Surgery question for MilMD and others

Discussion in 'Military Medicine' started by bobbyseal, Mar 23, 2004.

  1. bobbyseal

    bobbyseal Boat boy
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    The point about life being pretty boring in the military as a general surgeon or ortho surgeon seems reasonable. ie, surgeons are needed for trauma in case that happens, otherwise, there isn't much to do.

    What about the life for other surgical subspecialists?

    Since they may not be as many billets out there because there isn't a theoretical need for them to be involved in mass casualties, it would seem to me that life as an ENT, Uro, or optho doc would be pretty good. On the same note, what about the gen surg subspecialties like CT, vascular, plastics, or onc?
     
  2. militarymd

    militarymd SDN Angel
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    It depends on where you are stationed. If you wind up at a program with a residency....Walter Reed, Bethesda, etc....you probably will have a fair amount of work as compared to overseas or non-teaching hospitals.

    Problem with a lot of the military hospitals is that you don't have support personnel to do your administrative work..or your administrative personnel keeps turning over, so you constantly have to re-train people to do things the way you like. It is very inefficient. It takes much longer to see the same number of patients at a military hospital as compared to a private practice-fee for service hospital.

    People say you work harder when you get out....that's true, but you work longer while in the military. Hour for hour, you will probably work more in the civilian sector, but total hours are probably the same, you will be re-imbursed a lot more. I know for a fact that in my civilian job, my total hours will be less...while patient encounters will go up....and pay will be a LOT higher.

    And I won't have to deal with BS committees, etc....
     
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  3. mitchconnie

    mitchconnie Member
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    The recent shift in focus to operational medicine and the implementation of Tricare has hit general surgery and it's subspecialties hard. Everyone who depends on the over-65 population for their big cases will be hurting.
    CT has a VERY thin case load and I can't imagine that programs outside Walter Reed and Wilford Hall will be around much longer. Vascular is in a similar boat, but made slightly better by taking on endovascular/angio work. Surg. onc. is going away. I think there is one surg. oncologist left in the AF and one in training. Plastics seems to have some work because there are a fair number of breast CA cases requiring reconstruction, as well as a potentially endless demand for cosmetic procedures. All the Gen. surg. subspecialties can deploy as general surgeons so they are not protected.
    I agree with military MD's comments about the lack of tech. support, but it doesn't neccessarily bother me that much. What kills surgical subs. is the lack of quality support from other subspecialists, nursing, and hospital administration. You can't do a Whipple without well-trained GI guys to do an ERCP. You can't fix an AAA without a well-staffed ICU with EXPERIENCED nurses (i.e. ones who are more than a year out of training). The administration certainly isn't interested in buying equipment to do the latest, greatest endovascular procedure. Most importantly, in surgery, you need experienced colleagues around when the sh** hits the fan, and there is really no one around with more than three years of solid clinical experience.
    The former AF surgeon general, P.K. Carlton, referred to the current situation at military medical centers as a "death spiral." That is, you start downsizing one specialty, like cardiology, then CT surg. has nothing to do and closes up. Then pulmonary/CCM has no one to do lung biopsies and are downsized out, then there is no one to manage the ICU, and so on. Pretty soon all that's left is a bunch of clinics.
    That being said, I think ENT, URO, and OPTHO are probably in a better position than General Surgery to maintain skills and have a reasonably busy practice.
     

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