Career Satisfaction of Military Medical Officers.

INTRODUCTION: Having a mentor is associated with higher job satisfaction among U.S. physicians. The objective of this study was to assess satisfaction among military medical officers and to assess if mentorship and job satisfaction are associated with intention to continue military service. MATERIALS AND METHODS: This is a cross-sectional study using voluntary, anonymous data from 2018 Uniformed Services Academy of Family Physicians Annual Meeting registered attendees who completed an online Omnibus Survey. Outcome measures: satisfaction with work hours and workload; voice in organizational decision-making; amount of teaching, research, and other administrative tasks; being and having a mentor; and likelihood of remaining in the military beyond current service obligation. Statistical analysis: descriptive statistics, chi-square, and logistic regression. RESULTS: There was a 66% response rate (310/568) among registered attendees. Respondents reported being satisfied with work hours-workload (53.3%), voice in organizational decision-making (47.4%), and amount of teaching-research-other administrative tasks (55.7%). About 64.6% of respondents reported being a mentor, and 80.7% reported having a mentor. About 53.4% reported being likely/very likely to continue military service beyond their current service obligation. Adjustment for demographic and occupational factors, with significance defined as P ≤ 0.05, revealed that higher percent time in clinical care was negatively associated with satisfaction with voice in organizational decision-making; being a mentor and working in an academic practice setting were positively associated with satisfaction in amount of time with teaching, research, and administrative tasks; and having a mentor was the only factor associated with being likely/very likely to continue military service beyond current service obligation (odd ratio 3.9, 95% confidence interval 1.2-12.1). CONCLUSIONS: Having a mentor was the only factor associated with intention to remain in the military among 2018 Uniformed Services Academy of Family Physicians Omnibus Survey respondents. These results support enhancing mentorship among military medical officers.

Post-Deployment Screening In The Military Health System: An Opportunity To Intervene For Possible Alcohol Use Disorder.

Unhealthy alcohol use in the military remains a serious threat to health and military readiness and raises the question of how to improve detection that facilitates diagnosis and treatment. Army active duty soldiers are routinely screened for possible alcohol use disorder in pre- and post-deployment health surveillance surveys. We examined the likelihood of having a follow-up behavioral health visit or receiving an alcohol use disorder diagnosis among soldiers returning from deployments associated with the Afghanistan or Iraq operations in fiscal years 2008-13, based on their post-deployment screening results. After we controlled for demographic and military treatment facility characteristics, military history, and comorbidities, we found that people who screened positive for possible alcohol use disorder were significantly more likely to have such a visit and receive such a diagnosis. Routine post-deployment alcohol screening represents an opportunity for timely intervention by the Military Health System for military members whose results indicate elevated risk for alcohol use disorder.

Assessing practice pattern differences in the treatment of acute low back pain in the United States Military Health System.

BACKGROUND: Acute low back pain is one of the most common reasons for individuals to seek medical care in the United States. The US Military Health System provides medical care to approximately 9.4 million beneficiaries annually. These patients also routinely suffer from acute low back pain. Within this health system, patients can receive care and treatment from physicians, or physician extenders including physician assistants and nurse practitioners. Given the diversity of provider types and their respective training programs, it would be informative to evaluate variation in care delivery, adherence to clinical guidelines, and differences within the MHS among a complex mix of provider types. METHODS: This study was a retrospective, cross-sectional quantitative analysis that examined variations in treatment between provider types within the Military Health System in 2015 for treatment of acute low back pain using administrative data. In addition to descriptive and summary statistics, binomial logistic regression models were used to assess variation in practice patterns among physicians and mid-level practitioners for prescribing of non-steroidal anti-inflammatory, opioids, plain radiography, computed tomography, and magnetic resonance imaging. RESULTS: With regard to prescribing practices, results indicated that the odds of receiving non-steroidal anti-inflammatory prescriptions increased significantly for both physician assistants and nurse practitioners when compared to physicians. For basic radiological referrals, odds increased significantly for ordering plain radiography for physician assistants and nurse practitioners when compared to physicians. For more advanced imaging, odds significantly decreased for ordering computed tomography (CT) and slightly decreased for magnetic resonance for physician assistants, nurse practitioners and physician residents compared to the physician group. Additionally this study discovered differences in the prescribing patterns between provider categories. Both contractors and civilians had higher odds of prescribing opioids compared to active duty providers. CONCLUSIONS: As physician assistants and nurse practitioners continue to gain popularity as physician extenders in the US and in addressing provider shortages for the Military Health System, further research should be conducted to determine what impact, if any, the differences found in this study have on patient outcomes. In addition, provider type warrants further investigation to determine if labor mix and outsourcing decisions within a single payer system impacts health delivery and value based care.