AVOID MILITARY MEDICINE if possible

[haujun]

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.

Little overweight based on civilian or military standard? During my military career (8years) I've seen many physicians who are little overweight even by civilian (U.S.) standard..Obesity is a serious problem in US. and it has no place in the military!
Also, I am curious were you in anesthes or IM subspec??

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[R-Me-Doc]

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.

MANDATORY 0530 PT?!?! FOR DOCS!?!?!? IN THE AIR FORCE!?!?!?!?
Holy ****!!!
Never again will I deride the "Chair Force!"
Other than that, your day sounds much like mine. I feel your pain and look forward to joining you in the real world.
And don't forget to mention that all that computer training is always due "C.O.B. tomorrow."

RMD 316

 

[militarymd]

Little overweight based on civilian or military standard? During my military career (8years) I've seen many physicians who are little overweight even by civilian (U.S.) standard..Obesity is a serious problem in US. and it has no place in the military!
Also, I am curious were you in anesthes or IM subspec??

anesthesiology

 

[USAFdoc]

MANDATORY 0530 PT?!?! FOR DOCS!?!?!? IN THE AIR FORCE!?!?!?!?
Holy ****!!!
Never again will I deride the "Chair Force!"
Other than that, your day sounds much like mine. I feel your pain and look forward to joining you in the real world.
And don't forget to mention that all that computer training is always due "C.O.B. tomorrow."

RMD 316

the worst of the net based training "due by COB tomorrow" stories was the latest CBRNE traing (I hope I said that right). Anyways, it actually was a pretty good net based training on chem warfare,terrorism, etc....the problem was it took about 40 hours if you actually did the training. I can neither confirm nor deny that our commander made cheat sheets that enabled us to complete the traing and testing in about 1 hour. I had never cheated on a test my entire life and although you could argue that someone cheating on this is no big deal, I hated the idea. The idea of spending an extra 40 hours (who has an extra 40 hours?) to do this was ridiculous. They did give us a coupleweeks to get it done.
This is just one example where the overwheming time demands to complete both a military and civilian mission end up compromising them both (and every officers integrity).

 

[GMO2003]

the worst of the net based training "due by COB tomorrow" stories was the latest CBRNE traing (I hope I said that right). Anyways, it actually was a pretty good net based training on chem warfare,terrorism, etc....the problem was it took about 40 hours if you actually did the training. I can neither confirm nor deny that our commander made cheat sheets that enabled us to complete the traing and testing in about 1 hour. I had never cheated on a test my entire life and although you could argue that someone cheating on this is no big deal, I hated the idea. The idea of spending an extra 40 hours (who has an extra 40 hours?) to do this was ridiculous. They did give us a coupleweeks to get it done.
This is just one example where the overwheming time demands to complete both a military and civilian mission end up compromising them both (and every officers integrity).

don't worry sir..you were not alone

 

[USAFdoc]

don't worry sir..you were not alone

It took me about 3 months at my last base to begin to realize "the depths" to which my new clinic at my new base had sunk. It took me 15 minutes at a USAF seminar wiyth 7 other bases to realize that nearly the entire USAF primary care platform was sinking as well. I was truly NOT ALONE.

 

[ChestRockwell]

To USAFdoc, militarymd and anyone else who may have some advice,
1st off I would like to thank you for offering your candid opinions about the state of military medicine on this website. As a student that is currently applying to medical school and thinking about applying to the hpsp I greatly value the advice of people who have actually experienced military medicine and who are willing to point out its shortcomings. This website is welcomed reprieve from the bs of recruiters who either don't know about problems of military medicine OR who aren't willing to speak of them.
Now on to my question and if this has been answered before then I appologize but please indulge me.
I will freely admit that one of the main reasons that I am interested in applying to the hpsp is for the money. But before everyone jumps on me and starts in with all the nasty "you shouldn't do it for the money" posts, I would also like to say that I would be extremely proud to serve my country as a physician but as of right now the money is the biggest reason. If I was to swallow the cost of medical school myself I would probably end up around 200 k in the hole when everything was said and done and to be honest with you that scares me to death. 50 k in loans for undergrad is one thing but 200 k is a whole different ballpark. So I guess my question is, should I really be worried about taking that much money in loans? If I was ever 200k in the hole I think I would feel like a wanted man.

 

[militarymd]

chest,

It's just money.....you can always make more of it.....you can't make up lost time with your family.

You'll be a "doctor"....you'll always be able to get loans....


or you could be an "officer"...and always be ordered around by someone of higher rank...usually a nurse.

 

[MoosePilot]

200K isn't bad. If you come out making even 100K, you could live on 50K and pay 50K towards loans to pay off in four years. The loans aren't large compared to the amount you'll be making.

 

[Spang]

To If I was ever 200k in the hole I think I would feel like a wanted man.

If you think you'd hate to feel like a "wanted man" you'll really hate cow-towing to some clipboard commando. I'm pro-military medicine, if that even is a position, but don't do it even a little bit for the money. You'll hate it, you'll hate me, and I'll hate you. There's already too much hate in the world.

Uncle Spang

 

[delicatefade]

Take the advice that's been given here time and time again. Take out the loans and go to medical school. If you still have a desire to be in the military, do the FAP program after you are finished with your residency.

I'm a second year HPSP student, and sometimes I wonder if I should have taken that advice. I think (hope) things will work out for me just fine, as I have the right mindset to handle what the military throws at me, I have military experience, and I've worked in a government healthcare system before as a PT (the VA system). I really do understand what government/military medicine is all about and I understand both the enormous headaches and rewards that come with it. I think the thing that will make it worth it for me is:

1. I've treated a lot of veterans and a few younger soldiers wounded in Iraq over the past couple of years. I'll be honored to serve them again in a system that's pretty much screwed up but can still be worked to their advantage sometimes, even if it means more personal hardship for me and my family while I'm doing my 4 year AD committment.
2. I'll be happy not to be in debt when out of school.

I guess I say all this to tell you that if I didn't have at least reason #1 for doing HPSP to pay for medical school, I'd be looking to be very miserable as an Army physician. I mean, I DIDN'T join "just" for the money and I still have my doubts sometimes. If you join just for the money, you will regret it, believe me. Taking the HPSP now for only that reason will only trade a short term sense of well being (knowing that you won't be in debt) for a potentially larger misery down the road (working for and being committed 4 years to a system that you hate).

The attendings here give good advice. Explore your options, don't let fear of the future cloud your decision, and make the right decision for you.

 

[ChestRockwell]

Thanks for the feedback. I am sure there are many hpsp students who end up choosing the program for the right reasons but I wouldn't be surprised to find out that money is the prime motivator for many others. It is of course only natural to fall into that trap. To a 22-24 yr old, 250k (approx. cost of med school) just seems like a surreal amount of money. I guess its difficult to imagine paying that sum of money off because im so used to earning chump change for entry level positions. But I do like really like your point delicatefade, the short term sense of well being would be just that, short term.

 

[delicatefade]

Best of luck with your decision. I won't lie and say that the money wasn't attractive to me. I also hadn't spent a great deal of time around this messageboard, although I had read a few posts here and there. The negative comments seem to have exploded in the past year, and sometimes I think I would have made a different decision had I been applying to medical school this year instead of in 2003-2004. Maybe I would have taken out the loans and re-evaluated how I felt after residency. Who knows, I may have joined up then anyway. But, like I said, I've been honored to work with veterans and soldiers in my past job, and I'm willing to bet that the VA system is every bit as screwed up as the military system, so at least I knew what I was getting into.

 

[Globus P]

You'll hate it, you'll hate me, and I'll hate you. There's already too much hate in the world.

Uncle Spang

Well said Spang, you crack me up.

 

[USAFdoc]

Best of luck with your decision. I won't lie and say that the money wasn't attractive to me. I also hadn't spent a great deal of time around this messageboard, although I had read a few posts here and there. The negative comments seem to have exploded in the past year, and sometimes I think I would have made a different decision had I been applying to medical school this year instead of in 2003-2004. Maybe I would have taken out the loans and re-evaluated how I felt after residency. Who knows, I may have joined up then anyway. But, like I said, I've been honored to work with veterans and soldiers in my past job, and I'm willing to bet that the VA system is every bit as screwed up as the military system, so at least I knew what I was getting into.

The VA system is probably a better place to work than some of the USAF primary care clinics.

 

[delicatefade]

Honestly, I've read your posts and haven't seen much of a difference between what you describe in your experience and the VA system, except that they can't force them to do mandatory PT 3 days a week. The FP clinics at my VA were understaffed, had poor clinical support, and often had incompetent bosses. The same went for my department.

 

[IgD]

Money worked out well for me when I went through HPSP. I went to a private medical school and would have also had about $200k in loans. I was able to invest a little money during medical school between the difference in the stipend and rent. During military internship and residency I made about double what a civilian would make. With the money saved I was able to make a few real estate investments. I purchased one of my houses with the VA home loan.

If you are disciplined and savvy you can really do well finanicially.

Military medicine isn't all good but it does have some advantages you can benefit from like I just described. Beware of the trolls here. Apparently some have made it their life's mission to scapegoat and badmouth military medicine.

 

[militarymd]

As with all decisions, there are Pros and Cons.

As a troll, I'm simply pointing out that the vast majority of physicians I know who took HPSP money wish that they had not because of the countless numbers of reasons that I have stated many times before.

That is a simple fact.

 

[delicatefade]

I wouldn't call them trolls. They had a bad experience, and prospective students need to hear about how bad things can be in the military. Recruiters certainly aren't going around telling these stories, and like I said, maybe I would have waited until after residency to consider the military had I spent more time around here while I was applying.

I guess the only complaint I have is that for someone who is already in and committed, I feel a lot like another poster who said that reading the posts on these boards made him feel like he was being sentenced to death row.

I mean, I think it's fantastic that prospective students can hear both sides of the story. But what about those of us who are in??? Is it really helpful to shoot us down when we try to be optimistic and proactive about our future? How about something constructive for a change??? How about some threads about how to best work within a broken system instead of all the bitching???
How about some threads about how families can deal with deployments??? Honestly, I feel like I'm back at USAFA. All people did there during freshman year was bitch about how bad it was and now that everyone is out in the real Air Force, they talk about how it wasn't so bad...

 

[MoosePilot]

I wouldn't call them trolls. They had a bad experience, and prospective students need to hear about how bad things can be in the military. Recruiters certainly aren't going around telling these stories, and like I said, maybe I would have waited until after residency to consider the military had I spent more time around here while I was applying.

I guess the only complaint I have is that for someone who is already in and committed, I feel a lot like another poster who said that reading the posts on these boards made him feel like he was being sentenced to death row.

I mean, I think it's fantastic that prospective students can hear both sides of the story. But what about those of us who are in??? Is it really helpful to shoot us down when we try to be optimistic and proactive about our future? How about something constructive for a change??? How about some threads about how to best work within a broken system instead of all the bitching???
How about some threads about how families can deal with deployments??? Honestly, I feel like I'm back at USAFA. All people did there during freshman year was bitch about how bad it was and now that everyone is out in the real Air Force, they talk about how it wasn't so bad...

You should avoid reading these.

 

[delicatefade]

Why??? I don't want to be blind to the experiences others have had in the military. Is it too much to ask for there to be come constructive discussion around here from those who are/have been on AD?

 

[MoosePilot]

Why??? I don't want to be blind to the experiences others have had in the military. Is it too much to ask for there to be come constructive discussion around here from those who are/have been on AD?

You gave the best reasons yourself. Read the title, it's clear this isn't going to be a constructive thread. Don't open it.

Is it too much to ask that others take their limited personal time to write what you want? What do you think?

 

[USAFdoc]

Money worked out well for me when I went through HPSP. I went to a private medical school and would have also had about $200k in loans. I was able to invest a little money during medical school between the difference in the stipend and rent. During military internship and residency I made about double what a civilian would make. With the money saved I was able to make a few real estate investments. I purchased one of my houses with the VA home loan.

If you are disciplined and savvy you can really do well finanicially.

Military medicine isn't all good but it does have some advantages you can benefit from like I just described. Beware of the trolls here. Apparently some have made it their life's mission to scapegoat and badmouth military medicine.

My life's mission to scapegoat and bad mouth military medicine?????
Did you really say that? Unbelievable!
Perhaps that is how YOU would describe anyone who states the TRUTH about what they have PERSONALLY witnessed during their military medicine career, should it be unfavorable to the military.

I recall a story told to me by a Commander from my base. It was back when our then SUrgeon GEneral was doing a base visit to push his Primary OPtimization plan about 5 years ago. The SG asked the various medical officers on the base of any concerns they might have. When this commander raised his hand and spoke his concern, what do you think the SGs response was? He "dressed" that commander up and down in front of the entire grour.."You are either part of the solution or part of the problem", you'd best find another job" were a couple quotes.

Like I have said in other threads,the "just make it happen" has its propper place in military warfare, but designing a Family Medicine clinic that is compromised on every level and gives it's staff and patients no chance to have a truly excellent clinic is wrong from the get-go. You can't increase patient numbres by 400%, staff it with brand new docs and PAs, go skeleton crew with support staff, put novice nurses in charge,and run the whole deal by computer metrics from Wash DC and think you are going to get a good product and be able to retain you staff.

You may still think it couldn't possibly be this bad...well explain that to 100% of the docs that left active duty that served there during the past 15 years, to 100% of the civilian nurses who quit, to 8 of 9 civ docs who quit during this time,to various mil med staff that left the military after 11-18 years served...............and if after considering all that you stiil think that WE are scapegoating the military,...I would argue just the opposite,.....you and the military are scapegoating all the physicians that are leaving.

Wake up and open your eyes IgD.

Does IgD stand for Immunglobulin of Denial???????????????????????

 

[IgD]

Your reply is an example of what I'm talking about. Basically you went on a 4 paragraph wild rant catastrophizing and painting an all or nothing picture about military medicine. There are good parts and bad parts just like everything else in life. Is it possible your expectations of military medicine are a little off?

My life's mission to scapegoat and bad mouth military medicine?????
Did you really say that? Unbelievable!
Perhaps that is how YOU would describe anyone who states the TRUTH about what they have PERSONALLY witnessed during their military medicine career, should it be unfavorable to the military.

I recall a story told to me by a Commander from my base. It was back when our then SUrgeon GEneral was doing a base visit to push his Primary OPtimization plan about 5 years ago. The SG asked the various medical officers on the base of any concerns they might have. When this commander raised his hand and spoke his concern, what do you think the SGs response was? He "dressed" that commander up and down in front of the entire grour.."You are either part of the solution or part of the problem", you'd best find another job" were a couple quotes.

Like I have said in other threads,the "just make it happen" has its propper place in military warfare, but designing a Family Medicine clinic that is compromised on every level and gives it's staff and patients no chance to have a truly excellent clinic is wrong from the get-go. You can't increase patient numbres by 400%, staff it with brand new docs and PAs, go skeleton crew with support staff, put novice nurses in charge,and run the whole deal by computer metrics from Wash DC and think you are going to get a good product and be able to retain you staff.

You may still think it couldn't possibly be this bad...well explain that to 100% of the docs that left active duty that served there during the past 15 years, to 100% of the civilian nurses who quit, to 8 of 9 civ docs who quit during this time,to various mil med staff that left the military after 11-18 years served...............and if after considering all that you stiil think that WE are scapegoating the military,...I would argue just the opposite,.....you and the military are scapegoating all the physicians that are leaving.

Wake up and open your eyes IgD.

Does IgD stand for Immunglobulin of Denial???????????????????????

 

[USAFdoc]

Your reply is an example of what I'm talking about. Basically you went on a 4 paragraph wild rant catastrophizing and painting an all or nothing picture about military medicine. There are good parts and bad parts just like everything else in life. Is it possible your expectations of military medicine are a little off?

Ok, I am not going to list all the positives of military medicine, but here are some. You do a service to our country,the greatest there is. You get to travel, if you like travel. You get med school paid for up front.

So, how about you tell me about the great things going on in USAF Primary care clinics? I will be looking fwd to your long list.

Perhaps you think you can give excellent care to your patients when you have next to no staff, no chart, no specialist in house, fewer and fewer off base docs that are willing to see TRICARE patients, a 400% increase in your patient load, etc.....................

Regarding my expectations being off? Absulutely they were off. I expect to have a chart when I see a patient, I don't expect techs to be shredding patients records instead of filing them, I expect a new PA to be supervised, I expect pateints to be treated for a BP of 248/148 and blood sugars of 450, and read my other threads to see a longer list if you must.

I have been military for most of my life (SINCE being enlisted NAVY 1983). I like to work, and have always been a part of organizations that did excellent work. I have been a NUKE plant supervisor, nuke instructor, University Regent Scholar, Family Practice Resident Teacher of the year, 10 years a Big Brother, and other things that speak to my work ethic and willingness to help others.


What I found in my USAF career was the worst organization I had ever seen.
You OBVIOUSLY cannot have any experience with what I am talking about or you would stop labeling this as just "some good with the bad".

PLease, at least tell me what USAF primary care experience you have as a physician, and when you reply with the answer "none", go ahead and call around some of the USAF primary care clinics (CONUS) and speak to some docs seeing patients and come back and tell us about all the wonderful stories and reenlistments you hear about.

Right.

 

[USAFdoc]

Your reply is an example of what I'm talking about. Basically you went on a 4 paragraph wild rant catastrophizing and painting an all or nothing picture about military medicine. There are good parts and bad parts just like everything else in life. Is it possible your expectations of military medicine are a little off?

the only thing "wild" is the level of denial that you will go to to avoid the truth.
Look, you may be a nice guy and well intentioned, but please limit your remarks to that which you know and have experience. I will do likewise. You will not see me say negative things about the USN, or Army, or surgery, or other things except for USAF Primary Care. That is my experience and that is what I have witnessed 1st hand. You may not want to hear it, but its the sad truth.

 

[IgD]

Primary care in the military is an opportunity to provide medical care to an underserved population. A significant number of people in the military most likely would not be able to afford health insurance if they were civilians. Compare it to primary care in rural areas or Canada where access to healthcare resources are tight. Some of the positive aspects of military medicine are patient access to medications at no charge, access to specialists if needed and advanced imaging capabilities.

A lot of the kids that enlist come from broken families and troubled homes. As a physician in the military you have the opportunity to be a positive role model and make a difference in someones life.

Our clinic faced similar challenges with difficulty accessing medical records. We came up with our own innovate ways to tackle the problem.

 

[USAFdoc]

Primary care in the military is an opportunity to provide medical care to an underserved population. A significant number of people in the military most likely would not be able to afford health insurance if they were civilians. Compare it to primary care in rural areas or Canada where access to healthcare resources are tight. Some of the positive aspects of military medicine are patient access to medications at no charge, access to specialists if needed and advanced imaging capabilities.

A lot of the kids that enlist come from broken families and troubled homes. As a physician in the military you have the opportunity to be a positive role model and make a difference in someones life.

Our clinic faced similar challenges with difficulty accessing medical records. We came up with our own innovate ways to tackle the problem.

what you say above is true. If your clinic allowed you to fix a problem (record availability), good. Our admin ignored us.
still, what you have to say above is alot of nice words and good intentions.that is fine but you still need doctors in the building to take care of the patients. Manning at 20% just burns out the staff left behind, and increases the risk to pateints.

You did not tell me your physician experience in the USAF primary care world.

 

[sunnyjohn]

Question.

I know you guys say docs should avoid the military, but what about other healthcare personnel?

Is the situation for Nurses just as toxic?

 

[MoosePilot]

Question.

I know you guys say docs should avoid the military, but what about other healthcare personnel?

Is the situation for Nurses just as toxic?

Ouch. Be careful, they don't like nurses

 

[sunnyjohn]

Ouch. Be careful, they don't like nurses

Really Moosey, or are you just pulling my freshly waxed leg?
RAWR!

 

[MoosePilot]

Really Moosey, or are you just pulling my freshly waxed leg?
RAWR!

I'm half serious. You'll have to catch up on the conversation to get what I'm saying without it being an overgeneralization.

Way to work the waxing in there... smoof

 

[USAFdoc]

Question.

I know you guys say docs should avoid the military, but what about other healthcare personnel?

Is the situation for Nurses just as toxic?

USAF primary care is also a BAD decision if you are a nurse, more so for a military nurse, but bad both ways. Again, 100% of our civilian nurses quit and all the military nurses expressed thier relief to leave and get back into a hospital environment. Our top nurse of 15 years left to go reserves.

What happened with the nurses is that they became glued to the telephones as they became the "buffer" between the 22 thousand patients enrolled and trying get appointments/refills etc, and the handfull of docs left.

Speaking about nurses also reminds me of a sad observance I had over my 3 years in the USAF....I must have seen at least 50% of the female military staff in tears at one time or another due to the stress, admin chew-outs, changing job duties, irate patients etc. I do not think this cast a poor light on them, just another piece of evidence to give you an idea on how bad that clinic was. The nurses (that were not commanders) and the docs all got along fine, it was just a pseudo-war zone.

 

[sunnyjohn]

Thanks for the reply.

All the active duty and reserve nurses I've meet can't say enough good things about their experiences. They all say go AF over Navy or Army, even those in the other services. They all site better facilities, housing, doctors, administrative support, but this thread has just got me thinking.


I really would like to serve my country. The GI bill would come in handy if and when I do decided to go to med school or other graduate training.

Lots to think about.

 

[sunnyjohn]

Questions?

Why doesn't the DoD concentrate soley on the care of soldiers and veterans and leave the care of dependents to outside vendors?

Wouldn't a decent PPO plan would be sufficent?

Seems to me, if you guys only had to worry about the care of veterans, soldiers and combat medicine the situation would drastically improve.


Am I oversimplifying things?

 

[island doc]

Questions?

Why doesn't the DoD concentrate soley on the care of soldiers and veterans and leave the care of dependents to outside vendors?

Wouldn't a decent PPO plan would be sufficent?

Seems to me, if you guys only had to worry about the care of veterans, soldiers and combat medicine the situation would drastically improve.


Am I oversimplifying things?

First a word of introduction. I am a former USAF Primary Care Physician, now a civilian.

You are absolutely right in that the situation would be much better if dependents and retirees were moved out of military treatment facilities. The reason they are not: politics. Military healthcare is a huge government entitlement program. To remove that entitlement would require congressional action and no politician is willing to touch that hot potato. (Heaven forbid cutting a government give away program. Don't get me started on "free" medical care in the military... That is one of it's biggest flaws:the fact that as far as the patient is concerned everything is "free". The result is a patient population that is spoiled rotten. Anything that is free soon becomes taken for granted, then abused. Military dependents and retirees have received too much, too free, for too long. Heavens, even the poorest of the poor medicaid patients have a co-pay for an office visit.)

Some may argue that to do so, would weaken military GME programs by reducing patient caseload. Military GME programs are already weak to begin with, that is why so many of them have working agreements with civilian institutions.

Lastly, why on earth would anyone want to be a nurse in the USAF? Unless they just want to boss doctors around, because they (nurses) are in charge in the USAF. Don't get me started on that either...it's backasswards from the way things should be.

 

[USAFdoc]

Questions?

Why doesn't the DoD concentrate soley on the care of soldiers and veterans and leave the care of dependents to outside vendors?

Wouldn't a decent PPO plan would be sufficent?

Seems to me, if you guys only had to worry about the care of veterans, soldiers and combat medicine the situation would drastically improve.


Am I oversimplifying things?

call nurses at some of the facilities you hope to work at. Realize that if you are going to be a mil nurse, they will send you where they want. If you are a civ nurse, you hold some of the "cards" at least in the decision making. Call and speak to newer nurses assigned to PCM teams. Try any base from Offutt NEB, Fairchild, Eglin, Robins, etc........do a google search of USAF family practice to get a list.

Mil medicine is not all 100% evil, but at the USAF primary care bases I have seen, 100% of the personnel leave as soon as they can.

should the dod send all the retirees to a PPO plan? Well, the best way in my opinion would be to run teh system of military docs the right way and you would have a great system and the best value for the money (and the patients like to see a mil doc too). However, the military is not structured, and will likely not change from a culture of super-micro-management. This precludes any chance of the current system being successful.
so, the sooner this all goes civilian, the better, unfortunatley.

 

[island doc]

Money worked out well for me when I went through HPSP. I went to a private medical school and would have also had about $200k in loans. I was able to invest a little money during medical school between the difference in the stipend and rent. During military internship and residency I made about double what a civilian would make. With the money saved I was able to make a few real estate investments. I purchased one of my houses with the VA home loan.

If you are disciplined and savvy you can really do well finanicially.

Military medicine isn't all good but it does have some advantages you can benefit from like I just described. Beware of the trolls here. Apparently some have made it their life's mission to scapegoat and badmouth military medicine.

I guess you are probably thinking of me as one of those mean, ugly "trolls". If I am, it is because I spent four years in the dungeon of the USAF: a primary care clinic.

 

[Mirror Form]

what you say above is true. If your clinic allowed you to fix a problem (record availability), good. Our admin ignored us.

I'm only an intern in the Army, but I've done a lot of clinic so far and record availability has been getting a lot better thanks to the new computerized chart system. Yes, there are a lot of problems with CHCSII, but it's definitely not any worse then the multitude of electonic chart systems I had to use at various civilian hospitals during med school.

Perhaps the reason your admin ignored you was b/c they figured the problem would be fixed with the electronic chart system anyway?

 

[r90t]

I guess you are probably thinking of me as one of those mean, ugly "trolls". If I am, it is because I spent four years in the dungeon of the USAF: a primary care clinic.

At my last command we actually had a cap on our patient panels, both for military and civilian physicians. The civilian physicians had larger panels since they had no other duties other than health care. Due to OEF/OIF we were missing military staff. We Tricare'd their pts to civilian providers where they had a co-pay. We also disenrolled pts from our clinic and referred them to tricare if they were xx miles away from the hospital to make room for the active duty/family members stationed locally. CO support makes a huge difference. He was looking for funding to hire additional physicians to support our FP department.

CHCS II Sucks. We went back to the old CHCS system. We also had all of our dictations available on Outlook so if we didn't have a chart, the nurses could print out the last couple of notes. BTW an O-5 nurse with 16 years of experience makes a heck of a lot more than her civilian counterpart.

 

[USAFdoc]

At my last command we actually had a cap on our patient panels, both for military and civilian physicians. The civilian physicians had larger panels since they had no other duties other than health care. Due to OEF/OIF we were missing military staff. We Tricare'd their pts to civilian providers where they had a co-pay. We also disenrolled pts from our clinic and referred them to tricare if they were xx miles away from the hospital to make room for the active duty/family members stationed locally. CO support makes a huge difference. He was looking for funding to hire additional physicians to support our FP department.

CHCS II Sucks. We went back to the old CHCS system. We also had all of our dictations available on Outlook so if we didn't have a chart, the nurses could print out the last couple of notes. BTW an O-5 nurse with 16 years of experience makes a heck of a lot more than her civilian counterpart.

you are correct that the mil nurse with 15 yrs makes more than her civ counterpart, so more reason that you might believe me about how bad things were/are.

you are correct; the local admin can make all the difference in the world. One might go through "hell" for a good leader; one will get out of the USAF asap when a hellish clinic is made even worse by its commander, and that same command places blame on the people bustin their behind.

caps on panels; excellent idea. Despite virtually no support staff, we had panel sized balloon from 700 up to 1500, then to 1700, then add in the 2 civ docs we were covering for (that makes it 3200 on many days). In my current civ practice that I have no OB duties for and no hospital duties, we have about 1000 patients per provider.

 

[MoosePilot]

At my last command we actually had a cap on our patient panels, both for military and civilian physicians. The civilian physicians had larger panels since they had no other duties other than health care. Due to OEF/OIF we were missing military staff. We Tricare'd their pts to civilian providers where they had a co-pay. We also disenrolled pts from our clinic and referred them to tricare if they were xx miles away from the hospital to make room for the active duty/family members stationed locally. CO support makes a huge difference. He was looking for funding to hire additional physicians to support our FP department.

CHCS II Sucks. We went back to the old CHCS system. We also had all of our dictations available on Outlook so if we didn't have a chart, the nurses could print out the last couple of notes. BTW an O-5 nurse with 16 years of experience makes a heck of a lot more than her civilian counterpart.

First post I've seen from you in a long time? How are you? I need to call you!

 

[r90t]

First post I've seen from you in a long time? How are you? I need to call you!

Give me a ring. Cell phone is still the same and I think you have my home number. I'm still hanging out with the wife and kids waiting for my admin stuff to clear. Lots of home improvements, parks, swimming, etc...

 

[MoosePilot]

Give me a ring. Cell phone is still the same and I think you have my home number. I'm still hanging out with the wife and kids waiting for my admin stuff to clear. Lots of home improvements, parks, swimming, etc...

I would say I'm jealous, but since it's an admin snafu, I won't.

 

[USAFdoc]

define an admin snafu, please.

 

[USAFdoc]

IgD
Registered User
10+ Posts


Join Date: Jul 2005

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# of primary care physicians in the air force = 400 ?
# of disgruntled former air force primary care physicians in this forum = 2 ?
% = 0.5

Would it really make a difference what branch of service and type of specialty I was in?

What if the original poster wanted to be a specialist and not work in primary care? Would the same opinion hold up?

IgD
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Today, 05:20 PM #11
USAFdoc
Registered User
50+ Posts


Join Date: May 2005

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1. how many primary USAF docs even know about this site? I found it by accident a few months ago.
2. how many USAF primary care docs have great things to say........ZERO.
3. How many USAF primary care docs have I spoken personally with during the last 4 years.....15.......how many share my concerns......100%
4. Read the last few issues of USAFP, the mil FP journal online......read the letters to the editor or even the president's editorial........the will echo similar concerns that I have voiced here.
5. Still waiting for your experience with what you are continuing to speak on.
6. Yes it would make a difference what is your specialy and service. You do not see me talking about radiology in the ARMY or surgery in the NAVY; I am speaking to that what I know. Is that such a hard concept for you IgD?
7. If the original poster did not want to be in USAF primary care, then my comments need to be put in that context. I would be most concerned for those going into USAF primary care, less so for other services Primary care, and even less so in other specialties........however, as stated in other threads, I am concerned that some of the same market forces that have adversely affected some civilian medical jobs are now running rampant in some military venues, and unlike the civilian markets, the doctor truly is owned and has few options when the line of safety and reasonable work loads are crossed.


People like IgD need to stop being so defensive about anything and anyone that has something negative to say about their military experience. IgD is basically going as far accusing docs of lying about thier experience, being negative about everything etc.....
I have yet to see any primary care docs that are still seeing patients say good things about their bases. NONE. That goes along with what I have seen in my USAF career. Even when I attended the primary care USAF workshop in TX, the instructors there admitted as much as they system is broken.

 

[r90t]

Admin snafu=FTOS contract not completed by service and hospital even though assured everything was fine. I report for training and am told to go home until contract issue is resolved. This is 2 months unchargable "leave." Starting up, finally, tomorrow.

 

[USAFdoc]

I had a civ admin snafu here as well; despite knowing I was coming here for 1+ years, they still hadn't entered my name in the blue care network system so those HMO patients I was unable to see.
As stated in other threads,the civ world is not perfect either, but the military admin snafu's at my last base are legendary and numerous.
On this point let me add, the military always had the xtra bodies and resources to balance a lack of admin wisdom and inefficiencies. In the new "Military-HMO" lets stretch "do more with less" to the max, the lack of admin wisdom can kill (careers).

 

[USAFdoc]

I had a civ admin snafu here as well; despite knowing I was coming here for 1+ years, they still hadn't entered my name in the blue care network system so those HMO patients I was unable to see.
As stated in other threads,the civ world is not perfect either, but the military admin snafu's at my last base are legendary and numerous.
On this point let me add, the military always had the xtra bodies and resources to balance a lack of admin wisdom and inefficiencies. In the new "Military-HMO" lets stretch "do more with less" to the max, the lack of admin wisdom can kill (careers).

grayce79;

my advice (since you are stuck,like I was), is to do the best you can, think of the glass as half full, but don't ignore the fact that it is really probably more than half empty). You are right, we are all way better off than most people in the world, but that is no excuse for the military to continue to put forward such as flawed health care system (I am speaking about USAF primary care....I cannot directly speak to other areas).
The tougher question is will you just put in the time and do the best you can and get out, or will you fight with admin (it would be nice for them to work with you on this, but expect the worse) and with the senior USAF admin to tell them that thier plan is failing and demand better for you and your patients and staff? (and if they do not fix it, then you get out). To fight comes with risks. Island doc was threatened by staff as was I at my base (threats to attempt to ruin your credentials etc). I went through my chain of command over 2 years which eventually included the IG and Congress. Everyone agreed with me (behind closed doors, but there was NO ONE willing to continue to fight for change). After 2 years of fighting and being threatened (although my commanders appologized later), things were worse than ever clinically for staff and patients. The only good that may have come from it was I am seeing more senior leadership in Wash DC vocalize my same concerns, but still no change.

Again, to those on this site, of which most are resident, medical students or similar, I do realize that when you hear the negative side of what MAY await you when you finish training, it must be frustrating. After all, what can you do? Your'e stuck. Well, I would encourage you to bring up these concerns with your residency directors, with other residents, and with congress if need be. There is risk involved to you as well if you begin to question the "establishment" but that is one of the things that being an OFFICER makes you responsible for.....doing the right thing, and not being just a "yes-man".

Since you have not experienced these things first hand, and in case you still have doubts about the reality the some of us physicians have made public here, then call some of the clinics around the CONUS and discuss them with a first termer doc.

 

[USAFdoc]

Dear USAFDoc

I am reading these fora to enlighten myself about the American medical
system and its personalities. (I am from the UK).

What, can I ask, do you mean by 'aint no suicide bombers in my clinic'
Do you mean that there are no suicide bombers in your clinic in the way
that there actually are no suicide bombers in any clinic in the USA or are
you racist?

Thanks.

I have NO IDEA what you are talking about. Please let me know where you got that quote.

If I did say "something" like that I would have meant that thank God we here in America are not having to deal with the day to day nightmare that those in Iraq and Israel have to deal with in that there are people just blowing up themselves along with whatever children, women and whomever else is there.
However bad my USAF clinic was, it doesn't even compare to that kind of nightmare.