Chief of the Medical Corps Newsletter-Sep 2007

[DiveMD]

A few interesting points...

7. GMO conversions: Over the next four years the Navy Medical Department will continue our phased conversion of PGY-1 level physician billets (GMOs, Flight Surgeons, UMOs) to residency trained primary care providers. Our ceaseless efforts to provide the highest quality services demand that we do so. On October 1st this year 106 of our current 553 PGY-1 level billets will convert to primary care specialists, including all of the GMO billets in our BSO-18 MTFs. At a rate of approximately 100/year, the remaining 447 will be converted over the coming 4 years.
Obviously the communities that will ultimately meet these requirements may not be sufficiently manned at this point, and the next several years will bring challenges to all physicians in the Navy. Beginning with the fall 2007 GME selection board, residency starts in primary care specialties will ramp-up. Until these pipelines are up to speed all Navy physicians have a role in assisting this transition.

8. Medical Corps Special Pays: October 1st brings a new fiscal year, and the anniversary date of Special Pays contracts for many of us. However, the Special Pays office cannot accept new contract requests until release of the NAVADMIN message (which is expected in September). As yet we do not have the final FY-08 special pays package, but proposals so far have called for some changes in some specialties. The most up to date information on special pays eligibility, release of the NAVADMIN, documentation requirements and application processing can be found on the Navy Medicine web site: http://navmedicine.med.navy.mil then select BUMED at the top of the screen and then Special Pays from the list of Departments in the column on the left side of the screen. Contact information for individualized service is also provided.

10. HPSP update: More good news on the HPSP shortfall issue…in addition to a $20K signing bonus funded in July for FY2007 and FY2008, effective 1 September the monthly stipend increased from $1,349 to $1,605. A second stipend increase is also programmed to take effect 1 July 2008, raising the stipend to $1,907. As of 1 September, the projections for HPSP fills this year are still at approx 60%, 175 of 290 available slots.
This is a good opportunity to reiterate that BUMED funds a Speakers Bureau for Navy physicians who wish to travel in support of recruiting. Medical Officers who wish to assist local recruiters at their Alma Mater medical schools, undergraduate schools, pre-med clubs, etc. can be funded through BUMED. Interested Medical Officers should contact the Recruiting Office in the location they wish to visit, request TAD orders from their command, and receive accounting data from BUMED to cover travel and per diem costs. POC is CAPT Bloom. The Physician Recruiter Assistance section of the NKO Medical Corps website has been updated with presentations, FAQ&As and contact information relating to Medical Corps Accession Programs (HPSP), Navy GME and career information. This information is provided to assist Navy Medical Program Recruiters as well as the medical officers and others who are assisting with the recruiting efforts.

13. FY-08 Medical Corps Accession Goals:: In response to the HPSP shortfall the Medical Corps has revised accession goals for Direct Accessions, Health Professions Loan Repayment Program, and the Financial Assistance program. The FY-08 Accession Plan calls for the following Medical Corps Accessions: 250 HPSP, 52 USUHS, 20 Direct/ Recall/Interservice Transfers and 20 Financial Assistance Program (FAP) in FY-08.

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[West Side]

10. HPSP update: More good news on the HPSP shortfall issue…in addition to a $20K signing bonus funded in July for FY2007 and FY2008, effective 1 September the monthly stipend increased from $1,349 to $1,605. A second stipend increase is also programmed to take effect 1 July 2008, raising the stipend to $1,907. As of 1 September, the projections for HPSP fills this year are still at approx 60%, 175 of 290 available slots.
This is a good opportunity to reiterate that BUMED funds a Speakers Bureau for Navy physicians who wish to travel in support of recruiting. Medical Officers who wish to assist local recruiters at their Alma Mater medical schools, undergraduate schools, pre-med clubs, etc. can be funded through BUMED. Interested Medical Officers should contact the Recruiting Office in the location they wish to visit, request TAD orders from their command, and receive accounting data from BUMED to cover travel and per diem costs. POC is CAPT Bloom. The Physician Recruiter Assistance section of the NKO Medical Corps website has been updated with presentations, FAQ&As and contact information relating to Medical Corps Accession Programs (HPSP), Navy GME and career information. This information is provided to assist Navy Medical Program Recruiters as well as the medical officers and others who are assisting with the recruiting efforts.

It's also a great opportunity to remind you that if you feel like you were mislead or even *gasp* out and out lied to as to what to expect with military medicine, you can go forth and tell your side of the story on the military's dime.

It is an undisputed fact that the people charged to your care are better served by people that want to be there and know what to expect. So instead of having a whole cadre of doctors disgruntled by the fantasties spun to them by military recruiters, why not get out there and make sure as many people as can be are...uh...gruntled?

 

[orbitsurgMD]

It's also a great opportunity to remind you that if you feel like you were mislead or even *gasp* out and out lied to as to what to expect with military medicine, you can go forth and tell your side of the story on the military's dime.

It is an undisputed fact that the people charged to your care are better served by people that want to be there and know what to expect. So instead of having a whole cadre of doctors disgruntled by the fantasties spun to them by military recruiters, why not get out there and make sure as many people as can be are...uh...gruntled?

A recruiter-sponsored liars club. What a great idea.

What exactly does "sponsored" mean, here? "Sponsored" as in you book your own travel, front your expenses and then wait for your local disbursement office to pay you back? Does it mean you have to read from a pre-approved presentation? Does it mean you will be able to answer questions frankly?

And what does this have to do with making education, training and practice better for Navy doctors anyway? Are they still stuck on the canard of "we don't have a medical corps problem, we have a perception problem?"

Would you have to ladle out Kool-Aid?

 

[IgD]

When I was a medical student I used to get newsletters saying GMOs were being phased out. My suggestion would be to remove GMOs from the doctrine and restructure the matching system to be compatible with the civilian world.

 

[West Side]

A recruiter-sponsored liars club. What a great idea.

What exactly does "sponsored" mean, here? "Sponsored" as in you book your own travel, front your expenses and then wait for your local disbursement office to pay you back? Does it mean you have to read from a pre-approved presentation? Does it mean you will be able to answer questions frankly?

And what does this have to do with making education, training and practice better for Navy doctors anyway? Are they still stuck on the canard of "we don't have a medical corps problem, we have a perception problem?"

Would you have to ladle out Kool-Aid?

Actually, I was being serious: if the military's willing to pay to get "real life doctors" out on the front lines of recruitment, why not take them up on their offer and tell prospective candidates the real dirt on the program? How your training has excellent chances of being interrupted. How the back-office functions and structures are light-years behind civilian facilities. How even as a top-scoring applicant, you have essentially no geographic control over your life for the next (minimum!) seven years after medical school.

Of course, if, as you say, you'll be forced to self-censor and read from an administration-approved script, then to hell with them. Hell, I'll pay for a few of you to go and spread the REAL gospel.

 

[IgD]

How even as a top-scoring applicant, you have essentially no geographic control over your life for the next (minimum!) seven years after medical school.

Does anyone in the military have "geographic control" of their life?

 

[DiveMD]

A recruiter-sponsored liars club. What a great idea.

What exactly does "sponsored" mean, here? "Sponsored" as in you book your own travel, front your expenses and then wait for your local disbursement office to pay you back? Does it mean you have to read from a pre-approved presentation? Does it mean you will be able to answer questions frankly?

And what does this have to do with making education, training and practice better for Navy doctors anyway? Are they still stuck on the canard of "we don't have a medical corps problem, we have a perception problem?"

Would you have to ladle out Kool-Aid?

I am sure that anyone who agrees to go out and recruit naïve medical students must also agree to provide selective information about the HPSP program. Remember, they want you to be a recruiter (liar) not a sympathetic peer looking out for the well being of your future colleagues. If your career goal is making O-6 and medicine is not in the top of you priority list then this program is for you.

 

[Galo]

Why are you guys thrashing military medicine. Have you not heard from army great A1qwerty that all is OK. All of you must individually have a personality problem, or are disgruntled, or wait, West side is not even in the military he's just some idiot that wants to lash out againt the military. There must be something going on in his world.

Wait I made a mistake. This is all NAVY, and a1qwerty represents the army where everything is just fine.

What a great observation that they still think this is a perception problem, not one of the medical corps.

 

[Homunculus]

you posted here just to pick a bone with with A1qwerty? he didn't even post on this thread, did he?

at least keep your petty bickering to one thread. don't infect the rest of the threads with it.

thanks.

--your friendly neighborhood gonna bring out the club caveman

 

[Perrotfish]

Why are you guys thrashing military medicine. Have you not heard from army great A1qwerty that all is OK. All of you must individually have a personality problem, or are disgruntled, or wait, West side is not even in the military he's just some idiot that wants to lash out againt the military. There must be something going on in his world.

Wait I made a mistake. This is all NAVY, and a1qwerty represents the army where everything is just fine.

What a great observation that they still think this is a perception problem, not one of the medical corps.

Sorry to disagree, but after hearing the concerns on this board I went out of my way to talk to as many post-military doctors as I could find, all of whom were out and had no particular reason to act positive. They generally painted a much rosier picture of military life than I've gotten here, and most of them said they would make the decision again. Also I talked to my recruiter for the first time today and he was up front with about the possibilities of GMO tours and the probability of getting various residencies, so I don't really feel lied to so far. I'm not saying he's right and you're wrong, but this board definitely isn't representive of the opinion I've gotten from a more random sample.

 

[Gastrapathy]

I am sure that anyone who agrees to go out and recruit naïve medical students must also agree to provide selective information about the HPSP program. Remember, they want you to be a recruiter (liar) not a sympathetic peer looking out for the well being of your future colleagues. If your career goal is making O-6 and medicine is not in the top of you priority list then this program is for you.

So, I was asked to do this by the recruiter for the area where I went to college. The deal is that BUMED pays for your travel and your command sends you no cost. I told the recruiter that I'd be happy to come talk but he needed to be prepared for me to be honest about my perspective and experience. The IM and IM subspecialty side of the house has never been anywhere near as bad off as the surgical side and I think I got good training based on my interactions with other GI fellows and IM housestaff during outservice rotations. So, I'm probably more what they have in mind than Galo. BUT, I deployed, I did a GMO, I'll almost certainly get out after my committment and my family gets their medical care outside our system. I told him to call me back in a week if he still wanted me to come out. That was a month ago.

 

[a1qwerty55]

I for one would answer questions honestly.
Can your training be interrupted? Yes (more likely for surgical subs, and for USN and USAF personnel)

If Bush starts a war with Iran, can you get killed - Yes

Will you earn less and work harder than your civilian colleages? Yes

Will the military go out of its way to express any thanks or appreciation for your service? No, and don't expect awards, as the military is notoriously skimpy with medical types.

Will you receive good training? Yes - in most cases - I do have concerns about surgical training programs.

Will you make a difference, i.e. help some 18 y.o. get back to his family, or maybe a 35y.o. with three kids make it back alive? Absolutely!

Will the military drive you crazy with administrative bullcrap? Yes

Will you look back on your service with satisfaction? I think so.

Should I take an HPSP scholarship, FAP, or USUHS? I think FAP as it gives you the most flexibility with training.
USUHS if you want to go career. Frankly I don't see any upside to HPSP.

Ultimately if you believe in something bigger than yourself, like your God, Country, Family, you will do well. If you are a self absorbed **** who is focused on #1, please, please avoid the military as you will hate it.

Lastly, 4 years of service matters, and in the big picture is what 5% of your life, and a learning opportunity.

Does anyone think they are going to call and ask me to recruit? Probably not but,, oh yes, per Galo, I'm already a recruiter.

 

[West Side]

I for one would answer questions honestly.
Can your training be interrupted? Yes (more likely for surgical subs, and for USN and USAF personnel)

Sure, if someone asks a specific question, but would you volunteer this information to prospective victims of your own volition? I think that's a significant distinction.

If Bush starts a war with Iran, can you get killed - Yes

Really? The current conflicts in Iraq/Afghanistan can't get you killed?

Will you receive good training? Yes - in most cases - I do have concerns about surgical training programs.

Given how many people have to do GMOs in the current environment, I think it's only fair that you consider that to be a part of "training". While many can honestly say it allows them to mature as doctors for the rest of their residency, every one mentions how their skills atrophy. Would you still say a GMO-interrupted residency qualifies as good training?

Will you make a difference, i.e. help some 18 y.o. get back to his family, or maybe a 35y.o. with three kids make it back alive? Absolutely!

And this is different from civilian medicine how?

Ultimately if you believe in something bigger than yourself, like your God, Country, Family, you will do well. If you are a self absorbed **** who is focused on #1, please, please avoid the military as you will hate it.

So every doctor that doesn't go into the military and hypothetically would hate putting up with all the BS in the military is a self-absorbed a-hole? All of them are in it for the money and ego massage? Do you not see the inherent flaw in your arguement? I'm sure you're going to say I'm putting words in your mouth, but given your body of work on this forum, I suspect I'm not.

Lastly, 4 years of service matters, and in the big picture is what 5% of your life, and a learning opportunity.

Well, given how few get deferrals, your service starts at the start of residency. It's closer to 10% of your life. Still sound like a good deal?

Does anyone think they are going to call and ask me to recruit? Probably not but,, oh yes, per Galo, I'm already a recruiter.

I rebut some of your points above. Bolds are mine.

 

[mitchconnie]

Sorry to disagree, but after hearing the concerns on this board I went out of my way to talk to as many post-military doctors as I could find, all of whom were out and had no particular reason to act positive. They generally painted a much rosier picture of military life than I've gotten here

this board definitely isn't representive of the opinion I've gotten from a more random sample.

Periodically someone on this board asserts that this forum is “too negative” and “not representative of the majority of military doctors.” I disagree. I feel it is almost exactly representative of the varied opinions of CURRENT physicians within all three branches of the armed forces. I look on the board and see the same types of characters and opinions that I hear in the hospital hallways and clinics every day.

You’ve got a few idealists, mostly newcomers or career guys, who seem to deny that any problems exist.

There are a few truly bitter folks who have been screwed over by the military with bogus investigations, prolonged GMO tours, or really horrendous practice situations.

And there are the vast majority in the middle who believe in service to the country and are generally proud to be in the military, but are quite dismayed over the recent decline in military medicine. Most are not bitter, just struggling to make the best of a bad situation and move on with their lives when their commitment is over.

I think most people on this board, like most people in my hospital, fall into the latter category and I would describe the overall mood as grim resignation punctuated by occasional bouts of bitterness.

You won’t find too many HPSP boosters on this board, but I don’t think you’ll find too many in the hospitals either. I think SDNF is the most representative sample out there--certainly better than a bunch of docs that got out before the current downturn, or some current AD docs that a recruiter puts you in touch with.

 

[Perrotfish]

You won’t find too many HPSP boosters on this board, but I don’t think you’ll find too many in the hospitals either. I think SDNF is the most representative sample out there--certainly better than a bunch of docs that got out before the current downturn, or some current AD docs that a recruiter puts you in touch with

First I didn't get in contact with those doctors through a recruiter, I'm not an idiot. I will admit though, that they weren't in the military in the past few years. Neither however, were they ancient WWII docs, they had mostly been at the tail end of their service for Gulf War I. Now I am interested in how you feel military medicine has declined since then. I'm not talking about the wartime stuff, I mean general systematic problems that would still be there if we declared peace tomorrow. Anything about the Navy, specifically, would be very helpful.

 

[DiveMD]

First I didn't get in contact with those doctors through a recruiter, I'm not an idiot. I will admit though, that they weren't in the military in the past few years. Neither however, were they ancient WWII docs, they had mostly been at the tail end of their service for Gulf War I. Now I am interested in how you feel military medicine has declined since then. I'm not talking about the wartime stuff, I mean general systematic problems that would still be there if we declared peace tomorrow. Anything about the Navy, specifically, would be very helpful.

AHLTA!!!

MSC ADMIN TYPES!!!

GMO TOURS!!!

GMT!!!

 

[Perrotfish]

AHLTA!!!

MSC ADMIN TYPES!!!

GMO TOURS!!!

GMT!!!

I have heard about the AHLTA disaster. I don't know what GMT means (unless you mean the time in Greenwich). As for GMO and the admin thing, my impression was that those had been around since the Korean War, and in the case of the GMOs are getting better rather than worse. Are GMOs more recent than I realized?

 

[Gastrapathy]

First I didn't get in contact with those doctors through a recruiter, I'm not an idiot. I will admit though, that they weren't in the military in the past few years. Neither however, were they ancient WWII docs, they had mostly been at the tail end of their service for Gulf War I. Now I am interested in how you feel military medicine has declined since then. I'm not talking about the wartime stuff, I mean general systematic problems that would still be there if we declared peace tomorrow. Anything about the Navy, specifically, would be very helpful.

Military medicine has changed vastly from that era. Its hard to even put it into context. The birth of TRICARE, the subsequent changes in patient population, mission and retention, the closure and semiclosure (which is worse) of countless facilities and...well, we can all go on.

Just one anecdote. I had dinner recently with a former military anesthesia department head of that era. He told me that when he had a new attending arrive, he would sit the newbie down and say that while he couldn't make up for the lost salary in $$, he could make it up in time. If they weren't deployed, he made darn sure they had time for family and moonlighting. That kind of thinking is absolutely gone. Now we expect doctors to be doctors, nurses, secretaries and more while CONUS.

Frankly, that era of military medicine is the reason I'm in the military. And, this is a different ballgame all together.

 

[mitchconnie]

I will admit though, that they weren't in the military in the past few years. Neither however, were they ancient WWII docs, they had mostly been at the tail end of their service for Gulf War I.

Military medicine has changed vastly from that era. Its hard to even put it into context. The birth of TRICARE, the subsequent changes in patient population, mission and retention, the closure and semiclosure (which is worse) of countless facilities and...well, we can all go on.

Seeking out the advice of physicians who got out of the military in the early-mid 90's would be a critical error. As noted by Gastropathy, things are vastly different today, and by comparison the early 90's seems like a golden age of military medicine. I joined in 1992 and started residency in 1996, and have personally observed the downturn.

And it's not just about the war and deployments, the whole culture of military medicine seems different. In addition to the problems mentioned by Gastropathy, I would add loss of physician control, stagnant compensation, dramatic drop in support staff, and increased administrative burdens.

When I signed up, the recruiters really didn't have to lie (much), because there really was "time for family" and "world-class facilities" and "modern equipment" and "great training opportunities" and so on. Sure, there was still some of the military BS in 1994, but there was also a lot more on the positive side 10 or 15 years ago.

 

[gastrodoc]

When I signed up, the recruiters really didn't have to lie (much), because there really was "time for family" and "world-class facilities" and "modern equipment" and "great training opportunities" and so on. Sure, there was still some of the military BS in 1994, but there was also a lot more on the positive side 10 or 15 years ago.

Could not agree more. The changes since the mid 90's are overwhelming, and all for the worse. I seriously cannot think of one thing that's gotten better.

On a side note, Westside was asking how saving an 18 yo guy or getting a 35 yo with some kids back to their families was different than a civillian; We're here, where the fighting is. There are no civillian medical providers here. And as much as I hate being deployed and am disillusioned/disappointed in the military at the moment, this IS the job. This IS why they pay/train us. Now if we could just get them to care a little and try to retain us...

 

[TX_NFS]

Great info, DiveMD. Is this document (and other stuff like it) available through NAVMED's website?

About 13.) and the FY-08 Accession Goals: I know there has been some repeated advice from posters here that "FAP > HPSP" if one really wants to serve. I know this has already been glossed over in the FAP thread, but just 20 FAP positions for the coming year? The scarcity of these positions compared to HPSP and what I consider another 'match' (needs of a service for a specialty with the speciality one chooses) makes me wonder how applicable FAP would be to a majority of doctors. Ditto for the 20 'Direct Accession' positions (which I hope means recruiting already residency-trained civilian docs).

Lastly, as to which docs to contact in milmed for questions, if one were to assume that active-duty docs are not willing to give a bare assessment of their experiences and "way-back-when" prior-service docs' experiences don't apply, what is a pre-med to do? Rely on the colorful posts on this board only? Try a brute-force approach and call/email every single doctor around me to ask if they've just separated?

 

[West Side]

On a side note, Westside was asking how saving an 18 yo guy or getting a 35 yo with some kids back to their families was different than a civillian; We're here, where the fighting is. There are no civillian medical providers here. And as much as I hate being deployed and am disillusioned/disappointed in the military at the moment, this IS the job. This IS why they pay/train us. Now if we could just get them to care a little and try to retain us...

I'm not trying to denigrate the work you or soldiers do. Just trying to draw close parallels between the work you do trying to save the life of a soldier and the work a civilian doctor does trying to save the life of a construction worker hurt on the job, or a person injured in a car accident with a drunk driver, or millions of other examples. You're all trying to do the same thing: send people home healthy. This only draws into sharper focus the disparity in compensation and general appreciation for your work and talents.

 

[The White Coat Investor]

I'm not saying he's right and you're wrong, but this board definitely isn't representive of the opinion I've gotten from a more random sample.

I am deployed with 6 other physicians. ALL agree with the general tone of this board. Ortho, surgery, FP, flight medicine, EM, and IM. All will be getting out ASAP. Don't be too quick to dismiss the opinions here. The random sample I got prior to signing up was also positive about their past experience, but military medicine is very different now than even 5 or 10 years ago, and not in a positive direction.

 

[DiveMD]

I have heard about the AHLTA disaster. I don't know what GMT means (unless you mean the time in Greenwich). As for GMO and the admin thing, my impression was that those had been around since the Korean War, and in the case of the GMOs are getting better rather than worse. Are GMOs more recent than I realized?

GMT= General Military Training: Useless on-line courses that are mandated by Big Navy. Soon enough you'll know all about it.

 

[DiveMD]

Great info, DiveMD. Is this document (and other stuff like it) available through NAVMED's website?

Not sure. I usually get this stuff in my navy e-mail account.

 

[Roshario]

Great info, DiveMD. Is this document (and other stuff like it) available through NAVMED's website?

I know this newsletter is on NKO.