Health Policy

A Doctor Draft Has Happened Before–It Could Happen Again

With a new conflict between Israel and Hamas in addition to the ongoing fighting in Ukraine, war is dominating the news. Hundreds of thousands have lost their lives. With no end to either conflict in sight, citizens of those nations may find themselves legally compelled to replenish the ranks and fight; in other words, they may be drafted. 

In major conflicts such as the First and Second World Wars, a national draft was utilized to fill the ranks of the US armed forces. Could something like that ever happen again? What would happen to skilled individuals like healthcare workers–could doctors be drafted like soldiers? What about a natural disaster–could healthcare workers ever be forced into public service?

Doctor Draft Defined

A “doctor draft” would be a controversial undertaking, to say the least. But it’s conceivable that should a large enough need ever arise, the government could require doctors, nurses, and PAs to work in disaster or under-served areas, if not the front lines, for a certain period. In fact, a plan has already been created. 

The Selective Service: America’s Sole Source of Conscripted Talent

The Selective Service is a US government organization that provides the Department of Defense personnel in the event of a national emergency. Male citizens are required to enroll in the Selective Service at the age of 18. 

According to the Selective Service website, failure to register is a felony. In addition to a felony charge, those who fail to register may be denied certain benefits for life such as government loans, grants, and jobs, for example. 

Medical Draft in Standby Mode

The Health Care Personnel Delivery System is an actual plan developed for the Selective Service system that would be used to draft healthcare personnel in a crisis. In the event of induction, young men (which currently includes transgender women who were male at birth) could be classified as either “1-A – Available for military service” or “1-AM – Medical specialist available for military service”. 

While there hasn’t been an active draft in the US since 1973, a draft held today would use a lottery system “under which a man would spend only one year in first priority for the draft—either the calendar year he turned 20 or the year his deferment ended, whichever came first. Each year after that, he would be placed in a succeedingly lower priority group and his liability for the draft would lessen accordingly. In this way, he would be spared the uncertainty of waiting until his 26th birthday to be certain he would not be drafted.”

The Health Care Personnel Delivery System is designed to draft doctors, nurses, medical technicians, and those with “certain other health care skills” if volunteer military healthcare workers were ever unable to meet demand. The Health Care Personnel Delivery System is supposedly not designed for use in peacetime and would correspond with a national mobilization.

Ensuring Fairness and Equality in the Drafting of Medical Personnel

This “doctor draft” would include women, unlike the current Selective Service registration, unless Congress and the President decide otherwise. Any healthcare workers whose absence would seriously hurt their communities could be deferred based on the needs of their community. The “doctor draft” would register male and female healthcare workers between the ages of 20 and 45 via local post offices. 

The US is not the only country preparing for war, however. According to the Pew Research Center, “The U.S. is one of 23 countries where the military draft is authorized but not currently implemented.” Many other countries, such as Israel for example, have a compulsory military requirement for young men (and sometimes young women, too).

The Korean War and America’s First Doctor Draft

This isn’t all hypothetical. In 1952, during the Korean War, President Harry Truman signed a law establishing a type of doctor draft that lasted through the Cold War years. Following their internship, doctors subject to the draft could be inducted for two years of service in the armed forces.

“The shortage of trained personnel is one of the worst problems we face. It is particularly serious when we try to meet the needs of the Armed forces for doctors and other medical personnel. As you all know, we are now drafting physicians, dentists, and veterinarians. This situation places on all of us–the health professions, the military, the Selective Service System, and the public–a solemn obligation to make wise disposition of our medical manpower,” said President Truman

Many physicians opted to serve their time in clinical research in the National Institutes of Health  Associate Training Program. These physician-scientists referred to themselves as “Yellow Berets.” 

Academia and the Doctor Draft

Dr. Roger A. Lalich, an OB/GYN from Wiscon and a former brigadier general in the United States National Guard shared his thoughts about the doctor draft in a 2004 paper in the Wisconsin Medical Journal.

He noted that physicians could be leaving both the Army Reserve and the National Guard due to financial losses incurred while deployed. “With the depletion of these supplemental physicians, who will the military use for future contingencies? A physician draft may be the only way to assure the health of our men and women in the military,” writes Lalich. 

Dr. Lalich also notes that while a general draft may be unlikely, a narrower draft of medical personnel could come first. He also writes of an effort announced by Selective Service in March 2003 to focus on a “special skills” mission, specifically targeting healthcare workers. 

But taking doctors and PAs out of civilian service where there is already so much unmet demand could be a disaster. It may even destabilize the entire healthcare system which is already limping along. 

Imagine how a rapidly increasing number of military and civilian causalities would magnify the current shortage of healthcare providers. PAs owe their conception to military medics and corpsmen who honed their skills on the battlefield.

But most Americans oppose the draft, not surprisingly. Clinicians may feel especially conflicted about supporting a cause that destroys life when their mission is to preserve it.

Pressing healthcare providers into service could also negatively affect the quality of medical care provided to soldiers. Anyone forced to serve against their will underperform. 

This would negatively affect the care provided. The result may be poorer health outcomes for soldiers which could undermine the effectiveness of military operations.

A doctor draft could lead to unhappy and unproductive physicians–bitter, without a sense of purpose and motivation. It is thanks to America’s volunteers that such a draft has not yet been needed–those who bravely, and voluntarily, choose to serve from a sense of duty or patriotism.

Whether you’re defending life or helping to save it, some jobs are more of a calling.

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