A Day in the life of a Military Emergency Medicine Physician

[ActiveDutyNavy]

Out of curiosity,
(i know about the differences in pay, deployment & debatable training)

How does a monthly schedule of a civilian EM vs military EM compare? I'm sure military EMs have more administrative responsibilities. Is military EM shift work like its civilian counterpart?


Any input would be appreciated.

[USAF MD '05]

Hey man. As a 2nd year attending in AF EM, and having trained in the military for residency, I can tell you a little about the gig if you like.
We do work shifts, just like the civilian world. We probably work about the same amount as well. That being said, there is always some CBT or readiness training crap that seems to pop on your radar, and we do get assigned various admin duties, that can range from committees to master paperwork punk, to disaster team chief for exercises. Your assignment could be easy as pie, 15-30 minutes a month, or it could suck the life out of you (having been a disaster chief at Lackland.)
The amount of shifts you will work will also be highly dependent on the level of staffing due to deployments, TDYs, etc.. For instance, at Lakenheath we are solidly staffed right now. In the next 2 months we lose 2 docs to deployment, one to PCS and a civilian contractor whose time is up. That will leave us 3 docs and a part-timer that comes in from the states and works 4-6 days most months. So much for go travel Europe, right? We do have a vague promise that the leadershio will try to get us some help from somewhere. *holds breath*
Hope this helps!

[tscottturner]

I'd also like to know a little more about military emergency medicine - particularly in the Army. I'm former AD and I'm really just trying to get a better idea about what my options will be when I finish residency in 2012. There seem to be a lot of conflicting opinions on how the new healthcare program will affect EM in the civilian world, if at all.

[notdeadyet]

Originally Posted by tscottturner

There seem to be a lot of conflicting opinions on how the new healthcare program will affect EM in the civilian world, if at all.

Anyone who professes to know what things will be like in medicine or a particular specialty in 2012 is either blowing smoke or reads spin like a bible.

No one really knows. It's new legislation whose ink isn't even dry. What form it will end up taking in the next year or two is anyone's guess. You'll have some cry that it's going to finally insure the large percentage of this country who is uninsured or underinsured. You'll have some cry that it's going to be a National Health Service with all doctors working in conditions like Bob Cratchit in A Christmas Carol.

How people read tea leaves says a lot more about them (and in this case their politics) than it really does about he tea.

[ActiveDutyNavy]

Originally Posted by USAF MD '05

Hey man. As a 2nd year attending in AF EM, and having trained in the military for residency, I can tell you a little about the gig if you like.
We do work shifts, just like the civilian world. We probably work about the same amount as well. That being said, there is always some CBT or readiness training crap that seems to pop on your radar, and we do get assigned various admin duties, that can range from committees to master paperwork punk, to disaster team chief for exercises. Your assignment could be easy as pie, 15-30 minutes a month, or it could suck the life out of you (having been a disaster chief at Lackland.)
The amount of shifts you will work will also be highly dependent on the level of staffing due to deployments, TDYs, etc.. For instance, at Lakenheath we are solidly staffed right now. In the next 2 months we lose 2 docs to deployment, one to PCS and a civilian contractor whose time is up. That will leave us 3 docs and a part-timer that comes in from the states and works 4-6 days most months. So much for go travel Europe, right? We do have a vague promise that the leadershio will try to get us some help from somewhere. *holds breath*
Hope this helps!

Thanks, it helps a lot.

1) How does op tempo for EM compared to other specialties?

2) Are most military ERs located at tertiary care centers? If not, how do you handle refering patients to specialist if you are not located at a tertiary care center?

[ActiveDutyMD]

Originally Posted by ActiveDutyNavy

Thanks, it helps a lot.

1) How does op tempo for EM compared to other specialties?

2) Are most military ERs located at tertiary care centers? If not, how do you handle refering patients to specialist if you are not located at a tertiary care center?

Ha ha. All this bluster from Lakenheath, like they have it hard. We have 3/8 docs deployed currently and deploy 2 more next month. 2 of the 3 contractors have quit. The 2 deployed docs had 24 hours and 72 hours notice prior to deployment (neither was in the current "band")

I did manning assist at Lakenheath once, it was the best 2 months of my Air Force career. Don't hold your breath, it isn't going to get better any time soon. The good news is that Lakenheath tends to get a manning assist doc every summer to help with the gap between the doc who separates in June and the one who finally arrives in August.

To the OP- the ops tempo is pretty darn high. I have a guy going out again for 6 more months that have only been home for 13 months. Most military EM docs are NOT at tertiary care centers. Patients that require a referral to a specialist when it is not urgent are told to see their PCM (or if I'm nice I put the referral in the computer myself.) Pt's requiring an emergent consultation for a specialty we do not have on call are transferred to a larger military hospital if one is available or to a local civilian hospital. No big deal really. I wouldn't spend much time worrying about that aspect as it is very similar to civilian medicine. But do let your significant other know you'll likely be in the middle east for over a year of your 3-4 year commitment. That much I can almost guarantee.

[Zroe]

Hey guys, I'm a 1st year ER resident in Little Rock. As far as I know, my application is almost approved for the FAP program. I have a good deal of questions I'm hoping you guys can answer.

1) is it possible for a non military residency trained doc to get stationed at either of the 2 european bases on their first tour?

2) at your ERs, can you comment on things like volume, acuity, average patients per shift, ER doc coverage, sub specialty backup, etc.

3) dumb question, but do you wear scrubs or do you have to be uniformed?

4) the 24h notice of deployment is a little scary, anyone else have similar/different experiences?

5) while deployed, can anyone comment on where they went, and similar comments as in question 2, and additionally, average shifts per week/hours while over there.

6) can anyone comment on availability of moonlighting opportunities around where they are and how often your regular shifts allow it.

I'm sure I'll have more questions later. I appreciate everyones time. Thank you.

[ActiveDutyMD]

Originally Posted by Zroe

Hey guys, I'm a 1st year ER resident in Little Rock. As far as I know, my application is almost approved for the FAP program. I have a good deal of questions I'm hoping you guys can answer.

1) is it possible for a non military residency trained doc to get stationed at either of the 2 european bases on their first tour?

2) at your ERs, can you comment on things like volume, acuity, average patients per shift, ER doc coverage, sub specialty backup, etc.

3) dumb question, but do you wear scrubs or do you have to be uniformed?

4) the 24h notice of deployment is a little scary, anyone else have similar/different experiences?

5) while deployed, can anyone comment on where they went, and similar comments as in question 2, and additionally, average shifts per week/hours while over there.

6) can anyone comment on availability of moonlighting opportunities around where they are and how often your regular shifts allow it.

I'm sure I'll have more questions later. I appreciate everyones time. Thank you.

1) Very unlikely, but not impossible. Lakenheath is the more likely option. I'd expect Keesler or similar. If you want to control this, join AFTER residency rather than FAP.

2) Back up is fine, volume is high to very high, acuity is low to very low, my coverage is single to triple (counting PAs), back up is better than average. We ideally have 40-48 hours of provider coverage per day and tend to see 90-120 patients per day, so ~ 2 pph. Of course, right now we're running with about 36 hours of provider coverage due to deployments, that's more like 3 pph. And given that the place is dead between 2 and 6 am, that's 10 more patients you can expect to see on the day shift. I'd say expect 25-35 patients on a 12 hour day shift, maybe 20 on a 12 hour night shift. Less if you're working 8s.

3) No dumb questions. Official policy is you wear the uniform of the day in, then hospital scrubs if you please. In reality, I wear my own scrubs in and no one says anything. Of if I feel like it, I just work the shift in BDUs, even if it is a blues day. Not a big deal at this base, but can be at larger MTFs.

4) Sorry deployments scare you. You REALLY need to be willing to deploy with little notice as you probably will once in a four year career. "A Lot" of notice is 1-2 months, but with the band system you have a year's notice or so in the ideal world.

5) Deployed situations vary. You can have low volume-low acuity, high volume-low acuity, high acuity-low volume, and very rarely high volume-high acuity. Both of my deployments were low volume-low acuity. My most recent one involved 10 outpatient providers seeing 250 patients in the course of 14 days. That worked out to what...2 per day per person (we weren't given days off despite the volume). In my experience, providers are generally over-deployed. But I know someone out right now who was deployed with 3 emergency docs, one of which went home early for some reason so now one works every day and the other works every night for the last couple months of their deployment. So it can really vary. You are the military's biatch and you will do what they tell you to do. Be okay with that or you will be miserable. So expect anywhere from 15-30 12-hour shifts per month while deployed, probably with less than 2 patients per hour.

6) I expect my docs to moonlight and all of them do. 2-4 shifts a month is typical. I'd say less than 2 and you're losing skills. YMMV. This area has 6 or 8 hospitals that are willing to have us come work for them. Typical rate is $150 per hour (independent contractor.)

[ahowardmd]

Is modern military medicine anything like 'MASH'? I'm starting at USUHS in the Fall, and I'm trying to decide between EM and some kind of surgery. What do EM docs do most of the time?

[dwb8p]

Originally Posted by ahowardmd

Is modern military medicine anything like 'MASH'? I'm starting at USUHS in the Fall, and I'm trying to decide between EM and some kind of surgery. What do EM docs do most of the time?

You are way too early in the game to make that decision with any certainty. A typical premed with typical shadowing and whatever else experience still doesn't know much at all about choosing a specialty. That's like debating whether to have 3 children or 4 when you haven't even found a girlfriend.

[ActiveDutyMD]

Originally Posted by ahowardmd

Is modern military medicine anything like 'MASH'? I'm starting at USUHS in the Fall, and I'm trying to decide between EM and some kind of surgery. What do EM docs do most of the time?

There is a lot of truth on MASH. There's a lot of truth in the book Catch 22. I'd recommend a healthy dose of both before signing up for military medicine. Most of the time EM docs see patients who come to the ED for chest pain, abdominal pain, shortness of breath, vaginal bleeding, lacerations, limb pain, trauma, altered mental status etc and try to rule out and treat any emergent conditions. You do some of this in military EDs, but you also tend to do a lot of rashes, diarrhea, and colds.

[ahowardmd]

Originally Posted by dwb8p

You are way too early in the game to make that decision with any certainty. A typical premed with typical shadowing and whatever else experience still doesn't know much at all about choosing a specialty. That's like debating whether to have 3 children or 4 when you haven't even found a girlfriend.

That's a pretty cool analogy

Originally Posted by ActiveDutyMD

There is a lot of truth on MASH. There's a lot of truth in the book Catch 22. I'd recommend a healthy dose of both before signing up for military medicine. Most of the time EM docs see patients who come to the ED for chest pain, abdominal pain, shortness of breath, vaginal bleeding, lacerations, limb pain, trauma, altered mental status etc and try to rule out and treat any emergent conditions. You do some of this in military EDs, but you also tend to do a lot of rashes, diarrhea, and colds.

Yeah, that's the only thing that worries me about military EM. I imagine spending my entire time in the ED treating VD and other little stuff.