Letter: Answering Our Nation's Call: A Solution for Military Neurosurgery Wartime Readiness Through Civilian Collaboration

Abstract

Sindelar, and Hooten should be commended for their recent article, "Answering Our Nation's Call: A Solution for Military Neurosurgery Wartime Readiness Through Civilian Collaboration." 1 In emphasizing a solution to enhancing wartime neurosurgical readiness, the central premise is critical important to our military neurosurgery community and to the sailors, airmen, soldiers, and Marines who will be under the care of the military neurosurgeon in theater.The authors highlight in detail the main problem necessary to address the decline in surgical case volume at military treatment facilities (MTFs, which are military hospitals) where nearly all military neurosurgeons practice. In one MTF, there has been a 45.7% decrease in cases from 2016 to 2022. During this period, not a single surgeon stationed at the MTF was able to meet the military's prescribed Knowledge, Skills, and Ability (KSA) metric for determining a neurosurgeon's wartime readiness. Thus, the issue is clear and understandable-a decline in case volume likely leads to a potential reduction in readiness for the neurosurgeon in wartime, a challenge requiring an urgent solution.The proposed solution is a dramatic increase in partnerships between military hospitals and supporting civilian institutions. In the article, the authors provide an excellent history of the evolution of these relationships from World War I to current conflicts. The authors advocate for an expansion to the Army-Medical Department Military-Civilian Trauma Team (AMCT3) program in which medical personnel are embedded in civilian level 1 trauma centers at the level of an attending staff neurosurgeon. Although this program is specific to the Army, we can infer that this concept applies to the Navy and Air Force as well. This concept can entail embedding surgeons for several year tours or even rotations lasting several months.In this arrangement, several considerations are important. The benefit to the military surgeon is clear in that the surgeon is engaged in a higher volume practice that includes trauma, which most will not see at the home MTF, unquestionably sustaining and augmenting wartime readiness. There is a cultural benefit here as well, as civilian and military neurosurgical and medical communities are often siloed from each other. The host institution essentially uses an attending neurosurgeon at the Department of Defense cost. It is important to integrate the officer into the civilian practice in a way that meshes well with existing practices and to ensure that the individual contributes to the life of the civilian group and vice versa. Addressing these points appropriately requires collaboration and teamwork, especially among more junior civilian attendings attempting to grow a practice. It is just a reality that there will remain a large disparity in compensation

In Reply: Answering Our Nation's Call: A Solution for Military Neurosurgery Wartime Readiness Through Civilian Collaboration

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To the Editor:We would like to thank Commander Menger and Commander Dunn for their support and knowledgeable commentary as well as for their service to their country (Menger et al 2023). 1 The reserve neurosurgical community is a perfect embodiment of militarycivilian partnership at work. The objective differences of the day-today activity of the reservist neurosurgeon and the active duty neurosurgeon permanently stationed at a civilian level 1 trauma center are minimal.

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