The decline of military medicine

[Galo]

First off I want to say that I finally think I found a souding board where people may actually get what I say. I have perused quickly throuogh some of these posts, and I see kindred spirits that have esperienced the mediocracy and worst the inneptitude that exists in a decaying system that by all means should be avoided by people who have any interests in medicine as a career. I said medicine, not officership, as they have conflincting tenents, and you will be good at one, and suck at the other.

I hope that this serves to begin discussion, and provide information that is "unbiased," from a recruiting standpoint, as well as to let people who are in this process, learn what they are getting themselves into.

I was an active duty general surgeon for over 6 years. Unfortunately the news that I have are not good. Miltiary medicine is in a steep state of decline. The reasons are lack of money, lack of patients, and a general pervasive attitude of mediocracy. Any specialty that requires extensive training, and a large support network, such as general surgery, and all its subspecialties, as well as highly technical medical fields, are rapidly declining. Although they don't want to admit it yet, military medicine, (at least the AF), is headed to being a provider of only primary care.

I met alot of great and dedicated people in the AF. Unfortunately I met more inferior and mediocre physicians that I would have ever imagined. It is a true fact with notable, but few exceptions, that physicians who make the military a career, are generally poor physicians. As they gain power (rank), they do less medicine, and more policing, and managerial work which many times they are as ill suited for.

Its best to let the institution speak for itself. Although I cannot post it here due to its size, ( I tried). I have the lecture given by Brian Peyton, the consultant for general and vascular surgery to the surgeon general. It clearly outlines the problems that exist with surgeon dissatisfaction, lack of work, and many other issues that are more relevant today, than 3 years ago when the lecture was given. The numbers it predicted exist today, just as they were outlined. It is imperative that anyone thinking about the AF as a career have acces to this document to make an informed decision.

As I briefly read though some of the posts, I see the unending enthusiasm, the great story posts and the ringing of patriotism, and greatness. It is a sad day when I can give you many more negative comments that should exist in this day and age when we are at war! The incompetency and gall of the leadership is appalling, and at times unbelievable. For every great story someone can come up with, I can come up with many more negative ones.

I will be happy to email it to anyone who wants it, or if the administrator truly wants an unbiased opinion, perhaps they can figure a way to post it on the site.

My email address:

[email protected]

Let's get some discussion going!!

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[militarymd]

when are you getting out?

 

[FliteSurgn]

I'd be very interested in Col. Peyton's remarks. I sent you an email.

As I've done a few times before, I can personally attest to the SAD condition of surgery in the AF. I just added up my case list for the last year. I did a pathetic 300 cases. That includes 200 endoscopies. Of those 300 cases, 120 cases were ones I did during 6 weeks as a locums surgeon before I came on active duty.

So in a year at the base, I did 180 cases with 140 of those being colonoscopy or EGD. That leaves a meager 40 "surgical" cases and that includes breast biopsies and hemorrhoids. I did 12 lap choles. Yes, I averaged one lap chole per month as a general surgeon. Sad.

 

[Galo]

militaryMD: I feel alot of your pain, and more. Sadly I've been out since 12 Nov 06, and I have this pathologic anger that I still need to work through. I don't think I will feel relieved till I have "saved" a few people from the horrendous experience that I went through. Also it is good to see that I am not the only one who has gone through this. As you will see in the lecture that Brian gave, this is a pervasive problem, its just that some people chose to react differently to it than others. I think that may have to do with how long you had to put up with it. At the end of 4 years I was ready to scratch my eyes out, but by the end of 6, I was lucky not to walk into work with a heavy arsenal and unload. I have boxes of paperwork, disks of emails, so much stuff that I want to put on paper, and let people know what they can expect, but it is a massive undertaking, and one that can bring up alot of bad feelings. I think this site may serve as my sounding board for a while to see if I can acutally save somebody. Anyways, I have way more to say. When I left the AF, I sent a 3 page letter explaining my displeasure to the mail list for surgeons. I will post it in the next few days, as it is in a computer I am currently not using. I hope we can continue this dialogue.

flitesurgn: I feel for you man. Where are you now?? My buddies at Offut where I started, had the OR closed on them. Before they were averaging 10 cases a month, the majority being scopes. Lack of work is the number one reason surgeons leave the AF. That is the ones that are compentent. I think you will love the lecture, as well as my letter. I'm surprised you did not see it a little over a year ago when I sent it out. I got a million stories about the incompetence and the bull****. Have you been castigated or threatened with CSTARS yet? That was the provervial drop for me. It started my discharge process, and I am proud of it. Honorably discharged but pissed of as hell, I look forward to talking to you more. I'll get to working on my letter. In the mean time look for the lecture. I already have some people emailed me for it. If you were not one of them, shoot me an email to:

[email protected]

I'll send a copy. In the mean time I hope someone will be able to post it.

Galo

 

[militarymd]

I started posting here in dec of 2003 because of many of the same things that you felt.


I'm still here, and will continue to post.

 

[pgg]

Posted here.

Pretty grim outlook. I was disappointed, though not too surprised to see this comment on the kind of people who come in via FAP:

During my 6 months as consultant, I have evaluated 4 surgery residents for the FAP program. Two were US born but had to go to the islands for medical school, one is an osteopath at the bottom of his class and one has had two felony arrests. Of the two general surgeons, they have 9 and 10 malpractice claims respectively, one of which had his privileges limited and closed his practice months ago.

Sometime last year there was a similar kind of satisfaction questionnaire sent out to Navy medical corps, dental corps, nursing corps. I don't have that powerpoint any more; if anyone does, it'd be a good addition to this thread.

 

[Galo]

ppg,

Thanks for posting the lecture. However, only the slides came through, the narrative is absolutely essential to understanding the slides. Like the excerpt that you posted. Its a joke to think that was the available applicant pool for surgeons to the AF via that program. Please see if there is a way to include the narative. I can change the format to a word document, and that seemed to do it for another application. You seem to have a much better handle on computer applications than me, so I hope you can come up with a solution.

As impressive as the lecture is, even without the narrative, I have the nagging suspicion and experience that it will do little other than to validate our complaints. People in current leadership are so weak, and narrowminded, or to be fair sometimes helpless, that nothing will change. Those predictions are now happening, and will continue to do so till there is only a service dedicated to people who are interested in military carreer only, and you already know how that will work out. I at least hope that potential future doctors will read this and see there are other ways to get your education paid for.

Let me know if you can fix the presentation.

Galo

 

[IgD]

I reviewed the PPT and the remarks here about general surgery. One of the biggest points I came away with was that military general surgeons don't get enough surgical cases. Does this suggest we have too many general surgeons? Maybe our population is too healthy and surgeons are only needed during wartime? It seems like an interesting problem.

 

[USAFGMODOC]

I dont' believe so. However, 10 years ago when we started down the Tricare pathway, our surgeons got alot of cases, handled many retirees who had alot more surgical cases, and had the staffing to perform cases.

Now, without and ER or inpatient beds and limited critical care nurses, how can a surgeon really gather alot of "quality" cases. Heck, at Offutt AFB in 1993 we had a 5-6 bed ICU with an occasional ventilated patient. If there is no ICU, how can one perform a complicated surgery... Many surgeons have/had the skills, but didn't/don't have the infrastructure around them to be able to perform the cases they truly desire... Basically, once we bought into the "superclinic" idea; surgery/OB/anesthesia and I-Med have slowly crumbled except at the few major medical centers... and even there, (Wilford Hall 2 years ago when I was rotating there) is a shell of what it was in the 80-90's.. It too will become a "superclinic" and I can fully understand why surgeon's can't get their cases up.

I honestly don't see a "fix" to this dwindling case load due to the path the military medical system has bought into. It's all about the $$ and attempting to make the military docs see more with less to "keep up with the civilian sector". Can anyone say --- purplesuited medical corps?

 

[Mirror Form]

I reviewed the PPT and the remarks here about general surgery. One of the biggest points I came away with was that military general surgeons don't get enough surgical cases. Does this suggest we have too many general surgeons? Maybe our population is too healthy and surgeons are only needed during wartime? It seems like an interesting problem.

This is a good question. To people not familiar with the military healthcare system, it might at first appear to be a paradox.

The problem is that the military needs enough active duty general surgeons to rotate deployments during wartime (currently to Iraq and Afghanistan). Right now, we don't have enough surgeons to fulfill that need, and many surgeons are getting deployed over and over again. However, when the surgeons aren't being deployed, they don't have anywhere near enough cases. This might not be the case in the major med centers, but it's certainly the case in the "med cen" that I work at and also at most army locations.

 

[pgg]

Thanks for posting the lecture. However, only the slides came through, the narrative is absolutely essential to understanding the slides.

Don't open the ppt in a web browser (by just clicking the link) or all you'll get is the slide show. If you save a local copy first then open it with Powerpoint, the comments are there.

 

[MoosePilot]

They should let them moonlight or set up a program to "hire" them out to civilian hospitals. I'm sure someone would freak, but surely a surgeon is not an uneeded resource if you get creative!

I'd be pissed watching my skills evaporate through disuse. I understand why they're unhappy.

 

[Galo]

ppg: thanks for the clarification. I hope people are doing that to get the full effect.


moosepilot: It took me over ONE YEAR to get approval to moonlight doing TRAUMA at Creighton University, and I was the only surgeon out of 4 to bother doing it. My buddies saw the **** I went through, and did not want anything to do with it. In the end, I did not get a good boy pat, or any praise, (not that I gave a crap or was looking for it), but I did get a 6 month long investigation for fraud by OSI who was tipped off by some pencil pushing bitch that knew nothing about medicine, and though there were irregularities. This was after 3 YEARS of me working there. But what killed me the most, is that the commander who knew full well that I was there for 3 years, did not bother to call me in once to get my side or even ask me questions, till I had been shafted for 6 months. This affected me very negatively. It is nearly impossible for most surgeons in the AF to get this accomplished, and many commanders want you to take personal leave to moonlight. Alot of them consider it double dipping. Although it was a requirement to have trauma, they make it impossible to do it. So you can see how some people would get very bitter.

Again, mediocre leadership who just passes the buck.

USAFGMODOC: I got to Offut in the summer of 98, so I'm sure you were gone by then. You may not be surprised to know that the once famous 55th regional hospital is now a superclinic with no inpatient capabilities, no OR, but still houses 3-4 general surgeons, 3 orthopods, some GYN, who now have to go downtown, and are averaging less than 10 cases a month, including scopes.

Anybody who reads this and still wants to go to the service is deserving of what they get, and will help perpetuate the system as it is, in a steep dive.

 

[MoosePilot]

Well, I've been concerned that my career might take me towards leadership and away from patient care before the end of my career. Maybe I should accept that and do my best to improve the system from the inside. Maybe it's not possible. I dunno. It sucks that they wouldn't rubber stamp moonlighting. It's like getting free training sorties.

 

[Galo]

moosepilot:

You know, I have know dedicated individuals like you who think they can be good officers, and work within the system to change it. I wish you the best. I think its a thankless effort, and if you are not careful, it will eat your life up. I also think its impossible for a variety of reasons, the least of which is the common knowledge that change in the military is "glacial". The lack of money, support, and the continuing acceptance of mediocrity as the standard, will never allow the system to change.

Also it is a known fact, that you will asked to step up to the plate and take more managerial resposibilities as you ascend in power. Your clinical hours will decrease as you get more and more involved in doling out punishment for the many young airman, and doctors who see the broken system, and try to bitch about it.

A primary care doc who just left the system has a wonderfully documented history of why POC is a failure. He will soon have it published in a medical journal, and hopefully I can persuade him to post it here as well. It is long, but extremely detailed, and if one cant understand the system after reading it, they belong in military for life.

Galo

 

[MoosePilot]

moosepilot:

You know, I have know dedicated individuals like you who think they can be good officers, and work within the system to change it. I wish you the best. I think its a thankless effort, and if you are not careful, it will eat your life up. I also think its impossible for a variety of reasons, the least of which is the common knowledge that change in the military is "glacial". The lack of money, support, and the continuing acceptance of mediocrity as the standard, will never allow the system to change.

Also it is a known fact, that you will asked to step up to the plate and take more managerial resposibilities as you ascend in power. Your clinical hours will decrease as you get more and more involved in doling out punishment for the many young airman, and doctors who see the broken system, and try to bitch about it.

A primary care doc who just left the system has a wonderfully documented history of why POC is a failure. He will soon have it published in a medical journal, and hopefully I can persuade him to post it here as well. It is long, but extremely detailed, and if one cant understand the system after reading it, they belong in military for life.

Galo

I don't think I can be a good officer, I know I can be a good officer. The question is whether I can be a good doctor and still be a good officer, but I've got plenty of time to learn how to best do that.

I don't think one person can change the military. I do think one commander can make a better microenvironment. If there is no regulation against it, the med group commander could probably authorize moonlighting, right? That alone might make life better for some of the surgeons. Maybe schedule a rotating scheduled to give them a week in the med group and a week in a civilian hospital. If the pace is that slow in the med group for surgeons, that shouldn't be impossible, should it?

It would all be in the little things, but maybe it's possible to make it a little better, someday.

 

[Galo]

I don't think I can be a good officer, I know I can be a good officer. The question is whether I can be a good doctor and still be a good officer, but I've got plenty of time to learn how to best do that.

I don't think one person can change the military. I do think one commander can make a better microenvironment. If there is no regulation against it, the med group commander could probably authorize moonlighting, right? That alone might make life better for some of the surgeons. Maybe schedule a rotating scheduled to give them a week in the med group and a week in a civilian hospital. If the pace is that slow in the med group for surgeons, that shouldn't be impossible, should it?

It would all be in the little things, but maybe it's possible to make it a little better, someday.

Unfortunately I think being a good physician, and a good officer can at times be mutually exclusive.

You have your core values of excellence in all we do. Well as I am sure you have experienced, it is impossible to do excellent work when you have no support, no staff, no one willing to advance. Service before self. Directly in the face of having to sacrifice resourses, or break or bend rules in order to take care of patients.

I know a true officer can spin them the other way. But at some point if you are a dedicated physician you will come up in a situation that will pit your hippocratic oath against officership.

I think my letter will help explain my bitterness. I will post them soon.

Galo

 

[MoosePilot]

Unfortunately I think being a good physician, and a good officer can at times be mutually exclusive.

You have your core values of excellence in all we do. Well as I am sure you have experienced, it is impossible to do excellent work when you have no support, no staff, no one willing to advance. Service before self. Directly in the face of having to sacrifice resourses, or break or bend rules in order to take care of patients.

I know a true officer can spin them the other way. But at some point if you are a dedicated physician you will come up in a situation that will pit your hippocratic oath against officership.

I think my letter will help explain my bitterness. I will post them soon.

Galo

I know just what you're talking about. Early in your career the point is to do the technical job you're given. For a physician, that's medicine and patient care. Making your boss happy isn't nearly as important as doing your core mission. I hope I will be able to continue that and will work to, despite opposition if necessary.

 

[Galo]

Although this letter will certaily personalize my plight and will no longer allow people to see me as unbiased, I think it will bring some insight into a little of what I and others went through.

It also need to be read with some insight as to how I am. I am a truly dedicated physician who will do most anything for proper, modern, timely patient care. Especially for the people who are risking their lifes, in defence of this country. To that effect: I do not like stupid rules. I think some rules need to be bent or broken as in medicine there are no absolutes. Certainly this set me out as a trouble maker, since I saw the need to circumvent many mandates to get proper care for my patients. I AHBOR mediocrity. The AF is FULL OF IT. THEY LOVE IT. THEY REWARD IT. No excellent dedicated physician will in the peak of their career choose to lessen their clinical load to sign papers and police and micromanage others more capable than them. I react to the feeling of being threatened. I am impatient. If its important, I want it done now, not tomorrow. Attributes that can be helpful when taking care of very sick patients. If I am in surgery, and I need something critical, I want it now, not from the downtown hospital.

OK, I am not perfect, but I am a damn good surgeon, and being in the military was like having a 2000 lb weight on my chest. It affected my health, my marriage, my whole life, and although I take part responsibility for my reactions, they were all justified in my eyes.

 

[Galo]

After sending it, and making sure he had gotten it, I only got a responce from the deputy surgeon general. An ophthalmologist female Col who tried to apease me and tell me everything would be allright, and that change in the AF is "glacial". GLACIAL!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

When I reminded her I wanted to talk to Karlton, and made several phone calls and emails, I was called to the office for the deputy commander of my hospital, an orthopod Col to threaten me with "picking weeds" in some pacific island where people deploy. I filed an IG complaint about this threat, and was told it would be my word against his. A looser.

 

[BOHICA-FIGMO]

I know I'm hogging this post, but I just got to get this off my chest.

This letter is pretty self explanatory.

After sending it, and making sure he had gotten it, I only got a responce from the deputy surgeon general. An ophthalmologist female Col who tried to apease me and tell me everything would be allright, and that change in the AF is "glacial". GLACIAL!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

When I reminded her I wanted to talk to Karlton, and made several phone calls and emails, I was called to the office for the deputy commander of my hospital, an orthopod Col to threaten me with "picking weeds" in some pacific island where people deploy. I filed an IG complaint about this threat, and was told it would be my word against his. A looser.



Please bring on the comments. I am bearing my soul!!

G

I gotta back you up on this one. before I entered med school I was a BSC aerospace physiologist with a rank of O-4. I was personally stabbed in the back by my commander, which is why I am now with the U.S. Navy. I can attest to what Galo is saying. Air Force medicine is filled with too many commanders who are more concerned with their next promotion than good patient care. As a whole, the USAF medical service has become a slave to the MSC bean-counters who care nothing about quality of care, only about how much they can cut costs. 90% of the active duty physicians I dealt with at my last base, in all specialties, were leaving the service at the end of their commitment. 75% of our flight surgeons were D.O.s or carribean FMGs (even though D.O.s and carribean FMGs make up less than 15% of the overall physician pool in the real world). This is a sad state of affairs folks. Unfortunately, the system will not change unless it totally collapses. There are early signs of a "breaking of the bank" but until these manifest in the inability to care for active duty members and their dependents, nothing will get done, Generals will get promoted, and doctors will continue leaving for greener pastures. Just my $.02

 

[USAFGMODOC]

75% of our flight surgeons were D.O.s or carribean FMGs (even though D.O.s and carribean FMGs make up less than 15% of the overall physician pool in the real world). This is a sad state of affairs folks.

Very misleading stat here BOHICA; 75% of "YOUR" Flight surgeons means likely out of a group of 4-6 and maybe 8 Flight Docs at a busy place--- this is definitely NOT USAF wide (can't speak for the Navy). This does not represent the "whole" USAF nor does degrading DO's/FMG's in a basket help the situation. I can't believe the generalizations I see about DO's.

Gosh, as a DO myself, I actually scored > 90 on the USMLE step I and II-- I wonder if that means I "still" am considered inferior to my M.D. counterparts.... By the way, heading off to Radiology soon, so I guess being a D.O. / previous FS wasn't that bad.... OUT

 

[Galo]

What I take from BOHICA's post is the realizationt that the military, is just not attracting quality people, or the cream of the crop. I think that unfortunately is how some perceive DO's and FMG's. That being said, I met DO's and FMG's that were superlative individuals.

This should not be that hard. What I am saying, and I think most people are agreeing, is that a career in medicine in the military of today, post TRICARE, post PCO, is a 100% complete LOOSER, if the end is to be at the top of your profession, or just even close to it.

The good guys like you, eventually tire out, and leave.

G

 

[dpill]

I gotta back you up on this one. before I entered med school I was a BSC aerospace physiologist with a rank of O-4. I was personally stabbed in the back by my commander, which is why I am now with the U.S. Navy. I can attest to what Galo is saying. Air Force medicine is filled with too many commanders who are more concerned with their next promotion than good patient care. As a whole, the USAF medical service has become a slave to the MSC bean-counters who care nothing about quality of care, only about how much they can cut costs. 90% of the active duty physicians I dealt with at my last base, in all specialties, were leaving the service at the end of their commitment. 75% of our flight surgeons were D.O.s or carribean FMGs (even though D.O.s and carribean FMGs make up less than 15% of the overall physician pool in the real world). This is a sad state of affairs folks. Unfortunately, the system will not change unless it totally collapses. There are early signs of a "breaking of the bank" but until these manifest in the inability to care for active duty members and their dependents, nothing will get done, Generals will get promoted, and doctors will continue leaving for greener pastures. Just my $.02

Want to elaborate on your commander stabbing you in the back? No problem if you don't, but I thought something like that must have happened to you because you were MORE than qualified for an AF scholarship.

 

[BOHICA-FIGMO]

75% of our flight surgeons were D.O.s or carribean FMGs (even though D.O.s and carribean FMGs make up less than 15% of the overall physician pool in the real world). This is a sad state of affairs folks.

Very misleading stat here BOHICA; 75% of "YOUR" Flight surgeons means likely out of a group of 4-6 and maybe 8 Flight Docs at a busy place--- this is definitely NOT USAF wide (can't speak for the Navy). This does not represent the "whole" USAF nor does degrading DO's/FMG's in a basket help the situation. I can't believe the generalizations I see about DO's.

Gosh, as a DO myself, I actually scored > 90 on the USMLE step I and II-- I wonder if that means I "still" am considered inferior to my M.D. counterparts.... By the way, heading off to Radiology soon, so I guess being a D.O. / previous FS wasn't that bad.... OUT

I didn't mean to imply that DOs were inferior physicians..they're not. I simply meant to imply that the vast majority of graduates from medical professional schools in the U.S. (i.e., 125 allopathic schools @ ~13k physicians/yr vs. 20 D.O. schools @ ~3K graduates /yr) do not seem to be attracted to the military. That was all I was trying to point out with that stat. Sorry if I offended.

 

[BOHICA-FIGMO]

Want to elaborate on your commander stabbing you in the back? No problem if you don't, but I thought something like that must have happened to you because you were MORE than qualified for an AF scholarship.

dpill, I sent you a PM with the story.

 

[HumptyDumptyMil]

I'm glad to finally hear some stories about docs that are in fields besides primary care. I was hoping that the situation will be a little better with them, but it seems like the situation is equally bad.

What I don't understand is how the primary care area can have too many patient cases (USAFdoc can back me up, i'm sure) and other specialities like general surgery have too few cases. Do people in the military get sick, but not seriously sick? or is this another one of those administrative issues where resources are not distributed properly??

 

[Mirror Form]

What I don't understand is how the primary care area can have too many patient cases (USAFdoc can back me up, i'm sure) and other specialities like general surgery have too few cases. Do people in the military get sick, but not seriously sick? or is this another one of those administrative issues where resources are not distributed properly??

The reason that general surgeons don't have enough cases is b/c the military needs lots of them to rotate deployments to places like Iraq and afghanistan during war time. In that sense, the Army is actually a bit under-manned, with many general surgeons getting deployed over and over. They do surgery while deployed, but it's not the type of surgery that will keep their thyroidectomy or lap gastric by-pass skills sharp. While the general surgeons aren't deployed, many of them don't have enough cases.

 

[Galo]

Let me give a little insight into this.

Because of the inadequacy in truly understanding surgery, and trauma, the AF has deployed many of us to places we are at just to say we are there and ready. I gave the example either earlier, or in another post about my friend Paul who for a cumulative deployment time of close to 8 months did something like 3 cases. Lets say I exagerated, and for doubters sake he did 10 time that, (HE DID NOT), but at 30 cases in 8 months, that is just hot how to keep current.

This concept of deploying precious resourses haphazardly started in the first gulf war. THe main theater was actually ran by Ken Mattox. One of the country's leading trauma experts for those of you who don't know.

After the war he made a blanket statement that the military was not prepared to take care of Trauma. There are not enough surgeons doing it on a regular basis, and the majority of the bulk of surgeons are not doing it at all.

Due to this lack of training, what came next was the development of associations with major trauma institutions in this country to rotate military surgeons through in order to keep them current. The AF started with Ben Taub in Houston, the Army or Navy was in Miami, and or LA, at various large institutions. The concept just so, so, but when the military leaders got involved, it became a complete waste of time and money.


An analogy for you aircraft lovers: Imagine an F-16 fighter pilot who has MANDATORY stick time for certain types of sorties to accomplish their missions. These guys have to document every second they spend on an aircraft, as well as pre and de-briefing, to better understand their successes/failures. It works great, as we have the finest fighter pilots in the world.

NOW. Imaging if that fighter pilot only practiced take-off, landing, drop bomb. Over and over, and over, and over. But he did not do missile evasion, radar tracking, evasion techniques, emergency landing procedures, FAC, superiority techniques etc etc. But when war breaks out, he goes to a ONE MONTH course where he sits in a B-model f-16 and lets the guy who has all the experience fly him around, YES FLY HIM AROUND, NO STICK TIME, and then signs off that he is war ready. Anybody would have a hard time arguing this would be an efficient way to keep a pilot at the top of his game.

Well, you have a bunch of small to medium bases with primarily a healthy population of AD people and their dependents. Tricare has decimated the ability for you to see people with more complex disease processes, and certainly Trauma experience is nonexistent. You are held to different standards everybase you are at based on the whim or interpretation of the rules by the monarch of your squadron or hospital as to what you are allowed to do for getting trauma experience. Some places like I said want you to take leave, some you are not allowed, some may take up to a year to set up,( like my experience), one guy was not able to operate for ONE YEAR!!!!!!!!! David White M.D. So back to the concept of rotating through a trauma center once a month every 2 years.

I'll speak for the AF, since that is what my experience was with. Well, like I said it started in Houston at Ben Taub under the direction of Ken Mattox. Trauma GOD of the USA. At much cost, consternation, politics, credentialling issues and so forth. The first person they sent him, an OB/GYN. To make matters worse, they had allowed AD military surgeons with trauma fellowships to be there as faculty, and apparently they helped themselves to their data bases and were writting papers without acknowledgement to the institution amongst other things, and Ken told them to get THE HELL OUT OF TEXAS.

They go looking for a place that will accept free labor, plus get paid who knows how many millions, and settle on Shock Trauma in Baltimore. Where now with new residency 80 work week guidelines, the suckers, I mean Docs from the AF will come and work as PGY-2, yes, second year residents, NOT be held to hour restrictions as they are not technically residents, although they are functioning at that capacity, and ride backseat for a month, in a place that sees in excess of 90% blunt trauma, where any penetrating trauma is taken immediately by the fellow, or chief resident who is really learning. It is also staffed again, by fellowship trained trauma attendings who are not deployable because they are in a "training" capacity. See where I'm going with this, IT MAKES NO SENCE. Also its designed for people who have not done trauma in over 2 years or more, since its meant to be a refresher, so technically 0-5's and 0-6's would be the prime candidates, but no senior officer is going bo be drawing blood, pushing patients, running for labs, doing H&P's, and discharge summaries. So you receive a tasking, and your boss who is the ****tiest surgeon in the AF, who could not even operate close to the capacity of Frank Burns, then sends you who were acting as an attending trauma surgeon 11 months prior (yes me), or any other sucker other than him.

AND THIS ladies and gentleman is who takes care of your sick and wounded children.

This should not be too alarming, as most AF base surgeons who are deployed, are usually getting bedsores from sitting on their ass.

Most injured soldiers are Army, and they go to army bases where their surgeons much in the same capacity as the AF guys, may not have an extensive trauma experience. As I understood it from my friend Paul. THe majority of Army guys are reserve surgeons who play week end warrior and never counted on a conflict. Are not usually practicing trauma, and therefore are not the most ideal to take care your children. Yes, I will say it, and its there in a morbidity and mortality conference held in the field that is likely available through FOI. The reserve surgeons allowed 2 US soldiers to die because they did not do things an experienced trauma surgeon would have done. THAT IS ALARMING!!

I know I may have gotten a little of course, but its again a prime example why military medicine is a sinking ship, a falling airplane, a broken down tank.

I don't know what else to say. Can't say it anymore plain and simple. Military medicine all around is LOST.

NOW DISCUSS

 

[HumptyDumptyMil]

Thanks for the reply Sledge.

Shouldn't we as doctors and future doctors supposed to be HAPPY that people are in good health and we do not need to work?? I guess some of you guys were under the impression that you will be busy and getting many cases while in the military.

As for me, I applied to Navy and AF HPSP and BOTH recruiters told me that the job will be easier than in the civilian world because of the relatively healthy patient population. I toured a military hospital in Cherry Point, NC and saw NO patients in the few beds they had there. I figured that it's because of the location, but it's sounding like the situation is similar at many other bases around the country. Ah, well. If I decide to go the surgery route, get lucky and become a surgeon, I hope i'll find a place that will allow me to moonlight.

If not, I might spend precious time with family b/c I won't have much time once I get busy out in the civilian world. Am I too optimistic?

 

[Galo]

humptydumbty

With that attitude you will not be a surgeon.

Most people become physicians to help heal people that are sick. NO surgeon I know joined because he thought he would be super busy or otherwise. We joined because at the time, it was a truly impressive organization with the most modern care available, the most interesting cases there, and were under the impression it was a quality highly competitive place. It changed dramatically.

You should really think about why you want to be a doctor, and if after reading all these posts, if you want to be in the military, just go to OTS and take any officer assignment they give you. You'll be much happier.

G

 

[r90t]

"After the war he made a blanket statement that the military was not prepared to take care of Trauma. There are not enough surgeons doing it on a regular basis, and the majority of the bulk of surgeons are not doing it at all."

Prior to OIF/OEF where would a military surgeon get extensive experience in blast injuries/IED on a routine basis? Or for that matter a GSW if he is assigned to a military hospital doing routine general surgeon duties? That is a major problem in all services.

Here is a problem that a physician friend faces. He is an ER physician currently specializing at a peds hospital for the next couple of years. He is required by Uncle Sam to keep his adult emergency medicine skills up to par, yet he is unable to moonlight at any ERs due to regulations. Degradation of skills, yes.

BTW, the head of the navy trauma training center (O-6) is currently voluntarily deployed to Iraq, TDY/TAD.

 

[Galo]

Keeping current in trauma, or any other skill that one should do on a regular basis, is very difficult to impossible in the military. Just as your friend, and myself have experienced.

This is just one of the critical examples why I'm crying the sky is falling!!


I'm glad that an experienced trauma surgeon is out there, I would hope the AF and Army do the same. Though I have to say, with FEW exceptions, most 0-6 surgeons through up a red flag to me. There are great dedicated individuals that have chosen to stay in the military despite the problems, but again, they are few.

The sky is falling.

 

[USAFdoc]

Keeping current in trauma, or any other skill that one should do on a regular basis, is very difficult to impossible in the military. Just as your friend, and myself have experienced.

This is just one of the critical examples why I'm crying the sky is falling!!


I'm glad that an experienced trauma surgeon is out there, I would hope the AF and Army do the same. Though I have to say, with FEW exceptions, most 0-6 surgeons through up a red flag to me. There are great dedicated individuals that have chosen to stay in the military despite the problems, but again, they are few.

It would only make sense (and my personal experience backs it up) that those officers demanding excellence and integrity and willing to work and do whatever it takes to acheive that, will be the most frustrated and most likely to exit the military asap. Those officers content with mediocrity, content to look the other way, and afraid to buck the system will be most likely to stay. There are of course exceptions.

As I have said before; the military is doing a disservice to everyone; the patient, the physician and their staff, and ultimately, even to the military itself. I hear all this stuff about "glacial movement" etc. When the SG of the USAF wanted to crank up patient numbers by 200-400%, that happened almost overnight. It is all a matter of priorities, and excellent leadership. Currently those are backward and backward respectively.

 

[Galo]

Let me ask you.

Why is it that there are some people in this forum, richlo25, a 19 yr army guy who is NOT yet a doctor, and GMO 52, (those two come to mind, but there are others), continually seem to get offended by our critique of a broken down system.

Much like militarymd, I am trying to provide information to potential candidates why it may not be the right choice for them to enter military service if they want to be a doctor. I know I will not be able to change policy, or the continuing spiral of military medicine. I just want to give information to potential HPSP/FAP, or whatever else way people may be getting suckered into a substandard program of medicine.

Is there any active duty physician, any service, who would like to comment otherwise. Please let them post, and lets discuss!!!

 

[backrow]

Let me ask you.

Why is it that there are some people in this forum, richlo25, a 19 yr army guy who is NOT yet a doctor, and GMO 52, (those two come to mind, but there are others), continually seem to get offended by our critique of a broken down system.

I don't think that they get offended by your critique. I think it is more that they get offended that every new thread that is started in this discussion forum is soon taken over (hijacked I dare say) by the anti-military medicine people and it goes into a downward spiral from there.

Yes, this is a free society, so you may do as you please, but it might be nice to open up a thread and not be lambasted by those who do not like what they see of military medicine these days. Maybe a good compromise would be to link to the threads that have already been started about "The decline of military medicine" when one wants to show their opinion.

I know, you can do what you want, and I don't have to read what is written, but these are just my thoughts.

 

[f_w]

disclaimer: I am not a surgeon and I am not part of the US military (and in all likelihood will never become one). However, having worked with some ex-military physicians, I watch the system with some curiosity.

So, your bad personal experiences with military medicine aside, HOW do you suggest that the US military maintain a pool of 'trauma-comfortable' surgeons for deployment ?

1. The current situation:

- active duty personnel is plagued by low case numbers due to the relatively healthy active duty community (the first time I heard that the military has bariatric surgery programs I thought this was a misunderstanding)

- farming fully trained surgeons out to high-profile trauma centers doesn't seem to work because they remain 'foreign bodies' within these systems and can't get their cases due to the plethora of trauma fellows and chief residents.

- reserve surgeons are often out in community practice and don't have a mechanism to maintain currency in the procedures necessary for a wartime deployment (different specialty, same story: a colleague of mine, by training a pediatric hematologist was pulled out of the reserves for active duty in iraq. I think she does a great job treating leukemia, but I am not sure whether this is the skill set you need to treat adult casualties....)

2. At the same time:

- many community trauma centers have difficulty filling their trauma call rotation. Often they have to either arm-wrestle their community surgeons into taking call, or they have to pay hourly stipends to the ones willing to take this responsibility. Malpractice and poor payor mix for trauma patients is another consideration (Joe Dirt might not have insurance, but if he flips his rusty pickup he sure as hell wants a perfect outcome with legs of equal length and an impeccable scar). In some parts of the country, trauma centers have down-graded their status or dropped the designation alltogether because they can't retain a roster of trauma physicians and necessary specialists such as neurosurgeons.

- VA hospitals have difficulty recruiting specialists. Often they either rely on cooperation with teaching hospitals to borrow their academic staff, or they resort to staffing their services through locums agencies.


Do you think that the problems of 1 could be the solution for the problems of 2 ?

It seems like there is no real work for military surgeons at the often rural bases. Keeping yourself busy with endoscopy sounds pretty pathetic. Do you think it would be feasible to pull the surgical coverage from these places alltogether and rather buy the necessary healthcare services for the active duty soldiers in the community ? Some of the surgeons freed up by this move could either work in the often urban VA hospitals (granted, no trauma, but plenty of GS and VS pathology), or they could be leased out to community trauma centers (with capped FTCA liability they wouldn't face lots of the litigation a normal surgeon is exposed to in trauma care).

 

[USAFdoc]

there are solutions to the problems that military medicine faces, and many of them are cost effective solutions, some are not.

but, I would almost guarantee you that the solution will NOT come from the mind of the surgeon general who has no clue of what might be happening at "ground zero", and who runs a system where those on ground zero (the docs actually seeing patients) have no voice or authority to fix the problems, and congress has no clue because the SG basically tells congress that everything is wonderful.

 

[f_w]

and congress has no clue because the SG basically tells congress that everything is wonderful.

'bubble boy syndrome' ?

I love the cr#_ the recruiters tell people. Reading that, and contrasting it to the stuff from that presentation posted above is interesting to say the least.

 

[colbgw02]

Let me ask you.

Why is it that there are some people in this forum, richlo25, a 19 yr army guy who is NOT yet a doctor, and GMO 52, (those two come to mind, but there are others), continually seem to get offended by our critique of a broken down system.

Is there any active duty physician, any service, who would like to comment otherwise. Please let them post, and lets discuss!!!

I'm not particularly informed about this topic, so I've just been reading and trying to learn while not becoming completely jaded. Certainly, we youngsters have a lot to learn, but, at the risk of beating a dead horse, I'd like to reiterate that this is a student doctor forum. I just hope that no one feels belittled on this board solely because they are young and/or inexperienced. The older I get, the more I realize that experience does not equate to intelligence nor intelligence to experience. I appreciate the opinions and comments of the folks who've actually been in the trenches, but please just remember that just because someone is young, in the Army, or not yet a doctor doesn't mean he or she is incapable of forming a cogent opinion.

 

[HumptyDumptyMil]

I'm not particularly informed about this topic, so I've just been reading and trying to learn while not becoming completely jaded. Certainly, we youngsters have a lot to learn, but, at the risk of beating a dead horse, I'd like to reiterate that this is a student doctor forum. I just hope that no one feels belittled on this board solely because they are young and/or inexperienced. The older I get, the more I realize that experience does not equate to intelligence nor intelligence to experience. I appreciate the opinions and comments of the folks who've actually been in the trenches, but please just remember that just because someone is young, in the Army, or not yet a doctor doesn't mean he or she is incapable of forming a cogent opinion.

I concur 👍 Yes, we may not know what it really is like in the military, but that doesnt mean we are blind about the current situation. We young ones are here to learn and are trying to make wise choices. And I would like to repeat how grateful I am about this forum and all the opinions posted.

 

[USAFdoc]

I'm not particularly informed about this topic, so I've just been reading and trying to learn while not becoming completely jaded. Certainly, we youngsters have a lot to learn, but, at the risk of beating a dead horse, I'd like to reiterate that this is a student doctor forum. I just hope that no one feels belittled on this board solely because they are young and/or inexperienced. The older I get, the more I realize that experience does not equate to intelligence nor intelligence to experience. I appreciate the opinions and comments of the folks who've actually been in the trenches, but please just remember that just because someone is young, in the Army, or not yet a doctor doesn't mean he or she is incapable of forming a cogent opinion.

agreed. many physicians have had such a terrible and disappointing experience with military medicine that we sometimes "blow-up" so to speak when the topic comes up. Some on this site seem to want to believe (and understandably so) that the problem must lie with the physicians.

Having said that; everyone deserves to be respected.

 

[USAFdoc]

I'm not particularly informed about this topic, so I've just been reading and trying to learn while not becoming completely jaded. Certainly, we youngsters have a lot to learn, but, at the risk of beating a dead horse, I'd like to reiterate that this is a student doctor forum. I just hope that no one feels belittled on this board solely because they are young and/or inexperienced. The older I get, the more I realize that experience does not equate to intelligence nor intelligence to experience. I appreciate the opinions and comments of the folks who've actually been in the trenches, but please just remember that just because someone is young, in the Army, or not yet a doctor doesn't mean he or she is incapable of forming a cogent opinion.

agreed. many physicians have had such a terrible and disappointing experience with military medicine that we sometimes "blow-up" so to speak when the topic comes up. Some on this site seem to want to believe (and understandably so... what student would want to hear the future looks bleak) that the problem must lie with the physicians.

Having said that; everyone deserves to be respected.

 

[Galo]

I don't think that they get offended by your critique. I think it is more that they get offended that every new thread that is started in this discussion forum is soon taken over (hijacked I dare say) by the anti-military medicine people and it goes into a downward spiral from there.

Yes, this is a free society, so you may do as you please, but it might be nice to open up a thread and not be lambasted by those who do not like what they see of military medicine these days. Maybe a good compromise would be to link to the threads that have already been started about "The decline of military medicine" when one wants to show their opinion.

I know, you can do what you want, and I don't have to read what is written, but these are just my thoughts.

I think its impossible to let people really feel, and know the dissapointment and pain I went through. Having found a sounding board where I may be able to spare somebody the same pain has made me a little "hijack" happy. Perhaps if this thread was stickied it may alleviate some of that.

Or as you said, people can ignore what we say, till I get tired of saying it. It just seems so right to try to educate people, and what I have to say is true, and important.

 

[Galo]

disclaimer: I am not a surgeon and I am not part of the US military (and in all likelihood will never become one). However, having worked with some ex-military physicians, I watch the system with some curiosity.

So, your bad personal experiences with military medicine aside, HOW do you suggest that the US military maintain a pool of 'trauma-comfortable' surgeons for deployment ?

1. The current situation:

- active duty personnel is plagued by low case numbers due to the relatively healthy active duty community (the first time I heard that the military has bariatric surgery programs I thought this was a misunderstanding)

- farming fully trained surgeons out to high-profile trauma centers doesn't seem to work because they remain 'foreign bodies' within these systems and can't get their cases due to the plethora of trauma fellows and chief residents.

- reserve surgeons are often out in community practice and don't have a mechanism to maintain currency in the procedures necessary for a wartime deployment (different specialty, same story: a colleague of mine, by training a pediatric hematologist was pulled out of the reserves for active duty in iraq. I think she does a great job treating leukemia, but I am not sure whether this is the skill set you need to treat adult casualties....)

2. At the same time:

- many community trauma centers have difficulty filling their trauma call rotation. Often they have to either arm-wrestle their community surgeons into taking call, or they have to pay hourly stipends to the ones willing to take this responsibility. Malpractice and poor payor mix for trauma patients is another consideration (Joe Dirt might not have insurance, but if he flips his rusty pickup he sure as hell wants a perfect outcome with legs of equal length and an impeccable scar). In some parts of the country, trauma centers have down-graded their status or dropped the designation alltogether because they can't retain a roster of trauma physicians and necessary specialists such as neurosurgeons.

- VA hospitals have difficulty recruiting specialists. Often they either rely on cooperation with teaching hospitals to borrow their academic staff, or they resort to staffing their services through locums agencies.


Do you think that the problems of 1 could be the solution for the problems of 2 ?

It seems like there is no real work for military surgeons at the often rural bases. Keeping yourself busy with endoscopy sounds pretty pathetic. Do you think it would be feasible to pull the surgical coverage from these places alltogether and rather buy the necessary healthcare services for the active duty soldiers in the community ? Some of the surgeons freed up by this move could either work in the often urban VA hospitals (granted, no trauma, but plenty of GS and VS pathology), or they could be leased out to community trauma centers (with capped FTCA liability they wouldn't face lots of the litigation a normal surgeon is exposed to in trauma care).

f w:

Thank you for your insights. Many of us have pondered the same questions you pose.

-allow surgeons in bases where they are doing next to nothing to work downtown, even if it means allowing them to be paid.
-allow surgeons and encourage them to moonlight doing trauma. Not making it an ordeal like I and others went through. I have addressed this before. It seems to be a hit-miss thing based on the whim of your commander.
-keep a reserve force of practicing trauma surgeons unders some type of contract where they know they will rotate into deployment positions, and a way to do that would be to actually pay them for it.
-Some bases, (in Alaska) already rotate the military surgeons to VA's. Again, its a hit and miss thing, as they are 2 separate beurocracy's with their own rules and regulations.

The suggestions you made are also viable.

The biggest problem, and why it will never happen, is just as USAFDoc alluded to, there is a big difference of perception from the physicians doing the actual work, and a leadership that as I have said before does not care, is ignorant of the problem, they are unable to fix it at their level, and ultimately it has to do with the acceptance of mediocracy in this system. Even when Gen Karlton, was the SG, (he is actually a general surgeon), nothing to begin to fix this was done. He passed the buck to the new guy, who's name I forget, but he, is a flight doc, that has NEVER completed a residency of any type, or taken care of patients like we have to, yet is where the buck stops.

This is why we are so frustrated, angry, resentful, and why I am here at 1040PM when I should be reading Curious George to my 2 year old.

Also, just as with everything, the mighty $$$$ comes into play. As this war is going on, and people are overworked, (army), in the AF, they are in the Phase II of force reduction where they are required by law to get rid of some 1500 officers, allow them early retirement, or give them severance pay, etc. So there is just no money or the actual management of the money is so poor, that it will never work

These suggestions have been made before. Just no one is listening.

 

[Galo]

I'm not particularly informed about this topic, so I've just been reading and trying to learn while not becoming completely jaded. Certainly, we youngsters have a lot to learn, but, at the risk of beating a dead horse, I'd like to reiterate that this is a student doctor forum. I just hope that no one feels belittled on this board solely because they are young and/or inexperienced. The older I get, the more I realize that experience does not equate to intelligence nor intelligence to experience. I appreciate the opinions and comments of the folks who've actually been in the trenches, but please just remember that just because someone is young, in the Army, or not yet a doctor doesn't mean he or she is incapable of forming a cogent opinion.

I cant quite think of the quote. Its something like the mother of inexperience is experience, or the way to experience is through inexperience, something like that, but I'm sure you get where I am going.

Yeah its a student forum, and what we are trying to impart onto you is education and experience. We can offer this to you solely because we have experienced it first hand, not read about it, or heard about it, or seen it on TV, or lectured on it, but actually LIVED it. So you are getting information much like you would from one of your more experienced teachers. Now would you try to challenge your teacher on something that you have never experienced, but they have??

I do not know if I was disrespectful to the 19 year army guy who is questioning my ability to comment on military medicine. If I was, sorry. I think after reading some of the responces that there are people who are unwilling to listen to anything we have to say, and want to think it must be our fault for what we reaped. I know it may be disrespectful to say this, but those people, will become the new leadership to continue this problem. Because they do not acknowledge there is a problem, so it will continue. Till then, I will keep posting and trying to save the few people who are willing to listen to my advice and that of other who have been in the trenches and did not have a worthwile experience to pass on to others.

I'm going home to bed.

G

 

[r90t]

Unfortunately, there is a whole range of experiences in military medicine that each physician goes through. This can vary service to service, to individual commands, departments and physician. Most people in military medicine are not in it for the long run and are frustrated by the "broken" system. The physicians can't wait to get out to get less work hours, more pay, and most importantly, support from all staff to get the job done.

I have the distinction of being promoted and demoted more than any officer that I know (not due to conduct). It has been an unusual career. Nothing surprises me anymore. I've enlisted, graduated from USNA, been a line officer, was an MSC, went HPSP, then GMO, now resident. I have had a good experience with my medical training and tours. I may be the exception, I don't know. Sounds like many physicians have had bad experiences during their AD time. From their stories, I would be bitter, as well.

Are there any USUHS graduates on this board that has good/bad experiences that they can discuss, as they are our "core" of professional military medical corps officers.

 

[Teufelhunden]

Not that many people will be interested in the Psychiatry perspective, but here goes anyway:

The differences between civilian and military psychiatry weighs heavily in favor of military in many aspect that are important to many (not all) psychiatrists. Civilian psychiatrists who want to be able to pay their mortgatge have been mostly relegated to doing 15-minute med management visits, while psychologists are doing the psychotherapy. In the military, I see many staff (attending) psychiatrists scheduling 45-minute visits. The Navy (I can't speak for other branches) is a place where you can still offer psychiatric care as is dictated by what you deem would best suit the patient, with regard to the balance between pyschotherapy and pharmacological treatment. I see this as a type of clinical "freedom" that you simply don't have as a civilian, where your pay would be aversely affected by seeing ANY patients for longer than 15 minutes.

Again, I have an appreciation for the anti-military-medicine arguments above. I just wanted to point out that many of these complaints are specialty specific. Don't get me wrong, I could also compile a pretty long list of "Cons" for Navy Psychiatry, but I believe that the "Pro" of clinical freedom is worth a mention in a forum that weighs in heavily on "Cons."

my 2 cents...

 

[colbgw02]

Yeah its a student forum, and what we are trying to impart onto you is education and experience. We can offer this to you solely because we have experienced it first hand, not read about it, or heard about it, or seen it on TV, or lectured on it, but actually LIVED it.

I understand this completely, and your knowledge and experience is appreciated. I'm merely suggesting that this isn't the perfect forum, although perhaps it's the best one available. Similarly, if I were a teacher, I don't think I'd use my students' after-school hang-out as a sounding board - as you put it - to pass on my experiences. You've obviously had some pretty terrible experiences, which you're right to want to share. My point is simply, IMHO, that it's more effective in the long-term to post your thoughts and allow us to reference it while making up our own minds. Otherwise, you run the risk of being counter-productive.

Now would you try to challenge your teacher on something that you have never experienced, but they have??

I hope I haven't done this. And really, I can't and won't comment on the intentions or motivations of anyone else. Like I said before, I know next to nothing about this topic.

I know it may be disrespectful to say this, but those people, will become the new leadership to continue this problem. Because they do not acknowledge there is a problem, so it will continue.

I think this is a really good point, and it's one that should resonate with all students and people still in training. I would only add that most of us are smart enough to deserve the benefit of the doubt, which is to say I don't think we need to be beat over the head with it.

I'm going home to bed.

Sleep well.

 

[Galo]

I understand this completely, and your knowledge and experience is appreciated. I'm merely suggesting that this isn't the perfect forum, although perhaps it's the best one available. Similarly, if I were a teacher, I don't think I'd use my students' after-school hang-out as a sounding board - as you put it - to pass on my experiences. You've obviously had some pretty terrible experiences, which you're right to want to share. My point is simply, IMHO, that it's more effective in the long-term to post your thoughts and allow us to reference it while making up our own minds. Otherwise, you run the risk of being counter-productive.

Although this may not be the perfect forum, it is the only one of its kind available. Also it is the one where people most likely would seek this information. What good would it do for all the physician who had a terrible experience to talk about it amongst themselves, if no one potentially going into it was not there to reap the benefits.

I think this post, and the "AVOID MILITARY MEDICINE" posts should be STICKIED. How do we go about this??? They clearly represent the majority of negatives with well documented paperwork, besides our personal rantings, and should be available to all who consider a military career.

I also would love to see people who got out and had a good experience it, post it, so we can see what else is out there. Hell, I may even start another post about what I felt was OK. I may digress into hell, but I can at least try.

Galo

http://www.pulitzer.org/works/1998-National-Reporting

I found this in some other part of the forum, cant remember exactly where. AVOID MILITARY MEDICINE also has links showing the demise.