Considering joining as attending anesthesiologist

[Zka7471]

Recently graduated US-trained anesthesiologist/intensivist. Have considered joining a branch of the US military on and off since college. Some family history with grandfather who was army and two uncles who were AF. Talked with a recruiter briefly a few times. Was very close to applying to HPSP but held off to have more control over picking residency/fellowship field and location. Med school roommate was/is still Navy. Now that training is done and I don't really have any more large career goals other than do my job well, I'm now thinking again about joining.

I've seen plenty of negative reviews around but I feel like they mostly come down to poor pay (which isn't a concern for me) or lack of autonomy (again, I'm honestly usually fine taking orders and as a single guy without strong family/regional ties am fine moving wherever, whenever). It really is mostly just a desire to serve, which I'm sure is somewhat romanticized on my part but is true nonetheless.

So I guess questions for people here would be:

• can anyone with military experience talk about pros/cons specific to anesthesia
• from a clinical side, any difference in practice split between anesthesia, ICU, or admin that will look different compared with a civilian job
• large differences between branches? With my family, I've had more exposure to AF than anything but not medical.

And feel free to add whatever else you think might be important while considering. I'm currently on a short-term contract through the next two years but am starting to consider career path afterwards. Thanks all!

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[DeadCactus]

I would strongly consider looking at the Guard or Reserve. Going Active Duty during peacetime when in a specialty that requires procedural skills and high pathology and has a civilian job market that pays double or triple what the military pays is a terrible choice. Make more money, control where you live, practice the kind of medicine you want, and go do military things on the weekend.

 

[armytrainingsir]

110% recommend you go Reserves.

 

[armytrainingsir]

Off the top of my head, the biggest con in Army Anesthesia is, depending on how you look at it, all the cool jobs that you’d see on a recruiting poster are generally filled with CRNAs and not MDs.

 

[comp1]

Can't speak to anesthesia, but if you really want to gear your life towards serving, why not do the reserves and get a VA day job? It is built specifically for reservist time (as opposed to just tolerating it as required by law) and while the VA definitely has some problems, as someone who has witnessed both the DoD and VA workflows in my own specialty, I really do think the VA will give you a better and more personally fulfilling place to work in general almost regardless of the particular sites compared.

 

[afteranesthesia]

Recently graduated US-trained anesthesiologist/intensivist. Have considered joining a branch of the US military on and off since college. Some family history with grandfather who was army and two uncles who were AF. Talked with a recruiter briefly a few times. Was very close to applying to HPSP but held off to have more control over picking residency/fellowship field and location. Med school roommate was/is still Navy. Now that training is done and I don't really have any more large career goals other than do my job well, I'm now thinking again about joining.

I've seen plenty of negative reviews around but I feel like they mostly come down to poor pay (which isn't a concern for me) or lack of autonomy (again, I'm honestly usually fine taking orders and as a single guy without strong family/regional ties am fine moving wherever, whenever). It really is mostly just a desire to serve, which I'm sure is somewhat romanticized on my part but is true nonetheless.

So I guess questions for people here would be:

• can anyone with military experience talk about pros/cons specific to anesthesia
• from a clinical side, any difference in practice split between anesthesia, ICU, or admin that will look different compared with a civilian job
• large differences between branches? With my family, I've had more exposure to AF than anything but not medical.

And feel free to add whatever else you think might be important while considering. I'm currently on a short-term contract through the next two years but am starting to consider career path afterwards. Thanks all!

Ugh. This is exhausting. You know - sign up. Enjoy the ^&*I( out of it. You obviously don't read any of our posts, and you deserve every bit of what is coming for you.

 

[DocSurgeon]

Ugh. This is exhausting. You know - sign up. Enjoy the ^&*I( out of it. You obviously don't read any of our posts, and you deserve every bit of what is coming for you.

 

[militaryPHYS]

Recently graduated US-trained anesthesiologist/intensivist. Have considered joining a branch of the US military on and off since college. Some family history with grandfather who was army and two uncles who were AF. Talked with a recruiter briefly a few times. Was very close to applying to HPSP but held off to have more control over picking residency/fellowship field and location. Med school roommate was/is still Navy. Now that training is done and I don't really have any more large career goals other than do my job well, I'm now thinking again about joining.

I've seen plenty of negative reviews around but I feel like they mostly come down to poor pay (which isn't a concern for me) or lack of autonomy (again, I'm honestly usually fine taking orders and as a single guy without strong family/regional ties am fine moving wherever, whenever). It really is mostly just a desire to serve, which I'm sure is somewhat romanticized on my part but is true nonetheless.

So I guess questions for people here would be:

• can anyone with military experience talk about pros/cons specific to anesthesia
• from a clinical side, any difference in practice split between anesthesia, ICU, or admin that will look different compared with a civilian job
• large differences between branches? With my family, I've had more exposure to AF than anything but not medical.

And feel free to add whatever else you think might be important while considering. I'm currently on a short-term contract through the next two years but am starting to consider career path afterwards. Thanks all!

Definitely consider the reserves. Will allow you to serve and check that box as it does seem like it is very important to you but would allow you to mainly keep your current gig in the civilian world.

Ugh. This is exhausting. You know - sign up. Enjoy the ^&*I( out of it. You obviously don't read any of our posts, and you deserve every bit of what is coming for you.

Who would have thought that some people still want to serve this country?! Mind blown 🤯

 

[DocSurgeon]

Definitely consider the reserves. Will allow you to serve and check that box as it does seem like it is very important to you but would allow you to mainly keep your current gig in the civilian world.


Who would have thought that some people still want to serve this country?! Mind blown 🤯

So, I think it’s probably fair to say the vast majority of everyone that’s done or wants to do HPSP has done/will do so with a desire to serve the country and be part of the military. Most understand there is going to be personal and financial sacrifice involved in doing so. They (we) join with the idealistic viewpoint that it will be ok because we can still practice medicine in a capacity in which we trained.

The frustration is that it’s not like that and there are so so soooo many of the same posts asking the same thing with the same answers. Take OP:

• from a clinical side, any difference in practice split between anesthesia, ICU, or admin that will look different compared with a civilian job

This has been discussed ad nauseam. The differences are continents apart. They’re not comparable. At all. I appreciate your passion on these boards, PHYS, I really do. The machine needs more people like you advocating for better medicine but if I’m not mistaken it’s all you’ve ever known? I did civilian gen surg residency, 4 year payback, now been out civilian 4 years general surgeon. I did more cases in my first 6 months out than I did the last 24 in. I’m not kidding. Way more complex too. It’s not the same and won’t be in any of our practice lifetimes.

To answer his question above, my military hospital ward was a glorified obs unit, my ICU was anyone I would send to the ward now. I remember I guffawed when I first got on station and we were running the list of people in the unit. “Why the hell is this guy in the ICU?!?” By the time I left I understood and wouldn’t dream of trusting the regular floor to anyone that needed any sort of competent nursing care or oversight. Some of my anesthesiologists would order type and screen on every case (lap choles) because “you never know.” And admin? I spent 60% of my week in my office, doing training modules, answering emails, or just surfing on my phone trying to look busy.

So, someone wants to serve? Awesome! Have fun! If you want out later you’re gonna need years of retraining when it’s over. That’s either going through fellowship or trial and error with real live human beings Hopefully you’ve got great partners and mentors like I did to help you through the latter.

And I was at a major MTF. I knew guys at other places who had half their case volume for four years as vasectomies in the OR.

 

[pgg]

Recently graduated US-trained anesthesiologist/intensivist

How recently? It's May so presumably you're at least ~1 year out. 🙂

Wanting to serve is a good reason to join. If the financial hit isn't a big deal to you, that's good. Hard to predict what kind of deployments you might do, but odds are they won't be comparable to the ones we did when Iraq/Afghanistan were very busy. Most deployments since COVID have been pretty low activity - lots of time doing nothing.


If I had one bit of caution to offer you, it'd be that as a new grad anesthesiologist / intensivist, you should take a job where you are busy with complex cases and sick patients. Finishing residency and fellowship made you safe and competent. It takes time to get efficient and good though - and the period when the learning curve is steepest is right out of residency. For a couple years.

Military hospitals do not, for the most part, offer an operative case load or ICU census sufficient to challenge new grads and help them grow. The majority of active duty anesthesiologists moonlight outside the military to supplement their case load. When I was faculty at a military residency program, I always pushed our grads to start off-duty employment as soon as they were able to do so. There is no substitute for sitting in the OR doing cases.

OR caseload might be OK at a couple of the big military hospitals. I was at one of the Navy big 3 (NMC Portsmouth). When I left in 2022 the caseload was poor. It may be better now - there were efforts to increase caseload, but the obstacles are many.

New joins have little input on where they get stationed. You might get stationed somewhere that has only the equivalent of an ASC.


Another wrinkle that could affect you specifically - as an anesthesiologist/intensivist, presumably you'd want to split some time between the OR and ICU? Apart from the poor ICU census, this kind of staff time splitting can be difficult at MTFs. There isn't a good reason for it to be a problem; I've just observed that there can be friction between the ICU dept and anesthesia dept. Granted, this kind of split practice can be tough to arrange in the civilian world too - but at least there you can change jobs.


Joining the active component now is not a professional risk I would take. The reserves may scratch the itch you have.


I think the odds of a large-ish, protracted military conflict involving the USA breaking out in the next few years are low. Consequently, I think it's unlikely that active duty military physicians will be called upon to do a great deal of combat casualty care or the kind of deployed/field medicine people imagine. If you join now, my guess is you'll be working at an under-utilized CONUS facility, doing 1/4 or 1/3 the cases you'd be doing as a civilian (and of FAR lower acuity), but burdened by an array of administrative pains that don't exist in civilian medicine.

The reserves aren't a bad option. Or you could consider the VA, if you want to serve this population.

 

[militaryPHYS]

So, I think it’s probably fair to say the vast majority of everyone that’s done or wants to do HPSP has done/will do so with a desire to serve the country and be part of the military. Most understand there is going to be personal and financial sacrifice involved in doing so. They (we) join with the idealistic viewpoint that it will be ok because we can still practice medicine in a capacity in which we trained.

The frustration is that it’s not like that and there are so so soooo many of the same posts asking the same thing with the same answers. Take OP:

• from a clinical side, any difference in practice split between anesthesia, ICU, or admin that will look different compared with a civilian job

This has been discussed ad nauseam. The differences are continents apart. They’re not comparable. At all. I appreciate your passion on these boards, PHYS, I really do. The machine needs more people like you advocating for better medicine but if I’m not mistaken it’s all you’ve ever known? I did civilian gen surg residency, 4 year payback, now been out civilian 4 years general surgeon. I did more cases in my first 6 months out than I did the last 24 in. I’m not kidding. Way more complex too. It’s not the same and won’t be in any of our practice lifetimes.

To answer his question above, my military hospital ward was a glorified obs unit, my ICU was anyone I would send to the ward now. I remember I guffawed when I first got on station and we were running the list of people in the unit. “Why the hell is this guy in the ICU?!?” By the time I left I understood and wouldn’t dream of trusting the regular floor to anyone that needed any sort of competent nursing care or oversight. Some of my anesthesiologists would order type and screen on every case (lap choles) because “you never know.” And admin? I spent 60% of my week in my office, doing training modules, answering emails, or just surfing on my phone trying to look busy.

So, someone wants to serve? Awesome! Have fun! If you want out later you’re gonna need years of retraining when it’s over. That’s either going through fellowship or trial and error with real live human beings Hopefully you’ve got great partners and mentors like I did to help you through the latter.

And I was at a major MTF. I knew guys at other places who had half their case volume for four years as vasectomies in the OR.

I said go reserves if serving is a personal must do. I don’t come on here recruiting. I’m honest about how MilMed right now is for a very select few. For most I end up recommending against signing up based on their unrealistic expectations while in or misguided reasons for joining in the first place. But I’m also not an absolutist like many on here. There are people it is a good fit for and it serves a very important purpose for many in this world of ours.

I know you all think that the efforts now are just like they were in the past but that just isn’t true. No more funding is coming. Further consolidation must happen and it will. Further optimization and partnerships will exist. But who knows. We will see how well this post ages in 5 years.

 

[Zka7471]

Alright everyone, thanks for all the replies so far. For more context:

How recently? It's May so presumably you're at least ~1 year out. 🙂

Yes, one year out. Graduated last July. Although haven’t done much clinical work since then which is likely why it feels more recent for me. I am currently contracted with a humanitarian organization and will be going to work for two years in a small hospital in a low-resource setting in West Africa that is nevertheless a referral site since there’s nothing else around. I’ll be the sole anesthesiologist with three green nurse “anesthetists” doing a mix of sitting the complex cases and supervising/teaching the nurses. The goal is also to help develop the ICU facilities while there and train providers on basic crit care. With that, the primary language is not English, and so I have been in intensive language school for the past six months with no clinical work during this time, just a bit of per diem stuff between graduating and being sent here.


And yes, I understand that similar questions have been asked before. I’ve done my fair share of searching looking for whatever answers I can find. However, with this post, I was more hoping to narrow down on my specific scenario. Things like joining as an attending (most posts here are re: HPSP/USUHS, it is originally for students after all) or specific to anesthesiology since most stuff is a mix of FM/EM/IM/surg.

Take the admin burden question, for example. Yes, I know there’s more with military than civilian. But as an anesthesiologist, I’m generally protected from the majority of at least clinical admin stuff since I don’t have a clinic. Not having support staff to schedule, fax, etc. presumably wouldn’t affect me as much, but if it’s generic military bs that every doc has to do, different story.

Or for the lack of case numbers. On the civilian side the anesthesia market right now is fantastic because there’s a lack of us in pretty much every city in the country when looking at surgeon/proceduralist numbers that need anesthesia. It’s why it’s so easy currently to do things like locums or the per diem work I did last year. If a similar problem in ratio exists in the military, then yes there might be only six surgeries for six surgeons, but if there’s only two anesthesiologists I’d be doing three times the number of cases as my surgical colleagues.

That said, yes, the skill attrition is concerning. I’m definitely not looking to have to try and relearn everything 5+ years out of residency.

As above, I’ve still got plenty of time before I have to make any decision. I’m not running to a recruiter tomorrow and joining active duty. This is just me contemplating possible next career steps and looking to be as well informed as possible when it is decision time. I’ll certainly be looking into reserves and/or VA positions as suggested.