Contrasting paths in healthcare: Military versus private medicine.

Military Medicine: Are Military Doctors Achieving Better Outcomes?

Reese Marlowe in Health & Wellness December 2025 • 4 min read.

"A closer look at a study reveals that military physicians may be outperforming their private-sector counterparts in carotid artery stenosis treatment."

In the ongoing debate about healthcare costs and quality, a recent study published in JAMA Surgery offers a compelling perspective. The research, originally focused on 'Provider-Induced Demand in the Treatment of Carotid Artery Stenosis,' inadvertently highlighted a significant difference in outcomes between military and private-sector physicians.

Carotid artery stenosis, a narrowing of the carotid arteries that can lead to stroke, requires careful management. The study, which examined data from the Department of Defense Military Health System (MHS), revealed that MHS beneficiaries were less likely to undergo major procedures like carotid endarterectomy or stent placement when treated by salaried military physicians compared to those treated by private fee-for-service (FFS) physicians.

But the most striking finding wasn't just the difference in procedure rates. It was that patients treated by military physicians experienced better outcomes. This article unpacks the details of this study, explores the potential reasons behind these findings, and discusses the implications for healthcare delivery and patient care.

Decoding the Data: Military vs. Private Care Outcomes

Contrasting paths in healthcare: Military versus private medicine.

The JAMA Surgery study revealed that FFS physicians performed more procedures for both symptomatic and asymptomatic carotid artery stenosis. However, after adjusting for various factors, patients treated by military physicians had a significantly lower risk of stroke, death, or other composite outcomes within two years after surgery.

This finding challenges the conventional wisdom that more treatment always equates to better care. In the case of carotid artery stenosis, it appears that a more conservative approach, often favored by salaried military physicians, may lead to superior results.

Reduced Stroke Risk: Patients treated in the military system had a lower incidence of stroke following carotid artery stenosis management.
Lower Mortality Rates: Military-treated patients experienced reduced mortality compared to those in the private sector.
Fewer Complications: The study indicated a lower rate of overall complications in military-managed cases.

The article by Nguyen et al. did not report cost data, but the higher rate of interventions performed on patients with “purchased care” (ie, performed by FFS physicians) almost certainly translated into higher costs than the “direct care” group. Moreover, because the costs of direct care in the MHS are largely fixed, purchased care generates higher marginal costs.

The Bigger Picture: What Does This Mean for Healthcare?

The findings from this study raise important questions about the drivers of healthcare decisions and the impact of different payment models. Are FFS physicians incentivized to perform more procedures, even when they may not be necessary? Does the salaried structure of military medicine promote a more cautious and evidence-based approach?

While surgical intervention for asymptomatic carotid artery stenosis remains controversial, with guidelines like the American Academy of Neurology's 'Choosing Wisely' campaign recommending against carotid endarterectomy unless the complication rate is low, the study suggests that the context in which care is delivered significantly influences outcomes.

Ultimately, this research underscores the need for a deeper understanding of the factors that contribute to high-quality, cost-effective healthcare. By examining the differences between military and private-sector approaches, we can gain valuable insights into how to improve patient care and create a more sustainable healthcare system for all.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1001/jamasurg.2017.2862, Alternate LINK

Title: Carotid Artery Stenosis: Although Military Physicians Operate Less, They Achieve Better Outcomes

Subject: Surgery

Journal: JAMA Surgery

Publisher: American Medical Association (AMA)

Authors: Arthur L. Kellermann

Published: 2017-12-01

Everything You Need To Know

What were the key findings regarding the outcomes of military physicians compared to private physicians in treating Carotid Artery Stenosis?

The study showed that patients treated by military physicians had better outcomes in the treatment of Carotid Artery Stenosis. These outcomes included a significantly lower risk of stroke, lower mortality rates, and fewer complications within two years after surgery, compared to those treated by private fee-for-service (FFS) physicians. The implications suggest a more cautious approach to healthcare delivery, potentially leading to superior patient results.

What is Carotid Artery Stenosis, and why is it significant in the context of the study?

Carotid Artery Stenosis is a narrowing of the Carotid Arteries, which are major blood vessels in the neck that supply blood to the brain. If left untreated, this condition can lead to a stroke. The study revealed significant differences in outcomes based on the healthcare provider. Patients treated by salaried military physicians exhibited better outcomes, including a lower risk of stroke, compared to those treated by private fee-for-service (FFS) physicians, highlighting the importance of effective management.

What did the JAMA Surgery study compare, and what were the primary results?

The study, published in *JAMA Surgery*, compared the outcomes of treating Carotid Artery Stenosis by military physicians and private fee-for-service (FFS) physicians. The main finding was that patients treated by military physicians experienced superior outcomes. These included reduced stroke risk, lower mortality rates, and fewer complications compared to the FFS group, despite the FFS physicians performing more procedures.

What are the potential reasons behind the differences in outcomes between military and private-sector physicians in treating Carotid Artery Stenosis?

The differences in healthcare delivery models, particularly the payment structure, likely play a crucial role in the outcomes. Military physicians are salaried, which may incentivize a more conservative and evidence-based approach. In contrast, private fee-for-service (FFS) physicians may be incentivized to perform more procedures, possibly leading to unnecessary interventions and potentially higher costs. The study does not explicitly mention the incentives, but it raises questions about the drivers of healthcare decisions.

What are the broader implications of this study's findings for healthcare delivery and patient care?

The implications of the study's findings are significant for healthcare delivery and patient care. The superior outcomes achieved by military physicians in Carotid Artery Stenosis treatment suggest that a more cautious, evidence-based approach may lead to better patient results. This raises questions about the potential for similar approaches to improve healthcare outcomes and control costs in the broader healthcare landscape. The findings challenge the conventional wisdom that more treatment always leads to better care. This study highlights the potential benefits of different payment models and their impact on clinical decisions and patient well-being.