The innovation imperative for an integrated Military Academic Health System: Aligning education, research, and clinical operations to sustain combat casualty readiness

The Military Health System faces increasing readiness strain as global peer competition, sustained operational demands and post COVID-19 workforce and budget constraints reduce military treatment facility (MTF) capability and shift care to civilian networks. This trend erodes readiness-relevant clinical experience across undergraduate and graduate medical education, threatening the ability to generate and sustain a ready medical force capable of delivering combat casualty care at the scale anticipated in large-scale combat operations, humanitarian crises, and mass casualty events. High-performing civilian Academic Health Systems (AHS) provide a proven framework to integrate clinical care, education and research into a single learning enterprise that improves outcomes, enables rapid adaptation during crisis, and accelerates innovation. The National Capital Region (NCR) already contains the core components of such a system, including the Uniformed Services University, the National Capital Consortium, and multiple major MTFs, yet remains limited by service parochialism, soloed governance, and misaligned referral management. Multiple National Defense Authorization Acts provide legal precedent supporting modernization and explicitly authorize the creation of an AHS in the NCR. We propose an NCR pilot integrated military AHS centered on physician-led clinical departments and a unified practice plan to align clinical volume, education, and research with readiness requirements, streamline referrals across the enterprise, and accelerate military-relevant innovation. Timely implementation would strengthen trauma readiness, improve medical force generation, and provide a scalable model for other Defense Health Networks. (J Trauma Acute Care Surg. 2026;00: 00–00.