AVOID MILITARY MEDICINE if possible

[qqq]

well, this is just a single story so it means really nowt if anything at all, but i'll share because i like this board and the interaction anyway, an airforce doctor at tripler almost killed my dad. my dad had apparently (and everything i've heard is through my dad and he is no MD, so grain of salt, yea) a slightly enlarged prostate which should have been treated entirely through meds. the airforce doc decided to do some type of rather new laser treatment and ended up destroying too much tissue. what happened is that my dad almost died. fortunately, he didn't, and after several years (about three) he is finally able to work again. needless to say, he cannot function sexually. well, since my dad's military (retired), there is no way to sue. He spoke to the doc's commander who fully acknowledged the error, but basically said he could give no greater punishment than preventing the doc from being promoted and doing that surgery again at tripler. it was a very unfortunate accident. Has my dad started seeing only civilian docs since? No way, he can't afford it.

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[qqq]

IMO, if an inquiry originates from outside the DoD, then it would not be answered by a clipboard commando. It would be answered through a very tightly regulated Public Affairs office, and if we are indeed talking about addressing public officials on the state of mil medicine, i would think it would be at the HQ level.

 

[qqq]

continuing the story on my dad . . . well, another reason he refuses to seek treatment outside the military medical system is because he actually thinks it's great (despite his near death experience). I have no evidence, but I think this is not uncommon, especially among very patriotic vets, of which most veterans are. It's the culture within the military, a culture of pride, and it's a good culture, and an absolutely necessary one in the operational military. Of course, folks get indoctrinated in the military and feel they are safe in the military or that they can trust the military. It's like how everyone thinks USAA is the only way to bank (and they are a good company, don't get me wrong, fortune 500, etc., just an example) because they are so military-oriented. Anyway, I think this feeling of safety MIGHT contribute to why so many military folks won't seek treatment outside the military (and of course because it's free). And many have been in the military since age 18 so they don't know what civilian medicine is like. They have no other standard with which to compare.

 

[UCBShocker]

continuing the story on my dad . . . well, another reason he refuses to seek treatment outside the military medical system is because he actually thinks it's great (despite his near death experience). I have no evidence, but I think this is not uncommon, especially among very patriotic vets, of which most veterans are. It's the culture within the military, a culture of pride, and it's a good culture, and an absolutely necessary one in the operational military. Of course, folks get indoctrinated in the military and feel they are safe in the military or that they can trust the military. It's like how everyone thinks USAA is the only way to bank (and they are a good company, don't get me wrong, fortune 500, etc., just an example) because they are so military-oriented. Anyway, I think this feeling of safety MIGHT contribute to why so many military folks won't seek treatment outside the military (and of course because it's free). And many have been in the military since age 18 so they don't know what civilian medicine is like. They have no other standard with which to compare.

Hey qqq, I am really really happy your Dad made it through, it really sucks he had to go through that. Unfortunately this is another problem that is not unique to the military. My experience has shown me that many people, civi and otherwise die because of professional error. Its kind of a catch 22 when your professional training is done in part with real people that can greatly suffer from mistakes, but you can't become a good doctor without that training. My Uncle died a few years back, probably because a new doctor mis read an xray (ofcourse I will never know what really happened)... months later he was diagnosed with very aggressive and milignant prostate cancer... two weeks after that he had passed away.

 

[BOHICA-FIGMO]

I'll bet that he was speaking to one of those all-knowing, all-powerful, all-clipboard carrying nurses in command.

I know mommax3's pain because I'm suffering along at the same godforsaken base. By the way, our Nurse-in-Command is nothing but a cheerleader in a blue uniform. She is oblivious. She has 20 years of nursing "experience", but was flabbergasted to hear that a patient scheduled for a big colon cancer operation would need to spend more than overnight in the hospital. When I told her that typically they spend 4-5 days...she got this concerned look on her face and said, "Jeez, that seems like a really long time for something like that. Is it more involved than usual? Do you need a second opinion?" I gave her a blank stare (which I have have on my face way too often these days) and assured her that I could manage ok on my own.

I think I know which base you're talking about (starts with an S, ends with a D?), and I know how USAF nurses can be. Our MDOS/CC is a nurse and she is a huge pain in the butt to everyone. I have been personally stabbed in the back by a few USAF nurses so I have a really bad taste in my mouth about trusting them (at least the non-clinical ones).

 

[CaliAtenza]

crap..maybe i should rethink going to the USAF after i get out of med school and do my civilian residency (im gonna be an USIMG...so i cant do my residency with the armed forces anyways). My dad (a FMG) did a tour with the USAF (probably one of the reasons he did it was probably because it was an easier route to citzenship), so maybe thats one of the reasons i want to do it. Also..ive always had a desire to serve my country as well..but reading this, im starting to have second thoughts. We'll see though...i have time to decide.

 

[UCBShocker]

crap..maybe i should rethink going to the USAF after i get out of med school and do my civilian residency (im gonna be an USIMG...so i cant do my residency with the armed forces anyways). My dad (a FMG) did a tour with the USAF (probably one of the reasons he did it was probably because it was an easier route to citzenship), so maybe thats one of the reasons i want to do it. Also..ive always had a desire to serve my country as well..but reading this, im starting to have second thoughts. We'll see though...i have time to decide.

Make your own decision. Every route comes with its annoyances. I chose to go in the end because its what I really wanted, and I am willing to accept what comes. It may not be right for you, hey it may not even be right for me, but I made my decision based on the research I had done. I can not provide you with any insight unfortunately, not for another 4 years atleast... I haven't even been a Lt. for 48 hours yet =). But hey, the last 32 hours have been great LOL.

 

[CaliAtenza]

Make your own decision. Every route comes with its annoyances. I chose to go in the end because its what I really wanted, and I am willing to accept what comes. It may not be right for you, hey it may not even be right for me, but I made my decision based on the research I had done. I can not provide you with any insight unfortunately, not for another 4 years atleast... I haven't even been a Lt. for 48 hours yet =). But hey, the last 32 hours have been great LOL.

Thanx for the input though..and gluck to u. I'll be doen with medical school in 4 years as well, so maybe i'll see u around in the military someday if i decide to join after residency

 

[UCBShocker]

Thanx for the input though..and gluck to u. I'll be doen with medical school in 4 years as well, so maybe i'll see u around in the military someday if i decide to join after residency

Maybe =)... ya never know. Best of luck to you.

 

[Monty Python]

.......assigning civilian family practice residents (who are mostly FMGs) to be the docs on call for the inpatient military pediatric patients was not a good policy, since they could not take care of neonates and civilian pediatricians were not willing to cover them.....the AF pediatricians are so short-staffed that they were not able to cover hospitalized patients as well as their clinics. This policy (which went into effect in March) had, by the end of May, left two premature babies with NO physician for several hours after their birth.....they were intubated by civilian nurses and basically left in limbo until a civilian pediatrician was finally persuaded by the civilian chief of staff to come in. .

Here's what you do: simply write that story in a short, objective letter and send it to your elected officials. Write it from a cause-and-effect perspective.

Honorable J. Smith
US House of Representatives
Washington DC 20515

Senator J. Smith
United States Senate
Washington DC 20510

If you have gobs of free time to look up the board membership, send copies to each elected member of the Armed Services Committee on Capitol Hill. Also, send copies of the letter which you sent to your senator to the Surgeons General of each military service. When you copy them with a letter you sent to your Senator, that WILL get their attention.

Then send copies to the editors of the newspapers at large towns nearby. Also send copies to USA Today, Newsweek, and Time.

 

[R-Me-Doc]

My husband is FINALLY out of the AF (actually he is on terminal leave ) and the uniforms are in a box in the attic. After an active duty residency and four years at a godforsaken base in north Texas, he and I are both more than thrilled to leave the military behind. He got great training in residency (he is an OB/Gyn) at WHMC and BAMC, but his time as an attending at a small hospital (which basically ceased to be a hospital and became a clinic over the past four years) was a whole different world. Put simply, it was VERY difficult for him to practice "good medicine" within the confines of the military. Contract staff and GS employees, as well as other active duty folks who were counting the days til retirement made for a horrible work environment.

My husband signed up mainly for the free ride through med school, although he was proud to be able to be a part of the armed forces, too. If the resources here would have been available to us 12 years ago, he would have made a different choice, but we knew no one who had taken the HPSP route and it sounded good to both of us. He worked very hard, did NOT count the days, and was well thought of by those above and below him.

During his last week of active duty, he was working hard to convince TPTB, both at his base and higher up, that assigning civilian family practice residents (who are mostly FMGs) to be the docs on call for the inpatient military pediatric patients was not a good policy, since they could not take care of neonates and civilian pediatricians were not willing to cover them.....the AF pediatricians are so short-staffed that they were not able to cover hospitalized patients as well as their clinics. This policy (which went into effect in March) had, by the end of May, left two premature babies with NO physician for several hours after their birth.....they were intubated by civilian nurses and basically left in limbo until a civilian pediatrician was finally persuaded by the civilian chief of staff to come in. This is only the LAST incident that my husband dealt with while an AF doc, but by no means the ONLY incident. For whatever reason, no one has the courage to pull the plug on dependent care in the military.....they are just going to short-staff it to death.

If you have a choice, stay out. If you don't, (you've already signed the papers) try to get assigned to a medical center if you can.....that has its own challenges, but I think it may be easier to practice good medicine in that atmosphere.

Those of you who downplay the opinions of the former/current military docs who post here are doing yourselves a huge disservice. They have nothing to gain by posting here.....my husband isn't willing to take the time.....but they are NOT the minority. It really does suck. Don't delude yourselves.

Sounds exactly like what I'll probably be writing in a year! Congrats on getting your lifeboat off the Titanic! Best of luck.

RMD 1-0-19 (unlike your hubby, I am VERY MUCH counting the days!)

 

[USAFdoc]

Sounds exactly like what I'll probably be writing in a year! Congrats on getting your lifeboat off the Titanic! Best of luck.

RMD 1-0-19 (unlike your hubby, I am VERY MUCH counting the days!)

I understand why someone who is already committed to HPSP or similar wouldn't want to hear what awaits them, they have to go anyways. The reason docs who have been in the system want to warn you is for a few reasons. If you have not signed, don't. This may sound counter intuitive (less docs...still worse conditions), however, I believe as long as the pipeline continues to be filled by unsuspecting med students, the problem will continue.
Also, students can start to bring up concerns with their meds schoools and congress and whoever will listen and perhaps promote change.
And lastly, to prepare you for when you get there. Foe 6 months I thought it was just my base that was so bad. That was until I attended several conferences and spoke with docs of 8 other military bases, all "bad" like mine.

Hey, if you are already committed, make the most of it. You ARE doing a great service to your country, just be prepared that you will likely change your mind about it being a military career about 6 months after you arrive as "the new doc".

 

[Kawen]

I've been thinking about doing HPSP as an AF pharmacist, but reading all of this makes me wonder if the environment is the same on the pharmacy side of things. If any of you has any experience with this, please let me know.

I've heard that there are substantial sign on bonuses to go along with everything else and it is awfully tempting, but after reading all of this, I don't know if it's worth it or not.

 

[USAFdoc]

I've been thinking about doing HPSP as an AF pharmacist, but reading all of this makes me wonder if the environment is the same on the pharmacy side of things. If any of you has any experience with this, please let me know.

I've heard that there are substantial sign on bonuses to go along with everything else and it is awfully tempting, but after reading all of this, I don't know if it's worth it or not.

I have regular conversations with our pharmacy people and some of the same types of problems and manning issues and USAF beurocracy problems are hamstringing them as well.
I strongly recommend you keep your options open by NOT going HPSP. Get a civilian training and if you want to serve the troops, they will hire you as a civilian....and if the job is terrible, you will have the choice to leave.

 

[miketike42]

I'm a 7 yr navy guy (SWO) and I'm set to med school this year. I've got a family and the Navy is willing pay 28 grand a year for me to go school. I sign the papers on Tuesday. Do I give up movie night for the next four years or do I suck up three years of pain on a ship to be a surgeon at Balboa in San Diego and keep movie night for the next four years. Popcorn too!

 

[USAFdoc]

I'm a 7 yr navy guy (SWO) and I'm set to med school this year. I've got a family and the Navy is willing pay 28 grand a year for me to go school. I sign the papers on Tuesday. Do I give up movie night for the next four years or do I suck up three years of pain on a ship to be a surgeon at Balboa in San Diego and keep movie night for the next four years. Popcorn too!

I hope things work out well for you and your family, really.
However, be prepared to be very frustrated and think about a non military career soon after you make it to your 1st duty assignment as a doc.

I could go on to tell you about undermanning and poor support staff etc...etc...but until you experience it for yourself, it won't have meaning to you.

 

[helo doc]

I'm a 7 yr navy guy (SWO) and I'm set to med school this year. I've got a family and the Navy is willing pay 28 grand a year for me to go school. I sign the papers on Tuesday. Do I give up movie night for the next four years or do I suck up three years of pain on a ship to be a surgeon at Balboa in San Diego and keep movie night for the next four years. Popcorn too!

I was in a similar situation (sub, not swo), so I share your pain bro'. You can look at it as glass half empty or full. Let me explain...

Glass half empty - Navy medicine is going through some trying times right now. Downsizing, I mean "rightsizing", BRAC, retention in the toilet, and multiple opportunities for all-inclusive vacations to sunny Iraq, beautiful Afghanistan or on the Haze Gray Cruise Lines. Add to that PBD-712, a stagnant incentive pay system for physicians and budget restraints because we've just got to have 200+ Raptors/JSF/V-22 ospreys/DDX-21's in our inventory and you've got a recipe for becoming a bitter Navy physician in a matter of weeks, if not days.

Glass half full - As a SWO, you already know the true definition of pain. So whatever they throw at you in the medical corps, you know it could be worse. Then, let's see... Getting paid to go to med school. You're at 7 yrs now. Internship (1yr) + 3 yr flight surgery/DMO job + 4 years of residency puts you at 15 years. Payback your time owe for residency (4 years), plus one more year, and badda-bing, your at 20yrs. Retire as an O-5 with 20. Assuming Congress decides not to f*** with the military retirement system, you could start collecting that check in your mid-40's. Over the average male life expectancy, that measley retirement could be worth about 3 million dollars (said with left pinky at corner of mouth a la Dr. Evil). So, you punch out of the Navy, go into the real world and then start making real money. You haven't practiced your specialty in the Navy long enough for your skills to truly atrophy, so you're still employable.

Pick up a different glass - use the GI Bill and take out loans to avoid setting sail on the Titanic known as Navy medicine. Make it work. Enjoy the flexibility to decide your own fate. Finish residency and immediately start making more than any 4 star admiral physician triple boarded in anesthesia/radiology/neurosurgery. No deployments. No clipboard commandos. No missing holidays, birthdays, anniversaries.

So, is it all worth it? Depends on your outlook - hell, it depends on the day of the week for me. Good luck.

 

[USC2003]

I am currently begining my 3rd year of residency as an Oral and Maxillofacial Surgery (OMFS) resident and I am on deferment from the Air Force. I owe the Air Force 3 years for paying for dental school and was wondering if anyone could shed some insight on what the lifestyle of an Air Force OMFS is like. Do they have similar problems as our medical colleagues in regards to numbers of patients and understaffing?

 

[USAFdoc]

I am currently begining my 3rd year of residency as an Oral and Maxillofacial Surgery (OMFS) resident and I am on deferment from the Air Force. I owe the Air Force 3 years for paying for dental school and was wondering if anyone could shed some insight on what the lifestyle of an Air Force OMFS is like. Do they have similar problems as our medical colleagues in regards to numbers of patients and understaffing?

I am primary care but know several of our dentists;
things are not great there either. USAF Dental has begun the deathmarch of "Optimization" that has poisoned Family Medicine. What happens with Optimization is that the USAF will markedly increase the numbers of patients and duties you will have as a provider. To make it look good on paper, they will "promise" all these support staff you will get so that you can concentrate on just seeing patients. Problem is, the support staff and other things promised will never be there, and certainly not with any consistency. In the end you will find your workload more than doubled with no increase in support help. This is what has happened in USAF Fam Med and this was started in Dental on my base recently. They are hating it.
Since you are already committed, just realize that it will be bad, do the best you can, try to have a "life", try to spend time with your family, and DEFINITELY plan to be a civilian 3 years from now.

 

[USAFdoc]

Sounds exactly like what I'll probably be writing in a year! Congrats on getting your lifeboat off the Titanic! Best of luck.

RMD 1-0-19 (unlike your hubby, I am VERY MUCH counting the days!)

I have decided to enter the civilian world again. After 12 years military, leaving kinda feels like a divorce, but with a relationship this bad, its gotta end.

 

[sumfratrisamor]

USAFdoc: Learn how to write.

and how to do math.

in your ten example pointers you used your tenth one to state that you had nintey more, and since that in and of itself is not a piece of advice related to military medicine you only had NINE valid example points to add to your ninety more, which adds up perfectly to your 100s of points!

 

[USAFdoc]

and how to do math.

in your ten example pointers you used your tenth one to state that you had nintey more, and since that in and of itself is not a piece of advice related to military medicine you only had NINE valid example points to add to your ninety more, which adds up perfectly to your 100s of points!

I just separated after 9 years active duty and some reserve time. After working 1 week in my new civilian family practice job, the difference when compared to the chaos going on in my old USAF clinic is incredible.

Even though I am working for an HMO-like organization now (like what the USAF has become) there is little comparison after that. One of the top bosses of the organization stopped by my office the other day and explained his philosophy......."we want to give excellent care and balance that with cost savings...and the only way we can do that is if we make this a place where the docs want to stay.......when the docs succeed, we all succeed".

Just words, I know, and the USAF has more "lip-service" than anyone, but my new place is already backing up their words in providing me staffing, equipment, and allowing me to make changes to my clinic to improve quality and efficiency. Add to that the fact that I know get to see much, much more of my family and get paid twice as much (120 K) and work only about half the hours (I work 8-4 M-Th and a half day on Fri), no weekends, no hospital etc. In the USAF I worked 12-18 hours a days and every Sat and some Sun for the past 3 years with admin "riding" the docs all the time demanding more work and better "numbers" metrics. Staffing was running at about 20% or less on most days.

I still wish I could be a USAF Family Doctor, but for the sake of my family I had to "DIVORCE" the US Air FORCE.

Life is better on the outside, quality of care is better, access to care is better, etc, etc, etc, at least here it is and ALL the docs I know that got out before me say the SAME thing.

The USAF Primary care platform is broken and sinking.

To quote one of my previous COMMANDERS (a nurse); "If the docs want to get out, let them, who needs 'em".

Your order completed M'am.

 

[Mirror Form]

get paid twice as much (120 K)

You have a lot of good points in your post. But how the heck did you only make 60k in military? If you did a gross-up (i.e., take your after-taxes pay in the military and calculate what you'd have to make in the civilian world to get the same pay after-taxes) most military interns start at around 60k. Since I should supposedly be getting four years in service, I'll be making the equivalent of over 70k as an intern. Of course in the end, you'll always come out ahead overall in the civilian world. But it is nice to not be destitute during internship and residency.

 

[Leviathanius]

For those of you gullible enough to let all of the complaining drivel from these 'altruistic' disenfrachised military docs deter you from pursuing military medicine, I have two things to submit to you. First, I have a nice plot of oceanside property in Florida to sell you; second, civilian medicine has no mismanagement, unmotivated colleagues, unnecessary paperwork, long hours, cranky nurses, or any other immaginable problem. Really, though, check things out for yourself and do not give any individual in this forum any more credence than you would any other military doc.

 

[militarymd]

Before you buy that ocean-side property, come to all the specialty forums and listen to all of us prior military docs complain about how our specialty sucks and how little money we make, and how we wish we had not gone into medicine....ooh, wait, or is it only this forum?

 

[jetproppilot]

For those of you gullible enough to let all of the complaining drivel from these 'altruistic' disenfrachised military docs deter you from pursuing military medicine, I have two things to submit to you. First, I have a nice plot of oceanside property in Florida to sell you; second, civilian medicine has no mismanagement, unmotivated colleagues, unnecessary paperwork, long hours, cranky nurses, or any other immaginable problem. Really, though, check things out for yourself and do not give any individual in this forum any more credence than you would any other military doc.

Ever been in private practice, Slim? From the readings of this thread I venture to say theres no comparison. I have no unmotivated colleagues. We arrive at work at 0615 and work together like dogs to get the cases started on time. Our turnover times are getting better and better. I work 2 weeks of days, a week of nights, then get a week off, and the nurses I work with will drop whatever they are doing to help me when I need help.
Is that how military medicine works?

 

[GMO2003]

Ever been in private practice, Slim? From the readings of this thread I venture to say theres no comparison. I have no unmotivated colleagues. We arrive at work at 0615 and work together like dogs to get the cases started on time. Our turnover times are getting better and better. I work 2 weeks of days, a week of nights, then get a week off, and the nurses I work with will drop whatever they are doing to help me when I need help.
Is that how military medicine works?

NO

 

[jetproppilot]

For those of you gullible enough to let all of the complaining drivel from these 'altruistic' disenfrachised military docs deter you from pursuing military medicine, I have two things to submit to you. First, I have a nice plot of oceanside property in Florida to sell you; second, civilian medicine has no mismanagement, unmotivated colleagues, unnecessary paperwork, long hours, cranky nurses, or any other immaginable problem. Really, though, check things out for yourself and do not give any individual in this forum any more credence than you would any other military doc.

Hey Levi, I just read all your verbose posts defending military medicine. Why don't you come shadow one of us civilian guys for eight hours, huh? Thats all it would take...eight hours....for you to change your stance, unless you keep lying to yourself and others.

 

[island doc]

I feel your pain. The worst four years of my life were spent as a primary care physician in the USAF. It was a miserable experience for all the reasons you mentioned, and more. I find your comments to be totally accurate.

The only way for your life to improve is for you to separate ASAP.

I agree that medical students should avoid USAF HPSP or USUHS.

 

[RichL025]

Hey Levi, I just read all your verbose posts defending military medicine. Why don't you come shadow one of us civilian guys for eight hours, huh? Thats all it would take...eight hours....for you to change your stance, unless you keep lying to yourself and others.

Are you trying to say everything is always hunky-dory on civvy street? 'Cause I know alot of civilian docs who are fed up with administrative BS and reimbursement hassles.

My mother works (as an NP, mind you) with a Heme-Onc group at a world-reknowned cancer center. The chief is a great guy and doc but lousy administrator, and they keep loosing docs because of it. And they loose patients, also (when half of your practice takes July 4th week off, the patients get pissed if they can't get seen for some reason.)

I think this whole "military versus civilian" medicine thing is a case of the grass being greener elsewhere....

 

[UncleRico]

This board is hilarious! Once again, a med student who has never practiced military medicine is judging current and prior staff physicians to be overly negative whiners falling prey to the "grass is always greener" syndrome.

Why is it so hard for med students to understand that military medicine is absolutely horrible, in nearly every way possible. In my department at an AF medical center, over the past two years 12 of 13 active duty staff physicians separated at the first chance they got, and NONE have come back! Now the staff that have replaced them are already counting the days to get out. It is a miserable existence, and as residents we are encompassed by it. It honestly feels basically like minimal security prison. The bad thing for me is that as a USUHS grad I am stuck until 2014...with no way out.

The reasons for the misery in military med have been well-documented and I agree wholeheartedly with them and I will not take the time to repeat them again here.

For those of you even having ANY second thoughts about joining...DON'T DO IT. You will be thanking yourself years later after you actually have the medical experience to understand what you would have gotten yourself into.

Based on the stubborn defensiveness of many pre-meds and med students on this forum, it looks like military medicine will be well-stocked for years to come with naive people (like I was) who fall prey to the promise of a few med school dollars and the smooth talking mililtary med recruiting propaganda.

 

[RichL025]

*Yawn*

Actually, what's absolutely hilarious is the knee-jerk response that any post on this subject gets.

I was responding to someone who challenged another poster to spend 8 hours with a civilian doc. Not only had I done that many, many times, but I have several good friends who are MDs (FP, peds ortho, EM) and hear about their ups and downs on a daily basis. Don't get me wrong - those 3 love their jobs, but they're sanguine about the downsides, also.

So, sparky, if you want to continue to pull your old-salty routine, go right ahead. Since I've been wearing Uncle Sam's tree suit for about 18 years now (14 of which in an ancillary medical field), you'll forgive me if I don't fall all over myself in worship.

Caveat - you keep repeating "Air Force", and the title of the thread is "military medicine" - I've always been USA, so our experience may not fully overlap - I have had only a limited exposure to AF medicine.

 

[Mirror Form]

My mother works (as an NP, mind you) with a Heme-Onc group at a world-reknowned cancer center. The chief is a great guy and doc but lousy administrator, and they keep loosing docs because of it. And they loose patients, also (when half of your practice takes July 4th week off, the patients get pissed if they can't get seen for some reason.)

The difference ist that those doctors had the option of quitting and joining a group with a better administrator who they like to work with (which is why those kinds of practices are not the norm in the civilian world). Had they been in the military, they'd have been stuck with that idiot forever. Not only that, but the idiot would have had a lot more control over their lives as well.

 

[militarymd]

Since I've been wearing Uncle Sam's tree suit for about 18 years now (14 of which in an ancillary medical field), you'll forgive me if I don't fall all over myself in worship.

Rich,

You do realize that a lot of the problems that physicians in mil med complain about is: the ancillary medical fields.

 

[MoosePilot]

This board is hilarious! Once again, a med student who has never practiced military medicine is judging current and prior staff physicians to be overly negative whiners falling prey to the "grass is always greener" syndrome.

Why is it so hard for med students to understand that military medicine is absolutely horrible, in nearly every way possible. In my department at an AF medical center, over the past two years 12 of 13 active duty staff physicians separated at the first chance they got, and NONE have come back! Now the staff that have replaced them are already counting the days to get out. It is a miserable existence, and as residents we are encompassed by it. It honestly feels basically like minimal security prison. The bad thing for me is that as a USUHS grad I am stuck until 2014...with no way out.

The reasons for the misery in military med have been well-documented and I agree wholeheartedly with them and I will not take the time to repeat them again here.

For those of you even having ANY second thoughts about joining...DON'T DO IT. You will be thanking yourself years later after you actually have the medical experience to understand what you would have gotten yourself into.

Based on the stubborn defensiveness of many pre-meds and med students on this forum, it looks like military medicine will be well-stocked for years to come with naive people (like I was) who fall prey to the promise of a few med school dollars and the smooth talking mililtary med recruiting propaganda.

I think it's all perspective. If you had experience as a civilian doc during your education and then went into military medicine, I bet military medicine looks awful. As an operator, my time shadowing a military doctor in the most likely field for docs to go into seemed pretty decent. His days were less than half as long as mine in an air-conditioned environment and he got to sleep in his own bed at night. I'm not saying it was perfect, nor that I know exactly how stressful parts of it might be, but not all of us are completely ignorant when we say we're interested in entering military medicine.

At the same time I appreciate your efforts to educate us. If nothing else, it insures fewer people can say "I had no idea, my recruiter said 'x'".

 

[USAFdoc]

I think it's all perspective. If you had experience as a civilian doc during your education and then went into military medicine, I bet military medicine looks awful. As an operator, my time shadowing a military doctor in the most likely field for docs to go into seemed pretty decent. His days were less than half as long as mine in an air-conditioned environment and he got to sleep in his own bed at night. I'm not saying it was perfect, nor that I know exactly how stressful parts of it might be, but not all of us are completely ignorant when we say we're interested in entering military medicine.

At the same time I appreciate your efforts to educate us. If nothing else, it insures fewer people can say "I had no idea, my recruiter said 'x'".

After being civilianized recently; I must tell you,three is NO COMPARISON between the quality of a military clinic (USAF anyways) and the civilian ones I have seen thus far. Both have similar problems but the military problems are exponentially worse and in the military world they do not let you fix even the simplest of problems.

I miss my USAF patients and career but not enough to go back to that chaos; not for me or my family.

God Bless the USA; and may God fix the USAF.

 

[Zoomer]

I miss my USAF patients and career but not enough to go back to that chaos; not for me or my family.

God Bless the USA; and may God fix the USAF.

Amen!

 

[jetproppilot]

USAFdoc is trying to argue that people should not apply for HPSP, and or should not go into military medicine period. I am simply looking at his argument, and it doesn't hold much weight with me. I don't have to explain my life history. Lets simply use logic and critical thinking skills.
Sure experience must count for something, but I also want to see die hard proof, statistics, and sound weighted arguments for not joining the military.
Most of the things I read on this thread are opinion, and people's perceptions, and nothing more.

When you sign up with the military, during med school (before your experiencestarts) is that time kinda like being an alcoholic, where you're in DENIAL about certain issues?


It really is interesting to hear med students speaking to tried and true, experienced military docs like they're the Dali Lama.

 

[USAFdoc]

Amen!

rumor from the assignment officer USAF....this year they will be 50 Family docs short and expected to be 150 family docs short next year.

and they said it can't get worse.

 

[BOHICA-FIGMO]

After being civilianized recently; I must tell you,three is NO COMPARISON between the quality of a military clinic (USAF anyways) and the civilian ones I have seen thus far. Both have similar problems but the military problems are exponentially worse and in the military world they do not let you fix even the simplest of problems.

I miss my USAF patients and career but not enough to go back to that chaos; not for me or my family.

God Bless the USA; and may God fix the USAF.

A big, big freakin AMEN to that!

 

[theblastopore]

I'm a pre-med thinking about military medicine. THANK GOD for this thread.

 

[USAFdoc]

I'm a pre-med thinking about military medicine. THANK GOD for this thread.

It is my sincere hope that USAF primary care med get it's act together, but I would be lying if I thought things would get better anytime soon. Till then I would advise all future docs that are considering the military option to REALLY, REALLY investigate the situation before they sign. I know I went HPSP without any idea of what I was getting into. I would recommend alternative ways to pay for med school, and then investigate the military option (if you are still interested) and look for them to pay off your debts then and CALL and SPEAK personnally to as many docs in the field you are interested in at a few different bases. DO NOT talk to administration, talk to docs with about 1-3 years in the military medical field since that will most closely resemble what your life will be like for you and your family, and what medicine is like at the time.

Again, I realize that at my base I didn't have car bombs killing my comrades, and I did get to see my family daily (although not much with 12-18 hr days M-F and working 95% of weekends)....but in my 22 years of professional life, teh USAF primary care environment was hands down the worst run organization I have ever been a part of; and most bases were similar (overseas and academy are noted exceptions).

 

[Homunculus]

although not much with 12-18 hr days M-F and working 95% of weekends

where was this? i've spoken with people (in all 3 branches) who worked a lot, but that is astronomical. none of the AF FP people i've run into have ever even hinted at work hours like that.

--your friendly neighborhood RRC 80 hr workweek caveman

 

[USAFdoc]

where was this? i've spoken with people (in all 3 branches) who worked a lot, but that is astronomical. none of the AF FP people i've run into have ever even hinted at work hours like that.

--your friendly neighborhood RRC 80 hr workweek caveman

the docs in my clinic started our day at 0530 for mandatory physical fitness training 3 days a week (the USAF said this PT stuff was supposed to be during work hours,ha), otherwise we started clinic at 0645 M-F. We saw pateints through lunch hour (I had lunch about 5 times over the past 2 years...ate in in between patients) with last patient scheduled about 1600 hours, then you had all the paperwork for the day, MEBs, patient call backs labs etc. I was never given time of to accomplish these. A special mention here goes to all the internet based training on chem warefare, HIPPA, etc which one month maxed out at about 40 hours of training of which again we were never given time to accomplish so that was weekend time. Then we had weekend clinic, and more paperwork that we came in on weekends to do. Typical end of the day for me ranged from 1800-1900 but that was because I came in usually about 0400 (my earliest arrival was 0230). Other docs chose to come in at 0630 but they were sometimes there till 2100 or later some days.

Again, this was my clinic which was 20-30 % manned for the past 3 years.
I spoke with other docs from Offutt to Fairchild, and many SE US bases and all had serious manning issues. My base was "lucky" in that we had no ER to cover, as many bases had the FP docs doing double duty with most ER docs deployed. Some of the workload was more on the docs were gave the most comprehensive care to the patients. For example; if some 60 yr old pt comes in with sinusitis, a doc can make it easy on him/herself but treating the sinusitis and moving on to the next pt. However, most of our docs would realize that this pt also had DM2, hi chol etc and has not been seen in 11 months and take care of everything. This is good care but also was necessary in our clinic because there were no appts available 95% of the time. We would open up the schedule on a Monday at 0700 and by 0730 all appts would be gone. Again, we had some 20,000 people assigned and many weeks had 2-3 docs and a couple extenders in clinic. My hours per month ranged from 280-320 most months with a high one month of 400 hrs) JHACO month. For those who are familiar with RVUs..I peaked at about 800 RVUs per month....and for three years we heard how "bad" the numbers were from from our admin, "why is access so bad etc.

I would encourage all the read the online USAFP quarterly Journal over the past 1-2 years. If you can "read between the lines" on the various service rep editorials you will see that they discuss similar ideas (in a bit more toned down pro-mil format) as what I have been stating here for months.

and by the way; my current job as a "full-time" FP is 40 hrs week (4 1/2 days) M-F 120K, no OB, no call, and my kids are getting to know daddy again.

and also important; when processes are broke, I have the authority to fix them (even in the managed care world).

 

[MoosePilot]

I've always kind of wondered how the military can motivate a doc to do all that. Some of it is self-motivation, like staying late to really take care of a patient instead of just writing the obligatory Entex prescription (I halfway believe that I could be a flight doc without further training, if they'd let me prescribe Entex, Motrin, and make referrals). What about the PT, though? What if you didn't go? Especially in your last year, when they can't send you remote. Do you think they'd "fire" a doctor? I don't see it as long as you didn't say "Screw you." in public. Just don't go... half of the folks I know don't show up to PT.

 

[militarymd]

I've always kind of wondered how the military can motivate a doc to do all that. Some of it is self-motivation, like staying late to really take care of a patient instead of just writing the obligatory Entex prescription (I halfway believe that I could be a flight doc without further training, if they'd let me prescribe Entex, Motrin, and make referrals). What about the PT, though? What if you didn't go? Especially in your last year, when they can't send you remote. Do you think they'd "fire" a doctor? I don't see it as long as you didn't say "Screw you." in public. Just don't go... half of the folks I know don't show up to PT.

Your bonus, more than half my pay, can be withheld. Everyone on this board talks like our bonuses are automatic....NOOOOOO...they are paid at the discretion of your CO....If they feel that you don't deserve, they don't have to sign the paperwork....and all of a sudden your bonus is gone.

Leave can be not granted...etc.

 

[USAFdoc]

Your bonus, more than half my pay, can be withheld. Everyone on this board talks like our bonuses are automatic....NOOOOOO...they are paid at the discretion of your CO....If they feel that you don't deserve, they don't have to sign the paperwork....and all of a sudden your bonus is gone.

Leave can be not granted...etc.

one of the docs did have his bonus' threatened to be withheld (that is a 20K threat).

 

[MoosePilot]

Your bonus, more than half my pay, can be withheld. Everyone on this board talks like our bonuses are automatic....NOOOOOO...they are paid at the discretion of your CO....If they feel that you don't deserve, they don't have to sign the paperwork....and all of a sudden your bonus is gone.

Leave can be not granted...etc.

A lot of my leave has not been granted throughout my career. My flight pay is by reg, I've never heard of anyone having to sign anything to continue it, except the examiner signing that I passed my checkride and the flight doc signing that I passed my physical.

Weird that your bonuses are different.

 

[USAFdoc]

A lot of my leave has not been granted throughout my career. My flight pay is by reg, I've never heard of anyone having to sign anything to continue it, except the examiner signing that I passed my checkride and the flight doc signing that I passed my physical.

Weird that your bonuses are different.

my USAF experience was a great learning experience for me.....ie I have learned how NOT to run a family practice clinic. I have also become a strong believer in the idea that if things are designed to fail, they will fail.

In regards to the bonus' we got as docs; why, why would the USAF "design" things that way were every doc had to download several forms, get various signatures and then wait to see if your commander would sign and then fax the forms to San Antonio and hope all went through. It is just a "stupid" way to do business. It also allows things like a Commander threatening to hold your 20K bonus on you.

 

[militarymd]

my USAF experience was a great learning experience for me.....ie I have learned how NOT to run a family practice clinic. I have also become a strong believer in the idea that if things are designed to fail, they will fail.

In regards to the bonus' we got as docs; why, why would the USAF "design" things that way were every doc had to download several forms, get various signatures and then wait to see if your commander would sign and then fax the forms to San Antonio and hope all went through. It is just a "stupid" way to do business. It also allows things like a Commander threatening to hold your 20K bonus on you.

It is designed to give the CO something to hold over you. I know of an orthopod who had his Bonus ($36,000) held because he was a little overweight.

My bonus ($36,000) at one year was very difficult to get, because no one would sign it....everyone claimed, "I cannot sign for that" because I was at a ROTC command for fellowship, but my pay record was a hospital command....Both CO's claimed..."I'm not really your CO"

The ROTC CO (former aviator) said "No student should receive a bonus this big"...to him a fellow is a "student" even though the Navy instruction clearly states that I'm eligible for it.

The hospital CO said,"I'm not really your CO...I only have your pay record here...the ROTC CO...has authority over whether you get the bonus or not"...

I was PISSED.....the only reason I accepted the fellowship in the Navy was because I was told that I would receive the bonus.