Air Force Residencies/Practice

[choip0817]

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One of my biggest fears/reservations is the quality of training in Air Force residencies. It just seems that even the largest facilities cannot compete with the caseload that civilian hospitals have, especially if hospitals are downsizing or sending patients to civilian contractors, which are rumors that i've heard. I was wondering if anyone would please comment on the state of Air Force residencies/practices.

 

[virilep]

i'd love to know about this too. somebody anybody tell me why... (in that bone thugs and harmony way)

 

[Rudy]

It's been commented on before on this forum, try searching. But in a nutshell, Wilford Hall Med Center in San Antonio is the "flagship" of AF medicine, but it is experiencing significant declines in caseload and case diversity due to Tricare, deployments, etc. I have heard the program directors in Cardiology, Heme/Onc, Pediatrics, Gen Surg, Emergency Med and others recently voice their concerns about their ability to maintain GME because of the paucity of quality teaching cases. The overall plan (though no one seems to know for sure) in the AF seems to be to focus only on operationally necessary fields (with a major emphasis on flight surgery/aerospace medicine), with the eventual phasing out of non-readiness essential specialties. How long this will take and how this will happen is still unknown, but anyone signing up for AF medicine should be aware that it is a somewhat unstable situation currently.

The other "medical centers" in the AF (Travis, Keesler, Wright-Patterson) are even smaller and less busy facilities. Some try to compensate with civilian rotations. They really are best classified as glorified clinics.

The biggest nightmare is what happens when you are assigned to a po-dunk base in the middle of nowhere after residency for your payback. Your skills atrophy if you are a specialist and you only see a few cases a week. Obviously, if the "med centers" are struggling for caseload, imagine what the smaller bases are like. I have seen many docs lose confidence in skills they had gained in residency because they spent several years at a small base doing mostly admin stuff. I have heard staff docs call assignment in the AF outside of Wilford Hall "career suicide". The problem is, somebody has to staff the smaller bases.

So, yes, there are major problems in AF medicine right now. Who knows what direction it may go. I would recommend spending a couple hundred bucks on a plane ticket and going to San Antonio to talk to the department heads/program directors of a few specialties at Wilford Hall and ask them for their take on the future of AF med. That is the only way to get the real scoop. Don't be afraid to knock on their door/email/call them, that is what they are there for. They will tell you MANY useful things that a recruiter either would not know or would be afraid to tell you. It would be well worth the cost of a plane ticket.

 

[medicine1]

The Wright-Patterson/Wright-State residency program is a joint civilian-military residency program, and is considered a deferment, yet you still receive the active duty assignment status. I spoke with Dr. Bennett, the Program Coordinator at Wright-Patterson two weeks ago. Dr. Paula Termuhlen is the Program Director at Wright-State USMC, Dept. of Surgery; she interviews with HPSP/USUHS D.O./M.D. graduates for the joint program in Surgery. I speculate that the other residency programs that are offered are similar in this respect.
Look at both web pages listed below 🙂 :

http://www.dagmec.org/gmeDayton.htm#Dayton-Area Residency and Fellowship Programs

http://www.med.wright.edu/surg/military.html

 

[Croooz]

This is not strictly an AF problem. If you do a search you will see this in the other branches as well. It's the "new", sleeker, better prepared...military medicine...?????? 👎

As far as the Navy is concerned our hospital of hospitals is the National Naval Medical Center (NNMC) located in Bethesda, MD. It is nothing more than a glorified clinic...a really big clinic but a clinic just the same. There is a tremendous push to have service members use Triscare and not NNMC. I saw first hand the life surgery residents had at NNMC versus Georgetown, JHU, Howard...basically all the MD & DC surgery residencies. There was no comparison. The best thing the military can do is allow more and more the combo of a civilian/military residency. This still does not address the problem of deteriorating skills. This is a very real concern. Many physicians moonlight, many. There's too much at stake not to. Problem is if you are stationed in a podunk town and your clinic is THE hospital then you're screwed.

What I see as a trend is rotating to a large metro area such as DC, VA, MD for the last tour. Working many, many hours moonlighting, reacquiring skills, networking and thereby transitioning without fear of incompetence to the civilian world.

If you do not absolutely need to join the military my recommendation is not to. Losing some of your freedoms isn't as big a deal as losing your medical skills.

 

[Alikia]

Is it still a bad deal if you just want to go into internal medicine? Something really broad?

 

[texdrake]

Is it still a bad deal if you just want to go into internal medicine? Something really broad?

I am not that far along, but when talking to others, the concern seems to be around subspecialties and surgery more than others. I find this odd though with the amount of surgery the army is doing right now. Could be a factor of the service joined as well, there are a lot less air force and navy soilders getting seriously injured.

I think your concerns would be a lot less in:

ER, FP, Pediatrics, or Internal Medicine...possibly psychiatry as well

 

[Croooz]

I am not that far along, but when talking to others, the concern seems to be around subspecialties and surgery more than others. I find this odd though with the amount of surgery the army is doing right now. Could be a factor of the service joined as well, there are a lot less air force and navy soilders getting seriously injured.

I think your concerns would be a lot less in:

ER, FP, Pediatrics, or Internal Medicine...possibly psychiatry as well

2 of the 5 you listed are on there way out...FP & Peds. ER doesn't get the volume. Most of the cases are bread & butter, nothing really challenging. BTW, most military ER's are subcontracted...the great NNMC subcontracts the ER. 😱 Internal medicine and psychiatry will give you enough work but not the kind you would think. With psych there is alot of "I just don't want to go on a 'sub/deployment/ship..."

There might be less Navy casualties but where I see people forgetting GMO tours are not DMO and Flight surgery. The GMO tours that I don't see discussed here are the "Haze grey & underway" nor the Marines. Now these devil dogs are definitely taking casualties...if you doubt this come on by to NNMC and see. Now who do you think is patching up these Marines? You guessed it Derm, Peds, OB/GYN, ER, Surg, Ortho....basically anyone in the medical corps.

 

[texdrake]

2 of the 5 you listed are on there way out...FP & Peds. ER doesn't get the volume. Most of the cases are bread & butter, nothing really challenging. BTW, most military ER's are subcontracted...the great NNMC subcontracts the ER. 😱 Internal medicine and psychiatry will give you enough work but not the kind you would think. With psych there is alot of "I just don't want to go on a 'sub/deployment/ship..."

There might be less Navy casualties but where I see people forgetting GMO tours are not DMO and Flight surgery. The GMO tours that I don't see discussed here are the "Haze grey & underway" nor the Marines. Now these devil dogs are definitely taking casualties...if you doubt this come on by to NNMC and see. Now who do you think is patching up these Marines? You guessed it Derm, Peds, OB/GYN, ER, Surg, Ortho....basically anyone in the medical corps.

So, here is my question. Say I decide to persue a career in Peds or FP and the army decides to faze that out after/durning residency...what happens to my commitment? Do I still fill it out and then just go on my merry way (my assumption) or do you think they would just release me from my contract since they no longer field those specialties???? Or as I suspect, will the phase out the residencies but still keep on board those that choose those specialties (to treat on base families and what not) and then just choose not to let them re-enlist.

 

[Croooz]

So, here is my question. Say I decide to persue a career in Peds or FP and the army decides to faze that out after/durning residency...what happens to my commitment? Do I still fill it out and then just go on my merry way (my assumption) or do you think they would just release me from my contract since they no longer field those specialties???? Or as I suspect, will the phase out the residencies but still keep on board those that choose those specialties (to treat on base families and what not) and then just choose not to let them re-enlist.

Phase out with no extension. Officers don't reenlist. This is my thought. I don't think they'll just let you out. You would be at the mercy of the militarys needs...as usual.

 

[edmadison]

So, here is my question. Say I decide to persue a career in Peds or FP and the army decides to faze that out after/durning residency...what happens to my commitment? Do I still fill it out and then just go on my merry way (my assumption) or do you think they would just release me from my contract since they no longer field those specialties???? Or as I suspect, will the phase out the residencies but still keep on board those that choose those specialties (to treat on base families and what not) and then just choose not to let them re-enlist.

I can't speak for the other services, but there is no evidence that the Army is phasing out pediatrics. Of course, things can change very fast. Rembmer that the army mission is different from the Navy and Airforce. We need more GMOs in the field. If they switch all the peds, fp and medicine docs to civilian, who is going to man the Battalian Aid Station? One thing I can never figure out is why the DOD doesn't know that pediatricians are much better trained to handle 18-25 year-olds that internists are. Oh well. In any event, we are expanding out residency program at Madigan for next year to 7 interns.

In terms of the quality of my residency, I think it is very high. I have a friend at Seattle Childrens and I find our program is just a good as theirs. Do they see more Zebra's and have a higher census? Sure, but we have a huge clinic and alot of NICU experience. There are pluses and minues, but mostly pluses as far as I'm concerned. Let's hear from Homonculus....

Ed

 

[texdrake]

I can't speak for the other services, but there is no evidence that the Army is phasing out pediatrics. Of course, things can change very fast. Rembmer that the army mission is different from the Navy and Airforce. We need more GMOs in the field. If they switch all the peds, fp and medicine docs to civilian, who is going to man the Battalian Aid Station? One thing I can never figure out is why the DOD doesn't know that pediatricians are much better trained to handle 18-25 year-olds that internists are. Oh well. In any event, we are expanding out residency program at Madigan for next year to 7 interns.

In terms of the quality of my residency, I think it is very high. I have a friend at Seattle Childrens and I find our program is just a good as theirs. Do they see more Zebra's and have a higher census? Sure, but we have a huge clinic and alot of NICU experience. There are pluses and minues, but mostly pluses as far as I'm concerned. Let's hear from Homonculus....

Ed

Looking forward to rotating with you guys this summer. I will be there for the end of July and start of August. Colonel Newman seems like a nice guy. Can't wait.