In this issue

A vision for the future

The decision of the U.S. Army surgeon general and her military service and contributions.

By Patrick H. DeLeon, PhD
The U.S. Army surgeon general

With her tenure coming to a close, U.S. Army Surgeon Gen. Patricia Horoho testified this spring before the Senate Appropriations Committee. In the history of our nation, she is the first female and first nonphysician surgeon general of any of the military services and brings with her a refreshing vision regarding the critical importance of focusing upon the whole soldier and his/her family. She appreciates the importance of transforming “Army Medicine from a health care system to a System for Health” and the clinical significance of the reality that “The patient health care encounter to be an average interaction of 20 minutes, approximately five times a year. Therefore, the average amount of time spent with each patient is 100 minutes; this represents a very small fraction of one's life. It is in between the appointments — in the Lifespace — where health really happens and where we desire a different relationship with Soldiers, Families and Retirees.”

After the fall election, Congress has continued, if not intensified, its interest in significantly curtailing federal budget expenditures. During this year's Senate testimony, Horoho expressed her “grave concerns essential programs for rebuilding our soldiers after over a decade of conflict will take the brunt of these cuts. The impacts will be visible in decreased resources to sustain initiatives in behavioral health (BH) and traumatic brain injury (TBI); a decrease in access to care; and extended appointment times for our soldiers, families and retirees at our health readiness platforms. MEDCOM would reduce research and training programs throughout the Command to ‘must-fund' levels. This will significantly reduce progress that has been made in medical programs over the last few years both in the areas of research and training of the force.”

As we indicated in our previous discussion of the recommendations contained in the 2015 report to Congress by the Military Compensation and Retirement Modernization Commission, a blue-ribbon panel established by Congress in 2013, there has been increasing pressure on the administration to privatize those governmental functions where cost-effective savings might be achieved. From our public policy and historical perspective, military health care and related human service resources represent prime targets. Why, for example, could not the private sector provide higher quality health care in the contiguous United States for military personnel, their families and retirees rather than continue to invest in Department of Defense or Veterans Affairs systems? These are serious institutional challenges, and we understand that many at the highest level of federal health care leadership have been pushing back against this argument. It does represent, however, a longstanding debate on the fundamental role of government — way beyond health care, health professions training and behavioral research.

Army medicine is so much more than a civilian health care system; we are national leaders in medicine, dentistry, medical research, education, training and public health … Over the last few years, we have made great strides in improving the health readiness of the force, leading Army's cultural change towards a more ready and resilient soldier. This success was achieved by promoting the performance triad, comprised of healthy sleep, activity, nutrition and increasing the impact of our readiness touch points to include embedded providers. Our medical force has remained ready and deployable, leveraging lessons learned in theater to improve care in garrison, and using evidence-based practice and cutting edge research to improve care delivered far forward. However, Army medicine is keenly aware of the unique stressors facing soldiers and families today, and continues to address these issues on several fronts. Taking care of our own — mentally, emotionally, and physically — is the foundation of the Army's culture and ethos, and is unquestionably an enduring mission. The Army is removing the stigma associated with seeking behavioral health (BH) care with programs such as embedded BH (EBH) that provides targeted care in close proximity to soldiers' unit areas and in close coordination with unit leaders.

A sister service

This spring I had the opportunity to attend the U.S. Public Health Service (USPHS) 72nd year Cadet Nurse Corps Recognition Ceremony, themed “Honoring their Legacy to Nursing.” Former acting USPHS Surgeon Gen. Boris Lushniak presented an inspiring tribute, quoting their pledge — “I will keep my body strong, my mind alert, and my heart steadfast; I will be kind, tolerant, and understanding … As a Cadet Nurse, I pledge to my country my service in essential nursing for the duration of the war.” The same message, decades later, Horoho has been delivering. I also had the pleasure of attending the first Uniformed Services University of the Health Sciences (USUHS) Department of Psychology Dining Out dinner, honoring the students who will soon be on their way to their internships, championed by acting Chair Jeff Quinlin. Another wonderful tribute.

Yet, it is important to appreciate that journeys continue. During our USUHS interdisciplinary health policy class, Ingrid Pauli, who played an active role during the USPHS response to the most unfortunate Navy Yard shooting, reminded those present that although they may really excel at clinical work, as military advanced practice nurses and psychologists they must expect to be called upon to demonstrate administrative leadership. Throughout one's career, one should reflect upon what the future might bring. A recent publication provides an intriguing perspective. “How We Built Our Dream Practice — Innovative Ideas for Building Yours,” by David Verhaagen and Frank Gaskill shares a very interesting and thoughtful vision. One critical message — enjoy your strengths and inner priorities. Decide to work with colleagues who share these same fundamental values. In the long run, you will best be served.