Don't get me wrong - obviously military physicians must adhere to the basic standards and other regulations that come with being an officer. I am absolutely NOT talking about trivial nonsense like weight standards, or any other bit of "officerness" that can't possibly conflict with being a good physician. Not being obese, wearing a uniform properly, saluting superiors, getting your subordinates fitness reports done on time, etc etc etc. Yes, of course do all that.
But if you ever have to choose between being a "good physician" and a "good officer" there is only one correct answer, and it sure isn't being an officer first.
With respect, one thing all of you well-meaning "officer first doctor second" people have in common is a failure of imagination. The basic problem is that you say those words sincerely, in good faith ... but without understanding that there are times when being a doctor WILL conflict with being a "good" officer. I'll give you a few examples from my own career.
You have a soldier (or Marine, or airman) who has previously tested positive for opioids and is confined to the base while pending disciplinary action. He is brought to your aid station drunk, but not in any immediate danger. Your CO says he wants you to give him a dose of naloxone to see if he's also currently under the influence of opioids, to bolster the pending court martial.
Your CO asks why a particular person in the command went to sick call on a particular day, citing his privilege as CO. The reason for the sick call visit does not affect the individual's deployability or ability to perform his duties. Your CO insists that you disclose the reason for the visit, because morale and good order depends on putting a stop to people skipping out on work for frivolous sick call visits.
You're a GMO, deployed to a faraway land. Providing free clinics to the local population is a marvelous source of both good will and intelligence for coalition forces. Your CO directs you to organize and run these MEDCAPs (medical civilian action program), both personally as a provider seeing patients, and delegating that provider role to a PA, IDC (independent duty corpsman), or other corpsman/medic personnel. Do you agree to run clinics yourself, potentially practicing out of your normal scope of care (pediatrics, geriatrics, OB, infectious disease, etc)? Do you agree to help non-physicians run these programs by seeing local nationals independently?
Your chain of command directs you to place a nasogastric tube in a detainee who is refusing to eat, whose health is now in peril because of it, in order to provide nutrition. The detainee will not cooperate and thus will require sedation as well. The senior physician in that chain of command concurs with this plan and expects you to carry it out.
And one final, mundane, snore-inducing example that is so universally true and ubiquitous that we openly joke about the physicians who choose being an officer first and physician second: You're now a mid-career O4 or O5 physician, and your chain of command wants you to cut back your clinical time to do more administrative work. There's an assistant directorship position that needs a motivated body. Or maybe the pharmacy committee, or MWR committee, or diversity committee, or blood utilization review committee, or sedation service committee needs a new vice chair. You don't
have to step into these administrative positions, but if you don't, you won't promote. Obviously, being an officer first and a physician second means pursuing promotion, and doing the non-clinical things that lead to promotion, right?
This is objectively incorrect. Most physicians joined for tuition assistance, with the expectation (or perhaps just a nervous hope) that they might also enjoy military service.
Regardless, an individual's motivation for joining is irrelevant to a discussion of which path to take when conflicts arise between being a good officer and a good physician.
This is an entirely different subject, but if you mean fold the active duty MTFs into the VA and make 90% of the active duty medical corps reservists - then yes. Yes, for many reasons completely unrelated to officer vs physician dilemmas.
And to get back to the point - sometimes being a soldier first DOES equal being a bad doctor. If you think there's never conflict, you are naive ... or to invoke Burnett's Law ... a bad doctor.
