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Discussion in 'Military Medicine' started by AvoidMilitaryMedicine, Dec 8, 2018.
Military psychiatrist have lots of medical boards to write . I would think they are necessary, but a contractor could write them too.
You regret your decision. Mine was the best thing I think could have happened for myself and my family. I would tell my friends everything I know about how to maximize their chance of happiness and to go in with 100% understanding of risks vs. benefits. It is not for everyone and many people end up disappointed.
BUT....I am less than 2 years post-residency (yes, I am a dual mil physician couple) and have a 700+ k net worth and a for-profit rental property. All of this started Day 0 at USUHS. We had no handouts or pre-existing wealth. Cut that number in half if you want an idea of what a USUHS person can reach if they are smart with their money. I now rent a house on a cliff overlooking the Pacific Ocean on a multi-million dollar property in a foreign country which makes me feel happier and safer than any day I ever lived in the U.S.
I owe 5 more years (8 now that I accepted my FTOS spot). Some of those years won't be as good as these years. We know that. But we also know that we can stop working completely at age 47 (45 for my wife) and be set for life. Or I can locums and make ridiculous money. Or I can consult and make ridiculous money. Sucking it up and accepting what we chose for ourselves is better than being miserable and complaining about what could be better (could it be?).
Yes, we have been lucky. We are the exception, but to tell those of us who have made decisions with intention to maximize chances of success, wealth and security for our families that there is no hope for those who choose military medicine really fires me up. Nobody will achieve exactly what we have. Many will not...some will outpace us. At the end of the day it is up to you. Never blame the university. Don't blame the system. You make your own decisions and are responsible for what you achieve or fail at.
Go Navy. It's better than Army Medicine regarding satisfaction every day of the week. Plus we are better at football (usually). Next 10 years?....anybody's guess.
To be honest, for personal reasons, I don't regret joining the military -- it's always been an itch I've wanted to scratch and I did. And now I am ready to move on. I know the military is not a healthcare organization, nor should it be, and it shows. Many docs feel the same way.
It seems to be the overwhelming consensus that the system is changing for the worse and I can personally attest to the fact that every year I've been in, rather impressively, has gotten exponentially worse, despite my own gains in skills/knowledge/etc. Unfortunately, the complete control the military has over lives bleeds into nearly every aspect of our personal lives as well, its tiresome, old and beyond the point of frustrating.
Congrats on your financial moves -- something I'm definitely trying to aspire to as well. Bravo!
Sometimes even staff officers are in harms way. In the Med in *86 on a DDG and my squadron medical officer was LT Parker. Hell of a nice guy and helpful in what to do with my problem sailors. He was killed in a helo crash a year later. Your GMO tour can be dangerous.
Agree that changes are happening. It will be for the worse for those who get passed over, pushed out and not retained. Hell, it may even effect my wife or I some day. Who knows. Thankfully we are set up for transitioning to a good alternative...making more money and given more freedom in the civilian world. But we have not felt the same progressive negative changes that you mention. Unfortunately everyone's experience is different and transient based on location/specialty/service.
The changes which are being made are aimed towards providing a more efficient MilMed system while also integrating it more within the civilian system to maximize skill maintenance. These are things all of us agree should happen. Now that its happening we are all crying foul and heading for the hills. Not every decision has been perfect. Everything is an unknown right now, sure. People will have less options based on specialty. Sometimes the big military makes budget cuts without thinking about the impact felt on the ground. But not everyone will be negatively impacted. I've said it before, those of us who remain to see the new final product will probably like it better than what we have right now...it is just going to take a while to get there. If the risk of being affected negatively by MilMed during this process or even after it is too much, just don't do it. Easy answer.
But my point was that you can make the most of it and it can be a good thing if we go in to it with the right mindset and maximize our chances of success. Only 1% of our nation serves the military. I have no idea what percentage of Premeds end up going military but hopefully it mirrors the general military numbers because MilMed is DEFINITELY NOT FOR EVERYONE. To be happy and successful it is for very few people. But for those few people it is a great calling, service and experience, so let's not forget about them.
I put my numbers out there as an example. Not to gloat. Not a rule of what to expect. We haven't been living mustachian lives either. We spend way more than we probably should and still ended up with an early solid footing for the future. Plus we have two 9/11 GI bills for our two kids. Good things are possible, but they can be transient, mixed with horrible deployments or duty locations with skill atrophy...even ultimate sacrifice as @d2305 mentioned. Nobody should stay longer than they have to if they are miserable. They should get out when they reach their saturation point but should stay positive and productive until that time.
That’s what MEDMACRE was. The current changes annotated POM20 for Navy have absolutely nothing to do with efficiency or skills maintenance and everything to do with being able to shift billets to the Line. From all the briefs I have been in the medical side was not involved in the initial decision to make the billet changes, but rather only when it became a “how are you going to do execute this decision” where they consulted. This is despite the stuff that was put out in the recent news article saying something to the contrary.
Remind me to come back to this in 5 years. You may be right, but I figure it is going to take at least that long for things to settle into a new normal.
In my opinion the next three years will be a time of staff reduction, billet re-allocation, and facility reduction/closures. You will see those at retirement get out and you will see many in the younger year groups bail at the first opportunity. You will see a generational gap as those who can get out do and those currently in long obligations stick around probably leaving what the lone calls a T-notch in the lineal order. Over these three years people’s orders will be running out that currently sit in to-be stricken billets and you will finally see the bottom as DHA tries to start to fill in with civilian staffing. In the meantime there will be drastic leakage to the market of non-active duty care. This will make skills sustainment difficult for those who need those patients to maintain KSA’s which will force them to look for other ways to keep those skills. Sharing agreements and MOU’s will be attempted where available, but because there won’t be enough staff to cover the active duty demand they won’t be as fruitful as could. Folks will look to moonlighting to maintain skills (already do) and people will be forced to use their leave to maintain their skills (Can you imagine if pilots were forced to take leave so they could go fly for American or Delta to get enough hours in a cockpit?).
Finally at about year 4 we may start to see the way up. Civilian hires will start to be made and those folks will start to fill in the loss of active duty folks. The AD docs left behind will be going on deployments and humanitarian missions where it will be feast or famine and about half will actually be used in ways that maintains their KSA’s. They will also have increased PCS demands as we now have fewer docs to cover the overseas locations.
Eventually by year 5 we start to see a rebalancing out and a new normal is close. How to maintain GME has been somewhat figured out, but the product coming in is not as strong a quality because recruiting has taken a big hit and there is a four year lead time on the “purchase” of a medical student to them arriving for GME. This will lead to more struggles within GME for remediation, extensions of trainings, and eventually Board difficulties.
Finally at the end of year 5 we see what the outcome of the decision being made actually looks like.
For someone looking to sign up for HPSP right now you are really looking at coming into the Service when all the dust has settled. An issue is that because nobody has a clue what it is going to look like it is difficult to give solid advice. We are all coming from our own biases and worlds.
My personal bias (at least one I recognize) is that I don’t like making a decision until I have all the data (or as much as possible) unless not making a decision at a certain point precludes one of the options. In this instance there are always ways to join in the future so one doesn’t have to make a decision right now when so much is up in the air.
(Well that turned into a wall of text, apologies)
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So we received this as guidance last year. Perhaps it correlates to the buckets but I kinda doubt it given how many tier 1 there are.
The MTFs will remain some of the best funded, most efficiently run hospitals with some of the best outcomes and graduate medical education programs in the country (Madigan and San Antonio were top ten in surgical residency programs). What will decrease are the number of empty billets, redundantly-parallel health systems in a geographic area between the three medical services corps, and contractors in areas with a low density of providers (by shifting some of those military physicians and support staff from high-density areas with over-redundancy of nearby airforce/navy/army clinics to those with lower densities). It will help reduce costs, and overall the caseload per provider will go up and more closely mirror their civilian counterparts to avoid articles like this one: https://www.usnews.com/news/nationa...military-surgeons-skills-preparedness-for-war
If you're a good pre-med student and you feel called to become a uniformed services physician (military or public health service) - don't let this deter you. Read up about it, ask the USUHS/HPSP people in the trenches (not the recruiters) about your concerns, and make an informed decision. Don't let one article headline or statistic mentioned by one person color your whole decision.
@Cavalry Please educate us on these "best funded, most efficiently run hospitals" and the metrics you believe demonstrate those claims.
Please educate us on these top-ten residency programs and the metrics you believe demonstrate those claims.
Which "one article headline" and "one person" are you referring to?
Look, you're a USU MS1. I get that hope is important. But there is no one outside of the your bubble (and truthfully, few senior folks inside it) that believe those claims about government run hospitals or low-volume surgical residencies. They can't keep the ORs open. That's what matters. Its not about board pass rates or quiz bowl championships.
I would have considered pursuing a surgical specialty a lot more had ORs not been run like they are at MTFs. Everyone actively works against you to actually perform surgery, turnover takes forever, and there is so much PCSing and turnover that none of the ancillary staff know what they are doing. By the time they do they're on to their next assignment or ETS.
This was 9 years of my life.
It’s not just a river in Egypt.
Who is this directed to?
USU/HPSP students would not be people in the trenches, sorry.
I'm happy to be a case study, or guinea pig...or voluntary tribute? I have to be around for the next 8 years or so. By then we should know something. For better or for worse I will report on how it's going.
"Day 674. DHA watch. The mood is tense!"
Like most people I want to serve my country and become a great physician so I applied for the Air Force HPSP and based off of what my recruiter has told me I'm in the final review part of the application. After reading all these posts (which thank you to everybody cause you could be helping me from making a huge mistake or the best decision ever) I have a couple questions if y'all wouldn't mind answering them. I just ask that if you respond please answer all of my questions so I do not have to hunt through multiple replies to get the full answer.
My questions are:
1. I am currently more-so interested in becoming a pediatrician, based off of the upcoming changes what are the chances (low, medium, high) that the air force will not have a residency position for me since they are trying to lower the number of pediatricians they have? If the answer is low, would I have a chance of doing a civilian deferral for a peds residency?
2. Same questions as above but for the following other types of specialties that I have an interest in: family medicine, ICU, PICU, Neurology, Emergency Medicine (would you mind answering for each one specifically so I have a clear answer for each one).
3. If I was able to do a pediatric residency through the air force, would the job with the air force be worth it? I don't mean that in the sense of I am doing this only for the money, but in the sense that I want to serve my county and the families of the men and women who are fighting for my freedom but I don't want to be in a pediatrician that has skill atrophy and does nothing all day due to this upcoming change the military has coming?
4. If based off of the responses I get for all of the questions above would I still be able to opt out of the HPSP application since I'm still under final review and haven't signed any contracts regarding I accept the scholarship?
I understand that some of these residency and fellowship spots are competitive and you need not only high board scores but other things as well, I'm just trying to get a grasp on this before I make any decisions. Like I said above it has been my dream to serve, but based off of this thread I am not sure if I can do a military first, physician second approach if I am going to be (kinda) forced to do GMO (which if it came down to it I wouldn't cry and throw a temper-tantrum it is just not my ideal desire to do that for I would rather become the type of physician I want to become then serve).
The truth is, I’m not sure if anyone can answer 1 or 2 yet simply because the changes that are occurring are so early in the process. It’s very difficult to know where things will be in 4 years. Traditionally, with good scores you could match peds without too much difficulty. Being deferred really depends upon service, specialty, and manpower at the time you apply. Very difficult to predict deferments for most specialties.
Not being a pediatrician, it seems like you can have a fairly satisfying outpatient peds practice in the military. Lots of families, lots of kids. The more subspecialized you become, the harder it will be to maintain your skills. At many small facilities, maintaining inpatient peds skills could also be difficult.
You can opt out right up until you sign the contract, and my understanding is right up until you’ve actually spent a certain amount of time on active duty (but I’m not 100% clear on that second part, as I never did it).
Your recruiter will throw a fit. That’s his problem.
So are they not entirely getting rid of residency positions like peds, just cutting down the number of available spots? Or is this one of those we don't entirely know until it happens.
We don’t know.
This may seem like a curt response, but it’s really the truth right now. I’m not even sure the people making decisions at the highest levels have a full answer yet.
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