Avoid Military Medicine

[navysurgeon]

I get out in a month.

It'll be the happiest days of my life.

Well, second only to the day I matched in plastics.

TNS

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[militarymd]

I get out in a month.

It'll be the happiest days of my life.

Well, second only to the day I matched in plastics.

TNS

Congratulations!!!!

 

[GMO2003]

I get out in a month.

It'll be the happiest days of my life.

Well, second only to the day I matched in plastics.

TNS

AMEN to that...and congrats!!!! AWESOME!!!

 

[UncleRico]

I am a sucker USUHS grad stuck on this sinking ship until 2014.

To all of you out there trying to decide whether or not to join, read NavySurgeons words carefully. Like 90% of all active duty docs in my dept, he can't wait to get out. In other words, they can't wait to be civilians like you! So, those of you that are civilians, stay that way and you will be glad you did.

Student loans are cheap. DO NOT JOIN THE MILITARY FOR FINANCIAL REASONS!!!!! It is not worth it.

 

[Croooz]

You guys are sooo wrong.

Military medicine is AWESOME! You get to do all kinds of cool stuff which have nothing to do with medicine. It's a blast to have studied so hard to get in medical school, make it thru school, make it thru residency and now not even have to worry about all those pesky medical issues.

Hoorah!

 

[aatrek]

Note:
having rotated and know MDs at penn, penn state, UIC, and four other less known programs, I can tell you that most of those civilian docs are also always complaining and CAN NOT WAIT TO GET OUT OF WORK..
In fact, in IL in the last year I know three physicians that joined the military cause they got sick of the ins crap and two others that retired early (even through they had to pay their ins tail (tens of thousands of dollars)..


All I am trying to say, is just imagine for once that the grass just might not be any greener on the other side..

A.

 

[militarymd]

Once again, note the trend....those who ARE docs in the military...diss it....those who want to be docs in the military say great things about...


I've been in, and now I'm out in private practice. There grass is WAY greener out here....and if it isn't, you can CHOOSE where you want to go, what you want to do, anytime you want.

While you're in....THEY OWN YOU.

 

[qqq]

I think this forum is a nice breather every once in awhile. When I'm at work and around superiors and subordinates, my uniform is sharp, I tote the party line with the best of them, and I'm motivated, motivated, motivated, Sir! It's simply not worth complaining out in the open because it's bad for your people and bad for your image, career, etc. It only hurts the mission . . . But boy, when I'm at home and I just need some perspective, it's nice to come to this forum and see that I'm not the only one fed up with certain aspects of the military. Now, I'm certainly a firm believer in a positive attitude, but the reality is that it is very comforting to know that I am not alone in seeing some of the less than great things that happen in the military. Anyway, it must be a great feeling to know that you are 'out.' From my perspective still waist-deep in commitment, I can only day-dream about how that must feel.

 

[GMO2003]

While you're in....THEY OWN YOU.

you hit the nail on the head with that statement...the lack of freedom to do whatever the hell you want to do whenever is what is so friggin unbearable...

 

[militarymd]

I can tell you that most of those civilian docs are also always complaining and CAN NOT WAIT TO GET OUT OF WORK..
In fact, in IL in the last year I know three physicians that joined the military cause they got sick of the ins crap and two others that retired early (even through they had to pay their ins tail (tens of thousands of dollars)..

A.

That's the point......don't work if you don't want....join the military if you want....retire early if you want....You can do whatever you want....you have choices....

In the military.....you have no choice....wait you do...you can do what you're told to do...or go to the brigg

 

[Capt_Mac]

Someone up there said that one should not go into the military for financial reasons.... This is what I tell anyone who asks me about HPSP. The military has some advantages... some, and the single biggest disadvantage is that you are in the military and THEY OWN YOU! (And they will remind you of this at every possible conveince.) One of our staff surgeons has spent 3 of the last 4.5 years deployed to some forsaken country that no one really cares about, sitting around and doing nothing. My tail is owned until 2014 as well. Honestly, if I had to do it again I would give some serious reconsideration to HPSP or any military commitment.

 

[grumbo]

I've been reading this board for about a year and a half now and there is just so much negativity it's just crazy. I was going to go on a long tirade about military medicine, but I know I'd just be dismissed as an idealistic young medical student. I'm sure there are many people who enjoy military medicine on this site, but don't want to get into an argument. I see two types of people in military medicine, people who got screwed over in some fashion, and those who didn't. One will be angry at the system and the other will likely be comfortable in their job. No matter what the screwed to non-screwed ratio is (50:50, 1:99, or 99:1), you will always hear more comments from the angry people.

My point is with all of the complaining on this board, it seems like no one is happy with military medicine, when that is just not true. There are plenty of people content with military medicine (it's not perfect but they enjoy it), but the only people with cause to speak up are those who are angry at the system. Complain if you want I suppose, it's my fault for reading it.

 

[Capt_Mac]

I've been reading this board for about a year and a half now and there is just so much negativity it's just crazy. I was going to go on a long tirade about military medicine, but I know I'd just be dismissed as an idealistic young medical student. I'm sure there are many people who enjoy military medicine on this site, but don't want to get into an argument. I see two types of people in military medicine, people who got screwed over in some fashion, and those who didn't. One will be angry at the system and the other will likely be comfortable in their job. No matter what the screwed to non-screwed ratio is (50:50, 1:99, or 99:1), you will always hear more comments from the angry people.

My point is with all of the complaining on this board, it seems like no one is happy with military medicine, when that is just not true. There are plenty of people content with military medicine (it's not perfect but they enjoy it), but the only people with cause to speak up are those who are angry at the system. Complain if you want I suppose, it's my fault for reading it.

One thing that you will see in your military career is, if a soldier ain't bitchin' he ain't happy. Many of us are looking for some form of outlet to express our frustration with a system that is overrun with clipboard carriers and then throw deployments on top of it. Imagine the largest HMO in the country and that is TRICARE. Top that off with staff changeover and being deployed to the dessert for 6-18 months. From what I have heard these are mind numbingly boring with spurts of chaos and mass casualty. Very stressful. You cannot blame anyone for voicing discontent or wanting to get over to the other pasture that sure looks a lot greener than the sandy one where they are standing.

 

[grumbo]

I can understand complaining, but there is just so much of it, this board is making it seem as there there are no possitives to military medicine other than paying for school. As far as OIF/OEF, our troops are over there whether we like it or not, and so they need docs to be over to take care of them. If I don't go over there to take care of them, someone else has to and that's not fair of me to push my responsibility off on someone else. My father left for the first Iraq war on Christmas Day and who do you think we wanted taking care of him? A medic? A nurse practitioner? A GMO? Or a certified doc? We wanted the doc as part of that system taking care of him. Families want that for their soldiers, so I willing to be that bored doc out there intermittenly using my skills because that's what I signed up for - not constantly deployed, but when I'm asked to go, going. The families and the soldiers deserve that.

I can understand blowing off steam, but don't hate the system; it's all we've got.

 

[militarymd]

There are plenty of people content with military medicine (it's not perfect but they enjoy it), but the only people with cause to speak up are those who are angry at the system.

I post on the anesthesiology board....I post positive things about anesthesia and critical care medicine(my specialties).... I see plenty of other attendings posting postive things about various aspects of medicine....

This board is the exception...I wonder why?????


The idea of military medicine is great...that's what idealistic medical students picture.....but that aspect of military medicine is a tiny percentage of what actually goes on (maybe a little more now that we actually have casualties on a daily basis).....99.99% is bull**** crap created by clipboard commandoes bucking for their next promotion.

 

[aatrek]

Wow.. So much anger... so much.... remember .. Anger leads to hate. Hate leads to suffering, all lead on a path to the dark side....

May I suggest everyone just chill and do what he or she wanna do.. Seriously.. All this bickering is getting me nauseated.. and that’s also a path to the dark side..very very dark..

Loved SW III.. The best of the six.. Don’t you guys agree.. ?

 

[militarymd]

Wow.. So much anger... so much.... remember .. Anger leads to hate. Hate leads to suffering, all lead on a path to the dark side....

Senator Palpatine = Recruiter

Young Anakin Skywalker = Medical Student

Senator Palpatine reveals his true self....The Evil Emporer Darth Sideous = Military medicine reveals itself to be a hateful bureaucracy which snuffs out the dreams of young physicians.

Anakin becomes evil Darth Vade trapped in his armor = Medical Student becomes embittered physician who has sold his soul and is trapped wearing his uniform until his time is up....

So I guess the physician is better off then Darth....obligation ends with private practice....Vader had to die.

 

[docbrown76]

For those of you considerig military medicine, "do your homework" before raising your right hand. As indicated in some of the earlier posts, military medicine is not for everyone. To make an informed decision, I suggest talking with (face-to-face) military physicians at a nearby military medical facility. Most will be more than willing to offer their opinion on this topic. From my experience, you will likely get 2 very different perspectives on military medicine. Most either hate it or they love it.

I have served with both Navy and Air Force docs over the past 9 years, and most (not all) indicated to me that overall they enjoyed their military service. In fact, many have gone on to retire or are approaching retirement. I am not trying to "polish" military medicine into something that is not. This is simply my experience working with military physicians.

With that said, please look beyond this post/forum for answers to very important questions regarding your career.

 

[navysurgeon]

are you the onc guy at madigan?

just curious.

 

[R-Me-Doc]

I've been reading this board for about a year and a half now and there is just so much negativity it's just crazy. I was going to go on a long tirade about military medicine, but I know I'd just be dismissed as an idealistic young medical student. I'm sure there are many people who enjoy military medicine on this site, but don't want to get into an argument. I see two types of people in military medicine, people who got screwed over in some fashion, and those who didn't. One will be angry at the system and the other will likely be comfortable in their job. No matter what the screwed to non-screwed ratio is (50:50, 1:99, or 99:1), you will always hear more comments from the angry people.

My point is with all of the complaining on this board, it seems like no one is happy with military medicine, when that is just not true. There are plenty of people content with military medicine (it's not perfect but they enjoy it), but the only people with cause to speak up are those who are angry at the system. Complain if you want I suppose, it's my fault for reading it.

Let me just point out the simple fact that medical corps retention is dismal. In case you just don't get it (which obviously you don't) that's because PEOPLE ARE VOTING WITH THEIR FEET RIGHT AND LEFT, EVERY DAY, by getting out as soon as their commitment is up. If military medicine is so wonderful and there are so many satisfied docs out there, how come me and another 8 of my fellow docs at my MTF who are eligible to leave next summer (out of a total of 10) are going to do so? That's a real statisitic, not made- up numbers. I don't know where you are getting your info from, but medical corps morale right now is probably at an all time low, and I haven't seen much to suggest that it's going to trend upward any time soon.

. . . . so I'm willing to be that bored doc out there intermittenly using my skills because that's what I signed up for. . . .

I'm glad you signed up to not use your skills. Skills not frequently used = skills lost. Maybe when your skills have completely atrophied they can make you a clipboard commando, put you in charge of whatever military hospitals are left, and you can drive out the last few remaining decent docs.


RMD 1-1-4

 

[Globus P]

For the doctors on this forum, in lieu of the dissatisfaction with military medicine, what specialties would you recommend a current Navy HPSP MS3 student to shoot for, or at least to stay away from?

Are there any Navy specialties less-malignant, less-negative than others? Physicians with a lesser amount of dissatisfaction? Family vs ER vs Surgery?

I've already signed on the dotted line and now need to make the best of it. Any advice would be welcome.

 

[traumasurgeon]

I'm an army surgeon stationed in a small hospital in the midwest. I spend half the time fending off the "clipboard commandos" and hate it. However, I spent several months in Iraq and was as busy as I ever was in residency and loved it. Other than the fact that I was away from my family, it was the best experience in my life. I was helping people and saving lives every day, American and Iraqi. I did over 200 cases. I know this was a better experience then most docs have because I was lucky enough to be stationed in a busy Combat Support Hospital. But this is what I dreamed medicine and surgery would be like when I was a student. Fortunately I made it back home in one piece to my family. Unfortunately, I am back to dealing with all the administrative BS. Too bad nothing is ever perfect.

 

[GMO2003]

I'm an army surgeon stationed in a small hospital in the midwest. I spend half the time fending off the "clipboard commandos" and hate it. However, I spent several months in Iraq and was as busy as I ever was in residency and loved it. Other than the fact that I was away from my family, it was the best experience in my life. I was helping people and saving lives every day, American and Iraqi. I did over 200 cases. I know this was a better experience then most docs have because I was lucky enough to be stationed in a busy Combat Support Hospital. But this is what I dreamed medicine and surgery would be like when I was a student. Fortunately I made it back home in one piece to my family. Unfortunately, I am back to dealing with all the administrative BS. Too bad nothing is ever perfect.

does the army have any medcens in the midwest??

 

[notdeadyet]

I was going to go on a long tirade about military medicine, but I know I'd just be dismissed as an idealistic young medical student.

How long a tirade could it be if you're still a medical student?

I like a balanced picture. For the good, happy, all-is-well side of military medicine, I can read the articles, folks blogs, military marketing materials, etc. They are out there.

What's hard is to find the sizable number of military physicians who aren't happy with their arrangement. This forum has them and it's nice to see the reasons NOT to join (if you're on the fence) and potholes to avoid if you do join (if you're committed).

The ratio aspect you're talking about _is_ interesting. You see lots of happy anesthesiologists and ER docs posting on their residency forums. I take this as a good testimony to the fields. You see lots of unhappy military docs posting on this one. That makes me say "hmmmm...".

Nice to have the balance though. SDN is obviously dominated by med students and pre-meds. Nice to see practicing physicans sounding off to give the rest of us the real scoop.

 

[notdeadyet]

I post on the anesthesiology board....I post positive things about anesthesia and critical care medicine(my specialties).... I see plenty of other attendings posting postive things about various aspects of medicine....

Cr@p. Posted without reading that mmd spoke my mind already. Cheers...

 

[Capt_Mac]

does the army have any medcens in the midwest??

Sorry, only MEDCENs are:

BAMC
William Beaumont (barely)
Eisenhower
Walter "Wonderful" Reed
Tripler (the great pink building in the sky)
Madigan

There are several MEDACS:

These aren't so bad. You just have to avoid the "clipboard commandos", which tend to dominate those environments.

 

[USAFdoc]

Let me just point out the simple fact that medical corps retention is dismal. In case you just don't get it (which obviously you don't) that's because PEOPLE ARE VOTING WITH THEIR FEET RIGHT AND LEFT, EVERY DAY, by getting out as soon as their commitment is up. If military medicine is so wonderful and there are so many satisfied docs out there, how come me and another 8 of my fellow docs at my MTF who are eligible to leave next summer (out of a total of 10) are going to do so? That's a real statisitic, not made- up numbers. I don't know where you are getting your info from, but medical corps morale right now is probably at an all time low, and I haven't seen much to suggest that it's going to trend upward any time soon.







I'm glad you signed up to not use your skills. Skills not frequently used = skills lost. Maybe when your skills have completely atrophied they can make you a clipboard commando, put you in charge of whatever military hospitals are left, and you can drive out the last few remaining decent docs.


RMD 1-1-4

the afpc believes they can continue to minimally staff our clinics at a rate just barely enough to keep them open; and unfortunately, they are probably correct,because there will be just enough HPSPers that have no idea on what waits "on the other side" to keep the doors open. The afpc is not about taking care of patients or staff; its about money and metrics. This perversion of medicine continues because the clinic physician has absolutely no power in this system (except to separate at DOS.)

I have been working in various fields for 22 years and in many organizations; the current state of primary care med in the USAF is unquestionably the worst I have ever seen. Avoid at all cost.

 

[UncleRico]

the afpc believes they can continue to minimally staff our clinics at a rate just barely enough to keep them open; and unfortunately, they are probably correct,because there will be just enough HPSPers that have no idea on what waits "on the other side" to keep the doors open. The afpc is not about taking care of patients or staff; its about money and metrics. This perversion of medicine continues because the clinic physician has absolutely no power in this system (except to separate at DOS.)

I have been working in various fields for 22 years and in many organizations; the current state of primary care med in the USAF is unquestionably the worst I have ever seen. Avoid at all cost.

This post basically sums up why many of us that are on AD post. We see how broken the military medical system is, and we realize that we had no clue what we were getting into when we were 22 to 24 year-old pre-med students. The problem is that the continual influx of clueless pre-meds who sign up for USUHS/HPSP allows the military to perpetuate the horrible system because physicians are not empowered to make changes or to even to get out and work somewhere else. Probably the only way that the system could possibly change for the better is if there were a significant drop-off in med student applications and therefore forcing the higher-ups to address these critical issues out of necessity.

But that is but a pipe dream for many of us, as we continue to watch inherently naive pre-meds zealously defend their reasoning about why military medicine is so great, in spite of what scores of active duty docs say on this board to the contrary. Meanwhile, military medicine is allowed to limp along in its current sad state, because there still enough poorly informed pre-meds who are willing to sign up.

 

[militarymd]

I've been posting here since December 2003. For a while, it felt like I was the only physician who has completed training posting here....I'm glad others are starting to post here to support my views to contrast those who are looking forward to completing training and joining the ranks.

 

[RichL025]

But that is but a pipe dream for many of us, as we continue to watch inherently naive pre-meds zealously defend their reasoning about why military medicine is so great, in spite of what scores of active duty docs say on this board to the contrary. Meanwhile, military medicine is allowed to limp along in its current sad state, because there still enough poorly informed pre-meds who are willing to sign up.

Well, nothing is ever as good as people think it will be. I've certianly heard enough civilian docs bitch about paperwork, reimbursement, and restrictive rules they have to operate under, that they feel occasionally precludes good patient care.

The military is socialized medicine, with all the good and bad that entails.

Myself, I'm another medical student. But I'm not sure I'd accept someone referring to me as "naive" or zealous. I've been in the army for 18 years now, and the majority of that as an enlisted guy. I am well aware of both the benefits and the drawbacks, and I've seen way too many people nonstop whine about the military... and then try and get back in after a year or so on the outside when they see what civilian life can be like.

Sure, I've hear alot of military physician's bitch about paperwork, or "clipboard commandos" (love that term, BTW). And exactly zero of the ones _I_ have met have practiced as a civilian.

Naivety cuts both ways.

Now, instead of bitching about how bad things are in general, how about some of you wise military docs provide some specific examples of how bad your job is.

To save you time, please omit any complaints about multiple deployments or work hours, because quite a few of your civilian counterparts bitch about the latter, and about the former, well, this IS the military, not the peace corps, and we're at war.

Don't bother mentioning retention rates, because of the above, also. Fair game, though, is understaffing as previously mentioned (and no, while the two are related, they are not inextricably linked)

So, what about your job as a military physician makes you guys thnk the system is so "broke" and "limping along"?

 

[militarymd]

Search and read my posts......I'm tired of typing them again.

I was military and now I'm private practice......don't even compare the two. Civilian docs who complain simply don't know what the military is like.

There is NO WAY I would go back.....Private practice is GREAT!!!!

 

[Globus P]

For the doctors on this forum, in lieu of the dissatisfaction with military medicine, what specialties would you recommend a current Navy HPSP MS3 student to shoot for, or at least to stay away from?

Are there any Navy specialties less-malignant, less-negative than others? Physicians with a lesser amount of dissatisfaction? Family vs ER vs Surgery?

I've already signed on the dotted line and now need to make the best of it. Any advice would be welcome.

Any advice for the above posting?

 

[militarymd]

Any advice for the above posting?

I always tell students the same thing.....pick a specialty that you see yourself doing 30 years down the road.....not what you want to do for the short term (duration of military contract).

You are asking a very complicated question....there is no good advice after you have signed.

 

[USAFdoc]

Well, nothing is ever as good as people think it will be. I've certianly heard enough civilian docs bitch about paperwork, reimbursement, and restrictive rules they have to operate under, that they feel occasionally precludes good patient care.

The military is socialized medicine, with all the good and bad that entails.

Myself, I'm another medical student. But I'm not sure I'd accept someone referring to me as "naive" or zealous. I've been in the army for 18 years now, and the majority of that as an enlisted guy. I am well aware of both the benefits and the drawbacks, and I've seen way too many people nonstop whine about the military... and then try and get back in after a year or so on the outside when they see what civilian life can be like.

Sure, I've hear alot of military physician's bitch about paperwork, or "clipboard commandos" (love that term, BTW). And exactly zero of the ones _I_ have met have practiced as a civilian.

Naivety cuts both ways.

Now, instead of bitching about how bad things are in general, how about some of you wise military docs provide some specific examples of how bad your job is.

To save you time, please omit any complaints about multiple deployments or work hours, because quite a few of your civilian counterparts bitch about the latter, and about the former, well, this IS the military, not the peace corps, and we're at war.

Don't bother mentioning retention rates, because of the above, also. Fair game, though, is understaffing as previously mentioned (and no, while the two are related, they are not inextricably linked)

So, what about your job as a military physician makes you guys thnk the system is so "broke" and "limping along"?

just a few of 100's of examples I could give you to describe a broken system:

1) I have the chart available to me at the time of the patient visit only 10-40% of the time.
2) Our clinic should have 31 people (docs + techs) fully manned; this week we mustered 7 each morning, a little lower than normal but not unusual.
3) I have seen 100's of abnormal labs, imaging results etc that were never acted upon, some years old. When brought up with the patient, they had no idea.
4) I have seen men at their retirement physical who went 20 years with untreated hypertensiion, they were seen 20-40 times over their career with blood pressures taken, and never even a mention of being offerred a medicine.
5) Using brand new PAs to function as physicians, with no supervision, seeing Internal Medicine patients.
6) Referral results making it back to the physician no more than 40% of the time (this was quoted at our PCO USAF course) and I beleive it.
7) Overworked (although that is no excuse) admin techs caught throwing away piles of patient notes rather that take the time to file them (I know proof positive of at least 2 bases this has occurred on).
8) The CHCSII and PGUI computer programs that sap physician-patient face-to-face time with no additional appointment time given to account for this.
9) Clinic meeting that have ZERO physician attendance yet that is where all local decisions are made. Complete disregard for our input. Held during clinic appointment times, run 100% by nurses. All clinic commanders but 1 being nurses.
10) Let me know if you need 90 more. Perhaps you are not a pprimary care doc and have not witnessed the above first hand.

 

[USAFdoc]

Any advice for the above posting?

Go ER doc; you will get deployed more and our primary care docs fight over the chance to get out of clinic and all have enjoyed being deployed. The down side is being away from family. Also crap to deal with in terms of paperwork and a better civilian lifestyle in some venues. Stay away from military Primary care.

 

[UncleRico]

Those points are great examples of just of few of the many "specific" problems happening throughout military medicine.

Now to reply to the following post by RichL05:

"Myself, I'm another medical student. But I'm not sure I'd accept someone referring to me as "naive" or zealous. I've been in the army for 18 years now, and the majority of that as an enlisted guy. I am well aware of both the benefits and the drawbacks, and I've seen way too many people nonstop whine about the military... and then try and get back in after a year or so on the outside when they see what civilian life can be like."

First of all, all medical students are inherently naive in terms of the practice of medicine because they never have practiced medicine. 'Nuff said.

There are many good prior military folks on this board who can tell great war stories about jumping out of planes, low-crawling through the mud, flying helicopters/fighter planes, etc., and while we all appreciate your service in the military, these activities do not give you experience in the medical profession.

Also, those of you like RichL05 who have 18 years of military service have very DIFFERENT financial motives for entering military, ie, you can reach retirement in 2 years and draw a government pension for the rest of your life, and you will make more money along the way (as an O-3E, for example) during your payback. The typical HPSP/USUHS with ZERO time in service has a very different financial picture awaiting them, and as many have posted before, in terms of economics alone, joining the military for the money is a poor choice.

Finally, in my dept at a "large" (no military med center is really big anymore) military medical center, there have been about 25 physicians over the past 5 years that chose to separate when their commitments ended, versus none that chose to stay on. NOT A SINGLE ONE HAS COME BACK TO MILITARY MEDICINE!!!!!!!!!!!!! We keep in touch with many of them and they are generally enjoying the practice environments in the civilian sector (financially and otherwise). Again, none have chosen to come back to the military after "seeing what civilian life can be like".

For those on the fence trying to decide: remember, you already are what so many military physicians long to be: a civilian. Cut out the middle man (the military) and the majority of you will not regret it as you look back on your choice.

 

[montypython]

I would just like to thank military md and USAFdoc and other AD docs for sharing their perspective on the current state of military medicine. I am an AF brat of a retired Pediatrician and I thought I had all the perspective I needed to accept an AF HPSP position. But thanks to reading this forum for a couple months and talking to the "young guns" that my dad got me in touch with I soon realized that the military medicine my dad knew and proudly served for 20 years is a shadow of the past. I fortunately took the advice of those who could not wait to get out and looked beyond the money and the idealistic patriotism that most 21 year old HPSPers have and picked freedom. Thanks again and please continue to offer an inside perspective to complement the info given to us by recruiters.

 

[USAFdoc]

I would just like to thank military md and USAFdoc and other AD docs for sharing their perspective on the current state of military medicine. I am an AF brat of a retired Pediatrician and I thought I had all the perspective I needed to accept an AF HPSP position. But thanks to reading this forum for a couple months and talking to the "young guns" that my dad got me in touch with I soon realized that the military medicine my dad knew and proudly served for 20 years is a shadow of the past. I fortunately took the advice of those who could not wait to get out and looked beyond the money and the idealistic patriotism that most 21 year old HPSPers have and picked freedom. Thanks again and please continue to offer an inside perspective to complement the info given to us by recruiters.

Glad to hear that this forum has helped at least one person make a better informed decision. I wish the sad state of USAF primary care wasn't this way but it is, here in the west and likely everywhere from what my collegues tell me. I still beleive we have the greatest country in the world and we are all incredible blessed to live here. Heck, in other countries docs like me would be inprisioned for speaking against the government like this. But again,what is going on is wrong; wrong to treat physicians and staff like this, but really most importantly, wrong to offer this shell of a health care system to those who deserve much more; our troops, their dependents and our retirees. They earned more than this with thier service, their deployment time,and sometimes the loss of their health, and lives.

 

[kedhegard]

What if I just got really ****in fat...think they would let me go? What if I just started smoking dope in my spare time?

Anybody ever wonder how much they would put up with to keep you in?

 

[R-Me-Doc]

What if I just got really ****in fat...think they would let me go? What if I just started smoking dope in my spare time?

Anybody ever wonder how much they would put up with to keep you in?

Get really fat? They'll have you doing "special population" PT at 0430, but you won't get out.

Smoking dope? You'll get put in the "impaired provider program," it'll follow you around for the rest of your life, but they won't let you out.

Believe me, I've seen just about everything. You'd pretty much have to be comatose and on a vent to get cut loose from the medical corps.

Or maybe "proveably" gay.


RMD 1-1-1

 

[kedhegard]

They make you prove it? Crap.

 

[kingcer0x]

Go ER doc; you will get deployed more and our primary care docs fight over the chance to get out of clinic and all have enjoyed being deployed. The down side is being away from family. Also crap to deal with in terms of paperwork and a better civilian lifestyle in some venues. Stay away from military Primary care.

Hmm... I may take your advice as well. What is the ER environment like stateside? Same issues with patient care or no?

 

[USAFdoc]

Hmm... I may take your advice as well. What is the ER environment like stateside? Same issues with patient care or no?

you may need to go to a different forum to get ER specific issues addressed. Advantage to ER over FP is that you have more control over quality to some extent. In the ER, you do the workup start to finish. There are not labs that get lost or referrals that results donnt get back to the chart. Also,you tend to work your butt off for a few days, then get a few off.

 

[FliteSurgn]

I have had the experience of serving as an enlisted Infantryman in the Army and now a general surgeon in the Air Force. I, like so many other uninformed souls, made the mistake of taking an HPSP scholarship for financial reasons. I had liked my time in the Army and figured that this would be a great experience...and a way to pay for med school. It certainly has been an experience, but was I ever wrong about the "great" part.

I went in to surgery because I love it...operating...fixing problems...curing disease processes...etc. As a well-trained surgeon with special aptitude in advanced laparoscopy and oncolgy, I would love to be able to use my skills. Instead, I sit on my ass in my office...wishing that I was anywhere but here. I see about 10-15 patients in clinic and then "squeeze" 4-6 cases into the next 4 days to round out my week. To add insult to injury, 80% of those cases are screening colonoscopy. What a complete waste.

Maybe the military thinks that by letting a surgeon's skills atrophy while they sit on their ass, those surgeons will be too scared to exit into the civilian sector where they have to be efficient and possess operative skill to make it. Instead, those surgeons can stay in the Military and become slow and inept...then they can be sent into a high-stress environment with actual wartime casualties. When our troops need the best, they may getting the worst. That sounds like a great idea, right? I think that our troops deserve better than that. Why have surgeons if you can't keep them busy enough to at least keep their skills up. Even the surgeons at the biggest AF hospital have the same experience.

The clipboard commandos aggravate me to no end. Nurses are great, but put them in charge of a hopsital and it's lunacy. Most leadership roles in military medicine are filled by nurses because, unlike doctors, a high percentage of them stay in the military after their commitment is up. It's a weird dynamic when you have nurses in command. Most of them dont' know one thing about delivering health care, but they sure try to tell everyone how to do their jobs. Heck, most of them have very little actual nursing experience...they get their nursing license, spend a couple of years in a pitifully slow patient-care environment, and then get promoted into a supervisory position where they no longer have direct patient contact. From there, they buck for promotion by coming up with all kinds of stupid ideas to make "the doctors" more efficient. They make sure that everyone knows how important it is that their hospital get a 99% on JCHAO inspections...anything less would be blasphemy...and may not look as good on their promotion package. Stupid is, as stupid does.

 

[UncleRico]

I have had the experience of serving as an enlisted Infantryman in the Army and now a general surgeon in the Air Force. I, like so many other uninformed souls, made the mistake of taking an HPSP scholarship for financial reasons. I had liked my time in the Army and figured that this would be a great experience...and a way to pay for med school. It certainly has been an experience, but was I ever wrong about the "great" part.

I went in to surgery because I love it...operating...fixing problems...curing disease processes...etc. As a well-trained surgeon with special aptitude in advanced laparoscopy and oncolgy, I would love to be able to use my skills. Instead, I sit on my ass in my office...wishing that I was anywhere but here. I see about 10-15 patients in clinic and then "squeeze" 4-6 cases into the next 4 days to round out my week. To add insult to injury, 80% of those cases are screening colonoscopy. What a complete waste.

Maybe the military thinks that by letting a surgeon's skills atrophy while they sit on their ass, those surgeons will be too scared to exit into the civilian sector where they have to be efficient and possess operative skill to make it. Instead, those surgeons can stay in the Military and become slow and inept...then they can be sent into a high-stress environment with actual wartime casualties. When our troops need the best, they may getting the worst. That sounds like a great idea, right? I think that our troops deserve better than that. Why have surgeons if you can't keep them busy enough to at least keep their skills up. Even the surgeons at the biggest AF hospital have the same experience.

The clipboard commandos aggravate me to no end. Nurses are great, but put them in charge of a hopsital and it's lunacy. Most leadership roles in military medicine are filled by nurses because, unlike doctors, a high percentage of them stay in the military after their commitment is up. It's a weird dynamic when you have nurses in command. Most of them dont' know one thing about delivering health care, but they sure try to tell everyone how to do their jobs. Heck, most of them have very little actual nursing experience...they get their nursing license, spend a couple of years in a pitifully slow patient-care environment, and then get promoted into a supervisory position where they no longer have direct patient contact. From there, they buck for promotion by coming up with all kinds of stupid ideas to make "the doctors" more efficient. They make sure that everyone knows how important it is that their hospital get a 99% on JCHAO inspections...anything less would be blasphemy...and may not look as good on their promotion package. Stupid is, as stupid does.

This is, in my opinion, one of the biggest reasons to avoid military medicine: specialists atrophy at small bases/clinics (or even at the larger centers like Wilford Hall) and cannot maintain their hard-earned skills from residency. After several years of this, these physicians become "institutionalized" and are no longer fit to practice in the civilian sector. These folks therefore often decide to stay until retirement, and so you get most of your O-5s and O-6s that are incompetent and horrible physicians. These guys are also supposed to be the leaders/mentors of the younger graduating residents, but this is often not the case as they typically just evade work and do "admin" all day. The problem is, the military can't get rid of these guys, and to add insult to injury, they sign up for 4 year extensions and get extra bonuses for their ineptitude. Finally, at retirement, I have seen many leave medicine altogether (with their tails between their legs), thus bringing to a pitiful end the once-promising medical career that they envisioned early in their careers. Again, this happens even at the "largest" military med centers (even though you can't call any of them large anymore; Wilford Hall only has about 200 active beds).

So if you want to be an institutionalized government employee working toward a government pension, don't go to med school, join the US Postal Service or something.

 

[DCM]

What can those of use who are going into military medicine do to maintain our skills for four to eight years. What about military residency training. Any specialties to avoid?

It sounds like a lot of you have gone on to be successful in civilian positions after being in the military; how did you do it?

 

[idq1i]

People here tend to complain about primary care, anesthesia and surgery... but...

Any opinions on Army diagnostic radiology? It can't be as bad, can it?

 

[R-Me-Doc]

People here tend to complain about primary care, anesthesia and surgery... but...

Any opinions on Army diagnostic radiology? It can't be as bad, can it?

Depends. If all you want to do is look at pictures, I guess it can be great. If you're looking to do a lot of hands-on, high-speed interventional stuff, you're going to be limited to Walter Reed or maybe BAMC. And if you are a rads guy at a small hospital like mine, you will be on call every other night (and getting called multiple times every one of those nights by the ER) because there is such a shortage of radiologists. Think about it: Army rads for 140K a year or civilian for $400K+ and 16 weeks off? You do the math . . . .

 

[Braveheart]

Depends. If all you want to do is look at pictures, I guess it can be great. If you're looking to do a lot of hands-on, high-speed interventional stuff, you're going to be limited to Walter Reed or maybe BAMC. And if you are a rads guy at a small hospital like mine, you will be on call every other night (and getting called multiple times every one of those nights by the ER) because there is such a shortage of radiologists. Think about it: Army rads for 140K a year or civilian for $400K+ and 16 weeks off? You do the math . . . .

 

[idq1i]

Depends. If all you want to do is look at pictures, I guess it can be great. If you're looking to do a lot of hands-on, high-speed interventional stuff, you're going to be limited to Walter Reed or maybe BAMC. And if you are a rads guy at a small hospital like mine, you will be on call every other night (and getting called multiple times every one of those nights by the ER) because there is such a shortage of radiologists. Think about it: Army rads for 140K a year or civilian for $400K+ and 16 weeks off? You do the math . . . .

Thanks for the response. It's too late to "think" - they own me for the next nn years

I can't stand to be in TX or in WA, and I don't want to spend 5 years on an island. Water reed or bust (crosses fingers for a civilian deferral)