Questions for current/prior military physicians

[armytrainingsir]

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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?

You either work in the hospital/clinic or ‘in the field’

In the field means you are with an operational unit. Artillery battalion, tank battalion, etc. In that job, you are an urgent care doc for your soldiers as well as the SME for all things medical for he commander.
You can do that as a GMO, primary care position, or if you get the short end of the straw, a specialist of any sort.

The other “field duty” would be being attached to a field hospital, forward surgical team, etc., etc. where you’re doing your specialty in a field hospital versus a fixed hospital

if you’re in the hospital/clinic setting, your day is theoretically almost indistinguishable from being a civilian. But there is always a double dose of military BS, such as PT test, drug screen, etc., etc.

 

[Kay_Em_Jay]

You either work in the hospital/clinic or ‘in the field’

In the field means you are with an operational unit. Artillery battalion, tank battalion, etc. In that job, you are an urgent care doc for your soldiers as well as the SME for all things medical for he commander.
You can do that as a GMO, primary care position, or if you get the short end of the straw, a specialist of any sort.

The other “field duty” would be being attached to a field hospital, forward surgical team, etc., etc. where you’re doing your specialty in a field hospital versus a fixed hospital

if you’re in the hospital/clinic setting, your day is theoretically almost indistinguishable from being a civilian. But there is always a double dose of military BS, such as PT test, drug screen, etc., etc.

Got it. Thank you for the clarification. I think I got thrown off by the specific name "OPFORCES," giving me the impression that there was more under the hood than I knew.

You say specialists would be on the raw end of the stick getting field duty. Is that common? It was indicated earlier that there are too many GMOs, so why would this be the case?

 

[armytrainingsir]

Why would it be the case?
Just because.
😂😂😂

It’s usually a case of wrong place at the wrong time and someone gets tasked.

My active duty time was a long time ago, and it was pretty rare for specialist to get dinged. In the reserves, never really happened to the best of my knowledge. Active duty now, it seems to be a bit more common, in the army at least. Navy? who knows.

 

[pgg]

Sorry, dumb, new-person question. But what is a BC/BE physician?

Board certified or board eligible. It essentially means a physician who has completed a residency.

Depending on specialty, after graduating from residency it may be a couple years or more before a physician can complete the board certification process. This period is called board eligibility, and BE physicians can generally be credentialed and collect payment from insurance for their work during this time.

Eventually, if the physician repeatedly fails or does not complete the examination process, their period of BE expires and some kind of additional/remedial supervised training is needed to become eligible again. This may or may not have consequences re: credentialing at some facilities or the ability to collect payment from some insurers. Within the military system it's less of an issue.

You say specialists would be on the raw end of the stick getting field duty. Is that common? It was indicated earlier that there are too many GMOs, so why would this be the case?

It's a bad deal because subspecialist physicians who get assigned to GMO billets most certainly aren't practicing in their specialty. They are rotting away.

Imagine being a surgeon stuck seeing Marines with URIs and knee pain in sick call, never operating. Or an radiologist doing the same, never reading CT scans and other films. Or a cardiac anesthesiologist - you get the idea.

 

[militaryPHYS]

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?

Before DHA, all medical assets were owned by BUMED (the Navy). There used to be a lot more "MTF billets" for people to fill. If you were in an MTF billet, you weren't typically deploying, doing trainups, etc. You had one daddy/mommy (the MTF which was also Navy). When DHA came along there was a long rollout of this two mommy/daddy system. DHA supports the Navy but they also have to run a hospital. DHA and Navy exist at each hospital. Lots of civilians exist at the MTF and in the future DHA will continue to hire more and more. That is because the Navy has platformed everyone now. Almost every person is assigned to an operational platform and so you often have to train/deploy with the platform. Before you were either at the MTF, or not. Now you can be a little of both depending on the platform you are assigned to. The Navy keeps building/expanding these platforms while pulling more and more of their medical billets out of the MTF. When that happens, if there aren't any patients to keep you busy, your skills rot. Some can and do go work at the local MTF but there are no mandates for this.

Anyway, so now certain platforms still support (fill) the necessary positions at the MTF. If you are in one of these platforms your job is to see and care for patients empaneled to that MTF. If you aren't in one of these MTF-supporting platforms you are grouped in to OPFORCES. Operational Forces medical assets that doesn't have any stake in MTF productivity, business rules, etc. These are where GMO's existed, Flight Surgeons, Underseas Medical Officers and now Operational Medical Officers (BC/BE physicians at the operational units). The Navy line community wants to control their medical assets but they don't realize their people are losing their medical skills if they aren't beholden to also support the MTF which gets them more volume and complex patients when not training/deployed.

Phewf...that was long. Also might not make any sense. The Army and Air Force do it a bit differently because they don't have ships that have to sail around all alone all of the time. They just have groups/squadrons that pickup, travel and then get plopped in a conflict. I am over simplifying this.

So, to answer your question. You can be assigned to a platform that primarily keeps the MTF running. Or you could be assigned to a more operational-focused platform that spends little or no time at the MTF.

Why would combining the DoD MTF and VA systems make more sense?

The VA has sick patients but not enough providers, OR time, etc. The DOD MTF has not enough sick patients and is more likely to have enough specialty providers to care for more patients. It would be a symbiotic relationship. Sharing of resources. Better access and care for all of the patients.

 

[comp1]

I've been involved in VA/DoD joint ventures and they can be really great, but wow are they hard to manage. Indeed, the VA has a surplus of patients and a paucity of providers. Care provided directly by feds is almost always more cost effective in any study I have ever seen and usually more clinically effective as well. The issue with getting involved with the DoD that I always run into is two fold, one the leadership at a given base changes literally every two years. There's no stability and new leadership can have dramatically different priorities. Two, deployments. It's very hard to ramp up patient care massively and then to within like a week's notice, draw down all of those services.