Army Doing civilian residency, can I join after?

[chondroblast]

So I'm about to graduate from a civilian medical school and do a civilian residency (general surgery if all goes well). I'm wondering if I can be hired as an attending general surgeon in the Army after my residency. Also, what is work life as a general surgeon in the Army? I've read that it's very similar to that of a private sector physician while stateside, but what about deployment? Do you travel with the troops or do you work in temporary hospitals? Also, in times of conflict can you request deployment? Though I don't hope we're in conflict by the time I complete residency if we are I would like to be deployed.

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[colbgw02]

So I'm about to graduate from a civilian medical school and do a civilian residency (general surgery if all goes well). I'm wondering if I can be hired as an attending general surgeon in the Army after my residency. Also, what is work life as a general surgeon in the Army? I've read that it's very similar to that of a private sector physician while stateside, but what about deployment? Do you travel with the troops or do you work in temporary hospitals? Also, in times of conflict can you request deployment? Though I don't hope we're in conflict by the time I complete residency if we are I would like to be deployed.

Check out the stickies to learn about FAP. Beyond that, not sure if general surgery is doing direct accessions, as it depends on what their numbers look like.

Regarding the bold, I think there are plenty of Army surgeons who would disagree with you. Where, precisely, did you read that?

Surgeons can deploy in a number of roles, such as with a forward surgical team (FST) or at a combat support hospital (CSH). In the recent past, it hasn't been too hard to be deployed, whether you requested it or not. However, if there is a war after a period of sustained peace, people are typically more anxious to deploy, so you might "lose out" to senior physicians who feel like they need/want to deploy for their career's sake. I've been around long enough to remember when people would climb over their own mother to be a part of Desert Shield/Storm.

 

[HighPriest]

You can also finish residency and go work at Burger King, since we're talking options. Don't do it, brother. Try the reserves first, then decide after your first backfill if indentured servitude is what you really want. Just my 2 cents.

 

[HighPriest]

I crossed the hall from my OR to see what our gensurg guys were up to yesterday. All three guys standing around one patient (one on each side and one in the magic zone), all holding a separate instrument for a Nissen. The entire department. That's how busy they are.

 

[chondroblast]

You can also finish residency and go work at Burger King, since we're talking options. Don't do it, brother. Try the reserves first, then decide after your first backfill if indentured servitude is what you really want. Just my 2 cents.

Why do you say this? What about it is "indentured servitude"? What if it's something I feel I should do?

 

[chondroblast]

So you're saying the patient volume is too low to be interesting?

 

[HighPriest]

Why do you say this? What about it is "indentured servitude"? What if it's something I feel I should do?

Well, like everything it's a matter of opinion. But military service is a form of indentured servitude.
The pay is poor. There's no benefit to working harder or doing more, so most people don't try to do so. That hinders your ability to do more, even if you want to. You have no choice about where you live. In many cases this also dictates that you have little choice in what kind of practice you have. Our general surgeons spend most of their time doing colonoscopies because we have no GI guy. In fact, they have been instructed to make colonoscopies their priority because they are one of the metrics that the Army uses to establish funding for the hospital. So if you have a sigmoidectomy pending, but a backlog of colonoscopies, guess what gets sent to the private guy down the road? That may not be true for every institution, but the point is you never know where you'll end up or what kind of crazy ideas the hospital commander will have when you get there. Want to go on vacation? Plan for three hours of training, precise paperwork dictating your itinerary, and a mandatory call to PVT Snuffy to let him know the exact time you're leaving and when you return.
Once you join, you're stuck. There's no going back. Deployment sounds cool, but you spend most of your time doing nothing. I've had colleagues deployed for 3-6 months who have operated 10-15 times. Mostly they play volleyball and work out. But experiences may vary.

If you feel like you should do it, that's your call. I really can't comment on your motivations. My personal opinion is that no ones owes the Army the kind of stuff the Army expects you to do.

Allow me to elaborate on that: I respect servicemen/women greatly. I place their service on a pedestal. I think treating soldiers is an honor. But the Army puts care and treatment about 12th on the list in terms of what they want you to do as a surgeon. Your primary job is to be where you're supposed to be. Secondary is to be trained up on things like what kind of clothing you need to wear in cold weather, and how to avoid being taken hostage in your own hotel room. Third is to make sure you're attending meetings to discuss the scheduling of other meetings. Fourth is to make sure you've taken your monthly urinalysis, even if it means you abandon your clinic.....somewhere down the list is "take care of soldiers."

Like many things which are federally regulated, Military Medicine is a great concept that has, in my opinion, lost its way and forgotten its purpose. In fact, if mission #1 were to care for soldiers, I would be absolutely ok with all of the other BS. But if you try to use patient care as an excuse to miss your mandatory personally-owned-vehicle inspection, the command looks at you like you're an a%#.

 

[HighPriest]

Surgical volume depends highly upon where you end up. If you get NCC, you'll get great cases. If you get Fort Armpit, you're in trouble. Never can tell...

 

[chondroblast]

Is it possible to volunteer for maybe a 6 month stint at some point in your career? What is it like in the reserves?

 

[pgg]

So I'm about to graduate from a civilian medical school and do a civilian residency (general surgery if all goes well). I'm wondering if I can be hired as an attending general surgeon in the Army after my residency.

You can join via FAP soon (and get money during residency in return for several years of service commitment after residency).

Or you can do nothing now, and consider joining after residency via direct accession, if the Army perceives a need and is hiring. They might or might not be. There's no way to predict. This path might offer you more negotiating leverage with regard to where you are stationed.

You might also consider the Navy. The culture is different ... not perfect, but from my perspective better than the Army and far and away superior to the Air Force in terms of work environment for physicians. You get a pretty skewed view reading this forum. There are a lot of grouchy people here and pissed off people tend to be more vocal people. While their gripes aren't without merit, and I join them in griping from time to time, overall my time in the Navy has been more good than bad.


At your point in your career, unless you are sure you want to join the military, it might be better to wait until done with residency or approaching the end of residency to consider joining. Totally apart from the complaints you can (and should) read at length on this forum, there are unusually large changes brewing in military medicine currently, now that Iraq is over and Afghanistan is almost over. There will be base closures, expansions, and major changes in the ways the different branches of the military run their medical departments, and how they choose to defer (to civilian hospitals) or not defer (keep) active duty, family member, retiree, and other eligible patients. Anyone who tells you they're sure how this will all settle out is lying.

You've got about 5 years before you'll be done with residency. Nothing wrong with choosing to decide later.

 

[idq1i]

Well, like everything it's a matter of opinion. But military service is a form of indentured servitude.
The pay is poor. There's no benefit to working harder or doing more, so most people don't try to do so. That hinders your ability to do more, even if you want to. You have no choice about where you live. In many cases this also dictates that you have little choice in what kind of practice you have. Our general surgeons spend most of their time doing colonoscopies because we have no GI guy. In fact, they have been instructed to make colonoscopies their priority because they are one of the metrics that the Army uses to establish funding for the hospital. So if you have a sigmoidectomy pending, but a backlog of colonoscopies, guess what gets sent to the private guy down the road? That may not be true for every institution, but the point is you never know where you'll end up or what kind of crazy ideas the hospital commander will have when you get there. Want to go on vacation? Plan for three hours of training, precise paperwork dictating your itinerary, and a mandatory call to PVT Snuffy to let him know the exact time you're leaving and when you return.
Once you join, you're stuck. There's no going back. Deployment sounds cool, but you spend most of your time doing nothing. I've had colleagues deployed for 3-6 months who have operated 10-15 times. Mostly they play volleyball and work out. But experiences may vary.

If you feel like you should do it, that's your call. I really can't comment on your motivations. My personal opinion is that no ones owes the Army the kind of stuff the Army expects you to do.

Allow me to elaborate on that: I respect servicemen/women greatly. I place their service on a pedestal. I think treating soldiers is an honor. But the Army puts care and treatment about 12th on the list in terms of what they want you to do as a surgeon. Your primary job is to be where you're supposed to be. Secondary is to be trained up on things like what kind of clothing you need to wear in cold weather, and how to avoid being taken hostage in your own hotel room. Third is to make sure you're attending meetings to discuss the scheduling of other meetings. Fourth is to make sure you've taken your monthly urinalysis, even if it means you abandon your clinic.....somewhere down the list is "take care of soldiers."

Like many things which are federally regulated, Military Medicine is a great concept that has, in my opinion, lost its way and forgotten its purpose. In fact, if mission #1 were to care for soldiers, I would be absolutely ok with all of the other BS. But if you try to use patient care as an excuse to miss your mandatory personally-owned-vehicle inspection, the command looks at you like you're an a%#.

Don't forget about your contractor colleague that makes 3x what you make, gets 2 months off because they exceeded their contracted hours, doesn't get deployed, doesn't have to do admin crap, and doesn't have to call PVT Snuffy to inspect their brand new vehicle before a trip to a local walmart.

IMO, the absolutely worst thing about milmed is in the 1st few lines of the post quoted - there is absolutely no incentive to work harder or better as a physician. No one cares or recognizes that. Yes, you were the strongest resident in your residency, can do a lap appy in 5 minutes, never had a complication.... BUT is your APEQS/DTMS up-to-date???? The duds stay in, and the stars leave, with very few exceptions.

 

[Kilgoretrout 65]

pgg

I am not one to defend the Air Force and all its inherent stupidity but the Navy medical environment is far and away better than the AF? If you mean there is likely a beach nearby as opposed to a desert or cornfield, then yes. Otherwise it is likely the same drab buildings with the same outdated equipment with the same worthless EMR with the same know nothing clipboard nurses running the show. All that and sometimes on a ship. I've worked at Bethesda and it looks like David Grant (Travis AFB). My impression from my Navy colleagues in the same specialty is they have the same BS just different acronyms.

 

[colbgw02]

Is it possible to volunteer for maybe a 6 month stint at some point in your career? What is it like in the reserves?

You should know that the minimum commitment for accepting a commission in the U.S. military is 8 years. That's not to say that you will spend 8 years on active duty, but rather they'll have some measure of control over your life (active duty: a lot, IRR: a little) for at least 8 years.

Army reserve options are generally not great. For one, you have to find a spot that fits your a) rank, b) specialty, and c) location. Otherwise, you could end up being classified as a CSH DCCS and go to the top of the list for deployment in a purely administrative role. Secondly, your civilian practice has to be conducive to your reserve obligations. That's typically less of an issue if you worked at the VA, for instance, but it can cause major problems if you're in a private group.

 

[pgg]

pgg

I am not one to defend the Air Force and all its inherent stupidity but the Navy medical environment is far and away better than the AF? If you mean there is likely a beach nearby as opposed to a desert or cornfield, then yes. Otherwise it is likely the same drab buildings with the same outdated equipment with the same worthless EMR with the same know nothing clipboard nurses running the show. All that and sometimes on a ship. I've worked at Bethesda and it looks like David Grant (Travis AFB). My impression from my Navy colleagues in the same specialty is they have the same BS just different acronyms.

One of the more frustrating things about milmed is the huge variability from place to place ... and the variable control we have in choosing where we go. Bethesda is Bethesda. I went to USUHS and was an intern at Bethesda. During my GMO tour, when applying to residency, I almost didn't rank Bethesda at all because it was a tough call as to whether it'd be better to do another GMO year, or return to that weirdly toxic place.

My perspective is of course a product of my experiences, duty stations, and deployments ... but over the years I've worked with Army and Air Force physicians, at home and abroad, and from time to time I run into some of my not-Navy USUHS classmates.

And yeah, my feeling is that the Navy medical environment really is far and away better than the AF, and probably a couple notches above the Army.

I've been at a small and isolated command for the last few years, minus a deployment, and there are some problems, the risk of skill atrophy chief among them. I certainly am not one to defend the ridiculousness of online Trafficking In Humans awareness training, or collateral duty creep, or the 3 weeks of Army combat training silliness during my last deployment workup (gotta learn how to search vehicles for bombs at entry control points!), or AHLTA, or the civilian-military pay gap, or the tendency for hospital leaders in most places to be non-physicians or physicians-who-don't-practice. It's not perfect, but we have a good facility, good equipment, good people, and we deliver great care to a great patient population.


I spent last weekend moonlighting out in town, and the pay is great and the EMR is fantastic and I did a couple of great cases ... but the floor nurses "weren't comfortable" with my thoracic epidural so the patient went to the ICU where the nurses weren't quite so afraid of the yellow pump ... and a surgeon put an elective case on after hours because it fit his social schedule better (but he makes it rain so that's OK!) ... and the cafeteria only serves turkey bacon because of the hospital founders' religious beliefs ... and shift change means a 2 hour delay ... and they're terrified of CMS so they have silly rules about sleeves and "wet time" during OR turnover ... and the patients on Big House Fridays are delightful lifers from the prison ... and my Omnicell account gets deleted if I don't login every 29 days ... and the nurses carry clipboards too ... and ... and ... and ... I could complain endlessly about anklebiter issues there.

 

[Kilgoretrout 65]

One of the more frustrating things about milmed is the huge variability from place to place ... and the variable control we have in choosing where we go. Bethesda is Bethesda. I went to USUHS and was an intern at Bethesda. During my GMO tour, when applying to residency, I almost didn't rank Bethesda at all because it was a tough call as to whether it'd be better to do another GMO year, or return to that weirdly toxic place.

My perspective is of course a product of my experiences, duty stations, and deployments ... but over the years I've worked with Army and Air Force physicians, at home and abroad, and from time to time I run into some of my not-Navy USUHS classmates.

And yeah, my feeling is that the Navy medical environment really is far and away better than the AF, and probably a couple notches above the Army.

I've been at a small and isolated command for the last few years, minus a deployment, and there are some problems, the risk of skill atrophy chief among them. I certainly am not one to defend the ridiculousness of online Trafficking In Humans awareness training, or collateral duty creep, or the 3 weeks of Army combat training silliness during my last deployment workup (gotta learn how to search vehicles for bombs at entry control points!), or AHLTA, or the civilian-military pay gap, or the tendency for hospital leaders in most places to be non-physicians or physicians-who-don't-practice. It's not perfect, but we have a good facility, good equipment, good people, and we deliver great care to a great patient population.


I spent last weekend moonlighting out in town, and the pay is great and the EMR is fantastic and I did a couple of great cases ... but the floor nurses "weren't comfortable" with my thoracic epidural so the patient went to the ICU where the nurses weren't quite so afraid of the yellow pump ... and a surgeon put an elective case on after hours because it fit his social schedule better (but he makes it rain so that's OK!) ... and the cafeteria only serves turkey bacon because of the hospital founders' religious beliefs ... and shift change means a 2 hour delay ... and they're terrified of CMS so they have silly rules about sleeves and "wet time" during OR turnover ... and the patients on Big House Fridays are delightful lifers from the prison ... and my Omnicell account gets deleted if I don't login every 29 days ... and the nurses carry clipboards too ... and ... and ... and ... I could complain endlessly about anklebiter issues there.

Fair enough. To me " a feeling" sounded more like a hunch or a wish and "far and away better" sounded like a meta data analysis. That being said, to all you potential HPSP and USUHS applicants, if you care
where you end up, try to do your homework on what branch you are joining if you have a choice. When I joined USUHS one of my goals was not to be on a ship and my Army veteran brother told me to stay away from the Army so here I am in the Air Force. All the Public Health Service spots were taken....

 

[HighPriest]

You can join via FAP soon (and get money during residency in return for several years of service commitment after residency).

Or you can do nothing now, and consider joining after residency via direct accession, if the Army perceives a need and is hiring. They might or might not be. There's no way to predict. This path might offer you more negotiating leverage with regard to where you are stationed.

You might also consider the Navy. The culture is different ... not perfect, but from my perspective better than the Army and far and away superior to the Air Force in terms of work environment for physicians. You get a pretty skewed view reading this forum. There are a lot of grouchy people here and pissed off people tend to be more vocal people. While their gripes aren't without merit, and I join them in griping from time to time, overall my time in the Navy has been more good than bad.


At your point in your career, unless you are sure you want to join the military, it might be better to wait until done with residency or approaching the end of residency to consider joining. Totally apart from the complaints you can (and should) read at length on this forum, there are unusually large changes brewing in military medicine currently, now that Iraq is over and Afghanistan is almost over. There will be base closures, expansions, and major changes in the ways the different branches of the military run their medical departments, and how they choose to defer (to civilian hospitals) or not defer (keep) active duty, family member, retiree, and other eligible patients. Anyone who tells you they're sure how this will all settle out is lying.

You've got about 5 years before you'll be done with residency. Nothing wrong with choosing to decide later.

There are a lot of grouchy people in Kiev too, but that's because of they situation they find themselves in

 

[HighPriest]

Having done some moonlighting myself, my experience is that all of the issues that occur at a civilian hospital occur at the military hospital, plus a metric $&!t tonne of things than only happen at a military facility. But I honestly don't know if the AF/Navy facilities are better.
I can say that the number of military docs I've spoken with who are happy in the military are in the minority. Maybe that's because they're quiet or shy, but the fact that most people do not re-up after their ADSO says something at least. (Admittedly open to interpretation).
And based upon what is happening at military institutions all over the DoD right now, I can also say that we're a civilian facility fun in such a fashion, it would not be run in such a fashion for very long.
And our D-Fac has a religious restriction, too. It only serves food that allows you to see through any piece of paper it's rubbed against.

One thing is true: it is possible to be happy at a military hospital. I tend to lean more towards idq1i's thought process as to why, but there are always exceptions. And as I've said many times before, experiences vary and depend highly upon where you end up ( of which you have no control). The problem is you don't know for sure if you'll be happy until it's too late.

It's all very Faustian.