Questions and Answers with the 49th Medical Group Commander

Q: Why is it so hard to get an appointment at the clinic?
A: The bottom line is that we don't have enough doctors and providers to see all of the patients that request appointments. Military members have some specific requirements for certain exams that we must see, and the physicians and providers have some military, proficiency and credentialing requirements that they must meet that sometimes decrease their availability. Our Medical Group is charged with "providing or purchasing" the care that is required...so we do have to refer some patients downtown either to the urgent care center of to the local ER depending on the medical need.

Q: Why don't you have enough physicians and providers?
A: Forecasting for clinic staffing occurs over two years prior to the year that the staffing goes "on the books". Mission and needs projections are a constant moving target and a lot can happen in that span of time. Several years ago, before the Remotely Piloted Aircraft (RPA) training mission was added to the 49 WG, the MDG staffing plan was already set. The short timeframe for the addition of the RPA mission and personnel occurred before any subsequent medical authorizations could be added. We are just now getting out of that staffing "bathtub" but the same process may occur in the coming year(s) as we transition to the F-16 mission here at Holloman--we still don't know what that end state will look like.

As many of you know, just having your staff authorizations "on the books" does not necessarily mean that you will get the body to go with it. This also occurred over the past several years as the Air Force Medical Service faced shortages in Family Practice physicians and Flight Surgeons. These gaps further compounded the problem with access at the clinic--in addition to filling deployment taskings that we've had. The Air Force provided funding for civilian hires to help bridge the gaps, but qualified applicants who would accept a short-term job at Holloman took a long time to find, and then we faced lengthy hiring processes to get them on board.

Q: What is the Medical Group doing in the mean time to help improve clinic access?
A: We have made some strides in improving the availability of our physicians and providers.

1) Medical Group training days and Commander's Calls are now conducted every quarter on a weekend to conserve appointment availability and minimize interference with patient care. This additional duty Saturday is uncompensated time for our staff, but saves over 300 various types of appointments over the quarter.

2) McAfee Army Health Clinic in White Sands Missile Range has agreed to assist with some urgent care appointment requests from Holloman Central Appointments. Sometimes we may be able to offer you a same-day appointment there--even after hours. Conveniently, pharmacy services are available for you then and there also.

3) Several of those short term civilian clinicians have been hired to ensure continuity of care and reduce lengthy manpower gaps and should be with us for most of 2011.

4) Our docs are seeing more appointments each day. The current standard for primary care appointments is 18 appointments per day--90 per week for a five day work week. Our docs have clinic schedules that accommodate 22 per day on most days. They spend additional time time to complete documentation, review results, do research, following up with you by phone, and complete medical board cases. Having them do too much more than that would rush you and the doctor excessively during your appointment--increasing the likelihood of overlooking something or making a mistake.

5) Our clinicians minimize the time they spend away from clinic. Required staff meetings are done during the lunch hour, the Medical Group PT sessions occur at 0545. Other requirements for staff to be away from clinic are thoroughly scrutinized to ensure that our docs are available to you as much as possible. The physicians who are Commanders and Chief of the Medical Staff see clinic each week in various clinics to fill in where they are needed.

6) Our nurses have taken the lead in helping supervisors to manage members who need to go on quarters for an acute illness. The supervisor is authorized to allow quarters for their members for the first day, then the nurse can help make the assessment on quarters for the second day or help get a doctor's appointment if needed. If you contact your team nurse, they will make an assessment for the doc over the phone. Our nurses are also working clinics to expedite the evaluation of sore throats and possible urinary tract infections.

7) Our pharmacists stepped up to see patient appointments that help manage administration of the blood thinner Coumadin, and in the near future will be working with the docs to run a clinic focused solely on cholesterol management.

Q: Why do I have to go so far away to get to see a specialist?
A: One of the challenges we have is the limited medical resources available in the immediate vicinity for our beneficiaries. At the moment, there is only one urgent care clinic in Alamogordo that accepts TRICARE beneficiaries and one hospital with an emergency room. There are also few specialty clinics available in the city--beneficiaries can get this care in cities such as El Paso, Las Cruces, and Albuquerque--some travel expenses are covered in these situations. Please contact the TRICARE office at 572-2778 for more information.

Q: What can I do to help?
A: One of the most important things that you can do is to keep your appointments when scheduled --arrive just a couple of minutes early, if possible. If you do need to cancel or reschedule your appointment please do so at least 2 hours before. Even with that short of a notice, we are usually able to book someone else into that appointment time. In addition to keeping all your appointments to decrease the-show rate, we have some resources available that can help you make basic health care decisions on your own. If you don't have a copy of the "Taking Care of Yourself" and "Taking Care of Your Child" books, please visit the TRICARE office or call 572-2778. Also, keeping your medicine cabinet at home stocked with a thermometer and a good supply of basic medications for fever, pain, congestion, cough, runny nose and diarrhea can help make a middle-of-the-night medical issue much easier to deal with.

Despite limited resources and Holloman's high ops tempo, the 49 MDG has been and will continue to provide quality medical care to you and your family. Your continued patronage and patience are greatly appreciated as the 49 MDG constantly looks for ways to make its services better for you.