PSLF is pretty good, but combining PSLF with EDRP is even better! There many, many ways to get your loans wiped pretty quickly after graduation that don't involve the military.
Questions for current/prior military physicians
- Thread starter Kay_Em_Jay
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As a surgeon, what’s so incredulous about AD military medicine in 2025 for anyone remotely considering a procedural specialty is this:
People are wondering if their future boss will let them use their vacation time so they can do more work elsewhere so they can stay competent in their chosen profession to which they’ve dedicated a decade of their life.
Talk about an elephant in the room!
In the end, what good is a ‘free’ medical education if the price is incompetence?
Good luck OP.
I had a great career, split between AD and reserve time. But my AD experience was a looong time ago, and isn’t relevant in 2025. My AD friends are mostly miserable and or resigned to their fate. Folks with prior mil time are about the only folks I think who should entertain AD medicine. Hopefully more folks in the specialties you’re interested in can chime in.
People are wondering if their future boss will let them use their vacation time so they can do more work elsewhere so they can stay competent in their chosen profession to which they’ve dedicated a decade of their life.
Talk about an elephant in the room!
In the end, what good is a ‘free’ medical education if the price is incompetence?
Good luck OP.
I had a great career, split between AD and reserve time. But my AD experience was a looong time ago, and isn’t relevant in 2025. My AD friends are mostly miserable and or resigned to their fate. Folks with prior mil time are about the only folks I think who should entertain AD medicine. Hopefully more folks in the specialties you’re interested in can chime in.
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No way to know if you’ll be a surgeon or non-surgeon specialty. So many change. I went from wanting to be family med and flight surgeon, then I wanted to do general surgery with trauma fellowship, then I switched to ortho and decided a couple years in to specialize in sports. Life and military and medicine are always changing and so will your preferences.
To MilMed or not MilMed. That is the question. Both are acceptable answers.
To MilMed or not MilMed. That is the question. Both are acceptable answers.
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The assistance surgeon general of the Army once bought me a beer and gave me the best advice I ever got from anyone in the Army, save the people who taught me how to operate: Never close a door you don’t have to close.
He was talking about leaving the option of an operational position on the table because I told him I had no interest in it.
But I would apply it to the idea that you, indeed, do not know if you’re going to do surgery. So make sure whatever you do, you can be a good surgeon on that path if you want, and not have to fight for it.
He was talking about leaving the option of an operational position on the table because I told him I had no interest in it.
But I would apply it to the idea that you, indeed, do not know if you’re going to do surgery. So make sure whatever you do, you can be a good surgeon on that path if you want, and not have to fight for it.
Kay_Em_Jay
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Thank you for this insight and honestly the main reason I am entertaining USUHS is because I am prior Navy. It does certainly concern me that I could not be in a clinical setting for potentially years if I take this path.
Although your service time was a long time ago, would you say that your AD time provided you with anything that enhanced your capabilities as a physician that you otherwise would not have gotten if you had not served?
Kay_Em_Jay
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This is no doubt great advice in all aspects of life. It is something I have lived by during my career as an engineer and will certainly take forward no matter what path I take.
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Absolutely. My philosophy of leadership. While the army is far far from perfect, leading from the front is a standard by which I judge all leadership.
The ideal is your boss and your boss’s boss at one point we’re in your shoes and technically understand your job and your place in time. And they are thus able to make sound decisions and lead well based on that past experience. Does it break down? Of course it does but that doesn’t mean we toss that ideal aside. It’s probably why I have such poor opinion of most hospital leadership. They have no clue about what we do. Hell, they don’t have any clue about healthcare. It’s all just widgets to them. And they certainly have no qualms telling people to do what they themselves would be either completely incapable or completely unwilling to do themselves. They tend to be self-serving, first in line, narcissistic dinguses.
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I don’t say this to be inflammatory in any way, because I agree with everything you’ve said here but:
This system breaks down in both the civilian and military worlds. It is for the most part a bit better in the military for two reasons:
1-most of the leadership structure is physicians
And
2-there’s essentially no realistic expectation for performance, so you can easily stand on ideals. (Which is not entirely bad)
Where it breaks down is
1-lots and lots of nurse commanders who have no idea, frankly, what it is like to actually practice medicine as a physician no matter how much they think that they do.
2-physician or nurse commanders who have spent so much time away from clinical practice that they barely remember what it was like, and they’re mostly concerned with what their next OER is going to say. Clinical medicine for some of them is like remembering what the third grade was like and equally relevant to them.
But, in the civilian world having disconnected leadership is the standard rather than the exception in most systems (physician lead systems or private practice systems aside). I definitely judge my leadership based upon how much I feel they try to understand what I do and why I do it.
For me, personally, I find it easier to work with a non clinical hospital CEO than I do with a nurse commanders who because I know what motivates the hospital CEO - optics and finances. If you can define what you want to do in one of those two ways, they get it. Nurse commanders? Who knows. It’s whatever they think will get them promoted, and that could be anything.
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Thankfully, I never had the ‘pleasure’ of nurse commanders on AD
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You are a lucky guy. That’s the majority of what I had to work with.
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No doubt. Around the time I left AD was when Tripler was blessed with its first nurse commander. And they received a perfect JCAHO score. I knew then the fix was in and the future was bleak. The medical corps could stave off the medical service corps guys, but when all of AMEDD is salivating to be your boss, all bets were off.
The reserves were so much more chill. I stayed clinical and didn’t pursue a command track so they left me alone. Mostly 70 series medical service corps types stabbing each other in the back.
I disagree here with some of the negative assertions about General Medical Officers. As a prior GMO myself, I think it was a good experience for me personally and professionally, and helped me mature quickly as a physician. There is a learning curve, but I believe I was absolutely an asset to my unit. It is all relative. There are not enough board-certified physicians to fill all the operational needs. Do you really want to send your fellowship trained subspecialists out to do GMO work and have their skill set atrophy? No. Is a GMO generally just as good, if not better, than a PA or an independent-duty corpsman? Yes. I think Navy Medicine would be better off if more people still did a GMO tour. It would certainly help ensure more medical officers understand the way the military actually works.
15 years in Navy Medicine and generally love what I do. Sure, I could get paid more if I got out, but I make plenty. Plus, I get to be part of the US military. I lived in Japan for three years and am about to move to Italy for three more. I get to deploy with Marines and help save American lives. I can help set health policy that makes a difference for our warfighters. I get to shoot weapons and fly in helicopters and travel to far-flung parts of the world. I enjoy playing a role, however small, in the mission of the US Navy.
My civilian medical school friends make more money than me. Most haven't moved since they finished residency. They seem so boring compared to what I have had the opportunity to do. We used to email each other every year or so but I started to feel bad with all the stories of the cool stuff I was getting to do in random parts of the world, while they are all like "Well I'm still here in the same group practice, no real change. We might mix it up this summer and take the kids to Disney." A lot depends on what you want out of life. If you want adventure, service, patriotism, and camaraderie, then the Navy is a great way to go. If you are looking to maximize income and settle down in one place for many years, then it isn't.
There are pros and cons to any job. There is no perfect medical job. Many people are simply not cut out for military service. As others have said, I would not do it just for the money. If you can see yourself enjoying the military, including the deployments and all the non-medical stuff, and enjoying it, then it is probably a good choice for you. It was for me. I would do it again in a heartbeat.
My civilian medical school friends make more money than me. Most haven't moved since they finished residency. They seem so boring compared to what I have had the opportunity to do. We used to email each other every year or so but I started to feel bad with all the stories of the cool stuff I was getting to do in random parts of the world, while they are all like "Well I'm still here in the same group practice, no real change. We might mix it up this summer and take the kids to Disney." A lot depends on what you want out of life. If you want adventure, service, patriotism, and camaraderie, then the Navy is a great way to go. If you are looking to maximize income and settle down in one place for many years, then it isn't.
There are pros and cons to any job. There is no perfect medical job. Many people are simply not cut out for military service. As others have said, I would not do it just for the money. If you can see yourself enjoying the military, including the deployments and all the non-medical stuff, and enjoying it, then it is probably a good choice for you. It was for me. I would do it again in a heartbeat.
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I don’t think anyone denies the personal and professional growth in GMO roles but personal growth=/= patient safety. I have often found myself down a similar line of thinking and I agree that, on balance, a gmo is likely better than a new grad PA and most IDCs but that doesn’t take away from under trained physicians serving in these roles. I know it’s not practical but ideally we shouldn't have undertrained PAs or IDCs in any of these roles. The Navy has made a judgment call and accepted the risk. Let’s increase the number of primary care docs. It is a little straw man to say these roles will be filled by surgical subspecialists.
Agreed, we have to find a way for physicians to get exposure to the line. I think it gives context to the role and our purpose. We aren’t the only show in town like civilian hospitals. We are stagehands for the war fighter, a supporting element to keep the machine running.
For the record, I wouldnt trade my experience for anything.
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Patient safety considerations left the building long ago with the proliferation of NPs.
If you’re truly worried about patient safety, go after nurse practitioners and other mid-level practicing on their own and not GMO physicians.
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Agree, but these aren’t mutually exclusive and there are essentially zero NPs in an operational roles.
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You know what else helps physicians mature as a physician? Residency. 🙂
Oh, I was an asset to my unit too. It was still an inappropriate delay in training, and an inappropriate offloading of risk from military planners to me. My near misses didn't hurt or kill anyone, AFAIK. I had a good time. It wasn't until years later that I fully understood how reckless it was to send us out like that.
That's only because the military can exploit its debt-averse training pipeline to cheap out on labor costs.
You're thinking about this all wrong. GMOs are not the best solution, lesser of evils, or some kind of necessary compromise to get at least some level of essential medical care to the troops. The entire GMO model is wrong.
There would absolutely be enough board-eligible & board-certified physicians to care for the troops if
1) in garrison, operational units got their medical care from appropriately staffed hospitals/clinics, as opposed to "concierge interns" directly attached to the units
2) while deployed, operational units got their medical care from BE/BC physicians who deployed with them for 90 or 180 day periods
3) the military offered a practice environment and paycheck that was appealing enough to recruit and retain physicians (not merely a "scholarship" program to tempt naive and debt-averse pre-meds into a vaguely defined paypack period 5 or 10 years away)
The GMO model hasn't changed a bit in something like 5 or 6 decades. Line units don't need concierge interns who are ineligible for medical licenses in many states. One of the many failures of medical corps leadership (and there have been many but this is the least forgivable) is in allowing this model to persist.
That's not the only other option. Foolish false dichotomies like this are part of the reason the military is stuck in the GMO rut. See above for the obvious solution.
Sure, a GMO would be better for the unit than nothing at all also, but those aren't the only options, and you're ignoring the idea that the tour is objectively harmful and risky for the GMOs themselves.
Completely disagree.
This notion that doctors have to "live the lives of their patients" to understand their healthcare needs is a silly military-ism.
Do civilian pediatricians need to spend two years working as a kindergarten assistant to understand kids' healthcare needs?
Do bariatric surgeons need to spend two years eating Bojangles 3 meals per day to understand obesity?
Do civilian FAA aviation medical examiners need to spend two years riding the jump seat in a FedEx plane to understand pilots?
It's ridiculous.
Now - I was a GMO for 3 years and a lot of that stuff was fun. It was uniquely rewarding in a lot of non-medical ways. That doesn't change the fact that GMO tours as they exist are unnecessary for the units, dangerous to patients, and abusive to young physicians.
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It’s an antiquated concept that made sense decades ago.
One of my now-retired partners’ father was the archetypical “small town doc.” Again, this is the father of a guy who has already retired himself, so we are talking before the war when the man in question finished medical school. He did four years of medical school and an internship and then went in to practice in a town where the closest hospital with more than ten beds was 3 hours away (at the time). And this guy did everything. Family medicine, ON/GYN, and even some surgeries. He would do appendectomies. Which is insane. But which was common at the time. Like wearing an onion on your belt. Why? Because the alternative was to go 3 hours away for your appendix and appendicitis wasn’t always caught early enough for that to be an option when people had to rely solely on physical exam with no labs and no imaging beyond plain films.
But no one would ever do that today because it’s crazy. And obviously GMOs aren’t doing appendectomies, but at what point do we look at that model and say “this concept is out dated and has been replaced everywhere but here?”
The answer is a long time ago.
One of my now-retired partners’ father was the archetypical “small town doc.” Again, this is the father of a guy who has already retired himself, so we are talking before the war when the man in question finished medical school. He did four years of medical school and an internship and then went in to practice in a town where the closest hospital with more than ten beds was 3 hours away (at the time). And this guy did everything. Family medicine, ON/GYN, and even some surgeries. He would do appendectomies. Which is insane. But which was common at the time. Like wearing an onion on your belt. Why? Because the alternative was to go 3 hours away for your appendix and appendicitis wasn’t always caught early enough for that to be an option when people had to rely solely on physical exam with no labs and no imaging beyond plain films.
But no one would ever do that today because it’s crazy. And obviously GMOs aren’t doing appendectomies, but at what point do we look at that model and say “this concept is out dated and has been replaced everywhere but here?”
The answer is a long time ago.
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Didn't expect to come across this background browsing the forum - I'm also a former nuke ET, currently M1. Would be happy to discuss options other than USUHS with you if you want more info from someone currently using it or the differences between nuke school and med school, just shoot me a DM and i'm happy to talk specifics. TLDR: VR&E is paying for my medical school and I owe no obligations to anything or anyone.
As an aside- I served from 2011-2021 (went to MARF in Ballston Spa in 2012 for prototype) so it's very likely we were at NNPTC together as students!
manojoblanco!
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Where do you go to school? lurker of this thread lol
Interesting responses here. I realize that there is wide variety in the kinds of experiences people may have had as GMOs. But based on my own experience, I am not convinced that the use of GMOs is blanket "unsafe" for patients and should be banned forever.
When I was a GMO (with USMC infantry), I needed to be good at the following:
-acute care
-minor procedures
-musculoskeletal injuries
-knowing what I could handle, how to effectively manage at my level, and when I to send to somebody else (medical judgment)
-familiarity with common emergencies and how to manage them (emergency preparedness)
-communicating health risk accurately to leadership (risk communication)
-determining what issues posed a risk to deployability and how to overcome them
-maximizing getting Marines back to work quickly with narrowly tailored duty restrictions as necessary, while not exacerbating their condition or prolonging healing
-basic mental health
-talking to the Marines in ways they could understand and act on
-developing the medical skills of my corpsmen (medical education/training) and employ them effectively to meet the health needs of the unit
-being able to thoughtfully plan for medical contingencies in austere environments with limited resources (wilderness medicine)
-engendering the trust and confidence of the line officers and senior enlisted in the unit
-fundamentals of preventive medicine/basic public health
-understanding common risk factors, work tasks, injury patterns, occupational hazards/exposures of those in my unit (a basic tenet of occ med)
-working with specialists to help maximize potential for Marines to return to work quickly (case management)
-knowing how and when to utilize the myriad medical resources available to me
I was at least decently good at all of these things, and very good at a number of them. I do think my Navy internship was reasonable preparation for my job as a GMO. I thrived in that environment enough that I extended my tour to do a second deployment. I saw specialists with much higher levels of training than me, working in the operational environment, that lacked the ability to do some of these things. This caused predictably significant problems for their units. Understanding the military, the way it works, and what your mission is as unit medical officer is absolutely critical and cannot be overstated. Many do not get that, and struggle in operational medicine even though they may be quite competent working in a hospital.
As a GMO I did not need to know much of anything about:
-OBGYN
-pediatrics
-advanced procedures
-care of chronic medical conditions
-complex medical conditions that typically require subspecialty care
-hospital medicine
-navigating the EHR
-dealing with hospital bureaucracy
In summary, I think that my skill set and level of medical knowledge and experience was appropriate for what I did as a GMO. I think that GMO experience is quite beneficial for most of the GMOs that do it (anecdotally, it seems that most prior GMOs I have worked with agree on that), that GMOs are a reasonably good fit for meeting the needs of many military units, and that they are not an inherently flawed concept for the Navy. There are legitimate reasons why the GMO system has worked as it has for many decades.
That said, everyone gets that there are tradeoffs as well as external pressures that give us good reasons to reconsider the model. I think the problem is that the alternatives also have their own drawbacks and tradeoffs, which haven't been discussed as much here on these boards but nonetheless are important to consider. As the Navy has and does.
When I was a GMO (with USMC infantry), I needed to be good at the following:
-acute care
-minor procedures
-musculoskeletal injuries
-knowing what I could handle, how to effectively manage at my level, and when I to send to somebody else (medical judgment)
-familiarity with common emergencies and how to manage them (emergency preparedness)
-communicating health risk accurately to leadership (risk communication)
-determining what issues posed a risk to deployability and how to overcome them
-maximizing getting Marines back to work quickly with narrowly tailored duty restrictions as necessary, while not exacerbating their condition or prolonging healing
-basic mental health
-talking to the Marines in ways they could understand and act on
-developing the medical skills of my corpsmen (medical education/training) and employ them effectively to meet the health needs of the unit
-being able to thoughtfully plan for medical contingencies in austere environments with limited resources (wilderness medicine)
-engendering the trust and confidence of the line officers and senior enlisted in the unit
-fundamentals of preventive medicine/basic public health
-understanding common risk factors, work tasks, injury patterns, occupational hazards/exposures of those in my unit (a basic tenet of occ med)
-working with specialists to help maximize potential for Marines to return to work quickly (case management)
-knowing how and when to utilize the myriad medical resources available to me
I was at least decently good at all of these things, and very good at a number of them. I do think my Navy internship was reasonable preparation for my job as a GMO. I thrived in that environment enough that I extended my tour to do a second deployment. I saw specialists with much higher levels of training than me, working in the operational environment, that lacked the ability to do some of these things. This caused predictably significant problems for their units. Understanding the military, the way it works, and what your mission is as unit medical officer is absolutely critical and cannot be overstated. Many do not get that, and struggle in operational medicine even though they may be quite competent working in a hospital.
As a GMO I did not need to know much of anything about:
-OBGYN
-pediatrics
-advanced procedures
-care of chronic medical conditions
-complex medical conditions that typically require subspecialty care
-hospital medicine
-navigating the EHR
-dealing with hospital bureaucracy
In summary, I think that my skill set and level of medical knowledge and experience was appropriate for what I did as a GMO. I think that GMO experience is quite beneficial for most of the GMOs that do it (anecdotally, it seems that most prior GMOs I have worked with agree on that), that GMOs are a reasonably good fit for meeting the needs of many military units, and that they are not an inherently flawed concept for the Navy. There are legitimate reasons why the GMO system has worked as it has for many decades.
That said, everyone gets that there are tradeoffs as well as external pressures that give us good reasons to reconsider the model. I think the problem is that the alternatives also have their own drawbacks and tradeoffs, which haven't been discussed as much here on these boards but nonetheless are important to consider. As the Navy has and does.
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Finally - someone using their past service benefits and not simply signing up for more! Intelligent solution to medical school debt. Well done!
Kay_Em_Jay
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From what I gather, this solution only applies to people who have some disability from their prior service, creating a barrier of entry to the career path that their military service trained them for. I have no disability rating from my time in service, and I've already been working as a nuclear engineer, making this not applicable to me or others in a similar situation. I understand that many other paths do not require military service, such as NHSC, grants, scholarships, loans, GI Bill, PSLF, or other state-specific VA support. I have thoroughly researched my options. The point of my post is to gather as much information as possible on one of the options I have in front of me that fits my circumstances.
Also, being condescending and assuming that anyone considering this path isn't intelligent enough to fathom other options to pay for medical school is very off-putting and does nothing to help your "mission" of steering premeds away from using the military to pay for medical school.
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I will add that disability and VRE CAN BE applicable to you and others in similar situations. I didn't apply for disability after I got out because I ignored my seemingly minor ailments at the time and didn't think I needed it. With the rigors of med school and residency these minor ailments started to get worse and after much persuasion by my military friends finally applied to the VA for disability more than 10 years after I separated. After a long process I was able to get disability, though, which has been a huge help to my financial situation (residency pay barely covers expenses with a family particularly in the early years). If you don't have documentation from your time in service it is more difficult to get approval, but it is possible (I was often my own medic so nothing ever got documented). It was too late for me to get VRE but if you can get your disability rating at least during med school you should still apply for VRE. I'd recommend contacting DAV for help with your application if you do decide to apply.
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Do GMOs in the navy see only active duty, or do they see dependents as well? I'm curious, and somewhat playing devil's advocate, as I only saw active duty as a psychiatrist in the Air Force and much of my work was military admin bs that didn't have much or anything to do with actually caring for a psychiatric patient. I'm only asking because, if GMO's only see active duty folks, my assumption is that even only after 1 yr of post grad training I wouldn't think they'd be that underqualified to care for a preselected healthy population of people that are required to maintain some amount of physical fitness and health standards to keep their job. Board certified fully trained primary care docs on the civ side would kill to have that level of standard for their patients lol.
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In general, active duty only. At least, that's how it's supposed to be. (In reality, circumstances might arise in which a GMO might see a dependent but it's not the normal course of business.)
The two main reasons GMOs haven't been tasked with seeing dependents -
One, dependents are generally higher risk patients than active duty. Even medical corps leadership didn't want to turn interns loose on servicemembers' kids, middle-aged to elderly parents, and/or spouses, none of whom have been screened like AD personnel and all of whom are much more likely to have medical issues that shouldn't be trusted to interns.
Two, Feres Doctrine used to protect AD physicians vs malpractice claims originating from active duty personnel, but it never covered dependents.
This actually raises another issue - now that the courts have ruled that Feres Doctrine doesn't apply to AD servicemembers receiving care in peacetime at CONUS facilities, there's even MORE risk offloaded to GMOs.
The main problems with the old "but active duty servicemembers are healthy!" refrain are that
One, they really aren't. A good chunk of every unit are simply failing the PFA outright every time. Tobacco and alcohol abuse are endemic. Active duty ranks include young guys who had stuff missed at their entrance, and 40- to 50-something guys whose coronaries have been subjected to chainsmoking between dips and drinks.
Two, everyone's healthy until they aren't.
I saw two ~50 year olds (one senior enlisted and one officer) present in theater with acute coronary syndromes. A 22 year old (or maybe he was 19? it's been 20+ years since that day) came into my BAS with ALL. Another guy (22 yo also?) seen by my co-GMO didn't have the usual NSAID gastritis but rather an esophageal adenocarcinoma. There's pathology out there.
Not to mention ... this "healthy" patient population has a HUGE incidence of significant psychiatric morbidity, mostly in the cluster B personality disorder realm, and interns are just not qualified to handle that kind of mental health care. They're just not.
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I can respect that opinion, mainly because I once shared it. 🙂
All I can say is this - take a step back. Look at the big picture here.
Here's a decent/concise summary of current state requirements for initial licensure:
By my quick count, 20 require at least two years of GME for US graduates. Some say 3 years. Some simply say "completion of residency".
For IMGs, many more require 2 or 3 years of GME, presumably because there's less confidence in the knowledge and skills of IMGs right out of the gate.
Incidentally, I would argue that the line of thought applied to IMGs ought to apply to graduates of many US DO schools. I'm not being anti-DO here, but the truth is that many of the newer ones don't have affiliated teaching hospitals, and their students get rather poor clinical experiences prior to internship. They also tend to be very expensive and heavily over-represented in HPSP class. (I haven't seen recent stats but I'd bet money that for every ivy league HPSP'er there are 20 from a DO school that doesn't have its own affiliated teaching hospital.)
Anyone who's been faculty at a residency program, military or otherwise, is painfully familiar with how unprepared many, many med school grads are these days compared to 20 years ago.
Beyond the licensing issue, this century has another hurdle to the concept of an intern-grad setting up an independent practice somewhere: insurance reimbursement. Good luck hanging up a shingle and getting paid if you're not a BC/BE physician these days.
It is 100% not even remotely the norm for an internship grad to be practicing independently anywhere in the United States, except for the military.
When it comes to GMOs practicing independently, instead of looking for reasons why this archaic practice can be excused, maybe ask yourself why it's still a thing? And why we tolerate giving a level of care to active duty servicemembers that the entirety of the non-military medical community finds unacceptable?
I'm just saying that's an awful lot of words and an awful lot of effort to justify doing things that aren't acceptable (and wouldn't be reimbursed by insurance) anywhere else.
The drawbacks are cost, and having to tell line colonels that they don't really need a concierge intern at their beck and call 24/7 while in garrison.
The latter would require medical corps leadership that both admits there's a problem and cares about the problem, and we don't have that. The fact that we're even having this conversation indicates that plenty of people below flag rank also don't recognize that there's a problem. 🙂
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Had a 51 year old colleague - physician- drop dead of a heart attack one day. Active duty. Seemed in great shape. Wife went to pick up their kid from practice and he was cold on the floor when they got home.
Also, from my end of the world, head and neck cancers present in younger and younger nonsmokers as time goes on. The sweet spot age-wise right now would be some senior enlisted persons. HPV vaccine would probably have helped that if we hadn’t decided as a country that vaccines are fake news.
But to your point, just being young and relatively active doesn’t make you healthy. It’s not the Olympic village.
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manojoblanco!
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Anyone can speak on this?
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My opinion that HPSP is not worth it or a good choice for anyone is my opinion, and you don't have to like it. I wasn't being condescending. The person using VR&E is really smart. I'm impressed, and it's a great utilization of a military benefit.
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Can I ask a simple question and limit responses to maybe two or three sentences…?
Assuming we consolidate a bit so the operational medical assets are only what they need to be, who is going to cover the medical care for these warfighters when training or deployed? You don’t want interns doing it, you don’t want board certified doing it. So it will be another IDC or a midlevel so how is that going to be any better medical care?? Sure it “protects” these physicians from having to do the job but the care rendered will suffer.
Thanks!
Assuming we consolidate a bit so the operational medical assets are only what they need to be, who is going to cover the medical care for these warfighters when training or deployed? You don’t want interns doing it, you don’t want board certified doing it. So it will be another IDC or a midlevel so how is that going to be any better medical care?? Sure it “protects” these physicians from having to do the job but the care rendered will suffer.
Thanks!
Smooglabish
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It primarily needs to be mid levels rendering care with board certified physician support at and above the regimental level with clear parameters for communicating with the (more senior) physician. For large training exercises a board certified physician should go but PA/NP types should be be most of the team. The physician's clinical schedule should be populated with more complicated patients or those where higher level decision making is needed. The strategy of elevating mid levels to senior clinical leadership positions doesn't solve this problem, as they are missing the training (KSAs) to navigate situations where the midlevels are in too deep. The challenge will be identifying the cases where early physician involvement is necessary, but our systems and training can overcome this.
To me, this is what makes the most sense if you could start the system over from the beginning. Basic operational billets should be covered by PAs/NP’s. This is all GMO/Flight/Dive billets. Then have a board certified doc oversee them on the next echelon up the chain. We are using interns as GMO’s functioning as PA’s/NP’s already. Sure, I’d argue that an intern has a little more training than a PA, but we can augment those gaps to get our military PA’s trained up to be able to provide good first level care at the squadron level.
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I agree but some of our colleagues will not and that’s OK.
The Navy operational side is currently fat on MD/DO and they don’t know what to do with them. We need to restart from ground up. Properly trained and sufficient number of IDC’s and mid levels to fill front line operational care. Smart, efficient structure of DO/MD oversight to coordinate increasing level of care when needed. Whether that is from the squadron clinic to MTF or from the theater to medevac to next echelon. It should work the same.
All it takes is operational medicine being honest about their assets and getting them back to the larger clinics or MTF. Physicians need to be maintained further back in echelon to maintain skills while still having a reach/oversight to frontline to ensure quality care is being delivered.
The Navy operational side is currently fat on MD/DO and they don’t know what to do with them. We need to restart from ground up. Properly trained and sufficient number of IDC’s and mid levels to fill front line operational care. Smart, efficient structure of DO/MD oversight to coordinate increasing level of care when needed. Whether that is from the squadron clinic to MTF or from the theater to medevac to next echelon. It should work the same.
All it takes is operational medicine being honest about their assets and getting them back to the larger clinics or MTF. Physicians need to be maintained further back in echelon to maintain skills while still having a reach/oversight to frontline to ensure quality care is being delivered.
Smooglabish
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I understand that some may not like these changes, but they are frankly the right thing to do. If you talk such an organizational restructure through with leaders in our organization, they don't disagree with the thinking... there's just a ton of organizational momentum to overcome.
If there's some way I can get involved in influencing these types of changes, I would be ecstatic to.
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I mentioned this upthread, but the solution is
1) in garrison, operational units get their medical care at MTFs staffed by BC/BE physicians (+/- appropriately supervised midlevels)
2) when deployed (or in the field for training ops like CAX), BC/BE physicians get assigned to accompany them for 90-180 day periods
The physicians in (2) could be anyone. Probably the best fit would be a primary care specialty, but even other specialists wouldn't be terribly harmed by a few months away from their specialty. Before you dismiss this a as a crazy thought, it was the standard model for the Air Force during much of the Iraq/Afghanistan conflicts. While the Army was abusing reservists with 12-18 month deployments with a 2 week R&R break in the middle, the Air Force was rotating people in and out of theater on 90-180 day trips. It was Just Fine.
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#1 - You can’t run a productive primary care product line at the MTF when you have operational units coming and going. Your MTF BC/BE staff are allocated based on empanelment for primary care. For MTF specialty care it is based off of average referrals. MTF primary care cannot constantly flex up and down for operational patients unless the operational BC/BE physician becomes part of the MTF access to care equation when in garrison. This mandate for operational MD/DO to the MTF doesn’t exist and it hurts MTF access to care and operational physician skill sustainment.
Whether deployed or in garrison the front line basic medical care for OPFORCES has to be their assigned operational assets (IDC/PA with MD/DO backup). If and when care exceeds this system then referral to specialty care at MTF is made and priority for AD referrals should exist.
#2 when deployed the minimum number of required operational BC/BE physicians would already be established and will go with their assigned operational unit. When not deployed or in training environment they would supplement MTF primary care staff to maintain skills and ensure access to care for empaneled patient plus operational assets in garrison.
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That is a convoluted and bizarre way to say that the current model doesn't support changing the model to be a better model.
Well of course the MTFs aren't staffed to care for the operational units' primary care needs. They've never had to! That task has been handled by GMOs. This is precisely the problem! Change the system so that doctors who've completed training are caring for the operational units, preferably from a real clinic or hospital.
Welll ... yeah? That's why I said the BC/BE physician should be at the MTF! 🙂
Right now the Navy has many BC/BE physicians billeted with operational units/platforms which then (sometimes) lend the physicians back to the MTFs while in garrison. This is completely backwards. The physicians should all* be at the MTFs and the troops can get care at the MTFs while in garrison. When the units deploy, the physicians should then deploy as IAs for relatively brief 90 day (180 at most) periods to minimize skill rot due to the usual inactivity while deployed.
* there's a role for a few to be directly attached to operational units, primarily for administrative/planning purposes (these should be BC/BE also)
The MD/DO backup should be BC/BE personnel primarily based at MTFs or clinics. IDCs or PAs attached to units can still be midlevels doing midlevel things, except with appropriate BC/BE supervision ... the way God and the licensing boards intended them to be supervised.
I don't know why you're telling me the way the system is as a response to me telling you the way the system should be.
Again, this is backwards. BC/BE physicians should be owned by the MTFs and lent to the operational units when they deploy.
And of course, GMOs shouldn't exist at all. 🙂
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It's not like this is a crazy/untested concept.
It's the standard for surgical care, right? Surgeons, anesthesiologists, intensivists, OR techs, OR/critcare nurses ... all work at MTFs full time. If servicemembers need surgery while in garrison, they go to the MTF and get care. Sometimes a unit deploys and needs surgical care available overseas, so these people pack their bags and go forward to run a FRSS on a ship or in a tent to support an operational unit.
I'm saying this should be the standard for primary care also, as a way to eliminate GMOs. BC/BE physicians (mostly primary care) all work at MTFs full time. If servicemembers need to be seen for a URI or knee pain or his personality disorder while in garrison, they go to the MTF and get care. Sometimes a unit deploys and needs primary care available overseas, so these people could pack their bags and go forward to run a clinic on a ship or in a tent to support an operational unit.
Notably absent: unsupervised interns (aka GMOs)!
It's the standard for surgical care, right? Surgeons, anesthesiologists, intensivists, OR techs, OR/critcare nurses ... all work at MTFs full time. If servicemembers need surgery while in garrison, they go to the MTF and get care. Sometimes a unit deploys and needs surgical care available overseas, so these people pack their bags and go forward to run a FRSS on a ship or in a tent to support an operational unit.
I'm saying this should be the standard for primary care also, as a way to eliminate GMOs. BC/BE physicians (mostly primary care) all work at MTFs full time. If servicemembers need to be seen for a URI or knee pain or his personality disorder while in garrison, they go to the MTF and get care. Sometimes a unit deploys and needs primary care available overseas, so these people could pack their bags and go forward to run a clinic on a ship or in a tent to support an operational unit.
Notably absent: unsupervised interns (aka GMOs)!
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They don't
Enlighten me
(With something more than "the line gets what the line wants and the line wants what the line thinks it needs" please. Obviously milmed exists to support the warfighter and the tail shouldn't be wagging the dog.)
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Right now OPFORCES have too many GMO’s and they are poorly utilized giving commanders the impression they don’t have support and physicians the impression their skills are being wasted.
Minimize number of OPFORCES physicians, expand IDC and mid-level control of basic healthy active duty military care.
When in garrison, commit a specific number of FTE from OPFORCES medical assets to the MTF to manage the influx of OPFORCES warfighters.
MTF FTEs remain constant and rely heavily on permanent civilian staff so that volume/complexity remains constant regardless of uptempo. Open MTF gates to civilian care just like BAMC and don’t bend the knee to local state politicians who don’t allow it because of negative impact on income of private hospitals. Oh yeah, and VA and DOD will be combined into one federal healthcare system.
Minimize number of OPFORCES physicians, expand IDC and mid-level control of basic healthy active duty military care.
When in garrison, commit a specific number of FTE from OPFORCES medical assets to the MTF to manage the influx of OPFORCES warfighters.
MTF FTEs remain constant and rely heavily on permanent civilian staff so that volume/complexity remains constant regardless of uptempo. Open MTF gates to civilian care just like BAMC and don’t bend the knee to local state politicians who don’t allow it because of negative impact on income of private hospitals. Oh yeah, and VA and DOD will be combined into one federal healthcare system.
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You cannot and never should have to shut down services every time a training mission or deployment happens. That is not how hospitals should function and is exactly what happens when we lend out FTEs to random operational requirements. It worked previously when money rained on DOD no matter what. It won’t fly moving forward and shouldn’t if we want to maintain high volume/complexity care at MTFs. Our patients stateside deserve better than to be at the will of operational training exercises
Smooglabish
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Is there truly any realistic path toward combining the VA and DOD MTF systems?
It always shocks me how many services are not available at the MTF, so we have to transfer folks a short distance literally down the road to a VA hospital, which uses a completely different medical record and has a completely different set of resources. The fact that VA clinicians can't just drive to the MTF and practice their specialty to render these services is frankly bizarre.
It always shocks me how many services are not available at the MTF, so we have to transfer folks a short distance literally down the road to a VA hospital, which uses a completely different medical record and has a completely different set of resources. The fact that VA clinicians can't just drive to the MTF and practice their specialty to render these services is frankly bizarre.
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Before DOGE, no. Now, maybe, because we seem to be making big drastic changes very quickly. Someone just needs to catch the right ear at the top to tell how much more sense it makes to combine them.
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On the subject of combining the VA and DoD medical systems: when I talk to my civilian colleagues they already assume that must be the case. In fact they often don’t intuitively understand that the different services have so many duplicated lines of effort.
I think the medical corps could be made into a separate medical service combined with the va and Public Health Service. But then in that scenario I’d be interested in seeing the system take care of more people than it currently does and greatly rework the way that physicians and promoted and retained. I still think it’s crazy that the navy could employ a person they pay to train into a subspecialized physician for 24 years and only get maybe something like 5 years of that as the final product. (And that’s not even keeping in mind that you spend the first few years after training continuing to consolidate your practice)
I think the medical corps could be made into a separate medical service combined with the va and Public Health Service. But then in that scenario I’d be interested in seeing the system take care of more people than it currently does and greatly rework the way that physicians and promoted and retained. I still think it’s crazy that the navy could employ a person they pay to train into a subspecialized physician for 24 years and only get maybe something like 5 years of that as the final product. (And that’s not even keeping in mind that you spend the first few years after training continuing to consolidate your practice)
Kay_Em_Jay
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Kay_Em_Jay
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So, I don't have a very clear understanding of the military's structure when it comes to physicians. You say here that OPFORCES has too many GMOs. I'm assuming OPFORCES is a DoD entity and not specific to any one branch when I read this, but I could be way off. I'll try to boil this down to a question.
- What different entities could I work under as a physician, and how does that impact day-to-day activities?
Kay_Em_Jay
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Why would combining the DoD MTF and VA systems make more sense?
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Board certified/Board eligible
Means someone that has finished their residency and has either passed or is eligible to take the exam in their chosen specialty
