Do you see military medicine improving?

[Randomstudent66]

So I've been going through this forum for a few months now, although I'm a naive high school senior graduating soon I'm interested in the idea of military medicine.

I'd like to serve my country in the future and I'd also like to be a doctor so obviously military medicine would seem like a viable option. My family isn't incredibly rich so I would probably go for an HPSP scholarship if I were to decide to join the military.

Anyway after reading through this forum I'm noticing the sheer volume of people who are saying military medicine is in a very bad place. Honestly, I think I'd be okay with the moving around and the constant orders and the military owning me (although this will probably change as I get more life experience) but the idea of skill atrophy is truly horrifying.

If military medicine would increase the chances of atrophy it would be a serious negative for me. I don't think my desire to serve is greater than my desire to be the best doctor I can be (not to say that any of you aren't amazing doctors, I do truly respect the work you all do but this forum has made me aware of the realities of atrophy)

I was very much interested in making a career out of military medicine (Being able to serve your country and be a doctor without being buried in a mountain of debt seems like a win-win) unti discovering this forum and learning about how messed up the system actually is.

There are some other negatives discussing me from enlisting but I won't go into those. As of now I don't think military medicine is for me but I will definitely revisit this decision during my undergrad when I'm applying for med school. I know I'm just a high school senior who is in a pool of premeds who will probably not even apply to med school but I think my question is valid.

Do you see the system of military medicine and the way military physicians are treated improving in the next 8-10 years?

Thanks for your replies and thank you for your service!

---

Members don't see this ad.

 

[pgg]

Too hard to predict. One thing that won't change is that a military doctor's experience will be service dependent, specialty dependent, and location dependent.

The only thing a HS student who is thinking about medical school should really do now is avoid a service academy or ROTC, and get As in school. Revisit HPSP in a few years.

Kudos for looking ahead but there are only headaches to be gained from staring too hard into fog this thick.

 

[armyvascsurg]

Yes, skill atrophy from low volume and low acuity is a huge problem. Obviously, it primarily affects surgeons and non-surgeon proceduralists. Primary care will always have plenty of volume but acuity can be an issue. Specialties with the best outlook in the military IMHO: family practice, sports medicine, OB, aviation medicine

 

[orbitsurgMD]

. . . and ortho, to a certain degree, although you won't be doing many total joints.

Unless there is a war, or unless the medical departments are completely revised and retirees are brought back into the panels, there won't be any big changes coming. Budgetary pressures on medical will likely continue, although sooner or later, someone who comes to the office to do actual work will realize what a huge number of chair warmers there are in the non-clinical side of the enterprise and actually do something substantial about that. A lot of nurse corps 0-5s will be hating life, but c'est la vie.

 

[HighPriest]

I don’t see skill atrophy ever becoming a non-issue.
Four things would all need to happen:

1. Massive increase in funding. Enough so that mid-sized facilities don’t balk at providing appropriate nursing coverage, OR time, etc.

2. Significant push to move VA patients into the military system and away from civilian care. Or, a push to seat military physicians in VA facilities part time.

3. Closure of small MTFs, or frequent rotation of senior surgeons to small MTFs with regular turnover. Make the small MTFs short, stepping-stone stations on the way to real facilities.

4. Actual attention and interest by leadership with regards to skill maintenance. They have to actually think it’s important, and worth putting time and effort into maintaining. Not just lip service.

The problem is that you could always see increased funding if we have another major war, but that funding will get primarily absorbed by the large MEDCENs first, and help smaller facilities less. Plus, that would mean increased deployments, and generally speaking people just aren’t maintaining their skills while deployed, with some exceptions of course. If all of this happened, there’s be less interest in taking care of the VA. People only think about VA care when there’s no serious fighting overseas, and things CONUS are slow, but then there’s no money. It’s -possible- that an insightful politician could realize that be funneling patients and money from the Veterans Administration to the DoD, earmarked for veterans care, they’d actually save money and provide better care, but that will never happen. Too much red tape and too many palms getting greased.
They’ll never rapidly rotate into/out of small MTFs because instead of stationing most people based upon needs of the service, they’re stationed based upon seniority and nepotism. At least, they sure as hell were in Army ENT. So you’ll never send an O-5 who’s been at Tripler for 9 years to Fairbanks, AK because he’ll throw a fit. Instead, they send some poor kid out of residency so he can watch his hard work melt away.

It’s a real Ouroboros.

 

[Randomstudent66]

I don’t see skill atrophy ever becoming a non-issue.
Four things would all need to happen:

1. Massive increase in funding. Enough so that mid-sized facilities don’t balk at providing appropriate nursing coverage, OR time, etc.

2. Significant push to move VA patients into the military system and away from civilian care. Or, a push to seat military physicians in VA facilities part time.

3. Closure of small MTFs, or frequent rotation of senior surgeons to small MTFs with regular turnover. Make the small MTFs short, stepping-stone stations on the way to real facilities.

4. Actual attention and interest by leadership with regards to skill maintenance. They have to actually think it’s important, and worth putting time and effort into maintaining. Not just lip service.

The problem is that you could always see increased funding if we have another major war, but that funding will get primarily absorbed by the large MEDCENs first, and help smaller facilities less. Plus, that would mean increased deployments, and generally speaking people just aren’t maintaining their skills while deployed, with some exceptions of course. If all of this happened, there’s be less interest in taking care of the VA. People only think about VA care when there’s no serious fighting overseas, and things CONUS are slow, but then there’s no money. It’s -possible- that an insightful politician could realize that be funneling patients and money from the Veterans Administration to the DoD, earmarked for veterans care, they’d actually save money and provide better care, but that will never happen. Too much red tape and too many palms getting greased.
They’ll never rapidly rotate into/out of small MTFs because instead of stationing most people based upon needs of the service, they’re stationed based upon seniority and nepotism. At least, they sure as hell were in Army ENT. So you’ll never send an O-5 who’s been at Tripler for 9 years to Fairbanks, AK because he’ll throw a fit. Instead, they send some poor kid out of residency so he can watch his hard work melt away.

It’s a real Ouroboros.

It seems pretty sad that after all that work and training all you get to do is sit and watch your skills wither away...

 

[Randomstudent66]

. . . and ortho, to a certain degree, although you won't be doing many total joints.

Unless there is a war, or unless the medical departments are completely revised and retirees are brought back into the panels, there won't be any big changes coming. Budgetary pressures on medical will likely continue, although sooner or later, someone who comes to the office to do actual work will realize what a huge number of chair warmers there are in the non-clinical side of the enterprise and actually do something substantial about that. A lot of nurse corps 0-5s will be hating life, but c'est la vie.

Although i definetely dont hope for a war, I do hope that something happens for the sake of the doctors who forego civilian life to serve.

Do you think that changes will occur if less people decide to go the military medicine route leaving those in charge to wonder what went wrong? (I doubt this is very likely with tuition and debt increasing every year, alot of people would do anything to avoid 250k in student loans)

 

[Randomstudent66]

Too hard to predict. One thing that won't change is that a military doctor's experience will be service dependent, specialty dependent, and location dependent.

The only thing a HS student who is thinking about medical school should really do now is avoid a service academy or ROTC, and get As in school. Revisit HPSP in a few years.

Kudos for looking ahead but there are only headaches to be gained from staring too hard into fog this thick.

Oh I definitely will continue to work hard so I can get into med school. But after reading these forums I just would like to know how I can help.

Perhaps referring others here or educating others about the situation our military doctors are in (although I am FAR from an expert about this and probably know very little) mabye even calling my senator and talking to him about the issue.

I just think there must be a serious problem if so many doc's are getting out as soon as possible with such a negative view on the organization.

 

[HighPriest]

Although i definetely dont hope for a war, I do hope that something happens for the sake of the doctors who forego civilian life to serve.

Do you think that changes will occur if less people decide to go the military medicine route leaving those in charge to wonder what went wrong? (I doubt this is very likely with tuition and debt increasing every year, alot of people would do anything to avoid 250k in student loans)

The military doesn’t do anything for the sake of anyone. That’s not it’s mission.
If they thought a physician problem was truly damaging it’s fighting ability, directly, it would garner attention. But that’s also unlikely. And I agree, there will always be meat for the machine due to tuition. Maybe if Bernie gets elected and makes school free for everyone, and ice cream trees in every back yard, HPSP will go away. But to do that, he’d have to either dramatically raise taxes and ration University time, or slash military budgets down to 1-3%, like other socialist countries, so it’s a wash in my book.

 

[pgg]

I just think there must be a serious problem if so many doc's are getting out as soon as possible with such a negative view on the organization.

Depends on how you define "problem" -

If the purpose of the Medical Corps is to have a sufficient number of licensed physicians on active duty to meet the military's operational needs, there is no "problem" as long as the recruitment pipeline (mainly HPSP) remains full enough to offset the physicians who leave service when their initial period of obligated service is up. It doesn't really matter if the departing physicians are happy or sad.

We've spent the last couple decades at war, with objectively excellent outcomes on the medical side. The survival rates for battlefield casualties have been nothing short of amazing. For lots of reasons, of course, but it's clear that physicians aren't a weak link. There are enough physicians in the pool, they are competent enough, and they have sufficient support to not be a liability to the military's primary mission of traveling to faraway places to kill people and break things.

Also, long term retention of physicians is an anti-goal of the military. Superficial (i.e. easy) analysis tells policymakers that a senior experienced physician doesn't fill an operational billet any better than a junior physician just out of residency, but the senior physician costs more. And retirement costs for career military personnel are astronomical.


Now - what's your argument for convincing Congress and senior military leaders, that there's a "serious problem"?

 

[militaryPHYS]

I just think there must be a serious problem if so many doc's are getting out as soon as possible with such a negative view on the organization.

"So many docs...with such a negative view" is your impression based on this forum (perhaps other avenues as well). It does not necessarily represent all military physicians. Just like any opinion-based forum, it is more common to hear from those with negative views than those with a positive experience. Seek out the people that are happy in military medicine to understand why they are happy to help you make a well-informed decision.

Back to the OP's original question...I do see the negative aspects of military medicine improving (acuity, case volume, etc), due to previously discussed NDAA2017 and the interim updates now that congress has set timelines and an implementation strategy. These changes can and will bring negative effects for certain people already in (those already specialized but seeking certain sub-specialization, those in less-demand fields like pediatrics, etc. who may see their population shrinking, and so on). Nobody knows what will happen in the next decade, but for new accessions milmed is not going anywhere and the recommendations remain the same: You must be flexible, you must understand the shortcomings of milmed, you must have some level of optimism and if you accept a scholarship you have to be willing to at least consider a career in the military as a potential option. If you don't meet those criteria then I would advise you going the civilian route, otherwise you will be miserable.

 

[Randomstudent66]

Depends on how you define "problem" -

If the purpose of the Medical Corps is to have a sufficient number of licensed physicians on active duty to meet the military's operational needs, there is no "problem" as long as the recruitment pipeline (mainly HPSP) remains full enough to offset the physicians who leave service when their initial period of obligated service is up. It doesn't really matter if the departing physicians are happy or sad.

We've spent the last couple decades at war, with objectively excellent outcomes on the medical side. The survival rates for battlefield casualties have been nothing short of amazing. For lots of reasons, of course, but it's clear that physicians aren't a weak link. There are enough physicians in the pool, they are competent enough, and they have sufficient support to not be a liability to the military's primary mission of traveling to faraway places to kill people and break things.

Also, long term retention of physicians is an anti-goal of the military. Superficial (i.e. easy) analysis tells policymakers that a senior experienced physician doesn't fill an operational billet any better than a junior physician just out of residency, but the senior physician costs more. And retirement costs for career military personnel are astronomical.


Now - what's your argument for convincing Congress and senior military leaders, that there's a "serious problem"?

I guess I don't really have one. Military medicine is still very effective so from an operational point of view there is no problem
Thanks for making me see it this way. I guess all there really is to do is to serve your time and get out.

Thanks for the insight.

 

[Randomstudent66]

"So many docs...with such a negative view" is your impression based on this forum (perhaps other avenues as well). It does not necessarily represent all military physicians. Just like any opinion-based forum, it is more common to hear from those with negative views than those with a positive experience. Seek out the people that are happy in military medicine to understand why they are happy to help you make a well-informed decision.

Back to the OP's original question...I do see the negative aspects of military medicine improving (acuity, case volume, etc), due to previously discussed NDAA2017 and the interim updates now that congress has set timelines and an implementation strategy. These changes can and will bring negative effects for certain people already in (those already specialized but seeking certain sub-specialization, those in less-demand fields like pediatrics, etc. who may see their population shrinking, and so on). Nobody knows what will happen in the next decade, but for new accessions milmed is not going anywhere and the recommendations remain the same: You must be flexible, you must understand the shortcomings of milmed, you must have some level of optimism and if you accept a scholarship you have to be willing to at least consider a career in the military as a potential option. If you don't meet those criteria then I would advise you going the civilian route, otherwise you will be miserable.

I think I'm beginning to understand the mentality that someone has to have before signing up for military medicine (and the military in general). If the military does not care about keeping their physicians around since they know that there's a constant inflow of new doctors ready to replace them I guess I understand why in the leadership's eyes there is no problem at all.

Although as of now I do believe I have the flexibility and some optimism, I'm not sure how that will change in the next 4 years. Med schools is very far away for me so I will definitely revisit this forum and seek out any military physicians with positive experiences as I get closer to making a decision.

Thanks for your help!

 

[Perrotfish]

"So many docs...with such a negative view" is your impression based on this forum (perhaps other avenues as well). It does not necessarily represent all military physicians. Just like any opinion-based forum, it is more common to hear from those with negative views than those with a positive experience. Seek out the people that are happy in military medicine to understand why they are happy to help you make a well-informed decision..

Don't try to create a false.sense of balance, though. Most people don't like military medicine. The best evidence if that is that almost everyone gets out at the first possible opportunity. Pleasant organizations don't churn through 80% of their physicians every 4 years.

Subjectively I know almost no happy military physicians. Not none, but it's a small minority, even smaller than the minority who are actually planning to stay. Normally the closest thing I see to a good attitude is the belief that it is worth 'sucking it up' until the admittedly very early retirement.

 

[Clap MD]

Don't try to create a false.sense of balance, though. Most people don't like military medicine. The best evidence if that is that almost everyone gets out at the first possible opportunity. Pleasant organizations don't churn through 80% of their physicians every 4 years.

Subjectively I know almost no happy military physicians. Not none, but it's a small minority, even smaller than the minority who are actually planning to stay. Normally the closest thing I see to a good attitude is the belief that it is worth 'sucking it up' until the admittedly very early retirement.

OP, take it from a guy that is in that small majority of military physicians like Perrotfish describes that are happy (aided by great assignments, rare opportunities, etc...) that is still getting out ASAP. Not that I haven't had a good four years, but is this what I wanted to be when going to med school? Think about your long-term goals, the type of practice you want to have, where your interests and aptitudes merge. Of course where you are right now, even these questions are a few years down the road but sometimes knowing in the back of your mind what questions will be pertinent lets you eventually get into situations where you can ask them.

tl/dr: Get good undergrad grades and if you find medicine is your passion, get into med school then immediately into residency and THEN figure out the best way to serve your country after you've secured a board certification. That's what I wish someone had told me. 11-15 years from now, who knows what milmed will be.

 

[Gastrapathy]

No

 

[militaryPHYS]

Most people don't like military medicine

I would argue that this a horrible generalization and the reason premeds get an unfortunately negative impression of milmed via SDN. By blanket stating things like this we are also subjecting some people who may have been happy in the military to hundreds of thousands of dollars in debt with a chance of not landing an internship, doing primary care (which makes the same or less than a milmed PCP) and/or decreased compensation once they actually receive a real paycheck as an attending. You don't think that this is a disservice?

All I am trying to do is make the shortcomings of milmed well known so everyone can make their own well-informed decision. In my opinion, a pathway through the military and the shortcomings it entails is just as scary as the unknowns of HUGE debt and possible failure to match or poor compensation and 10 years of financial loans to pay back.

Giving objective and unbiased information will let people choose for themselves instead of coming in to the decision with a skewed understanding.

almost everyone gets out at the first possible opportunity

This is because most people enter HPSP with the intent of getting out right away. Some stay longer, some stay for a career. Sure the incentive to stay isn't the best and is intentional via DOD, but that doesn't mean the reason everyone is leaving is because they don't like military medicine.

Subjectively I know almost no happy military physicians

I know quite a few, and surprisingly a couple of them are Ortho and could be making 3x more as a civilian. I do see a strong correlation between happy military physicians and working spouses. This obviously helps supplement the income differential, although I do not think it is purely monetary based additional happiness. I advocate for all young couples to avoid the "stay at home spouse" option if it is feasible. Being able to manage two jobs, kids and home life has more beneficial effects to the overall marriage than negative, in my opinion. Some of that is probably due to less stress about money, but the intrinsic value of an occupation and purpose beyond just your spouse and kids helps deter burnout from the same routine every day.

Rand put out a study a few years ago about retention. https://www.rand.org/content/dam/rand/pubs/rgs_dissertations/2010/RAND_RGSD275.pdf Biggest factors were money and duty location (obviously). I agree that the military is not focused on retention since turnover and young physicians are more advantageous for the overall system. That doesn't mean that there aren't great opportunities for lifestyle, family, leadership, FI and early retirement during the years you are in. If you can avoid focusing on the income differential and being at a small MTF for a bit, then you have the potential to be happy.

 

[Perrotfish]

I would argue that this a horrible generalization and the reason premeds get an unfortunately negative impression of milmed via SDN. By blanket stating things like this we are also subjecting some people who may have been happy in the military to hundreds of thousands of dollars in debt with a chance of not landing an internship, doing primary care (which makes the same or less than a milmed PCP) and/or decreased compensation once they actually receive a real paycheck as an attending. You don't think that this is a disservice?

Its not a generalization. Its an odds ratio. You can win the lottery but most people don't. You can be happy in military medicine but most people aren't. The objective data we have is retention. The subjective data I have is a large pool of military physicians. Both point to something like an 80% dissatisfaction rate.

If you tell everyone not to play the lottery you are, on average, helping them. You may be doing one person with lucky numbers a huge disservice, but on average you are helping.

 

[Perrotfish]

I I advocate for all young couples to avoid the "stay at home spouse" option if it is feasible. Being able to manage two jobs, kids and home life has more beneficial effects to the overall marriage than negative, in my opinion. Some of that is probably due to less stress about money, but the intrinsic value of an occupation and purpose beyond just your spouse and kids helps deter burnout from the same routine every day. .

This is a really odd thing to say. Most people view a working, non-military spouse is a worst case scenario for a military physician, which will likely involve long periods of separation as very few spouses with real careers can move to Ft. Irwin and maintain their career. The military really hasn't figured out how to accommodate anyone other than stay at home spouses and dual military couples.

 

[militaryPHYS]

To argue that retention is an indicator of happiness doesn't make sense since we know most people plan and want to get out for better pay and freedom. Plus, as discussed already, DOD likes turnover and not retaining everybody. But the debt free life and non-medical opportunities it provides helps compensate for the decreased pay and freedom for 4 years. Nobody is arguing that military medicine is better than civilian practice (not even me). I'm just saying that it shouldn't be just written off completely based on information provided on one opinion based forum. It is a great option for the right people

 

[militaryPHYS]

The military really hasn't figured out how to accommodate anyone other than stay at home spouses and dual military couples.

It isn't the military's job to accommodate for anyone. If you or your spouse can find side hustles that can be done from anywhere you can have a job, earn extra money and go anywhere. This day and age it is very easy to do online with amazon affiliate partnerships, adsense, etc. Takes no upfront equity and can at least pay something while providing an outlet for a passion or hobby.

 

[militaryPHYS]

If you tell everyone not to play the lottery you are, on average, helping them

School loans and possibility of no internship or residency as a civilian is also a gamble/lottery. If you can teach everyone the risks/benefits of a decision rather than telling them what you think is right then you let them decide for themselves while not neglecting anybody.

 

[Perrotfish]

School loans and possibility of no internship or residency as a civilian is also a gamble/lottery. If you can teach everyone the risks/benefits of a decision rather than telling them what you think is right then you let them decide for themselves while not neglecting anybody.

The point that people here are trying to get across is that a major downside of the decision to go into military medicine is that you will be less happy, on any given day during your 3 years of residency and 4 years of payback, than you would have been in a civilian job during that same time period. The working conditions, for at least 80% of us, are degrading, exhausting, threatening, isolating, and occasionally terrifying.

If you are saying that the freedom from debt is sufficient payment for that unhappiness, and will make you happier over some other period of time past your payback, that is a reasonable discussion. If you are arguing that by joining the military you are no more likely to be unhappy at in your job than a civilian then you are incorrect.

 

[Perrotfish]

It isn't the military's job to accommodate for anyone. If you or your spouse can find side hustles that can be done from anywhere you can have a job, earn extra money and go anywhere. This day and age it is very easy to do online with amazon affiliate partnerships, adsense, etc. Takes no upfront equity and can at least pay something while providing an outlet for a passion or hobby.

1) I am aware that it is not the military's job to accommodate anyone. That's my point. That's the reason not to join if you have, or might have, anyone in your life that might need an accommodation

2) Side hussles? WTF are you talking about? We were talking about the difficulties of having a spouse with a career, and how the military can for you to choose between the end of that career and prolonged separation. When they move someone with a lawyer spouse to guam and she needs to give up the job she worked so hard for it is in no way mitigating that she can now sell Lululemon out of her trunk.

 

[militaryPHYS]

The point that people here are trying to get across is that a major downside of the decision to go into military medicine is that you will be less happy, on any given day during your 3 years of residency and 4 years of payback, than you would have been in a civilian job during that same time period. The working conditions, for at least 80% of us, are degrading, exhausting, threatening, isolating, and occasionally terrifying.

This generalization is blatantly false. Please provide some resemblance of objective data if you are going to claim that Military Medicine residency is any more degrading/exhausting/isolating than a civilian one. Threatening and Terrifying? c'mon.

When they move someone with a lawyer spouse to guam and she needs to give up the job she worked so hard for it is in no way mitigating that she can now sell Lululemon out of her trunk.

A side hustle is a way to make money that isn't your primary profession. Im talking about alternatives in life when you get handed lemons. That someone and their civilian lawyer spouse didn't understand they might have to go to Guam, or Japan, or Europe at some point during their payback for free education when they chose that path in life? Understanding and adapting by earning money elsewhere in the meantime prior to the ability to practice law again isn't an option? Seems like they are missing out on more than just money during their tour abroad.

 

[Gastrapathy]

You aren’t “handed lemons”. You knowingly lined up at the lemonade stand. The argument makes no sense when you say it’s great and suck it up in the same breath.

Watching your inevitable decline into dissatisfaction will be sad.

 

[HighPriest]

Maybe 80% of everyone in milmed is unhappy. Maybe that number isn’t correct. I agree that retention is a biased way to decide. However, in some specialties the retention rate is almost zero, so that does say something.
In any case, unless we can agree on an objective measure on what constitutes happiness, it’s all opinion on both sides. My experience was very much aligned with what I saw on this thread. Most people were fairly unhappy, and only a rare one here and there was content. Not happy, but willing to eat his $#!tburger without complaining. I did meet a very rare bird who was actually liked it. But I bet I could count them on one hand. That’s just my experience. I think if I’d gotten a fellowship and a cush first duty station, I’d probably know more happy people.
But that’s why people come to this thread. For opinions. This isn’t a data thread. If someone is coming here for that, that’s kinda naive. Data shows up now and then, but that’s not the primary function.
Experiences may vary, but my experience (for what it’s worth) was basically what this thread describes, good and bad.

And it can be terrifying. When the DCCS shows up threatening to pull your credentials because you referred a pediatric intracranial tumor to a tertiary center instead of trying to handle it yourself at your 12 bed facility, because he’s focused on preventing OTSG from closing the facility, that can be pretty upsetting.

 

[militaryPHYS]

Watching your inevitable decline into dissatisfaction will be sad.

If I get tired of the beurocracy, If I get tired of the online training, If I get tired of the supply chain failures of basic things required to run a hospital in the Pacific ocean, If I get deployed and have a miserable experience I will get out and move on because it isn't right for me anymore. I'm not convinced I'm staying for 20 even though I will be at 15 when I am finished fellowship and payback. BUT I will still say that USUHS was right for me, military residency for orthopaedic surgery was right for me, choosing our overseas tour right out of residency was right for me and doing a sports fellowship while still active duty is right for me.

Just because someone gets out or eventually gets tired of working for the system doesn't mean that military medicine is never a good idea, a complete failure and/or nobody likes it. Most people want to go civilian ASAP and I completely understand that! I will probably want to as well by the time I am finished with my obligation. Who knows! Bottom line is the military affords a vehicle to your M.D. or D.O. without incurring financial debt while serving your country. You also get to max out retirement accounts, buy nice things if you are smart with your money and not put your life on hold until a real paycheck comes in 10 years later. Side by side for many specialties it is not as good as a civilian practice overall...but that is not an absolute. Even with the negatives I think the debt-free education and other positives balance it out. Just because someone had a miserable time doesn't mean that everyone will or does. Just because you are miserable by the time your time is up doesn't mean you were miserable the whole time or that someone else will be.

This forum is often the only avenue premeds use to research a possible military option. If the moderators are OK with a completely negative bias and false information then I think that is unfortunate and wonder if there is a way to help change that perspective. My experience thus far on here tells me otherwise which is why other avenues to help inform interested applicants make more sense.

As mentors I would think providing objective information and letting people decide for themselves would be much better than anecdotal stories and subjective misery.

 

[Gastrapathy]

The fact that anyone can envision being unhappy enough at 15 years to quit and lose the pension is objective evidence.

Retention of 8-10 year docs is one thing but when you can't retain O5s at 15 years, that is telling.

 

[HighPriest]

What I personally love most about this forum is the number of people who initially show up either pro-milmed or at least not anti-milmed, who end up being anti-milmed before they get out and stop posting. It’s like a magical roller coaster. I’ll let you know when I find someone for whom the opposite happens.

 

[pgg]

Retention of 8-10 year docs is one thing but when you can't retain O5s at 15 years, that is telling.

Someone was telling me yesterday that the O6 selection rate is about to skyrocket. Supposedly so many senior O5s are getting out that the pool of in-zone O5s has shrunk to something closer to the # of authorized selects.

 

[militaryPHYS]

The fact that anyone can envision being unhappy enough at 15 years to quit and lose the pension is objective evidence.

Retention of 8-10 year docs is one thing but when you can't retain O5s at 15 years, that is telling.

Pretty hard to retain someone who is sub specialized and has no further comittment. There is no hiding that the military isn’t going to pay you close to what you can make on the outside as a sub specialist. Again, That doesn’t mean Milmed overall is horrible or it doesn’t have its advantages. It has its mission and we choose to be a part of it for however long it requires of us or however long we need/want it. Not sure how that translates in to the overall message this forum has morphed in to... “don’t even think about it”

 

[HighPriest]

I always got the impression that the message of the forum was “it’s a good deal if you want to serve as an officer even as much or more than you want to be a doctor, otherwise buyer beware because there’s a lot of unhappy people.”

I think that’s a fair assessment.

 

[pgg]

This forum is often the only avenue premeds use to research a possible military option. If the moderators are OK with a completely negative bias and false information then I think that is unfortunate and wonder if there is a way to help change that perspective. My experience thus far on here tells me otherwise which is why other avenues to help inform interested applicants make more sense.

As mentors I would think providing objective information and letting people decide for themselves would be much better than anecdotal stories and subjective misery.

I'm a SDN moderator, but not of this particular forum. What we moderators "allow" is discussion that doesn't violate the TOS. There's no systemic pro/con bias.

A universal truism of life and the internet is that unhappy people tend to be more vocal. You see it in restaurant reviews, political campaigns, PTA meetings, every electronic forum since the 1200 baud dial up BBS days,and here too.

 

[Perrotfish]

I always got the impression that the message of the forum was “it’s a good deal if you want to serve as an officer even as much or more than you want to be a doctor, otherwise buyer beware because there’s a lot of unhappy people.”

I think that’s a fair assessment.

Honestly its not a particularly good place to be an officer either. If you're junior it's really not about being an officer: no military or leadership training, no opportunity to train or lead enlisted personnel in the hospital setting, no camradarie. It's just a bad job in a doctor's office .if you stay and you move to management it is about being an officer, but under the worst possible circumstances: multiple conflicting mandates originating outside of your chain of command, staffing models with extreme.variation from month to month, usually an expectation to maintain a busy clinical practice while giving you a more than full time management job, etc. We have a few former line officers in my command, who liked that job, and they don't generally like their current job.

 

[HighPriest]

Honestly its not a particularly good place to be an officer either. If you're junior it's really not about being an officer: no military or leadership training, no opportunity to train or lead enlisted personnel in the hospital setting, no camradarie. It's just a bad job in a doctor's office .if you stay and you move to management it is about being an officer, but under the worst possible circumstances: multiple conflicting mandates originating outside of your chain of command, staffing models with extreme.variation from month to month, usually an expectation to maintain a busy clinical practice while giving you a more than full time management job, etc. We have a few former line officers in my command, who liked that job, and they don't generally like their current job.

You’re preaching to the choir here, but nonetheless that was the impression I always got from the forum. Maybe it’s better to say “if you want to serve in the military more than being a physician.”

 

[militaryPHYS]

All I'm trying to point out is that this current thread is a great representation of the the Military Medicine forum on SDN as a whole. Interested people ask questions and get bombarded by negativity by a few active members. It started off with insightful thoughts from pgg, armyvascsurg, orbitsurgMD and then went the typical path. If any military physicians have anything objective or subjectively positive to add it is discredited by the same few active members.

I remember using SDN as a valuable resource when I was applying to medical school. Thank goodness there were enough people involved in the forum at the time to balance the discussion with objective facts and not just personal anecdotes so I didn't just write it off completely. Thank goodness I was also already in the military so I knew a little bit about milmed and had supportive mentors. They admitted shortcomings and headaches of milmed and taught me how to avoid them, excel, stay positive and maximize my opportunities while going through the process.

SDN isn't like a typical facebook political discussion that has no actual productivity or purpose. This place may be first step someone takes in researching military medicine and the current message they are receiving is basically "go away and be a civilian"

 

[TheEarDoc]

All I'm trying to point out is that this current thread is a great representation of the the Military Medicine forum on SDN as a whole. Interested people ask questions and get bombarded by negativity by a few active members. It started off with insightful thoughts from pgg, armyvascsurg, orbitsurgMD and then went the typical path. If any military physicians have anything objective or subjectively positive to add it is discredited by the same few active members.

I remember using SDN as a valuable resource when I was applying to medical school. Thank goodness there were enough people involved in the forum at the time to balance the discussion with objective facts and not just personal anecdotes so I didn't just write it off completely. Thank goodness I was also already in the military so I knew a little bit about milmed and had supportive mentors. They admitted shortcomings and headaches of milmed and taught me how to avoid them, excel, stay positive and maximize my opportunities while going through the process.

SDN isn't like a typical facebook political discussion that has no actual productivity or purpose. This place may be first step someone takes in researching military medicine and the current message they are receiving is basically "go away and be a civilian"

I've been on these forums for a long time (started out in the audiology forums and then branched out as my interest in milmed came about). I wish I had had people informing me about the health scholarship program for the military when I was trying to figure out what to do after undergrad. I would have signed up then and although I'm sure parts of it would have sucked, I'm sure I would have still felt the experience was worthwhile.

I guess I see it from a different prospective. I have student loan debt and I am going in as a reservist meaning now my life isn't just an N of 1. I have other people involved and can still see time overseas just like any active duty person would, but it's a long road to retirement in the reserves.

I take anything people say with a grain of salt. I'm sure people read some of my points of view about working in the civilian sector of government healthcare and think what you think of others on here posting their negative experiences about milmed, but hey I am happy it's not all rainbows and unicorn farts. We get enough of that from recruiters......

 

[Perrotfish]

I've been on these forums for a long time (started out in the audiology forums and then branched out as my interest in milmed came about). I wish I had had people informing me about the health scholarship program for the military when I was trying to figure out what to do after undergrad. I would have signed up then and although I'm sure parts of it would have sucked, I'm sure I would have still felt the experience was worthwhile.

I guess I see it from a different prospective. I have student loan debt and I am going in as a reservist meaning now my life isn't just an N of 1. I have other people involved and can still see time overseas just like any active duty person would, but it's a long road to retirement in the reserves.

I take anything people say with a grain of salt. I'm sure people read some of my points of view about working in the civilian sector of government healthcare and think what you think of others on here posting their negative experiences about milmed, but hey I am happy it's not all rainbows and unicorn farts. We get enough of that from recruiters......

One thing I have noticed is that very few people come back after leaving the military and tell me that the grass isn't really greener. Again, not none. I know one reservist who thought that the military was a much better work enviornment. But it's a small percentage. Similarly many of the posters on this board got out, and they weren't at all negative about their new careers. That does suggest there is something more than misanthropy going on here.

 

[militaryPHYS]

I am happy it's not all rainbows and unicorn farts. We get enough of that from recruiters......

Completely agree. Even satisfied/happy military physicians would never try to "sell" becoming a military physician to anyone. It definitely isn't for everyone and many people would be horribly miserable. Many could also excel, succeed and be happy. Discussing potential positives and negatives in an objective and collegial way is all I care about.

 

[Perrotfish]

All I'm trying to point out is that this current thread is a great representation of the the Military Medicine forum on SDN as a whole. Interested people ask questions and get bombarded by negativity by a few active members. It started off with insightful thoughts from pgg, armyvascsurg, orbitsurgMD and then went the typical path. If any military physicians have anything objective or subjectively positive to add it is discredited by the same few active members.

I remember using SDN as a valuable resource when I was applying to medical school. Thank goodness there were enough people involved in the forum at the time to balance the discussion with objective facts and not just personal anecdotes so I didn't just write it off completely. Thank goodness I was also already in the military so I knew a little bit about milmed and had supportive mentors. They admitted shortcomings and headaches of milmed and taught me how to avoid them, excel, stay positive and maximize my opportunities while going through the process.

SDN isn't like a typical facebook political discussion that has no actual productivity or purpose. This place may be first step someone takes in researching military medicine and the current message they are receiving is basically "go away and be a civilian"

The military has changed since you joined. This thread was about trends in military medicine. The trends since I have joined have all been negative. Staffing at my hospital was cut by 30% while our patient base expanded. We lost CME funding (which has made a very minor comeback) and funding for most new equipment for our hospital (which has not). We created several new metrics for our hospital with no time or staff given to implement them. We received an unfunded mandate to see more patients per week and another one to do late clinic every day. The in zone selection rate for first O6 and then O5 dropped, first to 50% and now to barely over 30%. We just received a still to be clarified memo that many kinds of subspecialty training are going away. Finally, in contrast, medical salaries in the civilian world have risen at several times the rate of inflation so that my profession now makes nearly 50% more, on average, than it did 8 years ago.

It may be that you are hearing less 'balance' than when you accepted you contract not because we have developed some kind of group think, but because military medicine has gotten significantly worse while civilian medicine has gotten better.

 

[militaryPHYS]

One thing I have noticed is that very few people come back after leaving the military and tell me that the grass isn't really greener. Again, not none. I know one reservist who thought that the military was a much better work enviornment. But it's a small percentage. Similarly many of the posters on this board got out, and they weren't at all negative about their new careers. That does suggest there is something more than misanthropy going on here.

I think this is why people automatically disagree with anything I say. I do NOT think that the grass is greener in the military. I would never say that milmed has a better working environment than civilian. Some units/commands may be better than some groups/practices on the outside, but nothing is universal. Everyone WILL have more money (except peds/FP) and freedom on the outside. Get out when you can if you don't like it. All I care about is not using those facts as a reason to tell people not to at least consider milmed as a viable option to avoid debt, serve your country and maybe have fun for a while if you play your cards right and are also "lucky". Many civilian residents and attendings are miserable too so we might as well just give people information and let them decide which one they want to pursue.

 

[narcusprince]

I will say I loved military medicine as a medical student and as a resident. As an attending I have found my happiness in other ways. Gone are the days of wanting to change environments or come up with ideas to save the ship. I show up work very efficiently in my practice, moonlight and go home. I dont want to be in the in crowd. I am hapoy being a worker bee. Honestly my hours are less then my civilian counterparts. I do not feel over worked with the job of anesthesia. Where I did feel undervalued or under appreciated my solution has been clear stop feeling. The navy is setup for people with the right look right color and right timing to excel. In all honesty President administrations also play into advancements and diversity with our current administration not seeing value in diversity it trickles down to local commands and leadership. The navy is not some benevolent peace loving organization like the federation moreso like the terran empire(star trek discovery reference) an organization that focuses on individual advancement. Everyone has a motive.

 

[HighPriest]

The fact is that no one on this thread has provided any factual information regarding the OP’s question. Because it’s an opinion-based question. “Do you think milmed will get better?” Of course, the follow up question is why does he feel it’s bad, and he’s commented on other posts in the thread. But that’s also subjective. All of this is subjective. It’s not like many posters come on and ask what the average number of patient encounters are, or what the average time in service is, or any other question that could be objectively measured. Occasionally they do, and even as a milmed naysayer (and not the worst one at all times), I try to answer those questions as objectively as possible.

But the rest of it is asking for opinions. And that’s what the thread is here for. Is it biased? Maybe. Or maybe you have an atypical outlook. You say it used to be more “objective,” which I assume means in line with your current outlook. But perhaps there’s a trend in milmed wherein people are generally more unhappy now than they were then, for the reasons Perrotfish mentioned, and maybe that’s reflected in the bias here. I’m speculating. But anecdotally, many of the really senior guys I know made that exact comment to me at one point or another “things are worse now than they’ve ever been before.” Again, their opinion, but I heard to so often, and independently and without provocation. So maybe what you’re seeing here is a reflective trend. Hell, if you follow my posts back...WAY back far enough, they were far more positive than they are now.

In any case, what you -usually- see is some kid coming on and asking for opinions, and then getting them. No one’s attacking positive posters. I don’t always agree with pgg. But he’s entitled to his opinion. $#!t, Perrotfish and disagree on more points than we agree. But again, that’s ok. But I’m not going to keep my mouth shut when I disagree on a question about which I have an experienced-based opinion simply because there’s a perceived negative bias on SDN. That’s as much of a disservice as anything.

If potential HPSP students base their entire decision upon how many positive vs negative comments pop up on SDN, well, that’s poor researching. It’s not unfortunate that they’re getting negative opinions. It’s an opinion.

If everyone was singing praises here, I’d feel like that was unfortunate too, because it wouldn’t reflect my experiences. But I wouldn’t think it was a troll tank just for that reason. Most of the people on here are verified military physicians. They have better $#!t to do than troll premed students. I get on here because I think it’s important to provide some insight into what I experienced. If that was positive, great. If not, so be it.

 

[militaryPHYS]

I get on here because I think it’s important to provide some insight into what I experienced. If that was positive, great. If not, so be it.

For once I agree with almost everything you said, HighPriest! I am just trying to provide a perspective on the trends I have seen since re-engaging SDN now that I am 13 years in to my time in military medicine. I hope we can provide positive and negative opinions, but when the overall message that premds are receiving is basically don't even look in to it, then I thought maybe we needed to re-evaluate what impact the whole forum is having.

Maybe not

 

[narcusprince]

I can only comment about anesthesia. I think things will get worse. Anesthesia residency spots are driven by demand. I think the overall quality of applicant has gone down. While manning numbers are being increased. I think it will still suck more of the same.

 

[militaryPHYS]

Ortho good. Bones break and need fixed. Lifestyle good for mil orthos in Navy. Fellowship spots are stable to slight upswing. No idea how long this will last. Asystole bad?

 

[Randomstudent66]

I can only comment about anesthesia. I think things will get worse. Anesthesia residency spots are driven by demand. I think the overall quality of applicant has gone down. While manning numbers are being increased. I think it will still suck more of the same.

I've heard this from civilian practitioners as well saying in the next few years the number of jobs for anaesthesiologists will decrease because nurse practitioners are widening their scope.

Not sure how true that is since most people (I assume) would rather have a doctor treating them than an NP.

 

[Randomstudent66]

Ortho good. Bones break and need fixed. Lifestyle good for mil orthos in Navy. Fellowship spots are stable to slight upswing. No idea how long this will last. Asystole bad?

If you are an orthopedic surgeon in the military (or any doctor really), do you feel that you are providing care to people in need and truly helping them. Are you satisfied with your patient care and happy that you get to treat who you treat.

How many patients do you treat in any given week? (Or did if you have gotten out)

 

[HighPriest]

For once I agree with almost everything you said, HighPriest! I am just trying to provide a perspective on the trends I have seen since re-engaging SDN now that I am 13 years in to my time in military medicine. I hope we can provide positive and negative opinions, but when the overall message that premds are receiving is basically don't even look in to it, then I thought maybe we needed to re-evaluate what impact the whole forum is having.

Maybe not

Maybe. I think back on my experience regularly. My overall opinion has changed over time, but it’s still not a very positive one. But, again, I think what we’re doing here is providing our experiences to potential students. So I’ll just keep doing that, until it’s no longer relevant. Which won’t be too much longer. But not yet.