Why is the military healthcare system inferior to civilian hospital systems?

I have been working with The MInneapolis VA Hospital. I have been incredibly satisfied with the Orthopedic and Mental health departments. I have not had the same experience with civilian hospital systems.

In my opinion it is because in order for the VA healthcare system there has to be a way to find and "retain" healthcare professionals is a better incentive system, don't forget those folks have bills just like the rest of us, and any form of professional school is a very costly item. There has to be a way of form of retention to keep "quality" healthcare professionals.

From my perspective and in my experience, they’re 2 different worlds. The DHRB came out and finally admitted what many of us in military health care have been saying for years. They finally validated the useless pursuit of civilian accreditation’s that MTFs were chasing at their own demise. Secondly, nothing runs less efficient and less proficient that a military free of conflict on a significant level. On the civilian side (I worked civilian ER, ground and air EMS 12 years before returning to Active Duty) we concentrated on proficiency, skill development, patient safety, evidence based medicine. That is how you grow and become better, gain experience and move up in your career. As a military medic, that career path doesn’t work. With the going away of our Major MTFs, under the brilliance of BRAC, we transitioned to these family medicine centered, dependent access driven, “super clinics” that do a whole lot of physicals, cold clinic, medical management type activities, that have little to do with readiness and down range applicable skill. In addition, you can’t just be a doctor, nurse, medic, lab technician. You are expected to show “career advancement” by joining the booster club, the rising 4 club, planning the local Air Force Ball and other things that have nothing to do with your ability to provide the best care
Possible for your patients at home or down range. There is a large, legal, HEPA filter on most installations that looks like a huge gate. That single device provide military healthcare with a level of protection and plausible deniability that is not afforded civilian healthcare. Every physician in my ER down town was board certified in Emergency Medicine. That is not the case for many military doctors. EMS medical directors ground and air units had to meet certain requirements, education and experience in order to be elected or hired to that position. In the AF we have Competent Medical Physicians instead of EMS Medical Directors who are assigned (often as an additional duty) by the MTF Commander. That is the hard, fast requirement. We have General Medical Officers with minimal patient contact, no ER or Trauma experience managing an installation Emergency Medical Service that don’t know what EMTALA is. They don’t know the scope or limits of those whom they supervise. Again, it’s an additional duty. They do this in between all of the other things that they are expected to do that have nothing to do with becoming a solid/better clinician. As a military medic, trained as a certified flight paramedic/critical care paramedic, we have no Human Resource department to ensure that we are used and maintained appropriately. If you can spin that rectangle around side ways and shove it into a square hole, well...that’s a fit. We place highly trained assets into positions where they won’t be used and will not be maintained, “Because I need you to manage the grounding management program worse than I need you in EMS because the local community covers our 911”. Medicine has had to transition in order to compete against line assets for relevance and profitability, even though they are completely different ideals and theories. What I have found in many levels of Senior Leadership is the impression of “If I’m not sick or hurt, I don’t need you. I always need to fly, or drive, or shoot.” Our inspection processes support much of this. It seems as though we have, long ago, moved to an inspection process that focuses on program manager and process development, confirmed via records inspection. There’s rarely any requirement to demonstrate that you are actually doing these processes or that your people can perform the tasks that they say they are qualified on. Down town, the state inspectors required a task demonstration and validation. The local health district stopped ambulances and spot inspected for equipment and supplies and quizzed the personnel. Our State EMS Director/Manager did unannounced course/class audits. I have not seen that in the military in the last 15 years. In a time when your functional manger must also be your flight chief, acting squadron superintendent, temporary first sergeant, Top 3 representative, moral club president and any other flavor of the week activity head, you can’t expect health care and true job performance to keep up with EPR development and “career advancement”. For these reason, you’ll often see those folks migrate into the VA healthcare system following military service and you get the same outcome. Again, this has been my experience and may not necessarily be the rule. Unfortunately, many of us who do chose to pursue higher level skill and certification, and grow in a profession, must work downtown in our free time to stay on top of medicine, technical expertise and management opportunities.