The Uniformed Services University of the Health Sciences

December 12, 2019 The Uniformed Services University of the Health Sciences In 1972, Congress established two programs to support the recruitment and retention of uniformed medical professionals: (1) a health professions scholarship program to train and prepare civilian students for a variety of careers as military medical professionals and (2) the Uniformed Services University of the Health Sciences (USUHS) for members of the uniformed services and certain civilians. USUHS is the only federally administered medical and health sciences school in the United States. Background Between the late 1960s and early 1970s, Congress and the Executive Branch initiated a series of reviews to consider reforms to the military draft and the Selective Service System as part of the transition to an all-volunteer force. Coinciding with these efforts were some congressional concerns about how the Department of Defense (DOD) would address critical shortages in military medical personnel, including the recruitment and retention of health professionals. Congress identified several factors influencing DOD’s critical shortage of military physicians, such as:  Nationwide Physician Shortage. In 1970, the Carnegie Commission on Higher Education estimated that the United States had a shortage of approximately 50,000 physicians.  Low Medical Officer Retention. A 1972 Senate Armed Services Committee report (S.Rept. 92-827) stated DOD’s military physician retention rate—for those with at least two years of service—was approximately 1%.  “Doctor Draft Law” Expiration. Section 5(a) of the Military Selective Service Act (P.L. 92-129, as amended), which authorized the President to draft a certain number of physicians into the military, expired on July 1, 1973. Since its inaugural class in 1980, USUHS has awarded nearly 10,000 degrees. The university continues to supply DOD (and the U.S. Public Health Service [USPHS]) with physicians, advanced practice nurses, health scientists, specialized medical technicians, and medical researchers. As the supply and demand of military medical personnel fluctuates over time, Congress periodically conducts oversight activities in an effort to ensure the military has a sufficient medical force to support U.S. military operations during peacetime and wartime. Governance Statute (10 U.S.C. §2113) requires the Secretary of Defense (SECDEF) to appoint a “President of the University.” DOD Instruction 5105.45 designates the USUHS President as the university’s chief executive officer, responsible for offering academic health programs, administering medical research initiatives, and maintaining other requirements that support certain military operations or national security objectives. The president works under the “authority, direction, and control” of the Assistant Secretary of Defense for Health Affairs. The law (10 U.S.C. §2113a) establishes a Board of Regents to assist and provide independent advice to the USUHS President and the SECDEF. The Board consists of nine voting members appointed by the SECDEF. Nonvoting members also serve on the Board, including the surgeons general of the uniformed services. Figure 1. USUHS Appropriations, FY2009-FY2020* Given these concerns, DOD advocated to Congress the “urgent need” for establishing a health professions university (see S.Rept. 92-827). In response, Congress passed the Uniformed Services Health Professionals Revitalization Act of 1972 (P.L. 92-426), which established USUHS and the Armed Forces Health Professions Scholarship Program (AFHPSP). USUHS’s mission is to “educate, train, and comprehensively prepare uniformed services health professionals, scientists, and leaders” to support the readiness of the uniformed services and the U.S. National Security Strategy. The university is co-located with Walter Reed National Military Medical Center at Naval Support Activity Bethesda, Maryland. USUHS also partners with several military treatment facilities and units across the United States that serve as student clinical sites and host certain research projects. Source: Prepared by CRS, based on a compilation of Defense Wide Budget Documentation, Defense Health Program, for FY2009-2020. Notes: *The FY2020 figure is the amount requested by DOD. Actual year-dollars, not adjusted for inflation. Figures are rounded. Funding The Defense Health Program account, under Operation & Maintenance in the annual defense appropriation, funds USUHS. From FY2009 to FY2019, the annual appropriation for USUHS increased by 95% (see Figure 1). For FY2020, DOD requested $170.6 million. USUHS also The Uniformed Services University of the Health Sciences receives external funding from other academic institutions, research organizations, federal agencies, and private entities to conduct certain medical research or programs. For academic year 2018-2019, USUHS received $210.6 million in total research funding awards, of which $41.5 million (20%) was from non-DOD sources. Academic Programs In addition to training physicians, Congress has directed the establishment of other health professions training programs at USUHS. The university offers a range of accredited degree or certificate-granting academic programs, such as Doctor of Medicine (MD), Doctor of Philosophy (numerous fields), Doctor of Nursing Practice, Doctor of Public Health, and several master’s and bachelor’s-level degrees. Academic programs organized under four schools:     F. Edward Hebert School of Medicine Daniel K. Inouye Graduate School of Nursing Postgraduate Dental College College of Allied Health Sciences Eligibility and Admissions Statute (10 U.S.C. §2114) requires the SECDEF to establish eligibility and admission requirements for USUHS. Each academic program establishes certain “academic, intellectual, and personal” admission requirements. Congressional nominations are not required for admission to USUHS. This statute also states that all students in the MD program must be a commissioned officer of a uniformed service. Civilians accepted into the MD program are commissioned as a second lieutenant or ensign (O-1 pay grade) prior to matriculation and remain in an active duty status during their studies. Prior military experience is not required. However, all applicants must meet commissioning requirements, including standards for physical and medical fitness prior to matriculation. Programs in the Postgraduate Dental College and College of Allied Health Services are available to active duty servicemembers only, while other programs in the School of Medicine and the School of Nursing are available to active servicemembers and civilians. Military Service Obligation and Tuition Servicemembers attending USUHS are typically required to fulfill a military service obligation (or service at a designated federal agency, if a USPHS member). The length of obligated service varies by academic program. MD graduates are statutorily required, by 10 U.S.C. §2114, to serve a minimum of 10 years, of which 7 years must be on active duty and the remaining time in the reserve component. Time spent on graduate medical education (i.e., medical residency program) does not count toward the service obligation. Generally, civilian graduates do not incur a military or national service obligation. USUHS does not charge tuition; however, students may be required to pay certain costs for books or other materials. Research Activities USUHS conducts biomedical research related to “military health needs” and “improvement in the health and wellbeing of the warfighter” through its 15 research centers, programs, and institutes. The university also partners with other federal and non-federal organizations through grants, contracts, cooperative agreements, and memoranda of understanding. Considerations for Congress The following lines of inquiry may support congressional oversight of the university and clarify the effectiveness of USUHS in addressing military medical personnel shortages. Military Recruitment and Retention  Critical shortages in certain clinical specialties (e.g., general surgery, anesthesiology, critical care) continue to challenge the military’s medical workforce requirements. What actions can USUHS take to address these shortages?  Numerous studies have reported that USUHS graduates tend to serve on active duty longer than their peers who have entered military service through other programs (i.e., AFHPSP, direct commission, financial assistance program). How can USUHS increase the capacity of its MD program and what resources would be needed?  Historically, Congress has directed the establishment of other health care training programs at USUHS. How can Congress best help these training programs meet DOD and USPHS requirements for other health care professionals (e.g., nurses, dentists, technicians)? Training Costs  Since 1976, numerous studies have noted that the annual education costs are lower for scholarship (i.e., AFHPSP) students than USUHS students. What role should cost have in determining future growth or reduction of these programs?  In 2018, the GAO recommended “USUHS develop a reliable method to accurately determine the cost to educate its medical students.” USUHS has since contracted with the Institute for Defense Analyses (IDA) to “determine the value proposition of USUHS students.” What are the findings of the IDA study? How will these findings inform the university’s ability to monitor its education costs and effectiveness compared to other medical accession programs? Relevant Statutes and Regulations 10 U.S.C. §§ 178, 2112-2117 32 C.F.R. §§ 242.1-242.10 CRS Products CRS In Focus IF10530, Defense Primer: Military Health System, by Bryce H. P. Mendez Other Resources DOD Instruction 5105.45, Uniformed Services University of Health Sciences (USU), May 30, 2019 GAO, Military Personnel: Additional Actions Needed to Address Gaps in Military Physician Specialties, GAO-18-77, February 2018 DOD, Report to Congress on Additional Actions Needed to Address Gaps in Military Physician Specialties, September 2019 Bryce H. P. Mendez, Analyst in Defense Health Care Policy IF11385 The Uniformed Services University of the Health Sciences Disclaimer This document was prepared by the Congressional Research Service (CRS). CRS serves as nonpartisan shared staff to congressional committees and Members of Congress. It operates solely at the behest of and under the direction of Congress. Information in a CRS Report should not be relied upon for purposes other than public understanding of information that has been provided by CRS to Members of Congress in connection with CRS’s institutional role. 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