The Coast Guard is struggling to recruit and retain doctors, flight surgeons, pharmacists, dentists and medical assistants after their five years with the service, the government’s accountability found in a new report.
The difficulties are largely due to a lack of promotion opportunities and financial incentives, the agency said. This means that the Coast Guard clinics studied by the GAO were often understaffed, lacked adequate personnel from the U.S. Public Health Service, and an insufficient number of technicians from the Coast Guard Health Services, which handles a variety of clinical tasks.
Approximately 37,000 Coast Guard men and women and more than 51,000 family members receive medical care from a variety of resources — service members through Coast Guard clinics run by clinicians from Public Health Service and Coast Guard health technicians, and members and beneficiaries through Department of Defense medical facilities and the civilian Tricare network.
For Coasties, Coast Guard clinics are the primary resource for medical care, given that they are located in “medically underserved areas” that lack sufficient numbers of health care providers.
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Staffing issues, a nationwide doctor shortage and the remoteness of many facilities are significantly affecting access to health care for Coast Guard members and their families, the GAO reported.
In September, the Coast Guard had a public health service vacancy rate of 18%, according to the service. The United States Public Health Service is one of eight uniformed services in the country, part of the Department of Health and Human Services that provides medical personnel and public health experts to the Centers for Disease Control and Prevention, Indian Health Services, Food and Drug Administration, Coast Guard and Bureau of Prisons.
Pre-deployment medical requests, along with the Coast Guard’s transition to a new electronic health records system, MHS Genesis, have increased the workload for health services technicians and also reduced the number of appointments. available at the reviewed clinics.
Service members who are not near a Coast Guard clinic and their beneficiaries may also seek medical treatment at Defense Health Agency facilities, although dependents have appointment priority. lower.
Given the remoteness of many duty stations, a significant number of Coast Guard recipients do not reside near a military health facility.
They can enroll in Tricare Prime Remote, a program that allows them to travel to a military treatment center or primary care provider despite excessive driving times. They can also enroll in Tricare Select, which means they rely on Tricare networks operated by civilian benefits management companies Tricare – Health Net Federal Services in the West region and Humana Military in the East.
This is where some Coast Guard families have had the greatest difficulty obtaining care, according to the report.
Coast Guard family members with access to military health facilities were generally able to obtain specialist care within the accepted standard of 28 days. But they faced challenges in the network, including for obstetrics and gynecology, mental health and dermatology.
According to the GAO, one Coast Guard clinic said its patients do not have access to a psychiatrist or psychologist who takes Tricare patients, while another said its patients have to wait up to five months. for a mental health appointment.
For its report, generated at the request of Congress in 2020, the GAO reviewed records and interviewed officials from six Coast Guard clinics: Kaehler Memorial Clinic in Buzzards Bay, Massachusetts; Air Station Detroit Clinic in Selfridge, Michigan; Sector Key West Clinic in Key West, Florida; Base Kodiak Rockmore-King Clinic in Kodiak, Alaska; Sector Humboldt Bay Clinic in McKinleyville, California; and Base Portsmouth Clinic in Portsmouth, Virginia.
The service is taking steps to improve access to care, including hiring contractors, relying more on telehealth, and moving assignments or filling vacancies with Reserve members.
The Coast Guard also launched a direct commission program to create its own corps of health services officers and had recruited six doctors and four dentists by November. And starting this year, it is training health services technicians to provide behavioral health care to Coast Guard personnel.
Still, the service needs to do more, GAO analysts said. They made seven recommendations, including that the Coast Guard investigate the reasons for the departure of public health service providers; improve data collection and sharing with the Defense Health Agency on Coast Guard recipients’ access to health care; regularly monitor access to care, not just when a problem arises; and better track access to military processing facilities and network providers.
In its response to the report, the Department of Homeland Security, which oversees the Coast Guard, broadly concurred with the GAO’s recommendations, saying the service had already taken steps to monitor recipients’ access to Tricare physicians and citing the new health service commissioning program.
Jim Crumpacker, director of DHS’s GAO-Office of Inspector General Liaison Office, said the service plans to implement many of the recommendations by March 2024.
“DHS remains committed to ensuring access to medical and dental care for active-duty Coast Guard personnel and their dependents, and others, in support of Coast Guard missions, as appropriate. “, Crumpacker wrote in the response.
— Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime
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