Civilian --> Military Career

[Dr Gradus ad Parnassum]

I am an IM-certified community hospitalist. I’ve strongly considered a medical career in the military for many years, but due to health reasons feared there was a good chance I wouldn’t pass the physical requirements to be accepted.

I enjoy but am not completely fulfilled with my career in private practice. My experience treating veterans in a VA setting in medical school and residency was very brief, but my memories were very fond. Veterans were the best patients, and even now when I take care of them in a non-VA setting it is rewarding work. I know that the VA is resource-limited, but I appreciated their mission to provide the best level of care possible at minimal or no expense to the veteran. Differing insurance coverage for patients, prior authorizations, peer-to-peers, etc are major factors driving patient care in my current job, and I have optimism that all of these barriers would be less significant if practicing in the US military.

I’m giving serious thought again to pursuing the military career; if they accept me great, or if their health/physical requirements disqualify me then it is what it is and I will just continue practicing civilian medicine (of note, my health has not impacted my ability to perform my current job duties at all, though there is no “boot camp” where I have to run an obstacle course or scale a wall). However, reading through this forum, I do fear that my impression of military medicine may be naïve or unrealistic because I do notice a number of people with multiple years of experience who seemed unhappy. I wanted to ask a few questions people with first-hand experience with military medicine:


1. Is it likely I would be able to live or practice in my home state, or would I most likely be moved around the country, overseas or both frequently?

2. Is there much role for hospital medicine physicians in the US military? With my license and certification I can practice outpatient general IM, which I’m fine with, though most of my experience is inpatient

3. Would you recommend one particular branch over another (Army, Navy, Air Force, etc)?

4. I fully understand that the pay in military medicine will be less than the private sector. However, do you find other aspects of the job (treating veterans, support from medical staff and leadership, not dealing with insurance companies, possibly less fixation with metrics and volume) more rewarding?

5. Any other pieces of advice you might recommend regarding things I may have lacked the knowledge to even ask about?

---

Members don't see this ad.

 

[DrMetal]

I am an IM-certified community hospitalist. I’ve strongly considered a medical career in the military for many years, but due to health reasons feared there was a good chance I wouldn’t pass the physical requirements to be accepted.

I enjoy but am not completely fulfilled with my career in private practice. My experience treating veterans in a VA setting in medical school and residency was very brief, but my memories were very fond. Veterans were the best patients, and even now when I take care of them in a non-VA setting it is rewarding work. I know that the VA is resource-limited, but I appreciated their mission to provide the best level of care possible at minimal or no expense to the veteran. Differing insurance coverage for patients, prior authorizations, peer-to-peers, etc are major factors driving patient care in my current job, and I have optimism that all of these barriers would be less significant if practicing in the US military.

I’m giving serious thought again to pursuing the military career; if they accept me great, or if their health/physical requirements disqualify me then it is what it is and I will just continue practicing civilian medicine (of note, my health has not impacted my ability to perform my current job duties at all, though there is no “boot camp” where I have to run an obstacle course or scale a wall). However, reading through this forum, I do fear that my impression of military medicine may be naïve or unrealistic because I do notice a number of people with multiple years of experience who seemed unhappy. I wanted to ask a few questions people with first-hand experience with military medicine:


1. Is it likely I would be able to live or practice in my home state, or would I most likely be moved around the country, overseas or both frequently?

2. Is there much role for hospital medicine physicians in the US military? With my license and certification I can practice outpatient general IM, which I’m fine with, though most of my experience is inpatient

3. Would you recommend one particular branch over another (Army, Navy, Air Force, etc)?

4. I fully understand that the pay in military medicine will be less than the private sector. However, do you find other aspects of the job (treating veterans, support from medical staff and leadership, not dealing with insurance companies, possibly less fixation with metrics and volume) more rewarding?

5. Any other pieces of advice you might recommend regarding things I may have lacked the knowledge to even ask about?

What state are you in? What kind of medical condition (can you run 2 miles, do push ups, planks?)?

Don't join the Active Duty medical corps. Consider the Reserves, it makes more sense for folks like you.

 

[armytrainingsir]

Agree with Dr Metal. Don’t go AD.

5. Have you considered the VA?

IMO, VA + Reserves is the best gig given what you’ve told us.

 

[Dr Gradus ad Parnassum]

Thank you so much for your feedback. I have definitely given thought to the reserves; my concern was balancing the one weekend monthly/2 weeks yearly requirement on top of my already fairly busy civilian job. I figured instead of trying to balance both simultaneously (and potentially do neither well), it might be best to just fully commit my time solely to the military through active duty.

I've also considered just working at a VA facility but not joining the military. I figured the only advantage of this vs active duty was guaranteeing where I could live (and the ability to leave if I did not like the job), but it would come with the comparative low salary of VA medicine without the additional benefits (health, retirement, etc) of joining the military.

If you don't mind me asking, what is the reason that you wouldn't recommend active duty to someone in my position? Again, salary is not a big factor to me. I know that there is a bureaucracy in the military (as exists everywhere), but I was hopeful that the military would be a good environment to take care of veterans with perhaps less focus on metrics and insurance. While remaining in the US and a stable home area would be ideal, I acknowledge to moving and deployment is a possibility.

 

[SirGecko]

I think the priorities that your questions indicate make it seem like VA or reserves would be better. I’m not IM but AD isn’t the place to be a hospitalist who wants to homestead in one location. Pretty much everyone has to do clinic and the way the DHA metrics work it’s kind of all they judge you guys on. Also the military will definitely move you and I’d expect with current manning levels that the ability to dictate where you want to be is only going to get worse not better in the foreseeable future. The ideal person to join the military as an active duty physician is flexible above all else. (Flexible in duty location, flexible in type of work or amount of work asked to do, able to be told to come back with form 2b stamped by a specific contractor who only works on Tuesday from 1330-1400 without popping an aneurysm, etc) A VA job with reserves tacked on top would let you self direct a lot more. (Type of work, location, etc)

That said if you want to know if it’s possible to stay in your home state you might get more specific answer if we know what state/service. Some places are easier to homestead than others. I wouldn’t anticipate being able to do the majority of your career in one location though.

 

[JerryMouse]

Find a VA job. If you can tolerate it, consider joining the reserves while staying at the VA job. The VA offers lots of leave, including military leave, which will make the time commitment of the reserves easier. If you have never worked for the government, joining as active duty will be miserable. Inefficiency and bureaucracy abounds. A VA job will give you a small taste of what that may look like.

 

[comp1]

What benefits were you thinking that the DoD offered that the VA did not? Free ammo? My understanding is that the benefits are quite similar, if not superior, in the VA as opposed to the DoD.

 

[pgg]

What benefits were you thinking that the DoD offered that the VA did not? Free ammo? My understanding is that the benefits are quite similar, if not superior, in the VA as opposed to the DoD.

Don't forget the free travel!

 

[Res Rehab]

In case, you didn't come across it elsewhere ..

My summary of the military medical experience. I just retired in May. Started at West Point in 1996, Infantry officer in 2000, university of Maryland school of Medicine in 2004, Ortho Surgery Residency 2008-2012 (Got tossed out... long story), GMO 2012-2018, Occupational Med Residency 2018-2020, Army Public Health Center 2020-2024 with a deployment in 2021.

Overall.. despite getting my surgical career absolutely wrecked for no reason.. I do recommend military medicine. Just understand the flaws and weaknesses going in and you will be able to adjust your expectations accordingly .

 

[DOswag]

In case, you didn't come across it elsewhere ..

My summary of the military medical experience. I just retired in May. Started at West Point in 1996, Infantry officer in 2000, university of Maryland school of Medicine in 2004, Ortho Surgery Residency 2008-2012 (Got tossed out... long story), GMO 2012-2018, Occupational Med Residency 2018-2020, Army Public Health Center 2020-2024 with a deployment in 2021.

Overall.. despite getting my surgical career absolutely wrecked for no reason.. I do recommend military medicine. Just understand the flaws and weaknesses going in and you will be able to adjust your expectations accordingly .

Dang Res Rehab sounds terrible. Glad overall it worked out and you can still recommend mil med. Based on OP's questions, I wouldn't recommend AD but def check out VA, maybe reserves as the VA would be much more flexible for your time commitment to reserves. Also you can double dip on the retirement that way. VA has great benefits though, you would have more control on location and not be required to move every few years. Yeah pretty much agree with what others have stated above. You'll be very restricted in type of practice, likely outpatient/clinic treating healthy active duty people, unless you're stationed somewhere that you can see dependents/veterans though my understanding is that milmed is trying to go away from treating dependents and veterans unless this has changed since I separated (july 2023). I'm a psychiatrist but only saw active duty. I typically don't recommend milmed in any capacity unless someone just absolutely cannot see themselves doing anything other than military. Benefits typically do not outweigh the risks with milmed and most doctors that I've spoken to are just biding their time until they can hit the button and return to the civ world.

 

[comp1]

Can confirm VA is ready, able and expects extended deployments from its providers as well as the regular drills. Staffing levels are prepped for it and there's a whole setup in the time cards for it. Veteran (including reserves) employment is part of the core mission of the VA.

 

[MHYDE]

What about GS positions in military hospitals? Do those exist? I know in the MTFs I was at (Air Force) there were frequently 1 or 2 GS physicians or "providers" working there at any given time. Then he could be a civilian and would have some control over where he lived/worked, wouldn't have to meet the same fitness requirements, but would be employed by the military and taking care of active duty and retirees like he wants to.

 

[comp1]

Sure, I mean civilian DoD jobs do exist. You can see them here:

USAJOBS - Search

That said, you're going to have a heck of a lot more luck with the VA, even with the current hiring frost and the benefits will be the same or better.

 

[usma05]

What about GS positions in military hospitals? Do those exist? I know in the MTFs I was at (Air Force) there were frequently 1 or 2 GS physicians or "providers" working there at any given time. Then he could be a civilian and would have some control over where he lived/worked, wouldn't have to meet the same fitness requirements, but would be employed by the military and taking care of active duty and retirees like he wants to.

GS exists but were hard to come by and carefully controlled by hospital leadership, meaning unless you knew people there your odds of getting one was remote. Much more plentiful was contract positions, but they come w/ a lot of headache too (no benefits, dependent on who wins the contract which could change yearly and put you in a position where you could lose your job and be left hunting a new one days later. No way to treat a physician.

Source: someone who was responsible for both GS and contract employees for 2 years at a large MTF when I was on AD previously.

 

[pgg]

Around the time I left active duty, a colleague of mine (pediatric anesthesiologist) was trying to get a GS position to stay in the department. He started the process something like 2 years ahead of his retirement.

The hospital needed him and wanted him. They couldn't get it done. Don't remember why.

The day came and he left for a locums job in another state, while they kept working on it. Some number of months later he gave up on the GS thing and took a full time position.

I don't know if the hospital's problem was primarily regulatory obstacles, or apathy, or incompetence. It was just amazing that a subspecialist who wanted to stay, despite the pay differential, couldn't.

I never met any other GS physicians. Plenty of contractors, but not GS. Seems like it's as impossible to hire them, as it is to fire a GS employee.

 

[afteranesthesia]

Around the time I left active duty, a colleague of mine (pediatric anesthesiologist) was trying to get a GS position to stay in the department. He started the process something like 2 years ahead of his retirement.

The hospital needed him and wanted him. They couldn't get it done. Don't remember why.

The day came and he left for a locums job in another state, while they kept working on it. Some number of months later he gave up on the GS thing and took a full time position.

I don't know if the hospital's problem was primarily regulatory obstacles, or apathy, or incompetence. It was just amazing that a subspecialist who wanted to stay, despite the pay differential, couldn't.

I never met any other GS physicians. Plenty of contractors, but not GS. Seems like it's as impossible to hire them, as it is to fire a GS employee.

why did they want to stay? Knowing our specialty and the opportunities out there....just curious

 

[pgg]

why did they want to stay? Knowing our specialty and the opportunities out there....just curious

Same reasons people take contractor jobs. Geography. Inertia. The department was pleasant. Small residency program with opportunity to teach, which he enjoyed. Reasonable workload. Reasonable hours. Minimal call. GS position = incredible job security. Paycheck is "enough" ...

I think once he started cashing those locums paychecks and got settled into his supposed-to-be-temporary bridge job between retiring and the GS position starting, his motivation to come back as a civilian/GS guy evaporated. Last I heard he was pretty happy being a W2 academic peds guy in the south.

The Navy could have had him, if it was able to get its collective **** together within that ~3 year window. I'm sure this story is as old as the medical corps itself.

 

[afteranesthesia]

Same reasons people take contractor jobs. Geography. Inertia. The department was pleasant. Small residency program with opportunity to teach, which he enjoyed. Reasonable workload. Reasonable hours. Minimal call. GS position = incredible job security. Paycheck is "enough" ...

I think once he started cashing those locums paychecks and got settled into his supposed-to-be-temporary bridge job between retiring and the GS position starting, his motivation to come back as a civilian/GS guy evaporated. Last I heard he was pretty happy being a W2 academic peds guy in the south.

The Navy could have had him, if it was able to get its collective **** together within that ~3 year window. I'm sure this story is as old as the medical corps itself.

That's so true. People settle and take less than they deserve for more effort on their part than it should be due to complete inertia. The phrase, "I can't move" irritates me, because it should be phrased, "I could move, but I don't want to." Sounds like this guy then had no choice but to move and discovered that the phrase, "I can't move out of this geographic area" is mostly bull%$^#.

 

[narcusprince]

Inertia is something that you don’t see a lot of in private practice. Especially non partnership groups. I helped write some GS position descriptions and you have to have someone meeting with HR weekly to get positions approved and hired. Someone within the department has to move the stick on that.

 

[afteranesthesia]

Inertia is something that you don’t see a lot of in private practice. Especially non partnership groups. I helped write some GS position descriptions and you have to have someone meeting with HR weekly to get positions approved and hired. Someone within the department has to move the stick on that.

nobody in the military selflessly cares that much....my entire experience of military medicine was people doing as little as possible for the military and as much as possible to get their day done as soon as possible so they could be done for the day.

 

[pgg]

That's so true. People settle and take less than they deserve for more effort on their part than it should be due to complete inertia. The phrase, "I can't move" irritates me, because it should be phrased, "I could move, but I don't want to." Sounds like this guy then had no choice but to move and discovered that the phrase, "I can't move out of this geographic area" is mostly bull%$^#.

True in all settings. Over on the anesthesia board there's a guy we (nicely) poke fun at because he's stuck in NYC with the worst job imaginable. Lousy pay, absurd working conditions. But he can't leave NYC, for reasons.

In the grand scheme of things, he's doing OK. Making a decent living, in a place he wants to be, not homeless, not starving. Got to keep some perspective - all of us have it pretty good. But man it sort of hurts to see what he's gone through, knowing that there are about 350 other places to work that are so much better, and that's just on the same latitude.

nobody in the military selflessly cares that much....my entire experience of military medicine was people doing as little as possible for the military and as much as possible to get their day done as soon as possible so they could be done for the day.

There are some. I think the system would break, tomorrow, without those O5 and senior O4 types who want to make it all work, and do all the little things they don't have to in order to make things slightly better for everyone else. I was one of them for a while until they broke me and I embraced being a terminal commander. I have deep respect for the ones who manage to keep on keepin' on. Don't know how they do it.

 

[usma05]

Inertia is something that you don’t see a lot of in private practice. Especially non partnership groups. I helped write some GS position descriptions and you have to have someone meeting with HR weekly to get positions approved and hired. Someone within the department has to move the stick on that.

I can't speak to your situation, but at the MTF where I was helping running things decision making for GS position was centralized and decided by the MTF commander. Made it a Hunger Games like scenario where departments had to vie for positions. Never had an anesthesia MTF commander, so never won that game despite the need by us and interest by others.

 

[narcusprince]

I can't speak to your situation, but at the MTF where I was helping running things decision making for GS position was centralized and decided by the MTF commander. Made it a Hunger Games like scenario where departments had to vie for positions. Never had an anesthesia MTF commander, so never won that game despite the need by us and interest by others.

I remember this meeting. Once the position made it through this meeting then the hiring process can start. Your right though all the proposed GS positions get listed and chopped. This requires buy in from the dss if the anesthesia DH and the DSS aren’t on the same page then its no bueno.

 

[MHYDE]

GS exists but were hard to come by and carefully controlled by hospital leadership, meaning unless you knew people there your odds of getting one was remote. Much more plentiful was contract positions, but they come w/ a lot of headache too (no benefits, dependent on who wins the contract which could change yearly and put you in a position where you could lose your job and be left hunting a new one days later. No way to treat a physician.

Source: someone who was responsible for both GS and contract employees for 2 years at a large MTF when I was on AD previously.

Yeah I guess now that I think about it those civilians I knew might have been contractors. I never really talked to them about their jobs.

 

[pgg]

IIRC there was a fixed number of GS positions the hospital was permitted to have. To add a GS in one department meant that a GS elsewhere had to quit, retire, or get fired. Obviously makes hiring that much more difficult. Possibly a consequence of typical well-meaning but ultimately dumb legislation to limit the size of government.

 

[DOswag]

Yeah both bases I was stationed at had contracted positions. They paid pretty well from straight up salary but from what I remember there was no benefits attached to the job so. Worked with 2 different contracted psychiatrists. One was a veteran though and at least was service connected through the VA.

 

[TheEarDoc]

I would go VA and then reserves or if you are ok with staying in one state Army National Guard or Air National Guard. You get a steadier day in the VA with good benefits and military leave and supposedly one of the most flexible employers when it comes to working with your military duties.

Others have mentioned it, but in a major time of war the VA is spun up as another MTF for military folks or other civilians depending on the nature of the emergency as it's one of their missions.