Are military doctors assigned? 2 questions

[WhoNeedsAShrink]

1. Do service members and their families get to choose their military doctor, or is the doctor assigned? Does an individual get to decide which specialist he wants to see, i.e. a psychiatrist or psychologist, internist or FP, pediatrician or FP, go to the ER for primary care or go to their PCP, get a PCP or seek a PA? I'm just curious what one's liberties are in the armed forces when it comes to healthcare.

2. ALSO, very good question here because I've wondered and don't know. Would all of these specialties and more deploy or are the deployed docs just surgeons and so forth and ancillary staff? Would/can a psych, peds, or any other such less relevant doctor get deployed?

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[colbgw02]

1. Typically they are assigned. There is some wiggle room though. At my MTF, active duty soldiers are normally assigned to a family practioner, but I know some who have had their PCP switched to an internist.

2. Everyone deploys. They don't always deploy as a member of their specialty (dermatologists deploying as GMOs), but all specialties deploy.

 

[WhoNeedsAShrink]

1. Typically they are assigned. There is some wiggle room though. At my MTF, active duty soldiers are normally assigned to a family practioner, but I know some who have had their PCP switched to an internist.

2. Everyone deploys. They don't always deploy as a member of their specialty (dermatologists deploying as GMOs), but all specialties deploy.

Ah, I see. Then it's presumed that all doctors will be fine general practitioners. Interesting.

 

[NoMoreAMCAS]

2. Everyone deploys. They don't always deploy as a member of their specialty (dermatologists deploying as GMOs), but all specialties deploy.

What's the point of sending someone through a Derm residency only to send them out as a GMO? I thought most GMO's were straight out of their intern year. Sounds like a massive waste of time and money to train someone as a specialist then have them fill the billet of someone with only the most basic of training.

 

[BigNavyPedsGuy]

What's the point of sending someone through a Derm residency only to send them out as a GMO? I thought most GMO's were straight out of their intern year. Sounds like a massive waste of time and money to train someone as a specialist then have them fill the billet of someone with only the most basic of training.

It's either that or you can't recruit because everyone wants to go straight through. It's a lose-lose. That's why I've long advocated that PAs fill GMO billets. They're better trained for it as long a doc somewhere nearby supervises (i.e. batallion surgeon or SMO).

 

[i want out]

What's the point of sending someone through a Derm residency only to send them out as a GMO? I thought most GMO's were straight out of their intern year. Sounds like a massive waste of time and money to train someone as a specialist then have them fill the billet of someone with only the most basic of training.

If a massive waste of time and money in the .mil surprises you, then you haven't been around any military anywhere in the world...

this deployment as GMO can sometimes take interesting turns.

I have seen Nephrologists, Allergist/immunologists Heme/onc, anesthesiologists and even one pathologist deployed as GMO's.

to be fair, the Pathologist wasn't in the US Military, but was serving on a US military base with his own country, but all the rest were in the US Military.

i want out (of IRR)

 

[DrMetal]

1. Do service members and their families get to choose their military doctor, or is the doctor assigned?

Yes and no. You get assigned a pcp and a clinic. From my experience in San Diego, I was able to go to any MTF; I could request a doc there, and they could get me in if he/she had appts available. In fact, I've never even met my pcp or been to clinic they assigned me to. I'd just call the SD appt line and get in, wherever, same goes for my dependents. Not sure if this is the case in other parts of the country. Now of course, if we're just talking about routine care (routine physicals, well baby visits, etc), you could be a little flexible and see whoever's available.

I had a couple guys/gals in my division that had some very sensitive, non-routine peds cases (kids had rare genetic diseases). Initially things were rough . . . but they eventually got really good care outta peds at NMCSD. [Their ped gave him a personal cell phone number, email, would even call to let the family know that he was going on leave and who was covering should anything come up.] Was very impressive customer service, I hope that's the norm elsewhere!

Now, the other interesting question is, what if you have a really unique case that no one (in milmed) in your geographical area is capable of treating? Can you go to a local hospital or university, will Tricare cover that? Can you participate in a non-mil clinical research study? I think the answer is yes, but I imagine it's a beauracratic nightmare.

Does an individual get to decide which specialist he wants to see, i.e. a psychiatrist or psychologist, internist or FP, pediatrician or FP,

I think you have to see a GP (internist, FP, ped) first, and get a referral. That's been my exp. Same goes in the civ med though. I think it's easier to get a referral in mil med though, where there's no HMO/PPO pounding on the GP to reduce his/her referrals.

go to the ER for primary care

Why on earth would you do that? you wanna wait 10 hours for a routine physical?

 

[WhoNeedsAShrink]

Yes and no. You get assigned a pcp and a clinic. From my experience in San Diego, I was able to go to any MTF; I could request a doc there, and they could get me in if he/she had appts available. In fact, I've never even met my pcp or been to clinic they assigned me to. I'd just call the SD appt line and get in, wherever, same goes for my dependents. Not sure if this is the case in other parts of the country. Now of course, if we're just talking about routine care (routine physicals, well baby visits, etc), you could be a little flexible and see whoever's available.

I had a couple guys/gals in my division that had some very sensitive, non-routine peds cases (kids had rare genetic diseases). Initially things were rough . . . but they eventually got really good care outta peds at NMCSD. [Their ped gave him a personal cell phone number, email, would even call to let the family know that he was going on leave and who was covering should anything come up.] Was very impressive customer service, I hope that's the norm elsewhere!

Now, the other interesting question is, what if you have a really unique case that no one (in milmed) in your geographical area is capable of treating? Can you go to a local hospital or university, will Tricare cover that? Can you participate in a non-mil clinical research study? I think the answer is yes, but I imagine it's a beauracratic nightmare.



I think you have to see a GP (internist, FP, ped) first, and get a referral. That's been my exp. Same goes in the civ med though. I think it's easier to get a referral in mil med though, where there's no HMO/PPO pounding on the GP to reduce his/her referrals.


Why on earth would you do that? you wanna wait 10 hours for a routine physical?

I wouldn't go to the ER for primary care. I just know that it's common with some individuals in American healthcare to do that, and I wondered if that happened in the military too. I'm only asking to see how these various specialties cohese in the armed forces.

 

[NoMoreAMCAS]

If a massive waste of time and money in the .mil surprises you, then you haven't been around any military anywhere in the world...

Lol, yeah I know the military is all about wasting money. It just seems that there would be a more efficient way. Like deploying more ER doc's or like the other guy said, PA's. I just wouldn't be too pumped about having some dude that just spent the last 3 or 4 years learning about skin conditions, attempting to save my life. I'd much prefer someone who has been focusing on similar scenarios.

 

[Ziehl-Neelsen]

Lol, yeah I know the military is all about wasting money. It just seems that there would be a more efficient way. Like deploying more ER doc's or like the other guy said, PA's. I just wouldn't be too pumped about having some dude that just spent the last 3 or 4 years learning about skin conditions, attempting to save my life. I'd much prefer someone who has been focusing on similar scenarios.

I think you may have a romanticized vision of what Battalion/Brigade Surgeons do. These are basic medical officer positions at the battalion/brigade level. These physicians are either GMO's or board certified physicians. Essentially, anyone with a medical license (i.e. having completed intern year) can staff this position. Brigade surgeons oversee all the medics in a unit along with (in the army a PA). You see sick call, you brief superiors on medical issues, you spend a lot of time working out/reading, and if you recognize a soldier who needs serious care, you refer them to the next echelon of care (the CASH). In mass casualty situations, these soldiers are evaced straight to the CASH, bypassing the Battalion level entirely. Movies tend to perpetuate the myth that these docs are performing surgery on the battlefield, but ina real casualty situation you deal with the ABCs and evac the soldier to a location where definintive care can be rendered. This is exactly what medics are trained to do.

 

[NoMoreAMCAS]

I think you may have a romanticized vision of what Battalion/Brigade Surgeons do. These are basic medical officer positions at the battalion/brigade level. These physicians are either GMO's or board certified physicians. Essentially, anyone with a medical license (i.e. having completed intern year) can staff this position. Brigade surgeons oversee all the medics in a unit along with (in the army a PA). You see sick call, you brief superiors on medical issues, you spend a lot of time working out/reading, and if you recognize a soldier who needs serious care, you refer them to the next echelon of care (the CASH). In mass casualty situations, these soldiers are evaced straight to the CASH, bypassing the Battalion level entirely. Movies tend to perpetuate the myth that these docs are performing surgery on the battlefield, but ina real casualty situation you deal with the ABCs and evac the soldier to a location where definintive care can be rendered. This is exactly what medics are trained to do.

Yeah, but training someone for 3-6 years in some field, to do something that a person with 1 year of medical training could do, is still dumb. Send the interns, FP's, and the ER docs on GMO tours.

 

[backrow]

Yeah, but training someone for 3-6 years in some field, to do something that a person with 1 year of medical training could do, is still dumb. Send the interns FP's and the ER docs on GMO tours.

Don't know of anyone who has done a 5 or 6 year residency sent as a GMO. Have heard of internal medicine specialists being sent to fill similar billets. But you're not going to find a neurosurgeon as a GMO, nor an ophthalmologist, nor a general surgeon or orthopedic surgeon.

Now these might get sent to an area that unfortunately might not have the volume or acuity they would like, but they won't be GMO's.

 

[Ziehl-Neelsen]

Yeah, but training someone for 3-6 years in some field, to do something that a person with 1 year of medical training could do, is still dumb. Send the interns, FP's, and the ER docs on GMO tours.

You are really missing the crux of the problem that most physicians have with the GMO model. Of course it sucks that my wife, who is a board-certified hematologist/oncologist, has to serve time as a battalion surgeon. More concerning to us however, is that physicians who have just completed an internship that consisted mostly of inpatient months and electives like radiology and anesthesia are deployed into a clinic based practice for which they are wholly untrained and not ready. Unfortunately, there are not a whole lot of options: we already deploy a PA for every physician depolyed at the battalion level, and there simply aren't enough FP, IM, and Peds primary care docs to fill all the billets.

The horror stories that I have known to come out of theatre don't involve board certified specialists (even dermies and physiatrists have enough clinical acumen to know when a patient needs to be kicked up to a higher level, though I'm sure its been a while since they did an anterior drawer test). The horror stories i have known involved a fresh out of internship GMO who sat on a problem he thought he could manage but required referral. A little knowledge is a dangerous thing. The farther one goes in residency, the more cautious and deferential one becomes. So in the end, if the Army has to err on sending the undertrained or the overtrained, I think the soldiers deserve the latter.

Sometimes it works out in funny ways though. My wife had a soldier evaced back to us with a clinical suspicion of Hodgkin's Disease. I received the biopsy and called it Classical Hodgkin's Lymphoma, Nodular Sclerosis subtype. Another doc in the same area was a deployed ID guy. He finagled a microscope from some local Iraqis and sent 3 soldiers home with plasmodium vivax he diagnosed on peripheral smears.

 

[ArkansasRanger]

You mention there not being enough peds docs among other specialties.

How many pediatricans would the military really need, and what else would they do besides see soldiers' kids at the bases?

 

[NavyFP]

You mention there not being enough peds docs among other specialties.

How many pediatricans would the military really need, and what else would they do besides see soldiers' kids at the bases?

First of all, there are a LOT of kids. Second, they can (and do) deploy as general medical officers as well as humanitarian missions.

 

[i want out]

You mention there not being enough peds docs among other specialties.

How many pediatricans would the military really need, and what else would they do besides see soldiers' kids at the bases?

As NavyFP has already said, there are lots of kids, and Peds deploy in GMO billets.

to elaborate a little bit, give a 19 year old a stable income, and even a little bit of time off, and he and she will try to procreate as much as possible. Add the stress of deployments with mixed gender units and crews, and they will not only try to procreate at home, they will continue same activities while deployed.

They are very good at this, and apparently very fertile.

I want out (of IRR)

 

[ArkansasRanger]

As NavyFP has already said, there are lots of kids, and Peds deploy in GMO billets.

to elaborate a little bit, give a 19 year old a stable income, and even a little bit of time off, and he and she will try to procreate as much as possible. Add the stress of deployments with mixed gender units and crews, and they will not only try to procreate at home, they will continue same activities while deployed.

They are very good at this, and apparently very fertile.

I want out (of IRR)

LOL.

Yes, I suppose it'd be akward to have a pediatrican attending to a soldier or something and have the grown man soldier ask about his medical specialy with a reply of, "Oh, I'm a pediatrician."

 

[i want out]

LOL.

Yes, I suppose it'd be akward to have a pediatrican attending to a soldier or something and have the grown man soldier ask about his medical specialy with a reply of, "Oh, I'm a pediatrician."

Many of the active duty folks that I treated were more overgrown kids than adults.

Keep in mind that the average age on an aircraft carrier is 19.5 years. I wasn't on a carrier, but that tends to be most of what you see.

While many of these kids are chronologicly adults, they are more big kids than adults.

Most of these kids wouldn't go to the doctor unless they were either ordered to, or it got them out of work. Generally they didn't know the difference between a pediatrician, and a cardiothoracic surgeon. They Just know that your a Doc, and don't bother to learn your name.

i want out (of IRR)

 

[a1qwerty55]

LOL.

Yes, I suppose it'd be akward to have a pediatrican attending to a soldier or something and have the grown man soldier ask about his medical specialy with a reply of, "Oh, I'm a pediatrician."

News flash - soldiers often are almost kids. Since peds does adolescent medicine it isn't a leap to take care of soldiers.

 

[i want out]

News flash - soldiers often are almost kids. Since peds does adolescent medicine it isn't a leap to take care of soldiers.

I would have argued at times that it was almost infantile medicine if you went by some of the knuckleheads behavior.

i want out (of IRR)