New doctor recruitment method seeks to boost ranks

By Tom Philpott: Military update

The number of medical students accepting Army and Navy scholarships has fallen sharply over the last two years, in part because of the mayhem in Iraq as depicted in daily news reports, say service medical leaders.

A scholarship program the Army surgeon general calls “our lifeblood, over time, for recruiting physicians,” is failing to attract enough qualified applicants by wide margins, except in the Air Force.

Difficulties in recruiting the next generation of Army and Navy physicians and dentists have spurred the Senate to approve new authorities to increase dramatically medical bonuses and stipends.

The increases, which potentially involve millions of additional dollars for medical personnel, are before a House-Senate conference committee and could win the full support of Congress by fall.

The services recruit roughly 70 percent of physicians and 80 percent of dentists through the Health Professions Scholarship Program (HPSP).
The rest graduate from a military-run medical school, accept military financial aid while in residency training or enter service as fully trained doctors.

HPSP scholars see full tuition covered in their civilian medical schools plus books and fees and receive a monthly stipend of $1,289. In return, students agree that for every year of schooling provided, they will serve a year as a military physician or dentist.

All the services had been meeting HPSP goals until fiscal 2005. The Navy had expected to sign 291 medical school students but could attract only 162, a 44 percent shortfall. Numbers for fiscal 2006 look about the same or a little worse, said Vice Adm. Donald C. Arthur, the Navy surgeon general.

The Army in ’05 expected to award 307 scholarships. It fell 70 short, missing its goal by 24 percent. Through nine months of fiscal 2006, the Army has awarded 179 scholarships, 61 percent of goal.

“I am concerned we’re going to be short” again, said Lt. Gen. Kevin C. Kiley, Army surgeon general. The impact will be felt “down stream,” Kiley said, creating future shortages but not affecting the current number of doctors available for war or patient stateside care. The training pipeline that turns a new medical student into a doctor is four to nine years long, he said.

Dental school students are another concern. In fiscal ’05, the Navy hoped to sign 85 dental students under HPSP. It attracted 65. The Army last year awarded 10 fewer dental scholarships than the 93 planned. It also wanted to sign 30 dentists through direct accession but could get only 16.

With three months remaining in fiscal 2006, the Army Dental Corps has less than half the HPSP students it seeks — 54 of 115 — and has enticed seven of the 30 dentists planned to be brought in through direct accession.

The Air Force is exceeding its HPSP goals. An official credited the Air Expeditionary Force concept, which limits combat assignments for medical and dental officers to predictable four-month tours, and several years in between. Applicants also are told the Air Force offers a higher quality of life.

Kiley and Arthur, in separate interviews, blamed some of their downturn on news and images out of Iraq. Young people, Kiley said, “look at this and say either ‘I don’t agree with our war’ or ‘I sure don’t want to be over there.’ So they see signing up for a scholarship as tantamount to enlisting and going right into combat. (In fact) it’s going to be anywhere from four to nine years before that would happen.”

The recruiting environment is toughening for other reasons. Kiley said more than half of medical school students are now women, a gender historically less interested in military service. Also, he said, the HPSP stipend of $1,279 a month “is not a lot to live on” and still stay debt free.

Arthur pointed out that more scholarship alternatives to HPSP are being offered by large managed care companies and even by rural communities sponsoring the education of students who become local doctors.

Many prospective medical students, he said, know little about the military, except what they read and see in the news, which upsets them.

To counter such impressions, the Army and Navy are beefing up medical recruiting and sending young medical officers with operational experience to visit colleges, medical schools and professional conferences to explain the quality of their training and the rewards of service in wartime.

Tom Philpott can be contacted at Military Update, P.O. Box 231111, Centreville, Va. 20120-1111, or by e-mail at: