Civilian doctors in military clinics--outsourcing for better medicine

To determine whether outsourcing of medical consulting services could improve the quality of medical treatment in military primary care clinics. Data were collected prospectively over 2 months in two regular army clinics manned by ordinary army doctors and in two intervention clinics also staffed with senior civilian doctors. The causes for doctor visits, diagnoses, and other patient data were collected. Information was recorded from 4970 soldier visits in the four clinics. Although a prescription of rest days was similar in both types of clinics, the level of tertiary referrals was lower by one-third in the intervention clinics compared to the regular clinics. Surrogate markers for quality of care, such as increased use of planned follow-up and reduced antibiotic use, were significantly better in the intervention clinics, and so was overall patient satisfaction. Integration of specialist civilian physicians in the military primary care system is highly beneficial and provides better care and saves costs.