Annual Report of the Surgeon General United States Army Fiscal Year 1958
MILITARY PERSONNEL
Early Release Program for Medical and Dental Officers
The strength of the Army was reduced substantially during the year and, since authorizations for Medical and Dental Corps officers are correlated with the total troop strength, this resulted in reduced authorizations for both corps. The Department of Defense directive requiring the reduction was received after most of the Medical and Dental Corps officers who were to be ordered to duty during the year had already either entered on active duty or received active-duty orders, making a cutback in procurement impossible. Faced with a potential overage of some 60 medical officers and some 200 dental officers, The Surgeon General decided to initiate a voluntary early release program whereby Medical and Dental Corps officers who were ordinarily due for separation during the spring and summer of 1958 could be separated upon completion of 21 months' service rather than the normal 24. This program was announced in Department of the Army Message 304795, dated 15 January 1958. A total of 52 medical and 146 dental officers took advantage of the opportunity for early release. Aside from the fact that this program enabled actual strength of these corps to approximate more nearly the authorizations as of the end of the fiscal year, a savings in terms of military pay and allowances of about $300,000 was realized.
Reduction in Force for Reserve Officers
In order to meet Department of the Army programmed reductions in officer and warrant officer strength during the fiscal year, the Army Medical Service was required to release involuntarily 6 Medical Corps, 12 Dental Corps, 3 Veterinary Corps, 31 Medical Service Corps, and 40 warrant officers between October 1957 and March 1958.
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Legislation
Provisions for calling doctors to active duty.-With the expiration of the so-called Doctor Draft Act, substitute legislation enacted on 27 June 1957 amended the basic provisions of the Universal Military Training and Service Act with respect to personnel in the medical, dental, and allied specialist categories. This legislation authorizes the President to call to active duty individuals in these groups who are liable for service under the regular draft. It likewise authorizes the President to order to active duty any member of a Reserve component in a medical, dental, or allied specialist category for a period of 24 months, with or without his consent, if he is otherwise eligible for the draft (under age 35 and not a veteran).
Congress also continued the National Advisory Committee to Selective Service and several other administrative features of the Doctor Draft Act. Among these are provisions which (1) permit commissioned physicians and dentists on active duty to resign their commissions after completing obligated tours of duty, (2) exempt from induction physicians and dentists who are found physically disqualified for a commission, and (3) provide authority to use in their professional capacities, in an enlisted grade, those who refuse to accept or fail for administrative reasons to qualify for a commission.
The existence of this legislation has led many persons to volunteer for service under the Armed Forces medical and dental officer commissioning programs.
Medical and Dental Officers' Career Incentive Act.-The provision of the Medical and Dental Officers' Career Incentive Act of 1956 which authorized additional constructive credit for promotion purposes for officers of these two professional groups was implemented by Department of the Army Special Orders 43, dated 1 March 1958. This and other features that provide for increased special pay, additional longevity credit in recognition of time spent in medical or dental schools, higher initial rank, and more liberal promotion policies have apparently had a salutary effect. In any event, the decline in Regular Army Medical and Dental Corps strength, which was so alarming in 1955, has been checked at least for the time being.
Doctors of osteopathy.-Public Law 763, 84th Congress, approved 24 July 1956 (70 Stat. 608), authorized the appointment of osteopaths in the Medical Corps, Regular Army. Since the enactment of this law, the Department of the Army has made the following policy decisions:
1. The law will not be implemented with respect to appointments in either the Regular or Reserve components.
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2. Osteopaths will not be utilized in any capacity under circumstances where the Department of the Army can exercise control through appointive or contractual agreements entered into before utilization.
3. Osteopaths may be paid for their services under circumstances where prior arrangements are not possible, such as emergency medical care, certain physical examinations, and the Dependents' Medical Care Program.
4. Officers who earn a degree in osteopathy will not be transferred to the Medical Corps, and those who have active duty obligations, which they incurred through the Reserve Officer Training Corps or otherwise, will be relieved of such obligations, unless they desire to serve in their basic branch.
Army Nurse and Medical Specialist Act of 1957.-The principal provisions of this act, designed to make a military career more attractive for Regular officers of the ANC and AMSC, are as follows:
1. Increased from captain to major the permanent grade to which the average nurse or medical specialist may expect to attain in her career.
2. Created the permanent grade of colonel and increased the number of officers authorized in the permanent grade of lieutenant colonel.
3. Established a mandatory retirement system under which majors are required to retire after 25 years of service, and lieutenant colonels and colonels are retired on the same basis as officers of the other corps.
4. Broadened the authority for appointing nurses and medical specialists by raising the age limitations and authorizing initial appointments in the grade of captain for Reserve nurses and medical specialists who have not reached their 39th birthday and who have at least 7 years of active commissioned service.
5. Liberalized the method of computing service for purposes of entitlement to retired pay. Initial promotions under the new authority were made in January 1958. This act pertains only to Regular nurses
and medical specialists. Corresponding changes to Reserve personnel legislation have been approved by the Army Chief of Staff for submission to the next Congress.
Reserve Officer Personnel Act of 1954.-Several provisions of this act which become effective after 1 July 1960 will adversely affect the Army Medical Service. In general, this law attempts to parallel for Reserve officers the promotion and elimination provisions applicable to Regular officers. For example, the elimination of Reserve officers in the rank of lieutenant colonel and below is provided for upon completion of 28 years of service. The term 'years of service' is defined as the greater of the officer's actual and constructive commissioned service
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or his age less 25 years. Accordingly, 28 years of service really means attainment of age 53 unless the officer has more actual service. There are now in force, under the interim provisions of the Reserve Officer Personnel Act, certain policies applicable to Army Medical Service officers (other than MSC officers) which provide further discretionary retention until age 55, or 58 if colonel, without regard to retirement qualification, and beyond age 55 but not later than age 60 for those who can qualify for retirement during this 5-year period. The Surgeon General has strongly recommended the continuance of the present policies and the modification of the law which would permit this.
Medical Service Corps promotion list.-In May 1957, The Surgeon General approved the recommendation of an ad hoc committee that legislation be introduced to abolish the separate Medical Service Corps promotion list and to integrate Regular MSC officers into the Army promotion list. Differences developed between The Surgeon General and The Adjutant General in regard to the manner in which the actual integration was to be accomplished. Consequently, at the request of the Chief of the Medical Service Corps, the recommendation was withdrawn from legislative processing before being acted upon by the Deputy Chief of Staff for Personnel. It was determined that it might be more advantageous to postpone the integration for two or three years.
Medical program for West Point graduates.-The Surgeon General is supporting legislation initiated by the Assistant Secretary of Defense (Health and Medical) to establish a program whereby a limited number of U.S. Military Academy graduates would be afforded an opportunity to attend medical school, with tuition and fees paid by the Government. This legislation was still being reviewed within the Department of Defense at the end of the fiscal year.
Meanwhile, the Chief of Staff approved the requests of seven Academy graduates for leave without pay to attend medical school, with the understanding that they will accept Medical Corps commissions, if tendered, upon successful completion of their medical school training. Two officers in this status are now completing their freshman year at medical school. The others will enter medical school this fall. The Surgeon General has recommended that, at the individual's request, Academy graduates in this status be detailed to the Medical Service Corps, permitted to participate in the program for medical students, and ordered to duty during the summer months at the Brooke Army Medical Center or some other medical installation while in medical school.
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The Army's fiscal year 1958 requirements for medical and dental officers were met entirely from among those who participated in the Armed Forces Reserve Medical Officer Commissioning and Residency
Consideration Program, the Reserve Dental Officer Commissioning Program, and other voluntary procurement programs. For the first time since July 1951 no special draft call was necessary. The existence of special legislation governing the drafting of physicians and dentists stimulated a great number of young medical and dental school graduates to participate in the procurement programs in an effort to fulfill their military obligations at an early date. The number of medical participants approximated the Army's requirements, and nearly all who desired active duty were accommodated. The number of dental participants, however, far exceeded Army requirements, and it was impossible to accept all who wanted active duty.
Medical Corps.-As a result of the strong emphasis placed upon measures to increase the professional attractiveness of a career in Army medicine, the status of Regular Army medical officer procurement and retention is better than it has been in years. At the end of the fiscal year there were 1,555 Regulars in the Medical Corps, compared with a low of 1,338 on 1 July 1956. This number, however, is still below the post-World War II peak of 1,730 reached on 1 July 1953. The ultimate goal is to have a Regular Army Medical Corps of about 2,200. Regular Army strength figures do not include participants in the Senior Medical Student Program.
A ceiling of 200 has been placed on acceptances into the Regular Army Medical Corps of graduates from any one medical school class. This action was taken to prevent an oversubscription or 'hump' in the year-groups in which they would he placed on the promotion list. Thus far only the medical school graduates of 1955 have presented a problem.
The total number of Medical Corps officers on active duty at the close of the fiscal year was 3,786, almost 100 less than the 3,878 figure of a year ago. During the year, 1,147 medical officers were ordered to active duty.
The first benefits of the deferment portion of the Berry Plan were realized in July and August 1957 when 40 deferees, who completed the minimum residency training requirements for board certification in the specialties of anesthesiology and pediatrics, were ordered to active duty. The first large increment (241) of board-eligible physicians in all specialities will be ordered to active duty in July and August 1958.
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It is anticipated that an equal or larger number of deferees will be called to active duty each year thereafter, and in time this will materially alleviate the Army's continuing need for qualified specialists. The planned increment of specialists for succeeding fiscal years, based on the total of 1,253 participants currently deferred, is 241 for fiscal year 1959, an average of more than 300 annually during the 3 following years, and 79 in fiscal year 1965. The purpose of the Berry Plan is to enable the Army to obtain more professionally experienced doctors by deferring physicians from active duty so that they may acquire training beyond internship (AR 135-105). The plan is named after its originator, Frank B. Berry, M.D., Assistant Secretary of Defense (Health and Medical).
A study has been made as to the effectiveness of the Senior Medical Student Program with the result that the number of spaces for fiscal year 1959 has been reduced from 200 to 100. It is believed that this will provide a sufficient number to meet the needs of the Army Medical Service and that the reduction will have a favorable effect on the Medical Intern Program.
A revision of Department of Defense Instruction No. 6000.2, dated 2 January 1958, subject: Medical Internship and Residency Training Policy, authorized candidates in Reserve status to receive residency training. The Army policy is to permit reservists to receive such training only after priority of consideration has been given to all Regular Army officers and Regular Army applicants requesting residency training.
Dental Corps.-The Regular Army strength of the Dental Corps increased from 426 to a new high of 505, compared to the authorized strength of 695. During the year, 101 applications for Regular Army commissions were received, in comparison to 156 in the previous year. Of the 156 applications in fiscal year 1957, however, 75 were from participants in the Senior Dental Student Program. The requirement that participants in this program make application for a Regular Army commission was withdrawn this year, so there were actually only 81 comparable applications submitted. The increase in applications and the decreased rate of resignations (only 0.6 percent of average strength) are attributed mainly to the Career Incentive Act of 1956, the efforts of the medical procurement officers, and the local training programs of the installation dental surgeons.
At the beginning of the fiscal year there were 2,173 dental officers on duty and the authorized year-end strength was 2,025. During the first quarter, 530 officers were ordered to duty, increasing the total on duty to 2,703. In the second quarter, when the strength of the Army
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was decreased by 100,000, the ceiling was reduced to a year-end total of 1,840. This reduction necessitated the implementation of the Early Release Program (discussed above). The strength at the end of the fiscal year was 1,894 as compared to 2,173 a year ago. As in fiscal year 1957, the Dental Corps was compelled to refuse many applications for active duty because of the projected overstrength. It is anticipated that the overstrength will continue during the first half of fiscal year 1959.
The Armed Forces Reserve Dental Officer Commissioning Program produced 437 dental officers during fiscal year 1958 and continued to be the prime source of procurement. With more individuals allocated to the Army than could be assigned to duty, it became the responsibility of CONUS Army commandeers to honor the request for active duty with the Army on a 'first-come, first-served' basis. Those who were not called were given the opportunity to volunteer for active duty in fiscal year 1959, and 128 indicated such a desire. These volunteers, together with the participants in other programs, reduced spaces to such an extent that it was possible to commission only 75 from among the 641 applicants from the 1958 dental graduates.
During the year, 40 participants in the Senior Dental Student Program were graduated and ordered to duty, and a similar number was selected from among 227 applications received for the 1958-59 academic year.
The response to the Early Commissioning Program for dental students was much greater than last year. This program is a Reserve officer procurement program and is not related to active duty upon graduation, except as the needs of the service dictate. Regulations governing the program are being reviewed.
Veterinary Corps.-Concurrent with the withdrawal of legislation recommending the abolishment of the Veterinary Corps, the Secretary of the Army authorized the appointment and entry on active duty of 25 veterinarians by 31 December 1957 and an additional 49 by 30 June 1958. Priority of consideration for active duty within these quotas was given to those veterinarians who were serving on active duty in an enlisted status or in a commissioned status with other corps. As a result of this policy, 6 enlisted men and 3 veterinary officers of other branches were appointed in the Veterinary Corps and were ordered to active duty by December 1957. An additional 15 veterinarians without military status, to whom commitments had been made regarding active duty, were also appointed and were ordered to active duty by December 1957.
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Difficulty was encountered in procuring the additional quota of 49 veterinarians by 30 June 1958, primarily because of the lack of volunteers from among those veterinarians who were graduated before 31 December 1957. To correct this situation, Army commanders were authorized to accept and process applications received from senior veterinary students who were within 4 months of graduation. By the end of the fiscal year it was possible to recruit only 35 of the 49 veterinarians authorized.
Although the Veterinary Corps was authorized a Regular Army strength of 171, the actual strength at the end of the fiscal year was only 154. There are 27 veterinary officers qualified to fill the 17 vacancies, but the Department of Defense will not authorize filling these spaces until a definite decision is reached regarding the future of the Corps.
Medical Service Corps.-Exclusive of ROTC participants in the Senior Medical and Dental Student Programs, initial plans were to order 355 MSC officers to active duty in fiscal year 1958. Of this number, 255 were to be obtained from direct procurement and 100 from the Reserve Officer Recall Program. With the reduction in the size of the Army, this procurement goal was reduced to 208 for direct procurement and to 46 in the recall program.
When critical shortages of specialists developed in the allied sciences field, the Deputy Chief of Staff for Personnel in February 1958 reinstituted 62 active-duty spaces for the procurement of 30 optometrists, 11 clinical psychologists, 8 clinical laboratory officers, 8 social workers, and 5 sanitary engineers.
Revised AR 601-100, dated 9 December 1957, and changes 4 to AR 601-124, dated 29 August 1957 (since superseded by AR 601-124, 2 January 1958), provide opportunities for appointment in the Regular Army of Reserve MSC officers on active duty. The former restrictions of specified periods of active duty and special dates for the submission of applications have been removed. The age limit is also modified by subtracting all periods of active commissioned service since 6 December 1941 from the current age of the applicant to determine whether the age limit of 30 is exceeded. Only applicants who can complete 20 years of active commissioned service by age 55 are eligible to apply. Any Reserve officer of the Army on active duty (including active duty for training) who meets these requirements may apply for a Regular Army commission at any time, unless application is still pending under the special Regular Army Augmentation Program (Circular 601-26, 1956) discussed below.
Department of the Army Circular 601-17, dated 29 April 1958,
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authorizes appointment in the Regular Army of former Regular Army officers and commissioned officers of the National Guard and Army Reserve not on active duty, as well as those on obligated tours of active duty.
These new procurement programs are designed to attract the necessary number of officers with the required qualifications through full utilization of all sources of potential officer material. Graduates of accredited colleges and universities not having ROTC, or those who could not participate in ROTC activities for valid reasons, are eligible for direct appointments. Certain technical specialists with advanced degrees or extensive experience in fields allied to medicine or business administration may be appointed from civilian life under the Technical Specialists Program (sec. VI, AR 601-100).
In the first phase of the Regular Army Augmentation Program, for which selections have been completed, 220 MSC officers have been appointed in the Regular Army to date. Even with this augmentation the strength of the Regular Army Medical Service Corps amounted to only 1,089, or more than 500 below the current interim authorization of 1,612.
The largest number of applicants for Regular Army appointment were officers who entered on active duty in the early 1940's. This placed that particular group within the critical year-groups where vacancies were limited. Consequently, adjustments in service credit were required for officers falling within this zone in order to insure that a maximum number would be appointed in the Regular Army. For example, where imbalances in the promotion lists do not permit the appointment of outstanding officers into the Regular Army in certain grades, such individuals may be tendered appointments in other zones lower in the promotion lists where vacancies exist. This adjustment in service credit will have a direct bearing upon Regular Army promotions and statutory retirement.
The Medical Service Corps has been unable to procure and retain a sufficient number of junior officers. At the end of the fiscal year, the corps had a total strength of 3,730 officers, of whom approximately 40 percent were in the grade of lieutenant. In order to maintain the required junior officer strength, it was necessary to call 2,043 to active duty during the period from fiscal year 1955 through fiscal year 1957. In that same 3-year period, 2,155 lieutenants were separated from the corps. Only 163 of the lieutenants are career officers, representing only slightly more than 4 percent of the corps strength.
During the past year, 44 ROTC officers entered on active duty in the corps for a tour of 2 years. Experience has shown that the ROTC
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is a poor source of career officers. It is preferable to procure these officers through the direct-appointment system under which the normal selectivity ratio is usually about one appointment out of five applications.
Army Nurse Corps.-The goal of increasing the strength of the Regular Army Nurse Corps was not attained, but the emphasis continued to be placed on procuring student nurses in the hope that a larger number will eventually desire Regular Army status. During the year, 98 student nurses completed their training in the Army Student Nurse Program, which began in 1956, and were commissioned, while 180 more were enrolled in the program. The majority of the latter will be commissioned and enter on active duty in fiscal year 1959.
The Regular Army strength of the corps at the end of the fiscal year was 1,250, a net loss of 24. The total active duty strength also declined, from 3,392 to 3,356. Army Nurse Corps officers were supplemented by the employment of about 1,350 civilian nurses. Approximately 250 of these were assigned overseas, primarily in Okinawa, Japan, Hawaii, and Germany, excluding indigenous nurses employed in Germany and Japan.
The Bolton Bill (Public Law 294, 84th Congress, approved 24 October 1955), which provided for the commissioning of male nurses in the Army Nurse Corps, has resulted in attracting many highly qualified men, especially in the clinical fields of nursing. Training in airborne nursing has also been made available to male nurses on a voluntary basis. Approximately 180 male nurses are on active duty.
Increased efforts are being made to procure nurses for the Army Health Specialty Program where nurses are assigned in the field of public health.
Army Medical Specialist Corps.-Shortages still exist in the Dietitian and Occupational Therapist Sections of the Army Medical Specialist Corps, even though there was a marked improvement in the procurement of dietitians. The procurement of occupational therapists continued the upward trend started the previous year. A sufficient number of physical therapists was procured to meet the requirements.
The chronic shortage of dietitians necessitated the initiation of three new educational programs: Summer Dietetic Practicum, Army Student Dietitian Program, and Graduate Dietitian Student Program. Forty applications were received for the Practicum and 32 were appointed to participate.
Applications received for the fiscal year 1959 dietetic and occupational programs numbered 50 percent more than for fiscal year 1958 programs.
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The total active duty strength of the Army Medical Specialist Corps declined from 447 to 412. Although procurement for the Regular Army increased more than 100 percent over that for fiscal year 1957, the net gain in Regular Army strength was slight, from 177 to 181.
Officer Assignment
Major problems in assigning medical officers continued to be (1) the shortage of qualified physicians in most specialties and subspecialties and (2) the acute shortages in the summer months resulting from the
fact that most officers are ordered to active duty during July and August. While no relief appears possible in the matter of summer shortages, the general shortage of trained specialists was somewhat relieved and promises to be virtually eliminated by the end of fiscal year 1959 or early the following year. There are still inadequate numbers of physicians trained in surgery, obstetrics and gynecology, psychiatry, orthopedics, ophthalmology, and otorhinolaryngology. Most Armywide requirements have been met in pediatrics, anesthesiology, internal medicine, and radiology. On-the-job training in certain specialties was conducted on a considerably reduced scale. Only 124 general duty medical officers were trained, as compared to 329 in fiscal year 1957.
Oversea staffing, a major problem in the summer of 1957, was considerably improved by the end of the fiscal year. Although both the European and Far East Commands had shortages in June that will continue through August, the severity of these shortages has been greatly minimized, and neither command should have any difficulty in bridging the gap until replacements arrive late in August.
The retirement during fiscal years 1957 and 1958 of approximately 300 Medical Service Reserve officers under the vitalization program has created difficulties in meeting requirements in certain specialty fields. The loss of 84 supply officers represented 17 percent of the total authorization in that field.
The chronic shortage of clinical psychologists continued. Of 78 such officers authorized, only 46 were on duty at the close of the fiscal year. A similar situation existed in regard to sanitary engineers, with the number on duty sufficient to meet only 70 percent of the authorization.
Due to the increased requirement for commissioned optometrists and a procurement prohibition during the early part of the year, there was an increasingly severe shortage in this field. Although 127 of the
142 authorized were on duty at the end of the fiscal year, a loss of approximately 40 during the first half of fiscal year 1959 will further aggravate the shortage.
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The authorization for Army Nurse Corps officers was reduced from 3,525 as of 30 June 1957 to 3,275 as of 30 June 1958.
The shortage of dietitians and occupational therapists continued to present a problem in making AMSC assignments.
Under the Mutual Security Program, mobile training teams were assigned to temporary duty with military missions of military assistance advisory groups in foreign countries for the purpose of training indigenous personnel in functions of the Army Medical Service. Four teams were sent to Taiwan, two to Peru, and one each to Turkey and Thailand.
Officer Promotions
Reductions in the strength of the Army greatly curtailed temporary promotions during the fiscal year. Zones of consideration for male corps of the Army Medical Service generally paralleled those established for the Army Promotion List. Medical and dental officers, however, are eligible for promotion 1 year in advance of their contemporaries on the Army Promotion List. Officers on the recommended lists are promoted in the order of seniority as vacancies occur.
Enlisted Personnel
Strength.-Consistent with the total Army strength, the authorized enlisted strength of the Army Medical Service was lower in fiscal year 1958 than the average for the previous year. This was due to the inactivation of several medical units. The actual strength, however, was somewhat higher than in fiscal year 1957.
Higher retention and enlistment standards.-A program was implemented to release from active duty enlisted personnel who lack job performance potential. This elimination is based upon the recommendations of commanding officers and low scores in the Army Classification battery tests. Concurrently, the Department of the Army raised its enlistment and reenlistment standards, both mental and physical. These two programs have improved the caliber of enlisted men in the Army Medical Service.
MOS imbalance in grades E5-E7.-Considerable difficulty was experienced in adjusting the imbalance of skill levels and pay grades in certain military occupational specialties. A Department of the Army retraining program was instrumental in reducing the overage in some MOSs and in bolstering the strength in those in which shortages existed. Although this program was not generally well received in the field, it achieved some excellent results. Maintenance of MOS?
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grade balance is one of the problems that will continue to receive attention in fiscal year 1959.
Atomic reactor power plant instruction.-Two more enlisted men were assigned to Fort Belvoir, Va., to undergo instruction in the fundamentals and mechanics of the atomic reactor power plant. These individuals were selected for their background in patient care and treatment and were not required, as formerly, to possess supply and mechanical ability. This training program is expected to produce the personnel required in a nuclear plant to give assistance and guidance to the commanding officer on the health aspects of his plant.
Reenlistment program.-Th~ reenlistment program was given additional emphasis by the new career presentation kit, pamphlets, reenlistment progress reports, and liaison visits. Although the Army Medical Service leads the other technical services in the percentage rate of reenlistment, there is still need to improve the program.
Selection of applicants for advanced courses.-Efforts were made to improve the quality of career enlisted personnel selected for advanced enlisted courses. It was possible during the year to screen applicants carefully and to reject those not qualified, as distinguished from the former policy of accepting nearly all candidates, including those for whom spaces were not available at the time of their original applications.
