Depressed reading about the match

[IgD]

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It's depressing reading the fallout from the military match. Obviously you can't please everyone but couldn't a better job be done?

Could we do away with the military match (and GMO tours) and integrate with the civilian match somehow? I suspect retention would go up and the quality of care for service members would increase.

 

[exPCM]

deleted

 

[alpha62]

funny thing I noticed about PAs in the military, we're always not qualified to provide care, unless it's to replace an MD in a really crappy assignment they're trying to wiggle out of.

 

[Gastrapathy]

funny thing I noticed about PAs in the military, we're always not qualified to provide care, unless it's to replace an MD in a really crappy assignment they're trying to wiggle out of.

Bingo. This is where the "do away with GMOs" argument falls apart. Doing away with GMOs doesn't change the need for operational medical types. So, then the options are to train more PAs and NPs (realizing that they also have good civilian alternatives and will get out if you treat them poorly) or to send primary care docs in those roles and significantly increase how crappy it is to be a general internist. Primary care is difficult and thankless already and you will retain no one if you make it worse. The best thing about the GMO system is that it more equitably distributes the operational jobs among people who intend to train in all specialties. Say what you will about quality of care and the ethics of putting people in GMO roles, but, I just don't see how the primary care specialties can survive in the military if they take all this on.

 

[The White Coat Investor]

It's depressing reading the fallout from the military match. Obviously you can't please everyone but couldn't a better job be done?

Could we do away with the military match (and GMO tours) and integrate with the civilian match somehow? I suspect retention would go up and the quality of care for service members would increase.

Sorry about the depression. I had the same feeling as an MSII (after finding this forum) and it persisted through to the military match. The good news is not everyone gets screwed and IN GENERAL those who do get screwed are worse medical students than those who don't. (Don't flame me on this one, I have no data other than talking to multiple PDs in my specialty and service) Study hard and be glad you have the advantage of knowing how the process works going in. That is a HUGE advantage in avoiding getting screwed.

I'd like to see the military get out of the GME business all together and put everyone through the civilian match. I don't see it happening any time soon.

 

[RugbyJC]

It's depressing reading the fallout from the military match. Obviously you can't please everyone but couldn't a better job be done?

Not everyone's upset with the match. Its just that none of us who are satisfied have posted here. I for one am very happy with my internship, and even if I do a GMO next year I would be cool with it. In fact, looking at the Navy match results, I know a lot of MSIVs who had their co-location issues met. I do not think any of the married couples who are both Navy got separated and I know about 30 people on that list who got their first or second choice, which is pretty good considering I only know about 30-40 people on that list total.

I know an AF HPSP student who did not get selected for an AF position in EM like he had hoped and instead got a transitional year deferrment--not even a choice he asked for. He had not scheduled any interviews and even though he is frantically calling up programs in locations where his wife is applying he handling this well. He knew this could happen and doing a GMO tour after is not the end of the world to him either.

I know people in the civilian match last year who did not get their top choices or their specialty of choice. Of course there are more options here, but it is still possible to not match or get stuck in a place you don't want.

Like most people have been saying to prospective recruites. If you are flexible and understand that this could happen it is really not that depressing. Maybe a set back, but not the end of the world.

 

[alpha62]

Bingo. This is where the "do away with GMOs" argument falls apart. Doing away with GMOs doesn't change the need for operational medical types. So, then the options are to train more PAs and NPs (realizing that they also have good civilian alternatives and will get out if you treat them poorly) or to send primary care docs in those roles and significantly increase how crappy it is to be a general internist. Primary care is difficult and thankless already and you will retain no one if you make it worse. The best thing about the GMO system is that it more equitably distributes the operational jobs among people who intend to train in all specialties. Say what you will about quality of care and the ethics of putting people in GMO roles, but, I just don't see how the primary care specialties can survive in the military if they take all this on.

I still think it's a good idea for docs to do the GMO tour. You need to see how the real army actually works and not the MEDCEN, that's not real. That way you know not to do stupid little stuff, like put eye ointment and a patch on a Tanker's eye.

You'd also be better equipped to spot a shamming manipulator milking the system. I don't know if anybody has ever told you this, but a lot of the soldiers are laughing at you in barracks at this very minute. They know you don't know squat about their jobs and you just gave them quarters for 3 days.

I know, because I used to be a shamming little private, with just enough skill to get over on lots of stuff... I later had all that bad Karma come back on me though when I became an officer.

 

[colbgw02]

You'd also be better equipped to spot a shamming manipulator milking the system. I don't know if anybody has ever told you this, but a lot of the soldiers are laughing at you in barracks at this very minute. They know you don't know squat about their jobs and you just gave them quarters for 3 days.

Your point about understanding operational medicine is a good one, but do you really think that we don't know that people are manipulating the system? After doing this for years, most of us can smell a malingerer from the waiting room. I sometimes worry that I might actually be hurting patients by not giving them the benefit of the doubt, because I basically assume that they're FOS.

The truth is, I'd rather just give someone quarters for 3 days than have to speak to them for an extra 5 seconds. Besides, quarters is just a suggestion, it's ultimately up to the soldier's commander. Luckily for everyone involved, I'm no longer in a job where I give out quarters or profiles.

 

[chaser08]

The truth is, I'd rather just give someone quarters for 3 days than have to speak to them for an extra 5 seconds. Besides, quarters is just a suggestion, it's ultimately up to the soldier's commander. Luckily for everyone involved, I'm no longer in a job where I give out quarters or profiles.

There aren't many commanders who are willing to overrule the doctor's "suggestion". However, that reminds me of when I was a platoon leader and one of my soldiers was repeatedly doing the malingering thing - I think he was trying to get out of taking a PT test or the annual 12-mile road march. Anyway, I talked to the commander about it and he ended up calling the doctor and they both decided that the soldier would no longer get quarters unless he had a compelling reason. But even at that time, the commander told me that this wasn't common, as that battle is often not worth fighting.

When I rotated on FM at Womack during sick call, it was all I could do to keep my eyes from rolling out of my head from all of the BS these soldiers came up with to get out of PT/road march/FTX. If I was FM, they'd ban me from sick call because I'd have a big red "RTD" (Return To Duty) stamp that I'd use on the sick call slip who was anywhere within 2 weeks of a PT test, FTX, or road march (and for the scared pogues, airborne ops)!

 

[Perrotfish]

Just out of curiosity, how would people here feel about taking the majority of GMO billets, particularly those in the Marine Corps, and converting them entirely to PAs? I mean, I know it might not be a choice job for a PA either, but the benifit to abuse ratio at least approaches what they would face in the private sector.

Also, same question about converting GMO billets to NPs.

 

[chaser08]

I see enough patients with stress fractures, labral tears, and other potentially career-ending injuries in Ortho clinic after sick call docs said, "Take two Motrin and get back on the road". If I get a few malingerers out of work, it's not the end of the world. But if I get some good soldiers PEB'd out of the service because I was overly aggressive with RTDs, then I'm not doing my job.

Fair enough. In my defense, I was shadowing before I started medical school and did not know about these things. However, from the other side, when a soldier only seems to have profiles/quarters when it's time to do a PT test or a road march, I think it's also fair to question the validity of their complaint. Besides, some of the soldiers don't even try to make up an excuse - I saw docs literally just ask if they wanted a profile and for how long! C'mon! It's not big deal to the doc, but if a soldier is not at work, it affects more than just him/her. Some jobs aren't necessarily interchangeable.

 

[Mirror Form]

The only real question is why GMO billets aren't being converted faster to BC/BE billets.

Because that would be an utter waste of a primary care doctor's skills. It would also cause the primary care doctor to probably lose a lot of his/her skills.

 

[IgD]

Just out of curiosity, how would people here feel about taking the majority of GMO billets, particularly those in the Marine Corps, and converting them entirely to PAs? I mean, I know it might not be a choice job for a PA either, but the benifit to abuse ratio at least approaches what they would face in the private sector.

Also, same question about converting GMO billets to NPs.

I think the Marines deserve a board certified Family Practice physician at each battalion. That would correspond to roughly one per 1,000 Marines. There will be times they will be twiddling their fingers but other times the help will be very much needed and appreciated.

The bottom line is that Marines deserve better.

 

[NavyFP]

Sorry about the depression. I had the same feeling as an MSII (after finding this forum) and it persisted through to the military match. The good news is not everyone gets screwed and IN GENERAL those who do get screwed are worse medical students than those who don't. (Don't flame me on this one, I have no data other than talking to multiple PDs in my specialty and service) Study hard and be glad you have the advantage of knowing how the process works going in. That is a HUGE advantage in avoiding getting screwed.

I'd like to see the military get out of the GME business all together and put everyone through the civilian match. I don't see it happening any time soon.

For those who get nothing they "want." I would agree, they are poorer candidates for the program they have chosen. This year 72% got their first choice. 90% got 1st or second. While some who got their 2nd choice would say they got screwed, I don't think this truly holds water.

I disagree on getting out of GME. We actually do better when we grow our own.

 

[Perrotfish]

So a primary care physician has a panel of a couple thousand patients, and treats them for both health maintenance needs as well as acute care visits. That's a waste of their skills why? Does a primary care doc have to see a large number of elderly, chronically ill patients to be doing their job?

Do Batallion Surgeons generally do anything a PA isn't trained and qualified to do?

 

[pgg]

So a primary care physician has a panel of a couple thousand patients, and treats them for both health maintenance needs as well as acute care visits. That's a waste of their skills why?

Because with the Marines, it's not a couple thousand patients for one doc ... it's maybe 900 of the healthiest people in the United States for two docs and an independent duty corpsman. It's crazy. They don't need two physicians and an IDC to see a dozen URIs and sprained ankles each day.

What they do need is someone who can handle the easy stuff but knows when to ask for help - a PA is perfect for that job. The other thing they need is an officer who's smart enough to stay out of the Chief's way when it comes to admin/personnel/supply issues. PAs can do that job too.

Let's be honest - GMOs, who are really just glorified interns, shouldn't be working without supervision even if the Marines bestow the title of "battalion surgeon" upon them. And now that we've established the fact that supervision is necessary, why is a properly supervised intern so much better than a properly supervised PA?

A BC physician or two at each regiment, supervising PAs at each battalion, seems appropriate to me. Of course, none of this answers the "where do we find enough PAs willing to do these jobs" question.

 

[IgD]

Because with the Marines, it's not a couple thousand patients for one doc ... it's maybe 900 of the healthiest people in the United States for two docs and an independent duty corpsman. It's crazy. They don't need two physicians and an IDC to see a dozen URIs and sprained ankles each day.

I think your assessment is true during peacetime but how about now? If you want to see what battalion surgeons are doing in theatre read Jadic's book. What are battalion surgeons doing in garrison these days? They are preparing for the next deployment but also trying to manage the sick and injured from the last.

To NavyFP, I'm not suggesting we get out of the GME business. I think its important we have military residencies. I don't know the answers.

 

[Gastrapathy]

I think your assessment is true during peacetime but how about now? If you want to see what battalion surgeons are doing in theatre read Jadic's book. What are battalion surgeons doing in garrison these days? They are preparing for the next deployment but also trying to manage the sick and injured from the last.

To NavyFP, I'm not suggesting we get out of the GME business. I think its important we have military residencies. I don't know the answers.

That kind of combat casualty care has been almost entirely ceded to the higher levels of medical care. The trauma patients usually bypass the BAS altogether now and the GMOs are back to the URI and ankle sprains.

Tired, you really have no concept what a primary care physician does if you think being a GMO would be a fulfilling existence. Staff internists run ICUs, put in central lines, push thrombolytics, etc actually on a fairly regular basis. FP's deliver babies, see well-babies, etc, all of which are not available in a GMO environment. I didn't mind my GMO tour timed when it was but would have hated it as a first or second staff tour.

 

[Gastrapathy]

I still think it's a good idea for docs to do the GMO tour. You need to see how the real army actually works and not the MEDCEN, that's not real. That way you know not to do stupid little stuff, like put eye ointment and a patch on a Tanker's eye.

You'd also be better equipped to spot a shamming manipulator milking the system. I don't know if anybody has ever told you this, but a lot of the soldiers are laughing at you in barracks at this very minute. They know you don't know squat about their jobs and you just gave them quarters for 3 days.

I know, because I used to be a shamming little private, with just enough skill to get over on lots of stuff... I later had all that bad Karma come back on me though when I became an officer.

Here was how I handled this. First trip to sick call on deployment for a routine complaint, see the IDC or senior 0000. Second trip, see the IDC or me. Third and every subsequent trip to sick call, see me. And if your a frequent flyer, you don't sit out and wait for me, the HM's tell me that you are here and you get to skip the line and go straight back to work. A simple policy like that pretty much eliminates the sick call commando.

And I couldn't care less if someone thinks they got over on me. I'm much more scared that I missed an appy along the way because of my skepticism.

BTW, I got everything I wanted out of the GMESB/detailer process. Selected for what I wanted at each point and got the GMO tour I wanted when I needed to be a GMO for a couple years.

 

[mitchconnie]

I know people in the civilian match last year who did not get their top choices or their specialty of choice. Of course there are more options here, but it is still possible to not match or get stuck in a place you don't want.

I generally agree with your point that not everyone is unhappy with the military match, but you can’t justify the military status quo by simply stating “some people in the civilian match don’t get what they want.” The military and civilian matches are not comparable in any way, shape, or form. In my civilian medical school class of around 150 there were about three people who didn’t get the specialty they wanted, mostly people with marginal stats who were going for ENT, derm, RADS, etc. All could scramble for a second choice specialty or do a transitional year in the location of their choice and re-apply the following year. Compare that to the AF match where 25% do not get their specialty of choice and will be forced to do a transitional year then 1-3 years of primary care. How many people in the civilian match will be forced to do an internship they don’t want in a location they don’t want and then have a practice they don’t want (primary care) for 1-3 years?

And in the civilian match, someone from a good school with solid board scores, good rotation grades, and decent letters is virtually guaranteed to get the specialty of their choice. The only question is whether they will get the exactly the location or program they want. If that top student is going into FP, IM, or peds, they can pretty much pick their location anywhere in the country. By comparison, the military match looks like a total crapshoot, and there are way less options. The most you can say with certainty is that if you want to do primary care, you’re likely to train straight through in the specialty you want.

 

[IgD]

And in the civilian match, someone from a good school with solid board scores, good rotation grades, and decent letters is virtually guaranteed to get the specialty of their choice.

You are on to something here. Why should an applicant need a GMO tour for a serious look? What is important to me is interviews, letters of recommendation, subinternship and board scores. What kind of message are we sending people when we weigh time in service/GMO tour completion over those other factors?

I think recruiting, morale and retention would improve if there was a single match like in the civilian world🙂

 

[alpha62]

Here was how I handled this. First trip to sick call on deployment for a routine complaint, see the IDC or senior 0000. Second trip, see the IDC or me. Third and every subsequent trip to sick call, see me. And if your a frequent flyer, you don't sit out and wait for me, the HM's tell me that you are here and you get to skip the line and go straight back to work. A simple policy like that pretty much eliminates the sick call commando.

And I couldn't care less if someone thinks they got over on me. I'm much more scared that I missed an appy along the way because of my skepticism.

BTW, I got everything I wanted out of the GMESB/detailer process. Selected for what I wanted at each point and got the GMO tour I wanted when I needed to be a GMO for a couple years.

I think it's important to mention learning all the paperwork, the true meaning of a profile and how to actually help a soldier get the bennies that's comming to him. He needs an advocate at the unit level doing that. The MEB process starts at the unit level and that's where a lot of delays happen.

 

[DiveMD]

Case in point: me. By the time I go out, I will have completed an Orthopedic Internship, complete with inpatient rotations in Neurosurgery, Vascular, CT, Trauma, ER, and ICU. Which part of my training will make me an excellent primary care physician for the Corps?

None...

 

[pgg]

If you want to see what battalion surgeons are doing in theatre read Jadic's book.

I don't need to read his book, I've been there twice, and 99% of the time there's no forward battalion aid station getting moved from bombed out building, to tent, to crater, to a lean-to staked out behind a tank. It's daily sick call that is no different than what gets done in garrison. No different.

And for the 1% of the time I spent in a forward BAS in a bombed out building, 100% of that time was spent watching casualties fly over my head to the FRSS 10 miles behind us. Trauma is fast tracked straight from the scene of the injury to regional surgical teams staffed by board certified surgeons, anesthesiologists, ER docs, FP docs, etc.

What are battalion surgeons doing in garrison these days?

Seeing healthy 18-25 year olds with URIs and sprained ankles. Admin duties. Powerpoint slides for weekly staff meetings.

They are preparing for the next deployment but also trying to manage the sick and injured from the last.

No they're not, the ones with deployment-related injuries get seen by board certified physicians at Walter Reed, or NNMC, or Naval Hospital Camp Lejeune, or get deferred out to board certified civilians. As of 3 or 4 years ago, at least at Camp Lejeune, GMOs aren't even permitted to submit med boards for their own sick and injured.

The most I ever did while in garrison, treatment-wise, for a Marine with a combat injury, was type up memos and sign light duty chits so they could get out of the battalion runs so they could go to their physical therapy appointments.

GMOs do not have medically challenging or stimulating jobs.

 

[BomberDoc]

Just out of curiosity, how would people here feel about taking the majority of GMO billets, particularly those in the Marine Corps, and converting them entirely to PAs? I mean, I know it might not be a choice job for a PA either, but the benifit to abuse ratio at least approaches what they would face in the private sector.

Also, same question about converting GMO billets to NPs.

If you haven't noticed, PAs are getting out almost as fast as MD/DOs. Unfortunately they tend to be retirement minded with all that prior time, etc. However, I've seen quite a few pull handles and get out with just one more assignment to make 20 years. The new 12-15 month deployments for PAs (yes, Air Force) are causing quite a stir.

You can get out, make a decent living, and not have to destroy your family by being in Afghanistan for a year or more. That retirement carrot gets less and less appealing every day.

 

[IgD]

I don't need to read his book, I've been there twice, and 99% of the time there's no forward battalion aid station getting moved from bombed out building, to tent, to crater, to a lean-to staked out behind a tank. It's daily sick call that is no different than what gets done in garrison. No different.

And for the 1% of the time I spent in a forward BAS in a bombed out building, 100% of that time was spent watching casualties fly over my head to the FRSS 10 miles behind us. Trauma is fast tracked straight from the scene of the injury to regional surgical teams staffed by board certified surgeons, anesthesiologists, ER docs, FP docs, etc.



Seeing healthy 18-25 year olds with URIs and sprained ankles. Admin duties. Powerpoint slides for weekly staff meetings.



No they're not, the ones with deployment-related injuries get seen by board certified physicians at Walter Reed, or NNMC, or Naval Hospital Camp Lejeune, or get deferred out to board certified civilians. As of 3 or 4 years ago, at least at Camp Lejeune, GMOs aren't even permitted to submit med boards for their own sick and injured.

The most I ever did while in garrison, treatment-wise, for a Marine with a combat injury, was type up memos and sign light duty chits so they could get out of the battalion runs so they could go to their physical therapy appointments.

GMOs do not have medically challenging or stimulating jobs.

I appreciate you sharing your experiences. On the other hand I've seen a totally different reality than what you described. What happened to your Marines after they received their treatment? You didn't have to treat/identify PTSD, TBI and manage injured Marines after they returned back to the battalion?

 

[mohody]

And the FP practice, it seems to me, could be remedied by attaching the NMC FPs to the Marines in the surrounding area (half GMO/half inpatient). Haven't been there yet, but would it really be so hard to do sick call at 2nd Marine Division a few days a week, and see clinic at the medical center the rest of the time?

This might work during peacetime, but a doc is involved in the workup and readiness of the batallion. You would also loose the bond and relationship that develops between the doc and the troops.

 

[alpha62]

This might work during peacetime, but a doc is involved in the workup and readiness of the batallion. You would also loose the bond and relationship that develops between the doc and the troops.

You are correct and until you've been dropped into a FUBARed BN at the last minute out of the PROFIS pool, you'll never know how right you are.

 

[alpha62]

If you haven't noticed, PAs are getting out almost as fast as MD/DOs. Unfortunately they tend to be retirement minded with all that prior time, etc. However, I've seen quite a few pull handles and get out with just one more assignment to make 20 years. The new 12-15 month deployments for PAs (yes, Air Force) are causing quite a stir.

You can get out, make a decent living, and not have to destroy your family by being in Afghanistan for a year or more. That retirement carrot gets less and less appealing every day.

You said a mouthful. they think they can keep depending on a fresh supply of E-4s coming into the military PA program. even cross branched Infantry officers, but everybody wises up eventually. What's even dumber, is they continue to train Females as PAs, thus burning even more slots... you can't put them in combat arms units, well at least not yet anyway.

I used to go on AD every once in a while to keep my reserve points going. I was a DoD contractor anyway. One day I did the math, getting deployed until I cleared the grey zone at age 60 didn't make sense. For what ? 1/4 pay on retirement and " great tricare benifits "

Please. just get out, work the two days a month you'd have made on the drill pay, put it in a Roth and you'll still come out ahead.

I live in an isolated retirement town and the joke's on the lifers... no doc in town will take their Tricare.

 

[BomberDoc]

What's even dumber, is they continue to train Females as PAs, thus burning even more slots... you can't put them in combat arms units, well at least not yet anyway.

And I have seen several get pregnant a month before their deployment bucket so that others have to fill the billet. One of the female PAs who has since moved on from here had 4 kids in 4 years in order to not deploy. Nobody hates these people more than the non-childbearing females who end up going in their place.

 

[The White Coat Investor]

For those who get nothing they "want." I would agree, they are poorer candidates for the program they have chosen. This year 72% got their first choice. 90% got 1st or second. While some who got their 2nd choice would say they got screwed, I don't think this truly holds water.

I disagree on getting out of GME. We actually do better when we grow our own.

2nd choice in the military match isn't the same as second choice in the civilian match. I ranked deferrment first, then was forced to rank the two programs in my specialty (both programs were worse than every one of the civilian programs I interviewed at) neither of which was in a state I wanted to live in. If I had gotten my 2nd choice I would have felt screwed. In reality it would have meant I was going to my 28th choice.

As far as GME, I think the military can still do reasonable FP GME, but I think its surgical and EM GME is substandard by the very population it serves. It is tough to run any GME program when the faculty is constantly getting deployed.

 

[ieatpizza]

Interesting thread. Some thoughts from an Army HPSP MSII (i.e. I may or may not know what I'm talking about). I don't think it would be a good idea to abandon military GME altogether even if it's just for specialties like general surgery that seem to be struggling (from what I have gathered from this forum anyway). The goal should be to improve these programs (stable staff? restructure or find affiliates to increase and vary caseload? a joint military and civilian hospital?). I really don't know, but I think it's important that the military has academic centers for teaching and research which focus on the interests and needs of the military. I would argue that military GME is important in improving care for the military which can't be done if we leave GME and research to the civilian side. Any thoughts on this?

Also, I think there are bound to be more people unhappy with the military match simply because it is such a small system in comparison to the WHOLE nation. For this reason, can the military really give everyone the residency they want? For instance, even if the military decides to turn everything over to the national match, they can't have everyone going into derm, rads, ortho, ENT, etc. So they would still have to set the number specialty slots based on their needs.

 

[mac61]

Color me silly, but am I the only one that thinks complaining about the location of the program you're accepted to is silly? I can completely understand if your first choice is deferrment and JHU and you get jammed into Fort Bliss because the level of training is likely a little different; you should be peeved. However, being mad because the location is in a state that you don't want to live in says that you have ABSOLUTELY no idea what you've gotten yourself into. I am willing to bet that 93.457% of soldiers (et. al.) stationed at crapholes like Fort Irwin, Hohenfels, the most popular place in the Army located in LA (not the one in California), and not to mention Iraq, Afghanistan, Kosovo, Bosnia, etc. are completely disgruntled. In fact, with the exception of the 4 major MEDCENs and MAYBE Ft. Carson, you are going to live someplace you don't want to live. If you really thought the Army was going to keep you living where you want to live it is definitely time to turn off the alarm clock and crack the Folgers because it's going to be a long, long couple of years paying for your medical education.

But that's just me.

And BTW: I completely expect to be left by my wife and lose my family when I tell them that we have to move to Fort Bragg for a year, then do two years at Fort Sill, while having no idea what kind of doc I'll be for a couple years and performing as less than a PA (in the opinions of some posters) and getting deployed once or twice, only to find out that I'm going to be forced to practice FP and get used and abused for the rest of my career...I love Christmas time. But, at least I know what's coming....maybe it's better to be blind and stupid than just plain stupid.

 

[Mirror Form]

Staff internists at major medical facilities do the things you describe, but that hardly constitutes the majority of Internal Medicine practice throughout the nation. If anything, the movement is away from Internists doing what you describe, and towards IM docs in clinics, with admitted patients being turfed over to a handful of "hospitalist" internists.

And the FP practice, it seems to me, could be remedied by attaching the NMC FPs to the Marines in the surrounding area (half GMO/half inpatient). Haven't been there yet, but would it really be so hard to do sick call at 2nd Marine Division a few days a week, and see clinic at the medical center the rest of the time?

Regardless, a typical FP doc has a panel of thousands of patients, many of which are elderly that have multiple medical issues, are on multiple drugs, and are susceptible to many illnesses.

Taking care of active duty soldiers is just 100% completely different. It's completely different patients, completely different pathology, and much easier to take care of young healthy people then old sick people. And an FP docs skills wouldn't just be wasted, they'd like atrophy.

 

[IgD]

Taking care of active duty soldiers is just 100% completely different. It's completely different patients, completely different pathology, and much easier to take care of young healthy people then old sick people. And an FP docs skills wouldn't just be wasted, they'd like atrophy.

The big question I think needs answered is what is the definition of a doctor? Is it one who graduated internship or one who completed residency? My definition is the latter. I think the idea a physician is someone who completed a residency is consistent with the expectations of the public and congress.

The second question is what is needed? A lot of times you have to have people around even if they will be underutilized "just in case". Right now I suggest a FP doc would be fully utilized but definitely not in peace time.

 

[Perrotfish]

How would people on here feel about significant pay bonuses for either GMO tours or IM/FP doctors who agree to do positions like batallion surgeon in the Marine Corps, say on the order of 100K/yr? What about direct commissioning FP/IM certified doctors for those positions at a salary way about what they would make in the civilian world, say 350K, to offset the poor patient population and military hassels they'll have to deal with? Would that help the situation, or would it cause too much bitterness amoung the post-HPSP specialists who are getting paid less (but who get to work in hospitals rather than out of the back of an ambulance)? Or would everyone just be so happy to have someone else willing to fill those positions that they wouldn't care about the pay difference?

 

[IgD]

Perrotfish, you bring up some interesting issues.

I have heard speculation that the military plans to replace MTF providers with GS employees and contractors while shifting uniformed providers to operational billets. Theoretically that would reduce the number of uniformed providers. At the same time I wonder if the remaining uniformed providers could be given super salaries like you described in order to make the positions highly sought after.

There are billets in the Navy that come with spot promotions:
http://www.npc.navy.mil/Boards/SpotPromotions/

Maybe another strategy would be to give greenside physicians spot promotions to make the billets more enticing.

Do you think the Marine Corps would benefit from having its own medical corps?

 

[Perrotfish]

Do you think the Marine Corps would benefit from having its own medical corps?

Uggh. Well you can see what the Corps has done with their law program: required all candidates to first get a 280 (on average) on the Marine Corps PFT, then survive their crazy OCS, then go to the full Marine Corps TBS basic officer training, and finally pay for law school on their own. I mean, oorah and all, but I'd hate to be cared for by the quality of doctor you'd get with those kind of requirements and that kind of payback.

 

[alpha62]

Your point about understanding operational medicine is a good one, but do you really think that we don't know that people are manipulating the system? After doing this for years, most of us can smell a malingerer from the waiting room. I sometimes worry that I might actually be hurting patients by not giving them the benefit of the doubt, because I basically assume that they're FOS.

The truth is, I'd rather just give someone quarters for 3 days than have to speak to them for an extra 5 seconds. Besides, quarters is just a suggestion, it's ultimately up to the soldier's commander. Luckily for everyone involved, I'm no longer in a job where I give out quarters or profiles.

That's why it's even more important you're stuck in the same unit you might be letting people get over in.

When your medics have to pick up the slack, doing non-medical duties, because you let a slacker pull one over, you'll soon enough feel the chill.

BTW, I once had an MD playing games with me, trying to block an evac downrange. The jerk still thought he was in residency, playing the House of God routine. I finally just ignored a direct order and acted like the operational officer I was supposed to be and send them anyway. The kid had a ruptured appy on top of the right ureteral stone That genius had dx 3 days prior, sent him back up to the field to sit on while it passed. Yeah, I'm a little bitter on that one.

 

[alpha62]

Color me silly, but am I the only one that thinks complaining about the location of the program you're accepted to is silly? I can completely understand if your first choice is deferrment and JHU and you get jammed into Fort Bliss because the level of training is likely a little different; you should be peeved. However, being mad because the location is in a state that you don't want to live in says that you have ABSOLUTELY no idea what you've gotten yourself into. I am willing to bet that 93.457% of soldiers (et. al.) stationed at crapholes like Fort Irwin, Hohenfels, the most popular place in the Army located in LA (not the one in California), and not to mention Iraq, Afghanistan, Kosovo, Bosnia, etc. are completely disgruntled. In fact, with the exception of the 4 major MEDCENs and MAYBE Ft. Carson, you are going to live someplace you don't want to live. If you really thought the Army was going to keep you living where you want to live it is definitely time to turn off the alarm clock and crack the Folgers because it's going to be a long, long couple of years paying for your medical education.

But that's just me.

And BTW: I completely expect to be left by my wife and lose my family when I tell them that we have to move to Fort Bragg for a year, then do two years at Fort Sill, while having no idea what kind of doc I'll be for a couple years and performing as less than a PA (in the opinions of some posters) and getting deployed once or twice, only to find out that I'm going to be forced to practice FP and get used and abused for the rest of my career...I love Christmas time. But, at least I know what's coming....maybe it's better to be blind and stupid than just plain stupid.

It's the same merry band of *****s you'll keep running into post after post. Only the buildings and uniforms change.

All the good assignments like Panama are gone. They've succesfully managed to turn the army into a lean mean misery machine.... for the families really, I really didn't care what physical location I was in and I was stuck in Hoenfels, Graf (permenent party no less), Wildflicken for two years once.

 

[alpha62]

I can't help but notice that many of the same people who comment on (1) the complete intelligence required to do the mundane tasks of a GMO, are also the same people who argue that (2) it is unsafe and inappropriate to have an internship-trained physician do the job instead of a BC/BE physician.

Why is that? If the job is so basic and requires so little thought, what's the big deal with any new-internship-grad going out to do it?

Agreed, as a PA working in GMO slots, the job was simple. The only real challange was the complete disconnect between the line and the so-called " experts" at the next level of care.

They seem to think they weren't in the army with the rest of us and that we served them, not the other way around. Really used to hack them off when they often found out my chain of command had more juice than their chain of command.

This was all garrison and occupation crap. The only good thing to come out of OIF is hopefully that's all a thing of the past with a fresh dose of reality for everyone concerned.

 

[Mirror Form]

I can't help but notice that many of the same people who comment on (1) the complete intelligence required to do the mundane tasks of a GMO, are also the same people who argue that (2) it is unsafe and inappropriate to have an internship-trained physician do the job instead of a BC/BE physician.

Why is that? If the job is so basic and requires so little thought, what's the big deal with any new-internship-grad going out to do it?

B/c just b/c the vast majority of what you see isn't acute, doesn't mean there won't be rare exceptions. Here's one example, a special forces soldier made it 3 days in the woods with a pneumothorax. Too bad he was then murdered by the GMO who put a chest tube into his liver. I've never heard of a US IM board certified (or FP board certified) physician killing somebody that way.

 

[BomberDoc]

They seem to think they weren't in the army with the rest of us and that we served them, not the other way around. Really used to hack them off when they often found out my chain of command had more juice than their chain of command.

A wise, cranky old doc told me once that the medgroup weenies think DoD stands for Department of Dependantcare. They think the military is medicine first and killing bad guys second.

As an operational doc working for a line unit, I get a little more perspective than the people who have never set foot outside of an MTF. The guys who run combat units still call the shots. Be sure to remind the nurse nazis of that once in a while.

 

[pgg]

But you can't have it both ways. You can't say that, "GMOs aren't competent to run medical care for a unit on their own", then turn around and talk about what a waste it is to stick the residency-trained docs in the same jobs. It's got to be one or the other, or get rid of docs entirely and replace them with IDCs.

No, but you can say that a BC physician would be wasted at the battalion level, and that battalion level PAs supervised by a BC physician at the regiment level would be appropriate.

funny thing I noticed about PAs in the military, we're always not qualified to provide care, unless it's to replace an MD in a really crappy assignment they're trying to wiggle out of.

The reason they are crappy assignments for BC physicians is not because they are located in bad places, or because we have to hang out with grunts, or because they are associated with deployments. They're crappy assignments because the skills and knowledge acquired in residency atrophy.

An infantry battalion is a perfect environment for a midlevel to work, provided he has appropriate backup.

 

[The White Coat Investor]

Color me silly, but am I the only one that thinks complaining about the location of the program you're accepted to is silly? ... because it's going to be a long, long couple of years paying for your medical education.

You are correct, it is a long, long "couple of years" (total of 15). But seriously, it turns out location matters a lot more to me now than I thought it would when I signed on the dotted line. By the way, in the civilian match, location is often (if not always) the first (if not only) criterion by which residency programs are selected. So I hardly think it fair to say anyone who actually cares where they live for 3-5 years is a fool.

 

[Mirror Form]

Color me silly, but am I the only one that thinks complaining about the location of the program you're accepted to is silly? I can completely understand if your first choice is deferrment and JHU and you get jammed into Fort Bliss because the level of training is likely a little different; you should be peeved. However, being mad because the location is in a state that you don't want to live in says that you have ABSOLUTELY no idea what you've gotten yourself into. I am willing to bet that 93.457% of soldiers (et. al.) stationed at crapholes like Fort Irwin, Hohenfels, the most popular place in the Army located in LA (not the one in California), and not to mention Iraq, Afghanistan, Kosovo, Bosnia, etc. are completely disgruntled. In fact, with the exception of the 4 major MEDCENs and MAYBE Ft. Carson, you are going to live someplace you don't want to live. If you really thought the Army was going to keep you living where you want to live it is definitely time to turn off the alarm clock and crack the Folgers because it's going to be a long, long couple of years paying for your medical education.

But that's just me.

Well of course nobody should join the army thinking that they'll be able to live where they want to. However, we're NOT PAYING OFF OUR COMMITMENTS while we're stationed in these absolute sh*tholes (have you ever lived in some of these places? it's miserable). In fact, we get to rack up ADDITIONAL OBLIGATION TIME while being stationed in sh*tholes. So yeah, it's a bit different.

Before I got stationed where I did for my internship, I was never that concerned about location. I just didn't realize how important it was!

 

[mac61]

Wow, I really didn't know it was possible to get blasted for pointing out a major flaw in the Army; I miss Rob, at least his responses were verbose and entertaining.

Seriously, I didn't mean to stir up trouble. Everyone with experience here signed the line for different reasons, some more informed than others. The bottom line is that the not-so-hidden agenda of many of the "experienced" posters is to educate the masses and stop people from making the same ill-informed decisions that they made. Believe it or not, I'm trying to help that cause.

My point was: The military (match) will make you live where they need you to live. Although it is possible to influence this action, success is an objective concept. I have lived in SEVERAL of these places, have reenlisted to get out of these places only to be stop-lossed, deployed, and returned to said locale without enough time on my contract to move, thus sticking me for 2 (23mos) more years. If you expected anything more than this, you made an uninformed decision. My continued decision is informed, and I don't believe that makes me any wiser than anybody here, in fact possibly the opposite.

Although I'm pretty sure that no one accrues committment while simultaneously NOT working off thier current obligation, I agree that this system is NOT equal to the civilian match; then again military medicine is NOT THE SAME as civilian medicine. Similarly, not having the ability to control the environment in which you practice medicine and maintain your skills is controlled by the military which is NOT THE SAME as civilian medicine.

Again, if you are considering signing the line and you do not fully understand what you're getting into, spend more time in this forum and less time studying for the MCAT; you will make a better investment. If you DO understand, that you will have LITTLE TO NO CONTROL OVER YOUR LIFE, PROFESSIONAL AND OTHERWISE, come on in...the water's fine.

Again, my apologies. Back to GME discussion.

I miss MedicalCorpse...where did he go????

 

[SF49ers Fan]

Wow, I really didn't know it was possible to get blasted for pointing out a major flaw in the Army;

Again, my apologies. Back to GME discussion.

Don't apologize, you were right on the mark with your earlier message. If I read one more post from some poor crying slob about how the military "screwed" him/her over because they were matched to someplace they didn't like or to someplace their sig other/fiance' doesn't want to go, I may start stabbing my eyes out!!

Let me try and break it down for those thinking about the military as an option.

Military truisms:

1. The military does not conform itself to you, you conform to it. There are certain standards (hair cuts, PT, whatever..), for the most part, these are not negotiable. If you don't like someone telling you how to dress, look, or act. DO NOT JOIN THE MILITARY!

2. It's not always about you! Just because you did not get the location you desired, doesn't mean you got "screwed", it just means that for whatever reason the military needed a body in your billet and your name came up. Call it needs of the Navy/Army/AF or whatever. That's just the way it is.

3. It's all about attitude! This is true whatever you do. If you have a good attitude, it won't matter where you go, you will have a good time. I'll admit, sometimes this takes alot of willpower to tell yourself that you are having fun but it will be worth it if you are successful. Attitudes are also very infectious so keep yours positive. Nobody enjoys hearing you b!*ch all the time, so stop doing it.

4. The military deploys !!! This may come as a shocker but it's true. I lost count of how many people at this site are whining about deployments. That's just the way it is with todays environment. You may be one of the lucky ones and stay stateside, but don't count on it or expect it.

5. If you don't like your command, wait 5 minutes. The military is always changing people out and moving people. I was at my first command for nearly five years before transferring, and in that time I went through 3 CO's and 4 XO's and numerous department heads. Everyone had their own way of doing things. In short, if your life sucks be patient and refer to truism #3. You will eventually get transferred or deployed or the person above you will, and things will be different.

6. The military isn't perfect. Change what you can, don't worry about the rest.

 

[sethco]

I really like your truisms 49ers fan (BTW I would not be advertising that you are a 49ers fan, they really suck )

I too get pissed off reading about how people did not get the location that they wanted or did not get their #1 choice, however the AF GME system is built around a LIE.

When we signed the contract, we were informed that "96% get their first choice of SPECIALTY (not location) and 98% get either their first or second choice SPECIALTY". This is clearly not true and has been proven year after year. How else would anybody explain all the GMOs/FS when they have been supposedly "phasing these positions out" for the good part of the last decade?

 

[IgD]

Color me silly, but am I the only one that thinks complaining about the location of the program you're accepted to is silly?

I think we may be talking about apples and oranges. There is a larger issue than just the location you matched to. The professional standard is for the physician medical education pipeline is to match for a training set that includes internship and residency in a complete package. I think it is important for the military to have its own residency training programs but why should the military be any different? Is the definition of a doctor different in the military?