Escaped 2 years ago

[a1qwerty55]

Well it's been two years since retirement and I figured I'd drop in for old time sake. Some of the older members of this forum will remember me. First, being a physician outside the military is exponentially better. Secondly I work way harder but I'm way more satisfied and far more supported. I have to acknowledge that I am where I am because of my military time which allowed me to actually get some skills that others in my community don't have. In my situation I would've done it again but if I were a medical student today there's no way I would do it. My main reason for recommending not joining is this the abhorrent quality of leadership in the current Army environment. I know I've said this before but it isn't cream that floats in the army it's ****. There is no loyalty to subordinates, no leading by example and ethics get lip service only. I did 23 years of active service, deployed twice, was a battalion surgeon made some significant changes to the entire MHS and was recognized as an expert in my field. I never got into trouble and always tried to set the example, by carrying the same or more clinical load as everyone in my department as Chief till the end. For this I received no end of tour or retirement award, neither did two other Colonels retiring with me, one of them was the head of medical education/GME and the other consultant to the Surgeon General. I am a bit bitter as my experience lead me to conclude that the physician is really nothing more than a employee in the minds of the current leaders. For those of you still in or joining I complement you on your service and asked that you fight against the inertia that tries to deprive service members and their families from quality care. PS for any of you USUHS people, I'm still not getting any of my retirement money for the time at USUHS. I've been waiting almost a year for them to process my pay inquiry. They can always hurt you a bit more. I'd also like to point out that while I have a medical center in my area I exclusively receive my healthcare in the civilian sector.

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[Helpful Troll]

Congratulations on the transition!

It might be time for a congressional inquiry to prompt the correction. Submit a pay inquiry monthly with the DoD Financial Management Regulation referenced until resolved. DoD FMR 7000.14 Volume 7B

27 years instead of the current 23 is a significant difference. Based on O6 and 28% tax that's already $20K+ for two years of back pay and they won't likely pay interest.

 

[Homunculus]

There is no loyalty to subordinates, no leading by example and ethics get lip service only. I did 23 years of active service, deployed twice, was a battalion surgeon made some significant changes to the entire MHS and was recognized as an expert in my field. I never got into trouble and always tried to set the example, by carrying the same or more clinical load as everyone in my department as Chief till the end. For this I received no end of tour or retirement award, neither did two other Colonels retiring with me, one of them was the head of medical education/GME and the other consultant to the Surgeon General.

first, this is awful. there is no excuse for not getting a retirement or end of tour award other than blatant incompetence of your command. this would never happen in combatant commands and I'm sorry this happened to you.

thanks for the update, and please stick around. we need people from all phases of their career, and your experience I'm sure isn't alone with the USUHS pay problem.

your post also brings up something I started feeling over the last couple of years. after being to some retirements of some of my mentors, it's not surprising but it is saddening just how quickly they are forgotten and replaced. I don't have any romantic expectations of people pining away for those that have left, but it just supports the notion we are all just cogs in a machine. 6 months after people ETS or retire you'll never know they existed. and this is true for some DoD civilians who have been at places 30+ years.

another point you make, that becomes more and more important to me as I go along-- leadership. early on people care about money, moving, deployments, etc, but as time goes by those things get a little more manageable. by far the most frustrating part of my life now is what you mention-- the all too common terrible leadership we are exposed to. my current OIC is a perfect example. they were an OK residency director. in the real world they would have never been a department chief. but because in the military most of those positions are awarded based on rank moreso than skills, and because not many people are typically interested, the applicant pool is small and frankly pathetic. my wife was on a previous OIC committee and NONE of those who applied were a good fit-- but someone had to be chosen nonetheless.

and even if you do luck out and get a good first or second line leader, the higher you go the more steeped in kool-aid they become. the longer they are in admin, the less they understand what's going on in the trenches. then eventually they go full admin and start talking like politicians or generals. they espouse loyalty and integrity to us but then themselves or as a hospital are the first to abandon these principles for "budgetary" or "staffing" reasons. the hypocrisy of it all grates against me on an almost daily basis. when i interviewed for a potential post-military job last fall, i was shocked to the point of "this can't be real" when every single staff i interviewed with, when i asked about their leadership climate, almost all gave some variation of "i trust my department chief will do what's best for us, he really cares and does everything he can to make our jobs easier. he asks us all the time 'what can i do to help?'" once he asked everyone in the department if they had unlimited research money what they'd do research on-- then came up with a giant chunk of money to give out to people. i must have looked like a caveman discovering a television for the first time. they work hard, but are supported and happy. it's amazing how that works.

at any rate, thanks for the update and i hope your pay gets ironed out. don't be a stranger.

--your friendly neighborhood fence sitting but leaning toward the greener grass caveman

 

[DrMetal]

Well it's been two years since retirement and I figured I'd drop in for old time sake. .

Thank you for your service. Can I ask, what specialty?

 

[a1qwerty55]

Well it's been two years since retirement and I figured I'd drop in for old time sake. Some of the older members of this forum will remember me. First, being a physician outside the military is exponentially better. Secondly I work way harder but I'm way more satisfied and far more supported. I have to acknowledge that I am where I am because of my military time which allowed me to actually get some skills that others in my community don't have. In my situation I would've done it again but if I were a medical student today there's no way I would do it. My main reason for recommending not joining is this the abhorrent quality of leadership in the current Army environment. I know I've said this before but it isn't cream that floats in the army it's ****. There is no loyalty to subordinates, no leading by example and ethics get lip service only. I did 23 years of active service, deployed twice, was a battalion surgeon made some significant changes to the entire MHS and was recognized as an expert in my field. I never got into trouble and always tried to set the example, by carrying the same or more clinical load as everyone in my department as Chief till the end. For this I received no end of tour or retirement award, neither did two other Colonels retiring with me, one of them was the head of medical education/GME and the other consultant to the Surgeon General. I am a bit bitter as my experience lead me to conclude that the physician is really nothing more than a employee in the minds of the current leaders. For those of you still in or joining I complement you on your service and asked that you fight against the inertia that tries to deprive service members and their families from quality care. PS for any of you USUHS people, I'm still not getting any of my retirement money for the time at USUHS. I've been waiting almost a year for them to process my pay inquiry. They can always hurt you a bit more. I'd also like to point out that while I have a medical center in my area I exclusively receive my healthcare in the civilian sector.

Congratulations on the transition!

It might be time for a congressional inquiry to prompt the correction. Submit a pay inquiry monthly with the DoD Financial Management Regulation referenced until resolved. DoD FMR 7000.14 Volume 7B

27 years instead of the current 23 is a significant difference. Based on O6 and 28% tax that's already $20K+ for two years of back pay and they won't likely pay interest.

I received a letter telling me they have up to a year to address the pay problem. There are no callback numbers and if you do get a hold of the office you only get an automated message telling you to wait for a year. It's really abysmal but completely predictable and par for the course with United States Army. I'm going to give them another month or two and if I don't get something then I will go the congressional route

 

[a1qwerty55]

Thank you for your service. Can I ask, what specialty?

Pulmonary and critical care medicine

 

[DrMetal]

Pulmonary and critical care medicine

I've been thinking about going the critical care route, but I have concerns about the actual practice in the .mil. The mil ICUs seem pretty weak, in terms of patient volume and case acuity. Any comments? If that is the case, I might just stay a general internist (I don't really have a strong interest in any of the other sub-specialties).

 

[Gastrapathy]

a1 was one of the great defenders of milmed when he first came on the board. His gradual transition to this point is what is experienced by the vast majority of us.

 

[Gastrapathy]

@DrMetal

Well, I can tell you that I had to totally recalibrate what was an ICU level patient when I left.

Real hospitals have pretty sick peeps on the floor.

 

[a1qwerty55]

I've been thinking about going the critical care route, but I have concerns about the actual practice in the .mil. The mil ICUs seem pretty weak, in terms of patient volume and case acuity. Any comments? If that is the case, I might just stay a general internist (I don't really have a strong interest in any of the other sub-specialties).

They are very weak. Moonlighting is critical.

 

[SurgDoc95]

What kind of surgical cases do gen surg and ortho get? I'd imagine in the field there's a lot of "meatball surgery", but am curious to the patient population/cases seen stateside.

 

[a1qwerty55]

a1 was one of the great defenders of milmed when he first came on the board. His gradual transition to this point is what is experienced by the vast majority of us.

I always defended the importance of being there for service members. I was never a company man so to say. I did not defend the administrative and cultural problems with military medicine but the importantance of having good, idealistic positions there for our service members.

 

[Gastrapathy]

I always defended the importance of being there for service members. I was never a company man so to say. I did not defend the administrative and cultural problems with military medicine but the importantance of having good, idealistic positions there for our service members.

Fair enough. You did engage in many an argument and name calling with some of our biggest naysayers over the years. I guess it's telling that the "pro" position was really neutral.

BTW, where we disagree is that trying to make a failing system work when the leaders don't care is really beneficial. I see it as one last round of chemo with metastatic pancreas cancer. Not much help and gives the illusion of doing something. I don't think wanting the system to crash down around you is immoral if you believe that crisis is the only way to get a bureaucracy to make meaningful change.

 

[a1qwerty55]

Fair enough. You did engage in many an argument and name calling with some of our biggest naysayers over the years. I guess it's telling that the "pro" position was really neutral.

BTW, where we disagree is that trying to make a failing system work when the leaders don't care is really beneficial. I see it as one last round of chemo with metastatic pancreas cancer. Not much help and gives the illusion of doing something. I don't think wanting the system to crash down around you is immoral if you believe that crisis is the only way to get a bureaucracy to make meaningful change.

So you let a bunch of 18-year-old kid to die on the front lines to make a point? I'm glad I was in Afghanistan I have a couple of double amputees who currently are leading productive lives that might not have otherwise.

 

[Gastrapathy]

So you let a bunch of 18-year-old kid to die on the front lines to make a point? I'm glad I was in Afghanistan I have a couple of double amputees who currently are leading productive lives that might not have otherwise.

Of course not. But, do you do surgery without the right equipment or appropriately trained staff back in CONUS because they want to keep the lights on? Do you let residents double count major cases so they can graduate? Do you teach medicine residents in ICUs with so few sick patients that they never get comfortable? How does that benefit your soldier in hemorrhagic shock? The compromises are so frequent that we lose track that we are even compromising. Defending this system by saying that we have to do our best for the patient in front of us is fails to acknowledge the harm done to next 10000 soldiers who will continue to receive subpar care.

 

[a1qwerty55]

Of course not. But, do you do surgery without the right equipment or appropriately trained staff back in CONUS because they want to keep the lights on? Do you let residents double count major cases so they can graduate? Do you teach medicine residents in ICUs with so few sick patients that they never get comfortable? How does that benefit your soldier in hemorrhagic shock? The compromises are so frequent that we lose track that we are even compromising. Defending this system by saying that we have to do our best for the patient in front of us is fails to acknowledge the harm done to next 10000 soldiers who will continue to receive subpar care.

You say "of course not" but then who would provide care if there's no good physicians in the military? Trust me, I hear what you're saying, military medicine has major problems and I'm quite happy to be out of it. Hopefully they will continue to be idealistic people that want to serve.

 

[a1qwerty55]

As an FYI - I still haven't gotten my USUHS credit for retirement and now have 3 years of back pay I hope I'll see - over a year waiting. I emailed them and received a "we know it is taking a long time" we are busy with PTSD applications. Shat bagginess of the DOD knows no bounds.

 

[HighPriest]

Just remember that most of them only do about 2 hours of actual work per day. So you’ve only been waiting about 6 weeks of work time.

 

[Perrotfish]

Just remember that most of them only do about 2 hours of actual work per day. So you’ve only been waiting about 6 weeks of work time.

Before I worked for the government I thought that government workers didn't do anything. Now I realize that government workers actually do quite a lot, they just don't accomplish anything. I am sure that pay people are sitting through the same daily meetings, online trainings, and inspections that we are, and are actually working quite hard in the 2 hours a day that they're allotted to accomplish all of their actual work.

 

[HighPriest]

Before I worked for the government I thought that government workers didn't do anything. Now I realize that government workers actually do quite a lot, they just don't accomplish anything. I am sure that pay people are sitting through the same daily meetings, online trainings, and inspections that we are, and are actually working quite hard in the 2 hours a day that they're allotted to accomplish all of their actual work.

You’ve had a very different experience than I have.

I mean, yes, they also have a lot of useless training, but more often than not far less than expected was ever accomplished by all but a few of the GS employees that I ever worked with.

And then there’s the strong disdain that they have for doing anything in the first place...with exceptions to the rule, of course.

My experience was ubiquitously that out of every 20-30 federal employees there was one who did 80-90% of the work. If you didn’t find that gal, you were screwed.

 

[Gastrapathy]

Agreed. Until you’be had to go to court because the employee deserves a nicer chair you haven’t worked with govies.

 

[dr zaius]

Before I worked for the government I thought that government workers didn't do anything. Now I realize that government workers actually do quite a lot, they just don't accomplish anything. I am sure that pay people are sitting through the same daily meetings, online trainings, and inspections that we are, and are actually working quite hard in the 2 hours a day that they're allotted to accomplish all of their actual work.

I'm not sure what utopia you're stationed at, but it sounds nice. Here there is an obstructionist mentality that permeates everything from the IRB to pass and ID workers. They do not work hard or a lot.

 

[DD214_DOC]

Agreed. Until you’be had to go to court because the employee deserves a nicer chair you haven’t worked with govies.

This is so terrible because it's completely true.

 

[TheEarDoc]

My experience in government has been that a small handful of employees do the majority of the work. Those unlucky few are almost never given any perks (bonus, accolades, a thank you, a good job from the middle management), while the slackers are at the coffee cart playing politics and getting promoted. It's still just a good old boys club where it isn't what you know or how good you are at your job, but rather who you know.

 

[d2305]

You can check out anytime you like, but you can never leave.

 

[notdeadyet]

It's still just a good old boys club where it isn't what you know or how good you are at your job, but rather who you know.

Anyone who thinks this is limited to government and not bureaucracies corporate and public are in for a very very rude awakening.

 

[HighPriest]

Definitely not -limited- to government. But it’s not the standard everywhere like it is in government. It’s certainly not that way where I am now, nor was it when I worked in a corporate job before med school. And while I’ve definitely seen it in some civilian hospitals, it hasn’t yet been as severe as in government.

But it was permeating everywhere I ever set foot in MEDCOM.

Anecdotal, I know, but that’s my experience.

 

[Gastrapathy]

I work in a large bureaucracy now. It has similarities but it’s 10% as bad. The .mil was good training for that though.

 

[TheEarDoc]

Anyone who thinks this is limited to government and not bureaucracies corporate and public are in for a very very rude awakening.

Oh I know this sort of thing happens in the private sector too, but not nearly as bad as it does in the government. I've seen plenty of highly qualified people with lots of experience passed over on jobs for people that were fresh out of school, but knew someone. Same thing with folks being hired for positions they had no experience in over people with years of experience in said position.

 

[DD214_DOC]

One important point being missed is that, as a civilian, you at least have the option to leave a crappy work environment.

 

[TheEarDoc]

One important point being missed is that, as a civilian, you at least have the option to leave a crappy work environment.

True, but when you believe in the mission, you tend to stick around and hope that eventually the higher ups will listen to reason and fix the problems you bring up. Just going to keep on keepin' on and do what I can do and hope that eventually something changes.

 

[HighPriest]

One important point being missed is that, as a civilian, you at least have the option to leave a crappy work environment.

This is huge to me. I'm sure it's not for everyone. But I like the idea of having that poisoned tooth available, even if I'll probably never use it. And so far, it seems to actually make a difference with regards to my interactions with hospitals. They know it's there, and that I could use it, even if I probably won't. Unlike the Army where you had no out except time, and so they had the opportunity to abuse you as much as they liked (even if they didn't actually do it).

I think it's because my first assignment after residency was incredibly hostile, and I was always waiting for the other shoe to drop with regards to what the command was going to do to screw me over. That feeling just stuck with me the entire time i was in.


it's a much better dynamic now. I suppose it would be less of an issue if I wasn't in a specialty that's fairly hard to recruit, or if I was in an area where it was fairly easy to recruit....

 

[Perrotfish]

This is huge to me. I'm sure it's not for everyone. But I like the idea of having that poisoned tooth available, even if I'll probably never use it. And so far, it seems to actually make a difference with regards to my interactions with hospitals. They know it's there, and that I could use it, even if I probably won't. Unlike the Army where you had no out except time, and so they had the opportunity to abuse you as much as they liked (even if they didn't actually do it).

I think it's because my first assignment after residency was incredibly hostile, and I was always waiting for the other shoe to drop with regards to what the command was going to do to screw me over. That feeling just stuck with me the entire time i was in.


it's a much better dynamic now. I suppose it would be less of an issue if I wasn't in a specialty that's fairly hard to recruit, or if I was in an area where it was fairly easy to recruit....

Agree with this. There is a saying, used mainly by financial planners, but its true of your work environment as well: 'as a doctor you can have anything you want, but you can't have everything you want'. Even the lowliest Pediatrician is valuable enough that practices usually adapt if you draw a line in the sand about an issue. Not over every issue, or even most issues, but when an order comes down from on high that is either really dangerous or extremely painful to implement you can occasionally just say no and they will adapt to you. And if they won't adapt you can leave.

Another saying that applies to the military work environment: 'if you add a drop of fresh water to a gallon of sewage its still sewage, but if you add a drop of sewage to a gallon of fresh water its now all sewage. The military hospital system is not a particularly bad work environment 98% of the time, but the 2% of the time when you feel that you're stuck in a really dangerous situation for your patients and there is nothing you can do to either make it better or get clear of situatoin ruins the other 98%. I feel like I have had pretty good luck with my various leaders so far, but I've still had enough 2% days that I'm not staying in.

 

[HighPriest]

Agree with this. There is a saying, used mainly by financial planners, but its true of your work environment as well: 'as a doctor you can have anything you want, but you can't have everything you want'. Even the lowliest Pediatrician is valuable enough that practices usually adapt if you draw a line in the sand about an issue. Not over every issue, or even most issues, but when an order comes down from on high that is either really dangerous or extremely painful to implement you can occasionally just say no and they will adapt to you. And if they won't adapt you can leave.

Totally agree. You gotta pick which hill to die on. Once you're fighting with the admin about everything, you're more trouble than you're worth.

Another saying that applies to the military work environment: 'if you add a drop of fresh water to a gallon of sewage its still sewage, but if you add a drop of sewage to a gallon of fresh water its now all sewage. The military hospital system is not a particularly bad work environment 98% of the time, but the 2% of the time when you feel that you're stuck in a really dangerous situation for your patients and there is nothing you can do to either make it better or get clear of situatoin ruins the other 98%. I feel like I have had pretty good luck with my various leaders so far, but I've still had enough 2% days that I'm not staying in.

I love the sewage thing. I cannot for the life of me figure out why I hadn't heard that before.

 

[Vandalia]

What has changed? I was fortunate enough to be around pre-Desert Storm and left at the end of the 90's before things became dramatically worse. So what went wrong? Here are my thoughts from the "golden era."

(For future reference, "back then" means the 80's when there was ample defense funding without major combat operations.)

1) A lot of people had the military put them through medical school. Residencies even in the civilian world were not quite a mandatory condition. This essentially meant that many physicians were not tied through a service commitment. It was well known by senior medical and line leadership that if they pushed the physicians too hard they would simply leave. It would be interesting to see if there are more physicians in clinical slots who are tied into service commitments than there were in previous decades. In other words a captive audience.

2) Unless you were at the level that your license was in jeopardy or received an Article 15 every week, and if you showed a tiny modicum of leadership, you were basically guaranteed O-6. When I was promoted, the wing commander joked "3 out of every 2 physicians make Colonel." They also made Colonel at 18 years, with it gradually moving back to match the line 22 years (at least in the AF.) Even though there may not have been a prohibition against anyone other than a MC officer being an MTF commander, it simply didn't happen. To put it simply, physicians ruled the proverbial roost. Nurses ate their young as always, but they essentially had authority only in their own corps and were almost always outranked by physicians. Now, this has apparently been completely reversed.

3) Having GME in military medicine only works if you have the population base. At the height of the Reagan buildup there were many more AD military members, plus we saw dependents and a ton of retirees. This is a pretty obvious change. However, back in that era there was little thought of a wartime mission. It basically received lip service. It was generally understood that if we fought a war, it would quickly go nuclear and that would solve everything from a medical perspective. When Desert Storm kicked off there was absolute chaos in many military units. I know at a B-52 bomb wing it was like a comedy routine; no one had even considered that B-52's might deploy. Now deployment and everything associated with it sucks up all the energy.

4) Perhaps for all the reasons above, renegades seemed to be much more tolerated in the senior medical leadership. There was a Major General back in the 80's who said in Stars & Stripes that the ASD (Health Affairs) was an idiot and would damage military medicine (and he was right.) He was moved to a less prestigious post but still was kept on until he hit 30 years. One AF SG fought the commander of SAC in a previous post to protect one of his hospital commanders and later resigned in protest when he was AF/SG. I worked for a BG and we came up with a proposal that we knew that the line would hate but was necessary for certain specialties. He said "I am not making MG. You aren't making BG. So what do we have to lose?" It worked out exactly as we thought, but we gave it a shot. I just don't see that happening now.

5) It is interesting that a few of the senior officers back then ended up in civilian administrative jobs, but at least as many went back to basic clinical medicine. Perhaps if your goal is to do the same thing "on the outside" you are a bit less risk-adverse than someone who sees administration/leadership as a brief intermission until you get back to your real profession.

This isn't by any means to imply that things were perfect; not by a long shot. But perhaps it is easier to see the changes that led military medicine to where it is now.

 

[HighPriest]

Those all seem like major changes that have, in fact and at least in part, lead to where things are. I say that as a lot of these points are problems I had with MEDCOM.

What I never understood, however, was the open hostility (or at the least neglect) that OTSG showed towards it's physicians when they weren't deployed. I understand the change of focus towards deployment. The military is a fighting force, and it's medical officers are there to support that force, so it makes sense to have them ready to deploy. The problem that I had was that there was no impetus whatsoever to try to keep their physicians trained. As you've said, the patient demographic now is almost solely young, healthy family members at most duty stations. Very little trauma. But MEDCOM was (at least the entire time I was in) very against training their physicians to actually be physicians. You would think they'd be frothing at the mouth to get as much trauma/critical care experience as possible, but in fact they did nothing but put up obstacles for most people (yes, I know there are programs out there where surgeons go to X trauma center, blah, blah...I know a lot of general and ortho surgeons and I don't think I ever met someone who actually did any of that, so it's not that common. At least, not in the Army).
It never made sense to me that the Army would mandate that it's pilots spend X amount of time in the air or that it's infantrymen spent X amount of time shooting and kicking in doors at a simulator, but it just figured it's physicians would be ok at a small MEDDAC where they did one appy every two weeks. (Oh, and pay for your own CME too because that's just unnecessary....except that you need a license which needs CME which you must have to practice medicine in the military, but that's also out-of-pocket...)

So I think the issue is that deployment became big Army's focus (rightfully so) and MEDCOM just stopped paying attention to it's physicians altogether. And maybe that's in part due to their being a captive audience, or due to nursing utterly taking over MEDCOM, I don't know.

The ridiculous thing about promotions is that, at least for me, I have no problem with them making O-6 more difficult to achieve. What I have a problem with is that making rank is the -only- way they can even begin to close the pay-scale gap with the civilian sector, and the only way to make rank now is to stop being a physician - practically, at least. Make it more difficult, fine. But decide why you're doing it and what the effect will be on morale and retention. If I'm going to max out at O-5 and make 1/2-1/3 of what I could outside of the Army, I'm not staying. It makes no sense, for me at least. So why not have some financial incentive beyond that? If the issue really is that you have too many birds flying about, then make it harder to be one but don't do so at the expense most of your senior leadership separating. Or, if the issue is that it simply shouldn't be an automatic promotion, then come up with a way that I can make O-6 while actually staying clinical. Not everyone would make it, but at least it's possible. It's amazing what a small carrot like that can do for morale.

GME is screwed. The DoD (at least the Army) should get out of the GME business. They're too fickle, and they only run GME nowadays for the prestige. It's like having a pet tiger. It's cool to tell people that you have one, but you can't take care of it properly and eventually it's either going to die or bite you.

 

[DD214_DOC]

Big picture right now seems to be that the Army IS getting out of the GME business. They seem to want to the majority of AD docs to no longer exist save a few specific specialties (read as, "the types we need to actually be able to deploy") and everything else to be through contractors or GS. Although, I'm convinced the long-term plan is to get rid of most GS physicians as well and try to survive contract-only or possibly even through community resources. The huge problem with that being they have absolutely zero control over what community docs will do, or if they'll even accept Tricare. For peds psych, there is nothing in the community -- at least in this area -- due to either most being cash-only or having a 6 month wait for a new patient appointment.

Most of this isn't really a secret, as it's all laid out pretty clearly in the 2017 NDAA.

 

[HighPriest]

Big picture right now seems to be that the Army IS getting out of the GME business. They seem to want to the majority of AD docs to no longer exist save a few specific specialties (read as, "the types we need to actually be able to deploy") and everything else to be through contractors or GS. Although, I'm convinced the long-term plan is to get rid of most GS physicians as well and try to survive contract-only or possibly even through community resources. The huge problem with that being they have absolutely zero control over what community docs will do, or if they'll even accept Tricare. For peds psych, there is nothing in the community -- at least in this area -- due to either most being cash-only or having a 6 month wait for a new patient appointment.

Most of this isn't really a secret, as it's all laid out pretty clearly in the 2017 NDAA.

Yeah, I've heard that. I think it's another example of small mind, short sight. Now, don't get me wrong, I think the Army should get out of GME. I think the Army should only retain deployable specialties full time at an MTF. But I also think that in order to make an outside, Tricare referral base work you need military-employed physicians because like you said you are otherwise at the mercy of local clinics and hospitals. So keep a stable of ENT docs and GI docs and peds psychologists or what-have-you in and around your MEDCENs, but have them retained by civilian institutions instead of working at the MTF. Because Tricare pays $#!T. I don't know anyone who takes Tricare for any reason other than that they feel like they have some kind of moral responsibility to do so.

 

[244913]

Yeah, I've heard that. I think it's another example of small mind, short sight. Now, don't get me wrong, I think the Army should get out of GME. I think the Army should only retain deployable specialties full time at an MTF. But I also think that in order to make an outside, Tricare referral base work you need military-employed physicians because like you said you are otherwise at the mercy of local clinics and hospitals. So keep a stable of ENT docs and GI docs and peds psychologists or what-have-you in and around your MEDCENs, but have them retained by civilian institutions instead of working at the MTF. Because Tricare pays $#!T. I don't know anyone who takes Tricare for any reason other than that they feel like they have some kind of moral responsibility to do so.

So basically unit level docs overseeing sick call and all the consults get farmed out to the community? Lovely.

GME probably should end though, if the .Mil refuses to do it right. It does the trainees a huge disservice.

- ex 61N

 

[TheEarDoc]

Big picture right now seems to be that the Army IS getting out of the GME business. They seem to want to the majority of AD docs to no longer exist save a few specific specialties (read as, "the types we need to actually be able to deploy") and everything else to be through contractors or GS. Although, I'm convinced the long-term plan is to get rid of most GS physicians as well and try to survive contract-only or possibly even through community resources. The huge problem with that being they have absolutely zero control over what community docs will do, or if they'll even accept Tricare. For peds psych, there is nothing in the community -- at least in this area -- due to either most being cash-only or having a 6 month wait for a new patient appointment.

Most of this isn't really a secret, as it's all laid out pretty clearly in the 2017 NDAA.

Well I would guess it would work like it does for the CHOICE program with the VA. Let's not hire more specialists and PCP's, instead we will farm the patients out to the community. Well the problem is in most places there aren't enough specialists to absorb the extra patients so the wait times are just as long as the VA (or longer), the referring facility has no real control over the quality or what is being done with the CHOICE providers, and most facilities will not accept the program because the pay is so low (just like Tri-Care).

So what you end up having is a skeleton crew that is overworked at the major med center and then the patients end up getting substandard care and waiting longer for it. Woohoo! I'm all for throwing money at a problem and saying "look I did something to help!", but please throw money at the right people!

 

[HighPriest]

So basically unit level docs overseeing sick call and all the consults get farmed out to the community? Lovely.

GME probably should end though, if the .Mil refuses to do it right. It does the trainees a huge disservice.

- ex 61N

Well, currently it's overrun with PAs and NPs, which is really not better than a unit doc.

But no, that's not what I meant. The Army should run a basic clinic. Family med, OB-GYN for female soldiers, etc. They'll always need a general surgeon or two on post at major facilities. What they don't need is a pediatric surgical oncologist and a neuro-otologist and a facial cosmetic surgeon. That stuff should go out to the community where, if done properly, there are Army-employed reservists or even active duty surgeons stationed at local hospitals who can take care of those patients for free. Just like they're doing now, except that those physicians have access to the hospitals resources and patient demographics for the copious amount of time that military surgeons have when they're not taking care of Tricare pateints.

This increases the number of subspecialists docs at local hospitals, provides access to them for Tricare patients, and helps prevent the utter lack of exposure to complex cases involved with working solely at a MEDDCEN. The downside is that the patient has to drive off post, and for the surgeons the Army doesn't only gets to crush your soul on occasion instead of every day.

 

[TheEarDoc]

Well, currently it's overrun with PAs and NPs, which is really not better than a unit doc.

But no, that's not what I meant. The Army should run a basic clinic. Family med, OB-GYN for female soldiers, etc. They'll always need a general surgeon or two on post at major facilities. What they don't need is a pediatric surgical oncologist and a neuro-otologist and a facial cosmetic surgeon. That stuff should go out to the community where, if done properly, there are Army-employed reservists or even active duty surgeons stationed at local hospitals who can take care of those patients for free. Just like they're doing now, except that those physicians have access to the hospitals resources and patient demographics for the copious amount of time that military surgeons have when they're not taking care of Tricare pateints.

This increases the number of subspecialists docs at local hospitals, provides access to them for Tricare patients, and helps prevent the utter lack of exposure to complex cases involved with working solely at a MEDDCEN. The downside is that the patient has to drive off post, and for the surgeons the Army doesn't only gets to crush your soul on occasion instead of every day.

I've often questioned why aren't all specialties in the reserves and guard not placed in an APMC type of situation and instead of drilling they do their 2 days in a civilian facility and only see Tri-care patients who are referred from active military installations. I would think this would be a better use of their skill set and a way to truly maximize resources. I know many physicians do condensed drill in this manner, but if you took every specialist in the reserves and guard and did this imagine what kind of a resource it would be?

 

[Zenman1]

I always defended the importance of being there for service members. I was never a company man so to say. I did not defend the administrative and cultural problems with military medicine but the importantance of having good, idealistic positions there for our service members.

I'm a GS Psych NP and the only reason I keep showing up is that I love my job trying to do what I can for the many poor bastards who are trapped and and suffering. I do a good job, work my ass off, make top evaluations, and never had a negative complaint. I have in the past, as a LCDR told me, "created a ****-storm with command." My LTC is a little afraid of me and has told me he respects my "healthy disregard for authority figures." However, I'm again getting fed up with BS crap that interferes with good patient care and ready for some action. I've already given a reporter a run-down on all the BS and waiting to hear back from him. I'm one step from sending a "What I think packet" to the OTSG, and even President Trump. I think the military is afraid of public exposure, and maybe even more so with the suicides on this toxic post. A female MAJ told me the other day that their female COL had them doing zumba for PT. She was uncomfortable with this and thought the males were even more uncomfortable. I read this recently, "The Army has more obese Soldiers than ever before, and to address the problem, senior Army leaders discussed a holistic approach that includes vegan options at dining facilities." Seriously! Senior Army leaders discussing anything is probably the scariest phrase in existence. How many freaking vegans do you think are in the Army? Three, and two of those are in California!

In any case, do you think the OTSG, or even Trump, will even blink if I do what I plan? At least I'll feel better.

 

[HighPriest]

If you tell Trump that female Col said he was an idiot, he’ll bring it up first thing in the morning.

 

[DrMetal]

"The Army has more obese Soldiers than ever before, and to address the problem, senior Army leaders discussed a holistic approach that includes vegan options at dining facilities." Seriously!

This is part of a much broader problem in our military right now. I call it the "de-militarization of the military". People forget that's we're still a fighting force. We're not a company, we're not a 'culture'....despite our best efforts to act like those things, tending to everyone's personal needs (zumba during lunchtime, touchy-feely courses, execute orders only if you feel like it). People need to remember that we're a fighting force that needs to maintain it's lethality, should it be called upon to defend a nation. But that's a stretch I suppose for some....after all, it's not 1943.

 

[Perrotfish]

This is part of a much broader problem in our military right now. I call it the "de-militarization of the military". People forget that's we're still a fighting force. We're not a company, we're not a 'culture'....despite our best efforts to act like those things, tending to everyone's personal needs (zumba during lunchtime, touchy-feely courses, execute orders only if you feel like it). People need to remember that we're a fighting force that needs to maintain it's lethality, should it be called upon to defend a nation. But that's a stretch I suppose for some....after all, it's not 1943.

I don't know, I feel like it's the opposite: The Infranryization of the military. It seems like promotion I'd based more and more on someone's ability to look and act.like they are in the Infantry, regardless of how irrelevant that is to the job description of the serviceman or how bad they are at their actual jobs.

 

[DrMetal]

I don't know, I feel like it's the opposite: The Infranryization of the military. It seems like promotion I'd based more and more on someone's ability to look and act.like they are in the Infantry, regardless of how irrelevant that is to the job description of the serviceman or how bad they are at their actual jobs.

Maybe the case in the Medical Corps (it's a paradoxical thing....the MC tries to act like the line......the line tries to act more like the MC).

 

[a1qwerty55]

P.S. Still no back pay for my USUHS time 15 months waiting. Sent an email to which I got a "we are really busy with PTSD claims". Basically no interested in doing what really is a 10 second fix. There is no doubt I went to USUHS and no doubt the time should be included for retirement. Just more of the same in the totally F'd DOD.

 

[ArmyTiger]

P.S. Still no back pay for my USUHS time 15 months waiting. Sent an email to which I got a "we are really busy with PTSD claims". Basically no interested in doing what really is a 10 second fix. There is no doubt I went to USUHS and no doubt the time should be included for retirement. Just more of the same in the totally F'd DOD.

After 12 months of having your legitimate pay not given to you, you should definitely ask your congressmen for help. Representatives are usually more responsive, but people listen more to senators. But generally, only go through one office.

Sent from my Pixel XL using SDN mobile

 

[d2305]

I thought the VA did PTSD claims. I wonder if the Board of Corrections would be of any help? The United States Army | Army Review Boards Agency