Since it seems most posters on here who took the HPSP scholarship hated it...

[asdf123g]

..do HPSP recipients tend to shy away from specialties with longer residencies because they have to serve longer ADT?

---

Members don't see this ad.

 

[asdf123g]

please move to mil med (@AlteredScale only mod i know). SDN glictched out on me.

 

[HighPriest]

No

 

[Cooperd0g]

Not from what I have seen. The ones who really want out fast will just do their 4 years as a GMO and then apply for the civilian match.

 

[HighPriest]

The fact is, from my experience and from my interactions with others, most people don't hate thier military experience until they are at least in residency if not after they have finished residency. As I and others have stated many times on this thread: your military experience will vary significantly depending upon pure chance, and you don't really get your turn on the roulette wheel until at least residency - usually not until your first assignment. So it doesn't seem to effect residency choice all that much. As mentioned, GMO is an option for those who hate the military before they've even spent any real time within it's terrible, soul-crushing grasp.

 

[BigNavyPedsGuy]

People want to do the specialty of choice. The ones that REALLY hate it are those that military doesn't let do the preferred specialty.

 

[orbitsurgMD]

Of course, in the civilian world they call this "not matching".

But for some reason we are willing to accept that military residents "weren't allowed" to do their specialty of choice...

It's not quite the same. Weren't "allowed" includes persons not allowed training deferments.

Some specialties are underrepresented or not allowed (PM&R is one) based on the service's interpretation of its needs, even when there is a factual justification for having trained specialists. Some specialties have very few in-service training opportunities for persons that are competitive in the civilian match.

The priorities of the medical corps has shown preference for using its supply of HPSP graduates as cheap fill for its dubious and antiquated tasking as general medical officers and then only as a source of candidates for residency. When they are desperate, they waive the GMO assignments, because if they aggravated everyone, no one would wait around for their residencies in fields where there are constant needs but relatively few applicants, like psychiatry.

 

[colbgw02]

Yeah, it seems pretty clear to me that "not matching" carries with it certain implications, namely having some sort of problem with your application - like a bad step score or failing to apply broadly enough.

In contradistinction, in the military, an applicant can have none of those problems yet still not match - hence the different terminology.

 

[Gastrapathy]

Particularly in small subs.

Tired, are there ortho subs that aren't offered every year? With minimum activity, a great candidate can have to wait years to even apply.

That is different than not matching.

 

[asdf123g]

if you had to put a # on it, what % of the time do people get "screwed" out of their specialty of choice in the military?

 

[colbgw02]

"Not matching" in the civilian world may have negative connotations for non-competitive specialties, but certainly there are many decent candidates to the competitive specialties that don't match.

It has negative connotations for competitive specialties too, not just as severe, even if it's as simple as someone who overrated his competitiveness by neglecting to apply broadly enough.

I just don't think we should be surprised that we use different phrases and terms to delineate between the distinctly different ways by which people don't match in the civilian vs. military world. Yeah, there are going to be crappy applicants who hide behind "military" reasons for not matching, but those people are just the big-boned folks of the obese world.

 

[IlDestriero]

if you had to put a # on it, what % of the time do people get "screwed" out of their specialty of choice in the military?

Nobody is screwed out of anything, as you can always GMO out and go civilian into whatever you want, with some great "war stories".

 

[BigNavyPedsGuy]

That's fair. And certainly I've interviewed a number of very quality applicants who failed to match. It just seems weird to hear about people getting screwed, when all it really comes down to is that there were better applicants. No one is getting tricked or having the rules changed.

I may be blinded to some of this because we are a categorical internship now. If I were in Ophtho or something else where GMO was still mandatory and the uncertainty persisted well past the initial PGY1 match, I might feel differently.

The availability flexes year to year. Peds barely ever had the same number of slots year to year. And Peds subspecialties...forget about it. Some they seem to train every 2-3 years, others they let somebody do once every 5-7 years. And no, when I was a 22 year old pre-med student I didn't know these numbers.

I think it's pretty dumb to say "well, people know what they re getting into when they signed up." It's just dumb to expect an undergrad to understand this nuance. And I'm talking about Peds ID. NOT a competitive subspecialty.

 

[j4pac]

You're talking about fellowships not residency. I was saying that the number of residency slots are stable. I'm personally and intimately aware of the variability in fellowship training.

And it's not dumb at all to expect people to educate themselves on major life decisions. Look at the level of detail the average pre-allo poster can break down medical school admissions! We're talking about people in their mid-20s, college graduates. It is not unreasonable to expect people to read their contracts, research the issues, and understand the nuances.

To think that the average pre-med student is an SDN junky is false. SDN consists of primarily gunners...especially on the pre-allo side. "I'm having a tough time deciding between Hopkins and Mayo...help plsss!"

The pre-med version of me was too busy trying to find cheap beer & wings...and an occasional free girl!

 

[backrow]

You're talking about fellowships not residency. I was saying that the number of residency slots are stable.

Actually residency numbers can fluctuate as well, especially in the smaller residencies. radiology at some sites has varied from 4-6 at some Navy sites over the last 5 years or so, ENT went without selecting anyone a couple years ago (if memory serves me correctly), and ophthalmology has varied between 2-4 over the last several years.

I would bet there have been fluctuations in others as well, those are just the ones I'm most familiar with for the Navy.

 

[Gastrapathy]

ACGME controls min and max spots per site. The Navy decides how many within that range. Residency numbers have been relatively stable over time with the exception of some smaller residencies (urology for example) and peds. I'm told that OB took a hit the last couple years but can't speak to specifics.

 

[HighPriest]

I generally agree that you're not "getting screwed" by not getting selected, in the sense that there are better candidates. I think people view it this way for two reasons: 1: many of them would in fact get selected in the civilian sector - perhaps not at a top ten program, but nonetheless. 2: Recruiters are out there telling applicants that you can do any residency/fellowship you want, and that GMO tours essentially never happen (Army), and that no one gets forced to do any specialty that they don't want to do. That's what my recruiter told me many years back, and it was a bold-faced lie. Now, I will also be the first to say that it is ultimately your responsibility to fact check and make sure you're signing what you think you are, but I can also understand why people would get pissed off after the organization's representative misrepresents it.

In any case, for me, the real hatred starts after residency when it comes to station choice or fellowship choices -that's where the real "chance" sets in.

Hilariously, we just got a mass e-mail in the Army from HRC. It was sent to multiple attendings, residents, and lowly jerkoffs like myself. It basically said that everyone on the list was due to PCS and that the only exceptions are people who have PCSed in the last 3 years, those in training, and those who are within 2 years of seperation/retirement. A lot of the people on the list were O-5/6s at cush stations who had been there for many years. The flood of e-mails that followed - LTC/COLs clawing at the walls trying to explain why they shouldn't be moved - it was like a cool breeze on a summer night. Nothing will ever come of that e-mail, but it was refreshing to watch HRC kick the stool that so many have been sitting on, and to watch their collective arms flail in response....speaking of things that they Army is well within their rights to do (PCS moves)...

 

[colbgw02]

Hilariously, we just got a mass e-mail in the Army from HRC. It was sent to multiple attendings, residents, and lowly jerkoffs like myself. It basically said that everyone on the list was due to PCS and that the only exceptions are people who have PCSed in the last 3 years, those in training, and those who are within 2 years of seperation/retirement. A lot of the people on the list were O-5/6s at cush stations who had been there for many years. The flood of e-mails that followed - LTC/COLs clawing at the walls trying to explain why they shouldn't be moved - it was like a cool breeze on a summer night. Nothing will ever come of that e-mail, but it was refreshing to watch HRC kick the stool that so many have been sitting on, and to watch their collective arms flail in response....speaking of things that they Army is well within their rights to do (PCS moves)...

Is that what that was about? I've got one foot out the door, so I'm only checking email sporadically and even then I've got a trigger finger for the delete button, but I was wondering why I was getting so many emails from random colonels. Oh man, I bet some jimmies were seriously rustled.

 

[j4pac]

I'll also say that FINDING information is incredibly difficult when it comes to the military. I never went to SDN as a pre-med. I started coming when a ton of questions began to arise along my military career. And even WITH SDN it's not easy to get clear answers.

I think that a big issue that many people have is that military GME is often more competitive than civilian GME. It's not always easy to get non-competitive nor competitive specialties. Lots of people just get the feeling that they are being funneled toward GMO.

I personally am a glass half full type of guy, so I don't sweat it. I was one of those guys kind of "screwed" by the military GME process...but in an effort to become competitive in the incredibly competitive military GME climate, I believe I made myself very competitive for civilian residencies.

 

[Ziehl-Neelsen]

Hilariously, we just got a mass e-mail in the Army from HRC. It was sent to multiple attendings, residents, and lowly jerkoffs like myself. It basically said that everyone on the list was due to PCS and that the only exceptions are people who have PCSed in the last 3 years, those in training, and those who are within 2 years of seperation/retirement. A lot of the people on the list were O-5/6s at cush stations who had been there for many years. The flood of e-mails that followed - LTC/COLs clawing at the walls trying to explain why they shouldn't be moved - it was like a cool breeze on a summer night. Nothing will ever come of that e-mail, but it was refreshing to watch HRC kick the stool that so many have been sitting on, and to watch their collective arms flail in response....speaking of things that they Army is well within their rights to do (PCS moves)...

Yes and no.

I certainly agree that there are many physicians hiding out in nice locales and cush positions that should be forced to share the pain of a Fort Polk or Fort Drum assignment, but there are those with a legitimate reason to homestead where it's also in the best interest of the Army.

If you are a standard, non sub-specialty trained insert medical specialty you shouldn't be allowed to hang out at Tripler or Madigan for 10+ years. If you volunteer and are selected for the suck of a being a program director you should be allowed to do the full six years in this position without PERSCOM threatening to move you. The military used to pay a bonus to those serving as program directors; I don't think that a homestead stint in a "desirable" location is too much to ask now that no extra money is forthcoming (especially in light of what would happen to a residency that had a different program director every 3 years).

Other stuff is just common sense. I noted that the Army's 2 orthopedic oncologic surgeons were on the e-mail list. One is at SAMMC and the other is at WRNMMC. Should the Army really swap those 2 docs between SAMMC and WRNMMC by means of Q3 year PCS moves just for the sake of propriety? I thought it was generally understood that homesteading required taking positions nobody else wanted or subspecializing one's self to the point that there are literally 1 or 2 billets in the entire Army one could fill.

I know some fat and happy O-5/O-6 homesteaders who deserve to have their cages rattled, but I'm not about to endorse a "cut off my nose to spite my face" blanket 3 year TOS PCS policy.

 

[HighPriest]

Yes and no.

I certainly agree that there are many physicians hiding out in nice locales and cush positions that should be forced to share the pain of a Fort Polk or Fort Drum assignment, but there are those with a legitimate reason to homestead where it's also in the best interest of the Army.

If you are a standard, non sub-specialty trained insert medical specialty you shouldn't be allowed to hang out at Tripler or Madigan for 10+ years. If you volunteer and are selected for the suck of a being a program director you should be allowed to do the full six years in this position without PERSCOM threatening to move you. The military used to pay a bonus to those serving as program directors; I don't think that a homestead stint in a "desirable" location is too much to ask now that no extra money is forthcoming (especially in light of what would happen to a residency that had a different program director every 3 years).

Other stuff is just common sense. I noted that the Army's 2 orthopedic oncologic surgeons were on the e-mail list. One is at SAMMC and the other is at WRNMMC. Should the Army really swap those 2 docs between SAMMC and WRNMMC by means of Q3 year PCS moves just for the sake of propriety? I thought it was generally understood that homesteading required taking positions nobody else wanted or subspecializing one's self to the point that there are literally 1 or 2 billets in the entire Army one could fill.

I know some fat and happy O-5/O-6 homesteaders who deserve to have their cages rattled, but I'm not about to endorse a "cut off my nose to spite my face" blanket 3 year TOS PCS policy.

Oh, I get it. I actually think that there are VERY good reasons for homesteading. (spefically in terms of having fellowship trained physicians at larger instillations and for resident training). I also don't advocate moving people without reason. But that doesn't make it any less funny. There is absolutely an "ivory tower (as it were)" situation in the Army (at least in my specialty) and I thought the e-mail was frought with comedy.

What I don't like is that most of the guys that I know who have been stationed at great stations for 10+ years without every having the threat of a move will be the first guys to tell you that "it ain't so bad" at some of the podunk stations in BFE. There are a lot of people in the Army (and likely the other services) who never have and never will have any idea what it's like to practice outside a large MEDCEN. Most of those guys end up being consultants at some point, and because of that we have a string of consultants who have no idea what it's like to work outside of a major MEDCEN either. I find that incompatable with good leadership.

I don't feel that being a program director is some kind of punishment that warrants special treatment or pay. Department Chiefs don't get special pay, but they do a lot of extra work. I'd happily take on a program directorship if it meant being at a desireable location, having residents to work with, and not having to worry about a PCS. But keep in mind, I support the idea of not moving program directors from the standpoint of training residents. It makes sense to keep them around.

Additionally, at least within my specialty, the retention rates approximate zero. The only people who have a snowball's chance of sticking around are the guys who are embedded into a major medical center. It would make more sense to me, as a lowly jerkoff with no relevant ideas, to keep at least ONE spot open for rotating lowly jerkoffs every 3-4 years. Then at least I'd have SOME change of getting stationed somewhere that God pays attention during my career. I think that would do WONDERS in terms of keeping people in service. Yes, many people would still leave, but if I thought there was even a 1/10 chance that I might end up in a better spot if I added some ADSO it would change the equation considerably. I have to assume that I'm not the only one who feels that way. As it is, there is zero chance that I would end up at a major MEDCEN unless I stayed in until I did a fellowship and/or got close to 20 years and a bird on my chest. I realize that not all specialties are that way, but the smaller ones most certainly are, and in most cases those are the places where retention is the worst.

 

[HighPriest]

I should also state: while I personally, professionally, and ethically agree that an orthopaedic oncologic surgeon should be stationed somewhere where he can do orthopaedic oncologic surgery, that is probably not why the Army is keeping those guys at their stations. I say this because people get stations all the time where they cannot perform the full spectrum of their duties. I'm at such a station currently. There's a pediatric neuro-ophthamologist out there filing paperwork all day long who agrees with me. We are overstaffed with surgical oncologists in my field coming out of training who have nowhere to go because the Army overtrained. So while I agree with the idea of homesteading those guys, it is tradition that keeps them where they are rather than logic. So I find their position to be a fortune of chance rather than a result of a homesteading policy. It is a good thing, but I don't give the Army credit for it. Their consultants deserve some credit, for sure.

PS - this is meant to be a bit tongue-in-cheek. Suffice to say that I think that often when the system works it does so in spite of itself.

 

[HighPriest]

I think that the real sub-sub-specialists (like Ortho Onc) just kind of giggled when they saw the email. Clearly it was a mass spam based on rank, and I don't think anyone really believes they're going to start doing those kinds of swaps. Especially since both of those guys do quite a bit more than just orthopaedic oncology.

Of course they won't. Although I don't think those guys should giggle at anything, especially since they sent a sub-sub specialist ophthamologist and a sub specialist dermatologist to a brigade surgeon billet. That's nothing to giggle about. They'll never act on anything like that for a variety of reasons, even in the specific cases where it would actually make sense to shuffle things around.

In any case, it was still funny to see the few freak-outs that did come through.

 

[HighPriest]

In the Army, brigade surgeon is a 2 year stint with little to no clinical time.

 

[idq1i]

Of course they won't. Although I don't think those guys should giggle at anything, especially since they sent a sub-sub specialist ophthalmologist and a sub specialist dermatologist to a brigade surgeon billet. That's nothing to giggle about. They'll never act on anything like that for a variety of reasons, even in the specific cases where it would actually make sense to shuffle things around.

In any case, it was still funny to see the few freak-outs that did come through.

1 - why the hell does the army need a super sub-specialized MDs?
2 - what's the excuse for allowing non-subspecialized (and non-EFMP) MDs to homestead at MEDCENs? If everyone needs to PCS Q2-3 years, how are our consultants granted powers to disregard policy? I thought the DoD was all about rules and regulations?

I take #2 personally. I've met multiple SMs at national meetings who have no idea why it's so bad in the MC. After all, they've been stationed at WR or San Diego for 5+ years, they all have a huge gut, they all have sleep apnea and other bullcrap profiles. I bet they can barely remember which hand to salute with. I can name names, but I won't.

On the other hand, after achieving top scores, top residency rankings, I got 2 crap assignments, one for location and the other for scope of practice. I am applying for fellowship now, but I am dreading starting the fellowship because of skill atrophy.

HRC should shake the tree and should take consultants' discretionary powers away. We should all be be exposed to the good(?) and the bad of milmed. If my specialty is raided for BDE surgeons, an ortho onc surgeon should also get a stint in FLW/Polk

The consultants should also be forced to interact face-to-face with their MOC cohort whether it's through TDY or VTC. The assignment process should be brought out into the light. Everyone should know what slots are open, and assignment decision process should be publicized (short of medical info). This is not a good ol' boys club

 

[idq1i]

Um...

...to begin directly after ETS. As if you didn't understand that. You should consider keeping insightful posts like that in pre-allo.

My point is that most complicated stuff gets sent to the real civilian medical world. There are too few sub specialists in the dod to make a difference/save money so there's no real reason to fund their training

milmed should realize that they have 3 real purposes:
1 - keep a pool of deployable MDs to triage battlefield injuries
2 - help PVT Snuffy pad/manage disability claims
3 - treat sniffles/STDs/pneumonia/stress fx and other mundane crap

We don't need an neuro-ophtho-surgeo-oncologist specializing in trilateral retinoblastoma in children under 22.2 months old

 

[HighPriest]

1 - why the hell does the army need a super sub-specialized MDs?
2 - what's the excuse for allowing non-subspecialized (and non-EFMP) MDs to homestead at MEDCENs? If everyone needs to PCS Q2-3 years, how are our consultants granted powers to disregard policy? I thought the DoD was all about rules and regulations?

I take #2 personally. I've met multiple SMs at national meetings who have no idea why it's so bad in the MC. After all, they've been stationed at WR or San Diego for 5+ years, they all have a huge gut, they all have sleep apnea and other bullcrap profiles. I bet they can barely remember which hand to salute with. I can name names, but I won't.

On the other hand, after achieving top scores, top residency rankings, I got 2 crap assignments, one for location and the other for scope of practice. I am applying for fellowship now, but I am dreading starting the fellowship because of skill atrophy.

HRC should shake the tree and should take consultants' discretionary powers away. We should all be be exposed to the good(?) and the bad of milmed. If my specialty is raided for BDE surgeons, an ortho onc surgeon should also get a stint in FLW/Polk

The consultants should also be forced to interact face-to-face with their MOC cohort whether it's through TDY or VTC. The assignment process should be brought out into the light. Everyone should know what slots are open, and assignment decision process should be publicized (short of medical info). This is not a good ol' boys club

Yeah, I hear you. In my field, there really aren't any non-fellowship trained staff docs at the major MEDCENs. If there are, they're typically an O-6 within spitting distance of retiring. But I couldn't agree more that in specialties where it matters they can and should mix things up more frequently. Like I said, I understand the logic behind stationing fellowship trained docs at larger centers, and the logic between keeping residency-program directors locked down (at least while they are directing said program). In certain, specific cases homesteading makes perfect sense. But there are a lot of guys who roll a 7 and end up at a cush spot the first go-around, and just never leave. We've applied homesteading to essentially everyone, without rhyme or reason. That's BS. The Army could increase its retention standards, I feel, just by eliminating that. I can also say that I certainly see a lot of favoritism in the process. I currently have a pretty reasonable consultant, but in the past that has not been the case. I have seen residents from my consultant's program get favorable treatment relative to everyone else. The consultants probably do have too much power in terms of that sort of thing, but the alternative is giving power back to OTSG or the real Army, and I think I'm more afraid of that.

In terms of whether or not the Army needs sub-sub specialists: I honestly don't know. I think that all of the subspecialties in my field are generally supported by our patient population with the possible exception of oncology. But our surgical oncologists have skillsets native to their field that make them very useful even if they aren't actually treating cancer. What I always find hilarious are the guys who do a fellowship so that they can be stationed at a MEDCEN, and then they don't actually practice the type of medicine they learned in their fellowship - or if they do, they don't practice the aspect of that fellowship that is actually useful to the Army. But that's another discussion entirely.

 

[idq1i]

What I always find hilarious are the guys who do a fellowship so that they can be stationed at a MEDCEN, and then they don't actually practice the type of medicine they learned in their fellowship - or if they do, they don't practice the aspect of that fellowship that is actually useful to the Army. But that's another discussion entirely.

Rampant in my MOC, and branch leadership keeps allowing it. I was forced to do things out of my comfort zone right out of residency, and I was told to screw off when I asked for help from the subspecialty-fat medcen, even via VTC.

 

[colbgw02]

I'd much rather see the consultants remain the prime movers in assignments. They may not always be fair or wise, but I trust them a whole lot more than I do HRC. We're just warm bodies with SSNs to the people at Ft. Knox. The consultants at least have a sense of what it means to practice specialty X, and they have a better idea of how to distribute resources, particularly for GME purposes.

 

[idq1i]

I'd much rather see the consultants remain the prime movers in assignments. They may not always be fair or wise, but I trust them a whole lot more than I do HRC. We're just warm bodies with SSNs to the people at Ft. Knox. The consultants at least have a sense of what it means to practice specialty X, and they have a better idea of how to distribute resources, particularly for GME purposes.

You REALLY, REALLY think that your consultant cares about you? Seriously? You mean the one that allowed for the BDE surgeon debacle? The one reaching for the star? I don't think he knows me from a pothole on I-10.

 

[Member 1337]

You REALLY, REALLY think that your consultant cares about you? Seriously? You mean the one that allowed for the BDE surgeon debacle? The one reaching for the star? I don't think he knows me from a pothole on I-10.

Yikes... kind of a negative nancy... debbie downer much?

 

[colbgw02]

You REALLY, REALLY think that your consultant cares about you? Seriously? You mean the one that allowed the BDE surgeon debacle? The one reaching for the star? I don't think he knows me from a pothole on I-10.

Well, the point is that I think the consultants, on the whole, will keep more people happy while also accomplishing the mission with respect to assignments than whatever non-physician at HRC who would otherwise be making the decisions. It was HRC, after all, who decided to tap "overmanned" specialists as BDE surgeons.

And, to answer your questions, because apparently we're talking about a specific person here, yes - I do think my current consultant cares about me, inasmuch as anyone in upper management ever cares about their rank-and-file employees. He did, after all, take on HRC to get me relieved from a BDE surgeon tasking because of some peronsal circumstances that would have made the assignment even more onerous than it already is. He didn't have to do that, so it'd be pretty disingenuous for me to say that he doesn't care about me.

I understand that he's a 'company man' and that he'd like to be a general officer, but that doesn't mean that he isn't a genuinely good person who tries to do his best within the system. I wouldn't say that about all of the consultants I've worked under, but I'll say it about him.

Lastly, he didn't "allow" the BDE surgeon debacle. Having had multiple face-to-face conversations with him when this first went down a few years ago, I can tell you that he made a lot of noise and made appeals until finally being shot down by the head of the entire medical corps - a two-star general. It's not like he was going to disobey orders, so I don't really know what else he - or any other consultant in that situation - was supposed to do.

 

[idq1i]

Well, the point is that I think the consultants, on the whole, will keep more people happy while also accomplishing the mission with respect to assignments than whatever non-physician at HRC who would otherwise be making the decisions. It was HRC, after all, who decided to tap "overmanned" specialists as BDE surgeons.

And, to answer your questions, because apparently we're talking about a specific person here, yes - I do think my current consultant cares about me, inasmuch as anyone in upper management ever cares about their rank-and-file employees. He did, after all, take on HRC to get me relieved from a BDE surgeon tasking because of some peronsal circumstances that would have made the assignment even more onerous than it already is. He didn't have to do that, so it'd be pretty disingenuous for me to say that he doesn't care about me.

I understand that he's a 'company man' and that he'd like to be a general officer, but that doesn't mean that he isn't a genuinely good person who tries to do his best within the system. I wouldn't say that about all of the consultants I've worked under, but I'll say it about him.

Lastly, he didn't "allow" the BDE surgeon debacle. Having had multiple face-to-face conversations with him when this first went down a few years ago, I can tell you that he made a lot of noise and made appeals until finally being shot down by the head of the entire medical corps - a two-star general. It's not like he was going to disobey orders, so I don't really know what else he - or any other consultant in that situation - was supposed to do.

I am not blaming him for inventing BDE assignments, and I am sure he couldn't have changed the entire army system. Maybe I am assigning too much direct blame here. If in his shoes and facing the directive, I would have resigned my position as the consultant - I feel that strongly about it. I think that a consultant should be much less of a company man as you put it, and much more of a specialty man. I think that once you set sights on a star, you should recuse yourself from direct dealing with the "common folk," particularly stationed at BFE locations. Also, how would you explain the chronic overmanning at SAMMC and WR? What's wrong with taking some of those non-procedural fellowship-trained people and sending them to an MTF for a year or two?

 

[idq1i]

Caring about people and always giving them what they want aren't the same thing.

Chronically screwing one group while favoring another (already at a good location) is also different. Maybe you have it better in the Navy. Then again, San Diego or Portsmouth... boo hoo (I know you also have some crappy locations too, but certainly less than USA)

 

[HighPriest]

We've had three consultants during my short tenure. The first was widely recognized as not really caring much about being a consultant. He was convinced that the Army was the best thing since sliced bread, and he generally went with the flow of whatever OTSG recommended. He wasn't known for sticking his neck out for anyone, and being consultant was really just a career move for him. The second, in my opinion, took the consultant's position because he thought it would look good on a resume. I don't think he really cared what happened to anyone beneath him. However, he certainly put on the air of caring. Super nice guy on-on-one, but he bent like a reed in the wind to anything OTSG demanded without much argument. That's just my opinion, not widely shared. He was only consultant for a very short period of time, and then retired. The latest guy does seem much more connected with his individual providers. I have one-on-one contact with him all the time, he is always readily available, and if he can't swing something he always has an explanation. I feel like he does go up to bat for us.

However, I do have to agree that in all three of these cases we were better off with them than we would have been with HRC in charge. And I say that feeling that I got royally screwed with my first station.

 

[HighPriest]

Campbell is actually a pretty good station relative to many, many places in the Army. For whatever that's worth.

 

[idq1i]

Yeah, in general the location of our MTFs and hospitals are fairly decent. That was actually one of the major reasons I didn't join the Army or Air Force. Our worst duty stations in terms of location are probably 29 Palms, Lemoore, and Pensacola. Those, in my mind, are worlds better than places like Hood and Campbell.

In the army and within my specialty, if you get stationed at a MEDCEN, you have visibility with high command and with the consultant, and you are allowed to stay. See colbgw02's post above - consultants will actually go to bat for you. Most do a fellowship and are allowed to homestead indefinitely. I got what's probably the worst or second worst assignment in USA straight out of residency. Fine, whatever - someone had to eat it. Once done with 2 years, did I get a nice assignment? Hells no. Why? Homesteading profiled-to-the-max 0-5s. Fair?

 

[Chonal Atresia]

We've had three consultants during my short tenure. The first was widely recognized as not really caring much about being a consultant. He was convinced that the Army was the best thing since sliced bread, and he generally went with the flow of whatever OTSG recommended. He wasn't known for sticking his neck out for anyone, and being consultant was really just a career move for him. The second, in my opinion, took the consultant's position because he thought it would look good on a resume. I don't think he really cared what happened to anyone beneath him. However, he certainly put on the air of caring. Super nice guy on-on-one, but he bent like a reed in the wind to anything OTSG demanded without much argument. That's just my opinion, not widely shared. He was only consultant for a very short period of time, and then retired. The latest guy does seem much more connected with his individual providers. I have one-on-one contact with him all the time, he is always readily available, and if he can't swing something he always has an explanation. I feel like he does go up to bat for us.

However, I do have to agree that in all three of these cases we were better off with them than we would have been with HRC in charge. And I say that feeling that I got royally screwed with my first station.

 

[Chonal Atresia]

I agree with your opinion of our last 2 consultants. While it is true that our first one was a "company guy" and is now an O8, he single-handedly got me out of a brigade surgeon tour that I was "voluntold" to take by the 2nd guy; therefore, I would have to disagree with your assessment of him. I have no love lost for the 2nd guy - he was a complete d#$chebag. The current consultant is by fay the most approachable.

Good assessment of the consultant position in general - if HRC was left to its' own vices, WWIII would result.

 

[HighPriest]

I agree with your opinion of our last 2 consultants. While it is true that our first one was a "company guy" and is now an O8, he single-handedly got me out of a brigade surgeon tour that I was "voluntold" to take by the 2nd guy; therefore, I would have to disagree with your assessment of him. I have no love lost for the 2nd guy - he was a complete d#$chebag. The current consultant is by fay the most approachable.

Good assessment of the consultant position in general - if HRC was left to its' own vices, WWIII would result.

We might be up one consultant from your point of reference. The MG to which you're referring was consultant before my time. Or at least before the time I had a horse in the race. I've had beers with him. He's ok in my book.

 

[backrow]

I think there are likely big differences in how the consultants/Specialty Leaders are viewed based on the specialty. For those in large specialties with extensive manning requirements then the SL likely has less lee-way in being able to make most people happy and there are going to be many instances of feeling like one got the shaft while others get a good gig. For those in smaller specialties they likely know the SL on a close to personal level or at least have spoken to them more than a handful of times. These specialties might not have as wide-ranging manning issues (or maybe they're worse if it's not a popular specialty) and therefore more people tend to get what they want.

In the end the military tends to be a "what have you done for me" type of organization. There can also be politics played and when one person has significant power "favorites" can also be seen. Other times it is simply a luck of the draw based on the year you were born or when you entered service. I've seen a person come directly into the military from a full deferred residency and spend their entire pay back at a large MedCen and I've seen others sent to middle-of-nowhere land. At one point I wondered how a few non-fellowship people were able to stay at one place that was desirable, but then I found out they had learned to play the game. Their original orders were for X years and just before those were up they deployed and then when they came back they got a reset on their orders and it was another X years at the same place. Then they were at the point they could play the "I'll retire" game. Some recently were called out on their bluff and did not win, but they "won" for a few years in the interim.

 

[HighPriest]

I think there are likely big differences in how the consultants/Specialty Leaders are viewed based on the specialty. For those in large specialties with extensive manning requirements then the SL likely has less lee-way in being able to make most people happy and there are going to be many instances of feeling like one got the shaft while others get a good gig. For those in smaller specialties they likely know the SL on a close to personal level or at least have spoken to them more than a handful of times. These specialties might not have as wide-ranging manning issues (or maybe they're worse if it's not a popular specialty) and therefore more people tend to get what they want.

In the end the military tends to be a "what have you done for me" type of organization. There can also be politics played and when one person has significant power "favorites" can also be seen. Other times it is simply a luck of the draw based on the year you were born or when you entered service. I've seen a person come directly into the military from a full deferred residency and spend their entire pay back at a large MedCen and I've seen others sent to middle-of-nowhere land. At one point I wondered how a few non-fellowship people were able to stay at one place that was desirable, but then I found out they had learned to play the game. Their original orders were for X years and just before those were up they deployed and then when they came back they got a reset on their orders and it was another X years at the same place. Then they were at the point they could play the "I'll retire" game. Some recently were called out on their bluff and did not win, but they "won" for a few years in the interim.

We have a small specialty. Most of us know each other. It ultimately is still entirely political. I've a former partner who tried the "I'll stay in if..." play. He was told to have a good civilian career. He didn't ask for anything unrealistic. He was an excellent surgeon and a very easy person with whom to work. I think that's just poor management and a poor investment. It would not have taken a lot of work to keep him in the service.

 

[Gastrapathy]

There's enough suck to go around that they can make everyone miserable or they can heap it on the unlucky 66% and create a few moderately happy peeps who might stick around.

 

[IlDestriero]

We have the same politics in a big academic department. Everyone wanting special deals, backdoor deals, people making the powerful look good get all the glory, extra perks, etc. while the clinical superstars that bring it every day get nothing. Some are mentored into a nice trajectory, others have to claw away their own path with no management support. Then they scratch their heads when some of the best fellows accept other offers or good faculty leave suddenly when a good offer falls in their lap.

 

[HighPriest]

There's enough suck to go around that they can make everyone miserable or they can heap it on the unlucky 66% and create a few moderately happy peeps who might stick around.

Had John Stuart Mill's boy in the basement been replaced with 66% of the population, I'm not sure that people would have bought into utalitarianism. I think that's just called feudalism. I don't buy it. I think rather than making a small portion of milmed extremely happy while most others are miserable, they could make most people moderately happy - the realistic level of happy for most people.

And yeah, there's politics everywhere that money is changing hands - military, academics, or otherwise. But Gotham University isn't going to make your family uproot, move them to the event horizon of the @#$hole of the country, and put you in a position wherein you may not be able to practice your trade. And if they do, you can always go somewhere else rather than move.

As far as I see it: there Army has two options: they can at least try to retain people, or they can keep doing what they're doing. Maybe I'm wrong, but I would think that it would be less expensive to retain people than to retrain people, and what's the number one issue facing the US military today? It ain't Putin. It's money. But we've never been good at making smart financial decisions.

 

[idq1i]

Maybe I'm wrong, but I would think that it would be less expensive to retain people than to retrain people, and what's the number one issue facing the US military today? It ain't Putin. It's money. But we've never been good at making smart financial decisions.

$ solution: Pay YOU less. They're doing it already. See BAH pay cut this year. We are next.

resignation letter burning a hole on my desk, waiting until July 1st, even though it's costing me 36k in ISP

 

[HighPriest]

Yeah, I have no doubt that incentive pay will be on the block sooner than later. The senate and CIC are also supporting another below-average base pay increase again this year (1.3%), making it yet another year that military pay across the board does not meet inflation.

 

[j4pac]

I'm starting to hear grumbling around the hall that the Navy is going to cut back promotion to O-5 significantly, along with essentially eliminating O-6 (with the exception being the CO of a hospital).

Tie this together with the stagnate specialty pay issue and worsening command climate...and you have a perfect storm for lousy retention.

 

[Shikima]

I'm starting to hear grumbling around the hall that the Navy is going to cut back promotion to O-5 significantly, along with essentially eliminating O-6 (with the exception being the CO of a hospital).

Tie this together with the stagnate specialty pay issue and worsening command climate...and you have a perfect storm for lousy retention.

I wonder how this ties in with reservists?

 

[BigNavyPedsGuy]

ACGME controls min and max spots per site. The Navy decides how many within that range. Residency numbers have been relatively stable over time with the exception of some smaller residencies (urology for example) and peds. I'm told that OB took a hit the last couple years but can't speak to specifics.

Exactly. Tired, your flat wrong about stable number of residency slots. I was talking about Peds RESIDENCY not just fellowship. This thread has moved on, but that point needed to be made.

On the Navy side, I personally know our consultant. And yes, he does care about us.

Caring about people and always giving them what they want aren't the same thing.

Some in our specialty get confused about that, but that's okay, so does my teenage daughter.

I completely agree with you here. In Peds my specialty leader (our consultant) was a former program director who had worked CONUS, OCONUS, MEDCEN and BFE.

But us pediatricians tend to be nice folks anyway.