An analysis of peacetime medical workload and staffing : should medical readiness be viewed through a peacetime lens?

Abstract

There is concern that the current approach to the peacetime medical mission of Navy Medicine does not adequately address the need to provide its personnel with the skill sets necessary for the surgically intensive environment associated with the wartime mission. Navy Medicine has shifted its focus on the delivery of health care over the last decade from treatment and intervention to prevention, health promotion and population health initiatives. This focus makes good business and clinical sense from the managed care and population health perspective. This thesis examined Navy Medicine's inpatient and outpatient surgical workload and military staffing to determine the level of support it provides for the readiness mission. A trend analysis was performed using workload data from the Medical Expense and Performance Reporting System between fiscal year 1999 and 2002. This analysis shows that there has been an overall decrease in the amount of inpatient surgical workload for all surgical specialties. However, not all surgical specialties have observed an increase in outpatient workload over this same time period. Additionally, an examination and trending of end strength data for the Medical Corps and Nurse Corps using primary subspecialty codes was performed for fiscal years 1990 through 2002. The results indicated that while there have been few changes in overall end strength over the last decade, changes in specialties have occurred consistent with an emphasis on a medical model that focuses on outpatient primary care. The evidence suggests an emerging gap between the dual missions of Navy Medicine that warrants further investigation as to its potential impact on medical readiness.