AFMS Flight Path: Building Future Leaders

1 AIR WAR COLLEGE AIR UNIVERSITY AFMS Flight path : Building Future Leaders by Shari F. Silverman, Lt Col, USAF, BSC A Research Report Submitted to the Faculty In Partial Fulfillment of the Graduation Requirements 12 February 2009 Report Documentation PageForm ApprovedOMB No. 0704-0188 Public reporting burden for the collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering andmaintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,including suggestions for reducing this burden, to Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, ArlingtonVA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to a penalty for failing to comply with a collection of information if itdoes not display a currently valid OMB control number.

2 1. REPORT DATE 12 FEB 2009 2. REPORT TYPE 3. DATES COVERED 00-00-2009 to 00-00-2009 4. TITLE AND SUBTITLE AFMS Flight path : Building Future Leaders 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Air War College,Air University,325 Chennault Circle,Maxwell AFB,AL,36112 8. PERFORMING ORGANIZATIONREPORT NUMBER 9. SPONSORING/MONITORING AGENCY NAME(S) AND ADDRESS(ES) 10. SPONSOR/MONITOR S ACRONYM(S) 11. SPONSOR/MONITOR S REPORT NUMBER(S) 12. DISTRIBUTION/AVAILABILITY STATEMENT Approved for public release; distribution unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT Same asReport (SAR) 18. NUMBEROF PAGES 44 19a. NAME OFRESPONSIBLE PERSON a. REPORT unclassified b. ABSTRACT unclassified c. THIS PAGE unclassified Standard Form 298 (Rev. 8-98) Prescribed by ANSI Std Z39-18 DISCLAIMER The views expressed in this academic research paper are those of the author and do not reflect the official policy or position of the government or the Department of Defense.

3 In accordance with Air Force Instruction 51-303, it is not copyrighted, but is the property of the United States government. ii Contents AFMS Flight Command Redefine Medical Groups (Organization)..13 iii Illustrations Figure 1, Medical Figure 2, Operations Table 1, Officer Table 2, Historical AFMS Squadron Commander Select Table 3, Corps Designation Table 4, PME Promotion iv Biography Lt Col Shari F. Silverman is a leader in the Air Force Medical Service. Currently, a student at Air War College, she was previously the Physical Medicine Flight Commander, 436th Medical Operations Squadron, Dover Air Force Base, Delaware. As a Flight commander, she was responsible for directing all clinical and administrative operations of the Physical Medicine Flight , serving over 19,000 beneficiaries, 77 providers and 12 clinics. In addition, she acted as the Deputy Squadron Commander for approximately 200 active duty and civilian members assigned to the 436th Medical Operations Squadron and led the squadron for three-months during the commander s deployment.

4 Concurrently, she led a 57-member Disaster Medical Readiness Team and served as the Biomedical Science Corps Executive advisor to 17 officers. Forging strong relationships with the Kent County Chamber of Commerce, she was the Wing Commander s representative during the 2008 Leadership in Central Delaware program. Lt Col Silverman graduated from the United States Air Force Academy in the top 15 percent of her class. As a medical officer, she has served not only as a medic but in several line-officer positions at the Squadron, Wing, and Headquarters Air Force levels. She is married to Lt Col Shawn Silverman and has a son, Trystan and daughter, Autumn. v INTRODUCTION As the nature of warfare has changed since Operations ENDURING FREEDOM and IRAQI FREEDOM, the structure of the Air Force has evolved to adapt to the current expeditionary needs of the Defense Department. The Air Force Medical Service (AFMS) is not spared in this process. The AFMS released the Flight path Implementation Guide for the Combat Wing Organization-Medical in April 2006 as the first step in its transformation to meet the demands of the 21st Century.

5 As a concept, military healthcare is somewhat of an oxymoron. A military organization such as the Air Force intent on killing people and breaking things requires a robust healthcare system that meets mission demands yet secures the health of family members. The military healthcare organization with two inseparable missions of military readiness and professional excellence must strive to perform both equally well. The Flight path strives to create a bridge between the two vastly different missions without comprising either role. The new Expeditionary AF role coincided with a revolutionary change in preparing airmen through Force Development policies and programs AF-wide. Both events required the AFMS to examine its way of conducting operations. On 28 May 2004, Chief of Staff of the Air Force (CSAF) Gen. John Jumper issued a memo entitled, Developing Expeditionary Medics A Flight path . This memo tasked the Air Force Surgeon General (AF/SG) to relook the then current Objective Medical Group (OMG) structure.

6 CSAF specifically stated the AFMS required improvements in Future senior leader development and medical group The guidance further directed the AF/SG to review the medical group structure for garrisoned and expeditionary medical The AF/SG, Lt Gen. (Dr.) James Roudebush identified, The overall goal of the Flight path is to develop a streamlined, consistent medical group structure, from clinic to medical center that provides a ready and fit medical force in support of 1 the Air Expeditionary Force. It assures military and functional medical competence; provides a power projection platform to deploy medics forward; and delivers high quality, cost-effective care. 3 A secondary goal of reorganization was to minimize the number of layers existing between airmen and The purpose of this paper is to examine the Flight path , in particular, the emphasis on leadership opportunities for AFMS officers. The paper will provide a brief background on Flight path development and the problems it attempts to address.

7 Although the AFMS is moving in the right direction, cross-functional promotion opportunities, senior leadership positions, Force Development tools, organizational structure at the clinic, and command opportunities continue to need refining to optimize leadership opportunities and meet the intent of the CSAF s guidance. This paper concludes with a series of recommendations for Future Flight path revisions as well as other areas outside the scope of the Flight path to build Future AFMS warrior- Leaders . THE AFMS Flight path Since 1993, the AFMS has operated under the Objective Medical Group (OMG) structure. At the time, the OMG represented a transformational change in the way medics did business. The OMG created a product line focus with four designated squadrons: Medical Operations, Aerospace Medicine, Dental, and Medical Support. The basic structure flexed for groups with less than 300 authorizations and for facilities greater than 600. Under the OMG, the dual nature of the medical professional was recognized satisfying both the line construct of command and control as well as the accreditation requirements for a healthcare facility.

8 In 2004, CSAF mandated an OMG relook as part of a broader effort to evaluate the development of medical Leaders . The relook was dubbed the AFMS Flight path for short. The Flight path was designed to better cultivate the development of expeditionary medics through the evaluation of three aspects of leadership development 1) Promotions, 2) Redefine Medical 2 Groups, and 3) Command Nine senior level working groups looked at aspects of each and worked under the following objectives: 1) corps-specific force development 2) balanced leadership team with the MTF 3) compliance with both military and civilian certification/accreditation requirements 4) cost-effective mission support in-garrison and deployed 5) provide streamlined/consistent OMG structure from clinic to medical center 6) focus on functional/clinical expertise 7) command opportunity in line with the Line of the Air Force (LAF) 8) reduced overhead costs/decreased administrative burden 9) trains/sustains expeditionary ,7 These panels made a number of recommendations that were quickly acted upon.

9 Per Assistant Surgeon General for Medical Force Development, The overarching goal of the " Flight path " is to guide more deliberate development for AFMS officers and senior enlisted, placing the member in the right job at the right time and setting them up for career success and personal satisfaction while maintaining expertise at the frontlines of patient care. 8 Leadership, both in garrison and in the expeditionary environment, therefore, is the real focus of the Flight path . Under the Promotion initiative, the CSAF letter provided for designated General Officer opportunities for all Both the Biomedical Science Corps (BSC) and Medical Service Corps (MSC) gained a Brigadier General slot. These billets were mandated in an effort to eliminate corps competition for senior leadership Prior to Flight path guidance, neither corps were guaranteed senior leadership opportunities beyond Colonel. Organizationally, medical treatment facilities (MTF) were redefined into several distinct categories: medical wing, medical centers, hospitals, clinic plus, clinics, and training ,12 At each MTF, mission and size may affect the basic clinic structure and variations may be authorized to comply with unique situations.

10 Initially the Flight path favored a corporate model for small MTFs and recommended a Group without Squadron structure for MTFs with less 3 than 250 manpower Under the corporate model 34 MTFs were targeted for squadron deactivation. In April 2007, NOVA reversed the According to Lt Gen Roudebush, The SGs unanimously supported maintaining our squadron organization. This confirmed what we had been hearing from Line leadership across the Air Force. Medical groups with squadrons best maintain our alignment under the Wing Commander. 15 The hybrid model of AF and corporate healthcare structure under the OMG was retained, and the small numbers of deactivated squadrons were reactivated. In general, the Flight path maintains the four squadron framework of OMG with an additional two squadrons for hospitals/medical centers as defined in AFI 38-101, Air Force Exceptions to structure exist especially under the Medical Wing (MDW) model. Finally, command opportunities at the squadron and group levels aligned with the line construct and took into consideration the cross-functional differences among the corps.