Flashback to the mid-1960s: Combat medics and corpsmen were providing outstanding health care to our troops in Vietnam, extending the capability of military physicians and nurses. These combat veterans returned to a country that was in dire need of the kind of medical skills they possessed.
In response, Dr. Eugene Stead, Jr, and Dr. Harvey Estes started the first PA program at Duke University, and at the University of Washington, Dr. Richard Smith launched the MEDEX PA training program—both specifically focused on fitting in the unique experience and knowledge of medics and corpsmen with those of community primary care physicians. Meanwhile, Dr. Henry Silver and Loretta Ford, RN, began the first training program for NPs at the University of Colorado.
All these programs recruited individuals who had been medics or nurses in Vietnam. According to Sadler et al, “The political appeal of providing a useful civilian health occupation for the returning Vietnam medical corpsman is enormous.”1
This was a monumental decision. The military had provided extensive training to these medics and corpsmen, who were responsible for providing battlefield medical care—emergent and ongoing care—in the absence of a readily available physician or nurse. They were considered an essential staple of military support, as every element was required to have a medic in attendance during hazardous missions. They were normally co-located with combat troops in order to easily move with them and monitor their health. They initiated treatment at the site of accident or injury, maintained medical support during evacuation to health care facilities, and provided continued treatment in those facilities.
Back to the present: Our professions (PAs and NPs) now have an opportunity to tap the skills of about 8,000 medics and corpsmen who leave military service in Iraq and/or Afghanistan each year2 by offering them a pathway to become PAs or NPs. This was our legacy in the 1960s, and now these dedicated men and women can offer their hard-earned competencies to our communities in need of primary health care.
Today’s medics and corpsmen receive far more advanced training than did those who served in Vietnam—or even in the first Gulf War. On average, they now receive training equivalent to that of an EMT, including wound management and trauma level care.
According to VFW data, more than 1,300 Army medics have served in Afghanistan, and more than 8,000 have served in Iraq. Due to rapid deployment of medics and corpsmen in the combat zones, more than 90% of soldiers who are wounded today are saved (compared with 73% in Vietnam).3 If these skilled medics and corpsmen can provide primary care in a combat zone, they can no doubt do so in rural and remote areas here at home—provided they are given the chance to do so with complementary civilian education.
PAs and NPs are well established in civilian and military health care, but barriers in the academic community prevent some of the most experienced medics and corpsmen from entering NP and PA education programs. It is time to find a solution—as Stead, Estes, Smith, Silver, and Ford did in the 1960s.
Returning medics and corpsmen face several obstacles in the civilian setting:
1. Lack of an undergraduate degree (some undergraduate work, but thousands of hours of real-world direct patient care provided)
2. Lack of formal science prerequisites
3. Absence of formal credentialing for military skills, knowledge, and training
4. Personal health issues (including PTSD and physical disabilities)
5. Family support issues
6. Lack of access to financial aid for professional degrees (although the GI bill program provides up to 36 months of education benefit that may be used for undergraduate degree and certificate programs).
Based on what we learned in the 1960s, returning medics and corpsmen could give back tenfold to their communities. Don’t we educators and clinicians have social, moral, and ethical responsibilities to these veterans—and to society—to help them gain access to the PA and NP professions?
Thousands of combat medics and corpsmen will soon return home with valuable medical experience. The challenge will be to match them up with opportunities and resources in the civilian medical field. How can we help them make the transition? Here are some suggestions:
1. Support a veteran’s preference process for admission to both undergraduate and professional school programs.
2. Create and support bridge programs, giving veterans accelerated opportunities to complete their undergraduate degrees and enter graduate programs.
3. Support the American Council on Education on the evaluation of equivalency of military training to that in the civilian sector (www .militaryguides.acenet.edu/Occu pationSearch.asp).