The U.S. Army Deputy Surgeon General Maj. Gen. Promotable Telita Crosland is leaving the Office of the Surgeon General and U.S. Army Medical Command (MEDCOM) to become the Director of the Defense Health Agency (DHA), where she will lead a global workforce of nearly 140,000 civilians and military personnel.
The DHA maintains administrative control of the Army, Navy, and Air Force’s military medical treatment facilities (MTFs). Crosland will be at the helm of operations, supporting nearly 10 million service members, family members, and military retirees. She will be managing the procurement and distribution of an $11 billion-a-year medical supply chain. The new role will see Crosland promoted to lieutenant general.
“[It’s] ironic. I started [my career] in an environment with all the services,” Crosland said. “I went to the Uniformed Services University of Health Sciences (USUHS). I started in an environment that was purple (consisting of multiple services). Some of my medical school classmates and friends are in the other services, and I will end my career where I started. That gives me a bit of measure to not mourn everything in between. We’ve all contributed. I got to do that as an Army officer, and I wouldn’t change that for the world.”
As the Army’s Deputy Surgeon General, Crosland executed her final Army assignment in the context of a global pandemic.
“I came to the headquarters as a general officer to be the deputy commanding general for operations and deputy surgeon general, I had those two jobs together as a pandemic kicked off. We left [the office] on a Thursday thinking we were doing a ‘mock’ preparation, and then we didn’t see most of our staff people again for well over a year,” she said.
Crosland explained that, even during the pandemic, her focus was on providing support.
“My job was to answer hard questions, make the best decision, keep the boss informed and take decisions to him, but the Regional Health Commands had the hard job of executing. They had the really, really hard job to execute in that environment. Our job is to help, to support, to enable. That mission is so important. They The entire team was having an impact all across Army Medicine,” said Crosland.
According to Crosland, Army Medicine worked to continue delivering services even when others couldn’t.
“We talk about the MTFs—hospitals and clinics. But look at dental. Most dental practices just shut down in the United States. Our dental couldn’t do that. They figured out how to do safe dental care and keep the force ready, and then build back the readiness as the pandemic continued. Nobody quit. Nobody was defeated. I know we were tired. I was tired. They had to be tired. But nobody ever showed up to work tired. Nobody. That’s impressive,” Crosland said.
Crosland said that the pandemic showed a great model of how the Military Health System (MHS) comes together, particularly during a crisis.
“What I thought worked well in the pandemic response was that interface between the DHA and the services’ medical departments. There were things that we did within the Army that enabled the overall (MHS) quite a bit. Whether it was actually sending human beings to civilian hospitals or calling up the reserves, we did that within the context of how it impacts the entire Army. Navy did that. Air Force did that. We were experiencing this problem in the context of healthcare in the United States,” she said.
She was especially impressed by the level of collaboration that led to a high level of success in all three services.
“Everybody was trying to figure out how do we man our facilities, how do we expand our capability beyond what we truly have, to take care of more human beings who all need critical care. It took the minds of the Navy, Air Force, and Army, and USUHS to put out those practice guidelines. It was a DHA-led initiative that we pushed out to all three services. We had a good live fire exercise that was real world. It gave us a chance to see where everyone’s strength is. That is how we were able to be so successful in a crisis like that,” said Crosland.
She stated that, despite the ongoing pandemic, “peace did not break out” and other missions continued. “My biggest challenge of this period was finding capacity, time, and ways to take care of our people,” she said. “What I described is within the best conditions, stressful but our entire system has been under a significant strain for a long period of time. In medicine, the unique people who go into medicine, regardless of your role, you carry a certain kind of a load. We volunteer to do that, and it doesn’t feel like a burden but then you add all of these demands on top of it: support systems, faith, and family—they’re under strain and that’s hard. What I’m most proud of—and what was hard—is figuring out how to take care of people in that environment.”
Crosland’s Army career has spanned three decades, and she is a graduate of the U.S. Military Academy at West Point. She said that her path was not a “sexy” one. At the age of 17, when the school approached her, she was a junior in high school and did not have any sort of strategy. She said all that she knew was that she was going to be a doctor—something she had known that since she was five years old.
“I took my preliminary SAT and I released the scores [to colleges], and West Point reached out,” Crosland shared. “I got a postcard from them and I filled out a reply card. The only question I had was, can I be a doctor? They said, ‘yes you can be a doctor, two percent of the class can go to medical school.’ I was getting many response cards, but my parents were like, ‘this West Point thing, you’ll have a great education, a job. You’ll figure out what you ultimately really want to do.’ I was like, yeah, be a doctor. So, I went to the U.S. Military Academy and that started my military career. No one in my immediate family is in the military.”
The Queens, New York, native chose family medicine as her specialty. “I went into family medicine for a couple of reasons,” she said. “I love the variation, the personal relationships with patients, and the expectation that you know them and their environment and their family. You get to be that person for other human beings. I really enjoyed that. There were other parts about medicine that I loved and that I could have enjoyed. I wasn’t wild about the operating room. I love that there are people who love that focus—they focus on that one thing to get it perfect. The repetitiveness of that makes you extraordinarily good at that. I really enjoyed the broader medicine. I really related to the people, the staff, the other senior people, the other docs I’d see when I did my rotations. I could see myself being them in 5 to 10 years.”
Crosland could have made a career as a family medicine practitioner in the civilian world, but she chose to stay in military service instead. She explained that several factors played a role in her decision.
“Like most people, you want to live a life of purpose and bring value. I feel like I’ve been able to do that in the Army. Being valued and bringing value is a bigger factor. I stayed in because, when I reached those crossroads of asking myself, am I on the trajectory for being where I want to be 5 years from now or 10 years from now, the opportunity, the team, and the mission always outweighed what I could have gained by leaving. As long as I feel like I can contribute and have something to offer and feel valued, I feel like I can make a difference,” said Crosland.
Crosland became a single mom when her husband passed away in January 2020, right before COVID-19 transitioned into a global medical crisis.
“There were people who lost loved ones and family members who couldn’t be there,” Crosland said. “Had I lost him 90 days later, I wouldn’t have been able to be there but I was there. Lt. Gen. Dingle (the Army Surgeon General) and the Army gave me all the room I needed. ‘Go be with your family,’ they said. The Army took care of me. My family took care of me. I have a very strong family. They were here when I needed them. I am blessed. I understand that.”
She added, “I am extraordinarily blessed and grateful that I have an extraordinary 12-year-old boy. His name is Jackson. He has not been unhappy or pouting about anything longer than 30 minutes—period. He could be a very different little boy based on what he has been through.”
As she wraps up her last assignment in an Army unit, Crosland said that she is most proud of the fact that she always found time to help and support others.
“Others have been with me from day one—just people in my career who’ve invested in me as a human being, I am most proud that I’ve paid that forward. I hear that come back at me. In any good organization, it’s always about the people. No matter what you’re doing in this world, it’s always about human beings and people. If you really love the organization, no matter what you’re doing, you have to invest in the people if you want it to be great going forward. In three to four years from now, I will hang up my uniform and do something different in this world. I want my past experience accomplishments to be surpassed by the next person. You have to invest in humans to do that,” said Crosland.
As she departs the Army to take the helm of the DHA, Crosland reflected on her experience of nearly 20 permanent change-of-station assignments. “I got to see the system from various perspectives and different lenses,” she said. There are things I didn’t get to do. I will have blind spots. I’ve been a general officer for six years. [As a general officer], you understand you will never know everything. What you need to know is how to manage, how to work with the team, and how to lead the team.”
Crosland also recognized the support and inspiration she’s received.
“I’ve had some extraordinary shoulders that I’m standing on, not the least of which is the current Surgeon General,” she said. “In many ways, he has very subtly shaped me, and in other ways, very clearly shaped me but most importantly he has modeled for me--I had someone to look up to and look at. He’s the first surgeon general who not a medical person—in a pandemic! He didn’t lose his mind. He found the capacity and prioritization to get the information and understand the information. He trusted us. He led us. He led the Army. He led in the MHS. I was privileged to be his number two. He does it, and he continues to do it with a grace. Taking care of people—he’s so good at that. Even in a pandemic, he found the time to hold ‘listening sessions’ in earnest to be present himself, to share of himself. He and CSM Hough have been out there from the ground to the strategic level. I don’t know when they sleep. He is genuine. The LDP (leader development program) sessions—whether they are for the general officers, the staff or for the whole command—he built all of that and executed all of that even in a pandemic. He always finds a way to get it done. He’s inclusive, and he’s a servant. He couldn’t have better role model. An inspiration and an example in what right looks like.”
Crosland said that the MHS needs to be able to not only deploy healthy forces, but also provide ready and healthy medical personnel. It also always needs to be positioned to receive casualties and take care of its 9.6 million beneficiaries no matter where they are in the world. At the DHA, she intends to harness innovation and help the Department of Defense (DOD) meet its priorities without shortcuts. She said that she is ready for the real challenges that will come her way as she directs the DHA. For her, it is all about the human beings to whom the MHS delivers care.
“When I hear the term value-based care, I think of health care having levers,” Crosland explained. “Right now, you have payers (insurance plans who pay for care), systems that deliver care, and the patient. In our country, those levers are not aligned. The payer wants something different than what the system wants, and the system wants something different than what the patients wants.”
Crosland is confident that the DHA can overcome this challenge.
“We are uniquely positioned to work that problem out. We are the payer. We run the system, and we care about our patients. Our patients are our patients for in perpetuity. You don’t sign up every year and bounce in and out of Tri-care. We see our patients for life. I see opportunities to modernize and go after value-based care.”