Which branch has the most families stationed abroad?

[brucecanbeatyou]

Just wondering which branch has the most bases with families stationed abroad?

As in, where would I be most likely able to serve abroad, taking my family with me, after building some seniority in the military?

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[The White Coat Investor]

Just wondering which branch has the most bases with families stationed abroad?

As in, where would I be most likely able to serve abroad, taking my family with me, after building some seniority in the military?

Specialty and time specific. Tough to get out of the states on a first tour in the AF if you're not an FP. On the other hand, once you have built "seniority" AKA done one tour, you'll probably be offered an overseas billet to stay in. Of course, like most of us, you'll probably turn it down...

 

[brucecanbeatyou]

Specialty and time specific. Tough to get out of the states on a first tour in the AF if you're not an FP. On the other hand, once you have built "seniority" AKA done one tour, you'll probably be offered an overseas billet to stay in. Of course, like most of us, you'll probably turn it down...

Why would you turn it down?

 

[The White Coat Investor]

Why would you turn it down?

Because it comes with an extended commitment. In my case, I couldn't go to Germany UNLESS I was willing to sign up for two more years. l would have done it for one additionall year the year before, and they told me I had it, but they pulled the rug out from under me a few months before I was to go.

 

[brucecanbeatyou]

Because it comes with an extended commitment. In my case, I couldn't go to Germany UNLESS I was willing to sign up for two more years. l would have done it for one additionall year the year before, and they told me I had it, but they pulled the rug out from under me a few months before I was to go.

That is lame. Probe to see who's interested, then throw the carrot further up the road.

 

[The White Coat Investor]

That is lame. Probe to see who's interested, then throw the carrot further up the road.

Yes, I naively thought I'd have an adventure during my 4 years on active duty. I had a deployment where I sat on my ass and was stationed at an out of the way hospital where you couldn't admit anything that actually needed to be admitted. Skill atrophy, bureaucracy, and low pay were my reward for serving my country.

HPSP is really only a good deal for those with prior service, those who enjoy some aspect of medicine you can only get in the military (flight med, dive med, special forces etc), those who want to do multiple residencies, those interested in administration more than clinical medicine, those who are incompetent to practice on the outside, and those who are so frickin' gung-ho about the military they wouldn't care if they were swabbing the deck on the enterprise for months at a time if they could just please watch the jets come off the catapult one more time.

It's not all bad, but when 95% of those who can leave the job do, you've got to wonder a bit. You think pilots or special forces have a retention rate that low? No way.

 

[NavyFP]

It's not all bad, but when 95% of those who can leave the job do, you've got to wonder a bit. You think pilots or special forces have a retention rate that low? No way.

Historically, 20% of medical corps officers retire. So, only 80% punch out.

 

[notdeadyet]

Historically, 20% of medical corps officers retire. So, only 80% punch out.

I'd love if someone had an actual figure they could cite. I've heard 4 and 5% on SDN, but never seen a linked source. This is the first time I've seen 20% (and while it may be historical, I'd be surprised if it's been the case in recent years) but would love to see a link to actual data.

 

[brucecanbeatyou]

I'd love if someone had an actual figure they could cite. I've heard 4 and 5% on SDN, but never seen a linked source. This is the first time I've seen 20% (and while it may be historical, I'd be surprised if it's been the case in recent years) but would love to see a link to actual data.

The assoc. dean of HPSP students told me that "About half of all physicians stay beyond their initial commitment, but only about 1 in 5 stay long enough to retire."

But I would actually like to see more posts regarding my original question; there are other threads concerning physician satisfaction.

 

[NavyFP]

I'd love if someone had an actual figure they could cite. I've heard 4 and 5% on SDN, but never seen a linked source. This is the first time I've seen 20% (and while it may be historical, I'd be surprised if it's been the case in recent years) but would love to see a link to actual data.

Those are good questions and a lot of numbers have been thrown around.
So, I called Tony Frabutt to ask. He does the personnel numbers for Navy Medical Corps.

At present 60% of the Navy Medical Corps is at least 1 year beyond thier initial obligated service. So these people had the opportunity to get out and did not. Staying a year beyond the obligated service eliminates those who stay the extra 3 months for ISP and those waiting for the next GME cycle.

16% of the Medical Corps spend 20 years or beyond in the actual MC. This does not account for those with prior service.

I did not go into the weeds about individual specialty retention rates. I believe it is safe to assume high paying specialties are more likely to get out than primary care. The exit rates (both retirement and just getting out) have been fairly stable at about 10% (+/-2%) per year.

The bottom line is this: There is no mass exodus from the Navy Medical Corps.

 

[notdeadyet]

Those are good questions and a lot of numbers have been thrown around.
So, I called Tony Frabutt to ask. He does the personnel numbers for Navy Medical Corps.

At present 60% of the Navy Medical Corps is at least 1 year beyond thier initial obligated service. So these people had the opportunity to get out and did not. Staying a year beyond the obligated service eliminates those who stay the extra 3 months for ISP and those waiting for the next GME cycle.

16% of the Medical Corps spend 20 years or beyond in the actual MC. This does not account for those with prior service.

I did not go into the weeds about individual specialty retention rates. I believe it is safe to assume high paying specialties are more likely to get out than primary care. The exit rates (both retirement and just getting out) have been fairly stable at about 10% (+/-2%) per year.

The bottom line is this: There is no mass exodus from the Navy Medical Corps.

Interesting stuff, NavyFP. This is actually the first hard data I've seen on the subject and it paints a much rosier picture than I would have thought. It would be interesting to see the specialty breakdown, but I think you're right about what the distribution would be.

I wonder where the 95% attrition rate that gets posted comes from? Thanks for the info...

 

[NavyFP]

Interesting stuff, NavyFP. This is actually the first hard data I've seen on the subject and it paints a much rosier picture than I would have thought. It would be interesting to see the specialty breakdown, but I think you're right about what the distribution would be.

I wonder where the 95% attrition rate that gets posted comes from? Thanks for the info...

Likely from anecdotal evidence, because "everyone I know is getting out so it must be like 95%"

 

[brucecanbeatyou]

Likely from anecdotal evidence, because "everyone I know is getting out so it must be like 95%"

Haha, yeah, you gotta love people basing life decisions on statistics based on "everyone I know," future physicians nonetheless. Thanks for these numbers! I'd still like to see some discussion on the original topic though.

 

[mitchconnie]

Those are good questions and a lot of numbers have been thrown around.
So, I called Tony Frabutt to ask. He does the personnel numbers for Navy Medical Corps.

At present 60% of the Navy Medical Corps is at least 1 year beyond thier initial obligated service. So these people had the opportunity to get out and did not. Staying a year beyond the obligated service eliminates those who stay the extra 3 months for ISP and those waiting for the next GME cycle.

16% of the Medical Corps spend 20 years or beyond in the actual MC. This does not account for those with prior service.

I did not go into the weeds about individual specialty retention rates. I believe it is safe to assume high paying specialties are more likely to get out than primary care. The exit rates (both retirement and just getting out) have been fairly stable at about 10% (+/-2%) per year.

The bottom line is this: There is no mass exodus from the Navy Medical Corps.

Those numbers sound right, and are about what I would guess for the other services as well. And honestly, I don't even think that 95% of surgical subspecialist get out at the first opportunity. But I would not gather from those numbers that there is general sastifaction with military medicine overall. There are lots of desperately unhappy people who end up staying an extra year or two for personal reasons that have nothing to do with career satisfaction.

For instance, both of my partners (surgical subspecialists), will stay to retirement despite being fervently anti-milmed. Why? Because both accrued long committments and/or had prior service, so they will be within 1-2 years of retirement when they are eligible to leave.

I also don't think that people aren't lying when they say "everyone I know is getting out." They are probably telling the honest truth, because really, the only people they know are the other cynical junior-level physicians who are seeing patients in the clinic. They rarely interact with the legions of admin people in the back offices or at the Pentagon who are committed to the program and staying in for 20 years.

I do agree that there is no overall "mass exodus" although certain fields certainly are critically short with dismal retention rates.

 

[The White Coat Investor]

I agree with MitchConnie that you've got to subtract out those who have such long commitments that it would be financially stupid to bail afterward. (Think ROTC+USUHS, second residency folks, long GMO tours then long residency etc.)

The 95% I throw around is from my service, and my specialty and comes from the specialty leader and the residency program directors. But so what if it's off 5%? How does that change anything?

And looking around my hospital (~55 docs), I can only think of 7 who are beyond their initial educational commitment:

1) Group commander O-6, IM subspecialist
2) Squadron commander O-6, Ortho
3) Squadron commander O-6, Flight doc
4) Came in from civilian life to do flight med, by his own admission wasn't cutting it in civilian life, O-5
5) Came in from civilian life to do ophthalmology, most of us suspect because he wasn't cutting it as he certainly isn't patriotic, O-4
6) Dermatologist (did second residency after finishing initial tour as an FP), still under second educational commitment, O-5
7) FP who is non-deployable and truly loves military medicine, O-4
8) Anesthesiologist who per the recent residency grads in their first commitment is "completely incompetent", O-5 or O-6.

Being in the ED, I think I know just about all of the docs.

That's it. 8/55=15%. It seems a bit higher in the Navy, but I'm not sure how much of that is the fact that these are folks who are at a major medcenter (more likely to be higher ranks), the fact that commitments are longer due to GMO tours so financially a better decision, or perhaps there is something different about Navy medicine. Whatever the number is, it's pretty low. I'd bet money that at least 75% of those eligible to get out in any given year in any given service in any given specialty do.

But let's examine Navy FPs numbers a little closer:

He says 10% get out in any given year. What does that mean? How many would we expect to leave in any given year if EVERYONE who could leave, did? What we need to know is what percentage CAN leave every year? Let's throw some educated guesses around and see what we come up with. Let's assume a typical doc stays "in the system" for internship, a 3 year GMO, a 3 year residency, and a further 3 year payback. That's ten years. So every year, 10% are eligible to get out. And apparently, about 10% get out per year. Seems awfully close to everyone to me. Even if you assume some people have shorter commitments, say a straight through 3 year residency and a 4 year payback for 7 total, and lower the average to 9 years, you only end up with 11% each year who CAN get out, and apparently 10% do. That doesn't look much better.

The numbers are rotten no matter how you paint them. Would you like to be in a job where even half of the people leave when given the choice? I wouldn't. I want to be in a job where not only do those who have it hold onto it with gritted teeth, but there are dozens of people banging on the door outside to take their spot. That's the way most of medicine is, but not military medicine. If the job was so good, why do so many people leave at 20 years? Why not stay 25 or 30 if it is so great?

 

[The White Coat Investor]

At present 60% of the Navy Medical Corps is at least 1 year beyond thier initial obligated service. So these people had the opportunity to get out and did not. Staying a year beyond the obligated service eliminates those who stay the extra 3 months for ISP and those waiting for the next GME cycle. (+/-2%) per year..

I didn't see this stat before my diatribe above. Remember that any non-USUHS-grad who goes back to residency after a GMO tour is beyond their initial obligated service. That's got to be a significant chunk of that 60%, half of them perhaps? A few are second residency/fellowship folks (they stay to get attending+ pay while getting additional training.)

Then throw out the ones who are staying for retirement due to long commitments not out of love for Navy Medicine (? half of the 16%)

That cuts that 60% down to well under 25%.

There is NO way that 60% of those who could get out as residency trained docs after 4 years of active service stay in. I would be surprised if that number were higher than 10%. You want to see that 60% number of yours drop in a hurry? Get rid of the GMO tour.

 

[brucecanbeatyou]

Okay, this thread has been hijacked.

 

[NavyFP]

I didn't see this stat before my diatribe above. Remember that any non-USUHS-grad who goes back to residency after a GMO tour is beyond their initial obligated service. That's got to be a significant chunk of that 60%, half of them perhaps? A few are second residency/fellowship folks (they stay to get attending+ pay while getting additional training.)

Then throw out the ones who are staying for retirement due to long commitments not out of love for Navy Medicine (? half of the 16%)

That cuts that 60% down to well under 25%.

There is NO way that 60% of those who could get out as residency trained docs after 4 years of active service stay in. I would be surprised if that number were higher than 10%. You want to see that 60% number of yours drop in a hurry? Get rid of the GMO tour.

No, not quite. The point of getting out that we are looking at is when was their first opportunity to get out? forget about GMO, adding time with residency and exclude Multi-year contracts. When did the total obligated service clock reach zero? At that point you can get out. If you stay 366 days beyond that you fall into the 60%. And the 16% have 20+ years in the MC and does not include prior service members. To assume half have had long commitments is pure conjecture.

I will agree with mitchconnie that some who stay may be so close to retirement that getting out makes no sense, but I would suggest that the level of total dissatisfaction is not quite as great as proposed.

Many people enter HPSP with the strict intent of doing their time and getting out. This decision is made prior to any of their negative experiences. Of the 6 who graduated from residency with me only one remains in the service. The other remaining was USU/ROTC and did a fellowship, so his obligated time has yet to run out. Of those who got out, none had any animosity towards the service, they just had other opportunities they wanted to pursue. I talk with them from time to time and am not convinced the grass is greener.

 

[NavyFP]

Okay, this thread has been hijacked.

Yes, it has, and to give you the best answer I can. Army. They are the biggest and should have the most opportunities. Navy would be #2 and AF #3.

Better question. what are you looking for? and what specialty?

 

[brucecanbeatyou]

Yes, it has, and to give you the best answer I can. Army. They are the biggest and should have the most opportunities. Navy would be #2 and AF #3.

Better question. what are you looking for? and what specialty?

Anything abroad, really. I speak Spanish... my wife speaks Japanese... and we'd love to go anywhere. Except maybe Siberia or Iran or North Korea, haha. I'm thinking that I want to do EM right now.

Also, thanks for getting this back on track. Not that I don't appreciate all of the above debating, but I'd just like an answer to my question.

 

[NavyFP]

Anything abroad, really. I speak Spanish... my wife speaks Japanese... and we'd love to go anywhere. Except maybe Siberia or Iran or North Korea, haha. I'm thinking that I want to do EM right now.

Also, thanks for getting this back on track. Not that I don't appreciate all of the above debating, but I'd just like an answer to my question.

Well, then Navy might be your choice. Lots of opportunities in Japan and I am told they speak Spanish in Spain (Rota). AF has opportunities in Japan.

Army overseas is more Northern Europe (Germany, Belgium) and Korea.

 

[brucecanbeatyou]

Well, then Navy might be your choice. Lots of opportunities in Japan and I am told they speak Spanish in Spain (Rota). AF has opportunities in Japan.

Army overseas is more Northern Europe (Germany, Belgium) and Korea.

Thanks, NavyFP

 

[J-Rad]

I don't think many in the AF primary care specialties have much difficulty going overseas right out of residency, especially if they specifically want to. Germany and Italy are going to be harder to get, but Japan not so much. In the last few years one of the Japan stations was put on a "We Need Volunteers Or People Are Going To Get Voluntold" list for peds along with Altus and Cannon. I think Army, like NavyFP said, is going to be #1 just for the sake of sheer numbers, but Navy and AF are going to be closely matched.

PS Isn't Rota going away?

 

[IgD]

Haha, yeah, you gotta love people basing life decisions on statistics based on "everyone I know," future physicians nonetheless. Thanks for these numbers! I'd still like to see some discussion on the original topic though.

Yeah I guess the detailer was right. Things are getting brighter every day! There are no recruiting and retention problems.

 

[NavyFP]

PS Isn't Rota going away?

Had not heard it, but would not be surprised if it was.

 

[dikoerastenie]

Had not heard it, but would not be surprised if it was.

Bump. So is it going away or not? How hard to get stationed there if you are FM?
Also if you do FM in the navy and don't like the city to which you are assigned would you be able to do a lot of deployments as a ship doctor? Or just going to afghanistan at will even if the unit from this city is not going to afghanistan? How about getting training and work as a flight surgeon if you just finished FM residency?

Also a question about army. Someone mentioned belgium. Does it mean that if you do a primary care specialty in the army you can get stationed in europe outside of a major medical center(landstuhl)? So how hard would it be to get stationed in Bavaria?

Also if you end up in afganistan/iraq, how is the role of a FM doctor different from a GMO and from an EM doctor?
Thanks.

 

[NavyFP]

Bump. So is it going away or not? How hard to get stationed there if you are FM?
Also if you do FM in the navy and don't like the city to which you are assigned would you be able to do a lot of deployments as a ship doctor? Or just going to afghanistan at will even if the unit from this city is not going to afghanistan? How about getting training and work as a flight surgeon if you just finished FM residency?

Also a question about army. Someone mentioned belgium. Does it mean that if you do a primary care specialty in the army you can get stationed in europe outside of a major medical center(landstuhl)? So how hard would it be to get stationed in Bavaria?

Also if you end up in afganistan/iraq, how is the role of a FM doctor different from a GMO and from an EM doctor?
Thanks.

I have heard no discussion of closing Rota. Getting there as an FP is not overly difficult.