MilMed Career Options

[Mt Kilimanjaro]

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I'm applying to med school this year and seriously considering HPSP or USUHS. Regarding the latter route, I'm curious about how different (or similar) my career options would be in the military vs. civilian side. I found this very old (but potentially still correct) document that lays out an Army medicine career. I still have a few questions I was hoping someone might be able to address.

1) It seems there is no purely clinical track for a milmed career. True? Would this make a transition back into full-time clinical practice post-military impossible or very difficult?

2) What do career military docs tend to do after they retire from the military?

3) How similar is academic military medicine to academic civilian medicine? Could one leave the military and move into a civilian academic position fairly easily?

4) What does "operational medicine" in the Army actually consist of? Is this more like parachuting into Mali with Delta Force or treating stomach flu in Kabul?

5) How much of the 20 year career is likely to be spent on primarily administrative assignments?

Thank you!

 

[Kilgoretrout 65]

First off, just because you go to USUHS doesn't mean you have to stay in past your 7 yr commitment.

1) It seems there is no purely clinical track for a milmed career. True? Would this make a transition back into full-time clinical practice post-military impossible or very difficult?
--Senior physicians can still practice medicine, it may be easier in the GME world of Program Director etc. For at least the first half of your career you would be full time clinical track.

2) What do career military docs tend to do after they retire from the military?
-- Most use their network of prior military or time moonlighting and find a good job. Some retire for good if they have enough years in/wealthy spouse.

3) How similar is academic military medicine to academic civilian medicine? Could one leave the military and move into a civilian academic position fairly easily?
-- Military academic medicine is very similar and the transition is do-able with the right preparation. Right now, military academic medicine is underfunded so it can be frustrating to attend meetings, be on national committees etc.

4) What does "operational medicine" in the Army actually consist of? Is this more like parachuting into Mali with Delta Force or treating stomach flu in Kabul?
-- I'll pass on this one since I am not Army but likely it is a job running a field hospital and all the operational/administrative headaches that go with it.

5) How much of the 20 year career is likely to be spent on primarily administrative assignments?
-- Again I am not Army but I doubt you could do less than 2 years of admin unless you were a program director and then the admin is sprinkled in every day. For dept chiefs the admin is also mixed in with patient care but sometimes it can take over.

 

[pgg]

1) It seems there is no purely clinical track for a milmed career. True?

It depends greatly on how badly you want to make O6. To some extent you'll always have some non-clinical duties. But getting promoted to O6 absolutely requires a major non-clinical leadership job that will take you away from patient care.

<rant>
Fitness reports were invented with line officers in mind, and unfortunately they do a terrible job of stratifying doctors according to clinical skill and knowledge. This is further complicated by the near-universal practice of grading doctors as "early promote" vs "must promote" vs "promotable" based solely on time in rank - ie how soon that person is in zone for promotion. The objective is to get people promoted, and that generally means whoever is before the board next year gets the EP.

The system is further broken by the fact that the final arbiter of fitrep scores is a physician of specialty A who really has no ability to objectively compare the clinical skill and knowledge of the physicians he's grading, who hail from specialties B - Z. (As if it was even possible to make meaningful direct comparisons between a surgeon's work and an internist's work, or a dermatologist's vs an ophthalmologist's.) What happens is that fitreps get scores based on a need to "show progression" and give whoever's in zone next the best shot at promotion.

Since the promotion boards only look at records, the difference between physician #1 and physician #1 is most apparent when it comes to non-clinical activities. Physician #1 served on three committees, but #2 only served on two. Obviously #1 is the better doctor and more deserving of promotion.

It's a silly farce of a system, but at least it's objective and uniformly arbitrary.
</rant>


There's certainly some element self-selection by some physicians who don't like clinical work toward administrative roles. Those who make the explicit decision to pursue a so-called executive medicine track often give up seeing patients entirely in favor of playing the admin game. Promotion boards love this kind of leadership and the fitrep bullets it generates.

 

[Mt Kilimanjaro]

Thanks for the responses!

@pgg: Enjoyed the rant. This sort of "admin vs. practice" tension exists in many careers, but I suppose in medicine the line between the two is especially stark. It does seem odd to me that senior MC officers are essentially forced into admin roles while the military hires (more expensive) civilian contractors to perform the clinical duties that many of the AD people would rather do.