Military reserve psychiatrist. What is it like?

[formerF1DO]

I am 39 years old. My full time job is at the VA, as a board certified psychiatrist. I am a recently naturalized US citizen. I am interested in joining the military reserves as a psychiatrist. I have never been in the military before.
Would anyone be willing to share some advice?
Thank you.

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[notdeadyet]

I'm a psychiatrist in the Army National Guard (ARNG). There will be some differences in the ARNG vs. Army Reserve (AR) thing, but a lot of overlap.

I enjoy my service. I am kept busy. For some physicians in the Reserve Corps (RC), there are complaints about not performing clinical duty. This is not the case for psychiatry. I am constantly doing evaluations of soldiers. Lots of PTSD, substance abuse, and axis II. Lots of evals for fitness for duty, security clearance. Occasional weighing in on psychological autopsy and other once-off issues. As a psychiatrist, I tend to get meatier and more unusual cases, as the more routine psychopathology is handled by behavioral health officers (BHOs, usually LCSWs) who do great work and I function as a de facto team lead a lot and get to conduct lots of training. Duties are pretty similar for Reserve Corps.

One thing you see a lot on these boards is discussion of skills atrophy. This is less of an issue for psychiatrists, and for most of the AMEDD folks from recent deployments (I have not), they've mentioned that the psychiatrist is typically one of the busiest docs. When things are busy and scary, psychopathology presents and you have to deal with it. When things are slow and boring, psychopathology gets noticed and you have to deal with it. Actual sickness gets amplified overseas and malingered sickness becomes attempted more overseas.

The big difference that I see between ARNG that is likely relevant to you is that ARNG is primarily combat units, and Army Reserve is primarily support. The big differences is that with this organization is that ARNG will mostly have you functioning as Division Psychiatrist for an infantry unit or some such (or assigned as such but drilling at state HQ) whereas with the Army Reserve you might be attached to a hospital unit. Not sure how much this affects drill. For deployment, the ARNG usually sends psychiatrists overseas with their home (infantry) unit or as an individual augmentee overseas. From what I've seen, the AR sometimes send the entire unit someplace, but much more common is to be activated as an individual augmentee for a stateside slot. Most of the AR psychiatrists I've talked to have been activated to Fort Hood, Fort Dix, etc., even in peacetime.

I mention this because (warning: editorializing) the Army has gotten used to activating docs/psychiatrists during OEF/OIF and I'd imagine that it is pretty attractive to help mitigate short-staffing stateside on Active side by activating docs/psychiatrists from the AR for 90 days every few years. This may be particularly true for psychiatrists, which is undermanned and there is more attention each year to mental health (and how it affects readiness). As an ARNG, when I get deployed, it's likely going to be for natural disaster in my state or internationally due to war; with AR, when you get deployed, it may be more frequently for stateside missions. Just my $0.02.

There's limited information on military psychiatry on these forums (especially RC). I'm happy to answer more questions.

 

[HighPriest]

Have you every seen Porky's or Porky's Revenge?

It's basically that, but with better resolution.

 

[notdeadyet]

Ah, Honeywell....

 

[formerF1DO]

I'm a psychiatrist in the Army National Guard (ARNG). There will be some differences in the ARNG vs. Army Reserve (AR) thing, but a lot of overlap.

I enjoy my service. I am kept busy. For some physicians in the Reserve Corps (RC), there are complaints about not performing clinical duty. This is not the case for psychiatry. I am constantly doing evaluations of soldiers. Lots of PTSD, substance abuse, and axis II. Lots of evals for fitness for duty, security clearance. Occasional weighing in on psychological autopsy and other once-off issues. As a psychiatrist, I tend to get meatier and more unusual cases, as the more routine psychopathology is handled by behavioral health officers (BHOs, usually LCSWs) who do great work and I function as a de facto team lead a lot and get to conduct lots of training. Duties are pretty similar for Reserve Corps.

One thing you see a lot on these boards is discussion of skills atrophy. This is less of an issue for psychiatrists, and for most of the AMEDD folks from recent deployments (I have not), they've mentioned that the psychiatrist is typically one of the busiest docs. When things are busy and scary, psychopathology presents and you have to deal with it. When things are slow and boring, psychopathology gets noticed and you have to deal with it. Actual sickness gets amplified overseas and malingered sickness becomes attempted more overseas.

The big difference that I see between ARNG that is likely relevant to you is that ARNG is primarily combat units, and Army Reserve is primarily support. The big differences is that with this organization is that ARNG will mostly have you functioning as Division Psychiatrist for an infantry unit or some such (or assigned as such but drilling at state HQ) whereas with the Army Reserve you might be attached to a hospital unit. Not sure how much this affects drill. For deployment, the ARNG usually sends psychiatrists overseas with their home (infantry) unit or as an individual augmentee overseas. From what I've seen, the AR sometimes send the entire unit someplace, but much more common is to be activated as an individual augmentee for a stateside slot. Most of the AR psychiatrists I've talked to have been activated to Fort Hood, Fort Dix, etc., even in peacetime.

I mention this because (warning: editorializing) the Army has gotten used to activating docs/psychiatrists during OEF/OIF and I'd imagine that it is pretty attractive to help mitigate short-staffing stateside on Active side by activating docs/psychiatrists from the AR for 90 days every few years. This may be particularly true for psychiatrists, which is undermanned and there is more attention each year to mental health (and how it affects readiness). As an ARNG, when I get deployed, it's likely going to be for natural disaster in my state or internationally due to war; with AR, when you get deployed, it may be more frequently for stateside missions. Just my $0.02.

There's limited information on military psychiatry on these forums (especially RC). I'm happy to answer more questions.

Thank you for your detailed insights.
May I ask this question?
If I work at the VA, and they deploy me, could I get my job back at the VA, or do I have to look for a new job?
Thank you !

 

[USArmyHPSP]

The Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) outlines the protections afforded to reservists called into active duty. Under USERRA, it is unlawful for an employer to deny initial employment, reemployment, promotion, or any benefit of employment to a person who is obligated to perform in a uniformed service.

 

[formerF1DO]

The Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA) outlines the protections afforded to reservists called into active duty. Under USERRA, it is unlawful for an employer to deny initial employment, reemployment, promotion, or any benefit of employment to a person who is obligated to perform in a uniformed service.

Great! Thank you for your answer

 

[formerF1DO]

I'm a psychiatrist in the Army National Guard (ARNG). There will be some differences in the ARNG vs. Army Reserve (AR) thing, but a lot of overlap.

I enjoy my service. I am kept busy. For some physicians in the Reserve Corps (RC), there are complaints about not performing clinical duty. This is not the case for psychiatry. I am constantly doing evaluations of soldiers. Lots of PTSD, substance abuse, and axis II. Lots of evals for fitness for duty, security clearance. Occasional weighing in on psychological autopsy and other once-off issues. As a psychiatrist, I tend to get meatier and more unusual cases, as the more routine psychopathology is handled by behavioral health officers (BHOs, usually LCSWs) who do great work and I function as a de facto team lead a lot and get to conduct lots of training. Duties are pretty similar for Reserve Corps.

One thing you see a lot on these boards is discussion of skills atrophy. This is less of an issue for psychiatrists, and for most of the AMEDD folks from recent deployments (I have not), they've mentioned that the psychiatrist is typically one of the busiest docs. When things are busy and scary, psychopathology presents and you have to deal with it. When things are slow and boring, psychopathology gets noticed and you have to deal with it. Actual sickness gets amplified overseas and malingered sickness becomes attempted more overseas.

The big difference that I see between ARNG that is likely relevant to you is that ARNG is primarily combat units, and Army Reserve is primarily support. The big differences is that with this organization is that ARNG will mostly have you functioning as Division Psychiatrist for an infantry unit or some such (or assigned as such but drilling at state HQ) whereas with the Army Reserve you might be attached to a hospital unit. Not sure how much this affects drill. For deployment, the ARNG usually sends psychiatrists overseas with their home (infantry) unit or as an individual augmentee overseas. From what I've seen, the AR sometimes send the entire unit someplace, but much more common is to be activated as an individual augmentee for a stateside slot. Most of the AR psychiatrists I've talked to have been activated to Fort Hood, Fort Dix, etc., even in peacetime.

I mention this because (warning: editorializing) the Army has gotten used to activating docs/psychiatrists during OEF/OIF and I'd imagine that it is pretty attractive to help mitigate short-staffing stateside on Active side by activating docs/psychiatrists from the AR for 90 days every few years. This may be particularly true for psychiatrists, which is undermanned and there is more attention each year to mental health (and how it affects readiness). As an ARNG, when I get deployed, it's likely going to be for natural disaster in my state or internationally due to war; with AR, when you get deployed, it may be more frequently for stateside missions. Just my $0.02.

There's limited information on military psychiatry on these forums (especially RC). I'm happy to answer more questions.

May I ask if you have any opinion or recommendation about serving in Army vs Air Force?
Thank you for your help.

 

[Zenman1]

I think we have had 3 reserve psychiatrists at a time called up for 90 days active duty to help us out. One active duty psychiatrist working with us had recently completed his contract, went to work at the VA and joined the reserves, then was called up right back to help us for 90 days. He wasn't too happy.

 

[notdeadyet]

Thank you for your detailed insights.
May I ask this question?
If I work at the VA, and they deploy me, could I get my job back at the VA, or do I have to look for a new job?
Thank you !

See the above post about USERRA, but realize that your mileage may vary. Employers are not obligated to sit on your job and hand it back to you, they just need to give you a job (if you're gone 90+ days).

So for the VA, if you have a great gig working in a PTSD Clinic 50% time and acting as attending on a resident-driven mood clinic 50% time, you may come back to find your job is Borderline Clinic 50% and C/L 50%.

That said, the VA has been extremely flexible to me with regard to military service. From speaking with others, this is typically the norm rather than the exception.

 

[notdeadyet]

May I ask if you have any opinion or recommendation about serving in Army vs Air Force?

Nope. My N=1 is just Army.

I do work with the Air Guard as well from time to time. But all I have are the usual stereotypes about how cush the Air Force has it. Whenever we do joint trainings and the Air Force is responsible for accommodations, that stereotype gets reinforced. Might just be my state though.

 

[notdeadyet]

Also, does anyone have any thoughts on or know someone working at a state hospital and in the reserves?

I know a reservist who works at a state hospital.

The larger the practice, the easier it is to get away. Also federal and state employers tend to have military leave. So a state hospital is about as easy a place as there is to get away for drill.

 

[SuperSoccer19]

I am currently in the Navy Reserves as a psychiatrist--I was active prior. Feel free to PM with any questions. There's pros and cons and im happy to talk about my experiences both active working with reservists and as a reservist now.

 

[RELDNAM]

I have been a doc many years, they say I would come in as a Col., I am very patriotic. I have a great job in leadership but what kind of impact on my employer when i am gone 2 weeks every summer?
How will they afford it with my specialty being in very short supply?

 

[notdeadyet]

Most practices can float your being gone for two additional weeks. The amount of pain it will bring depends on the size of the practice. Your colleagues will be somewhere on a spectrum of folks who don't mind pitching in to cover for you and see it as part of a service duty to folks who view you as unfairly being given an additional two weeks "off" that they don't get.

Keep in mind that as a physician in the reserve component, your commitment is more than just two weeks per year (Annual Training). You will also have a handful of 3 or 4 day drills that will require you off on Thurs/Fri or Mon/Tues. The frequency of this will depend on your unit and assignment.

And lastly, keep in mind the project of deployment. In a solo practice, the additional time away will hit you in the pocket book. Four months away could kill it. And even in a small practice, a deployment could be extremely painful to your business and your colleagues.

Personally, I've resigned myself to only work for large practices while I serve the Reserve. USERRA or not, I would feel like a jerk for causing all that hardship to colleagues when I deploy and justify it with federal law. In a large practice (VA, state, county, etc.), a deployment still causes a ripple effect, but the system is large enough to manage it without lots of folks working extra shifts, losing vacations, etc.

 

[chiPostBacc]

Most practices can float your being gone for two additional weeks. The amount of pain it will bring depends on the size of the practice. Your colleagues will be somewhere on a spectrum of folks who don't mind pitching in to cover for you and see it as part of a service duty to folks who view you as unfairly being given an additional two weeks "off" that they don't get.

Keep in mind that as a physician in the reserve component, your commitment is more than just two weeks per year (Annual Training). You will also have a handful of 3 or 4 day drills that will require you off on Thurs/Fri or Mon/Tues. The frequency of this will depend on your unit and assignment.

And lastly, keep in mind the project of deployment. In a solo practice, the additional time away will hit you in the pocket book. Four months away could kill it. And even in a small practice, a deployment could be extremely painful to your business and your colleagues.

Personally, I've resigned myself to only work for large practices while I serve the Reserve. USERRA or not, I would feel like a jerk for causing all that hardship to colleagues when I deploy and justify it with federal law. In a large practice (VA, state, county, etc.), a deployment still causes a ripple effect, but the system is large enough to manage it without lots of folks working extra shifts, losing vacations, etc.

I know this is a pretty old thread, but the information that you gave was really helpful and I'm hoping that I'll be able to get a few more thoughts from you. I'd like to join the National Guard and haven't found a good source for information on what being a psychiatrist in the Guard is like.

One issue is that I'm probably going to move out of state after I finish residency in 2 years, and which state I move to might depend in part on what their Guard units are like. The only feedback that I've received so far is that Guard experience depends more on local senior leadership instead of being having much to do with the state itself. Does that sound like an accurate assessment? (If it matters, I'm considering moving to the upper Midwest, the Four Corners states, NC, NH or VT for family reasons.)

I've also got a particular interest in building some expertise in disaster psychiatry which would probably include some global work, which leaves me with 2 questions: (1) is my ability to travel internationally on civilian time limited if I'm also in the Guard? For instance, if the world were a little less insane right now and we only had bad political relations with Venezuela and I wanted to do disaster relief work their on my own vacation time, would being a commissioned officer complicate my doing that travel (from the US side, I imagine that the Venezuelan security apparatus might have some questions about it)? (2) Am I wrong in thinking that I'd have an opportunity to do disaster psychiatry work with civilian populations in the US if I were mobilized, or is a Guard psychiatrist's work limited to the servicepeople in the Guard?

Thanks for your candor and your service.

 

[notdeadyet]

One issue is that I'm probably going to move out of state after I finish residency in 2 years, and which state I move to might depend in part on what their Guard units are like. The only feedback that I've received so far is that Guard experience depends more on local senior leadership instead of being having much to do with the state itself. Does that sound like an accurate assessment? (If it matters, I'm considering moving to the upper Midwest, the Four Corners states, NC, NH or VT for family reasons.)

Local senior leadership can basically be "the state itself" in the smaller states. But you're right in that most of the policies that make being in the Guard tolerable is based on those policies being adapted. And most of the helpful policies (like flexitraining in which you can flexibly drill every other month if necessary) are subject to your commanders approval.

(1) is my ability to travel internationally on civilian time limited if I'm also in the Guard? For instance, if the world were a little less insane right now and we only had bad political relations with Venezuela and I wanted to do disaster relief work their on my own vacation time, would being a commissioned officer complicate my doing that travel (from the US side, I imagine that the Venezuelan security apparatus might have some questions about it)?

During regular times, being the in the Guard (or Reserve or big Army) will not restrict your international travel much beyond a few key ones like North Korea, Cuba, etc. Right now, for instance, you're basically not allowed any international travel, but these are very unusual times. In general, you can go wherever you like with the exception of countries you'd expect the Army not to want you to go to.

(2) Am I wrong in thinking that I'd have an opportunity to do disaster psychiatry work with civilian populations in the US if I were mobilized, or is a Guard psychiatrist's work limited to the servicepeople in the Guard?

In general, your primary duties as a psychiatrist are going to be supporting your fellow soldiers. Just like your surgeons and FP folks are going to be primarily devoted to the wellness (and readiness) of their fellow soldiers. We don't really have big MASH-style units with very few smaller scale exceptions. That's more the Reserve (who don't do nearly as much emergency response).

On the upside, you will be the de facto disaster psychiatry expert for your state Guard because each state only has one psychiatrist slot (though they can go over if they want). Last count, I believe there were something like 8 practicing psychiatrists in the entirety of the Guard nationwide.

What the role of disaster psychiatry for the Guard is going to mean? Touch base with me in another two weeks. I'll have a better answer then, I'd imagine.

 

[chiPostBacc]

In general, your primary duties as a psychiatrist are going to be supporting your fellow soldiers. Just like your surgeons and FP folks are going to be primarily devoted to the wellness (and readiness) of their fellow soldiers. We don't really have big MASH-style units with very few smaller scale exceptions. That's more the Reserve (who don't do nearly as much emergency response).

On the upside, you will be the de facto disaster psychiatry expert for your state Guard because each state only has one psychiatrist slot (though they can go over if they want). Last count, I believe there were something like 8 practicing psychiatrists in the entirety of the Guard nationwide.

What the role of disaster psychiatry for the Guard is going to mean? Touch base with me in another two weeks. I'll have a better answer then, I'd imagine.

Thanks a lot for the reply, and for your work. I hope that you're doing ok. From the outside looking in I get the impression that California as a state has done a decent job of addressing the viral outbreak, but my view is limited and I'm sure that there's plenty of work still to be done. I'm in Chicago and we're still waiting for the worst to hit us. That said, it seems like the epidemiology folks are guardedly optimistic that the acceleration in the case rate is starting to decrease. I hope they're right, but I'm prepping to get redeployed to one of the medical services if they're not.

If you've gathered thoughts about it yet and some spare time, I'd love to follow up with you on being a Guard psychiatrist during a disaster on this scale has been like. What surprised you? What was challenging? What was learned? Where did most of your energy go? How do you think the Guard will change from the experience, if at all?

 

[notdeadyet]

Happy to address all of the above at a later point in time. I don't mean to defer, but some of your questions will get better answers if I'm able to reflect and be thoughtful. Right now things are very much in motion on my end.

Take care and stay safe. After much of this blows over, if you make another reply to this thread, I'll be happy to post.

 

[leomourabatista]

Hello, I’m in the process of applying for the AR as a psychiatrist here in MA. Anywhere I could learn more about the monthly drill? Type of work, and location (like medical unit, IMA, TPU, APMC etc).
Thanks!

 

[comp1]

It's true that they don't technically have to give you your exact job back after you deploy, but I don't think there is anywhere more accommodating to reservists than the VA. Management and your co-attendings will bend over backwards to make it work.

 

[Peterako]

What are the hours/days like when drilling and when doing annual trainings? Any percentages out there in terms of unit deployment per year?