Examining Retention Sentiments and Attrition Among Active Duty Army Medical Officers

INTRODUCTION

Providing quality care and maintaining exceptional medical providers are important priorities for military medicine. The present study examines the association between retention sentiments and voluntary separation from army service among Army Medical Corps and Nurse Corps Officers. Retention sentiments are derived from the Department of the Army Career Engagement Survey, a voluntary survey that Active Duty Soldiers complete annually.

MATERIALS AND METHODS

The sample included active Army officers in the Medical Corps (n = 1198) and Nurse Corps (n = 1016) who completed the Department of the Army Career Engagement Survey between May 06, 2020 and November 02, 2023, passed the embedded attention check, and said their responses could be used for research purposes. The most frequently cited "Extremely Important" reasons to leave the army were identified within each sample. Binomial logistic regression was used to examine the likelihood of separating from army service based on the top five reasons to leave the Army as identified on the Department of the Army Career Engagement Survey. This study was determined by Exempt Human Subjects Research.

RESULTS

An examination of the factors most frequently endorsed as an "Extremely Important" reason to leave the Army revealed that "Effects of deployments on Family or personal relationships" and "Impact of military service on my Family's well-being" were among the five most cited "Extremely Important" reasons to leave the army within both the Medical Corps and the Nurse Corps samples. When examined together (i.e., summed), the Composite Leave Score was associated with a significantly greater odds of separating from army service in each sample. Specifically, each additional top five "Extremely Important" leave reason identified was associated with a 38% greater odds of separating from army service within the Medical Corps and 50% greater odds of separating from army service within the Nurse Corps.

CONCLUSIONS

The current study highlights unique retention concerns among army medical providers in the Medical Corps and Nurse Corps. Additionally, this study ties medical provider sentiments to subsequent voluntary separation from the army. These findings can help army senior leaders evaluate, draft, and revise policy aimed at increasing retention among army medical providers, and increasing access to quality healthcare for service members and their families.

Improving Military Medical Retention Through Growth Counseling: A Cross-sectional Retention Survey of U.S. Army Physician Assistants

INTRODUCTION

Although compensation is often the only factor considered with military medical retention, retention has been shown to have many other important factors. Maximizing the retention of military medical personnel not only decreases the cost of recruiting them but also maintains the institutional knowledge of military medicine needed to conduct military medical operations. This study used a recent retention survey of U.S. Army physician assistants (PAs) to understand military medical retention needs.

MATERIALS AND METHODS

The study analyzed a survey created, implemented, and collected by the Statistical Cell at the U.S. Army Center of Excellence. In September 2020, all 864 active duty PAs were sent a link to the survey and 290 completed the survey, with a participation rate of 34%. The study used cross-tabulation, Pearson's chi-square, and multivariate logistical regression to analyze the results. Institutional review board approval was obtained through the Army Medical Center of Excellence and University of the Incarnate Word.

RESULTS

Pearson's chi-square found that 18 questions in the survey were answered significantly different (P < .05) among those who intended to stay for 20 years in the Army. Binomial logistical regression found that each point higher on a 5-point Likert scale of the belief a PA could accomplish their career goals in Army medicine increased probability of likelihood to stay for 20 years by 74% (95% CI [0.57-0.98]). Each point higher on a 5-point Likert scale of perception Defense Health Agency control of Army medicine affected retention increased probability of likelihood to stay by 54% (95% CI [0.39-0.75]). Every decade older of age increased probability of increased likelihood to stay for 20 years by 63% (95% CI [0.40-0.98]).

CONCLUSIONS

The belief a service member can reach their career goals in the military is critical for retention. Using Army Techniques Publication 6-22.1 as a guide, leaders can help subordinates meet their career goals, and this may be the most important task a leader can accomplish to improve their unit's retention. Strengths of this study include the high response rate of 33.6% and results demonstrating the importance of growth counseling which is already part of Army doctrine. Weaknesses include the use of secondary cross-sectional data which impair the ability to derive conclusions from the data. Future studies should explore how training programs for military leaders in growth counseling can help subordinates find their career goals in the military and the effect on military retention.

Care Under Fire: United States Army Physician Survey

United States Army healthcare has faced increasing criticism in recent years from its own active duty physicians. Internal surveys of active duty physicians demonstrate a lack of successful intervention in an annual exodus countered only by ongoing recruiting efforts. Anecdotal experience suggests much more widespread discontent due to numerous factors than has been reported publicly. This cross-sectional survey study of 94 active duty physicians paints a vivid picture of an organization in crisis: a majority of physicians planning to separate at the end of their obligation, leadership out of touch with the needs of physicians, and systematic deterioration of clinical skills. Subgroup analysis offers insight into why reforms are unlikely to come from within the medical corps. Prospective recruits are also provided the most comprehensive view yet of life as an active-duty Army physician with a majority reporting unmet expectations, a willingness to accept a financial debt in exchange for early separation, and a low likelihood to recommend participating in the current Army medical recruitment programs. Reorientation of recruiting efforts to focus on attending physicians is discussed to address core deficiencies with multiple downstream effects.

An Assessment of Physician Well-Being and Burnout Among Army Obstetricians and Gynecologists

INTRODUCTION

Physician burnout is associated with unsafe patient care and poor patient satisfaction. Civilian studies show burnout rates of 46% among obstetricians/gynecologists (OB/GYNs). Army Active Duty (A-AD) physician burnout rates range from 7.7% to 26% across specialties, but no studies have assessed A-AD OB/GYN burnout. The objective of this study was to quantify well-being of A-AD OB/GYNs by determining rates of professional fulfillment (wellness) and burnout and detect factors of potential protective or risk for wellness and burnout.

METHODS

A cross-sectional survey-based study was designed to determine well-being of A-AD OB/GYNs. This Institutional Review Board-approved study used the validated Professional Fulfillment Index. The survey was shared anonymously via email to 197 A-AD OB/GYNs. Additional questions asked as possible risk factors for burnout include location, training status, fellowship training, and remaining active duty service obligation (ADSO). Wellness and burnout rates were determined using published scales. Mean rates of wellness and burnout were reported, and chi-square tests detected associations between wellness/burnout and other variables.

RESULTS

Eighty-three A-AD OB/GYNs responded to the survey (42%), with 73 available for full analysis. 26.5% had positive wellness, and 50% reported burnout. Completing fellowship training and shorter ADSO (of 0-2 years compared to >5 years) had higher rates of wellness. There were no differences in burnout among groups.

CONCLUSIONS

Burnout rates in A-AD OB/GYNs appear higher than A-AD physicians of other specialties but are similar to civilian OB/GYNs. Fellowship training may confer higher rates of wellness. Further research is needed regarding improvements in A-AD OB/GYN well-being and burnout.

An Analysis of 13 Years of Prehospital Combat Casualty Care: Implications for Maintaining a Ready Medical Force

Background: Most potentially preventable deaths occur in the prehospital setting before reaching a military treatment facility with surgical capabilities. Thus, optimizing the care we deliver in the prehospital combat setting represents a ripe target for reducing mortality. We sought to analyze prehospital data within the Department of Defense Trauma Registry (DODTR). Materials and methods: We requested all encounters with any prehospital activity (e.g., interventions, transportation, vital signs) documented within the DODTR from January 2007 to March 2020 along with all hospital-based data that was available. We excluded from our search casualties that had no prehospital activity documented. Results: There were 28,950 encounters that met inclusion criteria. Of these, 25,897 (89.5%) were adults and 3053 were children (10.5%). There was a steady decline in the number of casualties encountered with the most notable decline occurring in 2014. U.S. military casualties comprised the largest proportion (n = 10,182) of subjects followed by host nation civilians (n = 9637). The median age was 24 years (interquartile range/IQR 21-29). Most were battle injuries (78.6%) and part of Operation ENDURING FREEDOM (61.8%) and Operation IRAQI FREEDOM (24.4%). Most sustained injuries from explosives (52.1%) followed by firearms (28.1%), with serious injury to the extremities (24.9%) occurring most frequently. The median injury severity score was 9 (IQR 4-16) with most surviving to discharge (95.0%). A minority had a documented medic or combat lifesaver (27.9%) in their chain of care, nor did they pass through an aid station (3.0%). Air evacuation predominated (77.9%). Conclusions: Within our dataset, the deployed U.S. military medical system provided prehospital medical care to at least 28,950 combat casualties consisting mostly of U.S. military personnel and host nation civilian care. There was a rapid decline in combat casualty volumes since 2014, however, on a per-encounter basis there was no apparent drop in procedural volume.