.

[Galo]

Man, this thread got hijacked a while ago. Which service is the question... the answer is NONE OF THE ABOVE. Military Medicine is dying and you would be a huge fcuking idiot to join at this time or anytime in the next 10 years. Seriously, haven't you been reading this forum? I'm disappointed in the lack of intellect from anyone who still thinks the military is a good deal.

Gotta say. This question just comes up way too often. Lots of times prefaced with I am about to do some research, or heard this from this ex-mil doctor, etc etc.

Unfortunately, and bluntly, this is the answer everytime. But we will continue to get additional same questions, and additional ex or current mil med docs who echo this sentiment either in a long diatribe with lots of explanations (as I have done myself countless times), or be blunt and say it like it is, (as I have myself done countless times). No later some psychotic hyperpatriotic manager who has lost his/her way will accuse us of being mentally deficient, or sleeping with Al Queda, or some other excuse as to why we think there is a problem rather than working in the best medical system in the world.

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[West Side]

I've read this answer, from bomberdoc alone, mutiple times per thread on several threads on this forum. I'm aware you don't think it's a good deal. I was aware of that the first time you posted. Personally I think the overemphasize the 'deal' your getting, but that's beside the point. If you have something new and specific (% change of GMO tours, crappy software, limited range of procedures) please share, but reading the same non-specific angry post over and over again is the visual equivilant of listining to a child banging on a cooking pot with a wooden spoon. I really do appreciate everyone that's helped me get specific answers about the military, but when I read things like this I feel like someone is calling me names for wanting to serve, and it's not the least bit helpful to me in making my decisions as a candidate.

Your reaction is understandable, but take the empathetic approach. A medical career marked by profound investment, with admittedly great potential return. A run-of-the-mill doctor in the civilian world endures:

• countless sleepless nights,
• lousy food for the better part of four years,
• working in one of the least well-run industries in America, and
• dealing with a customer that approaches the product like nothing else in the economy

Now, add in the LITANY of maladies found in the military: the deciet inherent in the GMO process relative to residency training and "first choice", abysmal technical infrastructure, general military bureaucratic BS (saw an example of online "training" and damn near laughed myself silly), low grade trainng for surgeons, etc. etc. etc. ad nauseum

The return that was promised (i.e., a standard medical career with patriotic warm fuzzies) isn't being delivered. Don't you think you'd be pissed on that tip?

So your analogy of a child banging a pot isn't apt at all. What you're hearing is the manifestation of two things. One, that these people got the shaft, and that they unwittingly put themselves in that position because they didn't have the information to make an informed position. Two, and this is where your ilk come in, that despite their best efforts to illuminate all that's wrong with their situation, there are still folks like yourself that, in the face of overwhelming reason, persist in trying to talk yourself into a special circle of hell a guy like Bomberdoc would pay suitcases of money to escape.

It certainly does sound harsh to question the intelligence of someone who reads these boards and still wonders "Is the military a good idea?" I'd tend towards the definition of insanity: doing the same thing repeatedly and expecting a different result. In this case, you're standing on the shoulders of proverbial giants, and obstinately looking in the opposite direction.

 

[orbitsurgMD]

A couple of facts
1. The Army has more training programs and slots . . . .

I have definitely seen good people get screwed, but at least in my experience this is a minority.

Limited experience, perhaps?

Actually the system of accession and GME training, even for the Army, results in disappointing far more than just a few well-qualified and deserving candidates. With such a low ratio between PGY-2 to PGY-1 slots, even doing a GMO tour is no kind of reassurance of finding a residency slot. All of the services depend on GMOs, including the Army, and have fashioned a system out of the HPSP program (which was not meant to be a GMO-making machine) that produces those GMOs. Since that is hardly the desire of anyone going into medicine, whether they are good candidates or not, and since the recruiting apparatus makes promises of training that the services simply do not have the resources to provide to most of their accessions, the widespread disillusionment of junior medical personnel is inevitable. No one likes to be played, and the military has been a ferocious player when it comes to recruiting doctors. That fact has not escaped widespread observation, both within and without the services. There are a lot of recently former military doctors who have nothing to be ashamed of in their past that will advise prospective applicants to find some other way to finance a medical education. That is a problem for the military that is not going to go away either.

Most (but not all) of the perpetual GMO's are there for a reason. Take this into account when reading posts from Bomberdoc and others. . . . .

True, but not for the reasons the poster believes are true. The military could only hope to be so rational in its ways of selecting who goes to GMO and who doesn't. The odds of picking up a PGY2 military residency slot in competitive areas, especially surgery, or of getting a deferment vice getting tracked to GMO assignment are low. They are lower in the Navy than the Army, but even in the Army the odds are not good.

If the O.P. really wants to serve, my only suggestion is to do FAP. That will be your best opportunity to come to military service with the training you will both want and need to be able to do the most good for your patients with the accumulated knowledge and experience of residency fresh in your mind. Of course that is no guarantee the services will help you maintain your training edge, but it will sure beat coming to the battle half-armed, which is what you will be forced to do as a GMO.

 

[BomberDoc]

Yeah, I'm angry. However, I'd rather come off as irritated and not irritating. It just kills me that people who haven't been through this keep insisting that their experience MIGHT be different. If somebody handed you a pistol, would you hold it to your head and pull the trigger because it MIGHT be unloaded? In this world, we are in control of shockingly few aspects of our lives. Why willingly give up control of 90% of those last few things in exchange for LESS training, staff, equipment, etc, and MORE paperwork, headaches, inefficiencies?

Look, if you're determined to prove me wrong, go ahead and join. And please keep us in the loop when you are going through your military medicine experience. Perhaps you will feel like I do, that my mistake is meant to be a lesson to others. Sometimes you will have to yell to get people to listen to you. I'm mad because I didn't have the information to make a good decision and I made a decision anyway. I don't wish that on anybody else. Here, you have a mountain of information and you are hoping it is untrue. Make the best decision for you, but caveat emptor... the military is good at selling its "strengths" and far better at hiding its weaknesses.

 

[megadon]

I don't agree with Bomber Doc and Galo, but I respect them. When I was on the sub, I was pissed off, all the time. 95% of the people around me were pissed off about work, about getting shafted, etc. So I do listen to Galo and Bomber Doc cause there is some truth in what they are saying. I haven't been out there yet, so I don't know how bad it is. They can point out what problems there are, so at least you are aware of getting your penis slapped. Sorry to be so crude, but that's how I view it. I made my decision already knowing that there were a lot of problems, nurses running the show, ridiculous beaucracy, etc. However, I don't think I knew how bad it was, and won't till I get out there. Personally, I'm not scared of doing a GMO tour, as long as I have some power to pick which one I do. My view was there were a lot of cool GMO tours to do, and the deployment didn't scare me. What does scare the pants of me is being a physician at some hospital who is coded to be called up. So you think you are going to a pretty stable job and move your family there, only to find out a month later you are randomly being deployed to Iraq, Afghanistan, or the USS Mercy. That sucks. That seems to be a fact of the life in the Navy, and it's not just med corps (except for the Mercy part). I was under the same gun as a submarine officer stationed anywhere other than a sub. But I did know that, and I think there point is all the non-prior are not. That is a very valid point. At the same time, I am not willing to turn absolutely everyone off to HPSP for a very selfish reason. That means I will have no colleagues, will be assigned as a doctor to a practice that is supposed to have five docs, yet I could have a staff meeting anytime cause I'm the only guy there. Or it's a staff meeting with Bomber Doc and Galo who are pissed off, cause they are the only guys left, with no replacement on the way cause we got no docs. I'm not knocking you guys, you have every right to be pissed, and please continue to post, it opens my eyes. At least it gives me the opportunity to learn from your experience.

 

[BomberDoc]

My staff meetings are already pretty lightly attended. I was supposed to get two new docs in my office this summer to replace guys that have already PCS'd out. I found out in April that one of the replacements vanished into thin air. Today, I found out the other isn't due until next year. This leaves my entire shop with TWO flight surgeons for the foreseeable future. This is not sustainable. Plus, the other guy is in the bucket to deploy again in September and I'm slated to go (3rd time in 3 years) at the end of the year. So really we only have two docs for a few months, then for 8+ months, it will be only ONE. This will lead to a complete and utter failure of all flight med programs except for patient care, for access is paramount.

Megadon, I appreciate and understand your outlook. Unfortunately, your prediction for having no colleagues isn't the future. It is today.

 

[megadon]

nah, it's got two years to turn around. That's enough time to get you on stop loss, so there will be at least another person there. Feel for you man, keep fighting. Hey, maybe the congressional investigation will unearth some real stuff and turn this thing around! Want to buy some ocean front property in Arizona? Real cheap!

 

[a1qwerty55]

the recruiting apparatus makes promises of training that the services simply do not have the resources to provide to most of their accessions.
The odds of picking up a PGY2 military residency slot in competitive areas, especially surgery, or of getting a deferment vice getting tracked to GMO assignment are low. They are lower in the Navy than the Army, but even in the Army the odds are not good.

The above statement is factually inaccurate: I would refer you to the match results - The odds of getting training of choice (different from location of choice are excellent)

https://apps.mods.army.mil/MedEd/HPSP/Powerpoint/MEDED4-07_files/frame.htm

 

[orbitsurgMD]

The above statement is factually inaccurate: I would refer you to the match results - The odds of getting training of choice (different from location of choice are excellent)

https://apps.mods.army.mil/MedEd/HPSP/Powerpoint/MEDED4-07_files/frame.htm

Not true.

If you are making your argument on the basis of the ratios posted on slides 12 and 13 of the linked powerpoint presentation, you are ignoring a larger and unaccounted-for group: those who elect not to apply or re-apply for Army residency positions in favor of leaving the service to do training as civilians. Most in those positions will be 3 and 4-year HPSP accessions. The data does not consider those accessions. The conclusion is valid only for those who choose to apply. Many applying and being deferred to do GMO service start making plans for civilian training and lose all interest in pursuing residencies in the Army. This is especially true for those who want residencies that require early match selection or that select for starts post-internship (i.e., for PGY2-starts, like rads). No one having started the expensive process of applying and interviewing (and particularly those who are then matched) will likely turn down a sure thing on the civilian side for a slot in a military program. The stats you are linking give no account of that, but the numbers are substantial. To use the stats you quote as a picture of reality is misleading.

 

[almostfamous]

then for 8+ months, it will be only ONE.

In the end, there can be only one....

and maybe a PA will show up for a few hours a week.


dammit, can't figure out how to make the picture smaller, so it's posted large.

 

[a1qwerty55]

you are ignoring a larger and unaccounted-for group: those who elect not to apply or re-apply for Army residency positions in favor of leaving the service to do training as civilians. Most in those positions will be 3 and 4-year HPSP accessions. The data does not consider those accessions. The conclusion is valid only for those who choose to apply. To use the stats you quote as a picture of reality is misleading.

Boy that doesn't make much sense.... Those who don't apply won't factor into the competetiveness of a particular residency? No ****... If you are an applicant, you really don't care who isn't applying but how many are.. Of course there are those who choose to finish out their time as GMO's...... as you allude to, this is a conscious decision on their part rather than the system screwing them.

My point is and continues to be that in the ARMY, there are many training opportunities, and the odds are actually quite good of getting your training. Your response in no way undermines that arguement.

 

[a1qwerty55]

I'd like to know what everyone else thinks the best solutoin for the recruiting problem would be. Draft every doctor out of Med school, make them serve a 1 year GMO tour in the military? Just double milimed's pay? Make military service a requirement for foreign doctors trying to get licensed? More outsourcing to the private sector? Other ideas?

- Draft doctors out of med school - that is how they filled the Army in the past during Vietnam,,,, most docs I have spoken too looked back on their time as a positive, and yes the military medical system was in many ways just as illogical then as now,,, MASH anyone. Since a "draft" is politically a nonstarter, I don't see than coming back, nor should it.

- Pay is part of the issue but not the main frustration as many have appopriately alluded to. Better staffing/ancillary support a more sustainable deployment schedule i.e. 6 month rather than 12-15 would help. Bonuses do however have to go up...

- Forcing FMG's in.... ughh... soldier deserve better... We don't need mercenaries, but Americans with a committment to their country and servicemembers.

- Outsourcing,,, already being done by all services to varying degrees.... It however isn't a solution to wartime needs, and civ docs often have no insight into military specific aspects to healthcare, job limitations, etc.

 

[West Side]

Boy that doesn't make much sense.... Those who don't apply won't factor into the competetiveness of a particular residency? No ****... If you are an applicant, you really don't care who isn't applying but how many are.. Of course there are those who choose to finish out their time as GMO's...... as you allude to, this is a conscious decision on their part rather than the system screwing them.

My point is and continues to be that in the ARMY, there are many training opportunities, and the odds are actually quite good of getting your training. Your response in no way undermines that arguement.

Objection: dissembling and misleading.

The crux of the problem is that the available positions are constantly in flux, and therefore it is pure speculation on your part that there are or will be many training opportunities. The PPT deck you reference is just as useful/relevant to next year as toilet paper.

And that, my simple friend, is why so many people elect to interrupt their medical education, to have fewer moving pieces to their residency match process.

If applying to, say, dermatology, in the military, you have a grasp of neither supply nor demand. They could have 1 spot, they could have 45 spots (ruddy unlikely). Similarly, you cannot possibly dispute the fact that odds are improved by doing a GMO tour.

Ergo, if you had a choice of a system where you knew how many spots there were, and would be adjudicated on your body of work already completed (grades, interviews, research), why would you voluntarily elect a system that gives you no ground rules to play by, and gives you (i.e., requires) brownie points for a few extra years of misery?

 

[orbitsurgMD]

Boy that doesn't make much sense.... Those who don't apply won't factor into the competetiveness of a particular residency? No ****... If you are an applicant, you really don't care who isn't applying but how many are.. Of course there are those who choose to finish out their time as GMO's...... as you allude to, this is a conscious decision on their part rather than the system screwing them.

My point is and continues to be that in the ARMY, there are many training opportunities, and the odds are actually quite good of getting your training. Your response in no way undermines that arguement.

It makes sense in that many otherwise competitive candidates elect to discontinue applying in favor of exiting the service and doing civilian residencies. To the doctor doing a GMO tour, the choice looks different: do another year of GMO and leave the military, or do a residency after the GMO tour and add more obligated time. Your stats, or rather the ones you are using, don't even consider that, the qualified doctors who want training in a particular specialty but don't want Army training or who decide they don't want it badly enough to have to extend their service obligations.

A more honest appraisal is to look at all accessions from USUHS and HPSP and compare that against all PGY2 starters in all the Army programs. That will give you a better sense of the ratios of entrants to post-internship trainees. A good bet they won't be hovering around 1.0, and I wouldn't be surprised to see a number more than twice that.

 

[BomberDoc]

A more honest appraisal is to look at all accessions from USUHS and HPSP and compare that against all PGY2 starters in all the Army programs. That will give you a better sense of the ratios of entrants to post-internship trainees. A good bet they won't be hovering around 1.0, and I wouldn't be surprised to see a number more than twice that.

I can't speak for the Army, but approximately 50% of my Air Force buddies from AMP (flight doc school) are planning on just doing their time and getting out. This isn't scientific data all fancy-schmancy like in a PPT presentation, but I can tell you that a lot of us are hitting the road and already have PGY2 starts lined up. One of my buds even found an Internal Medicine residency that needed a PGY2, so he's all set and won't have to repeat internship. The GME system in the military is simply maddening in that junior officers have the lowest chance of matching.

It was best described to me as a self-licking ice cream cone. Guys who are O4-5 and have done family practice or medicine for 10 years decide they want to be a dermatologist or radiologist or other competitive thing. They apply and get to do a second residency because they have a s#itload of "points" for rank and time and all that crap. This keeps the young guys out of competitive specialties in the military. Then these dudes finish residency at 14-16 years, pay their 4 years obligated by residency and get out at 20 so they can start civilian practice as a derm or rad and start making some decent money.

Seriously, I've met a guy who was a GMO flight doc for EIGHT YEARS before getting selected for a derm residency. I admire his dedication but shake my head at the waste of a lot of good years of his life.

 

[West Side]

Seriously, I've met a guy who was a GMO flight doc for EIGHT YEARS before getting selected for a derm residency. I admire his dedication but shake my head at the waste of a lot of good years of his life.

OK, this begs the question: why didn't he try to get a derm residency in the civilian world at the three junctures he could have?

Just because someone wants something badly, doesn't mean they should get it. If he's as lousy a doctor as he is a planner, I question his fitness as a candidate for a competitive residency.

As the guy in the corner of Joe's Bar might say, "I hate you! You suck at softball, and you suck at life!!"

As you said, though, full marks for stick-to-it-iveness.

 

[Gastrapathy]

It was best described to me as a self-licking ice cream cone. Guys who are O4-5 and have done family practice or medicine for 10 years decide they want to be a dermatologist or radiologist or other competitive thing. They apply and get to do a second residency because they have a s#itload of "points" for rank and time and all that crap. This keeps the young guys out of competitive specialties in the military. Then these dudes finish residency at 14-16 years, pay their 4 years obligated by residency and get out at 20 so they can start civilian practice as a derm or rad and start making some decent money.

quote]

This particular scenario is really quite uncommon. In fact, anyone O5 or above being selected for GME requires a waiver at the SG level for just the reason mentioned (they get out shortly thereafter). Not saying it doesn't happen, just that it is rare.

 

[BomberDoc]

Isn't this a reason to join, from an idealistic standpoint at least? It's not like they're not recruiting, from all acounts they're taking every doctor who applies. I know it's frustrating from a personal standpoint, but isn't encouraging people not to join because there's not enough doctors in the military perpetuating a vicious cycle?

Also (I'm jacking my own thread here) I'd like to know what everyone else thinks the best solutoin for the recruiting problem would be. Draft every doctor out of Med school, make them serve a 1 year GMO tour in the military? Just double milimed's pay? Make military service a requirement for foreign doctors trying to get licensed? More outsourcing to the private sector? Other ideas?

Idealism is likely what got most of us into the problem we're in at the moment. If you want to be idealistic, nobody will stop you. However, I wager that some of that will have worn thin after 3-4 years.

Encouraging people not to join doesn't perpetuate the vicious cycle. Hijacking the HPSP pipeline to fill GMO billets is perpetuating the vicious cycle. Informing people and encouraging them to stay the hell away from military medicine is intended to STOP the vicious cycle.

Real, viable solutions to the vicious cycle are difficult because the institutional inertia of the military is so enormous. You could pay me 2x, 3x what I'm making now and I would still leave. It would be nice while I'm stuck here, but there is no price I can put on my personal freedom. A civilian friend of mine who is an Internal Med doc works half-time. He chooses to do 20 hours per week for 50% of the pay of his counterparts. He values his time more than he values making a lot of money. This guy does fine financially, he just maintains a less extravagant lifestyle than most of his colleagues. Plus, he gets to play a much bigger part in the lives of his wife and kids. He has taught me a lot about what is really important.
Drafting docs is political suicide. I wouldn't be surprised to see someone try bringing it up in a few years, but I'd be shocked if it actually happened. Forced GMO will keep a lot more people away and the pipeline will dry up. A lot of the contract docs in the VA and family practice are foreigners and they are the bottom of the barrel because they can't get a job anywhere else. Forcing a wave of foreign docs on the military isn't likely to go over very well. Outsourcing is happening and I predict that within a few years, all dependents will be empaneled to civilian docs.

The first step to solving the problem is to stop lying. Tell people what is going to happen to them. The second step is to make good on your promises. This has a lot to do with step one. If 98% of people get their #1-2 choice of residency, why are there so many GMOs? The smart way to get docs into the military is to have a contract written out that specifies exactly what residency you will train in, and when. So if you want to do derm badly enough and are willing to sign a contract stating you must be a GMO for x years, at least you know that there is a light at the end of the tunnel. We were promised a fair shot at GME and it was a load of bulls#it. The tunnel just keeps getting longer or that light becomes a train. Step three is improve the support. If enlisted recruiting goals are being met, why is my clinic 40% manned for techs? Can't we open up numbers for training med techs? It doesn't take 4 years to get them up to speed, so the pipeline is relatively short compared to ours. Step four is to improve infrastructure. Buy some new equipment.

 

[BomberDoc]

OK, this begs the question: why didn't he try to get a derm residency in the civilian world at the three junctures he could have?

Just because someone wants something badly, doesn't mean they should get it. If he's as lousy a doctor as he is a planner, I question his fitness as a candidate for a competitive residency.

As the guy in the corner of Joe's Bar might say, "I hate you! You suck at softball, and you suck at life!!"

As you said, though, full marks for stick-to-it-iveness.

Honestly, I don't think he was a good enough candidate to get such a competitive residency in the civilian world. I also agree that just wanting it badly enough doesn't justify a sub-par candidate getting selected. What he did is out-wait the other young applicants to that residency until he had accumulated enough rank and points to get in. As has been discussed to death, the military doesn't always reward the best applicants.