Defense Health Care: Information Needed to Improve Monitoring of Military Personnel Staffing at Medical Facilities
Fast Facts
According to the Defense Department, its medical facilities have been chronically understaffed in recent years. Military medical staffing declined by about 16% from FYs 2015-23.
Facility management has transitioned from the military departments to the Defense Health Agency. This produced a complex management structure and exacerbated staffing challenges. To address the challenges, in 2024, the agency and the departments improved management with a collaborative approach to identifying staffing needs and assigning personnel.
However, DOD is using inaccurate and incomplete timecard data to monitor staffing. Our recommendations address this issue.
Military surgeons in scrubs and personal protective equipment operate in a hospital.
Highlights
What GAO Found
The number of military medical positions and assigned personnel in Department of Defense (DOD) medical facilities has declined over time. Specifically, the number of authorized positions for military medical personnel declined by nearly 7 percent (63,179 to 58,945) from fiscal year 2015 through fiscal year 2023. Likewise, assigned personnel declined by about 16 percent (60,479 to 50,590) during the same time. The decline in assigned personnel is in part attributable to fewer medical personnel in the Army, Navy, and Air Force (military departments). Senior leaders from the Defense Health Agency (DHA), which manages medical facilities, stated they anticipate substantial shortfalls in military medical personnel until at least 2027 when personnel levels may increase.
To help address facility staffing challenges, DHA and the military departments implemented a collaborative process to staff medical facilities with military medical personnel. Pursuant to 2024 guidance from the Office of the Assistant Secretary of Defense for Health Affairs (Health Affairs), DHA prioritized vacancies by facility and occupation, and the military departments identified personnel to fill them in 2025. DHA and the military departments are also collaborating to update medical facility personnel requirements for future years.
Health Affairs, DHA, and the military departments have taken steps to monitor the available work time of military medical personnel in medical facilities. The parties also agreed on how much time personnel would be expected to work in a facility as opposed to other military duties. These expectations vary depending on whether personnel are assigned exclusively to a facility.
Military Medical Personnel Categories and Annual Expected Medical Facility Work Time
To help ensure DOD meets these expectations, Health Affairs developed a monitoring tool that compares actual and expected work time by using medical facility timecard data from DHA. However, the monitoring tool is missing key information and relies on inaccurate and incomplete data. Specifically, the tool does not make key distinctions between facility work time and other time (e.g., deployments) or among personnel categories (e.g., exclusive vs. dual-assigned). Further, the tool relies on inaccurate and incomplete timecard data because DHA does not have a communication strategy, geared toward military medical personnel, that clarifies the importance of filling out timecards accurately, among other things. Until Health Affairs evaluates which activities count as facility work time in the tool and DHA communicates the importance of accurate timecard data, DOD will not have complete information to better monitor military medical personnel staffing at facilities.
Why GAO Did This Study
In 2023, DOD announced that its roughly 700 medical facilities have been chronically understaffed in recent years. The facilities are staffed primarily with military medical personnel and augmented with DOD civilian employees and private contractor employees.
Senate Report 118-58 includes a provision for GAO to review military medical personnel staffing at DOD medical facilities. This report describes (1) trends in military medical personnel staffing at the facilities from fiscal year 2015 through fiscal year 2023; and evaluates the extent to which DOD has (2) a collaborative facility staffing process, and (3) taken steps to monitor the availability of personnel to work in medical facilities, among other things.
GAO reviewed DOD guidance and documentation and analyzed personnel data for fiscal years 2015 through 2023 and timecard data for fiscal year 2023. GAO also interviewed DOD officials and nearly 350 personnel from six medical facilities selected for site visits based on military department affiliation, location, and size.
Recommendations
GAO is making seven recommendations, including that DOD evaluate which activities count as medical facility work time and communicate to military medical personnel the importance of timecard data and how it is used. DOD concurred with GAO's recommendations.
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Defense | The Secretary of Defense should ensure that the Assistant Secretary of Defense for Health Affairs, in coordination with the Director, DHA, evaluates activity codes used in DHA's timecard system to determine which ones will count towards expectations for medical facility work time versus those that will not. (Recommendation 1) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Defense | The Secretary of Defense should ensure that the Assistant Secretary of Defense for Health Affairs works to categorize military medical personnel working within medical facilities within its monitoring tool with a variable to identify them by personnel category (e.g., exclusive, dual-assigned, periodic-intermittent). (Recommendation 2) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Defense | The Secretary of Defense should ensure that the Director, DHA, develops and disseminates a clear and consistent communication strategy, geared toward medical personnel from the military departments, to increase their understanding of the importance of timecard data and how it is used. (Recommendation 3) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of Defense | The Secretary of Defense should ensure that the Director, DHA, analyzes and addresses root causes of data quality issues with military medical facility timecard data and implements any findings. (Recommendation 4) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of the Army | The Secretary of the Army should issue a policy requiring all military medical personnel to complete a timecard when working in a medical facility. (Recommendation 5) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
|
| Department of the Navy | The Secretary of the Navy should issue a policy requiring all military medical personnel to complete a timecard when working in a medical facility. (Recommendation 6) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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| Department of the Air Force | The Secretary of the Air Force should issue a policy requiring all military medical personnel to complete a timecard when working in a medical facility. (Recommendation 7) |
When we confirm what actions the agency has taken in response to this recommendation, we will provide updated information.
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