Maximum attainable rank during military career

[Perrotfish]

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I find it hard to believe that a person can be malignant and honest at the same time. Is he honest about his malignant intentions?

Upwards of 25 percent of your attendings in medical school will be malignant and few if any will be dishonest, military or not. 'Malignant' attendings are just bad bosses. That's all that term means. They might be screamers. They might be particularly unable to see someone else's point of view. They might be incompetent, or officious, or grudge holding, or conspicuously absent at key moments, or just inconsiderate of everyone else's time. We are not in a profession that attracts normal personalities, it happens.

Dishonest, though, is something else entirely. It means that they are lying and breaking rules to help themselves or, even more pathologically, to screw over people that they don't like. That's pretty rare even in the civilian medical world, and the military is (in my opinion) even better than civilian academic hospitals at weeding that kind of person out.

 

[Sean Lee]

No offense, but I don't think you have much experience in the real world saying things like this.



What you've read is a bunch of posts on SDN. That comes with its own set of issues.

(1) Yes, COs will threaten to refuse things. It happens. I have not heard of any of them following through on this, for all the reasons other posters have described. Revenge is always a double-edged sword, and for most COs the potential to screw themselves is not sufficient to try to screw you in any significant way.

(2) "Delay" is a relative term, and there are many reasons that it can occur. Some people use "delay" to mean they didn't get it as fast as they wanted. Others are actually delayed by months, but that is typically something that is controlled by the admin types not the commanders. Most of learn to 'help along' the process through frequent phone calls and emails. Squeaky wheel and all that. I have also had several close friends who complain bitterly about bonuses being delayed, when actually the problem was that they were late with their own paperwork .


What's the point of all these questions? Do you need validation for your decision not to pursue a military career? It's certainly not for everyone.

Not at all. It has been set in stone that I will start my medical career in the military either through USUHS or HPSP. I just want to know more about everything that has to do with the whole process/career.

 

[idq1i]

My impression has been that the people who try to "go it alone" and re-invent the wheel are the ones who suffer most. And when that's coupled with being generally disgruntled and complaining about everything, well, nobody wants to help out.

When the wheel is still square, reinvention is not a bad thing.

I am glad that you are having a good career and I genuinely hope you get to maintain the attitude to the end.

 

[sonofva]

So I just called finance and tey basically told me that my pay was ok. We had a ten minute back and forth about how I was only an intern and blah blah and he kept insisting he wasn't going to change it... Now what? Bear in mind that I was talking to someone who was a "specialist" in medical corps pay...


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[Sean Lee]

So I just called finance and they basically told me that my pay was too much. We had a ten minute back and forth about how I was only an intern and blah blah and he kept insisting he wasn't going to change it... Now what? Bear in mind that I was talking to someone who was a "specialist" in medical corps pay...


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I am confused. If he knows you are being overpaid, why won't he change it/take the money back?

It sounds like that he was trying to vent to you about how much you are making.

 

[pgg]

Go in person to the local office. Most pay problems can't be fixed over the phone.

 

[sonofva]

I am confused. If he knows you are being overpaid, why won't he change it/take the money back?

It sounds like that he was trying to vent to you about how much you are making.

Sorry. I had meant to say that my pay was fine, not that I'm being overpaid haha


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[Sean Lee]

Sorry. I had meant to say that my pay was fine, not that I'm being overpaid haha


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I see. So the other person on the phone is basically jealous/pissed that you make too much?

 

[denali]

Did you talk to the medical special pays person at your hospital, or to someone in the local finance office?

 

[anbuitachi]

Read the first page of this thread. Saw several instances where poster mentions doc getting kicked out of military. Just curious as to why this happens so much? I thought military wants doctors??

 

[Vandalia]

Read the first page of this thread. Saw several instances where poster mentions doc getting kicked out of military. Just curious as to why this happens so much? I thought military wants doctors??

This can refer to two different scenarios:

1) The traditional one is where a physician is "kicked out" due to misconduct. Physicians get in trouble. Military physicians are no exception. If a physician - or pilot, or whatever - gets in enough trouble, they will be separated no matter how much the military may in general need their skills.

2) More likely, you are referring to actual or proposed (RIFs) - "reduction in forces" (termed various other things throughout the years.) The military is downsizing and as it does so the need for support functions - including medicine - decreases. What is different now is the different trajectories of military and civilian medicine. Since 2000, military pay has increased fairly significantly. On the other side, since 2000, physicians in the civilian world have seen significant decreases in their pay. No civilian physician is making as much as they did 15 years ago (not even accounting for inflation) and a significant number have seen their pay cut by up to 50%. When you include inflation, the drop has been even more dramatic. So you have a case where the pay gap has almost disappeared for some specialties. An O-6 family physician in the military is likely making as much, if not more, than his civilian counterpart.

A reduction in need, combined with a reduced incentive to leave, can mean oversupply.

Even if the military has a net need for physicians, they may have too many in the wrong places. If they have too many pediatricians, that will not mean they don't have to recruit future internal medicine physicians. However, the real issue has to do with age (or more correctly, experience). The entire military personnel system is based on a flow of officers through increasing responsible positions as their time in service increases. So, for example, the military may have too many physicians who are lieutenant colonels with 15 years experience and you may think they would not need to recruit new physicians. However, if they did that, they could (and have with pilots) end up with a "bubble" where when you are looking for the future hospital commanders 20 years down the road and they simply don't exist.

So to put it in one sentence: The fact that the military may have too many physicians in general doesn't preclude the fact that they don't have enough in specific places (both in terms of specialty and experience.)

 

[deuist]

So I just called finance and tey basically told me that my pay was ok. We had a ten minute back and forth about how I was only an intern and blah blah and he kept insisting he wasn't going to change it...

I have the same thing happened to me when I went from my civilian deferred residency to active-duty. I called the lieutenant colonel in charge of special pays for emergency physicians and was told that there was nothing he could do and to "enjoy the money."

 

[deuist]

Since 2000, military pay has increased fairly significantly. On the other side, since 2000, physicians in the civilian world have seen significant decreases in their pay. No civilian physician is making as much as they did 15 years ago (not even accounting for inflation) and a significant number have seen their pay cut by up to 50%.

The special pays for physicians has not changed in over a decade. On the other side, for emergency physicians, pay has gone up significantly. If I were to leave the military today and work in a civilian hospital, I would triple my salary overnight. I am not sure why your paragraph paragraph referenced above has anything to do with the question posed on reduction in force, but it does seem like you are trying to promote something that isn't entirely true.

 

[Sean Lee]

The special pays for physicians has not changed in over a decade. On the other side, for emergency physicians, pay has gone up significantly. If I were to leave the military today and work in a civilian hospital, I would triple my salary overnight. I am not sure why your paragraph paragraph referenced above has anything to do with the question posed on reduction in force, but it does seem like you are trying to promote something that isn't entirely true.

EM doctors make close to 400k?

 

[deuist]

In some markets, EM doctors make more than $400,000 a year.

 

[Sean Lee]

In some markets, EM doctors make more than $400,000 a year.

But the average/median pay is around $250k, right?

 

[UltimateDO]

All depends on how many shifts you want to work. For shift based specialities you have a lot more control over how much you make and what your lifestyle is. A 1099 in hand also opens up some tax options that you otherwise would not have in a salaried job.

 

[deuist]

But the average/median pay is around $250k, right?

That depends on the location and the number shifts that you work. For places like New York City, DC, or many of the other desirable locations, then yes, $200,000 is a better estimate. If you were to go work for a CMG chop shop in flyover territory then the salary goes up quickly.

 

[Vandalia]

In some markets, EM doctors make more than $400,000 a year.

True (I am one). However, there is a huge caveat - when you hear that type of number, it is not take home pay. If you read the fine print you will almost certainly find that is for a physician who is an independent contractor. You have to subtract everything out of that. Malpractice insurance, health insurance, social security, retirement,etc. etc. In some cases, you have to pay for any vacation coverage out of that amount. If you want to compare the independent contractor number with something that would be equal to the typical salary, you need to cut that number in half. So $400K as an independent contractor is roughly the equivalent of $200K salary.

In my post, I specifically referred to primary care. I am on the board of directors of a hospital-affiliated physician practice corporation, (physicians run their own practice under the umbrella and the corporation takes care of the hr, billing, facility management, etc.) and the average salary for family med, internal med, and peds is $183,000 (n=23). Our EM physicians are in the low 200s. A locum may have an equivalent annual income of around $400K, but again that number has no benefits, and a lot of expenses.

If you don't believe me on the salary trend over the last 15 years, simply read the posts on any of the specialty boards.

 

[Perrotfish]

In my post, I specifically referred to primary care. I am on the board of directors of a hospital-affiliated physician practice corporation, (physicians run their own practice under the umbrella and the corporation takes care of the hr, billing, facility management, etc.) and the average salary for family med, internal med, and peds is $183,000 (n=23). Our EM physicians are in the low 200s. A locum may have an equivalent annual income of around $400K, but again that number has no benefits, and a lot of expenses.

If you don't believe me on the salary trend over the last 15 years, simply read the posts on any of the specialty boards.

THe world is definitely getting rough, however I am curious how a 400K locums salary becomes 200K. How much does malpractice really run you when you pay it on your own? Is the tax burden really that much higher?

 

[colbgw02]

THe world is definitely getting rough, however I am curious how a 400K locums salary becomes 200K. How much does malpractice really run you when you pay it on your own? Is the tax burden really that much higher?

The only tax disadvantages are the 1/2 of payroll taxes and self-employment tax (which may be the same thing, I'm not really sure) that now fall on the individual. And those disadvantages can often times be overcome through other tax benefits and shelters not available to employees.

Not to mention that being a contractor doesn't necessarily mean having to pay one's own malpractice insurance. Thousands of DoD contract physicians are evidence of that.

There are benefits of group disability policies, but even then some people prefer individual policies because of the greater security they provide, albeit at a greater cost.

In short, the $400K contract vs. $200K employed position is a no-brainer. You choose the former every time, unless there is some strange X factor - like a pension or near guaranteed job security (see GS positions).