All Branch Topic (ABT) More specific reasons why I left SDN in 2006

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MedicalCorpse

MilMed: It's Dead, Jim
15+ Year Member
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Some have asked me why I "went dark" at the end of 2006.

Besides personal reasons not having to do with SDN, I think this ancient post of mine
distills the bitterness I felt at having both my patriotism and my experiences after 15 years as an Air Force physician questioned by people who were either not qualified to do so, were being paid as recruiters with clear axes to grind, or both:

Specious Arguments we need less of in 2007

I wish I could believe that all of the severe problems that drove me out of the service as a
LtCol with 15 years toward retirement had been fixed by now. Sadly, talking to active duty
friends who are currently deployed, and reading the posts here, I regret that is not the case.

Peace,

Rob

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I would find a way to benefit from that much service. The VA or Coast Guard Reserve might work. I met a guy going to Iraq as a civilian that said he got out as an O6 which is hard to believe.
 
I would find a way to benefit from that much service. The VA or Coast Guard Reserve might work. I met a guy going to Iraq as a civilian that said he got out as an O6 which is hard to believe.
Not so hard to believe. If someone is working in iraq as a civilian they truly are dedicated to work in that country. Sounds legitimate. Glad to see your back corpse. The world has changed. I remember reading your posts as a premed student. Now a seasoned attending in the same specialty I share your concerns about service. I have met some truly good individuals in the process. And some maybe more not so good. The military is not a meritocracy. What determines your path isn’t about how much work you do. Its about those you meet in the path and luck.
 
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I would find a way to benefit from that much service. The VA or Coast Guard Reserve might work. I met a guy going to Iraq as a civilian that said he got out as an O6 which is hard to believe.

Thanks for the reply. However, the last thing I would want is a military retirement.

I do not want to be like the 86 year old clinical psychologist who was involuntarily recalled from retirement 20 years after
giving up the practice of psychology and sent down-range in Iraq to where it was a billion degrees in the shade, only to suffer a medical emergency and get shipped back to Walter Reed with your (and my) tax dollars (true story told to me by a 459th AES member who recognized me at my civilian hospital because I had helped teach him ACLS; he thanked me for being humorous and keeping him awake) . There are many more stories like that regarding involuntary recall to AD around if you search the internet.

Here are some of the relevant DoD instructions and U.S. laws allowing involuntary recall to active duty for life (as well as placing military retirees subject to UCMJ punishments for activities they engage in after retirement...for life):
==========================================================================
from
https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/135201_dodi_2016.pdf

a. Regular retired members and members of the retired Reserve may be ordered to active duty (AD) as needed to perform such duties as the Secretary concerned considers necessary in the interests of national defense as described in Sections 688 and 12301 of Title 10, U.S.C.
b. Regular retired members and members of the retired Reserve must be managed to ensure they are accessible for national security and readiness requirements.
c. Regular and Reserve retired members may be used as a manpower source of last resort after other sources are determined not to be available or a source for unique skills not otherwise obtainable.
d. Directors of agencies that have Defense related missions, such as the Federal Emergency Management Agency, the Selective Service System, and organizations with missions in support of the North Atlantic Treaty Organization, may identify military and federal civilian positions that are suitable for fill by retired military members in time of war or national emergency, and provide a list of requirements to the Military Services for validation and prioritization for fill.

from 10 U.S. Code § 688 - Retired members: authority to order to active duty; duties

(a) Authority.—
Under regulations prescribed by the Secretary of Defense, a member described in subsection (b) may be ordered to active duty by the Secretary of the military department concerned at any time.
(b) Covered Members.—Except as provided in subsection (d), subsection (a) applies to the following members of the armed forces:
(1) A retired member of the Regular Army, Regular Navy, Regular Air Force, or Regular Marine Corps.
(2) A member of the Retired Reserve who was retired under section 1293, 7311, 7314, 8323, 9311, or 9314 of this title.
(3) A member of the Fleet Reserve or Fleet Marine Corps Reserve.
(c) Duties of Member Ordered to Active Duty.—
The Secretary concerned may, to the extent consistent with other provisions of law, assign a member ordered to active duty under this section to such duties as the Secretary considers necessary in the interests of national defense.
(d) Exclusion of Officers Retired on Selective Early Retirement Basis.—The following officers may not be ordered to active duty under this section:
(1) An officer who retired under section 638 of this title.
(2) An officer who—
(A) after having been notified that the officer was to be considered for early retirement under section 638 of this title by a board convened under section 611(b) of this title and before being considered by that board, requested retirement under section 7311, 8323, or 9311 of this title; and
(B) was retired pursuant to that request.
(e) Limitation of Period of Recall Service.—
(1) A member ordered to active duty under subsection (a) may not serve on active duty pursuant to orders under that subsection for more than 12 months within the 24 months following the first day of the active duty to which ordered under that subsection.
(2) Paragraph (1) does not apply to the following officers:
(A) A chaplain who is assigned to duty as a chaplain for the period of active duty to which ordered.
(B) A health care professional (as characterized by the Secretary concerned) who is assigned to duty as a health care professional for the period of active duty to which ordered.
(C) An officer assigned to duty with the American Battle Monuments Commission for the period of active duty to which ordered.
(D) An officer who is assigned to duty as a defense attaché or service attaché for the period of active duty to which ordered.
(f) Waiver for Periods of War or National Emergency.—
Subsections (d) and (e) do not apply in time of war or of national emergency declared by Congress or the President.
(MedicalCorpse: Note: emphasis added above)

10 U.S. Code § 12301 - Reserve components generally

(a) In time of war or of national emergency declared by Congress, or when otherwise authorized by law, an authority designated by the Secretary concerned may, without the consent of the persons affected, order any unit, and any member not assigned to a unit organized to serve as a unit, of a reserve component under the jurisdiction of that Secretary to active duty for the duration of the war or emergency and for six months thereafter. However a member on an inactive status list or in a retired status may not be ordered to active duty under this subsection unless the Secretary concerned, with the approval of the Secretary of Defense in the case of the Secretary of a military department, determines that there are not enough qualified Reserves in an active status or in the inactive National Guard in the required category who are readily available.
=============================================================================

Finally, unbeknownst to many retirees, retired officers remain subject to the Uniform Code of Military Justice (UCMJ) and potential courtmartial FOR LIFE. This means that if you do anything that the government determines to be a violation of some arbitrary part of the UCMJ, such as Article 88, which prohibits criticism of the President, you could be brought back to active duty against your will at age 99, court-martialled, and sent to Leavenworth. If you don't believe me, read the law:

===============================================================================
10 U.S. Code § 802 - Art. 2. Persons subject to this chapter

Chapter 47: Uniform Code of Military Justice; Title 10 USC Subtitle A Part II Chapter 47 Subchapter I Para 802

802 Article 2: Persons subject to this chapter

(a) (4) Retired members of a regular component of the armed forces who are entitled to pay.
=============================================================================

Thus, after twenty-plus years of dedicated active duty service to one's country, by accepting the retainer fee of retirement pay (and benefits), you are agreeing to remain on call, subject to the UCMJ, for the rest of your natural life. No one told me this when I signed up in 1981...I'm glad I found out eventually...months after I had decided to separate without retirement.
===============================================================================

Now, I am aware of the option of "buying out" one's total active military service time (which, for me, would include USUHS, unlike retirement from the military) if I were to become a government employee at, say, the VA. I would fall under the "Top 3" retirement plan extant when I joined. I'm considering that route, given that this pandemic is causing havoc with my current career plan to support my family as a locum tenens doc. I need to keep my mind and options open. The only other "retirement" option will be to do as many surgeons around here seem to do, which is to keep practicing until they turn 100 or die in the OR...
 
Glad to see your back corpse. The world has changed. I remember reading your posts as a premed student. Now a seasoned attending in the same specialty I share your concerns about service. I have met some truly good individuals in the process. And some maybe more not so good. The military is not a meritocracy. What determines your path isn’t about how much work you do. Its about those you meet in the path and luck.

Thanks very much. Concur.

If I had had just one good Flight or Squadron commander in my last 7 years of service, things might have been different.

Not one of them was interested in mentoring or advising subordinates rather than cruising to retirement by doing the very least possible, unless it came to misuse of military authority to abuse underlings, in which case the opposite was true.

Sadly, as others here have mentioned, crap seems to float to the top in the current military system.

From:
Anonymous: Imperial Hubris, Chapter 6, section "Generals, G-men, and Lawyers: The Architects of Nonwar" (p. 177 of first edition hardback):

"Our military men and women from private to lieutenant colonel-- which seems to be where truth-telling earns retirement-- appear, as a group, to be people in whom those footing the bill can be confident…Beyond lieutenant colonel, however, things look iffy, and at the rank of brigadier general and above we find a disaster manned by senior officers, mostly men, who tack as needed to protect their careers and their institution's insider's club-- retired U.S. Army Colonel David H. Hackworth calls it the "Liar's Club".

P.S. Please don't forget to go to American Society of Anesthesiologists to register your opposition to the VA's plan to make CRNA independent practice permanent, thus neutering the role of anesthesiologist in the care of our veterans (like me).

Peace,
 
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Welcome back, @MedicalCorpse . I appreciate your insights back during my decision to join and the countless contributions to others over the years.

You and the other veteran members have excellent insight for the junior or mid-level MilMed staff as we navigate careers and the stay or go decisions. For some of us we can still tolerate the bureaucracy. For now I don't mind continuing to work for the man. Also helps that I still have a decent commitment. Only time will tell where my opinions end up at the end of my service.


Buying down your active duty years and applying them to completing a VA career would avoid your recall concerns, correct?
 
Welcome back, @MedicalCorpse . I appreciate your insights back during my decision to join and the countless contributions to others over the years.

Buying down your active duty years and applying them to completing a VA career would avoid your recall concerns, correct?

Thank you very much, @militaryPHYS. I sincerely appreciate it.

As far as the VA goes, I have put a lot of thought into that. It would be fitting to have my final years of practice devoted to helping veterans such as myself. It would also be nice to earn a defined pension that recognizes my 19 years of total active federal military service (since the government retirement system counts USUHS time before 20 years, unlike the military retirement system), rather than throwing that away. My current "retirement plan" doesn't even deserve that name, given that it involves continuing to work until I fall out in the OR like several of the surgeons I worked with in the civilian world, who wouldn't hang up their spurs voluntarily even into their mid-80s.

It's funny to recall that, when I first arrived "on station" at my civilian hospital on day one post military service, I looked around and thought: "Wow. I was considered an old man in the military as a 41-year-old O-5. It looks as though I have fifty more years of practice here, if I'm to keep up with the Joneses..." As I said, that lasted 12 years, until my colleagues got old and decided one day it was no longer fun to take call and my vision of my future path exploded into uncertainty.

I'd really like to hear from current VA anesthesiologists about their insights regarding VA practice today and tomorrow. Are they able to practice within the Anesthesia Care Team every day without toxic mismanagement from non-anesthesiologists? Is the system moving toward every "independent provider" running his or her own room to save money, regardless of what's best for our veterans' health? Does the system allow anesthesiologists to act as perioperative physicians, or is it more like "shut up and pass gas, trunk monkey", as the military system devolved into post-1998 or so? Are anesthesiologists subject to fits of apoplectic rage from testosterone-fueled surgeons of all genders if they suggest postponing the anesthetic for sexy cases for good reason (remember, we never cancel cases; the surgeon is always free to proceed under local)?

If the VA decides that anesthesiologists are expensive, unnecessary dinosaurs, the whole idea may be moot, in any case.

I guess I am waiting to see what the future holds...

Peace,

P.S. Shout out to my colleague @7by11thenout for the trunk monkey analogy. May we all enjoy our views in the trunk as much as possible, because being let out is overrated.
 
I'd really like to hear from current VA anesthesiologists about their insights regarding VA practice today and tomorrow. Are they able to practice within the Anesthesia Care Team every day without toxic mismanagement from non-anesthesiologists? Is the system moving toward every "independent provider" running his or her own room to save money, regardless of what's best for our veterans' health? Does the system allow anesthesiologists to act as perioperative physicians, or is it more like "shut up and pass gas, trunk monkey", as the military system devolved into post-1998 or so? Are anesthesiologists subject to fits of apoplectic rage from testosterone-fueled surgeons of all genders if they suggest postponing the anesthetic for sexy cases for good reason (remember, we never cancel cases; the surgeon is always free to proceed under local)?
Just like MilMed, VA practice will never be the ideal practice for someone who enjoys private practice, full autonomy, etc. etc. What it does is provide a solid paycheck, decent lifestyle and defined benefits. We all have our own definition of a life that balances most ideal and most sense.

I am happy to shut up and fix bones for now. Most likely that won't last forever. VA or a large system like Kaiser have been standard transitions for mentors of mine who didn't mind working for the man and still wanted the defined benefits and pension while avoiding regular sandbox vacations.
 
Good to see you again, MedicalCorps. It's been a minute.
 
Crazy to see MedicalCorpse pop up all these years later. I likewise saw his posts years ago. I hit 20 next July and have had a top 1% type military career but his posts were healthy for me to read back in the day. Despite my great career, I think it is clear that military medicine's best days are in the rear-view mirror.
 
MedicalCorpse, It is really great to hear from you again. I read all of your posts in the past, and I always appreciated that you took the time to express in such a detailed manner the challenges that so many others of us have witnessed and/or experienced. I thank you and salute you for your military service. You served with honor as well as courage, and it is plainly evident that you were among those who actually CARED, and who tried to make a positive difference, in the system. I wish you and your family a peaceful and safe holiday season, and a blessed New Year in 2021.
 
Crazy to see MedicalCorpse pop up all these years later. I likewise saw his posts years ago. I hit 20 next July and have had a top 1% type military career but his posts were healthy for me to read back in the day. Despite my great career, I think it is clear that military medicine's best days are in the rear-view mirror.
Would love to hear you unpack this a little bit more. Also with advice for those with commitments left that will be sticking it out for the next 5+ years. :)
 
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Would love to hear you unpack this a little bit more. Also with advice for those with commitments left that will be sticking it out for the next 5+ years. :)
I have had a great career with all the best aspects of military medicine (Air Force): residency in field of my choice, second residency four years later (both residencies with significant portions of civilian training). Stationed at great assignments all the way through. Had a smattering of humanitarian TDYs (three MEDRETEs) and TDYs to academic military medical centers. Finished my career at one of the Air Force's academic centers and I have been able to keep my skills up with a nice moonlighting gig that I'll transition to full-time when I retire. Other than AHLTA and crappy pay, it's been great. Glad I'll be out before having to work with Genesis and before the DHA shuts access to dependents and retirees (which will basically turn our patients into medicaid recipients if Tricare doesn't become more of a cadillac insurance policy).
 
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