of obligatory payback periods just when they are reaching full stride professionally. We are losing quantity and quality. Recruiting goals for nurses have varied significantly from year to year, resulting in an uneven flow in the nursing pipeline. We have taken steps to correct this problem. We will be implementing a pilot program that will permit reserve nurses to work on a regularly scheduled basis at our medical treatment facilities and receive drill credit for their work. This program will augment the hospitals' staffing and, we hope, attract some of these nurses into the active force. Some gains have been made in improving our recruiting programs. By the end of FY 88, for example, we will have 90 full time medical recruiters in the field. The improvements are already paying dividends. For example, 41 physicians have been recruited, 22 of whom practice critical specialties. We have streamlined the recruiting process with a goal of reducing the processing cycle from one year to no longer than 60 days. The medical department has taken action to shore up recruiting ensuring more physician-to-physician contact at the local level. Selected active duty physicians will receive training at the Navy's recruiting school to learn techniques to be more effective spokespersons for Navy medicine. Navy also initiated a mass mailing of questionaires to 180,000 physicians and nearly 250,000 registered nurses to determine if they might have an interest in serving in the Navy. We are now following up on the 3400 persons who responded. We will also participate in a similar undertaking sponsored by the Assistant Secretary of Defense (Health Affairs). Our Loan Repayment and Stipend Programs are gearing up. Two nurses are enrolled in the Loan Repayment program. Seven nurses and ten physicians are involved in the Stipend program and there are another 12 applications in process. We expect these programs to make significant contributions to improving our manning problem. Our recruitment and retention initiatives are crucial to improving our medical posture. Navy leadership supports us in these efforts. We are working with Vice Admiral Edney to develop a balanced, executable program for increasing the size of the medical force. Our efforts will produce a deliberate and steady increase. I request that you permit Vice Admiral Edney and me to present a balanced growth program for your review. The growth will include 300 medical department officers and the associated support personnel. We will also access all the Medical Department Officers we can possibly recruit. I ask, therefore, that you review the requirement to make 25 percent of all Navy officer accessions medical department personnel. EDUCATION AND RESEARCH A professionally vigorous, enthusiastic medical staff is a crucial variable in the complex equation that leads to retaining physicians in the Navy. To of the most important contributors to development of this professionally competitive medical staff are graduate medical education and the opportunity to conduct rigorous clinical investigation and research. In the prologue to their White Paper on Military Graduate Medical Education, the Society of Medical Consultants to The Armed Forces stated, "Graduate medical education is the keystone supporting the entire voluntary military medical structure for quality healthcare delivery in time of peace and war. Simply stated, if we cannot train physicians, we have little hope of 87-306 0 88 - 18 retaining them as career officers. Traditionally, among the most valued assets of the Navy Medical Department has been its education Graduate Medical Education (GME) programs and training programs. have been highly sought by physicians, and the competition for residency positions has been fierce. Recently, the operational focus of Navy Medicine towards readiness training and the increase in medical deployments, without significant increases in manpower, have interrupted program continuity in many cases, depleted seasoned teachers from the programs and caused a drop in residency applications. We must halt this diversion of talent if we are to maintain our future capability. Anything which threatens Graduate Medical Education programs, threatens our viability and the quality of people we can attract and retain. Retaining the highest quality people is already very tough. We must reward, stimulate, and retain our superior research scientists and revitalize our research and development programs. Several programs critical to wartime medicine are now in various stages of development. The projects involving the battlefield conversion of potable water into water for intravenous fluids are critical to resolving some of the most difficult wartime logistics problems. Similarly the conversion of all blood into type "O" negative cells which can be frozen and stored for years, then reconstituted for wartime use, using the onsite produced sterile intravenous solutions, has major impact on our readiness; and the development of a process which provides diagnostic x-ray images in the field without the need for x-ray film has the potential to significantly increase our wartime medical care capabilities and exploit space age technology. PHYSICIANS IN EXECUTIVE MEDICINE POSITIONS Each year we must deal with the issue of assigning physicians to executive medicine positions. There are those who argue that as long as we do not have the resources to satisfy all of our clinical demand, we should require all of our physicians to provide direct patient care in lieu of accepting management positions. In fact, the House Appropriations Committee Report on the Fiscal Year 1988 Department of Defense Appropriations Act directs each of the Services "...to reduce by 10% the number of physicians in administrative positions (from those assigned on September 30, 1987), returning them to patient services and replacing them in these administrative positions with Medical Service Corps personnel." This view fails to recognize that there are positions to which assignment of a physician is, in my view, essential to mission accomplishment. The first is the Surgeon General's position. This is followed closely by the Deputy Surgeon General and the Fleet Surgeons. We are also required to provide a Medical Corps Flag Officer for certain rotating positions in Joint Commands. My policy is that the best qualified individuals, regardless of Corps, will be assigned to command our military treatment facilities. It is my judgement that the Commanding Officers of our largest graduate medical teaching facilities must be clinically proficient, competent administrators, experienced in Graduate Medical Education and research oriented. I fully agree that physicians are not needed just to sign paperwork, or move it from one side of a desk to another. However, the Navy does need to to "grow" senior physician leaders for command positions in the organization. It is essential that a robust pool of highly qualified personnel, including physicians, be available to fill middle and top leadership and management jobs in Navy Medicine. are providing the finest management training courses available to our people; however, the skills developed in these courses, while We necessary, are not sufficient in and of themselves. These classroom-developed skills must be sharpened by the lessons of experience; experience which can only be gained by serving in middle and entry level management and leadership positions. Many of these experiences are available in the natural course of a physician's development. Internship, residency, senior resident status, Division Director, Department Head, Teaching Chief, and Chief of the Medical Staff are all important, challenging management development opportunities for physicians. However, their opportunities for development should not be artificially limited to these clinically oriented positions. If we want the best qualified persons to fill our key positions, then we must afford all our officer corps opportunities to develop the leadership and management skills needed to successfully perform in those jobs, including physicians. There are positions which, in my view, require assignment of a physician and there is, therefore, a requirement to develop a pool of talented managers from which we might select the "best" qualified to serve in our most challenging leadership positions. Physicians prefer to practice in organizations where they are confident that the clinical perspective is taken into consideration in all healthcare policy decisions. Make no mistake, leadership is the issue here. For these reasons, I do not think that a 10% reduction of physicians in "administrative positions" is in the best interest of the Department of the Navy or our patients and I request that you reconsider this direction. CHAMPUS REFORM INITIATIVE The Navy has been a strong supporter and partner in the CHAMPUS Reform Initiative (CRI) since its inception. I have given the program my personal endorsement and strongly support the objectives underlying CRI. This long-overdue initiative to increase access to healthcare services while reducing the cost and ensuring the |