Stay in or get out at the 10-14 year mark? What would you do?

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bricktamland

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I’m a Navy radiologist currently at 9 years of service with 3 years left on my contract. Thus, I’ll have 12 years in service when I have the opportunity to separate. It seems like 10-14 years of service is kind of a gray zone. Any time less than that and it’s a no-brainer to leave; any more than that, and well, you could probably tough it out until retirement without developing too much of a drinking problem.

Regardless, the time is drawing near when I need to start making preparations for the next stage in my career, which in my case is a fellowship. So lately I’ve been mulling over the decision of whether to stay in for the long haul or whether to separate.
Within the last few months several events have occurred that have really pushed me toward leaving.

The first was the denial of my CME conference application. I distinctly recall CME being one of the major selling points to the HPSP applicants back when I applied 13 years ago. These days, it seems nearly impossible to arrange for paid CME. I tried to do my part in this era of fiscal responsibility. I spent many hours researching for a conference that would minimize travel expenses while simultaneously maximizing the ratio of CME hours /conference fee. I spent even more time filling out these asinine forms trying to justify why keeping up my training and education is “mission essential.” It’s surreal how they force physicians to suffer through an endless slurry of pointless online training like “Office Ergonomics” and “Back Injury” (written like it's for people with a 4th-grade level of education), yet deny them basic CME. It’s like a slap in the face.

The second major event that’s got my blood on a boil has to do with my pay. My pay is already pathetically low, compared to what I can make on the outside. But I’m OK with that. I live comfortably enough, and when signing up for this, I knew what the pay scale would be like. What’s got me peeved is that all of a sudden, they just stopped paying my BCP 6 months ago. Fortunately, I just happened to notice one day when I was checking on my leave balance. It turns out an erroneous date was was entered by the credentialling people, making it look like my board certification expired 6 months ago. Granted, the BCP is not a large sum of money, but it’s the principle of the matter that irritates me. Did anyone bother to notify me that they were dropping my pay? No. They simply just cut off the funds and kept quiet. I find it to be a very underhanded way of conducting business. I have no doubt the system is intentionally designed that way. So much for those core Navy values of honor and integrity. The true irony of it is that according to their paperwork, I was then practicing medicine as a non-board certified physician. You would think maybe that would trigger some sort of concern. Not in the slightest. But on the contrary, the moment I’m a day late on filling out my DMHRSi, all hell breaks loose.

These two events to me are quintessential examples of the overarching attitude toward physicians in the Navy. We just aren’t valued very much and it shows. Of course, there are a myriad of other annoying things about being a military physician, as detailed extensively in the other thread “40 reasons not to join and counting.”

I won’t deny that the Navy has been great in a number of ways. The Corpsmen and other providers I’ve worked with have been fantastic, for the most part. The patient population is probably the best you could ask for. I received a top-notch education at my Navy residency, in my opinion.

But the plethora of negatives seems almost insurmountable. While I lament the prospect of 12 years toward retirement going to waste, I really doubt I can tolerate 8 more years. The worst part for me is the administrative duties—and that aspect is only going to get worse the longer I stay in. I’m already on three hospital committees, two of which I head up, and most of it is a complete waste of time. I try to do what I can to contribute in a positive way, but ultimately, I feel like the main function these committees serve is to provide a paragraph’s worth of empty calories for page 2 on fit reps. It’s a real shame that the actual patient care we provide as physicians counts for nearly zilch on our performance evaluations.

Just today, I met with my directorate leader. He’s a great guy and I believe he genuinely wants to help further my career in the Navy. Lately, he’s been trying to coerce me into taking on one of the real “high visibility” positions at the hospital, that would involve a lot of admin. I cringe at the thought. However, I know that if I plan to stay in the Navy, these are the types of leadership duties I need to seek out. I see the writing on the wall. If you want to advance your military career, the amount of leadership responsibilities begins to snowball until you’re doing almost all admin and nearly zero clinical medicine. The problem for me is that I love radiology and despise anything remotely
administrative/managerial. I think the Navy and I want different things from each other. Maybe I could try to schlep out eight more years shunning all these leadership jobs, but I’m sure that would be stigmatizing and I don't want to feel like a dirtbag all the time.

I’d like to know if anyone else has been faced with a dilemma like this at the 10-14 year mark, and what helped you make up your mind on whether to stay in or leave. Am I crazy to even still be thinking of staying in?

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The first step is to do your due diligence on the other side of the fence.

Are there opportunities that you want that might not be there 8 years later?

Just how much more income will you make after taxes? The pension you are flushing is worth $2M-$3M by my math, so you are being paid quite well for those 8 years.

Are there jobs in the military that are appealing enough to keep you in? How about waiting to do fellowship until you've signed an MSP at the end of your obligation (now thats a sweet deal)? Want to go to Rota, Naples, or points east (just don't go anywhere you'll be 1 of 1)?

Do you have to make O6 to feel like your Navy career was a success? Staying in and being a terminal O5 could be pretty fun.

You should moonlight and see if you like civilian practice.

I bailed but I think that most people at that point are making a financial mistake to do so. In my case, I'd have lost more in the divorce that would have come if I'd stayed in. All joking aside, I came out ahead to get out but not by that much. I like what I'm doing and I won't ever deploy again. I don't regret leaving.
 
I’m a Navy radiologist currently at 9 years of service with 3 years left on my contract. Thus, I’ll have 12 years in service when I have the opportunity to separate. It seems like 10-14 years of service is kind of a gray zone. Any time less than that and it’s a no-brainer to leave; any more than that, and well, you could probably tough it out until retirement without developing too much of a drinking problem.

Regardless, the time is drawing near when I need to start making preparations for the next stage in my career, which in my case is a fellowship. So lately I’ve been mulling over the decision of whether to stay in for the long haul or whether to separate.
Within the last few months several events have occurred that have really pushed me toward leaving.

The first was the denial of my CME conference application. I distinctly recall CME being one of the major selling points to the HPSP applicants back when I applied 13 years ago. These days, it seems nearly impossible to arrange for paid CME. I tried to do my part in this era of fiscal responsibility. I spent many hours researching for a conference that would minimize travel expenses while simultaneously maximizing the ratio of CME hours /conference fee. I spent even more time filling out these asinine forms trying to justify why keeping up my training and education is “mission essential.” It’s surreal how they force physicians to suffer through an endless slurry of pointless online training like “Office Ergonomics” and “Back Injury” (written like it's for people with a 4th-grade level of education), yet deny them basic CME. It’s like a slap in the face.

The second major event that’s got my blood on a boil has to do with my pay. My pay is already pathetically low, compared to what I can make on the outside. But I’m OK with that. I live comfortably enough, and when signing up for this, I knew what the pay scale would be like. What’s got me peeved is that all of a sudden, they just stopped paying my BCP 6 months ago. Fortunately, I just happened to notice one day when I was checking on my leave balance. It turns out an erroneous date was was entered by the credentialling people, making it look like my board certification expired 6 months ago. Granted, the BCP is not a large sum of money, but it’s the principle of the matter that irritates me. Did anyone bother to notify me that they were dropping my pay? No. They simply just cut off the funds and kept quiet. I find it to be a very underhanded way of conducting business. I have no doubt the system is intentionally designed that way. So much for those core Navy values of honor and integrity. The true irony of it is that according to their paperwork, I was then practicing medicine as a non-board certified physician. You would think maybe that would trigger some sort of concern. Not in the slightest. But on the contrary, the moment I’m a day late on filling out my DMHRSi, all hell breaks loose.

These two events to me are quintessential examples of the overarching attitude toward physicians in the Navy. We just aren’t valued very much and it shows. Of course, there are a myriad of other annoying things about being a military physician, as detailed extensively in the other thread “40 reasons not to join and counting.”

I won’t deny that the Navy has been great in a number of ways. The Corpsmen and other providers I’ve worked with have been fantastic, for the most part. The patient population is probably the best you could ask for. I received a top-notch education at my Navy residency, in my opinion.

But the plethora of negatives seems almost insurmountable. While I lament the prospect of 12 years toward retirement going to waste, I really doubt I can tolerate 8 more years. The worst part for me is the administrative duties—and that aspect is only going to get worse the longer I stay in. I’m already on three hospital committees, two of which I head up, and most of it is a complete waste of time. I try to do what I can to contribute in a positive way, but ultimately, I feel like the main function these committees serve is to provide a paragraph’s worth of empty calories for page 2 on fit reps. It’s a real shame that the actual patient care we provide as physicians counts for nearly zilch on our performance evaluations.

Just today, I met with my directorate leader. He’s a great guy and I believe he genuinely wants to help further my career in the Navy. Lately, he’s been trying to coerce me into taking on one of the real “high visibility” positions at the hospital, that would involve a lot of admin. I cringe at the thought. However, I know that if I plan to stay in the Navy, these are the types of leadership duties I need to seek out. I see the writing on the wall. If you want to advance your military career, the amount of leadership responsibilities begins to snowball until you’re doing almost all admin and nearly zero clinical medicine. The problem for me is that I love radiology and despise anything remotely
administrative/managerial. I think the Navy and I want different things from each other. Maybe I could try to schlep out eight more years shunning all these leadership jobs, but I’m sure that would be stigmatizing and I don't want to feel like a dirtbag all the time.

I’d like to know if anyone else has been faced with a dilemma like this at the 10-14 year mark, and what helped you make up your mind on whether to stay in or leave. Am I crazy to even still be thinking of staying in?

Time to go.

If you are not having fun at this point.......time to say good bye.


I love what I do. I have had some adversity and still want to put on the uniform every day. For those like me...easy choice, but don't trudge through.
 
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The first step is to do your due diligence on the other side of the fence.

Are there opportunities that you want that might not be there 8 years later?

Just how much more income will you make after taxes? The pension you are flushing is worth $2M-$3M by my math, so you are being paid quite well for those 8 years.

Are there jobs in the military that are appealing enough to keep you in? How about waiting to do fellowship until you've signed an MSP at the end of your obligation (now thats a sweet deal)? Want to go to Rota, Naples, or points east (just don't go anywhere you'll be 1 of 1)?

Do you have to make O6 to feel like your Navy career was a success? Staying in and being a terminal O5 could be pretty fun.

You should moonlight and see if you like civilian practice.

I bailed but I think that most people at that point are making a financial mistake to do so. In my case, I'd have lost more in the divorce that would have come if I'd stayed in. All joking aside, I came out ahead to get out but not by that much. I like what I'm doing and I won't ever deploy again. I don't regret leaving.

Is the reserve retirement enticing for someone in your position, gastrapathy? If you get out at 10-14 years (+ the time in HPSP) the reserve commitment for 20 would be pretty minimal, right?
 
I'm in a similar situation, albeit with fewer years. I've decided to bail, and for many of the same reasons you cite. I've been saving money for years now to live on during my civilian fellowship. Have you considering waiting for the right VA job to open up? You could apply those years toward a GS retirement.
 
The first step is to do your due diligence on the other side of the fence.

Are there opportunities that you want that might not be there 8 years later?

Just how much more income will you make after taxes? The pension you are flushing is worth $2M-$3M by my math, so you are being paid quite well for those 8 years.

Are there jobs in the military that are appealing enough to keep you in? How about waiting to do fellowship until you've signed an MSP at the end of your obligation (now thats a sweet deal)? Want to go to Rota, Naples, or points east (just don't go anywhere you'll be 1 of 1)?

Do you have to make O6 to feel like your Navy career was a success? Staying in and being a terminal O5 could be pretty fun.

You should moonlight and see if you like civilian practice.

I bailed but I think that most people at that point are making a financial mistake to do so. In my case, I'd have lost more in the divorce that would have come if I'd stayed in. All joking aside, I came out ahead to get out but not by that much. I like what I'm doing and I won't ever deploy again. I don't regret leaving.

I'm in a similar situation, albeit with fewer years. I've decided to bail, and for many of the same reasons you cite. I've been saving money for years now to live on during my civilian fellowship. Have you considering waiting for the right VA job to open up? You could apply those years toward a GS retirement.

Thanks for the replies. $2-3 million for 8 years is an interesting way to think of it. Certainly food for thought. Free health care isn't such a bad deal either.

Being a terminal O5 would be fine with me. Power and prestige aren't what motivate me. I genuinely enjoy patient care, interacting with other physicians, and the intellectual challenge of medicine. I would probably be happy doing some teaching at one of the residency programs. I'm just not excited about health care administration. And from what I perceive, that's what the Navy requires as you move through the O4-O6 level. Is there a place in the Navy for a physician who eschews admin?

On a separate note, is that loophole still open where you can receive MSP while doing a fellowship? That is also somewhat enticing.

I will be starting a moonlighting gig soon. No doubt this will help clarify things.

I've also considered other ways to put my time in service to use. Aside from the VA, there is the IRR. You get retirement and benefits starting at age 60 after accumulating 20 years service via your active duty time plus "retirement points."
 
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The first step is to do your due diligence on the other side of the fence.

Are there opportunities that you want that might not be there 8 years later?

Just how much more income will you make after taxes? The pension you are flushing is worth $2M-$3M by my math, so you are being paid quite well for those 8 years.

Are there jobs in the military that are appealing enough to keep you in? How about waiting to do fellowship until you've signed an MSP at the end of your obligation (now thats a sweet deal)? Want to go to Rota, Naples, or points east (just don't go anywhere you'll be 1 of 1)?

Do you have to make O6 to feel like your Navy career was a success? Staying in and being a terminal O5 could be pretty fun.

You should moonlight and see if you like civilian practice.

I bailed but I think that most people at that point are making a financial mistake to do so. In my case, I'd have lost more in the divorce that would have come if I'd stayed in. All joking aside, I came out ahead to get out but not by that much. I like what I'm doing and I won't ever deploy again. I don't regret leaving.

As usual, good advice. All the money in the world isn't worth staying in a job that makes you hate that world.

But at 12 years, except for the highest paying specialties, an honest number crunching session will prove the superiority of staying in the military until 20. But there's more to life than money.

I did the math and determined that if I was to get out at 12 years and walk away from the Navy pension, I'd have to find a PP job that guaranteed me at least $500K/year just to break even with Navy pay. (And that's not counting a single dollar from moonlighting while on active duty, or the lifetime family health care benefits the pension provides.) Counting moonlighting, the PP job would have to push $600K to break even - and even then, I'd have to save and invest everything in excess of the Navy pay. It's not like my standard of living would go up any. My taxes sure would though.

I've moonlighted a lot since residency, in several different settings. It's a joy in many ways, for variety if nothing else, but there's also plenty of crap that's as bad or worse than the military. JC still exists in the civilian world, nurses are still lazy. The patient population takes a nosedive. Job security? Heh.

The PP group a town away from me was abruptly underbid by a management company and almost overnight every one of those physicians was unemployed. Sure, they found new jobs quickly, but so much for community roots and job security. Every one of those civilian physicians suddenly found themselves doing a PCS move, and with less notice and more expense than any military move.

Deployments suck ... and they don't. I'm days away from flying home from my 3rd deployment (hooray, I am ready to get the hell outta here) and while it genuinely sucks to be pushing 40 years old and living in a dorm room with a roommate, eating in a cafeteria, 12.5 time zones away from family and my favorite dog, in the end THIS is why I joined the Navy and it's some of the most rewarding, pure medicine I've ever practiced.

Lots of the terminal O5s I know (even some terminal O4s with prior service) seem to be happier than the O6s, who had to take yearlong SMO tours outside their specialty to check the O6-promotable box. (There's one here now, a fellowship trained subspecialist, who won't touch a patient for a YEAR just to pad his fitrep for the O6 board.) And in the grand scheme of things, an O6 @ 20y pension really isn't worth that much more than an O5 @ 20y pension. Especially for a physician, for whom 1/2 the military pay doesn't even factor into retirement, and who'll retire from the military and go to work as a civilian for another 10 or 20 years.
 
In 10 years (or less) the current retirement might be taken away. They might raise the collection age to 60 or some crazy scheme. On the plus side is the GI Bill for dependents.
 
Are there opportunities that you want that might not be there 8 years later?

This was a concern for me, and probably should be for the OP as well, considering we're in the same specialty. There are practices out there who just aren't interested in hiring someone who's been practicing long enough to retire from the military. It's certainly not a deal breaker, but it was a limitation on job prospects that I was not willing to risk.

The other factor I'd highlight is fellowship, which is nearly ubiquitous outside of the military and almost obligatory for finding a PP job. In my mind, the question is not so much if to do one, but when. For me, I'm in a relatively good place now, and that gives me a measure of control over my future. But if I were to sign on for the fellowship, I'd relinquish that modicum of control, giving it back over to the whims of the Army. I'm just not interested in that, but the OP will need to ask himself how much the wants to move and how much he trusts the system to consider his wishes if he's willing to add to his commitment by way of fellowship.
 
In 10 years (or less) the current retirement might be taken away. They might raise the collection age to 60 or some crazy scheme.

No.

If they hyperinflated the US Dollar to the point that the wheelbarrows of cash were being used to build barricades to keep the zombies out in the streets where they belong, the .mil retirement scheme still wouldn't be retroactively changed.

On the plus side is the GI Bill for dependents.

Yes.

That is a very good deal. It wouldn't surprise me if they closed enrollment into that program at some point.
 
I'm in a similar situation, except a different specialty and service. 9 years in with 2 to go. I'm fairly resigned to the prospect of retiring a terminal O-5. On the current pay scale the difference between O-6 at 20 and O-5 at 20 works out to about $7K at 50% base pay.

I'll definitely take a $7K annual pay cut post-retirement (+COLA adjustments) for the pleasure of avoiding the whole-hog admin, full glass of Kool-Aid non-sense it would probably take to get to O-6. It is already worth at least $1.5M (assuming average life span). But then again, when I hit 18 years in, it may be on the upswing part of the cycle where the promotion rate is higher.

Make sure you are taking advantage of the GI bill transfer. You already qualify (or you will through your ADSO), but if you don't get on signed before 1 AUG13, you will incur a 4 year obligation. It's an excellent deal and you earned it. If you don't have kids yet, you can put down your spouse, and then transfer it to your future kids later.

The retirement money is going to be gravy in the initial years for me, because I don't envision myself retiring for at least another 25 years post-retirement. I love what I do too much.
 
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i will serve 4 year AD (with another 4 reserve total)- does that qualify for the GI bill?
 
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i will serve 4 year AD (with another 4 reserve total)- does that qualify for the GI bill?

Probably not. Here is the eligibility from http://www.gibill.va.gov/benefits/post_911_gibill/transfer_of_benefits.html

Eligibility

Any member of the Armed Forces (active duty or Selected Reserve, officer or enlisted), who is eligible for the Post-9/11 GI Bill, and:

1. Has at least 6 years of service in the Armed Forces (active duty and/or Selected Reserve) on the date of approval and agrees to serve 4 additional years in the Armed Forces from the date of election.

2. Has at least 10 years of service in the Armed Forces (active duty and/or Selected Reserve) on the date of approval, is precluded by either standard policy (Service or DoD) or statute from committing to 4 additional years, and agrees to serve for the maximum amount of time allowed by such policy or statute.

3. Is or becomes retirement eligible and agrees to serve an additional 4 years of service on or after August 1, 2012. A service member is considered to be retirement eligible if he or she has completed 20 years of active Federal service or 20 qualifying years as computed pursuant to section 12732 of title 10 U.S.C.

4. Such transfer must be requested and approved while the member is in the Armed Forces.

Typical HPSPer's are eligible 6 years in and agree to serve an additional 4 once you do the paperwork. (So then you're over 10 and you might as well stay!)
 
Probably not. Here is the eligibility from http://www.gibill.va.gov/benefits/post_911_gibill/transfer_of_benefits.html



Typical HPSPer's are eligible 6 years in and agree to serve an additional 4 once you do the paperwork. (So then you're over 10 and you might as well stay!)

But the additional commitment (to get to 10) can be done in the reserves or guard, right? This would be a possible option for someone wanting to leave active duty after their initial commitment and still have GI bill available for their kids/spouse.
 
This was a concern for me, and probably should be for the OP as well, considering we're in the same specialty. There are practices out there who just aren't interested in hiring someone who's been practicing long enough to retire from the military. It's certainly not a deal breaker, but it was a limitation on job prospects that I was not willing to risk.

The other factor I'd highlight is fellowship, which is nearly ubiquitous outside of the military and almost obligatory for finding a PP job. In my mind, the question is not so much if to do one, but when. For me, I'm in a relatively good place now, and that gives me a measure of control over my future. But if I were to sign on for the fellowship, I'd relinquish that modicum of control, giving it back over to the whims of the Army. I'm just not interested in that, but the OP will need to ask himself how much the wants to move and how much he trusts the system to consider his wishes if he's willing to add to his commitment by way of fellowship.

The possibility that emerging from the military after 20 years would be viewed negatively by practices is something that hadn't really dawned on me. What is the reason for this? Advanced age compared to other applicants?

I'm definitely planning to do a fellowship. Like you said, it's just a matter of when. The timing really hinges on my decision on whether to stay in or leave.

Like other people have mentioned, the GI bill transfer is a great deal. Thankfully, I have already done my transfer.

Has anyone looked into VA jobs? I know they're not the highest paying, but I have a med school friend in Anesthesia who works at a VA and he's pretty content. It sounds like a typical government job with average pay, average work load, predictable hours, and good benefits. I wonder if having prior service provides any sort of hiring advantage. For me, lifestyle and location trump money.

I may also look into the IRR. . . . but I am definitely skeptical.
 
Has anyone looked into VA jobs? I know they're not the highest paying, but I have a med school friend in Anesthesia who works at a VA and he's pretty content. It sounds like a typical government job with average pay, average work load, predictable hours, and good benefits. I wonder if having prior service provides any sort of hiring advantage. .

usajobs.gov will be your resource for VA jobs. Though I've heard of people finding jobs at a VA near where they live, this might be a bit tricky. In other words, you want to work at the VA in Tampa, but they aren't advertising for a radiologist there on usajobs. Can you work something to get a job on the sly... The VA does take veterans (ie anyone with prior service, not just deployed) with preference.

VA medicine is fairly easy, predictable, and you can pay 3% of your base pay x number of years served to buy into the federal retirement system.

It sounds like to me that you're frustrated with the job, and the admin is only going to pile on more. I know I'm jumping ship, but I'll only have 4 years in. It would be a tough decision at 12 years of service.
 
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But the additional commitment (to get to 10) can be done in the reserves or guard, right? This would be a possible option for someone wanting to leave active duty after their initial commitment and still have GI bill available for their kids/spouse.

That's a good point. I'm not sure, because I didn't research the reserve commitments.

It may be another possible avenue for people to take advantage of it.
 
usajobs.gov will be your resource for VA jobs. Though I've heard of people finding jobs at a VA near where they live, this might be a bit tricky. In other words, you want to work at the VA in Tampa, but they aren't advertising for a radiologist there on usajobs. Can you work something to get a job on the sly... The VA does take veterans (ie anyone with prior service, not just deployed) with preference.

VA medicine is fairly easy, predictable, and you can pay 3% of your base pay x number of years served to buy into the federal retirement system.

It sounds like to me that you're frustrated with the job, and the admin is only going to pile on more. I know I'm jumping ship, but I'll only have 4 years in. It would be a tough decision at 12 years of service.

Thanks for the info. I genuinely love my work as a radiologist, particularly in the Navy. I like the people I work with and the sense of comaraderie we have in the military. It's the emerging admin burden that is weighing me down. All the other things like the senseless online training, random drug tests, etc, are annoying too, but are more tolerable. I suppose more than anything, I especially don't like the feeling of guilt I have about wanting to avoid these high-end leadership positions. I do believe there is truth to the fact that in the military, you're an officer first, and physician second. It makes sense to me that this is what the Navy expects as you gain experience and rank. It's probably the pangs of cognitive dissonance I am experiencing, in that I wish it was the reverse (physician before officer).
 
I would offer the idea of transferring to the USPHS (if you could get the transfer approved from the USPHS side). Insofar as PHS is a little top-heavy I would think that an 0-6 has a fighting chance of a 'continuing mostly clinical work' option. PHS could allow you to keep your years towards retirement while continuing to work in a ~public service environment.
 
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I think the OP laid it out better than maybe anyone has on this forum, as far as the challenges in military medicine. This whole admin push to make 0-6 seems worse in the Navy, but it definitely exists in the Army. It is just so f*&% sad that people get out because they want to practice medicine. Thanks for your service, I hope for the sake of us that are stuck well beyond 12 years, and our patients that you decide to stay in. When the House of Reps holds up the budget again and we don't get our Oct. specialty pay until Feb., it might help make the decision easier. Paid CME is likely gone for the forseeable future.
 
My two cents, as a guy who got out a long time ago and has practiced in the private and academic hospital settings, is that I've never gotten a negative reaction from someone who finds out about my military background. Military docs are perceived as having their act together and being reliable, as far as I can tell. Maybe I've been lucky.

I had a love-hate relationship with the service, but really needed to get out after my commitment for family reasons. If your family likes the lifestyle and you're still enjoying it, why not keep on? Admin (again in my limited experience) is a mixed bag -- tedious, but not so bad if you can be the boss of your department in a small hospital. As long as you have a good relationship with the hospital command, you can run your department and try to minimize the military nonsense that gets in the way of the job. Do note, though, that leadership in military medicine doesn't seem to translate into the civilian world the way clinical experience does. Some of my colleagues have been disappointed at going from clinic commanders in the military to just plain doctors in the civilian world. The practical lessons translate pretty well, though.

If you do get out and stay in the Reserves, try and get a VA or academic position, that way you'll be covered if you get activated and you won't lose your position. Good luck!
 
I will be 11 years in when I am eligible to get out. The administrative burden is going to get worse in the Army. I had some COL come down from HRC and try to sell doing operational tours to a room full of skeptical AD physicians at my MTF. Some asked about skill atrophy if they are doing a 2 year tour as a brigade or flight surgeon. He incredulously stated that one could make time to do clinical work one day a week to keep skills up. He was gently told now that the primary clinics at our MTF who are down providers due to deployments cannot get those in the brigade to do shift because of their inordinate time commitments to admin work. He just blew off that concern and said people need to hash it out with the "chain of command." He said in so many words said that the Army needs operational AD physicians. Clinicians in CONUS MTFs can always be farmed out to civilian contractor or GS physicians. I am getting regular emails about enrolling in CCC in order to make LTC or signing up for some operational slot.

For the Army, the administrative boondoggle will get worse. There is a push to have residency trained board certified physicians fill these brigade or flight surgery slots. A buddy of mine who was in my fellowship class was recently involuntarily assigned as a brigade surgeon. My specialty is procedure oriented. I have no idea how he'll manage to do non-clinical job for two years without going mad.

Everyone is saying they'll be out this much or that much if they leave after so so many years on active duty. Well, there is no price on personal and professional happiness. I have a decent savings now. I am contributing to my TSP as well as IRA. I have no regrets about my time in service now. As a mid grade 04, the admin pressure is quickly heating up. Once my 11 years are up, I am out. I will be paid fairly well on the outside. I'll continue to save like I do now for retirement but I'll be happy. There will not be the threat of be assigned to some operational slot or having to take some sort of "leadership" admin command role as a 05 or 06. Just my $0.02.
 
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For the Army, the administrative boondoggle will get worse. There is a push to have residency trained board certified physicians fill these brigade or flight surgery slots.

On some level, I think this is going to be better in a couple of years. Here is a candid email about the new Army GME policy for fellowship training. This is from the person in charge of GME (if you know who she is):

Clinical consultants,

I have attached 2013 GME Announcement - there are several changes this year, one much more significant than others, and that is the "TOS/Utilization" requirement. The other items are the requirement for a personal statement to be included with the application, and that all documents, except the LORs and interview sheets will be scanned in to the MODS system for panel review.

The big, and contentious change is the TOS/Utilization portion. MC HRC will be distributing a policy in the next day or so which MG Thomas has endorsed outlining the new TOS/Utilization requirements for MC. With these very new requirements, I do have significant concerns over the effect on GME, and COL Smith and I have discussed at length the need for a transition period of at least one year for this substantial a change. I have tried to put enough flexibility in the instructions so that anyone can, and will, apply for residency and fellowship. (Please see modification of wording under the TOS heading that will be published on Monday, below). There are two changes - a requirement for 24 months TOS for any duty assignment (except Sinai and unaccompanied Korea), and a requirement for a utilization tour prior to fellowship. The primary reason for the 24 month requirement is that fiscal restraints are requiring closer adherence to the DODI and Army regs governing TOS (the DODI says 3 yrs TOS, Army regs say 4), and GME is no longer the unwritten exception to the rule. MC HRC is reasonably confident that exceptions to PCS or transfer with less than 24 months TOS will be rarely approved by the approval authority. Regarding the utilization tour, which may have a more profound effect on fellowship applications and our ability to fill our fellowships - this year, and potentially next, will be transition years prior to an anticipated full implementation of the requirement. Recognizing that 40+% of fellowship applications are from current trainees, institution of the requirement this year, would have a disastrous effect on applications this season, especially in those specialties where recruiting is a challenge. I have written the instructions stating that anyone can apply, but that TOS and utilization tours have taken on more import in the process (although the score sheets have not, and cannot, be changed - they are tri-service documents). One of the main reasons for this requirement is to alleviate the burden on the subspecialties to provide operational support. Having additional manpower from the post-residency population is intended to eliminate the need to send highly specialized, GME/research engaged, and MTF reliant sub-specialists to BDE surgeon and other positions, and I know most of you are well aware of the angst, and machinations surrounding filling the operational positions, especially with subspecialists. As the optempo declines and Army downsizing begins with loss of units, etc, there may be modifications, but for now, I hope you know we are committed to maintaining the GME pipeline for the projected future needs of the AMEDD.

NEW LANGUAGE:

TIME ON STATION (TOS) UTILIZATION REQUIREMENT:

a. There are no restrictions on eligibility for current FYGME trainees in applying for further GME.

b. Individuals who are currently GMOs in a staff utilization tour cannot begin training less than 24 months after arrival at their current duty station. Therefore, those individuals who will not have completed 24 months time on station (TOS) by 31 Aug 2014 are not likely to be selected.

c. Fellowship applicants should note the new requirement for a utilization and/or operational tour prior to beginning training. Although any individual interested in fellowship may apply, candidates who have completed such a tour by the start of fellowship will be prioritized for selection.

d. Officers who are .....


Thanks - please feel free to call or email for questions.

<snip>

I bolded the interesting part. I think this is going to damage the willingness of junior MC officers to stay past their initial ADSO, but what do I know?
 
Clinicians in CONUS MTFs can always be farmed out to civilian contractor or GS physicians.

This is another one of the frustrating tragedies of military medicine currently. Civilian contractors are hired to fill in for the vacuum of clinical medicine left after the military forces the AD physicians into admin positions. And in my experience, the majority of these civilian contractors are simply low quality doctors, probably near the bottom of the barrel in fact. Surely this is because the salaries are not too competitive. Granted, there are definitely some exceptions. The GS physicians I've dealt with at the residency programs are fantastic. But the contractors without any teaching responsibilities, who are hired only to provide clinical care, are just terrible. Most of the ones I'm talking about staff the ERs/urgent care centers and outlying clinics. It's a shame that we have great AD physicians who are effectively stonewalled from this clinical work and also a shame that AD members and their dependents are subject to subpar care from lousy civilian contractor providers.
 
This is another one of the frustrating tragedies of military medicine currently. Civilian contractors are hired to fill in for the vacuum of clinical medicine left after the military forces the AD physicians into admin positions. And in my experience, the majority of these civilian contractors are simply low quality doctors, probably near the bottom of the barrel in fact. Surely this is because the salaries are not too competitive. Granted, there are definitely some exceptions. The GS physicians I've dealt with at the residency programs are fantastic. But the contractors without any teaching responsibilities, who are hired only to provide clinical care, are just terrible. Most of the ones I'm talking about staff the ERs/urgent care centers and outlying clinics. It's a shame that we have great AD physicians who are effectively stonewalled from this clinical work and also a shame that AD members and their dependents are subject to subpar care from lousy civilian contractor providers.

So I guess the question is, what's the solution that gets AD docs back into clinic? Do you think that some the administrative positions are self-perpetuating and can be eliminated? If so which ones? Do you think they could be shifted to different members of the military, or to civilian contractors, with a better result? Is the solution just to make the medical corps larger to spread out the administrative burden? Is it better for these positions to be filled by late career physicians (like subspecialists) rather than early career physicians? How would you fix it?
 
So I guess the question is, what's the solution that gets AD docs back into clinic? Do you think that some the administrative positions are self-perpetuating and can be eliminated? If so which ones? Do you think they could be shifted to different members of the military, or to civilian contractors, with a better result? Is the solution just to make the medical corps larger to spread out the administrative burden? Is it better for these positions to be filled by late career physicians (like subspecialists) rather than early career physicians? How would you fix it?

I certainly don't have all of the answers, but the first thing I would do is change the way in which medical corps officers are evaluated and promoted. Pretty much everything that I can do to make myself look good to the promotion board has zero to do with my clinical acumen or my work ethic. The system incentivizes people not to practice medicine, and then it preferentially retains and promotes the people who tend to be good at not being a doctor.

I think that everyone recognizes that some degree of administration is a necessary adjunct to practicing medicine, whether it's in the military or private practice, but military medicine doesn't see it as an adjunct. It sees this admin work as the end, rather than just a means, and - even worse - it uses that means as the primary metric by which we're judged. That's a broken system.

Instead, make productivity a substantial factor in promotion. It doesn't have to be a graded scale or anything - just set a threshold and say, "you will not be promoted if you don't produce at least this much". Past that threshold, everyone's equal - like a PT test for doctoring. At best, some of these clowns who roll in at 0930 and work at a 0.5 FTE pace will get passed over and shown the door. At worse, some of those clowns will work harder, making it a nicer place to work for everybody else.

It would take some time, but eventually people with the correct perspective would make it into positions of power. And once that happens, the total administrative load will probably decrease, as these people will be a better judge of what's essential admin and what is not.
 
You make it sound like its a lazy physician provider issue. You have to ask yourself is their a support staff availible for me to work at 1.25 ffe. Also you have to eliminate the croneyism and make the system as a whole fair for all which it is not. Rules apply to certain people and not to others. Great care is provided for pts in my field but on the whole mil med needs radical restructuring.
 
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What would be my solution? I'd like to see the creation of two different career paths, an executive medicine path and an academic/clinical path. There would be opportunities in each pathway to make contributions to military medicine as a whole, but in different ways.

This system for the executive path is essentially what's already in place. Physicians are rewarded for making contributions to improving the organizational structure, business aspect, managerial issues, etc. You work your way up through positions like the executive committee, department head, directorate, XO at a small MTF, then XO at big MTF, then CO, etc. You would be afforded some time in clinical medicine for skill maintenance, but your main focus would be in an administrative role. You would be provided dedicated time for these administrative roles that would not come in conflict with your clinical duties. Your performance evaluation would be weighted more to your administrative accomplishments, with less emphasis on your clinical acumen (essentially the way it is in the current system).

The alternative pathway could consist of two parts, clinical and/or academic. If you go this route, you would be expected to be a clinical workhorse or an academician. As colbgw02 stated, in the current system, their is no incentive to be productive. In fact, the current system rewards the physician who shirks his/her clinical responsibilities in order to jump on as many hospital committees and other collateral duties as possible, in order to boost their chances of promotion. We probably have all known someone like this in the department, who is a total ladder climber and lets everyone else pick up their slack while they are off at "meetings" and such every day. A person like that would have to choose the executive medicine route, because in the alternative academic/clinical pathway, you would instead have your fitness evaluation be based on your level of productivity, as colbgw02 was alluding to. A side benefit of this system is that would free physicians from the time consuming admin responsibilities and allow them to really hone their skills and be the go-to people for difficult and challenging cases. They would be expected to be the experts in their fields. There would actually be incentives for doing a fellowship and improving your training and academic knowledge (instead of the opposite in the current system, where it is almost treated as a punishment). If you like academics, you could make contributions through research and teaching at the residency programs. I don't know about the other branches, but the Navy is making a pathetic attempt right now to increase emphasis on research at the residency programs. If you created this alternative pathway that would reward the physicians with academic inclinations, maybe there would be some genuine interest in research, as opposed to the half-hearted lackadaisical experience I witnessed.

I know that will never happen, but since you asked. . . .
 
I'd eliminate 90% of the medical corps. Turn us into a reservist organization with minimal conus mtf presence, get out of the gme business and the hospital owning business. Hire a bunch of case managers to sort out the fitness for duty stuff. Turn the lights out.

I'm not sure I'm serious but it's an interesting thought exercise.
 
I'd eliminate 90% of the medical corps. Turn us into a reservist organization with minimal conus mtf presence, get out of the gme business and the hospital owning business. Hire a bunch of case managers to sort out the fitness for duty stuff. Turn the lights out.

I'm not sure I'm serious but it's an interesting thought exercise.

Do you think that civilian providers would accurately diagnose our patients' level of illness? If we outsourced Peds, for example, I could imagine a scenario where every kid who had an inhaler would be EFMP level 5 and couldn't be based overseas. It seems like it would be easy for servicemen to doctor shop for the answer they wanted.
 
You make it sound like its a lazy physician provider issue. You have to ask yourself is their a support staff availible for me to work at 1.25 ffe. Also you have to eliminate the croneyism and make the system as a whole fair for all which it is not. Rules apply to certain people and not to others. Great care is provided for pts in my field but on the whole mil med needs radical restructuring.

I didn't intend to imply that. Most military physicians I know have a work ethic that's just fine, but I don't think that this work ethic gets rewarded properly. And by work ethic, I'm referring specifically to patient care. The overall result is that we have a disproportionate number of people in leadership positions who don't sufficiently value and contribute to the delivery of healthcare. Those people can admin the hell out of their day, but at some point they lose perspective on where that fits into the whole system, and that affects all of us.

And clearly a lot of this our frustrations come from outside of the medical corps, but I'm not so ambitious as to think that 1) the military will let us become our own service or 2) we change the overall military culture vis-a-vis stupid BS. I just think that if we can get the right people into the leadership positions, it would go a long way to making everyone a lot happier. And I think we can make that happen by rewarding the right type of behavior.
 
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I'd like to see the creation of two different career paths, an executive medicine path and an academic/clinical path.

Supposedly this is what the Air Force has established. However, the academic/clinical group is the on-deck circle for any exec jobs that go unfilled.

Most posts here, including mine, complain about the non physician bosses screwing up their clinic or MTF. I don't know what the answer is but we can't have it both ways. Some physicians have to be the leaders, but most of us want to stay doctors.
 
I'd eliminate 90% of the medical corps. Turn us into a reservist organization with minimal conus mtf presence, get out of the gme business and the hospital owning business. Hire a bunch of case managers to sort out the fitness for duty stuff. Turn the lights out.

I'm not sure I'm serious but it's an interesting thought exercise.

I think the Pentagon is (or should be) thinking about getting rid of GME. It is an elaborate expensive set up with demanding accreditation standards that are often at odds with the military mission. Certainly sequester has people scrambling, and this is just the beginning.
We send our patients downtown on tricare, and we ship our residents to outside rotations to gain experience....that alone says it all.
 
The alternative pathway could consist of two parts, clinical and/or academic. If you go this route, you would be expected to be a clinical workhorse or an academician.

I know that will never happen, but since you asked. . . .

F&$!n Amen brother. I am sick of getting emails about building tomorrows medical leaders, when they really mean non-medical, admin, non clinical leaders. This is far less than 5% of us in the medical corps (that is a guess of course). Ask yourself how many of those above you would have been promoted past Assistant Professor at even an average academic institution? There are a few, of course, but making 0-6 has nothing to do with the second pathway you proposed for many.
 
The Air Force on Thursday said that it would convene a selective early retirement board Dec. 9 to consider eligible lieutenant colonels and colonels for involuntary early retirement. Career fields affected include Nurse Corps, Biomedical Sciences Corps, Judge Advocate General Corps and Medical Services Corps.

They forgot to say MC.
 
If one wanted to do admin, why go to medical school? Getting an MHA or MPH is not that hard. Guess if you hate patient care, it's the way to go. I had to do a collateral duty of accounting when the 01 HCA went UA. To the OP, I never met anyone that's retired that regretted doing the time.
 
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Kind of hard to regret something you did for 20 years.

True. For me, there's a difference between regretting something and making the same choice twice. I definitely don't regret my time. I've met too many great people to ever say that, but I can't say I would do it again.
 
This talk of regret makes me think about my time as a GMO. For me, the GMO time was analogous to something like prison. It was a miserable experience, but I emerged a better person for it. Frankly, I was an immature underachiever before then. Those years afforded me time to get my act together. So do I regret it? No. But would I choose to do it again? Absolutely not.

It's funny to compare my GMO experience to residency. As a GMO, I had cake hours. I had a two hour lunch every day. Weekends off, holidays off. But the job itself sucked. It was probably 90% admin. Going to meetings every day, organizing shot stand-downs and tracking pre/post deployment health assessments and other wretchedly mundane chores.

Then I start residency. I'm working 2-3 times as many hours, going home and studying all night and on the weekends. Working long overnight call shifts. Getting pimped and feeling like a ***** everyday. I kept this pace up for four long years. But it was awesome. I was incomparably more satisfied during my residency, working my tail off, then when I was a GMO with it's cake lifestyle but admin-focused duties.

That is my fear now. I love my job as a radiologist. I want to practice radiology, not be an administrator. It took me 9 years of training to get here and this is what I enjoy and want to do with my life. I worry that during the coming years I will be forced/coerced/pressured into another admin-heavy role like when I was a GMO. That's why I'll probably be getting out at the earliest opportunity. I recognize that there is a need for physicians to fill leadership roles and for those who enjoy that line of work, I applaud them. But it seems like there isn't a place in the military for those of us who want to keep our focus on clinical medicine.
 
Make O5 and then don't do anything you don't want.

There's more than a little merit to this idea.

I don't think I have it in me to spend 5 years gunning for O6. I did the math and it would be worth an extra $404/month in 2013 dollars compared to my O5 retirement cheese. That ain't enough to make me enthusiastic about more voluntary bleeding on the committee altar.
 
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