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[Perrotfish]

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[navdoc47]

I have two friends whom I work with who are Battalion Surgeons - both can't wait to stop spinning their wheels in GMO land so they can get back to residency training. Anyone can be a Battalion Surgeon, as long as you're male. In fact, it's probably the least chosen, so if you want it, you'll likely get it. You can be a peds or obgyn intern and become a Battalion Surgeon. You'll remain a Navy physician, but you'll wear your American Apparel cami uniforms.

Typical job includes:
When not deployed - you typically work in a clinic. Sick call in the morning, and in the afternoon you'll do separation physicals and the like. Other concerns include trying to get your folks physically ready via MRSS (that annoying program that tracks immunizations, PHA - physical health assessments, pap smears, etc). You will enjoy getting your corpsmen to try to get Marines 100% ready in terms of their shots, etc. Likely you won't have a medical planner, so you will have to put up with the administrative role as well - going to daily morning meetings with the other Marine officers (it will bore you to tears as they talk about all sorts of non-medical issues).

When on deployment - you will have daily morning meetings. You will get pimped on CASEVAC related questions (ie how do you transport patients in the field if they need to be transported to a higher echelon of care). Sick call in the morning if you're on a ship. If you're in the field, you'll live out of the ambulance, since it's better to sleep in it than on the wet, cold, dirty field. You'll manage typical things like cellulitis, URI, dermatitis, musculoskeletal, along with who knows what else can pop in. In the field, you'll be bored for many hours on end as you'll likely have nothing to do but wait and stare at your corpsmen. If you're lucky, you won't be cold/hot/wet/freezing.

Typically the most popular GMO spots are:
1. Dive medicine. Most don't apply to dive, but for those who do, it's somewhat competitive. The physical requirements (strong swimmer) keep most of us out of the running. As for lifestyle of a dive officer, I'm not sure. Plenty of dive physicals though as you'll likely be the only one to sign off within hundreds of miles. Every person in the military who wants to apply for EOD or dive will need a physical from you.

2. Flight medicine. Cons - typically 3 yrs til you reenter residency. Pros - you don't have to lug around an 80+ pound rucksack (with your gear) along with another 30+ pounds of sappy plates (armor) while wearing kevlar (as you would as a GMO for Marines). Your day will always be sick call and flight physicals. The 6 months of flight surgery school is there for you to learn the bureaucracy of NAMI so you'll know how to file waivers, etc for flight physicals.

3. GMO for Marines or USS ship. Pros - you can get 1 yr unaccompanied tours (overseas, like in okinawa) with Marines, thereby entering residency w/only 1 yr delay. Cons - if you're not in the field with Marines lugging your rucksack, amor, kevlar, medical bag, then you may get deployed for a humanitarian medical mission. These humanitarian medical missions are becoming increasingly popular, as these provide bullets for fitreps (evaluations) for senior leaders in the 'global war on terrorism'. So basically, you'll go to some third world country (southeast asia) and hand out paracetamol (tylenol) for chest pain, along with a small bag of vitamins.

 

[Dr. Wexler]

3. GMO for Marines or USS ship. Pros - you can get 1 yr unaccompanied tours (overseas, like in okinawa) with Marines, thereby entering residency w/only 1 yr delay. Cons - if you're not in the field with Marines lugging your rucksack, amor, kevlar, medical bag, then you may get deployed for a humanitarian medical mission. These humanitarian medical missions are becoming increasingly popular, as these provide bullets for fitreps (evaluations) for senior leaders in the 'global war on terrorism'. So basically, you'll go to some third world country (southeast asia) and hand out paracetamol (tylenol) for chest pain, along with a small bag of vitamins.

I thought being a GMO with the marines and being a batallion surgeon were the same thing(with the exception of being an FS with the marines).

 

[beegeforty4]

Please clarify, what's an FS?

FS = Flight Surgeon, Flight Surgery, etc.

 

[psychbender]

2) How does a batallion Surgeon treat people in combat if they haven't had at least a general surgery residency? It seems like treating someone with a bullet wound through their lung might be a little beyond what they teach you in your intern year, and somewhat more along the lines of what you'd get in an EM residency.

Battalion Surgeon is just a title. It doesn't actually mean that you are a surgeon.

 

[psychbender]

Well, when a Marine gets shot/blown up, what is the job title of the person that does treat him, and what is that doctor's qualifications? I assume when Marine infantry deploys to Iraq there's someone on call to put them back together again.

Initially, probably the corpsman. Possibly the Battalion Surgeon (GMO "One-year wonder"). Once at a larger field hospital, probably someone board certified.

 

[navdoc47]

Thank you for the supply NavyDoc, a couple of followups:

1) Can I request a particular GMO posting after I've tried to compete for a residency, or if you tried to compete for a residency does the military just choose your GMO tour for you? You typically apply for residency and flight/dive. Once the selection list is posted, then (if you don't get residency)you select GMO billets - ie GMO on ship, Marines, or Seabees. If you're wait-listed for residency, you can commit to a GMO billet, but then if you're taken off wait-list for acceptance, residency will take priority over GMO.

2) How does a batallion Surgeon treat people in combat if they haven't had at least a general surgery residency? It seems like treating someone with a bullet wound through their lung might be a little beyond what they teach you in your intern year, and somewhat more along the lines of what you'd get in an EM residency. During internship you attend ATLS - that's all you need. Odds are, you won't be involved in a trauma situation. If you are, simply patch the wound as best you can, ABCs, apply needle decompression if necessary, send them off to nearest specialist.
2) Are their any opportunities to attach to the Marines for people who have finished a residency? To deploy away from Navy hospitals in general? What about MASH units (I hope that's still the proper terminology), how are they used/deployed in the modern military?

The only board certified folks I know of who are attached to Marines are typically family practitioners and psychiatrists. Depending on your specialty, you can certainly deploy to Middle East or large ship. You can be assigned to a hospital for instance, but still deploy on a large ship as part of the 'Fleet Surgical Team' (typically gen surg or family practice). You could also be a specialist comfortably working for a hospital, but then if the hospital needs to deploy an 'augment' to the hospital ship "Mercy" or if the hospital needs to send an 'augment' to the Middle East, then you will go.

As for who is responsible for training the corpsmen as a Battalion Surgeon, you are overall responsible. It's up to you in terms of how proactive/involved you want to be with their education. After all, you're the expert, in comparison to them.

 

[pgg]

Thank you for the supply NavyDoc, a couple of followups:

1) Can I request a particular GMO posting after I've tried to compete for a residency, or if you tried to compete for a residency does the military just choose your GMO tour for you?

You can request whatever you want. The Navy detailer will choose for you. However, if you ask for Marine infantry, you'll get it, because most people want other billets.

2) How does a batallion Surgeon treat people in combat if they haven't had at least a general surgery residency? It seems like treating someone with a bullet wound through their lung might be a little beyond what they teach you in your intern year, and somewhat more along the lines of what you'd get in an EM residency.

Two basic scenarios:

1) The GMO is off on his own at his little battalion aid station. This is echelon 1 care, meaning quick stabilization with emphasis on rapid transport to a facility with surgical capabilities. Bandages, splints, occasionally a chest tube, rarely an endotracheal tube ... this is 99% EMT/paramedic level care. Even if the "battalion surgeon" was really a surgeon, the stuff just isn't there for him to do any surgery. The bullet wound through the lung gets a chest tube while the urgent surgical 9-line is sent off, and you sit around hoping the guy doesn't bleed to death while you're waiting for the helicopter.

2) The GMO is colocated with a surgical team such as a FRSS. This is echelon 2 care, where typically you've got a couple of real surgeons, a CRNA or anesthesiologist, sometimes an ER or FP doc, one or two critical care nurses, and a couple dozen Corpsmen. In this environment, when casualties come in, the GMO will work under the supervision of the residency trained guys. The bullet wound through the lung gets a chest tube, and and if the guy's looking like he's bleeding to death, the real surgeon cuts him open and does his thing. Maybe the "battalion surgeon" holds a retractor, if he's not taking care of another patient or waiting in line at the internet cafe.

2) Are their any opportunities to attach to the Marines for people who have finished a residency?

Yes. It's probably easiest for FPs ... there's an effort underway, at least in Marine infantry, to replace all of the regiment-level GMOs with board-certified FP or IM types.

To deploy away from Navy hospitals in general?

Yeah, no shortage of opportunities to deploy these days.

What about MASH units (I hope that's still the proper terminology), how are they used/deployed in the modern military?

The model in place in Iraq now is one of

1) Small teams (1-2 surgeons, some flavor of anesthesia, 1-2 other docs, plus 20 or 30 support staff) placed in close proximity to areas where bad things are happening. Very limited surgical capabilities, essentially zero ICU or inpatient beds, emphasis on stabilization and rapid transport.

2) One very big, very capable, centrally located hospital in country (eg Balad in Iraq, Bagram in Afghanistan). Still not a lot of definitive surgery gets done here, though there are "wards" and some ICU beds ... the emphasis is still on stabilization and transport out of theater (usually Germany, sometimes Kuwait).

In Afghanistan, at least when I was there, you could add another level:

0) GMO "battalion surgeon" off on his own with a few of his Corpsmen, sitting in a fortified compound with a company of Marines. CASEVAC times are 2-3 hours, it's you and no one else except maybe a radio you can use to ask for advice. You're a glorified paramedic in this situation, and mostly you hope that casualties come to you one at a time, and not hurt very badly.

Well, when a Marine gets shot/blown up, what is the job title of the person that does treat him, and what is that doctor's qualifications? I assume when Marine infantry deploys to Iraq there's someone on call to put them back together again.

It's a Corpsman in the field, and where the blown up guy goes from there depends on a lot of factors.

Speaking of the Corpsmen, what are the Surgeons' responsibilities in terms of training and managing them?

Corpsmen arrive at the battalion pre-trained from Corps school. It's up to the senior Corpsmen, the battalion IDC (independent duty corpsman = additional formal training beyond Corps school), and the GMOs to supplement that training. The battalion surgeon has a huge amount of latitude in this area, and the truth is there really aren't any standards. A good battalion surgeon will at least help his Corpsman unlearn those parts of Corps School doctrine that are in direct conflict with the current Tactical Combat Casualty Care guidelines, but that's a whole 'nother thread.

 

[almostfamous]

It's probably easiest for FPs ... there's an effort underway, at least in Marine infantry, to replace all of the regiment-level GMOs with board-certified FP or IM types.


Yeah, no shortage of opportunities to deploy these days.



The model in place in Iraq now is one of

1) Small teams (1-2 surgeons, some flavor of anesthesia, 1-2 other docs, plus 20 or 30 support staff) placed in close proximity to areas where bad things are happening. Very limited surgical capabilities, essentially zero ICU or inpatient beds, emphasis on stabilization and rapid transport.

2) One very big, very capable, centrally located hospital in country (eg Balad in Iraq, Bagram in Afghanistan). Still not a lot of definitive surgery gets done here, though there are "wards" and some ICU beds ... the emphasis is still on stabilization and transport out of theater (usually Germany, sometimes Kuwait).

In Afghanistan, at least when I was there, you could add another level:

0) GMO "battalion surgeon" off on his own with a few of his Corpsmen, sitting in a fortified compound with a company of Marines. CASEVAC times are 2-3 hours, it's you and no one else except maybe a radio you can use to ask for advice. You're a glorified paramedic in this situation, and mostly you hope that casualties come to you one at a time, and not hurt very badly.



It's a Corpsman in the field, and where the blown up guy goes from there depends on a lot of factors.



Corpsmen arrive at the battalion pre-trained from Corps school. It's up to the senior Corpsmen, the battalion IDC (independent duty corpsman = additional formal training beyond Corps school), and the GMOs to supplement that training. The battalion surgeon has a huge amount of latitude in this area, and the truth is there really aren't any standards. A good battalion surgeon will at least help his Corpsman unlearn those parts of Corps School doctrine that are in direct conflict with the current Tactical Combat Casualty Care guidelines, but that's a whole 'nother thread.

I read today that they were eliminating about 100 GMO billets and replacing them with primary care 'specialists'. When pressed, someone told me that the majority of those were going to be with Marines... putting either a mid-level or a primary care specialist with them instead of a GMO.

Also, is IDC school really just 1-2 week rotations in different areas? Seems slightly more inadequate then sending fresh ex-interns out to practice.

 

[pgg]

Another followup question, though I'm not sure if anyone would actually know this one:

I've heard that the Navy medical staff attached to the Marines train in MCMAP. My question is: if I want to attach to the Marine's as a Battalion Surgeon, and I'm at a medical school where the undergraduate program has an NROTC program, can I train with the Marines there in MCMAP for credit towards earning higher belts, or do I have to wait until I actually attach to start logging training hours in Semper Fu? Do Battalion Sugeon's actually have the option of going to the MCMAP black belt course, or do they pretty much cap out at brown belt?

I think you'll be too busy treating injuries sustained in MCMAP classes to actually participate in them.

 

[megadon]

Another followup question, though I'm not sure if anyone would actually know this one:

I've heard that the Navy medical staff attached to the Marines train in MCMAP. My question is: if I want to attach to the Marine's as a Battalion Surgeon, and I'm at a medical school where the undergraduate program has an NROTC program, can I train with the Marines there in MCMAP for credit towards earning higher belts, or do I have to wait until I actually attach to start logging training hours in Semper Fu? Do Battalion Sugeon's actually have the option of going to the MCMAP black belt course, or do they pretty much cap out at brown belt?

I'm pretty sure that if you want to go, they'll accept you. I don't think its mandatory. This program is only a couple years old, but I still miss the LINE training, good ole cut twist pull.

Okay, purely semantical question, are the GMO's attached to Marine units called batallion surgeons? I thought that was an Army deal. I thought if you were green, you were just doc. Okay, just asked the wife, she said they just called them doc. So I have one vote from reputable source that says their working title was doc, who knows what their professional title was.

 

[FNU LNU]

This is coming from my previous life as a Marine officer, not my future as a navy doc. Perrotfish, anyone can do MCMAP training; I am sure that the ROTC unit would be happy to have you train with them. Corpsmen do this training all the time (when they are not on standby for breaks and sprains). In Iraq soldiers from other countries even participated.

Navy doctors attached to Marine infantry battalions are called battalion surgeons. There are however, many navy GMOs that support other Marine units and bases and are not called battalion surgeons. I don't remember them having any special title. I don't know if other combat arms branches (arty, tracks etc.) have battalion doctors, so not sure what their title would be.