36th MDG manning shortages affect available appointments Published May 5, 2008 By Staff Sgt. Angelique Smythe 36th Wing Public Affairs ANDERSEN AIR FORCE BASE, Guam -- The 36th Medical Group will experience a significant nurse and provider manning shortage throughout the summer of 2008, which will cause a decrease in access to health care here. This is due to deployments, permanent changes in duty stations, and manning shortfalls. The medical clinic is authorized to have five medical providers in the family medicine clinic. By June, they will have only two, and only 43 percent of nurses will be available. A total of 1,300 appointments per month should be available to service Andersen's 6,500 beneficiaries. When the biggest point of the manning shortage hits, the 36th MDG will be running approximately 500 appointments short. Though there may be people who will not receive appointments when requested for some minor problems, the 36th MDG wants to be sure that no one will be at risk for a bad outcome because they could not receive an appointment. "In the past, we've had a hundred percent access to care, and anyone who wanted or needed an appointment could get it," said Lt. Colonel Robin Schultz, 36th Medical Operations Squadron commander. "However, with a cold, viruses tend to run their course, and small cuts heal a lot of times without any of our best efforts. We certainly don't want someone who has chest pains, difficulty breathing or a significant injury to not be able to get access to health care." The 36th MDG has engaged in various efforts to mitigate this and prevent patient safety problems so that those who really need to be seen by a health care provider can receive an appointment. "We have requested manning assist from Pacific Air Forces," said Colonel Schultz. "Unfortunately, the remainder of the Air Force Medical Service in all of PACAF is in a very similar situation to us, so we don't anticipate seeing the fruition of that." The 36th MDG is also attempting to reclama deployments by providing Air Force Personnel Center with justification on why their Airmen cannot go on some of the deployments. "We don't know how that will work out," said Colonel Schultz. They have also contracted with a vendor used by the Air Force Medical Service to get a contracted physician assistant to work here. She is expected to be available by the first week of June. "Those things we've listed are all external to us - things we've tried to put in motion that will help with our access to care," said Colonel Schultz. "But we also looked internally to see what we could do." There are several independent duty medical technicians here at Andersen. They are enlisted personnel who have had additional medical training. In a deployed location where there is no medical provider, doctor or physician assistant available, IDMTs can provide help to active duty personnel. An afternoon acute care clinic will be implemented so these IDMTs can see active duty personnel here. Also, flight surgeons have agreed to assist by working a few half days in the family medicine clinic and seeing patients who require acute appointments. Lastly, an agreement was made with Hoa Nguyen, M.D., of the American Medical Clinic (across the street from the Micronesian Mall) to see patients by appointment and through collaboration with TRICARE over the summer. This will be available for dependents - family care, pediatric care, and even some internal medicine care. "The beauty of this is it's fairly close to the base; and Dr. Nguyen is a former Air Force family practice physician who was trained at Eglin AFB, Fla., retired from the Air Force and chose to remain on the island," said Colonel Schultz. "That will help us get over this hump this summer." Those are the things the 36th MDG will do for the base population and beneficiaries. But they also need Team Andersen members to do a few things as well in order to make this work. "We ask folks to remember that health care is a partnership between the patient, their families and the clinic," said Colonel Schultz. One way to foster this relationship is by knowing what medications are for or even carrying a list of them when going to the clinic for an appointment. This will help the medical providers in comparing what's in their computer system and what the patients say they're taking - prescribed medications, over-the-counter medications, vitamins or herbs. It helps to know if all the medications will work together in making the individual well. Another way to build this relationship is by arriving to an appointment at the show time that was given by the medical clinic. This will help in preventing them from running behind and other patients will be able to get in to their appointments on time. It's also important that patients do not "no show" an appointment. "Make sure you call us far enough in advance to let us know that you can't make it to the appointment because that appointment can be given to someone else who may really need it," said Colonel Schultz. Also, for annual preventive health assessments, active duty members must be sure to complete the online questionnaire before going in to their appointments. That will help to keep appointments on time and help providers in answering any questions that they may have. The last request is that everyone provides feedback to the 36th MDG. "How are we doing? Are we meeting your needs? Is access to care improving? Are some of these things that we've tried not working? These are always opportunities for us to improve our processes," said Colonel Schultz. With all that has been outlined, the 36th MDG is expecting to get close to the 1300 appointments available per month during the summer months of high manning shortages. They are expecting to be fully manned and back to business as usual by September.