Military medicine sucks. Avoid it!

[thenavysurgeon]

Just in case some of you have changed your minds.

xTNS

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[Informer]

we should rename the whole forum to "Military Medicine SUCKS" because it's gotten way out of hand with this bashing

Okay, military medicine sucks, we get the point. Have you tried posting on other forums?

 

[DD214_DOC]

I don't have a choice. It's the only way I can pay for school.

 

[backrow]

must have been a bad day at the office for TNS as this thread is

 

[militarymd]

Just in case some of you have changed your minds.

xTNS

welcome back.

 

[thenavysurgeon]

I continue to lurk on this forum because it is incredibly addictive.

Its like watching a horrible, multi-car accident about to happen. I just can't turn my eyes away from the collision, trauma, and ultimate bloodshed that is military medicine.

Wear your seat belts, friends and neighbors.

I'd like to serve as the Military Medicine Safety Officer for this forum. I've already functioned as a crash-test-dummy for the Navy. Perhaps I can help a few folks out.

xTNS

 

[Galo]

I continue to lurk on this forum because it is incredibly addictive.

Its like watching a horrible, multi-car accident about to happen. I just can't turn my eyes away from the collision, trauma, and ultimate bloodshed that is military medicine.

Wear your seat belts, friends and neighbors.

I'd like to serve as the Military Medicine Safety Officer for this forum. I've already functioned as a crash-test-dummy for the Navy. Perhaps I can help a few folks out.

xTNS

Thank you for posting. I'm sure you may have already posted some of your more horrible experiences, much like I did. Perhaps erosion of skills, lack of support, dealing with people like idg which I'm sure will spread his/her venom here any moment.

Maybe posting some of those experiences will allow some of these seemingly blindly, pro military before they experience it students, the insight as to why we experienced physicians post what we post.

Welcome back to the scene of the pile up.

 

[UCBShocker]

ya can you believe it...

My own mother had to spend 3 months getting her health care taken of because noone at headquarters had any idea how to get her covered for health benefits, and I have been on active duty for almost a year now.

And now that that is finally taken care of and she has gotten some initial tests done, the dang doctor goes on leave and she is not allowed to see another doctor about her case despite certain aspects of the examination needing immediate follow-up.

Man military healthcare really sucks... oh wait... thats not tri-care on my Mom's messed up bill that is charging for a completly different plan than the one she signed up for... its KAISER.

Perhaps instead of just bashing military medicine you should be looking at healthcare in this nation as a whole. And though I dont post much on this thread, do not be so quick to say I have no idea what I am talking about. I have more civilian medicine experience than most of you and have seen more than I care to remember. Yes there are good things as well, and there are well run hospitals... but the same exists for the military.

I am now studying to become a doctor in the military and I have had the pleasure of meeting and getting to know many military doctors in my trek to find the best suited speciality for my interests, and none of them would rather be anywhere else. Infact many of our students go well past their service obligation. Military medicine isnt for everyone... you will be giving up some of your freedoms... I spent a long time deciding on which path to follow and people like MilMD gave excellent counter-points to my stary-eyed view of the military and as such did not walk into the field blind. I can say beyond any doubt that I would rather be in this school than any other in the country.

P.S. The healthcare I have received thus far in my military career has been by leaps and bounds better (in both efficiency and effectiveness) than any I received in the civilian sector. This includes Kaiser and Blue Cross associated hospitals as well as my university run undergrad healthcare.

 

[Galo]

ya can you believe it...

My own mother had to spend 3 months getting her health care taken of because noone at headquarters had any idea how to get her covered for health benefits, and I have been on active duty for almost a year now.

And now that that is finally taken care of and she has gotten some initial tests done, the dang doctor goes on leave and she is not allowed to see another doctor about her case despite certain aspects of the examination needing immediate follow-up.

Man military healthcare really sucks... oh wait... thats not tri-care on my Mom's messed up bill that is charging for a completly different plan than the one she signed up for... its KAISER.

Perhaps instead of just bashing military medicine you should be looking at healthcare in this nation as a whole. And though I dont post much on this thread, do not be so quick to say I have no idea what I am talking about. I have more civilian medicine experience than most of you and have seen more than I care to remember. Yes there are good things as well, and there are well run hospitals... but the same exists for the military.

I am now studying to become a doctor in the military and I have had the pleasure of meeting and getting to know many military doctors in my trek to find the best suited speciality for my interests, and none of them would rather be anywhere else. Infact many of our students go well past their service obligation. Military medicine isnt for everyone... you will be giving up some of your freedoms... I spent a long time deciding on which path to follow and people like MilMD gave excellent counter-points to my stary-eyed view of the military and as such did not walk into the field blind. I can say beyond any doubt that I would rather be in this school than any other in the country.

P.S. The healthcare I have received thus far in my military career has been by leaps and bounds better (in both efficiency and effectiveness) than any I received in the civilian sector. This includes Kaiser and Blue Cross associated hospitals as well as my university run undergrad healthcare.

I don't think anyone would argue that this country has lots of health care problems, they are multiple.

However, this forum is for military medicine, which many of us experienced physicians think is even in worse shape in many aspects than civilian medicine.

As far as your attitude towards the military, that will go a long way to helping you deal with some of the problems you will certainly face. Except people like idg, nothing short of a coma can prepare you to deal with this type of individual.

 

[usnavdoc]

ya can you believe it...

Perhaps instead of just bashing military medicine you should be looking at healthcare in this nation as a whole. And though I dont post much on this thread, do not be so quick to say I have no idea what I am talking about. I have more civilian medicine experience than most of you and have seen more than I care to remember. Yes there are good things as well, and there are well run hospitals... but the same exists for the military.
.

Then maybe you should clarify your experience. You are med student(M1) and havent even started clinicals yet. Most of the people on this board have been practicing medicine as physicians for years. Not to mention all the premedical medical experience we all carry(EMTs, RNs, RTs, on and on). Regardless of what you may think, you really dont know much about military medicine until you are out there practicing it. By that I mean away from a medschool or residency.

 

[UCBShocker]

Then maybe you should clarify your experience. You are med student(M1) and havent even started clinicals yet. Most of the people on this board have been practicing medicine as physicians for years. Not to mention all the premedical medical experience we all carry(EMTs, RNs, RTs, on and on). Regardless of what you may think, you really dont know much about military medicine until you are out there practicing it. By that I mean away from a medschool or residency.

First I never said I was knowledgable about military medicine, I said I knew about civilian medicine. My point was that though you have your issues with military medicine, civilian medicine is no rose patch either, I only have second hand information when it comes to military medicine and the overwhelming majority of that has been positive. I think that was very clear in my post, but if it wasnt then I apologize.

And when it comes to civilian medical experience I was working side by side with doctors in hospitals as an EMT. It is true I can not do the procedures they can, however that is not relevent when considering our argument. I do not need an M.D. degree to see the abundance of flaws in patient care. Perhaps the most relevent issue where the doctors telling me the very same thing about their jobs that I am hearing repeated on this forum. Let me be clear, the flaws were 100% on the administrative side of the hospital, the M.Ds were amazingly skilled... however that is the overwhelming complaint many of you are making against the military... the administrative side. I can't help but notice the parallel between the two factions. My experience has been over two years in hospitals and two years in pre-hospital in a prehospital setting. For those that went HPSP and worked in the military and are now getting out, which seems to be most of you, (if I am wrong then I apologize) then yes, I do have more civilian medical experience than you.

My point has always been that yes you may hate military medicine, but I submit to you that civilian is right on par with that. There are good examples of civilian medicine, but there are also equally good examples of military medicine... you cannot tell me their are not because I have already witnessed them first hand during our clinical application courses at Walter-Reed.

Many of you feel that you need to be here to warn others of the downsides of the military, and I have no problem with that... people like you are probably why I will go into my career all the more prepared to handle the negatives that will come. However, this opinion is being so over-represented here that someone needs to show that your perspective is not the only perspective.

 

[UCBShocker]

I don't think anyone would argue that this country has lots of health care problems, they are multiple.

However, this forum is for military medicine, which many of us experienced physicians think is even in worse shape in many aspects than civilian medicine.

As far as your attitude towards the military, that will go a long way to helping you deal with some of the problems you will certainly face. Except people like idg, nothing short of a coma can prepare you to deal with this type of individual.

Oh I agree this is a military medicine forum, however people are comparing military to civilian medicine trying to show a huge disparity between the two in the problems that are inherent with their procedures. Since their argument includes both I can not make an effective counter-point by not using the same two fields.

 

[usnavdoc]

First I never said I was knowledgable about military medicine, I said I knew about civilian medicine. My point was that though you have your issues with military medicine, civilian medicine is no rose patch either, I only have second hand information when it comes to military medicine and the overwhelming majority of that has been positive. I think that was very clear in my post, but if it wasnt then I apologize.

And when it comes to civilian medical experience I was working side by side with doctors in hospitals as an EMT. It is true I can not do the procedures they can, however that is not relevent when considering our argument. I do not need an M.D. degree to see the abundance of flaws in patient care. Perhaps the most relevent issue where the doctors telling me the very same thing about their jobs that I am hearing repeated on this forum. Let me be clear, the flaws were 100% on the administrative side of the hospital, the M.Ds were amazingly skilled... however that is the overwhelming complaint many of you are making against the military... the administrative side. I can't help but notice the parallel between the two factions. My experience has been over two years in hospitals and two years in pre-hospital in a prehospital setting. For those that went HPSP and worked in the military and are now getting out, which seems to be most of you, (if I am wrong then I apologize) then yes, I do have more civilian medical experience than you.

My point has always been that yes you may hate military medicine, but I submit to you that civilian is right on par with that. There are good examples of civilian medicine, but there are also equally good examples of military medicine... you cannot tell me their are not because I have already witnessed them first hand during our clinical application courses at Walter-Reed.

Many of you feel that you need to be here to warn others of the downsides of the military, and I have no problem with that... people like you are probably why I will go into my career all the more prepared to handle the negatives that will come. However, this opinion is being so over-represented here that someone needs to show that your perspective is not the only perspective.

I understood what you were saying and agree with some of it. My point at asking for your clarification on your experience was that you stated you have more knowledge than we do on the topic of civilian health care. When someone tells me I know more than you do b/c of my experience, I want to know what that experience is. That is why many have called out IGD due to his failure to provide that level of background info.

I appreciate your past emt experience in your reasoning, but you are completely flawed in your belief that you have more knowledge of civilian health care than most HPSP students. I worked as a Nurse assistant for the first three years of undergrad then as an EMT-B/I through my senior year and for two years while awaiting acceptance to med school and through my M1 year. I went to a Civilian med school. Most HPSP students have a similiar background. We all have similiar premedschool medical experiences. And in actuality HPSP students have more of an understanding of civilian health care then do USUHS students just as at the end of your USUHS education you will have more military medicine knowledge than an HPSP graduate of the same year group. But right now we have more military and civilian health care experiences than you do. That is not to say you are wrong but just to put in perspective who you are talking to.

I do not hate military medicine. I do think it needs to be modernized and restructured especially with regards to the Navy. As I said before, Your understanding of military medicine will likely change when you have your own experience as a provider away from a teaching facility, especially if you become a gmo.

As to feeling that I need to "warn" others as to the downsides. Yes I feel that people should be made aware. The opinion is over-represented? possibly. but this is not the only source of info an applicant will have. Every applicant will have a recruiter who will be giving them only the positives. Some of which are outright lies.

There are several people on this board who have presented the positives. PGG for one. I think I have presented the military from a fairly even stance. Myself and PGG have very similiar backgrounds from the GMO perspective and we agree on several issues and disagree on others.

 

[leia05]

I'm curious as to your experiences with Naval dentistry, as that is the particular field of my choice. I'm attempting to get many different viewpoints in the hopes of getting a somewhat accurate representation of what I can expect from military dentistry. I understand that most people posting on this particular forum have a medical rather than dental background...but hey...everyone should see a dentist right? I'm waiting to hear if I will be accepted into the HSCP, and so I will (hopefully) have to make a decision sometime in the near future. I do not wish to do so blindly. If you're bashing, please back up your experiences with some details, as I would greatly appreciate that. Same for postive experiences (hoping to hear some of these as well)! Also, I will not be graduating dental school until 2010. Is it possible that the next presidential election will in some way influence the administrative aspects of the military? I noticed many of you wished for some restructuring of military medicine--what led to this way of thinking? I'm not saying you're wrong, just curious as to the origin of said thoughts. Thanks!

 

[UCBShocker]

I understood what you were saying and agree with some of it. My point at asking for your clarification on your experience was that you stated you have more knowledge than we do on the topic of civilian health care. When someone tells me I know more than you do b/c of my experience, I want to know what that experience is. That is why many have called out IGD due to his failure to provide that level of background info.

I appreciate your past emt experience in your reasoning, but you are completely flawed in your belief that you have more knowledge of civilian health care than most HPSP students. I worked as a Nurse assistant for the first three years of undergrad then as an EMT-B/I through my senior year and for two years while awaiting acceptance to med school and through my M1 year. I went to a Civilian med school. Most HPSP students have a similiar background. We all have similiar premedschool medical experiences. And in actuality HPSP students have more of an understanding of civilian health care then do USUHS students just as at the end of your USUHS education you will have more military medicine knowledge than an HPSP graduate of the same year group. But right now we have more military and civilian health care experiences than you do. That is not to say you are wrong but just to put in perspective who you are talking to.

I do not hate military medicine. I do think it needs to be modernized and restructured especially with regards to the Navy. As I said before, Your understanding of military medicine will likely change when you have your own experience as a provider away from a teaching facility, especially if you become a gmo.

As to feeling that I need to "warn" others as to the downsides. Yes I feel that people should be made aware. The opinion is over-represented? possibly. but this is not the only source of info an applicant will have. Every applicant will have a recruiter who will be giving them only the positives. Some of which are outright lies.

There are several people on this board who have presented the positives. PGG for one. I think I have presented the military from a fairly even stance. Myself and PGG have very similiar backgrounds from the GMO perspective and we agree on several issues and disagree on others.

I definitly see your point and your purpose, as I have said already. You obviously have more exp in years than I do though I am not sure if you have the breadth of locations that I do that showed similar patterns. However no, this is not the norm. The HPSPers I trained with were primarily straight out of college with absolutely no experience. Perhaps I was in a non representitive sample (a few hundred strong though), I have to admit that, but from what I have seen you are SDs above the mean for pre-med experience. The majority were straight out of college with no experience. I have to admit that everyone on this forum could have worked in the civilian world with advanced medical degrees for years before going to medical school, but it just seems highly unlikely. But my point remains about civilian medicine... you must have seen just as serious issues in civilian medicine during your time there, unless you are extremely lucky.

Now I hope you arent assuming I am saying military medicine is perfect. That is definitly not my stance... my stance is that it is simply a representitive sample of the greater whole (being the civilian world). You scream and yell against military medicine I am assuming to drive down military matriculation rates in hopes of effecting a change, however thats not whats going to happen. Military medicine is run "like" an HMO because on our current tax rates that is about the best we can do, and if the people with high potential are scared out of going the military then all that is going to happen is that the quality of doctors will go down which only hurts the patients that need us... Personally I think our system of health care is an absolute joke compared to what it could be. Unfortunately what is required to take our system to the next level is something not in line with capitalist ideals and probably wont happen in the forseable future.

OK I hope this is a coherent jumble and not just a jumble... still in class actually.

 

[USAFdoc]

Oh I agree this is a military medicine forum, however people are comparing military to civilian medicine trying to show a huge disparity between the two in the problems that are inherent with their procedures. Since their argument includes both I can not make an effective counter-point by not using the same two fields.

In many instances there IS a huge desparity between military and civ med;
I will use my military vs civ experience in FP to show

item..................................military.......................civilian....................

1) support staff age..........techs 1 yr from high sch........nurses 20 yr exper.
2) charts..........................avail only 20-40%................avail 100%
3) pts seen per day............30+....................................20+
4) my pay........................80K.....................................120K + bonus
5) my hours of work............275-375 month.....................160-200 month
6) referrals.......................TRICARE, enterred by doc....various, ent by nurse
7) Collat duties..................numerous..............................rare
8) admin...........................could care less of doc idea....regular input fr. doc
9) hard work results in.......more work assigned.................more pay
.....................................to the hardest workers
10)new pts......................OFTEN, new duty stations...........less often
11) new staff...................OFTEN......................................much less often
12) new rules....................with every new Commander...........less
......................................which happen q 2 years

13) doc experience..............almost 100% fresh from resid.........more exp
14) PAs..........................many novice, used as docs............less often so
15) general health of pt..........better in mil............................worse
16) panel size..................1600 on paper (3000+ reality)..........1000-2000
.......................................due to covering missing docs
.......................................deployed, separated etc

when you add it all up, the military side puts several disadvantages, concerns for patient care, admin problems etc that are not as bad as in the civilian world. Again, not to say that my current FP job is perfect, but after the USAF, everything smells like "roses".

 

[Tadgie]

In many instances there IS a huge desparity between military and civ med;
I will use my military vs civ experience in FP to show

item..................................military.......................civilian....................

1) support staff age..........techs 1 yr from high sch........nurses 20 yr exper.
2) charts..........................avail only 20-40%................avail 100%
3) pts seen per day............30+....................................20+
4) my pay........................80K.....................................120K + bonus
5) my hours of work............275-375 month.....................160-200 month
6) referrals.......................TRICARE, enterred by doc....various, ent by nurse
7) Collat duties..................numerous..............................rare
8) admin...........................could care less of doc idea....regular input fr. doc
9) hard work results in.......more work assigned.................more pay
.....................................to the hardest workers
10)new pts......................OFTEN, new duty stations...........less often
11) new staff...................OFTEN......................................much less often
12) new rules....................with every new Commander...........less
......................................which happen q 2 years

13) doc experience..............almost 100% fresh from resid.........more exp
14) PAs..........................many novice, used as docs............less often so
15) general health of pt..........better in mil............................worse
16) panel size..................1600 on paper (3000+ reality)..........1000-2000
.......................................due to covering missing docs
.......................................deployed, separated etc

when you add it all up, the military side puts several disadvantages, concerns for patient care, admin problems etc that are not as bad as in the civilian world. Again, not to say that my current FP job is perfect, but after the USAF, everything smells like "roses".

Don't want to be too nosy, but hot damn, where are you workin now, cause with stats like that, I want to be working there whenever I get out of the Navy.

 

[USAFdoc]

Don't want to be too nosy, but hot damn, where are you workin now, cause with stats like that, I want to be working there whenever I get out of the Navy.

not only that, but 1/2 day off every week (so I moonlight at the local urgent care center on that day and make an extra 2 grand a month)!

and no hospital or OB!!!!!

not everywhere in primary care is bad
(although that may not be true in the USAF)

 

[USAFdoc]

Now I hope you arent assuming I am saying military medicine is perfect. That is definitly not my stance... my stance is that it is simply a representitive sample of the greater whole (being the civilian world). You scream and yell against military medicine I am assuming to drive down military matriculation rates in hopes of effecting a change, however thats not whats going to happen. Military medicine is run "like" an HMO because on our current tax rates that is about the best we can do, and if the people with high potential are scared out of going the military then all that is going to happen is that the quality of doctors will go down which only hurts the patients that need us... Personally I think our system of health care is an absolute joke compared to what it could be.

Some of the problems that effect quality of care and morale are easily fixable, some are not. With physicians lacking any authority in a healthcare system overloaded, military medicine is likely going to have more problems. I do not believe military leadership "has it within them" to make the necessary changes. What I believe they nead is good leadership that puts quality people in local leadership positions that have the authority to make changes as they arise. Basically the exact opposite of micromanaging. The problem is micromanaging is what the military basis it managment practices on. That system doesn't work in todays everchanging overloaded system.

 

[UCBShocker]

In many instances there IS a huge desparity between military and civ med;
I will use my military vs civ experience in FP to show

item..................................military.......................civilian....................

1) support staff age..........techs 1 yr from high sch........nurses 20 yr exper.
2) charts..........................avail only 20-40%................avail 100%
3) pts seen per day............30+....................................20+
4) my pay........................80K.....................................120K + bonus
5) my hours of work............275-375 month.....................160-200 month
6) referrals.......................TRICARE, enterred by doc....various, ent by nurse
7) Collat duties..................numerous..............................rare
8) admin...........................could care less of doc idea....regular input fr. doc
9) hard work results in.......more work assigned.................more pay
.....................................to the hardest workers
10)new pts......................OFTEN, new duty stations...........less often
11) new staff...................OFTEN......................................much less often
12) new rules....................with every new Commander...........less
......................................which happen q 2 years

13) doc experience..............almost 100% fresh from resid.........more exp
14) PAs..........................many novice, used as docs............less often so
15) general health of pt..........better in mil............................worse
16) panel size..................1600 on paper (3000+ reality)..........1000-2000
.......................................due to covering missing docs
.......................................deployed, separated etc

when you add it all up, the military side puts several disadvantages, concerns for patient care, admin problems etc that are not as bad as in the civilian world. Again, not to say that my current FP job is perfect, but after the USAF, everything smells like "roses".

That does seem appealing, but much of that doesn't seem true. I have had instances where there were no charts for patients and many more instances where charts have wrong data on them such as NKA when they are infact allergic to penicillin. Im just one person, but its certainly not 100% for civilians. Whether or not its better in the civilian world or the military though I am not qualified to say. All I can say is that my medical records made it from Maxwell to USUHS without being lost.

Support staff is not just techs with one year experience. I may not be the best military mind but at NNMC for every doctor I saw I see Petty Officers 2nd class and higher helping them... and as far as I know it takes a lot more than a year to get that rank.

One thing for your side though is civilians make a butt load more than that. Even ER docs make more than 120K a year. The upside for us is that in residency I will be making more money than any civi doc in residency unless there are some special circumstances... and when I am finished with residency I will be making over 100K which is good enough for me. I dont know where you get 80K (after taxes?). We have plenty of USUHS grads coming to talk to us and fresh out of residency they are making above 100K, but that is before taxes. None of them were GMOs though, maybe thats where 80K comes in.

The hours are also very variable. A doctor I am going to try to shadow for some ER experience is working about 50 hours a week according to his schedule which equates to 200 hours a month or so, way below the 275 minimum you mentioned. Now maybe he has other patient care duties I dont know, but I will ask him next time I talk to him.

Anyways I got to start studying for a cardio test next week, but I just wanted to point out there are exceptions that I have seen and I am just one person. BTW I am assuming the stats are for you... why are you only making 80K? There is a bonus for FP still still isnt there?

 

[militarymd]

There will always be people who complain about civilian medicine, but the difference is in the degree...of ineptitude.


Take any person who is complaining about their civilian practice and give them a taste of military medicine, and they will be BEGGING to go back......and take a pay cut..

I'm sure USAFdoc would agree.

 

[rotatores]

Take any person who is complaining about their civilian practice and give them a taste of military medicine, and they will be BEGGING to go back......and take a pay cut..

Again...you always assume EVERYONE agrees with your taste of military medicine.


rotatores
USUHS 2006

 

[militarymd]

Again...you always assume EVERYONE agrees with your taste of military medicine.


rotatores
USUHS 2006

Let me rephrase...any physician interested in the practice of good medicine.

 

[IgD]

I continue to lurk on this forum because it is incredibly addictive.

I suspect that TNS is describing the thrill he and other negative posters get by bashing military medicine and discouraging others from joining.

 

[rotatores]

Let me rephrase...any physician interested in the practice of good medicine.

Thanks....and once again you've shown your maturity.

 

[militarymd]

Again...you always assume EVERYONE agrees with your taste of military medicine.


rotatores
USUHS 2006

BTW, I thought you were going to block me....PLEASE block me...STOP reading my posts....and definiitely STOP responding to them....

 

[militarymd]

Thanks....and once again you've shown your maturity.

Ahhhh...the all knowing MS4....I used to get a kick out of listening to you guys.

I'm so glad to be in private practice.

 

[rotatores]

Ahhhh...the all knowing MS4....I used to get a kick out of listening to you guys.

I'm sorry...I forgot that you bypassed the whole med school thing.

rotatores

 

[Galo]

I'm sorry...I forgot that you bypassed the whole med school thing.

rotatores

milmed,

Its an uphill battle with an all knowing premed student. You can just post what our experiences have been, and hope others will listen and take our advice, and actually make a concerted effort to call others in active duty to get a good idea of what they are going into. idg??? lost cause

 

[rotatores]

Ahhhh...the all knowing MS4....I used to get a kick out of listening to you guys.

When have I ever claimed to be all knowing....umm...never. I love how you guys like to start the name calling or the whole "your just a med student...your just an intern...your just a resident" line. I'm sorry if you guys had crappy careers...and I do appreciate your comments...but enough with all the condescending bullsh$t whenever others have a response.

rotatores

 

[rotatores]

Its an uphill battle with an all knowing premed student. You can just post what our experiences have been, and hope others will listen and take our advice, and actually make a concerted effort to call others in active duty to get a good idea of what they are going into. idg??? lost cause

Wow...now I've been demoted to a PREMED. I honestly can't wait until your guys get new hobbies.

rotatores
USUHS 2006

 

[militarymd]

When have I ever claimed to be all knowing....umm...never. I love how you guys like to start the name calling or the whole "your just a med student...your just an intern...your just a resident" line. I'm sorry if you guys had crappy careers...and I do appreciate your comments...but enough with all the condescending bullsh$t whenever others have a response.

rotatores

I did not call you names.... I called you an "all knowing ms4"...just a little sarcasm....having spent time teaching literally hundreds of MS4s, I think I have earned the right to call a spade a spade.

I didn't call you "just a ms4"....and you ARE a MS4 right??????

It is not condescension....it is simply I was where you are now almost 14 years ago.

BLOCK ME...DON"T READ MY POSTS....DON'T REPLY TO MY POSTS WITH YOUR MS4 TYPE SNIDE ALL KNOWING COMMENTS.....that shows how little you know.

Did n't you say you were going to block me??????

Keep your word.

 

[pgg]

Let me rephrase...any physician interested in the practice of good medicine.

Maybe you've addressed this before and I didn't catch it ... what's your take on anesthesia in the Navy? I know you were once part of the dept at NMCP, which is where I'm bound for residency this year.

Seems that most criticisms of military medicine concern things like ...

• administrative issues and Tricare
• nurses & MSCs running things
• anything related to primary care
• relatively junior/inexperienced support staff
• high turnover
• surgeons who get too few cases, or too few "quality" cases
• large patient panels (primary care again)
• midlevels burdened with too many or inappropriately complex patients
• the whole GMO model (especially in the Navy)

... most of which would seem to have minimal or no impact on one's life as a Navy anesthesiologist.

I'm pretty happy and optimistic about my immediate future as a resident. What, specifically, did you dislike about the way the Navy trains, uses, and/or treats anesthesiologists & CRNAs?

I know you're of the opinion that military medicine as a whole is an ongoing train wreck, but it would be interesting to hear your thoughts on Navy anesthesia. Minus the pay gap, what are the most significant differences between military and civilian anesthesia? Where does military anesthesia come up short? What are its bright spots?

 

[haujun]

In many instances there IS a huge desparity between military and civ med;
I will use my military vs civ experience in FP to show

item..................................military.......................civilian....................

1) support staff age..........techs 1 yr from high sch........nurses 20 yr exper.
2) charts..........................avail only 20-40%................avail 100%
3) pts seen per day............30+....................................20+
4) my pay........................80K.....................................120K + bonus
5) my hours of work............275-375 month.....................160-200 month
6) referrals.......................TRICARE, enterred by doc....various, ent by nurse
7) Collat duties..................numerous..............................rare
8) admin...........................could care less of doc idea....regular input fr. doc
9) hard work results in.......more work assigned.................more pay
.....................................to the hardest workers
10)new pts......................OFTEN, new duty stations...........less often
11) new staff...................OFTEN......................................much less often
12) new rules....................with every new Commander...........less
......................................which happen q 2 years

13) doc experience..............almost 100% fresh from resid.........more exp
14) PAs..........................many novice, used as docs............less often so
15) general health of pt..........better in mil............................worse
16) panel size..................1600 on paper (3000+ reality)..........1000-2000
.......................................due to covering missing docs
.......................................deployed, separated etc

when you add it all up, the military side puts several disadvantages, concerns for patient care, admin problems etc that are not as bad as in the civilian world. Again, not to say that my current FP job is perfect, but after the USAF, everything smells like "roses".

I think the bigest proof for the pro civilian medicine is that you have a time to post like this.
As for its content you are comparing apple vs orange. What's next, EXusafdoc, are you going to complain about wearing BDU and a possibility of dying for your country?!

 

[USAFdoc]

As for its content you are comparing apple vs orange. What's next, EXusafdoc, are you going to complain about wearing BDU and a possibility of dying for your country?!

haujun;

we agree on this, it IS comparing apples to oranges, as you say, the problem is that the military "apple" has "worms". There is NO EXCUSE for running primary care like they do. There is NO EXCUSE to not have the chart available 50-90% of the time, to staff the clinics with 7 people when there should be 31 people, to give 100% authority to everyone but a doc, and you can read other threads for more details. All of this absolutely compromises care, morale, and retention.

As for whats next? I guess I'll continue to see people like you in complete denial, continue to take all these things personally and make your flippant "BDU" jokes. At least it is nice to see you have a sense of humor, you will need it after residency.

 

[IgD]

At what point does all this military bashing turn into religious fanatacism? When I read the posts here I'm reminded of the poor souls that wander the streets in New Orleans wearing signs that say "the end of the world is coming".

 

[island doc]

I think the bigest proof for the pro civilian medicine is that you have a time to post like this.
As for its content you are comparing apple vs orange. What's next, EXusafdoc, are you going to complain about wearing BDU and a possibility of dying for your country?!

I have reached the conclusion that there are people on this site, who simply will not listen to the many voices of experience. They are much like teenagers, who think they know more than their parents, therefore refuse to listen. They will just simply have to learn the hard way.

I say let them join military medicine and experience it fully for themselves as attending physicians , and then they will eventually come to a knowledge of the truth.

I am not discounting the fact that there are some physician misfits whose place is not in civilian medicine, and who actually survive, thrive and relish the dysfunctional military medical environment.

 

[USAFdoc]

At what point does all this military bashing turn into religious fanatacism? When I read the posts here I'm reminded of the poor souls that wander the streets in New Orleans wearing signs that say "the end of the world is coming".

you are quite the character; you have played the sex card "sexual thrills", above you play the "religious" card with a touch of the "poverty/poor" card there at the end. I guess about all that is left is for you to mention the "race" card feeling this is all some racial bias.

you really are a unique person IgD. Keep those tremendous insights coming. You are certainly what mil medicine is all about.

 

[militarymd]

I know you're of the opinion that military medicine as a whole is an ongoing train wreck, but it would be interesting to hear your thoughts on Navy anesthesia. Minus the pay gap, what are the most significant differences between military and civilian anesthesia? Where does military anesthesia come up short? What are its bright spots?

My commentary applies mostly to military medicine as a whole.

As for training in anesthesia. You will get pretty training a NMCP. Your life will be pretty good. You will get to do rotations mostly where you want to do it.

The case load there is not bad, but not enough sick patients, and the pace is not fast enough.

Problems will come when you finish your residency and come up for orders.....than in will enter the fray and become disillusioned with the way the detailers work.....and depending where you wind up....you may have a good experience or not.....YOU WILL HAVE NO CONTROL...or very little control....and you won't be able to quit and move on if you are unhappy.

 

[pgg]

but not enough sick patients

This seems to be the biggest knock against residencies at MTFs. After spending some time at a couple of civilian hospitals, I was struck by how NOT-SICK and NOT-ACUTE many of our ER patients and admissions were. Goes hand-in-hand with the surgeons complaining about poor case counts.

depending where you wind up....you may have a good experience or not.....YOU WILL HAVE NO CONTROL...or very little control....and you won't be able to quit and move on if you are unhappy.

Well, that's par for the course for any job in the military - really doesn't have anything to do with medicine.

0311 Marines can't quit and move on either if they don't like Camp Lejeune, and I can't muster much sympathy when one tells me he wishes he was at Camp Pendleton 'cause it's less humid and the chicks are hotter.

I guess what I'm looking for are ways that life as a Navy anesthesiologist is inappropriately unpleasant. Ie, having to put up with line PME requirements to be eligible for promotion, onerous collateral duties that have no bearing on patient care, etc.

Lack of control regarding deployments or duty stations is a downside to military service, but it's not at all specific to or related to military medicine.

 

[Galo]

Wow...now I've been demoted to a PREMED. I honestly can't wait until your guys get new hobbies.

rotatores
USUHS 2006

Take our advice for whatever its worth to you. But remember it when you get in the field, and report your experiences back here. You got so much to learn. I hope you approach med school differently.

 

[bobbyseal]

I guess what I'm looking for are ways that life as a Navy anesthesiologist is inappropriately unpleasant. Ie, having to put up with line PME requirements to be eligible for promotion, onerous collateral duties that have no bearing on patient care, etc.

Lack of control regarding deployments or duty stations is a downside to military service, but it's not at all specific to or related to military medicine.

Here's one for you:

Being told that you have to train CRNAs to provide anesthesia independently of an anesthesiologist.

 

[rotatores]

Take our advice for whatever its worth to you. But remember it when you get in the field, and report your experiences back here. You got so much to learn. I hope you approach med school differently.

Umm...I guess you're not familiar with USUHS.

I hope you approach med school differently

Well...I'll be graduating from med school in about 30 days...so I'm not sure what you mean by this.

rotatores
USUHS 2006

 

[Galo]

Well...I'll be graduating from med school in about 30 days...so I'm not sure what you mean by this.

rotatores
USUHS 2006[/QUOTE]


It means if older people with experience are trying to teach you something, perhaps you should listen with some attention, and if you doubt it, find out for yourself. But looks like you'll be a resident soon, and then an attending. Good luck

 

[IgD]

Here's one for you:

Being told that you have to train CRNAs to provide anesthesia independently of an anesthesiologist.

Have you talked to your professional society about that? That might not be the case.

 

[UCBShocker]

Well...I'll be graduating from med school in about 30 days...so I'm not sure what you mean by this.

rotatores
USUHS 2006


It means if older people with experience are trying to teach you something, perhaps you should listen with some attention, and if you doubt it, find out for yourself. But looks like you'll be a resident soon, and then an attending. Good luck

Well that certainly has some logic to it, but age and experience do not always equate to being correct. What may apply to you, may not apply to some... you take the good you take the bad, you take them both and there you have... my opening statement. Sit booboo sit, good dog.

 

[leia05]

I don't want to come across as being pushy or anything, but I really would appreciate it if someone would reply to my earlier post. This is a big decision for me so I'd like to have some more information than what I have right now. Thanks.

 

[USAFdoc]

I don't want to come across as being pushy or anything, but I really would appreciate it if someone would reply to my earlier post. This is a big decision for me so I'd like to have some more information than what I have right now. Thanks.

I am a family doc, but I did know several of the dentist (military) at my last base. USAF.

Their commander as well as the new dentist were becoming frustrated and concerned over the "new" "optimization" plans being implemented USAF wide. Basically this is a plan that is supposed to enable the "providers" to do more with less. Supposedly the providers/dentists get more support staff etc which should enable them to see more patients. What happened in Family Med and what was happening in dentistry is that the extra work and patients arrive, but the extra staff never does. There was one dentist that seemed happy with things, the others were not, including the commander. Thats all the details I have.

 

[USAFdoc]

I don't want to come across as being pushy or anything, but I really would appreciate it if someone would reply to my earlier post. This is a big decision for me so I'd like to have some more information than what I have right now. Thanks.

you ought to start a dental thread and also call some bases, Small and lg and speak to dentist that are between 1-3 years in. That may give you a better idea.

 

[IgD]

Your best bet would be to call one of the big 3 Naval hospitals (Bethesda, MD, Portsmouth VA or San Diego, CA) and ask for the dental clinic. Then explain you are going to dental school and would like to talk to a dentist.

I'm curious as to your experiences with Naval dentistry, as that is the particular field of my choice. I'm attempting to get many different viewpoints in the hopes of getting a somewhat accurate representation of what I can expect from military dentistry. I understand that most people posting on this particular forum have a medical rather than dental background...but hey...everyone should see a dentist right? I'm waiting to hear if I will be accepted into the HSCP, and so I will (hopefully) have to make a decision sometime in the near future. I do not wish to do so blindly. If you're bashing, please back up your experiences with some details, as I would greatly appreciate that. Same for postive experiences (hoping to hear some of these as well)! Also, I will not be graduating dental school until 2010. Is it possible that the next presidential election will in some way influence the administrative aspects of the military? I noticed many of you wished for some restructuring of military medicine--what led to this way of thinking? I'm not saying you're wrong, just curious as to the origin of said thoughts. Thanks!