The purpose of the Enhancing Military-Civilian Medical Synergies study (2016) was to assess the state of Army medical practice in civilian facilities and identify opportunities for greater synergies. The study introduces the fact that there is a distinction between medical care demands in combat settings and the needs Army medical treatment facilities (MTF) located within the United States, which justifies the need for military medical professionals to operate within civilian hospitals, trauma centers, operating rooms and intensive care facilities.Due to the difference in services provided domestically, there are many benefits to MTF-based care providers providing direct care within civilian facilities. One type of agreement allows for MTF-based care providers, mostly physicians (typically surgeons), to provide direct care to Military Health System beneficiaries at civilian hospitals; there are similar resource-sharing agreements with U.S. Department of Veterans Affairs (VA) medical centers; and, at some locations, Army MTFs share medical resources with other services in multiservice markets. These arrangements are largely intended to improve the timing, quality, and efficiency of care for beneficiaries, but they also help military medical professionals maintain clinical proficiency. Other agreements enable military medical personnel to provide care to civilian patients, in a training context.The study found that of 28 Army MTFs, 13 have agreements for military medical personnel to provide care in VA or other civilian facilities. The most frequent reason for these agreements are to serve beneficiaries and meet routine proficiency maintenance needs. Often these agreements allow medical personnel to practice types of care not offered at a MTF as well as access training for medical readiness needs and deployment-related needs. Common themes from both military and civilian stakeholders are that these agreements are mutually beneficial. Benefits include access to quality care for patients; opportunities for Army medical practitioners to be exposed to industry best practices in civilian facilities; access to medical technologies that might not be available in MTFs but used more commonly in civilian facilities. Military personnel also cite good community relations as a benefit.Many factors contribute to the MTF’s decision about how and where they can best meet their various mission related requirements. In situations where MTFs have made agreements with civilian facilities, each MTF develops its own business plan based off of an assessment of the local profile and alignment with the needs of the MTF personnel, as well as cost considerations. Considerations for selecting a facility may include: patient mix, infrastructure, service, equipment and cost.A conclusion of the study recommended further enhancement of military-civilian medical synergies including identifying potential untapped opportunities for MTFs to utilize external practice, analysis of the cost and efficiency associated with further agreements, and if warranted bases on the analysis, encouraging the expansion of these agreements to include a wider range of Army medical professionals and medical teams. This week’s Friday Field Notes features another study from RAND, Inc. The Army Surgeon General has asked RAND Arroyo Center to assess current Army medical practices in civilian facilities. Just as with the last study from RAND, we are very excited to see that there is this level of interest as well as sponsorship for assessment of military-community partnerships! We’d like to highlight a few key points from the study as well as connect you to the full article. We’re happy to see that this type of synergy is taking place and proving to be beneficial for both stakeholders, and hope that these type of agreements continue to develop! For full access to this study, check out RAND’s publication site, which can be found here!