NDAA 2019 signed (2.6% raise)

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Is that 2.6% on top of the average 3% of inflation, or are you losing an adjusted 0.4%.
 
j4pac said:
Is that 2.6% on top of the average 3% of inflation, or are you losing an adjusted 0.4%.
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It's just 2.6%. The best that can be said for it is that it's better than 0%.

Medical special pays haven't changed or been adjusted for inflation in about 30 years, except for FM and IM which had their ISP increased 7 or 8 years ago. If the $15K ASP had been adjusted even 2% annually since 1990 it'd be over $26K now. Surgical subspecialties on a 4-year MSP contract would be $80-100K higher per year. The bottom line is that military physician pay has been cut every year, without fail, since the 1980s.

Remember, the military views physician retention as an anti-goal.
 
pgg said:
It's just 2.6%. The best that can be said for it is that it's better than 0%.

Medical special pays haven't changed or been adjusted for inflation in about 30 years, except for FM and IM which had their ISP increased 7 or 8 years ago. If the $15K ASP had been adjusted even 2% annually since 1990 it'd be over $26K now. Surgical subspecialties on a 4-year MSP contract would be $80-100K higher per year. The bottom line is that military physician pay has been cut every year, without fail, since the 1980s.

Remember, the military views physician retention as an anti-goal.
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Couldn’t agree with you more.

I wish more former military physicians would speak out on this subject. The lack of SKILLED physicians in their 40s (I’m not talking about the monkeys who hide in admin and haven’t seen a patient or operated in ages) should be a priority for military medicine but sadly it is not. There are many great young doctors in their 30s who are trying to do their best by our active duty troops but you can’t make up for the dearth of physicians in the prime of their careers.

Instead, the astute leaders in military medicine allow pay cuts to happen every single year as PGG alluded to above. Our economy is humming and I can only hope that prospective med students wise up and forgo this disaster.
 
Chonal Atresia said:
Couldn’t agree with you more.

I wish more former military physicians would speak out on this subject. The lack of SKILLED physicians in their 40s (I’m not talking about the monkeys who hide in admin and haven’t seen a patient or operated in ages) should be a priority for military medicine but sadly it is not. There are many great young doctors in their 30s who are trying to do their best by our active duty troops but you can’t make up for the dearth of physicians in the prime of their careers.

Instead, the astute leaders in military medicine allow pay cuts to happen every single year as PGG alluded to above. Our economy is humming and I can only hope that prospective med students wise up and forgo this disaster.
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Retention is not a priority, pretty sure that is clear and likely will never change. Reason being that military medicine does not need seasoned mentors to accomplish the primary mission, i.e. care for the warfighter. They cost too much and don’t have much value add since majority of milmed physicians just came from 3 to 7 years of residency with great mentors and strong education. Only incentive is benefited pension possibility and retention bonuses when eligible.

The only people who consider milmed a disaster are the ones who didn’t get to do exactly what they wanted to do when they wanted to do it. Understanding that your “Plan A” can change or fail should be understood by anyone signing up for milmed. Understanding that you can get screwed during your time should be well known to the informed applicant.

Retention bonuses are fairly reasonable but few stick around to receive them. You’re trading improved lifestyle for decreased compensation... to each their own.




Sent from my iPhone using Tapatalk
 
militaryPHYS said:
The only people who consider milmed a disaster are the ones who didn’t get to do exactly what they wanted to do when they wanted to do it.
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Which, let's be honest, is most people. At least, most people I've ever met. I only know a few who got "exactly what they wanted." I would argue, however, that this isn't entirely true. It is certainly true in a lot of cases, and it certainly does make up for a lot of the unhappy physicians. But, at least in the Army a lot of the unhappiness revolves around extremely poor management, extremely poor logistics, and extremely poor utilization of the physicians they have, regardless of retention.

However, I do agree that the military doesn't want the best physicians it can have. It just wants someone who can do the job - functional placeholders. Tools in a toolbox.

They want the best pilots they can get. They want the best NCOs they can get. They might even want you to be the best officer you can be. But it doesn't matter that you're a physician. Physicians are just another piece of equipment - contracted to the lowest bidder and maintained only as much as needed to keep them basically functional. Army docs are glorified office chairs.

That's why pay doesn't change. It will change when and if they start to see a problem with buying physicians. Just like buying office chairs. if suddenly the market dictates that you can't buy a chair for $120, they'll up the offering price to $125. Until then, you'll get whatever base raises the military gets in general. And why would you expect to meet inflation? So much of the budget had to be redirected to the Space Force, and you're just an office chair.
 
HighPriest said:
They want the best pilots they can get. They want the best NCOs they can get. They might even want you to be the best officer you can be. But it doesn't matter that you're a physician. Physicians are just another piece of equipment - contracted to the lowest bidder and maintained only as much as needed to keep them basically functional. Army docs are glorified office chairs.
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Too bad Tapatalk doesn't let you select specific text to quote, only the entire post. Otherwise I like the interface better than Safari on my phone.

Anyway. I agree with you here. Glorified office chairs. I almost love the analogy because it helps to provide realistic expectations for people considering signing up and also helps current unhappy milmed docs understand why they might be unhappy.

Some people are happy being office chairs. They may even like providing other contributions to the office rather than just a place for people's butts which affords them the opportunity to be in a corner office or moved up to the next highest floor.

When I saw the 2.6% increase I didn't grumble and get upset because it wasn't some other reasonable number to match inflation plus also compensate me for doing a great job. I was actually pretty happy because its one of the largest ones I've seen in the last 15 years and as an office chair I wasn't expecting anything more. I understand my situation and feel fortunate to be a debt free office chair which provides a service to the bigger mission...even if some people think I'm just a place for people's butt's to go all day.

I may steal your analogy in the future. Hope that is OK. I will of course give credit where credit is do.
 
Chonal Atresia said:
A 2.6 % raise on only your basic pay (less than half your salary for most specialists) equates to around a 1% actual raise AND this is the largest increase in 9 years?!
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If we want to talk specifics, military base pay increase doesn't have to match inflation or exceed it because there is a large component of pay that is not taxed, you don't have to pay for healthcare with your money and BAH is adjusted (yes not perfectly) based off of inflation and housing trends. But that's coming from an office chair who likes being an office chair...not an office chair who wishes he was a fancy/expensive projector that sits in the boardroom on the top floor all day.
 
militaryPHYS said:
Too bad Tapatalk doesn't let you select specific text to quote, only the entire post. Otherwise I like the interface better than Safari on my phone.

Anyway. I agree with you here. Glorified office chairs. I almost love the analogy because it helps to provide realistic expectations for people considering signing up and also helps current unhappy milmed docs understand why they might be unhappy.

Some people are happy being office chairs. They may even like providing other contributions to the office rather than just a place for people's butts which affords them the opportunity to be in a corner office or moved up to the next highest floor.

When I saw the 2.6% increase I didn't grumble and get upset because it wasn't some other reasonable number to match inflation plus also compensate me for doing a great job. I was actually pretty happy because its one of the largest ones I've seen in the last 15 years and as an office chair I wasn't expecting anything more. I understand my situation and feel fortunate to be a debt free office chair which provides a service to the bigger mission...even if some people think I'm just a place for people's butt's to go all day.

I may steal your analogy in the future. Hope that is OK. I will of course give credit where credit is do.
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Honestly, I used to (and have on this forum) used the analogy of just being a tool in a toolbox. But once I started thinking of myself that way, it really took the edge off the searing, blinding rage that filled every minute of my work day before I accepted it. Because I understood WHY I was being treated like a screwdriver rather than a highly trained professional. I still think it's poor planning, and I still think it's the exact reason the Army should farm out all of their hospitals rather than run them independently, but I understood why. I was always able to accept being pissed on. I just hated it that the Army always told me it was raining. "We want the highest quality medicine! Patient care is our number one priority! Military research is a cornerstone of (insert GME program)!" No. None of that is true. If they had just opened up with "Listen. You want med school paid for. We need someone to fill an office who has the training to do "x" so that if we need "x" we can have you do "x," but in the interim it means absolutely nothing to us whether you work or don't, train or don't, get rusty or don't. If you can keep yourself honed, that's great. But that's up to you." it would have saved me a lot of headaches and gray hair. But, I also probably wouldn't have joined. I was hilariously and mistakenly under the impression that the Army wanted highly trained physicians.
 
HighPriest said:
ut what I will say is that I have started to come to grips (because peace is not the right term in my case) with something that I knew to be true rationally, but refused to believe from an ethical standpoint for some time.

When you join the military - at least the Army - you are a tool. You and a bunch of other tools are tossed in a toolbox (your hospital) until a big project comes up (like a deployment, be it for war or otherwise). And that makes sense, right? The military is a war-fighting machine. It's one predominant goal is to seek out and destroy the enemies of the United States. You don't think so? Doesn't matter what you think, that's a fact. Now, that doesn't mean we don't occasionally do some side jobs for friends and family (like humanitarian work after tsumanis, etc.), but ultimately that's not what we do for a living.

The military doesn't see an issue with keeping a tool in it's toolbox for a prolonged period of time. It's in the toolbox, and the toolbox is its home, so everything should be fine. The tool will remain sharp because there's no reason it should get dull inside the toolbox. If the tool gets some work done in the toolbox, then the Army sees that as a bonus for the tool, because that's not why it bought the tool. The tool should just be happy that it's in the toolbox to begin with.

Also, it is a little unclear as to what the differences are between tools. A screwdriver, for example, can drive screws really well. But if you hit a nail the right way with a screwdriver then the nail still gets nailed, right? So a screwdriver should also be able to be a hammer in a pinch. But really, the military is better at demolishing old houses than it is at building. You can knock down drywall with pretty much anything, but building stuff means using the right tool for the right job, and we're not so good at that.

If there happen to be a lot of nails to hammer, then the hammers get a lot of work. If there aren't enough screws, then the screwdrivers don't get to work much. But that's ok, because the military didn't buy screwdrivers to screw screws. It bought screwdrivers in case it ever needed a screwdriver. In fact, it really just bought a bunch of tools based upon a general idea of what a toolbox should look like. Sometimes what it needs is a paperweight rather than a tool, but luckily a tool can be used as a paperweight, no problem.

Inside the toolbox, it generally makes sense to organize the tools in a fashion which makes the toolbox more efficient, but the Army doesn't use most of it's tools all that often, and the diagrams it has seen of a toolbox weren't clear enough, so usually it just tosses tools in whatever drawer happens to be open at that time.

This is why so many physicians have an issue with being a tool. As a general rule, we're organized, we like using the right tool for the right job, and we'd rather not do a job that we're not prepared to do. We see disorganization as a potential danger to the work we do. We worked really, really hard to be a tool, only to be used as if we were no more than a paperweight. But that's what we are to the Army, because a single F-35 is worth more than all the training of all your colleagues put together. The F-35 is the Army's Superduty Ford F-350 that it bought to haul lumber and horses and off road vehicles, but which it really only uses to pick up groceries and also its a pain in the ass to park. The Army barely notices its tools.
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There it is. From an old post. I know it sounds cynical. Because it totally is. But, realizing this really helped keep me out of a bell tower.
 
militaryPHYS said:
If we want to talk specifics, military base pay increase doesn't have to match inflation or exceed it because there is a large component of pay that is not taxed, you don't have to pay for healthcare with your money and BAH is adjusted (yes not perfectly) based off of inflation and housing trends. But that's coming from an office chair who likes being an office chair...not an office chair who wishes he was a fancy/expensive projector that sits in the boardroom on the top floor all day.
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I applaud your “the glass is half full” perspective. You will do fine in the military, whatever they may throw at you. 2-year brigade surgeon tour shredding your ortho surgical skills and making it impossible to be credentialed at a civilian hospital at the end of your ADSO - no problem, it’s all for the greater good.

I, on the other hand, couldn’t stand many (not all) of my clinically incompetent bosses. Instead of the “glass is half full” perspective, I view it as the “battersd wife analogy.” No matter how bad it gets, you keep coming back and defending your abusive spouse.
 
Chonal Atresia said:
2-year brigade surgeon tour shredding your ortho surgical skills and making it impossible to be credentialed at a civilian hospital at the end of your ADSO - no problem, it’s all for the greater good.
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Thankfully we don't have brigades in the Navy. Being Navy makes it a lost easier to stay glass half full.

I chose ortho (and then sports fellowship) because of my experience through military med school and residency which showed me how to maintain an active OR/practice while allowing time for dreaded administrative duties. Very easy to keep the patients coming, skills frosty and still have time to do tasks that can help with promotion no matter what duty station you are at. Also very easy to continue to do basic ortho trauma to maintain credentials for trauma call. If I chose to do something else (ENT, gen surg, neurosurg) it wouldn't be as easy. If I had chosen the army I would have been miserable no matter what I did. Your experience is your own and not universal.
 
I don’t think the green weenie considers military physicians as tools. They see us more as fire extinguishers. You have to have them around, but you hope you never have to “really “use them.
 
HighPriest said:
There it is. From an old post. I know it sounds cynical. Because it totally is. But, realizing this really helped keep me out of a bell tower.
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I like it. I'm in to these analogies. I might not have as much cynicism related to these same facts, but facts are facts and everyone should know what to expect when signing up. We are just pawns in the big scheme of things which is either a deal breaker or not depending on who you are.
 
HighPriest said:
A fire extinguisher is a tool, init?

I have a plunger. I hope I never need to use that.
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In my analogy, a tool is something you choose, cherish, use, and in which to take pride. I think of my grandfather's bench vise he used for 50+ years.

Fire extinguishers are required due to code and are a constant reminder of mortality and of failed precautions.


😉
 
armytrainingsir said:
In my analogy, a tool is something you choose, cherish, use, and in which to take pride. I think of my grandfather's bench vise he used for 50+ years.

Fire extinguishers are required due to code and are a constant reminder of mortality and of failed precautions.


😉
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They have those tools too. They're called M1A1s. That's your grandfather's bench vice. You're a plunger.
 
militaryPHYS said:
Reason being that military medicine does not need seasoned mentors to accomplish the primary mission, i.e. care for the warfighter. They cost too much and don’t have much value add since majority of milmed physicians just came from 3 to 7 years of residency with great mentors and strong education.
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I really disagree with this strongly.

Milmed deserves and needs senior, experienced, seasoned physicians. I'm now 9 years out of residency and it was only a few years ago that I felt like I was getting off the steep part of the learning curve. Then I left for a fellowship, finished about a year ago, and even now I feel like my subspecialty practice is improving and maturing still.

New residency grads are SAFE but all of us/them need time to become GOOD.

Anyone who thinks he's great a couple years out of training is on the wrong side of the Dunning Kruger curve.

If there is one great failure of military medicine, it's the system's lack of respect for senior experienced clinicians, and the lack of serious efforts to retain them. To the military, the value of a doctor with a little silver eagle is to push paper around.

I think it is very, very wrong and dangerous to think that all the military needs are junior physicians right out of residency.


And all of the above doesn't even touch on the importance of experience in faculty positions at military residency programs.

It's more than a little worrisome to me that at this point, if not for a handful of excellent contractors (who could vanish in a puff of contracting smoke), that I would be one the 2 or 3 most senior AD physicians at this big 3 Navy MTF residency program. Again, I'm only 9 years out of residency, barely entering what most would call the prime of my career. No non-military program would look at me and think "elder" but I'm on the edge of that role here.

I don't think this is OK.
 
pgg said:
Anyone who thinks he's great a couple years out of training is on the wrong side of the Dunning Kruger curve.
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Boy is that ever true.

Agree with everything else here as well. I agree with @militaryPHYS that the Army (probably the whole DoD, I dunno) has no interest in senior physicians. Clearly. That's why there's minimal incentive to stay and plenty of incentive to get out, and why they more or less shoehorn you into an operational slot if you want to make rank. But I agree with you that this is a dumb system. So, there are three options: it could change (which is laughable. There is a significantly higher probability that the corpse of Mr. Rogers will climb out of hell and start a zombie lawn maintenance service), or they can give up manning hospitals and let physicians be real physicians somewhere else until they're needed (which they'll never do because it would disrupt their fiefdom). Or they can just keep doing what they're doing. which is what will happen.
 
pgg said:
If there is one great failure of military medicine, it's the system's lack of respect for senior experienced clinicians, and the lack of serious efforts to retain them. To the military, the value of a doctor with a little silver eagle is to push paper around.
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I'm not advocating for the current system, but the current system is, well, the current system. Like @HighPriest said, unlikely this is going to change and nothing within the new NDAA's and DHA guidance give any glimmer of hope that this will change. Thus we are in the situation of this is reality and not going to change any time soon. Thus we can lament about it or just accept it as the state of being and make sure people understand it prior to signing up. Don't expect to be catered to or valued for your experience as you get to the end of your commitment.
 
I echo what was written above regarding the value of more seasoned physicians (and how little value the military medical system puts on them). I was fortunate that my residency location was right next to a large consultation center for my specialty, so I got to work with some physicians who have been practicing from 20+ years all the way up to 40+ years. The level of expertise in someone 20 years out of practice is impressive. They are also still mentally sharp and up to date in their practice. It's a shame they aren't valued more in this system.
 
militaryPHYS said:
I'm not advocating for the current system, but the current system is, well, the current system. Like @HighPriest said, unlikely this is going to change and nothing within the new NDAA's and DHA guidance give any glimmer of hope that this will change. Thus we are in the situation of this is reality and not going to change any time soon. Thus we can lament about it or just accept it as the state of being and make sure people understand it prior to signing up. Don't expect to be catered to or valued for your experience as you get to the end of your commitment.
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Well, I don't disagree with anything you just wrote here. But this post is also vastly different from your previous one which explicitly stated that the military doesn't need seasoned physicians, that they don't have much value, and that a medical corps made up of new grads fresh out of GME is just fine.

With respect, those points are wrong, wrong, and wrong, and I'm surprised you believe them.
 
I also have to say, while I don't think anything will change, I also don't think it's reasonable to just accept it. It's fine to emotionally prepare yourself for the disappointment that is milmed's respect for medical experience. It isn't reasonable to just let it slide. It isn't fair to the patients, to their families, or to the physicians involved (whether or not their actually entitled to a fair shake). The house is decrepit. There are holes in the floor, and the ceiling is leaking. Realizing it won't fix itself, calling it shelter anyway, and hoping no one falls through the cracks isn't reasonable. You don't have to expect milmed to turn in to Sloan-Kettering, but I think military physicians (and former physicians) should be strongly biased and vocal about the need for change. I think we owe it to service members. I usually list to the opinion that milmed should farm out their medical care specifically because I don't think they're capable of meaningful change. If there were an even somewhat likely, reasonable way to just improve the current system, I could get behind it. But, I've never heard or one. Just lip service, bad ideas, and new deck chair layouts for the Titanic.
 
pgg said:
With respect, those points are wrong, wrong, and wrong, and I'm surprised you believe them.
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Confused on what is going on here. The context of that post was simply me stating my impression on why things are the way they are related to retention. I don't agree with the current retention plan or handling of experienced physicians who are voluntarily staying in, but I understand WHY the services don't need to boost retention because they get what they (think) they need from young physicians with service commitments.

I am stating current facts and being objective so that people can have realistic expectations when considering Milmed. This is something you seasoned SDN'ers pressed upon me when I was being too optimistic about a year ago.

Bottom line is there are things you can change on a local level which I am actively involved in. Changing retention plans via bonus/pay restructuring, GME goals, etc. is way above my pay grade. Would I advocate for it if given the opportunity? Of course! But complaining about it and arguing about it on an online forum won't get us anywhere.

Hence, facts are facts, accept them or don't, try to impact and change what you can but don't let the things we can't change make you so bitter that you start calling military medicine (something you guys are/were intimately involved in, practiced in, influenced) a disaster...or decrepit.

There are improvements to be made, but by and large the system (at least navy medicine) is a decent one that I would defend while quietly trying to impact positive change where possible along the way.
 
What a conundrum. Stay in and accept the generous 2.6%, or more accurate 1% overall, pay raise, or accept one of these positions I’ve been offered for a hardly-better 75% increase?
 
of course they do. And every year the conversation goes something like this:

"How do we milk more out of our current budget? How is our influx of physicians? If it's good, then we don't need to offer anything more. What metrics are we going to pay attention to this year? What do you mean: "Do those metrics make sense out-of-context??" That's a court marshal for you, you insubordinate jerk! You've spent far too much time dealing with a clinical setting. Nothing a little brainwashing won't fix. This is why we need more MSC officers and nurses up here, and fewer physicians!"
 
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