Military Medicine: Pros, Cons, and Opinions

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Originally Posted by ShrinkDAC

The saving grace for Army medicine is that so far, the DOCTORS retain control.

Um...you might want to read this.

http://www.govexec.com/dailyfed/0511/050511BB1.htm

[QUOTE=ShrinkDAC;11360696]
The practice of medicine is NOT a business.

QUOTE]

SAY WHAAA?????

Originally Posted by Tired

Um...you might want to read this.

http://www.govexec.com/dailyfed/0511/050511BB1.htm

That makes me want to vomit.

How often are military doctors transferred around? Actually, my real question is...why are military doctors moved around in the first place? Wouldn't it be more efficient for them to be stationed at domestic location X and work there "forever" with deployments internationally/combat when necessary?

Originally Posted by Kallistos

How often are military doctors transferred around? Actually, my real question is...why are military doctors moved around in the first place? Wouldn't it be more efficient for them to be stationed at domestic location X and work there "forever" with deployments internationally/combat when necessary?

Did you just ask why the military does inefficient things?

Hello everyone! It looks like there hasn't been much action on this page recently but I will try my luck. I'm a 27yr old biology major - prior service in the Army (Psychological Ops). My original plan after service was Bio major, then PA school, work as a PA a few days/week and be a mom the others (I have a 2y/o and may have another in a few years). Now that I've been in the civi world for a few years I can honestly say I miss some parts of the military. Soo, I ran across the USUHS website and I am considering applying next year. This is a big change though from my fairy tale of working a few days/week. So I am trying to weigh my decision carefully on my desire to work in medicine and be a mom/wife. I will more than likely apply to PA school as planned and USUHS and possibly HPSP and see what happens. Here is my questions for anyone willing to shed some light - and I apologize if this has been asked, but I know the military is ever-changing.
What is the day to day work like for physicians in the military? I know I obviously won't be able to pick my hours but is it 9-5ish, shift work, 80hrs/wk? I know when I was in it was work hard when we were training up for something and pretty laid back other times. I know every branch is different. I'm just curious about the quality of life. Like I said, I'm a mother so it's good to know if I'm signing up for a job where I'm never home.
Also, has anyone had experience with dual-military life in this field? My husband is enlisted. When I was in we were in the same BN so it was never an issue. His MOS is on every base so I assume he would get stationed where I was?
I realize that the Army is always changing, I would just like to hear about other peoples experiences.
Thanks!

Originally Posted by ene5yb

What is the day to day work like for physicians in the military? I know I obviously won't be able to pick my hours but is it 9-5ish, shift work, 80hrs/wk? I know when I was in it was work hard when we were training up for something and pretty laid back other times. I know every branch is different. I'm just curious about the quality of life. Like I said, I'm a mother so it's good to know if I'm signing up for a job where I'm never home.
Also, has anyone had experience with dual-military life in this field? My husband is enlisted. When I was in we were in the same BN so it was never an issue. His MOS is on every base so I assume he would get stationed where I was?
I realize that the Army is always changing, I would just like to hear about other peoples experiences.
Thanks!

Excluding residency, I would expect to work 50-60 hours per week. Call will depend on specialty as will nights and weekends. There is huge variability in assignments though. Some clinic jobs will be very regular hours with nights and weekends free. If you do a specialty with inpatient responsibilities, add nights and weekends on occasion.

Then there are deployments. You should expect to deploy once every 3-4 years. Some specialties more, others less, but if you go in with that expectation you are not likely to be disappointed. I do think moms have a tougher time than dads, but many women have deployed. If you do rejoin, you have to promise not to be one of those women who gets pregnant everytime her number comes up.

Originally Posted by NavyFP

Excluding residency, I would expect to work 50-60 hours per week. Call will depend on specialty as will nights and weekends. There is huge variability in assignments though. Some clinic jobs will be very regular hours with nights and weekends free. If you do a specialty with inpatient responsibilities, add nights and weekends on occasion.

Then there are deployments. You should expect to deploy once every 3-4 years. Some specialties more, others less, but if you go in with that expectation you are not likely to be disappointed. I do think moms have a tougher time than dads, but many women have deployed. If you do rejoin, you have to promise not to be one of those women who gets pregnant everytime her number comes up.

Haha! No definitely not! I have an inner gypsy that wants to travel the world - even if it is to the desert. .
Thanks a lot for the input! I have a lot of pros and cons to weigh over the next year!

My application for an Army HPSP was denied today on the basis that I have a 7 in the physical science section of my MCAT. Everything else in the packet is good, (3 years experience as an emergency room nurse, 3.8 GPA with both a bachelors of science and masters degree, research experience and publications as a first author, letters of recommendation from leaders within the medical and materials sciences/chemistry communities, passed MEPS without any problems physically I'm in very good shape). My recruiter suggested that I retake the MCAT but with only 3 months before I start medical school and a full acceptance in hand, I have very little inclination to do so. If I come back and apply for a 3 year scholarship will I face the same problem with my MCAT score? If so is there any alternative route I could take that will provide me with financial assistance while in school?

Originally Posted by gonzo87

M If so is there any alternative route I could take that will provide me with financial assistance while in school?

Loans

Wow. That was a read. I'm currently doing my undergrad and in the Army reserves with an active duty husband who will ETS next year. I had thought about potentially using military funding to get through med school, but YIKES. From what I've seen it's suggested to go in after school and serve, IF you should do that. Perhaps I will simply gracefully bow out when my contract ends around the same time I graduate from college.

Originally Posted by ene5yb

Hello everyone! It looks like there hasn't been much action on this page recently but I will try my luck. I'm a 27yr old biology major - prior service in the Army (Psychological Ops). My original plan after service was Bio major, then PA school, work as a PA a few days/week and be a mom the others (I have a 2y/o and may have another in a few years). Now that I've been in the civi world for a few years I can honestly say I miss some parts of the military. Soo, I ran across the USUHS website and I am considering applying next year. This is a big change though from my fairy tale of working a few days/week. So I am trying to weigh my decision carefully on my desire to work in medicine and be a mom/wife. I will more than likely apply to PA school as planned and USUHS and possibly HPSP and see what happens. Here is my questions for anyone willing to shed some light - and I apologize if this has been asked, but I know the military is ever-changing.
What is the day to day work like for physicians in the military? I know I obviously won't be able to pick my hours but is it 9-5ish, shift work, 80hrs/wk? I know when I was in it was work hard when we were training up for something and pretty laid back other times. I know every branch is different. I'm just curious about the quality of life. Like I said, I'm a mother so it's good to know if I'm signing up for a job where I'm never home.
Also, has anyone had experience with dual-military life in this field? My husband is enlisted. When I was in we were in the same BN so it was never an issue. His MOS is on every base so I assume he would get stationed where I was?
I realize that the Army is always changing, I would just like to hear about other peoples experiences.
Thanks!

After over 20 years of experience as the wife of an Army doctor I would say be a civilian doc. This is not because of deployments and the moving. I love the people I have met at all our duty stations and my husband has found deployments very rewarding. It is just the way Army medicine is changing. It is run not by leaders anymore but by ladder climbing goons to tell you the truth. Sure there are some good leaders but to tell you the truth I have reflected on the medical corp leadership for quite a while. Why step out of medicine and track administration? Aren't you a doc? The AMEDD has forgot their roll. They are not the war fighters, get over yourselves. The AMEDD leadership has all sold out and stopped practicing medicine for some sort of perceived sense of "power" To tell you the truth if you want to serve do it for a short time and then get out. There is no way it makes financial sense no matter what anyone tells you.

Originally Posted by gettheleadout

That makes me want to vomit.

You have no idea. Get used to answering to nurses. Docs are checking out, and the ones that are staying in do so because they can't practice elsewhere. Many nurses stay in because it's financially lucrative for their profession compared to civilian practice (which also selects the wrong demographic).

I met her once, and all she spoke about were how we need to find new technology to reduce our expenditures on healthcare...like bluetooth blood pressure cuffs that reported back ambulatory BP's. All the while we are spending more on military healthcare in one year than we are on F-22's. Classic nursing focus. Many physicians don't get the big picture either though.

I think the civilian model is better, with dedicated administrators who respect the contributions of the entire healthcare team, and have the fiduciary competence to lead the team toward the appropriate goals.

To those that would join: DO NOT! To those that are in: GET OUT! Serve your country as a competent civilian physician and enjoy the benefits of having a team whom you lead and whose competence is vetted in an excellent residency (not a makeshift military program, nor solely an internship). The entire MHS is on a downward spiral.

Take loans out. Don't join.

You'll be better off financially (and medically) in the end.

You'll be a better physician. Really.

Air Force Doc here, logging in for the first time in many years to warn people away from military medicine. My dream had been a long AF career, but age, experience, and wisdom have opened my eyes to the deep flaws in military medicine and the disproportionate burden placed on my family by staying in.

I was one of the many people screwed by the military match coming out of medical school. I am currently a primary care provider with no desire to do primary care. Now, I am left with the wonderful choice of either escaping military medicine to practice a specialty I do not want on the outside, complete a second residency (*sigh*) under the auspices of the military, or do so as a civilian - but obviously with much less pay/benefits and now with 3 children in tow.

Let me warn you all again. I scoffed at the criticism of military medicine as a pre-med and medical student in this very forum. They were right. Understand, I am proud of my service, met some wonderful people (almost all of whom left at the first opportunity), and faithfully served to the best of my abilities even though the AF chose a career for me that I did not want.

If you absolutely can't bear the thought of not serving in the military, let me suggest the reserves or guard. I am considering continuing in my home state's ANG after separating, since one can serve without being burdened daily by the military medical system, and the guard won't pick your specialty!

FWIW, a friend of mine who did the HSPS program said it was the worst decision he's made in his life.

Originally Posted by WyldeWolf1

Air Force Doc here, logging in for the first time in many years to warn people away from military medicine. My dream had been a long AF career, but age, experience, and wisdom have opened my eyes to the deep flaws in military medicine and the disproportionate burden placed on my family by staying in.

I was one of the many people screwed by the military match coming out of medical school. I am currently a primary care provider with no desire to do primary care. Now, I am left with the wonderful choice of either escaping military medicine to practice a specialty I do not want on the outside, complete a second residency (*sigh*) under the auspices of the military, or do so as a civilian - but obviously with much less pay/benefits and now with 3 children in tow.

Let me warn you all again. I scoffed at the criticism of military medicine as a pre-med and medical student in this very forum. They were right. Understand, I am proud of my service, met some wonderful people (almost all of whom left at the first opportunity), and faithfully served to the best of my abilities even though the AF chose a career for me that I did not want.

If you absolutely can't bear the thought of not serving in the military, let me suggest the reserves or guard. I am considering continuing in my home state's ANG after separating, since one can serve without being burdened daily by the military medical system, and the guard won't pick your specialty!

I appreciate the advice. Thank you!

I stumbled across this forum after recently discussing physician recruiting with our local Army Medical Dept recruiter and thought I may be able to add some insight on the topic after having over 15 years in the Medical Corps. The last several entries trended more against the idea of serving, but as we know, there are pro's and con's with any career choice or life decision.

First, full disclosure, I come from a military family. My father had a 30 yr career and older brother graduated from West Point. But joining the Army was not on my mind until I became serious about medical school. The military is certainly not for everyone. A recent study showed only 0.5% of the US has served in the past decade, so it's obviously not a universally positive experience. If one is married, this is should certainly be a joint decision as the life of a military spouse is difficult. There will be the possibility of deployments and time away from family (I have deployed 3 times) and there is a command structure and not every decision will seem clear and logical at the individual level. Understandably, for some, these negatives will outweigh the positives. But for others, working inside an organization caring for those who have sacrificed and the camaraderie of working with others in uniform will tilt toward the positive.

The Army has allowed me to graduate from medical school debt-free (all-expenses paid and stipend during school), receive excellent training in a residency and later a fellowship program. When I became interested in further advanced training, the Army gave me a year of civilian training under one the pioneers in my field. In that time in a civilian hospital surrounded by civilian physicians, I can say the military GME compares very well. I was fortunate to receive my choice of programs and I've read here some did not receive the residency of their choice. I cannot speak for the Navy or AF but for the more competitive fields, I do not believe the Army match is any more competitive than the civilian match.

Following training, I have able to practice in wonderful facility with the best patients. Mostly, medical corps officers are only moved for training or at their own request for a more preferred duty station. We do have some issues with our choice of EMR (the VA has a better one) but I did work with a civilian contract physician who actually liked our system (AHLTA). The clinical hours are generally 8-9 hrs per day in addition to any call responsibilities. For my field, the call in a large civilian hospital is much worse than military hospitals.

Finally, there are the benefits. My salary with adjusted bonuses is certainly about half of my civilian colleagues. But after 20 years, one qualifies for retirement drawing 50% of base pay of retired grade (usually based on last 3 yrs of service) and very affordable health insurance for self and dependents. Twenty years may seem like a prohibitive amount of time but if I choose to retire, I will still have 20 years of time to practice on the civilian side. I am not sure of my decision in 2017 concerning retirement from the Army but it's certainly nice to have options. There is a lot of uncertainty on the civilian side regarding EMRs, physician reimbursement, healthcare reform, etc. and I have the next 5 yrs to see how it plays out. For now, I have the luxury of working in a new hospital with tremendous Army, Navy, and AF physicians and I still enjoy wearing the uniform after 15 years, 3 deployments, and countless times asking myself why did the Army do that?

Bryce Mays
LTC, MC
ILE Class 31-A
Fort Gordon, GA
The views expressed in this forum are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

18 years in the Army, a subspecialist like you, military family like you.
I felt the same way in ILE, now totally burned out. Tired of working more hours than my civilian colleagues for 50% pay for leaders who are veritable imbeciles. AHLTA sucks more than people can ever know and checking my email raises my BP by 20-30 points when I read the insanity that graces my box daily. The retirement is chump change equaling a couple of moonlighting shifts/month.

I know you had to do the ILE blog as did I but I did mine in a make believe blog like most of my classmates.

Frankly, I've seen a steady decline in all parameters especially quality of care which really saddens me. While we need great docs in the military - realize you will not be valued or supported by the the military, it is just the sad reality.

The ILE blog assignment generates about one post every two years on this website. Its always positive, always for attribution and then the poster disappears. Its almost as reliable as the SSG Clevenger bump.

Originally Posted by LTCArmyDoc

I stumbled across this forum after recently discussing physician recruiting with our local Army Medical Dept recruiter and thought I may be able to add some insight on the topic after having over 15 years in the Medical Corps. The last several entries trended more against the idea of serving, but as we know, there are pro's and con's with any career choice or life decision.

First, full disclosure, I come from a military family. My father had a 30 yr career and older brother graduated from West Point. But joining the Army was not on my mind until I became serious about medical school. The military is certainly not for everyone. A recent study showed only 0.5% of the US has served in the past decade, so it's obviously not a universally positive experience. If one is married, this is should certainly be a joint decision as the life of a military spouse is difficult. There will be the possibility of deployments and time away from family (I have deployed 3 times) and there is a command structure and not every decision will seem clear and logical at the individual level. Understandably, for some, these negatives will outweigh the positives. But for others, working inside an organization caring for those who have sacrificed and the camaraderie of working with others in uniform will tilt toward the positive.

The Army has allowed me to graduate from medical school debt-free (all-expenses paid and stipend during school), receive excellent training in a residency and later a fellowship program. When I became interested in further advanced training, the Army gave me a year of civilian training under one the pioneers in my field. In that time in a civilian hospital surrounded by civilian physicians, I can say the military GME compares very well. I was fortunate to receive my choice of programs and I've read here some did not receive the residency of their choice. I cannot speak for the Navy or AF but for the more competitive fields, I do not believe the Army match is any more competitive than the civilian match.

Following training, I have able to practice in wonderful facility with the best patients. Mostly, medical corps officers are only moved for training or at their own request for a more preferred duty station. We do have some issues with our choice of EMR (the VA has a better one) but I did work with a civilian contract physician who actually liked our system (AHLTA). The clinical hours are generally 8-9 hrs per day in addition to any call responsibilities. For my field, the call in a large civilian hospital is much worse than military hospitals.

Finally, there are the benefits. My salary with adjusted bonuses is certainly about half of my civilian colleagues. But after 20 years, one qualifies for retirement drawing 50% of base pay of retired grade (usually based on last 3 yrs of service) and very affordable health insurance for self and dependents. Twenty years may seem like a prohibitive amount of time but if I choose to retire, I will still have 20 years of time to practice on the civilian side. I am not sure of my decision in 2017 concerning retirement from the Army but it's certainly nice to have options. There is a lot of uncertainty on the civilian side regarding EMRs, physician reimbursement, healthcare reform, etc. and I have the next 5 yrs to see how it plays out. For now, I have the luxury of working in a new hospital with tremendous Army, Navy, and AF physicians and I still enjoy wearing the uniform after 15 years, 3 deployments, and countless times asking myself why did the Army do that?

Bryce Mays
LTC, MC
ILE Class 31-A
Fort Gordon, GA
The views expressed in this forum are those of the author and do not reflect the official policy or position of the Department of the Army, Department of Defense, or the U.S. Government.

For those who don't know any better: this is a class project for a doc sent to ILE (a school where you spend 3 months doing blog posts like this and not practicing any medicine). The 3 months w/o practicing any medicine is pretty scary for surgeons. Although it probably isn't so bad for non-surgical specialities.

I'm prior enlisted (4 years, Navy). I was offered admission at USUHS. Since it's early, I still have time to pick my service. I'm thinking about switching to AF or Army to avoid a GMO billet. Any input? I'd really like to go striat through for my residency. Will I be more likely to go strait through with my prior service?

Originally Posted by BigWillyGFunk

I'm prior enlisted (4 years, Navy). I was offered admission at USUHS. Since it's early, I still have time to pick my service. I'm thinking about switching to AF or Army to avoid a GMO billet. Any input? I'd really like to go striat through for my residency. Will I be more likely to go strait through with my prior service?

What determines whether or not youll go gmo is your competitiveness as an applicant, and your specialty of choice. For instance, a strong applicant applying for IM has a decent shot of going straight thru. For other specialties (more competitive stuff like rads, anes, ortho), youre likely to do a gmo no matter how strong of an applicant you are.

If youre gonna make a career out of it, and if you harbor the 7 year usuhs payback, then I think a gmo tour is a little easier to accept. You can rationalize that you'll be knocking off some payback, and youre gonna do a military residency anyway, so go out and do something interesting.

Are you really so opposed to doing a gmo, that you'd be willing to switch services? I dunno. Me, Id rather stay in the branch that I know and and am familiar with. If you switch, go Army, theyre bigger, have more residency spots, more straight thru training.

Originally Posted by BigWillyGFunk

I'm thinking about switching to AF or Army to avoid a GMO billet.

AF is definitely not the way to go if you're looking to avoid GMO/FS.

Thanks Dr. Metal and Deuist! Think I may stay Navy but still waiting to hear back from some civi schools so we'll see. I also found out that they normally give at least a point or two for prior service which could help with that match.

Originally Posted by BigWillyGFunk

Thanks Dr. Metal and Deuist! Think I may stay Navy but still waiting to hear back from some civi schools so we'll see. I also found out that they normally give at least a point or two for prior service which could help with that match.

True, all branches are supposed to give bonus points for prior service. You could also do research in medical school and churn out publications, which leads to more bonus points.

Originally Posted by BigWillyGFunk

Thanks Dr. Metal and Deuist! Think I may stay Navy but still waiting to hear back from some civi schools so we'll see. I also found out that they normally give at least a point or two for prior service which could help with that match.

IIRC it is one point for prior service and two for prior service medical. There is a larger 20 point "good future career officer" block that is more meaningful.

Originally Posted by Gatewayhoward

I was considering military medicine as one of my options. It seems like you have to be the right kind of person to enjoy it. I didn't know that you get little experience. That's bad.

It also greatly depends on where you are assigned. Not all positions are identical even within the Army.

Hey everyone, so I'm new to this page. I've been considered joining the AF to help fund my medical school education and I've been talking to a recruiter but I had a few questions I wanted to ask. As a quick background I come from a non military family and throughout my life my only exposure to the military have been reality shows and some friends who have served in the military.

So my questions are,

What is COT like? What can I expect? Is it like what see with boot camp; breaking down cadets and running you ragged?

Is it true that AF docs can expected to be stationed in one area for all four years?

Is it also true that during those four years you can expect 2 deployments, but less if your a family doc?

The AF won't let you start your active duty until your board certified? So this means they want you to train right through?

Overall is it worth it?

Understand I really do want to serve my country, but coming from a non military background there is a lot of things that make me nervous. Having said that however I don't mind the challenge and I don't run away from things just because their hard. There are a lot of men and women putting their lives on the line for my freedom and in all honesty I would love to give back and give those fighting a fighting chance. I know that I can serve other ways, but the military route is appealing in many ways.

Originally Posted by Medicdude

Hey everyone, so I'm new to this page. I've been considered joining the AF to help fund my medical school education and I've been talking to a recruiter but I had a few questions I wanted to ask. As a quick background I come from a non military family and throughout my life my only exposure to the military have been reality shows and some friends who have served in the military.

So my questions are,

What is COT like? What can I expect? Is it like what see with boot camp; breaking down cadets and running you ragged?

Is it true that AF docs can expected to be stationed in one area for all four years?

Is it also true that during those four years you can expect 2 deployments, but less if your a family doc?

The AF won't let you start your active duty until your board certified? So this means they want you to train right through?

Overall is it worth it?

Understand I really do want to serve my country, but coming from a non military background there is a lot of things that make me nervous. Having said that however I don't mind the challenge and I don't run away from things just because their hard. There are a lot of men and women putting their lives on the line for my freedom and in all honesty I would love to give back and give those fighting a fighting chance. I know that I can serve other ways, but the military route is appealing in many ways.

You need to spend several hours reading the countless relevant threads. Use the search function.

To give quick, simplified answers:

1. Don't worry about COT, worry about the subsequent decade.
2. You should count on a move between residency and utilization and not be surprised by another move.
3. You don't know what specialty you will pick. However, FP is a highly deployable specialty. I think 2 deployments in 4 years is a reasonable assumption.
4. You are active duty the moment you start internship. There is no guarantee you will go straight-through (see the circa 2008 threads about AF flight surgeons) but you probably will.
5. Can't answer "is it worth it" Too individual. Maybe 70/30 against.

Originally Posted by Medicdude

Hey everyone, so I'm new to this page. I've been considered joining the AF to help fund my medical school education and I've been talking to a recruiter but I had a few questions I wanted to ask. As a quick background I come from a non military family and throughout my life my only exposure to the military have been reality shows and some friends who have served in the military.

So my questions are,

What is COT like? What can I expect? Is it like what see with boot camp; breaking down cadets and running you ragged? Quick intro to the AF, enough PT to get you to pass your PT test, thus not much. Not going to break you down, just make you motivated

Is it true that AF docs can expected to be stationed in one area for all four years? Big push here to make CONUS assignments 4 years, but you will be subjected to the VML (vulnerable to move list) and it is very likely you may move, or get a 365 day short tour somewhere

Is it also true that during those four years you can expect 2 deployments, but less if your a family doc?not less if you are FP, but yes that is a good expectation for all

The AF won't let you start your active duty until your board certified? So this means they want you to train right through? not even close to the truth. they train who they want to train and the rest they will make use of you, i'd say 70/30 shot of going straight through, easier for primary care, harder for specialties

Overall is it worth it?It is if you are flexible and willing to accept a bad deal or two. it is the military, there is no free lunch.

Understand I really do want to serve my country, but coming from a non military background there is a lot of things that make me nervous. Having said that however I don't mind the challenge and I don't run away from things just because their hard. There are a lot of men and women putting their lives on the line for my freedom and in all honesty I would love to give back and give those fighting a fighting chance. I know that I can serve other ways, but the military route is appealing in many ways.

See above.

Originally Posted by AF M4

It's an interesting policy that the various services are going to, very much a war-time philosophy on the use of physicians instead of an institutional one. Seems like they've got a resource (which they measure as "Physician-Years" rather than actual Physicians) that they can either invest in the future - for example, give out several radiology or orthopedic surgery residencies so that in 5 years you can pay 3 military radiology attendings for the price of one civilian contractor. Or they can spend those "Physician-Years" now, only giving the bare minimum of specialty slots while pouring the rest into GMOs, Flight Surgeons, etc. They have to know that most of the docs won't stick around after their service time is up, but the current situation is so stretched that they have no choice but to burn up all their resources now to put bodies into empty slots. It's not a good policy since it's one that smacks of simply reacting to a situation instead of having a plan, and it's one that makes me feel uncomfortable because this type of mindset immediately reaches for the easiest, quickest solution to a problem - in this case a stop-loss as the GMOs leave and the HPSP well dries up.

I know I've already ticked off a recruiter who came to a military medical student association meeting at my school: a couple of M1s thinking about signing up attended, and I told them the current situation along with what I was having to deal with. The recruiter tried to argue that what I was talking about wasn't going on, but it quickly became obvious that he didn't know anything about the match boards or anything like that - he only knew about military, nothing about doctors in the military. I told the M1s what I wish someone had told me back then: that they were not prepared to make a choice of this magnitude, and that many many things can change over the course of medical school. The money looks scary, but don't worry about it - you'll make it back soon enough. If you're still interested in the military after med school, great, look into the FAP program - you can still work in the military and the money's good, plus you get to be the kind of doc you want to be. After that I nudged their surprised little faces out the door, and told them not to worry about returning any phone calls from the military. The recruiter looked at me as if I'd just grown horns and stabbed him with a pitchfork...he started to go off, but then I told him that I wasn't disrespecting the military and that I was proud of my commitment to serve, but I also felt it was my responsibility to make sure that those trusting, bright-eyed rookie med studs weren't taken for a ride that was going to cost them the back half of their 20s. He left, and I don't think he's coming back to any more of our meetings.

So, in effect, I've contributed to the probablity of a stop-loss by the time I'm done with my commitment.

wow, you save somebody and i hope they all listen to youhttp://dkmg2azsloi0e.cloudfront.net/images/smilies/biggrin.gif

Hey guys, I've been on SDN for the past few years mostly stalking Match stuff. Now I am a 1st yr internal medicine resident at a civilian program. I never considered military medicine during medical school, but now I am trying to learn more about military medicine for the life experience. The financial aspect of it is definitely not a driving force. It seems that a lot of people are anti-military medicine with a lot of the frustration coming from GMO tours and lack of choice in regards to what specialty to practice with the HSPS program. If I were to join as a resident or after completion of my civilian residency, would that change anyone's opinion? I don't intend on doing a career in the military, but I would like the military experience. I would probably be most interested in the Navy, but would be open to hearing about any branch. I have not talked to a recruiter yet, since I figure you guys would be a more informed and sincere group.

1) would I be subject to GMO if I'm already done with residency at time of entry?
2) what would be the minimum active duty required? I saw on Navy website that 3 yrs is minimum.
3) would I be guaranteed that I could do things aside from working at a VA or US hospital?
4) what kinds of options are there with the reserves, and do they get a chance to travel, etc?
5) do I have to do any military residency training?
6) what about entering after a fellowship such as critical care, would that change anything?

Thanks guys!

Originally Posted by Wodahs

Hey guys, I've been on SDN for the past few years mostly stalking Match stuff. Now I am a 1st yr internal medicine resident at a civilian program. I never considered military medicine during medical school, but now I am trying to learn more about military medicine for the life experience. The financial aspect of it is definitely not a driving force. It seems that a lot of people are anti-military medicine with a lot of the frustration coming from GMO tours and lack of choice in regards to what specialty to practice with the HSPS program. If I were to join as a resident or after completion of my civilian residency, would that change anyone's opinion? I don't intend on doing a career in the military, but I would like the military experience. I would probably be most interested in the Navy, but would be open to hearing about any branch. I have not talked to a recruiter yet, since I figure you guys would be a more informed and sincere group.

1) would I be subject to GMO if I'm already done with residency at time of entry?
2) what would be the minimum active duty required? I saw on Navy website that 3 yrs is minimum.
3) would I be guaranteed that I could do things aside from working at a VA or US hospital?
4) what kinds of options are there with the reserves, and do they get a chance to travel, etc?
5) do I have to do any military residency training?
6) what about entering after a fellowship such as critical care, would that change anything?

Thanks guys!

Recruiters hang out here too

I can only speak about the Army but some information is likely to cross over to other services.

I will try to answer your questions, Army specific

1. No GMO, you would apply directly as a 61F Internal Medicice Doctor and you can apply during your residency (FAP or STRAP)

2. If you were to take FAP, during residency you would owe 1 for 1 plus 1
Example: 3 years FAP would be 3 years (1 for 1) plus 1 Total 4 years contractual obligation and then 4 years of inactive service

3. Not too sure of your question,but on Active Duty you would be assigned to a Hospital at any Army location worldwide

4. You may travel with the reserves perhaps during annual training, deployment or humanitarian mission.

5. You would have to complete military training but not another residency or basic training. BOLC and standard CME

6. Any fellowship would only change the specific AOC (Area Of Concentration) that you apply to.

I hope this answers some of your questions.

Dont fear the recruiters, we are not that bad, feel free to ask questions here or by PM

Army Recruiter

[QUOTE=Wodahs;13491629]
1) would I be subject to GMO if I'm already done with residency at time of entry?

Technically no, actually maybe. The term 'GMO' is generally only used to refer to a billet that would typically be filled by a physician who has completed only an Internship, rather than a full residency, so in that sense, no you would not be required to do a GMO. Actually there are many 'operational' billets in all services that have little to nothing to do with the residency training you have recieved and therefore are, for all intents and purposes, a GMO tour.

FWIW if you don't want to do a GMO tour, I recommend the Navy. Since the have the most opperational billets filled by people who haven't finished a residency (more than half of navy Interns do a GMO before completing residency) they have the fewest opperational billets left for the residency trained. In the army the reverse is true.

2) what would be the minimum active duty required? I saw on Navy website that 3 yrs is minimum.

For you that is probably correct. Occasionally they will allow particularly in demand subspecialists to sign up for a shorter obligation. Right now the wars are winding down, and I don't think they ever extended the option to internists in any event.

3) would I be guaranteed that I could do things aside from working at a VA or US hospital?

In the military there are no guarentees. In the Navy an Internist might work either the floors or general clinic at a major medical center, they might get placed in a teaching role at one of the various family practice hospitals, you might work as an Internist in Guam, or Okinawa, or Japan, or Italy, or they might end up the senior medical officer on an aircraft carrier. You could even draw the short straw and end up at 29 palms (an awful base in the middle surrounded by 2 hours of desert on either side), Guantonamo bay (a prison for all involved), in a 100% admin role as a batallion surgeon (no patients at all), or even supporting Operation deep freeze (the antarctic mission is supported by one military physician). And of course, whatever you do, it can be inturrpted by deployments to our current warzone to support the current war. Your preferences will of course be taken into consideration, but that only really helps if your preferences are different from eveyrone elses preferences.

BTW the guys in the VA are not military physicians. You will not work in one.

4) what kinds of options are there with the reserves, and do they get a chance to travel, etc?

Don't know

5) do I have to do any military residency training?

Everybody does 4-6 weeks of 'basic training'. You can't fail, they don't expect much from you, and you don't learn to shoot. Think summer camp but with more yelling.

6) what about entering after a fellowship such as critical care, would that change anything?

If would change three things:

1) Where you can work. Only big hospitals have critical care units, so you would only work in big hospitals.

2) How often you deploy: ICU guys get sent to war a lot.

3) How much money you lose by doing the military. The salary for critical care in the military is very similar to a general internist, while the civilian salary is obviously much higher for a fellowship trained critical care specialist.

******hot hot hot very important notice******

the army is currently involuntarily diverting specialty trained attending physicians into 2-3 year tours in primary care as "brigade surgeons". These attendying physicians include cardiologists, nephrologists, radiologists, etc. This is 2-3 years out of their field of study which will grievously injure their medical skills. This foolhardy practice alone is reason to avoid military commitment.

This is absolutely true and first hand verified.

Originally Posted by USAFDoc1

******hot hot hot very important notice******

the army is currently involuntarily diverting specialty trained attending physicians into 2-3 year tours in primary care as "brigade surgeons". These attendying physicians include cardiologists, nephrologists, radiologists, etc. This is 2-3 years out of their field of study which will grievously injure their medical skills. This foolhardy practice alone is reason to avoid military commitment.

This is absolutely true and first hand verified.

Multiple threads about this. Its the inevitable consequence of the death of the GMO.

Originally Posted by AF M4

It's an interesting policy that the various services are going to, very much a war-time philosophy on the use of physicians instead of an institutional one. Seems like they've got a resource (which they measure as "Physician-Years" rather than actual Physicians) that they can either invest in the future - for example, give out several radiology or orthopedic surgery residencies so that in 5 years you can pay 3 military radiology attendings for the price of one civilian contractor. Or they can spend those "Physician-Years" now, only giving the bare minimum of specialty slots while pouring the rest into GMOs, Flight Surgeons, etc. They have to know that most of the docs won't stick around after their service time is up, but the current situation is so stretched that they have no choice but to burn up all their resources now to put bodies into empty slots. It's not a good policy since it's one that smacks of simply reacting to a situation instead of having a plan, and it's one that makes me feel uncomfortable because this type of mindset immediately reaches for the easiest, quickest solution to a problem - in this case a stop-loss as the GMOs leave and the HPSP well dries up.

I know I've already ticked off a recruiter who came to a military medical student association meeting at my school: a couple of M1s thinking about signing up attended, and I told them the current situation along with what I was having to deal with. The recruiter tried to argue that what I was talking about wasn't going on, but it quickly became obvious that he didn't know anything about the match boards or anything like that - he only knew about military, nothing about doctors in the military. I told the M1s what I wish someone had told me back then: that they were not prepared to make a choice of this magnitude, and that many many things can change over the course of medical school. The money looks scary, but don't worry about it - you'll make it back soon enough. If you're still interested in the military after med school, great, look into the FAP program - you can still work in the military and the money's good, plus you get to be the kind of doc you want to be. After that I nudged their surprised little faces out the door, and told them not to worry about returning any phone calls from the military. The recruiter looked at me as if I'd just grown horns and stabbed him with a pitchfork...he started to go off, but then I told him that I wasn't disrespecting the military and that I was proud of my commitment to serve, but I also felt it was my responsibility to make sure that those trusting, bright-eyed rookie med studs weren't taken for a ride that was going to cost them the back half of their 20s. He left, and I don't think he's coming back to any more of our meetings.

So, in effect, I've contributed to the probablity of a stop-loss by the time I'm done with my commitment.

Bingo. Absolutely correct. As a military physician you are treat as a cog in a wheel, not the professional that you are.

Your life in the military:
1) The Army is forcing Physicians in subspecialty fields into primary care positions!! A cardiologst not doing cardiology for 3 years? Nuts, and wrong. I know this has been said before, but please please listen! Cardiologist = cog and primary care position impossible to fill = hole. Cog goes into hole.

2) The leadership of the military medical corps are increasingly nurses or non practicing physicians. All the practicing physicians get out, so they are all that is left. I'll let you decide what that means. (Hint: Its like having a golfer coach a football team). Be ready to have a male NP command you aoround, it'll be a rude awakening and you will not be sure what twilight zone you are in--only this is your life and not a dream. Oh man, seriously, you'll be wishing you took loans out or maybe even wish you were a NP. Again, you are pawn, a worker bee, a commoditiy and not a professional.

3) Increasingly the bad doctors stay and good doctors leave, as the services do not seem to care about treating them correctly, and with respect. The nurses sure do stay though because how else would they become your boss?

For the recruiters on the forum, you could explain to the leadership that these moves, especially #1, are short-sighted, and should discourage persons from joining or staying.

Originally Posted by Army Recruiter

Recruiters hang out here too

I can only speak about the Army but some information is likely to cross over to other services.

I will try to answer your questions, Army specific

1. No GMO, you would apply directly as a 61F Internal Medicice Doctor and you can apply during your residency (FAP or STRAP)

2. If you were to take FAP, during residency you would owe 1 for 1 plus 1
Example: 3 years FAP would be 3 years (1 for 1) plus 1 Total 4 years contractual obligation and then 4 years of inactive service

3. Not too sure of your question,but on Active Duty you would be assigned to a Hospital at any Army location worldwide

4. You may travel with the reserves perhaps during annual training, deployment or humanitarian mission.

5. You would have to complete military training but not another residency or basic training. BOLC and standard CME

6. Any fellowship would only change the specific AOC (Area Of Concentration) that you apply to.

I hope this answers some of your questions.

Dont fear the recruiters, we are not that bad, feel free to ask questions here or by PM

Army Recruiter

Please answer why the Army is using board certified subspecialists, against their will, do fill primary care positions. This makes no financial sense, as they have to pay them their subspecialty bonuses and lose someone highly trained, AND cruel to their futures as they lose their subspecialty skill while out of their field. Certainly they will seperate ASAP.

Trying to apply logic in the AMEDD is a pointless exercise.

does that help?

Originally Posted by Kallistos

How often are military doctors transferred around? Actually, my real question is...why are military doctors moved around in the first place? Wouldn't it be more efficient for them to be stationed at domestic location X and work there "forever" with deployments internationally/combat when necessary?

I know this is an old post, but I had to quote it and laugh! If only that was the case. You can certainly be moved around and have your orders broken if someone wants your location. You could be living in one town loving life and then next thing you know those 4 years of commitment you thought would be paid off in one location are split into two locations. You have to uproot your family and all of your belongings just because someone with more "seniority" wanted to live in your location. Thus, that doc gets to move over and now your command is "overmanned." And since you are the lowly LT at the command, looks like you get to move to east bumble f*ck.

As I am preparing to leave medical school and start my AD time, I am faced with the prospect of deciding whether I want to specialize while in the Army or not. My options are to train in IM, do my 4 years and get out, and move on to fellowship on the outside, or to try to get straight through training while still in the Army.

I am apprehensive to do the latter, as I would then owe the Army 6-7 years as a specialist, vs just the 4 for HPSP. Reading about subspecialists being forced into brigade surgeon slots sounds like a nightmare.

My only concern is my competitiveness for a fellowship coming out of HPSP ADSO. Is it a big deal for somebody to do a fellowship 4 years after they finish residency?

Originally Posted by DocArmy

As I am preparing to leave medical school and start my AD time, I am faced with the prospect of deciding whether I want to specialize while in the Army or not. My options are to train in IM, do my 4 years and get out, and move on to fellowship on the outside, or to try to get straight through training while still in the Army.

I am apprehensive to do the latter, as I would then owe the Army 6-7 years as a specialist, vs just the 4 for HPSP. Reading about subspecialists being forced into brigade surgeon slots sounds like a nightmare.

My only concern is my competitiveness for a fellowship coming out of HPSP ADSO. Is it a big deal for somebody to do a fellowship 4 years after they finish residency?

It depends how competitive things are in the civilian sector for your specialty. My perception as an AD doc is that it might be easier to get into some fellowships while AD. The current budget problems have made training in the military more difficult; the DoD might offer fewer fellowships and the AD fellowships are going to gave corners cut. For example, you might get to go to a meeting to present a poster but be only allowed to stay for that one day and they wouldn't pay for your registration and only pay about half what the hotel costs. I think you could do 4 years and apply to a civilian fellowship without too much problem but you would have to convince them of your currency doing scopes or critical care etc.

If you are looking for some excitement while retaining your personal freedom, there has got to be a better way than joining the military... Maybe look into a contractor job with NOAA or the State Department or Doctors without borders....Hell I am sure some oil company will let you be a doc and travel for them and pay you much more.

If you need the money then by all means try DoD out. If you come in trained and board certified you may have more sway on your assignment choice but it doesn't mean you won't get deployed away from Germany or Japan. If you feel the patriotic pull than also feel free to join.

The main problem I see with my fellow DoD colleagues is the frustration of working for a boss (often a nurse, dentist or pharmacist) who doesn't understand what we do and doesn't value good patient care and the overall long term costs for providing good patient care (like currency, seeing patients over the age of 65, CME). I get in more trouble for doing a push up incorrectly or wearing the wrong uniform on the wrong day than if I were to screw up some patient care matter. I am serious about that. Sadly.

Originally Posted by DrMetal

What determines whether or not youll go gmo is your competitiveness as an applicant, and your specialty of choice. For instance, a strong applicant applying for IM has a decent shot of going straight thru. For other specialties (more competitive stuff like rads, anes, ortho), youre likely to do a gmo no matter how strong of an applicant you are.

If youre gonna make a career out of it, and if you harbor the 7 year usuhs payback, then I think a gmo tour is a little easier to accept. You can rationalize that you'll be knocking off some payback, and youre gonna do a military residency anyway, so go out and do something interesting.

Are you really so opposed to doing a gmo, that you'd be willing to switch services? I dunno. Me, Id rather stay in the branch that I know and and am familiar with. If you switch, go Army, theyre bigger, have more residency spots, more straight thru training.

I agree with the other posts, it is more about your resume when it comes to whether you can avoid the GMO tour and go straight through. All three services have GMOs. If you like the Navy then just stay in the Navy. If it drives you crazy try something else. I think USUHS is great but not sure what budget cuts have done to the training.

Originally Posted by Kilgoretrout 65

I agree with the other posts, it is more about your resume when it comes to whether you can avoid the GMO tour and go straight through. All three services have GMOs. If you like the Navy then just stay in the Navy. If it drives you crazy try something else. I think USUHS is great but not sure what budget cuts have done to the training.

So far as I can tell the budget cuts haven't done anything to the training here at USUHS. We are being told that travel money will become much tighter so this coming summer experience may be more limited compared to years past. Unknown how travel money restrictions will effect 3rd year clinical rotations. So far it isn't effecting them.

Originally Posted by Kilgoretrout 65

The main problem I see with my fellow DoD colleagues is the frustration of working for a boss (often a nurse, dentist or pharmacist) who doesn't understand what we do and doesn't value good patient care and the overall long term costs for providing good patient care (like currency, seeing patients over the age of 65, CME).

Is this unique to the military? I feel like I see a lot more 'nurse managers' with a lot less decorum in the civilian residency programs we rotate through than in the military. The 'social workers' alone harrass the attendings and senior residents for a good half hour a day about booting every patient whose insurance has run dry. And I can't count the number of times on civilian rotations I've seen scolding, snarling nurses dualing with civilian attendings about their percieved professionalism.

I think that maybe the issue is that the military spreads this particular pain around a little more evenly than in the civilian world. In my experience more profitable/rare physicians like surgeons, urologists, and anesthesiologists tends to get spared all nursing/admin rudeness so that they won't take their precious profit margins elsewhere, while all the harassment is dumped on the poor earners like Pediatricians, IM hospitalists, and Emergency medicine doctors (can you say Press Ganey?). In the military, if anything, the reverse is true: the specialties that are more harrassed in the civilian world tend to stay in, and therefore probably have more of a presense in the upper eschelons of military medicine to make the needs of their specialties known.

Thoughts?

Originally Posted by Perrotfish

Is this unique to the military? I feel like I see a lot more 'nurse managers' with a lot less decorum in the civilian residency programs we rotate through than in the military. The 'social workers' alone harrass the attendings and senior residents for a good half hour a day about booting every patient whose insurance has run dry. And I can't count the number of times on civilian rotations I've seen scolding, snarling nurses dualing with civilian attendings about their percieved professionalism.

I think that maybe the issue is that the military spreads this particular pain around a little more evenly than in the civilian world. In my experience more profitable/rare physicians like surgeons, urologists, and anesthesiologists tends to get spared all nursing/admin rudeness so that they won't take their precious profit margins elsewhere, while all the harassment is dumped on the poor earners like Pediatricians, IM hospitalists, and Emergency medicine doctors (can you say Press Ganey?). In the military, if anything, the reverse is true: the specialties that are more harrassed in the civilian world tend to stay in, and therefore probably have more of a presense in the upper eschelons of military medicine to make the needs of their specialties known.

Thoughts?

Don't know enough about the civilian world to compare v/v how docs are treated. Most of my friends that have left have said there is no comparison, they are treated with much more respect in the civilian sector.

I do laugh when my bosses list 5 priorities, each listed as the top priority: #1 readiness, #1 patient safety, #1 currency, #1 research/GME etc etc. If someone can mold military medicine in a way to see patients, save money, and teach new doctors then I would be impressed.

Originally Posted by Kilgoretrout 65

Don't know enough about the civilian world to compare v/v how docs are treated. Most of my friends that have left have said there is no comparison, they are treated with much more respect in the civilian sector.

There IS a comparison but it does NOT look good for the military.
1. In the civilian world the providers have a very valuable education and skill set that can make the hospital a lot of $$ if things are run efficiently. With that model, most hospitals will try to maximize their efficiency to maximize the bottom line. Efficiency is a nice thing!

2. With the freedom of the specialist to go somewhere else and leave a potential gap in the hospital's care, most hospitals have little perks to entice the providers to stay with them and to attract new providers (ie.. Doctors lounges, doctor parking, stocked refrigerators, paid GME, etc..). Now, not all hospitals can afford these nice things. I've rotated at some county hospitals where these kinds of things did not exist, just like they don't in the military. But, even at the county hospitals the providers are valued. I think most docs on here feel that they are severely undervalued.

3. Now, I have had a pretty good experience with the Navy so far, but I do pretty much the same job wherever they plug me. This is not true for some of my surgical buddies. On my last deployment he had ~15 surgeries in 10 months. That is EASILY < a weeks worth of cases for him as a civilian general surgeon.

4. Unfortunately for the military the detailing process is a huge deterrent for retention. There really is no civilian equivalent. Most docs don't give it much thought until their number is up. There is a big potential to getting screwed and/or feeling screwed when looking for new orders. I have numerous first and second hand stories where folks have gotten the shaft.

Just a few thoughts

AHLTA

I have worked on ~15 different flavors of EMR now. Some are better, some of them worse. Most are very similar in ease of use. This was surprising to me as I had read all the AHLTA hating threads on here. The AHLTA folks have been designing changes to make things better (finally!). I have noticed some improvements. Now I will say that after working on AHLTA through Citrix while deployed, I will NEVER complain about it in the clinic or hospital setting again. While deployed it would take hours to sign on (if you are lucky) and forever to switch screens.
I have found that if you template as much as you can. Life is soooo much easier. Agreed, it is not as easy as maybe having your note dictated, but if done right, should only take you a few minutes each note to do.
What the military does wrong is use all the different systems that don't talk to each other very well (ESENTRIS, CHCS, AHLTA ). And there is about 100 layers of security to go through as we'll that slows things down. I think this would be true no matter what system was being used.