RAND Highlights Army Medical Issues

The medical department of the U.S. Army has two primary missions: 1) to be ready to project medical forces in operations, for both war and peacetime deployments, and 2) to care for the health of beneficiaries, such as military personnel and their families, during both peace and wartime. These different objectives create a tension. The second demand is visible and often gets immediate attention when shortfalls arise. But operational demands are less visible, more uncertain, and sometimes far in the future. Concerned about the possibility that decisionmakers, burdened by day-to-day demands of beneficiary care, could lose sight of future needs on the operational side, the Army Medical Department (AMEDD) asked RAND to assess its operational posture and highlight issues requiring further consideration or analysis. RAND analysts recently released an issue paper, "Army Medical Strategy: Issues for the Future", documenting their assessment.

To identify the most critical issues, RAND researchers interviewed AMEDD officials, participated in and reviewed the results of wargames and workshops, and reviewed analyses of post-Cold War operations. RAND identified four issues that affect the Army's future ability to project and field the right medical forces:

  • Does the Process for Determining the Medical Force Yield an Appropriate Operational Force Structure?
    The Army employs an elaborate process called Total Army Analysis (TAA) to design and resource its forces. TAA models include assumptions about the expected conditions for military campaigns and project requirements based on campaign simulations of the combat forces. These models are sensitive to the assumptions about combat conditions and threats built into them. While these models closely follow constructs assumed during the Cold War, RAND discovered examples where the real threat faced by U.S. forces could be much different. Researchers also found that the process does not fully account for how DoD plans to conduct joint operations and does not include coordination with other medical assets (e.g., hospital ships), which may reduce risk. RAND made suggestions for improving the TAA process, such as extending future analyses to determine what happens when key assumptions are changed, or periodically convening panels of military and civilian experts to assess medical requirements for specific conditions and threats.

  • Is the Army Successful in Filling Its Medical Authorizations?
    The Army has decided to resource 38 of the 49 field hospitals that the TAA process indicates are needed, which suggests an acceptance by Army leadership of a shortfall in the required medical capability. However, RAND found that AMEDD appears to be facing a personnel shortfall in filling even this number of reduced authorizations - a shortfall that could hamper AMEDD's ability to support operations while also providing peacetime care. Based on a 1996 survey, AMEDD has surmised that the primary obstacles to retaining physicians are the perception of increasing peacetime deployments and financial concerns about civilian employment and mobilization. AMEDD has implemented a set of initiatives to address this shortfall; however, even if these initiatives work, they are designed to take a long time to resolve the problem. RAND cautioned that the personnel shortfall deserves further examination beyond a single set of survey data and recommended that, given current operational and budgetary trends, AMEDD should develop metrics to assess the outcomes of these initiatives and map out alternative strategies in case they are not as successful as planned.

  • Can AMEDD Support Operational Concepts of the Future?
    AMEDD faces some long-term (20-25 years) challenges in supporting future operational concepts. RAND has provided analytical support to a series of Army wargames and related workshops. The future operational concept employed during these games, Advanced Full Dimensional Operations (AFDO), explicitly promises to end conflicts rapidly and, therefore, implies lower casualties. During the games, however, casualties were higher than expected for early-entry forces, and it appeared that the AFDO concept would present significant challenges for AMEDD. Also, AMEDD's supporting concept was dependent upon numerous break-through technologies whose feasibility could be questioned because of budgetary, scientific, or political constraints.

  • Can AMEDD Become More Effective in Current Operational Planning?
    In addition to near- and far-future requirements for medical support, AMEDD currently supports missions around the world through operational planning in unified command headquarters (i.e., the joint commands, each commanded by a four-star Commander-in-Chief [CINC] who has responsibility for operations in a specific geographic theater). During the study, RAND interviewed command surgeons and their staff in unified and major command headquarters about their experiences with planning processes. Interviews indicated that both the structure of some CINC staffs and the rank of Army CINC surgeons inhibit communication of medical planning requirements and concepts to the CINC. RAND recommended that the military medical community consider revisiting medical staffing requirements for these headquarters.

While many of these issues are being addressed to some degree, researchers noted that they are situated within an interdependent system where the importance of any single problem or shortfall may be underestimated unless an overarching analysis is available. Researchers suggested that what is needed is sharper formulation of the problems and closer analysis of the risks they may imply overall for the Army, with sensitivity analyses to recognize the variability in requirements and capabilities under widely varying assumptions.

For more information about this study, read the report.