Military Medicine: Pros, Cons, and Opinions

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Originally Posted by 61November

Just throwing my hat into the ring, as a1 has cited the lack of Army docs chiming in on this forum as objective evidence that Army medicine is heading in the right direction, as opposed to AF, and Navy.

There are PLENTY of disgruntled army docs out there. Most of them just don't post on these forums. I don't know why- maybe the constant year-long deployments.

I hate Military Medicine, but love the Military, the Army, and especially the guys in my unit. Being the flight doc for a Combat Arms unit is the best decision I've ever made. As a GMO Flight Surgeon (yes we are still out there) I don't enjoy playing three card monty with my medical license, but that's life, and that's the mission.

The bureaucracy in the Army still SUCKS. The hospital I trained in was cowmanded by a Nurse "General." It was overrun with MSC commandos, dieticians, other non-deployable wastes of protoplasm who were an embarrassment to the Army and this country, whose prime concern was to leave the hospital at 1500 daily. And don't even get me started on the civilian contractors. My point is that laziness, incompetence, and complacency are a huge issue service-wide. It is a glimpse of the type of socialized medicine that the Marxists currently in control would like to foist on the rest of the country, God help us all.

And **** Metrics, RVU's, DHMRSi, H1N1 protocols, Respect.mil and other things dreamed up by the Clipboard commandos who, like the proverbial dead Carp in a fetid pond, have risen to the top in the Medical Corpse.

To back up my point above, and to discredit the Army-GMO fallacy, 5/6 of the flight docs in my Brigade are GMO's. And that's the norm, thanks to the Army's asinine policy of ending deferrals for ER, Ortho, Rads etc. in the HPSP years of 2007,2008 in a lame and short-sighted attempt to strong-arm people into undesirable specialties.

I've got 3.5 years left, and then I am popping smoke on this Charlie Foxtrot. Luckily I'll get enough experience downrange to forestall complete atrophy of what limited medical skills I possess.

This message probably reeks of bitterness- but it is bitterness towards Big Army Medicine and the idiot bureaucrats and time-servers currently in control. My advice to all the young HPSP'ers, get into a Combat Arms unit and enjoy the ride. You'll be PROFIS'd there anyways, so get in on the ground floor and become a part of the Army.

BTW, anecdotally, I know of ZERO docs who, when given the chance to get out, stayed in. This of course excludes the aforementioned groups- endless committments, those nearing 20, and those likely too dangerous to work on the outside.

61N

Thanks for the Army update. As a disgruntled GMO, I guess you are mostly in the second group of people who comprise this forum.

Name calling aside, and as a stand up professional, its good that your bias is not too obvious.

Hiding the facts of military medicine's inadequacies does not do anyone anygood. As messed up civilian medicine is, its no where near as screwed as military medicine in ALL services is today.

Originally Posted by AFRadiolgist

From AFRadiologist:
Any way, as the only radiologist in this clinic, I inform her that we need a new transcriptionist. Solution: She informs me that I should type my own reports. YEA! I'll get right on that - about 80 reports a day. Why don't I check the patients in, answer the phone, and shoot the xrays as well! I suggest voice recognition. "They can do that?" she asks. She later informs me that the Air Force has not 'approved' a voice recognition system yet and might do so in a year or so or it might take longer. AWESOME! In the meantime, patients and physicians continue to call and complain about their reports not being done. "Patient care is secondary," she informs me. GREAT! That's the second time in 6 months that I've heard that from a commander. At least they (the powers that be) are consistent.

There are things I liked about military medicine but you hit the nail on the head with some of the military medicine leadership issues I ran into. You present a valid request and it gets turned around on you. The expectation is someone would sit down with you, understand and validate the concern and support you. If you can't be supported that would be acknowledged and an alternative plan would be constructed.

I found military medicine to be political and malignant at times. The medical commanders would fear how they would look because they are always thinking about their next job. To a certain extent that is human but it seemed carried to an extreme. What if your commander called the regional medical commander and advised of a problem with radiology? "How would that make me look?" Then again, the regional commander might turn the issue around on the hospital commander just like what happened to you...

What did she mean by patient care is secondary? I really didn't understand that.

Originally Posted by IgD

What did she mean by patient care is secondary? I really didn't understand that.

Patient care in the military has always been secondary to paperwork/administrivia/training/whatever else nurse leadership feels is important at that moment.

To the potential HPSP victims out there, read these forums and contact several of us who are there or have been there. Caveat emptor.

Originally Posted by BomberDoc

Patient care in the military has always been secondary to paperwork/administrivia/training/whatever else nurse leadership feels is important at that moment.

To the potential HPSP victims out there, read these forums and contact several of us who are there or have been there. Caveat emptor.

BomberDoc,

Have'nt seen you here in a while. I myself have noted that time has healed some of these wounds, but never fully.

The abomination that military medicine is and the tragedies that our servicemen and women face always has me coming back.

I don't see change anytime soon, and it's a repeating cycle to watch all these naive ambitions people joining a system they really do not understand, and will grow to truly dislike.

Hope you are doing well in your residency. Let me know if you need anything.

I feel I had a quality internship, and I am enjoying my GMO tour (although of course, if I had a choice, I would have preferred to go straight through residency training).

Patient care is never subordinate to administrative tasks because I won't let it be. I have missed numerous meetings and "mandatory" training sessions due to patient care issues, and my Marine commanders have never second-guessed me.

When I feel policies and orders are interfering with my ability to provide the highest level of care, I push back or ignore the policies/orders. These instances are very rare, and usually turn out in my favor.

I have had the opportunity to do a lot of cool things I never would have been able to do in the civilian world. During my last deployment, I worked with Iraqi physicians and saw Iraqi patients, which was a fascinating glimpse into another culture and medical system. I have done combat training. I have done Marine Corps Martial Arts Training. I have seen TOW missles and SASRs fired. I have been forced to PT regularly, which makes my wife very happy.

All in all, I'm still happy, 2 years and change on active duty.

Originally Posted by Tired

I feel I had a quality internship, and I am enjoying my GMO tour (although of course, if I had a choice, I would have preferred to go straight through residency training).

Patient care is never subordinate to administrative tasks because I won't let it be. I have missed numerous meetings and "mandatory" training sessions due to patient care issues, and my Marine commanders have never second-guessed me.

When I feel policies and orders are interfering with my ability to provide the highest level of care, I push back or ignore the policies/orders. These instances are very rare, and usually turn out in my favor.

I have had the opportunity to do a lot of cool things I never would have been able to do in the civilian world. During my last deployment, I worked with Iraqi physicians and saw Iraqi patients, which was a fascinating glimpse into another culture and medical system. I have done combat training. I have done Marine Corps Martial Arts Training. I have seen TOW missles and SASRs fired. I have been forced to PT regularly, which makes my wife very happy.

All in all, I'm still happy, 2 years and change on active duty.

Thats good to hear. I assume based on your recent activity that you are home safely. Are you applying to go back to train inside or gonna go make the bucks as a civilian orthopod?

Originally Posted by Galo

BomberDoc,

Have'nt seen you here in a while. I myself have noted that time has healed some of these wounds, but never fully.

The abomination that military medicine is and the tragedies that our servicemen and women face always has me coming back.

You must wound easily if the peacetime AF left such deep scars.

A bit dramatic if you ask me.

With regards to posting on this form for the benefit of servicemembers - I would argue - this is a bit delusional. I definitely support getting accurate information in the hands of potential military medical physicians (I don't want coworkers who are bitter b/c they feel they were lied to or don't want to be there)- there has to be balance - to label military medicine as an abomination is obscene and not helpful to those looking for honest information.

I work every day to make things better for servicemembers and their families, as do most of my coworkers. Effective leaders, even mid level ones can make tangible differences in their immediate area - sure not at the Big Army level but at the level which counts - at the patient care level.

You would like to pigeon hole me as an apologist for the Army, or Military Medicine in general. This would be decidely innaccurate as I have taken professional risk in posting my very frank and unvarnished criticisms of Military Medicine. READ MY EARLIER POSTS IF YOU DOUBT THIS -

Unlike you - rather than trashing the system and working to undermine it, I'm chipping away at what I can fix which actually has been quite a bit.

I don't think I've had a resident, or medical student civilian or military, or visiting physician who has not been impressed with the quality of care provided in MY Department. I don't want to sound like I'm puffing my chest out here but I'm proud of what my coworkers have done and continue to do to the benefit of all servicemembers, retirees and family members in our area.

You can trash me all you want, and try to dismiss me but ultimately, I'm in the fight, you are not-

While I appreciate your service, and will assume you were a quality surgeon and officer (General Officer Letter or Remprimand aside) - I have issues with your current conduct.

If I am not mistaken, you served pre-9/11 (apologies if I am wrong on this), and as such have not deployed but are quite vested in undermining the system which supports OUR soldiers/airmen and sailors. In the 8 years since 9/11 what have you done tangible to improve the care of soldiers and servicemembers other than rant on a medical student board?

Originally Posted by Gastrapathy

Thats good to hear. I assume based on your recent activity that you are home safely. Are you applying to go back to train inside or gonna go make the bucks as a civilian orthopod?

I'm back, it was mostly boring, but a few interesting experiences with the photos to prove it.

My desire is still to go back to Navy training, but it's not going to be next cycle. Due to multiple family and financial issues, I'm going to extend out another two years with the Marines (assuming I haven't pissed them off to the point where the higher-ups don't want me around anymore). This will this keep the family happy a little longer, and give me a chance to pad the bank account before moving back to one of the hyper-expensive cities the Navy has major MTFs in.

There is also the question of what they are going to do with people like me, now that GMO is being "phased out". If everyone is doing straight-through training by the time I reapply, will they leave me out in the cold, or maybe FTOS becomes an option? We'll see how it looks in a few more years, but there is certainly an allure to applying to residency knowing full well that, if it doesn't work out or I don't like what I see, I can always bounce out to the civilian world.

If you are facing financial pressures, I suspect in a couple of years you'll have to get out. Civilian orthopods make a lot of money.

Originally Posted by a1qwerty55

You must wound easily if the peacetime AF left such deep scars.

A bit dramatic if you ask me.

With regards to posting on this form for the benefit of servicemembers - I would argue - this is a bit delusional. I definitely support getting accurate information in the hands of potential military medical physicians (I don't want coworkers who are bitter b/c they feel they were lied to or don't want to be there)- there has to be balance - to label military medicine as an abomination is obscene and not helpful to those looking for honest information.

I work every day to make things better for servicemembers and their families, as do most of my coworkers. Effective leaders, even mid level ones can make tangible differences in their immediate area - sure not at the Big Army level but at the level which counts - at the patient care level.

You would like to pigeon hole me as an apologist for the Army, or Military Medicine in general. This would be decidely innaccurate as I have taken professional risk in posting my very frank and unvarnished criticisms of Military Medicine. READ MY EARLIER POSTS IF YOU DOUBT THIS -

Unlike you - rather than trashing the system and working to undermine it, I'm chipping away at what I can fix which actually has been quite a bit.

I don't think I've had a resident, or medical student civilian or military, or visiting physician who has not been impressed with the quality of care provided in MY Department. I don't want to sound like I'm puffing my chest out here but I'm proud of what my coworkers have done and continue to do to the benefit of all servicemembers, retirees and family members in our area.

You can trash me all you want, and try to dismiss me but ultimately, I'm in the fight, you are not-

While I appreciate your service, and will assume you were a quality surgeon and officer (General Officer Letter or Remprimand aside) - I have issues with your current conduct.

If I am not mistaken, you served pre-9/11 (apologies if I am wrong on this), and as such have not deployed but are quite vested in undermining the system which supports OUR soldiers/airmen and sailors. In the 8 years since 9/11 what have you done tangible to improve the care of soldiers and servicemembers other than rant on a medical student board?

Your name calling, unprofessionalism and narcissism are dead on as usual.

You always claim here that whatever is around you colleagues, students, residents, patients... have the best experience in military medicine. That you somehow are immune to all the problems of military medicine, and that what you provide is better even than civilian medicine.

You really expect people to believe this??

It's no secret military medicine across all branches has serious and often irreparable problems. That somehow you (because of your superior personality? ability? whatever?) avoid it all really seems more dishonest than anything I have ever said on this forum.

My postings here are my experiences, and that of many other good and great physicians who experienced acrymony at the hands of much lesser officers who happen to have had nothing other than rank, and selfish intentions. Whether at war or not, (and yes I was post 9/11), those experiences were often beyond reason, and certainly not in the interest of patient care.

I think military medicine is badly broken. I think people considering it should know all they can, good and bad. Unfortunately its mostly bad. Since you seem to offer mostly good, how can you assure people they will work with you, or people like you? What exactly have you done to make things better? We offer many specific problems we face. You claim you have made criticisms, and you are afraid of being identified. I think your anonimity and your internet disinhibition has made you one of the most malignant and dishonest posters here. Just this week you accosted a poster suggesting that his army CRNA relative that warned him against joining the army did not like her job, and likely had no experience about how much worse AF hospitals. Anyone who had a bad experience and posts it is open to a personal attack from you.

We've been down this road before. If I make such outrageous claims, there are plenty of people here to call me on them, so why not take a break from your false vigilantism? Stick to what you know, and post exactly what you make better, other than just saying you make things better. People may take you more seriously other than comparing you to the guy on Animal House.

Originally Posted by Galo

Your name calling, unprofessionalism and narcissism are dead on as usual.

You always claim here that whatever is around you colleagues, students, residents, patients... have the best experience in military medicine. That you somehow are immune to all the problems of military medicine, and that what you provide is better even than civilian medicine.

You really expect people to believe this??

Hopefully those who read this forum will have enough insight to determine which posters are out there to provide balanced information and are credible and those with an axe to grind. I embellish nothing in my posts. As far as guarantees that everyone will have the same experiences I have had (sorry can't offer any, nor can anyone in life) as far as specific examples.. do you want me to post my CV? Not something for privacy reasons I'm willing to do. Even if I did you'd find someway to try to trivialize them anyway.

I have taken to stepping away from the computer and not responding to your inflammatory posts until a few days have passed and I can put something constructive. For about six months the tenor here was mostly civil actually bordering on boring and largely constructive. It's unfortunately to see it spin up again. It is such a waste of my time to banter with you. Afterall, there really is no reason to expect you and I will find some kind of common ground but some decorum would be nice.

Your global view is that military medicine is universally poor (you have stated so inumerable times)- my view on the other hand is that it is flawed no doubt but there is much good. The mission (caring for our servicemembers their families and vets) is essential and honorable - there are areas of excellence as well as weak ones but over time even the weak areas with good leadership can be made better. The reality of military life is that there will be sacrifices but so be it. There is honor in doing for others rather than measuring your life in terms of days off and dollars made. In my case my quality of life and income would improve substantially if I left the military but I have time after retirement to chase money if I wish. And no, I don't stay on because I can't make it outside - I do so b/c I can make the greatest tangible benefit where I am now, and I hope to be able to look back on my career with a sense of accomplishment as I transition to my civlian medical practice.

Originally Posted by 61November

There are PLENTY of disgruntled army docs out there. Most of them just don't post on these forums. I don't know why- maybe the constant year-long deployments.

Agree - I've never said everyone or even most Army docs are happy.

Originally Posted by 61November

The bureaucracy in the Army still SUCKS.
And **** Metrics, RVU's, DHMRSi, H1N1 protocols, Respect.mil and other things dreamed up by the Clipboard commandos

Couldn't agree more - My prior posts have detailled the countless hours lost to mandatory training - Had to reschedule patients twice this week for short notice mandatory training.

Originally Posted by 61November

To back up my point above, and to discredit the Army-GMO fallacy, 5/6 of the flight docs in my Brigade are GMO's. And that's the norm, thanks to the Army's asinine policy of ending deferrals for ER, Ortho, Rads etc. in the HPSP years of 2007,2008 in a lame and short-sighted attempt to strong-arm people into undesirable specialties.

Intersting point - because I work with military R1's and see very very few end up in GMO positions, I didn't really consider what is happing to those who do civilian internships- I would guess you did one and b/c many residencies are categorical - you were competing for a tiny number of open slots against R1's who were known commodities - b/c they were already working in the military system. To give you an example I reviewed the assignments for my facility's graduating R1's for the past 3 years and only 1-2 per year out of a large group were doing GMO's and usually one of them requested it and the other was a very weak applicant.

Originally Posted by 61November

I've got 3.5 years left, and then I am popping smoke on this Charlie Foxtrot. Luckily I'll get enough experience downrange to forestall complete atrophy of what limited medical skills I possess.

. Understandable given your experience

Originally Posted by 61November

BTW, anecdotally, I know of ZERO docs who, when given the chance to get out, stayed in. This of course excludes the aforementioned groups- endless committments, those nearing 20, and those likely too dangerous to work on the outside.

I know a fair number who have stayed past their obgliation but these are generally subspecialists with reasonably good lifestyles and with a deployment tempo which is more tolerable - Few primary care, or high pay specialists stay in for reasons I've detailed in an earlier post - which is understandable.

Whether you stay or not, you've likely done good for your soldiers and for what it is worth, I appreciate your service.
Thanks.

Originally Posted by Galo

You always claim here that whatever is around you colleagues, students, residents, patients... have the best experience in military medicine. That you somehow are immune to all the problems of military medicine, and that what you provide is better even than civilian medicine.

You really expect people to believe this??

I'm not taking up for a1, but I think this is worth responding to.

You and others tend to speak of this system like we are all comletely at its mercy, like the smallest whim from above destroys all ability to care for our patients. But you of all people should know that is hardly the case, the policies and regulations can be ignored and worked around, and that ultimately you are the biggest determinant of the care that your patients receive.

Obviously I can't do anything about physician pay, deloyments, utilization, budgeting, and resource allocation. But there is one thing I can do: I have 900 Marines assigned to me, and when they need something I go balls-to-the-wall to make sure they get it. This usually requires far more work than I would put in on the civlian side. I am frequently in the ER at midnight overseeing disposition on my Marines. I fight with people much higher ranking than me when patients are inappropriately deferred to civilian providers, or turned down for a particular procedure or consult. I beg, borrow, and steal to get the supplies and medications that I need, but the Marine Corps does not see fit to purchase for me. I have acquainted myself fully with all regulations, laws, and orders related to my field, and I wield them like a bat when outside forces try to force me to change my medical practice to meet the latest bull**** metric.

You can give quality care in this system. You can give care that exceeds civilian standards, and I know because I see it every day. But you have to work at it. The worst physicians in the military are the ones who cower in the face of commanders and higher-ranking administrators, and whine about how bad the system is while they drive home at 1530 every day.

I don't know if the system is broken. I'm not even sure I really care. But I know that my clinic isn't broken, because I make sure it's not. So I wouldn't be so quick to dismiss those on this board who say that they provide high quality care to their patients.

Some very interesting posts.

In the interest of full disclosure, I don't think that the entire system is broken, nor that every physician in it has been co-opted. I have seen plenty of great mil docs, even at the 05-06 level who bust their butts to provide great care and overcome the hurdles placed in front of them.

And Tired's post sums up the special devotion that many GMO's feel towards their charges- a unique experience that those not assigned to Combat units rarely experience. We can argue the merits of GMO all day long, but the genuine camraderie and sense of mission in these outfits is tangible- it is a wonderful thing to be a part of.

My issues with Military Medicine stem from what I have seen around the Big Hospitals and MEDDACS- civilian contract employees not accountable to those they work for, a furious outsourcing of the 65 and over population, and the proliferation of administrators who see no patients and instead spend their time making clinicians' lives miserable.

I've thought for a long while that the military should get out of the GME business all together, if it is not going to do it right. Let docs train civilian and then draft them for 2 year stints. That way people get adequate training, and aren't burdened with the long obligations that breed complacency and misery. You could incentivize the service by paying back a portion of the new doctor's student loans. Incidentally, if only those who were board eligible or board certified were drafted, you avoid the whole GMO issue.

61N

Originally Posted by Tired

I'm not taking up for a1, but I think this is worth responding to.

You and others tend to speak of this system like we are all comletely at its mercy, like the smallest whim from above destroys all ability to care for our patients. But you of all people should know that is hardly the case, the policies and regulations can be ignored and worked around, and that ultimately you are the biggest determinant of the care that your patients receive.

Obviously I can't do anything about physician pay, deloyments, utilization, budgeting, and resource allocation. But there is one thing I can do: I have 900 Marines assigned to me, and when they need something I go balls-to-the-wall to make sure they get it. This usually requires far more work than I would put in on the civlian side. I am frequently in the ER at midnight overseeing disposition on my Marines. I fight with people much higher ranking than me when patients are inappropriately deferred to civilian providers, or turned down for a particular procedure or consult. I beg, borrow, and steal to get the supplies and medications that I need, but the Marine Corps does not see fit to purchase for me. I have acquainted myself fully with all regulations, laws, and orders related to my field, and I wield them like a bat when outside forces try to force me to change my medical practice to meet the latest bull**** metric.

You can give quality care in this system. You can give care that exceeds civilian standards, and I know because I see it every day. But you have to work at it. The worst physicians in the military are the ones who cower in the face of commanders and higher-ranking administrators, and whine about how bad the system is while they drive home at 1530 every day.

I don't know if the system is broken. I'm not even sure I really care. But I know that my clinic isn't broken, because I make sure it's not. So I wouldn't be so quick to dismiss those on this board who say that they provide high quality care to their patients.

Ignoring orders that conflict with patient interest and safety, as well as privacy, or altering their use is a common practice that I use on behalf of my 1300 Marines. It works at times and I get in trouble at times and lose. But many of the complaints about military medicine are due to the fact that you have to fight these battles in the first place. It is a little more understanding from the military chain of command, but when orders with no medical evidence are given from the medical chain of command it is really frustrating.

Originally Posted by Tired

I'm not taking up for a1, but I think this is worth responding to.

You and others tend to speak of this system like we are all comletely at its mercy, like the smallest whim from above destroys all ability to care for our patients. But you of all people should know that is hardly the case, the policies and regulations can be ignored and worked around, and that ultimately you are the biggest determinant of the care that your patients receive.

Obviously I can't do anything about physician pay, deloyments, utilization, budgeting, and resource allocation. But there is one thing I can do: I have 900 Marines assigned to me, and when they need something I go balls-to-the-wall to make sure they get it. This usually requires far more work than I would put in on the civlian side. I am frequently in the ER at midnight overseeing disposition on my Marines. I fight with people much higher ranking than me when patients are inappropriately deferred to civilian providers, or turned down for a particular procedure or consult. I beg, borrow, and steal to get the supplies and medications that I need, but the Marine Corps does not see fit to purchase for me. I have acquainted myself fully with all regulations, laws, and orders related to my field, and I wield them like a bat when outside forces try to force me to change my medical practice to meet the latest bull**** metric.

You can give quality care in this system. You can give care that exceeds civilian standards, and I know because I see it every day. But you have to work at it. The worst physicians in the military are the ones who cower in the face of commanders and higher-ranking administrators, and whine about how bad the system is while they drive home at 1530 every day.

I don't know if the system is broken. I'm not even sure I really care. But I know that my clinic isn't broken, because I make sure it's not. So I wouldn't be so quick to dismiss those on this board who say that they provide high quality care to their patients.

Who gets to drive home at 1530??????

Originally Posted by rogershru2

Who gets to drive home at 1530??????

It better be people who started work at 0500. In civilian practices it is not unusual to leave at that hour if the clinic starts at 7:30 am so that they can round on the inpatients or beat rush hour traffic.

Originally Posted by Tired

You and others tend to speak of this system like we are all comletely at its mercy, like the smallest whim from above destroys all ability to care for our patients. But you of all people should know that is hardly the case, the policies and regulations can be ignored and worked around, and that ultimately you are the biggest determinant of the care that your patients receive.

Obviously I can't do anything about physician pay, deloyments, utilization, budgeting, and resource allocation. But there is one thing I can do: I have 900 Marines assigned to me, and when they need something I go balls-to-the-wall to make sure they get it. This usually requires far more work than I would put in on the civlian side. I am frequently in the ER at midnight overseeing disposition on my Marines. I fight with people much higher ranking than me when patients are inappropriately deferred to civilian providers, or turned down for a particular procedure or consult. I beg, borrow, and steal to get the supplies and medications that I need, but the Marine Corps does not see fit to purchase for me. I have acquainted myself fully with all regulations, laws, and orders related to my field, and I wield them like a bat when outside forces try to force me to change my medical practice to meet the latest bull**** metric.

That exactly describes the type of approach I had to take to be a Navy Division Psychiatrist serving with Marines. To get the mission done you had to do it Robin Hood style!

Originally Posted by Tired

I'm not taking up for a1, but I think this is worth responding to.

You and others tend to speak of this system like we are all comletely at its mercy, like the smallest whim from above destroys all ability to care for our patients. But you of all people should know that is hardly the case, the policies and regulations can be ignored and worked around, and that ultimately you are the biggest determinant of the care that your patients receive.

Obviously I can't do anything about physician pay, deloyments, utilization, budgeting, and resource allocation. But there is one thing I can do: I have 900 Marines assigned to me, and when they need something I go balls-to-the-wall to make sure they get it. This usually requires far more work than I would put in on the civlian side. I am frequently in the ER at midnight overseeing disposition on my Marines. I fight with people much higher ranking than me when patients are inappropriately deferred to civilian providers, or turned down for a particular procedure or consult. I beg, borrow, and steal to get the supplies and medications that I need, but the Marine Corps does not see fit to purchase for me. I have acquainted myself fully with all regulations, laws, and orders related to my field, and I wield them like a bat when outside forces try to force me to change my medical practice to meet the latest bull**** metric.

You can give quality care in this system. You can give care that exceeds civilian standards, and I know because I see it every day. But you have to work at it. The worst physicians in the military are the ones who cower in the face of commanders and higher-ranking administrators, and whine about how bad the system is while they drive home at 1530 every day.

I don't know if the system is broken. I'm not even sure I really care. But I know that my clinic isn't broken, because I make sure it's not. So I wouldn't be so quick to dismiss those on this board who say that they provide high quality care to their patients.

Clearly there is a difference in philosophy between the Marine Corps and the Air Force. I think its been clearly pointed out here that AF medical leadership is undoubtedly the worst of all services, and the reason that many of the fights you pick and win are not winable in the air force and paint a target on you that never goes away.

I think its great that you bust your butt to get your marine's taken care of. I did so as well, often to the detriment of my well being. I was the only surgeon who choose to accept the mandate to stay current in trauma by becoming an attending at the local level 1 trauma center, and despite doing it by the book it came back to haunt me. Only one example. Also, most of my people were not active duty but a combination of dependents and active duty.

I think the most important point, and another poster also made it, is that you have to fight these fights to provide care. That should not be.

I do think there is quality care given in the military. Its often because of the fights we have to make. I also know there is a majority of physicians who do not care to take up those fights, and their care of patients shows.

The following quotes are by a1qwerty55.

Years on this forum and I still can't use the quote thing correctly.

Hopefully those who read this forum will have enough insight to determine which posters are out there to provide balanced information and are credible and those with an axe to grind.

I feel the same way. People should be intelligent enough to read a post, and based on the posters history make somewhat of a determination on where that person is coming from. Fortunately all of our prior posts are here for people to look at if that's what they want to do. Even if they see too much drama to take you and me seriously, there are plenty of others to provide a more balanced and fair evaluation of what military medicine has deteriorated to.

I embellish nothing in my posts. As far as guarantees that everyone will have the same experiences I have had (sorry can't offer any, nor can anyone in life) as far as specific examples.. do you want me to post my CV? Not something for privacy reasons I'm willing to do. Even if I did you'd find someway to try to trivialize them anyway.

You may not think you embellish, but you're quick to condemn and belittle experiences you have absolutely no way to know are not true. You often do this in an insulting and nasty manner. Also you do it as a natural reaction to criticisms of military medicine, as if whoever says something negative has some alterior motive. Its a natural reaction to respond in the same fashion, and why you and I will never see things the same way. I'm glad you acknowledge that others may not have the positive experience as you, I think most will not.

I have taken to stepping away from the computer and not responding to your inflammatory posts until a few days have passed and I can put something constructive. For about six months the tenor here was mostly civil actually bordering on boring and largely constructive. It's unfortunately to see it spin up again. It is such a waste of my time to banter with you. Afterall, there really is no reason to expect you and I will find some kind of common ground but some decorum would be nice.

Its nice that you've taken 5 before blasting me. Though tenor here may have been boring to you, I think it's been pretty status quo. People ask questions about joining, and the answers are usually to proceed with heavy caution as there is multiple problems with military medicine. What instance do you see as constructive? We here cannot affect policy, cannot affect leadership, etc. Do you consider it positive if more people become military physicians into a system that alot of us think is very poor?

If you show decorum, you will get it.

Your global view is that military medicine is universally poor (you have stated so inumerable times)- my view on the other hand is that it is flawed no doubt but there is much good. The mission (caring for our servicemembers their families and vets) is essential and honorable - there are areas of excellence as well as weak ones but over time even the weak areas with good leadership can be made better.

I agree, I think military medicine is very poor. I think universally is a word you used, not I. Although there are some good things, I have often said the bad outweighs the good multiple times over. I also agree it is honorable to serve, I have never stated otherwise. Although the weak areas could be made better with good leadership, my point over and over is that good leadership does not exist, and I do not see it materializing any time soon.

The reality of military life is that there will be sacrifices but so be it. There is honor in doing for others rather than measuring your life in terms of days off and dollars made. In my case my quality of life and income would improve substantially if I left the military but I have time after retirement to chase money if I wish. And no, I don't stay on because I can't make it outside - I do so b/c I can make the greatest tangible benefit where I am now, and I hope to be able to look back on my career with a sense of accomplishment as I transition to my civlian medical practice.

Well put, and its good that you have been able to make yourself happy where many of us failed. I don't believe its the norm for most military physicians.

If your responces were on an even keel like this, you and I would not have the nasty back and forth. Thank you for once responding in an appropriate manner.

Originally Posted by rogershru2

Ignoring orders that conflict with patient interest and safety, as well as privacy, or altering their use is a common practice that I use on behalf of my 1300 Marines. It works at times and I get in trouble at times and lose. But many of the complaints about military medicine are due to the fact that you have to fight these battles in the first place. It is a little more understanding from the military chain of command, but when orders with no medical evidence are given from the medical chain of command it is really frustrating.

Maybe we shouldn't have the fight it, but the reality is that we do. I lose sometimes too, and get my pee-pee knocked around by the scrambled egg cover crews. It's okay. The joy of being a GMO is that it's a Marine LtCol who signs my FitReps, not a doctor. That gives me a degree of latitude that I will likely never experience again in military medicine.

I think any large insitution will have problems akin to what we deal with. The VA certainly does. HMOs do as well. This may not be as good as private practice in terms of autonomy and dealing with the non-clinical managers, but I also don't feel it's as bad as many other people are this board do.

I don't believe in "callings" or any of that other new-age crap. But I do believe that, regardless of the job you find yourself in, you have a responsibility to do it to the absolute best of your abilities. That's what I'm doing, and it's what I will continue to do. For some of my colleagues, the daily battles they have to wage wear them down, and they become bitter and give up. Those are the 1530 departures I was talking about; I haven't met too many of them, but definitely a few. They aren't doing anything for their patients, and I don't have much respect for them.

Originally Posted by Galo

BomberDoc,

Have'nt seen you here in a while.

Galo, thanks for the kind words. I check in once in a while in order to remind myself how great civilian life is. I'm not very active here anymore, but continue to vigorously spread the truth about military medicine, especially to the medical students who rotate through my department. Quite a few describe the shady tactics and lies that the recruiters tell once a year to the med studs during some "roadshow." A few have decided to stop answering the recruiter's calls and emails at least in part due to our conversations.

Residency is grand. The B.S. factor is lower by a few orders of magnitude compared to milmed. Keep fighting the good fight. I hope you continue to do well.

-ex BomberDoc

Originally Posted by BomberDoc

Galo, thanks for the kind words. I check in once in a while in order to remind myself how great civilian life is. I'm not very active here anymore, but continue to vigorously spread the truth about military medicine, especially to the medical students who rotate through my department. Quite a few describe the shady tactics and lies that the recruiters tell once a year to the med studs during some "roadshow." A few have decided to stop answering the recruiter's calls and emails at least in part due to our conversations.

Residency is grand. The B.S. factor is lower by a few orders of magnitude compared to milmed. Keep fighting the good fight. I hope you continue to do well.

-ex BomberDoc

Thanks for the encouragement! I am thankfully nearing the end of my GMO tour with the Marines, 1 more deployment to go. Then I'll be in my dream CIVILIAN residency (which my military experience/GMO tour helped me get) and life will be good.

What were the ages of people that were accepted to the army program??

Originally Posted by rogershru2

Thanks for the encouragement! I am thankfully nearing the end of my GMO tour with the Marines, 1 more deployment to go. Then I'll be in my dream CIVILIAN residency (which my military experience/GMO tour helped me get) and life will be good.

Life will be good in residency . . . .. HAHAHAHAHAAHAHAHAHAHAAHAHAHAHHAHAHAAHAHAHAH


Sorry! I couldn't resist.

Originally Posted by Mirror Form

Life will be good in residency . . . .. HAHAHAHAHAAHAHAHAHAHAAHAHAHAHHAHAHAAHAHAHAH


Sorry! I couldn't resist.

Sounds like someone has a case of the Mondays!!!!


As compared to GMO life, yes absolutely, no question!

[QUOTE=Tired;8646697] The joy of being a GMO is that it's a Marine LtCol who signs my FitReps, not a doctor. That gives me a degree of latitude that I will likely never experience again in military medicine.


Having a LtCol write the FitRep (as if a LtCol ever actually writes the fitrep, we write our own) is one of the absurdities of GMO-land. If you have a good haircut, wear your uniform correctly, show up to meetings, and PT, then they think you're the best doctor in the world, even if you don't know a thing about medicine.

[QUOTE=a1qwerty55;8617007]Cheerleader is dismissive and intellectually dishonest.

"Regarding attrition: There is a normal attrition that is just a feature of being in the military or any system in general. HMO's also have significant attrition, not always a sign of a poor work environment. I think it is totally understandable that most who enter the military to pay bills will when given the opportunity to control their where they live, eliminate deployment risk and increase income will exit - appropriately. The military will never ever be able to equal the pay of top tier civilian jobs."


Ironically, the above commnet is an example of the problem in the Navy: the more senior officers live in another galaxy.
"Normal attrition"? I suppose that this point is proven by (1) looking at te declining numbers in recruitment in 2004-6 (~07). The almost quadruplying of the HPSP scholarship in only 3 years; (3) the offering of 20K bonuses to sign up, and all sorts of half-deals and "sweat deals"--almost any kind of contract being offered, akin to the the practice of hiring mercenaries of old. In addition, it is not only misinformed but misleading to suggest that the rise of nurses and adminstrators in the Navy to "run the show" reflects poor performance in the physicians. The problem is that they prefer to get the "mules" (the physicians) not to do any admin (most may not want to do this anyway, though not at the expense of the fiasco that is spreading as a contagion of poor adminstration); the Navy wants RVUs!! Productivity!! It is the "business model" mentality applied to the low income world of the military that is partly sinking the ship. But what would our friend above know about any of this--he is the embodiment of the status quo, what needs serious improvement. One more thing, where I work civilians do not stand the same watches as the uniformed providers--an added bonus per our friend above I guess (since what his peers do is "poor performance" in his eyes).
I repeat--nurses will try to run your life and will try to push you around if you joint the medical corps at this time. I know one that works at my place--a very unprofessional pedigree of nurse that was placed (really misplaced) in my Dept. I won't even describe the unprofessionalism since our friend above will most likely emit a soft mea culpa!
Cheers!

[QUOTE=Magnesium;8773587]

Originally Posted by a1qwerty55

Cheerleader is dismissive and intellectually dishonest.

"Regarding attrition: There is a normal attrition that is just a feature of being in the military or any system in general. HMO's also have significant attrition, not always a sign of a poor work environment. I think it is totally understandable that most who enter the military to pay bills will when given the opportunity to control their where they live, eliminate deployment risk and increase income will exit - appropriately. The military will never ever be able to equal the pay of top tier civilian jobs."


Ironically, the above commnet is an example of the problem in the Navy: the more senior officers live in another galaxy.
"Normal attrition"? I suppose that this point is proven by (1) looking at te declining numbers in recruitment in 2004-6 (~07). The almost quadruplying of the HPSP scholarship in only 3 years; (3) the offering of 20K bonuses to sign up, and all sorts of half-deals and "sweat deals"--almost any kind of contract being offered, akin to the the practice of hiring mercenaries of old. In addition, it is not only misinformed but misleading to suggest that the rise of nurses and adminstrators in the Navy to "run the show" reflects poor performance in the physicians. The problem is that they prefer to get the "mules" (the physicians) not to do any admin (most may not want to do this anyway, though not at the expense of the fiasco that is spreading as a contagion of poor adminstration); the Navy wants RVUs!! Productivity!! It is the "business model" mentality applied to the low income world of the military that is partly sinking the ship. But what would our friend above know about any of this--he is the embodiment of the status quo, what needs serious improvement. One more thing, where I work civilians do not stand the same watches as the uniformed providers--an added bonus per our friend above I guess (since what his peers do is "poor performance" in his eyes).
I repeat--nurses will try to run your life and will try to push you around if you joint the medical corps at this time. I know one that works at my place--a very unprofessional pedigree of nurse that was placed (really misplaced) in my Dept. I won't even describe the unprofessionalism since our friend above will most likely emit a soft mea culpa!
Cheers!

Cut back on the magnesium is seems to be affecting your attention.- you are reading too much into my post.

I'm one of the "mules" as a full time clinician. So please don't try to ascribe the problems of military medicine to me.

I understand reading is challenging for many, but nowhere did I defend the "status quo". I only pointed out the irrefutable fact that attrition while not desirable is a reality in any system. It also is not totally reflective of physician satisfaction with their work environment. Even if pay in the military were 150% the civilian sector and they blew flowers up your ass, plenty of people would leave to control their destiny, in other words not deploy, control where they live, what they wear and who they screw and what they do on their off time.

Originally Posted by a1qwerty55

Even if pay in the military were 150% the civilian sector and they blew flowers up your ass, plenty of people would leave to control their destiny, in other words not deploy, control where they live, what they wear and who they screw and what they do on their off time.

Quote of the year.

[QUOTE=a1qwerty55;8774649]

Originally Posted by Magnesium

...Even if pay in the military were 150% the civilian sector and they blew flowers up your ass, plenty of people would leave to control their destiny, in other words not deploy, control where they live, what they wear and who they screw and what they do on their off time.

If you really think about the implications of this comment it is that the problems with retention are more about leadership then money. Deployments aren't the issue. It's the b.s. policies and leadership decisions that leave physicians with their hands tied feeling like they can't practice medicine the way they were trained to do it. I'll never forget the time the nurse commander ordered that anytime a psych patient had to be admitted from the ER a physician had to drive into the hospital and physically sign the admission paperwork. The commander wouldn't permit telephonic admissions although that is the standard of care everywhere else for psych and the fact there was just 2 psychiatrists at a mid size Navy MTF.

[QUOTE=IgD;8774901]

Originally Posted by a1qwerty55

If you really think about the implications of this comment it is that the problems with retention are more about leadership then money. Deployments aren't the issue.

Deployments are a tremendous issue -
One thing I didn't make clear is that retention is important but my point was that low retention doesn't not always equate to a crappy work environment. I do feel there is some threshold value above which it implies things are really bad.

As a former Navy enlisted service member for 7 years and recently selected Army Reserve physician, reading through these posts stirs some mixed emotions. I certainly can emphasize with the frustrations echoed by many posts that are inherent in the military chain of command.

Since my discharge "many moons ago" and completing medical school, I have struggled with the decision and timing to re-enter military service. Presently, I have reached a point where the demands and routine of my civilian practice has signaled the moment. I meet this decision with the hopes to provide my professionalism and service to those active duty soldiers and colleagues willing to serve.

Any input from other army reserve physicians or other really *&^^%#$ off physicians is welcome.

If you are considering military medicine but are not sure, I highly recommend looking into the Army National Guard. As a student recruiter you would be commissioned as an officer (2nd Lieutenant) and then to Captain upon graduation. You get $4500/fiscal year and health and dental insurance for you and your family. Depending upon how many dependents you have and where you live, you can get paid a stipend of $3000-$4000 or more per month! This is because you would be considered temporary active duty and get BAH and BAQ (money for food and housing) in addition to your monthly basic pay. Wear your uniform a few times a week to school and tell people about the program, etc. and you can cut your student loans to less than half by taking money out just for tuition and not for living expenses- unless of course you want to! Your commitment to the Guard is 8 years and the countdown starts as soon as you get commissioned. (So theoretically, you can complete med school and residency with nothing to owe, if you end up not wanting to stay in). I have been in the Guard for 7 years and I love it. It gives you opportunity to enjoy both worlds- the variety of being in the military and special skills you will learn there, yes, you will learn to shoot an M-4 and go to Officer Basic for 25 days, but also live in the civilian world and get to pick where you do residency and where you live. Furthermore, if you are concerned about being shipped overseas, in the National Guard you can only be deployed as a doc for 90 days and once every 2 years. Please e-mail me (dubreyda@yahoo.com) if you would like more info- this is the best program the national guard has to offer!!!

Originally Posted by SnowyOwl

If you are considering military medicine but are not sure, I highly recommend looking into the Army National Guard. As a student recruiter you would be commissioned as an officer (2nd Lieutenant) and then to Captain upon graduation. You get $4500/fiscal year and health and dental insurance for you and your family. Depending upon how many dependents you have and where you live, you can get paid a stipend of $3000-$4000 or more per month! This is because you would be considered temporary active duty and get BAH and BAQ (money for food and housing) in addition to your monthly basic pay. Wear your uniform a few times a week to school and tell people about the program, etc. and you can cut your student loans to less than half by taking money out just for tuition and not for living expenses- unless of course you want to! Your commitment to the Guard is 8 years and the countdown starts as soon as you get commissioned. (So theoretically, you can complete med school and residency with nothing to owe, if you end up not wanting to stay in). I have been in the Guard for 7 years and I love it. It gives you opportunity to enjoy both worlds- the variety of being in the military and special skills you will learn there, yes, you will learn to shoot an M-4 and go to Officer Basic for 25 days, but also live in the civilian world and get to pick where you do residency and where you live. Furthermore, if you are concerned about being shipped overseas, in the National Guard you can only be deployed as a doc for 90 days and once every 2 years. Please e-mail me (dubreyda@yahoo.com) if you would like more info- this is the best program the national guard has to offer!!!

Holy recruiter batman.

Even if that is the case now, I find it unlikely that this is gauranteed by law. More than likely it is an administrative policy that can changed with the stroke of a pen. If it is law it is a little harder to change and not being a lawyer I don't know how it would work if the law was one way when you signed up but changed during your payback. But either way, if WWIII broke out you can bet that you'll be on deployment a whole lot longer than 90 days.

So don't make promises. State facts. Something like "at this time the policy is to deploy you for only 90 days per two year period. Of course like any policy this is subject to change and dependent upon the needs of the service."

I agree with the above poster. If something seems to good to be true, it generally is. And how quickly that 90 day policy can be altered by "needs of the service."

Speaking of service, is it true that your entire commitment in the Guard can be done during med school and residency? If that is the case, the only thing you are serving is yourself. So give yourself a pat on the back there, weekend warrior/recruiter.

Having just read through ever post on this thread since I last logged on in August I can see the back and forth continues about many a matter. I hope to offer only an outsiders opinion to one of the debates…retention.

Some of the posters point to milmed’s low retention rate as a sign of its poor performance/poor physician satisfaction. Simply stated, if there’s a very low retention rate then this is clear evidence to a problem/ unsatisfaction. Other’s say that low retention rates must be “accepted” because physicians are going to leave the military. As A1 put it, “Even if pay in the military were 150% the civilian sector and they blew flowers up your ass, plenty of people would leave to control their destiny, in other words not deploy, control where they live, what they wear and who they screw and what they do on their off time.” So since these forums are designed to inform medical students mainly on whether or not to go military I will tell you how I interpret the numbers from my seat.

Possibly to the chagrin of some I see low retention in the military as a fact of life. I really do not expect docs to “put in their 20” when many could become substantially more wealthy in the civ world. Most that I know in med school at this moment have no/nor do I see the will to put in more than the bare minimum commitment. Of course there are a few, mainly prior service, who I believe will, but it is more advantageous for them to retire from the military than those of us who have no prior service. What A1 said really hits the nail on the head. Most med students looking in do not expect to see docs stay 20 years because after that initial payback is completed they can usually go make more money, never deploy, live where they want, etc. in the civ world.

What adds to this is the fact that of my friends who currently serve (enlisted AD) they are counting down the days to discharge. One individual in particular, my very good friend, originally considered putting in 20 years for the AF, even thought about going OTS. However, within his first year of service can’t wait to get out and go to Vet School. So the fact that he and others, who are very similar in mindset as myself, serve their time and jump ship after their 4 years gives me the impression that this is the norm. Low retention weight confirms to and outsider that milmed is good for the short term, but can’t compare to the long term civ world. I stipulate, it does not give me the impression nor suggest to outsiders that something is wrong with milmed (I’m not suggesting there is or isn’t something wrong with it).

So, maybe this will help both sides understand that low retention rates has little to no weight in the majority of med students minds (or maybe just mine). It does little good to point to this as a sign that milmed is bad. Those of us who are still looking in from the outside accept low retention as the norm for any military job. It’s not that I’m taking any sides, but merely trying to let both parties know how I interpret retention rates. Maybe I’m ignorant, but when I recall the service of every friend, friend’s father, friend’s grandfather, and then recall the service of every one of my family members over the last 100 years (I’m not exaggerating either reflection) I know of only 1 individual that served more than his four year enlistment/or till the end of the war. He, my great-great uncle, was a West Point grad. So you can see where I, as I think many, come with a preconceived notion that most will do their stint and go home.

In regards to the National Guard program mentioned above.

Yes, the basic deal is (or was, as the program is not currently running) an 8 year commitment to the Guard beginning when you sign. In exchange for signing, you get 3 years of ADSW (or up until you graduate) which provides you a nice income since you're receiving full-time pay as an officer.

Yes, the current policy is 90 days "boots on ground" deployments. Yes, that policy can change. But let's be honest, we're dealing with the US government. The people who can draft you. If WWIII breaks out, being a civilian doctor isn't a guaranteed protection from deployment. You can really only deal with probabilities with the government.

Protection from deployment through medical school and internship year are about as guaranteed as you can get. So what are the odds of 90 day deployments and protection during residency? Well, we're rapidly approaching a decade into a war on two fronts and the policy has stood firm.

Is it possible it will go up? Yes. I wouldn't be surprised to see it at 120 days by the time I finish residency. Will it go up to match the 15 month deployments of AD folks? I doubt it. It would be to incompatible with actually holding a civilian job as a physician and ensure an end to recruiting and retention numbers on the Guard side.

Originally Posted by CharlieBrown009

So, maybe this will help both sides understand that low retention rates has little to no weight in the majority of med students minds (or maybe just mine).

You are a medical student, yes? Are nearly all your most experienced attendings 3-5 years out of training? Do you think that should matter to a trainee?

Originally Posted by CharlieBrown009

So, maybe this will help both sides understand that low retention rates has little to no weight in the majority of med students minds (or maybe just mine).

I think there is some truth to what you are saying that many people want to serve and get out. I don't think that is what is happening in military medicine today. I think what you have is physicians who want to stay in, are willing to go on deployments but who can't tolerate the leadership problems, the overall environment and leave in frustration.

I think that the "churn rate" or attrition rate is much higher for military medicine than any other community in the military. I don't think it is a money issue, I think it has to do more with leadership and the military medicine environment.

Retention should be at the top of anyone's mind. Would you accept a position at any employer if it had a history of employees leaving after a short time? If so, how long do you think you would last there if that was the case?

IMHO, medical students should be asking whether or not they will be required to go on a GMO tour and if they will be able to pursue the type of residency training their heart desires. Another question would be would they be able to practice medicine in the way they were trained and the way they want to once they decide to serve.

Originally Posted by Gastrapathy

You are a medical student, yes? Are nearly all your most experienced attendings 3-5 years out of training? Do you think that should matter to a trainee?

Yes, I am a first year. Yes, I believe it could matter. My point is simply to state that most med students have preconceived notions that low retention rates in the military are the norm. Could it be important? I'm sure that it is. However, I'm not discussing what truly exists, but simply what appears to exist. This is in an effort so that those on this site who quote low retention rates realize that it does not always have the desired impact as was intended.

You're other statements were quite informative, thank you.

Originally Posted by IgD

Retention should be at the top of anyone's mind. Would you accept a position at any employer if it had a history of employees leaving after a short time? If so, how long do you think you would last there if that was the case?

As to your question. If that employer said, "if you do your job well for four years you won't be fired, if you accept the job you must stay all four years, go where we tell you, wear what we tell you, etc and I will pay off all of your student loans." Then yes, I'd probably go to work for them. If I like the employer and he'll keep me on then I'll keep working for him. If I didn't then I'll finish up my contract and go about my merry way debt free.

I don't think we can quite compare the military to the civ world. Here in the south you can be fired without cause. In the military, unless you screw up, you don't get sacked. If your scenario includes a right-to-work clause then I would pay more attention to retention rates. If the employer has to keep me on provided I do my job then it's no big deal.

I hope those reading this do not not think me focused on only money in life. I'm only trying to inform upon what many of my fellow first-years think when military retention rates are mentioned. Do to the fact that we are out-siders we cannot fully grasp what each of you already do. Sometimes the dots have to be linked in order for us to understand what you all know.

We need comparisons like the one you made that retention rates are much lower than other military occupations. Of course I'm sure that by our fourth year we will have greater understanding than we currently do, but many are HPSPers who signed did so well before reaching fourth year of med school (one reason why I decided to wait to decide on the military rather than take HPSP first year of medical school).

It's my sincere hope that this makes some sort of sense and allows informed posters like yourself to know how little some of us understand about the military. I don't dispute the accuracy of what all of you say, but that it does not always have the impact that was desired.

Originally Posted by IgD

I think that the "churn rate" or attrition rate is much higher for military medicine than any other community in the military.

Of course it is, few military officers or enlisted can make the same income outside, and job security and health care is a big deal to a lot of military. Doctors aren't worried about getting a job outside, and almost universally get paid better on the outside. The other issue is docs are less tolerant of living in crappy locations and their spouses more so. You aren't going to keep most docs. I mean come on, who is going to stay in if they are spending a year out of 3 in Iraq or Afghanistan, get paid less than their civilian peers, and get all the other military specific baloney? I think the answer it those with long committments (don't have a choice), those with military buy-in, family history, sense of contribution to the military/country, and those who can't make it outside.

Originally Posted by IgD

I don't think it is a money issue, I think it has to do more with leadership and the military medicine environment.

I disagree, it is money and control. Civilian hospital leaders can be just as screwy, and senior partners not uncommonly screw the new guy, the JC is just as miserable in the civilian sector.

Originally Posted by IgD

Would you accept a position at any employer if it had a history of employees leaving after a short time? If so, how long do you think you would last there if that was the case?

Yes - if the position is a stepping stone to something else - the military is a great way to get a skill, training, OJT etc that often isn't available in the civilian sector. New RN grads are pretty hard to employ as most hospitals want some experience - a 4 year stint in the Army for example opens a lot of doors.

Originally Posted by IgD

IMHO, medical students should be asking whether or not they will be required to go on a GMO tour and if they will be able to pursue the type of residency training their heart desires. Another question would be would they be able to practice medicine in the way they were trained and the way they want to once they decide to serve.

Sure, good idea to understand all the implications of joining. If this is the primary fear then join the Army where uninterrupted training is the norm not the exception.

Caveat, I am not in the military. I can only speak from my experience over the last decade dealing with medical students, residents and attendings that have or had military obligations... My replies are paraphrasing or understanding of what they have told/taught me.

Originally Posted by IgD

...many people want to serve and get out. I don't think that is what is happening in military medicine today. I think what you have is physicians who want to stay in, are willing to go on deployments but who can't tolerate the leadership problems, the overall environment and leave in frustration.

I think that the "churn rate" or attrition rate ...I don't think it is a money issue, I think it has to do more with leadership and the military medicine environment...

First point I have found, most have a military obligation because at some point they felt they had no choice.... i.e. they were afraid as to how they were going to pay for someting (undergrad, med-school, accumulated costs by the time they reached residency, etc...). After they incurred the obligation, some do start to rationalize of convince themselves of some innate calling to serve....

Once deployed, numerous have expressed having a "reality check". It sounds exciting, etc.... but, you don't get to decide how long. You see, if you go on a "roughing it" camping trip, you can always just pack up and go to the local Hilton. That is not the case in the military. Further, you don't even have much say in what your practice will be like within the military. Maybe you want to be a breast surgeon or MIS or bariatrics, or plastics.... etc..... In the military, you do what the local need is and that is just how it is. So you did a fellowship in vascular.... if they have a soldier with a peri-rectal abscess, your the surgeon....

Money has a good deal to do with it. You have worked hard for a very long time. Once in the military you are fairly underpaid compared to civilian practices. Further, as noted, you don't get to set your hours or your area of practice. I knew interventional cardiologists that found themselves doing primary care H&Ps and "sick-call" duty on deployment. So, you are underpaid, do you really want to put in 20yrs for the health benefits? I don't know many that say, "gee, I can't wait until I qualify for VA care".

Originally Posted by IgD

...Retention should be at the top of anyone's mind. Would you accept a position at any employer if it had a history of employees leaving after a short time? If so, how long do you think you would last there if that was the case?...

I think turn-over is quite common in civilian practice. That is why there are minimum community/location service obligations when recruited. Physicians will often meet their ~3 year local obligation and then look for greener pastures. Because, at that point most are board certified and can now boast "x" number of years experience.... Civilian practices run about 3yrs for your first job. Military contracts run about 8yrs for your first contract...

Originally Posted by IgD

...IMHO, medical students should be asking whether or not they will be required to go on a GMO tour and if they will be able to pursue the type of residency training their heart desires. Another question would be would they be able to practice medicine in the way they were trained and the way they want to once they decide to serve.

You can ask all those questions..... not sure the answer would mean much. The military contract is not going to specify all those points. Further what a recruiter tells you today may be completely honest and in accordance with what the current military command's position is... However, operation orders change as a result of :
1. New president and/or international policy
2. New congress
3. New generals
4. New missions
5. change in the "NEEDS of The Military" as perceived at all levels to include but not limited to items 1-4 above.

In short, your contract is to meet the "NEEDS of The Military" and this generally is completely independent of your likes, dislikes, family likes/dislikes, and career goals/ambition....

Originally Posted by CharlieBrown009

...I hope those reading this do not not think me focused on only money in life. I'm only trying to inform upon what many of my fellow first-years think when military retention rates are mentioned. Do to the fact that we are out-siders we cannot fully grasp what each of you already do...

I'm making an assumption that you are a first year HPSP student. You've decided to make a sacrifice, stepped up to the plate and agreed to give a pound of flesh to the government. What do you expect in return? What does the government need to do to hold up its end of the bargain? What do you need to feel satisfied with your sacrifice?

Originally Posted by JackADeli

Caveat, I am not in the military. I can only speak from my experience over the last decade dealing with medical students, residents and attendings that have or had military obligations...

Welcome to the forum and the discussion! What do you think of military medicine's policy of allowing non-residency trained physicians to practice medicine in an independent setting? I would be also curious what you think of the fact that military physicians are required to submit separate applications for PGY1 and PGY2 training.

Originally Posted by IgD

Welcome to the forum and the discussion! What do you think of military medicine's policy of allowing non-residency trained physicians to practice medicine in an independent setting? I would be also curious what you think of the fact that military physicians are required to submit separate applications for PGY1 and PGY2 training.

Most states in America still allow you to be licensed and practice independently with an internship alone -not good practice but there are plenty of docs out there in rural America faking it.

As I've pointed out, continuous residency contracts are the norm in the Army.

Originally Posted by IgD

Welcome to the forum and the discussion! What do you think of military medicine's policy of allowing non-residency trained physicians to practice medicine in an independent setting? I would be also curious what you think of the fact that military physicians are required to submit separate applications for PGY1 and PGY2 training.

I think folks need to understand they are adults now. Life isn't fair. I still see residents that have a parent or significant other call the residency to demand "fair" treatment, etc.... Often speaking in terms as if they have some position of authority. Well, it does not appear to become any more fair within the military. My take is that in accepting military funding and/or signing a military contract you agree to and/or accept two important principles:

1. Your job is whatever is in the best interest of the military
2. The best interest of the military is determined by someone other then you (may be "dumber" then you) and can (often will) change without your input.

If you grasp those points, you will do fine. You will understand your service... i.e. being a soldier is a great sacrifice of liberty. If you can not understand these points and/or accept that sacrifice, you need to not CHOOSE a military path.

Retracted

Originally Posted by IgD

I'm making an assumption that you are a first year HPSP student. You've decided to make a sacrifice, stepped up to the plate and agreed to give a pound of flesh to the government. What do you expect in return? What does the government need to do to hold up its end of the bargain? What do you need to feel satisfied with your sacrifice?

Actually, no I'm not an HPSP student. I looked into it, but decided to wait until after medical school to join the service. Therefore, I have no chip on my shoulder. I have no need nor do I think I will have a need for someone to make me feel satisfied with my choice to join and serve my country.

My entire purpose for commenting in the first place was to, like I previously stated, inform upon what many of my fellow first-years think when military retention rates are mentioned. Many first-year medical students and pre-meds have a preconceived notion that the retention rate is going to be low. Therefore, I thought I would point this out so both the pro and con sides could more adequately reference evidence that would resonate with students.