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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. OIF GMO4

    OIF GMO4

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    Obviously I was not the top of my class, but reasonably competitive. I was applying to orthopedics. B+ type board scores and grades, research awards, prior work experience as an orthopedic surgical tech, letters of recommendation from multiple colonel physicians, and was currently licensed and credentialled at one of the hospitals I was applying to. The programs are geared to accept the most competitive applicants to keep their numbers up, even if that means screwing over veterans.
    If I could do it over again, I would have not done ortho rotations through military facilities and concentrated on civilian residencies. Your forced to apply to military, so if they take you, great. However, don't burn your civilian opportunities. After having done all my available rotations through the military, I had no chance at a civilian residency as I had not rotated through. If you really want a military residency, rotate there in another similar specialty and actively expose yourself to the program, without using up your rotations.
  2. Marine2004

    Marine2004

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    I'm an active duty Marine Officer, and a combat veteran. I'm interested in HPSP among other programs. In researching military medicine I came upon this thread, and I have read every post in its entirety. I can say a few things with confidence.

    Many of you, simply don't get it. If you joined the military to be a doctor first, or to have your college paid for, IMO you are wrong. The military, and being a leader in the military is a calling, just as being a doctor is a calling. Do not misinterpret what I am saying. I am not saying you must be a soldier first, and a doctor second. I'm saying that both Oaths are of equal importance. Regardless of your education, your rank, or your profession in the military, you must be dedicated to the mission of our military, its troops, and the families that support them. I've seen military docs treat my wounded Marines, and I've been touched by their concern and their dedication. More than touched, inspired. Those doctors get it, or at least they get it for the moment.

    I am not a doctor so please excuse what I am about to say. This thread sounds more like a bunch of spoiled whining kids (with exceptions) than it does highly educated and dedicated professionals. You think the troops you serve don't do long hours for crap pay? You think the troops don't get screwed over administratively, or logistically? They do. And some of them get shot at too.

    I put forth, that there is no finer group of individuals for which physicians can be responsible for, than the nation's sailors, soldiers, airmen and Marines.

    I'm sure the system isn't perfect. It isn't perfect in any part of the military. I wish MEDEVAC helo's took 5 min instead of 20 to 30. I wish one of our corpsman didn't lose a leg to friendly fire. I wish the Marine Corps had the same quality of gear that the other services enjoy. I wish our supply system took days instead of weeks and months to get combat essential gear. But, I work with what I have. I have a responsibility to my Marines, and that is an awesome and weighted responsibility I don't take lightly.

    Sure, I could get paid more on the civilian side (the same is true for professions across the military, not just docs.) I could also find a job with less hours, no deployments, less stress, less bureaucracy, and no moves every 3 years. I'm even considering doing just that. But I don't complain about the deal I have in the military.

    Remember who you serve, and why you do what you do. If at the end of the day, the soldiers, sailors, airmen and Marines are not worth the aggravation, then please leave the military at your earliest opportunity.

    For those of you who do get it, thank you for what you do. Words cannot express the gratitude I have for the men and women who care for the Marines I have had the pleasure of serving with.

    I encourage everyone to read this post by a doctor who obviously gets it.
    http://www.rb-29.net/html/63erdoctor.htm

    If you are frustrated by milmed, take time to talk to the troops. Ask them their stories. If you can't then find the inspiration to continue to do the work we all so desperately need you to do, I'm afraid you are lost...
  3. Miska002

    Miska002

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    great post Marine2004! That is exactly why I am accepting a Navy scholarship, to medically serve great men such as yourself and your marines! I am a middle eastern Christian, and I feel so incredibly fortunate to have grown up in such a great country where i don't have to fear persecution because of my religious beliefs. 8 years of service to this great country is something i look forward too regardless of the negative conditions people have mentioned. After all it is military service, SERVICE being the key word.
  4. pokerslut

    pokerslut

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    Great post sir-- except for the "calling" cliche :)

    12 year Army veteran now 3rd year medical student.
  5. notdeadyet

    notdeadyet Still in California Moderator

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    The problem is that anyone willing to be anything other than a physician first will be a worse physician. This is a discredit to the troops. If you're willing to let any of your officer duties compete with your patient care, you're doing a disservice.
    When troops complain about lack of armor, are they "spoiled whining kids"? What about when they talk about how multiple tours are increasing PTSD? Soldiers complain, whether they're officers or enlisted, infantry or milmed. To assume that any complaints coming from non-combatants is "whining" is short-sighted.

    If you do a more careful read of this site, you'll find that most of the discussions about salary discrepencies and perks is brought up in the context of how to improve retention. And give your background, you're probably well aware that this is exactly how it works in the enlisted ranks as well: I'm not that familiar with the Marine Corps, but in the Army, reenlisted bonuses are the standard MO.

    The big complaints folks have about milmed itself are things like GMO tours, clincial exposure in residency programs, scope of practice, ancillary support. All of these things have a direct affect on a physician's ability to provide care to his/her troops.

    Your comments are appreciated, but if you dig a little deeper if and when you decide to go into medicine, you might see that most of the complaints about milmed are gripes about policies that prohibit effective patient care. Reminding military docs to remember who they are serving is about as useful as them telling you to not forget your battle buddy. Well aware, thank you...

    Hope everyone enjoys Memorial Day tomorrow and takes a few moments to reflect what the holiday represents...
  6. a1qwerty55

    a1qwerty55 Attending

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    This is a common fallacy used on this site - the False Dilemma Fallacy. It suggests that somehow being an officer and a physician is a zero sum proposition. In other words doing more of one degrades the other. I'm sorry but this is faulty logic and not accurate. Granted if you are not engaged in clinical medicine you aren't going to be a very good doctor, but for those you are fully engaged in cinical medicine they can still be excellent officers as well.
    Last edited: Sep 12, 2009
  7. notdeadyet

    notdeadyet Still in California Moderator

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    Really? I don't get that. I don't think being an officer and a physician should conflict, at least not under the right leadership. But if (if being key) you are put in a position where you need to be one at the expense of the other, always go with being a good doctor.
  8. IgD

    IgD The Lorax

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    I can understand your perception. I do think there are some serious no-kidding issues in military medicine that need to be addressed. I think the challenge is to look past the emotions and see the issues underlying all the frustration. I think there are some legitimate issues comparable to the lack of armor on humvees that needs to be addressed.

    A number of physicians in my department focus their efforts on serving an underserved population: homeless patients with severe/chronic medical conditions including co-morbid substance problems. In a way the situation is similar to military medicine because it amounts to selfless public service. They serve until their heart is content in substandard conditions for low pay. The difference is they aren't being smothered with B.S. policies and leadership decisions like military physicians are in many cases.
  9. IgD

    IgD The Lorax

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    How would you respond to this scenario:

    You are a LTCOL in the Army a couple years away from being in zone for promotion to COL. You work on a remote island with 10,000 soldiers and their family members. There are only 3 physicians in your department and no Tricare network. Objective information is that your department can barely meet the clinical need of those soliders and family members. Your commander is in zone for a flag officer selection. The small hospital where you work has had budget problems in the past and your commander is under tremendous pressure to be in the black. One day, the hospital commander meets with you and tells you that he has no choice but to cut your staff from 3 physicians to 2. You try to tell the commander that there is no way 3 physicians can cover outpatient, inpatient and the emergency room safely or effectively but he is not interested. He tells you "yesterdays 66% is todays 100%". Internally you feel conflict. As a physician, you know you have an obligation to advocate for your patients but as a medical officer you have an obligation to follow orders and ensure the financial stability of the military. If you try to take a stand, your commander could give you a black eye on your fitness report jeopardizing your promotion. What do you do?
  10. a1qwerty55

    a1qwerty55 Attending

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    Typo on my part.

    Should It rather than I suggests.

    Anyway, I think we are in general agreement that you need to ensure you keep your clinical skills sharp. My point is that the two are not mutually exclusive. You can be a good leader officer and excellent physician.
  11. a1qwerty55

    a1qwerty55 Attending

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    Take the hard right over the easy wrong. Care for the patients, inform Commander this is a dangerous decision and you feel obligated to raise the issue to a higher Command if necessary. MEDCOM IG etc. You might take some lumps but so be it.
  12. notdeadyet

    notdeadyet Still in California Moderator

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    I agree. And should the rare time come up when you find the two conflicting, go with being the physician rather than the officer.
  13. AF M4

    AF M4 Junior Member

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    Wow, you make it sound so simple.

    Simple fact is, the mantra of milmed has become "do more with less." That's a cool philosophy for awhile, but pretty soon they're telling you to build a motorcycle using only two tires and a stick.

    It's important to note this in the above scenario, since it means that even if the LtCol in question were to summon the considerable chutzpah to file an IG complaint, there is a good chance that he would simply be thanked for his concern and told that 2 is still the new 3.

    So then you've got the worst of both worlds - same unsafe clinical environment, plus your commander and soon-to-be flag officer is now going to be very interested in torpedoing the military career that you've already invested more than a decade of hard work in after you endangered his career prospects by tattling.

    This is why I'm so uninterested in being promoted, ever.
  14. DrMetal

    DrMetal To shred or not shred? Lifetime Donor

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    Set your hair on fire and jump out the nearest window!!!!

    I think in all walks of officer country, there's times when you may feel your profession conflicts with officership. And I do think these instances are rare, and that the conflict is really only perceived; the main source of frustration is something else (bad superior, bad subordinates, whatever).

    And when there really is such a conflict, I think most would agree that you should err on the side of your profession. And hopefully your superiors wont fault you for that, I certainly wouldn't.

    Was on a ship once where the starboard engine went out. The CO told the chief engineer to do whatever it takes to fix it, to get underway and pass inspection. In other words, at that given moment, the CO didn't give two sh!ts about his CHENG's skills as an officer and wanted him to fix the ship, even if it meant getting his own hands dirty and cut up. So the poor CHENG went to Home Depot and paid for the tool himself, brought it back and used it to fix the engine. He broke every rule in the Navy supply chain and used an unauthorized tool to fix the ship, actions which could be construed as conduct unbecoming of an O. We got u/w on time, hitailed it to Pearl and impressed all of our dignitaries. And the CHENG got ranked 1/5 come FITREP time.

    Not sure what's it's like in other services. But in the Navy at least, I've see a good amount of latitude, allowing officers to do their job and produce the best quality of product or service. I hope the same goes in the MC.
  15. a1qwerty55

    a1qwerty55 Attending

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    I don't want to make is sound simple as it clearly is not. I also know there are some really toxic leaders out there. My point is and continues to be, try to do what is right, understanding that you have to choose battles. You have to do the math each time. There may be times there is no option - at which time you have to do the best with what you have but if an option is available you need to push for it.
  16. NavyFP

    NavyFP Senior Member

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    Me, I take the hit. (As a doc looking to make CAPT) It is an integrity issue. The CO must go to BUMED (or AMEDD) and get the money to keep all three docs. If the CO is more inclined for the promotion than doing what's right, they need the black eye.
  17. AF M4

    AF M4 Junior Member

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    Heh, unfortunately we didn't get a bunch of one-year wonders practicing independently across the country by telling the folks running the show what we really thought of safety issues. Lotsa folks talk big but wilt when push comes to career-threatener.

    Respect the hell out of the people who'd actually do it though.
  18. Gastrapathy

    Gastrapathy no longer apathetic

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    The do more with less mantra helps the bottom line, gets CHENG his XO ride but what does it do to quality? Well, in the fleet, I think you only have to look at INSURV results to answer that. For patients, however, its much tougher to measure. I use equipment thats not quite right for the job because its too hard to get everything I need. Not a problem in my moonlighting gig. But after several years of begging and pleading for the right stuff, you start to lower expectations and "do more with less." For your ship, Big Navy takes the risk of this strategy, but in medicine, the risk is borne by the individual patient (and by me, if something goes wrong). I can't go buy the stuff I need, I have to rely on the system to provide it. When it provides the 90% solution, I have to go with it or my patient suffers. And I hope I don't hurt someone in the process.

    Bringing your line experiences to medicine will no doubt help you. But these are very different professions and not every lesson you've learned applies as directly as you seem to think.
  19. Gastrapathy

    Gastrapathy no longer apathetic

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    And I believe you'd do this. But all this talk about doing the "hard right" is nice in abstract. What percentage of O5 or even O6 military medicine administrators would be willing to throw away their chances at advancement to keep the O3 provider from suffering?
  20. Miska002

    Miska002

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    This might not be relevant to this particular thread but I passed my MEPS physical, and was accepted for the NAVY scholarship about a month ago. When will my recruiter contact me to swear in? He said a couple of weeks but exactly how long?
    Thanks
  21. futuredoc30

    futuredoc30

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    Does anyone on here know anyone who is in or has been through a military (air force if possible) hematology/oncology residency? Thanks,
  22. Gastrapathy

    Gastrapathy no longer apathetic

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    HO is an IM subspecialty (therefore a fellowship rather than a residency). Yes I know people who have been through HO fellowship inside the military. How may I help you?
  23. Boilermaker

    Boilermaker

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    Thank you for this post. I am wondering if you can gain admission to military medical school without having served before or if this is a near impossibility because of the qualified applicants that have already been in active duty? I have always been interested in serving and have a friend tell me of his marine experiences which helped give me a new perspective on serving. I ultimately want to be a doctor 1st and foremost but also feel this as another calling and a viable I should look at considering the financial benefits as well as fulfillment in doing something I would enjoy. Although I have read profiles of sub 2.8 GPA profiles gaining admittance to Armed Forces Medical School, I feel this would be tough with a 3.0-3.1 science and cumulative GPA in chemical engineering from Purdue and not having served. The only thing I have done remotely close to military is obtaining the rank of Eagle Scout in Boy Scouts, which I am sure some people in the military might have or recognize.
    Last edited: Jun 13, 2009
  24. DrMetal

    DrMetal To shred or not shred? Lifetime Donor

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    you're talking about USUHS, for which there's an extensive thread on this forum. Check it out. Yes, you can gain admission to the school even without prior service (almost half the class has no prior service). Not sure where you read about a sub-2.8 gpa getting into USUHS . . .it'd be hard to believe that, unless the individual had some wierd circumstances during college and then rocked the MCAT. Average numbers for USUHS are a 3.5/30 (if you're low in one number, you can use the other to boost your application). The school has also gotten more popular over the past few years, so it's getting a little more competitive. Would advise applying as early as possible. Being an Eagle Scout is a nice extra-curriculur to have (shows discipline, leadership, etc etc). You can definitley leverage that. But in and of itself, the military doesn't give you any formal recognition or credit for your activity in BSA.

    Anyway, check out the USUHS thread, lot of good reading . . .good luck.
  25. Future Doctor J

    Future Doctor J

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    Yes, i definitely agree. You dont need prior experience and as for the 2.8 GPA, that is highly unlikely. Like he said you would really have to rock the MCAT and i mean get almost a perfect mark.

    Good Luck
  26. Magnesium

    Magnesium

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    The other thing you find is that as the military runs shorter of physicians, they end up having nurses and administrators running the clinic where doctors are treated like mules. I have seen it where I worked; they had a Junior Nurse many times harassing doctors--pretending to tell them what to do and even writing their evaluations--a nurse giving you an estimation of your worth as a doctor that can affect your promotion/salary increase. The worst part is that sometimes they schedule patients for you that should be seen in the ED and because they do not consult with the doctors, the patients often end up getting delayed care. Nurses also are placed to grant you or deny your vacation (leave). Given their limited education, having them "running the show" guarantees mediocrity and chaos--they tend to overbook patients and tend to keep the clinic in overload mode.
    As a contrast, the Line Officers have right--the most experienced and skillful is the one making the big decisions; they try hard to avoid putting a junior as "supervisor" of a senior. But int he medical or frankly "nurse' or "health care" corps, they want to keep doctors under subjection without any say in how the clinic operates. Maybe that is more isolated, clinic dependent but I must ell you that this is a growing trend.
    The uniformed physicians are few, and the contracting (civilian) physicians often do not have the same responsibilities as the uniformed providers and they certainly do not deploy. Where I work, the clinic phone is only carried by active duty providers, where we have a majority of civilians. So that means that you are getting increasingly less time free while not deployed--your "resting period."
    The latest is that they want to run the military as a business, civilian style, except that the pay is significantly less and you also get exposed to more terrorists than you could imagine away from your family--the sense of balance is lost.
    You could imagine that I would not renew my contract :)

    In case you did not know....
    Last edited: Feb 21, 2011
  27. TopSecret

    TopSecret

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    Are you in the AF?
  28. Galo

    Galo Senior Member

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    My bet would be yes.

    I was talking to a colleague of mine today who was in the Navy. I told him my horror stories, and he as not shocked, but a bit incredulous. It definitively seems the AF has the leadership in screwed up leaders, total loss of vision, and is generally the most malignant way to practice medicine.

    Do not think for a minute that I believe the Navy and Army are much different despite the kudos persistently given by one person who seems to have made a relatively pain free nest for himself.

    I still think military medicine as a whole is SCREWED, and should be avoided like a disease.
  29. a1qwerty55

    a1qwerty55 Attending

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    Another unbalanced post by our most malignant member of the forum.

    Sorry to break the news to you but those I work with are pretty satisfied with the support, equipment, the quality of colleagues and the general care we provide. This is DESPITE - deployments, AHLTA, inadequate pay. There is really almost nothing that I get or do faster in my facility than in the civilian arena. I'm definitely not saying this is the norm, but some hospitals can work when the leadership is decent and stays out of the physician's way.
  30. rogershru2

    rogershru2

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    Good for you. It's nice to know that some people find a satisfying career in military medicine. It's just different strokes for different folks - most Navy GMO's get fed up and get out in my experience, but some enjoy and stay and are happy throughout their career. Personally my "con" list filled up a page while my "pro" list for staying in remains blank.
  31. Magnesium

    Magnesium

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    I am Navy.
    I bet the recruiting districts send their recruiters/snipers to counter what other AD members are saying to throw confusion in the website, so that one cannot get a true north in all this. Instead of taking notes and trying to work at the policy level to assure the horrors described here do not occur, they use anecdotal counterpoints and one wonders if they are fabricated. The thing is that if the military leadership had it right, without the hand waving that goes on, they may correct FIXABLE problems. But the 04-05 officers layers is only interested in tenure, getting good fitreps regardless of the skulls they leave behind. Many of them are terminal in their career, so they do not care for improvements--status quo is good for them. I was told by someone that at the beginning of the transition from communism to "whatever they have now" there was plenty of chaos in Russia, something that gave the advantage to the mafia bosses to entrench themselves in that country. Sometimes I wonder if the same attitude is found in the military in a more "sanitized way." Relatively incompetent leadership at the O5-O6 level keeps the Admiralty in ignorance. And the "Stars," misinformed by their immediate subordinates, cannot wisely develop constructive policy to help mitigate the root cause of the massive exodus of physicians out of the military.
    I will submit that physicians, outside of the line officers should have decisive power in interpreting and applying navy policy with the responsibility of giving immediate feedback straight to the ones that want to retain them--those in D.C. When you placed a "middle man' that is not a physician, I bet that the message is either suffocated or significantly modified by the non-physicians. But what if the 'middle man" is not the 'sharpest tool in the drawers"--meaning people that by training are not forced to make critical decisions based on multiple pieces of information, some of it being red herring. The unproven assumption that any one in uniform with a given rank is equivalent to the other with the same rank is remarkably naive and betrays a fundamental misunderstanding of anthropological truths. To solve the problem with the physicians' exodus out the military SHOULD take physicians to work for a solution--not nurses, or any other lower bidder--no disrespect. The thing is that they want the reins in the military that they do not have in the civilian sector for a reason (yes, there are always exceptions..so barring those...)
    In any case, I should let you know that I love the navy. But it has been changing real fast as we end up with the most inept (the brightest escapes at the first opportunity).

    Cheers!
  32. IgD

    IgD The Lorax

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    Welcome to the forum. Your post really resonates with you. That's pretty much exactly what I experienced in the Navy. They said on the greenside that one of the best way to protect Marines from PTSD was with caring and competent leadership. Leaders would never risk the lives of their Marines to send them on a fool's errand but that is what is happening in Navy medicine. It's devastating to work in that kind of environment. I love the military. Maybe I'm a bit of an idealist but there has to be a better way.
    Last edited: Aug 28, 2009
  33. TopSecret

    TopSecret

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    This should cheer you up. :)

    [YOUTUBE]http://www.youtube.com/watch?v=i6cwcIPf9Xs[/YOUTUBE]
  34. Galo

    Galo Senior Member

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    The most vocal cheerleader speaks again. No surprise. Is it just your hospital that does not have the same attrition rate for physicians DoD wide, or is it just your department because you are such a great leader that all the ills of military medicine are avoided by you and your department. I fail to see how you can compare anything in your hospital to a well run civilian facility where the physicians are in charge, and not the nurses, as you do not work in one.

    Off rant.

    Anyone here knows the history between us, and should not be surprised.

    Anyone new to this forum should make decisions based on a whole host of factors including as I've always said, speaking to current physicians in the system, as many as possible, and avoiding high rankers who are vested in keeping a dying system viable just long enough for them to get their retirement. Reading this forum thoroughly will show that there are mostly negative reactions to what has happened to military medicine, and general warnings against continuing to participate in a system where you may not get to train in what you want, or be in a position where your skill will erode. People should be intelligent enough to seek out information and make an appropriate decision based on as unbiased information as possible. Since the cheerleader and I are at seemingly extreme ends, the truth lies somewhere in the middle. All of what happened to me was real, as it has been for many physicians who post here. Anyone thinking about military medicine should really have a good reason to do it, knowing the many detriments.
  35. Magnesium

    Magnesium

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    I meant 0-5/0-6 at all times above; most O-4 doctors are hardworking physicians, the ones that truly carry the load in the Medical Corps.

    :laugh:
  36. IgD

    IgD The Lorax

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    The senior physician in my civilian workspace is in his mid to late 50s and works very hard. He sees as many patients as I do plus he handles all the admin stuff on top of that!
  37. a1qwerty55

    a1qwerty55 Attending

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    I haven't seen any evidence of this. There definitely is a awareness at the higher levels of the power of new media and the internet, but I am unaware of any official push to put our misinformation. Those of us who do positive experiences are dismissed as recruiters by those who cannot accept that there are positive aspects to military medicine. I am neither a recruiter nor an upper level bureaucrat. I'm a full time clinician.


    As on O5 I take offense with this characterization. I wake up every day asking what I can do to improve the care of my patients, make my hospital work better and at the same time build the morale of my coworkers. Other than a fair number of O-6's who I agree are retired on active duty- I don't see many of us accepting the status quo.

    OK - nice concept but the reality if if I have 5-7 years of residency, or fellowship training, and I'm in the prime of my career why would I want to disengage from clinical medicine? You cannot make policy part time. This means those who choose this track tend to be sorry clinicians or disenchanted primary care types who just don't get it.

    Nurses carry plenty of weight in the civilian sector as do non clinician medical administrators. This has become more and more the case - Physicians are no longer driving the train in the civilian or military world, in large part due to poor performance (variation in practice and outcomes), uncontrolled egos, and self serving decisions (fraudulant billing, and inappropriate pharmaceutical and referral relationships). Big brother steps in with regulations which it enforces with non clinicians in large part b/c of our own failings as professionals.
  38. a1qwerty55

    a1qwerty55 Attending

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    Cheerleader is dismissive and intellectually dishonest.

    Regarding attrition: There is a normal attrition that is just a feature of being in the military or any system in general. HMO's also have significant attrition, not always a sign of a poor work environment. I think it is totally understandable that most who enter the military to pay bills will when given the opportunity to control their where they live, eliminate deployment risk and increase income will exit - appropriately. The military will never ever be able to equal the pay of top tier civilian jobs.

    I actually do work in the civilian sector - The care is better in my military facility over our civilian peers mainly because the physicians are younger, more idealistic, better trained, and don't have to see 50 patients a day to pay the bills. I have the luxury of time with patients that I decidedly DO NOT have in the civilian world. I have top notch equipment and support. I would not imply this is the standard across all military facilities, especially the small ones. I also point out that there is no comparing Army and USAF facilities - USAF is far less capable, poorly staffed and has a more draconian leadership structure.



    Off rant.

    Boy I agree.
    Last edited: Sep 5, 2009
  39. a1qwerty55

    a1qwerty55 Attending

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    Regarding attrition: There is a normal attrition that is just a feature of being in the military or any system in general. HMO's also have significant attrition, not always a sign of a poor work environment. I think it is totally understandable that most who enter the military to pay bills will when given the opportunity to control their where they live, eliminate deployment risk and increase income will exit - appropriately. The military will never ever be able to equal the pay of top tier civilian jobs.

    I actually do work in the civilian sector - The care is better in my military facility over our civilian peers mainly because the physicians are younger, more idealistic, better trained, and don't have to see 50 patients a day to pay the bills. I have the luxury of time with patients that I decidedly DO NOT have in the civilian world. I have top notch equipment and support. I would not imply this is the standard across all military facilities, especially the small ones. I also point out that there is no comparing Army and USAF facilities - USAF is far less capable, poorly staffed and has a more draconian leadership structure.
  40. IgD

    IgD The Lorax

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    The military medicine attrition rate has to be very high 70-90%. I saw some stats that suggested the number of active duty physicians is pretty close to the number of physicians in training.

    I think there is some truth to that. At the same time, experience is very important. How a physician fresh out of training handles a clinical situation can be very different than how someone with 10-15 years experience does. I would suggest the military needs more 45-60 year old physicians who really know what they are doing and can be mentors.
  41. a1qwerty55

    a1qwerty55 Attending

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    Almost zero doctors stay at any one practice for 20 years. Professionals have options to move to other practice locations and often do. I think attrition isn't the right variable - more importantly is was the time in the military productive, were there enjoyable times, did you learn anything, make a difference and are you better for it. Most of the former - non SDN posting - military doctors I know look back with generally positive memories.

    The problem with this forum is everything is painted in absolutes - i.e. "military medicine sucks". No doubt in some areas this is very true, while in others it clearly is not. I try to add some balance to this grossly unbalanced forum.

    Even the USAF which by all accounts is the least capable military medical branch and has the most systemic problems still has excellent people working hard to make things better. To label anyone as good/bad, competent/incompetent, lazy etc. - either by speciality, rank (O6's), source of degree (DO/MD) etc. is useless is intellectually primitive.
  42. Gastrapathy

    Gastrapathy no longer apathetic

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    Attrition is one variable that can be easily measured and isn't subjective. To dismiss our dismal retention ignores the cost to training. We run training programs and our staff physicians are so junior that they lack the experience to do so. The most experienced gastroenterologist in the Navy is 7-8 years out of training. The rare people who remain tend not to be clinically oriented. The bottom line is that, as soon as they had the option, your silent majority of non-posting physicians all voted with their feet.

    Further, the opinions of physicians who retired in the 90's are irrelevant. Military medicine is vastly different now from what it was then. Their memories, positive or negative are not germane to this discussion. I think that physicians who left the military in the 80s and 90s have a more positive outlook than the current crop of departing doctors. They had it pretty good in the pre-AHLTA, pre-RVU, once-a-career deploying medical corps.
  43. AF M4

    AF M4 Junior Member

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    No offense a1, but every time I read one of your posts like this I imagine you looking and sounding exactly like this guy:

    http://www.youtube.com/watch?v=zDAmPIq29ro
  44. TopSecret

    TopSecret

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    Agreed.

    They are often working for HMO's reviewing the medical necessity for procedures and the documentation for reimbursement, i.e., they decide how physicians are paid.
  45. IgD

    IgD The Lorax

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    See that's what I'm talking about. It has been really humbling in the civilian world to work with physicians who have 20+ years of experience. They've seen 10s of thousands of patients, prescribed meds no one in the Navy knows, done every procedure many many times and have an interesting perspective on things. That's the kind of mentor you want and the person pulling the strings on big clinical decisions.
  46. Galo

    Galo Senior Member

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    Not to add wood to the fire, but that seems dead on.

    I think its imperative to look at the attrition rate. Additionally the experiences about one's time are important. My experience was that most physicians getting out of the military did not have a positive experience for many of the various reasons we discuss here daily.

    There is a huge problem and disconect between the physicians and the people in charge, and marginalizing the problem, just allows it to get worse and worse.
  47. a1qwerty55

    a1qwerty55 Attending

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    Did you read my post? I think it is logical and expected that most doctors will leave the service after their obligation - I mean, give me a break, where in the civilian world are they going to deploy you away from your family for 6 months to a year or more, expect you to work extra hours without reimbursement, expect you to take a PT test twice a year, get moved to places you have no interest in living etc. These realities of military life will not and cannot change. Retention is a pretty stupid benchmark to measure during a war - Again, more important albeit more subjective benchmarks are detailed in my earlier post. Those staying in to retirement are going to be those who have tremendously long obligations, have no deployment risk and comparable salaries, and those who can't make it outside.

    With regards to experience after about 10-15 years - knowledge and skills start to atrophy - I'd ideally like a doc 3-4 years out of training.

    "Military medicine is vastly different now from what it was then." Duh - as is civilian medicine - find me a happy civilian doctor who was in practice in the 1980's. Medicine sucks overall... everywhere -- and it isn't getting better. RVUs are a civilian creation, Medicare is cutting reimbursement, the Federal Govt expects every doc to have an EMR but there isn't an industry standard and you are expected to pay for it out of your practice. Every year another "never ever" diagnosis gets crafted by the government as if the 600 pounder will never get a decub when vented for 3 months or a VAP, or the hypercoaguable cancer patient won't get a DVT.

    Unlike my detractors who in the absence of ideas and facts resort to name calling, I try to lay it out there as balanced as I can. I'll continue to do so. The quality of information and posts on this site are a direct refection of the composition of the group.... This forum is mainly comprised of three groups... 1. wide eyed medical students who have no idea is going on be it military or civilian - and who have plenty of uninformed opinions, 2. disgruntled GMO's (whom I don't blame) and 3. former AF and Navy attendings. Each has a bias whether or not they have enough insight to realize so.
  48. AFRadiolgist

    AFRadiolgist

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    From AFRadiologist:

    I'm just checking in to give you all an update on the latest absurdity in my little clinic.

    Problem: We have no transcriptionist (big deal in radiology). Our only transcriptionist is leaving. Air Force Solution: Replace her with a deaf, illiterate who can't type. NICE! I counted twenty (20) errors on my last MRI dictation - and this is a significant improvement over a month ago when the new transcriptionist started. Also, we are only 7 days behind. Obviously, as the radiologist, I have no say in who gets hired or fired.

    Problem: My flight commander is a nurse bureaucrat with an IQ of 50. She recently ordered a venogram to exclude DVT. I informed her that these days we can do that easily with ultrasound. She also ordered a diagnostic mammogram and needle localization on a patient with a lump. Poor patients. Any way, as the only radiologist in this clinic, I inform her that we need a new transcriptionist. Solution: She informs me that I should type my own reports. YEA! I'll get right on that - about 80 reports a day. Why don't I check the patients in, answer the phone, and shoot the xrays as well! I suggest voice recognition. "They can do that?" she asks. She later informs me that the Air Force has not 'approved' a voice recognition system yet and might do so in a year or so or it might take longer. AWESOME! In the meantime, patients and physicians continue to call and complain about their reports not being done. "Patient care is secondary," she informs me. GREAT! That's the second time in 6 months that I've heard that from a commander. At least they (the powers that be) are consistent.


    I could ramble on about the inadequacies of AF medicine for hours (and have done so to prospective HPSPers.) For example, we recently had a case of a 43 year old with an ultrasound showing a complex ovarian cyst on an ultrasound last December. We recommend short term follow up (4-6weeks) as a few of these end up being neoplasm. What does the Air Force do? They deploy her for 6 months. So, now it's September and she has an ovarian mass. Oh well, needs of the Air Force and all that...Did I mention shes G3P4?

    I'll stop for now. If you have taken money from the Air Force, you have sold your soul to the devil, and good luck. If you haven't yet taken the money or signed on the dotted line, DON'T DO IT!!! IT WILL BE THE BIGGEST MISTAKE OF YOUR LIFE!

    You've been warned.
    Last edited: Sep 9, 2009
  49. Gastrapathy

    Gastrapathy no longer apathetic

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    I read your post. And since you complain about name calling, I'd think you'd be above that sort of comment. Here is my summary of your posts:

    You claim a silent majority that feel as you do. You claim that the Army is better than the other services in a myraid of ways (a drumbeat that has benefited Army recruiting at the expense of other services). You claim that if we could just measure an unmeasurable subjective benchmark, we would see that things aren't as bad as people here claim.

    I claim that this silent majority is actually a minority. I claim that every time I've interacted with Army bureaucracy, I've been glad I am in the Navy (see 15 month IAs for staff Navy doctors in Army GMO billets, which, despite what you've said, still are happening). I claim that measurable benchmarks are less subject to the bias (which we all lack the insight to appreciate per your post) and attrition is an important reflection of overall satisfaction.

    The only way attrition isn't relevant is if you start from the assumption that military medicine sucks so badly that everyone will want to get out. If you accept that assumption, then I think you are proving the naysayers point.

    You say that skills atrophy after 10-15 years and you want someone 3 years out of training. Thats true in the military system but nowhere else.
  50. 61November

    61November Flight "Surgeon"

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    Just throwing my hat into the ring, as a1 has cited the lack of Army docs chiming in on this forum as objective evidence that Army medicine is heading in the right direction, as opposed to AF, and Navy.

    There are PLENTY of disgruntled army docs out there. Most of them just don't post on these forums. I don't know why- maybe the constant year-long deployments.

    I hate Military Medicine, but love the Military, the Army, and especially the guys in my unit. Being the flight doc for a Combat Arms unit is the best decision I've ever made. As a GMO Flight Surgeon (yes we are still out there) I don't enjoy playing three card monty with my medical license, but that's life, and that's the mission.

    The bureaucracy in the Army still SUCKS. The hospital I trained in was cowmanded by a Nurse "General." It was overrun with MSC commandos, dieticians, other non-deployable wastes of protoplasm who were an embarrassment to the Army and this country, whose prime concern was to leave the hospital at 1500 daily. And don't even get me started on the civilian contractors. My point is that laziness, incompetence, and complacency are a huge issue service-wide. It is a glimpse of the type of socialized medicine that the Marxists currently in control would like to foist on the rest of the country, God help us all.

    And **** Metrics, RVU's, DHMRSi, H1N1 protocols, Respect.mil and other things dreamed up by the Clipboard commandos who, like the proverbial dead Carp in a fetid pond, have risen to the top in the Medical Corpse.

    To back up my point above, and to discredit the Army-GMO fallacy, 5/6 of the flight docs in my Brigade are GMO's. And that's the norm, thanks to the Army's asinine policy of ending deferrals for ER, Ortho, Rads etc. in the HPSP years of 2007,2008 in a lame and short-sighted attempt to strong-arm people into undesirable specialties.

    I've got 3.5 years left, and then I am popping smoke on this Charlie Foxtrot. Luckily I'll get enough experience downrange to forestall complete atrophy of what limited medical skills I possess.

    This message probably reeks of bitterness- but it is bitterness towards Big Army Medicine and the idiot bureaucrats and time-servers currently in control. My advice to all the young HPSP'ers, get into a Combat Arms unit and enjoy the ride. You'll be PROFIS'd there anyways, so get in on the ground floor and become a part of the Army.

    BTW, anecdotally, I know of ZERO docs who, when given the chance to get out, stayed in. This of course excludes the aforementioned groups- endless committments, those nearing 20, and those likely too dangerous to work on the outside.

    61N

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