Civilian Contact for Army Surgeons (esp trauma) ?

[romansfive]

I'm wondering both how much and to what degree are army physicians, in contact with civilian patients. I ask because I'm concerned that the volume for trauma surgeons may be low during peacetime, and that may hamper training, and may be detrimental to becoming competent.

I've read threads from airforce and navy surgeons, but what about army?

I've also read in other threads that during residency, there may be opportunities to moonlight depending on commanders, or train in civilian trauma centers. How much of that is true?

What about after training? Are there opportunites to hold dual positions in military and civilian hospitals?

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[usnavdoc]

I'm wondering both how much and to what degree are army physicians, in contact with civilian patients. I ask because I'm concerned that the volume for trauma surgeons may be low during peacetime, and that may hamper training, and may be detrimental to becoming competent.

I've read threads from airforce and navy surgeons, but what about army?

I've also read in other threads that during residency, there may be opportunities to moonlight depending on commanders, or train in civilian trauma centers. How much of that is true?

What about after training? Are there opportunites to hold dual positions in military and civilian hospitals?

All services are having problems with this topic in peacetime and wartime.

To my understanding Moonlighting is not authorized for military residencies at any of the Navy MTFs. I would think that is the common theme at all MTFs. Yes gen surg residents in the military get their trauma time at other institutions as well as a few other rotations. That doesnt make up for the differences in training at a university program with "in house" training.

Some attendings hold "dual" positions but it is up to the command and as others have mentioned that is sometimes hard to come across.

 

[tec]

At the R Adams Cowley Shock Trauma Center at the University of Maryland (the one where the golden hour was conceived), there are always military physicians (residents, fellows and attendings) there from all three of the services. The Air Force has a large presence because of the C-STARS program where they have full-time attendings on faculty, rotating residents and attending through for training. Many of the residents from Walter Reed and Bethesda also rotate through. One of the Surgical Critical Care fellows right now is Navy.

 

[FliteSurgn]

At the R Adams Cowley Shock Trauma Center at the University of Maryland (the one where the golden hour was conceived), there are always military physicians (residents, fellows and attendings) there from all three of the services. The Air Force has a large presence because of the C-STARS program where they have full-time attendings on faculty, rotating residents and attending through for training. Many of the residents from Walter Reed and Bethesda also rotate through. One of the Surgical Critical Care fellows right now is Navy.

Yes, but the biggest complaint about this program is that the Air Force "attendings" are treated as scut monkeys and get very little useful experience while there.

 

[Capt_Mac]

I'm wondering both how much and to what degree are army physicians, in contact with civilian patients. I ask because I'm concerned that the volume for trauma surgeons may be low during peacetime, and that may hamper training, and may be detrimental to becoming competent.

I've read threads from airforce and navy surgeons, but what about army?

I've also read in other threads that during residency, there may be opportunities to moonlight depending on commanders, or train in civilian trauma centers. How much of that is true?

What about after training? Are there opportunites to hold dual positions in military and civilian hospitals?

The Army actually is sitting pretty as far as trauma goes. BAMC in San Antonio is a level I trauma center that gets about 3000 trauma admissions a year. When Wilford Hall closes in 4 years, we will be one of the top 10 largest trauma centers in the country. We work closely with UTHSCA (UT San Antonio - University Hospital another level I center) and there is a lot of great trauma research being done. We have the ONLY burn unit in the DOD. As a resident at BAMC you cover trauma as part of your regular call, you take care of trauma patients for all 5 years of residency (for better or worse). Our new trauma director is a young guy from Parkland who came onto active duty for this job. We have a very nice trauma program here at BAMC.

The overall incidence of penetrating trauma is so low here in the United States that there is no program or place where you will be "trained up" and completely ready for what you will see (this according to my staff who have been there multiple times now). You should instead focus programs where you learn sound surgical principles and good judgement, providing the foundation for what we will encounter in Iraq (or Iran).

The trauma experience that the military surgeons comming back from Iraq have is second to NONE in the US. They are busy than Maryland Shock trauma and as a collective group have the most experience anywhere with penetrating trauma and mass casualty triage and care. This experience is disbursed throughout the DOD right now and if you get into the right program with people willing to teach you should have no problem.

 

[Galo]

Yes, but the biggest complaint about this program is that the Air Force "attendings" are treated as scut monkeys and get very little useful experience while there.

This is 100% true. Again, something I experienced. Being a board certified General Surgeon with extensive trauma experience and beind treated as a PG-Y2 with none of the new RRC hour restrictions because you are not technically a resident, really really is a waste of time and money. The people who conceived CSTARS really had their heads up their behinds.

As far as Army Trauma, yes, there may be more of it, especially at BAMC. So if you happen to get selected to train there, you may get some good trauma experience. But then as a junior attending, you will likely be set off to a place where not only will you not be practicing trauma, but may not have inpatient support at all, and if you do, it will be for minimal care patients. As I understand it from my recent conversation with an Army chief resident, most people out of training, are unlikely to be sent to a major medical center. Besides BAMC, I do not know what other army hospitals are considered level I trauma centers. So you may be in the field, so to speak, doing lumps, bumps, endo, and then you're in Iraq for 6-8 months doing trauma, every other year.

My point is that not every surgeon in the Army is living life as a trauma attending primarily. I think its far from that. If trauma is something of an interest of yours, explore known trauma centers, Ben Taub, Detroit Receiving, LA, NYC, Philly, etc...you will find far more penetrating trauma there, and dare I say, perhaps better training. Shock Trauma sees in excess of 90% blunt trauma. Not an ideal place to try to assimilate a surgeon into penetrating trauma by treating him/her like a pgy-2 for one month.

 

[romansfive]

Thank you all for speaking frankly and insightfully from your experiences with military general/trauma surgery!

I think the BAMC, as a level I trauma center handling both civilian/military cases is a great model for the military.

I have been accepted to USUHS as well as some civilian medical schools. I'm trying to figure out the best way to train, so that I will be able to effectively serve in our military conflicts as well as in our urban cities.

I really appreciate the invaluable information provided in this thread. Thanks!

 

[Galo]

Thank you all for speaking frankly and insightfully from your experiences with military general/trauma surgery!

I think the BAMC, as a level I trauma center handling both civilian/military cases is a great model for the military.

I have been accepted to USUHS as well as some civilian medical schools. I'm trying to figure out the best way to train, so that I will be able to effectively serve in our military conflicts as well as in our urban cities.

I really appreciate the invaluable information provided in this thread. Thanks!

Remember that if you choose to get your training in the military by attending a military medical school, you are closing some doors. You may not be able to practice exactly what you want, or even get the training for it. If you do get the training, you still may not be able to use it if you are in a facility where you do not even have inpatient capacity. Although in the outside, this is still a competitive field, if you have the grades, and the abililty, you can get good training, actually practice it, and the military will always take you on as a trained trauma surgeon in a reserve capacity, or volunteer capacity so you can serve your country in what you feel is best. You also won't incurr some ridiculous chunk of your life to a system that we've been discussing is on a steep decline.

Like I have given advice before. Call up BAMC, and talk to some residents, to some attendings, call other army bases, hear what they have to say. Based on my experience in the AF. I would recommend heavily against military medicine.

Galo

 

[mitchconnie]

The trauma experience that the military surgeons comming back from Iraq have is second to NONE in the US. They are busy than Maryland Shock trauma and as a collective group have the most experience anywhere with penetrating trauma and mass casualty triage and care. This experience is disbursed throughout the DOD right now and if you get into the right program with people willing to teach you should have no problem.

I hear this a lot and think it has become WAY overstated. I am currently serving in the middle of the Sunni Triangle, at what is billed as "the most advanced deployed hospital on the planet." We take mortar fire nearly every day, and admit as many patients daily as Maryland Shock Trauma. You would think that the trauma surgical experience would be fantastic--not so. Not from a general surgery standpoint, anyway.

Fact is, body armor prevents most penetrating thoraco-abdominal injury, and head and extremity trauma predominates. As a general/vascular surgeon, we basically resuscitate patients and then hand them over to neurosurg. and ortho to do the complex, interesting stuff. Case numbers for primary laparotomy for trauma are very small--which really surprised me. So as a general surgeon in a deployed location, you may or may not have the fantastic experience you anticipated.

Personally, I got way more experience in penetrating thoraco-abdominal trauma at Ben Taub in Houston that in Iraq. Seems strange, but true.