Did you moonlight on active duty? How many hours a week did you work?

[Beneath the marquee]

Also what branch/specialty

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[pgg]

I left in 2022. The norms may be different now. I did a lot of moonlighting from 2009 - 2022. Navy, anesthesia.

Some specialties (anesthesia, ER) are very conducive to moonlighting because they are fundamentally shift work without any need for continuity, and there's a lot of demand for intermittent and spotty shift coverage. Other specialties, it can be a real challenge just to FIND work that can mesh with your military job schedule.

It was extremely dependent upon duty station and circumstances.

At a small hospital where I was one of a four-person department, I was typically on call q3. I worked outside the Navy on most of my post-call days, and covered calls elsewhere on maybe 1/2 of the weekends. This generally worked out to 5 or 6 weekdays per month plus a couple weekends. I would also take leave occasionally to moonlight full time.

At a large MTF I took a lot less call because the dept was so much bigger, and as a consequence had a lot fewer post-call days. There, I was generally limited to moonlighting on leave and occasional weekends. For a while I arranged a moonlighting job that I could go to in the afternoons/evenings after a regular Navy day.

There were work hour limitations imposed by the Navy - generally 16 hours per week if not on leave, with mandatory 8 hour rest periods before Navy shifts. These rules were loosely enforced and many people skirted the edges here or even exceeded this. The only people I saw get burned were the dumb ones who'd schedule ODE pager call shifts right up to the start of their Navy shifts, and eventually lightning always struck.

Waivers to rules are possible and I asked for and was granted one by my CO at my last command. This is certainly not the norm, though reasonable requests can get a yes from the CO, particularly if you are (a) not a problem child already, (b) make a compelling skill maintenance argument, (c) have a plausible contingency plan for coverage with your dept if a conflict unexpectedly arises during a waiver period.

One of the biggest caveats you'll get to this moonlighting question is that your ability to do off-duty work is highly and unpredictably dependent upon who your dept chair, director, XO, and CO are. I have encountered a few who were openly hostile to the idea of moonlighting, and very much view your desire to moonlight as greed or disloyalty to the military or other negative character traits. Remember that while a lot of these "leaders" are physicians in the technical sense that they have medical degrees, some don't practice medicine any more and don't have the same care you do for case load and skill maintenance. If you have leaders who are nurses, be prepared for more open hostility - lots of the nurse-turned-administrator types resent physicians and may take very adversarial stances toward their minions (you). Be prepared for the possibility that ZERO moonlighting may be possible for extended periods of time.

Leave policies also have an effect. There are sane commands that will let you spend a day of leave to take an isolated Monday or Friday, and some will not permit you to combine weekend liberty and leave. Some commands will be OK with 5 charged days for a M-F, and some will insist you burn leave for the bookending weekends too. It can be arbitrary and sometimes seemingly malicious. Getting charged 5 vs 8 days for a "week" of leave can really impact the amount of time off you have. Someone has to OK your leave - there can be tremendous variability in that person's comfort level with staffing levels and spare capacity, so getting your time off can be trouble.

My last ~18 months on active duty I burned all of my accrued leave to moonlight. Took about a week off per month to moonlight. I felt I needed to do it in order to buff my caseload before joining a civilian practice full time. It worked out, but it was a grind.

 

[HighPriest]

I was eligible for moonlighting 2013-2017. ENT. I would generally have to take leave to do it, as it usually wasn’t available locally. So this meant 1-2 week stints. That’s not true everywhere, some larger centers you can find local work, but most places you have to take leave and drive or fly elsewhere.

This also usually meant working as many hours as possible when I did it, but how often was limited by how much leave I wanted to spend doing it. Usually 2 weeks a year or something.

 

[militaryPHYS]

No

 

[DrMetal]

No

Are you pleading the 5th?

 

[narcusprince]

I moonlighted a fair bit. Yes the money was nice but always let your public face show your doing it for skill sustainment. And keep your moonlighting between those that need to know.

 

[DrMetal]

your doing it for skill sustainment

and for good community civilian partnership.

 

[HighPriest]

I do agree with this. Get approval. I’ve seen situation where people did not and command pulled that privilege from everyone. Don’t be that guy.

But once they say yes, don’t say anything more than you have to to do the moonlighting. Fill out your leave paperwork, do the work, come back. Tell everyone you’re more competent. Leave it at that. I had a nurse commander once try to get my partner to do surgery we should not have been doing at our tiny $#!tstain “hospital” because he was doing it while moonlighting at a tertiary center. They don’t need to know.

Man. It’s been a minute since I last thought about the fact that I used to have to ask someone to go on vacation. Then fill out paperwork to do it. Then had to get my &&$king car examined by a dude who had been driving a total of 5 years to make sure it was “safe.” Then I used that time to make up for how poorly they paid me at my real job…..do not miss.

And foreign travel? Having to do four hours of wilderness survival training to go see my in-laws. Who live in a first world democracy…..

 

[pgg]

I do agree with this. Get approval. I’ve seen situation where people did not and command pulled that privilege from everyone. Don’t be that guy.

But once they say yes, don’t say anything more than you have to to do the moonlighting. Fill out your leave paperwork, do the work, come back. Tell everyone you’re more competent. Leave it at that. I had a nurse commander once try to get my partner to do surgery we should not have been doing at our tiny $#!tstain “hospital” because he was doing it while moonlighting at a tertiary center. They don’t need to know.

Man. It’s been a minute since I last thought about the fact that I used to have to ask someone to go on vacation. Then fill out paperwork to do it. Then had to get my &&$king car examined by a dude who had been driving a total of 5 years to make sure it was “safe.” Then I used that time to make up for how poorly they paid me at my real job…..do not miss.

And foreign travel? Having to do four hours of wilderness survival training to go see my in-laws. Who live in a first world democracy…..

Agreed, and for the love of god don't ever talk to anyone who isn't a physician you trust, in a private area, about compensation. No words about how much money you made over the weekend. No words about how the hourly rate was 4x your effective .mil rate. Not only is it rude and poor form, but it breeds resentment and people who resent you will undermine you and your permission to moonlight if given the chance.

Work, and STFU about it.


As for the hoop jumping to go on leave - there's always a story about someone screwing it up for everybody.

The most stridently anti-moonlighting middle-management roadblocker at one of my commands was a CRNA who missed movement on a ship because of a moonlighting shift.

Another one went to South America for a week without telling anyone ... while on house hunting TAD.

These are people who, if they did comparably dumb or dishonest things in the civilian world, would be fired or voted off the partnership island. But the military can't/won't fire anyone, so the policies have to account for the absolute dumbest and most irresponsible actions imaginable.


I still do get a laugh that you Army guys had to get your cars inspected by some E5 before going on vacation. At least that Good Idea Fairy never made it to the Navy. Once we got past our immediate leave approver, everything was pretty smooth.

 

[Apollyon]

who missed movement on a ship

My Dad was enlisted Navy over 65 years ago. He told me that the one, immutable thing that you can never, ever do is miss movement. He told me, "if you ain't got stars on your shoulder, they ain't sending a helicopter to get you!"

 

[DrMetal]

My Dad was enlisted Navy over 65 years ago. He told me that the one, immutable thing that you can never, ever do is miss movement.

Oh you sure can miss ship's movement in today's Navy. Just go to the ER the night before and claim SI. Nobody will kick you @$$ and make you get underway, everyone is so scared.

 

[militaryPHYS]

Are you pleading the 5th?

I don’t moonlight

 

[Correlate Clinically]

Absolutely, 100% concur about following the guidelines and being discrete. Never be the person who messes it up for everyone. Don't be that guy.

The rules may be annoying at times, but at least in the AF they are generally less restrictive than they used to be. How many extra hoops a given command makes you jump through can vary from base to base.

The amount of moonlighting varies by specialty and location (how hard it is to do part time work, demand, etc). In some specialties almost everyone moonlights, in others only a few.

Never get into details about compensation, except with another physician you trust. If at all possible, only discuss moonlighting in relation to readiness, skill sustainment, and trauma care. I tend to point out that the trauma cases I see are all from moonlighting, barring deployments.

 

[pgg]

I don’t moonlight

You're sports ortho. You've got plenty of work to do at the MTF, I assume. 🙂

I am a cardiac anesthesiologist. The only times I saw the inside of a chest between 2018 when we closed our cardiac surgery program and 2022 when I retired was when I was moonlighting.

 

[Chonal Atresia]

I do agree with this. Get approval. I’ve seen situation where people did not and command pulled that privilege from everyone. Don’t be that guy.

But once they say yes, don’t say anything more than you have to to do the moonlighting. Fill out your leave paperwork, do the work, come back. Tell everyone you’re more competent. Leave it at that. I had a nurse commander once try to get my partner to do surgery we should not have been doing at our tiny $#!tstain “hospital” because he was doing it while moonlighting at a tertiary center. They don’t need to know.

Man. It’s been a minute since I last thought about the fact that I used to have to ask someone to go on vacation. Then fill out paperwork to do it. Then had to get my &&$king car examined by a dude who had been driving a total of 5 years to make sure it was “safe.” Then I used that time to make up for how poorly they paid me at my real job…..do not miss.

And foreign travel? Having to do four hours of wilderness survival training to go see my in-laws. Who live in a first world democracy…..

This ^

Wonder why retention of physicians in the military at the end of their ADSO is well under10%?

I've been gone over 10 years and still can't believe I was ever subjected to this BS. This info is what should be presented to prospective med staudents.

 

[militaryPHYS]

The military isn’t the only employer who coordinates their employees leave time to ensure there is appropriate call/clinic coverage.

I have never had my car inspected in last 21 years of being in.

Wilderness survival is not a required foreign leave course. However there is required anti-terrorism training, country clearance and foreign travel briefings that have to be done because, well, there are stupid terrorists and also stupid employees who ruin it for everyone.

 

[militaryPHYS]

You're sports ortho. You've got plenty of work to do at the MTF, I assume. 🙂

I am a cardiac anesthesiologist. The only times I saw the inside of a chest between 2018 when we closed our cardiac surgery program and 2022 when I retired was when I was moonlighting.

I was just answering the OP question

 

[Chonal Atresia]

The military isn’t the only employer who coordinates their employees leave time to ensure there is appropriate call/clinic coverage.

I have never had my car inspected in last 21 years of being in.

Wilderness survival is not a required foreign leave course. However there is required anti-terrorism training, country clearance and foreign travel briefings that have to be done because, well, there are stupid terrorists and also stupid employees who ruin it for everyone.

Hate to break this to you but private hospitals/clinics do not work this way. They actually trust just a single department physician to ensure work/call coverage and come up with a schedule. No big brother requiring unnecessary paperwork, vehicle "checks" by E-3s and computer "wilderness" and "terrorist" training.

What a joke.....

 

[militaryPHYS]

Exactly. Departments still have to coordinate/approve leave.

Defending the country isn’t a joke

 

[pgg]

I was just answering the OP question

I know. You're just kind of judgmental of this discussion of moonlighting. There's a Marge Simpson brow-furrow and "Hhhhmmmmmmm!" coming across as you interject.

It's the kind of attitude I ran into occasionally on active duty. Some people felt that ODE was very much a privilege and threw up resistance or discouragement to those who needed it.


The twin issues of low income and skill maintenance / professional growth is by far the largest concern amongst active duty physicians. ODE goes a long way toward addressing that problem. The military benefits from it via better doctors and improved morale/retention.

My case load from a week of ODE typically exceeded the load I had at the MTF for the rest of the month put together, and a portion involved sicker patients and bigger surgeries. After our heart program closed, all of my cardiac caseload came from ODE.

The math I did when deciding to stay or go when my initial ADSO was up accounted for ODE. I would not have stayed if not for ODE narrowing the military-civilian pay gap.

The military should be encouraging and supporting ODE. It clearly recognizes the value of it, as it works to expand ERSAs and other civilian partnerships. The tragedy is that for the entirety of the 20 years I spent on AD as a physician, it fell to me to create those opportunities for myself, despite unnecessary and occasionally even malicious headwinds from the Navy.

Of course clinic/hospital coverage is important. (We can talk about the manning waste and inefficiency of MTFs if you like.) The overseas travel hoops are kind of silly and a minor inconvenience. The Army and AF were always somewhat worse about that than the Navy.

I'm in full agreement that the military needs to manage leave and other time away from the duty station in a way that doesn't compromise operational demands. I don't think you'll find any arguments to that point here.

 

[militaryPHYS]

I haven't said anything negative about it. I support all moonlighting for skill sustainment.

My other job is to help initiate MOU’s and moonlighting options for surgeons and physicians who don’t get the volume/complexity they need at the MTF.

 

[Chonal Atresia]

Exactly. Departments still have to coordinate/approve leave.

Defending the country isn’t a joke

Not what I said,

Your comment "for skill sustainment" is telling. Obvious how you view those that moonlight for extra money.

 

[HighPriest]

The military isn’t the only employer who coordinates their employees leave time to ensure there is appropriate call/clinic coverage.

I have never had my car inspected in last 21 years of being in.

Wilderness survival is not a required foreign leave course. However there is required anti-terrorism training, country clearance and foreign travel briefings that have to be done because, well, there are stupid terrorists and also stupid employees who ruin it for everyone.

I had to take a 4 hour long online SERE course to go to Japan.

This was in, probably, 2014?

And coordinating vacation is not the same as asking permission. Trust me, I’ve done both. That’s a false equivalency. You can say you don’t mind either, but it’s not the same.

And don’t get me wrong, I understand why you have to ask for leave in the military. Makes perfect sense. Still sucks to do it.

The survival training made very little sense, however.

 

[pgg]

I haven't said anything negative about it. I support all moonlighting for skill sustainment.

My brother in nautical combat, I saw your deleted post upthread before you thought better and erased it.

Would you like to undelete it so we can discuss that comment?

My other job is to help initiate MOU’s and moonlighting options for surgeons and physicians who don’t get the volume/complexity they need at the MTF.

Excellent.

In 2018 I was looking for cardiac cases, and had an invitation from a former Navy doc to come help out at a VA hospital where he was working. I had to conjure a MOU myself, route it through our legal dept, route it through the VA's legal dept, deconflict their edits, campaign for approval through my DSS and XO, then coordinate the VA credentialing process, background checks, medical exam on my post-call days. I considered the fact that I was permitted to do so at all to be a win.

To my dept chair's credit, he was very supportive of my requests for TAD to go there. It worked out for a while, but unfortunately the VA didn't really have enough volume for their own CT anesthesiologists, so I had to share cases with another anesthesiologist when I was there. The exposure was better than nothing, but eventually I quit going to the VA and fell back on ordinary moonlighting where I could be fully responsible for my own cases.

I wish someone with your job had been around then to help. I'm genuinely glad to see there's better institutional support for that now.

 

[militaryPHYS]

It was deleted for a reason. I mistakenly generalized and allowed my history with all of you to get the better of my phrasing.

However, the point within it about MTF access to care and productivity is real. It’s true that one person can ruin it for the rest of us. Unfortunately there are multiple persons just within my own department who I know either abuse the privilege or inflated their lifestyle so much that if they don’t moonlight (I.e. required deployments or training) their family will be in a tight spot. Many consider it their real job when they still wear a uniform or are a core faculty for their program.

But I know not all people do that. Unfortunately there are many. I’m sure most are using it for skill sustainment and not just the money so I have to remind myself of that. I fully support it when it is used for the right reasons and comes second to the commitment someone signed up for.

 

[pgg]

It was deleted for a reason. I mistakenly generalized and allowed my history with all of you to get the better of my phrasing.

However, the point within it about MTF access to care and productivity is real.

It really isn't though. People moonlight on liberty or leave time. It doesn't impact their case load or availability at the MTF. The very idea is kind of bizarre - one of the primary reasons for moonlighting in the first place is lack of clinical work to do at the MTF.

Yours is a core line of the faulty reasoning I heard many times from people who threw up ODE roadblocks. I believe it stems from an underlying resentment from non-moonlighters that the moonlighters were getting something they didn't need or didn't deserve.

It came more commonly from specialties that had structural difficulties moonlighting - the primary care physicians who didn't have plentiful options for isolated shift work the way anesthesiologists, EM docs, radiologists, and surgeons usually do. This is a big reason I advise people to be discreet about their ODE. Resentment (jealousy) is real from some quarters.

It’s true that one person can ruin it for the rest of us. Unfortunately there are multiple persons just within my own department who I know either abuse the privilege or inflated their lifestyle so much that if they don’t moonlight (I.e. required deployments or training) their family will be in a tight spot. Many consider it their real job when they still wear a uniform or are a core faculty for their program.

How are they abusing the privilege, and how does it impact the MTF? Are they missing shifts or calling out sick (lying) to work elsewhere? Do you feel like they're too tired to be effective, because they're working elsewhere?

If you have people violating rules or policies in a way that makes them unavailable for their .mil shifts, that's a problem. Fortunately, there's an easy solution that only needs to impact the person in question.

But I know not all people do that. Unfortunately there are many. I’m sure most are using it for skill sustainment and not just the money so I have to remind myself of that. I fully support it when it is used for the right reasons and comes second to the commitment someone signed up for.

We'll just have to agree to disagree on this point. I don't look down on anyone who chooses to work for extra money. I don't quite have a Benjamin Franklin level work ethic and devotion to personal industry, but I admire it in others.

Anyway. Even if some people are choosing to work just for the money why does that bother you?

Maybe they, like me, factored in ODE income as part of the calculus that justified staying on active duty vs getting out. Absent the opportunity to work off duty and supplement my Navy income, I would have not stayed on active duty past my ADSO.

It's certainly foolish for an AD physician to inflate their lifestyles to the point that ODE is necessary to support it. In general terms, whatever the cause, the stress of debt can impact anyone's work. This is as true of the E4 who moonlights at Taco Bell to make payments on the Mustang he bought at 28% APR, as the physician who moonlights at Sentara to make payments on the his-her BMWs in the driveway.

Some people think the problem in these scenarios is the ODE. I think that's silly, and it bothered me when I encountered people in the ODE approval chain who felt that way.

 

[militaryPHYS]

I have no resentment. I have no faulty reasoning. I am talking about things I see currently. Early Fridays or no Friday at all to travel to ODE sites for the weekend is the usual one.

Perhaps you assume everyone is as good a steward of the government’s time as you and quickly jump down the throat of anyone trying to come in and have a discussion about it.

Also, never said anything about being bothered if people work just for the money. It only matters if and when the commitment at the MTF is in question. If someone needs to maintain their skills and is busting their butt to do it and the MTF program is suffering because of it, well what good is that surgeon without the right reps/complexity? Cant really say the same about doing it to fund a vacation home or something else.

 

[pgg]

Early Fridays or no Friday at all to travel to ODE sites for the weekend is the usual one.

Unless the individual isn't working a week's FTE on the other days of the week, that sounds like it's not authorized liberty. ODE during designated military work hours (whether on Friday or another day) sounds like fraud to me and something that the command ought to take an interest in. Our legal dept discussed this specifically in the context of paid outside employment while on cost or no-cost TAD, and even "skill maintenance" wasn't deemed sufficient justification to permit it.

Work a regular Navy day for Navy pay at a civilian hospital as part of an ERSA = OK

Work a regular Navy day for civilian pay at the same civilian hospital for "skill maintenance" = not OK

If you've got people in positions of power (i.e. those with scheduling authority) colluding to give themselves and their buddies time off that isn't available to everyone, that's abusive and inappropriate.

But that's not a problem to attribute to ODE. It's just garden variety fraud waste and abuse.


There are ways this can work and can be above board. We would give compensatory liberty days to people after some types of weekend call shifts. If someone does 24 hours in the hospital on Saturday it's completely reasonable to give them a Friday off, because they'd be well over 40 hours for the week. What they did on their Friday (or Monday, or whatever) off was their business. Not everybody was moonlighting, but everybody got these comp days.

 

[militaryPHYS]

But that's not a problem to attribute to ODE. It's just garden variety fraud waste and abuse.

Agree. ODE not the problem. Misuse of it is.

 

[flightdoc09]

I still do get a laugh that you Army guys had to get your cars inspected by some E5 before going on vacation. At least that Good Idea Fairy never made it to the Navy.

I'm pretty sure I remember this happening to junior enlisted when I was with the Marines. Can't remember if it was junior corpsmen, or junior marines that had to get their vehicle inspected though. Or maybe I'm misremembering something.

Oh you sure can miss ship's movement in today's Navy. Just go to the ER the night before and claim SI. Nobody will kick you @$$ and make you get underway, everyone is so scared.

Can confirm. You do anything dumb, just go to the ER and claim SI, or that someone slipped drugs in your drink, or whatever. No CO wants to take on liability of someone hurting themselves.

Wonder why retention of physicians in the military at the end of their ADSO is well under10%?

I've been gone over 10 years and still can't believe I was ever subjected to this BS.

Is it really less than 10%? That's crazy.

And yeah, there are times when I just want to go driving outside of the liberty radius when I've got a few days off, and I can't believe that as an adult, in my 30's, that is a physician, I have to fill out paperwork well in advance to make sure it gets routed and signed in time so I can officially go out of town.

I had to take a 4 hour long online SERE course to go to Japan.

Can confirm. OCONUS travel still requires this for most places, as far as I'm aware. At least while I've been attached to USMC commands.

 

[DrMetal]

No CO wants to take on liability of someone hurting themselves.

If a major war occurs, and we lose, this will be noted as the greatest travesty of the American military: that the Commanding Officer of a warfighting unit is more concerned with liability than lethality.

 

[flightdoc09]

If a major war occurs, and we lose, this will be noted as the greatest travesty of the American military: that the Commanding Officer of a warfighting unit is more concerned with liability than lethality.

Definitely. I frequently have this conversation with colleagues. I'm pretty sure China or Russia doesn't give a crap about a soldier/sailor/marine that says "if you deploy me I'll kill myself." In fact, I bet they know not to say something like that because they'll not only get deployed anyways, but they'll have the SI beaten out of them first. Like, if you're Russian of fighting age right now, and you don't want to deploy to Ukraine, you better actually cut off your foot or something. Otherwise you're going. No malingering allowed.

I kid you not. I was once out in town, eating somewhere, and I remember overhearing a group of young sailors talking. One of them told the others "if you're feeling too stressed out, just go to the Naval hospital and tell them you think you want to hurt yourself. And if they ask if you feel safe going home, tell them no. Then they have to keep you."

I'd be willing to bet if we did a better job of administratively separating these individuals for failure to adapt, and taking away their free paycheck, this would stop.

Anyways, I could give a lot of stories, but getting way off topic.

 

[HighPriest]

Like, if you're Russian of fighting age right now, and you don't want to deploy to Ukraine, you better actually cut off your foot or something. Otherwise you're going. No malingering allowed.

Do not need foot to fire rifle or load tank, comrade.

In fact, less rations, lighter weight, cannot desert. Is good.

 

[pgg]

If a major war occurs, and we lose, this will be noted as the greatest travesty of the American military: that the Commanding Officer of a warfighting unit is more concerned with liability than lethality.

Well

Let's not get too carried away.

Policy in peacetime doesn't/won't necessarily reflect policy in wartime.

Sure there are readiness and "train like you fight" issues to be aware of, but I wouldn't assume or expect that a CO who says "**** it leave that guy behind" when someone acts out prior to a an exercise or peacetime deployment would do the same under other circumstances.

Indeed, lethality is probably enhanced by leaving those screwups behind.

My first USMC deployment, I rec'd that we leave some pending psych cases behind. CO didn't want to set a bad example by giving in to lazy or cowardly Marines, so he brought them along. They caused all kinds of problems and we ended up sending a few home early. Second deployment with that CO, I gave him my recs for Marines to leave behind (19 of them I think?) and he left them. No problems on deployment ... until we got one of the problem Marines as a combat replacement. Sometimes less is more.

If there's a problem it's at the recruiting end letting unfit people into service in the first place, not the COs who don't have the patience to "fix" them.

Admin separations are underutilized.

 

[xffan624]

Well

Let's not get too carried away.

Policy in peacetime doesn't/won't necessarily reflect policy in wartime.

Sure there are readiness and "train like you fight" issues to be aware of, but I wouldn't assume or expect that a CO who says "**** it leave that guy behind" when someone acts out prior to a an exercise or peacetime deployment would do the same under other circumstances.

Indeed, lethality is probably enhanced by leaving those screwups behind.

My first USMC deployment, I rec'd that we leave some pending psych cases behind. CO didn't want to set a bad example by giving in to lazy or cowardly Marines, so he brought them along. They caused all kinds of problems and we ended up sending a few home early. Second deployment with that CO, I gave him my recs for Marines to leave behind (19 of them I think?) and he left them. No problems on deployment ... until we got one of the problem Marines as a combat replacement. Sometimes less is more.

If there's a problem it's at the recruiting end letting unfit people into service in the first place, not the COs who don't have the patience to "fix" them.

Admin separations are underutilized.

During my deployment in Iraq in 2009-10 out of unit of 4,000 soldiers, we lost 3 soldiers to suicide. We lost only one to combat action. I wish we'd done a better job screening and keeping those soldiers home, maybe they'd still be with their families today. There's no leeway for stressors (either internal or external) over there, and they are basically walking around with the means to kill yourself with a trigger pull all day long.