Increasing Surgical Volume for Active Duty Surgeons Through Use of Clinical Opportunities Outside the Military Treatment Facility Yields Significant Benefits to Surgical Readiness

Introduction: The Military Health System (MHS) created a readiness program that identified the knowledge, skills, and abilities (KSAs) necessary for surgeons to provide combat casualty care. Operative productivity is assigned an objective score based upon case type and complexity which is then totaled to assess overall readiness. In 2019, only 10.1% of surgeons met goal readiness threshold. At one Military Treatment Facility (MTF), leadership took an aggressive approach towards increasing readiness by forming Military Training Agreements (MTAs) and allowing Off Duty Employment (ODE). We sought to quantify the efficacy of this approach. Methods: Operative logs from 2021 were obtained from surgeons assigned to the MTF. Cases were assigned CPT codes and processed through the MHS KSA calculator. Each surgeon was surveyed to identify time away from clinical duties for deployment or military training. Results: Nine surgeons were present in 2021 and spent an average of 10.1 weeks (19.5%) abroad. Surgeons performed 2343 cases (Avg 260±95) including 1575(Avg 175; 67.1%) at the MTF, 641(Avg 71.2; 27.4%) at MTAs, and 167(Avg 18.6, 7.1%) during ODE. Adding MTA and ODE caseloads increased KSA scores by 56% (17,765 ±7,889 v 11,391 ±8,355). Using the MHS threshold of 14,000, three of nine (33.3%) surgeons met readiness threshold from MTF productivity alone. Including all cases, seven of nine (77.8%) surgeons met threshold. Conclusion: Increased use of MTAs and ODE significantly augments average caseloads. These cases provide considerable benefit and result in surgeon readiness far exceeding the MHS average. Military leadership can maximize the chances of meeting readiness goals by encouraging clinical opportunities outside the MTF.