Financial Impact of Deployments on Reserve Health Care Providers, The

Military Medicine, Aug 2008 by Petinaux, Bruno

ABSTRACT This study retrospectively surveyed the financial impact of deployments on 17 U.S. Army Reserve health care providers. Due to multiple mobilizations, 29 separate deployments were reported. The deployments, mostly between 2001 and 2005, typically lasted 3 months during which 86% reported no civilian income and 76% reported no civilian benefits. Solo practice providers reported the greatest financial losses due to continuing financial responsibility related to their civilian practice despite being deployed. Overall, 2 deployments did not change, 9 increased, and 16 decreased the medical officer's income. Two were not reported. In this small retrospective convenience sample study, solo practice U.S. Army Reserve health care providers were found to be at highest risk of financial losses during military deployments. This being said, no price can be put on the privilege of serving our men and women in uniform.

INTRODUCTION

The ongoing Global War on Terrorism has accelerated the use of the U.S. Army Reserve in military operations.1 One small part of this large force is military health care providers serving in the U.S. Army Reserve. Providing medical support to active duty military members, their dependents, and eligible retirees is one of the core missions of the military health care providers.2 To augment and support the active duty component, reserve military providers are mobilized and deployed, during which time these providers leave their civilian medical practices. Such deployments are typically 90 to 110 days long. This study examined the financial impact of deployments on a military health care provider's civilian medical practice. An earlier study examined the impact of deployments on the earnings of reservists3-this study focuses only on medical personnel.

METHODS

This study was exempted by the Walter Reed Army Medical Center's Department of Clinical Investigations Human Use Committee. A 46-question survey examined a convenience sample of military health care providers on the impact of their deployment on their finances. Each health care provider could participate more than once in the study if mobilized repeatedly because the financial impact of each deployment was reported separately. The study took place in 2005 without my participation in the survey; respondents' anonymities were ensured.

STUDY POPULATION

The study population of health care providers consisted of 15 physicians and 2 certified nurse anesthetists (CRNA). A list of their practice specialties appears in Table I. Six of these 17 providers were mobilized once, 10 were mobilized twice, and 1 was mobilized three times, totaling 29 different deployments. At least 83% of the deployments occurred between 2003 and 2005. Twenty-one deployments were within the continental United States, which permitted five participants to live at home during their deployment to local military treatment facilities. With respect to military rank at time of deployment, four were captains, 10 were majors, and 15 were lieutenant colonel and above. At the outset of the deployment, the employment status included eight solo practitioners, 16 physician/CRNA employees, and four government services employees. For one deployment, employment was not specified. All mobilizations were involuntarily, although in three deployments, the participants voluntarily extended their active duty service.

RESULTS

Impact on Civilian Finances

During 10 deployments, the participants reported annual civilian income less than $120,000; 9 were between $120,000 and $200,000; and 8 were more than $200,000. For two deployments, no information was given on annual civilian income by the participants. The participants neither received any continued civilian income during 86% nor any continued civilian benefits during 76% of the deployments. In four (14%) of the deployments, partial or full monthly income was paid to the participants totaling $49,300. During one deployment a secondary income, other than military salary, was reported less than $5,000. Additional benefits, other than salary provided by civilian sources, were reported by participants during 24% of deployments (Fig. 1). These benefits in decreasing frequency were: malpractice/liability insurance coverage, retirement contributions, life insurance premium payments, healthy insurance premium payments, financial bonuses, and disability insurance premium payments. Some participants received more than one benefit from their employer while deployed.

Regarding professional liability insurance, during eight deployments participants reported paying their annual premiums. These were less than $8,000 during one, $16,000 during two, and between these figures during five deployments. Similarly, in eight deployments monthly office expenses, such as office rentals and service contracts continued to be paid by the participants: two paid between $6,000 and $8,000; two between $8,000 and $10,000; and four more than $10,000 while deployed. For a total of six deployments, $108,000 in additional costs were reported due to the interruption of professional services such as equipment leases or contracts while mobilized. Due to two deployments, participants reported having to pay their partners, group, or employer a combined total of $500,500 for their inability to provide medical services while deployed. Two solo practice health care providers, both deployed twice, reported having to layoff office personnel each time they were deployed. In addition, during half of all deployments, participants reported further unexpected costs due to dieir mobilization totaling $38,000.