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Still a shill, great to see.
Military Medicine: Fire. Aim. Ready.
Started by MedicalCorpse
Because you have actual self-respect and want to be a physician? Going into admin is the dark side. Is there something darker than the dark side? Most of us became physicians to do medicine and help people. If you go into admin you have forsaken that.
Touché. Good point.
But who said anything about working a different job during your off time?
You see, the real men of genius are our active duty uber sub-specialists/surgeons/anesthesiologists who seem to 'disappear' a lot during normal gov't working hours.
Where do they go? I don't know for sure. Maybe they're working on their iron play trying to achieve that single-digit handicap. Or maybe they're working some side gig. I would bet the latter, given their earning potentials in their chosen specialties (I do play golf with some of them, they are quite good).
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This isn't far off the deal I had from about 2009-2014. I was an anesthesiologist (a generalist; not fellowship trained at that point) at a small command.
The active duty job was easy. Very easy. Very low acuity. Very low case load. I had few admin duties until the last year I was there - more on that in a bit.
q3 call, but call was from home, and just covered low-volume OB. Even if I was called in, I'd typically put in an epidural and go to sleep. Post-call days were off.
So easy was my AD job, that I daylight'd on post-call days at a nearby community hospital. Also relatively low complexity case load, but the patients were sick. Between my AD pay and moonlighting pay, I was making somewhere around $400-450K per year. And not working that hard.
So what's not to like?
Well.
The easy AD job turned to **** in 2013. For forever-unexplained reasons, I was passed over for O5 and had to take on more admin work, so I took the DSS job. For the next year I was 90% nonclinical as we executed the Small Hospital Study recommendations and closed the inpatient ward, closed OB, and downsized to a pathetic remnant of a surgicenter that had to game the OR utilization stats by moving office vasectomies and dental extractions to the main OR. So proud was the Navy of this achievement that I got a Meritorious Service Medal and promotion to O5.
Even before that, it was not the career I wanted. For year after year, I applied for fellowship but the Navy had zero slots at the GME selection board. No one was getting selected. It wasn't until the 2015 GMESB that I got a FTOS cardiac anesthesia select.
Spending most or all of your time off (generally including most weekends and most leave) working a second job, because your primary job doesn't have the volume for you to remain competent, much less excel and grow, is something that mitigates badness. It's not a point of pride for the system. There's also stress and uncertainty that comes with being the part-time locums-ish guy at the side gig, which can disappear at any moment because either the job changes or your CO or DSS or DH decides that moonlighting harms the mission in some vague way.
I stayed in because I finally got that fellowship selection. Earning $250K+ as a FTOS fellow on a 4-year retention contract was a nice deal. Transferring my GI Bill benefits to my kids was a nice deal. The future looked better - as a subspecialist I'd get parked at a large MTF the rest of my career and do those subspecialist cases routinely. And then I'd retire and take my pension to a busy private practice.
Of course, well-known drawback #1 to military service (unpredictability) reared its ugly head and 6 months after I finished fellowship the Navy closed the cardiac surgery program, and I had nothing to do.
Also, it's a grind. I can't really emphasize that enough. It was OK early on when I was newly out of residency and picking up extra shifts at the hospital 5 minutes from my house for extra cash and cases.
It was quite another thing later on when I had to burn 100% of my leave to fly to another city to do locums work in my subspecialty.
It's something you can do for a while to stem the bleeding, but it's no way to live long term.
There's a couple ways this happens.
The above-board way, which rarely actually happens[1], is that the individuals, with the explicit blessing of their department heads, directors, XOs, and COs, are tabulating 40 hours per week of productive "work" at the MTF, and then are on "liberty" the remaining hours of the week. There's no reg that says "liberty" must be evenings and weekends. So they can arrange their schedules to have regular predictable "liberty" during weekday business hours so they can hold regular predictable outside jobs.
The usual way is that at MTFs that are stupidly overstaffed and underworked, and I'm sure you all know the singular model MTF I'm talking about, people just don't appear on the MTF schedule certain days because they've worked out mutual backscratching deals with individuals in positions of authority. They aren't doing 40 hours per week in the MTF. If pressed, they might point to hours of "backup 3rd or 4th call" taken from home that they claim counts as their work time. Of course, this "backup call" time can be spent working somewhere else because there's an understanding that they're not actually on call and there's no risk of getting called in.
Most of the "real men of genius" are committing fraud by working a second job while getting paid for work they're not doing at the government job, if you want to be honest about it. Legally, I object. Morally, I'm agnostic to whether it's OK to reverse-Uno an organization that frequently and needlessly harms its people with nonsensical if not capricious policies.
[1] It practically never happens with physicians, who are managed by admin-track physicians who hold the core belief that a doctor-week isn't 40 hours. But it's common with nurses because all of them are shift-working creatures through and through. They might do a 40-hour week via a 24-hour call on a Saturday (evenly split between doing nothing in the lounge and sleeping in the call room) and two 8s on Monday & Tuesday. Then they work job #2 Wednesday Thursday and Friday. (Good for them!)
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Welcome back. I am back from my hiatus for personal reasons, and ready to reason with you.
Since you have access to military hospitals and I, as a veteran, do not, I would like to ask you a big favor, one physician to another.
When you have a chance, please drop by your OR and ask three O-5 anesthesiologists one simple question:
What is their opinion of the state of military medicine (not "health care") in the year 2024 and beyond?
Please note:
O-3s don't count, because they are either in training or just learning how to become attending physicians (which takes 5-10 years, as you know).
O-4s don't count, because 100% of them have countdown timers on their cell phones indicating the moment they can separate, resign their commissions, and run far away (so they can avoid being called up to WWIII while they are on IRR).
O-6s don't count, because they have all had their mandatory lobotomies after losing their clinical skills while breaking in their camo knee pads in the course of pleasing their brain dead higher ups.
There are no active duty anesthesiologist O-7s and above. You might as well try to poll three unicorns.
I'll wait.
PS Extra bonus points for asking those three active duty O-5 anesthesiologists whether the problems I identified and points I made about military medicine from 2006 onward, both here and on my web site, aged like fine wine or milk.
PPS As of October, 2023, the Anesthesiology Consultant to the Air Force Surgeon General was a LtCol, which means he is still smart, caring, and sane.
Obviously, as a mere anesthesiologist, he must have been passed over for O-6 at least once so far.
Maybe I should send him a link to boost his career vector: Amazon.com : camo knee pad
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Or as my fellowship preceptor would say, "sure, and let me get out my high-button shoes and spats."
I recently deployed with 3 anesthesiologists that fit your description.
We discussed the main points you raise countless times even while deployed. I've complained about the same things. The pitfalls of milmed are real BUT they are not universal in how they affect people. Not everyone is impacted to the same extent based on service, specialty, sub-specialty, spouse income, family situation, location, year group, and on and on.
What I would like to know is why this community feels it is OK to personally attack, shame or try to discredit the people who aren't impacted as greatly and who choose to continue to serve...at least for now?
Are we trying to save someone else whom we don't know, don't know their family, don't know their financial situation, don't know their likes, dislikes, attitudes from having the same exact experience?
Are we trying to destroy the active duty medical force so that when our warfighters do go to the next great conflict we are even less ready to care for them?
Seriously. What is the goal? Because if it is just getting our story out there to try to save people well we have already accomplished the mission. I send every single applicant that I interview to this forum to read for themselves what can happen. It is one way I try for informed consent if they are otherwise a really solid applicant and have direct experience with MilMed.
If we are trying to destroy military medicine faster than it is destroying itself then for what purpose? To right a wrong done to us?
[edited to remove "you" as the question was more for the group]
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If words on an obscure forum on the internet with millions of fewer eyeballs than the latest underdressed TikTok or YouTube influencer can "destroy military medicine", what does that say about the institution? Do you really think our collective goal here is to insult and degrade you personally vs. offering up our true, sometimes heartbreaking experiences in the trenches as active duty physicians for years (11, in my case)?
So you are enjoying your time as a Navy orthopedic surgeon. Great for you. Now ask yourself:
- Are your patients being well served by the system you are enjoying?
- Would you advise your family member to have complex surgery at a military treatment facility (MTF) or downtown, if cost were not an object? Really?
- Are you happy with all of the non-physician "providers" who have taken over actual patient care, including orthopedic PAs who think they know as much as you do? (I have a great story I believe I have shared before about the brilliant orthopedic surgeon, LtCol (Dr.) KL, and how he demonstrated in about 1 second the critical difference between a board-certified specialist physician and surgeon and a gaggle of PAs...maybe later).
- What has changed in the military's tri-service (now quad-service) capability to provide competent, caring, local and free medical care at well-staffed, well-provisioned, and well-organized MTFs between 1990 (when I was graduated from USU) and today? Is it better or worse?
- Are surgeons and others able to maintain their skills during their careers, or are the competencies they built up over years of medical school and residency degrading every day with endless non-clinical demands to do meaningless things with the limited time they have that they could be using to see patients and keep current?
- How much medical care should military physicians anticipate providing during the non-WWIII deployments of the future? Should they bring medical references or decks of cards to stave off the boredom, punctuated by moments of sheer terror when the drones lock on to the GPS location of their forward position? Will their last sight be the face of the assistant to the assistant physician's assistant trying to intubate them with the laryngoscope backward?
- Should prospective military docs know the facts about the myriad challenges they will face during their time in service to our great nation, or are those dirty truths to be swept under the rug to avoid the costs and effort required to fix the serious problems we all recognize, and which pose serious threats to patient safety now more than ever?
I raised my right hand to swear the Oath for Commissioned Officers at ROTC Det 365 when I was 17 years old. I spent a large chunk of the most productive years of my life trying to do the best I could for the active duty members, retirees, and dependents under my care, even if that meant alienating commanders and others who resented me for sticking up for what is right rather than what is cheap, incorrect, and politically expedient. I was trained by USU and the Air Force Blue Book that Integrity was First and Service should be before Self, only to learn, to my great chagrin, that those were only empty words to the people in charge at all levels above me.
This cost me much in reprimands, strife at work and at home, and, in the end, my very career. I still type with tears in my eyes sometimes when I continue to cathart my rage and depression at the premeditated murder of both military medicine as I knew it from 1986 to around 1998 and what I had hoped would be my Air Force career until retirement as a full colonel.
I hope you finish your military career with the dedication, patience, and honor you have demonstrated by staying in to serve our country. I also look forward to hearing from you five years or so after you leave to share your insights as to the differences between civilian and military orthopedic practice. Trust me, the civilian world is far from perfect. However, I have yet to be ordered to commit malpractice, cover up Sentinel Events, or perpetrate crimes against humanity and the Geneva Conventions at any of the many sites I have worked at since 1 July 2005.
Peace,
Rob
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There several niche specialties that have a nicer gig in the military than outside. That's not the case for the vast majority of military physicians. So to say "well, I'm happy" is all well and good. That opinion should be taken into consideration with all the other opinions out there.
I will say that moonlighting is saving me. If it weren't for moonlighting, I would be an incompetent physician. And for reference I have only been stationed at major medical centers post-residency.
I will say that moonlighting is saving me. If it weren't for moonlighting, I would be an incompetent physician. And for reference I have only been stationed at major medical centers post-residency.
Well - as you know 🙂 I've been one of the more generally positive people here. I had a mostly good experience on active duty, as luck mostly followed me around, and in general it doesn't take a lot to make me reasonably content. I was mostly blessed with good department and command leadership. In this context what "good" means to me is that they didn't overburden me with too much nonclinical work and they mostly stayed out of my way with regard to off-duty employment.
The last few years were a bit tough because I had to travel and moonlight so much to get cases.
I am certainly happy right now, as a partner in a private group, busily practicing in my specialty and subspecialty, to be collecting about $70K/year from the pension. It all worked out nicely for me, in the end. But I don't think it'd go so well if I was 23 years old again and stepping onto the USUHS campus for the first time.
My opinion on the wisdom of joining as a medical student has evolved a lot over time. It was a much different medical corps when I retired in 2022 than when I was a GMO in 2003, or a resident in 2006, or a new attending in 2009.
We gripe here because we care, and because senior leadership didn't pay a bit of attention to our gripes while we were on active duty - at least not in a way that resulted in any kind of meaningful action. These experiences shouldn't be lost in the wind, because -
It's easy to lose sight of why this web site and these forums exist. While the majority of us use them for social purposes, their actual primary purpose is to guide and advise future doctors. It's the eternal headline on the home page: Helping Students Become Doctors.
When premeds come to the milmed forum, they should benefit from true information and sound advice, to help them become doctors. Sound advice only comes from experience. There's a place for people like you here, to emphasize the positives of military service. I have also, repeatedly, posted about my positive experiences in the Navy.
There's also a place for people to point out that joining the military is very likely to be a significant obstacle and a handicap to becoming the best doctors they can be. It's important to get debt-averse premeds staring down the barrel of 4 years of osteopathic tuition to understand the full cost of that HPSP "scholarship".
I personally don't advise anyone to accept HPSP at this time, mainly for reasons related to GME, but also because the case load and variety post-residency is insufficient for most physicians in most specialties to reach their full potential. There's a small group of prior-service people for whom I think USUHS or HSCP or possibly HPSP might make good sense.
I agree that one-liner personal attacks on anyone posting their experiences with milmed are unhelpful and not really in keeping with the rules or spirit of SDN.
If there are leaders still in place that forced your to commit malpractice, cover up sentinel events or cover up crimes then you should expose them. But please don’t imply that that behavior is current common place in MilMed because it is not. In fact, the checks and balances on the care that we provide are now just as good, if not better than the civilian world.
Skill atrophy, lack of autonomy, online training, mid level battles, sure.
I’m sorry you were stuck under toxic leadership that was committing crimes or intentional malpractice. I really am because it takes a very bad situation to leave at 19. In no way am I downplaying it but in no way is that tolerated or accepted in current MilMed nor do I think it was ubiquitous during your time. It definitely shouldn’t be implied as a current issue as we discuss.
I would be out in a second if I encountered what you describe and especially if there was no avenue of accountability and punishment for those responsible.
What is this "A" word of which you speak?
I don't recall anything like that at any level of government, military or civilian, in my 60 years of life (so far).
I think most Americans can make a long list of bad things that happened where no one was held accountable.
In our system, only whistleblowers are held accountable for embarrassing the government, whose prime Core Value is covering up crimes and other official and unofficial misdeeds by shooting the messenger. If you tell the truth, expect to get punished, jailed, killed, forced into exile, or just reprimanded out of your career and the life you had before, whether military or civilian.
You only have to look at our news headlines for a few days to see how those in power get away with murder, while the dedicated folks like us who actually believe in our nation and Constitution are eventually chewed up and spat out by a system that sneers at their charming naïveté after we have dedicated our lives to trying to do what is right, rather than what is expedient.
I spent this whole morning recapitulating my story, including my many cries for help to correct the course of military medicine before it was too late, but I decided to spare y'all. Those who wish can look back on my many posts over the years and put things together. Those who don't care can move on.
As I said before, I wish you fair winds and following seas on your continuing voyage as a Navy physician and surgeon. I just hope the Navy continues to care for you the way you care for it.
PS In the future, if you are giving prospective military medical students and others advice, in addition to this most excellent forum, feel free to send them to the page I just wrote, which curates many lengthy threads on SDN and other links regarding why people should think twice before joining milmed after the year 1995 or so, and certainly in 2024 and beyond:
Reasons Not to Join or Stay In Military Medicine
Please PM me with other valuable threads I certainly missed, because nobody's perfect.
Sincerely,
Your favorite Oscar.
Again. Nobody is covering up crimes. I hold leaders, residents, front desk staff, etc. accountable every day. I still think it is overstepping to continue to imply that milmed is associated with cover ups, murder, etc. You can't look at a patient wrong anymore without being held accountable, let alone commit malpractice without a full investigation coming your way.
Thanks for sending those links. It was interesting reading back on the old day posts and then my "discussions" back and forth after finishing residency. I would respond to every doom and gloomer's request to let them know how its going in 3 to 5 years but they'd all find some way to still discredit me for finding satisfaction in my continued active duty service.
I will continue to send applicants this way. I think the SDN forums (especially MilMed) have more impact than we all realize.
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Ehhh, I think it's somewhat naive to think this is not happening at all at any level of government if that's what you're saying. I don't doubt you are doing your part to hold people accountable. I think medicalcorpse is also suggesting this as we know there have been things that have happened (at least that have made their way to the media that of course will spin it whatever way helps the certain political swaying of that specific media outlet) in government, which begs the question of, what are we not being informed about? Which I have little reason to doubt there are plenty of other things that have happened and have been covered up. I know at a previous base I was stationed at an O-6 at the group level was a whistleblower for some, let's call it shady business that I don't know all the details, which led to that individual being PCS'd somewhere else and as far as I know, nothing came of it. I had an O-6 group commander come in as a patient because he was intoxicated on the job and blacked out at work and by the time I saw him was in etoh withdrawal and was sent to the ER. He straight up told me before he went that this had happened before at work and he was just sent home to sleep it off, it was brushed under the rug. Investigations ensued after I saw him in which his leadership (and the individual himself) denied any past history of this. He was eventually relieved of his position but pretty much nothing else happened to him last I heard (which was a couple years later when I had already PCS'd and getting out of the military), still retained his O-6, was allowed to continue on and he may have retired by now since that was a few years ago and he was already past his 20 years. This happened in my brief 4 year stint post residency as an active duty psychiatrist. I wasn't called to testify to any type of discharge trial or anything else as I had been for much lesser offenses of airmen during my time. It certainly happens for those in power who rub elbows with others in power.
First off, Dr. Jones, from one Jones to another, thank you very much for joining us here on SDN and for your informative video. I watched it as well as your first video. They were both very well done. Your first video should be mandatory viewing at all military Graduate Medical Education (GME) sites and USUHS.
I'm not sure I can concur with your advice to "take the money" from HPSP, but everyone has to make his/her/their own decisions based on all the relevant facts they can find.
I am so sorry that you were subjected to this inhumane and criminal behavior by your superiors in the Army. I honestly feel your pain, even though I am about as white as one can be without being albino.
My new definition of déjà vu: "...with so much damage to my reputation simply by men putting pen to paper..."
Also: "...there's no recourse."
And, of course, "nurses will say things about you...other people will start to whisper behind your back..."
Having your military career destroyed due to tribalism is not limited to African-Americans, as this severely melanin-challenged Welsh-German-Italian American can attest. My experience as *the* 1985 distinguished Harvard graduate of ROTC Det 365 (Harvard/M.I.T./Tufts/Wellesley) was not enough to get me into the inbred tribe of ring-knocking Air Force Academy grads that runs the entire Air Force, not just military medicine (back when that was still a thing).
As a former LtCol anesthesiologist who had his career destroyed by a series of evil commanders and senior surgeons (all of whom were classmates at both the Air Force Academy and USU) who reprised against me for speaking out for patient safety instead of shutting up like a good peon while the military downsized itself into oblivion after the end of the Cold War, I would humbly like to offer you a few topics for you to address in future video(s).
You are far more telegenic than I am. Also, I was unable save 4K UHD videos from my time in the service to use as you have, because we were still scribbling on paper charts, trying to use fax machines (when they worked), and taking pictures with chemically-treated plastic at that time.
A few more questions that prospective military physicians may not know they need to ask:
--Will I be commanded by a nurse?
--Will I be subject to arbitrary UCMJ punishment for doing my job?
--Can I be forced to be on call every other night for months at a time?
--Are military treatment facilities (MTFs) dumps, other than maybe the top five or so?
--Is graduate medical education in the military healthy and vigorous, or dying on the inside like a termite-ridden tree about to blow over with the first strong breeze?
--If I retire, will I be subject to involuntary recall to active duty for the remainder of my natural life whenever the National Command Authority realizes that they need my body because they did not plan on having enough doctors to [fill in the blank] because senior leadership are all mor0ns who got promoted for breathing instead of competency oops?
--Extra bonus: If I don't like the military, can I quit?
--Extra extra bonus: What is the difference between the consanguineous clique of U.S. service academy graduates who went on to be classmates at USUHS and cover up each other's mistakes and incompetencies for their careers while ostracizing outsiders (see: tribalism) with the power of their high military ranks and traditional Southern European crime syndicates?
For my own personal answers to these questions, please see my new web page on my site: Questions for the Other Dr. Jones to Address
Looking forward to your next videos with popcorn at the ready...
Rob Jones, M.D.
PS I liked, subscribed, and signed up for notifications from your channel...it's the least we can all do.
Prime example of why relying mostly on reserves doesn't work:
Realizing challenges of AT and last minute tasking, I went through the trouble of getting an AT approved/budgeted/phased through my unit and on my civilian work's books 8-9 months out. It took a lot of social capital at work to get the time off. Patiently waited for orders which were going to happen 1-1.5 months out. A month ago, unit came back asking if the active duty hospital could pay for travel (hotel, car, flights)? Sure, they offered initially, but you insisted on paying for it. Therly are still fine with paying that. Were now 3 weeks away still without orders. Now all of the sudden they've sent the request. It's at Brigade and sitting there but there's no funds. Division has no money to fund ATs, which they were pushing all providers to do as recently as last BA (and still are at later dates). My BC tells me directly on the phone that there's a strong possibility that funding may not come through and will have to figure something else out...but maybe it will...at the last minute. Multiple people look into it for me and confirm (including having a future flag officer ask on my behalf). Now I'm stuck with two weeks of no pay in limbo with a strong possibility that they won't come through and then at a later date they'll ask me to take another two weeks off unpaid to makeup my AT requirement this year.
And you think they are going to convince civilian providers and civilian employers that's ok? Ha.
Realizing challenges of AT and last minute tasking, I went through the trouble of getting an AT approved/budgeted/phased through my unit and on my civilian work's books 8-9 months out. It took a lot of social capital at work to get the time off. Patiently waited for orders which were going to happen 1-1.5 months out. A month ago, unit came back asking if the active duty hospital could pay for travel (hotel, car, flights)? Sure, they offered initially, but you insisted on paying for it. Therly are still fine with paying that. Were now 3 weeks away still without orders. Now all of the sudden they've sent the request. It's at Brigade and sitting there but there's no funds. Division has no money to fund ATs, which they were pushing all providers to do as recently as last BA (and still are at later dates). My BC tells me directly on the phone that there's a strong possibility that funding may not come through and will have to figure something else out...but maybe it will...at the last minute. Multiple people look into it for me and confirm (including having a future flag officer ask on my behalf). Now I'm stuck with two weeks of no pay in limbo with a strong possibility that they won't come through and then at a later date they'll ask me to take another two weeks off unpaid to makeup my AT requirement this year.
And you think they are going to convince civilian providers and civilian employers that's ok? Ha.
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Maybe I'm just getting old, but you may wish to define the acronyms AT and BC for your non-Army and/or civilian readers.
Thanks.
I'm pretty sure that Google was just trolling me with AT: Preposition (Place) and British Columbia...
AT = Annual Training for reserve components, BC = Army Batt Commander
I’m happy that you’ve had a good career with the military. And I will not at all discourage you from sharing that on this board. I’m glad you can provide a different perspective than what appears to be the vast majority of those on here. I think those who are considering joining the military need to have as much info as possible to make an informed decision (just as I hope we all do when offering a treatment for a patient) regardless the good the bad and the ugly.
But it does appear that at least on SDN the positive experience you’ve had is in the overwhelming minority. I know that all my residency classmates were absolutely ready to check out the second they could due to the absolute Charlie Foxtrot that is milmed. Many if not most other docs I interacted with were as well. That may not be indicative of 100% of every doc but it sure seems the sentiment overall in the MC is pretty negative.
For Reserves the old phrase is "a weekend a month and two weeks a year." AT is the two weeks of Annual Training.
Thanks. I figure that, if I'm confused by an acronym and can't find the answer quickly using search engines, someone else out there is also scratching their head.
Was ich denk' und tu, trau' ich auch andern zu.
(Rough translation: What I think and do, I trust others [are thinking/can think/are doing/can do] as well)
--Old German saying/proverb
Traduttore, Traditore.
(Translators are traitors.)
--Italian saying
PS As I've said before, I have no confidence that the U.S. military reserve system could ever attract/train/retain/pay/employ/deploy enough qualified civilian reservist physicians and other "providers" to avoid mission catastrophe, let alone mere mission failure in the next big war.
Ignoring the lack of reservist hospitals/clinics/buildings/transportation/money, the primary "weakest link" is that the highest ranks in the Air Force/Space Force Air Evac and Army/Navy medical reserve system are filled with arrogant/ignorant nurses, MSC officers, and other non-doctors with zero medical experience.
These clipboard-carrying mor0ns are led by flag rank ex-military academy [pilots/navigators/ship-drivers/submariners] who all golf together and regale each other with how bad@ss they are when they strap their pasty white butts into [planes/tanks/ships/subs] and pretend that WWIII will be exactly like a Tom Clancy novel from the 1980s rather than more like this: Slaughterbots (viewer discretion advised).
At Harper Hospital in Detroit, there is a museum hallway for the institution. There is displayed a banquet camera photo (a device that also deserves a place in a museum) showing the entire staff of 1917 or so, in uniforms, mobilized as a unit for WW1. That is the kind of reserve that will be needed.
This is a very fair summary of what it means to serve in MilMed. For you to have put together such a thoughtful and thorough piece, despite what happened to you, is surprising, noble, humble, crazy all wrapped in to one. Your videos are honest and your values are clear. I am truly sorry to hear what happened to you and I am so thankful we have/had people like you to fight for change. Thank you for your service and thank you for doing what you do. I’ll be reaching out directly to learn more about the active efforts currently in place to impact change to make sure myself and colleagues are doing everything we can.
It’s funny, we always say “it’s a small Navy” which is true but more and more I realize that our medical communities between services are so isolated outside of the main “purple” institutions. I hope that continues to change because we all have a lot to offer in the differences we have as individuals and organizations.
Deleted due to misunderstanding.
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I believe this insightful observation by my active duty Navy colleague lies at the heart of much of the misunderstanding and disbelief I have experienced here on SDN since 2006 as I related the story of my murdered military career.
"I was an Army/Navy anesthesiologist/other physician, and my experiences were not the same as MedicalCorpse's in the Air Force, so he must be grossly mistaken or just lying."
This was true even the year after I left, so I am not even counting the changes (mainly for the worse) that military medicine has undergone in the past 19 years since I hung up my spurs and walked away.
As the smallest of the three military services that had physicians on their rolls in the year 2005 (not counting the Public Health Service), I eventually recognized that the USAF, which I had loved from 1981-1998 without reservation, exhibited the following flaws in culture, dogma, and leadership:
1) The military academy clique formed a far larger cohort than in the other services, leading to cover-ups for their buddies.
2) The USU clique (of which I was a part) constituted a larger percent of docs, thus reinforcing tribalism and groupthink.
3) Having wings on your uniform (from prior service flying or flight surgery) was almost mandatory for promotion past O-5.
4) Regardless of the Little Blue Book, Integrity was last, Self was before Service, and Excellence is approved but unfunded.
5) Forcing people to take Air War College in residence reinforced the clannish clique of senior leadership.
6) Starting at the Air Force Academy, there was an unconstitutional culture of One Air Force Under Jesus that excluded many.
7) When a few specialists were deployed from small Military Treatment Facilities in the Air Force, it shut down entire units.
8) The whole "Keeping up with the Joneses" thing with Physical Training: gotta make sure we are just as manly as the Army.
9) Pervasive anti-intellectual climate promoted "Sir, yes Sir" rather than doing what was right for the nation and our patients.*
10) In four years at Wilford Hall, I was never invited or ordered to visit William Beaumont across town. Letterman had shut down by the time I was sent to Travis. When I served at Andrews for five years, it was the same with Walter Reed and Naval Hospital Bethesda. The Air Force never gave me the option or opportunity to work at other services' medical centers to learn and grow professionally and socially. That was not a priority for the Air Force vs. forcing me work to death at Andrews with our minimal staffing, underfunding, and no functional mentors. I never got to know any anesthesiologists from other services in the 11 years I served after residency, except for brief "Howdys" when I was lecturing in physiology at USU.
I could go on, but these are just off the top of my head.
*The anti-intellectual bias in the Air Force is a real problem that is ongoing. I honestly feel is it one reason why the Space Force was created, so that smart, geeky officers could be promoted equally with functionally-illiterate ex-Aggie, ex-Academy Good Ol' Boys who had strapped themselves into flying tin cans a decade before to prove their studliness.
For further reading, I recommend the following:
Flying High, Thinking Big
The Uniformed Intellectual And His Place in American Arms Part I
Soldier-Scholar (Pick One): Anti-Intellectualism in the American Military
Anti-Intellectualism in American Life
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Deleted due to misunderstanding.
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I wonder what the relative physical fitness of your average physician was back then, when automobiles were a novelty, and most people walked 10X more than we do nowadays. Then there is the BMI issue. Most importantly, there is the polarization issue, which pretty much didn't exist in 1917 the way we experience it today, because they had yet to live through the events of the 20th and early 21st century that destroyed our inherent trust that the government would always do the right thing and tell the public the truth, no matter what.
I don't think we'd have enough prison cells to incarcerate the number of people who would refuse to be drafted or forced into the reserves in any future conflict not involving invasion of our homeland.
It's too bad we have to learn the same lesson after every war: downsizing the military to the point of mission failure is stupid. After WWI: check. After WWII: check. After the Korean War: check. After the Vietnam War: check. After the Cold War: check. After the Iraq Fiasco: check. Now, we have Russia; China; home-grown radicals on both sides of our polarized society; the ongoing Middle East disaster; unknown unknowns like lab-created biological pandemics; possibly alien vs. terrestrial UAPs; nanotech viruses; and ineluctable hostile AI; and yet the idiots in charge at the highest levels of both the civilian and military leadership are laser-focused on every single topic (fill in the blank) except building up our forces and materiel to meet the inevitable conflict(s) just around the corner.
Hate to say I told you so (all right).
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I deleted my prior posts.
I have been studying German since childhood, first from my father's college textbooks, then by listening to vinyl records from my local library, then four years in high school, then at Harvard, where I tutored German and Japanese and ran the Mather House German Table (Stammtisch), as well at the Japanese Table.
In the military, I was listed on a call roster to translate German, Japanese, and (ha!) Latin at every medical center I was stationed at. This came in handy when an intubated dependent mother-in-law originally from Germany who didn't speak English was thrashing around and scribbling on a piece of paper in German at Wilford Hall during my residency. I was paged overhead to respond to her "crazy" behavior, only to find that she was thrashing to prevent the 2LT ICU nurse from giving her a medication that would have killed her, because the nurse failed to read her allergy band.
As soon as I told her "Alles wird in Ordnung sein," she relaxed. I recommend those magic words to anyone who needs to calm a German/Austrian/German-speaking Swiss person who is frustrated by the less conscientious humans around them who are failing to ensure that "Everything will be in order." Rough English pronunciation: All'-ess veert in Ord'-noong zein. (emphasis on the syllables All and Ord; "zein" rhymes with "mine", not "mean").
I also talked down a psychotic dependent wife who only spoke Japanese (during her psychotic breaks, I later found out) when she went haywire at Travis attempting to elude the fox demons (kitsune) trying to drag her into the afterlife, but that's another story.
I apologize for my misunderstanding of your, um, misunderstanding of what I had previously written. This highlights the dangers of communication via the medium of text vs. face-to-face or even voice communication, which might have clued me in that you simply didn't understand the meaning of what I had written. Sorry.
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Of course I am a minority on SDN.
I signed up to learn about MilMed and apply to med school. I came back after residency to see if I could help based on my lessons learned. I stayed to maintain the minority.
I’m a big fan of finding and maintaining balance in all aspects of life.
I am looking forward to hearing your perspective after you've been an attending on active duty for 11 years.
May I ask what year that will be?
Dude, that’s about as pedantic as one could get.
Your last day in the military is so long ago now that it’s almost as old as people enlisting in the military at this point. (Ok, not really I know, but it’s about a “generation” ago at this point). You also know that one doesn’t need to be an attending for a X years to make the arguments they make.
Their experience is different than yours, it’s different than mine, and it’s different than many others, but that doesn’t make it wrong. As they say in the enlisted world “choose your rate, choose your fate”; certain specialties/subspecialties have a VASTLY different experience in the military than others.
I see you are still extremely bitter from your time in the military and nothing has changed that feeling over several years. That’s okay, you had a terrible experience and it’s important for people to know that’s a possibility.
My point was this: one's military experience can turn on a dime without any notice. See the other Dr. Jones's first video. He went from being a graduate of the U.S. Military Academy (West Point) and a rising hopeful orthopedic surgeon, to having his dreams and visions of his future in the armed forces destroyed due to the malfeasances of a gang of racist/tribal losers who were out to get him. This kind of trauma wounds your psyche for the rest of your life, as you can probably tell from my posts here so many years later.
Honestly, from 1994 until 1998, I was pretty happy as an attending at Travis. We all had to deal with one supremely narcissistic and toxic pediatric surgeon, who almost (but not quite) balanced his evil ways with his amazing skills with his hands, but, other than that, things were pretty good.
We followed Air Force and hospital regs regarding the anesthesiologist being the leader of the anesthesia care team model. We had pretty much enough bodies to get the job done without needing to be on call every other night. Our squadron commander may have been a nurse, but we never saw her except for when she pinned on our rank after promotions. She gave us positive words of encouragement and zero interference with clinical decisions.
Plus, northern California was an amazing place to live in the 1990s: blue skies for nine months of the year, Napa and Sonoma a few minutes away, computer conventions almost every month at the Moscone Center with tons of free swag, and my best friend and college roommate just down the road in San Francisco.
Then, all of a sudden, it all went down the toilet. Between the Objective Medical Group inciting civil war between the militant CRNAs and the dumbfounded anesthesiologists from 1999 onward; the ascension of five "leaders" from the USU Class of 1984 into positions far beyond their competencies; the insane downsizing of anesthesiologists through terminal failure of retention due to mistreatment; slashing and then closing the ONLY USAF training site (Wilford Hall); and unforgivable lack of planning by the incompetent senior leadership who somehow failed to realize that a force posture barely adequate for the rinky-dink Military Operations Other Than War of the 1990s would fail disastrously if the USAF were tasked with Missions Involving War in the future; what had been my military career went up in flames. This was even before one of the USU Class of 1984 bozos gave me my trifecta of UCMJ punishments for attempting to do the right thing as an officer and physician as I had been trained to do since I put on the uniform at age 17, rather than for failing to prevent crimes against humanity in Iraq, for example.
Anyway, your point about different experiences of different specialties is important to emphasize as being 100% correct.
I think this topic deserves its own thread, however, because we have drifted pretty far from my Original Post...so you have something to look forward to in the near future.
Peace.
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2027
Is 11 years as a staff a magical number? Since things can change on a dime, why 11 years?
You ever seen the ring?
Rings are for 12 years (military academy + USU).
I got nothing for 11 years (ROTC + USU) except my mental scars and VA benefits...
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So that’s a no, then.
The ring did an 11 year anniversary sequel? 🤷♂️
I’m fairly certain none of us has any idea
I did. The implication being that, as in the film, something terrible happens at exactly 11 years (7 days in the movie) for arbitrary reasons. Obviously this fell flat.
Eh. Even Seinfeld had a bad episode.
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I will say that FWIW time does matter. I vacillated from being fully invested in a stint in the military as a med student to thinking about a career in the military as a resident to hating milmed with a white hot passion as a staff doc and shortly after separating. It’s been 7 years now and as I look back I have mixed feelings, but mostly negative. Part of that is just my personality. I don’t hold grudges. Even if I should, I just can’t hang on to anger for a long time. It’s burns hot and intense but only for a short time.
And I think that while I don’t have most of the experiences @militaryPHYS has, I appreciate that so much of the milmed experience is two things:
1-Whether you’re an eternal optimist.
2-the luck of the draw.
I know guys who got what they wanted when they wanted it, and who were happy to work less and get paid less while surfing at 4pm every day. When the guy holding your leash is feeding you well it’s easy to ignore the leash.
And I know guys who had to retrain themselves to be doctors after spending 4 years up inside America’s @$$hole doing nothing of importance. The guy holding their leash was beating them regularly and starving them.
It’s the same guy holding both leashes.
I think that’s part of the goal here - show med students that both things are possible. But they should understand that it’s partly outlook and a huge spoonful of luck and that, in my opinion based upon my experiences and as demonstrated in this thread, the odds are stacked against them.
And I think that while I don’t have most of the experiences @militaryPHYS has, I appreciate that so much of the milmed experience is two things:
1-Whether you’re an eternal optimist.
2-the luck of the draw.
I know guys who got what they wanted when they wanted it, and who were happy to work less and get paid less while surfing at 4pm every day. When the guy holding your leash is feeding you well it’s easy to ignore the leash.
And I know guys who had to retrain themselves to be doctors after spending 4 years up inside America’s @$$hole doing nothing of importance. The guy holding their leash was beating them regularly and starving them.
It’s the same guy holding both leashes.
I think that’s part of the goal here - show med students that both things are possible. But they should understand that it’s partly outlook and a huge spoonful of luck and that, in my opinion based upon my experiences and as demonstrated in this thread, the odds are stacked against them.
Best way I’ve heard it described is folks with a Forrest Gump experience where everything just works out look back with fondness. Others, not so much, lol.
I had a good time both AD and reserve time where everything just worked out, so I stuck around until the (R). But I’ll be the first to admit I’m the exception, and don’t really recommend HPSP or AD to anyone anymore. Reserves if you just have to serve, but they seem hell bent on screwing that up these days as well.
Not gonna lie, I’m kinda sad at how ‘they’ screwed the MC and I went from being a fanboy to meh at best.
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I hate to say it the navy was hell bent on promoting a certain demographic of males apart of a boys club. Navy Ortho was full of that. At least in the anesthesia community their was a bit more diversity. I hope your not the one who thought it was more appropriate to get your teeth cleaned while you had a patient on the table…..
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I’m not sure who you’re asking, but no that seems pretty inappropriate. I mean they would have to be pretty dirty…
What is the point of a comment like this?
The point is these things happened due to the promotion and advancement of individuals who never earned their spot. Boys club loyalties led to loose ethics when it pertains to patient care and safety. If this story struck a nerve I have many many more. I will say in the anesthesia community we prioritized our patients. Their were boys club loyalties but those only really started when you made O5 to O6. I can only speak for my experience in the Navy.
Is the assumption that all Navy orthopedic docs are a part of and responsible for this? I was never in the Navy nor was I an Ortho doc, but I don’t know militaryphys from anyone else on the forum. Maybe I’m the one being naive but it seems inappropriate to make serious assumptions about his character based on his specialty and service. Maybe you know him personally?
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