All Branch Topic (ABT) Mental aspect of skill atrophy

[Baron Samedi]

So, unfortunately, straight out of subspecialty training got put into a dead end duty assignment that doesn't utilize my training. No real opportunities to improve the situation, nonsympathetic supervisory chain, and no significant moonlighting opportunities. I've requested an early PCS and been in communication with my consultant who understands my struggles but, obviously, cannot force things to change.

What I am now struggling with is the mental aspect. I feel like I am a "____ doctor" by title only. When I talk to others in my field about what my practice looks like, they literally laugh and are dumbfounded by how mundane it is. I constantly find myself questioning how I will eventually get back into real clinical practice being so far out of it, and wondering if I need to repeat my fellowship once I get out. I've been fantasizing about nonclinical careers as an alternative.

I'm sure I am not the only person who has had an experience like this, as milmed has a reputation for producing skill atrophy and underutilizing specialists. How have others overcome this mental aspect? For those who got out feeling "out of the game", what was your experiencing getting back into clinical care?

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[Monty Python]

If your fantasy about nonclinical alternatives gets stronger, pursue that training on Uncle’s dime. The Army-Baylor MBA/MHA program takes clinicians from all services as well as bean counters. I have known several hospital COs, XOs, and deputy commanders who all spoke very highly of the education.

Army-Baylor Programs | Graduate Programs | Baylor University

 

[Gastrapathy]

Don’t give up on what you’ve learned. The key will be to get our as soon as you can and find a practice with a supportive culture. Be honest with them, it will take months for you to get up to speed.

For me, I was able to moonlight and mostly maintain my skills. But it still was a transition. the biggest adjustment was the volume of complications. Even if your complication rates decrease with higher volume, if you are doing 5-10x the work, you’ll inevitably have more complications. This can compound that feeling of inadequacy when really it’s just an increase in the denominator.

A couple of my friends were really worried about this and it was all about the practice they found. One literally went back to his fellowship program as an attending and they were very cool and got him up to speed. He’s moved on but it worked well. Another joined a solo practice and it was rough. I think he’s ok now but he didn’t get back to the breadth of his field like he hoped.

 

[Baron Samedi]

If your fantasy about nonclinical alternatives gets stronger, pursue that training on Uncle’s dime. The Army-Baylor MBA/MHA program takes clinicians from all services as well as bean counters. I have known several hospital COs, XOs, and deputy commanders who all spoke very highly of the education.

Army-Baylor Programs | Graduate Programs | Baylor University

Does this program extend ADSO?

 

[Monty Python]

Does this program extend ADSO?

I think yes; might be service-specific driven. Here’s their faculty, with representatives from all the services. Pick one from yours and give them a call.
Faculty Directory | Graduate Programs | Baylor University

Chapter 2, Section II of this has info:
https://armypubs.army.mil/epubs/DR_pubs/DR_a/pdf/web/AR 351-3.pdf

 

[HighPriest]

Don’t do anything that will extend your ADSO.

Moonlight whenever possible.

See if there are any local, similar specialty practices who need call coverage or who might want someone to moonlight with them. Depending upon how serious your situation is, you may do this for next to nothing (you would need malpractice however).

Let your consultant know that you’re willing to backfill somewhere if that would mean working more within your specialty.

PCS ASAP.

My first duty assignment was this way. It’s a real skull $&@k. If, for whatever reason, you can’t PCS somewhere they can handle you properly in the military, agree with what gastrapathy said. Keep your mind focused on getting somewhere where you can re-hone your skills.

Is what you do procedure-oriented?

 

[Baron Samedi]

Yes, very heavily procedure oriented.

I had a PCS lined up this summer through my consultant but my local commander refused to release me(which is crazy because my productivity is next to nothing). I am in an over strength billet, so there would be no backfill which creates an issue for them.

 

[pgg]

I had a PCS lined up this summer through my consultant but my local commander refused to release me(which is crazy because my productivity is next to nothing). I am in an over strength billet, so there would be no backfill which creates an issue for them.

Sorry to hear that.

I think it's worse when the inability to work in your subspecialty is the result of arbitrary - if not openly capricious - policies set by an idiot with authority over you. The low point in my career, from a mental health perspective, was my first duty station out of my anesthesiology residency. My dept head was a nurse anesthetist who was hostile to the very idea of greedy moneygrubbing doctors working outside the MTF. So much wrong with that arrangement, in so many ways. Even so, I was grudgingly allowed to work, even though she somehow made me feel bad about it.

Since then it's been better, and I've mostly had excellent moonlighting opportunities in my specialty, supportive commands.

I am currently a little worried that for the next year or so the world will have a very low need for locums docs, because of all the COVID-19 shenanigans. But though that makes me a bit anxious, it doesn't come with the cloud of depression my first command had. No one's trying to maliciously and needlessly screw me, and that makes a difference.

 

[HighPriest]

Yes, very heavily procedure oriented.

I had a PCS lined up this summer through my consultant but my local commander refused to release me(which is crazy because my productivity is next to nothing). I am in an over strength billet, so there would be no backfill which creates an issue for them.

Your situation sounds almost exactly like the one I had. The difference was that our consultant was actually very interested in downsizing the footprint of our specialty (getting out of the tiny POS meddacs). So all he had to do was convince HRC that they were wasting a resource in one place while starving for one in another. I don’t know how, but however it worked it then didn’t matter that the command didn’t want to let me go.

I would work on the “everyone should have a turn” angle. Once you’ve been there a couple years, it’s time for some other newly graduated resident to take a hit, and let you go somewhere where you can brush up your skills. It sucks for that new guy, but maybe you can set a precedent that would make it easier for him to PCS early as well.

So much of this depends upon how seriously your consultant takes the situation. It’s very easy for them to lean back and daydream out their window at their MEDCEN and say “hey, this is part of the deal. You knew that when you joined.” But at least in my specialty the consultants almost never had any experience at these smaller facilities. It’s really a hunger games scenario and they have no qualms that someone else got screwed because it didn’t happen to them. And they convince themselves that it really isn’t that bad. But it is.

THIS kind of crap is exactly why I warn people about milmed. It really wasn’t ever money for me. I honestly think I had a little, mild, PTSD from my first duty assignment.

I hope your consultant is sympathetic. Or if they are not, I hope you get a new one soon.

 

[HighPriest]

And these hospital commanders get this autocratic mindset. Their hospital is their little fiefdom, and it’s honestly just a matter of pride that they have some specialty that they never use. It’s like the Ferrari in a garage that you never drive. You just like the idea that you have it, and you like to show it off. Except in this case, you’re not maintaining it in any way, and it’s rusting out from the inside. And you’re ok with that as long as you can tell people you have one. It’s absolutely shameful.

Is there a local group that could handle your cases if you weren’t there?

 

[Helpful Troll]

So, unfortunately, straight out of subspecialty training got put into a dead end duty assignment that doesn't utilize my training. No real opportunities to improve the situation, nonsympathetic supervisory chain, and no significant moonlighting opportunities. I've requested an early PCS and been in communication with my consultant who understands my struggles but, obviously, cannot force things to change.

What I am now struggling with is the mental aspect. I feel like I am a "____ doctor" by title only. When I talk to others in my field about what my practice looks like, they literally laugh and are dumbfounded by how mundane it is. I constantly find myself questioning how I will eventually get back into real clinical practice being so far out of it, and wondering if I need to repeat my fellowship once I get out. I've been fantasizing about nonclinical careers as an alternative.

I'm sure I am not the only person who has had an experience like this, as milmed has a reputation for producing skill atrophy and underutilizing specialists. How have others overcome this mental aspect? For those who got out feeling "out of the game", what was your experiencing getting back into clinical care?

Baron Samedi - Didn't you indicate in a previous thread that the position you are assigned in your sub specialty is no longer part of the TDA/'authorization' of your hospital/clinic? Is this location over strength for your specialty and sub specialty? Sounds like waste of a resource that could be better utilized in an authorized position elsewhere. Or, is your specialty over strength across the Army?

 

[Baron Samedi]

Yes, I am over strength. That's part of the issue, though. My command won't release me early due to no backfill.

 

[Gastrapathy]

Have you sat down with your CO in person?

 

[Baron Samedi]

Have you sat down with your CO in person?

They declined to meet with me regarding my PCS request. I haven't tried to re-engage since then. Honestly, just trying to keep my head down and avoid getting noticed.

 

[Gastrapathy]

They declined to meet with me regarding my PCS request. I haven't tried to re-engage since then. Honestly, just trying to keep my head down and avoid getting noticed.

wow, rejecting you without having the courage to meet with you. What a loser

 

[Baron Samedi]

Is there a local group that could handle your cases if you weren’t there?

Yes, there are several. I was brought in because there was a claim for a need for someone to do a particular procedure that was previously being civilian deferred (a very minor one that takes about 5 minutes). I've done 4 of them since I arrived 10 months ago. For years before my arrival, these patients were just sent to network without issue.

 

[pgg]

They declined to meet with me regarding my PCS request. I haven't tried to re-engage since then. Honestly, just trying to keep my head down and avoid getting noticed.

Commanding officers can't decline to meet with their people. You can insist. Whether or not this will improve your odds of success in the end, or invite some manner of retaliation (obviously illegal but that doesn't mean it can't happen) is a separate question. It sounds like you have little to lose at this point. They've given you a passive, avoidant, BS kinda hope-he-goes-away answer. They want, hope, and expect you to accept it.

FAQs - What are the applicable statutes/regulations?...

www.secnav.navy.mil

The right of all Navy and Marine Corps members to directly communicate grievances to, or seek assistance from, their Commanding Officers is established in U.S. Navy Regulations (Articles 0820c and 1151.1) and the Marine Corps Manual (par 805). This right is exercised through the formal process of Request Mast.

OPNAVINST 3120.32C, Standard Organization and Regulations of the U.S. Navy

As I recall, you're not Navy (?) but I can't imagine there isn't a similar process for the other services.

 

[Gastrapathy]

But if he’s the kind of person who would try to avoid the meeting, it’s probably not worth forcing him to meet.

 

[Baron Samedi]

I feel like forcing a meeting could result in "Oh you don't have enough work to do? We can fix that" moreso than granting a PCS request or creating meaningful change in the work environment.

As they say, it can always get worse.

 

[HighPriest]

I'm not sure what you'll get from forcing a meeting. The facts that he 1 - circumvented your PCS and 2 - refused to meet with you means that he really doesn't care about anything other than his side of the story. If there was a chance you could convince him of reason, he would have met with you when he heard about the PCS request and before he shot it down.

 

[LTMCUSN]

I’ve seen people request mast and it ruin their relationships/reputation up the COC...I think you’re right to save that as a last resort.

 

[Baron Samedi]

Just as an update I got the greenlight to PCS early and got my YMAV adjusted. I am so unbelievably relieved. I am going to look back at this as a second fellowship in resiliency training.

 

[HighPriest]

Good for you. For the sake of anyone else who might read this thread with interest, how did you manage it?

 

[Baron Samedi]

First I made sure to get my consultant on board and talked to him openly about the struggles I was having. From that point it was a matter of monthly emails to my HRC manager outlining my concerns. My consultant gave them a few calls as well.

To my dismay when I sent a simple followup question a few weeks ago I discovered that the request hadn't been processed yet and this finally advanced the actual approval process, which took about a month to get a decision on.

My biggest piece of advice for anyone else in a similar situation is to reach out early and often. I let HRC know a year in advance that I wanted out and just barely got it approved for Phase 1 of the Marketplace. If I had waited until a few months ago there is little doubt in my mind it would have been rejected.