A late “PS” to John who raised the question about “why didn’t they merge (the Marine Hospital System) with the VA”:
As far as the physician manpower squeeze on the PHS Commissioned Corps caused by the end of the draft: the VA system didn’t have that problem for one very important reason. That is because way back in its early years, the VA system forged a very important alliance that insured it a continuing high quality of physician staffing at its major hospitals.
That was the alliance of the major VA medical centers with the medical schools of the country. Just about every major VA Hospital is affiliated (and often physically close) with a University level medical school. The lead people in major positions are granted faculty appointments (even if paid by the VA) insuring high quality people in those posts, and the rank & file physician staff is supplied by fellows, residents and interns training and qualifying under those faculty, with medical students tagging along for their first clinical experiences.
It’s win/win for the VA and the school, which gets a huge expansion of its facilities and abundant clinical material for training. Some individual PHS Marine Hospitals had some limited degree of that kind of arrangement with a few schools, but the “care AND training” model never became central to the MHS system, probably for a number of reasons.
Political considerations and the funding that flows from it was of course completely different, but that perhaps helps explain why the staffing considerations were also quite different.