Military Medicine - Its what you make of it - My journey

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After another incredibly frustrating day at the local MTF, I'm just here to throw my hat into the "don't do HPSP" ring. Full disclosure, I'm staff that got my residency of choice in my specialty of choice and ultimately in top 5 of my preferred assignments. The deal is just not worth the headache. I'd love to explain why, but everything that needs to be said has already been said in a dozen other threads. Everyone just hears what they want to hear anyway because the forum is just another internet echo chamber. Some say "it's what you make it." Sorry, man. You can't make chicken salad out of chicken ****. I look forward to hearing why I'm wrong.

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I look forward to hearing why I'm wrong.

I must have missed the part of your post where you provided any information about whatever it is you're unhappy about. How can we tell you you're right or wrong or anything else, if the post you joined the forum to make says nothing?

Oh, wait, here it is:

I'd love to explain why, but [...]

but you can't be bothered. Trolls are unwelcome. Try again, or go away.
 
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I must have missed the part of your post where you provided any information about whatever it is you're unhappy about. How can we tell you you're right or wrong or anything else, if the post you joined the forum to make says nothing?

Oh, wait, here it is:



but you can't be bothered. Trolls are unwelcome. Try again, or go away.
classic psyops to undermine the medical corps LOL
 
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Fine. How about adding more physicians in an already crowded facility without adding ancillary staff (let alone patient population) to properly support the increased manning, horribly outdated systems malfunctioning in the MTF causing partial/full diverts and going unfixed for weeks when a civilian institution would have them back up in a day, constant computer "upgrades" causing essential medical programs to brick. This all on top of the usual nonsense that has beaten everyone down to a point where things like a DOS system to enter and view orders can be considered almost acceptable.
 
Fine. How about adding more physicians in an already crowded facility without adding ancillary staff (let alone patient population) to properly support the increased manning, horribly outdated systems malfunctioning in the MTF causing partial/full diverts and going unfixed for weeks when a civilian institution would have them back up in a day, constant computer "upgrades" causing essential medical programs to brick. This all on top of the usual nonsense that has beaten everyone down to a point where things like a DOS system to enter and view orders can be considered almost acceptable.

You're right. These are all things that have been discussed on here before.

More insight in to WHY you feel like these common pitfalls are so burdensome to you would help. Why did you not know about these common issues when you signed up? Service, specialty, Active Duty residency vs. Deferment (civilian residency), etc. will help us learn and be able to give back to future MilMed applicants.

Complaining about CHCS and IT issues is a giveaway of someone who was not fully informed when they signed up. That or you went to a civilian med school (HPSP) then got a deferment to train civilian and forgot what Military Medicine is like. Nothing wrong with that pathway so long as you remain dedicated/accepting of the commitment you originally signed up for. Otherwise, if you wanted to be a civilian physician, why did you sign up for HPSP in the first place?
 
More insight in to WHY you feel like these common pitfalls are so burdensome to you would help.
This is important. I think it could be taken as a bit of a slight, kind of throwing it back in the face of the poster. But I don’t think it was meant that way. It’s good to know how we can better inform people. Knowing how they formulated the opinion they have is a useful insight into the pitfalls of what is offered here. Assuming, of course, that the applicant knows about this site.
 
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@HighPriest is right. It was not meant to be me throwing it back. I am really trying to help us all understand where the branches are failing during recruiting and/or where we are failing our future MilMed physicians during training by not fully preparing them for the military system that they will eventually be placed in to.

Thanks for clarification. Sorry if my focus on answers came across the wrong way.
 
@HighPriest is right. It was not meant to be me throwing it back. I am really trying to help us all understand where the branches are failing during recruiting and/or where we are failing our future MilMed physicians during training by not fully preparing them for the military system that they will eventually be placed in to.

Thanks for clarification. Sorry if my focus on answers came across the wrong way.

The failure occurs due to the fact that the systemic level of dysfunction in military medicine is so pervasive that it affects almost everything. You honestly can’t list everything to a premed coming in and even if you did they wouldn’t get it.

Example: it takes years to hire support staff at some hospitals and this results in these jobs being chronically understaffed.

The reality and significance of this one problem doesn’t really hit home until you are a resident or staff doing hours of extra secretarial work each day that civilian counterparts don’t have to deal with.

For the record, I’m a happy military physician who puts up with the downsides of military medicine so don’t take this as me just complaining. I just think that it is very difficult for a premed to get a deep enough understanding of the medical system to understand how the unique problems of the military impact it.
 
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It’s funny to me how we’ve transitioned from claiming things are fine to blaming people for joining when they should have known better and being unhappy.
 
The failure occurs due to the fact that the systemic level of dysfunction in military medicine is so pervasive that it affects almost everything. You honestly can’t list everything to a premed coming in and even if you did they wouldn’t get it.

Example: it takes years to hire support staff at some hospitals and this results in these jobs being chronically understaffed.

The reality and significance of this one problem doesn’t really hit home until you are a resident or staff doing hours of extra secretarial work each day that civilian counterparts don’t have to deal with.

For the record, I’m a happy military physician who puts up with the downsides of military medicine so don’t take this as me just complaining. I just think that it is very difficult for a premed to get a deep enough understanding of the medical system to understand how the unique problems of the military impact it.

Not many Americans understand what socialized medicine means, especially not Americans who want to be physicians.

Lowest bid contracts, bureaucratic headaches, salary-based employees, paperwork nightmares and inefficient systems. Plus, with the military aspect you also add in possibility of delay in training due to GMO tours, deployments, etc., and also risk of not being able to train in your specialty if needs of the military change.

That should be the opening statement given to anyone thinking of joining. It sums up the thousand pitfalls we all deal with daily. If the person is still interested then they should keep investigating and considering MilMed as an option. If not, go civilian route.

My point was that if a MilMed staff is complaining about CHCS and IT issues, then WE (military medicine as a whole) did a huge disservice to that person and likely many others by not preparing and mentoring them properly. We need to understand why/how things like that happen if we are ever going to change anything. Or the OP signed up on SDN just to troll. The former is not the person's fault and hence why I'd like to know more.
 
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Look, I don't care if people think I'm a troll. I needed some catharsis screaming into the void. Also, I'm not going to turn this into a "socialist vs capitalist" discussion on medicine but it's not about being socialist medicine. It's military medicine. 19 yo fresh grad tech students thrown into a med tech and scrub tech slot who are terrible and don't care about their job because that's not what they signed up for. Or the ones that become competent only lasting in their job for 1-2 years until being promoted allowing more an influx of more incompetent techs starting over at square one. It's taking...How many years?!?... to unroll Genesis?? And every time it's started somewhere it's a giant cluster. Its an MTF basically shutting down because they don't have the capability to care for patients properly and having to talk to a civilian physician 2 minutes down the road and ask them embarrassingly to please accept the transfer of my patient with simple XYZ diagnosis because I literally cannot admit them to my own facility. Sure, maybe it's partially my fault. I only discovered sdn in med school. But my point is well articulated in that, for example, the IT thing is so pervasive that its basically accepted and the response I get is "well you should have known better."
 
I’m in a place where we don’t have the luxury of a civilian guy down the street. AND for some reason they thought it was smart to load us with mainly junior techs/staff straight from the schoolhouse.

We first scrubbed our Manning document and then adjusted the billets for brand new versus seasoned techs. Then, since that still isn’t reliable, we overhauled the check-in/PQS process to standardize and simplify training to ensure we maximized the talent that we were getting. We transitioned to a dedicated specialty team system to mitigate broad, inefficient/inconsistent experience while also implementing a rotation schedule to ensure techs were properly cross trained and ready to deploy.

If you understand the pitfalls/limitations of the big system we all volunteered for there are actually ways to improve things or accommodate for shortcomings. Or we can just complain/blame the huge, unmovable bureaucratic system we joined and be miserable until our time is up.

We have all of our changes formalized in case people want to review and implement at other locations.

I’ve been using the same crappy IT systems for the last 10 years. Are they archaic and clunky? Sure. Do my order sets, templates and quick codes make them tolerable? Yes. But I’m also not seeing a 60 person clinic everyday like a civilian surgeon so I have time to deal with the extra 3 minutes per encounter it likely costs me. Do my skills suffer because of the lower volume? Yes. But I was anticipating it and did things to mitigate the effects.

Let me know if you need someone to bounce ideas off of. We can help each other or just echo chamber complain all of the time.
 
I’m in a place where we don’t have the luxury of a civilian guy down the street. AND for some reason they thought it was smart to load us with mainly junior techs/staff straight from the schoolhouse.

We first scrubbed our Manning document and then adjusted the billets for brand new versus seasoned techs. Then, since that still isn’t reliable, we overhauled the check-in/PQS process to standardize and simplify training to ensure we maximized the talent that we were getting. We transitioned to a dedicated specialty team system to mitigate broad, inefficient/inconsistent experience while also implementing a rotation schedule to ensure techs were properly cross trained and ready to deploy.

If you understand the pitfalls/limitations of the big system we all volunteered for there are actually ways to improve things or accommodate for shortcomings. Or we can just complain/blame the huge, unmovable bureaucratic system we joined and be miserable until our time is up.

We have all of our changes formalized in case people want to review and implement at other locations.

I’ve been using the same crappy IT systems for the last 10 years. Are they archaic and clunky? Sure. Do my order sets, templates and quick codes make them tolerable? Yes. But I’m also not seeing a 60 person clinic everyday like a civilian surgeon so I have time to deal with the extra 3 minutes per encounter it likely costs me. Do my skills suffer because of the lower volume? Yes. But I was anticipating it and did things to mitigate the effects.

Let me know if you need someone to bounce ideas off of. We can help each other or just echo chamber complain all of the time.
I think two of the fixes you've mentioned here are in many cases precisely what infuriates people. Yes, if you want to take away from your clinical time and add more to your administrative time, and update regulations and request additional employees, and go to staff meetings, you can improve things. Somewhat. Over a period of years. And assuming you have an understanding command. (And I would add to that: orthopedics was the golden child of every hospital I ever worked at in the military. They snapped their fingers, and if people didn't jump, they at least asked "who snapped?" Whereas if you were OB/GYN or an ophthalmologist, they really didn't care if you needed something. So it is possible that's not true at your command, but there may be some bias insofar as how easy it is to get what you ask for. At my first command, I outpaced every department except ortho in terms of RVU production (and there were three ortho guys), and so when I asked for things they were somewhat receptive. At my second command they barely realized that they had an ENT department).

The other issue is the "balancing" effect of seeing fewer patients to make up for the inefficiencies in the system. Most people don't want to do that. That's why they went in to medicine.

For both of these issues, this is why I think it's important to let students know that you don't go into milmed because you want to be a doctor. Being a doctor is your second or third responsibility. You have to want to be a part of the military apparatus FIRST, and being a physician is just a line item on your OER.
 
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Unfortunately if you are the guy at small MTF life can be hard. You just have to lower or accept different standard in the military (don’t compare it to civilian hospital- different mission different standard) and bring up challenges to your chain of command. Instead of saying shortage of doctors result increased the work load for you say that you are concern of lack of access for your patients due to shortage of doctors. Do not increase appointment template. Some military doctors do this but they get burned. I rather see 25-30 patients in the civilian hospital than see 8 patients in the military. I would say experiences are variable depending on location and people you work with. I am look forward to a new PCS assignment just 3 years before retirement!
 
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You definitely need to know how to phrase things when you're asking for them. Not just in the military, of course, but definitely in the military. Everything has to be formulated in a way that makes it seem important to the guy with the purse strings. That's why I had success at my first duty station - I was generating a lot of theoretical revenue (RVUs). So as long as I could even reasonably tie what I wanted to a story about how not having it would result in my producing less, I could get what I wanted. If I used any other excuse, even one that might be very reasonable or important, it fell on deaf ears.

example:

"I need an ultrasound. If I don't have one, we'll need to send people out for FNA because the radiologists are capping out on what they can do, and we have a huge backlog of patients that could be treated here who cannot be because we're waiting on USs and FNAs. If I had an US, I could do it all in clinic."

That's good. I got that US.

"Hey, I would like to get an US because frankly we're getting very low quality USs done in radiology, the reports are subpar, and the research shows that FNA performed by a surgeon is actually superior. Plus, having it in clinic would streamline the process, and require fewer appointments for patients between diagnosis of a neck or thyroid mass and treatment."

That will get you nothing but scorn.
 
@HighPriest I’m sure it infuriates people. It did for me too for a while, then I realized it’s what I’ve got so I might as well do what I can to stay happy/relevant and positive. People go in to medicine to help people. I am still helping people. Not in the same way I exactly anticipated doing it when I was learning about medicine in high school and college. Definitely not the same way a civilian doc does it in the US, but I’m still helping people. And to be honest, I’m glad I’m not a civilian orthopod right now. If you want to help people via civilian medicine, do civilian medicine. If you want to help people via military medicine, do military medicine. Don’t mix the two until we have made enough changes where the lines are blurred (civilian partnerships, etc).

————

Everything has to be framed to improve the safety of the patient or improve things for the command. Doesn’t matter who you are, if you ask for something because you or your department “need” it you will be sorely disappointed, no matter who you are.

To that end, we literally created a CUSP team in MOR to make changes happen as that is not my department but there were systems and practices in place that were frankly unsafe to overall patient care. The BOD listens to CUSP presentations once a month. It is a decent system to improve patient safety and has support nationwide to include civilian hospitals.

The other project we worked on was improving the time and efficiency of care of MSK injuries as this is main reason for lost duty days and non-deployability. I literally had to go command to command and create a tri-service MSK working group that then achieved BOD presentation approval to get changes to happen. But having all services on board, group think proposals and trying to improve something every command cares about made this possible.

Look at the problem and realize the impact on the mission. I focus on that while I’m stuck somewhere with crappy IT all while losing skills. Because the command/mission stuff I can impact. The latter stuff I knew about and even expected during my time here. Do everything to mitigate skill atrophy but at the end of day there isn’t much we can do about it right now except complain about the obvious.
 
@HighPriest I’m sure it infuriates people. It did for me too for a while, then I realized it’s what I’ve got so I might as well do what I can to stay happy/relevant and positive. People go in to medicine to help people. I am still helping people. Not in the same way I exactly anticipated doing it when I was learning about medicine in high school and college. Definitely not the same way a civilian doc does it in the US, but I’m still helping people. And to be honest, I’m glad I’m not a civilian orthopod right now. If you want to help people via civilian medicine, do civilian medicine. If you want to help people via military medicine, do military medicine. Don’t mix the two until we have made enough changes where the lines are blurred (civilian partnerships, etc).

————

Everything has to be framed to improve the safety of the patient or improve things for the command. Doesn’t matter who you are, if you ask for something because you or your department “need” it you will be sorely disappointed, no matter who you are.

To that end, we literally created a CUSP team in MOR to make changes happen as that is not my department but there were systems and practices in place that were frankly unsafe to overall patient care. The BOD listens to CUSP presentations once a month. It is a decent system to improve patient safety and has support nationwide to include civilian hospitals.

The other project we worked on was improving the time and efficiency of care of MSK injuries as this is main reason for lost duty days and non-deployability. I literally had to go command to command and create a tri-service MSK working group that then achieved BOD presentation approval to get changes to happen. But having all services on board, group think proposals and trying to improve something every command cares about made this possible.

Look at the problem and realize the impact on the mission. I focus on that while I’m stuck somewhere with crappy IT all while losing skills. Because the command/mission stuff I can impact. The latter stuff I knew about and even expected during my time here. Do everything to mitigate skill atrophy but at the end of day there isn’t much we can do about it right now except complain about the obvious.
I don't disagree with you. But, its usually not what people signed up for, and I think the military does a very, very poor job of illustrating the differences between military healthcare and civilian healthcare. In fact, most recruiters really sell it as "being a doctor, just in the (insert service branch.)" It isn't. Plus, you're dealing with a desperate crowd. Like it or not, most of the people looking at HPSP and even USUHS aren't bleeding red, white, and blue. They're looking to avoid massive debt, and hopefully they're at least ok with military service. People in that position don't want to hear about potential pitfalls. I mean, they say that they do, but when you feel like you're going to drown, you'll grab anything that floats, even if its on fire.

It's like Hiroshima after the bomb. People who survived had severe burns. they got dehydrated. They were desperate. Then it started to rain. The rain was highly radioactive. The people who drank it due to their crippling dehydration all died faster and more horribly than those who didn't. But tell a street full of burned, thirsty men not to drink the rainwater, and see how many listen.

Hyperbole, to be sure, but $400,000 of debt for someone who grew up on a household with a median income of $60,000 is a hell of a burn.

So, to find out how to best educate students, you need to figure out how to make then realize the water is radioactive, know what that entails and what the consequences are, and have them still want a sip.

Just saying that "yeah, the water is radioactive, but you just have to concentrate on how cool and refreshing it tastes" isn't enough.
 
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Hyperbole, to be sure, but $400,000 of debt for someone who grew up on a household with a median income of $60,000 is a hell of a burn.

This is the elephant in the room right here and the reason I didn't even want to get into specifics of my gripe. It doesn't matter what I or anyone says to most medical students. Thats a large looming number that is increasingly the norm in medical schools, especially after compounding interest through residency. Add a spouse that doesn't work or worse, a spouse that is in medicine too... oh boy that's hard to pass up. Students are gonna rationalize anything to take that HPSP money. "4 years isn't so bad. Flight surgery doesn't sound so bad. The computer system can't be THAT bad. Deployment sounds fun! I get to travel the world*! Patriotism! America!" Etc etc. Maybe a few people will listen? Most don't. And sure, it isn't ALL bad. I love my patients. I'm going to miss this patient population the most from my job. They're amazing. And I've done some rrrrreal cool stuff that I'll look back on in 30 years and tell my grandkids about with pride. But, man. Right now... Every. Damn. Day. There's just something new and unique that is FUBAR that makes me want to pull what little hair out of my head. Right now it just isn't worth it.
 
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I’ll just say I find the hyperbole horribly distasteful.

Even exaggerated, the two have zero correlation. You are still laying blame externally as if we had no choice in our positions as military physicians. The people of Hiroshima truly had no choice. You may be far removed from the region and military service in general, the rest of us are not.

I try to provide productive discussion for people who may feel stuck in their voluntary commitment but instead of tangenting in a productive route we nosedive in to insensitive hyperboles and blaming recruiters.
 
I’ll just say I find the hyperbole horribly distasteful.
Ok. I felt like it might be shocking, but distasteful is your opinion. I'm sure others might agree with you. If the setting of my analogy was the bubonic plague, or the sack of Constantinople, would that have been more acceptable? I chose the analogy that I did specifically because its one I'm very familiar with, and because in the course of learning about it one of the lessons was that desperate people do desperate things.
I didn't in any way, in my opinion, diminish the horrible things people had to suffer through after we (the US) unleashed that hell on a civilian population. It was awful.
I only mention it because the setting of the analogy I was trying to make was in the wake of that attack. The point of it was that desperate people don't always think logically, or respond to logical arguments, because they're desperate. That argument is true for people looking at med school funding. The scales aren't even close to equivalent, which is why its hyperbole, but the point is still the same: desperate people make desperate decisions.

BUT, argue the point and not the way in which the point was made rather than ad hominem arguments.


You are still laying blame externally as if we had no choice in our positions as military physicians.

We DO have a choice as to whether or not we join the military, but the whole point is that in many, many cases those decision are made under duress. You are severely downplaying the pressure on a student when they're trying to decide how to pay for medical school. It doesn't help that the military takes advantage of that duress. That's the point of the analogy. Students in that position very often feel like it's the military or giving up on their hard work and dreams. The best way we could serve them is by letting them know what other options they have, so that they can make decisions about the military without feeling like it's their only realistic option. I'm laying the blame on the system that we have (the costs), the pressure associated with the decision, the lack of available information (regarding not only military medicine, but also regarding alternative options), the true inability to "really understand" what you're getting yourself in to as a 22-23 year old kid from a lower or middle class upbringing, AND also the military's complete lack of responsibility in how they advertise to that demographic. I'm certainly not the first person to make that argument, and it's not because of collusion.


I try to provide productive discussion for people who may feel stuck in their voluntary commitment but instead of tangenting in a productive route we nosedive in to insensitive hyperboles and blaming recruiters.
You try to pretend that people with no possible way to truly understand what military service entails should somehow be able to just figure that out. I think that's completely unrealistic. So while you may disagree with blaming recruiters (who in fact deserve a modicum of blame. If not the actual recruiters, then the recruiting apparatus itself. That is by no means an isolated opinion, even to military medicine), I disagree with the idea that a desperate person can just do a little reading and completely understand what military medicine means. -especially- when they have a recruiter point blank telling them that it's just like being a civilian physician. That's a bold faced lie that is told day-in and day-out, and to dismiss it as something that a student should just realize is a lie, and so it's OK, is irresponsible. Your inability to understand why someone might not be able to get a full picture of what military medicine is like just from reading a forum or that people tend to downplay known risks when they feel cornered is exactly why things "nosedive into insensitive hyperboles."

I would also say that "hey, man, suck it up" isn't a productive argument. "hunt the good stuff" was dumb when I heard it from the Army. It's fine, but you need to be able to at least justify the bad stuff, otherwise you're just hoping you can brainwash yourself.
 
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I’ll just say I don’t get the whole financial duress argument. People may be scared of tons of debt, but medical school and becoming a physician is a stereotypical way to financial success.

Are people horribly under informed about what military life is like and the implications of practicing medicine in the military while serving out a contract? Absolutely. Is the military to blame for this lack of information? Yes. Do individuals share some of that blame? Also, yes.
 
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Oh, they share the responsibility. Its just not a scenario where you can say "well if you get in and your unhappy, you should have known better." I'm certainly not saying that the applicant has no blame.

But I get the financial duress argument completely. That is why MOST people come on to this forum asking about military medicine. MOST of the people I met in the military who did HPSP did it because they wanted to pay for med school. If they had free schooling, they probably would never have joined the military. That in-and-of itself illustrates that financing is part of the equation. How much duress it causes it undoubtedly variable.

But I think people have come to terms with the fact that while being a physician means financial success, not all physicians are making enough money where $400,000 in loans with interest, compounded over 7-10 years isn't a huge deal.
 
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I disagree with the idea that a desperate person can just do a little reading and completely understand what military medicine means

I agree with you here. People cannot just read and then fully understand something. Unfortunately most think they can. In reality they need to get out, shadow, experience it.

Our current society utilizes google first so websites and forums are the frontlines. The next step is compiling an easy avenue for them to contact local MTF’s, clinics etc for site visits, shadowing opportunities and experience.

I agree recruiting is a problem, but bottom line is we can’t blame the system if our 22 year old selves made an uniformed decision.

My ideas for informing students does not involve sugar coating, but also doesn’t include hyperboles. Premeds need high yield, up-front and realistic information. They don’t need recruiters. Students need administration officers to facilitate their entry in to the service after the student has been properly informed, physically spent time exploring MilMed and compared all available options.
 
My ideas for informing students does not involve sugar coating, but also doesn’t include hyperboles.
To be perfectly clear, my hyperbole had nothing to do with informing students, or even the merits or pitfalls of military medicine. It was in regards to the situation in which these kids find themselves.

They don’t need recruiters. Students need administration officers to facilitate their entry in to the service after the student has been properly informed, physically spent time exploring MilMed and compared all available options.
That's not a bad idea, so long as these officers are actually touting demonstrable information and not a party line. One of the issues with recruiters has always been that they have absolutely no background or experience in either military or civilian medicine.

we can’t blame the system if our 22 year old selves made an uniformed decision.
We can't blame the system - utterly. But it absolutely carries some of the blame. I can't agree with the idea that it's ok for our government to be predatory because it's up to us to make informed decisions.

It is up to us to try to make informed decisions.

It is not ok for the government to be predatory.
 
Only 1% of Americans serve in the military. Even less in military medicine.

Nearly 100% of Americans own a car, take on student loan debt, mortgage their home or rack up credit card debt in their lifetime. How many of them were properly trained or informed before signing the contract?

Much different than military service. But my point is, as Americans we have many opportunities available to us which provide a great benefit to our lives. If we don’t read or take it upon ourselves to know what we are getting in to, those benefits can become burdens.
 
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Only 1% of Americans serve in the military. Even less in military medicine.

Nearly 100% of Americans own a car, take on student loan debt, mortgage their home or rack up credit card debt in their lifetime. How many of them were properly trained or informed before signing the contract?

Much different than military service. But my point is, as Americans we have many opportunities available to us which provide a great benefit to our lives. If we don’t read or take it upon ourselves to know what we are getting in to, those benefits can become burdens.
I agree.

I would say that comparing a car loan to 8-12 years of military service is also a bit of a hyperbole.

If someone sells you a $#itty car, there are lemon laws that work in your favor.

Even if there weren’t, the car company is a private entity. My tax dollars aren’t paying for it to turn around and scam me. So again, there’s a difference between a predatory home loan warehouse or used car salesman (although in principle I don’t agree with that either) and a predatory government.

No one gets shot to death because they took a home loan.

When you buy a car, you can test drive it first. When you buy a home, you can walk through it. When you join HPSP, shadowing is not always an option.

I’m not saying the applicant has no responsibility. I am saying that the system is intentionally, and also by circumstance, weighted against him.

Now, the circumstances are what they are. So unless Bernie gets elected and manages to summon his magic genie from his Karl-Marx-shaped syrup bottle and make school free for everyone, the duress isn’t going away.

But the military certainly could be more realistic and more helpful when it comes to how they recruit.

Listen, I general medicine isn’t what people think it is when they decide to do it. That’s true no matter what. But the military has some very tangible differences that are unique to its function that are not obvious or clear to most applicants. And I honestly, having done my time, don’t know if any source that really does a good job of telling prospective students what it’s like. But I do know what recruiters tell them. I went to recruiting functions at the request of recruiters more than once. And I know what the official stance is because I can go to the .mil websites. And they’re chock full of embellishment and inaccuracies.

If they were a private used car salesman, I wouldn’t care.
 
Military medicine is a mixed bag. Some have a really bad time. Few good. Most mixed. My expericence during 11 years on active duty was mixed. My residency and fellowship training were good. I have fond recollection of my training and felt well trained. My payback was mixed. I was geographically separated from my active duty wife (different service) for 2 years. I had some crappy assignments in between residency and fellowship and after fellowship. I ended up my last two years in the area I wanted to make permanent roots. My last two years on active duty were positive. However the headwinds had changed and I knew I couldn't stay in. Operational medicine was the way of the future in the Army. I am 3 years post leaving. I have no regrets about joining but I am significantly happier and feel more professionally satisfied as a civilian. If a medical student asked about joining, I'd caution them about it. The halycon days of military medicine, especially Army are way past and not likely to return. I joined before 9-11 and was in training during the height of OIF/OEF. The character of Army medicine and to a lesser extent AF/Navy is very different currently. Only exceptions where I'd say it is reasonable to consider is someone who is dead set on going into primary care (peds, IM, FP). A short obligation and being relatively debt free isn't bad. One can tough out a crappy 3-4 year payback and get out.
 
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There are definitely some misleading statements on the recuiting website (medicineandthemilitary.com). Just because the truth is out there doesn't make that any less reprehensible. Here are a few statements that I either believe are false or create a simplified rosy picture when the truth is much more complex.

"The military has a commitment to work-life balance"

"Unless you are deployed, your call schedules will be similar to those for a civilian physician. Since you also won't need to manage your own practice or deal with multiple insurance companies, you may have a little more free time to spend with your family."

"If you are interested in medical research, the Military offers specific benefits that aren't always available to civilian physicians. For example, you might find yourself working with a range of partners beyond academia, including the Department of Defense and foreign governments. Also, compared to the civilian sector, the Military has a high acceptance rate for the clinical trials that are so crucial to research. Finally, the Military offers the technical resources that help you keep track of patients and gather data for potential breakthroughs."

"The Military offers many continuing education opportunities, including funding for clinical specialization courses and travel allowances for professional society conferences."

"Health Professions Scholarship Program (HPSP) and Uniformed Services University of the Health Sciences (USUHS) students have the same chances of getting their residency of choice as civilian students, and the Military will never dictate which specialty you choose."

"While the life of a military physician can be demanding, it can also bring you closer to your patients by removing many of the administrative hassles that common civilian practices have to deal with daily."

"In the Military, patients come first."

"Furthermore, you will be working with technology that is as good as, if not better than, what you will find in any civilian hospital.

"If you are a medical student participating in the Health Professions Scholarship Program or attending the Uniformed Services University of the Health Sciences, or if you are a resident in the Financial Assistance Program, you will not deploy until you are finished with your medical training."
 
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The premise that "it is what you make it" ignores the large subset of people who tried their best to make it positive and ended up like @jabreal00. Mixed is as good an outcome as can be hoped for. Everyone who joins is playing to tie.
 
The premise that "it is what you make it" ignores the large subset of people who tried their best to make it positive and ended up like @jabreal00. Mixed is as good an outcome as can be hoped for. Everyone who joins is playing to tie.

We are, often times, saying the same things but choose to go about it in a different way. MilMed is a great middle of the road, great way to play to tie. I 100% agree. Those who leave after 4 are usually net neutral to slightly disappointed, otherwise they may have stayed longer. Regardless, playing to tie during the medical school, residency and early staff years is the right choice for some people. Therefore, the message should be straightforward and realistic to weed out those who will surely be miserable while still at least offering this pathway as an option to those who might capitalize on it. Recruiting is a problem. I am not a recruiter. I have been fortunate and collected tips to help those trying to capitalize if they already made the decision to join. I am not trying to get them to join.

-- Before signing dotted line: Provide extreme caution, educate those who think MilMed is a civilian scholarship dressed in camouflage, provide examples for those who may actually be able to make it work for their lives.

-- After signing dotted line: You're already in it, man. You have to capitalize on every piece of the system afforded to you. We're in it together and this is what worked for me, perhaps it can work for you. If not, here is someone I know who is more in line with your personality and specialty who can help you capitalize. Don't sit idle complaining during your entire payback, at least do something to keep you professionally and personally happy otherwise you will implode.
 
This statement is a crock of shyte, and I say this as a very satisfied military physician. The administrative hassles are way worse, more in the form of silly military online training, meetings which have nothing to do with your specialty, and down time and phone calls because the PACS is slow or down again! :p

"While the life of a military physician can be demanding, it can also bring you closer to your patients by removing many of the administrative hassles that common civilian practices have to deal with daily."
 
I spent hours in boring arse meetings listening to all the metrics the nurses came up with. However, no matter how bad things got on shore duty, I got to go home at night.
 
Of course, that's assuming you're preparing your mind for what is actually to come and not just what you think is going to happen, which goes right back to post-hoc rationalization.
 
At least according to Virgil.

Indeed!

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