Would you do it again

[idq1i]

Seeing all the new potential victims posting on the site asking questions about the military, I wanted to start a non-scientific poll. Please only post if you are an attending and you are currently on active duty (or recently retired)

The question: Knowing what you know now, would you sign up for military medicine again?

If you are a high-schooler, college student, med school applicant, resident, recruiter, please stay away from voting.

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[DrMetal]

Seeing all the new potential victim

Victim?! Nice choice of word. Victim nothing, you make your own decisions, you make your own bed in this world. If you feel you made the wrong decision for yourself and seek a change, that's totally fine. You're entitled to change and move on.

The question: Knowing what you know now, would you sign up for military medicine again?

You know the answer you're looking for, and you know the answer you're going to get on this forum. So what kind of affirmation are you looking for?

If you are a high-schooler, college student, med school applicant, resident, recruiter, please stay away from voting.

And why not? I've met people at all levels of training that are not happy with their decision, they'd probably help your cause. You don't have to wait until you're a fellowship-trained physician to become disgruntled at the military.

Please, lets try not post polls or threads that purposely exclude the some 75% of the readership here. This post is well in the running for 'Douchebag-post-of-the-Year'.

 

[BigNavyPedsGuy]

The goal is to ban a bunch of second year med students who all say how great things are. Until you've been forced to work in an unsafe, horrible environment that you can't quit without being sent to jail, you really don't fully grasp the suck.

 

[idq1i]

Please, lets try not post polls or threads that purposely exclude the some 75% of the readership here. This post is well in the running for 'Douchebag-post-of-the-Year'.

The experienced resident has spoken. Nothing else to say. Everyone move on along...

Love the personal attack. Excluding 75% is on purpose. Sorry, but your opinion without experience doesn't count.

I'll give you a couple of months at some Fort Pondscum, doing apeqs, PT and admin 50% of your time. Come back and talk then. See how employable you are by the end of your commitment.

The point of the post is to give the casual visitor looking for information an idea that his recruiter may be feeding him BS. Just a small incentive to keep reading. If you are not prior enlisted/otherwise, there is almost no way to know what you are getting yourself into.

 

[SuperSoccer19]

The experienced resident has spoken. Nothing else to say. Everyone move on along...

Love the personal attack. Excluding 75% is on purpose. Sorry, but your opinion without experience doesn't count.

It use to annoy me that people would post in this community as if expert in military medicine, when sometimes they weren't even HPSP yet. Now I just find it amusing.

I still have a year left on my committment and if I could go back in time, I would do it again. Yeah, I've been through a lot of crap situations, had to deal with malignant chain of commands, been placed in positions to do things that I did not feel the most comfortable, the admin sucks, etc., but the positive things I have done and seen have actually been really cool.

I've been on a ship and partied it up with other awesome sailors at NYC fleet week, I spent time on the USNS Comfort in South America, have escorted a friend's remains to his family as a military tradition (sounds morbid, but was probably the most meaningful thing ive done in my life), made awesome friends, I've lived in Japan, I served in Afghanistan.

I think (or would like to hope) I provided good, quality patient care even when in a crappy situation (ended up doing things outside of my specialty in Afghanistan due to very poor deployment screening system in the Army).

I might be an outlier in these forums, but there are some people who actually did have a decent tour. I also did my research and knew when my recruiter was filling me with crap. I also am not sure if i would be saying this if I was in another branch.

 

[EsTxDr]

I'll give you a couple of months at some Fort Pondscum, doing apeqs, PT and admin 50% of your time. Come back and talk then. See how employable you are by the end of your commitment.

A lot of the complaints I hear are not specific to military medicine. Some of these issues sound like a bad locum job. They are however why I chose to avoid active duty and pursue a more part time involvement in military medicine (which gives me significantly more control). I think what is important for the interested reader more so than the casual reader, is that every opportunity in life will come with positives and negatives. There will also always be those who hated/loved said decision. The moral of this story is to know what you're getting into. These negatives stories are as important as the positive ones to help you in that search. Just know that individual's experiences differ. If you are joining the military understand that you are joining the military. If that (and all it entails) is acceptable, issues like these become tolerable. The military doesn't have a monopoly on crap shows. .

 

[idq1i]

A lot of the complaints I hear are not specific to military medicine. Some of these issues sound like a bad locum job. ......

. If you are joining the military understand that you are joining the military. If that (and all it entails) is acceptable, issues like these become tolerable. The military doesn't have a monopoly on crap shows. .

You can quit a locums job.

People who have never been in the military rarely fully understand what they are getting themselves into. It's too much of a closed system for you to get a complete picture from the outside. If just one person, hypnotized by a recruiter wakes up and realizes that there is another side to this system, that's my goal in posting here.

If you know both sides of milmed and you still want to join, good for you. Go on ahead. The service members desperately need to have competent physicians to balance out the barely-competent mid-levels, the contractors that flunked out of the civilian world and settled at an MTF because the MTF is more forgiving of a lack of residency training, personality disorders and multiple NPDB hits.

 

[pgg]

I voted yes, because I've had pretty good experiences thus far and those have outweighed the bad.


But what the pollster is asking here, and what he means, are two different things. I signed up in the 1990s. The Navy and the world were different then. If it was 1990-something again and I was a 22 year old college senior and Clinton was president ... would I sign up again, as the poll asked? Sure.

Would I sign up NOW, if I was a 22 year old college senior NOW and a different Clinton was about to be president SOON ... well, probably not. These days I generally advise premeds to avoid HPSP (mainly because of the early commitment to inservice GME, the future of which is uncertain) in favor of civilian training and entry at a later time via FAP or direct accession - at a time when you're trained, better know what you really want, and better know what the military is offering right then. Notable exceptions being when the applicant has prior service, which changes the pay, retirement, and know-what-I'm-getting-into calculus.

 

[idq1i]

But what the pollster is asking here, and what he means, are two different things. I signed up in the 1990s. The Navy and the world were different then. If it was 1990-something again and I was a 22 year old college senior and Clinton was president ... would I sign up again, as the poll asked? Sure.

I was specifically not putting any restrictions on when you signed up. I wanted to see if those that are living through/lived thorough the milmed system would be willing to go through the process again.

Sure, a quick search of the posts here would quickly reveal that I am no fan of milmed, and I know exactly how many days I have left until I submit my resignation. However, it was not my intent to argue the pros and cons of the system. The interesting thing here is that the biggest defenders of the system are the ones that haven't lived through it yet.

I'm glad that you've had a good experience. It's also refreshing that you are able to see through the cool aid, and see that military is not a good place to get good training now, Most O-5/6s that got this far develop cool aid poisoning, and stop seeing any negatives in their back yard.

 

[DrMetal]

I'm glad that you've had a good experience.

No, you're not glad that he had a good experience, and you're probably pissed off that people actually posted some positive experiences above.

Be honest, admit it, you started this thread looking for a collective negative rant--as evidenced by the way you opened it, calling people 'victims', which mind you is kinda insulting. Plenty of people (even avid readers of this forum) have chosen to join after doing the research. You're hardly a victim if you voluntarily sign up.

And i have nothing against negative rants, Ive joined in on some of them, deterring people from joining. Just be honest about your intentions.

Im sorry this thread didnt turn out to be what you wanted.

 

[pgg]

It's also refreshing that you are able to see through the cool aid, and see that military is not a good place to get good training now,

No, that's not quite what I meant, though what I wrote was admittedly kind of vague.

Inservice training quality really is specialty dependent. Most are good, a few are OK. Truly poor training is uncommon. There probably isn't any truly "top tier" training program in the military ... then again, 90%+ of civilian programs aren't "top tier" either and that doesn't mean that residents don't get solid training.

The two potentially deal-killing problems that have swayed me to generally dissuade non prior service pre-meds from taking HPSP are:

1) A pre-med doesn't know ahead of time which specialty he'll choose, even if he thinks he does. What if he wants to do rad onc? This problem has always existed but I didn't recognize or appreciate it as a premed. Fortunately for me, I didn't pick rad onc.

2) More than a decade may pass between signing up and finishing residency, given the length of med school, the unknowable odds of GMO time, and then the length of an unknown residency. The structure of medicine in the US is changing rapidly, especially in the military, and that's a long time to commit yourself to a GME system that may be very very different when you actually enter it.

But I wouldn't agree that the military is a bad place to get training now. I got excellent training 2006-2009, that program isn't really any different now than it was then (1 fewer resident), and I don't see it changing appreciably.

Most O-5/6s that got this far develop cool aid poisoning, and stop seeing any negatives in their back yard.

I try to see the world for what it is, rather than what I wish it was. What I've seen of Navy medicine has certainly been imperfect. (What I've seen of civilian medicine via the last 4 years of moonlighting has been differently imperfect.)

Pay your money, take your chances, live your life, gripe to your wife and the internet, just don't kick the dog.

 

[DrMetal]

Pay your money, take your chances, live your life, gripe to your wife and the internet, just don't kick the dog.

Well said, nice post. Yours is the more mature attitude.

 

[EsTxDr]

You can quit a locums job.

Precisely my point. Your gripe is your inability to quit something you learned was not what you thought. Speaks to my broader point ... do your homework kids. If you join the military, understand what that entails. I've been a civilian contractor for the military at one point so I have some exposure, but it is not impossible to gain enough of an understanding of what you are getting into, to make a rational and educated decision. The fallacy of "you can't understand till you have done it" is a gross oversimplification. Logical, rational, educated decision are made everyday about the military.

Look, I hear you, I don't recommend HPSP to anyone. I think reserves and/or guard are great ways to go first. But there are those who understand enough of what they are getting into and are willing to overlook certain negatives (that aren't specific to the military) in order to serve. That's all.

 

[idq1i]

No, you're not glad that he had a good experience, and you're probably pissed off that people actually posted some positive experiences above.

Be honest, admit it, you started this thread looking for a collective negative rant--as evidenced by the way you opened it, calling people 'victims', which mind you is kinda insulting. Plenty of people (even avid readers of this forum) have chosen to join after doing the research. You're hardly a victim if you voluntarily sign up.

And i have nothing against negative rants, Ive joined in on some of them, deterring people from joining. Just be honest about your intentions.

Im sorry this thread didnt turn out to be what you wanted.

From personal attacks to mind reading... If you have a problem with my tongue-in-cheek "Victim"... ok. The intent of this thread was not to discuss pros and cons, as I mentioned previously. Once again, how long have you been on AD as staff?

I'm sincerely glad that he has had a positive experience. Different strokes for different folks. I think quite a bit depends on what specialty you are in, and where you are trained. Having had civilian training, some of the day to day operation of milmed shocks me. Putting PME before CME shocks me. Inability to demote/fire imbeciles scares me. Affirmative action pushing though some real gems through the enlisted ranks is saddening. Promotion/desirable assignment completely separated from medical skills scares me. Completely independent practice of mid-levels scares me. Near complete loss of control over your own medical care is frightening. Being threatened for practicing according to the latest guidelines is shocking. Your superiors being divorced from the daily practice of medicine is saddening, and results in low morale for those of us who still give a damn.

Can you see any of these things in the civilian world? Sure. However, milmed does a great job of collecting and condensing all of these in one place.

 

[idq1i]

... do your homework kids. If you join the military, understand what that entails. I've been a civilian contractor for the military at one point so I have some exposure, but it is not impossible to gain enough of an understanding of what you are getting into, to make a rational and educated decision. The fallacy of "you can't understand till you have done it" is a gross oversimplification. Logical, rational, educated decision are made everyday about the military.

You made my point for me. You were on the inside. Your homework was already done. There is no fallacy. There is no "logic" in this. You either know, or you don't know. People on the outside have very few means to discover what milmed is really all about. You don't even do anything military for over a year once you commit yourself to 4 years with just a signature.

Only once you KNOW can you more on to Educated Decisions and Logic.

 

[colbgw02]

Precisely my point. Your gripe is your inability to quit something you learned was not what you thought. Speaks to my broader point ... do your homework kids. If you join the military, understand what that entails. I've been a civilian contractor for the military at one point so I have some exposure, but it is not impossible to gain enough of an understanding of what you are getting into, to make a rational and educated decision. The fallacy of "you can't understand till you have done it" is a gross oversimplification. Logical, rational, educated decision are made everyday about the military.

Look, I hear you, I don't recommend HPSP to anyone. I think reserves and/or guard are great ways to go first. But there are those who understand enough of what they are getting into and are willing to overlook certain negatives (that aren't specific to the military) in order to serve. That's all.

I appreciate what you're saying, and it's good advice, but I think there's a bit of a false dichotomy here. That is, it is possible to make an educated, reasoned decision but still not know what you're getting into.

There were a lot of aspects of military life for which I was well-prepared. I grew up in the Army and "joined" via ROTC with the original intention of being a line officer. But the things that really get to me - and largely why I'll be separating at my first chance - are all of the things that I had no knowledge of or had no impact on me until I became staff. Even after half a decade in uniform as a resident, I had no idea about the ridiculous things that happen to which I am now exposed on a daily basis.

So, I guess what I'm saying is that yes, you should absolutely do your research and make an informed decision, but there is also value in listening to those of us who live this everyday. And yes, I'm afraid - at least in my case - that being staff has vastly changed my view of military medicine as compared to when in residency.

 

[corpsman33]

The experienced resident has spoken. Nothing else to say. Everyone move on along...

Love the personal attack. Excluding 75% is on purpose. Sorry, but your opinion without experience doesn't count.

I'll give you a couple of months at some Fort Pondscum, doing apeqs, PT and admin 50% of your time. Come back and talk then. See how employable you are by the end of your commitment.

The point of the post is to give the casual visitor looking for information an idea that his recruiter may be feeding him BS. Just a small incentive to keep reading. If you are not prior enlisted/otherwise, there is almost no way to know what you are getting yourself into.

So then why can't prior enlisted have an opinion? I'm not going to vote on the poll because I have not worked in the capacity as a physician. But I absolutely love the military (even the monotonous stuff they make junior enlisted do). Everybody here whines how bad it is, but I don't think SDN accurately reflects the same proportion of content physicians I have seen over the past 6 years working active duty.

 

[corpsman33]

No, that's not quite what I meant, though what I wrote was admittedly kind of vague.

Inservice training quality really is specialty dependent. Most are good, a few are OK. Truly poor training is uncommon. There probably isn't any truly "top tier" training program in the military ... then again, 90%+ of civilian programs aren't "top tier" either and that doesn't mean that residents don't get solid training.

The two potentially deal-killing problems that have swayed me to generally dissuade non prior service pre-meds from taking HPSP are:

1) A pre-med doesn't know ahead of time which specialty he'll choose, even if he thinks he does. What if he wants to do rad onc? This problem has always existed but I didn't recognize or appreciate it as a premed. Fortunately for me, I didn't pick rad onc.

2) More than a decade may pass between signing up and finishing residency, given the length of med school, the unknowable odds of GMO time, and then the length of an unknown residency. The structure of medicine in the US is changing rapidly, especially in the military, and that's a long time to commit yourself to a GME system that may be very very different when you actually enter it.

But I wouldn't agree that the military is a bad place to get training now. I got excellent training 2006-2009, that program isn't really any different now than it was then (1 fewer resident), and I don't see it changing appreciably.




I try to see the world for what it is, rather than what I wish it was. What I've seen of Navy medicine has certainly been imperfect. (What I've seen of civilian medicine via the last 4 years of moonlighting has been differently imperfect.)

Pay your money, take your chances, live your life, gripe to your wife and the internet, just don't kick the dog.

I always enjoy your posts and perspectives.

 

[Perrotfish]

nvm

 

[BigNavyPedsGuy]

So then why can't prior enlisted have an opinion? I'm not going to vote on the poll because I have not worked in the capacity as a physician. But I absolutely love the military (even the monotonous stuff they make junior enlisted do). Everybody here whines how bad it is, but I don't think SDN accurately reflects the same proportion of content physicians I have seen over the past 6 years working active duty.

Gripes go up not down. I don't complain to my corpsmen. It's not appropriate. And I'd venture to say that most of them have no idea how much I hate my job/how bad it is.

 

[WernickeDO]

This is a post from someone training in GME currently: All in all I feel good about the training I am getting. I think my program is exceptional. That said, I voted NO in the poll simply because my life changed in significant ways from beginning med school until now. When I joined HPSP, I was single and pretty sure I was going into primary care. When I graduated, I was married and heading for a non-primary care specialty. I had to ask my wife to make career compromises so that we could re-locate together, and I would have preferred to not do that. Additionally, you are always beholden to the needs of Big Army, so the training you want may or may not be available for any myriad reasons (sequester, Army doesn't need allergists, etc).

For most people, you simply cannot predict what your life will be like, what career you will want, or what your priorities will be 4 years in advance. If military service is something you want, I think you are better off doing FAP or coming to the mil as a contractor. Agree with above posts about some people being well suited for the HPSP, and I myself am still happy to be in the mil and to serve. I just wouldn't do it again.

 

[corpsman33]

Gripes go up not down. I don't complain to my corpsmen. It's not appropriate. And I'd venture to say that most of them have no idea how much I hate my job/how bad it is.

That may be, but the OP explicitly said "If you are not prior enlisted/otherwise, there is almost no way to know what you are getting yourself into" and I was just expanding on that. I agree that I don't fully understand what a doctor has to deal with (although I will in 2 years, but not yet). But I do FULLY understand about the time commitments and the loss of freedom/control that surround being an active duty member of the military. A noob who is joining the military may not grasp those points as well as somebody who has served for multiple years already. And I think that is where the OP was going with that statement.

But I stand by point that SDN does not reflect the opinions of the majority of doctors that I have personally worked with (and I have worked with a lot, 90% of whom tremendously encouraged me to join the medical corps community.......it is doubtful they would have done so if they hated their jobs soo much). I think there is a much higher percentage of whiners on here then you will see in reality (those who are happy with their military service do not tend to come on here to vent out there frustrations at being short sided and blind sided by the evil HPSP recruiters).

I cannot wait until I have a few years under my belt as an attending so I can post my experiences........maybe you all will be able to tell me "I told you so", but I highly doubt it......time will tell.

 

[bobbyseal]

I would probably do it again. But, if my family's finances were different I wouldn't. When I got accepted to medical school, federal financial aid was not going to cover the full cost of school, and I would need institutional aid. Most med schools require your parents financial information. It's a long story, but I wouldn't be able to do that. So, HPSP was really the only way in which I could have gotten the funding to go to med school. My time in the military hasn't been too bad. If I could have taken out all the loans, I probably would have done so.

 

[idq1i]

That may be, but the OP explicitly said "If you are not prior enlisted/otherwise, there is almost no way to know what you are getting yourself into" and I was just expanding on that. I agree that I don't fully understand what a doctor has to deal with (although I will in 2 years, but not yet). But I do FULLY understand about the time commitments and the loss of freedom/control that surround being an active duty member of the military. A noob who is joining the military may not grasp those points as well as somebody who has served for multiple years already. And I think that is where the OP was going with that statement.

Prior enlisted have a much better idea about the hooaaah/whatever the heck navy/AF have to say. They understand the loss of freedom, autonomy, needing to account for your location at all times, etc

They don't understand about the useless countless meetings that you have to go to where you don't talk about anything related to medicine, all the times where you have to go to sexual harassment training run by people that don't speak English instead of doing medicine, the adherence to outdated protocols just because they were put in place by some d-b O-6, the lack of case load and steadfast refusal to allow moonlighting, the CAP patient admitted to the floor for 2 weeks because the FP running the floor is clueless, a midlevel that tries to push you around because you are just a lowly 0-4, the incompetent contractor that never finished a residency and has multiple incompetence/dereliction hits on NPDB but is still employed because you are in an undesirable geographic location... This list goes on.

I don't love the hooaah stuff, but I know I have to deal with it. I've accepted it. I have a calendar in my office where I cross off each day that has gone by. I refuse to accept all the other stuff that doesn't let me take care of my patients to the best of my ability.

 

[IlDestriero]

I voted no, but I would do it again if I could have the same things happen. I caught every break and got everything I wanted, including not taking a prolonged trip to the sand box or a GMO tour. That is not the norm at all. Most don't catch all the breaks.
I also only owed 3 years so the financial damage was decreased. Losing a few years for a GMO tour and a few more during payback could add up to a couple million dollars for a specialist, much more for some specialties. You have to want to serve.

 

[corpsman33]

Prior enlisted have a much better idea about the hooaaah/whatever the heck navy/AF have to say. They understand the loss of freedom, autonomy, needing to account for your location at all times, etc

Completely agree!

They don't understand about the useless countless meetings that you have to go to where you don't talk about anything related to medicine, all the times where you have to go to sexual harassment training run by people that don't speak English instead of doing medicine, the adherence to outdated protocols just because they were put in place by some d-b O-6, the lack of case load and steadfast refusal to allow moonlighting, the CAP patient admitted to the floor for 2 weeks because the FP running the floor is clueless, a midlevel that tries to push you around because you are just a lowly 0-4, the incompetent contractor that never finished a residency and has multiple incompetence/dereliction hits on NPDB but is still employed because you are in an undesirable geographic location... This list goes on.

I don't love the hooaah stuff, but I know I have to deal with it. I've accepted it. I have a calendar in my office where I cross off each day that has gone by. I refuse to accept all the other stuff that doesn't let me take care of my patients to the best of my ability.

I agree with 90% of this as well, but enlisted do understand about countless meetings (especially when you are at a higher rank of enlisted you have to do even more meetings than most clinical medical corps officers) and stupid committees that you have to serve on to advance in rank, etc. etc. We also have to do all the sexual harassment training too (SAPR), etc. However, we have no idea how it feels to be forced to deal with patients that shouldn't be admitted due to incompetence, or having to use outdated standards to write orders, etc. on patients.

I voted no, but I would do it again if I could have the same things happen. I caught every break and got everything I wanted, including not taking a prolonged trip to the sand box or a GMO tour. That is not the norm at all. Most don't catch all the breaks.
I also only owed 3 years so the financial damage was decreased. Losing a few years for a GMO tour and a few more during payback could add up to a couple million dollars for a specialist, much more for some specialties. You have to want to serve.

I also agree with this and I desperately want to continue to serve. It pisses me off that people join that don't want to serve. HPSP isn't what it used to be, the standard MCAT is over a 30 now and there is a line of people that want to join (most of who won't get to because there aren't enough spots). If you aren't sure you want to serve, then don't sign up.

 

[EsTxDr]

I also agree with this and I desperately want to continue to serve. It pisses me off that people join that don't want to serve. HPSP isn't what it used to be, the standard MCAT is over a 30 now and there is a line of people that want to join (most of who won't get to because there aren't enough spots). If you aren't sure you want to serve, then don't sign up.

This is the bottom line to all of these discussions. If you want to serve, serve. If you are trying to just get school paid for, there are far better ways. Serving in the military is not without its negatives and risks. Its the same as people wanting to join and not deploy. Deploying is part of military, if you want to serve bad enough you will accept that.

 

[corpsman33]

This is the bottom line to all of these discussions. If you want to serve, serve. If you are trying to just get school paid for, there are far better ways. Serving in the military is not without its negatives and risks. Its the same as people wanting to join and not deploy. Deploying is part of military, if you want to serve bad enough you will accept that.

+1,000,000

I agree......I cannot stand the whining. And I bet one of those whiners will jump on here and tell me "just you wait until you get there".......well I'm looking forward to it!

 

[colbgw02]

+1,000,000

I agree......I cannot stand the whining. And I bet one of those whiners will jump on here and tell me "just you wait until you get there".......well I'm looking forward to it!

There's a middle ground that's largely being missed here.

I don't have much sympathy for people who join military medicine and then gripe about things like taking PT tests, wearing a uniform, moving to BFE, or getting deployed. Those are realities of the job that everyone is aware of or should be aware of before they sign up.

But there are real issues in military medicine - issues that chiefly don't exist outside of this particular system. I won't try to recount them here at the risk of being redundant, but let's just say that there are a lot of really great people who have been worn down by that system. And these weren't people who joined for the wrong reasons, did their time, and got out. I'm talking about people who are academy graduates and people who re-upped after their initial ADSO. People that wanted to stay until retirement, but instead are getting out at 13, 14, and even 17 years.

So let's not just dismiss everyone who complains about military medicine as a "whiner". That's an excellent head-in-the-sand approach that will undoubtedly permit one to reach general officership.

 

[deuist]

Deploying is a lot different than the skill atrophy, poor management, and asinine meetings/CBT that people typically complain of. I am about to attend my 5th sexual harassment seminar in 3 months. I had to get training on what HIPPA means. I had to receiving training on how a guaiac card works. I have to routinely transfer out all of our sick and semi-sick patients because the inpatient team is too incompetent to handle them. I didn't get to pursue a fellowship despite the specialty leader explicitly telling me that I would get to do so. I was lied to by my recruiter about how the match process works, as well as the salary that I would receive. I've had my personal information posted on publicly accessible websites.

These are the reasons I wouldn't join again. I'm looking forward to deployment just to get out of here.

 

[corpsman33]

There's a middle ground that's largely being missed here.

I don't have much sympathy for people who join military medicine and then gripe about things like taking PT tests, wearing a uniform, moving to BFE, or getting deployed. Those are realities of the job that everyone is aware of or should be aware of before they sign up.

But there are real issues in military medicine - issues that chiefly don't exist outside of this particular system. I won't try to recount them here at the risk of being redundant, but let's just say that there are a lot of really great people who have been worn down by that system. And these weren't people who joined for the wrong reasons, did their time, and got out. I'm talking about people who are academy graduates and people who re-upped after their initial ADSO. People that wanted to stay until retirement, but instead are getting out at 13, 14, and even 17 years.

So let's not just dismiss everyone who complains about military medicine as a "whiner". That's an excellent head-in-the-sand approach that will undoubtedly permit one to reach general officership.

I agree. I just take such a polar opposite approach because there are so few people on here who stick up for the military that I feel it's necessary to stand up for the other side.

But you make a good point (however, there are a ton of whiners on here and I do mean WHINERS, but others who do fall under the category you are talking about). I've followed many of your posts and I would have never put you in that category.

 

[EsTxDr]

There's a middle ground that's largely being missed here.

I don't have much sympathy for people who join military medicine and then gripe about things like taking PT tests, wearing a uniform, moving to BFE, or getting deployed. Those are realities of the job that everyone is aware of or should be aware of before they sign up.

But there are real issues in military medicine - issues that chiefly don't exist outside of this particular system. I won't try to recount them here at the risk of being redundant, but let's just say that there are a lot of really great people who have been worn down by that system. And these weren't people who joined for the wrong reasons, did their time, and got out. I'm talking about people who are academy graduates and people who re-upped after their initial ADSO. People that wanted to stay until retirement, but instead are getting out at 13, 14, and even 17 years.

So let's not just dismiss everyone who complains about military medicine as a "whiner". That's an excellent head-in-the-sand approach that will undoubtedly permit one to reach general officership.

Certainly I'm not attempting to paint all negative responses with the same brush. I've said several times the negative responses are as valuable in the decision making process as the positives. However, I just dont agree that its impossible to understand (to a large enough degree to make an educated decision) the issues with military medicine. Anyone who truly does their homework on the military and especially military medicine should expect these things. Its no secret how the federal government works these days. Granted I'm an old fart with lots of different life experiences behind me, but one's due diligence can be done and can avoid the shock and awe of .mil medicine. What I'm saying is that its possible to expect the status quo for the military in your medical practice and not be caught completely unaware when these issues take place. Are they frustrating? Yes. Do they burn good people out? Yes. Are they going to change? Probably not. Is this a secret? Absolutely not. Is it for everyone? Again, absolutely not. Can you understand you will face some serious issues (it is the military after all) and still enjoy your time and have a positive experience? Absolutely.

My point has only (and always) been that one can learn about these issues (not specifically but in general) and go in with eyes open. If an individual buys everything a recruiter (or any human being for that matter) sells them, they deserve what they get. No one is going to hold your hand and look out for you. You are responsible for your own life. If you can't get the answers you need, dont join. Joining and thinking happy thoughts leads to severe burnout like we see here. (not saying you guys have done that, just that it leads to the same place). Will many get there even with eyes open? Yes. But going in aware is possible. That. Is. All.

Deploying is a lot different than the skill atrophy, poor management, and asinine meetings/CBT that people typically complain of. I am about to attend my 5th sexual harassment seminar in 3 months. I had to get training on what HIPPA means. I had to receiving training on how a guaiac card works. I have to routinely transfer out all of our sick and semi-sick patients because the inpatient team is too incompetent to handle them. I didn't get to pursue a fellowship despite the specialty leader explicitly telling me that I would get to do so. I was lied to by my recruiter about how the match process works, as well as the salary that I would receive. I've had my personal information posted on publicly accessible websites.

These are the reasons I wouldn't join again. I'm looking forward to deployment just to get out of here.

I'm not comparing deployment to the issues, I'm drawing a comparison to the ability to understand what to expect. You can't know the date and time of your deployment just like you cant know the extreme details of what meetings will make you want to kill yourself, but you can (and should) know deployment is coming as is the pointless bureaucracy that is the military. See my post above.

 

[Gastrapathy]

Just look at retention. That is how this question is really answered. Getting out at 10+ years is commonplace and yet often a poor financial decision. Why are doctors making a poor financial decision? Maybe because they don't understand the value of an indexed pension but more likely because they've decided they can't do the time.

I totally disagree with the premise that you can make an informed decision about HPSP. The leadership doesn't have a clue about what the next 3 years will bring and an applicant can understand the next 15?

 

[EsTxDr]

Just look at retention. That is how this question is really answered. Getting out at 10+ years is commonplace and yet often a poor financial decision. Why are doctors making a poor financial decision? Maybe because they don't understand the value of an indexed pension but more likely because they've decided they can't do the time.

I totally disagree with the premise that you can make an informed decision about HPSP. The leadership doesn't have a clue about what the next 3 years will bring and an applicant can understand the next 15?

Nah. There are a million things that go into reasons for retention stats. To try and simplify it to this one is disingenuous.

Poor financial decision? An HPSP student gets out at 10 years as a 35 year old physician who can put in another 30+ years is in no way a poor financial decision. There is no comparison, in fact the opposite of your statement is true. Its a great financial decision to get out even at 10+ years. That's probably whats driving your retention stats.

Look, I get your point and I basically agree. I think HPSP makes no sense whatsoever for medical students. But understanding the modus operandi of the United States Military and the not-so-secret problems with military medicine (to anyone willing to become educated on them) can be had by interested individuals. There are those who understand this and are willing to accept it in order to serve.

 

[Gastrapathy]

Well, I guess you proved the point about not understanding the value of a military pension. I made the decision to leave but I did it with a clear understanding of what I was leaving and I'm in a highly compensated specialty. A 21 year O6 retirement is worth at least $1.8 million. You have to make a variety of assumptions to get to any estimate (how long you and your spouse will live, inflation, how my boglehead investing strategy will do, etc) but I believe that its probably worth more like $2.5m . So, to get the conservative end of that money in a decade, you'd need to save an extra $180,000/year after taxes and therefore make an extra $320,000. Now assume you are making $180,000+ in the .mil over that decade, add $320,000 and thats the approximate break-even point.

A .mil pension is a unique investment; indexed to inflation, impossible to outlive and held by a bank that isn't going to go bust. To say that there is no comparison is absurd for the vast majority of specialties. I'm not saying stay for the money but I'm consistently amazed at how much people undervalue the pension.

Here's a little pop psychology. I think people don't want to admit what its worth because they are so deeply unhappy and don't want to find reasons to stay.

 

[corpsman33]

Well, I guess you proved the point about not understanding the value of a military pension. I made the decision to leave but I did it with a clear understanding of what I was leaving and I'm in a highly compensated specialty. A 21 year O6 retirement is worth at least $1.8 million. You have to make a variety of assumptions to get to any estimate (how long you and your spouse will live, inflation, how my boglehead investing strategy will do, etc) but I believe that its probably worth more like $2.5m . So, to get the conservative end of that money in a decade, you'd need to save an extra $180,000/year after taxes and therefore make an extra $320,000. Now assume you are making $180,000+ in the .mil over that decade, add $320,000 and thats the approximate break-even point.

A .mil pension is a unique investment; indexed to inflation, impossible to outlive and held by a bank that isn't going to go bust. To say that there is no comparison is absurd for the vast majority of specialties. I'm not saying stay for the money but I'm consistently amazed at how much people undervalue the pension.

Here's a little pop psychology. I think people don't want to admit what its worth because they are so deeply unhappy and don't want to find reasons to stay.

I really don't think most people are aware that a retirement is worth this much. There was a thread awhile back about how much one would have to save per year to get out at the ten year mark and still break even. Most people had no idea. I'm pretty sure a lot of people are just ignorant to the value of a military pension.

 

[colbgw02]

I really don't think most people are aware that a retirement is worth this much. There was a thread awhile back about how much one would have to save per year to get out at the ten year mark and still break even. Most people had no idea. I'm pretty sure a lot of people are just ignorant to the value of a military pension.

I think many people have a very good idea what the retirement is worth, particularly nowadays when full coverage health insurance is worth a lot more than it used to. It just doesn't sway them enough. I don't buy the idea that people are separating because they're underinformed about the benefits of retirement.

 

[IlDestriero]

Would you do it again and should you stay in for the retirement are 2 different questions.
I might do it again, as I had a good experience, but I wouldn't stay for many reasons.
I could also save a lot more money if I wanted to live like I was making ~$200k instead of my current civilian income.
Not to mention my wife, who is also a professional, can enjoy a successful career without the stress of relocation.
As we inevitably march on toward more government involvement in healthcare and universal coverage, I'm not betting that 20-30 years from now that the healthcare retirement benefit will be a great added value.

 

[corpsman33]

I think many people have a very good idea what the retirement is worth, particularly nowadays when full coverage health insurance is worth a lot more than it used to. It just doesn't sway them enough. I don't buy the idea that people are separating because they're underinformed about the benefits of retirement.

Maybe and that would make logical sense (that people would look into the value of a pension thoroughly before separating) but the thread I'm talking about really spoke otherwise. When I have more time I will try and find it. I was actually surprised by the responses. Maybe Gastrapathy is right and people just do not want to find out.

 

[pgg]

Here's a little pop psychology. I think people don't want to admit what its worth because they are so deeply unhappy and don't want to find reasons to stay.

There's probably some truth to that. A number of physicians I've talked to over the years haven't even attempted to do the math, instead just assuming that a $200K pay raise as a civilian (at 1099 jobs, no less) makes the decision obvious.

Another wrinkle to getting out and aggressively saving that $180K+/year as a civilian ... You don't have much tax-advantaged space to use as a high earning civilian. It's all after-tax investment and all gains will be taxed too. (I think we all know where capital gains tax rates will be going in the next 20-30 years.)

I really don't think most people are aware that a retirement is worth this much. There was a thread awhile back about how much one would have to save per year to get out at the ten year mark and still break even. Most people had no idea. I'm pretty sure a lot of people are just ignorant to the value of a military pension.

That reminds me, that thread prompted me to write a web app to do the math, based on specialty, time in service, rank, and other factors. I'll see if I can finish debugging it this week and post it here for everyone to play with. If nothing else it'll throw some gasoline on the fire.

 

[BigNavyPedsGuy]

+1,000,000

I agree......I cannot stand the whining. And I bet one of those whiners will jump on here and tell me "just you wait until you get there".......well I'm looking forward to it!

This is the reason that he asked for experienced attendings only. The enlisted side of the house - making logical points=whining. I have a new dumb@ss senior chief in my directorate who personifies this attitude. To dismiss counterpoints as "whining" is incredibly disrespectful. Keep in mind, that those of us who have already done our medical school, our residency, and are now physicians are ahead of you on this path. Disrespect it if you want. But it's the same as an HN insisting his chief doesn't really know how the Navy works.

Feel free to look back through all of my posts. I started out as pro-military, then balanced, then frustrated but trying to make it work, and now I hate it and can't wait to get out. I don't have any regrets, but no, I wouldn't do it again knowing what I know now. I'm qualified to say. No corpsman is. That's why the OP asked for my opinion, it's qualified.

 

[corpsman33]

...

 

[jabreal00]

I am an attending two years out of fellowship training. I was an attending for one year prior to fellowship. Do I have regrets about joining milmed? The answer is no. I think I've gotten really good training both as a resident and a fellow. It was comparable to top tier university based programs. Would I sign up again? The answer is also no. My two years as a staff has been trying. Milmed has been inflexible in regards to my family situation.

 

[bricktamland]

I'm a Navy radiologist. Today our fluoro machine broke for the umpteeth time. We had to reschedule one of our patients for his upper GI study for the second time now for the same reason. The guy has been NPO all morning and made time out of his day to show up for his appointment and we then we go and waste his time for the same stupid reason twice in a row. This makes Navy medicine look like poo. This fluoro machine has been due for replacement for at least 4 years now, and it malfunctions probably at least 1 out of every 3 times we use it. But because we're at a small hospital, and we due a limited amount of fluoro studies, the Navy won't shell out the dough to get us a new machine that actually works. We desperately cling to this piece of junk because we want to continue offering as many radiology services to our patients as possible. Without fluoro, we can't offer any barium studies, HSGs, arthrograms, etc. The Navy would be totally happy if we just discontinued these services and referred out more and more of the work. It would certainly make my job easier if we just gave up on fluoro. . . .I don't get paid any more money to do these studies and I would have more time for internet surfing. But having fluoro available at our hospital provides better continuity of care and is better for our patients and referring providers. It's frustrating that we have to fight this battle. This is just one concrete example of the demoralizing nature of military medicine today. With budget restraints, this is only going to get worse. The email I received today reminding me of the complete lack of CME funding is yet another blow to the cojones.

Based on what I know today, I would not sign up again or advise anyone else to. That said, I don't regret my decision and am thankful for many of the experiences I've had. Overall, I ended up in a great position and the decision to join the Navy is largely responsible for that. I'm just tired of the broken promises, my constant mistrustfulness, the cloud of uncertainly, and general lack of control over my life. I also want to grow a beard.

 

[BigNavyPedsGuy]

..... I also want to grow a beard.

I know! The Canadian navy lets them have beards!

 

[corpsman33]

I know! The Canadian navy lets them have beards!

Unfortunately, I have never been able to grow a beard (I know thirteen year olds who can grow more facial hair than me) so in the Navy I am able to hide under the regulation and claim my continued lack of facial hair is because they will not allow it.

 

[a1qwerty55]

Voted no because in today's environment there is absolutely zero chance I would be happy with declines and funding, quality, and floridly inept leadership. I am happy I joined, and have had a good career but that was then, and this is now. Trust me, the opportunities which made military medicine enjoyable and satisfying are drying up and there is no evidence that will change in the foreseeable future. This is just the truth. I could not in good conscience recommend military medicine to my family, or a potential applicant. I feel so bad for those with long obligations, they are in for a very painful ride.

 

[pgg]

I know! The Canadian navy lets them have beards!

Facial hair just doesn't look right on lots of people.

There was a mustache growing contest held during my last deployment. I have never seen a creepier crowd of 70s pornstars and van-by-the-river dwellers in my life.

 

[i want out]

Voted no because in today's environment there is absolutely zero chance I would be happy with declines and funding, quality, and floridly inept leadership. I am happy I joined, and have had a good career but that was then, and this is now. Trust me, the opportunities which made military medicine enjoyable and satisfying are drying up and there is no evidence that will change in the foreseeable future. This is just the truth. I could not in good conscience recommend military medicine to my family, or a potential applicant. I feel so bad for those with long obligations, they are in for a very painful ride.

I remember when a1qwerty55 was the eternal optimist...

I have watched as many (myself included) went from loving the .mil to felling like an abused spouse.

 

[notdeadyet]

I remember when a1qwerty55 was the eternal optimist...

Me too. I was thinking a similar arc with IgD too. There have been a lot of posters whose attitude shifted considerably from the enthusiasm of med school/residency to... less enthusiastic.

I think NavyDiveDoc stayed pretty positive, but if I remember correctly he pretty much stopped posting after residency....