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- Attending Physician
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Hey everyone...I used to be a regular poster on this forum, but I made my last post a year ago yesterday. That was the day I picked up my DD 214 and went on terminal leave. I wanted to "tell my story" then, but I didn't think it would be appropriate while I was still on active duty. A few weeks later, when I had officially separated, I had kind of lost the will to post, if you will, and I decided that it might be prudent to wait a year, gain some perspective, and then say my piece.
I was an Army brat growing up, with my dad retiring the same fall that I joined Army ROTC. There was a strong expectation from my family that I would serve, and serve as an officer. Back then, medical school wasn't really on the radar, so I accepted a scholarship for ROTC with the idea of being a line officer. Medical school only entered the picture later on, but luckily, when it did, I received an educational delay to attend. I got this despite deciding to forego HPSP, which would have given me an 8-year post-residency commitment, because even as a college senior that seemed like way too long of an obligation. The bottom line though is that, between growing up and ROTC, I had a better idea than most of what I was getting into.
During medical school, I was really left to wander the figurative forest without any guidance. Back then, there weren't any official online resources, and – not being on scholarship – the HPSP office had little-to-no visibility of me. I was so lost that it wasn't until 3rd-year that I had pieced together enough information to know that I had the same obligations vis-a-vis residency as an HPSP student. It was also then that I found this forum, which turned out to be my best source of information.
I fully admit that the Army treated me just about as well as I ever could have hoped. I matched into my preferred specialty at my number one choice out of medical school. After residency, I was sent to one of the major MEDCENs (against my preferences, BTW), where I never had to worry too much about skill atrophy. I never deployed, although it wasn't something I avoided. By the time I was done with residency, we were essentially out of Iraq and operations in Afghanistan were winding down. Lifers and people senior to me were lining up to deploy at that point, and I simply didn't get in their way.
Things really changed for me on 15 October 2012. That was the day that I was paged to my chair's office, where I was informed that I had been selected to be a brigade surgeon. I’m a radiologist, which makes me, arguably, the least qualified person to do that job. Also, that two-year tour would have been my last two in uniform, which would have ruined my chances of getting a civilian job right away, effectively obligating me to stay on active duty beyond my contract in order to rehabilitate my skills.
Over the course of 4 months, and through I process that I still don't understand, I was eventually relieved of the tasking. My slot just up and vanished, probably because my consultant went to bat for me. So, luckily, I was able to stay at my MEDCEN and do my best to keep my head down.
However, what that 4 months really taught me is that the Army no longer had any plans simply to let me practice the craft it had trained me to do. To me, it was the first indicator of a paradigm shift from the system that I had been told about by and witnessed in the senior officers I saw in residency. To wit, if you want to be a lifer, you do a utilization tour in BFE, do a fellowship, get back to a MEDCEN, and then homestead until you're ready for your mailbox money. Sure, sprinkle in some administrative duties here and a deployment there, but the Army generally left you alone to do your job.
And I'm not talking about leave you alone in terms of standard military stuff. Wearing a uniform, staying in shape, taking PT tests - these are all standard military fare that never really bothered me. I mean, they bothered me inasmuch as no one really likes waking up at 0400 to run in circles, but they never really were such an issue as to be a deal breaker. Also, even though I never did it, I felt the same way about deployments - that was the job I signed up to do. No, I'm talking about leaving me alone to actually practice medicine – the job they hired me and invested many hundreds of thousands of dollars in me to do.
Over my last my last few years in uniform, the Army's new approach went from insidious to codified doctrine. "Don't just be a doctor" became the mantra of every higher-up giving a state-of-the-medical corps talk. By that time, it already become clear to me that this was an organization that I no longer wanted to be a part of. I think, like most people in our profession, I conceive of myself primarily as a physician, and the (perceived) needs of the Army took a very distant backseat in my mind. I had spent too much time, money, and energy to be able to practice medicine, and I wasn't about to give that up to be what the Army wanted me to be.
I think the divergence between what Army physicians want and what the Army wants out of its physicians could fill a book, but suffice it to say, I decided to separate. There were a number of reasons I chose to separate, but one of them is that, as silly as it sounds, the Army and I grew apart. Not only was I a far different person than the teenager that signed that ROTC scholarship contract, but I was vastly different than the brand new O-3 who showed up to internship orientation. Similarly, the medical corps I heard about and saw as a medical student and resident no longer existed. It had been replaced by one that was less interested in delivering healthcare, and more keen on making sure its soldiers had plenty of physicians to track their flu shots and make sure their cold-weather training was current.
And so, after three and a half decades as either a dependent, and ROTC cadet, or an officer, the last year of my life has been my first without the Army. I thought it might feel strange, but it hasn't, and I honestly don't miss it at all. The first time I went out of town I caught myself feeling weird about not filling out no few than 5 different documents, but it's funny how quickly one forgets about all of the headaches that used to be such a big part of life. Even though I'm at a large place where there's still a lot of bureaucracy, there's really no such thing as the death-by-a-thousand cuts phenomenon I experienced in the Army. And, of course, the idea that anyone would be forced to stop practicing medicine by the administration is such a foreign concept that I doubt my partners are able even to conceive of it. Nope, you're not going to catch me hedging on this - as a physician, civilian medicine is way better than military medicine. And that's without even considering things like salary.
When I think about my time in the Army, I keep coming back to this: I have no regrets, but I wouldn't do it all over again. On one hand, I am proud that I did my part, as small as it was, and did it honorably. And I can't say that I'm unhappy with where I've ended up. On the other hand, I'm not convinced that the Army really helped me that much and, on balance, it was probably a hindrance both financially and professionally. Then again, I'm okay with that, because it's not really service if you don't sacrifice anything, and I try to remember that a lot of people have given up a whole lot more than I did. Still, it's an organization and an experience that I'm happy to have behind me.
For those of you considering HPSP or USUHS, I think there are two big warnings that I'd like to pass on. Number one: the person who signs on the dotted line is very rarely the same person who comes out of training. So many things about you and your life will change, and that is especially true if you are a traditional student. What seems like no big deal as a single 23 year old becomes a huge issue as a 33-year old spouse and parent. Secondly, and this may be branch specific, understand just how different your idea and the Army's idea of the practice of medicine will be. Even if you train in the military, you will train to civilian standards (USMLE, ACGME, civilian board certification, etc.), and you will almost certainly develop a sense of your professional self based upon that training and those experiences. Understand that the Army doesn't care about that, and so you have to ask yourself how you're going to feel when you have to cancel clinic to piss in a cup in front of someone barely half your age.
I'll say again what so many others have said already - your number one reason for joining has got to be a desire to serve. The quality of your COs, your locations, your training, and your pay (as compared to civilian remuneration) is all going to vary so much that no two people will have the same experience. You cannot rely on those things to break your way. As we say, hope is not a method. I believe that you need to have a well-developed deontologic ethic to serve. If you don't, then there's a good chance you're going to be upset and angry about how you've been treated unfairly, because, invariably, you will be shat upon. I can't always say that I always practiced that, but I think I did it enough that it never affected patient care, and I came away psychologically unscathed. And that's good enough for me.
I have a tremendous amount of respect for everyone who wears the uniform honorably. I realize we're not trigger pullers, and I would never put myself on the same level as the guys sleeping in the muck. But it's also true that even us medical corps REMFs have given more than the overwhelming majority of our countrymen, and all of you deserve credit for that, so thank you for your service. If you've found a happy place and decided to stay in, good for you. Keep fighting the good fight, and do as little as possible to perpetuate the broken parts while hopefully fixing a few things too. For those of you, like me, who need a clean break, realize that really is light you’re seeing at the end of the tunnel and, at least for me, the grass really is greener on this side.
Thanks for reading. Out.
I was an Army brat growing up, with my dad retiring the same fall that I joined Army ROTC. There was a strong expectation from my family that I would serve, and serve as an officer. Back then, medical school wasn't really on the radar, so I accepted a scholarship for ROTC with the idea of being a line officer. Medical school only entered the picture later on, but luckily, when it did, I received an educational delay to attend. I got this despite deciding to forego HPSP, which would have given me an 8-year post-residency commitment, because even as a college senior that seemed like way too long of an obligation. The bottom line though is that, between growing up and ROTC, I had a better idea than most of what I was getting into.
During medical school, I was really left to wander the figurative forest without any guidance. Back then, there weren't any official online resources, and – not being on scholarship – the HPSP office had little-to-no visibility of me. I was so lost that it wasn't until 3rd-year that I had pieced together enough information to know that I had the same obligations vis-a-vis residency as an HPSP student. It was also then that I found this forum, which turned out to be my best source of information.
I fully admit that the Army treated me just about as well as I ever could have hoped. I matched into my preferred specialty at my number one choice out of medical school. After residency, I was sent to one of the major MEDCENs (against my preferences, BTW), where I never had to worry too much about skill atrophy. I never deployed, although it wasn't something I avoided. By the time I was done with residency, we were essentially out of Iraq and operations in Afghanistan were winding down. Lifers and people senior to me were lining up to deploy at that point, and I simply didn't get in their way.
Things really changed for me on 15 October 2012. That was the day that I was paged to my chair's office, where I was informed that I had been selected to be a brigade surgeon. I’m a radiologist, which makes me, arguably, the least qualified person to do that job. Also, that two-year tour would have been my last two in uniform, which would have ruined my chances of getting a civilian job right away, effectively obligating me to stay on active duty beyond my contract in order to rehabilitate my skills.
Over the course of 4 months, and through I process that I still don't understand, I was eventually relieved of the tasking. My slot just up and vanished, probably because my consultant went to bat for me. So, luckily, I was able to stay at my MEDCEN and do my best to keep my head down.
However, what that 4 months really taught me is that the Army no longer had any plans simply to let me practice the craft it had trained me to do. To me, it was the first indicator of a paradigm shift from the system that I had been told about by and witnessed in the senior officers I saw in residency. To wit, if you want to be a lifer, you do a utilization tour in BFE, do a fellowship, get back to a MEDCEN, and then homestead until you're ready for your mailbox money. Sure, sprinkle in some administrative duties here and a deployment there, but the Army generally left you alone to do your job.
And I'm not talking about leave you alone in terms of standard military stuff. Wearing a uniform, staying in shape, taking PT tests - these are all standard military fare that never really bothered me. I mean, they bothered me inasmuch as no one really likes waking up at 0400 to run in circles, but they never really were such an issue as to be a deal breaker. Also, even though I never did it, I felt the same way about deployments - that was the job I signed up to do. No, I'm talking about leaving me alone to actually practice medicine – the job they hired me and invested many hundreds of thousands of dollars in me to do.
Over my last my last few years in uniform, the Army's new approach went from insidious to codified doctrine. "Don't just be a doctor" became the mantra of every higher-up giving a state-of-the-medical corps talk. By that time, it already become clear to me that this was an organization that I no longer wanted to be a part of. I think, like most people in our profession, I conceive of myself primarily as a physician, and the (perceived) needs of the Army took a very distant backseat in my mind. I had spent too much time, money, and energy to be able to practice medicine, and I wasn't about to give that up to be what the Army wanted me to be.
I think the divergence between what Army physicians want and what the Army wants out of its physicians could fill a book, but suffice it to say, I decided to separate. There were a number of reasons I chose to separate, but one of them is that, as silly as it sounds, the Army and I grew apart. Not only was I a far different person than the teenager that signed that ROTC scholarship contract, but I was vastly different than the brand new O-3 who showed up to internship orientation. Similarly, the medical corps I heard about and saw as a medical student and resident no longer existed. It had been replaced by one that was less interested in delivering healthcare, and more keen on making sure its soldiers had plenty of physicians to track their flu shots and make sure their cold-weather training was current.
And so, after three and a half decades as either a dependent, and ROTC cadet, or an officer, the last year of my life has been my first without the Army. I thought it might feel strange, but it hasn't, and I honestly don't miss it at all. The first time I went out of town I caught myself feeling weird about not filling out no few than 5 different documents, but it's funny how quickly one forgets about all of the headaches that used to be such a big part of life. Even though I'm at a large place where there's still a lot of bureaucracy, there's really no such thing as the death-by-a-thousand cuts phenomenon I experienced in the Army. And, of course, the idea that anyone would be forced to stop practicing medicine by the administration is such a foreign concept that I doubt my partners are able even to conceive of it. Nope, you're not going to catch me hedging on this - as a physician, civilian medicine is way better than military medicine. And that's without even considering things like salary.
When I think about my time in the Army, I keep coming back to this: I have no regrets, but I wouldn't do it all over again. On one hand, I am proud that I did my part, as small as it was, and did it honorably. And I can't say that I'm unhappy with where I've ended up. On the other hand, I'm not convinced that the Army really helped me that much and, on balance, it was probably a hindrance both financially and professionally. Then again, I'm okay with that, because it's not really service if you don't sacrifice anything, and I try to remember that a lot of people have given up a whole lot more than I did. Still, it's an organization and an experience that I'm happy to have behind me.
For those of you considering HPSP or USUHS, I think there are two big warnings that I'd like to pass on. Number one: the person who signs on the dotted line is very rarely the same person who comes out of training. So many things about you and your life will change, and that is especially true if you are a traditional student. What seems like no big deal as a single 23 year old becomes a huge issue as a 33-year old spouse and parent. Secondly, and this may be branch specific, understand just how different your idea and the Army's idea of the practice of medicine will be. Even if you train in the military, you will train to civilian standards (USMLE, ACGME, civilian board certification, etc.), and you will almost certainly develop a sense of your professional self based upon that training and those experiences. Understand that the Army doesn't care about that, and so you have to ask yourself how you're going to feel when you have to cancel clinic to piss in a cup in front of someone barely half your age.
I'll say again what so many others have said already - your number one reason for joining has got to be a desire to serve. The quality of your COs, your locations, your training, and your pay (as compared to civilian remuneration) is all going to vary so much that no two people will have the same experience. You cannot rely on those things to break your way. As we say, hope is not a method. I believe that you need to have a well-developed deontologic ethic to serve. If you don't, then there's a good chance you're going to be upset and angry about how you've been treated unfairly, because, invariably, you will be shat upon. I can't always say that I always practiced that, but I think I did it enough that it never affected patient care, and I came away psychologically unscathed. And that's good enough for me.
I have a tremendous amount of respect for everyone who wears the uniform honorably. I realize we're not trigger pullers, and I would never put myself on the same level as the guys sleeping in the muck. But it's also true that even us medical corps REMFs have given more than the overwhelming majority of our countrymen, and all of you deserve credit for that, so thank you for your service. If you've found a happy place and decided to stay in, good for you. Keep fighting the good fight, and do as little as possible to perpetuate the broken parts while hopefully fixing a few things too. For those of you, like me, who need a clean break, realize that really is light you’re seeing at the end of the tunnel and, at least for me, the grass really is greener on this side.
Thanks for reading. Out.
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