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gilversplace gilversplace (Member)

Under DHA, centralization of military healthcare

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Any insights on the centralization of military healthcare move in regards with recruiting, work assignements, deployments etc. im just curious as a future direct accesion applicant. Thanks

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I don't think the DHA thing has been fully thought-out yet. It's still pretty early in its infancy. They function as a governing body for military medicine, and their current focus seems to be trying to standardize practices throughout all 3 branches where possible.

Congress' dream for DHA is to one day have a purple-suited military medical organization that serves all three branches. However, they've been talking about that for decades. I can't really see that happening any time soon. The MHS genesis fiasco (the new EHR), and its associated network and hardware requirements, is about all they can handle right now. That roll-out is supposed to take years.

I honestly don't see it affecting you as an applicant if you're applying any time in the next decade.

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In the Army it will only effect who you are assigned to. Before the change FORSCOM (Forces Command) units like Combat Support Hospitals, FST etc only had one nurse assigned to the unit while the rest were PROFIS (Professional filling system) and assigned to fix site facilities like regular hospitals, non deploying units. Now that DHA is in charge Nurses are assigned to a FORSCOM unit and are BMM (Bowered Manpower) to the fix site. We are hearing this was done so soldiers can stay up to date with training to be able to deploy in short notice. Also, AOCs/MOSs which do not have a role when deployed are being eliminated like pediatric dentist, labor and delivery nurse. Its still a wait and see game on how it is going to effect the system on both the military and civilian side of the house.

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I read an article womack army med is already under DHA and 3 AF facilities, Jax naval hosp will be the next in transition.

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I read an article womack army med is already under DHA and 3 AF facilities, Jax naval hosp will be the next in transition.

Right, and that affects the administration of the actual facility far more than the day-to-day operations of the servicemember. I think we are going to see more services outsourced to civilian facilities (like maternity care) as certain specialties are downsized or eliminated. Plenty of the smaller facilities already do this when they don't have a specialty in-house. At my MTF, we didn't have Cardiology or GI, for example, so any patients with those needs went to a civilian provider. Even now, as a VA patient, I have to go outside my VA for my cardiology care.

I think this transition is going to take a long time and that we'll see standardization of offerings across the system.

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I wonder eventually if all healthcare facilities will be staffed by 3 services like no more army navy specific med facilities. And i assume recruitement will be heavy on highly deployable positions like crit care, ER, OR and like you said labor delivery peds, GI, Etc will be outsource or will be GS jobs or USPHS members.

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That is what we are being told that areas like L&D will be staffed by GS employees and other areas like peds which has low census will be sent out to the local hospital. We have already seen this with the peds inpatient at the hospital I work at. I am not sure if the USPHS will pick up more slots at military hospitals than they already have. As far as one medical service in the military back about 8 years ago the Army & Navy were for it but the Air Force was not, at least that was the rumor so we really do not know what the truth is.

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Yes, the AF doesn't like the idea because traditionally every AF hospital commander is supervised by a "line officer" air base commander, who is typically a pilot. That pilot completely defers to the hospital commander for hospital-related decisions, since they know nothing about medical stuff. Therefore, each AF MTF essentially is more or less independently run.

Giving in to a new system that involves MTF/hospital commanders being supervised by people that actually know what's going on means giving up power. Human nature generally wants to avoid that.

Sure, AF MTF commanders technically have to obey AFMOA and the AF surgeon general. However, without a direct chain of command, stuff tends to be ignored. I can think of many examples. How long has AFMOA been talking about enlisted techs giving meds stateside? I currently work with 1 tech out of ~20 that actually is signed off to do it.

Navy and Army have distinct medical chains of command that run directly to their surgeon generals. So of course they wouldn't have a problem with centralized management; they're already doing it.

Edited by jfratian

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Found an article excerpt about my question regarding recruitment and division of DHA and the military branch

"DHA will be responsible for budgetary matters, information technology, health care administration and management, administrative policy and procedure, and military medical infrastructure at all MTFs. The Services will be retain responsibility for operational mission support and recruiting, organizing, training and equipping medical airmen."

I guess recruiting is still under the branches but administration and management will be under DHA. I wonder if promotion will be affected like slowed down or something.

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From what I've seen and heard in the Air Force, peds, OB and L&D will either become staffed by non-mil (or atleast non-AF) nurses or moves off-base altogether. For example, Langley has already closed all their inpatient services.

I don't know how this will effect recruitment, retention or possible retraining of theses nurses though.

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They'll make them do med-surg just like they do when they deploy. They've already reduced the ISP retention bonuses for the outpatient people. I expect they are going to be doing the same for everyone without a deployed mission.

Honestly, it's for the best. No offense to anyone, but it kinda sucks to be deployed with people who don't know what they're doing. A lot of these NICU, L&D, and peds nurses are a bit like fish out of water when they are asked to deploy as med-surg. It would be better if they were forced to do their deployed mission back at home too.

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