All Branch Topic (ABT) Amazing opportunities and epic careers - the good parts of military medicine

[Cooperd0g]

I have been in the military for over 24 years. Not all of that time has been as a physician. I have deployed multiple times and I have worked in joint environments. As a pilot, there aren’t many civilian jobs that are very appealing to me. Many people are happy as airline or corporate pilots, generally considered the pinnacle of civilian aviation, but it held little interest for me. In my relatively short tenure in the medical corps I have already worked at over a dozen different MTFs and clinics across all three services. As before in aviation, I found that being a traditional clinic or hospital physician did not appeal to me; that doesn’t mean there is anything wrong with it. But that is why I am heavily involved in operational medicine.

By the time I retire I’ll have done 32 total years (including academy, some reserve time, USUHS, and active duty) and my pension will be based on over 22 years of active duty. I am probably one of the most pro military guys around. But my wife constantly gets annoyed with how “negative” I sound when I get asked to talk to people who are thinking about having the military pay for their medical school. I try to explain that I’m not being negative, but rather trying to ensure they have a full understanding of what they are getting into.

There are amazing opportunities in military medicine, things that you simply cannot really do as a civilian physician. And nearly all of these opportunities lie in the operational realm. Do you want to fly in fighter, land on aircraft carriers, land on a mountain top in a helo, dive with SEALs, be on standby for casualties during a commando raid, etc? You can really only do these things in the military. There are even specialties that lend themselves well to these types of jobs such as family, emergency, aerospace, and hyperbaric (fellowship). Heck, you can even become a pilot in the Air Force as a physician, possibly the Navy too.

If these things sound appealing to you then the military may be a good fit. You could want to do these kinds of thing for a short time and then go to a regular physician lifestyle. You could make a career out of them and be very successful. But if these possibilities sound terrible, then the military is less likely to be a good fit for you.

The military does need other types of physicians as well, but the focus is going towards operational medicine and less towards subspecialization. The more you want to be a traditional style physician, the less likely you will fit in the military system. Even people like me grow weary of the urinalysis, putting in for leave, liberty/pass driving limits, online ridiculous training, etc. But those are tolerable if you enjoy the rest of your main job. They are needles in your brain, pure torture devices, if you are already unhappy or miserable with other aspects of your job.

The other thing about the military is that you could be following the “ideal” career path deemed by higher authority only for them to change said path to something that now does not favor what you did. No one enjoys this.

There are good aspects to military medicine, but you have to fit within the constraints of the system; don’t expect the system to conform to your desires.

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[MTGas2B]

YMMV


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[Cooperd0g]

YMMV


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Very true. Not all operational tours are going to be good. I’m just trying to point out that there are some interesting things that can be done in military medicine.

 

[Vandalia]

This is true. It is possible to have incredible experiences that only a few people in the world have had: flying on the Presidential Fleet (SAM), sitting in on the highest level SI/SCI intelligence briefings for 3 years, etc. It is also true to have an absolutely horrific experience. I would say that if you want military medicine, you have to be comfortable with doing things other than medicine. If all you want to do is see patients or operate, do not sign up. If you are comfortable with the operational side of your service and know what that means (no one but a current physician truly knows this, but you can pick up a few things), then it might be a reasonable choice.

 

[Matthew9Thirtyfive]

Very true. Not all operational tours are going to be good. I’m just trying to point out that there are some interesting things that can be done in military medicine.

Personally, I'm looking forward to some operational time. I'd love to get back to sea if I can. As much as being away from family sucks, I miss being underway and being part of a crew.

 

[Perrotfish]

I have been in the military for over 24 years. Not all of that time has been as a physician.

How much of it was as a physician?

 

[militaryPHYS]

Can’t we just hear some optimism and positivity on here for a bit before we try to completely negate or squash it?

 

[Vandalia]

There are two posts in this thread that basically say that the military is a great place to practice medicine as long as you're not expecting to practice any actual medicine. Is this really what passes for optimism now?

Not exactly. I can name at least two dozen physicians in my area who do not practice medicine exclusively or are looking at not practicing medicine exclusively; consulting, active investments, "hobbies" as businesses, etc. Probably closer to 50 are dreaming about that. There are a lot of physicians who love medicine but don't want to spend all their time seeing patients. A mix is nice.

 

[militaryPHYS]

Not exactly. I can name at least two dozen physicians in my area who do not practice medicine exclusively or are looking at not practicing medicine exclusively; consulting, active investments, "hobbies" as businesses, etc. Probably closer to 50 are dreaming about that. There are a lot of physicians who love medicine but don't want to spend all their time seeing patients. A mix is nice.

This is a good point. There should be a balance. I used to want to be gen surg and then trauma fellowship. During med school I realized I didn’t want to spend ridiculous hours in the hospital and away from my family. I learned quick what I could do in the military, have a good practice and a great life with my family.

 

[backrow]

Can’t we just hear some optimism and positivity on here for a bit before we try to completely negate or squash it?

You’re going to get opposing views whether there is a positive or negative post. If someone posts a negative some will come and post some opposite positive and vice verse.

The fact that you have stated you were actively recruited to be a moderator to try and give the place a more positive vibe makes this post have less impact. I for one am glad you disclosed that information because now I know exactly where the bias lies.


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[militaryPHYS]

You’re going to get opposing views whether there is a positive or negative post. If someone posts a negative some will come and post some opposite positive and vice verse.

The fact that you have stated you were actively recruited to be a moderator to try and give the place a more positive vibe makes this post have less impact. I for one am glad you disclosed that information because now I know exactly where the bias lies.


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You’re right. Having one positive/optimistic voice in a sea of negativity is the bias.

Lets add up the positive vs negative posts over the last 10 years and see where we fall out. I was simply stating that the rare positive post doesn’t need to be immediately inappropriately discredited by the masses.

 

[pgg]

The military has meaningful opportunities to get experience in healthcare administration much earlier in one's career. As a 30-something year old O4, I was a department head and later the director of surgical services at a small Navy hospital.

Today as a 40-something year old O5 who'll be in zone for O6 shortly, I could seek such positions at major MTFs and expect to be seriously considered for those jobs. (The fact that I choose not to at the moment, despite some pending local vacancies, is actually getting me hassled a little bit.)

In the civilian world these jobs go to much more senior people. People in their 50s or older with business degrees who've been working admin for a couple decades. Definitely not doctors who are a couple years out of residency.

There's an argument that many of milmed's ills can be laid at the feet of putting relatively junior people in charge of it for high-turnover, 1-2 year stints. But I learned a lot in that time and the experience has served me well.

People who are interested in that career track have great opportunities in milmed.

 

[teacherman84]

I'll bite...I'm primary care sports medicine. I love MSK medicine...keeping a healthy and motivated patient and keeping him active or at peak performance does it for me. I've taken care of high level athletes in the civ world and its not near as satisfying as working with our high level athletes.
Keeping someone 100% to keep playing football at their best is rewarding...but keeping a AFSOC/SF/ranger/EOD guy going in his career field is much more so.

Much of the civilian world in MSK medicine is obese/lazy/old people who hurt. Even my patients who arent high level are athletes to a degree and keeping the going/getting them back to duty is pretty rewarding, whether they are flying a fighter jet or spinning wrenches on the flight line.

Plus my primary care clinic is full of MSK complaints too...a perk of having such an active patient population.

Human performance/humans as a weapon system stuff is growing in the mil and i foresee more and more opportunities for my career. From working full time with special forces to a mixed practice like I have, its values and likely growing.

All that said...between deployments, beaurocreacy, awful EMR, awful leadership...I dont see myself staying in beyond my initial commitment. Love the patients but they make it so hard.

 

[244913]

I have been in the military for over 24 years. Not all of that time has been as a physician. I have deployed multiple times and I have worked in joint environments. As a pilot, there aren’t many civilian jobs that are very appealing to me. Many people are happy as airline or corporate pilots, generally considered the pinnacle of civilian aviation, but it held little interest for me. In my relatively short tenure in the medical corps I have already worked at over a dozen different MTFs and clinics across all three services. As before in aviation, I found that being a traditional clinic or hospital physician did not appeal to me; that doesn’t mean there is anything wrong with it. But that is why I am heavily involved in operational medicine.

By the time I retire I’ll have done 32 total years (including academy, some reserve time, USUHS, and active duty) and my pension will be based on over 22 years of active duty. I am probably one of the most pro military guys around. But my wife constantly gets annoyed with how “negative” I sound when I get asked to talk to people who are thinking about having the military pay for their medical school. I try to explain that I’m not being negative, but rather trying to ensure they have a full understanding of what they are getting into.

There are amazing opportunities in military medicine, things that you simply cannot really do as a civilian physician. And nearly all of these opportunities lie in the operational realm. Do you want to fly in fighter, land on aircraft carriers, land on a mountain top in a helo, dive with SEALs, be on standby for casualties during a commando raid, etc? You can really only do these things in the military. There are even specialties that lend themselves well to these types of jobs such as family, emergency, aerospace, and hyperbaric (fellowship). Heck, you can even become a pilot in the Air Force as a physician, possibly the Navy too.

If these things sound appealing to you then the military may be a good fit. You could want to do these kinds of thing for a short time and then go to a regular physician lifestyle. You could make a career out of them and be very successful. But if these possibilities sound terrible, then the military is less likely to be a good fit for you.

The military does need other types of physicians as well, but the focus is going towards operational medicine and less towards subspecialization. The more you want to be a traditional style physician, the less likely you will fit in the military system. Even people like me grow weary of the urinalysis, putting in for leave, liberty/pass driving limits, online ridiculous training, etc. But those are tolerable if you enjoy the rest of your main job. They are needles in your brain, pure torture devices, if you are already unhappy or miserable with other aspects of your job.

The other thing about the military is that you could be following the “ideal” career path deemed by higher authority only for them to change said path to something that now does not favor what you did. No one enjoys this.

There are good aspects to military medicine, but you have to fit within the constraints of the system; don’t expect the system to conform to your desires.

Yes, there are definitely opportunities to do cool guy stuff. I was an operational FS, two deployments, did several of the things routinely which you referenced. If you join the .Mil wanting to be an Officer more than a Doctor you'll probably come out reasonably satisfied. The problem is most people who sign up for HPSP want to be Doctors, and the .Mil is making this task increasingly difficult. It's not a good recruiting strategy. That's why I think HPSP is such a risk. The .Mil gambles on the perceived burden of debt to grab 22 yo's and lock them into a long commitment on the back end.

This may sound like hyperbole but in hindsight all the close calls I had on deployment are small change compared to the risk of sacrificing 8-10 years of my life to achieve a long sought after goal only to waste away in a BDE surgeon slot for 2-3 yrs or be staff at some godforsaken MEDDAC operating twice a month. Now it sounds like even the residency training will be further restricted and degraded.

The exodus of experienced O3's/O4's from this system shows people are voting with their feet. Healthy systems don't have these retention problems.

 

[backrow]

You’re right. Having one positive/optimistic voice in a sea of negativity is the bias.

Lets add up the positive vs negative posts over the last 10 years and see where we fall out. I was simply stating that the rare positive post doesn’t need to be immediately inappropriately discredited by the masses.

Go back through all my posts and you will find that overall I have a pretty positive take on things, but I am not naive to the fact that many more have had neutral to negative experiences. This site certainly trends along what I hear from my peers and others, including those who I would say have a quite neutral take on things and therefore would not be expected to be present on this site.

It is not the bias of the site, but rather the bias of the individual to which I speak. I feel this site does quite the service to the individuals who take the time to read it. If we paint a picture of that which does not exist then I feel we do a disservice. An example where a negative member was criticized: Galo.

I certainly have no problems with adding positive stories, but I don’t think we should criticize folks or call it “inappropriately discredit[ing]” when others bring out opposing views.


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[Matthew9Thirtyfive]

I certainly have no problems with adding positive stories, but I don’t think we should criticize folks or call it “inappropriately discredit[ing]” when others bring out opposing views.

I agree, except every time someone posts something positive, the swarm descends to "correct" them and make sure everyone knows just how negative the experience can be as well, often criticizing by saying "they don't have enough experience" or "are unique" or whatever. The opposing view does the same thing. Anyone who talks about positive experiences at best gets a begrudging admission that some people can have a positive experience, but usually it is dismissed as being unique or naive. At least that's how it seems.

 

[Gastrapathy]

@Cooperd0g The list of highlights you mentioned is a good one and the key is to understand what it takes to be one of those people. The vast majority of military physicians can take a helo joy ride (of course, that was what killed one of the two physician casualties in OIF/OEF) but the rest of that requires a very specific set of interests and skills. The DMOs with the SEALs and MARSOC are all board-certified and nearly always second tour. That means doing a career. It also wasn't that exciting to hear the stories and largely consisted of trying to wean them off inappropriately prescribed testosterone they were given for "low-T" by a midlevel. There are hundreds of typical docs for every future astronaut.

In the early days of the Iraq war, the Marines liked taking some of the docs on patrol. That, thankfully, waned after my GMO tour and is not the norm. For those of us who have been outside the wire as physicians, we know that was a poor choice.

The most positive things for the vast majority of physicians are that the cocoon provided to medical students and residents is great and that the quality of their colleagues is so high.

 

[Cooperd0g]

@Gastrapathy I completely agree. Just like not all operational tours are going to be good, not all civilian jobs are going to be good either. But that is why I titled this about opportunities and careers.

Here is an interesting example: an EM doc wanted to go to dive school. Was originally told “no” so this doc said “fine, I’ll resign; I don’t owe any more time.” Guess what, the doc got dive school, did a UMO tour in a pivotal, high profile, role. That doc is also going on to fellowship and will likely return to operational medicine as well.

A military medical career isn’t for everyone. Some shoudln’t do it at all. Some may want to do it for only a brief period of time and some may find their calling in a career. It’s all okay.

 

[HighPriest]

The patient population is great in milmed. Loved working with soldiers. Loved getting them t’ed up and back to duty. Loved giving them a better quality of life knowing that’s what many of them were doing for everyone else either directly or indirectly.

Of course, that same patient population is part of the problem when it comes to skill maintenance, depending upon what you do.

Completely agree with pgg regarding administrative options. You will not get those chances on the civilian side without really working for years to get them. The other side of that coin is that, frankly, unless you want to be an administrator, being one 2-3 years out of residency is the worst time to do it. That’s when you need to be spending all of your time doing medicine so that you can build your confidence and ability. But, if you’re thinking about admin, the military will get you there fast.

So far as being an SF doc doing HALO jumps. Yeah. I suppose that’s possible. But people should keep in mind that it’s also possible to be an astronaut or president. It doesn’t work out that way for many people. Most of the guys I knew doing this stuff had prior military experience as well. And most importantly, if you want to do this stuff it’s going to usually mean limiting your specialty choices. There aren’t any ENT docs attached to an SF unit. They don’t need them. And even if there were, that doc wouldn’t be doing ENT. So students need to know that those positions are not tailored to a lot of specialties. But they are available.

Finally, equipment and CME. Depending upon how flush OtSG is, the military will send you almost anywhere and buy you almost anything with, really, pretty weak rationale in most casss. It might take 3 years to get your gear, but they’ll buy it. Even the smallest hospitals I worked at had the best equipment. Or it was on order and just never arrived while I was there. Granted, for 3 of my ADSO years there was a moratorium on CME funding which was freaking horrible. But, that’s not usually the case.

 

[HighPriest]

Here is an interesting example: an EM doc wanted to go to dive school. Was originally told “no” so this doc said “fine, I’ll resign; I don’t owe any more time.” Guess what, the doc got dive school, did a UMO tour in a pivotal, high profile, role. That doc is also going on to fellowship and will likely return to operational medicine as well.

Sometimes that works. I know an ENT who just wanted to be sent to one of three places where they actually needed an ENT. He was initially told no, so he said he wouldn’t extend. So they said ok. Now he makes 4x as much in a nice metro area and just took his wife on a 10 day first class trip to Italy without having to ask an obese, sweaty, brain-dead GS-4 for permission.

 

[Gastrapathy]

Many civilian jobs aren’t good but that sort of argument is a race to the bottom. It’s why most people leave their first job.

My job is good. I’m treated like a doctor. It’s like @Homunculus and so many others have observed in their first few months out.

 

[Perrotfish]

I agree, except every time someone posts something positive, the swarm descends to "correct" them and make sure everyone knows just how negative the experience can be as well, often criticizing by saying "they don't have enough experience" or "are unique" or whatever. The opposing view does the same thing. Anyone who talks about positive experiences at best gets a begrudging admission that some people can have a positive experience, but usually it is dismissed as being unique or naive. At least that's how it seems.

The issue is that the swarm is often correct. The positive opinions here usually come from people who have either gotten something that < 5% of milimed docs will get, or from people who just haven't been attendings at all. It doesn't help much to hear from the guy who went on to be an astronaut, and still less from a premed who thinks he's going to be an astronaut.

We will, very rarely, have a physician who does something normal (residency -> small hospital or residency -> fleet) and enjoys it. A1 was like that for awhile, and militaryphys seems to be another. Now I will point out that as experiences accumulated A1 ended up being deeply embittered and now just comes back once a year to post about how the military won't pay his pension, and militaryphys is still very early in his career, but I think people still showed much more respect for their opinions than they do for positive posts from medical students and residents..

 

[backrow]

We will, very rarely, have a physician who does something normal (residency -> small hospital or residency -> fleet) and enjoys it..

I would say I’m one of those unicorns: internship—>GMO—>residency—>fellowship—>Staff and now in what I would consider to be the early prime of my time as a physician. Been out of residency/fellowship long enough to have hit my stride, feel extremely comfortable with the routine stuff and feel more and more comfortable with increasingly complex stuff.

I truly enjoy my work, I get up everyday and get to do what I like to do. I’m relatively left alone and serve on committees that I truly care about and mesh well with my future goals in medicine. (i.e. I’m not on some committee just because it was what was open and not what I’d like to do). I get to have an impact on the entire command and doesn’t take me out of clinic.

From an early career standpoint the only disappointment I had was in the location of my GMO tour; however, it ended up working out well and I had a great tour and got to take care of folks in a combat zone. I then was selected for residency at my first opportunity and same again for fellowship. Went to a good location for my staff tour and been able to extend at the same location.

I realize though that I have had everything line up perfectly and am one of the few to whom this happens. I have seen cases that the “negative” posters describe and I do not discount their experience. I try and provide a balanced view when I post that takes into account experiences of those who do not necessarily post here.

Even though I have led “the good life” I can see the writing on the wall with the current changes and realize this is not the favorable environment that I joined at the beginning of the most recent wars.


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[Gastrapathy]

@backrow So, with all that, are you staying?

 

[militaryPHYS]

The issue is that the swarm is often correct. The positive opinions here usually come from people who have either gotten something that < 5% of milimed docs will get, or from people who just haven't been attendings at all. It doesn't help much to hear from the guy who went on to be an astronaut, and still less from a premed who thinks he's going to be an astronaut.

We will, very rarely, have a physician who does something normal (residency -> small hospital or residency -> fleet) and enjoys it. A1 was like that for awhile, and militaryphys seems to be another. Now I will point out that as experiences accumulated A1 ended up being deeply embittered and now just comes back once a year to post about how the military won't pay his pension, and militaryphys is still very early in his career, but I think people still showed much more respect for their opinions than they do for positive posts from medical students and residents..

When I first came back in to activity on SDN with positive things to say I did not feel respected. I felt like I had to defend every little thing I said. It felt like I was trying to be run-off by veteran members. It’s half the reason I stayed active...if I couldn’t tell people about my story, I wondered how many others with a good experience just gave up and left the cynicism and negativity to perpetuate.

—————

Anything MSK related is going to be a pretty darn good experience no matter where you are practicing in the military. Ortho, family med and then sports med, PM&R, etc. For the Navy, pretty much all ortho subs (minus joints, spine, trauma) have a good volume of cases no matter where you go. So this includes sports, hand, foot and ankle (+/-), pediatrics, general. You can’t always put in joints at every MTF and big time trauma is lacking at all MTFs, even the big 3.

I have been very fortunate in my pathway as well. Unicorn? Maybe...but not really since at least half or 3/4s of ortho in Navy go straight through, plus it is a critical wartime specialty so the need will always be there. Ortho was in high demand when I was coming out of USUHS and I had the scores and CV to get selected and go straight through. I loved my time at USUHS and I loved my time in military ortho residency at NMCP. We chose to go overseas and now I’ve got a good practice of ortho sports and general trauma, became department head 8 months after finishing residency, and got selected for ortho sports FTOS fellowship.

Being department head gave me a seat at the table at a small MTF where I’m given a lot of responsibility and respect for my opinions regarding peace vs wartime activity in our region. Am I super junior without a ton of experience? Yes. Is there a better person out there to do my job? Definitely. Are we getting the job done while I learn a hell of a lot of invaluable experience on business administration, readiness, oplans, etc? Yes.

Am I a unicorn in relation to all of milmed? Perhaps. But I would argue that anyone in the navy who ends up wanting to do ortho sports, hand, foot/ankle, pediatrics can go anywhere and maintain an OK volume for clinical experience while also getting placed in leadership roles. So I’m not an Ortho unicorn. I know many like me. They all complain about making 1/4 of what they could on the outside but we all knew the pay scale when we signed up. Lots of us didn’t know we would end up doing ortho so I can’t be upset about where I am at. Many get out to get paid more or to have a higher volume of joints, trauma or even sports/hand/peds. Most seem to value their experience as acceptable.

In summary: Navy ortho in subs listed above usually stay productive and satisfied during payback. Pay differential and volume cause most to leave after 4 years.

 

[backrow]

@backrow So, with all that, are you staying?

I am beholden to the govt until 19yrs so I can’t imagine not staying the final one.

Now, if that weren’t the case I don’t know what I would do. There are opportunities that I could take in the civilian sector at nearly a moment’s notice so it would be very tempting to leave. I am essentially at the “tipping point” in years when comparing the financial sense to stay/leave so I would be making some hard decisions soon. If the current manning thoughts pan out I would probably leave.




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[haujun]

I like training opportunities exist in the military. Outstanding pay during residency and fellowship motivate you to train hard and long. You can become very competitive candidate for military sponsored civilian fellowship as military provides a free labor for civilian institution.

 

[TheEarDoc]

Part of the draw for me to the Army Reserves was that my Army duties are vastly different than my civilian duties. Sure there is some overlap, but more admin in the Army compared to my civilian job (since it's pretty near impossible to get admin experience as an audiologist in the VA to move up without being hired as a chief, but to be hired as a chief they want admin experience......) which is what I want. It also gives me a chance to go new places, meet new people, hang out with other guys (since having a child this is dang near impossible it seems, but if I can hang out with some cool new people each month and do stuff I enjoy and get paid for it it's a win all the way around for me!), and just do something different many of my coworkers and other audiologists do not do.

I personally am looking forward to field training, weapons training, etc.. Then again I've always been an outdoors geek who loves doing survivalist camping, cold weather camping, etc. so the military was kind of up my alley to begin with!

 

[Perrotfish]

Part of the draw for me to the Army Reserves was that my Army duties are vastly different than my civilian duties. Sure there is some overlap, but more admin in the Army compared to my civilian job (since it's pretty near impossible to get admin experience as an audiologist in the VA to move up without being hired as a chief, but to be hired as a chief they want admin experience......) which is what I want. It also gives me a chance to go new places, meet new people, hang out with other guys (since having a child this is dang near impossible it seems, but if I can hang out with some cool new people each month and do stuff I enjoy and get paid for it it's a win all the way around for me!), and just do something different many of my coworkers and other audiologists do not do.

I personally am looking forward to field training, weapons training, etc.. Then again I've always been an outdoors geek who loves doing survivalist camping, cold weather camping, etc. so the military was kind of up my alley to begin with!

I don't think anyone here is arguing that the military is a bad place for audiologists. Ditto midlevels, nurses, nutritionists, psychologists, optometrists, lab managers, and medical administrators.