Military Dentistry

[pmoney]

I have read up in this forum for quite a while now. While most of the posts are about mil medicine, I am assuming that a lot of the problems and benefits carry over. I wrote this long and convulted post requesting your opionions on my main points/questions.

From what I see as a naive student considering the HPSP scholarship (Army). I will start off by saying that I am not in it just for the money. That obviously would be a major mistake.

Benefits:
There are quite a few, but I really don't need to list them all. I'm sure the recruiter can hook you up with a nice bulleted list.

1. I have heard from a variety of ex mil dentists (it is tough to take everything they say without a grain of salt now, because they were all buddies of my father and entering the service in the 80s was pretty chill) and a few currently in the service that the AEGD/GPRs are very good. You get to experience a whole variety of cases with many specialists to confer with. The 1 year AEGD programs are depending on your contract included in payback time. The downside is you may have more of a chance of deploying.

2. If I am interested in a particular specialty and I leave the service after 4 yrs, the military experience should provide me with a good basis for applying to a variety of civvie specialty programs. At the minimum, it almost seems like an extended period to learn, develop further skills, and speed before entering private practice. Unless of course, I end up doing the same procedures over and over (see below #1).

Issues (in no particular order-I am trying to focus on stuff that I feel would affect me both personally and proffessionaly; perhaps my list is different from others.):

1. Lack of caseload or getting on the amalgam mill. I have read many posts (mainly by md/dos) that docs have trouble with getting enough cases to keep their skills from going to hell. I don't believe that the caseload itself will be too little for dentists, but I have read that you may get stuck doing filings, fillings and more fillings. In certain DENTACs where there are many specialists, you may rarely do any work that the specialists are there for.

2. Paperwork/Admin BS/'Optimized' Care, etc. I understand that in any large organization you will be dealing with an exponential increase in BS paperwork and that as you climb the rank ladder, you become more of an administrator. However, my concerns in this department seem to focus on having overloads of work and not being able to effectively complete correct procedures. Also, considering the fact that many military dentists may be subpar at clinical procedures and that there is little or no liability for shoddy work, I would be concerned about falling into the rut of just doing adequate or poor work since there is no incentive to do well.

2a. I also am wondering the affect that having a nurse or non dental officer commanding a unit or something has on your work.

3. Commitment Time. I know its 4AD/4IRR. I am not as concerned about this since if I did want to cut and run after 4, unless stop loss is in effect, I do not believe IRR would be called up on the Army Dental Corps unless something major happens. Of course this is a possibility but I have yet to hear of docs being called up for IRR, its mainly been engineers, MPs, etc. Please correct me if I'm wrong here.

4. Earning Potential. I don't know how much of a problem this is. If one plans on leaving after 4 yrs I guess you need to consider you make a decent amount in the service vs higher pay outside but with loans to pay off. It also must be hard for a young guy to come out of all the hard work of D school and all your classmates are rolling out to relatively high paying jobs while you head out to Fort XXXX, AR or the like. I have looked at all the pay charts, etc, etc. I am more concerned about issues 1 and 2 as disadvantages than this here.

5. Moving around every so often/deployments. This isn't a big deal for a young unmarried man but with a family I defintiely see it being an issue. But, this is an obvious concern with military duty in general. I have talked to a couple of mil dentists about this.

Well thats all I can think of right now, I'm sure I'll come up with more concerns/benefits later on. Overall, I'm more concerned with the military affecting my clinical ability (either positively or negatively) whether I decide to serve 4 or 20 yrs.

I was hoping some of the posters in this forum could comment on my main points and add their comments. I read a lot of negativity in this forum and I appreciate that you guys spend your time educating us about the good and bad of military medicine. I want to know if some the issues I read about are also prevalent in dentistry.


And on a sidenote, the information I've gotten about this stuff is from retired O6 navy/cg dentist and an O6 army reservist who was just called up to go to Germany about a year ago, both of which are coworkers with my dad. Their experiences and information are good, but they did serve their early years back when mil medicine may have indeed been 'all that'. I am also talking to a new dentist stationed in germany.

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[alpha62]

In the army, I was sleeping out in a hole in the sand with a poncho stretched over it out at Ft. Irwin in the fall of 2003 with a division training for Iraq. A dentist was out there with me. We were both due to finish our active duty service obligation in March 2004.

I was remotely attached to the unit in a thing called PROFIS,which means Professional Filler System. That means I was assigned to a medical center, but attached to a combat unit if they got deployed, and they were, to Sadir City and I later learned that unit took heavy losses.

The dentist was actually assigned to the unit, I was only attached.

The dentist got stop lossed and sent with the unit to Iraq. I was exempt from stop loss since I was PROFIS and was allowed to separate.

This dentist was working out of tent with some setup that looked like it was designed in the 1950's. At that early stage of the war, I doubt the guy went on to work in a Palace like we're seeing on TV now.

I worked with another dentist on the Korean DMZ you could see the N. Korean flag flying from the office window.... if you could call it an office. We've been there 50 years and the dental set up looked like something that was originally intended to be used for only 72 hours.

 

[pmoney]

In the army, I was sleeping out in a hole in the sand with a poncho stretched over it out at Ft. Irwin in the fall of 2003 with a division training for Iraq. A dentist was out there with me. We were both due to finish our active duty service obligation in March 2004.

I was remotely attached to the unit in a thing called PROFIS,which means Professional Filler System. That means I was assigned to a medical center, but attached to a combat unit if they got deployed, and they were, to Sadir City and I later learned that unit took heavy losses.

The dentist was actually assigned to the unit, I was only attached.

The dentist got stop lossed and sent with the unit to Iraq. I was exempt from stop loss since I was PROFIS and was allowed to separate.

This dentist was working out of tent with some setup that looked like it was designed in the 1950's. At that early stage of the war, I doubt the guy went on to work in a Palace like we're seeing on TV now.

I worked with another dentist on the Korean DMZ you could see the N. Korean flag flying from the office window.... if you could call it an office. We've been there 50 years and the dental set up looked like something that was originally intended to be used for only 72 hours.

Good info. So these are basically times you have been either deployed or been training to deploy?

 

[alpha62]

Korea not deployed, it's a one year army unaccompanied tour and just another goat rope everybody has to bite off sooner or later if they stay in the army.

That country is so developed now, the luxury SUV's are bumper to bumper from Uijongbu to Seoul. Worse than Los Angeles. They got Russians doing the prostitution rackets, and Pakistanis working the rice paddies...... and dumb ass Americans protecting them while living is shacks and taking the bus while the locals drive a $ 50k air conditioned autos.

just my opinion, if you are are a Korean and you're too good to work a paddy, walk to work, or toil in the flesh trade, then our job and mission are done. Mission Accomplished.

Marriages to GI's are down to nearly zero. If you think your daughter is too good to marry a GI, then you really need to completely fend for yourself. And no, I wasn't jilted by a local

You could spend the rest of your career asking yourself these types of questions in places worse than what I've described.

Good info. So these are basically times you have been either deployed or been training to deploy?

 

[mac61]

My last assignment as an MSC officer before coming to USUHS was the executive officer of the 561st Medical Company (Dental Services) out of Vilseck (now Grafewoer) Germany.

On to what the recruiter doesn't tell you.

There are 5-6 (the number is changing as deployable dental companies are being realligned) MTOE dental companies in the Army. That is, companies that are 100% deployable, all personnel and equipment, no questions asked. Our company was assigned 61 soldiers, with 16 officers, ~45 enlisted. I was the only non-dental officer. Of the dentists in my company, and our sister companies with the same numbers, I would bet that 10 were happy to be in a deployable company. The reason is simple:

The beauty of being in an MTOE company as opposed to a TDA assignment (DENTAC etc.) is that all of the requirements of maintaining deployability apply, and clinic time does not factor into the alghorithm. My company got most our docs into the clinic 3 days a week, and we were way ahead of our sister companies. The rest of the week was dedicated to equipment maintenance (vehicles, light weight dental sets, etc.) and training (from officer professional development to SGTs time training i.e. soldier skills like reading a compass). We bent a lot of rules and rewrote a lot of policies to make 3 days happen, along with working with the DENTAC commander who ran the clinic, which brings it's own set of issues.

During periods of training or other requirements, our docs rarely got clinic time. When we were ramping up for OIF III, our docs went 2 months with maybe 2 days clinic time.

Ah, didn't mention the other great things that come with MTOE units. Leadership responsibilities. NONE of our docs were without 2 or 3 additional duties, from being platoon leaders to running rifle ranges to planning training events and managing the IT equipment for the company. These additional duties almost always came at the expense of patient contact. Our training officer worked harder than anyone I know..in and out of the clinic.

Also figure this out. Even if the commander got the docs in the clinic, the clinic was not assigned the assistants to work with our docs. Our assistants came from our unit, usually 1 per doc. Factor in all of the things that soldiers have to do from appointments to training to tdy to you name it and 2 things happen: 1) Even if you can get to the clinic you can't work because there's no assistant. 2) You might work with a different assistant weekly/daily/hourly.

Bottom line: With the exception of some of the field grade docs, most did not even know that the possibility existed. None of the docs got enough chair time. Everyone in the unit goes to the field, fires automatic weapons, goes to the gas chamber, works on thier HMMWV, and puts up the tents.

If you know that this is a possibility, and are OK with it...rock on. Your XO will love you. Nothing sucks worse than telling your docs that they can't go to the clinic because we have to clean weapons today.

I will tell you that almost all of the incoming docs were VERY suprised to be in this situation, and most would have sold the jewels to get to a DENTAC.

 

[pmoney]

Wow, Mac thanks for that information. I had heard of deployable dental companies, but did not really know what they entailed. I think overall I would be okay with the field excersize stuff to an extent; no doubt I'd be bitc*ing about it after awhile, but it wouldn't be the end of the world.

What I find most concerning, other than the extra work doing other jobs, is the lack of clinical time. This is the first time I have heard of such a lack of actual treatment/chair time unless the unit was deployed. I certainly did not have any idea that there would be this problem when not deployed but in a TOE unit. This would be an awful situation for a young dentist coming straight out of D school, or even a year of AEGD to have limited patient contact, when that is needed to actually learn dentistry.

If there was more chair time, I would probably think this would simpley be an annoyance of being in a MTOE unit.

 

[mac61]

Wow, Mac thanks for that information. I had heard of deployable dental companies, but did not really know what they entailed. I think overall I would be okay with the field excersize stuff to an extent; no doubt I'd be bitc*ing about it after awhile, but it wouldn't be the end of the world.

What I find most concerning, other than the extra work doing other jobs, is the lack of clinical time. This is the first time I have heard of such a lack of actual treatment/chair time unless the unit was deployed. I certainly did not have any idea that there would be this problem when not deployed but in a TOE unit. This would be an awful situation for a young dentist coming straight out of D school, or even a year of AEGD to have limited patient contact, when that is needed to actually learn dentistry.

If there was more chair time, I would probably think this would simpley be an annoyance of being in a MTOE unit.

No problem. I'm more than happy to get you in touch with one of several docs, including the Company Commander (he's an OMFS, and I can almost guarantee he's seeing few if any patients. Command time sucks up all your time.), Battalion Commander (I think he's endo...definitely NEVER sees patients) or any of the junior docs who are still there or have moved on. Shoot me an email if you'd like and I'll forward you some contact info.