Straight talk about ARMY surgery

[hopelessness]

---

Members don't see this ad.

Ok, I've read enough on this website to realize most of you are either delerious or just don't know what you are talking about when it comes to army surgical programs. I'm in one now and rotated at another 3 for 6 weeks each when I was a med student.
First off, if you are a potential medical student and want to do surgery and are interested in the HPSP program, STAY AWAY FROM THE ARMY...STAY SO FAR AWAY!
With the exception of WRAMC, BAMC, and Madigan, the other 3 are aweful compared to civilian programs in terms of case load(not even close), experience, and competency out of residency. You have 2-3 pts on a team on service most times and most of them are "rocks" that in the civilian world, you could ship out somewhere else. it sucks and everyday is like ground hog day. My other fellow residents in the civ world perform lap appys as interns and lap choles and early 2nd yrs. I havent done either and im a freakin 2nd yr. I regret it everyday of my life. The training sucks and if i had it to do over, I'd train civilian and go back to the army to serve my damn country because thats all i want to do. period. Not train in a ****ty program that you dont get any experience and the attendings aren't letting you get experience. oh trust me, you'll be an expert at fixing umbilical hernias, but your SICU rotation will have 1-2 pts that arent really even sick..just ther because the floor nurses are ******s.
Oh, and all the surg programs are pyramid programs so if you dont get picked up, seeya in the middle east next yr unless you want to chabge to something dreadful like FP or IM...I rather die than deal with mundane problems all day like back pain and DM. I have high aspirations for myself and if could get out of this hell hole, I would.
Please, god. Don't listen to the recruiters. None of them know what they are talking about. Train civilian and come back to the armed forces. It will help your career and make you an excellant surgeon instead of a mediocre one. The decision is yours and do not end up like me.

 

[notdeadyet]

Ok, I've read enough on this website to realize most of you are either delerious or just don't know what you are talking about when it comes to army surgical programs.

The only thing I've heard on this board and from folks elsewhere is that the best military surgery programs are somewhere around civilian-average and the less-than-stellar military surgery programs don't compare well to their civilian counterparts.

Does anyone really talk up military surgery programs? This surprises me... Volume and diversity seems to be always cited, at least by the military surgery-types I've heard from.

 

[DrMetal]

The decision is yours and do not end up like me.

(often things I hear about Navy and AF surgery)
Thanks! I shall choose the medical route!

 

[Jet915]

Yeah, when I was an intern, our Navy Surgery program was put on probation for "too many hours, not enough cases."

 

[Trajan]

I'm an aspiring anesthesiologist, not a surgeon, but I encourage medical students to heed this advice. There are no military residencies that rival elite civilian programs. Anyone who claims otherwise is lying or grossly misinformed. However, there are still very solid programs in the military, so the situation is not dire for everyone.

I did an internship at one of the Navy's big three. The strength of the internship was its breadth. The weakness was that the wards and ICU months were heavy on hours but the patient volume was very light. Overall, a reasonable base year -- learned what I needed to know. Among the specific departments at that Navy med center, ortho, peds, and derm were all very solid, on par with above average university based civilian programs. In part that was because they had strong faculty who happened to be there at the time (that can change quickly btw). But even more important than the faculty was the fact that the military community fed large numbers of patients into the system who required those specialties. Sick people are an essential part of medical education (seems pretty elementary, right?)

On the other hand there were the gen surgery and IM programs. You cannot learn critical care when your units have a census of three or medicine with two to four ward patients per intern (and yes the patients are often rocks). Meanwhile, my med school classmates were getting comfortable managing 10+ ward patients in LA and NYC. My medical school had average IM and GS programs -- solid training, good faculty, but not elite programs. Many of the residents were FMG's, as most U.S. students could match at stronger programs. That said, the training opportunities at my med school -- and therefore the residents that they produced -- were head and shoulders above what I saw with Navy IM and GS.

The empty units and wards are a direct result of TRICARE. NMCSD at one point started sending all retirees and beneficiaries over the age of 65 to civilian facilities -- all in the name of bogus cost savings. Basically, they dump patients onto TRICARE, which is a different budget than Navy medicine, and voila we saved the government money. Only you didn't. It's basically a balance transfer from the Navy's credit card to TRICARE's and/or MEDICARE's. Such tricks allow some "executive medicine" O-7 "physician" to get another Legion of Merit. Of course the Legion of Merit citation doesn't answer how the hell you train IM residents without patients over the age of 65. Disgusting. Thankfully MC leadership has improved over the past few years, and they have reversed the policy, but damage is done. Huge numbers of elderly patients now going out in town for their care haven't come back, so the wards remain by and large empty.

This is the sort of nonsense that you have to worry about if you train in IM or GS in the military. It's really quite sad that once distinguished medical centers have fallen so far. I know some excellent young Navy physicians who are planning to stay and improve the system. I applaud their committment. However, at the end of the day it's your career. Most of us have worked too hard to get this far only to get mediocre training.

Bottom line, some bad leadership inflicted tremendous damage to Navy Medicine over the past decade. The shattered pieces are not easily restorable either.

All that said, you can still become a good doctor in the military in many specialties. Your colleagues will include some wonderful people if you join. However, prospective HPSP'ers need to recognize that their medical education is not the Department of Defense's top priority, so caveat emptor.

Should aspiring physicians join the military? In some cases the answer is yes, in others no. Do it if you want to be in the uniform regardless of any scholarship funds. The military needs good doctors. But if you do want to serve, please think about your specialty and do your homework. If your specialty has solid training and you want to serve, then seriously consider it. However, if your specialty seems to have poor training -- or you're not sure -- there's FAP. If you do -- or already have signed up for -- HPSP, there's always 4 as a GMO/FS/UMO and out. That can be a great option for some, terrible for others. Again, buyer beware.

 

[glamqueen]

I'm an aspiring anesthesiologist, not a surgeon, but I encourage medical students to heed this advice. Granted I'm Navy, not Army, but the OP's points are exactly why I'm glad that the Navy still feeds interns into GMO/FS/UMO. That system allows you to do your time, serve your country, and get out for better training -- exactly my plan. There are no military residencies that rival elite civilian programs. Anyone who claims otherwise is lying or grossly misinformed. However, there are still some solid programs in the military, so the situation is not dire for everyone.

I did an internship at one of the Navy's big three. The strength of the internship was its breadth. The weakness was that the wards and ICU months were heavy on hours but the patient volume was very light. Overall, a reasonable base year -- learned what I needed to know. Among the specific departments at that Navy med center, ortho, peds, and derm were all very solid, on par with above average university based civilian programs. In part that was because they had strong faculty who happened to be there at the time (that can change quickly btw). But even more important than the faculty was the fact that the military community fed large numbers of patients into the system who required those specialties. Sick people are an essential part of medical education (seems pretty elementary, right?)

On the other hand there were the gen surgery and IM programs. You cannot learn critical care when your units have a census of three or medicine with two to four ward patients per intern (and yes the patients are often rocks). Meanwhile, my med school classmates were getting comfortable managing 10+ ward patients in LA and NYC. My medical school had average IM and GS programs -- solid training, good faculty, but not elite programs. Many of the residents were FMG's, as most U.S. students could match at stronger programs. That said, the training opportunities at my med school -- and therefore the residents that they produced -- were head and shoulders above what I saw with Navy IM and GS.

The empty units and wards are a direct result of TRICARE. NMCSD at one point started sending all retirees and beneficiaries over the age of 65 to civilian facilities -- all in the name of bogus cost savings. Basically, they dump patients onto TRICARE, which is a different budget than Navy medicine, and voila we saved the government money. Only you didn't. It's basically a balance transfer from the Navy's credit card to TRICARE's and/or MEDICARE's. Such tricks allow some "executive medicine" O-7 "physician" to get another Legion of Merit. Of course the Legion of Merit citation doesn't answer how the hell you train IM residents without patients over the age of 65. Disgusting. Thankfully MC leadership has improved over the past few years, and they have reversed the policy, but damage is done. Huge numbers of elderly patients now going out in town for their care haven't come back, so the wards remain by and large empty.

This is the sort of nonsense that you have to worry about if you train in IM or GS in the military. It's really quite sad that once distinguished medical centers have fallen so far. I know some excellent young Navy physicians who are planning to stay and improve the system. I applaud their committment. However, at the end of the day it's your career. Most of us have worked too hard to get this far only to get mediocre training.

Bottom line, some bad leadership inflicted tremendous damage to Navy Medicine over the past decade. The shattered pieces are not easily restorable either.

All that said, you can still become a good doctor in the military in many specialties. Your colleagues will include some wonderful people if you join. However, prospective HPSP'ers need to recognize that their medical education is not the Department of Defense's top priority, so caveat emptor.

Should aspiring physicians join the military? In some cases the answer is yes, in others no. Do it if you want to be in the uniform regardless of any scholarship funds. The military needs good doctors. But if you do want to serve, please think about your specialty and do your homework. If your specialty has solid training and you want to serve, then seriously consider it. However, if your specialty seems to have poor training -- or you're not sure -- there's FAP. If you do -- or already have signed up for -- HPSP, there's always 4 as a GMO/FS/UMO and out. That can be a great option for some, terrible for others. Again, buyer beware.

What specialties have you seen to be particularly strong in the military? Thank you for sharing your insight - I am just curious what your thoughts are for this also? Not to hijack the thread, but I plan to pursue OB/GYN, and I understand this to be a strength for the majority of residencies due to the volume. Hoping this is correct.

 

[a1qwerty55]

Ok, I've read enough on this website to realize most of you are either delerious or just don't know what you are talking about when it comes to army surgical programs. I'm in one now and rotated at another 3 for 6 weeks each when I was a med student.
First off, if you are a potential medical student and want to do surgery and are interested in the HPSP program, STAY AWAY FROM THE ARMY...STAY SO FAR AWAY!
With the exception of WRAMC, BAMC, and Madigan, the other 3 are aweful compared to civilian programs in terms of case load(not even close), experience, and competency out of residency. You have 2-3 pts on a team on service most times and most of them are "rocks" that in the civilian world, you could ship out somewhere else. it sucks and everyday is like ground hog day. My other fellow residents in the civ world perform lap appys as interns and lap choles and early 2nd yrs. I havent done either and im a freakin 2nd yr. I regret it everyday of my life. The training sucks and if i had it to do over, I'd train civilian and go back to the army to serve my damn country because thats all i want to do. period. Not train in a ****ty program that you dont get any experience and the attendings aren't letting you get experience. oh trust me, you'll be an expert at fixing umbilical hernias, but your SICU rotation will have 1-2 pts that arent really even sick..just ther because the floor nurses are ******s.
Oh, and all the surg programs are pyramid programs so if you dont get picked up, seeya in the middle east next yr unless you want to chabge to something dreadful like FP or IM...I rather die than deal with mundane problems all day like back pain and DM. I have high aspirations for myself and if could get out of this hell hole, I would.
Please, god. Don't listen to the recruiters. None of them know what they are talking about. Train civilian and come back to the armed forces. It will help your career and make you an excellant surgeon instead of a mediocre one. The decision is yours and do not end up like me.

Judging from your post your either at EAMC or WBAMC. Your comments don't apply to the other medical centers.

While you have legitimate gripes - you don't show yourself in the best light based on your post - I get that your post is a rant - but I'm not sure I'd want you in my program given your lack of interest in what you feel is mundane -

 

[Trajan]

What specialties have you seen to be particularly strong in the military? Thank you for sharing your insight - I am just curious what your thoughts are for this also? Not to hijack the thread, but I plan to pursue OB/GYN, and I understand this to be a strength for the majority of residencies due to the volume. Hoping this is correct.

Disclaimer: I was not an OBGYN intern. I did a one month OBGYN rotation as an intern where the residents shared some of the plusses and minuses of their program.

The good: sailors and marines make lots of babies. NMCSD has TONS of routine OB. If that is what you want to do for a living, the Navy will prepare you extremely well. High risk OB actually had some wonderful attendings. I know that some of their residents have gone to very prestigious MFM fellowships. Overall, I thought the residents were a solid group.

There were a few gripes. Some of the residents were more interested in surgical aspects of OBGYN. I don't think the Navy programs will give you the GYN-ONC exposure that you could get at a top civilian university program. Those that fell into that category did not seem thrilled with the program.

Hope that helps. However, I would recommend that you talk to people in the Navy OBGYN programs before completely making up your mind.

 

[Gastrapathy]

Disagree with Trajan. The damage to IM was short term. Its amazing how forgiving our retirees are. The Navy IM programs have swung back to being busy. Its a good change. NMCP never let up but the others both did.

In my current job, I see civilian residents from a "good" program and Navy IM residents. Generally, I think the quality is about the same.

As for surgical volumes, thats another story.

For the OP, I'm curious about your claim that the surgical programs are pyramid programs. The Navy programs definitely are not. Oh, and IM is not a dumping ground for lousy surgeons. I've never met a surgical washout in a Navy IM program.

 

[Trajan]

Disagree with Trajan. The damage to IM was short term. Its amazing how forgiving our retirees are. The Navy IM programs have swung back to being busy. Its a good change. NMCP never let up but the others both did.
QUOTE]

I'm a few years out of internship. If IM is busy again, that's great news. NMCSD IM was not busy when I was there. and, yes, I always had heard that NMCP managed to keep up volume better than NNMC and NMCSD.

2003 - 2007 were dark years for Navy Medicine. Again, I do not plan on staying, but I sincerely hope that for the sake of our patients and for those doctors who will stay that it is getting back on track. However, I do think that some of the damage does not lend itself to quick fixes.

 

[Trajan]

...

 

[glamqueen]

Disclaimer: I was not an OBGYN intern. I did a one month OBGYN rotation as an intern where the residents shared some of the plusses and minuses of their program.

The good: sailors and marines make lots of babies. NMCSD has TONS of routine OB. If that is what you want to do for a living, the Navy will prepare you extremely well. High risk OB actually had some wonderful attendings. I know that some of their residents have gone to very prestigious MFM fellowships. Overall, I thought the residents were a solid group.

There were a few gripes. Some of the residents were more interested in surgical aspects of OBGYN. I don't think the Navy programs will give you the GYN-ONC exposure that you could get at a top civilian university program. Those that fell into that category did not seem thrilled with the program.

Hope that helps. However, I would recommend that you talk to people in the Navy OBGYN programs before completely making up your mind.

Thank you for the comments. I'm actually AF, but they put a few AF with the Navy program in Portsmouth, so a Navy analysis is actually very helpful as it is one of the ones I'm considering. I'm not planning on specializing in OB - going general - so I'm not necessarily looking for a necessarily high Gyn-Onc - more OB and GYN heavy. Sounds encouraging from your insights. Thanks again.

 

[colbgw02]

Judging from your post your either at EAMC or WBAMC. Your comments don't apply to the other medical centers.

I wholeheartedly agree with this in principle. To me, doing a rotation at other programs as a medical student hardly qualifies someone to categorically judge a specialty across the entire Army (or across all of military medicine, as is too often the case). I'm not a surgeon, so I can neither confirm nor refute the OP's claims, but in general, people need to qualifty their statements more carefully.

 

[bustbones26]

Overall, in my honest opinion, I feel that in Army medicine, low volume is a big problem in all residencies, all specialties, all institutions. Surgery is not alone with that problem!

Now there are ways that some places compensate for this. They usually give the resident a number of outside rotations at nearby hospitals that are VERY GOOD. For example, when I was at MAMC, MANY specialties did months at UW and Harborview and had great experiences there and learned a lot.

Another thing, Army programs tend to push didactics. No we are not MGH or Johns Hopkins but a number of very educated docs come out of the Army. When I was at MAMC, I know the IM department there mopped the floor at medical jeopardy competitions compared to other IM residencies for example.

Ask around, I think that as long as you stay educated, well read, and prepared, you will leave the military being able to handle civilian practice, just know that you will have larger volume. Let's face it, a number of our senior O-5s and O-6s that stick around know damn well they could never handle civilian medicine.

 

[mitchconnie]

The only thing surprising about this post is that the OP is surprised. I assumed it was widely known that military general surgery programs were very weak on case volume and variety--the attendings know it, the residents know it, and the RRC knows it. And I disagree with the above posters who suggest that it's just a problem at places like EAMC and WBAMC. I was faculty in the NCA and staff at WRAMC and NNMC and there were the same issues. The only difference is that in the NCA there are established relationships with high-volume local hospitals like Georgetown, Inova Fairfax, and the Washington Hospital Center.

And you can't excuse the poor training environment by stating "Well it's not MGH, or the Mayo, but it's fine for the Army." Honestly, it's not even Inova Fairfax, or Miami Valley Hospital, or any number of community programs. The advantage to a community program is that while it may not have the big names, cutting edge trials, and great research program, it will usually provide a high-volume operative experience from day 1, with a super-busy and efficient OR and solid floor nursing and ancillary staff. In many respects, military surgical programs combine the worst aspects of academic and community-based training.

But for the OP, I would suggest that you CAN get good training eventually, especially if you are super-aggressive about picking up cases at away rotations. And a lot of weak general surgery training can be made up for in a high-volume civilian fellowship. Consider your five years of general surgery as a nice preliminary experience before your real training in Vascular, or Colorectal or CT surgery. As a PGY 2, completing the program is probably a better option than quitting and doing a GMO. And if you can’t do a fellowship right away, then just be sure that you know your limits in practice. Stick to the straightforward, easy cases and refer the complex stuff downtown. Don’t be the cowboy trying to do an open AAA on an 80 year-old guy at some tiny military hospital with a one-bed ICU. I’ve seen it done, and it usually does not end well.

 

[a1qwerty55]

Overall, in my honest opinion, I feel that in Army medicine, low volume is a big problem in all residencies, all specialties, all institutions. Surgery is not alone with that problem!

Now there are ways that some places compensate for this. They usually give the resident a number of outside rotations at nearby hospitals that are VERY GOOD. For example, when I was at MAMC, MANY specialties did months at UW and Harborview and had great experiences there and learned a lot.

Another thing, Army programs tend to push didactics. No we are not MGH or Johns Hopkins but a number of very educated docs come out of the Army. When I was at MAMC, I know the IM department there mopped the floor at medical jeopardy competitions compared to other IM residencies for example.

Ask around, I think that as long as you stay educated, well read, and prepared, you will leave the military being able to handle civilian practice, just know that you will have larger volume. Let's face it, a number of our senior O-5s and O-6s that stick around know damn well they could never handle civilian medicine.

Many military programs make up for low in house surgical volume by outside rotations - this is a strength rather than a weakness as you get to operate in multiple systems and with multiple different attendings. This avoids some of the inbreeding you see in some of the big name academic programs. I did a little research and found that the surgical residents in my facility are having no trouble reaching 1000 major cases or more. This compares favorably to most civilian residencies.

 

[former military]

military surgical residency suck? What a shocker.
Current and former military surgeons have been posting the present and potential landmines of training in the military on this forum for years.

 

[IgD]

Disagree with Trajan. The damage to IM was short term. Its amazing how forgiving our retirees are. The Navy IM programs have swung back to being busy. Its a good change. NMCP never let up but the others both did.

I was a medicine intern at NNMC. The residents were very smart due to the malignant pimping especially during morning report but there were hardly any procedures at all. I became concerned that if I stayed on that path it would adversely effect my education. Sounds like times have changed and things have improved there.

Psych on the other hand is busy everywhere and its like drinking from a firehose in terms of patient volume!! We don't see the chronically severely ill like you do in the civilian world.

 

[SeminoleFan3]

Can anyone speak as to pediatric training in the Navy?

 

[mitchconnie]

Many military programs make up for low in house surgical volume by outside rotations - this is a strength rather than a weakness as you get to operate in multiple systems and with multiple different attendings

I appreciate the sentiment here, but would like to suggest that almost no one involved in surgical education in the United States in any significant way agrees with this statement. That's why the RRC has strict limits on the number of away rotations, and mandates that the entire chief year be done in-house.

If away rotations were so great, why not spend your entire residency as a journeyman doing a series of away rotations at MGH, Cleveland clinic, Hopkins, etc? The reason is that surgery is an apprenticeship, and trainees need some kind of longitudinal experience with a core group of committed faculty who have a stake in their training. The outside institution rotator will never have the same quality learning experience as the in-house guy.

 

[Galo]

The fact that surgical residencies in the military, (across all branches) are generallly POOR in comparison to even mid to low tier civilian residencies has been established on this forum by experienced ex, and current military surgeons numerous times.

As usual someone who is not a surgeon chimes in to negate experiences they could never experience.

Same as always.


This is one of many threads that should be referenced by any prospective student to military medicine. Training is poor, practicing is poor, and military and medicine just do not mix well.

 

[Trajan]

.

 

[former military]

i had an 0-6 command urologist ask me to teach him how to do a vasectomy.
that is on par with asking what end of the stethoscope you put in your ears and which you put on the patient's chest.

occasionally he would stop by at our teaching conference for morale's sake and to keep himself "current". Under threat of death from our residency director, none of the residents were allowed to engage him in any type of conversation that could expose the fact that he knew absolutely nothing about the specialty. We could only talk about airplanes to him.

 

[orbitsurgMD]

Many military programs make up for low in house surgical volume by outside rotations - this is a strength rather than a weakness as you get to operate in multiple systems and with multiple different attendings. This avoids some of the inbreeding you see in some of the big name academic programs. I did a little research and found that the surgical residents in my facility are having no trouble reaching 1000 major cases or more. This compares favorably to most civilian residencies.

No, that is really a weakness spun as a "strength."

Good "big name academic programs" don't have inbreeding problems; most get a widely-drawn and top-notch faculty, with many different perspectives. That is part of what makes them what they are.

 

[Galo]

Wow,

I was just sending an email to a prospective student, educating him on the ways of military medicine and its unending decline. While I never served in the army I can only make opinions based on the numerous conversations with other ARMY surgeons and my experiences with military medicine in general So I had no direct experience to tell this person about, and this thread comes back from a rest. How appropriate.

So once again, its borne out that military medicine continues to suck, especially when it comes to specialty practice.

 

[Perrotfish]

I was a medicine intern at NNMC. The residents were very smart due to the malignant pimping especially during morning report but there were hardly any procedures at all. I became concerned that if I stayed on that path it would adversely effect my education. Sounds like times have changed and things have improved there.

Psych on the other hand is busy everywhere and its like drinking from a firehose in terms of patient volume!! We don't see the chronically severely ill like you do in the civilian world.

How do you feel that Navy Psych training? It's probably my top choice at the moment.

Also, can anyone comment on the quality of Navy training in EM? Neuro?

 

[IlDestriero]

No, that is really a weakness spun as a "strength."

Good "big name academic programs" don't have inbreeding problems; most get a widely-drawn and top-notch faculty, with many different perspectives. That is part of what makes them what they are.

Amen. I posted a long series of comments on what I witnessed first hand at NMCSD in comparison to my lengthy experiences at 2 "elite" university hospitals (not med school rotations, but years. And my time there was before they dumped all the sick old folks at NMCSD). The same lame support for military GME was voiced. Outside rotations are strong, the Army isn't a problem, better didactics, plenty of research (??!), etc. The only one yet to be added here is that it is unfair to compare military GME to 1st tier hospitals/training as the residents would not be strong enough to match there anyway.🙄
Thanks for posting OP, particularly because it is Army experience. Maybe your post will help change one mind, to FAP vs HPSP, and it will be worth the effort.👍
If I were you, I would strongly consider a fellowship after you're out.

 

[ieatpizza]

The only one yet to be added here is that it is unfair to compare military GME to 1st tier hospitals/training as the residents would not be strong enough to match there anyway.🙄

This is totally a dig at me. But it's true, man. I'm an intern in military GME and have been secretly underwhelmed by the patient volume, acuity, and complexity compared to experiences at my top ten medical school. But if you talk to someone who came from USUHS or a lower tier or DO school, they don't know the difference and are quite impressed or at least content with the "rigor" of training and patient population. Or maybe they're all secretly underwhelmed as well?

BTW, I'm in a non-surgical specialty, so it probably doesn't suck as much.