So after spending a week reading through what feels like 1000+ posts on the horrors I am supposedly going to end up working in, just had a quick question.
The most unhappy people on this site seem to be Primary Care and returning GMOs who couldn't get into their preferred residency. Are there any surgeons/surgical residents who read these strings and may have some opinion on the quality of their work environment? And I don't mean second-hand info like, "All the surgeons I know are miserable and can't wait to get out . . .", I already read those posts.
I'm not trying to discount the experiences of the Medicine/FP folks, it's just that I matched to a surgical specialty, and the majority of Staff surgeons I interacted with this year seemed generally satisfied with their choice to join up. I recognize though, that they're not going to air all their grievances with a med student, so I thought someone here might give me a more honest opinion.
Here's my experience as a surgeon (otolaryngology) in the AF:
1) I entered not knowing if I would stay in longer than my ADSC, but it took about 4 months before I realized anything longer than my 3 years was going to be a huge mistake.
2) When I started at my base we were a hospital with inpt beds, an ED, and 10 surgeons in the flight. When I leave this summer, I'm leaving a clinic (hospital closed) with a UCC, and only 1 surgeon left (an orthopod). Every surgeon I know has gotten out immediately when their ADC was up, they wouldn't even stay an extra 3 months to get the Oct bonus worth around 28-36K depending on specialty.
3) I am understaffed. I'm slotted for 3 staff members, I have 1.
4) I am underfunded. It took 2.5 years to have 8yo flexible scopes updated to ones that even meet standard of care. I wasn't even able to evaluate kids until this new scope came in.
5) I am overworked.
a)Not with patients. I don't see enough patients. I see maybe 16/day. But if I see more, the amount of work I generate keeps my one AD staff around until 1800 or later, and when the work day generally finishes around 1630, I find that inappropriate and am not going to do that for him.
b) I'm overworked because I have to do everything myself. I don't have a nurse. I have to call every pt back because techs aren't allowed to give medical advice over the phone. Mine does as much as possible, but he knows he can't do it as much as he's capable because someone will give him trouble.
c) Here's what I have to do to do an inpatient surgery: I have to submit a consult request to who? Myself. Why? because that's what TriCare says I have to do. They say there's no way to avoid this. Once I submit the consult, since I'm the only AD ENT guy, I have to approve my consult to myself. The great thing is that I get 3 e-mails confirming each step.
d) To do outpt surgery at our clinic, even for a set of tubes that will take 5 mins max OR time, I take about 15 mins to fill out a pre-op packet. Within this packet, I have to write out "Recurrent Acute Otitis Media" or whatever the Dx is 5x on 4 sheets of paper among other stuff (twice on the same page and I can't write "see above"). I am not supposed to use abbreviations even though I do.
e) At one point the JAG office told us we would have to hand write consents instead of using pre-printed ones. I threatened to take this to an ADC and they finally relented when I was able to get letter signed from community surgeons indicating that this was not the standard of care. I had to do it though.
f) I don't mind doing the AD training stuff even though it's ridiculously stupid. That's just part of being military. I do not like how much there is and how much it takes me away from my clinical work. In fact, there was one time I finished CBRNE training and took the mandatory test (took about an hour or so) in March--it's supposed to be good for 12 months. Then, because ACC changed their policy and wanted everyone to train at the same time each year, I had to redo everything again just 4 months later. However, this time I had to go do the remedial course they said would take about 8 hours and gave me 20 days to accomplish it. Maddening. Fortunately, I combine efforts with a fellow MD and we did it together in like 2.5hrs.
g) Our OR is understaffed and manned only by CRNA's. If a kid has anything close to resembling a URI, I have to reschedule because they are too skitish to do the anesthetic. I cancel at least one surgery a week because of this. We don't have enough CRNA's to run all the rooms that we need to when one is on leave and therefore cases pile up and patients get mad.
h) I'm on call 24/7/365 because I'm the only ENT. Granted call isn't killer because every patient is my own and I do a lot of teaching so I don't get nervous Mommy calls at 2AM, but I have no control over the guy who waits until midnight to come in with the peritonsillar abscess that's been brewing for 3 days.
i) I'll stop on this section, because it's just depressing
6) I don't get paid on time. Oct 1 comes every year at the same time. I'm supposed to get 30K each year on Oct 1. An amount I count on as part of my salary. I'm trying to get out of debt and fund Christmas and whatever else I have budgeted, but when they fail to get me money every year on time and sometimes as late as February I have heard from my commander, it puts a significant strain on how I appropriate family funds.
You want to know more, just ask. Click on my name and read my old posts. It's just sickening as a surgeon. I honestly don't know any ENT's other than fellowshipped-trained ones or those who are attendings in residency programs who are staying beyond their ADC's. I'm sure there are some, but of the 8 that entered my year, we're all getting out. Of the 17 the following year that came in, I know of only 1 planning on staying 20 last I head, but he had a 16 year commitment anyway.
The general surgeons that are leaving told me the same thing. The urologist who's left said the same thing. The ophthalmologist is also saying the same. The orthopods, well, I think they've ROADed with 6 months left to go.
It's not just primary care, gmo, flight surgeons.
It's system-wide.
And it's broke.
