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During the COVID-19 pandemic, staffing the nation’s healthcare facilities has been a challenge pretty much across the board. But the military’s hospitals and clinics faced special circumstances. Military clinicians whose day jobs were at military treatment facilities could be pulled away for other COVID-19 missions with little or no notice. The Defense Department office of inspector general looked into this. 26 out of 30 facilities said staffing problems were their biggest challenge. Andre Brown is Program Director for Military Healthcare and Operations at the DoD IG’s office. He talked about their findings with Federal News Network’s Jared Serbu.

Interview transcript:

Andre Brown: In some cases, these challenges had preexisted to the pandemic. However, the pandemic exacerbated those problems. The officials that we spoke to reported that they did not receive additional staffing during the pandemic. And while you know, they also had to conduct the COVID-19 response requirements such as testing vaccinations and contact tracing. They also had to do those missions with existing medical personnel which took away from other daily functions. And then also, you know, they stated that recruiting and hiring during the pandemic was extremely difficult. They, you know, attributed that difficulty, mostly to non-competitive salaries, especially for nurses and specialty care. And that was due to a long drawn out hiring process.

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Jared Serbu: What did MTF officials tell you about how, if at all, that these shortages actually impacted the delivery of care?

Andre Brown: So, when we spoke to the MTF officials, they often talked about the staffing and manpower shortages, combined with long work hours, right, which was, you know, commensurate with the private sector, obviously resulted in severe burnout and fatigue. They also talked about that, you know, patient safety incidents had increased, and that the lack of staff or overworked staff could potentially compromise the quality of care to patients on the burnout and fatigue. And, you know, in some cases caused some staff to quit, which further exacerbated the shortages. And then the requirement to perform that additional MTF COVID mission with testing, your vaccinations, contract tracing resulted in reduced health care services, and in some instances, delayed health care, preventive care to your regular patients.

And then there was a couple other areas, such as reduced staff training, the ability for the workers to maintain the proficiency of the skills which you know, affects the overall care of your patient. And then also patient referral to the civilian network, the MTFs were inundated with appointments. And so if patients wanted to be seen, they had the option to be able to go to the civilian network. But because everyone was trying to get appointments, they were often not be able to be seen in their local area. So they may have to drive one to three hours away from their local area.

Jared Serbu: I want to focus a little bit on the military provider side of this, I think, as most of our listeners know, in an MTF setting, it’s kind of a blend of military providers, civilian providers, contract providers. A lot of the military folks got pulled out to go do other COVID missions. And I think the restructuring of the MTF system has kind of created this unique situation where the MTF administrators don’t actually control their entire workforce, their military folks can get pulled out kind of at any time, which seems like that makes it extra important for the military departments to coordinate with the MTF to make sure that they actually have the people that they need, or at least conduct some kind of balancing to decide where these folks are needed most. How much of that coordination happened in this case? And does DoD need to do better on that front?

Andre Brown: Yes, this is an area where we were we identified that, you know, there needs to be some improvement and where we made recommendations to the department to improve. We didn’t necessarily designate a degree of you know, whether it was good or bad. But we, you know, talking to the MTF, officials, obviously they indicated where there was a severe lack of coordination between the services and the DHA about personnel who were diverted from the MTF. Obviously, you know, they stayed in some cases they weren’t fully kept in the loop about the mission. You know, they weren’t told until the last minute that these personnel would be going somewhere else which left, you know, the MTF in a very bad position. So we were making recommendations to improve that coordination between service personnel, DHA and MTFs to allow the MTFs to plan for shortage of personnel due to deployments in the future. And then also the coordination for receiving backfills to replace deployed personnel. That was an area of improvement as well, because in some cases, the MTF they applied for backfills. And in some cases they were denied. In other cases, they applied for a certain number. For example, in one case, they sent a request for eight personnel they only received, you know, one of the eight, so they didn’t receive the number they requested. So obviously puts the MTF in a bad position.

Jared Serbu: And I think part of the ingredient here is the military services had already, for a few years now, I think, planned on reducing the overall number of military medical billets. And I think the plan there was to replace those with civilian providers. But from what you’ve said earlier, it sounds like they’ve been challenged on that front just hiring those folks to to fill the slots. Is that part of this?

Andre Brown: Correct. So in 2021, the DoD issued a plan for the delivery deduction in response to Section 719 of the NDAA 2020, which included the plans to hire for civilian and contract personnel for those exact positions. However, it’s currently on pause, because Congress wants to relook at that. So Section 732 NDAA 2020 requires a further assessment of that plan. You know, obviously, during this particular report evaluation, we had MTF officials who expressed their concern about military billet reductions, a lot of the times those billets that, you know, the military member had vacated ability, you know, someone was not, or the billet was left unfilled, or else, you know, no one had come in behind them to replace them or they weren’t able to replace it with a civilian personnel. So, you know, it still left the the MTF short, but we are monitoring progress of the billet reduction plan, but we did not have an update at this point.

Jared Serbu: Got it. Just down to our last couple of minutes here, and maybe you can spend that time talking about some of the recommendations that you made to the department. You’ve touched on a couple of them already. But fill us in a little bit more on what the IG recommended and how the department has responded.

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Andre Brown: We made a couple of recommendations to the Defense Health Agency and then to the Assistant Secretary of Defense for Health Affairs. So the defense health agency, we made recommendations to address the staffing challenges streamlining the hiring process, to fill the civilian staffing positions, to look at salaries for nurses, obviously in the private sector, they’re hiring at a higher rate. And so being able to look and see if we can hire at those salaries so we can bring in higher quality nurses. Assessing the ability of the MTFs to receive augmentation from for staff from the reserve components during pandemics. We also wanted them to look at manpower requirements for COVID-19 and identify medical personnel requirements during the MTFs for future pandemics. And with the ASD for Health Affairs, the big things for personnel obviously was staff burnout and such. We wanted them to look at or develop actually, a DoD policy for maximum hours worked, maximum shifts, the coverage of duties for staff working in MTFs to reduce the impact on the staff. And then lastly, the ASD Health Affairs were in charge of the Military Health System COVID-19 AER. Nothing has been done on that at this point. So we made a recommendation to either direct or create a new or existing working group to look at this and monitor the milestones. The AER was conducted from April 2020 to January 2021, which resulted in 23 Key lessons learn and 79 recommendations. We determined that 13 of the 23 lessons learned could address MTF challenges in this report.

Jared Serbu: And sorry, one last quick follow up. Did your work this time around get into at all whether DoD has the hiring and salary authorities it needs to actually bring those clinicians in at higher pay rates or is that another project for another day?

Andre Brown: Yeah, that’s another project. We identified the issue but that was, we did not go into the details of that in this report.

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