Let me preface my comments by saying that as an active duty resident at a military medical center, I am happy to be serving my country and the folks that are fighting for our freedom. I am grateful for the opportunities that the military has provided me and I will serve my committment to the best of my ability. With that being said, I hope you will take my comments as someone trying to provide an honest perspective on one of the major challenges facing military medicine right now. As MilitaryMD has alluded to in prior posts, one major problem in military medicine that is not addressed by recruiters is the diminishing case loads and lack of opportunity to maintain specialized skills in military medicine. This is most pronounced at smaller bases away from the larger medical centers, and most severely affects specialized fields such as radiology, pathology, rad onc, surgical subs, etc. The result is that physicians in these fields that are stationed for prolonged periods of time at these bases can atrophy in their training and therefore be poorly equipped to seek a job on the civilian sector or as a teaching staff at a military medical center. Therefore, you get these O-5 and O-6 docs that are barely competent and barely working, becoming a burden to the military medicine, making $140,000 a year just hanging out and biding their time to retirement. These are the kinds of docs that many of the new graduating residents have to work with right out of residency. In my experience, most of the competent, motivated docs get out after their committment is up (we lost four great teaching staff this year), and what you are left with is the dead weight. Obviously, there are exceptions to this; there are some O-5 and O-6 docs who are competent and stay in military medicine because they like it. But I think this issue of low case volume is becoming a major problem for military medicine and someone has to start deciding what to do about it. To be honest, even our largest medical centers have been drastically downsized. Look the once busy Bethesda Naval Hospital (or should I say "the President's hospital") for example; it has now been reduced to a very large clinic. Wilford Hall Air Force Medical Center used to be a 1000 be hospital; now 100 beds would be pushing it. The caseload for general surgeons at Wilford Hall has been shrinking; they only do a few cases a week. Yet with Tricare, increasing numbers of patients go to civilian docs for elective surgeries, thus further reducing much needed cases for staff skill maintenance and resident teaching. All of these factors make one wonder how long military medicine can maintain GME and staff these large medical centers that were built in the post WWII years. Something needs to be done. I mention this on this board to give some perspective about this issue to those who may be trying to decide on whether military medicine is for them. This is an area of military medicine I knew nothing about prior to signing up. I think the bottom line is that if you love the military, join up; the deployments, lack of physician respect, remote assignments, bureaucracy garbage, etc will not phase you. If you are only doing it for financial reasons, think long and hard; $150,000 in debt can be dealt with fairly easily for most physicians. Just know that in military medicine, you may eventually get the residency of your choice, but maintaining those specialized skills during your payback years may be difficult.