Post-Military Expectations

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DOswag

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I've posted several times about my views on military medicine (Psychiatrist) and I am definitely planning on separating when my commitment is up. I've generally had what would probably be considered big expectations for how much better things are going to be outside of the military but there's a little part of me that is wondering if I should temper my expectations some. I know things are not perfect in the civilian world of medicine. But I'd say it's pretty miserable in mil med right now and I feel like I have to expect things will be much improved based on what I've read, who I've talked to, even a couple of interviews I've done so far at places on the civilian side. My expectations are to see a sizeable difference in my paycheck, not taking home as much stress from work, better overall work/life balance, better support in the work place as far as assistance/resources within clinic or support staff within the clinic, less admin burden (that's a big one for me) etc. Are these unrealistic expectations? Will I be getting my hopes up just to have them crushed in the outside world? Is the civ side that much better than mil side of medicine?

SIGNED

Angsty Psychiatrist hoping for a better world post mil

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I've posted several times about my views on military medicine (Psychiatrist) and I am definitely planning on separating when my commitment is up. I've generally had what would probably be considered big expectations for how much better things are going to be outside of the military but there's a little part of me that is wondering if I should temper my expectations some. I know things are not perfect in the civilian world of medicine. But I'd say it's pretty miserable in mil med right now and I feel like I have to expect things will be much improved based on what I've read, who I've talked to, even a couple of interviews I've done so far at places on the civilian side. My expectations are to see a sizeable difference in my paycheck, not taking home as much stress from work, better overall work/life balance, better support in the work place as far as assistance/resources within clinic or support staff within the clinic, less admin burden (that's a big one for me) etc. Are these unrealistic expectations? Will I be getting my hopes up just to have them crushed in the outside world? Is the civ side that much better than mil side of medicine?

SIGNED

Angsty Psychiatrist hoping for a better world post mil

Yes, temper your expectations. The civilian medical world is a sht show. Better volume, better pathology, maybe better pay, but it can get pretty nutty (pun intended), especially of mental health.

Do you moonlight? Highly recommend it. No better way to get a flavor of the civilian world and what you might want/not want.
 
Yes, temper your expectations. The civilian medical world is a sht show. Better volume, better pathology, maybe better pay, but it can get pretty nutty (pun intended), especially of mental health.

Do you moonlight? Highly recommend it. No better way to get a flavor of the civilian world and what you might want/not want.
No moonlighting for me. Thought about it but I was stressed enough during the week that I felt I needed that weekend time off. We had some civ exposure outpatient/inpatient in residency and I did enjoy it. I know there are always going to be headaches, but just seems the mil side goes out of its way to increase paperwork, admin burden etc. Especially in Psychiatry, lots of regular patient encounters turn into extra patient encounters because then you have to schedule a treatment team meeting with leadership (and extra documentation for that). If that's the case you're likely seeing that patient on a weekly basis because they're on the HIL thus adding to your already stacked patient load. I do like the aspect that If we need to send someone to a higher level of care we have the ability to do so without worrying about them paying for it. Meds are covered as well though we are limited in what we can use because some classes of meds are pretty much automatically unfitting for USAF. But the admin stuff, extra meetings, excessive paperwork in compared to what I experienced civ side in residency isn't even comparable.
 
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No moonlighting for me. Thought about it but I was stressed enough

No you're not. No doctor in the military is all that busy or stressed. We think we are, but we're really not. PCMs in my clinic think they're busy when they have to see 10 patients a day. They have no idea that a typical PCM will see up to 30 in a busy civilian clinic.

I'm being facetious . . . of course you might be busy, all your points about the busy work are valid.

But seriously, moonlight. It's the only way to get a feel for things in the civilian world. Even if you just did some tele-psych. How much time do you have left on active duty?
 
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No you're not. No doctor in the military is all that busy or stressed. We think we are, but we're really not. PCMs in my clinic think they're busy when they have to see 10 patients a day. They have no idea that a typical PCM will see up to 30 in a busy civilian clinic.

I'm being facetious . . . of course you might be busy, all your points about the busy work are valid.

But seriously, moonlight. It's the only way to get a feel for things in the civilian world. Even if you just did some tele-psych. How much time do you have left on active duty?
I agree that on the civ side a busy PCM clinic would see a lot more patients as would a civ psychiatrist. But I can tell you from my experience in mental health, seeing 5-8 patients in a day in a military MH clinic is > 12-14 patients in a civ clinic due to the extra burden of documentation, phone calls that have to be made, walk-in patients that must be seen, adding in eyes on for tech intakes, ADAPT intakes, TTM's, 1Sgt phone calls asking about whether their member can perform their job. Those suck the time to do that extra documentation all while leadership is constantly telling you you're not doing enough, "Why are those NARSUMs late", "why are CBT's not completed", "why is our access to care so bad"? Yes the number of patients is lower, but that's offset by seemingly a higher burden in other areas. Not to say that paperwork and admin isn't a problem on the outside. I would say my perspective from exposure during residency while also working on the mil side, was that the civ side had a significant amount less than the mil side. I could be wrong on that and it could all be a factor specific to certain work environments. That's just the perspective I have. And that includes multiple inpatient/outpatient rotations during residency which wasn't that long ago (2015-2019).

I'm at the point now where I'm not sure If I can moonlight just logistically unless it was for telepsych in the specific state I'm licensed in since I don't have a license in the state I'm currently in. And I only have about 7 months left of active duty time.
 
Yes, temper your expectations. The civilian medical world is a sht show. Better volume, better pathology, maybe better pay, but it can get pretty nutty (pun intended), especially of mental health.

Do you moonlight? Highly recommend it. No better way to get a flavor of the civilian world and what you might want/not want.
And I appreciate your pun lol. Yes compared to mil side, civ side definitely has some more nutty cases at least in regards to severe mental illness. Civ inpatient during residency was awesome.
 
Judging by the amount of non-clinical work you are describing, I think you will like the civilian world much better. The pathology will be more interesting and the paperwork a breeze compared to what you're having to suffer through right now. Take the VA for example:

Typical outpatient workload
- 6 hours per day of face-to-face patient care, 60 minute intakes (some VAs offer 90 minutes) and 30 minute follow-ups. This amounts to no more than 12 patients per day. However, it is not as easy as it sounds due to the lack of support staff
- Call: if there is an inpatient unit or residential unit, there will be occasional call divided amongst all the psychiatrists, usually no more than one weekend day rounding on inpatients every 1-2 months and a few days of pager call every 1-2 months
- Extraneous work requirements: care coordination due to lack of outpatient support staff, view alerts (the equivalent of an inbox), TMS training (useless powerpoint classes, nothing happens if you don't do them), clinical reminders (yearly or quarterly checklist type forms on various issues, you may not get a bonus if you don't do them), treatment plans (a Joint Commission requirement, nothing happens if you don't do them)

Typical inpatient daily workload
- 5-10 inpatients per day, which is lower than the private sector. However, the care coordination takes a lot longer due to the larger number of services offered by the VA
- Call: same as above
- Extraneous work requirements: same as above except the care coordination is inpatient related and social workers can help with some of it

The VA probably has the one of the highest paperwork/busywork requirements out there. Other places will have far less paperwork. However, even at the VA, the extraneous paperwork is less mandatory than at the military. If you don't do the extraneous paperwork such as TMS trainings, the worst that will happen is the loss of a small bonus no more than $15000 per year called Pay for Performance.

If you're interested in the VA, one perk is the abundance of 100% virtual jobs at the VA of varying desirability. For example, search "clinical resource hub psychiatrist" or "CRH" on USAjobs.

In the civilian world, administrators will be after different metrics that incentivize seeing more patients and billing more for encounters, which can still affect you, but overall you will likely be happier. If not, there is always private practice.
 
If the typical BS of the military healthcare system irritates you to no end then you will likely be much happier as a civilian but I’m sure you’ll still find things to complain about.

Life is all about tradeoffs. If you have not integrated yourself in to the civilian system that you will be transitioning to then don’t be surprised when you find things that you don’t like. Just like people who blindly sign up for HPSP or USUHS with little understanding of MilMed. Do the due diligence to have enough information to make a well informed decision and know what the actual trade offs are for you, your family and your clinical practice in your specialty.
 
If you are 7 months from separation you are already late to make a well informed decision after integrating/socializing with potential practices in the planned area you will separate to. Most commands require about 12 months lead time to submit paperwork for separation/retirement. Because of this people deciding to stay or go should be thinking of researching their next steps 2 to 3 years ahead of time. Apply for positions. Talk to people in the practices you are applying to. This should be done >12 months before end of active duty date.
 
There was some challenges as far as being stationed in an OCONUS location and not really knowing where I'd like to end up post military (several factors involved in that). Most places I've talked to seemed to want to find someone within a year and I reached out back in 2021 and was told it was too soon at that time. I've been looking for a few months now and notified the AF that I was separating about a year before my separation date.
 
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I've posted several times about my views on military medicine (Psychiatrist) and I am definitely planning on separating when my commitment is up. I've generally had what would probably be considered big expectations for how much better things are going to be outside of the military but there's a little part of me that is wondering if I should temper my expectations some. I know things are not perfect in the civilian world of medicine. But I'd say it's pretty miserable in mil med right now and I feel like I have to expect things will be much improved based on what I've read, who I've talked to, even a couple of interviews I've done so far at places on the civilian side. My expectations are to see a sizeable difference in my paycheck, not taking home as much stress from work, better overall work/life balance, better support in the work place as far as assistance/resources within clinic or support staff within the clinic, less admin burden (that's a big one for me) etc. Are these unrealistic expectations? Will I be getting my hopes up just to have them crushed in the outside world? Is the civ side that much better than mil side of medicine?

SIGNED

Angsty Psychiatrist hoping for a better world post mil

I would suggest maybe starting somewhere easier like the VA. I know for my field mil med is a cakewalk compared to the private sector or the VA. As for admin work, I did a ton of it in the private sector, I do less in the Army when on active duty, and I do a ton of it in the VA.

I would just be prepared to see probably 3-4 times the amount of patients, still have tons of admin work, be expected to work through lunches, stay late, come in early, etc.. and I wouldn't count on admin support. Most places are so hard up for good help that you end up doing your job as a provider, plus the job of a secretary and all support staff.

Good luck and just try and take it a day at a time.
 
I would suggest maybe starting somewhere easier like the VA. I know for my field mil med is a cakewalk compared to the private sector or the VA. As for admin work, I did a ton of it in the private sector, I do less in the Army when on active duty, and I do a ton of it in the VA.

I would just be prepared to see probably 3-4 times the amount of patients, still have tons of admin work, be expected to work through lunches, stay late, come in early, etc.. and I wouldn't count on admin support. Most places are so hard up for good help that you end up doing your job as a provider, plus the job of a secretary and all support staff.

Good luck and just try and take it a day at a time.
I talked to several prior service Air Force psychiatrist who now work for the VA who said pretty much the opposite. Yes they see more patients, but less admin work compared to active duty psychiatry and better work/life balance. But it certainly could be the specific VA they work at may be better staffed and better leadership.
 
I talked to several prior service Air Force psychiatrist who now work for the VA who said pretty much the opposite. Yes they see more patients, but less admin work compared to active duty psychiatry and better work/life balance. But it certainly could be the specific VA they work at may be better staffed and better leadership.

They have a saying in the VA. "If you've seen one VA, you've seen one VA". It's pretty true, but I know for my field the admin work has just been getting more significant every year especially post COVID. It's a pretty common issue in my field nationwide.
 
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I think generally speaking, the military does a very bad job of providing you with the correct support staff. The limitation in patient volume is usually a combined effect of not enough space and not enough support. You would be surprised at how many more patients you can see when they are worked up and ready to go. We have one aspect of our practice that is optimized for volume, and we will put more patients through than most civilian practices. It makes you realize that medicine is a team sport and mil med is a football team made up of mostly quarterbacks being asked to play as offensive linemen.
 
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