Work Environment in Military Medicine

[TopSecret]

I have a few questions for the military docs out there.

1) Were there any commanding officers that you enjoyed working with who were non-physicians?

2) How does working in a military clinic or hospital compare with working in a county hospital or at the VA?

3) Are physicians basically the transcriptionist, receptionist/scheduler, and phlebotomist all in one during clinic?

4) Are board-certified physicians still being sent on GMO tours?

5) If you're sent overseas on a GMO tour, will you have Internet access to complete CME courses online in order to update your knowledge base?

6) Is there much interaction with physicians who are civilian contractors and how do they fit in with the milmed chain of command?

---

Members don't see this ad.

 

[VassarLiberal]

In the spirit of the OP, I have a quick question.

7) I've heard about the Air Force's "Objective Medical Group," where, so I've read, appointment to command roles is not based on what corps an officer is in. Hence, in this field, it's possible for a CRNA to have the overall responsibility for patient management over a MD/DO anesthesiologist. Is this correct? Does it apply to other fields in the AF? Also, does this apply to the other uniformed services?

 

[TopSecret]

In the spirit of the OP, I have a quick question.

7) I've heard about the Air Force's "Objective Medical Group," where, so I've read, appointment to command roles is not based on what corps an officer is in. Hence, in this field, it's possible for a CRNA to have the overall responsibility for patient management over a MD/DO anesthesiologist. Is this correct? Does it apply to other fields in the AF? Also, does this apply to the other uniformed services?

I hope not.

 

[VassarLiberal]

I hope not.

Dude, this is scary: This guy was a LtCol MD anesthesiologist in the Air Force who retired at 19 years of service out of spite because the "objective medical group," in his opinion, messed up patient care way too much.

 

[TopSecret]

Dude, this is scary: This guy was a LtCol MD anesthesiologist in the Air Force who retired at 19 years of service out of spite because the "objective medical group," in his opinion, messed up patient care way too much.

I visited that website. It's hard to believe that he lasted that long in that kind of environment.

 

[pgg]

In the spirit of the OP, I have a quick question.

7) I've heard about the Air Force's "Objective Medical Group," where, so I've read, appointment to command roles is not based on what corps an officer is in. Hence, in this field, it's possible for a CRNA to have the overall responsibility for patient management over a MD/DO anesthesiologist. Is this correct? Does it apply to other fields in the AF? Also, does this apply to the other uniformed services?

I hope not.

Anything is possible in an institution as big and varied as military medicine, but generally this is not a problem. I'm the sole anesthesiologist at a small Navy hospital. There are 3 CRNAs in the department, and the hospital XO is also a CRNA who occasionally does cases. Our department head is an O5 CRNA (I'm a fairly junior O4 right out of residency) and thus far there's been no friction or problems. We talk about cases, but I don't direct her management and she doesn't pull rank to make me do a case any particular way. We see an extremely low acuity patient population though; at my (military) residency program CRNAs were supervised and assisted with more complex cases and sicker patients. In a department that size you'll never see a non-physician DH.

You also have to understand that in the military, CRNAs are fully credentialed providers of anesthesia who practice independently. This was borne of operational necessity long, long ago because there just aren't enough anesthesiologists to staff every deployed location where anesthesia services might be needed. They routinely deliver anesthetics without input or supervision from anesthesiologists, they do peripheral nerve blocks, they manage obstetric anesthesia to include spinals, epidurals, and c-sections.

In any case, horror stories on this forum notwithstanding, I have never once - as an intern, GMO, resident, and very new attending - had any kind of problem with a higher ranking NC or MSC officer interfering with or dictating the medical care I deliver. One could argue that command and policy level decisions made by non-physicians trickle down and affect me, but I honestly can't put my finger on any personal milmed problems I've experienced that I can say are a result of a non-physician making a decision.

To an extent I'm shielded from that kind of bureauocracy simply because I'm an anesthesiologist: I basically work alone, and don't really need institutional support for much of anything beyond keeping the lights on, the O2 pipeline pressurized, and the supply room full. If I had to deal with AHLTA or clinic RVUs I might feel differently about NC admin weenies making decisions for me.

 

[TopSecret]

Anything is possible in an institution as big and varied as military medicine, but generally this is not a problem. I'm the sole anesthesiologist at a small Navy hospital. There are 3 CRNAs in the department, and the hospital XO is also a CRNA who occasionally does cases. Our department head is an O5 CRNA (I'm a fairly junior O4 right out of residency) and thus far there's been no friction or problems. We talk about cases, but I don't direct her management and she doesn't pull rank to make me do a case any particular way. We see an extremely low acuity patient population though; at my (military) residency program CRNAs were supervised and assisted with more complex cases and sicker patients. In a department that size you'll never see a non-physician DH.

You also have to understand that in the military, CRNAs are fully credentialed providers of anesthesia who practice independently. This was borne of operational necessity long, long ago because there just aren't enough anesthesiologists to staff every deployed location where anesthesia services might be needed. They routinely deliver anesthetics without input or supervision from anesthesiologists, they do peripheral nerve blocks, they manage obstetric anesthesia to include spinals, epidurals, and c-sections.

In any case, horror stories on this forum notwithstanding, I have never once - as an intern, GMO, resident, and very new attending - had any kind of problem with a higher ranking NC or MSC officer interfering with or dictating the medical care I deliver. One could argue that command and policy level decisions made by non-physicians trickle down and affect me, but I honestly can't put my finger on any personal milmed problems I've experienced that I can say are a result of a non-physician making a decision.

To an extent I'm shielded from that kind of bureauocracy simply because I'm an anesthesiologist: I basically work alone, and don't really need institutional support for much of anything beyond keeping the lights on, the O2 pipeline pressurized, and the supply room full. If I had to deal with AHLTA or clinic RVUs I might feel differently about NC admin weenies making decisions for me.

I just went through both parts of the Avoid Military Medicine threads (1000+ posts) and it seems that a lot of docs leave after they fulfill their obligation because of the undermanning, problems with admin at their hospitals, and issues related to AHLTA (not being able to review charts and abnormal labs going unnoticed). The Navy doesn't seem to have as many problems as in the Air Force from what I understand.

 

[a1qwerty55]

I have a few questions for the military docs out there.

1) Were there any commanding officers that you enjoyed working with who were non-physicians?

2) How does working in a military clinic or hospital compare with working in a county hospital or at the VA?

3) Are physicians basically the transcriptionist, receptionist/scheduler, and phlebotomist all in one during clinic?

4) Are board-certified physicians still being sent on GMO tours?

5) If you're sent overseas on a GMO tour, will you have Internet access to complete CME courses online in order to update your knowledge base?

6) Is there much interaction with physicians who are civilian contractors and how do they fit in with the milmed chain of command?

1. Yes - one of my better commanders was "gasp" a nurse
2. Similar - information systems in the military are more onerous though.
3. Depends - in most hospitals no, but in a troop medical clinic, could be - receptions/scheduler/phlebotomist unlikely anywhere.
4. Yes - especially primary care and medical subspecialties.
5. Yes - internet is almost always available and if you are smart you can work the signal corps people to give you better bandwidth for "medical readiness" reasons.
6. Yes - plenty of civilian contractors, they are performance rated by a military physician but don't fall under traditional military chain of command - they have contracts clearly spelling out max hours, job duties etc. Sometimes civilians can be department heads but would not be rating military.

 

[TopSecret]

1. Yes - one of my better commanders was "gasp" a nurse
2. Similar - information systems in the military are more onerous though.
3. Depends - in most hospitals no, but in a troop medical clinic, could be - receptions/scheduler/phlebotomist unlikely anywhere.
4. Yes - especially primary care and medical subspecialties.
5. Yes - internet is almost always available and if you are smart you can work the signal corps people to give you better bandwidth for "medical readiness" reasons.
6. Yes - plenty of civilian contractors, they are performance rated by a military physician but don't fall under traditional military chain of command - they have contracts clearly spelling out max hours, job duties etc. Sometimes civilians can be department heads but would not be rating military.

Thanks.

Are most civilian contractors former military?

 

[a1qwerty55]

Thanks.

Are most civilian contractors former military?

Many are, but I'm not sure I'd say most are.

A fair number of retired officers slide into their former job as a contractor.

 

[TopSecret]

Many are, but I'm not sure I'd say most are.

A fair number of retired officers slide into their former job as a contractor.

Thanks. I know someone who became a civilian contractor right after leaving the Navy and I figured that others would take that route, too.