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Ehh. USA MEDCOM is worse in a lot of ways, but as I've said before, the idea that one service is categorically worse or better than the others is bunk.

As much as some of the idiosyncrasies of Army Medicine piss me off and sometimes make me dream about life as a zoomie or a squid, when I talk to my Navy colleagues (from my joint Army-Navy residency) who are 3 quarters through their Navy career there are 2 major issues that I can't countenance and make me glad that I'm not Navy--scope of practice away from the big MEDCENS and promotion rate.

The Navy just does not have medium sized MEDCENS away from Balboa, Portsmouth, or Walter Reed that support a robust scope of practice for my specialty. I talk to my colleagues at Jax, Bremerton, Oki, Yokosuka, and the like; the skill atrophy for them is very real. Not the case in the Army where we have medium sized MEDCENS away from our big 3 that support a relatively robust scope of practice (Fort Bliss, Fort Bragg, Schofield Barracks) that reduce the skill atrophy to an ooze instead of a pulsatile arterial bleed. When I talk to my Navy colleagues who are out and away from the big 3 and hear about their case volume and complexity, I definitely feel better about my scope of practice at an Army MEDCEN. And this issue dovetails with the other issue nicely...

Most of my old residency mates who have gone to Oki, Yoko, Jax whatever, went there to get the administrative title and geographic change on their FitRep or OPR (I've been joint for so long now I can't even remember what the different services call their evals). In the past year I've been talking to most of them and listening to how a significant number of individuals (that were good solid doctors and people from my assessment of them in residency) were passed over for O-5. Now granted, I don't know how they've performed as attendings, but these are guys and gals that checked all the boxes (Marine GMO, good performance during residency, board certified, etc.) and I find it hard to believe that some of these individuals weren't deserving of being picked up for Commander on the first go-round. Again, it makes me a little less upset with the Army when I talk to these individuals who volunteered to go to a place where they knew their skills would atrophy specifically to make rank, and then have Lucy pull back the football at the last moment.

AAUUGGHH!
Good Grief.

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Don't you Army guys have to endure a few iterations of Captain/Major/Whatever Super Career Great Leader Course or some nonsense like that to get promoted?
Captains Career Course, ILE, etc., yes. Unless you're referring to something else. There's never a paucity of ridiculous courses. Those are the only of which I am aware that are directly related to promotion, however. There are plenty of others that are just across-the-board required (stress management, leadership, etc.)
 
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In the past many people made O6 without these courses. Now it seems you need the three week captain career course for O5, and ILE for O6. Plus preferably no DUIs... although that's probably negotiable from what I've seen from the general pool of soldiers and officers in today's army.

I've interacted with several Navy docs over the last couple years (surgical/anesthesia realm) and it seems they have the same problems the army does in regwreg to low case volumes, lack of complexity, etc. My sample size is low and limited to the west coast.

Our residencies score extremely well cause we have so much extra time to Ace the test. High end programs can provide comprehensive training for their residents. Even at the largest MEDCENs we have to send residents out to the economy (from almost all subspecialties) to get adequate training.

The general feeling from most people I work with is that milmed is a rudderless ship in rough shallow water. Maybe it is intentional since we waste so much money, they want it to sink.
 
If anyone active duty Navy has listened to the most recent short-fused tasker from SG for CO calls within 2 weeks of receipt last week then you would have heard his responses to the big 4 myths surrounding MilMed and DHA transition. I'll wait for official message traffic to be released to talk specifics.

We can claim that "they" are trying to intentionally make it fail or we can look at the official correspondence, new policies and interim updates from DHA on their intent and goals. You all may not trust the government one iota and believing politicians isn't good judgment (I agree here), but in the same respect, we also can't just assume we know anything specific unless there is solid evidence to back it up.
 
Way too little too late. The “myths” exist because of a leadership failure. And, still today, no one knows what will happen to my specialty. That is not a myth.
 
Nobody knows anything specific about any specialty yet which is exactly my point.

Buckets, tiers, wartime critical....all of those are from each service branch up. Nothing has come back down so far as I know. Still awaiting further guidance. Until then I'm keeping my skepticism to a minimum and using official guidance to guide me and others.
 
Thats pretty much the definition of a leadership failure at the highest levels. You can tell people to wait all you want but they are often in the position where they have to make decisions now based on the available information. And when good people like David Lane are calling the cuts "drastic", they have every reason to be concerned. Putting your head in the sand makes sense if you have a lengthy obligation already but not if you are making a stay/go decision or an accessioning decision.

Military doctors in crosshairs of a budget battle
 
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It’s $5500 not $55k per beneficiary. Approximately half the per capita spend is what I’ve always heard quoted so this sounds right.

Friendly neighborhood pharmacist always here to check the math!
I would be interested to know how that compares to age and health matched controls within the general population, excluding the elderly, etc.
 
Thats pretty much the definition of a leadership failure at the highest levels. You can tell people to wait all you want but they are often in the position where they have to make decisions now based on the available information. And when good people like David Lane are calling the cuts "drastic", they have every reason to be concerned. Putting your head in the sand makes sense if you have a lengthy obligation already but not if you are making a stay/go decision or an accessioning decision.

Military doctors in crosshairs of a budget battle

Not freaking out and patiently waiting for official instruction to come down isn't putting your head in the sand. Staying up to date on all interim updates and preemptively adapting our clinics to meet DHA guidelines before we are even under their control isn't putting your head in the sand. Do you think big corporations have any better transparency down to the deck plate worker during major re-structuring and layoffs? I doubt it.

In Milmed situation, if a doc has the opportunity to go and be free of any question of what is to come by instantly doubling their salary and increasing their freedom as a civilian, why is there any question? If anything, those of us with lengthy obligations should be the pissed off ones demanding better transparency to try to understand what the next decade of our lives will entail. But alas, I'm still a LCPL at heart just here to serve my country and follow orders. It's not worth it to me to let basic military function or leadership issues get me upset. Won't change a darn thing.
 
Don't you Army guys have to endure a few iterations of Captain/Major/Whatever Super Career Great Leader Course or some nonsense like that to get promoted?

Yes, any promotions beyond Major require attendance at Captain's Career Course (CCC) and ILE. I believe ILE is required for promotion to O5, but I knew that would never apply to me so haven't given it much attention.
 
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This question is based on speculation, but I’d like to hear some of your opinions. Word on the street is that CCC is going to be 20 weeks long in the very near future. As someone with an obligation that basically extends to the threshold for O5, my thought was screw that. Not practicing for 20 weeks will definitely hurt my capacity as a physician (supposedly something the DHA was trying to fix). I can easily make peace with the decision of forcing myself out after O4, but my coworkers seem to think they will make it mandatory...my questions is, do you think they will make CCC mandatory? This is kind of a big deal because I could potentially go to the three week course in the near future, but I don’t really care about making O5 before my obligation is up. Extra pay for a few months does not make the 20 weeks worth it. What do you all think?
 
This question is based on speculation, but I’d like to hear some of your opinions. Word on the street is that CCC is going to be 20 weeks long in the very near future. As someone with an obligation that basically extends to the threshold for O5, my thought was screw that. Not practicing for 20 weeks will definitely hurt my capacity as a physician (supposedly something the DHA was trying to fix). I can easily make peace with the decision of forcing myself out after O4, but my coworkers seem to think they will make it mandatory...my questions is, do you think they will make CCC mandatory? This is kind of a big deal because I could potentially go to the three week course in the near future, but I don’t really care about making O5 before my obligation is up. Extra pay for a few months does not make the 20 weeks worth it. What do you all think?
Can you do the Air Force SOS by-correspondence version to check the box?
 
Can you do the Air Force SOS by-correspondence version to check the box?

Not to my knowledge. No one I know has done this. I could try to fit the three week course in before it changes, but it would be poor timing.

20 weeks?! You might as well go to the War College and start your tract to a Star and nothing clinical.

20 weeks seems like a ridiculous requirement for someone outside of the line community

Yeah, I think anyone who is working as a doc would see this as absurd, but I believe that this change is coming from the Medical Serices Corps. Most MS officers have no conception of what is needed to work as a doc, so they are trying to apply the CCC standards of the rest of the Army to the Medical Corps. The irony is that it will certainly make docs less capable especially in the surgical fields. You can find the articles online of why they think it’s necessary, and I think the problem is a general misunderstanding of what most of us do. Yes, someone on an admin track could probably benefit from a 20 week course on how to run things, but most of us want to remain clinical and have no interest in becoming admin.

My thought is to skip it entirely. It’s not necessary for promotion to O4, and I don’t see myself staying in longer than that. My concern is that they are going to try to force me to go to this 20 week course before I get out.
 
They’ve been talking about that for a long, long time. I'm a little out of the loop now, but this always seemed like one of those things that they talk about for years, but it never happens. When my class came up for C3 we were told that 20 weeks was going to be the only option. Then it wasn't. It's an absolutely ludicrous thing to do to a physician, it adds zero benefit to the Army, and it's really just one of those "everyone else does it, and uniformity is key" things, regardless of what they say. question is: will line units require it when people start turning up reverse-PROFIS?
 
Not to my knowledge. No one I know has done this. I could try to fit the three week course in before it changes, but it would be poor timing.



Yeah, I think anyone who is working as a doc would see this as absurd, but I believe that this change is coming from the Medical Serices Corps. Most MS officers have no conception of what is needed to work as a doc, so they are trying to apply the CCC standards of the rest of the Army to the Medical Corps. The irony is that it will certainly make docs less capable especially in the surgical fields. You can find the articles online of why they think it’s necessary, and I think the problem is a general misunderstanding of what most of us do. Yes, someone on an admin track could probably benefit from a 20 week course on how to run things, but most of us want to remain clinical and have no interest in becoming admin.

My thought is to skip it entirely. It’s not necessary for promotion to O4, and I don’t see myself staying in longer than that. My concern is that they are going to try to force me to go to this 20 week course before I get out.

How in the world would anyone in the reserves do this? 20 weeks? Most people can barely break it down for 3 weeks for DCC, 4 weeks for in person BOLC component, and 4 weeks for CCC.
 
42E47454-FA6D-48BF-A396-43DC9DFDA74A.jpeg
 
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This question is based on speculation, but I’d like to hear some of your opinions. Word on the street is that CCC is going to be 20 weeks long in the very near future. As someone with an obligation that basically extends to the threshold for O5, my thought was screw that. Not practicing for 20 weeks will definitely hurt my capacity as a physician (supposedly something the DHA was trying to fix). I can easily make peace with the decision of forcing myself out after O4, but my coworkers seem to think they will make it mandatory...my questions is, do you think they will make CCC mandatory? This is kind of a big deal because I could potentially go to the three week course in the near future, but I don’t really care about making O5 before my obligation is up. Extra pay for a few months does not make the 20 weeks worth it. What do you all think?

The AMEDD specifically instituted a truncated 3 -week, MC only CCC offered multiple times per year at the schoolhouse on Fort Sham in 2015. This was done because they recognized the lunacy of the line model which requires a PCS for a 20 week course. The MC only CCC has a dedicated MC OIC, and insofar as I am aware, there are no plans to cancel it. I've watched multiple Army physicians go TDY for this course in the past 4+ years.

Yes, any promotions beyond Major require attendance at Captain's Career Course (CCC) and ILE. I believe ILE is required for promotion to O5, but I knew that would never apply to me so haven't given it much attention.

ILE is slotted into the MC career progression path during the senior O-4/junior O-5 years. Rumor is that it represents the most important box to check on an ORB or promotion to O-5, but it is not a sine qua non for promotion to O-5 (I should know, I was selected for O-5 in PZ without having started ILE). CCC is absolutely required for promotion to O-5.

ILE is a bear. 20 weeks in residence away from your practice if selected (and possibly family) for the in-residence course or a year of nights and weekends for the correspondence course. Friends who have come back from the course (and haven't been assimilated into the Borg and convinced to pursue an admin/leadership track) have told me that the course was mostly a giant waste of time and definitely harmful to their clinical practice and respective hospital departments. I have no plans to complete ILE. While ILE is essentially de rigueur (Wow! I'm using a lot of foreign language idioms in this post) for promotion to O-6 nowadays, I am aware of the rare individual selected for O-6 in the past few years without having completed ILE.

It is certainly a different Army than it was a decade ago. I can still remember my first department Chief's response when I asked him about career progression as a brand-new attending: "Career progression? I got constructive credit for Officer Basic Training, so I never attended. I've never attended a single Army Professional Development Course and I've promoted in PZ all the way up to O-6. You don't need to worry about career progression." Needless to say, I stopped asking that physician for career advice.
 
The AMEDD specifically instituted a truncated 3 -week, MC only CCC offered multiple times per year at the schoolhouse on Fort Sham in 2015. This was done because they recognized the lunacy of the line model which requires a PCS for a 20 week course. The MC only CCC has a dedicated MC OIC, and insofar as I am aware, there are no plans to cancel it. I've watched multiple Army physicians go TDY for this course in the past 4+ years.



ILE is slotted into the MC career progression path during the senior O-4/junior O-5 years. Rumor is that it represents the most important box to check on an ORB or promotion to O-5, but it is not a sine qua non for promotion to O-5 (I should know, I was selected for O-5 in PZ without having started ILE). CCC is absolutely required for promotion to O-5.

ILE is a bear. 20 weeks in residence away from your practice if selected (and possibly family) for the in-residence course or a year of nights and weekends for the correspondence course. Friends who have come back from the course (and haven't been assimilated into the Borg and convinced to pursue an admin/leadership track) have told me that the course was mostly a giant waste of time and definitely harmful to their clinical practice and respective hospital departments. I have no plans to complete ILE. While ILE is essentially de rigueur (Wow! I'm using a lot of foreign language idioms in this post) for promotion to O-6 nowadays, I am aware of the rare individual selected for O-6 in the past few years without having completed ILE.

It is certainly a different Army than it was a decade ago. I can still remember my first department Chief's response when I asked him about career progression as a brand-new attending: "Career progression? I got constructive credit for Officer Basic Training, so I never attended. I've never attended a single Army Professional Development Course and I've promoted in PZ all the way up to O-6. You don't need to worry about career progression." Needless to say, I stopped asking that physician for career advice.

The word from higher ups is that there is a very strong possibility that the three week CCC is going to be a thing of the past. They are encouraging us to go ASAP to avoid the 20 week course, but there isn’t a great time for me to go, and I’m not set on staying in past 12 years which is when you would normally promote to O-5. The current word is that you should complete CCC if you want to make O-5 and ILE for O-6, but completing both greatly improves your chances for O-5. The promotion rates are going down across the board as they slim down the medical corps. I just don’t want to hurt my clinical ability for a career move I don’t need. I’m just worried they are going to mandate CCC for anyone who hasn’t yet taken it.
 
The word from higher ups is that there is a very strong possibility that the three week CCC is going to be a thing of the past. They are encouraging us to go ASAP to avoid the 20 week course, but there isn’t a great time for me to go, and I’m not set on staying in past 12 years which is when you would normally promote to O-5. The current word is that you should complete CCC if you want to make O-5 and ILE for O-6, but completing both greatly improves your chances for O-5. The promotion rates are going down across the board as they slim down the medical corps. I just don’t want to hurt my clinical ability for a career move I don’t need. I’m just worried they are going to mandate CCC for anyone who hasn’t yet taken it.
Where is the ILE course located?
 
The word from higher ups is that there is a very strong possibility that the three week CCC is going to be a thing of the past. They are encouraging us to go ASAP to avoid the 20 week course, but there isn’t a great time for me to go, and I’m not set on staying in past 12 years which is when you would normally promote to O-5. The current word is that you should complete CCC if you want to make O-5 and ILE for O-6, but completing both greatly improves your chances for O-5. The promotion rates are going down across the board as they slim down the medical corps. I just don’t want to hurt my clinical ability for a career move I don’t need. I’m just worried they are going to mandate CCC for anyone who hasn’t yet taken it.

The advice given to me for medical services corps was to complete CCC for 04 boards and for 0-5 boards and if you completed ILE it would boost chances of first pass at 0-5 boards, but then again it's a different animal than medical corps. If I make 0-5 before it's time to pull the plug I will be surprised with the way things are going, but then again another big conflict and with the medical service corps being whittled down I guess anything is possible.
 
The word from higher ups is that there is a very strong possibility that the three week CCC is going to be a thing of the past. They are encouraging us to go ASAP to avoid the 20 week course, but there isn’t a great time for me to go, and I’m not set on staying in past 12 years which is when you would normally promote to O-5. The current word is that you should complete CCC if you want to make O-5 and ILE for O-6, but completing both greatly improves your chances for O-5. The promotion rates are going down across the board as they slim down the medical corps. I just don’t want to hurt my clinical ability for a career move I don’t need. I’m just worried they are going to mandate CCC for anyone who hasn’t yet taken it.
This is what they've been talking about for years. This is exactly what I was told when I finished residency 6 years ago. FWIW, it wasn't true when I finished my ADSO. Whow knows if/when they'll implement it. I started to think it was a scare tactic to get medical officers to just go ahead and do CCC. And it worked, by and large. I know a ton of people who just signed up for CCC "just in case."
 
The advice given to me for medical services corps was to complete CCC for 04 boards and for 0-5 boards and if you completed ILE it would boost chances of first pass at 0-5 boards, but then again it's a different animal than medical corps. If I make 0-5 before it's time to pull the plug I will be surprised with the way things are going, but then again another big conflict and with the medical service corps being whittled down I guess anything is possible.

Supposedly, in MC, you will make O-4 as long as you don’t do something egregious.




This is what they've been talking about for years. This is exactly what I was told when I finished residency 6 years ago. FWIW, it wasn't true when I finished my ADSO. Whow knows if/when they'll implement it. I started to think it was a scare tactic to get medical officers to just go ahead and do CCC. And it worked, by and large. I know a ton of people who just signed up for CCC "just in case."

I hope that is the case. I’ll go as long as I can find a time to go, but this is coming up at a really bad time. 20 weeks is unreasonable, and I won’t go unless I’m forced.
 
Supposedly, in MC, you will make O-4 as long as you don’t do something egregious.

Well I had almost enough years credit when I signed up that if I had waited another year I probably could have strolled in as an 0-4. Oh well. I figured I will make 0-4 quick enough and then maybe 0-5 before my obligation ends. I guess it will depend how I like things and whether I feel I have a good chance of 0-5 early in a re-up and what incentives they put on the table whether I will sign up again.
 
20 weeks?! You might as well go to the War College and start your tract to a Star and nothing clinical.

20 weeks seems like a ridiculous requirement for someone outside of the line community

I think it is a possible option for those military doctors who want to get away from clinical duty and “relax.” Military pay system do not motivate doctors to see many patients as much as possible. I went to 2 weeks CCC back in the days and during that time I was surprised to see a fellowship trained urologist in a clinic opted to go CCC for several months to get away from clinical duty.
 
Heard recently that VADM Bono and other senior leadership reinforced that these changes everyone is talking about are already happening. The time to argue and influence the initial change was missed many years ago.

Those who now constantly complain are being left behind. True leaders are the ones who are trying to understand the changes, adapt, and then step through the new doors that are opening for those who can see the opportunity to affect the details of what this change will mean. Doesn’t matter what specialty, service or rank you may be.

The interpretation was well received. Wish I could have been there for the talk.
 
House Appropriations Committee on Defense Health Programs, 03APR2019

 
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Yup, that sounds like Rocky. Of course she never asked anyone what they thought back then either. Shes the only flag I’ve ever met who didn’t at least feign interest in meeting the people in the room.

And, if it’s already happened, why can’t they say what the plan is?
 
Did I hear correctly that the rockstar ortho PD in SD just quit at 15+ or did he do 20? I know the ENT PD has been a revolving door too
 
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Also, what she didn’t address was why anyone should join and put themselves in a position to face all this uncertainty
 
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.

Those who now constantly complain are being left behind. True leaders are the ones who are trying to understand the changes, adapt, and then step through the new doors that are opening for those who can see the opportunity to affect the details of what this change will mean. Doesn’t matter what specialty, service or rank you may be..

So, some of the best physicians we have are going to be left behind, that sounds like a high reliability organization to me.

This is where getting out of the the idea that “every physician should be a military leader” could be productive. Some want to just be a physician and be a physician-leader and not worry about all the other stuff it takes to be Director or OIC or CO. Figure out a way to make this work, let folks who want to be those who “can see the opportunity” self declare and let them go the administrative route. The Services need both and it takes good clinicians who are bad administrators out of administration and takes good administrators and weak physicians out of clinical medicine. It’s a win-win.

Ostracizing further those who are disgruntled by making statements like above is not productive to either group. We need to develop buy-in from the middle, the senior O3’s, the O4’s, and junior O5’s if this is going to succeed. So far they are the ones most in the dark. The senior O5’s and O6’s are short timers, the junior to mid O3’s are just trying to survive. It’s this middle group that is going to be the key to success and on the ground I don’t see buy-in or any real attempts to get them onboard.
 
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So, some of the best physicians we have are going to be left behind, that sounds like a high reliability organization to me.

This is where getting out of the the idea that “every physician should be a military leader” could be productive. Some want to just be a physician and be a physician-leader and not worry about all the other stuff it takes to be Director or OIC or CO. Figure out a way to make this work, let folks who want to be those who “can see the opportunity” self declare and let them go the administrative route. The Services need both and it takes good clinicians who are bad administrators out of administration and takes good administrators and weak physicians out of clinical medicine. It’s a win-win.

Ostracizing further those who are disgruntled by making statements like above is not productive to either group. We need to develop buy-in from the middle, the senior O3’s, the O4’s, and junior O5’s if this is going to succeed. So far they are the ones most in the dark. The senior O5’s and O6’s are short timers, the junior to mid O3’s are just trying to survive. It’s this middle group that is going to be the key to success and on the ground I don’t see buy-in or any real attempts to get them onboard.

So far, they have only made decisions that are going to make it difficult for us to maintain our skills. They don’t seem to have a great idea of what is going to happen, which doesn’t inspire confidence, and they keep taking away career opportunities. Why should we stay in? That should be the question they answer. Everything suggests that they want us to get out.
 
So far, they have only made decisions that are going to make it difficult for us to maintain our skills. They don’t seem to have a great idea of what is going to happen, which doesn’t inspire confidence, and they keep taking away career opportunities. Why should we stay in? That should be the question they answer. Everything suggests that they want us to get out.

Unfortunately once you sign the dreaded dotted line, the only power you have is to speak with your feet and leave at the end of your ADSO. If military medicine can be decimated from within (through near 0% retention and poor HPSP recruitment), things will change. But until that happens, poor leaders like Bozo (sorry Bono) will continue to act like the monkeys on a flagpole that they are.
 
Some want to just be a physician and be a physician-leader and not worry about all the other stuff it takes to be Director or OIC or CO.
This is already possible. It's just that the price for being that person is a promotion handicap.

I'm here to tell you though, embracing one's terminal rank and opting out of all that other stuff is liberating. You can be involved with collaterals that interest you instead of the ones that (might) check a box to (maybe) get you an EP to (maybe) get you promoted. You can spend your time on clinical work, teaching, even research. You can do a dozen little things that improve patient care and the work environment in your department. And so what if it's not recognized on your fitrep?

In the grand scheme of things, a little silver eagle doesn't mean a lot to a physician. We're not line officers, for whom O5 vs O6 amounts to a massive lifetime economic difference.
 
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This is already possible. It's just that the price for being that person is a promotion handicap.

I'm here to tell you though, embracing one's terminal rank and opting out of all that other stuff is liberating. You can be involved with collaterals that interest you instead of the ones that (might) check a box to (maybe) get you an EP to (maybe) get you promoted. You can spend your time on clinical work, teaching, even research. You can do a dozen little things that improve patient care and the work environment in your department. And so what if it's not recognized on your fitrep?

In the grand scheme of things, a little silver eagle doesn't mean a lot to a physician. We're not line officers, for whom O5 vs O6 amounts to a massive lifetime economic difference.

I actually had this talk with a MSC officer recently discussing my promotion timeline saying I would likely opt out of the O-6 board as I would be able to retire the next year. He was all "but if you get O-6 and stick around for 3 more years then the retirement goes up about $20k per year for life." And that is true; it has serious value. But I said "I could also make that $20k in a few weeks or couple of months if I wanted to as a physician and be out 3-4 years earlier." He just said "oh, I can't do that."
 
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Opportunity cost for military physicians is high even higher for those who want to work hard in efficient system that rewards them.
 
It's kind of like watching Game of Thrones. You have no idea what will happen next or who will get the axe to the head. Unfortunately any of us could be the next to be swallowed by the Dragon.

All I can do is to continue to do what I originally signed up to do. Follow orders and carry out the mission. I did NOT sign up for a free ride through medical school or for a pseudo civilian-physician life while in the military.

If life is going to be miserable for me in a few years as the doom and gloomers predict, at least I am staying positive/motivated now while contributing as much as I can. If life is about the same or better due to a blending of military and civilian systems with more opportunity for skill sustainment then I'm already positioning myself ahead of my peers to take advantage of the major changes occurring.

Any young Milmed's or Premeds already on a contract, I advise you to stay optimistic. We can't change the wheels already in motion but we can influence the direction those wheels take all of us and what direct impact it has on each of our personal situations.
 
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Premeds “already on contract” should bail. Everyone else might as well try to be happy.
Agree. No matter who you are, if you have the opportunity to bail and you don't have a compelling reason to stay then you should bail. With lower total numbers expected in the future we can't afford to have unhappy, non-performers filling billets.
 
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I've never heard of a surgeon general not retiring upon completion of their tour (Bono).
 
All of the general surgeons that I can recall meeting who retired after 20 years were elderly. Meaning they did it a couple of generations ago.
 
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