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Uniting Critics with Applauders of Military Medicine

Discussion in 'Military Medicine' started by navdoc47, Apr 28, 2007.

  1. navdoc47

    navdoc47 10+ Year Member

    Sep 17, 2006
    Whether you're a critic of military medicine or a cheerleader of military medicine, I think one common idea we should all share is the following:

    Discourage people from entering military medicine or staying in military medicine (if they want the positives, they can ask their recruiter, though even that's risky since non-physician recruiters sometimes inadvertently give out the wrong info for the simple reason that they never worked as a military physician).

    Here's why:

    Military pay bonuses for physicians is based purely on supply and demand. It has absolutely nothing to do with who deserves what. So from a strictly financial point of view, everyone in military medicine benefits from having fewer people entering as well as fewer people staying beyond their commitment. The greater the exodus, the greater the potential for pay bonuses for those who remain. This is true for any military community: bonuses for docs, pilots, ship drivers, intel, specwar, etc.

    So if you're a cheerleader of medicine, just remember that you stand to financially benefit from the exodus of physicians :laugh:
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  3. BigNavyPedsGuy

    BigNavyPedsGuy Junior Member 10+ Year Member

    Apr 11, 2006
    Even better - that will make those of us that are still in the military have to do all of the GMOs and operational billets even after we're residency trained. More experience=more medals. More medals=more free drinks at weddings (see Wedding Crashers)
  4. i want out

    i want out Member 10+ Year Member

    Jul 12, 2006
    unfortunately your not accounting for the Lag time.

    The military doesn't plan ahead well, they tend to wait for the crisis to arise before responding to it.

    What this means for the supply/demand you make reference to, is that when the supply of new meat (HPSP) from 05 and 06 classes doesn't show up to go to GMO tours in 2010 and 2011 then they will have to put someone in those spots.
    That Demand for GMO's will force some folks into billets they really don't want, and when it gets bad enough that all those folks are seperating, they will be looking for a low cost way to meet the demand.

    Low cost means not paying more, but demanding more from the active duty folks that can't say no because they go to jail if they do for failure to obey a lawful order.

    then the feedback from those folks who are being called back from IRR and hitting the stop loss at the end of their time will make the HPSP pipeline dry up almost completely.

    Then and only then will the talking heads decide that maybe they need to spend a little more money to make Milmed work.

    So, you could potentially spend an entire career in the downhill slide that is milmed and never see the reward.

    The bad part, is that the folks who do HPSP starting now, are at the greatest risk.

    Just for fun lets look at a possible timeline:

    2008, matriculate to med school, and take HPSP;

    2013 come on active duty and go to your 2 yr GMO tour

    2015 come back and apply to a failing milmed residency system and be denied
    because they need GMO's more than residents.

    2017 you should be able to go home since you have done your four, but wait,
    theres more. RAD is denied due to shortage of milmed physicians.
    They will let you do a residency now because you have some seniority
    but you can't get the residency you want because its filled by folks who
    have done 3 GMO tours.

    2019 you come back from your 3rd GMO tour, and now you have enough
    seniority to get into that FP residency.

    2021 you graduate from FP residency with 2 more years of obligation

    2023 your 2 yrs into a utilization tour, and payback is complete for your FP
    residency, but now you have 10 yrs on active duty, and since you did
    such a high need specialty, they stop loss you indefinitely while you
    watch your peers that did less critical specialties go home.

    2026 now you have 13 years of creditable service towards retirement, and
    since your divorced from the back to back deployments, why not make
    it 20. after all, who is going to license an alcoholic FP that doesn't
    know anything about how to practice in a litiginous society?

    somewhere in the middle of all of that, when your posting on SDN, you will notice that there aren't any more med students that ask about HPSP, and when you post asking if anybody wants to talk about it, you will get venom filled posts about why you can't do your job well enough to keep them from bringing back the 'Doctor draft'.

    and when they do bring back the 'Doctor draft' some bean counter will realize they could save lots of money by eliminating any special pay for physicians, since they can't leave anyway, why waste money trying to make them happy? And he will get his award, and live miserably ever after always wondering why the doctor that he goes to for his annual physical is especially rough with the rectal exam.

    i want out
  5. Trajan

    Trajan Senior Member 10+ Year Member

    Jun 2, 2002
    Mon Dieu!
  6. USAFdoc

    USAFdoc exUSAFdoc 5+ Year Member

    May 21, 2005

    while some truth in your assessment, the "spirit" of your argument sickens me (although your logic seems in line with the current thinking of milmed's all about the money)

    I feel that I can speak for many of the milmed and exmilmed physicians on this site, when I say that our most pressing concerns are not about the amount of our bonus checks. You can increase the bonus checks and that does not guarantee any aspect of the broken milmed system gets fixed.:thumbdown:

    and "I want out's" critique above is awesome:laugh:
  7. FizbanZymogen

    FizbanZymogen Guitar Hero Champion 5+ Year Member

    Nov 1, 2005
    here's another problem with the OP's thoughts. The Military will bleed docs and simply contract civ. docs to meet their needs because the funding used to pay these contracted docs comes from a different source, so even though they are paying these docs more (and it would make more sense to pay the active duty docs a little more to keep them rather than pay more for a contracted civ. doc) the military doesn't care becuase in their minds the money is coming from a different budget. Ahhhh good old military politics.
  8. monkeybaronjr

    monkeybaronjr New Member 2+ Year Member

    May 18, 2006

    This is the saddest and scariest thing I have read yet. All I can do is go all out on my ADTs and hope I don't get screwed in next year's match. :scared:
  9. Ex-44E3A

    Ex-44E3A 7+ Year Member

    Oct 30, 2006
    SE US

    Oh hell yes... that point bears repeating. Whenever the military has a chance to tap somebody else's budget ("it's coming from a different pot of money"), they'll do it. Don't fix the problem, just rob somebody else's budget to compensate... that's the ticket.

    Ever wonder why turf wars happen? Ten percent is ego, the rest is money.
  10. BigNavyPedsGuy

    BigNavyPedsGuy Junior Member 10+ Year Member

    Apr 11, 2006

    Peds spots were significantly cut 2-3 years ago, but they actually increased last year. The reason: they're hoping pediatricians can fill some of utilization tour void when they finish their residency. That will coincide with the HPSP shortfall.

    If you're a med student, there's really not much point in staying up nights stressing about it. It won't change anything. Also my ADTs were very positive experiences and I had terrible expectations after being on this site.
  11. DCM

    DCM Member 7+ Year Member

    Dec 9, 2004
    Poulsbo WA
    Peds was cut because it was seen as "not military relevant". Turns out there is a huge demand for them in Iraq/Afghanistan (unfortunately) because of the # of civilian children over there who are caught up in the war. 25% of inpatients in theatre we were told at a peds meeting last year. So now the numbers are coming back up.
  12. Ex-44E3A

    Ex-44E3A 7+ Year Member

    Oct 30, 2006
    SE US
    Yep. There's not a US soldier of any age or sex who can walk past a wounded/injured child and not pick him up in an effort to help him.

    Note: I'm not saying that's bad... quite the opposite. It's part of who we are... and it's one of the things that differentiates us from some of the people we're fighting.
  13. BigNavyPedsGuy

    BigNavyPedsGuy Junior Member 10+ Year Member

    Apr 11, 2006
    While it's a terrible stat, that sounds better to me than us just filling up a GMO deficit. That's terrible/remarkable 25%! I'd gladly help kids who need it.
  14. DCM

    DCM Member 7+ Year Member

    Dec 9, 2004
    Poulsbo WA
    Yeah, probably a very rewarding way to deploy. We've had some great presentations from the returning peds guys: a lot of the usual theatre medicine(which is interesting) but then a lot of personal experiences helping in the community. There was one story recently where the doctor got a young girl funded by a charity for an operation that could only be done in one of the US academic centers.

    To try to loosely relate this to the OP: it seems the military values good GME in all specialties either because of military demand or because it is too expensive to contract out. I don't know about other branches but if you take a look at navy GME, there is a good selection. Exception is neuro, neurosurg, and radonc are very limited. Same for army except without the exceptions. My impression of air force is that you can do anything you want as long as it is primary care.
  15. BigNavyPedsGuy

    BigNavyPedsGuy Junior Member 10+ Year Member

    Apr 11, 2006
    Talk with my AF classmate:

    Me: so where are you going to do Peds?
    Her: Keesler
    Me: Oh . . . . good for you
    Her: No I'm pissed
    Me: Oh
  16. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD Physician Partner Organization 10+ Year Member

    Nov 18, 2002
    SDN Partner
    Funny how different people want different things. The last place in the country (with the possible exception of NYC) I'd want to live is in D.C. "right on the metro line."

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