AVOID MILITARY MEDICINE if possible

[Galo]

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I personally experienced these exact same threats, not the psych one, but a vindictive, frivolous, and failed attempt to discredit me personally and damage my future civilian career.

I was threatened to spend the rest of my enslavement changing tires and picking weeds in Diego Garcia. It was by an inexperienced new orthopod who was playing the administrative role. It was regarding me trying to contact the surgeon general after having sent him a 4 page letter that was going unanswered.

THese *****s know they can close to do anything they want to you if they have rank. Its no joke like being a made man in the mob.

 

[alpha62]

I worked with 3 other officers. They were constantly shaking in their boots. Trying not to make any waves or they'd be sent to Iraq to a line unit.

They were correct in that assumption. It's very easy for command to simply call the PROFIS desk and make somebody disappear.

The whole farce started to remind me of Hogan's Heroes. Col. Klink always kissing ass, trying to avoid being sent to the Russian Front 😀

 

[DropkickMurphy]

The whole farce started to remind me of Hogan's Heroes. Col. Klink always kissing ass, trying to avoid being sent to the Russian Front

I VOLUNTEERED to be sent to Kuwait ahead of the invasion- I wanted to do what I had signed up to do....then I was ordered to have a psych eval because apparently that means I am insane.

Yeah, the whole incident reminded me of Hogan's Heros, except none of the players wound up strangled with a lamp cord or beaten with a camera tripod during the filming of a kinky sex tape after the show ended.

 

[Yersinia]

Wow. I just read through everypost inthe past 19 pages starting almost a year ago. I have this kinda time as I am currently on the all expenses paid Big Grey Cruise Line. And I gotta say that y'all are right! If I could do it all over again I would have gone into engineering. My internship experience was so scary that it soured me on medicine in general. A contractor today was telling me his daughter is premed and I was telling him she should reconsider. I just thank my luck stars that I have a great CO and a great SMO but stay tuned since that all changes in a year anyway. 😉

 

[alpha62]

I'm ex-army, so I don't know much about afloat. I hear they use civilian contract docs on ships now days. Things like sub tenders and such.

Is that true ? That sounds like something that would be almost tolerable.

Wow. I just read through everypost inthe past 19 pages starting almost a year ago. I have this kinda time as I am currently on the all expenses paid Big Grey Cruise Line. And I gotta say that y'all are right! If I could do it all over again I would have gone into engineering. My internship experience was so scary that it soured me on medicine in general. A contractor today was telling me his daughter is premed and I was telling him she should reconsider. I just thank my luck stars that I have a great CO and a great SMO but stay tuned since that all changes in a year anyway. 😉

 

[Monty Python]

I hear they use civilian contract docs on ships now days. Things like sub tenders and such.

Is that true ?.

Since 2000 I've served on the USS Kearsarge (LHD class USMC infantry assault ship with four ORs) and on the USS George Washington (Nimitz class nuclear powered aircraft carrier) with one OR. Never saw nor heard of civilian docs, although there were civilian employees of Boeing, Lockheed, etc, on board as technical representatives.

Don't know about sub tenders.

At several Naval Hospitals where I served in between ship assignments they were civilianizing some non-combat related specialties, such as peds, FP, derm. The long range goal is to have only combat-related folks in uniform, such as general surgery, neurosurg, ortho, anesthesia, etc. Supposedly this will save money somehow somewhere. Yeah, right.

 

[USAFdoc]

FYI on military plans at civilianizing military medicine;


http://www.moaa.org/todaysofficer/columnists/Strobridge/Medical.asp

 

[alpha62]

If I were to ever go back to contracting again, it'll be OCONUS and out of the dependent/retiree panels. That was the worst of 4 worlds: HMO style care, military bureaucracy, outta control civilian nurses, and pissed off self-entitled pts all day.

FYI on military plans at civilianizing military medicine;


http://www.moaa.org/todaysofficer/columnists/Strobridge/Medical.asp

 

[militarymd]

FYI on military plans at civilianizing military medicine;


http://www.moaa.org/todaysofficer/columnists/Strobridge/Medical.asp

I've read that article before...right when it came out.

It will work only if they are willing to fund it appropriately.

Everything boils down to money.

 

[orbitsurgMD]

From the linked article:

"One consistent theme we hear from members is that thousands already encounter great difficulty in finding providers who will accept TRICARE patients. With that experience, we’re considerably less than certain that there are enough civilian doctors willing to step up and accept the patient load now cared for by those 5,500 Navy professionals."

This is a very valid concern. If the plan means turning more active duty billets over to the local communities with TRICARE as the supporting insurer, there may not be enough providers to reliably meet the need. TRICARE is in many places comparable to state Medicaid in the quality of its reimbursement, which is to say, not very attractive. Practitioners that strain to accept Medicaid probably won't be so ready to take on another government-sponsored low-dollar payor.

 

[NavyFP]

From the linked article:

"One consistent theme we hear from members is that thousands already encounter great difficulty in finding providers who will accept TRICARE patients. With that experience, we’re considerably less than certain that there are enough civilian doctors willing to step up and accept the patient load now cared for by those 5,500 Navy professionals."

This is a very valid concern. If the plan means turning more active duty billets over to the local communities with TRICARE as the supporting insurer, there may not be enough providers to reliably meet the need. TRICARE is in many places comparable to state Medicaid in the quality of its reimbursement, which is to say, not very attractive. Practitioners that strain to accept Medicaid probably won't be so ready to take on another government-sponsored low-dollar payor.

The referenced article is very old news. That was PBD-712 (program budget decision). Already happened. The big thing with those cutbacks was reducing the number of techs (rad techs/us techs/lab techs). There were some docs in there, but they were to be converted to GS docs not contracts.

 

[USAFdoc]

excellent article on what is wrong with military medicine, particularly HPSP;

comments welcomed.

http://www.usminstitute.org/content/HPSP.doc

 

[NavyFP]

excellent article on what is wrong with military medicine, particularly HPSP;

comments welcomed.

http://www.usminstitute.org/content/HPSP.doc

Interesting article. Some I agree with, some I do not. USU students do not stay until retirement at the 90% level. Last numbers I saw were in the 25-30% range. The "tails" some have alluded to (not those here) are not based in fact. Most physicians get out well prior to retirement.

This is not entirely bad, but we could do better keeping doctors.

To address VADM Koenig's conclusions:

1) There is a method of reducing debt. It is Health Proffessions Loan Repayment Program. It can and will be modified in the future, but it does assist in loan repayment.

2) The Navy has engaged AD physicians for recruiting med students. This year BUMED has put 100K into a travel pot to fund physicians to go to the potential students. I disagree with making HPSP a unified application, I don't believe it will improve recruitment. (my opinion). Would be happy to add SMCAF ombudsman for students.

3) That will happen soon enough with the upcoming Unified Medical Command.

4) The Navy is working on this. RDML Robinson (the current chief of the medical corps) strongly believes we need to at a minimum cut back on the number of GMOs. He has asked the line to look closely at the GMO billets we do have and which can be dropped down to the PA/NP level and which can be done by BC docs. The problem is that the line is quite happy with GMOs. The Marine Corps does not particularly want board certified docs. They tend to be at the O-4 and above level and that messes with the whole command structure. The MC does not feel the need for field grade docs.

These are my opinoins, to quote Dennis Miller, "I could be wrong."

 

[USAFdoc]

Interesting article. Some I agree with, some I do not. USU students do not stay until retirement at the 90% level. Last numbers I saw were in the 25-30% range. The "tails" some have alluded to (not those here) are not based in fact. Most physicians get out well prior to retirement.

This is not entirely bad, but we could do better keeping doctors.

To address VADM Koenig's conclusions:

1) There is a method of reducing debt. It is Health Proffessions Loan Repayment Program. It can and will be modified in the future, but it does assist in loan repayment.

2) The Navy has engaged AD physicians for recruiting med students. This year BUMED has put 100K into a travel pot to fund physicians to go to the potential students. I disagree with making HPSP a unified application, I don't believe it will improve recruitment. (my opinion). Would be happy to add SMCAF ombudsman for students.

3) That will happen soon enough with the upcoming Unified Medical Command.

4) The Navy is working on this. RDML Robinson (the current chief of the medical corps) strongly believes we need to at a minimum cut back on the number of GMOs. He has asked the line to look closely at the GMO billets we do have and which can be dropped down to the PA/NP level and which can be done by BC docs. The problem is that the line is quite happy with GMOs. The Marine Corps does not particularly want board certified docs. They tend to be at the O-4 and above level and that messes with the whole command structure. The MC does not feel the need for field grade docs.

These are my opinoins, to quote Dennis Miller, "I could be wrong."

agreed; however, missing in the VADMs comments are the problems that non-continuity (especially in Primary Care), lack of authority, problems with support staff etc. and the effect that has on care of the patient and satisfaction of Physicians. The USAF could have increased my pay to 200K+ and I still would have vacated USAF primary care.

 

[alpha62]

If the MC is like the Army line units, they don't want field grade medical officers. It would mess with their command structure, what it would really mess with would be the ego structure of a unit.

I was the same rank as the company commander. He had positional authority over me, but it ended at the orderly room desk... and it pissed him off to no end.

agreed; however, missing in the VADMs comments are the problems that non-continuity (especially in Primary Care), lack of authority, problems with support staff etc. and the effect that has on care of the patient and satisfaction of Physicians. The USAF could have increased my pay to 200K+ and I still would have vacated USAF primary care.

 

[USAFdoc]

If the MC is like the Army line units, they don't want field grade medical officers. It would mess with their command structure, what it would really mess with would be the ego structure of a unit.

I was the same rank as the company commander. He had positional authority over me, but it ended at the orderly room desk... and it pissed him off to no end.

trying to run medicine via command structure is just a bad plan, for many reasons, not just field grade egos.

 

[USAFdoc]

Carlton said another major goal is to optimize the Air Force Medical Service-make it more efficient and effective-so that it can take care of many more people than is now the case.

Major growth is quite possible. Right now the AFMS has an enrollment of about 960,000 people, yet officials figure that 2.32 million people are eligible for their services.

The goal is to have one primary care provider for every 1,500 enrolled persons. Each provider should be able to see 25 patients a day and should be helped by 3.5 support personnel and have access to two exam rooms.

Some Air Force facilities have already surpassed this efficiency level.Carlton reports establishment of the principle of primary care model blocks. A block will have four primary care providers, two nurses, eight medical technicians, and four administrators. It will be able to take care of 6,000 people.

"And then it's a very simple building block," said Carlton. "As you go from 6,000 to 12,000 to 18,000 [people], you add [primary care model] blocks. And it makes us look at the support staff and say, 'Is it value added?' and then [we] eliminate the non*value added."

"Scott Air Force Base [Ill.] laughs at [the ratio of] 1,500-to-1," said Carlton. "The last time I was there, they were at 1,900-to-1, and they still had open appointments."

Believe me, despite what Gen Carlton says, nobody in USAF primary care is laughing!

the above exerps are from the USAF then Surgeon General who authored the failed Primary Care Optimization plan that has wiped out quality of care and quality of life in USAF clinics. While many things played a role in this, none more so then the failed promise to deliver the support staff he mentions above. He talks about 3.5 support staff per provider. What did we have in reality? Many days were as low as 0.5 support staff per providers, with an average of about 1.0
And most days were manned with 30% staffing in terms of providers.

FYI

 

[Monty Python]

Carlton said another major goal is to optimize the Air Force Medical Service-make it more efficient and effective-so that it can take care of many more people than is now the case.

Major growth is quite possible. Right now the AFMS has an enrollment of about 960,000 people, yet officials figure that 2.32 million people are eligible for their services.

The goal is to have one primary care provider for every 1,500 enrolled persons. Each provider should be able to see 25 patients a day and should be helped by 3.5 support personnel and have access to two exam rooms.

Some Air Force facilities have already surpassed this efficiency level.Carlton reports establishment of the principle of primary care model blocks. A block will have four primary care providers, two nurses, eight medical technicians, and four administrators. It will be able to take care of 6,000 people.

"And then it's a very simple building block," said Carlton. "As you go from 6,000 to 12,000 to 18,000 [people], you add [primary care model] blocks. And it makes us look at the support staff and say, 'Is it value added?' and then [we] eliminate the non*value added."

"Scott Air Force Base [Ill.] laughs at [the ratio of] 1,500-to-1," said Carlton. "The last time I was there, they were at 1,900-to-1, and they still had open appointments."

Believe me, despite what Gen Carlton says, nobody in USAF primary care is laughing!

the above exerps are from the USAF then Surgeon General who authored the failed Primary Care Optimization plan that has wiped out quality of care and quality of life in USAF clinics. While many things played a role in this, none more so then the failed promise to deliver the support staff he mentions above. He talks about 3.5 support staff per provider. What did we have in reality? Many days were as low as 0.5 support staff per providers, with an average of about 1.0
And most days were manned with 30% staffing in terms of providers.

FYI

I knew Carlton when he was the 2 star CO at Wilford Hall in the 1990s. I was on C-130 medevac flight status next door at Kelly AFB, and our staging area was in Wilford's ground floor. Some of his thinking was typical Academy grad / Zoomie management BS. He also wanted to eliminate the vast majority of the nurse corps. Wanted all bedside care delivered by enlisted med techs, with only one RN on duty per floor as a supervisor. Said RNs were completely unnecessary.

 

[USAFdoc]

I knew Carlton when he was the 2 star CO at Wilford Hall in the 1990s. I was on C-130 medevac flight status next door at Kelly AFB, and our staging area was in Wilford's ground floor. Some of his thinking was typical Academy grad / Zoomie management BS. He also wanted to eliminate the vast majority of the nurse corps. Wanted all bedside care delivered by enlisted med techs, with only one RN on duty per floor as a supervisor. Said RNs were completely unnecessary.

and for those NON-primary care physicians and dentists, note the below plan that the USAF has for you; a quote from then Surgeon General Carlton;

As we continue to improve PCO, our next step will be to pursue specialty care optimization. We are reviewing a limited number of AFMS product lines associated with surgical specialties in larger, bedded facilities: obstetrics/gynecology, orthopedics, ophthalmology, otolaryngology, general surgery, and anesthesia. As we implement our primary and specialty care optimization programs, the resourcing decisions arising from the work of various functional panels will have full visibility at all levels of our corporate structure to ensure that the long view is the ultimate focus.

 

[ExNavyRad]

As we continue to improve PCO, our next step will be to pursue specialty care optimization.

specialty care optimization=drastic cuts in funding and personnel

We are reviewing a limited number of AFMS product lines associated with surgical specialties in larger, bedded facilities:

Here's the crux of much physician dissatisfaction: You're not taking care of patients, you are producing a "product line", much like a factory worker cranks out widgets. If you could be replaced by a cheaper robot, or a 10 cents/hour Asian wage-slave, the "leadership" would do it in a heartbeat, and smile all the way to their MSM award ceremony...

As we implement our primary and specialty care optimization programs, the resourcing decisions arising from the work of various functional panels will have full visibility at all levels of our corporate structure

functional panels=non-physician administrators and bean-counters. After all, nurse corps and MSC officers need those panels (and the AF commendation medals that go along with them) as fit-rep bullets, too, ya know...

to ensure that the long view is the ultimate focus.

i.e. "until I PCS or retire and take that nice cushy TRICARE admin job."


In the Navy, we called it "admiral-speak". Any time an O-7 or above got up on his hindlegs and opened his pie-hole, I assumed it was all B.S. until confirmed by at least 2 additional sources.

ExNavyRad

 

[USAFdoc]

specialty care optimization=drastic cuts in funding and personnel



Here's the crux of much physician dissatisfaction: You're not taking care of patients, you are producing a "product line", much like a factory worker cranks out widgets. If you could be replaced by a cheaper robot, or a 10 cents/hour Asian wage-slave, the "leadership" would do it in a heartbeat, and smile all the way to their MSM award ceremony...



functional panels=non-physician administrators and bean-counters. After all, nurse corps and MSC officers need those panels (and the AF commendation medals that go along with them) as fit-rep bullets, too, ya know...



i.e. "until I PCS or retire and take that nice cushy TRICARE admin job."


In the Navy, we called it "admiral-speak". Any time an O-7 or above got up on his hindlegs and opened his pie-hole, I assumed it was all B.S. until confirmed by at least 2 additional sources.

ExNavyRad

another couple great quotes from General Carlton;

"I think we (military medicine) forgot there's a product. The provider on the outside has a product---and it's called money."

"Some doctors still want to write down their own patient histories...it's more efficient to have another member of the team do it."

how clueless (what other members of the team) and how off the mark (my product as a family doc is NOT money!!!)

and this is the author of the current situation military medicine finds itself in! 😡

quotes from MILITARY UPDATE archives aug 10, 2000

 

[island doc]

another couple great quotes from General Carlton;

"I think we (military medicine) forgot there's a product. The provider on the outside has a product---and it's called money."

"Some doctors still want to write down their own patient histories...it's more efficient to have another member of the team do it."

how clueless (what other members of the team) and how off the mark (my product as a family doc is NOT money!!!)

and this is the author of the current situation military medicine finds itself in! 😡

quotes from MILITARY UPDATE archives aug 10, 2000

P.C.O.= Primary Care Obstruction

 

[USAFdoc]

[/QUOTE]
recent, very recent article noting the problem recruiting HPSP.

The military unfortunately thinks that by just increasing the $$ that more people will find the military "style" of doing medical care will work. I guess everyone has thier price, but as I said before, the USAF could have doubled my pay and I would have exited asap anyway.

http://www.military.com/features/0,15240,104359,00.html

 

[Galo]

While we are on the subject of Carlton, and SCO, although I never met him, I can from experience say that although he was (WAS) a surgeon, he got tainted by the typical mediocracy and turned a blind eye to what was important for patient care.

SCO, subspecialty care optimization, was an expensive JOKE. I've posted this before, but while PCO was languishing, we had a 4-5 person team from the surgeon general's office come and totally disrupt 48 hrs of our clinic and OR time to "discuss" SCO. It was clearly ovious from the discussion that they had no clue what was going on in the field. They spoke about hiring ortho techs that were nonexistent in the community, nursing staff that we did not need, but were unable to answer questions about basic supply materials, and increasing personel in order to be able to run the OR. A classic case of telling us they want to buy and Escalade, when in fact we have no gas to put in it.

Another example of the incredibly *****ic stupid ignorant ass attitude was the purchasing of equipment. When I got there, our laparoscopic light units and cords where third world equipment. We needed an upgrade badly, and it was actually a patient safety issue becuase we could not see well with 5 mm scopes. The immediate solutions were mandates to use 10 mm scopes, (not always in the patients best interest), but the best was when some idiot instead of buying one or two full set ups, bought a whole lot of light sources, but failed to realize that without the purchase of new light cords, you could hook it up to the sun, and it would not make a difference. When we vocally complained about this, they said the budget did not allow for purchase of the light cords or new scopes for another year.

SCO was a total exercise in self-agrandization by a pompous useless piece of crap beurocrat who forgot what it was to be a phycisian. He is now the dean of some school in Texas.

I wrote directly to him asking for help when I was being screwed with big time by the ignorance of the people running our base hospital, and all I got was a call from some deputy of his telling me that they knew everything, but could do nothing, and that, my favorite quote from a higher level administrator, that "change in the military is glacial."

NO matter how passionate and personal we make these pleas that military medicine is in the s@#thole, there are always going to be people who will not get this and want to experience it for themselves, or are so ignorantly blind that they will never get it.

Military medicine needs to be avoided at all costs until this country's leadership begins to understand the problems that it has, and offer some solutions. I do not see this happening in the next decade.

 

[NavyFP]

While we are on the subject of Carlton, and SCO, although I never met him, I can from experience say that although he was (WAS) a surgeon, he got tainted by the typical mediocracy and turned a blind eye to what was important for patient care.

SCO, subspecialty care optimization, was an expensive JOKE. I've posted this before, but while PCO was languishing, we had a 4-5 person team from the surgeon general's office come and totally disrupt 48 hrs of our clinic and OR time to "discuss" SCO. It was clearly ovious from the discussion that they had no clue what was going on in the field. They spoke about hiring ortho techs that were nonexistent in the community, nursing staff that we did not need, but were unable to answer questions about basic supply materials, and increasing personel in order to be able to run the OR. A classic case of telling us they want to buy and Escalade, when in fact we have no gas to put in it.

Another example of the incredibly *****ic stupid ignorant ass attitude was the purchasing of equipment. When I got there, our laparoscopic light units and cords where third world equipment. We needed an upgrade badly, and it was actually a patient safety issue becuase we could not see well with 5 mm scopes. The immediate solutions were mandates to use 10 mm scopes, (not always in the patients best interest), but the best was when some idiot instead of buying one or two full set ups, bought a whole lot of light sources, but failed to realize that without the purchase of new light cords, you could hook it up to the sun, and it would not make a difference. When we vocally complained about this, they said the budget did not allow for purchase of the light cords or new scopes for another year.

SCO was a total exercise in self-agrandization by a pompous useless piece of crap beurocrat who forgot what it was to be a phycisian. He is now the dean of some school in Texas.

I wrote directly to him asking for help when I was being screwed with big time by the ignorance of the people running our base hospital, and all I got was a call from some deputy of his telling me that they knew everything, but could do nothing, and that, my favorite quote from a higher level administrator, that "change in the military is glacial."

NO matter how passionate and personal we make these pleas that military medicine is in the s@#thole, there are always going to be people who will not get this and want to experience it for themselves, or are so ignorantly blind that they will never get it.

Military medicine needs to be avoided at all costs until this country's leadership begins to understand the problems that it has, and offer some solutions. I do not see this happening in the next decade.

Sorry, dude, whether tis nobler in the mind to suffer the slings and arrows of outrageous fortune or to take arms against a sea of troubles and by opposing, end them....

I choose the latter. Do I have large dents in the wall where I have banged my head? Yes. Oh, yes.

But (even after 12 years) I still believe. (why I don't know, I have not taken my vitamin H lately)

 

[Galo]

Sorry, dude, whether tis nobler in the mind to suffer the slings and arrows of outrageous fortune or to take arms against a sea of troubles and by opposing, end them....

I choose the latter. Do I have large dents in the wall where I have banged my head? Yes. Oh, yes.

But (even after 12 years) I still believe. (why I don't know, I have not taken my vitamin H lately)

Believe what????? That the cause of your frequent headaches are from banging your head against the wall???

Honestly what true positive or even semi intelligent answer would you have against the experiences that so many of us have had. Certainly without having to stoop to personal insults like some people in this forum. It impossible that every attending here who posts their negative history/experience in military medicine has some defect that acts up only in the military.

SO bang out an intelligent rebuttal to our complaints. I've yet to see one single pro military person do that.

 

[NavyFP]

Believe what????? That the cause of your frequent headaches are from banging your head against the wall???

Honestly what true positive or even semi intelligent answer would you have against the experiences that so many of us have had. Certainly without having to stoop to personal insults like some people in this forum. It impossible that every attending here who posts their negative history/experience in military medicine has some defect that acts up only in the military.

SO bang out an intelligent rebuttal to our complaints. I've yet to see one single pro military person do that.

I agree, the system has to change. I WANT it to change. But if intelligent, competant people are unwilling to go there, we will end up just where we are.

I do not discount the negative, I FEEL it. I just want it to be better. I do this not because it is easy, but because it is hard. Will I fail? Probably. But I will be satisfied that I did my best. Accepting that it has always been this way is part of the problem. I reject this. I am working within the system to bring about change.

As I have said before, I welcome the negative discourse on this site. There are problems in the system, but we must identify them to solve them.

 

[alpha62]

It's so easy to blame it on a "system" or "the government" or "the army"
like it's an inanimate object.

Most of this crap has a name and a face attached to it. The idiots that cause this mess don't spontaneously generate. It starts the minute you hit OBC or your first assignment and even 0-6s had to start out somewhere.

It's true, you can't do much about a jerk that outranks you. But you CAN do something about a clown that is your "peer" It's your responsibility to call idiots on their BS the minute you see it. If everybody did that when they were 0-3, there might be a chance these *****s would be attrited before the could make some rank, or at least their behavior might in some way be influenced.

I've pissed off a good many 0-1 through 0-3. A couple of times, it even got physical. Sometimes they'd go crying to the command because I told them to start acting like a leader and stop acting like an HMO people pleasing little bitch.

If somebody would have just not made life so non-confrontationaly pleasant for these idiots early in their development, I wonder if things would have been different... and yeah, Bill Clinton might have something to do with it by establishing a culture of wussyness.

I agree, the system has to change. I WANT it to change. But if intelligent, competant people are unwilling to go there, we will end up just where we are.

I do not discount the negative, I FEEL it. I just want it to be better. I do this not because it is easy, but because it is hard. Will I fail? Probably. But I will be satisfied that I did my best. Accepting that it has always been this way is part of the problem. I reject this. I am working within the system to bring about change.

As I have said before, I welcome the negative discourse on this site. There are problems in the system, but we must identify them to solve them.

 

[IgD]

Are you even in the military or just making this up? If you did this in my workspace you'd get court maritialed and thrown in prison.

I've pissed off a good many 0-1 through 0-3. A couple of times, it even got physical. Sometimes they'd go crying to the command because I told them to start acting like a leader and stop acting like an HMO people pleasing little bitch.

 

[alpha62]

See what I'm talking about ?

Are you even in the military or just making this up? If you did this in my workspace you'd get court maritialed and thrown in prison.

 

[chopper]

See what I'm talking about ?

I almost fell out of my chair laughing at this.

 

[haujun]

If somebody would have just not made life so non-confrontationaly pleasant for these idiots early in their development, I wonder if things would have been different... and yeah, Bill Clinton might have something to do with it by establishing a culture of wussyness.

I think this so called easy climate has a lot to do with all volunteer system that U.S. military adopted. Military has to soften up little to meet the unique needs of individuals. I clearly saw those individuals at basic training, OBC....I think this is so much more true today due to high attrition...

 

[chopper]

I think this so called easy climate has a lot to do with all volunteer system that U.S. military adopted. Military has to soften up little to meet the unique needs of individuals. I clearly saw those individuals at basic training, OBC....I think this is so much more true today due to high attrition...

I don't think it has as much to do with the all-volunteer system as it does the general cultural shift towards a more PC, entitlement environment throughout America. Volunteer or draft, the military is a reflection of the wider population. The military has been all-volunteer for 30+ years now, but only 'wussyifying' for about the past 10-15 years.

 

[Pemberley]

I don't think it has as much to do with the all-volunteer system as it does the general cultural shift towards a more PC, entitlement environment throughout America. Volunteer or draft, the military is a reflection of the wider population.

I suspect you are right. Society would no longer tolerate the sort of discipline that would be required to make conscripts do what they didn't want to do.

I suspect most military units are more effective with volunteers, for most of whom the threat of getting kicked out would actually be a punishment.

 

[alpha62]

There are so many people losing arms, legs, eyesight and of course the ultimate sacrifice. People are taking risks every day.

Taking the risk of hurting some jerk's feelings, deflating their ego a bit and maybe not getting a top block on your OER seems like such a small sacrifice to make from the comfort and safety of your air conditioned office with the flush toilets and all. Taking a risk to make things better for the guys on the line. It is all about them isn't it? Or is it all about you ?

The danger of office politics and your precious career does seem pretty ridiculous compared to what guys are putting on the line in Iraq and the Stan don't you think?

 

[former military]

I knew Gen Carlton in the mid 90's...He shut wilford hall down for 2 weeks because we were over our fiscal budget... no clinical patients and no surgeries... our residency coordinator told us to all be positive and work on some research.... he then claimed that he never gave the order to shut down the hospital- that his deputies did that without his authorization....
I remember an USAFA Col anesthesiologist telling us he was there in the meeting and that Carlton was a liar.
Liar is a very strong word and we, of course, no use the term "Spin Expert"

 

[former military]

This is pathetic. The military goes hat in hand asking for civilian surgical specialists to work in forward medical facilities for free because they won't pay properly to attract someone to active duty, and then they publish this as if it were an achievement instead of the shameful embarassment that it ought to be. The military buys all sorts of other things on the economy all around the world, fuel, food, lightering and pilotage, contract civilian maintenance, technical training, but they won't pay for medical services. Why? Some administrator probably has this beggar's plan as a fitrep bullet. This kind of pathological thrift is just as much evidence of poor fiscal responsibility as is contract overspending.

It is obvious they have not kept pace with the compensation of the private market for surgeons, and aren't even likely close to what competing offers will provide. That wouldn't be acceptable for other mission-essential resources, so what is the excuse for this?

When I recently separated from the AF as a surgical subspecialist I was never asked to stay. Nobody at my hospital or at Randolph AFB HQ said "Hey we can't pay you as much as civilian jobs do but we appreciate your service and would love for you to stay". They just figured I would stay if I wanted to chase the retirement farce or leave if I hated it. What kind of a retention strategy is that?

 

[former military]

Please note this is an Army specific instance. Most AF and likely Navy surgeons are not doing crap when it comes to trauma. I gave the example of my friend who deployed for 8 months cumulative time, and did less than 10 cases. I have another friend who deployed for 4 months and did one trauma case and one appy. Not until the army left Balad, did the AF surgeons have anything to do at all. While non deployed, and if not at Wilford Hall, which is closing, you will likely do ZERO trauma, unless you seek it out on your own, and may have to take personal leave in order to do it. There is no active trauma training in the AF, and likely the Navy. I'm sure other than Iraq, which is at times mostly manned by reserve army surgeons, most army surgeons are not doing much trauma at all.

Any surgeons from the army with other experience??

Galo

I can tell you that at the AF's second largest hospital David Grant Medical Ctr there is little trauma...Occasionally an old lady bonks her head in the shower on coumadin or Timmy falls off his big wheel and breaks an ulna....The gen surgeons there had a gimmick where they would moonlight downtown on govt time to "keep their skills up". Well new management came along and put a stop to a lot of that.... they would rather have a surgeon bored playing computer solitaire than moonlighting"

most of trauma at my old hospital is dealing with the psychological trauma of unbelievably low morale, idiotic policy...."We are going to row the Titanic home boys... get your oars".

 

[former military]

i agree. even being on the side that benefits (at least financially, as we can still get names in the national practitioner data bank), i don't understand the reasoning of not letting active duty members have the right to sue over negligent medical care. spouses and dependents can sue the system, why can't we? 😕

-your friendly neighborhood looking out for #1 caveman

At my base, Travis AFB, our OR had 3 clean kills in less than 4 yrs. One was the 30 yr old appendectomy with the lost airway you saw on the front page of the AF times, one was a shoulder surgery on a healthy 28-30 yr old that they blamed on ephedra, and one was a 5 year old boy after tonsil-adenoids. For the volume of surgery done should 3 healthy people be dead? I don't think so... luckily the system is not accountable... one family member was reportedly walking the halls with a handgun... we were supposed to be on the lookout for him...oh yes, we gave someone third degree facial burns with the bovie using an alcohol prep on the face during blepharoplasty...

I invite those who champion military medical care as excellent to look at the healthy person/death ratio and compare it to the norm.

 

[Ankylosed]

At my base, Travis AFB, our OR had 3 clean kills in less than 4 yrs. One was the 30 yr old appendectomy with the lost airway you saw on the front page of the AF times, one was a shoulder surgery on a healthy 28-30 yr old that they blamed on ephedra, and one was a 5 year old boy after tonsil-adenoids. For the volume of surgery done should 3 healthy people be dead? I don't think so... luckily the system is not accountable... one family member was reportedly walking the halls with a handgun... we were supposed to be on the lookout for him...oh yes, we gave someone third degree facial burns with the bovie using an alcohol prep on the face during blepharoplasty...

I invite those who champion military medical care as excellent to look at the healthy person/death ratio and compare it to the norm.

It sounds like you were part of the problem if this "we set the pt. on fire" included you.. Any person in the OR, from the guy mopping the floor to the Board Certified Specialists know that you let the alcohol completely evaporate before using the bovie and never let it pool under pt! As an unlicensed technician, I prep with alcohol in a safe manner all the time. Were you dumping the alcohol on the pt's head like a Dr. Dre video (if you don't know watch the video Nuthin but a G thang for visual). I've heard of a pt's internal trachea getting set on fire from a duraprep that was not dried and draped over with ioban, but never seen it happen.
If there is an upside, at least your pt had 3rd degree burns so they couldn't feel the agony of their face melting off.. Dip$hit docs are the same in military and civilian life. Sounds like you've made your mark on both..

 

[former military]

It sounds like you were part of the problem if this "we set the pt. on fire" included you.. Any person in the OR, from the guy mopping the floor to the Board Certified Specialists know that you let the alcohol completely evaporate before using the bovie and never let it pool under pt! As an unlicensed technician, I prep with alcohol in a safe manner all the time. Were you dumping the alcohol on the pt's head like a Dr. Dre video (if you don't know watch the video Nuthin but a G thang for visual). I've heard of a pt's internal trachea getting set on fire from a duraprep that was not dried and draped over with ioban, but never seen it happen.
If there is an upside, at least your pt had 3rd degree burns so they couldn't feel the agony of their face melting off.. Dip$hit docs are the same in military and civilian life. Sounds like you've made your mark on both..

smart guy,
when I say "We" I mean the hospital. I am urology... so I don't operate on people's faces too often.

 

[IgD]

I invite those who champion military medical care as excellent to look at the healthy person/death ratio and compare it to the norm.

This debate surrounding military medicine really should focus on hard facts instead of whining and name calling. Can you cite specific figures about this kind of data?

 

[orbitsurgMD]

This debate surrounding military medicine really should focus on hard facts instead of whining and name calling. Can you cite specific figures about this kind of data?

That shouldn't be all that hard a study to do. Review complications against ASA classification pre-op.

 

[alpha62]

Hard facts and data will do nothing to persuade a fully indoctrinated true believer such as yourself Igd.

Guys like you think if they keep bending over long enough and remain loyal to the party line, they'll be rewarded with rank, retirement... and 20 virgins when they die.

This debate surrounding military medicine really should focus on hard facts instead of whining and name calling. Can you cite specific figures about this kind of data?

 

[IgD]

I'm impressed by your superb intellect. Have you considered joining the military? Maybe you could fix the problems.

Hard facts and data will do nothing to persuade a fully indoctrinated true believer such as yourself Igd.

Guys like you think if they keep bending over long enough and remain loyal to the party line, they'll be rewarded with rank, retirement... and 20 virgins when they die.

 

[alpha62]

Well, of course, I was in the military for many years. Probably while you were still in junior high.

I'm impressed by your superb intellect. Have you considered joining the military? Maybe you could fix the problems.

 

[USAFdoc]

Hard facts and data will do nothing to persuade a fully indoctrinated true believer such as yourself Igd.

Guys like you think if they keep bending over long enough and remain loyal to the party line, they'll be rewarded with rank, retirement... and 20 virgins when they die.

the surgeon general doesn't care about hard facts (in my opinion), only metrics, and they are about as acurate as the weather forcast for next year.

the pipeline for military docs is already starting to dry up, and that is the best news for those patients and military doctors of the future, because it might force the SG to make some positive changes in his business model. But for those patients and docs stuck in the system today...good luck.

 

[Ankylosed]

smart guy,
when I say "We" I mean the hospital. I am urology... so I don't operate on people's faces too often.

Rightttt.. I guess it is hard to operate on a face when your hands are around different shlongs all day.. I misinterpreted your post when you said "we" set a lady on fire. Usually You + me = we. If I were you, I would really try to distance myself from the EXTREMELY PREVENTABLE medical negligence that you spoke of.

 

[USAFdoc]

Rightttt.. I guess it is hard to operate on a face when your hands are around different shlongs all day.. I misinterpreted your post when you said "we" set a lady on fire. Usually You + me = we. If I were you, I would really try to distance myself from the EXTREMELY PREVENTABLE medical negligence that you spoke of.

many military docs are distancing themselves from extremely preventable negligence these days; they leave military medicine.

 

[alpha62]

Yes, what their idea and my idea of " Risk Management " seems to be two different things.

Their concept: damage control, bring in fresh horses.
My concept: don't assume avoidable risk in the first place

Military or civilian, doesn't seem to be much different in that arena

many military docs are distancing themselves from extremely preventable negligence these days; they leave military medicine.