The Defense Department plans to transfer thousands
of uniformed health care personnel out of their positions in
military medical facilities over the next few years and
replace them with civilian workers or contractors.
The initiative is part of a larger Pentagon effort
to reassign military members to jobs that are more directly
tied to war-fighting and national security, leaving the
tasks they had been performing to civil servants or private
contractors, or eliminating the positions.
The plan could bring important changes in the way
the Defense Health Program provides medical and dental care
to 8.9 million active members of the military, their
dependents and military retirees. The changes are expected
to affect thousands of doctors, dentists, nurses,
administrators and ancillary staff employed in a network of
75 military hospitals and 461 military clinics.
What will not change, officials contend, is the
quality and level of care provided in a system that employs
40,648 civilians and 91,917 military members, with a current
budget of $17.3 billion.
Pentagon officials declined to discuss most details
of the plan, saying it is part of the department's
budget-development process. The administration has requested
$17.6 billion for the department's health program next year,
including $35.8 million to fund the conversion of positions
held by military personnel to civilian workers or private
contractors.
The rationale behind the plan is that only certain
jobs -- for instance, those of surgeons who care for Marines
wounded in battle -- must be performed by a person in
uniform, officials said. Others can be done by civilian or
contract workers -- or could be eliminated.
"Generally speaking, should a position be converted
from military to civilian, the military personnel would be
reassigned to another position in military medicine that
requires a military person with that expertise," Marianne
Coates, a Defense spokeswoman, said in an e-mail response to
questions. "Importantly, the military's health plan,
Tricare, has tremendous flexibility designed in so that our
beneficiaries continue to receive the care they need, when
they need it. . . . We have civilian physicians and nurses
working in our military medical facilities today, so having
more would not degrade our standard of care."
Navy Lt. Cmdr. Tim Weber, division director for
manpower operations at the Navy's Bureau of Medicine,
elaborated on how the planned changes are expected to play
out in one branch of the military's medical facilities.
Under the plan, a uniformed pediatrician at, say,
Naval Hospital Jacksonville in Jacksonville, Fla., might be
replaced by a civilian doctor or private contractor, Weber
said. The same might be true of a Navy nurse or uniformed
administrator who works at the San Diego Naval Medical
Center.
As many as 5,415 jobs now held by uniformed Navy
members will be switched to contractors or civilians by
fiscal 2011, including 1,772 positions over the fiscal year
that begins Oct. 1, he said. The affected personnel will
transfer to a "military essential" position when their
rotation in their current post ends.
"They will continue in their military careers,"
Weber said. "We are not involuntarily reducing our numbers.
. . . Navy medicine globally is slightly understaffed at the
moment."
Weber said the plan is expected to save money in
the long run by reducing the number of uniformed military
health care workers, which in turn will reduce the Navy's
retirement and infrastructure obligations. Officials also
believe some of the positions being converted can be done
more cheaply by civilians than by military members, he said.
Weber said the plan will not affect the 10,500
doctors, nurses and health care support staff members who
travel with the Navy and Marines every day and provide
direct care for them in battle. Nor will it change the jobs
of the 24,000 health care workers in Navy hospitals in the
United States who are part of a readiness group that can be
deployed to hospital ships and fleet hospitals on short
notice to support military missions, he said.
Navy Lt. Cmdr. Chito Peppler, a spokesman for the
National Naval Medical Center in Bethesda, said officials
there will not know how many people will be affected by the
conversion plan until October.
Jim Yonts, executive director of the Association of
Military Osteopathic Physicians and Surgeons, said the
group's members -- the majority of them uniformed military
members -- have not been told how the plan will work.
"On paper, it sounds like it would certainly be
workable and I'm not sure that it would necessarily have any
negative impact on our members," he said.
Weber, the Navy official, said: "We
will continue to provide outstanding health care. All we're
doing is changing the flavor of the uniform."
