AVOID MILITARY MEDICINE if possible

USAFdoc · May 29, 2005

below are just a few notes from a thread that bear repeating, and repeating again. For those doubters,just speak to other docs and bases for similar stories. I have been to several military conferences and spoke with docs from 10+ bases and it's all the same,and its bad.

Originally Posted by USAFdoc
the afpc believes they can continue to minimally staff our clinics at a rate just barely enough to keep them open; and unfortunately, they are probably correct,because there will be just enough HPSPers that have no idea on what waits "on the other side" to keep the doors open. The afpc is not about taking care of patients or staff; its about money and metrics. This perversion of medicine continues because the clinic physician has absolutely no power in this system (except to separate at DOS.)

I have been working in various fields for 22 years and in many organizations; the current state of primary care med in the USAF is unquestionably the worst I have ever seen. Avoid at all cost.

This post basically sums up why many of us that are on AD post. We see how broken the military medical system is, and we realize that we had no clue what we were getting into when we were 22 to 24 year-old pre-med students. The problem is that the continual influx of clueless pre-meds who sign up for USUHS/HPSP allows the military to perpetuate the horrible system because physicians are not empowered to make changes or to even to get out and work somewhere else. Probably the only way that the system could possibly change for the better is if there were a significant drop-off in med student applications and therefore forcing the higher-ups to address these critical issues out of necessity.

But that is but a pipe dream for many of us, as we continue to watch inherently naive pre-meds zealously defend their reasoning about why military medicine is so great, in spite of what scores of active duty docs say on this board to the contrary. Meanwhile, military medicine is allowed to limp along in its current sad state, because there still enough poorly informed pre-meds who are willing to sign up. a few of 100's of examples I could give you to describe a broken system:

1) I have the chart available to me at the time of the patient visit only 10-40% of the time.
2) Our clinic should have 31 people (docs + techs) fully manned; this week we mustered 7 each morning, a little lower than normal but not unusual.
3) I have seen 100's of abnormal labs, imaging results etc that were never acted upon, some years old. When brought up with the patient, they had no idea.
4) I have seen men at their retirement physical who went 20 years with untreated hypertensiion, they were seen 20-40 times over their career with blood pressures taken, and never even a mention of being offerred a medicine.
5) Using brand new PAs to function as physicians, with no supervision, seeing Internal Medicine patients.
6) Referral results making it back to the physician no more than 40% of the time (this was quoted at our PCO USAF course) and I beleive it.
7) Overworked (although that is no excuse) admin techs caught throwing away piles of patient notes rather that take the time to file them (I know proof positive of at least 2 bases this has occurred on).
8) The CHCSII and PGUI computer programs that sap physician-patient face-to-face time with no additional appointment time given to account for this.
9) Clinic meeting that have ZERO physician attendance yet that is where all local decisions are made. Complete disregard for our input. Held during clinic appointment times, run 100% by nurses. All clinic commanders but 1 being nurses.
10) Let me know if you need 90 more. Perhaps you are not a pprimary care doc and have not witnessed the above first hand.

BOHICA-FIGMO · May 29, 2005

USAFdoc,
the more I read your posts the more I feel like sucking it up and taking out loans to pay for my education!

callendm · May 29, 2005

Though you have some experience at conferences with other military professionals. Please, change the title of your post to "avoid AF medicine" as this is what you have experienced first hand. As you know there are many differences in each branches medical systems. Therefore it is inappropriate to lump them all together.

kaikai128 · May 30, 2005

A few months ago it was "avoid the navy," "the navy screwed me," etc. There are always going to be ppl to complain, but in all honestly if the worst thing I encounter in my career is a nurse walking into the break room or a nurse on a bit of a power trip, I am going to think I have one heck of a great life. However, my opinion on the heirarchy of power and how I will react is nil, since I'm just one of those idealistic stupid medical students....

I think that this forum is nice in that it gives a counterpoint to a lot of the other information out there. That being said, when people repeat the same things over and over...and I read the same things again and again, I just quit reading them.

USAFdoc · May 30, 2005

kaikai128 said:
A few months ago it was "avoid the navy," "the navy screwed me," etc. There are always going to be ppl to complain, but in all honestly if the worst thing I encounter in my career is a nurse walking into the break room or a nurse on a bit of a power trip, I am going to think I have one heck of a great life. However, my opinion on the heirarchy of power and how I will react is nil, since I'm just one of those idealistic stupid medical students....

I think that this forum is nice in that it gives a counterpoint to a lot of the other information out there. That being said, when people repeat the same things over and over...and I read the same things again and again, I just quit reading them.

my USAFdoc "avoid military medicine" are not meant to be taken just as "the USAF screwed" me venting. Yes, the hours (12-18/day) are ridiculous, then add all the military administrative hogwash.......but,hey.,I signed the papers, I got my med school paid for, and hey, aint no suicide bombers in my clinic. There a certainly things to be grateful for.
My main concern is for the quality of the care in my clinic,and it is poor. And it is poor because the USAF has designed it to be poor with extreme undermanning,lack of experience and please read some of my other posts for the details on pt care and charts etc. The reason the USAF should take care of its staff is because the single biggest way to improve quality (although not the only way) is through the retention of its docs. And at my base,and many others,this retention in ZERO,and has been for 10-15 years.

It makes no sense that the USAF would invest so much $$$$ andd then get an inexperienced doc that will have to learn the military system,do more frequeny TDYs out of clinic etc. and not want to retain them. Once retained, they would have a better doc, whoo can do more, cost less (already paid off his med school once) and be more efficient and available.

For those not in the USAF; my concern is that your Surgeon General may do to your clinic what ours did back in 2000. HE decided we should run like an HMO and more that doubled the # of patients our clinic sees overnight. The things he promised (support staff) to do this never materialized. THERE WERE certainly many problems before 2000; this decision just made them happen twice as fast,twice as much, and sometimes with twice as bad patient outcomes.

As health care cost continue to spiral upwards, the idea that somebody who has no real clue on what a Primary care clinic needs to run will be looking at his computer screen to view this months metrics and then make a decsion that screws patients and staff alike is not an organization that you want to link your life to. Alot of these problems are fixable, but not in this "command from afar" design we have in the military.

militarymd · May 30, 2005

kaikai128 said:
........but in all honestly if the worst thing I encounter in my career is a nurse walking into the break room or a nurse on a bit of a power trip, I am going to think I have one heck of a great life.......

kaikai128 said:
However, my opinion on the heirarchy of power and how I will react is nil, since I'm just one of those idealistic stupid medical students....

Don't forget this 8 years down the road and you look back on your life.

kaikai128 said:
when people repeat the same things over and over...and I read the same things again and again, I just quit reading them.

So when ACLS repeats Airway, Breathing, Circulation over and over again, you stop reading it when you don't get it the first time???

RichL025 · May 30, 2005

USAFDoc,

Should have replied to you in the other thread, but since we'r eina new one here...

Thanks for being more specific about your complaints - I think that will be more helpful to people trying to make up their mind.

FWIW, in the Army setting, the people who it seemed to me to be least satisfied with their jobs, and how the Army supports them in doing their jobs, have been the primary care docs. Their complaints are similar to yours, but not as intense across the board. (By less intense I don't mean their complaints, but their perception of the problem).

Maybe the statement should be "avoid USAF / Military Primary Care" ????

I don't know what the retention numbers are for FP docs in the army, but the clinic I just got done with (large army post in the south) seemed to be fully staffed (except for those on deployment) - well, let me qualify that - I didn't see a TO&E, but there weren't any empty offices for anyone else to come in.

And the more I think about it, the "happy docs" I've met, including the ones who came to the military from civilian practice, have all been specialists.... Hmmmmmm

Well, anyway, thanks for your perspective.

USAFdoc · May 30, 2005

RichL025 said:
USAFDoc,

Should have replied to you in the other thread, but since we'r eina new one here...

Thanks for being more specific about your complaints - I think that will be more helpful to people trying to make up their mind.

FWIW, in the Army setting, the people who it seemed to me to be least satisfied with their jobs, and how the Army supports them in doing their jobs, have been the primary care docs. Their complaints are similar to yours, but not as intense across the board. (By less intense I don't mean their complaints, but their perception of the problem).

Maybe the statement should be "avoid USAF / Military Primary Care" ????

I don't know what the retention numbers are for FP docs in the army, but the clinic I just got done with (large army post in the south) seemed to be fully staffed (except for those on deployment) - well, let me qualify that - I didn't see a TO&E, but there weren't any empty offices for anyone else to come in.

And the more I think about it, the "happy docs" I've met, including the ones who came to the military from civilian practice, have all been specialists.... Hmmmmmm

Well, anyway, thanks for your perspective.

Thanks for the reply.
My experience and what I am speaking on is 90-99% USAF primary care (mostly FP,but exposure to flight med, internal med, and pediatric clinics).

Specialist have not yet been "bitten" by our surgeon generals "optimization" fang, but those plans for failure are in the works. Dental clinics currently beginning to feel the bite.

It is a challenge to describe the tens of thousands of patients I have seen (and the frequent sustandard care and near misses); the non physician commanders that are clueless and wish to remain that way (for them to know what is going on means they might have to do some work and fix it), the numerous colleagues I have seen exit the military with 10-18 years of time in service...yes, as high as 18 years). It is all terribly disturbing, and the reason I am angry about it is because I give a dam_.

What has been interesting also are the conversations I have had with my patients that are non-medical personnel,especially the commanders. What I have witnessed in terms of degradation of quality,manning, morale, and the constant "do more with less" is premeating all of the USAF at this time. This is directly from the mouths of commanders. I have grave concerns for what the next 2-5 years have in store. It would be one thing to for the USAF to say "we have problems and this is our lan to fix them" but instead we have the montra that "retention is great, more is at an all time high" etc.

The only thing that has exited the USAF faster than it's people are the USAF core values from it's leadership.

medicine1 · May 30, 2005

You quote yourself, over and over again. I would like to actually see more than just two or three people complain. You are a vocal minority. I have personally seen the primary care doctors at the VA and other Military hospitals, and I know for a fact that you are lying. And if you are going to be constantly complaining about the hours you work, than maybe medicine wasn't your true intention. People also shouldn't go into military medicine soley on the fact that their medical education is/or will be paid for.
I give you a thumbs down USAFdoc.

medicine1 · May 30, 2005

USAFdoc: Learn how to write.

militarymd · May 30, 2005

Medicine1,

Personal history and experience please:

Age?
Level of education?
Military experience?
Military medicine experience?

Saying that you know what it is like because "you've seen it" is like those Holiday Inn express commercials......I slept there last night...so today I can do your quadruple bypass.

militarymd · May 30, 2005

medicine1 said:
I would like to actually see more than just two or three people complain.

Navysurgeon, rudy, xmmd, mitchconnie.....plus usafdoc....hmmmm that's 4 right there.....hmmmm, I mean 5.

medicine1 said:
You are a vocal minority.

Perhaps....but the minority with EXPERIENCE!!

USAFdoc · May 30, 2005

medicine1 said:
You quote yourself, over and over again. I would like to actually see more than just two or three people complain. You are a vocal minority. I have personally seen the primary care doctors at the VA and other Military hospitals, and I know for a fact that you are lying. And if you are going to be constantly complaining about the hours you work, than maybe medicine wasn't your true intention. People also shouldn't go into military medicine soley on the fact that their medical education is/or will be paid for.
I give you a thumbs down USAFdoc.

Your last entry was the ridicullous and offensive. I am not lying and resent your acusation. Whatever you saw at the VA, I cannot comment on. I can only tell you what I have seen and heard during my time, and at the conferences and bases I have been at.
I am not the minority. Although I cannot claim (and do not) say that 100% of primary care docs are frustrated and leaving, the number is extremely high.

I do not claim to be a writer and I cant type worth crap. What a riduculous remark that was...but very typical for someone (like admin) to remark on nonsignificance and ignore the heart of the matter. You sound like an up and comming pencil pusher.

I didnt get into medicine for the $$$$ I am previously enlisted and if I wanted to make bucks I certainly would not have chosen primary care and military. And if you read my previous entries, I make clear what my # 1 concerns are,and it's not the hours.

You may think I cant write,well you cant make an argument that holds water.

USAFdoc · May 30, 2005

medicine1 said:
You quote yourself, over and over again. I would like to actually see more than just two or three people complain. You are a vocal minority. I have personally seen the primary care doctors at the VA and other Military hospitals, and I know for a fact that you are lying. And if you are going to be constantly complaining about the hours you work, than maybe medicine wasn't your true intention. People also shouldn't go into military medicine soley on the fact that their medical education is/or will be paid for.
I give you a thumbs down USAFdoc.

And by the way, just what don't you ubderstand obout ZERO% of docs at my base, and none that I know or have met elsewhere staying active duty?

You may think I am a minority; I certainly hope you are a minority (a short sighted, false accusing, head stuck in the sand, minority at that).

Get a clue before you speak.

medicine1 · May 30, 2005

militarymd said:
Medicine1,

Saying that you know what it is like because "you've seen it" is like those Holiday Inn express commercials......I slept there last night...so today I can do your quadruple bypass.

Are your arguments not based on "I've seen it" type of thing? :laugh:

militarymd · May 30, 2005

medicine1 said:
Are your arguments not based on "I've seen it" type of thing?

Everything boils down to "what you've seen" and EXPERIENCED.

My experience: 11 years AD.....board certified 2 specialties....Education Chairman for residency program for 4 years at one of the Navy Big threes...in private practice...etc..etc.

Your experience: ????please fill in the blank...

Once we have all the info, then we can decide whose experience is more valid or have "seen more"....Holiday Inn express or actual knowledge.

medicine1 · May 30, 2005

USAFdoc is trying to argue that people should not apply for HPSP, and or should not go into military medicine period. I am simply looking at his argument, and it doesn't hold much weight with me. I don't have to explain my life history. Lets simply use logic and critical thinking skills.
Sure experience must count for something, but I also want to see die hard proof, statistics, and sound weighted arguments for not joining the military.
Most of the things I read on this thread are opinion, and people's perceptions, and nothing more.

USAFdoc · May 30, 2005

militarymd said:
Everything boils down to "what you've seen" and EXPERIENCED.

My experience: 11 years AD.....board certified 2 specialties....Education Chairman for residency program for 4 years at one of the Navy Big threes...in private practice...etc..etc.

Your experience: ????please fill in the blank...

Once we have all the info, then we can decide whose experience is more valid or have "seen more"....Holiday Inn express or actual knowledge.

I am at my 12 year point,3 at my current base, board certified etc.....but that is not the point, and my argument is not with you. I don't expect you to know what id going on in many primary care USAF clinics; how would you know that. I would expect you to beleive a fellow officer who has witnessed these things first hand. You may chose to not believe, that is your right. I believe things at the VA are probably better and there are likely reason for that (more civilian docs that could leave if the quality sank to low). I am not speaking to that. I am speaking to what I know first hand to be the truth.

I do not care if you are a specialist multipplied 10 times over, with sugar on it. You do NOT know what is going on in many primary care clinics like mine or the patients that have been mamed (248/148 blood pressure not treated, s/p stroke now), failed to notify pt of abnormal labs (blood sugar 408..pt told about it 6 months later when he returns thinking he was dying of prostate cancer) and 100's of others. I don't even expect for you to be as angry as me about these instances. But I am their advocate, thier doctor, I haev seen them and know them by name. I fixed the problems when I found them,but many of them should have nver occurred in the first place.

I'll keep my comments focus'd on what I know,you do the same.

medicine1 · May 30, 2005

Well I hope you continue to be the patients advocate, and fight for what ever help and resources they need.

USAFdoc · May 30, 2005

medicine1 said:
Well I hope you continue to be the patients advocate, and fight for what ever help and resources they need.

Thanks for understanding. I know I sound angry, and I am. Some things in life should make you angry (if not, take a pulse, you might be dead etc).

There are characteristics of the military (don't complain, suck it up, make it happen) that are needed in time of war etc. The problem is those same characterisitics can lead to trouble at times as well. We are feeling that in USAF primary care and leadership seems to be in denial.

If you and I are deployed somewhere, treating the injured and we don't have the supplies and support we need, we just have to make the best of it.
That should not be the case for our day to day care in our CONUS primary med clinics, especially taking care of dependents and kids.

thanks again.

medicine1 · May 30, 2005

militarymd · May 30, 2005

USAFdoc said:
I'll keep my comments focus'd on what I know,you do the same.

I agree with you on the whole about military medicine...both as a specialist and in primary care.

My wife was active duty also...She was an internist attending in a primary care clinic....Need I say more?

RichL025 · May 30, 2005

USAFDoc,

What has been interesting also are the conversations I have had with my patients that are non-medical personnel,especially the commanders. What I have witnessed in terms of degradation of quality,manning, morale, and the constant "do more with less" is premeating all of the USAF at this time. This is directly from the mouths of commanders. I have grave concerns for what the next 2-5 years have in store. It would be one thing to for the USAF to say "we have problems and this is our lan to fix them" but instead we have the montra that "retention is great, more is at an all time high" etc.

Well, in the few short hours I was gone we seem to have had a character assasination and then an abrupt turn around

. Don't quite know what the heck THAT was, but hopefully it's passed.

Just one thing I'd like to add - in the mid-90s (in a different career field) I felt the same way you do, above. Retention looked like crap, the high-ups were clueless and didn't care about training - they just wanted to hear that there were no accidents or injuries - if we accomplished that by not training at all, they were just as happy. Things looked very dismal for the future, and the only people staying in were those who were trying to make their 20. I got out only to start pre-med, otherwise I'm not sure what _I_ would have done.

OK, so this is morphing into TWO points.

1) Things got better. Much better. The career field of which I spoke suddenly became the darling of the establishment, training money started flowing again, 20 fanatics flew planes into our buildings and those former friends of mine got to demonstrate how good they were. They are still overdeployed, micromanaged from above, and still bitch about it on a daily basis, but they love it and are doing great things. I'd be a liar if I told you I hadn't considered chucking med school and rejoining them.

2) We are often part of the problem ourselves. In my past life, the "good ones" often got so fed up with the problems that they got out at the first opportunity. That left the incompetent pencil-pushers to rise up to command levels. Why we expected the ticket-punchers to suddenly develop a conscience and do what's right just because they're now our commander is beyond me.

You mentioned earlier that the commanders were all non-physicians. Why? Could it be because physicians avoided the job, leaving Nurse Practitioners to sieze the power? And those clinic meetings scheduled during appointment times - why are the nurses allowed to do that? Could it have been because physicians weren't attending them in the first place? In the FP clinic I just left that's what was happening - physician's didn't want to attend admin meetings, they just wanted to bitch about the results that came out of them

So what's the answer? (Well, I'm just one of those naive med students... but if you think this problem is specific to medicine, well, I won't insult you, but I'll just say I doubt it.) Could the answer be for motivated, caring FP docs to bite the bullet and serve in command positions? To go to all of those boring ass admin meetings and fight to make the necessary changes?

I know it's hard to do, no one wants to fall on their sword and take the bullet for everyone else, but all this somewhat reminds me of the mice who all agreed what a great idea it would be to bell the cat....

Enough of my moralizing. You probably think the above is incredibly patronizing, if so, I apologize. After almost two decades of wearing a tree suit, though, I guess I felt I had the right to climb up on a soapbox a bit.

rotatores · May 30, 2005

she was an internist attending in a primary care clinic....Need I say more?

...but that kinda makes sense...that's what many internist in the military do...unless she was stuck doing just sick call...which would be a total waste of her training.

denali · May 30, 2005

militarymd said:
So when ACLS repeats Airway, Breathing, Circulation over and over again, you stop reading it when you don't get it the first time???

No, but when your monotonous diatribes even remotely begin to approach the importance of ABCs, I and others might be more inclined to disregard the tiresome repetitiveness & patronizing tone.

Have a nice day.

militarymd · May 30, 2005

denali said:
No, but when your monotonous diatribes even remotely begin to approach the importance of ABCs, I and others might be more inclined to disregard the tiresome repetitiveness & patronizing tone.

Have a nice day.

Typical responses I used to get from USELESSU medical students who get passed on rotations, just so I don't have to deal with them again.

rotatores · May 30, 2005

Typical responses I used to get from USELESSU medical students who get passed on rotations, just so I don't have to deal with them again.

I really think youd be doing yourself a favor if you were less patronizing and welljust less childlike in your responses. I swearsome of your responses I would expect from my 10-year-old nephew. But denali does have a good pointyoure very unoriginal at this point and Im sure if we took a poll youd realize that the majority of the non-military bashers on SDN skip over your posts.

We understand that you feel it is important to get the word out on your disappointments with the military (which we ALL agree is important) but youd really get more respect if you actually for once gave some.

militarymd · May 30, 2005

denali said:
No, but when your monotonous diatribes even remotely begin to approach the importance of ABCs, I and others might be more inclined to disregard the tiresome repetitiveness & patronizing tone.

That's exactly what my 7 year old son sounds like when he is trying to sound like an adult. Big words without understanding the concepts/analogies.

I'm addressing a lot of the military medical students as they would be addressed and treated when they finish their training go into the real military. If you don't like it on an anonymous forum, then how are you going to deal with it in real life. Wait until some Cow-mander doctor-want-to-be with more rank then you starts giving you crap.

Finally, my posts are directed to those who are sitting on the fence, trying to make a big decision in their life....not those who have signed and have to make the best of it....so for those are committed, please DO ignore me....

The lip I get on this forum sure reminds me of my time in the service....I certainly do not get it in private practice.....I wonder why?

Spang · May 30, 2005

I'd like to post a lengthy reply here, but to be honest OB call is sucking the life out of me right now. What I would like to ask x-militarymd and USAFdoc, which I think I have asked before, is what do you suggest those of us who either by ignorance or because of other circumstances ARE going into military medicine for atleast a brief period, do about all this. What is the solution to providing care for the AD and dependents? Is suggesting that no one take the HPSP a solution? I can't see how. Or is your aim just to inform people? Because it seems a little more like you're try to disuade them (AVOID MILITARY MEDICINE!, etc). Sorry for all the run-ons, clauses, etc. Commenting on my writing is not required!

Spang (13 years active duty, carrier qualified aviator, yada, yada, yada....)

backrow · May 30, 2005

militarymd said:
Typical responses I used to get from USELESSU medical students who get passed on rotations, just so I don't have to deal with them again.

Backrow climbs to the top of the watertower to once again defend the honor of his medical school.

I'm not going to get involved in this monkey business but let's keep the bashing of the schools to a minimum please.

UCBShocker · May 30, 2005

backrow said:
Backrow climbs to the top of the watertower to once again defend the honor of his medical school.

I'm not going to get involved in this monkey business but let's keep the bashing of the schools to a minimum please.

well I doubt there is a medical school called uselessu... so don't worry about it.

...... =)

backrow · May 30, 2005

UCBShocker said:
well I doubt there is a medical school called uselessu... so don't worry about it.

...... =)

Unfortunately I am pretty sure he was referring to the nickname for USUHS.

rotatores · May 30, 2005

Backrow climbs to the top of the watertower to once again defend the honor of his medical school.

Well said backrow.

USAFdoc · May 30, 2005

Spang said:
I'd like to post a lengthy reply here, but to be honest OB call is sucking the life out of me right now. What I would like to ask x-militarymd and USAFdoc, which I think I have asked before, is what do you suggest those of us who either by ignorance or because of other circumstances ARE going into military medicine for atleast a brief period, do about all this. What is the solution to providing care for the AD and dependents? Is suggesting that no one take the HPSP a solution? I can't see how. Or is your aim just to inform people? Because it seems a little more like you're try to disuade them (AVOID MILITARY MEDICINE!, etc). Sorry for all the run-ons, clauses, etc. Commenting on my writing is not required!

Spang (13 years active duty, carrier qualified aviator, yada, yada, yada....)

If you haven't signed,do not sign. Pay for school yourself. If you want to serve our troops,investigate what the medical corps is at that time. I am sure there will be some debt forgiveness program available. Even then, before you sign,visit and talk to several docs (1st termers) and get the low-down.

If you are already in: hope for the best,prepare for the worst. I am fighting for you. I have been to congress and the inspector general and willcontinue to fight for my patients and you. Get ready to do this yourself. If you haven't chosen a specialty, you still have to choose what you want to do for the rest of your life. FP is bad right now, but I will continue to be the best FP I can be, I might just have to change who I work for. Donot choose something that militarily mighjt be adventageous, but not who you are.

hope that helps.

Also,I am considering staying (although very unlikely). I did consider staying so that I could become a commander someday,but even local commanders lack the authority to make changes that need to be done, Wash DC hold most of the cards. And FP USAF is being dealt alot of losing hands.

militarymd · May 30, 2005

backrow said:
Backrow climbs to the top of the watertower to once again defend the honor of his medical school.

I'm not going to get involved in this monkey business but let's keep the bashing of the schools to a minimum please.

OK, I was out of line.

militarymd · May 30, 2005

Spang said:
I'd like to post a lengthy reply here, but to be honest OB call is sucking the life out of me right now. What I would like to ask x-militarymd and USAFdoc, which I think I have asked before, is what do you suggest those of us who either by ignorance or because of other circumstances ARE going into military medicine for atleast a brief period, do about all this. What is the solution to providing care for the AD and dependents? Is suggesting that no one take the HPSP a solution? I can't see how. Or is your aim just to inform people? Because it seems a little more like you're try to disuade them (AVOID MILITARY MEDICINE!, etc). Sorry for all the run-ons, clauses, etc. Commenting on my writing is not required!

Spang (13 years active duty, carrier qualified aviator, yada, yada, yada....)

Do your best is all that I can say. There are those out there who stay because they feel it is the right thing to do....and I admire them for it. Be one of them.

Unfortunately, I think there needs to be a major crisis before things will change.

denali · May 31, 2005

militarymd said:
That's exactly what my 7 year old son sounds like when he is trying to sound like an adult. Big words without understanding the concepts/analogies.

I'm addressing a lot of the military medical students as they would be addressed and treated when they finish their training go into the real military. If you don't like it on an anonymous forum, then how are you going to deal with it in real life. Wait until some Cow-mander doctor-want-to-be with more rank then you starts giving you crap.

Finally, my posts are directed to those who are sitting on the fence, trying to make a big decision in their life....not those who have signed and have to make the best of it....so for those are committed, please DO ignore me....

The lip I get on this forum sure reminds me of my time in the service....I certainly do not get it in private practice.....I wonder why?

I'm sympathetic to your POV; really I am. I can understand why you may feel like the lone (but growing) voice crying out in the wilderness. I've appreciated your posts when they've contributed something insightful and informational, especially when you've backed them with examples from your experiences. Unfortunately it's getting to be a rare occasion when they're like that. Instead they're mostly smarmy little rejoinders with a smug sense of superiority infused throughout, and the post I quoted from is a perfect example. Your POV is an important one to have around on this board, but it's getting lost in the delivery, and your response to kaikai128 pissed me off enough to finally chime in.

I'm not cherry when it comes to the real military, especially the medical side of the house; your tone/attitude are nothing I haven't already encountered and dealt with/sucked up before. But just because it's out there doesn't mean it's worth emulating. Is it your intent to come across like the "Cow-manders" you despise, especially when trying to influence fence-sitting medical students? I think your argument suffers when it's repetitively wrapped up in "You poor, naive med student, you've no idea," "Wait 8 more years," or "See, I told you so." No one likes hearing that all the time, especially us useless seven year olds.

militarymd · May 31, 2005

militarymd said:
So when ACLS repeats Airway, Breathing, Circulation over and over again, you stop reading it when you don't get it the first time???

That's why I posted this line. Repetition is what is left once all the evidence/experience/examples has been presented.

In what way are my "diatribes" being like a "Cow-mander"? The Cowmander's impose their will on physicians via a broken down system that allows them to distort the delivery of healthcare to allow themselves to be promoted.

I'm voicing a POV on a public anonymous forum that you can read or not....How is that in anyway similar?

UncleRico · May 31, 2005

militarymd said:
That's why I posted this line. Repetition is what is left once all the evidence/experience/examples has been presented.

In what way are my "diatribes" being like a "Cow-mander"? The Cowmander's impose their will on physicians via a broken down system that allows them to distort the delivery of healthcare to allow themselves to be promoted.

I'm voicing a POV on a public anonymous forum that you can read or not....How is that in anyway similar?

The sad thing about USUHS is that the dog and pony show in the little bubble of the National Capital Area does not reflect what is happening in military GME and especially in military medical practice at large. If I were to poll 100 staff active duty physicians at Wilford Hall Medical Center where I work as an active duty resident, I would say that the 70-80% would express similar concerns as those of the staff that post on this forum. It is comical to see how stubborn and defensive the pre-med and med students are on this board; the sad thing is that we won't likely get to see them eat humble pie in 6-10 years when they finally get the experience to realize that what was said on this board was accurate.

One of my biggest gripes about USUHS has nothing to do with the school per se, as the medical school education itself is decent. The problem is that when you sign up for USUHS and tour the school, talk to faculty during interviews, etc, is that your time at USUHS is only a relatively small part of your overall military medical experience. You are marrying yourself to military medicine at large for an extremely long period of time, and it is only when you leave USUHS that your really become acutely aware that the military medical system is dysfunctional and that the ship is sinking. By then, it is too late and you are signed up until halfway through the next decade with no options to get out.

I think that USUHS owes it to folks that sign their lives aways to play a more active role in educating students about challenges facing military medicine as a whole and to also play a more active role in potentially helping to fix those problems. It is a disservice to sit back in the "bubble" and pretend like the problems don't exist.

navysurgeon · May 31, 2005

Experience matters.

When you've got a military doc (or five) telling you NOT to sign the HPSP contract, then take that advice seriously.

Military medicine is going the way of the dinosaurs...ready to take a dirt nap...preparing to sleep with fishes....

As a Navy man, my professional opinion is to NOT embark on a sinking ship. Or a stalling airplane, or a Army buried in the sand...

mommax3 · Jun 10, 2005

My husband is FINALLY out of the AF (actually he is on terminal leave

) and the uniforms are in a box in the attic. :clap:

After an active duty residency and four years at a godforsaken base in north Texas, he and I are both more than thrilled to leave the military behind. He got great training in residency (he is an OB/Gyn) at WHMC and BAMC, but his time as an attending at a small hospital (which basically ceased to be a hospital and became a clinic over the past four years) was a whole different world. Put simply, it was VERY difficult for him to practice "good medicine" within the confines of the military. Contract staff and GS employees, as well as other active duty folks who were counting the days til retirement made for a horrible work environment.

My husband signed up mainly for the free ride through med school, although he was proud to be able to be a part of the armed forces, too. If the resources here would have been available to us 12 years ago, he would have made a different choice, but we knew no one who had taken the HPSP route and it sounded good to both of us.

He worked very hard, did NOT count the days, and was well thought of by those above and below him.

During his last week of active duty, he was working hard to convince TPTB, both at his base and higher up, that assigning civilian family practice residents (who are mostly FMGs) to be the docs on call for the inpatient military pediatric patients was not a good policy, since they could not take care of neonates and civilian pediatricians were not willing to cover them.....the AF pediatricians are so short-staffed that they were not able to cover hospitalized patients as well as their clinics. This policy (which went into effect in March) had, by the end of May, left two premature babies with NO physician for several hours after their birth.....they were intubated by civilian nurses and basically left in limbo until a civilian pediatrician was finally persuaded by the civilian chief of staff to come in. This is only the LAST incident that my husband dealt with while an AF doc, but by no means the ONLY incident. For whatever reason, no one has the courage to pull the plug on dependent care in the military.....they are just going to short-staff it to death.

If you have a choice, stay out. If you don't, (you've already signed the papers) try to get assigned to a medical center if you can.....that has its own challenges, but I think it may be easier to practice good medicine in that atmosphere.

Those of you who downplay the opinions of the former/current military docs who post here are doing yourselves a huge disservice. They have nothing to gain by posting here.....my husband isn't willing to take the time.....but they are NOT the minority. It really does suck. Don't delude yourselves.

navysurgeon · Jun 10, 2005

amen, sister.
good luck in the real world!

TNS

UncleRico · Jun 10, 2005

As a USUHS grad, I would love to have Mommax3's post forwarded to all of the higher ups at USUHS, especially to those in the Office of Student Affairs, so that they are aware of the garbage that is going on in military medicine right now. They put their heads in the sand and silently watch as 165 new students sign their lives away to languish in the atrophic, dying mess that is military medicine. I have personally seen countless situations similar to those on described by Mommax3.

To those of you so pre-meds that are so eager to judge and discount what those of us who experience military medicine every day have to say, I will ask: what does Mommax3 have to gain from her posts? She is simply sharing her painful, yet true-to-life experiences about a world that you all are about to enter, yet are oblivious to the realities that world will bring.

The absolute worst thing about it is that everyone knows that it is dying, but no one has the political guts to pull the plug and put dependent care out of its misery. Instead, we are all tortured as we watch it die a slow and painful death. It does make for a miserable working environment.

If you are having any doubts whatsoever (ie if you are not have 18 years prior service with 2 left to go 'till retirement, like many on this forum), do not sign up.

MILITARY MEDICINE: BE SMART, DON'T START!!!!!!!!!!!!!!!!

gravy4thebrain · Jun 10, 2005

If the situation with dependent care is as bad as described by Mommax3 then why doesn't the patient's family notify their congressional representative? This generally raises the awareness across the board (in congress, the enitre chain of command, anyone that can be blamed, etc...) and makes it difficult to "explain away" these shortcomings as isolated incidents if they are as widespread as described. All it takes is one letter.

militarymd · Jun 10, 2005

gravy4thebrain said:
If the situation with dependent care is as bad as described by Mommax3 then why doesn't the patient's family notify their congressional representative? This generally raises the awareness across the board (in congress, the enitre chain of command, anyone that can be blamed, etc...) and makes it difficult to "explain away" these shortcomings as isolated incidents if they are as widespread as described. All it takes is one letter.

Consumers of healthcare are notorious poor judges of quality. Healthcare consumers value bedside manners, clean offices, short waits, etc.... over qualty of care.

USAFdoc · Jun 10, 2005

militarymd said:
Consumers of healthcare are notorious poor judges of quality. Healthcare consumers value bedside manners, clean offices, short waits, etc.... over qualty of care.

I have been to congress.......my congressman contacted the USAF and the USAF told em that retention is higher than ever, we have the greatest healthcare system in the world etc,,,etc, etc,,,,

BOHICA-FIGMO · Jun 10, 2005

USAFdoc said:
I have been to congress.......my congressman contacted the USAF and the USAF told em that retention is higher than ever, we have the greatest healthcare system in the world etc,,,etc, etc,,,,

YGTBSM!!!! We are about 60% manned on docs overall and 25% on flight docs at my facility!!! (I'm currently a USAF BSC, 11 years AD, accepted to med school this fall) It is just like every other problem I've seen in th last 11 years. The CGOs see the problem coming YEARS before the O-6 and ups. Just like the pilot shortage of the late 90's, I think you will see such a doctor shortage in the late 2000's that someone will actually get off their ass and do something about it. Seriously, if we had to mix it up with North Korea right now we would either (a) have to empty every medical facility in the CONUS and cease civilian (retiree and dependent) care or (b) institute a medical draft. Possibly both. Un-freakin-believable!

FliteSurgn · Jun 10, 2005

USAFdoc said:
I have been to congress.......my congressman contacted the USAF and the USAF told em that retention is higher than ever, we have the greatest healthcare system in the world etc,,,etc, etc,,,,

I'll bet that he was speaking to one of those all-knowing, all-powerful, all-clipboard carrying nurses in command.

I know mommax3's pain because I'm suffering along at the same godforsaken base. By the way, our Nurse-in-Command is nothing but a cheerleader in a blue uniform. She is oblivious. She has 20 years of nursing "experience", but was flabbergasted to hear that a patient scheduled for a big colon cancer operation would need to spend more than overnight in the hospital. When I told her that typically they spend 4-5 days...she got this concerned look on her face and said, "Jeez, that seems like a really long time for something like that. Is it more involved than usual? Do you need a second opinion?" I gave her a blank stare (which I have have on my face way too often these days) and assured her that I could manage ok on my own.

UCBShocker · Jun 10, 2005

UncleRico said:
As a USUHS grad, I would love to have Mommax3's post forwarded to all of the higher ups at USUHS, especially to those in the Office of Student Affairs, so that they are aware of the garbage that is going on in military medicine right now. They put their heads in the sand and silently watch as 165 new students sign their lives away to languish in the atrophic, dying mess that is military medicine. I have personally seen countless situations similar to those on described by Mommax3.

To those of you so pre-meds that are so eager to judge and discount what those of us who experience military medicine every day have to say, I will ask: what does Mommax3 have to gain from her posts? She is simply sharing her painful, yet true-to-life experiences about a world that you all are about to enter, yet are oblivious to the realities that world will bring.

The absolute worst thing about it is that everyone knows that it is dying, but no one has the political guts to pull the plug and put dependent care out of its misery. Instead, we are all tortured as we watch it die a slow and painful death. It does make for a miserable working environment.

If you are having any doubts whatsoever (ie if you are not have 18 years prior service with 2 left to go 'till retirement, like many on this forum), do not sign up.

MILITARY MEDICINE: BE SMART, DON'T START!!!!!!!!!!!!!!!!

Is dependent care basically like a care facility or convelescent home? If so, then being in EMT in Los Angles county I can almost guarantee that the civilian end is not much better. I have been in and out of the absolute worst places I can ever imagine. Any of you play doom3 at all? Kinda like that, just more light. I wish I could say I was joking... but damn... its bad. I have seen good ones too, but they were the overwhelming minority.

Just thought I would put in my two cents.

USAFdoc · Jun 10, 2005

gravy4thebrain said:
If the situation with dependent care is as bad as described by Mommax3 then why doesn't the patient's family notify their congressional representative? This generally raises the awareness across the board (in congress, the enitre chain of command, anyone that can be blamed, etc...) and makes it difficult to "explain away" these shortcomings as isolated incidents if they are as widespread as described. All it takes is one letter.

patients do not "complain" for alot of reasons,despite poor care and a poor system. Alot of time they have no idea that something "bad" happened or nearly happened. Many patients like their doc and realize the system is poor and the docs are doing the bast they can. PAtients do not know they CAN sue (if they are civilians); and our patients are generally not a very latiginous (spelling?) group in general. There are certainly other reasons as well.

The even worse thing is that Commander's DO know, and despite being officers and sometimes physicians, they look the other way.

AVOID MILITARY MEDICINE if possible

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