All Branch Topic (ABT) "Worst" specialties to be in the military?

[asdf123g]

im just wondering if there is a general consensus on this. Maybe some 'suck' because they get deployed more often (i thought i read somewhere on here primary care along with something else is more prone to be deployed). Some get little to no complex cases. Some more prone to skill atrophy. Some more bureaucratic BS, etc

thanks in advance.

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[HighPriest]

That all depends upon your perspective. I have my own personal opinions. If you think deploying is the worst thing in the world, then you'll want to steer clear of primary care and general surgery. If you think skill rot is the worst thing in the world, then steer clear of surgical subspecialties. If you just mean crap training, then that's more dependent upon the residency than it is the specialty.

 

[asdf123g]

That all depends upon your perspective. I have my own personal opinions. If you think deploying is the worst thing in the world, then you'll want to steer clear of primary care and general surgery. If you think skill rot is the worst thing in the world, then steer clear of surgical subspecialties. If you just mean crap training, then that's more dependent upon the residency than it is the specialty.

that is exactly the kind of answer I was looking for.

More opinions are welcome!

 

[pgg]

It's going to be service dependent, too.

The Navy gets its GMO pound of flesh up front, so residency/fellowship trained specialists generally don't get involuntarily tasked with multi-year, non-clinical billets. It appears most of the post-residency GMO-like tours go to people who ask for them (to pad their fitreps for the O6 board).

The Army is known to take non-primary-care residency/fellowship trained specialists and order them to non-clinical brigade surgeon tours, which appears to me to be an outrageous kiss-o-death to procedural specialists whose skills rot unused for two years.

 

[Clap MD]

It's going to be service dependent, too.

The Navy gets its GMO pound of flesh up front, so residency/fellowship trained specialists generally don't get involuntarily tasked with multi-year, non-clinical billets. It appears most of the post-residency GMO-like tours go to people who ask for them (to pad their fitreps for the O6 board).

The Army is known to take non-primary-care residency/fellowship trained specialists and order them to non-clinical brigade surgeon tours, which appears to me to be an outrageous kiss-o-death to procedural specialists whose skills rot unused for two years.

and if it matters to your consideration, the USAF is like the Navy in this regard.

 

[asdf123g]

How is emergency medicine? I'd imagine itd suck working those crazy odd hours during active duty and getting military pay...I'd imagine they get deployed often, correct?

 

[HighPriest]

How is emergency medicine? I'd imagine itd suck working those crazy odd hours during active duty and getting military pay...I'd imagine they get deployed often, correct?

Out of professional courtesy, I'm not going to comment.

 

[pgg]

How is emergency medicine? I'd imagine itd suck working those crazy odd hours during active duty and getting military pay...I'd imagine they get deployed often, correct?

EM residency is generally more competitive to get in the military than out. Few slots, and an applicant population (people who join the military to be doctors) with a skew toward that kind of specialty.

My impression as a non-EM outsider is that the training is solid, supplemented as it is by out rotations.

But the practice after residency appears to kind of suck. Real trauma from the community doesn't go to military hospitals. There's a gate and guards and rules that keep people out, mostly. Military ERs at small hospitals are glorified urgent care clinics, and even at the med centers they tend to be the the same. It's a function of the patient population and access.

They do deploy. Those are luck of the draw - even at the height of Iraq and Afghanistan, an ER doc might be crazy busy at the Kandahar Role 3, or bored to tears at the Dirt Mountain FRSS.

 

[HighPriest]

Ok, I will comment, but I'll try to remain political.

As an EM doc, and for the reasons pgg mentioned especially in the military, most of your job seems to be sick call and OB/GYN complaints. It's a reflection of your patient population and the inability to see civilian trauma either due to lack of access or lack of a civilian population nearby, or because if there is a civilian population there's a civilian hospital that handles trauma preferentially.

I've seen a few strangulation injuries, rarely an airway issue (many of which are, frankly, sent to civilian hospitals simply because there's more care available), some facial trauma (no where near as much as I see on the outside), some small facial lacerations (which our ER docs seem to not want to treat anyway, hence I see them). These are very few and very far between. Even in residency, most of our trauma experience came from outside rotations simply because we didn't get that much at a large MEDCEN. 99% of my calls from the ER are related to colds. So let that reflect on the content of our ER however you'd like.

I know that when I did my ER rotation (and this was years ago), it was 80% coughs and colds, 15% OB/GYN complaints, and the remainder was a toss up between appendectomies, gallstones, trauma, heart attacks, and the like.

 

[asdf123g]

So...EM sounds awful should one go the milroute....

 

[HighPriest]

Keep in mind that unless you're EM at a major trauma center, most of your patients are going to be colds, sore throats, and the occasional med or surg patient that you briefly see and then call for consult. Thems the digs, man military or not.

 

[jabreal00]

Ok, I will comment, but I'll try to remain political.

As an EM doc, and for the reasons pgg mentioned especially in the military, most of your job seems to be sick call and OB/GYN complaints. It's a reflection of your patient population and the inability to see civilian trauma either due to lack of access or lack of a civilian population nearby, or because if there is a civilian population there's a civilian hospital that handles trauma preferentially.

I've seen a few strangulation injuries, rarely an airway issue (many of which are, frankly, sent to civilian hospitals simply because there's more care available), some facial trauma (no where near as much as I see on the outside), some small facial lacerations (which our ER docs seem to not want to treat anyway, hence I see them). These are very few and very far between. Even in residency, most of our trauma experience came from outside rotations simply because we didn't get that much at a large MEDCEN. 99% of my calls from the ER are related to colds. So let that reflect on the content of our ER however you'd like.

I know that when I did my ER rotation (and this was years ago), it was 80% coughs and colds, 15% OB/GYN complaints, and the remainder was a toss up between appendectomies, gallstones, trauma, heart attacks, and the like.

I would venture to say that this (above) is the experience for most non level-1 trauma and some level-2 trauma centers on the civilian side. The major thing that draws people to ER is the "shift work." Even in trauma centers, there's usually a "trauma team" comprised of surgeons and anesthesiologists who are called down to the ER. Not sure what the ER docs do apart from initial triage and primary survey. It's even worse in the military. It's basically urgent care. Over 10 years ago, I did my residency at BAMC. That is (or was) the only level-1 trauma center in the DoD. BAMC accepted civilian trauma and medical emergencies (stroke, MI, etc). However, even rotating in the ER there was mainly comprised of UTIs, back pain, drug seekers, and ob issues. The surgeons were called directly for traumas and often did all the lines and procedures.

 

[Homunculus]

im just wondering if there is a general consensus on this. Maybe some 'suck' because they get deployed more often (i thought i read somewhere on here primary care along with something else is more prone to be deployed). Some get little to no complex cases. Some more prone to skill atrophy. Some more bureaucratic BS, etc

thanks in advance.

kind of answered your own questions for the army. each field has its own army/military unique dysfunction ranging from 2 year admin tours to lack of cases. the "BGD" (big green d*ck) as I like to call it knows no bounds, is blind to its victim, and has an insatiable appetite.

the two things you can count on regardless of branch-- 1) you will not see a patient load like your civilian counterparts (for better or worse) and 2) being 100% clinical for a career is (near) impossible. I've seen it once.

--your friendly neighborhood maybe prev med is ok with all of this caveman

 

[Shikima]

Oh the green weenie. How you're most effective without lube and the courtesy reach around.

 

[Ziehl-Neelsen]

the "BGD" (big green d*ck) as I like to call it knows no bounds, is blind to its victim, and has an insatiable appetite.

A long time ago (internship) at an MTF far, far away (Walter Reed), I was raging about an instance of military stupidity. A wise senior resident told me something that has always stuck with me and that I often repeat to residents when I see them in the same predicament, "The military is like prison rape. The more you struggle; the more it hurts."

BGD, BOHICA, prison rape analogies, or whatever the particular service calls it... It's kind of like how all of these geographically separate primitive cultures developed myths that are remarkably similar. Some things are eternal and link us all.

And with regard to the OP's question. The answer is 61J (general surgery). While the BGD comes after all of us, the BGD that comes after the general surgeons has a giant, syphilitic chancre right on the glans.

 

[HighPriest]

And with regard to the OP's question. The answer is 61J (general surgery). While the BGD comes after all of us, the BGD that comes after the general surgeons has a giant, syphilitic chancre right on the glans.

Yeah, but look at how they dress.

 

[Ziehl-Neelsen]

I don't know if anybody here gets sucked into playing Cards Against Humanity with their millennial siblings (like I do), but based on the above discussion I thought this needed to be left here for the sake of posterity.

http://www.armytimes.com/story/ente...d-game-rival-cards-against-humanity/79783394/

"The pulsating and unbearable girthiness of the Green Weenie."

That's some Edna St. Vincent Millay **** right there.