Got my DD214 prematurely. What to do now? (Psych + others)

[Fluidity of Movement]

UPDATE / EDIT:
Thanks to everyone for their concern and wonderful advice. I'm feeling a lot better now, and more well informed. I apologize if my post was a bit too narrow concerning civ psychiatry. I have no ill-will against it, and am very aware that it is not just 15 minute sessions. I've left the original post for reference:


Greetings,
I am a pre-medical student that was recently discharged from the ARNG. I had completed many pre-bct drills and was about to be sent to AIT when discovered I had a minor medical condition (keratoconus) and was discharged with a 3 just before one year of TIS.

I enlisted, with hopes to commission with matriculation into medical school after my 6 years. I was devastated by my DD214, as I was specifically checked for the condition at MEPS, yet apparently the doc there didn't diagnose me correctly.

I'm still a pre-medical student, after much deliberation, yet I'm unsure of what the future holds for me as far as how I will practice (assuming I can get into med school). I really wanted to work as a psychiatrist, as civilian psychiatry has many issues and problems that put me off. I was just wondering what my options were as a civilian to potentially work for the military and see service-members, since I doubt that the conditon will be waiverable anytime soon.

I know there is the VA, and I saw some civvies on base in the active troop clinic, but I was wondering what the actual job was like, and how it differs when in uniform. I had wanted to have a lot of time for talk therapy and regular visits and still be in charge of medication. Also, if civilians were taken into war zones. Any other general advice / encouragement is welcome as well.

Thank you all for reading. I really appreciate it.

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[NavyFP]

Hard to say without knowing the condition, but code 3 means it is waiverable. When it is time to join apply. Worst they will say is no.

 

[notdeadyet]

I'm curious what the "many issues and problems" that put you off to civilian psychiatry are that you feel you won't have in Army psychiatry?

 

[Fluidity of Movement]

Hard to say without knowing the condition, but code 3 means it is waiverable. When it is time to join apply. Worst they will say is no.

Keratoconus, a progressive eye disease that slowly makes your vision worse. It's common knowledge in the affected's circle that waivers aren't given for this, unless you can prove that the condition is gone or is getting better (which it cant, as there is no FDA accepted treatment for it, and it can't get better on it's own). There have even been a few news programs covering it. It's ridiculous because most people don't have issues with it, and corrective lenses typically work well until old age. There is also a cure for it, but it is not an FDA accepted treatment, so the military won't recognize it.

I'm curious what the "many issues and problems" that put you off to civilian psychiatry are that you feel you won't have in Army psychiatry?

The single biggest reason is that (from my research and personal experiences) civ psych has shifted mostly towards 15 minute pill calls, with psycotherapy reserved for the psychologists/other mental health professionals. Thus, a tag team is formed, and it works well. But I am interested in doing both, without having to go into private practice and then only able to see patients that can afford the premium compared to a psychologist.

I'm not saying that civilian side is something I'm not interested in, or that milmed would be ideal, but the cost factor alone is a huge incentive alone for people to come, or if someone was assigned to me, I know that I would be given the time and resources to work with them. Obviously everything depends on where stationed, and everything I mentioned above probably doesn't exist in some (or maybe even most) of them.

I'll leave out the obvious reasons that go alongside wanting to serve in the military.

 

[backrow]

Keratoconus, a progressive eye disease that slowly makes your vision worse. It's common knowledge in the affected's circle that waivers aren't given for this, unless you can prove that the condition is gone or is getting better (which it cant, as there is no FDA accepted treatment for it, and it can't get better on it's own). There have even been a few news programs covering it. It's ridiculous because most people don't have issues with it, and corrective lenses typically work well until old age.

Except it's not ridiculous as many require hard contact lenses to correct the irregular astigmatism from keratoconus. Contact lenses are not approved for wear in many deployed settings, so one would have to wear spectacles which would likely not produce the best vision for many keratoconus patients. When setting global policy these are the things the military looks at. Now, physicians have a lower threshhold for waiver approval in my experience so just because one won't get a waiver for a condition as a line officer/infantrayman/etc doesn't mean they wouldn't get one to come in as a physician.

There is also a cure for it, but it is not an FDA accepted treatment, so the military won't recognize it.

Just because a treatment is not FDA approved doesn't mean the military won't do it/support it/recognize it. I think collagen crosslinking is well known for keratoconus and well accepted in Europe. It is only a matter of time before it is FDA approved. I know of at least a few places (non-military) that perform the procedure in the U.S. I have no clue how the military would look at someone with a history of ectasia and had collagen cross-linking. My guess is that it would be individually reviewed by a cornea specialist.

 

[Mad Jack]

The single biggest reason is that (from my research and personal experiences) civ psych has shifted mostly towards 15 minute pill calls, with psycotherapy reserved for the psychologists/other mental health professionals. Thus, a tag team is formed, and it works well. But I am interested in doing both, without having to go into private practice and then only able to see patients that can afford the premium compared to a psychologist.

I'm not saying that civilian side is something I'm not interested in, or that milmed would be ideal, but the cost factor alone is a huge incentive alone for people to come, or if someone was assigned to me, I know that I would be given the time and resources to work with them. Obviously everything depends on where stationed, and everything I mentioned above probably doesn't exist in some (or maybe even most) of them.

I'll leave out the obvious reasons that go alongside wanting to serve in the military.

I think you have a very skewed view of psychiatry. You should post a bit in the psych forums to re-evaluate if your reasoning is correct in regard to psychiatry, as cash-only solo psych can give you far more control over your working conditions, treatment options, and patient panel.

Also keep in mind that you'll likely have to do a military residency in psych if you do a military scholarship. This will give you a far narrower patient population and exposure to psychopathology than doing a civilian residency. I would highly encourage you to do the NHSC route (no debt, 4 year payback of working in an underserved area) rather than the military route unless you absolutely want to serve and spend the majority of your life working with military personnel.

 

[Fluidity of Movement]

Thanks to everyone for their posts. I have a lot more to think about and consider, and some research to do as well.

Except it's not ridiculous as many require hard contact lenses to correct the irregular astigmatism from keratoconus. Contact lenses are not approved for wear in many deployed settings, so one would have to wear spectacles which would likely not produce the best vision for many keratoconus patients. When setting global policy these are the things the military looks at. Now, physicians have a lower threshhold for waiver approval in my experience so just because one won't get a waiver for a condition as a line officer/infantrayman/etc doesn't mean they wouldn't get one to come in as a physician.

Just because a treatment is not FDA approved doesn't mean the military won't do it/support it/recognize it. I think collagen crosslinking is well known for keratoconus and well accepted in Europe. It is only a matter of time before it is FDA approved. I know of at least a few places (non-military) that perform the procedure in the U.S. I have no clue how the military would look at someone with a history of ectasia and had collagen cross-linking. My guess is that it would be individually reviewed by a cornea specialist.

I had suspected in the back of my mind that medical officers may have different waiverable thresholds, but I have been too distraught the last few months in dealing with trying to get back in as enlisted that I completely repressed that thought.

I think you have a very skewed view of psychiatry. You should post a bit in the psych forums to re-evaluate if your reasoning is correct in regard to psychiatry, as cash-only solo psych can give you far more control over your working conditions, treatment options, and patient panel.

Also keep in mind that you'll likely have to do a military residency in psych if you do a military scholarship. This will give you a far narrower patient population and exposure to psychopathology than doing a civilian residency. I would highly encourage you to do the NHSC route (no debt, 4 year payback of working in an underserved area) rather than the military route unless you absolutely want to serve and spend the majority of your life working with military personnel.

This is a very interesting idea. Get through school without debt, and then open a practice that charges pennies to keep the lights on. I had planned on doing something like this on a larger scale after or near retirement, only on a larger scale, funded by whatever I had made throughout the years.

I didn't mean to insult psychiatry. I know there a lot of different settings (hospitals, rehab centers, etc) for them; I was referencing the type of practice I was most interested in, and some of the negative trends (in my desires for what I want to do) with it in the civilian world.

 

[jabreal00]

The single biggest reason is that (from my research and personal experiences) civ psych has shifted mostly towards 15 minute pill calls, with psycotherapy reserved for the psychologists/other mental health professionals. Thus, a tag team is formed, and it works well. But I am interested in doing both, without having to go into private practice and then only able to see patients that can afford the premium compared to a psychologist.

I'm not saying that civilian side is something I'm not interested in, or that milmed would be ideal, but the cost factor alone is a huge incentive alone for people to come, or if someone was assigned to me, I know that I would be given the time and resources to work with them. Obviously everything depends on where stationed, and everything I mentioned above probably doesn't exist in some (or maybe even most) of them.

I'll leave out the obvious reasons that go alongside wanting to serve in the military.

If you are not interested in only pushing pills, don't join the military. The military has a plethora of active duty and civilian psychologist and licensed clinical social workers who actually provide the psychotherapy. From my experience psychiatrist are just reduced to initial assessments, pushing pills, adjusting medications with minimal to no psychotherapy.

 

[notdeadyet]

You would have a lot more opportunity to practice the kind of psychiatry you want in the civilian world. If you don't like your working environment, you just change employers. Or you hang your own shingle and do what you want. Many private psychiatrists do a combination of psychotherapy and medication management.

You also would be able to do a civilian psychiatry residency. Aside from having more of them to choose from and therefore having a much better chance of a good fit, you just get a more diverse patient base. The drawback with lots of the military medical training is that we tend to discharge folks who have chronic conditions that make them unfit. This is particularly problematic for psychiatry since the most challenging cases are the chronic illnesses. You'll get psychotic breaks in the military, but they're easily managed. You want to handle a panel of chronic schizophrenia ten to thirty years after that break.

I'd suggest learning more about the career options in psychiatry, what psychiatrists do, and spend more time investigating before signing up. From your perception of civilian psychiatry as being 15 minute medication management visits, I'm concerned you don't know enough about the field to make an informed choice right now.

 

[Fluidity of Movement]

You would have a lot more opportunity to practice the kind of psychiatry you want in the civilian world. If you don't like your working environment, you just change employers. Or you hang your own shingle and do what you want. Many private psychiatrists do a combination of psychotherapy and medication management.

You also would be able to do a civilian psychiatry residency. Aside from having more of them to choose from and therefore having a much better chance of a good fit, you just get a more diverse patient base. The drawback with lots of the military medical training is that we tend to discharge folks who have chronic conditions that make them unfit. This is particularly problematic for psychiatry since the most challenging cases are the chronic illnesses. You'll get psychotic breaks in the military, but they're easily managed. You want to handle a panel of chronic schizophrenia ten to thirty years after that break.

I'd suggest learning more about the career options in psychiatry, what psychiatrists do, and spend more time investigating before signing up. From your perception of civilian psychiatry as being 15 minute medication management visits, I'm concerned you don't know enough about the field to make an informed choice right now.

Thank you so much for post. I really appreciate it. I will give a lot of though to what you and the others of have said. However, I do have a general idea of how civ psychiatry works, and I didn't mean to imply that it was (as a whole) 15 minute pill calls. Just that there has been a trend lately, especially for poor people or people with minimum insurance, to see psychologists and LCSW over having one person to do both since it costs more. And that the time with PTs that psychs have seems to be getting lower and lower (as all doctors are noticing), due to financial reasons , (either in hospital or in private practice) as well as the physician shortages coupled with ever growing PT base

 

[trev5150]

I was Dxd with KC by a Navy optometrist and confirmed by the Optho dept chair at Balboa Naval Hospital 15 years ago. At that time there were no fixes, no options.

As of today I am 1-week post-op after Intacs, conductive keratoplasty and corneal collagen crosslinking with riboflavin (epithelial layer on).

I don't know why you got discharged. I finished my enlistment, kept my flight physical and deployed for the push into Iraq in 2003. I surmise they just bounced you for the convenience of the service?. That makes sense since they didn't have a lot invested in your training ( read: they hadn't spent a lot of money on you yet). I was a flight instructor in a critically short MOS and still able to do my job.

Your chief concern should be to get the disease under control before it progresses too deeply, because the end state is invariably cornea transplantation. Leading up to that you're going to have problems with contacts - I wore FlexLens XCL and they were a medieval torture device only when I absolutely had to. Soon, glasses won't get you even close to 20/20, if you aren't there already. The star bursts and flares from the refractive errors in your cornea will be distracting. You will begin to find ways to accommodate your inability to see well. You will miss street signs. You will have to stop and turn around. You will adapt.

It took 15 years to be in a position where the options would be there and I could get it dealt with. I'm telling you that you don't want to wait that long. Take care of this first before you get too wrapped around the axle about what your career trajectory is actually going to look like.

 

[trev5150]

You probably didn't get discharged because your doctors didn't know what they were doing. I discharged two Marines for this condition while I was a GMO.

Why? Were they very unstable? Even the FAA will let you keep flying with KC if you're stable. Keratoconus is not a disqualifying condition. Did you bounce two Marines for no good reason?
Or was it two dudes that had no problem taking the option of GTFO?
Actually I'm rounding off. By 15 years ago I mean 13 years, 8 months ago - right after 9/11. The eye exam where the optometrist at MCAGCC was part of my September birth month flight physical. I'm willing to bet good money that drug deals were done in the background to keep me on. By critically short I mean we were at 50% manning for pilots across both squadrons and looking at deploying on a short fuse. Personnel actions that didn't say stop-loss at the top were frozen. Whatever thoughts of discharging me were probably circular filed quick, fast and in a hurry.

 

[trev5150]

That sucks. At that point my KC was barely detectable an I was still correctable with glasses to an acceptable level to continue to fly. Hard contacts - or contacts of any kind - were not offered.

I did wear flex lens contacts later on, multi focal custom made contacts ($400 a set), but they weren't gas permeable and torture after a few hours. I have two grand worth of now-useless contacts that I have to toss out.

I would reiterate that I was a UAV guy - not actual enlisted manned aircrew. No flight suit, wings or white scarf.

 

[trev5150]

Fair enough. You don't want to to TIC and suddenly have a sudden transient blurry patch.

 

[backrow]

Hard contacts are not permitted in a combat zone, for really excellent reasons. .

Except for air crew

 

[backrow]

Nobody cares about zoomies.

Until they need that CAS...

 

[ArmyTiger]

Until they need that CAS...

The Navy has pilots who actually want to do CAS, though. The Air Force is still trying to beat Top Gun.

 

[trev5150]

Air Support - Plan For It, But Don't Count On It