USAWC STRATEGY RESEARCH PROJECT 

SUSTAINING AMEDD PROFESSIONAL STRENGTH 

IN THE RESERVE COMPONENTS 

by 

Colonel James M. Fetter, III 

United States Army Reserve 

Colonel Wayne Foxworth 

Project Advisor 

This SRP is submitted in partial fulfillment of the requirements of the Master of 

Strategic Studies Degree. The views expressed in this student academic research 

paper are those of the author and do not reflect the official policy or position of the 

Department of the Army, Department of Defense, or the U.S. Government. 

U.S. Army War College 

CARLISLE BARRACKS, PENNSYLVANIA 17013 
ii 
iii 

ABSTRACT 

AUTHOR: Colonel James M. Fetter, III 

TITLE: Sustaining AMEDD Professional Strength in the Reserve Components 

FORMAT: Strategy Research Project 

DATE: 19 March 2004 PAGES: 37 CLASSIFICATION: Unclassified 

Reserve components of the U.S. Army are a strategically valuable resource to U.S. 

military policymakers. Within these components are the majority of professional medical 

personnel. As of July 2002, the AMEDD consisted of 19% Army National Guard, 34% Army 

Reserve and 47% active component. In 2000 concerns were raised about dwindling numbers of 

doctors, dentists, physician assistants and nurse anesthetist officers in Army Reserve and Army 

National Guard (Selected Reserve [SELRES]) that, without intervention, would result in 

projected shortfalls through 2005. Also in 2000, significant increases were projected in the 

percentage of retirement letter eligible Medical Corps, Dental Corps, Army Nurse Corps, and 

Physician Assistants. This has potential risk in light of the changing nature of activations and 

increased OPTEMPO. Potential effects of mobilization and deployment on recruitment, 

retention and other related issues are explored. Suggestions for improving recruitment and 

retention are discussed. 
iv 
v 

TABLE OF CONTENTS 

ABSTRACT .................................................................................................................................................. iii

ACKNOWLEDGEMENTS ........................................................................................................................... vii

LIST OF ILLUSTRATIONS .......................................................................................................................... ix

LIST OF TABLES......................................................................................................................................... xi

SUSTAINING AMEDD PROFESSIONAL STRENGTH IN THE RESERVE COMPONENTS ....................... 1

RESERVE COMPONENT AMEDD UP TO 1990 .................................................................. 3

RESERVE COMPONENT AMEDD SINCE 1990 .................................................................. 4

CURRENT AMEDD STRUCTURE ........................................................................................ 5

RETAINING RC AMEDD PROFESSIONALS ....................................................................... 6

RECRUITING RC AMEDD PROFESSIONALS .................................................................... 7

EXAMINATION OF DATA COLLECTED FOR THE ARMY ............................................... 11

1996 SURVEY OF USAR PHYSICIANS ............................................................................. 11

2001 MAIL SURVEY OF ARNG AND USAR PHYSICIANS, DENTISTS AND NURSE 

ANESTHETISTS .................................................................................................................. 12

2001 FOCUS GROUP DATA ............................................................................................... 13

EXAMINING SOLUTIONS ................................................................................................... 14

SHORT-TERM SOLUTIONS ............................................................................................... 14

LONG-TERM SOLUTIONS .................................................................................................. 15

CONCLUSION ..................................................................................................................... 16

ENDNOTES ................................................................................................................................................. 17

BIBLIOGRAPHY ......................................................................................................................................... 23
vi 
vii 

ACKNOWLEDGEMENTS 

I would like to acknowledge the helpful Army War College Library staff and particularly 

Kathy M. Hindman for her efforts in borrowing difficult-to-find resources. The following 

individuals are not a part of the Army War College staff or faculty but provided information and 

sources of information that were valuable in the course of researching this paper (alphabetical 

by last name): 

MAJ Michael D. Luraschi, Army Medical Department Center and School, 

COL William F. Martin, Office of the Surgeon General, 

COL Jane I. McCullough, Medical Command Headquarters, 

MAJ Mary K. Roou, Army Medical Department Center and School, and 

LTC Randal A. Schwallie, Office of the Surgeon General. 

Lastly, I want to express appreciate appreciation to my project advisor COL Wayne 

Foxworth for his guidance and direction through the entire process. 
viii 
ix 

LIST OF ILLUSTRATIONS 

FIGURE 1: DOCTORS, DENTISTS, PHYSICIAN ASSISTANTS AND NURSE ANESTHETIST 

OFFICERS IN USAR AND ARNG SELECTED RESERVE (SELRES)......................................... 1

FIGURE 2: RESERVE COMPONENT CONTRIBUTION TO MISSIONS ..................................... 5

FIGURE 3: CIVILIAN SPECIALTY COMPENSATION VS. RECRUITING ACCOMPLISHED .... 10
x 
xi 

LIST OF TABLES 

TABLE 1: RETIREMENT ELIGIBLE SELECTED RESERVE CLINICIANS .................................. 2

TABLE 2: PERSONNEL CHANGES WITH MRI ........................................................................... 6

TABLE 3: AMEDD INCENTIVE PROGRAMS .............................................................................. 9
xii 
SUSTAINING AMEDD PROFESSIONAL STRENGTH IN THE RESERVE COMPONENTS 

The mission of the AMEDD is to maintain the health of members of the Army, 

conserve the Army's fighting strength, and prepare for health support to members 

of the Army in times of deployment across a continuum of scenarios, ranging 

from international conflict to civic actions and disaster relief. The AMEDD also 

provides health care for eligible personnel in peacetime for the sustaining base. 

The AMEDD is also responsible for maintaining the readiness and 

clinical/technical competence of medical personnel to support Army 

requirements.i

The Army Medical Department [AMEDD] requires sufficiently trained professionals to 

accomplish its mission. Through the AMEDD Center and School, it examines force structure, 

personnel inventories, and life-cycle management—in all AMEDD career fields.ii One of the 

chronic problems in personnel inventories has been the inability to fill professional positions in 

the reserve component [RC] AMEDD—usually in the Medical Corps. 

In 2000, particular effort was made to broadcast to the regional medical commands and 

their affiliated reserve medical commands problematic trends in the RC personnel inventory of 

doctors, dentists, physician assistants and nurse anesthetist officers. These AMEDD specialties 

were of concern because they were (and are) considered vital to deploying units.iii 

Unfortunately, these specialties had the lowest numbers assigned as a percentage of their 

authorized positions.iv Through problems in recruiting and retention, aggregate strength (given 

past shortfalls and projected future shortfalls) was and continued to be insufficient to fill 

authorized positions (see Figure 1). For example, the Army National Guard [ARNG] and Army 

Reserve [USAR] were nearly equal in shortage percentages in 2000 with the Selected Reserve 

Medical Corps fill only 63.58% of the authorization.v

4000

5000

6000

7000

8000

9000

1994

1996

1998

2000

2002

2004

POM Year

Strength Authorized

Assigned

FIGURE 1: DOCTORS, DENTISTS, PHYSICIAN ASSISTANTS AND NURSE ANESTHETIST 

OFFICERS IN USAR AND ARNG SELECTED RESERVE (SELRES)vi

This particular officer group was also graying. The data was revealing given the contrast 

of current and future retirement-eligible SELRES clinicians (see Table 1). 
2 

Corps/Specialty Retirement Letter In Hand FY99 

(PEBD Pre-1980) 

Retirement Letter In Hand FY04 

(PEBD Pre-1985) 

MC 36% 51% 

DE 69% 82% 

AN 27% 49% 

SP(physician assistant) 49% 72% 

TABLE 1: RETIREMENT ELIGIBLE SELECTED RESERVE CLINICIANSvii

To summarize, the AMEDD was faced with a reserve clinician strength management 

problem. Recruiting and retention efforts had not been able to meet readiness standards for 

projected wartime strength, and the remaining strength was growing older. An increasing 

operations/operating tempo [OPTEMPO] had negative efforts on the strength of this group in the 

past; and there was no reasonable likelihood of OPTEMPO decreasing in the near future. 

Simply continuing what had not worked in the past was not a viable option. This was a problem 

deserving of research, thought, and decisive action. It has been a long-standing and recurring 

problem. It was and remains a problem worthy of the attention of strategic leaders. 

During the 8 May 2003 Reserve Component Coordination Council meetingviii, General 

John Keane, then Vice Chief of Staff of the Army; Major General Kenneth Herbst, Deputy 

Surgeon General; and Lieutenant General James Helmly, Chief, Army Reserve; discussed this 

issue—the AMEDD clinician aggregate inventories were “insufficient to meet wartime 

requirements.”ix The problem remains largely in the Medical Corps. There have been 

improvements in the other AMEDD corps. In order to maintain sufficient personnel, the 

President may issue what is known as a “stop loss” [also written STOPLOSS] during any 

Presidential Selected-Reserve Call-up or higher mobilization action.x

 (A STOPLOSS is the 

Presidential suspension of any law relating to promotion, retirement, or separation.)xi However, 

despite recent STOPLOSS actions and despite the adjustment downward of the number 

authorized in the Medical Corps, the Medical Corps remained at only 78 per cent of their 

authorized strength as of 31 March 2003.xii

 Given the resilience of the problems of RC AMEDD clinician strength management, it is 

worthwhile examining and discussing related factors. This paper will examine some of these 

factors, review surveys and interviews of Army Reserve AMEDD professionals, and make 

recommendations to improve recruiting and retention of Army Reserve AMEDD clinicians. 

Before examining factors and surveys, additional background is worthwhile reviewing. 
3 

RESERVE COMPONENT AMEDD UP TO 1990 

The Army Reserve AMEDD came into existence in the early 1900s. Prior to the existence 

of the Army Reserve, the AC looked to civilian and National Guard medical professionals to 

supplement the AMEDD in wartime. In peacetime, although the National Guard had physicians 

within its ranks, they were not available to supplement the U.S. Army unless federalized. As a 

result of the Spanish-American War the Army and its AMEDD realized significant changes had 

to occur. Added to this, in the early 1900s, the AMEDD was continuously short of physicians, 

even when supplemented with contract physicians. In 1908 Congress created the Medical 

Reserve Corps. This was extremely important both to the AMEDD and the Army as it was the 

Army’s first reserve corps that would be federally available without having to mobilize state 

forces.xiii This is also considered the establishment of the Army Reserve. That is, when the 

Medical Reserve Corps was absorbed into Officers' Reserve Corps in June 1917,xiv the concept 

of a federal reserve for the Army was broadened. Thus, from a portion of the AMEDD, sprang 

what has become the Army Reserve. 

The newly created Medical Reserve Corps (later known as the AMEDD officers of the 

Army Reserve) and, when federalized the National Guard, supplemented the Regular Army 

AMEDD, both in peacetime and wartime. To summarize a complicated history into few words, 

after several decades and several major wars, both the active and reserve AMEDD changed 

significantly, adding specialties and branches along the way. Maintaining adequate 

professionals in the Regular Army was periodically very problematic. The period following World 

War II is illustrative. The Army needed to be larger following World War II than it was before that 

war. Therefore, Congress authorized, for an eight-month period shortly after World War II, the 

U.S. Army to provide Regular Army appointments to officers with reserve commissions. The 

name for this program was the “Regular Army Integration Program.”xv There were more than 

45,000 medical officers who could have applied for a Regular Army commission during World 

War II, but only slightly more than one percent applied.xvi Despite the Army’s post World War II 

program to increase AC commissioned officers of all branches, a dramatic shortage of 

physicians and dentists continued. This broad shortfall attracted national attention as it existed 

in the Navy and the Public Health Service, not just the Army. 

This created an awareness, not only in the top levels of the military service but 

also among members of Congress, that in order for the military services to 

maintain Medical and Dental Corps of suitable size and quality, some special 

provision would have to be made for their members to compensate for the extra 

time and money invested in their education and training, and permit them to have 

a standard of living at least closer to that of their civilian counterparts.xvii
4 

Subsequently, doctors of medicine and dentistry had their pay increased by $100 per 

month and procurement authorized up to the grade of colonel.xviii This is the first time legislation 

was created for the particular advantage of officer clinicians in these specialties.xix

Other than the use of 240,000 soldiers of the Organized Reserve in the Korean Conflict and a 

mobilization of 69,000 Army Reservists during the Berlin Crisis, activations of Army Reserve 

units during the Cold War (prior to Desert Shield/Storm) were not, by comparison, nearly as 

significant. During those quiescent Cold War years, the relationship between the active and 

reserve AMEDD grew into one where RC AMEDD officers understood themselves as an asset 

likely to be used only in the event of a major conflict. The likelihood of mobilization of the Army 

Reserve AMEDD officer was estimated in the 1980s to be once, maybe twice, in a career—

possibly never. Desert Storm changed that. 

RESERVE COMPONENT AMEDD SINCE 1990 

Desert Shield/Storm resulted in a large call-up of the RC AMEDD. “The medical forces on 

active duty reached 87,487 in February 1991, the largest force since World War II. More than 

23,000 AMEDD personnel, about 55% of whom were Reserve Component, were deployed to 

SWA.”xx Despite the use of 198 medical units (in addition to medical assets already organic to 

combat divisions), the General Accounting Office (GAO) characterized this effort in the title of 

their report as “Full Army Medical Capability Not Achieved.”xxi Despite this less than glowing 

report, the RC was tasked more than ever. In the years following Desert Shield/Storm, the RC 

were mobilized and deployed much more frequently than before 1990. A graphical presentation 

of the growing RC duty days is represented in Figure 2 and bears a brief explanation. The solid 

line shows the RC direct support. The pattern reveals an increasing baseline operations tempo 

(OPTEMPO) that is independent of the spikes (dashed lines) of Operations Desert Shield/Storm 

and Nobel Eagle/Enduring Freedom. The RC AMEDD was proportionally mobilized during this 

period of increasing OPTEMPO. 
5 

5.2 M

FY86 FY87 FY88 FY89 FY90 FY91 FY92 FY93 FY94 FY95 FY96 FY97 FY98 FY99 FY00 FY01 FY02

DESERT SHIELD / STORM

CONTRIBUTION

CONTRIBUTION EXCLUDING 

DS/DS & ONE/OEF

NOBLE EAGLE / ENDURING FREEDOM 

CONTRIBUTION

39.0M Duty days

23.9M Duty days

.9M Duty days

5.2M Duty days

13.5M Duty days

12.6M Duty days

17.1M Duty days

NOTE: DATA SHOWS

“DIRECT SUPPORT” ONLY, 

NOT “INDIRECT SUPPORT” 

(e.g., RECRUITING, USPFO, 

MOST AGR SUPPORT). 

NOTE: DATA SHOWS

“DIRECT SUPPORT” ONLY, 

NOT “INDIRECT SUPPORT” 

(e.g., RECRUITING, USPFO, 

MOST AGR SUPPORT). 

5.2 M

FY86 FY87 FY88 FY89 FY90 FY91 FY92 FY93 FY94 FY95 FY96 FY97 FY98 FY99 FY00 FY01 FY02

DESERT SHIELD / STORM

CONTRIBUTION

CONTRIBUTION EXCLUDING 

DS/DS & ONE/OEF

NOBLE EAGLE / ENDURING FREEDOM 

CONTRIBUTION

39.0M Duty days

23.9M Duty days

.9M Duty days

5.2M Duty days

13.5M Duty days

12.6M Duty days

17.1M Duty days

NOTE: DATA SHOWS

“DIRECT SUPPORT” ONLY, 

NOT “INDIRECT SUPPORT” 

(e.g., RECRUITING, USPFO, 

MOST AGR SUPPORT). 

NOTE: DATA SHOWS

“DIRECT SUPPORT” ONLY, 

NOT “INDIRECT SUPPORT” 

(e.g., RECRUITING, USPFO, 

MOST AGR SUPPORT). 

FIGURE 2: RESERVE COMPONENT CONTRIBUTION TO MISSIONSxxii

CURRENT AMEDD STRUCTURE 

 The Army Reserve is a significant portion of AMEDD assets. The AMEDD structure is 

47% AC (not including civilians) and 53% RC (34% Army Reserve and 19% Army Nation 

Guard).xxiii At this point a fair question would be, “Why mention AMEDD structure in a paper 

entitled ‘Sustaining AMEDD Professional Strength in the Reserve Components’?” The answer is 

that structure drives the requirements. Changing the structure may improve (or worsen) the 

manning requirements. Currently there is much work underway in this regard. For much more 

detail, the reader is referred to the Medical Reengineering Initiative (MRI) Program 

Implementation Office website.xxiv Important to RC AMEDD strength requirements is that one 

purpose of the MRI is reduction of the need for difficult-to-recruit specialties in the Army 

Reserve. “MRI improves personnel readiness within the United States Army Reserve (USAR) by 

reducing requirements for officer and enlisted specialties that are difficult to recruit and retain. 

The USAR medical personnel savings estimate is 2500 spaces.”xxv

It is worthwhile to examine the changes to the Army Reserve that MRI could bring. Table 

3 (from data presented January 2003) illustrates potential improvements. Assigned total Medical 

Corps, general surgeon, and orthopedic surgeon figures in Troop Program Unit (TPU) positions 

and Professional Filler System (PROFIS) positions are under the assigned header. When those 

assigned figures are used in the current authorized Medical Force 2000 (MF2K) positions, you 
6 

can see the percentage fill in the next to the last column. Under the structure proposed by MRI, 

the assigned percentage fill is in the last column; all three improve—Medical Corps (111 percent 

with MRI), general surgeons (100 percent), and orthopedic surgeons (88 percent). 

CATEGORY ASSIGNED MF2K AUTH MRI AUTH MF2K 

ASSG% 

MRI 

ASSG %

TPU PROFIS TOTAL 

TOTAL MEDICAL CORPS 610 88 698 878 625 79 111%

61J-General Surgeon 125 0 125 198 125 63 100%

61M-Orthopedic Surgeon 39 5 44 94 50 47 88%

TABLE 2: PERSONNEL CHANGES WITH MRIxxvi

RETAINING RC AMEDD PROFESSIONALS 

Retaining the large number of specialties in the AMEDD is no small task. Within the 

Medical Corps—currently the most problematic to fill—the specialties number forty one (41).xxvii

Each of those specialties has its medical board certification requirements, and each its market 

supply and demand issues. Providing ongoing meaningful and balanced military training and 

continuing education to all those specialties is also challenging to both the AC and RC. These 

ongoing issues have to be addressed to retain quality professionals. 

Mobilizations also have a considerable effect on retention of physicians. Those physicians 

in solo practice are most affected by the disruption to their practice. Five years following Desert 

Shield/Desert Storm, some mobilized units retained only fifty percent of the number of 

physicians before that operation.xxviii The Department of Defense Inspector General 1996 report 

gives a broader, more objective and more sanguine history. From FY 1990 to FY 1995, there 

was a decline of twenty-five percent in the number of assigned physicians in the Army Selected 

Reserve.xxix However, commenting on problems of physician recruitment and retention in the 

selected Army Reserve, the Inspector General of the Department of Defense reported: 

The perception that a Reservist would be mobilized only for a major conflict has 

been replaced with the realization of greater Reserve Component participation in 

peacekeeping missions. For physicians, the greater participation in peacetime 

missions equates to a greater risk of extended active duty, income loss, and 

business loss, and this adversely affects recruitment and retention in the 

Reserves.xxx

Echoes of that Inspector General’s 1996 comment resounded when a third of the Army Reserve 

physicians sent to the Balkans from 1995 to1998 left the Army Reserve.xxxi Recruitment to fill 

those losses was difficult.xxxii
7 

RECRUITING RC AMEDD PROFESSIONALS 

Recruiting is a huge service industry and an enormous topic about which volumes have 

been written. There is even a specialized service industry built around recruiting medical 

professionals. Even within the Army, the AMEDD officer recruiting is operated separately. It is 

therefore the intent of this section to address three relevant issues—those that may lend 

themselves to potential improvements in recruiting Army RC AMEDD professionals. The first 

issue will be a short discussion of the importance of locality in RC recruiting; the second will be 

the some management and advertising issues; and the third will be incentives and 

compensation. 

A major difference between recruiting for the AC and RC is that RC recruitment is based 

on locale. That is, when a soldier is recruited for the RC, he (or she) is recruited for a unit 

nearby his (or her) home. Changes in AMEDD recruiting have noticeably changed in the past 20 

years. Formerly some RC hospitals had AMEDD recruiters physically collocated.xxxiii This 

situation has changed as these recruiting efforts have been regionalized, and sometimes these 

regional offices are an uncomfortable distance away from reserve medical units.xxxiv AMEDD 

recruiters are not as likely to recruit local medical professionals to units that are some distance 

away. When these distant units receive recruits, they may be from further away than most 

AMEDD professionals are willing to travel for regular participation in RC units. RC AMEDD 

recruiters will likely use or need to use more travel funds (than AC counterparts) if the RC 

AMEDD recruiting cannot locate closer to the RC medical units they support. 

The second recruiting issue concerns the management of the recruiting effort, and part of 

this issue again involves the structure of AMEDD recruiting regions. This effort must include 

increased recruiter efficiencies by improved management and better targeted marketing. The 

Army G1 recognizes a need to “improve AMEDD Recruiting by increasing recruiter efficiency 

and revising structure.”xxxv AMEDD recruiting regions are the same for AC and RC. The AMEDD 

recruiting regions are not completely geographically collocated with regional medical commands 

or regional reserve commands. This contributes to inefficiencies in coordinating with these 

regions. Some other regional discontinuities are difficult to explain. Some AMEDD recruiting 

centers are, in some areas, located near the borders of their regions. This makes recruiting 

efforts on the periphery of their region take significant travel time. Also, medical schools and 

large population centers close to reserve medical units are sometimes placed in another 

recruiting region. Returning to the theme of locale, the reduced availability of those schools and 

centers to the assigned recruiter makes the local recruitment effort all the more difficult. 
8 

While the AMEDD recruiters remain of high quality, there have been recent changes that 

reduce the overall effectiveness of RC recruiting efforts—specifically those attempts to transition 

officers from the Individual Ready Reserve (IRR). The mission to recruit from the IRR into TPUs 

has been shifted to retention and transition noncommissioned officers (RTNCOs), military 

occupational specialty (MOS) 79V, within the Army Reserve. United States Army Recruiting 

Command (USAREC) no longer has this mission. This mission change affected recruiting of all 

IRR personnel—both non-AMEDD and AMEDD. However, these RTNCOs do not have the 

requisite training or experience to address AMEDD-specific issues. Compared to the USAREC 

AMEDD-specific recruiters, the generalist RTNCOs are sent scurrying to research questions 

about the RC AMEDD. However difficult recruiting or transitioning RC AMEDD personnel from 

the IRR to TPU was before the change of mission, that effort is now all the more difficult. 

RTNCOs that support medical units need AMEDD-specific training. Recruiting efforts for RC 

AMEDD professionals must be more focused on RC-specific factors to improve. 

The advertising for the RC AMEDD must be targeted. For example, when medical units 

are short of orthopedic surgeons in a state (or region), advertising and marketing dollars should 

target that specialty and area. That is, funds should be spent on orthopedic journals, orthopedic 

medical society meetings, and orthopedic residency programs. Further, those funds should 

target the state, region and major metropolitan area. Many times specialties will organize even 

as small as a city level to share information on a regular basis. However, no amount of 

advertising and marketing will compensate if the incentives and compensation package is 

incorrect. 

A relevant discussion of recruiting and retention must address incentives and 

compensation. In depth studies of military compensation, recruiting, and retention are readily 

available.xxxvi,xxxvii A singular message can be gleaned from a review of those studies. The 

economics of recruiting are dynamic and complex. Army recruiting and Army AMEDD recruiting 

professionals have recognized these variable complexities. Programs analysis and evaluation 

sections within Army personnel management continuously monitor the need for appropriate 

incentives and compensation. However, these packages are limited by law and may require 

changes. 

There are a variety of incentives to attract professionals and potential professionals. A 

sample of these programs briefed during 2002 is in Table 4, AMEDD Incentive Programs. 
9 

Financial 

Assistance 

Program (FAP) 

MC, DE 

(RA) 

$1058/mo plus annual grant of $23,379 2 years for 

each year 

Specialty Training 

Assistance 

Program (STRAP) 

MC, DE, AN, 

MS (USARWCSL) 

$1058/mo 1 year for 

each year 

plus 1 year 

Loan Repayment DE, MS 

(RA); 

(USARWCSL) 

DC, MS (Pharm) up to $100,692; USARWCSL $50,000 

Health 

Professions Bonus 

DE, AN 

(RA); MC, 

DE, AN 

(USAR) 

RA DC $30,000; RA AN $5,000; USAR 

MC, DC, and 66F $30,000; USAR 66H8A 

$9,000 

Early 

Commissioning 

Program (ECP) 

VC, DE (RA) Time in service and time in grade accrue 

from commissioning date 

Educational 

Programs 

MSN Nurse Anesthesia, MSN Critical Care, PT Baylor, Dietetic Internship, 

PA Program, OTFWE, CPIP, Pharmacy Residency 

TABLE 3: AMEDD INCENTIVE PROGRAMSxxxviii

These incentives attract large numbers, but they are not the whole story. Some of the incentives 

have been in place without change for a number of years and are becoming threadbare with the 

wearing. For example, the $50,000 loan repayment for USAR participants has lost value over 

time and appears less and less significant to physicians graduating with heavy education debts. 

To those recently graduated physicians, the risk to their practice by involvement in the Army 

Reserve is less and less compensated—especially in an increasingly higher OPTEMPO 

environment. 

Within the AMEDD, there are a variety of compensations available. Health Professions 

Special Incentive and Retention Payxxxix is a somewhat flexible tool to tackle variable shortages 

of AMEDD clinicians.xl The constant monitoring and the flexibility of compensation have 

combined to keep compensation from being a major issue for most AMEDD retention and 

recruiting—at for the AC. RC AMEDD compensation issues are excepted for reasons that 

follow. 

When comparing the compensation of the civilian physician, the individual-to-individual 

compensations, as a general rule, are somewhat competitive with the total military 

compensation (with notable exceptions in the highest paid specialties). Figure 3, Civilian 

Specialty Compensation versus Recruiting Accomplished, reveals the difficulties recruiters face 

in those specialties that are the highest compensated. That is, the offered compensation to 
10 

orthopedic and neurosurgeons are not attractive enough to entice them into the Army Reserve. 

However, simply equating the compensation of the individual, whether civilian or military, does 

not consider the practice or business factors (beyond the individual compensation) that are 

important to the physician who gets mobilized. Consider that the physician in a private practice, 

whether group or solo, has to leave his patients to the care of others. When those patients 

leave, some never return. This is both a business and a relationship issue. 

$0

$50

$100

$150

$200

$250

$300

$350

$400

$450

$500

61F Internal

Medicine

61H, Family

Practice

60W,

Psychiatrist

61J, General

Surgeon

60J, Ob/Gyn 61M,

Orthopedic

Surgeon

61Z,

Neurosurgeon

(000)

Percentage of 

Mission 

Accomplished

150%

100%

50%

Average Civilian Physician Compensation

and FY 01 USAR Mission Performance

Average 

Civilian Comp

FY 01 Mission 

Performance

FIGURE 3: CIVILIAN SPECIALTY COMPENSATION VS. RECRUITING ACCOMPLISHEDxli

There are more specific business issues. Malpractice coverage is an excellent example of 

a difficult issue. Those physicians leaving their practice must continue malpractice insurance 

coverage, even during military service, and for high-risk specialties the cost may be 

considerably more than $100,000 annually. This cost is not considered when equating civilian 

and military compensation; military physicians are not required to carry separate malpractice. 

Here is another example. When a physician leaves a practice, that physician leaves behind 

associated office and clinical staff which depend on physician-generated income to pay their 

salaries. How can that loss be covered to keep the office open or at full capacity? An Army 

Reserve physician would be wise to have agreements to cover their practice prior to 

mobilization but most do not. That planning failure will be discussed later in this paper. 
11 

EXAMINATION OF DATA COLLECTED FOR THE ARMY 

Well conducted collections of objective data may cast off predisposed thinking about 

particular groups and open up new possibilities. As stated earlier, the problem of insufficient 

personnel has historically been and remains largely in the Medical Corps, both AC and RC, 

although it is currently more a problem for the RC. Examining relevant data concerning that 

group has led strategic leaders to make decisions in an attempt to solve the problem. In the 

three subsections below are very brief discussions of the following: a “1996 Survey of USAR 

Physicians,” a “2001 Mail Survey of ARNG and USAR Physicians, Dentists and Nurse 

Anesthetists,” and a collection of data from Kosovo rotation focus groups during March to 

November 2001. The latter focus groups were conducted with the 313th And 399th Army 

Reserve Combat Support Hospitals. 

1996 SURVEY OF USAR PHYSICIANS 

This 1996 sample of 835 responding Army Reserve physicians was representative of the 

larger population. Almost half had been mobilized at least once during the previous six years.xlii

Mobilizations were a, if not the, prominent concern. The summary of the survey report is 

illustrative: 

Receiving money from the USAR is not a major motivator for joining or staying in 

the Reserve—service to country is consistently the highest rated reason. The 

fear of financial difficulty, however, due to mobilization is a major consideration in 

decisions to leave. Basically, physicians join and stay for altruistic reasons (i.e., 

service to country), find service gratifying, but when service threatens their 

personal financial security, they chose (or are forced) to leave the Reserve.xliii

In light of the previous section’s discussion of compensation, this statement bears further 

explanation. Simply put, Army Reserve physicians do not join for the money. Were that the 

case, economics would dictate far fewer would join. When mobilized and paid equivalently, their 

individual income—even when close to the same as their AC counterparts—does not 

compensate for the damage to their practice, continuing malpractice costs, etc. In many cases, 

the Army, with its increasing OPTEMPO and related increased RC mobilizations, pushes the 

altruistic motivations of some clinicians beyond the acceptable. 

Not contained in the above report summary are two relevant items discussed elsewhere in 

this 1996 survey. One of these is the survey recommendation of “definitely implement the 

Ready Reserve Mobilization Income Insurance.”xliv This insurance program was already 

implemented by the time the report was published, but the self-funded program went bankrupt 

and was discontinued in 1997. Private insurers steered clear of that insurance for many 

reasons, but the idea remains relevant, and it has not completely disappeared. A 2003 GAO 
12 

report reveals, “The Army has proposed a new special pay targeting critical health care 

professionals in the reserves who are in private practice and are deployed involuntarily beyond 

the established rotational schedule.”xlv

A second item worth reviewing was not contained in the 1996 summary 

recommendations. This item was a suggested by data further within the report and was later 

transformed into policy. That policy is the ninety days boots-on-the-ground (90-day BOG) policy. 

Eighty-one percent of the physicians surveyed said they would have serious negative impact to 

their civilian practices if mobilized more than ninety days.xlvi A pilot policy was initiated by the 

Assistant Secretary of the Army (Manpower and Reserve Affairs) limiting the involuntary 

mobilization for RC physicians, dentists and nurse anesthetists to 90 days.xlvii This pilot program 

was successful and improved retention, especially among the self-employed.xlviii Today, the 90-

day BOG is established as policy and is now included on published orders. Unfortunately for 

some, the implementation has not been the 90-day mobilization they expected. Because of the 

needs of the Army, the 90-day mobilization was changed to 90-days BOG. Slow in and out 

processing and additional train-up periods for overseas deployment have meant up to 180-day 

mobilizations for some—with 90 days in theater—resulting in additional serious negative impact 

to the RC AMEDD provider’s practice. Also, awareness of this policy has not been uniform as 

will be shown in the 2001 Survey of RC Physicians. 

2001 MAIL SURVEY OF ARNG AND USAR PHYSICIANS, DENTISTS AND NURSE 

ANESTHETISTSxlix

This 2001 survey and the focus group data are related. In, “2001 OTSG contracted with 

AmerInd, Inc. and its subcontractor, Applied Research Analysts to evaluate the Presidential 

Reserve Call-up 90-day Rotation Pilot Program for RC Physicians, Dentists, and Nurse 

Anesthetists via mail-out survey, focus groups from deployed RC units, and in-depth interviews 

with operational officials responsible for implementing the program.”l

There were 865 responses with data adequate for analysis.li From the title it is obvious 

this was a broader population than the 1996 survey. There was significant interest in separating 

results into populations that had and had not been mobilized. The following are just two of 

many, actionable bullets from this survey: 

The majority of respondents (55% in both groups) had made no preparations in 

their practices for the possibility of mobilization.lii

A large number of respondents were not aware of the 90-day cap (40% of USAR 

respondents and 51% of ARNG respondents).liii
13 

Recommendations contained in this survey should be distributed to RC medical 

commanders and staffs at all levels. It is not surprising that mobilization would be upsetting to a 

group fifty-five percent of whom are without preparation of their practice. Redeployment 

retention might improve if a practice or business care plan (to parallel the current Army “Family 

Care Plan” policy) to reduce business losses were a pre-mobilization requirement. The large 

number unaware of the 90-day cap is also surprising. The RC must do a better job of educating 

its professionals. This is especially true considering the finding that “of the USAR respondents 

who were aware of the 90-day cap were significantly more likely to say that they intend to 

remain in service (59%) than respondents who were not aware of the cap (42%).”liv

Length of service also has a role in retention. Those who stay longer are more likely to 

want to remain until retirement. This is supported by the finding that “the percentage of USAR 

respondents who intend to remain until retirement increases dramatically in the period shortly 

after 10 years of service (about 7 years for ARNG respondents), most likely because they are 

‘over the hump.’”lv Incentives should be incorporated in contracting with professionals for 

commitments that get them past 10 years. If U.S. Army incentives could induce a commitment 

of 10 years, this would apparently increase the intention to stay until retirement. 

2001 FOCUS GROUP DATA 

John Whaley and Dr. Sandra Baxter of Applied Research Analysts moderated six focus 

groups with the 313th and 399th USAR Combat Support Hospitals deploying to and returning 

from Kosovo during March to November 2001.lvi There were a total of 46 participants. There are 

some general statements that can be made after review of that data. Most participants thought 

90 days was about right; although they realized the 90-day cap would increase the speed of 

rotations and their likelihood of being deployed again.lvii The biggest frustration was the wasted 

time and redundant training during the deployment and redeployment process.lviii When 

replacements arrived in a timely fashion, short overlap periods were all that were necessary. 

There were several suggestions for the 90-day BOG policy after the focus groups. Those 

falling under the 90-day BOG policy are called “cappers.” These suggestions were numerous, 

so those listed here are just a sample and the reader is referred to the 2001 report for more: 

improve unit chemistry, educate “non-cappers,” expand the 90-day BOG to other small business 

owners, allow “cappers” to provide medical care to indigenous personnel, and include motivated 

redeploying “cappers” in recruiting efforts.lix

After examining feedback, Amerind and Applied Research Analysts, Inc., recommended 

several changes to the 90-day policy in their recommendations. Again the reader is referred to 
14 

the study for a complete list.lx However, one of these recommendations was to change to the 

90-day BOG policy to a 100-day door-to-door policy. They suggested allowing for seven 

administrative days at the front-end and three at the back. Unless the current method of 

mobilizing and redeploying these AMEDD professionals is changed significantly, few officers will 

have their total administrative processing completed in ten days. 

EXAMINING SOLUTIONS 

In regard to the problem of adequately manning the RC AMEDD with sufficient 

professional clinicians, the background, history and recent surveys have been presented. Now it 

is time to review the solutions. These will be discussed in two sections—short-term and longterm solutions. 

SHORT-TERM SOLUTIONS 

Short-term solutions include targeted marketing, restructured and focused recruiting, 

policy education, improved and shortened deployment and redeployment procedures, 

contracting, and compensation. Targeted marketing includes advertisement in problem areas. 

Marketing firms specialize in targeting populations; those firms can help the Army fine tune its 

efforts. USAREC can redesign RC AMEDD recruiting boundaries to align with medical and 

reserve commands and to include nearby population centers and medical schools with 

supported reserve medical units. They can also allocate RC AMEDD recruiters to smaller 

regions. These recruiters will then more available locally. All RC AMEDD recruiting needs to be 

focused locally. 

Education about RC AMEDD issues must be improved. RTNCOs, at least those that 

support medical units, need education in RC AMEDD-specific issues and recruiting. Education 

about policies such as the 90-day BOG policy must be improved and must be briefed to all 

medical personnel—not just the affected clinicians. 

The deployment and redeployment of personnel affected by the 90-day BOG policy must 

be consistently shortened if the policy is to have the intended effect. That is, the Army cannot 

market a 90-day BOG then add significant additional time in deployment and redeployment. The 

deployment and redeployment processes also bear refinement. If physicians routinely deploy 

and redeploy through the same mobilization center, some additional attention can be paid them 

in the name of retention. (For that matter, that is true for all soldiers going through those 

processes.) Downtime needs to be reduced for these professionals, and where possible, 

downtime needs to have meaningful options. Counseling regarding medical pay, meaningful 
15 

train-ups, and continuing medical education videos could be made available to fill up waiting 

time. 

Contracting should be viewed more as a short-term solution since contracting is generally 

costlier than mobilizing the RC. However, in the interest of providing medical specialists in short 

supply to deployed units, contracted civilian specialists can fill the gap within the United States 

thus freeing military specialists for overseas deployment. Contracting is already being used to 

some extent. During Operation Iraqi Freedom, Army hospitals within the United States had AC 

AMEDD professionals deployed from those facilities. Expected backfill was sixty percent from 

the RC with the remainder to be made up from realignment of local structure, contracting 

medical professionals for the local hospital, or outsourcing to TRICARE. 

Minor adjustments in compensation to Army medical clinicians are programmed to 

compensate for short-term market variations. For example, when a specialty is in short-supply, 

certain parts of the Health Professions Special Incentive and Retention Pay can be adjusted to 

attract those specialists. While the current status of compensation and incentives were 

discussed in an earlier section, they need more improvement than the currently available minor 

adjustments. However, other improvements to incentives and compensations will have to come 

through legislation—a longer term solution. 

LONG-TERM SOLUTIONS 

Long-term solutions include restructuring the force, rewriting contracts (with incentives) to 

get younger RC professionals over the 10-year “hump,” and flexible consideration for AC 

professionals willing to take an extended RC commitment in place of a much shorter AC 

commitment. 

The Medical Reengineering Initiative program may make the problem of finding and 

keeping enough RC AMEDD professionals a moot point. As stated earlier, one of its goals is to 

reduce the requirement for specialties that are in short supply. It is designed to provide full 

medical capability with reduced resources and to reduce the medical footprint in the theatre. 

MRI is the AMEDD’s transformation spearhead, and the restructuring has already begun with 

some units already activated. This is truly a long-term solution as the execution plan extends to 

2010. However, a large part of MRI has yet to be resourced, that is, has yet to have been 

allocated planned resources. 

Incentives should be improved. Incentives that have deteriorated over time with inflation 

should be updated and a mechanism engaged to keep those incentives current. The Army 

should conduct additional research into assistance to the deployed, such as mobilization 
16 

insurance/private practice deployment pay, to make sure those solutions are viable. Further the 

RC needs to carefully examine how much involvement it should have with individuals who play 

key roles in small partnerships and solo practitioners. Specifically, a plan should be in place 

before these soldiers are mobilized. This issue becomes more critical with the increasing use of 

RC AMEDD professionals. 

Some additional thought can be given to encouraging AC physicians who are leaving at 

the end of their commitments to continue their participation in the RC as an active participant 

(attending monthly drills) instead of being sent to the IRR, where they have little to no 

participation in the RC. Even if this included a guarantee of no mobilization for 3 years (except 

in the event of total war) or reduced AC time in exchange for somewhat longer RC participation, 

the valued experience they bring to the RC, in addition to adding to RC strength, would be a 

multiplier. This period of stabilization for young physician would reduce uncertainty during their 

period of transition to civilian practice. 

CONCLUSION 

The implied contract with the RC has changed significantly since 1990. In March 2003, the 

GAO worded this well: 

Since the end of the Cold War, there has been a shift in the way reserve forces 

have been used. Previously, reservists were viewed primarily as an expansion 

force that would supplement active forces during a major war. Today, reservists 

not only supplement but also replace active forces in military operations 

worldwide.lxi

Senior leaders implementing potential solutions for improving the RC AMEDD professional 

strength must keep in mind just how much this implied contract with RC soldiers has changed. 

This paper has reviewed the status of the chronic problem of achieving sufficient RC 

AMEDD professional strength and proposed solutions. Today’s solutions must adapt to the 

current circumstances, which have changed dramatically since Desert Storm. We cannot expect 

solutions from ten, or even five years ago, to be current; we will have to continue to innovate. 

Whatever solutions are implemented, rest assured the Army must and will continue to provide 

quality medical care to its soldiers. 

WORD COUNT= 5,885 
17 

ENDNOTES 

i

 Department of the Army, Installation Management, Field Manual 100-22, (Washington, 

DC: U.S. Department of the Army, 11 October 1994), 1. 

ii U.S. Army War College, How the Army Runs: A Senior Leader Reference Handbook, 

2003-2004, (Carlisle Barracks, Pennsylvania: U.S. Army War College, 2003), 419. 

iii LTC Nancy Fortuin, Office of the Surgeon General (Reserve Affairs), “OTSG Update,” 

data from briefing slides, Atlanta, Georgia, Southeast Regional Medical Command Readiness 

Conference, 18 March 2000. 

iv Ibid. 

v

 Ibid. 

vi MG Kenneth Herbst, Deputy Surgeon General, “Army Reserve Medical Corps Recruiting,” 

briefing slides with commentary, Washington, DC, Office of The Surgeon General, Department 

Of The Army, 15 August 2003. Presentation was forwarded with related information to the 

author from the AMEDD Center and School on 18 September 2003. Graph is extracted from a 

briefing slide. 

vii Fortuin, briefing slide. 

viii COL John L. Strong, Director for Reserve Affairs, Office of the Chief of Staff, Department 

of the Army, “RCCC Meeting Memorandum of 8 May 2003: Key Points and Taskings,” 

memorandum for Reserve Component Coordination Council, Washington, DC, 16 May 2003. 

ix Herbst, briefing slide. 

x

 U.S. Army Forces Command, Reserve Component Unit Commander’s Handbook, 

FORSCOM Regulation 500-3-3 (Fort McPherson, GA: Forces Command, 15 July 1999), 7. 

xi Ibid. 

xii Herbst, briefing slide. 

xiii Mary C. Gillett, The Army Medical Department, 1775-1818, (Washington, DC: Center of 

Military History, United States Army, 1995), 322. 

xivIbid., 382. 

xv John H. McMinn and Max Levin, Personnel in World War II: Medical Department, United 

States Army (Washington, DC: Office of The Surgeon General, Department Of The Army, 

1963), 505. 

xvi Ibid., 507. 

xvii Ibid. 

xviii Ibid. 
18 

xix Ibid., 508. 

xx LTG Frank F. Ledford, Jr., “From the Surgeon General of the Army: Medical Support for 

Operation Desert Storm,” Journal of the US Army Medical Department (January/February 

1992) 3-4. 

xxi General Accounting Office, Operation Desert Storm - Full Army Medical Capability Not 

Achieved: Report to the Chairman, Subcommittee on Military Personnel and Compensation, 

Committee on Armed Services, House of Representatives, (Washington, DC: U.S. General 

Accounting Office, August 1992), title page. 

xxii John D. Winkler, Deputy Assistant Secretary of Defense (Manpower and Personnel, 

Reserve Affairs), “Reserve Component Contributions to National Defense,” briefing slide with 

commentary, Arlington, VA, Dr. Winkler was the moderator of a panel briefing to Defense 

Department Advisory Committee on Women in the Services (DACOWITS) meeting, 9 May 

2003; available from <www.dtic.mil/dacowits/briefings/ReservePanel.ppt>; Internet; accessed 

14 October 2003. 

xxiii LTG James B. Peake, U.S. Army Surgeon General, “Introduction to the AMEDD,” 

briefing slides with commentary, Washington, DC Office of the Surgeon General, Department of 

the Army, July 2002. 

xxiv U.S. Army Surgeon General, Medical Reengineering Initiative Program Implementation 

Office, Fort Belvoir, Virginia, Medical Reengineering Initiative Program Home Page [webpage]; 

available at <http://mrimedforce.belvoir.army.mil/index.html>; Internet; accessed on 21 

December 2003. 

xxv Doug Rabren, “Medical Reengineering Initiative (MRI) Program,” information paper, 

Medical Reengineering Initiative Program Implementation Office, Fort Belvoir, VA, 

6 December 2002; available from 

<http://mrimedforce.belvoir.army.mil/memoranda/MRIInfoPaperDec02.htm>; Internet; accessed 

21 December 2003. 

xxvi U.S. Army Surgeon General, Medical Reengineering Initiative Program Implementation 

Office, Fort Belvoir, VA, “Medical Reengineering Initiative Information Briefing: United States 

Army Reserve General Officer Update,” 17 January 2003; available at 

<http://mrimedforce.belvoir.army.mil/briefings.htm>; Internet; accessed 20 December 2003. 

xxvii United States Army Medical Department Regiment, Army Medical Department Guide, 

Chapter 3 [undated webpage] (Fort Sam Houston, Texas: United States Army Medical 

Department Regiment); available from 

<http://ameddregiment.amedd.army.mil/otg/chapter_3.htm>; Internet; accessed 21 December 

2003. 

xxviii Personal experience with the 5010th U.S. Army Hospital, Louisville, KY, under the 332nd

Medical Brigade. Both units were mobilized for Desert Storm. 

xxix Department of Defense Inspector General, Physician Recruitment and Retention in the 

Army Selected Reserve, Report No. 97-033, 26 November 1996, executive summary page. The 
19 

actual numbers declined from 4,391 assigned physicians in FY 1990 to 3,288 assigned 

physicians in FY 1995. 

xxx Ibid., 2. 

xxxi AmerInd, Inc. and Applied Research Analysts, “Evaluation of the Presidential Reserve 

Call-up 90-Day Rotation Pilot Program,” briefing slides of presentation to U.S. Army Surgeon 

General, Washington, DC, 9 December 2002. 

xxxii Ibid. 

xxxiii Personal experience with the 5010th US Army Hospital, Louisville KY. 

xxxiv Personal experience with the 4212th U.S. Army Hospital, Kingsport, TN. The AMEDD 

recruiting office for that hospital is in Huntington, WV, nearly 200 miles away with no direct 

interstate highway travel between. 

xxxv LTG John Le Moyne, G1, U.S Army, “LO-03 Annex I (Manning the Force and Investing 

in Quality People) to the Army Transformation Campaign Plan (28 1400 Feb 03)” (FOUO), 

(Washington, DC: U.S. Department of the Army, 28 February 2003), 11. 

xxxvi Curtis L. Gilroy, David K. Horne, and D. Alton Smith, eds., Military Compensation and 

Personnel Retention: Models and Evidence (Alexandria, VA: U.S. Army Research Institute for 

the Behavioral and Social Sciences, 1991). 

xxxvii Eitelbert, Mark J., and Stephen L. Mehay, eds. Marching Toward the 21st Century: 

Military Manpower and Recruiting. Westport, Connecticut: Greenwood Press, 1994. 

xxxviii LTC J. D. Quivalen, “SERMC Readiness Recruitment Brief” briefing slide from 

presentation of the 2nd AMEDD Recruiting Detachment at the Southeast Regional Medical 

Conference, March 2002. 

xxxix Le Moyne, 17. There are 7 categories of these payments—all governed by Title 37, 

U.S.C. 

xl Ibid. 

xli Quivalen. 

xlii AmerInd, Inc., “Results from the Survey of USAR Physicians” (Washington, DC: Office of 

the Chief, Army Reserve, summer 1996. Distributed to numerous senior Army medical offices. 

Copy obtained from the AMEDD Personnel Proponent Directorate.), I.3. 

xliii Ibid., I.4. 

xliv Ibid. 

xlv General Accounting Office, Military Personnel—Preliminary Observations Related to 

Income, Benefits, and Employer Support for Reservists: Testimony Before the Subcommittee on 

Total Force, Committee on Armed Services, House of Representatives, (Washington, DC: U.S. 

General Accounting Office, 19 March 2003), 9. 
20 

xlvi AmerInd, Inc., I.3. 

xlvii LTC Garland Knott, Office of Reserve Affairs, Office of the Surgeon General, “AC/RC 

Integration Item 98-96B, Reserve Component Medical Recruiting, Retention and Strength 

Management,” memorandum for Reserve Component Coordination Council, Washington, DC, 

1 December 2001; available through Army Knowledge Online; Army Intranet; accessed 9 

December 2003. 

xlviii U.S. Army Medical Department, “Reserve 90-Day Rotation Policy Implemented (1999),” 

April 2003 [webpage]; available from <http://www.armymedicine.army.mil/about/tl/99-

reserve90.htm>; Internet; accessed 9 December 2003. 

xlix AmerInd, Inc. and Applied Research Analysts, “Evaluation of the Presidential Reserve 

Call-Up 90-Day Rotation Pilot Program: Results from a Mail Survey of ARNG and USAR 

Physicians, Dentists and Nurse Anesthetists,” (Conducted for The Office of the Surgeon 

General, National Guard Bureau and U.S. Army Reserve, 5109 Leesburg Pike, Suite 686, Falls 

Church, VA 22041-3258, 23 May 2001). 

l

 MAJ Jane A. Cronk, “Clinician Retention Analysis Plan – Background Information re: 90-

Day Rotation Policy” [Informational Paper from Major Cronk to Colonel Jane McCullough, both 

of Headquarters, Medical Command, U.S. Army], 22 September 2003. Forwarded in related Email to the author on 13 November 2003. 

li AmerInd, Inc. and Applied Research Analysts, xv. 

lii Ibid., iii. 

liii Ibid., ii. 

liv Ibid., iii. 

lv Ibid., iv. 

lvi AmerInd, Inc. and Applied Research Analysts, “Evaluation of the Presidential Reserve 

Call-Up 90-Day Rotation Pilot Program: Results from Six Focus Groups Conducted with 313th 

and 399th USAR Combat Support Hospitals Deploying to and Returning from Kosovo,” 

(Conducted for The U.S. Army Reserve, March—November 2001), (no page; reference is to the 

entire document.) 

lvii Ibid., 3. 

lviii Ibid., 8. 

lix Ibid., 13-14. 

lx AmerInd, Inc. and Applied Research Analysts, “Evaluation of the Presidential Reserve 

Call-up 90-Day Rotation Pilot Program,” briefing slides of presentation to U.S. Army Surgeon 

General, Washington, DC, 9 December 2002. 
21 

lxi General Accounting Office, Military Personnel—Preliminary Observations Related to 

Income, Benefits, and Employer Support for Reservists: Testimony before the Subcommittee on 

Total Force, Committee on Armed Services, House of Representatives, (Washington, DC: U.S. 

General Accounting Office, 19 March 2003), highlights page. 
22 
23 

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25 

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26