AMEDD Captains Career Course

[Chonal Atresia]

To clarify: there are things you can't put a price on, and there are good reasons to do a lot of things that aren't financially advantageous. However I've noticed whenever I hear someone SAY 'you can't put a price on...' whatever what comes next is almost always very poor financial decision made for transient emotional reasons. It's the 'hey, hold my beer' of financial planning.

Examples of things people say they can't put a price on, and what they tend to mean:

Love
Translation: you agreed to pay 75K for your wedding

Memories
Translation: You're in a five star hotel on a two star budget. Alternatively you just bought a boat.

Dignity
Translation: You just told your boss to f- himself. You don't have another job lined up.

Peace of mind
Translation: You're over insured

Freedom
Translation: To avoid 2 more years of full time work at your crappy job with a non-physician nurse boss, you will instead work full time for 20 years at a slightly less crappy job with a non-physician MBA boss.

Just a personal opinion. And I'm in no way saying everyone who has been in for 4, 8, or 12 years should stay to 20. If the goal is to maximize happiness, and you hate your job in the military, then 8+ years of misery is a lot to trade for even 20+ years of part time work and/or an early retirement. I do, however, think the guy getting out at 18 years is out of his f-ing mind.

All good points, but I would humbly disagree. These following things do not happen in civilian medicine:

1) No nurses as either your immediate or overall (see army "surgeon" general) bosses. I had a nurse tell me the other day that I couldn't start my OR 15 minutes early b/c they had a meeting. Do you think that would happen at an ASC?

2) $170,000 salary for a surgical subspecialist. I don't think so. I've seen the numbers at the practice I'm joining several partners are making 700K+. Pretty reasonable compensation in the military, huh?

3) Mandatory APEQS computer training that takes precedence over clinical duties.

4) Calling in/out for leave and being required to have all computer training completed before being "allowed" to go on leave. Makes you feel like you are in kindergarten.

5) Semi-annual PT tests with E3s refusing to count your push-ups and sit-ups. I run half-marathons so I have no trouble passing my tests, but come on.

7) Having to jump through major hurdles to perform ODE and being made to feel that this is a privilege and not your "right" to better yourself and family financially.

8) 2-year brigade surgeon tours taking you completely out of clinical medicine. Think that a civilian hospital would credential you after one of these tours or that a practice would hire you? I don't think so.

9) A hiring freeze going on one year making it impossible to adequately staff your clinic and ORs.

10) Federal employees that are impossible to fire despite pure incompetence.

11) No more funded CME to meet state requirements. If you think this is coming back, you are mistaken.

12) Slow, inefficient ORs with 30-40 minute turnovers making productivity a joke. This is important in the current fiscal climate.

13) Completely worthless military courses like CCC, ILE, SSC, etc required for promotion. How do those things benefit me in my practice as a military physician? Answer - they don't.

Are these enough things that you can't put a price on? Good riddance to the military. Watch the mass exodus of physicians over the next few years. Once the next conflict happens, the services are going to be in big trouble.

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[DoctorDoom]

All good points, but I would humbly disagree. These following things do not happen in civilian medicine:

1) No nurses as either your immediate or overall (see army "surgeon" general) bosses. I had a nurse tell me the other day that I couldn't start my OR 15 minutes early b/c they had a meeting. Do you think that would happen at an ASC?

8) 2-year brigade surgeon tours taking you completely out of clinical medicine. Think that a civilian hospital would credential you after one of these tours or that a practice would hire you? I don't think so.

13) Completely worthless military courses like CCC, ILE, SSC, etc required for promotion. How do those things benefit me in my practice as a military physician? Answer - they don't.

While many of your complaints are the same as the ones I have, you need to keep in mind that some of your complaints are tied together and are often addressed in the civilian world by physicians taking administrative roles. In milmed, there are many who seem to have an expectation, and you sound like one of them, of have everything your way without having to be in charge of making sure that is the case. In the military, the way to dictate your operating procedures is to achieve rank and take charge, that's the nature of the organization. You don't want to do the things that will get you rank, that actually educate you on the force you are supposed to support, and yet you complain when other people who DO get the training they need to understand the military as an organization get to be in charge. While I agree that the military education courses need to be better, and the proper management of career tracks in milmed needs to be resurrected, you can't have it both ways, both not have to fit into the military institution or even understand it, and yet be in charge of that institution.

 

[pgg]

1) No nurses as either your immediate or overall (see army "surgeon" general) bosses. I had a nurse tell me the other day that I couldn't start my OR 15 minutes early b/c they had a meeting. Do you think that would happen at an ASC?

At the civilian places where I moonlight, it's not uncommon for the first case of the day to be delayed 15 minutes because the nurse or room isn't ready. Sucks, but it's not the end of the world.

2) $170,000 salary for a surgical subspecialist. I don't think so. I've seen the numbers at the practice I'm joining several partners are making 700K+. Pretty reasonable compensation in the military, huh?

No one makes $170K on a MSP contract - more like $250-275K for surgical subs. Still far shy of the $700K+ and I totally agree that for many specialties milmed pay is lowball BS, but c'mon, use real numbers.

3) Mandatory APEQS computer training that takes precedence over clinical duties.

It's ******ed, I'll give you that, and I gripe about it too. But in the grand scheme of things? A few days per year, I kill a few hours clicking.

4) Calling in/out for leave and being required to have all computer training completed before being "allowed" to go on leave. Makes you feel like you are in kindergarten.

This must be command dependent because I've never had leave denied, regardless of how delinquent my clicking is.

5) Semi-annual PT tests with E3s refusing to count your push-ups and sit-ups. I run half-marathons so I have no trouble passing my tests, but come on.

Come on indeed, twice a year you have to go exercise for half an hour.

And some days ... I have to ... wait for it ... wear a uniform. Damn.

7) Having to jump through major hurdles to perform ODE and being made to feel that this is a privilege and not your "right" to better yourself and family financially.

Totally agree with you.

8) 2-year brigade surgeon tours taking you completely out of clinical medicine. Think that a civilian hospital would credential you after one of these tours or that a practice would hire you? I don't think so.

The Navy doesn't do this. We foist that job off on GMOs prior to residency, which is a wholly different problem, but at least we're not sending subspecialists out to rot. If I was in the Army, this brigade surgeon nonsense would drive me to mutiny.

If I got orders to a GMO / brigade surgeon kind of billet now, I don't know what I'd do. I honestly don't feel competent to practice any kind primary care any more. I haven't examined a knee or evaluated a rash or prescribed hypertension meds in many years. It's been a decade+ since I've done a pelvic exam. I would be a terrible GMO at this point.

I've been watching this Army brigade surgeon nonsense the last couple years in utter amazement. That nurse surgeon general, too.

9) A hiring freeze going on one year making it impossible to adequately staff your clinic and ORs.

Perhaps a command (and specialty) specific problem. Not an issue where I am, or for what I do. I can imagine that if I had a clinic that this would make me miserable.

10) Federal employees that are impossible to fire despite pure incompetence.

Completely agree. I'm fortunate enough to be in a specialty that generally doesn't need much support staff. It's the nature of anesthesia to do everything ourselves.

11) No more funded CME to meet state requirements. If you think this is coming back, you are mistaken.

Yeah, it sucks. On the other hand, the local civilian groups I moonlight for don't buy plane tickets and pay hotel/conference fees for anyone. Is funded CME common anywhere, outside of academia? For PP groups, funding has to come from somewhere, and it's just less money available to distribute to partners, no?

12) Slow, inefficient ORs with 30-40 minute turnovers making productivity a joke. This is important in the current fiscal climate.

Agreed, this sucks.

It's fixable though, if the command stays out of the way and lets you send AD people home when the work is done. Tell a surgical tech he can go home at 3 if the cases are done and that turnover goes fast.

13) Completely worthless military courses like CCC, ILE, SSC, etc required for promotion. How do those things benefit me in my practice as a military physician? Answer - they don't.

Yeah, I imagine those are a steaming pile of crap. The Navy doesn't require them. The last bull**** Navy course I had to go to was Officer Indoctrination School, about 15 years ago. Maybe someday stuff like AMDOC will be forced.

Five years ago I read this forum and marveled at the amazingly abusive and inefficient BS the Air Force routinely inflicted on its doctors. Now it seems the Army is going that way. I just hope the Navy doesn't follow the example, at least for a while.

Are these enough things that you can't put a price on? Good riddance to the military. Watch the mass exodus of physicians over the next few years. Once the next conflict happens, the services are going to be in big trouble.

We'll see. There has always been a mass exodus of physicians leaving the instant their ADSOs are up, and there probably always will be.

Since they bumped the stipend a few years ago, HPSP has been full. There's no reason to think it won't remain full. It took a booming bubble economy and the depths of a boondoggle of a war to create a transient recruiting shortfall. The training pipeline is full.

If anything, over time as Obamacare evolves, there will be less and less difference between doctors working for the government in the military, and doctors working for the government in the civilian world. We're all going to be government employees some day. Go make that $700K+ hay in PP while the sun is shining.

 

[DoctorDoom]

The Navy doesn't do this. We foist that job off on GMOs prior to residency, which is a wholly different problem, but at least we're not sending subspecialists out to rot. If I was in the Army, this brigade surgeon nonsense would drive me to mutiny.

If I got orders to a GMO / brigade surgeon kind of billet now, I don't know what I'd do. I honestly don't feel competent to practice any kind primary care any more. I haven't examined a knee or evaluated a rash or prescribed hypertension meds in many years. It's been a decade+ since I've done a pelvic exam. I would be a terrible GMO at this point.

I've been watching this Army brigade surgeon nonsense the last couple years in utter amazement. That nurse surgeon general, too.

By way of clarification and just a friendly FYI for a Squid , in the Army, some of the issues are definitely command dependent. Interestingly, it was in the line units that I got the fewest problems with things like going on leave, computer training, E-4's not counting my pushups, etc. If the CoC/ troops think you actually care about them, they bend over backwards for the "Doc." And I'm a Major, if I am displeased with how an E-whatever is treating me, I have the option of throwing the oak leaf on the table and making their lives miserable. A MC officer who actually knows Army Regulations can be a powerful officer, but too many of us are so busy complaining we don't bother reading the AR's.

Unfortunately, the problems with inadequate staffing and the like are chronic in the Army.

Too few Army doctors though, seem to realize many of our complaints have their civilian equivalents. For example, QA is a joke in the military, but in many major hospital systems, they have real power. Having to beg (or pay someone to beg) some clipboard nurse to get paid by an insurer for a standard of care diagnostic test is seemingly something our fellow MC officers seem to forget is a reality of civilian medicine.

I would like to clarify the Brigade Surgeon assignments though, which is not the same as a GMO tour, even though one is credentialed as a GMO. As Brigade Surgeon, you really are special staff and are responsible for medical aspects of operational planning. Most of the PCM duties are provided by the Brigade/Battalion physician assistants or MTF medical providers. And they are often the ones who do the MEB paperwork. Most of the planning and operational readiness staff work and meetings are done by the MSC Medical Operations Officers (MEDO's). I was unlucky enough to be assigned to a Brigade that had no Brigade PA, no MEDO's, and so I got my Commander's support in not having anyone empaneled to me so I could do the Staff jobs on my own and block out OR time. The only MEB's I did as Primary were the ones for Brigade HHC, and for the Battalions only if there was a problem leading to delay, to advise or help out the PA/Battalion Surgeon. It's not an ideal assignment, especially for sub-specialists and those specialties that are procedure dependent, but some of the complaints and everyone being up in arms is a bit over the top. How many liver resections did I really miss out on in the 2 years as a Brigade Surgeon? But it is not surprising since MC tends to be more vocal about complaints, myself included, and we do justifiably have a lot to complain about.

 

[idq1i]

but some of the complaints and everyone being up in arms is a bit over the top

Now this is a just a gem. As a subspecialist, you train anywhere from 5 to 9 years post medical school, take inservices, work weekends and holidays, are routinely forced to work over the 80 hour rule, study your butt off to pass your boards.. and all of a sudden you are forced into a position where you have to hand out band aids for ouchies, go to meetings and do hernia exams. Any and all complaints are justified.

Milmed at it stands just needs to die. They need to replace it with a scholarship that is upfront about these BDE/GMO/etc utilization tours - military pays for med school, and in return you play GMO/BDE/wtf else they want to call it for 3-4 years and then you are done. Outsource routine care to civilian hospitals, get rid of the overwhelming bureaucracy and overhead, close all the MTFs, and get rid of the incompetent civilian "provider" dreck holed up in these MTFs for years, outside of the reach of state boards and real credentials oversight committees.

 

[DoctorDoom]

Now this is a just a gem. As a subspecialist, you train anywhere from 5 to 9 years post medical school, take inservices, work weekends and holidays, are routinely forced to work over the 80 hour rule, study your butt off to pass your boards.. and all of a sudden you are forced into a position where you have to hand out band aids for ouchies, go to meetings and do hernia exams. Any and all complaints are justified.

Milmed at it stands just needs to die. They need to replace it with a scholarship that is upfront about these BDE/GMO/etc utilization tours - military pays for med school, and in return you play GMO/BDE/wtf else they want to call it for 3-4 years and then you are done. Outsource routine care to civilian hospitals, get rid of the overwhelming bureaucracy and overhead, close all the MTFs, and get rid of the incompetent civilian "provider" dreck holed up in these MTFs for years, outside of the reach of state boards and real credentials oversight committees.

You obviously missed the first part of the sentence where I said this:

"It's not an ideal assignment, especially for sub-specialists and those specialties that are procedure dependent..."

Or where I said:


"...and we do justifiably have a lot to complain about."

The fact that sub-specialists get screwed, which I have said over and over, doesn't justify "any and all complaints" about Brigade Surgeon assignments. How does a NICU new grad getting screwed justify complaints about having to go to a Brigade Surgeon assignment if you want to be a hospital commander some day?

No one was upset about Brigade Surgeon assignments when it was FP and non-residency trained physicians. Are you under the impression that the average Board certified PCP doesn't "take inservices, work weekends and holidays, are routinely forced to work over the 80 hour rule, study your butt off to pass your boards"? What about surgical non-sub-specialists?

There are no sub-specialists being sent solely to GMO (Battalion/flight) slots.

Your comment, and your "solution", are both, like I said, over the top. Is the current situation crappy? Certainly, but stamping your foot and throwing a tantrum like a child is exactly the decision-making approach that got us in this mess in the first place.

 

[idq1i]

Your comment, and your "solution", are both, like I said, over the top. Is the current situation crappy? Certainly, but stamping your foot and throwing a tantrum like a child is exactly the decision-making approach that got us in this mess in the first place.

There is nothing over the top about my comment. They need to be more up-front about these utilization tours. Pointing to the "needs of the military" clause in the contract is too vague and nonspecific for someone fresh out of college, with no military experience.

Sending a subspecialist to BDE who has no desire to drink the cool aid, be a commander, or be a lifer doesn't benefit the army, the subspecialist, or the patient.

 

[colbgw02]

Your comment, and your "solution", are both, like I said, over the top. Is the current situation crappy? Certainly, but stamping your foot and throwing a tantrum like a child is exactly the decision-making approach that got us in this mess in the first place.

Please expound.

 

[idq1i]

Please expound.

I just don't understand how someone identifying himself as a surgeon would actually defend BDE assignments on any level as they stand now. I just don't get it... There must be an element of denial and/or attempted rationalization

Saying BDE Sx is a terrible thing is not throwing a temper tantrum.

As a side note, it's interesting how most threads here always end the same way

 

[Perrotfish]

Milmed at it stands just needs to die. They need to replace it with a scholarship that is upfront about these BDE/GMO/etc utilization tours - military pays for med school, and in return you play GMO/BDE/wtf else they want to call it for 3-4 years and then you are done. Outsource routine care to civilian hospitals, get rid of the overwhelming bureaucracy and overhead, close all the MTFs, and get rid of the incompetent civilian "provider" dreck holed up in these MTFs for years, outside of the reach of state boards and real credentials oversight committees.

One problem with this is that military healthcare is theoretically the gatekeeper to all of the benefits. Civilian providers not associated with the bulletproof malpractice coverage of military hospitals just give people what they ask for. How do you outsource EFMP? Do you honestly think a civilian surgeon would give a reasonable estimate of time to return to active duty when faced with a Marine who was demanding more time off? Even with GMOs doing some of the routine screening, sometimes you need a specialist's opinion of what is reasonable. I'm not sure how you get that if you outsource everything.

Of course the other issue is that we need a lot of subspecialists in warzones, and also in remote (often non-US) locations. An MTF exists primarily for the sake of providing something to keep the surgeons and anesthesiologists busy while they are, basically, waiting to go somewhere that civilians can't go. Or to produce specialists to provide care in places like Okinawa and Japan where civilians won't go. Would you really want to trust your child to the local healthcare system in Guam? Would you trust that, without the MTFs and HPSP, we'd have enough trauma surgeons left over when we fight the next war? We need GMOs, but we also need people who are not GMOs.

 

[Chonal Atresia]

At the civilian places where I moonlight, it's not uncommon for the first case of the day to be delayed 15 minutes because the nurse or room isn't ready. Sucks, but it's not the end of the world.



No one makes $170K on a MSP contract - more like $250-275K for surgical subs. Still far shy of the $700K+ and I totally agree that for many specialties milmed pay is lowball BS, but c'mon, use real numbers.



It's ******ed, I'll give you that, and I gripe about it too. But in the grand scheme of things? A few days per year, I kill a few hours clicking.



This must be command dependent because I've never had leave denied, regardless of how delinquent my clicking is.



Come on indeed, twice a year you have to go exercise for half an hour.

And some days ... I have to ... wait for it ... wear a uniform. Damn.



Totally agree with you.



The Navy doesn't do this. We foist that job off on GMOs prior to residency, which is a wholly different problem, but at least we're not sending subspecialists out to rot. If I was in the Army, this brigade surgeon nonsense would drive me to mutiny.

If I got orders to a GMO / brigade surgeon kind of billet now, I don't know what I'd do. I honestly don't feel competent to practice any kind primary care any more. I haven't examined a knee or evaluated a rash or prescribed hypertension meds in many years. It's been a decade+ since I've done a pelvic exam. I would be a terrible GMO at this point.

I've been watching this Army brigade surgeon nonsense the last couple years in utter amazement. That nurse surgeon general, too.



Perhaps a command (and specialty) specific problem. Not an issue where I am, or for what I do. I can imagine that if I had a clinic that this would make me miserable.



Completely agree. I'm fortunate enough to be in a specialty that generally doesn't need much support staff. It's the nature of anesthesia to do everything ourselves.



Yeah, it sucks. On the other hand, the local civilian groups I moonlight for don't buy plane tickets and pay hotel/conference fees for anyone. Is funded CME common anywhere, outside of academia? For PP groups, funding has to come from somewhere, and it's just less money available to distribute to partners, no?



Agreed, this sucks.

It's fixable though, if the command stays out of the way and lets you send AD people home when the work is done. Tell a surgical tech he can go home at 3 if the cases are done and that turnover goes fast.



Yeah, I imagine those are a steaming pile of crap. The Navy doesn't require them. The last bull**** Navy course I had to go to was Officer Indoctrination School, about 15 years ago. Maybe someday stuff like AMDOC will be forced.

Five years ago I read this forum and marveled at the amazingly abusive and inefficient BS the Air Force routinely inflicted on its doctors. Now it seems the Army is going that way. I just hope the Navy doesn't follow the example, at least for a while.



We'll see. There has always been a mass exodus of physicians leaving the instant their ADSOs are up, and there probably always will be.

Since they bumped the stipend a few years ago, HPSP has been full. There's no reason to think it won't remain full. It took a booming bubble economy and the depths of a boondoggle of a war to create a transient recruiting shortfall. The training pipeline is full.

If anything, over time as Obamacare evolves, there will be less and less difference between doctors working for the government in the military, and doctors working for the government in the civilian world. We're all going to be government employees some day. Go make that $700K+ hay in PP while the sun is shining.

I guess I don't share your pessimism about where civilian healthcare is going. I certainly disagree with the assumption that we are "all going to be government employees" someday. I, for one, will never work for a hospital let alone the government after I leave the military. I will sink or swim based on my on merit and work ethic in private practice. This may be location-dependent so pick your location wisely. If you decide to locate to an area with a high-amount of Medicaid and Tricare, than it sucks to be you with regard to reimbursement. Only way to make good money in this situation is with increased volume. Might sound harsh, but it's reality. I think a two-tier health system is coming.

BTW, I do make 170K (w/o moonlighting) because I am still serving my initial ADSO and there is no way in hell that I will ever sign an MSP contract. My buddy who left 2 years ago (same age) made 700K last year. I realize this certainly is not possible for all specialties, but for many surgical and medical sub-specialists it is.

 

[colbgw02]

One problem with this is that military healthcare is theoretically the gatekeeper to all of the benefits. Civilian providers not associated with the bulletproof malpractice coverage of military hospitals just give people what they ask for. How do you outsource EFMP? Do you honestly think a civilian surgeon would give a reasonable estimate of time to return to active duty when faced with a Marine who was demanding more time off? Even with GMOs doing some of the routine screening, sometimes you need a specialist's opinion of what is reasonable. I'm not sure how you get that if you outsource everything.

The British have a good approach to this, IMO. Of course, they also have a one-payer system, which comes with its own set of problems. If we ever have such a system in the U.S., I would like to see us adopt a similar approach to military medicine.

Of course the other issue is that we need a lot of subspecialists in warzones, and also in remote (often non-US) locations. An MTF exists primarily for the sake of providing something to keep the surgeons and anesthesiologists busy while they are, basically, waiting to go somewhere that civilians can't go. Or to produce specialists to provide care in places like Okinawa and Japan where civilians won't go. Would you really want to trust your child to the local healthcare system in Guam? Would you trust that, without the MTFs and HPSP, we'd have enough trauma surgeons left over when we fight the next war? We need GMOs, but we also need people who are not GMOs.

To me, this paragraph is a great example of how military medicine tries to be all things to all people, but comes up short. You say that MTFs exist primarily for keeping surgeons, etc., busy in garrison, but then you cite dependent care as a reason to keep MTFs. So which is it? You also reference trauma surgery as a reason for MTFs, even though only 1 DoD facility is a level-I trauma center and major trauma at other MTFs is either very rare or funneled to civilian trauma centers. So how exactly does that further your point about the usefulness of MTFs vis-a-vis military trauma surgery preparation?

What I'm getting at is that military medicine justifies its existence and prioritizes its resources based on occasional care in military-specific austere environments, but demands civilian standards (TJC, state licensure, board certification, ACGME accreditation, civilian tort standards) for the majority of the care it delivers. The two are frequently at odds, and it's the physicians who get stuck trying to implement the latter within the confines of the former.

 

[pgg]

Of course the other issue is that we need a lot of subspecialists in warzones, and also in remote (often non-US) locations. An MTF exists primarily for the sake of providing something to keep the surgeons and anesthesiologists busy while they are, basically, waiting to go somewhere that civilians can't go. Or to produce specialists to provide care in places like Okinawa and Japan where civilians won't go. Would you really want to trust your child to the local healthcare system in Guam? Would you trust that, without the MTFs and HPSP, we'd have enough trauma surgeons left over when we fight the next war? We need GMOs, but we also need people who are not GMOs.

Yeah, but do they really need to be active duty?

I used to be a firm believer in vagaries like "institutional memory" and the need for the military to have career subspecialist physicians who "remember the last war's lessons" and other buzzphrases like that.

I sort of doubted when, as a GMO, that "institutional memory" was instilled in me via a 2-week Field Medical Service School at Camp Lejeune, taught by Corpsmen. Lots of admin instruction, field sanitation, that sort of thing.

And after my last deployment, I believe it less.

At my location, we had anesthesiologists, a trauma surgeon, thoracic surgeon, vascular surgeon, plastic surgeon, general surgeon, several orthopedic surgeons, a neurosurgeon, an ophthalmologist, OMFS, anesthesiologists, radiologists, intensivists, pulmonologists, FM, IM, dentists, probably more that escape me right now, and a bunch of support staff.

You know what? NONE of us, except for the trauma surgeon, did trauma back home at our MTFs. The trauma surgeon wasn't even stationed at a MTF, he had a billet at a civilian institution! My inservice residency did no trauma (unless you count gomeric hip fractures) and sent us to a civilian institution to get our legit trauma numbers. We did a 3-week trauma refresher course before deploying, mostly useless, but the reading list was really good. I'm just not sure what kind of institutional memory we brought with us. I don't see how the 3 years I spent between residency and this deployment at a small MTF doing low acuity B&B cases made me more of an asset than a civilian/reservist anesthesiologist would've been. That trauma hospital in Afghanistan ran amazingly well, but was that because most of the physicians were active duty?

Do we really need O6 physicians who've been in 20 years to remind us how field sanitation works? Do they know something about 1:1:1 transfusion ratios that civilians can't know or read about on the flight over? Do we really need active duty subspecialists?

 

[pgg]

I guess I don't share your pessimism about where civilian healthcare is going. I certainly disagree with the assumption that we are "all going to be government employees" someday. I, for one, will never work for a hospital let alone the government after I leave the military. I will sink or swim based on my on merit and work ethic in private practice. This may be location-dependent so pick your location wisely. If you decide to locate to an area with a high-amount of Medicaid and Tricare, than it sucks to be you with regard to reimbursement. Only way to make good money in this situation is with increased volume. Might sound harsh, but it's reality. I think a two-tier health system is coming.

Could be. My perspective is of course colored by my field (anesthesia) and moonlighting experience. Time will tell.

BTW, I do make 170K (w/o moonlighting) because I am still serving my initial ADSO and there is no way in hell that I will ever sign an MSP contract. My buddy who left 2 years ago (same age) made 700K last year. I realize this certainly is not possible for all specialties, but for many surgical and medical sub-specialists it is.

Sure, but the correct comparison is between civilian pay, and post-ADSO pay with a MSP contract.

Your pre-ADSO pay includes, as part of its compensation, "time instead of money payback" for the $ the military spent to put you through med school, and the interest you didn't pay on student loans while in residency. You're not making $170K - you're making $170K plus a debt payment for education.

The only comparison that matters is between choices you can possibly make. Pre-ADSO you can make no choice. Post-ADSO, you can choose between civilian pay and MSP-augmented pay.

Again, not that $250K is soooooo much more appealing than $170K when $700K is offered, but if we're going to throw around numbers, we should use the right ones.

 

[delicatefade]

By way of clarification and just a friendly FYI for a Squid , in the Army, some of the issues are definitely command dependent. Interestingly, it was in the line units that I got the fewest problems with things like going on leave, computer training, E-4's not counting my pushups, etc. If the CoC/ troops think you actually care about them, they bend over backwards for the "Doc." And I'm a Major, if I am displeased with how an E-whatever is treating me, I have the option of throwing the oak leaf on the table and making their lives miserable. A MC officer who actually knows Army Regulations can be a powerful officer, but too many of us are so busy complaining we don't bother reading the AR's.

Unfortunately, the problems with inadequate staffing and the like are chronic in the Army.

Too few Army doctors though, seem to realize many of our complaints have their civilian equivalents. For example, QA is a joke in the military, but in many major hospital systems, they have real power. Having to beg (or pay someone to beg) some clipboard nurse to get paid by an insurer for a standard of care diagnostic test is seemingly something our fellow MC officers seem to forget is a reality of civilian medicine.

I would like to clarify the Brigade Surgeon assignments though, which is not the same as a GMO tour, even though one is credentialed as a GMO. As Brigade Surgeon, you really are special staff and are responsible for medical aspects of operational planning. Most of the PCM duties are provided by the Brigade/Battalion physician assistants or MTF medical providers. And they are often the ones who do the MEB paperwork. Most of the planning and operational readiness staff work and meetings are done by the MSC Medical Operations Officers (MEDO's). I was unlucky enough to be assigned to a Brigade that had no Brigade PA, no MEDO's, and so I got my Commander's support in not having anyone empaneled to me so I could do the Staff jobs on my own and block out OR time. The only MEB's I did as Primary were the ones for Brigade HHC, and for the Battalions only if there was a problem leading to delay, to advise or help out the PA/Battalion Surgeon. It's not an ideal assignment, especially for sub-specialists and those specialties that are procedure dependent, but some of the complaints and everyone being up in arms is a bit over the top. How many liver resections did I really miss out on in the 2 years as a Brigade Surgeon? But it is not surprising since MC tends to be more vocal about complaints, myself included, and we do justifiably have a lot to complain about.

Which AR would be most helpful? I've got plenty of time to read right now in Afghanistan.