Should IDCs not see patients on shore duty?

LT Private RallyPoint Member — Fri, 17 Apr 2015 11:00:13 -0400

There are recent conflicting opinions surfacing within the Navy Medicine community regarding Independent Duty Corpsmen (IDC) patient care duties while assigned to a Military Treatment Facility. IDCs are being assigned as Primary Care Managers at their clinics just like PAs but are responsible for seeing half the number of patients. Many IDCs believe they should spend more time in leadership duties and less time seeing patients. Many senior leadership disagree arguing readiness. On deployment, IDCs are often the sole medical provider with no physician or other practitioner nearby to consult. What is your take?

Response by PO1 Norm Burns made Apr 5 at 2016 6:54 AM

PO1 Norm Burns — Tue, 05 Apr 2016 06:54:32 -0400

I think I can see both sides of this discussion. The IDCs want to work on their leadership duties, and I am thinking it is because without leadership roles and development, promotion is not going to happen. I also understand the need for readiness, and getting the job done. It seems there should be some way so that their time spent as clinic managers should be considered as a leadership role, and count for leadership development. Or am I missing something here?

Response by CPO Patricia Waddell made Apr 5 at 2016 8:05 AM

CPO Patricia Waddell — Tue, 05 Apr 2016 08:05:26 -0400

I think they are quite capable of handling a full load of patients. Look at the number they see when deployed.

Response by CPO Curtiss Hill made Apr 5 at 2016 8:53 AM

CPO Curtiss Hill — Tue, 05 Apr 2016 08:53:28 -0400

Does the level of care change when an IDC treats and AD member afloat compared to an AD member ashore? Should the IDC not see patients on ships and operational units with a Medical Officer? How about an operational unit that is not deployed, should the IDC not see patients and defer the Sailors and Marines to the MO? For units that are deployed, without an MO, and with today's technology, if there is an issue that an IDC can not resolve, they are able to communicate with a medical officer. An IDC on shore duty should be assigned as a medical provider for the AD population at that command. Often, they are assigned to the Acute Care Facility where they are able to keep up on their provider skills. YES, IDCs should see patients on shore duty.

Response by PO2 Private RallyPoint Member made Apr 5 at 2016 9:08 AM

PO2 Private RallyPoint Member — Tue, 05 Apr 2016 09:08:38 -0400

Worst medical care I've ever received was from an IDC. And I was told to suck it up because it was free. Unethical malpractice. I'll never trust another one. If I walked in on an IDC as my PCM I would about face the hell outta the room and never look back.

Response by PO1 Chris Crawley made Apr 5 at 2016 9:21 AM

PO1 Chris Crawley — Tue, 05 Apr 2016 09:21:23 -0400

The problem with shore duty clinics is that there are never enough providers to begin with. Patient care should be top priority. Teaching HM3 Deepneedle how to give an eval input is secondary.

Response by PO1 Todd Cousins made Apr 5 at 2016 10:12 AM

PO1 Todd Cousins — Tue, 05 Apr 2016 10:12:28 -0400

As a retired IDC that finished his time up on shore I do think IDC's should be seeing patients while on shore duty. You can't expect a person to do two or three years ashore and not get rusty in their medical skills at the same time. That said they are leaders. Onboard ship they fill a huge role in leadership. So the answer is to have them fill do both. If your patient pool for a regular provider is 1200 then your department head or division officer usually has a smaller number like 800. It shouldn't be an issue to give the IDC a pool of Active Duty only patients around that size and block off appointment slots for their admin and leadership time. To not use the the medical abilities and the leadership value that your IDCs bring to the table is just wrong.

Response by PO2 Daniel Dancer made Apr 5 at 2016 10:21 AM

PO2 Daniel Dancer — Tue, 05 Apr 2016 10:21:54 -0400

Depends on the current other requirements they have to meet to promote, which could be a reason for wanting to lean towards leadership, training and admin duties. On the other hand, why let your skills diminish?

Response by PO1 Eric Moore made Apr 5 at 2016 10:34 AM

PO1 Eric Moore — Tue, 05 Apr 2016 10:34:19 -0400

I have not been active duty for over 20 years. But I had an opinion then and I still have it today. I believe IDC's can easily be faced with a medical issue above their capabilities and I believe that any unit ashore or afloat needs a Medical officer assigned. Corpsmen have their place in a military unit just like EMTs and Paramedics have their place in a civilian community. But there needs to be a doctor available to back those individuals up.

Response by CN Dennis Stender made Apr 5 at 2016 11:47 AM

CN Dennis Stender — Tue, 05 Apr 2016 11:47:48 -0400

Why not utilize their training, you know they're able to handle 9-12 deployments so let's go!

Response by CDR Jerry Burton made Apr 5 at 2016 12:27 PM

CDR Jerry Burton — Tue, 05 Apr 2016 12:27:02 -0400

I would say that as long as the standard of care is maintained there should be no change in the IDC's responsibilities at sea or ashore.

Response by PO1 Aaron Baltosser made Apr 5 at 2016 1:45 PM

PO1 Aaron Baltosser — Tue, 05 Apr 2016 13:45:27 -0400

IDC's are well trained by the Navy at not an insignificant cost. While they may want to be a more traditional leader on shore duty with more administrative things, the fact is they are often needed due to lack of sufficient providers to see patients. They sy in the Navy choose your rate, choose your fate. An IDC has to understand that once they start down the IDC path, forever will it dominate their destiny. IF they want to take a strong role in Sailorization, then it is up to them to find those roles on shore duty and apply themselves in addition to meeting the expections the Navy has of them.

Response by LCDR Robert Owen made Apr 5 at 2016 2:11 PM

LCDR Robert Owen — Tue, 05 Apr 2016 14:11:51 -0400

Retired LCDR, MSC. Was IDC. Agree with senior leadership. By the time you go to IDC school, you will have proven your leadership skills, which is one trait considered when choosing IDCs for that duty afloat. Those previous comments are spot on!

Response by PO2 Mike Vignapiano made Apr 5 at 2016 2:17 PM

PO2 Mike Vignapiano — Tue, 05 Apr 2016 14:17:37 -0400

IF IDCs are being assigned as Primary Care Managers at their clinics and are ONLY assigned half the patients of the PAs, this should give them PLENTY of time in leadership duties while maintaining readiness for deployments. They can be F/T seeing patients Mo-Tu-We and on Th-Fr they can fill leadership duties (or vice versa).

Response by PO2 Mike Vignapiano made Apr 5 at 2016 2:20 PM

PO2 Mike Vignapiano — Tue, 05 Apr 2016 14:20:40 -0400

IDCs should be assigned as Primary Care Managers at their clinics. Since they see half the number of patients that the PA's do, they can also fill leadership roles too. I see no reason why they cannot do both, as they do while on deployment.

Response by CMDCM Gene Treants made Apr 5 at 2016 7:42 PM

CMDCM Gene Treants — Tue, 05 Apr 2016 19:42:43 -0400

YES. Their job is to see patients. As a IDC they see patients, unless working out of rate and THAT would be a crime IMHO. With the amount of time and training put into making a good IDC, they need to work as they are trained. Patient care is their primary responsibility, BUT that does not negate their duties as a Petty Officer of whatever pay grade. Leadership and other duties are all still a part of the requirements that need to be done and must be to stay competitive IN THEIR NEC for advancement.

Although I have seen it, I hate to see an IDC assigned as an administrator in a Naval Hospital. Master Chief HM who is IDC still needs to see patients as his/her primary duty IMHO OR go the Command Master Chief Route and Free up that Slot!

Response by CWO3 John Bails made Apr 5 at 2016 8:52 PM

CWO3 John Bails — Tue, 05 Apr 2016 20:52:26 -0400

I think the management of IDC should be left up to the leadership of the shore assignment. liability is an issue.

Response by LT Private RallyPoint Member made Apr 5 at 2016 9:19 PM

LT Private RallyPoint Member — Tue, 05 Apr 2016 21:19:30 -0400

Update since this was originally posted. BUMED instruction now requires that IDCs be empaneled for 500 patients on shore duty. That is about 50% of the expected empanelment of full time licensed providers.

Response by LT Private RallyPoint Member made Apr 5 at 2016 9:28 PM

LT Private RallyPoint Member — Tue, 05 Apr 2016 21:28:25 -0400

Perhaps the better question is whether the Navy should make IDCs Warrant Officers since they are the "technical experts of their rating"

Response by CPO John Clapp made Apr 5 at 2016 11:23 PM

CPO John Clapp — Tue, 05 Apr 2016 23:23:06 -0400

A Corpsman is just that If they get rotated to shore duty,they should be seeing patients.

Response by CPO Paul Acedera made Apr 6 at 2016 8:54 AM

CPO Paul Acedera — Wed, 06 Apr 2016 08:54:24 -0400

Retired HMC (non-IDC; retired 15 years ago) here, working as the risk manager for a Level 1 Trauma/Academic medical center and dozens of clinics, I continue to hear that when IDCs retire, there is no certification of sorts that would make their vast and intense clinical experience (no LPN, and such) marketable and compensable commensurate to such level of experience. I would assume that part of it is the type of patient population that IDCs see in the service; more likely than not, the lack of political will to fight for the civilian certification "equivalency"- and funds generated when IDCs have to take "a few more courses" to get that LPN or RN or PA degree. Unless the status quo changes, the IDCs, for whatever it's worth, should be permitted to spend 50% in clinical practice and 50% administrative. This would reinforce their resumes and give them a good fighting chance at landing administrative/management-type employment upon retirement- and meet operational needs. I would even argue that the closer retirement comes, the administrative percentage should go up higher. Another approach could be enhancing the IDC curriculum to as close as possible, approximate civilian curricula (LPN, RN, PA) to reinforce the argument for equivalency certification.
As an Adjunct Professor for an undergraduate Health Care Management program as well, I advise all my students to take their Master degrees- which has become the minimum to be competitive in the civilian world. I hope this helps.

Response by PO1 Larry McDonald made Apr 6 at 2016 9:55 AM

PO1 Larry McDonald — Wed, 06 Apr 2016 09:55:28 -0400

As long as care remains the same yes they should as someone who is retired from the US Navy I understand the importance of staying proficient in your career. Things change even more so in the medical field.

Response by PO3 Jeremy Herrera made Apr 6 at 2016 10:43 AM

PO3 Jeremy Herrera — Wed, 06 Apr 2016 10:43:10 -0400

As a non-IDC corpsman I would have to say that IDC's are a must in shore duty. In many cases I preferred to be seen as a patient by and IDC than a doctor and as for working with them, they helped teach me more than I did in corps school in my first command. They also need to be able to stay on top of the game while on shore duty to ensure their next fleet tour is going to keep our shipmates healthy.

Response by PO1 Private RallyPoint Member made Apr 6 at 2016 11:59 AM

PO1 Private RallyPoint Member — Wed, 06 Apr 2016 11:59:35 -0400

I am not a part of the medical community, but as a submarine nuclear electrician, most of my medical care has come from IDCs. Most I have dealt with are top notch, and I know it is not an easy job. After reading through some of the comments, I can't help but wonder if this is the same issue all (most) deal with, trying to perform your daily job but also trying to break out by pursuing leadership roles (in any capacity). Some may already be in a leadership role as part of their daily job (LPO of a division) but when you have a division with several senior people, those who aren't the LPO (don't have to be an LPO to be a leader!) have the challenge of finding a way to make a difference and (consequently) get noticed. Thoughts?

Response by PO1 Tharin Young made Apr 6 at 2016 6:40 PM

PO1 Tharin Young — Wed, 06 Apr 2016 18:40:06 -0400

it seems to me that this is kind of a perishable skill and seeing patients while on shore duty is a good way to keep in practice. I'm not sure I'd feel very comfortable if my doc had just got off shore duty and had not seen patients regularly since their last sea tour.

Response by PO1 Ron Clark made Apr 11 at 2016 3:57 PM

PO1 Ron Clark — Mon, 11 Apr 2016 15:57:12 -0400

It all depends upon the "Needs of the service" coupled with the experience and training qualifications of the (IDC). You always take into consideration the needs of the service. If the service doesnt need you seeing patients then it's OK to spend time developing your leadership role where and when applicable. While all members need leadership training, patient care should not lack. If the unit in which the IDC is serving is flush with medical personnel, it is also OK to try other leadership roles, the IDC Primary function is to provide medical services "Just stick to the playbook"!

Response by SCPO Private RallyPoint Member made Dec 29 at 2016 12:49 PM

SCPO Private RallyPoint Member — Thu, 29 Dec 2016 12:49:43 -0500

As a retired IDC, when I was on shore duty my time was balanced with managing a clinic and seeing patients and having duty in the ER. An IDC onboard ship has many duties and shore duty never carried the same work load as it did being forward deployed. The IDC needs to see patients and train junior corpsman in clinical skills. In regards to leadership, being a professional that is able to balance duties, responsibilities and problem solve setting an example for junior sailors will be recognized by Navy leadership and a contributor to upper mobility in promotion and assigned responsibilities.