AVOID MILITARY MEDICINE if possible
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below is an excerpt from a USAF memo giving some insight on Primary Care Optimization. As I have stated elsewhere, this was a major factor leading to increased patient panel sizes (up from 700 patients per doc to as much as 1700-3000 patients per doc). Note that GYN and Surgery etc mentioned at the end...the full memo net address at the end.
In February 2000, initial Primary Care Optimization (PCO) education and training was conducted and 68 of 74 MTFs sent two primary care teams and leaders from their facilities to participate. The MTFs were brought in groups by MAJCOM with leaders from the MAJCOMs also participating. The training included a basic course on population health, how to work together as a team, individual roles and responsibilities and an understanding of productivity goals (also based on civilian benchmarks). The sustainment training has been built into the enlisted and officer training and traveling teams are also available that offer on the road training. The first meetings were tantamount to initial immunization in a vaccine series. Boosters will continue to be needed. With culture change this large, education and training is as important as the resourcing. This same type of program modeling is now taking place for five surgical product lines: orthopedics, ophthalmology, OB/GYN, general surgery and otorhinolaryngology.
http://www.ndu.edu/library/n4/n03AMurphyTransformation.pdf.
In February 2000, initial Primary Care Optimization (PCO) education and training was conducted and 68 of 74 MTFs sent two primary care teams and leaders from their facilities to participate. The MTFs were brought in groups by MAJCOM with leaders from the MAJCOMs also participating. The training included a basic course on population health, how to work together as a team, individual roles and responsibilities and an understanding of productivity goals (also based on civilian benchmarks). The sustainment training has been built into the enlisted and officer training and traveling teams are also available that offer on the road training. The first meetings were tantamount to initial immunization in a vaccine series. Boosters will continue to be needed. With culture change this large, education and training is as important as the resourcing. This same type of program modeling is now taking place for five surgical product lines: orthopedics, ophthalmology, OB/GYN, general surgery and otorhinolaryngology.
http://www.ndu.edu/library/n4/n03AMurphyTransformation.pdf.
I wonder if any of you on this forum recall the Cox News Service (Dayton Daily News) articles on military healthcare. They were an expose' on military medicine entitled "Dangerous Medicine", and clearly described the poor quality healthcare provided by the US military.USAFdoc said:
There is an interesting article written in the aftermath, entitled: "Image Repair of Military Healthcare":
http://www.ou.edu/deptcomm/dodjcc/g...Methodology.htm
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island doc said:
by your username I'm envisioning you in Hawaii or something...by the time I get out I will have served 3 years on active duty with 5 years left on IRR...I can almost taste my freedom..btw, I absolutely loved oahu...I've been there twice and am very seriously contemplating on eventually ending up there to practice when it's all said and done 👍
GMO2003 said:
I am currently relishing life on a smaller, exclusive tropical resort island paradise off the coast of the continental United States. FYI, some of the finest beaches in the world are 10 minutes away from my office. Patient clientele is also among the finest in the world.
USAFdoc said:
I can definitely believe that...as a GMO in a TMC sometimes I feel like throwing my hands up in exasperation...I mean...I learned a great deal during internship and going on working 2 years of primary care medicine in a outpatient clinic alongside a board certified family medicine physician...I feel like I've went through a pseudo-family practice residency...I've learned a tremendous amount from the MAJ family practice doc...lucky for me he likes to mentor and teach 👍 I guess this is one advantage I have from being in the military...I still cannot wait to ETS and start a civilian residency
GMO2003 said:
one of the nice things (and challenging) is all the stuff that a primary care doc can do, and all the new and ever expanding meds and tx we can offer.
Don't let the military choke the "FP" life out of you. There are places in teh civ world where you can really enjoy coming to work and helping people and not be "hamstrung" by "friendly fire".
The longer I am here at my civilian job, the more and more I realize just how screwed up military medicine (USAF Pimary Care) is.
GMO2003 said:
A few years ago, I was right where you are:a GMO in a military clinic. Good that you have someone with more knowledge and experience willing to help you out, I did not. The good news is that if you have enough active duty service time, you just might be eligible to receive separation pay on your way out like I did. This is because military policy at the time I separated did not allow physicians to remain on active duty beyond their active duty service commitment if they had not completed residency training. Thus, I was "involuntarily" separated and pocketed a large sum of cash (sep pay) on the way out. Very helpful to have while taking a pay cut as a civilian resident.
Hang in there buddy. This will come to an end and you will be so much better off and alot happier.
grmaster1 said:
This is correct. In order to be eligible for separation pay, you must first have over 6 years active duty service time at the time of separation, and you must be involuntarily separated based upon a decision of the military, not of your own volition, even though you may want to separate anyway.
I was fortunate in that because of my prior line service I met the first criteria, and because of the military's decision to discontinue the utilization of GMO's beyond their active duty service commitment, I met the second criteria.
Good Luck GMO.
I hope you qualify.island doc said:
when I applied and received a HPSP scholarship, I was told that they were very competative and that only about 10% of applicants were accepted. If there are so many people trying to get in, why would the military opt to use GMO's? It seems like a desservice to the doc, the patient, and everyone. Why not wait till you get a fully qualified doc? Are they really that hung up on money that they are trying to save board certif pay?
I don't think that the scholarships are anywhere near that competitive. When I got mine, the USAF acceptance rate was about 50% while the USN and USA rates were upwards of 90%.USAFdoc said:
They don't care if people get sub-par medical care just so long as they meet the quotas that have been set-up. The military has one big reason why they have propagated GMOs...because when those physicians are finally allowed to enter a residency (hopefully of their choosing) the physicians will likely feel less competitve for civilian residencies. Therefore, they'll enter a military residency which will increase their commitment. They'll get to extract a little more out of the poor HPSPers hides.
FliteSurgn said:
Pretty clever...aren't they?
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I have been reading these posts for several years, never posted before, but today I had some free time so here goes:
Agree USAF Primary Care is a broken process, and is like the Titanic-- everyone knows it's sinking, but there seems to be nothing we can do that will make it better and it is invariably going down. Alot of these posts have demonstrated the frustration USAF primary care docs have in day-to-day clinic life.
It's true, the docs that attempt to work their butts off in the trenches, are fighting an uphill battle. The clinic chief or commander is usually a person who knows absolutely nothing about running a clinic and even less about how to manage the staff needs. If you were a civilian FP doc or PA shoved into this world, you would exit ASAP from this and that is exactly what happens to our docs/PA's. There is absolutely no incentive to stay in for a doc, unless he/she has multiple years in service or happens to be at a great assignment or some other extraneous reason.... It isn't that the USAF primary care system is what's keeping them.
Funny thing is, the USAF SG staff/medical staffs seem to present it as "everything is great" and we are 100% manned. Any working military physician knows this to be untrue. It used to be the FP docs would actually have a decent amount retained in service, but now it's almost unheard of for a new FP doc with <4 - 5 years of service to sign on for more.... This should be a red flag, but it seems as if no one is looking (or blinders are on).
In case anyone with any connections is reading this: you must take a different approach to the complete process of clinic staffing/policies/procedures or it will continue to decline and eventually be lost.
My personnel recommendations:
1) Give Docs/PA's more power to make their clinics to run more efficiently
2) Take a hard line on patients following proper guidelines/instructions and make patients adhere to referral policies on ER visits and missed appointments. Make it a privilege to be seen on base, not a last resort.
3) USAF SG staff should send out anonymous quesionnaires to all docs/PA's/NP's and ask their honest opinions on what they think/feel is wrong
4) Realize that a physician must run the clinic or be the person all of these crucial "decisions" go thru in order to be implemented-- it only makes sense
5) Make nurses actually do nursing care again-- they should be involved in patient care, calling results, attending to patient complaints/concerns. Right now, I know of only 1-2 nurses in our medical group that actually have given a shot in the last 6 months and only 2-3 of them acutally know what is even in the code cart
6) Revisit updating physician bonuses, I mean in 20 years the ASP has not changed-- c'mon guys, have some acknowledgement for the training/education and professional abilities we provide.
I actually do have alot of positive things to say about USAF health care, so don't think I am disgruntled. I actually have > 15 yrs in and I would like to be able to make the system better. It is just difficult for the few of us who are staying around to make improvements unless some of the above stuff is addressed. I will keep trying and hopefully the young docs coming on board will not throw in the towel when they start experiencing these same things.
Agree USAF Primary Care is a broken process, and is like the Titanic-- everyone knows it's sinking, but there seems to be nothing we can do that will make it better and it is invariably going down. Alot of these posts have demonstrated the frustration USAF primary care docs have in day-to-day clinic life.
It's true, the docs that attempt to work their butts off in the trenches, are fighting an uphill battle. The clinic chief or commander is usually a person who knows absolutely nothing about running a clinic and even less about how to manage the staff needs. If you were a civilian FP doc or PA shoved into this world, you would exit ASAP from this and that is exactly what happens to our docs/PA's. There is absolutely no incentive to stay in for a doc, unless he/she has multiple years in service or happens to be at a great assignment or some other extraneous reason.... It isn't that the USAF primary care system is what's keeping them.
Funny thing is, the USAF SG staff/medical staffs seem to present it as "everything is great" and we are 100% manned. Any working military physician knows this to be untrue. It used to be the FP docs would actually have a decent amount retained in service, but now it's almost unheard of for a new FP doc with <4 - 5 years of service to sign on for more.... This should be a red flag, but it seems as if no one is looking (or blinders are on).
In case anyone with any connections is reading this: you must take a different approach to the complete process of clinic staffing/policies/procedures or it will continue to decline and eventually be lost.
My personnel recommendations:
1) Give Docs/PA's more power to make their clinics to run more efficiently
2) Take a hard line on patients following proper guidelines/instructions and make patients adhere to referral policies on ER visits and missed appointments. Make it a privilege to be seen on base, not a last resort.
3) USAF SG staff should send out anonymous quesionnaires to all docs/PA's/NP's and ask their honest opinions on what they think/feel is wrong
4) Realize that a physician must run the clinic or be the person all of these crucial "decisions" go thru in order to be implemented-- it only makes sense
5) Make nurses actually do nursing care again-- they should be involved in patient care, calling results, attending to patient complaints/concerns. Right now, I know of only 1-2 nurses in our medical group that actually have given a shot in the last 6 months and only 2-3 of them acutally know what is even in the code cart
6) Revisit updating physician bonuses, I mean in 20 years the ASP has not changed-- c'mon guys, have some acknowledgement for the training/education and professional abilities we provide.
I actually do have alot of positive things to say about USAF health care, so don't think I am disgruntled. I actually have > 15 yrs in and I would like to be able to make the system better. It is just difficult for the few of us who are staying around to make improvements unless some of the above stuff is addressed. I will keep trying and hopefully the young docs coming on board will not throw in the towel when they start experiencing these same things.
Great post. Thanks 👍
FliteSurgn said:
I that was their intent with me, things did not go as they planned. I spent the whole four years as a GMO, got out, and completed a civilian residency, albeit a less competitive one. I'd be darned if they were going to get any more of my hide.
I had multiple years in service, 10 at time of separation, and realized that I could no longer tolerate the AFMS. Any desire I might have once had to complete an AF career had long since been destroyed.
Won't this thread die? It's been going on for too long.
Let's start a new one.
Let's start a new one.
sunnyjohn said:
I have heard nurses (USAF) say how much better being stationed at a hospital was over being in a out patient primary care clinic. All the nurses left as sson as they could to go back to the inpatient facilities. In a out patient clinic, nurses are used as "triage"phone receptionist. They are the "buffer" between the 20,000 patients assigned to our clinic and they few docotors left to see patients. Our admin did some work and came up with a demand for 1200-1300 appointments per week. That is fine if we were fully staffed (12 providers), but usually we had 3-6 any given week, so their was no way we could meet demand...the nurses simply diverted requests,refilled meds etc.
So, if you can get inpatient, it will be better for you.
USAFDoc,
I applied for one in 2002 (I went to USUHS instead) and was told the accept rate was ~30-50% for the Army.
That sounds fairly competitive to me, also.
Now, with the war on and everything, I wouldn't be surprised if it was less, though.
I applied for one in 2002 (I went to USUHS instead) and was told the accept rate was ~30-50% for the Army.
That sounds fairly competitive to me, also.
Now, with the war on and everything, I wouldn't be surprised if it was less, though.
RichL025 said:
Perhaps the acceptance rate went up from 1995 till 2002...med school acceptance rates went up as well. The HPSP "pipeline" is 7-12 years long depending on what one specializes in (med school + residency) so teh military would have some problem forcasting exactly, but with so many people applying, I still disagree with the use of GMOs and undermanning clinics.
USAFdoc said:
Interesting.Acceptance rates obviously differ for civilian vs active duty candidates. According to the Air Force Times in a 2001 article, "So You Want to be an MD", the HPSP selection rate for active duty applicants at that time was 100% and had been for quite some time. Even more interesting given the fact that in 1992 as an active duty candidate, my AFHPSP application was initially rejected, but later in a turn-around I was given a position.
USAFdoc said:
amazing the number of emails I now receive from the military asking me to re-join; the number of advertisements in the medical journals, and even banners on my yahoo email all touting the wonders of a military career in Primary care....talk about false advertising! My favorite shows a guy/doc
out on the golf course talking about this is how he spends his afternoons. Another good one was that in Military med, you can escape all the "unnec" paperwork. Heck, the USAF has 5 x as much useless paperwork as what I now have as a civilian.
Does this really surprise you, knowing that military physician recruiting is deceptive smoke and mirrors?
island doc said:
I guess what frustrates me is that the USAF must be spending thousands and thousands, if not millions of $$$$ to buy "yahoo banners" and put ads in just about every medical journal I receive, and yet they refused to invest $$$ in getting the staff, support staff and infrastructure to give a clinic a fighting chance, and therefore keep the docs they already had.
Nothing the USAF does surprises me anymore, but the idealist in me still gets a bit frustrated at the nonsense.
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USAFdoc said:
More $$$$ and Misrepresentation as noted below; pasted from another thread.
The Navy purchased a full page Ad in this week's AMA News. "Take Your Medical Career Places It's Never Been Before". The Ad promises, "Your career will know no boundaries. You'll see more, learn more, and experience responsibility faster than you ever thought possible. You'll work with the latest technology, get financial assistance, and do what you set out to do."
The photo is a full length view of the USNS Comfort at sail in an inland waterway.
I was never in the Navy, and am curious as to what those of you who are might think of what this Ad promises. Any of you worked on the Comfort or been on board. What is it like? What can be done on board?
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10-10-2005, 07:59 PM #2
militarymd
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I was onboard during the invasion. 95% of it is a lie. The remaining 5% exaggerated.
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USAFdoc said:
In yesterdays JAMA issue; a full page add for the USN with the following quote: "Then you enter a thriving medical practice --...no administrative hassles -- so you can focus on patient care....the Navy is committed to helping your career take off."
I can't speak to the USN, but if this were a USAF ad, I would have to laugh out loud at the "lie" being stated here. "No admin hassles!" ......but I can say that the USAF helped my career take off...ie...take off to greener pastures on the civilian side.
Wow, there have been 183 replies to this string. I wonder if that is an SDN record. If so, I just had to be in on it. Maybe I'll use it in my next fitrep... let's see how the write up would go... "Team player: Made key contribution in field of information technology and military medicine bashing." Can't wait to use that one.
helo doc said:
Just goes to show how correct and accurate the title of this thread is.
island doc said:
i don't know if i'd go that far. just because it's a "popular" thread doesn't in and of itself make it true. besides, USAFdoc has almost a third of the posts in this thread. combine that with you and milmd, and almost 50% the posts in this thread belong to 3 users. i doubt it is accurate as much as it is post padding 😎 😀
--your friendly neighborhood investigative caveman
Homunculus said:
I never said I wasn't a big mouth. 😀
Homunculus said:
for those of you that may still be unsure of the authenticity and truthfullness of this thread, PLEASE call around to various primary care clinics and speak with 1st term docs. As a physician in the USAF, I met family docs from many bases (8 bases when I was at a Charleston SC meeting, 1 other base doc from Fairchild when I was playin war games in Texas, and several other bases when I was at Primary Care Orientation, and another doc in Nebraska that I went to residency with)...and 100% were leaving the USAF asap. And at my last base 100% have left for the past 10 years (except one recently re-uped, but that was to go to admin).
Caveman is correct in that just because it is a "popular" thread, doesn't mean it is true. But I was there and promise it is unfortunately very true and there are docs leaving the USAF on a reguular basis that also know of the TRUTH.
Homunculus said:
Homunculus; being a moderator, I was wondering if you had special access to any USAF info on retention rates. I was told (actually congress was told) by the USAF that retention rates for docs like me was 40%. I found that number tom sound GROSSELY inflated, being that no had had stayed in at my base in 10-15 years, and at other conferences I had been at, no-one planned on staying and did not know of anyone else in the USAF planning on staying. I since do know of one FP doc that did stay in but that was to go ADMINand get out of patient care. Specifically, what are the re-up rates for first term non USUHS fp docs?
USAFdoc said:
no i don't know the AF retention percentages. i doubt they are fantastic, but i fail to see how that means the AF "is teh suxxor". Many people serve their 4 years and leave, but that's because their obligation is up and they want to go back to civilian life-- it's not necessarily a reflection of what they think of the military. we've had perfectly happy docs leave after their payback because it was simply the right time for them to go.
and to be honest, it doesn't matter what the retention rates are. my point in my post was the title of this thread can't be construed as fact simply because of the volume and vehemency (invented another word there, woo-hoo!!) of the people posting in it. if the thread were titled "AF retention rates" or "avoid the AF" sure, you may have a point. but to paint all services with your brush of AF primary care, while well-meaning, is a bit broad. surely you would agree that your feeling on AF primary care are not particularly relevant for someone looking at army pediatrics, for example.
as always, i appreciate everyone's input here. i just want to make sure people don't take one person's word as the end all be all. you wouldn't want people falling hook, line, and sinker for a recruiter, right? 🙂
--your friendly neighborhood thin paintbrushing caveman
Homunculus said:
as stated previously; I cannot comment directly on anything but USAF Primary care, mostly Family Med, but also some exposure to PEDS, Flight Med, and Internal Med................and it was all "bad" as stated elsewhere.
I completely DISAGREE with you about retention rates not being IMPORTANT. It is ironic that one of the major creedos of the AF is "retention is the oxygen of the AFMS"....................well if that is true, FP is cyanotic and about to croak....................but really, how can you have a truly excellent health care system if nearly 100% of your providers have ZERO experience. Nealrly 100% of the FPs I met, and all the FPs when I started at my last clinic were right out of residency. Having experience is important for any business, and certainly medicine, and hopefully those experienced people that do stay will be some of the best.
USAFdoc said:
exactly. so why create a thread entitled "AVOID MILITARY MEDICINE"? why not "AVOID AIR FORCE PRIMARY CARE"? wouldn't that be more appropriate?
USAFdoc said:
they're not important in relationship to my stance that you can't use the air force retention rates of primary care docs as a barometer for the entire military medical system's health. sure they're important but not in the context of this thread 🙂
USAFdoc said:
most places that i'm aware of the docs dont all leave at once-- though the latest wartime activities probably caused a lot of ship-jumping at the same time which may have created that appearance. for the most part the influx and efflux of people is fairly balanced. the subspecialists are around seemingly forever, and there are enough of us 8+ year payback folks around to give some kind of continuity between the 3-4 year folks. the system is what it is-- unfortunately until they make the military medical system so sweet people never want to leave they will *always* suffer from this problem.
--your friendly neighborhood finishing up clinic caveman
Homunculus said:
yes, that would be a more appropriate thing for me to say, as I have no first hand knowledge of other subspecialties......however......with the great financial stress being placed on military medicine, I am gravely concerned over how this will affect all of military medicine................the military is perhaps the most micromanaged organization in the world, and that is ok if you have a surplus of manning and supplies, but when you have severe problems in these areas and you "handcuff" the people on the front line from making the necessary changes to achieve success, you will meet with failure and "burn out" those troops that are there. As things stand, the current design of Primary Care in the USAF is one that is designed to fail, both patients and doctors.
In my new civilian life I am caring for a panel of 1000 FP patients and I have an excellent experienced nursing staff and the ability/authority to correct "broken" parts of our clinic for the good of everyone. In the USAF, I was caring for 2400-3000+ patients, I was a brand new doc, my support staff was just out of HIGH SCHOOL, most everything was broken (referral system, lab tracking, etc), and all admin wanted was the "metrics" to look better. I presented to them a list of 100 "misses" or "near misses" that I discovered over a few month period and guess what changed?..............nothing.....................so I changed.......my work address at least................I am NOT anti-military, I love the US and hope the best for the USAF, but I am 100% "anti-teriibly run clinic" that endangers it's patients and discards its staff like unwanted stray pets.
Homunculus said:
a couple other points on applicability and causality of USAFs current problems:
1) in 2000, the then SG started something called Primary Care optimization. Stated more bluntly, it means "they will man you at a minimum and scratch every bit of income they can from you" to save the USAF $$$$. The plan was actually pretty decent, the failure was in delivering all the parts of that plan to make it work. You can't expect a military clinic with multiple callaterral duties and a constant changing flux of docs and patients, to OUT-PERFORM that of a well managed HMO clinic. Yet, that was the plan, and it has failed and continues to fail.
2) Why this matters to other services and specialties is that the USAF SG has touted his program as a huge success, and that puts pressure on "everyone" else to do what he is doing and save all those big $$$. USAF dental is currently being placed in this system with other subspecialties to follow.
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USAFdoc said:
just to give you an idea about the big $$$ the SG has his eye on.
http://www.airforcemedicine.afms.mil/sg_newswire/may_05/MilitaryStruggling.htm
Also,the current inefficient design of "his" primary care platform I would contend doesn't even save money because of a lack of continuity and experience on the provider level. Examples like new PAs having complete unsupervised control of panels,ordering frequent unnec MRIs of the knee etc.
IgD said:
IgD;
Everyone on this site is still waiting for your list of clinic primary care docs that are staying in the military active duty, and or believe the system is quality for patients and staff.....................I know, it will be a long wait because there is no such list to be had.
In my life, I do not think I have ever heard anyone as much of a "blind follower" and anyone defend "harm to patients" as WAH as what you seem to say here in your memos. Again, thank GOD you are not my doctor. I guess if you mamed your patients your defense would be that it happens in the civilian world too! You arguments are incredibly weak. I will stop here to prevent myself from degrading you further.
IgD said:
I was being totally serious; I have never heard anyone completely disregard the obvious and disregard first hand accounts of poor patient care like you have, all in the name of "go military!".
I do realize that there is a huge "audience" for these concerns about Military medicine? ABSOLUTELY! That because I have had discussions with docs accross the USA and they all voiced similar concerns.
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