Military Medicine: Pros, Cons, and Opinions

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Originally Posted by CharlieBrown009

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.

I'm surprised by your post. I would have thought you would have been in HPSP. Can you tell us a little about what your thought process was for not joining?

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.

If the military paid 150% of what civilians get, there would be so many people signing up and renewing contracts that there would be no billets left for everyone. Even if they paid 100% of civilan salaries with reasonable deployment bonuses, etc, they would fully staff with board certified docs and not need to lure broke 21 year olds with $20K in cash upfront along with full tuition and a stipend, while, at least in the Navy, lying about their future GME prospects.

JAD - Thank you for taking an interest in military medicine, I really enjoy your surgery posts. As for the whole thing with sending Navy docs fresh out of intern year to the front line, lets be clear: For the people getting assigned now this was a total bait and switch. My telephone interview, when the paperwork was basically done, was the first time I even heard about this possibilty, and I was told it was 50/50 that I would do 1 year on a ship. Then the Navy told all of the medical core training at ODS in 2007 in person that they were going to be down to 200 of these positions by this year (from 600 orginially), and 100 next year, and we really wouldn't have to worry about it unless we were interested. Instead, they simply shifted many of the ship jobs (2 years deploying on a ship) to board certified docs, and left the marine jobs (2 years deploying to the sand pit) and the flight surgery and undersea medicine (3 years) to the graduating interns. Gen surg interns have a 87% chance of being forced to take one of these positions, and ortho, rads, ENT, anethesia, and EM have a 100% chance. JAD, you as much as anyone have to appreciate that it is difficult to make am informed decision when you are being outright LIED TO.

What the military should do is compensate docs appropriately, say at 100% of civilian pay with appropriate relocation and deployment bonuses, and I believe the vast majority of the problems would go away. They could get board certified physicians trained at high powered civilian institutions, and they could get out of the GME business. They would dealing honestly with people at a stage in their career where they could appropriately consider all of the variables before making a decision, and probably because of that people would be a lot happier. But could you ever see a line admiral signing off on $750k + bonuses for a spine surgeon, nevermind congress?

Originally Posted by buchemist

Then the Navy told all of the medical core training at ODS in 2007 in person that they were going to be down to 200 of these positions by this year (from 600 orginially), and 100 next year, and we really wouldn't have to worry about it unless we were interested...

Have you seen this thread:
http://forums.studentdoctor.net/showthread.php?t=620270

Basically it's the Assistant Secretary of Defense Health Affairs saying that GMO tours are not good medicine and they will be phased out. But that was in 1998. Don't get me wrong, I love military medicine but there has to be a better way.

Originally Posted by buchemist

...As for the whole thing with sending Navy docs fresh out of intern year to the front line, lets be clear: For the people getting assigned now this was a total bait and switch. ...you as much as anyone have to appreciate that it is difficult to make am informed decision when you are being outright LIED TO...

I definately appreciate what you are saying. The same goes for civilian practices as well..... Bottom line, you are signing a very costly contract. In civilian practice, when all is said and done, that contract value (depending on the math) can be worth in excess of 1 million dollars even if your yearly "salary" is under $300K. Well, a military contract is similar. You may only be seeing the $75-150k medical school costs, or the $20k stipend in residency, etc.... The actual "value" of that contract (again, depending on how & who does the math) is in excess of several 100s of thousand dollars. So, as in civilian contracts.... if it's not in the contract, it doesn't really matter much what the recruiter or CEO promised you!

So, military contracts.... how many pages are they? Not many relatively speaking. A civilian contract can be in excess of 12 pages. Military contracts spell out a few important points, as I noted before:

Originally Posted by JackADeli

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...

I don't like folks young or old getting "tricked" or "lied to". But, in all honesty, I have had some residents show me their military contracts..... frankly, they are far simpler and easier to read then the legal jargon of a civilian practice contract. Your obligation is as noted in points 1 & 2 above and it doesn't matter what recruiter a, b, c, d, etc.... says today or tomorrow. What matters is what is in the contract. If your contract specifically spells out: 1. you will get to choose your specialty (i.e. residency) and 2. you will get to complete residency after medical school and before any tour/deployment/utilization, great. But, I don't think any such contract has been drawn up.

If you look at the military medical history, numerous physicians have sat in the ranks of the reserves for several decades pre-9/11 without ever being called up or deployed. Recruiters can say "historically" most have just collected a monthly stipend and kept a uniform in the closet. That is not the reality anymore. The points that have not changed are a contract is signed and the obligation is to "whatever is in the best interest of the military" at any given point.... it does not take into consideration what you think would be best for the military or what you think is best for you or what your recruiter may have told you.... There is also usually some clause in the contract to the effect that the military may change terms of contract and or obligation... particularly during times of war or increased need. Sad, but those are just the facts.

The best we can do is encourage folks that serious contracts such as employment, mortgages, car loans, military, etc.... need to be read. they need to be taken seriously. If it is not in the contract, you have no expectation of receiving it.

Originally Posted by IgD

...Basically it's the Assistant Secretary of Defense Health Affairs saying that GMO tours are not good medicine and they will be phased out. But that was in 1998. Don't get me wrong, I love military medicine but there has to be a better way.

I suspect in an ideal world the military truely believes that. Unfortunately, given the current numbers, I think military command is accepting the lesser of two evils.... either no physicians in the field (cause they are all caught up in residency) or fresh med-school grads with two years of "clinical experience" in med-school....

As for a better way, then there needs to be funding and physicians need to be willing to be "real soldiers". I am always surprised at the level of entitlement expressed by some attendings and residents in the military as compared to the foot soldiers and other branches of the military. I have a good number of friends in the military. I spent some of my residency next to a military hospital and did some VA rotations. I have listened to residents brag how the stopwatch was "paused" an extra 2 minutes to allow them to "pass" the 2 mile run or how the measuring tape was "stretched" to allow passage of the height/wt requirements... to avoid loosing a doctor.... Alot of rules are bent for military healthcare providers and that in and of itself hurts the credibility of any arguments. Think about it.... you have the "best & brightest", some of the most highly educated.... can't read a contract, can't eat healthy and exercise, can't maintain proper weight and fitness standards, etc.... (obviously a generalization).

Originally Posted by JackADeli

...frankly, they are far simpler and easier to read then the legal jargon of a civilian practice contract. Your obligation is as noted in points 1 & 2 above and it doesn't matter what recruiter a, b, c, d, etc.... says today or tomorrow. What matters is what is in the contract.

I knew a Navy medicine subspecialist who was given a contract to do an outservice fellowship with an inservice payback. This was done because of a critical manpower need. When you normally do an outservice fellowship, the payback is tacked on to the end of any existing service obligation. For an inservice payback, the payback is concurrent.

At the start of the fellowship, this individual owed 2 years payback. During the 2 year utilization tour, this physician submitted a resignation letter. It was rejected and the military argued that the contract though in plain writing was invalid and that this individual owed an extra 2 years. The physician managed to get out on time but had to waste a lot of money in legal expenses.

Originally Posted by JackADeli

...I am always surprised at the level of entitlement expressed by some attendings and residents in the military as compared to the foot soldiers and other branches of the military...

It is at least the same or better than similar dysfunctional behavior you would encounter in academia or on message board like this I'd like to point out that in the military there is no bickering over private parking spaces, having a personal secretary, expense budgets or catered lunches because they don't exist.

Originally Posted by JackADeli

... I have listened to residents brag how the stopwatch was "paused" an extra 2 minutes to allow them to "pass" the 2 mile run or how the measuring tape was "stretched" to allow passage of the height/wt requirements... to avoid loosing a doctor.... Alot of rules are bent for military healthcare providers and that in and of itself hurts the credibility of any arguments. Think about it.... you have the "best & brightest", some of the most highly educated.... can't read a contract, can't eat healthy and exercise, can't maintain proper weight and fitness standards, etc.... (obviously a generalization).

The people reading the contract are broke 21 year olds who are having 20K put in their face upfront and, as you say, a $300k contract (or higher). These people at the time aren't the most highly educated; they're not even done with their bachelor's. And then when it's time to go off to do your GME, your experience becomes so vastly different from that of your peers that at times you're shouting "serenity now!" trying to change the internal expectations that you have for your career. This isn't complaining about having to work 90 hours a week vs. the advertised 80 hours a week, or not getting to operate as much as expected. It is having to work in a totally different, archaic educational paradigm from your peers that multiple people dressed in the US military uniform, some themselves MD's, promised you wouldn't have do deal with.

As for the PT stuff, others with more experience can comment, but people generally have to pass or they get put on the fat boy program, which is not something anyone wants to do. I did not hear about any stretching of the rules for the residents or attendings this year....

Originally Posted by buchemist

The people reading the contract are broke 21 year olds who are having 20K put in their face upfront and, as you say, a $300k contract (or higher). These people at the time aren't the most highly educated; they're not even done with their bachelor's....

Do not get me wrong, I understand the circumstances, etc... I appreciate all these factors. But, again, we are talking about adults. Maybe not done of their bachelors but clearly smart enough to understand a serious contract is being presented. If not smart enough to understand what is included, at least smart enough to find someone who can help them... The temptation may be great. But, still adults and you still have the chance to seek out guidance and counsel. Many have already taken car loans (i.e. a first experience with contracts)... There are consequences and folks are making moral, ethical, and legal agreements. We are talking on this forum openly. The facts about military medicine and military contracts and military funding of education are NOT new. They have existed for a very long time to include ROTC and academies.

By the same train of thought, we should release all those young 18 & 19 year olds that are offered $5-10K signing bonuses out of high school to join the military and see the world. They clearly have less education then the individual at a university, completing a bachelors degree, accepted into a medical school.... with plenty of internet access, numerous folks on campus with differing views on the military, maybe even a law school where you can walk over and ask them about some of these things....

I just get so disappointed when someone signs up for a military scholarship, then cries "trickery" when the bill comes later. I knew plenty in the health scholarship program that lived financially better then many in med-school, occassionally walked around in a military uniform, made a point to use uniform for graduation, etc.... then, after all the pomp and circumstance and the 4 years of hearing how they would make double what I would during their residency and have no student loans, suddenly, "I was tricked", "it's unfair", "it was a lie"..... etc....

Except, I remember the conversations when they tried to recruit others during medical school. the question of GMO came up often. They would always say, "it's possible but not likely cause the Air Force/Army/Navy want you fully trained...". the questions from the potential recruit would be pushed, "but there's no guarantee, right?".... The scholarship recipient/amateur recruiter, "well, technically, there is no guarantee, I mean your in the military.... but, I just don't see it happening".

Again, I don't like people being "lied to" or "tricked". Ideally everyone would go into every decision with their eyes wide open and fully aware of all the consequences..... But, at some point, someone needs to take some responsibility for the consequences of a decision they voluntarily chose to make. Read your contract, if it doesn't say you will get your residency and get to complete it before any deployments.... then do not expect the absence of such a guarantee to be an "oversight".... What it means is that is not part of the deal.

Originally Posted by IgD

It is at least the same or better than similar dysfunctional behavior you would encounter in academia or on message board like this I'd like to point out that in the military there is no bickering over private parking spaces, having a personal secretary, expense budgets or catered lunches because they don't exist.

I will take your word for that... from those I spoke with, you are probably correct. There is a great deal of self-importance amongst those within the healthcare field. I think this adds to some of the complaints once one enters the military.

Looking at the military from the outside and with only second hand information... I would not join as a physician. I have plenty of loans to pay... loan repayment might be nice. But, it's taxable income! I have spent years training to be a specialist and provide a high level of specialty care. In the military, I fear conditions and/or admin (aka command) could mandate or obligate watered down or mediocrity in the care I provide. Ethicly, I would be in conflict everyday providing "the best I could... under the circumstances" knowing I chose circumstances that did not allow for the best of care... Would I be a "soldier"? I'm not sure. I'm not sure the military would risk providing me with the "exciting" or "high speed" training opportunities. I think they would probably be afraid I might get injured and then they would loose a doctor.... So, in essence, if I joined today, 1. not a great income, 2. none of the great adventure, 3. internal conflict as to the level of care I am trained to provide as opposed to level I am able to provide, 4. not sure I want the retirement benefits... Thus, IMHO, folks not rushing to join and difficulty in retaining those already joined.

JAD

PS: look at the TriCare Prime discussion thread....
http://forums.studentdoctor.net/showthread.php?t=687425

Originally Posted by IgD

I'm surprised by your post. I would have thought you would have been in HPSP. Can you tell us a little about what your thought process was for not joining?

Sure. First, I started looking into it too late for the four year HPSP, and could only apply for the three year.

Due to my current location an AF residency would move me a long way off. However, my hometown is near DFW and I currently reside near several major Okla cities with residency programs. I'll be married before the end of med school and had to account for her wishes also. The family can put up with a four year contract that takes me away from home, but putting a mil residency on top of that wouldn't fly so well. I lost my father a few years ago and so still working things out getting used to him being gone. It leaves only my mom on the ranch. And also some other personal family stuff.

Also, I calculated the approximate total med school payment through a 3year HPSP. I then calculated the FAP payments for 3years also. Due to the fact that HPSP pays direct school costs rather than a set payment like FAP does I can actually make more money with FAP (this is because my med school is relatively cheap compared to some). That extra money means I can pay off 4 years of medical school with a 3year FAP versus 3 years of medical school with a 3 year HPSP. Granted I would have to serve four years under FAP and 3 under HPSP. However, if I took the optional bonus under HPSP I would owe four years and still have a large amount of debt. These are approximations of course.

The FAP would allow me to be residency trained before signing and provide me a bit more control if but only where I do my residency. I have no prior service, and am not sure that I am looking for a career active duty. I am open to the idea of moving to the guard or reserves after finishing my four years AD.

Also, I know a lot can change in four years. So if I decide the debt doesn't worry me as much, I may opt to serve in the guard, rather than FAP, in order to fulfill my wish to serve my country.

That's some of the reasons I decided to wait to sign. I felt it was best for me at this place in time.

Originally Posted by JackADeli

...Looking at the military from the outside and with only second hand information... I would not join as a physician. ...Would I be a "soldier"? I'm not sure. I'm not sure the military would risk providing me with the "exciting" or "high speed" training opportunities. I think they would probably be afraid I might get injured and then they would loose a doctor.... So, in essence, if I joined today, 1. not a great income, 2. none of the great adventure, 3. internal conflict as to the level of care I am trained to provide as opposed to level I am able to provide, 4. not sure I want the retirement benefits... Thus, IMHO, folks not rushing to join and difficulty in retaining those already joined...

I thought about this more and more today when looking at the global picture...
We had 9/11, other events after 9/11

Then we had an election & overnight there was no "war on terror"

We have an emergency to close Gitmo and bring war criminals to civilian trial.... in New York.

Ft. Hood massacre that involved a Jihadist, in contact with an Imam (apparently recently killed) that acknowledged advising the Ft. Hood guy to kill US soldiers.... This was apparently NOT terrorism attack... maybe something coined as "second tier PTSD"...

Now, we have a guy with a bomb, on the terror watch list, his own father calling US embassies, gets on a plane.....

Is it military medicine? Not exactly. But, the point is that these contradictions and spins are all part of the military reality. Thus you need to have your eyes open when you sign these contracts. We like to think of ourselves as "special".... especially since we are.... "Doctors". Please don't fool yourselves. Keep your eyes open.

Originally Posted by JackADeli

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...

As a recently released AF radiologist, I can tell you that being a physician in the military is miserable. It is so much worse than I ever could have imagined when I accepted the HPSP. I wish I could say that my opinion is in the minority, however, it is the vast majority. I would estimate that only around 10% of AF health professionals felt that joining was a good decision. Whatever you do, do not join the military as a physician, dentist, pharmacist, etc.

Originally Posted by exafdoc

As a recently released AF radiologist, I can tell you that being a physician in the military is miserable. It is so much worse than I ever could have imagined when I accepted the HPSP. I wish I could say that my opinion is in the minority, however, it is the vast majority. I would estimate that only around 10% of AF health professionals felt that joining was a good decision. Whatever you do, do not join the military as a physician, dentist, pharmacist, etc.

Please don't speak for me. I have a very busy, satisfying practice with both oppourtunites to teach residents, travel, do some minimal research, and have very good coworkers, patients and equipment. I recognize my experience may not be the norm, but there are some of us how despite being irritated with the military have a good practice environment. We seem not to be in the USAF.

Originally Posted by exafdoc

As a recently released AF radiologist, I can tell you that being a physician in the military is miserable. It is so much worse than I ever could have imagined when I accepted the HPSP. I wish I could say that my opinion is in the minority, however, it is the vast majority. I would estimate that only around 10% of AF health professionals felt that joining was a good decision. Whatever you do, do not join the military as a physician, dentist, pharmacist, etc.

Welcome to the forum. I see clearly that you say opinions like yours are the MAJORITY, so it stands that there will be a minority of physicians that for multiple reasons, (whatever they may be), will tolerate and even thrive in the military. Although in my experience, its not as physicians, but as ranking officers. The radiologists I knew were in that vast majority who wanted to get out. Although no eruptions of fire have occured on this forum for a while, do not be surprised at personal attacks because you feel as you do. Thanks for your service, and best of luck in your future which I'm sure is much brighter professionally and personally.

As an introduction, I'm a former Navy flight surgeon. I'm 33 years old. I spent the past four years fulfilling my commitment and am now in a civilian residency program. I spent roughly a year in flight school, the better part of a year in Iraq (which was fairly miserable), and the remaining two stateside at a base doing typical clinic primary care stuff. I am not a recruiter and I am not prior enlisted.

I want to start by saying that I agree wholeheartedly with much of what I've read in these forums - both the good and the bad. My reason for writing this post - and this is my first sdn post - is to provide honest experiences/information for those considering the HPSP route. I think sdn is a valuable resource on many levels, and may be one of the only real forums people have that are considering military medicine. As such, I think it's important that those looking for guidance get as many opinions as possible, both the positive and the negative.

It's funny because I read the posts on this topic and it takes me back to all of the frustration I felt both on deployment and in my clinic. Answering to knucklehead Marine LtCol's who know nothing about medicine, writing BS evals for people I barely know, being administratively burdened to the point of it detracting from quality patient care, being overruled by O5 nurses ... I've seen it all. Military medicine is seriously f'ed up. I mean, seriously, it is unbelievably screwed up.

One thing I find interesting is that the Army docs seem to be the happiest with their experiences, while the Air Force and Navy docs seem to be universally upset. I would have never imagined this to be the case, but since leaving active duty I have heard people say that in the Army you are a physician first and an officer second. I think this is definitely not the case in the Navy, and I would suspect the same is true in the Air Force. Perhaps this is much of the source of negativity, I don't know.

In any case, despite how much of a disaster military medicine is in its current state, I have to say that I am thankful for what the military has done for me. The system isn't perfect - far from it. But I would do it again, and I think my wife and three kids would say the same. The military has become a part of who I am, whether I like it or not. I'm proud of the service I have given to my country over the past four years.

And I think, for those considering this route, this conflict is the source of much of the debate on this forum. I think that the vast majority of physicians who join the military do it for more than just the money during med school. They do it for the same reasons they went into medicine: they are idealistic and they are commited to service. They are patriotic and they want to be a part of something bigger than themselves. I am no different. And, when we see the idiocy and the hippocracy that is so rampant in military medicine, it angers us. Some of us it angers to the point that we get out and tell others to stay away at all costs. Others stay in, and still others (like me) fade away without being vocal about the positive experiences we have had.

I'm not writing this to contradict anything that's been written so far on this forum. In fact, I'm agreeing with most of it. All I can relate is my own experiences, and I feel that, in the end, the positives have outweighed the negatives.

Money: Since I'm going into one of the higher paying fields in medicine, I would suspect that my 4 years in the Navy have left me at somewhat of a financial deficit if you compare what I made in the Navy to what I would have made as an attending for those 4 years. Had I done a civilian residency, I would be an attending by now and would be making a healthy salary.

On the other hand, I made the civilian equivalent of roughly $100k/year during my GMO tour. I paid off several undergrad loans, I have a decent savings, I payed off 2 cars, bought a house, furnished said house, and was able to send one of my kids to private school. I am going into residency financially ahead of most of my civilian counterparts.

Additionally, I am now taking my GI Bill and I am reservist in the Medical In Training program. Between these 2 sources of additional income, I pull in roughly $2k/month above my paltry resident's salary. This especially helps since I have a family. As a resident, I live very comfortably. I do not eat ramen noodles. I do not have $200k of loans looming over me. Things are tight financially, but we are happy.

Again, I'm thankful for what the military has done for me financially.

Training: Personally, I would not do a military residency, save for maybe one or two fields at one or two specific MTFs. I think that there are a couple of military programs that compare favorably to their civilian counterparts. I do not think the military has any top notch residency programs. That's just my opinion, and I don't mean to offend any military trained docs, as there are many great doctors in the military (see below). I hope things change, but I strongly feel like the training is definitely better on the outside.

Now, the flipside to this is that I ended up at a top civilian residency program largely, I believe, as a result of my military service. Going strictly by board scores and grades, I probably had no place even applying to the programs I was accepted to. And yes, you read that right, the programs I was accepted to. I didn't go through the match. I applied, interviewed, and was offered a job, just like it should be (don't get me started on the match...). I had my choice of top residency programs. I am now at the residency program of my dreams, and I credit much of that to my experiences in the military. True, I am older than most of the people in my program, and even some attendings, but I also think my past experiences help me tolerate some of the BS a little easier than some of my colleagues. Again, I am happy, and I am getting great training.

Deployments: I went. It sucked. The Marines took 5 times as many "providers" than they needed. I had 4 of every 5 days off in the desert. I spent 9 months away from a new baby and a 7 year old son who needed me. I wasn't there to teach him to play baseball, to help him with his homework, to go on bike rides with him. My wife had to be a single parent without me. It was hard for her, extremely hard.

On the other hand, I spent my days off on deployment with some of the most incredible people I've ever met. Don't get me wrong, the time sucked. But I met a few true leaders. I spent time with the Explosive Ordnance Disposal Team (think 'The Hurt Locker'), I rode in MRAP's and humvees with some of the baddest ass Marines you could imagine, and I shot cars with a 50 cal sniper rifle at 1800 meters. In flight school, I did barrel rolls over the coast of Miami in a T-34. I've front seated in a CH-53 helicopter multiple times. I've traveled the world.

These are experiences I would have never had outside the military. Do they make up for all of the disppointments and the heartache? Maybe, maybe not, but they help. I have some great pictures.

The People: Military physicians are an interesting bunch. Many are insitutionalized and I think they love being protected from the competition in the outside world. However, many of the doctors you find who are either in training or fulfilling their commitment, are some of the greatest I have had the pleasure of working with. Now, I realize the caveat to that is that the vast majority pop smoke when they get the chance, but there are some great physicians in the military. And still some stay in because, not only are they great doctors, but they are idealists who work hard to make a difference in a patient population that truly needs them.

I have found that active duty nurses in the military are usually fantastic, but once they reach O5, they become administrative nightmares. The civilian nurses in military MTF's are often the bottom of the barrell and are abysmal to deal with.

The Patients: One word: fantastic. My deployment sucked, but I was honored to take care of the people who protect this great nation. I may have missed out on seeing a lot of pathology that you would see as a civilian, since most people in the military are generally healthy, but the truth is that with one year of internship under my belt, I wasn't qualified to care for much more than what I saw. Even stateside at my clinic, I always felt a sense of pride helping people who had devoted their lives to serving our country. For the most part, I found the patient population to be grateful and a pleasure to work with.

Tricare: A headache, to say the least. A difficult system. But I still think it's better than most civilian HMO's. I never had problems ordering a test, everyone is seen and cared for, and I had as much time as I needed to see patients. I am sure I am in the extreme minority here, but I think tricare, while not perfect, is a good single payer system. Since my paycheck was never affected by how many patients I saw in a day, I could spend an hour with a serious patient if I needed to. And I never felt bad about it.

Remember, when they can't affect your paycheck, and they can't fire you, they can tell you to move faster all they want, but how will they enforce it? I caused a lot of fights during my time in military, but I also refused to be bullied around. I am a doctor first, no matter what I'm wearing and who I work for.

Administrative burden: It sucks. I went to more meetings and was in charge of more departments than I wanted to. I sat in meetings while my patients waited for me. It was horrendous. I hated the Navy for doing that to the people I was charged with caring for.

On the other hand, I gained serious managerial experience. I ran a clinic. I taught, I lectured, I dealt with disciplinary issues, and I dealt with some of the more business-like aspects of medicine. It was a valuable experience. It's a confidence builder to be in charge, especially when we spend so much of our professional lives being the low man on the totem pole. As a GMO, I was my patients' doctor. I was all they had. In many ways, it was the way medicine should be. I knew all of the people in my squadron. I knew their families. I felt like I was able to make an impact in people's lives because I was in charge. I felt like an attending (even though I wasn't qualified to be one).

Corpsmen/Medics: I worked with both. There are definitely some ****-poor ones out there, but they are rare. I'll tell you, as a group, these are some of the most impressive and hard working people I have had the pleasure of meeting. I spent much of my time teaching, lecturing, etc to them. They are the backbone of military medicine. I have nothing but respect for these individuals. If you like to teach, then they are your medical students. Work hard for them and they will bend over backwards for you.

AHLTA: Where do I start? It's the electronic health records system in the military. It's horrendous. It goes offline every other day. It was the source of many, many headaches.

On the other hand, I'm now at one of the top hospitals in the world, and I have to use four computer systems to check vitals and write notes. It's ridiculous. My point is this: medicine has always been a late adopter of technology. Doctors are technological idiots. AHLTA may be bad, but worse systems exist, I promise you. I am now dreaming of my AHLTA days...

Beauracracy: It is amazing in the military. No one can refute this. It will drive you crazy.

People cite this as a reason to become a civilian. I'm finding that large hospitals make almost as many silly mistakes as military MTF's. Any time you belong to a large corporation, you will be amazed at the red tape. It will make your head spin. Don't let this be a reason for not choosing the military.

Being underprepared: The military definitely puts you in positions you aren't ready for. I wasn't ready to be a family medicine doc for 3 years after doing a surgical internship. I wasn't ready to take care of seriously sick/injured people. I wasn't ready to run a clinic.

But I figured it out. I'm not ready for a lot of the positions I get put in everyday as a resident. I thought this was unique to military medicine. It's not. It's medicine. It's how we do our best learning. I haven't hurt anyone yet.

So, my final verdict is this: the military is no free lunch. It's hard. They'll tell you where to live and they'll likely take you away from your loved ones for extended periods of time. But I'd do it all again. I wouldn't change a thing.

My advice to anyone who is considering this route is to know ahead of time what you're getting into and expect the bad stuff. Know that you will get your turn. It will be hard, but know this before you sign the papers. Don't listen to recruiters, they're worthless.

If you do choose this route, don't ever let administrators bully you. Stand up for yourself. Cause fights if you need to. Stand at attention in front of your CO while he screams at you. I've been there. But stick up for yourself and you'll be fine. Don't sign anything you don't feel comfortable signing and take comfort when you go home at night that you are doing what's right for your patients. In the end, stick to what you believe in and work hard. Remember, they can't fire you and they can't withhold your paycheck. Military medicine may be seriously flawed, but that doesn't mean you can't be a great doctor and provide quality care within that system.

Finally, If you're someone who is a driven type-A who needs to get through residency as soon as possible, don't even consider the military. But if you're someone who isn't in a hurry, and wants to have a little fun and do some crazy stuff before you spend the rest of your life as an attending, then consider this route seriously. If you're going to sit around and think about all of the money you "lost" by being a GMO, then forget this way of life. It's not for you.

But if you think you'll look back on the pictures of you in your flight suit drinking beers in Japan or on the deck of an aircraft carrier or in the cockpit of an f-18, and you'll say "damn, that was cool," then maybe you should talk to someone who enjoyed their time.

I've seen the world, I've met amazing people, and I learned a lot about myself and what I wanted out of my career during my time on active duty. In fact, I think so highly of the people I took care of that I now drill when I can with my old unit. Maybe I'm a glutton for punishment, maybe I'm idealistic, maybe I'm a patriot who just can't let go. Whatever the case may be, the military is in my blood.

Good luck with your decision and contact me if you want to talk.

Oh, and definitely choose flight surgery or undersea medicine. Don't even consider being a straight GMO.

Peace out,

Navyflightsrgn.

Great post, thanks for taking time to share your experience.

That was the best pro con military medicine have read. Thank you for taking the time to write it.

GO ARMY !!!!!!!!!!!!!!!!!!!!!!!!!
ACCEPTED 2014 UCF!!!!!!!!!!!!!!!!

Wow, great insights and a great post showing the good and bad parts of many aspects of milmed. For what it's worth, I think that may have been the best post I've ever read on this forum.

Originally Posted by 2 Wycked

Wow, great insights and a great post showing the good and bad parts of many aspects of milmed. For what it's worth, I think that may have been the best post I've ever read on this forum.

this is in no way meant to offend you (so if it does, lighten up), but given your # of posts and join date, that comment made me lol

Originally Posted by cuadrado

this is in no way meant to offend you (so if it does, lighten up), but given your # of posts and join date, that comment made me lol

Could be like me, I lurked for over two years before I joined SDN.

phenomenal post. thanks for making the effort.

Hi I'm currently filling out the army hpsp app I'm having second thoughts with the honest opinions that pretty much bash military medicine. I had high hopes of being an amazing doc while serving my country as I have always wanted to join the military, but now I'm scared. I was aware of the cons before but now it just seems so real. Call me a broke 21yr old in awe of the opportunities but am I making a mistake? If there's an army hpsp out there who can have an honest heart to heart with me I'd seriously appreciate it.

Originally Posted by biolover88

Hi I'm currently filling out the army hpsp app I'm having second thoughts with the honest opinions that pretty much bash military medicine. I had high hopes of being an amazing doc while serving my country as I have always wanted to join the military, but now I'm scared. I was aware of the cons before but now it just seems so real. Call me a broke 21yr old in awe of the opportunities but am I making a mistake? If there's an army hpsp out there who can have an honest heart to heart with me I'd seriously appreciate it.

What do you want? You've read the forum, now man up and make your choice. Its just nuts to request the opinion of someone currently in school about whether getting the army to pay for school was a good choice. That's like asking someone who bought a sofa with no payments or interest for a year if the sofa's comfortable.

Originally Posted by Gastrapathy

What do you want? You've read the forum, now man up and make your choice. Its just nuts to request the opinion of someone currently in school about whether getting the army to pay for school was a good choice. That's like asking someone who bought a sofa with no payments or interest for a year if the sofa's comfortable.

I love it. No babying in this forum.

Originally Posted by EMDoc0411

I love it. No babying in this forum.

Lol, I can just see Gastro during his ob month:

"What do you want? You've had the intercourse, now man up and pop that sucker out. Its just nuts to request the opinion of some pregnant lady about whether getting knocked up was a good choice. That's like asking someone who had a C-section whether the epidural knocked out her labor pains."

(Slaps mom, punches dad in the gut, spits on the floor and stomps out, telling the nurse on the way to call when baby crowns)

To the previous poster: If you live in the US, chances are there's an Army base within driving distance. And chances are that there's a doc attached there, and there's good odds that that person did HPSP. If not, they'll know a ton of people who did. Time to make some calls and a field trip. Buy 'em lunch - we're easily bribed - and make sure it's a captain that you're talking with; they're the ones closest to where you are and are most familiar with the medical training available both in the .mil and out.

I know it's a bother. But you're also committing almost a decade of the primo years of your life. Make the effort, you'll be glad you did.

Originally Posted by Gastrapathy

What do you want? You've read the forum, now man up and make your choice. Its just nuts to request the opinion of someone currently in school about whether getting the army to pay for school was a good choice. That's like asking someone who bought a sofa with no payments or interest for a year if the sofa's comfortable.

Listen douche bag it really isn't a lot to ask for others to give their opinions when your about to sign a contract that will chnage your life. I am not asking for someone to hold my hand, and if I did it wouldn't be any of your damn business. When your a 21 year old female who is pretty much on her own and has no immediate family members who went to medical school or college it really is ok to utilize whatever resources possible to make a decision. So do yourself a favor, go outside and enjoy the spring weather rather than sitting in front of a computer stalking sdn just waiting for the chance to pounce on a post with your cynical humor.

Originally Posted by AF M4

To the previous poster: If you live in the US, chances are there's an Army base within driving distance. And chances are that there's a doc attached there, and there's good odds that that person did HPSP. If not, they'll know a ton of people who did. Time to make some calls and a field trip. Buy 'em lunch - we're easily bribed - and make sure it's a captain that you're talking with; they're the ones closest to where you are and are most familiar with the medical training available both in the .mil and out.

I know it's a bother. But you're also committing almost a decade of the primo years of your life. Make the effort, you'll be glad you did.

Thanks, I'll definitely try that!

Originally Posted by AF M4

Lol, I can just see Gastro during his ob month:

"What do you want? You've had the intercourse, now man up and pop that sucker out. Its just nuts to request the opinion of some pregnant lady about whether getting knocked up was a good choice. That's like asking someone who had a C-section whether the epidural knocked out her labor pains."

(Slaps mom, punches dad in the gut, spits on the floor and stomps out, telling the nurse on the way to call when baby crowns)

OB month...internship prior to work hour rules...no categorical OB interns on the service for some reason. Just me, a tranny and a surgical intern. We never left triage except to round. Honestly, when my wife delivered a few months later, I walked around thinking, "so this is where patients go after they leave triage."

Now, since I've apparently offended the sensibilities of our young future physician, allow me to restate. You will notice that, on this forum, the most optomistic posters tend to be current HPSP or USUHS students who have yet to experience being a physician in the military. Asking one of them for advice is a poor choice because they lack perspective. Similarly, physicians who finished their military careers and retired in the pre-TRICARE era lack perspective. Oh, and if you're the kind of person who can't take a little heat, these next few years aren't going to be any fun.

Originally Posted by Gastrapathy

. . . . Oh, and if you're the kind of person who can't take a little heat, these next few years aren't going to be any fun.

Now why did you spoil the surprise and tell her that?

Originally Posted by Gastrapathy

OB month...internship prior to work hour rules...no categorical OB interns on the service for some reason. Just me, a tranny and a surgical intern. We never left triage except to round. Honestly, when my wife delivered a few months later, I walked around thinking, "so this is where patients go after they leave triage."

Now, since I've apparently offended the sensibilities of our young future physician, allow me to restate. You will notice that, on this forum, the most optomistic posters tend to be current HPSP or USUHS students who have yet to experience being a physician in the military. Asking one of them for advice is a poor choice because they lack perspective. Similarly, physicians who finished their military careers and retired in the pre-TRICARE era lack perspective. Oh, and if you're the kind of person who can't take a little heat, these next few years aren't going to be any fun.

So you're saying that you did do some mommy-slapping and daddy-punching? You must have been like House, except with babies.

(Sweet fancy Moses...just you, a tranny and a surgical intern? If the ob world were like a three-man NBA Jam team, you guys would have been the Golden State Warriors.)

Originally Posted by af m4

(sweet fancy moses...just you, a tranny and a surgical intern? If the ob world were like a three-man nba jam team, you guys would have been the golden state warriors.)

lol!!!

Originally Posted by AF M4

So you're saying you did do some mommy-slapping and daddy-punching? You must have been like House, except with babies.

(Sweet fancy Moses...just you, a tranny and a surgical intern? If the ob world were like a three-man NBA Jam teamm, you guys would have been the Golden State Warriors.)

No slapping or punching. We were all too tired to do anything other than exactly what the nurses told us. Whichever one of us was post-call did all the rounding and the other two just went bed to bed conveyer belt style. Thanks for the trip down memory lane, I'd blocked that month out. I ran into that surgical intern a while back (now a surgical oncologist) and he mentioned that it was the most painful month in his entire training.

BTW, I can't remember your story. Did you get GMOed?

Originally Posted by Gastrapathy

No slapping or punching. We were all too tired to do anything other than exactly what the nurses told us. Whichever one of us was post-call did all the rounding and the other two just went bed to bed conveyer belt style. Thanks for the trip down memory lane, I'd blocked that month out. I ran into that surgical intern a while back (now a surgical oncologist) and he mentioned that it was the most painful month in his entire training.

BTW, I can't remember your story. Did you get GMOed?

Yes I did and still am. Just got done matching into a nice civilian residency that I will be attending when I separate, so I'm much happier right now. Sorry to bring back bad memories. I have many similar thoughts of my internship, and it's a lot of trouble to go through just to be at the mercy of others' decisions.

Originally Posted by biolover88

Hi I'm currently filling out the army hpsp app I'm having second thoughts with the honest opinions that pretty much bash military medicine. I had high hopes of being an amazing doc while serving my country as I have always wanted to join the military, but now I'm scared. I was aware of the cons before but now it just seems so real. Call me a broke 21yr old in awe of the opportunities but am I making a mistake? If there's an army hpsp out there who can have an honest heart to heart with me I'd seriously appreciate it.

Military medicine is a screwed up minefield. Take to heart the con's you've read about, as they are very real.

From you post, the key word is "broke", which means you are considering HPSP for the MONEY. This is the single worst reason to consider military medicine. The only reason should be if you want to be a military officer.

You'll have to struggle for the next 4-10 yrs, but in the end you'll be much happier and a better doctor if you have "choice", something the military can severely restrict.

Best of luck.

Originally Posted by AF M4

Yes I did [get GMO'd] and still am....

I'm USUHS-bound this fall and have been assuming that as long as I do well and know what I want then I'll match a residency (family/internal medicine) and not have to GMO. Does this sound reasonable? I'm almost afraid to ask... >_<

Originally Posted by Erald Coil

I'm USUHS-bound this fall and have been assuming that as long as I do well and know what I want then I'll match a residency (family/internal medicine) and not have to GMO. Does this sound reasonable? I'm almost afraid to ask... >_<

depends on your service - Army, little chance you will have to do a GMO before completing residency. USN and USAF much higher likelihood but I think the odds are pretty good of going straight through in FP in the Navy. Others on this board know this better than I.

Originally Posted by a1qwerty55

depends on your service - Army, little chance you will have to do a GMO before completing residency. USN and USAF much higher likelihood but I think the odds are pretty good of going straight through in FP in the Navy. Others on this board know this better than I.

Who can say what the environment will be in 4 years. The flip side is that USUHS grads owe so much time that doing a GMO doesn't really matter.

Originally Posted by Erald Coil

I'm USUHS-bound this fall and have been assuming that as long as I do well and know what I want then I'll match a residency (family/internal medicine) and not have to GMO. Does this sound reasonable? I'm almost afraid to ask... >_<

Flip a coin, you'll have as much chance of being right as anyone you could possibly ask, including the folks upstairs. As Gastro and a1 noted, there are too many uncertainties for any kind of certain answer. Doing well and making a few friends out of your attendings and program directors will certainly give you the best positioning for catching what opportunities do end up being out there. Good luck.

Originally Posted by AF M4

Doing well and making a few friends out of your attendings and program directors will certainly give you the best positioning for catching what opportunities do end up being out there.

That's all the reassurance I could hope for.
BTW I'm going AF. :-)

Sorry for all the duplicates, I don't know what happened...

duplicate

duplicate

Originally Posted by Erald Coil

I'm USUHS-bound this fall and have been assuming that as long as I do well and know what I want then I'll match a residency (family/internal medicine) and not have to GMO. Does this sound reasonable? I'm almost afraid to ask... >_<

A couple years ago when I was an intern in the Navy, this was a reasonable expectation as long as you were competent during your intern year.

As an aside, if you are planning on signing up for HPSP or FAP, please do it because you want to be in the military and serve your country. The money should NOT be the main reason why you sign on the dotted line, you will only regret it...

Originally Posted by Cathance

I brought this over from another string. It's more relevant to this one.

Cath,
Speaking as a retired MSG, Arty, Inf, Medical and etc. let me say, Thanks for your hard work and dedication to our fellow soldiers. The Military isn't for everyone, and I for one don't think less of anyone, let alone a Physician, who has sacrificed much, and done so much for those still in uniform. You need to take care of you and your family. First, last, always.
I hope you get the Residency you are applying for, and maybe see you now that we both are on the "outside". Thanks again for your Service!

MSG Ski (retired)

Hey all - non-prior trying to do his due diligence here before signing my life over the the AF (USUHS). This may seem like a stupid/naive question, but please bear with me.

I have read thru these threads pretty extensively, but I still haven't gotten a good understanding of the amount of mortal peril we face as AD physicians, and this is clearly an important question. Of course, I understand that if the higher-ups want to put you on the front lines with an AK, they can. They own you. But in practice, how much danger do physicians typically face? I am assuming that there is a fair amount. Transporting between bases in Iraq etc, you face the danger of IEDs, all that.

Forgive the ignorance, but have many of the casualties in our wars been doctors? I just want to fully understand what I am signing up for, and I am finding that this is a question that people are reluctant to discuss.

Originally Posted by 0919mmk

Hey all - non-prior trying to do his due diligence here before signing my life over the the AF (USUHS). This may seem like a stupid/naive question, but please bear with me.

I have read thru these threads pretty extensively, but I still haven't gotten a good understanding of the amount of mortal peril

Mortal Peril?! None if you're in the AF, just work on your golf swing and you'll be fine! (j/k)

There's always some risk of getting hurt or killed, in some situations. Flying in a helo over Afghanistan is a lot more dangerous than treating tennis elbow in suburban america.

But no one's ever going to give you an 'AK' and ask hold the line, not as a lawful order at least. If we're still in the business of winning wars, we're not going to ask MDs to do that.

Now, you may be deployed to a forward operating area, asked to treat wounded service-members . . .oh and btw carry this sidearm or rifle in case you take fire. That's a perfectly legitimite order.

Can you get hurt/killed? Of course. But what's that risk compared to say dying in a car accident on a large highway? I'd venture to say the same, maybe the car-accident death is even more probable, given how much we commute.

There's plenty of other facets of military life that you should be thinking about too, not just the safety issue. Oh and (I dont know if this is your case) if you chose the AF thinking its the least 'military-like' or the least dangerous of the services, that is bad logic. The AF deploys plenty, operations are becoming more joint, a doctor from any service can be deployed anywhere if the need arises (except for maybe out to sea, the Navy's realm). Good luck in your decision.

Originally Posted by DrMetal

Mortal Peril?! None if you're in the AF, just work on your golf swing and you'll be fine! (j/k)

There's always some risk of getting hurt or killed, in some situations. Flying in a helo over Afghanistan is a lot more dangerous than treating tennis elbow in suburban america.

But no one's ever going to give you an 'AK' and ask hold the line, not as a lawful order at least. If we're still in the business of winning wars, we're not going to ask MDs to do that.

Now, you may be deployed to a forward operating area, asked to treat wounded service-members . . .oh and btw carry this sidearm or rifle in case you take fire. That's a perfectly legitimite order.

Can you get hurt/killed? Of course. But what's that risk compared to say dying in a car accident on a large highway? I'd venture to say the same, maybe the car-accident death is even more probable, given how much we commute.

There's plenty of other facets of military life that you should be thinking about too, not just the safety issue. Oh and (I dont know if this is your case) if you chose the AF thinking its the least 'military-like' or the least dangerous of the services, that is bad logic. The AF deploys plenty, operations are becoming more joint, a doctor from any service can be deployed anywhere if the need arises (except for maybe out to sea, the Navy's realm). Good luck in your decision.

No, I actually chose Navy as my first choice, and got offered AF, which I was totally fine with. Yeah, from what I can tell, the divisions between the branches are getting smaller rather than larger. I understand that making this decision means joining the military first, and medicine second.

Thanks for your response- very helpful. Of course there is always risk, but I'm trying to gauge it a little better, and you gave me a better picture of things.

Also, I am definitely considering many, many factors in this decision, not just this one. I'm speaking with current Ad docs etc, but this issue is one the the most important I think. People need to understand what they are getting in to, and there is a big difference between "Doctors are dodging mortar rounds on a daily basis" vs. "Doctors are in mortal peril comparable to driving on a highway."

Also, shred on! I am working on my shred as much as possible before COT - dont want to get too rusty, lose the mechanics :-)

Hi. Long time reader, first time poster. (Seriously, took me forever to read this thread...)

AF M4: You are about a Tron quote away from hitting every obscure reference possible. I lul'd often.

As a former enlisted Marine (Please stay away from me, sirs, I've had my final physical), I thought HPSP might be for me. After all, I love to PT, I love to get in the mix and I love being a geek.

So, after getting accepted, I tracked down a recruiter, filled out all the paperwork and stayed on him for a month and a half until I finally got to go through MEPS, again. I forgot how much it sucked the first time.

And then I came here and read everything possible prior to actually signing my contract. Needless to say, I will not be signing my contract. If I choose to enter the ring for round two, it will be with the FAP program, after I have chosen my own destiny, or NRMP has chosen it for me...

Before I begin, let me say something that is probably stated quite often. I don’t care about money. There, I said it. I didn’t consider the scholarship to pay for medical school––I’ll rob a bank, I’ve got the talent. I saved every penny I made in Iraq and Afghanistan (blew it all on an old car because I thought all southern boys should learn how to rebuild an engine, but I digress), but even that measly (and depressing) sum didn’t force me into the civilian sector where PMCs (private military contractors) are making 10x what I was making. So, I’ve already experienced what it is like to have a skill set that is worth more on the outside than the inside.

With that said, here are my reasons for changing my mind:

1. Everything I disliked about the military as an enlisted Marine is present in milmed, or so it seems. Meaning, individuals who have no idea how to perform your job are directly involved in how you are utilized. It wasn't fun then, it doesn't look like it would be fun now.

2. I don't like the idea that patient care ends at COB (close of business). I don't know if that is true, but that is the vibe I got on here; 1630 rolls around and everyone punches out. Or, my personal favorite, sick-call closed because the Old Man wants a meeting with all the officers.

3. Lack of straight through training. Unlikely chance of deferment. Sub-par continuation of training. Loss of skill. Let’s face it, I don't know how well I'm going to do in medical school. I might have a sudden realization of self-worth and dominate. If so, should I be punished in the end by not getting the residency I deep down desire? And is my bad attitude, if and when that happens, going to reflect on patient care? If so, then I have no business jeopardizing their well being because I have a bone to pick with the establishment. It serves no-one's interests.

4. But, I could forgive most of all of that because I'm a former Marine, who likes most of the Marine Corps, and therefore wouldn't be too distraught if I had to do a few GMO tours greenside. I might even get to cancel some PT (those crazy red and black flags can be fun, right?) just because I always wanted to...

Here is what I can't live with, though. I strive to be the best I can be, in all things. I do not accept second best for myself. And that is the rub. If I took the HPSP, would I get the absolute best training I could get for my profession? It doesn't sound like it.

And, I may be wrong, but it seems that residencies and training is limited in its scope. The Navy prides itself on the fact that it has to farm out rotations to civilian hospitals. If that is true, that is disappointing. I want complex cases (naïve to think so?), for the same reason I wanted complex training in the Marine Corps; it makes me better at my job. Isn’t that the goal?

Can I deep down, without a doubt and with no dispute say that I will get the best training I can get, if I choose HPSP right out of the gate, with no real idea of where I will be on match day? No.

But I can say this: regardless of how well I do in medical school, the military will need doctors when I’m done. No harm in waiting until then to make my decision.

Well, the interior of my car will have to wait… stupid loss of $1900 a month…

Originally Posted by 0919mmk

Hey all - non-prior trying to do his due diligence here before signing my life over the the AF (USUHS). This may seem like a stupid/naive question, but please bear with me.

I have read thru these threads pretty extensively, but I still haven't gotten a good understanding of the amount of mortal peril we face as AD physicians, and this is clearly an important question. Of course, I understand that if the higher-ups want to put you on the front lines with an AK, they can. They own you. But in practice, how much danger do physicians typically face? I am assuming that there is a fair amount. Transporting between bases in Iraq etc, you face the danger of IEDs, all that.

Forgive the ignorance, but have many of the casualties in our wars been doctors? I just want to fully understand what I am signing up for, and I am finding that this is a question that people are reluctant to discuss.

I think there were a couple of Army docs who died during OIF. I haven't heard anything from OEF. As an AF doc, I would think your chances are pretty low considering your platform and length of deployments. I know a few docs w/the grunts out in forward operating bases (FOB) so they are definitely in greater danger from IEDs but still "relatively" safe.

Originally Posted by 0317

And, I may be wrong, but it seems that residencies and training is limited in its scope. The Navy prides itself on the fact that it has to farm out rotations to civilian hospitals. If that is true, that is disappointing. I want complex cases (naïve to think so?), for the same reason I wanted complex training in the Marine Corps; it makes me better at my job. Isn’t that the goal?

The Navy's goal is to support the Marines in direct combat operations, drive ships, buy bombs and guns, etc. I think Navy Medicine is way down on the list in terms of priorities and funding.

The Marines always pride themselves on being better trained but have much fewer resources than other branches of the military. I think you could succeed in Navy Medicine if you had the same mentality. You are out manned, out gunned and out resourced but somehow you are going to make it work and be proud doing it.