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The number of medical students accepting Army and Navy scholarships has fallen sharply over the last two years, in part because of the mayhem in Iraq as depicted in daily news reports, say service medical leaders.

A scholarship program that the Army surgeon general calls “our lifeblood, over time, for recruiting physicians” is failing to attract enough qualified applicants by wide margins, except in the Air Force.

Difficulties in recruiting the next generation of Army and Navy physicians and dentists have spurred the Senate to approve new authorities to increase dramatically medical bonuses and stipends.

The increases, which potentially involve millions of additional dollars for medical personnel, are before a House-Senate conference committee and could win the full support of Congress by fall.

The services recruit roughly 70 percent of physicians and 80 percent of dentists through the Health Professions Scholarship Program (HPSP). The rest graduate from a military-run medical school, accept military financial aid while in residency training or enter service as fully trained doctors.

HPSP scholars have their civilian medical school tuition, books and fees paid by the military and receive a monthly stipend of $1,279. In return, students agree that for every year of schooling provided, they will serve a year as a military physician or dentist.

All the services had been meeting HPSP goals until fiscal 2005. The Navy had expected to sign 291 medical school students but could attract only 162, a 44 percent shortfall. Numbers for fiscal 2006 look about the same or a little worse, said Vice Adm. Donald C. Arthur, the Navy surgeon general.

The Army in ’05 expected to award 307 scholarships. It fell 70 short, missing its goal by 23 percent. Through nine months of fiscal 2006, the Army has awarded 179 scholarships, 61 percent of goal.

“I am concerned we’re going to be short” again, said Lt. Gen. Kevin C. Kiley, Army surgeon general. The impact will be felt “down stream,” Kiley explained, creating future shortages but not affecting the current number of doctors available for war or stateside care. The training pipeline that turns a new medical student into a doctor is four to nine years long, he said.

Dental school students are another concern. In fiscal ’05, the Navy hoped to sign 85 dental students under HPSP. It attracted 65. The Army last year awarded 10 fewer dental scholarships than the 93 planned. It also wanted to sign 30 dentists through direct accession but could get only 16.

With three months left in fiscal 2006, the Army Dental Corps has less than half the HPSP students it seeks — 54 of 115 — and has signed seven of the 30 dentists planned to be brought in through direct accession.

The Air Force is exceeding its HPSP goals. An official credited the Air Expeditionary Force concept that limits combat assignments for medical and dental officers to predictable four-month tours, and several years in between. Applicants also are told the Air Force offers a higher quality of life.

Kiley and Arthur, in separate interviews, blamed some of their downturn on news and images out of Iraq. Young people, Kiley said, “look at this and say either ‘I don’t agree with our war’ or ‘I sure don’t want to be over there.’ So they see signing up for a scholarship as tantamount to enlisting and going right into combat. [In fact] it’s going to be anywhere from four to nine years before that would happen.”

The recruiting environment is toughening for other reasons. Kiley noted that more than half of medical school students are now women, a gender historically less interested in military service. Also, he said, the HPSP stipend of $1,279 a month “is not a lot to live on” and still stay debt-free.

Arthur pointed out that more scholarship alternatives to HPSP are being offered by large managed-care companies and even by rural communities sponsoring the education of students who become local doctors.

Many prospective medical students, he said, know little about the military, except what they read and see in the news that upsets them.

To counter such impressions, the Army and Navy are beefing up medical recruiting. and sending young medical officers with operational experience to visit colleges, medical schools and professional conferences to explain the quality of their training and the rewards of service in wartime.

Meanwhile, the Senate package would:

Double, to $30,000 a year, the stipend for HPSP scholarships.Increase to $60,000, from $22,000, maximum student loan repayment to entice more medical and dental school graduates into service.Increase to $45,000, from $15,000, maximum annual grants allowed under the Financial Assistance Program for doctors who choose to complete residency training in the civilian sector before military service.Increase to $25,000, from $10,000, the size of special pay offered to Selected Reserve health professionals trained in critically short wartime specialties. Some who might qualify include emergency room physicians, surgeons, urologists, ophthalmologists and dermatologists. This is the only initiative in the Senate packet that the Bush administration sought.Enhance dental accession bonus authority. Dentists currently are offered an accession bonus of up to $30,000. That would be raised to $200,000, recognizing that dentist salaries in the private sector have increased with demand for their services in an improving economy.Allow a new accession bonus of up to $400,000 for physicians and dentists in war-critical specialties. Enticed from civilian life, the doctors would promise to serve at least four years. Specialists who might qualify include maxillofacial surgeons, thoracic surgeons and orthopedic surgeons.Arthur said the Navy would like to have all of the new authorities and would use most of them immediately. The Army, said Kiley, would use the $200,000 to $400,000 accession bonuses “carefully and judiciously.”

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