Health Care Workers and the Medical Draft
If you think the draft is just for young men, think again. The first people to be drafted will probably be health care workers. If you're a doctor, nurse, technician, therapist, or other medical professional -- man or woman, age 20 through 44 -- and if Congress authorizes a draft, you could be in boot camp in just a few months.
This FAQ explains how a medical draft is likely to work, what you can do now if you don't want to be drafted, and why we hope you'll join us in draft resistance.
Will There Be A Draft of Health Care Workers?
The peacetime U.S. Army doesn't have very many doctors, nurses, or medical technicians; most of those in the military are in the Reserves. Once someone volunteers for the military in any capacity, they can be recalled for active duty at any time. During the 1990-1991 Gulf War, even retired physician assistants were called back to active duty -- the first time in 30 years that any retired soldiers had been recalled. In April 2006, the Department of Defense published new rules to permit them to call up "as many retirees as necessary to meet national security needs".
In December 2004, the New England Journal of Medicine reported that casualties in the wars in Afghanistan and Iraq have created a severe shortage of military surgeons: "Many surgeons have been on a second deployment or an extended deployment, and even this has not been sufficient. Planners are having to contemplate pressing surgeons into yet a third deployment." But it's politically difficult to keep reservists on active duty indefinitely, and extended call-ups of Reservists make other potential new Reservists less willing to sign up.
The military can't fight wars without doctors. During past wars there was a special "Doctor Draft" with a higher age limit and fewer deferments. By the early 1980's, the General Accounting Office predicted that there might be a "severe" shortage of trained medical personnel in the military in case of war. "Shortages of surgical personnel would be especially critical," the GAO reported. In 1987, Congress enacted Public Law 100-180 -- codified in 50 U.S.Code Appendix, Section 460(h) -- ordering the Selective Service System to prepare contingency plans for a compulsory "Health Care Personnel Delivery System" (HCPDS):
The Selective Service system shall be maintained as an active standby organization, with (1) a complete registration and classification structure capable of immediate operation in the event of a national emergency (including a structure for registration and classification of persons qualified for practice or employment in a health care occupation essential to the maintenance of the Armed Forces), and (2) personnel adequate to reinstitute immediately the full operation of the System, including military reservists who are trained to operate such System and who can be ordered to active duty for such purpose in the event of a national emergency.
Selective Service published its plans for the HCPDS as proposed regulations for public comment on August 15, 1989 (54 Federal Register 33644-33654), and has had them ready ever since. "The concept underwent a preliminary field exercise in Fiscal Year 1998, followed by a more extensive nationwide readiness exercise in Fiscal Year 1999. The 1999 exercise was the first time all of the programÃ?Â?s components were thoroughly evaluated. Based upon the 1999 exercise, the Agency determined that HCPDS is a sound, workable program." (Selective Service System Annual Report to Congress, Fiscal year 2000, p. 25)
As soon as Congress authorizes a draft of health care workers, Selective Service is ready to finalize the regulations, put them into effect, and begin sending out induction notices.
Proposals to reinstate the draft have been introduced in Congress every year since the last draft ended in 1973. And even those who claim there won't be a general draft admit that a medical draft is more likely, and will be "needed" by the military sooner, than a general draft of young men. According to one military doctor, writing in a 2004 medical journal article explaining Selective Service plans:
A physician draft is the most likely conscription into the military in the near future.... Currently, this ["special skills"] mission is only for health care personnel, but in the future it is foreseeable it may include linguists, environmental engineers, computer specialists, and other professions.
Also in 2004, a Selective Service spokesperson said, "Talking to the manpower folks at the Department of Defense and others, what came up was that ... they thought that if we have any kind of a draft, it will probably be a special skills draft."
As the wars and the casualties continue and escalate, a medical professionals' draft could start in a hurry. Draft registration probably won't be needed: In the past, the AMA arranged to provide licensing lists to Selective Service, and Congress will probably require other professional and licensing boards to do likewise.
The 2003 AMA House of Delegates passed a resolution, introduced by the AMA Medical Student Section, ordering a study and report on the implications of the Health Care Personnel Delivery System. That November 2004 report by the AMA Council on Medical Education recommended, "That our American Medical Association continue to monitor the Health Care Personnel Delivery System (HCPDS) and initiate communication with the Selective Service System and other relevant governmental bodies to address questions and concerns related to the implementation of the HCPDS."
Congress could approve a draft any day, and the Selective Service System says they are ready to begin a mass registration of health care workers within two weeks. Health care workers need to start thinking now about what they'll do if they are drafted -- and what they can do now to prevent the draft.
Many health care workers object to being forced to serve in the military. People go into health care careers because they care about saving lives. But Army medical workers are supposed to patch up wounded soldiers, so that they can go back to the front to fight (and perhaps kill) other soldiers. Some doctors don't think that's what their Hippocratic Oath to preserve life is all about. During the 1990-1991 Gulf War, some active-duty and Reserve doctors refused orders to the Gulf, and civilian health care workers began preparing for a draft and organized a health care workers' pledge against militarism and the draft.
Who Will Be Drafted?
Much will be up to Congress. Selective Service has complete standby plans for a medical draft that could start tomorrow, and has published regulations for how it could work. But it would need permission from Congress, and the authorizing legislation could require changes in the standby plans.
Congress could decide not to include women in the medical draft. But it will be hard to get enough nurses and other professionals in some of the desired specialities without drafting women. A health care workers' draft will most likely include women.
Congress could specify which occupations would be included. It will probably leave it up to the President, who will probably leave it up to the Pentagon. In 1986, when Congress last debated registration for a medical draft, the proposal allowed the President to designate for inclusion any "health-care occupations that are essential to the Armed Forces and in which personnel may not be available to meet the needs of the Armed Forces".
Selective Service says it is prepared to draft people "professionally qualified" in 57 medical and related specialties, including physicians, dentists, psychologists, therapists, dietitians, technicians, nurses, veterinarians, pharmacists, opticians, "other medical care and treatment personnel", and "miscellaneous allied specialists" such as "medical equipment repair". This list of "job categories" is on the last page of the proposed regulations, but the President, Congress, and/or the Selective Service System could change it, or could decide to draft only certain of these categories:
- Aerospace Medicine
- Thoracic Surgery
- Orthopedic Surgery
- General Surgery
- Colon-Rectal Surgery
- Internal Medicine
- Emergency Medicine
- Oral Surgery
- General Dentistry
- Miscellaneous Allied Specialists
- Clinical Psychology
- Medical Technology
- Audiology/Speach Therapy
- Environmental Health
- Physical Therapy
- Registered Nurses
- Medical/Surgical Nursing
- Surgical Nursing
- Certified registered Nurse Anesthetist
- Mental Health Nursing
- Medical Care Technicians
- Licensed Practical/Vocational Nursing and Other Medical Care and Treatment Personnel
- Other Specialists/Technicians
- Dental Laboratory
- Medical Administration
- Respiratory Therapy
- Medical Laboratory
- Dental Assistance
- Operating Room
- Medical Supply
- Medical Equipment Repair
- Physical Therapy
- Environmental Health
- Occupational Therapy
Past Congressional proposals would have authorized a draft of medical workers ages 20 through 54, but Selective Service says that "requirements would likely be met" by those 20 through 44. The youngest would be drafted first. Since few physicians are 20 years old, significantly older people could be drafted in at least some fields.
As with current contingency plans for a general draft, health care workers who are drafted will have only ten days to report for examination and induction or to make any claim for deferment or exemption. If you don't want to be drafted, you should plan ahead. If you think you might qualify for deferment or exemption, see a draft counselor now. If you want to lobby against the draft, do it now. If you plan to resist, say so now.
What Can I Do If I Don't Want to Be Drafted?
If you don't want to be drafted, you're not alone. A national survey led by a Harvard Medical School instructor and published in the International Journal of Health Service in 2007 found that while few medical students were aware of the possibility that they could be drafted, most of them said that they would try to avoid being drafted, whether by legal or illegal means:
Knowledge of the potential for a military draft was scant (Table 2). While 23.8 percent of students thought that a medical draft was more likely than a general draft, only 3.5 percent of students were aware of the HCPDS. When asked what course of action they might take if a physician draft were proclaimed next week, 8.7 percent said they would "volunteer for service," just over one-third would use legal means to avoid or defer service, and more than one-fifth would emigrate or refuse military induction. Thus, fewer than 50 percent of respondents would willingly serve.
But if you don't want to be drafted, what are your options?
You could be drafted if you're a U.S. citizen or resident licensed in a health- care profession. (Both U.S. citizens residing abroad, and foreigners residing in the U.S., are subject to the U.S. draft.) You can avoid the draft by renouncing your citizenship and leaving the U.S., or by leaving your profession -- now, before you are drafted. Not much of a choice unless you're already planning to leave.
You could just hope to get lucky. Depending on your age and your specialty, you might not be drafted at all. Unless you want to gamble with your life, you should make some other plan as well.
You'll have to take a physical exam, but anyone "practicing their profession in the private sector" will be automatically "considered able to do the same in a military environment, notwithstanding physical conditions which would cause rejection as a regular registrant."
You could apply for a deferment or exemption, but most people don't qualify for any. Selective Service proposes to defer those who convince draft boards that they are "engaged in direct patient care ... essential to the health care within their own communities." But no one knows just what this will mean in practice, or can count on such a deferment.
Those who qualify as conscientious objectors (COs) don't have to fight. But you're a CO only if you oppose all wars (not just certain ones), for religious or moral (not political) reasons, and if you can convince your draft board your beliefs are deep and sincere. Many COs serve as medics; health care COs will have to explain why they object to such military medical duty. If they succeed, they'll have to do alternative service -- possibly in a civilian hospital handling overflow military patients.
Refusal to register has been extremely effective in preventing a draft of young man. But health care workers won't get the chance to refuse to register if call-ups are based on professional licensing lists rather than self-registration. Your first word from Selective Service could be an induction notice. Once you get it, there is no safe or easy way out.
The easiest, safest, and potentially most effective actions you can take to avoid being drafted are those you can take now to prevent the draft. If there's enough resistance now, no one will be drafted.
I am a board-certified family physician, a wife, a mother of three children ages 2, 5, and 8, [and] a captain in the U.S. Army Reserve Medical Corps.... I am refusing orders to be an accomplice in what I consider an immoral, inhumane and unconstitutional act, namely an offensive military mobilization in the Middle East. My oath as a citizen-soldier to defend the Constitution, my oath as a physician to preserve life and prevent disease, and my responsibility as a human being to the preservation of this planet, would be violated if I cooperate with Operation Desert Shield....
I had hoped that we as the people had learned the lessons of Vietnam -- 50,000 Americans dead, hundreds of thousands of civilian dead -- and environmental disaster. What we face in the Middle East is death and destruction on a grander scale....
The majority of casualties will be civilians.... Neither the U.S. military nor the Allied forces possess adequate medical facilities to respond to such medical needs. From a medical point of view the public has been misled concerning the catastrophic nature of wounds and injuries that will befall combatants and civilians.
As a doctor I know that where there can be no medical cure, prevention is the only remedy. I, therefore, commit my medical knowledge and training to this effort to avert war by refusing orders to participate in Operation Desert Shield.
I consider myself a patriot and have taken these actions in support of American troops who have been deployed in the Gulf region, in support of the American people, and in support of the children both here and in the Middle East who have no voice. I hope that in some small way my act of conscience will help promote a peaceful resolution of the Gulf crisis.
[Yolanda Huet-Vaughn, M.D., January 9, 1991]
What Can We Do Now?
- Write letters to newspapers and journals. Write to your Senators and Representative in Congress. Let them know that you're against the draft and that you'll resist if they try to draft you.
- Educate yourself about the draft. Inform your co-workers. Organize a forum or discussion on the medical draft at your workplace, home, or school. Think about what you will do if you are drafted.
- Tell your patients, friends, and neighbors. Encourage professional associations and unions to take a stand against the wars and the draft, and not to collaborate with the Selective Service.
- Organize an anti-war, anti-draft, or resistance group. (During the 1990-1991 Gulf War, peace groups formed at many hospitals, clinics, and medical and nursing schools.)
- Join in collective expressions of your commitment to resist the draft. (During the 1990-1991 Gulf War, hundreds of health care workers signed a joint health care workers' pledge to resist militarism and the draft.)
- Join with others -- young people, students, parents, veterans, etc. -- to oppose any draft. Get involved in anti-war and anti-draft coalitions.
(this Web site of information about the draft of health care workers)
(additional information about the draft, draft registration, and draft resistance, including printable PDF versions of this and other leaflets)
- Proposed Health Care Personnel Delivery System
(draft regulations published for public comment, 54 Federal Register 33644-33655, 15 August 1989)
- List of occupations potentially subject to the
Health Care Personnel Delivery System
(final page of the draft regulations)
Care Personnel Delivery System
(Title 50 U.S.Code Appendix Section 460(h), added in 1987 by Public Law 100-180)
- Health Care
Personnel Delivery System: Another Doctor Draft?
(Wisconsin Medical Journal, 2004; by the state surgeon of the Wisconsin Army National Guard)
- The Return of the Draft
(Rolling Stone, 27 January 2005. "Richard Flahavan, spokesman for Selective Service, tells Rolling Stone that preparing for a skills-based draft is 'in fact what we have been doing.' For starters, the agency has updated a plan to draft nurses and doctors. But that's not all. 'Our thinking was that if we could run a health-care draft in the future," Flahavan says, "then with some very slight tinkering we could change that skill to plumbers or linguists or electrical engineers or whatever the military was short.'")
- Uncle Sam Needs Coders. Here's How The Military Could Draft Them.
(by David Wood, Huffington Post, 10 May 2016. "Back in the early 1990s, Flahaven said, the Selective Service staff put together a plan on how they could register Americans by profession or expertise. They took their proposal to the Pentagon. It didn't go well. 'I briefed them on how we could register, say, linguists and computer professionals. They weren't interested at all,' Flahaven recalled somewhat sourly.... The 1987 plan sits on a shelf gathering dust, along with much else at the Selective Service.")
and Mobilization of Regular and Reserve Retired Military Members
(Department of Defense regulations, 32 CFR 64, 71 Federal Register 19827-19829, 18 April 2006; "It is DoD policy that military retirees be ordered to active duty as needed.... The DoD ... shall plan to use as many retirees as necessary.")
- Severe shortage of military surgeons
(Washington Post, 8 December 2004, reporting on an article in the New England Journal of Medicine)
Has Contingency Plans for a Draft of Medical Workers
(The New York Times, 19 October 2004)
- U.S. Medical Students' Knowledge About the Military Draft,
the Geneva Conventions,and Military Medical Ethics
(by Dr. J. Wesley Boyd, et al., International Journal of Health Service, Volume 37, Number 4, Pages 643-650, 2007)
- Doctors, Torture, and the War:
Physicians have the power to prevent more prisoner abuses. The first step: educate thyself.
(Op-ed by Dr. J. Wesley Boyd, Boston Globe, 28 October 2007)
- Med students don't study war, ethics:
Medical students receive little training about their duties and obligations in wartime
(Harvard University Gazette, 1 November 2007)
- Examining the
Implications of the Health Care Personnel Delivery System
(resolution adopted by the American Medical Association, 2003)
of the Health Care Personnel Delivery System
(report of the AMA Council on Medical Education, November 2004)
- Possibility Of A Military Draft Of Doctors Worries The AMA
(Wall Street Journal, 8 December 2004)
- Medical Draft Would Have Force Ready In 6 Months
(U.S. Medicine, June 2004; includes detailed timeline for a health care workers draft)
Service eyes women's draft; The proposal would also require registration of critical skills
(Seattle Post-Intelligencer, 1 May 2004)
initiates steps for selective draft
(Seattle Post-Intelligencer, 13 March 2004)
- Medical Reserve Corps
("Pre-identifying, training and organizing medical and public health professionals" so that they can be asked to volunteer "when an emergency ... need occurs".)
- "Medical Reserve Corps" collecting names ...
for a medical draft?
(by Edward Hasbrouck, 2 November 2005)
plans draft of medics; Selective Service wants doctors, nurses ready in event of worst-case crisis
(Newhouse News Service, March 2003; free registration and cookie acceptance required)
- Selective Service System Annual Performance Plan, Fiscal Year 2004
("Strategic Objective 1.1: ...enhance the Agency's ability to respond flexibly to a DoD request for health care personnel using the Agency's HCPDS.")
- Selective Service System Annual Report to Congress, Fiscal Year 2000
(see p. 25, "Status of the Heath Care Personnel Delivery System)
- Selective Service System newsletter, "The Register", November-December 2003
(see discussion of health care and "special skills" draft on pp. 6-7)
Draft In Standby Mode
(Selective Service System "Fast Facts", Feb. 2004)
- Will There Be Enough Trained Medical Personnel in Case of War?
(General Accounting Office report HRD-81-67, 24 June 1981)