United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1998-04-29 monographic deposited born digital 31 p. GA 1.13:HEHS-98-121 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-98-121 P0b002ee180399295 f:he98121 DGPO 2010-08-12 2011-03-28 GAOREPORTS-HEHS-98-121 machine generated eng fdlp REPORT GAOREPORTS-HEHS-98-121 HEHS-98-121 Physicians Military personnel Medical education Graduate education Base closures Health care programs Military downsizing Military cost control Site selection Combat readiness DOD TRICARE Program Letter Report HEHS Pursuant to a legislative requirement, GAO reviewed a Navy advisory council's recommendations for restructuring Navy graduate medical education (GME) focusing on: (1) why the Navy did not accept its council's recommendations for Bethesda GME closures and why its other closure attempts did not succeed; (2) whether the other services already have faced or may face similar experiences; and (3) what improvements may be needed if the services are to successfully make and implement their GME sizing decisions.<p/>GAO noted that: (1) in early 1997, the Navy Surgeon General decided to eliminate 162 GME positions to comply with lower projected wartime requirements and with Department of Defense (DOD) restrictions on the ratio of physicians in training to those deployable; (2) a Navy advisory council, lacking specific guidance but responding to the Navy Surgeon General's indications that GME should occur where active duty personnel are concentrated, recommended that such training be dropped at the Bethesda Medical Center; (3) the Navy Surgeon General, however, instead decided to close some of the Navy's Portsmouth Medical Center's programs following a then newly discussed agreement among DOD and the services' surgeons general to concentrate GME in four geographic locations that included Bethesda and San Diego but not Portsmouth; (4) lacking site selection guidance, the council submitted its recommendation to the Surgeon General without taking account of the agreement, which has never been formalized or acted on by the other services; (5) when announced, the Portsmouth closure decision surprised Navy command and medical center officials there, as well as local congressional representatives; (6) publicized arguments ensued that Portsmouth was as advantageous as Bethesda for concentrating GME and that losing Portsmouth's GME would reduce trainee-provided health care to active duty personnel and other beneficiaries and would harm Navy readiness; (7) although it was unsuccessful, the Surgeon General's office tried justifying the decision and later withdrew it for further study; (8) shortly thereafter and for the same ends, the Army Surgeon General's office sought to eliminate the 64 GME positions at the William Beaumont Medical Center in El Paso, Texas, also without site selection guidance and likewise failing to involve those who were affected; (9) while the Air Force also foresees the need for GME program closures, it has not yet attempted to make them; (10) but in the absence of closure policies and criteria and judging from the Navy's and Army's closure attempt experiences, GAO has no reason to believe that the Air Force would be any more successful in bringing about required GME program adjustments; and (11) while not a direct parallel to DOD GME with its readiness dimension, private-sector medical schools and hospitals have been downsizing their GME programs and in doing so have documented success factors that may provide a useful reference for DOD in developing guidance for its future sizing efforts. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-98-121/html/GAOREPORTS-HEHS-98-121.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-98-121/pdf/GAOREPORTS-HEHS-98-121.pdf GAO/HEHS-98-121 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-98-121 Letter Report GAO/HEHS-98-121; Defense Health Care: Collaboration and Criteria Needed For Sizing Graduate Medical Education; Physicians Military personnel Medical education Graduate education Base closures Health care programs Military downsizing Military cost control Site selection Combat readiness DOD TRICARE Program Public Law 105-85