Surgeons in the US Military

[emnicjr]

Hey everyone, I am currently a premed student and I am thinking ahead to what sort of career paths I'd like to take if I were to complete medical school. I am really interested in becoming a surgeon in the US Navy, but after reading a few posts on SDN, it seems like surgeons are extremely poorly trained by the military.
Are there any current/ex military surgeons on here that can shed some more light onto what it is like being a surgeon in the military? Do you feel like you guys are lacking the proper amount of training for your job? How bad (or good) is it to be a doctor in the military? I am mainly interested in the US Navy, but input from all branches are welcome (especially any National Guardsmen). Keep in mind that I want to join the military for personal reasons, not for money or anything (so please don't go all crazy about the HPSP).

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[HomeSkool]

I'm an anesthesiologist, not a surgeon, but I trained in the US Army and have worked extensively with both military and civilian surgeons. It's true that military medicine wasn't always up to the same standards as the civilian world, but that has changed dramatically over the last few decades. Throughout my career, I've appreciated no significant differences in the methods or quality of care between my military and civilian colleagues. On the contrary, my military colleagues have encountered no trouble securing highly desirable civilian positions upon leaving government service; in fact, they've been highly sought after.

If you decide to go into military service, you should most definitely go to USUHS or through HPSP. Taking out all the loans and then joining the military is like volunteering for the labor pains without at least getting to enjoy the fun part.

 

[HighPriest]

I never found training to be an issue, although I have colleagues who trained at other military facilities who feel otherwise. Skill atrophy, however, is very very real. Not only is it difficult to secure a duty station where there’s a good variety of cases (especially high acuity cases), there’s just no way to maintain a volume of cases comparable to a civilian practice. You can always see more patients in clinic, but there’s never enough OR time to accommodate them, so there’s not much point.

So far as lifestyle, that really depends upon what kind of surgeon you’re talking. General? Ortho? ENT? Urologist?

As an ENT in the Army you’re very limited in where you can practice. Many MTFs don’t have ENT support, or if they do it’s 1-2 guys. You almost never have a chance to deploy. But, your life at home is fairly quiet.

My GenSurg colleagues deploy about yearly. They’re always going overseas, and most of the time that they’re there, they’re sitting on their hands or lifting weights.

I hated being in the military, and would never do it again for a huge number of issues, rather than for one big one.

It is definitely true that it was very easy to get a job. But, there’s a huge shortage of ENT docs, so that helps. Also, people automatically assume things about military physicians, true or not. They assume you’ve done a ton of trauma even though no one has relative to a civilian trauma center. They assume you have a lot of leadership experience....which is sometimes true. They assume that as a military surgeon, you must have met some kind of standard that civilians just don’t have. That’s definitely untrue. Most of the military surgeons I worked with were very competent. But not all. I think the real benefit is the propensity of military surgeons to be younger and more recently trained relative to the civilian world. So standard of care is more often up to date, and %-wise, they’re more likely to be familiar with new techniques. The only surprise I had when I got out was how archaic some of the older fellas can be in their practice. Whereas there were no older fellas in the military.

This is all Army, btw.

 

[militaryPHYS]

but after reading a few posts on SDN, it seems like surgeons are extremely poorly trained by the military

Sad that this is becoming a common impression for young premeds seeking out information on military medicine via SDN. Sorry that you feel this way and I would say it is definitely not true.

Military training (residency) is good no matter what specialty you go in to. In my opinion it is better because you get to rotate in and out of the military which gives you a second perspective on both sides of the house. You have the same requirements for ACGME as your civilian counterparts, take the same board exams, etc. Ortho at Portsmouth hasn't had someone fail their board exam in over 20 years. As far as I know this is the longest streak nationwide, military and civilian.

Once training is over skill atrophy can be an issue depending on duty station and specialty/sub-specialty you chose. The biggest factor in this is your choice of specialty. If you want to be a world-renowned trauma surgeon but have an HPSP scholarship to pay back it is dealer's choice whether or not you will be stationed somewhere where you will see high-acuity cases. Most would say the likelihood is very low. Also unpredictable if you will be close to a civilian trauma center that allows you to moonlight. If you think about it the other way ("I'm going to be a world-renowned trauma surgeon but the military screwed me by putting me at this duty station") then you are asserting blame on the military when you should have understood the system when you signed your contract.

For ortho you can stay pretty busy no matter where you go in the Navy. That being said, it is sports, basic hand and basic trauma heavy at the smaller MTFs. Joints are only done at stateside MTF's and big trauma cases are few and far between.

I enjoy the military but have been fortunate thus far. The system hasn't "screwed" me yet. Whether that is objective or subjective based on my outlook and understanding of milmed is up to debate.

 

[Gastrapathy]

Why do so many (most) surgeons get out after 13-17 years of service and give up a pension worth $2M+ that is only a few years away? I can think of 2 17 year surgeons that got out in the past 18 months in my town. That is a terrible financial decision and yet...

 

[militaryPHYS]

Why do so many (most) surgeons get out after 13-17 years of service and give up a pension worth $2M+ that is only a few years away? I can think of 2 17 year surgeons that got out in the past 18 months in my town. That is a terrible financial decision and yet...

If milmed is so horrible then why did they stay for 17 years in the first place? I'm guessing they were happy with their situation in the military even after their obligation was done. Opportunities come and go, preferences change....Thus is life. I know quite a few who left just shy too. They had huge contracts waiting for them and the additional freedom a civilian life provides. That doesn't mean military medicine is the worst thing in the entire world. Most were smart enough to stay reserves to lock in an eventual pension and benefits.

 

[Gastrapathy]

Cause that was the end of their obligated service. Easy with GMO and fellowship.

In fact, didn’t a Peds Ortho (TM) just get out at 15 plus.

 

[psychbender]

Cause that was the end of their obligated service. Easy with GMO and fellowship.

In fact, didn’t a Peds Ortho (TM) just get out at 15 plus.

He actually got out? I don't recall that he dropped his papers when I last saw him before I left (if it's the same guy, but not many Peds Ortho in the Army, particularly with those initials). The more you say, the more I think we've crossed paths in real life.

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[hooperg]

Army Surgeons are definitely the most fun to party with.

 

[Jolie South]

With regards to general surgery, I came out of an AF program that trained me well, but I think that is because 90% of our time is spent with civilian faculty at a civilian institution doing tons of penetrating trauma. The surgeons I have come into contact with that I am least impressed with came from primarily military programs. I don’t think MTFs have the volume or complexity to support training unless partnered with civilian institutions.

I think those who make the most of their payback time by getting appointments at partner civilian institutions are much happier in that they are able to keep up skills, potentially contribute to resident education, and at least attain a partial reprieve from some of the bureaucracy. This is from my observation from residency and now talking to my classmates/former colleagues. I haven’t been there yet but that is what I plan to do.

I may have trained at a place that was unique in that regard.