grotto

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The biggest folly I see on these boards is pre-meds that want to do HPSP soley for finacial reasons. However, a close second would have to be the line officers that think they have a good idea about what military medicine is like based on their prior service. Sorry, but doctors aren't just all complaining b/c they're pampered whiners who got a bad assignment.

Agreed. I'm not the type to ever rub another man's rhubarb (to quote Jack Nicholson) - that is why I was asking the questions, and I am not here to lambast anyone on their personal decisions and opinions. From milmed folks posting on the board, it seems that MSC and Nurse corps leadership (or lack thereof) is a major point of contention, but then I hear that the "good" physicians aren't taking leadership roles because they can't treat patients. You can't have it both ways.

So what is the real deal? I'm sorry, but when I hear that the number one reason not to be a military doctor is because there is no where to masturbate, I have to question things a bit. I of course respect the experience and expertise of everyone who has navigated the road to becoming a doctor, but as someone trying to make a decision to whether I should continue to serve as a physician in the military or I should take my business elsewhere because milmed is not worth the time... I need a bit more. I am absolutely determined to be a doctor either way, but the important question is if I will be in uniform or not.

I think there is an issue with being a specialist in an organization that is heavily bureaucratic and prizes, for the most part, those with broad skills. On the line, our specialists are LDO's - limited duty officers. They are experts in their fields, prior enlisted, without the opportunity to ever command - and most of them never make any rank past O-4, and only make that rank if they are lucky. These officers are highly prized and respected, but there is only so far they can go... some might say there is only so far they want to go.

It seems there is angst at the choice that needs to be made - be the best possible physician, or be a high ranking officer. And it seems that those who make the latter choice in milmed are usually not looked upon well. Who is better to make the decisions required in military medicine than a fully qualified physician? But if none of the best want to take on that responsibility, the bureaucracy has to turn to other means to fill spots. What is the solution? Maybe this is the rotten core of the problems that milmed faces? I don't know, because I don't know enough about the environment yet... just looking for some discussion from those who do know.
 
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[Bolds mine]



There is a tremendous mismatch between responsibilities and training to meet those responsibilities. Most GMOs start work as doctors with a single year of hospital-based training. In the real world--outside that world created by the military services and their fantasies of bygone days--that training makes you qualified for your next year of supervised training, and nothing else. Civilian hospitals would not allow you to practice independently with so little training, they have gone well beyond the 1930s model the services so irrationally refuse to give up.

What the military needs is to keep a tighter leash on your responsibilities, one that keeps you in a setting where senior residents and attending faculty are watching what you are doing.



Yes. My department in squadron. I was a department head.



I had as much training as the doctor I replaced and the one who replaced me. Which is to say, not enough.



I deployed immediately on reporting. Fast. Steep.



Difficult question to answer. Probably yes, but not by the usual standards of the medical profession. In medicine, leadership presupposes a developed knowledge base, completed training and the ability to demonstrate and convey that knowledge to your colleagues and juniors. The military does not really give you the opportunity for that when it cuts you out of the training pipeline.

I don't recommend this as a good way to prepare medical leaders; the GMO concept is really very outdated and inappropriate for modern medical practice in or out of the military. It is morally and professionally bad for the doctors and it does no good for patients either. The fact that it exists at all is indefensible. Arguments about preserving it as a "peculiar" need of the military only begs comparison to other odious and "peculiar" practices thankfully long gone from our nation.

Well balanced. Thank you for the response. :)
 

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Just fyi - my list of reasons is meant to be informative as well as having a sprinkle of dark humor. Hopefully the humor doesn't detract from the main thesis which is simply that anyone considering an HPSP scholarship should think long and hard about accepting one.
 

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I think there is an issue with being a specialist in an organization that is heavily bureaucratic and prizes, for the most part, those with broad skills. On the line, our specialists are LDO's - limited duty officers. They are experts in their fields, prior enlisted, without the opportunity to ever command - and most of them never make any rank past O-4, and only make that rank if they are lucky. These officers are highly prized and respected, but there is only so far they can go... some might say there is only so far they want to go.

It seems there is angst at the choice that needs to be made - be the best possible physician, or be a high ranking officer. And it seems that those who make the latter choice in milmed are usually not looked upon well. Who is better to make the decisions required in military medicine than a fully qualified physician? But if none of the best want to take on that responsibility, the bureaucracy has to turn to other means to fill spots. What is the solution? Maybe this is the rotten core of the problems that milmed faces? I don't know, because I don't know enough about the environment yet... just looking for some discussion from those who do know.

Rhubarb rubbing aside, you raise a few good points/questions. Our organization (milmed) is indeed heavily bureaucratic. I can honestly count the docs and midlevels who actually see patients and there is at least a 1-to-1 ratio of managers and bureaucrats who aren't involved in patient care. The system is horribly horribly inefficient. There are higher ranking docs, NPs, PAs, etc who haven't seen or touched a patient in 10 years. They occupy a billet but do not share any of the patient load. Effectively, they double the workload for those of us who do see patients.

I have had a patient's wife tell me that they will only see O-3 and O-4 docs because the higher ranking ones aren't confident or competent. I absolutely agree. Once you make O-5 (maybe even senior O-4), you become stuck in the management quagmire and your skills erode precipitously. Some of the best docs I've had the pleasure to work with actively sought to not get promoted so they wouldn't have to give up patient care. Unfortunately these are few and far between. Of course this leads to the problem that you state above: "if none of the best want to take on that responsibility, the bureaucracy has to turn to other means to fill spots." And it does. It turns to nurses. In droves. And they love it. And they are awful at it. And we suffer. For nurses, command is the chance to never wipe another a$$ again. For a dedicated physician, command is the loss of patient care that they worked so hard for so many years to achieve.

I'm not a line guy and I don't claim to be. I have, however, worked directly for the line (and reported directly to the flying SQ/CC) for 3.5 of my 4 years, so I see how they work. First of all, the line is not top heavy. You have a clearly defined structure that looks like a pyramid. People get promoted (for the most part) based on merit and not for just sticking around. There are 45 year old Majors and 40 year old Colonels. This is efficient. Also, in a flying squadron, everyone flies. The commander has to maintain currency for flight events just like the newest crewdog does. The CC gets a checkride once in a while just like everyone else does. He might not fly several lines per week, but he flies, deploys, and is involved in the mission.
Milmed looks like an hourglass: lots of junior officers and lots of Colonels. Not much in between. Med weenies get automatically promoted just for sticking around. In my opinion, those who stick around generally couldn't make it on the outside. Therefore, the O-5 and O-6 docs are the weakest of the herd. These folks sit up in their offices hidden from view. Sure, they do administrivia, go to meetings, etc... but does this really add much value. I've been to some of these meetings and it seems that management holds a lot of meetings just to justify their existence. The milmed management is not involved in the mission. They don't take care of patients and probably don't want to.

What is the solution? That is an extraordinarily difficult question to answer. It is different for each individual. I don't believe that an entire generation of physicians would be willing to sacrifice 20 years in order to make it to command in order to force change. 90+% of us walk after our time is up and move on to greener pastures. That is pretty overwhelming evidence.
 

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1) ..and no, there are no special rooms in Camp Victory for you to masturbate - you'll have to find your own privacy)

Out of all the reasons you listed, this one is what bothers me the most.:scared:

...but then I hope my love of the red, white, and blue will fuel my patience.

I am a new US citizen (who came here as a refugee), and I LOVE this country! Now, MY country. I am planning to join the AF because I want to, regardless of the disadvantages. I want to give back to the USA. The only country that took me in and helped me. I will defend it until the day I die, and will fight against my own people if I had to.
 

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you should change the title of this thread to "40 Reasons not to join the Navy Medicine" a good number of reasons are specific to the Navy..


Just my .02
 

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I agree that the GMO tour is a load of crap. However, your remarks concerning your deployment truly bring out your true character. You don't even know how good you had it on your deployment. At least you had a tent to sleep in, and cards to play with. Try wearing 28 pounds of kevlar/LBV in 140 plus heat; carrying a 240B or SAW for 18 months (with a full combat load of ammo). Try attending funerals for the men you lost in front of your own eyes, whose lives were your responsibility. Try writing letters home to the families of those men. Try taking the life of another human when you have been taught your whole life that killing is wrong (although against my beliefs, I'll kill more terrorist again if I have to). Try scaring your wife and kids night after night when you wake up in a screaming/shaking rage after a nightmare. While you were forced to sleep in conditions as lowly as a tent, my men and I slept in vehicles, or not at all! While you were force to play cards during your downtime, we cleaned our weapons and rehearsed for our next mission….And we had it good compared to our grandfathers in WWII!

I agree that the system is not perfect, and certainly doesn't seem fair. Nobody wants to owe more than they should. However, if you did not understand the conditions of your obligation before you signed the dotted line, it's your own damn fault. There is certainly a sacrifice to serving in the military. Real soldiers know that, and respect that fact. We don't complain about it. Everyone knows that military docs make less money. If you didn't do the math before hand, whose fault is that? Honestly, did you even read the regulations before you signed your contract?

For anyone considering the HPSP, consider this. This is not your ideal private practice or cushiony salary job. If your true passion for being in medicine is money, then the military is probably not the best place for you. There are going to be plenty of tough times, however, I can tell you there are more good times than bad. You and your family will make sacrifices. In my 13 years of service, the branch managers have done their best to accommodate my wants; however, their main job is to ensure the military's needs are met first. Your time in the military is what you make of it. Your attitude will make or break your experience. If you are planning on accepting the HPSP, be aware of the details of your obligation. Read the regulations.....ALL OF THEM! You're certainly going to find plenty of complainers in the military. The best advice I can give you is to ignore their constant whining and make your own opinions. Most of these individuals are going to complain even when they are making 400K/year.


What you do in the military is not about or for you. It is about the people around you!
 
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I agree that the system is not perfect, and certainly doesn't seem fair. Nobody wants to owe more than they should. However, if you did not understand the conditions of your obligation before you signed the dotted line, it's your own damn fault. There is certainly a sacrifice to serving in the military. Real soldiers know that, and respect that fact. We don't complain about it. Everyone knows that military docs make less money. If you didn't do the math before hand, whose fault is that? Honestly, did you even read the regulations before you signed your contract?

I think the problem is that when people do understand the conditions, they generally don´t join. All of the services are falling short of their recruiting targerts because of this. I explained the regulations, obligations, and finances of HPSP to about half a dozen other potential HPSP applicants from my Ugrad. Once they understood the finances and commitments, which the recruiters were somewhat blurry on (many seemed to be under the impression that they wouldn´t deploy, and none were aware of the GMO thing), all but one of them decided not to join. It´s not a matter of current military docs complaining, it´s a matter of the military needing to adjust if they want their soldiers/sailors/doctors to continue to recieve medical care.

Also I would point out that they´re not selling HPSP on idealistic ground, because they know that medical students tend not to be idealistic patriots (the idealistic ones tend to go in Paul Farmer directions), so I don´t see why people who were recruited before forums like this existed shouldn´t feel annoyed when they found out they were sold a different product than they recieved.
 

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Forum or not, each individual has the responsibility to know what they are getting into. If you trust that recruiters will tell you all the bad stuff, well, I guess you've got it coming.

As far as my combat experience being "humorous", Thanks for highlighting my point.
 

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Forum or not, each individual has the responsibility to know what they are getting into. If you trust that recruiters will tell you all the bad stuff, well, I guess you've got it coming.
But most of these kids have zero experience with recruiters. Most of them have led pretty good middle or upper middle class lives going to all right schools in neighborhoods where the policeman is the good guy.

So when a guy in uniform tells them what is what, a lot of these kids will have the tendency to believe them. Surely a soldier/sailor wouldn't outrigt lie to them?

And as much as I appreciate the sacrifices you've made for your country, something to keep in mind: when folks complain about something being bad, whipping out that others have it worse isn't really helpful.

Imagine you shared your stories of fear, PTSD and sacrifice to someone and their response was by saying, "your remarks bring out your true character". They then minimized your complaints and then went on to tell tales of their time in Mogadishu or somesuch. Not all that useful, huh?

Someone always has it worse than you. But that fact doesn't make any wrong you're going through all right.
 

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You don't even know how good you had it on your deployment. At least you had a tent to sleep in, and cards to play with. Try wearing 28 pounds of kevlar/LBV in 140 plus heat; carrying a 240B or SAW for 18 months (with a full combat load of ammo). Try attending funerals for the men you lost in front of your own eyes, whose lives were your responsibility. Try writing letters home to the families of those men. Try taking the life of another human when you have been taught your whole life that killing is wrong (although against my beliefs, I'll kill more terrorist again if I have to). Try scaring your wife and kids night after night when you wake up in a screaming/shaking rage after a nightmare. While you were forced to sleep in conditions as lowly as a tent, my men and I slept in vehicles, or not at all! While you were force to play cards during your downtime, we cleaned our weapons and rehearsed for our next mission….And we had it good compared to our grandfathers in WWII


This is exactly the type of attitude most people outside of medicine have, and it's perfectly rational. I'd probably think the same way if I had never gone into medicine.

The difference is that rangers didn't sacrifice the entire decade of their twenties JUST TRAINING to START being a ranger, and then get deployed to do something that causes them to lose those skills they spent ten years accumulating. Especially if this contributes to a possible medical mistake in the future.

The fact is, 10 year training processes and the military don't mix. After sacrificing such a large part of your life to medical training, you can't just put the control of your career into the hands of the military. You invest way to much in your education and career to have it continually jeapordized later on. Medicine is a stressful enough job, and it isn't just the lives of our friends and ourselves that we have to worry about on a deployment. It's the stress (and sometimes guilt) that comes with taking care of thousands of people.

EDIT: Just in case I didn't do a good job making my point, here's an example for the Rangers of what many physicians have complained about in regard to the military. Lets say that you, as a Ranger, spent years of grueling training learning everything about infantry and combat. Then the army deployed you to alaska where you worked at a desk, and fired a rifle once a month. First, you'd be pissed that you were losing the skills you spent so long to acquire. Now lets say the army then deployed you to OIF, and put you in charge of a battalion, and then some of your troops got injured or killed b/c your skills had eroded.

This is the way some surgeons feel. They don't get an adequate case load. And so along with having a 10 year training process wasted (and we're not talking about training as in college, we're talking about training as in not knowing your kids, assuming your spouse hasn't divorced you), they also live with the guilt of wondering if their surgical complications are due to them being out of practice.
 

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What a crybaby:thumbdown:. Here is a thought.

Do you want to die as a person who did something for this country or die someone who did nothing? Take a look at the WWII generation and many who have followed. They are proud of what they did. I may not be in for a long time, but I will sacrifice now so that I can be proud later.

I have a nice job right now that I am about to leave so I can be someone someday. Publishing papers and helping some patients is nice, but the real impact is during war.

The losers who do nothing for anyone but themselves die just that, nothing. The point about the sacrifice being comparable to any soldier, Marine, Airman, or Seaman was excellent. Just because you have an MD (or PhD in my case) does not mean you are some superior human being who does not have to sacrifice. Either sacrifice for the good of this country or die someone who didn't do squat.

Yes, some MDs and PhDs need to stay civilians to progress the world we live in, but many also have to sacrifice and deal with the military. Me, well I can do a lot as a civilian, but I can also put some of it off in order to be an Officer.

Officer means 10,000X more to me than the stupid doctor title, I guarantee you that. I hardly cared when I received it even though it was a major goal. I assure you I will be thrilled the day I am considered an Army Officer.

We should be paid more, but so should a ton of other professions including other soldiers and teachers.
 

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Forum or not, each individual has the responsibility to know what they are getting into. If you trust that recruiters will tell you all the bad stuff, well, I guess you've got it coming.
You´re missing my point. When you dismiss the complaints of current military physicians with lines like "you should have seen it coming", "it´s not about you", and "other people have it worse" you´re contrbuting to the denial/dismissal of the problems that keep them from getting fixed or compensated for. Now if all that meant was that the physicians would stay unhappy, I could see how that wouldn´t greatly upset someone whose priority is the wellbeing of the military and it´s members. But physicians aren´t staying unhappy, they aren´t staying (or joining) at all. The problems cited in this thread are the reason why the Military has so many problems recruiting and retaining physicians. That comes back and affects every member of the armed forces, and their families, when the medical care they need isn´t there for them.

I´ll admit that there are places where complaining does no good and much harm, especially coming from someone in a position of authority. When there´s a job to do you put on the best face you can and do the job with the resources you have. However this is not a warzone, or even an understaffed clinic, it is an internet forum. If you can´t air greivances here, where can you?

Also, fine, I´ve deleted the thing about your service.
 

Perrotfish

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Officer means 10,000X more to me than the stupid doctor title, I guarantee you that. I hardly cared when I received it even though it was a major goal. I assure you I will be thrilled the day I am considered an Army Officer.
If my title was psychologist I wouldn´t care much about it either. :)
 

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What a crybaby:thumbdown:. Here is a thought.

Do you want to die as a person who did something for this country or die someone who did nothing? Take a look at the WWII generation and many who have followed. They are proud of what they did. I may not be in for a long time, but I will sacrifice now so that I can be proud later.

I have a nice job right now that I am about to leave so I can be someone someday. Publishing papers and helping some patients is nice, but the real impact is during war.

The losers who do nothing for anyone but themselves die just that, nothing. The point about the sacrifice being comparable to any soldier, Marine, Airman, or Seaman was excellent. Just because you have an MD (or PhD in my case) does not mean you are some superior human being who does not have to sacrifice. Either sacrifice for the good of this country or die someone who didn't do squat.

Yes, some MDs and PhDs need to stay civilians to progress the world we live in, but many also have to sacrifice and deal with the military. Me, well I can do a lot as a civilian, but I can also put some of it off in order to be an Officer.
Ah, anotherr immature self-righteous person who thinks he know everything. It's about time you told all of us active duty practicing physicians how it really is. BTW, in your field there's a lot of danger of you possibley not counseling somebody long enough someday! Must be stressful!

EDIT: btw, do you realize that people like you actually do nothing besides discredit some of the legit pro-mil med people?

Officer means 10,000X more to me than the stupid doctor title, I guarantee you that. I hardly cared when I received it even though it was a major goal. I assure you I will be thrilled the day I am considered an Army Officer.

Well I think I speak for at least 90% of physicians when I say that being a medical doctor means more to me than being a military officer. I wouldn't expect you to understand.
 

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However, your remarks concerning your deployment truly bring out your true character. You don't even know how good you had it on your deployment. At least you had a tent to sleep in, and cards to play with. Try wearing 28 pounds of kevlar/LBV in 140 plus heat; carrying a 240B or SAW for 18 months (with a full combat load of ammo).

For the umpteenth time, stories about how tough the rifle slingers have it are as irrelevant to potential HPSP/FAP recipients as the trials and tribulations of asthmatic firefighters, migrant farm workers, or nuns serving the poor in deepest darkest Africa.

The relevant comparison is: life as a civilian student/resident/physician vs life as a military student/resident/physician

People who are thinking about taking an HPSP slot aren't also thinking about carrying a SAW, or driving a fire truck, or picking lettuce, or joining a convent. They want to know
  • how military GME compares to civilian GME
  • how the military practice environment compares to the civilian practice environment
  • GMO tours (military medicine) vs straight through training (civilian medicine)
  • how military medicine pay stacks up to civilian medicine pay
  • how military medicine intangibles compare to civilian medicine intangibles
  • etc
Note that the relevant issues do not include
  • how a military doctor's field accomodations compare to a rifleman's Ranger Roll
  • if a military doctor's backpack weighs more than a infantry radio operator's backpack
  • if the freshly brewed coffee in the rear with the gear tastes better than that crystallized crap in the MRE reconstituted with heavily chlorinated water and drunk out of a dirty canteen cup
We all love and respect the line. But the rewards and challenges specific to the line aren't relevant to a discussion of whether or not HPSP or FAP is a good career move for a particular person.

Mirror Form said:
Well I think I speak for at least 90% of physicians when I say that being a medical doctor means more to me than being a military officer.

Ditto.

Every soldier, sailor, Marine, and airman already has a bunch of officers looking after him. When he needs a doctor, he needs a doctor, not another officer.

Mirror Form said:
EDIT: btw, do you realize that people like you actually do nothing besides discredit some of the legit pro-mil med people?
RangerDO, I'm one of those pro-milmed people you're apparently undermining and discrediting. Nice work.
 
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This is exactly the type of attitude most people outside of medicine have, and it's perfectly rational. I'd probably think the same way if I had never gone into medicine.

The difference is that rangers didn't sacrifice the entire decade of their twenties JUST TRAINING to START being a ranger, and then get deployed to do something that causes them to lose those skills they spent ten years accumulating. Especially if this contributes to a possible medical mistake in the future.

The fact is, 10 year training processes and the military don't mix. After sacrificing such a large part of your life to medical training, you can't just put the control of your career into the hands of the military. You invest way to much in your education and career to have it continually jeapordized later on. Medicine is a stressful enough job, and it isn't just the lives of our friends and ourselves that we have to worry about on a deployment. It's the stress (and sometimes guilt) that comes with taking care of thousands of people.

EDIT: Just in case I didn't do a good job making my point, here's an example for the Rangers of what many physicians have complained about in regard to the military. Lets say that you, as a Ranger, spent years of grueling training learning everything about infantry and combat. Then the army deployed you to alaska where you worked at a desk, and fired a rifle once a month. First, you'd be pissed that you were losing the skills you spent so long to acquire. Now lets say the army then deployed you to OIF, and put you in charge of a battalion, and then some of your troops got injured or killed b/c your skills had eroded.

This is the way some surgeons feel. They don't get an adequate case load. And so along with having a 10 year training process wasted (and we're not talking about training as in college, we're talking about training as in not knowing your kids, assuming your spouse hasn't divorced you), they also live with the guilt of wondering if their surgical complications are due to them being out of practice.

Not bad. Although I am basically the most biased gung-ho Army medicine guy on here, these are some good points, from a poster who generally right down the middle anyway. For me, from freshman in college to 2 Masters degrees and a PhD has been about 12 years, and from that standpoint, I would not want the Army to screw me over either. As a prior service, clinical psychologist, there is less risk for that happening to me, but it could--and I will be first to admit, 3 years from now it is possible that I will be disgruntled.
 

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Thought I'd bump up this thread. I refined it a little. Been too lazy for the past 1.5 yrs to warn others - lol.
 

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That's what I used to think. But so far I haven't heard of a single one of the many army docs I know that finished residency recently getting sent out as GMO's. One did, but that was by choice (partially b/c she wants to moonlight a lot). Perhaps that army has gotten a bit smarter over the past couple years . . . or maybe most of their older residency trained docs quit, who knows.

Where are you at? Where I am at, we are not only seeing the typical IM, FP, PEDS, going out as GMO fresh out of residency, we are also seeing OB/GYN, dermatology, and neurology!!!
 

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Is this thread still completely relevant? Two years seems like quite a while. Much of the military medicine board seems very old.
 

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Wow, thanks NavyDoc. I was half way considering military medicine but you completely scared the heck out of me.

Thank you so much for taking the time to write those 44 reasons out!

Much appreciated.
 
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I am intending to go HSCP to provide for my family while I am in med school. I have no problems with military life (4 years USMC, 9 years Contractor overseas with the military with two years in Afghanistan) I like the structure and discipline and I like the lifestyle. But, with my "type A" personality I want to be the best doctor I can possibly be and the idea of being short changed on my training turns me off a little to mil-med. So, my questions are: Do you feel that Navy trained doctors are at a disadvantage compared to CIVs post residency with regards to technical proficiency and knowledge base? I have been told that HSCP time in med school will count for retirement is this correct? As a non-trad with a family (single income) how does one provide without taking advantage of a program like this during med school?
 

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Do you feel that Navy trained doctors are at a disadvantage compared to CIVs post residency with regards to technical proficiency and knowledge base?

I'm Army but work with Navy physicians.
With the exception of some surgical subspecialties (who do well but have case volume issues), military trained physicians do as well on the boards and clinically as civilian peers - sometimes better. We are extremely marketable upon leaving the military, there is no system or geographic area where I can't get a job tomorrow.
 

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I'm Army but work with Navy physicians.
With the exception of some surgical subspecialties (who do well but have case volume issues), military trained physicians do as well on the boards and clinically as civilian peers - sometimes better. We are extremely marketable upon leaving the military, there is no system or geographic area where I can't get a job tomorrow.

But what about skill atrophy? I've been frequenting these boards as I'm a premed interested in military medicine (specifically trauma surgery) and it seems there is a common theme of posts illustrating very low patient volumes which results in rusty skills.

I keep hoping this is not the case because serving my country as a physician seems to be the only route that I am truly interested in.
 

a1qwerty55

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But what about skill atrophy? I've been frequenting these boards as I'm a premed interested in military medicine (specifically trauma surgery) and it seems there is a common theme of posts illustrating very low patient volumes which results in rusty skills.

I keep hoping this is not the case because serving my country as a physician seems to be the only route that I am truly interested in.
There is no single answer to the question because it depends on not only your speciality but also your location.

Example - A total joint specialist at a major medical center will do more total joints than one assigned to a smaller hospital (Neither will do the same volume as one in a civilian total joint practice), similarly, a trauma surgeon at a trauma center will do more trauma but the military really only has a couple trauma centers. This is true even of deployments where one general surgeon (I specifically list general surgeon as all are deployed as "trauma surgeons"), at one deployed setting will be very busy another sitting on his/her hands.

Same for a Neurosurgeon, retinal specialist etc. Skill atrophy is more an issue for surgical subspecialties than let's say general surgeons but even general surgeons can have case load issues in some settings.

Certain specialties have less of an issues with case load such as OB/Gyn, Peds, FP, IM (although they can be deployed for a year as an augmentee in a GP capacity but usually this doesn't degrade skills that much if at all for less procedure based specialities).

The messy answer is it all depends. I know this isn't satisfying but it is accurate.
 
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But what about skill atrophy? I've been frequenting these boards as I'm a premed interested in military medicine (specifically trauma surgery) and it seems there is a common theme of posts illustrating very low patient volumes which results in rusty skills.

I keep hoping this is not the case because serving my country as a physician seems to be the only route that I am truly interested in.

Dude, go civilian. Every VA and military medical center in the country will still hire you and you'll get to see just as many military patients while also maintaining the freedom to maintain your skills at other civilian/academic institutions as well. All your concerns are moot then. Best of both worlds.

And God's honest truth? If serving your country as a physician is the only route you're interested in, then active duty isn't for you. It just isn't. You also have to serve as an officer. Those two roles can be difficult to balance depending on where you end up, and there's a very good chance you'll end up being one of the many "I just want to practice medicine!" posters on this board in a few years.

Vaya con Dios.
 

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There is no single answer to the question because it depends on not only your speciality but also your location.

Example - A total joint specialist at a major medical center will do more total joints than one assigned to a smaller hospital (Neither will do the same volume as one in a civilian total joint practice), similarly, a trauma surgeon at a trauma center will do more trauma but the military really only has a couple trauma centers. This is true even of deployments where one general surgeon (I specifically list general surgeon as all are deployed as "trauma surgeons"), at one deployed setting will be very busy another sitting on his/her hands.

Same for a Neurosurgeon, retinal specialist etc. Skill atrophy is more an issue for surgical subspecialties than let's say general surgeons but even general surgeons can have case load issues in some settings.

Certain specialties have less of an issues with case load such as OB/Gyn, Peds, FP, IM (although they can be deployed for a year as an augmentee in a GP capacity but usually this doesn't degrade skills that much if at all for less procedure based specialities).

The messy answer is it all depends. I know this isn't satisfying but it is accurate.

This answer is taken from another thread where I asked a similar question about low volume:

BAMC treats civilians and is a level 1 trauma center, which I think is unique in the Army.

Would this be a good area to aim for residency? I'm interested in USUHS for medical school as opposed to HPSP (though I'm not entirely against FAP if none of this works out) and I don't know exactly how competitive each program (residency/location) is. Are there any resources regarding this? I'm sorry if I've missed them on this forum.

An Army Colonel that came to an AMSA Conference to speak said that they didn't even fill the general surgery positions last year. Is there any way to verify this?

Dude, go civilian. Every VA and military medical center in the country will still hire you and you'll get to see just as many military patients while also maintaining the freedom to maintain your skills at other civilian/academic institutions as well. All your concerns are moot then. Best of both worlds.

And God's honest truth? If serving your country as a physician is the only route you're interested in, then active duty isn't for you. It just isn't. You also have to serve as an officer. Those two roles can be difficult to balance depending on where you end up, and there's a very good chance you'll end up being one of the many "I just want to practice medicine!" posters on this board in a few years.

Vaya con Dios.

The thing is I'm actually very interested in Forward Surgical Teams and performing surgery while deployed, so I would have to be an officer. Maybe I'm just being young and silly but I think that is the epitome of trauma surgery; if you can perform lifesaving procedures with minimal equipment in the middle of the desert it seems you would be well-equipped for most anything.

I also realize that I will most likely not be deployed in the middle east as I will finish my undergraduate degree in 2013 followed by four years of medical school, five years of residency (also, are there trauma fellowships if general surgeons are being deployed to fit this niche?), and two years of fellowship which means there is a chance of not even being deployed.

Again, I apologize if anything I've asked has appeared elsewhere.

Thank you for your time and responses.
 

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I don't think there's anything you'd get in the stan that you couldn't get from training in Detroit or Baltimore.
 

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I don't think there's anything you'd get in the stan that you couldn't get from training in Detroit or Baltimore.

:confused:

have you been to iraq or afghanistan? i've seen things there that no civilian will ever take care of-- unless, of course, EFP's and IED's start being used regularly over here.

the surgeons i've talked to, and the exposure to some of the trauma i've personally seen i don't think any civilian training can prepare you for on a level that they see regularly over there. i assume it's not as bad now, but when things were hopping in iraq i can't imagine what the CSH's were like on a day to day basis.

i think this is one of the few areas where the military may have greater experience-- multisystem trauma stabilization/treatment.

--your friendly neighborhood got the OIF t-shirt caveman
 

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I also realize that I will most likely not be deployed in the middle east as I will finish my undergraduate degree in 2013 followed by four years of medical school, five years of residency (also, are there trauma fellowships if general surgeons are being deployed to fit this niche?), and two years of fellowship which means there is a chance of not even being deployed.

Something that everyone contemplating HPSP or USUHS should consider is the above.

By signing up now, you're committing yourself to service that won't really start for 10+ years. It is impossible to predict
- the state of the world, wars, deployment schedules
- the state of military GME
- the military practice environment

More and more I'm coming to believe that FAP is the best option, unless prior service and retirement calculations favor an earlier entry.


I don't think there's anything you'd get in the stan that you couldn't get from training in Detroit or Baltimore.

Ever been to Detroit?

I know you're probably just being facetious here, but a Detroit 38spl GSW just ain't the same as an Afghanistan 7.62x54 GSW for a bunch of reasons, Detroit doesn't get blast injuries, people in Detroit aren't wearing body armor, etc.
 

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I don't think there's anything you'd get in the stan that you couldn't get from training in Detroit or Baltimore.
Baloney - How many blast induced triple and quad amputees to you see in a non war zone? The extent of injuries are absolutely horrifying and have absolutely no civilian comparison. Those who have not deployed to a war zone with lots of IED injures has no clue what they are talking about.
 

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But what about skill atrophy? I've been frequenting these boards as I'm a premed interested in military medicine (specifically trauma surgery) and it seems there is a common theme of posts illustrating very low patient volumes which results in rusty skills.

I keep hoping this is not the case because serving my country as a physician seems to be the only route that I am truly interested in.

You've gotten varied advice from various people on this board. I experienced military medicine as an active duty surgeon for 6 years in the AF.

If you're goal is to do trauma surgery, or any surgery, you will not be happy in the military. As was offered by one of the posters, there is no way to know what will happen in more than 10 yrs, but one thing I can pretty securely bet on is that military medicine will be just as screwed up or worse than it is now.

The only reason to join military medicine is to be a military officer. There are way too many variables that will make your training and your practice mediocre to poor. It is just not worth it to close doors and let the military direct the way you will start and train in a profession that you will want to practice for the rest of your life.

Read this forum thoroughly, and talk to as many people as you can.

I wanted to direct you to this link:
http://www.health.mil/Debates/Debate.aspx?ID=9&a=1

However, it appears in the infinite wisdom of the military, they have taken the link down. I never thought to copy the information down, but it was 12 pages of physicians from all branches telling it like it is.

Anyone have a copy of that debate?

Best of luck, and do your research.
 

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You've gotten varied advice from various people on this board. I experienced military medicine as an active duty surgeon for 6 years in the AF.

If you're goal is to do trauma surgery, or any surgery, you will not be happy in the military. As was offered by one of the posters, there is no way to know what will happen in more than 10 yrs, but one thing I can pretty securely bet on is that military medicine will be just as screwed up or worse than it is now.

The only reason to join military medicine is to be a military officer. There are way too many variables that will make your training and your practice mediocre to poor. It is just not worth it to close doors and let the military direct the way you will start and train in a profession that you will want to practice for the rest of your life.

Read this forum thoroughly, and talk to as many people as you can.

I wanted to direct you to this link:
http://www.health.mil/Debates/Debate.aspx?ID=9&a=1

However, it appears in the infinite wisdom of the military, they have taken the link down. I never thought to copy the information down, but it was 12 pages of physicians from all branches telling it like it is.

Anyone have a copy of that debate?

Best of luck, and do your research.

Thank you for your advice. It saddens me that this is the way things are for reasons posted previously. I still have a lot of time to think about it and FAP is looking like the route to go if I choose to serve at all.

I suppose I had some inflated optimistic notion of what it would be like doing trauma surgery for the military and it's slowly eroding.

I feel odd that everybody keeps telling me to stay the hell away and I still want to, but maybe I'm just being rebellious young'n.
 

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I wanted to direct you to this link:
http://www.health.mil/Debates/Debate.aspx?ID=9&a=1

However, it appears in the infinite wisdom of the military, they have taken the link down. I never thought to copy the information down, but it was 12 pages of physicians from all branches telling it like it is.

Anyone have a copy of that debate?

Don't worry, they'll hold the debate again in a couple years and redo the survey. The comments and survey result will be the same as they ever were, and if we're lucky to ever see any followup, the conclusions drawn by the committee will be totally unrelated to the data collected. They'll tell us what we REALLY want are more mentoring opportunities, or an afternoon of special liberty for a diversity potluck, or some such nonsense.


I feel odd that everybody keeps telling me to stay the hell away and I still want to, but maybe I'm just being rebellious young'n.

It's because you're probably motivated by the same thing most of us are - a sincere and patriotic desire to serve the people who go into harm's way to defend our country. Medicine's a cool career, but the patients are why we get up in the morning to go to work, and military patients at home & abroad are the best patients in the world.
 

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It's because you're probably motivated by the same thing most of us are - a sincere and patriotic desire to serve the people who go into harm's way to defend our country. Medicine's a cool career, but the patients are why we get up in the morning to go to work, and military patients at home & abroad are the best patients in the world.

This is exactly how I feel. I know there are a lot of bad things about doing HPSP, but somehow, it's still something I'm considering.
 

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Baloney - How many blast induced triple and quad amputees to you see in a non war zone? The extent of injuries are absolutely horrifying and have absolutely no civilian comparison. Those who have not deployed to a war zone with lots of IED injures has no clue what they are talking about.

The thing is I'm actually very interested in Forward Surgical Teams and performing surgery while deployed, so I would have to be an officer. Maybe I'm just being young and silly but I think that is the epitome of trauma surgery; if you can perform lifesaving procedures with minimal equipment in the middle of the desert it seems you would be well-equipped for most anything.

For the most part I agree with Brickhouse, but with some caveats. If you haven't seen much trauma (like 95% of the recently trained GMO's, tech's, nurses, Internists, etc.) then seeing blast trauma in Iraq can be a uniquely disturbing experience, and it is not to be minimized.

But if you did five years in a surgery residency that had a significant inner-city trauma component, you will not be shocked by what you see in Iraq. Are there IED's in Detroit? No, but there are short-range shot-gun blasts which can produce a similar injury pattern. Massive burns, traumatic amputations, extensive crush injury, open cranial injury, and high-velocity GSW all occur sporadically in the civilian setting. The difference in Iraq is the concentrated volume of visually spectacular injuries. There also tend to be more muti-extremity and multi-system injuries--i.e. 3 or 4 extremities injured rather than just 1. But is the overall surgical approach really any different? Probably not.

And this may be difficult for the non-surgeon to understand, but just because an injury looks spectacularly bad, doesn't mean that it is surgically complex or has a complicated decision tree. There is nothing particularly challenging about doing wound washouts or debriding and dressing a traumatic amputation, and running standardized resuscitation protocols is simple after you've done a handful. In many cases, I found working trauma at Ben Taub (Inner-city Houston) to be more medically challenging than Iraq. Certain complex injuries like thoracic and abdominal vascular trauma are actually seen more often in a civilian setting, probably because in Iraq they are either prevented by body armour or lethal at the point of injury.

A lot of guys want to over-hype their war experience as some amazing learning environment, and only in rare cases is that true. For the most part, surgeons who were well-trained before the war did good work IN the war, and surgeons who were incompetent before the war (i.e. the career desk jockies) did poor work DURING it. I never saw anyone go to war as an incompetent and come back as a good surgeon.

If you join with intent to come home from a war as some sort of operative wizard, you stand a 99.9% chance of being dissappointed.
 

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For the most part I agree with Brickhouse, but with some caveats. If you haven't seen much trauma (like 95% of the recently trained GMO's, tech's, nurses, Internists, etc.) then seeing blast trauma in Iraq can be a uniquely disturbing experience, and it is not to be minimized.

But if you did five years in a surgery residency that had a significant inner-city trauma component, you will not be shocked by what you see in Iraq. Are there IED's in Detroit? No, but there are short-range shot-gun blasts which can produce a similar injury pattern. Massive burns, traumatic amputations, extensive crush injury, open cranial injury, and high-velocity GSW all occur sporadically in the civilian setting. The difference in Iraq is the concentrated volume of visually spectacular injuries. There also tend to be more muti-extremity and multi-system injuries--i.e. 3 or 4 extremities injured rather than just 1. But is the overall surgical approach really any different? Probably not.

And this may be difficult for the non-surgeon to understand, but just because an injury looks spectacularly bad, doesn't mean that it is surgically complex or has a complicated decision tree. There is nothing particularly challenging about doing wound washouts or debriding and dressing a traumatic amputation, and running standardized resuscitation protocols is simple after you've done a handful. In many cases, I found working trauma at Ben Taub (Inner-city Houston) to be more medically challenging than Iraq. Certain complex injuries like thoracic and abdominal vascular trauma are actually seen more often in a civilian setting, probably because in Iraq they are either prevented by body armour or lethal at the point of injury.
With regards to injury patterns, and civilian comparisons - It really depends where you are and what techniques the enemy is employing -
Damage control surgery is just that damage control, but there is a marked difference between a civilian traumatic amputation and one from and dismounted IED. Especially when you add the myriad of other injuries encountered in the combat injured patient. It is not appropriate for me to get into the gory specifics of the injury patterns being seen but suffice it to say, none of the trauma surgeons (civilian trained) I have worked with would agree with the assertion that any civilian trauma center sees the degree of devitalized tissue and type of wounding being seen.

Detractors aside, the military had done a phenomenal job with injuries that previously would have been thought unsurvivable. Ask any trauma director at a major civilian Level 1 who is in the know.

Now, what does any of this mean to someone desiring to become a trauma surgeon in the military because they perceive this a great way to get trauma training? The reality is the military does not have many trauma centers and a general surgery resident doesn't have much chance of ending up at one anyway at least initially out of residency. As far as war experience - who knows where we will be in 10 years, and even if deployed to a war zone, you might not operate if you are in a location where much isn't happening like a Forward Surgical Team or let's say Iraq now. So I agree that it is disengenuous to sell the military as a great place to hone trauma skills.
 

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none of the trauma surgeons (civilian trained) I have worked with would agree with the assertion that any civilian trauma center sees the degree of devitalized tissue and type of wounding being seen.

Woah woah woah, I didn't say any trauma center, I said Detroit or Baltimore. BIG BIG BIG difference. For those of you who haven't been there, we're basically talking 3rd world medicine in the 2 most dangerous cities in America.
 

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Woah woah woah, I didn't say any trauma center, I said Detroit or Baltimore. BIG BIG BIG difference. For those of you who haven't been there, we're basically talking 3rd world medicine in the 2 most dangerous cities in America.
Sorry buddy but I worked R Adams Cowley aka Shock Trauma Baltimore - there is no comparison. I'm not new to trauma.
 

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I've rotated through Baltimore shock trauma, (as a surgeon), during the ridiculous attemtp by the Air Force to keep its surgeons "trained" in trauma. Its a hospital that now receives 95% blunt trauma. Its resusitation algorithm is to CT you as you get wheeled in.

Not the best place to learn penetrating trauma.
 
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