Drafting Doctors

by Charles Richter and John S. Emrich
March 2023

Since its founding, many members of the American Association of Immunologists (AAI) have had close ties to the National Institutes of Health (NIH) and its precursor agencies. Located just outside of Washington, DC, NIH has funded and trained countless immunologists. Two generations of AAI members joined its staff and leadership during periods of NIH expansion, thanks in part to a Cold War era policy that attracted young physicians to the Maryland suburb of Bethesda.

A Wartime Need

During the First and Second World Wars, the rapidly expanding U.S. Armed Forces needed physicians to treat sick and injured soldiers on the frontlines and at bases back home, as well as to conduct war-related research. AAI members responded during both wars by volunteering for military service or carrying out important disease research on the homefront.

Within a decade of the end of the Second World War, Cold War tensions between the United States and the Soviet Union were felt around the world. In 1948, to maintain readiness during this new era, the U.S. government reorganized the Selective Service System, the agency responsible for furnishing able men for common defense and national emergency, including a military draft. The legislation also contained provisions for drafting physicians in peacetime. Less than five years later, President Harry S. Truman signed into law an act establishing the male-only Doctor Draft, which changed the trajectory of many physicians and future AAI members.

From 1953 to 1973, countless young doctors satisfied their two-year military obligations as staff physicians or researchers at military installations or the frontlines of the Korean and Vietnam Wars. Additionally, more than 4,000 newly minted doctors fulfilled their service by spending at least two years as associates at the NIH, gaining invaluable clinical and research experience. Of these, more than 160 would go on to become members and leaders of AAI.

The Doctor Draft and Associate Training Program

John L. Fahey (AAI ’64) first heard about the new Associate Training Program (ATP) at the NIH Clinical Center in the spring of 1950, when he was a student at Harvard Medical School. He viewed the program, which was set to begin in 1953, as an excellent career opportunity. Little did he know that by the time he was accepted, it would also be an alternative to military conscription.

When North Korean forces suddenly invaded South Korea on June 25, 1950, Congress and President Truman quickly responded by reactivating the general military draft and launching a new Doctor Draft. Over the next six years, more than 30,000 physicians, dentists, and veterinarians would be drafted to serve both overseas and in stateside bases.

Under the new law, all doctors up to the age of 50 would be required to serve in a branch of the armed forces or in the Public Health Service (PHS), which includes the NIH (see sidebar on page 67). Fahey later described how the NIH program benefited new doctors: “A commission in the PHS was regarded as equivalent to military service. By joining the PHS at the NIH, I was able to help the new national effort to develop a Medical Research Center and continue my career development in biomedical research without an interruption for military service.” Fahey and the rest of that first group of clinical associates arrived at the NIH on the opening day of the Clinical Center, July 2, 1953, just weeks before the end of the Korean War.

The Berry Plan

After the Korean War, Frank Berry, the new Assistant Secretary of Defense for Health and Medical, came into office with a plan that he hoped would both provide sufficient military personnel for the Cold War military and satisfy the concerns of hospitals, medical schools, and physicians’ associations. Under the “Berry Plan,” new doctors had more flexibility as to when they began their service: they could choose to join a branch of the armed forces or PHS immediately following their internship, after one year of residency, or after a full residency in the specialty of their choice. Although their preference of service branch had to be stated in their fourth year of medical school, graduates were not guaranteed to receive their first choice. Those who entered the PHS were commissioned at the rank of senior assistant surgeon, equivalent to lieutenant in the Navy.

The Doctor Draft continued into peacetime following the Korean Armistice Agreement, according to Berry’s plan. For some doctors, it provided their first experience with immunology, which for many of them became a lifetime pursuit. A number of these immunologists became pioneers in the field and future AAI leaders.

Military Service

Even for those who did not become NIH associates, it was still possible to end up in Washington, DC. K. Frank Austen (AAI ’62, resident 1977–78) was the only one out of his cohort of 12 interns at Massachusetts General Hospital who did not apply to the ATP in 1956, but joined the Army instead. He recalled: “When I completed my basic training in Fort Sam Houston in Texas, and the nice sergeant who was doing our assignments looked and saw that I had three papers in the New England Journal of Medicine, the sergeant decided I might have potential as a scientist, and rather than assign me to overseas (I was assuming it would be South Korea), sent me to the Walter Reed Army Institute of Research, where, in turn, they assigned me to the one immunologist [Elmer L. Becker (AAI ’52)] that the Army had at a time when the NIH did not have an immunology program.”

PHS and NIH

Entrants into the NIH associate program were in one of three categories: clinical associate (CA), research associate (RA), or staff associate (SA). When the Clinical Center opened in 1953, all associates were CAs. RAs were added in 1957, and the first SAs joined in 1960.

CAs had primarily clinical responsibilities caring for NIH patients, while RAs, having no obligations in the clinic, were each assigned to an institute and laboratory that fit his research interests. SAs gained experience in both basic research and research administration. Associates in all categories would generally spend two years at NIH, except for those placed in the National Institute of Allergy and Infectious Diseases (NIAID), which had three-year clinical associateships consisting of one year in the clinic and two in the laboratory. In those early years, though, CAs in all institutes had the chance to perform a great deal of basic research, as the Clinical Center had not yet built up the robust referral system it has today.

The vast majority of future AAI members in the ATP worked in three institutes: the National Cancer Institute (NCI), NIAID, and what was then known as the National Institute of Arthritis and Metabolic Diseases (now the National Institute of Arthritis and Musculoskeletal and Skin Diseases or NIAMS).

Being accepted into the new associate program at NIH seemed like winning a scientific jackpot. Thomas A. Waldmann (AAI ’71) arrived at NCI as a CA in 1956, having had almost no laboratory research experience. He enjoyed learning “from the corridors” during his walks to lunch with various colleagues. Many associates were in a similar situation. As Henry Metzger (AAI ’65, AAI president 1991–92) remembered, when he was an RA in 1959 “…they also had some courses, lectures…because many of us didn’t have all that much basic science training when we came.”

In the early 1960s, according to William E. Paul (AAI ’67, president 1986–87), who was a CA at NCI from 1962 to 1964, “…it wasn’t Vietnam, it wasn’t Korea, but people would still prefer not to be in the service if they could avoid it.…If you were fortunate enough to get a position at NIH…that was an entrée to science, not just for me, but for a whole generation.”

Matthew D. Scharff (AAI ’64) received encouragement from New York University Medical School to apply to the ATP as an alternative to the draft. The NIH option within the PHS was particularly attractive to Scharff, who was an RA from 1961 to 1963: “Instead of going off and being a physician in the Aleutian Islands or some place in some clinic, you could go to the NIH and essentially be a postdoctoral fellow.” Even though the United States was not currently engaged in a war, the NIH offered a much more interesting way to serve than, as Metzger put it, “doing physicals at some army base.”

The NIH itself told prospective applicants that it offered “unusual opportunities” unlike those found elsewhere. Getting into the program, however, was not easy; in 1962, the ATP received 1,200 applications to the program, and accepted 123 new associates. This was a large increase over the 85 acceptances from 500 applications the previous year.

The Vietnam War Era

The number of associates at the NIH steadily increased through the 1960s and through the duration of the Vietnam War (1965–75). Even before the general draft lottery was instituted in 1969, new physicians were subject to the Doctor Draft and deployment to Vietnam. As American involvement in the war ramped up after the Gulf of Tonkin Resolution in 1964, an ATP position at the NIH looked increasingly desirable, both to avoid the hazards of war and as a stepping stone to scientific opportunity. Robert R. Rich (AAI ’73, EIC 2003–08) was not unique among his generation when it came to serving as a military doctor. “I could have gone to Vietnam,” he recalled, “but I decided the NIH was probably more to my liking for that period of service.”

Prospective associates had to apply during their final year of medical school, and most of those who accepted chose to complete their medical residency before beginning their NIH training. With the number of applicants skyrocketing, the deadline for the program had to be moved up from September to May in 1965, and then to April in 1968. A student hoping to start as an associate at the NIH in July 1968, for example, would have to have his application completed by early May of 1966. The schools that supplied the most future AAI members to the ATP included Harvard Medical School (24), Columbia University College of Physicians and Surgeons (13), New York University School of Medicine (12), and Johns Hopkins University School of Medicine (10).

The war drove Ethan M. Shevach (AAI ’73, EIC 1987–92) to apply to the ATP and pursue a career in medical research. As he explained later, “The big career decision in 1967 when I graduated medical school was the Vietnam War. That was a big influence on one’s career. And as a physician, to be honest, it didn’t appeal to me to go to Vietnam. I was drafted by the army, as every male physician was drafted in those days, and was pretty likely going to spend a year as a general medical officer in Vietnam. The other alternative was to embark on a career in medical research and come to the NIH.” Shevach had to plan his honeymoon so that he could quickly get to Bethesda if he got the call for an interview. His eventual placement at NIAID led to a life-long career at that Institute.

Irving Weissman (AAI ’71, AAI president 1984–85) was an activist against the war in Vietnam while attending Stanford Medical School in the early 1960s. He was interested in joining the ATP, but after organizing a petition stating that physicians could not ethically serve under the military code, Weissman reported two consequences: “One, I got my draft notice early, and two, when I called to go to the NIH, they said, “You’ve been blackballed.” So I couldn’t go to NIH.” Only a swift appointment at Stanford kept Weissman from being drafted.

As the Clinical Center matured and benefited from the growing influx of bright young minds, the associates enjoyed a remarkably collegial environment. John I. Gallin (AAI ’75) described how, as a clinical associate in the early 1970s, he was “adopted by all the senior staff” and “felt totally free to interact with all of them.” At least 39 AAI members were ATP associates in the early years from 1953 to 1965, and a few, like Waldmann and Metzger, had long careers at NIH, where they became mentors to many ATP associates and future AAI members. William Paul became mentor to Charles A. Janeway Jr. (AAI ’74, AAI president 1997–98) in 1970. At any given time from 1967 to 1973, there were never fewer than 36 future AAI members in the ATP, and at times as many as 50.

ATP and the “Yellow Berets”

Before long, the Vietnam-era physicians who fulfilled their military obligation through service at NIH acquired the nickname of “yellow berets.” While the term was initially used as an insult against those who avoided the war, it was appropriated as an ironic badge of honor by many of the associates. Janeway considered the “yellow beret” moniker a “joking name for the group that came of age at the end of the 1960s and did not want to serve in the Army in Vietnam in what [they] regarded as an unjust war.” Particularly as competition for spots at NIH grew fiercer, the proud few who were selected had been at the top of their classes in medical school.

Not everyone appreciated the “yellow beret” label; Anthony Fauci (AAI ’73), who was a CA from 1968 to 1970, at the height of the war, argued that it gave the false impression that the associates were “afraid of going to war.” On the contrary, he explained, “I always felt that if indeed it came to that, that I would go. I was not philosophically in favor from the political standpoint of the real rationale of why we were there. As long as American soldiers were going there and getting killed and getting maimed, as a physician I felt if I had to go, I would gladly do my part to try to help them. I did not have a problem going to Vietnam even though I had a problem with the war itself.”

Metzger, who ran a laboratory in the Arthritis and Rheumatism Branch, in what is now NIAMS, in the late 60s, said of his own RAs’ reasoning for selecting the NIH during the Vietnam War, “I guess it wasn’t something that we discussed because if they were here, in a sense they had accomplished what they wanted to.” When Metzger interviewed prospective associates, he did not inquire as to their reasons beyond scientific interest. The NIH campus was a welcoming place for those who were not in favor of the war; beginning in 1969, the National Institute of Mental Health (NIMH) had organized the NIH-NIMH Vietnam Moratorium Committee, which sponsored an annual rally onsite to protest the ongoing war.

Through the war years, total enrollment in the program steadily rose from 177 associates in all fields in 1966 to a high of 224 in 1973, when both the general draft lottery and the Doctor Draft ended. After the war, the ATP continued as it had originally been intended, with no connection to conscription.

Shaping the Future

The ATP also had the unintended consequence of limiting opportunities for women scientists at the NIH. Fauci remembered a recruiting major in the Marines visiting his fourth-year class at Cornell Medical School to remind everyone to put in their preferences of service branch—everyone except the two women out of a class of 88. As only men were subject to the draft, only men were eligible to be selected as associates at the NIH. For some NIH investigators, hiring a woman outside of the ATP meant sending a man into war, so they would only hire men as associates. Associates at NIH were much more likely than their peers to become full professors, department chairs, and deans, as well as to receive major science awards and memberships in honorary societies. Thus, the unofficial male-only policy denied women an equal chance for advancement at a time when they made up a small, but growing, percentage of young physician-scientists.

The research performed by Vietnam-era AAI members during their time in the ATP produced long-lasting and widely used methods, basic science, and clinically relevant papers published in The Journal of Immunology (The JI). Several highly cited manuscripts provided descriptions of lymphokines and growth factors, laying groundwork for the ongoing study of cytokines and chemokines. The two most-cited articles both described assays for chemotactic factors, one for granulocytes and the other for agranulocytes. The function of immunosuppressive cells was discovered in the early 1970s, and The JI published a number of papers concerning suppressor cells, mostly T cells—and one on suppressive macrophages, which has laid the groundwork for today’s research in regulatory T cells, myeloid-derived suppressor cells, and more recently regulatory B cells.

For the associates, the NIH became such an attractive place to conduct research that many took the opportunity to continue their careers there far beyond the two or three years of the associateship, creating a hub for immunology research and training. Former associates have been instrumental in many major developments: long after they were associates, Waldmann and Paul made the NIH an important center for interleukin research; Gallin has used immunotherapy and gene therapy to treat chronic granulomatous disease and led the Clinical Center from 1994 to 2017; and Fauci became a pioneer in AIDS research, headed NIAID from 1984 to 2022, and also led the nation’s response to the COVID-19 pandemic.

The legacy of the Doctor Draft endures to this day. Many of those who participated in the Berry Plan remained in Bethesda and directed the future of the NIH. A cohort of scientists who were given a unique opportunity became leaders and mentors, shaping federal science policy and training new generations of immunologists and future innovators in the field.

 

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References

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• Rich, Robert R. Interview by Brien Williams. AAI Oral History Project, May 11, 2015. The American Association of Immunologists Archive.
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• “123 Young Doctors to Begin Clinical and Research Training Here July 1.” The NIH Record, May 22, 1962.
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