militarymd said:
He has said this much more eloquently than I, but that is how I feel....it needs to crash and burn to a crisp, so that it can be remade.
As a military flight surgeon departing the pattern at my End-of-Obligation due to the exigencies of multiple life circumstances, I have something to offer here. The military certainly deserves good docs, and it has many. Those that like their jobs do it with heart. They love the patient population. They thrive on the sense of purpose. Many times, I have even felt this way. Let's face it. For some, military medicine is more than enjoying the highest prestige, having the coolest technology, or making the most money. These would do it even if the pay decreased and the workload increased and the support staff didn't support. Many simply feel called, and that's fine. The military needs people like that.
But the military has obvious and major flaws. CHCS II/ALHTA is a joke, so far, with no light at the end of the tunnel (oh, but all the censored service newsletters rave about it!). Never mind that it makes you spend half your day in front of a computer screen, not seeing patients. Also, the pay structure and retirement structure is not competitive (except perhaps for FP, peds, and residents). There is no ability to hire and fire help; the bureaucracy is ridiculous. Opportunities to change the system, as stated elsewhere in this string, are near absent (you have to change it from outside the system, with political pressure, where you can really get to the top brass). The experience and training is dismal; I went my entire Navy internship without intubating or running a code, not by choice! I haven't done a central line since med school, where I did PA caths, IJs, and sutured closed the scalp of a child surgically treated for scaphocephaly -- working mms from his dura! My step 3 took a dive compared to my steps 1 and 2!
Perhaps the part I dislike the most is you can find yourself in a position where you don't feel very useful but you can't leave, not even to interview for residency, not even to see your twins born during deployment, not even when you have colleagues -- other military doctors -- offering to fill in for you, all because it wouldn't be "fair" to the junior enlisted folks, not because the line command actually needs you. You become a politico-leadership "pawn." "Doctor" says less about your position than does "Junior Officer." Call me a non-patriot for wanting to get out. I have a family to take care of, and my military leaders got in the way of that. Who wouldn't leave from my position? Now I look forward to the freedom to interview when I need to, to take jobs wherever necessary to pay the bills, and to get the training I want in the location I want, and to see and hold my new beautiful family. And after it all, I hope to run into patients who serve or served in the service, because they really are a unique and wonderful bunch. I'll never forget that. I'd love to go to Iraq to support them, but it would mean another year or two of putting off residency due to lost interview opportunities. That, and a really unhappy CINC House.
So, here's how the military will get good docs: The military will outsource all of its medical training, except for some uniquely military training such as C4 and other select courses (MTM, SERE, etc, which I have to say have been quite well done). It will outsource medical care that does not need to be done by military deploying doctors (peds, tele-rads, most OB, many nonsurgical subspecialists). It will look for the doctors who are experienced in big trauma, ortho, I.D., etc., to recruit with civilian or short-term active duty contracts. The military will get out of the business of residency training, except for select rotations. It will choose fully-trained and board certified doctors (or else PAs and NPs) to do its deployment medicine. The medical record system will be made web-based, accessible anywhere, with dictation support and a single central digital scan location somewhere in BFE, North Dakota, for all specialty care reports to be uploaded into that electronic system (fewer lost reports). The career active duty military doctor pool would be shrunk down to a selective group of future leaders of a joint medical command, transcending the traditions and boundaries of the 4 services (and that part is actually talked about, thankfully, although reality is a long ways off). And leaders would be sought and cultivated and selected, not just chosen because they're the only ones that stuck around after the self-respecting doctors moved on. That's my vision. Maybe someone else can make it happen.
