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ASA members know they practice in a democratic country
with many individual freedoms. Defending these freedoms
requires dedicated citizens and a powerful military.
Anesthesiologists support their country and its ideals
in many ways. I have chosen service in the United States
Army Reserve.
I work 12 days each year in an Army hospital. This time,
known as annual training, is fun and differs from my
usual academic practice. In many ways, it feels like
an educational vacation. I find reserve work easier
today than during the two years I spent on active duty
in the Army Medical Corps in the early 1970s. I still
feel patriotic, but escape bureaucratic entrapments.
| “Since
government programs may influence future
national health care delivery systems,
anesthesiologists who join reserve programs
may help the specialty as well as their
country.” |
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This year I trained at Fort Hood in Killeen, Texas,
and two years ago at Fort Bliss in El Paso, Texas. Fort
Hood has 43,000 soldiers, hundreds of tanks and 39 horses
and is the home of the Army cavalry, which is now mechanized
and airborne. Fort Bliss trains the air defense artillery.
Each post possesses a unique history and culture, something
I would never have known except for my Reserve experiences.
Previous assignments have included Fort Campbell with
its war-fighting infantry and Fort Gordon with the academic
Eisenhower Army Medical Center.
The Army needs more anesthesiologists. In addition to
active surgical and obstetric suites in Army hospitals,
anesthesiologists would constitute a wartime priority
for trauma care. Active-duty anesthesiologists train
for such possible deployments, and this interferes with
staffing and practice efficiency. At present, the Army
has only about 60 active-duty anesthesiologists and
220 nurse anesthetists. A decade ago, the number of
anesthesiologists exceeded 100. Recruitments by private
practices that can pay more than the military services
have been the primary cause of this decrease. To help
support military anesthesiologists, ASA decided recently
to form a separate military component and to reduce
fees for reservists called to duty (see
article by Thomas H. Cromwell, M.D., in the July 2002
NEWSLETTER).
Many active-duty army anesthesiologists work at Walter
Reed Medical Center in Washington, D.C., or Brooke Medical
Center in San Antonio, Texas, both of which have resident
training programs. Thus the Army has needed me to work
elsewhere where nurse anesthetists have predominated.
As a senior anesthesiologist, I have brought balance
to these departments, in addition to clinical skills,
and offered perspectives to surgical chiefs and hospital
commanders.
I usually carry teaching slides with me and present
a couple of lectures during annual training. I learn
a great deal, too. Military hospitals treat relatively
healthy patients, work under less production pressure
than other systems and generally do not bill for care.
This environment encourages the acquisition of new clinical
techniques. Thus I placed my first laryngeal mask airway
and performed my first mask induction with sevoflurane
in military hospitals. I administer more regional anesthetics
than in my civilian practice. I have used the portable
anesthesia machine developed for military field use,
which now serves as the prototype for office-based anesthesia.
Seeing how patient safety programs such as protection
from wrong-site surgery have developed in the large
military health care system has helped me to implement
similar programs in my civilian practice.
Through the Army Reserve, I have met many uniquely accomplished
anesthesiologists. Paul C. Reynolds, M.D., an anesthesiologist
I met one summer at Fort Bliss, now commands the NATO
hospital in Belgium. Paul J. Teiken, M.D., an anesthesiologist
I worked with another summer at Fort Campbell, won a
Bronze Star for meritorious service during Desert Storm.
Also, I have discovered a commonality with many civilian
anesthesiologists who formerly served in the military.
For instance, Eugene P. Sinclair, M.D., (2003) First
Vice-President, worked in the hospital at Fort Campbell;
Thomas H. Cromwell, M.D., (2002) Secretary, served in
the Navy during Vietnam.
At home, I wear my university identification card in
an Army holder, and patients and their families comment
on it nearly every day. Many older men served in the
military during World War II or the Korean War and quickly
connect with someone now serving. It may help that West
Virginia has the highest state percentage of citizens
who are retired from the military as well as the highest
percentage of its citizens serving on active duty.
During my annual training, I take a physical fitness
test consisting of push ups, sit-ups and a two-mile
run. Because I am competitive, I train hard for it.
I have always been a runner, but I would have ignored
strength training if not for this test. This annual
ritual has kept me healthier.
The Army reimburses travel expenses, provides lodging
and compensates for Reserve work. Other programs more
involved than the one I signed up for offer retirement
pay. The Navy and Air Force offer a similar diversity
of programs. If interested, the Web sites and recruiters
for each branch can provide information. I often hear
anesthesiologists with previous active-duty experience
talk about joining the Reserves. Since government programs
may influence future national health care delivery systems,
anesthesiologists who join reserve programs may help
the specialty as well as their country. 
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Robert
E. Johnstone, M.D., is Professor and Chair, Department
of Anesthesiology, West Virginia University, Morgantown,
West Virginia. He is ASA Director for District
28. |
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