Military Family Medicine Readiness for National Pandemic Hospital Support

We read with great interest the article “Family Medicine and Emergency Redeployment: Unrealized Potential”¹ by Drs Byun and Westfall from the Graham Center in the January issue of Family Medicine. In this article, the authors highlight the versatility of family medicine training to cover the diverse needs of medical resource deficient populations, while demonstrating that physicians working in multiple care settings maintain a broader scope of practice and as a result are better prepared to support personal shortages secondary to the COVID-19 pandemic.

We explored this concept early in the COVID-19 pandemic for family medicine in the military services. Military family physicians are expected to maintain a broad scope of practice with readiness to provide medical support in global armed conflicts, humanitarian missions, and national emergencies, yet the majority of military family physicians primarily work in outpatient clinics. While the scope of practice varies within military family medicine, inpatient and obstetric care is primarily limited to those in academic medicine and smaller hospitals that are overseas or geographically remote. Although military family physicians regularly change positions, only a minority ever serve in these positions during their career. In early 2020, almost all military family physicians had experience in the post-9/11 wars but no previous experience with national pandemic hospital support. We asked members of the Uniformed Services chapter of the American Academy of Family Physicians (USAFP) to assess their own immediate readiness to provide effective medical care in the inpatient or intensive care settings. A total of 253 participants (11% response rate) were included in the analysis. USAFP members are primarily active-duty family physicians with a small number of retired or civilian physicians who work with the military health system. Survey respondents differ from USAFP membership with a higher proportion working in academic medicine and who are female but are similar in distribution of postresidency experience. This study was approved by the Uniformed Services University Institutional Review Board.

Fifty-one percent of the 253 survey respondents reported being clinically ready to perform inpatient care, either requiring no preparation or only minimal literature review. The other half of respondents felt they required refresher training with an experienced provider for up to 2 weeks or more before being able to work independently. For intensive care unit (ICU) care readiness, 14% of respondents felt they were ready, while 86% felt they required more expansive training. A multivariate logistic regression demonstrates that two factors are associated with increased readiness for both environments: having inpatient experience of at least 14 days in the last year (OR for ward readiness=8.6, 95% CI 3.8-19.3, and OR for ICU readiness=7.9, 95% CI 2.2-28.1) and being residency faculty (OR for ward readiness=3.8, 95% CI 1.5-9.4, and OR for ICU readiness=6.3, 95% CI 1.3-31.2).

These results support Drs Byun and Westfall’s findings of the capacity of family physicians to fill diverse roles and provide complex care across many medical settings and demonstrate the importance of maintaining this broad skill base. The breadth of family medicine training develops uniquely qualified physicians whose skills are largely underutilized in both the civilian and military communities. Our survey results also demonstrate the important reserve of broad scope physicians represented by residency faculty. The military services have since mobilized hundreds of family physicians to support pandemic relief, both from residency programs and outpatient clinics. Partially in response to this experience, the services are starting to require family physicians to maintain minimum levels of experience in inpatient, urgent, and obstetric care to maintain a broad scope of practice. With the current Accreditation Council for Graduate Medical Education family medicine residency guidelines under active review, we also advocate and believe our results add to the Graham Center argument for maintaining comprehensive, coordinated, and complex training within our graduate medical education programs. Family physicians are uniquely qualified to meet the health care needs of our communities.