Does the Military Medical Academy cost PLN 1 billion? “Expensive juggernaut”

Tomasz Stankiewicz, “Wprost”: The problem of lack of doctors for the army is real. But is the law that is supposed to solve it well designed?

Prof. UW Ph.D. Krzysztof Koźmiński: I would start by saying that the problem itself actually exists. The available data shows that there is a lack of doctors who could perform tasks for the Polish Armed Forces. The Regulatory Impact Assessment shows that out of 1,506 medical positions in the military health service, 888 are filled, i.e. 59 percent. There is one doctor for every 260 soldiers, while the NATO standard is one for every hundred. The scale of the problem is real. Therefore, I do not question the need to strengthen the military’s medical base.

However, I have serious doubts whether the proposed solution is appropriate. I say this as a lawyer who analyzed the project, the regulatory impact assessment and the justification for the act, but also as an academic who knows the problems of higher education. I work, among others, in the Polish Accreditation Committee, I visit universities and see how the system works.

Reactivating a university from over two decades ago is a huge organizational and financial challenge. This is not a project for a year or two, but rather for seven, eight, maybe ten years of serious expenditure. We must therefore ask whether these costs are commensurate with the effect and when they will pay off in the form of expected effects.

Where do you see the greatest risk?

In that the doctor may find himself in a situation of double loyalty. On the one hand, he is obliged to save the patient’s life and health, in accordance with the ethics of the medical profession. On the other hand, if from the beginning he is educated in a structure subordinated to the ministries of force. And while subordination in the structure of the Ministry of National Defense is obvious, the announced marriage with the structures of the Ministry of Internal Affairs and Administration makes me shiver. If WAM were to rely on staff from the Ministry of Interior and Administration and introduce non-medical subjects for the needs of the Ministry of Interior and Administration, a question immediately arises in my mind to whom it will be primarily loyal and responsible: to the patient, to the military hierarchy, or perhaps to the civilian “security service”?

This is not an abstract problem. History shows that when medicine becomes too closely incorporated into the logic of law enforcement structures specifically designed to maintain internal public order, threats to human rights emerge. A year ago, in our opinion on the draft act on the establishment of the Military Medical Academy prepared by the Center for Regulatory Impact Assessment of the University of Warsaw, we referred, among others, to: the experiences of Abu Ghraib or Guantanamo. These are examples from about twenty years ago, so not very distant at all. Moreover, what happened in the army of a country that strongly refers to human rights, the separation of powers and civil guarantees. This smells like a return to the infamous cadres of Vistula units. I warn you not to do this.

So, in your opinion, a patient may have problems trusting such a doctor?

The patient often has no choice. Sometimes he doesn’t even know how the doctor treating him was trained. But this is why the state should design such institutions very carefully.

A doctor should save regardless of who the patient is, what his views are, what his function is and how we morally evaluate him. This also applies to persons deprived of their liberty or opponents who are captured during an armed conflict. If a medic in uniform thinks in terms of a soldier and military service, this is not a problem, but if, as a result of various contacts at the university with the security apparatus, he begins to think differently and still feel an obligation towards lecturers from the Ministry of Internal Affairs and Administration or, to put it bluntly, is recruited during his studies as an agent of the security services, a real danger arises, not only for patients but also for soldiers.

However, supporters of the project will say that the army needs doctors prepared to work on the front.

And they will be right when it comes to diagnosing the problem. The army needs doctors prepared to operate in war conditions. However, this does not automatically mean that a new university should be created, and one linked to the structures of the Ministry of Interior and Administration.

We have very good medical universities in Poland: in Warsaw, Łódź and other cities. They are already educating doctors. I am not convinced by the thesis that a completely different doctor is needed to save the life of a man in uniform and a completely different one to save a civilian.

You can use the potential of existing universities and then send doctors to specialized military courses. They can be taught the specifics of operations during war, the organization of aid at the front, or procedures specific to the army. This seems to me a more rational solution than building a large institution from scratch.

So an alternative would be to create modules or courses at existing universities?

In my opinion, yes. Let’s not weaken what is already working well. The existing medical universities have staff, experience, infrastructure and achievements. They educate doctors, dentists and representatives of other medical professions.

Nothing stands in the way of creating a superstructure: a system of courses, specializations, coordination with the army. This would make better use of the resources we already have. Meanwhile, the WAM reactivation project may mean the creation of a new, expensive behemoth that will compete for people and money with existing universities.

You mentioned costs. How big a problem can this be?

Very big. The current Regulatory Impact Assessment provides specific amounts: PLN 448 million for personnel and teaching costs in the next ten years and PLN 430 million for infrastructure expenditure in the first five years. A total of almost PLN 878 million – all from the defense budget, at the expense of other items in the expenses of the Ministry of National Defense. And experience with regulatory impact assessments in Poland shows that such estimates are sometimes underestimated. Let us also remember that the university is established on July 1, 2026, but it will start its education in the academic year 2027/2028 at the earliest – for fifteen months it will function as an organizational unit of the Ministry of National Defense, with full financing, but without students. This is an expensive incubation at the expense of the defense budget

It’s not just about buildings or administration. It’s also about the staff. Today, medical universities have their own lecturers, researchers and practitioners. These people cannot be treated like furniture that can be freely moved from place to place. They are often successful precisely because they work in a specific environment, have facilities, teams, and conditions for research and teaching.

If we start ripping these resources away from existing universities, we may simply weaken them. And science doesn’t like chaos. Since we have well-rated units that undergo evaluation and accreditation inspections, it would be wiser to strengthen them rather than dissipate their potential. And reaching for staff from the State Medical Institute of the Ministry of Internal Affairs and Administration in Wołoska, as announced by Minister Tomczyk and the director of the Department of Military Health Service Kosovo, is a total misunderstanding.

Do you also see a constitutional problem in the project?

Yes, although I would rather talk about serious doubts about the political system. The Polish constitution introduces a far-reaching division of competences in the area of ​​defense and foreign policy. We have a president as the commander-in-chief of the armed forces, we have a government, we have a minister of national defense. In addition, there are vague concepts that in practice may lead to disputes.

If a university educating military doctors were strictly subordinated to the Minister of National Defense, the question arises whether it would not become an extension of this minister’s policy. What about in the event of a war conflict? What if there is tension between the president and the government? These are questions that cannot be ignored.

What about the involvement of the Ministry of Interior and Administration structures? Could this also be a problem?

In general, subordinating medicine to internal power departments is risky. In liberal democracies, we have adopted the division into the civilian and military spheres precisely to ensure that uniformed structures do not dominate areas related to civil protection, public health or fundamental rights, and vice versa.

It is necessary to clearly distinguish the army from the internal security apparatus – this is a fundamental political difference. The army defends the state against external threats, and the citizen is by nature not the subject of its actions; the internal security apparatus, however, operates towards citizens, and a doctor incorporated into this structure faces a patient whose constitutional rights are sometimes subject to the actions of his parent institution. It is a conflict of a structural nature, inherent in the very logic of such a relationship. Poland consciously abolished the uniformed medical department of the Ministry of Internal Affairs in 1990 – based on our own, bad experience. It’s hard for me to understand what has changed over the last thirty-five years that today we are considering returning to this model.

Of course, in emergency situations, these spheres must cooperate with each other. However, cooperation is one thing and another is the permanent subordination of the process of educating military doctors to the logic of the Ministry of Internal Affairs.

In your opinion, does the project have primarily a symbolic dimension?

I have this impression. The very word “reactivation” makes me cautious. The world has changed, the war in Ukraine has shown a new face of the conflict, and we are returning to the concept of an institution from two decades ago, rooted in a different model of the state and army.

If something works well, it should be strengthened. Meanwhile, here I see a solution that is primarily symbolic and emotional, and poorly justified organizationally and economically. As a person who assesses the effects of regulations, I always ask: is it tense? In this case, I am not convinced about the costs, organization or selection of tools for the diagnosed problem.

Can the interests of specific groups be behind such a project?

I have no proof of this, so I speak carefully. But in my experience, if a project is poorly justified and yet comes up in public debate, it often means that there is an interest group.

There doesn’t have to be anything illegal about it. Interest groups are a natural part of public life: academic teachers, lawyers, judges, politicians, trade unions and employer organizations have them. There are also people in the academic environment who are looking for a path to promotion, new positions or institutional opportunities.

Should the president veto the bill?

I think there are certainly arguments for a veto. Firstly, there are economic and organizational arguments. Secondly, ethical, related to the risk of double loyalty of the doctor. Thirdly, systemic, concerning the relationship between the president, the government and the minister of national defense.

The problem with weak law in Poland is often that the problem is recognized well, but the tool for solving it is poorly selected. This is what I see here. The shortage of doctors for the army is real. But the answer does not have to be the reactivation of a large, expensive university subordinated to the logic of the ministries of power.

The president, as the commander-in-chief of the armed forces, should consider not only the arguments for the act, but also those against it. And there are a lot of them.