Reasons Not To Join or Stay in the USAF Medical Corpse
by an ex-LtCol Board-Certified Anesthesiologist, ROTC and USU Grad
Last updated 5 Dec 2020
by an ex-LtCol Board-Certified Anesthesiologist, ROTC and USU Grad
Last updated 5 Dec 2020
"There sighs, lamentations and loud wailings resounded through the starless air, so that at first it made me weep; strange tongues, horrible language, words of pain, tones of anger, voices loud and hoarse, and with these the sound of hands, made a tumult which is whirling through the air forever dark, as sand eddies in a whirlwind."
--Dante Alighieri, Inferno, Canto III, line 22
0) Tyrannical, Pointy-Haired Boss (PHB) commanders: Idiots in charge have lost all touch with clinical medicine, yet feel free to micromanage/punish those with more knowledge/training/skill than themselves. Note: many of these commanders will be nurses, PAs, or MSC officers with zero hours of medical school.
1) Unending deployments to remote locations: At remote, IED-filled sand traps, surgeons will be ordered to see sick call (runny noses, jock itch), while primary care docs will act as glorified techs under the watchful eye of R.N. commanders. Clinical skills of highly trained physicians will atrophy in smelly tents, a tedium uninterrupted except for rare moments of sheer terror.
2) AEF (Aerospace Expeditionary Force) is a broken promise: Abysmal management of deployments and AEF system-- 3 month AEF "buckets" increased to 4-8 month window with transitional Blue/Silver AEF groups (due to sheer poor personnel planning on USAF's part). [Update to Legacy Reason: Before 9/11, the Air Force was promising 90 day deployments to improve morale/retention. Then, when the balloon went up with the Iraq war, it was all "Oops! Due to Sheer Poor Planning, we don't have enough bodies to fulfill that promise we made to our service members, so we will just take it back." Accordingly, highly trained ophthalmology technicians were deployed to the sand as part of Army units to serve as machine gunners in the back of trucks (true story) for a year or more: "Um, you will be deployed as long as the rest of the members of your Army unit, because the Air Force generals at the Pentagon don't want to have their manhoods compared to the Army generals during rounds of golf."] Basically, in 2020, you'll be deployed for some vague time, and then they'll extend it, and then extend it again, until the day you have your bags packed to go to the airport, then they will extend it again. Lack of predictability leads to family strife, loss of morale, and minimization of retention post-deployment.
3) The Objectionable Medical Group: All animals are equal, but some are more equal than others. Starting in 1993, the "Objective" Medical group made physicians = nurses = pharmacists = housekeepers in terms of rank and command potential on the org chart. Thus, the Commanding General of Andrews AFB hospital from 2000-2003 was a nurse, who had life-or-death UCMJ authority over the physicians beneath her. Gulp. Better not annoy *any* nurse in the hospital, or you'd better pack your bags for Greenland...
4) Inappropriate subordination of anesthesiologists to surgeons: In the civilian world, anesthesiology is its own department. In the military, anesthesiologists are lumped in with all the surgeons, including surgical subspecialists. When a surgeon is the person who writes your OPR (Officer Performance Report, which determines promotion and assignments, among other things), are you going to cancel a sexy yet high-risk case and ruin your career, or are you going to endanger the patient's life, in violation of medical standards of care? Do you want to hang or get shot?
5) Inappropriate subordination of physicians to nurses, pharmacists, and other non-MC officers who are able to attain rank/position due to OMG: Corollary of 4, but worth repeating. The first time a nurse overrules your doctor's order because of the rank she wears on her shoulders, you will not a happy camper be.
6) Extremely poor long-term planning by everyone above O-5: Multiple AF Surgeons General and the Air Staff woefully miscalculated regarding needed end-strength in both medical corps and line. Entire year groups of physicians who wanted to become anesthesiologists were alienated between 1997-2001 due to perceived lack of flight surgeons/GMOs-- they were prevented from going to residency and forced into GMO/flight surgeon billets (Roadman). This dried up the pipeline of fresh, new anesthesiologists entering the Air Force. Remaining stale schmucks like myself were forced to pull every-other-night call for THREE MONTHS after 9/11 just to keep up the Ops Tempo of the Operating Rooms (surgeons might have one O.R. day per week, if they're lucky; anesthesiologists have 5-7 O.R. days/week). No one cared about the after-effects of burnout and demoralization this caused (which contributed in no small part to the disastrous career-ending reprisals against me when I spoke out as a patient safety advocate when we were forced to both perform our own stat C-section anesthetics while "covering" four CRNAs on the other side of the hospital against all anesthesia ethical standards of care because "we're short-staffed and this is the only way to keep up our ops tempo so shut up").
7) Zero emphasis on retention: Nothing is done to make life as a physician in the military easier. You get no respect, little pay, long hours, and minimal opportunity for leadership. Embittered and demoralized staff docs leave after 4 years post-residency, just when they are hitting the prime of their skills, leaving behind the largest two cohorts of M.D.s: intelligent but inexperienced folks right out of residency, and pencil-pushing dinosaurs who haven't touched a patient (appropriately, at least) in years. This reminds me of the hospital Vice Commander surgeon who would only come to the O.R. to scrub in on breast reductions, so he could spend 5 minutes massaging the patient's mammaries while she was under general anesthesia, before the real plastic surgeon did the case in a professional manner...
8) Stop-Loss and IRR Call-ups: The inevitable result of the Sheer Poor Planning and Lack of Retention documented above.
9) AF emphasis on non-physician medical care (PAs, NPs, Nurse Midwives, etc.). This is subtly different from the OMG issue. You, your family, and your patients are more likely to see non-physicians operating with inadequate physician supervision when they present for care at MTFs. The resulting malpractice will injure and demoralize you, your family, and your poor patients.
10) Lack of appropriate chain of command designation in absence of Flight Commander creates authority vacuum: There are three kinds of bosses in the military a) Absentee Landlords/Landladies, who never show up for work, but spend all of their time on fictitious "TDYs" while watching TV at home with their twins or building their McMansions; b) Tyrant PHBs, who micromanage more competent subordinates with utter brutality, and c) Clueless GOBs (Good Old' Boys) who made rank because of their Air Force Academy and/or Aggie Flight Surgeon street cred. When your boss is an Absentee Landlady, the Tyrant above her will continually scream for immediate action on worthless paperwork that only she can sign. If she passively refused to set up a hierarchy in her absence, it will lead to confusion and stress: Should the LtCol Nurse sign the doctor's OPR, or should the next senior Doc, or what about Mr. Rob, the housekeeper...
11) Misusing anesthesiologists as IV start service: nursing staff, techs, ward clerks feel "empowered" to consult anesthesia service to start IVs, because they are completely incompetent to do anything except chart vital signs on the computer and update their social media statuses on their phones. Interns and residents become completely incapable of starting IVs (a critical ACLS skill) due to their addiction to anesthesia doing their jobs for them at 0300. In the outside world for 15 years, I was never (not once) called to the ward to start an IV, because they knew I would CHARGE MONEY for the CONSULT, and nobody wanted to pay that. The solution is to have the military train a cohort of "rapid response" nurses/techs to respond to things like patient decompensation on the ward or lack of IV access. That, of course, would require money and planning, which is harder for the system than abusing board-certified physicians in the middle of their call night.
12) No (Competent) Pediatric Care: Andrews AFB Adult Ward was magically designated pediatric ward after I complained that kids were being recovered on an adult ward sans peds nursing, peds equipment, or inpatient pediatricians. This is a result of both downsizing (closing pediatric ward and sending pediatricians to staff only outpatient clinic) and inadequate training of staff. Every SINGLE peds patient requires anesthesia to start/restart IV. An active duty CRNAs son got sick; his wife (medical tech) had to stay with kid 24/7 because ward nurses were "uncomfortable" caring for kids and didn't even know how to take kids' temperatures, let alone draw blood. All the nurses have to say is that they are "uncomfortable" in order to draft specialist physicians to do their jobs. Of course, the nursing chain of command will support them 100% in the "interest of patient care" vs. getting butter bar nurses adequate training to do their jobs competently.
13) Polyester uniform pants: Being told not to wear BDUs in time of war due to arbitrary decision of people at HQ AMC for propaganda purposes ("The War Is Over, See, We're In Blues Now") is uncomfortable and demoralizing. This is just one of many examples of seemingly-minor "crazy makers" that drive physicians out of the military. BDUs are 1,000x more comfortable to wear all day than polyester, but some General at the Pentagon wasn't saluted from 30 feet away because the rank was subdued rather than shiny, so the rest of the Air Force has to suffer so he can avoid using his ED meds by getting dopamine hits from groveling underlings.
14) Keeping up with the Army Syndrome: 1.5 Mile run --> psycho ergometry --> 1.5 mile run + pushups + sit-ups. Too many overweight NCOs and Senior Officers were keeling over dead on the tracks during annual 1.5 mile runs. Thus, in the 1990s, the AF spent literally millions of dollars implementing "psycho ergometry": stationary bike testing, which measures your ability to relax rather than cardiac conditioning (I passed every time by hypnotizing myself into a relaxed state, thus preventing excessive tachycardia). When our Army colleagues started making jokes about the "Chair Force", the Chief of Staff unilaterally implemented increased PT requirements in order to make him look more manly in the Pentagon bathroom. Line officers and enlisted folks shut down their offices to train during duty hours. You will notice this fact when you try to go to finance or MPF on your limited time off duty before they close at 1500, only to find their offices closed for "Unit PT". Guess when you, as a doc, will have to do your PT training: on your own time, or after hours (see #18 below).
15) New bright Blue BDUs after I have spent hundreds of $$ getting green ones: [Legacy Complaint, but uniforms change way too often to justify the jobs of the dweebs in the DAUCFNGR [Department of Arbitrary Uniform Changes For No Good Reason]). As officers, you have to buy your own uniforms rather than have them issued to you (for the most part). Just when you get your uniforms broken in, lusers whose only job is to change uniforms constantly will change them (example: cheap plastic name tags on Service Dress Uniform --> No name tags for a few years--> Mandatory $15.00 polished metal name tags--> ? tomorrow).
16) Woeful lack of experience on wards: constant shuffling of officers and NCOs as soon as they get good at one job due to antiquated assignment system prevents maintenance of "cadre" of seasoned nurses and techs. Nurses FOB (Fresh off the Boat) expected to recover patients after thoracic surgery. One 2Lt looked at the sternal dressing after CME and asked me if that's where the a-line had been placed. "Ya, right into the aorta...we get very accurate readings that way," I replied.
17) No meetings during patient care hours: Part of what I call the SARS: Stupid @ssed Rules Syndrome. Other SARS include non-use of military telephones to call home to tell your family you will be two hours late because the charting computer crashed AND you can't use your cell phone in the hospital (Catch 22.5); restriction of Occupational Badges to keep nurses happy (i.e., senior and chief physician badges used to be based on residency training; now based on longevity alone); and requirement to wear your uniform to work on weekends/holidays UNLESS you are a surgeon or internist, because they just ignore the SARS anyway with impunity.
18) Mandatory "Fun Runs" with squadron commander after hours or on training days instead of getting home an hour or two early to see one's family
(to be continued...hit character limit...too much character gets you in trouble in the military...)
Lasciate ogni speranza, voi ch'entrate.
Translation: Abandon all hope, you who enter here (speaking of USAFMC).
--Dante Alighieri, Inferno, Canto III, line 9
Rob Jones, M.D.
Ex-LtCol, USAF, MC
Ex-Medical Director of Anesthesia, Travis AFB, CA
Ex-Assistant Chief Anesthesiologist, Andrews AFB, CA
OEF Anesthesiologist, 39th EMEDS, Incirlik AB, Turkey (2002)
Harvard '85 (ROTC Det. 365); USUHS '90; WHMC Anesthesiology '94
Nemo Me Impune Lacessit