40 (and counting) Reasons Not To Join

[mitchconnie]

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.

Couldn't agree more with these two points, but lets take a closer look.

First, the contaminated wound with extensive devitalized tissue is the iconic injury of the current conflict and probably not reproduced in a civilian setting. But what's your protocol to treat it? In-theater management is hemostasis/washout/debridement then air-evac to Landstuhl. Back at WRAMC it's serial Q3D washouts with debridement +/- VAC until there is good granulation and then STSG or plastics consult for rotational flap. Washout and VAC change is a PGY 1 case. It's an important job, but quite tedious and surgically trivial. Not usually the sort of thing a budding trauma surgeon is looking for when joining the military.

Secondly, the in-theater survival may well be better than previous conflicts ( if you completely buy the military data), but is it really because of advanced new surgical procedures or amazingly talented military surgeons? Hardly. It's probably some combination of body armor, early tourniquet use, and incredibly rapid evacuation to the highest level of care. All are important developments from the standpoint of a combat trauma system, but are largely irrelevant to the individual surgeon and his post-war practice.

My point is not that military surgeons are incompetent, or that war-time injuries are exactly like civilian trauma. It's that military surgical practice, even on the front line, is not nearly as professionally stimulating as the uninitiated think. It's day after day (after day...after day...after day) of wound washouts followed by the occasional great save or unusual case.

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[Galo]

Truthfully and eloquently stated.

There has been a number of posts with enthusiatic prospectives who do not really have any reliable knowledge of military medicine, or have been told outright lies by recruiters, or others, and have this complete misconception or romantization of what a surgeon in the military does, especially in regards to trauma.

I very much agree, and there have been a number of observations, both practical and published, that very much support Mitch's explanation of the higher survival rate for war injured soldiers.

The only misconception is that military surgeons have some sort of unique expertice in trauma, and that is simply not true.

 

[a1qwerty55]

My point is not that military surgeons are incompetent, or that war-time injuries are exactly like civilian trauma. It's that military surgical practice, even on the front line, is not nearly as professionally stimulating as the uninitiated think. It's day after day (after day...after day...after day) of wound washouts followed by the occasional great save or unusual case.

Sounds like trauma surgery in general - this is romaticized but it reality isn't so exciting - most trauma is blunt and nonoperative - even in the most exciting inner city trauma centers - most work consists of serial exams, clearning C-spines, observation, suturing soft tissue injuries.

I would say the subspeciality surgeons (Ortho/ENT) I've worked with have done things they would never ever would do/see in in a career stateside - out of necessity (this is on local nationals, who have no other options) not on military who you correctly point out receive definitive care outside of the theater. Anyway - it all depends on where you are, what your speciality is and the mix of military and local national/EPW patients is. Some of us have/are seeing/treating things we would never ever see in the US and this at least for me has been challenging and satisfying.

 

[MLT2MT2DO]

Though it isn't one of the "big factors" on the list...

#43 is now obsolete: As of about 4 months ago FB, and personal emails are now accesible.

 

[AF M4]

Though it isn't one of the "big factors" on the list...

#43 is now obsolete: As of about 4 months ago FB, and personal emails are now accesible.

Pfft, we just roped one of the systems guys into our fantasy football league a couple of years ago. All our profiles have had the above super powers and more ever since.

 

[Nirv]

No CME is paid when you have 12 months or less in. Meaning: you have 11 months and 29 days left on your commitment. You will not get CME paid. The military is the only employer that lets you go an entire year and not get CME paid.

If you start your commitment in July, you shouldn't apply for the bonus your final year, otherwise your commitment extends 3 months more. Basically, you lose 20 grand (depending on your specialty) by adhering to a 36 or 48 month commitment. You get tricked into a 39 or 51 month commitment. In 3 months, you'll make more than your pay and the 20k, so it is not worth it.

So, in your final 12 months, you are down 23k from the year prior.

 

[UCSFdreamin]

I don't suppose that, 1 year later, these issues have received any attention and are improving?

 

[Mr Wizard]

I don't suppose that, 1 year later, these issues have received any attention and are improving?

Not really. The needs of the Army, Navy, Air Force supercede the needs of patient care. Military physicians are expected to be military officers first, physicians second.

That is why a military neonatologist is still sent over to OEF for 8 months while fully knowing that there will be no premature infants waltzing in for care.

 

[navdoc47]

Just wanted to remind everyone that writing a student loan check is WAAAAAY more convenient than joining the military.

 

[Silent Cool]

Just wanted to remind everyone that writing a student loan check is WAAAAAY more convenient than joining the military.

Navdoc,

At what $$ value of student loans might you change your opinion? 400K? 500K? 600K?

Just curious.
thanx

 

[deuist]

Navdoc,

At what $$ value of student loans might you change your opinion? 400K? 500K? 600K?

Just curious.
thanx

For my specialty it would have to be $520,000. If I lived in an rural area, maybe $700,000. Even then as a civilian I would get to chose where I lived and could leave if I ever hated it. Civilians also don't get deployed.

 

[Silent Cool]

For my specialty it would have to be $520,000. If I lived in an rural area, maybe $700,000. Even then as a civilian I would get to chose where I lived and could leave if I ever hated it. Civilians also don't get deployed.

Interesting. What is your specialty?

 

[UltimateDO]

Deuist is EM, he is right in line with what I would estimate the loan value to be ~500-600k.

 

[Kilgoretrout 65]

No CME is paid when you have 12 months or less in. Meaning: you have 11 months and 29 days left on your commitment. You will not get CME paid. The military is the only employer that lets you go an entire year and not get CME paid.

If you start your commitment in July, you shouldn't apply for the bonus your final year, otherwise your commitment extends 3 months more. Basically, you lose 20 grand (depending on your specialty) by adhering to a 36 or 48 month commitment. You get tricked into a 39 or 51 month commitment. In 3 months, you'll make more than your pay and the 20k, so it is not worth it.

So, in your final 12 months, you are down 23k from the year prior.

This quote is amusing now that you could go an entire ADSO or career without getting CME paid for. If you see a recruiting ad saying CME conferences are paid for you should forward it to your specialty leader and your commander and maybe your congressman...

 

[TxsMed14]

Though later posts are a bit more legit with real concerns, that initial top 40 post is hilarious...

Granted, I totally get that not everyone wants to rough it in a third world country. but if you wanted to be a doctor so that you can have a TempurPedic mattress, HD televisions in every room, and vacay in Maui, then obviously the military was and IS a really bad decision. I mean, getting deployed to to a war zone and put in danger? Yea, its the MILITARY. Is this a joke? I mean.. duh. If there are that many people signing contracts who don't know this is what they're getting into, then I hope this stays a top forum post.

..and SERIOUSLY, getting laid is a major factor in your long-term career goals? Forget the glass ceiling, you guys have it way worse with the Bronze Zipper.

 

[TxsMed14]

Also, none of these replies on the financial side of things accurately takes into account the Net Present Value of the scholarship vs. making loan payments over the course of a life time:
http://en.wikipedia.org/wiki/Net_present_value

Obviously, money shouldn't be a factor in joining, but people should be aware that there is a much bigger long-term loss whenever you take out any kind of loan, because you have to consider the value of interest rate payments AND the opportunity cost of not investing your money over the decades you are paying it back. And it's unwise to invest when you have loans, because you'll almost never get a higher rate of return vs interest.

Sorry, it just bugs me that no one ever mentions that.

 

[Perrotfish]

Also, none of these replies on the financial side of things accurately takes into account the Net Present Value of the scholarship vs. making loan payments over the course of a life time:
http://en.wikipedia.org/wiki/Net_present_value.

Its amazing how much things have changes in less than a decade. When this thread was made way a physician would take out federal loans that didn't accrue interest in medical school or residency and which were largely subsidized. The result was that a physician on a disciplined 10 year payment plan could expect to pay back something very like the principle on his original loan. Now the interested is through the roof and accrues continuously in medical school: if you're disciplined and stick to a 10 year payback plan you'd be lucky to pay back nearly 2.5 times what you initially borrowed. Also the tuition itself got much, much higher.

 

[notdeadyet]

True. There are lots of examples of hard to quantify financial reasons both for taking AND not taking the scholarship.

In addition to the ones mentioned above, I think people may not take into account is the cost of potentially doing a military residency versus doing a more respected civilian one. This has the potential for having financial repercussions over the course of a career, sometimes significant ones.

But we don't really take it into account, because it's almost impossible to quantify. But for some, residency limitations were a factor in not taking the scholarship. The days of the military GME having best-of-breed residency training (Like the Armed Forces Institute of pathology, in the old days) do not appear, by any indications over the past several years, of coming back. For some of the primary care focused specialties or community practice goals, it's less of an issue, but it can be of concern for the research and academia bound. When I was about to start med school, I was looking at psych, surgery, and emergency med, and none of the military residencies appeared to match the training at the better civilian ones. That weighs heavy for some and can have overlooked costs.

 

[idq1i]

Yea, its the MILITARY. Is this a joke? I mean.. duh. If there are that many people signing contracts who don't know this is what they're getting into, then I hope this stays a top forum post.

Let's be serious here. What percentage of people doing HPSP do it for the "love of the country?" I'd guess under 20%, and I'm being generous here. Is it right? No. Is it true? Yes.

Milmed recruiter prey on young, naive medical students that just received their financial aid counseling from their school. They talk about no loans (I could realistically pay back the education cost in 2 years in pp), exotic places you can go to (Missouri?), high quality training (this must be why the residents get sent to 4-5 different hospitals to get experience).

MilMed GME and practice is a closed system. It's not like a med student can just go and see for himself what it's really like. Anyone signing on the dotted line is buying a cat in a bag. (and the cat has rabies)

 

[BigNavyPedsGuy]

Anyone signing on the dotted line is buying a cat in a bag. (and the cat has rabies)

Can we give the cats sabre toothed fleas and rabies? Maybe a clawed off ear?

Sorry that was a funny parenthetical.

 

[pgg]

Let's be serious here. What percentage of people doing HPSP do it for the "love of the country?" I'd guess under 20%, and I'm being generous here. Is it right? No. Is it true? Yes.

As long as we're being serious, "love of the country" is a perk. And it's a big one. No, of course a patriotic desire to serve isn't the only factor that motivates people to join, but you better believe it's a big factor amongst those of us who stay.

I've done time at a variety of civilian institutions, both as a guest resident and as a moonlighting attending, and I'll just say there's a lot to be said for being in the military and not having to deal with the dregs of society, high risk noncompliant self-abusers with self-inflicted disease and a +meth screen, and litigious entitled *******s. The patients are probably the best thing about military medicine, and it's nice to take care of them. At least the .mil joint doesn't have Big House Fridays when they bus in the child molesters and other murderous lifers from the prison for their hernia field trips.



That said, even I, perhaps the last happy .mil attending on SDN, joined for the money. Mostly. It's taken me 15ish years to really appreciate that the patients make for a pretty nice work environment. (At least, when the administrators stay out of the way, and no one's harping about group PT, and I'm not suffering through one committee duty or another.)

 

[NavyFP]

That said, even I, perhaps the last happy .mil attending on SDN, joined for the money. Mostly. It's taken me 15ish years to really appreciate that the patients make for a pretty nice work environment. (At least, when the administrators stay out of the way, and no one's harping about group PT, and I'm not suffering through one committee duty or another.)

Second to last. Still happy to wear the uniform.

 

[idq1i]

That said, even I, perhaps the last happy .mil attending on SDN, joined for the money. Mostly. It's taken me 15ish years to really appreciate that the patients make for a pretty nice work environment. (At least, when the administrators stay out of the way, and no one's harping about group PT, and I'm not suffering through one committee duty or another.)

People stay in for different reasons, and I'm sure you have yours. It is very specialty-dependent. I don't know what you specialty is, but it makes sense for an FP to stay, but very little sense for an ortho/rad/derm/NS/ENT to stay in. It's not just about the money. I do make 1/2-1/4 of what I could make in pp. That's just strike 1. I was forced into a chief position, where I regularly get invites for 7-10 meetings a week, and I have no desire to administrate. Strike 2. Group PT - Strike 3. Ft Polk/Leonard wood/Irwin/El Paso/Riley - strike 4. Potential deployments - strike 5. OER that looks mostly at military stuff and makes no accommodations for medicine - strike 6. Ranks that reflect longevity, and not skills-strike 7. Obstinate command - strike 8. APEQS garbage, being constantly told in ebonics, spanglish or louisiana-glish not to rape people - strike 9. Military not giving a crap about your non-military spouse - strike 10. Having to account for my whereabouts at all times - strike 11

Oh yeah, our equivalent of a Big House Friday is an 0-1 through O-6 showing up for a procedure, with an attitude that his rank actually matters in a medical setting. Absolutely detest that. I had someone actually check my rank before i started (mine was higher FWIW). Most of the hardcore prisoners that I dealt with had a better attitude and more appreciation

I am proud to wear the uniform, but I am not happy.

 

[orbitsurgMD]

Receiving! Do they still have that sci-fi-esque underground tunnel with the hand scanner locks? Forget exotic travel. A walk around the DMC campus was a way more interesting view of humanity.

 

[BigNavyPedsGuy]

I am proud to wear the uniform, but I am not happy.

Good line. I'm going to steal that one.

 

[idq1i]

31 reasons to not join, from my perspective. In no particular order

1. Low pay for specialties (rad/ortho/ent)
2. Deployments
3. PT
4. Bad base locations (middle-of-nowhere Missouri, Kansas, Louisiana, other flyover holes)
5. Your spouse doesn't matter if (s)he is not military as far as assignments
6. Required military online training is often an insult to your intelligence (How to dress when it's cold)
7. Your colleague may be a total *****, but since he has been in for longer, he outranks you, and makes more money
8. Your commander below POTUS is a nurse
9. Your nurse probably outranks you
10. You are automatically demoted to "provider" level, where you are in the same group as the RN, LPN, DC, DPM, PA, DDS, social worker, etc.
11. Want CME? Go pay for it yourself.
12. Want to go away for the weekend? Nope – your "Cold Weather training" is not up-to-date. Not allowed. Anywhere you go, they need to give you permission.
13. Meetings, meetings to schedule meetings, meetings to schedule meetings about having a meeting. You are (involuntarily) invited.
14. Do you have a serious illness? They will never release you unless you are dead.
15. Potential stop-loss
16. IRR leaves you vulnerable to call-up
17. Lazy, incompetent civilians that can't be fired due to union protection
18. You have to go to meetings where they remind you not to rape women
19. Old equipment that your command won't replace.
20. They do anything possible to extend your commitment. Want to get your (ISP) bonus in your last year? Ooops, you just signed up for 4 more months
21. Need medical care? Go see how many times your physician has been sued or disciplined before he ended up washing up at your MTF
22. Forced, often unnecessary, often dangerous vaccines. Refusal lead to prosecution.
23. Drug tests at 4 am. Someone actually watching you urinate into a cup. The fact that drugs stay in your system for days is lost on them.
24. You can be forced to undergo an invasive medical treatment against your will
25. Your social security number is posted everywhere for thieves to take
26. There is no incentive to improve your skills. No matter how good or bad you are, you still have your job.
27. Progressive skill rot. Cases seen will not allow you to keep up your skills
28. Moonlighting is considered a privilege, even though it is needed to keep up #27
29. Want a fellowship? Minimum of 2 years extra commitment
30. Three letters – G M O
31. Residency training of variable, borderline deficient quality.

 

[Chonal Atresia]

31 reasons to not join, from my perspective. In no particular order

1. Low pay for specialties (rad/ortho/ent)
2. Deployments
3. PT
4. Bad base locations (middle-of-nowhere Missouri, Kansas, Louisiana, other flyover holes)
5. Your spouse doesn’t matter if (s)he is not military as far as assignments
6. Required military online training is often an insult to your intelligence (How to dress when it’s cold)
7. Your colleague may be a total *****, but since he has been in for longer, he outranks you, and makes more money
8. Your commander below POTUS is a nurse
9. Your nurse probably outranks you
10. You are automatically demoted to “provider” level, where you are in the same group as the RN, LPN, DC, DPM, PA, DDS, social worker, etc.
11. Want CME? Go pay for it yourself.
12. Want to go away for the weekend? Nope – your “Cold Weather training” is not up-to-date. Not allowed. Anywhere you go, they need to give you permission.
13. Meetings, meetings to schedule meetings, meetings to schedule meetings about having a meeting. You are (involuntarily) invited.
14. Do you have a serious illness? They will never release you unless you are dead.
15. Potential stop-loss
16. IRR leaves you vulnerable to call-up
17. Lazy, incompetent civilians that can’t be fired due to union protection
18. You have to go to meetings where they remind you not to rape women
19. Old equipment that your command won’t replace.
20. They do anything possible to extend your commitment. Want to get your (ISP) bonus in your last year? Ooops, you just signed up for 4 more months
21. Need medical care? Go see how many times your physician has been sued or disciplined before he ended up washing up at your MTF
22. Forced, often unnecessary, often dangerous vaccines. Refusal lead to prosecution.
23. Drug tests at 4 am. Someone actually watching you urinate into a cup. The fact that drugs stay in your system for days is lost on them.
24. You can be forced to undergo an invasive medical treatment against your will
25. Your social security number is posted everywhere for thieves to take
26. There is no incentive to improve your skills. No matter how good or bad you are, you still have your job.
27. Progressive skill rot. Cases seen will not allow you to keep up your skills
28. Moonlighting is considered a privilege, even though it is needed to keep up #27
29. Want a fellowship? Minimum of 2 years extra commitment
30. Three letters – G M O
31. Residency training of variable, borderline deficient quality.

Couldn't have said it any better myself. Not even the staunchest supporters can argue these points.

 

[colbgw02]

I'm curious about number 24. Are you able to cite specific examples without compromising yourself?

 

[d2305]

I was going to ask also. Lobotomy prior to putting on 06?

 

[Gastrapathy]

They kept trying to get my wisdom teeth for reasons they could never explain. I stopped arguing, let them schedule me and then called back to cancel a couple weeks later. Worked for about 5 years running.

 

[idq1i]

I'm curious about number 24. Are you able to cite specific examples without compromising yourself?

Forcefully admitted to the hospital. Tried to force cardiac cath

 

[Kilgoretrout 65]

Forcefully admitted to the hospital. Tried to force cardiac cath

Cardiologist suffering from #27.

We are suffering from #19 with a twist: perfectly good old equipment no longer allowed to be used but command won't buy new equipment. Attention Major Major.

 

[pgg]

I'm curious about number 24. Are you able to cite specific examples without compromising yourself?

Vaccines, particularly smallpox and anthrax, are sore points with some people in the military.


I'm certainly no antivaxer nut, but I didn't particularly want the anthrax series. About 10 years ago when I was a GMO everyone had the option of declining it because of ongoing legal challenges, and most did. Not now.

 

[idq1i]

Vaccines, particularly smallpox and anthrax, are sore points with some people in the military.


I'm certainly no antivaxer nut, but I didn't particularly want the anthrax series. About 10 years ago when I was a GMO everyone had the option of declining it because of ongoing legal challenges, and most did. Not now.

A near-complete loss of autonomy and the complete loss of the right of self-determination, especially for a physician is something that all the premeds posting in this thread should think about. Don't be stupid - don't join. listen to the 85%+ people telling you not to join. If you are overcome with patriotism, go become a civilian MD, make money and donate to wounded warrior project. Go volunteer with homeless vets.

 

[colbgw02]

Vaccines, particularly smallpox and anthrax, are sore points with some people in the military.


I'm certainly no antivaxer nut, but I didn't particularly want the anthrax series. About 10 years ago when I was a GMO everyone had the option of declining it because of ongoing legal challenges, and most did. Not now.

That would be a #22. Not #24.

 

[d2305]

Are they still using the Anthrax vaccine for horses? I never got it, but they did make me get a yellow fever 6 months prior to retirement. Another case of a nurse in command. One last barb (pun intended).

 

[BioBeaver]

Holy **** this thread is scaring me..... It makes the military sound like some sort of house of horrors.....

 

[pgg]

Holy **** this thread is scaring me..... It makes the military sound like some sort of house of horrors.....

Meh.

YMMV.

 

[Perrotfish]

Holy **** this thread is scaring me..... It makes the military sound like some sort of house of horrors.....

If you're worried but still strongly want to join during medical school, a middle ground is to join the Navy via HPSP with a commitment of four years. Worst case you do an Internship and 4 years a GMO. Its a comparable commitment to people who enlist in the military out of high school, and leaves you the option of pursuing the civilian residency of your choice when you get out.

 

[deuist]

Or do FAP. You can do the residency of your choice, but at least make some extra money.

 

[deuist]

Also, none of these replies on the financial side of things accurately takes into account the Net Present Value of the scholarship vs. making loan payments over the course of a life time:

...

Sorry, it just bugs me that no one ever mentions that.

My college loans are 2%. I make much more through investing. For me, I have no incentive to pay through my loans so quickly. But let's say that I didn't take HPSP and instead took out $250,000 in loans for medical school. If interest rates became higher than investment rates, I could pay off all of my loans in under 3 years. Instead, I will now spend more time in the military, get paid less, not get CME, get PCS'ed to locations I don't want to work, experience skill rot, not teach academics, or do research, or do a fellowship. I can get deployed for months away from my wife---the same person who had to give up her lucrative career because I was PCS'ed across the country. Sorry, it just bugs me when pre-meds try to teach me about how financially lucky I am.

 

[idq1i]

Sorry, it just bugs me when pre-meds try to teach me about how financially lucky I am.

Completely agree. In addition:

I hate it when medical students, pre-meds, line officers, former enlisted post supposed "facts" about life in the medical corps. You have no friggin' idea. You may or may not like your experience if and when you are in, and as one of the mods above said "YMMV," but please, don't post mis- and disinformation.

You don't have to like any posts or posters. You can even set any, including mine to "Ignore," but please, don't tell the active duty people posting here about how great of financial deal HPSP is, how it's unpatriotic to complain about the milmed, or how your "grandpa" served and said it was great.

I post here so I could get at least one person to not make the same mistake I made. You may not like my posts or my "SDN personality," but unlike "you" (see above for membership), I can back up any of my posts with experience.

 

[Perrotfish]

My college loans are 2%. I make much more through investing. For me, I have no incentive to pay through my loans so quickly. But let's say that I didn't take HPSP and instead took out $250,000 in loans for medical school. If interest rates became higher than investment rates, I could pay off all of my loans in under 3 years. Instead, I will now spend more time in the military, get paid less, not get CME, get PCS'ed to locations I don't want to work, experience skill rot, not teach academics, or do research, or do a fellowship. I can get deployed for months away from my wife---the same person who had to give up her lucrative career because I was PCS'ed across the country. Sorry, it just bugs me when pre-meds try to teach me about how financially lucky I am.

Grad loans have a different rate than college loans and the cost of medical school has also increased drastically. Right now the average student at a private school with no parental support can expect to take out 350K of loans at a rate of 7.5% a year. Those loans are all unsubsidized so they accumulate interest throughout medical school and residency, so when you're ready to pay them back you'll owe approximately 500K. If you try to pay them back over an (optimistic) 10 year time period you'll owe 75K of after tax income every year for all 10 years. At this point most of my classmates are planning to NEVER pay the loans back, instead using IBR and are consigning themselves to having multi-million loans hanging over themselves and their families into their late 50s. They're just praying that the federal government doesn't change the rules on them any time in the next 20 years. Because what could possibly happen to a loan forgiveness program for 'rich doctors' in a debt ridden nation in the middle of a class war?

There aren't many medical specialties that pay over 300K a year anymore, and most medical students don't marry lawyers and investment bankers. YMMV, but for most medical student's its now a better deal to be in the military than out, and for primary care it might be the only hope of a middle class income. Maybe it wasn't that way when you joined, maybe it won't be in a few years, but it is now.

 

[notdeadyet]

I agree with Perrotfish about the rising and hidden costs of student loans. I also agree with the X factor that is IBR (though I'm using it, as IBR payment is about all I can afford as a resident right now).

I'm not sure I'd agree with the conclusion that military medicine is a better deal right now than it used to be, given the decline of military residency training and the uncertainty of long term benefits (such as retirement). That's to say nothing of the other "hidden costs." If you are married (or marry) a waitress, your career may have no impact, but if your wife is a physician or lawyer, the cost of your military service can far outweigh many of the savings.

Also, for the debt averse, there are MANY programs that will assist with student loan payouts that do not require the sacrifice of military service. Excluding the National Guard (which pays $40K towards student loans for every year you're a board eligible physician), practicing in underserved areas qualifies you for yearly reduction in loan burden. And many private employers also use student loan repayment as a benefit.

Again, I still fall on the side that joining for the money is a bad strategy.

 

[idq1i]

As far as the argument that students going into primary care should join the military because primary care doesn't pay a livable salary when large loans are factored in, I got a solution - don't go into primary care AND stay away from milmed!

It's really like watching someone picking Art History as a college major - a slow train wreck in progress.

You should consider that physician extenders have already metastasized into full fledged primary care provider positions, and soon, they will be able to practice without any physician supervision. "Primary care", with some exceptions, is dying a slow, painful death. This is process is particularly painful to watch in milmed, where your often rank substitutes for education, degree, and clinical acumen. Think I'm wrong? Go to your nearest MTF and observe.

 

[Perrotfish]

As far as the argument that students going into primary care should join the military because primary care doesn't pay a livable salary when large loans are factored in, I got a solution - don't go into primary care AND stay away from milmed!

It's really like watching someone picking Art History as a college major - a slow train wreck in progress.

You should consider that physician extenders have already metastasized into full fledged primary care provider positions, and soon, they will be able to practice without any physician supervision. "Primary care", with some exceptions, is dying a slow, painful death. This is process is particularly painful to watch in milmed, where your often rank substitutes for education, degree, and clinical acumen. Think I'm wrong? Go to your nearest MTF and observe.

What is the safe profession in medicine these days? Anesthesia? How many states let CRNAs practice independently now? Radiology? How long until the 'wet reads' from India just become the official read? Pathology is already gone and IR is collapsing. The IM and Peds subspecialties are full of NPs too, and psych is under assault from half a dozen different kinds of mental health professionals that are being granted increasing prescription powers. What's left? EM is a market bubble just waiting to collapse. Derm only survives because they let less than one student per medical school match. Do we all need to be intensivists and surgeons to pay the bills? And how much longer are those few remaining specialties going to be safe before a new technology or midlevel starts to take THEM over? Also the vast majority of medical students won't even have the options to do EM, ENT, ICU, Gen Surg or ortho, those are all competitive. On match day most people get to choose between FM, Peds, community IM, Psych, and Path. If your plan when you go into medical school requires you to match into a specialty that less than half of your class will have the stats for it might not be the best plan.

Which brings me back to my point. The military, financially, is a sure thing. Maybe IBR will come through. Maybe physicians will develop more niche markets where midlevels can't practice. Maybe medical reimbursement will once again reach the unparralled heights of the early 1980s. But if it doesn't and you sank 350K into loans at 7.5% you're SCREWED. Medical students need to seriously consider that they might be buying their education at the peak of a market bubble. The military is a guarantee of a debt free middle class income in exchange for just 4 years of service. Again, I'm not saying that your finances should be the only consideration, but if you roll your eyes when someone says the military is a good financial deal I think your understanding of graduate student loans and civilian medical reimbursement might be outdated.

I'm not sure I'd agree with the conclusion that military medicine is a better deal right now than it used to be, given the decline of military residency training and the uncertainty of long term benefits (such as retirement).

I disagree that the quality of military residency training is on a decline. I think both the complexity of the pathology in the MTFs and quality of the average resident we attract has been on the upswing since I started medical school. Maybe that will change with the end of the wars and the recent budget cuts, but right now things are going pretty well. I also don't see what the uncertainty of a military retirement has to do with the value of a 4 year HPSP contract. The value of staying in the military for a career is an entirely different question. FWIW the VALUE of the long benefits has gone way up, with the advent of the new transferable GI bill and the way that base pay has risen much faster than inflation. And while retirement has been uncertain since WWII no one has ever successfully managed to get rid of it.

 

[Silent Cool]

As far as the argument that students going into primary care should join the military because primary care doesn't pay a livable salary when large loans are factored in, I got a solution - don't go into primary care AND stay away from milmed!

It's really like watching someone picking Art History as a college major - a slow train wreck in progress.

You should consider that physician extenders have already metastasized into full fledged primary care provider positions, and soon, they will be able to practice without any physician supervision. "Primary care", with some exceptions, is dying a slow, painful death. This is process is particularly painful to watch in milmed, where your often rank substitutes for education, degree, and clinical acumen. Think I'm wrong? Go to your nearest MTF and observe.

Yeah, like the pay parity bill passed recently in Oregon. It's a slippery slope and, just as the CRNA debacle, is a sign of things to come:

http://www.oregonrn.org/displaycommon.cfm?an=1&subarticlenbr=670

 

[idq1i]

What is the safe profession in medicine these days? Anesthesia?

There is no safe profession. We are all too fragmented and too concerned about our own pockets to stand as a united front to stop physician extender creep, to stop reimbursement cuts, to stop state medical boards from implementing ridiculous new rules and fees on our profession, to stop democratic-supported trial lawyer lobby, to stop the new socialist model that is growing and spreading rapidly

Medicine is a bad career investment, and it gets worse every day. The military condenses the absolute worst of today's medicine practice, and places it in the MTF.

 

[Perrotfish]

There is no safe profession. We are all too fragmented and too concerned about our own pockets to stand as a united front to stop physician extender creep, to stop reimbursement cuts, to stop state medical boards from implementing ridiculous new rules and fees on our profession, to stop democratic-supported trial lawyer lobby, to stop the new socialist model that is growing and spreading rapidly

Medicine is a bad career investment, and it gets worse every day. The military condenses the absolute worst of today's medicine practice, and places it in the MTF.

Bill Paxton, is that you?

[YOUTUBE]http://www.youtube.com/watch?v=dsx2vdn7gpY[/YOUTUBE]

Anyway, if you think medicine is truly collapsing into a single payer government run, midlevel managed system, that seems to go along with my point that it would be wise to jump in to the deep end of such a system and keep your loans to a manageable minimum and start accumulating time towards retirement.

 

[idq1i]

Anyway, if you think medicine is truly collapsing into a single payer government run, midlevel managed system, that seems to go along with my point that it would be wise to jump in to the deep end of such a system and keep your loans to a manageable minimum and start accumulating time towards retirement.

If "I" think? What do YOU think?

It is "Game Over." Now it's just a question of time when the reality of declining salaries will reach the medical schools and their ever increasing tuition.

As for your final question, there are too many negatives in milmed. I put my thoughts into a list a few posts earlier. as for retirement, 19 years 364 days counts for nothing as far as retirement, so unless you want to be a coolaid drinker for 20 years, there is no point to starting.