All Branch Topic (ABT) HPSP, Just don't do it.

[fishbulb999]

Hi all
I am writing this in the hope that I can save just one person from joining the military medical complex. I am writing you after being out for 18 months after 15 years of service. Yes, I was a surgeon. Yes, I deployed. I worked smaller MEDDACs and MTF.
PROS
You work with the finest American patients. They are men and women who have or are serving our country at a time where it is not fashionable to do so. The sacrifice much, if not all for their brothers and sisters and serving them will always be something I am proud of. That's it. That's all the pros.
CONS
The system is hopelessly broken. In the 80s, with unlimited money and CHAMPUS insurance there were patients. Surgeons operated, residents trained and students learned. Now, Elvis has left the building.
VOLUME
Volumes are at historic lows. There are no good plans to force patients back into the system. Osler once said "To perform medicine without texts is to sail to the sea without maps, to perform medicine without patients is to go to sea without a ship"
This is not hyperbole, the numbers are well known and available. The average general surgeon, even at a major MTF is doing 12 or so x laps a year. Yes, that is 12 MIDLINE INCISIONS TO GET INTO THE BELLY. Perhaps 40 to 60 total cases is not common. Complex cases are nearly unheard of. Deployed surgeons may operate 4 times in six months. Chief residents at even the largest "flagship" institutions are in the bottom 5% of case volume. They are triple scrubbing hernias. I have seen it. They are bullied by a "chain of command" and terrified to say anything for (well founded) fear of reprisal. Please look at the data for military medicine volume. It is out there for all to see. Ask and press your recruiter on this point. Challenge the answers and demand hard data.
TRAINING
Nearly all of the complex procedures are done at outside rotations. Senior surgeons with invaluable experience are leaving when their obligations are up. Subspecialists are massively below minimal safety requirements for case volume across all disciplines. Example, ZERO MTFs meet the minimum number of heart bypass numbers. ZERO. Experienced surgeons are as rare as hen’s teeth. Most Colonels are sitting around doing paperwork and are the least productive members of the chain. The only people doing procedures are massively green, surgeons who are far too inexperienced to actually train residents and fellows. So, you may watch operations, you will not do them. Your intern year will be spent learning paperwork and doing the social workers job so that social workers can sit in an office and do nothing. I did 11 cases as an intern. That was 17 years ago. Think it’s better?
Want to go to a conference, haha. NO. The military is not paying for CME at this point. I went to one, two day conference in the six days of my residency. I did not even really know what a conference was until a friend training civilian asked me to go to the ACS. They may occasionally say they will pay, but the red tape they put up makes it easier to pay on your own.
SUPPORT
As to support, leadership is utterly useless. They are aware of the problem but are helpless to fix it. They continue to put pie in the sky solutions forward only to preserve their leadership positions as they have no chance of survival in a competitive civilian environment. The civilian support consists of an impenetrable government union bureaucracy which exists to do as little as possible and protect its members from work. The fate of the union is not tied to output of the organization. One more patient in the civilian setting is the difference between keeping the lights on and not. Ten more patients in the military is just more work. They are vastly more concerned about updating facebook than taking care of a busy desk. Try to challenge it.... well..... good luck and get ready for harassment suits against you, personally.
Nursing and MSC (medical support) now run the institutions. The set the rules and determine who gets promoted and make no mistake, they do not like you. They exist to "put docs in their place". I would encourage you to ask about promotion rates to LTC and COL. They are dropping like stones. Where they were once 90+ percent now they are 60 for LTC and as low as 30 for COL. So, no full bird for you.
MILITARY TRAINING
Even so, you will be required to waste your valuable training time on endless required computer modules. (human trafficking, car maintaince, alcohol training, moral training, escape and evade, cyber security, winter safety, fall safety, summer safety, why not to light your x mas tree on fire....... yes, they are all real and you will be doing them) Ask about captains career course and the required 6 months of ILE. Yes, that's six months where you’re not touching patients. All to learn about the army and tactical medicine. I am sure your patients are concerned about that when your operating on their carotid arteries. I suppose the intent is to "train leaders" but your training should and must only consist of patient care. Mom and Dad do NOT care if you know the difference between a squad and platoon. They only care that you can find and control a bleeding portal vein. End.
SUMMARY
Guys, take this for what it is. It makes me sick to see what has happened to military medicine. It was once run by physicians who only wanted to operate, train and do good work. Now patients have left and are not coming back. Nurses and MSC make the calls and the rules. They cannot understand the trust and bond between a doctor and patient. How can they?
If you want to be a doctor then eat the loans and be a doctor. If you want to help soldiers then by all means train civilian and join the reserves, these soldiers need better than what is being provided to them. If you want to be an officer and then, secondarily a doctor, if you want to fear any complex procedure, if you want to become a part of an organization whose sole mission is no longer patient care but sustainment of a massive bureaucracy then sign up.
But remember, you must make a decision. Do you want to maximize your potential and tell your patients that no matter what the outcome, you have the experience and training to do the job right? Or, do you want to tell them that you trained in a system that values rules, regulations, and meaningless bull**** over patient care.
I wish you the best and I sincerely hope this helps.

---

Members don't see this ad.

 

[colbgw02]

whoa boy...some of that gave me flashbacks. so glad to have that organization getting smaller in the rear-view mirror.

 

[fishbulb999]

Hi all
I am writing this in the hope that I can save just one person from joining the military medical complex. I am writing you after being out for 18 months after 15 years of service. Yes, I was a surgeon. Yes, I deployed. I worked smaller MEDDACs and MTF.
PROS
You work with the finest American patients. They are men and women who have or are serving our country at a time where it is not fashionable to do so. The sacrifice much, if not all for their brothers and sisters and serving them will always be something I am proud of. That's it. That's all the pros.
CONS
The system is hopelessly broken. In the 80s, with unlimited money and CHAMPUS insurance there were patients. Surgeons operated, residents trained and students learned. Now, Elvis has left the building.
VOLUME
Volumes are at historic lows. There are no good plans to force patients back into the system. Osler once said "To perform medicine without texts is to sail to the sea without maps, to perform medicine without patients is to go to sea without a ship"
This is not hyperbole, the numbers are well known and available. The average general surgeon, even at a major MTF is doing 12 or so x laps a year. Yes, that is 12 MIDLINE INCISIONS TO GET INTO THE BELLY. Perhaps 40 to 60 total cases is not common. Complex cases are nearly unheard of. Deployed surgeons may operate 4 times in six months. Chief residents at even the largest "flagship" institutions are in the bottom 5% of case volume. They are triple scrubbing hernias. I have seen it. They are bullied by a "chain of command" and terrified to say anything for (well founded) fear of reprisal. Please look at the data for military medicine volume. It is out there for all to see. Ask and press your recruiter on this point. Challenge the answers and demand hard data.
TRAINING
Nearly all of the complex procedures are done at outside rotations. Senior surgeons with invaluable experience are leaving when their obligations are up. Subspecialists are massively below minimal safety requirements for case volume across all disciplines. Example, ZERO MTFs meet the minimum number of heart bypass numbers. ZERO. Experienced surgeons are as rare as hen’s teeth. Most Colonels are sitting around doing paperwork and are the least productive members of the chain. The only people doing procedures are massively green, surgeons who are far too inexperienced to actually train residents and fellows. So, you may watch operations, you will not do them. Your intern year will be spent learning paperwork and doing the social workers job so that social workers can sit in an office and do nothing. I did 11 cases as an intern. That was 17 years ago. Think it’s better?
Want to go to a conference, haha. NO. The military is not paying for CME at this point. I went to one, two day conference in the six days of my residency. I did not even really know what a conference was until a friend training civilian asked me to go to the ACS. They may occasionally say they will pay, but the red tape they put up makes it easier to pay on your own.
SUPPORT
As to support, leadership is utterly useless. They are aware of the problem but are helpless to fix it. They continue to put pie in the sky solutions forward only to preserve their leadership positions as they have no chance of survival in a competitive civilian environment. The civilian support consists of an impenetrable government union bureaucracy which exists to do as little as possible and protect its members from work. The fate of the union is not tied to output of the organization. One more patient in the civilian setting is the difference between keeping the lights on and not. Ten more patients in the military is just more work. They are vastly more concerned about updating facebook than taking care of a busy desk. Try to challenge it.... well..... good luck and get ready for harassment suits against you, personally.
Nursing and MSC (medical support) now run the institutions. The set the rules and determine who gets promoted and make no mistake, they do not like you. They exist to "put docs in their place". I would encourage you to ask about promotion rates to LTC and COL. They are dropping like stones. Where they were once 90+ percent now they are 60 for LTC and as low as 30 for COL. So, no full bird for you.
MILITARY TRAINING
Even so, you will be required to waste your valuable training time on endless required computer modules. (human trafficking, car maintaince, alcohol training, moral training, escape and evade, cyber security, winter safety, fall safety, summer safety, why not to light your x mas tree on fire....... yes, they are all real and you will be doing them) Ask about captains career course and the required 6 months of ILE. Yes, that's six months where you’re not touching patients. All to learn about the army and tactical medicine. I am sure your patients are concerned about that when your operating on their carotid arteries. I suppose the intent is to "train leaders" but your training should and must only consist of patient care. Mom and Dad do NOT care if you know the difference between a squad and platoon. They only care that you can find and control a bleeding portal vein. End.
SUMMARY
Guys, take this for what it is. It makes me sick to see what has happened to military medicine. It was once run by physicians who only wanted to operate, train and do good work. Now patients have left and are not coming back. Nurses and MSC make the calls and the rules. They cannot understand the trust and bond between a doctor and patient. How can they?
If you want to be a doctor then eat the loans and be a doctor. If you want to help soldiers then by all means train civilian and join the reserves, these soldiers need better than what is being provided to them. If you want to be an officer and then, secondarily a doctor, if you want to fear any complex procedure, if you want to become a part of an organization whose sole mission is no longer patient care but sustainment of a massive bureaucracy then sign up.
But remember, you must make a decision. Do you want to maximize your potential and tell your patients that no matter what the outcome, you have the experience and training to do the job right? Or, do you want to tell them that you trained in a system that values rules, regulations, and meaningless bull**** over patient care.
I wish you the best and I sincerely hope this helps.

whoa boy...some of that gave me flashbacks. so glad to have that organization getting smaller in the rear-view mirror.

Damn Straight. Should have a support group for x military docs.

 

[HighPriest]

strikingly accurate. I often feel like most of the hospital command is of the opinion that if they could just not have to deal with doctors, things would be right where they want them to be. Some sugar coat that more than others.

 

[Atlas Shrugged]

Holy ****. I've already signed my young life away, but this is bleak. Hopefully AMEDD and milmed in general shapes up. The Air Force Medical Corps is currently dying, and I'm very happy I didn't commission into that service. But if we're all doomed I'm in a terrible position. Military GME still exists, but if it is on it's way out in totality, I'm screwed.

 

[WernickeDO]

Holy ****. I've already signed my young life away, but this is bleak. Hopefully AMEDD and milmed in general shapes up. The Air Force Medical Corps is currently dying, and I'm very happy I didn't commission into that service. But if we're all doomed I'm in a terrible position. Military GME still exists, but if it is on it's way out in totality, I'm screwed.

Match to a specialty, get all the training you can, hope for some luck that you avoid a Brigade Surgeon job, and GTFO ASAP. Pray you don't end up in GMO land.

 

[fishbulb999]

Holy ****. I've already signed my young life away, but this is bleak. Hopefully AMEDD and milmed in general shapes up. The Air Force Medical Corps is currently dying, and I'm very happy I didn't commission into that service. But if we're all doomed I'm in a terrible position. Military GME still exists, but if it is on it's way out in totality, I'm screwed.

Your not doomed. I was where you were once. My mistake was signing on for surgery and doing a fellowship. Just do your time, get out ASAP, never never never sign an extension. Then, get your advanced training when your obligation is up. That way you can get the benefit, serve your country and not commit yourself to 15 years or more. You will still be plenty young enough to do a residency in whatever you want.

 

[Gastrapathy]

Holy ****. I've already signed my young life away, but this is bleak. Hopefully AMEDD and milmed in general shapes up. The Air Force Medical Corps is currently dying, and I'm very happy I didn't commission into that service. But if we're all doomed I'm in a terrible position. Military GME still exists, but if it is on it's way out in totality, I'm screwed.

So not to be a dick, but you were on this board in 2013 and this message is nothing new. The cast of characters making the argument slowly changes over time but the message hasn't changed in a decade. You even told someone else not to sign up. You signed up anyway. So now go do your part. Things may be marginally worse but really its just that individual's perspective's change once they've been through it. The stickies talk about the suck going back to 2004. Couple years too late for me.

 

[Perrotfish]

Your not doomed. I was where you were once. My mistake was signing on for surgery and doing a fellowship. Just do your time, get out ASAP, never never never sign an extension. Then, get your advanced training when your obligation is up. That way you can get the benefit, serve your country and not commit yourself to 15 years or more. You will still be plenty young enough to do a residency in whatever you want.

Is your username a Simpsons reference?

 

[fishbulb999]

So not to be a dick, but you were on this board in 2013 and this message is nothing new. The cast of characters making the argument slowly changes over time but the message hasn't changed in a decade. You even told someone else not to sign up. You signed up anyway. So now go do your part. Things may be marginally worse but really its just that individual's perspective's change once they've been through it. The stickies talk about the suck going back to 2004. Couple years too late for me.

Ahhhhhh
Was wondering how long it would take for the coolaid drinkers. Everything is fine. It's all fine!! For the record, no. I Have not been on before. Also for the record, my part is played. I would again, encourage those interested in the truth to simply do the research and look at the numbers. They don't lie. Massive amounts of data For anyone who would care to look. Volume = success. Lack of volume = poor outcome. Military volume for general surgeons is less than 20% of standard.
I'm sure your on here telling students it's great!! Fine. I will go ahead, be a dick, and tell these kids what they need to know as people like you still think that, despite even your OWN DATA (Mary Edwards) its all good. Sir..... look at your own data, your in deep trouble. I suppose It all depends on what you want to be. I put my money where my mouth is and walked away to be a high volume surgeon. My choice. I would only ask you to give these kids the truth before they sign away their next 10 years.
Remember guys. When confronted with the above, request hard data. Numbers. If, after you look and understand, you want to move forward the do so. But do it knowing what your getting into. You deserve at least that.

 

[Mace1370]

Ahhhhhh
Was wondering how long it would take for the coolaid drinkers. Everything is fine. It's all fine!! For the record, no. I Have not been on before. Also for the record, my part is played. I would again, encourage those interested in the truth to simply do the research and look at the numbers. They don't lie. Massive amounts of data For anyone who would care to look. Volume = success. Lack of volume = poor outcome. Military volume for general surgeons is less than 20% of standard.
I'm sure your on here telling students it's great!! Fine. I will go ahead, be a dick, and tell these kids what they need to know as people like you still think that, despite even your OWN DATA (Mary Edwards) its all good. Sir..... look at your own data, your in deep trouble. I suppose It all depends on what you want to be. I put my money where my mouth is and walked away to be a high volume surgeon. My choice. I would only ask you to give these kids the truth before they sign away their next 10 years.
Remember guys. When confronted with the above, request hard data. Numbers. If, after you look and understand, you want to move forward the do so. But do it knowing what your getting into. You deserve at least that.

I think you might be misinterpreting Gastrapathy's post. Having read his posts over the last couple years I can say he does not come off like a coolaid drinker at all.

 

[fishbulb999]

I think you might be misinterpreting Gastrapathy's post. Having read his posts over the last couple years I can say he does not come off like a coolaid drinker at all.

Here is the quote
"So not to be a dick, but you were on this board in 2013 and this message is nothing new. The cast of characters making the argument slowly changes over time but the message hasn't changed in a decade. You even told someone else not to sign up. You signed up anyway. So now go do your part"

Difficult to misinterpret this little ditty. I am being told I am being somehow deceptive, then to "go do my part". Whatever. I'm Sure Mr. Gastric is fun at parties but if he is gonna poke then I will simply respond with facts. They are, stubborn things.
I am simply tired of the BS. Too many people are being deceived. I put this post up because I am asked weekly about HPSP and what students are being told is not the truth. The numbers are what they are. No meaningful fix is coming. No skin off my back, just trying to help.

 

[psychbender]

Also, fishbulb, Gastrapathy was quoting Atlas Shrugged, not you. Read it again in the context of him replying to a medical student who is complaining about having signed, when the medical student was on this board three years ago (when these same complaints from you and others were being expressed), and previously advised someone else not to sign. He made his mistake, now he has to face it.

I completely agree with your initial post, and it would have been nice to have heard all of this when I was first inquiring about HPSP. Now, I am poised to get out, and move on with my life.

 

[fishbulb999]

Also, fishbulb, Gastrapathy was quoting Atlas Shrugged, not you. Read it again in the context of him replying to a medical student who is complaining about having signed, when the medical student was on this board three years ago (when these same complaints from you and others were being expressed), and previously advised someone else not to sign. He made his mistake, now he has to face it.

I completely agree with your initial post, and it would have been nice to have heard all of this when I was first inquiring about HPSP. Now, I am poised to get out, and move on with my life.

AHHHHHH
ok, well if that is the case, then I apolgize to Gastrapathy. I have not read the book. I thought he was stating I am just another bitter / talking head that signed up and then bitched about it. Clearly a misunderstanding, guess I need to read more. As I banged my head against the wall trying to get prople to listen I always had to deal with a chorus of those who kept telling me to shut up and all is fine. So, gotcha Gastro. Clearly your more fun at parties than I first suspected.

 

[Gastrapathy]

@fishbulb999

The quote function is designed to help you understand to whom a post is directed.


The search function is a helpful tool that can provide context based on prior posts.

There is a sticky at the top with a hundred posts like yours (including mine). This board has talked countless folks out of making the mistake of joining. It didn't exist circa 1997 when I joined but the people who read it and then decide to join have chosen their lot. Going back in time, people like militarymd, mitchconnie, WCI (before he was WCI), medicalcorpse, Galo, and countless others have railed against the same frustrations. There are threads titled 40 plus reasons not to join and worse. Anyone signing up now should know the truth. This board is easily found via google (it's on the first page if you google "should I join hpsp").

FWIW, I don't blame you for the anger, even if it was misdirected.

 

[pgg]

Ahhhhhh
Was wondering how long it would take for the coolaid drinkers.

That there is funny.

 

[fishbulb999]

@fishbulb999

The quote function is designed to help you understand to whom a post is directed.


The search function is a helpful tool that can provide context based on prior posts.

There is a sticky at the top with a hundred posts like yours (including mine). This board has talked countless folks out of making the mistake of joining. It didn't exist circa 1997 when I joined but the people who read it and then decide to join have chosen their lot. Going back in time, people like militarymd, mitchconnie, WCI (before he was WCI), medicalcorpse, Galo, and countless others have railed against the same frustrations. There are threads titled 40 plus reasons not to join and worse. Anyone signing up now should know the truth. This board is easily found via google (it's on the first page if you google "should I join hpsp").

FWIW, I don't blame you for the anger, even if it was misdirected.

Indeed. Anger a plenty. Clearly we're all interested in helping. I wish that help was there in 96 when I joined. Anyway, apologies again and have a good one. Hopefully we can all steer people in the right direction.

 

[asdf123g]

as Fishbulb said, I dont think it is unreasonable to request the hard data before signing the line. If they (the recruiter or whoever else) cannot produce that data upon request, that says a lot.

 

[Atlas Shrugged]

So not to be a dick, but you were on this board in 2013 and this message is nothing new. The cast of characters making the argument slowly changes over time but the message hasn't changed in a decade. You even told someone else not to sign up. You signed up anyway. So now go do your part. Things may be marginally worse but really its just that individual's perspective's change once they've been through it. The stickies talk about the suck going back to 2004. Couple years too late for me.

I'm not complaining. I suppose it's just becoming a bit more real. I've enjoyed most of my rotations and have dealt with minimal problems at USUHS and rotations at a few of the medical centers. At this point I would sign up again, but I realize as an MS3 that doesn't mean much. The physicians have seemed competent. Support staff not so much, which has been frustrating even as a student.

To be fair to the military, administration is running the show now in the civilian sector as well. I think physicians as a whole need to step up and stop taking crap.

 

[colbgw02]

To be fair to the military, administration is running the show now in the civilian sector as well.

On what basis are you making this claim?

 

[Atlas Shrugged]

The perspective of civilian physician friends and acquaintances?

 

[Perrotfish]

The perspective of civilian physician friends and acquaintances?

The financial incentives on the civilian side mean that the highest profit margins are from procedures. My surgeon and anesthesiologist friends from medical school really don't seem to feel the admin at all in their hospitals, and the ones who get out of the military seem to feel a very night and day difference.

The PCMs I know in systems like Kaiser, though, are dealing with a lot of the same things. Not to the same degree, but they feel it. The same admin leaders, same pointless meetings, same metrics, and same star chamber treatment for a patient complaint. More of a night and dusk difference than a night and day difference.

 

[Incis0r]

How much of this would you say applies to your counterparts in the Dental Corps?

 

[fishbulb999]

How much of this would you say applies to your counterparts in the Dental Corps?

Honestly I cannot say. Pretty much out of my wheelhouse.

 

[Incis0r]

. The Air Force Medical Corps is currently dying, and I'm very happy I didn't commission into that service.

What's happening?

 

[bobbyseal]

Wow, it's been awhile since I was on the board. But Fishbulb's post really rings true for me. I know it's the same old story from us surgeons on the board. But, I definitely experienced this issue. I got deferred and logged over 100 robotic prostatectomies and probably about 20 cystectomies during my training. I really felt like I could do some decent oncologic surgery.

I go to the land of healthy 18-40 year olds and I barely find 2 prostates over a 4 year period which I do open on two retirees. Not having taken out a bladder in 4 years, I decided to just stop doing that operation now in civilian practice. Not that anyone particularly enjoys managing a post op cystectomy.

Anyway, it's been a bit of a challenge over the past 2 years getting back into the swing of a real urologic practice. If you have any other way of getting through med school financially, I would do it.

 

[ijustwannasaveppl]

Hi all
I am writing this in the hope that I can save just one person from joining the military medical complex. I am writing you after being out for 18 months after 15 years of service. Yes, I was a surgeon. Yes, I deployed. I worked smaller MEDDACs and MTF.
PROS
You work with the finest American patients. They are men and women who have or are serving our country at a time where it is not fashionable to do so. The sacrifice much, if not all for their brothers and sisters and serving them will always be something I am proud of. That's it. That's all the pros.
CONS
The system is hopelessly broken. In the 80s, with unlimited money and CHAMPUS insurance there were patients. Surgeons operated, residents trained and students learned. Now, Elvis has left the building.
VOLUME
Volumes are at historic lows. There are no good plans to force patients back into the system. Osler once said "To perform medicine without texts is to sail to the sea without maps, to perform medicine without patients is to go to sea without a ship"
This is not hyperbole, the numbers are well known and available. The average general surgeon, even at a major MTF is doing 12 or so x laps a year. Yes, that is 12 MIDLINE INCISIONS TO GET INTO THE BELLY. Perhaps 40 to 60 total cases is not common. Complex cases are nearly unheard of. Deployed surgeons may operate 4 times in six months. Chief residents at even the largest "flagship" institutions are in the bottom 5% of case volume. They are triple scrubbing hernias. I have seen it. They are bullied by a "chain of command" and terrified to say anything for (well founded) fear of reprisal. Please look at the data for military medicine volume. It is out there for all to see. Ask and press your recruiter on this point. Challenge the answers and demand hard data.
TRAINING
Nearly all of the complex procedures are done at outside rotations. Senior surgeons with invaluable experience are leaving when their obligations are up. Subspecialists are massively below minimal safety requirements for case volume across all disciplines. Example, ZERO MTFs meet the minimum number of heart bypass numbers. ZERO. Experienced surgeons are as rare as hen’s teeth. Most Colonels are sitting around doing paperwork and are the least productive members of the chain. The only people doing procedures are massively green, surgeons who are far too inexperienced to actually train residents and fellows. So, you may watch operations, you will not do them. Your intern year will be spent learning paperwork and doing the social workers job so that social workers can sit in an office and do nothing. I did 11 cases as an intern. That was 17 years ago. Think it’s better?
Want to go to a conference, haha. NO. The military is not paying for CME at this point. I went to one, two day conference in the six days of my residency. I did not even really know what a conference was until a friend training civilian asked me to go to the ACS. They may occasionally say they will pay, but the red tape they put up makes it easier to pay on your own.
SUPPORT
As to support, leadership is utterly useless. They are aware of the problem but are helpless to fix it. They continue to put pie in the sky solutions forward only to preserve their leadership positions as they have no chance of survival in a competitive civilian environment. The civilian support consists of an impenetrable government union bureaucracy which exists to do as little as possible and protect its members from work. The fate of the union is not tied to output of the organization. One more patient in the civilian setting is the difference between keeping the lights on and not. Ten more patients in the military is just more work. They are vastly more concerned about updating facebook than taking care of a busy desk. Try to challenge it.... well..... good luck and get ready for harassment suits against you, personally.
Nursing and MSC (medical support) now run the institutions. The set the rules and determine who gets promoted and make no mistake, they do not like you. They exist to "put docs in their place". I would encourage you to ask about promotion rates to LTC and COL. They are dropping like stones. Where they were once 90+ percent now they are 60 for LTC and as low as 30 for COL. So, no full bird for you.
MILITARY TRAINING
Even so, you will be required to waste your valuable training time on endless required computer modules. (human trafficking, car maintaince, alcohol training, moral training, escape and evade, cyber security, winter safety, fall safety, summer safety, why not to light your x mas tree on fire....... yes, they are all real and you will be doing them) Ask about captains career course and the required 6 months of ILE. Yes, that's six months where you’re not touching patients. All to learn about the army and tactical medicine. I am sure your patients are concerned about that when your operating on their carotid arteries. I suppose the intent is to "train leaders" but your training should and must only consist of patient care. Mom and Dad do NOT care if you know the difference between a squad and platoon. They only care that you can find and control a bleeding portal vein. End.
SUMMARY
Guys, take this for what it is. It makes me sick to see what has happened to military medicine. It was once run by physicians who only wanted to operate, train and do good work. Now patients have left and are not coming back. Nurses and MSC make the calls and the rules. They cannot understand the trust and bond between a doctor and patient. How can they?
If you want to be a doctor then eat the loans and be a doctor. If you want to help soldiers then by all means train civilian and join the reserves, these soldiers need better than what is being provided to them. If you want to be an officer and then, secondarily a doctor, if you want to fear any complex procedure, if you want to become a part of an organization whose sole mission is no longer patient care but sustainment of a massive bureaucracy then sign up.
But remember, you must make a decision. Do you want to maximize your potential and tell your patients that no matter what the outcome, you have the experience and training to do the job right? Or, do you want to tell them that you trained in a system that values rules, regulations, and meaningless bull**** over patient care.
I wish you the best and I sincerely hope this helps.

Thank you very much for this. I was recently accepted into a premed fast track program and put USUHS down as my med school of choice with starry eyes. Now I'm not so sure. I want to save people, not a failing medical system. It really helps to hear an actual perspective instead of recruiter BS. If some foolish person (read:me) is dead set on military medicine, is there any specialty or branch you would advise in particular? Or is it all doomed and should I just try to get out before it's too late?

 

[Incis0r]

Thank you very much for this. I was recently accepted into a premed fast track program and put USUHS down as my med school of choice with starry eyes. Now I'm not so sure. I want to save people, not a failing medical system. It really helps to hear an actual perspective instead of recruiter BS. If some foolish person (read:me) is dead set on military medicine, is there any specialty or branch you would advise in particular? Or is it all doomed and should I just try to get out before it's too late?

Paging Dr. @HighPriest. Sir, your services are needed.

 

[deleted707454]

My aim is to take HPSP and immediately pay back as a GMO, postponing residency until I'm out of military. @j4pac has some good guidelines for this. Removing the ineffective doctor training aspect, which parts of this path would you suggest are most disagreeable?

My Justification
- Only accepted to private medical schools
- I have pilot ratings (Private & IFR) and advanced SCUBA training (Divemaster). Might streamline me for UMO or FS
- Don't mind potential deployments*
- Grew up in BFE, can tolerate returning to BFE
- Former employee of federal government. I know bureaucracy well

My Concerns
- ease of matching civilian residency mid-GMO duty. Interest in Rads, Rad Onco, PMR, FM
- *deployments on a boat. What are those like?
- working hours/conditions as GMO. unsure of what they look like across different areas

Would love to hear anyone's input on this, personal stories, etc. Looking to apply beginning of November or so.

 

[WernickeDO]

My aim is to take HPSP and immediately pay back as a GMO, postponing residency until I'm out of military. @j4pac has some good guidelines for this. Removing the ineffective doctor training aspect, which parts of this path would you suggest are most disagreeable?

My Justification
- Only accepted to private medical schools (Congrats on being accepted)
- I have pilot ratings (Private & IFR) and advanced SCUBA training (Divemaster). Might streamline me for UMO or FS (Any idiot, myself included, can become a FS fairly easily, at least in the Army, can't speak to the other services. Your pilot rating won't come into play here. Can't speak to UMO/dive).
- Don't mind potential deployments* (You say that now, and it's one thing to not mind being deployed, but quite another to be deployed and bored while your medical school colleagues are putting in chest tubes, taking care of patients, and advancing their medical careers).
- Grew up in BFE, can tolerate returning to BFE (You will run into the problem of patient volume/acuity in BFE. You have to have patients to practice medicine).
- Former employee of federal government. I know bureaucracy well (Are you prepared for bureaucracy to trump taking care of patients?).

My Concerns
- ease of matching civilian residency mid-GMO duty. Interest in Rads, Rad Onco, PMR, FM (Your interests will likely change throughout medical school, so be prepared for that. GMO time is largely viewed as a positive when applying as far as I can tell).
- *deployments on a boat. What are those like? (Smooth sailing? Can't say).
- working hours/conditions as GMO. unsure of what they look like across different areas (GMO hours, at least mine, can vary from literally nothing to do, all the way to being swamped and working late. On deployments you will work every day)

Would love to hear anyone's input on this, personal stories, etc. Looking to apply beginning of November or so.

See above bolded for my response. I typically warn people away from joining the mil as a pre-med simply because you surrender way too much control way to early in your career. For some it works out just fine and they are happy, but for others not so much. Personally, joining has been mostly negative with respect to my medical career, and if I could do it all over again I wouldn't. As a pre-med, you can read this forum and see complaints like lack of volume/acuity, trying to open up OR time, or just trying to take care of patients in a basic way, and maybe you can think that it's a bummer but not a problem that you will face. I can assure you that in the mil you will face all these problems and more, and none of them will aid you in practicing medicine. If your #1 goal is to become a competent physician and to take care of patients and have some modicum of control over your career, then take the loans out and never look back. If military SERVICE is something you desire, then continue to learn what that SERVICE entails. It often means offering up your medical career as a sacrifice to accomplish the mission. Your goals and the mil goals will not always be compatible, but the mil will win every time.

 

[KoolKeith]

See above bolded for my response. I typically warn people away from joining the mil as a pre-med simply because you surrender way too much control way to early in your career. For some it works out just fine and they are happy, but for others not so much. Personally, joining has been mostly negative with respect to my medical career, and if I could do it all over again I wouldn't. As a pre-med, you can read this forum and see complaints like lack of volume/acuity, trying to open up OR time, or just trying to take care of patients in a basic way, and maybe you can think that it's a bummer but not a problem that you will face. I can assure you that in the mil you will face all these problems and more, and none of them will aid you in practicing medicine. If your #1 goal is to become a competent physician and to take care of patients and have some modicum of control over your career, then take the loans out and never look back. If military SERVICE is something you desire, then continue to learn what that SERVICE entails. It often means offering up your medical career as a sacrifice to accomplish the mission. Your goals and the mil goals will not always be compatible, but the mil will win every time.

Very informative thread. One of the most common complaints I hear on the MilMed forum come from surgeons regarding lack of adequate volume to keep skills sharp. In your opinion does the "never do HPSP" mantra stand for a nontrad going into primary care? The stipend would go a long way in supporting my family during school and avoiding crushing debt that in my case may end up over 300k which would then compound. Not sure if I can responsibly pursue my interests in a low paying specialty without some sort of scholarship like the hpsp or rural hospital loan repayment program. Any advice is appreciated, thanks

 

[WernickeDO]

Very informative thread. One of the most common complaints I hear on the MilMed forum come from surgeons regarding lack of adequate volume to keep skills sharp. In your opinion does the "never do HPSP" mantra stand for a nontrad going into primary care? The stipend would go a long way in supporting my family during school and avoiding crushing debt that in my case may end up over 300k which would then compound. Not sure if I can responsibly pursue my interests in a low paying specialty without some sort of scholarship like the hpsp or rural hospital loan repayment program. Any advice is appreciated, thanks

Having a family can certainly make HPSP more attractive, and having a huge amount of compounding debt can be scary. However, remember that even the lower paying specialties are going to pay in excess of 100K after graduation from residency, with that number going up as you gain more experience and a deeper work history. You are not getting a liberal arts degree; you are earning a degree that will land you in a very lucrative field that will allow you to get out of debt very quickly if you are disciplined in your financial house. There are good threads on this forum about comparing the strictly financial terms of HPSP and civilian: look those over before making any decisions. The consensus is that doing primary care with HPSP puts you ahead financially (only slightly), whereas becoming a surgeon or one of the ROAD specialties means you will be behind.

Also consider what being in the military means. Does your spouse work? He/she will have to uproot their own career to follow you around in the mil. Same with your kids. Are you willing to be separated from your family to deploy? Are you willing to stop practicing medicine so you can compile powerpoints and sit in meetings as a brigade surgeon? Do you want to have some 25 y/o inspecting your car before being allowed to drive 100 miles for a long weekend? Even if you were in a position to benefit financially from HPSP, it is my opinion (and that of many others on this forum) that the downsides to milmed far outweigh the positives. Also consider that you will likely change your mind about specialty while in med school, which may put you on the losing end of this equation. Keep reading this forum and think carefully before signing away control of your (not even started yet) medical career.

 

[Cooperd0g]

My aim is to take HPSP and immediately pay back as a GMO, postponing residency until I'm out of military. @j4pac has some good guidelines for this. Removing the ineffective doctor training aspect, which parts of this path would you suggest are most disagreeable?

My Justification
- Only accepted to private medical schools
- I have pilot ratings (Private & IFR) and advanced SCUBA training (Divemaster). Might streamline me for UMO or FS
- Don't mind potential deployments*
- Grew up in BFE, can tolerate returning to BFE
- Former employee of federal government. I know bureaucracy well

My Concerns
- ease of matching civilian residency mid-GMO duty. Interest in Rads, Rad Onco, PMR, FM
- *deployments on a boat. What are those like?
- working hours/conditions as GMO. unsure of what they look like across different areas

Would love to hear anyone's input on this, personal stories, etc. Looking to apply beginning of November or so.

Your plan is not bad actually. The key thing is knowing what you are getting into and being willing to accept the delay in training. I know several people who were happy to trade the debt for what they saw as potential fun and rewarding short time in the military.

Your previous qualifications as a pilot and scuba diving might help pick your application look better, but don't count on it streamlining any training. In your case I would probably recommend the Navy for dive or flight or the Air Force for flight.

 

[pgg]

In your case I would probably recommend the Navy for dive or flight or the Air Force for flight.

Any reason you recommend the AF over the Navy for flight surgery?

 

[Cooperd0g]

Any reason you recommend the AF over the Navy for flight surgery?

I didn't. I said the Navy for dive or flight or the Air Force for flight. Basically saying don't join the Army.

 

[pgg]

I see, I missed the flight in the Navy bit.

 

[KoolKeith]

Having a family can certainly make HPSP more attractive, and having a huge amount of compounding debt can be scary. However, remember that even the lower paying specialties are going to pay in excess of 100K after graduation from residency, with that number going up as you gain more experience and a deeper work history. You are not getting a liberal arts degree; you are earning a degree that will land you in a very lucrative field that will allow you to get out of debt very quickly if you are disciplined in your financial house. There are good threads on this forum about comparing the strictly financial terms of HPSP and civilian: look those over before making any decisions. The consensus is that doing primary care with HPSP puts you ahead financially (only slightly), whereas becoming a surgeon or one of the ROAD specialties means you will be behind.

Also consider what being in the military means. Does your spouse work? He/she will have to uproot their own career to follow you around in the mil. Same with your kids. Are you willing to be separated from your family to deploy? Are you willing to stop practicing medicine so you can compile powerpoints and sit in meetings as a brigade surgeon? Do you want to have some 25 y/o inspecting your car before being allowed to drive 100 miles for a long weekend? Even if you were in a position to benefit financially from HPSP, it is my opinion (and that of many others on this forum) that the downsides to milmed far outweigh the positives. Also consider that you will likely change your mind about specialty while in med school, which may put you on the losing end of this equation. Keep reading this forum and think carefully before signing away control of your (not even started yet) medical career.

Very helpful, thanks. My wife is on board with the military, but I think deploying would be hard for me. Do you think doing a gmo tour between internship and residency would contribute to as much skill erosion as doing gmo after completing residency? In other words would I be too rusty after a gmo to be competent during residency? Thanks

 

[WernickeDO]

Very helpful, thanks. My wife is on board with the military, but I think deploying would be hard for me. Do you think doing a gmo tour between internship and residency would contribute to as much skill erosion as doing gmo after completing residency? In other words would I be too rusty after a gmo to be competent during residency? Thanks

Well there will certainly be skill rot/knowledge atrophy when you transition to GMO. I would rather take that hit as an intern rather than a board certified doc. If you have completed a residency then you won't be a GMO, you will be a brigade surgeon, or possibly attached to a CSH as an attending at a hospital. But then you aren't doing your time and getting out, so that point is moot. The real question is to ask yourself if you are willing to stop practicing medicine in order to shuffle paperwork around and sit in meetings that have nothing to do with your area of concern. That is what being a mil doc, especially a primary care doc, is all about. Read more on this forum about what being a brigade surgeon means and consider if you are willing to go down that path.

 

[KoolKeith]

Well there will certainly be skill rot/knowledge atrophy when you transition to GMO. I would rather take that hit as an intern rather than a board certified doc. If you have completed a residency then you won't be a GMO, you will be a brigade surgeon, or possibly attached to a CSH as an attending at a hospital. But then you aren't doing your time and getting out, so that point is moot. The real question is to ask yourself if you are willing to stop practicing medicine in order to shuffle paperwork around and sit in meetings that have nothing to do with your area of concern. That is what being a mil doc, especially a primary care doc, is all about. Read more on this forum about what being a brigade surgeon means and consider if you are willing to go down that path.

Are loan repayment perks easy to find in civilian jobs? I want to go to medical school but I feel that COA will cripple my family financially if I don't have a reasonable chance of repayment assistance. I would like to eventually practice in a rural area if that makes any difference.

 

[WernickeDO]

Are loan repayment perks easy to find in civilian jobs? I want to go to medical school but I feel that COA will cripple my family financially if I don't have a reasonable chance of repayment assistance. I would like to eventually practice in a rural area if that makes any difference.

I'm not an authority on this subject but yes these programs exist. This at least gives you some flexibility for where you want to practice, whereas HPSP gives you none.

 

[pinay58]

i'm applying to af hpsp mainly because my boyfriend is currently an officer in the air force and since we plan on getting married later on, we think that having both of us active duty would be the best for us. also, i plan on going into primary care. are all these things about not doing hpsp still applicable to me? if i really hate it, i am fine doing the four years and getting out asap. thanks!

 

[WernickeDO]

i'm applying to af hpsp mainly because my boyfriend is currently an officer in the air force and since we plan on getting married later on, we think that having both of us active duty would be the best for us. also, i plan on going into primary care. are all these things about not doing hpsp still applicable to me? if i really hate it, i am fine doing the four years and getting out asap. thanks!

See above and the copious amounts of information on this forum about the negatives and positives of HPSP. If you are okay with not practicing medicine, then milmed is probably going to be a good fit for you. Remember that preferences change while you are in med school and many people who go in thinking they want to do primary care change their minds. Family situations change. You have to be married before the mil will consider making exceptions and for you, so bear that in mind.

 

[Doctor Bob]

I had the complete opposite experience with the military as far as the effect it had on my training, skillset, and post-mil employability... but I recognize that my military course was far and away the exception so I still tell people to do their research first and make sure you're ok with the probable milmed track and not the possible milmed track.

 

[Ziehl-Neelsen]

I had the complete opposite experience with the military as far as the effect it had on my training, skillset, and post-mil employability... but I recognize that my military course was far and away the exception so I still tell people to do their research first and make sure you're ok with the probable milmed track and not the possible milmed track.

Same here.

My training was excellent and I was far better prepared for actual practice on my first day as an attending in comparison to my colleagues who had done civilian residencies. I have been stationed primarily at major and mid sized MEDCENS (with numerous backfill duties at tiny Army Community Hospitals--so I know how the other half lives) where the volume, complexity, hours, and immediate administrative responsibilities were incredibly painful in my early career but helped immensely in my development as a physician. After practicing as a generalist in my specialty for a number of years, I was selected for a sponsored outservice fellowship. My previous experiences (and certainly the money that came with me) were looked upon extremely favorably by all civilian institutions that I applied to for fellowship and led to me completing fellowship at a prestigious civilian institution that is tops in my field and was my first choice.

That said, I've been around the block and know that while there are others like me (within my specialty and others), there are also many others whose careers have been harmed and in some cases totally derailed by the military. I'm well aware that I could have been sent to Korea straight out of residency where I would have rotted due to lack of volume and complexity in my specialty and an inability to moonlight. I'm also aware that I could get orders for a brigade surgeon tour, a position for which I am woefully ill equipped and would seriously affect my ability to practice my specialty competently. I also realize that certain specialties (Ob/Gyn, Peds, FP, General IM, Psych) are at much less risk of having a career derailed due to these issues because of the nature of these specialties and the military and that there is a greater risk that the military will harm one's career the more subspecialized one becomes.

People who sign up for USUHS or HPSP today are not absolutely doomed to poor training and a lack of volume as an attending that will result in an incompetent physician after separation, but that is a real possibility for every single medical student that signs on the dotted line and is compounded by the oft pointed-out reality that those who sign on the dotted line today are committing themselves to serve as physicians in this organization at least 7 years hence--and none of us have any true sense of what things will be like 7 years from now. The real question for all of these prospective military docs is whether this proposition represents "prudent risk" (to use a military term). In my estimation its foolhardy to takes risks with one's livelihood and why I only recommend USUHS and HPSP to people who are GMO and out or are dead-set on a primary care/Psych/OB career where the expense of their medical school is financially crippling.

 

[deleted707454]

Everyone, thanks for your informative responses. Trying to get as much info as possible before talking to recruiters, so this has been a great help.

 

[WernickeDO]

Everyone, thanks for your informative responses. Trying to get as much info as possible before talking to recruiters, so this has been a great help.

Talking to HPSP recruiters is fine but recognize that they are not doctors and have absolutely no idea what they are talking about. They are informed on the nuts and bolts of HPSP (contract length, bonuses, etc) but they cannot give you an idea as to what it will actually be like to be a physician in the military. Think about it: recruiters are usually sergeants who were trained as medics, which is an EMT-B. Maybe they became paramedics, maybe not; regardless, they are not doctors. Why would you accept a non-physician informing you about life in milmed as a physician, and all of the dips, traps, and mishaps that can occur? This forum is the best place for information about milmed: it's straight from the mouths of those of us who have lived it, or are actively living it now.

 

[Kilgoretrout 65]

Talking to HPSP recruiters is fine but recognize that they are not doctors and have absolutely no idea what they are talking about. They are informed on the nuts and bolts of HPSP (contract length, bonuses, etc) but they cannot give you an idea as to what it will actually be like to be a physician in the military. Think about it: recruiters are usually sergeants who were trained as medics, which is an EMT-B. Maybe they became paramedics, maybe not; regardless, they are not doctors. Why would you accept a non-physician informing you about life in milmed as a physician, and all of the dips, traps, and mishaps that can occur? This forum is the best place for information about milmed: it's straight from the mouths of those of us who have lived it, or are actively living it now.

WernickeDo said it.

Don't believe what the recruiters say, not because they are liars but because they have been pumped with garbage from a higher up who doesn't understand the front line issues.

Sorry if you've heard this before - I was a prospective HPSP applicant who the recruiter took to visit the ED at WPAFB way back in 1992. He smoked in the car the whole way. We got to WPAFB ED and the doc there, a Major, was the one roped into talking to me. This guy was a disgruntled ED doc who complained about the lack of real ED cases. His partner had left for the day (it was 1300) because his philosophy was "half a days work for half a days pay". Now that I have dropped my retirement paperwork I can laugh at this stuff while looking for a civilian job with folks who are used to working three to four times as hard for twice the pay.