Careers After Military Service

[ericd8]

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[Vandalia]

Not necessarily. I know of several former military physicians who have been highly recruited for medical administration jobs. If you look at the faculty at many high level training programs you will find a fair number of former military physicians. For example the director of spine surgery in the Neurosurgery department at the University of Virginia is a former military physician. While it is something many worry about, skills atrophy is not considered a significant problem. Most things in medicine are like riding a bicycle - it might take a couple of months to get back up to speed, and you might have to be supervised for a couple of procedures, but it is not a long term issue. I know of one former AF Brig Gen who was in administration for about 2 decades, after retirement decided he wanted to be a surgeon again, and stepped right into a high volume surgery practice in Texas.

I am hiring physicians now, and was in the AF for many years, and I have never heard of anyone having any additional problem finding a job because they were in the military. The advantage is that if you are a military physician - and not kicked out - I know that your credentials are good, you have had several years of supervised practice (you would be shocked with some of the things that physicians can get away with in outpatient medicine), and you probably have no major skeletons in your closet. I know you have a decent amount of self discipline, probably don't have any major mental health/substance abuse problems, and will probably show up for work. Again, some are worried about the ability to step into a high volume practice (in EM for example.) As someone who does hiring, that is not a concern. When we hire someone, we expect the relationship to last for decades. A couple months of being slow is not something we are even concerned about. Even with new EM grads, it takes a minimum of 3-4 months before they are up to speed.

 

[HighPriest]

A lot of these issues are addressed elsewhere in this forum, and so I'll just touch on a couple of issues.

1 - I can't off the top of my head think of any surgical specialty that isn't available through the military. However, it can be more difficult to get into some specialties (and easier in others) than it is on the civilian side. You will also require approval to do fellowships, but ultimately it is -possible- to do them. probability is another metric entirely.

2 - You can find ways to pay off your debt, no matter what. You can find ways to do it now or after you're finished with your training. I would strongly encourage you to look at your decision in two lights: finances entirely aside, and then with finances included. If, in both cases, you feel that HPSP is a good option then do HPSP. The other combinations, I would argue, should direct you away from HPSP.

3 - Skill atrophy is very real. It doesn't necessarily mean that you won't be able to find a job, however. The truth is that the only one who knows how atrophic your skills are is you. With some surgical specialties, and depending upon what armpit in which you get stuck, you may possibly have trouble with getting credentialed for procedures that you haven't done in 2+ years. In fact, Joint Commission is heading towards requiring retraining on any procedures you haven't done in 48 months or more.

4 - Military service, as mentioned above, looks great on a resume. It's not a reason to join, however. I don't see or hear from too many docs who are living on the streets because they didn't have military service on their resume. That, in and of itself, is NOT a reason to join. It's just a perk of having done so.

5 - Research in the military, at least in the Army, sucks. It is not, and will never be, anywhere near comparable to a moderately-funded university-based civilian research center. If you really want to do research, don't do HPSP. You can do research in the military, don't get me wrong. You can do good research. But it'll be harder and less efficient to be certain.

 

[cgk]

A lot of these issues are addressed elsewhere in this forum, and so I'll just touch on a couple of issues.

1 - I can't off the top of my head think of any surgical specialty that isn't available through the military. However, it can be more difficult to get into some specialties (and easier in others) than it is on the civilian side. You will also require approval to do fellowships, but ultimately it is -possible- to do them. probability is another metric entirely.

2 - You can find ways to pay off your debt, no matter what. You can find ways to do it now or after you're finished with your training. I would strongly encourage you to look at your decision in two lights: finances entirely aside, and then with finances included. If, in both cases, you feel that HPSP is a good option then do HPSP. The other combinations, I would argue, should direct you away from HPSP.

3 - Skill atrophy is very real. It doesn't necessarily mean that you won't be able to find a job, however. The truth is that the only one who knows how atrophic your skills are is you. With some surgical specialties, and depending upon what armpit in which you get stuck, you may possibly have trouble with getting credentialed for procedures that you haven't done in 2+ years. In fact, Joint Commission is heading towards requiring retraining on any procedures you haven't done in 48 months or more.

4 - Military service, as mentioned above, looks great on a resume. It's not a reason to join, however. I don't see or hear from too many docs who are living on the streets because they didn't have military service on their resume. That, in and of itself, is NOT a reason to join. It's just a perk of having done so.

5 - Research in the military, at least in the Army, sucks. It is not, and will never be, anywhere near comparable to a moderately-funded university-based civilian research center. If you really want to do research, don't do HPSP. You can do research in the military, don't get me wrong. You can do good research. But it'll be harder and less efficient to be certain.

Are research opportunities more abundant at places like Walter Reed, working with residents, and close by to the NIH?

 

[Vandalia]

Bottom line: Military service is not going to give you a tremendous advantage in getting a civilian job, nor will it be a tremendous hindrance. It all basically evens out and as a result shouldn't be a factor in your decision. There are many things that are far more relevant and far more important.

And just to clarify, I agree that skill atrophy is very real. However, my point was that it should not be a major factor in getting a job offer. Unless you want to do locums for a long time. Most reputable employers are looking for a long term relation with a physician and are willing to take the long perspective. If not, you should be concerned.

As an example, our system recently hired a new physician. He was a perfect fit for a number of reasons. However, he wanted to delay his start for 3 months due to some personal reasons. No problem. Our system agreed to provide full benefits during that time period and let him start when he wanted. In the long term, 3 months benefits is a trivial cost to get a very good physician.

 

[HighPriest]

Are research opportunities more abundant at places like Walter Reed, working with residents, and close by to the NIH?

I would think that Reed would have similar opportunities to the other major MEDCENs that are located near research institutes (university or otherwise). You can usually arrange research with outside institutions, but bear in mind that unless there is a pre-existing pathway for that, you will be doing all of the legwork yourself to get it set up. It is not a small amount of legwork. Also, at least when I was a resident and at least at MAMC, any IRB with which you are associated will need to be approved by your MEDCEN IRB as well as the outside IRB. In other words, lets say NIH agrees to let you in on a project, and they have an IRB review of their study and it gets approved - you will still need to get the military IRB to approve the study before you will be allowed to participate. That is a huge pain in the @$$. Again, that may very institution to institution, but it was definitely that way at MAMC back in the day. I knew a lot of people who had to go through that to do research with the UW system or some of the research centers in Seattle.

 

[HighPriest]

That's a personal choice, really. The truth is that if you do well in med school, well on USMLE, get some research under your belt, you should be competitive. If you're competitive, then you shouldn't have too much trouble getting the residency that you want. There are exceptions. For example, at one point the match rate for ENT was 25% in the Army because of an unusually high number of applicants. In that scenario, you'd be better off applying on the civilian side. Other years, the match rate is significantly better/comparable with the civilian match. Then there are some specialties for which you're probably better off applying in the military. I can remember a year when rad onc actually had fewer applicants than positions, whereas that is fairly competitive in the civilian match. The kicker is going to be when/if you apply for a fellowship. You might be ultra-competitive, but if the branch doesn't need you, you don't train - period. The only way around that is to not do HPSP.

 

[pgg]

Are research opportunities more abundant at places like Walter Reed, working with residents, and close by to the NIH?

The problem with doing meaningful research in the military generally isn't that there's something fundamentally lacking at the large MTFs ... it's more that the staff rolls over and changes every 2-3 years, and people abruptly disappear for chunks of 7 or 12 or 18 months at a time.

 

[HighPriest]

The problem with doing meaningful research in the military generally isn't that there's something fundamentally lacking at the large MTFs ... it's more that the staff rolls over and changes every 2-3 years, and people abruptly disappear for chunks of 7 or 12 or 18 months at a time.

I would agree with this, but I would also say that I feel that there is something fundamentally lacking in terms of research at large MTFs: a focused dedication to research. While it might be argued that the military has that from time to time, or that great research has come from the Army (it has), research is not prioritized in the military like it is at most large University programs, places like Mayo, or NIH (which is obviously just research). There will always be a difference between a place that has a lot of research opportunities and a place that wants to be a research center.

If the military really wanted to focus on research, they would do things like: offer more funding, support a centralized IRB, streamline inter-institutional research, provide funding for the hiring of research assistants and/or grant writers - things like that. I get it, tight budget and the fact that we're a fighting force first. I'm not criticizing, but I am saying that it's not a focus.

 

[Cooperd0g]

Another thing to consider as far as finances go is to attend the cheapest school you get into. But a lot of that depends on what state you are a resident of.