Army Shenanigans

[Chonal Atresia]

So my buddy is a fellowship-trained surgical subspecialist stationed at a major army MTF. He has two years left with his ADSO and has been stationed at the same MTF for the last 8 years. In the army's infinite wisdom, they are moving him to Bumblef#$%, AK unaccompanied (he is married with 2 children < 12 years of age) where he will not practice any of his skill set.

I know there are much worse stories out there, but the army is essentially killing his opportunity to get hired after he leaves active duty and are essentially making him unemployable in civilian medicine. He performs extremely complex surgeries and will certainly not be doing any of these procedures in AK. Furthermore, the army will have to pay to PCS both him as well as his replacement at said MTF.

I wish these were the stories that made it out to prospective med students. We recently had to turn down a former general surgeon (retired COL) from being hired at our practice but his caseload was not up to par and the hospital refused to credential him. Buyer beware - these stories are true and could happen to you as long as the military owns you.

---

Members don't see this ad.

 

[WernickeDO]

Amazing. This and other horror stories like it should be stickied.

Is there any kind of rebuttal process?

 

[68PGunner]

Ouch. This was by design in order to keep your buddy until retirement mark.

 

[Gastrapathy]

Not by design to keep him. That suggests a conspiracy that is beyond the capacity of the leadership. This is simple apathy. He just isn't valued.

 

[pgg]

That's almost as crazy as putting subspecialists into brigade surgeon slots.

The cynical side of me wonders if this is deliberate, to push him toward extending his time on AD afterwards to renew his skills before looking for a post-Army job. The realist side of me doesn't believe the Army is that clever.

 

[pgg]

Ouch. This was by design in order to keep your buddy until retirement mark.

They don't want us to stay until retirement. Pensions are very, very expensive.

 

[HighPriest]

It's not apathy. Its not a conspiracy. He's just a screwdriver, and they need a screwdriver in that toolbox. Doesn't matter that he's a powered screwdriver that only screws Phillips-head screws - he's a screwdriver. End of story.

 

[bommer1389]

Is this a learning experience for med students and why completing ADSO (thru GMO?) before residency should be heavily considered?

 

[turkish]

So my buddy is a fellowship-trained surgical subspecialist.

What's he going to do in AK?

 

[HighPriest]

What's he going to do in AK?

stew. and watch his skillset rot. all for principle.

 

[turkish]

stew. and watch his skillset rot. all for principle.

Brigade or battalion surgeon? I ask because the Stryker brigade there (supposedly) has the worst medical readiness in the army, and I wonder if someone is getting replaced early.

 

[HighPriest]

Neither. He'll be working a clinic, but the clinic doesn't actually support his skillset.

 

[WernickeDO]

Is this a learning experience for med students and why completing ADSO (thru GMO?) before residency should be heavily considered?

No, this is a learning experience for pre-meds to avoid the military all together.

 

[sonofva]

What's he going to do in AK?

Hunting big game? Salmon fishing? Freezing?


Sent from my iPhone using SDN mobile

 

[HighPriest]

Hunting big game? Salmon fishing? Freezing?


Sent from my iPhone using SDN mobile

Have you seen insomnia? Either version? I imagine it'll be exactly like that. Let's just hope he's Al Pacino and not Robin Williams.

 

[pgg]

Have you seen insomnia? Either version? I imagine it'll be exactly like that. Let's just hope he's Al Pacino and not Robin Williams.

30 Days Of Night is what I think of when Alaska comes up in conversation.

 

[HighPriest]

At least you'd get to kill the bloodsuckers. In the Army, you work for them.

 

[Ziehl-Neelsen]

30 Days Of Night is what I think of when Alaska comes up in conversation.

I think of Grizzly Man.

Sometimes you eat the bear, and sometimes the bear, well, he eats you.
-- The Stranger

 

[GMO2003]

So my buddy is a fellowship-trained surgical subspecialist stationed at a major army MTF. He has two years left with his ADSO and has been stationed at the same MTF for the last 8 years. In the army's infinite wisdom, they are moving him to Bumblef#$%, AK unaccompanied (he is married with 2 children < 12 years of age) where he will not practice any of his skill set.

I know there are much worse stories out there, but the army is essentially killing his opportunity to get hired after he leaves active duty and are essentially making him unemployable in civilian medicine. He performs extremely complex surgeries and will certainly not be doing any of these procedures in AK. Furthermore, the army will have to pay to PCS both him as well as his replacement at said MTF.

I wish these were the stories that made it out to prospective med students. We recently had to turn down a former general surgeon (retired COL) from being hired at our practice but his caseload was not up to par and the hospital refused to credential him. Buyer beware - these stories are true and could happen to you as long as the military owns you.

Very sad but all too common....hope he is close enough to and is allowed to moonlight in some capacity if possible

 

[Gastrapathy]

The problem with being very specialized is that it's hard to moonlight at the top of your skills because those patients tend to require follow up care in a tertiary environment.

 

[GMO2003]

The problem with being very specialized is that it's hard to moonlight at the top of your skills because those patients tend to require follow up care in a tertiary environment.

What about asking for early release from active duty...isn't the military downsizing service wide...unless of course your friend is one of only a handful in his specialty specific MOS and is needed.

If that's the case, then he needs to have a heart to heart with his specialty consultant to the surgeon general and get the phuck out of wherever he is misplaced ASAP.

This situation looks bad for everyone involved. Did he piss some clipboard commando off along the way that is now getting some sort of underhanded payback by doing the good ole military stasheroo?

This really needs to stop.

 

[Gastrapathy]

Why would they release someone they've shoved into a hole? It probably fell to the consultant to find a victim and he picked this guy. There is no way out unless he can manufacture an EFM issue or the like.

 

[Monty Python]

So my buddy is a fellowship-trained surgical subspecialist stationed at a major army MTF. He has two years left with his ADSO and has been stationed at the same MTF for the last 8 years. In the army's infinite wisdom, they are moving him to Bumblef#$%, AK unaccompanied (he is married with 2 children < 12 years of age) where he will not practice any of his skill set.

I know there are much worse stories out there, but the army is essentially killing his opportunity to get hired after he leaves active duty and are essentially making him unemployable in civilian medicine. He performs extremely complex surgeries and will certainly not be doing any of these procedures in AK. Furthermore, the army will have to pay to PCS both him as well as his replacement at said MTF.

I wish these were the stories that made it out to prospective med students. We recently had to turn down a former general surgeon (retired COL) from being hired at our practice but his caseload was not up to par and the hospital refused to credential him. Buyer beware - these stories are true and could happen to you as long as the military owns you.

If he's not interested in an Army career and wants out ASAP, a Congressional might help. Especially if his letter to his Congressman alleges Army fraud, waste, and abuse of the tax dollars which funded his specialty training which are not needed in AK.

 

[BlackFrancis33]

I'm not throwing the BS flag, just a 'suspicion' flag. We have all seen sub-specialists tagged for these assignments against their will, it seems like every Peds Cardiologist I know or have met for example. But, lately when I have seen folks getting PCS'd right up to their ADSO there has been some mitigating circumstances. For example, profiles that all of a sudden pop up when said individual is suddenly atop the order of merit list to deploy. The situation described by CA is particularly egregious given that he will lose skills he needs once he gets out, but I can't help but wonder if there isn't some other reason a consultant would do this to someone.

 

[Gastrapathy]

He has 2 years left. At least for the Navy, that's exactly when people can still be moved. He probably made it clear he was planning to get out in many conversations, so there was no reason to keep him happy. Need to fill a bad billet? Send the guy you've kept at a major MTF for 8 years and yet still are going to lose.

The lesson here is that no one should know your exit plan until the day you drop your papers.

 

[Gastrapathy]

If he's not interested in an Army career and wants out ASAP, a Congressional might help. Especially if his letter to his Congressman alleges Army fraud, waste, and abuse of the tax dollars which funded his specialty training which are not needed in AK.

Let's say, for the sake of argument, that the guy is an ENT subspecialist (say he did a fellowship in cranial base tumors or something). He's an ENT first. Its an ENT billet. He's never had to PCS. The Congressional is completely pointless. The fact of the matter is, there are plenty of people inside mil med who would see this outcome as only fair. They were the ones who couldn't get back to the MTF from BFE because snugglebunnies like this dude were never forced to leave. There's never any guarantee you'll get to practice in your specialty, let alone at the peak of your skill set. This story sucks but its commonplace and entirely believable.

 

[pgg]

Let's say, for the sake of argument, that the guy is an ENT subspecialist (say he did a fellowship in cranial base tumors or something). He's an ENT first. Its an ENT billet.

That's not a universal truth.

I don't know how the Army handles these things, except what I read here, and a general sense that they're far more screwed up than the Navy ...

In the Navy, anesthesia subspecialists (mainly peds, CT, critical care, pain) have a separate block of billets compared to the general anesthesiologists. Out of residency, I spent a few years at a tiny MTF where they'd never ever send a peds, cardiac, CCM, or pain guy. Afterwards, one of the "catches" I was made aware of when I applied for CT fellowship was that by specializing I was burning future bridges to operational billets and small MTFs, and that I'd be at one of the Navy big 3 thereafter. This would tremendously reduce my odds of ever making O6. So while I've accepted that O5 will be my terminal rank, I don't really fear a skill-rotting PCS to Naval Clinic Nowhere.

It helps that we don't have a brigade surgeon phenomenon in the Navy, since that pound of flesh is excised pre-residency.

 

[Gastrapathy]

I doubt that you have a separate block of billets coded for subspecialist anesthesiologists. What you have is a specialty leader who has designated certain billets to be filled by subspecialists. Its not in the manning document and there is no separate code for it. GME needs you to be at MTFs. But, if there were more subspecialists than spots, then suddenly that rule would evaporate.

 

[Perrotfish]

I've always wondered why they can't seem to create any kind of carrot for these really undesirable billets. A cash bonus or something that would actually attract people to move voluntarily. I feel like there would be a lot less angst in the military if the reward for a deployment, or moving to the middle of cow country, was more tangible than the vague hope that a promotions committee would eventually notice your misery.

 

[Gastrapathy]

I heard a doc advocate a bidding system to the SG for billets. The irony is that the opposite is true. You will take a pay cut to move to BFE because BAH is higher in the more desirable places. Now, you can say it will cost more to live there and that is true but that isn't the way the market works in the real world.

 

[HighPriest]

I'm not throwing the BS flag, just a 'suspicion' flag.

I am very familiar with this situation. The person is a good doc, top FTE producer, plenty of additional non-clinical responsibilities on top of it. The doc didn't personally do anything that I'm aware of to bring this on. There are some mitigating circumstances that were very much out of the doc's control that a very cynical person like myself might argue came into play with this decision, but they make the decision -more- questionable, not less. I can't go into more detail without more or less identifying this person, but what C. A. stayed is accurate and not embellished.

 

[HighPriest]

That's not a universal truth.

It is, however, the truth in the Army. It is the prerogative of the specialty consultant to put fellowship-trained docs at billets where they can maintain their skillset, but MEDCOM doesn't see a difference. We're at a point in my specialty where we have trained too many fellows, but we're consolidating, so we're starting to see guys sent places where traditionally they haven't had their skillsets. This is different, however, as the hospital to which this doc is being sent cannot possibly support his skillset. It's a matter of facilities and population rather than just establishing the practice and educating staff. But the point is: an ENT is an ENT, an anesthesiologist is an anesthesiologist. I guess I can't say with certainty that would apply for an internist who trained in GI, for example. I honestly don't know. But for us, the only thing the Army looks at is your MOS, and it's all the same.

 

[pgg]

I doubt that you have a separate block of billets coded for subspecialist anesthesiologists. What you have is a specialty leader who has designated certain billets to be filled by subspecialists. Its not in the manning document and there is no separate code for it. GME needs you to be at MTFs. But, if there were more subspecialists than spots, then suddenly that rule would evaporate.

Could be. I don't know exactly how it's coded, just that we've got billets for 3 at one, 4 at another, etc. There IS something formal to it, because it changed about a year ago, and that was the evidence our SL needed to prove the need to open up more FTOS fellowship positions to train these subspecialists. Peds and CT anesthesia is undermanned at present, to the point that my current duty station is actually going to be gapped CT anesthesia for part of this year. We have one generalist who's credentialed to do cardiac cases, which is perfectly OK (most hearts in the US aren't done by fellowship trained CT anesthesiologists), but it's not optimal.

Perhaps if our subspecialists were overmanned they'd be considered fair game for small hospitals.

 

[Gastrapathy]

Interesting. It would be good if they have started coding subs but that would be a change.

GI docs won't be billeted in IM billets but they can (and are, more often than not) be deployed as internists.

 

[GMO2003]

Another cog being filled in the wheel of the big green machine

 

[BlackFrancis33]

I am very familiar with this situation. The person is a good doc, top FTE producer, plenty of additional non-clinical responsibilities on top of it. The doc didn't personally do anything that I'm aware of to bring this on. There are some mitigating circumstances that were very much out of the doc's control that a very cynical person like myself might argue came into play with this decision, but they make the decision -more- questionable, not less. I can't go into more detail without more or less identifying this person, but what C. A. stayed is accurate and not embellished.

OK, that sounds like a legit case of getting shafted. I just had a sub-specialist colleague of mine recently take a Brigade Surgeon slot to reduce the chance of getting deployed in the next 2-3 years. It is not as crazy as it sounds right now. The really big MEDCENs are on about a 2.5 to 3 year cycle for deployments (I am all too familiar with this reality right now). I actually think this is fair, and becomes the price of being a part of a GME program. If you are a junior to mid level clinician, and not a Residency PD or Chief (protected from deploying), you quickly rise to the top of the list. With people PCSing, ETSing, and when you add in people with profiles, some very legit of course, the list moves even faster. I think my lower back is starting to hurt...J/K homey don't play that. It is hard to not harbor some angst against folks who can work full time in a hospital but are non-deployable. I do think that if you are non-deployable you should be on top of the list to fill brigade surgeon slots which don't require deployment (e.g. Wounded Warrior Battalions) although this is a minority of those positions.

 

[plukfelder2017]

So my buddy is a fellowship-trained surgical subspecialist stationed at a major army MTF. He has two years left with his ADSO and has been stationed at the same MTF for the last 8 years. In the army's infinite wisdom, they are moving him to Bumblef#$%, AK unaccompanied (he is married with 2 children < 12 years of age) where he will not practice any of his skill set.

I know there are much worse stories out there, but the army is essentially killing his opportunity to get hired after he leaves active duty and are essentially making him unemployable in civilian medicine. He performs extremely complex surgeries and will certainly not be doing any of these procedures in AK. Furthermore, the army will have to pay to PCS both him as well as his replacement at said MTF.

I wish these were the stories that made it out to prospective med students. We recently had to turn down a former general surgeon (retired COL) from being hired at our practice but his caseload was not up to par and the hospital refused to credential him. Buyer beware - these stories are true and could happen to you as long as the military owns you.

What if one were to join the guard/reserves rather than an active component? Would they still be able to manage a solid case load at say a well known academic center while doing their 2 weeks a year and one weekend a month?

 

[notdeadyet]

What if one were to join the guard/reserves rather than an active component? Would they still be able to manage a solid case load at say a well known academic center while doing their 2 weeks a year and one weekend a month?

The Guard is primarily combat units and combat support units. For AMEDD, this means that docs are basically either Field/Battalion/Brigade Surgeons, Flight Surgeons, or Psychiatrists. For this reason, surgical subspecialists are rare in the Guard, as they don't want to slot as functioning as a primary care doc. When deployed, docs deploy with their unit as primary care doc or get activated within their specialty as augmentees to other units.

The Reserve has these slots, but while the Guard tends to get docs called up for combat deployments, the Reserve is much more likely to get called up for backfill for domestic slots. It's pure editorializing on my part, but now that the seal has been broken and the Army is used to activating Reserve Corps docs, my hunch is that they will be less shy about activating docs to backfill domestically even during peacetime.

"One" shouldn't join the Guard or Reserve unless they are comfortable deploying. And it varies a lot by command, but for me, the one weekend a month/2 weeks a year things is a bit of a misnomer. This is probably more true Guard-side, but since there is a full-time component on state orders at any given time, we tend to do more clinical work and I know that I probably spend about 10-20 hours per month with military duties outside of the drill weekend.

 

[MirrorTodd]

The Guard is primarily combat units and combat support units. For AMEDD, this means that docs are basically either Field/Battalion/Brigade Surgeons, Flight Surgeons, or Psychiatrists. For this reason, surgical subspecialists are rare in the Guard, as they don't want to slot as functioning as a primary care doc. When deployed, docs deploy with their unit as primary care doc or get activated within their specialty as augmentees to other units.

The Reserve has these slots, but while the Guard tends to get docs called up for combat deployments, the Reserve is much more likely to get called up for backfill for domestic slots. It's pure editorializing on my part, but now that the seal has been broken and the Army is used to activating Reserve Corps docs, my hunch is that they will be less shy about activating docs to backfill domestically even during peacetime.

"One" shouldn't join the Guard or Reserve unless they are comfortable deploying. And it varies a lot by command, but for me, the one weekend a month/2 weeks a year things is a bit of a misnomer. This is probably more true Guard-side, but since there is a full-time component on state orders at any given time, we tend to do more clinical work and I know that I probably spend about 10-20 hours per month with military duties outside of the drill weekend.

lol One weekend a month in my old unit was frequently Friday at 0600 until Sunday 2400, and two weeks a year was frequently three weeks on ADT orders.

 

[HighPriest]

OK, that sounds like a legit case of getting shafted. I just had a sub-specialist colleague of mine recently take a Brigade Surgeon slot to reduce the chance of getting deployed in the next 2-3 years. It is not as crazy as it sounds right now. The really big MEDCENs are on about a 2.5 to 3 year cycle for deployments (I am all too familiar with this reality right now). I actually think this is fair, and becomes the price of being a part of a GME program. If you are a junior to mid level clinician, and not a Residency PD or Chief (protected from deploying), you quickly rise to the top of the list. With people PCSing, ETSing, and when you add in people with profiles, some very legit of course, the list moves even faster. I think my lower back is starting to hurt...J/K homey don't play that. It is hard to not harbor some angst against folks who can work full time in a hospital but are non-deployable. I do think that if you are non-deployable you should be on top of the list to fill brigade surgeon slots which don't require deployment (e.g. Wounded Warrior Battalions) although this is a minority of those positions.

Well, for what it's worth this guy is fully deployable, and certainly not doing this to skate a deployment.

 

[plukfelder2017]

The Guard is primarily combat units and combat support units. For AMEDD, this means that docs are basically either Field/Battalion/Brigade Surgeons, Flight Surgeons, or Psychiatrists. For this reason, surgical subspecialists are rare in the Guard, as they don't want to slot as functioning as a primary care doc. When deployed, docs deploy with their unit as primary care doc or get activated within their specialty as augmentees to other units.

The Reserve has these slots, but while the Guard tends to get docs called up for combat deployments, the Reserve is much more likely to get called up for backfill for domestic slots. It's pure editorializing on my part, but now that the seal has been broken and the Army is used to activating Reserve Corps docs, my hunch is that they will be less shy about activating docs to backfill domestically even during peacetime.

"One" shouldn't join the Guard or Reserve unless they are comfortable deploying. And it varies a lot by command, but for me, the one weekend a month/2 weeks a year things is a bit of a misnomer. This is probably more true Guard-side, but since there is a full-time component on state orders at any given time, we tend to do more clinical work and I know that I probably spend about 10-20 hours per month with military duties outside of the drill weekend.

.
-I am trying to determine if there are any attending slots in mil-med general surgery where an individual would not experience skill atrophy and could actually be dealt responsibilities that are commensurate with a similar role in the civilian side. If so, what would you recommend that I do to obtain this spot? I was under the impression that the guard/reserves would provide me with this flexibility, but clearly not. Thank you very much for your assistance.

 

[notdeadyet]

I just want to make sure that I don't end up getting the short end of the stick by having my skills disintegrate. I've seen a few posts where general surgeons on active duty are getting shafted hard with minimal caseload. (Source: http://forums.studentdoctor.net/threads/army-general-surgery-questions.471797/)
-If you were in my position, would you refrain from joining the Guard/Reserves and maybe take a civilian contracting role or FAP in etc? Please note that I am not rejoining for the financial benefits, as I know that I could make much more in private practice.

I'm not sure I follow your logic here.

If you are worried about getting burned by minimal caseload as an active duty surgeon for the military, why would you think you'd be any better off (in terms of caseload) as a civilian contractor?

And your talking about doing the Guard/Reserve vs. FAP makes me wonder if you're confusing stuff. FAP is just a financial incentive in residency that obligates you to active duty service afterwards.

-I am trying to determine if there are any attending slots in mil-med general surgery where an individual would not experience skill atrophy and could actually be dealt responsibilities that are commensurate with a similar role in the civilian side. If so, what would you recommend that I do to obtain this spot? I was under the impression that the guard/reserves would provide me with this flexibility, but clearly not.

Again, this is confusing. There's no real skills atrophy with Guard/Reserve duty, as this is a very part-time gig (unless deployed).

The skills benefit to going the Guard/Reserve route is twofold: your residency and your job.

Military residencies (for the most part) do not have the same volume of procedures that you get at the better civilian programs. So Guard/Reserve is handy because you can get skills at a better training program (assuming you have the chops to get into a good residency).

After residency, the potential skills atrophy on active duty side is real. Folks (particularly those not at a high volume site) try to minimize it with moonlighting at the like. With the Guard/Reserve, you have a civilian job, so there is no real risk of non-volitional skills atrophy. What you do at drill is incidental, as your skills are honed civilian side.

So yes, the Guard/Reserve does provide you with the flexibility. You can get whatever job in the civilian sector you want.

Let me know if I'm missing something here.

 

[plukfelder2017]

-My apologies. I was under the impression that as a civilian contractor you could have control over whether you would be placed on a FST in country versus being placed in a CSH with minimal volume. I've been overwhelmed on this sub-forum and the mil-med subforum by the plethora of available information. Some attendings/residents advise HPSP while others recommend FAP. Others seem to recommend the NG and reserves. Your post did give me clarity, so thank you.
-I think I will stick with the guard option and work on securing a quality residency. Just as a follow-up question, how easy is it to secure a moonlighting opportunity while in a mil-surg residency?

 

[notdeadyet]

-My apologies. I was under the impression that as a civilian contractor you could have control over whether you would be placed on a FST in country versus being placed in a CSH with minimal volume.

For your control as a civilian, you will be thinking North Carolina or Louisiana >>> FST in Iraq vs CSH in Afghanistan. For the latter jobs, your best bet is to join the military.

-I think I will stick with the guard option and work on securing a quality residency. Just as a follow-up question, how easy is it to secure a moonlighting opportunity while in a mil-surg residency?

If you do a civilian residency, surgical or medical, you shouldn't have to worry about skill atrophy. You're actively developing skills. And you may not have the time to moonlight anyway.

How far along in this process are you? I think pre-allo might be a good bet.


Sent from my iPhone using Tapatalk

 

[Ziehl-Neelsen]

It is, however, the truth in the Army. It is the prerogative of the specialty consultant to put fellowship-trained docs at billets where they can maintain their skillset, but MEDCOM doesn't see a difference. We're at a point in my specialty where we have trained too many fellows, but we're consolidating, so we're starting to see guys sent places where traditionally they haven't had their skillsets. This is different, however, as the hospital to which this doc is being sent cannot possibly support his skillset. It's a matter of facilities and population rather than just establishing the practice and educating staff. But the point is: an ENT is an ENT, an anesthesiologist is an anesthesiologist. I guess I can't say with certainty that would apply for an internist who trained in GI, for example. I honestly don't know. But for us, the only thing the Army looks at is your MOS, and it's all the same.

Medicine subspecialists (and interventional radiologists, nuc meds, plastic surgeons, vascular surgeons, etc.) all receive new AOCs when they complete fellowship. And the AOC is the only thing that matters to MEDCOM when they man hospitals according to the TDA. All the other subspecialty fellowships that don't receive a new AOC after completion of the fellowship are SOL when it comes to being "officially protected" by Army regulations when it comes to manning--and are wholly dependent on a specialty consultant who understands that it's kind of stupid to station a neuroradiologist at an MTF without a neurosurgeon or a neurotology-trained ENT at Fort Ain't Right. Provided below are the officially recognized Army MC AOCs. I don't care if you are Atul f*cking Gawande, the Army considers you a 61J and will send your @ss to Fort Riley to do appendectomies and cholecystectomies while you write trenchant critiques of American healthcare in your free time.

http://dmna.ny.gov/arng/ocs/forms/amedd_aoc.pdf

And this is not unique to the Army. Back in the day, I knew a Navy pathologist with subspecialty training in hematopathology sent (against her will) to a small Navy MTF where there is no hematologist/oncologist. Why? Because said MTF needed a pathologist and the Navy had enough hematopathologists to cover the work at the major MEDCENS. A more recent example: Army and AF hematologists/oncologists can do sub-subspecialty training in HSCT at Fred Hutch in Seattle, and after this specialized training, these individuals are usually stationed at one of the 2 DOD MTFs that perform inpatient HSCT. Well one of the AF heme/oncs with HSCT subspecialization recently received orders to an AF MTF that would implode if it was asked to manage inpatient induction therapy for an acute leukemic let alone contemplate HSCT. Why? Because said MTF needed a heme/onc and the DOD facilities that perform HSCT have enough physicians to cover the work.

Military physicians need to be able to read the tea leaves. I like tea, so when it came time for me to choose a subspecialty fellowship, I chose a fellowship that nobody likes (so there would be no competition) and doesn't require a tertiary care medical center to be practiced (so that even if I don't end up at a major MEDCEN, I can still practice my subspecialty). I have ultimate sympathy for this ENT (who I don't think I know) and all the other hyperspecialized physicians I do know who have been placed in these predicaments, but IMO this is getting mad at the scorpion for being a scorpion.

 

[HighPriest]

IMO this is getting mad at the scorpion for being a scorpion.

You are correct about that. Although the problem is that a scorpion is a scorpion simply because it is. The Army is the way the Army is because people make it that way. And this is one of those things that no one ever tells you when you sign on the line in blood, so it's fairly important to make an issue of it - for those who still own their souls.

 

[Chonal Atresia]

Big army used to be "reasonable" regarding physician career tracks back in the day. When I started med school at USUHS in 1998, we actually were told in class that there were 3 career tracks: 1) Operational, 2) Academic and 3) Clinical. Now if a full-scale war broke out (see 9/11), all bets were off with regard to deployments but you could still return to your chosen "track" once deployment was over.

Well, things have changed just a bit. The days of making O-6 rank by staying strictly clinical or academic are over. Operational slots (FSTs, brigade surgeons, JSOC/USASOC surgeons) are no longer "optional" and are being forced on primary care and subspecialists alike. Clinical work is NOT VALUED! Before I separated, I was told by the "Chief of Surgery" that it was "expected" that all physicians were of high quality and productive which is why these things were not included on the OER. Really? The two most important things that we are judged on in civilian medicine don't matter for promotion in the military? BTW, this guy was not even allowed to remove lipomas by himself in the main OR but had somehow managed to ascend to the status of chief and he was the one signing my OER .

I guess my point is that all HPSP/USUHS students should be told up-front by recruiters that operational work WILL BE REQUIRED if you take the scholarship. This should be written in bold red letters on the top of every application. In addition, it should be explained what it actually means to be pulled out of your chosen field to be a brigade surgeon for 2 years (I don't think a 22 yo college student fully grasps this concept). I was fortunate to escape with my career intact but I personally know at least 2 high-quality surgeons who are likely to not be as fortunate.

Deception at the highest level. It needs to end.

 

[WernickeDO]

They don't use doctors to recruit 18 year olds who want to go infantry, so why do they use E6 68W to recruit docs? Simple: if the mil sent an operational doc to speak to a pre-med the kid would go running to the hills in about 5 minutes flat. Without the deception, doc numbers would fall even lower. The military can overcome the abysmal retention rate by swelling their ranks with unknowing, fresh-faced pre-meds who have a med school acceptance in their hands and the world by the short hairs. If those numbers go then then milmed is in trouble, and they will either have to bring in more civilian contractors or actually start valuing medicine. My money is on the former.

 

[Homunculus]

Medicine subspecialists (and interventional radiologists, nuc meds, plastic surgeons, vascular surgeons, etc.) all receive new AOCs when they complete fellowship. And the AOC is the only thing that matters to MEDCOM when they man hospitals according to the TDA. All the other subspecialty fellowships that don't receive a new AOC after completion of the fellowship are SOL when it comes to being "officially protected" by Army regulations when it comes to manning--and are wholly dependent on a specialty consultant who understands that it's kind of stupid to station a neuroradiologist at an MTF without a neurosurgeon or a neurotology-trained ENT at Fort Ain't Right. Provided below are the officially recognized Army MC AOCs. I don't care if you are Atul f*cking Gawande, the Army considers you a 61J and will send your @ss to Fort Riley to do appendectomies and cholecystectomies while you write trenchant critiques of American healthcare in your free time.

http://dmna.ny.gov/arng/ocs/forms/amedd_aoc.pdf

please note-- pediatric subspecialists are *all* 60Q. this was "pediatric cardiologist" technically. the blatant oversight with this is that TDA has "n" 60Qs, but doesn't say what the mix is. as a result, staffing looks fat when in reality there are maybe 1-2 subspecialists in each category. so if you have 2 peds endo, 2 Peds GI, 2 peds cards, 1 peds rheum and 1 peds pulm, 2 developmentalists and 1 peds heme/onc, and your TDA is 10, you look over strength. but deploying any 1 person would either deplete staffing by 50% in that specialty or kill it entirely. this is the system we deal with.

Big army used to be "reasonable" regarding physician career tracks back in the day. When I started med school at USUHS in 1998, we actually were told in class that there were 3 career tracks: 1) Operational, 2) Academic and 3) Clinical. Now if a full-scale war broke out (see 9/11), all bets were off with regard to deployments but you could still return to your chosen "track" once deployment was over.

Well, things have changed just a bit. The days of making O-6 rank by staying strictly clinical or academic are over. Operational slots (FSTs, brigade surgeons, JSOC/USASOC surgeons) are no longer "optional" and are being forced on primary care and subspecialists alike. Clinical work is NOT VALUED! Before I separated, I was told by the "Chief of Surgery" that it was "expected" that all physicians were of high quality and productive which is why these things were not included on the OER. Really? The two most important things that we are judged on in civilian medicine don't matter for promotion in the military? BTW, this guy was not even allowed to remove lipomas by himself in the main OR but had somehow managed to ascend to the status of chief and he was the one signing my OER .

I guess my point is that all HPSP/USUHS students should be told up-front by recruiters that operational work WILL BE REQUIRED if you take the scholarship. This should be written in bold red letters on the top of every application. In addition, it should be explained what it actually means to be pulled out of your chosen field to be a brigade surgeon for 2 years (I don't think a 22 yo college student fully grasps this concept). I was fortunate to escape with my career intact but I personally know at least 2 high-quality surgeons who are likely to not be as fortunate.

Deception at the highest level. It needs to end.

amen. academic is basically gone except for a select few, and clinical is just a holding pen for manning operational slots. the icing on the cake for me is when they tell us to "make a career map" as if we have any control over the matter. if our consultant gets a wild hair up their ass, we could be doing a year unaccompanied in korea-- which i doubt anyone is going to pencil in on their career map, let alone 2 years as BDE surgeon. if i end up staying i will be perfectly content as a terminal O5 signing year to year until the last 3. i just wish the goalposts and rules weren't changed on us midstream. but at least we still have the potential of a cliff vested retirement (so far, at least...)

--your friendly neighborhood over strength but not really caveman

 

[Homunculus]

OK, that sounds like a legit case of getting shafted. I just had a sub-specialist colleague of mine recently take a Brigade Surgeon slot to reduce the chance of getting deployed in the next 2-3 years. It is not as crazy as it sounds right now. The really big MEDCENs are on about a 2.5 to 3 year cycle for deployments (I am all too familiar with this reality right now). I actually think this is fair, and becomes the price of being a part of a GME program. If you are a junior to mid level clinician, and not a Residency PD or Chief (protected from deploying), you quickly rise to the top of the list. With people PCSing, ETSing, and when you add in people with profiles, some very legit of course, the list moves even faster. I think my lower back is starting to hurt...J/K homey don't play that. It is hard to not harbor some angst against folks who can work full time in a hospital but are non-deployable. I do think that if you are non-deployable you should be on top of the list to fill brigade surgeon slots which don't require deployment (e.g. Wounded Warrior Battalions) although this is a minority of those positions.

tell your friend to be careful. unless his/her BDE deploys, his/her dwell time will not be reset. some commands care about previous BDE experiences, but for deployments we've been told it is a different criteria-- starting with dwell time. rightfully so to a degree. deployments are a totally different animal. i've seen this first hand with someone who came back from a BDE assignment and within a year was top of the order of merit list for deployment and was wheeling/dealing for what slot they'd end up filling. the "but i did BDE surgery!" argument didn't stick. this was within 6-8 months of returning to clinical medicine.

-- your friendly neighborhood different types of suck caveman