Cons of military medicine

[haujun]

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. 👎

If you check my previous posts...I am very much neutral about military medicine, or military life in general. Could it be that I may have some significant and more broad exposure, field exposure...
in the miltary medicine? Perhaps, have either of you, GALO or USAF ever stationed at Fort Bragg??? I read your articles and they do support the idea that military physicians are not most capable individuals in the academic medicine and unfortunately, this discrimination creates an environment where even military dependents seek civilian docs for their medical care (*which wasn't mention in the article and this may reduces the case loads for residency prog...)

I think it is healthy to bring some positive force into the forum. Although I appreciate your inputs from USAF family medicine clinics site I am sure it doesn't hurt to bring some inputs from the REST of the U.S. military medicine.

The mission of military medicine (AMEDD) is to conserve the fighting strength of soldiers to fight and win...While I always embrance your notion of excellent patient care THE Military Medicine has much more broad based goal than the civilian medicine...Apple vs orange argument applies here.

Lets keep the personal attacks to min. We are all professionals here.

---

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[Galo]

If you check my previous posts...I am very much neutral about military medicine, or military life in general. Could it be that I may have some significant and more broad exposure, field exposure...
in the miltary medicine? Perhaps, have either of you, GALO or USAF ever stationed at Fort Bragg??? I read your articles and they do support the idea that military physicians are not most capable individuals in the academic medicine and unfortunately, this discrimination creates an environment where even military dependents seek civilian docs for their medical care (*which wasn't mention in the article and this may reduces the case loads for residency prog...)

I think it is healthy to bring some positive force into the forum. Although I appreciate your inputs from USAF family medicine clinics site I am sure it doesn't hurt to bring some inputs from the REST of the U.S. military medicine.

The mission of military medicine (AMEDD) is to conserve the fighting strength of soldiers to fight and win...While I always embrance your notion of excellent patient care THE Military Medicine has much more broad based goal than the civilian medicine...Apple vs orange argument applies here.

Lets keep the personal attacks to min. We are all professionals here.

Are you for real???

What, Haujun is your vast experience in US army medicine??

Almost every post you have written is in direct contradiction to the fact that we post, and the general media states, that military medicine has, in the nicest way, a whole lot of problems.

You totally do not understand our posts, and try, (just like idg), to demean us, in order to belittle our experience. Most of the people who end up getting out, are vastly more academic than the people who stay in. There is the mere fact that there is hardly anywhere, other than WH or BAMC, where you could possible do research, and there is not enough support to properly take care of patients, let alone ask for research money. Many of us had to pay our own way to surgical meetings because there was no TDY money. I had to deal with some administrator having made the unilateral decision to spend a whole years budget on new light sources, when the light cords, and scopes were so old, that the light of a thousand suns would not go through.

Unless you have some actual operational experience as a physician, a resident, dare I say a med student perhaps having done a rotation for 3 weeks somewhere, then let it be known so we can judge your amazing insight into military medicine based on that experience.

This is not a personal attack. Its merely an observation of yet another person who blindly seems to be so 100% military, but has yet to tell us based on what experience that is so.

This, people, is part of the military medicine decline problem.

P.S. Haujun, the positive parts of military medicine, go on the PRO sticky. But as I recall, you already posted there, and started some bizare argument, that brough out the caveman threatening to erase some of the posts. Really, dont go the idg route, tell everybody who you are and what you do.

 

[colbgw02]

edited because my graphic didn't work, sorry.

 

[USAFdoc]

If you check my previous posts...I am very much neutral about military medicine, or military life in general. Could it be that I may have some significant and more broad exposure, field exposure...
in the miltary medicine? Perhaps, have either of you, GALO or USAF ever stationed at Fort Bragg??? I read your articles and they do support the idea that military physicians are not most capable individuals in the academic medicine and unfortunately, this discrimination creates an environment where even military dependents seek civilian docs for their medical care (*which wasn't mention in the article and this may reduces the case loads for residency prog...)

1) haujun, you are about as neutral as I am pro-USAF primary care.
2) could it be that you will enlighten us with your experience as to give more weight to your claims?

 

[USAFdoc]

important first hand experience/info; read and weep (from "Rudy")

As an active duty resident at Wilford Hall Med Ctr, the "flagship" of AF medicine, I can tell you that there is widespread concern about the vitality of AF GME across multiple specialties within AF medicine. I have spoken personally with the program directors and senior residents in the fields of Urology, ENT, Emergency Medcine, General Surgery, and Heme/Onc, and each of them voices similar concerns about the declining numbers and diversity of teaching cases. The fact that military medicine is continually shrinking is absolutely undeniable. For example, I recently saw a powerpoint presentation which showed that there are currently about 600 active inpatient beds within the entire Air Force medical system (Wilford Hall has about 125-150 beds, and it is the largest), and in 1992 there were about 1000 beds at Wilford Hall alone. It is very clear that the emphasis from the AF medical leadership is primarily on troop medicine, to the inevitable exclusion of the dependents and over-65 retirees that are so vital for a maintaining a healthy, full-service GME program.

The only way that many of these programs stay accredited is through smoke and mirrors, just hoping to squeak by the RRC inspection and make it another 4 years.

The overall consensus is that military GME is dying, but that no one has been willing to step up and completely pull the plug. I feel that the military would be much better off to outsource GME so that all military physicians would have the opportunity to obtain a first class education at a high volume, legitimate academic center. Forget about cost, it is about training the best physicians to take care of our troops and their family members. By the way, at our facility there is very little "military unique" education at all; just underutlized facilities with inadequate teaching caseloads.

The worst part of AF med, though, is what happens after residency as one watches his or her hard earned skills go down the tubes while stagnating at some tiny clinic in the milddle of nowhere (as has been well documented by others on this forum). As a USUHS, joining the military has been one of the worst professional decisions of my life. I only take the time to mention these things so that others may learn from my mistake. Unfortunately, I am stuck to go down with this sinking ship until 2012, with no way out.
As examples of the current struggle to maintain GME in the AF, let me cite a just a few specific examples:

-- Wilford Hall residents in gen surg spend more than 50% of their time at the University Hospital to make up for inadequate caseloads
-- Anesthesiology sends residents out for 10-12 months
-- ENT recently requested authorization to send residents to MD Anderson in Houston because they were not seeing enough head and neck cancer cases

What is the point of having residency programs at military hospitals if residents have to continually go outside of the military to get the training that they need? For those that have a spouse and children, those away rotations are very difficult and disruptive to the already difficult family life of a resident.

Bottom line: do us all (patients and physcians) a favor and shut military GME down.

 

[USAFdoc]

another article presenting problems with military medicne;

http://www.usmedicine.com/column.cfm?columnID=16&issueID=12

 

[haujun]

Are you for real???

What, Haujun is your vast experience in US army medicine??

Almost every post you have written is in direct contradiction to the fact that we post, and the general media states, that military medicine has, in the nicest way, a whole lot of problems.

You totally do not understand our posts, and try, (just like idg), to demean us, in order to belittle our experience. Most of the people who end up getting out, are vastly more academic than the people who stay in. There is the mere fact that there is hardly anywhere, other than WH or BAMC, where you could possible do research, and there is not enough support to properly take care of patients, let alone ask for research money. Many of us had to pay our own way to surgical meetings because there was no TDY money. I had to deal with some administrator having made the unilateral decision to spend a whole years budget on new light sources, when the light cords, and scopes were so old, that the light of a thousand suns would not go through.

Unless you have some actual operational experience as a physician, a resident, dare I say a med student perhaps having done a rotation for 3 weeks somewhere, then let it be known so we can judge your amazing insight into military medicine based on that experience.

This is not a personal attack. Its merely an observation of yet another person who blindly seems to be so 100% military, but has yet to tell us based on what experience that is so.

This, people, is part of the military medicine decline problem.

P.S. Haujun, the positive parts of military medicine, go on the PRO sticky. But as I recall, you already posted there, and started some bizare argument, that brough out the caveman threatening to erase some of the posts. Really, dont go the idg route, tell everybody who you are and what you do.

"vastly more academic", "dare to say medical student having done three weeks somewhere.." "This is not personal attack" It is obvious that why you and others did not have leadership qualities nor the tact to confront the problems and solve them. Instead you retreat to this forum and warn others to do what?? So no one joins the USUHS and HPSP program? DO you honest think that is actually can be called a solution???! What a noble plan all you have... 👎.

Leadership is a process by which a person influences others to accomplish an objective and directs the organization in a way that makes it more cohesive and coherent. This is what all of you lack.

 

[USAFdoc]

"vastly more academic", "dare to say medical student having done three weeks somewhere.." "This is not personal attack" It is obvious that why you and others did not have leadership qualities nor the tact to confront the problems and solve them. Instead you retreat to this forum and warn others to do what?? So no one joins the USUHS and HPSP program? DO you honest think that is actually can be called a solution???! What a noble plan all you have... 👎.

Leadership is a process by which a person influences others to accomplish an objective and directs the organization in a way that makes it more cohesive and coherent. This is what all of you lack.

haujun;
again, you are somebody feeling that they have all the answers and all the insight to describe the clinics and physicians in those clinics, yet you have ZERO experience there.

the physicians I worked with were good to great leaders, the problems was we all had ZERO authority. With that, you can still offer encouragement to the enlisted looking up to you, but the military has problems that go a whole lot deeper than that.

It would be ridiculous for me to critique USUHS, or an ARMY residency etc, things of which I have no experience with, yet you and others seem to be more than eager beavers to critique the physicians and clinic military medicine in areas that you have no experience in. You lack what military medicine needs most; the integrity to do the right thing and not just follow the status quo and promote a false image of a military medince heathcare system void of serios problems. You appear to be exactly the type of leader that enables the current sad state of military medicine to exist.

 

[Galo]

haujun;
again, you are somebody feeling that they have all the answers and all the insight to describe the clinics and physicians in those clinics, yet you have ZERO experience there.

the physicians I worked with were good to great leaders, the problems was we all had ZERO authority. With that, you can still offer encouragement to the enlisted looking up to you, but the military has problems that go a whole lot deeper than that.

It would be ridiculous for me to critique USUHS, or an ARMY residency etc, things of which I have no experience with, yet you and others seem to be more than eager beavers to critique the physicians and clinic military medicine in areas that you have no experience in. You lack what military medicine needs most; the integrity to do the right thing and not just follow the status quo and promote a false image of a military medince heathcare system void of serios problems. You appear to be exactly the type of leader that enables the current sad state of military medicine to exist.

Good responce!!

Note, I asked what your experience was, and gave possible examples. I do not know where your experience is because you have yet to post it. Regardless, you do speak like you know so much, yet you have so much to learn. You really need to look at your posts, and think why are you so fervently supporting something you seem to know so little about. Do you think you are being some type of patriot, and defender of good?? We are powerless to change a system that is on its way downhill. Even people who devote their lives to the military cannot make changes by themselves. You will soon experience this incompetency, and wonder what the hell you were defending. If you do not recognize it, you are part of the problem.

 

[haujun]

haujun;
again, you are somebody feeling that they have all the answers and all the insight to describe the clinics and physicians in those clinics, yet you have ZERO experience there.

the physicians I worked with were good to great leaders, the problems was we all had ZERO authority. With that, you can still offer encouragement to the enlisted looking up to you, but the military has problems that go a whole lot deeper than that.

It would be ridiculous for me to critique USUHS, or an ARMY residency etc, things of which I have no experience with, yet you and others seem to be more than eager beavers to critique the physicians and clinic military medicine in areas that you have no experience in. You lack what military medicine needs most; the integrity to do the right thing and not just follow the status quo and promote a false image of a military medince heathcare system void of serios problems. You appear to be exactly the type of leader that enables the current sad state of military medicine to exist.

I never stated directly or indirectly that the military medicine has no problems. Having spent both as an enlisted and a officer in the military medicine (field and garrison) and now training as a resident in the U.S. Army hospital I have to be blind, deaf and mentally ******ed to deny the problems in the U.S. military medicine... However I know that the "right thing" is NOT getting out of the military and posting all these negative posts to decrease the participation rates (HPSP & USUHS). This is way too simple if not cowardly to be even called right thing.

I know you are smart and caring individual to figure the meaning of this statement: There is old saying in my country...If you want to catch a tiger you need to go into the cave.

 

[USAFdoc]

I never stated directly or indirectly that the military medicine has no problems. Having spent both as an enlisted and a officer in the military medicine (field and garrison) and now training as a resident in the U.S. Army hospital I have to be blind, deaf and mentally ******ed to deny the problems in the U.S. military medicine... However I know that the "right thing" is NOT getting out of the military and posting all these negative posts to decrease the participation rates (HPSP & USUHS). This is way too simple if not cowardly to be even called right thing.

I know you are smart and caring individual to figure the meaning of this statement: There is old saying in my country...If you want to catch a tiger you need to go into the cave.

and there is a saying in my country;

"if it smells like crap, if it looks like crap, and if it taste like crap, it just might be crap"

military medicine is crap

now many of you students have not yet made it close enough to appreciate the distinct aroma and texture of todays clinical medicine in the military, your time will come. 😍

 

[haujun]

and there is a saying in my country;

"if it smells like crap, if it looks like crap, and if it taste like crap, it just might be crap"

military medicine is crap

now many of you students have not yet made it close enough to appreciate the distinct aroma and texture of todays clinical medicine in the military, your time will come. 😍

Your response like this not only wastes a space but questions the validity of your other posts.

here is a con of military medicine:
--some post tramatic military physicians

 

[USAFdoc]

Your response like this not only wastes a space but questions the validity of your other posts.

here is a con of military medicine:
--some post tramatic military physicians

the "crap" was a jab at your "crouching tiger" line. Military medicine is NOT 100% crap, but it is certainly flawed on many levels to the extent that reasonable physicians will not tolerate.

 

[Galo]

For anyone who's read this far, and still has doubts, read the following link:


http://forums.studentdoctor.net/showthread.php?t=286700

It discussed the declining case load, and there is good information there.

Galo

 

[Galo]

Wow, amazing to see that the last link I placed has alot to do with this other link:

http://forums.studentdoctor.net/showthread.php?p=3955817#post3955817

Once again, the highly doubtful situation that you may get your choice or training out in the spotlight. How could anyone knowingly want to take that chance with the beginning of their careers??

 

[deuist]

I certainly did not know about the difficulties of military residencies when I signed my contract. Naturally, I'm worried about losing out on my dream job and getting stuck as a GMO. To the people on this thread who started as GMO's, how easy/hard was getting a residency after so many years away from college?

 

[DiveMD]

I certainly did not know about the difficulties of military residencies when I signed my contract. Naturally, I'm worried about losing out on my dream job and getting stuck as a GMO. To the people on this thread who started as GMO's, how easy/hard was getting a residency after so many years away from college?

I am trying to match in Ophthalmology at the moment. I will post my results after January 2007.

BTW, this website is a great way to spend your time during your GMO tour....haha.

 

[island doc]

I certainly did not know about the difficulties of military residencies when I signed my contract. Naturally, I'm worried about losing out on my dream job and getting stuck as a GMO. To the people on this thread who started as GMO's, how easy/hard was getting a residency after so many years away from college?

All depends upon what specialty you want. If you want to become a civilian neurosurgeon or a cardiothoracic surgeon-forget it, same goes for derm, etc. Civilian Primary care (IM, Peds, FP) should be no problem after military GMO.

I had no problem becoming a civilian FP, but lost out on my dream of becoming a neurosurgeon simply because I wasted four years of my life as a military GMO.

Good Luck. You're going to need it.

 

[MedicalCorpse]

here is a con of military medicine:
--some post tramatic military physicians

Have you stopped to ask yourself:

Why are all of these docs from different medical specialties post-tramatic (sic)?

Is not your complaint a validation of what we are saying: that military medicine tramatizes (sic) the best and brightest physicians who chose to serve their country in uniform?

How can I question the validity of the complaints of these active duty and ex-military physicians if I cannot *even* spell the word "traumatic"?

Have I earned my oxygen today?

Happy contemplation,

--
R.
http://www.medicalcorpse.com
...Looking for my time machine and my gnarled stick...

 

[deuist]

All depends upon what specialty you want. If you want to become a civilian neurosurgeon or a cardiothoracic surgeon-forget it, same goes for derm, etc. Civilian Primary care (IM, Peds, FP) should be no problem after military GMO.

I had no problem becoming a civilian FP, but lost out on my dream of becoming a neurosurgeon simply because I wasted four years of my life as a military GMO.

Good Luck. You're going to need it.

I've heard that going through a second residency in the civilian world counts as a ding against your application because of Medicare's funding rules for time spent in training. When a board-certified physician gets out of the military (let's say family practice), will he have 3 non-funded years should he decide to apply to civilian hospitals as part of a career change?

 

[island doc]

I've heard that going through a second residency in the civilian world counts as a ding against your application because of Medicare's funding rules for time spent in training. When a board-certified physician gets out of the military (let's say family practice), will he have 3 non-funded years should he decide to apply to civilian hospitals as part of a career change?

The answer to your specific question is yes or no, depending upon whether or not the residency (say FP) was military or civilian. If military, since military residencies are not funded by medicare, one's medicare GME entitlement would remain intact allowing completion of a second civilian residency afterward. If the residency had been a civilian one, there would be no further medicare GME entitlement, thus completing a second civilian residency would not be funded by Medicare. Getting a civilian GME program to accept a non-medicare funded candidate is virtually impossible.

Uncle Sam is a confused guy isn't he? One the one hand he thinks it is important enough for all civilian physicians to be BE/BC thus provides for their full and complete residency funding by medicare, but on the other hand he tells his military physicians that they are not allowed to complete a residency (see recent AF/SG policy). He needs a psych referral.

 

[i want out]

I've heard that going through a second residency in the civilian world counts as a ding against your application because of Medicare's funding rules for time spent in training. When a board-certified physician gets out of the military (let's say family practice), will he have 3 non-funded years should he decide to apply to civilian hospitals as part of a career change?

Since I am getting out of the Navy after a second GMO tour, this is a topic that is near and dear to me right now.

I don't have the link in front of me, but there is an ACGME brochure floating around the internet that addresses HCFA funding of GME.

Essentially what it says, is that for an initial period of training, the hospital gets a 1.0 to multiply against the formula used to determine their HCFA funding, and for any training beyond that they use a 0.5 multiple.

The brochure addresses military specifically, and mentions that if you even do a linked internship that is linked to a program like FP or IM, then you are locked onto that funding track even if your training is interupted (GMO).

In other words, if you do an IM internship, regardless of any HCFA funding, then do 2 GMO tours, and apply for a surgery residency then only the first 2 years of your surgical residency will get the 1.0 multiple, the remaining 3 will get 1/2 the HCFA funding.

They also mentioned, that if you do a transitional internship, that doesn't lock you onto a funding track.

Like I said, this is all detailed in an ACGME brochure, I don't have the link in front of me, but will post it if I can find it again.

i want out

 

[DiveMD]

Since I am getting out of the Navy after a second GMO tour, this is a topic that is near and dear to me right now.

I don't have the link in front of me, but there is an ACGME brochure floating around the internet that addresses HCFA funding of GME.

Essentially what it says, is that for an initial period of training, the hospital gets a 1.0 to multiply against the formula used to determine their HCFA funding, and for any training beyond that they use a 0.5 multiple.

The brochure addresses military specifically, and mentions that if you even do a linked internship that is linked to a program like FP or IM, then you are locked onto that funding track even if your training is interupted (GMO).

In other words, if you do an IM internship, regardless of any HCFA funding, then do 2 GMO tours, and apply for a surgery residency then only the first 2 years of your surgical residency will get the 1.0 multiple, the remaining 3 will get 1/2 the HCFA funding.

They also mentioned, that if you do a transitional internship, that doesn't lock you onto a funding track.

Like I said, this is all detailed in an ACGME brochure, I don't have the link in front of me, but will post it if I can find it again.

i want out

WOW! I am so glad I did a Transitional Internship.. i want out 2

 

[Galo]

Once again, a post that should be saved for prosperity:


http://forums.studentdoctor.net/showthread.php?t=324400

Read them and weep. On down the post is another 35 from Rob. If you've read this far, you should know his site, but just in case:

www.medicalcorpse.com

Stay away from military medicine!!!

 

[Galo]

And another!!

Although short at this time, it repeats some incredibly critical reasons that military medicine should be avoided like a cancer.

http://forums.studentdoctor.net/showthread.php?t=354000

 

[megadon]

So, have quickly gone through this, my general impression is 1. surgeons don't get enough cases and are rightfully disgruntled 2. Air Force family practice potentially has a lot of problems and 3. Having NC and MSC running the show can be a bad idea. All valid points, can't comment except for 3.

My specific question is, can someone tell me reasons why I would to go after a civilian internal medicine residency vice military, and what the great drawbacks to practicing internal medicine in the military over civilian life is. If it is TRICARE paperwork/pain in the butt problems, don't bother, I already understand that. Seriously, it would make me consider doing a GMO tour and punching if valid enough.

My background is different, I'm Navy, MS1, but did seven years as a submarine officer. Guess what, your patients all know that TRICARE sucks, so you can bond over that. Off topic, there is a growing number of people who are pushing for the exact same system for the entire country, so once you get out, guess what you would deal with. Thank God for private practice! Made possible by your lack of debt due to Uncle Sam, and the fact that we all decided to prostitute ourselves to pay for school. Maybe that's coarse, but this is the second time I've done it (USNA grad) so I went into this deal eyes wide open, so I do feel some sympathy for those who have been shocked by the ordeal of placing yourself into Uncle Sam's care and guidance. As a note of condolence to everyone complaining about being deployed outside your speciality, it is happening big time with my old community, subs. Since subs don't really do a whole lot to contribute to Iraq, their officers and enlisted are easy pickings to be sent on one year tours to Iraq and Afghanistan. So it's not just med corps, a lot of people are feeling the pain, which doesn't make it any more right, just that we aren't a minority. It's a group grope.

Basically, I want to be a GI, that's six years of training = six years of payback, therefore one more year I retire. So I think picking up internal medicine will be pretty easy, but I understand getting the fellowship is a pretty big gamble, that's okay. Sounds like it would be cutting into the surgeon's endoscopy time, and I can see how that work against me.

So, to more accurately post against me, here are also some of my beliefs
1. I like moving around, it also means your boss changes, although it means your friends leave.
2. You have to take leave for Sat/Sun for vacations, that sucks, but that's been the rule for years.
3. Tricare is an administrative nightmare, and more and more hospitals are requiring you to itemize everything to track expenses (ie Portsmouth) in order to look at ways to cut costs.
4. I understand as you become more senior, you get pulled out of the clinic to more administrative things, which sucks.
5. You wear the same everthing day, been there, done that, makes it easy in the morning.

Basically, I want to know about being understaffed, overworked, overtasked. I want to know about NC not supporting. I really want to hear about drawbacks to internal medicine in the Navy primarily (ie, don't see wide enough variety of problems to develop as a physician), and then in the joint world of Army and Air Force. So, hook me up, I believe I have bounded the problem sufficiently to eliminate general criticism that is not poignant to my problem at hand.

Very Respectfully,
Thomas Stickle
once again, ENS, USNR

 

[Galo]

So, have quickly gone through this, my general impression is 1. surgeons don't get enough cases and are rightfully disgruntled 2. Air Force family practice potentially has a lot of problems and 3. Having NC and MSC running the show can be a bad idea. All valid points, can't comment except for 3.

My specific question is, can someone tell me reasons why I would to go after a civilian internal medicine residency vice military, and what the great drawbacks to practicing internal medicine in the military over civilian life is. If it is TRICARE paperwork/pain in the butt problems, don't bother, I already understand that. Seriously, it would make me consider doing a GMO tour and punching if valid enough.

My background is different, I'm Navy, MS1, but did seven years as a submarine officer. Guess what, your patients all know that TRICARE sucks, so you can bond over that. Off topic, there is a growing number of people who are pushing for the exact same system for the entire country, so once you get out, guess what you would deal with. Thank God for private practice! Made possible by your lack of debt due to Uncle Sam, and the fact that we all decided to prostitute ourselves to pay for school. Maybe that's coarse, but this is the second time I've done it (USNA grad) so I went into this deal eyes wide open, so I do feel some sympathy for those who have been shocked by the ordeal of placing yourself into Uncle Sam's care and guidance. As a note of condolence to everyone complaining about being deployed outside your speciality, it is happening big time with my old community, subs. Since subs don't really do a whole lot to contribute to Iraq, their officers and enlisted are easy pickings to be sent on one year tours to Iraq and Afghanistan. So it's not just med corps, a lot of people are feeling the pain, which doesn't make it any more right, just that we aren't a minority. It's a group grope.

Basically, I want to be a GI, that's six years of training = six years of payback, therefore one more year I retire. So I think picking up internal medicine will be pretty easy, but I understand getting the fellowship is a pretty big gamble, that's okay. Sounds like it would be cutting into the surgeon's endoscopy time, and I can see how that work against me.

So, to more accurately post against me, here are also some of my beliefs
1. I like moving around, it also means your boss changes, although it means your friends leave.
2. You have to take leave for Sat/Sun for vacations, that sucks, but that's been the rule for years.
3. Tricare is an administrative nightmare, and more and more hospitals are requiring you to itemize everything to track expenses (ie Portsmouth) in order to look at ways to cut costs.
4. I understand as you become more senior, you get pulled out of the clinic to more administrative things, which sucks.
5. You wear the same everthing day, been there, done that, makes it easy in the morning.

Basically, I want to know about being understaffed, overworked, overtasked. I want to know about NC not supporting. I really want to hear about drawbacks to internal medicine in the Navy primarily (ie, don't see wide enough variety of problems to develop as a physician), and then in the joint world of Army and Air Force. So, hook me up, I believe I have bounded the problem sufficiently to eliminate general criticism that is not poignant to my problem at hand.

Very Respectfully,
Thomas Stickle
once again, ENS, USNR

You have alot of advantages that most students looking into military medicine do not. Your time in has allowed you to learn alot of the tricks in surviving a military environment. Also, from your post, you have 7 years left towards retirement. All positives in your favor. Now, although I'm sure Milmed can chime in about the Navy, (and others), you run certain risks that you may not be willing to, or able to deal with well. The most important, is you run the risk of not being able to do what you want. Which puts you out potentially 4 years away from your goal of GI. Also, with GME in the military being the way it is, you certainly run the risk of mediocre training. With your time in, rank is on your side, but there will always be someone above you that may turn out to be a real pain in your ass.

An alternative suggestion would be go to civilian med school, get civilian training, and when you are done, go to the reserves. You can still accumulate your time towards retirement while making alot more money than you would being in the service, no matter what your rank or time in grade is.

At this point in time, military medicine is just too broken for me to recommend it to anybody, even in your situation.

Good luck, and thanks for your service.

 

[The White Coat Investor]

[

 

[erawka]

So...I understand that I am only a student (and not even a medical student at that!), but I am a slightly older student and I have been considering a career in medicine for quite some time. Also, I feel that I have researched the field pretty significantly. I've worked alongside several different physicians in several different capacities and, although I can't *actually* know what it's like to be a physician, I feel that I have a pretty good idea.

That being said, with the exception of deployments, it seems to be that many of the "Cons" listed by current military docs are very similar - if not identical - to the "Cons" listed by civilian docs. A physician that I have worked with once told me - flat out - not to enter medicine. She works in FP in an underfunded and understaffed state hospital, works long hours, never sees her kids, has to take on additional on-calls to compensate for retiring or relocating physicians, etc. She reported normally working 12-14 hour days, and more often than not that didn't include paperwork. All too often, she does not have the equiptment she needs, does not have the staff she needs, and does not have support or understanding from the administration. She often feels frustrated with the quality of care that her patients receive, but feels helpless in the situation.

She had other problems as well, that many (but I'm sure not all) military doctors don't see. She does OB, so her malpractice is through the roof, and she's pretty much drowning in red tape. Many of her new patients arrived on her doorstep already addicted to pain medication, and if they cannot get more from her they seek other (illegal) ways of getting it (One man addicted to vicadin was reportedly involved in a mini drug trading ring where he would trade viagra with another patient for more vicadin). And she would probably laugh at the idea of 30 days paid leave. I don't think that's something that she could even consider.

I know nothing of her monetary situation, but I don't think she gets paid exceptionally well, and she attended private medical school, so I'm sure her student loans are through the roof.

This all being said, I'm certainly not trying to diminish the complaints made by current military docs on this forum. And unlike many military docs, this physician does have the choice to seek better employment, if it exists anymore.

She is not an exception. Although they may not have been quite so candid, the other physicians I have worked with certainly alluded to similar complaints.

In my opinion, as inexperienced as I may be, it seems like most of the complaints made in this forum are really complaints against the field of medicine in general. A career as a physician requires long hours, an unbelievable amount of stress, plenty of beaurocratic nonsense, inexhaustable patience, and years of getting shat on. And unless you land yourself in one of the "lifestyle" fields, you can pretty much count on it anywhere.

So to add my two cents, if you are reading these forums and find yourself getting disenchanted with the idea of military medicine, I'd say that you should take a long hard look at medicine in general. Because you'll find that civilian medicine is pretty broken as well. If you're turned off by the idea of a lot of work and a lot of sacrifice for little compensation - financial or otherwise - then medicine might not be for you.

It would be great, however, to get a feel for some of the downsides of military that do not apply to civilian medicine - like how often military docs have to relocate, how frequent deployments are, etc. I've been trying to find specific info on that EVERYWHERE with no luck.

 

[gastrodoc]

Relocation: Once for internship
Once for GMO (1-3) years- Navy>AF and Army
Once for residency (2-5 years)
Once for utilization tour (1-3 years)
Once for fellowship (2-3 years)
Once to utilization tour as a sub-specialist
Don't have to move after that if you don't want to
Once when you get out.

Deployments:
FP/Peds/Med/PM+R- every 3 years. Worst I've heard of is a guy on his fourth 12 month deployment.
Med subs- Every 3 years. Procedural subs get 6 month tours, at least sometimes.
Gen Surg- 3-6 month tours every 18 months
I don't know about Ortho/Rads/Peds.
Uro/ENT are usually on 6 month tours.
Anesthesia- Widely variable. At least every 3 years, typical tour is 6 months.

 

[Mirror Form]

That being said, with the exception of deployments, it seems to be that many of the "Cons" listed by current military docs are very similar - if not identical - to the "Cons" listed by civilian docs.

Yeah, a lot of pre-meds come to that conclusion, I don't really think it's that true though. But even if it is, there's a whole different level in the military. For example, civilian docs who complain about their EMR have absolutely no clue how horrendous the military's EMR is. Any competent civilian doc that was forced to use AHLTA would quit immediately and find a better job.

A physician that I have worked with once told me - flat out - not to enter medicine. She works in FP in an underfunded and understaffed state hospital, works long hours, never sees her kids, has to take on additional on-calls to compensate for retiring or relocating physicians, etc. She reported normally working 12-14 hour days, and more often than not that didn't include paperwork. All too often, she does not have the equiptment she needs, does not have the staff she needs, and does not have support or understanding from the administration. She often feels frustrated with the quality of care that her patients receive, but feels helpless in the situation.

Not to belittle FP, but that's why it's the least competitive residency. And to be practicing FP in a understaffed area truly puts you near the bottom of civilian physician job desirability. So sure, the very bottom of civilian physician jobs are similar to all military physician jobs.

Although, as a side note though, not all military clinics are understaffed, and most actually have excellent equipment. The military is seriously lacking though when it comes to issues like appropriately trained technicians and secretarial support. One staff from our clinic who retired last year now has SIX techs just working on his patients and then more people to take care of his secretarial duties. Whereas, we have six doctors per tech. He also does more surgery in one day then one of us does in two months. And to add insult to injury, he works far fewer hours. Yes, you read that right. That's because he's doing patient care and surgery within an efficient system while military doctors are doing data entry all day.

She had other problems as well, that many (but I'm sure not all) military doctors don't see. She does OB, so her malpractice is through the roof, and she's pretty much drowning in red tape. Many of her new patients arrived on her doorstep already addicted to pain medication, and if they cannot get more from her they seek other (illegal) ways of getting it (One man addicted to vicadin was reportedly involved in a mini drug trading ring where he would trade viagra with another patient for more vicadin). And she would probably laugh at the idea of 30 days paid leave. I don't think that's something that she could even consider.

It's more than most military docs are allowed to take as well!

I know nothing of her monetary situation, but I don't think she gets paid exceptionally well, and she attended private medical school, so I'm sure her student loans are through the roof.

This all being said, I'm certainly not trying to diminish the complaints made by current military docs on this forum. And unlike many military docs, this physician does have the choice to seek better employment, if it exists anymore.

Yep, her job sounds like crap. Medicine is a tough field. So now take her lifestyle and add all the stress and difficulties that the military will add onto it.

The military is very worthwhile for a lot of fields b/c most fields dont' have the same sense of purpose that medicien does. Working in the military gives you a sense of purpose greater then just a paycheck. Whereas, in medicine we already have a sense of purpose. The military seems to get in the way of it just as much as it adds to it.

She is not an exception. Although they may not have been quite so candid, the other physicians I have worked with certainly alluded to similar complaints.

In my opinion, as inexperienced as I may be, it seems like most of the complaints made in this forum are really complaints against the field of medicine in general. A career as a physician requires long hours, an unbelievable amount of stress, plenty of beaurocratic nonsense, inexhaustable patience, and years of getting shat on. And unless you land yourself in one of the "lifestyle" fields, you can pretty much count on it anywhere.

So to add my two cents, if you are reading these forums and find yourself getting disenchanted with the idea of military medicine, I'd say that you should take a long hard look at medicine in general. Because you'll find that civilian medicine is pretty broken as well. If you're turned off by the idea of a lot of work and a lot of sacrifice for little compensation - financial or otherwise - then medicine might not be for you.

It would be great, however, to get a feel for some of the downsides of military that do not apply to civilian medicine - like how often military docs have to relocate, how frequent deployments are, etc. I've been trying to find specific info on that EVERYWHERE with no luck.

That's b/c there are no specifics. If there were, they'd be different by next week. And it's true that medicine is a tough non-lifestyle field. We all know that it's not for people who want easy money. And most people who get into med school could probably make more money doing other things. But you have no idea what you're talking about beyond that.

 

[erawka]

Relocation: Once for internship
Once for GMO (1-3) years- Navy>AF and Army
Once for residency (2-5 years)
Once for utilization tour (1-3 years)
Once for fellowship (2-3 years)
Once to utilization tour as a sub-specialist
Don't have to move after that if you don't want to
Once when you get out.

Deployments:
FP/Peds/Med/PM+R- every 3 years. Worst I've heard of is a guy on his fourth 12 month deployment.
Med subs- Every 3 years. Procedural subs get 6 month tours, at least sometimes.
Gen Surg- 3-6 month tours every 18 months
I don't know about Ortho/Rads/Peds.
Uro/ENT are usually on 6 month tours.
Anesthesia- Widely variable. At least every 3 years, typical tour is 6 months.

Thank you. This is really helpful.

 

[NoMoreAMCAS]

I'm sure it's posted all over in different threads but I don't want to spend forever looking for it. Can somebody please list for me the services in terms of odds that a student will go straight through in their training (school-> residency)?

I keep hearing contradicting stories and I'm basically wondering if there is a consensus about the probability in each service. Thanks.

 

[deuist]

It depends on specialty, but overall, the Air Force has 75% go straight through.

 

[The White Coat Investor]

I'm sure it's posted all over in different threads but I don't want to spend forever looking for it. Can somebody please list for me the services in terms of odds that a student will go straight through in their training (school-> residency)?

I keep hearing contradicting stories and I'm basically wondering if there is a consensus about the probability in each service. Thanks.

It is very service, specialty, and year specific. For example, the overall AF numbers might be 75%, but that is only because EM is 50% and Peds is 98% etc etc.

 

[Lab Rat MD]

Is this true:

A big pro in military medicine is the Montgomery GI bill. If you go to an upper tier medical school you could be 200k in debt by the end. Instead of the debt growing while you are in residency, with HPSP you have zero debt. Do an internship your 4 years and get out. Now cash in the GI bill and do a civilian residency. The GI bill will pay you about $1000 month for 2 years while you are a civilian resident.

All you've done is put your residency training on hold for 4 years and made yourself a boatload of money in the interim.

 

[DH78]

Is this true:

A big pro in military medicine is the Montgomery GI bill. If you go to an upper tier medical school you could be 200k in debt by the end. Instead of the debt growing while you are in residency, with HPSP you have zero debt. Do an internship your 4 years and get out. Now cash in the GI bill and do a civilian residency. The GI bill will pay you about $1000 month for 2 years while you are a civilian resident.

All you've done is put your residency training on hold for 4 years and made yourself a boatload of money in the interim.

1) Upper tier or no, 200K is a reasonable debt to incur;
2) You could do a GMO tour, and then I believe your IRR responsibility could be covered by your time in a mil residency, but I don't know about a civilian one.
3) I don't honestly know much about the Mon GI bill, but I personally have never heard of a HPSP recipient getting payments from it, deferred residency or not. I thought the bill was a result from prior service, and not meant to be combined with another scholarship designed to have a doc in an active duty role for x amount of years. Feel free to correct me on this one.
4) The "boatload" you refer to amount to about 24K before taxes. Would you really be willing to postpone your residency training for 4 years for a lousy 24K? Most will tell you they would rather PAY 24K to go straight through.

Good luck.

 

[sethco]

Is this true:

A big pro in military medicine is the Montgomery GI bill. If you go to an upper tier medical school you could be 200k in debt by the end. Instead of the debt growing while you are in residency, with HPSP you have zero debt. Do an internship your 4 years and get out. Now cash in the GI bill and do a civilian residency. The GI bill will pay you about $1000 month for 2 years while you are a civilian resident.

All you've done is put your residency training on hold for 4 years and made yourself a boatload of money in the interim.

Check out the thread in the FAQs. All the answers to you rquestions are there (and more) and the thread is not too long at all.

👍

 

[jabreal00]

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

You forgot Ft. Polk or Ft. Leonard-Wood, which are probably worse than Riley or Sill.

 

[brazz15]

All this crying and complaining. WERE SOLDIERS DARNIT! The best of the best, wake up early, stay up late. Go hard or go home. Haha.

 

[Jab1113]

I dont want to sound naive or anything but I do need to ask this question, is this the same living conditions and experiences that a US Navy Dentist would go through?

 

[Regmbr]

To students considering military medicine: I was in your shoes. I got into a civilian medical school and got scared of how expensive it was. I signed on for an HPSP scholarship. One of the fundamental and simple questions is this: Does being a military physician suck, or does it not suck? Answer: its sucks.

 

[DrMetal]

To students considering military medicine: I was in your shoes. I got into a civilian medical school and got scared of how expensive it was. I signed on for an HPSP scholarship. One of the fundamental and simple questions is this: Does being a military physician suck, or does it not suck? Answer: its sucks.

Wow, you take the prize for the most thoughtful post of the year...well done.

 

[WernickeDO]

Definitely worth the necrobump.

 

[pgg]

Definitely worth the necrobump.

Bonus points for it being his 2nd post in 8 years!

 

[dr zaius]

Wow, you take the prize for the most thoughtful post of the year...well done.

I mean...is he wrong?

 

[Perrotfish]

I mean...is he wrong?

He's not wrong, but he's not helpful either.

I think most people come in realizing that, being in the military, your initial obligation is going to suck. Even 18 year old Marines mostly know that much before they sign. I think a lot of people hold out hope that it will suck less than the debt would have sucked (which I think is true for at least some people) or that it will suck significantly less as they rise in rank and thereby justify a military career, but no one is unclear that it will basically suck for at least the first 4 years after residency.

To help future applicants you need to try to accurately describe and quantify the sucking, to help them decide which of their options sucks the least.

 

[haujun]

PRIORITIES and NEEDS are DIFFERENT prior to medical school and during payback. It is impossible to predict your Future military situation during payback when you are signing for HPSP Now. It is pure chance and grace from God if you stuck in a place where you like during pay back. That is Con for HPSP when you just don’t know and I just don't know how anyone can make informed decision to sign up HPSP.

Current climate in the military is also different when I signed up HPSP too: emphasis on military education, lower promotion potential, emphasis on operational assignment...All this is bad for clinician I guess. The only things that did not change were poor admin support and stagnant pay.

As for me I would have spent 15 years living in an area that I would have never considered to live. I really hate where I live but working environment is good. 5 more years before retirement!

 

[Perrotfish]

Con: having to cut weight like a high school wrestler every 6 months to stay out of fat camp. Nothing says 'I have a doctoral degree' like sitting in a sauna until you lose 10 pounds of water weight.

Meanwhile at my age I can basically walk the 1.5 miles for the PFT, because actual physical fitness doesn't matter.

 

[pgg]

Con: having to cut weight like a high school wrestler every 6 months to stay out of fat camp. Nothing says 'I have a doctoral degree' like sitting in a sauna until you lose 10 pounds of water weight.

Meanwhile at my age I can basically walk the 1.5 miles for the PFT, because actual physical fitness doesn't matter.

I prefer the bike. I have to burn about a half-bagel’s worth of calories. The only annoying thing about it is that if I hit my half-bagel benchmark at 8 minutes, I have to keep pedaling for 4 more or the bike shuts itself off and it’s an automatic failure. So I just turn the resistance down real low and keep the pedals moving. If I’m lucky I got a bike near a TV.