Insufficient Emergency Dept. Coverage

[EMDoc0411]

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I have heard that Naval Hospital Guam will be going down to 4 docs covering the ED (single coverage) while 3 are deployed to Iraq. This doesn't seem right to me considering that this is the highest acuity ED in the Navy. They see traumas and codes on a regular basis. In addition Guam is half way around the world (essentially forward deployed), so the families of those deploying are left behind without much support from their own family. Does anybody know what the current deployment ratio is at other places?

 

[orbitsurgMD]

I have heard that Naval Hospital Guam will be going down to 4 docs covering the ED (single coverage) while 3 are deployed to Iraq. This doesn't seem right to me considering that this is the highest acuity ED in the Navy. They see traumas and codes on a regular basis. In addition Guam is half way around the world (essentially forward deployed), so the families of those deploying are left behind without much support from their own family. Does anybody know what the current deployment ratio is at other places?

Who is doing the covering? Are there EM-residency trained people or are they GMOs? Or are they FPs being assigned ED duty?

Understaffing is bad in any case, and the Navy does do that, but worse, they will staff some of those forward EDs with GMOs working alone, frequently with much less than the level of ancillary support expected for a similar facility in the US.

 

[The White Coat Investor]

I have heard that Naval Hospital Guam will be going down to 4 docs covering the ED (single coverage) while 3 are deployed to Iraq. This doesn't seem right to me considering that this is the highest acuity ED in the Navy. They see traumas and codes on a regular basis. In addition Guam is half way around the world (essentially forward deployed), so the families of those deploying are left behind without much support from their own family. Does anybody know what the current deployment ratio is at other places?

I heard the same thing from a very good source just two days ago, so I'm positive it is accurate, and in fact I know some of the docs currently at Guam. Time to shoot off the flares and get some help in there (manning-assist etc). My planned deployment ratio is 20%, 2/8 docs with 2 contractors who don't deploy. 3/7 is way too high. If anyone is looking for a volunteer to go to Guam for a month or two, I'll go.

 

[Chonal Atresia]

Does anybody know how to get this info into the lay press? It seems that the only way the military ever changes anything for the better (see Ft. Bragg barracks as well as the Walter Reed fiasco) is if they get "caught" doing stupid sh..t like this. Maybe, just maybe, this will shed some light on the medical corps and the problems that exist (i.e. poor retention, AHLTA, lack of adequatre staff and horrific compensation).

 

[Gastrapathy]

Does anybody know how to get this info into the lay press? It seems that the only way the military ever changes anything for the better (see Ft. Bragg barracks as well as the Walter Reed fiasco) is if they get "caught" doing stupid sh..t like this. Maybe, just maybe, this will shed some light on the medical corps and the problems that exist (i.e. poor retention, AHLTA, lack of adequatre staff and horrific compensation).

Be careful what you wish for. The "solutions" may be more painful than the current state: stop-loss, IRR call-ups, etc.

 

[DrMetal]

Does anybody know how to get this info into the lay press? It seems that the only way the military ever changes anything for the better (see Ft. Bragg barracks as well as the Walter Reed fiasco) is if they get "caught" doing stupid sh..t like this. Maybe, just maybe, this will shed some light on the medical corps and the problems that exist (i.e. poor retention, AHLTA, lack of adequatre staff and horrific compensation).

Well, there's nothing stopping you from pening a letter to your favorites news outlet. My guess is that many people have, and of course you have to reveal your identity. But hey, if you feel you're in the right, it's your privelage as an American (some may say its even your duty) to voice your concerns; stick to your guns if you want, just make sure you have enough ammo.

I had a friend who actually worked on the research staff of '60 Minutes'. He said they got thousands of letters every day, from all walks of life. He said they loved to pursue stories that were really one-sided (something was really great and everybody loved it, or something was really awful). Hence their Walter Reed story ("how awful that soldiers aren't getting proper care") and their more recent story on Army ortho ("how wonderful that soldier amputees are getting these revolutionary prosthetics"). They like the polarizing stories that either make your blood boil or give you a warm fuzzy. That equals ratings.

So, if you wrote a broad brush letter about how everything in milmed (retention, AHLTA, comp) sucks . . that's all very debatable, and most news orgs wouldn't run with it. There's plenty who think retention isn't that bad, AHLTA's the best thing since sliced bread, and comp isn't so bad for certain kinds of medicine.

 

[Gastrapathy]

. There's plenty who think retention isn't that bad, AHLTA's the best thing since sliced bread, and comp isn't so bad for certain kinds of medicine.

Coffee spew. Plenty of people think ALHTA's the best thing since sliced bread? How about no.

 

[Chonal Atresia]

Gastrapathy, point well taken regarding IRR/stop-loss.

DrMetal, I don't know what specialties you're talking about but mine makes <50% the 2008 MGMA average. I would venture to say it's down right embarassing. You hear "regular army" guys complain all the time about the 3-4% "pay gap" with their civilian counterparts. Try 100% - it's ridiculous and many non-medical corps types think we're overpaid with our "bonuses." They are clueless. I make almost HALF my military salary moonlighting only 7 weeks a year. It's the only thing allowing me to keep my sanity.

 

[DrMetal]

Gastrapathy, point well taken regarding IRR/stop-loss.

DrMetal, I don't know what specialties you're talking about but mine makes <50% the 2008 MGMA average. I would venture to say it's down right embarassing. You hear "regular army" guys complain all the time about the 3-4% "pay gap" with their civilian counterparts. Try 100% - it's ridiculous and many non-medical corps types think we're overpaid with our "bonuses." They are clueless. I make almost HALF my military salary moonlighting only 7 weeks a year. It's the only thing allowing me to keep my sanity.

I dont diagree with you regarding salaries, especially wrt to your particular specialty. But I suppose an internist, FP, or general Ped stationed in a part of the country w/ high BAH, and say 10 years prior service (not an unlikely scenario) is making near tje equivalent of his civi counterpart, especially given the tax break on BAH and no need to pay for insurance.

So again, if you penned a letter about how all military comp sucks for all docs, that may be hard to sell. But if you penned a letter specifically about poor compensation in your particular specialty (or in all specialty medicine), that I think would be more intetesting, and youd certainly have a lot of evidence. Good luck...

 

[Chonal Atresia]

DrMetal -

I agree with you on FP/Peds/IM - but those are the only specialties. I don't think anybody is going to pay attention to a physician "whining" about his/her pay, even if he/she is totally in the right. I do think, however, that "shortchanging" our troops and their families in far off areas of the world (i.e. Guam) of just adequate medical care could make some noise. It's not PC to "screwover" our servicemen and the media seems to run with these stories.

 

[Gastrapathy]

DrMetal -

I agree with you on FP/Peds/IM - but those are the only specialties. I don't think anybody is going to pay attention to a physician "whining" about his/her pay, even if he/she is totally in the right. I do think, however, that "shortchanging" our troops and their families in far off areas of the world (i.e. Guam) of just adequate medical care could make some noise. It's not PC to "screwover" our servicemen and the media seems to run with these stories.

What is interesting to me is that, despite the relatively better financial comparison for low-paying specialties, retention is just as bad. And because they don't add time for residency, I suspect these folks actually spend less time in the military on average.

 

[EMDoc0411]

Who is doing the covering? Are there EM-residency trained people or are they GMOs? Or are they FPs being assigned ED duty?

Understaffing is bad in any case, and the Navy does do that, but worse, they will staff some of those forward EDs with GMOs working alone, frequently with much less than the level of ancillary support expected for a similar facility in the US.

The acuity is too high to have anyone but an emergency trained physician staffing it. At times there will be PA's covering with the ED doc, but currently there are no PA's to help.

 

[IgD]

This scenario describes exactly what I experienced with psychiatry. We were at a small overseas MTF. Navy Medicine was deploying my fellow psychiatrists as IAs leaving the department depleted. It was frustrating because back in the continental United States the large MTFs had a pool of GS physicians and contractors to fall back on. They also had a robust Tricare network to fall back on. Very frustrating...

 

[tsbuqh]

This doesn't seem right to me considering that this is the highest acuity ED in the Navy.

minor hijack
As a medical student intrested in EM this caught my attention. My main concern with going back to active duty as a doc is the acuity/skill atrophy issue. Is Guams acuity on par with what you would see in a civilian small hospital? Are there other navy hospitals where skill atrophy might not be an issue?

side note
I took an ambulance ride to the naval hospital in Guam once. It was the friendliest hospital I have ever been in. The radiologist came out and talked to me personally. I took that to mean there was not much going on, but maybe not...

 

[EMDoc0411]

minor hijack
As a medical student intrested in EM this caught my attention. My main concern with going back to active duty as a doc is the acuity/skill atrophy issue. Is Guams acuity on par with what you would see in a civilian small hospital? Are there other navy hospitals where skill atrophy might not be an issue?

side note
I took an ambulance ride to the naval hospital in Guam once. It was the friendliest hospital I have ever been in. The radiologist came out and talked to me personally. I took that to mean there was not much going on, but maybe not...

Guam is unique in that it is the highest level of care on an island of about 140000 with most of those being civilian. As a result, they frequently have civilian traumas and arrests coming in. In the last few weeks they have had a couple of crics in order to secure an airway.