Perceptions of current and recent military internal medicine residents on operational medicine, managed care, graduate medical education, and continued military service

Abstract

Current and recent internal medicine residents were surveyed on their level of confidence in practicing operational medicine, satisfaction with graduate medical education, the impact of TRICARE, the military managed care plan, on their patients and education, and intentions on remaining in uniformed service. Their sentiments were recorded on a five-point Likert scale (1 = strongly agree, 3 = neutral, 5 = strongly disagree). Two hundred twenty-one of the 294 surveys were returned (75.2%). Most physicians felt unprepared to perform duties in a nuclear, biological, or chemical warfare environment, or handle administrative aspects of operational medicine (mean scores, 3.2-3.7). A majority of respondents felt satisfied with the quality of their residency experience (mean score, 1.9). Although more than half of those surveyed (53.6%) listed the opportunity to teach residents as a top factor influencing their retention decision, most felt skeptical that graduate medical education would remain important in the future (mean score, 3.6). Most physicians agreed that restriction of TRICARE to patients less than 65 years old may degrade the quality of military internal medicine residencies (mean score, 1.6). Previous service, Reserve Officer Training Corps experience, and graduation from the Uniformed Services University of the Health Sciences were factors associated with increased physician intention to remain beyond their obligated service. The most common factors inducing physicians to leave the military included frequent deployments, relocations, and financial compensation. Factors cited most frequently as influencing physicians to stay on active duty included high-quality colleagues, opportunities for teaching residents, and freedom from malpractice and office management details.