AVOID MILITARY MEDICINE if possible

[USAFdoc]

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one of the other treads' mention of "more with less" reminded me of this recent USAF memo on the continued drastic manning cuts headed down on the USAF.

pay attention especially to the next to last paragraph and the promise that this is not just another "do more with less exercise".

This is not to say that the USAF has a monopoly on the idea to slam its "employees" with drastic reductions in manning and increases in work load. This is to say that when you are the doctor working for a "company" like that (and the USAF and its evil cousin, TRICARE, are much more in line with a company in medicine than a "military service"), then you best be ready to bend over because it is in their short term best interests to underman you, to ignore you, to refuse you CME etc.......and no matter how reckless the whole thing becomes, you are stuck for several years at least.

TO THE MEN AND WOMEN OF AFMC

I am sure you have all heard about the significant personnel reductions
facing our Air Force. In this e-mail, I want to talk about these
reductions¦but first, I need to set the stage by discussing the
environment we serve in today.

The Strategic Environment¦


The most important fact to remember is we are at war, we have been at
war for a long time, and by most estimates we will continue to be at war
for several years to come. This war presently costs the Department of
Defense $318M a day to fight, a large commitment of resources by any
measure, but it's a commitment that we must make and a fight we must
win. While our focus must be on winning the Global War on Terror we
still have to ensure we are prepared to win the next war. To add to our
challenge, we operate in an ever more fiscally constrained environment.
Defense budgets are shrinking while the cost of doing business is
rising. Additionally, we are fighting this war with equipment that is
older than we have ever had in the Air Force. If left to run its course,
the combination of fighting the GWOT (global war on terror), shrinking
budgets, and aging aircraft could result in the perfect storm and
leave us unable to win the next war;an option that is simply not
acceptable.


The Department of Defense recognized this danger and directed the Air
Force to cut approximately 57,500 people and use the savings generated
to recapitalize our aging fleet. In addition to reducing people, the
Air Force has plans to retire some of our oldest and most
expensive-to-maintain weapon systems. We have also started on a journey of continuous
process improvement through our AFSO21 efforts. Taken together, the
retirement of weapon systems, the reduction of personnel end strength,
and AFSO21 efforts will generate the capital needed to ensure our Air
Force remains the most dominant in the world.

What this means to AFMC¦


Within the context of that strategic environment, AFMC is projected to
cut approximately 3,200 military, 1,150 civilian, and 1,700 IMA
positions over the next four years. The vast majority of the military and
civilian personnel reductions will happen in FY07.

On the military side, the FY07 Force Shaping message has been released
and includes force reduction measures such as a force shaping board,
voluntary separation pay, and selective early retirement boards for
targeted members. Our implementation of the civilian reductions is
currently being finalized and by the end of this month we will have identified
almost 1,100 civilian positions that will come off the books in FY07.
We are doing everything possible to avoid non-voluntary reductions to
include using programs such as VERA/VSIP. These programs will be
available to employees soon and you will receive more information on these
programs from your Center leadership in the near future.

Let me assure you that I and your Commanders/Directors are working very
hard to make sure we are taking these cuts in such a way as to minimize
the risk to our mission accomplishment. But let me stress that this is
not an exercise in doing more with less...your Senior AF leadership is
committed to the fact that we must do less with less. These cuts
don't just make our Air Force smaller and leaner, they make us a different
Air Force, and in the long term, a better Air Force. I can't promise
you it will be easy, but I can promise you that I will walk this tough
road right beside you.

In the months ahead I will resume my Commander's Log communication with
you and share my vision for the future of our Command. Thank you for
your continued service to our great Nation.

Bruce

 

[resxn]

[/U]your Senior AF leadership is
committed to the fact that we must do less with less.
[/B]

Right. 👍

Also, I know this Prince in Nigeria who needs you to invest $10k in this oil field, and as a partner, he's guaranteed a 300% return in 3 months. Just send a check made out to "Resxn" and I'll get you in on it.

 

[USAFdoc]

Right. 👍

Also, I know this Prince in Nigeria who needs you to invest $10k in this oil field, and as a partner, he's guaranteed a 300% return in 3 months. Just send a check made out to "Resxn" and I'll get you in on it.

Hey, talk with that Prince guy from Nigeria. With a change of citizenship, maybe he's interested in the soon to be vacant USAF SG job?

 

[USAFdoc]

several months ago it was suggested that I change the thread name of this thread to AVOID USAF FAMILY MEDICINE if possible................this was because I speak mainly from my experience in the USAF Primary care field. There has since been quite a number of other physicians from various fields and services that give good reason not to change the name of this thread.

 

[MedicalCorpse]

several months ago it was suggested that I change the thread name of this thread to AVOID USAF FAMILY MEDICINE if possible................this was because I speak mainly from my experience in the USAF Primary care field. There has since been quite a number of other physicians from various fields and services that give good reason not to change the name of this thread.

Hear, hear!

--
Rob
Ex-LtCol, USAF, MC
Ex-USAF Anesthesiologist

 

[USAFdoc]

Hear, hear!

here's a little quote from another top echilon USAF Commander discussing how important it is to retain docs. Reading this is like hearing Gene Simmons of the band KISS telling somebody how important celibacy is.

Many (including myself) went into HPSP either planning on a career in the military (me), or at least giving it strong consideration. Six months after you arrive on your first duty station (sometimes sooner) you are telling yourself "what in the world was I thinking?"

This is just more "lip service" from the Armed Service".


Chief of Medical Corps





Brig. Gen. (Dr.) David Young III



By Steve Pivnick
81st Medical Group Public Affairs

KEESLER AIR FORCE BASE, Miss. (AETCNS) -- Brig. Gen. (Dr.) David Young III, commander of the 81st Medical Group, has been appointed chief of the Air Force Medical Corps by Lt. Gen. (Dr.) George Taylor Jr., Air Force surgeon general.

In this role he's responsible for making recommendations about retention and professional development for the service's 3,500 physicians.

General Young is also the surgeon general's representative on the Graduate Medical Education Forecast Board that determines who the medical corps trains for specific specialties and locations.

"Physician retention in the Air Force is a very serious issue," General Young said. "While the quality of physicians is extremely high, we need to do a better job of making them think of making Air Force medicine a career rather than leaving the service after their initial commitments."

He noted the Army and Navy have had flag officers leading their respective medical corps for some time. He said General Taylor felt the Air Force needed a flag officer to lead the medical corps, in addition to the current staff already handling medical corps issues at Bolling Air Force Base, D.C.

General Young, who also serves as lead agent for the Department of Defense Health Services Region IV, said for the first time the Department of Defense has tri-service medical corps leaders.

The Air Force surgeon general also has flag officers leading the nursing and dental corps who provide him with advice on issues specific to those areas.

 

[resxn]

"Physician retention in the Air Force is a very serious issue," General Young said. "While the quality of physicians is extremely high, we need to do a better job of making them think of making Air Force medicine a career rather than leaving the service after their initial commitments."

Maybe he should just make us "think" that the system is worth while.

To quote a recently enshrined cliche, "If you build it, they will come." Or rather if you fix it, they will stay.

I'd be willing to bet that over 50% of those who get out the split second their commitment ends would stay if those physicians were treated as assets and not as liabilities. And if the core values actually applied to more than flying an airplane--I would've when I first came on AD, but now I've been to jaded to even consider it regardless of whether they make leaping reformations even while I remain AD.

 

[USAFdoc]

Maybe he should just make us "think" that the system is worth while.

To quote a recently enshrined cliche, "If you build it, they will come." Or rather if you fix it, they will stay.

I'd be willing to bet that over 50% of those who get out the split second their commitment ends would stay if those physicians were treated as assets and not as liabilities. And if the core values actually applied to more than flying an airplane--I would've when I first came on AD, but now I've been to jaded to even consider it regardless of whether they make leaping reformations even while I remain AD.

You have it exactly right. Interesting, with my current CIVILIAN FP position, the hospital has approached me asking "what can they do to ensure that I stay". Working about 60% as hard as I did in the USAF, I am already the second most productive FP doc in the hospital system, in my first year. The USAF wouldn't even ask that kind of "question"..................because they could care less, and even if some Commander did care, he or she would be powerless to implemement the changes needed to at least make a USAF FP clinic even reasonably safe, manned, managed etc.

Leaping reformations would be wonderful, but more likely is continued changes for the worst, deception, false advertising to med students, false advertising by the SGs to congress, Priorities of Metrics and Promotion, the Trampling of USAF Core Values and continued substandard care for our troops and their families. 👎 👎 👎

 

[USAFGMODOC]

I posted this awhile back, last year I was approached by an IG inspector (off the record-- so he said) to attempt to get a more objective reason as to why more USAF docs don't stay-- well, in 16 years of active duty this was the 1st and only time I was ever asked that question. This O-6 heard my 45 minute answer with multiple examples of how docs are "crazy" to stay in a system that doesn't even attempt to take care of them or the patients. I gave examples of the crappy metrics, poor technician care/manning, poor clinic manning, having nurses "run" the clinic when they have absolutely no idea what they are doing and not to mention all of the ridiculous non-medical tasks they throw in to make it even more frustrating! Add AHLTA (b/c we just started it 2 weeks before he showed up) and I told him straight up I don't blame any physician for leaving... If I were not prior service, I'd have likely been gone as well.

Why do I stay, sometimes I can see some small steps forward and I try to make positive changes for whatever clinic and staff around me to make it better-- but it is only a drop in the bucket... Needless to say, I don't think any of my comments ever got back to the AFMS higher ups-- I'm sure that O-6 got way more than he ever bargained for-- but it felt good to give an honest perspective with no punitive measures for speaking the truth!

 

[USAFdoc]

If I were not prior service, I'd have likely been gone as well.
QUOTE]

I was prior service (6 years enlisted), but still that was not enough for me to stomach what the USAF was cookin'.

The upper echilons DO KNOW WHAT IS GOING ON, which makes the continued slide into the toilet all the more troubling.

 

[USAFdoc]

I was prior service (6 years enlisted), but still that was not enough for me to stomach what the USAF was cookin'.

The upper echilons DO KNOW WHAT IS GOING ON, which makes the continued slide into the toilet all the more troubling.

To those entering the USAF physician "meat-grinder",..............................Do your time, then wash off the slime, work somewhere else to make your dime; civilian medicine has its problems, but militatry medicine, ..........now thats a crime.

😍


I know, better keep my day job.

 

[Ex-44E3A]

Nobody here need apologize for bringing problems in military medicine to light. Why?

Q: What's the standard to which we're held when proposing treatments, procedures, or important medical decisions to patients?

A: Informed consent.

Informed consent means advising your patient of the risks, benefits, and alternatives to a certain course of action. Armed with that information, a patient can make the most appropriate decision for their situation. How can a young med stud make an informed decision about undertaking a military medical career without a serious consideration of the risks/benefits of said decision? We do this every single day for our patients... how can we do less for our young colleagues?

And for you young bucks who have already signed the paperwork and are in the pipeline, pay close attention to the ex-military guys here. You will run into many situations where you will have unpleasant choices to make... you'll be caught between the needs of your patient and the needs of the command chain. You may be given unlawful or dangerous orders. You may be asked to sign off on things that are absolute madness.

I encourage you to stand your ground, don't be intimidated, and always do the right thing for the patient. However, keep in mind that there is danger involved and risk to your status/career/leave/must-move status/etc when you rock the boat in your command chain. Doing so is very much equivalent to walking on ice... what we're trying to do is provide some guidance on how to walk where the ice is thick.

I'm a newbie to this forum, and I found this place on my own... nobody asked me to come here. Also, lest you think there's some sort of monolithic stereotype of a bitter, disgruntled ex-military doc, there's plenty I don't share with some of the other posters here... eg. medicalcorpse. Just from reading his website, I can tell you that he and I are on opposite ends of many issues, but I have to say that his criticisms of military medicine and accounts of various incidents ring true, because I encountered similar incidents while on active duty.

Pay attention, students and residents. It is at your own peril that you'd dismiss the former military docs on this forum as bitter losers that simply couldn't hack the military life.

Just my $.02. Carry on.

 

[Galo]

Informed consent: Very nice comparison. Clearly you speak from experience, so be ready to be thought of as having some personal problem by some of our more dysfunctional, unexperienced trolls.

Welcome to the forum, and thank you for helping let people know what they are getting themselves into before they sign.

Though I have mentioned it before, despite the gloom, many of the people who have been roped into this can learn from our experiences as to what to avoid, and how to fight some battles. But the most important lesson, is to never forget you are a physician first, and an officer a distant second.

 

[Ex-44E3A]

Thanks for the props, Galo.

My family has a strong tradition of military service (I think that out of my nine male uncles and cousins, 7 of us have served or are serving). Patriotism is a strong motivator for me... and even after separating (which I couldn't wait to do), I really agonized over the idea of resigning my commission. Service can be its own reward, and putting yourself on the line for others is a noble thing to do. Everyone has their own personal priorities, and if the satisfaction of service is enough of a motivator for people to suck up the other problems with military medicine, then good on them... but I punched out.

Don't get me wrong here; my military experience wasn't all bad, and I don't want to give that impression. I deployed to the desert multiple times, got to do some VERY interesting things, and meet/support some people who I would never have encountered otherwise. The rub is that without people with sufficient patriotism or a strong enough ethic of service (like most physicians), the military would be in even deeper trouble than it is.

I don't necessarily think of myself as an anti-recruiter, but I think recruiters give an incomplete picture of what military medicine is, and new military docs are understandably shell-shocked when they step into their role. That nagging feeling that you were lied to, misled, or hoodwinked is the very foundation of the resulting distrust, cynicism, and anger that peppers so many of the threads in this forum.

You only have to encounter so many situations where things end up not-as-advertised, people reneg, high-ranking officers pull RHIP moves, or you get otherwise stepped on before you start distrusting your entire command structure. It got so bad that I would demand people sign hand receipts for important paperwork that I was turning in, because they would flat-out lose so many things, and then claim they "never got it" (and I would then have to spend days redoing it). It's ludicrous that you should have to go that far to get a little accountability.

Here's one for the general cynicism file: I remember being on active duty when the GWOT was spinning up, and when they instituted stop-loss (and a bunch of generals immediately exempted themselves and retired), that really created anger in the enlisted and company/field-grade officer ranks. Ever wonder why there's distrust, and scorn directed towards the our leadership? Look no further than policies like this... extremely corrosive for morale.

More money isn't the answer when you can't even trust that it'll be provided as promised (the late ISP bonus this year is a prime example).

Disillusionment is the first brick in the edifice of the AF's retention problem. Having a realistic view of what you'll be facing will help to cushion the blow; forwarned is forearmed. If people elect not to join up after a frank and open discussion of the risk/benefit ratio, then it's clear what the AF needs to do if they want to continue to recruit qualified and dedicated physicians: offer more incentives or change their system. Criminey... simply applying a bit of that "customer service" orientation that they love so much to some of their internal processes (and then actually implementing the resultant recommendations) would work wonders.

In any case, I think it's incumbent upon us to be truth-tellers; up-front and honest about the entire enterprise. I say again, how could we do less for our colleagues than we do for our patients?

 

[MedicalCorpse]

Nobody here need apologize for bringing problems in military medicine to light. Why?

Q: What's the standard to which we're held when proposing treatments, procedures, or important medical decisions to patients?

A: Informed consent.

Informed consent means advising your patient of the risks, benefits, and alternatives to a certain course of action. Armed with that information, a patient can make the most appropriate decision for their situation. How can a young med stud make an informed decision about undertaking a military medical career without a serious consideration of the risks/benefits of said decision?

Welcome to the forum! I am a relative newbie here myself (hard to believe I've only been here a little over a month, huh guys?). Pull up a chair and set a spell (cracking open virtual cool one).

This is one of the most cogent explications of the benefits of "negative" posts I have seen. May I have your permission to quote you in my book (if I ever get around to finishing it)? This concept is foreign to military recruiters: their modus operandi is to lure people into the military by any means necessary, including especially exaggerating and distorting such crucial facts as residency probabilities, flight surgery flight infrequency, and the ever-popular Nurse Commander Blues. Only bad and unethical doctors fail to disclose the risks and alternatives of procedures to patients; and the medical malpractice system is there to hammer those who fail to provide appropriate informed consent for risky procedures. Sadly, there is no military malpractice system for recruiters or others who give false information to kids eager to serve their country.

Which is yet another reason so many of us current and former military attendings have gravitated here...

--
R

 

[Ex-44E3A]

MedicalCorpse,

Thanks for the warm welcome.... if you want to use any of that, please be my guest.


Addendum:

Don't know why this didn't come to me earlier, but this brings a quote to mind. I have no idea who said it, but I think it's applicable here:

"Beware of he who would deny you access to information, for in his heart he dreams himself your master"

 

[USAFdoc]

QUOTE]

below memo discussing recruiting shortfalls in the military. Notice how the USAF seems to at least be doing better than the other services in attracting at least a bare minimum number of HPSP students. Note that on this site numerous physicians have experienced just how poor the USAF military healthcare system is. My take on all of this is that as of the time this memo was written, the USAF propaganda machine was better at giving a completely false picture of what life as a USAF physician is like. I know I had no clue (as it turned out) about just how poor of a healthcare system the USAF had.

http://www.ama-assn.org/amednews/site/free/prl20828.htm

Military doctor recruiting takes wartime hit
A sharp decline in medical students accepting Army and Navy scholarships sparks a new recruiting campaign.
By Myrle Croasdale, AMNews staff. Aug. 28, 2006.


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Concerned about racking up hundreds of thousands of dollars in debt, Erik Olson, a first-year student at the University of Nevada School of Medicine in Reno, responded to a Navy recruiter's e-mail offering a chance to apply for a scholarship that would pay for his tuition, books, lab fees and medical supplies, as well as give him a stipend of about $1,300 a month.

He received the scholarship, and by accepting it, he has agreed to serve in the Navy one year for each year that the military helps pay for his education.

With this article

Fewer military physicians
How it's going
"Being able to not have to worry about money during school and coming out of school debt free" was the deal-maker for Olson. He said the chance that he could end up deployed into a war zone, like Iraq, wasn't an issue for him.

Olson, though, is among a shrinking pool of medical students choosing to pay for school with the help of the military's Health Professions Scholarship Program. In 2005, the Navy, which also supplies doctors to the Marine Corps, achieved just 56% of its goal to give scholarships to 291 medical students. The Army reached 77% of its goal, falling 70 medical students shy of its target.

Military officials say HPSP is responsible for recruiting 80% to 90% of the physicians in the Army and Navy, and continued low numbers could create a serious shortage of physicians within these military branches. In addition, HPSP graduates, along with graduates from the Uniformed Services University of the Health Sciences, supply the bulk of the medical military's leadership.

To try to turn around these figures, Army and Navy officials said they have ramped up medical student recruitment efforts, something neither branch had done much of before.

"It sold itself," said Col. Bernard DeKoning, MD, the Army's assistant surgeon general for force projection. "There was little competition [from other scholarships] and no war. Now we are in a very challenging situation. We realize we need to make an effort to attract students into the Army."

Cmdr. David McLean, MD, Navy Medical Corps, director of medical department accessions, said the global war on terrorism certainly plays a role in why fewer medical students are applying for the HPSP, a program established in 1972 during the Vietnam War and a year before the draft ended.

But, he said, several other factors also are at work: Students today are more willing to graduate with debt. There are more scholarship and loan programs for medical students to tap. And an all-volunteer military means that students are less likely to have a parent in the armed forces -- a connection that often makes a child more likely to join.

Recruitment efforts
Beyond e-mailing medical students, for the first time Army and Navy representatives are visiting campuses. Each branch has set up speakers' bureaus through which active military physicians go to campuses to speak. Dr. DeKoning has been among those to meet with students.

"The best way [to attract more students] is to have practicing Army physicians going out and speaking with premedical and medical students, talking about what it's like to be a doctor in the Army, telling the story in their own words -- that generates interest in the students," he said.

Olson, having heard a physician from the Army speak about the HPSP during his orientation week, agreed.

"I had already applied by then to the Navy," Olson said, "but I did find it helpful. He talked about how the Army's deployment works, where he has got to travel, and what it's like if you stay after your payback time."

In addition, the Defense Dept. has a package before the Senate that aims to improve physician recruitment among medical students, medical residents and practicing physicians. The military is asking Congress to:

Double the stipend for HPSP scholars, bringing the total to $30,000 annually.
Triple the stipend for medical residents who are part of the military's scholarship program aimed toward them, the Financial Assistance Program, from $15,000 a year to $45,000.
Offer to help offset the military's lower salaries with a signing bonus of up to $400,000 for practicing physicians in war-critical specialties, such as maxillofacial, thoracic and orthopedic surgery, if they agree to serve at least four years.
Meanwhile, the Air Force has seen its HPSP numbers stay at or above recruitment targets.

Col. Arnyce Pock, MD, Air Force Medical Corps director, attributed this to its deployment schedule. The Air Force gives its members a window of time when they will be deployed if a deployment occurs.

"One of the things the Air Force has worked hard on is to instill predictability," she said. "We have predictable rotations, and they are limited to 120 days, so people can plan to some degree."

Cynthia Smith with the Defense Dept. press office said the Pentagon had no plans to create a physician draft.

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ADDITIONAL INFORMATION:
Fewer military physicians
In 2005, the Army and Navy awarded fewer scholarships for medical school than planned. Students taking the financial assistance are the main source of military doctors, and the groups have stepped up recruitment efforts this year. Here's a look at the numbers.

2003 2004 2005
Air Force
Scholarships awarded 225 213 220
Goal 201 211 191
Percent of goal 112% 101% 115%
Army
Scholarships awarded 319 294 237
Goal 284 300 307
Percent of goal 111% 98% 77%
Navy
Scholarships awarded 289 232 162
Goal 290 265 291
Percent of goal 99% 88% 56%

Source: U.S. Army, Navy and Air Force Health Professions Scholarship Program offices

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How it's going
After declines in previous years, the Army and Navy are actively recruiting medical students for the Health Professions Scholarship Program. This is the status of program awards as of June 30:

Air Force: Goal is 191 scholarships; 191 awarded.

Army: Goal is 295 scholarships; 179 awarded.

Navy: Goal is 300 scholarships; 80 awarded.

Source: U.S. Army, Navy and Air Force Health Professions Scholarship Program offices

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Copyright 2006 American Medical Association. All rights reserved.

 

[siinew]

My thanks to USAFDoc and others on this thread. I have introduced myself on other threads, so I apologize for any repetition, but I'm a prior service enlisted Army (Interrogator the first time in, Special Forces Medic the second) with about 11 years total military service.

I was seriously considering an HPSP scholarship over the few years it took me to get all my premed stuff done while working fulltime, supporting my family, wondering how in the hell we were going to be able to afford med school even though my kids are about grown now (I'm 42). At first, I was really excited about the idea of going back into the Army. I have been a programmer for about the past 11 years, and sometimes miss some of the more "exciting" aspects of the military, esp. when compared to being a cubicle slave, as I have had to do at various points in my IT career.

Anyway, long story longer... I have been accepted into my 1st choice target school (San Antonio, yay!), and have realized, over the course of applying, interviewing, being accepted at various schools and deciding which school's offer I wanted to take, that there is just no way I am going to give the Army any more years of my life. With my prior service, even at my age I could have had the time in service/grade to receive the HPSP scholarship and go back in, but (especially after getting into one of the most reasonably priced med schools in the country), there is just no way I want to "sell myself off" for that cheap. Even if it were a lot more tuition money, I just don't think it would be worth it. Additionally, my political opinions have changed drastically from what they once were, so there are those reasons as well.

Sorry to blab on, but this thread has helped assure me that I actually am making the right decision by staying a civilian doctor. I'm not sure yet what specialty I'll go into... could be IM, could be PM&R, could even be general (trauma) surgery. At any rate, it feels good to know that I'll be doing it on my own. In fact, I think (speaking from my own personal experience) that joining the military at a young age, right out of HS, kind of creates an almost pathological dependency on that military lifestyle. It was very hard for me to adjust to civilian life, and right after getting my degree, the only thing I could imagine myself doing was going back in. I think raising my family and making a career in the civilian world (I co-owned my own small software company, among other things) probably helped me realize that I don't need the military as a crutch any more. Besides... everything that is supposed to be "fun" they have already taken the enjoyment out of for me: Backpacking, Skydiving, Scuba Diving, Camping... why add medicine to that list? Just kidding, sort of. 🙂

Thanks again for such informative posts and glimpses into military medicine from insiders.

 

[MedicalCorpse]

My thanks to USAFDoc and others on this thread. I have introduced myself on other threads, so I apologize for any repetition, but I'm a prior service enlisted Army (Interrogator the first time in, Special Forces Medic the second) with about 11 years total military service.

I was seriously considering an HPSP scholarship over the few years it took me to get all my premed stuff done while working fulltime, supporting my family, wondering how in the hell we were going to be able to afford med school even though my kids are about grown now (I'm 42). At first, I was really excited about the idea of going back into the Army. I have been a programmer for about the past 11 years, and sometimes miss some of the more "exciting" aspects of the military, esp. when compared to being a cubicle slave, as I have had to do at various points in my IT career.

Anyway, long story longer... I have been accepted into my 1st choice target school (San Antonio, yay!), and have realized, over the course of applying, interviewing, being accepted at various schools and deciding which school's offer I wanted to take, that there is just no way I am going to give the Army any more years of my life. With my prior service, even at my age I could have had the time in service/grade to receive the HPSP scholarship and go back in, but (especially after getting into one of the most reasonably priced med schools in the country), there is just no way I want to "sell myself off" for that cheap. Even if it were a lot more tuition money, I just don't think it would be worth it. Additionally, my political opinions have changed drastically from what they once were, so there are those reasons as well.

Sorry to blab on, but this thread has helped assure me that I actually am making the right decision by staying a civilian doctor. I'm not sure yet what specialty I'll go into... could be IM, could be PM&R, could even be general (trauma) surgery. At any rate, it feels good to know that I'll be doing it on my own. In fact, I think (speaking from my own personal experience) that joining the military at a young age, right out of HS, kind of creates an almost pathological dependency on that military lifestyle. It was very hard for me to adjust to civilian life, and right after getting my degree, the only thing I could imagine myself doing was going back in. I think raising my family and making a career in the civilian world (I co-owned my own small software company, among other things) probably helped me realize that I don't need the military as a crutch any more. Besides... everything that is supposed to be "fun" they have already taken the enjoyment out of for me: Backpacking, Skydiving, Scuba Diving, Camping... why add medicine to that list? Just kidding, sort of. 🙂

Thanks again for such informative posts and glimpses into military medicine from insiders.

It is because of people like you, your wives, and your kids, that I continue to post the Truth about military medicine here. I wish you only the best in your medical career.

Thank you very much for your excellent post,

Rob, former member of IEEE Computer Society and ACM
http://www.notbob.com/wlani

--
R

 

[7by11thenout]

I am going to quit posting the truth here because We are running everyone off from Mil Med. I need people to join so I dont get bit by Stop Loss🙂 🙂

 

[Ex-44E3A]

I need people to join so I dont get bit by Stop Loss

Ah, naked self-interest... I wondered when you'd show up

 

[MedicalCorpse]

I need people to join so I dont get bit by Stop Loss

Ah, naked self-interest... I wondered when you'd show up

Um, QA + Naked self-interest = I need a cold shower.

http://www.medicalcorpse.com/gallery/quality ass.jpg

--
R

 

[USAFdoc]

Um, QA + Naked self-interest = I need a cold shower.

http://www.medicalcorpse.com/gallery/quality ass.jpg

--
R

it appears the USAF is finally becoming enough of a "ghost town" of family physicians that "naked self-interest" is taking over.

it has been somewhat gratifying to see the continued influx of new docs on this site stating the same thing I was accused of "lying" about when I found this site 2 years ago. USAF Primary care is a shame. DO I hope it gets better, absolutely. The memo below gives a glimmer of hope, but the USAF has a way of estinguishing glimmers pretty quickly. On to the memo (also found in another thread).

As some of you in the AF may may know, there was a summit meeting of sorts in Virginia last month. Basically it was a bunch of Hospital Commanders and selected "providers of PCO". One of my colleagues (Family Physician) made the trip. The topic: "How can we get our doctors to stay?" Apparently, the "higher ups" are finally concerned about the quickening pace of physicians getting out. Concerned enough that they schduled a week in Virginia to apparently pick the brains of physicians and to discuss potential solutions to issues and problems. My colleague claims that my Hospital Commander was "very interested" in hearing how we can "fix things". Last week I rec'd an e-mail requesting my presence at a meeting with the other "PCO Providers" and the Hospital Commander. Apparently he wants to discuss possible "solutions to problems we are having/how can we help make this a place you'd want to stay and continue to work in".
I am happy since this is the FIRST time ANYONE in the Air Force has ever asked my opinion on how to manage any problem in my clinic. However, I am completely overwhelmed on how to approach this issue. On one hand, we all know the issues facing our profession in the military are MUCH bigger than what he can fix after an hour meeting. But, this is a real opportunity to actually be heard and (cross my fingers) get something constructive done. So my question to the group is this: How would (or have ) YOU handled this situation/opportunity? Do you concentrate on simple and seemingly fixable issues or do you try to convince him to fix bigger issues that might have more "ripple effect"? Either way, I am not optimistic that anything big will be done that will change my patients or my life very much. Unfortunately, my time in the Air Force Medical system has taught me to be pessimistic about changes for the good.

 

[USAFdoc]

military.com article on the military doctor shortage. Note one of the last paragraphs descibing that nearly every HPSP applicant is accepted (it was 10% when I was an applicant more than a decade ago, now its nearly 100%)

http://www.moaa.org/todaysofficer/columnists/philpott/doctors.asp

OBSERVATION POST
For Military-Trained Doctors, Laird Fights On

--------------------------------------------------------------------------------

By Tom Philpott
October 2006 Online


Melvin Laird, while defense secretary in the first Nixon administration, backed a plan to establish a military medical school on the campus of the Bethesda Naval Medical Center outside Washington, D.C. He did so despite opposition from the White House's own Office of Management and Budget, the Association of Medical Colleges, and the American Medical Association.

With Laird's support, Congress in 1972 authorized the Uniformed Services University of the Health Sciences. Today it's the 15th-largest medical school in the country. Over the last three decades, Laird has fought to protect USUHS from various threats including a stream of budget analysts who have portrayed a military-run medical school as a costly indulgence.

Laird also helped to pull USUHS off the chopping block during three rounds of BRAC (Base Realignment and Closure) Commissions since the late 1970s, mostly recently last year when he urged Defense Secretary Donald Rumsfeld to toss a Navy recommendation that USUHS be closed. It took a series of calls and letters, Laird recalled, but Rumsfeld finally assured him in a final brief phone conversation, "Mel, don't worry about it."

The 84-year-old former defense chief is understandably proud of his past battles on behalf of USUHS, and never more so than today. That's because the Bethesda school's importance to military medicine is suddenly being heralded by some of the same leaders who sought last year to close it.

The Army, Navy, and Air Force surgeons general are pressing USUHS to double its number of students. They do so because interest in a more prominent source of physicians, the Health Professions Scholarship Program, has fallen sharply. The surgeons general blame the Iraq war and a stiffening competition for medical students from other scholarship offers, particularly from the large health maintenance organizations.

The president of USUHS, Dr. Charles L. Rice, confirmed service interest in doubling his current class size of 175 students admitted to the medical school annually. If Congress agrees, Rice said, USUHS will face some significant hurdles, including how to expand laboratories and clinical training programs with military medical centers around the country.

Critics of USUHS typically have focused on the cost per physician produce, Rice said. The Congressional Budget Office estimates that it costs more than twice as much to send a student through USUHS as it does to provide an HPSP scholarship to a student attending a civilian medical school in return for a tour in the military when they become physicians.

"It is an argument, I think, that is entirely analogous as to the cost of producing a second lieutenant from [the U.S. Military Academy, West Point, N.Y.] or an ensign from [the U.S. Naval Academy, Annapolis, Md.]," Rice said. "Yes it's more expensive than NROTC or ROTC, but you get something different from it. The service academies produce the leadership of the officer corps at the O-5 and O-6 level. We think that's what we produce for the medical department."

Laird made a more detailed argument in his letters last year to then-Deputy Defense Secretary Paul Wolfowitz and to Rumsfeld. In the face of a growing physician shortage, Laird said, the military needs "a steady source of highly competent, uniquely trained, deployable military physicians and medical planners." USUHS provides that, he wrote, in the absence of a physician draft.

He also noted that USUHS graduates serve three times longer on active duty than HPSP recipients, ensuring leadership and continuity. While USUHS graduates represent only 13 percent of all physician recruits, they represent 33 percent of medical officers in the ranks of O-5 and O-6 and 33 percent of physicians serving with Special Forces units. Quality too is high. The USUHS School of Medicine gets 10 qualified applicants for every slot versus one qualified application for every HPSP scholarship.

Said Laird in his letter to Wolfowitz, "I have gone through this on four separate occasions when they wanted to close this University. Each time, I have had to go to Congress and overrule the Executive Branch. I hope it will not be necessary again."

It wasn't -- this time.

Laird doesn't crow that his years fighting for USUHS are now vindicated by plans to expand rather than close the university. Rather, he suggests, his commitment has been vindicated through the years with each graduating class of physicians, dentists, and nurses who enrich military medicine with a deeper commitment to, and understanding of, the special needs of an all-volunteer force.


Tom Philpott is a freelance writer and syndicated news columnist. His column, "Military Update," appears in 48 daily newspapers throughout the United States and overseas.

 

[USAFdoc]

Below memo from yet another doc agreeing as to the description myself and others have given of miltary medicine.

Originally Posted by USAFdoc
Your thread was Army specific; here is some USAF Primary Care specific, and please do not take this personally, you are probably a great officer and have great perseverance to have lasted as long as you have in the beaurocratic nightmare of military med:

1) Pay. You are correct in that Military salaries and civilian SALARIES (that word salary is impt here) are similar in Primary care. HOWEVER. As a civilian FP I am salaried at 120K doing only 40-50 hrs per week (4 1/2 days clinic only). In the military, I was doing about 275-300 hrs a month (with one month at 400 hours) so per hour, I was getting half pay in the military, when you consider hourly pay. Currently I also moonlight at an urgent care center. If I wanted to work there to equal the number of hours I worked in the military, I would be making 200K.

2)The military does NOT give you more time to diagnose, spend time with patients etc. In the USAF, I had 15 minutes per patients, no matter who the patient was, or the problems. When they closed our Int Med clinic and I inherited all thier patients, the same was true. Funny how the IM docs had 30 min per patient (pts they knew) and the FP docs got 15 min with new IM patients. PLus as a military doc, the doc does all the data entry, referrals, etc. As a civilian, most of my appts are 15 minutes, but because I HAVE CONTROL over my schedule, those new patients with 15 meds, uncontrolled diseases etc get 30 min. Heck, even a bad sprained ankle in the military comes with a load of red tape (4T profiles, quarters, etc..) that sucks up your staff time.

3)Military docs ARE IDEALISTIC as you say. That is part of the conflict. Here you have a wonderfully idealistic population of docs, not in it for the money, and here you have this military healthcare system and reeks of everything that goes directly against our idealism (and what the USAF states are their core values). Real USAF Core Values are money metrics and promtion, not excellence, service, and integrity.

4)Deployments: 100% of the docs that deployed PREFERRED deployment to being in our CONUS clinic. That should tell you something about what it is like working in todays military med primary care clinic. Most of the leadership from the Uniformed Family Physician/Pentagon reps like to refer to our clinics as "war zones". A little over the top, but not off the mark either.

5)You say it is "NOT BETTER in the civilian world"; that is generally a big lie. If the military were better, then why does everyone leave, and even more important, why isn't everyone going back to the military as soon as they find out how "bad" the civilian med life is? Yes, civilian med has its problems, but they are dwarfed my milmed problems in comparison.

6)Your point about acepting what you cannot change is right on the mark. The problem is that some of what is wrong with military medicine is not, and should not, be up for compromise/debate. Everyone has a price, whether it is the price to stay or the price to leave. The price to stay in military primary care; (lack of staff, lack of trained staff, autonomy, pay, safety issues with patients, lack of leadership willing to work WITH doctors, continuity issues, TRICARE) and the list could go on....is simply TOO HIGH of a price for a doctor in primary care to pay, with the poor patient care problem being tops on my list. Look, I am willing to work as hard as it takes to give my patients and my staff great care and a great place to work. I am not willing to work that hard when the end result is still a piss poor healthcare system that places patients at risk, and makes my staff miserable.

7)The night vis goggles and parachute jumping etc sound nice, but in todays USAF Primary care world there is simply no time for those things when you are staffed 20% and 20,000 dependents expecting care. Alot of the unique aspects of being a military Family doc have been removed and replaced with the worst aspects of the HMO civilian world.

lets just sell a few of those goggles and get me another doc in my clinic to see patients.


The Reply to USAF DOC:

I agree with all that you said. I have posted on this forum before, but not in the past year and a half since I left active duty.

I am happy to agree with the FACT that life is better on the outside in ways too numerous to count. Here are just a few:

I control my own schedule.

I decide if I want a day off and take it. I don't need the permission of a bitter nurse colonel who hates me because I am a physician.

I can implement any program or policy I want in my practice and tailor it to really fit the needs of my patients.

I can decide the mix of patients I want to see.

I can decide if I want to to procedures as part of my primary care practice.

I decide if I want to inpatient care, and can even decide how much of it I want to do and when.

I make more money now than I did on active duty.

When I order a test, it is done in a matter of days instead of weeks.

I haven't had to write (or re-write) one Officer Performance Report. One hundred percent of my time is involved in patient care, not stupid stuff.

I can be a doctor for the rest of my career, and not be forced into an administrative role because I have been a doctor longer than anyone else at my clinic.

I enjoy respect from my peers and coworkers, instead of contempt from my commanders. People value my opinion. (The nurses and staff that I work with now laughed when I started civilian practice because they could not believe the true stories I told them about how military physicians are treated and how their opinions are not valued or even listened to. To this day, I don't think they believe me.)

Regarding the "higher calling" that is touted as a reason for staying active duty: I am still helping people and making a difference in my community even though I am one of the disaffected ones who got out for the "big money and the private parking place." I did my part to serve my country, and I am still doing my part to help my community. Serving in military medicine is not "better" than what I do now in civilian practice. Both help humanity, both are valuable to society in general, and I think it is a little self-righteous to think that every civilian doctor is a greedy slob who is only in it for the money and every military doctor is some sort of "saint" because they choose to stay in beyond their commitment. I signed on the dotted line to serve a certain number of years in exchange for a free education. I fulfilled my obligation honorably and completely, and moved on. I am sure that the military got their money's worth out of me. I am not short-changing humanity by leaving active duty service.

I can decide how long to spend with each patient. I can give them what I feel they need, to educate them, to make them understand how important taking care of themselves is, to make a friend of them and earn their trust, and to become their true family doctor in the old-fashioned sense of the word. I love my patients (Well, most of them. Some drive me crazy, of course.) I enjoy helping them, I enjoy being there to talk to when they need it, I enjoy watching them themselves get healthy, and so on. I enjoyed them on active duty, and the civilian patients are just as deserving of affection and respect.

I have never been happier with my job than I have been in the past 18 months. Sure, there are issues in civilian medicine. It is not utopia. But having faced both, I choose civilian medicine. NO COMPARISON.

I have not faced one minute of regret for separating despite 15 years of active service, except perhaps when I pay my health insurance premium, but that monthly nanosecond of remorse does not outweigh the entire rest of the past 18 months and beyond.

I am sad to say, but as a veteran of "primary care war zone", and an expeditionary clinic deployment, I am qualified to offer an opinion. The USAF health care system is broken, and according to the USAF Surgeon General, Gen. Peach Taylor, in his own words that I heard with my own ears in 2005, it is not going to get any better. Congress is not allocating any additional funds it improve manning, and as long as they can do the job with current manning levels (not measuring quality, of course) why would they ever invest in increasing personnel? Don't kid yourself on this, readers.

If you have the desire to stay, and the ability to go through your career oblivious to the sinking ship that is military medicine, then best of luck to you. Just don't say you weren't warned by those who know...

I for one have not regretted my decision to become a civilian family doctor, spend more time with my children, grow a private practice, do part time hospice work to care for the dying population, and serve in volunteer capacity in my community with the Boy Scouts, and many other reasons.

One final request to the flamers: please do not attribute every negative comment from every current and former military physician as "sour grapes". We are trying to spare others from suffering through the same dreadful circumstances that we have. I have seen both sides. I think that makes my opinion at least worth hearing. If you are in, get out as soon as you can. If you are thinking of joining, don't. If you do join, choose anything but primary care.[/I]

 

[USAFdoc]

Another insightful entry, this time from a patients perspective on military medicine. Incredible how on the mark even a patient can be on the problems and yet the leader of military medicine (a Surgeon General) appearas to be oblivious to the problems. My take is that the SG absolutely knows what is going on and frankly, just doesn't consider his staff (physicians) and the patients high enough priority to trump his priority of "appearences". Read all the enties various SGs have made before congress and every SG makes it sound as if military medicine is the best thing going. At least the "blind faith", "the problem must be with the physicians" naysayers have been silenced with the continuing long list of docs, patients, staff continuing to speak truthfully on military medicine.
The Patient Perspective

--------------------------------------------------------------------------------

I have been lurking around these forums for awhile now and thought I would give a patient's perspective on Military Medicine. I will go ahead and say that I am not a Medical Student, I am not even a Pre-Med Student. I am waiting for my Active Duty Enlistment to end so I can begin school full-time.

I know there are quite a few Military Physicians on here posting how bad things are in Military Medicine. Well, they are right. The system is broken and the only thing, in my opinion, keeping it alive is the few extremely dedicated physicians who truely care about their patients.

I am NOT one of those people that runs to Medical for every little reason. I only go as a last resort and my experience has been overwhelming negative. Particularly in the Primary Care Facilities. I was seen twice by PC Physicians for difficulty breathing and was just given a "cold pack" and told, "Suck it up." Not until I was taken to the ER after falling out of a PT session did they determine I had a severe case of Pneumonia.

I have given in and gone to Medical on several other occasions only to be treated horribly. In most cases the Physician didn't care what I had to say, barely looked at me, and then prescribed me three or four medications (none of which helped) without actually telling me what was wrong.

I was once told I could only have one complaint per appointment because they didn't have time take care of more than that. On another visit I was told I had mucus on my tonsils. The problem with that: My tonsils were removed when I was a kid. I even had my wife (a nurse) double check and they are not there.

Just two days ago I took my son to the ER for a fever of 104.1 and the nurse rolled her eyes, shrugged her shoulders and said, "He doesn't look that bad."

These are just a few examples. I have had a few positive experience but all of them have been with Specialists. For example, the staff in the Pediatrics Ward were great when my son was first born and was very ill.

I will say this, after reading posts by various Military Physicians and getting some insight on what they deal with, I can see how that would affect their attitude toward patients. Not all of them, but a vast majority. I also know there are a lot of service members out there just trying to get out of work by going to Medical.

All in all, this isn't meant to bash Military Medicine or discourage people from doing HPSP or going to USUHS. I am considering it myself, but that is a good distance in the future. But I truely love serving my country and I have learned how to deal with military politics. But just listen to what these guys who are there or have been there are telling you. They are only trying to help you make an informed decision. And if you do join, please become one of those Physicians who truely believe in what they are doing and cares about your patients whether you like the military or not. But then again, this is just the perspective of a patient but I hope it is helpful. Thanks.

 

[MDS]

Hello.

I am a fourth year medical student who ended up accepting the HPSP scholarship./ I know that some of you speak of your friends who have been able to get out. What have they done?

Thank you so much for your help!

 

[NavyFP]

Hello.

I am a fourth year medical student who ended up accepting the HPSP scholarship./ I know that some of you speak of your friends who have been able to get out. What have they done?

Thank you so much for your help!

Even the detractors on this part of the forum are of the same mind. You made a commitment, live up to it and then get out.

If there is a compelling reason you can't fulfill your obligation the military may listen, but just wanting out is not good enough.

 

[MedicalCorpse]

Even the detractors on this part of the forum are of the same mind. You made a commitment, live up to it and then get out.

If there is a compelling reason you can't fulfill your obligation the military may listen, but just wanting out is not good enough.

Word.

--
R
Not The Biggest Fan of MilMed, but a Scion of Honor.

 

[a1qwerty55]

What a collection of carping bitches.

USAFdoc - you have 700+ posts - you must be a real winner.
medicalcorpse - your at nearly 500 - good to see you are keeping up with CME. - medicalcorpse - can I say "borderline" - I'm pretty sure your LOR (that is letter of reprimand) was well deserved -

Lets get frank..

So you want to trash military medicine - Oh yes, but do so as a "service" to others -

Well you shatheads, guess who pays the price? That 18 year old who is looking for college money or job training or who maybe gives a damn about his country who gets his f'ing arms and legs blown off in an IED. Yep his family will most definitely appeciate your committment to "informed consent".

I am so glad each of you carping a-holes are out of the service - it is better to work with a few grounded, patriots than a collection of carping axis II personality disorder docs. Healthcare providers have strong tendancies towards Narcissicm, and Borderline tendancies, both of which are readily apparent in the feculent posts on this forum.

Now for some facts and value statements.

News flash - military docs make a difference, for America, for our servicemembers, for the US as a whole - anybody wonder where most vascular surgical techiques, burn and trauma surgery concepts came from....????

---THE MILITARY---

Why, despite some of the most horrible wounds ever seen by healthcare providers (IED's), are soldier's and Marines surviving at an unprecedented rate- oh yes... because the docs are so sorry/incompetent/lazy etc. of course.

Well guess what, my colleagues - although disgruntled as are all American docs - are head and shoulders better than the civilian counterparts in my community (major metropolitan area), and frankly, the medical student crop at least to date looks pretty good - to my surprise. Each comes back with positive experiences from Iraq, as well as heart wrenching life changing ones as well, but none (not one) has told me that they didn't make a difference.

Now a message to potential military scholarship applicants: If your are a medical student and have the current American ethos that is all about me, please do not join the military because - guess, what it isn't about you. If your primary goal is monetary, or prestige - please stay in the civilian sector.

From a fully engaged - 100% clinical Army doc (me) - I work f'ing hard, frankly harder than my civilian colleagues - who for the same pay work 12-13 twelve hour shifts per month in comparision to my 20-25, Maybe I am a freaking idiot but you know, I work within a system which is stressed but is adapting, I push it to make changes for the benefit of our patients and yes, positive changes do come, but take - diplomacy, intellect, and much work.

And you know - I'm still richer than 90+% of Americans, and 99% of other residents of the world. I've got a great family, job satisfaction, despite the stress and challenges. And,,, I can look in the mirror with a sense that I'm in something bigger than me... I'm going to eat my turkey with my wife and family and will cherish it as I know that the opportunity to do so is a gift from US servicemembers, and recognizing that next year I'll probably be eating sand covered crap. I bet I have a more meaningful holiday than the USAFdoc or medicalcorpse.

Lastly, I'm not a f'ing recruiter, I'm an American Soldier, and American Physician. To each of the mil. med bashers, you cheapen your service though your vitriolic crap. To current and future HPSP and USUHS students - thanks for being there for all of us (America), thanks for committing a part of your life to your country and your countrymen, and be assured that there is good in every experience for those you are emotionally sound enough to see it.

Be thankful there are idealists, be thankful there are heros, and people who can place others over self. - This after all is actually the ethos from which medicine arose.

 

[USAFdoc]

What a collection of carping bitches.

USAFdoc - you have 700+ posts - you must be a real winner.
medicalcorpse - your at nearly 500 - good to see you are keeping up with CME. - medicalcorpse - can I say "borderline" - I'm pretty sure your LOR (that is letter of reprimand) was well deserved -

Lets get frank..

So you want to trash military medicine - Oh yes, but do so as a "service" to others -

Well you shatheads, guess who pays the price? That 18 year old who is looking for college money or job training or who maybe gives a damn about his country who gets his f'ing arms and legs blown off in an IED. Yep his family will most definitely appeciate your committment to "informed consent".

I am so glad each of you carping a-holes are out of the service - it is better to work with a few grounded, patriots than a collection of carping axis II personality disorder docs. Healthcare providers have strong tendancies towards Narcissicm, and Borderline tendancies, both of which are readily apparent in the feculent posts on this forum.

Now for some facts and value statements.

News flash - military docs make a difference, for America, for our servicemembers, for the US as a whole - anybody wonder where most vascular surgical techiques, burn and trauma surgery concepts came from....????

---THE MILITARY---

Why, despite some of the most horrible wounds ever seen by healthcare providers (IED's), are soldier's and Marines surviving at an unprecedented rate- oh yes... because the docs are so sorry/incompetent/laxy etc. of course.

Well guess what, my colleagues - although disgruntled as are all American docs - are head and shoulders better than the civilian counterparts in my community (major metropolitan area), and frankly, the medical student crop at least to date looks pretty good - to my surprise. Each comes back with positive experiences from Iraq, as well as heart wrenching life changing ones as well, but none (not one) has told me that they didn't make a difference.

Now a message to potential military scholarship applicants: If your are a medical student and have the current American ethos that is all about me, please do not join the military because - guess, what it isn't about you. If your primary goal is monetary, or prestige - please stay in the civilian sector.

From a fully engaged - 100% clinical Army doc (me) - I work f'ing hard, frankly harder than my civilian colleagues - who for the same pay work 12-13 twelve hour shifts per month in comparision to my 20-25, Maybe I am a freaking idiot but you know, I work within a system which is stressed but is adapting, I push it to make changes for the benefit of our patients and yes, positive changes do come, but take - diplomacy, intellect, and much work.

And you know - I'm still richer than 90+% of Americans, and 99% of other residents of the world. I've got a great family, job satisfaction, despite the stress and challenges. And,,, I can look in the mirror with a sense that I'm in something bigger than me... I'm going to eat my turkey with my wife and family and will cherish it as I know that the opportunity to do so is a gift from US servicemembers, and recognizing that next year I'll probably be eating sand covered crap. I bet I have a more meaningful holiday than the USAFdoc or medicalcorpse.

Lastly, I'm not a f'ing recruiter, I'm an American Soldier, and American Physician patriot. To each of the mil. med bashers, you cheapen your service though your vitriolic crap. To current and future HPSP and USUHS students - thanks for being there for all of us (America), thanks for committing a part of your life to your country and your countrymen, and be assured that there is good in every experience for those you are emotionally sound enough to see it.

Be thankful there are idealists, be thankful there are heros, and people who can place others over self. - This after all is actually the ethos from which medicine arose.

what a pile of propaganda, lies, and egotistical self righteuosness. it has been quite awhile since somebody went so far over the top. Nice job A1 on attaining such a high level of self delusion. I won't waste time even addressing the specifics of your delusions and gargage verbage. Those have all been proven ridiculous many times before.You are not doing anything different that scores of docs havn't already done. You just seem to think that you are somehow morally superior to the hundreds of docs who refused to look the other way in the face of a broken medical system.

 

[i want out]

What a collection of carping bitches.

USAFdoc - you have 700+ posts - you must be a real winner.
medicalcorpse - your at nearly 500 - good to see you are keeping up with CME. - medicalcorpse - can I say "borderline" - I'm pretty sure your LOR (that is letter of reprimand) was well deserved -

Lets get frank..

So you want to trash military medicine - Oh yes, but do so as a "service" to others -

Well you shatheads, guess who pays the price? That 18 year old who is looking for college money or job training or who maybe gives a damn about his country who gets his f'ing arms and legs blown off in an IED. Yep his family will most definitely appeciate your committment to "informed consent".

I am so glad each of you carping a-holes are out of the service - it is better to work with a few grounded, patriots than a collection of carping axis II personality disorder docs. Healthcare providers have strong tendancies towards Narcissicm, and Borderline tendancies, both of which are readily apparent in the feculent posts on this forum.

Now for some facts and value statements.

News flash - military docs make a difference, for America, for our servicemembers, for the US as a whole - anybody wonder where most vascular surgical techiques, burn and trauma surgery concepts came from....????

---THE MILITARY---

Why, despite some of the most horrible wounds ever seen by healthcare providers (IED's), are soldier's and Marines surviving at an unprecedented rate- oh yes... because the docs are so sorry/incompetent/laxy etc. of course.

Well guess what, my colleagues - although disgruntled as are all American docs - are head and shoulders better than the civilian counterparts in my community (major metropolitan area), and frankly, the medical student crop at least to date looks pretty good - to my surprise. Each comes back with positive experiences from Iraq, as well as heart wrenching life changing ones as well, but none (not one) has told me that they didn't make a difference.

Now a message to potential military scholarship applicants: If your are a medical student and have the current American ethos that is all about me, please do not join the military because - guess, what it isn't about you. If your primary goal is monetary, or prestige - please stay in the civilian sector.

From a fully engaged - 100% clinical Army doc (me) - I work f'ing hard, frankly harder than my civilian colleagues - who for the same pay work 12-13 twelve hour shifts per month in comparision to my 20-25, Maybe I am a freaking idiot but you know, I work within a system which is stressed but is adapting, I push it to make changes for the benefit of our patients and yes, positive changes do come, but take - diplomacy, intellect, and much work.

And you know - I'm still richer than 90+% of Americans, and 99% of other residents of the world. I've got a great family, job satisfaction, despite the stress and challenges. And,,, I can look in the mirror with a sense that I'm in something bigger than me... I'm going to eat my turkey with my wife and family and will cherish it as I know that the opportunity to do so is a gift from US servicemembers, and recognizing that next year I'll probably be eating sand covered crap. I bet I have a more meaningful holiday than the USAFdoc or medicalcorpse.

Lastly, I'm not a f'ing recruiter, I'm an American Soldier, and American Physician patriot. To each of the mil. med bashers, you cheapen your service though your vitriolic crap. To current and future HPSP and USUHS students - thanks for being there for all of us (America), thanks for committing a part of your life to your country and your countrymen, and be assured that there is good in every experience for those you are emotionally sound enough to see it.

Be thankful there are idealists, be thankful there are heros, and people who can place others over self. - This after all is actually the ethos from which medicine arose.

Once you get out of residency at the military version of an ivory tower, and get some sand in your boots on an operational tour, then come on back.

I am absolutely certain that your rose colored glasses will lose some of the shine after you take your over educated residency trained @$$ and actually practice some down and dirty GMO (yes, even after your specialty, and subspecialty training, you will likely do a basic utilization tour) medicine.

I also hope you survive your time in operational medicine, so that you may come back and reread this with more perspective than what you have read on recruiting posters.

i want out

 

[mitchconnie]

What a collection of carping bitches.

USAFdoc - you have 700+ posts - you must be a real winner.
medicalcorpse - your at nearly 500 - good to see you are keeping up with CME. - medicalcorpse - can I say "borderline" - I'm pretty sure your LOR (that is letter of reprimand) was well deserved -

Lets get frank..

So you want to trash military medicine - Oh yes, but do so as a "service" to others -

Well you shatheads, guess who pays the price? That 18 year old who is looking for college money or job training or who maybe gives a damn about his country who gets his f'ing arms and legs blown off in an IED. Yep his family will most definitely appeciate your committment to "informed consent".

I am so glad each of you carping a-holes are out of the service - it is better to work with a few grounded, patriots than a collection of carping axis II personality disorder docs. Healthcare providers have strong tendancies towards Narcissicm, and Borderline tendancies, both of which are readily apparent in the feculent posts on this forum.

Now for some facts and value statements.

News flash - military docs make a difference, for America, for our servicemembers, for the US as a whole - anybody wonder where most vascular surgical techiques, burn and trauma surgery concepts came from....????

Uh....huh....Let me be the first to congratulate you on that flag-waving, self-righteous diatribe. If you don’t have anything of substance to say, then by all means wrap yourself in the flag, extol the saintliness of the troops, and condemn from on high the “disgruntled” docs who have been battling in the trenches of the GWOT for years.

Have you ever even been to the OIF/OEF? Ever spent 10 hours in a 100-degree OR up to your hip waders in blood from the latest IED carnage? If you have, then congratulations, but somehow I doubt it. Most people who have seen the war and operational medicine up close have a much more nuanced perspective. I know it really opened my eyes to the way military medicine is actually run.

Do you REALLY think that military hospitals are BETTER across the board than their civilian counterparts? Do you honestly believe that improved survivability in the field is due to the amazing technical skills of military surgeons and not better body armor and more rapid evacuation? Do you actually think that there are incredible medical advances being made on the current battlefields of the GWOT that are revolutionizing civilian medicine? I just can’t tell if you are serious.

This sort of overly-patriotic hyperbole just stifles debate, and perpetuates an increasingly dismal status quo in military medicine.

 

[siinew]

What a collection of carping bitches.

USAFdoc - you have 700+ posts - you must be a real winner.
medicalcorpse - your at nearly 500 - good to see you are keeping up with CME. - medicalcorpse - can I say "borderline" - I'm pretty sure your LOR (that is letter of reprimand) was well deserved -

Lets get frank..

So you want to trash military medicine - Oh yes, but do so as a "service" to others -

Well you shatheads, guess who pays the price? That 18 year old who is looking for college money or job training or who maybe gives a damn about his country who gets his f'ing arms and legs blown off in an IED. Yep his family will most definitely appeciate your committment to "informed consent".

I am so glad each of you carping a-holes are out of the service - it is better to work with a few grounded, patriots than a collection of carping axis II personality disorder docs. Healthcare providers have strong tendancies towards Narcissicm, and Borderline tendancies, both of which are readily apparent in the feculent posts on this forum.

Now for some facts and value statements.

News flash - military docs make a difference, for America, for our servicemembers, for the US as a whole - anybody wonder where most vascular surgical techiques, burn and trauma surgery concepts came from....????

---THE MILITARY---

Why, despite some of the most horrible wounds ever seen by healthcare providers (IED's), are soldier's and Marines surviving at an unprecedented rate- oh yes... because the docs are so sorry/incompetent/laxy etc. of course.

Well guess what, my colleagues - although disgruntled as are all American docs - are head and shoulders better than the civilian counterparts in my community (major metropolitan area), and frankly, the medical student crop at least to date looks pretty good - to my surprise. Each comes back with positive experiences from Iraq, as well as heart wrenching life changing ones as well, but none (not one) has told me that they didn't make a difference.

Now a message to potential military scholarship applicants: If your are a medical student and have the current American ethos that is all about me, please do not join the military because - guess, what it isn't about you. If your primary goal is monetary, or prestige - please stay in the civilian sector.

From a fully engaged - 100% clinical Army doc (me) - I work f'ing hard, frankly harder than my civilian colleagues - who for the same pay work 12-13 twelve hour shifts per month in comparision to my 20-25, Maybe I am a freaking idiot but you know, I work within a system which is stressed but is adapting, I push it to make changes for the benefit of our patients and yes, positive changes do come, but take - diplomacy, intellect, and much work.

And you know - I'm still richer than 90+% of Americans, and 99% of other residents of the world. I've got a great family, job satisfaction, despite the stress and challenges. And,,, I can look in the mirror with a sense that I'm in something bigger than me... I'm going to eat my turkey with my wife and family and will cherish it as I know that the opportunity to do so is a gift from US servicemembers, and recognizing that next year I'll probably be eating sand covered crap. I bet I have a more meaningful holiday than the USAFdoc or medicalcorpse.

Lastly, I'm not a f'ing recruiter, I'm an American Soldier, and American Physician patriot. To each of the mil. med bashers, you cheapen your service though your vitriolic crap. To current and future HPSP and USUHS students - thanks for being there for all of us (America), thanks for committing a part of your life to your country and your countrymen, and be assured that there is good in every experience for those you are emotionally sound enough to see it.

Be thankful there are idealists, be thankful there are heros, and people who can place others over self. - This after all is actually the ethos from which medicine arose.

Cool, you just qualified for the "******* of the year" award, in my book.

Also, why don't you take that flag-waving gibberish to a board where the average education level is nearer to the level it needs to be for anyone to actually buy it. Like maybe 5th grade or so? Maybe there's a forum for elementary school kids somewhere you can go strut your hero stuff on. It doesn't work on people who can actually think for themselves though. Especially those of us who have already spent many (decorated, btw) years in the military - like myself and many others posting here, in case that fact slipped by you, while breaking your arm patting yourself on the back.

Not sure who the f*ck you think you are to make statements about poor-quality civilian docs and students who think medicine is "all about me," but you obviously have your head up your a$$ anyway, based on everything you have posted so far, so I won't even bother arguing the point that it is pretty gd hard to have anything be "all about me" by the time one finishes paying one's dues to become a doc. I've done my time, and I daresay it was likely a lot harder time than you have done, in the military. The folks who are bitching on this forum have obviously done theirs too.

Keep wearing your rose-colored glasses and keeping your nose warm in your superior's ass, but there are some on this board who are actually willing to share their stories to hopefully make some change in what is apparently (yet another) jacked-up part of our military.

 

[USAFdoc]

Well you shatheads, guess who pays the price? That 18 year old who is looking for college money or job training or who maybe gives a damn about his country who gets his f'ing arms and legs blown off in an IED.

we all pay the price for the broken system. The patient, the doc, the tax payer.🙁

Maybe I am a freaking idiot but you know, I work within a system which is stressed but is adapting,

you a freakin idiot? I would have never guessed

Lastly, I'm not a f'ing recruiter, I'm an American Soldier, and American Physician patriot. .

and a few other things as well. Thanks for the hard work you do for the troops, but if you think you are doing everyone a favor by blindly supporting a broken system, then you are deluded.😱

Happy Thankgiving.
Thank God for our Troops, our Freedom and our Country.

 

[resxn]

Since when did A1 devolve from an intellectual proponent of his career to an epithet-laced hollow trash talker?

As someone who is AD and is a surgeon I'm beyond offended by your remarks. Just because I believe the system of which I belong is broken doesn't mean I'm any less of a patriot than you. In fact, since I'm willing to face the problems head on and work to improve them, I would argue I'm even moreso.

What is most offensive is that you argue that those servicemen and women who get injured in the desert are most hurt by my criticism. "Suck it, Trebek." My patients get my best care regardless of my feelings about the system. I don't lower my standards because I don't like how the military treats me. I take pride in caring for family members so that our fighting men and women can concentrate on caring for/protecting mine.

The whole basis of this nation was built on the potential fallability of the system and that's why our founding fathers provided a way for us to fix it. People like you who fail to see the system as broken as it is are the ones who hurt us the most by failing to promote effective change.

I'm also shocked by your lack of admitting that civilians get better training than military docs. You know why innovative procedures come from war? Necessity is the mother of invention. We don't get people coming into our civilian institutions with limbs blown from their trunks, with hunks of car imbedded in their chest, etc. You have also failed to acknowledge that the majority of surgeons in the military are civilian-trained HPSP and not USUHS making your argument moot in the first place.

Also, the reason most residents in military surgical specialties outscore civilians on in-service exams is that those military residents aren't in the OR nearly as much, they have dedicated study time. If you look at the RRC numbers, military residents on average graduate with 15% fewer cases than do civilian counterparts at the highest volume military hospitals. Any idiot can read a book, but you can't learn surgical technique nearly as easily after residency.

Military docs do make a difference. I know I do. I am told by my patients over and over again. And every time an AD patient gives me thanks, I take it and return it moreover, simply because I owe them. I owe them somebody who is willing to fight for their best care, not just shout from the mountains that they're getting it when they're really not.

And for all the HPSP students who are coming into military medicine. Bravo for serving, but be prepared for what you'll be dealing with. And if you don't come in, don't think of yourself as lacking patriotism because you're not. A1 seems to think that if you don't join up, our soldiers will suffer. Well, it's simply not true. The military will continue to farm more and more care out to the civilian providers and just keep a deployable few around. That's probably the way it needs to be until the system is fixed and docs can/should come flooding back into the DoD.

When over 78% of docs leave the military when they're commitment is up, and that number jumps to 89% for surgeons, the problem is laid bare. For A1 to say that 80% of military surgeons are carping unpatriotic whiners simply demonstrates the entire problem with the system--blinded promotion of a broken system.

You want to get frank, A1?

Then back up your arguments with facts, not emotional drivel. You want to get frank? Then address the problems, not mask them with insults.

Anyone who has ever read this forum knows that NOT ONE single former or currently AD military physician said that they got out or want to get out because of money. Money isn't the issue. Patriotism simply outweighs money. It does for those in the military, it does for those in the FBI/CIA, local police, fire department, and so forth. Money is an issue but by no means a major factor in who stays and who doesn't of at least the posters here that I've seen.

Oh, yea, nice argument on CME and number of posts. That's a finely tuned attack wasn't it?

Your defensive swipes and personal attacks simply have demonstrated how insecure you are with your position.

But thanks for the effort, I guess.

 

[NavyFP]

From my perspective tirades on either side of the issue provide no real value added thoughts. As with arguments, the truth lies somewhere in the middle. The military is full of dedicated physicians who want to do right by their patients, as we all should. There are some who could not survive outside the system, and they need to be put into positions where they can do no harm as getting them out is next to impossible. Many of the negative posters were/are passionate physicians dedicated to their patients and feel the upper administration does not desire to do the right thing.

Military medicine is changing and it is hard to say if in the end it will change for the better. As one who is committed to Navy Medicine, I intend to do all I can to assure that it survives in a fashion of which I can be proud. Am I naive? Maybe a little. I have seen the system from 20,000 feet, but still work in the weeds.

As arrogant as it sounds (from non-doctors perspectives) physicians need to be the center of world of milmed. If there are no doctors the purpose in life of all the others is nil. The upper leadership (mostly line guys) need to have that idea pounded into their heads. The line needs to understand that you cannot buy the doctors we need, we need to grow and nurture them. This is a VERY long process and it starts in Med School. The best doctors in milmed came in through USU and HPSP. Some trained in the military system, some in the civilian world. Having that balance allows the injection of new ideas and keeps the system healthier.

Many of the decisions that plague our system come down to pure funding. Our mission increases, our patient populations continue to grow as the retired population increases and lives longer. The cost of providing care continues in an upward fashion but the DoD budget does not keep pace. We are spending huge amounts on the GWOT and that is a priority to the DoD. Getting the newest and best equipment sometimes falls below what we can afford. There were many discussions on a stipend increase and signing bonus. A lack of funding prevented this from happening.

How will this be fixed? Not sure, but I will continue to try.

The purpose of this forum is to have an open exchange of ideas and provide those with questions about the system an area where people who know are available to answer them. Name calling does not accomplish that purpose and we need to remember to be civil. I am occasionally angered by posts on this site, but shooting back in anger does not provide any real use.


These are just my opinions.........I could be wrong.

 

[USAFdoc]

Many of the decisions that plague our system come down to pure funding.


How will this be fixed? Not sure, but I will continue to try.


These are just my opinions.........I could be wrong.

You are not wrong, you are right on. Perhaps the biggest problem is funding, and when you mix that with micromanagement to the extreme, a military culture of "suck it up", metrics, promotion etc................then force feed it to patients and docs,.......well, expect a little vomitus....and the military is currrently "vomiting physicians".

Will a doc like you or me fix the system? Absolutely not. But your effort is worthy as is all the docs that have given extraordinary effort despite friendly fire from admin.

 

[MedicalCorpse]

What a collection of carping bitches.

(snip)

medicalcorpse - your at nearly 500 - good to see you are keeping up with CME. - medicalcorpse - can I say "borderline" - I'm pretty sure your LOR (that is letter of reprimand) was well deserved

That's "you're".

Lets get frank..

Yes, let's. First of all: apostrophes exist.

So you want to trash military medicine - Oh yes, but do so as a "service" to others -

Yes. The status quo sucks donkey Surgeon General. You argue for the status quo. And your rank is...um...LtCol? Major? No...um... what? Captain? And you are qualified to speak out for the excellence of the current military medical fiasco because...um...?

Well you shatheads, guess who pays the price? That 18 year old who is looking for college money or job training or who maybe gives a damn about his country who gets his f'ing arms and legs blown off in an IED. Yep his family will most definitely appeciate your committment to "informed consent".

One of us got an "A" in "Ethical, Legal, and Social Aspects of Medicine" at USU, and one of us did not. Guess who is who. Oh, and, to be frank, commitment has one "T".

I am so glad each of you carping a-holes are out of the service

Is. "Is" out of the service. I hope your diagnostic and therapeutic skills are light-years ahead of your grammatical capabilities.

- it is better to work with a few grounded, patriots than a collection of carping axis II personality disorder docs. Healthcare providers have strong tendancies towards Narcissicm, and Borderline tendancies, both of which are readily apparent in the feculent posts on this forum.

No comma after "grounded". Were they DNIFed? Oh, and it's "tendencies". However, mirabile dictu, you spelled "feculent" correctly. Hmmm. Now, it's widely known that psychiatrists suffer from mental issues, and G.I. docs obsess about their alimentary tracts...what can we make of an illiterate maroon (sic) who nonetheless manages to spell "feculent" correctly? Is he/she full of himself/herself?

Now for some facts and value statements.

Ah, a "Values Voter". I always wanted to meet one (getting popcorn).

News flash - military docs make a difference, for America, for our servicemembers, for the US as a whole - anybody wonder where most vascular surgical techiques, burn and trauma surgery concepts came from....????

Based on the multiple vascular surgeons I knew during my 15 years in military medicine, I'd have to say "The Mayo Clinic". No one I knew ever graduated from a vascular fellowship in Balad.

---THE MILITARY---

---THE DUH---

Why, despite some of the most horrible wounds ever seen by healthcare providers (IED's), are soldier's and Marines surviving at an unprecedented rate- oh yes... because the docs are so sorry/incompetent/laxy etc. of course.

You clearly have not spoken with the military docs who responded to the injuries at Ypres, Belgium in 1915; or the military docs who responded to the injuries at Hiroshima and Nagasaki (oh, you meant "American" military healthcare "providers", didn't you?); or the...you get my point.

To be frank, your use of "are soldier's" [sic] and "laxy" undermines your claim to belong to species Homo sapiens sapiens. Although I am conversant in seven languages, I don't speak Neanderthal. Sorry.

Well guess what, my colleagues - although disgruntled as are all American docs - are head and shoulders better than the civilian counterparts in my community (major metropolitan area), and frankly, the medical student crop at least to date looks pretty good - to my surprise. Each comes back with positive experiences from Iraq, as well as heart wrenching life changing ones as well, but none (not one) has told me that they didn't make a difference.

Every member of the -Totenkopfverbände felt the same way. This validates their feelings (as opposed to their thoughts) exactly how?

Now a message to potential military scholarship applicants: If your are a medical student and have the current American ethos that is all about me, please do not join the military because - guess, what it isn't about you. If your primary goal is monetary, or prestige - please stay in the civilian sector.

And if you aspire to attain the orthographic excellence of a1qwerty55 and other illiterate military rah-rah sheep, by all means, raise that right hand.

From a fully engaged - 100% clinical Army doc (me) - I work f'ing hard, frankly harder than my civilian colleagues - who for the same pay work 12-13 twelve hour shifts per month in comparision to my 20-25, Maybe I am a freaking idiot but you know

Ipse dixit. Work harder. Get paid less. Be a freaking idiot. Be commanded by a nurse. Have your medical care second-guessed by Outlook-wielding commandos who stopped seeing patients around the time I graduated from residency (1994). Go fight wars in the sand with no exit strategy. Do more with far less until you cry in your pathetic deployed bunk because you are expected to do everything for our fine troops with nothing. Ignore the advice of ex-Majors, ex-LtCols, and the prescient words of ex-Major Generals: http://www.medicalcorpse.com/MG_Scotti_responds.html

I double dog dare you to attain the rank of LtCol/CDR in any U.S. military medical corpse (sic) and come back here to refute the wisdom freely given you by the active duty and former active duty physicians here.

Until then, keep believing your propaganda, keep thinking that Arbeit Macht Frei, and pleasant dreams...

http://www.dreamquencher.com

 

[USAFdoc]

Since when did A1 devolve from an intellectual proponent of his career to an epithet-laced hollow trash talker?

As someone who is AD and is a surgeon I'm beyond offended by your remarks. Just because I believe the system of which I belong is broken doesn't mean I'm any less of a patriot than you.
Your defensive swipes and personal attacks simply have demonstrated how insecure you are with your position.

But thanks for the effort, I guess.

Another thing to consider for those weighing the positives and negatives of a military physician career;

think about the attitude of A1; his self righteousness etc. Now realize that people like him are about the ONLY people that STAY in the military healthcare realm. Nearly everybody else leaves ASAP. Now imagine you are on your first tour and frustrated at all the poor conditions around you and this guy is your Commander. You will absolutely have unacceptable problems with how the military "does healthcare" and this is how many "Commanders" feel about doctors who have problems with the status quo.

 

[BomberDoc]

With the exception of a few exceptional people, the lazy incompetent *****s stay in, make rank, and become your commanders. Everybody else flees the towering inferno at the earliest opportunity. Read A1's post and realize that this hypocrite or some similar iteration of self-righteous monster will be running military medicine for decades to come. Get the hell out and never look back.

 

[NavyDude]

I can only assume the flag-waving "Joe Military" types that get on here and all but call everybody a liar are those who are more worried about that shiny "collar candy" down the road than their patients at present.

Don't misunderstand me, there is nothing wrong with love of country and service. I am a patriot and love being able to serve. I am not, however, blinded by all the propoganda every service tries to shove down your throat. Just live overseas for any amount of time at all and you will be subjected to the Armed Forces Network, and then you will know what I mean.

I think I am also safe in assuming that those on here warning people about military medicine are the few Doc's that care, cared, and will continue to care about their patients long after their service is complete. They care enough to warn students now instead of having them become the next generation of mediocre physicians that hate the military so much they take it out on their patients.

I don't know anybody here personally, and I could be wrong, but that is just my observation.

 

[Bubblehead-to-MD]

One of us got an "A" in "Ethical, Legal, and Social Aspects of Medicine" at USU, and one of us did not. Guess who is who. Oh, and, to be frank, commitment has one "T".


No comma after "grounded". Were they DNIFed? Oh, and it's "tendencies". However, mirabile dictu, you spelled "feculent" correctly. Hmmm. Now, it's widely known that psychiatrists suffer from mental issues, and G.I. docs obsess about their alimentary tracts...what can we make of an illiterate maroon (sic) who nonetheless manages to spell "feculent" correctly? Is he/she full of himself/herself?


Ah, a "Values Voter". I always wanted to meet one (getting popcorn).


Based on the multiple vascular surgeons I knew during my 15 years in military medicine, I'd have to say "The Mayo Clinic". No one I knew ever graduated from a vascular fellowship in Balad.


You clearly have not spoken with the military docs who responded to the injuries at Ypres, Belgium in 1915; or the military docs who responded to the injuries at Hiroshima and Nagasaki (oh, you meant "American" military healthcare "providers", didn't you?); or the...you get my point.

Don't you hate it when you are harassing someone because of their grammatical errors, and you end up exposing several of your own in the process?

Punctuation marks (commas, periods, etc.) go inside the quotation marks, not out. Check out your use of the semi-colon as well.

I have nothing but love for you. I just found this ironic. 👍

 

[MedicalCorpse]

Don't you hate it when you are harassing someone because of their grammatical errors, and you end up exposing several of your own in the process?

Punctuation marks (commas, periods, etc.) go inside the quotation marks, not out. Check out your use of the semi-colon as well.

Seriously now: I do that intentionally, because, as a computer programmer since age 15, I can't stand the contamination of a logical string (denoted by quotes) by stinking commas. You are, of course, 100% correct; if I ever get my books published, the editor will have a field day with my hackish punctuation.

For what it's worth, I am not alone among geeks and hackers rebelling against this illogical, purely American English grammatical convention:

http://aprendizdetodo.com/language/?item=20050203

http://community.livejournal.com/grammargasm/272865.html

http://www.outpost9.com/reference/jargon/jargon_6.html#SEC13

From which I quote:

Consider, for example, a sentence in a vi tutorial that looks like this:

Then delete a line from the file by typing "dd".​

Standard usage would make this

Then delete a line from the file by typing "dd."​

but that would be very bad -- because the reader would be prone to type the string d-d-dot, and it happens that in vi(1) dot repeats the last command accepted. The net result would be to delete two lines!

The Jargon File follows hackish usage throughout.

Interestingly, a similar style is now preferred practice in Great Britain, though the older style (which became established for typographical reasons having to do with the aesthetics of comma and quotes in typeset text) is still accepted there. "Hart's Rules" and the "Oxford Dictionary for Writers and Editors" call the hacker-like style `new' or `logical' quoting.

Pip pip, cheerio, and all that rot!

P.S. My use of semi-colons in the sentence beginning: "You clearly have not spoken with the military docs..." is perfectly correct; the insertion of feculent commas between my examples would lead to confusion in the reader's mind. I highly recommend the most excellent book Eats, Shoots & Leaves by the English grammarian Lynne Truss: http://www.amazon.com/Eats-Shoots-Leaves-Tolerance-Punctuation/dp/1592400876 (unsolicited and unremunerated endorsement).

--
R

 

[Ex-44E3A]

Ah... a vi user.

Too bad EMACS is so much better... *runs, ducks*

 

[ExNavyRad]

What a collection of carping bitches. <<snip>> Yadda, yadda, yadda; etc, etc.<<snip>>

Your name isn't Frank Burns, perchance, is it? And you don't have a girlfriend named Margaret Houlihan, do you?

Just checking...

ExNavyRad

 

[MedicalCorpse]

Ah... a vi user.

Too bad EMACS is so much better... *runs, ducks*

Nah, I still use TECO on my vintage PDP-6. From time to time, I just use my 31337 h@X0r skills to alter the magnetic medium directly.

--
R, aka Dreamquencher
ObHack: [redacted]

 

[island doc]

A1, I'm disappointed that you didn't include me. Why only USAFdoc and medicalcorpse? Haven't I been outspoken enough?

 

[Ex-44E3A]

I had a post penned and ready to go in response to AI's little self-righteous, apple-polishing screed... but then I remembered something an attorney friend once told me.

"If the facts are on your side, argue the facts. If emotions are on your side, argue the emotions. If all else fails, impugn and assassinate the credibility of opposing council's witnesses"

AI has clearly lost this argument... he's got nothing.

 

[USAFdoc]

I had a post penned and ready to go in response to AI's little self-righteous, apple-polishing screed... but then I remembered something an attorney friend once told me.

"If the facts are on your side, argue the facts. If emotions are on your side, argue the emotions. If all else fails, impugn and assassinate the credibility of opposing council's witnesses"

AI has clearly lost this argument... he's got nothing.

and thats about what the USAF has in terms of retention of it's clinical FPs