How good are military hospitals for residency and medical training?

[kgpremed11]

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Im guessing since the patient population would be relatively young and healthy, there would not be that much sickness and pathology to see. Im interested in internal medicine, neurology, psych, and maybe ER and anesthesia. If I took the Air force HPSP how good would the training be?

 

[Kilgoretrout 65]

Im guessing since the patient population would be relatively young and healthy, there would not be that much sickness and pathology to see. Im interested in internal medicine, neurology, psych, and maybe ER and anesthesia. If I took the Air force HPSP how good would the training be?

It depends... here's my two cents:
internal medicine - the graduates have good board scores, some programs (like Wright Patt) are affiliated with civilian programs, seems like they have good attendings that teach, but our hospitals see relatively few really sick patients over 65; neurology- good training and test scores; psych - seems like they have a busy deployment tempo, not sure how that impacts training program(s), ER - also has a program affiliated with Wright State (or used to) and San Antonio has trauma; anesthesia can't really say but there have been a few posts from anesthesia on this thing....

The challenge ahead is the budget battle and the more outside rotations you need to train, say anesthesia on neurosurgery, the bigger danger that this training will be sacrificed. Your decision should also be whether you can stomach 4 years of being staff, covered well in other posts.

 

[bustbones26]

Im guessing since the patient population would be relatively young and healthy, there would not be that much sickness and pathology to see. Im interested in internal medicine, neurology, psych, and maybe ER and anesthesia. If I took the Air force HPSP how good would the training be?

In general, military programs tend to focus heavily on didactics across the board in all specialties. But buyer beware! Sometimes all this method does is create the smartest group of dumb doctors (if that made any sense) that you will ever see. I think what I am trying to say here is, what good is it to be a well read doctor that can score exceptionally high on an exam if you do not know how to apply it or what to do in a practical setting due to lack of experience?

Most of the training facilities will make attempts to ensure that you have seen enough. If they cannot, they may farm you out to sister institutions nearby to enhance your experience.

In my opinion, the big problem with military medicine is not training, its adequate, but rather keeping your skills after training.

 

[UltimateDO]

Im guessing since the patient population would be relatively young and healthy, there would not be that much sickness and pathology to see. Im interested in internal medicine, neurology, psych, and maybe ER and anesthesia. If I took the Air force HPSP how good would the training be?

The three MTFs (TAMC, WBAMC and WAMC) that I have spent extensive time in all had a large populations of VA patients that they service and we had pretty healthy censuses (10-20 pt / team) with a good mix of pathology both on the wards and in the MICU. The active duty patients are usually in the minority (significantly) on the teams. If anything I felt like the work / academics balance was more on work where I trained (WBAMC). That said, all the MTFs are very different animals with regards to their volume and acuity.

 

[pgg]

Im guessing since the patient population would be relatively young and healthy, there would not be that much sickness and pathology to see. Im interested in internal medicine, neurology, psych, and maybe ER and anesthesia. If I took the Air force HPSP how good would the training be?

a) No one knows.
b) It depends.

Few if any residencies at MTFs could fairly be called top tier. But of course, more than 90% of civilian residency programs aren't top tier either, so that's not really a huge issue IMO. I know every pre-med expects to get straight As and top 1% board scores, so every pre-med plans on a top-tier residency too. The military trains competent doctors. Individuals with desire and aptitude can be excellent doctors with inservice training.

There is an acuity and sometimes volume problem at MTFs. Some residency programs overcome this with substantial time spent at other institutions. Others don't.


The Air Force would be my distant 3rd out of 3 choices for service, in large part because they seem to be the most determined to 'lead' the way with downsizing and organizational decisions that harm the medical corps most. That's not to say the Army and Navy don't have some issues too.



The biggest problem is that as a pre-med, you're asking a question that won't be reliably answerable for another 10 years.

Anyone who says they can predict the overall state of inservice military residency training circa 2023 in any given specialty at any given location is either high or simply FOS. Nobody knows what effects budget cuts will have. Nobody knows how much outsourcing will become the norm. Nobody knows how many slots in which specialty and where will be open. Nobody knows how the GMO burden will be managed then. Nobody knows if we'll be at war in Iran or if peace will break out in the Middle East after a trillion barrels of light sweet crude are discovered in Idaho.

If you take HPSP today, you're making a bet that whatever specialty you decide on (and right now you don't know which field you will choose, even if you think you do) will have training both available and of quality commensurate with your talent/motivation/grades.

Paying for medical school with loans, and then entering service via FAP or another route after a civilian residency is a different kind of bet.

Of course, everything you do is to some extent a leap of faith, especially the decision to go to med school in the first place.


Do you want to be in the military? Why are you most interested in the Air Force?

 

[Kingfisher]

a) No one knows.
b) It depends.

Few if any residencies at MTFs could fairly be called top tier. But of course, more than 90% of civilian residency programs aren't top tier either, so that's not really a huge issue IMO. I know every pre-med expects to get straight As and top 1% board scores, so every pre-med plans on a top-tier residency too. The military trains competent doctors. Individuals with desire and aptitude can be excellent doctors with inservice training.

There is an acuity and sometimes volume problem at MTFs. Some residency programs overcome this with substantial time spent at other institutions. Others don't.


The Air Force would be my distant 3rd out of 3 choices for service, in large part because they seem to be the most determined to 'lead' the way with downsizing and organizational decisions that harm the medical corps most. That's not to say the Army and Navy don't have some issues too.



The biggest problem is that as a pre-med, you're asking a question that won't be reliably answerable for another 10 years.

Anyone who says they can predict the overall state of inservice military residency training circa 2023 in any given specialty at any given location is either high or simply FOS. Nobody knows what effects budget cuts will have. Nobody knows how much outsourcing will become the norm. Nobody knows how many slots in which specialty and where will be open. Nobody knows how the GMO burden will be managed then. Nobody knows if we'll be at war in Iran or if peace will break out in the Middle East after a trillion barrels of light sweet crude are discovered in Idaho.

If you take HPSP today, you're making a bet that whatever specialty you decide on (and right now you don't know which field you will choose, even if you think you do) will have training both available and of quality commensurate with your talent/motivation/grades.

Paying for medical school with loans, and then entering service via FAP or another route after a civilian residency is a different kind of bet.

Of course, everything you do is to some extent a leap of faith, especially the decision to go to med school in the first place.


Do you want to be in the military? Why are you most interested in the Air Force?

Absolutely agree

 

[Kilgoretrout 65]

The Air Force would be my distant 3rd out of 3 choices for service, in large part because they seem to be the most determined to 'lead' the way with downsizing and organizational decisions that harm the medical corps most.

Wow pgg, if you aren't in the Air Force you sure have been paying attention! I say join the military if you want to work for a dentist, that works for a pharmacist that works for a nurse. That being said, way easier (again in the past) to get fellowships from the Air Force than other services. That could change.

 

[haujun]

The Air Force would be my distant 3rd out of 3 choices for service, in large part because they seem to be the most determined to 'lead' the way with downsizing and organizational decisions that harm the medical corps most.

Wow pgg, if you aren't in the Air Force you sure have been paying attention! I say join the military if you want to work for a dentist, that works for a pharmacist that works for a nurse. That being said, way easier (again in the past) to get fellowships from the Air Force than other services. That could change.

Yeah very true. My boss is medical school drop out who is a commander and his boss is NCO...🙄

 

[haujun]

In my opinion, the big problem with military medicine is not training, its adequate, but rather keeping your skills after training.

Unfortunately, most military attendings if not all agreed to this statement.

Here is a question for current military attending: If your boss who hasn't practice medicine for over 10 years and not competent actually order you to do something for your patient which you do not agree do you guys have courage to not obey his order?

It is rather challenging to work as "indepent practioner" in MEDAC...

 

[pgg]

Here is a question for current military attending: If your boss who hasn't practice medicine for over 10 years and not competent actually order you to do something for your patient which you do not agree do you guys have courage to not obey his order?

I've never once had this happen to me. I have difficulty imagining a situation in which it could realistically happen in my specialty. No one can make me do a case, or make me do it a certain way.

 

[bustbones26]

I've never once had this happen to me. I have difficulty imagining a situation in which it could realistically happen in my specialty. No one can make me do a case, or make me do it a certain way.

Really?? Give it time!!

I can recall an orthopedic surgeon with a patient in respiratory distress who admitted that he needed help and was left out there to hang. He got bawled out by his DCCS for not knowing how to perform vent management.

 

[pgg]

Really?? Give it time!!

If you say so. In the anesthesia world we sometimes face pressure from surgeons to do cases we'd rather postpone, but ultimately if we say no, we say no. No one has ever forced me to do a case and no one ever will.

I can recall an orthopedic surgeon with a patient in respiratory distress who admitted that he needed help and was left out there to hang. He got bawled out by his DCCS for not knowing how to perform vent management.

Left out to hang by who? Did an intensivist or anesthesioloist decline to help?

And the consequence of being bawled out by a DCCS (what's that?) was what, exactly?


Sorry, this notion of being told to do something against my medical judgment is utterly alien to me.

 

[Kingfisher]

Unfortunately, most military attendings if not all agreed to this statement.

Here is a question for current military attending: If your boss who hasn't practice medicine for over 10 years and not competent actually order you to do something for your patient which you do not agree do you guys have courage to not obey his order?

It is rather challenging to work as "indepent practioner" in MEDAC...

I think it boils down to how confident you are with your knowledge and training. Ultimately you are the one who is to make the medical decision. If your non med superiors have boundary issue, there are several ways to deal with this.

1. "I don't remember you in the back of class at med school graduation!" (For nurse types)

2. Blank stare followed by 8-10 seconds of silence. Then, "no, I don't think I will do that/order that/whatever". Then go back to work ignoring any protests.

3. In a firm voice state, "that treatment plan is wrong based on (fill in your favorite study/book/expert opinion)..."

Don't be afraid of rank. If that scenario were to play out in the civilian sector what would you say? Do that.

 

[haujun]

I think it boils down to how confident you are with your knowledge and training. Ultimately you are the one who is to make the medical decision. If your non med superiors have boundary issue, there are several ways to deal with this.

1. "I don't remember you in the back of class at med school graduation!" (For nurse types)

2. Blank stare followed by 8-10 seconds of silence. Then, "no, I don't think I will do that/order that/whatever". Then go back to work ignoring any protests.

3. In a firm voice state, "that treatment plan is wrong based on (fill in your favorite study/book/expert opinion)..."

Don't be afraid of rank. If that scenario were to play out in the civilian sector what would you say? Do that.

Non med superiors are relatively okay as they may give recommendation but do respect my decision. My problem is "ex-physician" in admin position who think they know everything. Small knowledge can be dangerous.

 

[Kingfisher]

Non med superiors are relatively okay as they may give recommendation but do respect my decision. My problem is "ex-physician" in admin position who think they know everything. Small knowledge can be dangerous.

Aaahh I get it. I had a similar situation. I was polite and thanked him for the help. Then did what I wanted.

Most of the admin only types just want to think they are still involved in some small way. If you ask their opinion they usually appreciate that you value their thoughts. Ultimately it should still be YOUR call. Sometimes you have to pick your battles. If it affects the well being of the patient and/or deviates from the standard of care, you are obligated to make a stand. Good luck. 😀