For the first time in memory, no branch of the U.S. armed services has enough physicians to provide the level of health care that American military families around the world have come to expect as a major benefit of service life. This military doctor shortage is forcing the more than 114,000 service dependents living in the Washington area to place greater reliance on civilian physicians, paid by the military's equivalent of Medicaid, or to drive long distances to military installations that might provide the health care service which their base lacks.
The chief cause of the doctor shortage is the decision of a record number of military doctors - many of whom entered the services during the Vietnam War era - to leave as their tours of duty come to an end this summer.
Without the draft, the military is finding it difficulat to fill the ranks of its medical corps and physicians are reluctant to join the volunteer Army when they can earn more and develop their specialties as civilians.
As a consequence, the Navy and Air Force have suffered because they are no longer appealing as havens for physicians wishing to avoid induction into the wartime Army.
There are more personal reasons, too, such as low job satisfaction and unhappiness with the transient military life, that are responsible for the flight of military physicians. Departing doctors have complained of poor support facilities and abuse of their duty time by military families who demand services for innocuous injuries because the medical care is free.
"I want a home, I want to by a house and live in a community and practice medicine in my own field," said Air Force Major Alan D. Stenfeld, a radiation therapist who is one of the many doctors leaving this year. "But it's implicit in the military that you're moved around, either because the military needs it or because they think it's good for your development. You often can't practice in your field. I don't like that system . . . I don't think I'm asking for a lot, but this system can't give it."
Unfortunately for the Air Force, Stenfeld's speciality at Andrews Air Base's Malcolm Grow Medical Center is one of five that is on the Army-Navy-Air Force endangered species list. Washington area military medical centers and hospitals are running short of radiologists, gynecologists, family doctors, internists, and anesthesiologists.
For the first time in recent history the U.S. Army has not had enough physicians to fill posts around its bases. Last year 75 positions were vacant and this year the number has grown to 370 unfilled positions, according to an Army spokesman.
In a crops of fewer than 5,000 medical officers, these shortages have had a more severe impact than the statistics may reflect! Some bases, particularly the smaller ones, will lose whole departments, and their communities will suffer more than bases serviced by large military hospitals in urban areas.
For example, the Walter Reed Medical Center will be short some 61 physicians this summer but still have a staff of 151 medical officers. The Kirk Army Hospital at the Aberdeen, Md., Proving Grounds, meanwhile, will lose only nine doctors, yet that loss will cut the hospital's staff in half.
"Only active personnel can be assured of treatment," explained Maj. Richard N. Hanson, Kirk hospital director. "We aren't going to refuse to treat dependents and retirees, but there will be long waiting lists and they may want to go to a private physician."
At issue for the dependents of Aberdeen's 16,000 active servicemen - and the thousands of other Washington area military families - are the benefits that are part of the allure of military life.
The choice will be shopping around for a nearby military hospital with the staff and time to treat an ailing military dependent (all three branches share medical services) or using CHAMPUS, the Civilian Health and Medical program for Uniformed Services that resembles Medicaid.
With the increased reliance of military families on civilian physicians, taxpayers can expect to foot growing CHAMPUS costs that will far exceed the $512.9 million paid out by the federal government in fiscal year 1975 - before the doctor shortage hit.
The Veteran's Administration Hospitals are not directly affected by this shortage since the bulk of their physicians are civilians, according to a V.A. spokesman.
In the Washington Metropolitan area, representatives from Walter Reed, Bethesda Naval and Malcolm Grow medical centers are meeting to coordinate medical services to fill each other's needs and those of surrounding military bases.
That won't be enough, according to military spokemen, and families who can't travel long distance or who need immediate care will be forced to go to civilian physicians.
"Our need is in primary care fields: family physicians and pediatricians who are absolutely critical for running a hospital . . . Families have already had to use private physicians and many (doctors) just won't accept them, they don't want CHAMPUS claims," explained Pat Bragg, spokeswoman for the U.S. Air Force.
Already the Air Force, at least, has been hit with staggering numbers of refusals for CHAMPUS claims. Bragg said that the Texas Medical Association notified the Air Force last year that its physicians did not want CHAMPUS patients. The association cited what it called the low payments that the military authorizes for services as the main reason.
This year the Myrtle Beach Air Force Base in South Carolina received a similar warning from civilian physicians in that area, according to Bragg.
The crisis atmosphere has already hit nearby Ft. Belvoir in Fairfax County, where rumors about impending health care cuts recently prompted the local base newspaper to devote an entire issue to a detailed expanation of the physician shortage.
The total physician shortage for the Air Force is now 389, while for the Navy it is around 200, according to service spokesman.
All three branches are loooking for alternatives, and their representatives on Capitol Hill have been bombarding Congress with requests for more money and help in devising new solutions.
The military has begun hiring retired military physicians - paying as much as $44,000 in salaries while allowing the physicians to draw their service pensions as well. New programs for medical assistants, like Malcolm Grow's nurse-midwifery training course, are also seen as partial solutions.
The controversial Uniformed Services University of tha Health Sciences, the military's own medical school near Bethesda, was not mentioned by the spokemen as a realistic alternative to make up the shortage.
Continued-bonuses to physicians in the service and tax-free scholarships to medical students planning to join the military were the choices military spokesmen said were most preferred.
The impact of the 1973 end of the draft is dramatically demonstrated by the number of physicians left in the service who joined under the Vietnam-era Berry Plan, which allwoed physicians to finish medical school before entering the military for two years.
Last year there were 584 Berry Plan physicians entering the service. This year there were 144, next year there will be 59, while in 1979 there will be 13. The last four will join up in 1980.
Army physicians at Ft. Belvoir's DeWitt Hospital told the base newspaper that they were leaving because there was not enough job satisfaction. Dr. Thomas Cleary, a pediarician, said that he was leaving because he was "fed up!"
"It's not the money, I'm taking a $6,000 cut in pay to leave . . . The focus of concern among the decision makers is not with quality care but with numbers for the sake of numbers," he said. "After two years of fighting to get proper equipment, adquate numbers of supportive staff, and being forced to work in areas where I am not qualified, I am fed up."
The question of care within the military life style is part of the reason why Maj. Kenneth Dozeir, a 30-year-old family physician, is leaving Malcolm Grow and the Air Force to set up a private practice in a small town outside Nashville.
"The Air Force's mission is to fight, ours is to take care of people, and sometimes there is a clash," explained Dozier. "Say a man's wife is having emotional problems. He's in a specialized field and the Air Forece transfers him to a remote assignment in Korea, alone. As a physician I wouldn't agree with the assignment, but I would be overridden."
Dozier said that he generally liked practicing at Malcolm Grow but he and his wife wanted to set down roots and return, permanently, to Tennessee.
He and his colleague Dr. Stenfeld both agreed that the military life would be much more attractive if permanent assignments were available, but no one has offered any solution like that to entice them to stay, they said.