Life in the Military

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militarymd

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Here's something for all you potential physicians to think about. I'm going to leave the names out and alter the details so as not to directly identify individuals and ships, but this story is essentially accurate, and it happened in the last 6 months.

I have a friend who is the surgeon on one of the fleet surgical teams in the navy. These are small medical teams that embark on small deck marine aircraft carriers. The medical teams include a surgeon, internist, and support staff to allow surgical/medical capabilities.

The team does not have an anesthesiologist, but a CRNA, and the surgeon is medically responsible for the patient during surgery for the actions of the CRNA.

So, my friend the surgeon was actually one of the people lucky enough to get a full deferment to train in a well regarded civilian hospital. He comes on active duty and is assigned to this unit. As an O-3, he is entitled to a 2 man state-room on the ship with a public bathroom that you share with everyone in the officer area of the ship.

So his accommodations is essentially what a college student gets in a dormitory....just a little smaller. The internist is the same rank, so he gets the same thing....Not a bad deal considering you are on a warship.

Now, the CRNA has been in the navy for a number of years. He is an O-6. He actually makes more money then the surgeon and the internist. He was a nurse who went to CRNA school for 2 years to be credentialled as a CRNA. He stayed in the navy, because he likes the rank he gets overtime....giving him parity to physicians in the eyes of the Navy.

The CRNA lives in a suite (sitting room and bedroom with 2 TVs, frig, etc.) with his own bathroom. Only the Commanding officer and the second in command on the ship has that. When the ship pulls in for liberty, he gets his own personal driver and car, and rides into port in the captains personal launch.

The surgeon and internist rides in with everyone else.....I don't know what you guys all think, but as someone who as gone through all the training of medical school and residency, and as the person who stands between life and death for someone who gets critically injured on that ship, that would really piss me off.

All those years of call and sacrifice...working 80 to 100 hour weeks in residency....means squat to the navy. The CRNA who has spent the last 15 years sitting on hospital committees coming up with rules to impede physicians is seen by the Navy as a more important person....Someone who works maybe 30 to 40 hours a week..sitting in committes...maybe doing a few cases here and there.

All of you have to ask yourself, can you really put up with the disparity in that kind of treatment between a nurse and yourself after all the sacrifice you've put into your training?

If the answer is yes, then military medicine is for you.

OK....flame away

sincerely yours,
mmd
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No flames intended in replying, however, you have to honor the rank difference, though you may not respect the person wearing the eagle. That is part of the military structure. I agree, if the above bothers you, you probably won't enjoy the military or your time as a military physician. I grew up at a service academy, so the respect the rank thing with a sir/ma'am really isn't a big deal.

My CO would give me the use of the capt's launch when he wasn't using it, access to his duty driver, and any other perk when he wasn't planning on using it. My stateroom was a one man room with an adjoining shower/bathroom with 2 other people. I am on cell phone duty, even while deployed, not required to stay near the ship. It varies from command to command, on the perks you receive as a physician. The carrier, with so many senior officers, have little rank perks for an O-3 or O-4. You are a small fish in a very big pond. Every department head and some division officers will outrank you. On the smaller ships you are very senior. I'm the #5 man on board and enjoy the perks of it.
 
You are right about the military structure. It is essential for the line to function. There is a need for a clear chain of command to allow the military to accomplish it's function.

Depending on the size of the ship or the size of the unit, there are certain ranks given to the officer who is in command. I know for a fact that for certain jobs, line officers are actually given spot promotions just for that job, then they return to their original rank after they finish that tour.

However, this rank structure which serves the warriors well is detrimental to the support corp. How can a nurse ever outrank a board-certified physician and "accorded the respect and responsibilities" of that rank.

It makes no sense whatsoever, that a nurse gets better quarters and privileges than a physician.

Go to any hospital and look for "nurse's lounges" or "nurse's parking". You won't find any. However, you'll find "doctor's lounges", etc.... I object to a nurse having preferential treatment in the military.

10 years ago, I never thought about it. Now that I've invested 4 years in med school, and multiple years in post-graduate training, I can't swallow it.
 
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The nurse in the military setting will outrank the physician by military rank, however will not by qualification or experience. As an intern, I've asked senior nurses to sign an order, after they disagreed with a treatment plan. None have ever taken me up on the offer. That would remind them that they may be an O-4, however, are still a nurse and not a physician.
Our increased pay is an attempt to keep us above our non-physician co-workers and competitive with our civilian peers. Our bonuses exceed all others in health care and are greater than most warfighters. Sub guys are the exception, as they get lots of cash to go on a vessel that sinks daily.
As for nurses getting better privileges, it is easier to swallow if you think of it as a Commander/Captain, rather than nurse. It's the same feeling that senior enlisted get, I'm sure, when they are talking to a new second lt/ensign. Don't get me wrong, I'd love a doctor's lounge, parking, and all of the other perks that come with being a physician. My internship had us rotating at a civilian trauma facility and we had access to every perk that physicians get in the real word. I love them.
 
Man, the navy sure has a lot of O-6's.

My active duty USAF Fighter wing (72 airplanes, about 5K people) had a total of 2 O-6's. The Wing Commander and the Base Commander.

The Senior medical officers were O-5's. Now, we only had a clinic, but at the nearest AF hospital, the seniors were all O-5's as well.

The really big USAF hospitals had O-6's (and were commanded by an O-7) but these were the really big ones. The O-6's were generally well removed from anything approaching providing care, they were usually administrators, or medical service chiefs.

I retired as an O-5 (pilot type). I really never thought about how unfair I was being treated as an O-3 or O-4 having to stay in (say) BOQ's that had all the charm of a Motel-6 room, when those non-pilots (and in the AF, it all revolves around the pilots) were getting suites and private houses, just because they out ranked me. I just appreciated having the suites or private houses all the more when I became an O-5. Or, when I was an instructor pilot / stan/eval pilot as an O-3, (both higher levels of qualification as pilots go) and had to take the regular crew bus, instead of the staff car, just because I was an O-3 and not O-5.

MilMD, how are you going to react when the hospital administrators secretary has a better parking space than you have? Or, has a bigger office? WTF, some secretary having a better work space than a physician?

How much longer before you get out? You're starting to sound pretty .... petty about the way the military works. Probably be a good thing for you to leave, soon. You're obviously unhappy in the service.
 
To Military MD: How do you feel about a soldier (E-7) w/ over twenty years in the military who has to salute O-1 everyday who just signs bunch of paper in the air conditioned room...??? Fair?

As a doctor or nurse we are there to "support" our troops. So be prepare to obey the command from infantry officer (O-3) in the field environment even though you may be a physician (O-4)...
 
I guess it is all perspective. For those of you who pretty much have prior careers in the military, your perspective is that this is how the military functions, so you accept that.

For those of us who enter the service as physicians (and told that by recruiters), it is different.

I will never accept that a nurse "outranks" me.

I'll be out of the military by July, and for 400,000 a year, I'll drive the secretaries to work, and wax their cars.
 
Wow, 400,000 a year. Your doing big things milmd, congrats. I wish you the best in your career outside of the military, and if your still not happy you can just wipe your tears with a benjamin or two. :D By the way, what specialty are you in?
 
militarymd said:
I'll be out of the military by July, and for 400,000 a year, I'll drive the secretaries to work, and wax their cars.
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:laugh:

I enjoy your posts milMD. You make me think about things I haven't thought of yet.
 
I am not necessarily bothered by the fact that O-6 nurses get some perks that O-4 physicians don't. If they have stuck it out in the system long enough to make O-6, then I guess they deserve the big office and I'll salute them. Doesn't irritate me much. But I do wholeheartedly agree with milmd that the military rank structure distorts healthcare delivery in bizarre ways.

The person directly above me in my chain of command is a nurse. Whenever problems arise in my practice--conflicts with the OR over starting an emergency night-time case, disputes with the GI service over timeliness of an ERCP, a witch-hunt by the QA department after a surgical death, etc--the person who is supposed to be supporting me is a nurse. A nurse has NO CLUE about physician-level decision-making and they are TOTALLY INEPT at supporting the people under their command. Pretty much all they can do is sit in their office and send out e-mail about being a "team-player."

On the wards, the O-5 nurse who disagrees with my O-3 intern about patient care usually gets her way. Do you think our "Commander," an O-6 nurse, will take our side? Not a chance. Supervisory nurses in both civilian and military hospitals think they know more than doctors--the difference in the military is that they actually can give the doctor an order. Can they directly change an order in the chart? Of course not, but a high-ranking nurse has far more clout than her civilian counterpart even dreams of.

The cadre of individuals making major decisions in the hospital that directly affect patient care includes--a couple of O-6 clipboard nurses, an O-5 MSC officer, and a couple of O-6 administrative physicians who haven't seen patients in 10 years. It results in truly *****ic decision-making because these people have no clue about patient management in the year 2004. There is no hospital on the planet where actual clinicians have so little input.
 
mitchconnie said:
I am not necessarily bothered by the fact that O-6 nurses get some perks that O-4 physicians don't. If they have stuck it out in the system long enough to make O-6, then I guess they deserve the big office and I'll salute them. Doesn't irritate me much. But I do wholeheartedly agree with milmd that the military rank structure distorts healthcare delivery in bizarre ways.

The person directly above me in my chain of command is a nurse. Whenever problems arise in my practice--conflicts with the OR over starting an emergency night-time case, disputes with the GI service over timeliness of an ERCP, a witch-hunt by the QA department after a surgical death, etc--the person who is supposed to be supporting me is a nurse. A nurse has NO CLUE about physician-level decision-making and they are TOTALLY INEPT at supporting the people under their command. Pretty much all they can do is sit in their office and send out e-mail about being a "team-player."

On the wards, the O-5 nurse who disagrees with my O-3 intern about patient care usually gets her way. Do you think our "Commander," an O-6 nurse, will take our side? Not a chance. Supervisory nurses in both civilian and military hospitals think they know more than doctors--the difference in the military is that they actually can give the doctor an order. Can they directly change an order in the chart? Of course not, but a high-ranking nurse has far more clout than her civilian counterpart even dreams of.

The cadre of individuals making major decisions in the hospital that directly affect patient care includes--a couple of O-6 clipboard nurses, an O-5 MSC officer, and a couple of O-6 administrative physicians who haven't seen patients in 10 years. It results in truly *****ic decision-making because these people have no clue about patient management in the year 2004. There is no hospital on the planet where actual clinicians have so little input.
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This perfectly sums up some of my experiences in the navy. I wasn't even a physician then but I understood these facts just the same.
 
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militarymd said:
It makes no sense whatsoever, that a nurse gets better quarters and privileges than a physician.

Go to any hospital and look for "nurse's lounges" or "nurse's parking". You won't find any. However, you'll find "doctor's lounges", etc.... I object to a nurse having preferential treatment in the military.

10 years ago, I never thought about it. Now that I've invested 4 years in med school, and multiple years in post-graduate training, I can't swallow it.
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Geez, talk about a superiority complex . . . :mad:
Take your $400,000 and leave, enjoy civilian life.
 
I'll pitch one more "funny" thought here, going back to the 1990s when I was a line officer.....we couldn't believe that they would direct commission a physician as an O-4 or O-5 due to education/experience/training, as it took a naval officer on a normal career path 12 years to get to that career point. An OIS wonder, not even OCS, would get the perks of a senior officer with only a very short time in service. Keep in mind, a CO of a ship/sub/squadron is an O-5. That is 17 years of hard work to get that rank/position.

Fast forward to 2004. Do I like the perks/stature that physicians get in civilian hospitals, hell yes. Does it bother me that O-6 nurses/MSCs are in charge of a hospital. Not so much, as many civilian hospitals are run by people who may or may not be physicians. Smart leaders will defer the clinical aspects to the experts, i.e. us, and not do command policy from the hip. Naval Medical Center in SD has an "executive steering committee" that is about 10 people including nurses, doctors, msc and I think a senior enlisted.

MilMD, congrats on the new job/big salary. Your input/opinion is always appreciated as it keeps the future military physicians informed of potential problems they may face in a few years!
 
Many docs are unhappy with the fact that nurses are calling the shots. The nurse at Bethesda Naval is an O-7. This is a trend that has been increasing in recent years as most of the competent docs get out of the military to pursue more lucrative civilian careers, whereas the nurses have little/no incentive to get out since they can make $80K+ staying in as they reach higher rank.
 
Informer said:
Geez, talk about a superiority complex . . . :mad:
Take your $400,000 and leave, enjoy civilian life.
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On reflection, I guess I do have kind of a superiority complex, but I guess it's kind of hard not to have that when you deal with life and death everyday.

I spend 25% of my time as the attending in a combined MICU/SICU with patients whose chances of survival are sometimes at best 10%. I make life and death decisions for people everyday.

I (with a capital I) along with 3 or 4 other intensivists are the only people in a rather big hospital who routinely decides who lives or dies....withdrawing care, etc.

I've stopped counting the number of lives that I have saved.....not just to have them be a vegetable, but to complete recovery with meaningful return to their prior productive lives.

I've also stopped counting the number of lives that I thought were salvagable, but lost due to only god knows what reasons.

That is a responsbility that, until this last war, has not been given to a non-physician in a long time.....even with war, the line commanders don't make decisions on whether someone lives or dies...just who goes into harm's way.

So, I guess I feel entitled to certain things because they go with the responsibility.

There are no nurses or administrators around when I tell families that their loved ones are going to die. They aren't around at 2 am when **** hits the fan hard and starts slinging around the ICU bay. The nurses are not around when the lawsuits come.....guess who is ultimately responsible....ME.

Responsible, but not necessarily given all the authority and perks that go along with the responsibility.
 
Andrew_Doan said:
How many hospitals will have have an O-6 nurse in charge?
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The big hospitals will have physicians as their COs, but as mentioned already, I guess that has changed already for Bethesda.

I believe recently, the military has opened up the CO spot to other allied health types....dentists, OD's, Podiatrists, etc.....as long as they have administrative experience.

A good number of the smaller commands will have non-physicians in charge, but as an opthalmologist, I doubt you will wind up at one of those.

What would you say, hypothetically, if you wind up with an OD as your boss, and he/she wants you to instruct other ODs to do procedures you think is inappropriate? and then credential them to be independent practitioners? :eek:

That is certainly happening already in other fields....anesthesia, peds, IM, hyperbarics, etc.
 
Are there really that many situations where a doc has to answer/ be subserviant to the desires of a nurse? That doesn't make sense.
 
flighterdoc said:
Man, the navy sure has a lot of O-6's.

My active duty USAF Fighter wing (72 airplanes, about 5K people) had a total of 2 O-6's. The Wing Commander and the Base Commander.

The Senior medical officers were O-5's. Now, we only had a clinic, but at the nearest AF hospital, the seniors were all O-5's as well.

The really big USAF hospitals had O-6's (and were commanded by an O-7) but these were the really big ones. The O-6's were generally well removed from anything approaching providing care, they were usually administrators, or medical service chiefs.

I retired as an O-5 (pilot type). I really never thought about how unfair I was being treated as an O-3 or O-4 having to stay in (say) BOQ's that had all the charm of a Motel-6 room, when those non-pilots (and in the AF, it all revolves around the pilots) were getting suites and private houses, just because they out ranked me. I just appreciated having the suites or private houses all the more when I became an O-5. Or, when I was an instructor pilot / stan/eval pilot as an O-3, (both higher levels of qualification as pilots go) and had to take the regular crew bus, instead of the staff car, just because I was an O-3 and not O-5.

MilMD, how are you going to react when the hospital administrators secretary has a better parking space than you have? Or, has a bigger office? WTF, some secretary having a better work space than a physician?

How much longer before you get out? You're starting to sound pretty .... petty about the way the military works. Probably be a good thing for you to leave, soon. You're obviously unhappy in the service.
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Hey Flighterdoc, do you know who else has a bigger office then you? Kerry!
 
Masonator said:
Hey Flighterdoc, do you know who else has a bigger office then you? Kerry!
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Thats OK with me, I just wish he'd stay there and not cause trouble.
 
Active duty cannot bring suit. Dependents and retirees can definitely bring suits. Just type into google "military malpractice" and quite a number of lawyer sites pop up, advertising about how to bring suit.

The, "you can't get sued", is another recruiter ploy. You are protected financially from a suit, but you will be named into the practitioner data base just like everyone else.

Just goto Walter Reed's legal office and ask about malpractice suits. They can tell you how many active ones are on the books.

You will be surprised.
 
militarymd said:
Active duty cannot bring suit. Dependents and retirees can definitely bring suits. Just type into google "military malpractice" and quite a number of lawyer sites pop up, advertising about how to bring suit.

The, "you can't get sued", is another recruiter ploy. You are protected financially from a suit, but you will be named into the practitioner data base just like everyone else.

Just goto Walter Reed's legal office and ask about malpractice suits. They can tell you how many active ones are on the books.

You will be surprised.
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So, MilMD... Got any terminal leave programmed? Filling in your short-timer calendar yet?
 
I'm being "given" 2 weeks of separation leave. I usually lose 10 to 15 days of leave per year. On average I carry 50 to 60 days of leave on the books. I guess I'm a workaholic. I actually didn't mind losing the leave....I liked my job and the people I work with.

I had figured that I would take 60 days of separation leave to get ready for my new job......Guess what...my command decided this year that only 2 weeks are authorized because people in my specialty are leaving left and right, and they needed to keep as many around as possible for as long as possible so productivity is not diminished.

I guess I sprung my separation papers on them so late (9 months ago :rolleyes: ) that they couldn't adjust their manning appropriately.
 
Bummer with that decision higher up. Damn nurse administrators! Joking aside, that is a shame that they couldn't predict manning levels with a 9 month advanced notice.

If you sell back leave, make sure they give you the tax free rate, if you have deployed and carry that on the books. Good luck!
 
militarymd said:
I believe recently, the military has opened up the CO spot to other allied health types....dentists, OD's, Podiatrists, etc.....as long as they have administrative experience.

A good number of the smaller commands will have non-physicians in charge, but as an opthalmologist, I doubt you will wind up at one of those.

What would you say, hypothetically, if you wind up with an OD as your boss, and he/she wants you to instruct other ODs to do procedures you think is inappropriate? and then credential them to be independent practitioners? :eek:

That is certainly happening already in other fields....anesthesia, peds, IM, hyperbarics, etc.
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Response? Dr. Doan? :confused:
 
militarymd said:
What would you say, hypothetically, if you wind up with an OD as your boss, and he/she wants you to instruct other ODs to do procedures you think is inappropriate? and then credential them to be independent practitioners?
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One can have non-physicians in command positions but they also need to know what is the appropriate scope of practice. Just because an OD is my Captain, he has no right to order me to instruct other ODs surgery. This is not within their scope of practice. There are bigger fish than Captains, and I know how to go up the chain of command.

Here's a real story.

My friend was working for a hospital that appointed an OD as the Chief of Surgery. He didn't like that very much. He called his ophthalmology consultant, who then contacted the Army's Surgeon General. The OD was removed from that position immediately.

While you must follow commands from superior officers, there are reasonable commands and inappropriate ones. If someone orders me to murder someone, then do I do it? Clearly not. Likewise, if I'm ever ordered to teach an OD cataract surgery, then you can be assured that a lot more people will get involved than just my commanding officer and me.
 
MilMD,

Do you have an anecdote to share w/ us to the contrary of Dr. Doan's case?
 
Just a sensational example

A lot of things happen in slow gradual steps, so that you don't realize what happened until it is too late.....like having a nurse be your boss....like the nurse having the better accommodations that I was not happy about, that some readers think I'm being petty about.

It's a slippery slope that rank allows everyone to slide down while in the military, but like I said earlier, when the **** hits the fan with a bad patient outcome....the guy with MD/DO behind their name is always responsible, just without the authority and perks.
 
I believe, according to the article, it was the leader who decided on that course of action....the female Admiral of the hospital at the time.
 
militarymd said:
I believe, according to the article, it was the leader who decided on that course of action....the female Admiral of the hospital at the time.
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I think he's saying we need good leaders and contrasting that with what we sometimes have right now. In other words, if all the good folks jump ship, who's going to improve the problems that are causing them to jump ship? Some have gotta stay in and change the system from the inside, while some need to get out and help from the outside.

Just a militarily knowledgeable, but medically ignorant POV.
 
Hopefully, some of the good physicians stick around long enough to make policy changes from above, and not below. USUHS is supposed to be turning out the core leaders for the future of military medicine. That is why they spend more per student than using HPSP. HPSP/FAP are hired guns to fill the man power gap. This is similiar to thought for service academies in the past. When I was commissioned we were roughly 15% of the commissioned officers, but 40+% of the flag officers. Why? We were more career oriented, rather than using the military as a way to pay for school.

Are they sticking around in large numbers? I don't know, but I have met several O-6s that are competent clinicians and great leaders that were USUHS.

If all good military docs get out as O-4s/O-5s, we will leave the leadership positions to NC/MSC/DC to fill the gap. It will be our fault as much as senior leadership.
 
MoosePilot said:
I think he's saying we need good leaders and contrasting that with what we sometimes have right now. In other words, if all the good folks jump ship, who's going to improve the problems that are causing them to jump ship? Some have gotta stay in and change the system from the inside, while some need to get out and help from the outside.
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Exactly what I am saying.
 
All right then....for those of you who are going to stick it out....demand that all physicians (regardless of rank) be treated like I think we need to be treated.

Don't slide down that slippery slope that happens because of "rank".

Don't let the nurses (and other allied health types) have the perks (and responsibility)....demand the things that I felt I should have received but did not.

It starts with the little things. I feel that what happened to Dr. Manalaysay is a BIG DEAL.... it is something that erodes the profession of being a physician.

BIG DEAL things like that don't just happen out of the blue. It starts with small steps at eroding our profession....smaller office, lack of physicians' parking, lack of physicians' dining area, smaller accommodations, etc.

All this happens because of "rank"....for you career guys....FIX IT for all other future military physicians.

I'm a little ashamed to say I can't bear it anymore at this time of need and have punched out.
 
MilMD, better to change and be happy, than to brood in your misery for Uncle Sam. I applaud your decision to change the course of your career so it betters your lifestyle and happiness! You can only get kicked so many times before it gets to be no fun.

One of the reasons why I like operational medicine at my command is that they treat you like a physician, bend over backwards for you and they support any decision that you make. They picked up the tab for my last conference, flew me all over the country for residency interviews and gave me a couple of other TADs in my interest. Not all commands will do that. Too bad the senior medical admin guys can't learn from the warfighters on how to treat a doc.
 
I think that a great fix (that will NEVER be implemented) would be to make the nurses Warrant Officers. This would realign the ranking to the way it is in the civilian world and eleviate the senior officer problems. This would alos be cost effective by lowering the pay per nurse ratio. Of course this would be fought tooth and nail by those nurses/msc in the higher ranks.
 
Funny you mention that. USN did have nurse CWOs and slowly phased them out. The last one that I saw walking around was in the mid-90s. There may still be some out there, however, usually are now commissioned ensigns.
 
militarymd said:
All right then....for those of you who are going to stick it out....demand that all physicians (regardless of rank) be treated like I think we need to be treated.

Don't slide down that slippery slope that happens because of "rank".

Don't let the nurses (and other allied health types) have the perks (and responsibility)....demand the things that I felt I should have received but did not.

It starts with the little things. I feel that what happened to Dr. Manalaysay is a BIG DEAL.... it is something that erodes the profession of being a physician.

BIG DEAL things like that don't just happen out of the blue. It starts with small steps at eroding our profession....smaller office, lack of physicians' parking, lack of physicians' dining area, smaller accommodations, etc.

All this happens because of "rank"....for you career guys....FIX IT for all other future military physicians.

I'm a little ashamed to say I can't bear it anymore at this time of need and have punched out.
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I'm someone that's going to be around for at least 20 years and I think there should be a rank structure. Rank is a necessary part of the military. Of course, there are always things that could be improved upon but rank will always have its privileges. You talk about treating physicians how we should be treated. I think we should be treated as support officers to doing what the military does: fight. You are part of the MILITARY. You are not a CIVILIAN (yet). Physician parking, physician dining, smaller offices????? Give me a break! I understand my role in the AF machinery and am glad to fill it.
 
Did you read the rest of the posts? Do you understand the issues? Did you read the link about what happened to Captain Manalaysay (O-6) Double board certified (anesthesia and IM)?

If these are issues that you are not worried about, and you don't mind being a nurse's butt-boy, then I'm truly worried about what's going to happen to military medicine.

In order for the medical community to truly and fully support the military machine, the medical community needs to provide good care and give the troops' confidence in the care that they and their dependents are getting.

If the troops know that physicians aren't in charge of their care, but nurses, what do you think it is going to do for the morale of the troops....how is the mission going to get accomplished when the grunt in the field is wondering if he is going to get good care when he gets a piece of shrapnel in his eye.

My examples (doctors' parking, lounge, etc..) represent the slippery slope that the military allows the hierarchy of medical care to slide down because of rank.

You sound like a good officer, but are you even a physician? Do you know what it means to be a physician?

Why the judgemental tone? Where is the intelligent discussion I've come to expect from fellow physicians and medical students?
 
Rank causes problems too just amongst physicians. You have no idea how many times I have had to deal with physicians who confuse rank with experience and clinical skill.

There are a lot of former line officers who achieve higher rank because of prior service or from prolonged GMO tours (read couldn't get into residency) who allow their rank to inflate their egos to the point where it's the ego and not medical training that is making the decisions about patient's lives.....

It happens, and the rank structure fosters this.

I'm always suspicious of physicians who refer to themselves as Colonel So-and-so, and not Dr. So-and-so.
 
militarymd said:
In order for the medical community to truly and fully support the military machine, the medical community needs to provide good care and give the troops' confidence in the care that they and their dependents are getting.

If the troops know that physicians aren't in charge of their care, but nurses, what do you think it is going to do for the morale of the troops....how is the mission going to get accomplished when the grunt in the field is wondering if he is going to get good care when he gets a piece of shrapnel in his eye.

My examples (doctors' parking, lounge, etc..) represent the slippery slope that the military allows the hierarchy of medical care to slide down because of rank.
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I was not trying to be judgmental. Since I'm not yet a physician, I can't speak to some of the issues you raise. However, I can speak to the operational side of the military...the side that doctors are supporting. One thing that annoyed me was working 2x as many hours in a week as anyone in the finance office and having the only time I could get over there was Friday during lunch, only to find the shop closed for a barbeque, or training, or whatever. This has happened in the hospital, too. I guess it was just a little annoying to be on the tip of the spear, the one with their life in harm's way, and have to revolve my life around when finance would "accept" my travel voucher or a f/u appointment or referral to a specialist with an appointment in 1+ months. I guess when I read your slippery slope of parking spaces and dining facilities I found it odd that physicians in the military would even consider worrying about such things. And that's the misnomer: physicians in the military should read military physicians. When I was trying to get into med school, I shadowed some surgeons. One of them had put in his papers to separate and in return, earned himself a 3 month tour to Turkey. It wasn't punitive but he had never been deployed 1 time...ever. (And I want to apologize to Dr. Rosenrosen, if he's reading this.) He tried every available means to get out of going. I just wanted to tell him to suck it up. He was supposed to be supporting me as an aviator and if I'm over there and need his help, he better be over there! I think the attitude was, "I'm a doctor." As if that should exempt him from deploying. How is the grunt with shrapnel in his eye going to feel if nobody in the medical community has to deploy with him to support him? I think a grunt's biggest concern when he gets shrapnel in his eye is, "Get it out and save my eyesight." He wants whoever is qualified to do the procedure. If it's a nurse, fine. Just get the job done. There's a bigger picture that needs to be recognized and those coming into the service need to know it up front.

That's why I think you serve a valuable purpose in these threads. I think you should continue to point out every little thing you can that is wrong with the military medicine. People need to know what they're getting into BEFORE they accept the scholarship. But as you pointed out earlier in this thread, those of us with prior service understand the rank structure and know it's part of military life. There is much about the military that could stand to be changed. But incoming physicians need to come to terms with inherent aspects of military life, like deployments. And if we start worrying about parking spaces and private dining facilities (I'm being a little facetious), we're missing the big picture.
 
militarymd said:
Rank causes problems too just amongst physicians. You have no idea how many times I have had to deal with physicians who confuse rank with experience and clinical skill.

There are a lot of former line officers who achieve higher rank because of prior service or from prolonged GMO tours (read couldn't get into residency) who allow their rank to inflate their egos to the point where it's the ego and not medical training that is making the decisions about patient's lives.....

It happens, and the rank structure fosters this.

I'm always suspicious of physicians who refer to themselves as Colonel So-and-so, and not Dr. So-and-so.
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I don't think you'd get much argument from anyone that rank should take a back seat to experience regarding patient care. But at the end of the day, there should be a balance between the rank and experience. Obviously, a slug with a bird on his shoulders is just that: a slug w/ a bird on his shoulders. I think you're "kicking against the pricks," though, if you think eliminating the rank structure from the hospital is a reality. You can't have the military w/o a rank structure. And that holds true in a military medical facility.
 
So, I guess we concur on all the issues, except that we were talking about some different things.

I was talking about rank among the support corps (docs, nurses, admin, etc...) , while you were talking about the relationship between line corps and support corps.

I agree wholeheartedly about deployments, etc....I've taken more than my share because of whiners who "have family issues"..."just happened to get pregnant"... etc.

What I'm talking about is how the rank structure interferes with how the medical community interacts amongst itself, and how the line recognize the medical hierarchy. The relationship between physicians and everybody else who works in the a hospital (nurse, resp tech, admin, lab officer, etc.) is extremely bizzare because of nurses, etc. who outrank physicians. I have met more than my share of warriors who get confused by the rank issue in the support corps.

The perks I'm referring to is an example of how rank (amongst the support corps) has interfered with the normal hiearchy that exists in a medical facility. There are no warriors stationed where I work everyday. If they were, I would let them have my imaginary "doctors' parking spot" & "dining area". However, the fact that nurses have "my spots" is just that slippery slope I've been talking about.
 
And let my tell you, I love it when the likes of Dr. Rosenrosen get sent to far away places. Everybody needs to do their share.
 
Heeed! said:
I think a grunt's biggest concern when he gets shrapnel in his eye is, "Get it out and save my eyesight." He wants whoever is qualified to do the procedure. If it's a nurse, fine. Just get the job done.
Click to expand...

Nurses are not qualified or trained to practice medicine. Only physicians practice medicine.

That grunt needs the likes of Dr. Doan (after he finishes training) to take care of him, or if Dr. Doan is not in the field, then someone like Dr. Doan would make the decision on who takes care of him.

Rank (in the support corps) has eroded that decision making hierarchy to the point where nurses think they can do this.....they are clearly not supposed to do this (doesn't happen in the civilian world)....but look what happened under Dr. Manalaysay's watch.....his authority was eroded...so that care at the President's hospital is below that of area hospitals....oh...unless of course you are a flag officer or other VIP.
 
Nurses have a lot of power in the private sector as well as pharmacists. As a pharmacist, we wrote protocols for drug therapies and made formulary decisions that physicians had zero control over or power over because they were all evidence based and finincially supported(insurance companies dictate what a patient can or cannot receive including surgery). As far as nurses making recommendations, it would be stupid for them to give an order that had no basis or was outside their expertise, yet one would have to take into consideration any recommendation that has the ability to improve patient care. I don't think military medicine is as far off from civilian medicine as one might think, especially with managed care.
 
chillin said:
Nurses have a lot of power in the private sector as well as pharmacists. As a pharmacist, we wrote protocols for drug therapies and made formulary decisions that physicians had zero control over or power over because they were all evidence based and finincially supported(insurance companies dictate what a patient can or cannot receive including surgery). As far as nurses making recommendations, it would be stupid for them to give an order that had no basis or was outside their expertise, yet one would have to take into consideration any recommendation that has the ability to improve patient care. I don't think military medicine is as far off from civilian medicine as one might think, especially with managed care.
Click to expand...

Once again, I must pose the same questions. Are you even a physician (finished med school and residency and fellowship)? Have you ever been a physician? Have you been in the military? and then see what it is like outside the military?

Do you have a clue about the relationship between a fully trained physician and the rest of the medical support infrastructure?

It is one thing to observe the relationships as a supporting allied health professional. It is another to finish your training and become the leader of that team.

I'm simply pointing out one of the reasons why military medicine is experiencing its mass exodus of physicians right now, and why they "can't give away the HPSP scholarships" as stated by a program director I know in DC.

I'm asking those who are going to stick it out to change from within (if they can)...otherwise, all you military docs will experience what Dr. Manalaysay experienced.

I don't mean to belittle your background as a pharmacist, but I know what it takes to train as a pharmacist......completing one's training as a physician is a much more intense and grueling process which it should be, because physicians have the authority and responsibility to lead and direct the healthcare team.....well at least it was when I did my training.
 
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