- Joined
- Oct 2, 2006
- Messages
- 912
- Reaction score
- 29
I am currently AD USAF ENT. Inspired by finding out that I'm not alone in my department as well as military-wide on this website, I thought I'd throw in my own 2 cents as to why I'd never, ever, ever, recommend military medicine to anyone. I got in to have enough money to get married, keep debt low, and serve my country. It wasn't the best way to do any of it. I have well more than 10, but to keep it reasonable:
1 - No respect for my position. I hate that I don't get money when I'm supposed to. I should have had 30K deposited in my account 4 days ago, but as of right now, they don't even have the ISP contract available to sign. Seriously, is it that hard to predict when Oct 1 comes each year? And does it really make anyone feel good about how much the AF respects their docs when they havn't raised the ISP since 1976?
2 - Incredible efficiency? So the hospital at my base shut down as they have many other places. Now, I'm the only ENT doc here so any consult to any ENT, whether to me or to a civilian has to get approved by me. If I want to do inpt surgery at the university (neck dissection, for example) I have to write a consult to myself. Then I have to approve the my consult to myself. Once that's approved, then I get to schedule the surgery and then I get 3 e-mails detailing that each of the steps was accomplished. I love that. When our surgical department complained to TriCare, they said that there was nothing that could be done to change it.
3 - I don't have an anesthesiologist. I have outpt surgery available at my base, which I'm the majority user being ENT. I account for 40% of the surgical volume myself. However, we only have CRNA's. Fortunately, my CRNA's are excellent, but if there is so much as a hiccup and that can mean a kiddo under 2 who is not of herculean health, I can't get approval to do the surgery here.
4 - I get zero support. I have a great surgical tech. He's awesome. But I am slated to have 3. He has to do the work of 3 people by himself. He supports audiology as well. So he has to run the clinic, schedule surgeries, answer phones, assist in the OR, run hearing aid programs, and do all the meaningless task work like being door monitor during mandatory fire drills. The guy is getting crushed. The FTE for an ENT in the community is 3.4-6.3 per provider, depending on location and practice size. I have one. If the military is so bent on saving money, why don't they look at those people who exist solely to be fiscally solvent--the private world. Furthermore, I don't have a nurse. I'll never get a nurse. I have to call every t-con myself. I'm the only provider in my clinic, which means I'm on call 24/7/365 unless I call the university and ask for them to cover me on a weekend. I cover the base urgent care clinic (aka useless care clinic) as well as 2 civilian ED's ( I have to cover these for TriCare patients to maintain my priveleges there to take care of TriCare inpatients AND I have to pay for that which is sometimes reimbursed.)
5 - Stupid, stupid, stupid rules. Flyers are grounded if the get a myringotomy and tube for eustachian tube dysfunction. I think every pilot on the planet should have tubes so that they never have to worry about otologic barotrauma. But oh no, not the AF. A tube is a dangerous intervention that could have spooky albeit unodocumented problems that may cause a pilot to fly his F-16 into your house. Even dumber. If you've got OSA with an RDI of 90 and you're not even overweight. You're not going to be a good candidate for surgery, and the liklihood of surgically reducing your cardiovascular risk to less than severe is smaller than 20%. You need CPAP. But not in the good ole AF. Nope, if you decide to go with CPAP, they're going to board you and possibly boot your from the military. And here's why: "We can't guarantee you'll get deployed where there's electricity to run your CPAP." No kidding, they told this to an ELECTRICAL FREAKING ENGINEER. So even if they can't guarantee that, they'd rather you be at severe cardiovascular risk 100% of the time instead of using it while your home and leave it behind when your deployed therby substantially decreasing your risk of an MI or CHF for a majority of any given year. Brilliant.
6 - Even though I still owe a year of commitment, the AF won't pay for a CME TDY this year. I can't go to my Academy meeting unless I fork over the approximately $2200 on my own. Even though I'm working for them, because I'm separating they won't support me. Why do I even want to work hard?
7 - Obtaining serviceable equipment is about as easy as breaking your femur while floating in space. I have 3 nasopharyngoscopes that are so bad, I can't even see letters on a Snellen chart, much less look for subtle vibratory abnormalities on the vocal margin of a smoker. I've asked for them to be fixed, but I was told they've been repaired so many times that they won't repair them anymore because the cost of repairs is more than the cost of a new scope. When asked if I could get new scopes, the answer was no. I have to defer pt's off-base for videostroboscopy, even though with the number of deferrals I've made in the last 10 months alone, I've cost the MTF more money in consultations than it would have been to get me the equipment.
8 - This place moves about as fast as a dehydrated slug. I got approval for a camera on my operating microscope 19 months ago so I could teach the residents who rotate with me every month. I still have yet to receive it.
9 - the left hand has no idea that there is even a right hand. My position at this base was eliminated in MAPPG06, but the AF brought in 10 more ENT's that FY than they had room for. Therefore I was kept at my current base--they didn't want to move me and have 11 ENT's to shove in various spots. However, they eliminated all of my support staff because I wasn't supposed to be here. I had no support for a short time, but then I got my current tech, who like I said is great, but who cannot keep up with the workload. Now, there is a contract to hire a civilian ENT to run this clinic because I'm not supposed to be here. When I informed them that the clinic was not busy enough to support 2 ENT's, especially a civilian one who will make double my salary, they said, "Well, the money's there, so we're going to hire him."
10 - Despite "excellence in all we do" the AF will allow any idiot to be a civilian contract physician. The new civilian urologist they had planned on hiring took 3 residencies to finish his training. He was booted from 2. The guy the want to hire as a civilian ENT hasn't had hospital priveleges for 3 years. The IM doc they hired was such a CHF catastrophe, she'd get out of breath just walking between rooms in clinic. And here's a classic, when this place still had inpt beds, I did a T&A on a kiddo with significant OSA. These kids are required to be watched o/n because of the risk of desaturations. As long as they are in a monitored bed, I am ok with them getting codeine to help with the pain. Well, with one particular kiddo, he was desatting all over the place in the PACU. When he finally made it to the floor having become more stable as he was less sedated, the nurse gave him Lortab elixir. There was no order for Lortab. I'd never in the name of all that is holy give a 3 yo Lortab --especially a post-op OSA kid, especially a post-op OSA kid with post-op desats in the PACU. The nurse just randomly decided that was the medication she should give (she never checked the orders) randomly picked the dose (she never looked to see what the dose of Lortab should be in Harriet Lange nor did she simply mistake the tylenol with codeine dose for the Lortab--she admittedly just picked a dose that "seemed" right) and administered it to the kid. Yep, you guessed it, she's been promoted since and is still and AD nurse at a new base.
I've read a few people here who take the high road and said that all that matters to them is taking care of people. Others who say ask not what your country can do for you. Others who say that money doesn't matter. Others who say I really want to serve. I agreed with every one of you. Seriously. I came into the AF not knowing if I'd want to stay in longer than my commitment. It took 4-6 months before I was so jaded I'd take a pencil to my eyeball before staying in longer than 3 years. I HATE the medical corps. The USAF may be the finest AF in the world, certainly our Airmen are among the best people I've ever met, but the way that this thing is run is sickening, and it only gets worse and here's why.
Think of military medicine like an enormous snow ball rolling down a mountainside. It's too big to stop, it's too big to change it's direction, it just goes on wiping out anything in it's path. If you are in it's way, the only thing you can do to make your existence tolerable is to tack yourself on and try to stick a few things into your part of the snowball on your descent down. As one of the more wizened guys here said, as a doc in the AF you're more of a liability than an asset. And you'll be treated as such.
If nothing else, this serves as a nice place to rant. I apologize if you wasted time reading it, but if I even so much as convince one person not to do the HPSP thing, I'm satisfied.
1 - No respect for my position. I hate that I don't get money when I'm supposed to. I should have had 30K deposited in my account 4 days ago, but as of right now, they don't even have the ISP contract available to sign. Seriously, is it that hard to predict when Oct 1 comes each year? And does it really make anyone feel good about how much the AF respects their docs when they havn't raised the ISP since 1976?
2 - Incredible efficiency? So the hospital at my base shut down as they have many other places. Now, I'm the only ENT doc here so any consult to any ENT, whether to me or to a civilian has to get approved by me. If I want to do inpt surgery at the university (neck dissection, for example) I have to write a consult to myself. Then I have to approve the my consult to myself. Once that's approved, then I get to schedule the surgery and then I get 3 e-mails detailing that each of the steps was accomplished. I love that. When our surgical department complained to TriCare, they said that there was nothing that could be done to change it.
3 - I don't have an anesthesiologist. I have outpt surgery available at my base, which I'm the majority user being ENT. I account for 40% of the surgical volume myself. However, we only have CRNA's. Fortunately, my CRNA's are excellent, but if there is so much as a hiccup and that can mean a kiddo under 2 who is not of herculean health, I can't get approval to do the surgery here.
4 - I get zero support. I have a great surgical tech. He's awesome. But I am slated to have 3. He has to do the work of 3 people by himself. He supports audiology as well. So he has to run the clinic, schedule surgeries, answer phones, assist in the OR, run hearing aid programs, and do all the meaningless task work like being door monitor during mandatory fire drills. The guy is getting crushed. The FTE for an ENT in the community is 3.4-6.3 per provider, depending on location and practice size. I have one. If the military is so bent on saving money, why don't they look at those people who exist solely to be fiscally solvent--the private world. Furthermore, I don't have a nurse. I'll never get a nurse. I have to call every t-con myself. I'm the only provider in my clinic, which means I'm on call 24/7/365 unless I call the university and ask for them to cover me on a weekend. I cover the base urgent care clinic (aka useless care clinic) as well as 2 civilian ED's ( I have to cover these for TriCare patients to maintain my priveleges there to take care of TriCare inpatients AND I have to pay for that which is sometimes reimbursed.)
5 - Stupid, stupid, stupid rules. Flyers are grounded if the get a myringotomy and tube for eustachian tube dysfunction. I think every pilot on the planet should have tubes so that they never have to worry about otologic barotrauma. But oh no, not the AF. A tube is a dangerous intervention that could have spooky albeit unodocumented problems that may cause a pilot to fly his F-16 into your house. Even dumber. If you've got OSA with an RDI of 90 and you're not even overweight. You're not going to be a good candidate for surgery, and the liklihood of surgically reducing your cardiovascular risk to less than severe is smaller than 20%. You need CPAP. But not in the good ole AF. Nope, if you decide to go with CPAP, they're going to board you and possibly boot your from the military. And here's why: "We can't guarantee you'll get deployed where there's electricity to run your CPAP." No kidding, they told this to an ELECTRICAL FREAKING ENGINEER. So even if they can't guarantee that, they'd rather you be at severe cardiovascular risk 100% of the time instead of using it while your home and leave it behind when your deployed therby substantially decreasing your risk of an MI or CHF for a majority of any given year. Brilliant.
6 - Even though I still owe a year of commitment, the AF won't pay for a CME TDY this year. I can't go to my Academy meeting unless I fork over the approximately $2200 on my own. Even though I'm working for them, because I'm separating they won't support me. Why do I even want to work hard?
7 - Obtaining serviceable equipment is about as easy as breaking your femur while floating in space. I have 3 nasopharyngoscopes that are so bad, I can't even see letters on a Snellen chart, much less look for subtle vibratory abnormalities on the vocal margin of a smoker. I've asked for them to be fixed, but I was told they've been repaired so many times that they won't repair them anymore because the cost of repairs is more than the cost of a new scope. When asked if I could get new scopes, the answer was no. I have to defer pt's off-base for videostroboscopy, even though with the number of deferrals I've made in the last 10 months alone, I've cost the MTF more money in consultations than it would have been to get me the equipment.
8 - This place moves about as fast as a dehydrated slug. I got approval for a camera on my operating microscope 19 months ago so I could teach the residents who rotate with me every month. I still have yet to receive it.
9 - the left hand has no idea that there is even a right hand. My position at this base was eliminated in MAPPG06, but the AF brought in 10 more ENT's that FY than they had room for. Therefore I was kept at my current base--they didn't want to move me and have 11 ENT's to shove in various spots. However, they eliminated all of my support staff because I wasn't supposed to be here. I had no support for a short time, but then I got my current tech, who like I said is great, but who cannot keep up with the workload. Now, there is a contract to hire a civilian ENT to run this clinic because I'm not supposed to be here. When I informed them that the clinic was not busy enough to support 2 ENT's, especially a civilian one who will make double my salary, they said, "Well, the money's there, so we're going to hire him."
10 - Despite "excellence in all we do" the AF will allow any idiot to be a civilian contract physician. The new civilian urologist they had planned on hiring took 3 residencies to finish his training. He was booted from 2. The guy the want to hire as a civilian ENT hasn't had hospital priveleges for 3 years. The IM doc they hired was such a CHF catastrophe, she'd get out of breath just walking between rooms in clinic. And here's a classic, when this place still had inpt beds, I did a T&A on a kiddo with significant OSA. These kids are required to be watched o/n because of the risk of desaturations. As long as they are in a monitored bed, I am ok with them getting codeine to help with the pain. Well, with one particular kiddo, he was desatting all over the place in the PACU. When he finally made it to the floor having become more stable as he was less sedated, the nurse gave him Lortab elixir. There was no order for Lortab. I'd never in the name of all that is holy give a 3 yo Lortab --especially a post-op OSA kid, especially a post-op OSA kid with post-op desats in the PACU. The nurse just randomly decided that was the medication she should give (she never checked the orders) randomly picked the dose (she never looked to see what the dose of Lortab should be in Harriet Lange nor did she simply mistake the tylenol with codeine dose for the Lortab--she admittedly just picked a dose that "seemed" right) and administered it to the kid. Yep, you guessed it, she's been promoted since and is still and AD nurse at a new base.
I've read a few people here who take the high road and said that all that matters to them is taking care of people. Others who say ask not what your country can do for you. Others who say that money doesn't matter. Others who say I really want to serve. I agreed with every one of you. Seriously. I came into the AF not knowing if I'd want to stay in longer than my commitment. It took 4-6 months before I was so jaded I'd take a pencil to my eyeball before staying in longer than 3 years. I HATE the medical corps. The USAF may be the finest AF in the world, certainly our Airmen are among the best people I've ever met, but the way that this thing is run is sickening, and it only gets worse and here's why.
Think of military medicine like an enormous snow ball rolling down a mountainside. It's too big to stop, it's too big to change it's direction, it just goes on wiping out anything in it's path. If you are in it's way, the only thing you can do to make your existence tolerable is to tack yourself on and try to stick a few things into your part of the snowball on your descent down. As one of the more wizened guys here said, as a doc in the AF you're more of a liability than an asset. And you'll be treated as such.
If nothing else, this serves as a nice place to rant. I apologize if you wasted time reading it, but if I even so much as convince one person not to do the HPSP thing, I'm satisfied.
