"The Real (army) World"

[Homunculus]

so it's been almost 3 months since i graduated residency and joined my current MEDDAC.

some basic background info-- i was 4 year army ROTC, then 4 year army HPSP. I researched HPSP well-- it was prior to 9/11 of course, and easily 90% of the docs i spoke to (MEDCEN and MEDDAC) were having a decent go of it. piddly stuff here and there, but people were happy. no real deployments (peacekeeping stuff and backfill mainly) and people homesteaded fairly easily. Anywho, things changed.

i completed my 3 year residency straight through without GMO's. 'cause the army is phasing those out you know. well, sorta. the billets are still there, they're jsut filled by primary care docs now.

i hesitated in residency to comment on "the real army" or, as some of my attendings liked to put it "out at the MEDDAC" because i had no experiences to comment on. Honestly, life at a MEDCEN ain't bad, and i'll try to return to one someday just because it means less work and call as an attending residents are good to have around . . .

well, i think i can comment on it some now. bad and good so far in 3 months at a major training base MEDDAC:

1) EFMP is broken. i see kids who have no right being here. not a suprise, i was warned about this

2) standard of care for my specialty (peds) here is *horrible*. our ER is rampant with crazy **** like treating kids with antibiotics to PREVENT an ear infection from a URI, diagnosing 2 week olds with laryngitis, giving 'roids and z-max to every kid with a cough and a fever, 3 wbc's on an otherwise clean UA is pyelo, etc etc. the list goes on. the only EM boarded doc is the chief-- the rest are old surgeons, FP's, etc contracted by the hospital. some gems from some of the physician extenders?? systemic roids for unexplained lymphadenopathy, babies getting robitussin DM, rotateq or gardasil never being recommended, among others. stuff i took for granted in residency doesn't occur here-- which is part of hte reason i'm here, but at the moment i'ts a bit overwhelming. i don't know where to start, lol.

3) RVU's are king. it's the metric used to determine money, staffing, patients, everything.

4) deployments have taken half our providers, and in return we get one reservist FP for backfill. thanks.

5) speaking of deployments, biding your time waiting for when your turn is up is like me telling you i'm going to punch you in the face, but never telling you when, then walking past you a dozen times a day. it's a little nerve wracking. honestly, the 15 month thing for primary care is ******ed. IMO my pediatrics skills will deteriorate as much as a surgeon's will-- at least he gets to practice *some* of what he does. i doubt i will be seeing many kids in the local BAS, lol. newborns?? rofl. anyway, if i had a 6 month deployment i'd volunteer. or a 4 month AF deployment? it'd be like a vacation 15 months is just too damn long. and yes, i would like some cheese with my "whine".

so that's the main bad stuff. good stuff:

1) i'm appreciated here so much more than at the MEDCEN. patients are excited to have a real pediatrician. at the MEDCEN's, they were annoyed i wasn't a gastroenterologist to see their constipated 4 year old.

2) going along with that, there aren't any subspecialists. period. so i get a chance to manage stuff that would get auto-turfed to the subspecialists. this is good and bad, because sometimes it's nice to have the curbside consult available.

3) hours: aren't nearly as bad as some posters have said in the past. one particular air force poster or two () mentioned crazy-ass work hours. i work m-f 7:30 to 5:30 (depending on notes and follow ups), with calls smattered here and there, with weekend calls and backup calls as well. it's better than residency at least.

4) the cafeteria is cheap.

5) being a CPT at a medcen? /yawn. being a CPT here with a million E-nothings running around? something. it's little, but i almost feel bad the way they part like the red sea when i come through.

anyway, i'm sure there's more, but that's all i have for now during a brief pause in the action (20 minute slots all day).

going to do the r-me-doc thing:

7-9-10 to go!!!

--your friendly neighborhood MEDDAC-ing caveman

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[R-Me-Doc]

going to do the r-me-doc thing:

7-9-10 to go!!!

--your friendly neighborhood MEDDAC-ing caveman

I think this is the first time I've ever been "cited in the literature"!

Thanks for the honor. No offense but I hope I'm still not surfing SDN when you get to 0-0-1!



Seriously, great post. I think you nailed the good and bad quite nicely. Best lesson is the huge difference between the MEDCEN and MEDDAC worlds.

Good luck!

X-RMD

ETS+ 1-2-21

 

[Galo]

Good to see your surviving. Imagine if you flew off at the handle at every stupidity that the ER *****s did. Now imagine if it was more urgent stuff like surgical urgencies. You can began to appreciate how some of us made waves. My main beef has always been with the inadequacies in being able to provide quality care, and you've pointed some of them out in your specialty. Wait till you meet 0-6 Frank Burns that has a wild hair up his ass for you complaining that he gave antibiotics to a kid with a pimple. You get my drift.

Best of luck.

 

[Homunculus]

ETS+ 1-2-21

thanks for rubbing it in

actually i hope you're around when i hit my ETS. you'll be a good resource-- "living history" if you will . . . to tell what things were like "back in the old days". . .

--your friendly neighborhood respects his elders caveman

 

[The White Coat Investor]

5) being a CPT at a medcen? /yawn. being a CPT here with a million E-nothings running around? something. it's little, but i almost feel bad the way they part like the red sea when i come through.

I know what you mean. I feel like I'm going out to collect salutes when I walk over to the chow hall.

 

[militarymd]

so it's been almost 3 months since i graduated residency and joined my current MEDDAC.

some basic background info-- i was 4 year army ROTC, then 4 year army HPSP. I researched HPSP well-- it was prior to 9/11 of course, and easily 90% of the docs i spoke to (MEDCEN and MEDDAC) were having a decent go of it. piddly stuff here and there, but people were happy. no real deployments (peacekeeping stuff and backfill mainly) and people homesteaded fairly easily. Anywho, things changed.

i completed my 3 year residency straight through without GMO's. 'cause the army is phasing those out you know. well, sorta. the billets are still there, they're jsut filled by primary care docs now.

i hesitated in residency to comment on "the real army" or, as some of my attendings liked to put it "out at the MEDDAC" because i had no experiences to comment on. Honestly, life at a MEDCEN ain't bad, and i'll try to return to one someday just because it means less work and call as an attending residents are good to have around . . .

well, i think i can comment on it some now. bad and good so far in 3 months at a major training base MEDDAC:

1) EFMP is broken. i see kids who have no right being here. not a suprise, i was warned about this

2) standard of care for my specialty (peds) here is *horrible*. our ER is rampant with crazy **** like treating kids with antibiotics to PREVENT an ear infection from a URI, diagnosing 2 week olds with laryngitis, giving 'roids and z-max to every kid with a cough and a fever, 3 wbc's on an otherwise clean UA is pyelo, etc etc. the list goes on. the only EM boarded doc is the chief-- the rest are old surgeons, FP's, etc contracted by the hospital. some gems from some of the physician extenders?? systemic roids for unexplained lymphadenopathy, babies getting robitussin DM, rotateq or gardasil never being recommended, among others. stuff i took for granted in residency doesn't occur here-- which is part of hte reason i'm here, but at the moment i'ts a bit overwhelming. i don't know where to start, lol.

3) RVU's are king. it's the metric used to determine money, staffing, patients, everything.

4) deployments have taken half our providers, and in return we get one reservist FP for backfill. thanks.

5) speaking of deployments, biding your time waiting for when your turn is up is like me telling you i'm going to punch you in the face, but never telling you when, then walking past you a dozen times a day. it's a little nerve wracking. honestly, the 15 month thing for primary care is ******ed. IMO my pediatrics skills will deteriorate as much as a surgeon's will-- at least he gets to practice *some* of what he does. i doubt i will be seeing many kids in the local BAS, lol. newborns?? rofl. anyway, if i had a 6 month deployment i'd volunteer. or a 4 month AF deployment? it'd be like a vacation 15 months is just too damn long. and yes, i would like some cheese with my "whine".

so that's the main bad stuff. good stuff:

1) i'm appreciated here so much more than at the MEDCEN. patients are excited to have a real pediatrician. at the MEDCEN's, they were annoyed i wasn't a gastroenterologist to see their constipated 4 year old.

2) going along with that, there aren't any subspecialists. period. so i get a chance to manage stuff that would get auto-turfed to the subspecialists. this is good and bad, because sometimes it's nice to have the curbside consult available.

3) hours: aren't nearly as bad as some posters have said in the past. one particular air force poster or two () mentioned crazy-*** work hours. i work m-f 7:30 to 5:30 (depending on notes and follow ups), with calls smattered here and there, with weekend calls and backup calls as well. it's better than residency at least.

4) the cafeteria is cheap.

5) being a CPT at a medcen? /yawn. being a CPT here with a million E-nothings running around? something. it's little, but i almost feel bad the way they part like the red sea when i come through.

anyway, i'm sure there's more, but that's all i have for now during a brief pause in the action (20 minute slots all day).

going to do the r-me-doc thing:

7-9-10 to go!!!

--your friendly neighborhood MEDDAC-ing caveman

now..you believe me

 

[alpha62]

mid-levels aren't your problem. The ****** they work under are.

If it weren't for them, your *** would be sitting there whining from the tailgate of Bradley right now alreadypicking sand out of your teeth and it wouldn't be for 4 months, more like 18.

BTW, came upon a newbie PA shooting up a hot joint with steroids in a kid with a lymphoma out at NTC. I tried to stop it, but the BDE CO was tickled pink he had a 2LT that would do anything to keep the boss happy.... and the BDE Surgeon... a Pedi, was was in love with the guy to, so who was I to jump into that 3 way ?

Everybody in this mess is part of the problem, I don't think you've been in this long enough (rotc don't count) to really know who truly screwed up this thing has become

 

[FizbanZymogen]

the only EM boarded doc is the chief-- the rest are old surgeons, FP's, etc contracted by the hospital. some gems from some of the physician extenders?? systemic roids for unexplained lymphadenopathy, babies getting robitussin DM, rotateq or gardasil never being recommended, among others.

--your friendly neighborhood MEDDAC-ing caveman

Your overall post is very interesting and informing to read. I just have to say in the two EDs I worked in before med school the above quoted statement was true too (these were rual ED in cities with populations around 30,000-40,000). The ER docs were almost exclusively FP guys who weren't making enough (or just plain not making it) and so worked in the ER. My understanding is the older docs (pre-ER residency) were just grandfathered in under the ER umbrella and could practice without problems. Sounds like you are seeing the same thing in your MEDDAC. Good luck!

 

[Homunculus]

mid-levels aren't your problem. The ****** they work under are.

If it weren't for them, your *** would be sitting there whining from the tailgate of Bradley right now alreadypicking sand out of your teeth and it wouldn't be for 4 months, more like 18.

BTW, came upon a newbie PA shooting up a hot joint with steroids in a kid with a lymphoma out at NTC. I tried to stop it, but the BDE CO was tickled pink he had a 2LT that would do anything to keep the boss happy.... and the BDE Surgeon... a Pedi, was was in love with the guy to, so who was I to jump into that 3 way ?

Everybody in this mess is part of the problem, I don't think you've been in this long enough (rotc don't count) to really know who truly screwed up this thing has become

i never said anything about ROTC counting for anything other than more obligation. and the average army deployment is 15 months. if i had the chance for a 4 month deployment i'd be first in line to go.

the physician extenders are primarily contractors. and the few active duty NP's we had never deployed and are retiring and coming back as contractors. a few of the PA's have gone though.

now i'm 7 months in, and nothing has really changed since my original post. every department is understaffed/overworked, and the only reason patients don't suffer is because the providers have high enough standards to go the extra mile.

i doubt things are better or worse here than anywhere else-- with the current attrition rates (no one here has re-upped in years-- if anything they turn around and become contractors and get paid more to do less) everyone is hurting. i'll let you know if anyone i know re-signs. even people who are 1-2 years away are telling me there's no way in hell they're staying in.

it will be interesting what happens when those of us with >4 year obligations are the only ones left, and by default, get promoted into leadership positions. in 3-5 years the lack of MAJ in the medical corps should be quite noticeable. the only way i see things changing is if deployment length for EVERYONE, not just echelons above brigade, change to 6 months, and they do something with the pay scale to make it closer to civilian. until then it's going to be a bunch of rapid cycling captains who GTFO at their first chance with no senior leadership to know how to do anything, lol.

--your friendly neighborhood 7-4-17 to go caveman

 

[a1qwerty55]

I wouldn't reply to the PA goon.

As far as your experiences, I think they are quite reflective of the AMEDD in general, especially as it pertains to primary care. There hasn't been any push to retain primary care, especially peds, FP or IM. The result is and will continue to be a steady reduction in the already poor continuity and access to care for our beneficiaries.

As you pointed out, care is ok, not b/c of the system but despite the system b/c people like yourself are working above and beyond the call.

Since most primary care docs get deployed as GMO's, the newest ALARACT reducing deployments to 6 months does nothing for them.

Thanks for doing your best for our servicemembers and their kids. I don't expect you will get any thanks from anyone with rank on their shoulder. I never have.

 

[militarymd]

homoc

glad to see you coming around

mil

 

[alpha62]

My civilian job was a PA contractor at a large MTF. I agree some of them sucked. They were usually menopausal females on their second career and had no military background.

You don't have to respond, but you're running out of " goons " and your number is coming up. Ever notice how they "surge" up, but they never "surge" down in Iraq ?

 

[civic4982]

I realize this is an old thread but it's very valuable and I wanted to bring it to the top.

As a resident currently looking into FAP it's definitely value added in my decision making process.

Thank you.