All Branch Topic (ABT) $43 B For Staffing MTF’s

[armytrainingsir]

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While the officer first BS did get tiresome, you ARE a military officer and that comes with certain responsibilities and obligations. It’s not some big secret.

I had nearly as much distain for those that rebelled against every aspect of being an officer as I did for those that drank the officer first koolaid.

 

[armytrainingsir]

My guess is they treat it he same as many private facilities treat Medicaid. So many slots dedicated to Medicaid/TriCare patients per day and have a different wait list for TriCare vs say BCBS

I have been affiliated with three different hospital systems in the past 10 years. Tricare patients weren’t restricted in any way. Of course, that can certainly change at any time in the future.

 

[HighPriest]

While the officer first BS did get tiresome, you ARE a military officer and that comes with certain responsibilities and obligations. It’s not some big secret.

I had nearly as much distain for those that rebelled against every aspect of being an officer as I did for those that drank the officer first koolaid.

I don’t disagree with this. But in the cases where there truly is a conflict between being an officer and being a doctor (the patient’s care is actually suffering, not just that it theoretically could suffer) if you choose being an officer first you’re wrong. That doesn’t mean you need to buck the system at all times.

 

[HighPriest]

I have been affiliated with three different hospital systems in the past 10 years. Tricare patients weren’t restricted in any way. Of course, that can certainly change at any time in the future.

When I was in private practice we certainly did. If you work for a place with state funding, you can’t.

 

[pgg]

While the officer first BS did get tiresome, you ARE a military officer and that comes with certain responsibilities and obligations. It’s not some big secret.

Those responsibilities should

1) end with staying in weight standards, wearing the uniform appropriately when needed, rendering and returning proper courtesies, completing required paperwork (like fitreps) on time, and not developing crippling low back pain four minutes after being notified of a deployment

2) not include anything that interferes with, delays, or interrupts patient care, except in the specific instance when a line commander asserts that the objectives of a combat mission might be compromised (a true "never event" at any CONUS facility)


The entire notion of the absolutely abhorrent "officer first" mentality, and make no mistake, it is abhorrent in every sense of the word, is that it explicitly places officership above patient care.

I had nearly as much distain for those that rebelled against every aspect of being an officer as I did for those that drank the officer first koolaid.

Agreed.

Those people were a lot rarer than the ones who started and ended their days at the punchbowl, however.

 

[armytrainingsir]

When I was in private practice we certainly did. If you work for a place with state funding, you can’t.

No doubt private practices do discriminate. Not only by payer, but by complaint. The 88yo blind amputee with Parkininson’s post CVA referred by the NP for dizziness vs the 65 yo with sinus disease on CT referred by a competent internist, for example.

The hospital systems and their legions of employed physicians, IME, don’t.

(At the moment).

 

[HighPriest]

The 88yo blind amputee with Parkininson’s post CVA referred by the NP for dizziness

I might still send this guy somewhere else. 😁

 

[armytrainingsir]

I might still send this guy somewhere else. 😁

hahahahahahaha
#metoo

 

[militaryPHYS]

Man, @pgg just retired and he’s already sounding like the rest of ya’ll salty crabs!

Once you’re finally paid what you’re worth as a physician it’s easy to forget why those who are still in have to strike a balance between physician and officer. 1) we aren’t paid well enough to try and function at a full FTE in the military system 2) promotions still rely on officer work and 3) 25% of our lives we are pulled/tasked/assigned to be an officer instead of a physician whether we want to or not.

 

[usma05]

The problem with the "Shut them down" crowd is that view works for peacetime, but w/ near peer conflict there's no way the civilian system can or will want to absorb what casualties do make it stateside, nor is the military system setup to disposition soldiers stateside to so many different civilian centers. And I have a hard time believing those hospitals could be stood up ad hoc in the middle of such an event. Do we need all the currently MTFs? No, but there's strong arguments for most MEDCENs if we want to be able to absorb the high number of casualties stateside. At the minimum Wally World, BAMC, TAMC, Landstuhl, Korea, and Madigan.

It also ignores the downsides and (command-dependent) stupidity of the Reserves.

 

[militaryPHYS]

The problem with the "Shut them down" crowd is that view works for peacetime, but w/ near peer conflict there's no way the civilian system can or will want to absorb what casualties do make it stateside, nor is the military system setup to disposition soldiers stateside to so many different civilian centers. And I have a hard time believing those hospitals could be stood up ad hoc in the middle of such an event. Do we need all the currently MTFs? No, but there's strong arguments for most MEDCENs if we want to be able to absorb the high number of casualties stateside. At the minimum Wally World, BAMC, TAMC, Landstuhl, Korea, and Madigan.

It also ignores the downsides and (command-dependent) stupidity of the Reserves.

Yep. Instead of how can we dissolve an undissolvable system, the mindset has to be how can we improve an imperfect system.

It can’t go away. Majority reserve will never work and I’m sorry but I roll my eyes every time someone on here says it.

We are stuck with it so how can we make things better. I know DHA has been trashing things but I’m serious when I say that I see hope improvement is coming…everyone is just going to have to live up to a physician first standard when functioning within their designated FTE. Culture change

 

[TheEarDoc]

None of this matters because neither the VA or DHS pays their doctors worth a s$&@. Our local VA has been without ENT over 10 years. Why would anyone accept $200k/yr when you can cross the street and make $800k by working just slightly harder but with adequate staff? Answer, 10 years of an open position.

They farm it all out to me and I charge a level 4 new visit for 10 minutes of clinic time (if that). I would guess that well over half of referrals are a complete waste. So much waste with the government and throwing $43B more means $43B in debt with nothing to show for it.

Can’t believe some people think a single-payer government run health system is still the answer. Both systemsare train wrecks.

Yep. We pay way more for CITC and most of the time it's subpar care with longer waits than our current slightly longer than 1 month wait time for most specialties.

Unfortunately the VA and DOD are never going to pay close to the private sector because they are content with working providers to death expecting them to do the jobs of 3-4 people and then are amazed when people up and quit or they give low scores on the All Employee Survey.

"Wow I can't believe we scored so high on burnout? The VA is a great place to work! It's so laid back" - Some lazy admin who does maybe 5 hours of actual work a week and it's usually subpar.....

 

[armytrainingsir]

After a while numbers don’t seem to mean much, especially when the federal government is throwing them around.
For fun, I wanted to see just how much healthcare $43 billion can buy.
The University of Alabama at Birmingham (UAB) is a 1100 bed Academic Medical Center, medical school, has every residency know to man, plenty of fellowships, one of the top 10 largest hospitals in the country, and was voted a few years ago by Forbes as the best company in the US to work for. Yearly budget is just a hair under $4 billion. Does anyone think the $43 billion is going to buy a decade of UAB quality and quantity of care?

 

[HighPriest]

After a while numbers don’t seem to mean much, especially when the federal government is throwing them around.
For fun, I wanted to see just how much healthcare $43 billion can buy.
The University of Alabama at Birmingham (UAB) is a 1100 bed Academic Medical Center, medical school, has every residency know to man, plenty of fellowships, one of the top 10 largest hospitals in the country, and was voted a few years ago by Forbes as the best company in the US to work for. Yearly budget is just a hair under $4 billion. Does anyone think the $43 billion is going to buy a decade of UAB quality and quantity of care?

It’ll (one way or another) buy enough votes for the next $40B