The Hidden Catches of HPSP/USUHS

[MedicalCorpse]

I recently received a PM requesting my impression of the "hidden catches" of joining military medicine through HPSP or USUHS in 2007 and beyond. I hope the extensive reply below will prove of value to anyone who is thinking of going into the U.S. Military Medical Corpse (sic) by these routes.

I must emphasize: I am not anti-U.S. or anti-military. As a former LtCol ROTC and USU grad, I am a patriotic American citizen. However, it is virtually impossible for potential HPSP/USU students to get any accurate information from the services about the serious "challenges" they will face as attending military docs. This post and my website aim to do my small part to correct this problem.

The "Hidden Catches" of HPSP/USUHS
Catch 1-8 of 100​

Executive summary, as one who went through ROTC to Harvard, USUHS, and military residency: DO NOT JOIN THE DEAD MILITARY MEDICAL SYSTEM of 2007 and beyond.

Hidden catch #1: (Updated) If you choose to join the Air Force or the Navy, you will most likely NOT get the residency of your choice right out of internship. The USAF and Navy force interns to do General Medical Officer/Flight Surgeon tours of 2-3 years after internship, where you will be treating the runny noses and jock itch of soldiers/sailors/airmen/marines with no opportunity for further education during that time. I have been informed (see below) that the U.S. Army is currently (late 2006) treating its interns better; there appear to be more opportunities for residency right out of internship in the Army. However...

Hidden catch #2: In all branches of service, even after your GMO tour, you will not be guaranteed the residency of your choice. The number of slots available in each service varies from year to year; often, between 50-100% of people who want training in a specific specialty fail to match. Even after you are residency trained, there is no guarantee you won't get deployed to fill a GMO slot anyway (imagine being a pediatrician, urologist or radiologist and being sent to see sick call in a busy ER in the desert-- this happens [see our honorable moderator's post on this topic below]).

Hidden catch #3: Every single U.S. military medical facility on Earth (except for our overseas Combat Support Hospitals in Balad, Baghdad, and, soon, Tehran) is a hollow shell of what it used to be in the 90s, due to downsizing, funding cutbacks, excessive deployments, physician retention failure, lack of upkeep of infrastructure, and sheer poor planning. You will be asked to do nearly all of your own scut work with minimal support personnel. You will be tasked to come in on weekends to straighten out the primary care records room...as a board-certified psychiatrist of my acquaintance was ordered to do. You may even be tasked to cancel your clinic to go out to pick up leaves and sticks from the hospital grounds after a hurricane, as a LtCol oral surgeon I knew once experienced.

Hidden catch #4: If you do HPSP and fulfill your 4 year payback, you will still owe Uncle Sam 4 more years of IRR (Individual Ready Reserve) service...and many, many docs are being recalled involuntarily from their cushy civilian lives back to active duty right now, even BEFORE we invade (Iran, Syria, Somalia, North Korea, fill in the blank). The military has done a tragically atrocious job of retaining active duty docs; the regular reserves of all services are tapped out...thus, they are right now drawing on troops with IRR commitments and 86 year old retirees (remember, if you retire from the military as an officer, you are subject to involuntary recall to active duty FOR LIFE [yes, I know of an 86 year old psychologist who was given a flak jacket and sent to the desert at a remote location, only to be air evaced back to the U.S. when he *surprisingly* developed a medical problem]).

Hidden Catch #5: Due entirely to addle headed policies advocating "nursing/PA/housekeeper empowerment" in all three branches, you will be subject to two separate chains of command while on active duty: the military chain of command, which wields UCMJ (Uniform Code of Military Justice) power over your life; and the emasculated, vestigial medical chain of command, which only carries "advisory" power to the all-mighty military chain. You WILL be commanded by a nurse, pharmacist, physical therapist, or non-clinical M.D. who last touched a patient when you were in 6th grade. Some of these will leave you alone, except for incessant e-mails to keep up your productivity numbers, get your shots, do your after-hours or before-clinic mandatory exercise, and make sure you have hankies in your deployment bag. Others will mistake their military rank for medical competence and second-guess your medical judgment regarding your personal patients. The first time you are ordered to kill a 2 year old child by giving them sedation despite a life-threatening brain hemorrhage because the politically-powerful but clinically-ignorant Vice Commander of the hospital tells you to, you will not be a happy doctor (yes, this happened to a friend of mine). Appeals to your medical chain of command (through your specialty chief, to the SGH [chief of clinical services], to the Consultant for your specialty) will fall on deaf ears...because the OPRs (Officer Performance Reports) of your medical superiors are written by the very fiends who are ordering you to commit what you deem to be malpractice.

Hidden catch #6: Even after you think you have fulfilled your Active Duty Service Commitment, you can be kept on active duty indefinitely if the Secretary of Defense invokes Stop Loss. Several of the folks I worked with at Andrews were prevented from retiring after 20 years of honorable service to their country for a year or more due to the Stop Loss policy implemented every SINGLE time we start a new war/intervention/peacekeeping mission.

Hidden catch #7: You may have heard that the military shields you from the "red tape" of the civilian world. In the words of one poster at SDN, the military only replaced "red tape" with "red barbed wire", such as endless computer based training, mandatory meetings on a daily basis, workload metrics, patient care coding by docs without any support, mindless short notice/no notice taskings (medicolegal reviews, readiness, questionnaires, etc.). I have experienced far less "red tape" by a factor of 1000 in my 1.5 years as a civilian than I experienced during my 15 years as a military doc.

Hidden catch #8: You will be ordered to allow non-physicians to practice essentially independently under the fig leaf of your medical license. In violation of civilian Federal and State law, the military has actively encouraged the independent (mal)practice of CRNAs, NPs, and PAs with inadequate or absent physician supervision. This has been seen as necessary because the current retention rate of M.D.s hovers around the 8% range...while advanced practice nurses, PAs, and other non-M.D. "providers" get a good deal in the military: pay commensurate or better than the outside world, PLUS the ego-boosting chance to gain life or death, UCMJ Command authority over the cowering, low-ranking physicians under them (a situation which essentially never occurs in the outside world). Remember: if a patient dies because of malpractice committed by a PA/CRNA/NP working independently, but your name is on the chart, guess who is going to be reported to the National Practitioner Databank? And do you think that your appeal to the Chain of Command that you never saw the patient, because the system is set up to encourage the independent practice of non-physicians by forcing you to sign charts of patients you were never consulted about, will be grounds for your exoneration, or used as a club to destroy your military career, life, and family in retribution for your "unbecoming conduct" of speaking out in violation of the military medical omerta (code of silence)?

(to be continued)

Rob

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[MedicalCorpse]

The "Hidden Catches" of HPSP/USUHS
Catch 9-100
​

Hidden catch #9: Not so hidden, but downplayed by recruiters: YOU CANNOT QUIT. If you are ordered to commit crimes against humanity, you cannot quit. If you are ordered to commit what you deem to be malpractice, you may get a career-ending Letter of Reprimand (as I did when I refused), but you cannot quit. If a micromanaging nurse sabotages your every attempt as Medical Director of Anesthesia to provide quality medical direction of anesthesia care, you still cannot quit. If you are punitively given an unaccompanied assignment to Alaska without your two handicapped children, while your active duty physician wife is on the OB deck in premature labor with your preemie third child, all because you spoke out to improve patient care in the military, guess what: YOU CANNOT QUIT. If any of the above affected your practice in the civilian world, the hospital administration would know that physicians would quit en masse. In the military, given the captive thrall status physicians enjoy, the administrative drones in charge just do not give one small [fecal matter] about the working conditions, quality of life, or inadequate and untrained support staff doctors have to endure on a daily basis.

Hidden catch #10: The pay is really insulting. Nobody joins the military to get rich. Most join out of financial need, a sense of patriotism, family tradition, desire for revenge for attacks on America, or all of the above. However, the base pay you get as a Captain and Major is pathetic, even when you include the few extra housing allowance (VHA) dollars thrown in, supposedly to allow folks to afford housing in high-rent areas like Northern California and Washington, D.C. Thus, a huge chunk of your income depends on bonuses granted twice per year: the ASP (Additional Special Pay) of $15,000.000 before taxes ca. July (not available to interns and residents) and the ISP (specialty-specific Variable Specialty Pay) ca. November or December*. Currently, the max ISP of $36,000.00 per year is given to anesthesiologists, orthopedic surgeons, radiologists, and some subspecialists. There are two other bonuses: VSP and MSP. VSP (Variable Specialty Pay) starts out at $1,200.00 per year for interns, maxes out at eight years of service at $12,000.00, then starts to go *down* if you are stupid enough to stay in, until it reaches only $7,000.00 per year after 22 years of service. The military is basically betting that people who stay in to make O-6 (Colonel/Naval Captain) are willing to trade money for power...as well as the now-tarnished brass ring of retirement (see number 4 above). MSP (Multiyear Special Pay) is a pathetic additional bonus for *****s who decide to sign up for X number of years' commitment after their initial ADSC has expired; it maxes out at an insulting $14K/year for a 4 year commitment (for an excellent review of current special pays for physicians, see: http://www.military.com/benefits/military-pay/special-pay/special-military-pay-for-medical-officers). Now for the catches: ASP hasn't been changed since I was an intern. Back in 1990, $15K/year (around $10K after taxes) seemed like a big deal. In 2007, it's chump change. ISP varies from year to year, and is dependent on your specialty (Peds gets the short stick at $12K/year; Aerospace Medicine and FP get a paltry $13k/year-- barely a third of what anesthesiologists like myself make). *The biggest "Catch" of ISP is that it is NEVER (never) paid on time. It is supposed to be paid on 1 October of each year. However, Congress and the military have historically held off making the funds and/or contracts available until November or December, in order to shift the expense later into the fiscal year (in essence, an involuntary, interest-free loan made by all Medical Corps specialists to the U.S. government). VSP, as noted above, starts to fall after 8 years of service (just one of many military intelligence tests medical General Officers fail). In my opinion, however, the biggest catch of all is that all bonuses can be withheld at the whim of a vindictive commander, acting as a representative of the Secretary of Defense (see http://www.e-publishing.af.mil/pubfiles/af/41/afi41-109/afi41-109.pdf (page 5), and the court case http://www.justice.gov/osg/briefs/1988/sg880375.txt). I know of one ophthalmologist who was threatened by my evil Squadron Commander with termination of his bonus pays if he refused to take patients to the O.R. in the absence of qualified ophthalmology O.R. technicians. In essence, if you do anything which anyone in the MILITARY chain of command deems is "conduct unbecoming an officer" (like trying to be a patient safety advocate in the face of the crumbling and dangerous military health care prevention system), POOF! There goes about half of your yearly income. Try enjoying going to work for $50K a year when you had been making over $100K per year before you pissed off the non-clinical, often non-physician bureaucrat who wields the Sword of Damocles over your head through the Uniform Code of Military Injustice.

For a far more in-depth and economically-insightful analysis of the financial risks and benefits of HPSP vs. civilian practice, see this most excellent recent post and thread by Desperado: In-Depth Financial Analysis of HPSP

Hidden catch #11: (Controversial, but true) If you are not a Bible-thumping, born again, evangelical Christian, you will be made to feel very uncomfortable in today's One USAF Under Jesus. A fanatic group of fundamentalist Christians has used the US Air Force Academy to put high-ranking Evangelicals into positions of power throughout the Air Force. They have explicitly made it their agenda to hijack what used to be a secular institution protected by the First Amendment from inappropriate proselytization, in order to use the U.S. military as a vehicle to spread their particular religious beliefs like a virus throughout the military and around the world. IF you are Jewish, Hindu, Buddhist, Muslim, atheist, agnostic, or, like myself, Pagan/Buddhist, you WILL be subject to subtle and overt religious intolerance while on active duty. You will likely get worse OPRs and assignments than those who are on the "inside" of this powerful movement. The former Commanding General at Malcolm Grow Medical Center (who is now AFMC Command Surgeon) forced a "Spiritual Life Committee" down the throats of his subordinates while I was there. He insisted that supervisors quiz their subordinates during mandatory military feedback/evaluation sessions regarding their "spiritual biceps"; his vision was that supervisors should assist their underlings to get closer to "God" to improve their happiness and productivity. As if my clueless supervisors would have had clue one how to get me closer to my Goddess! Be warned: bring your King James Version Bible to boot camp if you plan to join the USAF. If you think I am exaggerating, read the recently published book by a former USAF lawyer, USAFA grad, and Reagan administration official regarding the unconstitutional Christianization of the U.S. military: With God On Our Side: One Man's War Against an Evangelical Coup in America's Military:

Amazon product ASIN 0312361432
Hidden Catches 12-100: Read the following posts and threads on SDN:

Ten Things I Hate about my Job

40 (and counting) Reasons Not To Join

All Branch Topic (ABT) - 33 Reasons Not to Join Military Medicine

Hope this helps,
Rob Jones, M.D.
On Hiatus
webmaster_AT_medicalcorpse_D0T_com

 

[chopperdoc]

Sir,
With all due respect, are you smoking crack? This rampage is illogical and many of the things you are saying are simply untrue. You destroy your credibility when you make such outlandish claims. I understand that military medicine has problems and is not a perfect system, but it is clear that you have an agenda. You need to look at the most recent match results and see how many folks are doing GMO tours and not matching into their desired specialty -- you will find the numbers are few. In addition, I've met several people who have matched into competitive specialties, that simply would not have matched into them in the civilian world. Also, you anti-Christian sentiments were appalling, ignorant, and downright disrespectful to the many amazing Christians soldiers that fight in out great military.

 

[g293]

 

[Bubblehead-to-MD]

Just kickin' back & enjoyin' the show?

 

[MedicalCorpse]

Sir,
With all due respect, are you smoking crack?

Hint #1: When anyone says "with all due respect", it is a clear indication that they have none. And, no, I am not.

This rampage is illogical and many of the things you are saying are simply untrue.

Prove it. Prove it. That's all I ask. Prove it.

Also, you anti-Christian sentiments were appalling, ignorant, and downright disrespectful to the many amazing Christians soldiers that fight in out great military.

You anti-anti-Christian sentiments (sic) are appalling. When you can admit that there are many, many patriotic Pagan, Jewish, Hindu, Muslim, and atheist military members serving today in our armed forces with distinction, then you have learned.

Read my true story here: http://www.medicalcorpse.com/oneUSAFunderJesus.html

Then read Mikey Weinstein's book (available online, or at your local mega-bookstore): http://www.amazon.com/God-Our-Side-Evangelical-Americas/dp/0312361432

...then come back and tell me that many high ranking officers in the USAF do not have an Evangelical agenda.

Peace out,

--
Rob

P.S. No one is paying me one red cent to flog Mikey's book. It is, however, truth, based on the traumatic events of his life, and that of his son, an AFA grad.

P.P.S. It is very interesting to me as a student of human behavior that, whenever I mention the radical Christian agenda in one of my posts, all of my other points are forgotten in the rabid zeal to oppose my religious viewpoint. Curious. So, killing and maiming active duty and retirees due to inadequate numbers/experience/training of physicians is less egregious than speaking out about the religious doctrine actively espoused by many high ranking officers?

http://www.milarch.org/news/newsletters/NL050600.pdf (page 11)
http://medicalcorpse.com/godblesssquared.jpg
http://chronicle.com/free/v52/i31/31a04701.htm
http://www.washingtonpost.com/wp-dyn/content/article/2005/06/22/AR2005062200598.html
http://www.usatoday.com/news/nation/2005-05-11-chaplain-academy_x.htm
http://coloradoconfidential.com/sho...39A71CFC717D3B5E945303D8B1D2B9C0?diaryId=1170
http://www.hqda.army.mil/chaplain/Education/ChristianEmbassy.htm
http://www.washingtonpost.com/wp-dyn/content/article/2006/12/10/AR2006121000883.html
http://www.cnsnews.com/ViewCulture.asp?Page=/Culture/archive/200612/CUL20061212a.html

 

[Ex-44E3A]

I'm not here to tell anybody to shutup, but I have to back MC up on this one. We've never met, I don't know him, and he and I are on opposite ends of any number of issues. Even with all that, I've witnessed similar incidents and circumstances to what he outlined. I do disagree on the Christian issue... and it's disappointing to me that one of my fellow Christians would use his political power to coerce others into espousing belief. I've never seen it happen, but that doesn't mean that it didn't happen to somebody, somewhere.

As for his other points, he's basically right.

• 1. Residency choice is significantly constrained by the needs of the military. This is an undeniable fact.
  
  
• 2. Even as a returning GMO, the needs of the military still dictate whether you'll be allowed to do your desired residency. Ultimately, it's NOT up to you, and you're not in control.
  
  
• 3. MTFs have been closing and downsizing all over the country for years. Hospitals to super-clinics, super-clinics to clinics, or closed entirely. Military medicine is a shadow of its former self, and this includes the infrastructure.
  
  
• 4. The IRR committment is in your contract. It didn't used to be a big deal, since nobody ever got called up from IRR. With our recent military actions around the world, that has entirely changed. An IRR callup is absolutely on the radar screen of any recently-separated miltary doc.
  
  
• 5. Nurse/PA/etc commanders are a reality. It's not necessarily the end of the world to be commanded by a nurse, provided they're people of integrity, have a personal goal of quality patient care, support/protect their people, and recognize the limits of their own knowledge. If they lack any of the above (and I've seen that multiple times) you're in for a rough ride.
  
  
• 6. Stop-loss is also a reality. It burned several of my colleagues who had jobs lined up, only to be retained on active duty.
  
  
• 7. The military has more red tape than the civilian world. way more. Infinitely more. You can't even imagine the difference... and in the military it's all mandatory, on pain of LOC/LOR/Article 15/bonus witheld/court martial. In the civilian world, I can blow off a meeting because I'm busy with patients, and somebody will actually come apologize to me for the scheduling conflict. In the military, you get a nasty-gram and orders to attend ALL meetings.
  
  
• 8. The military does use a lot of extenders (cheaper, easier to retain), and many practice independently, particularly in the deployed environment.
  
  
• 9. You cannot quit. No matter how fed-up you get, how disgusted, or how angry/depressed. You're in for the duration... kind of like a prison sentence.
  
  
• 10. The pay is significantly worse than civilian for many specialties. Peds does OK in the military... but many other specialties lose money. MC is also right about "bonus pays." Those can be witheld by your commander for all sorts of capricious reasons. By doing so, they're essentially docking 50% of your pay without due process, and without any sort of UCMJ action.
  
  
• 11. I disagree with Corpse on this one... that was never my experience. I am a Christian, but I worked with many agnostic docs, and we never discussed our religious faith at work. I personally abhor the concept of "forced" belief.

 

[rotatores]

The USAF and Navy force interns to do General Medical Officer/Flight Surgeon
tours of 2-3 years after internship, where you will be treating the runny noses and jock itch of soldiers/sailors/airmen with no opportunity for further
education during that time.

While I admit a lot of what you speak of is true....the AF does not require interns to do GMO's anymore (the Navy of course still does).

rotatores
PGY-1 Pediatrics, GMO select

 

[pgg]

the AF does not require interns to do GMO's anymore (the Navy of course still does).

Didn't the AF Surgeon General just decree that 100% of incoming interns who didn't match to a categorical internship will be required to serve a tour as a flight surgeon? As in, will not even be permitted to apply for GME-2+ as interns? I think a thread with his letter was posted to the forum a few months ago.

11. I disagree with Corpse on this one... that was never my experience. I am a Christian, but I worked with many agnostic docs, and we never discussed our religious faith at work. I personally abhor the concept of "forced" belief.

I can point to a few specific instances where I felt those in my chain of command went too far, but they were exceptions.

Though I must admit, as a GMO, the apparent need for a chaplain to bless every single thing we ever did as a group was occasionally irritating. The Marines can't have a barbecue without a safety Corpsman assigned to stand by with a med bag ready, and they can't seem do it without a non-denominational-yet-definitely-Christian blessing either.

 

[rotatores]

Didn't the AF Surgeon General just decree that 100% of incoming interns who didn't match to a categorical internship will be required to serve a tour as a flight surgeon? As in, will not even be permitted to apply for GME-2+ as interns? I think a thread with his letter was posted to the forum a few months ago

Okay...i stand corrected. I'm guessing that just means the transitional interns? In any case...I just know that all of the AF interns at my program (navy peds) got to go straight through while only 4/6 Navy interns got to go straight through.

 

[navdoc47]

[*]7. The military has more red tape than the civilian world. way more. Infinitely more. You can't even imagine the difference... and in the military it's all mandatory, on pain of LOC/LOR/Article 15/bonus witheld/court martial. In the civilian world, I can blow off a meeting because I'm busy with patients, and somebody will actually come apologize to me for the scheduling conflict. In the military, you get a nasty-gram and orders to attend ALL meetings.


LOL - that is so true...you get way more respect in the civilian world WITHOUT wearing a uniform.

 

[Galo]

Sir,
With all due respect, are you smoking crack? This rampage is illogical and many of the things you are saying are simply untrue. You destroy your credibility when you make such outlandish claims. I understand that military medicine has problems and is not a perfect system, but it is clear that you have an agenda. You need to look at the most recent match results and see how many folks are doing GMO tours and not matching into their desired specialty -- you will find the numbers are few. In addition, I've met several people who have matched into competitive specialties, that simply would not have matched into them in the civilian world. Also, you anti-Christian sentiments were appalling, ignorant, and downright disrespectful to the many amazing Christians soldiers that fight in out great military.

Onward Christian Soldier!! I think I've heard one of those hyper religious songs start like that.

Mr Chopper, you are way off here. All of the instances Rob posted about have occured, and will continue to occur. For you to call him out like that with absolutely no proof shows a lack of intelligence, and an emotional reaction. Since you specifically addressed the religious issue, I imagine that was what you were most upset at.

Regardless, all of what he posted, (nothing new by the way, all on his website, and posted before by him, me, exusafdoc, milmed, mitchconnie, flitesurgn, rsxn,etc etc etc), is the downright truth, and EVERY perspective HPSP/FAP/USHUS candidate should know that before they sign. That is the objective here.

What's yours??

 

[backrow]

All true, all true. Very well put.

 

[chopperdoc]

Thanks to all for your kind comments!

I will first off state that though I am not new to the military, I am new to military medicine. I was an officer and an aviator before going to medical school and did two combat tours in the middle east. I enjoyed my time in the Army, despite the deployments and busy lifestyle. I am excited about doing a career in military medicine. I am an Evangelical Christian that is why I took offense to many of the things MC stated. Promotion in the military is a very political animal. Unfortunately, it is not always the best person that gets the rank/position. I cannot say that I've ever seen someone chosen for a position/rank based on being in some Evangelical Christian buddy club -- nor have I ever heard of it. From what I've seen it is those that kiss the most a**, and occasionally those that are the most qualified, that are placed in prominent positions. On the whole, I would say that my being a Christian was probably more detrimental to my promotion / advancement than anything else, because my Christian values often clashed with Commands idea of a good time. I don't know what the AF is like, but that was my experience in the Army.

As far as residency positions in the Army are concerned. I was completely able to choose my specialty, with no coercion whatsoever. I chose a very competitive surgical sub-specialty. Of the twenty or so close friends that I have that have recently matched through the military (in all branches, Navy and AF included) all of them have been able to do their specialty of choice with no delay in training. The Army has completely done away with the GMO system from all I can tell and I think the other branches are moving in that direction. In addition I know people that were able to match into very competitive specialties, like Orthopedics, who would not have matched in the civilian world. So not only are you able to choose what you want to do, you may have a better chance of getting it in the Army than in the civilian world. So it is untrue for you to say that most people are not able go into the specialties they desire -- things may have changed since you went through.

As far as facilities are concerned. I have spent significant time at some of the finest hospitals in the country (Johns Hopkins, Duke, etc.) and in addition, I spent have time at Brooke Army Medical Center and Walter Reed. I have to say that I was impressed with these facilities and everything that was going there. They may not be quite as glamorous as the finest civilian institutions, but they were busy, clean, well-staffed, and provided great care for the soldiers being treated there.

The problem I have with your negative posts is that though you are putting out some good and true information it is mixed with falsehoods that deter good people from entering military medicine. You are absolutely wrong about residency selection in the Army, when you say that there is a good chance applicants won't be able to do the specialty they want -- this is completely false, and a huge deterant. If you are going to state a case with such authority make sure you are up to date with the way things currently work. No doubt alot has changed since you went through. I recognize that there are problems with the system and I am committed to doing my part to help mend a broken system. Wouldn't you want good people in military medicine caring for our soldiers and rectifying the problems that you've mentioned?

Peace.

 

[chopperdoc]

Thanks to all for your kind comments!

I will first off state that though I am not new to the military, I am new to military medicine. I was an officer and an aviator before going to medical school and did two combat tours in the middle east. I enjoyed my time in the Army, despite the deployments and busy lifestyle. I am excited about doing a career in military medicine. I am an Evangelical Christian that is why I took offense to many of the things MC stated. Promotion in the military is a very political animal. Unfortunately, it is not always the best person that gets the rank/position. I cannot say that I've ever seen someone chosen for a position/rank based on being in some Evangelical Christian buddy club -- nor have I ever heard of it. From what I've seen it is those that kiss the most a**, and occasionally those that are the most qualified, that are placed in prominent positions. On the whole, I would say that my being a Christian was probably more detrimental to my promotion / advancement than anything else, because my Christian values often clashed with Commands idea of a good time. I don't know what the AF is like, but that was my experience in the Army.

As far as residency positions in the Army are concerned. I was completely able to choose my specialty, with no coercion whatsoever. I chose a very competitive surgical sub-specialty. Of the twenty or so close friends that I have that have recently matched through the military (in all branches, Navy and AF included) all of them have been able to do their specialty of choice with no delay in training. The Army has completely done away with the GMO system from all I can tell and I think the other branches are moving in that direction. In addition I know people that were able to match into very competitive specialties, like Orthopedics, who would not have matched in the civilian world. So not only are you able to choose what you want to do, you may have a better chance of getting it in the Army than in the civilian world. So it is untrue for you to say that most people are not able go into the specialties they desire -- things may have changed since you went through.

As far as facilities are concerned. I have spent significant time at some of the finest hospitals in the country (Johns Hopkins, Duke, etc.) and in addition, I spent have time at Brooke Army Medical Center and Walter Reed. I have to say that I was impressed with these facilities and everything that was going there. They may not be quite as glamorous as the finest civilian institutions, but they were busy, clean, well-staffed, and provided great care for the soldiers being treated there.

The problem I have with your negative posts is that though you are putting out some good and true information it is mixed with falsehoods that deter good people from entering military medicine. You are absolutely wrong about residency selection in the Army, when you say that there is a good chance applicants won't be able to do the specialty they want -- this is completely false, and a huge deterant. If you are going to state a case with such authority make sure you are up to date with the way things currently work. No doubt alot has changed since you went through. I recognize that there are problems with the system and I am committed to doing my part to help mend a broken system. Wouldn't you want good people in military medicine caring for our soldiers and rectifying the problems that you've mentioned?

Peace.

 

[mitchconnie]

As far as facilities are concerned. I have spent significant time at some of the finest hospitals in the country (Johns Hopkins, Duke, etc.) and in addition, I spent have time at Brooke Army Medical Center and Walter Reed. I have to say that I was impressed with these facilities and everything that was going there. They may not be quite as glamorous as the finest civilian institutions, but they were busy, clean, well-staffed, and provided great care for the soldiers being treated there.

The Army has completely done away with the GMO system from all I can tell and I think the other branches are moving in that direction.

I agree that Medical Corpse can be a little over-the-top, but statements like this call your entire post into question. How much time have you really spent at WRAMC? I work there all the time and beg to differ. Clean? Busy? Well-staffed? Compared to what?

Did you see the cockroaches in the surgeons locker-room? I do--once a month or so. Busy? Our service can't do more than 2 cases a day because the OR turnover averages about 2 hours. Clean? my office hasn't been cleaned in 3 years. Well-staffed? We can't get a secretary that can answer the phone consistently, and there are clinics that have "self-service vitals" because they don't have enough personel to take a BP.

Any comparinson to Johns Hopkins or the Duke is simply ludicrous. Walter Reed has about 16 SICU beds. The civilian institution where I trained had over 50. Walter Reed has about 200 staffed beds. Major civilian teaching institutions have 900+.

And I don't know about the Army match results, but check out this years AF match. Far and away the most common internship is 'transitional year': roughly 1/3 of the MS 4's are doing this (transitional year = forced GMO tour). The notion that the services are doing away with GMO's is total fantasy.

 

[midn]

The residency stuff is rather scary. Even after you do a GMO tour, they can kick you into another one? I've yet to take a break from school and start up again so I wonder how this is going to work out.

Hopefully all will change miracluosly in 2012 👍.

 

[Galo]

Thanks to all for your kind comments!

I will first off state that though I am not new to the military, I am new to military medicine. I was an officer and an aviator before going to medical school and did two combat tours in the middle east. I enjoyed my time in the Army, despite the deployments and busy lifestyle. I am excited about doing a career in military medicine. I am an Evangelical Christian that is why I took offense to many of the things MC stated. Promotion in the military is a very political animal. Unfortunately, it is not always the best person that gets the rank/position. I cannot say that I've ever seen someone chosen for a position/rank based on being in some Evangelical Christian buddy club -- nor have I ever heard of it. From what I've seen it is those that kiss the most a**, and occasionally those that are the most qualified, that are placed in prominent positions. On the whole, I would say that my being a Christian was probably more detrimental to my promotion / advancement than anything else, because my Christian values often clashed with Commands idea of a good time. I don't know what the AF is like, but that was my experience in the Army.

As far as residency positions in the Army are concerned. I was completely able to choose my specialty, with no coercion whatsoever. I chose a very competitive surgical sub-specialty. Of the twenty or so close friends that I have that have recently matched through the military (in all branches, Navy and AF included) all of them have been able to do their specialty of choice with no delay in training. The Army has completely done away with the GMO system from all I can tell and I think the other branches are moving in that direction. In addition I know people that were able to match into very competitive specialties, like Orthopedics, who would not have matched in the civilian world. So not only are you able to choose what you want to do, you may have a better chance of getting it in the Army than in the civilian world. So it is untrue for you to say that most people are not able go into the specialties they desire -- things may have changed since you went through.

As far as facilities are concerned. I have spent significant time at some of the finest hospitals in the country (Johns Hopkins, Duke, etc.) and in addition, I spent have time at Brooke Army Medical Center and Walter Reed. I have to say that I was impressed with these facilities and everything that was going there. They may not be quite as glamorous as the finest civilian institutions, but they were busy, clean, well-staffed, and provided great care for the soldiers being treated there.

The problem I have with your negative posts is that though you are putting out some good and true information it is mixed with falsehoods that deter good people from entering military medicine. You are absolutely wrong about residency selection in the Army, when you say that there is a good chance applicants won't be able to do the specialty they want -- this is completely false, and a huge deterant. If you are going to state a case with such authority make sure you are up to date with the way things currently work. No doubt alot has changed since you went through. I recognize that there are problems with the system and I am committed to doing my part to help mend a broken system. Wouldn't you want good people in military medicine caring for our soldiers and rectifying the problems that you've mentioned?

Peace.

You'll quickly find that when you post BS, you will get called on it immediately. The fact that you may be very early in your career and do not have the experiences we do, does not make your experience the norm. The fact remains that military medicine is in the toilet in almost every conceivable way, and we feel its out duty to let others know so they do not come in with the expectations that we did, only to be let down severely. Don't post BS, you have too many people here with experience triservice wise to tell you first hand that there are many more problems than answers.

Let prospectives make an informed choice we did not have.

 

[Apollyon]

Any comparinson to Johns Hopkins or the Duke is simply ludicrous. Walter Reed has about 16 SICU beds. The civilian institution where I trained had over 50. Walter Reed has about 200 staffed beds. Major civilian teaching institutions have 900+.

As a few military guys here know, I support everything you guys do and have put up with. As such, I'm just funnin' here.

Duke has 16 SICU beds, and is licensed by the state for 811 beds total.

 

[edmadison]

The Army has completely done away with the GMO system from all I can tell....

Well, it depends on what you mean by "completely done away with". We have been told that of the 24 graduating peds PGY-3s, 16 are expected to do operation medicine. So rather than cement my skills by seeing patients I was trained to see, I'm likely going to be treating adults for the next 2 years. Thank god I had one month of ED in my intern year. That's adequate preparation for treating adults, right?

Ed

 

[MedicalCorpse]

Sir,
With all due respect, are you smoking crack? This rampage is illogical and many of the things you are saying are simply untrue. You destroy your credibility when you make such outlandish claims.

(snip)

Also, you anti-Christian sentiments were appalling, ignorant, and downright disrespectful to the many amazing Christians soldiers that fight in out great military.

You might have read this:

Inquiry Sought Over Evangelical Video
Defense Department Asked to Examine Officers' Acts Supporting Christian Group


By Alan Cooperman
Washington Post Staff Writer
Monday, December 11, 2006; Page A03
http://www.washingtonpost.com/wp-dyn/content/article/2006/12/10/AR2006121000883.html

"I found a wonderful opportunity as a director on the joint staff, as I meet the people that come into my directorate," Air Force Maj. Gen. Jack J. Catton Jr. says in the video. "And I tell them right up front who Jack Catton is, and I start with the fact that I'm an old-fashioned American, and my first priority is my faith in God, then my family and then country. I share my faith because it describes who I am."

Now watch the unedited video of uniformed Flag Rank officers in the Pentagon talking about how Christian Embassy helps them bring "The Lord" into the Department of Defense:

http://www.jewsonfirst.org/military.html#video

(Note: Christian Embassy pulled the video from their site the day the Post article was published...but not fast enough to hide the truth: that there are many Evangelical Christians at the highest levels of the military who are willing to abuse the power and connections bestowed by their military ranks to further their personal religious agendas [see my website re: General Germann, current AFMC Command Surgeon]).

Who's smoking crack? Hmm?

--
Rob

 

[Ex-44E3A]

You know, it's funny. I talk to many of my still-active-duty colleagues, and none of them works at an adequately-staffed military hospital... and that goes for medical staff, ancillary staff, and admin/secretarial support staff.

I've YET to encounter a military doc who was fat for help. There's a reason why they do their own T-Cons, enter their own orders, type their own notes, and generally do low-level secretarial scut tasks that the civilian world (concerned with throughput as they are) offloads to support personnel. The military seems to pride itself on "doing more with less," though that concept quickly runs up against a practical limit once any real (or imagined) "fat" is pared away.

 

[MedicalCorpse]

Thanks to all for your kind comments!

Careful! I am the Supreme Pontificus Maximus of Sarcasm here. I would thank you to remember this. 😀

I will first off state that though I am not new to the military, I am new to military medicine. I was an officer and an aviator before going to medical school and did two combat tours in the middle east. I enjoyed my time in the Army, despite the deployments and busy lifestyle.

Sigh. Folks, show of hands: should we start referring to illogical arguments by number?

Argument #2 of 10: http://forums.studentdoctor.net/showpost.php?p=4554845&postcount=55 "I enjoyed my time as an aviator back in the day, so all of you current and former military attendings are wrong about military medicine"

I am excited about doing a career in military medicine.

Let us know how it has gone when you have been an attending for 11 years (as I was when I walked away from my aborted military medical career on 30 June 2005).

I am an Evangelical Christian that is why I took offense to many of the things MC stated.

Really? Never would have guessed.

Promotion in the military is a very political animal. Unfortunately, it is not always the best person that gets the rank/position. I cannot say that I've ever seen someone chosen for a position/rank based on being in some Evangelical Christian buddy club -- nor have I ever heard of it. From what I've seen it is those that kiss the most a**, and occasionally those that are the most qualified, that are placed in prominent positions. On the whole, I would say that my being a Christian was probably more detrimental to my promotion / advancement than anything else, because my Christian values often clashed with Commands idea of a good time. I don't know what the AF is like, but that was my experience in the Army.

Yes, you don't know what the AF is like, now do you? You haven't lived through my experience as a non-Christian subordinate of a rabidly evangelical General. Yet you have the unmitigated gall to call me a liar and a crack smoker. Is that reflective of Christian values? What would Jesus do? Did your Lord and Savior call Pontius Pilate a crack smoker? So much for Matthew 5:9 (yes, I grew up in the Southern Baptist church as the son of a Southern Baptist preacher, so don't even begin to think you know more about my religion [Paganism] than I do about yours).

The key difference is this: Evangelicals evangelize, just as viruses replicate. It's what they do. For the first 18 or so years I spent in uniform, the USAF explicitly frowned upon commanders pushing their religious views down the throats of their subordinates (it's in our "Little Blue Book" of Air Force Core Values). Starting with the election of GWB, that all went out the window.

By the way, not all religions share the viral nature of Evangelical Christianity. When was the last time you were stopped on a street corner and proselytized to become Jewish, Hindu, Buddhist, or Wiccan? None of these world religions proselytizes per se (outreach & education, maybe; "Think like me or burn in Hell, no").

All I ever wanted at Andrews was freedom from having my arm twisted to get on board the Evangelical Christian bandwagon. Have you seen the video yet?
http://jewsonfirst.org/audio-video/christian_embassy.wmv

As far as residency positions in the Army are concerned. I was completely able to choose my specialty, with no coercion whatsoever.

How nice for you. Two out of three of the services, however, emphasize the GMO/Flight Surgery tour for a vast majority of their graduating interns. Thus, my point: "You will most likely NOT get the residency of your choice." Most likely, as in: IF you are lucky enough to be in the Army, and IF the Army needs residents in your chosen specialty that year, and IF there are slots, and IF you are granted either a military slot or a deferment, then MAYBE you might get the residency of your choice. I still stand by my "most likely" verbiage, given the moribund status of today's GME across all services, combined with the perceived need by ignorant COCOMs and Pentagon dweebs for one year wonder GMOs and FSs in at least 2 out of 3 of the services.

The Army has completely done away with the GMO system from all I can tell and I think the other branches are moving in that direction.

Perhaps some folks with Army GMO experience can chime in. However, this is absolutely not true with regard to the Air Force. Get your facts straight. Galo posted this under a sticky on this forum: http://forums.studentdoctor.net/showpost.php?p=4023187&postcount=18

From which I quote:

(begin quote)

DEPARTMENT OF THE AIR FORCE
HEADQUARTERS UNITED STATES AIR FORCE
WASHINGTON DC
30 May 2006
MEMORANDUM FOR OBLIGATED AIR FORCE OFFICERS (4TH YEAR MEDICAL
STUDENTS) APPLYING TO THE 2006 JOINT SERVICE
GRADUATE MEDICAL EDUCATION SELECTION BOARD (JSGMESB)
FROM: HQ USAF/SG
1780 Air Force Pentagon
Washington, DC 20330-1780

SUBJECT: Critical Shortfall in AFMS Flight Surgeons - Interim Policy

The Air Force is facing a critical shortfall in aerospace medicine. We are having difficulty meeting the operational needs of our war fighting squadrons. Flight Surgeons provide much of the first-line support to our flyers and their families. Active Duty physicians in specialties that are already optimally manned have been actively encouraged to consider a career broadening tour as an operational flight surgeon. In spite of our efforts the shortfall remains.

We will be re-instating a policy utilized in the mid 1990's in order to ameliorate this situation. Under this policy, individuals who apply for and/or are selected for a PGY-1 year only will automatically be required to complete the six-week Aerospace Medicine Primary course and a two-year tour as a Flight Surgeon immediately following completion of their PGY-1 year. This policy will apply to individuals who meet the 2006 JSGMESB and is not waiverable. Individuals who are unable to pass a Flying Class II physical will be assigned to a primary care environment for a two-year period. This requirement must be completed before proceeding with the residency training of your choice.

(end quote)

If you don't believe Galo, read a summary confirming the reality of this letter on the afms.mil site:
http://airforcemedicine.afms.mil/id...nEducation&doctype=subpage&docname=CTB_053317


So thus, Chopperdoc, all your happy talk about YOU getting the residency of YOUR choice out of internship does not translate into my being a liar. In fact, your case seems to be the exception rather than the rule, in 2007 and beyond.

In addition I know people that were able to match into very competitive specialties, like Orthopedics, who would not have matched in the civilian world. So not only are you able to choose what you want to do, you may have a better chance of getting it in the Army than in the civilian world.

An intelligent reader might infer that the Army is so desperate for bodies, that their second-rate programs are accepting inferior physicians for training who would never make it in the civilian match. Of course, there ARE fewer intelligent readers nowadays, so your secret is safe with us.

As far as facilities are concerned. I have spent significant time at some of the finest hospitals in the country (Johns Hopkins, Duke, etc.) and in addition, I spent have time at Brooke Army Medical Center and Walter Reed. I have to say that I was impressed with these facilities and everything that was going there. They may not be quite as glamorous as the finest civilian institutions, but they were busy, clean, well-staffed, and provided great care for the soldiers being treated there.

Too bad WRAMC (where my first son was born in 1990, whence my ex-Army wife graduated from internship, and where I spent much of my time while a med student at USU) is going the way of the Parasaurolophus. It's a pity more Washington, D.C. residents didn't vote Republican in 2004...perhaps then they wouldn't have been car-BRACked. I will never forget the shell-shocked looks on the faces of the WRAMC surgical residents rotating through Andrews in May, 2005, when the announcement was made. Talk about DABDA: "They'll never close Walter Reed! How could they, the b*stards! But, what about the rehab center, they can't close that! Waaah, I might not be able to finish my residency..." Nobody got to "A"...no one sane in the military ever does.

The problem I have with your negative posts is that though you are putting out some good and true information it is mixed with falsehoods that deter good people from entering military medicine.

The problem I have with your insulting and belittling posts is that, though you are putting out some bad and false information, it is mixed with your idiosyncratic experience in the U.S. Army, and is not reflective of the experiences HPSP/USU students will have in the USAF and the USN (two out of three of the physician-containing services, I should point out, lest our Marine Corps friends slash my virtual tires). Good people who are thinking about entering military medicine deserve to know the truth about the fiasco they are getting into. I highly encourage people who really, really wish to serve their country as uniformed physicians to consider FAP; alternatively, they could simply sign up after finishing residency. Regardless, what college students and medical students deserve is the truth, not the inaccurate propaganda they get from the military, such as this:

http://www.airforce.com/careers/job.php?catg_id=3&sub_catg_id=1&af_job_id=63

Ether? Sodium pentathol? Assigning nurses and medical techs? I think not.

You are absolutely wrong about residency selection in the Army, when you say that there is a good chance applicants won't be able to do the specialty they want -- this is completely false, and a huge deterant.

Show me where I mentioned the U.S. Army in my post. I said "most likely", knowing that 2 out of 3 of the services are still addicted to the GMO/FS abomination (which, incidentally, has probably killed as many troops as small arms fire has-- remind me to tell you about the Flight Surgeon who ordered me over the phone to treat his patient in unstable V-Tach with a huge dose of dig).

If you are going to state a case with such authority make sure you are up to date with the way things currently work. No doubt alot has changed since you went through.

Dude, I left the USAF about a year and a half ago. Since that time, I have been in continual communication, via e-mail, phone, and this board, with folks still inside. Specious Argument Number 43: "Yes, there were problems when you left on 30 June 2005, but we fixed all those on 1 July 05. You missed it. Too bad, so sad. So shut up about our now-nonexistent problems."

I recognize that there are problems with the system and I am committed to doing my part to help mend a broken system.

The one and only constructive sentence in your response.

Wouldn't you want good people in military medicine caring for our soldiers and rectifying the problems that you've mentioned?

I hope they are the kind who could match into civilian residencies. Ba dum bum ksssh.

Seriously, the exact problem I have is that one most accurate method of identifying the best, brightest, and most experienced military physicians is to look at the list of those who have left, or are in the process of leaving. After 15 years as an Air Force physician (11 years after residency), not one O-6 physician left in the military had my respect as a clinician. Not one. Moreover, the hard-working Majors and junior LtCols were constantly bombarded by the artillery of militant mediocrity which is used to punish physicians who care about such silly concepts as "quality of care" or "biomedical ethics". Thus, to a man and woman, the only people who choose to stay in the decrepit, pathetic shell of the Military Medical Corpse are those who cannot make it on the outside, because their clinical skills have atrophied to the point of necrosis. The military not only does nothing to retain highly skilled specialist physicians...as you will doubtless find out, it actively shoves competent docs out the airlock, so that they cease showing up the glitter-bestrewn *****s piloting the doomed starship.

Peace.

If only. I hope everyone here can read the handwriting on the wall regarding the "Surge" to be announced later this month. Providing a target-rich environment for fanatic, well-armed insurgents: Not so priceless. There will be a very, very sad price to pay, indeed.

Mene mene tekel upharsin.

Rob
Ex-LtCol, etc.
http://www.medicalcorpse.com

 

[Homunculus]

Well, it depends on what you mean by "completely done away with". We have been told that of the 24 graduating peds PGY-3s, 16 are expected to do operation medicine. So rather than cement my skills by seeing patients I was trained to see, I'm likely going to be treating adults for the next 2 years. Thank god I had one month of ED in my intern year. That's adequate preparation for treating adults, right?

Ed

oh, c'mon ed. we all know that adults are just oversized kids.

missed my one shot at avoiding deployment for 3 years when i didn't match for felowship (don;t get me started on that, lol)

and i can't get pregnant.

did finally get my ACU's tho. they're actually not too bad. love the new tshirts. we'll see what i think about them in a year . . .

all i want right now is to be able to take boards prior to deploying into my GMO slot.

--your fellow combat pediatrician caveman

 

[Homunculus]

When you can admit that there are many, many patriotic Pagan, Jewish, Hindu, Muslim, and atheist military members serving today in our armed forces with distinction, then you have learned.

this is something i never really took notice of until after MC brought it to my attention. it's not blatant, in-your-face type things. but the tacit approval given by allowing chain emails and all sorts of traditional christian (which i am) stuff go through our outlook accounts is a bit annoying. we have non-christians in our residency program who are great people-- and i doubt if they started an email chain forwarding stuff about buddhist beliefs and traditions it'd make it far before some G8 secretary craps her pants. but the angels and prayer chain stuff can go on without a peep.

--your friendly neighborhood that's me in the corner caveman

 

[armybound]

Are all of these complaints (understaffing, poor care, GMOs) relevant to the Army as well?

I notice you all complaining about the AF and Navy, but I don't see much about the Army.

Are USUHS/HPSP/former military physicians seen as inferior in the civilian world when looking for a job?

 

[Homunculus]

Are all of these complaints (understaffing, poor care, GMOs) relevant to the Army as well?

I notice you all complaining about the AF and Navy, but I don't see much about the Army.

Are USUHS/HPSP/former military physicians seen as inferior in the civilian world when looking for a job?

depends on where you are in the army i guess. we have adequate staffing and good care, but we're the top of the food chain at WRAMC. GMO's still exist-- oh yes. it's just that they now fill what used to be GMO slots with pediatricians, lol.

i don't know of anyone who has recently GTFO and had issues finding employment. most get good gigs-- at nice places to boot.

--your friendly neighborhood army strong caveman

 

[chopperdoc]

MC,
I'm sorry that you had such a terrible experience serving our nation through medicine -- from your posts, I think you might have been happy in the military as an attorney.


Armybound,
The Army can be a great place to train -- it does not have many of the problems that have been highlighted in this thread that exist with the Navy and AF. In my field, Urology, recently guys have left careers in the military to go on to great academic positions. The chairs of the Urology Departments at Duke, UAB, UT San Antonio, Kansas, and others all did careers in the military Urology. So in the case of Urology, military folks are very well respected in the civilian world.

 

[armybound]

depends on where you are in the army i guess. we have adequate staffing and good care, but we're the top of the food chain at WRAMC. GMO's still exist-- oh yes. it's just that they now fill what used to be GMO slots with pediatricians, lol.

i don't know of anyone who has recently GTFO and had issues finding employment. most get good gigs-- at nice places to boot.

--your friendly neighborhood army strong caveman

Thanks for the information. I was an Army brat and lived a few places like Benning and Hood, and I never thought my medical care was substandard. Maybe I didn't know any better.

I've very recently become extremely excited about the opportunity to serve our boys and girls fighting in Iraq, but reading all of this negativity about the state of military medicine worries me.. especially if the training programs (I'm thinking neurosurgery/neurology) are seen as inferior to civilian programs.

Guess I need to keep reading and thinking..

I'd also like to add in here, for anyone that does care.. my future father-in-law is an AFA grad and did his general surgery residency at Wilford Hall. He's now the chair of his department at a very successful clinic in Louisiana and has nothing bad to say about his experience in the AF at all. He loved his experience there and he was obviously trained very well, since he's been listed as one of the best doctors in his field.

 

[mitchconnie]

I'd also like to add in here, for anyone that does care.. my future father-in-law is an AFA grad and did his general surgery residency at Wilford Hall. He's now the chair of his department at a very successful clinic in Louisiana and has nothing bad to say about his experience in the AF at all. He loved his experience there and he was obviously trained very well, since he's been listed as one of the best doctors in his field.

I'm glad your father-in-law had a swell time AF, and I get your point. But let me say this (and I cannot emphasize this enough)--IT IS TOTALLY, COMPLETELY, UTTERLY IRRELEVANT what the AF medical service was like 20, 10, or even 5 years ago! Things are different now...so very, very different.

When your father-in-law did residency at Wilford Hall in 1985 it was one of the largest, busiest hospitals in the state of Texas. They had over 1000 inpatient beds, were one of the highest-volume transplant services in the state, and took complex referral patients from all over the planet. That hospital was a giant regional player, the equivalent of Parkland, Baylor, or UTMB. He probably received training that could quite literally be described as world-class. Now fast-forward to 2007 when Wilford Hall, like all AF medical centers, is devolving into a large outpatient clinic that no longer even has it's own free-standing surgery residency.

Your father-in-law would not recognize the AF medical system circa 2007. The command structure is radically different, the priorities have changed, and the deployment taskings are much more oppressive. I don't mean to denigrate your father-in-law's service in any way, but his 'deployment' probably consisted of a four-month vacation to England, Germany, or Turkey during Desert Storm.

The only thing that hasn't changed is that blue polyester uniform. Please, please do not make any career decisions based on someone's fond memories from the glory days of the '80's and 90's.

 

[Ex-44E3A]

my future father-in-law is an AFA grad and did his general surgery residency at Wilford Hall. He's now the chair of his department at a very successful clinic in Louisiana and has nothing bad to say about his experience in the AF at all.

He probably separated before the slide really accelerated.

Let me attempt to address the concern about "inferior" training and difficulty in the job hunt.

As far as inferior training, not all military programs are purely military. Some are integrated with civilian programs, and in those cases the training is essentially the same. Also, as with anything else, you get out of your training almost exactly what you put into it. If you're a drag-ass slacker at a big-name program, you're going to graduate as a weak sister.

Now, it's true that once on AD, your case volume at the military facility will be lower and accumulate slower than the civilian world (for all sorts of reasons, including the many military inefficiencies). Last time I talked about this with an AF neurosurgeon, it was taking them about twice as many years to accumulate enough cases to sit for their boards as their civilian colleagues.

If you stay in for a while (or you're USU, and you sold your soul) the AF has a tendency to push you into administrative roles once you gain rank. All your colleagues will have popped smoke by that time, so you may get pushed into that squadron commander or SGH slot by default. That administrative overhead is large, and will eat up your clinic and OR time. Your clinical skills may decline over time if you're not doing those big, challenging cases.

Moonlighting is one way to put your finger in the dike. In my own specialty (EM), the AF hospital was basically a large urgent care. We saw little trauma, and we shipped out lots of sick people. Fortunately, I moonlit at the nasty trauma center on the wrong side of the tracks, so I didn't lose my skills... but I can tell you that every single group I approached when I was separating wanted to know, right off the bat, the extent of my moonlighting. Apparently, the word is getting out.

I don't know about the other branches, but in the AF it can be difficult to moonlight, primarily due to administrative barriers. A surgeon friend of mine was so concerned with the atrophy of his skills that he attempted to work at a nearby trauma center for free... just to stay in the game. The AF denied his request on the basis of some nebulous fear of "vicarious liability." They sat on his paperwork and he wasn't allowed to do it.

That kind of idiocy combined with all the crazymakers killed the military medicine option for me. All the little annoyances and slaps-in-the-face (like having to buy all your own pens, because you weren't allowed to accept even a pen from a drug rep; it might create an appeareance of impropriety after all) added up to complete madness for me.

Generally speaking, you will probably be OK if you moonlight enough, but don't count on the military hospital case mix to maintain your skills.

 

[The White Coat Investor]

!

 

[armybound]

More great information, thanks.

 

[midn]

So I was looking over the dates for the USMLE tests and it turns out Step 3 is taken one year after residency. Since mil med doctors are shoved into GMO tours before doing residency, how is Step 3 done for them? Also, if you still take it one year after residency, how much harder is it coming from a GMO tour, doing one year of residency, and then taking Step 3?

 

[orbitsurgMD]

So I was looking over the dates for the USMLE tests and it turns out Step 3 is taken one year after residency. Since mil med doctors are shoved into GMO tours before doing residency, how is Step 3 done for them? Also, if you still take it one year after residency, how much harder is it coming from a GMO tour, doing one year of residency, and then taking Step 3?

Step 3 is taken during internship. You will have to pass this last test before you will be eligible to apply for an unrestricted license. Your GMO assignment will require having a license in order to be credentialed for "independent" practice (a travesty left for other threads).

 

[Bubblehead-to-MD]

Step 3 is taken during internship. You will have to pass this last test before you will be eligible to apply for an unrestricted license. Your GMO assignment will require having a license in order to be credentialed for "independent" practice (a travesty left for other threads).

I was just going to address this! Step 3 will be taken BEFORE doing a GMO tour. Also, the years of postgraduate training required to be completed before taking the Step 3 varies from state to state. For most, you just have to have completed an internship. For others, it can be anywhere from PGY-2 to completed residency. Take a look:

http://www.fsmb.org/usmle_eliinitial.html

 

[midn]

Whew, ok that doesn't sound as bad.

 

[62Alpha]

I'm an Army Emergency Physician currently on my ninth month in Iraq. I thought of a few more "hidden catches" you could add to your list MC:

--There is a war on and as a military doctor you may have to actually come over here and take care of young Soldiers, Sailors, Airmen and Marines who make much less money than you but are actually putting their lives on the line.

--While deployed you will likely deal with primadona physicians who cannot seem to understand why they personally have been so inconvenienced. While you will at times want to kill them yourself, all of the primadonas will make it home safely at the end of their tours, unlike the soldiers you'll be asked to treat.

--Because there are fewer and fewer medical students willing to suffer the inconveniences of military service you will have to bear a greater share of the burden.

--Every time some congressperson demands an investigation into something that happened on some base somewhere it will translate into an additional hour of annual mandatory training for the million plus people in the Military, and no the people who make this crap up don't let you off the hook because you are a really smart doctor. I personally have had two hours of training in the last year to prevent me from raping people.

--A plurality of people in the military are overworked, underpaid and undervalued. Since most of them cannot double, triple, quadruple or better their salary the moment they get out it is hard to find non-doctors in uniform who understand what a hardship that low six-figure salary is for you.

--Once you graduate from medical school without owing a penny and earn 10K more a year as a resident than your civilian counterparts, the fact that a lot of money has been spent on your sorry butt will fade from your mind as you compare and despair with your civilian buddies who are making a mint while you are in the damn Military and actually have to do what you said you would do (what were you thinking?!)

 

[Bubblehead-to-MD]

--Because there are fewer and fewer medical students willing to suffer the inconveniences of military service you will have to bear a greater share of the burden.

As an active duty submarine officer that is transitioning to medical school, I have had the opportunity to do a lot of shadowing of military physicians. The point you made above, combined with the attrition rates for physicians within the specialties I am currently interested in (Ortho, Anesthesia, Rads), are huge concerns of my when considering military medicine as an option. I've seen clinics that are triple-booked, resulting in less than 15 minutes of patient contact for the physician - it goes without saying that it is extremely tough to provide quality care under those circumstances.

I also worry that the inability to meet recruiting goals will inevitably result in a lowering of standards for people entering military medicine. I can easily foresee military medicine entering a downward spiral that can quickly get out of control.

The only thing that really motivates me to consider pursuing military medicine at this point is the idealistic view that I can be one of those good physicians who really busts his ass to provide quality care for the people that are making huge sacrifices on a daily basis.

 

[armybound]

--There is a war on and as a military doctor you may have to actually come over here and take care of young Soldiers, Sailors, Airmen and Marines who make much less money than you but are actually putting their lives on the line.

This has been the basic concept that's fueling my run for medical school the last year and a half or so

 

[g293]

--A plurality of people in the military are overworked, underpaid and undervalued. Since most of them cannot double, triple, quadruple or better their salary the moment they get out it is hard to find non-doctors in uniform who understand what a hardship that low six-figure salary is for you.

Hence why our ISP pay is never paid on time. In the AF our pay is controlled by the line, not the medical service. They could care less if or when we get our pay since to them we are so overpaid anyway. Can you imagine if they witheld aviation pay from all the flyers for a month, two or three?? That would last for about one day until some 4 star pilot was on the phone with someone whose head would be rolling on the ground.

Another observation about this phenomenon of pay. Today I received an initial briefing about my MEB (medical evaluation board) that I must have for a new chronic medical condition i have developed while on active duty. The lady was trying to tell me about all the appeals and recourses I would have if it were recommended that I be released from active duty. I kept telling her that if they were willing to let me go I wouldn't be fighting it--she seemed surprised. There are a lot of people who don't want to leave (patriotic reasons, retirement, benefits, pay etc) but I don't know too many docs that would fight a forced seperation. We are one of the few career fields in the military that has a large demand for our services in the civilian sector and can make more money on the outside. Why do military nurses fight for promotion and once they make Lt Col/Colonel require dynamite to get them out of the service? Because they are making far more money in the service with far less work and if they are really lucky can even boss physicians around.

 

[62Alpha]

All sarcasm aside, I'm ambivalent about posts like MC's. Highlighting weaknesses in the Military's system may ultimately serve to make things better--if the right people get the message. By the looks of his website, MC is clearly on jihad, and I wonder about his motives. I agree that MUCH more should be done to retain good docs, not just because the docs deserve more cash (they do), but because I believe good soldiers DESERVE good docs.

Scaring people away from military service by telling them they won't get their residency of choice (this really chaps me as it doesn't square with my experience--and ever heard of someone not getting the match they wanted in the civilian world? I have.) or that they'll be ordered to do something unethical or illegal (you have NO obligation to obey such an order) is NOT helping. As a GMO I told my rater, a full COL (I was a CPT at the time) that I would not do what he'd asked because it was wrong. His response was literally "f--- you." I didn't back down. In the end he gave me a "top block" evaluation (i.e. A+) and the best narrative summary I'd gotten to date. Doesn't always work out like that but temptations to do the wrong thing are not unique to the military.

If you want to take care of troops please don't let MC scare you off. You're exactly the kind of doc we need, now more than ever. You've had fair warning--it's no cake walk.

 

[62Alpha]

Hence why our ISP pay is never paid on time. In the AF our pay is controlled by the line, not the medical service. They could care less if or when we get our pay since to them we are so overpaid anyway. Can you imagine if they witheld aviation pay from all the flyers for a month, two or three??

I've not had that experience, though I believe it as pay problems in the military are pandemic and certainly not unique to docs.

There are a lot of Air Force on this thread. This is completely anecdotal but in my experience the Air Force is the absolute WORST at taking care of it's docs. Add that to the fact that the AF (forgive me for saying this ;-) seems to draw folks with the greatest aversion to getting shot at and you've got yourself one pissed off medical department.

As a med student in the 90's rotating in AF hospitals I noticed a palpable difference in the culture of AF medicine v. Army/Navy. AF doc's were bragging about not getting promoted, VERY conspicously keeping track on the wall of how many days left before their commitment was up, etc. A lot of unhappy people. I'd really like to see the Air Force change that culture and start taking care of it's own.

Not that it's peaches and cream in the Army but it doesn't suprise me in the least that MC was in the Air Force.

 

[pgg]

I'm an Army Emergency Physician currently on my ninth month in Iraq.

Great, thanks for serving. I did two deployments as a GMO with Marine infantry (14 months total) and am now a Navy resident.

There is a war on and as a military doctor you may have to actually come over here and take care of young Soldiers, Sailors, Airmen and Marines who make much less money than you but are actually putting their lives on the line.

In defense of MC and others who are negative about military medicine, the privilege of serving the troops is consistently cited as a positive, redeeming aspect of being a military physician.

As I read their posts, most (including MC) aren't outraged by having to serve, or deploy, or even doing the insultingly stupid CBT trash flung upon us all. They're angry that the troops, their families, and retirees are getting substandard care in many cases because their physicians are ignored, abused, understaffed, underfunded, commanded by nurses, etc.

Because there are fewer and fewer medical students willing to suffer the inconveniences of military service you will have to bear a greater share of the burden.

I am absolutely happy on active duty. I enjoyed my GMO tour so much that I voluntarily extended it a year so I could deploy to Anbar with my Marines again. Here's my concern, as I eyeball Navy medicine ... keeping in mind that I have a comfortable 2.5 year residency cushion before I rejoin the ranks of the deployable:

I see a LOT fewer physicians coming in ... HPSP 50% unfilled.

I see a LOT fewer physicians staying in ... and no indication that the surgeons general, the line, Congress, or anybody except military physicians are the slightest bit interested in doing anything to improve retention.

At some point, that increasing burden on a decreasing number of physicians has got to have negative effects on patient care. MC and others say that has already happened ... maybe they're right. I haven't personally observed the compromises in patient care they relate.

They (MC, milmed, et al) say the system is irreparably broken; I don't quite see that yet. But I do see pieces of it breaking.

A plurality of people in the military are overworked, underpaid and undervalued. Since most of them cannot double, triple, quadruple or better their salary the moment they get out it is hard to find non-doctors in uniform who understand what a hardship that low six-figure salary is for you.

Look, I love serving my country. I loved serving my Marines. Should the need still exist in 3 years, I'll be happy to deploy again.

But I'm going to flat out reject as absurd your argument that military physicians should be content earning a fraction what civilian physicians earn, simply because some high school graduates - brave and noble though they are - make a lot less than we do.

I also worry that the inability to meet recruiting goals will inevitably result in a lowering of standards for people entering military medicine.

It already has.

 

[pgg]

This is completely anecdotal but in my experience the Air Force is the absolute WORST at taking care of it's docs. Add that to the fact that the AF (forgive me for saying this ;-) seems to draw folks with the greatest aversion to getting shot at and you've got yourself one pissed off medical department.

As a med student in the 90's rotating in AF hospitals I noticed a palpable difference in the culture of AF medicine v. Army/Navy.

My experience parallels that, though my med student at an AF hospital experience was in 1999.

Just 'cause they're chairforce pansies doesn't mean they're wrong about everything though. 🙂

 

[62Alpha]

I'm going to flat out reject as absurd your argument that military physicians should be content earning a fraction what civilian physicians earn, simply because some high school graduates - brave and noble though they are - make a lot less than we do.

I'm not making that absurd argument.

I don't think we disagree so much as you seem to think we do.

 

[Bubblehead-to-MD]

I'm not making that absurd argument.

I don't think we disagree so much as you seem to think we do.

I was going to reply to pgg - I interpreted that statement as an argument for why the other servicemembers do not empathize with military physicians with regards to the pay disparity - not your saying that they deserved to be paid much more, and military physicians should just suck it up. Please correct me if I'm wrong.

 

[g293]

All sarcasm aside, I'm ambivalent about posts like MC's. Highlighting weaknesses in the Military's system may ultimately serve to make things better--if the right people get the message. By the looks of his website, MC is clearly on jihad, and I wonder about his motives. I agree that MUCH more should be done to retain good docs, not just because the docs deserve more cash (they do), but because I believe good soldiers DESERVE good docs.

Scaring people away from military service by telling them they won't get their residency of choice (this really chaps me as it doesn't square with my experience--and ever heard of someone not getting the match they wanted in the civilian world? I have.) or that they'll be ordered to do something unethical or illegal (you have NO obligation to obey such an order) is NOT helping. As a GMO I told my rater, a full COL (I was a CPT at the time) that I would not do what he'd asked because it was wrong. His response was literally "f--- you." I didn't back down. In the end he gave me a "top block" evaluation (i.e. A+) and the best narrative summary I'd gotten to date. Doesn't always work out like that but temptations to do the wrong thing are not unique to the military.

If you want to take care of troops please don't let MC scare you off. You're exactly the kind of doc we need, now more than ever. You've had fair warning--it's no cake walk.

I've not had that experience, though I believe it as pay problems in the military are pandemic and certainly not unique to docs.

There are a lot of Air Force on this thread. This is completely anecdotal but in my experience the Air Force is the absolute WORST at taking care of it's docs. Add that to the fact that the AF (forgive me for saying this ;-) seems to draw folks with the greatest aversion to getting shot at and you've got yourself one pissed off medical department.

As a med student in the 90's rotating in AF hospitals I noticed a palpable difference in the culture of AF medicine v. Army/Navy. AF doc's were bragging about not getting promoted, VERY conspicously keeping track on the wall of how many days left before their commitment was up, etc. A lot of unhappy people. I'd really like to see the Air Force change that culture and start taking care of it's own.

Not that it's peaches and cream in the Army but it doesn't suprise me in the least that MC was in the Air Force.

The match process IS much different in the military than in the civilain sector. If you are a civilian and #1 in your med school class with great board scores, etc, you will match in your desired specialty somewhere, and won't be yanked out of it after your intern year to do something else for a few years before returning to residency. The mil match is based not only on the needs of the military, but a point system of matching applicants to residency openings. You could be the #1 grad in your civilian medschool with better qualifications than all the GMOs on the planet, but they will beat you out of that residency spot due to points. I know in my surgical sub specialty my year of matching there were 2 active duty slots and 3 civilian deferred. About 10 GMO's were applying for the 2 active duty slots, so I had no chance of getting one of those. The poor USU 4th year applying had a zero chance of matching since he could not beat out the GMO's for an AD slot and was not able to be civilian deferred.

I do think we AF folk are more adverse to getting shot at (we call that being smarter 😉 )and many of us joined expecting a softer lifestyle (no tents, ships, etc) and a more business-like work environment. The AF already has its golden children (pilots, specifically fighter pilots) and really has no special warmth for all of us docs who trained for years to come on active duty and give a hand to the mission. I think the downsizing of our hospitals and the decrease in surgical cases (for us surgeons), combined with deployments to tent cities, hours of CBT and nurse commanders has soured many on active duty medicine.

Take care of yourself over there!!!

 

[Ex-44E3A]

but I don't know too many docs that would fight a forced
seperation

I did.

I had a medical condition that cropped up in med school, and they tried to board me out. I successfully fought it, because I knew I could do the job (better than most, in fact), and I'd signed my name on the line.

62Alpha:

Yes, there are a lot of AF on this thread.

Years ago I came to the conclusion that military medicine would NEVER improve until the HPSP pipeline dried up. As long as the recruiters could rope in enough young med studs (who unfortunately don't know the right questions to ask) to keep the system afloat, the slow downward spiral would continue. It was like watching a traffic accident in slow-motion. Now, just as I suspected, they're only just starting to pay attention, just as the house of cards threatens to collapse, and right in the middle of a friggin' war no less. I'm pretty damned pissed off that it has come to this.

I don't envy you where you are now (I deployed to the desert twice)... but I question whether the war justifies giving our leadership a pass on their utter neglect of the military medical system, or whether whitewashing anything for our young physicians-in-training is the right thing to do. Putting it bluntly, our leadership hasn't dealt with this issue in good faith. They haven't demonstrated ONE IOTA of willingness to make any changes that would contribute to retention, or fix the system problems we currently have. The military leadership could fix this tomorrow if they were sufficiently motivated... but they're not. I hate that the young soldiers/sailors/airmen/marines may bear the brunt of milmed's poor system/choices (and they unfortunately always have)... but that's not on me for pointing out the problems... it's on milmed's leadership for not addressing them.

While physicians can't strike (and military docs can't quit), we can certainly educate young students about the hostile environment they'll be facing (and I don't mean the incoming rounds). After sober reflection on the whole picture, some students will undoubtedly think twice; complicate recruiting, starve the beast.

The students certainly get the rah-rah pitch from the recruiting side, so I think it's incumbent upon all of us to speak the whole truth about military medicine to the students, warts and all.

Before forums like this, students had nowhere to go to find out the real skinny. Don't hate on us for giving it to them straight.

 

[g293]

I did.

I had a medical condition that cropped up in med school, and they tried to board me out. I successfully fought it, because I knew I could do the job (better than most, in fact), and I'd signed my name on the line. For some of us, our word still means something.

Good for you.

OK, maybe i should have said that I certainly wouldn't fight it if they wanted to kick me out instead of saying that I don't know too many docs who would fight it. I guess we have an N=2, one would fight to stay and one wouldn't. I don't think that means my word doesn't mean anything. I served 7 years active duty before med school and am in a second time. If they think my medical condition means I can't serve, fine. If they say I can continue (which they will) I am happy to continue with my service.

I've enjoyed your posts in the past and hope I am just reading too much into your last sentence. My word means a lot to me, but i feel very comfortable in my soul that my contract and my promise to the military does not include me having to fight to stay in if they don't want me.