Defense officials haven’t yet figured out the size and mix of operational medical and dental personnel needed for wartime, according to government auditors.

And until DoD puts together joint planning criteria for developing these personnel requirements, it “won’t know whether it has the optimal requirements to achieve its missions,” according to a report released Feb. 21 by the Government Accountability Office.

The Army, Navy and Air Force don’t have a common method of determining their medical and dental personnel requirements during wartime, GAO auditors said.

Leaders in the Office of the Secretary of Defense have disagreed with the military departments’ initial estimates of their requirements, citing concerns that the services haven’t factored in assumptions for operating jointly in a deployed environment and “for leveraging efficiencies among personnel and units,” auditors stated.

However, service officials told GAO they are concerned that parts of OSD may be seeking efficiencies that could cause an unacceptable amount of risk to their ability to provide medical and dental care in the event of a major regional conflict. Officials said future conflicts could require more operational medical and dental personnel in the theater of operations than what was needed earlier in the conflicts in Afghanistan and Iraq.

The GAO review was required in the fiscal 2017 National Defense Authorization Act, as the Senate Armed Services Committee and DoD in recent years have raised questions about whether the military health system has prioritized peacetime care to the detriment of combat casualty care capability and wartime medical skills. The auditors noted that in contrast to services like trauma surgery and critical care, the most common services delivered in military medical treatment facilities are related to pregnancy, childbirth and pediatrics.

DoD has not yet submitted a report to Congress on its process for defining the medical and dental personnel necessary for operational readiness.

DoD has begun several initiatives to maintain the critical wartime readiness of military medical providers, the auditors noted, such as standardizing and expanding pre-deployment training, and developing new policy on medical provider readiness. But auditors found problems with DoD’s method for measuring medical readiness, contending it’s not based on reliable data, nor have officials calculated the cost of meeting their readiness goals, auditors found.

Last summer, DoD launched a medical manpower working group to establish a single process to define the medical and dental personnel needed to meet operational requirements.

GAO auditors noted that, to the credit of DoD’s senior leaders, the issues of determining the right size and mix of operational medical and dental personnel, and pursuing approaches for maintaining and measuring wartime readiness, have received sustained attention. But there have been challenges. are issues that have elicited sustained attention from DOD’s senior leaders.

GAO recommended that the secretary of defense:

  • Ensure that joint planning assumptions be established to develop operational medical and dental personnel requirements — including a definition of what forces should and shouldn’t be identified as “operational.”
  • Ensure that a method is established to assess options for achieving “joint efficiencies” in the medical and dental personnel requirements, including assessing any risks with those options.
  • Ensure that these planning assumptions and the method for assessing efficiencies be used to determine operational medical and dental requirements, and report them to Congress. In DoD’s response, officials stated they will also engage the service processes to make sure the final structure addresses the services’ unique requirements.
  • Identify and address limitations in the method for measuring military clinical readiness.
  • Determine which critical wartime specialties are needed, and use the information to prioritize specialties where the clinical readiness metric could be expanded.
  • Estimate the costs and benefits, by specialty, of implementing a clinical readiness metric. The costs to be considered should include those needed to provide additional training for medical personnel, and to hire additional civilian personnel in military treatment facilities to backfill military providers who leave to attend training.