Military General Srugery Quality?

[ParamagicCCP]

Hi all,

I am considering joining the Army or Navy as an HPSP candidate. I was wondering if people could comment on the quality of general surgery residencies in the military? How good is the education, is it comparable to civilian residencies?

Thanks

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[HighPriest]

The srugery is good. You'll certainly get more trauma srugery at a civilian center, but most residencies make up for that with away rotations. Your real concern should be what you'll do after residency.

 

[dr zaius]

http://www.journalacs.org/article/S1072-7515(16)30034-5/abstract?cc=y=

 

[ParamagicCCP]

The srugery is good. You'll certainly get more trauma srugery at a civilian center, but most residencies make up for that with away rotations. Your real concern should be what you'll do after residency.

Ahhh, I see the srugery is good haha. Thanks for pointing out the spelling issue.

What is the concern after residency that I would face as a surgeon? Skill atrophy?

 

[HighPriest]

Ahhh, I see the srugery is good haha. Thanks for pointing out the spelling issue.

What is the concern after residency that I would face as a surgeon? Skill atrophy?

That would be a big one, yes. I think the article that monkey man posted is pretty good at touching on the issue.

 

[WernickeDO]

If you are concerned about medical training and becoming a proficient dcotor, as well you should, then forget about the military, take out the loans, and never look back. Whether you train as a srugeon, itnernist, pdes, or BO/YGN, the military sees you as an officer first and dcotor second. This means assignments outside of your field of medicine, clerical jobs, and the like. Read these forums thoroughly and you will see this as a recurring theme. Good luck.

 

[jabreal00]

I think that in the military the training is generally good with a lot of didactic teaching and better oversight/mentoring by Attendings vs the civilian. The civilian side in regards to procedures will do 40-50% more cases and be involved in more complex cases. The difference is that there is less emphasis on teaching. The residents are more of a cog in the wheel. Once they finish, they aren't necessarily better surgeons or procedurists than their colleagues in the military. This goes for most surgical fields as well as medical sub-specialty fields that are procedure oriented.

However, like alluded to already, the rub is when one finishes their training. It's more likely in the military to get assigned to a very low volume military treatment facility where their skill can and do atrophy. In many of these places surgeons are seeing more clinic than doing operations or are just reduced to doing appendectomies or cholecystectomies. Only way to mitigate this is to try to moonlight, which has it's own sets of hassles.

 

[HighPriest]

I think that in the military the training is generally good with a lot of didactic teaching and better oversight/mentoring by Attendings vs the civilian. The civilian side in regards to procedures will do 40-50% more cases and be involved in more complex cases. The difference is that there is less emphasis on teaching. The residents are more of a cog in the wheel. Once they finish, they aren't necessarily better surgeons or procedurists than their colleagues in the military. This goes for most surgical fields as well as medical sub-specialty fields that are procedure oriented.

However, like alluded to already, the rub is when one finishes their training. It's more likely in the military to get assigned to a very low volume military treatment facility where their skill can and do atrophy. In many of these places surgeons are seeing more clinic than doing operations or are just reduced to doing appendectomies or cholecystectomies. Only way to mitigate this is to try to moonlight, which has it's own sets of hassles.

100% agree with this. I came out of residency feeling very confident in my surgical skills and with my breadth of ability. A lot of my civilian colleagues felt like they needed additional training not just because of interest or career, but because they saw a lot but didn't do a lot, and their in-service scores were crap, frankly. But, that is very anecdotal. However, my first duty station was a CF and while my patient flow was great, my ability to practice was severely limited by the local MTF and the fact that almost no one over the age of 50 came to see me. I really do feel like it did a lot of damage in a very short period of time. Since PCSing, I feel like I've been able to repair a lot of that damage. The truth is that even if you go into civilian practice there will be types of cases that you decide you simply aren't going to do anymore for one reason or another, but at least you're making that choice - it's not being made for you (save for cases in which the market makes that decision for you, but you can always move to a different market).
Moonlighting can help - sometimes. However, I have done quite a lot of moonlighting in more than a few areas for more than a few companies. Thus far, at least for my specialty, I haven't found the moonlighting to be particularly helpful for skill maintenance. For the most part you're covering call. Maybe something comes in that you need to see, maybe it doesn't. More often it doesn't. The types of things you usually see on call usually come in to any hospital anywhere. Plus, you're eating up leave whenever you moonlight for many surgical specialties, because it can be very difficult to moonlight locally.

 

[fishbulb999]

The training is horrible.
Please see below.
Do not sign up, ever.


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.
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.