AVOID MILITARY MEDICINE if possible

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bobbyseal said:
I got a full deferment. I matched where I wanted to. I'll serve my 4 years and probably be done. Sure it may be a pain in the neck for those 4 years, but I very well may be better off for taking the HPSP. I went to a private med school with tuition >$35k per year, plus health insurance, plus fees, plus books, plus, $15-16k per year in stipend. That's like $200k right there from the military. For anyone right out of residency $50k a year after taxes is somewhat hard to swallow to pay that back.

But then again, there are many more people who were screwed by the military than those who got the good deal. The screw may have just not turned on me yet.

Bobbyseal, I'm guessing you joined the Navy??? What is all this noise on this thread about serving more than your 'year for year' commitment? I just interviewed with officers in the USN MC that say it really IS A YEAR FOR YEAR commitment, unless you opt to go on more active duty tours after your one year GMO... do we need to dispel these rumors?

And a small note to those of you who continually bash the system-- I think its pretty incredible that as a 3rd or 4th year student you could do clerkships in flight surgery. I am referencing a 4th year student I met here in Fallon, NV who is doing a rotation with the Flight surgeons for Top Gun. Thats a pretty damn cool rotation. Definitely something to add to your obituary (sarcasm).
 
curlycorday said:
Bobbyseal, I'm guessing you joined the Navy??? What is all this noise on this thread about serving more than your 'year for year' commitment? I just interviewed with officers in the USN MC that say it really IS A YEAR FOR YEAR commitment, unless you opt to go on more active duty tours after your one year GMO... do we need to dispel these rumors?

And a small note to those of you who continually bash the system-- I think its pretty incredible that as a 3rd or 4th year student you could do clerkships in flight surgery. I am referencing a 4th year student I met here in Fallon, NV who is doing a rotation with the Flight surgeons for Top Gun. Thats a pretty damn cool rotation. Definitely something to add to your obituary (sarcasm).

One of the main issues that people complain about is having to do a GMO tour in the AF, Army, or Navy. Basically, you come out of intern year, owing time for the number of years you took the HPSP with a minimun of two years as I understand it. So, you do your two or three years in the GMO, and you knock off some time off your commitment.

But then you need to finish a residency. So, you start accruing more commitment time. If the length of your residency is longer than your current commitment (owe 2 years, but want to do ortho which is 4 years), now you've gone back up to a 4 year commitment after residency. And so, those 2 years as a GMO really didn't help you get out of the military any quicker.

But, I got a deferment, so I'll do my training outside of the military and then I'l come back in as an O-3 or 4 with no time in service. Sure, the military would point out that those who do their training in house get the time in service benefits. Oh well. I'll get the benefit of training at a top institution and actually see some pathology and not just read about it in a book.
 
Air Force?... GMO?... haha thats pretty funny. =)

bobbyseal said:
One of the main issues that people complain about is having to do a GMO tour in the AF, Army, or Navy. Basically, you come out of intern year, owing time for the number of years you took the HPSP with a minimun of two years as I understand it. So, you do your two or three years in the GMO, and you knock off some time off your commitment.

But then you need to finish a residency. So, you start accruing more commitment time. If the length of your residency is longer than your current commitment (owe 2 years, but want to do ortho which is 4 years), now you've gone back up to a 4 year commitment after residency. And so, those 2 years as a GMO really didn't help you get out of the military any quicker.

But, I got a deferment, so I'll do my training outside of the military and then I'l come back in as an O-3 or 4 with no time in service. Sure, the military would point out that those who do their training in house get the time in service benefits. Oh well. I'll get the benefit of training at a top institution and actually see some pathology and not just read about it in a book.
 
majleap said:
Thank you for qualafying your remarks, now I at least can see where you are coming from. However, I guess it is safe to assume that the position you are in now is trouble free? No place is trouble free, but the "trouble" in the USAF dwarfs anything I see in my current civilian job, and when there is a problem, guess what, somebody lets me fix it, unlike USAF protocol. I guess it is safe to say that your time as an AF doc was totally a waste? Absolutely not a waste. I worked my butt off and gave 100% to my patients and the USAF, I likely saved lives and gave the best compassionate care I could. The waste is on the part of the USAF in that they "waste" the people they had who wanted to serve their country and fellow soldiers as their "family doc". The USAF made the system so bad that NOBODY could stomach staying in. That is sad and a waste of our training and the USAF investment. I would conclude that other than professionally, your time in the AF away from work was totally horrible. No, when I did have some time off, I spevnt all of it with my 2 children, both less than 5 yo, and wife. working 275-400 hours a month for 3 years made free time pretty sacred.[/COLOR] Do we have problems? Yes. Are we short on docs? Absolutely, that is a problem from the top, and they are now working to change that. I would say that a staff fully manned would solve many problems you faced. Even close to fully manned would have helped. We had many days where our clinic of 31 staff had 6-7. We ran on 15-50% manning 3 years straight. All the time listening to admin harp about how the "numbers" are not good and how "on paper" we are fully manned. Didn't you say you were in the Navy, got out, joined the AF, got out? Some people can't be pleased. I got out of the NAVY to go to med school, and ended up in the USAF because the USN lost my application and the USAF nabbed me first. I did not join the military or become a family doc to be "pleased". I am here to serve my patients as best I can, and I am willing to do whatever it takes to be an excellent doc and excellent dad/husband. The USAF lost me and many fine physicians because they created a terrible healthcare system and appeared to have no clue on how to run a professional medical clinic or how to treat people with respect. Well USAF doc, I am sorry your AF time was so bad. (Why do you use the title USAF doc?) Because I was a USAF doc when I joined this site. I guess I should change to ex-USAFdoc?[/COLOR] Do you try to hide your AF service when you talk to other physicians. I dont hide it or promote it.You wouldn't use this horrible experience to further your career would you? Whats this "further my career" stuff about? I'm just a small town family doc and hope to be that till the Lord takes me away. If after everything you say, if you keep your service to your country off your resume, then I will respect you.
I hope to never write another resume, I love my job, and staff and everything. No it's not perfect, but after what I saw in the USAF, everything else looks like roses.[/COLOR]

the above "orange" is my answers to Majleap.
USAF doc
 
Heeed! said:
OOOHH, AAHHH...nice color coding! That must have taken a while.

actually it was pretty quick.

and just a note; it still surprises me when I read what Majleap wrote, that he thinks the docs on this site have some selfish motive for discussing our experiences with military medicine. The other thing I seem to read alot is that they assume the problem MUST be with the physician. The fact that nearly ALL physicians are making a mass exodus from military med (and in the case of the US Navy, the already cant get any new HPSP in) seems to go right pass them.

I do not think myself and other physicians ask too much in just wanting to be given the chance to practice good medicine, and with that have a professional atmosphere.
 
USAFdoc said:
actually it was pretty quick.

and just a note; it still surprises me when I read what Majleap wrote, that he thinks the docs on this site have some selfish motive for discussing our experiences with military medicine. The other thing I seem to read alot is that they assume the problem MUST be with the physician. The fact that nearly ALL physicians are making a mass exodus from military med (and in the case of the US Navy, the already cant get any new HPSP in) seems to go right pass them.

I do not think myself and other physicians ask too much in just wanting to be given the chance to practice good medicine, and with that have a professional atmosphere.

What I don't get is why people getting ticked off by reading the gripes of those that have been there, done that. This is a public forum....a great conduit for information. Those of us that have dealt with the intelligence career field know the more information you have, the better decisions you can make. So I say, bring on the good and the bad. I want to hear it all so I can avoid making poor decisions with my career and maybe along the way, leave the system a little better than when I found it. (If that's possible.....otherwise, I'll just do my time and get out, like everyone else :laugh: )
 
Heeed! said:
Those of us that have dealt with the intelligence career field know the more information you have, the better decisions you can make. So I say, bring on the good and the bad. I want to hear it all so I can avoid making poor decisions with my career and maybe along the way,


Good point. It's ironic how many of the people that criticize the military medicine haterz, are the same ones who say that anybody who signed up after being duped by recruiters deserved it b/c they didn't do enough research.
 
I spoke with a good friend of mine still stationed at my last base. Apparently the Surgeon General slapped the hands of the local commander for going way over the limits placed on enpanneling providers. The limit was supposed to be 1400/doc and our commander usually went about 1700/doc. Also, the commander is now only to enpannel the providers there. It was common for our commander to bring in thousands of patients to doctors not even practicing there (separated, etc). He would fill based on what the maximum fills slots were for the clinic. That meant many of us covered for patient panel sizes of 3000+

just a small step in the right direction.
 
below is a link to the USAFP web page, look under past and current newsletter issues to learn more about Primary care med in the military.

A quote from the Fall 2005 issue states "the FP shortage that previous USAF rep Col Robe Manaker ..predicted.."

I spoke with Col Manaker and all his successors; they were all aware of the serious problems, and even at thier high level within the USAF (reps to the Pentagon), they were ignored as well in their concerns.

http://www.usafp.org/Word_PDF_Files/2005-Fall-Newsletter-Bookmarked.pdf

http://www.usafp.org/Newsletter.htm
 
Below a few more exerpts off the web supporting what physicians on this site have been telling you all. Some of you (most) at least seem to incorporate this into your thought processess, while a few out there seem to think all the physicians on this site are not representing the truth. Below is some more truth.


Aaron Belkin, director of the center and an associate professor of political science at the University of California, Santa Barbara, said the discharges provide evidence that the ban is hampering military readiness. "The consequences of shortfalls in medical specialists during wartime are serious," he said. "When the military lacks the medical personnel it needs on the front lines, it compromises the well-being not only of its injured troops but of the overextended specialists who have to work longer tours to replace those who have been discharged."

The revelation comes at a time when the military has acknowledged it is struggling with significant shortfalls in recruitment and retention of medical personnel for the wars in Iraq and Afghanistan.

According to a Senate report issued in 2003 by senators Christopher Bond and Patrick Leahy, hundreds of injured Guard and Army Reserve soldiers "have been receiving inadequate medical attention" while housed at Fort Stewart because of a lack of preparedness that includes "an insufficient number of medical clinicians and specialists, which has caused excessive delays in the delivery of care." The situation created the perception among soldiers that they were receiving care that was inferior to that received by active duty personnel, which had a "devastating and negative impact on morale."
 
USAFdoc said:
Below a few more exerpts off the web supporting what physicians on this site have been telling you all. Some of you (most) at least seem to incorporate this into your thought processess, while a few out there seem to think all the physicians on this site are not representing the truth. Below is some more truth.


Aaron Belkin, director of the center and an associate professor of political science at the University of California, Santa Barbara, said the discharges provide evidence that the ban is hampering military readiness. "The consequences of shortfalls in medical specialists during wartime are serious," he said. "When the military lacks the medical personnel it needs on the front lines, it compromises the well-being not only of its injured troops but of the overextended specialists who have to work longer tours to replace those who have been discharged."

The revelation comes at a time when the military has acknowledged it is struggling with significant shortfalls in recruitment and retention of medical personnel for the wars in Iraq and Afghanistan.

According to a Senate report issued in 2003 by senators Christopher Bond and Patrick Leahy, hundreds of injured Guard and Army Reserve soldiers "have been receiving inadequate medical attention" while housed at Fort Stewart because of a lack of preparedness that includes "an insufficient number of medical clinicians and specialists, which has caused excessive delays in the delivery of care." The situation created the perception among soldiers that they were receiving care that was inferior to that received by active duty personnel, which had a "devastating and negative impact on morale."

Yeah, and part of that "unpreparedness" is Rumsfeld's assumption that Iraq would be a casualty-free evolution, where the newly-freed natives would lay down a highway of rose petals to the American liberators. Guess it didn't exactly work out that way, and now our "planning" is coming home to roost.
 
trinityalumnus said:
Yeah, and part of that "unpreparedness" is Rumsfeld's assumption that Iraq would be a casualty-free evolution, where the newly-freed natives would lay down a highway of rose petals to the American liberators. Guess it didn't exactly work out that way, and now our "planning" is coming home to roost.

more military info; stop loss is another term for poor planning. I really hesitate when I place these things about my county and its military, casting them in a bad light. At the same time, I hate that the military lies about the situation and it ends up effecting those that volunteered to serve the most.

http://news.yahoo.com/s/nm/20060129/pl_nm/iraq_usa_stoploss_dc
 
I agree that "stop-loss" is a horrible, last-chance way to accomplish manpower and retention goals, but its use here is hardly unique.

I would hesitate to say the military "lies" about the situation, it's more a case of they don't exactly go out of their way to point out the "fine print" (ie, an initial enlistment contract is actually for eight years, etc etc).

Soldiers bellyached about stoploss during the First Gulf War also, and many MOSes were "stop-lossed" after 9-11, way before Iraq v2.0 kicked off.

Stop loss is a bad way of accomplishing their goals, but in all fairness, sometimes it's necessary. We can argue until we're blue in the face about alternative ways of accomplishing the mission (of keeping warfighters on the ground) but once we are in a situation that demands it's use, stop-loss is the only option. Or maybe what I'm trying to say is that it's sometimes a neccesary evil. During WW2 soldiers were enlisted "for the duration", but the corps of the peacetime army in early 1941, around which the massive wartime army would be built, was on "contracts" with expiration dates. If the army had allowed soldiers to "ETS" in 1943 just because they were enlisted under the previous system, they would have lost some of the upper-level leadership that a citizen-army needs the most.
 
RichL025 said:
I agree that "stop-loss" is a horrible, last-chance way to accomplish manpower and retention goals, but its use here is hardly unique.

I would hesitate to say the military "lies" about the situation, it's more a case of they don't exactly go out of their way to point out the "fine print" (ie, an initial enlistment contract is actually for eight years, etc etc).

Soldiers bellyached about stoploss during the First Gulf War also, and many MOSes were "stop-lossed" after 9-11, way before Iraq v2.0 kicked off.

Stop loss is a bad way of accomplishing their goals, but in all fairness, sometimes it's necessary. We can argue until we're blue in the face about alternative ways of accomplishing the mission (of keeping warfighters on the ground) but once we are in a situation that demands it's use, stop-loss is the only option. Or maybe what I'm trying to say is that it's sometimes a neccesary evil. During WW2 soldiers were enlisted "for the duration", but the corps of the peacetime army in early 1941, around which the massive wartime army would be built, was on "contracts" with expiration dates. If the army had allowed soldiers to "ETS" in 1943 just because they were enlisted under the previous system, they would have lost some of the upper-level leadership that a citizen-army needs the most.

Well, if it is necessary to do this, that is no excuse for not also being just. The services should be obligated to pay fourfold the usual pay of a member retained under stop-loss during the time of additional involuntary retention beyond EAOS and an additional 360 days of severance after separation. If we are going to press-gang our troops, then it's time to acknowledge that those extraordinary demands have value.

These decisions need to be placed in proper perspective: they cause hardship to military reserve families that are not borne by our society at large and are at once, and I think cynically, being exploited by the senior defense leadership. Mr. Rumsfeld and the administration he serves need to do right, here. An outsized payment to the person suffering the loss of liberty and contrary to the terms of his contract doesn't restore lost civilian opportunities or make separation from family less difficult, but it at least compels the services to share the pain and to think really seriously about whether breaking someone's contract is as necessary as it seems.

Unless fairness is part of the solution, then the administration's critics have them dead to rights: stop-loss is nothing more than an underhanded and backdoor draft.


Edited by the poster for clarification.
 
RichL025 said:
I agree that "stop-loss" is a horrible, last-chance way to accomplish manpower and retention goals, but its use here is hardly unique.

I would hesitate to say the military "lies" about the situation, it's more a case of they don't exactly go out of their way to point out the "fine print" (ie, an initial enlistment contract is actually for eight years, etc etc).

.


My problem with stop loss is NOT so much that it happens, but why it happens.

Many have been claiming from the beginning that the military was "under-manned" to get the job done correctly in IRAQ. Still, the Pentagon said troop stregth was more than adequate.

In my personal experience in USAF primary care, we have been in a similar, although certainly, less personally dangerous situation.

WE JUST DID NOT HAVE ENOUGH PEOPLE TO GET THE JOB DONE CORRECTLY AND SAFELY. The frustration was listening to admin with little clue tell us that we did.

Now in IRAQ you have things like stop loss taking place. In a USAF primary care clinic you have a shortage of 150 family docs because everyone separated or went admin.

In the end, everybody suffers.
 
The issue of stop-loss is completely seperate from the contention that we "don't have enough troops there" - this is a distinction the press has largely missed also.

If you'll re-read that link that was posted you'll see it only applies to units heading to combat tours. Now, I think even those here who have not served in the muddy-boot army can agree (or at least appreciate) that if you have a unit training for months to go to combat, and you have new replacements coming in the week before deployment, those newbies aren't going to be fully integrated into the team yet.

That gets people killed.

Yes, it sucks that some soldiers are getting extended in the name of keeping combat teams together. But the other soldiers in the unit, and the new replacements who would be needed to fill in for the short-timers, would be very poorly served if it wer enot used. And so would the army as a whole, and the american public who sees their sons and daughters come home in bodybags - "sorry Mrs Jones, but your son's squad had two or three brand new privates in it who weren't yet up to speed. Here's a flag for you...."

This issue is seperate and distinct from the question of whether we have "enough" troops to do the job.
 
RichL025 said:
The issue of stop-loss is completely seperate from the contention that we "don't have enough troops there" - this is a distinction the press has largely missed also.


This issue is seperate and distinct from the question of whether we have "enough" troops to do the job.


I disagree; there is absolutely a link. The military (in primary care medicine as well) has neen thinned so much that there is "no slack" left in the line. Properly manned and planned, and barring massive unforseen happenings, you can plan your deployments, turnovers, .......have appointments available to see patients etc. In the name of saving $$$ and by failing to design a healthcare system capable of delivering timely excellent care, the USAF compromised both missions, deployed and homeland. At the same time it leads to personnel burnout. I would venture that you would rather be told you will be stationed in IRAQ for 6 months and have the USAF keep that plan, then to be told you will be there for 3 months and then have it extended at the last minute for another 3 months.

The safety issue you bring up is valid, but with adequate troop levels and good planning, you accomplish all without the added stress and broken "promises".
 
USAFDoc,

What you are describing and talking about has nothing to do with "stop-loss", please go back and re-read that link.

Under the policy, soldiers who normally would leave when their commitments expire must remain in the Army, starting 90 days before their unit is scheduled to depart, through the end of their deployment and up to another 90 days after returning to their home base.

Now, where do you see anything about Air Force primary care in there?
 
RichL025 said:
USAFDoc,

What you are describing and talking about has nothing to do with "stop-loss", please go back and re-read that link.



Now, where do you see anything about Air Force primary care in there?


same type of admin decisions; do more and more with less and less; remove "front-line" people from the decision process, in fact, don't even ask front line people what they need, "Fib" in public about the actual state of things (say they are wonderful when those in the "know" realize the opposite is really true, burnout your staff/troops then wonder whats happening when retention takes a nose dive, etc.......)

I have heard the SG talk about how retention is at an alltime high in the medical corps and then when you look at the true numbers you see what a lie it was. In the same light, you have heard Rumsfeld talk about troop levels being more than adequate, despite soldiers saying the opposite. Now you see stop loss happening, and given the "inadequate troop levels", stop-loss is probably the correct move at this point, but if they planned correctly to begin with, it would have been a decision that would never have to be made in this situation.
 
USAFdoc said:
you have heard Rumsfeld talk about troop levels being more than adequate, despite soldiers saying the opposite. Now you see stop loss happening

It wasn't just soldiers saying the opposite- a formal study concluded our military is in trouble. Yet Rumsfeld denies it. The military has issues on levels that far surpass military medicine. So how do we reconcile these issues? Or should we just give up on the system and wait for the draft to be reinstated? Even with the inadequacies, I think most people understand we still need quality people to serve in our military. That is the "conflict" in the back of my mind when I read some of the more negative posts on this site... I realize problems exist, but what can we do about them without abandoning the system all together? Just my perspective- not really directed at you specifically, USAFdoc.
 
USAFdoc said:
same type of admin decisions; do more and more with less and less; remove "front-line" people from the decision process, in fact, don't even ask front line people what they need,...

Please stop trying to obfuscate the issue.

The "Stop-loss" in the article is a policy that allows the military to keep combat untis together before deployment to war.

It has nothing whatsoever to do with a "back-door draft", which is merely a political term that the current administration's political opponsents are using as a sound bite.

If you asked the "front-line people" who are deploying to Iraq, if they would rather go to battle only 75% manned (because soldiers whose ETS occured during the dpeloyment went home) or whether they think it would be better to keep the unit fully manned with people who have been working together for more than a year, which option would they choose?
 
RichL025 said:
Please stop trying to obfuscate the issue.

The "Stop-loss" in the article is a policy that allows the military to keep combat untis together before deployment to war.

It has nothing whatsoever to do with a "back-door draft", which is merely a political term that the current administration's political opponsents are using as a sound bite.

If you asked the "front-line people" who are deploying to Iraq, if they would rather go to battle only 75% manned (because soldiers whose ETS occured during the dpeloyment went home) or whether they think it would be better to keep the unit fully manned with people who have been working together for more than a year, which option would they choose?

1) of course you want to be fully manned, and you should be. Because of the decisions made by leadership, stop-loss is the only viable alternative at this point. The question is whether stop-loss was avoidable. It would be except for the "ultra-lean" military we now have.

2) I agree with you, stop loss is NOT a draft. You, me, and everyone else joined of free will, and in signing, we became gov. property.
 
RichL025 said:
If you'll re-read that link that was posted you'll see it only applies to units heading to combat tours. Now, I think even those here who have not served in the muddy-boot army can agree (or at least appreciate) that if you have a unit training for months to go to combat, and you have new replacements coming in the week before deployment, those newbies aren't going to be fully integrated into the team yet.

That gets people killed.

Many of us fell under stop loss after 9-11 but the part that made it "not so bad" was that it was temporary. The problem is that the Army is still using it today. I put my separation paperwork in a year before my commitment was up- plenty of time to bring in and train another pilot to take my spot in the squadron. So why can't the Army do the same? If someone has a separation date that falls before the unit is scheduled to deploy, can’t they identify that person in advance (assuming they want to separate) and find a replacement in enough time to get the replacement ready to deploy? They don’t have wait and bring in the replacement at the last minute.

Notice that it isn't just the liberal politicians that see the danger of a prolonged stop-loss:

A report commissioned by the Pentagon called stop-loss a "short-term fix" enabling the Army to meet ongoing troop deployment requirements, but said such policies "risk breaking the force as recruitment and retention problems mount." It was written by Andrew Krepinevich, a retired Army officer.

So, what is the definition of a "short-term fix"?
 
dpill said:
Many of us fell under stop loss after 9-11 but the part that made it "not so bad" was that it was temporary. The problem is that the Army is still using it today. I put my separation paperwork in a year before my commitment was up- plenty of time to bring in and train another pilot to take my spot in the squadron. So why can't the Army do the same? If someone has a separation date that falls before the unit is scheduled to deploy, can’t they identify that person in advance (assuming they want to separate) and find a replacement in enough time to get the replacement ready to deploy? They don’t have wait and bring in the replacement at the last minute.

Notice that it isn't just the liberal politicians that see the danger of a prolonged stop-loss:

A report commissioned by the Pentagon called stop-loss a "short-term fix" enabling the Army to meet ongoing troop deployment requirements, but said such policies "risk breaking the force as recruitment and retention problems mount." It was written by Andrew Krepinevich, a retired Army officer.

So, what is the definition of a "short-term fix"?

thanks dpill for stating this more clearly than I did.
 
USAFdoc said:
thanks dpill for stating this more clearly than I did.

The problem is that it is being used frequently as a "short-term fix" and it is being done at the convenience of the services whenever their troop replacement schedules fall short. That undermines the credibility of the "contracts" the services establish at enlistment.

Strong-arm contract-breaking, which is exactly what is being done here, shouldn't come without a price to the breaker. Let the services pay the inconvenienced party and his family an amount that penalizes this kind of poor planning, not merely continuing their usual pay, but a significant amount more, and a severance, recognizing that delays to discharge can have costly effects in losing civilian work opportunities that last long after the delayed discharge date. Doing anything less makes the services a dishonorable and lousy employer at a minimum, and really does make for a back-door draft, since it deprives a citizen of liberty beyond the agreed-upon contract to the advantage and at the convenience of the government. Unit cohesion and combat readiness considerations are beside the point.

Changing contract terms in other business costs money, why should the services get a free ride?
 
orbitsurgMD said:
The problem is that it is being used frequently as a "short-term fix"

Agreed. The "short-term fix" has now become an indefinite quandary and will likely make things worse for the long-haul (more difficult recruiting/ retention). I think the issue goes beyond the individual services (reference earlier posts- the Sec Def doesn’t think a problem exists).

Another insightful quote from the same article:
"As the war in Iraq drags on, the Army is accumulating a collection of problems that cumulatively could call into question the viability of an all-volunteer force," said defense analyst Loren Thompson of the Lexington Institute think tank.
"When a service has to repeatedly resort to compelling the retention of people who want to leave, you're edging away from the whole notion of volunteerism."
 
dpill said:
I put my separation paperwork in a year before my commitment was up- plenty of time to bring in and train another pilot to take my spot in the squadron. So why can't the Army do the same?


How many pilots are there in the air force? How long does the average pilot serve?

Now answer the same questions about infantrymen. No need for exact numbers, just relaize the orders of magnitude differences that exist.

Also I would hazard that "teamwork" means different things to pilots than it does infantrymen. How often does a pilot perform combined missions with his whole squadron, or a flight greater than 2-3 aircraft? An infantryman, on the other hand, seldom fights in less than a platoon (20-30 men) sized element. Although, having never been a pilot and not being fully conversant in their tactics, I'll defer on this last point if aviators wish to rebut. I've never seen a sortie of close-air support A/C more than 2-3 at one time, however...
 
orbitsurgMD said:
Changing contract terms in other business costs money, why should the services get a free ride?

Because the service is not a business, does not exist to make money, and does not follow civil rules of contract law.

If you have notions of military service as being quaintly bound by the same rules an employment contract at IBM is, I think I see the source of some of your dissatisfaction with military service....
 
there is a price to pay for running "lean", and part of that price is stop-loss. Is there really any question at this time that the military as a whole is stretched thin?

With adequate manning, you could have more FULLY TRAINED personnel, more available OVERLAP time to turn local missions over to the oncoming troops etc.

With undermanning you get stop-loss, burnout, at times compromised missions etc.
 
USAFdoc said:
there is a price to pay for running "lean", and part of that price is stop-loss. Is there really any question at this time that the military as a whole is stretched thin?

With adequate manning, you could have more FULLY TRAINED personnel, more available OVERLAP time to turn local missions over to the oncoming troops etc.

With undermanning you get stop-loss, burnout, at times compromised missions etc.

I agree with your statement in principle, but remember the whole "peace dividend" thing?

If we keep the army (and other services) at the current manning levels, they would be able to pull off a _major_ commitment like Iraq once a decade or so, suffering some short-term damage (morale, recruitment, retention) in doing so.

To be able to handle extended commitments like Iraq without that damage, the army's permanent size would need to be increased to something approaching cold-war levels (perhaps a little smaller, but not much). To be honest with you, I just don't see that political will in Washington, or amongst the american public (the bill payers).

The fact that the army cannot sustain major engagements like Iraq indefinitely is somehwat of a comfort to me - it means our policymakers would be less likely to jump into embroiling us into major engagements if they knew the forces couldn't handle it without the damage described above.... although of course, they jumped into Iraq without expecting it to be a major engagement, so take that logic for what it's worth. Still, having an army designed for brief interventions would be better than one designed for staying power (which, if you think about it, can be synonymous with "occupation").

Regardless, we (the US) made a concsious decision to make our military a leaner force with less staying power. We CAN take such a force and "make it stay" somewhere as is, but at the cost of those factors I mentioned earlier. If the goal is lofty enough, perhaps those costs are acceptable, because morale will eventuall improve, and when combat in Iraq is a memory (either having been won or lost) recruitment & retention levels will return to normal.
 
RichL025 said:
I agree with your statement in principle, but remember the whole "peace dividend" thing?

If we keep the army (and other services) at the current manning levels, they would be able to pull off a _major_ commitment like Iraq once a decade or so, suffering some short-term damage (morale, recruitment, retention) in doing so.

To be able to handle extended commitments like Iraq without that damage, the army's permanent size would need to be increased to something approaching cold-war levels (perhaps a little smaller, but not much). To be honest with you, I just don't see that political will in Washington, or amongst the american public (the bill payers).

The fact that the army cannot sustain major engagements like Iraq indefinitely is somehwat of a comfort to me - it means our policymakers would be less likely to jump into embroiling us into major engagements if they knew the forces couldn't handle it without the damage described above.... although of course, they jumped into Iraq without expecting it to be a major engagement, so take that logic for what it's worth. Still, having an army designed for brief interventions would be better than one designed for staying power (which, if you think about it, can be synonymous with "occupation").

Regardless, we (the US) made a concsious decision to make our military a leaner force with less staying power. We CAN take such a force and "make it stay" somewhere as is, but at the cost of those factors I mentioned earlier. If the goal is lofty enough, perhaps those costs are acceptable, because morale will eventuall improve, and when combat in Iraq is a memory (either having been won or lost) recruitment & retention levels will return to normal.

RichLo25; I agree with just about all the above. Now if only there was more honesty in our military leaders, Commanders etc..........would it be that hard for them to vocalize something similar to what you just wrote.

If my past command would have at least come clean and admitted that manning was "too thin" and at least work with the staff to "limit the pain", things would have still "sucked" but admin would have at least had our respect and if they would have listened we could have solved problems together (wow, what a concept).
 
RichL025 said:
I agree with your statement in principle, but remember the whole "peace dividend" thing?

If we keep the army (and other services) at the current manning levels, they would be able to pull off a _major_ commitment like Iraq once a decade or so, suffering some short-term damage (morale, recruitment, retention) in doing so.

To be able to handle extended commitments like Iraq without that damage, the army's permanent size would need to be increased to something approaching cold-war levels (perhaps a little smaller, but not much). To be honest with you, I just don't see that political will in Washington, or amongst the american public (the bill payers).

The fact that the army cannot sustain major engagements like Iraq indefinitely is somehwat of a comfort to me - it means our policymakers would be less likely to jump into embroiling us into major engagements if they knew the forces couldn't handle it without the damage described above.... although of course, they jumped into Iraq without expecting it to be a major engagement, so take that logic for what it's worth. Still, having an army designed for brief interventions would be better than one designed for staying power (which, if you think about it, can be synonymous with "occupation").

Regardless, we (the US) made a concsious decision to make our military a leaner force with less staying power. We CAN take such a force and "make it stay" somewhere as is, but at the cost of those factors I mentioned earlier. If the goal is lofty enough, perhaps those costs are acceptable, because morale will eventuall improve, and when combat in Iraq is a memory (either having been won or lost) recruitment & retention levels will return to normal.

RichLo25; I agree with just about all the above. Now if only there was more honesty in our military leaders, Commanders etc..........would it be that hard for them to vocalize something similar to what you just wrote.

If my past command would have at least come clean and admitted that manning was "too thin" and at least work with the staff to "limit the pain", things would have still "sucked" but admin would have at least had our respect and if they would have listened we could have solved problems together (wow, what a concept).
 
RichL025 said:
Because the service is not a business, does not exist to make money, and does not follow civil rules of contract law.

If you have notions of military service as being quaintly bound by the same rules an employment contract at IBM is, I think I see the source of some of your dissatisfaction with military service....

I'll suspend my comments on your ad hominem. I have no illusions at all regarding the military's treatment of its contracts obligations or its civil liabilities. There have been cases where the Navy has lost civil suits and refused to pay anyway; the USDOJ had to intervene. (I rather relish the thought of a U.S. Marshal bringing a Navy flag officer in front of a U.S. magistrate).

The fact that the military is not a business whose purpose is to generate profits is irrelevant to the issue of whether its contracts should be considered valid, or in their breach, whether those harms caused by the breach be compensated. That the government or the military doesn't make money (they do) or "profit" (they don't right now) has nothing to do with the contract.

At present the military is exercising a privilege to retain personnel against their will beyond the agreed-upon enlistment terms. It is doing so because it has failed to attract sufficient new volunteers to staff the expeditionary forces that are required for present mission commitments. The courts, so far, have sided with the government and against the servicemembers in the handful of cases that have been brought (three, total, last I read). So far, I have not read where the government has been found liable for damages for these involuntary extensions. That would be an interesting test of the notion of the uniqueness of the government's privilege to make contracts that it may later breach with impunity.

Of course, these liberties will have their price. The voluntary nature of the military is under suspicion. The ease and willingness with which the military has turned to dishonoring its enlistment agreements, regardless of the license to do so granted by lower courts, lends credence to the idea that the military is an untrustworthy organization that cannot be held to its agreements. Saying it is perfectly legal won't help them one bit.
 
Orbitsurg,

I'm sorry if you feel these are ad hominem attacks. I actually rewrote that sentence a few times trying to be more civil. I'm not trying to insult you, I'm trying to respectfully and tactfully point out that you have some rather.... civilian .... notions of how things work in the military. Such notions would, of course, cause you to be extremely dissatisfied when they conflict with how things are.

The courts, so far, have sided with the government and against the servicemembers in the handful of cases that have been brought (three, total, last I read). So far, I have not read where the government has been found liable for damages for these involuntary extensions. That would be an interesting test of the notion of the uniqueness of the government's privilege to make contracts that it may later breach with impunity.

I'm not a lawyer, and have no formal legal training, but I have an avid (albeit amateur) interest in constitutional law.

As far as I remember, every case you have read about, and several similar ones that arose long before the second gulf war, hinge on one major principle that people keep forgetting about: under article 2 of the consitution, the president is commander-in-chief of the armed forces. The supreme court has interpreted this over the years as that he has broad powers when it comes to running the military, and due to the interest the country has in not diluting those powers, courts have historically deferred to the executive branch in running the military.

(Incidentally, I think this is the same rationale whereby discrimination against homosexuals is still allowed, and even heterosexual adultery is still a prosecutable offense)

Secondly, another question is: are the contracts even broken????? I went through my old files, and found one of my old contracts (SF form 4/2 dated May 1988). On the contract is a page entitled "Partial Statement of Existing Laws of the United States". Here are some pertinent exerpts:

9 (a) My enlistment is more than an employment agreement.

9 (c) In the event of war, my enlistment in the Armed Forces continues until six (6) months after the war ends, unless my enlistment is ended sooner by the President of the United States (note: don't know if legally, this means legal state of "War" as only congress can declare, or "war" as commonly defined by combat actions. I suspect the former, but again, I'm not a lawyer)

10 (d) - as a member of the ready reserve I may be required to perform active duty without my consent (note: anyone discharged from the military with less than 8 years service is in the ready reserve, until they reach the 8 year mark)

10 (d)(1.) In time of national emergency declared by the President of the United States, I may be ordered to active duty (other than for training) for not more than 24 consecutive months.

<end exerpts>

So to be completely honest with you, all the people who are filing legal suits against the military to be let out have pretty little to stand on.

There have been cases where the Navy has lost civil suits and refused to pay anyway; the USDOJ had to intervene. (I rather relish the thought of a U.S. Marshal bringing a Navy flag officer in front of a U.S. magistrate).

As interesting as that may be, when the matter eventually got to the supreme court, I think the US magistrate would find himself slapped down. Unless, of course, the naval officer was brought in for personal actions, not for actions he took while acting as a representative of the President of the United States (commissioned officer). Still, I'd be interested in links to those cases you talk about, where the Navy lost a civil suit and refused to pay.
 
RichL025 said:
Orbitsurg,

I'm sorry if you feel these are ad hominem attacks. I actually rewrote that sentence a few times trying to be more civil. I'm not trying to insult you, I'm trying to respectfully and tactfully point out that you have some rather.... civilian .... notions of how things work in the military. Such notions would, of course, cause you to be extremely dissatisfied when they conflict with how things are.



I'm not a lawyer, and have no formal legal training, but I have an avid (albeit amateur) interest in constitutional law.

As far as I remember, every case you have read about, and several similar ones that arose long before the second gulf war, hinge on one major principle that people keep forgetting about: under article 2 of the consitution, the president is commander-in-chief of the armed forces. The supreme court has interpreted this over the years as that he has broad powers when it comes to running the military, and due to the interest the country has in not diluting those powers, courts have historically deferred to the executive branch in running the military.

(Incidentally, I think this is the same rationale whereby discrimination against homosexuals is still allowed, and even heterosexual adultery is still a prosecutable offense)

Secondly, another question is: are the contracts even broken????? I went through my old files, and found one of my old contracts (SF form 4/2 dated May 1988). On the contract is a page entitled "Partial Statement of Existing Laws of the United States". Here are some pertinent exerpts:

9 (a) My enlistment is more than an employment agreement.

9 (c) In the event of war, my enlistment in the Armed Forces continues until six (6) months after the war ends, unless my enlistment is ended sooner by the President of the United States (note: don't know if legally, this means legal state of "War" as only congress can declare, or "war" as commonly defined by combat actions. I suspect the former, but again, I'm not a lawyer)

10 (d) - as a member of the ready reserve I may be required to perform active duty without my consent (note: anyone discharged from the military with less than 8 years service is in the ready reserve, until they reach the 8 year mark)

10 (d)(1.) In time of national emergency declared by the President of the United States, I may be ordered to active duty (other than for training) for not more than 24 consecutive months.

<end exerpts>

So to be completely honest with you, all the people who are filing legal suits against the military to be let out have pretty little to stand on.



As interesting as that may be, when the matter eventually got to the supreme court, I think the US magistrate would find himself slapped down. Unless, of course, the naval officer was brought in for personal actions, not for actions he took while acting as a representative of the President of the United States (commissioned officer). Still, I'd be interested in links to those cases you talk about, where the Navy lost a civil suit and refused to pay.

I wish I could give you the citiation; it got mentioned now and again when I was on active duty as an example of the Navy's contempt for civil procedure. The Navy paid; I don't think they had to serve a flag officer for contempt. As far as any issues between a U.S. federal judge and an admiral, that would pretty much be a closed book, I doubt that any admiral who didn't want to go out in a smoking blaze of glory would willingly show contempt for a federal court ruling. That would be a career-ender for sure.
 
Good article. I'm a bt confused by your caveat, did the article strike you as being negative or something?

The idea of bringing in neurosurgeons as civilians is a good one, but I have to admit I'm uneasy about extending it to (for example) _all_ neurosurgeons. I'm one of those that doesn't quite like the idea of the military relying so heavily on civilian contractors in a warzone - Landstuhl, no problem, but Balad is something different. Still this might be a good mechanism to help with the recruiting shortfalls.

And this is something that always amazes me..... one-third of all active duty physicians are in training! (And therefore non-deployable)
 
RichL025 said:
Good article. I'm a bt confused by your caveat, did the article strike you as being negative or something?

The idea of bringing in neurosurgeons as civilians is a good one, but I have to admit I'm uneasy about extending it to (for example) _all_ neurosurgeons. I'm one of those that doesn't quite like the idea of the military relying so heavily on civilian contractors in a warzone - Landstuhl, no problem, but Balad is something different. Still this might be a good mechanism to help with the recruiting shortfalls.

And this is something that always amazes me..... one-third of all active duty physicians are in training! (And therefore non-deployable)

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?
 
Notice that everyone is an MSC that is being quoted not a physician. I don't endorse type of program however..

With that said, I have met a couple of physicians who would want to do something like this.

One trauma fellow was considering joining the navy just to get exposure to the significant trauma cases that our surgeons are treating in Iraq.

Another civilian ortho specialist has more money than he knows what to do with was also discussing how he would like to volunteer his services to the military.
 
r90t said:
Notice that everyone is an MSC that is being quoted not a physician. I don't endorse type of program however..

With that said, I have met a couple of physicians who would want to do something like this.

One trauma fellow was considering joining the navy just to get exposure to the significant trauma cases that our surgeons are treating in Iraq.

Another civilian ortho specialist has more money than he knows what to do with was also discussing how he would like to volunteer his services to the military.

To have a visiting specialist at a military facility is fine. It is good for everyone-staff specialists, patients, residents. But this is different. This isn't having an eminent neurosurgeon come to scrub in and assist in treating patients alongside the regular staff; there is no regular staff.

Imagine the air ops boss saying that SAR will be done by the local Coast Guard during operational launches because there aren't enough helo pilots ready.
 
RichL025 said:
And this is something that always amazes me..... one-third of all active duty physicians are in training! (And therefore non-deployable)


as a primary ex-USAF doc; the "loss" incurred by the military by losing nearly all its primary care docs after their 1st term is tremendous and plays the biggest part as to why 33% of docs are in training. You have to have that many in training because so many leave every year.

A family doc with 4 years of training can do circles around a new military doc; not only in terms of general medical knowledge and confidence, but in knowing the military and military aspects of the job. A first term USAF doc goes to several classes/training programs and needs to be trained in CHCS II and other admin related aspects of the job. By the time they are proficient, they are already counting down the days to escape the "broken" overloaded, mismanaged military primary care system.

What a waste of training. Every family doc I worked with (8 docs total) at my last base had STRONG intentions to be a "lifer" as a clinical family doc in the USAF. How many stayed with that intention? ZERO!!!!!!!!!!!!!!!!!!!!!

One doc did stay but went admin. Another (with 10+ years in) is coming up to his DOS and will separate unless given the admin job of his choice.
 
r90t said:
Notice that everyone is an MSC that is being quoted not a physician. I don't endorse type of program however..

With that said, I have met a couple of physicians who would want to do something like this.

One trauma fellow was considering joining the navy just to get exposure to the significant trauma cases that our surgeons are treating in Iraq.
As a former Army medic, I would note that the military is a good place for both trauma physicians and orthopods looking to get experience. Most of your patients will be otherwise-healthy young adults who've been screened for congenital and preexisting problems prior to enlistment and who are usually in excellent physical condition and eager to recover quickly.
 
lrooff said:
As a former Army medic, I would note that the military is a good place for both trauma physicians and orthopods looking to get experience. Most of your patients will be otherwise-healthy young adults who've been screened for congenital and preexisting problems prior to enlistment and who are usually in excellent physical condition and eager to recover quickly.


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
 
Galo said:
Please note this is an Army specific instance. Most AF and likely Navy surgeons are not doing crap when it comes to trauma.
I probably should have noted that this was Army-specific. I would also add that the nicest duty I had in my ten years as a medic was the six months when I wound up attached to the Navy for duty. (Balboa Naval Hospital in San Diego, 26-2B for anyone who's been assigned there.) After Vietnam, Korea, Ft. Polk LA, etc., it was like a trip to paradise. The only negative about San Diego is that it takes a physician's income to live there, and they don't pay sergeants anywhere near that much... 🙂
 
another interesting article below.The mention of the temporary hire docs below, hits right on the mark, as our base went through about 10 physicians in just over 2 years.
Reading this memo just makes it all the more frustrating, because like so many other broken parts of the system, the SG admin should have been fully aware of what was going on, this memo pointed it out to them in back and white.

the best part of the article I copied below. the entire article email is at the end.



Other concerns are: • How will the remnants of the military medical departments be able to take care of troops involved in the various theaters of operations that are or will be involved in fighting the War on Terror? • Will urologist/general surgeons be reduced to treating routine situations on an active duty only population within the United States? • If so, how do can DOD interest them in remaining on active duty? Most retirees and their family members under the age of 65 join TRICARE-Prime to continue care in the military system. Forcing them out of military care denies them the care they want and doctors the full range of patients they need for their training and skills. • What about the retired Medical Corps officers that were lured to return as civilian doctors to staff MTFs?

Many in military medicine have been concerned for years about the eroding patient base. Closing TRICARE-Prime to retirees and their family members at the base level accelerates the erosion of the referral base to military medical centers where most of the specialized training takes place.

Funding shortfalls that are more than likely a reaction to a mid-term budget review and other DOD imposed restrictions that causes MTF commanders to cut off retirees from direct military medical care and that forces them to seek care in the civilian sector has the potential of harming the military medical departments.

We are also concerned about staffing MTFs with “temporary” hire physicians. After witnessing an ever changing medical program that has no job security, what kind of physician can be found to work in such an environment? Would they be the ones at the end of their careers that are anxious to leave at the first sign of trouble or a better job? Additional questions also arise concerning the time, money, and effort was used to secure contract physicians in the first place.

Not all retirees are old. Many are retiring at the 20-year point between the ages of 37-42. Others, many who are now patients at our military medical centers are being treated for wounds received in Iraq and other places, and will be placed on the retired list while they are in their very early 20’s or 30s. What reaction can we expect from these wounded troops after being told that if they stay in the military or are medically retired will be persona non grata in the direct care system at age 65?

Mr. Chairman, the overall goal of the National Association for Uniformed Services is a strong National Defense. We believe that comprehensive, lifelong medical and dental care for all Uniformed Service beneficiaries regardless of age, status or location furthers this goal. As evidenced by the recent changes in the military health care system locally none of these goals can be achieved without adequate funding, and without the people to work on, the skills that are so important to our military doctors could diminish.


http://appropriations.senate.gov/hearmarkups/record.cfm?id=221159
 
It really seems we're really preaching to deaf ears. I've been waiting to see if anybody had anything remotely sensible to refute this article. I thought I'd give it 48 hrs, but just could not wait any longer.

Is this not an obvious commentary on the state of decline of military medicine?? Where are the people who so vehemently defend it when we post our negative experiences?? Can you refute this criticism??

I guess its not all futile, as to date, I have been able to help 3-4 people see the other side enough to make them really think if the military is something they want to do. It does make me feel that this system will continue to recruit young doctors who are lied to and prayed upon because of poverty and patriotism into a system that will frustrate and embiter the majority of them.
 
Galo,

search my posts from dec 2003 forward....I've been at it for more than 2 years...
 
Galo said:
It really seems we're really preaching to deaf ears. I've been waiting to see if anybody had anything remotely sensible to refute this article. I thought I'd give it 48 hrs, but just could not wait any longer.....

You know, this is beginning to get a bit tiring. Nobody's doubting that military medicine has some big problems, we're just sceptical that it's fixin' to explode as you keep claiming.

Look, we like it when you post intersting information here, but this is beginning to get old. It's starting to seem like you have a martyr's complex... or maybe you just like being the "voice in the wilderness"*. If you just want to have conversations with yourself because you "just could not wait any longer" then I invite you to start a blog or something.
 
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