By Hope Hodge Seck
HOW THE NATION IS FAILING TODAY'S TROOPS AND VETERANS
AFTER 13 YEARS OF WAR, TROOPS FEEL BURNED OUT AND WITHOUT A SENSE OF MISSION. MORE DOUBT THEIR LEADERS AND THEIR JOB SECURITY.
For many of the war-weary troops who deployed to combat zones over and over again for 13 years, the end of an era of war in Iraq and Afghanistan is good news.
But for Marine Sgt. Zack Cantu and other service members, it's a total morale killer. For many of them, particularly the young grunts and others in combat arms specialties, it's the realization that they may never go into battle for their country and their comrades.
"Most people in [the Marine Corps] are in because of the wars," said the 25-year-old Cantu, a former infantryman at Camp Pendleton, California. Cantu has retrained as a telephone system and computer repairer, a specialty more likely to survive as the service downsizes.
"Now, everyone's coming to the realization, 'It's probably not going to happen for me,'" he said.
The wars against America's enemies gave troops like Cantu a noble purpose. Their training had focus, their sacrifices were appreciated by a largely grateful nation. That gratitude was reflected from the White House to the citizen in the street, all of whom heaped praise upon military members for their service.
Congress lavished generous pay increases and expanded benefits on them while spending deeply to provide the gear and weapons they needed. Recruiters raced to grow the size of the services, and society vowed to never again undervalue the 1 percent of the country who stepped forward to keep them safe.
Today, however, that gratitude seems to be dwindling. The services have weathered several years of deep cuts in funding and tens of thousands of troops have been unceremoniously given the boot. Many still in uniform and seeking to retire from the military fear the same fate, as those cuts are not yet complete.
A Military Times survey of 2,300 active-duty troops found morale indicators on the decline in nearly every aspect of military life. Troops report significantly lower overall job satisfaction, diminished respect for their superiors, and a declining interest in re-enlistment now compared to just five years ago.
Today's service members say they feel underpaid, under-equipped and under-appreciated, the survey data show. After 13 years of war, the all-volunteer military is entering an era fraught with uncertainty and a growing sense that the force has been left adrift.
One trend to emerge from the annual Military Times survey is "that the mission mattered more to the military than to the civilian," said Peter Feaver, a political science professor at Duke University who studies the military. "For the civilian world, it might have been easier to psychologically move on and say, 'Well, we are cutting our losses.' But the military feels very differently. Those losses have names and faces attached to [them]."
'Bare necessities'
According to the Military Times survey, active-duty troops reported a stunning drop in how they rated their overall quality of life: Just 56 percent call it good or excellent, down from 91 percent in 2009. The survey, conducted in July and August, found that 73 percent of troops would recommend a military career to others, down from 85 percent in 2009. And troops reported a significant decline in their desire to re-enlist, with 63 percent citing an intention to do so, compared with 72 percent a few years ago.
Army Spc. David Potocnik is one of the troops who has seen morale in his unit take a hit, though he can't really put a finger on why. A Black Hawk mechanic with 2nd Battalion, 4th Aviation Regiment, 4th Combat Aviation Brigade, at Fort Carson, Colorado, Potocnik said stress levels in his unit seem to be on the rise, despite a softening deployment tempo. Fellow soldiers, he said, struggle to connect what feel like excessive training and additional duties in garrison with operational readiness and the overall mission.
"There are people who are really motivated, really high-speed ... but they don't seem to be a majority," he said. "You'd think garrison would be more relaxed, but it's frantic — for no reason."
Troops said more stress is created by long-term budget cuts imposed on the force through sequestration — the much-despised but apparently inexorable automatic spending reductions over a decade approved by Congress — and drawdown measures designed to shrink the force. An Air Force captain working in security forces said the fiscal insecurity is taking its toll, causing more workplace exhaustion and frustration. And personal career uncertainty, he said, is driving many of his colleagues out of the service, perhaps earlier than they otherwise would have departed.
"It makes it really hard for folks to build strong résumés for themselves if we can't provide the opportunities for them, both in and out of the service," he said. "If they see us pinching pennies, and we can't afford to send them to school, there's no long-term stability for them. So at that point, they start to look for a job outside, where you don't have the additional strain on their family."
A Navy aviation machinist's mate first class based in El Centro, California, said operational budget cuts left him and fellow sailors cannibalizing working parts from other aircraft entering phased maintenance so they could repair higher-priority broken jets. Even uniforms are in short supply, he said, as the Navy embarks on what could be a decade of scrimping under sequestration.
"We are on the bare necessities and sometimes not even that. For example, I need new boots but they'll ask me, 'How long can you stretch that?'" he said.
Dismal outlook
Survey data show that service members are also feeling pain in their own wallets. Congress this year capped the military pay raise at 1 percent, rather than the 1.8 percent that would have kept pace with average annual growth in private-sector wages. It was the first military pay raise since 1999 that did not at least keep pace with private-sector wages, and it was also the lowest annual military pay raise in 40 years.
To save money, the Pentagon had sought to roll back the tax-free housing benefit provided to troops by, in effect, making troops pay 5 percent of their housing with out-of-pocket cash. The new deal on Capitol Hill will result in next year's housing allowance covering 99 percent of estimated costs and troops themselves covering the 1 percent shortfall. Service members are unlikely to see an outright reduction in their housing allowance unless they change duty stations, but rates for troops moving into new areas will be set slightly lower when compared to projected housing costs.
Several services also have cut pay for special duty assignments — such as recruiters, divers, drill sergeants and others — while promotions in some fields slow as competition for jobs during a drawdown heats up. And of course, those troops who have frequently collected hazardous duty and deployment pay over the last decade may now have fewer opportunities to do so.
In 2009, 87 percent of active-duty troops who participated in Military Times' survey rated their pay and allowances "good" or "excellent." This year, the figure was just 44 percent. When asked how quality of life might change over the next several years, 70 percent of respondents predicted it would decline further.
A Navy fire controlman chief with 10 deployments said budget fears are contributing to a feeling of distrust and abandonment. "If sailors are worried about not getting paid, how am I supposed to do my job?" he said. "I'm not an effective warfighter if I don't have the backing of my government at home."
A pervasive sense of pessimism about the post-9/11 wars may also contribute to the overall feeling of dissatisfaction among troops and a feeling of detachment from the decision-makers who sent them to those fights. Of those surveyed, 52 percent said they had become more pessimistic about the war in Afghanistan in recent years. Nearly 60 percent felt the war in Iraq was somewhat unsuccessful or not at all successful.
Keeping a wary watch
Despite the cloudy outlook, Pentagon officials report recruiting figures are as high as ever across the services. Data for the first quarter of fiscal 2014 showed all the services except the Army Reserve had achieved 100 percent of their recruiting goal or better. Predictably, retention also remains high, officials say, as most services look to natural attrition to meet mandated reductions in force size, and many troops fight to save their place on active duty, in spite of the quality-of-life and budget troubles.
Many of them hang on only because prospects for good civilian jobs have been dismal for many years. And often those who do land good jobs on the outside are those the military can least afford to lose.
Last year, retired Army Lt. Gen. David Barno joined a small chorus of military experts who decry a perceived "brain drain." Barno wrote for the website Foreign Policy that the services are losing their most talented junior officers and enlisted leaders to opportunities in the civilian sector because military leadership wasn't providing them with the right opportunities or fighting hard enough to keep them.
Departing Defense Secretary Chuck Hagel said all military leaders are watching morale very closely, and for the most part he believes it is holding up.
"The reality is that every day I'm sure is not jolly," Hagel told the Military Times on Nov. 14. "But morale is critically important for any of us, and any institution to do our jobs right. And we watch it. We are concerned all the time about it, but I think, overall … the morale of our men and women in uniform, our civilians, is high. I know there are different dimensions of that, depending on the force."
When Hagel made those comments, he was on a visit to Minot Air Force Base, North Dakota — where he was trying to buck up the morale of airmen in the intercontinental ballistic missile community. Over the past year, repeated scandals in ICBM units — drug use, cheating on tests, failing a safety inspection — have forced the Pentagon's top leadership to focus attention on the community. That included firing several nuclear commanders, finding more money and manpower for ICBM units and taking dozens of measures to improve quality of life for those airmen.
This morale crisis is prompting Air Force officers to give new thought to how procedures and policies can improve or erode morale. For example, Lt. Col David Rickards, the 91st Operations Group deputy commander at Minot, believes commanders should resist the urge to aggressively micromanage from the top down.
"What seems to impact morale the most is empowerment," Rickards said. "We're trying to take the decision-making and push it down, so that you're still accountable, but you also have the authority to do it."
Just 10 days after his visit to Minot, Hagel resigned under pressure from the White House. The given reasons were vague, leaving many to believe the move only reinforced the impression that the Obama administration had no clear vision for the post-war role for the military.
That's anything but reassuring to a force that, according to survey results, widely believe the Defense Department, Congress and the president do not have the troops' best interests at heart.
Tackling intangibles
When it comes to long-term retention, good leadership actually matters more than pay and benefits, said retired Brig. Gen. Thomas Kolditz, a professor and director of the Leadership Development Program at Yale School of Management.
"The traditional wisdom holds [that] what brings people into the service are the tangibles" such as benefits and bonuses, Kolditz said. "But what keeps them in the service are the intangibles: the feeling that service matters, good leadership. Retention is more about meaning, leadership and pride."
Morale is often lower among the lower ranks. One prior enlisted Marine officer, Capt. Micah Hudson, recalls being disgruntled as a young lance corporal in the late 1990s. But that changed as he moved up in rank.
"Lance Corporal Hudson could not wait to get out of the Marine Corps," the captain said, referring to himself years ago. "He didn't like sitting around and cleaning his rifle and having the gunnery sergeant yell at him all day. So that is part of it."
"Me, Capt. Hudson, my morale is really high," he said.
Spc. Zach Stafford, an Army infantryman, discusses morale.
That means training aggressively and strategically, he said, and finding ways to make troops understand they are valued and their jobs are significant. At the same time, he said, leaders should steer clear of overemphasizing minor discipline issues — a common tendency during peacetime. Recent controversy in multiple services over appropriate women's hairstyles, and the Army's tightening of its tattoo policy this year, are evidence of that trend, he said.
Leaders also should be conscious of troops who negatively impact morale by denigrating the service of others, particularly those who have not had the opportunity to deploy to a combat zone, he added.
In the Army, some soldiers say sinking morale stems from the Army's reduced recruiting standards at the peak of the wars in Iraq and Afghanistan, especially six and seven years ago, when the service granted waivers for people with criminal records and filled the ranks with not-so-highly-motivated soldiers.
"What you have right now is just a retroactive action of what the Army did by letting in the influx of soldiers when it was quantity, not quality," said Sgt. 1st Class Jose Fernandez, a 17-year soldier at Fort Drum, New York.
"And now we have a whole bunch of people and they can't wait to get out. They hate the Army. There's a lot of negativity," he said.
Embracing the challenge
Amid the doubt and frustration, there are leaders embracing the challenge of inspiring a postwar force during these lean times.
Capt. Samuel Baumer, the active-duty adjutant for the 4th Marine Logistics Group, a Marine Corps Reserve unit in New Orleans, said morale in his section was at its highest level in months — the result, he said, of new initiatives in which he and enlisted leaders worked to build unit rapport through weekend barbecues and even group community service at organizations like Habitat for Humanity. It all worked to inspire troops to succeed in their own careers, regardless of whether Marines were deploying to combat zones, he said.
"You get meritoriously promoted. You get to go to school. You get to do those things that the Marine Corps is all about," he said. "Whatever me and my gunny have to do to make sure that [the unit's Marines] do well and get promoted, that's what we're going to do."
For Cantu, the Marine sergeant at Camp Pendleton, he's choosing to make the best of a career, even as many colleagues choose to bail. With few deployments in the offing, Cantu will try to land a special duty assignment in an effort, he said, "to be a little more adaptable."
When it comes to leading Marines through a lean era and what appears to be a nadir in morale, he suggested taking advantage of institutional knowledge from prior eras of war and peacetime.
"You go back to the super senior staff [noncommissioned officers] and officers that were around pre-war time, and you ask them, 'Hey, how did you guys do it?' A lot of them said, 'We had stories, war stories that we would tell,'" Cantu said. "We're going to have to survive with stories and traditions until the next time we go to war."
Staff writers Andrew Tilghman, David Larter, Stephen Losey and Michelle Tan contributed to this story.
Civilian support subsides
THE DAYS OF FAT BONUSES, BIG PAY RAISES AND EXTRA COMBAT CASH ARE OVER -- AND TROOPS FEAR THE WORST IS YET TO COME.
By Michelle Tan
The height of the wars in Iraq and Afghanistan were fat times for military pay and benefits. Troops were flush with combat cash and other special pays, tax breaks and sometimes six-figure re-enlistment bonuses.
Those who wore the uniform were confident that the nation appreciated their sacrifices. Citizens thanked them for their service in word as politicians did in deed, generously raising military pay and other compensation, year after year.
And the payoff was sky-high morale even though it was a time when troops pulled repeated war tours that separated them from family and friends for long stretches.
Five years ago, a full 87 percent of active-duty respondents to the annual Military Times poll rated their pay and benefits as "good" or "excellent."
But that's all changed. Several years of steep cuts in defense spending, troop layoffs and diminished pay raises has left those in uniform shaken, worried whether the military remains a viable career path and whether they can get ahead while in uniform.
In the most recent Military Times poll, just 44 percent of 2,300 active-duty respondents rated their pay and benefits as "good" or "excellent" — a new low.
More than 10 percent say they struggle to pay monthly bills, and at least once during the past year resorted to a high-interest payday loan service to make ends meet.
"I can't tell you how many sailors and Marines I know who have been in a few years but are still barely making it," said a Navy hospital corpsman second class stationed at Camp Pendleton in Southern California, where the cost of living is among the highest in the nation.
"They're still living paycheck to paycheck," said the sailor, who asked to remain anonymous. "It's really only after you've been in 10 or 12 years when you actually start making money."
Money spigot tightens
Troops today are pocketing far smaller annual pay raises. The 2014 bump of just 1 percent was the smallest in the 41-year history of the all-volunteer force. That compares with 3.9 percent in 2009 — and 6.9 percent in 2002. Congress may well vote to authorize just another 1 percent in 2015. In the best-case scenario, that might go to 1.8 percent.
On top of that, the once-vast pool of cash that flowed directly into service members' pockets in the form of combat pays and re-enlistment bonuses has dried up. In 2014, troops received $3.8 billion in special pays and incentive pays, down from $6.1 billion, adjusted for inflation, in 2003, according to VisualDoD, a company that tracks Pentagon spending. For 2015, that budget is expected to fall to $3.5 billion.
And looking ahead, many military families see a future filled with uncertainty. They worry about the Defense Department's new plan to cut housing allowance rates, which would amount to a direct pay cut for most troops who live off post. The newly minted 2015 defense authorization bill mandates that future allowance rates cover an average of only 99 percent of troops' housing costs, not the traditional 100 percent. Service members would have to cover that 1 percent shortfall out of pocket.
That's better than what the Pentagon originally wanted — to reduce the subsidy to 95 percent — but it's yet another worrisome sign that lawmakers on Capitol Hill are not nearly as staunch in their support of military pay and benefits as they were just a few years ago.
In addition, troops worry they might not have a job in a few years. And if they do, they wonder if they'll see the same retirement package provided to previous generations.
Moreover, the survey shows about half of troops say they are "very worried" or "somewhat worried" about their household finances.
An Air Force security forces captain, who asked that his name not be used, said the airmen he works with are stressed because they don't know if they'll be cut next as the services draw down in light of shrinking budgets. The airmen also are working longer hours to make up for colleagues who have already been cut.
"You don't know if you will have a full-time job in a year or three or five because the Air Force keeps cutting bodies," said the captain, who has 13 years of service. "It adds to family stress. There's stress across the board for our folks."
The uncertainty is noticeable in the workplace, the captain said.
"When you're looking at trying to plan for your kids and their education and being able to provide for your family in the near and the long term, you can definitely see with some of our folks that it's wearing on them a little bit," he said. "Folks are more stressed at work, a little more tired at work."
Managing expectations
Even troops who have had long careers and planned well are feeling the pain and are making sacrifices on the home front to ride out the downturn in military compensation.
Army Capt. Jerry Wolford has given up bullets for arrows, movie theaters for DVDs, and bookstores for libraries as he and his family work to save money and cut expenses.
For Washington, D.C., the military's basic allowance for housing for his rank "is not bad," he said. "It covers rent and utilities."
To make that happen, however, "I have to live an hour away."
Wolford, a prior-enlisted soldier with 19 years of service and three deployments under his belt, works at the Pentagon. He and his family — wife, Victoria, a first sergeant in the Army Reserve, and four kids, two of them still at home — live in Stafford, Virginia, 40 miles south of the Pentagon.
To save money while Victoria finishes her master's degree to become a teacher, the family relies on coupons and visits the library, and holds off on new movies until they hit DVD.
Wolford, an infantry officer, also has found a way to practice shooting without spending money on ammo.
"We live out in the country now, so we've got a crossbow. I don't have to spend $50 a day on ammo if I want to go shooting," he said. "I can just walk out into the backyard with a handful of arrows and we can shoot all day."
The Wolford family is hardly unique.
A staff sergeant who serves as a Chinook mechanic with the 160th Special Operations Aviation Regiment at Hunter Army Airfield, Georgia, said he's living a minimal lifestyle.
"I don't have to go without food or anything like that, but I don't like to live paycheck to paycheck," said the noncommissioned officer, who asked that his name not be used. "Basically everything I do from one month to the next is all covered, but by the end of the month the paycheck is gone."
The staff sergeant, who has deployed multiple times to Iraq and Afghanistan, is twice divorced and has four kids.
"You're always waiting for the second week to hit so you can get more money, whether it's providing something for the children, or right now I'm trying to buy a house," he said. "It's hard to put money in the bank and anticipate those [unexpected expenses] when there are already bills. There's nothing left at the end of the day for savings. It's all going somewhere."
The staff sergeant said he sometimes has to use installment loans to make ends meet.
"I still use them, unfortunately. So far, my credit score is still bouncing around, but it's climbing," he said. "I'm not a financial genius. [Balancing the budget] is usually a combination of robbing Peter to pay Paul, and planning."
Spouse income suffers
For the Wolfords, part of the reason for their scrimping goes back to the many moves the family has made for Jerry Wolford's career — moves that put dents in his wife's civilian career, he said.
"Before we got married, she lived in Pennsylvania, and she had a career ... as an insurance agent," Jerry Wolford said.
When they married and he got assigned to Fort Hood, she found herself jobless in Texas.
Victoria Wolford eventually landed a job managing the fitness programs on Fort Hood.
Her husband got orders for the Pentagon, and she was uprooted again. "She had to quit Fort Hood, and when we moved up here to Virginia, she began substitute teaching," Jerry Wolford said.
It's one of the main reasons Victoria Wolford is now working on her master's degree in teaching, Jerry Wolford said.
"One factor for her going back to school to teach is because it's portable," Wolford said. "My wife will finish the first half of her program in December, and she's doing a career switcher's program, so she'll finish the first half and she'll be able to teach the second half of the year in order to get her provisional license."
Meanwhile, the family still has a house in the Fort Hood area, and both parents' cars are paid off — a 2010 sedan and a 1994 Jeep.
They also moved to their current house from one that was closer to work in order to save $1,000 a month in rent, Jerry Wolford said. But that means less time with his family and more time spent slogging through the relentless traffic in northern Virginia.
His wife is the real money-saver, "big into coupons," Jerry Wolford said.
She's also in a circle of friends who help each other save, he said.
"You don't need to buy every movie that comes out. Somebody's going to buy it. Borrow stuff. Go to the library," he said. "We have friends who go to the movies every week, and that's insanely expensive."
The family also gets creative at home.
"That's something my wife and I were able to work with the kids, to find stuff around the house and use that to entertain yourself," he said. "And all of their old toys and stuff like that, we've encouraged them to donate to the thrift stores, and we go to thrift stores. When I was younger, you got made fun of when you went to thrift stores. Now, nobody cares."
Staff writers Andrew Tilghman, David Larter, Stephen Losey and Hope Hodge Seck contributed to this story.
A big promise unfulfilled
TROUBLE GETTING A MEDICAL APPOINTMENT IS TROOPS' CHIEF COMPLAINT. AND THE PENTAGON WANTS TO SQUEEZE THE SYSTEM MORE.
By Patricia Kime
Army Spc. Zach Stafford has a family history of cancer. So when the 28-year-old infantryman first noticed a painful tumor growing in one of testicles in August 2013, he wanted to see a doctor immediately.
No way — that wasn't possible, in spite of the medical urgency. Why not? Simply because he was not at his home duty station; rather, he was at Fort Polk, Louisiana, in the field on a monthlong training exercise.
"They just didn't want to deal with me down there because I wasn't stationed there," Stafford recalled in a recent interview. "And my unit didn't want to send me back. ... I was like 'That's great, I'll be in pain the entire month.' "
One of the most well-known selling points of military service is its health care system. Legions enlist in large part because of that benefit. Many, like Stafford, learn the military's health-care system sometimes falls short of its reputation. Complaints continually surface in surveys, Pentagon studies and anecdotal conversations: Getting an appointment is very difficult.
In part, that's due to staffing shortages, especially at smaller military treatment facilities. In town hall meetings that were part of a massive Defense Department review of its health system, 27 percent of all negative comments involved understaffing, coupled with a focus on efficiency and quantity of visits, that put quality at risk. In addition, some treatment facilities have let contracted physicians and nurses go because their military counterparts have returned from deployments or combat.
The most recent annual Military Times readers' survey of 2,300 active-duty troops shows Stafford is one of many frustrated with the military health system appointment process. Nearly one in four are dissatisfied with getting an appointment at a military hospital or clinic.
Nearly 70 percent said they are "very satisfied" or "somewhat satisfied" with the military health program, called Tricare — yet about the same amount said that given a choice, they would rather find health care at private-sector or civilian facilities.
After getting back home to Fort Bragg, North Carolina, in September, Stafford waited about a month to see a doctor, who promptly slotted him for surgery a few weeks later in October.
The good news: the tumor was benign.
The bad news: When they sewed him back together, they damaged a nerve bundle in his groin, he said.
Enduring "excruciating" shooting pains that sometimes made walking tough, Stafford spent about eight months trying to get the military health system to fix its screwup.
He tried calling for an appointment to see a doctor at Womack Army Medical Center, but that proved all but useless, he said.
"They don't always answer the phone. It was easier to just to go up there and wait and hope there's not a long line of people waiting to schedule an appointment."
He eventually got one, but his unit's training demands forced him to reschedule several times.
"As soon as I canceled an appointment, it would be another month before the next opening ... that was the best-case scenario," he said.
In June, he finally got a procedure — a "radio frequency ablation" — that ended the pain.
"Once I got in to see an actual doctor, it was OK. But there are so many people here and so few health professionals ... it takes a month to see anybody," he said.
"They'll just throw pills at you until they can get you in."
Getting on the calendar
A Pentagon review of the military health system published in October found most military hospitals and clinics meet Defense Department standards for appointment wait times — 24 hours for an urgent care visit, a week for routine care and four weeks for a specialty appointment. But DoD patient surveys, as well as the Military Times poll, tell a different story: Patients don't think they can get timely appointments, even if they're on active duty and have access to sick call.
"The bottom line is the Army health care system is broken and ineffective," said one Army noncommissioned officer who asked not to be identified. He said he can't go to sick call because of his work hours and can't get an appointment with his primary care doctor, who is the most popular physician at the Presidio of Monterey clinic in California.
"I have gone to urgent care more in the last six months than I have [to] my own provider, and I almost consider them my new primary care physician," the Army NCO said.
Frustration abounds
Navy Lt. Nathan Deunk described the doctors and corpsmen he sees at Portsmouth Naval Hospital in Virginia as "dedicated professionals who do their best to care for their military patients." But their patient load, he said, is overwhelming, and trying to get an appointment is "frustrating." Deunk has spent 23 months trying to get treatment for a tumor in his foot.
"Three weeks to get an appointment, two more weeks to get a referral and then two more weeks to get the first procedure approved. And in the case of my foot, I've had to go see different specialists. And every time you see a new guy, add another month onto that," Deunk said.
Military leaders acknowledge the problem. In response to the military health review earlier this year, departing Defense Secretary Chuck Hagel has ordered military treatment facilities that don't meet DoD access standards to draft a plan to fix that.
The service surgeons general have said they are investigating disparities between the facilities' reported wait times and negative feedback from patients.
Some leaders wonder whether the official data on wait times reflect the reality experienced by military patients.
"In many cases where we believe we are meeting access standards, we have beneficiaries who think we're not," Navy Surgeon General Vice Adm. Matthew Nathan said in October. "So we're telling our hospitals, 'OK, you've told us 95 percent of your people are getting seen, based on Tricare standards, yet when we survey the people, they are not happy.' We have to figure out where that disconnect is."
Hagel ordered the health system review in May after Veterans Affairs Secretary Eric Shinseki resigned his post amid an unfolding scandal at VA hospitals over delays in patient care and appointment wait times. Those problems were related largely to pressure applied by administrators on schedulers to game the appointment system to meet VA access standards. Allegations also swirled that excessive treatment delays may have lead to patient deaths.
The Pentagon-level review found no evidence of systemwide problems in Army, Navy and Air Force facilities regarding appointment scheduling and wait times. The report concluded that the system provides care equal to that of similar private health care companies such as Kaiser Permanente and Intermountain Healthcare.
But service members who answered Military Times' survey poll think the system's scheduling processes need improvement.
Not 'gaming the system'
Some describe a system that prevents schedulers from booking appointments more than a month in advance. For those dates, schedulers often jot down names using pencil and paper and call the patient when the calendar opens. Or they tell beneficiaries to call back on a certain day.
"They are not necessarily gaming the system, but with the appointment books not being open, they write down your name and email you when the window opens. Then you end up with an appointment that looks like it meets the standards, but it really doesn't because you've already waited days to make it," said Air Force Master Sgt. James Alverson.
Years ago, Alverson was diagnosed with a rare spine disorder, but it took eight years bouncing from doctor to doctor, and being told the excruciating pain was "all in his head," before he found out what was wrong.
The time he spent among primary care visits, neurologists, spine experts, chiropractors, lab tests and rescheduled appointments at various military facilities, and finally at Portsmouth Naval Hospital, added up to more than 18 months, from diagnosis to final treatment.
"Civilian docs have told me they could have gotten me in, done the procedure and had me back at work within 30 days. But that doesn't happen at military facilities, and it's cost me my career," said Alverson, a former Marine combat engineer now serving as an Air Force imagery analyst.
Deunk agrees that the Navy and Marine Corps health system is not ideal.
"The paper scheduling system probably isn't the most efficient way to manage appointments," Deunk said. "It's better than it was years ago, when they would only open up the appointment books for only two to three days. But it's still not great."
Although they had complaints about the system, many troops said they wouldn't want to spend more money to see a civilian provider, for themselves or their families. In the reader survey, 49 percent of respondents said they would not pay more to go outside the military system.
Creating a backup
Some service members report no major problems. "In El Paso, the hospital here seems to be better than others I've been to," said Army Capt. Eric Hatch, who is stationed at Fort Bliss in Texas. "My wife had the baby here [at Beaumont, the Army hospital], and it was top notch."
But some personnel think the Defense Health Agency could design a system that would allow service members and families enrolled in Tricare Prime at military treatment facilities to see a civilian doctor if their own physician is booked.
"Relying on civilian physicians to provide surge capacity is a good idea ... VA is doing it," Deunk said.
Other improvements proposed by these troop patients include fixing electronic health records to ensure they can be viewed by primary care doctors and specialists regardless of their duty station, overhauling the scheduling system and freeing up specialists from tasks other than seeing patients in their specialty.
Military medical care falls short
Some respondents said DoD also should outsource care for military dependents and retirees — a proposal unlikely to sit well with those groups or the Pentagon, which is working to rein in the amount of money it spends on health care.
"I feel like since spouses have been allowed to be seen at the Presidio of Monterey clinic, it has become nearly impossible to get an appointment," said the California-based Army officer who uses urgent care.
The scheduling crunch makes some troops wonder whether the millions of dependents and retirees lining up for appointments are overloading the system.
"Active-duty personnel are supposed to have priority, but I don't see a lot of evidence of that," Alverson said. "We should cut out care for retirees and dependents, unless there really is room. They can go to a network doctor. And I say this even though I'm going to be a retiree soon."
Staff writers Andrew Tilghman, Stephen Losey, Hope Hodge Seck, Michelle Tan and David Larter contributed to this report.
Surveying the military
From July 8 through Aug. 7, 2014, Military Times conducted a voluntary, confidential survey of readers who include active-duty, National Guard and reserve component service members as well as military veterans, retirees and spouses.
About 70,000 subscribers received e-mail invitations to participate. Others were recruited via social media. In total, about 10,000 respondents completed the survey, including 2,299 who identified themselves as current active-duty personnel.
The sample is not a perfect representation of the military as a whole; it over-represents soldiers, officers and noncommissioned officers, and under-represents junior enlisted personnel. However, it is representative of the more senior and career-oriented members of the force who run the military's day-to-day operations and carry out its policies.
After the survey's completion, Military Times reporters spent several months interviewing dozens of active-duty survey respondents, speaking with them in detail about their views on military life today. In some instances, service members asked not to be identified so they could speak more candidly about military policy, senior leaders and political views.
Military Times has conducted a similar survey routinely for the past 10 years. Survey data cited from years prior to 2014 are based on those survey results. This is the only long-term, independent tracking survey of its kind.
The voluntary nature of the survey, the dependence on e-mail and the characteristics of Military Times readers may affect the results. Statistical margins of error commonly reported in opinion surveys that use random sampling can't be calculated for this survey.
Reporters and researchers with questions about the methodology and analysis can contact staff writer Andrew Tilghman at atilghman@militarytimes.com.
HOW THE NATION IS FAILING TODAY'S TROOPS AND VETERANS
AFTER 13 YEARS OF WAR, TROOPS FEEL BURNED OUT AND WITHOUT A SENSE OF MISSION. MORE DOUBT THEIR LEADERS AND THEIR JOB SECURITY.
For many of the war-weary troops who deployed to combat zones over and over again for 13 years, the end of an era of war in Iraq and Afghanistan is good news.
But for Marine Sgt. Zack Cantu and other service members, it's a total morale killer. For many of them, particularly the young grunts and others in combat arms specialties, it's the realization that they may never go into battle for their country and their comrades.
"Most people in [the Marine Corps] are in because of the wars," said the 25-year-old Cantu, a former infantryman at Camp Pendleton, California. Cantu has retrained as a telephone system and computer repairer, a specialty more likely to survive as the service downsizes.
"Now, everyone's coming to the realization, 'It's probably not going to happen for me,'" he said.
The wars against America's enemies gave troops like Cantu a noble purpose. Their training had focus, their sacrifices were appreciated by a largely grateful nation. That gratitude was reflected from the White House to the citizen in the street, all of whom heaped praise upon military members for their service.
Congress lavished generous pay increases and expanded benefits on them while spending deeply to provide the gear and weapons they needed. Recruiters raced to grow the size of the services, and society vowed to never again undervalue the 1 percent of the country who stepped forward to keep them safe.
Today, however, that gratitude seems to be dwindling. The services have weathered several years of deep cuts in funding and tens of thousands of troops have been unceremoniously given the boot. Many still in uniform and seeking to retire from the military fear the same fate, as those cuts are not yet complete.
A Military Times survey of 2,300 active-duty troops found morale indicators on the decline in nearly every aspect of military life. Troops report significantly lower overall job satisfaction, diminished respect for their superiors, and a declining interest in re-enlistment now compared to just five years ago.
Today's service members say they feel underpaid, under-equipped and under-appreciated, the survey data show. After 13 years of war, the all-volunteer military is entering an era fraught with uncertainty and a growing sense that the force has been left adrift.
One trend to emerge from the annual Military Times survey is "that the mission mattered more to the military than to the civilian," said Peter Feaver, a political science professor at Duke University who studies the military. "For the civilian world, it might have been easier to psychologically move on and say, 'Well, we are cutting our losses.' But the military feels very differently. Those losses have names and faces attached to [them]."
'Bare necessities'
According to the Military Times survey, active-duty troops reported a stunning drop in how they rated their overall quality of life: Just 56 percent call it good or excellent, down from 91 percent in 2009. The survey, conducted in July and August, found that 73 percent of troops would recommend a military career to others, down from 85 percent in 2009. And troops reported a significant decline in their desire to re-enlist, with 63 percent citing an intention to do so, compared with 72 percent a few years ago.
Army Spc. David Potocnik is one of the troops who has seen morale in his unit take a hit, though he can't really put a finger on why. A Black Hawk mechanic with 2nd Battalion, 4th Aviation Regiment, 4th Combat Aviation Brigade, at Fort Carson, Colorado, Potocnik said stress levels in his unit seem to be on the rise, despite a softening deployment tempo. Fellow soldiers, he said, struggle to connect what feel like excessive training and additional duties in garrison with operational readiness and the overall mission.
"There are people who are really motivated, really high-speed ... but they don't seem to be a majority," he said. "You'd think garrison would be more relaxed, but it's frantic — for no reason."
Troops said more stress is created by long-term budget cuts imposed on the force through sequestration — the much-despised but apparently inexorable automatic spending reductions over a decade approved by Congress — and drawdown measures designed to shrink the force. An Air Force captain working in security forces said the fiscal insecurity is taking its toll, causing more workplace exhaustion and frustration. And personal career uncertainty, he said, is driving many of his colleagues out of the service, perhaps earlier than they otherwise would have departed.
"It makes it really hard for folks to build strong résumés for themselves if we can't provide the opportunities for them, both in and out of the service," he said. "If they see us pinching pennies, and we can't afford to send them to school, there's no long-term stability for them. So at that point, they start to look for a job outside, where you don't have the additional strain on their family."
A Navy aviation machinist's mate first class based in El Centro, California, said operational budget cuts left him and fellow sailors cannibalizing working parts from other aircraft entering phased maintenance so they could repair higher-priority broken jets. Even uniforms are in short supply, he said, as the Navy embarks on what could be a decade of scrimping under sequestration.
"We are on the bare necessities and sometimes not even that. For example, I need new boots but they'll ask me, 'How long can you stretch that?'" he said.
Dismal outlook
Survey data show that service members are also feeling pain in their own wallets. Congress this year capped the military pay raise at 1 percent, rather than the 1.8 percent that would have kept pace with average annual growth in private-sector wages. It was the first military pay raise since 1999 that did not at least keep pace with private-sector wages, and it was also the lowest annual military pay raise in 40 years.
To save money, the Pentagon had sought to roll back the tax-free housing benefit provided to troops by, in effect, making troops pay 5 percent of their housing with out-of-pocket cash. The new deal on Capitol Hill will result in next year's housing allowance covering 99 percent of estimated costs and troops themselves covering the 1 percent shortfall. Service members are unlikely to see an outright reduction in their housing allowance unless they change duty stations, but rates for troops moving into new areas will be set slightly lower when compared to projected housing costs.
Several services also have cut pay for special duty assignments — such as recruiters, divers, drill sergeants and others — while promotions in some fields slow as competition for jobs during a drawdown heats up. And of course, those troops who have frequently collected hazardous duty and deployment pay over the last decade may now have fewer opportunities to do so.
In 2009, 87 percent of active-duty troops who participated in Military Times' survey rated their pay and allowances "good" or "excellent." This year, the figure was just 44 percent. When asked how quality of life might change over the next several years, 70 percent of respondents predicted it would decline further.
A Navy fire controlman chief with 10 deployments said budget fears are contributing to a feeling of distrust and abandonment. "If sailors are worried about not getting paid, how am I supposed to do my job?" he said. "I'm not an effective warfighter if I don't have the backing of my government at home."
A pervasive sense of pessimism about the post-9/11 wars may also contribute to the overall feeling of dissatisfaction among troops and a feeling of detachment from the decision-makers who sent them to those fights. Of those surveyed, 52 percent said they had become more pessimistic about the war in Afghanistan in recent years. Nearly 60 percent felt the war in Iraq was somewhat unsuccessful or not at all successful.
Keeping a wary watch
Despite the cloudy outlook, Pentagon officials report recruiting figures are as high as ever across the services. Data for the first quarter of fiscal 2014 showed all the services except the Army Reserve had achieved 100 percent of their recruiting goal or better. Predictably, retention also remains high, officials say, as most services look to natural attrition to meet mandated reductions in force size, and many troops fight to save their place on active duty, in spite of the quality-of-life and budget troubles.
Many of them hang on only because prospects for good civilian jobs have been dismal for many years. And often those who do land good jobs on the outside are those the military can least afford to lose.
Last year, retired Army Lt. Gen. David Barno joined a small chorus of military experts who decry a perceived "brain drain." Barno wrote for the website Foreign Policy that the services are losing their most talented junior officers and enlisted leaders to opportunities in the civilian sector because military leadership wasn't providing them with the right opportunities or fighting hard enough to keep them.
Departing Defense Secretary Chuck Hagel said all military leaders are watching morale very closely, and for the most part he believes it is holding up.
"The reality is that every day I'm sure is not jolly," Hagel told the Military Times on Nov. 14. "But morale is critically important for any of us, and any institution to do our jobs right. And we watch it. We are concerned all the time about it, but I think, overall … the morale of our men and women in uniform, our civilians, is high. I know there are different dimensions of that, depending on the force."
When Hagel made those comments, he was on a visit to Minot Air Force Base, North Dakota — where he was trying to buck up the morale of airmen in the intercontinental ballistic missile community. Over the past year, repeated scandals in ICBM units — drug use, cheating on tests, failing a safety inspection — have forced the Pentagon's top leadership to focus attention on the community. That included firing several nuclear commanders, finding more money and manpower for ICBM units and taking dozens of measures to improve quality of life for those airmen.
This morale crisis is prompting Air Force officers to give new thought to how procedures and policies can improve or erode morale. For example, Lt. Col David Rickards, the 91st Operations Group deputy commander at Minot, believes commanders should resist the urge to aggressively micromanage from the top down.
"What seems to impact morale the most is empowerment," Rickards said. "We're trying to take the decision-making and push it down, so that you're still accountable, but you also have the authority to do it."
Just 10 days after his visit to Minot, Hagel resigned under pressure from the White House. The given reasons were vague, leaving many to believe the move only reinforced the impression that the Obama administration had no clear vision for the post-war role for the military.
That's anything but reassuring to a force that, according to survey results, widely believe the Defense Department, Congress and the president do not have the troops' best interests at heart.
Tackling intangibles
When it comes to long-term retention, good leadership actually matters more than pay and benefits, said retired Brig. Gen. Thomas Kolditz, a professor and director of the Leadership Development Program at Yale School of Management.
"The traditional wisdom holds [that] what brings people into the service are the tangibles" such as benefits and bonuses, Kolditz said. "But what keeps them in the service are the intangibles: the feeling that service matters, good leadership. Retention is more about meaning, leadership and pride."
Morale is often lower among the lower ranks. One prior enlisted Marine officer, Capt. Micah Hudson, recalls being disgruntled as a young lance corporal in the late 1990s. But that changed as he moved up in rank.
"Lance Corporal Hudson could not wait to get out of the Marine Corps," the captain said, referring to himself years ago. "He didn't like sitting around and cleaning his rifle and having the gunnery sergeant yell at him all day. So that is part of it."
"Me, Capt. Hudson, my morale is really high," he said.
Spc. Zach Stafford, an Army infantryman, discusses morale.
That means training aggressively and strategically, he said, and finding ways to make troops understand they are valued and their jobs are significant. At the same time, he said, leaders should steer clear of overemphasizing minor discipline issues — a common tendency during peacetime. Recent controversy in multiple services over appropriate women's hairstyles, and the Army's tightening of its tattoo policy this year, are evidence of that trend, he said.
Leaders also should be conscious of troops who negatively impact morale by denigrating the service of others, particularly those who have not had the opportunity to deploy to a combat zone, he added.
In the Army, some soldiers say sinking morale stems from the Army's reduced recruiting standards at the peak of the wars in Iraq and Afghanistan, especially six and seven years ago, when the service granted waivers for people with criminal records and filled the ranks with not-so-highly-motivated soldiers.
"What you have right now is just a retroactive action of what the Army did by letting in the influx of soldiers when it was quantity, not quality," said Sgt. 1st Class Jose Fernandez, a 17-year soldier at Fort Drum, New York.
"And now we have a whole bunch of people and they can't wait to get out. They hate the Army. There's a lot of negativity," he said.
Embracing the challenge
Amid the doubt and frustration, there are leaders embracing the challenge of inspiring a postwar force during these lean times.
Capt. Samuel Baumer, the active-duty adjutant for the 4th Marine Logistics Group, a Marine Corps Reserve unit in New Orleans, said morale in his section was at its highest level in months — the result, he said, of new initiatives in which he and enlisted leaders worked to build unit rapport through weekend barbecues and even group community service at organizations like Habitat for Humanity. It all worked to inspire troops to succeed in their own careers, regardless of whether Marines were deploying to combat zones, he said.
"You get meritoriously promoted. You get to go to school. You get to do those things that the Marine Corps is all about," he said. "Whatever me and my gunny have to do to make sure that [the unit's Marines] do well and get promoted, that's what we're going to do."
For Cantu, the Marine sergeant at Camp Pendleton, he's choosing to make the best of a career, even as many colleagues choose to bail. With few deployments in the offing, Cantu will try to land a special duty assignment in an effort, he said, "to be a little more adaptable."
When it comes to leading Marines through a lean era and what appears to be a nadir in morale, he suggested taking advantage of institutional knowledge from prior eras of war and peacetime.
"You go back to the super senior staff [noncommissioned officers] and officers that were around pre-war time, and you ask them, 'Hey, how did you guys do it?' A lot of them said, 'We had stories, war stories that we would tell,'" Cantu said. "We're going to have to survive with stories and traditions until the next time we go to war."
Staff writers Andrew Tilghman, David Larter, Stephen Losey and Michelle Tan contributed to this story.
Civilian support subsides
THE DAYS OF FAT BONUSES, BIG PAY RAISES AND EXTRA COMBAT CASH ARE OVER -- AND TROOPS FEAR THE WORST IS YET TO COME.
By Michelle Tan
The height of the wars in Iraq and Afghanistan were fat times for military pay and benefits. Troops were flush with combat cash and other special pays, tax breaks and sometimes six-figure re-enlistment bonuses.
Those who wore the uniform were confident that the nation appreciated their sacrifices. Citizens thanked them for their service in word as politicians did in deed, generously raising military pay and other compensation, year after year.
And the payoff was sky-high morale even though it was a time when troops pulled repeated war tours that separated them from family and friends for long stretches.
Five years ago, a full 87 percent of active-duty respondents to the annual Military Times poll rated their pay and benefits as "good" or "excellent."
But that's all changed. Several years of steep cuts in defense spending, troop layoffs and diminished pay raises has left those in uniform shaken, worried whether the military remains a viable career path and whether they can get ahead while in uniform.
In the most recent Military Times poll, just 44 percent of 2,300 active-duty respondents rated their pay and benefits as "good" or "excellent" — a new low.
More than 10 percent say they struggle to pay monthly bills, and at least once during the past year resorted to a high-interest payday loan service to make ends meet.
"I can't tell you how many sailors and Marines I know who have been in a few years but are still barely making it," said a Navy hospital corpsman second class stationed at Camp Pendleton in Southern California, where the cost of living is among the highest in the nation.
"They're still living paycheck to paycheck," said the sailor, who asked to remain anonymous. "It's really only after you've been in 10 or 12 years when you actually start making money."
Money spigot tightens
Troops today are pocketing far smaller annual pay raises. The 2014 bump of just 1 percent was the smallest in the 41-year history of the all-volunteer force. That compares with 3.9 percent in 2009 — and 6.9 percent in 2002. Congress may well vote to authorize just another 1 percent in 2015. In the best-case scenario, that might go to 1.8 percent.
On top of that, the once-vast pool of cash that flowed directly into service members' pockets in the form of combat pays and re-enlistment bonuses has dried up. In 2014, troops received $3.8 billion in special pays and incentive pays, down from $6.1 billion, adjusted for inflation, in 2003, according to VisualDoD, a company that tracks Pentagon spending. For 2015, that budget is expected to fall to $3.5 billion.
And looking ahead, many military families see a future filled with uncertainty. They worry about the Defense Department's new plan to cut housing allowance rates, which would amount to a direct pay cut for most troops who live off post. The newly minted 2015 defense authorization bill mandates that future allowance rates cover an average of only 99 percent of troops' housing costs, not the traditional 100 percent. Service members would have to cover that 1 percent shortfall out of pocket.
That's better than what the Pentagon originally wanted — to reduce the subsidy to 95 percent — but it's yet another worrisome sign that lawmakers on Capitol Hill are not nearly as staunch in their support of military pay and benefits as they were just a few years ago.
In addition, troops worry they might not have a job in a few years. And if they do, they wonder if they'll see the same retirement package provided to previous generations.
Moreover, the survey shows about half of troops say they are "very worried" or "somewhat worried" about their household finances.
An Air Force security forces captain, who asked that his name not be used, said the airmen he works with are stressed because they don't know if they'll be cut next as the services draw down in light of shrinking budgets. The airmen also are working longer hours to make up for colleagues who have already been cut.
"You don't know if you will have a full-time job in a year or three or five because the Air Force keeps cutting bodies," said the captain, who has 13 years of service. "It adds to family stress. There's stress across the board for our folks."
The uncertainty is noticeable in the workplace, the captain said.
"When you're looking at trying to plan for your kids and their education and being able to provide for your family in the near and the long term, you can definitely see with some of our folks that it's wearing on them a little bit," he said. "Folks are more stressed at work, a little more tired at work."
Managing expectations
Even troops who have had long careers and planned well are feeling the pain and are making sacrifices on the home front to ride out the downturn in military compensation.
Army Capt. Jerry Wolford has given up bullets for arrows, movie theaters for DVDs, and bookstores for libraries as he and his family work to save money and cut expenses.
For Washington, D.C., the military's basic allowance for housing for his rank "is not bad," he said. "It covers rent and utilities."
To make that happen, however, "I have to live an hour away."
Wolford, a prior-enlisted soldier with 19 years of service and three deployments under his belt, works at the Pentagon. He and his family — wife, Victoria, a first sergeant in the Army Reserve, and four kids, two of them still at home — live in Stafford, Virginia, 40 miles south of the Pentagon.
To save money while Victoria finishes her master's degree to become a teacher, the family relies on coupons and visits the library, and holds off on new movies until they hit DVD.
Wolford, an infantry officer, also has found a way to practice shooting without spending money on ammo.
"We live out in the country now, so we've got a crossbow. I don't have to spend $50 a day on ammo if I want to go shooting," he said. "I can just walk out into the backyard with a handful of arrows and we can shoot all day."
The Wolford family is hardly unique.
A staff sergeant who serves as a Chinook mechanic with the 160th Special Operations Aviation Regiment at Hunter Army Airfield, Georgia, said he's living a minimal lifestyle.
"I don't have to go without food or anything like that, but I don't like to live paycheck to paycheck," said the noncommissioned officer, who asked that his name not be used. "Basically everything I do from one month to the next is all covered, but by the end of the month the paycheck is gone."
The staff sergeant, who has deployed multiple times to Iraq and Afghanistan, is twice divorced and has four kids.
"You're always waiting for the second week to hit so you can get more money, whether it's providing something for the children, or right now I'm trying to buy a house," he said. "It's hard to put money in the bank and anticipate those [unexpected expenses] when there are already bills. There's nothing left at the end of the day for savings. It's all going somewhere."
The staff sergeant said he sometimes has to use installment loans to make ends meet.
"I still use them, unfortunately. So far, my credit score is still bouncing around, but it's climbing," he said. "I'm not a financial genius. [Balancing the budget] is usually a combination of robbing Peter to pay Paul, and planning."
Spouse income suffers
For the Wolfords, part of the reason for their scrimping goes back to the many moves the family has made for Jerry Wolford's career — moves that put dents in his wife's civilian career, he said.
"Before we got married, she lived in Pennsylvania, and she had a career ... as an insurance agent," Jerry Wolford said.
When they married and he got assigned to Fort Hood, she found herself jobless in Texas.
Victoria Wolford eventually landed a job managing the fitness programs on Fort Hood.
Her husband got orders for the Pentagon, and she was uprooted again. "She had to quit Fort Hood, and when we moved up here to Virginia, she began substitute teaching," Jerry Wolford said.
It's one of the main reasons Victoria Wolford is now working on her master's degree in teaching, Jerry Wolford said.
"One factor for her going back to school to teach is because it's portable," Wolford said. "My wife will finish the first half of her program in December, and she's doing a career switcher's program, so she'll finish the first half and she'll be able to teach the second half of the year in order to get her provisional license."
Meanwhile, the family still has a house in the Fort Hood area, and both parents' cars are paid off — a 2010 sedan and a 1994 Jeep.
They also moved to their current house from one that was closer to work in order to save $1,000 a month in rent, Jerry Wolford said. But that means less time with his family and more time spent slogging through the relentless traffic in northern Virginia.
His wife is the real money-saver, "big into coupons," Jerry Wolford said.
She's also in a circle of friends who help each other save, he said.
"You don't need to buy every movie that comes out. Somebody's going to buy it. Borrow stuff. Go to the library," he said. "We have friends who go to the movies every week, and that's insanely expensive."
The family also gets creative at home.
"That's something my wife and I were able to work with the kids, to find stuff around the house and use that to entertain yourself," he said. "And all of their old toys and stuff like that, we've encouraged them to donate to the thrift stores, and we go to thrift stores. When I was younger, you got made fun of when you went to thrift stores. Now, nobody cares."
Staff writers Andrew Tilghman, David Larter, Stephen Losey and Hope Hodge Seck contributed to this story.
A big promise unfulfilled
TROUBLE GETTING A MEDICAL APPOINTMENT IS TROOPS' CHIEF COMPLAINT. AND THE PENTAGON WANTS TO SQUEEZE THE SYSTEM MORE.
By Patricia Kime
Army Spc. Zach Stafford has a family history of cancer. So when the 28-year-old infantryman first noticed a painful tumor growing in one of testicles in August 2013, he wanted to see a doctor immediately.
No way — that wasn't possible, in spite of the medical urgency. Why not? Simply because he was not at his home duty station; rather, he was at Fort Polk, Louisiana, in the field on a monthlong training exercise.
"They just didn't want to deal with me down there because I wasn't stationed there," Stafford recalled in a recent interview. "And my unit didn't want to send me back. ... I was like 'That's great, I'll be in pain the entire month.' "
One of the most well-known selling points of military service is its health care system. Legions enlist in large part because of that benefit. Many, like Stafford, learn the military's health-care system sometimes falls short of its reputation. Complaints continually surface in surveys, Pentagon studies and anecdotal conversations: Getting an appointment is very difficult.
In part, that's due to staffing shortages, especially at smaller military treatment facilities. In town hall meetings that were part of a massive Defense Department review of its health system, 27 percent of all negative comments involved understaffing, coupled with a focus on efficiency and quantity of visits, that put quality at risk. In addition, some treatment facilities have let contracted physicians and nurses go because their military counterparts have returned from deployments or combat.
The most recent annual Military Times readers' survey of 2,300 active-duty troops shows Stafford is one of many frustrated with the military health system appointment process. Nearly one in four are dissatisfied with getting an appointment at a military hospital or clinic.
Nearly 70 percent said they are "very satisfied" or "somewhat satisfied" with the military health program, called Tricare — yet about the same amount said that given a choice, they would rather find health care at private-sector or civilian facilities.
After getting back home to Fort Bragg, North Carolina, in September, Stafford waited about a month to see a doctor, who promptly slotted him for surgery a few weeks later in October.
The good news: the tumor was benign.
The bad news: When they sewed him back together, they damaged a nerve bundle in his groin, he said.
Enduring "excruciating" shooting pains that sometimes made walking tough, Stafford spent about eight months trying to get the military health system to fix its screwup.
He tried calling for an appointment to see a doctor at Womack Army Medical Center, but that proved all but useless, he said.
"They don't always answer the phone. It was easier to just to go up there and wait and hope there's not a long line of people waiting to schedule an appointment."
He eventually got one, but his unit's training demands forced him to reschedule several times.
"As soon as I canceled an appointment, it would be another month before the next opening ... that was the best-case scenario," he said.
In June, he finally got a procedure — a "radio frequency ablation" — that ended the pain.
"Once I got in to see an actual doctor, it was OK. But there are so many people here and so few health professionals ... it takes a month to see anybody," he said.
"They'll just throw pills at you until they can get you in."
Getting on the calendar
A Pentagon review of the military health system published in October found most military hospitals and clinics meet Defense Department standards for appointment wait times — 24 hours for an urgent care visit, a week for routine care and four weeks for a specialty appointment. But DoD patient surveys, as well as the Military Times poll, tell a different story: Patients don't think they can get timely appointments, even if they're on active duty and have access to sick call.
"The bottom line is the Army health care system is broken and ineffective," said one Army noncommissioned officer who asked not to be identified. He said he can't go to sick call because of his work hours and can't get an appointment with his primary care doctor, who is the most popular physician at the Presidio of Monterey clinic in California.
"I have gone to urgent care more in the last six months than I have [to] my own provider, and I almost consider them my new primary care physician," the Army NCO said.
Frustration abounds
Navy Lt. Nathan Deunk described the doctors and corpsmen he sees at Portsmouth Naval Hospital in Virginia as "dedicated professionals who do their best to care for their military patients." But their patient load, he said, is overwhelming, and trying to get an appointment is "frustrating." Deunk has spent 23 months trying to get treatment for a tumor in his foot.
"Three weeks to get an appointment, two more weeks to get a referral and then two more weeks to get the first procedure approved. And in the case of my foot, I've had to go see different specialists. And every time you see a new guy, add another month onto that," Deunk said.
Military leaders acknowledge the problem. In response to the military health review earlier this year, departing Defense Secretary Chuck Hagel has ordered military treatment facilities that don't meet DoD access standards to draft a plan to fix that.
The service surgeons general have said they are investigating disparities between the facilities' reported wait times and negative feedback from patients.
Some leaders wonder whether the official data on wait times reflect the reality experienced by military patients.
"In many cases where we believe we are meeting access standards, we have beneficiaries who think we're not," Navy Surgeon General Vice Adm. Matthew Nathan said in October. "So we're telling our hospitals, 'OK, you've told us 95 percent of your people are getting seen, based on Tricare standards, yet when we survey the people, they are not happy.' We have to figure out where that disconnect is."
Hagel ordered the health system review in May after Veterans Affairs Secretary Eric Shinseki resigned his post amid an unfolding scandal at VA hospitals over delays in patient care and appointment wait times. Those problems were related largely to pressure applied by administrators on schedulers to game the appointment system to meet VA access standards. Allegations also swirled that excessive treatment delays may have lead to patient deaths.
The Pentagon-level review found no evidence of systemwide problems in Army, Navy and Air Force facilities regarding appointment scheduling and wait times. The report concluded that the system provides care equal to that of similar private health care companies such as Kaiser Permanente and Intermountain Healthcare.
But service members who answered Military Times' survey poll think the system's scheduling processes need improvement.
Not 'gaming the system'
Some describe a system that prevents schedulers from booking appointments more than a month in advance. For those dates, schedulers often jot down names using pencil and paper and call the patient when the calendar opens. Or they tell beneficiaries to call back on a certain day.
"They are not necessarily gaming the system, but with the appointment books not being open, they write down your name and email you when the window opens. Then you end up with an appointment that looks like it meets the standards, but it really doesn't because you've already waited days to make it," said Air Force Master Sgt. James Alverson.
Years ago, Alverson was diagnosed with a rare spine disorder, but it took eight years bouncing from doctor to doctor, and being told the excruciating pain was "all in his head," before he found out what was wrong.
The time he spent among primary care visits, neurologists, spine experts, chiropractors, lab tests and rescheduled appointments at various military facilities, and finally at Portsmouth Naval Hospital, added up to more than 18 months, from diagnosis to final treatment.
"Civilian docs have told me they could have gotten me in, done the procedure and had me back at work within 30 days. But that doesn't happen at military facilities, and it's cost me my career," said Alverson, a former Marine combat engineer now serving as an Air Force imagery analyst.
Deunk agrees that the Navy and Marine Corps health system is not ideal.
"The paper scheduling system probably isn't the most efficient way to manage appointments," Deunk said. "It's better than it was years ago, when they would only open up the appointment books for only two to three days. But it's still not great."
Although they had complaints about the system, many troops said they wouldn't want to spend more money to see a civilian provider, for themselves or their families. In the reader survey, 49 percent of respondents said they would not pay more to go outside the military system.
Creating a backup
Some service members report no major problems. "In El Paso, the hospital here seems to be better than others I've been to," said Army Capt. Eric Hatch, who is stationed at Fort Bliss in Texas. "My wife had the baby here [at Beaumont, the Army hospital], and it was top notch."
But some personnel think the Defense Health Agency could design a system that would allow service members and families enrolled in Tricare Prime at military treatment facilities to see a civilian doctor if their own physician is booked.
"Relying on civilian physicians to provide surge capacity is a good idea ... VA is doing it," Deunk said.
Other improvements proposed by these troop patients include fixing electronic health records to ensure they can be viewed by primary care doctors and specialists regardless of their duty station, overhauling the scheduling system and freeing up specialists from tasks other than seeing patients in their specialty.
Military medical care falls short
Some respondents said DoD also should outsource care for military dependents and retirees — a proposal unlikely to sit well with those groups or the Pentagon, which is working to rein in the amount of money it spends on health care.
"I feel like since spouses have been allowed to be seen at the Presidio of Monterey clinic, it has become nearly impossible to get an appointment," said the California-based Army officer who uses urgent care.
The scheduling crunch makes some troops wonder whether the millions of dependents and retirees lining up for appointments are overloading the system.
"Active-duty personnel are supposed to have priority, but I don't see a lot of evidence of that," Alverson said. "We should cut out care for retirees and dependents, unless there really is room. They can go to a network doctor. And I say this even though I'm going to be a retiree soon."
Staff writers Andrew Tilghman, Stephen Losey, Hope Hodge Seck, Michelle Tan and David Larter contributed to this report.
Surveying the military
From July 8 through Aug. 7, 2014, Military Times conducted a voluntary, confidential survey of readers who include active-duty, National Guard and reserve component service members as well as military veterans, retirees and spouses.
About 70,000 subscribers received e-mail invitations to participate. Others were recruited via social media. In total, about 10,000 respondents completed the survey, including 2,299 who identified themselves as current active-duty personnel.
The sample is not a perfect representation of the military as a whole; it over-represents soldiers, officers and noncommissioned officers, and under-represents junior enlisted personnel. However, it is representative of the more senior and career-oriented members of the force who run the military's day-to-day operations and carry out its policies.
After the survey's completion, Military Times reporters spent several months interviewing dozens of active-duty survey respondents, speaking with them in detail about their views on military life today. In some instances, service members asked not to be identified so they could speak more candidly about military policy, senior leaders and political views.
Military Times has conducted a similar survey routinely for the past 10 years. Survey data cited from years prior to 2014 are based on those survey results. This is the only long-term, independent tracking survey of its kind.
The voluntary nature of the survey, the dependence on e-mail and the characteristics of Military Times readers may affect the results. Statistical margins of error commonly reported in opinion surveys that use random sampling can't be calculated for this survey.
Reporters and researchers with questions about the methodology and analysis can contact staff writer Andrew Tilghman at atilghman@militarytimes.com.
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