Considering rejoining Active Duty as Anesthesiologist

[jollygoodfellow]

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You all may think I'm crazy and maybe I am. I'm a former USAF Flight Surgeon, now practicing Anesthesiologist for the last 6.5 years, considering rejoining the military. Looking to go active duty for a year or two and apply for a military Pain Fellowship. Private practice anesthesia isn't all it's cracked up to be and I'm looking to diversify. For those of you who say "just do a pain fellowship" I've already tried - went through the match and after 80 applications only got 2 interviews and no match. It's extremely competitive and there was a 27% non-match rate. Looks like I'm too far out of academics and don't have the connections I used to. This among other reasons is why I'm considering getting back in the military and into academics. Private practice is rapidly changing and those of you in anesthesia can attest to this. Specifically I am looking at the Navy due to location and fellowship opportunities. Anyone in San Diego that can comment on the life of a Navy Anesthesiologist? Moonlighting opportunities? Thanks so much.

 

[pgg]

You're probably crazy. I say that mainly because your stated reason for joining the Navy doesn't have anything to do with wanting to be in the military, but rather a hopeful second stab at GME.

Moonlighting opportunities vary greatly with location. I wouldn't sign up at all if one of your preconditions for happiness and satisfaction is a good moonlighting gig. In general, opportunities are better with orders to small hospitals because there are fewer AD people like you looking for extra hours. If you're at NMCSD surely there will be a dozen or 20 other anesthesiologist looking for shifts in a saturated, lower pay, high cost of living area.

There are two Navy pain fellowship positions, one at San Diego and one at Porstmouth. They fill each year. I have no idea how competitive they are, but if you didn't have the grades or board scores to be competitive for a spot in the civilian world, it's risky to assume you'd be able to get one in the Navy.

So what if you join up and year after year you don't get selected for the pain fellowship? As a new accession I'm not even sure if you'd have any hope of serious consideration until your first tour was up.

You'd also be #1 first número uno on the list to deploy. Which is fine if that was why you joined, but maybe not such a perk if your only reason for joining was a stab at fellowship.

Honestly, if you're mobile enough to be willing to join the military, why not look for a job out in BFE someplace? There is good work and good pay out there, if "live in a big coastal city" isn't a requirement.

 

[narcusprince]

Joygood why don't you try to get a job at an academic place with a pain fellowship and work your way in from within. Or check out a nonacgme fellowship. The .mil is not a place to improve your chances for fellowship. You should never count on moonlighting in the .mil. I cannot think of any .mil leadership that encourages moonlighting.

 

[pgg]

I agree narcusprince, generally speaking the best that can be said is that the leadership grudgingly tolerates moonlighters.

The best leaders understand that it's a wonderful way to enhance the skills and readiness of military physicians, nurses, surgical techs, RTs, etc. Not all leaders see that big picture, however.

From their perspective, it's a headache. IG typically tags along during JCAHO visits. They do their own parallel inspection of hospital programs, and they always - always - find deficiencies in ODE documentation and oversight. What's more, hospital leadership is usually heavily over-represented by non-clinical or ex-clinical people, who've got exactly zero skin in the skill maintenance game. Throw in a couple of small, petty people who resent the fact that others are making extra money by working out in town, and commands can waffle from being tolerant of moonlighters to openly hostile in an instant.

One shouldn't count on either permission or the opportunity to moonlight. Too many variables, too much veto power in others' hands.

 

[jollygoodfellow]

pgg- I PM'd you

I am considering doing a non ACGME fellowship, or even creating one at my current gig, and I do have some support for it. But I'd like to do ACGME and am willing to do some sacrificing for it. But I'm not sure how I can make my cv any better than it already is. What's done is done as far as grades go, and i've got plenty of experience.

narcusprince and pgg I agree. I moonlighted while in the USAF as a Flight Surgeon, working also all my leave a second job. But - it was at my commander's sufferance. I'm not saying I have to do it..just wondered at opportunities to supplement income. I have family expenses that I have to factor into all my decisions.

 

[jabreal00]

You have to consider why you want to make the switch. My wife was a former AD pain-anesthesiologist. She recently got out and is doing private practice pain. She does like the autonomy of pain better than anesthesia (she hated dealing with surgeons and their varying temperaments). She likes having no in-house call. However reimbursements has gone down for pain. She probably would make more as an anesthesiologist unless she was a needle jockey and just stuck anyone who walked in the door without regard. The pathology of the patients can wear someone down. A good portion of patients are simply there for opiates. If you join a practice headed by spine surgeons then expect to be their word for female dog.

She does shifts twice a month as an anesthesiologist to keep her skills up because she'd like that as a fall back if she gets burned out. Just something to think about.

 

[jollygoodfellow]

it's about the autonomy and unpredictability of my schedule, also the nature of private practice anesthesia in general.

 

[jollygoodfellow]

And I am every day someone's female dog.

 

[narcusprince]

Thats anesthesia at times...

 

[d2305]

There is this http://www.med.navy.mil/sites/nmotc/nami/Pages/Department33AerospaceMedicineResidency.aspx

 

[IlDestriero]

You are going to make a big mistake. If you're not competitive for a pain fellowship as a civilian, you probably won't be competitive for a .mil one either.
You're better off taking a good academic job and trying to secure a position from within. And a good academic job may be better than a lot of PP/AMC jobs.

 

[jollygoodfellow]

It's a moot point. Finding out that no AD billets in Navy, and likely AF as well.

 

[pgg]

It's a moot point. Finding out that no AD billets in Navy, and likely AF as well.

I am not surprised. On paper, Navy anesthesia is overmanned.

I wouldn't expect direct accession billets and bonuses to be available for the next few years.

Good luck on the civilian side. 🙂