In military hospitals, the number of general surgery procedures fell by 25.6% between 2015 and 2019. In KSA (Knowledge, Skills, and Abilities) terms, this translates to a 19.1% reduction in clinical readiness.
Dr. Michael Dalton, MD, MPH, lead author of the study and a former fellow at Brigham's Center for Surgery and Public Health, noted that military surgeons have traditionally operated in low volumes. However, the continuous decline trend in recent years is concerning.
While military hospitals witnessed a significant drop in surgical volume, civilian hospitals saw a 3.2% increase in purchased surgical services from service members covered by TRICARE, the military's healthcare program. The study’s authors contend that this rise is insufficient to explain the significant drop in military surgery volumes.
Surgical training in military hospitals has been criticized for at least 20 years. According to a 2018 U.S. News study into low surgery volumes in military hospitals, no facility fulfilled the recommended volume limits for 10 high-risk surgeries as of 2016. Many meetings and discussions have taken place, but clear solutions to these issues have yet to emerge.
As a result, military surgeons are becoming less experienced and trained in high-risk procedures that keep them clinically prepared and enable them to provide care in military medical treatment facilities (MTFs) and deployed settings.
MTFs are designed to ensure that military medical personnel gets the surgical experience to care for service members. Moreover, as service members and their dependents seek care at civilian hospitals, surgery numbers at MTFs have been dropping. The military surgical community created KSA criteria to assess this reduction and its possible impact on surgical readiness.
“Retaining a skilled medical workforce may be put at risk if medical caseloads for surgeons keep on decreasing," said Dr. Lesly Dossett of Michigan Medicine.
By the end of 2021, the Defense Health Agency will have taken over all MTFs to centralize and maybe shrink the MTF system.
"Medical professionals may need to rethink the best way to build expeditionary surgical teams, including recruiting reservists who maintain busy clinical practices while not deployed or finding other ways to procure them,” suggested Dossett and Dimick.