Lt. Gen. Robert “Bob” Miller was halfway through his tenure as Surgeon General of the Air Force and Space Force when one of his bosses, General CQ Brown (Air Force Chief of Staff), tasked him with reviewing the present structure of the Air Force Medical Services (AFMS) to ensure it effectively supported where the Department of the Air Force (DAF) was going with great power competition.
The strategic landscape of the world had significantly changed over the last few years and the DAF had to adjust accordingly or risk losing a future conflict. This would be consistent with Gen. Brown’s motto: “Accelerate Change or Lose”. In addition, Lt. Gen. Miller was still making changes to the AFMS following the creation of the new Defense Health Agency. This agency consolidated authority, direction, and control over the delivery of the health care benefits in the Military Health System with impact on all services (Army, Navy, Air Force).
Lt. General Robert Miller,
Chief Executive / Operations / Medical Officer
While this was not one of his priorities upon becoming the AFSF Surgeon General, it did become his primary mission for the rest of his tenure. His recommendation was to create the Air Force Medical Command (AFMED), and DAF leadership supported his plan.
The Air Force Medical Command (AFMED) will realign 30K+ medical personnel at 76 military treatment facilities in 36 US states and 6 foreign countries on 3 continents under the command and control of the Air Force Surgeon General with support from two newly created Intermediate Headquarters lead by medical general officers involving 400+ staff and a $500M budget to execute the mission of the DAF. Ultimate authority still resides with the Chief of the Air Force & Space Force, but the medical staff at the bases will now report to medical leadership as opposed to non-medical leadership up the chain to the Surgeon General, while also partnering with the Defense Health Agency. The model is very similar to the present Army and Navy structure, but once again, the Air Force has always been different with medics working for non-medics or line leadership at bases in support of the organize/train/equip mission of the DAF which focused on readiness.
This was one of those transformational moments that created many appropriate questions and concerns at multiple levels, starting with his own Air Force Medical Staff. They had recently been through a lot of change with the Global COVID Pandemic, Afghanistan support, and a new readiness structure to support future tasks, just to name a few. However, Lt. Gen. Miller needed them to understand the reasons behind the creation of AFMED. In addition, non-medical leadership at 76 bases — and up the chain of command to the Pentagon — had concerns with how a loss of command authority over medics would impact their ability to execute their mission and possibly support a “fight tonight” scenario. The Defense Health Agency had their own concerns given the ongoing balancing act between readiness preparation and the daily need for health care delivery. Finally, this change needed to be discussed with Congress. Lt. Gen. Miller needed to communicate and obtain the WHY behind this significant organizational change before moving on to the WHAT and HOW (which is being finalized over this upcoming year).
This is a historic moment in the 75-year history of the AFMS as the prior 23 Surgeon Generals never had command authority over the 30K+ active-duty medics; not even considering 15K+ Reserve and Guard medics. It is important to ensure that the Air Force Medical Service is organized, trained, and equipped to support the readiness mission, which is our reason for being; creating “ready medics & medically ready Airmen & Guardians” for the next fight. In addition, this would allow the AFMS to best support the Defense Health Agency with the delivery of the health care benefit at our 76 military treatment facilities in compliance with Congressional law. The challenge for every Air Force Medic is to do their day job with delivery of healthcare at the home station to our beneficiaries while being ready for the deployed mission whenever our nation calls. This new AFMED structure will ensure that they are successful at both for years to come and are already experiencing early wins while finalizing the structure, thanks to Lt Gen Miller’s leadership.
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