POM20 Navy Medicine Billet Reduction

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Some of you may have heard that Navy Medicine just had a significant billet cut. This has been referred to as the “POM20” (Program Objective Memorandum 2020) or “divestiture” billet cut. To be honest, the details are all still being worked out, so there isn’t a whole lot of solid information available about this, which is why I haven’t addressed it yet. Here is the high-level overview of what I know right now cut/pasted from the BUMED guidance/messaging sent out to Specialty Leaders:

  • Recent decisions by the Department of Defense have resulted in a reduction of military medical department billets across all Services beginning FY 2021, but could occur as early as FY2020. All of the Services’ medical departments will manage their own reductions.
  • We expect many of the billet cuts to the Navy medical department will be re-invested in other Navy priorities and communities that increase lethality.
  • The Navy Medicine reductions to medical end strength will impact both the Active and Reserve Components. These cuts are NOT related to MedMACRE.
  • Currently (as of 7 November), we anticipate potential billet reductions will affect the entire enterprise.  The exact number of billets and locations have somewhat been identified but decisions for all of the cuts are still pending.  We are sharing the known cuts and are prepared to share specifics as soon as the additional decisions are made.
  • The reductions impact our operational medical capabilities (e.g. Expeditionary Medical Facilities), as well as the scope of services available at facilities across the military health system.
  • While the specifics of the additional divestiture by Navy Enlisted Classification (NEC) / Officer Specialty and rank / grade mix, have yet to be finalized, we understand some billet changes have already been programmed, which are impacting future assignments.
  • At this point, we expect reductions will impact graduate medical education (GME) and other training opportunities and adjustments will be necessary.
  • We will not be receiving replacement funding to address these billet reductions.
  • While we wait for decisions to be finalized, we’ve started formulating risk mitigation strategies and next steps to include:
    • Request partial restoral of POM20 issue cuts; especially Student / Training accounts.
    • Re-locate/reallocate platforms across the enterprise to ensure the most efficient and effective readiness placement/posture.
    • Working with the Regions to re-balance existing Operations & Maintenance (O&M) funding to ensure essential services are provided.
    • Work with the regions to conduct service reduction analysis.

9 thoughts on “POM20 Navy Medicine Billet Reduction

    3 years to go said:
    November 19, 2018 at 19:24

    I find it somewhat disturbing that these cuts in billets are being made by someone other than BUMED and apparently without BUMED input. Seriously, would it be appropriate for the SG to divestiture a bunch of submarines because the medical community thought they weren’t needed? The MSCs barely even know what it takes to successfully run a hospital… The fact that the line think they know what they are doing is even more alarming. 3 years to go…stuff like this will spook the herd. Draft incoming.

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      Joel Schofer, MD, MBA, CPE responded:
      November 19, 2018 at 19:45

      BUMED is going to be able to shape the cuts. It will just take time. In the end, we work for the line, and in this case they decided to assume more medical risk to become a more lethal force.

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    Frustrated is an understatement said:
    November 19, 2018 at 21:12

    As a current physician, and someone who is considering getting out this makes the choice so easy. If you want trainees to be prepared to operate as gmo/flight/dive and want your “lethal killers” to have access to medical care GME has to be a priority. I am very tired of hearing “we work for the line”, false we support them and if they want sub-par medical care then here it comes.

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    Michael said:
    November 20, 2018 at 09:47

    We are already struggling to fill critical positions at NH Jax due to detailers unwilling to send bodies for future billet cuts.

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    Corey said:
    November 20, 2018 at 12:20

    What will be interesting is seeing how/logic applied as to how BUMED shapes the cuts.-ie, shrink some, increase others in alignment with a push for increased lethality.
    I would think they would look at the more critical wartime specialties (EM, Gen Surgery, Anesthesia, Ortho, Psych, and FP) place a premium on their status. At a minimum they’ll likely need to determine what is a critical specialty. A lot of our colleagues will be affected, not to mention how the recruiting will change. Strange times indeed.

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    Page said:
    November 20, 2018 at 13:34

    It’s funny that I submitted a RAD and was denied because we needed more bodies to increase are numbers, but, then they cut are billets. Makes no sense at all.

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      3 years to go said:
      December 12, 2018 at 19:59

      Page

      What specialty are you in?

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    Did we really think this through? said:
    November 20, 2018 at 13:48

    I’m interested to know how the DoD expects these changes to play out in the long term. I see the cost-cutting ideal, at least in the short term, and removing billets/personnel to pay for seems to be an easy option, relatively speaking.

    However, unless we’re changing the limits of what Tricare covers, or what overall services we will reimburse, we’re still going to be paying for the services the cut billets would have provided. If it’s in-house, that either means we’re going to be increasing the workload of the remaining personnel, which I would imagine would impact quality of care; or it will necessitate hiring more civilian providers (already a difficult prospect at many MTF’s). I would hazard a military paycheck is less than a contract/GS paycheck, with fewer restrictions on work hours necessitated by those civilian employees.

    If we refer out in town, we already know how many civilian institutions bill for as much as they can from tricare and then turf patients back to an MTF for the less lucrative long-term recovery, I would see that only being exacerbated if we ourselves are referring more patients to the civilian sector initially. All of which will increase DoD cost obligations.

    Not to mention that, while I fully support an operationally ready medical force, a lot of the scuttlebutt revolves around certain specialties being hit harder by these cuts than others (for example, GI and oncology). It would seem to a non-medical administrator or outside viewer that these are not direct contributors to your young, active duty healthcare concerns for warfighters. But I would argue they’re critical for retaining in-house medical readiness of our providers at the least, and fulfilling our retiree obligations. Intensivists and EM get their massive hemorrhage training/protocols refreshed by having GI support in our MTF’s, our Internists achieve high call volume/stress conditioning by managing onc floors, as examples.

    Removing/reducing specialties that are not obviously useful directly in a combat environment (no one’s arguing for an oncologist to be at a Role II packing wounds as an oncology billet), would reduce the capability of those who will be in those situations. If we’re still training people in the DoD.

    Of course, that could be the first step in breaking the system, to make the argument that it truly doesn’t work, and therefore it’s in the best interest to remove DoD GME entirely and train only civilian. Which if we defer residents out, strains an already strained resident funding system, if we do FTOS, per resident cost will be the same as it is now, but without the corollary benefit of having resident exposure to the active duty military population they’re expected to work with. Which would reduce their effectiveness in the operational environment we’re supposedly sacrificing our system to benefit.

    All of that long essay being said, it’s great to experiment, but a manpower experiment this large is a dangerous thing. If we discover, after removing difficult to replace manpower, that it was cheaper for them to be around, we will have a very difficult time recovering that resource. People will be wary of joining an organization that, at a whim, removes a sizeable fraction of its workforce, when the ask is a multi-year long contract in return for less pay than they’d receive on the outside. Our options if a manpower reduction fails in cost-cutting goals are trying to rebuild a now broken system, or finish breaking it.

    My concerns are best summed as follows:
    -Initial cost decrease (someone gets a gold sticker for the next couple FY’s)
    -Later cost increase to pay for: 1. civilian providers 2. civilian services to maintain care obligations
    -Decreased value of military residencies
    -Leading to deferment or FTOS, reducing military physician exposure to the military environment
    -Reduction in operational medical personnel readiness
    -Poorer outcomes for warfighters
    -If this fails in 5-10 years: long road to rebuild vs. complete system dismantlement
    -Either option leads to long period of poorer outcomes for warfighters

    I get it, going after 8.37% (48.8 billion) of the DoD budget seems a prime reduction target, however, for 9.4 million beneficiaries, that is literally half the cost of per person healthcare expenditure as it is for the civilian sector. (9.4mil/48.8 bil = 5,191/person vs. 10,345/person in 2016).

    I find myself falling back to an excellent article written by Dr. Kellerman which I think would be well placed on the desk of those making difficult budget decisions: https://www.healthaffairs.org/do/10.1377/hblog20170427.059833/full/

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    Is this the right choice? said:
    November 20, 2018 at 16:34

    Thank you Dr. Schofer for giving an excellent update. Some concerns I have about POM20 can be best summed by the timeline of events that seems most probable:
    -Initial cost decrease
    -Later cost increase to pay for: 1. civilian providers 2. civilian services to maintain care obligations no longer met by active duty personnel
    -Decreased value of military residencies due to lack of in-house specialist services affected by POM20.
    -Leading to deferment or FTOS for training, reducing military physician exposure to the military environment
    -Reduction in operational medical personnel readiness due to lack of exposure to the military population during civilian training
    -Poorer outcomes for warfighters/poorer integration to deployed line units because of this lack of exposure
    -If this fails in 5-10 years to produce long-term cost reduction: long road to rebuild vs. complete system dismantlement seem to be the solutions
    -Either option leads to a long period of poorer outcomes for warfighters

    Addressing cost reductions in 8.37% (48.8 billion) of the DoD budget is a good goal, however, we serve 9.4 million beneficiaries, at half the cost the civilian sector does the job for, without even taking into account humanitarian endeavors and the costs of medicine in adverse environments (9.4mil/48.8 bil = 5,191/person vs. 10,345/person civilian healthcare cost average in 2016). We should be striving to always be more efficient, but I wonder how much of an efficiency increase a manpower cut will truly have on its own.

    I find myself falling back to an excellent article written by Dr. Kellerman which highlights many ways we could improve efficiency, reduce costs, and improve our medical personnel readiness, and ability to accomplish both our mission of providing care to the active duty population, their families, and those who retired as well as the overarching mission of supporting the line.

    https://www.healthaffairs.org/do/10.1377/hblog20170427.059833/full/

    I’m curious if any of those efficiency or utilization measures have been considered and whether they may provide more sustainable savings and cost reductions.

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