Patient Care Access News

Hiring Overhaul at DoD Health Could Improve Patient Access to Care

The Department of Defense should rework its hiring processes so it can create an adequate workforce mix and close patient access to care gaps.

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Source: Thinkstock

By Sara Heath

- There are insufficient clinician hiring practices at Department of Defense (DoD) healthcare facilities, limiting patient access to care, according to a recent GAO report.

Currently, DoD employs over 241,000 individuals, including active and reserve faculty, federal civilian staff, and private sector contractors. However, DoD has insufficient strategies for understanding its worker mix and creating an optimal and adequate mix to meet the needs of its patient populations, the GAO report found.

The report, which was conducted in accordance with the National Defense Authorization Act of Fiscal Year 2018, noted that each military department has its own procedures in place to determine its hiring practices. However, separate branches are not considering different staff hiring decisions – military personnel versus federal civilian personnel – nor do they consider the costs of hiring decisions.

Specifically, the DoD has not fully considered the use of federal civilian personnel.

“The military departments have not assessed the extent to which federal civilians and contractor personnel can be used to meet identified operational medical personnel requirements,” GAO wrote in its report.

“Specifically, after the military departments have determined their operational medical personnel requirements, they generally have designated all such positions as ‘military-essential’ (i.e., the activity must be performed by a military servicemember) and have not formally assessed the extent to which civilians or contractors could be utilized to fill these positions, according to officials.”

Army, Navy, and Air Force representatives told GAO that they typically rely on both active and reserve military personnel for the delivery of medical care. When these agencies do hire federal civilian personnel, those workers typically do not travel with the DoD branch. For example, federal civilians working for the Navy do not travel on ships to treat patients.

Furthermore, when DoD agencies work to fill these hiring gaps, they do not usually consider the full cost of doing so, GAO found. While most branches consider some costs, they do not look into the balance between active and reserve military personnel and the cost differences that emerge from those separate hires.

“In some cases, using reserve units to achieve the same operational capacity over time may be more costly than using active units,” GAO explained. “However, the lack of full cost information on active and reserve component medical personnel is a barrier to an analytical-based determination on the balance between active and reserve component medical personnel.”

Within Military Treatment Facilities (MTFs), of which there are six across the country, GAO found that DoD has begun to create processes for achieving an optimal mix of active and reserve personnel and federal civilian personnel.

Each MTF is responsible for determining its own personnel needs by looking at their previous workload information and the size of their respective populations for care.

However, there are some limitations to the process of hiring personnel, especially as it relates to federal civilian personnel. The length of the civilian hiring process is cumbersome as facilities wait for job listings to post and contracts to be drawn.

Additionally, uncompetitive salaries make it hard for facilities to attract top talent, GAO reported.

Finally, civilian hiring freezes often impede processes.

These hiring practices hinder patient access to care, representatives from five of the six DoD hospitals across the country reported. When patients access care at home, DoD workers have reported sending those patients outside of the agency for care because of civilian hiring freezes and lengthy hiring and contract processes.

GAO recommended DoD take the following three actions.

First, DoD should assess where hiring of federal civilian personnel would be applicable and effective. This could help close patient care access gaps.

Second, DoD should compile cost information for hiring both active and reserve military personnel as to better understand its hiring practices.

Third, DoD should create best practices for carrying out MTF plans that ensure optimal hiring mixes.

Ideally, these recommendations will help create a more adequate workforce within the DoD. While GAO did not investigate whether patients were unable to access their care, workforce shortages or inconsistencies often do result in lapses in care access.

Previous GAO reports have also asserted that better medical education opportunities could help address the department’s workforce shortage. By creating incentives for aspiring clinicians to seek education through DoD programs, the agency may create more career pathways for those individuals.


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