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Research Questions

  1. What is the effect of PROFIS on providers?
  2. What is the effect of PROFIS on nonmedical Army personnel?
  3. What issues or problems led to the establishment of PROFIS? Do those issues still exist?
  4. Is an alternative to PROFIS required? What potential improvements are needed?

The Army Medical Department uses the Professional Filler System (PROFIS) to manage the deployment of health care professionals. PROFIS allows health care providers to practice in a military treatment facility (MTF) when not deployed, which contributes to the maintenance of their medical and technical skills. There are concerns that PROFIS is not fully meeting the requirements it was designed to satisfy. Underlying concerns are that some medical personnel deploy more frequently and for longer durations than others, that PROFIS may cause dissatisfaction among health care professionals that may affect their retention, and that PROFIS deployments may lead to reduced access to care at the MTFs from which health care professionals deploy. In addition, receiving units report that some PROFIS personnel are not well-trained soldiers and that they are not well integrated with their PROFIS unit when they deploy. This report assesses the current functionality of PROFIS and how the system could be improved. The authors (1) reviewed the literature and interviewed key stakeholders; (2) analyzed databases to determine which health care professionals were deployed, how often, and for how long; and (3) conducted a web-based survey of Army health care professionals. They found that PROFIS has a variety of impacts on the predictability of deployments, the skills and training of medical personnel, perceived access to care at the MTFs, the perception of equity among medical personnel, and the retention of medical personnel. The authors describe 23 potential modifications to the system and highlight 11 as being most promising.

Key Findings

PROFIS Generally Works, But There Are Areas for Improvement in Terms of Equity, Predictability, Skills and Training, and Impact on Medical Treatment Facilities

  • PROFIS generally works, enabling the Army to deploy the required number of health care professional with the appropriate skills.
  • PROFIS is largely viewed as equitable, but a sizable minority view it as inequitable.
  • Those who perceive it as inequitable belong to the more frequently deployed skill groups.
  • Deployments differ substantially in number and length, depending on the area of concentration of the health care professional.
  • Filling the battalion surgeon position imposes additional demands on some physicians because these positions can include extended deployments and there is more often a mismatch between the needs of the position and the skills of the physician (e.g., a specialist having little opportunity to practice his or her specialty during deployment).
  • Notification of deployment and delivery of formal orders occurs very late in the process for a substantial percentage of PROFIS deployers.
  • The PROFIS selection process involves noticeable turmoil that results in negative outcomes for the PROFIS deployers and the units to which they are assigned.
  • Some health care professionals report that certain clinical skills degrade during deployment; however, leadership skills are almost universally seen as improving.
  • Medical personnel perceive that PROFIS deployments result in increased workload and reduced access to medical care at the military treatment facility from which health care professionals deploy.
  • Long or multiple deployments and a perception of inequity are associated with decreased propensity of physicians to remain in the military.

Recommendations

  • Four modifications are likely to be most effective if implemented in an integrated approach, while seven others could be done independently and quickly, but with modest effect.
  • Shift Army medical personnel requirements to increase personnel in areas of concentration that are in demand for deployment (integrated modification).
  • Alter the method of paying back the cost of medical training by allowing personnel trained in subspecialties to opt out of serving on active duty in exchange for a long-term contract with the Army to serve in military treatment facilities (MTFs) (integrated modification).
  • Fill all PROFIS battalion surgeon positions with physician assistants and nurse practitioners (integrated modification).
  • Convert the battalion surgeon position to an organic physician assistant/nurse practitioner position and using borrowed military manpower to ensure providers have adequate time in clinical practice to maintain skills (integrated modification).
  • Limit consecutive assignments in nondeployable positions (standalone modification).
  • Reduce the number of nondeployable personnel in deployable positions (standalone modification).
  • Provide short-term sick call and trauma refresher for subspecialists and nonpracticing MDs who deploy as battalion surgeons (standalone modification).
  • Improve the timeliness with which PROFIS personnel receive deployment orders (standalone modification).
  • Implement an Army Force Generation cycle for PROFIS positions (standalone modification).
  • Implement a more formal reassessment of staff skills upon redeployment (standalone modification).
  • Implement a national backfill contract for regional medical commands/MTFs (standalone modification).

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Background

  • Chapter Three

    Data and Methods

  • Chapter Four

    Effect of and Concerns About PROFIS

  • Chapter Five

    Potential Modifications to PROFIS

  • Chapter Six

    Conclusions and Recommendations

  • Appendix A

    PROFIS Areas of Concentration/Military Occupational Specialties, by PROFIS Tier and Number of Army Personnel in Each, as of December 2009

  • Appendix B

    AOCs, by Strata, Used in the Survey Sampling and Analyses

  • Appendix C

    AOCs That Are Allowed Substitutions for the Battalion Surgeon

The research described in this report was sponsored by the Army Office of the Surgeon General. It was conducted jointly by RAND Arroyo Center and RAND Health. RAND Arroyo Center, part of the RAND Corporation, is a federally funded research and development center sponsored by the United States Army.

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