After reading posts recently submitted by a GMO ("GMO 2003"), it is apparent that the military continues to access and utilize general medical officers (GMO's).

My understanding was that back in 1999 Congress had enacted legislation (as part of a defense appropriations bill) which directs the military services to discontinue GMO's over the next six years, so that by FY06 all military physicians were to be BE/BC. This was behind the AF policy to prohibit GMO's from serving beyond their ADSC.

The accession and utilization of GMO's is an archaic practice. The US Military is the only employer that I know of which does not require board eligibility or certification. Why I do not know. The practice of employing GMO's is a throwback to the early days of modern medicine. This is just one more area in which the military healthcare system has not kept pace.

FYI, my own personal experience as a former AF GMO is a bit bizarre. In 1997, the AF had a policy which stated that no transitional intern was allowed to complete residency training. (This due to the "needs of the AF" for GMO's.) Yet four years later, a new policy was created which involuntarily separated GMO's (because GMO's were supposedly no longer wanted), which made me eligibe for sep pay. ( I wanted out anyway.) What I do not understand is that the AF, and other services apparently continues to utilize GMO's as both primary care physicians and flight surgeons. It is actually quite shocking that the US military has entrusted the health and well-being of it's most valuable human resources: it's pilots, to the least trained and least experienced physicians. This makes no sense at all. Anyone know why?

It's a money thing. GMO's don't get specialty bonuses. GMO's are less expensive than family practice physicians for example. This is comparible to paying a nurse practioner to see patients instead of a physician.

It's a money thing. GMO's don't get specialty bonuses. GMO's are less expensive than family practice physicians for example. This is comparible to paying a nurse practioner to see patients instead of a physician.

It is a dirty trick to play with a physician to force them to become a GMO with insufficient education and training to do the job, (the current model for medical education is focused toward seamless completion of residency) simply to save money. In the end, it is the patients who suffer the most, but I don't think that military admin/leadership care about the patients. They just care about money, metrics, and their next promotion.

I share some of your sentiments. I think the "dirty trick" part results when the recruiter tells the prospective medical student that they can have their choice of specialty. Does anyone know the history of the GMO? I wonder if it extends back to WWII for example.

I think this is due to the misinterpretation by the various services' regarding what type of work their GME graduates might want to do. For instance, I WANT to do operational medicine (FSO or UMO) in the Navy, but would like to get a residency (leaning toward IM or EM at this point) done first. Honestly, if I wanted to do "routine" (i.e., non operational medicine) it would be more beneficial to me to go civilian. Operational medicine is WHY folks get into the military in the first place, isn't it? How many civilian FP/IM/EM/etc docs get to fly fighters or freefall or do "extreme" diving on a regular basis? I think the services ought to consider this. Yes, it may cost them more in ISP/MSP, but it will give them better qualified and better motivated physicians and operational medicine would improve overall. Just my take on things FWIW.

I think this is due to the misinterpretation by the various services' regarding what type of work their GME graduates might want to do. For instance, I WANT to do operational medicine (FSO or UMO) in the Navy, but would like to get a residency (leaning toward IM or EM at this point) done first. Honestly, if I wanted to do "routine" (i.e., non operational medicine) it would be more beneficial to me to go civilian. Operational medicine is WHY folks get into the military in the first place, isn't it? How many civilian FP/IM/EM/etc docs get to fly fighters or freefall or do "extreme" diving on a regular basis? I think the services ought to consider this. Yes, it may cost them more in ISP/MSP, but it will give them better qualified and better motivated physicians and operational medicine would improve overall. Just my take on things FWIW.

With the current Navy medicine model, a BCP would be under-utilized as a Flight Surgeon or UMO. I guarantee your skills and knowledge would diminish as you saw URI's, VGE's, and simple ortho/psyche issues day in and day out. Your patient population would be healthy 18-30 year olds with relatively no medical problems. Granted, there are those "holy crap" moments where you would see genuine trauma, but those are relatively few and far between, and given your resources in a forward deployed unit, there's little you can do, but stabilize until they reach the next eschelon of care.

In addition, given your rank after board certification, you would likely be appointed an administrative supervisory role. Don't get me wrong. This is not always a bad thing. I know some BCP's who tired of clinic life and came over as MAG/FSSG/DIV/WING Surgeons and are enjoying shifting papers from one side of their desk to the other.

Just my two cents......

I think this is due to the misinterpretation by the various services' regarding what type of work their GME graduates might want to do. For instance, I WANT to do operational medicine (FSO or UMO) in the Navy, but would like to get a residency (leaning toward IM or EM at this point) done first. Honestly, if I wanted to do "routine" (i.e., non operational medicine) it would be more beneficial to me to go civilian. Operational medicine is WHY folks get into the military in the first place, isn't it? How many civilian FP/IM/EM/etc docs get to fly fighters or freefall or do "extreme" diving on a regular basis? I think the services ought to consider this. Yes, it may cost them more in ISP/MSP, but it will give them better qualified and better motivated physicians and operational medicine would improve overall. Just my take on things FWIW.


What is your concept of Operational Medicine? I suspect it is very different from what you think it is.

With the current Navy medicine model, a BCP would be under-utilized as a Flight Surgeon or UMO. I guarantee your skills and knowledge would diminish as you saw URI's, VGE's, and simple ortho/psyche issues day in and day out. Your patient population would be healthy 18-30 year olds with relatively no medical problems. Granted, there are those "holy crap" moments where you would see genuine trauma, but those are relatively few and far between, and given your resources in a forward deployed unit, there's little you can do, but stabilize until they reach the next eschelon of care.

In addition, given your rank after board certification, you would likely be appointed an administrative supervisory role. Don't get me wrong. This is not always a bad thing. I know some BCP's who tired of clinic life and came over as MAG/FSSG/DIV/WING Surgeons and are enjoying shifting papers from one side of their desk to the other.

Just my two cents......

What is the point in going to medical school and residency if one does not wish to practice medicine?? (Become a "paper shifter") Seems like a waste of education.

This is a good question to raise and seems to be applicable to any clinician who moves into administrative work, and leadership in general. The question of why we need leadership may help answer this. Essentially, it seems, leaders are needed to get things done that otherwise would go untended.
Sure, a small sliver of "paper shifters" who are docs may have had that in mind when pursuing their medical education and, thus, in the eyes of some are wasting their education. Most, I would submit, find themselves drawn to such responsibilities well after their formal education is over. Furthermore, a "paper shifter" with greater technical competence than one without should be able to provide a better service to those she leads. Much has been made in other threads on this forum of non-clinical "paper shifters" weilding too much influence on the practitioners. One way to address this may be to encourage clinicians to act beyond the scope of their medical training as paper shifters in order to better serve the practitioners. These are my thoughts and I'm interested to hear your take on things.

What is your concept of Operational Medicine? I suspect it is very different from what you think it is.
I've been operational and XMilMD question is valid. I didn't know of too many who got to do any of the high speed stuff previously mentioned.

The only difference between "operational" medicine and not is the uniform you're wearing and wear you end up sleeping for the night. If stateside you go home, onboard ship then.....onboard the ship, if wearing greens then in a tent somewhere. That has been the only difference. Sure there is the potential of doing some things you probably couldn't otherwise but civilians have shooting ranges, skydiving clubs, scuba clubs.......with the extreee you make as a civilian you can afford to pay for all the "high speed, low drag" stuff and go home and sleep in your own bed...... :cool:

This is a good question to raise and seems to be applicable to any clinician who moves into administrative work, and leadership in general. The question of why we need leadership may help answer this. Essentially, it seems, leaders are needed to get things done that otherwise would go untended.
Sure, a small sliver of "paper shifters" who are docs may have had that in mind when pursuing their medical education and, thus, in the eyes of some are wasting their education. Most, I would submit, find themselves drawn to such responsibilities well after their formal education is over. Furthermore, a "paper shifter" with greater technical competence than one without should be able to provide a better service to those she leads. Much has been made in other threads on this forum of non-clinical "paper shifters" weilding too much influence on the practitioners. One way to address this may be to encourage clinicians to act beyond the scope of their medical training as paper shifters in order to better serve the practitioners. These are my thoughts and I'm interested to hear your take on things.

Military vs Civilian comparision

Tons (literally) of clipboard cowmanders (not small sliver) VS financially dicated number of admin..meaning you have enough to do the work.

clinically inept goes into admin VS hired admin who listens to clinician

Those who go into admin has no clue but will be promoted because they are admin VS. Admin exists to serve clinicans...help with work.

This is a good question to raise and seems to be applicable to any clinician who moves into administrative work, and leadership in general. The question of why we need leadership may help answer this. Essentially, it seems, leaders are needed to get things done that otherwise would go untended.
Sure, a small sliver of "paper shifters" who are docs may have had that in mind when pursuing their medical education and, thus, in the eyes of some are wasting their education. Most, I would submit, find themselves drawn to such responsibilities well after their formal education is over. Furthermore, a "paper shifter" with greater technical competence than one without should be able to provide a better service to those she leads. Much has been made in other threads on this forum of non-clinical "paper shifters" weilding too much influence on the practitioners. One way to address this may be to encourage clinicians to act beyond the scope of their medical training as paper shifters in order to better serve the practitioners. These are my thoughts and I'm interested to hear your take on things.

a prime responsibility of a leader is to enable those they lead to succeed.
Todays leaders in the USAF (primary care anyways) are not about having the docs succeed, they are about metrics, numbers, promotions, and they have very little concern about "the docs". To quote my last Commander "If the docs want to get out, let em, who needs em". At my last base, every single doc for 10-15 years have separated from active duty after being stationed there. For 2 years, there was ZERO family docs in my whole chain of command (lots of nurses, an ENT doc and a surgeon). These people had little to no idea on how to run a fam med clinic, let alone how to run one that was 20% manned and sinking.

As stated previously in other threads; things are going to get worse because we have a flawed medical system design in terms of admin, manning, and infrastructure that is now being placed under financial stresses that it cannot support.

A truly great leader would be hard pressed in these times; an average or poor leader has no chance, as do those they lead.

Military vs Civilian comparision

Tons (literally) of clipboard cowmanders (not small sliver) VS financially dicated number of admin..meaning you have enough to do the work.

clinically inept goes into admin VS hired admin who listens to clinician

Those who go into admin has no clue but will be promoted because they are admin VS. Admin exists to serve clinicans...help with work.

I apologize for the misunderstanding,

For the first comparison, by sliver, I am referring to a subset of those who end up in admin, not the total number in admin.

For the second comparison, the "listens to clinician" factor is merely a better leadership characteristic independent of one's clinical ability. Also, I believe I noted that other things being equal (i.e. leadership ability) it is better to have a leader with technical, or clinical, knowledge. I think you agree with me that a very competent doc can be a poor leader. Is the opposite also possible: an inept doc making a better leader? I suppose the question comes down to how much one is willing to distinguish between technical competence and quality of leadership.

For the third comparison, the flipant promotion of those 'with no clue' may explain a portion, if however big, but likely does not explain all of the situation. I suspect you and USAFdoc would agree, incentives for promotion at this level are not properly aligned with creating value (quality & efficiency), or that value is imprecisely measured. Edit: that should read inaccurately measured.

the only people in the Army who serve as GMO's anymore are those that for whatever reason chose to (we had an intern leave us and be a GMO to be with her husband overseas). The Navy is the only service that still heavily relies on them.

The GMO alone is a reason not to join Navy HPSP IMO, lol.

--your friendly neighborhood landlubbing caveman

I apologize for the misunderstanding,

For the first comparison, by sliver, I am referring to a subset of those who end up in admin, not the total number in admin.

For the second comparison, the "listens to clinician" factor is merely a better leadership characteristic independent of one's clinical ability. Also, I believe I noted that other things being equal (i.e. leadership ability) it is better to have a leader with technical, or clinical, knowledge. I think you agree with me that a very competent doc can be a poor leader. Is the opposite also possible: an inept doc making a better leader? I suppose the question comes down to how much one is willing to distinguish between technical competence and quality of leadership.

For the third comparison, the flipant promotion of those 'with no clue' may explain a portion, if however big, but likely does not explain all of the situation. I suspect you and USAFdoc would agree, incentives for promotion at this level are not properly aligned with creating value (quality & efficiency), or that value is imprecisely measured.

Yes, you are correct on almost all counts.

However, I disagree on those with leadership skills. Most of the good leaders were also good at what their original jobs were.

Now that I'm a civiian, I also find that those who are good at their clinical jobs are also the ones who become good managers...because they know what is important.....however, most of the docs and nurses who are good at their clinical jobs....want to continue doing their clinical jobs...and usually has distaste for management.

the only people in the Army who serve as GMO's anymore are those that for whatever reason chose to (we had an intern leave us and be a GMO to be with her husband overseas). The Navy is the only service that still heavily relies on them.

The GMO alone is a reason not to join Navy HPSP IMO, lol.

--your friendly neighborhood landlubbing caveman

I believe you just get to be a GMO after reisdency....so you either do it before or after residency...what's the dif?

I believe you just get to be a GMO after reisdency....so you either do it before or after residency...what's the dif?

finishing your residency. i'm not sure about everyone else, but i'd hate to do an internship, leave for a 3y GMO tour, then not have a residency spot waiting on me when i came back (which is always up in the air with the Navy). Then you have to hope a civilian program will take you in, or train in something they do have available. . . or serve out your commitment as a GMO. any of those scenarios leaves too much to chance for my tastes.

--your friendly neighborhood play it safe caveman

finishing your residency. i'm not sure about everyone else, but i'd hate to do an internship, leave for a 3y GMO tour, then not have a residency spot waiting on me when i came back (which is always up in the air with the Navy). Then you have to hope a civilian program will take you in, or train in something they do have available. . . or serve out your commitment as a GMO. any of those scenarios leaves too much to chance for my tastes.

--your friendly neighborhood play it safe caveman

That's exactly what happened to me. It was during my internship when I was notified that I was to enter service as a USAF ER GMO. After two years as a GMO I applied for Surg residency, and was rejected. The following year I applied for EM residency and was again rejected. I was not selected to train in EM which is what I was doing as a GMO! (I was never informed as to why I was rejected either time.) Looking back, the fact that someone with only one year of postgraduate training was forced to work as a solo emergency department physician, was totally insane. By this time, I was so fed up with the military, that I just wanted to get the _____ out.

Going back to civilian residency after four years as a military GMO was not easy. For one thing, the competitive specialties/programs were out of the question, because I was an unknown subject to the program directors. Furthermore, I could clearly see how I had stagnated clinically during those four years, especially when it came to inpatient care.

I have already been referred to as a "troll" in this forum, when it comes to the military. This is why.

What is your concept of Operational Medicine? I suspect it is very different from what you think it is.

Well, I spent 11 yrs in the USAF, 6 of that in the Biomedical Science Corps working in the MDG. Granted, I know diddly about NAVY medicine (long story about why I'm going USN vs. USAF, PM me if you want details). But, I DO know, I would be granted opportunities to do things I would NEVER be able to do in the civilian world.

That's exactly what happened to me. It was during my internship when I was notified that I was to enter service as a USAF ER GMO. After two years as a GMO I applied for Surg residency, and was rejected. The following year I applied for EM residency and was again rejected. I was not selected to train in EM which is what I was doing as a GMO! (I was never informed as to why I was rejected either time.) Looking back, the fact that someone with only one year of postgraduate training was forced to work as a solo emergency department physician, was totally insane. By this time, I was so fed up with the military, that I just wanted to get the _____ out.

Going back to civilian residency after four years as a military GMO was not easy. For one thing, the competitive specialties/programs were out of the question, because I was an unknown subject to the program directors. Furthermore, I could clearly see how I had stagnated clinically during those four years, especially when it came to inpatient care.

I have already been referred to as a "troll" in this forum, when it comes to the military. This is why.

FWIW, I sympathize, bro. USAF decisions regarding the medical corps are absolutely assinine sometimes! Read some of my past posts and you'll understand where I'm coming from...(e.g., "BOHICA Rings True...") That is probably why I'm Navy bound!

FWIW, I sympathize, bro. USAF decisions regarding the medical corps are absolutely assinine sometimes! Read some of my past posts and you'll understand where I'm coming from...(e.g., "BOHICA Rings True...") That is probably why I'm Navy bound!

Well, sounds as though I am not the only one with residual anal dilation :scared: after my USAF MC experiences.

Well, I spent 11 yrs in the USAF, 6 of that in the Biomedical Science Corps working in the MDG. Granted, I know diddly about NAVY medicine (long story about why I'm going USN vs. USAF, PM me if you want details). But, I DO know, I would be granted opportunities to do things I would NEVER be able to do in the civilian world.

I can't speak for GMO's/UMO's, but as a Naval Flight Surgeon, you will have many opportunities to do very cool stuff. Water survival, parachute, and flight training just to name a few. I've flown in Hornet's, SuperCobra's, Huey's, and SeaStallion's, and been at the controls of all three. I'm a horrible stick, but's it's a great experience. The Airforce and Army do have FS programs obviously, but as far as I know, none of them include specific hands on flight training. It's been a great experience for me and I'm very glad I went Navy instead of the other branches. A good friend and classmate of mine who was Army HPSP will be finishing his HEM/ONC fellowship next year, and there's a chance he'll be sent to Iraq in a GMO capacity. That's ridiculous and a waste of resources. How much knowledge and skills will he lose seeing sickcall for 6-12 months?

Please don't misunderstand, you will deal with bureaucratic BS daily, but not nearly as much as the other services from what I see on this fourm. I'm not trying to start a "Navy vs Army vs Airforce" argument, but like I said, I feel fortunate to have chosen the Navy HPSP program, and would have still done it all again given what I know now.

I can't speak for GMO's/UMO's, but as a Naval Flight Surgeon, you will have many opportunities to do very cool stuff. Water survival, parachute, and flight training just to name a few. I've flown in Hornet's, SuperCobra's, Huey's, and SeaStallion's, and been at the controls of all three. I'm a horrible stick, but's it's a great experience. The Airforce and Army do have FS programs obviously, but as far as I know, none of them include specific hands on flight training. It's been a great experience for me and I'm very glad I went Navy instead of the other branches. A good friend and classmate of mine who was Army HPSP will be finishing his HEM/ONC fellowship next year, and there's a chance he'll be sent to Iraq in a GMO capacity. That's ridiculous and a waste of resources. How much knowledge and skills will he lose seeing sickcall for 6-12 months?

Please don't misunderstand, you will deal with bureaucratic BS daily, but not nearly as much as the other services from what I see on this fourm. I'm not trying to start a "Navy vs Army vs Airforce" argument, but like I said, I feel fortunate to have chosen the Navy HPSP program, and would have still done it all again given what I know now.

Sounds like flight "surgery" (a misnomer), may be a "gee whiz", thing for a doc, but this still does not explain why military pilots and their families do not deserve a fully trained, BC/BE physician. Can someone please explain to me why civilian professional commercial pilots receive their healthcare from BC/BE physicians, but military pilots do not, when military pilots are working in a more hazardous (combat) environment. This still makes no sense.

Sounds like flight "surgery" (a misnomer), may be a "gee whiz", thing for a doc, but this still does not explain why military pilots and their families do not deserve a fully trained, BC/BE physician. Can someone please explain to me why civilian professional commercial pilots receive their healthcare from BC/BE physicians, but military pilots do not, when military pilots are working in a more hazardous (combat) environment. This still makes no sense.

Well... I can't justify it. It doesn't really seem like a good choice to me, but I can understand it.

We're so heavily filtered for health conditions and most of us are at a young enough age, where there is very little health care required. Seriously, I could now handle 99% of my own medical care. I'd prescribe entex for congestion, motrin for any pain, and send me on my way with a week DNIF. Come back when you feel better.

Sounds like flight "surgery" (a misnomer), may be a "gee whiz", thing for a doc, but this still does not explain why military pilots and their families do not deserve a fully trained, BC/BE physician. Can someone please explain to me why civilian professional commercial pilots receive their healthcare from BC/BE physicians, but military pilots do not, when military pilots are working in a more hazardous (combat) environment. This still makes no sense.

island doc,

No offense, but you really don't understand how flight "surgery" works in the Navy. We definitely do not see dependents. Our population is very healthy, and if any medical problems arise beyond simple URI's/VGE/Ortho/etc, our pilots and aircrew require aeromedical waivers which require them to see specialists. While in garrison, our squadrons have access to the full complement of Navy specialists. If a pilot has HTN, he has to see an internist for a full workup. If an aircrew member has palpitations, he must see a cardiologist for an Echo, ETT, and Holter. If a squadron member has a suspicious skin lesion they must see a dermatologist, etc, etc...Healthcare for aircrew is more scrutinized than any other MOS in the Navy, and most of the waivers require annual review by a specialist as well.

I wonder if your practice relies on PA's, NP's or the like. We function the same way albeit with more training. I look at my job as triage and administrative more than anything else. As far as treatment within a combat environment, I admit I'd be nervous to throw in a chest tube or perform a pericardiocentesis, but I'm ATLS and OEMS certified so I hope I have some idea what I'm doing. Also, you have to realize that if you're forward deployed, you don't always have much specialized equipment beyond IV's and turniquets. To be perfectly honest though, besides emergency medicine and trauma/general sugery trained physicians, how much legitimate trauma do most physicians see? How much do you see in your practice? I'll bet those patients likely go to the ED first.

There are good and bad GMO's, just like there are good and bad FP's (I think that's your specialty). The GMO's know their own capabilities and when to refer. If you think the two extra years of training you recieved over my one year of Internal Medicine interniship (which included OB/GYN and Ortho) makes you better at triage and admin, that's your opinion, but there are very few GMO's I know who I wouldn't trust seeing sickcall each day. Don't misunderstand though, there is NO WAY I am comparing my skills to yours as a BCP (I often refer to specialists for ongoing care of issues that you would likely feel very comfortable treating) , I'm just saying I feel that military pilots and aircrew are in no way getting the "short end of the stick" when it comes to health care. Sorry for the rant....the bad weather always puts me in a feisty mood. :)

I respect your opinion. While I admit that I am ignorant as to how flight medicine works in the Navy (or the AF for that matter since I was not a FS), I can tell you that while I was an Emergency Medicine GMO in the AF I was often called upon to treat pilots and their dependents with all types of acute life threatening problems. Looking back, I was in no way adequately prepared to do so fresh out of a transitional year.

In answer to your questions, yes in the Urgent and Primary care environment in which we work we do utilize ARNP's, but not PA's. The NP's are closely supervised and come with the right mix of experience. We do not use PA's because we do not consider them as well prepared for this type of work.

We do see alot of trauma, but not major multi-system trauma, as those patients are generally not ambulatory. Although, in the last Urgent Care Center in which I worked, I did have a patient hobble in after a motorcycle accident with a comminuted acetabular hip fracture. Unbelievable! Just last week I had a patient walk in here with a serious chain saw wound to the hand requiring synthetic tendon replacement. (By ortho of course.)

With all due respect, this still does not answer my question of why civilian professional pilots receive their healthcare from fully trained physicians and military pilots do not. Perhaps the answer to this question comes down to the relevancy of residency training to the practice of modern medicine. Which leads in to another important question: Why is it the standard of care for civilian physicians to be residency trained, yet not for the military. For example, civilian facilities will not credential a physician who is not at least board eligible.

I respect your opinion. While I admit that I am ignorant as to how flight medicine works in the Navy (or the AF for that matter since I was not a FS), I can tell you that while I was an Emergency Medicine GMO in the AF I was often called upon to treat pilots and their dependents with all types of acute life threatening problems. Looking back, I was in no way adequately prepared to do so fresh out of a transitional year.

In answer to your questions, yes in the Urgent and Primary care environment in which we work we do utilize ARNP's, but not PA's. The NP's are closely supervised and come with the right mix of experience. We do not use PA's because we do not consider them as well prepared for this type of work.

We do see alot of trauma, but not major multi-system trauma, as those patients are generally not ambulatory. Although, in the last Urgent Care Center in which I worked, I did have a patient hobble in after a motorcycle accident with a comminuted acetabular hip fracture. Unbelievable! Just last week I had a patient walk in here with a serious chain saw wound to the hand requiring synthetic tendon replacement. (By ortho of course.)

With all due respect, this still does not answer my question of why civilian professional pilots receive their healthcare from fully trained physicians and military pilots do not. Perhaps the answer to this question comes down to the relevancy of residency training to the practice of modern medicine. Which leads in to another important question: Why is it the standard of care for civilian physicians to be residency trained, yet not for the military. For example, civilian facilities will not credential a physician who is not at least board eligible.


I'm on board with what your saying. Most states only require an internship and successful completion of all three USMLE or COMPLEX exams for licensure. So I'm sure there are civillian physicians running around out there practing medicine without having completed a residency. That being said, I fully plan on residency training next year after completing my final tour.

I think I tried to answer your question however regarding military pilots and aircrew. I simply feel there is little need for a BCP for an initial patient encounter/triage situation. Just like your NP's going to you for advice, we do the same with our specialists. I likely place at least one consult, or call at least one specialist for advice daily. (I only see 7-10 patients/day most days when we're not busy.)

I respect your opinion as well. You've given some good points for potential HPSP scholarship recipients to think about.

Alright! That's all I've got on that topic, I've got to stop surfing the internet and get back to the mountain of paperwork on my desk.

Any other opinions out there? What think ye?

The Questions:

Just exactly what is the educational standard today for physicians prior to the practice of medicine? (Given the fact that one can still be licensed with only one year of GME. Do the State Medical Boards set the standard, or does the profession itself?)

How many of your civilian classmates chose not to complete residency training and entered into aerospace, undersea, primary care or emergency medical practice instead?

Hypothetically speaking, would you feel completely comfortable knowing that the Captain of the commercial airliner you and your family are flying in is being cared for at home by a physician with only one year of GME? Should his or her "gatekeeper" be residency trained or not?

P.S. For those of you who may be thinking that I am just having a lazy time here on the Island today with nothing more to do than create these posts, I am home sick this week with pneumonia. I became a patient :eek: ! Sudden onset of fever 104F, cough, headache, generalized weakness, etc. Felt like a piece of ______. ER visit in the wee hours of Tues morning: RUL infiltrate. I am glad my ER doc was not a GMO!! Thank Heaven for Levaquin.

I apologize for the misunderstanding,

For the first comparison, by sliver, I am referring to a subset of those who end up in admin, not the total number in admin.

For the second comparison, the "listens to clinician" factor is merely a better leadership characteristic independent of one's clinical ability. Also, I believe I noted that other things being equal (i.e. leadership ability) it is better to have a leader with technical, or clinical, knowledge. I think you agree with me that a very competent doc can be a poor leader. Is the opposite also possible: an inept doc making a better leader? I suppose the question comes down to how much one is willing to distinguish between technical competence and quality of leadership.

For the third comparison, the flipant promotion of those 'with no clue' may explain a portion, if however big, but likely does not explain all of the situation. I suspect you and USAFdoc would agree, incentives for promotion at this level are not properly aligned with creating value (quality & efficiency), or that value is imprecisely measured. Edit: that should read inaccurately measured.

I think you and I are on about the same page here,or at least in the same chapter.
The 6 various "medical commanders" I worked under the last few years had this in common:
1). vast majority nurses
2). vast majority smart, intelligent
3) frequent turnover of command positions (every 2 yr,sometimes q 2-6mo)
4). 50% had NO experience in the job
5) 80% asked no input from physicians and the same 80% ignored all offerred input.
6) 100% of them had priorities in line with the surgeon general (access,metrics, $$$$).
7) Rarely did commanders speak of,or attempt to implement procedures to improve quality. (also in line with SG priorities which are void on this as well).
8) 100% not performing any clinical duties, or very ,very rarely doing so.
9) 100% admitting (only behind closed doors) that the system is broken.
10) 100% showing leadership and decision making improvement over their 2 mo- 2 year stint as commanders; but then time to change leadership again.

I do not hold the commanders I worked under responsible for the poor way USAF primary care is running. I ultimately hold the surg general resposible for a plan which includes running clinics at 20% manning with more PAs than docs,all novice docs, novice techs and nurses, commanders leading clinics that are not in their specialty, TRICARE as a vastly INFERIOR insurance program, publically stating priorities void of any mention of improving clinic quality, managing nearly 100% by metrics, using metrics numbers that are well known to be highly inaccurate, ignoring the across the board recommendations of clinic docs to fix the system,for wasting tax payer money on a 9.6 BILLION $$$ pseudo-electronic med health record system (CHCSII), for repeatedly lying to the public about the status of our health care system (Congress told that FP's are 100% manned and retention higher than ever ...40%) and the list goes on.

As stated in an earlier thread; 90% of Commanders given the job to run a clinic under the above circumstances, and faced with ever growing financial restrictions and manning deficits,are going fail, and fail those they lead.

The SG is manning the helm of a sinking ship; obviously with his eyes closed.

An officer I met that worked with the SG stated it this way. Remember the story about the emperor that had no clothes on? That the situation with our SG. He beleives that everything is ok,while everyone aroung him realizes he's butt naked". (ie the systm is broke).
8)

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With all due respect, this still does not answer my question of why civilian professional pilots receive their healthcare from fully trained physicians and military pilots do not. >>

As previously stated, if a military pilot need specialized care from a specialist, it's available. Routine primary care is given by flight docs.

For civilian pilots, they get their care from what ever -ologist they choose, but their "blessing" for physical qualification for flight status comes from an FAA medical examiner, many of whom are former military flight surgeons. In order to become an FAA examiner without prior military experience, one has to have the requisite equipment (most of which isn't used every day in any practice), as well as get permission from the FAA to take their 3 day (yes - 72 hour) course in Kansas City. No other "specialty" training required, other than a current medical license. Some have residency training, some don't.

It's a little bit of a scam in that the FAA controls how many examiners there are in a given area, there by controlling the "supply" in a market. Military examiners aren't allowed to see any civillian aviators, and hence not "allowed" to charge their military patients money. Some will tell their patients that they have to buy pizza for the corpsmen that operate the antiquated equipment and type out (ouch!) the fourms. Other bubbas have asked that their patients donate into the Marine Corps Ball fund or MWR fund at their squadron. For civillian doc's who can get it, it's a cash cow, as the malpractice cost is minimal (or so I've heard) and the price is not regulated by the FAA. I think it's somewhere on the order of $75 to $100 where I live, but I don't know for sure.

Check it out if you want more info - http://www.faa.gov/other_visit/aviation_industry/designees_delegations/designee_types/ame/ametraining/

Trix

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With all due respect, this still does not answer my question of why civilian professional pilots receive their healthcare from fully trained physicians and military pilots do not. >>


The answer is that military pilots receive healthcare from properly trained physicians. I can only speak for the Navy side of the house. Navy Flight Surgeons go through a special 6-9 month training program in order to gain qualifications to work with the pilots. During the training they get flight time, training in aerodynamics and receive instruction on issues surrounding aerospace medicine that civilian trained physicians do not receive.

My friend was a flight surgeon. Most of the stuff he did was basic primary care with duty status determination and other administrative tasks. He also acted as a gateway to higher levels of care. You don't need a specialist for that.

That's exactly what happened to me. It was during my internship when I was notified that I was to enter service as a USAF ER GMO. After two years as a GMO I applied for Surg residency, and was rejected. The following year I applied for EM residency and was again rejected. I was not selected to train in EM which is what I was doing as a GMO! (I was never informed as to why I was rejected either time.) Looking back, the fact that someone with only one year of postgraduate training was forced to work as a solo emergency department physician, was totally insane. By this time, I was so fed up with the military, that I just wanted to get the _____ out.


In the Navy, each GME candidate is given a point total. They are ranked and the spots are given to the candidates with the most points. The system is set up so those who have completed a GMO tour get the largest number of points. Most of the time a GMO tour is considered a trump card.

Navy dermatology and radiology can be very competitive. For example you might have to complete two GMO tours in order to get enough points to get the position. Do you have any idea why you got turned down twice? Did you interview with each program and/or rotate through the service? Did you establish any kind of relationship with the program directors? My friend who was a flight surgeon took a month TAD and rotated at least a week at each hospital he wanted to apply to.

I had another friend who got placed on limited duty for a medical condition after internship. She was extended at the MTF and basically completed a 2-3 year GMO tour. She applied for a GME position but was turned down. She applied again the next year and got a full time outservice residency position for a super competitive specialty.

I'm really puzzled by your scenario.

In the Navy, each GME candidate is given a point total. They are ranked and the spots are given to the candidates with the most points. The system is set up so those who have completed a GMO tour get the largest number of points. Most of the time a GMO tour is considered a trump card.

Navy dermatology and radiology can be very competitive. For example you might have to complete two GMO tours in order to get enough points to get the position. Do you have any idea why you got turned down twice? Did you interview with each program and/or rotate through the service? Did you establish any kind of relationship with the program directors? My friend who was a flight surgeon took a month TAD and rotated at least a week at each hospital he wanted to apply to.

I had another friend who got placed on limited duty for a medical condition after internship. She was extended at the MTF and basically completed a 2-3 year GMO tour. She applied for a GME position but was turned down. She applied again the next year and got a full time outservice residency position for a super competitive specialty.

I'm really puzzled by your scenario.

I too was puzzled. :confused: Yes, I did surgical externships with the programs as a student, and a TDY to the emergency department as a GMO. So, I do not know why being a GMO was of no value toward being selected. All I ever received from the USAF in terms of GME was a deferment for internship and lies. If it was because I was not a good doctor while a GMO, then that would have been because they did not allow me to obtain the necessary education and training, as the result of to the policy forbidding transitional year interns from any further education and forcing us into GMO positions.

the only people in the Army who serve as GMO's anymore are those that for whatever reason chose to (we had an intern leave us and be a GMO to be with her husband overseas). The Navy is the only service that still heavily relies on them.

The GMO alone is a reason not to join Navy HPSP IMO, lol.



As background, I'm a Navy reservist. I just received this update from official sources:

1. the Navy had numerous HPSP scholarships go unused last year, whereas the Army and USAF had all taken.

2. the Navy still plans on having ~80% of post-interns do a GMO tour.

3. the Navy is so short of general surgeons that they're using OBGYNs on some platforms as substitute general surgeons. I guess that's great if you need an emergency D+C in combat zone.

. the Navy is so short of general surgeons that they're using OBGYNs on some platforms as substitute general surgeons. I guess that's great if you need an emergency D+C in combat zone.

Army doing the same thing also. And I _think_ with urologists, also.

As background, I'm a Navy reservist. I just received this update from official sources:

1. the Navy had numerous HPSP scholarships go unused last year, whereas the Army and USAF had all taken.

2. the Navy still plans on having ~80% of post-interns do a GMO tour.

3. the Navy is so short of general surgeons that they're using OBGYNs on some platforms as substitute general surgeons. I guess that's great if you need an emergency D+C in combat zone.

The wartime role for AF Gynecologists has always been as trauma surgeons. OK if you get shot in the vagina. :scared: