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I felt it was time to update the forum, seeing as though I've been here since pre-medschool (back in the olden days of SDN) and have pretty much run the gamut of emotions and feelings toward the army, military, GME, politics and life in general. Hopefully it will helps someone else out there or spur on some productive discussion.
Quick background-- I was ROTC/HPSP, medschool from 2000-2004, residency 2004-2007, staff 2007-2011 and am starting a military fellowship. Deployed to Iraq in 2008/2009 as a battalion surgeon, "only" 12 months (seriously, I appreciated not dealing with the 15+ the folks before me had).
I was not a doe-eyed applicant to HPSP. I knew the military system and its proclivity for screwing people in the interests of "big army" and did my homework. I spoke to active duty staff in several places, and all said prettym uch the same thing-- deploy for maybe 30 days, mostly humanitarian, homestead if you want, not a bad deal if you can deal with a little less money in exchange for your school and not having to manage a practice. Then after my MS1 year 9/11 happened and you know the story from there.
At times I have hated the system, and other times enjoyed it and couldn't imagine anything else. As one of my navy colleagues told me a few weeks ago, what other job would allow someone like him to go from staff pediatrician to DMO working with SEALS to academics to fellowship? I've been able to "experience" a lot of different things, and as a person am better off for it. From being thrown into a chief of a clinic to being the only doc on a FOB, I've learned about myself and grown in a lot of unforseen ways. There's not much left that will rattle you in clinic or in the civilian world after you've been rocketed/mortared and dealt with trauma-- or, been able to disagree and stand up for yourself with with line commanders or ODA groups. It definitely matures you.
Anyway, I was in general peds for 4 years, spent a year of that deployed and a year of it as a clinic chief. Which, for peds, is pretty good. I was at a small understaffed, underfunded, underappreciated MEDDAC, and fought the good fight. My DCCS told me you really haven't been an effective leader at one of those places unless you leave with at least 1 union grievance, IG complaint, EO complaint, and a smattering of ICE comments.
I'm convinced you could trim 20% off the AMEDD budget simply by delegating budgeting authority down to the clinic level. GS employees are getting paid 50k+ a year to surf the internet, and contractors are seeing the minimum amount of patients because they know in the end the green suiters will pick up the slack. MEDDAC issues are a separate thread, but I couldn't help but mention a couple, lol.
So, with my jumping off point in 2015 (and my wife's october 2011) why would I extend with a fellowship? A few reasons.
Peds, in general , is a good deal in the military. I would wager most primary care specialties are. Yes, our support staff is not equivalent to a civilian practice, but seeing 25 patients a day is a far cry from the 40+ 5 minute speed sessions I've seen local pediatricians forced to do to keep the cash flowing. I don't get paid more for seeing more, but on the flipside I don't get paid less for seeing less . . . or going to meetings. I get paid pretty well for those mandatory training sessions, or the morning for a PT test. I also didn't worry about overhead or advertising or insurance reimbursements.
That being said, I had to get out of general peds. It's easy to be a half-assed pediatrician, damn near impossible nowadays to be a thorough one. I enjoyed details, workups and digging into things. And, I wanted a bit better compensation.
I also knew another deployment was looming. Another 12 months would have been hard to swallow.
So, I was looking at another deployment, continued frustration with general peds, and getting out in 2015 for no retirement and going into a move the meat civilian system. Enter fellowship: 3 years non-deployable (give us time to GTFO of iraq/afghanistan), 6 month deployment if it did occur (yay), more money while I'm in, more money when I get out (nice), and get to go back to civilization/academia from middle of nowhere (yes, I wanted to get back to education). This puts me at 14 years when I finish fellowship. Retirement isn't a bad deal (if they leave it alone, lol) and as subspecialist staff it means MEDCEN and better location. It also means I can shift what I'd like to do (education/research/clinic, even god forbid operational/admin). Or, I can get out and move on to civilian practice, with a skill set that is more marketable than general peds.
Of course there are headaches in the military, and rational thought is sometimes hard to find, but for me it's tolerable and mostly a known quantity. We will see how things go, and I will post a few other topics as well but I can't complain too much at this point. /knock on wood.
-- your friendly neighborhood chasing the carrot caveman
Quick background-- I was ROTC/HPSP, medschool from 2000-2004, residency 2004-2007, staff 2007-2011 and am starting a military fellowship. Deployed to Iraq in 2008/2009 as a battalion surgeon, "only" 12 months (seriously, I appreciated not dealing with the 15+ the folks before me had).
I was not a doe-eyed applicant to HPSP. I knew the military system and its proclivity for screwing people in the interests of "big army" and did my homework. I spoke to active duty staff in several places, and all said prettym uch the same thing-- deploy for maybe 30 days, mostly humanitarian, homestead if you want, not a bad deal if you can deal with a little less money in exchange for your school and not having to manage a practice. Then after my MS1 year 9/11 happened and you know the story from there.
At times I have hated the system, and other times enjoyed it and couldn't imagine anything else. As one of my navy colleagues told me a few weeks ago, what other job would allow someone like him to go from staff pediatrician to DMO working with SEALS to academics to fellowship? I've been able to "experience" a lot of different things, and as a person am better off for it. From being thrown into a chief of a clinic to being the only doc on a FOB, I've learned about myself and grown in a lot of unforseen ways. There's not much left that will rattle you in clinic or in the civilian world after you've been rocketed/mortared and dealt with trauma-- or, been able to disagree and stand up for yourself with with line commanders or ODA groups. It definitely matures you.
Anyway, I was in general peds for 4 years, spent a year of that deployed and a year of it as a clinic chief. Which, for peds, is pretty good. I was at a small understaffed, underfunded, underappreciated MEDDAC, and fought the good fight. My DCCS told me you really haven't been an effective leader at one of those places unless you leave with at least 1 union grievance, IG complaint, EO complaint, and a smattering of ICE comments.
I'm convinced you could trim 20% off the AMEDD budget simply by delegating budgeting authority down to the clinic level. GS employees are getting paid 50k+ a year to surf the internet, and contractors are seeing the minimum amount of patients because they know in the end the green suiters will pick up the slack. MEDDAC issues are a separate thread, but I couldn't help but mention a couple, lol.
So, with my jumping off point in 2015 (and my wife's october 2011) why would I extend with a fellowship? A few reasons.
Peds, in general , is a good deal in the military. I would wager most primary care specialties are. Yes, our support staff is not equivalent to a civilian practice, but seeing 25 patients a day is a far cry from the 40+ 5 minute speed sessions I've seen local pediatricians forced to do to keep the cash flowing. I don't get paid more for seeing more, but on the flipside I don't get paid less for seeing less . . . or going to meetings. I get paid pretty well for those mandatory training sessions, or the morning for a PT test. I also didn't worry about overhead or advertising or insurance reimbursements.
That being said, I had to get out of general peds. It's easy to be a half-assed pediatrician, damn near impossible nowadays to be a thorough one. I enjoyed details, workups and digging into things. And, I wanted a bit better compensation.
I also knew another deployment was looming. Another 12 months would have been hard to swallow.
So, I was looking at another deployment, continued frustration with general peds, and getting out in 2015 for no retirement and going into a move the meat civilian system. Enter fellowship: 3 years non-deployable (give us time to GTFO of iraq/afghanistan), 6 month deployment if it did occur (yay), more money while I'm in, more money when I get out (nice), and get to go back to civilization/academia from middle of nowhere (yes, I wanted to get back to education). This puts me at 14 years when I finish fellowship. Retirement isn't a bad deal (if they leave it alone, lol) and as subspecialist staff it means MEDCEN and better location. It also means I can shift what I'd like to do (education/research/clinic, even god forbid operational/admin). Or, I can get out and move on to civilian practice, with a skill set that is more marketable than general peds.
Of course there are headaches in the military, and rational thought is sometimes hard to find, but for me it's tolerable and mostly a known quantity. We will see how things go, and I will post a few other topics as well but I can't complain too much at this point. /knock on wood.
-- your friendly neighborhood chasing the carrot caveman
mainly due to inefficiencies. at a MEDCEN, gen peds staff are more like 80% outpatient and attend the ward intermittently-- because the inpatient service is run by residents.
