“The reception of these changes received from serving CFMS members varied from rare cautious neutrality, to a more common cynicism and hostility. It will take years to recover; things will worsen before there is any hope of improvement, and the survival of a military medical service of value, is in doubt.” - Spring 2000

Two years ago Cec Berezowski and I wrote an opinion piece for DANN News on the changes proposed for the medical services supporting our Canadian Forces. The quote above was our final paragraph, and you will see that at the time we were not optimistic that the changes would be beneficial. Now, after the main part of the changes have been started, it seems appropriate to review the current status and see whether our dire predictions were valid. This review was prompted in part by the recent Defence Medical Association meeting here in Victoria, when a full presentation of the current status and foreseen problems was made.

The organization of the change was well handled, and in certain areas, funding for materiel in particular, great strides have been made. The Canadian Field Hospital is being refitted, while armoured ambulances are finally being bought for field units. Unfortunately, medicine and medical care do not require only equipment, but personnel as well. This is where the re-organization is coming apart.

The original review that generated this further look at medical care came about because of complaints about the standard of garrison care. To resolve this, the plan was to have a mix of civilian and military staff in base hospitals, with the civilian component managed by an outside contractor. This has gone ahead, but the obvious source of staff to the contractor was military members. They could retire and walk into a firm position without further risk of postings, service overseas and family separation. The civilian contractor paid more as well. So many serving members, particularly physicians, took off their uniforms and walked across the hall. Garrison care was maintained, but now the pool of uniformed, available for deployment, physicians began to shrink.

This year approximately half of the “working rank” medical officer postings will be filled. The physicians that remain are being used excessively to fill in the blanks, so when their time is up, they also will take the walk. This was predictable and predicted. It comes from trying to solve one problem at a time without looking at the whole picture.

Unfortunately, the shortage of General Duty Medical Officers (GDMO) will have a more catastrophic result down the road. The CFMS has always “grown” its own specialists (surgeons, anaesthetists) by selecting from the best GDMOs and training them in the desired specialty. There used to be a line up of aspiring specialists, who had a few years of frontline medicine experience and wanted something different. No longer. Even the most attractive of specialties cannot attract enough recruits, as the pool has shrunk (see all those vacant postings), changes in medical school training policies, and lack of faith in the long term life quality in the reformed CFMS. Within a short time there will be few specialist physicians and this will mean that no matter how good the equipment, it will not be used as the personnel to use it will not be there.

This will impact the expeditionary capability of the Canadian Forces as a whole, unless we beg medical support from another country–as we did in Afghanistan. Eventually the shortages will even begin to impact the ability of the military to support crises in our own country, unless they occur next to good local civilian medical support.

Long range plans? Well, they are talking about money again, but this hasn’t worked for long in the past, and I think it will have less effect now. We already pay them enough to keep a household comfortable, now it is lifestyle and job satisfaction, and that means you need a big boost of numbers all at once, so they all know they won’t be forever on field tasks. There is also a plan in early stages to fund places in medical schools. This will be super-expensive but may be the only solution. If they started today, the first specialist would reasonably be available in 2014.

Money will not resolve this problem. Money has been provided. Now it has become a lifestyle issue. The small numbers remaining are being used and re-used, so they leave, which means the numbers become even smaller so they get tasked more.... and leave. Recruiting programs have largely failed and are certainly not producing the numbers needed. Even more critical is the time it takes to train a specialist physician; 12 years from medical school recruitment to a usable field-capable specialist. Even if we started now, there will be a decade of difficulty and reduced operational capability for the whole of the Canadian Forces.

Col E. Peter Green was Command Surgeon at Land Forces Command and Theatre Surgeon, NATO Intervention Force Bosnia before retiring to Victoria, B.C.

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