Emergency Medicine in the Navy

[Asclepius293]

Hello all,

M1 here checking out emergency medicine. I’ve wanted to get involved in the Navy for some term and was curious how the field of EM was within the service. I’ve read a few threads on here but was curious if any current or past Navy EM docs would be able to weigh in.

I was going to do HPSP or USUHS but ended up doing a full ride instead at a state school so have a lot of freedom going forward into residency. Would still like to fit military service in somehow though if possible. Also think international medicine is interesting within EM and its public health merits might be a positive within military med?

Thanks for any insight! Appreciate it.

---

Members don't see this ad.

 

[HighPriest]

Brah. If you have a full ride through medical school, you would be absolutely insane to join the military. There's nothing in it for you. If you want to serve your country, sign up for jury duty or join the reserves.

 

[Matthew9Thirtyfive]

As much as I love the Navy, EM is mostly primary care. You might see higher acuity stuff occasionally, but you’re not seeing any trauma coming into Balboa. Yes, a lot of civilian EPs see mostly primary care, but you at least have a chance of seeing trauma if that’s your thing. In the Navy, you’ll only see that stuff on deployment.

 

[Asclepius293]

As much as I love the Navy, EM is mostly primary care. You might see higher acuity stuff occasionally, but you’re not seeing any trauma coming into Balboa. Yes, a lot of civilian EPs see mostly primary care, but you at least have a chance of seeing trauma if that’s your thing. In the Navy, you’ll only see that stuff on deployment.

Thanks for the insight! Would the spread out deployments as an EM physician offer that trauma/acuity you lose out on during normal assignment? Also would a more major medical center such as Walter Reed or San Diego see more trauma similar to a civilian hospital?

 

[Matthew9Thirtyfive]

Thanks for the insight! Would the spread out deployments as an EM physician offer that trauma/acuity you lose out on during normal assignment? Also would a more major medical center such as Walter Reed or San Diego see more trauma similar to a civilian hospital?

Won’t comment on the first part since I’m not a Navy MD yet, and deployments in the surface Navy as an enlisted dude are different than what an EM doc would experience.

For the second part, in my experience, no. Civilian rescue squads can’t come on base. If an accident happens right outside Balboa, the SDFD guys will come take them to a UCSD (and this has happened). There has been some talk about opening Walter Reed to civilian emergencies, but I would definitely not count on that.

Edit: just to illustrate, we occasionally had traumas or other medical emergencies on the ship even in port. When those happened, we responded and rendered whatever aid we could, then turned them over to SDFD when they got there, who took them to UCSD—which was at least as far as Balboa. So even if it happens to a Sailor on a ship, it’s still not coming to you.

The stuff we sent over to Balboa was less acute. Gal with thrombophlebitis and cellulitis. Dude fell on the non-skid and broke his hand. Stuff like that.

 

[Asclepius293]

Brah. If you have a full ride through medical school, you would be absolutely insane to join the military. There's nothing in it for you. If you want to serve your country, sign up for jury duty or join the reserves.

Haha I want the life experience/service component of it. I get financially there’s nothing to gain in military vs civilian routes post residency. Might pursue FAP or loan repayment for a short stint though. Or alternatively thinking maybe just contracting to a military medical center for a term.

 

[Asclepius293]

Won’t comment on the first part since I’m not a Navy MD yet, and deployments in the surface Navy as an enlisted dude are different than what an EM doc would experience.

For the second part, in my experience, no. Civilian rescue squads can’t come on base. If an accident happens right outside Balboa, the SDFD guys will come take them to a UCSD (and this has happened). There has been some talk about opening Walter Reed to civilian emergencies, but I would definitely not count on that.

Edit: just to illustrate, we occasionally had traumas or other medical emergencies on the ship even in port. When those happened, we responded and rendered whatever aid we could, then turned them over to SDFD when they got there, who took them to UCSD—which was at least as far as Balboa. So even if it happens to a Sailor on a ship, it’s still not coming to you.

The stuff we sent over to Balboa was less acute. Gal with thrombophlebitis and cellulitis. Dude fell on the non-skid and broke his hand. Stuff like that.

I gotcha. Thanks for the insight man! So might not be the best for acuity and functioning as a trained EM doc. Maybe just pursue service through contracting for a term or something.

 

[Matthew9Thirtyfive]

I gotcha. Thanks for the insight man! So might not be the best for acuity and functioning as a trained EM doc. Maybe just pursue service through contracting for a term or something.

Depends on what your priorities are. If the opportunity to practice in an ED that sees a lot of trauma is at or near the top of your list (and above taking care of service members), then the Navy is probably not your best bet. Which is fine! There are other ways to serve the public, and as you said, reserves or contracting might be options.

 

[HomeSkool]

Brah. If you have a full ride through medical school, you would be absolutely insane to join the military. There's nothing in it for you. If you want to serve your country, sign up for jury duty or join the reserves.

Or just go work at a Navy hospital as a civilian.

Sent from my Pixel 2 using SDN mobile

 

[HighPriest]

Haha I want the life experience/service component of it. I get financially there’s nothing to gain in military vs civilian routes post residency. Might pursue FAP or loan repayment for a short stint though. Or alternatively thinking maybe just contracting to a military medical center for a term.

Contract if you must. At least then they don't own your soul. Most people find out that service in this fashion is not what they expected it to be.

 

[Matthew9Thirtyfive]

Contract if you must. At least then they don't own your soul. Most people find out that service in this fashion is not what they expected it to be.

Will agree there. The military is a special beast that you really can’t prepare someone for without having them just go through it. It’s not for everyone, that’s for sure.

 

[HomeSkool]

Contract if you must. At least then they don't own your soul. Most people find out that service in this fashion is not what they expected it to be.

Agreed. There are ways to serve without giving up so much control over your own life. As a DoD civilian or contractor, you'll make better money and avoid both deployments and frequent PCSs (Permanent Change of Station, i.e. move) but you'll still be able to serve the service members and train military residents. The autonomy you forfeit in military service affects not just you, but also your family and friends. I opted to separate from active duty after seven years, and my wife and I made one final move to get to our permanent home -- our son's fifth home by age 8. All that moving was hard on our kids, and my wife and I also struggled with it as we had to say goodbye to far too many of our own friends.

 

[Matthew9Thirtyfive]

Agreed. There are ways to serve without giving up so much control over your own life. As a DoD civilian or contractor, you'll make better money and avoid both deployments and frequent PCSs (Permanent Change of Station, i.e. move) but you'll still be able to serve the service members and train military residents. The autonomy you forfeit in military service affects not just you, but also your family and friends. I opted to separate from active duty after seven years, and my wife and I made one final move to get to our permanent home -- our son's fifth home by age 8. All that moving was hard on our kids, and my wife and I also struggled with it as we had to say goodbye to far too many of our own friends.

Yeah, parts of it suck. It's a different lifestyle for sure. I've been in 6 years, and we've moved as many times. But we happen to really like it. I'm not going to say anyone is wrong for wanting to get out, but believe it or not, there are people who enjoy the military lifestyle but didn't drink the Kool-Aid.

 

[HomeSkool]

Yeah, parts of it suck. It's a different lifestyle for sure. I've been in 6 years, and we've moved as many times. But we happen to really like it. I'm not going to say anyone is wrong for wanting to get out, but believe it or not, there are people who enjoy the military lifestyle but didn't drink the Kool-Aid.

True: it is for some, but not for all. I have no regrets about my time in service, but I made the right decision getting out when I did. My kids are of the temperament that the moves were getting pretty hard on them.

OP, my point is that you should look at various ways of serving, considering the impact that each is likely to have upon you and your loved ones. The military is like any other employer: there are benefits and drawbacks, and no job is perfect. The military is also an enormous government machine with all the red tape and politics that entails. Do your homework before deciding to sign the dotted line, and figure out whether you'd be happiest serving in the uniform or alongside it.

 

[Matthew9Thirtyfive]

True: it is for some, but not for all. I have no regrets about my time in service, but I made the right decision getting out when I did. My kids are of the temperament that the moves were getting pretty hard on them.

OP, my point is that you should look at various ways of serving, considering the impact that each is likely to have upon you and your loved ones. The military is like any other employer: there are benefits and drawbacks, and no job is perfect. The military is also an enormous government machine with all the red tape and politics that go along with it. Do your homework before deciding to sign the dotted line, and figure out whether you'd be happiest serving in the uniform or alongside it.

Agreed. And it seems like OP would be better as a civilian contractor or possibly reserves.

 

[HighPriest]

Yeah, parts of it suck. It's a different lifestyle for sure. I've been in 6 years, and we've moved as many times. But we happen to really like it. I'm not going to say anyone is wrong for wanting to get out, but believe it or not, there are people who enjoy the military lifestyle but didn't drink the Kool-Aid.

Agree to disagree.

 

[Matthew9Thirtyfive]

Agree to disagree.

Agree to disagree that some people like it or on the benefits to negatives ratio?

 

[HighPriest]

The military is like any other employer: there are benefits and drawbacks, and no job is perfect.

Except that you can switch jobs if you don't like your employer. No job is perfect, for sure. However, small to medium sized companies tend to at least take their employees concerns into account to avoid a mass exodus due to poor decision making. Large companies may not, but at least the employees can leave. And they generally pay you better for your suffering.

My beef was never about pay, to be fair. It was about poor leadership, a poor mission plan, an utter lack of attention to detail, a complete misunderstanding of the needs of clinical medicine on the part of the leadeship, a complete lack of concern for all of that, with a corresponding emphasis on secondary and tertiary issues like keeping the nurses and the GS front desk happy in spite of a disgruntled and under-utilized medical staff, skill rot, operational billets, etc., etc.

There's a balance between eating horse$#it and having enough lemonade to wash it down. The military is going to feed you buckets of horse$#it. They're going to want you to choke it down because its service to your country and because they're promising a glass of lemonade if you eat it for 20 years.

I prefer eating as little horse$#it as possible, and having that fairly mitigated by a relatively matched amount of lemonade.

I do actually agree that you -can- be a lifer and not actually drink the kool aid. I think those guys are -really- rare, but I've known some. Some of them just bought a truck load of horse$#it up front by doing rotc/West Point/UHSU right off the bat without thinking about what that meant until later. Others just suck it up, know the system is crap, but stick around anyway because every now and then there's an apple in their horse$#it. But most people drink the kool aid. Either they take a heaping gulp, or just a few sips that help them was down the horse$#it because there isn't enough lemonade and that's what they need to do to survive.

 

[HighPriest]

I should also say: I think there are far, far more people who aren't in MEDCOM to really do like military service. I think that's much more of a norm. MEDCOM is a totally different beast. The Army is also a totally different beast from the Navy or AF. It always tickles my cockles when I hear someone with prior service talking about how great it'll be as a military doc.

I think if anyone has a chance at really liking military medicine, it'll be a prior service guy/gal, but even in those situations most of them get tired of eating horse$#it.

 

[Matthew9Thirtyfive]

Except that you can switch jobs if you don't like your employer. No job is perfect, for sure. However, small to medium sized companies tend to at least take their employees concerns into account to avoid a mass exodus due to poor decision making. Large companies may not, but at least the employees can leave. And they generally pay you better for your suffering.

Yes, that is one of the downsides. You can leave, but you have to wait until your contract is up. I happen to think the pay is pretty good, but it could always be better, and when I am working 100+ hours a week and getting the same pay as when I'm working 50 hours per week, it kind of sucks.

My beef was never about pay, to be fair. It was about poor leadership, a poor mission plan, an utter lack of attention to detail, a complete misunderstanding of the needs of clinical medicine on the part of the leadeship, a complete lack of concern for all of that, with a corresponding emphasis on secondary and tertiary issues like keeping the nurses and the GS front desk happy in spite of a disgruntled and under-utilized medical staff, skill rot, operational billets, etc., etc.

There's a balance between eating horse$#it and having enough lemonade to wash it down. The military is going to feed you buckets of horse$#it. They're going to want you to choke it down because its service to your country and because they're promising a glass of lemonade if you eat it for 20 years.

I prefer eating as little horse$#it as possible, and having that fairly mitigated by a relatively matched amount of lemonade.

I do actually agree that you -can- be a lifer and not actually drink the kool aid. I think those guys are -really- rare, but I've known some. Some of them just bought a truck load of horse$#it up front by doing rotc/West Point/UHSU right off the bat without thinking about what that meant until later. Others just suck it up, know the system is crap, but stick around anyway because every now and then there's an apple in their horse$#it. But most people drink the kool aid. Either they take a heaping gulp, or just a few sips that help them was down the horse$#it because there isn't enough lemonade and that's what they need to do to survive.

The lifers are definitely less common. I'd say out of both of the commands I've been to (~350 people each), maybe 20-30 at each command were lifers. Some of them are the kool aid lifers, but many of them just like the job and like serving. It's not that rare IME.

I should also say: I think there are far, far more people who aren't in MEDCOM to really do like military service. I think that's much more of a norm. MEDCOM is a totally different beast. The Army is also a totally different beast from the Navy or AF. It always tickles my cockles when I hear someone with prior service talking about how great it'll be as a military doc.

I think if anyone has a chance at really liking military medicine, it'll be a prior service guy/gal, but even in those situations most of them get tired of eating horse$#it.

Army is different. I have never met an Army doc who liked being part of Army medicine. I have met far more Navy and Air Force docs (including in my own family) who enjoy/enjoyed their jobs.

 

[HighPriest]

So, for starters, not everyone has a contract. (we're talking civilian medicine, right?) And, generally you do not have to wait until your contract is up to leave. You may pay something for that, but if it's bad enough, it may be worth it. I work about as much as I did in the Army, but I make three times as much. Granted, I tried to work as hard as I could in the Army because I felt that was the right things to do. But if you're working 100 hours/week as a civilian and making what you did in the Army, you're doing something very wrong....or perhaps you're just in a bad specialty. Not all things are applicable across the board, and I think for primary care the military is a much better option than it is for anyone else.

Lifers are becoming much less common, especially with O-5 becoming the standard terminal rank, and O-5 promotions becoming much harder to achieve. When I say people who like being in the military are rare, I'm talking about military medicine. I can count on two hands the number of people who I met in 9 years who told me that they liked their job. Most of them were drinking so much Kool Aid that their tongues were purple.

 

[Matthew9Thirtyfive]

So, for starters, not everyone has a contract. (we're talking civilian medicine, right?) And, generally you do not have to wait until your contract is up to leave.

No, I was referring to military.

You may pay something for that, but if it's bad enough, it may be worth it. I work about as much as I did in the Army, but I make three times as much. Granted, I tried to work as hard as I could in the Army because I felt that was the right things to do. But if you're working 100 hours/week as a civilian and making what you did in the Army, you're doing something very wrong....or perhaps you're just in a bad specialty. Not all things are applicable across the board, and I think for primary care the military is a much better option than it is for anyone else.

Again, talking about military.

Lifers are becoming much less common, especially with O-5 becoming the standard terminal rank, and O-5 promotions becoming much harder to achieve. When I say people who like being in the military are rare, I'm talking about military medicine. I can count on two hands the number of people who I met in 9 years who told me that they liked their job. Most of them were drinking so much Kool Aid that their tongues were purple.

Yeah, anecdotes are common. I know several Navy physicians and a couple AF physicians who love/loved military life. I agree that as the terminal rank goes down, fewer people will likely stay in as not many want to depart from clinical medicine just to advance in rank. But I'm okay retiring at O-4.

 

[HighPriest]

Yeah, anecdotes are common. I know several Navy physicians and a couple AF physicians who love/loved military life. I agree that as the terminal rank goes down, fewer people will likely stay in as not many want to depart from clinical medicine just to advance in rank. But I'm okay retiring at O-4.

Good for you. I would not think that is a common sentiment, considering how much you're giving up. I will be interested to see how you feel after 1-2 years as a staff physician.

 

[Matthew9Thirtyfive]

Good for you. I would not think that is a common sentiment, considering how much you're giving up. I will be interested to see how you feel after 1-2 years as a staff physician.

Yeah, we'll see. I'm coming from 6 years enlisted in Navy medicine in extremely high optempo commands, so I am pretty confident I'll stick it out. But as I've learned in my military career, you never know until you're in it, and working ship's medical isn't the same as being a staff doc.

 

[HighPriest]

Yeah, anecdotes are common.

Anecdotes are common. Retention rates, however, are not anecdotal. Most people do not retire. The real question is: are those that do doing so because they love the abuse, or because it's worth doing once you get past a certain time in service, or because they were committed to doing it, or because they just aren't cut out for civilian medicine? My experience was always that those that truly love it were a slim minority and most of those were fully institutionalized. But, you know, anecdotes are common.

 

[Matthew9Thirtyfive]

Anecdotes are common. Retention rates, however, are not anecdotal. Most people do not retire. The real question is: are those that do doing so because they love the abuse, or because it's worth doing once you get past a certain time in service, or because they were committed to doing it, or because they just aren't cut out for civilian medicine? My experience was always that those that truly love it were a slim minority and most of those were fully institutionalized. But, you know, anecdotes are common.

Yeah, you can't deny numbers. As I said, the happy lifers are definitely the minority.

 

[alpinism]

Agree with the above.

If you want to serve join the reserves after residency.

For all intensive purposes emergency medicine = family medicine in the military with the exception of deployments and even those can be hit or miss.

 

[DrMetal]

As much as I love the Navy, EM is mostly primary care.

Uh...no. I'd argue that EM is not mostly primary care (they don't titrate BP medications or insulin regimens). You could argue that it's mostly urgent care.

Quite honestly, unless you're at a major trauma center, which none of the MTFs are, you're not going to see much as a Navy EM doc. You'll be treating a whole lot of nothing, that a mid-level provider could just as easily do.

 

[Apollyon]

For all intensive purposes

"Intents and purposes"

For fun: D.O. that matched allopathic EM programs with COMLEX only?

"Agnosium"

 

[Matthew9Thirtyfive]

Uh...no. I'd argue that EM is not mostly primary care (they don't titrate BP medications or insulin regimens). You could argue that it's mostly urgent care.

Quite honestly, unless you're at a major trauma center, which none of the MTFs are, you're not going to see much as a Navy EM doc. You'll be treating a whole lot of nothing, that a mid-level provider could just as easily do.

Good distinction. That’s actually what I meant, but primary care at 0200 is a common way to describe EM at places where you aren’t seeing trauma.

 

[BombsAway]

Why navy? Go army or airforce and end up at sammc. Civilian traumas all day 'err day.

 

[Matthew9Thirtyfive]

Go army or airforce

Yeah, but then you have to be in the Army or the Air Force (tbf, my cousin is an AF orthopod and loves it, but I’ve seen those guys get super ****ed admin wise).