I came across this 2005 USAF report that places a number on the "stress" level of various USAF medical positions; what an bunch of meaningless numbers these things are. Like the thousand other METRICS the USAF now uses to make it decisions (METRICS replaced common sense about 10 years ago in the USAF), these just go to show you how you can have numbers say anything> You would think that by just completely fabricating numbers, the USAF would be more accurate. Looking at these numbers you would think that FPs are fully manned when in fact most all bases run at about 20-50% on any week.


http://usmilitary.about.com/library/milinfo/blafstressedmedical.htm

I came across this 2005 USAF report that places a number on the "stress" level of various USAF medical positions; what an bunch of meaningless numbers these things are. Like the thousand other METRICS the USAF now uses to make it decisions (METRICS replaced common sense about 10 years ago in the USAF), these just go to show you how you can have numbers say anything> You would think that by just completely fabricating numbers, the USAF would be more accurate. Looking at these numbers you would think that FPs are fully manned when in fact most all bases run at about 20-50% on any week.


http://usmilitary.about.com/library/milinfo/blafstressedmedical.htm

Isn't the AF using civilian contract docs to fill slots? With all the deployments and ETS moves, contractors are pretty much the only thing that's been keeping our primary care clinics open at my MTF.

RMD 315

Isn't the AF using civilian contract docs to fill slots? With all the deployments and ETS moves, contractors are pretty much the only thing that's been keeping our primary care clinics open at my MTF.

RMD 315

About 2-3 years ago,our admin ventured into the "lets hire some civilian docs" mode. Only they did not hire the docs to fill slots; they hired 2 civilian docs so they could enroll more patients to the clinic. So we accepted another 3000+ NEW patients (and guess what types of patients are "waiting at the gait" to get a doc on base...yes, the sickest of the sick on multiple meds..because everything on the base is free), anyways, in the 3 years since our base FP clinic "civilianized" we have had 8 of 9 civ docs quit or get fired. In my clinic we had gone most of the last 15 months missing both civ docs with no replacements. Now we only had 6 providers total so that meant we were down to 4 at most. Then toss in a deployment here and there, leave, and our female mil NP having a baby, then you are down another.
Civ nurses similar situation; every civ nurse has quit (100%).
so,before anyone jumps on the civilian bandwagon they better realize that when you hire civilians, they can jump off (unlike the mil docs).

It is also unmanned at the training facilities as well. I've rotated through Travis (2x), Scott, Eglin and Keesler and they all appear to be needing more people. I haven't seen too many people work on the weekends tho (except for the residents/attendings on call)

They have increased the number of FP slots at Travis to 16, Eglin has 10, Scott as 8-10, Offut has 8, and Andrews has 6 (though it is a sinking ship!)

The non-training facilites are much worse from what I hear. USAFdoc, just curious, which base are you at?

It is also unmanned at the training facilities as well. I've rotated through Travis (2x), Scott, Eglin and Keesler and they all appear to be needing more people. I haven't seen too many people work on the weekends tho (except for the residents/attendings on call)

They have increased the number of FP slots at Travis to 16, Eglin has 10, Scott as 8-10, Offut has 8, and Andrews has 6 (though it is a sinking ship!)

The non-training facilites are much worse from what I hear. USAFdoc, just curious, which base are you at?


I was at a non training facility in the southeast...and beleive me, they are all hurting. We had days where our 6 doc clinic was only manned by a PA.

That list is pretty telling.


Scores well over 1.0 for most every physician and/or clinical billet where the work of taking care of pts actually takes place.

A score of 0.95 for Health Services Administration.

heh.

I'll never understand the detailing system. One of my colleagues got PCS'd early to fill a "hot fill" position. When she got to the new command there was so little demand for her services that the vast majority of appointments when unfilled. Meanwhile our command continued to be short staffed. We saw as many patients in a day as she saw in a week.

They have increased the number of FP slots at Travis to 16, Eglin has 10, Scott as 8-10, Offut has 8, and Andrews has 6 (though it is a sinking ship!)


To clarify, these numbers are for INCOMING residents, ie 16 new FP interns next year. Travis will have 48 FP Residents (!) in a few years

I'll never understand the detailing system. One of my colleagues got PCS'd early to fill a "hot fill" position. When she got to the new command there was so little demand for her services that the vast majority of appointments when unfilled. Meanwhile our command continued to be short staffed. We saw as many patients in a day as she saw in a week.

similar situations in my clinic; we were running on about 20% staffing for nurses and so they hired 2 more nurses, only they gave them NON CLINICAL duties in adminisration! Another good one was when they "let go" the civilian nurse from my PCM team because they wanted to hire a different nurse for less wages. The kickers on this situation were that they did not have a replacement available, and then they rehired the same nurse for a more expensive admin type nursing position that requires less than half the work!


I wish all my colleagues could be where I am now in the civilian world. Compared to what I saw in the USAF this is a dream job in the sea of tranquility. Would I have loved to complete my 20 years in the USAF; absolutely! As bad as that place was being managed it became an absolutely not. And sadly, I still beleive my last base was better than many.

I'd like to second USAFdoc's sentiment that being a civilian (compared to life in the USAF) absolutely rocks! I had no idea until I got out! Maybe the USAF MC/MSC/BSC/NC needs to wake up and smell the (a.roses b.coffee c. dogsh*t, pick one :-)).

Isn't the AF using civilian contract docs to fill slots? With all the deployments and ETS moves, contractors are pretty much the only thing that's been keeping our primary care clinics open at my MTF.

RMD 315

Yes indeed they are. One of my civilian FP friends just took a job as a contract doc at the local AF base. She tells me that there are only 3 uniformed FP's there now, which is way down from back when I was there. Believe it or not, she tells me that she actually enjoys her new job there. But then again, she does not have as much BS to contend with as the military docs.

Yes indeed they are. One of my civilian FP friends just took a job as a contract doc at the local AF base. She tells me that there are only 3 uniformed FP's there now, which is way down from back when I was there. Believe it or not, she tells me that she actually enjoys her new job there. But then again, she does not have as much BS to contend with as the military docs.

If you work as a CIVILIAN at the military clinic, you at least weild the power to leave if admin decides they are willing to run a clinic poorly. That power to leave will force improvment, eventually.

A problem with partially civilianizing the clinic is that it leaves fewer and fewer military docs to do the military duties. At my last base, we started with 4 mil FP's and 4 mil extenders in 2002. By summer of 2005 there was 1 mil FP left, 2 mil extenders, and 2 civ docs (new ones). Also, as noted in some long ago thread, we had 8 of 9 civilian docs quit after being there between 1-12 months. Every civ nurse that worked there in 2002 had quit by 2004.

And to end with a quote from a previous clinic Squadron Commander (a nurse of course)....
" If the docs want to get out, let 'em, ...good ridence!"

If you work as a CIVILIAN at the military clinic, you at least weild the power to leave if admin decides they are willing to run a clinic poorly. That power to leave will force improvment, eventually.

A problem with partially civilianizing the clinic is that it leaves fewer and fewer military docs to do the military duties. At my last base, we started with 4 mil FP's and 4 mil extenders in 2002. By summer of 2005 there was 1 mil FP left, 2 mil extenders, and 2 civ docs (new ones). Also, as noted in some long ago thread, we had 8 of 9 civilian docs quit after being there between 1-12 months. Every civ nurse that worked there in 2002 had quit by 2004.

And to end with a quote from a previous clinic Squadron Commander (a nurse of course)....
" If the docs want to get out, let 'em, ...good ridence!"

Knowing how much of a mess it is, I am not a bit surprised. It will be interesting to discuss this more privately.

Out of curiosity, was the commanding officer a physician or other?? And, good or bad leader. I think bad leadership can break the spirit and the back of any command, regardless of the quality of people behind him. Island doc and usaf doc could have busted their back trying to fix the problems, but without CO support, it is near impossible and a waste of time.

The "best" senior military physicians that I have run across in the navy often have more operational time/less desk than their peers. They know their officers and sailors. Usually very visible and not hiding behind their secretary. Our 2 star admiral would be down urinating with the E-1s for the random drug urinalysis when his number was called (with head of the line priviledges).

Prior line officers/enlisted personnel gone physician that are terminal O-5s (before hitting 20 years) and have no desire for O-6/flag often do what they see as best for the command/department/sailor and handle junior/senior officers and enlisted better than others. Not all people are born with leadership skills. The years junior officers acquire these skills are bypassed while in medical school by doing to O-1 to O-3 jump coming onto active duty.

I know one navy physician that was commissioned as an O-5! Rank of someone with 16+ years of service, but couldn't lead a cop to a donut shop. Put someone like that in charge of a clinic and I see major problems.

I'm always glad to see our ex-military physicians doing well, as well will all be there one day in private practice, some much sooner than others.

Out of curiosity, was the commanding officer a physician or other?? And, good or bad leader. I think bad leadership can break the spirit and the back of any command, regardless of the quality of people behind him. Island doc and usaf doc could have busted their back trying to fix the problems, but without CO support, it is near impossible and a waste of time.

The "best" senior military physicians that I have run across in the navy often have more operational time/less desk than their peers. They know their officers and sailors. Usually very visible and not hiding behind their secretary. Our 2 star admiral would be down urinating with the E-1s for the random drug urinalysis when his number was called (with head of the line priviledges).

Prior line officers/enlisted personnel gone physician that are terminal O-5s (before hitting 20 years) and have no desire for O-6/flag often do what they see as best for the command/department/sailor and handle junior/senior officers and enlisted better than others. Not all people are born with leadership skills. The years junior officers acquire these skills are bypassed while in medical school by doing to O-1 to O-3 jump coming onto active duty.

I know one navy physician that was commissioned as an O-5! Rank of someone with 16+ years of service, but couldn't lead a cop to a donut shop. Put someone like that in charge of a clinic and I see major problems.

I'm always glad to see our ex-military physicians doing well, as well will all be there one day in private practice, some much sooner than others.

The Medical commanders were docs that did not see patients anymore. They were nice guys but I would not call them outstanding leaders or managers of the clinic. As a physicians, I should not have to rely on the having to have an excellent top notch commander just to be able to survive. The system needs to at least give a doc the OPPORTUNITY for success if he/she is willing to work hard. The docs I worked with busted thier butt 12+ hrs a day 300 + hours a month....and we had NO CHANCE.

Our CO took the flak for disenrolling patients from our hospital and sending them out in town for their needs. The FP department was at critical mass and adding new patients would have caused a situation like you described. Our physicians brought their problems to the department head, took it up the chain and the CO, though he didn't like to turn people away did so. It resulted in shorter waits for the patients and a staff that was not worked beyond a reasonable work week. We turned away active duty family members whose spouse was >E-5 for a while. The assumption was that they should be old/mature enough to fend for themselves in the civilian health care system.

You are correct to state in another post that you can't compare navy to air force clinics. Or even, different clinics in the same service. Everyone has a different experience with military medicine. It is the luck of the orders/specialty/civilian staffing/etc.....I hope we have senior people in the future who want to change it for the better, and not to change things in order to get a set of stars.

I recall a point where we were down 3 of our 6 providers, 2 gone 1 year, the other 2 months (pregnancy) and our command was still enrolling new patients on top of what we had.

I'd be disgruntled as all hell as well. With that kind of command environment, I wouldn't expect you to have had a good experience. The cards were definitely stacked against you.

another "good one"was when they hired a physiatrist MD to be a "sick call" doc, and then at the last minute made that doc the permanent replacement doc for our last IM doc who left (we closed the IM clinic and the FP clinic "absorbed" it).
The physiatrist was a nice person but no where near ready to assume a IM clinic. "Bad stuff" soon ensued; and the Mil docs were then left covering her patients when she was "dismissed", which then led to law suits etc. Lots of stories like this one from this base.