DO students saving military med

[Rudy]

If it were not for Osteopathic schools, military medicine would be dead. I have nothing against osteopathic schools or their students. I do, however, greatly dislike military medicine and the lies/partial truths that are told by recruiters. As has been posted before, the number of MD applicants has dropped significantly over the past several years. Now at least half of all HPSP applicants are DOs, greatly over-representing the overall proportion of DO students vs MD students graduating each year. The reasons for the attraction of DO students to mil med seem clear: 1) Most DO schools are private and expensive (significant debt concerns) and 2) Most DO students that I have known are interested in pursuing "MD" residencies, and there is a perception that some of the more competive specialties are easier for DO students to match into in the military than in the civilian sector.

My concern is that because of the above factors, DO students may be turning a blind eye to some of the serious problems with military medicine, and may therefore be joining for the wrong reasons. Further, if it were not for the "DO pipeline" military medicine would face a crippling shortage of physicians and may actually be forced to make some real changes in the way they do business (or close altogether and outsource more care to the civilian sector, which would be my choice).

Again, I have no problems with DO students. Most that I have met are hardworking, bright people. I just wish that they would stop flocking to mil med and stop helping to prop up a broken system that needs a severe overhaul.

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[R1krazy]

So do you offer a better solution for DO students? If the above reasons are not good enough for you what is one good reason that people on here would accept going into military med. If its to serve your country... how can you be sure a percent aren't doing it for that reason?

Is the system seem broken, from SDN it does seem that way. I dont have direct knowledge. I did work in the VA system for a bit, which was in ways similar (in structure), and it was a heck of a lot better than my civilian hospital jobs. So thats the only reference I have.

Overall, I have a problem with this post for blaming DO's, sure a good percentage is in military medicine, but the other percentage is MD. Im not sure what the point of this post was? To vent about DOs. Tell DO's suck it up and take the debt or the AOA residencies?

So if your going to spout of nonsense give SOLUTIONS not blame.

If you have no problem with DOs then why didnt you tell MDs to stop joining? Whats your evidence that "atleast half are DOs"?

 

[IgD]

I think it is an interesting observation that needs to be validated. I don't have any knowledge of the quality of USUHS applicants but logically the government could lower admission standards slightly to attract students. In exchange for a shot at a medical education those students sell their souls for a 7 year payback.

 

[R1krazy]

Lowering standards would not solve the apparent problem in military medicine. What solves the problem is people taking on accountability. Many who come on here and say how bad it is, are directly working in it who have the potential to do something about it. Yes I understand that Orders come down from above and the majority of time your hands are tied. But if the chance arises why not offer a solution.

Lowering standards would make the situation worse. There is already lower standards when you see barracks with holes, molds, and leaks so people complain. Same would happen with the health care system.

If you saying its an interesting observation that half are DO's and should be validated... it doesnt even matter b/c the other half is MD .... 1/2 DO + 1/2 MD = a whole military medical corp

 

[RugbyJC]

If it were not for Allopathic schools, military medicine would be dead. I have nothing against allopathic schools or their students.

The reasons for the attraction of MD students to mil med seem clear: 1) Most MD schools are private and expensive (significant debt concerns) and 2) Most MD students that I have known are interested in pursuing "MD" residencies, and there is a perception that some of the more competive specialties are easier for MD students to match into in the military than in the civilian sector.

My concern is that because of the above factors, MD students may be turning a blind eye to some of the serious problems with military medicine, and may therefore be joining for the wrong reasons. Further, if it were not for the "MD pipeline" military medicine would face a crippling shortage of physicians and may actually be forced to make some real changes in the way they do business (or close altogether and outsource more care to the civilian sector, which would be my choice).

Again, I have no problems with MD students. Most that I have met are hardworking, bright people. I just wish that they would stop flocking to mil med and stop helping to prop up a broken system that needs a severe overhaul.

 

[R1krazy]

 

[Rudy]

I wasn't intending this to be offensive. There is no question that DOs are significantly overrepresented in military med today. Just look at this board. Most HPSP students that post have osteopathic affiliation. Here is an article that has been posted before from a senior leader in mil med (former Navy Surgeon General). The article was written in 2003, but I imagine that things are similar today--though difficulties in recruiting have increased in the last couple of years.

http://www.usmedicine.com/column.cfm...147&issueID=56

Like some of the other active duty staff physicians that post on this board, I would NEVER have joined military med if I could go back in time. I regret that decision nearly every day. I marvel at the constant source of young pre-meds who, in various levels of naivete and misguided by recruiters, commit to sign on the dotted line in support of a sadly broken system. Some of us have learned through experience that the only time that the military makes real change is when forced by crisis(such as the recent decision to give huge retention bonuses to surgeons). If the pipeline of pre-med students were to dry up, maybe then mil med would have to make real change (or shut down, which would be my choice). So, if DOs only entered military med at a rate similar to MD students, the system would crash and there would be hope that this might obligate improvements.

 

[BomberDoc]

Guys, the DO/MD debate hasn't been relevant for years. It just doesn't matter anymore. They are different names for essentially the same degree and education. I'm sure somebody will get offended and tell me that OMT and the "holistic" approach are differences... fine. It still doesn't matter. The fact is that the military is using and abusing doctors of all flavors. We are like diapers. They s#it on us and throw us away because there is always another ready to take our place. I would love to see the pipeline of any and all medical professionals, MD/DO/PA/etc dry up and force the military to make some real changes in order to attract and retain quality people.

Here are some thoughts:

Start honoring the promises of autonomy and ability to practice medicine without some bean counter always looking over your shoulder.

Only let nurses command nurses. Physicians need to be led by other physicians.

We know you can't pay us what we're worth... but get closer. Increase the bonuses substantially, make them payable as monthly pays instead of the silly yearly lump sum that you have to apply for every year. Index the bonuses like base pay YEARLY, not every 1.5-2 decades. If you want us to make RVUs, pay us a production bonus like the civilian sector you try to model. If you really want docs to stick around, make the retirement based on total pay, not just base pay.

Protect us from doing days and days of computer based training for things that have absolutely no bearing on our jobs. Minimize or eliminate additional duties for physicians.

Get some ancillary support staff. Either grow more 4As/4Ns, or hire civilians. Let us be a part of the hiring decisions. Even better, let us get rid of useless/stupid/ineffective techs/nurses/etc.

The list goes on and on, but my patience does not.

 

[Founder]

This is strange.

Here we have experienced physicians in the military telling us (current students) the system is broken and not to join. All the competent physicians are leaving. And of course on the internet everyone is at the top of their specialty and knows more than God.

But here it is. We are told not to join, there is a severe lack of leadership and a severe lack of well... anything worthwhile. The system is broken. There are problems and I wont argue against someone who has been in the system for years and knows the problems and have seen the failure in milmed firsthand.

Yet... for all this complaining and all these observations, it always seems it is "not my fault!" that there are physician problems in retention leading to decrease care, problems with leadership, problems with everything.

Yet... no one complaining is actually willing to stay in and fix it but get out at the earliest opportunity. I think it is... uh... irresponsible (since the word I want to use is a bit stronger) for physicians to advocate that we as HPSP students or perspective HPSP students do not join to exacerbate the problem so milmed may do something. I guess all those military families being shat on while you go and do your little protest wont be affected. Advocating people to not join so milmed deteriorates to a point of uselessness is irresponsible and I'd like to know how you plan to at least attempt to keep military families healthy?

 

[endocardium]

This is strange.

Here we have experienced physicians in the military telling us (current students) the system is broken and not to join. All the competent physicians are leaving. And of course on the internet everyone is at the top of their specialty and knows more than God.

But here it is. We are told not to join, there is a severe lack of leadership and a severe lack of well... anything worthwhile. The system is broken. There are problems and I wont argue against someone who has been in the system for years and knows the problems and have seen the failure in milmed firsthand.

Yet... for all this complaining and all these observations, it always seems it is "not my fault!" that there are physician problems in retention leading to decrease care, problems with leadership, problems with everything.

Yet... no one complaining is actually willing to stay in and fix it but get out at the earliest opportunity. I think it is... uh... irresponsible (since the word I want to use is a bit stronger) for physicians to advocate that we as HPSP students or perspective HPSP students do not join to exacerbate the problem so milmed may do something. I guess all those military families being shat on while you go and do your little protest wont be affected. Advocating people to not join so milmed deteriorates to a point of uselessness is irresponsible and I'd like to know how you plan to at least attempt to keep military families healthy?

Very well said.

 

[colbgw02]

 

[haujun]

This is strange.

Here we have experienced physicians in the military telling us (current students) the system is broken and not to join. All the competent physicians are leaving. And of course on the internet everyone is at the top of their specialty and knows more than God.

But here it is. We are told not to join, there is a severe lack of leadership and a severe lack of well... anything worthwhile. The system is broken. There are problems and I wont argue against someone who has been in the system for years and knows the problems and have seen the failure in milmed firsthand.

Yet... for all this complaining and all these observations, it always seems it is "not my fault!" that there are physician problems in retention leading to decrease care, problems with leadership, problems with everything.

Yet... no one complaining is actually willing to stay in and fix it but get out at the earliest opportunity. I think it is... uh... irresponsible (since the word I want to use is a bit stronger) for physicians to advocate that we as HPSP students or perspective HPSP students do not join to exacerbate the problem so milmed may do something. I guess all those military families being shat on while you go and do your little protest wont be affected. Advocating people to not join so milmed deteriorates to a point of uselessness is irresponsible and I'd like to know how you plan to at least attempt to keep military families healthy?

I share your sentiment. IRAQ war will end someday and/or government will just increase the HPSP fringe benefits. Subsequently, enrollment of HPSP will pick up. MildMD, GALO, EX whateever military docs will balk and MD vs DO threads will continue. There is lack of progression in this SDN website...

 

[RugbyJC]

And of course on the internet everyone is at the top of their specialty and knows more than God.

Isn't that true?

I wonder if god went to a DO school or an MD school

 

[endocardium]

The idea that we don't provide good care is laughable, and not supported by my current experience.

Point taken. However, I think the main thrust of his post was that instead of shifting into blame and all the things associated with that modality, shift into taking responsibility. At least that's what I took from it.

 

[colbgw02]

I tend to agree with Tired about the quality of care.

I live and work in a relatively large city with many civilian hospitals. Furthermore, my wife is a civilian doctor, so I have exposure to both sides.

With the exception of a major trauma, which my military hospital doesn't handle and isn't equipped for, I would prefer to be treated at the MTF everyday of the week and twice on Sunday.

The stories that my wife tells about civilian access to care, particularly subspecialty care, are horrendous. It makes the care that the military beneficiaries get look like a trip to club-med.

Obviously, my experience isn't universal, but it's equally imprudent to paint a monolithic picture of poor military healthcare.

 

[pgg]

2) Retiree dependents get farmed out to civilian doctors. Yes, believe it or not, there are a lot of elderly dependents out there who are livid that they no longer get to see military doctors. I hear tons of complaints about the quality of care from the community physicians.

Just to play devil's advocate here, I'll point out that patients (in or out of the military) are notoriously poor at judging the quality of the care they receive.

Good care to a lay person is a short wait to be seen, one stick vs two for an IV, a friendly nurse. Superficial stuff that doesn't affect outcomes and really doesn't matter.

They don't know enough to judge the stuff that really matters: did they get the right antibiotic, was dad's ventilator set to appropriate tidal volumes, is their kid's asthma being managed optimally in accordance with current evidence.

I do think we deliver care that's at least on par with the civilian (albeit also academic) institutions I've gone to for out rotations. My experience has been good.

Of course the civilian institutions resist it, in order to milk as much Tricare money as they can.

You do realize that Tricare reimburses less than, well, every single other option out there, right?

The idea that we don't provide good care is laughable, and not supported by my current experience.

I agree. Others will, of course, retort that we're residents and still too wet behind the ears to make good judgments there.

 

[Founder]

Maybe I was misunderstood: The people advocating that we as students get out of the military ASAP or potential HPSP applicants not accept is what is bothering me. The reference to care was that if no one accepts HPSP or we all get out ASAP then who would care for the military families and members? I'm not questioning whether physicians try to provide the best care possible.

What is being advocated is to destroy milmed to such a point that it would force the bureaucracy to take measures to improve it. Because it is destroyed by physicians leaving left and right and no one accepting HPSP.

That is what is being advocated here. Sabotage the system so it is forced to change.

Instead why not those who are complaining and seem to feel so passionate about it stay in the military so they can reach a leadership position and fix what is wrong?

There is a lack of leadership and many just want to bitch about it without doing anything. Then they come in and tell people not to join the military, run away, get out, etc. That's horribly hypocritical and counterproductive.

 

[IgD]

Let me be the devil's advocate here. Suppose your friend is an alcoholic. Do you move into his house, build trust with him over several years and then finally succeed at convincing him to stop drinking? Or do you just cut him off and force him to change? The former is called enabling.

I think its clear especially by the comments on the healthy debates website that military medicine needs to go through a monumental rapid evolution process. If we try to prop it up by sacrificing ourselves are we hampering the process?

 

[Founder]

Except that doesn't really work with some organizations. Rapidly destroying milmed isn't going to force any quick changes because medicine, military, and bureaucracy are not quick.

If every doctor quit tomorrow I"d put all my blame on the doctors, not the system. Look at it from the perspective of a patient. You going to blame the system or the doctors for leaving? Even if you know the problem is the system, emotions almost always tend to override logic. And people get emotional if they don't think you care or they are being ignored or not given quality care.

 

[notdeadyet]

I hear tons of complaints about the quality of care from the community physicians.

When I rotate out in the civilian hospitals, we occassionally see military families, and almost every single one agitates to get send back to the military MTFs. Of course the civilian institutions resist it, in order to milk as much Tricare money as they can.

Doctors are queueing up to take Tricare about as much as they're chomping at the bit to take Medicare. The reimbursements from Tricare (time and amounts) are some of the worst going. Many docs won't deal with them.

One of the reasons folks might b!tch about the community physicians they're seeing is because they're seeing the ones desperate enough to take Tricare. Shouldn't be that way, but so it goes.

 

[notdeadyet]

Others will, of course, retort that we're residents and still too wet behind the ears to make good judgments there.

I have to be honest, I'm pretty interested in hearing what military attendings have to say. Nothing against med students and residents, but championing the quality of military medical care as you're still going through the training military medicine provides is kind of like the rookie in spring training claiming that his team is the best in the league.

Maybe someone can explain this one thing that doesn't add up for me:

Something like 95% of folks in milmed leave after their initial commitment is up. For most folks, this is between 4-7 years.

This tells me that the vast majority of military sugeons and specialists out there have a max of 4-7 years experience. If (god forbid) I were to have a critical surgery done, I'd sure like to have it done by the guy with 20 years experience, not 2.

So if most of your practitioners only have a few years of experience under their belts and most of those with more experience and stick it out are promoted to leadership positions which have less and less clinical time, I'd be curious how this can lead to wonderful patient care. Not talking about good bedside manner, good intentions, or good motivation, I just mean basic experience. If I were choosing an HMO and one of my options was one in which there were dozens of doctors, but none had been praticing for more than 5 years, I'd chuckle and keep looking.

 

[R1krazy]

I couldnt agree more with the direction this post has gone. This is NOT one of those stupid DO/MD debates, which i was trying to make a point of. My major point was hearing how bad it is by everyone running away from it instead of giving solutions better than dont join it was a big mistake. I have spoken face to face with 10 doctors who went through the military older ones and recent grads, who rave constantly about it. Saying the complete opposite of this forum.

This goes without saying one of the biggest decisions of our lives, so i hope many people get their info from more than one place.

I am hoping this forum could come up with ways the "NEW" HPSPers could be part of the solution rather than the problem.

 

[Rudy]

arguing against staff physicians who have spent 10+ of blood sweat and tears working and sacrificing on behalf of military troops, their families, and retirees. Yet whenever we raise honest criticism of the system that we work in EVERYDAY, we are attacked by overly defensive, holier-than-thou, and completely clueless medical students/pre-meds. Unbelievable.

Thank you notdeadyet, for your willingness to listen. You asked an excellent question regarding the lack of experience among military staff physicians. That is an excellent observation, as there is a definite lack of competent, middle and late career clinicians who are experienced enough to serve as mentors to young docs. Basically, what you have in military med are 3 categores of staff physicians:

1) Young physcians (capt/major) struggling to develop into competent, independent practicioners of medicine
2) Mid-career docs who were Academy/ROTC grads, or prior service, who have so much time in service that they are going to stick around for retirement.
3) Higher ranking docs, most of which are incompetent, afraid of practice in the civilian sector, lazy, abusive of leadership authority, and a detriment to the practice of medicine (Lt Col and above). There are a few exceptions to this, but not many.

Those of us in the first group are working our tails off for the patients we serve. Our patient population does deserve good care, and we work to achieve that in spite of the broken system and the obstacles put in our path by our "senior leadership". Yet you med studs are accusing us of not trying to champion change. All I can say to you is, wait 5-10 years after you have some experience and are in our shoes, then you will see. Please come back and share your experiences with us, and all of the great ideas you have in how to make this system better.

 

[notdeadyet]

Which is, of course, the major fallacy in basing your decision to accept the HPSP based on this forum.

Agree with this ^^^. Making a big decision like whether to take HPSP based solely on one web board is insane. You should ask around and get as many opinions as you can.

But for many of us, this can be hard. I don't know a lot of web communities that have as much milmed representation as SDN. The docs I've worked with in Hawaii at Tripler all bar one pretty much said "run" when I mentioned HPSP. Active duty friends I have have had mixed reports of their treatment under milmed, skewing towards dissatsified. Older vets I've worked with have loved it (though, granted, their alterantive was probably medicare/medicaid).

If anyone other than Rudy wants to address my point above, I'd love to hear it. I'm very much considering FAP in the future, but I just don't see how a system 95% composed of inexperienced to first stage phyiscians can be delivering this amazing quality care rivalling private sector. This is not a criticism of the physicians involved, just the system in place. I'm curious how milmed can succeed with the way it's positioned and prioritized.

 

[pgg]

But second, I think you underestimate the savy of patients today. With the rise of the internet, people are more and more involved in their own care, and are easily able to check their care against others'.

I'm dubious. I spent April in our (anesthesia) preop clinic talking to patients about their upcoming surgery. Many people don't know what drugs they're taking or why. The questions they ask, on the rare occasion when they actually have questions to ask, are usually irrelevancies ... often spurred by superficial media reports. For example, lots of people asked if they'd be awake but paralyzed and in agonizing pain during surgery. No one asked how their bad heart/lungs/kidneys/whatever would affect surgery.

On the day of their surgery, if their anesthesiologist has to stick them twice to get an IV, many will conclude they had a crappy anesthesiologist. If they survive to walk out of the hospital, and everyone was nice to them, that'll be all they need to conclude they had world class care.

Many of those "others" are ready-to-get-out GMOs. Obviously their experiences are superior to ours in terms of operation experience.

No way, I did my GMO time and deployments; the departing GMOs have less experience than me. I was referring to attendings, particularly the ones who've seen both military and civilian life, and the truth is they're right ... I'm sheltered from many of the problems that they say make practice in the military intolerable. I can't comment intelligently on their complaints, so I don't.

I'm very much considering FAP in the future, but I just don't see how a system 95% composed of inexperienced to first stage phyiscians can be delivering this amazing quality care rivalling private sector.

Many departments have a substantial number of civilian contractors who add both experience and departmental longevity. Hours/compensation for contractors generally seems to be competitive with local civilian options, so they get good people (ie, they're not FMGs with no other options).

 

[Founder]

arguing against staff physicians who have spent 10+ of blood sweat and tears working and sacrificing on behalf of military troops, their families, and retirees. Yet whenever we raise honest criticism of the system that we work in EVERYDAY, we are attacked by overly defensive, holier-than-thou, and completely clueless medical students/pre-meds. Unbelievable.

What you advocated was not honest criticism. The "honest criticism" I got from your post was to advocate something which is absurd. Yu hope the pipeline dries up so milmed would shut down. Even if this were the case it would not happen overnight and it doesn't take an Einstein to figure out it would result in a lot of problems for a long time.

Believe me I understand the concept of "long term" and that planning for the long term is far preferable to the short term. And I see what you advocate as beneficial in the long term. Except it is totally unrealistic in the short term because medicine isn't like... loosing weight. You can loose 100 pounds over two years, but you can't have milmed not exist for two years while the military figures out what to do.

And milmed wont be going anywhere. Bringing about "honest criticism" with "solutions" from left field really help no one. Such suggestions are so radical they help no one because they are not feasible. Completely gutting milmed is not feasible and advocating such serves no purpose.

And maybe I am acting a bit holier-than-thou and being an ignorant med student with no experience.

Yet it gets insanely tiring and annoying when people like me or those seeking HPSP and wanting to be in the military as physicians keep having to listen to the bull**** about how it is the worst ever, how your boss is the devil, and how you get screwed in the *** everyday. So if my annoyance is unfairly directed at you, I apologize. But the constant negativity I see in this forum regarding milmed certainly isn't helpful. Fully 99.99% of it is just downright nasty attacks with no answers.

I haven't decided if I want to go career, but if I do I'd like to be educated on the matter. I like coming to this forum so I can learn and be educated on the subject before becoming a full part of it. But nothing good is accomplished when all of us on HPSP just read negative comment after negative comment.

Yeah, milmed needs help. We get it. What we don't need are asinine threads like "40 reasons not to join".

 

[The White Coat Investor]

I think its clear especially by the comments on the healthy debates website that military medicine needs to go through a monumental rapid evolution process. If we try to prop it up by sacrificing ourselves are we hampering the process?

I refuse to hurt individual patients in order to change the system. I will do my best to shepherd them through the medical system we have to get the care they need and deserve. If that is what we mean by sacrificing ourselves, then I think most of us are hampering the process.

 

[IgD]

Except that doesn't really work with some organizations. Rapidly destroying milmed isn't going to force any quick changes because medicine, military, and bureaucracy are not quick.

If every doctor quit tomorrow I"d put all my blame on the doctors, not the system. Look at it from the perspective of a patient. You going to blame the system or the doctors for leaving? Even if you know the problem is the system, emotions almost always tend to override logic. And people get emotional if they don't think you care or they are being ignored or not given quality care.

It happens all the team in organizations at every level. The superstars quit and things take a turn for the worse. Then there are 2 possibilities: management is replaced or the organization falls apart.

Isn't this essentially what has been happening to military medicine especially over the past 4-5 years?

 

[IgD]

I refuse to hurt individual patients in order to change the system. I will do my best to shepherd them through the medical system we have to get the care they need and deserve. If that is what we mean by sacrificing ourselves, then I think most of us are hampering the process.

Totally agree with you here on the point about do no harm. My neighbor is an active duty physician who works from 0700-2200 because of a number of different problems. He has exhausted every avenue of trying to address the problems proactively and now has entered a stage of learned helplessness. He is literally sacrificing himself and his family to try help. If he signed up for another tour, wouldn't that enable the broken system to engage in the same behavior? His leaving after his contract expires may harm patients in some way. Are you saying he has an ethical obligation to stay on active duty?

 

[DredPiratRobrts]

Yeah, milmed needs help. We get it. What we don't need are asinine threads like "40 reasons not to join".

Agree.

 

[Galo]

Totally agree with you here on the point about do no harm. My neighbor is an active duty physician who works from 0700-2200 because of a number of different problems. He has exhausted every avenue of trying to address the problems proactively and now has entered a stage of learned helplessness. He is literally sacrificing himself and his family to try help. If he signed up for another tour, wouldn't that enable the broken system to engage in the same behavior? His leaving after his contract expires may harm patients in some way. Are you saying he has an ethical obligation to stay on active duty?

On point, but I'm afraid its not doing any good for a large number of people. This thread seems like the broken record that usually ends up between the cheerleader and I. The only difference is that the blind ones (read into that what you want) really believe their points, and are really convinced the attendings that post here to the contrary are must have had a bad deal, or are defective, non patriots, etc etc, the same old crap that even the one's that are currently on active duty use to denigrate our experience. Not to mention that reference was made to the recent Military Health System debate which was filled with the negatives we point out need to change from a variety of attendings from all different branches. Have these premeds, med students, and residents looked at it?? How do you oppose those views posted by multiple military physicians which were uniformly negative??

This story seemingly will continue to be played out till those people either see and experience it firsthand, and either choose to leave and do nothing, leave and warn others, or stay and attain power and become part of the problem. The suggestion of why don't you stay in and do something about it, comes from pure unadultered ignorance. All of us played that game, some better thatn others, but its a no win situation. All of the problems we talk about are so forcefully compounded, that there is absolutely no way to win if the system is not willing to change, and its not.

SO, time will tell. Its fun to take a back seat and watch the carnage sometimes. As many promised, I hope they report back when they are attendings. Till then, and after, I'm sure the # of reasons not to join will continue to grow.

 

[ieatpizza]

On point, but I'm afraid its not doing any good for a large number of people. This thread seems like the broken record that usually ends up between the cheerleader and I. The only difference is that the blind ones (read into that what you want) really believe their points, and are really convinced the attendings that post here to the contrary are must have had a bad deal, or are defective, non patriots, etc etc, the same old crap that even the one's that are currently on active duty use to denigrate our experience. Not to mention that reference was made to the recent Military Health System debate which was filled with the negatives we point out need to change from a variety of attendings from all different branches. Have these premeds, med students, and residents looked at it?? How do you oppose those views posted by multiple military physicians which were uniformly negative??

This story seemingly will continue to be played out till those people either see and experience it firsthand, and either choose to leave and do nothing, leave and warn others, or stay and attain power and become part of the problem. The suggestion of why don't you stay in and do something about it, comes from pure unadultered ignorance. All of us played that game, some better thatn others, but its a no win situation. All of the problems we talk about are so forcefully compounded, that there is absolutely no way to win if the system is not willing to change, and its not.

SO, time will tell. Its fun to take a back seat and watch the carnage sometimes. As many promised, I hope they report back when they are attendings. Till then, and after, I'm sure the # of reasons not to join will continue to grow.

I understand how some docs don't want to be part of a medical system that they believe is detrimental to patients and cannot be changed--that is fine. Of course it's unreasonable to expect someone to stay in and sacrifice so much to try to "fix" the system. But it's another thing to believe your dissent and anti-recruitment activities will somehow bring a revolution in the system. It's a rather irrational rationalization which borders on apocalyptic delusion, but the dreamers will dream. Some radical, crazy ideas do instigate revolutions, but most don't.

And "it's fun to take a back seat and watch the carnage sometimes"? That's sort of sick. Yes, let's all watch military medicine die and revel that we had predicted it.

 

[IgD]

...it's another thing to believe your dissent and anti-recruitment activities will somehow bring a revolution in the system. It's a rather irrational rationalization which borders on apocalyptic delusion, but the dreamers will dream. Some radical, crazy ideas do instigate revolutions, but most don't.

Seems to be working so far. Problems with recruiting and retention now have attention at the highest levels. What other bargaining chip do physicians have other than to leave? I envy your enthusiasm. Let me know what you think when you graduate internship, residency and your utilization tour.

 

[BomberDoc]

Seems to be working so far. Problems with recruiting and retention now have attention at the highest levels. What other bargaining chip do physicians have other than to leave? I envy your enthusiasm. Let me know what you think when you graduate internship, residency and your utilization tour.

I wonder if the highest levels have their hands tied, too. Ultimately it will be the Congress that decides whether military medicine is given a chance to succeed or if it will continue to suffer slow decay. Without money and manpower which Congress may or may not give, the decline will continue on as we physicians vote with our feet. The question is how many milmed docs have to leave before the system collapses. Will it be as soon as a few years when the unfilled pipeline of Army and Navy HPSP victims come of age and enter practice? Will the USAF be forced to shunt some of its docs to help the USA and USN shortage? Hell, it might take a decade or more for the weight of the system to overwhelm the trickle of new recruits. We know that leadership thinks very short term. They knew of the impending shortage of General Surgeons > 5 years ago, and only started worrying about it this year. Current leadership will be retired before the big collapse happens so why should they really care? I think that the highest levels of milmed leadership are blind or corrupt or more likely both.

 

[mitchconnie]

it's another thing to believe your dissent and anti-recruitment activities will somehow bring a revolution in the system. It's a rather irrational rationalization which borders on apocalyptic delusion, but the dreamers will dream. Some radical, crazy ideas do instigate revolutions, but most don't.

And "it's fun to take a back seat and watch the carnage sometimes"? That's sort of sick. Yes, let's all watch military medicine die and revel that we had predicted it.

I would like to point out that the current recruiting problems and physician shortages, which may or may not be related to “anti-recruiting,” have led directly to the only positive changes that I have seen the leadership make in my 12 years on Active duty. To wit:

1. A serious effort by the Navy to cut down on the use of GMO’s.
2. HPSP stipend increases and sign-on bonus that actually come close to covering your living expenses
3. A serious effort by the Air Force to increase compensation for surgeons to something near market level and retain some good people.

There has been no shortage of people making suggestions for positive change to the command. But nothing got done until the Army and Navy HPSP started filling at a rate of 60-75% and the AF noticed that they would only be 30% manned in general surgery--unmitigated disasters that would be on the front page of the New York Times if the effects weren’t delayed by four years.

And as far as I am concerned, the worst of the “carnage” has already occurred. 16 years ago I joined a comprehensive medical system which delivered care that was the equivalent of any civilian university hospital, was respected for quality GME, and attracted the best and brightest for a highly competitive scholarship program. Now I work in a system that is similar to, and possibly worse than, the VA—not particularly respected, not particularly high-quality, but mainly just limping along and “good enough for government work.” I doubt that it will get much worse.

 

[ieatpizza]

Seems to be working so far. Problems with recruiting and retention now have attention at the highest levels. What other bargaining chip do physicians have other than to leave? I envy your enthusiasm. Let me know what you think when you graduate internship, residency and your utilization tour.

Actually, I can see myself getting frustrated with the system and leaving it after doing everything I can. I'm not blaming anybody who is leaving the system. It's unrealistic to think that a doc should stay in, if his efforts to effect change are miniscule in the large scheme of things. But I also think it's unrealistic to think that dissent and anti-recruiting activities will somehow solve problems as well. I'm okay with people on this board educating potential applicants on the bad sides of HPSP and the military medical system because everyone should know what they're getting into, but some things people advocate here are a little ridiculous--like I said, bordering on delusional.

 

[ieatpizza]

I would like to point out that the current recruiting problems and physician shortages, which may or may not be related to "anti-recruiting," have led directly to the only positive changes that I have seen the leadership make in my 12 years on Active duty. To wit:

1. A serious effort by the Navy to cut down on the use of GMO's.
2. HPSP stipend increases and sign-on bonus that actually come close to covering your living expenses
3. A serious effort by the Air Force to increase compensation for surgeons to something near market level and retain some good people.

There has been no shortage of people making suggestions for positive change to the command. But nothing got done until the Army and Navy HPSP started filling at a rate of 60-75% and the AF noticed that they would only be 30% manned in general surgery--unmitigated disasters that would be on the front page of the New York Times if the effects weren't delayed by four years.

And as far as I am concerned, the worst of the "carnage" has already occurred. 16 years ago I joined a comprehensive medical system which delivered care that was the equivalent of any civilian university hospital, was respected for quality GME, and attracted the best and brightest for a highly competitive scholarship program. Now I work in a system that is similar to, and possibly worse than, the VA—not particularly respected, not particularly high-quality, but mainly just limping along and "good enough for government work." I doubt that it will get much worse.

Point taken. The poor retention and recruitment are resulting in some changes, but it's hard to believe that this is all because of the anti-recruiting as you noted (the war, perhaps?). I hope the worst of the "carnage" is over, too, and that these band-aids are followed up by real changes in the system.

Wow, I didn't know it was that much better 16 years ago.

Again, I think it's a good thing that potential recruits are getting the full picture here on SDN (just without the apocalyptic manifestos and reveling in the destruction of military health care).

 

[notdeadyet]

delete

 

[notdeadyet]

The poor retention and recruitment are resulting in some changes, but it's hard to believe that this is all because of the anti-recruiting as you noted (the war, perhaps?).

It's all anti-recuriting, at the end of the day, no? Whether folks are not taking HPSP because of they fear the war, the military or milmed, it still produces the same shortfall in recruiting. And it's the shortfall in recruiting that seems to be bringing about any positive change (bigger scholarships, less GMO, etc.) that mitchconnie is referring to.

So it makes sense that if you're looking to improve the system, and the system can be improved by getting less people to enter it via HPSP, then pointing out how the system is not working and getting people to not enter in via HPSP is a way to affect change.

 

[ieatpizza]

It's all anti-recuriting, at the end of the day, no? Whether folks are not taking HPSP because of they fear the war, the military or milmed, it still produces the same shortfall in recruiting. And it's the shortfall in recruiting that seems to be bringing about any positive change (bigger scholarships, less GMO, etc.) that mitchconnie is referring to.

So it makes sense that if you're looking to improve the system, and the system can be improved by getting less people to enter it via HPSP, then pointing out how the system is not working and getting people to not enter in via HPSP is a way to affect change.

Okay, you're right that it's all anti-recruiting in the end. And I was wrong to state that poor recruitment and poor retention cannot instigate change because it clearly has in some ways (whether substantial or not). I guess it bothers me when it seems people are hoping for carnage (statements like "it's sometimes fun to watch [it]" or "the military system must go down"). Is this truly effecting change? It seems to me that the carnage is more organic--a dysfunctional system (military medicine) and stresses on it (the war) don't need help from anti-cheerleaders (coined by me just now) to bring about its own demise.

 

[notdeadyet]

I guess it bothers me when it seems people are hoping for carnage (statements like "it's sometimes fun to watch [it]" or "the military system must go down").

Oh, I think I understand where they're coming from. Have you ever worked long and hard for what was ultimately a messed up organization? I remember working for the internet start-ups in the mid-90's and watched a couple companies I worked for absolutely implode. Spending money improperly, marketing that was all lies, unethical leadership, lack of vision/accountability, etc. Folks were running around trying to hold it together with no possibility of success.

When you get to that state, there's a certain sad enjoyment in watching the absurdity of the mayhem. You can't change the system so your options are to watch your blood pressure skyrocket as you bang your head against a brick wall or just to laugh-so-you-don't-cry. This is not unique to the military. It's not unique to the start-ups in the 1990s. Talk to folks who worked at GM in the 1980s or US Steel in the 1970s. These stories don't usually end well.

Don't read hate into the "It must go down" philosphy, read frustration.

It seems to me that the carnage is more organic--a dysfunctional system (military medicine) and stresses on it (the war) don't need help from anti-cheerleaders (coined by me just now) to bring about its own demise.

No, but if publicizing the dysfunction both helps bring about the change and (very importantly) saves some sap from not realizing what he's getting in to, why not?

 

[ieatpizza]

Oh, I think I understand where they're coming from. Have you ever worked long and hard for what was ultimately a messed up organization? I remember working for the internet start-ups in the mid-90's and watched a couple companies I worked for absolutely implode. Spending money improperly, marketing that was all lies, unethical leadership, lack of vision/accountability, etc. Folks were running around trying to hold it together with no possibility of success.

When you get to that state, there's a certain sad enjoyment in watching the absurdity of the mayhem. You can't change the system so your options are to watch your blood pressure skyrocket as you bang your head against a brick wall or just to laugh-so-you-don't-cry.

Don't read hate into the "It must go down" philosphy, read frustration.

No, but if publicizing the dysfunction both helps bring about the change and (very importantly) saves some sap from not realizing what he's getting in to, why not?

Thanks, notdeadyet. These are all very good points and I appreciate them. I hope the remarks I referred to are more out of frustration than out of vindictiveness. And I'll stop contributing to an endless cycle of the same arguments back and forth. I guess it's just a matter of a difference in philosophy on how to solve such a difficult, bureaucracy-laden problem. Perhaps both arms of attack are necessary.

 

[notdeadyet]

I hope the remarks I referred to are more out of frustration than out of vindictiveness. And I'll stop contributing to an endless cycle of the same arguments back and forth. I guess it's just a matter of a difference in philosophy on how to solve such a difficult, bureaucracy-laden problem. Perhaps both arms of attack are necessary.

No worries. And healthy debate is always a good thing. The only time it gets nasty on this point is from two camps. Folks that are so chewed up by the system that they're approaching burnout and can't see any value at all in what they do. And folks who have taken HPSP that feel insecure about the environment they haven't yet really been exposed to and react out of anger or (quite possibly) fear.

But either way, hearing experiences from folks who've walked the walk for a few years as military attendings is always welcome, whether they're pro-milmed or anti-milmed. Everyone elses opinions are just that.

 

[Galo]

Okay, you're right that it's all anti-recruiting in the end. And I was wrong to state that poor recruitment and poor retention cannot instigate change because it clearly has in some ways (whether substantial or not). I guess it bothers me when it seems people are hoping for carnage (statements like "it's sometimes fun to watch [it]" or "the military system must go down"). Is this truly effecting change? It seems to me that the carnage is more organic--a dysfunctional system (military medicine) and stresses on it (the war) don't need help from anti-cheerleaders (coined by me just now) to bring about its own demise.

Clearly you misundertood what I meant by "fun to watch". I have no joy in watching the military system destroy itself. I did not join it because I had some evil plot in my head that 12 yrs from the time I signed my papers, I would come into a system that was a mere shadow of what it was when I had investigated it, and that I would do everything in my power to take care of my patients to the best of my ability only to be continually frustrated, persecuted, and just barely getting to the state of the majority of my colleagues: learned helplessness.

I think its a horrible, and sad matter to watch a system that is supposed to give care to those who place their lives on the line, receive what I many times experienced very poor care often, but not always, subplanted by extraordinary efforts of physicians who were then often neglected, or even reprimanded.

So what is fun to watch is someone with no experience, (not sure what medical operational experience you've had?), argue with those who have lived it, with such fervent verocity, (thus the term cheerleader), and not get involved like I always end up doing. Why do I do it????????????????

I've said it before. I think its exceedingly important for people who have little to no information, and often misinformation from recruiters, or people who are part of the problem, get a view of what is actually happening in military medicine, and where in 5-10 yrs when they come into actual practice, what it may be like. I have no idea how much impact this forum has had. I know I've convinced a handful of people that at this point in time, mil med is probably not the best choice to start a medical career, yet, tons of people still sign up. I has to be a combination of war and other things, but its something that has been predicted for a long time. I truly feel we have terribly poor leadership, and a mentality that will likely never change. But on top of that, you have another layer of difficulty that someone else mentioned: Congress.

I always give the same advice. Talk to people who are in the system now, as many as you can. Know that there is a good chance that you will interupt your desired specialty and training, and never do it for money alone. If you understand all that, and you still want in, then best of luck, but be honorable enough to let others know if its something you would choose again, if you had the experience you will have.

 

[ieatpizza]

Clearly you misundertood what I meant by "fun to watch". I have no joy in watching the military system destroy itself. I did not join it because I had some evil plot in my head that 12 yrs from the time I signed my papers, I would come into a system that was a mere shadow of what it was when I had investigated it, and that I would do everything in my power to take care of my patients to the best of my ability only to be continually frustrated, persecuted, and just barely getting to the state of the majority of my colleagues: learned helplessness.

I think its a horrible, and sad matter to watch a system that is supposed to give care to those who place their lives on the line, receive what I many times experienced very poor care often, but not always, subplanted by extraordinary efforts of physicians who were then often neglected, or even reprimanded.

So what is fun to watch is someone with no experience, (not sure what medical operational experience you've had?), argue with those who have lived it, with such fervent verocity, (thus the term cheerleader), and not get involved like I always end up doing. Why do I do it????????????????

I've said it before. I think its exceedingly important for people who have little to no information, and often misinformation from recruiters, or people who are part of the problem, get a view of what is actually happening in military medicine, and where in 5-10 yrs when they come into actual practice, what it may be like. I have no idea how much impact this forum has had. I know I've convinced a handful of people that at this point in time, mil med is probably not the best choice to start a medical career, yet, tons of people still sign up. I has to be a combination of war and other things, but its something that has been predicted for a long time. I truly feel we have terribly poor leadership, and a mentality that will likely never change. But on top of that, you have another layer of difficulty that someone else mentioned: Congress.

I always give the same advice. Talk to people who are in the system now, as many as you can. Know that there is a good chance that you will interupt your desired specialty and training, and never do it for money alone. If you understand all that, and you still want in, then best of luck, but be honorable enough to let others know if its something you would choose again, if you had the experience you will have.

Thanks, Galo. It's clearly a misunderstanding. I understand that strong language is necessary to express the gravity of your message sometimes (especially on the Internet), but you have to understand that that post (and some other posts that I have read by you) do give an impression of vindictiveness, a level of which I think is sometimes unnecessary to communicate what you're trying to say.

And yes, it was interesting that Bomberdoc mentioned Congress as another barrier for military medicine. Currently, I, myself, have no plans to become involved in health policy despite my 9 year commitment to the Medical Corps post-residency (Academy + HPSP) because like many people here, I am interested in, first and foremost, being a clinician, so I can completely understand why it's unreasonable to think someone else should be obligated to get involved in policy and bureaucracy. How can this bureaucracy be penetrated? Who knows? I don't have any answers, but it's critical to recognize that it's going to have to happen at many different levels, and there's going to have to be some military leaders within the military health system who are radical and effective enough to cause some waves, that poor retention and recruitment can't do alone.

 

[Galo]

Thanks, Galo. It's clearly a misunderstanding. I understand that strong language is necessary to express the gravity of your message sometimes (especially on the Internet), but you have to understand that that post (and some other posts that I have read by you) do give an impression of vindictiveness, a level of which I think is sometimes unnecessary to communicate what you're trying to say.

And yes, it was interesting that Bomberdoc mentioned Congress as another barrier for military medicine. Currently, I, myself, have no plans to become involved in health policy despite my 9 year commitment to the Medical Corps post-residency (Academy + HPSP) because like many people here, I am interested in, first and foremost, being a clinician, so I can completely understand why it's unreasonable to think someone else should be obligated to get involved in policy and bureaucracy. How can this bureaucracy be penetrated? Who knows? I don't have any answers, but it's critical to recognize that it's going to have to happen at many different levels, and there's going to have to be some military leaders within the military health system who are radical and effective enough to cause some waves, that poor retention and recruitment can't do alone.

Yes, its going to have to be a multifactorial approach. Not to plagiarize one of my friends, but you can see his post on the military health debate, he considers this problem like a cancer that has to be attacked multiple ways. Us doing anti-recruiting, or really telling just the truth, the AF trying to give more money, the mention by the navy of decreasing GMO, etc etc, all are just parts of the treatment. Unfortunately, the real meat of it, the one from congress, and the mentality of the military system towards medicine, I don't think will happen.

Best of luck. I know a neurosurgeon in the same boat as you, and at this point in time he is been promoted to the consultant level, and likely an 0-5, but he is torn three ways from tuesday about his constant fight to do the right things. I hope he keeps it together as well as his family.

Best of luck.

 

[sethco]

My wife recently had a surgical procedure at a Navy hospital. After reading this message forum you would think she was going to die. However she was extremely pleased with the procedure and care she was received. I was present for the procedure and was very pleased with my interactions with the corpsman, nurses and surgeon. The ambulatory procedure unit was very clean and well organized.

The critics have some good points but they have chips on their shoulders. This forum is not representative of how most doctors in the military feel. They represent a small vocal minority.

orbitsurgMD, the reasons why readers should discount many of the opinions here is because of bias. Most of the critics have discussed personal motivations for making anti-military medicine remarks proving the bias. In fact if one looks closely at the critics posts here they can see a very clear pattern of trolling.

Seems to be working so far. Problems with recruiting and retention now have attention at the highest levels. What other bargaining chip do physicians have other than to leave? I envy your enthusiasm. Let me know what you think when you graduate internship, residency and your utilization tour.

These first 2 quotes were from IgD almost 2 years ago, while the last quote was from today.

All of you premeds/med students/residents/prior enlisted, please take note of IgD's change in POV over ONLY 2 years time!!! Please do not act like you know what you are talking about when you have not experienced it firsthand.

IgD, sorry for calling you out, but your posts serve as a very good example of how opinions change when you have a frame of reference. Would you be so kind as to share your story and what made you cahnge your tone?

 

[sethco]

I doubt that it will get much worse.

Please don't say that.

Murphy's Law: Just when you think things can't get any worse, they do.

 

[IgD]

IgD, sorry for calling you out, but your posts serve as a very good example of how opinions change when you have a frame of reference. Would you be so kind as to share your story and what made you cahnge your tone?

I will share my story when appropriate

 

[a1qwerty55]

Why do you accept their contention that military families aren't being well-cared for? I think that's the biggest bunch of nonsense that comes out of this board.

Of all the dependents I have cared for this year, I can count on one hand the number who don't want to be in the system (and those are usually the pregnant women who don't want military Ob care, for a lot of really excellent reasons).

In general, the two biggest complaints I hear are:

1) It took too long to get into a specialty clinic. But guess what? A 2-4 week wait is excellent in the civilian world. When my wife has needed to see her doctor on short notice, she usually has to wait 1-2 days.

2) Retiree dependents get farmed out to civilian doctors. Yes, believe it or not, there are a lot of elderly dependents out there who are livid that they no longer get to see military doctors. I hear tons of complaints about the quality of care from the community physicians.

When I rotate out in the civilian hospitals, we occassionally see military families, and almost every single one agitates to get send back to the military MTFs. Of course the civilian institutions resist it, in order to milk as much Tricare money as they can.

The idea that we don't provide good care is laughable, and not supported by my current experience.

Right on target. At my installation, a new suspected cancer in general gets evaluated, biopsied, imaged and has chemo or xrt flowing in a week or so. It just about never happens that quickly downtown. I have a family member - nonmilitary - recently diagnosed with a widely metastatic malignancy, 3 weeks since the bone mets, etc, were found, and to date, waiting on an Oncology appt, went to get his PET scan but there was "no order", his primary care doc can't see what the subspecialists are writing (no digital record). This is in a major US city, with very high quality insurance. Please don't tell me that at least at Army MEDCEN's we don't do a lot better. Plus what about a tumor board? MEDCENS usually have them. Whose your local private practice Oncologist going to confer with.

Care is excellent - at least at the subspecialty level, access to primary care is a problem, and the military's treatment of physicians is generally quite poor.

Again, this applies to the MEDCEN's, community hospitals are a totally different animal.