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Military Medicine: Pros, Cons, and Opinions

Discussion in 'Military Medicine' started by Homunculus, 04.26.06.

  1. bibio7

    bibio7

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    In what areas exactly do you think the Surgeon Generals are not providing anything more than lip service? The Military Health System is currently doing all it can to provide the best health care for service members. We've been at war for years, and YES, I do agree the service is probably not where it needs to be but what exactly do you expect from a military working to focus on several missions at once?
  2. bibio7

    bibio7

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    And what exactly is wrong with that? What is wrong with having a chain of command? What is wrong with being the property of the U.S. government, as you have so called it? And what is wrong with being an officer first? Yes, that is what you are when you sign up to join the military. If those few, limited ideas and mindsets are the issues you have, then you need to start looking for newer ones.
  3. GtownCobra

    GtownCobra Junior Member

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    Folks, I'm sorry to intrude with a personal question, but I can't seem to find exactly what I'm looking for on these threads:

    Most of the discussion regarding military medicine focusses on clinical care. I'm a civilian pathology resident considering an Army or Air Force FAP. How do you folks view pathology in the military?

    I'll admit, I was considering the FAP to get a jump-start on cracking down on my loans (which are substantial).

    They recently increased FAP compensation to nearly 70K a year, so I think it's actually worth it, in the long run. Especially since I only plan on completing my 4 years of service (for a 3 year FAP) and moving on to fellowship.

    Any thoughts would be greatly appreciated.
  4. Homunculus

    Homunculus SDN Caveman Administrator Moderator

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    try posting in the general forum. we have a couple of pathologists who may be able to answer your questions. geoleox i'm pretty sure is one of them.
  5. USAFdoc

    USAFdoc exUSAFdoc

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    1. Look at the set of USAF Core Values, then work as a doc in one of the USAF Primary Clinics and you will NOT see any of those Core Values implemented by the leadership at Command levels (SG). One of my Commanders said just that, just being honest to us, frustrated at the SG 's office and lack of concern over the issues taking place in our clinics.
    2. Listen to various SG briefs to Congress over the past decade on Primary Care in the USAF. For the most part it is described in glowing terms and "best healthcare in the world." For those that have actually "lived there" it has been the "worst" healthcare infrastructure" we have ever seen.
    3. Hear the footsteps of docs leaving MilMed asap. and notice the mass advertisement campaign as Milmed tries to covers its tracks. HAving "chased out" numerous docs that already had the milmed training on Ahlta, deploying, and how to best function in a broken Milmed system, not to mention at least a few years of doctoring completed, they are trying to replace with fresh meat the docs theyalready had, and could have kept, if they were not so inept at running a clinic.

    its all sad, (and paid for by your tax $$$) :(
  6. Medicalgesia

    Medicalgesia

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    hello,

    i see a lot of people aren't happy with military medicine. i'm a first-year medical student, thinking of committing to military medicine. not because of debt, not for a supposedly better medical setting - but to do something "different." i grew up thinking i wanted to go into the military, always fascinated by working hard, being competitive and getting dirty.

    maybe i was too timid to pull the trigger and actually join. in high school, i was serious about service academies and ROTC programs, but ultimately i was drawn to a d3 college for sports and academics. there, i found my calling was research and medicine; i dismissed military medicine because i though i'd just be working with patients of whom i was jealous (guys doing the real work of our military - putting themselves in harm's way, etc).

    however, to my main question - i've recently heard about less cookie-cutter roles that military docs can do. i'm curious if anyone can expand on some of the more "different" or "adventurous" things one can do in military medicine.

    thanks

    (first time on sdn. not too sure how it all works... if this would be better suited as a new forum, please let me know. )
  7. EMH

    EMH M4 - Army NG

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    I'd like to ban-hammer everyone who replies to any argument with the following argument:

    "You're too young/inexperienced to know what your talking about so what you say doesn't matter/is wrong"

    If you think what someone said is wrong than say so and support your position.

    Edit: changed wording to be more clear.
    Last edited: 06.21.08
  8. Boopieness

    Boopieness public health/pathologist

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    One can do something different in the reserves. 90 day deployments are opportunities to serve and get away (to other countries and experience different cultures) to do something different and training for the schools are the exact same as for active duty.

    e.g flight surgeon, diving medical officer, attached to special forces directly supporting them without being brutalized by the initiation, helo training, civil affairs teams - you would be surprised what they do and how they do it. All sorts of humanitarian short term missions for the two weeks a year:El Salvadore, Guatemala, Guiana or even things like monkey pox research in the Congo.

    If you want to be miserable, go Active. Living under austere conditions, practicing in remote areas with bare minimum resources is a challenge. I enjoy the National Guard, but I know that I would be miserable if I did my military service 365 days a year.

    The docs serving the active military who I saw as happiest were the public health service officers serving the coast guard and marine corps as well as the very rare special forces docs - either attached or tab qualified and the rare helo med doc who underwent their exact same training.

    In the National Guard you see docs all around putting in their twenty because they enjoy it and it breaks up the monotony of civilian practice. In addition, you are revered and appreciated by your civilian colleagues because you have the guts to step forward while they are prohibited by spouses, debt, children, practice obligations that would restrict their ability to do what the reserves docs do.

    I underwent combat water survival training in the Army flight surgeon course and I loved it because soldiers rarely if ever get that type of extensive water training. It was actually challenging and fun. Hopefully, I'll never have to use my ability to egress from a sinking inverted helicopter crash, but at least I have been trained.

  9. EMH

    EMH M4 - Army NG

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    Thanks for that boop. I'm about to sign up for the ARNG. You seem to have summed up what excites me about the guard quite well. To the OP check out this thread about the Army national guards new med student program.

    http://forums.studentdoctor.net/showthread.php?p=6812643#post6812643

    To be clear, you seem to have used reserves and NG interchangeably. Was your experience with the guard or reserves. And if you're knowledgeable enough about it, could you clarify the differences in experiences a doc would have in each?
  10. kwick release

    kwick release urologist

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    Got my resignation paperwork (DD-214) and I am officially out of the Navy as of June 2008. I am a civilian now with no more ties to the military or IRR, so I can finally speak freely! :hardy::hardy:

    First off, to those considering following in my footsteps, buyer BEWARE! :scared::scared:

    I signed up for the Navy HPSP program in 1990 hoping to serve my country and at the same time get medical school paid for. I finished medical school in 1994. After internship and a 1 year GMO tour with the US Marines (my best 1 year in the Navy!), I went on to complete my residency and then a fellowship. At the end of training, I owed 6 more years of pay back and finished my Navy career at Portsmouth Naval Hospital (probably the worst of the big 3 Naval Hospitals) as an attending Urologist and a Commander (O5) in the US Navy.



    Things I despised about Navy medicine:

    1. the horid bureaucracy run by nurse administrators and drop out incompetant clinicians who are only interested in their own self advancement at the expense of good patient care

    2. the military's pathetic excuse for an EMR called CHCS II/AHLTA (if this is not $12 billion dollars of fraud, waste, and abuse I don't know what is!!)

    3. the lazy and incompentant civil servant employees that you can't fire

    4. TRICARE is a complete joke of an HMO (I paid extra to get my wife's delivery done on the civilian side)

    5. the perpetual turnover of ancillary staff (nurses, surgical technicians) makes the military operating room a dangerous place (my experience so far with the civilian OR is like night and day compared to the Navy!)

    6. the pay was 1/5 of what I am making now, but I knew that going in

    7. when you are in, believe me, they got you by the b*lls and you are US government property


    Things I liked about the Navy (not necessarily Navy medicine):

    1. served my country and proud of it!!

    2. opportunity to see the world

    3. did my best to help the enlisted members (they are the true heros)

    4. now I am debt free


    Currently I am in private practice and loving it! :D:D


    Fair winds and following seas....
  11. Gastrapathy

    Gastrapathy no longer apathetic

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    :laugh::laugh::laugh:
  12. TRJN71

    TRJN71

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    I've read through most of this thread and some other related threads on here, and it seems like people are definitely down on the Air Force medical system. Is the Army system is any better?
  13. Galo

    Galo Senior Member

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    Although I was not in the army, (AF 6 yrs general surgeon), and some psychopath may jump down and try to denigrate my experience, things may be slightly better in that you may get to choose what you want to do, but the training is still army, you still give up certain freedoms most americans take for granted, you still will deploy, etc etc. Its military medicine, and I think it's a bad choice if your aim is to learn and practice good medicine. If you want to be a military officer, then keep reading, and see if you think it may be a good fit. Also call up as many active duty docs as you can, and remember this is an internet forum.
  14. a1qwerty55

    a1qwerty55 Attending

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    Well, if you take in to account the Army still has medical centers, well respected residency programs, and more opportunities for continuous training, I would say yes. Contrary to other posts, the training is generally excellent at least in the nonsurgical specialities. Surgery has more challenges with regards to case loads but in general I've felt comfortable with the graduates from the programs, I've worked with.
  15. Galo

    Galo Senior Member

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    This author also wrote this as a description of military medicine, (he is army by the way), and apparently still stands by this statement as he recently stated so. They do not seem totally congruent statements, but you decide for yourself:


    Originally Posted by a1qwerty55
    There once was this unwritten understanding that the discrepency in pay between military physician and civilian pay was offset by professional and personnal benefits of military service. For example, work hours were generally less, hassles (insurance, billing etc) less, and the system worked much like a traditional academic medicine system with time for CME, GME and research.

    Then the HMO craze started becoming the norm in the civ sector so the government started to try to apply civilian performance metrics on military providers with providing them with any of the resources and incentives that HMO's provided their docs.

    Roughtly the same time the bean counters figured, hey let's unload the retirees - and make them use medicare and go civilian - not a good move for residencies or for subspecialists who need old people with old people diseases.

    They started collecting bogus metrics ala UCAPERS, RVU's, whatever which were based on totally erroneous data. With flawed data, they started to cut positions since it was so apparent to them that we (military docs) were a bunch of inefficient dolts. Panels increased, and life got really bad for the primary care docs in particular. Time for research disappeared and lifestyles were degraded....

    JCAHO then became this plaque that appeared and administrative requirements went through the roof. As we increasingly lost sight of the real mission PATIENT CARE, we started to alot days for sexual harrassment training, Consideration of other training, NO FEAR training, Ethics, Customer service, Sex abuse responder training, HIPAA, CBRNE and a zillion other training requirements which only served to degrade patient care further. We have closed my clinic several times this year to try to get this generally useless training accomplished.

    Guess what? The "benefits" of military service - quality of life, access to training, research etc, disappeared and people started to head for the exits. The exodus wasn't really noticed because we had like 8 years worth of docs in the pipeline either in residency, or obligated through HPSP or USUHS. Adding the "War on Terror", to the mix further demoralized staff especially as deployment decisions were in many ways not equitable, and the increased workload required on nondeployed staff ballooned. Then, more headed for the exits (more than could be filled by HPSP and USUHS accessions). Add to that the decrease in HPSP enrollment in the past 2 years and in 4-5 years you face a cataclysmic collapse in the system.

    So where are we? In a very bad place.

    Attempts to privatize military healthcare or high civilian contractors is almost uniformly a failing enterprise. Let's face it, the civilian job marked it very tight and pay higher there, so who do we end up hiring? A bunch of FMG's who have no buy-in to the system and don't feel any particular ownership or appreciation for the military beneficiary.

    I wish I had reason to be more optimistic but our rating systems do not allow for the best and brightest to become policy makers and GO's, thus in some respects the crap floats to the top. Lastly because we do not have a seperate funding stream distinct from that where beans and bullets are procured, there will always be attempts to raid medical funds to support ongoing combat ops - further degrading care and morale.

    My solution - a unified medical command, a competely seperate budget stream, a rating scheme which is based on clinical skills/excellence, bedside manner, in addition to administrative skills. Protected and dedicated funds to each doc for CME. Reasonable work hour guidelines, taking into account mission creep - "do more with less".
  16. a1qwerty55

    a1qwerty55 Attending

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    I would argue that there are two different issues, my post you referenced was an attempt at a historical outline defining the events which have befallen military medicine most of which also has affected/degraded the quality of life and care in the civilian medical world as well.

    Some of my pessimism is now tempered a bit by the prospect that recruiting is not as bad as projected (although I still have concerns about the overall caliber of new accessions), and if the situation in Iraq continues to stabilize maybe we can reduce the deployment frequency. There have been some positive changes since that post.
    - deployments for AMEDD personnel (nurses, docs) are now 6 months rather than 15 at the time of the post (at least for those at hospital level)
    - some movement albeit anemic with regards to bonuses - to include a first ever nurse professional bonus.
    - Improvements to AHLTA and prospect for more in coming year
    - Funding increases (likely a direct outcome of the Walter Reed Post Articles)
    - Interest in recapturing retirees as new budgeting plans rely heavily on workload, which means you can preserve or increase your budget by capturing retiree workload.

    My recurring theme is that warts and all, there is still excellent care being provided, the mission is essential, and there are positives both professionally and personally to serving. I'm all for full disclosure for prospective applicants, but I take exception to the broad generalizations and misinformation which often show up on this board.
  17. michellejmcnama

    michellejmcnama

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    I am a new member and realize that you had posted your message several months ago, however, I felt that I had to respond. I am currently a third-year resident in pathology. I am also an army veteran of 7 years; I was enlisted (sergeant). One thing that my military experience taught me is that once you sign on the dotted line, you have given away your right to make decisions for yourself until your obligation is complete. I would think VERY hard before taking that scholarship. Most civilian residencies participate in ERAS and the match. Two of my medical school classmates with HPSP "matched" in military primary care training programs in the winter of their senior year and were, therefore, not eligible for any of the civilian residency programs for which they had applied. Taking out $150,000 in student loans may be daunting, however, I felt that it was worth it to be able to choose what I wanted. Pathology is becoming increasingly competitive (generally speaking there are probably 300 applicants for every 10 positions), and there are only a few available positions in the military (all branches). If I couldn't get one of those positions, would I be a GMO until my obligation was complete, and I could apply to the civilian matching program? That was not a possibility that I could live with. At the time that I was in the military, I was married...was I stationed at the same post with my spouse...absolutely not. The bottom line in the military is what they need, and not what you want. Be very careful...you can always pay back loans.
  18. michellejmcnama

    michellejmcnama

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    I am a new member and realize that you had posted your message several months ago, however, I felt that I had to respond. I am currently a third-year resident in pathology. I am also an army veteran of 7 years; I was enlisted (sergeant). One thing that my military experience taught me is that once you sign on the dotted line, you have given away your right to make decisions for yourself until your obligation is complete. I would think VERY hard before taking that scholarship. Most civilian residencies participate in ERAS and the match. Two of my medical school classmates with HPSP "matched" in military primary care training programs in the winter of their senior year and were, therefore, not eligible for any of the civilian residency programs for which they had applied. Taking out $150,000 in student loans may be daunting, however, I felt that it was worth it to be able to choose what I wanted. Pathology is becoming increasingly competitive (generally speaking there are probably 300 applicants for every 10 positions), and there are only a few available positions in the military (all branches). If I couldn't get one of those positions, would I be a GMO until my obligation was complete, and I could apply to the civilian matching program? That was not a possibility that I could live with. At the time that I was in the military, I was married...was I stationed at the same post with my spouse...absolutely not. The bottom line in the military is what they need, and not what you want. Be very careful...you can always pay back loans.
  19. kwick release

    kwick release urologist

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    Came across this website while surfing the net for other disgruntled ex-military doctors that have recently resigned their commission.

    37.5 Reasons Not To Join or Stay in the USAF Medical Corpse

    http://www.medicalcorpse.com/37reasons.doc
  20. cbiscuit84

    cbiscuit84

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    If I sign on Navy HPSP, what is my time line? My recruiter tells me that my obligation starts after my residency training, but I keep reading posts about people who have several yrs between their intern yr and when they actually start residency.

    What is going on? Why does the Navy want partially-trained doctors serving on boats? Why not just train me all the way through so I can fulfill my duty properly?

    I feel like I am considering HPSP for all the right reasons, but I am not very excited about postponing residency for several years.

    Would appreciate your response.
  21. EMH

    EMH M4 - Army NG

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    I'm not an expert on this but I'll throw in my 2 cents.

    The GMO is a way for them to get extra time out of you. The GMO to me is the downside of the Navy HPSP. If not for the commonness of the GMO in the Navy I'd think that branch sounds the best of the three.

    My impressions of the biggest negative differences in the branches
    Navy: GMO
    AF: The AF docs complain the loudest
    Army: Good chance of spending a lot of time in the desert
  22. Gastrapathy

    Gastrapathy no longer apathetic

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    Used to post here a lot. Has dropped off the planet..anyone know what happened?
  23. devilpup

    devilpup

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    Yes, I was wondering the same thing...
  24. kwick release

    kwick release urologist

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    Maybe THEY got him!! :laugh::laugh:
  25. orbitsurgMD

    orbitsurgMD Senior Member

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    It depends on what they need and to a lesser degree on what you want.

    You will be required to apply for the military match in your last year of medical school. If you are requesting a deferment for civilian training, and they are granting deferments (they often don't, or not for many specialties) and are accepted, you can be allowed to complete an entire residency in the civilian program where you can match. But if you are "accepted" (read: assigned) to a military training program, you must take the military program. You can refuse to do a whole residency with them, but you will still be required to do an internship and then do GMO time until you are granted the program you want or are able to leave once your HPSP obligation is repaid in term of service (3 or 4 years after internship).

    Your recruiter is presenting you only one possible scenario, maybe the best case scenario. If you want training in a competitive specialty, you will probably not get a slot straight away and will have to do a GMO tour (or two.) Why? Because they just don't have enough training slots in their organization to accommodate all of the possible candidates. They rely on some candidates just getting out at the end of their GMO tours. Doing a GMO tour has become a filtering device for applications, and in some hard-to-get fields, not having a GMO tour renders you non-competitive.

    Why use under-trained doctors? Because they can and because hiring replacements on the open market is more expensive. They would have to attract residency-trained and board eligible/certified physicians who would rightly expect better pay and support than they can offer a minimally-trained intern who depends on the goodwill of his (criminally derelict and abusive, government) employer for the opportunity to go on to further residency training of his choice.

    BTW, no U.S. civilian hospital would find you fit for work as other than a second-year house officer having done only a year of residency training; the Navy will put you in places and situations where you have no business practicing medicine. Anyone who says different I don't mind calling a liar.

    I recommend you don't take HPSP. It has been a much-abused program by the Navy particularly, and it is failing to attract the same quality of applicants it regularly attracted in the past. Getting an HPSP scholarship was actually competitive at one time. Not anymore. They can't give them away. In my Portsmouth intern class, there were med school graduates of Duke, Columbia, Harvard, UCSF, Cornell, Mayo, Yale, Temple, NYU, Georgetown and other similar schools. That doesn't happen so much anymore, even as medical school has become much more expensive and the "scholarship" presumably more valuable. The sad fact is that as the catalogue of Navy abuses of its junior physicians has grown longer, there are more than just a few former Navy doctors who can give the warning to medical students to keep a wide berth of that program. At this point, the Navy just can't get out from under the shadow of their own deservedly bad reputation. C'est la vie (pas la guerre).

    At least you can read this board and think of your options.
    Last edited: 07.30.08
  26. RedLemond

    RedLemond

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    I just received an interview invite to USUHS for Oct 16. How many of you attended USUHS vs. receiving the military scholarship for medical school - and does that make a difference in opportunities for a residency? I'm interested in USUHS because of the tropical medicine and field medicine training, as well as opportunities to travel. Ultimately I want to serve in an underserved area - at home or overseas, and the training advertised at USUHS seems optimal for preparation for such a career (including leadership training). Plus the students I'd be in school with and the patients I'd be serving would be top notch during military service - seems like it would be a great atmosphere for medical school as opposed to every man for himself. What are your comments on my assumptions/observations there? Also - this may seem like an outdated question - but is there any sexism going on in military medicine? Will it be more difficult for me, as a woman, to compete for residencies - especially if they're ones that have been traditionally filled by men -such as surgery and urology?
    Thanks so much for any feedback!:)
  27. Galo

    Galo Senior Member

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    You are at a very early stage to sign your life away. I'm assuming by now you have spent alot of hours reading the stickies, and possibly taking the advice of contacting current active duty docs. You have alot of misconceptions about USHUS. The one's you need to realize before you do anything, is that you will be signing away your rights for 7 yrs. You may not be able to choose the specialty you want to go into. You certainly will not be able to choose where you live and who you work with, and while the military bills itself as free of racism and sexism, both are very much in play, as I saw it. Military officers are just human, and flawed just like other humans not in the military. The problem compounds when you get one very flawed human, but suddendly he/she has extreme power, (rank), and you get the picture. As far as leadership training, perhaps some who went to USHUS can comment. You are going to medical school to become a doctor, and then hopefully choose a practice of your own choice.

    Best of luck, but I think you need to do some extensive reading and thinking.
  28. crazybrancato

    crazybrancato

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    Wow Galo . . .you are jaded beyond belief! I luv it . . .what on earth happend to you?!

    little dramatic here, don't you think? by joining the military, you're not signing away your rights. you still have your rights. Privelages now may come and go . . .

    its not a "certainty" that you wont be able to choose where you live or are stationed. Orders are negotiable, and the military tries to negotiate with officers especially, b/c they tend to be highly educated and expensive (so they're interested in retention). Now having said that, a need is a need, and if the military needs you somewhere, they will cut you orders and move you. That's reality in military life . . . but I wouldn't say that's a "certainty". 7 years in, (6 sets of orders), I've always gotten what I've asked for.

    Tis true. but the military doesn't "bill itself as free" of racism/sexism. If that were the case, then it would completely ignore these problems and not enforce training/policies that address it. That's not the case. There are such training/policies. How effective they are is another debate.
  29. Galo

    Galo Senior Member

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    What happened to me has happened to alot of free thinking smart individuals caught in a complex system run by ignorant to mediocre self serving careerist who put themselves before patient care. It has been covered before when I first joined this forum though I doubt you really want to know.

    I'm guessing that you served not as a doctor, and so think you can pass on your experience to those potentially thinking of being in the medical corps.

    Its a known fact that when you join, you serve to protect rights that you no longer have. You are basically property of the goverment, and they can do what they want with you. Certainly you do not have the right to choose your specialty. Ask how many of the up to 30-40% of incoming GMO/FS asked to delay their training for 2-4 yrs. Or to be forced (with the choice of staying a GMO/FS) to do residencies that may not be as good as civilian ones. Or forced to go to a place where as a surgeon your biggest case was the equivalent of an occasional appendectomy, and skin lumps, while your skills whither. Unlike you, I do not know ONE doctor who got his/her orders changed because it was more convenient for them. I do not want you to mislead people reading this forum with no military knowledge. When you sign up, you do as your told, that includes moving, deploying, medications, vaccines, etc. Also, once you are somewhere, if your boss is a mindless idiot, you are stuck there till either of you leaves. So no, you do not get to choose who you work for. In the civilian world, if your boss is an idiot, you always have the choice to leave, no matter how incovenient. Also you have time to do your homework on the people with whom you may be working with or for.

    The military may bill itself as racism/sexism free, but you cannot escape the behaviour of few, especially when it seems to be condoned. Tailhook, USAF Academy rapes, sexual assaults in Iraq. Its got no comparison to the outside world, but its not free of it.

    My whole point is, people need to know what they are signing up. If they are willing to live with what MAY happen, then go for it.

    What was your job in the Navy?
  30. crazybrancato

    crazybrancato

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    No, I'm not a doc, but have served as a SWO and an EDO officer, have been the division officer of some 100 sailors at one point or another. I can't speak of any experiences in the med. corps obviously, but I can speak of experiences in the military, in general. i've gone through my share of tough times, perhaps in different contexts than yourself.

    really??? exactly what "rights" did you give up in joining the service? Again, I think you're being overly dramatic.

    No, not really. They can't give you an unlawful order. They can't ask you to pilot an F-18 not having gone to flight school. ok, that's an extreme example. but they can't ask you to do something that's grossly out of your job description. now if you're a Ped, and they want you to go be a GMO somewhere, then so be it. that's not out of your job description, you're still a doctor. and you're right, you should understand that that's a possibility before you sign up.

    ok. So how about the doctors that have received their chosen specialties, and are happy with their assignments? Are they just delusional???

    Really, not ONE?!?! I've talked to several at Balboa (including some close friends, so I know they're not BSing) that got the orders they wanted, and everything turned out to be convenient for them. Again, maybe they're delusional.

    relax boss. no one's trying to mislead anyone. if anything, you're doing just that with your border-line fanatical rhetoric.

    look, your opinion regarding milmed is very valid and important, and goes beyond my knowledge. If your jadedness was confined to just milmed, then I'd totally understand. But that doesn't seem to be the case. You're implying that joining the military is the worst thing somebody could do ("losing your rights", "becoming gov't property", etc). And that's just not right. Again, as the DIVO of several kids, I've seen the military work wonders for people, especially when they harness all of the opportunities afforded to them.

    No, I'm not a recruiter (I think we should get rid of all recruiters), and no, I'm not a doc. But I've walked in enough shoes in this business to see many members (in all professions) become so jaded that they continuously bash being in the service and make exaggerated claims. the military isn't all fun and games, and I agree that you have to seriously consider what you're getting yourself into . . . but it's not as bad as what you project.

    wherever you are, you seem to be enjoying enough leisurely time, during which you're logging on here and posting lots of comments, so life can't be that bad, right?!?
  31. Galo

    Galo Senior Member

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    really??? exactly what "rights" did you give up in joining the service? Again, I think you're being overly dramatic.


    No, not really. They can't give you an unlawful order. They can't ask you to pilot an F-18 not having gone to flight school. ok, that's an extreme example. but they can't ask you to do something that's grossly out of your job description. now if you're a Ped, and they want you to go be a GMO somewhere, then so be it. that's not out of your job description, you're still a doctor. and you're right, you should understand that that's a possibility before you sign up.


    ok. So how about the doctors that have received their chosen specialties, and are happy with their assignments? Are they just delusional???





    relax boss. no one's trying to mislead anyone. if anything, you're doing just that with your border-line fanatical rhetoric.

    look, your opinion regarding milmed is very valid and important, and goes beyond my knowledge. If your jadedness was confined to just milmed, then I'd totally understand. But that doesn't seem to be the case. You're implying that joining the military is the worst thing somebody could do ("losing your rights", "becoming gov't property", etc). And that's just not right. Again, as the DIVO of several kids, I've seen the military work wonders for people, especially when they harness all of the opportunities afforded to them.

    No, I'm not a recruiter (I think we should get rid of all recruiters), and no, I'm not a doc. But I've walked in enough shoes in this business to see many members (in all professions) become so jaded that they continuously bash being in the service and make exaggerated claims. the military isn't all fun and games, and I agree that you have to seriously consider what you're getting yourself into . . . but it's not as bad as what you project.

    wherever you are, you seem to be enjoying enough leisurely time, during which you're logging on here and posting lots of comments, so life can't be that bad, right?!?

  32. regnaR175

    regnaR175

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    Posted elsewhere
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  33. brentb23

    brentb23

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    .
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  34. undecided2009

    undecided2009

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    the right to work hard in med school to choose the specialty/career and program i want to train in after already have made sacrifices, which equates to hard work doesn't always pay off. there were more than plenty of long nights with the books when i could have been enjoying my life, friends, and family considering the outcome compared to what i thought it would be...
  35. Galo

    Galo Senior Member

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    Just to clarify, I did not ask that question. I know fully well what rights you give up, and I totally agree with your statement.

    You'd think that I would know how to use the quote function properly on this forum, but I guess I do not. I was answering that question to "crazy brancatto" who apparently was in the navy line for some years, has committed himself to either USHUS or HPSP, and has taken it upon himself to trash us for pointing out the truth about military medicine as if denigrating us will make military medicine not the pile of crap that it has become for multiple reasons talked about in this forum and other places consistently by many current and post active duty physicians.
  36. crazybrancato

    crazybrancato

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    Allow me to demonstrate the proper usage of quotes:

    Yeah, you would think that. The problem here is that you're so blind-sided by your own bitterness and jadedness that you can't think straight! I hope you're more attentive in the OR.

    Oh thank you wise "truth-teller", so sorry for challenging you.

    Don't be such a baby. Do you really get this upset when someone challenges what you're saying? Can't take the heat, step out of the engine room!

    The problem here is that most of the opinions on this forum tend to be negative. And that's fine, but you can't get so upset if someone offers a different opinion.

    You Galo are a special breed of bitterness. At least the others (IgD, ActiveDutyMD) can be somewhat positive at times.

    I really doubt that you're happy. I know you've said you're happier in your civilian life now, but I doubt that. I'd bet if we had the chance to interview some of your civilian colleagues, they'd claim you to be the same bitter guy we see here. The only difference is that your civilian institution probably doesn't have a forum, where you can log on to b!tch. So you take your rage out on the rest of us here. . . . waytago, so mature.

    Hey whatever floats your boat . . .I hope that by expressing your rage here, you can be happier elsewhere in life!

    Toodles,

    [now, you can reply using quotes. I purposely wrote a long post, so you can have some practice.]
  37. Galo

    Galo Senior Member

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    The mark of a true moron is someone who has such faith into a system they do not know much about and can only get his jollies by insulting others who put down that system. You are a special breed, and will either be very sorry one day, or will be part of the system that continues to breed mediocrity in its doctors, I'd bet the latter.

    I wonder what your colleagues would say about you.

    You are now dubbed clueless cheerleader.
  38. Mirror Form

    Mirror Form Thyroid Storm

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    Correction, he can get upset if somebody with ZERO milmed experience as a physician begins posting comments in reference to being a milmed phyisican that are both naive and personally insulting.

    Perhaps if your previous posts weren't so rude and ridiculous you'd get a different response.
  39. DrMetal

    DrMetal To shred or not shred? Lifetime Donor

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    I've been reading a lot of your posts. You do seem to be very 'jaded' as mentioned above, but that's ok, I'm sure you have your reasons.

    I think amongst all your posts, the most common theme is that of 'mediocrity', you seem to stress that a lot.

    Do you mean to say that everyone you worked with in military medicine was mediocre??? You never ran into someone (a colleague, a mentor, a subordinate physician even) who struck as a 'great' doctor??? Maybe someone who cared for you with great detail, or cared for one of your dependents.

    I'm not in milmed yet, but I do have 8 years in the RL Navy, and have been a patient (a 'customer') of milmed on several occasions, as have my dependents. The last thing that comes to mind (based on my experiences) is 'mediocrity'. My health care professionals have tripped over themselves in taking care of my dependents and I. Maybe it's b/c I'm an officer, maybe I've just been lucky.

    I'm sure there is mediocrity in milmed, as there is any walk of life . . .but to make blanket (or near-blanket) statements that all are mediocre, I don't think that's accurate.
  40. Galo

    Galo Senior Member

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    Thank you for pointing this out. Its no secret that I think military medicine is totally messed up and getting worse. I will try to qualify why I mention mediocrity so often, and why I think its one of the biggest problems facing military medicine today.

    First off, I would like to say that there are MANY good physicians in the military. I met and got taken care of by many good ones, and I also knew who to stay away from. They are young, hard working, dedicated, and thirsty for advancement of their careers as PHYSICIANS, ie to advance their skills, to continue to learn, etc. The problem is that the military structure does not lend itself well for this. I can remember clear lectures from the surgeon general showing a progression in rank would mean less time being a physician, and more time doing administrative duties. Invariably, the vast majority of physicians see this as a dead end, and leave the military at first chance. This leaves a number of doctors who then get in charge, or worse, nurses or administrators who get in charge, that have NO idea what a particular physicians job really entails. There is no money for CME, there is no purchasing of new equipment, to try and do new procedures may take trying to convince multiple people who are not physicians, and who really do not want to bring risk into their "command," who are fine with the status quo, and concentrate more on metrics than on the advancements of medicine. As it happens that most major medical centers have closed, this becomes an evergrowing problem that not only impacts current AD physicians, but most important, residents trying to learn. So the combination of all these failures in MY experience breeds mediocrity, trying to make advacement, and changes is a staggering often impossible and unattainable goal. With few exceptions some physicians who attain rank have the ability to stay clear of administrative positions and continue to practice and advance thier skills as well as pass them on, but with the continual brain drain, this is becoming harder and harder. There is absolutely NO comparison in the level of education and innovation when you compare mil med today, to a university program.

    SO, I do think mediocrity is a serious problem brought on by a host of other serious problems. You may find doctors tripping over themselves to take care of you and your family, but it often comes at a professional military price. Especially if you are seen as bucking the system and not working well within it. If you happen to see that system as broken, and do more to take care of your patients, then you have problems coming. I did.

    Its no secret that there are multiple problems. Just like when I was in the military, I pointed them out often, and loudly. I think that is a flaw of mine to not be able to keep my mouth shut when I see what I believe is a problem affecting my ability to take care of a patient. Seems that just like then, some people just don't want to hear about it. Have (by some miracle) had better experiences, or just have a blind faith in a system they really know nothing about, but think they do. It truly is complicated how all these problems have come together to make military medicine just a shadow of what it once was. I am still very bitter about it not only because it sucked, but I think the people in the military deserve better.

    Once again, I place this link so people can see that I am not the only one who has issues with military medicine.

    http://www.health.mil/Debates/Debate.aspx?ID=9&a=1

    I hope that clarifies a little what I mean by mediocrity in military medicine today.
  41. DrMetal

    DrMetal To shred or not shred? Lifetime Donor

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    Ok, so I follow you right, you're talking about a general 'auroa' of mediocrity. But there are individuals that become great doctors in milmed, and you certainly wouldn't label them (the individual) as being mediocre.

    the doctor who treated me (and who I've been talking to at great length regarding mil med) is an O-6 internist (it think he's the chief, or just an senior attending, i dunno for sure). he kind of agrees with what you're saying. He claims that he could've easily taken the 'admin' path, work a 9 to 3 job four days a week. Instead, he chose to continue seeing patients and publish case-studies. He sais his work still involves a considerable amount of admin--and he agrees with you in the sense that if admin is not your forte, then you should steer clear of milmed. But he also made the interesting point that admin (and loss of patient contact) occurs in many parts of civilian medicine too . . .although of course in civi med you can chose to 'walk away' from a situation.

    the other doc that I've come to know is my optimologist, he's an 0-5 LASIK/PRK guys, does about 30 cases/week. has done about 25K cases throughout his career . . . published numerous papers. He's quite happy, definintely not a 'mediocre guy'. He is getting out next month . . . but that's ok. If you get out of the military as an O-5/O-6, that's not nec. a knock on your community in the military. It's just time for you to go. (If you get out as a JO, then that's telling of problems).

    So, you're a civlian now? What kind of institution do you work at? (large metro hosp, academic, small clinic?) How does it compare? (i know you'll say its 100x better than milmed . . .but honestly, is there anything about milmed that you miss or feel had a leg up on civi med???)
  42. Galo

    Galo Senior Member

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    Private practice as part of a hospital. There is no comparison. People do their job, and they do it well, or they do not see my patients.

    What I miss about milmed is the fact that everyone is there with the same patient care goal in mind, although as I've said before, you know who to steer clear off, although sometimes that may not be possible. I liked the fact that no money is involved, so that's one issue you do not even consider while on the outside, that's how you pay your bills. Of course, on the outside, the money is so much better that its once again impossible for the military to get close.

    Look, there are mulitple problems with mil med, as there are with medicine in the civilian world, but the problems with milmed are so much more fundamentally worse,(lack of choice or potential delay in training, potentially poor GME, poor infrastructure, POOR leadership, low pay, loss of skills, etc) that it's easy to say its by far better on the outside. The military does have a good medical prevention program, but not enough staff to see it through well.

    The two docs you talked to are O-5/6, and are pretty high on the hierachy, and protected to some extent, especially the one that does alot of administration. Most of the docs are capts and majors, and have done their time and leave. Also, I disagree that in the civilian world you get shuffled into administration. You can do it by choice, if you want to, but most surgeons die being surgeons.

    If you have no choice other than to do USHUS, you have prior military knowledge, your life will be alot easier than mine was. Unless you suddenly realize that your being put into dangerous situations and that people can be there to protect themselves, rather than to do the right thing. I'm jaded because I met alot of those MEDIOCRE people who stayed in, got power, and did pretty much whatever they wanted.
  43. DrMetal

    DrMetal To shred or not shred? Lifetime Donor

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    Yeah, well I'm not quite the traditional applicant. I'm a little bit older (30), a little bit ahead in the game of life (have a wife/kid, a mortgage, car payments, etc). I have 8 years on both active and active-reserve duty. I'm pretty used to the military side of the house, although I'm sure milmed will throw some curve balls my way. I have no problem being in the military, I know how to play the political game, play the admin game. . . Up until now, I've gotten everything that I've wanted in the military (every set of orders, every job). so life has been good thus far, hopefully that'll continue to be the case in the future.

    i considered the civi med track as well . . . but I just can't swing it. I personally don't mind living frugally, have done so for many years. But I don't want to subject my family and lose my belongings (property, cars, default on loans etc) just to become an MD. I like medicine, but not enough to destroy my livelihood over it. If I were single, just outta college, my decision would be different.

    So for me, it's either USUHS or bust . . .in other words, either milmed or nomed.

    good thing is I'm used to and can deal with the military aspects of life, although I have an idea of what kind of medicine I want to do, I am flexible, and I don't mind delaying my training if nec. Also, with my prior service, when my USUHS commitment is up, I'll be right at the 20-year mark, so I can punch out. I'll be 50, retiring as an O-6 (hopefully) with 25 years (holy god!). The retirement calc. sais I'll be taking home a $120K/year retirement (that's accounting for pay raises and inflation).

    I worked out a spreadsheet, comparing myself to a civilian doing the same thing. with some assumptions, and assuming i follow the track of an internist, possibly a specialiast (I used card), assuming debt from med school for tuition and income, and assuming a GMO tour on the mil side, assuming a civi card makes say $400K/year, bla bla bla . . . .my civilian mirror would come out ahead at the age of 50 by about +$700K.

    But on the other hand, I could join my civilian friends at the age of 50, with my $120K retirment. So I'd be caught up to them (erase that 700K delta) by the age of say 56 or 57.

    Whatever . . . . the immediate financial aspect (being able to support my family, in a comfortable way) in the immediate term is more important for me than the final salary. and if milmed (particluarly thru usuhs) can do that for me, then I'll sign the dotted line . . . . thanks for the discussion.
    Last edited: 11.13.08
  44. a1qwerty55

    a1qwerty55 Attending

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    No, he loses it when anyone disagrees with him even those with more military experience than him.

    Uggh, here it goes again but.

    Galo, try not to freak out.

    I think I'm still allowed to have an opinion. I would advise you to take Galo's comments with a grain of salt. I appreciate Galo's service but lets not forget, he never deployed, hasn't served in years, and when he did serve, did so in the USAF (don't get me started on the USAF medical department) - he received a letter of reprimand for "jaywalking" - (anyone think this was a way for his Command to stick it to him?). There is more going on here than just being outspoken - lots of us are, but aren't getting letters of reprimand.

    His experiences while probably factual, are not remotely representative of the medical departments of the USN and USA. The Army and Navy have big problems, as I've detailed above, but I still contend that most (not just many) military physicians are exceptional, dedicated professionals.
  45. crazybrancato

    crazybrancato

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    I agree with you here on the AF. I gotta hand it to them, they're very professional, but the problem is following everying stinkin rule down to the letter . . . never letting anything bend for the sake of forward progress. Case in point: at my home (navy) command, I needed some office supplies. it would've taken men 6 weeks to get em thru my supply office, so I just went out and bought it on my own dime at Staples (cost me $20), no big deal.

    When I was TAD to an AF command, i tried to do the same thing. They wouldn't allow me to bring in my own office supplies, b/c the supplies (a stapler, hole puncher) had to be officially registered in the inventory, and had to have been purchased from a gov't account! yikes! (I brought the supplies in anyway, figuring no one was going to court-martial me over it.

    Galo is this true? you rec'd a letter of reprimand for something, care to talk about it???
  46. Galo

    Galo Senior Member

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    Well Crazy,

    If you bother looking at my very first post, its all explained there, but since you seem so eager, here it is along with my rant, and the reasons most physicians leave:


    Not that after 14 yrs of school/training, most people would expect to be treated with a modicum of respect, but IF you become a doctor and ever serve in a civilian manner, you'll notice that at the very least there is a parking area reserved for doctors. Not in the military where you are treated right along the A1C just out of tech school, and have to fight for a parking spot. So at our base it was either park and walk a good ways, or park in the Base church, and walk across the street to the hospital where the entrance was closest to my office. This happened every day with no problem for many people docs or not. There was an unwritten rule that you needed to walk down two blocks to the light, cross at the intersection, and walk back up, which sort of defeated the purpose of parking there. Some years back, some urologist decided to forget what we teach our 3 yr olds, and walked out in front of a car, thus the unwritten rule. Well, along comes 9/11, and suddenly everybody is worried about security. Since our hospital was not physically located within the base, security was posted at the multiple entrances, and on one occasion when I walked across the street, I got a Letter of counseling. I don't remember the reason, nor does it matter, but I walked across the street, after looking both ways of course, without a problem. Fast forward 5 or so months, I had developed a condition in my knee which required surgical correction, and I had difficulty walking. I had a signed profile from the orthopod, and a scheduled surgery date. I no longer could park in the slum lot, as it required a large climb of steps which I could not do, and parking in the lot for patients was treated as equal to treason. So I was parking in the church again, and ridiculously walking down to the light. Well on a late February day, the sun had melted the snow, and towards the end of the day, as the temp got low, the sidewalk became a downhill skating rink. I said, screw this, walked across the clear salted street with my limp, and got across just fine, and subsequently a letter of reprimand. I filed an IG complaint, as it was clear I had a safety reason to do it, but once again, when you are a Tony Soprano, you are untouchable. A year or so later, as they decided to build a large fence around the entire hospital, the sidewalk was not usable due to the construction, SO, a small sign was erected, and for the time people had to use the instructions they learned as 3 yr olds, and look both ways before crossing the street that got me the LOR.

    I know of a physician that got an LOR's for using a polka dot umbrella in a downpour, instead of the official black one. One that ended up with an article 32 for moonlighting.

    If someone had a wild hair up their ass for you, you could have easily been prosecuted for not following orders and bringing in your own supplies.

    Milmed sucked for me, and apparently for lots of others as they are finding themselves in a manning crisis.

    I would appeal to your better sense when it comes to insulting me because I speak the truth about my experiences in milmed, one's that you have no idea about because you have a long time before you are able to be in those postitions. I've been down this baiting nasty road with A1 because of his abrasive unprofessional demeanor, and I'd rather not continue it with you. The fact that you've had a good experience in the line will not necessarily transfer once you are in the middle of mil med, and it seems you have a hard time accepting that. You can easily see that I am not the only one who's had negative experiences.

    Best of luck to you
  47. a1qwerty55

    a1qwerty55 Attending

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    Galo - Good story, and plausible, thanks for sharing. I'm really sorry you worked for some certifiable idiots. I fortunately have not had that experience. That being said, I can always get blindsided by some psychotic MSC.

    In the Command climate you describe, I would have been incarcerated.
  48. Galo

    Galo Senior Member

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    Thank you for your words. Frankly I thought you knew this all along. My reactions became even more forcefull as the idiots got bigger.

    The last straw was when I refused to function as a second year resident without the RRC work limitations since we were not technically residents, and was sent home from CSTARS. I promptly filed an AF level IG complaint with multiple documents showing how this program was a complete waste of time and money, and how it inadequately prepared surgeons who had not been doing trauma to suddenly be deployed to an area where they would be doing nearly 100% penetrating trauma.

    I was denied my bonus and received yet another letter of reprimand for this, and I gave the Col an ultimatum which fortunately she followed through, and in a few months I was honorably discharged. The people I met in command in the AF were beyond criminal, and that is one of the reasons I am so bitter, and tell people why I think military medicine is in the toilet. I also do it from hearing other physicians comments, and experiences. I've always told people dead set on going in, that they have a leg up and can set their expectations different than I did.

    Oh, I forgot to say that when I got my LOR for walking across the street, I had also had a profile which stated that I could not climb stair, or prolonged walking. It mattered not. This woman cancelled the commendation of a fellow nurse because that month she failed her weigh in, she made us (the entire hospital staff) to line up at 6 AM in blues to get lectured because an airman had gotten a DUI, this was done on 3 separate occasions. That's what we dealt with.
  49. IgD

    IgD The Lorax

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  50. BomberDoc

    BomberDoc ex-BomberDoc

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    SDN 2+ Year Member
    Maybe I'm a bit paranoid, but I'm going to wait until my IRR obligation is up before sharing the really good stories... the ones involving multiple IG complaints against the coven.

    Galo, it sounds like the nurse commanders at your base were cut from the same cloth as the nurse commanders at mine. The open corruption, hypocricy, and outright favoritism within the nurse corps alienated and enraged the entire professional staff.

    I've talked to a few docs who were in back in the 80's and early 90's and it is nothing like that anymore. Since 2001, milmed has been on a steady asymptotic plummet straight into hell. Caveat emptor.

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