Colonel Merbin Carattini

Introducing Colonel Merbin Carattini: A Distinguished Leader in the US Army Medical Department 

National Security Fellow Program at Harvard Kennedy School (2020-2021)

Colonel Merbin Carattini

For this People of HAIH post, we had the honor of speaking with Colonel Merbin (Mer) Carattini. Recently, Colonel Carattini was Commander of the US Army Medical Department Activity – Bavaria in Germany, where he was the Chief Executive Officer for five Military Treatment Facilities spread through the South of Germany, Romania, and Bulgaria following his completion of the National Security Fellow Program at Harvard Kennedy School.

Previously, Colonel Carattini served as the special assistant to the Surgeon General of the US Army at the Pentagon. In this capacity, he played a crucial role in supporting and advising the Surgeon General, contributing to the strategic direction of the US Army's medical initiatives, particularly during COVID-19 operations.

Let’s start from the beginning. Tell me about life before Colonel Carattini, before the hospitals, before the military – how did it all start?

I grew up in Puerto Rico, where Spanish was my first language. As a child, I had dreams of becoming a doctor and helping people. It was a noble profession that I admired. In college, I enrolled in a pre-medical degree program at the University of Puerto Rico, Mayaguez Campus, determined to pave my way toward a career in medicine.

However, as I approached the time to apply for medical school, I was confronted with the staggering cost of tuition. During this uncertain period, my father, who had served in the US Army National Guard in Puerto Rico, suggested I join the ROTC (Reserve Officers' Training Corps). The ROTC could allow me to pursue a medical education while serving in the military. This way, the Army would cover the cost of my studies, and I could fulfill my aspirations of becoming a doctor in the future. I was fortunate to receive tremendous support from many individuals, most notably Colonel (Retired) Daniel Vazquez. With their guidance and assistance, I was able to embark on a new path toward becoming a healthcare professional.
During my nursing clinical experiences, I discovered something unexpected. As I worked closely with healthcare teams and witnessed the inner workings of hospitals, I realized that my true passion lay in a different role within the healthcare field. So, I decided to shift my focus from becoming a doctor to pursuing a career as a healthcare administrator. 

What made you realize you didn’t want to be a doctor?

I wanted to be involved with patient care, but I didn't want to be at the bedside. I mean, I have to have that calling, and the people around me in the nursing program wanted to be there. I also felt that my impact was limited to the four walls of the ward and the patients in front of me. 

But you continued in military healthcare – what drove that decision?

As time went on, I found myself increasingly drawn to the role of a hospital administrator. Being in the military, I had the privilege of observing many mentors whom I deeply admired. These individuals were able to apply their battlefield management skills to the field of healthcare administration. During my deployments in support of the Global War on Terror, I began to see healthcare administration as a complex and challenging beast that motivated me.

The more I matured in the US Army Officer Corps, the more opportunities I saw for myself in the realm of healthcare administration. With the guidance and support of remarkable individuals like Major General (Retired) Patrick Sargent, I was fortunate enough to witness firsthand what excellence looked like. The experience inspired me greatly, reinforcing my desire to dedicate myself to serving others through healthcare administration. From that point forward, I couldn't envision myself pursuing any other path.

When you started in the military, did you still need to deploy, or did you dive straight into hospital administration?

I first received my commission in the military as an officer, and I became a Medical Service Corps Officer – not a nurse, not a doctor. I was in the Officer Basic Course, getting ready to go to my first unit in Fort Drum, NY, and there was a bulletin board. It said, "If you want to become a Medical Service Corps Army Aviator, just fulfill these requirements”. It sounded fun to me! Not only could I serve in the medical service corps, but I could also become an aviator. That's the thing with me; when opportunities present themselves, I just go for it. So, for the first twelve years in the military, I flew helicopters, especially in the role of evacuating wounded soldiers, and I completed five deployments in Iraq.

What did you learn from your time in Iraq?

When I fought in Iraq, I was part of a coalition where we collaborated with other countries' armies, as well as the US Air Force and US Navy. In my mind, there is no doubt that the US Army is the most capable in the world. It's not just about what we can do, but also about what we choose not to do. Our ability to reduce human suffering is paramount to our profession and seeing it during war gave me a firsthand perspective.

Today, I endeavor to impart these lessons from the front lines to the staff and team members within the organizations I lead.

Let’s pivot to hospital administration in the military. What are the objectives of hospitals in the military?

From my perspective as a hospital administrator, our primary objective is to leverage our healthcare platforms to ensure the delivery of safe and quality healthcare to all our beneficiaries. Our overarching goal is to prioritize the medical readiness of our military personnel in preparation for our nation's wars. The Military Health System (MHS) also faces the challenge of managing costs associated with our operations. Balancing the imperative of maintaining military readiness with the associated expenses is one of the most difficult tasks we face.

A former U.S. Secretary of Defense once highlighted the importance of controlling healthcare costs, as failure to do so could lead to a situation where we have to choose between allocating resources to bullets or to healthcare. This underscores the close connection between hospital costs and combat readiness. In 2017, the U.S. Congress directed the Department of Defense to consolidate the MHS into a single agency. Previously, each branch of the US armed forces managed its own healthcare system, resulting in significant duplication and waste of resources. Currently, we are actively involved in the process of merging the healthcare services of all branches.

Do you think civilians also serve in the military healthcare system?

Yes, both civilians and the military serve together. We face a huge challenge in recruiting healthcare professionals because we compete in the same talent market with institutions like the Cleveland Clinic, Mayo Clinic, John Hopkins, Kaiser Permanente, and others. The challenge we face is attracting medical talent because the military has salary caps set by Congress. On the other hand, civilian hospitals can offer higher pay. However, our appeal lies in the opportunity to give back to the country.

What can the military offer aspiring healthcare professionals that civilian institutions cannot?

It's an accelerated graduate medical education program that propels your leadership in the practice of medicine. In the corporate and civilian world, competition is fierce, even for individuals with great potential. The military provides an opportunity for young doctors with leadership potential to assume leadership roles. It is rare to see a young doctor leading any department or section in the civilian world, where leadership roles require extensive experience demonstrated through years of practice and attendance. The military offers valuable experience and a conducive leadership environment, enabling individuals to assume leadership positions at an earlier stage compared to their civilian counterparts. I have witnessed medical professionals acquire dual specialties by joining the military and subsequently returning to the civilian world to lead sections or departments.
 

What is the business model of a military hospital?

In its simplest form, we operate as a sub-capitated model, receiving a budget primarily determined by the number of beneficiaries enrolled. This sets us apart from other business models where hospitals are compensated based on the quantity of healthcare services delivered. As a result, I lack control over our revenue, particularly the per-patient revenue. To ensure our operations align with the available budget, we maintain a strong emphasis on cost reduction and value healthcare. This compels us to explore value-based care strategies, including preventive care. We conduct regular health assessments, mammograms, and screenings for other diseases that impact the combat readiness of our troops, thus prioritizing their well-being.

Great, you are rising up the ranks of the military and serving by helping patients. Tell me more about your stint as a National Security Fellow at Harvard Kennedy School.

My experience at Harvard was nothing short of surreal. The program brings together experts from the US armed forces and across the world, allowing me to explore topics at a profound level. Additionally, I had the opportunity to take courses at the Business School, as well as cross-institutional courses at MIT. I was also able to participate in Senior Executive Programs and became a Senior Executive Fellow. I made every effort to make the most of my time at Harvard, and it truly was a once-in-a-lifetime experience. If you are in the military, I highly recommend seeking out an opportunity to attend Harvard, as it proved to be a transformative moment in my life.

What’s next?

After Germany, I will become the Executive Officer for the US Army Deputy Surgeon General for about a year. Afterward, I am going to Fort Bragg, where I will serve as the Commander of the Womack Army Medical Center. This facility is responsible for providing healthcare to the largest number of beneficiaries in the Army, totaling 200,000. It is truly a massive institution, and with that comes a significant level of responsibility. Additionally, I have been contemplating how I will transition into the civilian world and utilize the valuable experiences I have gained. My ideal goal is to lead the Veteran Health Affairs hospital in Puerto Rico and contribute my time to give back to the community there. If I am fortunate enough to achieve this aspiration, I will be sure to send you a note!

Any parting advice?

Build relationships. In any organization, it all comes down to the people you work with. I often ask myself, "How can I assist individuals in achieving their goals on their terms, and how can we support one another?" To accomplish this, I focus on developing strong relationships and utilizing my capacity, authority, and influence to help my team members succeed. This is how I effectively lead my organizations. This mindset motivates others to do the same, creating a chain reaction of positive behavior. I firmly believe that this approach propels us all forward in the right direction.

Complied and Interviewed by Nini Ren