Uniformed Services - Navy
Join Date: Oct 2008
A little optimism...
As an introduction, I'm a former Navy flight surgeon. I'm 33 years old. I spent the past four years fulfilling my commitment and am now in a civilian residency program. I spent roughly a year in flight school, the better part of a year in Iraq (which was fairly miserable), and the remaining two stateside at a base doing typical clinic primary care stuff. I am not a recruiter and I am not prior enlisted.
I want to start by saying that I agree wholeheartedly with much of what I've read in these forums - both the good and the bad. My reason for writing this post - and this is my first sdn post - is to provide honest experiences/information for those considering the HPSP route. I think sdn is a valuable resource on many levels, and may be one of the only real forums people have that are considering military medicine. As such, I think it's important that those looking for guidance get as many opinions as possible, both the positive and the negative.
It's funny because I read the posts on this topic and it takes me back to all of the frustration I felt both on deployment and in my clinic. Answering to knucklehead Marine LtCol's who know nothing about medicine, writing BS evals for people I barely know, being administratively burdened to the point of it detracting from quality patient care, being overruled by O5 nurses ... I've seen it all. Military medicine is seriously f'ed up. I mean, seriously, it is unbelievably screwed up.
One thing I find interesting is that the Army docs seem to be the happiest with their experiences, while the Air Force and Navy docs seem to be universally upset. I would have never imagined this to be the case, but since leaving active duty I have heard people say that in the Army you are a physician first and an officer second. I think this is definitely not the case in the Navy, and I would suspect the same is true in the Air Force. Perhaps this is much of the source of negativity, I don't know.
In any case, despite how much of a disaster military medicine is in its current state, I have to say that I am thankful for what the military has done for me. The system isn't perfect - far from it. But I would do it again, and I think my wife and three kids would say the same. The military has become a part of who I am, whether I like it or not. I'm proud of the service I have given to my country over the past four years.
And I think, for those considering this route, this conflict is the source of much of the debate on this forum. I think that the vast majority of physicians who join the military do it for more than just the money during med school. They do it for the same reasons they went into medicine: they are idealistic and they are commited to service. They are patriotic and they want to be a part of something bigger than themselves. I am no different. And, when we see the idiocy and the hippocracy that is so rampant in military medicine, it angers us. Some of us it angers to the point that we get out and tell others to stay away at all costs. Others stay in, and still others (like me) fade away without being vocal about the positive experiences we have had.
I'm not writing this to contradict anything that's been written so far on this forum. In fact, I'm agreeing with most of it. All I can relate is my own experiences, and I feel that, in the end, the positives have outweighed the negatives.
Money: Since I'm going into one of the higher paying fields in medicine, I would suspect that my 4 years in the Navy have left me at somewhat of a financial deficit if you compare what I made in the Navy to what I would have made as an attending for those 4 years. Had I done a civilian residency, I would be an attending by now and would be making a healthy salary.
On the other hand, I made the civilian equivalent of roughly $100k/year during my GMO tour. I paid off several undergrad loans, I have a decent savings, I payed off 2 cars, bought a house, furnished said house, and was able to send one of my kids to private school. I am going into residency financially ahead of most of my civilian counterparts.
Additionally, I am now taking my GI Bill and I am reservist in the Medical In Training program. Between these 2 sources of additional income, I pull in roughly $2k/month above my paltry resident's salary. This especially helps since I have a family. As a resident, I live very comfortably. I do not eat ramen noodles. I do not have $200k of loans looming over me. Things are tight financially, but we are happy.
Again, I'm thankful for what the military has done for me financially.
Training: Personally, I would not do a military residency, save for maybe one or two fields at one or two specific MTFs. I think that there are a couple of military programs that compare favorably to their civilian counterparts. I do not think the military has any top notch residency programs. That's just my opinion, and I don't mean to offend any military trained docs, as there are many great doctors in the military (see below). I hope things change, but I strongly feel like the training is definitely better on the outside.
Now, the flipside to this is that I ended up at a top civilian residency program largely, I believe, as a result of my military service. Going strictly by board scores and grades, I probably had no place even applying to the programs I was accepted to. And yes, you read that right, the programs I was accepted to. I didn't go through the match. I applied, interviewed, and was offered a job, just like it should be (don't get me started on the match...). I had my choice of top residency programs. I am now at the residency program of my dreams, and I credit much of that to my experiences in the military. True, I am older than most of the people in my program, and even some attendings, but I also think my past experiences help me tolerate some of the BS a little easier than some of my colleagues. Again, I am happy, and I am getting great training.
Deployments: I went. It sucked. The Marines took 5 times as many "providers" than they needed. I had 4 of every 5 days off in the desert. I spent 9 months away from a new baby and a 7 year old son who needed me. I wasn't there to teach him to play baseball, to help him with his homework, to go on bike rides with him. My wife had to be a single parent without me. It was hard for her, extremely hard.
On the other hand, I spent my days off on deployment with some of the most incredible people I've ever met. Don't get me wrong, the time sucked. But I met a few true leaders. I spent time with the Explosive Ordnance Disposal Team (think 'The Hurt Locker'), I rode in MRAP's and humvees with some of the baddest ass Marines you could imagine, and I shot cars with a 50 cal sniper rifle at 1800 meters. In flight school, I did barrel rolls over the coast of Miami in a T-34. I've front seated in a CH-53 helicopter multiple times. I've traveled the world.
These are experiences I would have never had outside the military. Do they make up for all of the disppointments and the heartache? Maybe, maybe not, but they help. I have some great pictures.
The People: Military physicians are an interesting bunch. Many are insitutionalized and I think they love being protected from the competition in the outside world. However, many of the doctors you find who are either in training or fulfilling their commitment, are some of the greatest I have had the pleasure of working with. Now, I realize the caveat to that is that the vast majority pop smoke when they get the chance, but there are some great physicians in the military. And still some stay in because, not only are they great doctors, but they are idealists who work hard to make a difference in a patient population that truly needs them.
I have found that active duty nurses in the military are usually fantastic, but once they reach O5, they become administrative nightmares. The civilian nurses in military MTF's are often the bottom of the barrell and are abysmal to deal with.
The Patients: One word: fantastic. My deployment sucked, but I was honored to take care of the people who protect this great nation. I may have missed out on seeing a lot of pathology that you would see as a civilian, since most people in the military are generally healthy, but the truth is that with one year of internship under my belt, I wasn't qualified to care for much more than what I saw. Even stateside at my clinic, I always felt a sense of pride helping people who had devoted their lives to serving our country. For the most part, I found the patient population to be grateful and a pleasure to work with.
Tricare: A headache, to say the least. A difficult system. But I still think it's better than most civilian HMO's. I never had problems ordering a test, everyone is seen and cared for, and I had as much time as I needed to see patients. I am sure I am in the extreme minority here, but I think tricare, while not perfect, is a good single payer system. Since my paycheck was never affected by how many patients I saw in a day, I could spend an hour with a serious patient if I needed to. And I never felt bad about it.
Remember, when they can't affect your paycheck, and they can't fire you, they can tell you to move faster all they want, but how will they enforce it? I caused a lot of fights during my time in military, but I also refused to be bullied around. I am a doctor first, no matter what I'm wearing and who I work for.
Administrative burden: It sucks. I went to more meetings and was in charge of more departments than I wanted to. I sat in meetings while my patients waited for me. It was horrendous. I hated the Navy for doing that to the people I was charged with caring for.
On the other hand, I gained serious managerial experience. I ran a clinic. I taught, I lectured, I dealt with disciplinary issues, and I dealt with some of the more business-like aspects of medicine. It was a valuable experience. It's a confidence builder to be in charge, especially when we spend so much of our professional lives being the low man on the totem pole. As a GMO, I was my patients' doctor. I was all they had. In many ways, it was the way medicine should be. I knew all of the people in my squadron. I knew their families. I felt like I was able to make an impact in people's lives because I was in charge. I felt like an attending (even though I wasn't qualified to be one).
Corpsmen/Medics: I worked with both. There are definitely some ****-poor ones out there, but they are rare. I'll tell you, as a group, these are some of the most impressive and hard working people I have had the pleasure of meeting. I spent much of my time teaching, lecturing, etc to them. They are the backbone of military medicine. I have nothing but respect for these individuals. If you like to teach, then they are your medical students. Work hard for them and they will bend over backwards for you.
AHLTA: Where do I start? It's the electronic health records system in the military. It's horrendous. It goes offline every other day. It was the source of many, many headaches.
On the other hand, I'm now at one of the top hospitals in the world, and I have to use four computer systems to check vitals and write notes. It's ridiculous. My point is this: medicine has always been a late adopter of technology. Doctors are technological idiots. AHLTA may be bad, but worse systems exist, I promise you. I am now dreaming of my AHLTA days...
Beauracracy: It is amazing in the military. No one can refute this. It will drive you crazy.
People cite this as a reason to become a civilian. I'm finding that large hospitals make almost as many silly mistakes as military MTF's. Any time you belong to a large corporation, you will be amazed at the red tape. It will make your head spin. Don't let this be a reason for not choosing the military.
Being underprepared: The military definitely puts you in positions you aren't ready for. I wasn't ready to be a family medicine doc for 3 years after doing a surgical internship. I wasn't ready to take care of seriously sick/injured people. I wasn't ready to run a clinic.
But I figured it out. I'm not ready for a lot of the positions I get put in everyday as a resident. I thought this was unique to military medicine. It's not. It's medicine. It's how we do our best learning. I haven't hurt anyone yet.
So, my final verdict is this: the military is no free lunch. It's hard. They'll tell you where to live and they'll likely take you away from your loved ones for extended periods of time. But I'd do it all again. I wouldn't change a thing.
My advice to anyone who is considering this route is to know ahead of time what you're getting into and expect the bad stuff. Know that you will get your turn. It will be hard, but know this before you sign the papers. Don't listen to recruiters, they're worthless.
If you do choose this route, don't ever let administrators bully you. Stand up for yourself. Cause fights if you need to. Stand at attention in front of your CO while he screams at you. I've been there. But stick up for yourself and you'll be fine. Don't sign anything you don't feel comfortable signing and take comfort when you go home at night that you are doing what's right for your patients. In the end, stick to what you believe in and work hard. Remember, they can't fire you and they can't withhold your paycheck. Military medicine may be seriously flawed, but that doesn't mean you can't be a great doctor and provide quality care within that system.
Finally, If you're someone who is a driven type-A who needs to get through residency as soon as possible, don't even consider the military. But if you're someone who isn't in a hurry, and wants to have a little fun and do some crazy stuff before you spend the rest of your life as an attending, then consider this route seriously. If you're going to sit around and think about all of the money you "lost" by being a GMO, then forget this way of life. It's not for you.
But if you think you'll look back on the pictures of you in your flight suit drinking beers in Japan or on the deck of an aircraft carrier or in the cockpit of an f-18, and you'll say "damn, that was cool," then maybe you should talk to someone who enjoyed their time.
I've seen the world, I've met amazing people, and I learned a lot about myself and what I wanted out of my career during my time on active duty. In fact, I think so highly of the people I took care of that I now drill when I can with my old unit. Maybe I'm a glutton for punishment, maybe I'm idealistic, maybe I'm a patriot who just can't let go. Whatever the case may be, the military is in my blood.
Good luck with your decision and contact me if you want to talk.
Oh, and definitely choose flight surgery or undersea medicine. Don't even consider being a straight GMO.