I want out, but I can last. what are my options?

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mildoc04

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Good evening, everyone.

For some quick background: I'm currently a PGY2 in a 4-year military residency. I started as Navy HPSP.

To sum it up: I've had a feeling this wasn't for me since my 3rd year of medical school. I know now that this is not the life I want when all is said and done, but I don't mind sticking it out to completion because I know I don't want to quit. Once I finish my residency I'll have four years as active duty before my time served in finished.

I know I can get through my PGY3 and PGY4 years, but my question for everyone is what are some of my options post-residency? What types of jobs can I look to have that don't necessarily involve practicing medicine? Or is that even possible? If anyone could just give me a few examples of "here's what your day-to-day could be like" I would be much appreciative.

Again, I know I can make it through everything. I started this and I don't want to quit, but I also know that this isn't what I want to do for the rest of my life. I just want to know there's a light at the end of the tunnel and I can fulfill my military commitment doing something I might like.

Thanks!
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mildoc04 said:
Good evening, everyone.

For some quick background: I'm currently a PGY2 in a 4-year military residency. I started as Navy HPSP.

To sum it up: I've had a feeling this wasn't for me since my 3rd year of medical school. I know now that this is not the life I want when all is said and done, but I don't mind sticking it out to completion because I know I don't want to quit. Once I finish my residency I'll have four years as active duty before my time served in finished.

I know I can get through my PGY3 and PGY4 years, but my question for everyone is what are some of my options post-residency? What types of jobs can I look to have that don't necessarily involve practicing medicine? Or is that even possible? If anyone could just give me a few examples of "here's what your day-to-day could be like" I would be much appreciative.

Again, I know I can make it through everything. I started this and I don't want to quit, but I also know that this isn't what I want to do for the rest of my life. I just want to know there's a light at the end of the tunnel and I can fulfill my military commitment doing something I might like.

Thanks!
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Well, in your case, if you finish and become an attending, you'll be presently surprised to discover how little medicine some attendings do! At a military teaching hospital, for instance, we do a good job of diverting most of the patients to the residency programs (they need them, as per ACGME, they can't go without seeing patients). But that often leaves the attending with very little to do! (it's not like civilian academic residencies, where you have enough patients for both the resident and non-teaching attending services)

So if you mean what you say, I'd go to a teaching MTF. Or, do something operational. 'Operational medicine' actually involves very little medicine, most times.

And consider yourself lucky. Without HPSP, you'd have a nice $400K debt, which would entrap you.
 
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IMO, the military is the easiest place to be as a physician if you don't like medicine, but still want to be 'involved' with medicine.


Not sure how Navy works, but in the army, much of 'operational' medicine is the admin of medicine and preventive health. Lots of talking, not much doing.

Do your homework. Spend time now learning about how operational medicine works in the Navy, which gigs sound best, and who decides gets them.
Volunteer for operational assignment right out of the gate based on your homework.
If you like it, continue in the Navy. If you don't, your operational stuff will translate to the civilian world for an admin type job better than knocking out four years being a clinical doc and then making the jump. Civilians don't understand the reality of .mil medicine (MASH and yelling 'Medic' sums up their knowledge) , so you can push whatever narrative works best for you.

But, if you want to be an engineer or artist now instead of anything to do with medicine, I got nothin' ;)
 
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Can you expand more on operational medicine in the army please?
 
I knew a guy who finished an ENT residency, practiced for a month or two, and realized he really didn’t like it. He knew it in residency, but have it a go anyway.

So he ended up requesting a brigade surgeon spot, which they gave him with bells on. He did that for two years and then ended up, I think, in some kind of leadership position at one of the hospitals. He was still technically an ENT and still got the pay for it, but just didn’t see clinic or operate. The military needs administrators more than it needs soldiers.
 
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HighPriest said:
I knew a guy who finished an ENT residency, practiced for a month or two, and realized he really didn’t like it. He knew it in residency, but have it a go anyway.
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LOL, I know a civilian ENT that practiced a few years but now owns/operates a family practice/urgent care biz that farms out the work to a stable of NPs and one FP doc(who will be the fall guy in case of medmal case since he is dumb enough to sign off on the NPs running amuck.)
 
armytrainingsir said:
LOL, I know a civilian ENT that practiced a few years but now owns/operates a family practice/urgent care biz that farms out the work to a stable of NPs and one FP doc(who will be the fall guy in case of medmal case since he is dumb enough to sign off on the NPs running amuck.)
Click to expand...
Always have a fall guy.
 
HighPriest said:
He was still technically an ENT and still got the pay for it, but just didn’t see clinic or operate.
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How's that not waste fraud and abuse? You're getting the specialty pay, but you're hardly doing the job? Same happens in the Navy.

I love it when these executive leader bubbas come to the hospital to pickup a team for a week, once a year. As if that maintains their skills somehow.

It's no wonder the line military wants to get rid of the medical corps and completely civilianize military medicine.
 
DrMetal said:
How's that not waste fraud and abuse? You're getting the specialty pay, but you're hardly doing the job? Same happens in the Navy.

I love it when these executive leader bubbas come to the hospital to pickup a team for a week, once a year. As if that maintains their skills somehow.

It's no wonder the line military wants to get rid of the medical corps and completely civilianize military medicine.
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Oh, it’s total BS. But that’s the milmed way.
 
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DrMetal said:
It's no wonder the line military wants to get rid of the medical corps and completely civilianize military medicine.
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It's complicated

The "line military" at the O7+ level may think that way.

The "line military" at O6 and below absolutely don't want to lose the medical corps. I was DSS at a little hospital a while back, when we were closing our inpatient wards. The local line commanders lost their minds, especially about losing OB.

Anyone who's had firsthand experience with family members getting punted from the .mil clinic to sub-par local civilian options who'll work for Tricare-level reimbursement can probably understand where they're coming from. I've always fought to get my family taken care of at the hospital I work at.
 
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pgg said:
It's complicated

The "line military" at the O7+ level may think that way.

The "line military" at O6 and below absolutely don't want to lose the medical corps. I was DSS at a little hospital a while back, when we were closing our inpatient wards. The local line commanders lost their minds, especially about losing OB.

Anyone who's had firsthand experience with family members getting punted from the .mil clinic to sub-par local civilian options who'll work for Tricare-level reimbursement can probably understand where they're coming from. I've always fought to get my family taken care of at the hospital I work at.
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Well, most of the line commanders I know are just trying to keep their heads above water, trying not to get fired or end up on the front page of the Navy Crimes.

By the way, on the subject of civilian care, has any one else noticed that over the last 5 years or so, the civilian network has actually become more welcoming of our deferments? Maybe it's a geography thing: in southeast Virginia, the Sentara system was gobbling up anything we threw at them, Virginia Oncology as well. In San Diego: more dependents and retirees are going to the SHARP/Scripps system for primary care. And they're keeping the patients! (doesn't make for great GME, as this renders the MTFs/clinics a ghost town, but whatever).

Does this have something to do with Tricare now being managed by UnitedHealth or Humana? I know Tricare is a better payer than Medicare/Medical.
 
DrMetal said:
Well, most of the line commanders I know are just trying to keep their heads above water, trying not to get fired or end up on the front page of the Navy Crimes.

By the way, on the subject of civilian care, has any one else noticed that over the last 5 years or so, the civilian network has actually become more welcoming of our deferments? Maybe it's a geography thing: in southeast Virginia, the Sentara system was gobbling up anything we threw at them, Virginia Oncology as well. In San Diego: more dependents and retirees are going to the SHARP/Scripps system for primary care. And they're keeping the patients! (doesn't make for great GME, as this renders the MTFs/clinics a ghost town, but whatever).

Does this have something to do with Tricare now being managed by UnitedHealth or Humana? I know Tricare is a better payer than Medicare/Medical.
Click to expand...

In my opinion, there are two reasons civilian providers are more welcoming to Tricare.

1. As you said, Tricare pays better than Medicaid/Medicare and more people are on government insurance with Obamacare and the aging population. You can also renegotiate Tricare reimbursement rates (we have done it by power in numbers with a subspecialty surgical clinic of 40+ providers near a major Army post).

2. Also, you make up for less private payer by increasing your volume. I typically book 45-50 patients per clinic day and do not limit new patients. My satellite clinic is 2/3 Tricare right now. Almost no one complains if they are waiting 1-1.5 hours for their visit. They are just happy to be seen and not kicked to the curb like their MTF has done to them.

With the CMS rule changes on criteria needed to meet level 4 new/established visits coming in 2021, the bill for civilian care is about to go through the roof!
 
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Chonal Atresia said:
In my opinion, there are two reasons civilian providers are more welcoming to Tricare.

1. As you said, Tricare pays better than Medicaid/Medicare and more people are on government insurance with Obamacare and the aging population. You can also renegotiate Tricare reimbursement rates (we have done it by power in numbers with a subspecialty surgical clinic of 40+ providers near a major Army post).

2. Also, you make up for less private payer by increasing your volume. I typically book 45-50 patients per clinic day and do not limit new patients. My satellite clinic is 2/3 Tricare right now. Almost no one complains if they are waiting 1-1.5 hours for their visit. They are just happy to be seen and not kicked to the curb like their MTF has done to them.

With the CMS rule changes on criteria needed to meet level 4 new/established visits coming in 2021, the bill for civilian care is about to go through the roof!
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Makes sense. My kids (born in 2007) have never seen a Navy pediatrician. We've always been deferred out, currently to Childrens Rady's in San Diego. Great care! Our pediatrician's office is walking distance from my house. Can't argue with that.
 
Well if there is any institution where you can be a doctor without practicing medicine, it’s the military. Finish your residency and a single utilization tour and then reevaluate.
 
DrMetal said:
Makes sense. My kids (born in 2007) have never seen a Navy pediatrician. We've always been deferred out, currently to Childrens Rady's in San Diego. Great care! Our pediatrician's office is walking distance from my house. Can't argue with that.
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My kids were born in 2014 and 2016, and we’ve only seen mil pediatricians in Hawaii and Bethesda. Had a great civilian pediatrician in San Diego, but man did we have a horrible experience with the ED at Rady. And my wife worked in the heme onc clinic there (one of her coworkers also had an atrocious experience there as well). Some bad misses.
 
Chonal Atresia said:
In my opinion, there are two reasons civilian providers are more welcoming to Tricare.

1. As you said, Tricare pays better than Medicaid/Medicare and more people are on government insurance with Obamacare and the aging population. You can also renegotiate Tricare reimbursement rates (we have done it by power in numbers with a subspecialty surgical clinic of 40+ providers near a major Army post).

2. Also, you make up for less private payer by increasing your volume. I typically book 45-50 patients per clinic day and do not limit new patients. My satellite clinic is 2/3 Tricare right now. Almost no one complains if they are waiting 1-1.5 hours for their visit. They are just happy to be seen and not kicked to the curb like their MTF has done to them.

With the CMS rule changes on criteria needed to meet level 4 new/established visits coming in 2021, the bill for civilian care is about to go through the roof!
Click to expand...

If those patients you reference in #2 are there in uniform, I doubt you will ever get complaints no matter the wait. That's called a nice easy work day. "Where have you been all morning seaman recruit?" "Chief, at a medical appointment." "Ahh, good to go shipmate."
 
blax34 said:
If those patients you reference in #2 are there in uniform, I doubt you will ever get complaints no matter the wait. That's called a nice easy work day. "Where have you been all morning seaman recruit?" "Chief, at a medical appointment." "Ahh, good to go shipmate."
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lol wut? You know how many times I got bitched at for taking too long at a medical or dental appointment?
 
Matthew9Thirtyfive said:
lol wut? You know how many times I got bitched at for taking too long at a medical or dental appointment?
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Bro I need to evaluate your technique because that is the excuse to end all excuses.

Wait a minute... How often were you at the dentist? I'm on to you...
 
blax34 said:
Bro I need to evaluate your technique because that is the excuse to end all excuses.

Wait a minute... How often were you at the dentist? I'm on to you...
Click to expand...

On my one ship, I legit was told I couldn’t leave to go meet my wife at the hospital when she was having a postpartum hemorrhage.
 
You need to pick a residency like Occupational Medicine or Preventative Medicine. These are great specialties, and I have some brilliant active duty colleagues in these specialties. There is a way to go directly to a non-clinical track in these specialties, which are not heavy on the clinical side to start out with. You can create a career in operational and military research settings, and have a big impact. Don't pursue a clinical residency, primary care or otherwise, if you don't want to do clinical medicine. You will be miserable and this can negatively impact the other trainees in the program. My anecdotal experience is that many people with this mindset do not make it through residency. You might survive internship with all the current restrictions on hours and independent practice. But, you will then be a PGY2 with a 100% clinical job and in the hospital on call every 3 or 4 days. If you aren't 100% all in, the chance of failure is high. My opinion only, and not aimed at the OP as a slight in any way. You are not alone and it says a lot about you that you have this insight.
 
mildoc04 said:
Good evening, everyone.

For some quick background: I'm currently a PGY2 in a 4-year military residency. I started as Navy HPSP.

To sum it up: I've had a feeling this wasn't for me since my 3rd year of medical school. I know now that this is not the life I want when all is said and done, but I don't mind sticking it out to completion because I know I don't want to quit. Once I finish my residency I'll have four years as active duty before my time served in finished.

I know I can get through my PGY3 and PGY4 years, but my question for everyone is what are some of my options post-residency? What types of jobs can I look to have that don't necessarily involve practicing medicine? Or is that even possible? If anyone could just give me a few examples of "here's what your day-to-day could be like" I would be much appreciative.

Again, I know I can make it through everything. I started this and I don't want to quit, but I also know that this isn't what I want to do for the rest of my life. I just want to know there's a light at the end of the tunnel and I can fulfill my military commitment doing something I might like.

Thanks!
Click to expand...
Go to law school or business school. A Navy colleague left after his flight surgeon payback tours and went to law school (Michigan, IIRC). He decided that as a lawyer, being board-certified in a medical specialty was optimal as a dual-professional, and he went into a psychiatry residency following law school.
 
Matthew9Thirtyfive said:
Actually the XO was cool. It was actually an LPO who was too afraid to make decisions for her Sailors so she just said no to everything so she wouldn’t risk getting herself in trouble.
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I thought your XO wouldn't let you leave as an IDC. We were kind of hard to replace on short notice.
 
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