A Long Goodbye
Ted Beal
Rumored for years, long anticipated, yet sudden in arrival, and sobering when it happened, the US Army announced that our civilian contract to provide medical services to veterans and current servicemen and women would not be renewed. I felt simultaneously angry and liberated. Angry that I had to stop providing a service that had given me so much. Liberated because I knew at some level, I might not have been able to stop on my own. In retrospect, these nearly eight years of providing medication and psychotherapy to service members and their families has been an unexpected gift, a capstone to over fifty years in a medical career.
In 2009, I was intrigued by a medical recruiter’s phone call offering a position in the Department of Psychiatry at the Walter Reed Army Medical Center. The call came in the shadow of the 2008 great economic freefall during which I had watched my retirement account disappear. Working as a government-employed psychiatrist offered tantalizing retirement possibilities. Seeing patients in remote locations via closed circuit television, seemed unusual but I decided to look further. The application and security clearance process was onerous. Credentialing approval at a dozen Army installations was long and tedious. Training courses and learning to use electronic medical records taxed my brain. But the “trappings” were inspiring.
The Walter Reed campus, the location of Tele Health, was more than 100 years old. Uniformed men and women are exceedingly polite and gracious. The weekly helicopter landing with evacuees is mesmerizing. Watching service-men with multiple amputations negotiate the cafeteria with their wives and children or girlfriends is something every American should see. I have to admit I was smitten.
By providing medical services, we were with the military but not in the military. We provided the service virtually (closed circuit television) to them, but it was a vicarious experience for us. Their altruism is infectious.
Paradoxically, the virtual experience allowed us to get closer to the servicemen. They knew that they and their secrets would not meet us later in the PX or on their base. The physical distance allowed more emotional candor.
By 2010, telehealth had fifteen years of experience providing service to locations outside of the United States. Before my arrival, the leader had decided to develop a virtual MTF or military training facility. The service had grown from five people to more than seventy with psychiatrists, psychologists, social workers, neurologists, neurosurgeons, nurse practitioners, physician assistants, physical therapists, occupational therapists, and dermatologists with locations across the country. There were many ongoing research projects.
Our telehealth service was growing. But so was Walter Reed, which was in the midst of a transition from its historic location to the new facility combined with the Navy. Unfortunately, our charismatic leader, who allegedly got direct funding from Congress and the “powers that be” at Walter Reed, did not allocate sufficient space for our service in the transition to the new Walter Reed location. They left, and we were left in the old location that was closing.
Finding an electronically secure building approved by the Department of Defense is complicated. Eventually, the logistical problem was resolved by a move to a secure building near the Pentagon. We moved into a floor that seemed the size of a football field. The space was too big for our current staff but large enough for our anticipated growth.
In finding a place, the logistics were one thing, but finding an administrative home was another. We worked well clinically and administratively within our unit, but we were not administratively connected to the larger military service. We provided clinical service all over the United States. But not fitting into a TOE, someone’s Table of Operations and Equipment, and not being “owned” by a higher level military institution may have been our undoing. We were “rogues,” but we clinicians were oblivious to the administrative issue.
We survived many problems on our journey. When the government was shut down in October 2013, our service was suspended. Later, a failure to get the civilian contracts in order put us out of work for three to four weeks. One day, to everyone’s surprise, our leader was escorted off the premises by armed military guards. It was tense, but we created a space for our own support. Nevertheless, these disturbances led some of the younger professionals to seek more “stable” employment.
New leadership thought we were insufficiently productive. It is called not enough “billable hours.” We thought we were working very hard. An investigation revealed that our work was not being properly coded; hence, it looked as if we were not doing enough work. Coding workshops and an onsite coder remedied that problem. Armed with coding expertise, we continued our work. Shortly, thereafter, we became, on paper, the most efficient productive unit in military Tele Health. “They” thought we were cheating, so another investigation ensued. The conclusion: Proper coding showed that we were in fact doing that much work.
Leadership changed again, and an effort to close our unit ensued. It became politically impossible because our service was deemed so essential to the various sites around the country. This type of stress yields attrition.
Gradually, providers sought other jobs. Our provider numbers declined. Finally, the sudden, really unexpected, announcement arrived. The civilian contract would not be renewed. A Tele Health service, firmly administratively ensconced at another military post, would replace us. The date was set. More providers left.
Now, near the end, there are three psychiatrists remaining. We have over 1,000 patients among us. We are saying “goodbye” to each and everyone one of them. How does one explain the above story? Yet, every one of these service members “gets it.” They know how a large bureaucracy works. They know these decisions are often made by individuals who never see “patients.”
We three psychiatrists have more than 150 years of clinical experience and over twenty-five years of experience in Tele Health. None of that makes the goodbyes any easier. These eight years have been a gift.
Edward W. Beal, MD, Psychiatrist, Dept. of the Army,
Dept. of Tele-Health, U. S. Army Medical Department Activity,
Fort Meade
Ted Beal is currently working on his book of essays tentatively entitled
The Forgotten One Per Cent: Soldiers Speak, It is Time to Listen
To be published in November
