Page 105 - JSOM Fall 2022

The Present State of Military Physician Leadership

A Lacking Paradigm?

James A. Pfaff, MD

It is not the critic who counts; not the man who points out required to become a board­certified physician is substantial,
how the strong man stumbles, or where the doer of deeds with continuing requirements to maintain professional creden­
could have done them better. The credit belongs to the tials on a yearly basis thereafter. There is also a requirement
man who is actually in the arena, whose face is marred by for these officers to meet the same professional military educa­
dust and sweat and blood; who strives valiantly; who errs, tion requirements required of officers in all branches.
who comes short again and again, because there is no ef-
fort without error and shortcoming; but who does actually Physicians are an integral part of the medical team and must
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strive to do the deeds; who knows great enthusiasms, the be strong academically and clinically. This need, however,
great devotions; who spends himself in a worthy cause; must be balanced by a set of knowledge, skills, and behaviors
who at the best knows in the end the triumph of high that will enable them to engage and lead in highly complex,
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achievement, and who at the worst, if he fails, at least rapidly changing environments. In the civilian community,
fails while daring greatly, so that his place shall never be ongoing clinical practice is needed to maintain credibility with
with those cold and timid souls who neither know victory other practicing physicians, though this is highly variable in
nor defeat. military medicine. 2
—Theodore Roosevelt
An old adage exists that “to be a good medical corps (MC)
The military health system (MHS) has two unique missions: officer, one must be a good physician.” Yet there is no require­
(1) It supports active­duty Servicemembers with health care ment for MC leaders to establish a reputation for clinical or
and preventive measures and (2) it provides skilled medical specialty excellence by any standard measure including the
personnel who deploy with our warfighters to provide life­ number of patients seen, outcome measures, patient satisfac­
sustaining care during conflict and other contingencies. Simul­ tion, peer­reviewed publications, or other measures expected
taneously, the MHS provides care to all military beneficiaries of MC subordinates. While many line officers in leadership
in a manner that meets, or exceeds, the civilian community positions articulate that excellence in their craft is a core of
standard. The delivery of health care is a complex endeavor, their leadership and an important part of their soldierly skills,
as displayed by myriad controversies surrounding initiatives to no comparative standard exists for MC leadership to establish
improve our domestic health care system (e.g., the Affordable a reputation for clinical excellence.
Care Act).
Soldier
In community hospitals and medical centers, the Army Med­
ical Department (AMEDD) leadership is composed of a vari­ Readiness is essential for one to function, assimilate, and pro­
ety of officers with diverse backgrounds such as physicians, vide medical support for the finest military in the world. It
nurses, dentists, health care administrators, and other medical demands competence as both a Soldier and a physician. In the
disciplines. This often differs from the civilian model in which late 1990s, a historical shift required operational surgeons
physicians lead academic institutions and/or act as chief med­ (MC officers assigned as battalion and brigade surgeons) to be
ical officers, while hospital administrators provide the bulk of trained and credentialed in a primary care specialty, requiring
community hospital administration. Although this article will them to be board eligible or board certified.
specifically address the AMEDD, the pertinent points are sim­
ilar in the other service branches. Army Medical Corps (MC) One of the requirements of military readiness is the seemingly
Officers should be competent in three roles: physician, Soldier, unending litany of administrative and training requirements,
and leader. despite little evidence of their efficacy. Given the sheer volume,
these requirements may negatively impact both development
of leaders and the efficiency of the health care system. Phy­
3,4
Physician
sicians do military required training to advance in rank, meet
As in any branch specialty in the Army, professional excel­ the requirements of a professional military officer, and avoid
lence for an MC officer is paramount. The amount of effort being a battlefield liability during times of conflict.
Correspondence to jampfaff@aol.com
Army Medical Corps Colonel (Ret) James A. Pfaff is an emergency medicine physician affiliated with Brook Army Medical Center, Joint Base San
Antonio­Fort Sam Houston, San Antonio, TX.

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