How to make things better - staying or quiting?

[militarymd]

Here is an excerpt from a Time magazine article on military spending on how we are not spending enough.

"Army Chief of Staff Peter Schoomaker, who came out of retirement in 2003 to run the service, told a congressional committee last monthy that defense spending during World War II neared 40% of GDP; it is now 3.8% and shrinking. He is frustrated, says a retired general who is a friend of Schoomaker's. Frustrated enough to quit if funding isn't boosted? Says his friend: "Absolutely.""

If leaving because he can't change things is good enough for the Army Chief of Staff, then I think it is a good approach for the rest of us....who have infinitely less influence.......BTW that means it is wise NOT to sign.

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[Monty Python]

Here is an excerpt from a Time magazine article on military spending on how we are not spending enough.

"Army Chief of Staff Peter Schoomaker, who came out of retirement in 2003 to run the service, told a congressional committee last monthy that defense spending during World War II neared 40% of GDP; it is now 3.8% and shrinking. He is frustrated, says a retired general who is a friend of Schoomaker's. Frustrated enough to quit if funding isn't boosted? Says his friend: "Absolutely.""

If leaving because he can't change things is good enough for the Army Chief of Staff, then I think it is a good approach for the rest of us....who have infinitely less influence.......BTW that means it is wise NOT to sign.

If current and future HPSP, USUHS, post-residency recruitment, and retention rates continue to trend downwards, what's the risk of a health provider draft?

Maybe they'll get around calling it an outright draft by, say, including automatic student loan payoffs. But the service is still mandatory.

 

[i want out]

If current and future HPSP, USUHS, post-residency recruitment, and retention rates continue to trend downwards, what's the risk of a health provider draft?

Maybe they'll get around calling it an outright draft by, say, including automatic student loan payoffs. But the service is still mandatory.

I am hoping and praying they don't implement a stop loss before I get out.

But I think that will happen before they try anything that even remotely resembles a draft.

I went to a civilian Doctor a number of years ago to get a flight physical.
At the time I had been accepted to medical school, and had taken the HPSP scholarship, so the topic of military service came up.

He mentioned that when he had graduated from Medical school (during WWII) the 'recruiters' had come to his class and had offered them a choice. He said the choices they offered were Army, and Navy. Those were the only choices, as there was not a seperate Air Force at the time. The impression that I came away with, was that it was a little less formal than a true draft, but still one did not have a choice of not serving.

I also hope that if they do anything with mandatory service, that it will exclude those of us that have done our time already.

i want out

 

[USAF_Dentman]

How is the US government going to increase Mil spending? So much of the current tax dollars are going into other BS progams (welfare, helping illegals, etc) and the current ideology held by a majority of citizens will see an increase in spending as completely proposterous to them..

Its sad really... I dont blame the military so much as I blame the fluffy, sugar coated ideals that this new generation perceives we all live under..

With the fall of the old-style traditional society, the military is destined to follow the same future..



I still belive that the tap root of the problem is the politicians.

 

[orbitsurgMD]

I am hoping and praying they don't implement a stop loss before I get out.

But I think that will happen before they try anything that even remotely resembles a draft.

I went to a civilian Doctor a number of years ago to get a flight physical.
At the time I had been accepted to medical school, and had taken the HPSP scholarship, so the topic of military service came up.

He mentioned that when he had graduated from Medical school (during WWII) the 'recruiters' had come to his class and had offered them a choice. He said the choices they offered were Army, and Navy. Those were the only choices, as there was not a seperate Air Force at the time. The impression that I came away with, was that it was a little less formal than a true draft, but still one did not have a choice of not serving.

I also hope that if they do anything with mandatory service, that it will exclude those of us that have done our time already.

i want out

When selective service draft candidate assessments were made, there was a separate category--4A--for those who served prior and completed their military obligations. Aside from placing those individuals in a lower category for priority of callup, I don't believe they were considered absolutely ineligible. As a physician, you would likely be treated differently and in a true draft scenario, would be considered an acceptable candidate beyond the age of general enlistment draft. It is hard to be considered too old as a physician.

That being said, this country had better demonstrate a more significant commitment to a war effort before turning to a draft to fill in the shortage of medical personnel. The medical department leaders assign blame to the war for their recruiting shortfall, but the real reason is the chronic abuse of the HPSP program, the reduction in quality residency training opportunities, misrepresentation by recruiters and others of the availability of professional and educational support once in a clinical setting, the withholding and misappropriation of necessary funds to support quality medical practice, and the pervasive sinecure culture of non-clinical and non-physician senior leadership which has thus far failed miserably to support or inspire. The HPSP has failed to supply in either numbers or quality--as it once did, even in war-- because those who run that program and the medical departments they work for have dishonored their obligations to the doctors they recruited. Those doctors who left feeling they were cheated of the support they were promised didn't just disappear. They are all around, in the community and academic practice, and some don't mind telling others what they think.

 

[pgg]

The medical department leaders assign blame to the war for their recruiting shortfall, but the real reason is the chronic abuse of the HPSP program, the reduction in quality residency training opportunities, misrepresentation by recruiters and others of the availability of professional and educational support once in a clinical setting, the withholding and misappropriation of necessary funds to support quality medical practice, and the pervasive sinecure culture of non-clinical and non-physician senior leadership which has thus far failed miserably to support or inspire. The HPSP has failed to supply in either numbers or quality--as it once did, even in war-- because those who run that program and the medical departments they work for have dishonored their obligations to the doctors they recruited. Those doctors who left feeling they were cheated of the support they were promised didn't just disappear. They are all around, in the community and academic practice, and some don't mind telling others what they think.

I don't think I buy that, but all I have is anecdotal experience to support my conjectures. I think it is the war that is primarily reducing HPSP's numbers.

The average pre-med isn't reading SDN. This is a place for gunners and compulsive type As, for the most part.

The average pre-med isn't polling civilian physicians for their opinions on military medicine. Their interaction with physicians is frequently as superficial and insignificant as a couple weeks doing an "internship" in an ER to check a box on their applications.

The average pre-med doesn't have a clue how GME works. He doesn't go looking for informed opinions on how military GME stacks up to civilian GME. I swear at least half of the pre-meds I knew in college thought they'd walk out of their med-school graduation ceremony and start working as trauma surgeons and gynecologists the next morning.

The average pre-med doesn't understand or care how "non-clinical and non-physician senior leadership" affects the delivery of care. How can they? They're pre-med; they don't know the first thing about medical care. Besides, they're preoccupied with getting past being pre-med and into med school so they can be doctors.

But everybody knows that there's a war going on. In the absence of any evidence or compelling argument to the contrary, I have to believe that HPSP can't recruit pre-meds for the same reason that the Army can't recruit enough guys to carry rifles: Iraq.

 

[cavaor]

But everybody knows that there's a war going on. In the absence of any evidence or compelling argument to the contrary, I have to believe that HPSP can't recruit pre-meds for the same reason that the Army can't recruit enough guys to carry rifles: Iraq.

I'll throw in my two cents.
I agree that the ongoing war does detract some people. I think there are more factors involved to explain the declining numbers however. Unfortunately, alot of my thoughts do revolve around increased spending on the military's part.
1. HPSP provides nice incentive (paid tuition) however the monthly stipend is comparable to many other programs out there.
HPSPers are still taking out loans to cover expenses in many cases. Ive heard current med students point this out. Offering additional incentive will entice higher numbers of applicants.
2. Outstanding debt too high for a long committment.
Offering students not in their first year of medical school the option to have prior loans paid off in exchange for time (yes, there is FAP...but I mean while they are still in school). I see many second and third years starting to realize how much they really owe and looking for options but the HPSP programs are just not as attractive when they will cover only part of your education (say last 2 years) and the student is still staring at 100K+ owed PLUS military commitment.
3. I don't know if this is everywhere, but the from what I have seen, the recruiters stink.
I had a heck of a time getting returned phone calls when I showed interest completely on my own. The details of the programs are also not solidly known. As my husband put it, you can't use the same techniques to recruit a high school kid as you do a medical student. Its an different dmographic and background. You have to know the program inside and out and be able to answer nearly all the questions without "having to get back to you"... sometimes doing so, sometimes not. At the very least, know the names of the licensing board exams.
4. Consider retired military physicians as recruiters.
I had a great preceptor who was retired army trauma surgeon who was able to provide honest answers..the good, the bad, and the ugly of what it was like to serve. Even so, his overall experience was positive as several other physicians I have ran into (maybe they all are a rarity and happen to congregate in the same location, either way..I am thankful).
5. If they want to retain physicians, you have to up the incentives once again.
Retiring for 75,000 a year or so isn't going to entice many physicians when they can make more and save that in the civilian realm. Additionally, in many specialities you are going to earn less each year vs. civilian. Its hard to justify to the wife or husband to stay in when you can make more on the outside without having the strings.
6. Additionally, openly allowing and encouraging moonlighting- especially for specialities like surgery, you may not see the #s needed to maintain your skills. Encouraging civilian work will keep these skills up and probably help with PR in terms of competency of military physicians. When the civilians see competent military physicians, its more likely to help future recruiting efforts.

Obviously, this isn't going to fix the problem however if changes are seen in the positive direction, folks are more likley to stick around and see what happens.

 

[orbitsurgMD]

I don't think I buy that, but all I have is anecdotal experience to support my conjectures. I think it is the war that is primarily reducing HPSP's numbers.

The average pre-med isn't reading SDN. This is a place for gunners and compulsive type As, for the most part.

The average pre-med isn't polling civilian physicians for their opinions on military medicine. Their interaction with physicians is frequently as superficial and insignificant as a couple weeks doing an "internship" in an ER to check a box on their applications.

The average pre-med doesn't have a clue how GME works. He doesn't go looking for informed opinions on how military GME stacks up to civilian GME. I swear at least half of the pre-meds I knew in college thought they'd walk out of their med-school graduation ceremony and start working as trauma surgeons and gynecologists the next morning.

The average pre-med doesn't understand or care how "non-clinical and non-physician senior leadership" affects the delivery of care. How can they? They're pre-med; they don't know the first thing about medical care. Besides, they're preoccupied with getting past being pre-med and into med school so they can be doctors.

But everybody knows that there's a war going on. In the absence of any evidence or compelling argument to the contrary, I have to believe that HPSP can't recruit pre-meds for the same reason that the Army can't recruit enough guys to carry rifles: Iraq.

Average MCAT scores were falling significantly among Navy HPSP accessions even prior to the war in Iraq. The accessions then went from marginal to none after the war started. I will believe the war hasn't helped matters, but the trend was already there.

 

[pgg]

Average MCAT scores were falling significantly among Navy HPSP accessions even prior to the war in Iraq. The accessions then went from marginal to none after the war started. I will believe the war hasn't helped matters, but the trend was already there.

I didn't know that, thanks for the info.

 

[chopper]

I didn't know that, thanks for the info.

I also thought there was a long trend of higher DO accession vs MD. Not that I have any dog in the DO vs MD thing. I just feel that being such a large organization, military medicine would somehow reflect the demographics of the greater population (comparable ratio of DO/MD as in civilian practice). And a trend line leading to a high DO/MD ratio would have been caused by SOMETHING - either within the military or in the civilian world to tip this balance. And also a trend, I believe, that has been going on for more than a few years?