I feel that this is a skewed statement, if not also possibly pompous and closed minded.
Skewed, pompous, and closed minded?
Do you know what you're talking about? I do.
I'm an Anesthesiologist. The more challenging the cases are that you get routinely during training, the better training you have. It's pretty much just that simple. In the OR, the better training that you have, the easier it is to recognize and handle emergent things as they happen, where the margin for error is slim and the risks are high. I've had the opportunity to train and work at a couple of the top ranked hospitals in the country, world class referral centers, as well as the Naval Medical Center San Diego.
Here's a little reality check about Navy Anesthesia/Surgery at NMCSD. The "Starship of Navy Medicine." THE Navy referral center for the pacific rim. How much trauma does NMCSD get? None. They farm the residents out to UCSD, which doesn't even get a lot of trauma. How much complex Peds does NMCSD get? None. They farm the residents out to Rady Children's Hospital for experience with complex peds cases. When I was there the number of Cardiac surgeons went from 3 to 1. Not good for training, they had to send the residents out somewhere else for more cardiac experience, somewhere with PP anesthesiologists that did not know or trust them. Sounds like great training. How many vascular surgeons were there you ask? One, think he was operating every day? How many anesthesiologists were staff in the ICU? None, they had to send the residents to Texas, Texas!, for their ICU time. How much transplant experience do the residents get? None. How many anesthesiologists, or surgeons, had ongoing clinical trials? None in the 3 years that I was there, that I was aware of. I know about trials that the surgeons are doing at my current hospital, even if we (anesthesiologists) are not directly involved with drugs, etc. How many talked a big game about research that they did during their civilian training that they wanted to take up again after they got out, and got back into academics? Many. How many anesthesiologists were actively engaged in research? 2, sort of. Was any of that research funded by the NIH, etc? No. How many publications came out of the department in the 3 years that I was there? None in any remotely major journal, though there were a couple of case reports and some abstracts. How many anesthesiologists were involved with the anesthesia boards (question writers for the written exam or oral examiners)? None, though there were some former staff and residents involved. Did any of the anesthesiologists have any significant role, other than membership, in one of the Anesthesia societies? No, none. How many chapters for major textbooks were written or co written by the staff? None. What was the ratio of junior staff (<8 yrs) to senior, experienced, staff? I think that you know the answer. How many of the senior staff were burned out and forced, by rank and seniority, into BS, non clinical, command functions? Most. One of the most senior and talented anesthesiologists there got pulled out into a "leadership" position that cut his clinical time by 50%. That alone hurt anesthesia training. The one thing that the hospital did have was all the toys. If you needed some new system or gadget, you could probably get it.
You know what happened when a really, really complex case came in to be evaluated, something that required an expert team with substantial experience in these super complex procedures? They sent them out to the major university referral centers for treatment. And it was the right thing to do, but not good for the residents.
Now ask these same questions about an academic referral center affiliated with a major university. I think just about every answer is the opposite.
After I left, it actually got worse. Tricare, or whatever it is called now, was farming the older and sicker patients out to the community hospitals. One of my old colleagues referred to it as "the largest ambulatory surgical center in the world" and another joked that it was "the starship of outpatient surgery". Do you really think that the training at this place compares to that at a major referral center? Do you really think that the military system will give anyone better than average training?
How many of these anesthesiologists and surgeons were nice, smart and competent, working WELL below their potential? Almost All! How many were great teachers that really cared about mentoring and maximizing the potential of the residents? Almost all.
The problem is simple. It is that the complex caseload was just not there. Regular complex caseload is what separates adequate training from great training. Why would anyone want to simply get adequate training?
I don't think that NMCSD, THE Navy hospital on the West coast, is some random outlier.
I'm not pompous, I'm a realist, and you don't know what you are talking about. Some of these things may have changed a bit, like the number of surgeons in a particular field at any given time, or maybe someone in the department is serious about research now (until he is transferred to Guam for 3 years) However, the general themes remain the same. Those are the facts, no exaggeration, no BS. I was there. I have seen both sides of the coin. A reasonably challenging day for one of my residents and/or fellows now is 3 times harder than any day that I had at NMCSD. Decide for yourself. After all, I'm sure that the other military hospitals are much better...
P.S. I can't comment on anything other than my anesthesia experience, I have no idea how the surgical training is or how it compares to a major referral center, but I hope that they had a lot of time at other facilities to get regular exposure to very complex cases.
P.P.S. I didn't join for the $$, and I'm not bitter at all about the time that I served, so don't go there my young friend. The military has a lot of problems, but I'm proud to have served, and hope that other talented physicians join the military and provide exemplary care to our soldiers and veterans. However, I don't recommend training in the military, that's all. If you're an above average student, or even an average one at a top 20 medical school, you're doing yourself a disservice to train at one of these pseudo-academic pseudo-referral centers. Go train elsewhere and come back in and bring your talents with you, and than get out.
P.P.P.S. I think that the time when the military was the leader in cutting edge plastics, trauma, burns, etc. was during Vietnam, sorry. Though, I would bet that there might be some new trauma and ortho stuff related to Iraq/Afghanistan coming out from military physicians now, if they use their own personal time to write it up for publication. But, having said that, I'd still rather have the Trauma surgeon that trained at USC or Baltimore Shock Trauma taking care of me when I get in a serious MVA. There also may be some programs at some centers much more involved in research, etc. But they still don't hold a candle to what is going on at any of the major referral centers all around the country.