AVOID MILITARY MEDICINE if possible

[NavyFP]

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I doubt that USUHS will ever close. I would wager that there is a greater likelihood of a another camnpus opening up in TX given the BRAC recommendations for facilities in that area.

I have heard of no plans to move or close USUHS.

 

[jsnuka]

I have heard of no plans to move or close USUHS.

I think you misunderstand me. The site in Bethesda will never be closed or moved. There will be another campus in San Antonio. Having one would solve some problems, but maybe create some others.

 

[Croooz]

When administrations are looking to cut military funds one of the first items on the chopping block is USUHS. Inouye speaks...USUHS gets taken off the chopping block. I would like to believe that USUHS will never go away as well. However I would never say never. Many believed that WRAMC would never get closed either. Some may say "well it isn't" but now we're talking semantics.

It would be a very, very sad day for military medicine if USUHS ever did close down. I don't expect to see it in my lifetime. So I'll say I don't believe USUHS will ever close down...in my lifetime. 👍

Now back to your regularly scheduled program of........
AVOID MILITARY MEDICINE if possible

 

[USAFdoc]

They DO know..... the article is over a year old. All these matters were sorted out last summer.

USAFdoc: there are a plethora of issues to take up with military medicine. is it really necessay to create new ones through a nifty bit of yellow journalism?

the article is from May 2005. I had not seen it before, and was surprised (although nothing should surprise me anymore) that closing USUHS would ever be a serios consideration. Imagine what the state of getting/fillingkeeping/retaining military physician slots would be WITHOUT USUHS.

My opinion on the BIG PICTURE of military medicine goes pretty much like this;
some have claimed that civilian primary care is on the brink of failure, well, current military primary care is EXPONENTIALLY worse of right now that civilian primary care. I hope things work out better for the sake of military docs and their patients, but, that may be too much to hope for.

 

[Monty Python]

MilitaryMD, Murphy DK: Severe cerulean testicle syndrome as demonstrated by elevated seminal vesicle wedge pressure.

Hmmmm.....unless you plan to do this ultrasonically, I shudder to think of the invasive transducing system 😱

 

[Monty Python]

I doubt that USUHS will ever close. I would wager that there is a greater likelihood of a another camnpus opening up in TX given the BRAC recommendations for facilities in that area.

USUHS was almost on the autopsy table a decade ago. It's always a DoD financial football. With the DoD Pathology Institute on the BRAC list, I wouldn't be surprised to see the educational parts of USUHS closed, and the physical plant becoming AFIP's new home. The vast majority of the educational portion of USUHS can be accomplished at civilian medical schools, and the military can give the field training aspects during summer camp.

Just my .02 worth.

 

[RichL025]

The vast majority of the educational portion of USUHS can be accomplished at civilian medical schools, and the military can give the field training aspects during summer camp.

Just my .02 worth.

Spoken as well as anyone who's never been there! And how, exactly, would a member of the class of 2010 have the tools to evaluate what USUHS can or can't do differently than civilian medical schools????????

Seriously, there's a bit more that goes on at USUHS than summer-camp possible training. And the school itself has done a good job of selling itself to congress, - since 9-11 there has been nothing more than rumors of the uninformed about closure - USUHS's future is as well-assured as any other military institution.

 

[rotatores]

Originally Posted by trinityalumnus
Just my .02 worth.

I believe your .02 is worthless!! 😉

rotatores

 

[NavyFP]

I think you misunderstand me. The site in Bethesda will never be closed or moved. There will be another campus in San Antonio. Having one would solve some problems, but maybe create some others.

You may be right, they are consolidating the remainder of DOD enlisted medical training there. A satellite campus of USUHS would make reasonable sense. Would probably be in the 2011+ time frame.

 

[Monty Python]

Spoken as well as anyone who's never been there! And how, exactly, would a member of the class of 2010 have the tools to evaluate what USUHS can or can't do differently than civilian medical schools????????

.

Correct, I'm not a USUHS grad.

But ..... I've been in the military continously since 1992. I've been a Navy Professional Schools Liaison Officer (working directly for the Navy Surgeon General) since the 1990s. I've given anesthesia at Bethesda (home of USUHS) ad infinitum. I have been through USUHS many times in various non-medical student roles. I have numerous friends/contacts who are former and/or current staff at USUHS, as well as multiple O-6 friends at BUMED. Those are the sources of my info.

My previous post merely summarized what I've heard throughout the years, in a feast-or-famine manner, depending on the budget. Unlike a squadron of nuclear-capable B-2s, or nuclear-powered subs, etc, (functions which are purely military), the education received at USUHS conceivably could be obtained anywhere. If budgetary push came to shove, and the school's staunch defenders were unable to protect it, the school might be sacrified on the altar of "something has to go." It will go prior to a squadron of B-2s. The unique military aspects of the educational program could, with some tinkering and adjustment, be offered in a non-USUHS setting if needed due to financial constraints.

Nothing is sacred in the federal budget. It's a function of which way the political wind is blowing, and the presence and strength of a particular program's supporters on Capitol Hill. Supporters die, retire, or get voted out periodically, replaced by legislators of opposite ilk.

 

[orbitsurgMD]

Correct, I'm not a USUHS grad.

But ..... I've been in the military continously since 1992. I've been a Navy Professional Schools Liaison Officer (working directly for the Navy Surgeon General) since the 1990s. I've given anesthesia at Bethesda (home of USUHS) ad infinitum. I have been through USUHS many times in various non-medical student roles. I have numerous friends/contacts who are former and/or current staff at USUHS, as well as multiple O-6 friends at BUMED. Those are the sources of my info.

My previous post merely summarized what I've heard throughout the years, in a feast-or-famine manner, depending on the budget. Unlike a squadron of nuclear-capable B-2s, or nuclear-powered subs, etc, (functions which are purely military), the education received at USUHS conceivably could be obtained anywhere. If budgetary push came to shove, and the school's staunch defenders were unable to protect it, the school might be sacrified on the altar of "something has to go." It will go prior to a squadron of B-2s. The unique military aspects of the educational program could, with some tinkering and adjustment, be offered in a non-USUHS setting if needed due to financial constraints.

Nothing is sacred in the federal budget. It's a function of which way the political wind is blowing, and the presence and strength of a particular program's supporters on Capitol Hill. Supporters die, retire, or get voted out periodically, replaced by legislators of opposite ilk.

There was medicine in the military before USUHS, and there would still be medicine in the military after USUHS. Other more venerable institutions in military medicine have been closed: Gorgas, Letterman, Oak Knoll, they're now practically forgotten. And plenty of purely military facilities have seen the axe. USUHS is not a sacred cow.

There have been all sorts of ways the military has drawn on the civilian community when needed. I am reminded of a group photo displayed in the museum area of Harper Hospital (Detroiters would know) that shows the entire staff of the hospital in uniform having been mobilized en masse as an Army general hospital in World War One.

 

[DropkickMurphy]

Gorgas, Letterman, Oak Knoll, they're now practically forgotten.

Yup, I've never heard of any of those. Were they hospitals?

 

[Monty Python]

venerable institutions in military medicine have been closed: Gorgas, Letterman, Oak Knoll, they're now practically forgotten. .

For the asker in a previous post:

Gorgas Army Hospital, Panama Canal Zone. I remember landing one day at Howard AFB in the Canal Zone, dropping the loading ramp on the C-130, and the 110 degree heat with 100% humidity just rolled into the airplane.

Oak Knoll Navy Hospital, Oakland

Letterman Army Hospital, The Presidio, San Francisco. Absolutely the most primo supremo real estate in the USA, overlooking the Golden Gate on the SF side.

 

[DropkickMurphy]

Thanks for the clarification.

 

[RichL025]

I am reminded of a group photo displayed in the museum area of Harper Hospital (Detroiters would know) that shows the entire staff of the hospital in uniform having been mobilized en masse as an Army general hospital in World War One.

The same thing happened to most larger civilian hospitals during WW1 and WW2.

What that picture _didn't_ show, is the doctors who didn't make it to a nice field or general hospital - the ones who were ut in a battalion or brigade aid station, literally a week after putting on a uniform for the first time.

Some of them did quite well and learned quite quickly. Many others didn't - there are hundreds of stories out there about surgeons performing double-layered, hand-sewn bowel anastomoses on a patient.... while three others were exsanguinating at the front door.

Anyone in the military for any length of time will have heard the comment "forgetting the lessons of the last war" - well, after the army medical department having to reinvent the wheel multiple times during the 20th century, it was thought that maybe, just maybe, you can't take civilian docs fresh off the street and make them military surgeons.

Now HPSP accessions have a 10-day course they go to. USUHS students spend perhaps 30 days doing field medical training at various levels, with other military medical specific curriculum interspersed during the first 2 years.

The conscious decision behind USUHS was to have a cadre of physicians who would not have to re-invent the wheel during the next major conflict!

You are quite right that political realities change, and supporters get voted out of office, etc. I find it VERY HIGHLY unlikely, though, that at least a small minority of legislators would not see the value in keeping USUHS... all they need to do is start tossing around acronyms like "WMDs" and USUHS's place is assured.

To de-escalate my rant, USUHS _was_ on the chopping block at least once after the end of the cold war, but that was back when people were talking about a "peace dividend" ... have you heard that term lately??????

 

[USAFdoc]

Interesting article on being a military doctor in ENGLAND. Sounds as if they have some of the same problems as what is going on in the USA. This goes along with what I have bben saying for awhile now; the current healthcare system in the military (apparently England as well as the USA), is designed to fail both its patients and its staff. Without somebody with the courage and the position to step up to the plate and fix things, expect more of the same failing system.

http://www.medicalnewstoday.com/medicalnews.php?newsid=25165

 

[alpha62]

The only way to change anything is to NOT JOIN in the first place. As long as there is a fresh supply of new officers, nothing will change.

The situation we find ourselves in right now is not much different than an alcoholic or a drug addict. They will not change their behavior until all the enabling is stopped, a crisis is created, and all contact with their support system is cut off.

Just like an alcoholic who gets a DUI, then it's go to treatment or go to jail, so it will be with this current system....something really bad is going to have to happen to get their attn.

We just haven't allowed them to hit a low bottom yet. We're part of the problem.

Interesting article on being a military doctor in ENGLAND. Sounds as if they have some of the same problems as what is going on in the USA. This goes along with what I have bben saying for awhile now; the current healthcare system in the military (apparently England as well as the USA), is designed to fail both its patients and its staff. Without somebody with the courage and the position to step up to the plate and fix things, expect more of the same failing system.

http://www.medicalnewstoday.com/medicalnews.php?newsid=25165

 

[former military]

I can't echo these sentiments strongly enough.... I just finished 11 years in the USAF as a surgeon.... every hospital and base commander turns over each 2 years.... I went through 4 hospital commanders... each time the new guy is really going to make a difference.... typically the commanders are nurses, physical therapists, dentists, pharmacists, or family practitioners or flight doctors. However, our family practitioner commander was so out of touch with real medicine that they had to have a real FP "help" him by making sure he didn't do anything dangerously stupid... but not offend his knowledge at the same time. He was 15 years behind the times and had forgotten a bunch of the old school knowledge he had. Nice guy if he isn't running your hospital or guessing at a cholesterol regimen for you.

Another problem is that the agenda of the hospital changes each two years in a completely different direction with the different commander. Nobody will invest money for the future that they will not see instant gain during their tenure. The goal of all the department Colonels and chief of physician is to shield the commander and get him or her promoted. This means spending less money and working more... .less efficiently....

if you have signed up and cannot get out you will get through it all.... then, and only then, can you appreciate what a big mistake it was.

 

[island doc]

I can't echo these sentiments strongly enough.... I just finished 11 years in the USAF as a surgeon.... every hospital and base commander turns over each 2 years.... I went through 4 hospital commanders... each time the new guy is really going to make a difference.... typically the commanders are nurses, physical therapists, dentists, pharmacists, or family practitioners or flight doctors. However, our family practitioner commander was so out of touch with real medicine that they had to have a real FP "help" him by making sure he didn't do anything dangerously stupid... but not offend his knowledge at the same time. He was 15 years behind the times and had forgotten a bunch of the old school knowledge he had. Nice guy if he isn't running your hospital or guessing at a cholesterol regimen for you.

Another problem is that the agenda of the hospital changes each two years in a completely different direction with the different commander. Nobody will invest money for the future that they will not see instant gain during their tenure. The goal of all the department Colonels and chief of physician is to shield the commander and get him or her promoted. This means spending less money and working more... .less efficiently....

if you have signed up and cannot get out you will get through it all.... then, and only then, can you appreciate what a big mistake it was.

Welcome former military! Glad to have you in our camp!

 

[Galo]

I can't echo these sentiments strongly enough.... I just finished 11 years in the USAF as a surgeon.... every hospital and base commander turns over each 2 years.... I went through 4 hospital commanders... each time the new guy is really going to make a difference.... typically the commanders are nurses, physical therapists, dentists, pharmacists, or family practitioners or flight doctors. However, our family practitioner commander was so out of touch with real medicine that they had to have a real FP "help" him by making sure he didn't do anything dangerously stupid... but not offend his knowledge at the same time. He was 15 years behind the times and had forgotten a bunch of the old school knowledge he had. Nice guy if he isn't running your hospital or guessing at a cholesterol regimen for you.

Another problem is that the agenda of the hospital changes each two years in a completely different direction with the different commander. Nobody will invest money for the future that they will not see instant gain during their tenure. The goal of all the department Colonels and chief of physician is to shield the commander and get him or her promoted. This means spending less money and working more... .less efficiently....

if you have signed up and cannot get out you will get through it all.... then, and only then, can you appreciate what a big mistake it was.

CAN I GET A HARUMPH!!!!!!!!!!!!!!

Yet another experienced physician comes out of the woodwork to tell people that after 11 years it was time to get out, and that the place is a languishing cespool, (my words).

What else could it possibly take for the military holdouts, and the students seeking military medicine to realize the place is in a shambles, and joining it, will lead to most likely a painful lesson in life, and certainly worse training, and inability to keep skills.

Now how is this guy going to get attacked and put down in order to minimize his complaint as yet another angry military physician with a bone to pick.

Honestly, if people reading this join the military after what's been posted, clearly medicine is not their first interest.

Welcome former military, get ready to seem like you're banging your head against the wall. At least you don't seem as pissed as I was after just 6 years of that hell.

Please feel free to expand on your experience.

 

[former military]

I was a surgical subspecialist in a three man shop... one guy finished his commitment and got out... the other guy got deployed for 5 months. I was on call 50% of the time until our command realized that it was too expensive to send people out who came in through the ER... so they asked me to take call half the time and just carry my cell phone and pager around the other days... that way I could answer questions and give advice... but I didn't have to come into the hospital... thus I wasn't on call. When I bitched to my bosses (an ER physician and a physical therapist- not a lot of call there huh?) that carry a cell phone and pager was call- how could I have a couple drinks or take my kids to the water park- they questioned my patriotism.

I also remember the physical therapist Col Surgical commander and the CMSgt coming to my clinic when I was by myself and was swamped with patients and devoid of tech help. I thought maybe they would get some insight into the frenetic pace I was running.... instead they told me that my pink scrub top didn't match my green scrub pants and I need to be all color coordinated.

I was in a different solar system in terms of priorities.

1)excellence in all you do
2)service before self
3)thankfully I have forgotten the third biggest lie.

 

[former military]

I was a surgical subspecialist in a three man shop... one guy finished his commitment and got out... the other guy got deployed for 5 months. I was on call 50% of the time until our command realized that it was too expensive to send people out who came in through the ER... so they asked me to take call half the time and just carry my cell phone and pager around the other days... that way I could answer questions and give advice... but I didn't have to come into the hospital... thus I wasn't on call. When I bitched to my bosses (an ER physician and a physical therapist- not a lot of call there huh?) that carry a cell phone and pager was call- how could I have a couple drinks or take my kids to the water park- they questioned my patriotism.

I also remember the physical therapist Col Surgical commander and the CMSgt coming to my clinic when I was by myself and was swamped with patients and devoid of tech help. I thought maybe they would get some insight into the frenetic pace I was running.... instead they told me that my pink scrub top didn't match my green scrub pants and I need to be all color coordinated.

I was in a different solar system in terms of priorities.

1)excellence in all you do
2)service before self
3)thankfully I have forgotten the third biggest lie.

 

[USAFdoc]

I was a surgical subspecialist in a three man shop... one guy finished his commitment and got out... the other guy got deployed for 5 months. I was on call 50% of the time until our command realized that it was too expensive to send people out who came in through the ER... so they asked me to take call half the time and just carry my cell phone and pager around the other days... that way I could answer questions and give advice... but I didn't have to come into the hospital... thus I wasn't on call. When I bitched to my bosses (an ER physician and a physical therapist- not a lot of call there huh?) that carry a cell phone and pager was call- how could I have a couple drinks or take my kids to the water park- they questioned my patriotism.

I also remember the physical therapist Col Surgical commander and the CMSgt coming to my clinic when I was by myself and was swamped with patients and devoid of tech help. I thought maybe they would get some insight into the frenetic pace I was running.... instead they told me that my pink scrub top didn't match my green scrub pants and I need to be all color coordinated.

I was in a different solar system in terms of priorities.

1)excellence in all you do
2)service before self
3)thankfully I have forgotten the third biggest lie.

thankfully I am beginning to forget the "third biggest lie" myself. The President of the USAFP said it quite well in the Spring USAFP journal when he stated "that there is just not enough work that we can do to keep them happy". The "them he spoke of were the CEOs, TRICARE, Commanders, etc.
In certain areas of the civilian heathcare world, things can also get "bad" but at least there will always be some balance given by the fact that the physicians will vacate any system that remains substandard in its treatment of staff and patients. In the military, that "balance" is lost and the continued monetary pressures have pushed the last positive aspects of military medicine off the table. Unfortunately, since military doctors typically have 4 years till they can vacate the broken system, Surgeon Generals can continue their losing strategies.

thanks to all the physicians who have served.

 

[jsnuka]

Help me to understand something.

If military medicine is failing, or fails, and by all accounts it will if there aren't physicians to take care of troops, then what will happen to it?

If there aren't enuf folx to cover for those leaving and those no longer coming in, then what is the alternative?

 

[alpha62]

Contractors. Overpriced contractors. Contractors that have already proven themselves unreliable, have a high turnover rate, and fall outside the UCMJ, and the chain of command.

They used to be called mercenaries

Help me to understand something.

If military medicine is failing, or fails, and by all accounts it will if there aren't physicians to take care of troops, then what will happen to it?

If there aren't enuf folx to cover for those leaving and those no longer coming in, then what is the alternative?

 

[jsnuka]

Contractors. Overpriced contractors. Contractors that have already proven themselves unreliable, have a high turnover rate, and fall outside the UCMJ, and the chain of command.

They used to be called mercenaries

OK, but as a taxpayer don't you have a problem with an "overpriced" contractor?

Overall, there must be a better solution than a decrease in HPSP awardees and USUHS applicants to alleviate the many problems.

 

[USAFdoc]

Help me to understand something.

If military medicine is failing, or fails, and by all accounts it will if there aren't physicians to take care of troops, then what will happen to it?

If there aren't enuf folx to cover for those leaving and those no longer coming in, then what is the alternative?

what may happen;
1) more contractors brought into military facilities, and this is a bad option financially (the contractors will demand more pay than what a mil doc gets) and they will leave faster, thus even more non-continuity.
2) simply send everyone to civilian programs, at civilian sites. Again, more money, and will place a burden on civilian markets due to troop fluxuations in size etc.
3) the Surgeon General decides to make some changes that encourage good docs to stay for an entire career in the patient care aspect of medicine. This includes giving decent pay, call, autonomy, duty station stability, authority, incentives etc. It is all do-able, however, I do not believe our leadership has it in their character to make changes like this. And widespread changes are what is needed if the military healthcare system is to thrive in todays market. The linchpin in the whole thing is the military keeping good doctors and that will just never happen with the current state of things.

 

[DropkickMurphy]

They used to be called mercenaries

I've always wanted to be a mercenary....

 

[IgD]

I was a surgical subspecialist in a three man shop... one guy finished his commitment and got out... the other guy got deployed for 5 months. I was on call 50% of the time until our command realized that it was too expensive to send people out who came in through the ER... so they asked me to take call half the time and just carry my cell phone and pager around the other days... that way I could answer questions and give advice... but I didn't have to come into the hospital... thus I wasn't on call. When I bitched to my bosses (an ER physician and a physical therapist- not a lot of call there huh?) that carry a cell phone and pager was call- how could I have a couple drinks or take my kids to the water park- they questioned my patriotism.

I think this is the first time I've read a post here where a surgeon complained he was working too hard. Most of the time here surgeons complain they don't get enough cases!

 

[militarymd]

I think this is the first time I've read a post here where a surgeon complained he was working too hard. Most of the time here surgeons complain they don't get enough cases!

Being tied to a cellphone/pager is not the same as getting enough cases.

I was tied to a pager 24/7 for a year in Guanatanmo Bay, Cuba. I didn't do many cases, but the lifestyle still sucked.

 

[orbitsurgMD]

I think this is the first time I've read a post here where a surgeon complained he was working too hard. Most of the time here surgeons complain they don't get enough cases!

IgD, you are either not a physician and therefore have no clue as to what the difference between being on call and being surgically busy means, or you are deliberately being misleading, and you know perfectly well what that poster meant. Being on call 24/7 does not mean surgical cases or diversity of cases or even available OR time. It means nothing about facility support. All it means is that the E.R. feels free to demand you answer back or come in anytime it calls, You, the doctor, (particularly in the military where unreasonable call demands cannot be refused, they carry legal authority of orders) have to be able to drop and run in whenever called. That means carrying a cellphone or pager, always. That means any social plans are temporary and subject to change or cancellation without notice.

Oh, and the civilian standard for acceptable call demands for surgery subspecialists? Ten days a month, maximum.

IgD, your dishonesty is confirming my opinion of you.

 

[orbitsurgMD]

I think this is the first time I've read a post here where a surgeon complained he was working too hard. Most of the time here surgeons complain they don't get enough cases!

IgD, you are either not a physician and therefore have no clue as to what the difference between being on call and being surgically busy means, or you are deliberately being misleading, and you know perfectly well what that poster meant. Being on call 24/7 does not mean surgical cases or diversity of cases or even available OR time. It means nothing about facility support. All it means is that the E.R. feels free to demand you answer back or come in anytime it calls, You, the doctor, (particularly in the military where unreasonable call demands cannot be refused, they carry legal authority of orders) have to be able to drop and run in whenever called. That means carrying a cellphone or pager, always. That means any social plans are temporary and subject to change or cancellation without notice.

Oh, and the civilian standard for acceptable call demands for surgery subspecialists? Ten days a month, maximum.

IgD, your dishonesty is confirming my opinion of you.

 

[alpha62]

I was part of the problem. I was a contractor on post as my day job and a reservist on the side. Some of the contract providers really sucked. they would refuse cases, call in sick all the time, refuse to see more than 18 pts a day. Refused to come in before 9 am. For you consultants, that's where your BS consults came from. It was easier to hit "send" on the consult in CHCS than to argue with a soldier and send them back to the motor pool.

At the most basic TMC level, it's a problem. You fall outside the chain of command. I was an enlisted AD at one time, knew every slicky boy scam in the book and was wise to it. Most of the civilian providers didn't and would fall prey to every shammer in the AO.

Word got around the barracks pretty fast a new civilian was working sick call. You'd come in to work and see an ant trail of troopies literally lined up around the outside of the building waiting to see only Dr. X, "she really understands us" 😡

OK, but as a taxpayer don't you have a problem with an "overpriced" contractor?

Overall, there must be a better solution than a decrease in HPSP awardees and USUHS applicants to alleviate the many problems.

 

[IgD]

In response to the critics, former military wrote that he was on call 50% of the time. I equated this with more cases. About carrying a cell phone and pager 24/7, I agree it is frustrating but unfortuately that appears to be reality at a small command. For example overseas or smalltown USA. I think Cuba is an example of this. If you are the only specialist on the island, you take call 24/7. To go on leave, someone has to fly in from CONUS to relieve you.

Former military, how many phone calls did you actually get outside of normal business hours? One per night or one per week? The other aspect of this is it is important set limits with your command. In Cuba you might get one call per month.

How long did you agree to answer calls 24/7 like that? Several weeks, several months?

 

[alpha62]

I was filling a BDE Surgeon Slot and I was the commander and xo personal little prison bitch 24/7 for 365 days.

When I rotated stateside, I saw BC docs being ordered to the post guest house to personally hand deliver refills of Premarin to some long deceased general's wife.

 

[former military]

I got called out of my daughters graduation ceremony and admitted to the psych ward for suicidal ideation for all the stress of handling 3 doctor's patients myself with no help. I set records for RVUs and patient visits in my hospital. Does that answer your questions?

 

[former military]

IgD,
I will tell you a few things about being on call 24/7....

at that time, I told my commanders ( the ER physician and the physical therapist) that I was going through a divorce and was having a lot of stress in my personal life and at work seeing an unsafe amount of patients (for me and for them). They didn't want to ask for manning assistance for my department because it made the commander look weak... ( I know this as I saw it on an email thread that somebody foolishly forwarded on to me!)
Consequently... here are the educational benefits and opportunities of one person doing the job of 3 surgeons...

1) I got to haul my kids out of the movie theater 3 times
2) I could not go further than 25-30 miles of the hospital... no sporting events, trips to the local fairs, we could not go fishing, could not go to a waterpark
3) I couldn't schedule call around single parenting since I was on call all the time... I had to have patients' families watch my two young kids on weekends and weeknights in the waiting room when I did emergency surgeries
4) I was called out of parent teacher conferences
5) I almost lost custody of my kids as my ex spouse's attorney threatened to use my busy schedule and work "stress" against me in court

yes IgD, I was the busiest AF surgeon of my subspecialty by patient visits and operations done during the year prior to my separation.... so I guess I shouldn't be complaining that I didn't have a "Wingman" watching out for me.

 

[RichL025]

I was filling a BDE Surgeon Slot and I was the commander and xo personal little prison bitch 24/7 for 365 days.

When I rotated stateside, I saw BC docs being ordered to the post guest house to personally hand deliver refills of Premarin to some long deceased general's wife.

Sucks to be them. I guess they never heard of the word "no", huh?

 

[alpha62]

If it were easy, or legal to say "no" to the patently ridiculous, we wouldn't have had Viet Nam, Lebanon, Mogadishu, Iraq, ect, ect.

Sucks to be them. I guess they never heard of the word "no", huh?

 

[DropkickMurphy]

Oh, and the civilian standard for acceptable call demands for surgery subspecialists? Ten days a month, maximum.

****......Maybe I should reconsider writing off being a surgeon as an option then.

 

[Galo]

IgD,
I will tell you a few things about being on call 24/7....

at that time, I told my commanders ( the ER physician and the physical therapist) that I was going through a divorce and was having a lot of stress in my personal life and at work seeing an unsafe amount of patients (for me and for them). They didn't want to ask for manning assistance for my department because it made the commander look weak... ( I know this as I saw it on an email thread that somebody foolishly forwarded on to me!)
Consequently... here are the educational benefits and opportunities of one person doing the job of 3 surgeons...

1) I got to haul my kids out of the movie theater 3 times
2) I could not go further than 25-30 miles of the hospital... no sporting events, trips to the local fairs, we could not go fishing, could not go to a waterpark
3) I couldn't schedule call around single parenting since I was on call all the time... I had to have patients' families watch my two young kids on weekends and weeknights in the waiting room when I did emergency surgeries
4) I was called out of parent teacher conferences
5) I almost lost custody of my kids as my ex spouse's attorney threatened to use my busy schedule and work "stress" against me in court

yes IgD, I was the busiest AF surgeon of my subspecialty by patient visits and operations done during the year prior to my separation.... so I guess I shouldn't be complaining that I didn't have a "Wingman" watching out for me.

Former military,

You'll quickly learn to avoid being baited by this piece of work, idg. He is some type of resident with sexual issues, is fervently blind to the operational issues in military medicine and even more ignorant of surgical subspecialties, despite claiming to be a senior level resident, and having trolled on this forum for a very long time. He will use your admission of having had stress related problems as some sort of personal weakness, and will point directly at it as the reason you left, or were asked to leave the military, whichever way it seems to make you look worse. That is what he has done with every single experienced physician that has posted negative experiences with the military, including me, ex usaf doc, ex mil md, island doc, and the list seems to keep growing. So don't get yourself worked up over his blind, and indifferent ignorance. He is the type of person that will likely flourish in the military, and be great at being mediocre at best, because he truly seems to believe that officership is highly above and beyond being a physician, and he repeatedly has made remarks like the one above that show his immaturity, and potential to be a great military medical officer.


On a personal note, I'm sorry to hear of your troubles. I experienced severe marital stress as well, and I'm slowly trying to heal wounds that I allowed myself to bring home. The level of stress the military can provide for you if you truly care about patients, is something that few people on this board can experience, and its next to impossible to explain it to them. Its just a shame that desite all the posting we do, there are still young chickens out there who will sing on without ever bothering to read these posts, or even joining after they read them.

Best of luck to you.

 

[USAFdoc]

I concur with the marital problems, perhaps not caused, but certainly exacerbated by the stress, hours away from home, possible depoyments etc from todays military.

Also, in another thread, someone said quite well, that in deciding to take HPSP, you have to decide between financial freedom and practice freedom. Well, it is a little more complicated than that, but it made me think of this analogy;

you have 2 people asked to lie on the ground (docs) while other people (admin) stick hot pokers in thier sides. Now one of the people on the ground (doc #1) is tied down and gagged, while the other (doc #2) lies there with the option to get up and leave and is allowed to talk as well. Lastly, both people (docs) are given the same treatment, same amount of pain etc.

Question: what person will be the most miserable?
Answer: even if both people stay on the ground, the person tied and gagged will be the worse off. That is one of the reasons military medicine is so much worse compared to civilian medicine. In the military you are tied down, have no voice, no options, no way to improve the situation for your patients, your family or yourself. where as in the civilian world, even if things got so bad (admin "hot pokers"), at least you have a voice and the ability to get up and leave. And do not forget, that unlike most ALL other military jobs, it is the responsibility of the physician for the outcome of the job (care of the patient). In most other military jobs, the ultimate responsibility is with the supervisor. In military medicine, the supervisor is usually a novice nurse.

For those in the decision stage, you cannot overestimate the value of your freedom in todays medical world (military or civilian for that matter).

 

[RichL025]

If it were easy, or legal to say "no" to the patently ridiculous, we wouldn't have had Viet Nam, Lebanon, Mogadishu, Iraq, ect, ect.

Apples and oranges.

Your friends let themselves be abused, so they were. While their commander deserves some blame for being a tool, they too get some for rolling on their backs for their belly rub.

I can understand how kind with HS education in the infantry fall into a mindset that would let them do things like that, but how a person with 13+ years of higher education has such a small sense of ego that they will allow that is baffling.

 

[NavyFP]

I concur with the marital problems, perhaps not caused, but certainly exacerbated by the stress, hours away from home, possible depoyments etc from todays military.

Also, in another thread, someone said quite well, that in deciding to take HPSP, you have to decide between financial freedom and practice freedom. Well, it is a little more complicated than that, but it made me think of this analogy;

you have 2 people asked to lie on the ground (docs) while other people (admin) stick hot pokers in thier sides. Now one of the people on the ground (doc #1) is tied down and gagged, while the other (doc #2) lies there with the option to get up and leave and is allowed to talk as well. Lastly, both people (docs) are given the same treatment, same amount of pain etc.

Question: what person will be the most miserable?
Answer: even if both people stay on the ground, the person tied and gagged will be the worse off. That is one of the reasons military medicine is so much worse compared to civilian medicine. In the military you are tied down, have no voice, no options, no way to improve the situation for your patients, your family or yourself. where as in the civilian world, even if things got so bad (admin "hot pokers"), at least you have a voice and the ability to get up and leave. And do not forget, that unlike most ALL other military jobs, it is the responsibility of the physician for the outcome of the job (care of the patient). In most other military jobs, the ultimate responsibility is with the supervisor. In military medicine, the supervisor is usually a novice nurse.

For those in the decision stage, you cannot overestimate the value of your freedom in todays medical world (military or civilian for that matter).

Sorry, but I think that is a little bit harsh. Physicians can make a difference in their work spaces, but it too requires work. I can't count the times I have heard people complain without presenting viable solutions. Never helps anything. Getting things done in the military is a game, and it must be played to get what you want.

Now I am not going to say there are not pointy haired bosses in the military. Had my share, always managed to get what I needed despite them.

What happened to Former Military was just wrong, but when you have only one of a given specialty it can happen at the smaller duty stations. His boss should have been more creative in solving that. Sometimes when your the boss you need to find money in the budget to alleviate those kinds of injustices and "educate" others as to the proper reasons to consult.

Military Medicine has its share of problems. I know I will not fix them all, but I will continue to fix the areas I work in.

 

[USAFdoc]

Sorry, but I think that is a little bit harsh. Physicians can make a difference in their work spaces, but it too requires work. I can't count the times I have heard people complain without presenting viable solutions. Never helps anything. Getting things done in the military is a game, and it must be played to get what you want.

Now I am not going to say there are not pointy haired bosses in the military. Had my share, always managed to get what I needed despite them.

What happened to Former Military was just wrong, but when you have only one of a given specialty it can happen at the smaller duty stations. His boss should have been more creative in solving that. Sometimes when your the boss you need to find money in the budget to alleviate those kinds of injustices and "educate" others as to the proper reasons to consult.

Military Medicine has its share of problems. I know I will not fix them all, but I will continue to fix the areas I work in.

response:

1) absolutely, try and fix what you can; but MY EXPERIENCE was that our commanders had a completely different agenda compared to the physicians. For the majority of my time in, there were almost no family physicians/primary care docs in the chain of command; the majority of the chain was nurses, and many of them complete novices at running a primary care clinic. Mix that with trying to run a clinic designed to run on 31 staff on 6-7 staff, and even the best commander is going to watch a clinic and the patients have major problems.

2)If you managed to get what you and your staff needed despite your commander, great. But in the design of Military Medicine; commanders to not have to give a crap what the physician wants or what the physician believes is safe.

3)Absolutely physicians can make a difference; I uncovered HUNDREDS of missed diagnosis', lost labs etc. I spent about 300 hr/month trying to make the clinic as excellent as I could, having to deal with ADMIN "friendly fire" almost every step of the way. That is not the career I would choose to have, and thankfully DOS came along and I now work in an environment where I have some authority to ensure a quality clinic.

4) I presented 15 pages of solutions to the Commander. He actually agreed with them and forwarded them to the SG of the USAF. A month later my commander suddenly changed his tune and basically never had any conversations with any of the docs. I suspect the SG told him to shut up and make more metrics.

 

[USAF Staff Doc]

All:

I am an AF staff MD at a CONUS base. Very interesting thread.

I could write a very long post discussing my experience in the AF so far, but it would take way too long. Better to discuss specific issues as they come up.

My overall feeling though: I was "gung-ho", "sir-yes-sir", "I'm going to be the AF SG someday" when I entered active duty. My AFMS experience has done far more than cause me to doubt whether AF medicine is right for me; it has caused me to doubt whether the US is really the great country I thought it was just a few short years ago.

Looking forward to participating in this thread...

vr,
USAF Staff Doc

 

[USAFdoc]

You sound like me just after residency; just before I started my active duty tour.

I was previously enlisted; I had the USAF fight song on CD, several model airplanes to decorate my office, and was about to start my first of an entire career as a USAF Family doc. Within 3-6 months in my USAF clinic, I was wondering how in the world anybody could be running a clinic so recklessly, so undermanned, no charts, no support staff, and some commanders who had no clue and did not care to ever get one. During the next 3 years I saw every single civilian nurse quit, I saw 8 of 9 civilian docs leave/quit, I saw every military doc want to quit, I saw docs get out at their 18 yr point, nurses get out at the 15 year point, etc. read this whole post to get more gist.


Welcome to SDN USAF Staff Doc; if only this site were available to me in 1995!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

 

[Pemberley]

You'll quickly learn to avoid being baited by this piece of work, idg. He is some type of resident...

Did he say that much? Last I'd heard he was refusing to give any background info at all.

 

[alpha62]

Well, I said screw it and got out. I simply got tired of being the only guy in my AO calling BS all the time, while the rest just stood by in the background.

They use a lot of threats, fear, and loathing to gain total submission. They'll threaten to burn you with a paper trail that will follow you after the military, I've seen them try to discredit troublemakers with command directed psych evals.... that's an old favorite.

Your average trooper hasn't worked for anything, so they don't have as much to lose. They like to use your own achievement and the threat of taking it from you, as a method of capitulation.

Apples and oranges.

Your friends let themselves be abused, so they were. While their commander deserves some blame for being a tool, they too get some for rolling on their backs for their belly rub.

I can understand how kind with HS education in the infantry fall into a mindset that would let them do things like that, but how a person with 13+ years of higher education has such a small sense of ego that they will allow that is baffling.

 

[island doc]

Well, I said screw it and got out. I simply got tired of being the only guy in my AO calling BS all the time, while the rest just stood by in the background.

They use a lot of threats, fear, and loathing to gain total submission. They'll threaten to burn you with a paper trail that will follow you after the military, I've seen them try to discredit troublemakers with command directed psych evals.... that's an old favorite.

Your average trooper hasn't worked for anything, so they don't have as much to lose. They like to use your own achievement and the threat of taking it from you, as a method of capitulation.

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.