SMO billet on small deck

[Teufelhunden]

Haven't been here for a while. Greetings, all. It's been so long, I don't know many of you, so I'll briefly reintroduce myself. My background, in a nutshell:

1989-95...Enlisted Marine
1996-05...College/Med School (HPSP)
2005-09...Psychiatry Residency (Navy/NMCP)
2009-10...Brigade Psychiatrist, II MEB (deployed to Afghanistan)
2010-11...Regimental Psychiatrist, 3d Marines, K-Bay, Hawaii
2011-...... Division Psychiatrist, 3d MARDIV, Okinawa

So, I have a year left on my obligation, and the wife and I are weighing lots of options. For reasons I won't dwell on here, I don't have any desire to take orders back to a hospital right now (not to mention, speciality leader isn't offering any desired locations). So, I emailed the Operational detailer the other day to see what he had to offer.

Detailer sent me a long list for open billets next year. It was mostly what you'd expect: green-side billets (regimental surgeon, group surgeon, some MARSOC billets, and a few wing billets). He also had a bunch of FST (Fleet Surgical Team) spots, that I'm not too familiar with. What he did have, that really caught my attention, were a few SMO billets on small decks (LHDs, LPDs), that he's willing to place a shrink into (I think these are usually filled by primary care types, no?)

For me, this is attractive because I've never truly felt like I've been in the Navy. Residency, as many of you know, really doesn't count, and all my post-residency time has been with the Marines! So, there's an attraction to do something *really Navy* (can't get more 'Navy' than being on a ship, right?) The second appeal is the opportunity to fill a leadership billet (it's an O-5 billet; I'm an O-4) that is outside of my profession, i.e. general medicine versus psychiatry. This is one of the unique upsides to the military: being able to take a billet outside your field, and still progress in your career.

Before I jump at this, does anyone out there have any experience on ship either as a GMO or SMO who can give me an idea of what a SMO does? I imagine it's similar to Div and Reg Surgeon billets in the Marines, that I have some peripheral experience with, having filled "Deputy Surgeon" billets -- i.e. I'm imagining there's a lot of tracking/reporting of immunizations, dental readiness, etc., oversight of prev med, and a bunch of admin duties. I would hope to do some clinic (I'd probably have the docs route psych/neuro chief complaints my way).

Two reasons I'm a little intimidated to take such a billet:

(1) I have no ship experience (minus a deployment as a Marine during Desert Shield/Storm, where I read books and played spades for 9 months). I will have junior docs who have their SWO pin, and know shipboard medicine more than I do (at least initially), so I'd be a little self-conscious about that.

(2) Now, I know a lot of primary care aboard ship or with the Marines is psych-related (what's the old saying? 1/3 Psych, 1/3 ortho/sports, 1/3 derm), but as a specialist I'm probably not ideally suited for such a billet. Many aspects of my general medicine are rusty, and I'd definitely have some brushing up to do!

Any thoughts, former shipboard docs?

Kevin

P.S. It's good being back on SDN. This site was invaluable to me for many years.

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[Gastrapathy]

A few thoughts. First, about your qualifications and the ethics of you taking this role.

I'm not sure what job this is. If you are talking about being a big deck SMO thats very different than a small deck GMO. The big deck amphibs are the LHDs and LHAs. Those are DH jobs with a junior doc onboard. The junior doc used to be a GMO but now is more likely residency trained. That is the O4/O5 job. I remember a neurologist in that job ~10 years ago.

The small decks are the LSDs and LPDs. You are in solo practice with an IDC. This is a job for a primary care physician and is really an 03 job, not an O5 job. I don't think a psychiatrist should fill a primary care job. Although psych is a part of the job, its not the most acute part. Are you comfortable managing gyn, ortho, chest pain, diverticulitis, etc? You shouldn't be.

So, it depends but I thnk you mean big deck and that would be better. If you have a residency trained primary care doc working for you and you are the DH who goes to meetings, supervises the embarked GMOs, etc on a big deck, thats probably reasonable (although you better have a good junior doc cause you are counting on him big time). Solo practice in primary care would be a bad idea.

Now, as for whether you would enjoy it. I bet you'd hate it after life on the green-side. SWOs are the opposite of Marines in so many ways. Its a petty, rules-obsessed world and unlike the Marines, they firmly believe they know your job (they believe they know everyone's job, especially the aviators). Workups are painful and the amphib navy is the short bus navy. The best and brightest go CRUDES. Also, the mission isn't really defined. You spend a lot of time transiting from A to B only to get there and have nothing to do.

As for your lack of ship experience, don't sweat it. Nothing a medical officer does with a line unit is anywhere near as hard as your average clinic day. You're a prior service Marine and staff physician. You'd be fine.

This is all a bit dated. There are the new LPDs now and I'm not sure if they are big or small (which I would define by whether or not the FST embarks and/or you have a junior MO).

 

[Teufelhunden]

Thanks, Gastrapathy. The two billets I'm looking at are LHD 3 KEARSARGE and LHD 7 IWO JIMA. The listed requirement is LCDR, but the people currently in those billets are Commanders. I have been under the assumption that there will be junior docs aboard the ship (plus, how can you be the "senior" medical officer, i.e. SMO, if you're the only medical officer, right?) The way the detailer described the small deck SMO billets was "very admin heavy, very little clinical" again supporting my assumption that there'll be junior docs onboard.

 

[Gastrapathy]

Thanks, Gastrapathy. The two billets I'm looking at are LHD 3 KEARSARGE and LHD 7 IWO JIMA. The listed requirement is LCDR, but the people currently in those billets are Commanders. I have been under the assumption that there will be junior docs aboard the ship (plus, how can you be the "senior" medical officer, i.e. SMO, if you're the only medical officer, right?) The way the detailer described the small deck SMO billets was "very admin heavy, very little clinical" again supporting my assumption that there'll be junior docs onboard.

Those are big decks. Someone's terminology is wrong. I think you could do the job but you won't be able to share sick call with your junior MO and that will suck for him/her.

 

[Teufelhunden]

Those are big decks. Someone's terminology is wrong. I think you could do the job but you won't be able to share sick call with your junior MO and that will suck for him/her.

Thanks for clarifying/correcting that. Maybe my detailer is referring to amphibs as "small deck" as compared to the SMO jobs on carriers (??)

I would want to see sick call. I'd of course ask for all psych/neuro cases to be routed my way, but I'd also consider brushing up on general medicine and seeing other cases as well. Having completed an internship myself, I'm equally qualified as a GMO in that capacity (although I acknowledge that my general medicine experience is more remote than his/hers will be).

 

[orbitsurgMD]

Will they even let you take a SMO billet if you don't agree to accept core privileges; the same privileges as any GMO? Taking the billet and being credentialed to do sick call then pulling rank and dumping all the sick call on the intern GMO (and I'm guessing all emergency after-hours watch as well) will be a sure way to link your name and the term "no-load." It will get around on the back channel. Sooner or later, you will be inspected, and they do interview junior medical people about the conduct and support provided by SMOs, and people speak their minds.

 

[Teufelhunden]

orbitsurgMD, I agree that would surely be a crappy thing to do, and I have no intention of 'dumping' on the GMOs. I would absolutely want to carry my weight in sick call, and help out as much as possible. Heck, that's one of the attractions of taking a billet like this -- getting to do some primary care.

 

[Gastrapathy]

orbitsurgMD, I agree that would surely be a crappy thing to do, and I have no intention of 'dumping' on the GMOs. I would absolutely want to carry my weight in sick call, and help out as much as possible. Heck, that's one of the attractions of taking a billet like this -- getting to do some primary care.

You did a psych internship and then have practiced in your field for several years. That does make you less qualified than a GMO to do primary care (which is not really a standard I'd be proud of). Plus, your junior MO is likely to be residency trained nowadays in a primary care field. Say what you will about doing your share, you just can't. The crew will know that you're a shrink and they will want to see a "real" physician or even the IDC for their non-mental health complaints (especially the gyn stuff). You may not intend to be a "no load" guy but its going to be hard to shake that impression. You will spend most of your time in meetings and the junior doc will do most of the doctoring. If thats not what you want, you should look to another job.

 

[EMDoc0411]

Having been in this godforsaken Navy the last 4 years, while it doesn't make sense to have a residency trained psychiatrist functioning in a SMO roll, that doesn't mean it won't happen. If you want to do it, do it. And don't look back.

 

[IgD]

You did a psych internship and then have practiced in your field for several years. That does make you less qualified than a GMO to do primary care (which is not really a standard I'd be proud of). Plus, your junior MO is likely to be residency trained nowadays in a primary care field. Say what you will about doing your share, you just can't. The crew will know that you're a shrink and they will want to see a "real" physician or even the IDC for their non-mental health complaints (especially the gyn stuff). You may not intend to be a "no load" guy but its going to be hard to shake that impression. You will spend most of your time in meetings and the junior doc will do most of the doctoring. If thats not what you want, you should look to another job.

I suspect the SMO is probably mostly an administrative position: consulting with the commanding officer, running the medical department and coordinating care with Navy medicine. He would be great for that role. We've read on this forum surgeons being utilized as GMOs. I was also aware of a hemo/onc physician who was being utilized as a GMO. Either of those individuals would not be accustomed to primary care and would have to brush up on their FP stuff.

 

[Gastrapathy]

I suspect the SMO is probably mostly an administrative position: consulting with the commanding officer, running the medical department and coordinating care with Navy medicine. He would be great for that role. We've read on this forum surgeons being utilized as GMOs. I was also aware of a hemo/onc physician who was being utilized as a GMO. Either of those individuals would not be accustomed to primary care and would have to brush up on their FP stuff.

There are 2 doctors assigned to ship's company. If the senior doctor wants to be an administrator, he certainly can. Not real cool to the junior physician and again, that individual is no longer a GMO (at least that was true a couple years ago, when I was "offered" the same job). An oncologist did a medicine residency and probably practices at a site with a residency (i.e. attends on the wards and goes to morning report, etc). Comparing that physician to a psychiatrist is totally unreasonable. No surgeon has been a big deck SMO that I'm aware of.

Also "Brush up their FP stuff" is pretty disrespectful of FP. You can't "brush up" on my specialty without doing a fellowship and I doubt you would feel that I could just brush up on yours and go practice.

The OP would probably have a successful tour but primarily as an administrator, not a clinician. If I was the junior doc (lets say FP) working for him, I wouldn't be thrilled at that. The biggest reason not to do it is that he calls himself devil-dog and that makes me bet that he will find SWO-land super frustrating.

 

[MTGas2B]

I suspect the SMO is probably mostly an administrative position: consulting with the commanding officer, running the medical department and coordinating care with Navy medicine. He would be great for that role. We've read on this forum surgeons being utilized as GMOs. I was also aware of a hemo/onc physician who was being utilized as a GMO. Either of those individuals would not be accustomed to primary care and would have to brush up on their FP stuff.

The ESG surgeon is probably the most administrative doc on the ship, but his/her territory covers all the medical assests in the strike group.

 

[IgD]

There are 2 doctors assigned to ship's company. If the senior doctor wants to be an administrator, he certainly can. Not real cool to the junior physician and again, that individual is no longer a GMO (at least that was true a couple years ago, when I was "offered" the same job). An oncologist did a medicine residency and probably practices at a site with a residency (i.e. attends on the wards and goes to morning report, etc). Comparing that physician to a psychiatrist is totally unreasonable. No surgeon has been a big deck SMO that I'm aware of.

Also "Brush up their FP stuff" is pretty disrespectful of FP. You can't "brush up" on my specialty without doing a fellowship and I doubt you would feel that I could just brush up on yours and go practice.

The OP would probably have a successful tour but primarily as an administrator, not a clinician. If I was the junior doc (lets say FP) working for him, I wouldn't be thrilled at that. The biggest reason not to do it is that he calls himself devil-dog and that makes me bet that he will find SWO-land super frustrating.

It's an interesting discussion. As psychiatrists we are doctors first. We did an internship and covered all the basics. I would argue we should be able to address basic primary care stuff that you would see on a ship. If tomorrow I was asked to do "GP" work I could do it but would need to review some of the current practice guidelines.

So what do you think of nurse practitioners, PAs etc? In some ways they have less training than a psychiatrist in medical issues...

 

[NavyFP]

I would agree that a Psychiatrist could perform all of the duties required to be an SMO, if (and it is a big if) they have an extremely low threshold for consulting with other docs should they choose to do sick call. They know the basics and could spin up in a few weeks. Underway there is no shortage of people to bounce thoughts off of.