Cons of military medicine

[USAFdoc]

story on recruiters:

http://www.objector.org/insider.html

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Members don't see this ad.

 

[Galo]

I'm sure that article will get lots of flak from the military defenders on this forum. Sure you have to consider the source, and I'm sure people will say its a rare thing that happened to him, just like the guys at ABU.

However, I think its common knowledge, and has been profiled in the mass media, how the army is stretched very thin, how recruitment has suffered, and how poor blacks and hispanics have been targeted specifically by recruiters.

Here's mainstream media with a similar comment: you may have to sign up to see it, but its free:

http://www.washingtonpost.com/wp-dyn/content/article/2006/01/24/AR2006012401011.html

 

[RichL025]

I'm sure that article will get lots of flak from the military defenders on this forum. Sure you have to consider the source, and I'm sure people will say its a rare thing that happened to him, just like the guys at ABU.

Umm I'm not going to argue that what that ex-marine experienced was rare... I'm going to argue that he made the whole thing up. His essay is so slanted that I would sooner trust Baghdad Bob's version of events <g>.

As an example, his characterization of the GI bill is so slanted - he quotes an E-1 pay rate of $700 / month - which is about how much it was when I first signed on the dotted line 20 years ago. Current E-1s make $1178 / month, and realize that a soldier only remains at E-1 for 4-6 months or so before being promoted to E2 (1400 / month) and most soldiers who can find their @$$ with both hands will see E-3 before a year is out (1500). Are these generous wages? Hardly - but factor in the 30 days paid leave per year, and full medical, and the average E3 is doing a helluva lot better than most of his friends "on the street"...

Some other examples:

You will be lucky if you get your monthly G.I. Bill check in your first three months of college anyway, as the bureaucracy is so inept that you had better hope to have enough money saved up before you arrive.

Not only did my benefits start arriving within one month of me starting school, but my college told me I didn't have to pay tuition until I started receiving them.

Another point recruiters leave out is that most students who are independent and over 25, civilians and veterans alike, are eligible for enormous amounts of financial aid anyway. That is, unless you already receive the G.I. Bill.... Yep, ask any veteran over 25 working in college, and they will tell you that the financial aid office determines one's eligibility for grants and fellowships (free money) according to one's income, and then deletes one's income from the amount of aid one is eligible for.

Again, another great example of technically true but misleading (I suspect deliberatly) - even though I received the GI Bill + Montgomery College Fund, I was still eligible for quite a bit of 3% guarunteed stafford loans. Also, loans are just that - and you will need to pay them back _sometime_ (maybe less of an issue with physicians, but it will be a big issue for someone going to school to be a primary school teacher, for example) whereas the GI Bill + college fund money is FREE AND CLEAR. I don't remember for sure, but I don't even think it was taxed.

I expect slanted articles like that from the far-liberal press, but to see actual militay physicians post it is rather sad....

 

[PathOne]

Can't comment specifically on military medicine, as I've never practised it. However, I have noted what has happened within my own field, pathology.

For many years the Armed Forces Institute of Pathology (AFIP), a joint-service institute in Washington DC, was probably THE premier pathology institution in the world, even compared to Memorial Sloan-Kettering, Harvard, Johns Hopkins, etc., and across a very wide range of subspecialities.
However, in the past five years or so, the quality at AFIP has deteriorated rapidly and very noticably. World-renowned experts have quit, and been replaced by far blander juniors.

Of course, those leaving are getting much higher pay elsewhere. But it's always been like that. Yet, in the past decades, AFIP had no problem holding on to their best people, despite being unable to match private sectory salaries, because it apparently was a great place to work. I haven't been to AFIP for years now, but it's obvious that the place has changed dramatically, and not for the better.

This, of course, does not imply that ALL of military medicine is going down the drain. But I think it's very sad, and perhaps symptomatic, that what was once described as the "crown jewel" of military medicine is a shadow of it's former self, with bad morale, bad retention and severe budget cuts (according to people I know who have worked there until recently).

 

[Galo]

I expect slanted articles like that from the far-liberal press, but to see actual militay physicians post it is rather sad....[/QUOTE]

Ahhh...........EX-military, not actual.

Not surprised by your comments, and like I said, I think the article is a bit out there myself. The Washington Post article however, gives clear, concise and modern reasons why there is a current problem.

 

[Galo]

Can't comment specifically on military medicine, as I've never practised it. However, I have noted what has happened within my own field, pathology.

For many years the Armed Forces Institute of Pathology (AFIP), a joint-service institute in Washington DC, was probably THE premier pathology institution in the world, even compared to Memorial Sloan-Kettering, Harvard, Johns Hopkins, etc., and across a very wide range of subspecialities.
However, in the past five years or so, the quality at AFIP has deteriorated rapidly and very noticably. World-renowned experts have quit, and been replaced by far blander juniors.

Of course, those leaving are getting much higher pay elsewhere. But it's always been like that. Yet, in the past decades, AFIP had no problem holding on to their best people, despite being unable to match private sectory salaries, because it apparently was a great place to work. I haven't been to AFIP for years now, but it's obvious that the place has changed dramatically, and not for the better.

This, of course, does not imply that ALL of military medicine is going down the drain. But I think it's very sad, and perhaps symptomatic, that what was once described as the "crown jewel" of military medicine is a shadow of it's former self, with bad morale, bad retention and severe budget cuts (according to people I know who have worked there until recently).

Nice summary Pathone.

I too experienced this demise. As a surgeon, we often sent questionable tissue diagnosis to AFIP. We noted incresing difficulty in multiple ways, the most increasing was the ability to get results back in a timely manner. Invariably we would end up having to call and get them that way, and still not always succesful. I've even experienced lost specimens. It got to the point that we would rather send tissue out locally than to bother with AFIP. Also, speaking from experience, and from that of others, I do think its a sign that there is a clear decline in military medicine.

Since I have started posting, I have yet to see an experienced current military phycisian state a clear and convincing opposing view. We've seen good experiences from people in training, and people in the military system for a long time, but nothing as concrete as myself, and the others phycisians with experience have posted.

I and exusafdoc have placed this link on other posts, but have yet to see any rebuttal, excuse, or explanation from those that may not have as negative a view of military medicine as us.

http://www.pulitzer.org/year/1998/national-reporting/works/index.html

I'd like to hear what people have to say after reading something like this?? Especially prospective students considering the military as a place to practice, even if its for a short time.

GO

 

[RichL025]

Since I have started posting, I have yet to see an experienced current military phycisian state a clear and convincing opposing view.

Yes, well, this being the "Student Doctor Network, why would you expect BC physicians to frequent this place? One of the other 3 attendings postign the majority of the "avoid military medicine" posts specifically said that the only reason he is here is to warn others. And while you haven't said that explicitly, you certainly have implicitly. So why would a contented physician post here?

http://www.pulitzer.org/year/1998/national-reporting/works/index.html

I'd like to hear what people have to say after reading something like this?? Especially prospective students considering the military as a place to practice, even if its for a short time.

Excellent and sobering series, I'm 3/4 of the way through it now. Here's what one 'famous' civilian physician commented on:

But, he added, ``There are two kinds of doctors in the military. They're either fabulous, wonderful doctors, or they're spectacularly incompetent.''

The good Lord give us all grace to fall into the former category...

 

[militarymd]

One of the other 3 attendings postign the majority of the "avoid military medicine" posts specifically said that the only reason he is here is to warn others. ...

There are more than 3 attendings who post here....more like 10 or so....and they are all against milmed.

 

[RichL025]

There are more than 3 attendings who post here....more like 10 or so....and they are all against milmed.

"majority"....


as our mod Homonculus has already noted.

 

[Galo]

Yes, well, this being the "Student Doctor Network, why would you expect BC physicians to frequent this place? One of the other 3 attendings postign the majority of the "avoid military medicine" posts specifically said that the only reason he is here is to warn others. And while you haven't said that explicitly, you certainly have implicitly. So why would a contented physician post here?

drdaria who quite passionately defended the military and pointed out I bash anyone with no personal experience had this to say earlier in this thread:

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.

Clearly there are no active duty physicians interested in refuting what we have to say. I also gave a number of other excuses earlier, which I theorize may be in play: dont care, just want to get out, may have some self centered idea that others should go through the same, etc etc, I think I may just have to send a link to the current AF surgeon general, and see how it goes. If I can get somebody at the top to try to make a cogent argument why military medicine is something a young phycisian should attempt. Drdaria, if you're such a staunch supporter, perhaps you should recruit some experienced physicians to contribute to the pro thread so people can really get a balanced view. Richlo, why should a content physician post here? I imagine if there are any, they would be on the pro thread, perhaps you can also recruit some?



Excellent and sobering series, I'm 3/4 of the way through it now. Here's what one 'famous' civilian physician commented on:
The good Lord give us all grace to fall into the former category...

Pretty damaging stuff. Unfortunately as I have been screaming, as some would say, much of the same is happening, and its getting worse.
I'm glad you seem to have kept an open mind in reading it, and going in knowing material like this may allow you to navigate better than some of us did.

 

[Galo]

A while back in one of the posts I mentioned trying to get other experienced physicians to air their concers with military medicine. I mentioned that I had a difficult time trying to get others to post for various reasons none of which the least includes repercussions from the military, or the desire to not bring up something that caused so much pain and anguish.

The letter below was written in 2004. A 15 year AF officer who cut her carrer short and got out because of the frustrations that she expresses, were also felt by many of us. In the letter she mentions the persecution of a 14 year veteran officer who had his life turned upside down becuase of his conviction for appropriate medical care. He has 2 notebooks worth to rival the information on the pulitzer price winning expose written by the Dayton paper journalists that I have placed a link to in this thread. His life is so incredibly better, and he is still healing himself and his life with his family. I know another 15 year veteran, interventional radiologist who left to collect nothing because he felt his life being drained.

These are real examples of the real decline of military medicine. I know this type of posting has brought out very negative feelings from people who are currently in the early part of the system that so far either have had a good experience, or expect that they will be able to function in the system better than those of us who post with passion and anger about a system we feel is severly damaged and beyond repair. To them I say, I acknowledge your good experiences and ability to make judgements based on your experience to date. However, the negatives so far are far outweight the postitives. I hope this continues to be a place where we can have civilized discussion, and at the same time educate those thinking about military medicine to the realities of the system today, and in the near future.

PS. I ommited Sandy's phone number. She currently went back to WP as a civilian contractor, and is less hampered by being part of the officer system, but still frustrated by the decline in medicine. I'm sure in this day and age of computers and phones, if someone really wants to reach her, they could probably do it in two phone calls.


I'd love to hear what people think!!












MEMORANDUM FOR THE RECORD 7 Oct 2004

SUBJECT: Physician Concerns Regarding Quality of Care Degradation at WPAFB

1. I am Lt. Col. Sandra Herrington Ph.D., M.D., Chief of Radiation Oncology and Cancer Committee Chair at Wright-Patterson’s hospital. I am an AFROTC Distinguished Graduate originally commissioned in 1985, and I have been on full-time active duty for nearly 14 years. I am a cancer specialist, board certified in Radiation Oncology by the American Board of Radiology, and also highly trained as a biological scientist with Master of Science, Master of Philosophy, and Ph.D. degrees in addition to the M.D. This note is in response to the concerns expressed by Lt. Col. Steve Filardo M.D.
2. I have known Steve for the past four years, since Radiation Oncology was moved from the Medical Support Squadron to the Medical Operations Squadron. Steve is a person who maintains the highest standards in both the quality of medical care he gives, and in his personal ethics. He is unwilling to accept substandard care, and is unwilling to sit idly and silently by when he witnesses substandard care. Steve is highly respected by his peers (including me), and one would think that he would be praised and valued for his attempts to ensure high quality care for our medical beneficiaries. Unfortunately, that has not been the case. I am aware of Steve’s overall situation. Indeed, I have faced similar situations myself. There can be no doubt that the overall level of care, and physician morale have declined sharply since the departure of Brig. Gen. Kelley, who formerly commanded the 74th Medical Group. I don’t believe this decline is due simply to failings of the hospital’s upper level commanders, but rather it stems from careerist motivations of some mid-level commanders, and from a general “loss of direction” within the institution. Simply put, any individual who dares to identify substandard care, and suggest that things should be done differently, is branded as “not a team player,” and punished through personal comments and either neglect, or frank damage to the person’s career.
3. I too have seen instances of very poor care, and callous disregard for patients. Some of these instances have been ones I have actually referred to the hospital’s risk manager, because the hospital would clearly be found liable if a malpractice suit were initiated. Yet the general response from some individuals in positions of authority has been one of hostility toward me for “blowing the whistle” and “causing trouble.” The institutional environment currently is one in which only the rosiest pictures and most glowing reports are allowed. Contributing to this self-aggrandizing group-think (by saying only good things, which makes the mid-level commanders look better) results in glittering OPR’s and PRF’s, frequent decorations, and pushes for the earliest selection to O-6. Bringing problems out in the open results in bitter recriminations, isolation, and career sabotage. Even worse, the problems with patient care are not fixed. Over time, the lower level of care has become the norm. Those of us who don’t accept that standard are forced to choose between staying on active duty for only a few additional years until eligible for retirement while we languish in an environment where our clinical skills erode (because we do not have the resources to deliver the level of care we were trained to give) and our patients do not receive the level of care they deserve, versus separating as soon as we can, with nothing to show for 15 or more years on active duty other than a deep sense of sadness for the demise of what was once a medical service to be truly proud of.
4. I love the Air Force. I would like nothing more than to be able to come to work feeling pride and satisfaction in what we do here. Instead, I feel that all I do is work to ensure this or that administrator has his/her paperwork completed, while I beat my brains out trying to keep track of everything being done to the patients so if (when) someone screws up, I can try and avert disaster.
5. Please feel free to contact me at ……………………. if you would like to speak further. I will be on leave the next two weeks, but will be back 25 October.


Lt. Col. Sandra J. Herrington
Chief, Radiation Oncology
Cancer Committee Chair

 

[Galo]

http://forums.studentdoctor.net/showthread.php?t=266181


I don't care in what direction this post goes, but this is something that deserves to be saved so people thinking about military medicine can look at it and make their own decisions.

This guy, IDg, is a clear and present danger to military medicine. He typifies the type of OFFICER we as physicians despise. He is a person who has choosed officership way over being a physician, and thus allows for mediocracy at best to be the defining mode of caring out his mission in medicine, even if he is not actively seeing patients. He is the unfortunately more true than not person who will be your boss someday telling you how to see and act with patients, or worse yet, determining what your support system will comprise of, which will usually mean you cannot provide care in any way close to the standard of care. This is exactly the type of person who will stand in the way of progress, and flourish in the militaries eyes as a great leader. This makes me so mad I want to scream. Remember him if you sign up. You will meet a version of him. Again, they are like clones, and even if you meet great people, it will take one of him to ruin your experience, and your life.

Galo

 

[Pemberley]

http://forums.studentdoctor.net/showthread.php?t=266181
He is a person who has choosed officership way over being a physician.

I think your definition of officership is a little off. The post you refer to shows a lack of critical thinking and an inability to construct an effective argument. Neither is an aspect of good officership.

Remember him if you sign up. You will meet a version of him.

Sadly, I cannot disagree with this.

Still, I can't subscribe to the blanket message of dispair. I hold out hope that I can re-enter the military -- in the Navy this time; I really have given up on the Air Force -- without letting the kind of officer who LACKS officership ruin my life.

 

[RichL025]

...
I don't care in what direction this post goes, but this is something that deserves to be saved so people thinking about military medicine can look at it and make their own decisions.

This guy, IDg, is a clear and present danger to military medicine. He typifies the type of OFFICER we as physicians despise. He is a person who has choosed officership way over being a physician,...
Galo

OK, I'm glad I got some sleep post-call before replyng to this.

Galo, quit being a TOOL. The guy IgD posted that as a JOKE. Not a particularly funny one, but the fact is, you are SO SENSITIVE that you take everything as a personal insult, and now you're construing some jokes (about physician stereotypes floating around the regular army) as evidence that IgD is somehow "part of the problem" and emblematic of the decline and fall of the roman empire.

You know, earlier I would tell you how much we value your input, but now more and more I have to wonder how objective it is. If you're really this sensitive, and you get "so mad I could scream" about a lukewarm out of context joke, I have to wonder how much stock I'm going to place in your other opinions, also.

I edited this multiple times to avoid giving personal offense, but oh, why bother, I'm sure now you'll call _me_ part of the problem.

 

[USAFdoc]

OK, I'm glad I got some sleep post-call before replyng to this.

Galo, quit being a TOOL. The guy IgD posted that as a JOKE. Not a particularly funny one, but the fact is, you are SO SENSITIVE that you take everything as a personal insult, and now you're construing some jokes (about physician stereotypes floating around the regular army) as evidence that IgD is somehow "part of the problem" and emblematic of the decline and fall of the roman empire.

You know, earlier I would tell you how much we value your input, but now more and more I have to wonder how objective it is. If you're really this sensitive, and you get "so mad I could scream" about a lukewarm out of context joke, I have to wonder how much stock I'm going to place in your other opinions, also.

I edited this multiple times to avoid giving personal offense, but oh, why bother, I'm sure now you'll call _me_ part of the problem.

thanks for the input on the "just for fun" threads posted here.

and as I stated before; many (if not most) of the physicians, including myself are recovering from "post traumatic military medicine syndrome". I am nearly recovered now, but it takes some time. Symptoms include a short fuse when it come to certain aspects of military medicine discussion.

 

[Galo]

OK, I'm glad I got some sleep post-call before replyng to this.

Galo, quit being a TOOL. The guy IgD posted that as a JOKE. Not a particularly funny one, but the fact is, you are SO SENSITIVE that you take everything as a personal insult, and now you're construing some jokes (about physician stereotypes floating around the regular army) as evidence that IgD is somehow "part of the problem" and emblematic of the decline and fall of the roman empire.

You know, earlier I would tell you how much we value your input, but now more and more I have to wonder how objective it is. If you're really this sensitive, and you get "so mad I could scream" about a lukewarm out of context joke, I have to wonder how much stock I'm going to place in your other opinions, also.

I edited this multiple times to avoid giving personal offense, but oh, why bother, I'm sure now you'll call _me_ part of the problem.

I too rested well last night, and in all honesty, ***k you. You clearly have predicted you are a part of the problem. There is no place in the thread that IDg, your aparent soulmate, states that what he is refering to is a joke of any kind. He is defending it to the end. All in the purpose of making our informed opinions look bad. I ask you, how many students have called you for advice based on your vast experience?? What can you contribute to an intelligent critique of a system we all know has taken a beating, and continues to do so. I know you personally insult me because I have hit a nerve with you. I have personally acused you of being close minded because all you have known is the Army, and you can't accept the fact that there is something very wrong in at least the medical part of it. So despite my multiple insults to you, (including my rebuttal for being called a tool), I say, lets stop making this personal. If I insult somebody else, let them defend themselves. I have yet to see idg post anything personal about himself. Perhaps I just have not seen it, but I do not know as much about him, as I do about you, even though that is very little.

I think our goal is all the same, or perhaps not? I want to be able to tell people that the military is doing a poor job of provinding quality care to its personell and their families. It is a combination of a lack of leadership, money, interest, and many other reasons. Others have stated it more eloquently than I, and have vast documentation. This is supposed to be a place for discussion, and emotions are going to run high. I just want people to know really what they are getting themselves into. It seems people like idg, and you, are constantly attacking our assesments by attacking our personalities, and making the conclusion that there is something wrong with us, and not the system. Like I said before. Clearly idg's post is something he believes. I think he is part of the problem. I think you are too.


Galo

 

[RichL025]

Galo,

Right, whatever. ***k me. Feel better now?

You're the same guy who thought "pot calling the kettle black" was a racial insult, right? I'll write that off to more manifestation of the short fuse USAFDoc was talking about.

I lost track of how many times I tried to say that we appreciate your perspective here. The fact is though, since you've been here, you've been on a hair-trigger, and I have to wonder about your claims of persecution in the past; if you haven't been on that same hair-trigger when you were on active duty.

End result? People are going to stop believeing you because of the way you deliver your message, bristling at every imagined affront to your experience. Hey, this is the internet, penis-measuring contests don't go over very well.....

Do you really think that those jokes aren't based on stereotypes the regular army has about MDs?

 

[Galo]

Galo,

Right, whatever. ***k me. Feel better now?

You're the same guy who thought "pot calling the kettle black" was a racial insult, right? I'll write that off to more manifestation of the short fuse USAFDoc was talking about.

I lost track of how many times I tried to say that we appreciate your perspective here. The fact is though, since you've been here, you've been on a hair-trigger, and I have to wonder about your claims of persecution in the past; if you haven't been on that same hair-trigger when you were on active duty.

End result? People are going to stop believeing you because of the way you deliver your message, bristling at every imagined affront to your experience. Hey, this is the internet, penis-measuring contests don't go over very well.....

Do you really think that those jokes aren't based on stereotypes the regular army has about MDs?

Rich, you are probably as good an advertisement as idg, as to why people should stay away from military medicine. You seem to think every responce I put forth in my defense, or in explaining what my experience and that of others with military medicine, is a hair-trigger responce. I can't see why one should stay quiet if they are being attacked, if their profession , livelihood, or their oath of medicine is being attacked. Much in the way many of us experienced this in active duty. You and idg expect us to sit by idly and let people like you perpetrate a continual rape, abuse and neglect of a system many of us joined expecting excellence. You say how many times you appreciate my input, but you keep craping on me.

Let our words speak for themselves. I for one have offered my personal email address for students who want a more in-depth and personal advice. Fortunately I have been able to help manyof them see that for many reasons, one of which is people like you and idg, the military for a carreer in medicine is not a very good choice today. So I have not experienced a loss of faith in what I have to say. How many people have sought out your councel?

As far as racism, I experienced it both subtly and overt. But you being a middle aged white man probably have no idea what I am talking about. Why dont you limit yourself to posting on the pro thread, and things you think you understand, and stop harrasing those of us with the agenda of telling people the truth about military medicine. Futhermore, everytime I hear from you and people like idg, I feel so happy to be out of the military, yet sad that you guys are part of what ruin it for everyone else. Call your buddy idg and see if he thinks his post is still a joke.

 

[Homunculus]

hey Galo-- spellcheck much? the "craping on me" line actually made me laugh how does one "crape"?

honestly though-- i don't think *anyone* would be willing to agree with your comparison of Rich and IgD being soulmates. Rich's responses have been civil and thought out, while yours tend to be crass and impulsive -- ("***k you" is so professional ) raping, abusing, and neglecting the system? good lord man, get a grip. attempting to discuss things with you is like banging your head against a wall. rich gave it the ol' college try, and i think i'd recommend he find another fruitless activity to adopt, lol.

--your friendly neighborhood exasperated caveman

 

[Galo]

hey Galo-- spellcheck much? the "craping on me" line actually made me laugh how does one "crape"?

honestly though-- i don't think *anyone* would be willing to agree with your comparison of Rich and IgD being soulmates. Rich's responses have been civil and thought out, while yours tend to be crass and impulsive -- ("***k you" is so professional ) raping, abusing, and neglecting the system? good lord man, get a grip. attempting to discuss things with you is like banging your head against a wall. rich gave it the ol' college try, and i think i'd recommend he find another fruitless activity to adopt, lol.

--your friendly neighborhood exasperated caveman

Geee, sorry, not sure how to spell check on the posts. Just when I though you may be semi neutral you show your cards. Calling me a "TOOL" is "civil and thought out" according to you, but my responces are crass and impulsive. Its clear which side you are on. Maybe you should post your opinions under a different name, and be a neutral moderator because its clear you have some side issues and personal ones, much like rich. I may be more lyrical and expressive than usafdoc, milmd, etc, but you dont seem to call them out on their just as factual assesments of the state of military medicine. By the way cussing is a personal choice, it has its place, I'm sure you've never heard it around your work place.

 

[Galo]

I guess the appropriate term is CRAPPING, with two p's.

 

[Homunculus]

I'm sure you've never heard it around your work place.

never in serious conversations. i can unequivocally state that i've never heard "f-ck you" spoken in anger between two individuals in my workplace.

galo, you miss the forest for the trees. in your haste to group everyone together in the "raping abusing neglecting" military medicine group who is out to get you, you aren't seeing the big picture. If you were anything like this on active duty, I can't imagine what working with you was like, let alone what a *deployment* to Iraq or Afghanistan would be like.

i sincerely hope you are enjoying your life outside the military. but please, for the love of everything you find sacred, stop and try to see things outside your point of view. you may be pleasantly surprised.

with that, i'm done with this thread for awhile. i've got basketball to watch and sick kids to take care of.

--your friendly neighborhood weekend call caveman

 

[Galo]

never in serious conversations. i can unequivocally state that i've never heard "f-ck you" spoken in anger between two individuals in my workplace.

galo, you miss the forest for the trees. in your haste to group everyone together in the "raping abusing neglecting" military medicine group who is out to get you, you aren't seeing the big picture. If you were anything like this on active duty, I can't imagine what working with you was like, let alone what a *deployment* to Iraq or Afghanistan would be like.

i sincerely hope you are enjoying your life outside the military. but please, for the love of everything you find sacred, stop and try to see things outside your point of view. you may be pleasantly surprised.

with that, i'm done with this thread for awhile. i've got basketball to watch and sick kids to take care of.

--your friendly neighborhood weekend call caveman

So in your vast experience, what is the big picture. It seems we go back and forth, and you and your kind, (if that is not too harsh), continually try to diminish our experience, based on what I still do not understand, since you have no operational experience other than at your training base. So what is the big picture homunculus, enlighten us, and all the students trying to decide if the military is a good choice to enter into. What are your words of wisdom.

Answer when your done with your basketball, and your kids. I'll be looking forward to seeing you sage advice. Don't bump yourself on a big oak as you walk out of your forest.

 

[Homunculus]

So in your vast experience, what is the big picture. .

search my posts. i know there are flaws in the system.

It seems we go back and forth, and you and your kind, (if that is not too harsh), continually try to diminish our experience, based on what I still do not understand, since you have no operational experience other than at your training base. .

i don't try to diminish your or the rest of the ex-military folks experience. I WELCOME AND APPRECIATE YOUR INPUT. your comments and experiences are invaluable toward the overall picutre that military medicine is. your comments on what you experienced are valid. i've said this a million times. my point has always been that you, as an ex-military surgeon who was never deployed, cannot comment on my situation or what i have gone or will be going through. period. the second you see me commenting on air force surgery, feel free to call me on it. until then, as much as it may pain you to do so, please PLEASE refrain from attempting to use your experience as some type of moral leverage to refute my own experiences.

So what is the big picture homunculus, enlighten us, and all the students trying to decide if the military is a good choice to enter into. What are your words of wisdom..

the big picture? for some people it is a good choice, for others a bad one. not much in life is black and white, or as simple as you or IgD may try to make it. profound, eh?

--your friendly neighborhood fending off ER admissions as he types caveman

 

[DRDARIA]

Oh, Galo, you just don't get it.

I've dropped back in this thread for the first time in more than a month, but I see that reasoned conversation still isn't taking place. I was absolutely stunned to see that in a reply to my post you had commented that I "staunchly supported" and "passionately defended" military medicine. Hello? In my post, which was all about the WAY people are posting, and was a response to criticism of Homunculus moderating abilities, I didn't say anything that was vaguely supportive of military medicine! In fact, what I said was I found the military system deeply flawed, and that I think VA funding (or lack thereof) is a tragedy. I also pointed out why some of your arguments might be flawed and other people might have a different point of view (hence my devil's advocate argument that just because people don't post doesn't mean they don't exist). You asked why I didn't find supporters then post here-- why? because I too think military med is in trouble, and more importantly as a student I have more pressing concerns. My point in that post was the same as now-- there are adult ways to have conversation, and all posters experience should be valued-- at whatever level of experience they may have.

Now, having seen how you utterly twisted and mischaracterized my post, I wouldn't trust any information you present, as I have no reason to believe you would be accurately presenting it. I'm sure that has occured to other readers of the thread. It's too bad, too- you have a valuable message and apoint to make, but your way of doing so alienates readers that the message is lost. If you really want to make your point, perhaps you should consider how you come across.

I'm sure this post will be misconstrued and twisted too. That's okay. It makes my point for me. Signing off for another month or so.

 

[USAFdoc]

Now, having seen how you utterly twisted and mischaracterized my post, I wouldn't trust any information you present, as I have no reason to believe you would be accurately presenting it. I'm sure that has occured to other readers of the thread. It's too bad, too- you have a valuable message and apoint to make, but your way of doing so alienates readers that the message is lost. If you really want to make your point, perhaps you should consider how you come across.

.

DRDARDIA;

I understand your "reflex" to be put off by the emotional responses some of the PHYSICIANS have written here. But realize where that emotion comes from. If I didn't give a crap of military medicine (and my patients) I would not have fought so hard on behalf of the patients and my colleagues to improve the system. The EASY way is to just go with the flow and look the other way. Yea, you should use the chain of command, but after they ignore your concerns, then what? If patients continue to be at risk, the ethical answer is to continue the fight.

Your logic on how to interpret GALOs comments is also partly flawed. To disregard everything he says just because he is "too emotional" or misinterpreted your thread is off the mark. Sure, you may lose a little respect for what he says, but it is either true or not true. This stands by itself.

 

[DRDARIA]

DRDARDIA;

I understand your "reflex" to be put off by the emotional responses some of the PHYSICIANS have written here. But realize where that emotion comes from. If I didn't give a crap of military medicine (and my patients) I would not have fought so hard on behalf of the patients and my colleagues to improve the system. The EASY way is to just go with the flow and look the other way. Yea, you should use the chain of command, but after they ignore your concerns, then what? If patients continue to be at risk, the ethical answer is to continue the fight.

Your logic on how to interpret GALOs comments is also partly flawed. To disregard everything he says just because he is "too emotional" or misinterpreted your thread is off the mark. Sure, you may lose a little respect for what he says, but it is either true or not true. This stands by itself.

I have never said anything about any post being "too emotional", nor have I judged the content of a post based on emotion (other than when it degenerated to personal attacks). I understand emotion and passion. I respect the fight to make a difference, or to change things, either from within or without the system. What I said was clearly that when a person is caught grossly misrepresenting and stating someone said something they didn't (as he has done with my post and the posts of others here), then I can no longer take what that individual says seriously.

I'd like to point out again that I am NOT disagreeing with the premise that military medicine is messed up. I am no longer in the military and did not take HPSP for that reason. I have never disagreed with this point (and if Galo had read my first message carefully he would have realized that). My point is that a valid message is being lost because of the way it is presented, and that is a shame. The person carrying the message has to be credible. Since on a forum like this we don't know each other personally, credibility is based based on reasoned arguments and accurate presentation of information (at least that is how I judge it). Based on this criteria, Galo is not credible. Based on your posts USAFDoc, you are. As you said, you and some of the other docs may be emotional, but that is understandable and appropriate (and yes, there is certainly some emotional component to this post-- I DON'T like being misquoted and having other posters misrepresent what I said).

Well, that's enough from me. If I haven't made my point, I doubt I'll ever be able to.

 

[RichL025]

Rich, you are probably as good an advertisement as idg, as to why people should stay away from military medicine.

Why? Because I DARE to take you to task for your ranting?

You say how many times you appreciate my input, but you keep craping on me.

The only time I "crap" on you is when you made wild accusations that you have no way of backing up (ie, claiming experience in ALL of military medicine) or when you bristle at imagined insults ("pot calling kettle")

I for one have offered my personal email address for students who want a more in-depth and personal advice. ... How many people have sought out your councel?

There are 2 signs of when someone fails in an internet discussion... and one of them is claiming imaginary friends who email the poster in support, but mysteriously never manage to find the courage to post on an open forum. Or if they do, they arrive with a post count of 'one' and are never heard from again (this is also referred to as a "sock puppet").

So tell me Galo, if there are so many people soaking up your advice, why have none of them posted here saying "thank you Galo"? And please don't say that they're afraid of being persecuted

As far as racism, ...But you being a middle aged white man probably have no idea what I am talking about.

Once again, your limited horizons show through. Since I'm a white man, I couldn't possibly know anything about prejudice, could I? And it naturally follows, since you're a black man, you couldn't possibly be racist, could you?

 

[Galo]

drdaria's original post

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.


drdaria,

You certainly have reason to be angry, mistrustful, etc. I looked for an hour to see where I had said "staunchly supported, and passionately defended." I thought there must be some mistake having reread your post which I copied above.

I found it buried in a post of mine replying to richlo, but definitely refering to you with the words you quoted. Certainly from your post above those quotes do not seem justified. I have to apologize to you. I am sorry. I certainly seem to have got caught up in the moment and lumped you in with what I have experienced as personal attacks not only for the way I present my arguments, but also by what I have had to say. In reading your post, I certainly have a difference of opinion about who is qualified to better comment on the state of military medicine, and I still belive that those who were or are in actual operational slots, and lived this, have a much more keen understanding than those who are in training, or been in a different part of the system for a long time. I can see how one would take offence at me dismissing their experiences, as I take greater offence when mine and those of other experienced physicians are similarly dismissed. Also we come from different branches of medicine. Medical specialties, (peds, IM FP) rarely have the same degree of urgency that I may find myself in an operating room with a patients life as my responsibility, or the ability to get that patient to the operating room, and do the appropriate procedure on them. This sense of urgency is not something that can easily be translated into words or to make people understand it, unless they have lived it. So I do feel much more certainty in explaining the failures of military medicine than those who have yet to be in a situation like mine. Also many other physicians have had the same experience in different fields. Yet there seems to be a notion that all specialties are completely separate, and that therefore I cannot make comments of the same type of certainty like the ones from my experience in surgery. The whole military medical system is interconnected, much like everything else in life. You can't expect that my experience in surgery, (amongst others), those in FP, Anesthesia, ortho, neuro, urology, cardiology, oncology, etc, are isolated to just those fields. Perhaps your pointing out that I should take everyone's views, (despite their inexperience) with as much weight as mine, is why I said what I said. Regardless, I apologize again.

This acknowledgement may seem like the perfect opportunity for rich and homun, idg, etc to further chip away at my credibility. Hey, I am human, I occasionally make mistakes, I am impatient, I would like things to be done right away. These traits make me a great surgeon who will fight like anything to help my patient. Unfortunately they sometime slide into the rest of my life, and that's just the nature of who I am. It does not detract one bit from my experience in the military, and that of others. I still think it is a declining system that is being perpetrated by the likes of Idg and people who are unwilling, unable, or just don't care to make the system change.

I urge every person thinking about going into the military for medicine, that they read all these posts, make your own conclusions, but most importantly call bases, and speak to physicians, as many as you can. You can get a ton of phone numbers online. The more you speak to, the better idea you will get about what you are getting into. Then you can make a more informed decision about your future. I will remain available to those who wish to contact me, and ask about medicine, surgery, and/or the military.

[email protected]

If you're wondering about the time, I just got out of the OR, I am winding down, and happy that I don't have to justify my presence in clinic or the hospital tomorrow by having to explain to somebody why I do not need 12 hrs of mandatory "crew rest." Or wonder why the Col. cancelled an entire day of clininc because he was up past one doing a case. Life is much better outside the military.

 

[Galo]

Rich, the people that I have helped, have no reason to post. They sought out information and left it at that.

As far as race, I knew you'd be a white man. I however, are not black, but like I said have experienced racism both subtle and overt.

You are no longer worthy of further responce. Stay in the army and maintain the status quo, I'm sure like idg you will shoot through the ranks.

 

[island doc]

I too have been on something on a "leave of absence" for a while, alot of other things going on and less time to spend on the internet. But, as I sit down and read these recent postings I am disappointed by the overall tone, that being a lack of civility. I can fully empathize with Galo's emotions concerning his AFMS experiences, as I have had similar feelings after being on the receiving end of injustices myself too, but the use of profanity whether implied or not, is unprofessional and unhelpful in putting forth a credible argument for avoiding employment with the Air Force Medical Service. It is time to stop the personal attacks here (this is the "con" thread, aren't we on the same team?) and get back to attacking what needs to be attacked, that being the awful state of affairs in the Air Force Medical Service. (Notice I am not criticizing Galo himself, but rather the use of implied profanity.)

 

[island doc]

It is not surprising that a surgeon (speaking above) would be of the opinion that they have a monopoly on being faced with urgent problems, but the clear statement or inference that those in medical specialities such as FP do not displays ignorance of what we do. I say this as an FP with several years of experience practicing emergency medicine and urgent care, in which dealing with emergent immediately life threatening problems was a very frequent occurrence. What some surgeons do have a monopoly on though is egotism.

 

[Galo]

It is not surprising that a surgeon (speaking above) would be of the opinion that they have a monopoly on being faced with urgent problems, but the clear statement or inference that those in medical specialities such as FP do not displays ignorance of what we do. I say this as an FP with several years of experience practicing emergency medicine and urgent care, in which dealing with emergent immediately life threatening problems was a very frequent occurrence. What some surgeons do have a monopoly on though is egotism.

You're absolutely right. I guess I am trying to justify to these people why I make such passionate pleas. I am in no way trying to downplay FP, ER, IM in what they do under the identical brutal conditions the military has alloted them. I guess I am trying to really explain why my behavior is such, to people that really do not seem to understand it. Usafdoc has clearly documented the problems in FP. Egotism, would'nt you want your surgeon to say he is the best!!??

 

[island doc]

You're absolutely right. I guess I am trying to justify to these people why I make such passionate pleas. I am in no way trying to downplay FP, ER, IM in what they do under the identical brutal conditions the military has alloted them. I guess I am trying to really explain why my behavior is such, to people that really do not seem to understand it. Usafdoc has clearly documented the problems in FP. Egotism, would'nt you want your surgeon to say he is the best!!??

No, in fact, I would not want him to say that he is the best, just simply BE the best. Outcomes speak for themselves, and much louder than words.

 

[Galo]

No, in fact, I would not want him to say that he is the best, just simply BE the best. Outcomes speak for themselves, and much louder than words.

Agreed.

 

[USAFGMODOC]

I actually think Tricare does have some good points, but one thing that is wierd is when I refer someone 50-55 whom has never had a colonoscopy for "screening"--- it is declined b/c tricare doesn't cover screening colonoscopy even though they spout prevention and all.... you basically have to list something like abd pain/rectal bleeding or some significant Family History, or they won't approve the referral.

They will however approve flex sig for screening, great, we all know this will miss 30-50% of significant polyps and cancers.

 

[militarymd]

I actually think Tricare does have some good points, but one thing that is wierd is when I refer someone 50-55 whom has never had a colonoscopy for "screening"--- it is declined b/c tricare doesn't cover screening colonoscopy even though they spout prevention and all.... you basically have to list something like abd pain/rectal bleeding or some significant Family History, or they won't approve the referral.

They will however approve flex sig for screening, great, we all know this will miss 30-50% of significant polyps and cancers.

Hypocrisy....the military way....

The other thing is that they like the ILLUSION of care.

 

[Galo]

This is another big con about the military, and one that often goes unattended till you get the call. Most people need to realize that they will have an IRR requirement for 4 more years when they finishe their 4, even if they resign their commission. Is that not correct?

Anyways, here's the link for prosperity:

http://forums.studentdoctor.net/showthread.php?t=272483

 

[RichL025]

This is another big con about the military, and one that often goes unattended till you get the call. Most people need to realize that they will have an IRR requirement for 4 more years when they finishe their 4, even if they resign their commission. Is that not correct?

http://forums.studentdoctor.net/showthread.php?t=272483

Pretty correct. The extra commitment is whatever is needed to total you to eight - so someone with a longer commitment (say you owed 5 year) would only have 3 in the IRR when they got out.

To the best of my knowledge, the IRR is governed and calculated by army-wide regs, not those inherent to the medical corps, so someone who did a military residency (let's say 4 years of active duty) and then had a four year 'payback' would then have a zero commitment in the IRR.

Galo, I understand you did a civilian residency, so the above would not apply.

In addition, medical officer keep a reserve commision even when all their commitment is up, so even after your eight years of total (active + IRR) service is up, you need to take the active step of resigning your commission, or you could conceiveably be called back to active duty in time of emergency. This would be the point at which they were scraping the bottom of the barrel, and had already exhausted the supply on active duty, the reserves & NG, and then the IRR...

(and even then, "in time of emergency", the government could always draft doctors who had no commitment at all, and had never been in the military, like in the Korean war)

 

[haujun]

Smart people don't do well in the military.So they leave and develop post military stress disorder. This causes them to spend a lot of time posting negative remarks against military.

 

[usnavdoc]

Smart people don't do well in the military.So they leave and develop post military stress disorder. This causes them to spend a lot of time posting negative remarks against military.

If that is true then the converse of your statement must also be true.

Stupid people excell in the military. So they stay in and make surgeon general. This enables them to pave the way for further stupidity.


This is obviously partially a joke....partially

 

[Galo]

There is a certain irony in the name of this thread. "Cons" has an extremely negative connotation and reflects badly on the big 4 posters: MilitaryMD, USAFDoc, IslandDoc and Galo. Moderator, would you please change the title of this thread?

Does this even make sense? Homuculus, you really should weigh in on this. Its pruning time, and take idg along with it. This post has no relevance to anything other than once again to insult or demean experienced physicians, I think? Once again from some nurse/msc/who knows what that after repeated call outs has failed to identify who he/she is and where he/she gets such wonderfully useless drible. Perhaps the advice posted before of not paying attention to this may better serve us all. How about it Homunculus?

 

[Sarg's kid]

There is a certain irony in the name of this thread. "Cons" has an extremely negative connotation and reflects badly on the big 4 posters: MilitaryMD, USAFDoc, IslandDoc and Galo. Moderator, would you please change the title of this thread?

What relevance does this post have to anything? The "Cons of Military Medicine" thread is the best place for people to post their opinions of those aspects of military medicine with which they are dissatisfied. There are cons to military medicine, and premed's like me need to be able to understand the downside of any future commitment. No-one should join the military without having their eyes wide open.
I've read this entire thread, as well as several others. The information on this forum is a great resource. I still plan on joining the military as soon as I get that acceptance letter, though I will now be able to enter the military understanding some of the flaws in the system. Thank you MilitaryMD, USAFDoc, IslandDoc and Galo.

 

[militarymd]

What relevance does this post have to anything? The "Cons of Military Medicine" thread is the best place for people to post their opinions of those aspects of military medicine with which they are dissatisfied. There are cons to military medicine, and premed's like me need to be able to understand the downside of any future commitment. No-one should join the military without having their eyes wide open.
I've read this entire thread, as well as several others. The information on this forum is a great resource. I still plan on joining the military as soon as I get that acceptance letter, though I will now be able to enter the military understanding some of the flaws in the system. Thank you MilitaryMD, USAFDoc, IslandDoc and Galo.

Sarg's Kid....good luck to you.

 

[Galo]

What relevance does this post have to anything? The "Cons of Military Medicine" thread is the best place for people to post their opinions of those aspects of military medicine with which they are dissatisfied. There are cons to military medicine, and premed's like me need to be able to understand the downside of any future commitment. No-one should join the military without having their eyes wide open.
I've read this entire thread, as well as several others. The information on this forum is a great resource. I still plan on joining the military as soon as I get that acceptance letter, though I will now be able to enter the military understanding some of the flaws in the system. Thank you MilitaryMD, USAFDoc, IslandDoc and Galo.

Yes, indeed good luck. You have the fortune of knowing so much more than I did, that with your knowledge you will hopefully be able to stave off people like idg, and all the other non medical military stuff that will detract from your ability to practice in an acceptable safe way. It will be nice to hear your experiences once you are in, an attending, although that may be a long way off.

Until then, I expect as more ex military physicians come out, you will see many of the same complaints we have posted. For surgeons, not enough cases, loss of clinical skills, no administrative support, no opportunity for advancement of your skills.................. I'm sure you've seen exusafdoc extensive documentation on primary care, and many others of different fields.

I repeat, you are far ahead of the game compared to us that went in with great expectations, and came away disillusioned, angry, and resentful.

 

[Sarg's kid]

I repeat, you are far ahead of the game compared to us that went in with great expectations, and came away disillusioned, angry, and resentful.

Give it a few years.
Thanks guys.

 

[USAFdoc]

important article; read and be warned


http://www.pulitzer.org/year/1998/national-reporting/works/index.html

This is a very clear and to the point piece on the large amount of incompetence in military medicine. It won a pulitzer price, and was published in 1998!!!!!!!!!!!!!!!!!!!!!!! Yet you continue to see much of the same.

 

[haujun]

important article; read and be warned


http://www.pulitzer.org/year/1998/national-reporting/works/index.html

This is a very clear and to the point piece on the large amount of incompetence in military medicine. It won a pulitzer price, and was published in 1998!!!!!!!!!!!!!!!!!!!!!!! Yet you continue to see much of the same.

If your many points were true the present military system should NOT be "much of the same." It should be a lot WORSE after eight years...Please keep the relevant info. to this century.......

 

[USAFdoc]

If your many points were true the present military system should NOT be "much of the same." It should be a lot WORSE after eight years...Please keep the relevant info. to this century.......

haujun;
you read something as serious as those articles that won the P-Prize, and that is your response?

not relevant? multiple physicians are telling you the same problems are STILL going on and you say not relevant. The only thing not relevant is your responses because you obviously have NO CLUE, NO EXPERIENCE, and NO CONSIDERATION for the care of patients. For YOU, it is all about appearances and you seem intent on promoting the FALSE appearance that military medicine is not in need of serious fixing.

you are no patient advocate, you are simply 100% pro-mil to the point of blindness

you just keep your blinders on, it will make your time as a military physician much more palatable.

 

[Galo]

haujun;
you read something as serious as those articles that won the P-Prize, and that is your response?

not relevant? multiple physicians are telling you the same problems are STILL going on and you say not relevant. The only thing not relevant is your responses because you obviously have NO CLUE, NO EXPERIENCE, and NO CONSIDERATION for the care of patients. For YOU, it is all about appearances and you seem intent on promoting the FALSE appearance that military medicine is not in need of serious fixing.

you are no patient advocate, you are simply 100% pro-mil to the point of blindness

you just keep your blinders on, it will make your time as a military physician much more palatable.

Haujun and idg must be the same person. They have the same blind idea that military medicine is going strong, and there is nothing wrong with it. How do you argue or educate such fervent denial?