Guard Doc: Ensuring Every Medical Capability for the Warfighter and Their Family
Interview with
Major General Deborah C. Wheeling
Deputy Surgeon General for the Army National Guard
Major General Deborah C. Wheeling assumed duties as deputy surgeon general for the Army National Guard, Office of the Surgeon General on November 1, 2005. As deputy surgeon general, She provides consultative services and strategic planning in all aspects of medical readiness, health care, medical personnel, medical operational and training issues that comprise the critical medical readiness indicator’s pertaining to the Army National Guard and its more than 340,000 citizen soldiers.
Wheeling began her military service in September 1975 with a direct appointment to the Army Nurse Corps. Her experiences have encompassed a myriad of assignments within both Active and Reserve Components, serving as the assistant surgeon general for mobilization, readiness and Army National Guard affairs prior to assuming the deputy surgeon general position in 2005.
Her awards and decorations include the Meritorious Service Medal (with 2 Oak Leaf Clusters); Army Commendation Medal (with 1 Oak Leaf Cluster); Good Conduct Medal; Army Reserve Components Achievement Medal (with Silver Oak Leaf Cluster and Bronze Oak Leaf Cluster); National Defense Service Medal (with 2 Bronze Service Stars); Global War on Terrorism Service Medal; Humanitarian Service Medal; Armed Forces Reserve Medal (with Silver Hourglass); Army Superior Unit Award; The Order of Military Medical Merit; and The Surgeon General’s 9A Proficiency Designator.
Major General Wheeling was interviewed by MMT Editor Jeff McKaughan.
Q: What are the synergies that National Guard medicine bring to the active force and down at the warfighter level?
A: The National Guard brings a force of highly qualified professional soldiers and officers to support our warfighters. In fact, the Army National Guard and Army Reserve make up approximately 74 percent of the total health care professional strength of the Army Medical Department. Additionally, over 50 percent of the total Reserve components mobilized to date for all services comes from the Army National Guard.
Our medical personnel attend the same levels of military training as required by the active component. In addition to that training, many of our personnel are employed in the civilian medical arena in a variety of capacities which ultimately serves to increase their value to our deployed units. Our deploying formations typically have much longer histories as a unit. This creates an environment where soldiers are keenly aware of the strengths and weakness of the soldiers surrounding them and are able to leverage that knowledge to enhance overall unit effectiveness.
Q: How is the National Guard doing in terms of recruiting and retaining skilled physicians and clinicians especially in some of the more specialized domains? Have bonuses and the use of other perks been a successful tool?
A: The Army 90-Day Boots on the Ground policy was specifically designed for Reserve component physicians, dentists and nurse anesthetists allowing them to deploy in 90-day increments while still maintaining their civilian practices, medical support to their local communities and availability for homeland security and homeland defense missions. Even after multiple deployments our retention rates on our health care professionals remains high, these are truly some of our nation’s heroes. Many of these providers have already completed their service obligations, could retire, but yet they stay out of their dedication to their country and their fellow soldiers.
We have had some challenges recruiting Army Medical Department [AMEDD] personnel, but the ARNG leadership recognizes the problem and recently authorized the implementation of the AMEDD Student Recruiting Program. This program targets specifically medical, dental and physician assistant students who earn full-time salaries and health care benefits for themselves and eligible family members while performing recruiting duties for the ARNG while in school.
We have seen an amazing response to this new resourced program which just started in July 2008. We expect to see tremendous growth in our ability to recruit students who are hungry for financial support and recruiting of other new commissions of health care professionals is on an upswing.
Q: What are some of the challenges we face in recruiting nurses— active and RC—and what are some of the programs you have in place designed to attract them?
A: According to the latest projections from the U.S. Bureau of Labor Statistics, more than 1.2 million new and replacement nurses will be needed by 2014. Government analysts project more than 703,000 new registered nurse positions will be created through 2014, which will account for two-fifths of all new jobs in the health care sector. The shortage of nurses and nurse educators, competitive market conditions and current operational demands for the Army continue to be a challenge. In addition, faculty shortages at nursing schools across the country are limiting student capacity at a time when the need for nurses continues to grow.
The Army Nurse Corps [AN] accesses officers for the active component through a variety of programs, including the Reserve Officer’s Training Corps [ROTC], the Army Medical Department Enlisted Commissioning Program, the Army Nurse Candidate Program, and direct accession recruiting, with ROTC optimally being the primary accession source. The Active component AN accessed an average of 16 percent fewer officers than required over the past several years, which continues to challenge increased recruiting efforts. The Active Component requires a Bachelor’s Degree in Nursing [BSN] for all AN appointments.
The Army National Guard [ARNG] and Army Reserve [AR] also accesses officers into the AN coming from direct accession recruiting. Unlike the active component which has a minimum of a BSN degree requirement for accession, the Reserve components have a stipulation in congressional law allowing for the accession of quality nurses from National League of Nursing Associate and Diploma Degree programs throughout the country. However, in support of the Chief, Army Nurse Corps recent initiatives to raise the professional standards of the AN, the ARNG and AR are aggressively working to improve incentive programs encouraging these higher degree requirements for continued service and promotion eligibility to senior ranks.
In order to compensate for the nursing deficit and current OPTEMPO, the active component considerably expanded contract nursing support. For fiscal year 2007, across the Medical Command, we contracted for 717.6 full-time equivalents in registered nursing at a cost exceeding $53.6 million. An additional estimated $1.22 million was spent in direct support of the global war on terrorism. While contract nursing supports operational needs, it is not a sound long term strategy, and we need to focus on efforts to recruit and retain quality military RNs.
The Active component, ARNG and AR assess nurses into the AN through a wide variety of accession and retention incentive programs currently available.
An example is our Health Professions Loan Repayment Program [HPLRP] which is offered as an accession and retention incentive. This program provides up to $32,000 repayment for Active Component and $50,000 for Reserve Component for educational loans;
Accession special pays is another program we offer. Currently, there is a nurse accession special pays of $15,000 to $30,000 for Active Component direct accession officers in exchange for a three or fouryear service obligation respectively. The Reserve Components offer accession special pays of $10,000 per year for a BSN degree nurse and $5,000 for graduates of associate and diploma programs. The Reserve components through a recent modification to their incentive program procedures are able to offer special pays as a retention tool as well if their nursing specialty is on the Selected Reserve Healthcare Professionals in Critically Short Wartime Specialties list;
The Army Medical Department Enlisted Commissioning Program [AECP] allows active component enlisted soldiers who can complete a BSN within 24 months to do so while remaining on active duty. This program provides a successful mechanism to retain soldiers, while ensuring a continuous pool of nurses into the Army;
Another opportunity is the Reserve Specialized Training and Assistance Program for BSN completion (BSN-STRAP). This is available for both new accessions and Army Reserve component nurses without a BSN degree. This program provides a monthly stipend, currently $1,905, for those who can complete their BSN within 24-months or less. These strategies will assist in providing welleducated professional nurses for the Army National Guard and Army Reserve in the years ahead;
My last example here is the Professional Nurse Education Program. In an effort to minimize the impact of faculty shortages, the AN identified a strategy to leverage its resources on this important issue. This program serves as a retention tool, as well as provides an additional skill set for active duty officers. Mid-grade Army nurses with clinical master’s or doctoral degrees are detailed to a baccalaureate nursing program to serve as clinical faculty for two years at a time. In return, a predetermined number of otherwise fully qualified Army students would be guaranteed admission into that program. The presence of these officers in the BSN programs serves as an excellent marketing tool for Army nursing.
Our ability to compete with other services, local civilian health care institutions, the Veteran’s Administration and other government agencies whose salary base is well above Army salaries for new graduates is challenging for the active component. Reserve nurses on the other hand who are trying to raise a family, balance civilian work with their military service obligations and frequent deployment hampers their ability and available time to return to college to earn their BSN degree presents unique challenges for ARNG and Army Reserve AN officers.
The Army Nurse Corps is therefore challenged to seek solutions to alleviate the deficit of nurses often without sufficient resources. Additional recruiting and retention incentives, bonuses, educational partnerships and changed legislation initiatives will need to occur to keep the AN ranks filled for the immediate- and long-term future.
Q: Are there any medical job descriptions that you normally will not find in the National Guard?
A: Back in the early 190s, the director of the ARNG and the chief of the Army Reserve had a meeting known as the offsite agreement, in which it was decided the ARNG would transfer all its hospital units to the Army Reserve. This began the era we are in where the preponderance of ARNG medical force structure is embedded in our combat structure. The result is the ARNG does not have positions for many specialty physicians—i. e., thoracic surgeons and neurosurgeons. The ARNG can use these personnel as general physicians, but they would not be working directly with their subspecialties.
Q: How do you teach the reality of combat medicine in an extraordinary environment to physicians whose full time job is in a peaceful, state-of-the-art hospital with every piece of support equipment imaginable?
A: We make every effort to train our physicians in environments which will provide them a sense of the realties of a combat setting. With the fielding of medical simulation training centers [MTSC] across the Army and within the Army National Guard, our ability to do this is increasing.
We currently have two fully functioning MTSC sites within the ARNG and are looking to increase that number over the next couple of years. It has been proven, time and time again the more realistic training we can provide, enhances soldier survivability in the field. Our equipment modernization program within the National Guard has kept pace with the equipment being fielded our active component brethren so our medical forces and providers are deploying with state of the art filed medical equipment.
Q: Reaction to and management of health care needs during natural disasters and humanitarian crisis’ is a hallmark of the National Guard. What do you do to ensure that your people are staffed, trained and equipped to handle such diverse mission sets in addition to preparing for combat medicine?
A: As the Guard is federally funded to meet the requirements of its wartime mission, how we leverage that capability to support domestic operations does vary from state to state. The National Guard has always been a community based force which could rapidly deploy in support of local, state and regional disasters. Since pre-9/11 with the fielding of civil support teams across the country, and post 9-11 with the stand up of enhanced response packages across the states, the Guard is focused on attaining wartime proficiencies while simultaneously assisting with domestic emergency response efforts. We continue to assess what capabilities are required for a full-spectrum domestic response and continue to work with our leadership to attain appropriate levels of resourcing for the domestic mission.
Q: In your view, what are some of the significant technologies or equipment items that have a significant impact on combat casualty care in recent years?
A: Throughout history combat has been the genesis of many of today’s life-saving medical procedures and technology. The increased skill level of the combat medic and the introduction of combat life saver training to non-medical soldiers have increased the battlefield survivability.
During Operation Iraqi Freedom and Operation Enduring Freedom, our Joint Theater Trauma Registry provides us crucial information to analyze combat injuries and provide solutions to improve survivability. Better control of bleeding has had a major impact on the number of soldiers surviving traumatic injuries.
The development and fielding of the one-handed combat application tourniquet and chitosan hemostatic dressings reduces blood loss even before our soldiers get to our trauma facilities. New hypothermia kits help prevent worsening shock and injury during patient transport, and the use of 1:1 plasma to red cell ratios and factor VII facilitate improved resuscitation. In theater, CT scanners and portable ultrasounds allows for proper diagnosis and treatment to occur in theater and decrease unnecessary evacuation.
Additionally, all active duty forward surgical teams, scheduled for deployment are first required to spend several weeks at the Army’s Ryder Trauma Center at Jackson Memorial Hospital, Tampa, Fla. where they have an opportunity to train while caring for civilian trauma patients. Many of our Reserve component members also take advantage of this training opportunity integrating their often advanced civilian ER and trauma skills to improve the overall training program success.
Q: To add on to that, are there any technologies that are getting close that you would like to see efforts accelerated?
A: The Army is proceeding to field the two new hemostatic dressings recommended by the Committee on Tactical Combat Casualty Care: Combat Gauze and WoundStat. These dressings show significantly improved survival and hemorrhage control when compared to HemCon and QuikClot in studies performed by the Institute of Surgical Research.
Q: What is the ARNG doing to foster medical readiness, fitness and resiliency in its soldiers and family during long war?
A: Maintaining force strength and sustaining critical operations rely heavily on healthy, fit soldiers.
The ARNG implemented soldier health and wellness programs in the past, but they took a broad-brush approach rather than focusing on a single deployment and readiness issue at a time. A new ARNG program introduced in 2006 called The Decade of Health will target a specific concern each year and will leverage existing programs and launch an intensive outreach to enhance health literacy and produce measurable results.
The Decade of Health is a 10-year strategic deployability and readiness marketing campaign supporting personal responsibility for health and wellness. The Army National Guard launched an intense, focused media strategy targeted at soldiers and their families promoting readiness, healthy lifestyles and enhanced resiliency. The objectives are best reflected in the Decade of Health Campaign tag line, ‘Always Ready, Always There… Always Healthy.’
In support of the Decade of Health, the Army National Guard forged an alliance with the American Heart/American Stroke Associations [AHA/ASA] to leverage the strengths of both organizations in fulfilling national objectives to create a culture of wellness for all Americans. The ARNG is the largest corporation to partner with the AHA/ASA. The AHA/ASA lends enhanced credibility and name recognition to the ARNG Decade of Health annual campaigns, and expands program community outreach regionally and locally. The ARNG offers the AHA/ASA unique participation in an innovative health promotion and prevention marketing activity that carries the AHA/ASA message and torch to over 1.5 million ARNG soldiers and families, and potentially to nearly nine million Department of Defense servicemembers, families, veterans, retirees, and DoD civilians.
Q: How has this benefited the ARNG soldier/family?
A: The fruits of this relationship are many, but specifically the world-class status of the AHA/ASA in addressing cardiovascular disease offers the ARNG access to expertise and peer-reviewed alliance co-branded multimedia education that is distributed to ARNG soldiers and families. The AHA/ASA offers the ARNG the benefit of world-class; evidence-based scientific information and patient education.
Over 1.5 million pieces of patient education have been cobranded by the alliance and distributed to ARNG soldiers and families to date. This activity booster’s awareness of high blood pressure and healthy lifestyle management indicated by usage statistics on the Decade of Health Web site located at www. decadeofhealth.com and from electronic surveys and soldier and family feedback gathered at the site, conferences, and at alliance events.
Public service announcements provided free-of-charge to the ARNG have been co-branded and broadcast OCONUS by the Armed Forces Radio and TV network last year and this year with a potential outreach to over 800,000 viewers.
Q: Any final thoughts you would like to add?
A: The Army National Guard has proven its value time and time again. In support of our nation’s warfighters, Guard medical units and providers have shown the concept of citizen soldier works. We stand beside the active component and the United States Army Reserve medical forces and look forward to continued integration with them and the opportunity to support America’s sons and daughters. ♦