who's who of SDN military med knowledge?

Pemberley said:

The most frustrating part for those of us trying to use this forum to learn something is that every thread ends up having exactly the same topic -- or should I say, exactly the same disorganized mish-mash of topics.

For example, some of the RN/PA discussion a few pages back was useful and interesting, but it was found on the 2nd or 3rd page of a thread that nominally biographies people with military medical experience! I think both topics are less usefully discussed by being scrambled with several others.

So, frequent posters, any suggestions how to keep threads on-topic, even though there will always be trolls trying to draw them off-topic? I've already expressed my preference for our friendly neighborhood caveman to give himself some less restrictive ROEs for pruning and/or moving posts. Any seconds?

Just trying to make the board more useful.

-Pemberley

Click to expand...

1)Threads will never remain 100% on what the thread starts as. That is not a problem.
2) Physicians on this site have been lumped together and have been called everything from "trolls", "products of Weeding out" and IgD even went weird enough to say there is some sexual thing involved (very weird IgD).

Pemberley, please read through the thread you started on "Whos who" on this site and the vast majority on physicians had serious problems with "military medicine." Despite this, despite numerous public articles backing up our concerns, we continue to have people feel that they know better than us as to what is going on in CLINCAL medicine. You will find that many of the rebuttles we make are just that, rebuttles to WRONG statements made by IgD and others. You may want to call our correcting of "wrong statements" as "high-jacking", I call it letting the truth be known. You won't find me critiquing USUHS, or some medical school or residency I never attended, yet how many med students and non-clinical physicians are on this site disputing what the physicians saw and dealt with first hand?

Many students have emailed me and thanked me for giving them some info that they would have never known about. If you and IgD get a little wrinkled under the collar about the things we physicians present..............too bad.

Sometimes the truth hurts.

[

I respectfully submit that we can organize things so that the fighters are not deprived of a chance to refine their arguments and the learners are not deprived of a chance to learn. I don't believe that this suggestion should anger or injure parties on either side of the frequent arguments.

-Pemberley[/QUOTE]

I tried to do this over a year ago with the viewpoint thread, people tried again with the pros and cons threads. Good luck.

USAFdoc said:

MilitaryMD;

just realize that for every IgD or Portier out there, there are several others that at least have some idea of what might be awaiting them on the other side of residency. You and I and other physicians certainly could be spending time doing other things other than informing students, but IT IS time well spent, and it is the right thing to do.

Click to expand...

So I posted some banter...sorry. I didn't realize that we have to be serious in the military forum all the time.

I think lumping me in with IgD is a bit excessive, though....I mean I told everyone who I am...

I formally apologize for deviating from the established course.

Portier said:

So I posted some banter...sorry. I didn't realize that we have to be serious in the military forum all the time.

I think lumping me in with IgD is a bit excessive, though....I mean I told everyone who I am...

I formally apologize for deviating from the established course.

Click to expand...

Portier.

You're cool...I 'm not lumping you with anyone....You are one more voice here...and that's good.

Portier said:

So I posted some banter...sorry. I didn't realize that we have to be serious in the military forum all the time.

I think lumping me in with IgD is a bit excessive, though....I mean I told everyone who I am...

.

Click to expand...

I formally appologize for mentioning your name in the same sentence as the IgD person. No one should be mentioned in the same sentence as that poster (or should I say im-poster?).

It was absolutely excessive.

GMO2003 said:

ID: GMO2003
Service: Army
Specialty: General Medical Officer
Duration: 2003-2007
Would do it again: No. I would've taken out low interest student loans. The military owns you plain and simple. If you're ok with that and don't mind the unique and exotic practice environments that you may find yourself in, by all means sign on the dotted line. For everybody else, unless you want to make the military a career, I would highly discourage you from becoming a military medical officer.

OTOH, my time off has given me a chance to truly reflect on why I became a physician in the first place. Like others have said before, it truly is an honor and privilege to take care of the common soldier and give back to the backbone of the military. Also, the hours and pay couldn't be better. I work about 40hrs/week and with all specialty pay, bonuses added up make close to 100k/yr. As a GMO overseas in an outlying branch clinic, my patient panel size is significantly smaller than a CONUS physician at or near a MEDCEN (ie USAFDoc). Practicing semi-independently on my own license and making clinical decisions on my own have also helped me mature somewhat as a physician. Make no mistake about it though, I feel that the military is doing a dis-service to the community I serve by not providing them with a board certified family practice physician. I also feel like my clinical skills are deteriorating by the day and look forward to starting a civilian residency soon.

Click to expand...

I'm an ARMY HPSP 3rd yr. How do people end up in GMO slots in the army? And what do you do as a GMO?

Pemberley said:

I respectfully submit that we can organize things so that the fighters are not deprived of a chance to refine their arguments and the learners are not deprived of a chance to learn. I don't believe that this suggestion should anger or injure parties on either side of the frequent arguments.

Click to expand...

What you are asking for is moderation. The ToS already cover all the crap here.

In the end you've got about 4 people MilitaryMD, USAFDoc, Island Doc and Galo who account for the majority of the posts on the board. It seems like they get a sexual thrill out of spreading misinformation about military medicine and discouraging people from joining. Until they are gone it's impossible to have any meaningful discussion here because they just take over threads.

It seems the military asked them to leave. Why can't we do the same here?

IgD said:

What you are asking for is moderation. The ToS already cover all the crap here.

In the end you've got about 4 people MilitaryMD, USAFDoc, Island Doc and Galo who account for the majority of the posts on the board. It seems like they get a sexual thrill out of spreading misinformation about military medicine and discouraging people from joining. Until they are gone it's impossible to have any meaningful discussion here because they just take over threads.

It seems the military asked them to leave. Why can't we do the same here?

Click to expand...

Corrections:

1) I don't get sexual thrills from posting on SDN
2) I don't spread misinformation, although I'm discouraging folks from signing
3) I left the military...after they begged me to stay...but they could not meet my terms, so i left.

IgD said:

What you are asking for is moderation. The ToS already cover all the crap here.

In the end you've got about 4 people MilitaryMD, USAFDoc, Island Doc and Galo who account for the majority of the posts on the board. It seems like they get a sexual thrill out of spreading misinformation about military medicine and discouraging people from joining. Until they are gone it's impossible to have any meaningful discussion here because they just take over threads.

It seems the military asked them to leave. Why can't we do the same here?

Click to expand...

Amazing, the person most advocating for censorship is the one with his mind and threads in the gutter. "sexual thrills????" Come on IgD, were you just visiting a porn site before you wrote that thread? You IgD seem to be the ingredient that promotes the dissention on this site more than anyone. You more than anyone present mis-information.

Nice to see your "meaningful" discussion you just enterred.

By the way, the military continues to request that I return to active duty. Your threads, and realizing you might be a commander someday are just an additional reason and reminder why that would be the wrong choice.

IgD said:

What you are asking for is moderation. The ToS already cover all the crap here.

In the end you've got about 4 people MilitaryMD, USAFDoc, Island Doc and Galo who account for the majority of the posts on the board. It seems like they get a sexual thrill out of spreading misinformation about military medicine and discouraging people from joining. Until they are gone it's impossible to have any meaningful discussion here because they just take over threads.

It seems the military asked them to leave. Why can't we do the same here?

Click to expand...

All 4 of us and many more have posted extensively our experiences, and our goals to try and educate people why the miltiary is not a good option for medicine now. You on the other hand have done nothing but try to derail that for whatever nefarious, sexually perverted reason you have. You have yet to intelligently try to confront us on any reason we have legitimately placed stating the decline of military medicine. Once again, you are the perfect example of people in the military who ruin everything for everybody. You are probably afraid to identify yourself because if your superiors ever saw what you wrote, they would strip you of the uniform you so misguidedly support. You are a DISGRACE!

Pemberley said:

I'm afraid my post has been mis-interpreted: I did NOT ask ANYBODY on either side of the conversation to leave the board!!!

I hope that we can use threads to separate different discussions, and different tones of discussion. I would love to see the request of the original poster on the USUHS 2010 thread respected, as mine was not on this thread.

HOWEVER, experienced points of view from all sides are valuable, and should not be exiled.

-Pemberley

Click to expand...

Pemberley,

Although we have our different opinions, I do respect your ideas. I would be interested on your take on IgD and his increased furvor on offending the docs (sexual thrills etc).

Pemberley said:

I consider blanket evaluations of other posters' characters to be counterproductive, so please forgive me for not issuing one on IgD.

I do not hesitate, however, to evaluate specific posts and comments. The sexual remarks are so clearly out of line (and apparently random) that I wonder you find them worth responding to. One of my favorite phrases from my favorite author is "the compliment of rational opposition." Don't give that compliment to such a tactic.

-Pemberley

Click to expand...

there are different levels of disagreement;

1) I think I am right and you are wrong because I saw this/experienced that etc. This can degrade into
2) All your ideas are wrong, you have no idea etc. this can degrade into
3) You are stupid! this can degrade into
4) What "sexual thrill" are you into (where IgD is currently lingering).

not sure what level these threads will degrade to next.

IgD said:

What you are asking for is moderation. The ToS already cover all the crap here.

In the end you've got about 4 people MilitaryMD, USAFDoc, Island Doc and Galo who account for the majority of the posts on the board. It seems like they get a sexual thrill out of spreading misinformation about military medicine and discouraging people from joining. Until they are gone it's impossible to have any meaningful discussion here because they just take over threads.

It seems the military asked them to leave. Why can't we do the same here?

Click to expand...

I have been trying to stay out of this fray, but now you have clearly lowered the bar, and lost your mind somewhere along the way as well...

deleted

Cathance said:

HPSP at a SUPERB private med school (big positive)
Trans Intern at "Balboa" (NMCSD) (considerably less intense and well-powered than med school, negative)
GMO at NMCSD ("stashed," just waiting for FS school, got married !! positive)
Trainee for 6 months at NAMI Flight Surgeon school (paid to learn aeromedicine and fly, lived on the keys as a newlywed, biggest positive)
3 years and counting as FS for P-3 community (lots of positives and negatives, overall negative in my particular billet/experience -- others vary)

Do it again? Yes, but only for the school/money, then I'd get out as soon as possible just like I'm doing. Get in, get schooled, pay back, get out. Let freedom reign.

Click to expand...

The thing is you would have gone to the"SUPERB private med school " regardless of HPSP. Then people will say "well he got to do it for free." That is simply not true. He paid for his education with time and a delay in his choice as a specialty.

And this statement "Trans Intern at "Balboa" (NMCSD) (considerably less intense and well-powered than med school, negative) " Everyone needs to pay attention to this statement. The Civilian rotations at your med schools are a much more intense/educational than any MTF will give you.

Fact: CHCS II (now "ALHTA") is the DoD-wide electronic medical record system that is currently (and slowly) in the process of being implemented.

Editorialized facts: POSITIVES : Concept of electronic record, no paper record to lose, population studies are easier although not necessariy accurate because people "free text" to save time and don't use the system as expected. NEGATIVES : Concept is far from being realized, adds considerable time to each visit and less time with patients or my family, does not support dictation, the hardware is undersupported which makes it very slow, it is not wwweb-accessible, it is not even accessible outside the military medical clinic or hospital, the "promised" support staff is not as promised, providers are expected to put in the considerable time to develop their own templates.

My overall rating: Very poor. Lowers quality of life for physicians and quality of point-of-care service for patients.

What it needs :
#1: web accessibility -- otherwise useless to operational squadron-based providers and has to be upgraded by clinic computer staff and not centrally
#2: dictation support -- "Click and Talk"
#3: ultimate oversight by actual providers, not line officers or administrators
#4: shipboard and deployment capability
#5: interfacing with patients via NKO or something for pre-visit questionnaires
#6: dedicated fulltime expert in provider visit template construction at each clinic
#7: hardware to match load
#8: leadership who listens to the guys on the deck plates

Fact: I have been told by Navy CAPTs (almost Admiral, for those who are not familiar) that someone wanting good residency training should lean strongly toward doing it outside the service, due to large budget cuts and staffing/teaching problems likely to come. (Their statements are opinion, but their having said them is fact.)

I have not been told that getting out for my training is a bad idea -- from anyone!

Fact: An unopposed force on a mass will result in acceleration -- in this case, the force is O-6 opinion, I am the mass, and the acceleration is toward getting out.

Cathance said:

Fact: I have been told by Navy CAPTs (almost Admiral, for those who are not familiar) that someone wanting good residency training should lean strongly toward doing it outside the service, due to large budget cuts and staffing/teaching problems likely to come. (Their statements are opinion, but their having said them is fact.)

I have not been told that getting out for my training is a bad idea -- from anyone!

Fact: An unopposed force on a mass will result in acceleration -- in this case, the force is O-6 opinion, I am the mass, and the acceleration is toward getting out.

Click to expand...

Are you going to start your residency when you get out?

To those considering military medicine ("militiatroblasts?" ):

Fact: You might have a boss who is not a healthcare provider at all. As an operational provider (like me), you will be under command of a non-medical line officer.

You will always have two patients: the one in front of you, and the Command/Navy. This may sometimes present a conflict of interest. Usually it is not a serious problem for one of strong moral fiber, but reports on Abu Graib and Gitmo raise serious questions, in the least. You may find yourself in a difficult, but not unmanageable, ethical situation. All I can say is tread carefully, and always choose the right. You'll be fine if you do not cower to line authority pressure to do other than what your heart says is truly ethical and according to your Hippocratic Oath.

To the pluripotent stem-student considering being a militiatroblast:

Fact: Your contract is what matters, not what the recruiter or a brochure tells you.

Fact: Recruiters have lied. More than one, probably less then "all of them." Exact number unknown.

Advice: Insist on having language in the contract that gets you what you expect out of the deal. If want to be sure of a certain track, make sure it is in there, or "no deal." "No deal" is okay, too.

Fact: Legally, you will go where your detailer says you will go. Much depends on luck and timing. Very little depends on merit, unless you are really foolish, inept, or immoral.

Residency is an exception, to an extent.

Fact: If the Navy doesn't foresee a need for pediatricians, you won't get peds training in the Navy, at least not for the time being. The same goes for any other field, regardless of what you want to be when you grow up.

Fact: Navy GME residency applicants are judged sight-unseen, ultimately. A 65-point-scale score is broken down into 5 points for research/PhD/etc, 20 points from each of three services (USA, USN, USAF) that give up to 5 points in 4 categories: Military service; board scores; interviews; med school class rank; letters of recommendation. (Two of these are combined into one, but I'm not sure which two, scores/rank or interviews/letters.) You cannot legally find out your score. At least, that's the Navy way. Why Army and Air Force have a different system is beyond my understanding. (Enter the "purple suit?")

Will others clarify? Just the facts, please.

Fact: US Navy flight surgeons vary greatly in their experiences.

Some get a billet (job) with fast jets or low-flying helos, fun people, and have an amazing quality of life (F-18 training squadrons (family-friendly, no deployments, lots of two-seaters and turn/burn/lightyourhaironfire flight opportunities), the Blue Angels (gone a lot, not so great for family types), land-based and ship-based squadrons (deploy, some better than others, some families are hit harder than others by deployment). Others live a more mundane existence among slow flyers, but spend more time with their families or work on career or outside interests (papers, research, golf). Still others might as well not even be flight surgeons, or even doctors, because 95% of what they do could be done by a PA or nurse, or an "admin specialist."

My advice: Get in, get schooled, pay back, get out. Try to have some fun while you're at it, and keep on reading.

Lastly, to USNavDoc, USAFdoc and others disenchanted about military medicine: Why did you train in the military and take on the extra commitment if you already knew it "sucked"?

orbitsurgMD said:

Are you going to start your residency when you get out?

Click to expand...

Of course. But I need to beef up my resume with some research experience to get into my residency of choice. (I'm staying vague for a reason.)

Choice. What a concept!

Cathance said:

Fact: US Navy flight surgeons vary greatly in their experiences.

Some get a billet (job) with fast jets or low-flying helos, fun people, and have an amazing quality of life (F-18 training squadrons (family-friendly, no deployments, lots of two-seaters and turn/burn/lightyourhaironfire flight opportunities), the Blue Angels (gone a lot, not so great for family types), land-based and ship-based squadrons (deploy, some better than others, some families are hit harder than others by deployment). Others live a more mundane existence among slow flyers, but spend more time with their families or work on career or outside interests (papers, research, golf). Still others might as well not even be flight surgeons, or even doctors, because 95% of what they do could be done by a PA or nurse, or an "admin specialist."

My advice: Get in, get schooled, pay back, get out. Try to have some fun while you're at it, and keep on reading.

Lastly, to USNavDoc, USAFdoc and others disenchanted about military medicine: Why did you train in the military and take on the extra commitment if you already knew it "sucked"?

Click to expand...

[Bolds mine]


This is getting off-topic; the thread was started to allow posters who had opinions-- pro, con and mixed-- somewhere to place a bullet summary of their military and medical experiences.

I did not have the benefit of an internet-based bulletin board to read opinions about the HPSP program or the Navy before I signed aboard. Like many others, I was led to believe residency training was generally available to military doctors, that GMO assignments were brief--never more than two years--and that outservice training opportunities were more available than they later proved to be. From a remove of four years before graduating from medical school, I suppose the complete truth and a complete fiction would have had about equal chances of representing the practice and educational conditions that applied 4-5 years down the road. But I certainly would have given signing up more careful consideration had I heard negative reports.

As far as HPSP making school "free", that just isn't the case. You are repaying your debt in service and at the convenience of the government. The difference in compensation for GMOs compared to whatever pay you might otherwise earn once trained in your specialty is substantial, as is the opportunity cost of delaying training and the hardships and hazards inherent in deployed duty, in war zones and not.

Cathance said:

Fact: US Navy flight surgeons vary greatly in their experiences.

Some get a billet (job) with fast jets or low-flying helos, fun people, and have an amazing quality of life (F-18 training squadrons (family-friendly, no deployments, lots of two-seaters and turn/burn/lightyourhaironfire flight opportunities), the Blue Angels (gone a lot, not so great for family types), land-based and ship-based squadrons (deploy, some better than others, some families are hit harder than others by deployment). Others live a more mundane existence among slow flyers, but spend more time with their families or work on career or outside interests (papers, research, golf). Still others might as well not even be flight surgeons, or even doctors, because 95% of what they do could be done by a PA or nurse, or an "admin specialist."

My advice: Get in, get schooled, pay back, get out. Try to have some fun while you're at it, and keep on reading.

Lastly, to USNavDoc, USAFdoc and others disenchanted about military medicine: Why did you train in the military and take on the extra commitment if you already knew it "sucked"?

Click to expand...

While my USN days included very long hours, deployments, and military "stuff", it DID not have the problems that USAF Primary care had. As a nuclear pwr plant operator in the USN we did not do things that were against safety. We did maintenance that needed to be done. We were short of staff (20-40%), but not like the 50-90% we had in the USAF medical field.
Basically, I am still convinced that USAF Primary care on many levels is/was being run UNSAFELY for both the staff and patients.

So your question of why I took on the xtra commitment was because I wanted to be a USAF Family Doc, and I knew that could mean deployments, less pay, less autonomy etc. I had no idea that it would mean partaking in poor medical practices, recklessness, and a system that completely ignores those with the most knowledge and responsibility (the docs). Basically the USAF not only has you, they have your medical licsence.

Basically there was no comparison between my USN Nuclear experience and my USAF medical experience. I am a very hard worker and always have been. I demand excellence of myself and always have. Things do not have to be perfect, but the USAF Primary Care organization, as it is now and has been for some time, is/was simply unacceptable, even reckless how it operated at times.

deleted

Cathance said:

Fact: US Navy flight surgeons vary greatly in their experiences.

Some get a billet (job) with fast jets or low-flying helos, fun people, and have an amazing quality of life (F-18 training squadrons (family-friendly, no deployments, lots of two-seaters and turn/burn/lightyourhaironfire flight opportunities), the Blue Angels (gone a lot, not so great for family types), land-based and ship-based squadrons (deploy, some better than others, some families are hit harder than others by deployment). Others live a more mundane existence among slow flyers, but spend more time with their families or work on career or outside interests (papers, research, golf). Still others might as well not even be flight surgeons, or even doctors, because 95% of what they do could be done by a PA or nurse, or an "admin specialist."

My advice: Get in, get schooled, pay back, get out. Try to have some fun while you're at it, and keep on reading.

Lastly, to USNavDoc, USAFdoc and others disenchanted about military medicine: Why did you train in the military and take on the extra commitment if you already knew it "sucked"?

Click to expand...

Well you have me wrong. I did my internship in the Navy and that is all. The rest of my time has been spent as a GMO. I am getting out for civilian residency. I made a conscious choice to leave for better residency training.

USAFdoc said:

While my USN days included very long hours, deployments, and military "stuff", it DID not have the problems that USAF Primary care had. As a nuclear pwr plant operator in the USN we did not do things that were against safety. We did maintenance that needed to be done. We were short of staff (20-40%), but not like the 50-90% we had in the USAF medical field.
Basically, I am still convinced that USAF Primary care on many levels is/was being run UNSAFELY for both the staff and patients.

So your question of why I took on the xtra commitment was because I wanted to be a USAF Family Doc, and I knew that could mean deployments, less pay, less autonomy etc. I had no idea that it would mean partaking in poor medical practices, recklessness, and a system that completely ignores those with the most knowledge and responsibility (the docs). Basically the USAF not only has you, they have your medical licsence.

Basically there was no comparison between my USN Nuclear experience and my USAF medical experience. I am a very hard worker and always have been. I demand excellence of myself and always have. Things do not have to be perfect, but the USAF Primary Care organization, as it is now and has been for some time, is/was simply unacceptable, even reckless how it operated at times.

Click to expand...

I hear you. I feel like an indentured servant, as do most military docs I know. I won't argue with that. Re: military medicine: it's so variable. Some places are superb (yes, they do exist), most offer decency, some appear to be outrageously poor (but everyone's FITREPS say wonderful things!). Glad to be getting out for those reasons, and others.

usnavdoc said:

Well you have me wrong. I did my internship in the Navy and that is all. The rest of my time has been spent as a GMO. I am getting out for civilian residency. I made a conscious choice to leave for better residency training.

Click to expand...

I concede that I had you wrong. Oh, yeah. Anesthesia, right? Carry on!

My question was directed at those who "chose" to continue on and train in the military. Maybe it was better then. ??

Enlisted USN 1985,
USNA 1990 Graduate, resigned my commission in 98 to take a ENS MC USNR
HPSP 1998-2002
Navy transitional internship
GMOx2 years
1 year afloat and deployed
1 year at a smaller teaching hospital waiting to start residency
FTOS Radiation Oncology Resident.

Would I do it again? In a heartbeat. I have reached every training goal that I have wanted to attain. In the military you get the best of the best and the worst of the worst in the service. Some of the best people you will ever meet are the young sailors/soldiers/marines and airmen doing their jobs in any situation. Worst problems...nurses with leadership positions. But the good news is, everyone is afraid to come into a rad onc department because the radiation will sterilize them, make them glow, give them cancer, etc...thus less problems from administration.

One of the problems that I have seen is a new LT/CAPT physician given the responsibilities of a department head with 8 weeks of OIS and he/she doesn't know how to run a department/work with a chief/make final decisions against your chief (senior non-com), or handle the responsibilities that go with being an officer and a physician.

We should try to stay on topic for the OP and others who may question our backgrounds.

Cathance said:

Fact: US Navy flight surgeons vary greatly in their experiences.

Some get a billet (job) with fast jets or low-flying helos, fun people, and have an amazing quality of life (F-18 training squadrons (family-friendly, no deployments, lots of two-seaters and turn/burn/lightyourhaironfire flight opportunities), the Blue Angels (gone a lot, not so great for family types), land-based and ship-based squadrons (deploy, some better than others, some families are hit harder than others by deployment). Others live a more mundane existence among slow flyers, but spend more time with their families or work on career or outside interests (papers, research, golf). Still others might as well not even be flight surgeons, or even doctors, because 95% of what they do could be done by a PA or nurse, or an "admin specialist."

My advice: Get in, get schooled, pay back, get out. Try to have some fun while you're at it, and keep on reading.

Lastly, to USNavDoc, USAFdoc and others disenchanted about military medicine: Why did you train in the military and take on the extra commitment if you already knew it "sucked"?

Click to expand...

because we didn't know it sucked...and we tried to make it change...and because of all the naive reasons that young people have....and I didn't do a GMO...I went straight into training.

I am currently burning my time as a UMO:

-3 year HPSP
-Transitional Internship
-UMO/DMO training
-Currently doing my payback and looking forward to an Ophthalmology Residency in a civilian program.

So far...no regrets. Would I do it again? NO!!! I hate the fact that I am a non-residency trained physician. Hopefully my experiences as a UMO will be a good topic of conversation during residency interviews.

5 years enlisted as arabic linguist
4 years HPSP
1 yr Peds intern in Navy (oops)
Currently on 2nd year of GMO with infantry marines

I got offered a spot to go straight through with Peds but turned it down due to the unstable state of Navy Peds and the chance to do an awesome GMO tour. The peds program was strong.

Deployed to most of middle east and north/east africa at one time or another.

I'm in no great hurry to start making the big bucks, so I have enjoyed my GMO thus far. I get to learn a lot of esoteric medicine, see some patients, do some research, and get to know my kids better. It's kind of nice, but not conducive to retention of intern skills.

I haven't decided if I'll stay in yet. I pretty much ignore this forum with respect to that, b/c most of the posts are too emotionally charged one way or the other. But the posts are entertaining to read when I'm on duty. I'm pretty neutral with respect to military medicine. I'm leaning towards getting out, but it has more to do with family stuff than any animosity I have toward the military. I wish I had the guts to stay in b/c I do get a sense of satisfaction taking care of people who are serving our country.

I plan on doing an anesthesia residency. That decision has come about due to experiences I have had during my GMO tour, so there has been some good to come out of it medically also.

NavMtnDoc said:

..................
I plan on doing an anesthesia residency. That decision has come about due to experiences I have had during my GMO tour, so there has been some good to come out of it medically also.

Click to expand...

what experiences?

What are people's general opinion on military residencies vs civilian residencies? I've heard good and bad...

6 yrs enlisted Army, combat engineer; medic--8 yr service obligation already up.
Currently commissioned as a 2nd Lt in Nat'l Guard (3rd yr med student)...not sure if I want to do military residency or civilian...

or please PM me if you know if guardsmen can even go into military residencies unless they enter contractual obligation...

militarymd said:

what experiences?

Click to expand...

You didn't ask me, but I'll answer anyway.

I got to do quite a bit of anesthesia while deployed as a GMO. In Afghanistan, at an Army hospital in Bagram, I made friends with an anesthesiologist and CRNA and was able to do ~6 cases/week with them. It helped slow the GMO-induced brain rot, and solidified my desire to go into anesthesia. They did lots of free surgeries for the locals, so it was a nice mix of cases ... not just trauma-fill-er-up-with-fluids while the surgeon does a fasciotomy and ties things off before pushing them out the door kind of stuff. I didn't do nearly as much in Iraq (most of that was watching fasciotomies ), but I was still able to latch on to a couple of anesthesiologists.

More stories of GMO-land anesthesia ... while off by myself at a little FOB on the Afghan-Pakistani border, there were many instances where an injured local national came to us but was denied CASEVAC ... no local doctor/etc to pass them off to ... three needed "anesthesia" of one kind or another ...
- An 8 year old girl whose uncle accidentally set her on fire with gasoline while burning trash. We did qod dressing changes with the help of some morphine and ketamine, until about 10 days and several more denied CASEVAC requests later when she predictably wound up with wound infections and pneumonia ... then the CASEVAC was approved and she went to Bagram for treatment. (Apparently the cut for "life/limb" lies somewhere between sepsis and 30% 2nd/3rd degree burns.)
- An adult male who got his hand and wrist caught in some machinery. CASEVAC denied (they said it was not life/limb since the loss of the limb was a foregone conclusion), so ketamine + Versed, finished the amputation, gave him a nice little stump. He actually healed up very nicely.
- A boy (10ish) who got shot in the face during some family altercation. He had a fractured mandible. I knocked him out with ketamine while a visiting dentist wired his jaw shut.
I didn't carry those drugs; they all came from an Army SF medic at the FOB. We had a little bit of morphine and some fentanyl lollipops, but tons of ketamine and Versed.

For the record, I'm not suggesting any of the above was a good thing - at best it was a result of horrible manning decisions made by the people in charge, at worst an example of why the whole GMO scheme is a bad idea. But it sure was fun, and thankfully I didn't kill anybody. See, Marine GMOs get to do anesthesia without monitors, training, or supervision.

Seriously though, in garrison, for GMOs who want to, there are opportunities to do real work. Surgeons at the NHCL hospital were happy to have GMOs come in. The anesthesia department was willing too, though between my deployments I didn't sacrifice any more family time by spending more hours at the hospital. The didactics & morning conference for the FP program there were open to and advertised to green side GMOs. (I never took advantage of that, though, having realized long ago that the IM/FP life was absolutely not for me. )

Not that I'm saying that GMO time isn't, first and foremost, prime brain/skill rot time, but some GMOs have the opportunity or make the effort to get something useful out of it. In my case, rather than sit in a tent watching DVDs over and over again, I got in a bunch of OR time, a lot of 1-on-1 teaching from a pair of anesthesiologists, and two great LORs from attendings while deployed.

My experience is apparently not typical, though.

militarymd said:

what experiences?

Click to expand...

Well, I don't have anything nearly as exciting as PGG. My "experiences" consist more of working with some (civilian) anesthesiologists locally and having an opportunity to talk extensively about the profession. I have also been involved in some (military) research that is very physiology / pharmacology oriented. I initially planned to do NICU/PICU from peds. It's just brutal to do 3 years of residency in something you really don't enjoy, then a 3 year fellowship. The path is only 1 year different either way, but I think the day to day job of an anesthesiologist seems more appropriate to my personality and interests. I also enjoy the type of problem solving involved in anesthesia more than that involved in peds clinic. So... no great epiphany due to a case or cases, just a chance to sit back and evaluate the situation.

Like PGG said, your GMO experience in garrison is often yours to utilize as you see fit. In my case, I am in a command that pretty much lets me do what I want as long as I ace the PFT, keep my hair cut, and don't screw anything up. For better or worse, that's often the case with the marines. Some guys moonlight, but I don't really need any more money, so I choose to spend some time trying to further my knowledge of medicine. There's no way to keep up with your peers in GME, so you do what you can to stay informed.

1984-1993 Enlisted USAF Aircraft Electronics
1993-1997 USUHS
1997-1998 Military Transitional Internship
1998-2001 Flight Surgeon F-15C
2001-2005 Radiology Resident Civilian
2005-Present Radiologist USAF

Would I do it again? Yes but I would have started sooner.
Would I get out now? Yes if they let me, after 20+ years you get tired. However I would not ask to get out until my commitment is up as I signed on the dotted line.

I trained in a surgical subspecialty at the AF flagship hospital WHMC for 6 yrs
Served as staff for 5 yrs (I got an extra year of obligation 5, not 4 yrs because of it)
Got out first opportunity.
My training was excellent compared to civilian residencies so I can't complain about that. It was excellent because the group of subspecialty staff who trained me were smart and hard working to circumvent all the restrictive rules that constantly tried to freeze out our patients and tried to limit our OR opportunities. This ambition was also my downfall. They left me with a hardworking mindset to see every patient possible, never disengage, treat every patient encounter like I was being paid for it. I didn't want to be lazy when I separated and I continued to work this way when I left to be a staff somewhere else. I was the busiest clinician in terms of patients seen, procedures done in the office and operations done. The problem is that the hospital military administrators don't have that mentality. They had no allegiance to patients or retirees. I was told to stop seeing patients over 65, then six mos later start seeing them in droves. At some hospitals in the AF the command wants to send all over 65s out as they get no benefit from them. Our hospital went to a "business plan" where we all of a sudden were allotted a pool of money with the expectation of seeing a certain number of outpatients, doing a certain amount of inpatients, and a certain amount of surgeries. We lost money from the hospital's budget if we didn't meet this and got more money if we exceeded this. Patient's were jerked around- welcome? unwelcome? who knows this month? The super colonels agenda besides minimizing their work was only to keep the hospital in the black so the commander could be promoted. Patient and physician welfare came second and a distant third.

Anyways... training was good in 95-01 but we were always afraid that the knife would fall and patient volume would plummet.

Pemberley said:

Inspired by a thread in the pre-allo forum, I found a way to make this thread more useful to me (I have trouble keeping people straight sometimes, especially if I've only seen a few of their posts)

So for me and anybody else who wants a handy reference to people's experiences, here's an indexed list. I originally used smilies, but the program didn't let me use that many in one post, so I went to an awkward verbal form of smilie. Let me know if I mis-spelled, mis-capitalized, mis-referenced, mis-characterized, or just pain missed anybody.


Navy Anesthesia and/or Critical Care
mad militarymd
cool pgg with amplification

Navy Flight Surgeon
sad orbitsurgMD
cool medivac
content chickendoc
cool Cathance

Navy GMO
cool usnavdoc
cool NavMtnDoc with amplification

Navy Internal Medicine
cool GMO_52

Navy Pediatrics
cool Homunculus

Navy Radiology
content ExNavyRad
content r90t

Navy Undersea Medicine
sad JA_Perez



Army GMO
sad GMO2003
content hosskp1



Air Force Family Practice
mad USAFdoc

Air Force GMO
mad island doc

Air Force Radiology
content USAFGMODOC
content Milrad

Air Force Surgery
mad Galo
mad FliteSurgn
sad mitchconnie
sad former military

Click to expand...

So where do we put IgD?

i know this is just semantics, but Homunculus is Army. I figured he wouldn't be so Cool if he were Navy because he'd probably be in the desert with some MEU right now.

nice

You can change me from Sad to Mad or if you can find a symbol of a guy with the middle finger up that would be most descriptive