The Defense Department, reacting to an internal audit that found military doctors were traveling as far as 500 miles from their assigned bases to moonlight at civilian hospitals, is preparing an order that will limit the hours physicians can work and the miles they can travel to make extra money.
Dr. Jarrett Clinton, deputy assistant secretary of defense for professional affairs and quality assurance, said yesterday that he expects the order, now under review by the Army, Navy and Air Force, will go into effect in about two weeks and "will indeed tighten" controls over military medical personnel.
"I think there is general agreement that something like this is needed," Clinton said. "It was found that regulations were not consistent between the services and not followed consistently within each individual service."
A survey of 10 military hospitals, completed about a year ago by the Office of the Inspector General, found that 231, or about 18 percent, of the 1,267 doctors eligible for outside employment took jobs. Eighty-nine of those cases, or about 7 percent, posed problems, the audit found.
The audit found, for instance, that two military doctors assigned to Keesler Air Force Base, Miss., traveled 500 miles to part-time jobs. In addition, 26 doctors from Wilford Hall Medical Center in Texas traveled more than 200 miles to earn money during off-duty hours. At four of the hospitals reviewed, 23 physicians who worked during their off-duty hours had "little time for rest" before seeing military patients, the audit showed.
The new order limits military doctors, nurses and other health care providers from jobs located farther than one hour by car from their military station. They cannot work more than 16 hours a week at those outside jobs, the order states, and they must have at least six hours of rest between those outside jobs and their regular military duties.
In addition, the health care providers must inform both the outside hospital and the military about the kind of work they are doing and must receive approval from their commanding officer, the order states.
The Defense Department's order is the latest in a series of reforms that has been instituted since the Inspector General's audit and individual audits by each branch of the military were completed last year. The audits pointed out some deficiences in quality control measures at military hospitals, which care for 10.2 million active service personnel, retirees and dependents.
Clinton said yesterday that doctors appeared to abuse existing moonlighting regulations in a "very few instances," but the newest order is a "useful" step in establishing better controls.