DoD uses a mix of military, federal civilian and contractor personnel in the military health system but the planning process does not take all the comparative factors into account and there is a bias in favor of using uniformed personnel, GAO has found.
It said that the department’s medical positions break down as about 48 percent active duty, 30 percent reserve, 18 percent federal civilian and 4 percent contractor. They fulfill roles ranging from first responder care in combat zones to routine care for family members and retirees in DoD hospitals and clinics.
The department “has not assessed the suitability of federal civilians and contractors to meet operational medical personnel requirements” even though non-military personnel already play support roles in areas including combat support. “Military department officials expressed a preference for using military personnel and cited possible difficulties in securing federal civilian and contractor interest in such positions. An assessment of the suitability of federal civilians and contractors could provide options for meeting operational medical personnel requirements,” it said.
Further, DoD policy states that such workforce decisions “must be made with an awareness of the full costs,” taking into account costs such as manning, training and equipping. However, “when determining the balance of active and reserve component medical personnel, the military departments’ processes generally do not consider full personnel costs, including education and benefits. Specifically, officials stated that the Army and the Navy do not consider personnel costs in their assessment of the appropriate balance between active and reserve personnel, and the Air Force’s analysis had some limitations.”
GAO found that DoD has done more to determine the proper mix of military, federal and contractor employees at military treatment facilities but it lacks a strategic workforce plan.