USUHS Infectious Diseases Quality (MD/PhD)

[deleted826437]

Hi all,

I intend to pursue a career as a physician-scientist, potentially in the field of infectious diseases. I was wondering if anyone could offer some perspective on the quality of the USUHS ID program, both MD and PhD.

Thanks!

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[HighPriest]

If you want to do meaningful research, don't do military medicine. It's not that you can't do research in the military, it's just that its not even in the same league as a large civilian program.

 

[militaryPHYS]

Major Walter Reed (RIP) is probably rolling over in his grave!

To the OP: I have no personal knowledge of the best ways to grade/rate a research program. I do know that USUHS has a good lab with great funding, partnerships with NIH across the street, worldwide partnerships across the globe. Most civilian academic institutions have these as well. You definitely don't have to join a military affiliated program to get a good Infectious disease research experience. Military or government association comes with pitfalls you need to understand fully before engaging.

There are tons of e-mail addresses freely visible on Uniformed Services University so my recommendation is to reach out directly to the sources. Same with civilian institutions you are interested in. This is the only way to learn the information you seek personally. SDN is a very select group of people who will offer their opinions, but don't always have personal experience or facts to provide to you.

I can say that when I call my active duty infectious disease docs (non-academics) for bugs that don't respond to Ancef they always provide great antibiotic choices for me to choose from.

Infectious Diseases

www.med.navy.mil

 

[HighPriest]

No one said they were bad ID docs.

But Walter Reed, MD and The Walter Reed are very different things. I can name my bicycle the Starship Enterprise, that doesn't mean I can explore strange new worlds on it.

And BTW, if military research doesn't have Walter Reed rolling over in his grave, nothing I say will.

Plus, once you're out of the belt good luck doing any real research. You cannot seriously compare a military MD/PhD with and real civilian academic center. Even at NCC/WR.

I do have at least some experience as to how to rate a good research program, as I went to graduate school before medical school. Funding is important. The military's funding for medical research is pretty subpar. Talk to an MD/PhD at a major academic university and ask them how much funding they personally have in grants. Then ask anyone at any military program the same question. Streamlining of ERB/ethics board approval is another measure. It's ludicrously difficult in the military, and even if you work with an outside institution like the NIH you generally have to have everything THEY have already approved ALSO approved in the military system, often times making you a burden to them. (That may have changed, but it was definitely true when I was a resident). Plus, there's no incentive to streamline board approval. Research is, simply put, not important to the DoD. Hell, they contract out their weapons research, why would they be really interested in great medical research? Plus, the general laziness and inattentiveness of government employment doesn't take a holiday when it comes to review boards. Finally: frequency of serious publications in serious journals is important.

Now, don't get me wrong. People publish in the military. Some people publish quite often in fact. But what's the substance of what they're publishing? Is it a real research study that answers an important question? Basic science research? Is it just 32 names attached to a case report or a small case series? That stuff happens at big centers, don't get me wrong. But they're also doing serious research. I mean, I suppose it depends upon what kind of scientist-physician you want to be. If you want to casually publish a moderate amount of smut, then the military can make that happen - but you'll work for it as hard as possible. if you want to do basic science and clinic research that is going to make an impact - the military....just...isn't interested in that. That's not why they picked you up. I'm not saying it CAN'T happen, I'm just saying that it's less likely to happen and that the system isn't designed to try to facilitate it.

 

[militaryPHYS]

Both points were supposed to be funny. Maybe I should start labeling my jokes and sarcasm so I'm not taken so seriously all of the time

Since you elaborated I'm happy to provide some counter discussion.

Long story short, depends on what you want to research. Infectious disease? Incredible opportunities via the military. We have labs/partnerships set up around the world constantly collecting data and combining with our medical mission trips but I don't know how they compare with civilian programs. Orthopedic (i.e. elite athlete population studies)? Incredible opportunities and numbers which are published in the top journals for our specialty. We have the most standardized, easily accessible data in huge numbers for studies in sports medicine injuries. https://www.ncbi.nlm.nih.gov/pubmed/27519675. Funding and grants? DHA gave USUHS/Geneva foundation $15 mil this past year for musculoskeletal injury research which is the most prevalent reason for lost duty days and medical separation. https://www.cmirr.org/research.

The areas of research have to provide something applicable to military/government success. So if someone's passion aligns with that and they wanted to serve anyway it is their decision to make.

Yes the paperwork is a bear and sometimes frustrating finding motivated individuals to assist. My point is, on SDN all you'll get our typical generic opinionated responses if we don't have personal specific information. The OP asked about ID. I'm not an ID doc. Contact the programs directly to see if your personal desires, passions and goals align with the program itself. There are opportunities for the people who's goals align with the specific program. I don't see it as my place to say if its a good fit or not. I feel better just providing the resources or advice to help the individual person make their own decision.

 

[HighPriest]

Both points were supposed to be funny. Maybe I should start labeling my jokes and sarcasm so I'm not taken so seriously all of the time

Since you elaborated I'm happy to provide some counter discussion.

Long story short, depends on what you want to research. Infectious disease? Incredible opportunities via the military. We have labs/partnerships set up around the world constantly collecting data and combining with our medical mission trips but I don't know how they compare with civilian programs. Orthopedic (i.e. elite athlete population studies)? Incredible opportunities and numbers which are published in the top journals for our specialty. We have the most standardized, easily accessible data in huge numbers for studies in sports medicine injuries. https://www.ncbi.nlm.nih.gov/pubmed/27519675. Funding and grants? DHA gave USUHS/Geneva foundation $15 mil this past year for musculoskeletal injury research which is the most prevalent reason for lost duty days and medical separation. https://www.cmirr.org/research.

The areas of research have to provide something applicable to military/government success. So if someone's passion aligns with that and they wanted to serve anyway it is their decision to make.

Yes the paperwork is a bear and sometimes frustrating finding motivated individuals to assist. My point is, on SDN all you'll get our typical generic opinionated responses if we don't have personal specific information. The OP asked about ID. I'm not an ID doc. Contact the programs directly to see if your personal desires, passions and goals align with the program itself. There are opportunities for the people who's goals align with the specific program. I don't see it as my place to say if its a good fit or not. I feel better just providing the resources or advice to help the individual person make their own decision.

I knew at least two non-MD/PhD students at a local academic institution with $8 million in grants each. That’s just that student. $15 million is a joke. Military research is a joke. You’re the only person I’ve ever encountered who wasn’t a DoD cheerleader who has ever tried to make a counter argument. Good on you, I guess. But you’re a suburbanite comparing his 1/2 acre lot to the Royal Family’s estate here. Yep. You got some land. Very nice, pat on the head, on your way.

Ask your DoD colleagues in Missouri how much research they’re getting done and what kind of impact it’s making.

You can’t possibly think that research opportunity is a selling point for military medicine.

A student comes to you, with an honest question: research is very important to me. It’s what I want to do. Should I join the military?

And you say yes?

If you say yes to that question, you’re a recruiter. You’re not here to give salient and honest advice.

I am directing him as to how to determine on his own whether or not the military offers good research opportunities. Unfortunately, a lot of that information is hard to come by. If you call a DoD facility, they’re going to put you in touch with a cheerleader who is going to tell you that they’re doing great things. Just make sure you contact an academic center and compare notes.

 

[HighPriest]

OP, the fact is if you join there’s no guarantee you’ll get an ID fellowship. Less so than in the civilian world. There’s no guarantee you’ll have any opportunity at all to do any research of any kind. There’s no guarantee that even if you can do meaningful research, you’ll be able to accomplish anything. Research will be a hobby the DoD allows you to do so long as it is convenient for them. There no “1/2 clinical, 1/2 research” positions in the DoD. You will accomplish significantly less than you would with much less effort at a civilian academic institution. If you really want to be a soldier or sailor, and research is something you want to dabble in, then join. But don’t do a PhD. It’ll be worthless for the military.

If you’d like to look at it in another way:

You know you can do good research pursuing an MD/PhD at a major academic center. That’s the gold standard. Why risk it joining the military, where your career is controlled by someone else with no interest in any personal goal that you have that doesn’t line up with their own? Maybe, maybe you get to do what you want. If you’re lucky. As opposed to a very good fighting chance on the outside?

PhDs in science are so much harder to get than an MD. It would be a real shame to risk it.

And if you think the military will afford you some kind of deference because you have a PhD? They won’t. If they do, it’ll be the tenth thing on their list that they consider. They don’t even give constructive credit for basic science advanced degrees anymore.

 

[militaryPHYS]

Hi all,

I intend to pursue a career as a physician-scientist, potentially in the field of infectious diseases. I was wondering if anyone could offer some perspective on the quality of the USUHS ID program, both MD and PhD.

Thanks!

1. What year in school are you?
2. What made you consider USUHS in the first place?
3. Do you have any previous or current military/government affiliation?
4. Why would you consider USUHS over a more well known, private academic institution?
5. Are you leaning full academic or more clinical advanced degree?

Answers to these can help us provide more helpful responses. Thanks!

 

[Gastrapathy]

If Navy medicine exists in its current state in the future and doesn’t stop training fellows, close the overseas research stations, etc (very big if), then ID is one of the few specialties with unique opportunities in the military. A PhD is pointless and these are clinical opportunities. The problem is that it may not exist at all.

 

[Atlas Shrugged]

Why are moderators that are non-academic non-USUHS grads outside of the capital region not involved in research regarding infectious disease writing long posts about the topic?

I am concerned for the future of this forum.

 

[pgg]

I am concerned about the amount of drama lately. Lighten up, guys. Discuss points raised on their merits and quit worrying about who has what tag next to their username. Moderation here is and always has been exceptionally light.


Research opportunities at MTFs are universally rather thin - it's an unavoidable consequence of the q2-3 year PCS cycle. Resources do exist, mainly at the larger MTFs, but there's hardly a guarantee any given person will go to one for a staff tour. Add to that our renewed focus on operationally relevant force shaping, the uncertainty regarding future fellowship/subspecialty training slots, and I would argue that a person who is very interested in a research oriented career wouldn't be a good fit for the military.

But the great thing is, no pre-med wannabe-physician-scientist needs to make this decision now. They can get their degrees and join later as a direct accession if it turns out that their eventual research interests mesh with the needs and opportunities of the military.

 

[HighPriest]

I gotta agree with pgg on this one. While I think militaryPHYS was a bit overzealous in his representation of military medicine, it's just an opinion. I've never worked in the belt, ever. Nor have I gone to USUHS. But, I know a thing or two about research, and a thing or two about both academic and military research opportunities, so I posted. Also, I found it pretty unlikely that an ID doc from the belt was going to hop on and answer this question, so I did the best I could.

MilitaryPHYS was just doing the same thing, just in a way more akin to the way people talk about a fad diet before the weight comes back.

 

[Gastrapathy]

TBH, I’ve blocked him so I can’t see those posts anymore.

I know several of the beltway ID docs personally. OP: If you want a personal perspective, I would recommend reaching out to David Brett-Major on LinkedIn. He’s a nice guy and i think he’ll respond well. You can tell him @pgg send you

 

[DrMetal]

If you're really interested in research, my personal advice . . .

* Don't expect to do much as a medical student. Perhaps you find a summer and a small project to latch onto. But tread cautiously: your time is better spent focusing on grades, boards, and performance during rotations. If you're a MD/PhD student, then of course you'll have a dedicated 3-4 years of research time, go nuts.

* As a resident: same advice above applies. Perhaps you can do a research rotation (4-6 weeks). Some residencies (general surgery) have a whole year dedicated to it. Again: find a small project, don't gun for a Nobel prize.

* As an attending: you might have some more time now. But I'd latch on to a real academic institution (which none of the military hospitals are). For instance, if I want to write the mother of all computational code that'll cure fibromyalgia while stationed in San Diego, I'd go to UCSD and use their supercomputing facilities....or find a lab at NIH (if I'm stationed in the DC Metro area) that I fancy and offer my help and interest. But again, tread cautiously here and be mindful of your other obligations.

By the time you're an attending, that golf course and bottle of scotch look real appetizing.

 

[militaryPHYS]

I think the key is understanding why people are coming to ask us about something specific to Military Medicine. This person obviously knew about USUHS through a friend, relative or personally through prior service. Who knows.

Just like someone coming to me to talk about wanting to become a General Surgeon, I might not agree with that pathway based on my own personal experience, but I understand that it is the right choice for some people and I'm happy that we have people to do those things. I would provide the positive and negatives that I know about to help that person make the decision for themselves. The negatives are usually covered extensively via other members, so all I have to write about are positives...hence why my responses might seem skewed.

Not sure who Atlas was referring to nor do I care. My wife and I are both USUHS grads. I have an in-law USUHS grad who did the ID externship and considering ID fellowship now that they are staff. That doesn't make my opinion more or less valid, but I'm not just over here spitting out random stuff all of the time and will usually preface when I am out of my lane and providing personal anecdotal opinion.

 

[Chonal Atresia]

W

I think the key is understanding why people are coming to ask us about something specific to Military Medicine. This person obviously knew about USUHS through a friend, relative or personally through prior service. Who knows.

Just like someone coming to me to talk about wanting to become a General Surgeon, I might not agree with that pathway based on my own personal experience, but I understand that it is the right choice for some people and I'm happy that we have people to do those things. I would provide the positive and negatives that I know about to help that person make the decision for themselves. The negatives are usually covered extensively via other members, so all I have to write about are positives...hence why my responses might seem skewed.

Not sure who Atlas was referring to nor do I care. My wife and I are both USUHS grads. I have an in-law USUHS grad who did the ID externship and considering ID fellowship now that they are staff. That doesn't make my opinion more or less valid, but I'm not just over here spitting out random stuff all of the time and will usually preface when I am out of my lane and providing personal anecdotal opinion.

I’ll add my two-cents.

One of my best buddies from USUHS did an ID fellowship and performed instrumental work on the vaccine for the Ebola virus. He has worked out of Ft. Detrick for the last several years.

He just received orders to an nameless MEDDAC (name withheld for obvious reasons) to essentially see general medicine clinic in order to “further his career through assuming more leadership positions.”

Makes perfect sense, right?

 

[militaryPHYS]

Makes perfect sense, right?

If he is a senior O4 and never held a DH role or Associate Director spot then yes. If he is a senior 05 and never held a director-level position then yes. Right or wrong we all know that in order to promote these jobs are required. Right or wrong we are often forced to rotate out of a billet we have been holding for a while. I am sure there is a lot more to his story and hopefully the military is sending him to Nameless MEDDAC for a very specific job for a while because he intends to stay in and wants to promote.

[To the OP and other future forum browsers]: To stay on track for the purposes of the OP and future premeds considering ID in the military, I would be interested in his opinion on ID in the military separate from any opinion related to standard military promotion/rotation issues. Unfortunately we can't do much about the latter and it needs to be understood/accepted by anyone signing the dotted line. Tours with skill atrophy will happen. Fortunately, while you are in such a location you can usually capitalize on the leadership/admin roles the military requires of us for promotion/retention. Even still, neither are guaranteed.

 

[Chonal Atresia]

If he is a senior O4 and never held a DH role or Associate Director spot then yes. If he is a senior 05 and never held a director-level position then yes. Right or wrong we all know that in order to promote these jobs are required. Right or wrong we are often forced to rotate out of a billet we have been holding for a while. I am sure there is a lot more to his story and hopefully the military is sending him to Nameless MEDDAC for a very specific job for a while because he intends to stay in and wants to promote.

[To the OP and other future forum browsers]: To stay on track for the purposes of the OP and future premeds considering ID in the military, I would be interested in his opinion on ID in the military separate from any opinion related to standard military promotion/rotation issues. Unfortunately we can't do much about the latter and it needs to be understood/accepted by anyone signing the dotted line. Tours with skill atrophy will happen. Fortunately, while you are in such a location you can usually capitalize on the leadership/admin roles the military requires of us for promotion/retention. Even still, neither are guaranteed.

The guy I am talking about is a senior 05 who is not trying to make 06. He wants to stay on at Detrick and keep performing research but is being forced to PCS. No “more to the story” other than trying to get to 20 and retirement.

I hate to say it but if you stay on for additional time past your ADSO and chase that retirement “carrot,” I have no sympathy for what the military does with you. Everybody at this point should know the current climate in military medicine and the emphasis being placed on operational billets and non-clinical positions (at least in the army). If you are a specialist and sign on for additional time, you are playing Russian roulette with your clinical skills and possibly post-military career.

But I still think it is stupid. Doctors are not “widgets” despite what the military says or does with them.

 

[dwb8p]

Bottom line is you shouldn't expect to practice medicine more than once or twice a week after pinning on O5 in the military. To expect otherwise is setting yourself up for disappointment. It's not normal by any civilian measure for a physician in their late 30s and early 40s to step out of clinical medicine in this fashion in order to assume these leadership roles, but that is what is expected of us in the military.

 

[militaryPHYS]

The guy I am talking about is a senior 05 who is not trying to make 06. He wants to stay on at Detrick and keep performing research but is being forced to PCS. No “more to the story” other than trying to get to 20 and retirement.

Ah yes, I forgot that option. The golden albatross/handcuff situation. Grumpus Maximus has a blog related to this. He's not a physician, but feels obligated to stick around to 20 since he is so close. But is it worth it?

Anyway, golden handcuff situation is still similar to needing to rotate out and asked to lead in order to promote. The military won't just promote you or keep you around to collect a pension if you are only maximizing research/clinical during your years. Again, not saying I agree or disagree, but it is a well known fact everyone should understand.

Doctors are not “widgets” despite what the military says or does with them.

Unfortunately, we are. This is a fact. In the big system of Military/Government we just provide a service. I don't agree with it but I also understand. If we don't like it there is always someone else coming in behind us, a contractor who would fill a spot or a NP/PA who they will try to justify and use in our place. I disagree with it but it is still a fact and something we must understand/accept. If we can't accept being a widget in MilMed then we will never be happy/content. If that is a hard stop for someone then they should get out ASAP or never sign up if they are premed considering the service.

 

[militaryPHYS]

Bottom line is you shouldn't expect to practice medicine more than once or twice a week after pinning on O5 in the military. To expect otherwise is setting yourself up for disappointment. It's not normal by any civilian measure for a physician in their late 30s and early 40s to step out of clinical medicine in this fashion in order to assume these leadership roles, but that is what is expected of us in the military.

I agree you will be doing less clinical medicine at that time period in your career compared to a civilian but #1 we are not civilian providers and #2 you are likely already done with your required payback so just get out if you care to compare yourself to a civilian physician. You can choose your own fate at that point.

I also think it is an over generalization that pinning O5 means destined to practicing once or twice a week. There are plenty of specialties and/or services that allow you to continue a moderate paced practice while also contributing to administrative/executive medicine at the O5/O6 level to allow you to stick around as a MilMed physician for 20 years. If you take a milestone billet or slate for CO/XO your clinical time really dries up, but that is when you are considering staying beyond 20 anyway. Choose your own fate.

 

[militaryPHYS]

Maintaining competency and skills as it relates to safe patient care is a default in anything I discuss. When I talk about these things it is with the understanding that the providers in question are in a specialty where they can remain clinically relevant despite the uptick in admin time.

Regardless, we are discussing a time when payback is done. If someone feels they aren't maintaining clinical competency due to volume then get out. Or moonlight. If they want to stay in they will need to rotate billets and take leadership positions.

 

[Cooperd0g]

You know, it would be nice if ALL threads didn’t devolve into hate and discontent about how “bad” military medicine is. There are enough general threads on that. You want a better careeer path then figure out how to work the system to your advantage, suck it up, or GTFO.

 

[Gastrapathy]

The topic of the thread was the quality of an IM subspecialty fellowship and MD/PhD in Bethesda. Are you saying that there isn’t a problem with choosing that path at the moment? You know that the fellowship will exist? You know that the case complexity will be acceptable? You know that the research stations will stay open? Because the people in charge don’t. You find us irritating, just ignore us but bad doesn’t need quotes.

For prospective students: there is the empathy your leaders will have: work the system to your advantage (at someone else’s expense), just deal or quit. Awesome options

 

[HighPriest]

Hey guys, I have a question about "X," but I only want to hear the good stuff.

When I see that title, I'll either abstain or try to limit my post. Otherwise this is a thread about military medicine, about which many people have a negative opinion. No one is stopping anyone from posting positive opinions, see @militaryPHYS.

I'm all for trying to make things better, but you know as well as I do that to do so you're asking to move planets. And, FWIW, I did GTFO. That doesn't change the fact that if you really want research to be a major part of your career, military medicine isn't your best option. It was that way before I GTFO, and it's that way now.

And to add to @Gastrapathy : he's right. A big part of the military mindset is to suck it up and deal with it. which I get. I really do. It makes perfect sense when you're hugging a rifle in some shelled out building, and that's what the military does. You just need to know that's what you're getting in to, and that if sucking it up means something very, very bad for the career you've just spent decades training for, then you have to suck it up. And there's this imaginary carrot that gets dangled that if you just work towards an operational billet, you can try to steer the system in the right direction. I say imaginary because it just doesn't actually happen. I've known lots of guys who have tried. The ones who stick to their guns usually top out at a position that lets them make some minute changes to their local system. The ones you drink the Kool Aid get to ride in the spaceship. So when they say "suck it up or get out" what they mean is just suck it up or assimilate. And this is going to sound like criticism. Its not meant to. It's just the way it is. If you're good with that, then you'll be happy in military medicine.

 

[militaryPHYS]

So when they say "suck it up or get out" what they mean is just suck it up or assimilate. And this is going to sound like criticism. Its not meant to. It's just the way it is. If you're good with that, then you'll be happy in military medicine.

This is my point and the only reason I keep posting in here. Some people are good with this. I know I am and I am not ashamed to admit it. I think this is what @Cooperd0g was getting at: There are people in the world who MilMed is good for....if they aren't, don't sign up or GTFO ASAP. You shouldn't feel obligated to use every thread as an avenue to uncover the "hidden secrets of military medicine" for that person. They are well known and discussed at length by certain members. I'd talk about them too but I can't get a negative word in edge wise. Maybe the OP is OK with assimilation and just wants down and dirty facts. We can't approach every thread as if we know what is best for that person. It doesn't work that way. Lets just provide objective facts, because you never know, that person may be open to assimilation and be a happy and productive member of MilMed.

Milmed is not always the BEST choice for practice environment, lifestyle, research avenue or income generator...but it is the right choice for some people.​

When the first comment is a blanket negative generalization which likely sends the OP running and then makes me feel obligated to comment and bring the discussion back to center for future people reading this, that's when we keep going down the same back and forth. And let's be clear. I don't feel obligated because I'm trying to recruit or make MilMed something better than what it is. I feel obligated because I was that OP 12 years ago. And if I would have cut and run based on the threads in this forum I would have missed out on my current life. And I say my life, not my practice, but my life (wife, kids, travel, free time, colleagues, net worth, sense of purpose). I happen to also really enjoy my practice, my fellowship acceptance and my future ahead of me, but I don't let that drive my posts anymore. For the people who are OK assimilating and find out that their motivation for specialty aligns with the needs of the military to offer a fruitful career they should NOT be given the disservice of skewed and blanket negative statements for all of MilMed. Let them make their own assessment on whether or not they want to suck it up for a while.

 

[Chonal Atresia]

This is my point and the only reason I keep posting in here. Some people are good with this. I know I am and I am not ashamed to admit it. I think this is what @Cooperd0g was getting at: There are people in the world who MilMed is good for....if they aren't, don't sign up or GTFO ASAP. You shouldn't feel obligated to use every thread as an avenue to uncover the "hidden secrets of military medicine" for that person. They are well known and discussed at length by certain members. I'd talk about them too but I can't get a negative word in edge wise. Maybe the OP is OK with assimilation and just wants down and dirty facts. We can't approach every thread as if we know what is best for that person. It doesn't work that way. Lets just provide objective facts, because you never know, that person may be open to assimilation and be a happy and productive member of MilMed.

Milmed is not always the BEST choice for practice environment, lifestyle, research avenue or income generator...but it is the right choice for some people.

When the first comment is a blanket negative generalization which likely sends the OP running and then makes me feel obligated to comment and bring the discussion back to center for future people reading this, that's when we keep going down the same back and forth. And let's be clear. I don't feel obligated because I'm trying to recruit or make MilMed something better than what it is. I feel obligated because I was that OP 12 years ago. And if I would have cut and run based on the threads in this forum I would have missed out on my current life. And I say my life, not my practice, but my life (wife, kids, travel, free time, colleagues, net worth, sense of purpose). I happen to also really enjoy my practice, my fellowship acceptance and my future ahead of me, but I don't let that drive my posts anymore. For the people who are OK assimilating and find out that their motivation for specialty aligns with the needs of the military to offer a fruitful career they should NOT be given the disservice of skewed and blanket negative statements for all of MilMed. Let them make their own assessment on whether or not they want to suck it up for a while.

The military came within a whisker of ruining my medical career back in ‘10/‘11 when I was tasked as a brigade surgeon. 2-year tour with no clinical exposure which I would have completed right at my ADSO end time. Think anyone would have hired me out of clinical practice for 2 years?

So yes, I am negative on military medicine. I will always do everything in my power to keep prospective med students from joining because I think it is a mistake for 99% of them (especially with the current environment of specialty “buckets”).

I gave an example in this thread of my close friend getting PCS’d when he has done research his entire career. He is an integral part of the Ebola vaccine project but the military feels it is more important that he sees clinic in bumblef$&@ Egypt.

If you don’t like my opinion or others who describe the dark side of military medicine, don’t read our posts or block us. However, I feel strongly that military medicine is beyond broken in so many ways and I won’t stop warning students to avoid what I think is a disaster.

 

[militaryPHYS]

Nobody will block you and everyone's experiences should be heard. But just like I realized I shouldn't be using my personal success stories and current happiness in MilMed in all of my responses, neither should other's be using their personal negative experience to drive every response on the forum. I learned from you guys when I first came back active in SDN. I would hope you provide a similar respect as we try to help students who may or may not be right for MilMed.

All of that being said, we are in the process of creating a different place for prospective students to come and receive only objective information. There will not be recruiting and similarly there will not be blanket negative generalizations. Students will come to ask a specific question and they will be given a specific answer. If there is nobody active who has a specific answer we will provide points of contact, websites, resources for them to find the information they seek in order to make their own decision.

 

[HighPriest]

You shouldn't feel obligated to use every thread as an avenue to uncover the "hidden secrets of military medicine" for that person

I mean: you don't have to use every thread as an avenue to blow off the problems with military medicine. This is the part that I don't understand, primarily because it makes zero sense:

Don't say anything bad about military medicine. Everyone knows the bad things. There are other people who post the bad things. Why not post good things and just ignore the bad stuff?

My counter argument would be that there are other people who post the good things. Not everyone knows the bad stuff. If they did, they wouldn't be posting here in the first place.

If I never said anything bad (read: realistic) about military research, OP would only have heard from you about how great it can be....maybe. So I would argue that he wouldn't be getting the full picture. If he came in here knowing what possible problems were there, he would have asked "Hey, what about the poor research opportunities at most MEDCENs? what about lack of funding? what about operational billets, and how would they effect research?" But he didn't ask those things. Maybe he was just holding off, but I imagine its because most of those things never even occurred to him. Just like most of the potentially good OR bad things that can happen in the military don't occur to most people. They don't know what they don't know.

Just because there's a relative preponderance of people on the forum with a poor opinion of military medicine doesn't make the positive opinions more valid.

I would argue that "uncovering hidden secrets of military medicine" is the whole $%^king point of the thread. If it's something they can read about on the Navy website, they don't need to come here. They come here for the stuff they won't hear about from their recruiter.

 

[HighPriest]

All of that being said, we are in the process of creating a different place for prospective students to come and receive only objective information. There will not be recruiting and similarly there will not be blanket negative generalizations.

Ah. A recruiting website.

No?

Lets play a little thought experiment here:

Will you be recruiting anyone with a negative opinion of military medicine to answer these "objective questions" and to provide "objective data?"

When you refer them somewhere else for answers, will it be a DOD webpage or a DOD point of contact who has expressed specific interest within the DOD to speak with prospective students? Because there's this thing called selection bias....

See, man, THIS is why some people don't necessarily trust you as a moderator. You don't like what you see, so your plan is to start a better casino with blackjack and hookers. It's not that its inherently WRONG, but its basically a wizard of Oz scenario where you are setting up a curtain. There's objective data and there's "objective data." There's also data and then there's complete data. If you eliminate any data that reflects badly (or even just don't include it), that's not complete data.
This is basically just saying "well, I couldn't turn the milmed forum into a place where milmed looks good, so I'll just try to direct students somewhere that does by design."

 

[Gastrapathy]

Ok, I removed ignore and read because of the responses. Here it is. As we all expected when we objected to the moderation, now you’ll just create a forum where you are the arbiter of the facts. Orwell eat your heart out.

 

[HighPriest]

Ok, I removed ignore and read because of the responses. Here it is. As we all expected when we objected to the moderation, now you’ll just create a forum where you are the arbiter of the facts. Orwell eat your heart out.

Right, yeah, faster was of saying what I was trying to say.

 

[militaryPHYS]

Think whatever you want about me. It doesn't change the fact that this forum is not what premeds, med students and junior MilMed's are looking for when all they want is to ask about MilMed without having to be subjected to all of THIS. When we bicker back and forth about the same stuff all of the time it is not a good representation of what students come to SDN looking for. It is a great place for veteran or retired/separated MilMed's to discuss amongst themselves but it is not a welcoming place for students. Ask around, I think you'd find truth to this. The forum is even subheaded under Physicians/Residents. Therefore it should remain there. But Premeds and Med Studs need a better place for specific questions/answers, not us echo chambering each other.

Like I keep telling you, I'm the bottom of the totem pole. People much more integral to the existence of this website make the final decisions. They are the ones who will make the final decisions so you can stop using me as your punching bag. If you have questions/concerns talk to them. Please stop just repeating the same expected responses and comments about what you think about me.

 

[Chonal Atresia]

I mean: you don't have to use every thread as an avenue to blow off the problems with military medicine. This is the part that I don't understand, primarily because it makes zero sense:

Don't say anything bad about military medicine. Everyone knows the bad things. There are other people who post the bad things. Why not post good things and just ignore the bad stuff?

My counter argument would be that there are other people who post the good things. Not everyone knows the bad stuff. If they did, they wouldn't be posting here in the first place.

If I never said anything bad (read: realistic) about military research, OP would only have heard from you about how great it can be....maybe. So I would argue that he wouldn't be getting the full picture. If he came in here knowing what possible problems were there, he would have asked "Hey, what about the poor research opportunities at most MEDCENs? what about lack of funding? what about operational billets, and how would they effect research?" But he didn't ask those things. Maybe he was just holding off, but I imagine its because most of those things never even occurred to him. Just like most of the potentially good OR bad things that can happen in the military don't occur to most people. They don't know what they don't know.

Just because there's a relative preponderance of people on the forum with a poor opinion of military medicine doesn't make the positive opinions more valid.

I would argue that "uncovering hidden secrets of military medicine" is the whole $%^king point of the thread. If it's something they can read about on the Navy website, they don't need to come here. They come here for the stuff they won't hear about from their recruiter.

“They don’t know what they don’t know.” Isn’t this what we say about dangerous physicians? I think the same applies to anyone who is thinking about joining military medicine. They need to be well-informed of the “s$&@ show” that goes on behind closed doors in military medicine. This forum affords them that opportunity. If they still decide to join knowing the pitfalls (poor pay, potential lack of residency choice, deployments, operational tours, skill atrophy, undesirable living locations, lack of support staff, no paid CME, etc, etc), then I got I no sympathy for them.

I disagree with militaryPHYS, the pitfalls of military medicine that I listed above (and there are many more of them) should be made readily available to all pre-med and med students on those specific forums. Knowledge is power and ignorance is not bliss.

 

[militaryPHYS]

Any new forum would provide this information. Just not in a subjective and generalized way. It would be specific to the questions at hand both positive and negative as it relates to MilMed

 

[Gastrapathy]

And you would control the content.

@pgg so that’s that eh?

 

[HighPriest]

Most of what is posted here is specific to the topic. It’s just not mostly to your liking. Things do get derailed, for sure, but that’s what forums do (see any other thread on sDN). So all you’re doing is adding a level of neo-facism and eliminating anything you don’t personally find productive. Which Soviet was it that did that...., right, the lot of them.

As it turns out, the DoD doesn’t generate a lot of data that might make it look bad, so only using approved “data” is fairly selective.

 

[militaryPHYS]

Nothing is set in stone. You still have time to derail it and I would encourage you to raise concerns as you see them. My hope was to have everyone involved in the creation of it, but it seems obvious you have zero respect for me or anything I would want to propose. Let me know if I am mistaken and we would love to have your input.

 

[pgg]

And you would control the content.

@pgg so that’s that eh?

There's been discussion of creating another milmed forum on the premed side of SDN. Our forum here is part of the "Physician / Resident Forums" that are generally aimed at, well, physicians and residents. But a large portion of the traffic here actually involves pre-meds considering HPSP or USUHS. From an organizational standpoint, it makes some sense to have a milmed forum over in the "Premed Forums" top level directory. As it is, we frequently move posts from the pre-allo neighborhood to here. This works OK for that OP but not so much for the other pre-meds who might've followed a thread in pre-allo.

The mechanics of how the forum would work (open, vs something more akin to confidential consult, vs a place with verified members like the practicing physician forums) were still being debated a few days ago. As a rule I favor minimal moderation. I'm here to keep spammers and trolls at bay; less interested in being a fountain of authority or designating others as such.

As the mission of SDN is to help students become doctors, I do think there's reason to evaluate and improve how pre-meds get info about milmed.

 

[HighPriest]

Nothing is set in stone. You still have time to derail it and I would encourage you to raise concerns as you see them. My hope was to have everyone involved in the creation of it, but it seems obvious you have zero respect for me or anything I would want to propose. Let me know if I am mistaken and we would love to have your input.

Quite the contrary. I’ve never suggested that I don’t think you should post your opinion simply because I feel like it’s counterproductive. I’ve actually defended your right to post it on more than one occasion. But the response I get is that I shouldn’t post if I don’t have anything nice to say. If that’s how any new proposed forum is regulated, I’d rather just stick to the surgery subforums.

 

[Gastrapathy]

somehow I think I know how it’s going to turn out:
Premed: hey, can I do ID?
Answer: there are excellent ID fellowships in the .mil. ( No need to say more since nothing official has been announced. It’s just 10 years of their life.)
etc. Fair and Balanced Hannity style.

 

[militaryPHYS]

Quite the contrary. I’ve never suggested that I don’t think you should post your opinion simply because I feel like it’s counterproductive. I’ve actually defended your right to post it on more than one occasion. But the response I get is that I shouldn’t post if I don’t have anything nice to say. If that’s how any new proposed forum is regulated, I’d rather just stick to the surgery subforums.

I didn't say you didn't want me to post. I said you don't respect me nor care to even try. Evident with things like...

This is basically just saying "well, I couldn't turn the milmed forum into a place where milmed looks good, so I'll just try to direct students somewhere that does by design."

As we all expected when we objected to the moderation, now you’ll just create a forum where you are the arbiter of the facts. Orwell eat your heart out

You already have preconceived thoughts about me and despite anything I ever say to the contrary continue to spew out stuff like this in an open forum. Forgive me if I take that as disrespect.

I said provide objective information, positive or negative related to specific questions. Do not blanket generalize. I never said don't say anything if you don't have anything nice to say. For example,

If someone asks a question about ENT in the Army...open season! Say something about your experience, positive or negative. Ensure it is still relevant and applicable to ALL of Army ENT through collaboration with current active duty surgeons and don't pretend it has ANYTHING to do with other specialties or services unless you actually know. I would also be working on adhering to this and making a fresh start in a new Premed/Med forum. ​

Want to know why the content of my website is still pending? Because early on it raised local eyebrows on the impression it gives of MilMed as a whole due to me being open and honest about the pitfalls. (also I haven't had time to finalize it and formally submit it given my upcoming Oral boards). Take your vendetta out on recruiters somewhere. All I am doing is answering questions to learn who would likely succeed and be happy in the military system to help guide their next steps while also helping to prevent those who would be miserable and non-contributors from joining. But we don't even get to know the OP's to understand which one they might be because we get a blanket NO IT ALL STINKS right off the bat on every single thread. That might be your feelings, but you don't represent us all. Neither do I.



I've tried for over a year to help us be more welcoming to people in this forum with zero luck. In fact it made it worse. People stopped posting and would just contact me directly for questions instead of posting due to knowing what kind of negative response they would get. This is why I suggested we try a different approach. Let me know if you'd like to be involved.

 

[HighPriest]

You already have preconceived thoughts about me and despite anything I ever say to the contrary continue to spew out stuff like this in an open forum. Forgive me if I take that as disrespect.

So, to begin with, I've never met you. Don't know who you are. don't know anything about you other than what you've posted here. So it's not really possible to have preconceived thoughts about you. A preconceived thought is an idea you have about something with which you've had no interaction. My conceptions about you are entirely based upon what you've posted here. They're not preconceived. You can argue that they're inaccurate, but they are based upon what I've read that you have posted thus far.

Nextly, Yeah, if someone posts about Army ENT I'll respond. If someone asks about research opportunities in the Army, I'll respond. Because I know research, and I did research in the Army. So I have at least as much experience with it as you do, and you posted. So why not me? You're not an ID fellow. You didn't do ID research. You're not (you've stated) in the belt. So I'm not sure where you're going here. If someone posts a question about PM&R, you'll notice that I leave that alone. Or, perhaps, make a sarcastic response that neither supports nor condemns the military, but that's another issue entirely.

In fact it made it worse.

Starting to agree sometimes, but only because of the strife not because of your opinions.

People stopped posting and would just contact me directly for questions instead of posting due to knowing what kind of negative response they would get.

Believe it or not, everyone gets these. The danger in your case is that these kids are desperate, and you tend to oversell the product. They want to hear good news so that they can justify a very, very difficult decision.
I've definitely seen you post both sides, but sometimes you forget that there are two sides to the story. Or, at least, you certainly only highlight one side, which is exactly what you accuse everyone else of doing. Simply stating that "things can be super great, you know as long as you fit in" really need a balancing statement indicating what exactly fitting in means.

For example "there are great research opportunities in the military." (not a direct quote)

Yep. Ok. But there are a lot of things that have to happen in your favor, many based entirely upon circumstance, to provide you those opportunities. And most people don't have them. See, you feel like pointing out the former point is the most important part of that conversation. I disagree. I'm a plan for the worst, hope for the best kind of guy.

Also, sometimes you don't have perspective -like with regards to whether or not 15 million is a lot of money for a major DOD research grant. Now, that actually isn't a criticism at all. If you've never been involved in a grant application at a civilian research center, I understand that. A lot of people haven't. But that why there are other valid posts and opinions aside from your own - even if they happen to have a negative view of milmed.

 

[militaryPHYS]

Oorah. Noted. Thanks for clarification. FYI, I'm pretty sure everyone I have talked to decides not to sign up. So you're welcome. Except for @Matthew9Thirtyfive of course. But he was already in and probably didn't rely on anything I said to make that decision.

 

[Cooperd0g]

The initial responses by HighPriest and Gas were actually quite good. My post was more analogous to pgg’s comment because it just started to fall apart into bickering.

I am not an ID doc, but in general it seems as though ID is well regarded in the military, with opportunities that may be actually better in the military than in the civilian world. The big issue is what the program will look like in the future with all the DHA changes and no one can really answer that right now. That means a lot of uncertainty making it difficult to recommend unless you really just want to be in the military and are willing to accept the unknown. Additionally it is hard to see the value of the PhD with the military as it is difficult to be a full time researcher. You’ll find many discussions about people being forced into non-clinical jobs or having to move; things that would disrupt the goal of being a full time researcher.

Wait, did I just post something that is both informative and truthful yet simultaneously not sound like I’m crying in my cornflakes?

As for my learn the system, suck it up or GTFO:
I always tell people that their ability to train straight through residency and fellowship has a lot to do with their chosen service, their desired field and the given year because things change all the time. I don’t see anything wrong with reminding people of that in pretty much every thread by a new person looking for advice. But after it has been stated once or twice per thread, it just looks like a bunch of crybabies to beat that dead horse.

If someone understands that and decides to join anyway then eventually they will have some experience and have met some people along the way. Most of the time you know when your orders are up. Here is what I do: I find out what jobs are going to be available at the time of my PCS, pick the one I want, reach out to people in the job and sell myself to the gaining command CO. When you have an open position, a qualified individual and a CO who requests you by name it is pretty hard to not get that job. That is working the system. Don’t be so negative that understanding how to get what you want equates to screwing someone else over.

Lastly, you’ll reach the end of your initial obligation. If you aren’t happy then get out. Don’t stay in and become some bitter person who hates their own life and job. You won’t be a better person for it and you probably won’t be much fun to hang out or work with. But if you do stay in chances are you know what you are in for, or you have had your head stuck in the sand. At that point you need to suck it up because you missed your chance to GTFO and if you are that unhappy then you didn’t know how to properly set yourself up.

 

[Gastrapathy]

For an ID doc, the end of the initial ADSO is often most of the way to 20. So again, if that is the goal, just get out at the end of your obligation if you are unhappy is not that simple. Residency, utilization tour, fellowship, payback= ~11-13 years

 

[grotto]

Modus operandi of this forum (for 10 years):

Q: military?

A1: military medicine is horrible, don’t join or you will become a poor physician like all of the other suckers I left behind at my EAOS. Plus you will die if you seek care in a MTF

A2: it’s not too bad- have realistic expectations. I’ve had a nice career but I didn’t like a few things...

A1 to A2: you don’t know what you’re talking about, you must be either insane or never practice anymore because no one even comes to military hospitals, and if they do they aren’t that sick, and if they are sick then they die. I’m a civilian and 1000 times happier and can do what I want when I want

This forum is a poisoned troll fest with very little good or even relevant information. Every discussion here devolves into knock down and is then abandoned by people who could help. It is basically 4 people posting to each other about how much the military sucks - most of whom haven’t been in the .mil for a while.

 

[Gastrapathy]

Yet it’s not the same people for the 10 years.

OK SWO-dog, what are people saying at your MTF right now?

 

[HighPriest]

I've posted positive things about milmed on this thread. They're there. You can find them if you want to do so. But I call it like I see it. If it warrants praise, it gets praise. If it warrants concern, it gets concern. If it warrants degradation, then that's what it gets. Do I have an overall negative bias? Yes. But that's because I had an overall negative military experience. Like many of the people I worked with in the military, but it wasn't 100% bad either. I've praised my residency which I actually really liked, although I admit there were faults. I've praised the patient population. I've railed on skill rot and on the way the military manages their physicians. I've stood up for guys like MilitaryPHYS on occasion, and I've called them out too.

This isn't a case of "if you don't have anything nice to say, don't say anything at all." I assume that most of the kids coming on the thread are looking for the same thing I was: honesty and the best answer I'm able to provide. That's what I try to give them.

I'm with Gastrapathy - there's a negative bias, but it's a constantly changing spectrum of posters. There's a reason for that, and its more than just "squeaky wheel." My opinion is that the milmed cheerleaders usually get drowned out because the points they make are often very narrowly applicable or easily shot down. Not always, though. Guys like pgg will make very good, reasonable statements. People may argue occasionally, but he gets his point across just fine.

 

[Mace1370]

Modus operandi of this forum (for 10 years):

Q: military?

A1: military medicine is horrible, don’t join or you will become a poor physician like all of the other suckers I left behind at my EAOS. Plus you will die if you seek care in a MTF

A2: it’s not too bad- have realistic expectations. I’ve had a nice career but I didn’t like a few things...

A1 to A2: you don’t know what you’re talking about, you must be either insane or never practice anymore because no one even comes to military hospitals, and if they do they aren’t that sick, and if they are sick then they die. I’m a civilian and 1000 times happier and can do what I want when I want

This forum is a poisoned troll fest with very little good or even relevant information. Every discussion here devolves into knock down and is then abandoned by people who could help. It is basically 4 people posting to each other about how much the military sucks - most of whom haven’t been in the .mil for a while.

Strongly disagree. When I applied to USUHS I had zero military experience or expectations. I liked the idea of serving for patriotic reasons, but had no idea what I was getting into. Talking with the regulars on this forum really helped me learn what I was in for if I joined and I am incredibly grateful for it. I have enjoyed my time in the military so far, but there are definitely down sides and I was prepared for them going in.

As for ID, I have only a little to add. I spoke with a few ID fellows during my training as a resident. They all seemed to think their training was good, but none of them were doing heavy research.