The Military Health System is actively spearheading initiatives to ensure doctors, nurses, medics and other health professionals sustain and enhance vital medical skills to keep service members at peak readiness.
“Our No. 1 priority is medical force readiness to ensure that our military forces are ready for combat,” said Dr. Stephen Ferrara, principal deputy assistant secretary of war for health affairs. “Our system is and remains the only medical system in the United States that goes to war. Our doctors, nurses, technicians, and support staff must be fully ready to deploy and provide care to our forces at a moment’s notice, anywhere in the world.”
With this mission come challenges — much of them rooted in what is referred to as the Walker Dip.
Rooted in history, with real-world impact
The Walker Dip is the decrease in medical readiness that happens during peacetime, when combat lessons fade and clinical skills can regress. It's not just a theory: It’s a lesson from the past.
The term comes from Adm. Alasdair Walker, a former surgeon general of the British Armed Forces who studied battlefield medicine. Ferrara said Walker looked back to the Napoleonic era and found a clear pattern: During war, military medical teams became highly capable through repetition, urgency, and experience. But in the years between conflicts, those skills diminished. When the next war starts, fatality rates can rise until the system relearns what it once knew.
The phenomenon, he noted, estimated about 106,000 avoidable U.S. deaths since World War II. That is why, Ferrara explained, the Walker Dip is a direct threat to readiness and addressing it across the MHS is an operational imperative.
“Medicine is both offense and defense. No one else will go to war and provide medical care on the battlefield, except us. That mission belongs to military medicine,” he emphasized.
While the Department of Veterans Affairs and private health systems partner with the MHS, they do not deploy into combat to care for wounded troops, Ferrara noted.
“I think of the MHS as a warfighting platform,” he said, stressing that military healthcare does more than treat the wounded after an attack. The MHS keeps troops in the fight, prevents disease and nonbattle injuries, and gives commanders confidence that trained medical teams can preserve combat power when it matters most. He also warned that as methods of military operations evolve, so must medical preparation and response. The tactics and techniques of executing modern warfare — such as the use of drones — could result in more severe injuries, delayed evacuation, and longer periods of field care. Military clinicians may have to hold patients for hours or even days in harsh environments instead of stabilizing them for a rapid flight out, he said.
“We have to anticipate the methods of combat,” Ferrara said. “We have to have a relentless focus and an obsession with these sorts of vulnerabilities.”
How the MHS mitigates the Walker Dip
Ferrara’s answer starts with a simple idea: Keep military medical teams engaged with the kind of work that builds combat-relevant skills.
“The best way to prepare is high-volume, high-complexity” care that sustains capabilities for battlefield care, he said. “Train how you’re going to fight.”
That is where partnerships have become essential.
Ferrara pointed to growing partnerships with the VA as a key way to keep teams sharp.
He cited collaboration with William Beaumont Army Medical Center in El Paso, Texas, and the El Paso VA Clinic to refer over 12,000 neurosurgery, orthopedic surgery, and general surgery cases a year.
“That should translate into more than 1,200 extra surgeries,” he said.
“That helps the surgical techs, the anesthesia providers, the nurses, the doctors,” Ferrara said. “Everybody is benefiting from that — strengthening the chain and sustaining our skills.”
He noted the MHS is bringing back more TRICARE For Life beneficiaries into larger military hospitals and clinics to increase the amount of complex cases physicians see.
Those patients give military clinicians more opportunities to sharpen assessments and hands-on skills while serving people who want care inside the system.
“Our military hospitals and clinics are our force-generation platforms,” Ferrara said, emphasizing military hospitals do more than deliver care. They pass knowledge from one generation to the next — from senior physicians and nurses to residents, medics, and corpsmen.
Military-civilian trauma partnerships
Ferrara also highlighted partnerships with civilian trauma centers and academic hospitals to expose military personnel to the kind of severe trauma cases they may not see often during peacetime.
For example, Navy Medicine coordinates extensive trauma training for deploying teams at the University of Pennsylvania, Cook County Health in Chicago, and the Navy Trauma Training Center at Los Angeles General Medical Center. Regional Navy Medicine commands also coordinate team training for fleet surgical teams at Harbor-UCLA Medical Center, UC Irvine, and Virginia Commonwealth University. Hospital corpsmen receive hands-on trauma experience in Level 1 trauma centers, known as Hospital Corpsmen Trauma Training, at four locations in the U.S.
The Army Medical Department Military-Civilian Trauma Team Training Program focuses on nine critical wartime specialties and provides individual and collective skills sustainment for U.S. Army trauma teams, including surgeons, emergency physicians, nurse anesthetists, intensive care and emergency room nurses, and combat medics.
Participants maintain their clinical proficiency through embedded and rotational assignments at eight premier Level 1 trauma centers across the country, such as Cooper University Hospital in Camden, New Jersey, and Grady Memorial Hospital in Atlanta, Georgia.
The U.S. Air Force operates the Las Vegas Military-Civilian Partnership, considered the largest and most integrated in the country. It combines the integration of military medics into the local civilian healthcare infrastructure and care provided at the Level III trauma center at Mike O’Callaghan Military Medical Center. It was designed to develop and sustain critical lifesaving skills for military medical personnel in all aspects of expeditionary medicine, while also supplementing local healthcare services.
Ferrara recalled his own experience while assigned to Naval Medical Center San Diego, where he worked at a Level 1 trauma center, which gave him exposure to high-complexity, high-volume cases that he would not have seen otherwise in his military practice.
The experiences gave him a broader case mix, more repetitions, and more exposure to the kind of injuries that matter in war, he said. “It was part of skill sustainment.”
Ferrara urged the next war will not wait for military medicine to regain lost confidence, lost volume, or lost instincts — and military healthcare professionals need to ensure that their skills remain sharp to be at the ready.
“You can’t plan to be prepared,” Ferrara said. “You just have to be prepared.”
“Every morning you wake up, and you say, ‘if we had to go into battle today, would I be at my best?’” he said. “And if the answer is not yes, then you say, ‘Where do I need to improve?’”
This mindset, Ferrara urged, is how military medicine keeps the dip from becoming the next war’s first casualty.