Anesthesia in the Navy

[SeminoleFan3]

I'm currently doing an anesthesiology rotation, and I absolutely LOVE it. However, I realize that in the Navy, it might be a bit different that at an academic medical center like my own. So, can anyone shed on light on what anesthesia is like in the Navy (work hours, case load, etc)?

Thanks!

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[BOHICA-FIGMO]

I'm currently doing an anesthesiology rotation, and I absolutely LOVE it. However, I realize that in the Navy, it might be a bit different that at an academic medical center like my own. So, can anyone shed on light on what anesthesia is like in the Navy (work hours, case load, etc)?

Thanks!

While I'm not an anesthesiologist, I do have an interest, and have done anesthesiology rotations at the NMC where I am currently doing internship. I think the program here is probably equivalent to any civilian program with the following exceptions: 1. didn't see as much regional anesthesia performed as civilian centers 2. fewer CT cases than civilian med center 3. no trauma 4. typically lower acuity ICU than avg civilian med center. That being said, I thought the residents and attendings were all very personable and smart; and the didactics were excellent. The downside is, you probably won't go straight through. The upside is the chance to serve on a forward surgical team REALLY close to the "front lines". Hope that helps!

 

[SeminoleFan3]

About how many spots does the Navy have? Are they granting deferrments?

 

[BOHICA-FIGMO]

About how many spots does the Navy have? Are they granting deferrments?

1. 16-18 between the "big 3" medical centers. About 1/16 is straight through from internship.
2. For the classes of 2009, 2010, 2011...absolutely NO civilian deferments (class sizes are too small). I don't know about the classes of 2012 and 2013.

 

[kleos atanatos]

While I'm not an anesthesiologist, I do have an interest, and have done anesthesiology rotations at the NMC where I am currently doing internship. I think the program here is probably equivalent to any civilian program with the following exceptions: 1. didn't see as much regional anesthesia performed as civilian centers 2. fewer CT cases than civilian med center 3. no trauma 4. typically lower acuity ICU than avg civilian med center. That being said, I thought the residents and attendings were all very personable and smart; and the didactics were excellent. The downside is, you probably won't go straight through. The upside is the chance to serve on a forward surgical team REALLY close to the "front lines". Hope that helps!

Thanks for the info. I'm also interested in anesthesiology in the Navy. I'm interviewing at USUHS this month and hoping I get in. Anesthesiology runs back a few generations in my family and I've really enjoyed my time doing clinical research with anesthesiologists in college. I know most people end up choosing a completely different specialty after 4 years of medical school, but I think my interest will most likely remain in anesthesiology.

With the fact that I would be graduating in 2014, do you think in your own opinion that the numbers of people going straight through will stay pretty similar?

I'm trying to choose between Navy and Army. Which one would you do if your goal was going into gas?

Thanks

 

[NavyFP]

1. 16-18 between the "big 3" medical centers. About 1/16 is straight through from internship.
2. For the classes of 2009, 2010, 2011...absolutely NO civilian deferments (class sizes are too small). I don't know about the classes of 2012 and 2013.

Not completely sure there will be no anesthesia deferments given for 2010 or 2011 but if there are it will only be 1 or 2. Using my very cloudy crystal ball would expect 4-5 in 2012 and 2013.

 

[SeminoleFan3]

Not completely sure there will be no anesthesia deferments given for 2010 or 2011 but if there are it will only be 1 or 2. Using my very cloudy crystal ball would expect 4-5 in 2012 and 2013.

Sadly I'll be in the c/o 2011, which I imagine is very small.

 

[psychbender]

I'm trying to choose between Navy and Army. Which one would you do if your goal was going into gas?

Thanks

In my incredibly biased view, I'd say go Army...we do straight through training for nearly everything.

 

[IDBasco]

1. 16-18 between the "big 3" medical centers. About 1/16 is straight through from internship.
2. For the classes of 2009, 2010, 2011...absolutely NO civilian deferments (class sizes are too small). I don't know about the classes of 2012 and 2013.

When you say the class size is too small, you aren't suggesting there aren't enough people wanting to anesthesia, right? I assume you mean they don't have enough total people entering residency for all specialties combined. Is that it?

 

[BOHICA-FIGMO]

When you say the class size is too small, you aren't suggesting there aren't enough people wanting to anesthesia, right? I assume you mean they don't have enough total people entering residency for all specialties combined. Is that it?

True...I mean there aren't enough interns altogether. We have 2 civies in our IM program due to shortages. As far as anesthesia, there will never be too few people wanting it. Several residents I know are prior board certified...usually in FP or peds, but occasionally something else. In short, anesthesia is VERY competitive.

 

[pgg]

I can only speak to the NCC and Portsmouth programs (and barely the NCC program, since I haven't been there since my internship in 02-03).

I think the program here is probably equivalent to any civilian program with the following exceptions: 1. didn't see as much regional anesthesia performed as civilian centers

The regional experience at the NCC and Portsmouth programs is quite good. Block numbers far in excess of the minimums required, and surgeons that generally encourage blocks or at least are willing to put up with us doing them.

2. fewer CT cases than civilian med center

CT exposure is very weak at the MTFs. Residents have to do out rotations at other hospitals to get CT numbers. There's an up and down side to this. I had a great experience at WHC in DC, but I can't say I was thrilled about living in a hotel for two months to get it.

3. no trauma

Unfortunately true. I was logging hip fractures as "trauma" to get minimum numbers ... certainly not enough true multi-system trauma to meet the minimum requirements. We did an out rotation at the Univ of VA for a month in their trauma ICU ... not so great, since it's all SICU work and no OR work.

4. typically lower acuity ICU than avg civilian med center.

The acuity is far lower. This is true for every residency at a MTF - not just anesthesia. I thought my program did a good job of compensating for this with out rotations, but that's not a perfect solution.


Military residencies typically have very high in-training exam scores and board pass rates. There are a probably a number of reasons for this, but i believe that chief among them are

1) The quality of the residents. Having rotated at several outside hospitals with residents from other highly regarded programs, I thought my class compared very well to the civilian residents. Plus, for some reason you simply don't see lazy, work-dodging, dishonest dirtbags at military programs. Maybe it's because military residents tend to be older, or have spent time in the desert as GMOs ... seems silly to have to talk about maturity level of a bunch of doctors, but there is a difference. My anecdotal experience is that there are more problem children in the civilian world.

2) Case load + reading time is a zero sum game; the case load at MTFs is relatively low, so we could read more.

 

[former military]

just a stupid surgeon... but I did well over 2000 cases in the military and the vast majority of the time nurse anesthetists were in my room... in fact...there were very few cases in the military hospitals that were high risk stuff...cardiovascular, high risk vascular, transplant....that stuff got pharmed out to civilian. I realize, that you won't always be an anesthesiologist in the military but you are going to spend a significant amount of time watching your skills decline. if they aren't going to do cases that go to an icu afterwards what does that tell you? I bet you are going to be doing a ton of admin and taking the medical legal risks for the nurse anesthetists as they train the nurse anesthetist students. doesn't sound like much fun to me. I work a lot with a former navy anesthesiologist and that was her experience. you are a vehicle to be deployed and go to the wrong place and you don't do many cases at all. You just fill a bucket space.

I spoke with a lot of anesthesiologists while operating in the military and they seemed like some of the most frustrated people in the hospital. Which says a lot because we were all extremely frustrated

I can only speak to the NCC and Portsmouth programs (and barely the NCC program, since I haven't been there since my internship in 02-03).



The regional experience at the NCC and Portsmouth programs is quite good. Block numbers far in excess of the minimums required, and surgeons that generally encourage blocks or at least are willing to put up with us doing them.



CT exposure is very weak at the MTFs. Residents have to do out rotations at other hospitals to get CT numbers. There's an up and down side to this. I had a great experience at WHC in DC, but I can't say I was thrilled about living in a hotel for two months to get it.



Unfortunately true. I was logging hip fractures as "trauma" to get minimum numbers ... certainly not enough true multi-system trauma to meet the minimum requirements. We did an out rotation at the Univ of VA for a month in their trauma ICU ... not so great, since it's all SICU work and no OR work.



The acuity is far lower. This is true for every residency at a MTF - not just anesthesia. I thought my program did a good job of compensating for this with out rotations, but that's not a perfect solution.


Military residencies typically have very high in-training exam scores and board pass rates. There are a probably a number of reasons for this, but i believe that chief among them are

1) The quality of the residents. Having rotated at several outside hospitals with residents from other highly regarded programs, I thought my class compared very well to the civilian residents. Plus, for some reason you simply don't see lazy, work-dodging, dishonest dirtbags at military programs. Maybe it's because military residents tend to be older, or have spent time in the desert as GMOs ... seems silly to have to talk about maturity level of a bunch of doctors, but there is a difference. My anecdotal experience is that there are more problem children in the civilian world.

2) Case load + reading time is a zero sum game; the case load at MTFs is relatively low, so we could read more.

 

[pgg]

The days at my little hospital are 1/2 filled with colonoscopies, basic ortho, and low risk OB. If not for moonlighting, it would be a very bad place for someone fresh out of residency like me.

As for the big 3, I think there's enough to keep an anesthesiologist current and competent unless you want to do CT or sick kids. I don't think the lack of trauma is too big a deal ... from an anesthetic perspective, managing a trauma patient is not that difficult.

And completely aside from the network deferrals impacting case load for attendings is the impact on GME. I have believed, and feared, for a solid 10 years now - starting back when I was a med student - that the trend of outsourcing and downsizing would be catastrophic for military GME. The Navy anesthesiology programs are still quite good, propped up as they are by out rotations, but overall nothing I've seen since day 1 at USUHS has made me think this fundamental problem has a long term solution.

Today, if I was a 2009 premed, I would not accept an HPSP slot simply because I have little faith that most military residencies will offer quality training 5-10 years from now (post med school +/- GMO time).

just a stupid surgeon... but I did well over 2000 cases in the military and the vast majority of the time nurse anesthetists were in my room... in fact...there were very few cases in the military hospitals that were high risk stuff...cardiovascular, high risk vascular, transplant....that stuff got pharmed out to civilian. I realize, that you won't always be an anesthesiologist in the military but you are going to spend a significant amount of time watching your skills decline. if they aren't going to do cases that go to an icu afterwards what does that tell you? I bet you are going to be doing a ton of admin and taking the medical legal risks for the nurse anesthetists as they train the nurse anesthetist students. doesn't sound like much fun to me. I work a lot with a former navy anesthesiologist and that was her experience. you are a vehicle to be deployed and go to the wrong place and you don't do many cases at all. You just fill a bucket space.

I spoke with a lot of anesthesiologists while operating in the military and they seemed like some of the most frustrated people in the hospital. Which says a lot because we were all extremely frustrated

 

[BOHICA-FIGMO]

Not completely sure there will be no anesthesia deferments given for 2010 or 2011 but if there are it will only be 1 or 2. Using my very cloudy crystal ball would expect 4-5 in 2012 and 2013.

Okay. To the OP, trust NavyFP his gouge is better than mine.😳

 

[SeminoleFan3]

Okay. To the OP, trust NavyFP his gouge is better than mine.😳

Yes, NavyFP is generally my standard 🙂