JOINT BASE SAN ANTONIO-RANDOLPH, Texas –
As part of the Air Force Recruiting Service’s Total Force recruiting enterprise, finding better ways to do business is a leading charge. A part of that is reducing redundancies and having one location conduct business for all of the Total Force partners and providing medical standards consistencies across all components.
AFRS has created a chief medical officer position to help expedite the waiver process and serve as one voice for each of the Total Force team members. The CMO is the unified voice on all medical accession matters on behalf of the Air Force Surgeon General, maintaining equities of the four recruiting avenues of the U.S. Air Force Academy, Air National Guard, Air Force Reserve and the active duty components.
“Prior to the standup of the division, the four recruiting avenues all had accession medical waiver authority. In an effort to standardize this across the Total Force and gain efficiencies, timeliness and equitability, this mission set was given to the Total Force organization, AFRS,” said Col. Maria Angles, AFRS CMO. “As CMO, we grant medical standards waivers after performing occupational suitability assessments for accession. The AFRS/CMO also is the waiver authority for initial entry into flying- or special-duty careers relative to the Department of the Air Force specific medical standards for the Total Force.”
In her role, Angles and her team must have awareness of each of the components’ standards.
“I collaborate directly with the owning accession source to help identify requirements for the specific mission set. The AFRS/CMO is the aerospace medicine specialist to certify flight safety-critical exams; so we are the certifier and the waiver authority,” Angles said. “So, no matter what accession source, coming in to serve the USAF and USSF, there is standardization and equitability for the occupational suitability decisions made.”
For Angles, she always knew she was going to be a doctor and follow in her father’s footsteps.
“My father is a retired Air Force lieutenant colonel general surgeon and flight surgeon. He also flew Critical Care Air Transports, before we had official teams,” she said. “I remember watching him do the swing landing trainer at Brooks Air Force Base, Texas, during his Aerospace Medicine Primary course … he was in his 50’s. I knew I wanted to be a doctor by the age of five, but my desire to serve in the military didn’t come into play for me until mid-college.”
Angles had a memorable morning that changed the trajectory of her career on a fateful day in Oklahoma City, Oklahoma.
“My desire to serve was solidified on April 19, 1995. I was driving to my medical school class when traffic stopped and the street was full of first responders,” Angles recalls. “While driving by, a cop asked me if I had medical training. As a second-year medical student, I just had my basic life support certification … but was asked to park on the side, don gloves and told to help the wounded. The Oklahoma City Bombing was blocks away from my school and the next few hours, shaped who I was and how much I wanted to serve. It was the closest thing to a battlefield that I had experienced and my desire to wear the uniform and serve in whatever conditions were required, like my father, became my goal.”
Fast forward 24 years, when Angles found out she was going to AFRS in 2019, she realized she had no idea about recruiting.
“When I PCS’d to Joint Base San Antonio-Randolph, I knew I was taking over a medical standards position, which seemed to make sense with my background at the Aeromedical Consult Service and my time at HQ AFSOC accomplishing the trained asset medical waivers for the MAJCOM,” Angles said. “When I heard I was moving to AFRS, my first thought was…why is my position in the Reserve?”
She realized that although she had been an Airman for many years, she had never experienced dealing with a recruiter other than receiving some literature while in school.
“I had no awareness of Air Force Recruiting Service,” Angles said. “My only experience was the large packet of Air Force information I received in the mail when I was accepted into medical school. I remember pictures of medical centers, deployments and golf courses. I didn’t give any thought to the organization that sent me this, just the organization I wanted to join, the Air Force.”
When Angles took the job with AFRS in July 2019 the plan was to stand up the new division by December 2019. The initial footprint was small, eight personnel moved from Air Education and Training Command Surgeon General to AFRS in November 2019. That initial group of experts had covered part of the active-duty mission for accessions.
“Our initial lines of effort included continuing to work the incoming flow of occupational suitability assessments, write position descriptions for new hires, both military and civilian, and work on stakeholder buy-in from the other accession sources,” Angle said. “We performed side-by-side reviews on waiver decisions for each of the different accession sources, identifying gaps and seams to help develop efficiencies and data-driven protocols to improve standardization.”
The new recruiting surgeon general office picked up the Air Force Reserve accessions mission in December 2019, the Uniformed Services University of the Health Sciences accession mission in February 2020, the USAFA mission in July 2020 and the ANG mission in October 2020.
“This momentum of advertising and hiring, standardizing and building a division while picking up new missions was only accomplished with engaged, supportive leadership and stakeholders,” Angles said. “The new transitions of authority drove changes in (Air Force Recruiting Information Support System-Total Force) that the AFRS/RSI team quickly responded to and developed streamlined products for all accession sources using this platform. AFRS/RSX expedited resourcing and hiring to ensure mission success with the growing mission demands, capturing quick onboarding, during the pandemic.”
And the AFRS commander helped highlight the importance of this mission set to senior leaders, giving us the ability to brief the U.S. Space Force chief of space operations, the Air Force vice chief of staff and the Secretary of the Air Force/manpower and Reserve affairs.
“This phenomenal support is what moved this concept and mission set to become a DoD benchmark within a year of initial operation capability,” Angles said.
While the need of having a singular office to handle medical waivers was talked about for years, it wasn’t until Air Force leadership made it a priority.
“The establishment of a single point of entry for accession medical waivers has been discussed for years and has been recommended in the past, but it was the push and direction of Gen. Stephen Wilson, U.S. Air Force Vice Chief of Staff on May 21, 2019, that drove the change in mission set, placement and priority,” Angles said. “His goal was to facilitate process improvements, standardization and program efficiencies across the Total Force recruiting enterprise.”
Initially, the team was comprised of eight to 10 people for mission coverage of waiver decisions, high-level inquiries and data queries. The average turnaround time was 35 duty days.
“Hiring and training during the pandemic was a challenge, but with a newly developed training program, defined workflows, and more personnel, we have driven that processing time to seven duty days or less,” Angles said. “Our goal is to stay at this timeline and shift personnel to help cover surges (boards, graduation shifts and A1 changes for certain AFSCs).”
With a review of the expanded mission set, the goal for the office is 37 personnel. Angles and her team have captured the validated requirements and will be working to get the right expertise in those additional personnel.
“I believe that when building a team, a focus on agility, innovation and transformation lend itself to hiring initiatives, finding multifactorial expertise and capturing the diversity of thought,” Angles said. “When finding the best fits for the mission set, we looked across the board for leaders at every level. We prioritized strong critical thinking skills, clinical acumen and operational experience. All of these attributes and skills will lead to this organization being able to continue supporting force development and gaining precision and relevancy in how we do this with the ever-changing military landscape and what the USAF and USSF will need to be in two, five or 20 years.”
The team is comprised of members who have served in Army, Air Force, Navy and Marines. Most of the branches have 90-plus military service years of experience between the members and are comprised of medical standards experts, major command functionals, public health technicians and rated aircrew.
“Our providers include a pilot-physician who initially served the Air Force as an F-16 pilot, then Air Force Special Operations Command, Command Surgeon (Dr. Rodger Vanderbeek), a physician from NASA who is the Chair of the Board of Preventative Medicine (Dr. Hernando Ortega) and a Marine Forward Air Controller who then became an aerospace medicine specialist (Dr. Eduardo Rizo).”
In many ways, Angles and her team are the benchmarks for all of DOD.
“As the division has picked up the mission set for the Total Force, the timeliness and consistency in our waiver decisions across the different accession sources have been recognized. As all the services work to develop forces that meet the requirements of today, tomorrow and on, the precision of occupational suitability decisions and timeliness have a direct impact on force development, recruiting timelines and surge capacity for the dynamic military environment,” Angles said. “The consolidation of waiver authorities also drives consistent data capture and quality that with analytics will be a data-driven demand signal to shape standards for the service and overall DoD accessions policy.”
Military medical standards are based on the requirements to support the military mission wherever and whenever the mission calls. The requirement to determine the risk to the individual and to the mission requires the balance of clinical acumen, operational requirements, worldwide deployability and how the military duties/environment may affect individuals with certain medical conditions.
“The Accession Medical Waiver Division supports the Total Force mission that spans across the enterprise to include the U.S. Space Force. Being embedded in AFRS has allowed the prioritization of this accession-focused mission set with direct ties to Force Development,” Angles said. “As our team is composed of active duty, AGR (Active Guard Reserve) and civilians, our Total Force team has the breadth of expertise and awareness of the diverse mission sets to best serve the Total Force enterprise. Not only are we helping bring in the Airman and Guardians of tomorrow, but we are also actively building leaders within the AMWD team to continue to innovate and lead change in their next endeavors supporting the U.S. Air Force and U.S. Space Force.”
Angles said the AMWD’s goal is to get to “fit”.
“Each case that we receive has been disqualified by either MEPCOM (Military Entrance Processing Command), DoDMERB (Department of Defense Medical Exam Review Board) or in initial training,” she said. “We review each case individually, reviewing all medical records, pharmacy records and consultant notes. Sometimes we request additional information. Our goal is to ensure we have a complete picture of medical risks and impacts.”
Part of her team’s ongoing work includes staying up to date on ever-changing medical standards.
“Our team of experts performs updated literature reviews, ongoing research and data to ensure adequate capture of risks to individual and mission. We use AF SG consultants in specific fields and have developed waiver protocols based on data-driven risk matrixes,” Angles said. “Medical standards are one of the few things in the military that are actively updated quarterly due to emerging research and growing data sets. Our team meets with the service medical waiver authorities for Navy, Army and Coast Guard to discuss accession standards for targeted risk assessments and changing mission requirements.”
An example of how things change in the world of waivers, Angles mentions keratoconus, a condition that affects the curvature of your cornea.
“In the past year, we have opened up the aperture for keratoconus which was previously disqualifying and not waiverable for accession,” she said. “Now with the treatment of crosslinking, individuals who have stability post-procedure are accessing into the military and some into rated career fields.”
Angles and her team have a robust workload, but their work is paying dividends.
“My team averages 15 to16 thousand occupational suitability decisions annually,” she said. “We are able to medically waive 50-60% of accession requests and certify about 90% of fly and special duty requests.”
Through all her moves, Angles knows she has had a remarkable career.
“My career has been blessed with phenomenal opportunities, amazing missions and exceptional people,” she said. “The Air Force has afforded me the opportunity to practice medicine on all continents, to deploy with joint units, supporting challenging mission sets that have shaped the medicine I practice and the way I lead.”
“I have been humbled working with SOF (special operations forces) across the Pan-Sahel region and with amazing military and international leaders in austere locations across CENTCOM (Central Command) and PACOM (Pacific Command),” she said. “The missions I supported with TRANSCOM (Transportation Command) and AFSOC for casualty and patient movement highlight the phenomenal agility of a multi-faceted system and the expertise and passion in those that support these critical missions. Each tour brings it home for me…it is those that we work beside, deploy with, face the mission challenges with that make this the best job in the world!”
Much like she learned to respect the military members she has served around the world with, Angles is now learning to appreciate the role recruiter’s play.
“Learning about the recruiting mission has been a steep learning curve, how hard our recruiters work to inspire the next generation of Airmen and Guardians, the way they are out and about every day, working to engage and enhance awareness of the amazing opportunities that the military provides,” she said. “Meeting and working with this motivated group of individuals that make up the recruiting enterprise has been an honor and truly is the foundation of force development. It is a phenomenal pairing, a perfect fit for force development at its core.”
And for her, it all ties back to her relationship with her father, the military and medicine.
“My father and I have always been close. Medicine brought us closer and the military has helped us share so many more aspects of our lives,” she said. “The shared understanding of serving on a military team, the challenges of trying to keep critically ill patients stable on the back of a C-130 for eight-hour transports, the honor in serving next to heroes day in and day out.”
Though her father is now in his 90s, he is still keeping up with his girl and medicine.
“My father still reads medical journals and he is a sounding board when I face leadership challenges and opportunities for the team,” she said. “His perspective on medicine and how we support the warfighter and how we take care of each other in the military is a wonderful foundation for me to build from. He is really loving the new things he is learning about recruiting, as this has been a learning curve for both of us.”