Military medical personnel are essential to  maintaining DOD’s large and complex health system and are in great  demand because of the need to treat injured or ill servicemembers and due  to advances in medical technologies that require specialized personnel. DOD’s Policy Emphasizes Jointness, although the Services’ Collaborative Efforts in Determining Medical Personnel Requirements Have Been Limited

While DOD has emphasized jointness and undertaken joint initiatives  across the department, the extent to which the services have incorporated  cross-service collaboration in their planning efforts for determining their  medical personnel requirements has been limited. Officials, however, have faced challenges in consolidating and realigning  the medical manpower portion of this newly formed joint medical effort  within the National Capital Region. DOD and the Services Collaborated to Develop a Recently Released Cross- Service Medical Manpower Standard for Mental Health Providers

A second joint medical personnel effort, quite different from that of the  realignment previously described, is DOD and the services’ ongoing  development and implementation of a cross-service medical manpower  standard known as the Psychological Health Risk-Adjusted Model for  Staffing (PHRAMS). Health Affairs sponsored the development  of the cross-service PHRAMS manpower standard to address the growth   in demand for mental health services, as well as to give the services a  standard by which to develop mental health requirements needed to meet  the common, day-to-day psychological health needs of eligible  beneficiaries across the services. Service-Specific Medical Requirements Determination Processes Are Not Consistent with Collaborative Planning

To the extent that PHRAMS represents a positive collaborative initiative,  to date it is the only model of its kind. With leadership emphasis and  expectations that the services will continue to explore opportunities to  develop cross-service medical manpower standards, such as PHRAMS, and  consistent management focus on collaboration within DOD’s Military  Health System, the services will have more opportunities to develop  collaborative work force planning efforts for common medical capabilities  that they share throughout their military treatment facilities—an approach  that is consistent with the Military Health System Human Capital  Strategic Plan’s vision of a more integrated approach across service  lines. The Services’ Respective Processes for Developing Requirements Are Not Validated and Verifiable in All Cases and Do Not Centrally Account for Civilian Personnel Requirements

While a need exists for the services to work more collaboratively to  determine their medical personnel requirements, the services’ also  maintain processes to address service-specific needs. While all of the services currently are taking  steps to update and refine their medical personnel requirement processes,  these processes, however, are not yet fully validated or verifiable. Army’s Model Contains Some Outdated Information and Is in the Process of Being Updated and Validated

The Army uses its Automated Staffing Assessment Model to determine  manpower requirements for Army fixed military treatment facility and  other Army Medical Command organizations. The model uses the current population of the various military treatment  facilities as the major determinant of the number of medical personnel  needed at each facility. Instead, Navy  officials explained that, the Navy’s process is to use current manning as a  baseline and adjust the figure based on emerging needs or major changes  in its medical mission. While the Navy routinely  employs this approach to determine its medical personnel requirements, it  is not a validated or verified methodology as required by DOD guidance. Air Force officials recognized that their recent efforts to develop medical  manpower standards stem from the Air Force’s need for a validated and  verifiable manpower requirements determination process. If the services do not identify  civilian personnel requirements for military treatment facilities in the  overall requirements planning process, the services may be missing the  opportunity to make a strategic determination of how many medical  professionals—military or civilian—are needed in total to carry out their  expected missions and workloads. Areas of  improvement exist within the services’ medical requirements processes,  and until these processes are up-to-date, fully validated, and verifiable, it is  not clear whether the services can be certain they are determining their  medical personnel requirements in an effective and efficient manner. Recommendations for Executive Action

Consistent with DOD emphasis on developing human capital solutions  across the services to enable departmentwide decision making and  analyses within its Military Health System, we recommend that the  Secretary of Defense direct the Assistant Secretary of Defense for Health  Affairs and the Service Secretaries to take the following two actions. Agency Comments and our Evaluation

In written comments provided in response to a draft of this report,   DOD concurred or partially concurred with all of our recommendations.
Why GAO Did This Study

Military medical personnel, who are essential to maintaining one of the largest and most complex health systems in the nation, are in great demand due to the need to treat injured or ill servicemembers, and advances in technology that require specialized personnel. To determine how well the Department of Defense (DOD) and the services are developing their medical and dental personnel requirements, GAO evaluated (1) the extent to which the services have incorporated cross-service collaboration in their medical personnel requirement processes, and (2) the service-specific processes for determining their requirements for military and civilian medical personnel. To conduct this review, GAO evaluated manpower policies, analyzed the services' requirements data and determination processes, and interviewed officials from the Office of the Secretary of Defense (OSD) and each of the services.

What GAO Found

While DOD's 2007 Military Health System Human Capital Strategic Plan emphasizes developing human capital solutions across the services to enable departmentwide decision making and analyses, the services' collaborative planning efforts regarding requirements determination for medical personnel working in fixed military treatment facilities have been limited. In one effort to integrate operations, DOD is consolidating medical facilities in the Washington, D.C., area under a joint task force that calls for joint staffing of the military treatment facilities in the region. However, officials have faced challenges in developing the manpower requirements for the joint facilities due to the use of outdated planning assumptions. Separately, the Office of the Secretary of Defense (OSD) sponsored another joint medical effort to develop a cross-service medical manpower standard for mental health personnel. This standard is being used to determine the amount of personnel needed to meet common, day-to-day psychological health needs of eligible beneficiaries across the services. However, to date, this standard is the only one of its kind, and OSD officials said that no other similar efforts currently exist. The services' continued focus on separate medical personnel requirements processes may not be consistent with the DOD strategic plan's vision of a more integrated approach, and the services may have missed opportunities to collaborate and develop cross-service manpower standards for common medical capabilities that are shared across military treatment facilities. Sustained and committed leadership emphasis on developing more effective ways of doing business, such as the use of cross-service medical manpower standards, is key to successful, collaborative human capital strategic planning. To the extent that the services need to maintain separate processes, GAO also found that their requirements processes are not, in all cases, validated and verifiable, as DOD policy requires. Selected specialty modules in the Army's model contain some outdated assumptions, such as the level of care currently being provided, and only a portion of the modules have been completely validated. While the Navy has employed an approach that uses current manning as a baseline and adjusts its requirements based on emerging needs or major changes to missions, the approach is not validated or verified as required by DOD guidance. The Air Force said it may not know its true medical requirements as the model it has relied on also is not currently validated or verified. Each of the services has recognized the need to have processes that can be validated and verified, and has taken steps to address these issues in recent years. However, without processes that are validated and verifiable, the services cannot be certain they are determining their medical personnel requirements in the most effective and efficient manner. Also, the services do not centrally manage their processes for their civilian medical personnel requirements. While local commanders determine these requirements, the services may be missing the opportunity to make a strategic determination of how many civilian medical professionals are needed to carry out their expected workloads.

What GAO Recommends

GAO recommends that OSD and the services emphasize a long-term joint approach to medical personnel requirements determination by identifying the common medical capabilities shared across the services and developing cross-service medical manpower standards, where applicable; and that the services take actions to improve their respective medical requirements determination processes. In written comments to a draft of this report, DOD generally concurred with these recommendations.