another letter, from another provider discussing PATIENT CARE issues (ie. the USAF doesn't care).
Patient Care Must Be Made
Military's Top Priority
I just finished reading [Dr. Harold Koenig's] article entitled "Physician Retention Within The Military," and I would like to share my comments and experiences with you concerning this issue. First, after reading your article, I felt as if you were speaking about me. I am a GMO in the USAF who entered into the military through an HPSP scholarship. I took this scholarship not only for the obvious financial benefits but also because of an underlying sense of proud patriotism. My father, uncles, and both grandfathers all served in the United States armed forces in one capacity or another. So, I entered into the USAF with expectations of serving my country proudly as my elders have done.
However, I have become quite discouraged during the past three years of active-duty service. After finishing a general surgery internship, I was sent to Kunsan, ROK, for a year as a GMO. Then I was sent to Los Angeles Air Force Base, where I have completed the second of my four-year active duty service commitment. I would like to relate to you my experiences with respect to Professional Development, Leadership, and Working Conditions.
Professional Development:
As stated above I am a GMO. My initial plans were to enter into a urology residency after medical school; however, the USAF did not need very many urologists my year, so I was sent to a general surgery internship. I had very little primary care training in medical school and virtually none in internship. Yet I was sent to Korea for a year to be one of four physicians in a remote primary care clinic.
I was lucky, because the other three docs were family practitioners who took me under their wings and taught me a lot. I call the type of medicine that GMOs practice
"trial by fire" medicine. We are thrown into staff positions with very little training, and we are expected to function like fully residency trained physicians. So, all that we can do to survive and not hurt anyone is to learn quickly on-the-job.
I have indeed run into several situations where I was and am being held to a higher standard than that to which I have been trained.
The most negligent is the fact that I am required to work a single-physician Saturday clinic once a month where half the patients are children. I have absolutely no training in pediatrics, and I related this fact to my supervisors. The other physicians in the clinic were very concerned about this issue, but because of a "manning shortage" I was told by my nurse commander that I had to do this anyway—even in spite of my concerns about my lack of training.
Leadership
I feel that there is a total void in the area of medical leadership. In medical school and internship, we were always around older physicians who could be called mentors. These physicians were full of experience and insight. They helped us develop into competent young physicians. They helped us choose our paths into residency and beyond.
There is very little mentorship within the Medical Corps. I am very worried about my future after the military: how competitive am I for a residency? Which residency should I pursue? etc. But there are no elder, wiser docs with whom to talk. My colleagues are straight out of residency. They are as young as I am. How are we to succeed professionally without the proper guidance?
Furthermore, I feel that you missed a very important aspect of leadership. We physicians are in a very tough situation with regards to choosing a career in military medicine. If we stay on active duty, then inevitably we will become administrators and not clinicians. Right now, this occurs by the time that one pins on Major. My SGH at Kunsan was a Major just two years out of his FP residency. He saw almost no patients during the whole year. How sad is that?
Most physicians that I know went into medicine because they liked to see patients—not because of a desire to push a pencil. But this becomes a much more sinister problem. Since most physicians have shied away from the "admin" roles, there are many essential leadership positions that have become available.
These positions are now filled by nurses, which leads to a fundamental management problem. How can a career nurse understand the day-to-day frustrations not to mention the career goals of a physician when he/she has never been in that scenario?
In my opinion, the clinics should be managed by folks trained in hospital administration not in medicine or nursing. We doctors should be consultants to our managers. In my current clinic, the nurses are more concerned about the "numbers" rather than patient care. We doctors try to make suggestions that would best benefit our patients, but these are often very unpopular with our commanders because they may sacrifice a "good" metric.
My question: who are we serving if we are not working on behalf of our patients? This is absolutely ludicrous.
Working Conditions
I sometimes feel like I am working in a 3rd world country, even though my office is in the middle of a major metropolitan area. We have supply problems all of the time. At one point, we had no table paper, gyn speculums, or tongue depressors—in addition to the fact that we are required to see 25 patients per day with minimal support staff. Civilian doctors see many more patients a day than we do, but they have 4-5 exam rooms, plenty of ancillary staff, and they dictate their notes. How are we supposed to compete with this?
How are we supposed to give good care to our patients in a 15-minute time slot when we spend half the time finding out why the patient is here because there is no chart and the other half of the appointment is spent writing?
If the Unites States military is the least bit concerned about retention, then they certainly are not showing it very much. I would like to say that I am in complete agreement with your assessment. If more of today's leaders would listen to the messages that are being sent by today's military physicians, then I believe both physician and patient would be much happier. And this in turn would lead to more physicians making a career out of the military.
Physicians are a very committed bunch. We toil through medical school and residency in spite of our family and other personal commitments. When we come onto active duty, why can't we be treated with the respect that we deserve? We are our patients' advocates.
Until some kind of paradigm shift is made so that the patients as well as the doctors who treat them are regarded as priority-one, I believe that the military will certainly "hemorrhage" doctors.
AN AIR FORCE PHYSICIAN
http://www.usmedicine.com/article.cfm?articleID=61&issueID=16
