Doctors in Khaki

March 23, 1994|By DANIEL S. GREENBERG

WASHINGTON — Washington. -- Military bases die hard, if ever. The same goes for medical schools -- high-paying employers, with devoted alumni and great staying power. Mate the two institutions, and the offspring is a model of durability, the Pentagon's own full-fledged medical school, the Uniformed Services University of the Health Sciences, in Bethesda.

Targeted for termination by Clinton-Gore economizers as a relic of richer times, USUHS is hauling out every conceivable argument for staying in business. It is, as supporters fervently argue, a good medical school. And its graduates do tend to remain in uniform beyond their obligated service of seven years. And, yes, it emphasizes studies of special military concern, such as tropical medicine, battlefield casualty management, high-altitude research and so forth.

But with 125 civilian medical schools annually adding 17,000 doctors to the already well-populated ranks of American medicine, USUHS's 150 or so grads per year don't make much of a difference. In fact, its graduates amount to only some 10 percent of military physicians. Most military doctors come through the federal Health Professions Scholarship Program, which requires a payback of four years of service.

There's a lot of argument about the exact relative costs of military versus civilian medical education, but there's no doubt that the tab per head at USUHS is by far the highest in medical education. In Vice President Gore's doomsday manual, the National Performance Review, the cost per graduate at the Bethesda institution is placed at $562,000, while scholarships at civilian schools are said to be $111,000.

The Gore report says closure would save $300 million over five years. USUHS backers dispute the number, contending that it fails to reflect the research grants and other support that federal agencies provide for civilian medical schools. They also contend that the longer service of USUHS graduates spares the turnover costs of short-termers from civilian schools.

The unspoken secret of USUHS, however, is that the military services don't want or need the school -- and never did. It was forced on the Pentagon 22 years ago by the late Rep. F. Edward Hebert, of Louisiana, who became obsessed with the idea of establishing a special medical school for the military.

For years, the Pentagon shrugged him off. But in 1971 Hebert ascended to the chairmanship of the House Armed Services Committee. The Defense Department then sweetly agreed to the fulfillment of the congressman's dream, but dawdled in the start-up tasks for several years in hopes that, somehow, it might be spared its unwanted role in medical education.

Salvation seemed at hand for the Pentagon in 1975, when an uprising on the Armed Services Committee removed Hebert from the chairmanship, shortly after which he died. Two years later, the Carter administration said the school was unnecessary and sought to terminate its prolonged gestation. Interpreting this as a slap at a departed colleague, the House decreed that the school must come into being -- and, in honor of its creator, christened it the F. Edward Hebert School of Medicine, though the name is rarely used.

Supporters of the school contend that its existence is justified by the special requirements of military medicine. But the real training for medical practice takes place after medical school, in hospital-based residency programs, where fledgling doctors work with patients under the supervision of experienced doctors. Residency programs don't distinguish between graduates of USUHS and its civilian counterparts.

The often-made claim of the school's strength in tropical medicine may have some merit, but not much. Research and competence in tropical medicine are not confined to USUHS. With civilian schools famished for money, the Pentagon could easily expand the field with a grant or two.

USUHS's greatest claim for survival is that it is producing a career cadre of physicians who are especially valuable because they are attuned to military needs. There's no sure means of weighing the validity of that argument. What's clear, however, is that the cost of USUHS graduates is extremely high. Meanwhile, graduates of civilian schools are in plentiful supply, and more of them are likely to be drawn to military careers as the medical economy comes under tighter control.

In these circumstances, it's difficult to justify a military medical school -- especially when the Pentagon is as eager as ever to unload this never-wanted responsibility.

Daniel S. Greenberg is a syndicated columnist specializing in the politics of science and health.

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