Reimagining the Army Medical Corps: Five Ideas for Raising Recruitment, Restoring Retention, and Restructuring Requirements

The Army Medical Corps comprises the physicians of the U.S. Army. In garrison, members of the Medical Corps ensure soldiers are medically fit for duty, providing medical care to service members and to dependents, retirees, and other beneficiaries in military medical treatment facilities (MTFs). When needed for war or other contingencies, Medical Corps members deploy to provide health service support to operations.

The Army has authorized requirements for over 4,000 physicians in the active component (AC) and nearly 2,000 physicians in the reserve component (RC). Maintaining this force requires the Army to recruit nearly 400 physicians for the AC and 200 for the RC each year to keep pace with the normal attrition of physicians due to separations and retirements. For the AC and RC, some physicians are direct accessions into the military. In addition, some physicians join the RC as part of leaving the AC.

However, the vast majority of Medical Corps officers enter the Army through the Health Professions Scholarship Program, in which the Army pays for the student's medical education in return for the student incurring an active-duty service obligation (ADSO) of one year for every year of scholarship support, with a two-year minimum. A lesser number enter through the Uniformed Services University of the Health Sciences, which incurs an ADSO of seven years. Military residency also incurs an ADSO; however, a medical education ADSO and residency ADSO can be fulfilled concurrently.

In recent years, the rate of recruitment has not been able to keep up with the pace of separations. A larger proportion of Army physicians who have fulfilled their ADSO are separating rather than extending their careers and, possibly, serving until they are eligible for military retirement. This trend results in positions at MTFs and other units being unfilled, possibly compromising the Medical Corps' ability to fulfill its missions, whether in deployed operations or in caring for service members and other beneficiaries at home.

Objective and Approach

The objective of the project was to examine alternative strategies for the Army Medical Corps to ensure that it remains agile in the face of uncertainty and has access to the personnel it needs to support operational requirements.

Our approach was to (1) consult with subject-matter experts and gather and analyze data to help identify alternative courses of action (COAs) that could increase retention, increase accessions, or reduce the requirement for uniformed physicians and (2) in consultation with our sponsor (the Army Office of the Surgeon General), select the most promising COAs for further development and investigation. The Army asked us to “think outside the box” in developing these COAs, including by restructuring the medical force or downsizing capabilities. Indeed, one senior leader asked us to come up with ideas that could make the Army uncomfortable: i.e., ideas that could have merit but, for one reason or another, could be unpopular in some circles, such that Army personnel might not dare suggest them.

Findings

In collaboration with the Army Office of the Surgeon General, we developed the following five COAs to investigate:

• Increase ancillary and administrative support staff. This could improve retention by improving support and reducing the administrative burdens.
• Expand military-civilian partnerships. This could improve retention by reducing the concern over degradation of skills. It may also improve recruitment by presenting an attractive set of possible places to work.
• Widen options to serve as an Army physician. This could improve recruitment and retention by promoting skill retention and improving pay through arrangements that include some degree of civilian employment.
• Expand Army-sponsored Graduate Medical Education (GME). This could improve recruitment by offering students a higher chance of matching with certain programs.
• Reshape Army community hospitals. This would restructure the Army's requirement for uniformed physicians.

Table 1 shows how these COAs link to the goals to increase accessions, increase retention, or reduce the requirement for uniformed physicians. For COAs that seek to improve retention, we show how the COAs relate to factors cited in the 2022 survey of Medical Corps officers: competitive salaries, ancillary support, and skill degradation.

COA	Increase Recruitment (Increases Accessions)	Make Salary Competitive (Increases Retention)	Improve Ancillary Support (Increases Retention)	Minimize Skill Degradation (Increases Retention)	Restructure Requirements (Reduces Requirements)
1. Increase support staff			Yes	Yes
2. Expand military-civilian partnerships				Yes
3. Widen options to serve		Yes		Yes
4. Expand Army ADSO	Yes
5. Reshape Army community hospitals				Yes	Yes

These COAs are not mutually exclusive: Implementing one does not prevent another from being feasible. Indeed, some of the COAs will work better in concert with each other. For example, moving uniformed physicians out of Army community hospitals necessitates finding new locations for them to practice and maintain their skills; if Army medical centers cannot accommodate these physicians, civilian partnerships will be required. Similarly, expanding ADSO can only work if there are sufficient patients to support residents and attending physicians; here, too, the Army may have to partner with civilian institutions.

These alternatives differ in terms of the delay associated with seeing an effect. None is a near-term solution. Some require cooperation with outside agencies (e.g., the Defense Health Agency). Some require enabling legislation.

Conclusions and Next Steps

We have documented five alternative COAs that might help the Medical Corps address concerns with retention, accession, or requirements. These COAs contain ideas that could contribute to future discussions and debate within the Army. Before any of these COAs can be put into practice, further work needs to be done. So, we suggest the Army consider the following next steps:

• Where possible, gather data and investigate relationships to further consider which COAs are feasible and desirable. One could use naturally occurring differences to try to identify the potential effect of some COAs: for example, see whether disparities between Army facilities in the ratio of support staff to physicians correlates with retention or whether participation in a military-civilian partnership correlates with attrition. It may be that the sample sizes are too small to identify any effects with precision, but it would be instructive to see whether the data are at all suggestive.
• Consider piloting one or more of the COAs to determine their efficacy in recruiting or retaining physicians. This would require careful consideration, as many of the COAs we consider would require coordination with outside agencies and may require enabling legislation prior to conducting a pilot study.