Routes to military medicine?

Discussion in 'Military Medicine' started by cavalier329, Jun 3, 2008.

  1. cavalier329

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    I am already very familiar with HPSP and USUHS. Right now, my top choice is USUHS for a number of reasons. I have already decided I want a career in military medicine for quite some time before crossing over into civilian medicine and am looking at every route to get there. Right now, the plan is to hopefully get a spot in the Navy through USU. I have heard something about the Naval Reserve, but I'm not sure what it is. Can someone explain it to me/point me in the right direction of some info?

    Also, what other routes exist? Sorry if this is an elementary question haha.


    Thanks!
     
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  3. Galo

    Galo Senior Member
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    Not to beat a dead horse, but what experience/knowledge do you have to potentially lock yourself into a military career??

    I'm wondering if you've read through this forum and are aware of some of the many problems military physicians face today, and worse likely in the future, and if you do know about those problems how can justify making a career out it.

    Just wondering for the benefit of others who may be thinking along your lines.
     
  4. cavalier329

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    Understandable. However, you may or may not understand my reasonings. Simply put, I want to be a military doctor because of my passion for medicine and my desire to serve my country.

    I have grown up surrounded by the military. Father, brother, uncles, cousins have all served/are serving their country and I have been raised to feel that military service is something that is my civic duty.

    I am aware of the challenges that come with military medicine, and im willing to sacrifice what I need. Fact of the matter is, we will always need soldiers and as long as we need our soldiers, we will need doctors to take care of them. Therefore, there will always be a job for a military doctor. Whether its glamorous or not doesn't matter to me, its what I want.

    My knowledge of military medicine goes as far as what I can read in books and on websites. If you told me that the only way I could be a military doc is if I would spend 10 years in Iraq, 99 times out of 100 I would say to you, "sign me up." My girlfriend doesn't quite get it, but my family understands.

    I hope that answers your question. If not, I would gladly clarify in greater detail.
     
  5. Goliard

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    HPSP is really a good oportunity. Financially you break even with civilian counter parts or sometimes a little better if limited to 4 year payback terms. If you extend your service the financial benefit is null. The lifestyle will most likely be harder in the military with being re-stationed about every two years. The reward can not be compared. The idea of serving civilians or soldiers are both noble. If you desire to serve in the military then HPSP is a great way to go.
    Alternatively, if you don't need the scholarship then you can wait till you finish Med/Dent school and sign up with bonuses for active/reserves and get your loans repaid by the military. Financially it's not quite as good of a deal in my opinion. However, this may allow more freedom in choosing your residency program. But this way makes you less of a priority for getting a military residency program. Remember military residency programs pay almost double civilian ones.

    *opinion*
    Also, depending on the civilian residency of course, military residencies allow you to see big procedures more frequently (because cost isn't an issue for the patient) but may not cover the spectrum that you will see in civilian.
     
  6. MaximusD

    MaximusD Anatomically Incorrect
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    This resembles a recruiting pamphlet. Most military residencies are of very high quality, however caseload and variation have become a major problem for surgical subspecialties with too few cases and not enough variation compared to what you might find at a major academic hospital.
     
  7. sethco

    sethco Senior Member

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    You do realize what you said could be consider (by a lot of people, not everybody) a contradiction? Are you saying that the military non-surgical residencies are high quality, but not the surgical specialities?

    How can a residency be very high quality, yet have low caseloads and variation?

    This is especially important for surgical specialties, whether civilian or military.

    As an example, when looking for an Anesthesia residency, it would be prudent to look at experience in Trauma, Regional, Transplant, Cardiac, OB, Pain, ICU, etc. If a program is severely lacking in one of these categories, it would have gone way down on the rank list (if ranked at all).

    I am not trying to call out any particular program, but they know who/where they are.
     
  8. Galo

    Galo Senior Member
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    OK, so you are making this decision based on your family's service, and your desire to give back to your country. Both noble and understandable reasons. Now, do you want to be an officer or a physician. Many here will argue you can do both. My 6 year experience as a general surgeon in the AF says otherwise.

    The myriad of problems facing military medicine and especially subspecialties like surgery, make it now an extremely difficult place to practice medicine. Notwithstanding that GME is, again from my AF experience, mediocre to substandard due to low volume and acuity as well as lack of experienced staff.


    You still have to get accepted and do 4 yrs of med school, and will not know what you'll want to specialize in. Contrary to what the dental student posted, ONLY if you do peds or family practice, would mil med potentially be financially similar to civilian practice. Anything else you will be taking a major economical hit. Although that is something that may not matter to you at this time, it will in the future.

    I propose to you an alternative. Make phone calls, LOTS of them!!!! Call up AD physicians as many clinics as you can, all services, and ask them what they think. You need to thoroughly read this forum. You could also just go into debt, pay for med school, and once you are an attending and fully trained in the specialty you choose, then you can go into the military, they will always take you.

    If you're dead set, at least know exactly what the consequences can be. As far as your girlfriend maybe she senses bad juju?

    Best of luck, but as is often said here, caveat emptor!!
     
  9. sethco

    sethco Senior Member

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    To be honest, if somebody "cold called" me looking for the real scoop and whether I am happy with my job, I would be extremely hesitant to tell the truth. I don't know the person on the other line and what intentions they have and who they will go to with whatever info I give.

    I know, I am a little paranoid, but I am just trying to finish up my remaining 2 years without making any waves.
     
  10. MaximusD

    MaximusD Anatomically Incorrect
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    I meant that the primary care specialties are more than adequate whereas the surgical residencies and fellowships, from what I've read in this forum, have trouble finding novel cases. No contradiction intended.
     
  11. Perrotfish

    Perrotfish Has an MD in Horribleness
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    This just doesn't seem right to me, unless you're not including the benifit of the HPSP scholarship itself or you have the option of an in state school that's nearly free. I'm going to an incredibly expensive school where I would have recieved basically no financial aid. When you add up the cost of my school, the signing bonus and stipend, the GI bill, the benefits, the difference in pay between military and civilian residencies, and interest on the loans I would have needed to take out, the schoarship seems to work out to a rather large finacial gain for primary care and nearly even financial benifits for some types of surgury and some medical subspecialties. Assuming military residency, by the time I complete residency I'll probably be just under 500K ahead of my peers, even with the difference in military and civlian payscales, if I do primary care, I'll still be significantly ahead by the end of my commitment.

    I'm not saying anyone should do the scholarship just for the money, I'm aware this says nothing about the other difficulties with the military (like their match rates), and I'm aware that the scholarship can still be a huge financial loss for some fields (ortho can lose well into seven digits, for example), but 'potentially financially similar only in peds and family practice' just seems like too dark an analysis.
     
  12. notdeadyet

    notdeadyet Still in California
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    Boy, your math was very different from mine. When I was making the decision on HPSP, I was about to attend one of the most expensive med schools in the country (UVM, tuition of about $50K for 4 years).

    By my math, I would have been slightly ahead had I gone into peds/FP. But for anesthesia and Emergeny Medicine, two other paths I was looking at, I would have been hundreds and hundreds of thousands of dollars worse off by going military, even via the shortest, most lucrative path possible. The pay difference between many non-primary care specialties I saw was in the six figures.
    I found HPSP to be financially beneficial if and only if you attend a very high priced med school and go into a very, very low paying specialty like peds and family practice. The math just didn't pan out in any other scenario I ran.

    Again, props to HPSP folks and their dedication. There are many good reasons to take the scholarship. But financially, I found it to pay for itself only in pretty specific circumstances over the long term.
     
  13. MaximusD

    MaximusD Anatomically Incorrect
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    Why do you still hang around here? You don't really have any new or valuable insight as compared to the rest of the posters who've been through the mill. Just curious and a little skeptical.

    Considering FAP?
     
    #12 MaximusD, Jun 4, 2008
    Last edited: Jun 4, 2008
  14. sethco

    sethco Senior Member

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    Understand. Got you ;)
     
  15. notdeadyet

    notdeadyet Still in California
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    Still strongly considering milmed. I ruled out HPSP as it wasn't the right choice for me. Most of the military residencies I looked at didn't seem very strong for my fields of choice, and the lack of control over my path to becoming a residnecy-trained physician didn't jibe with me. Again, not saying HPSP is bad in and of itself, just that it wasn't right for me.
    Strongly considering FAP. Also currently looking at possilby signing up with National Guard service now (AMEDD-specific, so no activation during the rest of medical school or residency) folllowed by a switch to active duty post-residency.

    If you ever see me claiming any kind of military expertise or experience, MaximusD, feel free to call me on it. I'm just familiar with the game pre-signature. And I advise folks to consider the same things I did very carefully. They may find HPSP is perfect for them and that's great. But blanket claims of HPSP being a great gig financially usually doesn't add up and I'd hate to see an enthusiastic young med student become a bitter practicing physician because they signed away many years of their life without making sure they were making an educated choice.
     
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  17. Perrotfish

    Perrotfish Has an MD in Horribleness
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    Both of the fields you cited would be barely breaking even, but I'm not calculating the loss as hundreds of thousands. The medican salay of anesthesia is around 250K (and you won't make the median straight out of residency). I have myself about 500K ahead of my colleagues at the end of residency, and by wanabedocs analysis military anesthestits make $133,816 per year. So I'm, losing about 120K per year over the course of resiendency, meaning I come out behind, but not very far behing. At the same time military FPs make, according to wanabe, $110,816 per year, which is only about 20K below what I would be making in civilian practice. So in FP I'm not coming out a 'little ahead', I'm coming way ahead. Also I firmly believe that finances matter more on the lower end: coming out a mortgage ahead is VERY important if I choose to go into a field like FP where, civilian or military, I'm going to be strugguling if I want a nice home, family, and retirement fund. Coming out behind, even hundreds of thousands behind, matters somewhat less in terms of my quality of life if I'm an ortho making 500K/year in private practice for the majority of my career. I believe that money, like all things, has diminishing returns in terms of your quality of life
     
  18. sethco

    sethco Senior Member

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    You're numbers are a little off.

    First, go over to the Anesthesia forum and find out about some of the job offers they have been recieving. Generally starting around 250-300K, but making partner in 2-3 years.

    Second, FP is highly variable. If you tailor your practice to a procedure-heavy practice, you can make a lot more than just 130K.

    Lastly, as mentioned above, partners make more than new hirees. The faster you become partner, the more your earning potential. This does not hold true in all specialites, though. The only way you make more in the military is by going up in rank or time in service, and these increases are minimal compared to making partner.

    A long time ago, I did the math and found that even if I GTFO ASAP after a GMO tour and then going into residency and taking into account all factors (i.e. Cost Of Living, Loans/Interest, BAH/BAS, etc.), I was still losing out on close to 300K. If I would of done a military residency, it would have been closer to 50K (Not that bad, I guess). A civilian deferment would have put me in the red by about 150K. One of the advantages of doing a military residency vs a civilian, is no IRR time after you finish your ADSC

    Regardless, it seems that you do agree that the longer you stay in the military, the more potential earning you lose.

    I do agree though that you choose a specialty for something you like and have a good quality of life rather than for the money.
     
  19. notdeadyet

    notdeadyet Still in California
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    I think you're lowballing your estimates of starting wages and opportunities for financial advancement in civilian sector (even in the first few years). But my numbers are highball as well. For anesthesia and EM, I was adding a two year GMO tour for my numbers, as I was looking at Navy HPSP which pretty much required a GMO tour for those specialties at the time. If you're assuming straight through training right after internship (more realistic for Army), the loss wouldn't be as great as I had predicted, but it would still be a loss for both EM and Gas (and that's assuming a high tuition school). But you don't join the military for the money.
    Yeah, I can definitely see how HPSP is much more attractive if you're certain you'll be going in to a very low pay primary care specialty. The only reason I could never completely buy off on that as a medical student (or suggest that other med students buy off on the premise) is that the many folks, if not most, who enter med school with the idea that they will become a family practice doc are going to change their mind and select another specialty by graduation. I had stats to back that up one time, but don't know where they are now. Feel free to disagree.

    So even folks leaning towards primary care as they enter med school should be comfortable with the idea of HPSP being a financial loss, as odds are good they'll change their mind to a more lucrative specialty by the time they finish. But that's the one maxim that folks across the spectrum have nearly universally agreed on about HPSP over the years I've been reading the board: do not take HPSP for the money.

    I think that's one of the big financial gambles with HPSP that some are willing to take and others aren't. You have to be pretty confident in what field you're going into to make any kind of judgement as to whether or not HPSP is going to be right for you financially. The type of specialty will very much determine both whether or not HPSP pays for itself or you lose your shirt. It's also a big determinant in terms of whether or not you want to do a military residecy. In some fields, like family practice, I'd be happy with most of the military offerings. In other fields, the military is not personally where I'd want to do my training.

    I applaud those who are completely committed to primary care to the point that they know their mind won't change. We need more people like this. And I applaud those folks who are willing to roll the dice and will be happy with the HPSP outcome regardless of specialty.

    For me personally, I couldn't say for sure in my heart that I knew what specialty I'd end up in, as I still have too many interests. Not knowing the specialty I'd be going into, I couldn't guess what sort of financial ramifications that would have on me and my family. And since the quality of some residencies are stronger than others in the military, I couldn't be sure I'd be happy with the level of training.
     
  20. Goliard

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    I said, if you limit to four year commitment. After four years the gap in salaries would indeed increase with the military paying less. If you do a specialty that requires a 5 year residency thus a five + year commitment.
     
    #18 Goliard, Jun 4, 2008
    Last edited: Jun 4, 2008
  21. Perrotfish

    Perrotfish Has an MD in Horribleness
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    Definitely agree here, my numbers are definitely a lot worse counting in a 2 or 3 year GMO.

    This is an interesting point. How does your time as an attending in the military affect the time inbetween being hired and making partner in private practice? If you work in a hospital (military or civilian) for 4 years and then switch to private practice, are you just as far from partner as the guy who took the job straight out of residency? Are private practice positions generally offered straight out of residency?

    again agreed (I'm going into this prepared to lose my shirt, or maybe even spend 4 years as a GMO), but I think that HPSP is not so much a financial gamble as taking the safe route financially. If you go family pracice? You're alright, your kids will still have a college fund. Medicine gets socialized and you can't top 100K anymore? You're alright. Hit by a bus and you're not a doctor at all anymore? You don't have any debt. Top neuroseurgury residency? you're just barely alright, event though you could have been crazy rich. In terms of lifestyle the military a huge risk, but in terms of finances the military compares to the civlian world like a certificate deposit compares to the stock market. You trade a potentially large opportunity cost for the safest possible option.
     
  22. Goliard

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    I can agree with that, at least you're guaranteed a job with a good income.
     
  23. spicedmanna

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    That's essentially the bottomline, here.

    Yeah, I agree with you. Plenty of students change their idea of what specialty they want to pursue at some point during the process, perhaps even several times throughout. I, myself, have already changed my mind since I started. Coming in I was all gungho for EM, but then as I am learning more and more about primary care, and medicine in general, I am becoming more attracted to primary care fields (although, it is probably true that I've had an affinity towards primary care for some time). I am pretty sure that Surgical specialties are not my cup of tea, having had some basic experience in that direction in my distant past. Thus, there is a pretty good probability that I will ultimately choose a primary care specialty. I am sure enough that it became part of the reason for me to choose HPSP. Which primary care field, I am still uncertain. Hopefully rotations will help me decide.

    Oh, I already have a sense that this is going to be a poor financial decision. It won't hurt as bad, because I am most likely going to go into a primary care specialty, but, yes, you are right that the upfront money should not be the primary motivating factor for joining the military.

    For me, it goes a lot deeper. I've been considering doing the HPSP for some time now and think that military medicine is where I want be right now, despite the considerable challenges and financial considerations ahead. Perhaps I'm a bit crazy, but I think it would be an honor to provide care to our troops and their families, and it is worth enduring the pain that has been carefully delineated in many posts throughout this forum. It is even worth the risk of being embittered by the process, which is something I hope doesn't happen to me, since I am making every effort to go in with my eyes open, knowing the potential issues.

    Again, I agree. I think choosing the HPSP is probably a pretty poor financial move, especially if you ultimately choose a higher paying medical specialty. I think it's probably most worthwhile if you are attending a very expensive medical school, think you would like being a military physician, despite the challenges ahead, and are fairly sure that you will want to do primary care. I think I fit the bill pretty well.

    Thanks. I am going in with my eyes open and have seen enough and heard enough to think that I am making an informed choice here. I really took the time to feel it out and my heart is into it. On the other hand, if things don't turn out to my liking, I know that I am 100% responsible for my choice. I have no one else to blame but myself.

    Good that you know yourself. :thumbup:
     
    #21 spicedmanna, Jun 4, 2008
    Last edited: Jun 4, 2008
  24. Boardrider32

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    For me, the only route into medicine is through the military. I am currently headed to USUHS this fall. I am 33 years old, have three kids, and have 5 years active duty time in, thus my options were very limited. True it would be nice to bank > 300K a year, but I won't be starving as a military physician either.

    I actually look forward to the opportunities to practice medicine outside the traditional clinical realm. I have never been one that desires to work the rest of my life in a clinic or hospital setting, so the chance to get out into the field and do some cool things appeals to me greatly.

    Hopefully I won't have the negative experiences with military medicine that others on this forum have had. However I do realize that they do not represent the views by all military physicians. Every physician that I have talked to have said that they enjoy working in military medicine and have no regrets, whether it be USUHS or HPSP.
     
  25. Galo

    Galo Senior Member
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    I hope you're not in for a rude awakening. Be sure to let us know how it goes. Much like one of the above posters stated, there is alot of reluctance on the part of some AD physicians to speak their mind. Fear of repriasal is only one aspect, but there are many others. The vast majority of my colleagues were more than displeased. Why do you think that they have such an abominable retention rate? Did you read the recent forum that was placed out by the Military Health system??:

    http://www.health.mil/Debates/Debate.aspx?ID=9&a=1

    A pretty good idea of what most miltiary physicans think about their job.
     
  26. Mirror Form

    Mirror Form Thyroid Storm

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    You're either a recruiter, or just really really bad at math. Sure, if you do a lower paying field, than that's true. But compare the annual salary of a civlian radiologist to a military radiologist again?
     
  27. cavalier329

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    My post was not whether military medicine was right for me. It was what are the ways to get into military medicine aside from USUHS and HPSP?

    I will not live on the street as a military doctor. My family and I will not starve. I will not live in a slum. I want to be an officer and a doctor. The money comes in a very distant second to this dream.

    So please, answer my original question.

    Also, every industry has its complainers. Im sure much of the negative chatter on here is justified. However, it would be foolish to believe that similar ranting is not heard by civilian doctors. I hear it from my primary doc all the time. I also hear it every time I come into the ED at work. I understand that as a military doc I will probably not drive the latest lexus and buy every member of my family a benz as I probably would if I landed a hot shot surgery position at Columbia. This doesn't bother me. I want to be a doctor in the military...the money will follow. And lastly, any military doctor that says they are hurting financially is lying. They are surely not making as much as their civilian counterparts, but so be it. I'll sacrifice it for serving my country. You may think im naiive for not making money my priority. Thats fine. I'm not here to convince you.

    So again, my question is: what are the routes to military medicine?
     
  28. sethco

    sethco Senior Member

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    All the regular posters on this site get tired of pre-meds coming onto this website and ask questions that get asked roughly once every week or two.

    I am sorry you feel that you are not getting the answer you want, but it has already been answered in various posts in this thread alone, not to mention several prior posts in the past couple of months.

    But just to reitterate for you, the main other option other than USUHS or HPSP, is the FAP program. This program allows to go into your own residency and then join the military while a resident. Other posters have chosen this program, so they can answer the financial benefits.

    Other than that, you can always sign up for no educational/loan benefits by joining after you have already completed residency. That way you can brag to everybody on this site how much you are joining the military for a certain financial loss, and therefore you are a true patriot and are truly sacrificing yourself by serving your country.

    BTW, I love when new people come to this forum and tell people how much they complain or call them unpatriotic, even though they have ZERO military medicine experience (some even no military experience, at all)

    Hope this answers your question.
     
    #26 sethco, Jun 4, 2008
    Last edited: Jun 4, 2008
  29. cavalier329

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    Why does my level of experience matter? It has NOTHING to do with my question. You must believe that my alleged lack of experience translates to my own ignorance about the bureaucracy of the military. That is quite an assumption since you have no idea of my background, connections within the military.

    I am also not commenting on anyone's patriotism for it is not my place to do so. I respect and appreciate anyone's service, whatever their motive may be.

    If you have an issue with the questions being asked on this site then you should simply choose not to answer them. No need for comments like that. They are not productive.

    Forgive me if I intruded on your experienced forum.
     
  30. spicedmanna

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    Eh, I wouldn't take it personally. Many people who post here are experienced and helpful, but sometimes, perhaps a bit jaded. It happens when you see the same questions over and over again, and then answer with the same answer time and again. Also, it can be frustating to some people to be confronted with righteous, inexperienced individuals daily who claim to know everything (I'm not saying that this is you, just pointing it out in general). Sometimes, innocent people get caught in the crossfire, when they are asking a simple, honest question. We shouldn't become jaded, but that's the reality. I try to guard myself against that whenever possible.

    I'm sorry that you feel like an outsider. I'm sure it is not the intent of anyone in this forum to make you feel that way. I am not experienced in the ways of the military, but for what it's worth, I welcome you here. I wish I knew the answers to your questions, but sadly, I am but a novice. I do know that the major pathways are HPSP, USUHS, and FAP, as was mentioned above, by Sethco. Sometimes, people join the National Guard and gain entrance that way; actually it appears that they have a pretty good program going on, from what I read in other threads here. Other ways, I do not know.

    Good luck with everything.
     
    #28 spicedmanna, Jun 4, 2008
    Last edited: Jun 4, 2008
  31. notdeadyet

    notdeadyet Still in California
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    Actually, if you sign up with no strings, couldn't you theoretically leave after a year and do 7 years IRR? That might actually end up being the least financial loss of all the options. Just playing devil's advocate here.
     
  32. a1qwerty55

    a1qwerty55 Attending

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    Galo, please try not to overreact.

    OP:

    I would put very little credence on the above poster. He seeks to undermine the military medical system and the care servicemembers receive under the guise of performing some kind of public service to prospective applicants. The paints broadlly and inaccurately, his experiences while no doubt real, are his, and largely limited to those serving in the failing USAF system. On one point I agree, call others and get opinions from those serving, take this site with a grain of salt as the internet is the purvue of the disenchanted and bitter. PM me, I will give you an unvarnished frank opinion if you care. It will not be recruiter speak, and will not gloss over the negatives and current challenges.

    Galo and I have a running battle from time to time. He and I are cut from very different cloth. I like you get that there is something bigger than me and my immediate comforts and needs. He does not appear to understand the concept of sacrifice and service (my perception). You apparently do. Bottom line is that serving ,as I have stated several times, is a priviledge, and opportunity. It is not perhaps the best financial way to fund a medical education but it is not a bad way of doing so.

    Military medicine is as good as the people who work within it. You can do something to impact the system believe it or not. Contratry to the false dilemma presented by Galo, you can be both an officer and physician. These are not mutually exclusive. You will have experiences, good and bad (mainly good) to learn and grow from. There are still good hospitals, physicians and even physicians in leadership roles.
     
  33. a1qwerty55

    a1qwerty55 Attending

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    Galo, please try not to overreact.

    OP:

    I would put very little credence on the above poster. He seeks to undermine the military medical system and the care servicemembers receive under the guise of performing some kind of public service to prospective applicants. The paints broadlly and inaccurately, his experiences while no doubt real, are his, and largely limited to those serving in the failing USAF system. On one point I agree, call others and get opinions from those serving, take this site with a grain of salt as the internet is the purvue of the disenchanted and bitter. PM me, I will give you an unvarnished frank opinion if you care. It will not be recruiter speak, and will not gloss over the negatives and current challenges.

    Galo and I have a running battle from time to time. He and I are cut from very different cloth. I like you get that there is something bigger than me and my immediate comforts and needs. He does not appear to understand the concept of sacrifice and service (my perception). You apparently do. Bottom line is that serving ,as I have stated several times, is a priviledge, and opportunity. It is not perhaps the best financial way to fund a medical education but it is not a bad way of doing so.

    Military medicine is as good as the people who work within it. You can do something to impact the system believe it or not. Contratry to the false dilemma presented by Galo, you can be both an officer and physician. These are not mutually exclusive. You will have experiences, good and bad (mainly good) to learn and grow from. There are still good hospitals, physicians and even physicians in leadership roles.
     
  34. sethco

    sethco Senior Member

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    Yeah, I'm so mean. Sorry I hurt your feelings.

    Do you know how to use the search function?

    (BTW, you're welcome for the answers)
     
  35. sethco

    sethco Senior Member

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    No.

    The minute you go on Active Duty, you have a 8 year Minimum Service Obligation (MSO). Any time that is not served on active duty, must be made up with IRR/Active Reserve/Guard. If you sign up with the reserves, then you must complete 8 years with the Reserves/Guard/IRR

    As an example, if you only signed up for a 1 year active duty commitment, you may think that you are totally done, but you actually have to do 7 more years (non-active duty). Even if you do IRR, 7 years is a long time to sit there without being mobilized (Especially given the current climate)
     
  36. cavalier329

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    Come on, guy, give it a rest. Go post elsewhere if you aren't going to be productive. OK? You're bitter, I get it. Go pollute someone else's question.
     
  37. sethco

    sethco Senior Member

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    Wow. Congradulations, only 12 posts to you name and you think you own the place enough that you can tell people where to post.

    I am done with having this pissing contest with a pre-med. It really isn't worth it, at all.

    Hope you find whatever answers you're looking for. Good luck. :thumbup:

    (BTW, feel free not to respond to this post)
     
  38. Galo

    Galo Senior Member
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    This is me not overeacting:

    One thing is certain, we are from a totally different cloth. While he claims that the army is a good system where you can be both an officer and a doctor, my experience, and that of many others is very much the opposite. Once again, check the following link for a number of different opinions from physicians from all branches of the military:

    http://www.health.mil/Debates/Debate.aspx?ID=9&a=1

    You can see that the problems are not limited to the Air Force or Navy, but are service wide. The veiled insult that I did not care to sacrifice for my country while he sacrifices more than me is the typical bait that leads us to unprofessional name calling that is usually started by him. Also, it could never occur to someone that has been so bought and sold on a decaying system, that being unable (because of the multiple problems discussed on this forum daily) to provide quality care is totally contrary to the oath we took as physicians. Its one thing to sacrifice of yourself, but its completely different when you have to compromise, (sacrifice) care of patients because of the problems in military medicine. My role here is not a public service. It is merely to allow prospective students like yourself a glimpse of what is the current military health care system. IF, I was the only single person on this forum ranting and raving about how bad it was, I could understand people dismissing it as an anomaly. The reality is that its not just me, but many. Once again I point you to the Military Health System debate from the link above.

    I will agree with AI on two points. You should take all this with a grain of salt, (especially his advice). You should call up as many places as you can to get a feel of what reality is now for current AD physicians.

    I also agree that there are good people. Unfortunately those good people leave the moment they get a chance to do so. Good people in leadership positions is an exceedingly rare occurrence. My experience is that mediocre and less than mediocre people, (nurses, physicians, administrators) stay in and gain positions of power out of attrition, and have routinely less and less support, money, and good people to work with leading to an extremely difficult system in which to practice medicine, and one of the worst places to train as a physician in our society.

    Sure our civilian system is no where near perfect, and has multiple flaws, but compared to the military system, its a thousand times better in nearly every aspect, (slight exageration, but you get the point).

    I wish you luck, but I'd advise you once again to do thorough research.

    If you've already made up your mind, be sure and give some feedback on your experiences. Thanks
     
  39. a1qwerty55

    a1qwerty55 Attending

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    My responses are the bullets in italics.
     
  40. cavalier329

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    I want to thank everyone for their thought provoking responses. I will be sure to research this topic in great depth. A few of you will also certainly be getting PMs from me soon.

    As for sethco, if I ever met you, I would probably be disappointed as I sometimes am with doctors who have become so bitter about their field where they are just miserable people to work with. And oh yes, I see these doctors all the time in my job. Don't forget, you were a premed once as well. But then again, what do I know, I'm a lower person than yourself.

    Again, thank you everyone for your responses. For the most part, they are extremely, extremely helpful and valuable to me. I look forward to reading more.

    Would anyone out there know of good books on the subject. I'm looking for something that leaves out the drama (On Call in Hell) and gives me a good idea what it may be like and perhaps mentions some of the problems you all have discussed. THANKS!
     
  41. Galo

    Galo Senior Member
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    Originally Posted by Galo
    This is me not overeacting:

    One thing is certain, we are from a totally different cloth. While he claims that the army is a good system where you can be both an officer and a doctor, my experience, and that of many others is very much the opposite. Once again, check the following link for a number of different opinions from physicians from all branches of the military:

    http://www.health.mil/Debates/Debate.aspx?ID=9&a=1

    The above debate is quite instructive, in that it fleshes out the problems, which I have not shied away from identifying (please see one of my earliest posts if you doubt this). It also however represents a chance for those complaints to get visibility in a more offical forum, and hopefully lead to some changes. I suspect we will see some tangible changes from the healthy debates forum.
    Retention is a tremendous problem, but that does not mean that those who worked off their committment regretted serving or left on bad terms. Most of my colleagues who left were glad to move on but were not bitter. There are many good reasons for leaving, and frankly doing your 3-4 years helps, and is something to be proud of.


    So when other complain and give examples its "quite instructive", but when I have given my examples, its due to the AF, or some "pathology". If that's what you call deductive reasoning, you are clearly mistaken.


    The veiled insult that I did not care to sacrifice for my country while he sacrifices more than me is the typical bait that leads us to unprofessional name calling that is usually started by him.

    You cheapen your service when you spend so much time and effort on undermining the healthcare system. We have never disagreed that there are problems, the disagreement is whether there are solutions, and if the system is worth fixing. We also disagree as to the magnitude of the problems. You continually assert that somehow one has to compromise their professional ethics to serve, this is patently false.
    I don't impune your service, but I question why someone would post daily on a medical student board years after their service. It suggests an axe to grind or some pathology. You may call this name calling, I call it reasoning.


    Pointing out the inadequacies and problems in military medicine is not cheapening my service, it is what a patriot does when they see that there are immediate and important fallacies in the system, and that by keeping quiet like you, nothing is going to change. Also I never compromised my professional ethics when it came to patient care. Although I witnessed many "officers" who placed their misguided ethics above patient care. Are you one of those? What possibly can you and these great physician leaders do to better the system when the people who actually run it seem to be ignorant of the problems happening? The pathology here is you have some ax to gring against me, and this forum is not the place for it. Being insulted by you is only reasoning in your deranged mind.


    I also agree that there are good people. Unfortunately those good people leave the moment they get a chance to do so. Good people in leadership positions is an exceedingly rare occurrence. My experience is that mediocre and less than mediocre people, (nurses, physicians, administrators) stay in and gain positions of power out of attrition, and have routinely less and less support, money, and good people to work with leading to an extremely difficult system in which to practice medicine, and one of the worst places to train as a physician in our society.

    Above are great examples of the differences between us. Galo paints with broad generalizations, e.g. "good people in leadership positions are exceedingly rare", and "those good people leave the moment they get a chance to". He cannot accept that there is a cadre of committed, intelligent professional and competent physician leaders, who are trying to guide of out of this mess. He deals in absolutes; examples being a common refrain that you must compromise quality or professional ethics to serve, or that all O-6's are incompetent, and unable to practice in the civilian world (I'm not an O-6 by the way). These are his words not mine.

    I have given examples of the attrocities I have witnessed 0-6's commit, and have often said that most physicians at that rank are not often practicing medicine, and some very poorly. I have also met a tiny minority that is competent, caring, and attempting to change the system only within their vicinity. I dare you to place "my words" where I make the statement that all 0-6's are incompentent. Once again that is a bold faced lie.

    Other false absolutes include assertions that civilian resdencies are better, military training is universaly poor, civilian healthcare is infiinitely better etc. etc. Any critical thinker will quickly see the fallcies of these arguments.
    He also lives in the world of anecdotes, "in my experience" figures prominently in his posts. Sometimes we make our experiences, be they good or bad.

    All those assertions are open to debate in this forum on a regular basis. Also in what world do you live in. What makes the army such a great place to practice? Do you post that based on the experience of others, or based on YOUR EXPERIENCE?? Where is the anecdote?



    If we dissuade good people from entering the system, what good is accomplished? None. I agree that applicants have the right to accurate information but I do not feel that hyperbolic rants accomplish this.

    If the system gets to the point where the leaders undertand the problems, something might be done about it. Why support a continually failing system? If my rants are hyperbole, what are yours, military gospel??


    Remember when he trashes Army medicine, that one of us actually has and still serves in the Army, the other, Galo has no first hand experience with with the Army and I believe left with an Article 15 years ago from the USAF.

    This is a bold faced lie, and a maliciously defamatory statement. Do I make up lies about you?


    I do not hold myself up as morally superior nor more patriotic, but I do take pride in the fact that rather than trashing the system, I am trying to make tangible contributions from within.

    What tangible contributions have you made? I don't recall you bragging about how you've changed the system for the better. The tone of every single responce of yours is that you are some kind of special army doctor, the word narcissistic does not even begin to describe how you write about yourself and denigrate others, especially me.

    Honestly the only reasons I even check this board is to serve as a counterbalance to Galo and to try to provide honest information to the best of my abilities.


    I think you and I need to meet face to face. Send me a PM and lets have a talk.

    My responces are in BOLD....Galo




    My responses are the bullets in italics.








    If you're only purpose here is to come against me, you really are misguided and sick.

    Anyone is free to search my posts, and on my very first post I explain my experience and my HONORABLE DISCHARGE.

    You have your experience, but in the entire time you have neglected to tell us what kind of physician you are, your rank, all under the veil that you are afraid of the Army. Of what I am not sure, since you continue to be their #1 cheerleader.

    Note I have reported this as an inappropriate post instead of lying and making up stuff about your professionalism, or lack thereof.

    You admittedly serve no purpose here other than to attack me, so have fun, I'm sure your lies have convinced the OP, who seems to have already made up his mind, that the army is a worthwhile place to practice medicine. You saved one, enjoy!!
     
    #39 Galo, Jun 5, 2008
    Last edited: Jun 5, 2008
  42. Perrotfish

    Perrotfish Has an MD in Horribleness
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    These are exceedingly hard to find, and all the ones that there are seem to focus on Iraq and not military care within the US. "Rule Nuber 2" gives a psychlogyists account of a major trauma center in Iraq. Still a lot of drama, but more useful than "on call in hell", which I've been told is very atypical. If you find anything better please let us know.
     
  43. a1qwerty55

    a1qwerty55 Attending

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    Remember when he trashes Army medicine, that one of us actually has and still serves in the Army, the other, Galo has no first hand experience with with the Army and I believe left with an Article 15 years ago from the USAF.

    This is a bold faced lie, and a maliciously defamatory statement. Do I make up lies about you? Actually you do.


    To clarify, on one of your posts, you mentioned nonjudicial punishment you received for I believe Jay-walking. If I am in error, please provide the clarification and accept my sincere apology. As stated before, I'd like this not to turn into unproductive name calling. If however you did receive a letter or reprimand, or Art, 15, this does say something (possibly) about your character, or at least behavior.

    I think you and I need to meet face to face. Send me a PM and lets have a talk.
    For what purpose? Is this some kind of ridiculous high school threat?

    Anyone is free to search my posts, and on my very first post I explain my experience and my HONORABLE DISCHARGE.

    For those who don't know, it is quite difficult to get anything less than an honorable discharge unless you commit a crime.

    It is like pointing to board certification as a marker of clinical excellence.
     
  44. Galo

    Galo Senior Member
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    To clarify, on one of your posts, you mentioned nonjudicial punishment you received for I believe Jay-walking. If I am in error, please provide the clarification and accept my sincere apology. As stated before, I'd like this not to turn into unproductive name calling. If however you did receive a letter or reprimand, or Art, 15, this does say something (possibly) about your character, or at least behavior.

    This will be my last post to A1 on this thread.

    Yea I got a letter of reprimand for jaywalking. As ridiculous as it sounds that is the truth, and I posted that on my very first post here on this forum.

    General Billy Mitchell was court martialed. What did that say about his character. Col John Boyd, was reprimanded for yelling at a superior officer, Col Bud Day was passed over for promotion after spending 6 year honorably resisiting as a POW. What does it say about their character. People who stand up for what they believe often will come up against a wall in the military mindset that often drives on mediocrity, and this is most true in the medical field. I do not consider it a generalization when I said that my experience has been that by majority, the leadership in the medical field is exceedingly poor, and resistant to change. That is a fact. It may not be so at your base, but its what I saw consistently AF wide.

    I accept your apology for that malicious lie.

    I also sent you a PM and reported your post as inappropriate. Lets take this personal vendetta that you have to another place.
     
  45. haujun

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    The purpose of HPSP/USUHS program is to provide soldiers who can function as an officer and doctor during WAR/Deployments. We are fully aware of what is to expect from us when we swear by raising our right hand to accept the "service" and others like (high school students, ROTC etc) across country doing the same before entering their training. We are all soldier.

    Those civilian contractors can stay in the military medical centers and provide medical care to solidiers/retirees, but they are not the same. I read thru the debate and many reasons that doctors have to leave the service. However great majority of universal complaints apply to all aspect to military service and are inherent part of military service. I am going address some of them.

    "I am not trained at what I do"
    I know this does not make sense. However this is a common complaints among other enlisted soliders finishing ADT and being stationed at various places around the world. For example MEDICS are working as a mechanics sometimes etc. The needs of service takes precedence of your needs in military.

    "Pay is not good" "I get pay same to other guy who is not productive"
    We all know the pay situation (Basic pay based on number of years) before raising the right hand to enter the service. This is how military has been paying service members all these years as well as foreign military. We do get paid bonus, ISP etc which may not be amount much to some of you who are enjoying civilian doc pay, but remember other soliders/ most U.S. median pay get paid signficant less than you.

    "I don't like deployments"
    We all raise right hand to protect this country as soldier and we all wear same uniform and paid according to rank and time of service. We all lost some of freedom so that others could keep theirs. Remember there other soldiers who are deployed longer/ more frequent than us.

    "civilian doctors have ***"
    If a 19 y/o infantry soldier (who should be in college) complain that his civilian counterpart can do *** what would you say? Again HPSP is not a scholarship or financial aid. We all took verbal part of MCAT. Read between the lines. We are military officer who happend to be a doctor.

    "I don't like where I am assigned. I don't like my supervisor. Moving every 2 year is difficult"
    Although this is true in civilian sector as well it is going to even more challenging in military climate when you deploy, move and work people you may not like. This is a part of military lifestyle adopt by your other non-doc soldiers as well. Military is not going treat us differently because we are doctor. Conversely if you stay long enough hope that you may enjoy some of people you contact, some of supervisor.

    "More money should devote on retain good doctors"
    This was an issue brought by NCO when military was offering very attractive signing bonuses to local high school recruits whereas there was little incentive for junior/senior NCO to stay in military. As long as U.S. military adopt all volunteer army military will offer financial incentive to those who are not in service and may not be as aggressive to those soliders who are already in the service. Again this is not the isolated problem in the miltary medcine.

    "Line officers are respected more"
    There no doubt that not captains are same. I met countless dedicated O-3 who able to lead group of young soldiers (just graduated out of H.S.) and mold them to outstanding at what they do. While we are fresh out of residency we worry about our next deployment, pay, how much my civilian buddys are making, bonuses etc. IF you are junior enlisted who would you respect more? While we say we care about solider's care this military forum is filled with money, deployment, bonus concerns etc.

    Debate website that GALO showed go into much discussion about state of military medicine. There are several good points that I hope U.S. government take serious consideration when it comes to our education and our ability to take care of soliders.
     
    #43 haujun, Jun 8, 2008
    Last edited: Jun 8, 2008
  46. DenaDoc

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    Hi,

    I am a re-applicant this year and am thinking about applying to the Army HPSP. While service to this country is a primary factor for my interest, I also want to see if it is possible to go through Ranger School or SFAS as a medical student or physician.

    Would someone please shed some light on training opportunities that may lie outside a physician MOS?

    Thanks and I wish the best of luck to you all.
     
  47. Mirror Form

    Mirror Form Thyroid Storm

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    I agree that nobody wants to hear anyone complain about being deployed. But the main issue for many docs is that they are deployed and do not use the skills they spent 10 years learning. So over 6 months in the sandbox their medical skills, and surgical skills (in some forms of surgery) erode and when they come back they feel incompetent (and frequently are).

    I agree with you to some extent on this. But there is a lot more to it than that. For example, keep in mind that in medicie there is a hierarchy, and the military screws with this hierarchy by making nurses higher ranking then doctors, which pisses people off. I also don't have the ability to choose comepetent technicians to work for me, and instead get stuck w/ lazy and incompetent ones. When these factors inhibit your ability to provide good medical care it becomes a lot more than just "wah wah i want what civ doc has."

    Aah, but how many enlisted just started paying off their 4 to 7 year commitment at the age of 30+? How about after spending three to seven years not paying back any of their obligation (or racking up more time) during a required military residency?

    Our commitments are in general a lot longer, and occur at a much older age. Yeah, if I was 18 y/o then moving around probably wouldn't bother me as much. If I was an infantry captain I wouldn't suddenly just be just starting on active duty w/ 8+ years to pay off.
     

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