Air Force Medicine FAQ's (after the new 2009 budget)

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hwatson

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Many are wondering about the Air Force and how the AF medical corps trends are developing. This will address the current trends.
This is not an opinion but just pointing out some of the decisions AF has implemented. I am basing my critique on 14 years in the military and having worked with all 3 branches at the national level.

AF is currently having funding issues. Because the AF is no longer able to depend on the DOD for the maintenance of their air craft, they are trying to figure out how to decrease expenses. They are being forced to follow the same rules that the Army is governed by. The following are the results of this budget deficit.

1) AF is cutting the total number of personnel in the Force. This means fewer people to care for and means that many of the specialties will/already have been cut from their ranks. In other words, they will stop offering residencies in a lot of the specialties. PM&R and Orthopedics are two examples.
The air force will adopt/continue a trend of making medical school graduates enter flight surgery or a primary care specialty. As evidence by their match rate around 50% and the fact that nearly 50% opted for flight medicine.

2) AF is now seeing fewer dollars dedicated to housing and bases. The playing field is leveled and the army and navy are now providing comparable housing and benefits to their doctors. (this is not true of a general airman vs soldier).

3) Air Force does still allow deferment into a civilian residency. In Fact, they still maintain the most deferment training slot in the military. However, they only allow certain specialties. This means that you still have to match in that specialty and then match civilian. Keep in mind that only when the military slots are filled that the air force allows deferments to happen.

4) your chances of interacting with the boys and girls fighting on the ground are severely diminished. The Air Force has removed itself from a rehab or long term care role of the heroes that fight in the wars. We only have a triage and flight role. Once the people are stable we pass them to the Army for care. This is seen by the lack of PM&R in the AF. The only chance you get to help those heroes is to go into orthopedic surgery. So don't be disillusioned into thinking you are going to help the people injured. You are only making them stable enough to go to an army facility for long term care.

5) End of the day. You still get to help people and the trauma experience is still the greatest in the world. The AF is good as long as you don't want to specialize.

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The air force will adopt/continue a trend of making medical school graduates enter flight surgery or a primary care specialty. As evidence by their match rate around 50% and the fact that nearly 50% opted for flight medicine.

This is the only point that I'm curious about in your post. I have the match results dating about 5 years back, with the exception of this year as the results were not made available. As we all know, the AF doesn't release match stats for specific specialties, but what I can clearly tell from the past match results is that far less than 50% (actually, somewhere around 25%) of those participating in the match were placed into a 1 year internship (a track usually leading to flight surgery). I don't know how many of that 25% went on to match when reapplying during their intern year, but even if you assume none did your numbers are still off. I'm also not sure exactly what you mean by "match rate", but I'm guessing that you're talking about the % of applicants that match into categorical residency positions. If this is the case, again, the past few years (? 2009 match) don't bear out these statistics.

Let me know if I am way off base, I'm curious where you came up with these numbers.
 
This is the only point that I'm curious about in your post. I have the match results dating about 5 years back, with the exception of this year as the results were not made available. As we all know, the AF doesn't release match stats for specific specialties, but what I can clearly tell from the past match results is that far less than 50% (actually, somewhere around 25%) of those participating in the match were placed into a 1 year internship (a track usually leading to flight surgery). I don't know how many of that 25% went on to match when reapplying during their intern year, but even if you assume none did your numbers are still off. I'm also not sure exactly what you mean by "match rate", but I'm guessing that you're talking about the % of applicants that match into categorical residency positions. If this is the case, again, the past few years (? 2009 match) don't bear out these statistics.

Let me know if I am way off base, I'm curious where you came up with these numbers.

Ya, I agree with above. Even with my class, which got the stinky end of the GMO stick, only about a third got the GMO treatment.

Think about that though, especially when your recruiter floats that 95-98% chance of matching that I vividly remember seeing on the AFPC website when I was a med stud.

Basically though, the AF - particularly the line side - sees medicine as an expensive and rather undesirable drain on resources that have become more scarce since various budget cuts and trimmings. It is very interested in clipping out those big expensive milmed centers (where most GME takes place btw) and turning them into glorified "super-clinics". Or to put it another way, RVU mills staffed entirely by primary care physicians, with the complicated stuff being referred out to civilian institutions via Tricare.

This is not a bad concept in general, unless you happen to be interested in acquiring a medical education. Then, well, it's horrible.

And as these things typically turn out, no one wants to be the hatchetman and end things in one fell swoop. So they'll let most of these once-respected milmed centers sort of rot out until things inside are lousy enough to where it can be said that shuttering the doors is an act of mercy/the best thing for the patients and staff. Wilford Hall is Exhibit A. This process takes years and the places involved will not be good places to work in the meantime.
 
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This information came from a survey by the recruiting and retention branch. It took answers of doctors who weren't able to get their first choice or chose another specialty because they were afraid of being slotted to GMO. I am trying to find that link and will post the article when I find it again.
 
You also make a good point. I failed to write that this specific number came from ER applicants. But that the match rate was similar to those who put other specialties as their first choice.
 
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This information came from a survey by the recruiting and retention branch. It took answers of doctors who weren't able to get their first choice or chose another specialty because they were afraid of being slotted to GMO. I am trying to find that link and will post the article when I find it again.

This survey sounds like heresay from angry applicants who didn't get what they wanted in the AF match. Probably not the most knowledgable or unbiased people to ask. If you find the article I'd be interested to read it.
 
This survey sounds like heresay from angry applicants who didn't get what they wanted in the AF match. Probably not the most knowledgable or unbiased people to ask. If you find the article I'd be interested to read it.

:laugh:
 
Disclaimer: I am pretty cynical about the mediocre GME programs in the military. It's especially sad because a generation ago Walter Reed, Bethesda, etc. really did have outstanding training programs.

GME is not a reward, it is an essential part of becoming a physician, and far more important than even medical school. Here's how I look at it: would you prefer for your surgeon to be someone with an MD from Harvard who did his gen surgery residency at a USAF hospital or would you prefer a FMG or a graduate of an average US allopathic school who did residency/fellowship at Mayo or MGH? This is a no brainer.

What kills me is how strong medical students and interns have their careers derailed by a system that offers a tiny fraction of the opportunities that their civilian counterparts have. Yes, in the civilian match some people don't get what they want. However, when that happens it is usually because the applicant was not strong enough for the field. Take a moderately competitive field like anesthesia -- 90% of US allopathic grads will get a spot. Now consider the USAF match where not even half of those applicants to anesthesia will get a spot. A solid but average student will probably not match at all into AF anesthesia at all, when he/she would be fine at many civilian programs (maybe not MGH or Hopkins, but a solid university program). The HPSP students who are strong enough to match into AF anesthesia have solid, at least above average credentials. These are the candidates who probably could get anesthesia interviews at Hopkins or MGH. Instead they hustle to get a spot at Wilford Hall or Travis where their most difficult cases are laparoscopic cholecystectomies. The same "medical centers" where the SICU is empty except when the choles go bad and patients end up septic -- which apparantly is not unheard of in miliatry hospitals.:idea: Meanwhile, their civilian counterparts who in some cases were less impressive medical students are learning to become excellent clinicians at solid university programs.

In sum, Air Force HPSP is often a terminal condition that ruins careers before they even leave the runway. If you are stuck, do four and out (I'm Navy and am doing just that). Work hard as a GMO/FS/UMO, don't be complacent, READ, and take care of your people to the best of your ability; they deserve nothing less. Then GTFO. This system is only going to get worse.

Quality GME is worth waiting for. At some point you have to have enough respect for yourself to do your time and sever your ties to milmed.

I agree with a lot of the points you are making, but I think it's still reasonable to differentiate between the specialties to some degree. For example, I'm a med4 who matched into a military peds spot and am very positive about the opportunities that are ahead of me. I visited all of the peds programs that AF applicants can apply to, and I think all are solid programs. From what I hear, the same can be said for family med which carries the most AF GME weight as it has the most spots in the match. So, while I think students considering HPSP should think long and hard about the possible GME limitations they may encounter, I would argue that its not a complete black hole especially if one is leaning towards primary care.
 
I agree with a lot of the points you are making, but I think it's still reasonable to differentiate between the specialties to some degree. For example, I'm a med4 who matched into a military peds spot and am very positive about the opportunities that are ahead of me. I visited all of the peds programs that AF applicants can apply to, and I think all are solid programs. From what I hear, the same can be said for family med which carries the most AF GME weight as it has the most spots in the match. So, while I think students considering HPSP should think long and hard about the possible GME limitations they may encounter, I would argue that its not a complete black hole especially if one is leaning towards primary care.

Pls f/u after 6 mos of actual residency.
 
Many are wondering about the Air Force and how the AF medical corps trends are developing. This will address the current trends.
This is not an opinion but just pointing out some of the decisions AF has implemented. I am basing my critique on 14 years in the military and having worked with all 3 branches at the national level.

AF is currently having funding issues. Because the AF is no longer able to depend on the DOD for the maintenance of their air craft, they are trying to figure out how to decrease expenses. They are being forced to follow the same rules that the Army is governed by. The following are the results of this budget deficit.

1) AF is cutting the total number of personnel in the Force. This means fewer people to care for and means that many of the specialties will/already have been cut from their ranks. In other words, they will stop offering residencies in a lot of the specialties. PM&R and Orthopedics are two examples.
The air force will adopt/continue a trend of making medical school graduates enter flight surgery or a primary care specialty. As evidence by their match rate around 50% and the fact that nearly 50% opted for flight medicine.

2) AF is now seeing fewer dollars dedicated to housing and bases. The playing field is leveled and the army and navy are now providing comparable housing and benefits to their doctors. (this is not true of a general airman vs soldier).

3) Air Force does still allow deferment into a civilian residency. In Fact, they still maintain the most deferment training slot in the military. However, they only allow certain specialties. This means that you still have to match in that specialty and then match civilian. Keep in mind that only when the military slots are filled that the air force allows deferments to happen.

4) your chances of interacting with the boys and girls fighting on the ground are severely diminished. The Air Force has removed itself from a rehab or long term care role of the heroes that fight in the wars. We only have a triage and flight role. Once the people are stable we pass them to the Army for care. This is seen by the lack of PM&R in the AF. The only chance you get to help those heroes is to go into orthopedic surgery. So don't be disillusioned into thinking you are going to help the people injured. You are only making them stable enough to go to an army facility for long term care.

5) End of the day. You still get to help people and the trauma experience is still the greatest in the world. The AF is good as long as you don't want to specialize.

You speak as one with authority, yet only 4 posts. A couple of things you mention have me scratching my head wondering just how good your sources are.

First is when you talk about doctors' housing. No doctor I know cares a lick about what housing the military provides them. We all get the same BAH and as near as I can tell, nearly all military docs own a home off base, a few rent a home off base, and very few actually stay in on base housing (I know of 1 at my base.) At a nearby Navy hospital, it's the same (base doesn't even have housing.) It's also similar at a nearby Army hospital, although I confess I don't know a lot of those docs very well, but the ones I do live off base.

Second, the trauma experience is NOT the greatest in the world. Most AF doctors come in and do their four years. They may take care of trauma patients during 1-2 6 month deployments, if they're lucky. If they're unlucky like me, they will NEVER see a true trauma patient in a military facility in their four years (true story...and I'm an emergency doc. Not one.) If that's the greatest in the world, well, so be it. But I see a lot more trauma at the local knife and gun club 1-2 days a month when I'm moonlighting. In fact, without that moonlighting experience, we'd all be far too rusty to take care of trauma patients when our turn to go to Balad or Bagram comes up.

Third, the AF is not making anyone enter a primary care specialty. They may make you do a GMO tour as a primary care doc, but that is very different from making you be a certain type of specialist. The overall match rate was significantly better than 50% last I checked, although a few fields are that low (EM was the year I applied.)

Fourth, why would the AF interact with the boys and girls fighting on the ground? It isn't the AF's job to fight on the ground last I checked. If you want to take care of grunts join the Navy or the Army. If you want to take care of a few pilots and a LOT of support personnel and dependents, join the AF. You think Army docs are all busted up about not being able to take care of cyberwarriors and satellite monkeys? I doubt it. On the other hand, I do know lots of AF docs who have filled army slots "in lieu of", usually for 12 months at a time. They REALLY enjoyed that (sarcasm). In fact, the biggest hospital in Iraq (Balad) became an AF facility basically because Army medical was spread too thin. But don't tell all those guys who are there that they aren't taking care of grunts. They're just "triage and flight folks." If you really want to take care of these guys long term, go work for the VA. And what makes you think Ortho is somehow different from General surgery, ophthalmology etc. Deployments and day to day practice are awfully similar from where I sit (with regards to how many injured grunts they take care of.)

Fifth, "The Air Force is good as long as you don't want to specialize?" I only know about 4 or 5 GMOs at my base, most in flight med, one in primary care clinic. All the rest of us trained straight through "specializing." Our day to day practice kind of blows, but saying it sucks if you want to specialize isn't exactly hitting the nail on the head.

14 years in the military and working with all 3 branches at a national level is significant, but I'm not getting the impression you've actually worked in military medicine. Correct me if I'm wrong (and thank you for you service, I couldn't take this nonsense for 14 years).
 
Dear Active Duty MD,
You make a few great points and I don't disagree with your post. I will elaborate a little more. I do have a lot of experience with the Medical Corps and have current and prior military doctors as my sources. I personally was involved in administration and took most of my information from docs that were retiring or getting out. As for my 4 posts....That is a long story with access problems. This post was in response to a request a large group of students at a conference.

I agree with your housing assessment. Most do get houses off base. But my point was that the Air force used to be able to brag about a better family life and better housing. This was seen by the personnel get extra money for "sub standard housing". This was different because the sub standard housing was the housing that the other branch's docs lived in. This is no longer the case. Air force no longer gets more money (per airman) than the other branches and the quality of life of the AF is the same. (long story but DOD no longer pays for all of AF plane maintenance...this caused huge budget cuts across the force.)

The trauma experience in the states is just as you described. However, if you get to serve in Germany or in a combat theater, the trauma is truly amazing and will blow any civilian program away. The injuries to a soldier/marine seen after an IED is something most civilian docs will never handle. So if you want that great experience, then volunteer to deploy.

As for the match rate, I agree that in the 5 primary care specialties the match rate is significantly higher. However, if you desire a specialty, you should have gone army. The latest numbers (of total personnel in the force) are shrinking and medical will follow suit. This means primary care will maintain and subspecialties will continue to be cut and civilian contractors will pick up the slack. The current base being tested for this is HILL AFB. (I don't have an article to back that up. Just people I know at Hill.)

Your Fourth point is almost correct. We are seeing airmen getting injured in supply runs on the roads. They get hit with IEDs and injured just like anyone else. This leads me to my point....The only people able to help in their rehabilitation are ortho and the army. The rest of us just stabilize and fly them out. It isn't that we aren't capable but that the AF won't accept the mission.
I agree with your assessment of the hospitals being AF. The same thing is happening in Bagram. But the average time from injury to exfil to Germany was/is 72 hours. Then we send the injured to Washington or San Antonio to get the long term care. Both are army facilities.

The reason that I believe ortho is different is that I spoke with the personnel at "wounded warrior program" and "the center for the intrepid" and both places indicated that the AF only has orthopods helping with the care. The rest are army (some navy). They also commented that the AF sends many of the wounded airmen to civilian personnel to be rehabbed. (even though they pay with "Tricare" and the wounded are often put last due to decreased reimbursement). This also presents the problem that the many of the best civilian trained docs are not accepting tricare/medicaid/medicare.

I believe I already addressed the fifth point. Cutting the total force is going to mean cuts to specialization, look at HIll AFB as an example of what is to come.......

Finally, I also agree that you are in the right place if you don't want to take care of the boys and girls on the ground. However,due to that mentality, look for budget cuts to the AF. Current budgets do take the branch's role in theater into account. That is why the AF is trying to get more airmen into the ETT (embedded tactical trainer) role inside both theaters. Although their role is not increasing much and the budget shows.

You make great points. Keep it up. It helps all of us to understand more. Would also love to hear about AF EM. Please post something on your day to day experience. That is still on my list.
 
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Dear Active Duty MD,
You make a few great points and I don't disagree with your post. I will elaborate a little more. I do have a lot of experience with the Medical Corps and have current and prior military doctors as my sources. As for my 4 posts....That is a long story with access problems. This post was in response to a request a large group of students at a conference.

I agree with your housing assessment. Most do get houses off base. But my point was that the Air force used to be able to brag about a better family life and better housing. This was seen by the personnel get extra money for "sub standard housing". This was different because the sub standard housing was the housing that the other branch's docs lived in. This is no longer the case. Air force no longer gets more money (per airman) than the other branches and the quality of life of the AF is the same. (long story but DOD no longer pays for all of AF plane maintenance...this caused huge budget cuts across the force.)

The trauma experience in the states is just as you described. However, if you get to serve in Germany or in a combat theater, the trauma is truly amazing and will blow any civilian program away. The injuries to a soldier/marine seen after an IED is something most civilian docs will never handle. So if you want that great experience, then volunteer to deploy.

As for the match rate, I agree that in the 5 primary care specialties the match rate is significantly higher. However, if you desire a specialty, you should have gone army. The latest numbers (of total personnel in the force) are shrinking and medical will follow suit. This means primary care will maintain and subspecialties will continue to be cut and civilian contractors will pick up the slack. The current base being tested for this is HILL AFB. (I don't have an article to back that up. Just people I know at Hill.)

Your Fourth point is almost correct. We are seeing airmen getting injured in supply runs on the roads. They get hit with IEDs and injured just like anyone else. This leads me to my point....The only people able to help in their rehabilitation are ortho and the army. The rest of us just stabilize and fly them out. It isn't that we aren't capable but that the AF won't accept the mission.
I agree with your assessment of the hospitals being AF. The same thing is happening in Bagram. But the average time from injury to exfil to Germany was/is 72 hours. Then we send the injured to Washington or San Antonio to get the long term care. Both are army facilities.

The reason that I believe ortho is different is that I spoke with the personnel at "wounded warrior program" and "the center for the intrepid" and both places indicated that the AF only has orthopods helping with the care. The rest are army (some navy). They also commented that the AF sends many of the wounded airmen to civilian personnel to be rehabbed. (even though they pay with "Tricare" and the wounded are often put last due to decreased reimbursement). This also presents the problem that the many of the best civilian trained docs are not accepting tricare/medicaid/medicare.

I believe I already addressed the fifth point. Cutting the total force is going to mean cuts to specialization, look at HIll AFB as an example of what is to come.......

Finally, I also agree that you are in the right place if you don't want to take care of the boys and girls on the ground. However,due to that mentality, look for budget cuts to the AF. Current budgets do take the branch's role in theater into account. That is why the AF is trying to get more airmen into the ETT (embedded tactical trainer) role inside both theaters. Although their role is not increasing much and the budget shows.

You make great points. Keep it up. It helps all of us to understand more. Would also love to hear about AF EM. Please post something on your day to day experience. That is still on my list.

Day to day EM in the states is about like this:

Day shift
7 am: 5 patients check in, 4 sent in by their supervisor for sick call. 2 have vomiting, 2 have URIs. 1 hurt his back in PT. I write a profile for the back pain, give some zofran to each of the vomiters, send the one that puked 5 times overnight home on 24 hours of quarters, send the one who puked one time back to work. Write prescriptions for motrin and similar over the counter meds for the URIers and send them back to work.
8 am: 7 more patients check in. My partner comes on and we start working through them. 4 of them are Navy and 3 more are AF sick call folks. A UTI from a nurse upstairs that couldn't get an appointment in clinic. First pelvic exam of the day, a vaginal discharge, probably BV. A sprained ankle from PT this morning. Wondering why the intel squadron gets to play ultimate for PT and all we do is run and do arm circles.
9 am: 6 more patients check in, including the first dependents of the day. Two kids with fevers for less than 6 hours, neither of which needs any testing. A 17 year old with a sore throat. Finally, an emergent complaint, a 48 year old check pain. EKG normal, enzymes normal. Sounds more like chest wall pain but the guy has risk factors. Arrange for a treadmill stress test (the only kind available at the MTF.)
10 am: Now have 15 patients waiting. My partner has another chest pain. I get an acute on chronic low back pain, a vag bleed in early pregnancy (no bleeding on examand IUP confirmed in an outside ED 2 days previously-no emergency here but the OB clinic couldn't get her in.) Two more kids who couldn't get into peds clinic this morning for their sniffles (an appointment was made for tomorrow, but they couldn't wait.)
11 am: A 25 year old woman with a week of ST and congestion insisting on a strep test and a flu test. Strep's negative. I spend 10 minutes explaining why she doesn't need a flu test since it is inaccurate for H1N1 and won't change my management. She remains unconvinced and becomes upset. Not a battle worth fighting, I order the test (neg of course) and discharge her. Another ankle sprain, this one via EMS from the gym. Partner does another chest pain, this one gets transferred to another facility. Another "I think I have a UTI"-you don't go back to work. "I think I have a sinus infection, that's what this was last time." How long have you had symptoms? "Three hours." You don't have a sinus infection.
12 am: We're way in the hole now and the next doc doesn't come on for another hour. We find out CHCS is down in the whole facility and the other clinics have ground to a halt. Apparently we're the only ones with a back-up paper system. Lab is sending couriers with the labs on paper. We're hand-writing orders for x-rays, then going over to radiology to look at them on their monitor.
1 pm (AKA 1300 for you military types): Next doc comes on and the pile of charts reverses directions, beginning to shrink rather than grow. We designate one of ourselves as "the fast track doc" and try to see patients and document them in 10 minutes or less. I get a guy who's here for a sprained ankle. His entire foot is bruised. It turns out his INR is 6. His other leg is swollen too, and he has crackles in his lungs and admits 4 days of dyspnea on exertion. I order some labs, and x-ray, and prepare to transfer the patient to a facility with a cardiologist.
2 pm: First EMS run of the day. Comes across the radio as auto-pedestrian injury with a bleeding head wound. Security forces trying to find out where the hit and run driver went. Medics arrive. The reason no car is there is because none hit her, she just tripped. 2 cm head lac comes back, gets head scanned due to being on plavix and being old. Scan's negative and she goes home with a couple of staples.
3 pm: Find out partner is being deployed with the army, leaving 2 months sooner than expected. The rest of us will have to pick up his shifts. He's disappointed because he won't be practicing medicine on this deployment, and certainly won't be doing much trauma....too busy teaching foreigners how to do medicine US style without US style equipment, expertise, or medications. Wouldn't be so sad if he were more than a year out of residency.
4 pm: Shifts over, going home. Wrap up a few admin tasks and get out the door.

Let me know if you want to hear about a deployed day. There would be more diarrhea and rashes, and if you're lucky, a trauma that doesn't come from the commissary.
 
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Wow, that is perfect. I appreciate your candor and the humor. That helps me see a little deeper into the situation. Thanks for taking the time to write it out.

Sounds as if you will do payback and move on?.?. Hope things improve for you.
 
Day to day EM in the states is about like this:

Day shift
7 am: 5 patients check in, 4 sent in by their supervisor for sick call. 2 have vomiting, 2 have URIs. 1 hurt his back in PT. I write a profile for the back pain, give some zofran to each of the vomiters, send the one that puked 5 times overnight home on 24 hours of quarters, send the one who puked one time back to work. Write prescriptions for motrin and similar over the counter meds for the URIers and send them back to work.
8 am: 7 more patients check in. My partner comes on and we start working through them. 4 of them are Navy and 3 more are AF sick call folks. A UTI from a nurse upstairs that couldn't get an appointment in clinic. First pelvic exam of the day, a vaginal discharge, probably BV. A sprained ankle from PT this morning. Wondering why the intel squadron gets to play ultimate for PT and all we do is run and do arm circles.
9 am: 6 more patients check in, including the first dependents of the day. Two kids with fevers for less than 6 hours, neither of which needs any testing. A 17 year old with a sore throat. Finally, an emergent complaint, a 48 year old check pain. EKG normal, enzymes normal. Sounds more like chest wall pain but the guy has risk factors. Arrange for a treadmill stress test (the only kind available at the MTF.)
10 am: Now have 15 patients waiting. My partner has another chest pain. I get an acute on chronic low back pain, a vag bleed in early pregnancy (no bleeding on examand IUP confirmed in an outside ED 2 days previously-no emergency here but the OB clinic couldn't get her in.) Two more kids who couldn't get into peds clinic this morning for their sniffles (an appointment was made for tomorrow, but they couldn't wait.)
11 am: A 25 year old woman with a week of ST and congestion insisting on a strep test and a flu test. Strep's negative. I spend 10 minutes explaining why she doesn't need a flu test since it is inaccurate for H1N1 and won't change my management. She remains unconvinced and becomes upset. Not a battle worth fighting, I order the test (neg of course) and discharge her. Another ankle sprain, this one via EMS from the gym. Partner does another chest pain, this one gets transferred to another facility. Another "I think I have a UTI"-you don't go back to work. "I think I have a sinus infection, that's what this was last time." How long have you had symptoms? "Three hours." You don't have a sinus infection.
12 am: We're way in the hole now and the next doc doesn't come on for another hour. We find out CHCS is down in the whole facility and the other clinics have ground to a halt. Apparently we're the only ones with a back-up paper system. Lab is sending couriers with the labs on paper. We're hand-writing orders for x-rays, then going over to radiology to look at them on their monitor.
1 pm (AKA 1300 for you military types): Next doc comes on and the pile of charts reverses directions, beginning to shrink rather than grow. We designate one of ourselves as "the fast track doc" and try to see patients and document them in 10 minutes or less. I get a guy who's here for a sprained ankle. His entire foot is bruised. It turns out his INR is 6. His other leg is swollen too, and he has crackles in his lungs and admits 4 days of dyspnea on exertion. I order some labs, and x-ray, and prepare to transfer the patient to a facility with a cardiologist.
2 pm: First EMS run of the day. Comes across the radio as auto-pedestrian injury with a bleeding head wound. Security forces trying to find out where the hit and run driver went. Medics arrive. The reason no car is there is because none hit her, she just tripped. 2 cm head lac comes back, gets head scanned due to being on plavix and being old. Scan's negative and she goes home with a couple of staples.
3 pm: Find out partner is being deployed with the army, leaving 2 months sooner than expected. The rest of us will have to pick up his shifts. He's disappointed because he won't be practicing medicine on this deployment, and certainly won't be doing much trauma....too busy teaching foreigners how to do medicine US style without US style equipment, expertise, or medications. Wouldn't be so sad if he were more than a year out of residency.
4 pm: Shifts over, going home. Wrap up a few admin tasks and get out the door.

Let me know if you want to hear about a deployed day. There would be more diarrhea and rashes, and if you're lucky, a trauma that doesn't come from the commissary.

An amazing story. I have read through hundreds of threads today and this was by far the most informative post. We need more posts like this!!
 
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