AVOID MILITARY MEDICINE if possible

[USAFdoc]

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You made 750 dollars a month as an Air force doc?

my bad. My checks were about 2500/2 x month so that is about 16 bucks an hour....wow, I was making more than minimum wage. 😛

actually, as stated elsewhere, the salary/$$ is the LEAST of the problems facing todays military FP. 😳

 

[RichL025]

Couple of interesting thoughts from the above posts, but the one that is intriguing to me the most is the idea of AD docs only taking care of AD patients.

Bad idea.

First of all, it would completely eliminate GME.

Second of all, it would condemn any doc who spent more than 4 years on AD to perpetually stay there - because he would have forgotten anything whatsoever about treating 90% of the pathology that exists among civilians. Even the benign stuff - how many AD servicemembers are diabetic?

 

[USAFdoc]

Bad idea.

First of all, it would completely eliminate GME.

Second of all, it would condemn any doc who spent more than 4 years on AD to perpetually stay there - because he would have forgotten anything whatsoever about treating 90% of the pathology that exists among civilians. Even the benign stuff - how many AD servicemembers are diabetic?

I agree. There are positives of the move, but overall, the negatives outweigh the positives, which makes it very probable such a plan is already in the works

 

[Sam Jones]

the guy with the pseudonym USAFdoc has an ax to grind. He needs to be discharged so that he can see what the rest of medicine is like, because clearly he does not have a clue that in civilian medicine, the hours are longer for residents, the pay is lower for residents, and some hospitals like Drew in Los Angeles are soooo bad that they are being closed and all the staff fired or laid off for things like sleeping on duty. Wakeup. USAFdoc is a traitor and should be shot.

 

[orbitsurgMD]

the guy with the pseudonym USAFdoc has an ax to grind. He needs to be discharged so that he can see what the rest of medicine is like, because clearly he does not have a clue that in civilian medicine, the hours are longer for residents, the pay is lower for residents, and some hospitals like Drew in Los Angeles are soooo bad that they are being closed and all the staff fired or laid off for things like sleeping on duty. Wakeup. USAFdoc is a traitor and should be shot.

Too lazy to check the who's who page? I doubt you would be the one to be schooling anyone, USAFdoc included.

 

[Sam Jones]

I agree with you on the whole about military medicine...both as a specialist and in primary care.

My wife was active duty also...She was an internist attending in a primary care clinic....Need I say more?

Seems liike you are implying that Internists are something more than primary care physicians. For someone who is supposedly board certified in two specialties, I would think that you would know that the primary care specialties are: Family Practice, OB/GYN, Internal Medicine and Pediatrics. Some people may have other grandiose illusions about their area of medicine or their spouses, but your spouse was correctly placed in a primary care clinic as that was the area of her specialty. Now that we understand that, all your other comments on this and every other thread are now brought into question as unreliable.

 

[USAFdoc]

the guy with the pseudonym USAFdoc has an ax to grind. He needs to be discharged so that he can see what the rest of medicine is like, because clearly he does not have a clue that in civilian medicine, the hours are longer for residents, the pay is lower for residents, and some hospitals like Drew in Los Angeles are soooo bad that they are being closed and all the staff fired or laid off for things like sleeping on duty. Wakeup. USAFdoc is a traitor and should be shot.

Mr. JONES;

1. exUSAFdoc knows very well what civilian medicine is like because I AM now a CIVILIAN doc and have been for 1-2 years. Yes Civilian docs/medicine has its own challenges but has (my opinion) no where near the level of placing patients safety in danger, misuse and mistreatment of staff etc that is commonplace in military medicine.
2) exUSAFdoc knows that the hours are long in residency because I was a resident. My concern over military medicine (FP in particular) does involve the hours, but that is way, way, way down the list (as stated elsewhere). Make note of the fact that the PHYSICIANS on this site do NOT tend to have problems with what we experienced in residency.
3) As far as your wishing to have me "shot", I hope you NEVER enter the judiciary because you would likely kill 90% plus of military FPs.
4) Your comparing salaries of resident to the pay physicians get seems off the mark. And again, is military pay an issue, sure. But most docs, especially FPs like myself did not join to get rich. We joined to serve our country, serve our patients, and live up the "Core Values" that attracted us to the military and being an officer. The dillemma comes when a physician/officer then arrives on station and finds that all of the "idealism" is almost nothing but lip service, that patients safety means nothing compared to the almighty metric, and while the military physician still has all the responsibility for the safety of his/her patient, the military physician has near ZERO authority to ensure that.

Mr Jones, I sincerely hope the military healthcare system is out of the gutter before you arrive (it sounds like you are a resident), but do not hold your breath waiting. And DO TRY to change things for the better when you get there, but do be surprised if some Commander thinks your ideas for change are treason and wants you shot.

 

[Galo]

the guy with the pseudonym USAFdoc has an ax to grind. He needs to be discharged so that he can see what the rest of medicine is like, because clearly he does not have a clue that in civilian medicine, the hours are longer for residents, the pay is lower for residents, and some hospitals like Drew in Los Angeles are soooo bad that they are being closed and all the staff fired or laid off for things like sleeping on duty. Wakeup. USAFdoc is a traitor and should be shot.

Being naive is one thing, but stupidity seems more up your alley. Have you even bothered to read this forum? Really, as a medical student to be giving attacks like this makes you look like an extreme idiot. Before you post again, think hard, about what you are going to say, and to whom you are addressing. With attitude like this, the military will chew you up and spit you out.

 

[resxn]

the guy with the pseudonym USAFdoc has an ax to grind. He needs to be discharged so that he can see what the rest of medicine is like, because clearly he does not have a clue that in civilian medicine, the hours are longer for residents, the pay is lower for residents, and some hospitals like Drew in Los Angeles are soooo bad that they are being closed and all the staff fired or laid off for things like sleeping on duty. Wakeup. USAFdoc is a traitor and should be shot.

"banned" for a reason

Ignored now for the same.

Troll.

 

[USAFdoc]

Being naive is one thing, but stupidity seems more up your alley. Have you even bothered to read this forum? Really, as a medical student to be giving attacks like this makes you look like an extreme idiot. Before you post again, think hard, about what you are going to say, and to whom you are addressing. With attitude like this, the military will chew you up and spit you out.

actually, the military will probably chew him up, spit him out, and then place a bird on his shoulders so he can Command his own clinic.

 

[a1qwerty55]

First, please stop posting 700 line cut and paste specials

Second:

Are you mathematically challenged? -

$750/mo, now $5000/mo - both wrong of course.

now let's see your base pay would have been around 4000-4500/month, I'm assuming you were an O3 however odds were you were an O-4.

Board cert pay (assuming you are board certified, may be a big assumption), around another $1000/mo.

Annual physician bonus for waking up and being a doc not in training $15,000K/yr

FP bonus should be getting this - I think is is either 13k or 18K/year, I don't have it readily available.

Housing allowance - BAH - nontaxable depends on your locale but about 1200-3000/mo depending on your local housing costs at your duty station
For USAFdoc - nontaxable means you have to adjust for the 28% you would have paid in taxes to come up with your civilian equivalent.

BAQ is another like $200/mo nontaxable.

So your real total is about

$2168/mo - taxable civilian equivalent (BAH/BAQ)
$2333/mo - annual bonuses
$1000/mo - board cert pay
$4500/mo - base pay

appox 10,000/month - so 120K annually - minimum - possibly more - if you get COLA - have a higher specialty bonus, or commit for extra time on active duty -

Now do you have any practice expenses? i.e. malpractice, etc.
Is healthcare included in your package or does that come out of your whopping 150K. Please tell us about your retirement plan? Is there one or are you totally dependant on your 401K and other investments which have to come out of your 150K? Don't forget disability insurance - I'm assuming you have this as well.....

Now - am I saying that military docs are adequately compensated - NO
am I saying that USAFdoc isn't making money now - Maybe not

I'm just trying to point some innaccuracies in his posts.

When like 80% of the posts come from one really disgruntled guy who spends way too much time on the internet, one should take some of his comments with a grain of salt.

Six more years and I'm out - drawing 5000K/mo for life inflation adjusted.
Healthcare covered - and still have a maxed out TSP/401K, Roth IRA's, real estate in a couple of different markets courtesy of Uncle Sam's moves.

I wonder which of us will come out ahead?

Do you think you are making more money with your whopping 150K as a civilian FP?

 

[cmeshy]

Despite my relatively short amount of time devoted to reviewing entertaining & yet troubling threads on this forum, I have noticed that some are quite determined in their goal of bettering a non-trivial problem within US military medicine. With all good intentions and curiosity, USAFdoc, have you tried corresponding with true influntial assests such as The O-Rielly Factor. While he may or may not be a fan of yours, his program gets REAL results and with all eyes on the military and its various problems, this topic may actually attract some air-time. Americans are not happy about certain abuses and short comings they had no idea existed with what they already know as over-used and underpaid soldiers.

Some of your posts have been written eloquently and "pithy." He really might bite on this subject. Its worth a thought. In fact, I'd be willing to bet that various other news agencies would run with this story.

I say give it a try. Send him a letter each week. Persistence might get ya through his advisors. This forum would give you mad props if you pulled it off. And I, like many I believe, would think that that time spent would be better off there than defending your mostly valid issues here on this forum. Good luck if you do decide to undertake the challenge. (be sure to post your letter here so we can give it a read...or input from the been there-done thats)

-C

 

[USAFdoc]

Do you think you are making more money with your whopping 150K as a civilian FP?

In reply;

1) First of all, IT AIN"T ABOUT THE $$$$$$$$$$$ (yes, we all have some concern in $$ but that is not why the majority of FPs like myself exit ASAP.
2) Yes I am making more money as a civilian than I was as a military doc. You did a fine job totalling up some financial pros/coms. But basically I look at it this way: in the USAF I got a check every 2 weeks for $2500K and now I get a check every 2 weeks for OVER $3500K. Even as a civilian I get bonus checks (and I do not have to fill out paperwork every year and hope the Commander will sign). As a civilian I have "better" and more convenient heathcare insurance, and other finacial perks...........
3) And even more important; the above is true while I have virtually NO CALL, NO weekends, 4 1/2 days a week schedule, about 45-50 hrs/wk (compared to the 70+hrs/wk in my USAF clinic. I occassionally moonlight at the local urgent care center when they are short docs, and if I did that enough to match my "usaf monthy hours) I would be taking home another $4000/month.
4) And now for the most important; as a civilian I have an excellent staff, fully manned, charts available 100%, a professional atmosphere, authority to make decsisions and implement immediate change for the benefit of my patients and staff, NO LOST LABS, NO 19 foot piles of unfiled results, NO shredded charts, NO 18 yo techs with NO EXPERIENCE, NO new Commanders changing every 2 years, NO EMRs that were chosen without my input, etc.

basically everything about being a civilian doc is WAY, WAY, WAY better than being a military Primary care doc, except two;
1) I miss serving our troops and retirees
2) For a FP, the military pay is reasonable (if only the rest of the job was).

basically, myself and many military FPs face the dilemma I mention elsewhere. What do you decide (about your career) when you love to serve our troops and retirees/families as their family doc, but the system is designed and manned so poorly that the very things that matter most to you (quality of care for your patients, of life for your staff and family) are thrown in the gutter and trashed?

Look around, read this site, talk to FPs seeing patients (not admin FPs), read the USAFP FP archive site....................docs are voting with their feet.

As for those interested, below is A1's initial profanity laden entry a couple months ago (I thought I recognized his banter).
Again, here is A1 at his/her best:

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.

 

[dhjyun]

USAFdoc, what do you look like? I'm guessing you're probably a short, skinny man who was ignored and beat up as a kid. I'm not an M.D. or a Ph.D but I can sense a sissy when I see one. You say you're about the soldiers and not about the money, but most of your complaints are about how much you had to work in the Air Force and how little you were paid. If you were really selfless and cared about the soldier like you try to make yourself out to be, you'd be doing something more constructive with your life than bashing the military, who paid off your loan and allowed you call yourself "USAFdoc."

 

[FizbanZymogen]

In reply;

1) First of all, IT AIN"T ABOUT THE $$$$$$$$$$$ (yes, we all have some concern in $$ but that is not why the majority of FPs like myself exit ASAP.
2) Yes I am making more money as a civilian than I was as a military doc. You did a fine job totalling up some financial pros/coms. But basically I look at it this way: in the USAF I got a check every 2 weeks for $2500K and now I get a check every 2 weeks for OVER $3500K. Even as a civilian I get bonus checks (and I do not have to fill out paperwork every year and hope the Commander will sign). As a civilian I have "better" and more convenient heathcare insurance, and other finacial perks...........
3) And even more important; the above is true while I have virtually NO CALL, NO weekends, 4 1/2 days a week schedule, about 45-50 hrs/wk (compared to the 70+hrs/wk in my USAF clinic. I occassionally moonlight at the local urgent care center when they are short docs, and if I did that enough to match my "usaf monthy hours) I would be taking home another $4000/month.
4) And now for the most important; as a civilian I have an excellent staff, fully manned, charts available 100%, a professional atmosphere, authority to make decsisions and implement immediate change for the benefit of my patients and staff, NO LOST LABS, NO 19 foot piles of unfiled results, NO shredded charts, NO 18 yo techs with NO EXPERIENCE, NO new Commanders changing every 2 years, NO EMRs that were chosen without my input, etc.

basically everything about being a civilian doc is WAY, WAY, WAY better than being a military Primary care doc, except two;
1) I miss serving our troops and retirees
2) For a FP, the military pay is reasonable (if only the rest of the job was).

basically, myself and many military FPs face the dilemma I mention elsewhere. What do you decide (about your career) when you love to serve our troops and retirees/families as their family doc, but the system is designed and manned so poorly that the very things that matter most to you (quality of care for your patients, of life for your staff and family) are thrown in the gutter and trashed?

Look around, read this site, talk to FPs seeing patients (not admin FPs), read the USAFP FP archive site....................docs are voting with their feet.

As for those interested, below is A1's initial profanity laden entry a couple months ago (I thought I recognized his banter).
Again, here is A1 at his/her best:

You mean to tell me that you are only making $7,000 a month as a doc in the civillian world. Is that really right? I am not jumping on the "bash USAFDOC" bandwagon, I just want to check your figures. That seems very low to me. So does your $5,000 a month salary in the military.

 

[a1qwerty55]

I'm proud of that post.

Thanks for bringing it back.

USAFdoc - If you had to worry about your Commander singing your bonus,,, it was because you either were a jerk, or a poor physician. No one gets their bonuses rejected unless they have really stepped on it.

Your math doesn't add up, and your financial literacy is atrocious. I also do not believe your inflated work hours. I did see a provider have similar hours but later was diagnosed with OCD....

I noticed that you didn't flesh out any of the of questions I asked you.

Malpractice, healthcare coverage, disability insurance, practice costs, etc.?

Why?

I feel sorry for you, but more so for your patients. You are not a bright bulb.

Where do you work? Can I call your supervisor and confirm that you are so euphorically happy? Obviously I don't expect you to provide this info, but the point is that disgruntled people are disgruntled and entitled no matter where they work, only in this forum for your crap to work you have to be orgasmically happy with your practice environment or all your arguments fall apart.

You are tiring, and the proverbial broken record. Please recongnize that many of your experiences are USAF specific and probably of your own making. Stop throwing stones at other services and other providers who have figured out how to make things work for ourselves and our patients.

 

[USAFdoc]

You mean to tell me that you are only making $7,000 a month as a doc in the civillian world. Is that really right? I am not jumping on the "bash USAFDOC" bandwagon, I just want to check your figures. That seems very low to me. So does your $5,000 a month salary in the military.

those are what I got/get in my paycheck (after taxes etc).Not PRE-taxed pay.

the current civilian check is actually around $4000.00 and on tax returns I get about $10 K back. Same story with the military pay, and neither includes Bonus' (sign on bonus' with civilian and civilian productivity bonus's and it doesnt include military bonus').

 

[USAFdoc]

USAFdoc, what do you look like? I'm guessing you're probably a short, skinny man who was ignored and beat up as a kid. I'm not an M.D. or a Ph.D but I can sense a sissy when I see one. You say you're about the soldiers and not about the money, but most of your complaints are about how much you had to work in the Air Force and how little you were paid. If you were really selfless and cared about the soldier like you try to make yourself out to be, you'd be doing something more constructive with your life than bashing the military, who paid off your loan and allowed you call yourself "USAFdoc."

well I guess your "sensor" is malfunctioning, so is your rush to judgement. Trying to decide how "selfless and what physique I have based on a SDN thread?

FYI: all star baseball player and hoops, 2nd place on USS Carl Vinson Arm wrestling contest during my enlisted days. Involved with Big Brothers/ Sisters for 15 years etc. Basically I would say I have devoted more time volunteering during my life than most, and have had great athletic competition success.

And if you would care to read my previous posts, you would know what my motivations for presenting the truth about the current primary care environment in the USAF, instead of wasting my time and yours answering your "sissy" questions. 👎

 

[USAFdoc]

I'm proud of that post.

Thanks for bringing it back.

USAFdoc - If you had to worry about your Commander singing your bonus,,, it was because you either were a jerk, or a poor physician. No one gets their bonuses rejected unless they have really stepped on it.

Your math doesn't add up, and your financial literacy is atrocious. I also do not believe your inflated work hours. I did see a provider have similar hours but later was diagnosed with OCD....

I noticed that you didn't flesh out any of the of questions I asked you.

Malpractice, healthcare coverage, disability insurance, practice costs, etc.?

Why?

I feel sorry for you, but more so for your patients. You are not a bright bulb.

Where do you work? Can I call your supervisor and confirm that you are so euphorically happy? Obviously I don't expect you to provide this info, but the point is that disgruntled people are disgruntled and entitled no matter where they work, only in this forum for your crap to work you have to be orgasmically happy with your practice environment or all your arguments fall apart.

You are tiring, and the proverbial broken record. Please recongnize that many of your experiences are USAF specific and probably of your own making. Stop throwing stones at other services and other providers who have figured out how to make things work for ourselves and our patients.

1. I never had to worry about my signing bonus, but 2 of the 4 other military family docs I worked with were threatened with that particular scenario by our Commander. In the end, they both got the bonus, and just another example of the caustic environ of todays USAF primary care clinic.

2. The personal attacks you make reveal your weak position in this debate.

3. My USAF experiece was unique in all my life. I have never witnessed a work environ so hostile to excellence, its staff and the people we were there to help. I have never said my experience is found everywhere in the military. I am previosly enlisted, and I worked my tail off ( the youngest ever on my ship to qualify as the Reactor Supervisor). Do you see me writing threads about the dangerous or poor practices of the USNavy Nuclear Program? NO. Do you see me writing concerns about long hours in residency? NO. Do you see me writing threads about any unsafe practices of my civilian practice? NO. In fact I just "re-uped" with my current emplyer. The USAF is the ONLY job I ever had that was simply unacceptable. What I witnessed first hand in the USAF, and described elsewhere in these threads, and found to be similar with many other USAF FPs I personnally know/knew elsewhere in the USAF was nothing short of SHAMEFUL and DANGEROUS to patient care. I have and can give the specifics in this while your dialogue in this debate is mostly made of of unwarrented and innaccurate personal attacks.

so go on, send more of your "high school" verbage.

and myself and other physicians will continue to let others know that while serving in the military is an honorable thing, there are current aspects that should have no place in our military, and the current conditions in USAF Primary Care are some of them.

A last point; the same type of verbal/off the mark attack that people like A1 and others make is the same type of situation that happens when people within the military system bring up problems to the Senior Admin staff.......ie......whoever brings up problems to be discussed gets personally attacked. I recall a conversation I had with the Psych unit Commander. Early in his career, when Primary Care Optimization (PCO) was just starting, the Surgeon General was on the base and asked everyone to critique his PCO plan. When this Commander (not a Commander at that point) raised some concerns, the SG gave him a tongue lashing in front of everybody with phrases like "you are either part of the soluton or part of the problem" "you'd best be looking for a new line of work" etc.

There are many reasons on how a military health care system sinks so low, and the above (ie. attack anyone who stands up to the status quo) describes one of the most important.

 

[Galo]

Its sad when people have to personally attack you when they disagree with what we know are all truths we and any competent physician in the military is currently experiencing. Its even more sad when it comes from someone who should know a little better in the face of being in the system for a while. But then again, it just goes to show how weak and ignorant people are about a system that they choose to look the other way, ignore patient care, as long as it benefits them and their career. Truly a great advertisement about why not to join military medicine. You will undoubtedly end up with a boss like this one. SHAME

 

[resxn]

USAFdoc - If you had to worry about your Commander singing your bonus,,, it was because you either were a jerk, or a poor physician. No one gets their bonuses rejected unless they have really stepped on it.

Our hospital commander refused to sign bonuses if our peer reviews were not up-to-date. A totally reasonable request for those who have control over their peer reviews (i.e. those whose peer reviews are completed by a colleague at the same base). However, there are at least 4 one-man shops here who have to send their peer reviews out to other bases and are at that base's mercy at when they get returned. A few docs had their bonuses delayed several weeks until the peer reveiws got back from the outside docs.

Other times, the commander held bonuses until CME's were proven (e.g. waiting for the certificates to arrive in the mail), or until some other check box was accounted for.

It's not always because the provider is a jerk or is a poor physician. Sometimes, it's because the commander is.

Whether you agree with USAFdoc's experiences or not, or whether his math was bad (he did apologize btw), the vehement personal attacks are a little over the top.

I have yet to hear a military doc disparage his/her patients. I only hear about the problems with administration. I for one love my patients. I honor them. I respect them for all they have done, now do, and will in the future accomplish for my family and I and our nation. I challenge anyone to find a military doc in any branch whether disgruntled or not who wouldn't agree wholeheartedly and probably more eloquently.

It may be about the money for some or at least in part for some, it may be about unsafe administrative care, it may be about too much paperwork, it may be about being handcuffed from providing standard of care, or it may be simply morale for any number of issues, but every point if told truthfully is valid and should be considered by anyone looking at joining.

 

[Ex-44E3A]

Galo and USAFdoc speak the truth.

You can basically be assured of one thing: whenever anyone starts with the personal attacks, beats their chest, or whips out some other macho bullsh*t, they deserve nothing but ridicule or indifference (at your own preference).

A1qerty55: your diatribes about "carping bitches" really only give us a chuckle, and while I'm sure it's cathartic for you to bitch about the physicians you so despise, it only makes you look bad. Who's carping to no good end?

Contrary to what they teach you in boot camp, pointing out flaws and problems in high-stakes environments (even if it's just by complaining) is far better than sweeping them under the carpet. It takes guts (particularly in a heirarchal command-driven environment like the military) to stand up and throw the bullsh*t flag, and takes almost none to swallow your integrity, salute smartly, and drive on... and it's the height of sick irony that many in the military will pat you on the back for doing the latter.

It really speaks to one's loyalties and motivations. Physicians have a loyalty to their profession, patients, ethics and professional duty... which constitute a higher duty and loyalty than that to any simple piece of pot metal that sits on somebody's shoulder. Some have more loyalty to rank and heirarchy... but if they're honest with themselves, even those yes-man individuals, deep down in their heart-of-hearts), secretly thank Almighty God that the physician cares more about their well-being than rank or authority.

Just because military med's leadership doesn't like our objections/solutions (or is flat-out unwilling to either acknowledge or implement them) doesn't make us wrong... and attacking the messenger is standard operating procedure when you don't have an answer to the message.

Party on, Wayne.

 

[West Side]

It may be about the money for some or at least in part for some, it may be about unsafe administrative care, it may be about too much paperwork, it may be about being handcuffed from providing standard of care, or it may be simply morale for any number of issues, but every point if told truthfully is valid and should be considered by anyone looking at joining.

a1qwerty55,

I think it's really sad how this thread has devolved into ad hominem attacks on someone trying to craft a net positive outcome from his apparently miserable experience. To claim that USAFdoc has cheapened his service because he critiques the institution honestly: that's not just sad in the same way calling people traitors for questioning political policy is sad, but also shows a pretty fundamental lack of understanding what it is you're trying to accomplish.

That all you can offer is some shared sense of sacrifice or ideal merely underscores the validity of this, and other posters', concerns. You can go about playing the disinformation/misdirection game all you want, but I suspect those already engaged can see through the tactic. It is my fervent hope that those young men and women considering military medicine continue to have a resource like this (and other, positive threads) to make as fully-formed a decision as possible.

Your line of reasoning champions ignorance, incuriousity, and inaction. Attaboy!

And you can come clean, we know you're a recruiter! 😀

 

[USAFdoc]

Despite my relatively short amount of time devoted to reviewing entertaining & yet troubling threads on this forum, I have noticed that some are quite determined in their goal of bettering a non-trivial problem within US military medicine. With all good intentions and curiosity, USAFdoc, have you tried corresponding with true influntial assests such as The O-Rielly Factor. While he may or may not be a fan of yours, his program gets REAL results and with all eyes on the military and its various problems, this topic may actually attract some air-time. Americans are not happy about certain abuses and short comings they had no idea existed with what they already know as over-used and underpaid soldiers.

Some of your posts have been written eloquently and "pithy." He really might bite on this subject. Its worth a thought. In fact, I'd be willing to bet that various other news agencies would run with this story.

I say give it a try. Send him a letter each week. Persistence might get ya through his advisors. This forum would give you mad props if you pulled it off. And I, like many I believe, would think that that time spent would be better off there than defending your mostly valid issues here on this forum. Good luck if you do decide to undertake the challenge. (be sure to post your letter here so we can give it a read...or input from the been there-done thats)

-C

I have, and continue to debate that type of idea. My concern is that, once everybody knows (especially the patients) the depth of problems......the outcome of that is not entirely predictable. Would all patients demand to go to non-military institutions? Would all civilian patients start to "sue the crap" out of the military instalations? etc. Would good, hard working physicians get smeared (sued) because of the institutional problems that persist in military med?

I consider(ed) writing a book, but the time required, and resources needed are a bit much for me, with work and 2 small children at home. Thus far I have been to congress, but with all the problems they are currently dealing with, I do not expect USAF Primary Care issues to make it to the front of the line anytime soon. 😳

 

[usarmyscholar]

This website is for anyone in the New York City Metro area who is interested in learning more about the Health Professions Scholarship Program. Contact info is included...

http://www.usarec.army.mil/1stbde/1zbn/NYCHPSP

If anyone has questions for me on this forum - shoot...I have been recruiting for over a year and I have an answer for most questions. Also - I have no interest in BS'ing anyone as I leave here in 5 months to attend the Interservice Physician Assistant Program in San Antonio. I, obviously, am not a doc, but I can get you in contact with over 75 active duty Army Physicians of various specialties (including Dr. (MAJ) Merrit Pember, the ortho featured on HBO's Baghdad ER). I do not want anyone to form their opinions of military medicine and HPSP based on the rantings of 2 popular docs in this forum. I also see a lot of postings from people who feel they were lied to or otherwise misled. I'm here to get you all the right answers asap. I hope I can help!

I look forward to hearing from you!!

CPT Letourneau
[email protected]

 

[orbitsurgMD]

This website is for anyone in the New York City Metro area who is interested in learning more about the Health Professions Scholarship Program. Contact info is included...

http://www/usarec.army.mil/1stbde/1zbn/NYCHPSP

If anyone has questions for me on this forum - shoot...I have been recruiting for over a year and I have an answer for most questions. Also - I have no interest in BS'ing anyone as I leave here in 5 months to attend the Interservice Physician Assistant Program in San Antonio. I, obviously, am not a doc, but I can get you in contact with over 75 active duty Army Physicians of various specialties (including Dr. (MAJ) Merrit Pember, the ortho featured on HBO's Baghdad ER). I do not want anyone to form their opinions of military medicine and HPSP based on the rantings of 2 popular docs in this forum. I also see a lot of postings from people who feel they were lied to or otherwise misled. I'm here to get you all the right answers asap. I hope I can help!

I look forward to hearing from you!!

CPT Letourneau
[email protected]

You are multiple-posting, Mr. Recruiter. That is just about as welcome as spamming. If you want to advertise, then buy some banner ad time.

 

[USAFdoc]

Also - I have no interest in BS'ing anyone as I leave here in 5 months to attend the Interservice Physician Assistant Program in San Antonio. I, obviously, am not a doc, but I can get you in contact with over 75 active duty Army Physicians of various specialties (including Dr. (MAJ) Merrit Pember, the ortho featured on HBO's Baghdad ER). I do not want anyone to form their opinions of military medicine and HPSP based on the rantings of 2 popular docs in this forum. I also see a lot of postings from people who feel they were lied to or otherwise misled. I'm here to get you all the right answers asap. I hope I can help!

I look forward to hearing from you!!

CPT Letourneau
[email protected]

1) Glad to hear you have the right answers. I hope you can help too.👍
2) Of course you would not want prospective applicants basing their opinions on virtually any of the docs on this site, because the vast majority have had very negative experiences with todays milmed.
3) There are certainly milmd docs out there that will have more good than bad to say about milmed, and Dr Pember is likely one of them. I would counter that with the strong belief that those docs are in minority by a long shot. I will add that the most positive aspects in milmed today are likely those that do get deployed. 100% of the FPs I know preferred deployment to working in the US in our primary clinic. I think that says alot about both the priviledge to serve our troops overseas and speaks to the severe problems stateside in clinics.👍 👎
4) You may well be able to answer questions, and I trust you to be honorable and truthful, but you do not have the power to change the severe admin problems and design flaws in todays military medicine. For those who for purely patriotic reasons want to serve NO MATTER WHAT; the country needs you. But students need to realize the details of what "NO MATTER WHAT" means. And the truth is it means you may NOT have control over your specialty, may have a problems with getting enough quality cases if you are a surgeon, will likely find yourself to be surrounded by a severely undermanned and underqualified staff if you are a Family doc, and will have little to no say in how your clinic functions(or doesn't function) despite the fact that you are still 100% responsible for patient outcomes/care.You can find yourself in a lawsuit (filed by nonactive duty patients)
5) While many try and minimize the issues brought up by myself and others as "limited" or "sour grapes" etc, physicians who have been there know the truth of what is going on "on the front lines".
6) I agree with you and also encourage students to contact docs doing the job they hope to do. If you plan on being a seasoned Military Ortho doc then Dr Pember may be the person to talk to. In general, students should stay clear of "admin" docs and seek those doctors in their first few years of active duty practice, since that is most like what they will experience. In my travels, conferences, docs I know who went military after residency etc,...100% had the type of experience I did. I do know of 2 docs that did stay, and both chose to go the Admin route and get out of clinic med.
7)Your choice of words in calling the threads on this site "rants" is concerning. You can go back to the very beginning of this thread, and if you consider those types of patient care concerns "rants", then I am glad that you will never be my physician.😉

 

[a1qwerty55]

In response to my few (16 posts I think), I have received quite a bit of name calling. But of course that is the response one usually gets if you put anything which goes against the common refrain on this forum that every thing sucks about military medicine.

I can't recall them all but I've been labelled as an administrator, accepting of mediocrity, a recruiter, a poor physician, and on and on.

- I only strive for the best for my patients, my colleagues and the Army.

I addition to providing daily direct patient care, I strive daily to fix something, sometimes it is minimal, on often it actually impacts at the hospital level and on one occassion has impacted the Army Medical establishment.

My point is and has always been that change is possible but only by those with enough force of personality and vision to push the system in the right direction. Stomping into the Command Suite and venting doesn't accomplish anything but ensure that you will be dismissed. I've watched a couple of great docs who had very valid concerns undercut themselves by their actions.

Let's be clear, maybe the USAF is different but I have never had a leader at any level tell me to compromise care when there was a safety concern. Never.

I work with very gifted docs, and nurses who want to do well but are junior or may at times lack necessary training. That is when physician leadership and mentoring is necessary. I get the feeling that rather than stepping up to the helm and directing the ship, many of our negative posters, ran for the life rafts screaming.

If you think I'm some kind of recruiter, please look at some of my prior negative posts on military medicine- I don't sit here and try to paint things as great, or even good in many areas.

I hate AHLTA
Deployments
Administrative Duties
Military Specific Crap - like military training
That my pay isn't what my civilian counterparts make
That I work more hours than my civilian counterparts.
OER's, the Awards System, and ROAD officers

But - as an idealist, I take heart in the believe that as flawed as any large system is, with government entities being the worst, good people can make a difference. When it comes to medicine.. making a difference equates to lives saved, and disabilities avoided. I also know that change really has to come from internal forces rather than by placing 805 redundant posts on a website.

My anger comes from the fact that frankly I don't really have a lot of respect for many of the posters here. Many aren't doc's, those that were often have been out long enough to make their experiences dated. They are overwhelmingly USAF personnel, so as I have not had the same experiences they have had I discount many of their complaints as USAF specific. They also are overwhelmingly liberal in their politics and delude themselves into believing that but undercutting military medicine they are supporting soldiers.

I'm probably done posting here because I have far too many more important things to do than to banter on this forum. Let's face it, nothing I say, will change opinions among the established bashers here. My sincere hope is to have put written enough to make visitors try to get info from alternate sources other than this website.

I'll probably check in from time to time for the humor value but really most of this site is more sad than humorous.

 

[Galo]

In response to my few (16 posts I think), I have received quite a bit of name calling. But of course that is the response one usually gets if you put anything which goes against the common refrain on this forum that every thing sucks about military medicine.

I can't recall them all but I've been labelled as an administrator, accepting of mediocrity, a recruiter, a poor physician, and on and on.

- I only strive for the best for my patients, my colleagues and the Army.

I addition to providing daily direct patient care, I strive daily to fix something, sometimes it is minimal, on often it actually impacts at the hospital level and on one occassion has impacted the Army Medical establishment.

My point is and has always been that change is possible but only by those with enough force of personality and vision to push the system in the right direction. Stomping into the Command Suite and venting doesn't accomplish anything but ensure that you will be dismissed. I've watched a couple of great docs who had very valid concerns undercut themselves by their actions.

Let's be clear, maybe the USAF is different but I have never had a leader at any level tell me to compromise care when there was a safety concern. Never.

I work with very gifted docs, and nurses who want to do well but are junior or may at times lack necessary training. That is when physician leadership and mentoring is necessary. I get the feeling that rather than stepping up to the helm and directing the ship, many of our negative posters, ran for the life rafts screaming.

If you think I'm some kind of recruiter, please look at some of my prior negative posts on military medicine- I don't sit here and try to paint things as great, or even good in many areas.

I hate AHLTA
Deployments
Administrative Duties
Military Specific Crap - like military training
That my pay isn't what my civilian counterparts make
That I work more hours than my civilian counterparts.
OER's, the Awards System, and ROAD officers

But - as an idealist, I take heart in the believe that as flawed as any large system is, with government entities being the worst, good people can make a difference. When it comes to medicine.. making a difference equates to lives saved, and disabilities avoided. I also know that change really has to come from internal forces rather than by placing 805 redundant posts on a website.

My anger comes from the fact that frankly I don't really have a lot of respect for many of the posters here. Many aren't doc's, those that were often have been out long enough to make their experiences dated. They are overwhelmingly USAF personnel, so as I have not had the same experiences they have had I discount many of their complaints as USAF specific. They also are overwhelmingly liberal in their politics and delude themselves into believing that but undercutting military medicine they are supporting soldiers.

I'm probably done posting here because I have far too many more important things to do than to banter on this forum. Let's face it, nothing I say, will change opinions among the established bashers here. My sincere hope is to have put written enough to make visitors try to get info from alternate sources other than this website.

I'll probably check in from time to time for the humor value but really most of this site is more sad than humorous.

Good riddance. You will never understand what it means to be a good physician, as clearly you have sold your soul to the miltiary and their way of thinking. Much like the recruiter, you want to attack us personally as an explanation of why we had bad experiences. You don't want to seem to see what's right in front of your eyes, and merely dismiss it as defective attitude on our parts. By the way, it is not only USAF, its Army and Navy. The whole system has problems, and you are choosing to support them by your attitude that nothing can be so wrong as we say it is. Like I said, good riddance.

 

[USAFdoc]

In response to my few (16 posts I think), I have received quite a bit of name calling......I can't recall them all but I've been labelled as an administrator, accepting of mediocrity, a recruiter, a poor physician, and on and on.

get some thicker skin, most of those "names" are not SLAMS and some made in jest. And by the way...please go re-read your first entry again...you were the instigator in any name calling. And nobody on this site has any idea what kind of doc you are; you probably are a great doc.

- I only strive for the best for my patients, my colleagues and the Army.

as do most physicians

My point is and has always been that change is possible but only by those with enough force of personality and vision to push the system in the right direction.

nice idea, flawed in reality. So, A1, I would like you to go over to IRAQ, and with your force of personality, vision, etc, and make everybody over there play nice. RIGHT !!!!!!!! In reality, there are certain situations that go beyond what can be fixed with anything, let alone you and me as dedicated patient advocates. USAF primary care aint quite the mess IRAQ is, but while you and I can go the extra mile and give the patient in front of us good care, we DO NOT have the ability to change a system the SG apparently does not want fixed.

Let's be clear, maybe the USAF is different but I have never had a leader at any level tell me to compromise care when there was a safety concern. Never.

And I am not saying a Commander comes down with a list of 10 directives specifically stating to hurt, kill, endanger patients. No, it is more subtle than that. What you do see, is docs replaced with PAs, nurses with techs, charts with blank pieces of paper, patient per doc increased by 400%, and docs taken out of the admin decision loop.[/QUOTE]

I hate AHLTA
Deployments
Administrative Duties
Military Specific Crap - like military training
That my pay isn't what my civilian counterparts make
That I work more hours than my civilian counterparts.
OER's, the Awards System, and ROAD officers

But - as an idealist, I take heart in the believe that as flawed as any large system is, with government entities being the worst, good people can make a difference. When it comes to medicine.. making a difference equates to lives saved, and disabilities avoided. I also know that change really has to come from internal forces

and you know this how? Tell me what wonderful changes have been made because you or someone on your level was listened to and acted upon by senior admin, please. In my experience I found senior admin people to be decent people but under the major pressures to make the "metrics" better etc. Of couse they wanted safe patient care, but that was not what they were directly pressured with. As the physician seeing the patient, that is what we are most pressured with, and in the design of today's military medicine, the priority of the practicing physician counts as squat.[/QUOTE]

And what do I base my opinions above on? Speaking to every Pentagon Rep from Family Med USAF over the past 5 years, to personally speaking to the Ast SG of the USAF, to multiple Commanders, to FP docs from 10+ bases, to the teachers who teach the current model of PCO (TX school) etc. THEY EXPRESSED the same ideas, frustrations, and concerns that I list here.

 

[USAFdoc]

FYI: interesting contact; Society of Medical Consultants to the Armed Forces. below is the link. I wonder how much influence they have.......

http://www.smcaf.org/

 

[mdm2fly]

I'm considering the Navy HPSP and trying to glean info from these forums. I don't have any experience, but just looking at the threads, I feel like a lot of problems seem to stem from a lack of human resources (doctors, nurses, techs...), and if anything, it makes me want to defy all those who were trained to become military doctors, left the military and now have negative feelings about military medicine

Because the lack of human resources is primarily a consequence of people leaving the military, I don't feel comfortable basing my decision on HPSP on problems that stem from issues on unqualified staff. I am open to any responses and bashing from this stance, if there is any. From what I have read on this forum so far, there will probably be some retribution eventually. If there are any of you out there in the same decision-making position like me, maybe I'll see you at OIS, and we can work together as an entire class to try to stick it through and build a better military medicine community.

I understand that I will appear really naive/ignorant to many of you, but I wanted to get my words in anyways.

 

[TX_NFS]

I'm considering the Navy HPSP and trying to glean info from these forums.

If you haven't done so already, I would definitely recommend contacting a recruiter to see if they can hook you up with contact info. for any or all of the following: current HPSP students, active duty docs, and reserve docs. I only mention this because (through this forum!) I was able to get in contact with a Navy doc and arrange a visit to a Naval hospital (which unfortunately was a collection of clinics). Additionally, a Navy med. recruiter happened to stop by last week at my school and mentioned he would be able to search out current HPSP'ers and reserve docs that would be willing to talk with us prospective pre-meds. I am ideally also going to somehow set a visit to an Army & Air Force hospital to at least get a glimpse of the other services that I am currently ignoring. 😛 If that goes through, it should give me a broader perspective of how mil med operates... if only because San Antonio contains a major Army(Brooke) AND Air Force (Wilford Hall) hospital.

... if anything, it makes me want to defy all those who were trained to become military doctors, left the military and now have negative feelings about military medicine

Glad to know I'm not the only one. Not meaning to offend those who have shared their experiences, but I wonder if there's some weird sort of 'reverse psychology' going on here and y'all are actually helping the recruiters out. 😱 Crazy, unfounded conspiracy theory, I know...

If there are any of you out there in the same decision-making position like me, maybe I'll see you at OIS, and we can work together as an entire class to try to stick it through and build a better military medicine community.

Ah, optimism and idealism. 😀 That would be a great thing to aspire to... although I'm guessing the wide-spread, institutional changes happen at the top of the mil med command, as opposed to the bottom (practicing docs). After I get my MCAT scores, then I'll figure out if I can even hope to attend OIS. Have to get through the first hurdle before tackling something 15 years down the road and all that.

FYI: interesting contact; Society of Medical Consultants to the Armed Forces. below is the link. I wonder how much influence they have.......
http://www.smcaf.org/

Under their "GME White Papers" section, there are two PDF files regarding military GME under stress: one labeled with the date 1987 and the other labeled with 1998. Makes me wonder if the dire and gloom that posters here have been referencing has been afoot longer than they know?

 

[USAFdoc]

Because the lack of human resources is primarily a consequence of people leaving the military, .

you would think that docs leaving would be the primary cause, but it is not. The primary cause is the almighty dollar sign, and the Surgeon Generals plan to save $$ (with a poorly executed plan to do so). Here I am talking about Primary care in the military. I am sure I talk about this in earlier threads, but this is basically what happened. In the year 1999, the SG adopted something called "Primary Care Optimization" (PCO). With this, the doc/pt ratio was basically changed overnight from 700 pts/doc to 1500pts/doc. Now, the idea was to give docs more support/staff to handle that. What happened in reality is that the support/staffing really never arrived. In the USAF you also had doc billets replaced by novice PAs, an ever expanding list of collateral jobs that used to be done by other USAF personnel that fell to the PCO docs, internal med bilets closed and those pt given to FPs, reservist called up and added to the FPs (and many other pts not included in the 1500 pt panel Number chosen) and on and on.
In the end you ended up with FPs covering 3000-6000 pts at times with basically the same lack of support/staff from pre-PCO times. Now add the problem of no chart availability, 18yo techs used as your nurses, a 19 foot pile of unfiled pt results, problems with tricare/referrals etc and you may start to get the idea that todays FP in the USAF might be a little frustrated, and todays patient in a FP clinic at risk. During my time, it was a daily event for me to uncover at least one, but sometimes 3-5 missed labs, unacted upon abnormal imaging results, etc.
It would take more than this thread for me to describe everything "gone wrong" here in a few minutes. I ended up writing a 15 page paper documenting the above and more with solutions to boot. My Commander loved it (I fwded the paper through my chain of Command, with discussions along the way) and he forwarded it to the Surgeon General. I suspect the SG "slammed my Commander" for doing so because 1 month later, that Commander basically stopped all discussions with FPs in our clinic, including me.

So, do docs leaving play a role in manning levels, sure. But the level of mismanagement, and how it affects the physicians and pt care goes way, way deepeer than that.

 

[USAFdoc]

Under their "GME White Papers" section, there are two PDF files regarding military GME under stress: one labeled with the date 1987 and the other labeled with 1998. Makes me wonder if the dire and gloom that posters here have been referencing has been afoot longer than they know?

the site you mention, and that society are ACTIVE. You happened to mention 2 older referrences. The site also mentions that the society has been around since like 1948 (which makes me think that they have little influence because things are terrible in the exact areas they are suppoosed to champion). The site mentions that they have regular meeting at USUHS, and how one can join.

I have mentioned numerous articles, sourses etc in this thread that are also active up-to-date sources (as are the docs on this site). You may wish to dismiss everything anybody tells you on this site, thats your option. And hopefully milmed is much better 5-10 years down the line. But, my opinion is that medicine in general is, and will continue to be under more and more "stress" both civilian and military for many reasons. And the military will be exponentially worse off because of the managment design, lack of physician control, lack of adequate and qualified staff, culture (just shut up and do it), micromanaging, and leadership which has placed the almighty metric in front of Core Values.

 

[TX_NFS]

the site you mention, and that society are ACTIVE. You happened to mention 2 older referrences. The site also mentions that the society has been around since like 1948 (which makes me think that they have little influence because things are terrible in the exact areas they are suppoosed to champion).

My apologies, but I was not implying that that society or its site was dead. The main reason I mentioned those two white papers is because I had thought many people here bemoaned the current, declining state of military GME (compared to previous, better times). Therefore, the downward spiral may not have happened only within the last decade but is in fact part of a larger trend. If that is the case (along with what you pointed about this society existing since 1948 and having a minimal effect), then I agree the outlook is not good.

I have mentioned numerous articles, sourses etc in this thread that are also active up-to-date sources (as are the docs on this site). You may wish to dismiss everything anybody tells you on this site, thats your option. And hopefully milmed is much better 5-10 years down the line.

I admit I have not really gone through this thread in some time (before I think I did when I was lurking here a year ago). As much as it makes me depressed, I guess a poignant reminder of how messed up milmed is and could be in the future is not such a bad thing. It is true that I could dismiss everything here on these forums as false, but that probably won't happen unless I find other evidence to the contrary. On the other hand, naiveté and hope for entering something not completely screwed up also fuel my skepticism.

But, my opinion is that medicine in general is, and will continue to be under more and more "stress" both civilian and military for many reasons.

Lovely setting we're all moving into... 🙁

I hope I filled my "piss other people off" quota for the time being and will endeavor to not idly comment on things I have no knowledge about. That being said, beware of my questions on those very same things! (If that made no sense, eh, it happens with me a lot.)


Edit: Well, thanks to stumbling across one of the article citations in this thread, I can now say that I have yet another source of info. at my disposal I hadn't yet considered: a research article database (e.g. PubMed). As if I didn't have enough other things to research. 😛

 

[USAFdoc]

delete

delete

 

[USAFdoc]

I hope I filled my "piss other people off" quota for the time being and will endeavor to not idly comment on things I have no knowledge about. That being said, beware of my questions on those very same things! (If that made no sense, eh, it happens with me a lot.)

there is really no reason that people have to "piss off" each other on this site. Usually what happens is somebody without direct experience of exactly what the physicians on this site speak, go about trying to either:

1) go with the ad hominem, personal attacks because they get angry that someone might have negative things to say about milmed.

2) they have a different experience as a doc that was not as negative (this is a rare doc), or they are students/residents and make claims for which they have no experience with.

Most 100% of the people on this site want the same thing; great care for our patients, and a reasonable quality of life for our staff, families, and ourselves. For some of the more lucrative specialities $$$ may play more of a role in satisfaction, but I really believe that for most all docs who joined, this is a minor point. It becomes more of a point though when the quality of care and quality of life erodes to the point that docs start to think that the job "is just not worth all the heartaches", and then consider that adding some $$$ would "ease the pain". Speaking only for myself, I would not have re-upped for even $300 K/ year as a FP doc, thats how bad, and how frustrated, and how against my "Core Values" (and USAF Core Values for that matter) things had fallen to.

 

[deliverer]

Hi,

Just to set the record straignt fot a1qwerty55. The board certification pay is NOT $1,000/month. It is $2500/year look it up at dfas.mil.

I am a practicing physician small meddac in the Army. a1qwerty55, attacking the AF doc who is now a civilian is unwarranted.

If I had to do it all over again, I wouldn't. I didn't realize that I would be so marginally as a staff physician. I expected in residency, but not as staff. My specialty works more hours than most. Granted it what I have chosen. But, let me give you a laundry of list things that are asinine.

1. ALTHA is clumsy and not designed provider friendly. It was designed for bean counters. Yes, I need to know how to do coding, however, the Army does not have the funds to send anyone on mystaff to a coding course. Neither med school or residency provided the necessary education for it.

2. The command, meddac or higher, makes decisions that affect providers w/out asking us. I could list many instances of such.

3. The Army moving to RVU based reimbursement (actual global budgets) is entirely stupid.

4. Micromanagement by command who are not physicians, is not appropriate.

5. GS civilian employees making management, clinic decisions because they can is inappropriate.

6. The meddac overhauling complete floors i.e. L&D w/o one physician input.

7. Not having control of your schedule, Tricare books anything and everything which is not appropriate. i.e. R/O triple A when I am not an internist or general surgeon.

8. Counting physician extenders as full time equivalent provider, when they should be only .75. This is done to de-emphasize the actual provider shortfall at the meddac.

9. When we are suppose to have certain number of providers and are short. Command still wants the "green suitors to fill the gap at all cost!"

10. When we have providers deployed, but still count as a FTE employee at the meddac; therfore, we can't get a new provider or contractor.

11. Being told by the DCCS, what, where, when, type of patient to see. I am not a resident anymore.

12. Nurses who out rank me not only question by care plans but goto into patient rooms w/o authorization to tell them about complications, when I have already discussed it w/ the patient. Then proceed to order crap in my name, when I never authorized it. This occurs just because they out rank me. Talk about loss of credability w/ my patient.

13. Finally, seeing the government pay civilian contractors 3 times more money and work 1/3 less than me. How does that work?

14. Providers have absolutely no input in how the hospital is run.

I am sick and tired of people who just say do it for your country. Patriotism is fine, I did it for it. I have volunteered for the next round of CSH deployments to IRAQ/Afganistan to help the brave soldiers in combat. However, if my recruitor told me that all above would occur, I would have simply declined. Again, if military medicine was good for providers, why is the retention rate for HPSP only 15%, quoted by the surgeon general and it's getting worse. The moral at my institution is so low, and the general view of my friends is so bad, where in the world are you practicing. FYI, from my experience, providers who have stayed past their initial commitment were for fellowships, academy grads w/ USHUS/HPSP scholarships or they got cushy jobs at medcens having residents do all the work.

Disenchanted

 

[R-Me-Doc]

Hi,


I am a practicing physician small meddac in the Army. . . . If I had to do it all over again, I wouldn't. . . .

Disenchanted

Welcome to the fold.
Grit your teeth, suck it up, stick it out. It'll eventually be over.
Best of luck with deployments, I hope all goes well for you.

X-RMD

 

[Ex-44E3A]

Welcome to the fold.
Grit your teeth, suck it up, stick it out. It'll eventually be over.
Best of luck with deployments, I hope all goes well for you.

Yep... what he said. Keep your head down, we'll see you when it's all over.

 

[USAFdoc]

Hi,

Just to set the record straignt fot a1qwerty55. The board certification pay is NOT $1,000/month. It is $2500/year look it up at dfas.mil.

I am a practicing physician small meddac in the Army. a1qwerty55, attacking the AF doc who is now a civilian is unwarranted.

If I had to do it all over again, I wouldn't. I didn't realize that I would be so marginally as a staff physician. I expected in residency, but not as staff. My specialty works more hours than most. Granted it what I have chosen. But, let me give you a laundry of list things that are asinine.

1. ALTHA is clumsy and not designed provider friendly. It was designed for bean counters. Yes, I need to know how to do coding, however, the Army does not have the funds to send anyone on mystaff to a coding course. Neither med school or residency provided the necessary education for it.

2. The command, meddac or higher, makes decisions that affect providers w/out asking us. I could list many instances of such.

3. The Army moving to RVU based reimbursement (actual global budgets) is entirely stupid.

4. Micromanagement by command who are not physicians, is not appropriate.

5. GS civilian employees making management, clinic decisions because they can is inappropriate.

6. The meddac overhauling complete floors i.e. L&D w/o one physician input.

7. Not having control of your schedule, Tricare books anything and everything which is not appropriate. i.e. R/O triple A when I am not an internist or general surgeon.

8. Counting physician extenders as full time equivalent provider, when they should be only .75. This is done to de-emphasize the actual provider shortfall at the meddac.

9. When we are suppose to have certain number of providers and are short. Command still wants the "green suitors to fill the gap at all cost!"

10. When we have providers deployed, but still count as a FTE employee at the meddac; therfore, we can't get a new provider or contractor.

11. Being told by the DCCS, what, where, when, type of patient to see. I am not a resident anymore.

12. Nurses who out rank me not only question by care plans but goto into patient rooms w/o authorization to tell them about complications, when I have already discussed it w/ the patient. Then proceed to order crap in my name, when I never authorized it. This occurs just because they out rank me. Talk about loss of credability w/ my patient.

13. Finally, seeing the government pay civilian contractors 3 times more money and work 1/3 less than me. How does that work?

14. Providers have absolutely no input in how the hospital is run.

I am sick and tired of people who just say do it for your country. Patriotism is fine, I did it for it. I have volunteered for the next round of CSH deployments to IRAQ/Afganistan to help the brave soldiers in combat. However, if my recruitor told me that all above would occur, I would have simply declined. Again, if military medicine was good for providers, why is the retention rate for HPSP only 15%, quoted by the surgeon general and it's getting worse. The moral at my institution is so low, and the general view of my friends is so bad, where in the world are you practicing. FYI, from my experience, providers who have stayed past their initial commitment were for fellowships, academy grads w/ USHUS/HPSP scholarships or they got cushy jobs at medcens having residents do all the work.

Disenchanted

sounds like there are alot of similarities between USAF and ARMY primary care.

1) the 15% retention rate is bad, but when you consider that probably all of those 15% that stay in are actually people that "stay in" to "get out" of clinical FP positions (they go admin, or get fellowships in sports med etc) you realize that the "real retention rate" (people staying as FPs taking care of FP patients) is probably about ZERO%.

2)The complete management FAILURE, by design, to implement whatever, whenever, by whomever....without as much as even asking those whom it most effects (the doctors and our ability to give timely and safe care) is ludicrous at best and reckless at worst.

3) One of the things that I did, perhaps different from most, was that I became VERY concerned about pt care when I began to notice huge amounts of abnormal labs, imaging studies etc, that were not in charts; not addressed etc. When I would do charts audits, nearly 100% of people over the age of 40 would have at least one glarring error in treatment (like pts with a LDL of 250, smokers, fam hx CAD, and no mention in the chart that the pt ever even told of the result let alone treated..................like pts with an U/S of the kidney consistent with cancerous kidney masses and no mention in the chart that pt ever notified etc). I spent alot of time finding and correcting these errors, but I know that this was only the "tip of the iceberg" (we had 20,000 pts assigned to our base) and typically only 2-3 FPs in the clinic.
What makes the military system so prone to these types of errors? The complete lack of continuity between pts and docs, lack of chart availability, lack of support staff, typical provider protocol of NOT printing out lab/imaging results (they just were reviewed in CHCS computer), lack of any "paper trail" on who viewed/acted on lab results, complete lack of staff/team continuity (I had 25+ changes to my PCM team in 3 years, all done without my input/request).

4) and lastly, I am with you in that, had I known how sadly poor the military primary care health design/management is, I would NEVER have placed myself, my family, my patients in such as position. Certainly our fellow soldiers who have lost their lives in service to our country have given more, sacrificed more.................but there is NO EXCUSE for the level of incompetence that our military currently performs at in the arena of primary care. NONE.👎

 

[RichL025]

What makes the military system so prone to these types of errors? .... lack of chart availability, lack of support staff, typical provider protocol of NOT printing out lab/imaging results (they just were reviewed in CHCS computer), lack of any "paper trail" on who viewed/acted on lab results,

As painful as it is to use, the AHLTA (tm) system addresses these particular issues.

I was even able to view lab & imaging results (but not the actual films) on studies performed on patients while they were in Iraq.

 

[resxn]

As painful as it is to use, the AHLTA (tm) system addresses these particular issues.

I was even able to view lab & imaging results (but not the actual films) on studies performed on patients while they were in Iraq.

And this may be the singular good thing about AHLTA.

My current favorite pet peeve is that when they recently updated AHLTA what happened to us is this:
If you go into A/P and type in the diagnosis and perhaps the meds and labs that you want to order and then leave to do the subjective and later come back, the diagnosis stays, but the ICD-9 code disappears.

This wouldn't be a problem except that TriCare still uses CHCS, not AHLTA, to get their codes. So what happens? If you don't catch the drop, you have to go back into AHLTA, find the right patient encounter, ammend the encounter, select the dropped code, delete the diagnosis (but be sure to save any info you typed in under than dx), resubmit the diagnosis (pasting back in the data you may have typed in), and then sign the note again.

Classic example of the bullcrap that adds time to an already miserable day in clinic.

What I wouldn't give to stay in the OR all day.

 

[USAFdoc]

As painful as it is to use, the AHLTA (tm) system addresses these particular issues.

I was even able to view lab & imaging results (but not the actual films) on studies performed on patients while they were in Iraq.

yes, that is a benefit. Still, you have years of "misses" floating out there.

With AHLTA, are things just added that are "new" tests/labs, xrays etc....or is somebody adding the old stuff into the record etc.?

 

[deliverer]

My current favorite pet peeve is that when they recently updated AHLTA what happened to us is this:
If you go into A/P and type in the diagnosis and perhaps the meds and labs that you want to order and then leave to do the subjective and later come back, the diagnosis stays, but the ICD-9 code disappears.


Oh yes, that is one of my favorites too. I have the "admin offiicer" from the department of surgery on me everyday about completing my charts. Because, as you know the chart is complete but AHLTA will not allow me to close the encounter because of the ICD-9 codes disappearing. His daily emails to remind me that I am deficient and will be reported to Chair of Surgery, DCCS and hospital commander is infuriating.

Another complaint is that the hospital commander wants us to be as efficient as the civilian providers, but the catch is that we do not have enough providers and support staff. Additionally, the hospital as a hiring freeze because they hired too many administrative personnel, who tell me that I am not efficient.

 

[USAFdoc]

My current favorite pet peeve is that when they recently updated AHLTA what happened to us is this:
If you go into A/P and type in the diagnosis and perhaps the meds and labs that you want to order and then leave to do the subjective and later come back, the diagnosis stays, but the ICD-9 code disappears.


Oh yes, that is one of my favorites too. I have the "admin offiicer" from the department of surgery on me everyday about completing my charts. Because, as you know the chart is complete but AHLTA will not allow me to close the encounter because of the ICD-9 codes disappearing. His daily emails to remind me that I am deficient and will be reported to Chair of Surgery, DCCS and hospital commander is infuriating.

Another complaint is that the hospital commander wants us to be as efficient as the civilian providers, but the catch is that we do not have enough providers and support staff. Additionally, the hospital as a hiring freeze because they hired too many administrative personnel, who tell me that I am not efficient.

one of many "stupid" things that ADMIN did to us at our base was to insist that we use PGUI (which really served no actual purpose at the time) because they said they wanted to report a "nice metric" in terms of physicians using the program. We then found out 2 months later that they reporting idea was scrapped and us using PGUI was now 100% worthless (not even good for a metric). ANd you would have thought that the commander would have at least let us know this so we could stop wasting our time with every patient encounter, but he did not. And he did know that the reporting idea was scrapped ahead of time (as has PGUI been scrapped....another waste of millions).😛

 

[resxn]

one of many "stupid" things that ADMIN did to us at our base was to insist that we use PGUI (which really served no actual purpose at the time) because they said they wanted to report a "nice metric" in terms of physicians using the program. We then found out 2 months later that they reporting idea was scrapped and us using PGUI was now 100% worthless (not even good for a metric). ANd you would have thought that the commander would have at least let us know this so we could stop wasting our time with every patient encounter, but he did not. And he did know that the reporting idea was scrapped ahead of time (as has PGUI been scrapped....another waste of millions).😛

Sounds familiar to our commander who insists we do as many surgical cases at our ambulatory surgery center because of how much money it helps generate even though he is well aware of the difficulty of doing surgeries there due to constraints on equipment purchases. And here is the kicker, even though he knows the ASC is going to close in 18 months. That's already decided and not up for debate. He wants to squeeze the surgeons for every last cent he can before the ship sinks simply because in our MDG, the ever-shrinking surgical department floats the business plan.

On the metrics, we're the only 6 providers who are always in the green in RVU's every month every year.

Also, there's only going to be only one AD surgeon left after this summer anyway. He can't float the ASC.

Again, the writing is on the wall.

 

[USAFdoc]

[

QUOTE=resxn;4774994]Sounds familiar to our commander who insists we do as many surgical cases at our ambulatory surgery center because of how much money it helps generate even though he is well aware of the difficulty of doing surgeries there due to constraints on equipment purchases. And here is the kicker, even though he knows the ASC is going to close in 18 months. That's already decided and not up for debate. He wants to squeeze the surgeons for every last cent he can before the ship sinks simply because in our MDG, the ever-shrinking surgical department floats the business plan.

On the metrics, we're the only 6 providers who are always in the green in RVU's every month every year.

QUOTE]

myself and one of the other milFPs used to have a friendly competition of who could get the most RVUs per day. (the USAF standard was 25). We would usually produce between 30-40 RVUs per day..............................and did it really matter? NO.....admin was still constantly on our case...do more, see more, walk in more patients etc...............another twist the Sg's office did was to downgrade RVUs........they would subtract a large % of the RVU stating this was "support staff RVU" and that would then reduce the doc RVUs significantly, making things look worse. They would also present average RVUs per doc/MTF and make that the standard (problem being that they would include docs deployed, TDY etc in the denominator of their RVU equation, again, making it look as if the docs there were not as productive as they really were).

just a few more of the millions of examples of just how anti-physician USAF primary care has become, and how poorly admin does their job. 🙂

 

[USAFdoc]

below is a link from CNN on the deplorable conditions at one of our milmed hospitals. A senior official describes the cause as a "failure of leadership", and while that is not the entire story, I would have to agree that that is the biggest part of the problem.

As I have stated elsewhere, medicine in general is under considerable financial stress, technological stress etc. Milmed is not any different. Where milmed run into DEEP problems is how they have designed thier leadership/power hierchy. In the military, the physicians seeing patients (not admin) have near ZERO authority,; near ZERO voice to anyone who has any authority. The deplorable conditions listed at Walter Reed could NEVER, NEVER, NEVER happen at my current civilian hospital. The reason why; the physicians would DEMAND that things be fixed, and if they were not, the docs would leave. In milmed, the docs can demand all they want, and the deaf ear of admin is the response. And they cannot leave until the DOS arrives, and they do leave then (again, in FP at least, any retention rate listed above ZERO % is mostly docs who stayed to GET OUT of clinical duties (went admin) or switched to occ med/sports meds fellowships etc).


http://www.cnn.com/2007/US/02/20/walter.reed/index.html