Regulars of this forum, please read.

[slants]

---

Members don't see this ad.

Here, I would like to post the direct emails I have gotten from military doctors. I am a senior undergrad, just got accepted to medical school and have accepted the HPSP, but have not sworn in. After reading this forum day-in and day-out, and after accepting but then getting a tour of BAMC, I am really starting to get cold feet - more like a gut feeling like this probably isn't the best path for me. My recruiter was pissed to hear that and told me I have taken a spot up that someone else could have had. He said he would put me in touch with a Col. doc of the USAF that just signed his son up for the HPSP AF. Obviously he will have nothing but positives to say, and I just want to put up this info so you guys can have a fair crack at it. Because I have been sending tons of your guys' comments to them, and they have told me many things, like disgruntled employees, can't believe them because they are anonymous, ect. I am one of those HPSPs you guys always talk about saving from a rash decision and I really need your help. I need advice.

 

[slants]

This is from a Family practice doc AD.

I am happy to give you my perspective on military medicine. I will try
to answer all of your questions and you can call me if the information
brings up any more questions. I will be gone from XXXX to XXXX so
you will not be able to contact me during that time.

To give you a little background information, I was not an HPSP recipient,
but rather an FAP (Financial Assistance Program) recruit. I did my 3.5 year payback and
separated from the Air Force to go into private practice. After 2 years
I came back into the Air Force for various reasons which I won't go
into, but suffice it to say I have been on both sides of the fence.
HPSP students tend to be happier with their choice to join the military.
The FAP program is for residents and offers a stipend during residency
which basically amounts to around $35K per year for a 1:1 +1 payback
(i.e. 4 year payback for 3 year assistance). I am not as familiar with
the HPSP program and payback rules but I believe it is 1:1 for medical
school and residency. The nice thing about the program is the fact that
you don't have medical school debt (I'm still paying mine). There may
be other incentives currently because of the shortage of providers in
the AF.

Some things your recruiter may not tell you or may not be clear:

1. Once you sign the papers, you are at the mercy of the Air Force. You
do not get to choose where you are stationed. You can request
assignments, but the needs of the Air Force take precedence.
Also...this is important and has angered more than one HPSP
student...the Air Force can, and often does, pull residents from their
residency after their intern year and puts them to work as a GMO
(General Medical Officer...same as a General Practitioner) in a Flight
Medicine Billet for 3-4 years. It is a nice assignment, but high rate
of deployment and less pay (loss of Incentive Special Pay [ISP] and
Board Certified Pay).

2. HPSP and FAP recipients are not eligible for Multiyear Special Pay
(MISP) until their active duty service obligation is completed. This is
a big bonus...$33K annually for Family Practice, varies by specialty.

I will give you a couple of examples of how your pay might break down
depending on your status:

1. New HPSP Family Medicine graduate:

- Captain Basic Pay $3,292/month
- Incentive Special Pay (ISP) $13,000/year
- Board Certified Pay $208/month
- Additional Special Pay (ASP) $15,000/year
- Variable Special Pay (VSP) $416/month
- Basic Allowance Quarters (BAQ) $789/month(w/o
dependents)
- Basic Allowance Subsistence (BAS) $193/month
______________
$7,231/month or
$86,776/yr

BAH may vary depending on if you have dependents, where you live, etc,
but that is pretty close. You may live in base housing and you will get
no BAH, but you will have no house payment or utilities to pay.
Depending on how you look at that, it may not seem like a lot, but
consider that fact that you have no medical school debt. An FAP
recipient gets the same, but unless they used their stipend in residency
to pay back their medical school debt, they have that disadvantage.

2. New HPSP GMO in Flight Medicine

- Captain Basic Pay $3,292/month
- Additional Special Pay (ASP) $15,000/year
- Variable Special Pay(VSP) $416/month
- Aviation Career Incentive Pay $125/month
- Basic Allowance Quarters (BAQ) $789/month (w/o
dependents)
- Basic Allowance Subsistence (BAS) $193/month
______________
$6,065/month or
$72,780/yr

Sounds a little less enticing, but you can start making more money
earlier (by two years) and there are opportunities to apply for military
residency programs following your first flight medicine assignment.

3. 9 year Family Medicine Doc with no active duty service obligation
(me)

- Major Basic Pay (over 8 yrs) $5,245/month
- Additional Special Pay (ASP) $15,000/year
- Variable Special Pay (VSP) $958/month
- Incentive Special Pay (ISP) $13,000/year
- Multiyear Special Pay (MISP) $33,000/year (for 4 yr
obligation)
- Basic Allowance Quarters (BAQ) $1131/month (with
dependents)
- Basic Allowance Subsistence (BAS) $193/month

_________________
$12,610/month or
$151,324/yr

Now we're talking! This is competitive just about anywhere and much
more than average for Family Physicians. These dollars are
all before taxes with BAS and BAQ being non-taxable income. There is
definitely incentive to staying in the military longer term. If you are
doing it for the easy money now, it may or may not be worth it to you.
Physicians are always in demand and you will be able to pay back any
loans you get eventually. Other things to consider that may affect your
decision are:

Advantages to military life:
- Travel; you get to see many places. If you don't like your job, it
will change in 3-4 years.
- Non-contributory retirement; 50% of your base pay at 20 years.
- Free medical care for you and your dependents while on active duty.
Tricare prime for retirees for a reasonable premium. Despite people
complaining, Tricare is one of the best covering insurances in the U.S.
- The uniform. People respect it. Surveys of the most respectable jobs
put physicians and military in the top 5...you get to be both.
- Hours are generally pretty good compared to civilian practice. Most
facilities are clinics now with no inpatient care...therefore no call,
no admissions, etc.
- Camaraderie...you will have something in common with everybody you
work with. You will make friends for life in the military.
- Free CME. Many opportunities for CME and additional training, all at
the Air Forces expense (travel, lodging, registration fees, food, etc.)

Disadvantages to military life:
- Travel; Some people don't like to move. It can be difficult for
families (i.e. kids changing schools every 3-4 years). The standard
time on station now before PCS is 4 years, up from 3 years. Deployments
can take you away from your family for up to a year (4-6 months is more
common).
- Loss of autonomy. You may (and will) be supervised by nurses,
administrators, or other non-physician officers. You must answer to
them and you cannot quit your job. There are many rules and regulations
(you will be frustrated more than once) in the military and some people
have a hard time adjusting to the structure.
- We are at war. The U.S. has been involved in some war or conflict for
most of the last 40 years. The current war shows no signs of ending
soon. There is always a risk that you will be deployed to an austere
environment and will be put in harm's way. This is our primary
mission...the reason we exist. If you are going in the military for any
other reason than to serve your country, reconsider.
- You must pay your dues. You will likely begin as a PCM (primary care
manager) in a clinic which is what you are training to be, but this can
be one of the most frustrating jobs in the military. You will be busy
and your schedule is not controlled by you. There is a lot to learn
during this time and this is when most docs begin to regret their choice
to join the Air Force and start counting the days until they get out. I
always advise my new docs not to make their decision based on this. If
you stick it out, opportunities will abound.

I love my job. I am not a recruiter and have no intention of being one.
I have tried to give you useful information without being biased. The
Air Force is not for everyone. It is all in the attitude. Don't come
in expecting an easy 0730-1630 schedule. Some recruiters try to sell
that. Manning is down and the U.S. military is always doing "more with
less". Expect to work hard, whether you are in civilian practice or the
military. Any job can be rewarding...even the Air Force. I hope you
make the choice that is right for you and I hope this helps. Best of
luck in Medical School and your future endeavors.

 

[slants]

Same Doc answering these questions.

1. If I am unsure about this scholarship, do you think I should just
wait it out and sign up FAP down the road? (Advantage vs. Disadvantages
of this route)
2. Do you think that HPSP students have an extra difficult time getting
the residency/specialty of their choice?
3. What reasons did you come back to the Air Force?

1. I would say NO to waiting for the FAP in residency. I was FAP and I
know one other doc that was FAP and he is very disheartened by his AF
experience (he is getting out in January). Most HPSP students will get
to finish their residencies...I didn't mean to make it sound like the AF
pulls people out of residency so frequently...most get to finish. Also,
there is the issue of tuition assistance. Medical school is expensive
and if you're like me, you will have a hard time spending your FAP
bonuses/stipends on repaying medical school loans, leaving you with a
substantial debt. I am still paying for medical school 12 years later.
There are advantages and disadvantages to both programs, but I think
that overall HPSP is a better deal. I think they have recently changed
the payout on one or both of these programs (increased the stipend) so
check the numbers carefully with your recruiter.

2. I don't think HPSP makes any difference for residency application.
As an HPSP recipient, you can apply to any program that you would have
applied to otherwise. In fact, there are more opportunities because you
can also apply to military sponsored residencies. I don't know if you
have received the attached brochure on military residencies, but
according to this, the board pass rate is higher for military residency
graduates. Military programs are every bit as good (if not better) than
civilian programs.

3. My reasons were more personal than professional. I'll give you the
Reader's Digest version: I was FAP and completed my 3 1/2 year
commitment to the AF without ever giving a thought to staying in the
military. I was convinced that I would want to stay in Rapid City and
that I couldn't do that while in the AF. I got out and went into
practice locally with a multi-specialty group and was under a 2-year
contract. The group was struggling financially and at the end of 2
years, I was in no position to take a financial risk by becoming a
partner in this group. I also had a 50 mile "no-compete" clause in my
contract, so I could not practice in XXXXXXXX. I also found that I
was not making as much money as I thought I would. I looked into the AF
as an option, thinking that I could stay in XXXXXXXX without worrying
about the no-compete issue. As it turns out, the AF needs come above
mine and I was sent to XXXXXXXXXXX to work at XXXXXXXX(an
assignment my family and I loved). Also, it turned out that the bonuses
for AF docs are much better when you don't carry a service obligation.
Now I am quite happy with my pay and my work schedule.

 

[slants]

Recruiter answering the same questions.

1. If I am unsure about this scholarship, do you think I should just wait it out and sign up FAP down the road? (Advantage vs. Disadvantages of this route)

The FAP was one of our main sources of recruiting physicians back in the Major’s day, however that is a limited program that is harder to come by and will probably get worse in the future. I have pasted this years openings for you to review. As you can see most specialties only have a handful of openings. These are opening Nationwide. Also notice some of the longer specialties are not sponsored for the whole residency, ie surgery is only sponsored for 2 or 3 years, NOT the full 5.

Then there is the simple money aspect of why the HPSP is better. At least $250K for school plus stipend, then if you match to AF residency you’ll make about $55k-$60k much higher than any civilian residency and only 1 for 1 payback. The FAP is a plus one payback. So a 4 year residency (if you’re lucky enough to get one) is a 5 year payback.

2. Do you think that HPSP students have an extra difficult time getting the residency/specialty of their choice?
NO, you have more chances than a civilian student. You apply to AF res and find out in Dec, if you don’t match you still have the civilian match, if you don’t match there you will get an internship year and re-apply with the AF again but this time you get points (seniority) over the other HPSP applicants.

3. What reasons did you come back to the Air Force?

FAMILY, not my personal family, but the AF family. I have never experienced nor heard of a company in the world that takes better care of it’s people. I have people I met through the AF that are family not friends. I know I could show up on their doorstep and they would have me in their house with open arms. I have numerous personal accounts of how the AF helped me or co-workers well beyond what is fair. Call me anytime and I’ll talk your ear off about how well the AF has treated me or we can discuss it when you come down for you physical and interview.

 

[slants]

Comment from doc about Avoid Military Medicine (original) first post (copy and paste)

Don't believe everything you read on the internet. These providers
actually may be giving some actual examples, although exaggerated. They
are also focusing on the negatives. The AFMS does have its problems and
some of the issues cited on these websites are things that need work.
However, it is not a conspiracy against the provider as this guy would
have you think. We are currently a wartime military with a relatively
high ops tempo and that makes recruitment and retention difficult,
resulting in lower manning. The military is not purposely understaffing
medical groups but we are spread thin. I am guessing that his
expectations were not met and now he is somewhat disgruntled. My goal
in the Air Force is not to fix all of the existing problems, but to do
my part to make the AFMS better. Unfortunately there are a lot of
providers who are biding their time, just waiting until their active
duty service obligation is up. They can blame bad care on not enough
time, or a broken system, but the responsibility of care to the patient
rests on the provider and I suspect they will find themselves just as
busy in civilian practice...they just won't be held to as high of
standards. I do think these providers are in the minority, although I
have run across them during my time in the AF. The majority of our
providers, while occasionally frustrated are committed to improving the
system. In the end, you need to make the decision whether or not to
join the military. It's good that you are looking at all the input of
others, but don't let anyone's opinion make your decision. Most of us
are not in the military for the money, or the fine military housing, or
because we like AHLTA (military electronic medical record), or because
it is a flawless system. Most docs who stay are patriots who are proud
to be part of the best military in the world.

 

[slants]

Replies from 3 different docs in response to the 40 reasons to avoid Military med.

1. Sorry for the delay in response. I wanted to run this by other docs in
the clinic to get their input on the article. I felt that it was a very
extreme view of a disgruntled doc. He has a view of life that is rather
unrealistic even in a civilian practice. Each of the docs that
responded echoed similar sentiments. You can read my program directors
comments below. I personally am very pleased with decision to take the
HPSP scholarship. I think you will have experiences that are
unforgettable. Serving the men and women who defend our nation is a
privilege. I hope you will feel the same. Best of luck in your future
endeavors. Please feel free to contact me with any other questions or
concerns. I will be in XXXXXXX until July. My next assignment is out and
I'll be in XXXXXXX for one year then XXXXXXX for the following 3yrs.
We're pretty excited about the upcoming adventures. Cheers.

2.Ditto what Dr [name] said below.
Someone tell this clown "humorsome" is not a word.

GO NAVY!!


3.Wow this got my blood pressure way up there!

First let me say that yes you will find people like this in every
service. In fact you will find people like this everywhere. To me and
with my read of this extremely long (and tiring) 'whine', this
individual will not be happy anywhere unless perhaps he is free from all
responsibilities and gets paid handsomely for his 'privileged rights' as
a doctor. In other words, he wants it all for nothing.

I counted somewhere in the neighborhood of a dozen or so references
throughout regarding pay. Another 7-8 issues relating purely to material
comforts and nearly an handful related to sex. In fact, his very first
complaint was about sex (or lack thereof)! HMMM?

He did mention the word freedom at least once but it was not in the
context of defending the freedoms that we all enjoy but in the context
of if he were to do something illegal that he could have his career
ruined. Duh!? In fact his one example of freedoms lost involves the
court martialing of a convicted adulterer. This guy must be a throwback
to the 80's (and I should know!) because it's all about him, its all
about stuff and its all about being 'privileged' as a physician. He
speaks about weekends off, bed size, eating out at fancy restaurants,
having broadband internet, sex, retirement salaries and the overall
inconvenience of it all to him and his life style as a 'privileged'
physician. I suspect this guy has never read any of the many various
physician oaths that most schools require to be administered at
graduation.

None of them talk about pay checks, sex (except not to use it as a
weapon wrt your patients!), TV, internet access etc. etc. etc. They do
speak about commitment to the art, about altruism, about professionalism
and about dedication to one's patients.

I also see this gentleman never mentions the fact that if he were good
enough to be selected for ortho training, that he would have the
opportunity to care for patients while deployed that his civilian
colleagues would never get to do.

I see no mention of patriotism or devotion to country and nation or of
serving two professions. He speaks merely of his deserved privileges as
a physician. What about his required privileges as an officer in the US
armed services?

Yes there will be stresses to your family. Yes there will be challenges
in the work area (deployed or not). Yes there will be differences in
pay, times off, in the standards used to measure your performance
(although I suspect he's never been to an academic center where they
very much do rate your performance on other things besides the # of knee
jobs he's done!), in the additional duties we must accomplish (how many
civ docs do MEB's, 469's, CBRNE etc.) etc. But ask anyone who was in the
military as a doc and is now practicing in the civilian sector and they
will tell you that while something's are different, many are just a
different shade. Do they have more autonomy? Can they pick and choose
who they work for, work with, where they work, who they'll see as a
patient, which insurance companies they'll deal with, which EMR they
use? Maybe. Maybe not. So where does see the grass as being so green?

I challenge this individual to show me anything (any article, any oath,
any statement of required training etc.) in the entire history of
medicine that specifically addresses the issue of being a medical
professional where it talks about ensuring that the physician's quality
of life meets some sort of standard to include # of days off, the size
of his bed or TV, the speed of his internet access, the fineness of his
cuisine, the beauty of his spouse, the size of his retirement paycheck
etc. etc. etc. Don't bother looking for it. It's not there.

I tell this guy to get off his damn high horse and grow up. To come down
from Mt Olympus and reread his medical oath. To take a look at the
service he is providing his family, his neighbors, his town, his state
and his nation.

Being a physician and an officer ain't about being privileged.

It's about the privilege to serve.

'nuff said.

You tell this student I'm proud to call him a colleague. And thank you
[name] for taking time out your hectic resident schedule to speak to this
student.

 

[slants]

Another response from Doc about 40 reasons...

I agree with Drs. [name] and [name] that this person is over the top. He
definitely needs a reality check, and I agree that he is unlikely to be
happy no matter where he goes.

However, I would not say that these folks are a miniscule minority in my
experience. I would say that we have a resident here with this type of
severely corrosive attitude every 2-3 years (and it was about the same in my
residency). That's about 1 in 10-15... a minority certainly, but not
miniscule. I would say that most of my residency class would agree with
about half of the bullets he listed... the point behind them, if not the
abrasive tone.

My personal opinion is that we do ourselves no favors by pulling punches
when recruiting. I think people coming into the military deserve to be told
some of the common gripes that we hear and say every day. If this griping
individual had been given an honest account of what we do, chances are he
would not have come in... and that would have been better for all of us.

What I personally would tell this potential recruit is that he will
certainly run across people with this type of attitude during his military
service. I would tell him that HPSP is not all peaches and cream.
Deployments suck in many ways... but I have also spoken with many people who
in retrospect would not give up their deployment for anything in the world.
I would say that it's true that the money isn't always great... and moving
is expensive, but also I am 2 years from paying off all of my family's
student loans. No way I would have been there if I hadn't done HPSP. Plus,
I lived pretty well as a student and a resident... better than most of my
colleagues. That was worth a lot. I would tell him that there have been
some days that I have woken up wondering what I got myself into (recalls,
exercises, etc), but that looking back at the experience in sum I have to
say that I wouldn't have done it any other way. And if I am less
enthusiastic than Drs. [name] and [name], perhaps that's why I am separating
and they making it a career... or perhaps it was because I never heard any
of these gripes before coming in, so I expected too much. I say do this kid
a favor and tell him the pros and cons in a balanced way. He and the AF
will thank you for it in the end... and I thank you for taking the time out
of your schedule to talk to him, [name].

 

[slants]

Army Doc, Army vs. Airforce?

Why the Army? The Army has the largest overall GME program of all the Services, so there are more opportunities for GME training and more variety in terms of academic assignments after completion of training. The Army also has more medical centers (although this is perhaps less significant with the integration/merging of the facilities in the National Capital Area and here in San Antonio). The Navy tends to have people serve as General Medical Officers (GMO's) on board ships after they have completed their internship year; although the Army also has similar GMO positions, there is more of a trend for people to go directly into their chosen residency if they know what they want to do and have an academically competitive record.

Having said all of this, I wish I could say it was a profound philosophical decision that made me choose the Army. You'll laugh when you realize what a petty issue it came down to. Basically, I applied for HPSP scholarships rather late in the academic year; by then, the Air Force had already closed their 4-year scholarships, and they could only offer me a 3-year scholarship. I was offered 4-year scholarships from both the Army and the Navy. How did I decide which one to take? I knew precious little about either Service, but I did know that I had worn a white uniform in high school, and I was not prepared to wear white uniforms ever again! That clinched it: I signed up for the Army!

I know you will make a far more informed decision than I did!

 

[slants]

Army Neurosurgeon's main points on HPSP,

1. Do NOT do it, you can get the money else where.
2. If you decided to do the specialty you'll make more money.
3. Nobody gets fired and it sucks.
4. Cannot get anything logical done.
5. RUN!

 

[slants]

Ok, so I've put it all out on the line. I want to hear some of the old man opinions. I guess only 2 things worry me.

#1: Why does the military need to sign up HPSPers instead of just offering board certified doctors a way to pay off their loans.

#2: How do I know that Galo, USAFdoc, Navdoc47, and militaryMD aren't all the same guy just different user names?

These two things give me the biggest headaches over this decision right now.

 

[BigNavyPedsGuy]

Ok, so I've put it all out on the line. I want to hear some of the old man opinions. I guess only 2 things worry me.

#1: Why does the military need to sign up HPSPers instead of just offering board certified doctors a way to pay off their loans. .

I'm not "old" (i'm an intern) but here's my crack. 1) It's cheaper, cheaper, cheaper! Just look at the pay difference b/t a new doc and the experienced major. They'd have to pay that much more to get experienced physicians.

2) Pre-meds don't know better. I didn't, you don't (although I have to commend the job researching that you are doing). Once people have finish med school they have a better grasp on practice opportunities.

3) You're also a lot less likely to get a guy with a wife and a kid or two on the way to sing up to deploy than you are a single twenty something. Especially if the aforementioned doc is being offered a contract to make two or three times what the military will pay, and he gets to choose where he lives.

#2: How do I know that Galo, USAFdoc, Navdoc47, and militaryMD aren't all the same guy just different user names?

These two things give me the biggest headaches over this decision right now.

I don't think they're the same guy.

One important point above. 150K is very competitive for a family practicioner, but 150K is about one third of what a lot of orthopedic surgeons make.

You can search my old posts and find that I try to be a pretty unbiased guy. I just believe in an "eyes wide open approach" Feel free to PM me with quesitons, I can't provide the 15yr vet salty opinion, but I consider myself moderately well informed.

 

[slants]

You can search my old posts and find that I try to be a pretty unbiased guy. I just believe in an "eyes wide open approach" Feel free to PM me with quesitons, I can't provide the 15yr vet salty opinion, but I consider myself moderately well informed.

BigNavyPedsGuy, Thank you Thank you for the advice. I have two questions for you, hope you don't mind that I didn't PM them.

#1: Would you do it again knowing what you know now?
#2: If I have no idea what specialty I want to pursue, but I want to help my country, is it worth it?

 

[Galo]

SHLOOOUMP!!

That's the sound of my boots coming off after reading through some of the BS you're being told.

PM me, I'll be glad to give you my phone # so we can talk, and I'll tell you what my 6 years as an active duty AF surgeon were like.

The neurosurgeon who sent you a note, do you think he is the only wierdo that has a problem in the military.

The CRAP about patriotism is the one that gets me the most.

Anytime you're ready send me a PM, we'll talk.

In the mean time, DO NOT SIGN ANYTHING!!

 

[Homunculus]

#2: How do I know that Galo, USAFdoc, Navdoc47, and militaryMD aren't all the same guy just different user names?

they're not. you can trust me and my magical admin powers.

btw-- thanks for posting-- some good info there, and i think it illustrates the disconnect between reality, providers, recruiters, and medstudents/premeds. it is very much dependent on individual experiences-- i know an air force pediatrician who is happy as a lark, and know at least a dozen army pedaitricians loathing life. the sum total for me is that if you have any doubts at all don't do it. you can always sign up later and try to dictate your own terms and have more leverage to do so.

--your friendly neighborhood 7-4-1 magical admin power toting caveman

 

[The White Coat Investor]

can't believe them because they are anonymous, ect. I am one of those HPSPs you guys always talk about saving from a rash decision and I really need your help. I need advice.

If you want some of us to become less anonymous PM us your phone number and we'll give you a call.

 

[NavyFP]

Recruiter answering the same questions.

1. If I am unsure about this scholarship, do you think I should just wait it out and sign up FAP down the road? (Advantage vs. Disadvantages of this route)

The FAP was one of our main sources of recruiting physicians back in the Major’s day, however that is a limited program that is harder to come by and will probably get worse in the future. I have pasted this years openings for you to review. As you can see most specialties only have a handful of openings. These are opening Nationwide. Also notice some of the longer specialties are not sponsored for the whole residency, ie surgery is only sponsored for 2 or 3 years, NOT the full 5.

Then there is the simple money aspect of why the HPSP is better. At least $250K for school plus stipend, then if you match to AF residency you’ll make about $55k-$60k much higher than any civilian residency and only 1 for 1 payback. The FAP is a plus one payback. So a 4 year residency (if you’re lucky enough to get one) is a 5 year payback.

The Air Force does things differently than the other two services. This continues even today. They are pushing HPSP more, but there are certainly benefits to both HPSP and FAP. FAP goals are smaller than HPSP and limited in specialty. What they actually offer every year differs. You might not be eligible for FAP depending on which specialty you choose to pursue. The benefit of FAP is about $70K per year. Yes the payback is year for year plus one, but your specialty of choice is assured and you could feasibly get about the same compensation depending on the length of sponsorship.

The primary difference is that as HPSP doing intership/residency in the service is the networking. Getting to know others in your specialty is helpful in your career. It would also benefit you towards retirement. While only about 20% of doctors stay in that long, it would make a difference. Not a big selling point, but something to consider.

Bottom line, both are good routes to service.

2. Do you think that HPSP students have an extra difficult time getting the residency/specialty of their choice?
NO, you have more chances than a civilian student. You apply to AF res and find out in Dec, if you don’t match you still have the civilian match, if you don’t match there you will get an internship year and re-apply with the AF again but this time you get points (seniority) over the other HPSP applicants.

Wow. What a non-commital answer. Over 50% of students get their first choice in residency and location. (don't know the specific AF numbers, but they are usually in line with the other services) I have been told that the AF is advertising that 91% get their first choice. While I believe this to be a gross exageration, many do get their first choice. I have never seen the stats for the civilian match, but the truism that applies is that if you are a good student with good grades and board scores, you are likely to get what you want.

3. What reasons did you come back to the Air Force?

FAMILY, not my personal family, but the AF family. I have never experienced nor heard of a company in the world that takes better care of it’s people. I have people I met through the AF that are family not friends. I know I could show up on their doorstep and they would have me in their house with open arms. I have numerous personal accounts of how the AF helped me or co-workers well beyond what is fair. Call me anytime and I’ll talk your ear off about how well the AF has treated me or we can discuss it when you come down for you physical and interview.

The military is the biggest fraternity on Earth. Whenever you meet another member, there is an automatic connection and invariably the swapping of sea stories. I do think he overstates it a bit though.

I have put my responses in red above. I am one of the pro-mil med members of this forum, but not blindingly so. Mil-med is not without its challenges. You obviously want to go to med school, so that is a good start. Paying for med school via HPSP is not a bad deal if you have a desire to serve in the military. This is the key. Is service in your plan. Do not do this for the money. It will only leave you bitter. Don't let the recruiter bully you into deciding. I don't believe they have given all of their scholarships away, but even so, this is not a decision to make lightly. Be sure. Its like the door to door salesman that comes by and says you have to take the deal now or you can't have it. My response to those guys is always no. You should do the same.

So these are my 2 cents.

 

[BomberDoc]

If you want some of us to become less anonymous PM us your phone number and we'll give you a call.

Absolutely. PM me your number and I'll call you. You have been fed a load of BS from the guys at Ellsworth. I'm guessing that those "several" docs who wrote back are the same guy. Turnaround is fair play, afterall.

 

[BigNavyPedsGuy]

BigNavyPedsGuy, Thank you Thank you for the advice. I have two questions for you, hope you don't mind that I didn't PM them.

#1: Would you do it again knowing what you know now?

hmmm, I'm going to give a qualified "probably not" here. Here's why, it's not because I'm unhappy with the system. It's not because I'm doing an involuntary GMO tour (although that's less than awesome). I went to med school to be an orthopeadic surgeon. You can tell by my screen name that I changed my mind along the way. I now have a goal to do pediatrics internationally with a focus on third world health. The Navy does some of that, but their primary job will always be to win wars.

All that being said, things have worked out pretty well for me. I got orders for a shipboard GMO (pretty covetted spot). Hopefully, I might even squeeze some humanitarian experience into my GMO. I love my program and I think the training is great, but peds is a lower paying specialty.

A surgical subspecialist will have to watch his civilian colleagues make 300-400K more per year than him just becasue he had his 250K for med school. I was also only an e-mail away form 15months in the sandbox.

Also, I've only been active duty for months (not years and years). I'm pretty green.

#2: If I have no idea what specialty I want to pursue, but I want to help my country, is it worth it?

Up to you. Anybody that is all negative or all positive shouldn't be trusted, or at least should be taken with a grain of salt. You should search in my old threads "tell me something good" was thread were a lot of the negative guys were pretty forthright. In my experience, most people plan to get out, but most people aren't miserable either. You can tell from above that I'm not going to tell you what to do. You shouldn't trust an internet forum alone.

Take these guys up on their offers to PM them. Especially the moderate guys like Homonculus and NavyFP.

 

[BOHICA-FIGMO]

I have put my responses in red above. I am one of the pro-mil med members of this forum, but not blindingly so. Mil-med is not without its challenges. You obviously want to go to med school, so that is a good start. Paying for med school via HPSP is not a bad deal if you have a desire to serve in the military. This is the key. Is service in your plan. Do not do this for the money. It will only leave you bitter. Don't let the recruiter bully you into deciding. I don't believe they have given all of their scholarships away, but even so, this is not a decision to make lightly. Be sure. Its like the door to door salesman that comes by and says you have to take the deal now or you can't have it. My response to those guys is always no. You should do the same.

So these are my 2 cents.

Here's my two cents. Like medicine in general, only do military medicine if it is truly in your blood. I don't know how else to put it. I am in this whole medical business because I love treating patients. I don't necessarily like my school, my classmates, or the process of medical education; but I do it because it is in my blood somehow. I follow a similar train of thought with the military. It doesn't pay as well, and it has way more hassles and sacrifices than equivalent civilian jobs. But I do it because it is in my blood.

If you entered medicine for the money, status, prestige, privelege, or just because you were smart and it seemed like the next best thing to do; or if you are thinking about HPSP because a scholarship to med school sounds like a good deal, DO NOT go into military medicine. You will only be disappointed.

Full disclosure: I am Navy HPSP, 3rd year med student, and spent 11 yrs AD USAF as a BSC with rank of O-4 before getting out.

FWIW

 

[bricktamland]

Here's my 2 cents.

1. A lot of people say "don't say do it for the money!" They are definitely right, but it is an oversimplistic statement. Here's my take:

As a specialist, you will definitely lose money in the long run, the ISP bonus for specialists just plain sucks. As a primary care physician (FP, IM, Peds) or Psych, you actually get paid very competitively, and it's more of a lifestyle decision than financial. If you are undecided or think you may change your mind, it is a risky financial decision. The one point, however, that I think often gets overlooked is that you get a relatively large amount of money upfront. While your civilian counterparts will most likely pass you up big time as attendings, you get paid very well during med school and residency. Frankly, I've enjoyed the extra pay immensely. I bought a great car, went on tons of vacations, and paid for an awesome wedding, all without having to pinch pennies. I think many people forget about those good times once they're attendings and all they can focus on is how much more their civilian med school buddies are earning.

2. Regarding patriotism, I think this is WAY oversold. Don't get me wrong, I'm a proud American, and proud that I've served my country, but there are plenty of ways to serve besides putting on a uniform (i.e. volunteer work, community service, etc). Most of the people I've met that are all gung-ho patriots are kind of jingoistic, and seem like a little unbalanced. What matters most to me is the cool people you meet and forging lasting relationships. There is definitely a "fraternity" kind of atmosphere that most of the time is pretty cool and really brings people together, but can also get a bit stifling at times. For the most part, I enjoy the camraderie.

3. Training. I really think it depends on the specialty. Some of my ortho buddies are very unhappy with the spectrum of cases they see. I thought my FP intership was OK, with some major strengths but also some glaring weaknesses.

4. Sacrifices. The most frustrating thing about the military is working for an incompetent leader. Sadly, most of these people never get canned, they just get transferred around. You have to learn to suck it up and tolerate the BS. On the upside, I've had some fantastic COs and all the program directors I've had or interviewed with have been outstanding.

Hope that helps

 

[elderjack21]

I am a senior undergrad, just got accepted to medical school and have accepted the HPSP, but have not sworn in. After reading this forum day-in and day-out, and after accepting but then getting a tour of BAMC, I am really starting to get cold feet - more like a gut feeling like this probably isn't the best path for me.

If you are able to, you should contact the nearest Air Force Base and their medical center (on your own, without the help of your recruiter). And set something up to shadow a couple doctors over the course of a day. You can see first hand what you are getting into and get the opinion of several people in person.

You seem extremely informed already, but it would probably be worth a day or two of your time and some money given the importance of the decision.

PM me if you need help contacting someone at your nearest base, I can guide you to some right numbers as I know that information as simple as phone numbers can be sometimes hard to come by as a civilian.

 

[MaximusD]

*yawn*

In the end it's gonna be your decision. Seems like you might want others to make it for you.

Good luck.

 

[Gastrapathy]

I have no advice for this person, however, I'm not too impressed by his/her decision to solicit private advice and then post it on the internet.

OP: I can only hope (although I seriously doubt) that you secured their permission to post their emails to you in this forum. If so, I apologize. Otherwise, its a punk move and one that will only make it harder for other people to get honest opinions from current military physicians.

 

[sethco]

Recruiter answering the same questions.



2. Do you think that HPSP students have an extra difficult time getting the residency/specialty of their choice?
NO, you have more chances than a civilian student. You apply to AF res and find out in Dec, if you don’t match you still have the civilian match, if you don’t match there you will get an internship year and re-apply with the AF again but this time you get points (seniority) over the other HPSP applicants.

😱...

(How do you know when a recruiter is lying???)

 

[sethco]

#2: How do I know that Galo, USAFdoc, Navdoc47, and militaryMD aren't all the same guy just different user names?

You can believe whoever or whatever you want to believe. Basically you have (like most people that frequent this site, looking for "advice") already made you're decision and are just looking for validation. We are merely trying to present the pros and cons. Take them for what it is worth. The good thing about this site is that it is anonimous. If you walked up to me at my clinic and asked me, I would answer something completely different because I would be afraid of the reprucussions.

This brings up another point. If you are applying for an Anesthesia residency and you are looking for advice regarding matching into that specialty, are you going to ask current residents or are you going to ask a person that was residency trained 20 years ago? By this same token, I think (and correct me if I am wrong), it is absolutely riduculous to get advice regarding the HPSP/FAP program from O-5/O-6s.

 

[sethco]

BigNavyPedsGuy, Thank you Thank you for the advice. I have two questions for you, hope you don't mind that I didn't PM them.

#1: Would you do it again knowing what you know now?
#2: If I have no idea what specialty I want to pursue, but I want to help my country, is it worth it?

1. Probably not, but hindsight is 20/20 so I don't think that is very fair. I did not know about this forum before I signed up. I basically went in blind.

2. Absolutely not, unless you are willing to possibly do a GMO tour first and are OK with maybe losing a lot of money if you choose a high paying specialty (>200K/year)

 

[edmadison]

With respect to several of the contributors here, be careful taking advice from residents. The world in which they live (GME) is quite different from the every day work at a MTF. Both the Cave Man and I were relatively positive about military medicine until we stepped out of the ivory tower. Now we see what we were protected from. I am not bitter (I don't think), just realistic.

The calculus is about control. Most kids (and I do mean kids) who sign up have never had a significant amount of independence in their life. Oh sure, they might have lived on their own or even been out of school for a few years, but it was always as part of a bigger plan. In every other job, you can take a walk and find a better working or living environment. You can't do that. Boss sucks? You have to wait until he/she or you can PCS. What about administrators who have never done Primary Care telling you that you must see a patient every 15 minutes -- including time for documentation (which takes 5-10 minutes due to a crappy computer system). Try handling a well child check or new dx ADHD in that 5 minutes. The examples aren't what's important. It's the principle.

You are binding yourself for eight or more years. You are obligating your spouse and children -- even if they don't exist yet. You have no personal context to understand what people are telling you. You want some hard numbers, here's one. Last year 18 Army pediatricians were eligible to leave the Army -- 17 did so! And for pediatricians, it has nothing to do about the money, because we make as much in the military as the do outside.

Get everything else out of your head and ask yourself how much money it's worth to give up control of your life. No one lied to me, I got what they promised and got good residency training. I'd give the Army back my scholarship money (probably 200,000) today if I could have just one year off my obligation -- just one year!

Ed

 

[sethco]

With respect to several of the contributors here, be careful taking advice from residents. The world in which they live (GME) is quite different from the every day work at a MTF. Both the Cave Man and I were relatively positive about military medicine until we stepped out of the ivory tower. Now we see what we were protected from. I am not bitter (I don't think), just realistic.

Just for clarification, I was making an analogy about asking people that have a more updated perspective about something. When I was talking about asking residents about GME, I was talking about in general, not in particular reference to the military. Obviously, military residents, in general, live a sheltered life, away from knowing the true beaucracy (sp?) that military medicine can become in the wrong hands. I think the one exception to this rule would be family medicine residents in the military, and even then, a case can be made that they have no clue what it is like.

 

[slants]

Thank you everyone for the information you provided. I would especially like to thank Galo, ActiveDutyMD, and BomberDoc for calling me to talk about their experiences. Thank you.

 

[Galo]

Thank you everyone for the information you provided. I would especially Galo, ActiveDutyMD, and BomberDoc for calling me to talk about their experiences. Thank you.

Either way, I would appreciate if you'd let us know your decision either in private, (PM), or post it.

Thanks

 

[MaximusD]

SHLOOOUMP!!

That's the sound of my boots coming off after reading through some of the BS you're being told.

PM me, I'll be glad to give you my phone # so we can talk, and I'll tell you what my 6 years as an active duty AF surgeon were like.

The neurosurgeon who sent you a note, do you think he is the only wierdo that has a problem in the military.

The CRAP about patriotism is the one that gets me the most.

Anytime you're ready send me a PM, we'll talk.

In the mean time, DO NOT SIGN ANYTHING!!

There's really only one signature that matters. You can sign all the other forms to your heart's delight. 😉

 

[Leetah]

I don't have a lot to offer since I just signed the contract with the Air Force. However, my husband broke his back in the AF 8 years ago, and I have spent tons of time in military and VA hospitals. I would recommend that anyone considering joining the AF or other military branch for medicine do the same. It is important to shadow doctors, but I think even more important to spend some time in the waiting rooms and get to know patients. This may seem odd but having spent so much time in waiting rooms, I really started to get to know and care for the many patients I met. There are good and bad things about military medicine (obviously, I suppose). I think you really have to care about it. It is not patriotism, but it is caring for a very specific group of people. They aren't more important than other people, but they do have different experiences that will be pertinent to their medical care. In the end, joining the military can't be about you, it should be about the patients. Maybe, at this point, I am a bit idealistic, but I do really believe that. I would never give up so much to the military if it was all about me. So, if you are worried about how the military will treat you, about the money, your personal rights, or other similar things, I would not suggest joining.

Anyway, I hope I didn't say anything that offends someone. It seems like forums can be pretty crazy sometimes, and I don't usually post in them so I don't know all the etiquette. Take care.

 

[sethco]

They aren't more important than other people, but they do have different experiences that will be pertinent to their medical care.

This is where we disagree. Because these troops are very unselfishly serving are Country to protect the freedoms that so many individuals take for granted everyday, they deserve MUCH better. Although you may be very altruistic now, the world doesn't always work out like this. VIPs in the health care setting are treated much different than your average Joe. Likewise, usually the people that are more wealthy generally get better care. Unfortunatly, this is just a way of life.

In the end, joining the military can't be about you, it should be about the patients. Maybe, at this point, I am a bit idealistic, but I do really believe that. I would never give up so much to the military if it was all about me. So, if you are worried about how the military will treat you, about the money, your personal rights, or other similar things, I would not suggest joining.

So, let me get this straight...I go to get at least 9-12 years education post-high school so I can be treated like sh**, have no personal rights, make little money in comparison to what I could be making, have people with less education overrule planned treament issues, be away from being with family, put my life in danger, have bosses who love to micromanage even if doesn't make any sense, and use an inherently poor insurance system (Tricare) that is getting less support every year from civilian providers. Where do I sign up?

Just kidding, I know what you meant. "Service before self" rings true. However, it also holds true that you should not join the military unless you want to be an officer first, doctor second. I am very glad that you know what you are getting into before joining the military

 

[FutureNavyFP]

have people with less education overrule planned treament issues

I've seen this complaint several times in this forum. Is it really that common (I guess once is even too much)? Does this happen more often in the hospital setting than in the clinics? I've heard BomberDoc and others mention their coven and I picture a group of nurses reviewing patient charts and changing the doctors orders. Am I far off on this? Are the nurses able to write and sign orders by themselves or do they change the orders and twist your arm with their collar device until you sign it? 😕

 

[BomberDoc]

I've seen this complaint several times in this forum. Is it really that common (I guess once is even too much)? Does this happen more often in the hospital setting than in the clinics? I've heard BomberDoc and others mention their coven and I picture a group of nurses reviewing patient charts and changing the doctors orders. Am I far off on this? Are the nurses able to write and sign orders by themselves or do they change the orders and twist your arm with their collar device until you sign it? 😕

I can't speak to the hospital environment since I'm stuck as a clinic monkey. I would estimate that it happens in my clinic once per month or two. Yes, once is too much. It isn't about changing orders (medical orders from a doc in this sense, not military orders), it is about questioning and refusing to do them. A nurse with rank is never wrong and can choose when to follow the medical order of a junior ranking doc.

Last time this happened in my clinic, a 20 something year old patient rolled in with "chest pain" x 3 days, no change with exertion, no true cardiac symptoms. Another doc, a PA, and myself were discussing the patient (even though we get a lot of dumb kids who bench press too much and complain of "chest pain" we still eval them to rule out the big bad stuff) and we decided that it wasn't cardiac in nature and that the kid didn't need to be seen right away but could wait for his scheduled appointment time. The nurse who hasn't touched a patient in years freaks out and starts questioning our judgment very loudly in the hallway. We ignore her and go on about our business. She continues to be irate and badgers someone from another clinic into seeing this "emergency" right away, all the while trashing us throughout the entire building for being bad providers. I hate the word provider, by the way, but that is another story. Eventually this gets up the chain and in a couple hours we are all standing in the commander's office (again, a nurse) explaining our actions and getting yelled at and being told that we have to work together. This is code for "do whatever a nurse tells you, no matter how ridiculous." Of course the kid with chest pain had some muscle soreness from, you guessed it, working out too vigorously.

Previous time that I remember was the same nurse refusing to give a patient a PCN shot because we already had an IV in him. Last time I checked, an IM shot in the butt doesn't have anything to do with a normal saline IV in the arm. So I took the antibiotic from her and did it myself. Naturally this got written up and the next day I was explaining to the Quality Manager or whatever stupid title that administrator holds, who happens also to be a nurse that hasn't touched a patient in years, how the two couldn't possibly interact. Naturally, common medical sense was ignored.

Nothing came of these actions because my colleagues and I appropriately treated the patients and they got better. Of course the nurse tyrants continue to try to dominate us and intimidate us with their rank.

 

[sethco]

I am very lucky in the sense that most of the bosses are docs. The SGH is a pediatrician that also runs the MEB meetings and is very smart. My SGP is a family practice trained RAM and although he doesn't see many patients anymore because of his job, he still keeps up very well with CMEs. The Med group commander is psychologist, but he usually defers to the SGP when it comes to flight medicine. The SGN, a nurse practioner, usually stays out of our way. The only nurses that are in my department are O-3s, they are usually good but sometimes they still give attitude and think they know more than us, even though they have also been doing only clinic duty for the past couple of years (like myself) and see the exact same stuff as I do.

What I find though is that power struggles become even more pronounced in a deployed setting. I can't really explain why. It is kind of scary when a Veterenarian (sp?) is the Med Group Commander and gives medical advice to people that ask him, knowing that he doesn't practice medicine and has not been a practicing vet for several years. Micromanaging becomes priority in this setting, even if they don't realize that they are doing it and people seem to complain about the stupidest things like "Why does the Flight doc get to fly while I am stuck seeing no patients in the clinic" or "Why don't the flight docs see as many patients as us family practionioners" (Even though we take on a lot of their joke of a "patient load") or "We take more call than these guys and this is unfair". I deal with so much whining everyday from my kids, I don't want to deal with it from my "colleagues". Not to say anything bad about the troops, but I am amazed about how many freakin' pansies there are in the military. You know these people. They make up excuses to come into sick call once a week. They will do anything to get out of their PT test. They want defibrillators in planes (just in case) . They go to their command whenever their feelings are hurt instead of talking to that person that upset them first. They convienently find ways to weasel their way out of deployments. It all makes me sick!

Done with my rant for tonight. Still counting down as my donut of misery continues to move counter-clockwise 🙄

 

[The White Coat Investor]

Done with my rant for tonight. Still counting down as my donut of misery continues to move counter-clockwise 🙄

You've gotta get that thing fixed!

 

[fetch]

It is kind of scary when a Veterenarian (sp?) is the Med Group Commander and gives medical advice to people that ask him, knowing that he doesn't practice medicine and has not been a practicing vet for several years.

Maybe my post in the other thread will attract nurses as you certainly have my attention now. By the way, I really appreciate you taking the time to look up the spelling of veterinarian when you were unsure... 🙄

I'd be very interested to learn more about this specific example since, to my knowledge, this is normally impossible. Even in the USAF. Public Health Officers who are veterinarians serve in an advisory capacity to the Med Group Commander not as the Commander. Although, I suppose if the Commander were absent and no one else of qualifying rank was around they could as a temporary assumption of command... But that is not what you implied; your comment leads one to believe the veterinarian was the Commander.

Finally, it depends on the medical advice, doesn't it. How to perform a posterolateral thoracotomy for resection purposes? Probably not. The epidemiology of and measures needed to prevent Toxacara VLM/OLM infections in Soliders deployed to Iran? Absolutely.

 

[Spartanvet4cows]

I don't know if this was mentioned before, and I'm sure this won't really influence your decision, but as long as you haven't signed anything, that "you took someone else's spot" thing is crap. It's a bit different for veterinary medicine because we only board once a year, but I was on the order of merit list for 6 months. I got pulled off because of increased funding, but if someone had turned down their scholarship, the list would have moved.
I've learned that HPSP for vet med is very different than for human med, mostly because we aren't required to do a residency, and we have different duties. So, because I've been commissioned all of 4 months and things are not going to be the same for me, I won't comment on the overall experience thing. Just wanted to let you know that if you decline your spot, I highly doubt you've taken away someone else's. At worst they have to wait another couple of months.

 

[sethco]

Maybe my post in the other thread will attract nurses as you certainly have my attention now. By the way, I really appreciate you taking the time to look up the spelling of veterinarian when you were unsure... 🙄

Really sorry, didn't mean to offend with my misspelling. Was tired and didn't feel like looking it up. Feel free to misspell pjysician, docter, flight sturgeon, etc. I really don't mind at all. 😉

I'd be very interested to learn more about this specific example since, to my knowledge, this is normally impossible. Even in the USAF. Public Health Officers who are veterinarians serve in an advisory capacity to the Med Group Commander not as the Commander. Although, I suppose if the Commander were absent and no one else of qualifying rank was around they could as a temporary assumption of command... But that is not what you implied; your comment leads one to believe the veterinarian was the Commander.

I stand by what I said, but I am not about to give my location up. Let's just say it is somewhere in the desert and he is temporary in the sense that he has been the commander for the med group for the past 6 months.

Finally, it depends on the medical advice, doesn't it. How to perform a posterolateral thoracotomy for resection purposes? Probably not. The epidemiology of and measures needed to prevent Toxacara VLM/OLM infections in Soliders deployed to Iran? Absolutely.

OK, let me straighten this out. I respect the hell out of Vets. Their education that they go through and the admission process to get in is quite rigirous. I know because I was heavily considering it when I was a Junior in College. With that said, I don't make recommendations to pet owners just because I have a medical background and I would assume the same would apply for Vets.

BTW, he was making a recommendation to an individual patient. Had absolutely noting to do with epidemiology. The Family Practioner, who is a Capt, was with him and told him to be careful about giving medical advice, since he is not actually a patient provider. His response was "What harm could come of it" The average enlisted person only sees that he is the commander and medical personnel and does not know what his degree is. Why wouldn't he take his medical advice at face value?

 

[sethco]

You've gotta get that thing fixed!

Called IT, but they have yet to fix it! Something about "above their pay grade". 😉

 

[Gastrapathy]

I've seen this complaint several times in this forum. Is it really that common (I guess once is even too much)? Does this happen more often in the hospital setting than in the clinics? I've heard BomberDoc and others mention their coven and I picture a group of nurses reviewing patient charts and changing the doctors orders. Am I far off on this? Are the nurses able to write and sign orders by themselves or do they change the orders and twist your arm with their collar device until you sign it? 😕

I've seen this repeated here as well and I have to say that it hasn't been my experience. Officers who are senior to you, no matter the corps, can certainly place administrative hassles in your way but none have ever attempted to overrule my patient decision-making. In 10 years, the only issue like this that even came close for me was a nursing supervisor objecting to a 1:1 watch for a suicidal patient that would have required her to call in an additional body. In this case, though, the psych intern on call had told them it wasn't necessary. It was. I won. How, you ask? I wrote an order and an event note, let the charge nurse know that I had done so. Even still, kinda hard to blame the nurses when there was another doctor being an idiot.

This isn't to say that I haven't had nurses point out things about patients, make suggestions, question my thinking, etc. That is what they are supposed to do. But, overrule me based on rank...never gonna happen.

 

[FutureNavyFP]

This isn't to say that I haven't had nurses point out things about patients, make suggestions, question my thinking, etc. That is what they are supposed to do. But, overrule me based on rank...never gonna happen.

Good to know, thank you.

I started having nightmares of nurses looking over my shoulder saying, "LT, I didn't agree with your plan on that last Pt. so I wrote him some new scripts, and scheduled him for an unnecessary exploratory Lap. Now sign off on it and make sure you check out with me next time!" 😱

I can sleep better now. 😀

 

[Gastrapathy]

I get the impression that the major complaint from the attendings here, especially the folks out in operational tours, is that they are hassled for the decisions they make, rather than actually having them overrided. The stories quoted here usually seem to go along the lines of: (1) Order written, (2) Nursing objects, complains, throws a fit, (3) Senior nurse catches wind of situation, calls the physician "on the carpet" and reads them the riot act. Even the tales on MedicalCorpse's website primarily revolve around nursing and admin refusal to support the physician, rather than stopping them from caring for their patients.

Not that I'm minimizing this at all. It's all very demeaning and I don't look forward to it. It's a good example of the problem with nursing being in the chain of command of a physician.

By way of full disclosure, I've worked for line officers and physicians, never directly for a nurse. However, this is where my "give a sh#t" meter gets pegged. The "riot act" is total futility on their part. That nurse can rant and rave, write you a meaningless poor evaluation (you'll still get promoted to O4 and your O3 fitreps are then meaningless thereafter) and, probably send you home for the day pissed off. And after that, he or she will still have 3 cats, 40 lbs to lose and a hyundai. You'll still be an orthopod and when you are hiring your own nurses someday, the irony won't be lost on you.

This is the kind of stuff that happens rarely that people here seem to make such a big deal out of. Most of our nurses are quite dedicated. They are often very young and inexperienced. Like I said, I just haven't seen this be any major problem.

 

[notdeadyet]

I have no advice for this person, however, I'm not too impressed by his/her decision to solicit private advice and then post it on the internet.

OP: I can only hope (although I seriously doubt) that you secured their permission to post their emails to you in this forum. If so, I apologize. Otherwise, its a punk move and one that will only make it harder for other people to get honest opinions from current military physicians.

Ditto, ditto, ditto.

Slants- when you posted the first private email sent to you, it contained his profesional background, educational history, current location and job title. You've essentially taken someone who is active duty and posted their personal thoughts about the military presumably given to you in confidence. At least go back and wipe out all of the personal information about himself that the person included.

And expect it to be a lot harder for the next person looking for honest info about HPSP... Not impressed...

 

[fetch]

Really sorry, didn't....

Thanks for the response; appreciate it. However, in the interest of not threadjacking, taking the reply to IM...

 

[a1qwerty55]

I get the impression that the major complaint from the attendings here, especially the folks out in operational tours, is that they are hassled for the decisions they make, rather than actually having them overrided. The stories quoted here usually seem to go along the lines of: (1) Order written, (2) Nursing objects, complains, throws a fit, (3) Senior nurse catches wind of situation, calls the physician "on the carpet" and reads them the riot act. Even the tales on MedicalCorpse's website primarily revolve around nursing and admin refusal to support the physician, rather than stopping them from caring for their patients.

Not that I'm minimizing this at all. It's all very demeaning and I don't look forward to it. It's a good example of the problem with nursing being in the chain of command of a physician.

1. Nurses don't undermine docs they respect.
2. Physicians who educate the nurses in a nonjudgemental manner get what they want
3. Docs, especially residents and GMO's make really really stupid decisions (at times), which endanger patients. Any member of a care team has the right to object if a decision is potentially harmful to the patient. GMO's kill patients, sometimes the nurse is the only failsafe.

Basically if you are good, respected, and collegial, it is exceedingly unlikely that you will run into the issue described above.

 

[a1qwerty55]

Thank you everyone for the information you provided. I would especially like to thank Galo, ActiveDutyMD, and BomberDoc for calling me to talk about their experiences. Thank you.

You got the real cream of the crop to PM you.

Recognize that people that exceedingly strident and negative usually have their own issues and aren't necessarily good sources of information.

 

[Galo]

You got the real cream of the crop to PM you.

Recognize that people that exceedingly strident and negative usually have their own issues and aren't necessarily good sources of information.

Why don't you expand on your cheerleading and tell him how great military medicine is and all the reasons he and others should join with no reservation? The cream of the crop usually rises and leaves the military, so what are you?

 

[BomberDoc]

Do you ever feel bad about the degree to which you trash your former mentors and colleagues on this board? Do you ever type out one of your insults, then stop and think, "Wow, that's just really going too far."?

If you get your feelings hurt by people on an anonymous forum, you should go back into the bubble. The real world is no place for you. Certainly medicine is too dangerous. Milmed is like jumping from the frying pan into the fire.