Would the Army save money by staffing hospitals with civilians?

SSG Genaro Negrete — Sat, 05 Apr 2014 19:06:15 -0400

I am new to the MEDCEN world. I've had the opportunity to interact with a multitude of civilian professionals that staff most of the positions in the hospital. Along with most being prior service, they have been working at the same jobs for 10-15 years. That type of longevity is hard to come by when we have PCS moves and deployments to balance. <br><br>Why not move towards making army medical centers staffed by civilians? Then push the soldiers out to the undermanned BCT's. <br><br>Civilian employees don't need to take an APFT biannually, don't have to qualify with an assigned weapon, etc. <br><br>There are probably a lot of holes in my theory. Leaders, what are your thoughts?<br>

Response by PO1 William "Chip" Nagel made Apr 5 at 2014 10:19 PM

PO1 William "Chip" Nagel — Sat, 05 Apr 2014 22:19:33 -0400

Seems to be the way of Government anymore Privatize Everything. Can't say I am a big fan of the Idea though. When I was in the Seabees either built everything we lived in or were directly involved in the construction. Very few problems if any. Since I've retired and the war in Afghanistan and Iraq I hear that all the quarters and construction was contracted out by KBR and we have Soldiers, Sailors, Airmen and Marines getting electrocuted in the Shower. I believe with these "Contracts" in the end we pay more and get less quality. Give me a Damn Seabee or a GS Government Employee any day.

Response by CPT Private RallyPoint Member made Apr 18 at 2014 4:07 PM

CPT Private RallyPoint Member — Fri, 18 Apr 2014 16:07:35 -0400

I have been a contractor in a healthcare facility. I can tell you, I know what the company was paid and I know what I was getting paid. My problem with GS employees is that too often the laws allow them to become complacent and not care. It is too difficult to fire them. Some of the military members don't want to bother with the hassle of documenting things. I am in favor of individual contracts. Each person gets a contract directly from the government, renewed annually. This allows for a contract to not be renewed if there are problems. It also reduces the overhead of the large company behind them. The company I worked for made $20-30/hour/position. The individual contractors could be paid a couple dollars more an hour and both the government and the contractors will be happy. <div><br></div><div>At the end of the day, though, active duty provide the most bang for the buck. Privatizing things sets limits on what you can make someone do. Military members can be worked 16 hours a day and you pay no overtime. I'm not advocating for that, but it can be done if needed. </div>

Response by SSG Robert Burns made Apr 18 at 2014 4:20 PM

SSG Robert Burns — Fri, 18 Apr 2014 16:20:13 -0400

Nope.  I've been managing civilians in hospitals for quite a while.  Without going into too much depth I'll make a bullet list for you.<div>1.  Calling out-its an endemic.  Nothing like waiting for your 7pm nurse to show up and she calls at 650 saying she's not gonna make it tonight.  Then either a military member gets called in (for free) or a civilian works super expensive over time.</div><div>2.  Salaries- the gs and contract positions cost/pay more than our military salaries do.  You can work me an extra 12 hour shift/wk at no cost.  You work a civilian like that and you will lose your job as a manager because you will bankrupt the department.</div><div>3.  Training-I see you saying send the military to the BCT's.  The problem is, there's no patients in the BCT's.  You can't send a nurse to ICU in Iraq and they haven't seen an ICU patient since they've joined the Army.  At the hospital is where you learn to be a nurse.  At the BCT is where you learn about equipment and paper work, and flu shots.</div><div>4.  Government shutdowns/sequestration- so during this last shutdown when all civilians got sent home without pay, do you think the hospital got shut down?  Nope.  Completely staffed with military, paid or not.</div><div>5.  Quit- civilians can and do quite at their leisure.  Find a better job somewhere else and they'll bounce in a heartbeat.  We don't have that luxury.</div><div>All that to say this....No.</div><div>Oh and what BCT is undermanned?  They are number 1 priority in strength/readiness.</div>

Response by LTC Private RallyPoint Member made Apr 19 at 2014 10:09 AM

LTC Private RallyPoint Member — Sat, 19 Apr 2014 10:09:30 -0400

<p>         First of all you need to keep doctors, nurses, PT/OT, and medics, etc in the hospital in garrison.   This is their downtime location between mobilizations and wars.   In the clinics and hospitals they learn the skills needed for deployments and their war time missions.   While state side they should be attending training, military school, conferences becoming better at their profession and skills.   Their deployment readiness should be top notch.   </p><p>         That being said, they tend to be the first to go, and when they do a reservist comes in and fills/holds their position.  Army Medical has a 20% Active/80% Reserve mix, which means most of your strength is in your ability to backfill, which is pretty much how the situation is now.   I just started my third backfill mission this last month.    </p><p>         I agree with SSG Burns assessment of the staffing situations.   My civilian job, the staff would be fired on the spot if they tried half the stuff I've seen at Govt hospitals.  The number one mission of the Military hosptals is to TAKE CARE OF THE SOLDIER and their FAMILIES.       </p>

Response by SSG Private RallyPoint Member made Apr 22 at 2014 10:54 AM

SSG Private RallyPoint Member — Tue, 22 Apr 2014 10:54:14 -0400

No in fact I think that the Army in all its services needs to be self-sustainin gas it was a decade ago and lessen civilian influence. Make your Soldiers, Peers, and Superiors DO THEIR jobs they were trained to do and if they cannot accomplish it cut the fat and hire competent Soldiers and Leaders willing to do what they need to keep their job as a NCO, Officer, or Soldier. Before 9/11 there were very few civilians working in organizations now its flooded we need to cut the fat. Dont allow ourselves to show weakness through necessity of civilian support. Yes they are helpful but not at the org. level WE need to do the work and WE need to support each other and our own. We dont need civilians to take vitals, establish a new standard of profiles, and develop more expensive means with less value to recoup injuries and sickness. BTW it is the sole responsibility of the military indivdual to be compliant with APFT, HT/WT, CTT, unit METL, and Soldier Standards at all times. If it is a responsibility to hard to bear then the servicmembers can just leave then. Let someone willing to work hard do it and not make excuses why their organization needs more outside support to conduct operations feasibly while remaining proficient as a servicemember.

Response by SSG Genaro Negrete made Apr 22 at 2014 11:02 AM

SSG Genaro Negrete — Tue, 22 Apr 2014 11:02:45 -0400

All great answers here. I've been learning a lot from your responses.

For the most part, I am understanding that soldiers in these slots are basically much more flexible. As salaried employees, under what I would like to imagine as a very "unique" contract, we can cover more jobs and duties always with the goal of accomplishing our mission. In this case, the care for our fellow soldiers, their families, and veteran soldiers.

What then are we to do about longevity? Those civilian employees, be they contract or DA civilian, stay put more often and for longer stints that the average military member. This allows them continuity in a corporate structure (hospital operations) that needs it. What then of the soldier that arrives on station, spends months trying to get up to speed, then has to shift gears because he/she either got moved to a different department in the same clinic, or comes up on PCS orders?

I would have to say that the obvious answer is to slow down PCS moves, but that's a whole other discussion (one I'm sure rally point is having as you read this).

With Army medicine adopting the new PCMH model, it seems we are leaning towards a more efficient business model for patient care. Many of these best practices are coming from the civilian world of hospital care. Does a 2 or 3 year assignment allow a Soldier enough time to know the ins and outs of this new model and all the various ways we are utilizing to employ it?

As for training, medical providers at the LVN level and above are clinicians by trade. There is no way for them to train (or in the case of an ICU nurse, to even do their job) inside the BCT model. But to imply that medics don't receive adequate training at the BCT level is flat out wrong. The scope and actual engagement of the training is decidedly different than the clinical setting. I strongly believe that 68W soldiers should own the EMS portion of hospital operations. Everything from manning the ambulance crews, to working side by side with the nurses and staff in that department. I feel that this is the best area to get both hands on experience in our career field (emergency medicine) as well as offering a glimpse into other specialty areas before sending medics off to ASI/SQI producing schools.

Response by CPT Zachary Brooks made Apr 22 at 2014 12:52 PM

CPT Zachary Brooks — Tue, 22 Apr 2014 12:52:20 -0400

Besides everything else that has been stated, I would rather work with a Service Member than a government employee. Talk about waiting forever to get ANYTHING done. And for saving money, the efficiency of civilian employees has always left something to be desired in my opinion.

Response by SSG Private RallyPoint Member made Sep 12 at 2017 1:56 AM

SSG Private RallyPoint Member — Tue, 12 Sep 2017 01:56:29 -0400

No, because the military hospitals also allow the medical MOS's to train and put their skills to practical use. 68Ws might be bored in a hospital, but 68As, 68Js, Pharm Techs, Caregivers, Surgeons, Nurses--they actually have pretty busy days in a hospital.

Response by Cpl Brett Wagner made Sep 12 at 2017 9:31 AM

Cpl Brett Wagner — Tue, 12 Sep 2017 09:31:31 -0400

I do not agree with the military staffing medical teams with civilians. Augmenting at times of need sure but not replacing. We need our people to have that experience and opportunities. As a Marine we love our Corpsman like nothing else. If you ever want to really piss off a jarhead try to screw with our docs when we are around.