ActiveDutyNavy

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Out of curiosity,
(i know about the differences in pay, deployment & debatable training)

How does a monthly schedule of a civilian EM vs military EM compare? I'm sure military EMs have more administrative responsibilities. Is military EM shift work like its civilian counterpart?


Any input would be appreciated.
 
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Hey man. As a 2nd year attending in AF EM, and having trained in the military for residency, I can tell you a little about the gig if you like.
We do work shifts, just like the civilian world. We probably work about the same amount as well. That being said, there is always some CBT or readiness training crap that seems to pop on your radar, and we do get assigned various admin duties, that can range from committees to master paperwork punk, to disaster team chief for exercises. Your assignment could be easy as pie, 15-30 minutes a month, or it could suck the life out of you (having been a disaster chief at Lackland.)
The amount of shifts you will work will also be highly dependent on the level of staffing due to deployments, TDYs, etc.. For instance, at Lakenheath we are solidly staffed right now. In the next 2 months we lose 2 docs to deployment, one to PCS and a civilian contractor whose time is up. That will leave us 3 docs and a part-timer that comes in from the states and works 4-6 days most months. So much for go travel Europe, right? We do have a vague promise that the leadershio will try to get us some help from somewhere. *holds breath*
Hope this helps!
 

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I'd also like to know a little more about military emergency medicine - particularly in the Army. I'm former AD and I'm really just trying to get a better idea about what my options will be when I finish residency in 2012. There seem to be a lot of conflicting opinions on how the new healthcare program will affect EM in the civilian world, if at all.
 

notdeadyet

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There seem to be a lot of conflicting opinions on how the new healthcare program will affect EM in the civilian world, if at all.
Anyone who professes to know what things will be like in medicine or a particular specialty in 2012 is either blowing smoke or reads spin like a bible.

No one really knows. It's new legislation whose ink isn't even dry. What form it will end up taking in the next year or two is anyone's guess. You'll have some cry that it's going to finally insure the large percentage of this country who is uninsured or underinsured. You'll have some cry that it's going to be a National Health Service with all doctors working in conditions like Bob Cratchit in A Christmas Carol.

How people read tea leaves says a lot more about them (and in this case their politics) than it really does about he tea.
 

ActiveDutyNavy

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Hey man. As a 2nd year attending in AF EM, and having trained in the military for residency, I can tell you a little about the gig if you like.
We do work shifts, just like the civilian world. We probably work about the same amount as well. That being said, there is always some CBT or readiness training crap that seems to pop on your radar, and we do get assigned various admin duties, that can range from committees to master paperwork punk, to disaster team chief for exercises. Your assignment could be easy as pie, 15-30 minutes a month, or it could suck the life out of you (having been a disaster chief at Lackland.)
The amount of shifts you will work will also be highly dependent on the level of staffing due to deployments, TDYs, etc.. For instance, at Lakenheath we are solidly staffed right now. In the next 2 months we lose 2 docs to deployment, one to PCS and a civilian contractor whose time is up. That will leave us 3 docs and a part-timer that comes in from the states and works 4-6 days most months. So much for go travel Europe, right? We do have a vague promise that the leadershio will try to get us some help from somewhere. *holds breath*
Hope this helps!
Thanks, it helps a lot.

1) How does op tempo for EM compared to other specialties?

2) Are most military ERs located at tertiary care centers? If not, how do you handle refering patients to specialist if you are not located at a tertiary care center?
 
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The White Coat Investor

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Thanks, it helps a lot.

1) How does op tempo for EM compared to other specialties?

2) Are most military ERs located at tertiary care centers? If not, how do you handle refering patients to specialist if you are not located at a tertiary care center?
Ha ha. All this bluster from Lakenheath, like they have it hard. We have 3/8 docs deployed currently and deploy 2 more next month. 2 of the 3 contractors have quit. The 2 deployed docs had 24 hours and 72 hours notice prior to deployment (neither was in the current "band")

I did manning assist at Lakenheath once, it was the best 2 months of my Air Force career. Don't hold your breath, it isn't going to get better any time soon. The good news is that Lakenheath tends to get a manning assist doc every summer to help with the gap between the doc who separates in June and the one who finally arrives in August.

To the OP- the ops tempo is pretty darn high. I have a guy going out again for 6 more months that have only been home for 13 months. Most military EM docs are NOT at tertiary care centers. Patients that require a referral to a specialist when it is not urgent are told to see their PCM (or if I'm nice I put the referral in the computer myself.) Pt's requiring an emergent consultation for a specialty we do not have on call are transferred to a larger military hospital if one is available or to a local civilian hospital. No big deal really. I wouldn't spend much time worrying about that aspect as it is very similar to civilian medicine. But do let your significant other know you'll likely be in the middle east for over a year of your 3-4 year commitment. That much I can almost guarantee.
 
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Hey guys, I'm a 1st year ER resident in Little Rock. As far as I know, my application is almost approved for the FAP program. I have a good deal of questions I'm hoping you guys can answer.

1) is it possible for a non military residency trained doc to get stationed at either of the 2 european bases on their first tour?

2) at your ERs, can you comment on things like volume, acuity, average patients per shift, ER doc coverage, sub specialty backup, etc.

3) dumb question, but do you wear scrubs or do you have to be uniformed?

4) the 24h notice of deployment is a little scary, anyone else have similar/different experiences?

5) while deployed, can anyone comment on where they went, and similar comments as in question 2, and additionally, average shifts per week/hours while over there.

6) can anyone comment on availability of moonlighting opportunities around where they are and how often your regular shifts allow it.

I'm sure I'll have more questions later. I appreciate everyones time. Thank you.
 

The White Coat Investor

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Hey guys, I'm a 1st year ER resident in Little Rock. As far as I know, my application is almost approved for the FAP program. I have a good deal of questions I'm hoping you guys can answer.

1) is it possible for a non military residency trained doc to get stationed at either of the 2 european bases on their first tour?

2) at your ERs, can you comment on things like volume, acuity, average patients per shift, ER doc coverage, sub specialty backup, etc.

3) dumb question, but do you wear scrubs or do you have to be uniformed?

4) the 24h notice of deployment is a little scary, anyone else have similar/different experiences?

5) while deployed, can anyone comment on where they went, and similar comments as in question 2, and additionally, average shifts per week/hours while over there.

6) can anyone comment on availability of moonlighting opportunities around where they are and how often your regular shifts allow it.

I'm sure I'll have more questions later. I appreciate everyones time. Thank you.
1) Very unlikely, but not impossible. Lakenheath is the more likely option. I'd expect Keesler or similar. If you want to control this, join AFTER residency rather than FAP.

2) Back up is fine, volume is high to very high, acuity is low to very low, my coverage is single to triple (counting PAs), back up is better than average. We ideally have 40-48 hours of provider coverage per day and tend to see 90-120 patients per day, so ~ 2 pph. Of course, right now we're running with about 36 hours of provider coverage due to deployments, that's more like 3 pph. And given that the place is dead between 2 and 6 am, that's 10 more patients you can expect to see on the day shift. I'd say expect 25-35 patients on a 12 hour day shift, maybe 20 on a 12 hour night shift. Less if you're working 8s.

3) No dumb questions. Official policy is you wear the uniform of the day in, then hospital scrubs if you please. In reality, I wear my own scrubs in and no one says anything. Of if I feel like it, I just work the shift in BDUs, even if it is a blues day. Not a big deal at this base, but can be at larger MTFs.

4) Sorry deployments scare you. You REALLY need to be willing to deploy with little notice as you probably will once in a four year career. "A Lot" of notice is 1-2 months, but with the band system you have a year's notice or so in the ideal world.

5) Deployed situations vary. You can have low volume-low acuity, high volume-low acuity, high acuity-low volume, and very rarely high volume-high acuity. Both of my deployments were low volume-low acuity. My most recent one involved 10 outpatient providers seeing 250 patients in the course of 14 days. That worked out to what...2 per day per person (we weren't given days off despite the volume). In my experience, providers are generally over-deployed. But I know someone out right now who was deployed with 3 emergency docs, one of which went home early for some reason so now one works every day and the other works every night for the last couple months of their deployment. So it can really vary. You are the military's biatch and you will do what they tell you to do. Be okay with that or you will be miserable. So expect anywhere from 15-30 12-hour shifts per month while deployed, probably with less than 2 patients per hour.

6) I expect my docs to moonlight and all of them do. 2-4 shifts a month is typical. I'd say less than 2 and you're losing skills. YMMV. This area has 6 or 8 hospitals that are willing to have us come work for them. Typical rate is $150 per hour (independent contractor.)
 

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Is modern military medicine anything like 'MASH'? I'm starting at USUHS in the Fall, and I'm trying to decide between EM and some kind of surgery. What do EM docs do most of the time?
 
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Is modern military medicine anything like 'MASH'? I'm starting at USUHS in the Fall, and I'm trying to decide between EM and some kind of surgery. What do EM docs do most of the time?
You are way too early in the game to make that decision with any certainty. A typical premed with typical shadowing and whatever else experience still doesn't know much at all about choosing a specialty. That's like debating whether to have 3 children or 4 when you haven't even found a girlfriend.
 

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Is modern military medicine anything like 'MASH'? I'm starting at USUHS in the Fall, and I'm trying to decide between EM and some kind of surgery. What do EM docs do most of the time?
There is a lot of truth on MASH. There's a lot of truth in the book Catch 22. I'd recommend a healthy dose of both before signing up for military medicine. Most of the time EM docs see patients who come to the ED for chest pain, abdominal pain, shortness of breath, vaginal bleeding, lacerations, limb pain, trauma, altered mental status etc and try to rule out and treat any emergent conditions. You do some of this in military EDs, but you also tend to do a lot of rashes, diarrhea, and colds.
 

ahowardmd

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You are way too early in the game to make that decision with any certainty. A typical premed with typical shadowing and whatever else experience still doesn't know much at all about choosing a specialty. That's like debating whether to have 3 children or 4 when you haven't even found a girlfriend.
That's a pretty cool analogy

There is a lot of truth on MASH. There's a lot of truth in the book Catch 22. I'd recommend a healthy dose of both before signing up for military medicine. Most of the time EM docs see patients who come to the ED for chest pain, abdominal pain, shortness of breath, vaginal bleeding, lacerations, limb pain, trauma, altered mental status etc and try to rule out and treat any emergent conditions. You do some of this in military EDs, but you also tend to do a lot of rashes, diarrhea, and colds.
Yeah, that's the only thing that worries me about military EM. I imagine spending my entire time in the ED treating VD and other little stuff.
 
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I know I'm digging up an old post, but I have a couple related questions.
Are (non-deployed) EM docs ever made to work in non-ED settings such as an Army version of an urgent care clinic?
Is there a comprehensive list somewhere of Army hospitals (containing ED's I might eventually get stationed at).
 

deuist

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I know I'm digging up an old post, but I have a couple related questions.
Are (non-deployed) EM docs ever made to work in non-ED settings such as an Army version of an urgent care clinic?
Is there a comprehensive list somewhere of Army hospitals (containing ED's I might eventually get stationed at).
AF ED's are also urgent care centers. As far as being forced to work elsewhere, if you are dual rated (e.g., EM and flight surgery) you might get forced into another clinic.
 

pgg

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Army EDs are urgent care centers.
Perfect answer, the truth in six words.

There isn't a specialty in milmed that I think routinely practices further below their qualifications than EM. Outside of BAMC (? not sure how that place functions these days, if they're still a L1 trauma center or not) there just aren't any real ERs at military hospitals, and to make it worse, the gates with guards with guns keep out all the sick/injured locals.
 
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I know I'm digging up an old post, but I have a couple related questions.
Are (non-deployed) EM docs ever made to work in non-ED settings such as an Army version of an urgent care clinic?
Is there a comprehensive list somewhere of Army hospitals (containing ED's I might eventually get stationed at).
If you go to 'more search options' and leave everything blank except service and whatever specialty you're searching for on this site seems like it should get most of them. http://www.tricare.mil/mtf/

But that wouldn't include flight/brigade surgeon type billets.
 

Doctor Bob

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Outside of BAMC (? not sure how that place functions these days, if they're still a L1 trauma center or not) there just aren't any real ERs at military hospitals, and to make it worse, the gates with guards with guns keep out all the sick/injured locals.
So, SAMMC (née BAMC) is a level 1 trauma center. Of the emergency departments in the DoD, this one is probably closest to a civilian emergency department. Nellis is full of sick people also, but with the new VA department opening up a lot of their sick people are going to get siphoned off.

Because SAMMC is a level 1 trauma center, and civilians have to easily get on base to see their injured family members who got flown/trucked in, command decided to open the ED to civilians also. So we see plenty of those here. But if they are well and truly sick and need surgery or an inpatient admission, we have to send them to a local hospital. Doesn't affect us in the department though because we still do whatever we think is necessary.

Even at a big center like SAMMC you still won't see the same frequency of high acuity that you will at a civilian ED. For one, things like full-arrests are going to go to the closest ED and military EDs are usually not in the middle of a population that is likely to arrest. The dependent and retiree population has had access to medical care for their entire life so you don't get many of the "I've had untreated high blood pressure and diabetes for 10 years and now my crack habit has upset the delicate balance" patients. Are you going to see sick people here? Sure; our ED has nearly 60 beds so by sheer volume some of them will be well and truly sick.
 

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If you go to 'more search options' and leave everything blank except service and whatever specialty you're searching for on this site seems like it should get most of them. http://www.tricare.mil/mtf/
This list is mostly complete, although for AF emergency medicine it did miss Elmendorlf in Alaska and BAMC, which are both found under "Joint Service." I'm not sure if Fort Belvoir in Virginia takes AF docs.
 

alpinism

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Army EDs are urgent care centers.

Sent from my iPhone using Tapatalk
As equal or worse in the Navy
AF ED's are also urgent care centers. As far as being forced to work elsewhere, if you are dual rated (e.g., EM and flight surgery) you might get forced into another clinic.
Perfect answer, the truth in six words.

There isn't a specialty in milmed that I think routinely practices further below their qualifications than EM. Outside of BAMC (? not sure how that place functions these days, if they're still a L1 trauma center or not) there just aren't any real ERs at military hospitals, and to make it worse, the gates with guards with guns keep out all the sick/injured locals.
+5

Exactly.

Think about it. Most the the people on any given military base are healthy males in their 20s and 30s with access to preventive medicine and primary care services. On top of that, most bases have small populations of less than 50K. Add it all up and you see very few truly sick/injured pts in a given week.
 
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Well I'm a 3rd year who is set on emergency medicine, and it's my understanding that the Army's ED programs are excellent so I am really looking forward to seeing them in person on my ADT's and then to eventually go through my residency at one.

My only concern is how I will keep up my skills following the completion of residency. This is important to me because I am very open to staying for my career with the hopes of eventually ending up at one of the major medical centers such as SAMMC in between deployments. If there are any current active duty emergency medicine physicians I would love to hear your strategies for keeping your skills up, and how understanding your command is with concepts such as moonlighting.
 
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+5

Exactly.

Think about it. Most the the people on any given military base are healthy males in their 20s and 30s with access to preventive medicine and primary care services. On top of that, most bases have small populations of less than 50K. Add it all up and you see very few truly sick/injured pts in a given week.
While there's obviously a difference between Baltimore Shock Trauma and an Army hospital, the Tricare beneficiary data paint a more complex picture than what you're presenting here.

http://www.tricare.mil/Welcome/About/Facts/BeneNumbers.aspx
 

deuist

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If there are any current active duty emergency medicine physicians I would love to hear your strategies for keeping your skills up, and how understanding your command is with concepts such as moonlighting.
You have to moonlight. Some commands are okay with it.
 

Doctor Bob

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My only concern is how I will keep up my skills following the completion of residency. This is important to me because I am very open to staying for my career with the hopes of eventually ending up at one of the major medical centers such as SAMMC in between deployments.
This is always a concern. And coming to SAMMC won't necessarily help with that. We have beaucoup residents here so the residents get first and often second crack at any procedures. If you don't moonlight, you'll get skill atrophy here as well. But that's the case with any academic center... staff do a lot of standing around with hands in pockets watching (ahem, excuse me, supervising) the residents.

So, most small facilities have low acuity and infrequent chance for procedures.
Large facilities have residents and infrequent chance for staff to do procedures.
Either way you have to moonlight.
 

Kilgoretrout 65

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Either way you have to moonlight.

I am straying from the ED here, but what happens to all of us if the nurses/commanders in charge decide that we should be doing "enhanced teamsteps" training instead of moonlighting?
There is an approval process in place for ODE and that always makes me nervous until the commander signs it. Of course some may flaunt the rules and do ODE anyway but that wouldn't be
the recommended course of action.
 

pgg

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Either way you have to moonlight.

I am straying from the ED here, but what happens to all of us if the nurses/commanders in charge decide that we should be doing "enhanced teamsteps" training instead of moonlighting?
There is an approval process in place for ODE and that always makes me nervous until the commander signs it. Of course some may flaunt the rules and do ODE anyway but that wouldn't be
the recommended course of action.
That's the risk. I've had about ten COs, XOs, directors, and dept heads since residency, and their attitudes toward ODE have ranged from supportive and understanding to overtly hostile. (And when I say "hostile" I mean that in every sense of the word ... open disdain for perceived greed as an already-filthy-rich doctor, my audacity to think I needed to do cases outside the military hospital, if I had time to work a 2nd job then I clearly didn't have enough collateral duties, leave requests for ODE were given a lower priority than leave requests for vacations, on and on and on.) Overall I've had very good ODE opportunities, but it's probably not the norm Navy-wide.

Mostly generally seem to 'get' the importance of skill maintenance. Others ... not so much. Once upon a time, one told me that the solution to my concerns about keeping current as an anesthesiologist was "when you deploy you'll be able to do more central lines" ... that statement made the short list of things in my left that left me genuinely speechless.

Overall I've had good fortune with a command that gets it, and has a reasonable ODE policy, so I've been able to consistently work on average 4 or 5 days per month out in town. Again though, probably not the norm Navy-wide.


And some of it depends where you're stationed. It can be easier to find ODE opportunities at small commands. There's a difference between being one of a couple military people in your specialty looking for work in the area, and being at a large military hospital where you have 26 colleagues also looking for weekend and evening shifts. I was a 1-of-1 for several years, now I'm a 1-of-2, and the local groups offer me far more hours than can possibly work. In a few months I'm PCS'ing back to one of the big 3 Navy hospitals, and I suspect that I won't be doing much moonlighting within 50 miles of the place.
 

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This is always a concern. And coming to SAMMC won't necessarily help with that. We have beaucoup residents here so the residents get first and often second crack at any procedures. If you don't moonlight, you'll get skill atrophy here as well. But that's the case with any academic center... staff do a lot of standing around with hands in pockets watching (ahem, excuse me, supervising) the residents.

So, most small facilities have low acuity and infrequent chance for procedures.
Large facilities have residents and infrequent chance for staff to do procedures.
Either way you have to moonlight.

From a urology standpoint I was pretty impressed with the SAMMC ED. Their consults were usually valid (per the attending and senior urologist's point of view while I was there, since I was a 4th year at the time my opinion doesn't count), and they had 9/10 done the appropriate workup. Just from being down there for consults it reminded me of the ED at my home institution where things were pretty fluid and organized. I really liked the SAMMC ED and thought they were great compared to other places where I rotated.