US News articles on MHS

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The quote from Col. Hiles is telling. Not a single Army General Surgeon is willing to recruit. Kinda similar to a post from a few days ago...

Skill atrophy isn’t just a GS phenomenon. That may be the current focus but it’s a problem for any specialist and even primary physician.
 
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Haven’t posted in a long time and came across this yet again another article revealing the extreme shortcomings of general surgeon training, skill retention, etc....
Nothing new here. There have been at least 3 large exposes including a Pulitzer price winning report that came out of Dayton OH.

The redoing is always similar.... now that there’s been a revelation and it has become public something gotta change...don’t hold your breath.

Military medicine remains broken and will continue to be so. The Why? Multiple well debated points which can be reviewed in the multiple posts and articles that exist in this topic. For a long time I vented my frustrations on this forum often fighting with what I called “cheerleaders” of a broken system.

If you join prepare to be an officer first and a doctor second. When I get home or in the next few days I’ll post a link to the previous damming article.

At some point I learned to stop banging my head. In today’s world if your not Davy enough to go your research....you could end up in a career path that was ways off what you thought, and often ar a detriment.
 
Galo said:
Haven’t posted in a long time and came across this yet again another article revealing the extreme shortcomings of general surgeon training, skill retention, etc....
Nothing new here. There have been at least 3 large exposes including a Pulitzer price winning report that came out of Dayton OH.

The redoing is always similar.... now that there’s been a revelation and it has become public something gotta change...don’t hold your breath.

Military medicine remains broken and will continue to be so. The Why? Multiple well debated points which can be reviewed in the multiple posts and articles that exist in this topic. For a long time I vented my frustrations on this forum often fighting with what I called “cheerleaders” of a broken system.

If you join prepare to be an officer first and a doctor second. When I get home or in the next few days I’ll post a link to the previous damming article.

At some point I learned to stop banging my head. In today’s world if your not Davy enough to go your research....you could end up in a career path that was ways off what you thought, and often ar a detriment.
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Typos from my phone
 
OK...not to keep banging head, but here's the article from 22 years ago. Its lengthy but obviously worthy of a Pulitzer. There was another large expose before that one. I just dont see the need to keep banging my head.

The Pulitzer Prizes

www.pulitzer.org www.pulitzer.org

I read the US news one. What I read from Dr. Nessen, (Col US Army) is similar to the lecture Dr. Payton gave when I was on active duty around 2000. Lack of leadeship, skill degradation, inadequate training, equipment, etc etc etc.

I posted that lecture here on SDN way back. If you are really interested search my posts or contact me.

Unfortunately taking care of our fighting men and women, especially when they are in their direst need, seems to continue to be a grossly poor evvort on the part of the DoD.
 
Everyone realizes that we are people either considering joining MilMed or persons currently in the suck, right? The former can be told how bad you had it or think it is right now. The latter don't need to be told because we are already in it. We need people supportive and providing innovative ideas on actionable tips for today and tomorrow.

We still have a job to do. Politics and high-level decisions get made which make our clinical lives hell, but those of us serving and caring for the warfighter and their families still put patient care first, despite the hurdles the system puts in front of us.

I thought we would be using this place as a resource to tell others about a best practice model or proper management of certain teams. Instead it is just a dropbox for complaining. I spend too much of my actual life working with people to improve systems/processes so when I hear complaining it just bugs the crap out of me.

My request still stands. Split MilMed forum in to PREMED advice (venting/complaining if that is what you are in to) and keep Resident/Physician MilMed forum for actual productivity and collaboration of those serving or previously served with goal of personal or system improvement.
 
militaryPHYS said:
My request still stands. Split MilMed forum in to PREMED advice (venting/complaining if that is what you are in to) and keep Resident/Physician MilMed forum for actual productivity and collaboration of those serving or previously served with goal of personal or system improvement.
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[bolds mine]

I, for one, would recommend your request be denied.

The MilMed forum exists as an area interest, not for the purpose of advising pre-meds (there are board areas for that group already and military topics aren't really relevant at that point in the development of an applicant. Applying to the military comes after getting an acceptance to medical school, USUHS being an exception, somewhat.)

As for the discussion about mil med being limited to "actual productivity and collaboration," that is an unacceptable position. All of the aspects of the military medical practice experience are fair game, not merely those comments that meet your or any other moderator's standard of what is worthwhile or meets your standard for "productivity" or any "goal of personal or system improvement." Sorry, but studentdoctor.net is not an organ or property of the .mil to be used to present a favorable image of military medicine or to be co-opted as a crowdsourced consultancy. If people want to complain about the way the military runs their organization, or about how they are poorly managed or have treated professionals poorly, that shouldn't be prohibited. They get billions of tax dollars. If they are doing a bad job, they deserve criticism.

Once again, I see you have lost necessary objectivity in your role as a moderator.
 
Please tell me why would it matter how MilMed is "presented" if it were a closed area only active or prior MilMed people are allowed access.

The open discussion about MilMed should remain open to everyone. Nothing changes.

Can you imagine a place for collaboration and us actually working together to help those still serving make it through our time serving? Mentorship, ideas, etc. if and when we are stuck somewhere with poor leadership/systems. A place people are excited to stay involved with through the process to learn and grow. Nobody seems to want to do that though. Priority seems to be to fight, bicker and complain about every little thing no matter what topic is brought up...mainly from people who have already moved on.

Responses like yours to a simple proposition for discussion on improvement for those serving is toxic.
 
People respond all of the time with actual, useful information and helpful tips. They’re just mixed in with the complaining and what-not. And admittedly, there’s more complaining, although one could argue there’s a reason for that.
What you’re looking for is distilled information that meets your criteria for “beneficial.” You know, the way China generates its news.
It really can only be helpful if problems with the system are first identified so that meaningful discussion can occur with regards to how to fix things. If you don’t have complaints drawn, there’s no reason to try to improve things.
And one could argue that nothing meaningful will come from a discussion of moderator-approved topics by moderator-approved individuals, especially when it’s so hard to fight the inertia of milmed function even when you’re doing it in person, with like-minded individuals.
 
militaryPHYS said:
Please tell me why would it matter how MilMed is "presented" if it were a closed area only active or prior MilMed people are allowed access.
...

Responses like yours to a simple proposition for discussion on improvement for those serving is toxic.
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Closed area, nice try. Your motives are becoming clearer. Sorry to disappoint you, but the value of SDN very much lies in the openness of the forum. It should stay that way.

In no way are my opinions "toxic" for being in disagreement with yours, but what a convenient way to lose an argument: ad hominem cum Mr. Yuk.

You should not be a moderator here. If you want to start your own closed site with a restricted membership, do that somewhere else.
 
I don't ever visit the pre-med areas of SDN. If we were to split the milmed forum into a premed and med student/resident+ area, I'd probably never visit that pre-med section either. I suspect I'm not in a minority here. As a consequence, I'm not convinced a new pre-milmed forum would be much value to inquiring pre-meds.

In general, excessive splintering of online forums into more and more specific subforums tends to harm participation and dilute conversations.

I don't think criticism is bad or inappropriate. Like @militaryPHYS I do get frustrated that the criticism so often comes with only one "constructive" element ... typically to burn it down, let it die, close it all.


We have a "closed" subforum in the anesthesia area. I think it's pushing 10 years old now, give or take. Only people who are verified members of the American Society of Anesthesiologists are granted access to view and post in the forum. It's a mixed success.
  • On the pro side, it's nice to have a vetted community of anesthesiologists, anesthesiology residents, and the rare medical student who's already joined the ASA.
  • There's a significant administrative burden in doing the verifying and access granting, which sometimes seems pointless because a very small percentage of registrants actually post in there. It's mostly the same people who post on the main forum.
  • I generally don't like to see clinically relevant things posted in there instead of the main forum, because it limits participation and input.
  • A big part of the reason it was set up was to deliberately exclude CRNAs. We have a long history of obnoxious toxic nurse trolls thread****ting in the main forum. While I and the other mods there have a very short fuse to ban their accounts, it is nice to have an area where we know they aren't even reading our conversations.
  • While one purpose is exclude nurses, there's no intent to exclude any physicians or particular line of (reasonably on-topic) conversation, or to promote an atmosphere or attitude. These kinds of efforts are herculean tasks for moderators and inevitably harm the forum.
The SDN forums do have an overarching purpose, and it's spelled out in the mission statement, printed in bold on the About page: we help students become doctors. The specialty-specific subforums that are mostly frequented by residents and attendings are still part of that, and I don't favor any organizational changes that aims to redirect pre-meds and med students away from them. They need to see where they're going (subspecialty forums), at least as much as they need to see where they are (pre-med forums) and how to get there (med student forums).

Our community explicitly includes people in medical, dental, optometry, podiatry, pharmacy, and veterinary fields. While I have a short fuse to moderate, delete, lock, and ban nurse "contributions" (especially on the anesthesia forum) I almost never favor firmer moderation of participants from these communities.
 
I think your attacks on people have hit new lows here. I never suggested anything “moderator approved” and there is no agenda. You continue to attack me personally for ideas that if brought up by anyone else still active duty and hoping to add value to something might be considered.

You could choose to respond to me in a respectful way with a no but instead choose to take the time to respond with belittling words with intent to shame.
 
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militaryPHYS said:
I think your attacks on people have hit new lows here. I never suggested anything “moderator approved” and there is no agenda. You continue to attack me personally for ideas that if brought up by anyone else still active duty and hoping to add value to something might be considered.

You could choose to respond to me in a respectful way with a no but instead choose to take the time to respond with belittling words with intent to shame.
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[bolds mine]

I am not sure if you were referring to my comments, but I don't see where I used the term you have quoted. And your suggestion that I have made "attacks on people" is plainly false and out of line, for a moderator or anyone else. I have not attacked you; I have disagreed with you. You seem to believe disagreement is an attack. It isn't. You have labelled me as "toxic" which is both untrue and unfair, and not of the character one should expect of a moderator. As for "belittling words" I am unsure what you mean. I have not treated you with disrespect by pointing out that your labeling my comment as toxic, which you did above, is ludicrous and untrue and is an ad hominem fallacy that does nothing to persuade.
 
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pgg said:
I don't ever visit the pre-med areas of SDN. If we were to split the milmed forum into a premed and med student/resident+ area, I'd probably never visit that pre-med section either. I suspect I'm not in a minority here. As a consequence, I'm not convinced a new pre-milmed forum would be much value to inquiring pre-meds.

In general, excessive splintering of online forums into more and more specific subforums tends to harm participation and dilute conversations.

I don't think criticism is bad or inappropriate. Like @militaryPHYS I do get frustrated that the criticism so often comes with only one "constructive" element ... typically to burn it down, let it die, close it all.


We have a "closed" subforum in the anesthesia area. I think it's pushing 10 years old now, give or take. Only people who are verified members of the American Society of Anesthesiologists are granted access to view and post in the forum. It's a mixed success.
  • On the pro side, it's nice to have a vetted community of anesthesiologists, anesthesiology residents, and the rare medical student who's already joined the ASA.
  • There's a significant administrative burden in doing the verifying and access granting, which sometimes seems pointless because a very small percentage of registrants actually post in there. It's mostly the same people who post on the main forum.
  • I generally don't like to see clinically relevant things posted in there instead of the main forum, because it limits participation and input.
  • A big part of the reason it was set up was to deliberately exclude CRNAs. We have a long history of obnoxious toxic nurse trolls thread****ting in the main forum. While I and the other mods there have a very short fuse to ban their accounts, it is nice to have an area where we know they aren't even reading our conversations.
  • While one purpose is exclude nurses, there's no intent to exclude any physicians or particular line of (reasonably on-topic) conversation, or to promote an atmosphere or attitude. These kinds of efforts are herculean tasks for moderators and inevitably harm the forum.
The SDN forums do have an overarching purpose, and it's spelled out in the mission statement, printed in bold on the About page: we help students become doctors. The specialty-specific subforums that are mostly frequented by residents and attendings are still part of that, and I don't favor any organizational changes that aims to redirect pre-meds and med students away from them. They need to see where they're going (subspecialty forums), at least as much as they need to see where they are (pre-med forums) and how to get there (med student forums).

Our community explicitly includes people in medical, dental, optometry, podiatry, pharmacy, and veterinary fields. While I have a short fuse to moderate, delete, lock, and ban nurse "contributions" (especially on the anesthesia forum) I almost never favor firmer moderation of participants from these communities.
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Thanks for the detailed feedback with examples and professional tone which helps continue the discussion in a forward direction.

Of course the primary mission is for helping students become doctors. Hence why I don’t think anything should change from what we currently have.

All I was proposing was an additional place for those of us in the suck to also collaborate. The site has grown beyond just helping premeds and expanded in to a repository of experienced professionals once they complete the process and continue to practice. Therefore there is a huge wealth of knowledge and experience.

Worst case is nobody uses it, which I agree that chances are high.

But you realize that what we have is basically a premed forum mixed with general discussion, right? It’s a resident/physician forum premeds can come dip their toes in until they are chased out and rarely come back even if they join milmed.
 
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Wow,

It's not surprising to see things have not changed much. You have what I like to refer to as "cheerleaders" who are exquisitely abject to any form of criticism of the system, you have really pissed off realists who are appalled that the system is that broken and they can't do anything about it, (me), and you have a few more level headed people that seem to try to function in a persistently dying system where they may have effect in their local area, but not much beyond that.

Although I will say it seems way more civilized than when I posted. I had a "malignant cheerleader" who seemed so out of touch and who's bait I could not resist taking. Our arguments were of the get popcorn and watch type.

No matter who or how its presented, its going to remain a broken system that stems primarily for a total lack of physician leadership. The primary mission of the military is to fight wars, and medicine is way down the list.

One of the biggest services I see this forum as providing is giving prospective members appropriate expectations. When I first looked into it military medicine was a powerhouse. Hospitals with 1000 beds and daily flights where you saw the most rare of cases, well staffed, funded etc. Twelve years passed for my medical school, and surgical training, and by then, the system was a complete shadow of itself. Totally defunded, with major closures of facilities, and more administrators than doctors with hardly any patients. So my expectations were completely shattered. If you explain to prospective doctors what they can expect and they still come into the system, they are much more likely to do what is asked of them without them feeling completely screwed by the system.

Its patently obvious to all of us who've been in, based on experience, but also based on these multiple and hardly believable but true exposes that continue to crop up every few decades that the system of military medicine is badly broken. It's unlikely to ever change. Why would a cheerleader want to hide that? It is a voluntary system, and if you get volunteers under misleading promises, you end up with people who are frustrated, unhappy, and will not do well.

I say let SDN continue to be an educating platform for people to understand what they are getting into. This forum will never enact the change that is needed no matter how many intelligent, obvious and evidentiary arguments are brought forth.

Cheerleaders will not silence people who know they've been done wrong.

Good to see this is a bit more civil.
 
militaryPHYS said:
Everyone realizes that we are people either considering joining MilMed or persons currently in the suck, right? The former can be told how bad you had it or think it is right now. The latter don't need to be told because we are already in it. We need people supportive and providing innovative ideas on actionable tips for today and tomorrow.

We still have a job to do. Politics and high-level decisions get made which make our clinical lives hell, but those of us serving and caring for the warfighter and their families still put patient care first, despite the hurdles the system puts in front of us.

I thought we would be using this place as a resource to tell others about a best practice model or proper management of certain teams. Instead it is just a dropbox for complaining. I spend too much of my actual life working with people to improve systems/processes so when I hear complaining it just bugs the crap out of me.

My request still stands. Split MilMed forum in to PREMED advice (venting/complaining if that is what you are in to) and keep Resident/Physician MilMed forum for actual productivity and collaboration of those serving or previously served with goal of personal or system improvement.
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I appreciate that you're frustrated with the moaning & groaning. I guess the idea is that we can come here and vent, and hopefully someone more senior will have ideas/solutions/insight that will help. I really don't want to have to tip-toe around how I describe how absolutely F***'ed Navy Medicine is right now. The way I read your post made me feel like I'm still walking around as an intern where we're actively discouraged from even talking about the problems/difficulties we face.
 
I agree with Galo - management of expectations is HUGE. Being able to join and then serve during the height of conflicts in a well funded system would have been awesome and was absolutely what I had in mind.

Now I'm on a f***ing barge, struggling to find basic medical supplies, and wondering if I'm even going to be able to get back into GME.
 
It’s pretty amusing that censorship and the creation of an echo-chamber are being proposed again in a thread about national news stories about the MHS.

The internet is a big place. You don’t like it here, make your own forum that you can censor as you see fit
 
I think some on here are ordered by bupers to register here and defend the corps. Makes a good fitrep bullet.
 
I get it. You like what’s been going on for the last 15 years here. Change is hard for some which is why I didn’t even propose change. I just suggested a completely SEPARATE area for us to post actionable tips, online mentoring and the like since we already have a large contingent of MilMed or prior Milmeds. Nobody said anything about censorship or other BS.

The fact that not a single person was supportive of something like that is really telling. Only responses we as a community got was go - yourself. No wonder why some feel like they are floating all alone with no hope.

Good luck out there
 
militaryPHYS said:
I get it. You like what’s been going on for the last 15 years here. Change is hard for some which is why I didn’t even propose change. I just suggested a completely SEPARATE area for us to post actionable tips, online mentoring and the like since we already have a large contingent of MilMed or prior Milmeds. Nobody said anything about censorship or other BS.

The fact that not a single person was supportive of something like that is really telling. Only responses we as a community got was go - yourself. No wonder why some feel like they are floating all alone with no hope.

Good luck out there
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You're in luck. You can start your own Google group and do just that. You can restrict the membership and police the discussion all you want. I belong to several such groups in different interest areas, and they're fine. All you really need is a community of like-minded and interested participants. And it costs you only your time. Or if you don't want to use google groups or Facebook, you can start your own blog and invite commentary.

Until now, you haven't advocated starting a new group elsewhere with the purposes you have advocated. What you have advocated is restricting this particular forum, by first dividing it into a group inappropriately (and irrelevantly) sorted to the pre-med section and another group that is an online gated community where someone, you perhaps, gets to be the policeman. That is not the same thing as inviting a forum for collaborative discussion or professional mentoring (BTW, one-on-one online mentoring could be easily done entirely off a public site), this is nothing more than window-dressing for shutting down a public site that occasionally attracts critical and thoughtful commentary.

The military leaders don't like public criticism or exposure of their waste, ineptitude and bad behaviors. They don't like accountability except when they get to decide who is accountable. They want to be able to control their public image. That is an inherent flaw of authoritarian organizations of all kinds, military and non-military. The funny thing is how often the military services claim to be defenders of freedoms, yet they just can't stand the freedoms of speech and press when the messages don't go their way.
 
militaryPHYS said:
The fact that not a single person was supportive of something like that is really telling.
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I only point this out because it needs it. Usually, when I have an idea that no one else thinks is a good idea, I assume it’s because it’s not a good idea. Not that they’re all jerks. So, it is a little telling, yes.
 
orbitsurgMD said:
What you are recommending is to make it less inclusive and less available because you don't like the negative tone some posters have or how they are critical of military medicine. You apparently want a forum that excludes those persons and those kinds of discussions. That is not what this forum has been about.
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This is also the impression I have had, in more than one forum now, from reading what you have posted. If that is true, then I absolutely agree with it being a bad idea for many of the reasons mentioned above. If it is not true, then please be aware that this is how it is coming across. To a lot of people.
 
HighPriest said:
This is also the impression I have had, in more than one forum now, from reading what you have posted. If that is true, then I absolutely agree with it being a bad idea for many of the reasons mentioned above. If it is not true, then please be aware that this is how it is coming across. To a lot of people.
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I edited that out only because on re-reading, I thought I was repeating the point lower down. I am glad you saved it.
 
It’s obvious that your vision of this separate forum from this and your prior postings would allow you to control the content. So you can characterize my view with profanity all you want but given that your intent is to limit discourse and you are a “moderator”, I’m pretty comfortable calling that censorship
 
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militaryPHYS said:
I get it. You like what’s been going on for the last 15 years here. Change is hard for some which is why I didn’t even propose change. I just suggested a completely SEPARATE area for us to post actionable tips, online mentoring and the like since we already have a large contingent of MilMed or prior Milmeds. Nobody said anything about censorship or other BS.

The fact that not a single person was supportive of something like that is really telling. Only responses we as a community got was go - yourself. No wonder why some feel like they are floating all alone with no hope.

Good luck out there
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Nobody ever implied go f$&@ yourself. Why do you take criticism so personalIy?

I completely disagree with basically everything you have ever posted about military medicine (except that those who don’t like it should get the f$&@ out ASAP) but I’ve never recommended a separate area just to rail on military medicine. If you want to post how military medicine is the best thing since sliced bread, by all means do so. Just don’t expect the majority to agree with you.
 
dwb8p said:
Has anyone else gotten an unsolicited PM from militaryPHYS? I got one back in May with the $&*^ word accusing me of trolling him. Talk about inappropriate.
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Yes, he PM me a few weeks ago telling me to stop “picking” on him. He frequently confuses disagreements with attacks on morale character.
 
That is unfortunate. Accusing other posters of "attacks" and trolling when the facts reveal otherwise is inappropriate forum conduct, particularly from someone who is a moderator. This has the additional and unfortunate appearance of "papering up" an unfounded complaint to ultimately ban posters for nothing more than disagreement or just dislike of their point of view.

Some people should simply not be moderators, it requires a temperament that tolerates contrary opinions without feeling the need to suppress, label as "negative" or "toxic" or do other things that stifle discussion.
 
If anyone feels that any particular post or collection of posts are stifling discussion, hit the report button and an assortment of SDN moderators and administrators who aren't regulars in this forum or otherwise affiliated with milmed can weigh in.

Also, let's keep a little perspective ... no one has been banned, no one is getting banned, nothing has been censored. Moderators aren't required to have neutral opinions; if that was the case I'd have been banned from the anesthesia forum a decade ago.


Welcome back, Galo. Long time no see.
 
There are legitimate issues with military medicine, even not counting the uncertainty of the future. These issues range from organizational and structural to cultural. I constantly struggle with the idea staying in to try and promote high enough to make real difference or just bailing. I am always trying to make it better for the sailors and Marines under my care.

For the right person, you can find a home in milmed. But if you just want “free” med school, then walk on by.
 
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I’m a two year old O4 with no association with the higher ups you all despise. I’m as frustrated with the system as you all are and I’m working my tail off just trying to fix small local problems which is pointless because I will just find them again when I PCS. I have drafted a down and dirty facts of MilMed that summarize the stuff we all rail on regularly, plus other useful information but I can’t publish because it was flagged out of concern for impact on recruitment.

Don’t pretend like you know what my intentions are just because of your own assumptions.

If anyone is getting silenced on this forum it is those of us who happen to enjoy what they are doing despite the BS and want to point out ways other active duty people can increase their odds of such satisfaction. But you know what? It probably won’t help and we will all likely get screwed. Hard. But if one person benefits from it then it’s worth it.

I don’t want premeds reading that kind of stuff because they might see something and assume life in MilMed is better than it really is. We shouldn’t take that risk. Discussion like that is for us and us alone because we understand it because we take it with a grain of salt.

Premeds should continue to see the same stuff we have always talked about which is assume the worst because that is often what you get. But once you are in you really have to fight hard, know people and ideas and hope for the best. Otherwise you get washed away. A closed area for that discussion isn’t censorship it is responsible management of information.

I’m happy to go elsewhere but figured this would be the first place to start since we are all already here.
 
militaryPHYS said:
I’m working my tail off just trying to fix small local problems which is pointless because I will just find them again when I PCS
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It's not pointless. Sometimes it's all you can do, and it sometimes doesn't feel like it's enough, but it's still worth doing. Keep it up.

I think even the angriest and most bitter people here mostly agree that we can always make our local environment at least a little bit better.
 
Gastrapathy said:
The quote from Col. Hiles is telling. Not a single Army General Surgeon is willing to recruit.
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I tried to offer myself in that role once, when I was still on AD, around 2010. All it did was paint a bigger target on my back, and got me accused of "shirking." The ratio of available vs. deployable vs. deployment slots to be filled in GenSurg was almost exactly the same as it is today, as cited in US News article. The chronicity of the problem in Army Surgery makes me very sad for an organization I once truly loved.
 
I really enjoy my job. Love taking care of the people that we do. Havent been screwed with assignments (yet), and have a busy practice. Lucky in that I am not personally dealing with MAP or insane deployment schedule with no cases to do at home station...

Would love to get paid more, cut 80% of the BS training/paperwork/leave requests, be valued for the unique skills I bring as a doc, and to have more control of the people that 'work' for me.

Mixed bag so far, but I had the benefit of listening to many of the senior docs who still post here over the past 12+ years in making my best informed decision. That came equally with reading the posts from cheerleaders, haters, and centrists.

I only visit SDN to read and ...rarely... post on this forum. I think diluting down to sub forums would be a mistake. As long as we have AD and prior service experienced docs who can continue to answer premed questions we should be fine. And allowing premeds insight into the discussions between AD/prior docs allows for an educated buyer if they join or a look behind the curtain to bail before misery for feeling tricked.
 
anbuitachi said:
Pretty crazy they wanted to use obgyn as substitute for trauma surgeon..
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What is stopping them? They use non-residency-trained GMOs in place of what would be residency-trained physicians everywhere else. This is a developing world accommodation, except in most developing countries they at least try to do better: equal parts stupid and shameful, and "leadership" of an unacceptably low quality.
 
I’ve been here since I was a premed, through USUHS, residency, and now into fellowship. This has always been a great resource as is, as long as you know to take what you read with a grain of salt.

I generally fall into the make the best of the situation you’re in and it’s worked out so far. That being said I’ve been protected in GME having done the 2nd longest residency the army has to offer and going straight into fellowship. All that being said I think the quote from Dr Hiles rings particularly true. In retrospect I think the system has been broken for much longer than I’ve realized. I think one of the biggest issues that the army (general) surgical community faces now is the lack of case volume while deployed in the setting of the crushing op-tempo. A decade ago no one minded, or at least didn’t mind as much, being deployed for 4-13 months because they were operating their faces off, basically doing operative trauma fellowships, contributing to the lowest died of wounds rates ever, and felt like they were truly making a difference/had a purpose. Now 4.5-9 month deployments consist of single digit cases that may or may not be trauma related.

Don’t get me wrong, this is absolutely a good thing. It means our people and our allies aren’t getting blown up, shot, mangled, disfigured, or killed. It means there are substantially fewer flag draped caskets being flown back to Dover. But when you spend 6 years (8 by the time it’s all said and done) training to perform a job and then the end state of that looks like a lot of time away from your family sitting on your hands/twiddling your thumbs and then coming home to a low volume practice it really makes you question those decisions.

I love my job, I’ve gotten amazing training, both in residency and at USUHS, but if you asked me now if it all was worth it I’m not sure I could honestly answer “yes,” which is why I’ve avoided doing recruiting events. When civilian residents, medical students, or premeds that rotate with us at my civilian fellowship institution ask about joining the .mil I’m really conflicted about what to say. Generally something along the lines of if you’re ready to potentially sacrifice clinical practice for officership go for it but if being purely clinical is your goal it’s a potential set up for dissatisfaction.
 
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mslall said:
I’ve been here since I was a premed, through USUHS, residency, and now into fellowship. This has always been a great resource as is, as long as you know to take what you read with a grain of salt.

I generally fall into the make the best of the situation you’re in and it’s worked out so far. That being said I’ve been protected in GME having done the 2nd longest residency the army has to offer and going straight into fellowship. All that being said I think the quote from Dr Hiles rings particularly true. In retrospect I think the system has been broken for much longer than I’ve realized. I think one of the biggest issues that the army (general) surgical community faces now is the lack of case volume while deployed in the setting of the crushing op-tempo. A decade ago no one minded, or at least didn’t mind as much, being deployed for 4-13 months because they were operating their faces off, basically doing operative trauma fellowships, contributing to the lowest died of wounds rates ever, and felt like they were truly making a difference/had a purpose. Now 4.5-9 month deployments consist of single digit cases that may or may not be trauma related.

Don’t get me wrong, this is absolutely a good thing. It means our people and our allies aren’t getting blown up, shot, mangled, disfigured, or killed. It means there are substantially fewer flag draped caskets being flown back to Dover. But when you spend 6 years (8 by the time it’s all said and done) training to perform a job and then the end state of that looks like a lot of time away from your family sitting on your hands/twiddling your thumbs and then coming home to a low volume practice it really makes you question those decisions.

I love my job, I’ve gotten amazing training, both in residency and at USUHS, but if you asked me now if it all was worth it I’m not sure I could honestly answer “yes,” which is why I’ve avoided doing recruiting events. When civilian residents, medical students, or premeds that rotate with us at my civilian fellowship institution ask about joining the .mil I’m really conflicted about what to say. Generally something along the lines of if you’re ready to potentially sacrifice clinical practice for officership go for it but if being purely clinical is your goal it’s a potential set up for dissatisfaction.
Click to expand...

Good hearing from you.

I think the point about loving your job yet not recruiting/cheeleading is poignant. People get sent my direction to use me for information but I would never go out "recruiting". I still think that MilMed can be a good choice for the right person but the right person is getting fewer and fewer as we all wonder what the final product will be. That right person will also find their own way in or likely reach out and ask questions. Nobody should be hunting for them. Until we see some changes that reflect improvements all I am willing to provide is information when asked.
 
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