Ending Navy GMO?

[SporkInaWall]

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I was told by my recruiter that the Navy is pretty much eliminating the GMO tour by 2013. Has anyone else heard anything about this?

 

[Perrotfish]

They're definitely not going away entirely. The plan as of right now is to convert 500 GMO billets to board certified billets over 5 years (100/year), which will bring GMOs down to about the same level as you see in the Army. That would mean all but the most competitive specialties would have straight thorugh training.

Most physicians on this board seem to be betting that this plan will stop short, if it happens at all. This plan may (though nothing's official) involve all physicians doing a GMO tour as their initial utilization tour after residency, regardless of what they're trained in (so surgeons will be fair game to provide primary care to Marines). The other alternative would be to have the IM/FP/Peds guys take over pretty much all the GMO duties that have previously been divided across the entire medical corps.

This is year 2 of the 5 year plan. In year 1 they did actually convert 100 billets. We'll know very soon (does anyone know already?) if they followed through for the second year.

I'm only an M2, BTW. Someone please correct me if I'm wrong about any of this.

 

[SporkInaWall]

They're definitely not going away entirely. The plan as of right now is to convert 500 GMO billets to board certified billets over 5 years (100/year), which will bring GMOs down to about the same level as you see in the Army. That would mean all but the most competitive specialties would have straight thorugh training.

I apologize ahead of time for being an idiot but what exactly do you mean by board certified billet? Does this essentially mean they are converting some of their GMOs to residencies?

Most physicians on this board seem to be betting that this plan will stop short, if it happens at all. This plan may (though nothing's official) involve all physicians doing a GMO tour as their initial utilization tour after residency, regardless of what they're trained in (so surgeons will be fair game to provide primary care to Marines). The other alternative would be to have the IM/FP/Peds guys take over pretty much all the GMO duties that have previously been divided across the entire medical corps.

This is year 2 of the 5 year plan. In year 1 they did actually convert 100 billets. We'll know very soon (does anyone know already?) if they followed through for the second year.

I'm only an M2, BTW. Someone please correct me if I'm wrong about any of this.

Wow there seems to be a pretty large difference between the two plans. Is there any time-frame for deciding one way or another?

Thanks for the response by the way.

 

[Roberie]

I apologize ahead of time for being an idiot but what exactly do you mean by board certified billet? Does this essentially mean they are converting some of their GMOs to residencies?

Not converting GMOs to residencies, but rather REPLACING GMOs with board certified physicians.

 

[blee]

Not converting GMOs to residencies, but rather REPLACING GMOs with board certified physicians.

and I suspect the realities of doing this are what keep pushing back the projected end of the GMO tour. I have my doubts as to whether GMOs will ever truly go away.

 

[IgD]

Wonder if we are still gonna be seeing threads like this 20 to 30 years from now!

 

[AF M4]

Wonder if we are still gonna be seeing threads like this 20 to 30 years from now!

Lol, my money's on "yes".

To the OP, if you dig around deep enough on this website you can find the threads discussing the various "this is the end of the GMO" plans that have been put forth over the years. Some discuss plans that went back to the late 80s/early 90s as the set point when GMOs were supposed to go kaput - every "5 year plan" got a moderate head of steam to begin with but then faltered when the .mil realized they couldn't retain enough board-certified docs to fill staff positions in their major hospitals, let alone hundreds of GMO billets. I think we're on 5-Year Plan Version 4.2 at this point.

Obviously the GMO "tradition" is still going strong today, and will be for the foreseeable future. When considering any kind of military medicine commitment, please anticipate that the GMO will still be in place and that there is a chance that you may be tasked to do a 2-4 year GMO tour between medical school/internship and a full residency.

 

[NavyFP]

Lol, my money's on "yes".

To the OP, if you dig around deep enough on this website you can find the threads discussing the various "this is the end of the GMO" plans that have been put forth over the years. Some discuss plans that went back to the late 80s/early 90s as the set point when GMOs were supposed to go kaput - every "5 year plan" got a moderate head of steam to begin with but then faltered when the .mil realized they couldn't retain enough board-certified docs to fill staff positions in their major hospitals, let alone hundreds of GMO billets. I think we're on 5-Year Plan Version 4.2 at this point.

Obviously the GMO "tradition" is still going strong today, and will be for the foreseeable future. When considering any kind of military medicine commitment, please anticipate that the GMO will still be in place and that there is a chance that you may be tasked to do a 2-4 year GMO tour between medical school/internship and a full residency.

I too believe we will never see the complete end to the GMO, but they do keep chipping away at it.

About 10 or so years ago, we had over 800 GMO billets. We are down to around 400. I believe we will bottom out at 150.

 

[SporkInaWall]

Obviously the GMO "tradition" is still going strong today, and will be for the foreseeable future. When considering any kind of military medicine commitment, please anticipate that the GMO will still be in place and that there is a chance that you may be tasked to do a 2-4 year GMO tour between medical school/internship and a full residency.

Thanks. I will definitely incorporate this into my decision. I don't think I'd be strongly against doing a GMO tour but it's nice to know what to expect. When I've spoken to recruiters or recruiter contacts I've gotten the impression that certain concepts were "skirted around" or details left out. More than anything I'm just trying to make an informed decision.

Thanks for all the input guys/gals.

 

[orbitsurgMD]

Thanks. I will definitely incorporate this into my decision. I don't think I'd be strongly against doing a GMO tour but it's nice to know what to expect. When I've spoken to recruiters or recruiter contacts I've gotten the impression that certain concepts were "skirted around" or details left out. More than anything I'm just trying to make an informed decision.

Thanks for all the input guys/gals.

I think it would be safe to say you can expect to do a GMO tour if you have plans to go into any specialty that is at least moderately competitive to match in as a civilian. You will almost certainly have to do a GMO tour to get derm, ortho, radiology, anesthesia, ophthalmology, ENT, pathology, urology, plastics, CT, vascular and colo-rectal surgery (unless they defer you first for surgery than make you do a utilization tour as a general surgeon before a fellowship.)

 

[BigNavyPedsGuy]

I think it would be safe to say you can expect to do a GMO tour if you have plans to go into any specialty that is at least moderately competitive to match in as a civilian. You will almost certainly have to do a GMO tour to get derm, ortho, radiology, anesthesia, ophthalmology, ENT, pathology, urology, plastics, CT, vascular and colo-rectal surgery (unless they defer you first for surgery than make you do a utilization tour as a general surgeon before a fellowship.)

I'd go one step further and say that you should be prepared to do a GMO regardless of specialty. Sometimes people in specialties that typically go strait through end up doing involuntary GMOs. Best to go in with your eyes wide open.

 

[edmadison]

I'd go one step further and say that you should be prepared to do a GMO regardless of specialty. Sometimes people in specialties that typically go strait through end up doing involuntary GMOs. Best to go in with your eyes wide open.

Yeah, be careful what you wish for. As someone who did a 2-year GMO tour as a residency trained physican, I can tell you I would have much rather done a GMO tour between intership and PGY-2. Sitting around seeing sick call for two years and letting my knowledge base and skills atrophy really sucked. Of course the big downside of the GMO (and what kept me from joining the Navy) is that it essentially increases your service time if you stay in for residency.

Ed (207 days and counting)

 

[BigNavyPedsGuy]

Yeah, be careful what you wish for. As someone who did a 2-year GMO tour as a residency trained physican, I can tell you I would have much rather done a GMO tour between intership and PGY-2. Sitting around seeing sick call for two years and letting my knowledge base and skills atrophy really sucked. Of course the big downside of the GMO (and what kept me from joining the Navy) is that it essentially increases your service time if you stay in for residency.

Ed (207 days and counting)

Yes, but at least you were eligible for ISP during your GMO. Every year one does as a GMO costs them 20K they would be making if they paid that time back after residency.

So hopefully $40,000 might ease your suffering a little bit. 🙂

 

[BOHICA-FIGMO]

I was told by my recruiter that the Navy is pretty much eliminating the GMO tour by 2013. Has anyone else heard anything about this?

Two words: Bull and crap.
Or: Lip and service.

Based on what I'm seeing so far, the Navy will continue to have significant numbers of GMOs for the next 10-15 years.

 

[BOHICA-FIGMO]

Not converting GMOs to residencies, but rather REPLACING GMOs with board certified physicians.

With who? There are not enough board certified IMs and FPs in the whole Navy to fill this requirement! (Of course, I think Bethesda could spare a few )

 

[Gastrapathy]

With who? There are not enough board certified IMs and FPs in the whole Navy to fill this requirement! (Of course, I think Bethesda could spare a few )

This the the crux of the problem. There are enough if you just deploy them to death. This is what the AF and Army have done to decrease their GMOs and the burden for this falls heavily on FPs, Internists and Pediatricians. This is supposedly why they increased the IM and FP bonuses.

The good thing about the GMO system is that the future Dermatologists, Anesthesiologists and Radiologists take part of the operational burden. The bad part is the at the future pathologists also take part (and the general standard of care).

 

[Tadgie]

The plan has always been to switch GMO billets to full fledged practicioners, and they even had decent momentum in converting the numbers each year. Lots of pretty graphs showing a gradual decline in GMO billets each year. However, this year with the sudden drop in recruiting 4 years ago, they had to stop the conversion. Only just over 50 interns were slated to go straight through to complete residency this year, navy wide out of over 250. Again, essentially because of poor recruiting, which the signing bonus apparently fixed. But we'll have to see how things go next year given the hold up this year.
Theres a lot of angry interns because of this, (had been told the same thing, GMOs will be gone shortly, everyone will go straight through)so we'll see how things go in 3 years when the majority of them decide to go civillian instead of returning for residency.

Current-intern-about-to-be-GMO

 

[Gastrapathy]

Quick search for similar threads going back a couple of years. Kinda classic.

http://forums.studentdoctor.net/showthread.php?t=278041
http://forums.studentdoctor.net/showthread.php?t=280950
http://forums.studentdoctor.net/showthread.php?t=357697
http://forums.studentdoctor.net/showthread.php?t=482760
http://forums.studentdoctor.net/showthread.php?t=430930

 

[IgD]

The plan has always been to switch GMO billets to full fledged practicioners, and they even had decent momentum in converting the numbers each year...

Where is the doctrine? Where is this plan and who created it? I'm asking those questions because I don't think you will find an answer to them. I'd like to point out that the discussion in this thread mirrors the discussions back in the late 1990's when the DoD directed that GMO tours be stopped.

I think the practice could easily be stopped. Navy medicine could change the credentialing instructions to prohibit clinical privileges for non-residency trained physicians. I suspect you won't see that happen nor will you see any discussion about the issue.

I want to believe but I would be skeptical of any military medicine leader who promises GMO tours are being phased out without providing any changes in the doctrine. Those military medicine leaders would have been in the system for 15-20 years, be well acquainted with the problem and know that GMO tours aren't going anywhere.

 

[Gastrapathy]

Where is the doctrine? Where is this plan and who created it? I'm asking those questions because I don't think you will find an answer to them. I'd like to point out that the discussion in this thread mirrors the discussions back in the late 1990's when the DoD directed that GMO tours be stopped.

I think the practice could easily be stopped. Navy medicine could change the credentialing instructions to prohibit clinical privileges for non-residency trained physicians. I suspect you won't see that happen nor will you see any discussion about the issue.

I want to believe but I would be skeptical of any military medicine leader who promises GMO tours are being phased out without providing any changes in the doctrine. Those military medicine leaders would have been in the system for 15-20 years, be well acquainted with the problem and know that GMO tours aren't going anywhere.

Easily stopped, yes...and NO. You can dictate policy all you want but don't say that makes it easy. What would the consequences be? Would you have been prepared to do 2 back to back GMO tours after finishing crazy people training since we need to fill the billets? Or would you just dictate policy and let the FPs suck up all the pain?

 

[IgD]

Easily stopped, yes...and NO. You can dictate policy all you want but don't say that makes it easy. What would the consequences be? Would you have been prepared to do 2 back to back GMO tours after finishing crazy people training since we need to fill the billets? Or would you just dictate policy and let the FPs suck up all the pain?

I would argue it doesn't make sense to put a psychiatrist, a surgeon, a radiologist or a pathologist in a primary care billet. I don't think it is good medicine or cost effective. I would argue on the greenside you want your battalion surgeon to be a family practice doc or internist. You want to position your Psychiatrists at the Division and Regiment levels. Not sure what the blueside and brownwater Navy equivalents would be. I would suggest that there are plenty of deployment opportunities for psychiatrists especially these days without throwing GMO tours in the mix.

What would you recommend for an internal medicine subspecialist? I've seen subspecialists rotate through the general medicine wards all the time. I suppose it would be reasonable for them to do primary care. Not sure what to think of Peds. I remember a while back someone quoted Rumsfeld as saying why do we have Pediatricians in the Navy if they don't deploy? There are some other outliers as well. It wouldn't make sense to me to deploy a dermatologist in a primary care billet. Do dermatologists deploy as subspecialists?

 

[Gastrapathy]

I would argue it doesn't make sense to put a psychiatrist, a surgeon, a radiologist or a pathologist in a primary care billet. I don't think it is good medicine or cost effective.

So your "easy" solution is only easy because it doesn't apply to you and people like you. Not so easy for the primary care physician who never gets to see sick people because they are the "right" people to fill these jobs over and over.

I think getting rid of GMOs without making primary care even crappier is a difficult problem. We need to find a way to train and accession more primary care physicians to maintain a remotely reasonable sea/shore cycle. Otherwise, we'll make the ones we do have so miserable, we'll lose them too.

I understand the concerns about substandard care. I would say that, in my experience, there is no evidence that GMOs have harmed patients in large numbers (yes we all have anecdotes but even in the worst examples, the patients usually do ok), probably because of the relative health of the population. I think we need to take a hard look at the number of operational billets and how many we really need. We could get rid of half the FS billets tomorrow (squadron time...really) and no one would notice. A ship sitting in a shipyard or a Marine battalion sitting at home doesn't need a physician to do admin all day.

To be honest, I favor converting isolated duty and any place that you could run into a kid into a BC position. But, the rest of the billets, with proper supervision, could stay GMO billets as far as I'm concerned.

 

[IgD]

I think getting rid of GMOs without making primary care even crappier is a difficult problem. We need to find a way to train and accession more primary care physicians to maintain a remotely reasonable sea/shore cycle. Otherwise, we'll make the ones we do have so miserable, we'll lose them too.

I agree and I think to do it right it would take careful planning. It would require significantly increasing the number of primary care physicians in the Navy. It would require recoding a number of billets and increasing the size of primary care residency training programs. I think if done right, it could be a win-win situation for everyone involved. I think the biggest roadblock to this is cost.

 

[IgD]

A ship sitting in a shipyard or a Marine battalion sitting at home doesn't need a physician to do admin all day.

I disagree with that. You need a physician attached to the ship or Marine battalion so they can train with their unit and form key relationships with the command. You need that physician to be on solid ground in the event of a sudden deployment so they can be effective.

I remember working on the greenside hospital corpsmen would be pulled from the Navy hospital shortly before deployment and it created a lot of chaos. The commanders were frustrated with this.

 

[Gastrapathy]

I disagree with that. You need a physician attached to the ship or Marine battalion so they can train with their unit and form key relationships with the command. You need that physician to be on solid ground in the event of a sudden deployment so they can be effective.

I remember working on the greenside hospital corpsmen would be pulled from the Navy hospital shortly before deployment and it created a lot of chaos. The commanders were frustrated with this.

The corpsmen need to integrate earlier than the physicians do. They are part of the unit in a way the doctors never can be. "Key relationships" and "effective" are admin buzzwords. This has nothing to do with patient care and means a doctor is hanging around rather than seeing patients. Keep an IDC with the unit and expect the doctor to establish an effective relationship on the fly. We do it in the exam room every day. It is a physician skill to be able to do that quickly.

When a pissed off Marine O6 called me yesterday, we didn't start off with an "effective relationship" but I calmly held my ground, explained what was going on and we got on the same page quickly. It isn't that hard. These are not complicated people. A straightforward, direct approach will pretty much always work.

 

[dru2002]

The corpsmen need to integrate earlier than the physicians do. They are part of the unit in a way the doctors never can be. "Key relationships" and "effective" are admin buzzwords. This has nothing to do with patient care and means a doctor is hanging around rather than seeing patients. Keep an IDC with the unit and expect the doctor to establish an effective relationship on the fly. We do it in the exam room every day. It is a physician skill to be able to do that quickly.

When a pissed off Marine O6 called me yesterday, we didn't start off with an "effective relationship" but I calmly held my ground, explained what was going on and we got on the same page quickly. It isn't that hard. These are not complicated people. A straightforward, direct approach will pretty much always work.

From the corpsman perspective I think that IgD has this right. A good battalion surgeon has formed key relationships within the battalion. He knows how things work. I'm not saying there aren't some physicians that could adopt quickly and make things work but nearly as effectively has someone who has been there all along.

 

[ftrflyr29]

From the corpsman perspective I think that IgD has this right. A good battalion surgeon has formed key relationships within the battalion. He knows how things work. I'm not saying there aren't some physicians that could adopt quickly and make things work but nearly as effectively has someone who has been there all along.

I will put a plug in from the pilot perspective as well. It is imperative for the FS to develop a good rapport with the aviators in a squadron, because of the delicacy of medical issues wrt aviation a corpsman just won't cut it, and lots of times there isn't a corpsman even available to be attached to the squadron. If the FS is an unknown quantity, no aviator will go to see them, for fear of being med down/grounded.

Also, due to the crazy flight schedules that change everyday--particularly in the USN/USMC when the flight schedule comes out the day before--most issues get discussed in passing in the squadron spaces. The only medical appointments most aviators make are the required annual flight physical appts, and then those are usually during the last week of the month--there just isn't time. So the squadron time is an absolute necessity. It typically consists of the FS getting some flight time if able, then being a known, available presence and as the he is walking out the door to go to clinic, some aviator will grab him (between the brief and walking to the a/c) and say, "Hey Doc.....what do you think about........" If that access wasn't available, no one would ever get treated. They would fly until their limb fell off or their sinuses exploded (not sure of the accurate term for this phenomenon, but just know it feels like your face blew up on the inside).

 

[AF M4]

I disagree with that. You need a physician attached to the ship or Marine battalion so they can train with their unit and form key relationships with the command. You need that physician to be on solid ground in the event of a sudden deployment so they can be effective.

I remember working on the greenside hospital corpsmen would be pulled from the Navy hospital shortly before deployment and it created a lot of chaos. The commanders were frustrated with this.

Machiavellian 5 Year Plan that I Hope No One Pulls While I Am Still in Uniform:

- Key assumption: roughly 95%+ of physicians leave the military as soon as their initial commitment is up. Reasons for this are listed ad nauseum on this web site, and none of them are changing without a major overhaul.

So instead of trying to repair this MilMed clunker, scrap it for parts instead.

First, burn out every doc currently in the service or training pipeline. Deploy them like crazy, work them to death in clinic and yes, cut their bonuses. They get paid for their rank and time in service just like everyone else. Then we plow that extra money into something else. Sure the docs will raise hell, but 95%+ of them were leaving despite getting the bonuses anyway, so what's the point?

While we're burning out the docs currently in the system, we're using that time to pull the plug on this whole .mil GME debacle. Yeah, yeah, they're ACGME-certified, but the training programs are expensive to maintain and we don't really need the residents because we've booted the retiree population to the civilian world anyway. A lot of the programs are half-dead as well, as evidenced by the fact that we have to farm the .mil residents to civvie programs to get proper training already. Also, killing off the GME programs frees up many of those attendings who were teaching there, giving us more options for docs to deploy. Bonus there.

So then we take all that money that we freed up by cutting bonuses and pulling down GME programs, and use that to essentially form a contracting service for military medicine. Make it a Purple Service as well.

We'll keep some GMO slots open, maybe fill them with a bunch of international grads and advertise it as a great way to enter the US, get a green card, and we'll even establish a pipeline to some civvie residencies for those international grads who do a good job - advertise serving the USA as a great way to get established here with your favored career, etc. Meantime all the other former GMO slots are filled with NPs and PAs. We also hire only board-certified docs for physician positions, and we'll pay a whopping bonus for those willing to deploy - make it a month by month thing, with points towards retirement or some other added incentive. Hell, hire back all those former active duty docs at multiple times their previous pay, give 'em the option of where they want to live and a cool new uniform and it's like all those promises they got back in the day are coming true.

And oh yeah, we're killing off AHLTA and grabbing the free CPRS from the VA. Enough's enough, and we'll save a buttload of cash too.

 

[Gastrapathy]

I will put a plug in from the pilot perspective as well. It is imperative for the FS to develop a good rapport with the aviators in a squadron, because of the delicacy of medical issues wrt aviation a corpsman just won't cut it, and lots of times there isn't a corpsman even available to be attached to the squadron. If the FS is an unknown quantity, no aviator will go to see them, for fear of being med down/grounded.

Also, due to the crazy flight schedules that change everyday--particularly in the USN/USMC when the flight schedule comes out the day before--most issues get discussed in passing in the squadron spaces. The only medical appointments most aviators make are the required annual flight physical appts, and then those are usually during the last week of the month--there just isn't time. So the squadron time is an absolute necessity. It typically consists of the FS getting some flight time if able, then being a known, available presence and as the he is walking out the door to go to clinic, some aviator will grab him (between the brief and walking to the a/c) and say, "Hey Doc.....what do you think about........" If that access wasn't available, no one would ever get treated. They would fly until their limb fell off or their sinuses exploded (not sure of the accurate term for this phenomenon, but just know it feels like your face blew up on the inside).

Again, this is only the expectation because we've trained it to be. CEO's don't need doctors at their beck and call. Healthy young people don't need doctors they can "hey doc" as they hang out. Pilots like to pretend they are so special but its just not true. Its an incredible waste of resources.

I've deployed as part of a unit and as an IA. Two days with the unit and I was part of the team. We expect patients to consent for risky, invasive procedures when they first meet us and gaining their trust is something you learn over time. The same thing applies here.

The line guys will keep saying it matters but basically its just a security blanket that has nothing to do with patient care and everything to do with handholding.

 

[IgD]

Again, this is only the expectation because we've trained it to be. CEO's don't need doctors at their beck and call. Healthy young people don't need doctors they can "hey doc" as they hang out. Pilots like to pretend they are so special but its just not true. Its an incredible waste of resources.

I've deployed as part of a unit and as an IA. Two days with the unit and I was part of the team. We expect patients to consent for risky, invasive procedures when they first meet us and gaining their trust is something you learn over time. The same thing applies here.

The line guys will keep saying it matters but basically its just a security blanket that has nothing to do with patient care and everything to do with handholding.

I don't agree with your statements at all. Based on my experience I can't see any way that a medical officer could show up a few days in an operational environment before deployment and be effective. I think if you were a subspecialist that could work but there would already be a medical officer embedded in the unit that would be your framework for success.

 

[Gastrapathy]

I don't agree with your statements at all. Based on my experience I can't see any way that a medical officer could show up a few days in an operational environment before deployment and be effective. I think if you were a subspecialist that could work but there would already be a medical officer embedded in the unit that would be your framework for success.

Fail how? Honestly, operational medicine is the easist thing we do.

Show up for the last phase of work-ups, then deploy. It would work fine.

We've created an incredibly entitled aviation community, in particular, where an O2 pilot thinks its completely reasonable to have a physician hanging around playing Xbox just in case he gets the sniffles. Its not the pilots' fault, its ours. And the FS community plays right in, since they are mostly people who don't really want to do primary care and would rather play Xbox than see sick call. Now, don't get me wrong, I kicked ass at Halo after a couple of years.

 

[ftrflyr29]

Again, this is only the expectation because we've trained it to be. CEO's don't need doctors at their beck and call. Healthy young people don't need doctors they can "hey doc" as they hang out. Pilots like to pretend they are so special but its just not true. Its an incredible waste of resources.

I will agree that this statement probably holds some water, it does remind me a little of the surface guys on the carrier that hate aviators and complain incessantly about the airwing. If I remember correctly, the carrier's focus is to launch an recover aircraft--without the airwing, it would just be a floating city with no purpose.

Having worked in the outside world for a large company, there were actually a handful of doctors employed specifically to treat the employees of said company. I imagine the CEO had said Dr's at his beck and call. This was their only job as physicians. Their call consisted of being available after hours for the employees.

The FS in a squadron is responsible for all members of the squadron--this can range from 140 (in the smallest single-seat squadron) to 400+ in your standard Maritime/Helo squadron.

Currently, our FS spends 2-half days as squadron days and the rest of the time is in clinic unless there is a det or deployment--which are frequent, so I would argue again, the little time spent in the squadron is imperative.

I've deployed as part of a unit and as an IA. Two days with the unit and I was part of the team. We expect patients to consent for risky, invasive procedures when they first meet us and gaining their trust is something you learn over time. The same thing applies here. The line guys will keep saying it matters but basically its just a security blanket that has nothing to do with patient care and everything to do with handholding.

Again, I agree there is some element of handhodling that goes on here, but back to my original statement, the flight schedule in many communities does not afford an aviator nor a maintainer to sit on the phone with central appointments to get an appointment in 3 weeks to see a physician. One cannot plan that far ahead. Or try to get a same day appt by calling at 0600 to snatch up one of the 3 appts available that day.

Also, on deployment--to Iraq and Afghanistan, the helo guys work 2 shifts--day and night. These consist of showing up (the time varied depending on the setting of the sun) early for day crew to get the turnover from the night crew guys then get their ASR's or JTARs (no flight sked for them), fly all day (8hours of flight time--not counting dwell on the ground)--drop off crap or pax, MIA's or KIA's, re-fuel, eat and p*ss at some point, then come back to debrief the night crew guys--who showed up early, so they can start their turn. Then make it back to their can/tent/hooch (whatever) just in time to force themselves asleep for the required 8 hours to do it again. The day crew guys can't ever make it to the clinic because it's only open when their flying--not fiscally responsible to stay open all night, so when is that guy supposed to see the Dr? The maintainers as well, they are launching a/c or working on all the broken a/c that need to be fixed to support the flight schedule.

The fixed-wing guys have a little more flexibility, but it's still difficult. Depending on who needs air support, the day can change in a minute. Off the boat, the missions to Iraq were routinely 5+ hours, while to Afghanistan 7+ hours, so again--not a lot of time to go to the clinic that may or may not be open.

Show up for the last phase of work-ups, then deploy. It would work fine.

We've created an incredibly entitled aviation community, in particular, where an O2 pilot thinks its completely reasonable to have a physician hanging around playing Xbox just in case he gets the sniffles. Its not the pilots' fault, its ours. And the FS community plays right in, since they are mostly people who don't really want to do primary care and would rather play Xbox than see sick call. Now, don't get me wrong, I kicked ass at Halo after a couple of years.

I will agree there are some entitled aviators and that is bread, so I'm not here to argue about that--it could be said about any community--MC as well.

I have to disagree with the first phrase of showing up during the last phase of workups--again, where are those workups? In the Navy, it will be the standard places--Fallon, Key West, the boat, but what about the Marine squadrons--Yuma, CAX, etc. Who treats the squadron during the work-up cycle? Medical at Fallon, Yuma, Key West, 29 Palms, they don't plus up their staff during a work-up just to cover those extra personnel that show up and they definitely don't change their hours for the guys that can only come at night.

There were many times during the work-up cycle of mission planning, briefing, flying, paperwork, tape review, TACTS debrief, mass debrief, element debrief, evaluation debrief, 8 hours crew rest, just to start all over again that one is not able to make a medical appointment and keep it. Again, the clinic is only open from 0730-1630 and closes early on Thurs at 1400 for field day at training, so when is the sick guy (aviator or maintainer) supposed to get treated. Oh, I know they can go to the ER--because that never takes FOREVER.

Now, this post is not meant to get into the argument of my existence sucks worse than your existence, but it is just some of the realities of Navy/USMC aviation and why IMHO, I think it's necessary for a FS to be part of a squadron.

 

[IgD]

Fail how? Honestly, operational medicine is the easist thing we do.

Show up for the last phase of work-ups, then deploy. It would work fine.

We've created an incredibly entitled aviation community, in particular, where an O2 pilot thinks its completely reasonable to have a physician hanging around playing Xbox just in case he gets the sniffles. Its not the pilots' fault, its ours. And the FS community plays right in, since they are mostly people who don't really want to do primary care and would rather play Xbox than see sick call. Now, don't get me wrong, I kicked ass at Halo after a couple of years.

Like I said I don't agree with that at all. I'm basing my experience dealing with battalions of 1000 Marines who had serious medical problems including TBI and gunshot wounds. It took an immense amount of communication/coordination with the command, subspecialists and others to make sure their needs were met. On top of providing restorative care, medical was also responsible for providing prevention and ensuring readiness. Maybe they should realign some of those Xbox players over to the infantry and MLG🙂

 

[pgg]

Or would you just dictate policy and let the FPs suck up all the pain?

Yes.

Not trying to be too snarky here, but if you join the military and choose primary care, what's so shocking about ending up with a line unit doing primary care? I sure as hell wouldn't want to do it (again) but that's why I didn't choose FP or IM.

It's the pediatricians who get sent to GMO billets that I sympathize with most ... even more so than the interns who have their training delayed by 2 or 3 years to go do something they're wholly disinterested in doing.

This is not to say that the system couldn't or shouldn't be arranged to allow FPs in GMO billets to get some kid/senior clinic or hospital inpatient time. And lots of the current GMO workload could be turfed to midlevels who explicitly signed up for that kind of pain. GMO-land is dysfunctional on many levels.

But yeah, if the Navy is going to acknowledge that a BC physician is appropriate for a particular GMO billet, who better than an IM or FP doc to put there?

 

[Gastrapathy]

Yes.

Not trying to be too snarky here, but if you join the military and choose primary care, what's so shocking about ending up with a line unit doing primary care? I sure as hell wouldn't want to do it (again) but that's why I didn't choose FP or IM.

It's the pediatricians who get sent to GMO billets that I sympathize with most ... even more so than the interns who have their training delayed by 2 or 3 years to go do something they're wholly disinterested in doing.

This is not to say that the system couldn't or shouldn't be arranged to allow FPs in GMO billets to get some kid/senior clinic or hospital inpatient time. And lots of the current GMO workload could be turfed to midlevels who explicitly signed up for that kind of pain. GMO-land is dysfunctional on many levels.

But yeah, if the Navy is going to acknowledge that a BC physician is appropriate for a particular GMO billet, who better than an IM or FP doc to put there?

Totally agree. My point was that the current numbers of internists and FPs make this unsustainable and we need to fix that first. Otherwise, we just pound them into the ground AF style. My objection was to a specialist who wouldn't take any of the extra load calling it an easy change.

ftrflyr: A couple of points. Supporting the line is an important mission, but unlike the carrier, not our only mission. Providing medical care to dependents and retirees is a big and important part of what we do. As pgg points out, many operational jobs could be filled by midlevels or even IDCs. Its a rare event that a young healthy person is sick enough to need an ED visit. If we scaled back on the number of "operational billets", we would absolutely need to improve access to short-notice acute care for AD back home. The more isolated units should still have a dedicated MO back here. But in FCAs, we could see a lot more patients with a little efficiency.

 

[IgD]

Its a rare event that a young healthy person is sick enough to need an ED visit.

OMG - Have you ever worked in a military medicine emergency room?

If we scaled back on the number of "operational billets", we would absolutely need to improve access to short-notice acute care for AD back home. The more isolated units should still have a dedicated MO back here. But in FCAs, we could see a lot more patients with a little efficiency.

Sounds like you have never worked in an operational setting before for any meaningful length of time. I remember when a senior Navy medicine leader made similar statements. One of the Marines told this individual at a conference to put her pack on!

 

[Gastrapathy]

OMG - Have you ever worked in a military medicine emergency room?

OMG, really, what are we 12? Have you? Just because we can't find any other way to handle acute low acuity patients in our system doesn't mean that they actually needed ED level care. Using the ED as an acute care clinic is part of the problem.

Sounds like you have never worked in an operational setting before for any meaningful length of time. I remember when a senior Navy medicine leader made similar statements. One of the Marines told this individual at a conference to put her pack on!

And telling her that was a cheap shot because out the other side of their mouths, they want more RVU's, more patients seen, etc. The reality is that supporting the line isn't our only mission. Ironically, in fact, as the surface line tries desperately to stay relevant, supporting us in humanitarian operations has become a major line mission.

As for never having been deployed...shall we play the lets count the sea service ribbons game? I'm only playing if we wager something real.

Our operational mission is important. I just believe we could be more efficient in how we use physicians when units are home. If we want rid of GMOs, we need to maintain our primary care docs skills and keep them productive. When we're close to deployment and certainly on deployment, send us out. Provide the infrastructure to be responsive to their needs when they are home. It just makes sense.

See above, my responses to a shrink who got out.

 

[pgg]

OMG - Have you ever worked in a military medicine emergency room?

One could make the argument, perhaps only a little bit tongue-in-cheek, that a lot of board certified military EM physicians have never worked in a military emergency room either. In many cases, calling the part of a military hospital where the (BLS) ambulances park an "emergency room" is a polite fiction.

(Out here, in the sticks, we don't even call it an ER - it's the ICC, or "immediate care clinic" ...)

 

[IgD]

The reality is that supporting the line isn't our only mission.

But it is the primary mission. Navy medicine's primary job is to support the operational force. My experience was Navy medicine didn't do that job well nor want to do it.

I heard Navy medicine compared to a self-licking ice cream cone once. The idea was Navy medicine was a large bureaucracy who's primary mission was to support itself.

Let me give you an example of that. You've got thousands of Marines who are kicking down doors in Iraq and need mental health support after they come home. Where are all the Navy mental health assets positioned? I would argue it wasn't where the operational force was or where they needed them.

 

[IgD]

Our operational mission is important. I just believe we could be more efficient in how we use physicians when units are home. If we want rid of GMOs, we need to maintain our primary care docs skills and keep them productive. When we're close to deployment and certainly on deployment, send us out. Provide the infrastructure to be responsive to their needs when they are home. It just makes sense.

It seems to me military medicine downsized and downsized to the point where they could barely fulfull the peace time mission and now they are in trouble. I don't see any reason why we can't have a sufficient number of doctors at home and on deployment. Can't be in both places at once and that really seems to be the issue these days. I really hope they get this right for the next war.

 

[Gastrapathy]

But it is the primary mission. Navy medicine's primary job is to support the operational force. My experience was Navy medicine didn't do that job well nor want to do it.

I heard Navy medicine compared to a self-licking ice cream cone once. The idea was Navy medicine was a large bureaucracy who's primary mission was to support itself.

Let me give you an example of that. You've got thousands of Marines who are kicking down doors in Iraq and need mental health support after they come home. Where are all the Navy mental health assets positioned? I would argue it wasn't where the operational force was or where they needed them.

Where are the mental health assets positioned? I don't have a clue. I know you have to be AD to get admitted to my MTF, otherwise you're out in town. So clearly they aren't taking care of dependents.

Self licking ice cream cone is a Marine expression that I've heard applied in plenty of directions. Since the context is that a self-licking ice cream cone is something that exists only to provide enjoyment to itself, I can't nominate Navy medicine for that. Maybe self-licking **** sandwich.

Supporting the line is our primary mission but that doesn't mean we should waste assets doing it. The example from before of 400+ people for one doctor is comical. A good primary care doctor has a panel of several thousand patients (some of whom are old and unhealthy😱).

BTW, I saw a PO1 today with the biggest FTN tattoo on his back.

 

[244913]

Gastrapathy pretty much describes my raison d'etre as a flight surgeon.

The pilots like having me around and I like hanging around with them, because if I'm at the flightline I'm not in the clinic, seeing my 8th patellofemoral syndrome patient of the morning or my favorite- "flu-symptoms." Or initiating medical boards on malingering supporters.

A school nurse could do my job, medically speaking. So damn right I'm going to do whatever I can to escape clinic hell.

I even find myself enjoying sitting through command and staff, training mtgs, and safety briefs.

In another 3 years I'll probably need to be taught how to perform ADL's, but for now I'll put my flightsuit on, my feet up (at the hangar) and enjoy the ride!

61N

 

[met19]

One could make the argument, perhaps only a little bit tongue-in-cheek, that a lot of board certified military EM physicians have never worked in a military emergency room either. In many cases, calling the part of a military hospital where the (BLS) ambulances park an "emergency room" is a polite fiction.

(Out here, in the sticks, we don't even call it an ER - it's the ICC, or "immediate care clinic" ...)

which is the reason why after my civ derferment is up i plan on paying back my time, moonlighting to keep my skills up and getting out. there just arent enough "sick" patients like im used to and if I wanted to work in an UCC, I could still earn tons more with less BS on the outside.

 

[backrow]

Or initiating medical boards on malingering supporters.

Luckily Navy flight surgeons aren't allowed per reg's to initiate med boards so that's one less thing on my plate and leaves more time for XBox.

One other aspect that some people forget is the medical logistics involved in deploying a squadron (especially land based units.) I worked harder during my predeployment time off the clinic schedule than when I was on the schedule. It would be nice if the MTF provided that support, but they don't so the organic medical asset gets stuck with it.

 

[BOHICA-FIGMO]

I don't know about what BS the recruiters are putting out there, but this year 2/3 of the current intern class will be doing GMO next year.