Could a doctor draft improve physician leadership, research, and U.S. health care?

Drafting young physicians to work at the intersection of medical research and patient care could be a way to improve the U.S. health care system, said a Nobel Prize-winning physician.

Robert J. Lefkowitz, MD, a Duke Health distinguished professor of medicine and recipient of the 2012 Nobel Prize for chemistry, was a keynote presenter for Sustaining the Biomedical Workforce: Innovative Pathways for Retaining and Supporting Physician-Scientists. It was a daylong workshop hosted in person and online by the National Academy of Medicine (NAM) and the American Junior Investigator Association.

Lefkowitz presented “The Yellow Berets: The Most Successful Program Ever Developed for Training Physician-Scientists.” He offered historical facts and personal anecdotes about his experience in the program, which at the time was an option for mandatory national service for newly degreed physicians.

Robert J. Lefkowitz MD
_{© Duke University School of Medicine}

The program may not be widely known today, although its influence continues across American medicine based on academic leadership and study. It also could be the model for a new training method combining research, patient care and public service.

“I want to stress two things. One, the importance of mentoring and developing physician scientists, and two, the obvious conclusion about the importance to medicine and biomedicine of research carried out by physician scientists,” Lefkowitz said.

The doctor draft

During the Vietnam War, there was a general draft of young men to serve in America’s armed forces, with a lottery to determine who would be conscripted. The situation was different for physicians: Following internship or a period of residency, they were inducted for mandatory two years of service.

That rule, known as the Berry Plan, had developed during the Korean War, and was part of the nation’s military preparations from 1954 to 1973. It involved 42,000 medical doctors.

Taking a commission as an Army, Navy or Air Force officer would guarantee a year in Vietnam at a time when that conflict was growing more and more unpopular with the American people. The U.S. Public Health Service was still part of the military, and there was a chance its officers would be assigned stateside, so competition for those slots was intense, said Lefkowitz, who was tapped for one of those posts.

Who were the Yellow Berets?

The Green Berets of the Army’s Special Forces became known as an elite combat force, and the song, “The Ballad of the Green Berets,” became a popular hit. Folk singer Bob Seger parodied that song in “The Ballad of the Yellow Beret” to mock draft dodgers, “fearless cowards of the U.S.A.,” young men who escaped service by going to Canada or seeking medical deferments for conditions such as bone spurs, Lefkowitz said.

Seger’s song was not about the U.S. Public Health Service, but the moniker “Yellow Berets” migrated to its officers, who did not don that headwear but who did wear white coats. They had two duties:

• Care for patients at the NIH Clinical Center
• Conduct mentored research

‘Bench to Bedside’

Clinical and research time varied by institute and program, with an emphasis on “Bench to Bedside.” The Clinical Center opened 1953 with 1.3 million square feet of space and labs in immediate proximity to patient rooms. In 1968, there were 516 patient rooms, 4,000 admission, and an estimated 1,400 research protocols, said Lefkowitz, who cited data of NIH and Ray Greenberg.

“The key feature is that the patient rooms and the laboratories were directly next to each other, separated only by some nursing service officers and service offices and walkways through between the two,” Lefkowitz said. “And so you can walk directly from your laboratory. It was maybe 30 or 40 feet onto the clinical service and this close physical proximity of the two tended to very much encourage those of us, even those doing very fundamental or basic research, to always be looking for the clinical ramifications and implications of that work.”

The service was intensive, said Lefkowitz, who was assigned to the clinical endocrinology branch. He described it as the first time he “ever encountered something where no matter how much effort I put into it, I did not seem to succeed.”

“I became very depressed,” he said. “The only thing that was clear to me was that research would have no future plan for me in my future career. As fate would have it, during the last six months, I did begin to make some success in my project and publish my first couple of papers. And as they say, the rest is history.”

Learning to lead

Once their service was complete, the Yellow Berets made careers in medicine and research. By 1998, the NIH History Office found their influence by working at Harvard, Johns Hopkins, Duke and Michigan universities. For example, at Duke, 29% of medicine division chiefs were Yellow Berets. The Yellow Beret classes would produce Nobel laureates, including Lefkowitz. Their academic lineage included numerous other Nobel Prize winners, and hundreds of other Yellow Berets would become leaders in academic medicine.

Lefkowitz cited seven key conditions, as outlined by the physicians Michael Brown and Joseph Goldstein, fellow Yellow Beret alumni and Nobel Laureates:

• The Vietnam War drove intense competition for USPHS commissions
• Participants had outstanding mentors
• Research was intense, with relatively few distractions
• Staff scientist taught evening courses in cutting edge areas of basic science
• There was a focus on fundamental research, but discoveries strongly influenced drug development, medical practice and human health
• Basic science was at the core of medical education
• Medical students were taught joy of finding new facts or overturning old ones

Examining what had changed in the last 60 years, there were some key points and lessons:

• There is no obligatory service for young adults.
• Basic science is no longer at the core of medical education.
• The sector has lost its conviction that progress in medicine ultimately rests on a fundamental understanding of physiology.

To counter those changes, medical education should enhance student exposure to basic science. And the nation could draft doctors to further medical research.

“This is one that I happen to believe in very deeply but may be totally impractical, but I keep hoping,” Lefkowitz said. “I favor the development of government supported peacetime service programs for physicians in training, highly incentivized and competitive, which offer research training opportunities modeled after the Yellow Berets. Only the most highly competitive applicants would be accepted, so that these would be prestigious appointments, and only the most highly accomplished mentors participate.

“I would add that my own personal view is that this shouldn't be just for those wanting to become physicians,” Lefkowitz added. He said he favors reinstitution of the draft, with an option for military service, but other public service options as well.

History of the Yellow Berets

To learn more about the Yellow Berets, Lefkowitz cited his memoir, “A Funny Thing Happened on the Way to Stockholm: The Adrenaline-Fueled Adventures of an Accidental Scientist.” “Medal Winners: How the Vietnam War Launched Nobel Careers,” by Raymond S. Greenberg, outlines the stories of the Class of 1968 physicians who would go on to win Nobel Prizes. Alan Alda and Kate Rope are the creators of the podcast, “Soldiers of Science: The Vietnam War, Anthony Fauci & the Doctors who Revolutionized American Medicine,” about the Yellow Berets and another famous alumnus.

Lighter moments

While the medical research and the Vietnam War were serious topics, Lefkowitz touched on some moments of levity from that time.

Fauci would become known in medicine as the longtime director of the National Institute of Allergy and Infectious Diseases of NIH. He became a household name during the COVID-19 pandemic.

Fauci also was part of the Yellow Berets with Lefkowitz in the Class of 1968. “He always tells us, when we get together, he feels like he has an inferiority complex. He claims he's the only one in the class who didn't get a Nobel Prize,” Lefkowitz said. “Well, we always reassure him and say, Tony, you did OK.”

The USPHS doctors did not have to wear military uniforms, but Lefkowitz and some peers bought one to share, wearing it for travel because military personnel could fly on stand-by around the country. They would salute senior officers, and one time a peer snapped to attention to salute the uniformed — but civilian — pilot of a plane.