Cons of military medicine

[Homunculus]

go!

--your friendly neighborhood fair and balanced caveman

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[RichL025]

Lest I be accused of being a pollyanna...

Loss of freedom - personal & professional. As many of the "negative" posters in the previous post-war pointed out, if your a civilan and it really sucks, you can always take a walk. Can't do that with Uncle Sam.

Loss of personal freedom: right to free speech is restricted, 4th ammendment rights are somewhat lessened, and you are held to a rigid code of conduct that (in theory) goes beyond what is expected of civilians. During my 19 years, I have yet to _feel_ any of those "losses", but I can see how they might be big deals to some people.

Another big minus - possibility of not getting used in a professionally appropriate manner. Like General Surgeons whose 75% of their cases are colonoscopies. How often does this happen? Dunno, but it has happened in the recent past, apparently.

For my career up to this point, the positives (see my contributions in the "pro" thread) have way outweighed the negatives, hopefully that will continue as I move from "military" into "military medicine"...

 

[Galo]

Clearly, these posts are something to be read throughly by someone thinking about miitary medicine. It seems access to this forum is being found more by people who are already in HPSP, and unfortunately have made up their minds the system is good.

It is not.

I urge you to read the post that I asked to be stickied since it contains information by individuals who lived through the system, and are there to give you their opinions, biased as they may be. They also contain links to internal documents as well as outside media clearly documenting the problems that exist


http://forums.studentdoctor.net/showthread.php?t=254552

This post is called the decline of military medicine, and I started it in late Jan 2006. I hope it is informative to those who want information not available from recruiters, or those who are blind to the problems of the system.

As always, I will be happy to take PM's, or you may also email me at:

[email protected]

Learn from those who have experienced the worst.

Galo

 

[Mirror Form]

My two main gripes:

1.) Much less control over your internship and residency training when compared to civilians.

2.) Loss of control over where you live. Although, I try not to complain about this b/c it's something we all knew about when we signed up.

 

[RichL025]

My two main gripes:

2.) Loss of control over where you live. Although, I try not to complain about this b/c it's something we all knew about when we signed up.

I agree with this one espescially - one of my recurring nightmares is to receive PCS orders to Ft Riley or Ft Sill

Still, in addition to being a "con", this one has a _small_ upside to it. You wind up getting sent to places you otherwise might not have ever had the opportunity to go. In my career up to this point, I've been stationed in

- Hawaii (not always as good as it might seem)
- Ft Bragg (yuch, couldn't wait to leave)
- San Antonio TX (expected the worst, but wound up loving it)
- Germany (loved it, but not everyone did)
- Key West, FL (what a hardship tour! <g>.)
- Bethesda (I never realized how much I hated traffic)
and now at Ft Lewis....

Many to most of those places, if I hadn't been "sent" (or at least been offered them strongly) I might not have gone to, content to be complacent in my own little universe of where I grew up (South Florida).

Maybe if I get those dreaded orders to Ft Sill in the future, I'll surprise myself by finding things to love about it, but I'm just keeping my fingers crossed that my luck still holds....

 

[USAFdoc]

see the AVOID MILITARY MEDICINE if possible thread.

Basically, the loss of freedom becomes the dominant issue because of the lack of a professional and quality environment in many if not most military medicine settings. If you had the freedom, a physicians threat to leave asap would force admin to raise the standards. As it is, those physicians with the highest standards tend to become the most frustrated with the failing system.

 

[Homunculus]

1) restrictive leave policies
2) year long deployments spent *not* doing what i'm trained in
3) fellowship opportunities being limited by the needs of the service
4) CHCSII
5) my colleagues in other fields being grossly underpaid
6) medical bonus pays not being calculated into retirement

--your friendly neighborhood tried not to sweat the little stuff caveman

 

[r90t]

How can you tell your detailer is lying to you? His mouth is moving.

You are at the whim of your detailer for:
Location
Command
Billet
Transfer date

Training. Some people find GMO time frustrating and a gross mistake for military medicine.

Pre-selected patient population. You will not see as many grossly diseased patients as you would training in some civilian programs.

Pay. Great as a intern/resident, but for some specialties, the bonuses are grossly underpaid once board certified. Even the 15k/year MC bonus, has not changed since at least, 1993. They need to keep up with inflation.

O-6 nurses.

 

[USAFdoc]

CONS

You know that life in your USAF clinic is bad when:

1) Everyone would rather be deployed to the middle east than remain in the clinic.
2) You repeatedly are taking leave days just to have the time needed to catch up on the clinic paperwork.
3) In any given week, 50% of the female military staff are in tears secondary to the stress.
4) You are considering "re-enlisting" just to get an assignment outta the clinic.

 

[USAFdoc]

1) You might be a USAF Family Doc if the only clothes you have worn in 2 years are your uniform, your mandatory PT gear, and pajamas.

2) You might be a USAF Family Doc if you realize that you have spent more time in conversation with your frequent flyer patients than your own family.

3)You might be a USAF Family Doc if they told you that all the docs will be kicked out/giving up your offices because the enlisted folks need more office space.

4) You might be a USAF Family Doc if your car is always the only one in the parking lot when you come/go.

5) You might be a USAF Family Doc if your entire chain of Command is filled with doctors in specialties other than your own.

6) You might be a USAF Family Doc if you accidently keep referring to your dads Recreation vehicle (RV) as a RVU.

7) You might be a USAF Family Doc if your favorite clinic phrase is "unbeleivable".

8) You might be a USAF Family Doc if your Vitamin D levels are outta sight low.

9) You might be a USAF Family Doc if your support staff gets changed more times than a babies diaper.

10) And finally, you are likely now an ex-USAF Family Doc if you were ever a USAF Family Doc for more than 3-4 years.

 

[Galo]

1) You might be a USAF Family Doc if the only clothes you have worn in 2 years are your uniform, your mandatory PT gear, and pajamas.

2) You might be a USAF Family Doc if you realize that you have spent more time in conversation with your frequent flyer patients than your own family.

3)You might be a USAF Family Doc if they told you that all the docs will be kicked out/giving up your offices because the enlisted folks need more office space.

4) You might be a USAF Family Doc if your car is always the only one in the parking lot when you come/go.

5) You might be a USAF Family Doc if your entire chain of Command is filled with doctors in specialties other than your own.

6) You might be a USAF Family Doc if you accidently keep referring to your dads Recreation vehicle (RV) as a RVU.

7) You might be a USAF Family Doc if your favorite clinic phrase is "unbeleivable".

8) You might be a USAF Family Doc if your Vitamin D levels are outta sight low.

9) You might be a USAF Family Doc if your support staff gets changed more times than a babies diaper.

10) And finally, you are likely now an ex-USAF Family Doc if you were ever a USAF Family Doc for more than 3-4 years.

Those are awesome, and easily applicable to any specialty in the military!!

As if it were not bad enough, here is yet another reason to not be in military medicine:

http://www.veteransforcommonsense.org/?Page=Article&ID=6370

Although I'd like to say these are the minority, this is what often times happens when physicians allow themselves to think officership is more important. I think even some officers may say that is inappropriate, but then you get the whole follow rules blindly debate, and you go in circles that never end.

this is just wrong

 

[RichL025]

Those are awesome, and easily applicable to any specialty in the military!!

As if it were not bad enough, here is yet another reason to not be in military medicine:

http://www.veteransforcommonsense.org/?Page=Article&ID=6370



this is just wrong

This is also a politically-motivated attack that merits no mention whatsoever in a supposedly 'balanced' discussion. I have read the both the NEJM * Lancet articles they mentioned, and they are portraying it in a very slanted manner with regards to physicians engaged in "abuse and torture".

There are some legitimate claims that military medical personnel, both medics, nurses and physicians, violated their professional ethics by not reporting abuse they saw evidence from.

There are also legitimate concerns about the role of psychiatrists in interrogation of detainees.

No where in those 2 articles (I just reviewed them to be sure) do those authors directly charge that medical personnel engaged in torture. Both of them raise concerns that further investigation IS necessary, but they do NOT rise to the level of claims that the Veterans for Common Sense article makes.

Furthermore, I find the allegations about psychiatrists making spurious diagnoses of mental illness to 'silence' whistle-blowers... slanderous. During my psych rotation at Walter Reed I worked under and for many of these doctors, and helped evaluate soldiers who were evacuated for psychological / psychiatric reasons. Not once did I see any soldier who did not have valid symptoms.

 

[Galo]

This is also a politically-motivated attack that merits no mention whatsoever in a supposedly 'balanced' discussion. I have read the both the NEJM * Lancet articles they mentioned, and they are portraying it in a very slanted manner with regards to physicians engaged in "abuse and torture".

There are some legitimate claims that military medical personnel, both medics, nurses and physicians, violated their professional ethics by not reporting abuse they saw evidence from.

There are also legitimate concerns about the role of psychiatrists in interrogation of detainees.

No where in those 2 articles (I just reviewed them to be sure) do those authors directly charge that medical personnel engaged in torture. Both of them raise concerns that further investigation IS necessary, but they do NOT rise to the level of claims that the Veterans for Common Sense article makes.

Furthermore, I find the allegations about psychiatrists making spurious diagnoses of mental illness to 'silence' whistle-blowers... slanderous. During my psych rotation at Walter Reed I worked under and for many of these doctors, and helped evaluate soldiers who were evacuated for psychological / psychiatric reasons. Not once did I see any soldier who did not have valid symptoms.

You say it merits no mention here, but then go on to say that there are legitimate claims of ethics violations. Is it such a stretch to believe that this could not have happened, or do you believe as well, that a bunch of enlisted folks just decided one day that torture is the way to go. Yet another instance where enlisted are treated as second class citizens, and the military protects officers, and those with rank. This is the syndrome where people who are so pro the system are unwilling to admit even the possibility that something like this may happen. Again, that is part of the problem.

Do you have a link to both those articles by chance. I would like to read them for myself

Thanks

 

[RichL025]

You say it merits no mention here, but then go on to say that there are legitimate claims of ethics violations. Is it such a stretch to believe that this could not have happened, or do you believe as well, that a bunch of enlisted folks just decided one day that torture is the way to go. Yet another instance where enlisted are treated as second class citizens, and the military protects officers, and those with rank. This is the syndrome where people who are so pro the system are unwilling to admit even the possibility that something like this may happen. Again, that is part of the problem.

Do you have a link to both those articles by chance. I would like to read them for myself

Thanks

The propaganda piece by the "common sense veterans" or whatever was what I said did not belong here, because it jumped to unsupported conclusions by selectively quoting respectable articles.

The inherent conflict between military and medical ethics is certainly a valid topic for discussion.

Sorry, I didn't save the links to the articles. You can google to find them both, the NEJM article was in the very first issue of Jan 2005, the Lancet article is in the 2nd or 3rd issue of Aug 2004. The lancet one can be read online after registering at the website, you have to have a subscription for the NEJM - if you do, it's easy to register for online access.

Is it such a stretch to believe that this could not have happened, or do you believe as well, that a bunch of enlisted folks just decided one day that torture is the way to go.

I was enlisted myself for 14 years. I believe it is very realistic that a small number of them could commit the Abu Ghraib abuses, espescially if they were stretched thin (which no one denies), and had poor supervision (which is allegeged, and why a brigadier general was fired for it).

I also know that their defense that they had never received training in the Geneva conventions & law of land warfare is BULLCRAP because every soldier gets it in basic training (now keeping awake for it, that's a different matter...)

 

[RichL025]

Addendum - you can't google the lancet article, just the nejm one. To get the lancet one, go to the lancet home page and navigate to the 2nd or 3rd issue of Aug 2004. It's about 2/3 of the way down, there's also an editorial up front on the topic.

 

[Galo]

The inherent conflict between military and medical ethics is certainly a valid topic for discussion.

Certainly there is no argument there. Except that in the military, medical ethics can be the looser when it interferes with the "mission."



I was enlisted myself for 14 years. I believe it is very realistic that a small number of them could commit the Abu Ghraib abuses, espescially if they were stretched thin (which no one denies), and had poor supervision (which is allegeged, and why a brigadier general was fired for it).

I also know that their defense that they had never received training in the Geneva conventions & law of land warfare is BULLCRAP because every soldier gets it in basic training (now keeping awake for it, that's a different matter...)[/QUOTE]

It seems surprising that you would believe just a handful of NCO's would perpetrate this witout higher orders. Being fired, is not the same as going to jail and having a permanent record for it. I'm sure the general will be quietly allowed to retire and collect his pension for the rest of his life, as will the officers directly responsible for these NCO's. My point being here that just as always, those with more power can do pretty much what they want with no repercussions, and ultimately they are people of mediocre standing, just like the majority of senior medical corps whether they are docs or nurses, that continue to allow the clear decline in military medicine!!

 

[RichL025]

It seems surprising that you would believe just a handful of NCO's would perpetrate this witout higher orders.

To be honest with you, it's kind of frustrating that on one hand, you berate posters for criticizing YOUR comments which you claim come from your experience, yet if _I_ offer a comment based on MY experience, you automatically dismiss it because it doesn't fit with your view of what must have happened.

What happened at Abu Ghraib is not clear-cut and easy to understand. But civilians (and people like yourself who were commisioned specialists for a few short years) seem to have the idea that enlisted people are robots, marching in lock-step to the orders of their 'betters'.

So if they did something bad, it MUST have been an officers fault, right? Why? Because you can't conceive of a Staff-Sergeant having any independant authority.

Caveat: I am not offering the gospel truth of what happened at Abu Ghraib. We simply don't know because we weren't there. What _I_ am saying is that despite what you and others believe, the official explanation is plausible.

NCOs operate independantly without explicit orders for what they are doing EVERY DAY. 99% of them are smart, dedicated, and want to do the right thing. A few of them are stupid, lazy, greedy, incompetent or just plain evil. The only thing required for the abuses at Abu Ghraib to have been perpetrated is "stupid" along with a poor command climate.

(Incidentally, I had opportunity to meet one of the more infamous defendants several times in a health care setting. Obviously HIPAA prevents me from being more specific, but this soldier was not the brightest bulb in the bunch. The soldier may not have even been fully intellectually mature - that's how dull the soldier seemed to me. But I digress....)


I completely agree that their higher commanders bear responsibility - but for failure to supervise properly, NOT for abusing prisoners. The general I mentioned had her career ended NOT because she abused prisoners, or because she was somehow complicit, but because she failed to properly supervise her troops. To be honest with you, from my tenure in the military, I would wager that the true failures resided in the O3-O4 levels, but the commander is responsible for THEM as well... and I honestly don't remember if there were other officers who received official reprimands & were relieved because of it.

Higher command _does_ bear responsibility for the "mixed messages" that were going out to the troops also, vis a vis the status of prisoners and what interrogation techniques were allowed (although this doesn't apply directly to those convicted, because they were only guards and not interrogators) - the defense at trial made the very valid claim that conflicting messages from the DoD made the soldiers unsure of what was right & what was forbidden. Unfortunatly, this is at the level of politicians, not soldiers, who are responsible only at the ballot box.

So to help put it in perspective for you - think back to when you were a very unhappy doc at your last USAF clinic. Suppose the OSI caught one of your medics pilfering supplies, would they send YOU to jail for it? Even if they felt you had not properly supervised the medics, you would not have gone to jail - you might have gotten a reprimand for the poor supervision (if warranted) that enabled him to steal, but that's due to your command responsibility, NOT legal culpability for his transgression.

Oh, and as far as other officers being punished for failure to supervise here's from a news article I found :

Without providing their names, the Army also said Thursday that one colonel and two lieutenant colonels linked to detainee abuses in Iraq and Afghanistan were given unspecified administrative punishment. Also, two other lieutenant colonels were given letters of reprimand.

More than a dozen other lower-ranking officers, whose names were not released, also received various punishments.

# Three majors were given letters of reprimand and one of the three also was given an unspecified administrative punishment.

# Three captains are to be court-martialed, one captain is to be given an other-than-honorable discharge from the Army, five captains received letters of reprimand, and one was given an unspecified administrative punishment.

# Two first lieutenants will be court-martialed, another got a letter of reprimand and one was given administrative punishment.

# One second lieutenant was given an other-than-honorable discharge and another was given a letter of reprimand.

# Two chief warrant officers are to be court-martialed.

Now let me make something perfectly clear: I am not absolving them all of responsibility. I am not saying that the army's explanation is true. What I am saying is that it is PLAUSIBLE and fits with what I know of how the army works. You are certainly free to believe whatever you want in the way of conspiracy theories, but then again, you might as well believe the moon landings were faked using the same logic

 

[Galo]

To be honest with you, it's kind of frustrating that on one hand, you berate posters for criticizing YOUR comments which you claim come from your experience, yet if _I_ offer a comment based on MY experience, you automatically dismiss it because it doesn't fit with your view of what must have happened.

Rich, yes you have 14 yrs of experience in the army as an enlisted person, congratulations, you by default are far more knowledgeable than me when it come to enlisted matters. I do not dismiss it because it does not fit with my view that the military is full of people who like you said, are not the brightest bulbs, and mediocrity is an accepted behavior. Also I have every right to criticize anybody who is making comments based on NO PERSONAL experience. You are still not a practicing physician, yet seem to give advice, or criticism that you really have no basis in giving. Try your hand at being a physician before you make the statements you make about medicine. TO date, I have yet to see an experienced physician make an honest criticism of the people who post their negative experiences.



What happened at Abu Ghraib is not clear-cut and easy to understand. But civilians (and people like yourself who were commisioned specialists for a few short years) seem to have the idea that enlisted people are robots, marching in lock-step to the orders of their 'betters'.

I hardly think 6 LONG years, would be considered short by anybody. Also in dealing with enlisted personell for those many years, I never got the impression that they were anything like robots, as much as some of the higher leadership wanted to treat them as such.


So if they did something bad, it MUST have been an officers fault, right? Why? Because you can't conceive of a Staff-Sergeant having any independant authority.

Caveat: I am not offering the gospel truth of what happened at Abu Ghraib. We simply don't know because we weren't there. What _I_ am saying is that despite what you and others believe, the official explanation is plausible.

NCOs operate independantly without explicit orders for what they are doing EVERY DAY. 99% of them are smart, dedicated, and want to do the right thing. A few of them are stupid, lazy, greedy, incompetent or just plain evil. The only thing required for the abuses at Abu Ghraib to have been perpetrated is "stupid" along with a poor command climate.

(Incidentally, I had opportunity to meet one of the more infamous defendants several times in a health care setting. Obviously HIPAA prevents me from being more specific, but this soldier was not the brightest bulb in the bunch. The soldier may not have even been fully intellectually mature - that's how dull the soldier seemed to me. But I digress....)


I completely agree that their higher commanders bear responsibility - but for failure to supervise properly, NOT for abusing prisoners. The general I mentioned had her career ended NOT because she abused prisoners, or because she was somehow complicit, but because she failed to properly supervise her troops. To be honest with you, from my tenure in the military, I would wager that the true failures resided in the O3-O4 levels, but the commander is responsible for THEM as well... and I honestly don't remember if there were other officers who received official reprimands & were relieved because of it.

Higher command _does_ bear responsibility for the "mixed messages" that were going out to the troops also, vis a vis the status of prisoners and what interrogation techniques were allowed (although this doesn't apply directly to those convicted, because they were only guards and not interrogators) - the defense at trial made the very valid claim that conflicting messages from the DoD made the soldiers unsure of what was right & what was forbidden. Unfortunatly, this is at the level of politicians, not soldiers, who are responsible only at the ballot box.

So to help put it in perspective for you - think back to when you were a very unhappy doc at your last USAF clinic. Suppose the OSI caught one of your medics pilfering supplies, would they send YOU to jail for it? Even if they felt you had not properly supervised the medics, you would not have gone to jail - you might have gotten a reprimand for the poor supervision (if warranted) that enabled him to steal, but that's due to your command responsibility, NOT legal culpability for his transgression.

Oh, and as far as other officers being punished for failure to supervise here's from a news article I found :



Now let me make something perfectly clear: I am not absolving them all of responsibility. I am not saying that the army's explanation is true. What I am saying is that it is PLAUSIBLE and fits with what I know of how the army works. You are certainly free to believe whatever you want in the way of conspiracy theories, but then again, you might as well believe the moon landings were faked using the same logic

Clearly there is an unbridgeable chasm in our judgement for the military. As a physician who spent actual operational time, I am vastly more able to make comment on medicine than you who are not yet a practicing physician. I will try to reserve my comments on things that I am not an expert in. However, propaganda or not, there seems to have been ethical violations by medical corps personell. I am saying this is yet another reason why military medice is in its sharp dive to oblivion, and why its is not a good place for someone primarily interested in practicing medicine. As long as people continue thinking and acting like there is no problem, it will continue to compound itself, and medicine in the military will continue to suffer, as well as those who its supposed to help.

 

[Homunculus]

I will try to reserve my comments on things that I am not an expert in.

seriously?? hmmm.

Those are awesome, and easily applicable to any specialty in the military!!

"any" specialty in the entire military? so included in that would be army pediatrics, yes? please tell me what part of USAF doc's post is applicable toward my specialty. after all, you reserve comments on things you're not an expert in . . .

i was going to let it slide, but after saying you reserve your comments i had to say *something* lol.

unless, of course, you are an expert in army pediatrics in which case i sincerely apologize.

--your friendly neighborhood tried to leave it well enough alone but couldn't caveman

p.s. this is a lighthearted post-- please don't take it as a personal insult or anything

 

[Galo]

seriously?? hmmm.




"any" specialty in the entire military? so included in that would be army pediatrics, yes? please tell me what part of USAF doc's post is applicable toward my specialty. after all, you reserve comments on things you're not an expert in . . .

i was going to let it slide, but after saying you reserve your comments i had to say *something* lol.

unless, of course, you are an expert in army pediatrics in which case i sincerely apologize.

--your friendly neighborhood tried to leave it well enough alone but couldn't caveman

p.s. this is a lighthearted post-- please don't take it as a personal insult or anything

Lighthearted as it may seem, I think its pretty shameful of you to act as the administrator, and be so biased at the same time. You are only a resident and seem to think you have a handle on being an attending. Even though I am not a pediatrician, I worked with many of them at Offutt, and at Wright Patt, where they basically lost hospital priviledges, and were confined to a building that was not even close to the hospital.

If you want to be literal, USAFdoc post:

- uniform, pt gear, pajamas, unless you sleep in the nude, so OK 3 sets of clothes
- if you are a dedicated phycisian, you may find yourself spending more time with patients than you do your family
-don't be surprised if you suddenly have to share a desk or a room with another couple of docs, its office dependent, but not an impossibility!
- your car may be the first in, last out, depending on your work load/commitment, amount of paperwork you will be doing
-i'm sure you wont be surprised when you find your boss is an 0-6 nurse who has not taken care of a patient for years. THis is all to common.

You get the drift, they are applicable, as they are common generalizations that make our live's as military physicians more and more difficult, but then again, as a resident, you have not fully experienced that. I'd love to see a post from you in a year or two after you are actually in the field, when you actually will have experience to post.

In the mean time, as administrator, I think you should remain a little more neutral.

 

[colbgw02]

I've been posting on several different online discussion boards for quite awhile now, and the administrator was never supposed to be completely neutral. Their function has always been to keep things clean while deleting inappropriate/repetitive threads, so I don't see why things should be different here. H-man, please don't let people keep you from posting your opinion.

 

[Homunculus]

Lighthearted as it may seem, I think its pretty shameful of you to act as the administrator, and be so biased at the same time. You are only a resident and seem to think you have a handle on being an attending. Even though I am not a pediatrician, I worked with many of them at Offutt, and at Wright Patt, where they basically lost hospital priviledges, and were confined to a building that was not even close to the hospital..

and this relates to army pediatrics, which i have no doubt i know more than you about, how exactly? you made a statement that i called BS on. don't take it so personally

You get the drift, they are applicable, as they are common generalizations that make our live's as military physicians more and more difficult, but then again, as a resident, you have not fully experienced that. I'd love to see a post from you in a year or two after you are actually in the field, when you actually will have experience to post..

ah yes, the "you aren't an attending" argument. well, you're not a pediatrician i *work* side by side with staff every day. i see what they do. your comments do not accurately reflect their lives, and i find it amusing you would state you "don't comment on things you aren't an expert on" but then attempt to paint my specialty with your broad brush of negatism from being a screwed over air force surgeon.

In the mean time, as administrator, I think you should remain a little more neutral.

i am as neutral as i can be, to a point.. i'm sorry you interpret my disagreeing with your statement as not being neutral. it's not that i don't think you have a valid argument, it's that i don't think your argument can be applied as widely as you apply it.

at any rate, this is my last post addressing this issue. if you wish to continue our conversation in PM's, feel free.

--your friendly neighborhood calls it like he sees it caveman

 

[DRDARIA]

Okay, I've been reading this for a while, and I can't keep quiet anymore. First, let me be absolutely clear on my position. I have 10+ years of military service as an officer in an allied science working daily with physicians in a variety of specialties. I think that the military medical system has many flaws, and needs to be pressured to improve. I think the abyssmal funding of the VA system is a national tragedy. I chose not to take HPSP because I didn't want a military obligation hanging over my head after graduation, and I didn't want my training interrupted. This is not to say I will not consider reserve service later. I haven't decided.

Now, on to my point:

I have found Homunculus to be incredibly neutral in his duties. Being moderator does not mean one is not entitled to their opinions!

I am tired of people who try to imply that anyone that doesn't agree with them doesn't have a valid point. Galo, you do not have consistent logic. By your logic, people should only comment on what they have personally done, (ie your personal experience as a physician) but not what they have observed (ie you discount the experience of people with more time in the military because they weren't physicians at the time). Then you turn around and comment on what you observed about pediatricians! So why don't the observations of those of us who were in the service and worked side by side with physicians in many specialties count? Your logic that any one who wasn't a physician while in the military doesn't have the ability to observe and draw valid conclusions is nonsense. You constantly try to throw out what you have seen in other specialties/branches, but then disregard what anyone else has seen/observed. At least be consistent!

You constantly say that no "experienced physician" with a positive comments posts here-- well, quite honestly I think many "experienced physicians" probably have better things to do with their time than posting on a student bulletin board. That doesn't mean I don't appreciate your sharing your opinions, when it is done in a civil way, but the fact that they don't post here (if they are even aware of the presence of this board and this thread-- why would they be?) does not mean they don't exist.

I doubt I'll post further on this topic, as it doesn't seem to be going anywhere, but I did want to commend Homonculus on his/her patience, and on the good job he/she is doing. Thanks for the time you spend doing this, Homonculus.

 

[Galo]

And the divisions widen.

Any actual pediatricians any service out there to comment?? It seems homunculus is in a great place having a great time. I just wonder if it will be the same tune when he goes out to a new base all trained and ready to go. It be great to get that feedback, although realistically it will take years.

 

[DRDARIA]

1

 

[USAFdoc]

DRDARIA
1) I 100% agree, Homonculus does a good job as the moderator.
2) We (the posters) and the readers always need to be careful to look at the "context" of the thread and who is the speaker. As a Family Doc, I would think either as a reader or poster that one would place high "worth" on what I might say about USAF primary care, and less "worth" on othr statements, not to say that any statements are not true or valid.
3) Anyone who disagrees with me has every right, but it can be frustrating to read a post from someone who has near zero experience in the line of work that I "lived" for the past several years. I realize that many of the objections people have are because they are "100% pro-military" and my posts are like a personal attack on 'Family" and they take it personally.
4) I have posted "positives" about my experience in the past; but the overwhelming picture I witnessed in USAF primary care was unacceptable. Still today when I think about what was going on in my clinic, I almost don't believe it happened.
5) For those who post without having experience, thats fine. Its interesting to see their beliefs on how the system operates. I was completely naive in what I expected. I thought military medicine would be a combination of USAF Core Values (excellence, integrity, Service before self) and good medicine. In reality, it was so disappointing to see it run by metrics, money, and management will no experience and not willing to team with the staff to make the most of a challenging sitaution. I would not expect anyone who was not there to really understand how bad it is/was.

 

[colbgw02]

Galo,

All other things being equal and your many years as an Air Force attending surgeon notwithstanding, I have to admit that I think a reasonable person would believe that a current Army pediatric resident would know more about Army pediatrics than an Air Force surgeon. So, I'm hoping you'd share why you don't seem to except Homunculus's relative expertise? Can you cite any specific experiences with Army pediatrics which have led to your conclusions? Furthermore, since you appear to believe that Homunculus's opinions concerning his career will change once he's been an attending for several years, I'm wondering on what specific experiences with Army pediatrics you're basing those beliefs.

You see, it's not that I think you're wrong; it's just that I'm having a hard time connecting the dots between your own experiences with Air Force surgery and your conclusions regarding Army pediatrics. Rather than just stating your thoughts and discounting the opinion of anyone who, in your eyes, isn't experienced enough, I'd appreciate a thorough, step-wise explanation, based on the principles of logic and deductive reasoning, of how you relate your own field of expertise with Army pediatrics.

If my requested format for your argument seems like overkill, then I apologize. It's just that in a forum such as this, lacking visual cues and voice inflection, I think it's important to state things as clearly as possible without leaving anything to assumption.

Additionally, I'd like to hear how your experiences with Air Force surgery changed, presumably for the worst, after you finished your residency.

Thanks in advance.

Cheers.

 

[HumptyDumptyMil]

I do believe that there is that pattern of physicians being unhappy AFTER they start their payback. I really havent noticed any negative comments about residency training from anyone.

So my question is why there are so many full-fledged physcians with negative experiences, but not as much negative comments from any residents in training right now(They just too busy to even bother with such a forum)?

Personally, I was wondering if Galo, AFDoc, MilMD, etc. will be willing to share their residency experiences as well. Just to get a more complete picture of their experiences. Thanks!

 

[militarymd]

Things were OK as a resident.

On my 2nd year as an attending, I began to realize the INCREDIBLY poor system we have in place.

Search and read my posts from Dec 2003 forward. That is all I have to say .

Don't do it.

YOU WILL REGRET IT...unless you don't want to be a physician, but would like to be an officer in the military...one who is not respected by physicians.

 

[RichL025]

Lighthearted as it may seem, I think its pretty shameful of you to act as the administrator, and be so biased at the same time. You are only a resident and seem to think you have a handle on being an attending. Even though I am not a pediatrician, I worked with many of them at Offutt, and at Wright Patt...

Once again we see another example of "do as I say, not as I do".

God forbid any of us report back to Galo about attendings we know who are satisfied with their jobs, because we oh so lowly med students, interns and residents coulnd't POSSIBLY have the intellectual tools to evaluate their statements.

BUT, when it suits your purpose, you have no problems quoting the secondhand opinions of "pediatricians I know".

OK, the above was a little snide (and it was certainly intended that way, at this point....) but I say the following with no offense intended whatsoever:

I've said it once before and I'll say it again Galo - I've seen your type for the past 19 years. You have legitimate gripes about (something), but because of your poor experiences you get a bad attitude and proceed to extend your dissatisfaction to things you could not possibly have any meaningful experience of.

Now you're lecturing a pediatric resident about pediatrics and how much he will hate it when he has 2 years out.

If you really want to do some good, stay on message. I have no reason whatsoever to doubt yoru experience in Air Force surgery, but by the same token, I'm going to laugh when you try and generalize that to include {i]everything[/i] with the word military in it! You managed to stop yourself just short of lecturing me on the NCO corps for Pete's sake.

Like I said previously, your experiences and opinions about Air Force medicine & surgery are welcome here. But please do not slip back into the embittered old man routine, all it will do is drown out your message and cause you to waste your time.

 

[Galo]

Galo,

All other things being equal and your many years as an Air Force attending surgeon notwithstanding, I have to admit that I think a reasonable person would believe that a current Army pediatric resident would know more about Army pediatrics than an Air Force surgeon. So, I'm hoping you'd share why you don't seem to except Homunculus's relative expertise? Can you cite any specific experiences with Army pediatrics which have led to your conclusions? Furthermore, since you appear to believe that Homunculus's opinions concerning his career will change once he's been an attending for several years, I'm wondering on what specific experiences with Army pediatrics you're basing those beliefs.

You see, it's not that I think you're wrong; it's just that I'm having a hard time connecting the dots between your own experiences with Air Force surgery and your conclusions regarding Army pediatrics. Rather than just stating your thoughts and discounting the opinion of anyone who, in your eyes, isn't experienced enough, I'd appreciate a thorough, step-wise explanation, based on the principles of logic and deductive reasoning, of how you relate your own field of expertise with Army pediatrics.

If my requested format for your argument seems like overkill, then I apologize. It's just that in a forum such as this, lacking visual cues and voice inflection, I think it's important to state things as clearly as possible without leaving anything to assumption.

Additionally, I'd like to hear how your experiences with Air Force surgery changed, presumably for the worst, after you finished your residency.

Thanks in advance.

Cheers.

I think I have been more than clear on why military medicine as a whole is in a steep decline. The majority of my experience comes from what I endured as a surgeon, but I did work at what was once a regional medical center, Offutt AFB, and what is now ready to become the premier AF medical center, Wright Patterson, after WH closes down. In those 6 years I was not inside a bubble of general surgery only. I participated and interacted closely with all of my collegues in all specialties including peds, medicine, Familiy practice, ortho, gi, GYN, hem onc, etc. I also for some time allowed my family to be treated by some of these specialties, as I had some say in who and how they saw someone. So I may not be an army pediatrician, but having lived and seen what is happening to the medical corps as a whole, in the AF, and knowing from conversations with other surgeons from the Army, and reading what is happening to the navy, I know it is not only an AF phenomenon, but a problem that is facing the military as a whole.

I think a big part of the problem is money. There is not enough to go around, and like other big industries, health care is becoming increasingly expensive. The military as a whole, is now getting funding to send active duty personell off base to get medical care. There is now a budget in congress for this. It was in an article in the Washington Post. Unfortunately I do not have the date, of the article. They are all making a big change towards primary care. You have heard the experience of primary care physicians on this board. So while some specialties are being overflooded with patients, others are below acceptable limits. There is no support, whether its intentional, poor planning, money related, you can pick the reason, there is just no support.

As I have stated before, there is an increasing difficulty in maintaining a separation between being a good physician, and an officer. At times they will conflict, and in the military being an officer comes first and foremost. This also ties in with the widespread acceptance of mediocracy as the norm. This is not just in surgery, but in all fields, across military medicine. As a quick example, at my last base, the chief of pathology cannot have a path report released unless it has been reviewed by one of the junior staff. The chief of nuclear medicine is not allowed to read stress thaliums, the cheif of surgery has been investigated twice, once in Germany, and once at our base for poor outcomes in vascular surgery, but no credentialing actions were ever taken. He killed a patient with one week of active duty left, retired without a problem. One of the cardiologists missed an ongoing myocardial infarction on the base deputy commander. The chief of medicine was an alleged chronic adulterer, and was eventually PCS'd. And everysingle one of these people were 0-6's with the exception of the cardiologist who was an 0-5. This is just at my hospital, but the stories abound. I posted a link to a pulitzer price winning expose on military medicine earlier in this post, or on my decline of medicine post. You will find that retention is extremely poor, and those who stay and ascend in power are usually, (not always), poor doctors and poor leaders.

You clearly have seen a very vocal few here that have mirrored my concerns about why military medicine as a whole is in a decline. I have tried to explain why some of my collegues who have had similar experiences just do not bother to post. I have yet to see someone post overly positive experiences refuting the ones of people with experience. I can see people, (me), getting tired of having to explain this over and over. I have discussed personal experiences, experiences of others in all fields, I have placed literature both internal and outside media, and personal letters. But you seem to want logic and deductive reasoning. I don't think you want to believe that there are problems to the magnitude I and others are describing. There seems to also be a few vocal people that want to make intelligent or appropriate observations, and want to have them acknowledged as fact, that their experiences are not what we had, and that somehow this invalidates our observations. This is supposed to be a place where potential students learn about what is going on in the military, and whether or not it is for them. I certainly wish I had this resource before I made my decision to join. It will be impossible to turn a 19 yr army veteran against the army. Its the only life he has known, and by the defensive nature of his posts, he has made up his mind that everything will be OK, and with that mindset, it may be OK for him.
Taking all the time that I am taking to put down my experiences and frustrations over the last 2 weeks has certainly brought out some angry feelings on my part. I am posting here only to allow others to make more informed decisions.

Furthermore, I did a 6 year civilian residency with one year of cardiovascular and transplant immunology research. I too am a published author, though I don't think that matters one way or the other. When I finished my residency and went to my first assignment, I quickly realized that anything else I learned would not come from the military, as there was no one older than me who was doing anything modern. I increased my education by going to Creighton University, and operating there with some of the country's top educators and surgeons, all on my own. Trying to bring some of that knowledge back to the AF was part of what made my experience so difficult. It is not a place for innovation.

I repeat myself in warning prospective doctors, that for these reasons and more, military medicine is in a steep decline, all around, and if being a physician is your primary goal, there are much better options than the military.

I do not know how much more clear I can make this. Most of the people here are intelligent, can read, can talk to others, and certainly can come to their own conclusions. I again make the offer for people to PM me, or write me on my personal email:

[email protected]

 

[RichL025]

It will be impossible to turn a 19 yr army veteran against the army. Its the only life he has known, and by the defensive nature of his posts,

Defensive? Hello, pot? This is kettle calling....

Once again we see your condescending stereotypes crop up. Since I've been in the army 19 years (and... *gasp* as an enlisted man no less) I'm obviously blindly obediant to the "only life I've ever known".

I don't know how much plainer we can make it. You say that you're getting tired of having to explain things over and over again, think about how WE feel....

I give up. Reason won't work. I'll just limit myself to tossing out the BS flag when you make impossible statements.

Have fun, and welcome to the forum.

 

[USAFdoc]

I do believe that there is that pattern of physicians being unhappy AFTER they start their payback. I really havent noticed any negative comments about residency training from anyone.

So my question is why there are so many full-fledged physcians with negative experiences, but not as much negative comments from any residents in training right now(They just too busy to even bother with such a forum)?

Personally, I was wondering if Galo, AFDoc, MilMD, etc. will be willing to share their residency experiences as well. Just to get a more complete picture of their experiences. Thanks!

I did a civilian residency; like probably everyones residency it was hard work, some long hours, and some occassional "razzing" as an intern. Still, compared to my "term" as a USAF Family doc, the residency was better, easier on me and my family, and gave a higher quality of care to patients by far, comapred to my USAF experience.

In my opinion, I would not expect military residency for primary care to "disintegrate" like non-residency clinics because:
1) In general, your excellent leaders that are in family med and not separated will gravitate to the residency staff positions. You have family docs in the chain of command.
2) In general, residency is not dominated by money and metrics like the non-residency clinic.

 

[USAFdoc]

Defensive? Hello, pot? This is kettle calling....

Once again we see your condescending stereotypes crop up. Since I've been in the army 19 years (and... *gasp* as an enlisted man no less) I'm obviously blindly obediant to the "only life I've ever known".

I don't know how much plainer we can make it. You say that you're getting tired of having to explain things over and over again, think about how WE feel....

I give up. Reason won't work. I'll just limit myself to tossing out the BS flag when you make impossible statements.

Have fun, and welcome to the forum.

I like your "devil's advocate" responses RichLO25, you are frequently on target.

I can relate to GALOs over the top entries; they remind me alot of mine right after I separated. Call it "POST TRAUMATIC SYNDROME". I think I had a bit of that and have since mellowed somewhat. Not that for one moment do I agree with the reckless attitudes running USAF primary care, but now after being separated for awhile, my blood doesn't immediately start to boil everytime I hear someone discount the problems military medicine has.

Being a family doc in the civilian world has been great "recovery" treatment.

 

[Galo]

Defensive? Hello, pot? This is kettle calling....

Once again we see your condescending stereotypes crop up. Since I've been in the army 19 years (and... *gasp* as an enlisted man no less) I'm obviously blindly obediant to the "only life I've ever known".

I don't know how much plainer we can make it. You say that you're getting tired of having to explain things over and over again, think about how WE feel....

I give up. Reason won't work. I'll just limit myself to tossing out the BS flag when you make impossible statements.

Have fun, and welcome to the forum.

OK, richlo25, since you seem to be full of knowledge, why don't you contribute something that you know to be the truth about military medicine, perhaps leaning toward the army since that's where your area of expertice is. You are posting on the con thread, so let's hear from you, what are your observations of the way military medicine is now, where is it going, is there any room for improvement??

Since I can't seem to make criticism of the system without you taking it as a personal attack, tell everybody what makes the army such a good and safe place for you. Kettle? Is that a racial slur?

 

[r90t]

Here are a few to ponder....
1. Deployments. Everyone should go, not the same 30% over and over again. Get the O-4 to O-6s NC officers the opportunity to deploy to Iraq and those people will retire ASAP.

2. MSC/NC in top hospital positions where clinical decisions may be affected. Do not give command of a hospital to a NC/MSC, just because they are an O-6 striving for higher rank. Give command of a medical facility to someone with a medical license. As a former MSC, in hindsight, I had no idea what physicians/interns/residents do on a day to day basis. Putting someone in control of decisions that directly affect them is not wise.

3. Experienced nurses gravitate to admin positions an banker's hours. After O-4, you never see a NC officer in the ICU after hours. They leave junior staff to the worst shifts, when there is the least support.

4. I thought our FP call schedule (q 4) for 3 years was much more than many civilian programs that my friends attended.

5. Poor professional training. Everyone assumes that a physician is smart and needs no further military training to function as an officer. They have multi-week Div-O, Dept Head, XO and CO schools for line officers, yet we get assigned to these types positions without further "leadership" training. This in turn leads to poor command climates, leading to the above types of postings.

 

[Galo]

Here are a few to ponder....
1. Deployments. Everyone should go, not the same 30% over and over again. Get the O-4 to O-6s NC officers the opportunity to deploy to Iraq and those people will retire ASAP.

2. MSC/NC in top hospital positions where clinical decisions may be affected. Do not give command of a hospital to a NC/MSC, just because they are an O-6 striving for higher rank. Give command of a medical facility to someone with a medical license. As a former MSC, in hindsight, I had no idea what physicians/interns/residents do on a day to day basis. Putting someone in control of decisions that directly affect them is not wise.

3. Experienced nurses gravitate to admin positions an banker's hours. After O-4, you never see a NC officer in the ICU after hours. They leave junior staff to the worst shifts, when there is the least support.

4. I thought our FP call schedule (q 4) for 3 years was much more than many civilian programs that my friends attended.

5. Poor professional training. Everyone assumes that a physician is smart and needs no further military training to function as an officer. They have multi-week Div-O, Dept Head, XO and CO schools for line officers, yet we get assigned to these types positions without further "leadership" training. This in turn leads to poor command climates, leading to the above types of postings.

These are excellent points. I can comment on them because I have seen them. Easy example, our base was tasked for surgeon deployments on a constant basis, and we were deploying our surgeons on a regular basis to places where they did nothing for 4 months. Other larger bases with larger pools of surgeons were tasked much different, and much less. It can lead to quick anger when deployments are abused like that. To be 100% honest, I was not deployable because of my knee condition, and one of my partners had asthma.

The rest of the points speak for themselves.

 

[deuist]

My two main gripes:

1.) Much less control over your internship and residency training when compared to civilians.

My big fear is that I'll get stuck doing a GMO or some other field that will waste 4+ years of my life.

 

[dpill]

Kettle? Is that a racial slur?

What is your point?

 

[Mirror Form]

My big fear is that I'll get stuck doing a GMO or some other field that will waste 4+ years of my life.

I used to fear it, but now I'm sort of warming up the idea. Although it still sucks compared to the options people in the civilian world have.

 

[Galo]

What is your point?

Some of these responces seem to be getting to a personal level on both sides. Also I dont particularly personally like that phrase.

 

[colbgw02]

I think I have been more than clear on why military medicine as a whole is in a steep decline.

Fair enough, but not what I asked.

The majority of my experience comes from what I endured as a surgeon, but I did work at what was once a regional medical center, Offutt AFB, and what is now ready to become the premier AF medical center, Wright Patterson, after WH closes down. In those 6 years I was not inside a bubble of general surgery only. I participated and interacted closely with all of my collegues in all specialties including peds, medicine, Familiy practice, ortho, gi, GYN, hem onc, etc. I also for some time allowed my family to be treated by some of these specialties, as I had some say in who and how they saw someone. So I may not be an army pediatrician, but having lived and seen what is happening to the medical corps as a whole, in the AF, and knowing from conversations with other surgeons from the Army, and reading what is happening to the navy, I know it is not only an AF phenomenon, but a problem that is facing the military as a whole.

Good stuff here, certainly a lot of experience to back up your claims. For my money though, in matters strictly regarding Army pediatrics, I'll defer to Homunculus.

I think a big part of the problem is money. There is not enough to go around, and like other big industries, health care is becoming increasingly expensive. The military as a whole, is now getting funding to send active duty personell off base to get medical care. There is now a budget in congress for this. It was in an article in the Washington Post. Unfortunately I do not have the date, of the article. They are all making a big change towards primary care. You have heard the experience of primary care physicians on this board. So while some specialties are being overflooded with patients, others are below acceptable limits. There is no support, whether its intentional, poor planning, money related, you can pick the reason, there is just no support.

I'm still with you here.

As I have stated before, there is an increasing difficulty in maintaining a separation between being a good physician, and an officer. At times they will conflict, and in the military being an officer comes first and foremost. This also ties in with the widespread acceptance of mediocracy as the norm. This is not just in surgery, but in all fields, across military medicine. As a quick example, at my last base, the chief of pathology cannot have a path report released unless it has been reviewed by one of the junior staff. The chief of nuclear medicine is not allowed to read stress thaliums, the cheif of surgery has been investigated twice, once in Germany, and once at our base for poor outcomes in vascular surgery, but no credentialing actions were ever taken. He killed a patient with one week of active duty left, retired without a problem. One of the cardiologists missed an ongoing myocardial infarction on the base deputy commander. The chief of medicine was an alleged chronic adulterer, and was eventually PCS'd. And everysingle one of these people were 0-6's with the exception of the cardiologist who was an 0-5. This is just at my hospital, but the stories abound. I posted a link to a pulitzer price winning expose on military medicine earlier in this post, or on my decline of medicine post. You will find that retention is extremely poor, and those who stay and ascend in power are usually, (not always), poor doctors and poor leaders.

More good stuff here. Nice examples.

You clearly have seen a very vocal few here that have mirrored my concerns about why military medicine as a whole is in a decline. I have tried to explain why some of my collegues who have had similar experiences just do not bother to post. I have yet to see someone post overly positive experiences refuting the ones of people with experience. I can see people, (me), getting tired of having to explain this over and over. I have discussed personal experiences, experiences of others in all fields, I have placed literature both internal and outside media, and personal letters. But you seem to want logic and deductive reasoning. I don't think you want to believe that there are problems to the magnitude I and others are describing.

You just lost me with that last sentence. You see, I'm capable of acknowledging the legitimacy of your claims while simultaneously not taking them as 100% gospel. I'd prefer to keep a skeptical eye not just about what folks say on this board, but about everything, to include my attendings, my residents, my recruiter, my textbooks, and the guy I just passed on the street who said that the end is near. I'm really glad that you and folks like you like to pass things on to us as-yet-undoctrinated folks, but I just don't think you should get too upset when we're not ready to recognize it as unassailable fact. Keep in mind, that doesn't mean I think you're wrong either, just that I'm trying to take everything with a grain of salt.

There seems to also be a few vocal people that want to make intelligent or appropriate observations, and want to have them acknowledged as fact, that their experiences are not what we had, and that somehow this invalidates our observations. This is supposed to be a place where potential students learn about what is going on in the military, and whether or not it is for them.

True, a good point that is often made. But I'm more worried about the student who accepts information wholeheartedly at first glance than the one who questions everything he/she is told.

I certainly wish I had this resource before I made my decision to join.

Me too.

It will be impossible to turn a 19 yr army veteran against the army. Its the only life he has known, and by the defensive nature of his posts, he has made up his mind that everything will be OK, and with that mindset, it may be OK for him.

Don't know much about that.

Taking all the time that I am taking to put down my experiences and frustrations over the last 2 weeks has certainly brought out some angry feelings on my part. I am posting here only to allow others to make more informed decisions.

Certainly understandable, but thanks for doing it.

Thanks for the response.

 

[RichL025]

OK, richlo25, since you seem to be full of knowledge, why don't you contribute something that you know to be the truth about military medicine, perhaps leaning toward the army since that's where your area of expertice is. You are posting on the con thread, so let's hear from you, what are your observations of the way military medicine is now,..

Already posted some, read back.

One more does come to mind, from reading some other people's posts:

The military's insistance on advancement and rotation among a wide variety of assignments means we frequently have people who are less experienced at their particular jobs (I'm thinking nurses & techs). This may be good for the army as a whole (large body of people with experience across the spectrum) but at the nuts & bolts level, you have very few clinics & departments that have a broad 'institutional knowledge' - the civilians provide this in some of the clinics, but on the floors you tend to have nurses with much less experience than in civilian hospitals.... like someone else humorously pointed out, "O-6 nurses" all peter up to the admin levels, you see very few of them directly caring for patients...

Since I can't seem to make criticism of the system without you taking it as a personal attack, tell everybody what makes the army such a good and safe place for you.

Hmm, one more pops to mind due to your below quoted comment - professionalism isn't just encouraged, it's mandated in some things. Racial slurs? Sexist comments? It's widely known that behavior like that will result in some form of disciplinary action, so in environments like the hopsital, it's incredibly rare to see.

This extends to "professionalism" across the board - people I know in civilian programs have stories of attendings striking or pushing residents & students (not with intent to cause damage, just humiliation, but that's assault anyway), a good freind of mine was flabbergasted at how his civilian OB/Gyn rotation treated indigent patients. At that same program another student had a stool kicked out from underneath him while he was doing an exam (wonder what the patient thought?) I have yet to hear any stories like that about military programs, and should something like that happen, there are mechanisms in place to punish the perpetrator.

In one of those incidents, the student discussed the incident with the program director, but was told it would be impossible to make a complaint stick because the surgeon in question "brought too much money into the hospital". It's possible, of course, that he would find equal resistance to making a compaint against a crusty O-6 surgeon, but I find that less likely, and there are multiple mechanisms for complaints when chain of command fails...

Kettle? Is that a racial slur?

Umm, it's an age-old aphorism akin to "glass houses" - "The pot calling the kettle black." I have no idea what your race is (nor is it remotely important) but to the best of my knowledge that saying has nothing whatsoever to do with race.

http://www.goenglish.com/ThePotCallingTheKettleBlack.asp

In the immortal words of Sgt Hulka ("our big toe"): "Settle down, Francis...."

 

[RichL025]

I used to fear it, but now I'm sort of warming up the idea.

Why? Just curious....

 

[RichL025]

You just lost me with that last sentence. You see, I'm capable of acknowledging the legitimacy of your claims while simultaneously not taking them as 100% gospel. I'd prefer to keep a skeptical eye not just about what folks say on this board, but about everything, to include my attendings, my residents, my recruiter, my textbooks, and the guy I just passed on the street who said that the end is near. I'm really glad that you and folks like you like to pass things on to us as-yet-undoctrinated folks, but I just don't think you should get too upset when we're not ready to recognize it as unassailable fact. Keep in mind, that doesn't mean I think you're wrong either, just that I'm trying to take everything with a grain of salt.

Well said! Better than I have so far been able to

 

[dpill]

Some of these responces seem to be getting to a personal level on both sides. Also I dont particularly personally like that phrase.

OK, not to get caught up on semantics- but I was surprised by your offense to that idiom. I have never heard it described as "racist" nor have I ever thought of it in that context (maybe that is my ignorance, if so I apologize). I doubt the poster was aware that it could be interpreted as racist, and I think the suggestion that he meant it to be racist isn't really justified. Here is a bit of the history/context of the idiom from the web. Notice the history of why the pot and kettle are black differ, but the point is that the phrase (as I learned it long, long ago) was never intended to be racist. Thanks for letting us know your view.

The New First Dictionary of Cultural Literacy: What Your Child Needs to Know
edited by E D Hirsch, William G Rowland, Michael Stanford

The pot calling the kettle black. A person who criticizes someone else for the very faults he or she possesses is the “pot calling the kettle black.” … When this idiom first appeared, all pot and kettles were black because they were made of blackened iron.

GoEnglish.com Pocket English Idioms

You are the pot calling the kettle black when you point to another person and accuse that person of doing something that you are guilty of doing yourself. Example: "You are accusing me of being lazy? Ha! That's the pot calling the kettle black!"

"The pot" (for cooking) and "the kettle" (for boiling water) sit on the stove over the fire and become black from the flames. Example: "I'm tired of you always wearing my clothing!" Answer: "Aren't you the pot calling the kettle black? You're wearing my pants right now!"

The pot and the kettle are like old friends who have turned black with time; the pot only sees the blackness which is on the kettle; he doesn't see the black on himself. Example: "Here comes the guy who is always late for work." Answer: "Aren't you the pot calling the kettle black? You are usually the last person to show up!"

 

[r90t]

Stay on topic please.

As for deployments, pre 9/11, it wasn't a big deal. Some people went on more med runs/west pacs. These were people assigned to operational units. It was expected.

Post 9/11, people are getting the same pre-9/11 deployment schedule + having to deploy for OIF/OEF. One of my friends just deployed for a 6 month cruise doing drug ops in the carribean. This is after two WestPacs of 9 months in duration each. WTF??? An example or two of deployment inequities:
1. An ER friend of mine just got out of the navy after 14 years service, up for, or just put on O-5. Why? He is married with 2 kids and has done three full deployments to Iraq. Other physicians in the same department have done 0. He is tired of repeatedly putting it on the line when others don't have to leave CONUS due to a variety of weak reasons. 2. Another friend of mine was tasked to redeploy immediately after returning from a WestPac because he was divorced and his peers were married.

GMO Tour. You can put it in the pro or the con catagory; it depends if the glass is half full or half empty. Many friends who did GMO tours changed their initial residency program choice from what they would have done after MS-4. Marriage, kids, new perspective on life. Family time becomes more important than OR time. Things change, as do career choices during the GMO tour. I thought it also gave me a leg up in interviewing against civilian MS4 students. I had solid interviews at all programs, and the chairs/PD did not want to talk about research that I had done recently. They all wanted to know about responsibilities as a GMO, not what I did as an MS-4. On the flip side, if you want to get residency over, it sucks. If you misused as posted previously in a careless situation, it sucks. If you don't like primary care it really sucks. I think the GMO tour also varies from individual MS-3/MS-4 and the type of internship that you choose. Our PGY-1 GS interns were post-op scut monkeys. Our peds interns saw very little people, not adults. FP/Psych/Transitionals, IMO, have the most rounded PGY-1 year for a GMO tour. Others that had a very specific PGY-1 year, may be set up for failure even before they start their tour.

 

[Galo]

Hmm, one more pops to mind due to your below quoted comment - professionalism isn't just encouraged, it's mandated in some things. Racial slurs? Sexist comments? It's widely known that behavior like that will result in some form of disciplinary action, so in environments like the hopsital, it's incredibly rare to see.

This extends to "professionalism" across the board - people I know in civilian programs have stories of attendings striking or pushing residents & students (not with intent to cause damage, just humiliation, but that's assault anyway), a good freind of mine was flabbergasted at how his civilian OB/Gyn rotation treated indigent patients. At that same program another student had a stool kicked out from underneath him while he was doing an exam (wonder what the patient thought?) I have yet to hear any stories like that about military programs, and should something like that happen, there are mechanisms in place to punish the perpetrator.

In one of those incidents, the student discussed the incident with the program director, but was told it would be impossible to make a complaint stick because the surgeon in question "brought too much money into the hospital". It's possible, of course, that he would find equal resistance to making a compaint against a crusty O-6 surgeon, but I find that less likely, and there are multiple mechanisms for complaints when chain of command fails...


Once again, personal experience. My 0-6 boss illegally took my personal medical chart, (he as not a squadron commander, and thus had not authority to do that), and while talking to another 0-6, my PCM, he called me his tarbaby. I filed an EEO complaint and it went through 4 appeals to AF level, but he denied it, and my PCM did not remember. He was found guilty of violating HIPPA, but nothing happened. I think its an extreme example as certainly he was a unique piece of work, and not the norm. My point is he was tolerated because of his rank. My hospital commander actually told me they can't kick people out because they are bad at their job which was evidently the truth at my hospital given the examples I talked about in the last post.


Umm, it's an age-old aphorism akin to "glass houses" - "The pot calling the kettle black." I have no idea what your race is (nor is it remotely important) but to the best of my knowledge that saying has nothing whatsoever to do with race.

http://www.goenglish.com/ThePotCallingTheKettleBlack.asp


Great, its an innocent idiom, I just said I personally did not like it.





In the immortal words of Sgt Hulka ("our big toe"): "Settle down,
Francis...."[/QUOTE]


Wow, you love everything about the army, even movies, I prefer Dr. Evil: "Take it down a notch Scotty"

 

[Mirror Form]

Why? Just curious....

1. out of the military sooner
2. more then three choices of where to do residency
3. it would be cool if I could get stationed over-seas in europe

 

[Galo]

Originally Posted by colbgw02
You just lost me with that last sentence. You see, I'm capable of acknowledging the legitimacy of your claims while simultaneously not taking them as 100% gospel. I'd prefer to keep a skeptical eye not just about what folks say on this board, but about everything, to include my attendings, my residents, my recruiter, my textbooks, and the guy I just passed on the street who said that the end is near. I'm really glad that you and folks like you like to pass things on to us as-yet-undoctrinated folks, but I just don't think you should get too upset when we're not ready to recognize it as unassailable fact. Keep in mind, that doesn't mean I think you're wrong either, just that I'm trying to take everything with a grain of salt.



I think its fine to have some skepticism, especially about what you read onan internet board. But if the majority of what people are saying about military medicine is bad, you should maybe try to investigate on your own, contact active duty physicians, go to a base and shadow somebody. Also you should be careful to be so skeptical of everything including your attendings, and your books. You are going to have to learn to trust that some people are trying to teach you from their experience, otherwise you will never learn the art of being a good physician. As far as being skeptical of your recruiter, or your 0-6 nurse boss, that goes without saying.

G