What it's all about

[militarymd]

---

Members do not see this ad.

Kind of long, but really cool.

U.S. Navy

 

[NavyFP]

It's why I joined.

 

[The White Coat Investor]

\

 

[paradude]

Desperado,

I know you have absolutely no sense of patriotism. I don't agree with you but I understand you. However, your need to belittle someone else with many years of service and a great deal of respect for his country is maddening to me. The day you stop wearing a military uniform will be a good day in my book.

 

[Galo]

Certainly alot of people join for the macho huhah stuff like that. I know I glorified war, and wanted nothing more than to fly and kill people. I was even offered a flight slot, but kept my HPSP scholarship.

There is alot of people who are heavily influenced by videos like that, but do not take the time to learn the potential consequences.

Without a doubt our soldiers deserve the best, but unfortunately they get much less. This is why we post.

 

[Galo]

It's also the reason that we (ie - the students on here) joined HPSP. You know better than we do because you've lived it, but our motivations are still real and have to be worth something.

Just a small plea to keep the tone of this thread a little lighter than they usually seem to turn out . . .

Its hard to make the truth light when its not. unfortunately you are joining a severely damaged system that none of you will be able to effectively change. You may be able to make things for yourself, and the immediate people around you tolerable, but often at your personal cost, if you adhere to the fact you are first and foremost a physician.

Unfortunatly I think all of us "bitter" attendings have come to realize that the only way to effect change is to let people know the real outcomes, so that so few people sign up, that someone gets a clue and acutally tries to fix it. Do I think it will work? NO, but I have no other alternatives, and if I can influence one person, (I've lost count by now), by telling them the truth that a brochure, recruiter, or macho video completely distorts, then I think I am doing my part.

Our soldiers deserve better!!!

 

[Homunculus]

Desperado,

I know you have absolutely no sense of patriotism. I don't agree with you but I understand you. However, your need to belittle someone else with many years of service and a great deal of respect for his country is maddening to me. The day you stop wearing a military uniform will be a good day in my book.

i think he was being sarcastic. or facetious. MC would know. 😛 i thought it was funny.

it's like watching a marine recruitment ad and wanting to join the marines so you can fight 30 foot tall lava monsters . . . 😀

cool video though. big, cool, multimillion(billion) dollar toys 🙂

--your friendly neighborhood joined to be all he could be, in green caveman

 

[The White Coat Investor]

[

 

[paradude]

See you in Afghanistan. Maybe your view of my sense of patriotism will change there.

The slideshow glorifies war, which IMHO is not a good thing. If you want to understand what military medicine is all about go shoot a video about what happened in the places those missiles/bombs/torpedoes etc touched down.

How would you like it if someone posted a slideshow full of IED injuries or a video of an al-qaeda sniper killing a marine (they're all available on the internet.) That would be equally tasteless. It has nothing to do with patriotism. You can be a patriot and avoid glorifying war.

Been there, and Iraq, and east Africa. I got into this game with my eyes wide open and for the right reasons. Spare me the whining about your AF HPSP obligation, and how you had no idea about the horrors of milmed. Please do your time in your cushy air conditioned clinic and get out.

 

[8744]

Good Lord. The navy is about sea power. I have spent a lot of time in the fleet and they do have big ships, people do work on them, and a lot of people have the interesting and skilled jobs they show in the recruitment ads. I realize that many of us would not find fullfillment as a machinist's mate or a cook but a lot of guys volunteer for those ratings. Some guys do end up chippng paint and pushing papers but can't you cut the Navy some slack here? It is not a crime to present yourself to advantage. Maybe military medicine sucks but that doesn't mean the rest of the military does.

And the Marine Corps never tried to sell me on an easy lifestyle. "We Never Promised You a Rose Garden" was one of our more famous ad campaigns. I agree that some of the current USMC TV spots are kind of idiotic but they are emphasiing qualities that we hope to build in Marines. I happen to think that a TV spot showing the hardships endured by our Marines in both war and peace wouldn't hurt enlistment at all. I think a lot of you guys don't understand, and what's worse, denigrate the psychology of somebody who voluteers in the Army or the Marines to see action. This is an impulse as old as mankind and there is nothing stupid or ignoble about it.

 

[Homunculus]

I agree that some of the current USMC TV spots are kind of idiotic but they are emphasiing qualities that we hope to build in Marines.

actually, i heard they fought and killed a lava-monster similar to the one in the ads somewhere in the outskirts of mosul. 😀 chopped that baby to pieces with their sabres.

the army ones are just as silly now. "son, you looked me in the eye". yup, join the army so you can finally look your parents in the eye. i'd rather see tanks fighting 30 foot lava monsters personally 👍

--your friendly neighborhood all he can be/army of one/army strong caveman

 

[Ex-44E3A]

Paradude:

With all respect to your enlisted PJ service (and I'm not saying that to be a smart ass... you guys pulled some pretty rough missions when I was deployed, and not everybody came back) I'm not sure it's applicable to most of the posters here... you may want to save your snark; we get that you're all hooah and a company man. I'm frankly curious why you decided to leave Pararescue for the medical corps. You may not realize it, but you're about to be demoted.

As a PJ, you do dangerous work, but you're also an elite member of a small and prestigious military fraternity, where people bend over backwards to help you (as we did when I was deployed). Your AFSC is well-funded, well-supported, respected, deferred-to, and the military actually attempts to retain you (At this very moment, PJs with 19 years and TSGT rank are being offered 150K to reup). Hell... even the most arrogant pilots give props to the PJs. Pararescuemen are valued, difficult to find and train, and there's no recruiter-fueled, guaranteed-in-writing HPSP pipeline that would allow the AF to get away with an 8% retention rate.

As a military physician, you'll be in a totally different boat.. and I'm not sure you realize it. Unless you plan to stay in the spec-ops realm, you're going to learn really quickly what a capricious, indifferent, and admin-heavy organization the military can be, toward both you and your patient. You'll be treated strictly as a warm body... that is, unless you stay in the black world where you'll be shielded from all that hassle; you'd hate to come back to this forum in a few years and have to apologize for your imperious attitude. I'm not trying to bust your balls here, but where do you get off shi**ing on your own team?

Been there, and Iraq, and east Africa.

Desperado (who I don't know and have never met) is an Army ER doc serving his country in the combat zone, fulfilling a role just like you'll be doing in a few years, assuming you make it that far. Was attempting to shame him into silence with your spec-ops bad-ass attitude supposed to be helpful? It is only the recent HPSP recruiting shortfall that seems to have gotten the leadership's attention, and I personally suspect they'd rather go to a "doctor draft" than make changes.

And why not? If the docs complain about said draft, there'll always be guys like you around to tell them to STFU.

I got into this game with my eyes wide open and for the right reasons.

Good for you... you have my respect for going out there and getting it done as a PJ. I mean that sincerely. You're a young, single guy though, right? Perfect. You were prior service, and knew what the deal was when you signed... now how about those who were fed a line of bullsh*t by their recruiter, didn't have a forum like this, or didn't otherwise have their eyes "wide open?"

Spare me the whining about your AF HPSP obligation, and how you had no idea about the horrors of milmed.

And what, pray tell, do you know about those horrors at this point in your medical education? You've been living the high-speed tip-of-the-spear PJ life for eight years, with your "fun meter" pegged all the way to the right. Being a doc in the regular force isn't nearly the same thing.

Please do your time in your cushy air conditioned clinic and get out.

So you only value the service of a doc if they're a snake-eater? C'mon... Admit it... you love sneering at the physicians on this forum. You think anyone who complains is a nancy-boy, and you clearly consider yourself better than them.

 

[8744]

...You think anyone who complains is a nancy-boy, and you clearly consider yourself better than them...

It's just that complaining about having to deploy in the military is like being a Catholic priest and complaining about giving communion. It's just something you have to do in a forward-deployed military like ours. It doesn't mean the military sucks, just that you don't want to do it. Perfectly understandable but taking care of the trigger-pullers is part of your job.

 

[resxn]

Spare me the whining about your AF HPSP obligation, and how you had no idea about the horrors of milmed. Please do your time in your cushy air conditioned clinic and get out.

I for one went to med school and joined the AF so I can sit in my slightly cushy, 60's decor, air-conditioned-in-January clinic. That's why I haven't gone AWOL. It's about the perks, baby. Keep them coming.

I hope to hell the next prostaff meeting I go to this afternoon we get to talk about another fire drill. Never can get enough of that stuff.

Hooooohaaaaaah!

20,168,593 seconds and counting.

 

[Ex-44E3A]

It's just that complaining about having to deploy in the military is like being a Catholic priest and complaining about giving communion. It's just something you have to do in a forward-deployed military like ours.

Fair point. Everyone going into the military now should expect to be deployed... multiple times.

I actually enjoyed my deployments in a lot of ways. It sucks to be away from your family (and it helps to have a supportive spouse... mine is way better than I deserve), but the medicine was actually easier than in CONUS. I say "was" because at that time the admin types weren't so keen to deploy, and we were generally left alone out in the desert to do what we thought was best. Recently, from what I understand, the administrative types have insinuated themselves into that environment too... I weep for deployed docs having to put up with that in addition to all the other vagaries of practicing in an austere environment.

Imagine... being given the stuff you need to do your job, and being allowed to do it unmolested by clipboard-carriers... what a concept.

Admittedly, I got dumber every single day I was out there (primarily because I spent months taking care of healthy young bucks without complicated medical problems)... but the tents, the sand, the scorpions/snakes... that stuff never bothered me.

 

[NavyFP]

You joined because you saw some pictures of planes on a carrier deck? Oh my.

Nah, I was thinking of the cats and going 0 to 200+ in under 2 seconds. 😀 Then praying the engines didn't quit, cuz I hate cold water.

 

[paradude]

I wasn't trying to pick on Desperado. It's not just him, frankly I'm tired of ALL of the whining from current and former military docs on this site. One of the stated objectives of a few former military doctors on here is to "kill" or "sink" military medicine (medical corpse comes to mind). I'll let you in on a little secret, that isn't going to happen. We're about to send a "surge" of up to 30,000 more troops into Iraq. Our obligations and commitments as a military go up each year around the globe. They aren't going down anytime soon. You can't find or fund enough civilian physicians as contractors to meet the needs of the military. The military medical depts. are here to stay.

So everyone on SDN knows that there are problems in military medicine. That means that you and I are going to have to solve those problems, not wish they weren't here, or gripe about how bad they were. We are 5 years beyond September, 11th! I'm not keeping anything from pre-med students when I tell them about HPSP and USUHS (which I think are both great programs). Everyone in America knows that when you join the military today you are going to go to Iraq, that's true whether you are an infantry grunt or an OB/GYN from Wilford Hall.

Desperado doesn't like the fact that we have shiny airplanes with big bombs and guns Well I do and I'm glad we're using them. Last week an AC-130 Spectre crew took out one of the planners of the 1998 African embassy bombings, while they were on a mission over Somalia. Desperado, are you ok with that? Does that hurt your sensibilities? The Islamo-Facists started a war with us 5 years ago and I don't expect that war to end before I finish my career in another 15-20 years. The Army and Navy didn't meet their recruiting goal for HPSP last year by a wide margin. Anyone here think that was because the potential recruits suddenly learned how messed up military medicine was and decided to steer clear? Or was it more likely that that pre-med student said "I'm not going to join the Army, they'll probably send me to Iraq."

Actually, I think we're probably getting a better product from both HPSP and USUHS now that there is a war on. It makes me think people are joining for the right reasons. The numbers will go back up when congress funds HPSP adequately, which I have some confidence they will do for next year.

Last thought, I can't speak for HPSP directly, (I'm at USUHS) although I would have joined the program if I would not have gotten into USU. In any case, I'm 7 months into this program and I'm pretty happy with my decision. In fact, I haven't met any current or prior students who are unhappy with their decision to attend. (Yes, medical corpse, you are an exception). This is why I like this university.

-I attend a tuition free institution, no fee for books, supplies or exams
-I'm going to make $65,000 this year(O1E with 8+), that's pretty nice for a former struggling student
-With that money I've been able to purchase a condo in the D.C. area, again a pretty nice deal for a young person, especially in this market
-I get to work out at a gym for free every day
-I will be able to retire with a decent salary at a very young age and move on to private practice
-My future patient pop. is the best in the world, hands down

So jump on in if you're so inclined, the water is nice and warm. All of you malcontents can crucify me if you like, for not toeing the party line, but all I hear is whining.

 

[Galo]

I wasn't trying to pick on Desperado. It's not just him, frankly I'm tired of ALL of the whining from current and former military docs on this site. One of the stated objectives of a few former military doctors on here is to "kill" or "sink" military medicine (medical corpse comes to mind). I'll let you in on a little secret, that isn't going to happen. We're about to send a "surge" of up to 30,000 more troops into Iraq. Our obligations and commitments as a military go up each year around the globe. They aren't going down anytime soon. You can't find or fund enough civilian physicians as contractors to meet the needs of the military. The military medical depts. are here to stay.

So everyone on SDN knows that there are problems in military medicine. That means that you and I are going to have to solve those problems, not wish they weren't here, or gripe about how bad they were. We are 5 years beyond September, 11th! I'm not keeping anything from pre-med students when I tell them about HPSP and USUHS (which I think are both great programs). Everyone in America knows that when you join the military today you are going to go to Iraq, that's true whether you are an infantry grunt or an OB/GYN from Wilford Hall.

Desperado doesn't like the fact that we have shiny airplanes with big bombs and guns Well I do and I'm glad we're using them. Last week an AC-130 Spectre crew took out one of the planners of the 1998 African embassy bombings, while they were on a mission over Somalia. Desperado, are you ok with that? Does that hurt your sensibilities? The Islamo-Facists started a war with us 5 years ago and I don't expect that war to end before I finish my career in another 15-20 years. The Army and Navy didn't meet their recruiting goal for HPSP last year by a wide margin. Anyone here think that was because the potential recruits suddenly learned how messed up military medicine was and decided to steer clear? Or was it more likely that that pre-med student said "I'm not going to join the Army, they'll probably send me to Iraq."

Actually, I think we're probably getting a better product from both HPSP and USUHS now that there is a war on. It makes me think people are joining for the right reasons. The numbers will go back up when congress funds HPSP adequately, which I have some confidence they will do for next year.

Last thought, I can't speak for HPSP directly, (I'm at USUHS) although I would have joined the program if I would not have gotten into USU. In any case, I'm 7 months into this program and I'm pretty happy with my decision. In fact, I haven't met any current or prior students who are unhappy with their decision to attend. (Yes, medical corpse, you are an exception). This is why I like this university.

-I attend a tuition free institution, no fee for books, supplies or exams
-I'm going to make $65,000 this year(O1E with 8+), that's pretty nice for a former struggling student
-With that money I've been able to purchase a condo in the D.C. area, again a pretty nice deal for a young person, especially in this market
-I get to work out at a gym for free every day
-I will be able to retire with a decent salary at a very young age and move on to private practice
-My future patient pop. is the best in the world, hands down

So jump on in if you're so inclined, the water is nice and warm. All of you malcontents can crucify me if you like, for not toeing the party line, but all I hear is whining.

paradude, you are a typical gung ho medical student that has very little clue about what is about to happen to you, yet you have the gall to call us whiners. You will learn when you are trying to take care of that deserving poulation what obstacles you find, and then come back and post. Till then keep you testosterone in check, as you only show your ignorace and immaturity.

 

[Ex-44E3A]

Maybe I missed where Medical Corpse wants to kill military medicine. Truth is, the bureaucrats and nurse-administrators have already done 90% of the job. The current illusion of "world-class" military medicine isn't good enough... the troops deserve better than what they're being given.

The military needs physicians... no doubt about it. Unfortunately, the way they're going about accessioning docs, delivering care to the force, and structuring the medical corps is upside down and backwards. We're currently engaged in a long war, and probably will be for decades. Simply throwing money at this problem will probably NOT be enough. Paradude's right... the military can't buy its way out of this problem.

Much of the care in CONUS could be delivered by civilians, particularly for dependents and retirees. If the military would beef up Tricare (and augment the VA system for retirees), set a decent reimbursement rate (Tricare is currently looked upon almost like Medicaid), and streamline referrals and payments, the dependent and retirees could be entirely offloaded from the AD military medical system. This would provide some temporary breathing room for the system to change.

There are civilian providers right now who would be willing to care for those retirees and dependents, if only Tricare weren't so painful and poorly reimbursed.

As for the active force, that's going to require some creativity, and it's not going to be painless. The military needs to stop milking the constant treadmill of docs going in-and-out of the service. It's an inferior and stupid way to keep the force staffed. It makes continuity of care a joke, and ensures that you're always dealing with a crop of greenhorn lowbies who have never deployed, and don't know the military system. There's a steep learning curve that newly-accessioned docs must climb, and it seems idiotic to continually expend that energy when some effort towards retention would make it unnecessary.

Truth is, the military needs docs a hell of a lot more than docs need the military. At the rate that HPSP accessions are dropping off, the military will have to go begging, and soon. The reality is that the hard-heads running the show will likely go to a doctor draft instead of tackling the hard task of eating the **** sandwich that's been so long in the making... that's how cynical I am about the future of military medicine.

Once you've tweaked retention and accessions to actually have enough docs, the next question become how to keep them adequately trained. Military hospitals are closing, case volumes are dropping, and too few military docs actually treat the kind of horrific traumatic injuries they'll encounter in wartime. That needs to change. I'd implement something like CSTARS, only on a much larger scale, with more funding, and in more places (CSTARS is a good idea, but the implementation of it needs some work). Regional and inner-city trauma centers are the only places with enough nasty trauma cases (penetrating and blunt) to keep military ER docs and surgeons Sierra-Hotel enough to get it done out in the field. Inner-city trauma centers have financial solvency problems, and difficulty keeping staff... seems to me there's an opportunity there. Keep permanent rotating teams at civilian trauma centers and trauma programs and compensate them. You could also significantly sweeten the reserve package, and gain access to more docs that way. This will all require money, but if you want fresh, skilled, up-to-date and Frosty-with-trauma docs, I fail to see a cheap way to do that.

I've said it before, and I'll say it again: military docs are a different breed of cat. They have a significantly different skill and knowledge set than civilians, practice in a unique environment, with its own computer system, its own paperwork, and its own idiosyncracies. We should recognize that right from the start. The military could go a long way towards fixing their doctor shortage by actually attempting to retain those who show a knack or interest in the service. Once a doc shows an interest, mentor them, show some flexibility, throw them a bone, give them some bennies, even the occasional attaboy... protect your team members and make them feel valued... leadership and team-building 101. Take care of your people, and they will take care of you... unit integrity.

As things stand right now (I can only speak for the AF), Randolph doesn't seem to give a flying hoot what docs think. They accept their single-digit retention rate, and rely on HPSP to keep the machine going (fixing that would require effort, money, and a change in philosophy). They don't expect to retain anybody, and it shows in everything they do. Physicians, as generally smart and terminally-degreed professionals, rapidly figure this out, and hence feel little loyalty towards a system that disdainfully treats their input and opinions with complete and utter indifference.

I'm game for a different kind of thread. Let us discuss potential solutions instead of dwelling on the problems, and anyone (even the studs, and I'm looking at you, Paradude) feel free to jump right in... and if you feel like I'm totally full of bullsh*t and none of the above will ever work, then fine... you can say that too, but you also had better tell me how you would fix it. I don't care how outside-the-box it is... cough it up.

Hell... if the ideas are good enough, maybe Homunculus will be kind enough to make a list and sticky it.

 

[orbitsurgMD]

I'm hardly a stud, but let me ask a question.

Many posts frequently lament the lack of physician members on assorted key committees and decision-making bodies. There also seems to be (in my admittedly limited experience) a general reluctance of physicians to become involved in administrative bodies and thereby detract from their clinical time.

Is it possible that, if more physicians were willing to participate in the higher-level administrative nitty-gritty of military medicine, things might improve? Or is the lack of physician participation more a matter being intentionally excluded by the other disciplines and the admin types?

The administrative graveyards are studded with the headstones of such committees (and real graveyards by now, with their members). Doctors have been invited to make such committees in the past, and yet, here we have the state of the present. The line drives policy inasmuch as anyone in the military determines anything. They don't get to write the laws of supply and demand, though.

The present trend is on final to fail within the decade. This time, fail will mean not enough GMOs from the internship and HPSP pipeline. They will have to cannibalize their residency-trained staff even more than they do now, and that still won't meet the need, since large numbers of doctors leave before starting residency PGY2 anymore. Cannibalizing the residency-trained will compel backfill from reserve units. This too will fail. In the minds of those in the line, who mostly don't want to think about medical at all, just like they don't like to think about recruiting or Tricare or other mundane matters, believe that Congress will bail their sorry arses out with a doctor draft when they finally hit the wall. That will result in fresh but resentful and angry accessions who in the leadership's thinking can be made to work as GMOs. What they are not prepared for is the larger fight, the public fight they cannot control and the hugely negative publicity that will result when they, first, try to get this through Congress and, second, get the exposure to their sickly habit of forcing doctors out of internship to work at a level of training well below what is acceptable anywhere else in American medicine.

They are inviting open opposition from every standards-making body that governs medical training and licensing standards in the U.S. today. That is a fight that will not be won and that will block their plans for a doctor draft.
And don't think that drafting residency-trained physicians is the solution; American civilian communities want those bodies, and unlike the military, are willing to pay for them. It will be a battle royal.

 

[Homunculus]

Actually, I think we're probably getting a better product from both HPSP and USUHS now that there is a war on. It makes me think people are joining for the right reasons. The numbers will go back up when congress funds HPSP adequately, which I have some confidence they will do for next year..

trust me, the product is not better. the quality of applicants for residency is widening-- you still have some overachievers, but the percentage of . . "less than desireable" candidates is increasing. and the military has no choice but to take them. i agree that at least those people are joining for the "right" reasons, but to say the product is better is a bit head-in-the-sand-ish. i overheard at least one department chief in a different specialty comment on "this years selection board was completely underwhelming" and how "disappointed" she was in the quality of applicants.

and i find it interesting that you comment on people joining for the right reasons, then stating that the numbers will go up when HPSP is "funded adequately". that's the problem. people who join for the money are not doing it for the right reasons. money is not and will never be enough of a reason to join. and honestly, i think they can jack the HPSP stipend up to whatever they want, and people are still going to stay away. OIF/OEF will be fresh on people's minds for a long time. the post 9/11 HPSP recruit will always be different than the pre 9/11 recruit. i guess we'll see how it pans out.

--your friendly neighborhood pre-9/11 HPSP/ROTC sign up caveman

 

[Ex-44E3A]

Sorry, tired.

"Stud" = med student

With regard to medical staff and hospital committees, I serve on them (and have even chaired a few), but the civilian administrative burden is relatively light, and meetings are quarterly. We also have the ability to implement changes with our colleagues instead of submitting them to yet another committee who may or may not accept them. The worst thing that can happen if I miss too many meetings is that I pay a nominal fine... which I'm happy to do.

Some civilian hospitals have gone to a system of financially compensating committee chairmen and chiefs-of-staff for their time. Some of those admin positions can eat up a significant number of personal and clinical hours, and the civilian medical system offers some consideration for that. For the military to do such a thing would require the fundmental paradigm shift of acknowledging the value of a physician's time. I won't hold my breath... the military practically invented the concept of waiting in line to find out what line to wait in.

The other problem is that military medical committees hold no real power... the whole thing (and most importantly the purse strings) are under the control of the line. Until the line side gets over its love/hate relationship with the medical side, nothing is going to get done.

 

[The White Coat Investor]

[

 

[8744]

Thank you, I will.

You got to do all the "cool" stuff in the military. Fly around Africa and the middle east, jump out of planes, shoot fun weapons, blow stuff up blah blah blah. So far I haven't done anything cool in the military, I couldn't even get stationed overseas despite requesting it.

The main problem I have with the slideshow that was posted isn't so much that it glorifies war (which it certainly does) but that it portrays this life of fun, adrenaline, explosions, cool travels etc which is so far from what I do day to day its laughable. The other day I saw 75 patients in 12 hours (do the math) in my "emergency" department. Only 2 were admitted to the hospital. 90% of them were 18-25 year olds and were sent in by their supervisors to get a note from me saying they could go home for the day. The "highlight" of the week was going to gas mask training class where I listened to an E-2 teach me about toxicology for 3 hours before signing my paper so I could go back to work. If the "paradudes" are at the tip of the spear, I'm way back at the handle with the accountants. It just ain't that cool.

You've seen the ole financial thread. I paid about $200,000 for the hassles of being a military medical officer. Great bargain. Different game for you. Previous service=high pay at USUHS and very little time left until retirement after your commitment is up. Not a bad financial deal at all.

You joined for all the right reasons? Are you suggesting that the military members shooting Somalians from the back of an AC-130 are somehow giving more to their country than the firemen who rushed into the twin towers? What about the inner city emergency docs taking care of the homeless, the destitute, the abused, and the dying on a daily basis in this country?

Thanks for your service, but don't think you're the only one out there making sacrifices for this country. I would be curious as to what you think "the right reasons" are?

To close with and destroy the enemy by means of fire and maneuver. Or to support the guys doing it. What's so complicated about that?

 

[The White Coat Investor]

.

 

[paradude]

What would the right reasons be for joining the military as a doctor?

They would embody something like the desire to treat our military hero's for whatever ails them and to place that treatment at a higher level than ones own personal desires and comforts. It would be the willingness to stare down our enemies with a steely resolve and say that our way of life is worth defending, that we value personal freedom. Mahmoud Ahmadinejad, has made it his goal to wipe Israel off of the map and then to take on the great Satan (the US). I fully expect to pull my next rotation in Tehran, just like I pulled one in Baghdad in 2003.

What would the wrong reason be?

It would not be coming in for a free education and complaining about the following:

-My E2 didn't take the vital signs for my last patient in the manner in which I prefer. I don't know how to deal with this insubordination.
-I have to work at an undermanned clinic and do more with less (much like every unit in the military).
-I just spent 6 months in the sandbox and it wasn't easy, I really missed my family while I was gone.

A previous poster asked me what I would do to rectify the military medicine problem. I have two suggestions;

First, as much as we like to pretend that it isn't the answer, one of the problems is about money. Serving your country in a combat zone is dangerous and you should be reasonably compensated. That includes beefying up the HPSP stipend, and paying military doctors a better wage. This could be easily accomplished by adjusting the bonus chart for board certified physicians and raising the HPSP stipend. Secondly, I would give doctors credit for the time spent in medical school. Currently, a physician comes in at the age of about 25 or 26, after med school at the rank of Captain, with 0 years time in service. They are 4 years behind their college classmate who got an English degree and is now an Infantry Captain with 4 years of service. This isn't right and fixing it would encourage many good docs to stay in rather than bail as soon as their HPSP contract expired.

I have also been accused of immaturity. Yes, I'm a med student, but I bet I'm one of only a handful of posters on this site who have flown dangerous combat missions in Iraq. I guarantee you that I'm the only one on this site who has done two HALO jumps in Iraq! I would submit that I sacrificed and put as much on the line as anyone on SDN and I'd appreciate it if you hold back from the immaturity characterization.

 

[MedicalCorpse]

I wasn't trying to pick on Desperado. It's not just him, frankly I'm tired of ALL of the whining from current and former military docs on this site. One of the stated objectives of a few former military doctors on here is to "kill" or "sink" military medicine (medical corpse comes to mind).

Show me where that's my stated objective, bucko. I am a mourner at a funeral of an already dead victim of premeditated murder. The victim is "Military Medicine" (not "Health Care"); the murderers are the Pentagon pukes who stood by while a proud institution was skull-raped in the name of saving dollars for the line, so that they could retire to golf courses, while active duty warriors, their dependents, and our honored retirees are shafted with shoddy care.

Secondarily, I am also the MedicalCorpse, in that my 19 year military career (15 toward retirement) was murdered by those who made staying in the corrupt and dysfunctional system so damaging to my honor that I could not continue. I just could not shut up about the malpractice we were being ordered to perform/enable on a daily basis.

I could not remain silent while in uniform. Now that I am free of the stifling mitt of the UCMJ over my mouth, I will speak out even louder now.

Deal.

P.S. I say again: when you have been an attending physician in uniform for 1.5 decades, come back here and tell me whether I was wrong in my assessments. That would be, um, 2025 or so, right?

--
R

 

[Galo]

What would the right reasons be for joining the military as a doctor?

They would embody something like the desire to treat our military hero's for whatever ails them and to place that treatment at a higher level than ones own personal desires and comforts. It would be the willingness to stare down our enemies with a steely resolve and say that our way of life is worth defending, that we value personal freedom. Mahmoud Ahmadinejad, has made it his goal to wipe Israel off of the map and then to take on the great Satan (the US). I fully expect to pull my next rotation in Tehran, just like I pulled one in Baghdad in 2003.

What would the wrong reason be?

It would not be coming in for a free education and complaining about the following:

-My E2 didn't take the vital signs for my last patient in the manner in which I prefer. I don't know how to deal with this insubordination.
-I have to work at an undermanned clinic and do more with less (much like every unit in the military).
-I just spent 6 months in the sandbox and it wasn't easy, I really missed my family while I was gone.

A previous poster asked me what I would do to rectify the military medicine problem. I have two suggestions;

First, as much as we like to pretend that it isn't the answer, one of the problems is about money. Serving your country in a combat zone is dangerous and you should be reasonably compensated. That includes beefying up the HPSP stipend, and paying military doctors a better wage. This could be easily accomplished by adjusting the bonus chart for board certified physicians and raising the HPSP stipend. Secondly, I would give doctors credit for the time spent in medical school. Currently, a physician comes in at the age of about 25 or 26, after med school at the rank of Captain, with 0 years time in service. They are 4 years behind their college classmate who got an English degree and is now an Infantry Captain with 4 years of service. This isn't right and fixing it would encourage many good docs to stay in rather than bail as soon as their HPSP contract expired.

I have also been accused of immaturity. Yes, I'm a med student, but I bet I'm one of only a handful of posters on this site who have flown dangerous combat missions in Iraq. I guarantee you that I'm the only one on this site who has done two HALO jumps in Iraq! I would submit that I sacrificed and put as much on the line as anyone on SDN and I'd appreciate it if you hold back from the immaturity characterization.

You just do not get it. As you thump your chest telling us how much of a billy bad ass you are, you are just once again showing your immaturity. I wonder if your going to tell us next how many Iraqi's you shot?

Money IS NOT THE ANSWER, I know that has been stated multiple times, and its never one of out top complaints.

Its doubtful that you will understand anything other than what you want to believe until you live it for yourself. Till that time, give us the benefit of experience and stop acting like you have the answers, I'm not sure you even undestand the questions at this time.

No one is going to denigrate your service, but do not use it to denigrate ours. Multiple physicians have outlined multiple times a very large number of legitimate complaints, and for you to tell us we are whining, while you outline how perfect you were in the military, is just plain stupid.

 

[resxn]

frankly I'm tired of ALL of the whining from current and former military docs on this site.

Everyone in America knows that when you join the military today you are going to go to Iraq,

Or was it more likely that that pre-med student said "I'm not going to join the Army, they'll probably send me to Iraq."

-I attend a tuition free institution, no fee for books, supplies or exams
-I'm going to make $65,000 this year(O1E with 8+), that's pretty nice for a former struggling student
-With that money I've been able to purchase a condo in the D.C. area, again a pretty nice deal for a young person, especially in this market
-I get to work out at a gym for free every day
-I will be able to retire with a decent salary at a very young age and move on to private practice
-My future patient pop. is the best in the world, hands down

(I rarely get physically upset on this board, but this previous post did it for me. I originally had a much longer post with 3 other points. These have been deleted for the following in order to prevent the loss of my rant on a closed mind)

I detest when people come on this board and tell me I'm whining when I constructively criticize the very system in which I work. ESPECIALLY, when that very poster is someone who is not even a part of the system. It's worse than if my 7yo child were to tell me that my economic philosophy was flawed.

5/6 bullets above for you deal with money in some fashion or another and only 1 deals with patients. Very interesting selection of positive points coming from someone who is so hell bent on saying how great it is to serve and the act of service itself should trump all concern. It would appear you're in it for the financial benefit. Great. Then get off your high horse and pay respect to those of us who are trying to vent about how difficult it is to fix a system that won't listen to us.

Prior to this board, I didn't have an outlet and I didn't have information. I didn't know if I was alone with my disappointment with not being able to properly care for my patients. This board allowed me to find that I was not alone and has allowed me to have more assurance so that when I do address my concerns to my superiors, I do not have to fear that I am without base. This board is a tool for those who use it appropriately, not just some meaningless place to whine.

There's a guy, not sure you've really listened to what he had to say, but he wrote something like this, "That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient causes; and accordingly all experience hath shewn that mankind are more disposed to suffer, while evils are sufferable than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same Object evinces a design to reduce them under absolute Despotism, it is their right, it is their duty, to throw off such Government, and to provide new Guards for their future security." (emphasis added)

Our nation, as Jefferson pointed out, was founded by those who believed in fighting for a better way, fighting for freedom, fighting for the opportunity to pursue individual and collective liberty. Every single doc on this board that I've read only wants the medical corps to exist with the passion of the core values eloquently stated, but poorly instituted, in my beloved AF: Intergity First, Service Before Self, and Excellence in All We Do.

I am not whining about my life and my job, I'm letting you and anyone else on this board know how upset that those very ideals for which I stand and which are a part of my own core values are not honored, are not encouraged, and are sacrificed at the alter of inertia in military medicine.

Accuse me of whining? Go count your money in your DC condo, you immature, superficial, holier-than-thou pathetic excuse for an officer.

 

[resxn]

BTW, to the OP, I really like the slideshow.

 

[militarymd]

paradude,

As I continue to read your posts....it is clear to me...that you're not getting what the others are saying...or trying to say.

 

[NavyFP]

If they actually let me fly them off the deck I'd gladly pay the $200,000. I agree, that does look cool. Has nothing to do with the doctor down below seeing sick call, but it does look cool.

True

 

[Ex-44E3A]

-My E2 didn't take the vital signs for my last patient in the manner in which I prefer. I don't know how to deal with this insubordination.

It'd be one thing if they actually worked for you, and you had control over their EPRs, and could fire them... but you can't. Care to tell me how to deal with worthless and recalcitrant airmen when the command chain above you won't back you up, because they need every single warm body they can get?

-I have to work at an undermanned clinic and do more with less (much like every unit in the military).

"World-class" medicine costs money. There comes a point where low staffing, outdated equipment, rusty providers, and administrative interference negatively impact the quality of care. You may be OK with that... I'm not. I've been in the military long enough to know that the squeaky wheel gets the grease. Rumsfeld was right when he said "you go to war with the army you have," but that doesn't mean sweeping the problem under the rug is the right thing to do. Address it. Fix it. Then we'll all shut up.

-I just spent 6 months in the sandbox and it wasn't easy, I really missed my family while I was gone.

Delivered with the airy dismissal that only a young, single guy can provide... Bravo.

 

[mitchconnie]

Yes, I'm a med student, but I bet I'm one of only a handful of posters on this site who have flown dangerous combat missions in Iraq. I guarantee you that I'm the only one on this site who has done two HALO jumps in Iraq!

I hate to pile on here, since I’m sure you are well-intentioned and will end up being a good physician. But are you serious? What on earth does a Halo Jump have to do with military medicine? Talk of “kick-ass” combat missions may impress an 18 year-old high school kid, but not any of the people on this board.

Let me give you some examples of the “high-speed” experiences of some of the attendings on this board.

Ex44E3A: Desperately trying to intubate a crashing patient in hypovolemic shock who sustained massive cranio--facial trauma in an MVA. O2 sats going 80…70…60…50. Patient codes and dies.

MilMD: Struggling to resuscitate a patient undergoing a Thoraco-abdominal aneurysm repair who has lost 10 liters of blood, now has a pH of 7.10 and is having an MI on the table.

Resxn: Patient on the ward S/P radical neck dissection for laryngeal CA blows out his carotid and is pouring out blood into the bed. Nurses are freaking out—he’s struggling to gain control of the carotid on the ward in a re-operative field.

Myself: Cross-clamping the thoracic aorta during a thoracotomy in the ER to prevent a patient from exanguinating after sustaining massive blunt abdominal trauma.

Homunculus: Watching a 4-year-old girl die of leukemia in the PICU, while his 25 year-old parents stand around crying.


I don’t know any of these docs personally, but I know they’ve seen this kind of stuff because everyone who’s been through residency has seen it and done it—probably a hundred times over. Many of the physicians on this board face literally life-or-death situations every day both in CONUS and in Iraq. I’m not so sure that your halo jumps are relevant to a discussion of military medicine, but I would suggest that the above experiences are.

 

[paradude]

I hate to pile on here, since I’m sure you are well-intentioned and will end up being a good physician. But are you serious? What on earth does a Halo Jump have to do with military medicine? Talk of “kick-ass” combat missions may impress an 18 year-old high school kid, but not any of the people on this board.

Let me give you some examples of the “high-speed” experiences of some of the attendings on this board.

Ex44E3A: Desperately trying to intubate a crashing patient in hypovolemic shock who sustained massive cranio--facial trauma in an MVA. O2 sats going 80…70…60…50. Patient codes and dies.

MilMD: Struggling to resuscitate a patient undergoing a Thoraco-abdominal aneurysm repair who has lost 10 liters of blood, now has a pH of 7.10 and is having an MI on the table.

Resxn: Patient on the ward S/P radical neck dissection for laryngeal CA blows out his carotid and is pouring out blood into the bed. Nurses are freaking out—he’s struggling to gain control of the carotid on the ward in a re-operative field.

Myself: Cross-clamping the thoracic aorta during a thoracotomy in the ER to prevent a patient from exanguinating after sustaining massive blunt abdominal trauma.

Homunculus: Watching a 4-year-old girl die of leukemia in the PICU, while his 25 year-old parents stand around crying.


I don’t know any of these docs personally, but I know they’ve seen this kind of stuff because everyone who’s been through residency has seen it and done it—probably a hundred times over. Many of the physicians on this board face literally life-or-death situations every day both in CONUS and in Iraq. I’m not so sure that your halo jumps are relevant to a discussion of military medicine, but I would suggest that the above experiences are.

The reference I made to HALO jumps in a combat zone was my attempt to refute a previous poster who labeled me immature because he didn't like my viewpoint.

You would prefer a medical reference? How's this? I was at the UN bombing in August '03. Do a google search on that one to see the carnage of Zarqawi's indiscriminate bombing campaign. My first patient was a Brit who didn't have his legs attached anymore and was missing most of an arm. That was a pretty difficult patient to intubate and give an IV to. The worst part was he was still semi-coherent. I picked up many young men, some Iraqi but mostly Army/Marine Corps who had been hit by gunfire, mortar, RPG, or IEDs and I had to watch a few of them die in front of me. Look I'm not "thumping my chest", just saying I do have relevant experience to add content to this discussion board.

Again, my thesis is that HPSP and USUHS are good options for a lot of people. Most of you don't agree and I'm ok with that. No, I'm not an attending physician and as medicalcorpse pointed out, I won't be one for a long time. I CAN talk about my 8+ years as an AF PJ and my 7 months at USU, 90% of which has been positive. You guys don't mind an alternative viewpoint on here do you?

BTW mitchconnie, I have yet to use the words "kick-ass" or "high-speed" in any previous posts so I don't think the quotation marks are appropriate but I'll let you get away with it because I do consider some of my combat missions "kick-ass" and at times I did do "high-speed" things, although often we were in a tent working on our SOCOM video game scores. 🙂

 

[West Side]

The reference I made to HALO jumps in a combat zone was my attempt to refute a previous poster who labeled me immature because he didn't like my viewpoint.

Uh, the point would be as follows:

"What does a HALO jump have to do with anything but physical maturity?"

i.e., How is jumping out of a plane used as a metric for quantifying emotional growth? You could probably train an adult ape to conduct the sequence.

Answer: obviously, it has nothing to do with emotional maturity. Maybe when you grow up to be a big boy, you'll see this, and be willing to accept informed and experienced opinions that deviate from your own world perception.

 

[BigNavyPedsGuy]

Look I'm not "thumping my chest",

Yes you are

 

[mitchconnie]

You would prefer a medical reference? How's this? I was at the UN bombing in August '03. Do a google search on that one to see the carnage of Zarqawi's indiscriminate bombing campaign. My first patient was a Brit who didn't have his legs attached anymore and was missing most of an arm. That was a pretty difficult patient to intubate and give an IV to. The worst part was he was still semi-coherent. I picked up many young men, some Iraqi but mostly Army/Marine Corps who had been hit by gunfire, mortar, RPG, or IEDs and I had to watch a few of them die in front of me. Look I'm not "thumping my chest", just saying I do have relevant experience to add content to this discussion board.

Again, my thesis is that HPSP and USUHS are good options for a lot of people. Most of you don't agree and I'm ok with that. No, I'm not an attending physician and as medicalcorpse pointed out, I won't be one for a long time. I CAN talk about my 8+ years as an AF PJ and my 7 months at USU, 90% of which has been positive. You guys don't mind an alternative viewpoint on here do you?

BTW mitchconnie, I have yet to use the words "kick-ass" or "high-speed" in any previous posts so I don't think the quotation marks are appropriate but I'll let you get away with it because I do consider some of my combat missions "kick-ass" and at times I did do "high-speed" things, although often we were in a tent working on our SOCOM video game scores

I put those terms in quotes mainly because those are words used by many of the hooah types to describe their exploits--terms that I myself would never use. I didn't necessarily intend to attribute them to you. My apologies.

I think your experience as a first responder in the field gives you some credibility, but I'm not sure it translates to what is going on at the MD level at the MTF or CSH. I don't wish to be too strident, but my point is that great experiences which are a big deal on the operational/line side may not be such a big deal to a bunch of senior residents and attendings. Particularly in a forum where the main issues are whether military medicine is a worthwhile career; whether military residencies are good; pitfalls of the match; long-term financial prospects of a military career; etc.

Frankly, we've all seen plenty of horrific blast injuries and traumatic amputations, and I for one hope to never see another. It's unfortunate that I started an "I've seen worse carnage than you" pissing match. My mistake.

 

[Ex-44E3A]

Mitchconnie:

My Lebsche knife is bigger than yours!

 

[notdeadyet]

-I have to work at an undermanned clinic and do more with less (much like every unit in the military).

My cousin did his time in Iraq and risked his life to an unnecessary extent due to having to resort to hillbilly armor on his vehicle. He complained and still complains about it. Nobody's called him a whiner yet.

To not use one's voice when the system around one is failing (and failing the servicemen you keep touting as the best patientbase in the world), now THAT is cowardice.

 

[The White Coat Investor]

]

 

[hidradenitis]

I'm in my last year of residency, a former HPSPer, with a bunch of great experiences in my years of active duty military service. In the time that I've been in, I've:

1. received a great education (military-civ combo)
2. gotten paid like a bandit (for a resident)
3. been flown overseas for medical missions and whatnot (probably the coolest thing I've done medically) and been well paid for the opportunity, to boot
4. gotten a dream follow-on assignment with full-scope priviliges (knock on wood - don't jinx me)

Having said that, I can't see myself staying in for 20. Why? Because IT'S ALL TRUE. For many reasons (being in residency probably the biggest) I've been insulated from most of the major problems. But you can't hide the obvious--the system is broken and isn't on track to being fixed. I'd go into more detail, but I really don't have anything to add to what previous posters have been saying.

I'm proud to serve. I'll also be happy to have my life back.

 

[8744]

Uh, the point would be as follows:

"What does a HALO jump have to do with anything but physical maturity?"

i.e., How is jumping out of a plane used as a metric for quantifying emotional growth? You could probably train an adult ape to conduct the sequence.

Answer: obviously, it has nothing to do with emotional maturity. Maybe when you grow up to be a big boy, you'll see this, and be willing to accept informed and experienced opinions that deviate from your own world perception.

Come on now. Combat operations and even intense training operations are a good deal more difficult than anything I have encountered in residency....and I am in the middle of my second intern year. The theme of this thread was the non-medical side of the military on which Paradude is perfectly qualified to comment. I can respect someone's distaste for war, fighting, deploying, dropping bombs, and any number of things involved with the military but I don't see why anybody would enlist or seek a commission if they weren't prepared for them, or at least happy to support the guys doing them.

 

[pgg]

Answer: obviously, it has nothing to do with emotional maturity. Maybe when you grow up to be a big boy, you'll see this, and be willing to accept informed and experienced opinions that deviate from your own world perception.

Wow, it's interesting to see you speaking about "emotional maturity" and being a big boy, when just a couple days ago you were frothing at the mouth and "willing to play dirty" (your bold, not mine) to con your fiance out of her military service obligation. Seriously, you were considering pregnancy (though "lesbianism" was out of the question) as a ploy to help her fraudulently renege on her commitment.

You're not a medical student, you're not a resident, you're not an intern, you're not an attending, you're not in the military. You have nothing of interest or value to add to this forum, except possibly as an example of immaturity and dishonesty yourself. Go away.