depending on which force they go into. This is overseen by a joint forces Defence Postgraduate Medical Deanery.
The army awards up to 30 medical cadetships every year. Cadetships are popular but there are shortages of trained doctors such as general practitioners (GPs) and in a few hospital specialties.
“This situation will improve as more army doctors complete their specialist training,” says a spokeswoman. The army only takes fully trained general practitioners and hospital consultants as direct entry applicants, but from 2013 there should be space for those who’ve completed the foundation programme but who have not yet started specialist training, she adds.
Medical cadets are encouraged to get involved in military life. For example, navy cadets are encouraged to join their local university Royal Navy units, which have dedicated training boats.
After completing foundation training, doctors spend six months on officer and military medical training and about 18 months as general duties medical officers. Most are placed with one of six medical regiments. But a few, such as Captain Hamish Reid, are posted to specific army regiments.
Reid is based at the medical centre of the 22 Royal Engineer Regiment at Tidworth, Wiltshire and hopes to go on tour next year.
“I didn’t fancy going straight into the NHS rat race from one job to the next up the old career ladder,” he says. “I was keen to get some broader experience of medicine.”
He particularly values the independence he has as a junior doctor in the forces. He has his own general practice list and more freedom and responsibility than he would have in the NHS.
Captain Reid also relishes other aspects of military life, not least opportunities to do adventure sports—he’s planning to row the coast of Britain with a fellow army doctor—and get involved in regimental life, including going on exercises.
He has made the most of the varied training opportunities available to military doctors and is in the first year of a postgraduate masters degree in sport and exercise medicine.
Rehab work in the army is also very different to the NHS, where doctors tend to work with elderly patients. “You’re working with young, fit guys who can get back a real quality of life,” says Captain Reid. “That gives you a lot of job satisfaction.”
Once army doctors complete their specialist training, GPs serve as regimental medical officers caring for soldiers and their families in military practices in the United Kingdom, Germany, Cyprus, and Brunei. Many accompany their regiments on tours of duty for up to six months every two to three years.
As in other forces, hospital consultants work in NHS hospitals. Currently, army consultants are likely to be deployed to the Field Hospital in Afghanistan for up to three months every year.
Territorial Army medical services recruit medical students from year four onwards and recruit most types of surgeons and consultants when they are fully qualified.
RAFThe RAF can sponsor up to 25 medical cadets a year. “I could fill those slots three or four times over,” says Group Captain Gordon Allison, deputy assistant chief of staff for medical professional support. Doctors complete their foundation programme, then do the 13 week specialist entrant and re-entrant course before undergoing further military medical training split between RAF College Cranwell, the RAF Centre of Aviation Medicine, and the Defence Medical Services Training Centre at Keogh Barracks in Hampshire.
They generally benchmark a year later than their NHS peers. Before starting specialist training they’re sent to units in the UK or Cyprus where they do general duties for six months, seeing patients under supervision.
Doctors training to be GPs do hospital rotations in the NHS, usually in a Ministry of Defence hospital unit, and then go to a military unit such as an RAF station, which has its own trainers. They also usually spend time in an NHS practice.
Once they get their GP certificate they are deployed on operations, having had extra training including pre-hospital emergency care and how to handle a weapon to protect themselves and patients.
In time, medical officers on a unit can apply to train as consultants in public health, occupational health, or aviation medicine. They can also become GP trainers and develop a special interest.
As in other forces, consultants will be deployed to a field hospital a couple of months every year.
Only in the RAF can anaesthetists be part of a critical care air support team, which transfers patients who are injured but stable to the UK. Or—as in the other armed forces—they may be part of a medical emergency response team, which resuscitates casualties in situ and brings them back to base.
Need for GPs
The RAF is keen to recruit more GPs and, as with other forces, direct entry GPs and other specialist groups may be eligible for a golden hello of about £50 000.
The retention rate for military GPs is often slightly lower than the NHS because of family ties and because pay does not match the highest NHS GP salaries—although it is above average.
Nevertheless, Group Captain Allison, who joined the RAF after the first Gulf War, has seen a considerable increase in interest. “I have got about 20 qualified GPs in the pipeline for recruitment,” he says. “In the past if I had three I thought I was doing well.”
The RAF Reserves are currently looking for GPs, orthopaedic surgeons, general surgeons, and general physicians.
The Royal Navy
The Royal Navy offers about 15 medical cadetships a year. “We get quite a few applications as it’s an attractive package and there’s such a variety of opportunities,” says Lieutenant Alison Embleton, specialist recruiter for nurses, dentists, doctors, and medical reserves.
Foundation year 1 doctors do a placement in a Ministry of Defence hospital unit, then officer training at Dartmouth plus a new entry medical officers’ course at the Institute of Naval Medicine. The navy also recruits about five direct entry doctors a year.
The Royal Navy Reserves only take consultants. About 35 are trained by specialist reserve units, attending weekly sessions, several training weekends, and a fortnight’s training each year.
Most reservist doctors are deployed, when needed, to the navy’s Primary Casualty Receiving Facility, the Royal Fleet Auxiliary Argus, which has a 100 bed hospital on board.
Surgeon Commander Stuart Millar is career manager for navy medical officers.
His father and grandfather were military doctors and he joined the navy as a medical cadet, serving in Sierra Leone, Kosovo, and Afghanistan. He says his time in Afghanistan was “professionally the three most rewarding months of my career.”
“Everything we do is about supporting ops,” he says. “That was when the impact of the work I was doing was most tangible—giving direct support to the guys on the ground. The people we treated were going out the front gate into a very dangerous environment.”
Pros and cons
Nevertheless, he’s straight with medical students and doctors about the pros and cons of navy life.
“The pros are general duties time, shared ethos and values, and working for a very professional organisation,” he says. “Doctors have diverse roles on a ship and then there’s the officer side of things such as leadership and management as well as opportunities to practise in a challenging environment and different situations, some of them extreme.”
Then there are the cons. “You’re going to be three years behind compared to the outside world. And there are specialties we don’t have in the navy, such as obs and gynae, paediatrics, and geriatrics, so you need to be sure you don’t want to do those.”
In the navy, junior doctors do general duties for two and a half to three years, having been assigned to a submarine, the Royal Marines, or a ship.
A junior doctor may be the only doctor on board a ship for a seven month stint, but he or she will have access to support and advice from senior medical officers on shore and will be well prepared through training, says Surgeon Commander Millar.
Doctors who go to a Royal Marine unit have the chance to undertake the all arms commando course and earn a coveted green beret.
As part of specialist training doctors can apply for overseas fellowships that might include working at US trauma centres or even with flying doctors in Australia.
But unlike in other forces, navy GP practices in the UK don’t cater for families, so GPs tend to do two days in a navy practice and three days in a general one. The opportunities are exciting in all three forces, but Millar is keen to hammer home one point.
Service comes first“The needs of the service come first—recruits are serving Queen and country,” he says. “We try to accommodate personal wishes and ambitions, but basically if they’re told to do something they have to do it.”
Medics do face danger, but Wing Commander McCallum is believed to be the first doctor wounded in action since the second world war.
“You have to be fit. It’s a rough, tough life living in tents and you don’t get to see your family,” adds McCallum, who has two young sons. But he’s driven by a conviction that military personnel deserve top quality medical care.
“Infantry soldiers in particular do a job I really wouldn’t like to do, and do it really well,” he says. “We as taxpayers are sending them out to get shot at, so they deserve the very best level of care.”
Case study: Squadron Leader Ken Murray
Squadron Leader Ken Murray joined the RAF after working as a GP partner in a Glasgow practice and in a rural practice in Stornoway.
He was initially posted to Cyprus for three years. Now a senior medical officer, he runs the medical centre at fast jet station RAF Wittering. There are three full time doctors for 2500 patients.
“One advantage in the military is you have more time to spend with patients and to practise quality medicine,” he says. “The RAF has a very high doctor-patient ratio.”
His first deployment was to the Falklands and he was in Iraq for two months in 2007.
“That involved some pretty scary flights over the roof tops of Basra to pick up people who had been mortared or hit with rounds,” he says. “But you’re very well trained. I went from GP to pre-hospital care doctor in a war zone, which was quite frightening at times but also exhilarating, as you felt you were saving lives.”
His most recent deployment was to Afghanistan, which included transferring casualties on night flights from Bastion to Kandahar.
“You look after the enemy as well as civilians caught up in the fighting,” he says. “People may wonder: how does a doctor and war go together? But we’re trying to reduce casualties and the amount of death and pain on both sides.”
He likes the variety. “I can be in a consulting room dealing with a chest infection then five minutes later I’m in a helicopter.”
He’s also taken advantage of funded training to become a member of the Royal College of General Practitioners and a GP trainer and has done a diploma in occupational medicine. Next summer he starts a four year training programme in the RAF to become a consultant in occupational medicine.
Squadron Leader Murray admits it is hard being away from his family, but he enjoys the camaraderie in the forces.
“There’s a great sense of family in the RAF,” he says. “Sometimes in the NHS you feel you’re just a doctor in a box. Here you’re very much part of a team.”