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Military Medicine: Pros, Cons, and Opinions

Discussion in 'Military Medicine' started by Homunculus, Apr 26, 2006.

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  1. Homunculus

    Homunculus SDN Caveman Administrator Moderator

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  2. Cathance

    Cathance Junior Member

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    I brought this over from another string. It's more relevant to this one.
  3. Gatewayhoward

    Gatewayhoward Senior Member

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    I was considering military medicine as one of my options. It seems like you have to be the right kind of person to enjoy it. I didn't know that you get little experience. That's bad.
  4. bliss72

    bliss72 HPSP counselor/student

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    I am sad that your military experience has been negative, I am in the Army, a HPSP counselor, nurse and a pre-med major. I would like to say your experience is unique but I know that is not true, I can also say that others have not experienced the same thing. I know nothing of Navy medicine but I know the military in general is a sacrifice at times, I am no different than being a cop in some ways but when it all boils down to it. I made a choice to serve and service in itself is my reward. I didn't do it for pay or prestige but to make a difference. Kind of the same reason I am choosing medicine. I love people.

    The main reason that physicians are so esteemed in society is because they have the awesome responsibility of caring for the sick and preserving life. As a nurse I have encountered many physicians that treat patients like their condition, an annoyance instead of treating the patient as a patient. Physicians worrying more about if they are going to get paid rather than whether or not they can preserve life. Military medicine is at least free from the hassles of malpractice and HMOs. It's funny but nowhere in the Hippocratic oath or the Osteopathic oath does it mention making loads of money. The profession of medicine is about one thing to me at least, the patient. Now I know you may believe that junior enlisted members are shown preferential treatment but I also know that in the Army at least, they sometimes live under conditions that officers would never be subjected to and for less pay at that.

    Don't get me wrong, I am not attacking you. I believe what you say has merit, however it is not the only experience that military physicians experience. I went to the Downstate College of medicine commencement and the Dean of the school said it best "if you got into the profession of medicine to get rich, you are in the wrong profession, if you think that a physician will make loads of money and go on exotic vacations the on call pager will dispel that illusion."

    I know that you have had to make sacrifices, sacrifices in time from family and financially, however, patriotism aside, there is another human being out there willing to take a bullet to preserve our way of life, your way of life. He doesn't care that he is not rich, he pays no mind to the sacrifices he must make as well. he is willing to die so that we can say what we want, make however much we want and live where we want. Army physicians, even the ones deployed will never, NEVER, sleep on the ground next to their weapon or ride along in a convoy they may never return from or stink without a shower for weeks because they are out in the field and definitely not for $24,000 a year.

    You may leave the service and you are still my brother Sir because for whatever reason, mercenary, selfish, selfless or compassionate, you made the choice to put on a uniform to defend what we stand for. Bless you sir and thank you for your sacrifice.
  5. bliss72

    bliss72 HPSP counselor/student

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    PS that was in reference to the above post not yours but in the Army you don't put off your residency like in the Navy because we do not have General medical Officers like the Navy. Look into it and if you have questions I am in the HPSP business, however I am here as a student not a recruiter.
  6. USAFdoc

    USAFdoc exUSAFdoc

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    wrong, TRICARE and HUMANA have assumed alot of control of our military clinics; supplying (or rather NOT supplying) staff, making decisions on how referrals are made etc. AND THEY DO IT WORSE THAN ANY OTHER HMO I HAVE worked with. They are militarty HMOs. Along that line, the beaurocratic redtape that todays primary care doc has dwarfs what I see in the civilian world. Military medicine is not what it used to be 20 years ago. It has lost most of the positive unique aspects it had, and adopted the worst aspects that civilian medicine has.

    It is all sad.
  7. st0rmin

    st0rmin Unregistered User

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    I would like to call BS on this one and humbly state that the Army does indeed have GMOs. They are not like the Navy, meaning it's almost guaranteed for Navy folks to do a GMO tour, but it is still possible for someone to do a GMO tour in the Army. A couple of interns from my current hospital just departed for their GMO tour after not matching after a transitional internship. If you are in the HPSP business please let the students know the truth about matching in the Army and the possibility of GMO tours (and therefore delaying their residency for a couple of years).

    Thanks.
  8. dtn3t

    dtn3t Member

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    I second that. The Army has much more GMO's than advertised, although it is true most specialties are going to continuous contracts. You just get screwed if you don't match out of med school.

    And no offense, but what exactly does an HPSP counselor do?
  9. AF M4

    AF M4 Junior Member

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    It's an interesting policy that the various services are going to, very much a war-time philosophy on the use of physicians instead of an institutional one. Seems like they've got a resource (which they measure as "Physician-Years" rather than actual Physicians) that they can either invest in the future - for example, give out several radiology or orthopedic surgery residencies so that in 5 years you can pay 3 military radiology attendings for the price of one civilian contractor. Or they can spend those "Physician-Years" now, only giving the bare minimum of specialty slots while pouring the rest into GMOs, Flight Surgeons, etc. They have to know that most of the docs won't stick around after their service time is up, but the current situation is so stretched that they have no choice but to burn up all their resources now to put bodies into empty slots. It's not a good policy since it's one that smacks of simply reacting to a situation instead of having a plan, and it's one that makes me feel uncomfortable because this type of mindset immediately reaches for the easiest, quickest solution to a problem - in this case a stop-loss as the GMOs leave and the HPSP well dries up.

    I know I've already ticked off a recruiter who came to a military medical student association meeting at my school: a couple of M1s thinking about signing up attended, and I told them the current situation along with what I was having to deal with. The recruiter tried to argue that what I was talking about wasn't going on, but it quickly became obvious that he didn't know anything about the match boards or anything like that - he only knew about military, nothing about doctors in the military. I told the M1s what I wish someone had told me back then: that they were not prepared to make a choice of this magnitude, and that many many things can change over the course of medical school. The money looks scary, but don't worry about it - you'll make it back soon enough. If you're still interested in the military after med school, great, look into the FAP program - you can still work in the military and the money's good, plus you get to be the kind of doc you want to be. After that I nudged their surprised little faces out the door, and told them not to worry about returning any phone calls from the military. The recruiter looked at me as if I'd just grown horns and stabbed him with a pitchfork...he started to go off, but then I told him that I wasn't disrespecting the military and that I was proud of my commitment to serve, but I also felt it was my responsibility to make sure that those trusting, bright-eyed rookie med studs weren't taken for a ride that was going to cost them the back half of their 20s. He left, and I don't think he's coming back to any more of our meetings.

    So, in effect, I've contributed to the probablity of a stop-loss by the time I'm done with my commitment. :)
  10. USAFdoc

    USAFdoc exUSAFdoc

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    when I accepted HPSP, I had no idea what the military healthcare system would be like. If I had known, I would NOT have joined. I thought I knew what I was getting into. I thought I would get paid less, not have a definite choice where I would live, I might get deployed, do all the military stuff with uniforms and tradition, have less autonomy etc.......

    Being previous enlisted, I planned on being a career USAF Family doc for the troops.

    When I finally emerged from the end of the HPSP pipeline, I found myself in a USAF Primary Care clinic more poorly run, poorly manned (as low as 15%), lack of equipment at times, no charts for patients, and with a high % Commanders that seemed to be doing their best to make mission "almost impossible" for the staff, mission "truly impossible". The best way I can describe it was "Reckless".

    I had falsly expected a reasonable quality of life. Many, many have described a military primary care clinic as a "war zone", and while that is over the top, there are enough similarities to make it valid.

    Todays military medicine (at least primary care, and thats the most common field) has gone completly over the edge. For those serving, or about to serve, you ARE doing a great service for your country. It is your countries Surgeon Generals that are doing a complete disservice to this generation of patients and staff in out Primary Care military clinics. The military has many mottos and impressive lists like the USAF Core Values.

    It is time the Surgeon General provided more than lip service. :mad:
  11. orbitsurgMD

    orbitsurgMD Senior Member

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    For your sake, I hope not. It is bad enough to force an incompletely-trained physician to complete all of his service as a GMO, but it would be unconscionable to make him spend any longer than that as a GMO by stop-loss.

    The situation does beg for better leadership, and right now. The train of top-level medical department ticket-punchers have not served as proper advocates for quality or continuity. They have accepted whatever direction has come from above as concerns cost-containment, and whatever the line thinks is good, but have failed in pushing back effectively with a plan to salvage the medical corps, letting it devolve into a poorer version of its past self. It is becoming a GMO service with a weakened hospital and training foundation. The lack of foresight, the failure to promote even a medium-term solution is truly disheartening.
  12. Mirror Form

    Mirror Form Thyroid Storm

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    LOL, I was wondering the same thing. It probably is synonomous with "recruiter."

    That said, I do give the Army GME kudo's for moving away from GMO's as much as they possibley could. There is no way we could have zero gmo's b/c otherwise we'd have to force people to go into residencies that they don't want. For example, if we only need 10 radiologists entering training, we can't give 15 people slots. So what to do with the rest? GMO's seem the most obvious, and most expediant solution. A large majority of people in Army's GME do go straight though now, but the minority who don't get screwed.
  13. former military

    former military Member

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    This is a lie.... the army urologist I graduated with went to baghdad as a GMO...yes gmo, not urologist, and he slept on the ground or the helicopter floor regularly.... lying in this format is not wise... save your lying for when it is just you and the sucker you are trying to Shanghai....
  14. USAFdoc

    USAFdoc exUSAFdoc

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    the point being, people should speak from what they know first hand. Many of the physicians here have done exactly that, speaking to the problems facing military medicine and the docs and patients "trapped" in that system. Others on this site have then gone on to attack those physicians (and myself). Those attackers usually have ZERO first hand knowledge of what they are speaking on. That does not make those people "bad", but as referenced above, they are frequently wrong. :idea:
  15. AF M4

    AF M4 Junior Member

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    The impression that I've gotten is that most of the folks at the top think that a doctor is a doctor - try to tell them why physicians need residency training and they ask you what medical school was for if you need more training to be a physician once you get out. It's the job of the high-level docs to tell the higher-ups why things are the way they are, but it seems like those docs are just following instructions rather than helping to shape policy.

    Anyway, I'm still hopeful that I'll match, but I've been getting used to the idea that I'll start my residency at age 30. I have a 3-year HPSP commitment, so I'd do my internship + my required 2-year Flight Surgeon tour, then ask to extend a year at which point I'd leave, although I don't quite understand all the mechanics of this. There's also a possibility I could stay in if it turned out I really liked it, but I'll have to see how it goes. I've had some administrators tell me that with 3 years of service time I'd have a really strong application to try to match again (although no stronger than the bundle of other people in my class who didn't match :) ), but at that point why go through the whole military rigamarole for another 6 years or so when I could just finish my last year and then be free to go wherever I want for better pay?
  16. bliss72

    bliss72 HPSP counselor/student

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    You said it right there, they did not match!!!The Army did away with the GMO program,unlike the Navy who makes you do it first. But if you do not Match for military or civilian residency, you will be a GMO (after all they did pay for med school). The Army doesn't make you a GMO from the the jump like the Navy. Please do not read into my posts. We do not have the GMO program!
  17. orbitsurgMD

    orbitsurgMD Senior Member

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    [Bolds mine]

    Yes you do, you just don't have as large a percentage of your post-PGY-1 physicians working as GMOs as does the Navy (and as soon will the Air Force). For you to say "we don't have a GMO program" implies that there is truly a program anywhere. All there are in any service is billets for GMOs. Navy just has more relative to its accession class-size.

    What the recruiters avoid discussing is the pyramidal shape the services' medical departments have had as far as numbers of new accessions relative to available PGY2 slots service-wide. Their system has expected, even required, attrition to maintain that form, as there are not enough PGY2 slots--by deferment, outservice or in-service--to accommodate all the returning GMOs.

    What the Navy isn't ready for is the coming hourglass by virtue of declining HPSP accessions, the pinch from the bottom that will leave them without enough PGY1s to fill their GMO slots (and forget direct-through training). What then? Force everyone to do GMO time? Force physicians who have done a GMO tour into a second tour? Stop-loss if things get really desperate? Some selling-point, that.

    The senior medical leadership and the responsible line are running the medical department into the ground.
  18. Mirror Form

    Mirror Form Thyroid Storm

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    Once again, I think it's great the Army did away with GMO's as much as possible. However, there is still a GMO program. What happens when 10 people apply for 3 PM&R slots???? Of course that's the most extreme example I know of. But still, you shouldn't sugar coat situation.

    As an "HPSP counselor," you may cause some future docs who do army gmo tours to become very bitter, b/c they'll feel like you lied to them.
  19. a1qwerty55

    a1qwerty55 Attending

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    I'm an active duty Army physician - 13 years of service, have deployed, currently run a department, and have seen the good and bad of medicine both military medicine and civilian medicine. I am not a recruiter, but obviously want good colleagues for the good of the nation, our soldiers and the system.

    I can't comment on the Navy or AF Medicine

    What follows is my unofficial take on some issues:

    Training - military vs. civilian -
    On average military residencies have higher board pass rates than their civilian counterparts. Military physicians are highly recruited by the civilian sector and in most cases have no difficulty with credentialling. Military residencies generally received longer periods of accredidation that civilian programs. Many residencies allow for rotations outside of the home institution (like to a big trauma center for surgeons)
    - I know of no one who has left the military and struggled to find a attractive job.

    Technology - No difference at least at medical centers - MRI, CT, US, ventilators, monitors, etc. all equal to or better than civilian counterparts.
    The glaring exception is the military digital record system (CHCS II/AHLTA) which is truly abysmal and may or may not improve.

    Colleagues - Most of my colleagues are idealistic - do what is right for the patient regardless of the fact there is no profit motive. Most are frustrated with the bureaucracy of the military and adminstrative burdens. Tempers are understandibly short as workload is spread accross a shinking pool of docs. Nearly all are highly competent, and collegial - those that are not usually quit or are forced out and find employment at your local civilian hospital. Take into account this fact when reviewing some of the venomous posts by "former military docs". Sour grapes anyone?

    Pay - FP, IM, Pediatrics - comparable to better pay than civilian sector with generally better lifestyle
    Surgeons, and the glamorous specialties - rads/ophtho/derm - pay doesn't come close but training is easier to get.
    Bonuses - they are going up every year and as long as retention is a problem the expectation is for this trend to continue -

    Benefits - NO ONE other than the military offers lifetime healthcare, inflation adjusted retirement income for life. At age 47 I will start drawing - for life - the equivalent of roughly a 1.8 million dollar annuity. This does not include my TSP, roth IRA, and other investments - not to mention no medical school debt. Also when comparing military and civilian pay - don't forget the fact that housing, food, and cost of living allowances are TAX FREE - so add an additional 28-30% to those dollars to come up with a taxable equivalent. Lack of medical malpractice, clinic overhead, health insurance and having to game Medicaide as reimbursement falls also have to be factored into the equation.

    Job Satisfaction - Depends - if you focus on why you're a doc - the patients and the doctor-patient relationship - it is great - I have more time to diagnose, educate and treat patients than I would as a civilian provider.
    I can order most any test or med I want without consulting an insurance company and I make decisions based on what is right and not on ability to pay. Clinic inefficiencies - lack of ancillary support, secretarial help is a major source of frustration, especially in the primary care arena.

    That being said administrative burdens are excessive in my opinion. If you like to joust against windmills - you will hate the military - Survival depends on your ablity to fix that which you can, and accept that which is out of your control.

    Military Specific Stuff - Ala deployments

    Deployments suck but almost everyone looks back on one as a growth experience - This changes with successive deployments but the Army is trying to share the wealth between all providers and this seems to be working. Most specialties are following an "everyone goes once before anyone goes twice", this helps morale as well makes deployments more predictable.

    I'm sure my post will be dissected in short order by some of the knuckleheads on this string, but I've tried to be even handed.

    Basically - Do I get pissed off at the Army - Hell yes.... Is it necessarilly better in the civilian world (I've been there and it is not). Ultimately it comes down to what floats your boat?

    The Army is what you make it, negative people have negative experiences - positive ones flourish - true in the Army and everywhere else.

    Later.
  20. former military

    former military Member

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    I am one of the knucklehead you referenced... AF active duty surgeon for 13 years. I must admit, I did not see my bonus going up each year. It stayed the same.... the only thing that may have gone up is incentive pay once you have reached your commitment... Also, lets talk technology... do you have a PET scanner? the second largest hospital in the AF doesn't. How many civilian pet scanners are there? The second largest hospital in the AF has an average inpatient census of about 35-60 patients including about 2 pediatric patients... That doesn't sound so incredible for GME. OR technology... we finally got a ligasure for our OR this year... welcome to 1997! Do we have a lithotripter? No we don't. Do we have cardiac surgery or internventional cardiology? Nope. Are surgical outcomes as good as high volume hospitals? No they are not. I have not worked in an Army hospital (BAMC) in five years but as I remember it was worse than the AF hosptals- Wilford Hall and David Grant- in one thing I didn't think possible _ the can't do attitude. Military medicine is also a good place to get divorced within... I am sure med in general has a reasonable high divorce rate but my experience, as a knucklehead, that is, is that the stress of the environment, moving, deployments etc. led to a bunch of my doctor friend's getting divorced and estranged from their kids... I guess it is all worth it if you can start IVs with night vision goggles.
    Peace
  21. USAFdoc

    USAFdoc exUSAFdoc

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    Your thread was Army specific; here is some USAF Primary Care specific, and please do not take this personally, you are probably a great officer and have great perseverance to have lasted as long as you have in the beaurocratic nightmare of military med:

    1) Pay. You are correct in that Military salaries and civilian SALARIES (that word salary is impt here) are similar in Primary care. HOWEVER. As a civilian FP I am salaried at 120K doing only 40-50 hrs per week (4 1/2 days clinic only). In the military, I was doing about 275-300 hrs a month (with one month at 400 hours) so per hour, I was getting half pay in the military, when you consider hourly pay. Currently I also moonlight at an urgent care center. If I wanted to work there to equal the number of hours I worked in the military, I would be making 200K.

    2)The military does NOT give you more time to diagnose, spend time with patients etc. In the USAF, I had 15 minutes per patients, no matter who the patient was, or the problems. When they closed our Int Med clinic and I inherited all thier patients, the same was true. Funny how the IM docs had 30 min per patient (pts they knew) and the FP docs got 15 min with new IM patients. PLus as a military doc, the doc does all the data entry, referrals, etc. As a civilian, most of my appts are 15 minutes, but because I HAVE CONTROL over my schedule, those new patients with 15 meds, uncontrolled diseases etc get 30 min. Heck, even a bad sprained ankle in the military comes with a load of red tape (4T profiles, quarters, etc..) that sucks up your staff time.

    3)Military docs ARE IDEALISTIC as you say. That is part of the conflict. Here you have a wonderfully idealistic population of docs, not in it for the money, and here you have this military healthcare system and reeks of everything that goes directly against our idealism (and what the USAF states are their core values). Real USAF Core Values are money metrics and promtion, not excellence, service, and integrity.

    4)Deployments: 100% of the docs that deployed PREFERRED deployment to being in our CONUS clinic. That should tell you something about what it is like working in todays military med primary care clinic. Most of the leadership from the Uniformed Family Physician/Pentagon reps like to refer to our clinics as "war zones". A little over the top, but not off the mark either. :smuggrin:

    5)You say it is "NOT BETTER in the civilian world"; that is generally a big lie. If the military were better, then why does everyone leave, and even more important, why isn't everyone going back to the military as soon as they find out how "bad" the civilian med life is? Yes, civilian med has its problems, but they are dwarfed my milmed problems in comparison.

    6)Your point about acepting what you cannot change is right on the mark. The problem is that some of what is wrong with military medicine is not, and should not, be up for compramise/debate. Everyone has a price, whether it is the price to stay or the price to leave. The price to stay in military primary care; (lack of staff, lack of trained staff, autonomy, pay, safety issues with patients, lack of leadership willing to work WITH doctors, continuity issues, TRICARE) and the list could go on....is simply TOO HIGH of a price for a doctor in primary care to pay, with the poor patient care problem being tops on my list. Look, I am willing to work as hard as it takes to give my patients and my staff great care and a great place to work. I am not willing to work that hard when the end result is still a piss poor healthcare system that places patients at risk, and makes my staff miserable. :(

    7)The night vis goggles and parachute jumping etc sound nice, but in todays USAF Primary care world there is simply no time for those things when you are staffed 20% and 20,000 dependents expecting care. Alot of the unique aspects of being a military Family doc have been removed and replaced with the worst aspects of the HMO civilian world. :eek:

    lets just sell a few of those googles and get me another doc in my clinic to see patients. :idea:
  22. orbitsurgMD

    orbitsurgMD Senior Member

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    Not having to struggle to find a job isn't the issue. Having sufficient experience from military practice, particularly with procedures, if you are a surgeon is an issue. Civilian hospitals credential by procedure. Having current volume experience does matter. Military hospitals have real problems here. Don't minimize that.

    An exaggeration of military hospital capabilities, IMO. In general, the best military medical facilities are no better than better quality civilian facilities.
    NNMC (Bethesda) is not superior to Inova Fairfax Hospital, a well-regarded community hospital near Washington,for example. It has nothing close to the depth in resources of Johns Hopkins or University of Pittsburgh. Not even close.

    Please. Don't embarrass yourself. And quit that ridiculous delusion that doctors who remain in service do so for having been selected for some quality above those who choose to leave. The reverse is true. Those who want professional satisfaction and a responsible employer learn quickly that leaving is the way to find those things.

    That is false on its face.

    Recruiter-speak, there, and not truthful. You get Tricare when you retire, which is poor-quality coverage. A 20-year retirement is not enough to retire well on. Good thing you will retire at 47. You will need time for a second career.

    The proof of the pudding is in the eating. Most doctors leave early. But you suggest that is because they aren't as good, even if they have no trouble finding quality work. Couldn't possibly be that the better ones are leaving and that is why they find work easily, could it?

    Recruit-poster cr*p.

    No you haven't.
  23. Mirror Form

    Mirror Form Thyroid Storm

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    Wow! I've worked in a good number of different clinics across two med cens (although I'm still a resident). I believe your description of your experiences, but that is definitely not even close to the norm (and yes, I've rotated through both FP and IM clinics).
  24. USAFdoc

    USAFdoc exUSAFdoc

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    there may be a difference between large residency med centers and smaller MTFs FP clinics like mine, can't say. But I will say that 100% of people liked their deployment, and people offered to take others place for future deployments.
  25. Galo

    Galo Senior Member

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    What is you specific field of medicine? You say you "run" a department. What department? Are you actively seeing patients, or are you just doing paperwork. I've experienced bosses like you who seem to think that everything is a-ok, (granted you do acknowledge some of the ovious negatives). However, I think you are way off the mark for job satisfaction. You also come off with the typical military, of you have high rank, therefore you must be right. Knuckleheads or not, we served our country honorably, and demanded excellence of a system that is not capable of giving it. So much so that many of us through our frustrations were able to leave the system and be here to tell others about the massive problems facing military medicine today. You are a minority on this forum of experienced military physicians who seem to think military medicine is still a good option.

    The questionable and dismal ability to train their current staff, (death of military GME), the horrible non supportive environment in which to practice medicine, and the constant hassle of non medical events that take up your time away from medicine, are some of the most glaring reasons why no one should risk going into military medicine today.

    I did 6 yrs of active duty as a general surgeon. I would highly recommend no one thinking of being a doctor first join military medicine at this time.
  26. a1qwerty55

    a1qwerty55 Attending

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    Anybody reading this with objectivity will see I am quite even handed.

    One last parting shot - Notice the common refrain - the USAF military treatment system is broken - I agree they are trying to get out of the medical business and have no institutional interest in keeping docs happy.
  27. orbitsurgMD

    orbitsurgMD Senior Member

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    Have whatever opinions you want, but you are not being persuasive when you imply that doctors who leave the military for better training opportunities or for better pay or for just plain better treatment than the services are accustomed to giving have some inherent flaw that doctors who remain in the services haven't got. For those like myself who left to do civilian residencies and fellowships, it very definitely wasn't for the money--I took a pay cut for four years--but it was to better ourselves with resources the military didn't have or didn't want to provide. I don't think that makes me flawed at all. In fact I found it extremely disappointing that the services saw better to waste physician activity in GMO assignments when by taking a longer view of their resources, they could have made use of the obligated repayments of HPSP accessions as fully-trained specialists, who offer much more value than do GMOs. It was and is a tremendous waste of taxpayer dollars and a misuse of personnel resources. But maybe that is OK by you.

    "Glam specialties"? I am not sure which you refer to, unless you mean surgical specialties that are competitive and in demand, which doesn't make them glamourous or trivial. Seems an ignorant and dismissive thing to say.

    So I stand by my observation above, you aren't being even-handed. Far from it.
  28. megadon

    megadon

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    I did six and half years as a submarine officer before transitioning to HPSP. Thus my view is a little different, 13 more years and I can retire, pension, straight to private practice, etc. So, throwing more time on me due to delayed residency is not my biggest concern. Plus, my ex-Marine wife will always be thrilled to know that she is finally making more money than me with her MBA. Anyway, I completely agree that we are in a SNAFU period, and it isn't just the med corps brass, in the Navy anyways it being driven by a profit bottom line driven MBA holding CNO. Look at the line programs and ship acquisition and it becomes very clear. I would guess this is probably also reflected by the Army and Air Force Chiefs of Staff. Good and bad, Rumsfield got what he wanted. To make a long story short, to look at the lunacy of change, the CNO wants to outsource all Pediatric billets to private sector (thus cutting the long term cost of pension and health care for life, a ballooning portion of the military budget, due to TRICARE being abysmal). Other Navy docs have told me this is lunacy and will directyl impenge on virtually every other clinic.
    I have done this junk for a while, four years at Canoe U, then six and a half in the fleet. It is very much a pendulum, and we are in the lunacy phase right now, which is also somewhat reflective in the craziness that is going on with HMOS, med care in general in the regular sector. Medicine is going to change in the next 10 years in this country, and I don't know how. However, being in the military does provide some buffer.
    As far as doing a GMO/Flight/Battle Surgeon/UMO/DMO, they do provide you with priority over graduating students for picking residencies. Plus, they knock out a deployment that you probably need for picking up higher rank down the road. If you take the long view, did you join the military to serve the troops, then you need to do a deployment. If you joined to pay off med school (nothing wrong with that), then do a GMO tour, pay back your time, get out and look for a civilian residency.
    And if you haven't figured it out yet, never trust a recruiter. I had to track one down to get in the program, and the Navy is trying to figure out what they are underassessing. I also worked as a defense contractor while waiting on this deal, and let me tell you, this is no different that being affiliated with any big organization. There is virtually no system to tell the right hand what the left is doing.
  29. 7by11thenout

    7by11thenout

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    The line military has no civilian counterpart -

    No one's job is "to Kill people and Blow up things" so their is no comparisons.

    Medicine is different - the Military leadrship look at us and say, "why cant you be as productive as the Civilian Health care system"

    Well, Lets see if I didnt have to do some stupid Computerbased testing 3 times/month, if I had the adequate support staff so that I could be the Doctor and only do patient care then maybe, but..

    I empty my own trash, change/clean my own anesthesia machine between cases, fill and stock my own cart, clean my own fiberscopes, order and stock my own supplies, have mandatory RSV (readiness skills verification) training, mandatory PT, Mandatory Commanders calls, Mandatory Prostaff meetings, Mandatory ECONS meetings, Mandatory suicide awareness briefings, Wingman Day, EMEDs training (even if you were depoloyed recently to emeds) Cstars training, --

    So during all that time I am not working on patients. I have no secretary to help with the paperwork, I cant get the techs in the preop clinic to take vitals becasue they dont work for me the Doctor (I dont write thier EPRS - preformance reports). I asked the Receptionist in the preop clinic to call the Cardiologist as ask what kind of pacemaker a patient had and the 1 LT nurse pagedme and said that wasn't their job.... I ask them to help me request old records from other facilities and I get blank stares, and I have to fill out and fax the paperwork myself.


    So when you account for all the time I spend doing other stuff I work as much as any civilian anesthesiologist, just not in the OR doing cases so my productivity case load volume seems low compared to my civilian counterpart. and then I have to answer to why.
  30. docstall

    docstall USAF FP

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    USAF DOC:

    I agree with all that you said. I have posted on this forum before, but not in the past year and a half since I left active duty.

    I am happy to agree with the FACT that life is better on the outside in ways too numerous to count. Here are just a few:

    I control my own schedule.

    I decide if I want a day off and take it. I don't need the permission of a bitter nurse colonel who hates me because I am a physician.

    I can implement any program or policy I want in my practice and tailor it to really fit the needs of my patients.

    I can decide the mix of patients I want to see.

    I can decide if I want to to procedures as part of my primary care practice.

    I decide if I want to inpatient care, and can even decide how much of it I want to do and when.

    I make more money now than I did on active duty.

    When I order a test, it is done in a matter of days instead of weeks.

    I haven't had to write (or re-write) one Officer Performance Report. One hundred percent of my time is involved in patient care, not stupid stuff.

    I can be a doctor for the rest of my career, and not be forced into an administrative role because I have been a doctor longer than anyone else at my clinic.

    I enjoy respect from my peers and coworkers, instead of contempt from my commanders. People value my opinion. (The nurses and staff that I work with now laughed when I started civilian practice because they could not believe the true stories I told them about how military physicians are treated and how their opinions are not valued or even listened to. To this day, I don't think they believe me.)

    Regarding the "higher calling" that is touted as a reason for staying active duty: I am still helping people and making a difference in my community even though I am one of the disaffected ones who got out for the "big money and the private parking place." I did my part to serve my country, and I am still doing my part to help my community. Serving in military medicine is not "better" than what I do now in civilian practice. Both help humanity, both are valuable to society in general, and I think it is a little self-righteous to think that every civilian doctor is a greedy slob who is only in it for the money and every military doctor is some sort of "saint" because they choose to stay in beyond their commitment. I signed on the dotted line to serve a certain number of years in exchange for a free education. I fulfilled my obligation honorably and completely, and moved on. I am sure that the military got their money's worth out of me. I am not short-changing humanity by leaving active duty service.

    I can decide how long to spend with each patient. I can give them what I feel they need, to educate them, to make them understand how important taking care of themselves is, to make a friend of them and earn their trust, and to become their true family doctor in the old-fashioned sense of the word. I love my patients (Well, most of them. Some drive me crazy, of course.) I enjoy helping them, I enjoy being there to talk to when they need it, I enjoy watching them themselves get healthy, and so on. I enjoyed them on active duty, and the civilian patients are just as deserving of affection and respect.

    I have never been happier with my job than I have been in the past 18 months. Sure, there are issues in civilian medicine. It is not utopia. But having faced both, I choose civilian medicine. NO COMPARISON.

    I have not faced one minute of regret for separating despite 15 years of active service, except perhaps when I pay my health insurance premium, but that monthly nanosecond of remorse does not outweigh the entire rest of the past 18 months and beyond.

    I am sad to say, but as a veteran of "primary care war zone", and an expeditionary clinic deployment, I am qualified to offer an opinion. The USAF health care system is broken, and according to the USAF Surgeon General, Gen. Peach Taylor, in his own words that I heard with my own ears in 2005, it is not going to get any better. Congress is not allocating any additional funds it improve manning, and as long as they can do the job with current manning levels (not measuring quality, of course) why would they ever invest in increasing personnel? Don't kid yourself on this, readers.

    If you have the desire to stay, and the ability to go through your career oblivious to the sinking ship that is military medicine, then best of luck to you. Just don't say you weren't warned by those who know...

    I for one have not regretted my decision to become a civilian family doctor, spend more time with my children, grow a private practice, do part time hospice work to care for the dying population, and serve in volunteer capacity in my community with the Boy Scouts, and many other reasons.

    One final request to the flamers: please do not attribute every negative comment from every current and former military physician as "sour grapes". We are trying to spare others from suffering through the same dreadful circumstances that we have. I have seen both sides. I think that makes my opinion at least worth hearing. If you are in, get out as soon as you can. If you are thinking of joining, don't. If you do join, choose anything but primary care.
  31. AF_PedsBoy

    AF_PedsBoy Stuffed Animal Overlord

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    Speaking of air force GMOs, what are THEY like? The Navy residents say their GMOs are a mix, from Japan which is supposed to be cushy and relaxed, to shipboard GMOs which are "good experience that you never ever want to do again." I only ask because I'll be a GMO in the air force after finishing about 6-7 months in a transitional program and they haven't briefed me on the GMO pick list or where or what - my impression is I'll essentially be a family practice doc anywhere from some base in the states or overseas or deployed somewhere
  32. island doc

    island doc Senior Member

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    I was an AF GMO for my entire ADSC of four years. I have to say that it is beneath standard of care for the AF to employ GMO's, it was so back then and remains so today. The AF will rationalize this by saying that GMO's possess full and unrestricted medical licenses and by virtue of that possess all the necessary preparation, knowledge and skills to practice medicine. My personal experience has taught me that nothing could be farther from the truth. I have said it before, and I will say it again-the GMO concept is an antiquated relic from the stone age of medicine. This is proof positive that AF medicine in locked in the past and unable to progress. In order to ever progress, the AFMS must totally divest itself of GMO's and all other types of "one-year-wonders" at all costs.

    Now to answer your question: As a GMO in the AF you could be utilized in one of three possible ways: Flight Medicine, Emergency Medicine, or Family Medicine. Which one and where is entirely up to them. What you want or desire is irrelevant. Geez, in flight medicine, the Air Force's most valuable human assets-it's pilots-are be cared for by it's least trained and knowledgeable physicians.:eek:
  33. AF_PedsBoy

    AF_PedsBoy Stuffed Animal Overlord

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    I'm not sure anyone would agree taking someone out of training one year in and then using them in a specialty they didn't train for is efficient, but there you have it, the higher ups have spoken! Pediatrics sure doesn't prepare you as well as a Medicine residency, but I sure feel sorry for the Psychiatry residents...
  34. finnyel

    finnyel

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    I've been watching this forum for long enough to understand that I will have my hands full when I go active duty, sour grapes or not. But I was wondering if those of you practicing family medicine in the AF would be willing to say a few words about what you like about it.

    thanks,
    AF M2
  35. USAFdoc

    USAFdoc exUSAFdoc

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    this questioned has been asked as well many times. I have been on this site for 2-3 years and have yet to see a USAF FP with a good story to tell. In fact, with the 50-100 FP docs, staff I met/know, I only can say that other than the REsidencies, Academy, and some overseas spots, it's all trashed. Finnyel, I appreciate your optimistic attitude, and yes, even in the worst of situations, it is very healthy to look at the bright side. I regularly thanked God for the job, and the opportunity to serve my military patients, and my fellow staff.

    At the same time, the "half empty" portion of a USAF FP clinic is made up by severe undermanning, lack of staff and quality of staff, commanders under the gun to make metrics look better, commanders who have priorities much different from your (the doctor) and you can read the "AVOID Milmed" post for a more comprehensive list, and it is a long list.

    FPs in the USAF are not asking for 1600 tee-times, and leather lounge couches etc. There are BASIC elements of a quality healthcare system that are broken in milmed, have been for years. And unfortunatley, the basic leadership design of milmed is NOT equiped to fix the problems.

    So, please enjoy your "half-full" FP career, but when your DOS arrives I will see you on the civilian side as well. Not because you or me don't love our country or don't desire to serve the troops, but because our standards for healthcare are higher than the gutter, where current USAF Family Med resides thanks to our SG.:(
  36. lacrosse52

    lacrosse52

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    i just got back from iraq and let me tell you the money you save is not worth the price of physical and mental exhaustion just my 2 cents
  37. intubator

    intubator

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    I'll like to say a few things about some of the other comments made in this forum.

    I am currently a resident in a large hospital for the Navy. Someone mentioned something about equipment/education and such. I think we have great equipment. I have been able to rotate in 6 other hospitals in town (and also in Willford Hall for ICU) and I think we have superior equipment and availability of drugs. Nonetheless, some yahoo in charge made the decision a while back to disengage everyone over 65. Now tell me.....what do you think that does for the education for internal medicine, cardiology, surgery, GI, anesthesia, and down the line? It kills it. Yet some how, that saves money because now those over 65 get care at a civilian hospital.

    However, I also work in our pain clinic, and there is not a better population to work with. I feel proud to be able to take care of these guys (marines mostly) that come back from Iraq with wounds.

    I also wanted to comment about GMO status - someone a few posts back mentioned that the Navy will soon have to send over qualified people to fill GMO billets. I think this is happening to some extend, although I am not quite sure it is the reason stated. Air Craft Carriers, instead of having GMO's on them (like I was), it is now staffed with FP docs (they got to love that!).

    Also, it amazes me how detailers take highly trained individuals and stick them in far away places doing things that are a waste of their time. I have known 2 cardiothoracic surgeons get deployed on a ship or something where they may do a few colonoscopies. That does great things for a person trying to maintain skills. :)

    Finally, I wanted to make a comment about my experience at officer indoctrination school that kind of sums up the dichotomy I feel in the Navy. The instructors and people that were billeted to yell at us at OIS would always say that we were "An officer first, a doctor second." I always found this absolutely hilarious......let's see, what did I do to become a doctor? I spent hours and hours of blood, sweat and tears, lost sleep, stressed out, increased debt, etc. over a period of 8-10 years. What did I do to become a Naval Officer? I signed on a piece of paper and gave it to the recruiter - the whole thing took 10 minutes. Yeah right, I can see your point that I should value being an officer over being a doctor.
  38. budhak0n

    budhak0n

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    Eh Dude Ranch, You signed on to the United States Navy... a Military Force. If you don't get the concept that by doing so, you are the property of the United States Government for the Time being... well then frankly you've got your head so far up there it's kind of comical.

    You are an Officer first... a "doctor" is just one of the many skills you have learned in life... The chain of command doesn't change because you can extract an admiral's gallbladder.. That's what they mean.. It's pretty simple really <g>
  39. Tired

    Tired Still winning.

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    Your profile lists you as "pre-health (undecided)", but you blithely dismiss the opinion of a practicing military physician. Perhaps you could detail your vast experience in medicine that makes you think your post is appropriate?
  40. ramstam

    ramstam Member

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    I am starting med school next semester and am filling out my forms to take the HCSP. I have a question about applying for residencies. When you apply you have to list a military site and the rest can be civilian? Can you list, say a military derm. program and four civilian EM programs? It seems like if I choose a difficult military program and less competitive civilian programs I would be likely to be able to do the civilian program. I'm sure I must misunderstand this system and I want to know more about what will happen before I sign. Since the only people that I can ask are the recruiters...and to be honest I don't think they even know. Also, when you apply for the military spots do you list them by location or is it by specialty, so could I list three military derm. programs, and then list civi's for a back-up?
  41. AngryDoc77

    AngryDoc77

    Joined:
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    Ramstam,

    Please, please, please throw away the application for HPSP. As a current practicing active duty doctor, I can tell you that taking the HPSP scholarship was without a doubt the single worst thing that I have ever done or will do in my lifetime.

    I don't want to get into to many details about myself, but suffice it to say that I am currently active duty, I have "served" 3 years, and I have 1 year remaining. I am in a subspecialty.

    I am someone that likes to work hard. I enjoyed working long hours during residency and fellowship. I like to take care of challenging patients. I enjoy challenging myself. The military is CLEARLY NOT INTERESTED IN THIS.

    Even if you completely ignore the difficulties raised by deployments, the ridiculously low salaries, and the bureacracy, the fact remains that the military does not want people that are interested in working hard.

    If you are someone who would be happy with seeing 10 patients a day once or twice a week...or if you are a surgeon, operating once a week...then this would be the perfect job for you. Most of the people that I have met who have stayed in either have very long commitments or do not enjoy working hard and would never ever make it in the outside world.

    I, on the other hand, am a horrible officer. I like to work hard. I don't think the clinic should shut down at 2 PM so everyone can go home, or retire to their office to do "paperwork". I don't agree that you can only do 2-3 cases in the OR per day because you're unwilling to have your nurses or techs stay later. I thought the purpose of being a doctor was to help people regardless of what time of day it is.

    Ramstam, I implore you not to join. Once I am out, in a few years, I plan on starting a scholarship just for people like you who are considering throwing away their lives and their careers with HPSP. If I can get through to just one person, I will really feel like I have done some good. Don't waste your life and your future. Think about your potential and your happiness. The military certainly will not.
  42. Galo

    Galo Senior Member

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    Welcome AngryDoc77. Not surprised at anything you have said. Having been an active duty surgeon in the AF for 6 years, I concur with all the negative you experienced. Most assuredly the pervasive mediocrity that exists when it comes to patient care.

    I have saved many a people from the mistake I made, by just letting see what is possible.

    Unfortunately on this forum you will find a number of malignant active duty cheerleaders, as well as residents, med students, and surprinsingly some pre-meds that will question your ethics, motives, personality, intellingence, and patriotism, just for letting people know what military medicine can be like.

    Look forward to hearing more of your CURRENT ACTIVE DUTY EXPERIENCE!!

    By the way, be careful where you post from. The weanies at HQ monitor this site, and you do not want to find yourself at the end of a computer fraud BS problem. Even the cheerleaders hide their identity.
  43. Tamburlaine

    Tamburlaine

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    Can we to assume that Navy and Army medicine are just as bad as AF? It's funny: it's mostly AF that gets criticized on these pages?
  44. Galo

    Galo Senior Member

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    Although I had limited experience with army/navy, I did talk to some physicians, (surgeons), who faced many of the same problems. Just looking at the forum, in the navy you will have a higher chance of having to do GMO, less so in the army. They all still have similar problems, lack of support, funding, administrators who are MORONS, etc.
  45. italian11979

    italian11979

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    I am a pharmacist and am interested in joining the navy or AF as a pharmacist. Is there any pharmacist out there who is (was) in the navy or AF that can give me their opinions and details on it?
  46. elderjack21

    elderjack21

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    I have found this to be a systemic problem with every organization that I have ever worked in or been involved with.
  47. NavyFP

    NavyFP Senior Member

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    This is why Dilbert is so popular and Scott Adams is never at a loss for material.
  48. Galo

    Galo Senior Member

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    Although this is true, I do not think the money generating civilian environment is as prone to this as the.... what nurse or MSC officer is left to promote and do the job which he/she is barely qualified to do with the most minimal of skills. Its a pervasive attitude of mediocrity and maintaining status quo, and concentrating on minutia that often times go directly against the acutal mission of patient care.
  49. 350011

    350011

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    Do you think the issue is that their is a moderate to strong financial incentive for NC, MSC to stay in the military as pay of rank matches or exceeds civilian pay and, basically, no financial incentive for MC to stay through past obligation? It seems like the financial incentive would lead to more of those NC/MSC types going for 20 years, attaining higher rank, and gaining greater administrative duties regardless of their inclination towards the military. Conversely, it would seem that the only docs who stay in either A) really want to be in the military, enjoy the culture and opportunities enough not to mind the BS and red tape; or B), as characterized in this forum, don't really have many options on the outside. On the NC/MSC side financial considerations promote retention whereas on the MC side they promote service and separation. Is their an issue where MC Officers would stay in but, as they move up the ranks, the administrative duties accumulate to the point that their practice becomes secondary? I know that would kind of be a red flag for me later on.
  50. Galo

    Galo Senior Member

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    I can remember as plain as yesterday sitting at a commanders meeting where the MORON from the surgeons office had a slide outlining the typical career of a medical officer, and as soon as you hit Lt. Col, you start being farmed out, (forced) into administrative positions. Oftentimes those start hitting majors, as there is more and more physicians leaving the service. Who would want to be at the peak of their profession to suddenly become a manager??

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