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- Mar 29, 2022
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Sorry for this very lengthy post, but any input/advice/opinion/help from the group would be highly appreciated.
To start off: I am a first time poster and if you had told me on February 23rd this year that I would be writing this post on the SDN ‘military medicine’ forum I would have told you that I must have gone totally crazy and that I need to be involuntarily admitted to inpatient psych – BUT as the world has gone mad the next day here I am – someone with NO MILITRY EXPERIENCE/AMBITION/WHATSOVER considering e-mailing an Air Force Healthcare recruiter…
I am not here to highlight what has lead me to this personal “Ask not what your country can do for you – ask what you can do for your country.” moment but I guess I need to provide some background info about myself for people to be perhaps able to give me better advice. Born in (West)-Germany to a (non-military) US-citizen father and Czech mother. Lived in Texas for a short time as a toddler and went to pre-school there before being back to Germany where I grew up and finished high school before studying medicine in Prague in the Czech Republic in the mid/end 1990’s. Then moved to NYC right after medical school in 2001 and did my internal medicine residency there and after some detours via basic cardiology research and a four year stint as a physician at a pharmaceutical company in Copenhagen/Denmark, I then ‘went back’ to clinical hospital based medicine at a small German island hospital (mostly to get my US Internal Medicine Board Certification recognized in Germany/Europe) for two and a half years before I ended up in Hawai‘i working as a hospitalist/nocturnist full time for the last eight years (community based neighbor island hospitals (60-90 beds) with open 7-9 bed ICU’s without any intensivists, with myself and the ED physician being in practical terms the only doctors available at night – i.e. very little subspecialty back-up).
So basically someone with a quite ‘non-linear’ CV who given the now completely changed global/European security situation feels the (sudden and unexpected…- and yes everyone of you who is serving or has served is of course more than welcome to judge me on that part…) moral obligation to at least ‘make myself available’ with my skill set if needed mainly because
1. If my miniscule contribution as an individual (and parent) may lead to more security for everyone (+ my kids) in the future I guess now is the time to do so. [I do not have any ‘heroism’ ambitions here and I am fully aware that I will only be a tiny ‘cog in the wheel’ of a huge military machinery and this is fully OK]. Alternatively if ‘things’ should ‘start hitting the fan’ even more than today [which unfortunately personally I am convinced that the risk of is much higher than a lot of people currently still think…] it would at least allow me to be in a small position to actively try to assure that we end up being the side who ‘looses less’ than the other side [I am deliberately writing this in this way as it is my deepest personal conviction is that no war is ever ‘won’ but that in the end there is just one side who looses more than the other…of course I am aware that I will have to switch to the official "Aim High, Fly-Fight-Win" slogan and that the prior can only be my private unvoiced opinion going forward].
2. As a US foreign medical graduate with ties to Europe as outlined above who owes his medical career to the largest part to my US internal medicine residency training (and no medical school debt as I ‘used’ the European system for that…) it goes against my sense of fairness and equitable distribution of risk to ‘turf’ the inherent risk of the current situation on a younger colleague from Kansas without any ties to Europe who joined the military on a HPSP scholarship because this (in the US system) was the only way she or he could ‘afford’ becoming a physician. The European ‘part’ of me has to fully acknowledge that I am at least partially co-responsible for this situation by being naïve and dumb and underinvesting in (+ undervaluing) military in the European context until 2/24/2022.
OK – enough of all the ‘(pseudo-)philosophical’ thoughts and just briefly ‘why Air Force as a branch’ before I get to my list of questions which I have despite doing my ‘google due diligence’:
1. Guess I am not eligible age wise to join AD in any other branch of the US military? (I will be turning 47 in May 2022)
2. I did always have a certain fascination with flying / planes (the passenger jet type… not military ones…) guess from spending a lot of time as a toddler going back and forth between the US and Germany when we lived in Texas for a while.
3. OK – I know the following is very sarcastic and cynical … [but this is (unfortunately) part of my personality which I guess I will have to strongly suppress if I do end up joining the Air Force]: In case a ‘mishap’ (guess from what I can tell this is the official Air Force lingo…. – a very poetic word choice…) should happen at least it is over and done more or less instantaneously… not that one has a choice but personally I prefer not to have a ‘Titanic’ or ‘Gladiator’ type of ending if I can have any influence on that….
So here my questions and if anyone can help with these (of course feel free to provide any sort of feedback on the above as well…) that would be great – some things might of course be classified information and nobody will be able to answer them which I fully understand.
A. How at all would I “fit” in with the ‘medical corp’ team given the info you have on me above? Guess the ‘accession’ route I would be choosing is not at all common in the military and the current impression I have from my ‘due diligence’ (and perhaps I am completely and totally wrong – this is just a total ‘outsider’ impression based on google searches…) is that there might be two ‘general’ groups in the medical corp: the group of relatively recent residency graduates who ‘do their payback’ time and then ‘get out as soon as possible’ and then the ‘long term military career physicians’ who likely have very strong idealistic military family traditions coming from USU who – very rightfully so (because they devoted their entire life to this) – are in the leadership positions [again just to remind everyone that I am someone with NO MILITARY WHATSOEVER … I have never held a ‘real gun’ in my hands in my life so far….] . I guess my ‘civilian-turned-military’ situation is a total ‘odd-ball’ one … Would I just be perceived as ‘totally insane’ by the ‘get out as soon as possible group’ for doing this at age 47 and/or likely perceived more as a ‘liability’ than a ‘help’ by the ‘long term military career physician group'? I am fully aware that whoever answers this will do so with their personal opinion which might not be generalizable but I really am looking for as cathartic (for me) and honest answers here as possible… (i.e. just punch me in the gut….).
B. What will I actually likely end up doing in AD with my skill profile above? Of course I fully understand that I have no control whatsoever on what I will be ordered to do in an AD situation and if my job will end up doing more ‘outpatient / occupational health internal medicine’ somewhere on a base in North Dakota so it is … (again I am totally fine at this stage of my life to be ‘just a cog in the wheel’ as I do not have any sort of ‘pressure’ of ‘skill atrophy’ some younger / not internal medicine type colleagues might have+I also really do not have any sort of military career ambitions). From a professional skill set it would be easiest for me just to continue working as a nocturnist with ‘basic ICU’ responsibilities – but does the MHS have hospitalists/nocturnists at all? Anyone knows if Landstuhl in Germany uses nocturnists covering their ICU at night? How ‘competitive’ is Landstuhl (and would I be at all part of that team as it is primarily run by the Army I guess if I am Air Force)? Would me being fluent in German be seen as an asset there – guess from what I found on google they are trying to collaborate with the surrounding civil German system and my German language skills could potentially be helpful in such setting if e.g. patient needs to be transferred to a German civil hospital for care which cannot be done at Landstuhl? Or would my 'German background' be more seen as a 'liability'?
C. How are ICU’s ‘run’ in the MHS – especially in the smaller facilities? Clearly, I AM NOT A FELLOWSHIP TRAINED CRITICAL CARE physician but I have taken care of mostly ‘bread and butter’ ICU patients very much on my own for the last eight years (intubated, septic on pressors, hypothermia protocol after cardiac arrest – I am comfortable intubating patients with a Glidescope and doing IJ and femoral central lines with ultrasound guidance – BUT no ‘advanced ICU’ skills like CVVH and ECMO – we have to transfer patients to Honolulu for this) … of course these are in the vast majority medical with the occasional post-op surgical patient who comes up from the PACU and very, very rarely the co-managed ‘too sick to fly out to Hawai‘i’s only level 1 trauma center - Queens Medical Center’ trauma patients (which unfortunately most of the time of course end up dying….). Clearly in the large MHS facilities I would not be the right person to work in a large 20+ bed specialized trauma / burn ICU – but how are the ICU’s in the smaller facilities manned?
D. Would I potentially ‘qualify’ to become part of an Air Force CCATT team with my ‘basic critical care’ skills or is this usually reserved for fully fellowship trained critical care physicians / anaesthesia / surgery? Looked at their requirements and clearly I would need to complete an ATLS course and also learn how to put in chest tubes + complete the really great training they are offering … but in some way looking at their info I can imagine myself getting a ‘feel cool’ feeling from being part of that team… - but I guess they are quite competitive?
E. Thanks to the already mentioned time at a large pharmaceutical company I know that I am a Myer-Briggs INTP-A…. (it might be surprising to some but at least the pharmaceutical company I worked in was very invested in making sure they ‘optimize’ the composition of the teams they have and as a physician you are definitely not ‘the top of the hierarchy’ as you are at least ‘perceived’ in a more clinical hospital setting...). However with this personality type I am clearly not what can be considered a ‘natural leader’… I do feel however that in the ‘civilian’ sector I am doing quite an OK job (at least I am told so by everyone) with “my” overnight team of nurses, RT’s etc. in ‘holding the fort down at night’. Now I guess this is a question which is not at all generalizable but what are the ‘leadership’ expectations from a ‘military MD’ from the ‘military RN’s’, ‘military RTs’ etc. in a clinical setting – is this fundamentally different than in the civilian sector? The main reason I am asking this is that basically the only ‘real conflict’ I ever have had with a RN the last eight years happened to be with a male ex-Army ICU RN (who BTW also has ‘issues’ with almost all his peer ‘civilian’ RN’s) (I never ever had any issue with my ex-Army ER night doctor counterpart….). Is there something like the expectation of a more (for the lack of a better word) ‘aggressive’ leadership style in the military than in the civilian sector? Is a ‘buy-in / consensus’ leadership style in the clinical setting in military medicine adequate at all or will this more or less be perceived as a ‘leadership deficiency’ which (in case of the ICU RN mentioned above) leads to ‘permanent questioning of my clinical competency’ situation?
F. How ‘bad’ is Officer Training Abbreviated? Clearly I will likely be in the total ‘odd-ball’ category there due to my age alone and although I think that I will definitely not enjoy my time I am totally ‘getting’ that this is a necessary, important and indispensable step (at the minimum out of respect to the enlisted members who have to go through basic training) and I will simple get through this and make the best out of it…. But what is the best ‘mindset’ to approach this and get through those 5 ½ weeks?
G. Any tips how to contact an Air Force Health care recruiter in my particular situation – should I send a long e-mail with some of the info above? Call? Make an appointment and show up in person??
Thanks for everyone’s time and help in advance!!
To start off: I am a first time poster and if you had told me on February 23rd this year that I would be writing this post on the SDN ‘military medicine’ forum I would have told you that I must have gone totally crazy and that I need to be involuntarily admitted to inpatient psych – BUT as the world has gone mad the next day here I am – someone with NO MILITRY EXPERIENCE/AMBITION/WHATSOVER considering e-mailing an Air Force Healthcare recruiter…
I am not here to highlight what has lead me to this personal “Ask not what your country can do for you – ask what you can do for your country.” moment but I guess I need to provide some background info about myself for people to be perhaps able to give me better advice. Born in (West)-Germany to a (non-military) US-citizen father and Czech mother. Lived in Texas for a short time as a toddler and went to pre-school there before being back to Germany where I grew up and finished high school before studying medicine in Prague in the Czech Republic in the mid/end 1990’s. Then moved to NYC right after medical school in 2001 and did my internal medicine residency there and after some detours via basic cardiology research and a four year stint as a physician at a pharmaceutical company in Copenhagen/Denmark, I then ‘went back’ to clinical hospital based medicine at a small German island hospital (mostly to get my US Internal Medicine Board Certification recognized in Germany/Europe) for two and a half years before I ended up in Hawai‘i working as a hospitalist/nocturnist full time for the last eight years (community based neighbor island hospitals (60-90 beds) with open 7-9 bed ICU’s without any intensivists, with myself and the ED physician being in practical terms the only doctors available at night – i.e. very little subspecialty back-up).
So basically someone with a quite ‘non-linear’ CV who given the now completely changed global/European security situation feels the (sudden and unexpected…- and yes everyone of you who is serving or has served is of course more than welcome to judge me on that part…) moral obligation to at least ‘make myself available’ with my skill set if needed mainly because
1. If my miniscule contribution as an individual (and parent) may lead to more security for everyone (+ my kids) in the future I guess now is the time to do so. [I do not have any ‘heroism’ ambitions here and I am fully aware that I will only be a tiny ‘cog in the wheel’ of a huge military machinery and this is fully OK]. Alternatively if ‘things’ should ‘start hitting the fan’ even more than today [which unfortunately personally I am convinced that the risk of is much higher than a lot of people currently still think…] it would at least allow me to be in a small position to actively try to assure that we end up being the side who ‘looses less’ than the other side [I am deliberately writing this in this way as it is my deepest personal conviction is that no war is ever ‘won’ but that in the end there is just one side who looses more than the other…of course I am aware that I will have to switch to the official "Aim High, Fly-Fight-Win" slogan and that the prior can only be my private unvoiced opinion going forward].
2. As a US foreign medical graduate with ties to Europe as outlined above who owes his medical career to the largest part to my US internal medicine residency training (and no medical school debt as I ‘used’ the European system for that…) it goes against my sense of fairness and equitable distribution of risk to ‘turf’ the inherent risk of the current situation on a younger colleague from Kansas without any ties to Europe who joined the military on a HPSP scholarship because this (in the US system) was the only way she or he could ‘afford’ becoming a physician. The European ‘part’ of me has to fully acknowledge that I am at least partially co-responsible for this situation by being naïve and dumb and underinvesting in (+ undervaluing) military in the European context until 2/24/2022.
OK – enough of all the ‘(pseudo-)philosophical’ thoughts and just briefly ‘why Air Force as a branch’ before I get to my list of questions which I have despite doing my ‘google due diligence’:
1. Guess I am not eligible age wise to join AD in any other branch of the US military? (I will be turning 47 in May 2022)
2. I did always have a certain fascination with flying / planes (the passenger jet type… not military ones…) guess from spending a lot of time as a toddler going back and forth between the US and Germany when we lived in Texas for a while.
3. OK – I know the following is very sarcastic and cynical … [but this is (unfortunately) part of my personality which I guess I will have to strongly suppress if I do end up joining the Air Force]: In case a ‘mishap’ (guess from what I can tell this is the official Air Force lingo…. – a very poetic word choice…) should happen at least it is over and done more or less instantaneously… not that one has a choice but personally I prefer not to have a ‘Titanic’ or ‘Gladiator’ type of ending if I can have any influence on that….
So here my questions and if anyone can help with these (of course feel free to provide any sort of feedback on the above as well…) that would be great – some things might of course be classified information and nobody will be able to answer them which I fully understand.
A. How at all would I “fit” in with the ‘medical corp’ team given the info you have on me above? Guess the ‘accession’ route I would be choosing is not at all common in the military and the current impression I have from my ‘due diligence’ (and perhaps I am completely and totally wrong – this is just a total ‘outsider’ impression based on google searches…) is that there might be two ‘general’ groups in the medical corp: the group of relatively recent residency graduates who ‘do their payback’ time and then ‘get out as soon as possible’ and then the ‘long term military career physicians’ who likely have very strong idealistic military family traditions coming from USU who – very rightfully so (because they devoted their entire life to this) – are in the leadership positions [again just to remind everyone that I am someone with NO MILITARY WHATSOEVER … I have never held a ‘real gun’ in my hands in my life so far….] . I guess my ‘civilian-turned-military’ situation is a total ‘odd-ball’ one … Would I just be perceived as ‘totally insane’ by the ‘get out as soon as possible group’ for doing this at age 47 and/or likely perceived more as a ‘liability’ than a ‘help’ by the ‘long term military career physician group'? I am fully aware that whoever answers this will do so with their personal opinion which might not be generalizable but I really am looking for as cathartic (for me) and honest answers here as possible… (i.e. just punch me in the gut….).
B. What will I actually likely end up doing in AD with my skill profile above? Of course I fully understand that I have no control whatsoever on what I will be ordered to do in an AD situation and if my job will end up doing more ‘outpatient / occupational health internal medicine’ somewhere on a base in North Dakota so it is … (again I am totally fine at this stage of my life to be ‘just a cog in the wheel’ as I do not have any sort of ‘pressure’ of ‘skill atrophy’ some younger / not internal medicine type colleagues might have+I also really do not have any sort of military career ambitions). From a professional skill set it would be easiest for me just to continue working as a nocturnist with ‘basic ICU’ responsibilities – but does the MHS have hospitalists/nocturnists at all? Anyone knows if Landstuhl in Germany uses nocturnists covering their ICU at night? How ‘competitive’ is Landstuhl (and would I be at all part of that team as it is primarily run by the Army I guess if I am Air Force)? Would me being fluent in German be seen as an asset there – guess from what I found on google they are trying to collaborate with the surrounding civil German system and my German language skills could potentially be helpful in such setting if e.g. patient needs to be transferred to a German civil hospital for care which cannot be done at Landstuhl? Or would my 'German background' be more seen as a 'liability'?
C. How are ICU’s ‘run’ in the MHS – especially in the smaller facilities? Clearly, I AM NOT A FELLOWSHIP TRAINED CRITICAL CARE physician but I have taken care of mostly ‘bread and butter’ ICU patients very much on my own for the last eight years (intubated, septic on pressors, hypothermia protocol after cardiac arrest – I am comfortable intubating patients with a Glidescope and doing IJ and femoral central lines with ultrasound guidance – BUT no ‘advanced ICU’ skills like CVVH and ECMO – we have to transfer patients to Honolulu for this) … of course these are in the vast majority medical with the occasional post-op surgical patient who comes up from the PACU and very, very rarely the co-managed ‘too sick to fly out to Hawai‘i’s only level 1 trauma center - Queens Medical Center’ trauma patients (which unfortunately most of the time of course end up dying….). Clearly in the large MHS facilities I would not be the right person to work in a large 20+ bed specialized trauma / burn ICU – but how are the ICU’s in the smaller facilities manned?
D. Would I potentially ‘qualify’ to become part of an Air Force CCATT team with my ‘basic critical care’ skills or is this usually reserved for fully fellowship trained critical care physicians / anaesthesia / surgery? Looked at their requirements and clearly I would need to complete an ATLS course and also learn how to put in chest tubes + complete the really great training they are offering … but in some way looking at their info I can imagine myself getting a ‘feel cool’ feeling from being part of that team… - but I guess they are quite competitive?
E. Thanks to the already mentioned time at a large pharmaceutical company I know that I am a Myer-Briggs INTP-A…. (it might be surprising to some but at least the pharmaceutical company I worked in was very invested in making sure they ‘optimize’ the composition of the teams they have and as a physician you are definitely not ‘the top of the hierarchy’ as you are at least ‘perceived’ in a more clinical hospital setting...). However with this personality type I am clearly not what can be considered a ‘natural leader’… I do feel however that in the ‘civilian’ sector I am doing quite an OK job (at least I am told so by everyone) with “my” overnight team of nurses, RT’s etc. in ‘holding the fort down at night’. Now I guess this is a question which is not at all generalizable but what are the ‘leadership’ expectations from a ‘military MD’ from the ‘military RN’s’, ‘military RTs’ etc. in a clinical setting – is this fundamentally different than in the civilian sector? The main reason I am asking this is that basically the only ‘real conflict’ I ever have had with a RN the last eight years happened to be with a male ex-Army ICU RN (who BTW also has ‘issues’ with almost all his peer ‘civilian’ RN’s) (I never ever had any issue with my ex-Army ER night doctor counterpart….). Is there something like the expectation of a more (for the lack of a better word) ‘aggressive’ leadership style in the military than in the civilian sector? Is a ‘buy-in / consensus’ leadership style in the clinical setting in military medicine adequate at all or will this more or less be perceived as a ‘leadership deficiency’ which (in case of the ICU RN mentioned above) leads to ‘permanent questioning of my clinical competency’ situation?
F. How ‘bad’ is Officer Training Abbreviated? Clearly I will likely be in the total ‘odd-ball’ category there due to my age alone and although I think that I will definitely not enjoy my time I am totally ‘getting’ that this is a necessary, important and indispensable step (at the minimum out of respect to the enlisted members who have to go through basic training) and I will simple get through this and make the best out of it…. But what is the best ‘mindset’ to approach this and get through those 5 ½ weeks?
G. Any tips how to contact an Air Force Health care recruiter in my particular situation – should I send a long e-mail with some of the info above? Call? Make an appointment and show up in person??
Thanks for everyone’s time and help in advance!!
