Chapter 3 discusses the quality of medical education obtained by military physicians and how physicians from each accession source are prepared to meet the special needs of military medicine. Considerable debate exists about whether other (non-DOD) federal support for medical education should be considered in the cost of obtaining military physicians. Our supplemental analysis showed that when an estimate of additional federal dollars that support civilian medical education is included in the analysis, the University is more costly on a per graduate basis, but on an expected year of service basis, the University is nearly equal the cost of the regular scholarship program and less costly than the deferred scholarship program. In addition to their graduate medical education, military physicians are required to have basic officer training, regardless of their accession source. Compensation costs are estimated to be highest for graduates of the University because, on average, they are expected to remain in the service longer and to earn retirement benefits at a rate higher than either their deferred or regular scholarship program peers. Traditional measures of quality place the University’s program within the midrange of medical schools nationwide and its graduates at or above other military physicians. These fall generally into two major categories: (1) education and training activities and (2) research, consultation, and archival activities. Education and Training Activities

The University provides medical education beyond that provided by the School of Medicine and also conducts training and education for other health care and related professions. The longer expected retention of University graduates is consistent with the legislative intent of providing long-term military medical officers. If the University is closed and DOD continues to need experienced career military physicians, DOD will need to find alternative ways to extend the careers of some military physicians while enhancing their exposure to military readiness training. Both the Assistant Secretary and University officials were concerned, however, about several presentational issues including what they viewed as • a focus in our comparative cost analysis on the cost per graduate of each program, rather than on the total cost to the taxpayer per staff year of DOD service, which they believe is the appropriate measure of cost; • a lack of emphasis on the activities of the University, which results in cost-avoidance for other DOD components; and • a lack of emphasis on the University’s unique contribution to providing military physicians schooled in militarily unique medical subjects and our failure to acknowledge the “acculturation process” provided by the University in meeting the needs of military medicine.
Why GAO Did This Study

Pursuant to a legislative requirement, GAO reviewed the Department of Defense's (DOD) Uniformed Services University of the Health Sciences (USUHS) and Health Profession Scholarship Program (HPSP), focusing on: (1) the cost of obtaining military physicians from all sources; (2) the quality of medical education provided by the University; (3) how physicians are trained to meet military medical needs; and (4) retention rate patterns among USUHS and HPSP.

What GAO Found

GAO found that: (1) by most measures, USUHS is the most expensive source of military physicians; (2) HPSP provides the majority of military physicians; (3) when all federal costs are considered, USUHS nearly equals the cost of the regular scholarship program and is less costly than the deferred scholarship program; (4) USUHS graduates are expected to have longer military careers, and USUHS receives less non-DOD federal support than civilian medical schools and graduate training programs; (5) the quality of USUHS medical education compares well with that of all medical schools and its graduates' abilities are at or above those of other military physicians; (6) although USUHS graduates appear to be better trained in military medicine than their civilian peers, the significance of their additional readiness training is unclear; (7) if USUHS is closed, USUHS officials believe that DOD would need to continue funding other USUHS services, such as academic affiliation for several military graduate medical education programs, training and education for other health care and related professions, and research, consultation, and archival activities; (8) on average, USUHS graduates, particularly those in critical military medical specialties, tend to remain longer in the services than civilian-educated physicians; and (9) because its changing physician needs are not known, DOD needs to assess whether alternative strategies for obtaining certain experienced, long-term physicians at less cost are available.