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Tarnished jewel
Chronicles of Small Beer
TARNISHED JEWEL A few months ago, I wrote about the radiologic-pathologic course at the Armed Forces Institute of Pathology. This is a good thing, I wrote, a jewel in our crown. It is the product of cooperation among organizations in radiology, in pathology, and in the military. Shortly after I wrote the piece and before you read it, political moves in the Defense Department may have doomed the AFIP and all of its programs. It was not an attack on the AFIP, though there may be some of that. Rather, it may be the result of the latest round of surplus military base closings. The Walter Reed Army Medical Center in Washington, where the AFIP sits on one corner, is on the list of facilities to be closed. For the past three decades, the military has been closing surplus military facilities. Many of them date to World War II and are no longer useful, hopelessly obsolete, costly, and dear only to the towns which live off of them and politicians from those states. An elaborate mechanism for selection avoids having the local congressman take the blame for cutting off this federal spending. So now comes Defense Secretary Donald Rumsfeld making the announcement instead of the anonymous closing committee. The army’s flagship hospital is no longer needed. Most of its functions can be assigned to the navy’s hospital a few miles away in Bethesda. This will take several years, but there is no solid opposition. Washington has no senators, only a nonvoting congresswoman. The AFIP had two historic roles. One was to operate the grownup military medical museum, now containing the most extensive and comprehensive collection of medical pathology materials in the world. The second was to provide pathology consultations by the AFIP pathologists to other military pathologists and, by extension, to civilian pathologists. The education programs of the various registries were an add-on activity. A couple of decades ago, senior AFIP pathologists were world renowned and the pathology community cherished them. With the passage of time and the constant cutting of military medicine, that is no longer true. Support for the AFIP has dwindled. By far the biggest current efforts at the AFIP are the radiology resident courses which now take six weeks out of the lives of almost every US resident plus a few hundred from other countries. For almost all US programs, this is the standard way of meeting the American Board of Radiology’s rad-path requirement. Allowing for the logistical support from
the AFIP, the salaries of the staff, and the free rent, the radiology courses pay their way and help with other programs. This is a time of uncertainty and indecision, but it begins to look like saving the radiology program apart from the rest of the AFIP may be possible— but only if radiology organizations make a concerted effort to find a new home for the program. Would that home be in another federal health facility, or would it need to be taken into the private sector? The easiest move would be to another military health facility. The Uniformed Services University of Health Sciences is located on the navy’s Bethesda campus. But it has no auditorium to commit for 36 weeks of teaching strangers and, by report, no excess space for offices, files, and other administrative needs. A move to USUHS would require some political clout. What about another military medical facility? Any volunteers? What about the Veterans Administration? The VA has strong teaching responsibilities including radiology residencies. But where are VA facilities available? The National Institutes of Health have no teaching responsibility. Despite nonstop construction on the campus, NIH has no idle auditoriums or other facilities seeking tenants. The new home, wherever it might be, must be reasonably convenient for residents, preferably less expensive than Washington, accessible to permanent and voluntary faculty, both radiologists and pathologists, and committed for a reasonable time period. In the civilian world, organized radiology would need to create a new administrative structure, establish financing to offset the lost federal subsidies, and recruit faculty to replace military assignees. All of this prompts a thoughtful question about whether the program should be saved in its current format— or whether it should move briskly into the electronic era. Years ago, videotaped lectures were fairly awful. Now, Powerpoint technology retains the same visual quality as the lecturer chooses. Could residents take the course electronically from home? A lot of questions would need to be solved. Could the course be a brief visit to the center followed by electronics? Would residents at home be exempt from clinical duties? At this point, the only certainty is that the AFIP is under attack and its traditional friends are not so friendly. A new home in the federal health sphere for either the AFIP or the radiology program will take some deft lobbying efforts. It will be some years before Walter Reed is closed. But it is not too soon to begin saving the rad-path program, if academic radiology programs want it saved. Otha Linton, MSJ Potomac, MD
1351
TARNISHED JEWEL A few months ago, I wrote about the radiologic-pathologic course at the Armed Forces Institute of Pathology. This is a good thing, I wrote, a jewel in our crown. It is the product of cooperation among organizations in radiology, in pathology, and in the military. Shortly after I wrote the piece and before you read it, political moves in the Defense Department may have doomed the AFIP and all of its programs. It was not an attack on the AFIP, though there may be some of that. Rather, it may be the result of the latest round of surplus military base closings. The Walter Reed Army Medical Center in Washington, where the AFIP sits on one corner, is on the list of facilities to be closed. For the past three decades, the military has been closing surplus military facilities. Many of them date to World War II and are no longer useful, hopelessly obsolete, costly, and dear only to the towns which live off of them and politicians from those states. An elaborate mechanism for selection avoids having the local congressman take the blame for cutting off this federal spending. So now comes Defense Secretary Donald Rumsfeld making the announcement instead of the anonymous closing committee. The army’s flagship hospital is no longer needed. Most of its functions can be assigned to the navy’s hospital a few miles away in Bethesda. This will take several years, but there is no solid opposition. Washington has no senators, only a nonvoting congresswoman. The AFIP had two historic roles. One was to operate the grownup military medical museum, now containing the most extensive and comprehensive collection of medical pathology materials in the world. The second was to provide pathology consultations by the AFIP pathologists to other military pathologists and, by extension, to civilian pathologists. The education programs of the various registries were an add-on activity. A couple of decades ago, senior AFIP pathologists were world renowned and the pathology community cherished them. With the passage of time and the constant cutting of military medicine, that is no longer true. Support for the AFIP has dwindled. By far the biggest current efforts at the AFIP are the radiology resident courses which now take six weeks out of the lives of almost every US resident plus a few hundred from other countries. For almost all US programs, this is the standard way of meeting the American Board of Radiology’s rad-path requirement. Allowing for the logistical support from
the AFIP, the salaries of the staff, and the free rent, the radiology courses pay their way and help with other programs. This is a time of uncertainty and indecision, but it begins to look like saving the radiology program apart from the rest of the AFIP may be possible— but only if radiology organizations make a concerted effort to find a new home for the program. Would that home be in another federal health facility, or would it need to be taken into the private sector? The easiest move would be to another military health facility. The Uniformed Services University of Health Sciences is located on the navy’s Bethesda campus. But it has no auditorium to commit for 36 weeks of teaching strangers and, by report, no excess space for offices, files, and other administrative needs. A move to USUHS would require some political clout. What about another military medical facility? Any volunteers? What about the Veterans Administration? The VA has strong teaching responsibilities including radiology residencies. But where are VA facilities available? The National Institutes of Health have no teaching responsibility. Despite nonstop construction on the campus, NIH has no idle auditoriums or other facilities seeking tenants. The new home, wherever it might be, must be reasonably convenient for residents, preferably less expensive than Washington, accessible to permanent and voluntary faculty, both radiologists and pathologists, and committed for a reasonable time period. In the civilian world, organized radiology would need to create a new administrative structure, establish financing to offset the lost federal subsidies, and recruit faculty to replace military assignees. All of this prompts a thoughtful question about whether the program should be saved in its current format— or whether it should move briskly into the electronic era. Years ago, videotaped lectures were fairly awful. Now, Powerpoint technology retains the same visual quality as the lecturer chooses. Could residents take the course electronically from home? A lot of questions would need to be solved. Could the course be a brief visit to the center followed by electronics? Would residents at home be exempt from clinical duties? At this point, the only certainty is that the AFIP is under attack and its traditional friends are not so friendly. A new home in the federal health sphere for either the AFIP or the radiology program will take some deft lobbying efforts. It will be some years before Walter Reed is closed. But it is not too soon to begin saving the rad-path program, if academic radiology programs want it saved. Otha Linton, MSJ Potomac, MD
1351