Air Force General Surgery

[toe2hand]

I read a few older posts describing the sorry state of practicing general surgery as an air force surgeon (low numbers of cases during deployment and at home, excessive politics, relatively poor technologies, etc...)

Can anyone give any recent information on this? I was considering the Air Force FAP during my general surgery residency, but now I'm wondering if it is going to be worth it. What's the point of becoming a surgeon, when you don't operate.

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[TheGoose]

are you strictly dedicated to the air force only?

 

[Doctor Bob]

I read a few older posts describing the sorry state of practicing general surgery as an air force surgeon (low numbers of cases during deployment and at home, excessive politics, relatively poor technologies, etc...)

Can anyone give any recent information on this? I was considering the Air Force FAP during my general surgery residency, but now I'm wondering if it is going to be worth it. What's the point of becoming a surgeon, when you don't operate.

The answer, as with everything, is it depends.
The docs at the base I'm at worked constantly while on deployment, but it was a lot of hernias and appendixes. At home here the politics are present, but not overwhelming. Most of the attendings shrug it off and go about their day. As for poor technology... well, ok I can't argue with that one. We don't have a DaVinci or anything like that, but again, we get the job done.

I think the biggest issue is with the diversity of cases, but that would probably be an issue at any military facility. Most of the patients in the military are young and healthy so the surgeries tend to be hernias, appendixes, the occasional gallbladder, breast lumps, lipomas, hemorrhoids, etc. We don't do many colectomies, liver cases, lung cases, and so on and so forth.

But that's just one facility. Maybe others are different, but I'd wager that most are like this one.

 

[EvoDevo]

I know that Wilford Hall does Gastric Bypass and some Trauma surgery in addition to the what Doctor Bob stated. I was involved in many of those as of last fall.

 

[Galo]

I read a few older posts describing the sorry state of practicing general surgery as an air force surgeon (low numbers of cases during deployment and at home, excessive politics, relatively poor technologies, etc...)

Can anyone give any recent information on this? I was considering the Air Force FAP during my general surgery residency, but now I'm wondering if it is going to be worth it. What's the point of becoming a surgeon, when you don't operate.

I am one of the old farts as I've been called by some of the cheerleaders here. I was an active duty AF surgeon for 6 years, and continue to communicate with surgeons in the AF.

If you want to be a surgeon, and do surgery and have a broad base to operate on, the single biggest mistake you could make in your early career would be to pick the AF. The smallest most militarily devastated branch of the military run by self serving nurses, medical service corps officers, and inept physicians who know its better for them to pretend to run things than to actually be doing patient care. Of course, there are exceptions, but they are few and far between.

Wilford Hall is slated to close. That leaves Wright-Patt, (where I did a 2 yr sentence), Biloxi, (delapidated and not even sure if it has an accredited residency at this point), and a few others, as "major" medical centers which really means super outpatient clinic with few if any diversity or really sick patients.

Call up as many places as you want, and talk to majors and capitains. Along with the severe mediocrity, you have an unfair deployment system that may find you in the middle of a place where you will act as a general medical officer, or where you will be doing trauma for up to 6 months. There are about 60 surgeons left in the AF, with a nearly 100% attrition rate, and alot of those are not operating.

If you PM me with you email address, I will send you the train wreck lecture that was penned yrs ago, and is now become truth.

Ask around, read this forum.

Good luck

 

[toe2hand]

Thanks Galo... I've sent you a PM.

As for the other question, I was only considering the Air Force.

Another major detractor is the likelihood of not obtaining fellowship after residency because of immediate contract obligations. I feel terrible, but I am probably going to have to let my recruiter know that I want my application pulled.

 

[BOHICA-FIGMO]

I know that Wilford Hall does Gastric Bypass and some Trauma surgery in addition to the what Doctor Bob stated. I was involved in many of those as of last fall.

How much of that is going to BAMC? When I got out of the Air Force 4 yrs ago, we had surgeons at my base who had to perform ALL (100%) of their surgeries at downtown civilian hospitals because our Med group had closed it's OR suite. Outside of Wright-Pat, Keesler, and Wilford Hall (and maybe Travis?), I don't know of any USAF bases with active ORs anymore.

 

[DrMetal]

How much of that is going to BAMC? When I got out of the Air Force 4 yrs ago, we had surgeons at my base who had to perform ALL (100%) of their surgeries at downtown civilian hospitals because our Med group had closed it's OR suite. Outside of Wright-Pat, Keesler, and Wilford Hall (and maybe Travis?), I don't know of any USAF bases with active ORs anymore.

Just outta curiosity, Do you prior AF folks think that the diversity/volume problems in GS (or possibly in all of AF medicine) has anything to do with the fact that most AF bases are not in huge, metropolitan (or even DOD-populated) parts of the country?

I mean when you think about it, the DOD population at places like WP (OH), Keesler (Biloxi) are a fraction of what you'd find in places like San Diego, DC, or even HI.

So how much do you think the geography matters?

 

[a1qwerty55]

As for the other question, I was only considering the Air Force.

Why would you only consider AF? Do you look especially good in blue?

 

[Doctor Bob]

Biloxi, (delapidated and not even sure if it has an accredited residency at this point)

It is on this sentence alone that it's clear that Galo isn't quite as in touch with AF surgery anymore as he/she may think. The hospital reopened not long after Katrina with some renovations, and yes our residency is accredited.

Another major detractor is the likelihood of not obtaining fellowship after residency because of immediate contract obligations.

Of my current attendings, one did breast fellowship, one did trauma/critical care fellowship, one did vascular fellowship, one did laparoscopic fellowship all through the air force (and 2 are not fellowship trained).

A handful of my attendings also recently went through a contract renewal cycle, and dammned if they didn't all re-sign for another 2 years. One of them was just a month or two back from deployment when he put pen to paper. Now it's true that as a resident I can't talk about the full air force surgery experience because I haven't been deployed and as a resident I get shielded from a bit more of the paperwork than the attendings. So all I have to go on is the lectures we get on one topic or another when the attendings start talking about "well, when I was in Qatar/Afghanistan/insert deployment location, we did X, Y and Z on a daily basis."

Look, most of what you're going to get on SDN is people bitching about one thing or another, and very few people saying positive things. Why? Because that's the general nature of things... people are more vocal when they have something to complain about. People who are satisfied with the way things are tend to be less energetic about taking the time to write out long explanations about why. They're happy and they've moved on to do something else. Unhappy people dwell on an issue and want to make sure everyone else knows why they're unhappy. You'll encounter this again and again in medicine.

It's all point and counterpoint. I say the AF is the way it is now because of talking to my attendings, other people say it is the way it is now because they're talking to old military friends... who's to say who is right? Like with everything, it's probably somewhere in the middle. Neither one of us has a monopoly on the truth of the current status. And in the end it really comes down to perception. I'm enjoying my time in the AF and get good vibes from my attendings, so that's probably why I like it. Other people have bad experiences for one reason or another so they hate it and don't look back fondly. That's not to say that they're wrong and I'm right.

The best way to make sure you have a good military experience is to go into it with your eyes open and learn as much as you can. The people who seem to have the worst time are those who didn't learn enough before starting and got blindsided with one thing or another. Don't take any one person's comments as gospel, especially on here... we tend to be a very whiny bunch. And don't believe your recruiter about things either. He/she isn't a doctor and doesn't know what it's like.

[/rant]

 

[TheGoose]

Off topic: We need more comments like the one above from DoctorBob. Kudos on actually taking the time to formulate a coherent, experience-based post to rebut comments that you disagree with. This is the type of discussion that this forum needs when considering pro vs. con rather than personal attacks/tirades on certain members.

 

[EvoDevo]

How much of that is going to BAMC? When I got out of the Air Force 4 yrs ago, we had surgeons at my base who had to perform ALL (100%) of their surgeries at downtown civilian hospitals because our Med group had closed it's OR suite. Outside of Wright-Pat, Keesler, and Wilford Hall (and maybe Travis?), I don't know of any USAF bases with active ORs anymore.

Good question. I'm not sure. There has been ongoing talk of making WH into a "Super Clinic" with the OR stuff heading to BAMC. Don't know when that is slated to really happen though.

I did know that the surgeons over there complained a lot, though how much was standard physician bitching v. standard military bitching v. something more I will not even attempt to address. I do know that the level of trauma that surgeons see over there is pretty weak, even though it's a Level I. Most of the trauma goes to the other major Level I in the city.

With respect to fellowships, it seemed that many of the attendings got to do fellowships: Trauma, Bariatrics, Laparoscopic, Colorectal are the ones that stand out.

 

[toe2hand]

Why would you only consider AF? Do you look especially good in blue?

Actually, yes. However, I come from a Air Force family (3 generations). It is what I know and the branch of service I was willing to join.

A couple of posters have stated that fellowships are possible to obtain during the Air Force. Considering there are a limited of number of slot assignments per fellowship the AF needs to fill, do they give preference to those coming from an actual AF residency program vs. those who are completing a civilian program and are enrolled in FAP? And are those fellowships obtained directly after residency or after completing original contractual agreements?

 

[DrMetal]

Actually, yes. However, I come from a Air Force family (3 generations).

Really?! How so, the AF isn't even that old (circa 1945)

So your only motivation in picking the AF is a familial influence? As loyal as you may be to your family (and as oftern as this happens, you're not the first), I would not select a branch solely based on heritage.

Selecting a branch based on geography, opportunities, training programs (as you're finding out, the quality/quantity of which can vary from service to service) . . . would be more reasonable.

In any case, just b/c you turned in an application/form to a rectuiter doesn't mean you've abided yourself to anything. You can pull it any time you like (up until the point of commissioning).

 

[toe2hand]

Rather, 2nd generation. (2 direct family members active, 1 retired). I have taken what you said in consideration with respect to military branches.

BTW

The National Security Act of 1947 became law on July 26, 1947. It created the Department of the Air Force, headed by a Secretary of the Air Force.

http://www.af.mil/history/overview.asp

 

[crazybrancato]

I am one of the old farts as I've been called

for the record, I don't think I ever called you an old 'fart' , old 'man', maybe.

by some of the cheerleaders here.

I take it you're talking about me, you seem to love this word. I don't know why you label me as such, I don't think everything is all wonderful and rosy about the mil or milmed. I just contest your rampant negativity and notions that it's a total lost cause. you just can't fathom how others may want to serve and make something good out of the situation, can you??? I'm sorry you had such a bad experience, but yours isn't necessarily transferable to eveyone else's situation.

It is on this sentence alone that it's clear that Galo isn't quite as in touch with AF surgery anymore as he/she may think.

No??? Do you mean to challenge the mighty Galo? Careful, he'll try to bully the crap out of you here, and label you as a 'cheerleader' . . . to which you probably wont (shouldn't) reply, b/c you'll be off doing better things. godspeed.

 

[TheGoose]

No??? Do you mean to challenge the mighty Galo? Careful, he'll try to bully the crap out of you here, and label you as a 'cheerleader' . . . to which you probably wont (shouldn't) reply, b/c you'll be off doing better things. godspeed.

this was the whole point of my last post. I actually think that Galo [correct me if i'm wrong, Galo] would respect the fact that the person making an argument against him has 1. been in the system, and 2. has experience that can justify his argument in favor of the system, as opposed to off-message personal attacks/rants. Granted, Galo is definitely not pro-milmed but he gives his rationale for being such and is generally bashed by people for it who don't have the experience to offer contradictory information. Doctorbob has done just this, and that is how you can start an actual conversation about the issues

 

[Galo]

this was the whole point of my last post. I actually think that Galo [correct me if i'm wrong, Galo] would respect the fact that the person making an argument against him has 1. been in the system, and 2. has experience that can justify his argument in favor of the system, as opposed to off-message personal attacks/rants. Granted, Galo is definitely not pro-milmed but he gives his rationale for being such and is generally bashed by people for it who don't have the experience to offer contradictory information. Doctorbob has done just this, and that is how you can start an actual conversation about the issues

Thank you for diplomatically pointing this out goose. Its absolutely true that after Katrina, Keesler was closed for a while, and did NOT have accreditation. So they do now, as was pointed out by Dr. Bob, and I have no reason to not believe it. I do find it odd that surgeons at his base signed up for more. I imagine the 300K carrot being waved had something to do with it, as well as possible staying in a spot where they are acutally doing something. I hope Dr. Bob finds himself in such a position, and not in a superclinic doing minimal work while his skills deteriorate.

Crazy, your persistent personal attacks based on absolutely nothing to do with military medicine, as you admitedly have NO such experience, make you seem more and more like a troll. You can contest my rampant negativity when you have some actual facts that you can refute it with. So far you have NONE. Are you even in medical school yet??

When people in the system come with factual information, (its easy to verify that Keesler is an ACGME accredited program), it does offer a platform for intelligent discussion. I do not doubt that people want to join they system and be succesful at being physicians. I think the vast majority do not fully know how bad the system is, and thus make assumptions, and have expectations that will never be fullfilled.

Anyone else with factual information about general surgery in the AF, can surely chime in.

 

[mslall]

Sorry to redirect here, but, what do you do now Galo? Are you still a general surgeon? or have you gone on to some sort of fellowship post military? I'm sure you've posted this at some point, i think i've just missed it.

 

[Galo]

Sorry to redirect here, but, what do you do now Galo? Are you still a general surgeon? or have you gone on to some sort of fellowship post military? I'm sure you've posted this at some point, i think i've just missed it.

I am a general surgeon specializing in minimally invasive surgery and bariatrics at a private hospital. I still have friends in military medicine, and 3 weeks ago talked to one who is still in his terminal leave, and confirmed and even gave me more horror stories about the current putrid state of medicine in the Air Force.
As time goes by I feel less compelled to log on and have to fight off people who fight the inevitable with emotion rather than reason or fact. However, my therapy is not complete, and I feel people going in need to have an understanding not attainable by talking to recruiters, or physicians who have drank the Kool aid.

 

[teacherman84]

Really?! How so, the AF isn't even that old (circa 1945)

Its possible...my older and younger brother were the 4th generation of airmen in family.

 

[TheGoose]

Its possible...my older and younger brother were the 4th generation of airmen in family.

in a family of what....Rabbits?!?!? j/k

 

[AFATexan]

I'm currently an MS4 coming up on the military match this year and I intend to apply for a surgical residency. Are there any current residents at WHMC, WP/WS, Keesler, or Travis who could give me some insight about the quality of education at these programs? How much volume/variety of cases are available? Also, I noticed that Nellis was approved for 2 surgical residents this year.Does anyone know anything about that program?

 

[mitchconnie]

I'm currently an MS4 coming up on the military match this year and I intend to apply for a surgical residency. Are there any current residents at WHMC, WP/WS, Keesler, or Travis who could give me some insight about the quality of education at these programs? How much volume/variety of cases are available? Also, I noticed that Nellis was approved for 2 surgical residents this year.Does anyone know anything about that program?

I made a couple general comments about the Nellis/Keesler situations in the "AF forecast board results" thread. Feel free to PM me if you want to hear my take on the current training situation with General Surgery in the AF. I just left the AF, and have now been involved with various military and civilian GS programs for almost 14 years.