A little history. I’m a psychiatrist who joined the AF through the FAP in 2005. I separated from the military in 2012. I worked at a fairly large MTF with 2 other psychiatrists and a psychiatric NP. I deployed with the Army as an IA to a small FOB in Afghanistan for what ended up being 7 months in 2009-2010. When I separated I had 2 years as an O4. Although I have had a successful civilian career since separation there has always been a piece of me that has missed those years on active duty. For the past several months I have seriously been contemplating rejoining. I have a few questions that I was hoping you guys could answer.
1) If I rejoined, would it be as an O5? If so, would I still have the traditional 6 year path before consideration of promotion to O6? Also, and I think I know the answer to this, is there anyway to get to O6 via the clinical route or is heavy administrative duties still expected/required in order for consideration?
2) What would be the chances of me being able to pick my duty station, particularly an OCONUS?
3) Does anyone have any insight into what current practice is like? I did my fair share of MEBs and admin seps but also saw quite a few dependents and retirees. Is this still the case or has the farming out of Tricare dependents changed this dynamic for the clinic setting?
Much appreciated.
I'm a current O4 psychiatrist with the Air Force. My initial gut reaction to this is to say, don't do it. Now this may be my own bias as I am planning on separating next year (woo hoo) so take it with a grain of salt. I completed residency in 2019 so I can't speak to how psychiatry was when you served, but I'm going to guess it has changed some.
1) I believe they would take into consideration the years you've been in profession so it is possible that you could come in as an O5. With that being said, it is very likely you'd be pushed into a role as a flight commander or some other sort of admin role. At the very least you'd be medical director and/or ADAPT program director on top of other patient duties. You would have to do some further military education in order to promote to O6 such as ACSC.
2) Chances of being able to pick your duty station would be.... up to the needs of the Air Force. Given rank and position as a psychiatrist you may get a little more say. There is a consultant and assignment officer that you would have contact information for and would be able to discuss your options/desires. I was able to go where I wanted to go on a recent PCS because it was not necessarily a highly desired area (closer to family for me though) and they had no problems with placing me where I currently am. OCONUS and some of the better places CONUS may be more difficult due to competing with others who want to go there as well. Ultimately it could be a complete gamble on getting to go exactly where you want to go unless it somewhere less desirable (i.e. minot, cannon etc).
3) Current practice. This is the biggest part for me deciding to separate. With DHA taking over, there's a push to see more patients while also continuing to do the admin duties that most certainly will be placed on you, while also cutting manning across the board. It does not seem like a sustainable model to me. We only see active duty so mostly will be depression, anxiety, personality disorder, substance use. That will make up the vast majority of your patients. Occasionally you may actually get a first psychotic break or manic episode. The paperwork is excessive and they are rolling out a new EMR that so far has proven to be inferior to AHLTA that you may remember. I am not aware of a single provider in any specialty who is a fan of the new EMR genesis including myself. The feeling just seems that while the Air Force proclaims that it wants to provide top notch care for its members, it consistently appears to go out of its way to place more hurdles on you to be able to provide said care. Higher ups that are in position to make decisions are typically very far removed from patient care. Recently something was sent out regarding how many patients were needed to be seen to keep up with medical advances for those in higher up admin positions. I can't remember the exact number but it was astonishingly low. Someone bragged that they could schedule that in one week and knock out the requirements thus getting them out of patient care for significant periods of time. Now this is anectdotal but I think it shows the mindset of many who have climbed the ranks to these higher up admin positions.
On the positive you don't have to take into consideration insurance issues since everyone is covered and everyone has access to care and services. Though as DrMetal stated above we are sending many more members into the community so you can be limited if you're in a smaller place or if providers don't take tricare.
You will likely make less money. Don't know anything about your current practice so it could only be a little bit less or it could be a lot less.
Hopefully this answers some of your questions. If you have any more specific ones about the current practice of psychiatry in the Air Force I'd be happy to answer them for you.
