Landstuhl Regional Medical Center in Germany at dusk. (Facebook/Landstuhl Regional Medical Center)

The average wait for urgent medical appointments at U.S. military bases outside the continental United States was as long as three weeks in some locations and even longer for routine appointments in 2024, a Pentagon watchdog agency said in a new report.

Treatment delays that service members and their families face while stationed outside the United States increased the risk for negative outcomes and preventable complications and decreased patient satisfaction, according to a Defense Department Office of Inspector General audit published last week.

The report also found that personnel working in military medical clinics and hospitals overseas experienced burnout and low morale and were at risk of decreased readiness.

Personnel at U.S. Naval Hospital Yokosuka in Japan train on a simulated patient during a mass casualty drill Feb. 20, 2025. (Daniel Taylor/U.S. Navy)

The agency reviewed 15 out of 79 military treatment facilities in overseas locations as well as Hawaii and Alaska, looking at 2024 data and conducting employee interviews.

The evaluation sought to assess how effectively the Defense Health Agency was managing care for its overseas patients, following the agency’s transition in 2022 to assuming full control of the Pentagon’s health care system.

Auditors highlighted several shortcomings, including wait times for medical appointments that exceed the federal and Defense Department guidelines, the IG said.

Between February and July 2024, service members and their families faced delays in access to care ranging on average from 1.2 days to 21.1 days for urgent appointments and from 7.2 days to 36.8 days for future routine appointments, the report said.

Federal and DOD guidance requires the military health care system to see patients within 24 hours for urgent appointments and seven days for routine care, according to the inspector general report.

While the guidelines allow for patients to be referred to a Tricare-approved civilian provider within the allotted time frame, finding care outside the military network overseas can be challenging due to language barriers, cultural differences and denial of U.S. health insurance claims, the report said.

DHA’s management of staffing at overseas locations is one area that needs to be improved to reduce appointment delays, the audit team determined.

Medical personnel told the team that clinics were not always fully staffed, particularly with nurses, who receive and prioritize messages that patients send to providers.

They also said that they had difficulty managing the volume of messages received from the online patient portal and that sometimes messages could be missed, putting patient safety at risk.

At one clinic, for example, providers did not see a prescription refill message and the patient did not follow up with another request. As a result, the patient did not take prescribed antidepressant medication for two to three weeks, according to the report.

At another military treatment facility, personnel said shortages in medical technicians led to canceled ultrasound appointments, delaying follow-on medical care and leading to an increased risk of preventable complications, according to the report.

Staffing data also showed shortages in personnel, according to the report. In September 2024, for example, one facility had only 27 of the 36 civilian personnel and 27 of the 37 contractors that it was authorized.

Another facility lost more than half its primary care clinic active-duty doctors between 2019 and 2024 and saw a 20% decrease in active-duty technicians, medics and licensed nurses, while patient workload remained steady, according to the report.

Hiring civilian staff, meanwhile, isn’t always an option due to funding and lengthy hiring timelines, personnel told auditors.

In 2024, DHA left some civilian vacancies unfilled because of budgetary constraints, and the average total days to hire in some locations ranged from 155 to 213 days, the report said.

Moreover, the agency did not have a process to identify why some civilian medical personnel left for other employment, auditors said.

To address staffing issues, the inspector general team recommended that the DHA director track data on why personnel are leaving military treatment facilities, review authorized staffing at its overseas locations, track support staff availability and better balance its workforce.

Though DHA agreed with the recommendations, auditors said they were still awaiting specific actions on how the agency plans to make a comprehensive review of staffing at overseas military treatment facilities.

The inspector general issued 11 recommendations in total, including directing DHA to issue finalized guidance to its personnel and better manage data discrepancies reported to the team.