Will these incentives fix the Army/Navy HPSP shortfalls?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Members don't see this ad :)
paradude said:
Will these incentives fix the Army/Navy HPSP shortfalls for 2007?

www.fra.org/AM/Template.cfm?Section=Home&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=3406
Click to expand...

The article mentions students dissuaded by the war, out of opposition to the administration's policies and out of personal wishes not to be sent to the areas of conflict. They will hardly see anything improved by making the stipend component of the deal pay better. The proposal offers nothing at all to those who don't want to experience the "churn and burn" of GMO assignments with delay and uncertainty of getting residency placement. That prospect is now as bad and maybe worse than ever. The people who would be choosing for money (and would be choosing for the wrong reasons) might be a little more tempted. I suppose to the services, when they need warm bodies, any reason to join is a good reason. I suspect they don't understand that most applicants who wouldn't join without the money offered still expect something more: respectable professional opportunities, quality training, a positive military experience. None of that is being addressed by the proposal.

So since this proposal fixes a pinhole leak while leaving the seacocks open, I doubt it will be the fix they are hoping it to be.
 
These numbers haven't passed yet. There is no guarantee that we'll ever see that $30,000 a year. Look at the criticisms on this board from the former attendings. Apparently the military has other concerns for its physicians beyond the salary gap between civilian and defense doctors.
 
The incentives need to be high enough that it pays MORE to be in the military than in the civilian world if we want to correct the problem. We need to attract the best and have people scratching and clawing to be military doctors. Then the best doctors would stay in and reform the system. The way it is now it doesn't make any sense to stay so only those without it (or whose patriotism is much, much greater than their sense of greed) do.

I would suggest raising ISP to 50-150K/year would do much toward the retention problem we have. Having the army and navy limit their deployments to 4 months would also help. Lastly, we need to divorce training from military medicine. Get rid of the enforced military match. Let medical students defer into whatever field they want, and then use them. If the military has too many of one specialty, make the docs right out of residency be flight docs/battalion surgeons for one year, then move them into their specialty.

The key to reforming the military medical system lies in solving the retention problem, solving the residency selection problem, putting physicians in charge of hospitals, and cutting through the B.S. that frustrates good docs.
 
sooooo....what you're saying is that nothing's going to change.
 
So I am assuming the GMO tour is the biggest problem along with the war..I see the article says that the Navy is having a more difficult time in getting docs and dentists than the Army...

Plus, I guees people wuss out and assume AF is going to be soo much better ;)
 
This is old news. Still have not seen the money.
 
There is a very simple two part solution to the whole problem of retention even at a time of war:
1. Dramatically increase physician salaries
2. Abolish the GMO tour
 
Desperado said:
The key to reforming the military medical system lies in solving the retention problem, solving the residency selection problem, putting physicians in charge of hospitals, and cutting through the B.S. that frustrates good docs.
Click to expand...

Also, free car washes for life for M.D.'s, zero Computer Based Training, and 100% clinician vs. administrator direction of patient care.

A Man Can Dream...

http://www.dreamquencher.com

--
R
 
What amazes me, well, not really is how many times the Dod has had the answer fully in front of them, and continually ignore it.

People reading this forum. Do you think for one second that I, or any of the people trying to educate you started on this crusade the day after we got out??

We've been writting letters, suggestions, phone calls, official complaints, unofficial ones, memmos, surveys, out interviews...........etc etc. The idiots on charge KNOW what the problems are. They hear it everyday, by active duty physicians who are naive enough to think they can make a difference.

I remember filling out MULTIPLE surveys from the Cheif of the Air Force, and dutifully spending HOURS typing away at the questions with multiple different suggestions that we place here all the time. The real problem is that they cannot implement those changes without radical changes that the system just cannot accomodate.

Money has always been less of a concern than say lack of skill retention, lack of support (admin and professional), GME, deployments. THe joke is that they are making money a more important issue than it really is. Sure the $ will get those that really do not understand, or those who have figured it out they cannot make it in the civilian world, but ultimately, this effort will continue to fail to meet their recruitment goals, as long as people contine to be educated about what they are really getting themselves into.

PATHETIC!!
 
Members don't see this ad :)
Also, free blow, er, car washes for life for M.D.'s, zero Computer Based Training, and 100% clinician vs. administrator direction of patient care.

A Man Can Dream...
Click to expand...

Personally throw in a cute and very flexible little blonde lieutenant to function as my source of after hours amusement and you might just get me to think about taking an HPSP scholarship. Wait.....I had that when I was in before, never mind..... :smuggrin:
 
paradude said:
Will these incentives fix the Army/Navy HPSP shortfalls for 2007?

www.fra.org/AM/Template.cfm?Section=Home&TEMPLATE=/CM/ContentDisplay.cfm&CONTENTID=3406
Click to expand...

I'm surprised that they don't raise the loan-repayment program to at least as much as they would spend on an HPSP student.

It would solve the GMO-tour complaint rather neatly, if they gave money to family practitioners (in large debt and facing a low-paying career field) who were already board certified. That way, they had fully qualified people who actually wanted to do primary care, doing primary care. It would generate a roundabout increase in HPSP, recruiting people who believe the chance of getting stuck with a GMO tour to be a major drawback to entering the service.
 
Pemberley said:
I'm surprised that they don't raise the loan-repayment program to at least as much as they would spend on an HPSP student.

It would solve the GMO-tour complaint rather neatly, if they gave money to family practitioners (in large debt and facing a low-paying career field) who were already board certified. That way, they had fully qualified people who actually wanted to do primary care, doing primary care. It would generate a roundabout increase in HPSP, recruiting people who believe the chance of getting stuck with a GMO tour to be a major drawback to entering the service.
Click to expand...


You're being logical....that never flies in military medicine.....or I should say...rarely flies.
 
Galo said:
People reading this forum. Do you think for one second that I, or any of the people trying to educate you started on this crusade the day after we got out??

We've been writting letters, suggestions, phone calls, official complaints, unofficial ones, memmos, surveys, out interviews...........etc etc. The idiots on charge KNOW what the problems are. They hear it everyday, by active duty physicians who are naive enough to think they can make a difference.
Click to expand...

Word.

Here is but a small sampling of the distress flares I shot up my dual chains of command (medical [SGH, Consultant] and coprocephalic [Squadron Commander on up]):

http://www.medicalcorpse.com/OPDformRCJ-redacted.doc

http://www.medicalcorpse.com/Grievances-redacted.doc

http://www.medicalcorpse.com/ClimateComments.doc

http://www.medicalcorpse.com/USUsurvey.doc

To quote my FAQ:

No one listened...because, as these documents indicate: "Clearly, negative input from a subordinate does not reflect adverse policies/practices of the institution, but rather deficiencies in the personality of the subordinate, which must be ruthlessly suppressed, utilizing the full power of military command authority, before he/she infects others with the desire to interact honestly and forthrightly with superiors appointed to mentor and guide junior officers along the Air Force career path."

Happy reading!

--
Rob
http://www.medicalcorpse.com
Look for new SDN banner ads Real Soon Now
 
They can promise you te moon but we've seen how they "giveth and taketh away" I.E. retirement medical benefits free for life to all retiress as promised - now my korea vet uncle must pay for tricare despite what he was promised back in the day, or arbitrarialy changing service committments, or .....



THEY CANT GIVE ME ANYTHING THAT WOULD BE ENOUGH TO COVER 6.5MONTHS OF 24-7 CALL (OTHERWISE KNOWN AS DEPLOYMENTS) WHICH KEEPS ME AWAY FROM MY CHILDREN...... THEY COULD PAY ME 1MILLION DOLLARS A YEAR AND I WOULD GET OUT WHEN MY COMMITTMENT IS DONE.


Not that I dont care about the troops, because I do, but since they send us over there without proper body armour, eyeprotection, make Medical techs, and nurses pull gate guard duty (which I think is against geneva conventions), When they allow Iraqi military people to sleep with US soldiers and they can carry their weapons but we can not ( as if none of the Iraqi police people are insurgents)... Then they have proven that My life is not valuable therefore my basic instinct is to my family.... If the military simply did what it should do many of us might consider staying longer, but since the baig monster has 500 heads and none of them have a brain big enough to control the feet then I must go.


Example of the many heads:

USAF is short of nurses - so they say - we cant admit patients to the hospital half the time because there is a bed shortage (AKA nursing shortage), but there are many high ranking clipboard nurses who can not touch a patient since somehow once you make Major you are allergic to hands on patient care.. Meanwhile someone else in the Air Force decided we have too many junior nurses (Huh?- then why cant we have more hospital beds open?) So they are not having promotion boards for Capt to Major causing many good nurses to leave, and they are allowing junior nurses to get out. Example two got out in 2005 at andrews LT type - leaving us with 1 pacu nurse.... A major.. Guess who got to be nurses then........


CRNA's and Anesthesiologists who did the case...This also happened at David Grant


Enough of a rant for today.
 
7by11thenout said:
THEY CANT GIVE ME ANYTHING THAT WOULD BE ENOUGH TO COVER 6.5MONTHS OF 24-7 CALL (OTHERWISE KNOWN AS DEPLOYMENTS) WHICH KEEPS ME AWAY FROM MY CHILDREN...... THEY COULD PAY ME 1MILLION DOLLARS A YEAR AND I WOULD GET OUT WHEN MY COMMITTMENT IS DONE.
Click to expand...

This is a good point, don't join if you don't want to deploy. (of course, that's what a military does so you probably should have been ready for it)
 
paradude said:
This is a good point, don't join if you don't want to deploy. (of course, that's what a military does so you probably should have been ready for it)
Click to expand...

Speaking only to potential family docs; 100% of the docs in my clinic preferred deployment to working in the clinic....for whatever its worth. That probably speaks more to the insanity of the stateside clinics than the wonderfullness of being deployed.;)
 
paradude said:
This is a good point, don't join if you don't want to deploy. (of course, that's what a military does so you probably should have been ready for it)
Click to expand...


You are right. But here is the rub. I was not rich growing up but I was an only child with two lower middle class parents - NO Financial aid available to me. So I joined the Military to pay for Med school when I was 21 years old. At that time I had no idea what my life would be so far in the future and 21 yr old me would have jumped at the opportunity to deploy and volunteered for it happily.

Then Life happened Now 12 yrs later I have other responsabilities that are more important than life to me. But I made what is in effect at 15 year committment before I had ever even heald a baby.

Also when I was young and blind I assumed that the military would need Docs so they would give us proper protective gear to keep us at least as safe as can be possible when in unsafe hostile places. WRONG - we have enough money to buy new desks at my current base, and 3 mill for new cabinenets that we dont need, why cant we supply our troops with Wileys or body armour first?

As for the docs who would rather deploy - I respect them, but since we cant even keep our female troops from being raped in their tents and we have a wingman down day to discuss this because it is so important why should i WANT to be sent into that environment. I am not saying that our enemies want to harm us I am saying that our own troops are doing some of the harm, and The briefing I got was that we did not have enough rape kits in theater to test the women who were injured.

I want to care for our troops, but if I cant take care of myself how can I care for them adequetely?

When you see the waste and abuse you just loose all interest in doing anything - I think it is called depression.
 
Dont get me wrong, when it is my time I will go and do my part and care for my patients to the best of my skills and equippment, but I will never say I want to deploy, my family is more important to me than that - I will go because I did make the committment, but being willing and Wanting to go are two separate things.

I am sure many people who find themselves in my situation feel the same way whether they admit it or not - not every soldier, sailor, airman, or marine WANT to be deployed. Although most of us consider it the main part of our job.


THats enough talking for now I will give the floor over to all those who think I am a piece of crap for wanting to raise my child. Feel free to commence bashing me.
 
7by11thenout said:
THats enough talking for now I will give the floor over to all those who think I am a piece of crap for wanting to raise my child. Feel free to commence bashing me.
Click to expand...

Simmer down!

He was addressing the question of whether the requirement to deploy could be considered a betrayal, a piece of abuse that ligitimately can be complained about as something the military does wrong to its doctors.

You addressed the question of whether you're a piece of crap for not loving deployments away from your family.

Those are two totally different questions.
 
7by11thenout said:
THats enough talking for now I will give the floor over to all those who think I am a piece of crap for wanting to raise my child. Feel free to commence bashing me.
Click to expand...

Don't forget, folks: I was given orders to go to Elmendorf without my two autistic children, while my wife was in premature labor on the labor deck at Travis on mag for a month...during the Air Force Year of the Family (YOFAM).

I considered it more a YOMOFO by the end of the year...

Entire story on this thread: http://forums.studentdoctor.net/showpost.php?p=4101757&postcount=4

I signed my life away at age 17...didn't reach the other end until age 41. That's a lot to ask of anyone.

The other point people should bring up: docs being deployed for no good reason. I can understand Balad, etc., where docs are kept busy; but many, many military docs (especially surgeons & anesthesiologists) deploy and do nothing. Vascular surgeons used to treat one or two "vascular" hemorrhoids in 6 months. Anesthesiologists used to sort through medical records of troops to make sure their shots are up to date, etc. Deployments usually dull one's skills rather than sharpen them...although I got pretty good at several video games while sitting on my ass in my VIP suite at the Hodja Inn (stocked to the ceiling with all the alcohol a Turkish General might want...and which I couldn't drink, since I was the only U.S. military anesthesiologist in the country). Tried video link to talk to my 2 year old a few times...very frustrating...almost worse to see the little ones from so far away than not...he couldn't understand...never mind.

--
R
 
7by11thenout said:
THEY CANT GIVE ME ANYTHING THAT WOULD BE ENOUGH TO COVER 6.5MONTHS OF 24-7 CALL (OTHERWISE KNOWN AS DEPLOYMENTS) WHICH KEEPS ME AWAY FROM MY CHILDREN...... .
Click to expand...


You chose to have children and be in the military...Should have known better..
 
interesting to read some of the contrasts and similarities between surgery related specialties and primary care.

differences: way too many patients versus way too few.
similarities: USAF manages to mismanage both situations.
 
I'm not getting personal. This is an educational website for those interested in military med. I guess we all know now (post-sep 11) that deploying is a part of life. I think that we can all agree that young men and women going into this career with eyes wide open is a good idea.

If you join the military medical corps you will deploy! Weigh that seriously against what else is important in your life.
 
paradude said:
If you join the military medical corps you will deploy! Weigh that seriously against what else is important in your life.
Click to expand...

When you have been out of Bethesda for 10 years, let us know what you think then. When 7by11 and I and many others were wandering around the MDL late at night, we had no idea what we would face in "the real world". We had no access to a forum such as this, where those who had graduated from USU 16 years prior took time out of their busy, civilian lives to give us the gouge, the poop, the real deal.

If we *did* have access to such a forum, we would have been grateful for the information passed on from centurion to legionary (Sorry, watching "Rome" on DVD recently). The point is not deployment or no; the point is how often, why, for how long, to what effect, and for what purpose. And, please, don't give me the Tennyson line, please...we have evolved too much as a species for that kind of willful blindness.

--
R
Nemo me impune lacessit.
 
MedicalCorpse said:
When you have been out of Bethesda for 10 years, let us know what you think then. When 7by11 and I and many others were wandering around the MDL late at night, we had no idea what we would face in "the real world". We had no access to a forum such as this, where those who had graduated from USU 16 years prior took time out of their busy, civilian lives to give us the gouge, the poop, the real deal.

If we *did* have access to such a forum, we would have been grateful for the information passed on from centurion to legionary (Sorry, watching "Rome" on DVD recently). The point is not deployment or no; the point is how often, why, for how long, to what effect, and for what purpose. And, please, don't give me the Tennyson line, please...we have evolved too much as a species for that kind of willful blindness.

--
R
Nemo me impune lacessit.
Click to expand...

"Forward, the Light Brigade! "Charge for the guns!" he said: Into the valley of Death Rode the six hundred. "Forward, the Light Brigade!" Was there a man dismay'd? Not tho' the soldier knew Someone had blunder'd: Their's not to make reply, Their's not to reason why, Their's but to do and die: Into the valley of Death Rode the six hundred. Cannon to right of them, Cannon to left of them, Cannon in front of them Volley'd and thunder'd; Storm'd at with shot and shell, Boldly they rode and well, Into the jaws of Death, Into the mouth of Hell Rode the six hundred. Flash'd all their sabres bare, Flash'd as they turn'd in air, Sabring the gunners there, Charging an army, while All the world wonder'd: Plunged in the battery-smoke Right thro' the line they broke; Cossack and Russian Reel'd from the sabre stroke Shatter'd and sunder'd. Then they rode back, but not Not the six hundred.


Rob,

Don't talk to me about the real world. I've watched friends fall in combat, have you? I've seen my share of dead bodies from sniper fire and IEDs, both Iraqi and Coalition casualities. Ok, you've been in an OR in the desert but all you and the rest of the "prior mil docs" on this site can do is nitpick. We are in a battle for our very culture and that is what I've signed up for. I know there will be sacrifices, hell I've already made them. But if the complaint is a 6.5 month separation from family and friends I call that a small sacrifice for the security of our great nation. Maybe the Navy/Army HPSP shortfalls for 2005 means we're getting rid of the dead weight we didn't want anyway. If you're ready to serve get on board, otherwise get out of the way.

When I'm out of Bethesda in 10 years I'll still be kicking ass and you, well you will be a distant memory.
 
Ok - If you think that loving family is a bad thing or that it makes me less of a person then your are entitled, however my beef with the general state of the military is that it does not take care of our soldiers such as yourself who have risked their --- and seen horible things. If you think that being deployed as a physician or anyother medical person is easy because we do not actually fight then rethink things for a while.

My friend part of the 82nd AirBorne was deployed from then end of 2004- beginning of 2005. He often called me to check on his wounded but alive soldiers recovering at WRAMC. He often emaild me about his personal losses, BUT HE also emailed me with positive things to say because he did see some good being done. My friends and coworkers DOCs nurses and Techs also deployed at the same time to the same places only had bad things to say - heres the rub... They only see destruction of human life, both ours and the Iraqi citizens. After a while even the most positive person starts to ask what am I doing this for? I fix this guy, but theres 5 more waiting all because someone hates me because I am not of their faith? I think everyone's job over there is important, but two groups of people who come back with more combat stress and PTSD are the chaplains and the Medical corp - not because we are weak, but because of the endless destruction we see and after so long it causes mental distress. Especially for a group of people who do not do well with failure and who chose to fight death by becoming health care givers in the first place. It goes against our nature. The AF "kills people and blows up things" - BUT as a Doc "I help peice things -people- back together - when possible"

As far as the comment of a 6.5mo separation being a "small" sacrifice then that is where we differ. My priorities are to GOD, Family then country. My point was that when I made my committment so many years ago my "family" did not exist so LIFE happened and changed me and my priorities.

AGAIN I LOVE THE TROOPS THAT I CARE FOR - THEY ARE WONDERFUL PEOPLE WHO DESERVE THE VERY BEST - and that is why I get frustrated and that is why I "nitpick" as paradude says -because the system does not treat them as the hero's they are. Try to get access to a Subspecialist surgeon whom you need to see, but cant because they have been deployed for 6 months to act as a GMO (Pediatric Oncologists, Urologists, Anesthesiologists,)

How about this one - I know someone who is not credentialed to be a critical care attending at his home base, but got deployed for 6 months last year as an ICU attending at Balad - you tell me - The TROOPS OVERTHERE DESERVE THE BEST - not just a warm body to fill out paperwork and do chart reviews.

Again I hit a tangent so I'll stop.

Paradude is right - If you dont want to deploy dont join. But for most on this website WE ALREADY HAVE JOINED so that logic may be better served at the HPSP recruiters office.
 
7by11thenout said:
Dont get me wrong, when it is my time I will go and do my part and care for my patients to the best of my skills and equippment, but I will never say I want to deploy, my family is more important to me than that - I will go because I did make the committment, but being willing and Wanting to go are two separate things.

THats enough talking for now I will give the floor over to all those who think I am a piece of crap for wanting to raise my child. Feel free to commence bashing me.
Click to expand...

I grew up in a military family, moving every year and went 12-23 monthes at a time, without my father at home. Cell phones were not available and no one (regular service) could afford long distance. Which also meant that we went monthes without hearing his voice

There is a well-known phrase about military service that has been around, at least 60 years or so.
"If the military wanted you to have a wife or family, they would have issued you one."

I empathise with you. But good luck, changing the system.
 

And from a Primary care stateside clinic perspective; that is not was the kids and dependents signed up for. I would still be against giving substandard care for active duty military, but I am even more against giving that substandard care to dependents. They are NOT "goverment property". The Surgeon General has obviously decided that he will cut staffing, experience, and just about everything else to save a buck. Active duty troops signed on the dotted line, agreeing to put themselves in harms way at the call of the goverment. If that harms way is being a patient in our clinic, that is tragic, wrong and sad, but it's the real deal. The dependents never agreed to that scenario.

Yes Dr 7by11thenout, we are indeed "in a battle". The troops in the middle east in a battle for democracy and against terrorism, and military docs will be there to support them there. . The physicians in the military are also in a battle here stateside against a medical beuracracy that has placed metrics and money up on their altar and swept excellence, integrity and physician careers into a gurney bag.:mad:
Click to expand...
 
MedicalCorpse said:
Also, free car washes for life for M.D.'s, zero Computer Based Training, and 100% clinician vs. administrator direction of patient care.

A Man Can Dream...

http://www.dreamquencher.com

--
R
Click to expand...

I would have liked to park less than 3/4 of mile from the hospital..."morning run" takes on a new meaning when parking at David Grant Medical Center.
 
MedicalCorpse said:
(Sorry, watching "Rome" on DVD recently
Click to expand...

good show. is there going to be a season 2?

in the army, general pediatricians are getting 12 month deployments, and subspecialists 6 month deployments (give or take). we have NICU docs who haven't see na patient over 2.5kg in the last 6 years going to Iraq/Afghanistan as GMO's seeing overweight middle-aged men with chest pain and every other adult condition under the sun. and those are just teh KBR contractors. would you want YOUR kid seeing a friggin NEONATOLOGIST if he were injured in iraq? i sure as hell wouldn't, lol.

at any rate, i knew the risk of deployment when i signed up. one year is a long time away from the family, but someone has to do it. and so far, nearly everyone has had to go. if anything, you're the odd man out if you haven't gone-- and trust me, people notice in a hurry who the "non-deployable" folks are, lol. active duty pregnancy rates have gotta be though the roof. if a woman plays her cards right, she can avoid deploying her entire obligation period by having well timed pregnancies. too bad us males don't have an option like that.

pediatrics in general is in a strange situation. we argue our "deployability" as GMO's as a reason to keep our GME programs around. needless to say, the army didn't exactly turn down the offer. we're the third highest man-hour deployed specialty in the military, behind general surg and FP. a bulk of the enlisted corps is <25, and generally in good health. which makes seeing them arguably within the realm of our expertise. it seems to be a huge waste though, as humanitarian missions, preventative medicine, and other interventions that we're actually good at aren't being implemented in either theater.

fixing the system will take money (and really not a ton of money-- just even us out with our civilian counterparts plus some kinda extra bonus for deployments beyond no taxes) and outsourcing everything except direct soldier oriented care. consolidate the services to eliminate redundant systems. then see what you have an go from there, lol.

-your friendly neighborhood non-ovary containing caveman
 
Hi there spelunker,

I think I mentioned before that one of the GMO's I worked with was in his first year of a civ peds residency when he was summoned to active duty as a GMO in the adult medicine clinic. So apparently, in the mind of Uncle Sam you guys are interchangeable with FP's. Better brush up on your geriatrics, with the 70 year olds now being recalled to AD to work in the desert, you'll be taking care of them next.
 
caroladybelle said:
There is a well-known phrase about military service that has been around, at least 60 years or so.
"If the military wanted you to have a wife or family, they would have issued you one."

I empathise with you. But good luck, changing the system.
Click to expand...

Well that quote is how they feel, but it is not how a loving mother or father feels.
 
7by11thenout said:
and when the Anesthesiologist said no he got in trouble with all kinds of reprisals, and his commander said, "you have to do this kind of thing in Iraq" and he said, "We are actually better equipped with blood and equipment in Irag than here" - no one listened and the case happened and the patient died on the table
Click to expand...

Here is the unedited, uncensored first part of an editorial I submitted to the American Society of Anesthesiologists Newsletter; an extremely redacted version was published by the ASA here: http://www.asahq.org/Newsletters/2006/05-06/lte05_06.html (look at the quality bottom of the web page)

In Praise of Disruptive Anesthesiologists:
Another way to "Support Our Troops"​

"The only one who should decide whether a surgery should proceed is the surgeon."
--LtCol (Dr.) (Thoracic) Surgeon, to myself and senior LtCol CRNA​

In response to the Feb 2006 ASA Newsletter article describing "Leadership and Problem Physicians: Managing the Disruptive Physician: The Responsibilities of Leadership" (pp. 23 & 25), as well as to the page 8 reference to U.S. military anesthesiology, I would like to bring the following thoughts to the attention of your readers, and to the ASA leadership.

The medical specialty of anesthesiology is inherently disruptive. This is not to say that we have an inherent tendency lose our tempers and lash out at our colleagues inappropriately. Rather, we are disruptive in the sense of "disruptive technology" (Christensen, Clayton M. [1997]. The Innovator's Dilemma, Harvard Business School Press. ISBN 0875845851; http://en.wikipedia.org/wiki/Disruptive_technology ). Unlike the cardiologists, gastroenterologists, and surgeons who require our services, we do not generally (outside of pain management) intervene positively to improve our patient's lives directly. Instead, we disrupt the processes of pain, hypotension, hypoxia, and death that would otherwise afflict our patients during procedures in our absence. When we, at the last minute, identify patients who are not ready to survive a procedure due to inadequate medical workup, we disrupt the operating room schedule and the surgeon's income (or sense of authority in the military, as will be addressed later). When we determine that a patient with severe sleep apnea needs to be admitted overnight after general anesthesia for respiratory monitoring, we disrupt the patient's plans for "in and out" surgery. When children are air-evaced from Guam for completely elective surgery under GETA and develop a severe URI en route, our discussion of perioperative anesthesia risk with the parents is seen as "poisoning the waters" (Major [Dr.] Pediatric Surgeon, 1996), rather than as an attempt to treat our patients as we would have our own children treated. Every single day, anesthesiologists around the world are subjected to verbal abuse, complaints to administration, and, in the case of the military, career-ending reprimands for doing our jobs as we understand them: to act as perioperative physician consultants whose key role is to ensure optimal patient care during the totality of the patient's perioperative experience—preop, intraop, and, yes, postop.

Sadly, in my 15 years as a military physician, I found that our treasured role as perioperative physicians co-equal to surgeons in importance to our patient's life was seen by every single high-ranking (O-6 and above) administrator, including one board-certified anesthesiologist hospital Vice Commander, as incompatible with good military order and discipline. In the civilian world, the fear of lawsuits somewhat (somewhat) modulates the surgical tendency to force anesthesiologists to commit malpractice in order to "just get the case done". In the U.S. military, the lack of fear of malpractice lawsuits due to the Feres Doctrine; the QA process that shields military physicians from the National Practitioner Data Bank; and the graciousness of military retirees and dependents; allows surgeons to push anesthesiologists to live beyond the edge of safe practice because they say so. This has led to a bizarre dynamic in which discussions of possibly canceling anesthetics (I never cancel surgery) due to inadequate patient preparation or hospital inadquacies routinely devolve into power struggles characterized by aggressive, alpha-male, primate dominance displays, during which "pulling rank" and airstrikes from non-clinical, e-mail-decubitus-suffering administrators trump all notions of appropriate, scientific, and humane anesthesia care. In every single U.S. military medical organization, anesthesiologists are lumped into Surgical Operations Squadrons (or their equivalents in the Navy and Army), where their necks are placed under the military command boot heels of surgeons, who exercise nearly unfettered life-and-death power over their subordinates' careers through the line-oriented military (in)justice system (UCMJ). Fear and reprisals are routinely used as bludgeons to silence all attempts by military anesthesiologists to increase their scope of responsibility from that of gas-passing, intraoperative technicians whose only military duty is to shut up and follow orders, regardless of patient safety.

Remainder of the complete editorial is here:
http://www.medicalcorpse.com/editorials.html

If an anesthesiologist's cautionary advice regarding a non-emergency case is listened to, the worst thing that happens is that a patient is transferred to a hospital with a higher level of care, undergoes further pre-operative workup, or waits until bad things diminish (ephedrine), or good things increase (pre-op beta blockers).

If all military anesthesiologists who speak out against commission of high-risk/low-volume surgeries on patients who have undergone inadequate workup and inadequate preparation are seen as "f***ing p***y case canceling cowards" by gung-ho surgeons eager to practice in a virtually malpractice-suit-free zone, the result is binary: Death, or Non-Death. If Death, it is swept under the rug. If Non-Death, the very fact the patient survived is used as a bludgeon to beat the anesthesia department into ignoring standards of care for the next dangerous case: "Hey, the last patient survived despite your whining, so..."

Cf. my earlier post re: kids riding around the neighborhood without bicycle helmets. Just because you go around the block once or twice and do not suffer brain damage does not mean you did a safe thing. Nor does it mean that your next bike trip will result in a similarly benign outcome, if you persist in your unsafe behavior. And, yes, kids will always...always whine when more experienced parents (er, anesthesiologists) warn them to take precautions.

To quote the late, lamented Steve Irwin: "Dain-jah, Dain-jah, Dain-jah!" As he proved, you can't swim with the most dangerous animals in the world forever. One of them will eventually do the "unexpected"...which is exactly what one should always expect in such situations. If swimming with Kevlar(R) isn't an option, not swimming should be considered to be a rational option, rather than a cause for bullying threats of LORs and Article 15s.

--
R
http://www.medicalcorpse.com
 
You must log in or register to reply here.
Next unread thread

Similar threads

I
Navy HPSP/HSCP information for those interested
Replies
14
Views
1K
militaryPHYS
militaryPHYS
K
  • Question
HPSP ODS seats - Navy
Replies
0
Views
787
km227566
K
V
Army VA HPSP and Army Reserve MDSSP at same time? And other questions about the programs
Replies
16
Views
2K
villain-cold
V
2
What percent of Air Force, Army, and Navy HPSP get into a military residency?
Replies
7
Views
2K
DrMetal
DrMetal
S
Navy HPSP Interviews
Replies
9
Views
3K
SupDoc1998
S
Top