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Thinking about DA as a fresh PulmCC grad

Discussion in 'Military Medicine' started by PlumoClinic, Jan 10, 2019.

  1. PlumoClinic

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    Hi all -

    I've spent the past week or so perusing the forum, so hopefully none of my questions have been addressed ad nauseum.

    Background:
    - Finishing pulmonary/critical care fellowship from a reputable institution. US-educated the whole way through school/training and no black marks along the way
    - No service obligation or background in the military. I've always been putting it off because I didn't want to restrict my residency/fellowship options and I didn't know what I wanted to do medically. Thankfully, I ended up falling in love with a specialty that (apparently) is desired by the military and now I *think* I'm ready to sign up.
    - I'm single and won't be tied down anytime soon. Very OK with relocation q3-4 years.
    - I have a **** ton of debt (400k despite no undergrad debt; 6.7% interest rate)

    Goals/motivations:
    - I know this sounds cheesy, but I don't feel like I've repaid my debt to society yet. I can't really explain it better than that; after doing some critical care moonlighting over the course of this winter, I just don't think pulling that type of money doing cushy private sector work would sit well with me. I'm probably crazy, though, so feel free to say as much.
    - I want to diversify my non-clinical skills. Things like leadership/management, resource management, etc.
    - Money isn't a big motivating factor as long as I'm not digging a big hole as far as my student loans go. I'm fine making 50-60% of what a private sector MICU job would entail as long as I'm not paying off my loans for 10-15 years.

    Here are the issues I'm hoping to get everyone's advice/experience/thoughts on:
    (1) When you're a "critically short wartime skills" IM subspecialty, how often do you end up doing non-specialty work? Am I running the risk of doing general medicine when I deploy or even just at station? Is there any way to negotiate that before signing and *actually* hold them to it?
    (2) Who should I be talking to right now? Is it kosher to just cold-call/email a pulmonologist who's active duty, or is it a small enough world that I run the risk of ruffling feathers?
    (3) I haven't been impressed with the recruiters I've spoken with so far. The navy and AF ones didn't know much (and said that most of their time is spent recruiting nurses), while the Army guy painted such a rosy picture that I'm worried he was blowing smoke up my arse. Will I eventually get referred to a physician-specific recruiter who can sit down and talk nuts/bolts with me? Do I get some sort of physician "liaison" within my subspecialty prior to signing?
    (4) What sorts of things are typically negotiable while also being enforceable after I sign?
    (5) Air Force told me "before you sign, we'd be able to give you a list of 3-4 places you'd almost certainly be stationed, that way you can estimate what sort of BHA you'd be getting". Is that a total lie?
    (6) How does clinical mentorship work? If my first job were to be with a private practice group, I'd have 4-6 more experienced attendings I could ask for help anytime I ran into a difficult clinical situation. Do military subspecialists end up being either solo or one of only like 2-3 people at their station?
    (7) Army is trying to get me to sign up for Reserves until I've taken my board exams, then convert to active duty. Would taking an accession bonus for Reserves disqualify me from getting the massive CSWSAB (looks to be about 300k for PulmCC)?
    (8) Is it even remotely possible that I could get my first placement at a place with residents +/- fellows and do some teaching? What about institution-sponsored research? Is that a thing?

    Thanks in advance for any wisdom/criticism. Part of my issue is that I haven't found anybody who's walked this path before, so I'm having trouble getting worthwhile reality-checks from people I can trust.
     
  2. armytrainingsir

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    Military medicine is a huge transition right now.
    You very well could end up as an internist, with no ICU or bronchoscope within 100 miles.
    Or one of three CC docs that staff an 'ICU' that admits a few patients per week that really aren't that sick.
    That 300K is taxable and is just an attempt to equalize your pay with what you would earn as a civilian for the first few years.
    Reserves is the way to go if you must go .mil IMO.

    To tackle 400k of debt, I would suggest you:

    Go as employee to a smaller, busier hospital that offers loan repayment of as much as you can get.
    Rent, don't buy.
    Pick low cost of living area
    Plan on at least four years there
    Modest lifestyle
    pay down your debt instead of lavish lifestyle
    Reserves if you want to be .mil, take all the bonuses, drill pay, and health care savings (Tricare Reserve Select $60/month vs employer plan) and pay down your debt.


    I understand your desire to serve, but the Reserves is the way to do it, not AD these days I'm afraid.
     
    68wdogdad likes this.
  3. DrMetal

    DrMetal To shred or not shred?
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    I agree with the above. And I know you said money doesn't matter, but you really do stand to make a great paycheck as a civilian Critical Care pulmonologist, one that far exceeds any active-duty salary, and you'll have no problem paying back your loans.

    Consider joining the reserves. It's a nice way to serve, possibly even deploy, while maintaining your civilian practice.
     
  4. DeadCactus

    DeadCactus SDN Lifetime Donor
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    Guard or Reserve should be able to offer you about $160k in loan repayment. You get to keep working as a civilian: earning good money and maintaining skills. You can work at a VA or critical access hospital as another way of giving back. You can volunteer to deploy or go to extra military training. Last I heard, the Air Guard and Air Force Reserve are working to set up more Critical Care Air Transport Teams. That might be something specific worth looking into.
     
  5. AvoidMilitaryMedicine

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    Absolutely DO NOT commission for the military. The system is being systemically being gutted, and unless you have a desire to be an underpaid, underappreciated, under-supported doctor who spends most of his time doing paperwork and BS admin -- then the military is NOT the place for you, or quite frankly, for anyone who wants to be a physician.

    It very well may be the worst decision you've ever made.
     
    Nash likes this.
  6. HighPriest

    HighPriest Specialized in diseases of the head holes
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    I think your heart is actually in the right place, but this is a dangerous time to join, from a career perspective. If you want regular Army/AF/Navy, you need to wait until the current changes shake out.

    Agree with the reserves/guard. At least if they deployed you as an internist, there’d be a light visible at the end of the tunnel and you’d definitely end up back in the ICU.
     
    Nash likes this.
  7. HighPriest

    HighPriest Specialized in diseases of the head holes
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    Oh, also, the Army recruiter is absolutely, without a doubt, surer than a frog’s a$$ is water tight, blowing smoke.
     
    Nash likes this.
  8. grotto

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    If you aren’t totally scared off you can PM me for more info on PCCM, I’m happy to get you in touch with a specialty leader. Tons of great people in our specialty in the military but challenges as well. Expect to deploy but there is some fun stuff to do. Practice models are variable depending on location, many do only civilian CCM.

    Sorry you came here first. As online communities tend to go over time, this forum has become a poisoned well - only the people with a lot of anger have the energy to post anymore.
     
  9. HighPriest

    HighPriest Specialized in diseases of the head holes
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    Psst, hey kid. Don’t listen to those fellers. They’re all old and grumpy. Candy is good for ya. Come meet me in this alley and I’ll give you some.
     
    notdeadyet, j4pac and haujun like this.
  10. haujun

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    Many posters here post the benefit of doing post graduate training before signing for the military. Unfortunately the climate of military is unpredictable with this reverse profis and cutting down opportunity for GME education to name the few. I may be one of very few positive posters here and I would not in good conscience recommend you to join military right now. IM specialist like you can be deployed as BN surgeon to treat primary care stuff etc and really experience that needs of military come before your own and physicians are not respected in military medical system.
     
  11. OP
    OP
    PlumoClinic

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    Thanks for the replies, everyone. All replies are welcome and appreciated.

    In my reading, “profis” and “reverse profis” are terms I haven’t been able to decipher. Translation?
     
  12. DeadCactus

    DeadCactus SDN Lifetime Donor
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    Profis: You work in a medical setting in the states and a deploying unit borrows you when it's time to go overseas.
    Reverse profis: You work for a deploying unit and a medical setting borrows you when you're not deployed.

    Basically, the military is moving away from your boss being someone who knows anything about your professional and personal needs as a physician. The trade-off is likely more time spent doing "military things". Military things are great if that's what you want but most specialists want to practice their specialty in a military setting, not learn and practice the largely administrative and public health specialty that is military medicine.

    If your goal is take care of sick people in an ICU and occasionally go to some fun military training or deploy overseas, the Reserve or Guard are a better option.
     
    notdeadyet, Nash and HighPriest like this.
  13. Gastrapathy

    Gastrapathy no longer apathetic
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    OP, military ICUs have the acuity of a typical step down (or ward in many cases). The docs moonlight relentlessly to keep their skills up and I think they are a generally strong group with more of an academic focus than many departments. They’ve had many open/unfilled fellowship slots over the past decade. The senior docs tend to get bored and go do something operational (dive in particular seems popular).

    @grotto is right that the Navy PCCM docs are relatively happy compared to most. It’s a self selected group who can be happy in PCCM in general and you’re already one of those ;) He’s wrong that the forum has changed over time. The anger goes back 10+ years to medicalcorpse, Galo, et al. It’s just that they were ahead of their time.

    40 (and counting) Reasons Not To Join
     
    #13 Gastrapathy, Jan 12, 2019
    Last edited: Jan 12, 2019

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