Career Advice

[Mace1370]

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Hey guys, I'm a new pathology PGY1 in training at Walter Reed. Since I just started, I was hoping to get a few questions answered so when I make big decisions in the near future I can do so with confidence that I'm making the right choice:

- I will owe 7 years AD commitment after I finish residency.
- I have the options of doing a fellowship right after residency (if I am accepted), several years after residency but still while on active duty, or after I finish my AD commitment (practice general path for 7 years, get out, and do a fellowship on the outside)
- If I do a fellowship in the military, it will add a minimum of 2 years to my time on active duty (1 year in the fellowship, 1 additional year commitment if it is a military fellowship, or 2 additional years commitment if it is a civilian fellowship)
- I have no prior service, so after finishing residency and my 7 years of commitment I will have 11 years in and will be 9 away from retirement.

Career wise, what makes the most sense for me to do? I have not decided if I want to stay in for the full 20 years for a pension.

Also, I hear that networking is extremely important for getting a private practice job. How would I accomplish this as a military pathologist? Go to conferences? Are there any other options that I have? If I decide to get out and do private practice I want to make sure I am setting myself up for success.

Thanks!

 

[yaah]

You may have an advantage in networking because there is no doubt a community of military pathologists (and ex-mil). I suspect you should be able to find this, and I would ask them for advice. There are probably some on here, I know of at least a couple I think, although not sure how active they are now.

Can't really say what makes the most sense for you - you have to decide that taking into account benefits and pay and such. Retiring with a military pension is nothing to sneeze at though.

 

[LADoc00]

I would do the full 20 yr at current Tricare costs. If those costs for enrollees explode in 10 years, all bets are off. The pension is good but not great.

Networking will be easy enough. Spend your time off doing locum gigs, pad the pockets and make connections.

A few years of that you will be better connected than any Hopkins or HMS grad.

There is FAR too much coming down the road to give you any concrete advice. Everything could be awesome when you get or it could be a total Mad Max wasteland, or anything in between.

You cant stress too much on it though with such an epic horizon. I would do the fellowship right after residency and not wait, but that is me.

G'luck!

 

[deleted314957]

agree very much with LaDoc and Yaah. that is exactly how i got my PP job out of the navy. these days, with decreasing reimbursement, stay the 20, retire as a colonel and go private for another 15-20 years.

 

[LADoc00]

agree very much with LaDoc and Yaah. that is exactly how i got my PP job out of the navy. these days, with decreasing reimbursement, stay the 20, retire as a colonel and go private for another 15-20 years.

Mike didnt you say there was a foriegn army posting where you reside in an Occupational Army-class mansion, complete with servants?

That. I would do that Mr. OP guy. I would carry around dual ivory handled revolvers and I would have the servants call me Gen. Patton. I would marry a 19-year Swiss girl with long braided hair named Heidi.

 

[Mace1370]

Thanks for the advice guys! It is much appreciated.

 

[Ziehl-Neelsen]

1. Fellowship immediately following residency appears to be going the way of the dodo with the new guidance from OTSG that requires a 2 year utilization tour before applying for fellowship. I personally think this is a good thing because it helps to solve the problem of having so many unfilled billets at smaller MEDDACS that then require a more senior and experienced pathologist (oftentimes with subspecialized training) to PCS to a small MEDDAC where his talent and experience is wasted. Furthermore, I think the first few years out of residency are critical in advancing one's ability as a general pathologist. IMO, people who do fellowship right out of residency lose that opportunity to sharpen their skills as a generalist.

2. It is folly to try and decide now whether you want to do a full career with so many unknowns. Will the pension be eliminated or altered? Will the bonuses that make military physicians' pay tolerable be cut due to the country's fiscal problems? Will the ACA make practicing in the military more appealing than civilian practice? Will family concerns and the ability to settle in one place become more important as you get older? Lest you be Tiresias reborn you must admit that the answers to these questions are unknown, and these things will have a significant impact on your future decisions.

An older military physician once told me once that he had "stumbled through" a full military career. When he started out as an intern he was neither certain of nor opposed to a full military career, and at many points throughout his career, he swore to himself that he would get out. But each time his contract came up for renewal and he reflected on the past and pondered the probabilities for the next "hitch" he found himself more satisfied than not and decided to "re-up", though many of his colleagues and friends came to the opposite conclusion through the same process. Before he knew it he was at 20 years. I've always appreciated that "Frostian" piece of wisdom and find myself employing it as my own career has progressed.

3. The best way to "network" is to do the absolute best one can each day at the job set before them. Hard workers who do high quality work, help out their colleagues, aren't afraid of new challenges, and are honest and of good cheer are noticed by their colleagues. And for good or ill, military pathology is a small world where reputations travel. For example, If I wanted to know what kind of resident you are, I'd call your assistant program directors, both of whom were residents with me.

Sure conferences are a good way to learn things and meet new people, but having a drink with somebody at a conference pales in comparison to developing good relationships with your military colleagues. Who are you going to call about a job prospect or for the "inside scoop" on a practice you're considering--some guy you had a drink with at a CAP conference or the guy who you covered call for and who QC'd your cases.

If I decide to work as a pathologist outside of the military (as I've stated previously, I may go Mance Rayder on this whole medical establishment shiznit), I'll rely on the relationships I established from my time as a 61U and ask only that they speak honestly about my character and abilities as a pathologist.

 

[Mace1370]

1. Fellowship immediately following residency appears to be going the way of the dodo with the new guidance from OTSG that requires a 2 year utilization tour before applying for fellowship. I personally think this is a good thing because it helps to solve the problem of having so many unfilled billets at smaller MEDDACS that then require a more senior and experienced pathologist (oftentimes with subspecialized training) to PCS to a small MEDDAC where his talent and experience is wasted. Furthermore, I think the first few years out of residency are critical in advancing one's ability as a general pathologist. IMO, people who do fellowship right out of residency lose that opportunity to sharpen their skills as a generalist.

2. It is folly to try and decide now whether you want to do a full career with so many unknowns. Will the pension be eliminated or altered? Will the bonuses that make military physicians' pay tolerable be cut due to the country's fiscal problems? Will the ACA make practicing in the military more appealing than civilian practice? Will family concerns and the ability to settle in one place become more important as you get older? Lest you be Tiresias reborn you must admit that the answers to these questions are unknown, and these things will have a significant impact on your future decisions.

An older military physician once told me once that he had "stumbled through" a full military career. When he started out as an intern he was neither certain of nor opposed to a full military career, and at many points throughout his career, he swore to himself that he would get out. But each time his contract came up for renewal and he reflected on the past and pondered the probabilities for the next "hitch" he found himself more satisfied than not and decided to "re-up", though many of his colleagues and friends came to the opposite conclusion through the same process. Before he knew it he was at 20 years. I've always appreciated that "Frostian" piece of wisdom and find myself employing it as my own career has progressed.

3. The best way to "network" is to do the absolute best one can each day at the job set before them. Hard workers who do high quality work, help out their colleagues, aren't afraid of new challenges, and are honest and of good cheer are noticed by their colleagues. And for good or ill, military pathology is a small world where reputations travel. For example, If I wanted to know what kind of resident you are, I'd call your assistant program directors, both of whom were residents with me.

Sure conferences are a good way to learn things and meet new people, but having a drink with somebody at a conference pales in comparison to developing good relationships with your military colleagues. Who are you going to call about a job prospect or for the "inside scoop" on a practice you're considering--some guy you had a drink with at a CAP conference or the guy who you covered call for and who QC'd your cases.

If I decide to work as a pathologist outside of the military (as I've stated previously, I may go Mance Rayder on this whole medical establishment shiznit), I'll rely on the relationships I established from my time as a 61U and ask only that they speak honestly about my character and abilities as a pathologist.

Thanks for the very thorough reply. I'm glad to know that even if I am not able to choose exactly when I do my fellowship there is an upside to either scenario (get all your training done vs. cement your general path proficiency).