BRAC bombshells

[tman]

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RichL025,
And FYI, there are many specialities that do not typically deploy into the theater of operations--think pediatrics, emergency med, psychiatry, ob/gyn, etc. This is particularly true for the USAF, whose specialists generally "deploy" to Germany to receive med-evacs.

-Blue

Ummmm wow that's news to me must have been something that just came down the pike in the last few days because EM has been one of the most deployed AF medical specialties for years. Psych docs are continually rotating into the CENTCOM AOR with boots in the sand, and after the AF took over the theater hospital in Kirkuk from the army earlier this year Ob/gyn and peds are regularly deployed into the AOR as well. While it is true that we provide CCATs out of Germany among other places including in theater, that is a fairly minor piece of the big picture in regards to the medical support we are providing in the current operational environment (though the impact of CCATs are huge). I'm not sure where you got your intel from but it's a bad source. Hell you could have at least came up with a more believable list (Path, Rad Onc, Ophtho maybe?). As the AF med system "right sizes" and transforms from a primarily peacetime force who happens to deploy sometimes, to an expeditionary operationally oriented corps it looks like we will be outsourcing the nondeploying specialties to the civilian world and maintaining those specialties which are needed to support combat operations. In the end there will probably be very few if any non-deployable specialties in the AF. My intention is not to slam you but you couldn't be more wrong on this.

 

[Homunculus]

holy crap. where to start.

first, ever since the GMO system was phased out (well, in the navy's case *supposed* to be phased out) there has still been a need for "general" medical officers (ie, docs) to take care of "generic" medical needs-- everything from preventative health, to medical mission assessments to trauma stabilization and triage. EM/FP/Peds/IM/OB/Surg/Anesthesia and all of their subspecialties-- everyone except the damned pathologists-- are going over there. and in capacities that they don't always fit best in. they're still filling the roles of an old GMO-- only now they're BC/BE docs instead of fresh 'terns. we have had peds GI docs, neonatologists, peds nephrologists, etc taking care of everything from low back pain to IED blasts. last year's graduating class of peds residents are all in operational slots and are in or soon will be going to the desert.

the navy gets you even sooner-- over half of our navy interns are getting GMO'd out and will be in Iraq next fall. the other thing with the navy-- the marines get their medical assets from them-- meaning that the navy isn't going to be all boats. many times they are even closer to the business end of warfighting that the army folks.

here's another interesting thing for you-- for the most part, each branch handles their own medical assets. meaning if you have airforce airmen deployed, you must have the docs to support them. and the airforce also comes to play with it's own version of forward support and surgical hospitals-- and the staff that go with them.

this quote is interesting:

Exceptions aside (e.g. medical support to Iraqis, a doc who really wanted to go, substituting one speciality for another to fill an empty billet, HQ billet, etc.),

what else is left? right now *everyone* is going over to replace someone-- that's what so many people are being affected. yeah, if you take out everyone who is going over there, no one is going over there. lol.

--your friendly neighborhood educational caveman

 

[Homunculus]

Ummmm wow that's news to me must have been something that just came down the pike in the last few days because EM has been one of the most deployed AF medical specialties for years. Psych docs are continually rotating into the CENTCOM AOR with boots in the sand, and after the AF took over the theater hospital in Kirkuk from the army earlier this year Ob/gyn and peds are regularly deployed into the AOR as well. While it is true that we provide CCATs out of Germany among other places including in theater, that is a fairly minor piece of the big picture in regards to the medical support we are providing in the current operational environment (though the impact of CCATs are huge). I'm not sure where you got your intel from but it's a bad source. Hell you could have at least came up with a more believable list (Path, Rad Onc, Ophtho maybe?). As the AF med system "right sizes" and transforms from a primarily peacetime force who happens to deploy sometimes, to an expeditionary operationally oriented corps it looks like we will be outsourcing the nondeploying specialties to the civilian world and maintaining those specialties which are needed to support combat operations. In the end there will probably be very few if any non-deployable specialties in the AF. My intention is not to slam you but you couldn't be more wrong on this.

well said.

--your friendly neighborhood in agreement caveman

 

[blueSkies]

Alright, you guys are citing the situation at present, i.e. with Iraq/Afghanistan. I have to admit my "data" is pre-Iraq; came back just before we went in, been in school for most of the 3 years since. My notes above were true at that point; you have reminded me that Iraq has changed things. Thanks.

Now, if Homunculus is finished flaming, perhaps we can return to the original topic: BRAC. Objections?

-Blue

 

[Homunculus]

Now, if Homunculus is finished flaming, perhaps we can return to the original topic: BRAC.

nah, no flaming. this was all educational. check out the everyone forum if you wanna see some flaming i thought i was pretty civil. 😕

--your friendly neighborhood harmless caveman

 

[DrBloodmoney]

Path only has one doc in-theater at the the big Baghdad hospital (44th CSH maybe?)-

I'm just waiting for some non-medical corps asshat to pull my card after residency:

Me: I've never had my own patients
Asshat: But you're a doctor right?
Me: Sure
Asshat: Then what's the problem?
Me: All of my patients hit my office in formalin-filled jars, or already dead... do you really want me to see patients?
Asshat: Wait, you're a doctor?
Me: Well... have you ever seen CSI *tries to draw *****-level comparision*
Asshat: dinguses and elbows get in that plane! I don't have time for this
Me: but I've never prescribed medication or taken care of people
Asshat: Get in the goddamn plane!
Me: fine they're your soldiers... let's see how many I can mismanage or kill

Hopefully that won't happen, especially now that path residents come straight in without an intern year.

 

[ishii123]

the navy gets you even sooner-- over half of our navy interns are getting GMO'd out and will be in Iraq next fall. the other thing with the navy-- the marines get their medical assets from them-- meaning that the navy isn't going to be all boats. many times they are even closer to the business end of warfighting that the army folks.

Navy doctors take care of both the Navy and Marine Corps. Both Navy and Marines deploy often. As long as these naval military organizations exist, Navy docs will ALWAYS deploy (either on a boat or ground unit). When you're on a boat, you're on a lonely vessel in the middle of the ocean millions of miles from shore...so you definitely need a doc. If you're working for the Marines, you need a doc because their always in the thick of combat. I personally think Navy docs working with Marines can be in as much danger (and likely more) as the Army of being killed in combat because the Marines are the first to fight and always in the front lines (who does the President send in when he wants to show MILITARY FORCE NOW?!).

Homunculus is correct...the Navy is the only military service that has NOT phased out the GMO billets after intern year (they said they were going to phase out GMO's in the late 1990s, BUT THEY LIED!). I think a major reason for this is because Navy docs support both the Navy and Marine Corps...So Navy doc assets are stretched thin between both military organizations. Thus, the Navy cannot afford to give up GMO billets. This sentiment is shared by the current Navy Surgeon General.

 

[denali]

My guess is that if you head off for a residency at WH next year, you'll get through the program without seeing many changes until maybe your last year there. These recommendations still have to get through the process (Congress, Prez.) and probably won't be ready for implementation until FY2007 at the earliest, as implementation planning has yet to start. The other piece to BRAC after the list has been approved is the machinery of actually closing/realigning a place, and that has A LOT of bureaucracy to get through--reuse plans, civil service job protections, beneficiary impact planning, etc.

The services will no longer have their own "flagships". The big-daddy med center for all three will be WRNMMC. Expect many residencies to become joint slotted. Given Rumsfeld's proclivities, the continued GWOT, and the continued increase in DOD healthcare costs, I wouldn't be surprised if I graduated in a "purple" uniform (though I doubt it'll happen that fast).

 

[denali]

FYI, it looks like the BRAC commission is interviewing the Medical Joint Service Group this afternoon @ 1330 EDT and CSPAN is covering it.

ETA: Well, I guess not. Looks like LTG Taylor testifies tomorrow at 0930.

 

[RichL025]

RichL025,
will you be more clear: what has "no one ever tried before"?

And FYI, there are many specialities that do not typically deploy into the theater of operations--think pediatrics, emergency med, psychiatry, ob/gyn, etc. This is particularly true for the USAF, whose specialists generally "deploy" to Germany to receive med-evacs.

No need to take a derogatory tone, either. Particularly when your point lacks clarity and your "facts" are questionable.

-Blue

Well, sorry if you thought the tone was derogatory, I was going for sarcasm...

And all of those specialties you mentioned are HIGHLY deployable in the army.

HIGHLY.

Don't know about the Air Force, but as far as the US Army people in those specialties can count on being deployed.

I'd like to hear what the pediatricians, psychiatrists and ob/gyns were doing in SWA, and in what number they were present. ... implies that definitive care is also provided forward, and that isn't consistent with the present concept of deployed medical ops.

Well, I can only speak about the Army, and then second-hand from people I know who have been back. Peds and OB/Gyn have been deployed both in their specialties, and as GMOs despite being specialty trained.

In their specialties - something like 15-20% of the deployed force is female, with all the attendant woman's health issues that OB/Gyn specializes in. As far as Peds goes - the AAP considers the scope of practice for a Pediatrician to go up to late adolescence, which they define as 22 y/o. A good chunk of the infantry (heck, the Army!) is in that age range.

As GMOs - I was working with a pediatrician who just got back after being a triage officer at a CASH. He's still a doctor after all. He wasn;t ecstatic about not working "in his specialty", but realized he was doing an important job.

And I am honestly surprised that you would count Psychiatrists as those who would not deploy. Not trying to flame you here, but this shows that you have not been paying attention to even news articles in the popular press about health care, espescially preventive psych health care, that is being provided in-theater. One of the basic principles of treating combat stress is to AVOID evacuating the casualty if at all possible.

 

[GeoLeoX]

everyone except the damned pathologists-- are going over there.

As the bloodmoney stated even we are going over there. There is a spot for one pathologist and unbelievably, a waiting list. The dude there now was a little less willing as he was sent as PROFIS not "voluntarily".

Dr. FutureAsshat, MD, PhD

 

[RichL025]

Exceptions aside (e.g. medical support to Iraqis, a doc who really wanted to go, substituting one speciality for another to fill an empty billet, HQ billet, etc.), I stand by my statement that many/most specialties won't deploy. I'll concede the Army deploys EM docs, as well as several other surgical/trauma specialists to their field hospitals. Don't believe you'll see that with the USAF unless we're filling in when the Army doesn't have enough docs. Am interested to hear how the USN works docs on deployments.

-Blue

As far as the Army goes, your first sentence above is wrong, wrong, wrong.

 

[kingcer0x]

The services will no longer have their own "flagships". The big-daddy med center for all three will be WRNMMC. Expect many residencies to become joint slotted. Given Rumsfeld's proclivities, the continued GWOT, and the continued increase in DOD healthcare costs, I wouldn't be surprised if I graduated in a "purple" uniform (though I doubt it'll happen that fast).

I'm a newbie so correct me if i'm wrong...

Is there a chance that all this restructuring could actually be better for Air Force GME in the long run? By this, I mean

1) the joint slotting of NCC GME which currently seem to only accept IM applicants from the AF (or whatever Malcom Grow handles).
2) The inevitable closing of GME programs at smaller AF hospitals which have been harped on for low patient volume (esp. surgical)
3) More specialty training deferments for those who want them, esp. in specialties the AF needs

 

[USAF MD '05]

Exceptions aside (e.g. medical support to Iraqis, a doc who really wanted to go, substituting one speciality for another to fill an empty billet, HQ billet, etc.), I stand by my statement that many/most specialties won't deploy. I'll concede the Army deploys EM docs, as well as several other surgical/trauma specialists to their field hospitals. Don't believe you'll see that with the USAF unless we're filling in when the Army doesn't have enough docs. Am interested to hear how the USN works docs on deployments.

Almost every attending I have met in EM (Air Force) has been or was going to Iraq. A buddy at Wright-Patt just got back from his second trip. On the first he was on a search and rescue team, on the second, his camp had 70 rockets land in their vicinity. Definitely some danger there.
In this new era of the GWOT, noone is "safe". In a pinch, Ob/Gyns have filled in as a general surgeon.