The Last Straw

[R-Me-Doc]

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OK, over the last 2 years or so, I have posted a lot of reasons why military medicine bites. But the one thing I have never whined about is the money issue. There are several reasons for this, one being that even with the artificially low military salary, I'm still in about the >90th percentile or so for income in this country (which I think everyone on this website should realize and appreciate when they bitch and moan about "low" or "declining" salaries in medicine); and the fact that I know full well I'd never make this much money doing anything non-medical, because I have pretty much zero motivation for any other kind of job. But I recently came across something that really ticked me off and made me realize how ridiculous the military medical salary structure truly is:

I recently discovered that after med school, residency, board certification, rank of O4, staff doc positions, assignments as section and department chief, and including all housing allowances, bonuses, etc etc etc, I am still paid LESS than the CIVILIAN PHARMACISTS who work in our hospital pharmacy. And I don't mean just a couple of bucks. I mean 15-25K.

'Nuff said. Caveat emptor.

Your friendly neighborhood AMEDD shoulda-been-a-pill-pusher:
RMD 323

 

[Homunculus]

OK, over the last 2 years or so, I have posted a lot of reasons why military medicine bites. But the one thing I have never whined about is the money issue. There are several reasons for this, one being that even with the artificially low military salary, I'm still in about the >90th percentile or so for income in this country (which I think everyone on this website should realize and appreciate when they bitch and moan about "low" or "declining" salaries in medicine); and the fact that I know full well I'd never make this much money doing anything non-medical, because I have pretty much zero motivation for any other kind of job. But I recently came across something that really ticked me off and made me realize how ridiculous the military medical salary structure truly is:

I recently discovered that after med school, residency, board certification, rank of O4, staff doc positions, assignments as section and department chief, and including all housing allowances, bonuses, etc etc etc, I am still paid LESS than the CIVILIAN PHARMACISTS who work in our hospital pharmacy. And I don't mean just a couple of bucks. I mean 15-25K.

'Nuff said. Caveat emptor.

Your friendly neighborhood AMEDD shoulda-been-a-pill-pusher:
RMD 323

that's not uncommon. pharmacists in the civilian world (esp retail) make more than many primary care docs do. my dad is a retail pharmacist who owns his own store and pulls in more than the majority of the docs (including surgeons/rads/ etc) in his area.

i understand where you're coming from though. salaries suck, and from what i've heard of recruiting (HPSP is supposedly under 50% of their target) unless things improve they may be *forced* to increase pay. nothing will bring them in faster than cash, lol.

as a sidenote- imagine how the longtime enlisted folks feel when they look at the officer pay scales. ugh.

--your friendly neighborhood sympathetic caveman

 

[militarymd]

OK, over the last 2 years or so, I have posted a lot of reasons why military medicine bites. But the one thing I have never whined about is the money issue. There are several reasons for this, one being that even with the artificially low military salary, I'm still in about the >90th percentile or so for income in this country (which I think everyone on this website should realize and appreciate when they bitch and moan about "low" or "declining" salaries in medicine); and the fact that I know full well I'd never make this much money doing anything non-medical, because I have pretty much zero motivation for any other kind of job. But I recently came across something that really ticked me off and made me realize how ridiculous the military medical salary structure truly is:

I recently discovered that after med school, residency, board certification, rank of O4, staff doc positions, assignments as section and department chief, and including all housing allowances, bonuses, etc etc etc, I am still paid LESS than the CIVILIAN PHARMACISTS who work in our hospital pharmacy. And I don't mean just a couple of bucks. I mean 15-25K.

'Nuff said. Caveat emptor.

Your friendly neighborhood AMEDD shoulda-been-a-pill-pusher:
RMD 323

What will you say, when i tell you that a lot of the senior nurses make more than you?

 

[militarymd]

as a sidenote- imagine how the longtime enlisted folks feel when they look at the officer pay scales. ugh.

--your friendly neighborhood sympathetic caveman

Why do we continue with the apples versus oranges comparison?????

That statement is exactly the same as the orderly in the hosptal comparing their salary to the doctors...

 

[FliteSurgn]

I recently discovered that after med school, residency, board certification, rank of O4, staff doc positions, assignments as section and department chief, and including all housing allowances, bonuses, etc etc etc, I am still paid LESS than the CIVILIAN PHARMACISTS who work in our hospital pharmacy. And I don't mean just a couple of bucks. I mean 15-25K.

My base has three active duty general surgeons, but really only has enough work to keep one busy full-time. Our clipboard commandos (in their infinite wisdom) decided that we needed another. They were going to hire a civilian contract surgeon for $300,000 per year. Keep in mind that I BEG for more cases and here they were trying to dilute the precious few cases that I do get. Geniuses. We were able to talk them out of this, but they're going to readdress it next fiscal year.

Another boondoggle...Our clinic (former hospital) has been undergoing rapid downsizing for years. Now they're giving the whole place an expensive and unwarranted makeover. They are literally hemorrhaging money. We overheard the facilities manager saying that they have so much money that they don't know how they're going to spend it all by October. They're even sending out emails asking us for ideas. (examples...I know one surgeon who was contemplating an order for his third pair of "free" loupes at $1000 a pop...they are buying $150,000 worth of anesthesia machines when it's VERY likely that the surgery section will close within the next 2 years) When posed the question, why do you HAVE to spend every cent, they respond that if they don't they have to give it back. So, they continue to buy absolutely ridiculous stuff just so they can burn through their hoard by the end of the fiscal year. Meanwhile, they can't fully staff any of the primary care clinics due to manpower shortages. Crazy.

 

[MoosePilot]

that's not uncommon. pharmacists in the civilian world (esp retail) make more than many primary care docs do. my dad is a retail pharmacist who owns his own store and pulls in more than the majority of the docs (including surgeons/rads/ etc) in his area.

i understand where you're coming from though. salaries suck, and from what i've heard of recruiting (HPSP is supposedly under 50% of their target) unless things improve they may be *forced* to increase pay. nothing will bring them in faster than cash, lol.

as a sidenote- imagine how the longtime enlisted folks feel when they look at the officer pay scales. ugh.

--your friendly neighborhood sympathetic caveman

HPSP not meeting their goals seems like a good thing, especially for me for at least one more year

 

[helo doc]

Atleast my ASP bonus has been adjusted to keep up the with civilian market demands and inflation... no, wait just a damn minute, it HASN'T CHANGED IN NEARLY 15 F*@%ing YEARS. So, adjusted for annual cost of living and inflation, the overwhelming $15k per year ASP bonus of 1991 is now worth, let's say $9,489 (assuming 3.1% per year COLA/inflation adjustment).

At least if we make it to 20 years we'll get half of our pay. So, you figure a general surgeon O-5 at 20 yrs is making $6,790 per month base pay, $1728 per month BAH (based from Portsmouth, VA), $184 per month BAS, ISP of $29,000 per year, ASP of 15k per year, and BCP&VSP of 13K per year . Sooo, add that up and you get $161,424 per year. Let's see, retire at 20 years, that's 50% of base pay only, so per year that's $6790 x 0.5 x 12 = $40740 per yr. Alrighty then, if you make it to 20, you really don't get half your pay, you get 25.2% of your pay. Motivating, huh?? It should motivate you to think about getting out or not coming in at all if you're doing it solely for the "easy" money of HPSP or the retirement pay.

Oh yeah, a few years ago on the Senate floor, when military medical pay was a concern, the issue of the retirement pay for physician was brought up. At that point, a well intention but totally misinformed senator from Maryland made the point that we get half of our bonus and other pays upon for military retirement. The issue died on the vine. Just like our pay is doing. Enjoy!!

 

[Homunculus]

Why do we continue with the apples versus oranges comparison?????

That statement is exactly the same as the orderly in the hosptal comparing their salary to the doctors...

if taken to that extreme, sure it's apples and oranges. but the only difference between some officers and the longtime enlisted men they command is a college degree (and many of the enlisted soldiers who are taking courses may literally only be a few semesters behind them, yet making half the money, lol).

it's not like a pharmacist is an uneducated peon-- pharmD's have like 6 years of schooling. i agree the pay disparity sucks, but it's not as extreme as you make it out to be. besides-- the *real* apples and oranges argument here is that r-me-doc is comparing a civilian job to a military one. how much does a *military* pharmacist make compared to a military doc? i imagine the doc makes more.

--your friendly neighborhood peds yearly physical administering caveman

 

[Homunculus]

Atleast my ASP bonus has been adjusted to keep up the with civilian market demands and inflation... no, wait just a damn minute, it HASN'T CHANGED IN NEARLY 15 F*@%ing YEARS. So, adjusted for annual cost of living and inflation, the overwhelming $15k per year ASP bonus of 1991 is now worth, let's say $9,489 (assuming 3.1% per year COLA/inflation adjustment).

At least if we make it to 20 years we'll get half of our pay. So, you figure a general surgeon O-5 at 20 yrs is making $6,790 per month base pay, $1728 per month BAH (based from Portsmouth, VA), $184 per month BAS, ISP of $29,000 per year, ASP of 15k per year, and BCP&VSP of 13K per year . Sooo, add that up and you get $161,424 per year. Let's see, retire at 20 years, that's 50% of base pay only, so per year that's $6790 x 0.5 x 12 = $40740 per yr. Alrighty then, if you make it to 20, you really don't get half your pay, you get 25.2% of your pay. Motivating, huh?? It should motivate you to think about getting out or not coming in at all if you're doing it solely for the "easy" money of HPSP or the retirement pay.

Oh yeah, a few years ago on the Senate floor, when military medical pay was a concern, the issue of the retirement pay for physician was brought up. At that point, a well intention but totally misinformed senator from Maryland made the point that we get half of our bonus and other pays upon for military retirement. The issue died on the vine. Just like our pay is doing. Enjoy!!

any ideas why they haven't changed it? it sounds like they're looking to see jsut how cheap they can go before their numbers drop off. hopefully the poor recruting continues so they'll adjust this, lol.

--your friendly neighborhood 2 kids to feed caveman

 

[militarymd]

but it's not as extreme as you make it out to be. besides--

You've got to be joking!!!!

I make a minimum of 4 times what I made in the Navy...maybe 5 times...depending on collection...(I was an O-4 with 11 years), and my hours are definitely better...a little more unpredictable, but better.

Maybe you don't think that is "extreme", but I consider that an "extreme" difference in pay.

 

[Homunculus]

You've got to be joking!!!!

I make a minimum of 4 times what I made in the Navy...maybe 5 times...depending on collection...(I was an O-4 with 11 years), and my hours are definitely better...a little more unpredictable, but better.

Maybe you don't think that is "extreme", but I consider that an "extreme" difference in pay.

he was commenting on the disparity of pay between himself as a physician and the civilian pharmacist that works at the same facility-- *not* the pay difference between him and his civilian physician counterpart.

your example of an orderly comparing himself to a physician isn't what r-me-doc was getting at. sorry if i wasn't clear enough in my post.

--your friendly neighborhood show me the money caveman

 

[MoosePilot]

You've got to be joking!!!!

I make a minimum of 4 times what I made in the Navy...maybe 5 times...depending on collection...(I was an O-4 with 11 years), and my hours are definitely better...a little more unpredictable, but better.

Maybe you don't think that is "extreme", but I consider that an "extreme" difference in pay.

From what I've read, that varies pretty radically by specialty. It sounds like some family practice docs make more in the military than they do out.

 

[USAFdoc]

From what I've read, that varies pretty radically by specialty. It sounds like some family practice docs make more in the military than they do out.

the ave family CIV doc makes about 147,000 a year. In the USAF I made about 80,000...but when you consider they pay the rent and cheaper things on base etc, you could say it is close to 100,000 value in the USAF.

In my new civilain job I am making 120,000 a year base, with room for incentives which could push me over 200K. I am working LESS then HALF the hours I worked in the USAF which gives me the option to do some moonlighting type work but since I rarely saw my family the last 3 years of my USAF career (worked 300+ hours per month) I am enjoying spending alot of time with the wife and kids as well as the lack of a chaotic clinic. My current clinic seems like tranquility incarnate compared to the USAF version.

And by the way...I had no problem with the $$$ the USAF paid me, 80K is more than enough to raise a family and plan a future. But NO AMOUNT of money is worth volunteering to put myself, family through a few more years of USAF incompetence.

I spoke with my best friend still serving at my base. They are supposed to have 9 active duty docs and 4 civilian docs,... and with me gone, he is the ONLY military doc left in the clinic (3 other extenders, and 2 civ docs, both new).

CRAZY

 

[MoosePilot]

the ave family CIV doc makes about 147,000 a year. In the USAF I made about 80,000...but when you consider they pay the rent and cheaper things on base etc, you could say it is close to 100,000 value in the USAF.

In my new civilain job I am making 120,000 a year base, with room for incentives which could push me over 200K. I am working LESS then HALF the hours I worked in the USAF which gives me the option to do some moonlighting type work but since I rarely saw my family the last 3 years of my USAF career (worked 300+ hours per month) I am enjoying spending alot of time with the wife and kids as well as the lack of a chaotic clinic. My current clinic seems like tranquility incarnate compared to the USAF version.

And by the way...I had no problem with the $$$ the USAF paid me, 80K is more than enough to raise a family and plan a future. But NO AMOUNT of money is worth volunteering to put myself, family through a few more years of USAF incompetence.

I spoke with my best friend still serving at my base. They are supposed to have 9 active duty docs and 4 civilian docs,... and with me gone, he is the ONLY military doc left in the clinic (3 other extenders, and 2 civ docs, both new).

CRAZY

Weird. I make about 80K as a pilot. As a GMO flight doc, I'd make significantly more.

 

[R-Me-Doc]

In my new civilain job I am making 120,000 a year base, with room for incentives which could push me over 200K.

Hey, USAFdoc. For those of us who will hopefully be out in the civilian world before too long, could you give us a quick lesson on how "incentives" work? I assume it boils down to "see more patients = make more money," but maybe it's more complex than that? Thanks.

RMD 321

 

[island doc]

Hey, USAFdoc. For those of us who will hopefully be out in the civilian world before too long, could you give us a quick lesson on how "incentives" work? I assume it boils down to "see more patients = make more money," but maybe it's more complex than that? Thanks.

RMD 321

I am assuming that you are referring to incentives in primary care. There are various types of incentives built in to contracts, but you are correct in that most are volume driven. Generally speaking, the more revenue one generates, the more incentive pay one receives. Some are based upon numbers of patients seen, but more commonly incentives are based upon relative value units (RVU's). In the private sector, whenever a physician provides a service to a patient RVU's are generated. This is a numerical figure derived from the service provided and is determined based upon the ICD and CPT codes. Thus, the more RVU's generated the more money a physician makes.

This is in contast to the military where one gets paid the same amount regardess of how much work they do, therefore there is a disincentive to see more patients. Why work harder if one is not going to be compensated for doing so? The military system is designed to promote laziness.

Hope this answers your question.

 

[USAFdoc]

Hey, USAFdoc. For those of us who will hopefully be out in the civilian world before too long, could you give us a quick lesson on how "incentives" work? I assume it boils down to "see more patients = make more money," but maybe it's more complex than that? Thanks.

RMD 321

If you are totally private practice, then seeing more patients is most important; coding higher (more complex patients, better documentation etc) would be 2nd in importance.

If you are managed care both of the above are important but there are some added details. Basically, you get a "pot of money", for example,one million dollars, in which you "manage" the care of all your HMO patients. SO if you are good at not using the most expensice meds,not ordering MRIs for all your headaches, taking care of problems yourself (not referring all your derm stuff to derm, not sending your DM2 patients to endocrine) then you do well and you get a % of the money saved. The top HMO FP doc in my area with the healthcare company here makes about 280 K; and we do not deliver babies or do hospital work, and call is a peice of cake. I have had a total of 6 calls after hours in the last 3 weeks.

As good as all the above is, even better is that people (including me) get treated with respect and our opinions count and are acted upon. The support staff are excellent and experienced (whereas my support staff in the USAF were just out of high school and more worried about boyfriends in the dorm than medicine).

And even better than that is having the ability and influence to fix problems and have a real shot at giving my patients truly excellent care and not a bunch of "lip service" and broken promises that are the norm in the USAF primary care clinics.