TSG and Brigade Surgeon assignments

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
A

armyvascsurg

Full Member
7+ Year Member
Joined
Feb 14, 2016
Messages
12
Reaction score
10
Members do not see this ad.
My hospital just had a briefing and open forum question session with the new TSG, LTG West. She's very well spoken and seems overall very knowledgeable, but I was dumbfounded with one of her responses. One of our cardiologists asked if the policy of putting subspecialists, especially procedural subspecialists into brigade surgeon spots was going to continue. She initially answered with a reassurance that every physician, regardless of specialty, would be eligible to compete for these career-enhancing positions! He re-phrased the question, suggesting that there may be an involuntary component in some cases. She seemed genuinely surprised that this would be the case! Maybe she hasn’t had a chance to talk with her specialty consultants yet. Our hospital commander jumped up and helpfully added that while some of these specialists went "kicking and screaming", that without exception, upon return they proclaimed that it was the best experience of their careers. Hmm.
 
armyvascsurg said:
My hospital just had a briefing and open forum question session with the new TSG, LTG West. She's very well spoken and seems overall very knowledgeable, but I was dumbfounded with one of her responses. One of our cardiologists asked if the policy of putting subspecialists, especially procedural subspecialists into brigade surgeon spots was going to continue. She initially answered with a reassurance that every physician, regardless of specialty, would be eligible to compete for these career-enhancing positions! He re-phrased the question, suggesting that there may be an involuntary component in some cases. She seemed genuinely surprised that this would be the case! Maybe she hasn’t had a chance to talk with her specialty consultants yet. Our hospital commander jumped up and helpfully added that while some of these specialists went "kicking and screaming", that without exception, upon return they proclaimed that it was the best experience of their careers. Hmm.
Click to expand...

Do you expect them to say anything differently? These guys have done their tours and will never have to do them again. There's no point to rock the boat from their perspectives. I would be hooahing it too if I'm in their positions.
 
I was surprised that TSG didn't know about the issue (and I do think she was being sincere). I certainly wasn't surprised at the hospital commander's propaganda. Going into my tenth year of hooah propaganda spanning 5 hospital commanders here.
 
armyvascsurg said:
I was surprised that TSG didn't know about the issue (and I do think she was being sincere). I certainly wasn't surprised at the hospital commander's propaganda. Going into my tenth year of hooah propaganda spanning 5 hospital commanders here.
Click to expand...

I ASSURE you that she is being less than forthright, to put it kindly. I personally experienced this deception at the highest level a little over 6 years ago. Yes, this BS has been going on for at least 6 years. My consultant feigned ignorance stating that it was a directive from MEDCOM HRC via the OTSG.

Why anyone would want to remain part of an organization whose leadership blatantly lies to his/her face is beyond me.
 
Especially when the lie is entirely unnecessary. That's the part that always gets me. If you want to withhold sensitive information from me, for example, and doing so helps opsec, then I get it and I'm cool with it. But so often there are lies and misdirection perpetrated with no reason, or at least none that I can perceive. I agree that she's not being forthwith. Break down the possible reasons:

1. She feels like everyone who is picked either eventually sees the light or feels that it was a great opportunity in the end.
- that's clearly BS. I can provide names and phone numbers for people who don't fit that bill and who are leaving the Army because of it. Most of us can. So either she's totally disconnected or she's living in a fantasy world. Both are bad. She might feel this way because she has no idea what's happening with her docs, or because people (consultants) aren't letting her know. Neither option is reasonable.

2. She feels like by pretending this doesn't exist, she'll make us feel more secure.
- that's terrifying. It's the slaughterhouse mentality - keep the cattle calm. It also means she doesn't see the problem, which is even more worrisome in terms of resource management.

3. She for some reason doesn't feel like we need to know this information.
- can't think as to why that is. Maybe she might feel like it's too infrequent to discuss? But clearly not since it was brought up in open forum.

I would actually feel much, much better about the situation is TSG would stand up and say "yep. It's happening. Tough $#it." At least that's transparent. I'd rather we not do it at all, but I hate the games more.

I suppose there's always the remote chance she doesn't know. Which means she's utterly disconnected with what's happening in MEDCOM. That should scare everyone as well. Because from this point on she will never learn any more about what's happening under her nose. The Emperor is wearing her new clothes now, and the yes men are raving.
 
I like High Priest's 'tough s$#!' transparency, and I only wish we could get that from all levels of command above us. I do think that is what is coming from some of the O-6's at HRC and some consultants. If leadership would stand up and say these are the 'overstrength' specialties who will be filling BS slots over the next few years, that would really help. This also may actually encourage 1 or 2 to volunteer, especially if planning to stay in long enough to make O-6.
 
armyvascsurg said:
My hospital just had a briefing and open forum question session with the new TSG, LTG West. She's very well spoken and seems overall very knowledgeable, but I was dumbfounded with one of her responses. One of our cardiologists asked if the policy of putting subspecialists, especially procedural subspecialists into brigade surgeon spots was going to continue. She initially answered with a reassurance that every physician, regardless of specialty, would be eligible to compete for these career-enhancing positions! He re-phrased the question, suggesting that there may be an involuntary component in some cases. She seemed genuinely surprised that this would be the case! Maybe she hasn’t had a chance to talk with her specialty consultants yet. Our hospital commander jumped up and helpfully added that while some of these specialists went "kicking and screaming", that without exception, upon return they proclaimed that it was the best experience of their careers. Hmm.
Click to expand...

Anyone who has a long commitments needs to realize that this is the new reality. Making rank above 04 is going to get more and more difficult. CCC and ILE are a must for 05. Five years ago people were making 06 who'd never done CCC/ILE in the medical corp but that was the old guard. The emphasis now is on completing requite professional military and doing an operational assignment for career advancement. For those who will get out after their obligation, the military will get their pound of flesh and cannot be bothered to try to assuage or convince people to stay. Due to the high costs of medical education there will be a perpetual crop of people signing up for monetary benefits. Most don't realize the nuances once they get in.

The second in command at HRC gave a talk at my MTF several years ago and said the same thing but more bluntly when asked about brigade surgeon assignments. The person stated that operational assignment would be looked at very favorably and even necessary if one is going to make a career in the military. It was the paradigm shift the military was moving towards. The person stated that the military was close to getting rid of GME in the late 90s because they could just farm out CONUS/OCONUS care to the civilian sector however they realized they'd need active duty physicians to deploy.

If one owes 3-5 years for payback, there's a decent chance they'd never get tasked for the brigade or any other operational assignments as well as bother to do CCC or ILE. However, if one owes more than 5 years the chances incrementally starts to increase every year of being tasked for an operational tour. They'd need CCC to get to 04. They'd need ILE to get picked up for 05 on first pass.
 
This is another thread that should be stickied, because this is yet another hidden gem of military medicine that no one tells you about when you are a pre-med. The reality of the situation is that if you intend to stay in the military for longer than your 4 year payback you are likely going to be placed in a non-clinical position for X number of years. Instead of refining the skills you have picked up over years of hard work, your knowledge will atrophy in the cauldron of powerpoints, C&S, and PRB. Heck, you can end up in a FS/battalion surgeon spot even if you finish residency and become board certified.

On the other hand, if you like administrative medicine, I think the military has a number of conferences you can attend as the key note speaker for how great BDE tours are. You can lecture to a disbelieving and repulsed audience of docs who have ETS counters on their phones (860 days for me).
 
ILE for O-5? What's next? War College and Division Surgeon to become O-6 in medical corp? Going through a long years of education and training to become a doctor seem more like handicap in the promotional board these days. My well trained colleagues are leaving after getting passsed over for O-5 which leave more work for me. Advice for incoming interns: Time to do family medicine/psych residency, forget fellowship or long residency and spend more time doing operational assignments if you have to stay in for 20 years (prior service with USUHS etc)
 
Lee said:
Not sure what the best answer is for Army Docs that want to make it a 20+ year career (other than being okay with LTC as a terminal rank) but, AMEDD is very clearly making Army education, operational assignments, and commands a requirement to get to O6.
Click to expand...

The Navy is doing the same.

My specialty leader is excellent and very open. Some months ago, when we were discussing my fellowship application to the GMESB, I was very explicitly told that if I pursued fellowship training at this time (I'm a junior O5) that the post-fellowship pgg would be expected to function in that subspecialty at one of the Navy's 3 med centers, and that opportunities to do operational medicine tours or take significant promotion-enhancing collaterals would be nearly non-existent. And that I should go in, eyes open, understanding that O6 is almost assuredly not going to happen. Because the Navy was going to spend a bunch of money to train me, and if I was going to take one of the few Navy-wide billets in this subspecialty, that it wouldn't be right to overburden the other subspecialists with my clinical load while I was off enhancing my fitreps by not doing that clinical work.

I have to say, it was refreshing to hear that kind of sanity, clearly and honestly expressed.

So I accept that the military is recalibrating itself from the "everyone who stays in and stays out of trouble makes O6" world of ye olden days, to a "the only people we'll promote to O6 are the ones who take on major non-clinical leadership positions" and part of me even agrees with that approach.

I'm OK with the (effective) rank limit imposed by my decision to stay on the clinical track. I expect to retire an O5.

I know a handful of O5s in my specialty who are a few years ahead of me, who have been passed over for O6. They're a lot less mellow about an O5 retirement than I am, and I have to believe a lot of that stems from the continuous smokescreen they breathed as they worked overtime on collateral duties that people assured them would help them make it to O6. And then the P and MP fitreps showed up - while the EPs went to people who'd taken on the big (nonclinical) leadership positions - and the illusion was revealed.

Pure clinicians don't get promoted to O6 any more.
 
Hurrah for DoD's continuing disinterest in fostering long term relationships with dedicated providers.
 
I don't have any problem with the concept that O6 is a leadership rank. In some ways it is a positive (fewer untouchable ROAD O6s). The problem is that the secondary consequence is to dramatically reduce the pension of most already underpaid career physicians. I wouldn't care about the rank but the lost income resulting from this new strategy is unfair.
 
O6 vs O5 retirement isn't a huge pay change for many (most?) of us. Here's why -

Terminal O5s retire the instant they hit 20 years. O6s generally can't, because they typically put on O6 around year 18 or 19. To get the high-3 O6 pay in retirement, they end up having to stay on active duty until 21 or 22 years.

The lifetime difference between
1) O6 @22 ret pay, and
2) O5 @20 ret pay + 2 more years of PP pay
is probably a wash for most mid+ pay specialties.

Financially speaking, in most cases, outside of lower paying specialties, every year one remains on active duty beyond retirement eligibility is a loss, regardless of rank. And those who get to O6 usually have to stay past 20.
 
Thats an interesting point. It looks to me like the difference in retirement pay is ˜$800/month. That is worth around $200k in the bank. Most people aren't going to save that but the overall difference isn't as big as I thought.

The other thing worth pointing out in this thread is that its not making O6 that requires a big shift to being an administrator. At least in the Navy recently, that has been required for CDR.
 
That is a good point in regards to the pay difference. That being said, there is some principle to this. We've decided that MEDCOM needs to be within the mold of the service standard (in my case the Army), but that mold is not built to be conducive to medical care. There is -some-difference in regards to pay, and it is true that I see my rank as little more than a paycheck. I can think of perhaps twice that I've invoked my rank for any reason, and both of those were to try to facilitate patient care in an unreasonable situation. However, while admittedly infrequent there are people out there (and I cannot be the only one who has run into them) who use their rank regularly to get what they want. In my opinion that has no place in medicine. So far as I'm concerned, rank ought to be disregarded outside of the hospital command structure. However, if I were going to commit 20 years to the military with the understanding that nothing will ever change, I would want the light at the end of the tunnel of carrying enough rank to not have to bend to the will of every nurnel or former-admin-now-bad-doctor wandering the halls. If the only way to do that is to become one of those guys, that's a bad deal. The current trend is akin to joining a practice in which you know that you'll always be the junior member. you're not starving, but it still sucks.

I guess, more than anything, it leaves a bad taste in my mouth that you could potentially spend 20 years in the medical corps and when someone asks you "why didn't you make O-6?" your answer is that you didn't want to compromise your principles. If that doesn't seem screwy, it should. I'm not saying that going admin is bad, but if you feel like you benefit your country best as a clinician, then being forced into an op slot is kind of a hit.

of course, I also understand that lots of line officers never make O-6, and that this is all looking through the rose-colored glasses of MEDCOM in which O-6 for the longest time was guaranteed. So its a mixed bag.

Moot point for me, though.
 
I think what rankles most for a lot of the clinical O5 cohort who are now finding O6 out of reach, is that there are still a bunch of clinical O6s around who made that rank simply by being good clinicians.

It's easier to accept that the goalposts are beyond kicking range than it is to watch the goalposts get moved back 20 yards after the six people in line ahead of you had their kick.

But hey, the world changes. And O5 @20 has at least one advantage over O6 @22, so it's not all bad.
 
idq1i said:
What is this obsession that people have with O-6? Is it a fetish? A sense of moral indignation over changes in promotion requirements? The $?
Click to expand...
It's some left over monkey $#!T mostly. Everyone has the innate need to climb to the highest branch.
 
idq1i said:
What is this obsession that people have with O-6? Is it a fetish? A sense of moral indignation over changes in promotion requirements? The $?
Click to expand...
Physicians are high achievers by nature, accustomed to success. All our lives and typically without exception, we've hit one goal / milestone after another, on time, every time, because of our academic and clinical excellence.

The notion of an O5 ceiling that can't be cracked with that academic and clinical excellence is upsetting.

The issue and the problem is real, and it's not just monkey-brain highest branch fetish. The pay difference, as I noted above, is really not significant. Actually, from a strict dollar value perspective, money now is worth more than money later, so the O5 @20 retiree who gets two years of retirement pay plus private practice pay before the O6 @22 retiree gets out and starts collecting either, may actually come out ahead.

But we're the Medical Corps, not the Medical Service Corps. Clinical performance should be the primary driver of promotions. Instead, we use line officer criteria to promote doctors.

The moral indignation isn't there merely because it's harder to make O6. It's there because it's only harder to make O6 if you're a doctor who practices medicine. The doctors who essentially quit the practice of medicine to work the admin / executive medicine track are still getting promoted. The doctors seeing patients aren't. Worse, the admin track physicians still typically occupy billets with associated patient loads that then have to be picked up by clinical physicians, who aren't getting promoted.

How can that not rile some moral indignation in you?
 
pgg said:
....Clinical performance should be the primary driver of promotions. >>>>>>Instead, we use line officer criteria to promote doctors.<<<<<<
....
How can that not rile some moral indignation in you?
Click to expand...

Not really, because I always understood the first quote. It's more scorn, derision and contempt for me, not indignation. The system is irreparably broken, and it was never designed with the medical corps in mind. The monkeys that managed to climb all the way to the top of the flag pole have no idea that there is a problem, and things will never change. The moment any MD climbs into the GO ranks, they instantaneously forget what it means to be a physician

I've done the absolute best that I could to protect my patients from the system, I got what I needed from the milmed (debt-free education) and I am getting out. I don't understand why any good physician would continue to battle the system to become an O-6, just so that they could be forced to stop being a physician.
 
Last edited:
pgg said:
How can that not rile some moral indignation in you?
Click to expand...
It does, in the sense that I have a problem with the principle of the thing. If the question is: should clinicians be judged on their clinical skills? Yes - clearly. MEDCOM disagrees, but I think it's a no brainer.

However, as rank means nothing to be clinically, and if the pay isn't significantly better, then I can't see any reason to shoot for O-6 other than that it's a milestone - as you put it. Which to me is just a higher branch. Monkey stuff. In that same way, I can see how if I were to stay in the military I might be interested in an O-6 promotion at some point, but for no other reason than to say I did it. To be frank, most of the O-6 clinicians that I've met are in that boat - they shot for that promotion just because the timing was right and they wanted to say they had done it. If you're interested in an operational command, then it means more than that to be sure, but then this discussion isn't relevant.

So I suppose my point is: I agree it's a kick in the nuts that they're making one leave clinical practice to get to O-6. I think it promotes good clinicians leaving, and it leaves less-good clinicians behind. I won't touch on whether that has always been an issue for MEDCOM anyway. But the motivation for getting to O-6 is either for the power (which isn't relevant clinically - or shouldn't be) or because of the pay (which we've established isn't a reason) or just because it's there.
 
Last edited:
pgg said:
I think what rankles most for a lot of the clinical O5 cohort who are now finding O6 out of reach, is that there are still a bunch of clinical O6s around who made that rank simply by being good clinicians.

It's easier to accept that the goalposts are beyond kicking range than it is to watch the goalposts get moved back 20 yards after the six people in line ahead of you had their kick.

But hey, the world changes. And O5 @20 has at least one advantage over O6 @22, so it's not all bad.
Click to expand...

pgg is spot on. I won't reiterate the obvious pay differences between military and civilian physicians (especially surgical subspecialists) but the retirement on the outside is not bad. I was able to reach the IRS max of 53K for highly-compensated employees in my 401K this past year, of which only 18K was my own pre-tax dollars.

Not as good as a 50K/year pension, but I also didn't have to serve 20 years to get it and I tripled my pay second year out.
 
Mace1370 said:
Won't all this be a moot point when we go to war in another 5-10 years and they have to promote and recruit as they used to?
Click to expand...

You hit one important thing. This whole monkey climbing thing, making O-6 virtually impossible for a pure clinician, is due to the whole supply and demand aspect. There're too many physicians enduring these bs from the military. If more physicians start getting out after their HPSP obligations, there wouldn't be too much supply allowing the military to push these measures on military physicians. I personally think that the new retirement plan and the next war will drain the military of any physician supply that's currently in the pipeline. Being stuck in theater for 15 months will open some eyes when we have the next war in 5-8 years.
 
68PGunner said:
You hit one important thing. This whole monkey climbing thing, making O-6 virtually impossible for a pure clinician, is due to the whole supply and demand aspect. There're too many physicians enduring these bs from the military. If more physicians start getting out after their HPSP obligations, there wouldn't be too much supply allowing the military to push these measures on military physicians. I personally think that the new retirement plan and the next war will drain the military of any physician supply that's currently in the pipeline. Being stuck in theater for 15 months will open some eyes when we have the next war in 5-8 years.
Click to expand...

The military does not care if most leave after their obligations, they'll get their pound of flesh during one's payback. I am transitioning out in a few months after my obligation and trust me there's been zero effort (outside of my immediate supervisors who are more worried about being able to fill my spot) from HRC to convince or implore me to stay in. As it is now the vast majority of physicians leave before the 20 year retirement eligibility. This statistic is even more pronounced in any specialty outside of primary care (IM/FP/Peds) with high remuneration on the outside. I owed a 3 year obligation from HPSP but my payback was 5 after sub-specialization. Most who specialize will owe additional time on top of their payback. During that time I've deployed and I've been worked hard (10+ hours/day) at one of my MTFs. For the work I put in there was no added incentive bonus or perks, it was just an expectation with a standard issued ARCOM on my PCS. So in my mind the military has gotten their worth out of me during my payback. There will always be people signing up for HPSP due to the escalating costs of medical education. Most will payback 3-7 years after training and get out.

The military would be more than happy if the minority of physicians who decide to make it a career as clinicians only achieve a terminal rank of 05. The even fewer who make 06 will be those who are happy or better suited for administrative military tasks and operational assignments. Most of these probably aren't the best clinically or have lost interest in clinical medicine. There will be less senior clinicians. From big military standpoint it's no problems because overhead costs are down with less 06 physicians doing little clinical work. However it will hurt GME. My wife was also military but is now out. In her specialty hardly anyone makes a career due to pay discrepancy vs outside. When she was training most of her clinical instructors (program directors etc) were 04 or junior 05s (on their way out the door).
 
68PGunner said:
If more physicians start getting out after their HPSP obligations, there wouldn't be too much supply allowing the military to push these measures on military physicians.
Click to expand...
But isn't the number given here on SDN as 90% leave after their ADSO is fulfilled? If that is true, "more" doesn't seem to mean as much.
 
Apollyon said:
But isn't the number given here on SDN as 90% leave after their ADSO is fulfilled? If that is true, "more" doesn't seem to mean as much.
Click to expand...

I think the number given on sdn is a little screwed on the negative side. After having talked to a few docs at a major MTF, there's a good portion of O5 and O6 who are very comfortable at their current positions.
 
The pipeline is so large that it doesn't take many to stick around for that to seem true. Also, many of the ones that stick either couldn't function in the real world, had an obligation that took them too close to quit or were prior service. You will see far more of these people in the major MTFs.

One reason I think the O6 thing stings is that, when we were coming up, you had to be pretty bad to be a terminal O5. They were generally not good doctors. I think the next generation will view it as a badge of honor and not trust the O6s.
 
68PGunner said:
I think the number given on sdn is a little screwed on the negative side. After having talked to a few docs at a major MTF, there's a good portion of O5 and O6 who are very comfortable at their current positions.
Click to expand...
And that group of people is even more biased than SDN.
 
HighPriest said:
I suppose there's always the remote chance she doesn't know. Which means she's utterly disconnected with what's happening in MEDCOM. That should scare everyone as well.
Click to expand...
I actually think this is the likely case. I'm no longer surprised by the ignorance of the ground truth on the part of Medical Corps 'leadership.' And yes, it should scare everyone.
 
Gastrapathy said:
I think the next generation will view it as a badge of honor and not trust the O6s.
Click to expand...

Oh its already started in this generation. To a large degree the clinically excellent O6 physicians have already retired and moved on to the civilian world since they were interested in doing clinical medicine and not admin. The O6s who are left (with exceptions) are hiding out until 30 cause they'd get eaten alive in an "eat what you kill" civilian practice. There are certainly exceptions, but a large percentage of the O6 MC officers are already viewed as shiftless, clinical nincompoops.

I knew a junior staff colleague who used to refer to the "double eagle sign": whenever she was reviewing a case for tumor board, if the 2 names on the report were O6s, the diagnosis would invariably be wrong.

A couple years ago I was in my office at about 1900 with another junior staff going over a difficult case. One of the brand new attendings who had been deferred to the civilian world for training wandered into the office with a perplexed look on his face. He had sought out one of the shiftless O6s for advice on a case and he had received an answer that didn't seem right to him. We looked at the case and assured him that the O6 was indeed wrong and that his original inclination (on this rather quotidian case) was the correct one. The brand new attending then asked how such an "experienced physician" could boot such a simple diagnosis. We laughed and told him that the terminal O5 down the hall was the true "experienced physician" in the department, and about the only thing that particular O6 could be counted on for was walking out of the department at 1500 after his meetings were done for the day.
 
You must log in or register to reply here.

Similar threads

C
Too old to be a Navy Flight Surgeon?
Replies
8
Views
673
pgg
pgg
K
AF Flight Surgeon Assignment
Replies
1
Views
2K
Caninehalitosis
Caninehalitosis
T
GMO and out advice - not straightforward
Replies
6
Views
523
pawprint
P
Konigstiger
How difficult is Navy flight surgeon training and what is the training like?
Replies
2
Views
4K
pawprint
P
SirGecko
Moonlighting and taxes
Replies
3
Views
2K
Gonio5
G
Top