Do you think there is any place where you can just practice medicine in the military and work your way to a decent retirement?
Not sure if you're asking rhetorically and in so making a point about the nature of military medicine, but taking your question at face value...
Yes, I've seen it done many times. I might go as far as to say that, for my specialty at least, it's the norm rather than the exception. Everyone will get saddled with some administrative duty, but I'd like to think that's not too different from the way a senior PP partner has to be part businessman. Many will get saddled with too much, but even that duty is frequently in hopsital administration that allows part-time practice. Only in the military could removal from the practice of medicine be couched as a "reward" and opportunity for career advancement.
I've thought a lot about this the past couple of months, and I think that your question highlights why medicine and the military don't mix. The overwhelming majoirty of physicians want to - wait for it - practice medicine. For us, that is the goal; it's our end. We train for years and years to reach indepedent practice, and once we do, most of us want nothing more than to keep doing it. We'll do it in Iraq, Afghanistan, Korea, wherever, but let us do our job.
The Army, specifically, and the military, generally, don't see it that way. They're so mired in the idea of "career development" and progressing to the next job, the next rank, that they can't even conceptualize that someone would be content to just hold what they've got. Medicine, for them, is just a means to an end - namely, to have a career. In the same way that a good company commander or good staff officer is more likely to make a good battalion commander, they see an MD/DO as the prerequisite to see if someone is good at running a clinic. Because, after all, people good at running clinics might be good at running hospitals.
The problem is that's not how medicine works. There's nothing that a surgeon learns at CCC that improves his appendectomy skills, nor is there anything I will learn as a BDE surgeon that will improve my specificity at detecting cancer on a mammogram. In that sense, medicine is no different than any other professional skill (e.g. lawyers, pilots). The difference is that we train to
civilian standards, and most of the time we practice to
civilian standards. Those are our measuring sticks. And when the Army superimposes its career arc onto those standards, it jeopardizes the safe and competent practice of medicine.
As long as the military neglects this fundamental difference between good medicine and good officership, the medical corps will limp along - held up only by those with the patience and stamina to continue practicing in the face of a system too often designed to undermine them. I have a great deal of respect for those who continue to work within military medicine but who retain their perspective on its flaws. Too many of our leaders have bought in, and are serving only to perpetuate the status quo. I have respect for them because I am not one of them. Like so many others, I've decided that life is too short to waste any more time with this organization than I have to.
