The Tale of BigNavyPedsGuy

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BigNavyPedsGuy

BigNavyPedsGuy

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Well, terminal leave is over and I'm officially off active duty. I figured I'd sit down and write a summary of my military experience. It's going to be long, but hopefully helpful to some. You can flame me afterward, but since this is my personal experience, I won't take it well. This was going to be one really long post, but that would make it almost unreadable. I've decided to break it down into posts by stage.
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Sign up and early medical school:

I applied for all 3 branches HPSP and got accepted by all 3. I went to a medium sized state school and even though I have a few cross country interviews, the only medical school acceptance I received was to my state school (University of Arkansas College of Medicine). It's worth noting that I declined my invitation to interview at USUHS. The fear that I would not be able to escape Arkansas played a large part in my decision to join.


Ultimately, I joined the Navy and I took my first Oath of Office when this war in Iraq was 6 weeks old. I wasn't too news/politically savvy, so I expected the war to last 6 months to a year and we would be greeted as liberators. It IS worth noting that I actually and an honest and knowledgeable Navy recruiter, I came in with head knowledge of GMO tours. Sidenote: I was engaged and m fiancé was on board with this decision as well.


Medical school went on, after my first year I went to OIS (before it was ODS). There I learned a lot more about how the "needs of the Navy" came before my career choice. I had started medical school with a goal to be an orthopedic surgeon, but by this time, I had already started to have an interest in Pediatrics.


Medical school progressed. I did OK. I was literally right in the middle of my class, my Step scores were just above average. It was somewhat frustrating being in a land-locked place VERY far away from any Navy knowledge or gouge. That's how I found this forum.
 
Late Med school and the match

I attended a conference (PAS) during my 3rd year and was able to bump into some Navy Peds folks who were gracious enough to take the time to sit down with me (and my wife) and discuss the whole process with me. At that time, there had been an edict/threat to shut down all Navy Pediatrics. That has obviously since been de-bunked, but still a scary threat.


I was VERY proactive and was able to schedule a Sub-I on the ward at NMCSD in August and a Sub-I on the ward at NMCP in Oct. These both counted as electives for my med school, so ultimately I did 3 sub-Is. They went well. My advice to any students reading this, is to take the most complicated patient with the most going on. You'll be a highly visible member of the team for quite some time. Ultimately, I was given the impression that I could somewhat choose which program because they both liked me. I ended up getting my first choice in San Diego. I was quite happy as that year there were 32 applicants for just 19 peds slots (NOTE: They had told us that USUHS students take priority, but I know for a fact that some USUHS students did not get to match in Peds).
 
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Internship and GMO

I loved my training program. I had a great group of residents that are still some very dear lifelong friends. I had a hard schedule right out of the chute, but had done fairly well. We were a small class of 8 residents, some had rocky starts, some did not.


The selection board met in Nov. The day before the results were released, I was collecting high-fives for luck and the Chief Resident hinted that I didn't need to worry. The next day the results came out and I had been selected for a a GMO tour. To say I was devastated would be an understatement. That same chief resident apologized and told me that I had been ranked in the top tier of residents and she didn't know what happened. My program director was terrific through this process. She came up to the nursery where I was working as I saw the results, she pulled me to a side room to talk. She told me to take the day and be with my wife. Then she called me that evening to see how I was doing. She answered all of my tough questions.


In the GMO selection/detailing/crap shoot/blindfolded horseshoes process my advice is this: ask anybody and everybody that might know anything, everything you can think to ask them. I'd heard that the USS LHA was going to decommission. I asked the detailer if it was available and it was. I was penciled in and ultimately received orders to it.


The process of the selection board took a previously close knit group of residents/interns and drove a spike through them in the middle of the tough academic year. It REALLY hit morale and separated the stayers from the goers.


I did my SWIMOIC class and reported to the ship in late July. My ship experience was disappointing. I was still on the fence about the Navy long-term and had hoped for a mentor SMO. Instead I got someone who checked in the same day as me, and was really out of his element. He was a great doc, but struggled in his leadership. I had an aggressive HMCS and a SMO who didn't have my back....just a toxic work situation.


We went underway for a month 5 days after I started work. While underway (Aug) we got official word that the ship would be decommissioning. I notified my program director and she said that the program was accredited for more slots than they had residents. I contacted the 0-6 Doc who was in charge of ship board medical assets and he supported this move.


I was on the ship 7 months (mostly brutal decommissioning work) and then I rolled back into residency in February. During my last 2 months on the ship, I functioned as a construction foreman, not a physician.
 
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Being away did make me appreciate it more than my co-residents. Even 1.5 yrs later they still called me on it and I liked working with kids. I started residency with an intent to pursue a Peds ID fellowship. I even applied to the Selection Board one year - not selected. As residency went on, though, I realized I liked acuity. I was drawn to Peds EM. Considered PICU but thought I would burn out in that specialty.


The Navy has let 2 people ever do a Peds EM fellowship, none for over 15 years. There isn't a place for those docs to work (they do let some EM trained folks do that fellowship b/c they can work as Gen EM docs too).



A note about training: I am obviously biased, but I think that Peds and OB are clearly the best Navy training programs (at least at NMCSD) and the reason is the volume of patients we see. Not having a lot of seniors and not being a trauma center really hurt all of the adult, surgical and emergency specialties, but we saw a ton of kids. We worked a lot with the residents from Rady Children’s when I was there and I would say the quality of our residents matched or exceeded with very few exceptions. We also spent a month at the CHOC PICU and the attendings there would literally say, “you’re a Navy resident, OK I’m going to the call room, call me if you need anything. If you were a CHOC resident, I’d stay up.”


As residency wound down, I was going to apply for the chief job (it's a Jr Staff billet in Peds), but the specialty leader told me that if I didn't get selected for chief, I was penciled in for Whidbey Island/Oak Harbor. I quickly declined to apply for chief in order to get this billet.
 
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Payback:

NHOH was in a unique situation: Big Navy had closed the UCC down overnight a few years ago to save money, but the front office still really insisted it was a fully functioning hospital even though there were no docs in the building overnight. Primary care physicians would get directly questioned about every transfer and why it couldn't stay there. The nursing was a mix of PACU, Med/Surg, and 1 nurse with NICU training. It was not a good place to admit children.


After a year at NHOH we were tagged to send a pediatrician to Pacific Partnership (PP12). We had 3 AD pediatricians. One had gone on PP08 and the other had done a 2 year GMO tour with the Marines in 29 Palms were he had earned a Bronze Star in pre-surge Afghanistan. So it was going to be me that went. I then volunteered. At the time my wife was pregnant with #2 and #1 was 18 months. My wife didn't deliver until well after I was home (thankfully) I basically missed the whole 2nd trimester.


Pacific Partnership was a practice in frustration. The reason the Navy does these missions is to make countries in Asia like the US and ally with us rather than China. It's about good PR. It has little to nothing to do with actually helping the people in those countries. Once that sank in, it was easier to spend 14 hour days lugging heavy gear, roasting in the sun to see kids that are clearly dying from congenital heart disease, cancer, etc all for me to give them some tylenol (occasionally I could give vitamins, but the formulary only had about 20% of the needed amount of vitamins. And no liquid vitamin suspension for infants). The back half of PP12 had some cool travel opportunities and it was neat to see Vietnam and Cambodia (Cambodia was especially fun).


When I returned to NHOH I had a lovely surprise. the Joint Commission had visited and decided that the hospital didn't meet standards b/c they didn't have a provider in house to respond Code Blue emergencies. It's worth noting that I was the Medical Director of the Urgent Care Clinic and Chair of the Code Blue Committee (my hope was that both of these collaterals would help me secure a Peds EM fellowship). This issue became an anchor around my neck. In addition to Q4 1 week Peds call, I now had 3-4 nights/month that I had to stay in-house. At the time there were elderly post-op patients on our ward. I expressed my discomfort as a pediatrician being assigned emergency medical coverage of elderly patients that went way outside my credentialing, specialty training, etc. I was told to stop complaining unless I wasn't to get rid of my MD and go be enlisted somewhere. Think about that for a minute: if it's your father, mother or grandparent that coded, would you want a pediatrician to be the Code Blue responder? I wouldn't!
 
BigNavyPedsGuy said:
Payback:


Pacific Partnership was a practice in frustration. The reason the Navy does these missions is to make countries in Asia like the US and ally with us rather than China. It's about good PR. It has little to nothing to do with actually helping the people in those countries. Once that sank in, it was easier to spend 14 hour days lugging heavy gear, roasting in the sun to see kids that are clearly dying from congenital heart disease, cancer, etc all for me to give them some tylenol (occasionally I could give vitamins, but the formulary only had about 20% of the needed amount of vitamins. And no liquid vitamin suspension for infants). The back half of PP12 had some cool travel opportunities and it was neat to see Vietnam and Cambodia (Cambodia was especially fun).


When I returned to NHOH I had a lovely surprise. the Joint Commission had visited and decided that the hospital didn't meet standards b/c they didn't have a provider in house to respond Code Blue emergencies. It's worth noting that I was the Medical Director of the Urgent Care Clinic and Chair of the Code Blue Committee (my hope was that both of these collaterals would help me secure a Peds EM fellowship). This issue became an anchor around my neck. In addition to Q4 1 week Peds call, I now had 3-4 nights/month that I had to stay in-house. At the time there were elderly post-op patients on our ward. I expressed my discomfort as a pediatrician being assigned emergency medical coverage of elderly patients that went way outside my credentialing, specialty training, etc. I was told to stop complaining unless I wasn't to get rid of my MD and go be enlisted somewhere. Think about that for a minute: if it's your father, mother or grandparent that coded, would you want a pediatrician to be the Code Blue responder? I wouldn't!
Click to expand...

I think I would've rather gone on PP12 than deployed to AFG. Jealous that you got to see Vietnam and Cambodia since its on my bucket list. Too bad you didn't get to do a significant meaningful care. That's a shame.

I think you are lucky that a patient didn't have a bad outcome during on of your stays overnight. I think you and your colleagues were hung out to dry by the USN and that is a prime reason to leave or for young medical students not to join. If I was you I would've risked fighting it. All the major organizations would've backed you and a call to Congress would've made the USN's day a nightmare. Can you imagine the testimony: "Admiral can you explain why board certified pediatricians who are not credentialed or trained to practice medicine on adults are running codes on dying patients?" I'm sure that would've went over well.

I also had some pretty simple PCP type stuff in AFG- besides the trauma there were some cases that definitely pushed my limits of practice. Luckily being EM- I had plenty of patients not sick during my training. But I am definitely not a primary care doc....But it was either the anesthesiologist, the general surgeon or myself.

Oh well congrats on getting out.
 
met19 said:
If I was you I would've risked fighting it. .
Click to expand...

I did. I actually contacted the Navy Times, but at that point I was hoping for RAD paperwork processing and terminal leave. My front office freqeuntly sought reprisal. I chickened out for my own self interest...

My biggest accomplishment as Peds DH? I got us off that call...at least for the last few months.
 
good job as DH :) I don't read the Navy Times hope they had a decent article on it.
 
Once you've pulled the pin on a **** grenade, you can't throw it far enough to avoid the fallout.
 
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BigNavyPedsGuy said:
I did. I actually contacted the Navy Times, but at that point I was hoping for RAD paperwork processing and terminal leave. My front office freqeuntly sought reprisal. I chickened out for my own self interest...

My biggest accomplishment as Peds DH? I got us off that call...at least for the last few months.
Click to expand...

Well, now there's a couple of "New York" Times reporters soliciting for mil med patient safety dirt...
 
Final payback and other thoughts

The more I was exposed to leadership in general, the more I lost faith in it. I had 2 great DMSes (sp?) but I now believe that the majority of higher leadership is a group of people trying to look as good for a set of 3 year orders in order to get a next set of 3 year orders. It’s about looking good to the right people and collecting bullet points.


I tried to do various things to improve my fellowship odds. I was basically shut out from moonlighting because of TriCare regulations and our remote location. I was 2+ hours to the nearest children’s hospital. There were no research opportunities. After weeks of work, I was able to set up an observership with one program (I couldn’t do any rotations there because training programs’ malpractice only cover trainees, not board certified physicians). I had another meeting penciled in with my second choice program.


After getting one of those random job advertisements, I ended up looking on a physician recruitment website. I saw a job listing that looked too intriguing to be true (7 on 7 off, salary competitive with what I’d make after fellowship). I e-mailed and it turns out that the job is in an area where my mom grew up, where grandma and grandpa’s house was growing up, where we always did our summer trip, etc. I contacted them, interviewed and ended up being offered the job 15 months before my Navy time ended! I believe firmly that our circumstances are controlled by a Higher Power and it was pretty clear to me that this was not just a coincidence.


I have some other annoying stories: I submitted a Patient Safety Report (PSR) after a newborn resuscitation did not go smoothly. In it I cited the lack of newborn training with a bunch of PACU ER nurses at a Birthing Center. The Peds Dept had requested NICU TAD training for the nurses and got shut down. The result of the PSR: I got to sit down with the CO, the XO and 7 NURSES!! It was a lot of, “The PSR said this, was that true!?” It was totally a firing squad. Lesson learned…I didn’t submit any more PSRs. The director of nursing and another O-5 nurse (who are good people) even apologized to me after the meeting.


Either way, I’m free now. It feels surreal. I think of it and I feel like I’m floating without a tether, but then I stop and ask what that tether really did? I am a bit instituionalized. I can imagine how anxiety provoking it would be for a 20 year lifer. I could’ve stayed and done well. I got the EP on my last O3 FITREP and got the EP on my first O4 FITREP. I was the Dept Head of 2 different departments (simultaneously), the chair of one big committee (Code Blue) and the vice chair of another (P&T). I just don’t believe in it anymore.


I’m sure there’s lots more, I just can’t think of it right now.
 
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I got to sit down with the CO, the XO and 7 NURSES!! It was a lot of, “The PSR said this, was that true!?” It was totally a firing squad.

Be prepared to pay when you take on the "Coven"
 
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DeadCactus said:
Heh, I think I've met you...
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PM me to confirm.

met19, I'm pretty sure we were at Portsmouth at the same time as med students.
NavyFP met me and outed me. That's when I changed my avatar - it was Mr. Incredible, and he and I have a resemblance...
 
The joint commission was easy when I was inspected. I think I know NavyFP.
 
Okay, ofter reading your subsequent posts I withdrew my earlier post. Yes, you DO have to like the military side as much as the medicine side. But your situation definitely sucks. I can't wait until I hit 20yrs (2018) when I can express my unbiased opinion with the "best-no-deal option" being GTFO with full retirement benefits while making a killing in the civilian world. Good luck to you in the civilian world!
 
BigNavyPedsGuy said:
PM me to confirm.

met19, I'm pretty sure we were at Portsmouth at the same time as med students.
NavyFP met me and outed me. That's when I changed my avatar - it was Mr. Incredible, and he and I have a resemblance...
Click to expand...

Nevermind. Rethought the time line, I was off a few years...
 
trinityalumnus said:
Whats the tat on the left wrist say? Hebrew?
Click to expand...
Yes, it's Hebrew. Says "Heaven". The goal is for things I do here to matter there (no, I'm not Jewish, but Aramaic is an extinct language).
 
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That's a shame about PSRs. I submitted one regarding lab values and not being called when they are critical.
My SGH at the time helped me create a personal plan but also changed lab protocol to help physicians. Sucks that yours led to criticism. That's unqualified malignancy.
 
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