AVOID MILITARY MEDICINE if possible

[militarymd]

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You know, this is beginning to get a bit tiring. .

Why?

 

[USAFdoc]

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.

I, nor anybody else said it was going to "explode", if you want the details of what it will do, just read some of my other entries; things such as:

1) admin techs shredding and throwing away patient results, office notes...
2) close to ZERO % of family docs staying in the USAF as clinicians.
3) effective patient panel sizes increasing by 400% over the past few years.
4) PGUI and CHCSII sapping away the time available to see patients.
5) people with absolutely no experience being appointed supervisory roles over physicians; ignoring suggestions by physicians to improve safety and morale

RichLo125; IgD and others; look, I understand that you do not want to believe what myself and others have seen and experienced first hand. I am not saying that EVERY single aspect of military medicine is broken and by this time next year the whole system will be on the scrap heap. What I am saying is that in my years as a primary care doc in the USAF, in my EXTENSIVE search, research, discussions with DC, comrades at various bases, etc..there is a theme playing through about military medicine and it is generally BAD, and tragic, and ignored by the surgeon general.

One of the Colonels I personally spoke with face to face (who worked in the SG office) said the following when describing the SG:

"it was like the emperor with no clothes"

ie...the SG thinks he has this wonderful thing going on when EVERYONE around him knew he was stark naked (the plan is failing).

my last entry was just another PUBLIC example that at least some people in congress/positions of power are becoming aware and voicing the same concerns myself and other PHYSICIANS have been doing here for some time. Instead of ignoring what we say I would suggest you do the following; investigate it for yourself. If you plan on military medicine as your career, get involved, find out the truth, and don't look the other way and don't be a "yes-man" when you do find out the truth.

I hope for the best for our country and in particular, the health system and care of our troops and families. But by what I know, it is a failing plan and somebody needs to speak up and right the ship. 😡 😡

 

[RichL025]

Why?

Sorry, I should have been clearer. What's getting tiring is not criticism of the military, or the military medical system. What's getting tiring is the holier-than-thou attidtude with which some people condescend to the student doctors on this forum.

It reminds me of high school - there were always 2-3 "college guys" hanging out with us high school kids. They always bad-mouthed everything, telling us how much it was going to suck, how stupid the professors were, how they tried to indoctrinate you into their brand of political philosophy, etc etc.

We thought they were sooo cool - I mean, these dudes were college students, and we were a little bummed out by how much they despised it. We never thought to ask ourselves how come a bunch of college guys were hanging out with us lowly high school students 😉 At least, until we got to college ourselves and saw who, exactly, it was who always went to the younger kids to socialize with...

Look, if people want to post about their bad experiences with military medicine, that's fine. But when they make sweeping generalizations they could not POSSIBLY have the experience for (ie, a Navy psychiatrist making comments about army pathology), I'm gonna roll my eyes and toss in the bs flag. Espescially when those same people act like it is their personal mission (to hang out with us young 'uns) to preach to us, and then condescend with "what the heck do YOU know" if we point out the obvious inaccuracies.

If you'll go back through my posts (assuming you have nothing better to do 😉 ) you'll notice that I do not "spring to the defense" of military medicine every time someone posts criticism. Only with posts where it is obvious that the posters experience is getting.... "stretched".

Edit: That last part was edited for.... respectfulness & propriety

 

[USAFdoc]

Look, if people want to post about their bad experiences with military medicine, that's fine. But when they make sweeping generalizations they could not POSSIBLY have the experience for (ie, a Navy psychiatrist making comments about army pathology), I'm gonna roll my eyes and toss in the bs flag. Espescially when those same people act like it is their personal mission (to hang out with us young 'uns) to preach to us, and then condescend with "what the heck do YOU know" if we point out the obvious inaccuracies.

RichLo25
while you seem to be somewhat more "balanced" is your opinions of military medicine, it would be encouraging to see you get half as emotional/angry about some of the reckless and unprofessional aspects going on in military medicine as how angry you seem to get when someone oversteps and overgeneralizes in a memo they write.

if a USN psych critiques army path; heck, take it for whats it worth and see where it stands against other opinions and experiences.

I have for about 10 months now produced specific examples, first hand knowledge, and articles backing up nearly everything I claim is going on, yet STILL, many (not all for sure) seem to think things "just aren't that bad". It is that attitude that plays a key role on how military medicine, while not on the scrap heap, is certainly closer to that position than to that of excellence.

 

[RichL025]

Good points, I guess I get angry about things I can influence and/or control. I've always been good about letting things I can't control not bother me.

If I had a congressman in my back pocket, trust me, I'd be getting pretty fired up about alot of things and calling in my chips. Unfortunatly, I'm not wealthy, and the whole Abramoff thing has made it that much harder to buy congressmen these days....

Trust me, if/when I see examples like have been given (enlisted techs shredding patient's records, clinic commanders violating HIPAA for a personal vendetta) I WILL get angry, and I WILL do what I can to crush that person's n...... erm, well, let me be a little more politic here... I WILL do what I can to rectify the situation.

I was fortunate, in a way, in my previous career, that after 10+ years of being a faceless nug, I was put into a position where I could make some (admittedly rather small) changes in the way things worked in my unit. I didn't always do it gracefully, nor was I always effective in making those changes, but I had some outstanding mentors that instilled in me the belief that you _had_ to.

Geez, and was I just criticizing someone for being pompous? I hope the above didn't come out as that, what I was trying to say is that I hope I will bring the same attitude (in a hopefully positive way) to the inevitable problems I will see in the future.

Once again, I value posts like yours (and a few others) that are critical, yet not.... well, let's just say some examples (not from you) have bordered on incredible. And I don't mean incredible as in "wow", I mean it as in barely credible. And if posters THEN launch on to condemn everything around them, I'm going to take whatever they say with a grain of salt. A big one.

 

[Galo]

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.

You have become tiring. As I've said it before, you're blind allegiance and defence of a system I still think you have no real idea what its about will continue to propagate its mediocracy. I do not recall using the word "explode", my main post has repeatedly used the word "decline" quite different and something you should be able to grasp as an army guy. Our postings are for people who do not have a complete picture of where military medicine is today, and where we see it going. So if our posts piss you off, go off and explode somewhere else. If you have evidence to refute them, let it be known in an intelligent and professional fashion. If you are to be a leader, start acting like one! You keep saying you are going to pull out the BS flag, but I have yet to see you do it.

 

[USAFdoc]

Good points, I guess I get angry about things I can influence and/or control. I've always been good about letting things I can't control not bother me.

If I had a congressman in my back pocket, trust me, I'd be getting pretty fired up about alot of things and calling in my chips. Unfortunatly, I'm not wealthy, and the whole Abramoff thing has made it that much harder to buy congressmen these days....

Trust me, if/when I see examples like have been given (enlisted techs shredding patient's records, clinic commanders violating HIPAA for a personal vendetta) I WILL get angry, and I WILL do what I can to crush that person's n...... erm, well, let me be a little more politic here... I WILL do what I can to rectify the situation.

I was fortunate, in a way, in my previous career, that after 10+ years of being a faceless nug, I was put into a position where I could make some (admittedly rather small) changes in the way things worked in my unit. I didn't always do it gracefully, nor was I always effective in making those changes, but I had some outstanding mentors that instilled in me the belief that you _had_ to.

Geez, and was I just criticizing someone for being pompous? I hope the above didn't come out as that, what I was trying to say is that I hope I will bring the same attitude (in a hopefully positive way) to the inevitable problems I will see in the future.

Once again, I value posts like yours (and a few others) that are critical, yet not.... well, let's just say some examples (not from you) have bordered on incredible. And I don't mean incredible as in "wow", I mean it as in barely credible. And if posters THEN launch on to condemn everything around them, I'm going to take whatever they say with a grain of salt. A big one.

thank you for the response.
please realize that, many of the physicians on this site have gone through some extreme frustration (to put it mildly) and that being human, one should expect some anger at times in our threads. Many of us have very high standards and career goals that the current military system forced us to compromise and abandon. Being about a year out, I can better write a thread without including the "anger" tone. But realize, there is/was good reason for the creation of that tone in many of us.

 

[Homunculus]

You have become tiring. As I've said it before, you're blind allegiance and defence of a system I still think you have no real idea what its about will continue to propagate its mediocracy. I do not recall using the word "explode", my main post has repeatedly used the word "decline" quite different and something you should be able to grasp as an army guy. Our postings are for people who do not have a complete picture of where military medicine is today, and where we see it going. So if our posts piss you off, go off and explode somewhere else. If you have evidence to refute them, let it be known in an intelligent and professional fashion. If you are to be a leader, start acting like one! You keep saying you are going to pull out the BS flag, but I have yet to see you do it.

i throw the BS flag out on people in a different service in a different specialty who make blanket statements about my specialty and it gets me the "you aren't experienced enough" response. USAF's articles (most of them anyway) do a good job of illustrating military medicines shortcomings.

neither I nor Rich are disputing the validity of your (meaning the "con" crowd) experiences. military medicine has flaws. we know that. what we can't figure out is why some posters repeatedly declare the terrible state of military medicine and claim everyone who disagrees with then does so either because they "have a blind allegiance" or "don't know any better". i've been here long enough i often know how people are going to respond before they even reply, lol. we allow you to repeatedly post without claiming you're crazy and an abberration-- in fact if you search my posts you'll see that i think we need y'all around and that your experiences are valuable to everyone. please respect us enough to respect our opinions without dismissing us as naive ignorant sheep.

i know military medicine is mediocre. i know it can be better. i know that some specialties are doing a disservice to their trainees/attendings. i know deployments suck, and they are unequally distributed and that people find ways out of them and inadvertantly screw their buddy. yet i also know that some specialties do a great job, some people deploy and do so willingly and do a great job in spite of the system, and i know physicians who enjoy what they do and re-sign (gasp) after their obligation is complete. i also know that what happens to an air force surgeon in nebraska has almost no bearing on a staff pediatrician at WRAMC. i also know the vast majority of my patients are appreciative of the care they receive.

like i've said so many times before, we're all on the same team, and are after the same goal. we just have different views on how far that goal is away.

--your friendly neighborhood on-call caveman

 

[USAFGMODOC]

For those of us old guys who have been around in the military medical system (PRE-Tricare circa 1996 and before); we have seen the slow death of a once strong system. Granted, military medicine was not very cost effective pre-tricare, but our residencies and tertiary referral centers did almost everything a major medical center does today to include transplant medicine. Many great docs came out of military medicine backgrounds and sad to say, that is on the great decline now. This includes all services (USA, USAF, NAVY).

I think alot of USAFdoc (ex) and Galo's thoughts are a reflection of this. A military residency now, is not exactly what it used to be (at most places) in almost any specialty. If you are at BAMC or a major institution, it is still good, and don't get me wrong, I am happy to be going to Rads at Lackland this summer; but with BRAC coming there in 3-4 yrs, radiology will be also evolving for the USAF to either BAMC taking over or it could even disappear altogether in 6-8 years. Fortunately for Rads, telemedicine can still allow this to take place several years down the road, but the inpatient Peds, IM, Surgery at Lackland will wilt in the next few years to a shell of what it once was.

That being said, know that every medical institution (be it civilian or military) has it's problems. My patients I have to refer for surgery off base now (ie. acute appy seen in clinic) have to suffer thru civilian ER waits of 8-10 hours before even being seen by a surgeon and then the floor care is shotty due to lack of nursing staff-- so , everything should be looked at in perspective. It isn't "just" the military medicine that has it's problems.

I hope the military keeps their residencies, but only if they can give good training and have the patient base to graduate competent docs. I'm sure we all are in agreement on this matter.

 

[Galo]

i throw the BS flag out on people in a different service in a different specialty who make blanket statements about my specialty and it gets me the "you aren't experienced enough" response. USAF's articles (most of them anyway) do a good job of illustrating military medicines shortcomings.

Although I have made a generalized statement that there is a decline in military medicine, and it has been backed up by numerous articles posted by USAF and others, I have not made specific statements about your experience wherever you are. But I have and will continue to express my opinion based on experience and what is being dissiminated by people who are currently in the system and seeing how its failing, except oviously in your current experience


neither I nor Rich are disputing the validity of your (meaning the "con" crowd) experiences. military medicine has flaws. we know that. what we can't figure out is why some posters repeatedly declare the terrible state of military medicine and claim everyone who disagrees with then does so either because they "have a blind allegiance" or "don't know any better". i've been here long enough i often know how people are going to respond before they even reply, lol. we allow you to repeatedly post without claiming you're crazy and an abberration-- in fact if you search my posts you'll see that i think we need y'all around and that your experiences are valuable to everyone. please respect us enough to respect our opinions without dismissing us as naive ignorant sheep.

I used the words blind allegiance because it seemed that rich has been unable to express beleif in anything remotely negative about the system. I may have been too harsh. Sorry. I guess time will tell when you guys come up against something so enraging that maybe you will understand the nature of these negative posts. Also I have never called you or rich crazy, nor naive ignorant sheep.............



i know military medicine is mediocre. i know it can be better. i know that some specialties are doing a disservice to their trainees/attendings. i know deployments suck, and they are unequally distributed and that people find ways out of them and inadvertantly screw their buddy. yet i also know that some specialties do a great job, some people deploy and do so willingly and do a great job in spite of the system, and i know physicians who enjoy what they do and re-sign (gasp) after their obligation is complete. i also know that what happens to an air force surgeon in nebraska has almost no bearing on a staff pediatrician at WRAMC. i also know the vast majority of my patients are appreciative of the care they receive.

I'm glad to see you acknowledge some of the problems. As far as what happens in Nebraska affecting you, think of it like a cold. Its a virus that although may predominantely affect your respiratory tract, it will eventually have an effect on your whole body. Also, I certainly agree that the vast majority of our patients are extremely appreciative. Its one of the reasons that I was able to stand it for as long as I did.


like i've said so many times before, we're all on the same team, and are after the same goal. we just have different views on how far that goal is away.

True that.--

 

[Homunculus]

For those of us old guys who have been around in the military medical system (PRE-Tricare circa 1996 and before); we have seen the slow death of a once strong system. Granted, military medicine was not very cost effective pre-tricare, but our residencies and tertiary referral centers did almost everything a major medical center does today to include transplant medicine. Many great docs came out of military medicine backgrounds and sad to say, that is on the great decline now. This includes all services (USA, USAF, NAVY).

interesting point. i haven't seen "pre-TRICARE" so i don't know that it was like then-- but like you say if it was that much better the level of exasperation milmd, galo, USAF et al have would make sense. i haven't seen the "greatness" of military medicine-- i only know what i've seen now and how it compares to the civilian places i've been. it's like getting traded from one mediocre MLB team to another-- not too different, each with its own pros and cons. but from their point of view, it's like breaking up the yankee$ and getting traded to the devil rays or something-- a definite depressing career ender 🙂

this would also make sense why, before i took an ROTC scholarship for college (and was planning on medical school after that-- i was/am a long term planner type of person, lol) i spoke with some active duty army physicians and they loved it. no malpractice, plenty of work, good fellowships (and at the time) most of them had been in the same place 6+ years. sure, there was Korea, but at the time (96) we really didn't have anyone else on the block to worry about. TRICARE + War on Terror = bigass changes, lol

thanks for the post

--your friendly neighborhood missed out on "the glory days" caveman

 

[USAFGMODOC]

interesting point. i haven't seen "pre-TRICARE" so i don't know that it was like then-- but like you say if it was that much better the level of exasperation milmd, galo, USAF et al have would make sense. i haven't seen the "greatness" of military medicine-- i only know what i've seen now and how it compares to the civilian places i've been. it's like getting traded from one mediocre MLB team to another-- not too different, each with its own pros and cons. but from their point of view, it's like breaking up the yankee$ and getting traded to the devil rays or something-- a definite depressing career ender 🙂

this would also make sense why, before i took an ROTC scholarship for college (and was planning on medical school after that-- i was/am a long term planner type of person, lol) i spoke with some active duty army physicians and they loved it. no malpractice, plenty of work, good fellowships (and at the time) most of them had been in the same place 6+ years. sure, there was Korea, but at the time (96) we really didn't have anyone else on the block to worry about. TRICARE + War on Terror = bigass changes, lol

thanks for the post

--your friendly neighborhood missed out on "the glory days" caveman

I think you have a great way of looking at both "sides" of the story. I loved your analogy above (MLB stuff) and I think it is right on. Kudos to you and keep up the good work.

 

[Galo]

For those of us old guys who have been around in the military medical system (PRE-Tricare circa 1996 and before); we have seen the slow death of a once strong system. Granted, military medicine was not very cost effective pre-tricare, but our residencies and tertiary referral centers did almost everything a major medical center does today to include transplant medicine. Many great docs came out of military medicine backgrounds and sad to say, that is on the great decline now. This includes all services (USA, USAF, NAVY).

I think alot of USAFdoc (ex) and Galo's thoughts are a reflection of this. A military residency now, is not exactly what it used to be (at most places) in almost any specialty.


An excellent point I too experienced. When I first committed, I did understand there to be excellence in military medicine. Between the time I took my scholarship, and the time I started my payback, 12 yrs passed (2 college, 4 med school, 6 surgery training). I remember being at WH at 4:30 AM to start rounds in CT surgery, and not leaving till midnight as a student. It was a true 1500 bed major medical center where you would see stuff you only read about. But in that time, and since I started active duty it went from a major med center, to a 300 bed community hospital, with more administrators than physicians, to now a defunct shell on the BRAC list. The situations that caused this are multiple, and certainly TRICARE is at the top of the list, with other money woes, as part of the general decline that multiple people continue to paint here. Sad but true.

 

[USAFdoc]

interesting point. i haven't seen "pre-TRICARE" so i don't know that it was like then-- but like you say if it was that much better the level of exasperation milmd, galo, USAF et al have would make sense. i haven't seen the "greatness" of military medicine-- i only know what i've seen now and how it compares to the civilian places i've been. it's like getting traded from one mediocre MLB team to another-- not too different, each with its own pros and cons. but from their point of view, it's like breaking up the yankee$ and getting traded to the devil rays or something-- a definite depressing career ender 🙂

TRICARE has had huge effects on the quality of care because TRICARE is all about $$$$ and they do not have to answer at all to the physicians (military) providing that care. HUMANA has also been involved. One example that comes to mind is when they "fired" my civilian nurse because they wanted to hire a different nurse for less money. They not only did not even ask/tell me at all until it was done, they didn't even ask me if she was good (she was a good nurse), and they had no one ready to hire to take her place.


As far as the MLB analogy goes; it may have some merit in certain specialties, but as stated before in another thread, CIVILIAN Primary care, as bad as it is in some places, is way better than USAF Primary care, there is very little comparison. The USAF provided us with techs just out of high school, with little to no experience, with 10-40% chart availability, with a 40% rate of return of results when we referred patients, with a 20-50% manning rate, with novice nurses in full authority of docs, with constantly added admin duties and redundencies and a work day that started with PT at 0530 and getting home to the wife and kids 12-16 hrs later every day and working 95% of the weekends (at least 1 day). My current CIVILIAN job is WAY, WAY better than that and everyone teats each other with respect. It is a professional environment.

USAF primary care is a far cry from that; It is "sandlot" medical care.

 

[Pemberley]

(Why do you use the title USAF doc?) Do you try to hide your AF service when you talk to other physicians. You wouldn't use this horrible experience to further your career would you? If after everything you say, if you keep your service to your country off your resume, then I will respect you.

That's a little extreme, isn't it?

USAFdoc's advice to prospective medical recruits may make you sad, but it does NOT negate his honorable service to his country! Instead of making the disagreement personal, why not offer a different perspective: if you believe that it's worth spending 4 years in, serving the country and caring for the best patients in the world, even if you can't "change the Air Force" (and I'm convinced that an officer in a non-rated career field has a very small chance in this Air Force) then say that!

It became clear to me as a mid-grade captain that I had three options
(1) become a self-centered careerist, thereby becoming part of the problem
(2) fail to achieve further promotion, thereby preventing myself from being part of the solution
(3) get out.

BUT, I had some marvelous learning experiences as a lt and jr captain, served for a time in Baghdad, and would recommend 4 years to anybody.

Honorable people can reach different conclusions, and give different advice, based on similar experiences. No need to insult each other.

 

[USAFdoc]

talk about extreme attitudes; check out the "RANT" below from this "wonderful" ARMY doc.

Originally Posted by DocNusum

Unless it's a specialty clinic... in civilian "professional medical clinics," PAs and NPs DO have their own patient panels. I've had up to a 986 patients on my panel that only seen the MD if I was unsure about something... or I was out of the office. The key to this working well is the mid-level MUST know their limitations (be able to admit when they don't know something!) and the MD/DO MUST be accessible.

What you describe is the utilization of Mid-levels in sub-specialty medicine. If you hired a FP, IM, EM or Derm Mid-level and utilized the above practice model... you would essentially be paying for a expensive $70k/year medical assistant. Mid-levels PRACTICE MEDICINE... not assisting.

NEW PAs should no more be watched than New GMOs... (considering that they are both recent Barbara Bates initiates... and 80% of MILITARY FP is well checks and routine care of the common ills of man... NOT the Zebras that consume that extra special "doctor" brainpower! )

Hell... during peace time... MOST of the patients seen in Military Medical Clinics are Healthy 17-35 year olds... which is why Military Surgeons have such a hard time.

Dude You don't know **** about me...
YOU couldn't hack the soft ass airforce... got shown the door... whilst carrying a "god complex' all the while... now you work for some sorry assed HMO... being pushed to see a patient every 12 1/2 minutes... knowing that you WILL NEVER be a partner demonstrates your problem.

You joined the Military for money... and probably whined the entire time they were paying off your loans...

Grow up... ditch the sense of entitlement... we ALL know how to take care of people... I have several pieces of paper on my wall that says "Licence to practice Medicine also." I own my practice... and have 2 MD independent contractors that I pay 20% each for "supervision." Previously I worked for a 3 MD IM group... each MD "supervised" 2 PAs... each of the 9 Providers seen ~ 20 patients/day in office (does not include Stress testing, Hospital, SNF, Dementia Care Facilities)... I regularly billed >$400k/year... of course... my pay was < $70k/yr + bennies.

for whatever reason, this guy gets pretty emotional as do many of us previously active duty. It would be a little more productive if you directed his energies at the military "politicians" making the decisons than at the other docs who also want the healthcare system markedly improved.

ex-USAFdoc[/COLOR]

 

[DocNusum]

Dude... You conveniently forgot to post YOUR inital personal attack...!!!

AND the part where I continually tried to redirect YOUR obvious disdain for the Armed Services... into a constructive solution so that WE can get our men and women in uniform... in harms way... the healthcare they need and deserve at the Battalion aid station level.

You continued with YOUR poisonous agenda... but offered NO solution for the guy... in the sand... with a hot 7.62 in his chest.

What is truely sad is that you feel the need/duty to troll this section and "inform" everyone about how bad our AF handles medicine.

Dude... let it go... You got your loans paid for a 3 year "lack of commitment"... get on with your life... it is not your job to dissuade any and all potential medical care that our servicemembers may get!


YOU ARE NOT A PROPHET...!!!!

DocNusum

 

[USAFdoc]

Dude... You conveniently forgot to post YOUR inital personal attack...!!!

DocNusum

what personal attack?; at the end of reading all your entries, the one that stated 80% of military FPs are spent doing well exams etc was ridiculous (hense the clueless term). Your well versed tirade on how utterly despicable I must be (you gave quite a list) predated anything I said of you. I know absolutely nothing about you except you have little idea what is going on in a USAF primary care clinic. You, despite what you think, obviously know nothing about me.

 

[DocNusum]

Sorry for the "spillage" guys...

DocNusum

 

[USAFdoc]

Dude... You conveniently forgot to post YOUR inital personal attack...!!!

AND the part where I continually tried to redirect YOUR obvious disdain for the Armed Services... into a constructive solution so that WE can get our men and women in uniform... in harms way... the healthcare they need and deserve at the Battalion aid station level.

You continued with YOUR poisonous agenda... but offered NO solution for the guy... in the sand... with a hot 7.62 in his chest.

What is truely sad is that you feel the need/duty to troll this section and "inform" everyone about how bad our AF handles medicine.

Dude... let it go... You got your loans paid for a 3 year "lack of commitment"... get on with your life... it is not your job to dissuade any and all potential medical care that our servicemembers may get!


YOU ARE NOT A PROPHET...!!!!

DocNusum

I spent 3 years trying to improve the situation; wrote several articles/memos with 15 pages of solutions; spoke with congress, the inspector general, the pentagon etc................all agree with what I had wrote...yet by the time by DOS arrived, things were worse than ever (manning, patient care, admin, etc),....

At this point, I will continue to offer solutions to congress and put pressure on the SG to improve the situation for the patients and staff. This forum may be a small way, but a way nontheless, to do the same.

I am no prophet, but I can describe well what reckelessness was/is going on in the militaryhealthcare world because I was there.

My agenda is that the USAF stop ignoring the degradation of its healthcare system.[/B] You may call it whatever you want. I hope to inspire others in the system to fight the system (and not turn and look the other way) when conditions are reckless, substandard, and unfit for what the USAF says it stands for...excellence, integrity, and service before self (and in the case of TRICARE...$$$$$$).

 

[USAFdoc]

You continued with YOUR poisonous agenda... but offered NO solution for the guy... in the sand... with a hot 7.62 in his chest.

What is truely sad is that you feel the need/duty to troll this section and "inform" everyone about how bad our AF handles medicine.

DocNusum

Actually, what IS TRULY SAD is the state of USAF primary care and its treatment of patients and staff, not how you or I "feel" about certain threads on this site, or my leaving the USAF because of the substandard quality of the healthcare system. I have gone into significant depth and detail in other threads but to name a few details:
1) repeatedly seeing troops at their retirement physical and in reviewing the chart seeing 20+ years of severe documented hypertention and not a single mention of being OFFERRED treatment.
2) reapeatedly finding abnormal labs results in the CHCS computer system that the patients (and the chart) have no idea about and are not in the chart, simply "lost in limbo". Many factors play a role in this, with a complete lack of continuity and lack of chart availability being the prime reasons (in my opinion).
3) Administrations comlpete focus on money and metrics to the complete exclusion of safety and morale. Certainly "M&Ms" must be addressed but should never outweigh or comprimise safety.
4) The complete exclusion (by design) of physicians from any discussion and decision making on the operation of the clinics. I cannot overemphasize this point as I beleieve many physicians would have not left the USAF if they believed they had some measure of control to make a difference and improve the system. After years of being ignored and seeing continued degradation, those with the highest standards will leave, as all have done (I still know of no clinician CONUS-wide) that has stayed (unless to leave clinical med and go admin).

As for solutions; there are many. Manning the clinics with at least something close to the minimum needed would be basic. Retaining physicians would exponentially improve clinics. Designing the system to give physicians/providers some measure of input (while holding them accountable for certian productivity measurments). Safeguard systems to track abnormal labs and test results. An adequate support staff to enable clinicians to compete "numbers wise" with our civilian counterparts if that is what the USAF wants to do. As a physician, I don't mind doing everything myself (and while in the USAF I did check patients in, do vitals etc because of lack of staff), but to think that a military doc will have the same productivity as a civilian well supported HMO doc when the military doc has no support staff, no chart, little to no specialist support and numerous "military only" duties is setting th system up for failure. And guess what, it IS FAILING.

 

[USAFdoc]

a thread below discussing the most important criteria/characteristics for those family docs that STAYED in the military/ARMY. Although from several years ago, I do agree with the assertion. I would note that in recent years I have seen many docs (including myself) separate from USAF Family Medicine that are prior service, 10+ years already served, and even USUHS grads intent on leaving because of the current system. My point being that no matter what the USAF does they would likely lose many docs, but now they are losing those most likely to stay. That leaves nobody left.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7816225&dopt=Abstract

 

[USAFdoc]

BELOW DESCRIPTION OF THE KIND OF POOR CARE I WITNESSED FREQUENTLY DURING MY OWN USAF PRIMARY CARE CAREER. NOT TO SAY THAT THIS TYPE OF POOR CARE DOESN'T EVER HAPPEN IN THE CIVILIAN WORLD, BUT IT IS UNFORTUNATELY COMMONPLACE IN THE USAF.

http://www.gazette.com/display.php?id=1313891&secid=1

 

[island doc]

BELOW DESCRIPTION OF THE KIND OF POOR CARE I WITNESSED FREQUENTLY DURING MY OWN USAF PRIMARY CARE CAREER. NOT TO SAY THAT THIS TYPE OF POOR CARE DOESN'T EVER HAPPEN IN THE CIVILIAN WORLD, BUT IT IS UNFORTUNATELY COMMONPLACE IN THE USAF.

http://www.gazette.com/display.php?id=1313891&secid=1

Just goes to show why the Federal Tort Claims Act should be repealed.

 

[Homunculus]

Just goes to show why the Federal Tort Claims Act should be repealed.

i agree. even being on the side that benefits (at least financially, as we can still get names in the national practitioner data bank), i don't understand the reasoning of not letting active duty members have the right to sue over negligent medical care. spouses and dependents can sue the system, why can't we? 😕

-your friendly neighborhood looking out for #1 caveman

 

[USAFdoc]

i agree. even being on the side that benefits (at least financially, as we can still get names in the national practitioner data bank), i don't understand the reasoning of not letting active duty members have the right to sue over negligent medical care. spouses and dependents can sue the system, why can't we? 😕

-your friendly neighborhood looking out for #1 caveman

although it is not a "good" answer, the answer is because "we" are government property. They own us and can pretty much do with us as they please. And as stated in earlier threads, it appears they also own our medical license. Admin was doing things that absolutely 100% of the physicians were against, things that placed patients at risk unnecessarily(in fact I just got called in to speak about a civilian court case pending against our military clinic). While in the civilian world, HMOs and hospital admin can certainly pressure a doc to practice a certain way, the doc ALWAYS has the option to say NO, and leave if admin insists. In the military, ADMIN has absolute power and has proven itself to be absolutely inefficient, unsafe, and failing itself, the physicians and most importantly, the patients.

 

[USAFdoc]

FYI: recent article on military physician recruitment problems:

US military struggles to recruit medical professionals
Goal missed for scholarship applications
By Bryan Bender, Globe Staff | October 20, 2005

WASHINGTON -- The Pentagon, already straining to fill the ranks, is facing a new headache: Army medical officials said yesterday they are struggling to recruit enough doctors, dentists, nurses, and other healthcare professionals to treat soldiers on the front lines and to care for the growing physical and mental health needs of troops returning from combat.

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Sign up for: Globe Headlines e-mail | Breaking News Alerts For the first time in five years, the Army has missed its goal for student applicants seeking medical or dental scholarships in exchange for military service, officials told a House armed services subcommittee. The Army is also falling short of personnel in some key medical specialties, including cardiology, officials said. Meanwhile, unable to compete with the private sector in pay and compensation, the Air Force is also struggling to retain physicians and recruit new specialists.

Major General Joseph G. Webb, the deputy surgeon general of the Army, told lawmakers that ''for the first time since 2000, we did not meet our goal for health professionals scholarship applicants in the Medical and Dental Corps."

He said the scholarships, in which the government pays for medical training in return for a commitment to serve on active duty, are the ''bedrock" of Army medicine. ''We rely on these scholarship programs because direct recruitment of fully qualified physicians, dentists, and nurses is difficult due to the extremely competitive civilian market for these skills," he said.

Webb added that officials have undertaken a new assessment to determine the causes for the drop-off, but it's too early to tell if ''it is just a blip or the beginning of a new trend."

Still, officials told lawmakers the slide in recruiting and retention is occurring when the need to provide battlefield medicine and treat soldiers for a wide variety of physical and mental ailments is at its highest in recent years.

It is ''a mission that, perhaps, has never before been so complex, challenging, or far-reaching as we find today," Dr. William Winkenwerder, the assistant secretary of defense for health affairs, said of the military's medical responsibilities.

The Army, which is shouldering most of the combat burden in Iraq, is particularly concerned. ''One area of concern is a shortage of cardiologists and some surgical specialties," said Army spokesman Paul Boyce. But the concerns extend beyond the Army.

The Air Force Medical Service ''continues to face significant challenges in the recruitment and retention of physicians, dentists, and nurses; the people whom we depend on to provide care for our beneficiaries," Lieutenant General George Peach Taylor, the Air Force surgeon general, told the House Armed Service's Committee's personnel panel.

He cited several contributing factors: The military pays significantly less than the private sector, the quality of life in uniform is more stressful, and in some cases the working conditions in military hospitals and clinics need significant improvements. ''The atmosphere in which our medics work is as important as any other retention factor," according to Taylor.

 

[RichL025]

although it is not a "good" answer, the answer is because "we" are government property. They own us and can pretty much do with us as they please....

Actually, it has nothing to do with decisions the military has made, but a quite different branch of the federal government.... google "Feres Doctrine" and complain about the supreme court for a switch 😉

Here's a quote from a lawyers web site (biased obviously, but still informative)

Congress has been requested many times to amend the statute to provide for liability, but has always refused to do so. Meanwhile, by case law developed in the lower federal courts, the Federal Tort Claims Act has been interpreted to allow federal prisoners to sue the United States for medical malpractice in prison hospitals. Thus it is that our country accords greater right to common criminals than it does to members of its armed forces.

 

[USAFdoc]

Actually, it has nothing to do with decisions the military has made, but a quite different branch of the federal government.... google "Feres Doctrine" and complain about the supreme court for a switch 😉

Here's a quote from a lawyers web site (biased obviously, but still informative)

I agree....put another way, the supreme court has agreed that "they own us".

 

[USAFdoc]

below; memo addressing the fact that the military is working towards "civilianizing" many of the positions previously held by military medical personnel. In my experience, this plan "backfired" as the USAF hired many civilian physicians, fully empanelled them with thousands of patients, and when the civilian physicians quit (USAF Primary Care clinic conditions so bad that NOBODY stayed) the remaining military docs were left "holding the bag" on the added thousands of patients. At my last base, 8 of 9 civilian physicians quit/left, many within months of starting.

http://www.usmedicine.com/article.cfm?articleID=695&issueID=52

 

[USAFdoc]

below is a link to the USAFP web site. This is a pretty reasonable "pulse" of what is going on within the military as far a Family Medicine. Realize this is a military web site so it is slanted pro-mil, but the military authors are much more honest and upfront about the problems than a recruiter (or an IgD).

Once you get to the site, go to the newsletter pages.

http://www.usafp.org/

 

[Sarg's kid]

I know I'm not a doctor yet. I'm just a know-nothing premed student, yadda yadda. I grew up in the military healthcare system. I was a tricare baby, and spent my whole life seeing military doctors at military clinics. Some of them were fantastic. They went above and beyond to make sure that they gave top notch care.
There were also others who "couldn't pour piss out of a boot with instructions written on the heel." They were snide, pushy, and inattentive. They hated their job, it was obvious, and they were just punching in and doing their time. I have read sooo many posts on this forum without saying anything, but I'm kind of sick of all the negative talk. Yeah, there are aspects of Military medicine that suck. I'm not going to presume to say that's not the case. I think, however, that this forum often degenerates into military bashing. I worked in an ER, and the civilian docs never quit complaining about admin, and paperwork, and everything else that people complain about here. The grass isn't greener, it's just on the other side.
I guess my point is 1) all jobs have aspects that are unpleasant. I think you would be hard pressed to find anyone in the world who doesn't think that there are things that could be improved about their situation, both military and civilian. and 2) this entire forum seems geared toward talking people out of military medicine entirely. I understand that it is vital to get a counter-perspective to the recruiters, but there’s got to be a happy medium. If you succeed at talking all of the competent, caring professionals out of choosing HPSP, then you’re simply insuring that the next generation of military doctors will be sub-par.
The reasons that I want to be a military physician are simple: Loyalty, Duty, Respect, Selfless Service, Honor, Integrity, and Personal Courage. I guess you'll say that my enthusiasm is due to lack of experience, and that's your prerogative, but it would be unfortunate if everyone who read this and was thinking of joining the military chose not to simply because the system isn't perfect.

 

[FliteSurgn]

it would be unfortunate if everyone who read this and was thinking of joining the military chose not to simply because the system isn't perfect.

I don't think anyone really expects perfection, but I do think that everyone expects an attitude that promotes quality healthcare. The military just doesn't have that. To say that the grass isn't greener, it's just on the other side is ridiculous. There are several posters that have been on both sides and there is one recurring theme...the grass is greener on the other side. I've had a commitment to the military since 1989 and I will count myself lucky this summer when I'm on the other side as well.

The real goal that we all share is providing information to the unsuspecting pre-med student that has had a bunch of sunshine pumped up their rear by the recruiter. If everyone went in with their eyes wide open and knew what to expect then they may not be so disgruntled when they find out how badly the system sucks. And if by passing along this knowledge we discourage a few people from accepting HPSP "scholarships" then maybe the military will have to open their eyes as well. Because if the supply of naive new doctors were to disappear, the military may actually have to HONESTLY look into what has happened to the Medical Corps. Then, and only then, may they decide to improve things.

 

[Sarg's kid]

The real goal that we all share is providing information to the unsuspecting pre-med student that has had a bunch of sunshine pumped up their rear by the recruiter. If everyone went in with their eyes wide open and knew what to expect then they may not be so disgruntled when they find out how badly the system sucks. And if by passing along this knowledge we discourage a few people from accepting HPSP "scholarships" then maybe the military will have to open their eyes as well. Because if the supply of naive new doctors were to disappear, the military may actually have to HONESTLY look into what has happened to the Medical Corps. Then, and only then, may they decide to improve things.

I agree whole heartedly. My dad's a retired MSGT, so I've known recruiters were full of it since I was old enough to walk. People need to know both sides, it's just a little discouraging to read nothing but negative points. There are those of us out there who have our eyes wide open, and are still planning to join up. There's no shame in that. It would just be nice if, amid all of the warnings there was a comment on something positive that you took away from your time in the military. The essence of military service is sacrifice. People forget that. They focus on getting as much money as they can and getting out, but it really is about sacrifice. For your country and for your fellow soldiers. Frankly, I don't ever want to be wounded and have some doc standing over me that is only there to get his student loans paid off.
So, if you want the cons of military medicine, then you've found the right forum. If you want the pros email a recruiter. If you want the truth, look somewhere in the middle.

 

[USAFdoc]

I know I'm not a doctor yet. I'm just a know-nothing premed student, yadda yadda. I grew up in the military healthcare system. I was a tricare baby, and spent my whole life seeing military doctors at military clinics. Some of them were fantastic. They went above and beyond to make sure that they gave top notch care.
There were also others who "couldn't pour piss out of a boot with instructions written on the heel." They were snide, pushy, and inattentive. They hated their job, it was obvious, and they were just punching in and doing their time. I have read sooo many posts on this forum without saying anything, but I'm kind of sick of all the negative talk. Yeah, there are aspects of Military medicine that suck. I'm not going to presume to say that's not the case. I think, however, that this forum often degenerates into military bashing. I worked in an ER, and the civilian docs never quit complaining about admin, and paperwork, and everything else that people complain about here. The grass isn't greener, it's just on the other side.
I guess my point is 1) all jobs have aspects that are unpleasant. I think you would be hard pressed to find anyone in the world who doesn't think that there are things that could be improved about their situation, both military and civilian. and 2) this entire forum seems geared toward talking people out of military medicine entirely. I understand that it is vital to get a counter-perspective to the recruiters, but there’s got to be a happy medium. If you succeed at talking all of the competent, caring professionals out of choosing HPSP, then you’re simply insuring that the next generation of military doctors will be sub-par.
The reasons that I want to be a military physician are simple: Loyalty, Duty, Respect, Selfless Service, Honor, Integrity, and Personal Courage. I guess you'll say that my enthusiasm is due to lack of experience, and that's your prerogative, but it would be unfortunate if everyone who read this and was thinking of joining the military chose not to simply because the system isn't perfect.

you have the right idea and reasons to join the military, whether physician or otherwise. Those are exectly why I joined, first as an enlisted after high school, and returning as a doctor after med school and residency.

As I said, those were the resons I joined. Many of my entries describe why I left, why many, many docs are leaving.

I heard the statement "you can't expect perfection" from others regarding my concerns about FP med in the USAF. Expecting to have the chart (50-80% of the time I saw patients with no chart), expecting to have a staff (many times we were running on a staff of 7-8 people out of 30 people supposed to be there), expecting results to be in the chart (we had a 20 foot high of lab/referral results never filed), expecting to be at least brought into the discussion on how to fix problems and at least not ignored when all the physicians have concerns about patient care etc....and the list could go on. It is not like we were asking for a new leather couch in our office etc. These are BASIC things needed to provide safe and timely care and not burnout your staff. Basic things that I have in my practice now (even though I am salaried). And not that civilian practice is perfect, but at least in is in the ballpark, whereas, military med (USAF FP at least) was/is a sad broken counterfeit of good medicine and a sad lie in terms of USAF core values.

 

[FliteSurgn]

If you want the truth, look somewhere in the middle.

I would say that if you want the truth talk to someone who has been there and done it. There are several of us on here. We all speak the truth. We all say about the same thing. Believe it or not.

 

[NavyDMO]

You quote yourself, over and over again. I would like to actually see more than just two or three people complain. You are a vocal minority. I have personally seen the primary care doctors at the VA and other Military hospitals, and I know for a fact that you are lying. And if you are going to be constantly complaining about the hours you work, than maybe medicine wasn't your true intention. People also shouldn't go into military medicine soley on the fact that their medical education is/or will be paid for.
I give you a thumbs down USAFdoc.

You asked so here is another reason to avoid military medicine. I did a transitional year and spend a huge chunk of it doing paperwork.....LimDu, Medivacs, Conleave......ect..ect A glorified socail woker at best. At the end of internship we are forced to apply for our unrestricted medical license, if not we don't recieve our GMO bonus.

My next stop was a clinic where for weeks at a time I was the only medical officer with the entire clinic under my license. I had NO back-up. I was required to practice at the level of a family practice attending as well as the occasional ER case. It was not fair to me or the patients. The patients didn't know the difference. I was always worried I was going to hurt someone as I was in over my head.

This is a common situation Navy Docs find themselves in.

 

[USAFdoc]

You asked so here is another reason to avoid military medicine. I did a transitional year and spend a huge chunk of it doing paperwork.....LimDu, Medivacs, Conleave......ect..ect A glorified socail woker at best. At the end of internship we are forced to apply for our unrestricted medical license, if not we don't recieve our GMO bonus.

My next stop was a clinic where for weeks at a time I was the only medical officer with the entire clinic under my license. I had NO back-up. I was required to practice at the level of a family practice attending as well as the occasional ER case. It was not fair to me or the patients. The patients didn't know the difference. I was always worried I was going to hurt someone as I was in over my head.

This is a common situation Navy Docs find themselves in.

all you can do is the best you can. in the end you did a great service for your country, even though one could argue that the Navy did not do a great service for you or the patients. your expereince is mirrored throught the military medicine world and one can only hope and pray that things change for the better. It is frustrating because there are many good docs that would join and stay to serve our troops and their families if only the military provided at least something close to the standard of care.

 

[island doc]

You asked so here is another reason to avoid military medicine. I did a transitional year and spend a huge chunk of it doing paperwork.....LimDu, Medivacs, Conleave......ect..ect A glorified socail woker at best. At the end of internship we are forced to apply for our unrestricted medical license, if not we don't recieve our GMO bonus.

My next stop was a clinic where for weeks at a time I was the only medical officer with the entire clinic under my license. I had NO back-up. I was required to practice at the level of a family practice attending as well as the occasional ER case. It was not fair to me or the patients. The patients didn't know the difference. I was always worried I was going to hurt someone as I was in over my head.

This is a common situation Navy Docs find themselves in.

With that particular background, it's a wonder you didn't kill anyone, and it is NOT your fault. With the military making such dumb decisions as this, it's a wonder also that our nation wins any wars.

 

[bobbyseal]

With that particular background, it's a wonder you didn't kill anyone, and it is NOT your fault. With the military making such dumb decisions as this, it's a wonder also that our nation wins any wars.

Yeah,

I know of a guy who was a flight surgeon. He finished his intern year and had to spend a couple months working at his local base's ER or urgent care center before going off to flight school. Literally, one day he is having all of his patients seen by staff and the next day, he is the staff. Kind of ridiculous.

 

[USAFdoc]

some more physician responses from the past years from a site called U.S. Medicine.

Again, the overwhelming PHYSICIAN take on military medicine is very negative. For the residents and medical students out there, just realize that there are problems and do what you can to fix them, but it is an uphill climb, and you will experience "friendly fire" along the way.

http://www.usmedicine.com/article.cfm?articleID=61&issueID=16

 

[USAFdoc]

Latest journal of USAFP (military branch of the AAFP) for Family docs.

Spring Issue; interesting reading for those in or interested in Family medicine in the military. Of note that USAF FP manning now down to 75% on paper (much less than that in reality).

http://www.usafp.org/Word_PDF_Files/2006-Spring-Newsletter.pdf

 

[USAFdoc]

interesting article describing the phasing out of military physicians (which I did see during my career as half of the clinic physicians were civilianized at one point), and also some mmention of phasing out physician special pay (which I did NOT see, although, the local clinic commander did threaten more than one physician as far as not giving the bonus pay).

http://www.usmedicine.com/article.cfm?articleID=695&issueID=52

also; another thread refers to me and others as "anti-recruiters". This may have some truth in it, but I believe I am "anti-BAD medicine" and "anti-BAD management" more than anything. I hope we someday have the kind of healthcare system that lives up to our many military promises and creeds, but the current system is not even close.

 

[DeepCowboy]

interesting article describing the phasing out of military physicians (which I did see during my career as half of the clinic physicians were civilianized at one point), and also some mmention of phasing out physician special pay (which I did NOT see, although, the local clinic commander did threaten more than one physician as far as not giving the bonus pay).

http://www.usmedicine.com/article.cfm?articleID=695&issueID=52

also; another thread refers to me and others as "anti-recruiters". This may have some truth in it, but I believe I am "anti-BAD medicine" and "anti-BAD management" more than anything. I hope we someday have the kind of healthcare system that lives up to our many military promises and creeds, but the current system is not even close.

That article is three years old!!

 

[USAFdoc]

That article is three years old!!

and still relevant!!!

and by the way, whats up with some of you thinking that if the article wasn't published yesterday (or last month) that there is some problem? Do you think that there is somebody out there publishing articles on military medicine on a daily basis? If there is, I'd post em!

 

[NavyFP]

Well, I certainly have seen a lot of negative attitudes expressed in this string. Can't say it is all without basis, but I believe it is heavily weighted by perspective. Yes, many clinics are understaffed. Yes, the current climate is to maximize production with less than the desired tools. Yes, deployments are up. All in all, I still believe the military has a lot to offer. I have been there and done that. I am going on 12 years of active service, I am currently at my 6th duty station, I have deployed 3 times, completed an unaccompanied tour and I still love being in the Navy (most days).

I have had the pleasure of working with some absolutely fabulous people, I have visited 8 (soon to be 9) countries.

I believe military medicine has an awful lot to offer prospective docs. Our training programs are excellent, our pass rates for boards are above the national average for all specialties. Yes there is the GMO tour, but once again the Navy is actively pursuing reducing those numbers. We made a significant cut 5 years ago and that trend is continuing. On the flip side that means more board certified docs will be deploying in GMO roles. The army is doing a lot of that with its pediatricians. Additionally we have a large contingent of docs who are looking to come back after deciding the grass on the outside was not necessarily greener.

In the end, your time in the service will be what you make it. If you want to be miserable you will be. There will be bad duty stations, there will be bad bosses, there will be bad situations. Making changes in the system is a game, and if you work the rules to your advantage, it is possible to affect change.

Many of my friends are deciding it is time to get out. Most for family reasons. But most still reflect positively on their time in the service. Military service is a calling. None should enter it because they just want med school paid for. You can do things in the military you could never do as a civilian. You can travel. You can learn to fly. All cool things. But there is a cost. One must decide where the balance is.

 

[Galo]

Well, I certainly have seen a lot of negative attitudes expressed in this string. Can't say it is all without basis, but I believe it is heavily weighted by perspective. Yes, many clinics are understaffed. Yes, the current climate is to maximize production with less than the desired tools. Yes, deployments are up. All in all, I still believe the military has a lot to offer. I have been there and done that. I am going on 12 years of active service, I am currently at my 6th duty station, I have deployed 3 times, completed an unaccompanied tour and I still love being in the Navy (most days).

I have had the pleasure of working with some absolutely fabulous people, I have visited 8 (soon to be 9) countries.

I believe military medicine has an awful lot to offer prospective docs. Our training programs are excellent, our pass rates for boards are above the national average for all specialties. Yes there is the GMO tour, but once again the Navy is actively pursuing reducing those numbers. We made a significant cut 5 years ago and that trend is continuing. On the flip side that means more board certified docs will be deploying in GMO roles. The army is doing a lot of that with its pediatricians. Additionally we have a large contingent of docs who are looking to come back after deciding the grass on the outside was not necessarily greener.

In the end, your time in the service will be what you make it. If you want to be miserable you will be. There will be bad duty stations, there will be bad bosses, there will be bad situations. Making changes in the system is a game, and if you work the rules to your advantage, it is possible to affect change.

Many of my friends are deciding it is time to get out. Most for family reasons. But most still reflect positively on their time in the service. Military service is a calling. None should enter it because they just want med school paid for. You can do things in the military you could never do as a civilian. You can travel. You can learn to fly. All cool things. But there is a cost. One must decide where the balance is.

You certainly said some nice things, and have some very important observations. Certainly I think military service should be a calling. Also it should never be a money issue. Unfortunately the vast majority of young people that get roped in have no idea what they are getting into, and are usually lied to intentionally or not by recruiters that really are not that well informed, or just do not care. A forum like this is a perfect place for people to begin to have skepticism, and hopefully learn what they will be facing.

Although board pass rates may be higher, ( I have not seen that data), certainly GME is along with the rest of military medicine in the throes of a great decline.

I somewhat disagree that the military has "an awful lot to offer prospective docs." Certainly in medical terms, that lot is increasingly shrinking for subspecialists, while exploding without support for primary care, neither a good position to be in. As far a military things, there is some "cool" stuff to do, but people have to realize much like you said, that there is a COST. That cost in my view, is loss of freedom to choose not only where you live, but sometimes what you do, and when you do it. You loose civil rights that you are fighting to protect. You will undoubtedly meet great people, but also some real low lifes that will make your life miserable without retribution.

On your comment about people coming back in after being civilian, in general that throws a HUGE RED FLAG. Most physicians who are competent and work hard will invariably have a better life on the outside. Of course there may be exceptions, but they would be a great minority.

In all, the military is not a great option for physicians today, I'd say it sucks!!

Galo

 

[323232.geo]

TRICARE has had huge effects on the quality of care because TRICARE is all about $$$$ and they do not have to answer at all to the physicians (military) providing that care.

CIVILIAN Primary care, as bad as it is in some places, is way better than USAF Primary care, USAF primary care is a far cry from that; It is "sandlot" medical care.

As a Navy FP who is about to join the ranks of the civilian world in a few weeks, I couldn't agree more. I was very committed at the beginning of my Navy career, thinking I would be a "lifer." But like many of the people posting here, my ideas for improvements and discussions of problems like the ones above became so irritating to the non-medical administrators that I was effectively told to "shut up and take it." A real eye opener was when I went to interview for my new civilian practice. I asked them what percent of the time a record was not available for the visit. They looked at me like I was stupid- "100%, of course. You don't get records for all of your visits?" Even more telling was the support staff. At my current clinic, we have 1 nurse and 4 techs staffing 6 providers. I had to work some way out so that we all could get our patients in rooms, as there was always a traffic jam in the vital signs area and it is still common to have patients put into a waiting, empty room 15mins after their appointment time, making me late. My new practice? 3 per provider- 9 staff supporting the 3 FP's. Both of my new partners have panels in excess of 3000 patients that they can see <3 days after they call for an appointment (with traditional access style!), and get home within 1 hour of finishing patient care, with all charts completed and all phone calls made.

So, for any prospective med students thinking of HPSP or loan forgiveness- even if you don't get shot at in Iraq, Iran, Africa, Indonesia, or any other of the places to which providers are getting increasingly deployed, in an unpredictable, random way, you will still have to deal with administrators who don't know what you do, don't know how you do it, and, in general (speaking from 6 different Army, Navy, and Air Force duty stations I have either directly experienced or had a close friend experience) don't care what you do- (as long as you don't kill anyone). Military medicine is a great deal. Worth >$100K, excellent full service FP residency training (with full inpatient and ICU training- this I have observed and benefitted from at both Navy and Army FP residencies), good pay and benefits.
p.s.- at my current duty station, 100% of providers who had paid off their committment got out as soon as they could- 5/5 providers, and the other 3 (all with 2-4 yrs committment to go) have stated their intent to get out ASAP.

 

[Galo]

As a Navy FP who is about to join the ranks of the civilian world in a few weeks, I couldn't agree more. I was very committed at the beginning of my Navy career, thinking I would be a "lifer." But like many of the people posting here, my ideas for improvements and discussions of problems like the ones above became so irritating to the non-medical administrators that I was effectively told to "shut up and take it." A real eye opener was when I went to interview for my new civilian practice. I asked them what percent of the time a record was not available for the visit. They looked at me like I was stupid- "100%, of course. You don't get records for all of your visits?" Even more telling was the support staff. At my current clinic, we have 1 nurse and 4 techs staffing 6 providers. I had to work some way out so that we all could get our patients in rooms, as there was always a traffic jam in the vital signs area and it is still common to have patients put into a waiting, empty room 15mins after their appointment time, making me late. My new practice? 3 per provider- 9 staff supporting the 3 FP's. Both of my new partners have panels in excess of 3000 patients that they can see <3 days after they call for an appointment (with traditional access style!), and get home within 1 hour of finishing patient care, with all charts completed and all phone calls made.

So, for any prospective med students thinking of HPSP or loan forgiveness- even if you don't get shot at in Iraq, Iran, Africa, Indonesia, or any other of the places to which providers are getting increasingly deployed, in an unpredictable, random way, you will still have to deal with administrators who don't know what you do, don't know how you do it, and, in general (speaking from 6 different Army, Navy, and Air Force duty stations I have either directly experienced or had a close friend experience) don't care what you do- (as long as you don't kill anyone). Military medicine is a great deal. Worth >$100K, excellent full service FP residency training (with full inpatient and ICU training- this I have observed and benefitted from at both Navy and Army FP residencies), good pay and benefits.
p.s.- at my current duty station, 100% of providers who had paid off their committment got out as soon as they could- 5/5 providers, and the other 3 (all with 2-4 yrs committment to go) have stated their intent to get out ASAP.

Yet another attending echoing what those with experience have lived. Where is it that there is still people wanting to go and experience this????

 

[USAFdoc]

the link below discusses the serious problems involving the military's failed and flailing attempt to implement EMR. Rememeber, the military has spent BILLIONS of tax dollars to come up with this failing version of an EMR, and not only did we pay the BILLIONS, now the doctors and patients are paying the price trying to work within such a bad system. below is a quote; below that is the LINK. Again, think twice before you volunteer to join. Serving the country is great, you may just want to find another way to do it other that HPSP etc.

Rollout of AHLTA, the Defense Department’s electronic medical record-keeping system, has reduced patient access to many military outpatient clinics and has lengthened workdays for many doctors, say physicians and system administrators.

Dr. Michael Nelson, a civilian staff pediatrician at Naval Medical Center San Diego, said that instead of four patients an hour he now only can see three because AHLTA is so slow to accept data.

"It takes on average two to four times more time to document in AHLTA than it did when we used paper," Nelson said. "For a simple visit like pink eye, patient time can take as little as three to four minutes to diagnose and explain to parents. On a good day [it] takes another three to four minutes to document in the computer."

Because of appointment backlogs, Nelson said, many parents are bringing children to the medical center’s emergency room for care.

"We are so far behind…we officially no longer have routine checkups for infants and toddlers, or annual checkups for older children. This goes against many national healthcare guidelines," Nelson said.

http://www.military.com/features/0,15240,93457,00.html