The war in Iran has done what years of policy papers could not. It has forced an honest reckoning with American military readiness. While commentators focus on vulnerabilities in industrial capacity and weapons procurement, they consistently omit a critical dimension of readiness: the uniformed medical and technical workforce that makes sustained military operations possible. Across the tri-service medical corps, encompassing the Army, Navy, and Air Force, the rate of recruitment has consistently struggled to keep pace with separations. A 2024 RAND Corporation study found that a larger-than-expected proportion of physicians are leaving after fulfilling their service obligations, citing pay disparity, administrative burden, and clinical skill degradation as key drivers. The compensation gap is the most frequently cited driver, and the most intractable. A 2020 Government Accountability Office study found that military physicians in two-thirds of specialties cannot reach even the 20th percentile of civilian compensation. While exact figures fluctuate, as a ballpark estimate, the gap between military and civilian earnings for procedural specialists can exceed $400,000 annually. Furthermore, clinical skills are degrading at garrison hospitals. A Department of Defense Inspector General report released in June 2025 found that emergency medical officers in critical wartime specialties were assigned to locations without direct patient care, degrading their clinical skills below readiness standards. The Medical Corps consists of physicians, most of whom enter through the Health Professions Scholarship Program. Under this program, the Navy funds medical school and provides a stipend in exchange for active-duty service, generally one year for each year of scholarship with a three-year minimum. Others train at the military’s Uniformed Services University of the Health Sciences, incurring a seven-year obligation, and fully trained civilian physicians may join directly. Whatever the path, every officer carries a total eight-year military service obligation. Any time not spent on active duty is completed in reserve status, often the Individual Ready Reserve, meaning the physician is not drilling but remains subject to recall. I entered the Navy Medical Corps in 1973 under the draft and served for more than 25 years, ultimately as attending physician to the U.S. Congress. Following my military retirement, I earned privileges at a university hospital and eventually achieved clinical professor status, an appointment driven largely by the fact that civilian academic institutions place a high premium on the unique leadership, discipline, and clinical experience forged in military service. During this dual-sided career, I watched the military health system function as one of the most effective training and care delivery platforms in the world. That system is now hemorrhaging talent, and the pipeline to replace it is narrowing at both ends. With the Association of American Medical Colleges projecting a physician shortage of up to 86,000 by 2036, the military is competing with the civilian sector for a shrinking pool of talent. Consider the supply side. The Uniformed Services University trains only a fraction of the physicians the military needs. The vast majority must be recruited from the approximately 180,000 students and residents in civilian programs. Of that pool, a small but nontrivial number are already medically ineligible under current Department of Defense accession standards. In my experience, many others are not interested because of significant discomfort with institutional policies they perceive as exclusionary. Medical school classes today are more diverse than at any point in history. Women now constitute roughly half of all matriculants, and the student body reflects the full demographic breadth of the country. When a substantial fraction of that talent pool declines even to consider military service, no signing bonus will close the gap. To preserve our military medical tradition, structural reforms are necessary. The military has utilized lateral entry in theory and partially in practice, but existing pathways do not reflect current economic and clinical practice realities. The era of the independent physician, such as the solo practitioner who would have had to shutter an office to serve, is largely over. As of 2022, fewer than half of U.S. physicians owned their practices. The relevant negotiating partners today are university health systems and the private equity-backed staffing groups that increasingly employ specialists across regional networks. These entities have the bench depth to absorb a physician’s periodic absence and the corporate infrastructure to manage the arrangement. What they currently lack is the incentive. Congress could create one through a structured, three-way arrangement. First, Congress should create a medical readiness partnership tax credit available to any employing organization that releases a physician for military service. For illustrative purposes, this could be set at a ballpark figure of $1,500 to $2,000 per day of military duty. This converts military service from a scheduling liability into a financial asset. For university health systems, this model offers profound institutional benefits. Beyond turning a scheduling absence into a financial asset via tax credits, these academic centers gain an elite cadre of battle-tested trauma and emergency specialists. Furthermore, because today’s postgraduate trainees are increasingly eager for meaningful public service, university hospitals that enthusiastically support military reserve duties will possess a unique, highly attractive recruitment tool for top medical talent. Second, we must pair employer incentives with flexible and meaningful benefits for the individual physician. This should include financial benefits, such as an exclusion from gross income for military reserve pay during service periods and the restoration of the above-the-line deduction for unreimbursed military expenses eliminated in 2017. Crucially, the military should balance these financials with attractive inducements such as robust family health care coverage, prescription drug cost reductions, and partial pension possibilities for those who provide vital service short of a full 20-year career. Third, the bureaucratic burden of obtaining military medical credentials is a significant deterrent. A standardized “green card” credentialing process recognizing civilian board certification and hospital privileging as the baseline would remove months of friction. We already know this clinical model works. Tri-service embedding programs, such as the Military Civilian Trauma Team Training and Navy embeds, have demonstrated that physicians at civilian Level I trauma centers accumulate readiness points at rates five to 10 times higher than their counterparts at military hospitals. These partnerships offer a powerful synergy: Civilian hospitals benefit tremendously from having highly disciplined, combat-trained specialists managing their most critical trauma cases, while the military successfully maintains a razor-sharp, deployment-ready medical force. What remains is building the financial and regulatory architecture to make it scalable. The military also must advertise its success stories and advantages more effectively. Military medicine’s contributions to vaccine development, trauma surgery, infectious disease research, and disaster response constitute one of the under-told stories in American public health. Clinicians drawn to the intersection of science and national security need to hear it. Finally, my regular conversations with medical students, postgraduate trainees, and even more experienced clinicians suggest that they are often eager for meaningful public service. They are looking for relevant work at the intersection of medicine and the public good, and they frequently welcome the variation in routine that temporary active-duty assignments could provide. They need the best possible opportunity to do so. Robert Krasner is a retired rear admiral, Medical Corps, U.S. Navy, retired professor of medicine, and former attending physician to Congress.
