Thinking about HPSP/USUHS? READ THIS.

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You shouldn’t feel safe to match into gen surg or EM. They’re highly competitive. If you have great scores, you should feel good about it. But not safe.

But if the military is pushing "military medicine" like EM, Surgery, FM, Psych, etc. and are straying away from all the higher radiology, IM subspecialties, radiation oncology, dermatology, pediatrics, etc. etc. then why would they be highly competitive fields. I guess my question is, what are they turning their doctors into if not for those?
 
I agree that a civilian and a lot of active probably don't have any clue what a GMO tour is like, but I was able to work pretty closely with our GMO and have a pretty good idea what it's like. There are ways to shadow them and see what their day-to-day is like, but I agree that a civilian probably has no real idea what that means.

You have a relative idea of what ONE GMO's day to day was like, but I suspect you have no idea what he was experiencing in his head and I doubt he would lead on to it if you are not running away. Then again... along those same lines, not everyone's experience will be the same and maybe he got something incredibly sweet.

The same way you knew you wanted to go into medicine before you did. :bored:

So you think you know that.
 
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So what will happen to people currently in residency for those bucket 2/3 specialties? I'm in a civilian deferred residency so I am really out of the loop on this and my consultant hasn't been able to give me many predictions for the future. From what it sounds like, there is a chance I would have to work as a GMO when I re-enter, but that seems... wrong.
 
wow wow wow, can you clarify on this. I know service is required so that's not a downside to me. Military family so I know how it works too. Now, if I know I want nothing to do with bucket II then what's the problem? Even if I simply don't match, I would have very little problem being a GMO for the entire 4 years. (<- this is predicated on the 4 years not having a significant negative impact on civilian residency chances, as I have gathered). SO, what's the issue for someone like me?

Would you buy a new car without a test drive? Would you buy a house you have never walked through or inspected? The truth is, you have no idea what you are buying with this scholarship at this juncture. You don’t have any idea because I am currently in the system, and I have no idea what is going to happen. Being a GMO is more of a military experience than a medicine experience. If your interests are primarily with the military and not medicine, then go ahead and apply. If your primary interest is medicine, and you are wanting to use the military to pay for your education, then do not apply.
 
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But if the military is pushing "military medicine" like EM, Surgery, FM, Psych, etc. and are straying away from all the higher radiology, IM subspecialties, radiation oncology, dermatology, pediatrics, etc. etc. then why would they be highly competitive fields. I guess my question is, what are they turning their doctors into if not for those?

This is where their logic is going to break down. Sure, you want EM and surgery residencies. What happens when you have sent your entire pediatric population to outside hospitals because you no longer have pediatricians? You no longer have pediatric inpatients which means the surgery residency will need to supplement with external rotations. If you close one program, you start to break the others. This is not necessarily true for primary care, but it is going to be true for most surgical fields, and it will likely affect EM as well. Basically, HPSP at this point should mostly be used if your primary interest is the military. If you want to be a physician first and an officer second don’t apply. That is my advice.
 
But if the military is pushing "military medicine" like EM, Surgery, FM, Psych, etc. and are straying away from all the higher radiology, IM subspecialties, radiation oncology, dermatology, pediatrics, etc. etc. then why would they be highly competitive fields. I guess my question is, what are they turning their doctors into if not for those?
Just because they’re not training dermatologists does not mean they’ll start training more general surgeons. I know what you’re thinking “what are they going to do with all of these extra med students?!? The answer is: they don’t know. I promise you they have not thought it out that far.
 
I agree that a civilian and a lot of active probably don't have any clue what a GMO tour is like, but I was able to work pretty closely with our GMO and have a pretty good idea what it's like. There are ways to shadow them and see what their day-to-day is like, but I agree that a civilian probably has no real idea what that means.
Or a civilian med student. Or a civilian pre-med, which is when they’re making that decision.
 
Just because they’re not training dermatologists does not mean they’ll start training more general surgeons. I know what you’re thinking “what are they going to do with all of these extra med students?!? The answer is: they don’t know. I promise you they have not thought it out that far.
Well ****, does that just mean more GMO's? Terrific
 
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It is like groundhog day. We can't provide the information to help them make their own decision, then question their decision when they make it. At some point they have to choose their own destiny. Plus we are all just hypothesizing anyway.
Yeah, it’s almost as if the people on this thread are for some reason hardwired to try to give advice based upon experience and education to other people with less of those things when raw data is lacking. Maybe we don’t know as much as we think we know. That’s what my naturopath says.
 
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It’s tough having this ortho brain.

“Me give info, you make decision“

I need to come up with more acronyms to help me trim down the content. It’s like we are writing internal medicine notes and then talking about our feelings in a psych group session.

For the next 10 days I will respond only via ortho speak.


Sent from my iPhone using SDN mobile
 
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Would you still not recommend if you're exclusively interested in bucket 1 specialties (ortho spine/trauma, gen surg w/sub specialty, EM, anesthesia are my picks in order). I ask this as a UG senior matriculating in the fall and have been in talks with a Navy recruiter for a while, planning on 4 year HPSP. Would it make a significant difference if I did 3 yr HPSP?

I'm a, "bucket 1", specialty, and I would NOT recommend HPSP/USUHS. Bucket 1 doesn't mean you get special treatment or more opportunities to be a doc. It means you won't be a hospital asset and will belong to a FORSCOM unit, which effectively makes you the ***** of some O3 commander who knows absolutely nothing about medicine or being a physician (Yes, even less than the MEDDAC people in charge). Surgical cases scheduled at the MTF that gets to, "borrow", you from the FORSCOM unit? Tough ****, your commander needs his surgeon to go with the unit on a FTX to do an endless amount of meaningless bull****.

Nobody knows how the next few years will play out. It may end up not being so bad. More likely, it'll be an epic cluster****. I wouldn't chance it.

I will tell you, I've been doing the initial mentoring for 3 docs who just arrived right out of residency or fellowship. I've been here for a few years and am on my way out of the Army. They've all been here less than 6 months and are completely miserable and already counting down the days of their ADSO. I do not envy them. Don't be them.
 
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It is like groundhog day. We can't provide the information to help them make their own decision, then question their decision when they make it. At some point they have to choose their own destiny. Plus we are all just hypothesizing anyway.

I think from now on any time a student asks for an example of the mature defense of, "reaction formation", I'm going to dig up a bunch of your posts from this time period and show them.
 
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Just because they’re not training dermatologists does not mean they’ll start training more general surgeons. I know what you’re thinking “what are they going to do with all of these extra med students?!? The answer is: they don’t know. I promise you they have not thought it out that far.

This. Basically the entire system is compartmentalized into silos. The people making decisions about one thing are likely completely oblivious to the myriad other related factors. This is how we end up with the inexplicable amount of stupid in the system.

Perfect example: The ultimate plan DHA has for specialty and subspecialty care is to push it out into the network. The problem with this, is that in many areas surrounding an army installation there is no network. The specialists/subspecialists are either physically not there or administratively have a very long wait time for new patients, cherry pick which patients they will accept onto their panel, or outright don't even take tricare anymore. Related to this, there is a rapidly-increasing number of practices dropping tricare because of its atrocious reimbursement. I believe it's something like 85% of the medicaid rates, which is absolutely ****ing HORRIBLE. It really is perplexing how completely out of touch this plan is. It isn't going to work.
 
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It's honestly so discouraging to hear all of this because I am very interested in military medicine. I know that I must obtain certain scores to be competitive for EM or general surgery which I know I will obtain, but seeing as it seems that these specialties are probably more competitive than civilian it worries me a lot. I just don't think I am willing to go into the military with the mindset of "military first medicine second". I still have wishes and desires and those seem to reside in either EM or general surgery so I don't want to be confined in that aspect. It's so frustrating.
 
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I'm a, "bucket 1", specialty, and I would NOT recommend HPSP/USUHS. Bucket 1 doesn't mean you get special treatment or more opportunities to be a doc. It means you won't be a hospital asset and will belong to a FORSCOM unit, which effectively makes you the ***** of some O3 commander who knows absolutely nothing about medicine or being a physician (Yes, even less than the MEDDAC people in charge). Surgical cases scheduled at the MTF that gets to, "borrow", you from the FORSCOM unit? Tough ****, your commander needs his surgeon to go with the unit on a FTX to do an endless amount of meaningless bull****.

Nobody knows how the next few years will play out. It may end up not being so bad. More likely, it'll be an epic cluster****. I wouldn't chance it.

I will tell you, I've been doing the initial mentoring for 3 docs who just arrived right out of residency or fellowship. I've been here for a few years and am on my way out of the Army. They've all been here less than 6 months and are completely miserable and already counting down the days of their ADSO. I do not envy them. Don't be them.
If they're out of residency (assuming it was the specialty they wanted) is it just the broken system that's a problem for the new 3?
Lack of doing-what-they're-actually-trained-to-do?
 
It's honestly so discouraging to hear all of this because I am very interested in military medicine. I know that I must obtain certain scores to be competitive for EM or general surgery which I know I will obtain, but seeing as it seems that these specialties are probably more competitive than civilian it worries me a lot. I just don't think I am willing to go into the military with the mindset of "military first medicine second". I still have wishes and desires and those seem to reside in either EM or general surgery so I don't want to be confined in that aspect. It's so frustrating.

Before anyone suggests anything to the contrary: -most- of us aren't specifically trying to be discouraging. Sarcastic? yes. Cynical? Sure (although the military really ramped up my cynicism) However, you need to understand the general issues with the system and the potential issues coming down the pipe before you jump headlong into a faustian deal that you can't get out of. Now more than ever it's a challenging decision for pre-meds to make as to whether or not the military is the right call. There's a huge financial burden that you're staring down immediately, on which the military has always capitalized. But there's a lot behind the scenes that is either not obvious or in most cases unknown to recruiters that is vital to making a good decision.

There's a chance that NONE of this happens. There's a really good chance that not ALL of it will happen. But you need to make a decision based upon the possibility that it will. There are always variables and constants in making the decision to join the military, especially as a physician, but right now there seems to be a general gestalt that change is coming and that change will probably make things more complicated - at least for some time.

The next few years may be a good time to take loans and look at programs by which you can join after residency, rather than hoping for the best and joining now before the dust settles.
 
If they're out of residency (assuming it was the specialty they wanted) is it just the broken system that's a problem for the new 3?
Lack of doing-what-they're-actually-trained-to-do?

It's a combination of the broken system, the number of very significant changes and how quickly they're happening, the uncertainty of how this will all end up once the changes are fully implemented, and the usual military silliness that's been around for decades. In my 3.5 years where I'm currently at, I was actually pretty happy for 3 of them -- granted my entire military experience has been very, very unusual. But then I also started hating it within the past 6 months, which is why I don't envy these poor souls just starting who have almost 4 more years to go.

To give a pretty clear example, the first time I actually felt like a physician was when I went on my first interview for a civilian position a couple months ago. The way I was treated was so alien to me that it was almost awkward, and certainly completely unexpected. I realize this is part of the smoke and mirrors with an interview, but even just walking around and meeting various people at the civilian hospital system was an entirely different feeling. I actually *felt* like someone with an absurd amount of education and experience, and a very sought-after set of skills that 98% of the population doesn't have.

Then I returned to my world where everyone's a, "provider", and my worth as a physician is solely based on how many RVUs I've cranked out in the past 12 months calculated from a completely broken-as-**** database that's so blatantly rife with inaccuracies it's actually humorous.
 
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You can always join the reserves or even AD after you do a .civ residency. I don't know why young applicants agonize so much about this. Most rational voices here are saying- don't commit yourself for a minimum of 5 years AD when you are a college senior. There are multiple paths to join...HPSP esp. in the current climate is the riskiest and probably the worst.
 
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It is like groundhog day. We can't provide the information to help them make their own decision, then question their decision when they make it. At some point they have to choose their own destiny. Plus we are all just hypothesizing anyway.

Oh but clearly you can. Only the people who disagree even slightly with the hive mind are hypothesizing. Everyone else KNOWS.
 
Yes... a civilian. Which is what I said.
My point is: most people do not have a chance to shadow a GMO. I think that's a pretty rare opportunity. Anyone can shadow a civilian physician and get an idea of what it's like to do their job. They're all over the place, and all you have to do is find one who's not an @$$hole.
 
My point is: most people do not have a chance to shadow a GMO. I think that's a pretty rare opportunity. Anyone can shadow a civilian physician and get an idea of what it's like to do their job. They're all over the place, and all you have to do is find one who's not an @$$hole.

That was my point. I'm not sure why you felt like you needed to correct something I said when we are saying the same thing. Unless you were just agreeing with me and I misread the tone.
 
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That was my point. I'm not sure why you felt like you needed to correct something I said when we are saying the same thing. Unless you were just agreeing with me and I misread the tone.
No, my bad. I was under the false impression that you were saying that people could shadow a GMO and find out what that's like. Harder, but possible. I misread it.
 
No, my bad. I was under the false impression that you were saying that people could shadow a GMO and find out what that's like. Harder, but possible. I misread it.

AH. Gotcha. Yeah, maybe I wasn't clear enough when I wrote it. Yeah, I totally agree that it's really difficult for civilians to make an informed decision wrt mil med particularly wrt GMO.
 
To Summarize:

I've been part of SDN for about 15 years now, and was in this exact same position of deciding if HPSP is worth it when I joined back then.

*MY* experience has been so incredibly unusual that it wouldn't surprise me if the story becomes some sort of legend shared within the military community for years to come, once I'm out and finally able to share details. Aside from the last 6-9 months of my time in (which, honestly, still hasn't been THAT bad), I've been unbelievably lucky/fortunate.

Pay attention to what I initially said -- my experience is so rare, everyone would think it was made up. This won't be your experience. I have watched everyone around me experience the suck that I was warned about 15 years ago. All of the reasons those back then shared about why I should avoid HPSP are absolutely true. I somehow managed to avoid all of it. None of my friends or those around did.

So please, please, please don't ignore the wisdom being shared by those who have actually, you know, done this. Consider what is being shared and assume your experience will be the same, then decide for yourself if you'd be willing to tolerate all the nonsense. Then you'll have your answer.

Remember, you're making a decision now and obligating yourself to something that won't even actually start for another 7-12 years or more, depending on the path chosen after med school, and will last at least 5 more years after. A lot of **** changes in 7-12 years.

In any other context, someone would have to be completely nuts to sign any type of contract with terms like that.
 
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It's just like picking a specialty. You pick it because of the parts you really enjoy. But, if you can't stand what it does day in and day out, the bread-and-butter, you're going to hate life.
 
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Oh but clearly you can. Only the people who disagree even slightly with the hive mind are hypothesizing. Everyone else KNOWS.

Well, the reality is that they DO know from personal experience. I would never discount anyone's personal opinions from direct experience.

BUT:
Problem #1 with SDN MilMed forum: Huge bias towards unhappy folks
Problem #2 with SDN MilMed forum: We (without direct intent) apply our personal biases towards everything related to MilMed
Problem #3 with SDN Milmed forum: We get defensive because we are talking about our own lives and people try to tell us we are wrong because they had a different personal experience.
Problem #4 with SDN Milmed forum: Strong opinions require the last thought

I am as guilty as anyone on the above issues. There is no way to 100% avoid these problems either. We should just all be aware of them.

For interested premeds: Understand the above limitations of this forum. Seek out mentors or connections you trust locally or at the very least someone you have been in touch with online. Your decision is yours alone to make and don't rely on senior members to tell you what to do.

For Veteran SDN Contributors: Understand your inherent bias. Provide personal experience with as much specifics as possible to allow the premeds to apply it to their own situation and perceived current preferences. Do not make the decision for them. Provide the resources to make the decision.

Bones good. Diseases bad. Navy good. Army Bad (except in football currently)
 
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Well, the reality is that they DO know from personal experience. I would never discount anyone's personal opinions from direct experience.

Agreed.

BUT:
Problem #1 with SDN MilMed forum: Huge bias towards unhappy folks
Problem #2 with SDN MilMed forum: We (without direct intent) apply our personal biases towards everything related to MilMed
Problem #3 with SDN Milmed forum: We get defensive because we are talking about our own lives and people try to tell us we are wrong.
Problem #4 with SDN Milmed forum: Strong opinions require the last thought

That's really what I was talking about.

I am as guilty as anyone on the above issues. There is no way to 100% avoid these problems either. We should just all be aware of them.

For interested premeds: Understand the above limitations of this forum. Seek out mentors or connections you trust locally or at the very least someone you have been in touch with online. Your decision is yours alone to make and don't rely on senior members to tell you what to do.

For Veteran SDN Contributors: Understand your inherent bias. Provide personal experience with as much specifics as possible to allow the premeds to apply it to their own situation and perceived current preferences. Do not make the decision for them. Provide the resources to make the decision.

Bones good. Diseases bad. Navy good.

This good. Fracture bad.

Army Bad (except in football currently)

Meh. 2 out of 15 is still bad.
 
The same way you knew you wanted to go into medicine before you did. :bored:

Nobody ever knows what they're getting themselves into. I didn't.

When reading SDN, I think often of the poop hot dog problem. (Don't judge me.) That thread has been going 16 years now.

Anybody offering advice to a premed is fighting a host of dreams and ideals and hopes and visions of what being a doctor is. I don't mean that in a condescending way toward premeds.

They bring their bias and we have ours. It's a wonder any information is exchanged in the first place.

The milmed forum has that problem, squared.
 
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Definitely not perfect, but considering the dramatic lack of information elsewhere, this forum is useful and I think still helpful.

I don't think it's really all that negatively biased compared to the general opinion in the Army. Not 18 months ago anyway, and I can't imagine it's gotten better with the current potential change. I really did not know that many happy Army docs. 99% of them were in administrative positions. And it's not like I was a social recluse. I knew a reasonable number of people who just dealt with it but weren't vocally unhappy. But if you really talked to them, the best they could give you was "there are a lot of problems, but it'll be over soon." I mean, that's fine. Acceptable, even. But they weren't happy.

In any case, take any advice you get with a grain of salt. Take any "hard data" with a grain of salt. If you're making up your mind based solely upon the research you did on one forum online, well, that's on you.

I would not eat a poop hotdog to get in to the school of my choice. I don't think I would have done it even then. But the Army fed me a whole lot of $#!tburgers. So I got my fill anyway.
 
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That chant of three-peat on the field Saturday must've meant something.... Hmm.. but, I'm clearly biased.

I don’t follow football and barely follow the Army Navy games. I didn’t even watch this years. Was it 3 out of 15? I don’t think that’s a statistically significant difference from 2. :p
 
3 of the last 3 is a bit more of a trend
 
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I don't think it's really all that negatively biased compared to the general opinion in the Army. Not 18 months ago anyway, and I can't imagine it's gotten better with the current potential change. I really did not know that many happy Army docs. 99% of them were in administrative positions. And it's not like I was a social recluse. I knew a reasonable number of people who just dealt with it but weren't vocally unhappy. But if you really talked to them, the best they could give you was "there are a lot of problems, but it'll be over soon." I mean, that's fine. Acceptable, even. But they weren't happy.

You are right. Happy or not happy I guess is relative. Acceptable or unacceptable as it pertains to the utility of their time in service, career, debt is the key factor. I believe that the majority of MilMed physicians who found their time acceptable (useful for what it was) do their time, get out and never look back at MilMed and don't contribute to SDN either. So I guess the bias is more related to those who found their time unacceptable and advocate that nobody ever does it under any circumstance. Thousands have gone before us and never got royally screwed but also never had it be majorly awesome for them. They likely found it acceptable. It served its purpose.

Again, with current situation I've been doing mainly EXTREME HIGH CAUTION discussions...but I would never say never to anyone so long as they have the right information to make their decision. MilMed can be acceptable to many people that sign up for the right reasons. There are far fewer members on here (maybe 1?) who will admit that...therefore there is inherent bias.

Our intent shouldn't be for us to convince the opposing view (ACCEPTABLE vs UNACCEPTALBE) that they are wrong because they have such an impression based on their personal experience. You can't change that. Just provide the objective information each of us brings to the table to Premeds when they ask. I think we do that...we just constantly veer off on trying to change people. That's a hopeless endeavor
 
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The GMESB results were released today. I haven't had the chance to really dissect it yet, but fellowship opportunities were thinner than usual, at least in my specialty. Looks like there was one FTOS fellowship (a 2020 pre-select for pediatric anesthesia). They filled the four inservice fellowship positions we have at San Diego, Portsmouth, and Bethesda (chronic pain management). Nothing else.
 
The GMESB results were released today. I haven't had the chance to really dissect it yet, but fellowship opportunities were thinner than usual, at least in my specialty. Looks like there was one FTOS fellowship (a 2020 pre-select for pediatric anesthesia). They filled the four inservice fellowship positions we have at San Diego, Portsmouth, and Bethesda (chronic pain management). Nothing else.

They posted somewhere?
 
You are right. Happy or not happy I guess is relative. Acceptable or unacceptable as it pertains to the utility of their time in service, career, debt is the key factor. I believe that the majority of MilMed physicians who found their time acceptable (useful for what it was) do their time, get out and never look back at MilMed and don't contribute to SDN either. So I guess the bias is more related to those who found their time unacceptable and advocate that nobody ever does it under any circumstance. Thousands have gone before us and never got royally screwed but also never had it be majorly awesome for them. They likely found it acceptable. It served its purpose.

Again, with current situation I've been doing mainly EXTREME HIGH CAUTION discussions...but I would never say never to anyone so long as they have the right information to make their decision. MilMed can be acceptable to many people that sign up for the right reasons. There are far fewer members on here (maybe 1?) who will admit that...therefore there is inherent bias.

Our intent shouldn't be for us to convince the opposing view (ACCEPTABLE vs UNACCEPTALBE) that they are wrong because they have such an impression based on their personal experience. You can't change that. Just provide the objective information each of us brings to the table to Premeds when they ask. I think we do that...we just constantly veer off on trying to change people. That's a hopeless endeavor

I don't think there's only one person on the forum who would say that milmed is right for the right person. I've said that, and you're here, so that's at least two. I think there are a few people on here who would say "no" under any circumstances. There are, believe it or not, a few who have what I would consider unrealistically positive opinions about milmed. But I've learned to accept that.

I just think that most people have a more negative view than you do. But most of the posters I've seen on here regularly have a certain niche of med students for whom they think milmed is the right call. The question is always how big of a niche that is. However, most of us will say that if you aren't joining primarily because you want to be an officer, with everything else second to that, then you shouldn't join. And frankly, most med students don't fit that bill. Most of the people in milmed didn't fit that bill when they joined, and that's why there are so many unhappy people. Then there are the guys who actually do want to serve, but who are under the impression that that means being a neurosurgeon who does HALO jumps with a special forces unit and plows the victoria's secret catalog on weekends. That guy really does need a dose of reality, frankly.
There are even fewer people who are actually -telling- students not to join. Advising against it, for sure. And even if they're -telling-, this is an online forum. If you're taking orders from it, you're a fool. So it really doesn't matter how opinionated they are. I see really dumb crap on Facebook all of the time, and it doesn't make me believe it. I was a student on here once as well, and I was perfectly able to look at an angry ranting post and figure out pretty quickly that someone is biased.

So far as what the intent of the forum should be: I'm not sure the moderators should be dictating what the other posters intent should be. Once that becomes the standard, I'll stop posting here entirely. Because that's a very slippery slope at the end of which is this forum becoming just another mouthpiece for milmed. Review. Make sure there's no unacceptable content. Break up fights or dog-piling. Obviously feel free to make counterpoints. But dictating the intent of the posters? Thats kind of bull$#!t. Even the most negative people on here aren't trolling. Don't you think most of the posters on the sight have better things to do than to troll a student forum about military medicine? I promise that they do, but they come on here, occasionaly with very anti-military voices because they feel strongly that going into military medicine is a mistake for most people and they know that students read this forum and they would probably rather not have other people go through what they feel that they went through.

There are discussions here and there where two people with military experience are arguing opposing viewpoints. I don't usually feel like they're trying to change the other person's mind. It's a debate. Occasionally someone will forget that the other poster has a valid experience as well, but that almost always gets brought up and the conversation (usually) gets back on point. Then there are the discussions where some med student comes on and feels absolutely certain about something that experience dictates simply isn't true. I wouldn't consider pointing that out to be badgering or trying to convert the student. That's what mentorship is. The student things X and the mentor tries to steer him in the right direction.

In any case, this is getting way off topic.

At some point in the not-too-distant future, I'll be far enough away from my military experience that my opinion on it simply won't be relevant anymore, and I'll stop posting. Until then, I'll give me honest opinion. Sometimes that opinion will be that I feel that milmed is a reasonable option for certain students. Much of the time it will not.
 
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@militaryPHYS you have a 10 year badge. Who did you used to be?

I’m not trying to change anyone. I don’t have an agenda. I’m also not interested in being lectured and I will share my point of view as long as @Lee decides I’m welcome.
 
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