Would you do it again

[idq1i]

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.

Isn't this the normal trend? Start off excited, eager, happy and proud, end up dejected, unhappy, disgusted, bitter, angry, mugged by reality? Can't wait to see the military draw-down plans the MC has for us in the next few months-year...

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[bobbyseal]

Isn't this the normal trend? Start off excited, eager, happy and proud, end up dejected, unhappy, disgusted, bitter, angry, mugged by reality? Can't wait to see the military draw-down plans the MC has for us in the next few months-year...

So true. My experience hasn't been that bad, but I still could not fathom spending an extra say beyond my obligation. I just had someone recently say something to the extent, "If we get this 'awesome toy' would you stick around to use it." My reply was not a snowball's chance in hell. And I'm someone who trained in the specialty I wanted, straight through. I've never been deployed, and have been located in regions with large civilian centers nearby to assist with more complicated patients. The job has been like a vacation compared to residency. The patients for the most part are good. I feel like I'm providing high quality care to those who typically had access to little health prior to joining. But the administration, the paltry pay, redundant training, little regard for professional courtesy, and on and on makes me want to leave the hospital this summer with my DD214 in one hand and my radial nerve innervating the extension of a certain finger on the other hand.

 

[Cooperd0g]

I hope there isn't too much draw down. I want to at least make it through residency and my commitment to take me to retirement. I'm not voting as requested since I'm still in school, but I am a prior O so USUHS was too good of a deal to pass for quality of life in school and getting the retirement as soon as the commitment is up. There is a lot about the military that is frustrating as many of you have clearly articulated. The grass may in fact be greener on the other side, but it isn't the land milk and honey. Don't go out blind to that. Civilian docs have their issues and complaints with hospital administrators, insurance companies, partners, etc. as well. Prepare properly and you'll be going to something better rather than just running from something you feel is bad. I have seen many disgruntled line officers leave out of frustration with the military and then struggle outside because they didn't prepare and set themselves up well. I know it isn't apples to apples, but don't get yourself into some crappy contract just because it sounds good and you simply can't wait to be out; emotion can be the enemy. Have a plan, research the location, the job and don't fully commit to a location (like buying a house) until you have actually lived and worked there for at least a few months.

 

[Kingfisher]

Voted Yes. Due to some prior service, about the time I will turn from happy/frustrated to cynical/bitter, I will be eligible for retirement.

 

[corpsman33]

I am just curious (I promise I am not trying to start an argument and am truly currious), but how many people that voted "no" were prior service?

Kingfisher's post got me thinking.....anyways interested to hear.

 

[idq1i]

I am just curious (I promise I am not trying to start an argument and am truly currious), but how many people that voted "no" were prior service?

Kingfisher's post got me thinking.....anyways interested to hear.

That would be interesting to know. How about how many people voting yes are prior service, too.

The thing that many milmed suppporters are missing when they talk about how there are many problems on the civilian side, is that YOU CAN WALK AWAY from a civilian position. Go get another job, in another city or state, or quit medicine altogether

 

[colbgw02]

The thing that many milmed suppporters are missing when they talk about how there are many problems on the civilian side, is that YOU CAN WALK AWAY from a civilian position. Go get another job, in another city or state, or quit medicine altogether

This point can be both under- and overstated.

On one hand, walking away from a job is much easier said than done. If the market is down - like it is for my specialty - then you'll find lots of civilian physicians who feel trapped by a job they hate. And if it's a private practice, many people will feel compelled to see a partnership track through to the end for a job they would otherwise leave. If changing jobs means relocating, then you're looking at dealing with many of the same issues that a military reassignment involves.

On the other hand, idq1i is right. There is real value in the ability to walk away. People can and do exercise that option, especially if the job market gives them choices. And then you'll find the physicians who have already banked away their fortune who just retire when faced with a job situation no longer to their liking.

The real difference, in my mind, is not that a civilian path permits one to walk away. It's that it allows one to avoid the bad situation to begin with. Allowing for a degree of volatility (i.e. unforeseen circumstances), the bad job is nearly always avoidable in the civilian world when due diligence is performed. Not so when in uniform.

 

[EsTxDr]

Which is why part time milmed is the only thing that makes sense anymore. While you may not be able to completely "walk away" you decrease the volume of whatever negative it is you dislike. Not to mention you can volunteer for more if you like and do your duty and "walk away" if not.

 

[corpsman33]

That would be interesting to know. How about how many people voting yes are prior service, too.

The thing that many milmed suppporters are missing when they talk about how there are many problems on the civilian side, is that YOU CAN WALK AWAY from a civilian position. Go get another job, in another city or state, or quit medicine altogether

I'm assuming that a disproportionate number of people that answered "no" had not served in the military prior to becoming a doctor, although I could be wrong. I would also be very interested to hear what percentage of those that answered "yes" had served (I assume a large percentage of the "yes" answers were prior service). I am also aware that there is a much larger pool of applicants from the civilian side of things, but I am talking about comparing the percentage of yes/no answers of the prior service members with those who have never served.

If I am right (and I could be wrong) then prior service actually does change your perception of military service in the medical corps (which also could be due to other factors.......namely the pension which is a great motivator). It would be very interesting to hear these results and I wish we'd get a few responses.

 

[colbgw02]

If I am right (and I could be wrong) then prior service actually does change your perception of military service in the medical corps (which also could be due to other factors.......namely the pension which is a great motivator). It would be very interesting to hear these results and I wish we'd get a few responses.

Well, I don't think the bold was ever really in question, or at least it shouldn't have been. It does. The real question is: does prior service - or even an active duty residency - permit one to understand the challenges of military medical practice fully?

 

[corpsman33]

Well, I don't think the bold was ever really in question, or at least it shouldn't have been. It does. The real question is: does prior service - or even an active duty residency - permit one to understand the challenges of military medical practice fully?

I think it was in question slightly. I had stated several times that I had no idea what it was like to deal with the Physician side of things, but rather that prior service members knew the military well, which prepared them more for any type of military service (i.e. it doesn't fully prepare us for being a physician in the military but it does prepare us for being in the military, and therefore a possible (although not guaranteed) greater level of satisfaction).

But I completely agree that there is no way that someone without medical corp experience can fully (if at all) grasp the intricacies that are specific to being a physician.

I'd still be interested to hear the status of those that answered yes/no and whether they had prior military experience.

 

[idq1i]

The real difference, in my mind, is not that a civilian path permits one to walk away. It's that it allows one to avoid the bad situation to begin with. Allowing for a degree of volatility (i.e. unforeseen circumstances), the bad job is nearly always avoidable in the civilian world when due diligence is performed. Not so when in uniform.

That's a good way of putting it.

 

[Kilgoretrout 65]

I voted no and had no prior service. I am struggling to hang on until retirement, 3.6 years to go.
I would be interested to hear from those with prior service who now, as senior medical officers, are frustrated by the
lack of power they truly hold to change the way their section operates. Civilians, MSCs, First Sergeants, nurses, IT, seem to
prevent, not help, docs from doing good patient care.

 

[corpsman33]

I voted no and had no prior service. I am struggling to hang on until retirement, 3.6 years to go.
I would be interested to hear from those with prior service who now, as senior medical officers, are frustrated by the
lack of power they truly hold to change the way their section operates. Civilians, MSCs, First Sergeants, nurses, IT, seem to
prevent, not help, docs from doing good patient care.

Just curious, but you came in as a civilian and then decided to stay until retirement. Did you have an increased obligation or was there some other factor that motivated you to remain active beyond your initial service commitment (i.e. retirement)?

 

[Kilgoretrout 65]

Just curious, but you came in as a civilian and then decided to stay until retirement. Did you have an increased obligation or was there some other factor that motivated you to remain active beyond your initial service commitment (i.e. retirement)?

USUHS+fellowship+GI Bill+promotion+really crappy job market in my specialty= lifer

 

[corpsman33]

USUHS+fellowship+GI Bill+promotion+really crappy job market in my specialty= lifer

Gotcha. Sounds like you've got a pretty good gig nonetheless. Thanks for the info!

 

[BigNavyPedsGuy]

I voted no and had no prior service. I am struggling to hang on until retirement, 3.6 years to go.
I would be interested to hear from those with prior service who now, as senior medical officers, are frustrated by the
lack of power they truly hold to change the way their section operates. Civilians, MSCs, First Sergeants, nurses, IT, seem to
prevent, not help, docs from doing good patient care.

Gotcha. Sounds like you've got a pretty good gig nonetheless. Thanks for the info!

What planet are you on Corpsman33?

 

[Perrotfish]

The one thing about reading threads like this is that I feel like the people who post tend to have a realistic/pessimistic view of the choice they took, which is fine, but then everyone contrasts their experienced pessimism with their optimistic/naïve view of the alternative. 300K of debt at 7.5% interest is never crippling and can always be paid off easily. Unlike the military system, the civilian residency training system never moves you to somewhere you have no interest in going or forces you into an unsafe work environment. Also all civilian GME is of the highest quality and strongly supports your CME and research. Unlike the constant uncertainty of working for the government, civilian medicine is stable as a rock, and half a dozen specialties have in no way seen huge changes in their pay or their competitiveness in the past year alone. Unlike the military, where you make a commitment to work for years in a system you can't really understand from the outside, when you sign up for civilian medicine you sign up to work in a system that you have a perfect understanding of as a premed, and which your non-dischargable debt in no way hinders you from walking away from on the off chance you are dissatisfied.

I'm still a resident, and I'm aware that there are a lot of miseries associated with the military that I haven't seen yet. I just think that you guys are grossly underestimating how crappy the civilian version of this is.

 

[corpsman33]

What planet are you on Corpsman33?

USUHS+fellowship+GI Bill+promotion+really crappy job market in my specialty= lifer

BigNavyPedsGuy, I was more responding to his comment about continuing in the Navy while the civilian job market was not good (as per his quote), and at the end of it all he will receive a retirement that continues to pay him an income year after year with the sole requirement that he wakes up with a pulse (not to mention the health insurance benefits that accompany it).

I understand that he does not like the current situation with nurses and others preventing his ability to do his job autonomously, but he only has 3.6 years remaining and I imagine he will make it successfully to the finish line.

It sounded like the civilian market was not good for him and so despite the fact that he did not enjoy his military service he remained in, received fellowship training, promoted, will shortly retire and will turn a bad thing into a good thing (or relatively less bad thing depending on how you view it I suppose)........and that is what I was referring too.

Was I so far off base with that assessment?

 

[colbgw02]

The one thing about reading threads like this is that I feel like the people who post tend to have a realistic/pessimistic view of the choice they took, which is fine, but then everyone contrasts their experienced pessimism with their optimistic/naïve view of the alternative. 300K of debt at 7.5% interest is never crippling and can always be paid off easily. Unlike the military system, the civilian residency training system never moves you to somewhere you have no interest in going or forces you into an unsafe work environment. Also all civilian GME is of the highest quality and strongly supports your CME and research. Unlike the constant uncertainty of working for the government, civilian medicine is stable as a rock, and half a dozen specialties have in no way seen huge changes in their pay or their competitiveness in the past year alone. Unlike the military, where you make a commitment to work for years in a system you can't really understand from the outside, when you sign up for civilian medicine you sign up to work in a system that you have a perfect understanding of as a premed, and which your non-dischargable debt in no way hinders you from walking away from on the off chance you are dissatisfied.

I'm still a resident, and I'm aware that there are a lot of miseries associated with the military that I haven't seen yet. I just think that you guys are grossly underestimating how crappy the civilian version of this is.

You're basically describing the grass-is-always-greener phenomenon, but here's the thing - as an attending - I have had the opportunity to work on the civilian market and outside of academia. So I feel pretty informed in my decision that the grass really is greener. And my specialty is one that has seen a tremendous downturn in reimbursement and the job market from the time I chose it, but the civilian world is still - on the whole - better for me than my current job.

I have what I consider to be a pretty substantial amount of debt. It's not $300K, but it's not too far off either. So I can speak with a degree of personal experience when I say that the debt - while not a small issue - is not nearly as crippling as viewed through the pre-med lens. And yes, I understand that the rules are different now. Nonetheless, It reminds of how I felt when I bought my first home. I remember thinking that I wouldn't have enough money to buy food, but you budget for it then adjust your expenses and lifestyle accordingly. Again, it's a fair point to consider, but I think it can be overstated.

I don't see too many people citing their GME experiences as a net negative. I think there are a few who know (or at least believe) they could have gone to Johns Hopkins or MGH if not for the military, so maybe those folks think little of their military residency/fellowship.

As I posted earlier (maybe even in this thread?), the real difference between the two systems isn't that you can't get into crappy situations in civilian medicine. You can, and I've known a lot of people who have done it. The difference is that those people have the chance to get out of that situation. And yes, it will cost them something - mostly financially, sometimes personally - but they're still able to change things. In the military, you're stuck and those bad situations are more common (see paragraph 1).

I understand that many of the naysayers' posts connote a false dichotomy between civilian and military medicine, but I encourage posters to wade through the oft low signal:noise ratio to tease out many of the real, legitimate issues that exist in military medicine.

 

[bobbyseal]

I know everyone likes to mention how great the retirement is for military members. And I do agree, it is a huge benefit. But just remember, you could go to nursing school, work for 20 years in the Navy and still get the same retirement that a doctor gets, just 4 years earlier... I think everyone would agree that the doctor puts a lot more sweat equity into that O5 retirement than the nurse does.

 

[corpsman33]

I know everyone likes to mention how great the retirement is for military members. And I do agree, it is a huge benefit. But just remember, you could go to nursing school, work for 20 years in the Navy and still get the same retirement that a doctor gets, just 4 years earlier... I think everyone would agree that the doctor puts a lot more sweat equity into that O5 retirement than the nurse does.

True, but doctors begin their pay scale at O3 and nurses begin at O1. If you do the math at 20 years difference between those pay grades it makes a bit of a difference. Plus the doctor will presumably retire at a higher pay grade and continue with the elevated pay for the remainder of his/her life, not to mention the benefit of working as a doctor in the civilian world once retired from the military.

 

[pgg]

I know everyone likes to mention how great the retirement is for military members. And I do agree, it is a huge benefit. But just remember, you could go to nursing school, work for 20 years in the Navy and still get the same retirement that a doctor gets, just 4 years earlier... I think everyone would agree that the doctor puts a lot more sweat equity into that O5 retirement than the nurse does.

Right, and I could've dropped out of high school, passed the GED with a hangover, enlisted at 17, and started collecting E9 retirement pay two years ago.

Or I could've been an ibanker, Wall Street is easy street.

 

[corpsman33]

Right, and I could've dropped out of high school, passed the GED with a hangover, enlisted at 17, and started collecting E9 retirement pay two years ago.

Or I could've been an ibanker, Wall Street is easy street.

Way to give your age away pgg.......I would've guessed you were like a 60 year old 3 star. Illusion blown...........

 

[bustbones26]

The one thing about reading threads like this is that I feel like the people who post tend to have a realistic/pessimistic view of the choice they took, which is fine, but then everyone contrasts their experienced pessimism with their optimistic/naïve view of the alternative. 300K of debt at 7.5% interest is never crippling and can always be paid off easily. Unlike the military system, the civilian residency training system never moves you to somewhere you have no interest in going or forces you into an unsafe work environment. Also all civilian GME is of the highest quality and strongly supports your CME and research. Unlike the constant uncertainty of working for the government, civilian medicine is stable as a rock, and half a dozen specialties have in no way seen huge changes in their pay or their competitiveness in the past year alone. Unlike the military, where you make a commitment to work for years in a system you can't really understand from the outside, when you sign up for civilian medicine you sign up to work in a system that you have a perfect understanding of as a premed, and which your non-dischargable debt in no way hinders you from walking away from on the off chance you are dissatisfied.

I'm still a resident, and I'm aware that there are a lot of miseries associated with the military that I haven't seen yet. I just think that you guys are grossly underestimating how crappy the civilian version of this is.

I recall what an ENT attending told my class back whenever we were medical students sitting in a lecture hall. Doctor like to whine! Period!! They all whine but at the end of the day do their job. Now that I am a civilian doctor, I agree. I hear doctors whine about cuts, hospital politics, healthcare organizations, etc. etc. etc. Its just a part of life and a part of the job.

Allow me to contrast:

Military:
Patient with a Chiari I gets onto google and complains that you will not perform a decompression surgery and write a letter to his congressman that you prescribed them Topirmate, which they know is a bipolar drug (after looking it up on Google). Truth is, you presribed Topiramate because it was FDA approved for migraines (they missed that part on Google). NOW you have to write a response back to the congressman, talk to JAG, your department head, possibly the DCCS. Also, the solider filed an ICE complaint that you have to respond to and filled out a negative review about you on APLS so now you have to explain this to a hospital commander that is an experience helicopter pilot. Hours and days go to waste!!

Civilian:
Patient just gets disgruntled, goes to see another doctor, and nothing beyond that really happens


Military:
Patient with pseudoseizures is told not to drive. Solider drives anyways, a motorcycle (unhelmeted of course) and crashed into a tree and dies. NOW you have to fill out gobs of paperwork proving that you indeed told the solider not to drive even though it is clearly in the chart. Hours at waste!

Civilian:
A lawyer may come after you, see's that you documented this in the chart, case closed!!

Military:
After at least four years of college, four years fo medical school, and anywhere from 3 to 8 years of GME training, you need to stand at attention and try to explain to an infantry commander that has three masters degress from the University of Phoenix why you did XYZ.

Civilian:
This just isn't going to happen, period!!

Military:
An orthopedic surgeon is ordered to figure out how to work a ventilator by his DCCS because the medicine team won't call him back. Orthopedic surgeon gets a counseling statement.

Civilian:
Patient probably would just die and the medicine attending gets in big trouble for refusing to call back.
I could go on an on here!!!

 

[BigNavyPedsGuy]

^^hilarious! (Sad but true)

 

[Perrotfish]

I have what I consider to be a pretty substantial amount of debt. It's not $300K, but it's not too far off either. So I can speak with a degree of personal experience when I say that the debt - while not a small issue - is not nearly as crippling as viewed through the pre-med lens. And yes, I understand that the rules are different now. Nonetheless, It reminds of how I felt when I bought my first home. I remember thinking that I wouldn't have enough money to buy food, but you budget for it then adjust your expenses and lifestyle accordingly. Again, it's a fair point to consider, but I think it can be overstated.

There's debt and then there's debt. Secured debt I don't count at all: if on Monday you have 20K in the bank and no debt, and on Tuesday you have 180K of debt secured by a 200K home your net worth hasn't changed a dime and you can discharge the debt without even going through bankruptcy. Even unsecured debt, though worse, is usually much lower interest than student loans and, more importantly, is always dischargable in bankruptcy. You can always walk away from those debts. I think large amounts of unsecured, non-dischargeable, high interest debt is a completely different animal, if only because it traps you in a way that even large quantities of credit card debt doesn't. You can't pay it down without working as a physician: 300K turns into 500K by the end of residency and fellowship and the interest alone (at 7.5%) is more than the median individual income. However you also can't walk away from it an go bankrupt like someone who made a decision to open a small business, or to build too large of a home, or to pursue a heroin addition. When you sign up for medicine as a premed you're effectively trapped in this profession until the debt is paid. While that can be overstated, I think that its instead drastically understated 999 times out of 1000

As I posted earlier (maybe even in this thread?), the real difference between the two systems isn't that you can't get into crappy situations in civilian medicine. You can, and I've known a lot of people who have done it. The difference is that those people have the chance to get out of that situation. And yes, it will cost them something - mostly financially, sometimes personally - but they're still able to change things. In the military, you're stuck and those bad situations are more common (see paragraph 1).

My point is that there isn't, really, an option for civilian medical students to walk away from bad situations until at least the end of residency, and there isn't an option for them to walk away from this profession until they've paid off their debts. While I know that legally you're always free to shoulder your 300K of high interest non-dischargable debt and quit, that's an option in much the same sense that its an option to leave a 10th story building by jumping out the window rather than taking the stairs. Now as an attending, you're right that you have much more power to at least leave or alter a bad employment situation, but I would argue that is balanced out by going through a civilian residency system where, without a clear place in the hospital's chain of command and no practical option to leave to do something like a GMO tour, you have significantly less power to avoid dangerous and unsafe situations than a military resident dose. In any event, even if you consider the residency systems comparable, the problems you have with military medicine (can't walk away, no control over where you live and how you practice) are 100% present in the civilian medical school and residency system, and the differences in military medicine are therefore a matter of duration rather than kind. Also, honestly, a military attending DOES wield power in the hospital system. Maybe not as much as they would like, or as much as they should, but they are nothing like completely powerless

 

[colbgw02]

There's debt and then there's debt. Secured debt I don't count at all: if on Monday you have 20K in the bank and no debt, and on Tuesday you have 180K of debt secured by a 200K home your net worth hasn't changed a dime and you can discharge the debt without even going through bankruptcy. Even unsecured debt, though worse, is usually much lower interest than student loans and, more importantly, is always dischargable in bankruptcy. You can always walk away from those debts. I think large amounts of unsecured, non-dischargeable, high interest debt is a completely different animal, if only because it traps you in a way that even large quantities of credit card debt doesn't. You can't pay it down without working as a physician: 300K turns into 500K by the end of residency and fellowship and the interest alone (at 7.5%) is more than the median individual income. However you also can't walk away from it an go bankrupt like someone who made a decision to open a small business, or to build too large of a home, or to pursue a heroin addition. When you sign up for medicine as a premed you're effectively trapped in this profession until the debt is paid. While that can be overstated, I think that its instead drastically understated 999 times out of 1000. My point is that there isn't, really, an option for civilian medical students to walk away from bad situations until at least the end of residency, and there isn't an option for them to walk away from this profession until they've paid off their debts. While I know that legally you're always free to shoulder your 300K of high interest non-dischargable debt and quit, that's an option in much the same sense that its an option to leave a 10th story building by jumping out the window rather than taking the stairs.

I should have clarified that I have was talking about my own student debt. I cited my mortgage payment only as an example of the emotional side of things.

If your choice is between $300K debt at the end of medical school and the military, then that changes the calculus obviously. However, that's not the norm. Taking all comers, AAMC data from just a month ago puts the average debt at a hair less than $170K, with the median at $175K. Now, I don't know enough about the AAMC to know if that includes DO students, but suffice it to say that there's no reason to assume that inquirers on this website are having to choose between as much debt as you're citing and the military.

Your thoughts about walking away from medicine completely are true, but I don't see how they're relevant. No one is advocating that HPSP is a good way to avoid debt in case you end up hating being a physician.

Now as an attending, you're right that you have much more power to at least leave or alter a bad employment situation, but I would argue that is balanced out by going through a civilian residency system where, without a clear place in the hospital's chain of command and no practical option to leave to do something like a GMO tour, you have significantly less power to avoid dangerous and unsafe situations than a military resident dose. In any event, even if you consider the residency systems comparable, the problems you have with military medicine (can't walk away, no control over where you live and how you practice) are 100% present in the civilian medical school and residency system, and the differences in military medicine are therefore a matter of duration rather than kind.

I'm not sure why you're concentrating so much on everyone's experiences through residency, and I certainly don't know why you think that civilian residents don't have a clear place in a hospital's chain of command. Again, I think most people would rate their residency as a net positive, and I don't see too many people complaining about the issues during residency that you're referencing. And what exactly are all of these unsafe situations that military residents are avoiding that civilian residents have to just suck up and deal with?

Also, honestly, a military attending DOES wield power in the hospital system. Maybe not as much as they would like, or as much as they should, but they are nothing like completely powerless

This is borderline crazy talk. A military attending is deprived of the single biggest weapon he or she has - the ability to walk away on his or her own terms. That's what civilian physicians do when the situation gets bad enough - they vote with their feet. Part of the reason the system never gets fixed is because there is perpetual supply of new, obligated physicians ready to take over when those docs do go away. And that doesn't even touch the day-to-day bureaucratic inertia that prevents real change from occurring. Come spent some time with me in my supervisor's role, and see what it takes for me to try to get a GS employee fired. I've seen civilian employees in the same job fired for 1/10th of the infractions in 1/10th of the time.

 

[pgg]

Allow me to contrast:

Ah, anecdotes! Can I play?

Military:
Providing healthcare is expensive. Navy decides to close ER soon, and outsource OB in a couple years. Extra staff are to be moved elsewhere.

Civilian:
Providing healthcare is expensive. Profit-driven hospital CEO and similarly-driven Board of Directors declines to renew anesthesia group's contract, turns it over to a national anesthesia management company who underbid by 10%, promising the world. AMC flies in a cohort of reject locums anesthesiologists and retread CRNAs. Predictable problems arise as predicted. Surgeons are angry and threaten to take their patients elsewhere. Meanwhile a couple dozen anesthesiologists with roots in the community, kids in school, spouses with jobs, suddenly need to leave their lush greenly grassed pasture and "PCS" themselves elsewhere, where I'm sure the grass is just as green.

 

[corpsman33]

This is borderline crazy talk. A military attending is deprived of the single biggest weapon he or she has - the ability to walk away on his or her own terms. That's what civilian physicians do when the situation gets bad enough - they vote with their feet. Part of the reason the system never gets fixed is because there is perpetual supply of new, obligated physicians ready to take over when those docs do go away. And that doesn't even touch the day-to-day bureaucratic inertia that prevents real change from occurring. Come spent some time with me in my supervisor's role, and see what it takes for me to try to get a GS employee fired. I've seen civilian employees in the same job fired for 1/10th of the infractions in 1/10th of the time.

I do agree with this 110%. It is nearly impossible to fire a GS employee. There was this particular GS nurse who I used to work with (who apparently had been a CRNA in another life but was now working as a PACU nurse for some unknown/untold reason) and had a stack or write-ups/infractions that would have rivaled the size of an encyclopedia. Department head after department head would rotate through the PACU and eventually would each come to the conclusion that this particular nurse needed to be fired, but each failing to bring it to fruition. Eventually the nurse did say some off-base racist comment of some sort and was fired, only to be re-hired at the Camp Pendleton hospital!

I remember this same nurse telling one of my patients when she was waking up from recovery that she looked "like a little slut" because she had a tatoo (he was trying to be funny and thought the patient would agree). I had to tell the nursing supervisor about it, but I still had to deal with him because he was overseeing me at the time because I was only a corpsman. I remember wanting to slap him silly after the comment, but instead was forced to continue working with him. It wasn't another year or so until he was eventually fired.

However, I don't think that the difficulty to fire GS employees is unique to the military. Any hospital with a union encounters similar problems. I remember the dealing with comparable situations when I worked at Kaiser Permanente.

 

[pgg]

I remember working at the old Walter Reed some time back. Horrible civilian staff. Just ... horrible.

They told me the civilians were untouchable. Absolutely un-fireable, because of some agreement the District of Columbia had with the Army, that X% of the staff at WRAMC had to come from the District, and there just weren't enough qualified people available to hire. Nasty place to work.

I'm not sure any union in the civilian world could match their level of malevolent lazy untouchableness.

 

[colbgw02]

However, I don't think that the difficulty to fire GS employees is unique to the military. Any hospital with a union encounters similar problems. I remember the dealing with comparable situations when I worked at Kaiser Permanente.

Certainly not unique, but - outside of supervisors - GS employment automatically means union representation, right? There are plenty of non-union hospital/medical jobs in the civilian world. And as painful as those unions might be, I fear the GS union has its own special nightmares.

 

[DrMetal]

I remember working at the old Walter Reed some time back. Horrible civilian staff. Just ... horrible.

They told me the civilians were untouchable. Absolutely un-fireable, because of some agreement the District of Columbia had with the Army, that X% of the staff at WRAMC had to come from the District, and there just weren't enough qualified people available to hire. Nasty place to work.

I'm not sure any union in the civilian world could match their level of malevolent lazy untouchableness.

This thread is killing me softly. Time to derail it: Did you see 'The Walking Dead' last night? A dead guy came back to life with an LMAO still stuck in his airway. Is that possible? In any case, it was an epic zombie-anesthesia moment.

 

[bustbones26]

Ah, anecdotes! Can I play?

Military:
Providing healthcare is expensive. Navy decides to close ER soon, and outsource OB in a couple years. Extra staff are to be moved elsewhere.

Civilian:
Providing healthcare is expensive. Profit-driven hospital CEO and similarly-driven Board of Directors declines to renew anesthesia group's contract, turns it over to a national anesthesia management company who underbid by 10%, promising the world. AMC flies in a cohort of reject locums anesthesiologists and retread CRNAs. Predictable problems arise as predicted. Surgeons are angry and threaten to take their patients elsewhere. Meanwhile a couple dozen anesthesiologists with roots in the community, kids in school, spouses with jobs, suddenly need to leave their lush greenly grassed pasture and "PCS" themselves elsewhere, where I'm sure the grass is just as green.

Certainly politics happen in the civilian world too. What I am dealing with now are a group of doctors that became disgruntled over their hospital for maneuvers as you had mentioned. Thus, they just opened up their own hospital locally. I think that this only lead to further problems myself.

But, I think that you made one really good point:
In the Navy, you are forced to deal with it, whether you like it or not.
In the civilian world, you are potentially more free to go as you like.

One thing that I will mention, it never ceases to amaze me that the doctors in the civilian sector that whine the most, have the most. 100K cars, mcmansions, trophy wifes (typically on 3rd one that is 10+ years junior), etc etc.
The Army did teach me to make due with what I had. As a board certified O-4, I was still making 100K less than most of my civilian colleagues. I learned to be happy with my Jeep, average house, and first wife. I think that whenever I got out and made that first nice paycheck, I sure appreciated it.

At the end of the day, the miltary does have some incentives and I for one do not completely regret doing Army Medicine; however, I feel that miliary medicine is NOT set up to add much incentive to stay in other than a guaranteed retirement after 20 years. I for one am not in a high paying specialty. For those that are, you have to be a bleeping idiot to retire poor! Yes, I am going to make fun a doctors for a minute. There is an anesthesiologist/pain doc in my community that bragged about the 100K bill for his lavish vacation. If tomorrow, Medicare makes dramatic cuts on say epidurals and his salary drops a bit, why should I feel sorry for him? He also drives a BMW 750 (90K minimum) and bought his wife a new porsche, so again, if Obama care ruins his practice, why should I feel sorry for him? Day in and day out I see doctors either spend money they don't have or spend what they have and don't save much? Bad idea, whether civilian or military.

 

[Kingfisher]

This thread is killing me softly. Time to derail it: Did you see 'The Walking Dead' last night? A dead guy came back to life with an LMAO still stuck in his airway. Is that possible? In any case, it was an epic zombie-anesthesia moment.

Was it an LMA? I was looking and I thought it was just a standard ET tube with the cuff stripped off. I could be wrong though. Love that show!

 

[EsTxDr]

Whoa whoa fellas. Lets not start divulging details on shows some of us haven't gotten a chance to watch just yet!

 

[idq1i]

This thread is killing me softly.

It's interesting to see that your life appears to depend on a thread on an anonymous board. I really want to see your opinion in 2-3 years, when you finally graduate from your residency.

 

[a1qwerty55]

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.

I was an optimist until around the 15 year mark when the caliber of peer physicians, senior leaders and the general quality of care started to take a nosedive. I am very very pessimistic now mainly based on the realization that there is almost no one at the helm who has a clue what they are doing. I mean it is really bad, much worse that the usual governmental incompetence. We are dismantling the few systems that worked well and replacing them with nurse driven garbage (standardization - in other words a standardized poor quality product/experience across the military), and attention to non-medical societal issues (diet, sleep, exercise) over life saving therapies (cancer, ICU, surgical care). So we have astoundingly poor military leaders, civilian leaders (executive and legislative branch) who despise physicians and healthcare in general (both political camps for different reasons) and a total loss of mission focus and funding. I think we are finished this time. I feel sorry for those of you will long obligations. Just do what is right for the patients and your family and let the leaders sit and spin.

 

[bricktamland]

I’ve said this before. My overall experience in Navy medicine has been much more positive than negative. I don’t regret my time, but I wouldn’t sign up again. The foremost reason is that I feel I was completely misled on what I was signing up for. The vast majority of the purported benefits of Navy medicine that were sold to me as a naive medical student have not come to fruition. Here are some direct quotes from Navy medicine for physicians from the official website: http://www.navy.com/careers/healthcare/physician.html

1. “As a Navy Physician, you can pursue your true passion for helping others and focus on the finer points of medicine without the financial and business complications of a private practice.”

Lie. I’m barely out of residency and all the collateral duties and hospital admin roles thrust upon me are way more time consuming than my actual clinical job. Back when I was a GMO, my job was 90% admin and 10% clinical. I really enjoyed the “finer points of medicine” like separation physicals and coordinating shot stand downs. In contrast, at my civilian moonlighting job, my work is 100% clinical.

2. “Further your expertise amid progressive thinking among 30 specialty and subspecialty areas. Distinguish yourself with pride and respect as a Navy Medical Corps Officer. You’ll find generous incentives, first-rate benefits and a world-class practice.”

Mostly a lie. The physicians at the MTF where I trained were generally very good. However, at the smaller remote hospitals, you encounter bargain basement civilian contractors and incompetent nurse practitioners practicing beyond their scope. And where are these generous incentives? I’ll acknowledge the GI Bill is a good benefit. World-class practice? No. . . probably better than average though.

3. “Working at top military medical facilities where you’re privy to advanced training and technology so progressive, the civilian world may not be aware of it yet.”

Some truth. I feel my residency training was excellent. The medical equipment and technology, at least at the MTFs, is top-notch. Not true at the small hospitals though.

4. “You will develop a unique sense of camaraderie and have the ability to focus on the finer points of medicine without the financial and business complications of private practice.”

Some truth, mostly lies. I have made some great friendships while in the Navy. There’s nothing that builds camaraderie more than enduring great suffering together. Again, the part about avoiding “financial and business complications” is total crap. The longer you stay in, the more your job is overwhelmed by admin and “business complications”.

5. “Earn excellent compensation in an established, thriving practice.”

Lie. My salary is less than half that of my civilian counterparts. Our small hospital is hemorrhaging money, so the Navy is currently closing out many of the services. . . . hardly a “thriving practice.” Subsequently, skill atrophy will become worse than it already is.

6. “Further your expertise via hands-on experience and Navy-funded advanced training.”

Lie. Funded CME is essentially non-existent.

7. “When you practice Navy Medicine, you won’t need to deal with many of the roadblocks your peers will find in civilian medicine:
• No start-up costs
• No malpractice insurance to buy
• No staff to hire
• No equipment to acquire
• No office to furnish”

Lie. This is a total burden. Endless admin. Part of being a department head involves reviewing contracts for civilian hires and reviewing equipment contracts.

8. “Plus, you’ll have a flexible schedule that leaves more time for family, personal pursuits and adventure.”

Lie. Most of my civilian counterparts have better vacation and sick leave arrangements.

9. “As a member of the Navy Medical Corps, you may serve at any one of more than 250 Navy and medical facilities around the globe, in some of the most dynamic environments imaginable … Hawaii to Japan, Germany to Guam, and Washington, D.C., to Washington state. You could work at a Navy medical clinic anywhere from London, England, to Kaneohe, Hawaii.”

Misleading. I’ve been stationed one place outside the US so far—Iraq. Desirable places like England, Hawaii, Italy, etc. are not so easily obtained.

10. "Navy can help ease your financial burdens and advance your career with generous scholarships, financial assistance and continuing education programs."

Partial lie. The HPSP scholarship can be a good financial deal for some. But again, funded CME is a total broken promise.

 

[twinning]

I’ve said this before. My overall experience in Navy medicine has been much more positive than negative. I don’t regret my time, but I wouldn’t sign up again. The foremost reason is that I feel I was completely misled on what I was signing up for. The vast majority of the purported benefits of Navy medicine that were sold to me as a naive medical student have not come to fruition. Here are some direct quotes from Navy medicine for physicians from the official website: http://www.navy.com/careers/healthcare/physician.html

1. “As a Navy Physician, you can pursue your true passion for helping others and focus on the finer points of medicine without the financial and business complications of a private practice.”

Lie. I’m barely out of residency and all the collateral duties and hospital admin roles thrust upon me are way more time consuming than my actual clinical job. Back when I was a GMO, my job was 90% admin and 10% clinical. I really enjoyed the “finer points of medicine” like separation physicals and coordinating shot stand downs. In contrast, at my civilian moonlighting job, my work is 100% clinical.

2. “Further your expertise amid progressive thinking among 30 specialty and subspecialty areas. Distinguish yourself with pride and respect as a Navy Medical Corps Officer. You’ll find generous incentives, first-rate benefits and a world-class practice.”

Mostly a lie. The physicians at the MTF where I trained were generally very good. However, at the smaller remote hospitals, you encounter bargain basement civilian contractors and incompetent nurse practitioners practicing beyond their scope. And where are these generous incentives? I’ll acknowledge the GI Bill is a good benefit. World-class practice? No. . . probably better than average though.

3. “Working at top military medical facilities where you’re privy to advanced training and technology so progressive, the civilian world may not be aware of it yet.”

Some truth. I feel my residency training was excellent. The medical equipment and technology, at least at the MTFs, is top-notch. Not true at the small hospitals though.

4. “You will develop a unique sense of camaraderie and have the ability to focus on the finer points of medicine without the financial and business complications of private practice.”

Some truth, mostly lies. I have made some great friendships while in the Navy. There’s nothing that builds camaraderie more than enduring great suffering together. Again, the part about avoiding “financial and business complications” is total crap. The longer you stay in, the more your job is overwhelmed by admin and “business complications”.

5. “Earn excellent compensation in an established, thriving practice.”

Lie. My salary is less than half that of my civilian counterparts. Our small hospital is hemorrhaging money, so the Navy is currently closing out many of the services. . . . hardly a “thriving practice.” Subsequently, skill atrophy will become worse than it already is.

6. “Further your expertise via hands-on experience and Navy-funded advanced training.”

Lie. Funded CME is essentially non-existent.

7. “When you practice Navy Medicine, you won’t need to deal with many of the roadblocks your peers will find in civilian medicine:
• No start-up costs
• No malpractice insurance to buy
• No staff to hire
• No equipment to acquire
• No office to furnish”

Lie. This is a total burden. Endless admin. Part of being a department head involves reviewing contracts for civilian hires and reviewing equipment contracts.

8. “Plus, you’ll have a flexible schedule that leaves more time for family, personal pursuits and adventure.”

Lie. Most of my civilian counterparts have better vacation and sick leave arrangements.

9. “As a member of the Navy Medical Corps, you may serve at any one of more than 250 Navy and medical facilities around the globe, in some of the most dynamic environments imaginable … Hawaii to Japan, Germany to Guam, and Washington, D.C., to Washington state. You could work at a Navy medical clinic anywhere from London, England, to Kaneohe, Hawaii.”

Misleading. I’ve been stationed one place outside the US so far—Iraq. Desirable places like England, Hawaii, Italy, etc. are not so easily obtained.

10. "Navy can help ease your financial burdens and advance your career with generous scholarships, financial assistance and continuing education programs."

Partial lie. The HPSP scholarship can be a good financial deal for some. But again, funded CME is a total broken promise.

After reading this it makes me think what is the point of going to USUHS. You did say that you don't regret your time but after hearing all this makes me wonder why you don't regret your decision. What positives have you had in your experience that beat the civilian side of medicine?


Sent from my iPhone using Tapatalk

 

[bricktamland]

Some positives:

1. Great training for internship and residency. Perhaps this doesn't hold true across all specialties in the military, but for my particular career path, I'm very satisfied with the education and medical training I received.

2. Rewarding friendships and camaraderie. I've worked alongside some fantastic people including awesome Corpsmen, physicians, IDCs, PAs, etc.

3. Wonderful patients. It's hard to find a better patient population than our active duty, their dependents, and vets.

4. Unique experiences. As a GMO, my deployment to Iraq with the Marines was generally a miserable experience, mainly due to horrible leaders. Between my a-hole psychopath Marine CO and my nut job, back-stabbing, ladder-climbing and completely medically incompetent Regimental Surgeon who would kill and gut his own mother if it would have gotten him promoted, my life was hell for 7 months. Ironically, though, as time passes, I look back at that experience through progressively more rose-colored glasses. As ridiculous as the whole thing was, it was nonetheless a total honor to serve with all those Marines and Corpsmen. It's been a few years now and it seems almost surreal to think that I went to war, deployed to a combat zone. . . . with mortars exploding right by my berthing. Crazy stuff happened that most people only come close to experiencing vicariously through movies or through a few seconds of censored footage on the nightly news. I served with a bunch of insanely brave guys, many of whom gave their lives and limbs for our country. I would never be so audacious to consider myself an actual hero or anything, but I sure as hell served with some true heroes. So, yes, I'm very proud to have been through that, but I'm not particularly interested in doing it again.

5. More comfortable life during residency. Having the extra income as a resident has afforded a more comfortable lifestyle for my family during that time period. That has been nice. But it's certainly come at a price, now that I'm an attending earning a fraction of my civilian counterparts, living in an undesirable location, undergoing severe skill atrophy, and having unwanted admin duties heaped upon me.

Yet I don't regret my decision. Regret is a waste of time. I made that decision not knowing what I now know. Besides, I'm very happy with my life, and the Navy experience has been more positive than negative (not good enough to tempt me to stay in, though). But the original question was whether I would sign up again. If I'm starting from scratch, the answer is no. It's "no" because a career as a physician in the Navy isn't anything like what is advertised by the Navy.

 

[Kilgoretrout 65]

“Working at top military medical facilities where you’re privy to advanced training and technology so progressive, the civilian world may not be aware of it yet.”

That may be true in some sections but think about how ancient CHCS is, how patient safety is compromised by its very existence, and how trying to get a new version
has taken 10 years and seemingly has gotten no where. Our section couldn't invite a workflow expert in from the civilian world because the first thing they would say is
"You need to get rid of CHCS", thanks my high school son could have told us that.

Then observe how the DoD has just added on to it with separate EMRs for inpatient and outpatient care (ignoring the systems the VA uses) plus HAIMS, PACS, ICDB, etc. none of which
effectively talk to each other. You want allergies listed in the EMR?? You want to bar code?? You want to track that defibrillator or hip implant in case it gets recalled?? You want lab values with reference ranges?? You want inpatient order entry??

And, even if we could buy technology from the civilian sector, we could never implement it because of cybersecurity/firewall/idiotic IMD rules and staff.

Maybe it is good that I can't go to conferences anymore as it would just be sad trying to explain to the salesman why we can't use that fancy new tool.

 

[idq1i]

“Working at top military medical facilities where you’re privy to advanced training and technology so progressive, the civilian world may not be aware of it yet.”

The incompetent buffoons at BAMC broke the inter-facility internet communication 7 days ago through one of their "upgrades." System still broke. How's that for progressive?

 

[idq1i]

delete me-duplicate

 

[Strategy]

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 always see posts like this and wonder when did these posters get the chance to complete these kinds of things? In a GMO tour I would have to think. Surely not following residency training as at that point you would be posted mostly at a MTF actually practicing? Correct me if I am wrong.

 

[IlDestriero]

The party doesn't end when you become an attending, believe me.

 

[bustbones26]

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.

I think that you make good points. I agree with you. I am proud of my service and what I did in milmed. That being stated, I got out. So would I do it again? Yes, but the result would have been the same.

I would not discourage anybody from exploring military medicine, so long as they fully accept that for a period of time, their life and career is in somebody else's hands and from time to time, they may be met with a few inconveniences. I'll be the first to admit, I went in thinking that I'd put on a uniform and maybe have to go to a few field training courses throughout my career. Then, during my first year of medical school, 9/11 happened. Even then, I thought nothing of it; however, by my MSII year, we were invading Iraq. By the time I was an intern, we had been in Afghanistan for a few years, but nobody really cared. Honestly, does anybody here remember back when it was all about Iraq and our presence in Afghanistan was rarely discussed?

A current prospective medical student may think that he/she would have it made in the military if there truly is a promise of draw back in Afghanistan. I would always remind them that anything can happen at any time. Even if we achieve a peacetime period, you would still have to accept that somebody else decides where you have to work, where you can do fellowship, etc. etc.

 

[NavyFP]

Went straight through so no GMO tour. As an attending I have been to 4 continents, lived in Hawaii and Japan, rode on the Comfort and played in the desert.

Would I do this again, yes. But I am brainwashed.

 

[Shikima]

I miss the camaraderie and fellowship provided in closely working units. Other than that, no kool aid for me.

 

[j4pac]

Can we all agree that the corpsmen/medics are a big perk of the job? I will be a mentor to many of these guys for life.