Point of Views about a Blue Angels Flight Surgeon

[militarymd]

First of all, I tell you my motivation:

I want military medicine to have soooo few recruits that they cannot fill any of their billets....or that they have to scrap off the bottom of the barrel so badly that they will finally recognize that the system needs a serious revamping.

How likely will that happen? Unlikely, but that doesn't mean I will give up my little campaign.

We all come here from different backgrounds and different level of experiences so try to put yourselves in my shoes if you can:

Someone who has wanted only to be a doctor....nothing else...someone who wants to practice medicine....NOT military medicine....someone who feels that being a doctor is privilege that is earned through hard work and dedication...someone who feels that the doctor LEADS the healthcare team.

Someone who got CONNED into the military, but paid his time....+ extra time...and has finally left for greener (my opinion) pastures.

So when I saw this Blue Angels FS post, it brought out VISCERALS feelings for me. It exemplified EVERYTHING wrong with military medicine.

From a physician perspective, this guy is a drop out...period. Anyway you want to look at it, he is a drop out. And in the civlian world, his chances for employment are not very good......reason for that....he's a drop out.

So what does the Navy do? Bring the drop out in, and give him a cool and exciting job....doing NOTHING!!!

What do you think a flight surgeon does???? Practice medicine???? They do flight surgeon stuff, and IT IS NOT practicing medicine. How much medicine can an intern practice independently?????

I read his newspaper clippings....."medical evacuations"...sounds real cool....but what do you think an intern does in true medical emergency....I've participated in these "medical evacuations" with Navy FS....I know how little they do.

The Navy medical system provides poor care, but it provides a cool job for a DROP OUT...so that HE can have fun at the expense of your tax dollars...doing NOTHING.

As a medical student/college student reading his post...you would not understand this....but as a fully trained physician who understands and knows that system....His experiences is one of many reasons why military medicine is a broken system that needs to die and be remade.

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[Heeed!]

Wow.

 

[Mirror Form]

From a physician perspective, this guy is a drop out...period. Anyway you want to look at it, he is a drop out. And in the civlian world, his chances for employment are not very good......reason for that....he's a drop out.

I think you're over dramatizing this. It's not that uncommon for people to change residencies once they discover that the field isn't for them. In fact, I don't think anybody would recommend that somebody continue on in an obgyn residency if they decided that they didn't like the field and wanted to do something else.

 

[MoosePilot]

This was a very useful post.

The military screwed up in not telling you what you were going to do and who you needed to be prior to commissioning you.

I'm not like you. I think I'm enough different from you that I'm not sure your feedback has more than incidentally relevant meaning to me. When I commit myself to being a military physician, I'm going to be a military physician, not a physician who was civilian trained and now is as uncomfortable in the military as I would be in shoes that don't fit.

I prefer the Blue Angel doc's attitude. He wanted to change fields after getting some experience in one. Completing a residency you're not interested in anymore is no virtue. He took a honorable road to doing something else, enjoyed his trip, served his country, and then went back to complete his education as a physician.

You'd think BC was like superhero status, along with being an attending. Wow. I thought the military was hierarchical, but at least I respect copilots and realize they're going to be sitting in my seat eventually and probably doing about the same job I do.

 

[island doc]

This was a very useful post.

The military screwed up in not telling you what you were going to do and who you needed to be prior to commissioning you.

I'm not like you. I think I'm enough different from you that I'm not sure your feedback has more than incidentally relevant meaning to me. When I commit myself to being a military physician, I'm going to be a military physician, not a physician who was civilian trained and now is as uncomfortable in the military as I would be in shoes that don't fit.

I prefer the Blue Angel doc's attitude. He wanted to change fields after getting some experience in one. Completing a residency you're not interested in anymore is no virtue. He took a honorable road to doing something else, enjoyed his trip, served his country, and then went back to complete his education as a physician.

You'd think BC was like superhero status, along with being an attending. Wow. I thought the military was hierarchical, but at least I respect copilots and realize they're going to be sitting in my seat eventually and probably doing about the same job I do.

There is no fault in changing residency programs mid-stream if one does not desire a career in a given specialty. No problem there at all, it is done quite frequently actually. The problem, and where he earns the label of "drop out" is the fact that he did not quit OB/GYN (arguably a wise move) to enter another specialty, but rather to begin the pre-mature practice of medicine. Not unlike quitting high school prior to graduation in order to go work at some menial job.

 

[MoosePilot]

There is no fault in changing residency programs mid-stream if one does not desire a career in a given specialty. No problem there at all, it is done quite frequently actually. The problem, and where he earns the label of "drop out" is the fact that he did not quit OB/GYN (arguably a wise move) to enter another specialty, but rather to begin the pre-mature practice of medicine. Not unlike quitting high school prior to graduation in order to go work at some menial job.

If the menial job paid about the same as the the graduate level job...

In this case he got a "menial" job that paid decently and left him open for career advancement later, that he took advantage of. The only way it hurt him is in income level for a few years, but depending on his priorities, the experiences might have been worth it. I don't see that deserving a label of "drop out".

 

[militarymd]

Moose,

You are not getting my point. It is accepted medical practice in N. America that you finish training before you practice medicine.

This fella did not finish training.

In N. Amercian, his job prospects are NOT good.....What does the Navy do????? Give him a cool job where he gets paid to have fun while contributing essentially NOTHING to the practice of medicine.

That is a problem with Navy medicine.

 

[dpill]

From a physician perspective, this guy is a drop out...period. Anyway you want to look at it, he is a drop out. And in the civlian world, his chances for employment are not very good......reason for that....he's a drop out.

The admissions committee at Harvard apparently didn't view him as a drop out. Do you really think a person residency trained in anesthesiology at Harvard is going to have a hard time finding employment???

 

[militarymd]

The admissions committee at Harvard apparently didn't view him as a drop out. Do you really think a person residency trained in anesthesiology at Harvard is going to have a hard time finding employment???

Is that what he is doing? Anesthesiology at Harvard?

 

[militarymd]

After you finish residency...employment is not difficult....However, after internship only....you will have a hard time with finding job....except in the Navy...where they will welcome you with open arms.

 

[MoosePilot]

Moose,

You are not getting my point. It is accepted medical practice in N. America that you finish training before you practice medicine.

This fella did not finish training.

In N. Amercian, his job prospects are NOT good.....What does the Navy do????? Give him a cool job where he gets paid to have fun while contributing essentially NOTHING to the practice of medicine.

That is a problem with Navy medicine.

I understand that in the civilian world it is the way things work. Will anyone really blacklist him as long as he gets the residency? He already posted that he's starting a residency, so it's not that he's ignoring the way things work, just delaying it, at some cost to him financially and speed of career progression, and some gain in life experience.

 

[militarymd]

I understand that in the civilian world it is the way things work. Will anyone really blacklist him as long as he gets the residency? He already posted that he's starting a residency, so it's not that he's ignoring the way things work, just delaying it, at some cost to him financially and speed of career progression, and some gain in life experience.

Bottom line....I think Navy medicine sucks.....and someone who says great things about Navy medicine ....causes me to have doubts about them as a physician.

 

[orbitsurgMD]

I understand that in the civilian world it is the way things work. Will anyone really blacklist him as long as he gets the residency? He already posted that he's starting a residency, so it's not that he's ignoring the way things work, just delaying it, at some cost to him financially and speed of career progression, and some gain in life experience.

He is probably going to do just fine, despite his lengthy GMO FS tours.

 

[MoosePilot]

Bottom line....I think Navy medicine sucks.....and someone who says great things about Navy medicine ....causes me to have doubts about them as a physician.

I can understand that, but it was my impression that his enthusiasm was for his experiences in his career not for Navy Medicine, which he only saw two small corners of. So he's not saying Naval medicine isn't broken, he's saying you can still have fun in it.

 

[MoosePilot]

He is probably going to do just fine, despite his lengthy GMO FS tours.

That's reassuring, because one of the tracks that I'm looking into will almost certainly guide me into a GMO tour, but I definitely want to be able to continue in my medical education and career progression.

 

[militarymd]

I can understand that, but it was my impression that his enthusiasm was for his experiences in his career not for Navy Medicine, which he only saw two small corners of. So he's not saying Naval medicine isn't broken, he's saying you can still have fun in it.

That's my point....there is something wrong with a system where physicians are having "fun" while the care provided (quantity and quality) is substandard

 

[usnavdoc]

That's my point....there is something wrong with a system where physicians are having "fun" while the care provided (quantity and quality) is substandard

I agree with the Vast majority of what you say about military medicine. At least what I have experienced from my level. But I have to take issue with you stating that the quality of medical care delivered by GMOs is substandard. Sure there are GMOs out there who I wouldnt let manage me or anyone else if I could prevent it. Just as you know MDs in the hospital you hope never walk into the room when you are on. But those individuals will never be good physicians and fortunately they are the minority.

The question is not whether a FP would do a better job. Of course they would, but they would deteriate doing this job just as I have. The Navy simply wont fund for an FP in all the GMO billets anyway. What we are really talking about is a job that a mid level provider can handle. We have more experience and knowledge than any PA coming out of PA school. And that is essentially the job we are asked to do.

While serving with the Marines the last 4 years I could count the number of patients with chronic conditions that I have cared for on my fingers. That is to say that the majority of my patients are patients that would get fast tracked at the ED and treated by a PA or sent away to follow up with their PCP.

The more serious/chronic patients have specialists guiding their care. There are shortcomings of course but that would exist if the PA were doing my job as well.

I am not defending this system at all. I hate that my career path has been stagnated the way it has. I finally start residency this next july as a civilian and after 4 years as a GMO I am excited as well as nervous due to the delay in training. I made the decision early in my GMO tour that I was not career minded, but I made the best of things always trying to let my moral/ethical compass guide me rather than the idea that I was an officer. So I would love for navy medicine to revamp from the ground up. I just dont think it will happen.

 

[orbitsurgMD]

"The Navy simply wont fund for an FP in all the GMO billets anyway."

Unfortunately true, unless Congress puts their necks to the wire and makes them, or they bottom-out their traditional pool of candidates for GMO duty and give in, which is what I think it will take. This issue has been burning for a very long time, and I am convinced that the Navy does not have the will to devote the resources to fix a problem that they think they can ignore more cheaply. And they cannot be shamed, no matter how far they deviate from the rest of the nation in their medical practices and staffing standards. For them, it really comes down to money; they just won't spend it unless someone makes them or unless they have no other choice.

 

[dpill]

Is that what he is doing? Anesthesiology at Harvard?

Yes, he is currently doing an anesthesiology residency at Harvard.

 

[island doc]

Yes, he is currently doing an anesthesiology residency at Harvard.

Is a Harvard anesthesiologist any better able to put someone to sleep, or (more importantly) wake them up than someone from somewhere else? How many times have you heard patients ask their anesthesiologist where they did their residency?

MilMD, what say you?

 

[dpill]

Is a Harvard anesthesiologist any better able to put someone to sleep, or (more importantly) wake them up than someone from somewhere else? How many times have you heard patients ask their anesthesiologist where they did their residency?

MilMD, what say you?

My point (which I am sure you understand without me spelling it out for you) is in reference to MilMD’s comment, "From a physician perspective, this guy is a drop out...period. Anyway you want to look at it, he is a drop out. And in the civilian world, his chances for employment are not very good......reason for that....he's a drop out.”

My point: If the Harvard admissions committee doesn’t view this guy as a drop out/ loser (if they did, why would they let him in their program?), I have a hard time believing the rest of the physician community will, either. While I agree most patients could probably care less where you do your residency, I doubt a Harvard-trained anesthesiologist will have a difficult time finding employment (again, ref the above quote).

 

[militarymd]

My point (which I am sure you understand without me spelling it out for you) is in reference to MilMD’s comment, "From a physician perspective, this guy is a drop out...period. Anyway you want to look at it, he is a drop out. And in the civilian world, his chances for employment are not very good......reason for that....he's a drop out.”

My point: If the Harvard admissions committee doesn’t view this guy as a drop out/ loser (if they did, why would they let him in their program?), I have a hard time believing the rest of the physician community will, either. While I agree most patients could probably care less where you do your residency, I doubt a Harvard-trained anesthesiologist will have a difficult time finding employment (again, ref the above quote).

After training, like you are supposed to, you won't have a hard time finding a job. I feel like a broken record ...having to say the same things over and over again....to people who are supposed to pay attention to detail....it kind of scares me.

When he dropped out....he had no opportunities...and a dysfunctional system takes him in...and gives him a cool job doing nothing.....All you medical students SHOULD NOT aspire to that.

As for getting into a residency program, many academic programs have reservists, and I know there are Navy reservist at MGH, and they tend to view military service as a positive....although I don't know why.....especially when all you did was NOTHING as a GMO.....

This fella is finally on a track that he should have been on 7 years ago.

 

[dpill]

After training, like you are supposed to, you won't have a hard time finding a job. I feel like a broken record ...having to say the same things over and over again....to people who are supposed to pay attention to detail....it kind of scares me.

When he dropped out....he had no opportunities...and a dysfunctional system takes him in...and gives him a cool job doing nothing.....All you medical students SHOULD NOT aspire to that.

As for getting into a residency program, many academic programs have reservists, and I know there are Navy reservist at MGH, and they tend to view military service as a positive....although I don't know why.....especially when all you did was NOTHING as a GMO.....

This fella is finally on a track that he should have been on 7 years ago.

Interesting comment coming from someone that didn't realize the person he was criticizing was in a residency program.

 

[militarymd]

Where on his post did he give us this information?

 

[dpill]

Where on his post did he give us this information?

snman31 stated in response to Ex_Blue's post, “Having contacted the OP, I know he is in a very competitive residency program in Boston, so at least for him the experience added value.” You responded to another line in this particular post, so you probably read this line as well? I did a little research and found out his residency was in anesthesiology. You know he never would've had the chance to do anesthesiology if he had finished his civilian OB/GYN residency. While his decision may have set him back a few years, I think it was a wise decision for him in the bigger picture (regardless of the merit/ lack of merit of a FS tour). Anyway, it doesn’t matter. I know you hate the Navy and nothing I say in reference to the possible benefits of this guy’s FS tour will change your mind about it. You had a terrible experience in the Navy, and I am sure someone talking about their great experiences doesn’t make you feel better about it. I am glad you are happy with your life now.

 

[militarymd]

While his decision may have set him back a few years, I think it was a wise decision for him in the bigger picture (regardless of the merit/ lack of merit of a FS tour). Anyway, it doesn’t matter. I know you hate the Navy and nothing I say in reference to the possible benefits of this guy’s FS tour will change your mind about it. You had a terrible experience in the Navy, and I am sure someone talking about their great experiences doesn’t make you feel better about it. I am glad you are happy with your life now.

That is my point. Great for him....but sucks for Navy Medicine....Great for a guy who dropped out and couldn't finish....

Terrible for Navy medicine in that the Navy wasted money paying for him to fly around looking good in a flight suit with neglible medical training.....

while deserving retirees, soldiers, and sailors get crappy care....

If you're in it to have fun, waste federal money, and contribute to a crappy medical system, then this guy is the poster child.

If you want to be a doctor, and want our sailors and soldiers to have a great medical system, then this is a guy that gets the comments that i wrote.

 

[island doc]

I just don't understand why people keep talking about "benefits" to a GMO/FS tour. How many times do we have to kick this dead horse??? Exercise some common sense here for a change. There are no benefits to be had in suspending one's medical education, in order to enter the practice of medicine prematurely, even something as clinically superficial as a GMO/FS tour. Modern medical practice simply does not justify it, no matter how or why one may choose to rationalize it.

 

[MoosePilot]

I just don't understand why people keep talking about "benefits" to a GMO/FS tour. How many times do we have to kick this dead horse??? Exercise some common sense here for a change. There are no benefits to be had in suspending one's medical education, in order to enter the practice of medicine prematurely, even something as clinically superficial as a GMO/FS tour. Modern medical practice simply does not justify it, no matter how or why one may choose to rationalize it.

For some, 3 years to grow and mature will help them to excel in their residency, don't you think? Doesn't the data presented previously about the performance of previous GMOs in their residencies support that?

I know the 10 years I delayed my education by, while perhaps not ideal, will help me to do well, which will help me get a good residency, etc. So for me it will end up helping my career. I missed 10 years, but I bet I'll go further this way than I would have.

 

[orbitsurgMD]

"For some, 3 years to grow and mature will help them to excel in their residency, don't you think? Doesn't the data presented previously about the performance of previous GMOs in their residencies support that?


The vast majority of U.S. medical school graduates have no association with the military and are not expecting to spend any time away from training, nor do their residency programs expect them to do anything except progress straight through until completion. They don't need time off for "maturing". These are committed professionals in training. The idea that HPSP or USUHS graduates are special cases that need the maturing effects of GMO duty tours in order for them to be excellent residents is just laughable.

 

[MoosePilot]

"For some, 3 years to grow and mature will help them to excel in their residency, don't you think? Doesn't the data presented previously about the performance of previous GMOs in their residencies support that?


The vast majority of U.S. medical school graduates have no association with the military and are not expecting to spend any time away from training, nor do their residency programs expect them to do anything except progress straight through until completion. They don't need time off for "maturing". These are committed professionals in training. The idea that HPSP or USUHS graduates are special cases that need the maturing effects of GMO duty tours in order for them to be excellent residents is just laughable.

Heh.

Slow down, some. I never said *need*. I said it might help. It might help an equal number of the civilians, but they don't have that chance, so many of them will get trounced in the competition, just like I trounced a bunch of them on the interview trail. It was like smacking bunnies, I felt bad interviewing and watching the 21 year olds skitter around like scared mice.

It might make the difference between a competitive and a non-competitive residency for me. I know how much I've grown. I don't know how much excelling in residency helps a career, but I'm sure it doesn't hurt.

 

[dpill]

I just don't understand why people keep talking about "benefits" to a GMO/FS tour. How many times do we have to kick this dead horse??? Exercise some common sense here for a change. There are no benefits to be had in suspending one's medical education, in order to enter the practice of medicine prematurely, even something as clinically superficial as a GMO/FS tour. Modern medical practice simply does not justify it, no matter how or why one may choose to rationalize it.

This is your OPINION... Don't you get it? Everyone doesn't see things the way you do. Look, I emailed the guy concerning his perspective of the pros and cons of a FS tour. Here is his response:

i was in a Harvard Medical School residency interview 5 minutes and it went something like this:
"i am very interested in people coming from the military because they bring certain attributes that regular medical students do not. you will not have, or cause, some of the problems that non-military people will have."

Those are not his words or my words, but the words of the admissions people in his residency program. The benefit FOR HIM is that he got into a competitive residency that he probably wouldn't have gotten into otherwise AND he felt it was a gratifying experience. That is obviously not the same way you view your experience. I understand that. Being a GMO wasn't good for you and you don't think it is good for the military. I understand that. You wish the military would do away with the GMO program. I understand that. TRUST ME, you have made your perspective clear enough.

 

[militarymd]

i was in a Harvard Medical School residency interview 5 minutes and it went something like this:
"i am very interested in people coming from the military because they bring certain attributes that regular medical students do not. you will not have, or cause, some of the problems that non-military people will have."

Academia appreciates military service and maturity. The above statement would apply to anyone with prior military service...medical or otherwise....any expericence is appreciated by academia...peace corp, former law enforcement, etc.

Academia DOES NOT understand military medicine, and what it represents.

As I said, he had a great experience at the expense of the American Taxpayer, the servicemen.....and he is supports this system.

 

[USAFdoc]

This is your OPINION... Don't you get it? Everyone doesn't see things the way you do. Look, I emailed the guy concerning his perspective of the pros and cons of a FS tour. Here is his response:

i was in a Harvard Medical School residency interview 5 minutes and it went something like this:
"i am very interested in people coming from the military because they bring certain attributes that regular medical students do not. you will not have, or cause, some of the problems that non-military people will have."

Those are not his words or my words, but the words of the admissions people in his residency program. The benefit FOR HIM is that he got into a competitive residency that he probably wouldn't have gotten into otherwise AND he felt it was a gratifying experience. That is obviously not the same way you view your experience. I understand that. Being a GMO wasn't good for you and you don't think it is good for the military. I understand that. You wish the military would do away with the GMO program. I understand that. TRUST ME, you have made your perspective clear enough.

I agree with you (dpill) that there can be some upside to GMO, and in fact, there is probably upside to anything in life, nearly all struggles included. And to that, one might as well look for the positives in any situation that one cannot change.

That having been said, I agree with Island doc that the GMO idea does more harm than good in most situations (not all), and in that regard should be phased out. If low experience and training are suitable for a job, then get a PA or NP.

Just because something good (admit to Harvard) comes out of something bad (GMO) does not justify the continuing of that poor practice. But till that changes, absolutely, look for the positives in anything.

 

[dpill]

I agree with you (dpill) that there can be some upside to GMO, and in fact, there is probably upside to anything in life, nearly all struggles included. And to that, one might as well look for the positives in any situation that one cannot change.

That having been said, I agree with Island doc that the GMO idea does more harm than good in most situations (not all), and in that regard should be phased out. If low experience and training are suitable for a job, then get a PA or NP.

Just because something good (admit to Harvard) comes out of something bad (GMO) does not justify the continuing of that poor practice. But till that changes, absolutely, look for the positives in anything.

Personally, I don't have a definitive opinion about risks/ benefits of GMO military medicine, primarily because I have haven't worked in that environment yet (I have only seen it as a "consumer"). I just know that there are pros and cons to just about everything in life (as you said above), and I want to gather as much info as I can (which is why I spent time on SDN in the first place). GMO medicine is a reality for the foreseeable future, and I may be in the situation where I have to choose between a GMO tour or living apart from my family for 3+ years (my husband is still quasi-military as full-time ANG), so I value ALL opinions from the people who have worked in "the system" (yours, USAFGMODOC, IslandDoc, Ex_Blue, MilMed, etc., etc.) Ideally, I will do a residency first, but I am going to keep my mind open because there are other things in life that are important (like family). Thanks for your input.

 

[MoosePilot]

I agree with you (dpill) that there can be some upside to GMO, and in fact, there is probably upside to anything in life, nearly all struggles included. And to that, one might as well look for the positives in any situation that one cannot change.

That having been said, I agree with Island doc that the GMO idea does more harm than good in most situations (not all), and in that regard should be phased out. If low experience and training are suitable for a job, then get a PA or NP.

Just because something good (admit to Harvard) comes out of something bad (GMO) does not justify the continuing of that poor practice. But till that changes, absolutely, look for the positives in anything.

I think this is the takeaway.

 

[dpill]

Another thing I've considered but am leaning against: what do you think about the RAM (Residency in Aerospace Medicine)? I know several people that have done RAM (some residency trained in other things but many who are only RAM trained). What do you really get out of the program? You spend one year getting your MPH (which I already have), and then two years doing flight med "stuff"- I can't imagine that you really get much quality exposure to clinical medicine through the program. In the end, I think you can become board certified in occupational medicine and preventative medicine as a RAM. But what can you do with this in the civilian world (without a primary care background)? Thoughts?

 

[militarymd]

Another thing I've considered but am leaning against: what do you think about the RAM (Residency in Aerospace Medicine)? I know several people that have done RAM (some residency trained in other things but many who are only RAM trained). What do you really get out of the program? You spend one year getting your MPH (which I already have), and then two years doing flight med "stuff"- I can't imagine that you really get much quality exposure to clinical medicine through the program. In the end, I think you can become board certified in occupational medicine and preventative medicine as a RAM. But what can you do with this in the civilian world (without a primary care background)? Thoughts?

The RAM in the Navy requires that you become board-certified in another specialty before you can be accepted into the program.

That information was current as of 2002/2003. There was talk of removing that requirement because of a lack of qualified applicant.

This is/was a requirement before you get to become the SMO on an aircraft carrier....so there is some place in the Navy where they believe in fully trained physicians....the very tip of the pointy spear where no one is sick....and when you do need care its because of some trauma (crashing your tomcat)...and then you don't need the SMO, but the surgeon and anesthesiologist/crna onboard who, although fully trained, haven't done a case in months.

As I said, this guy took extreme advantage of a very poorly designed/operated system, and got what he wanted.

Good for him.

But it was only good for him, because the system SUCKS.

Do you see what I am saying?

In a way, I'm criticizing him a little, but my major point is that this pathetic system supports the pathway he took at the expense of many other people.

 

[island doc]

Another thing I've considered but am leaning against: what do you think about the RAM (Residency in Aerospace Medicine)? I know several people that have done RAM (some residency trained in other things but many who are only RAM trained). What do you really get out of the program? You spend one year getting your MPH (which I already have), and then two years doing flight med "stuff"- I can't imagine that you really get much quality exposure to clinical medicine through the program. In the end, I think you can become board certified in occupational medicine and preventative medicine as a RAM. But what can you do with this in the civilian world (without a primary care background)? Thoughts?

In the civilian setting, there are full time occupational medicine physicians, and of course one could do FAA physicals, but could not make a living doing FAA exams. But there are full-time "occ docs" in the private sector.

Some things RAM graduates have done in the civ world include: faculty members at the two civilian aerospace medicine residency programs, work for NASA or for the major commercial airlines.

 

[orbitsurgMD]

In the civilian setting, there are full time occupational medicine physicians, and of course one could do FAA physicals, but could not make a living doing FAA exams. But there are full-time "occ docs" in the private sector.

Some things RAM graduates have done in the civ world include: faculty members at the two civilian aerospace medicine residency programs, work for NASA or for the major commercial airlines.

You would be pigeonholing yourself on the military side: working as a SMO or as a senior medical officer at a large flight clinic somewhere or getting stashed at a NAMI/NUMI staff billet. Some senior medical admin officers, usually at the wing level and above have had that background.

There are jobs in Occupational Medicine on the civilian side, but you would probably need to have another board specialty to be competetive. You would do lots of disability reviews. Some hospitals set up clinics just for that purpose, especially if there is a referral source among local industrial employers.

 

[Nylesor]

Someone who got CONNED into the military, but paid his time....+ extra time...and has finally left for greener (my opinion) pastures.

After training, like you are supposed to, you won't have a hard time finding a job. I feel like a broken record ...having to say the same things over and over again....to people who are supposed to pay attention to detail....it kind of scares me.

Almost as scary as the guy who didn’t do the research or consider the consequences BEFORE making a significant commitment and now feel he has to gripe about someone who made the same commitment and got the most out of the experience.

 

[militarymd]

Almost as scary as the guy who didn’t do the research or consider the consequences BEFORE making a significant commitment and now feel he has to gripe about someone who made the same commitment and got the most out of the experience.

Uhh....the internet didn't exist in 1989....Uhh....military medicine was quite different in the 80's....uhh....I wanted to be a doctor, not a advertising billboard for the Navy....

 

[HumptyDumptyMil]

What's the problem with doctor's doing jobs of a PA or a NP? Correct me if I'm wrong, but some people make it sound like the jobs of a PA/NP/GMO etc. are a waste of time for anyone that graduated from med school.

Granted the system is messed up, and resources maybe misplaced, but that doesn't mean that anyone has a right to degrade the jobs that these people do. Being a nurse assistant myself, I get frustrated when I see docs ask nurses to do things they can do on their own, or nurses asking nursing assistants to do jobs as if to say "i'm too good to do nurse assistant stuff"

 

[Nylesor]

Uhh....the internet didn't exist in 1989....Uhh....military medicine was quite different in the 80's....uhh....I wanted to be a doctor, not a advertising billboard for the Navy....

Uh, they did have military people around (non-recruiters) you could talk to...btw, how was military medicine in the 80's and what changed it?

 

[orbitsurgMD]

Uh, they did have military people around (non-recruiters) you could talk to...btw, how was military medicine in the 80's and what changed it?

Of course there were doctors around, if you knew who and where to ask, but there was no public medium like the web with information that was readily available and from different sources. As others have already posted, the web has made a difference as an information resource for potential applicants.

Prior to 1982, when DOPMA went into effect, entering HPSP students got time in grade credit for the time they spent in medical school as reserve ensigns. That meant when they became interns, they started as O-3s with 4 years service. That extra time in grade continued through their entire careers. It added up. They also were able to use the time in medical school as credit toward their 20 year mark in retirement. This ended after DOPMA was enacted.

GMO assignments used to be one year only with return to training right after that. There were relatively more training opportunities and more outservice training slots. At that time, the services were still trying to provide medical care for active duty dependents and retirees and their dependents, so the pool of available patients in the military medical system was larger and more diverse, hence the need for more housestaff and attendings. TRICARE didn't exist.

 

[r90t]

I can think of many PGY-1+ physicians that moonlight at urgent care clinics without a board certified physician overseeing their work in the evening. I would hope that after an internship year, you can manage asthma, bronchitis, birth control, paps, etc... without difficulty. I'll bet even the GMO skeptics could train an intern to be competent to work for them in 12 months to do the nuts and bolts of medicine. The difference between a moonlighting resident and a GMO is??? The GMO has an active duty population 18-40+ in reasonably good health, has access to routine medical care and has no language barrier. The urgent care gets all comers...80 y/o CHF, 18 y/o drug seeker, etc....A GMO should be able to handle the routine urgent care medicine that pops up at his command. I have to stress routine care issues, not cardiac stress tests, major trauma, reading CTs, managing an ICU, etc...Things outside of his comfort zone, whatever that my be, should be consulted out, sent to the ER, or get advice/guidance/supervision from a higher trained physician.

Yes I did a GMO tour and I think it did help for my civilian residency program selection.

With that said, scrap IDCs/PAs/NPs/GMOs and get a board certified/eligible FP in all deployable primary care positions in the military. That would provide a higher standard of care at all levels. In the perfect world, that is what the military would do. The politics, however, will have no community i.e. NC/MSC willing to give up officer positions (remember there is a cap) for another branch (MC). Being a previous MSC, I have seen the politics that occur at major and small commands.

 

[USAFdoc]

I can think of many PGY-1+ physicians that moonlight at urgent care clinics without a board certified physician overseeing their work in the evening. I would hope that after an internship year, you can manage asthma, bronchitis, birth control, paps, etc... without difficulty.
.

I would disagree with your statement that just about anybody could care for the above people. Look at the surveys done describing the very low numbers of asthmatics that are on the correct meds etc. I see it in my office every week, people on on the right meds, not on meds for BP, not being offered stepped up tx for uncontrolled DM2. Now there are alot of things behind that and not just training and experience. I would place "time" at the top of the list as primary care docs get 10 minutes to try and sort out a myriad of complaints.

As for the military in general; I object that they have set their standard at the minimum standard, and maybe a step below that. Yes, some civilian places have poorly experienced providers, poor work conditions etc. But why should that, and even less than that be acceptable for our troops and their families, especially when it can be fixed (if the military leaders would swallow their pride (or stick it somewhere else for awhile) and let somebody fix the situation.)

Any of the above beats a nearly broken system that the military continues to LIE about to congress.

 

[militarymd]

Being a previous MSC, I have seen the politics that occur at major and small commands.

I know you are not saying that we should let military politics stand in the way of what should be right.

 

[pgg]

With that said, scrap IDCs/PAs/NPs/GMOs and get a board certified/eligible FP in all deployable primary care positions in the military. That would provide a higher standard of care at all levels.

Sure, that'd be a higher standard of care. Putting a general surgeon with at least 10 years of experience there would be a still higher standard of care.

I'd point out this thread which includes a link to a presentation done three years ago. It cites, as the #1 cause of dissatisfaction among Air Force surgeons, their low case numbers. They don't do enough surgery, they don't see enough sick patients, their skills rot, and they hate it. They're miserable, they're bitter, and they're leaving.

Replacing GMOs with FPs would just inflict the same kind of idle hands brainrot on them. I can count on my fingers the number of patients I've seen in the last week. I've seen exactly one sick patient at my BAS in the last month, and I referred him immediately (to the ER physician 20 feet away, who in turn referred him to Balad, where he was then referred to Germany).

A PA could do my job. A PA should be doing my job.

My point is just this: a GMO's job is admin-intensive; it has a remarkably healthy patient population; it is in an environment that (at least for 2MARDIV GMOs) invariably has support close by.

If there's a place for a mid-level provider any place on earth, this is it.

 

[USAFdoc]

Sure, that'd be a higher standard of care. Putting a general surgeon with at least 10 years of experience there would be a still higher standard of care.

I'd point out this thread which includes a link to a presentation done three years ago. It cites, as the #1 cause of dissatisfaction among Air Force surgeons, their low case numbers. They don't do enough surgery, they don't see enough sick patients, their skills rot, and they hate it. They're miserable, they're bitter, and they're leaving.

Replacing GMOs with FPs would just inflict the same kind of idle hands brainrot on them. I can count on my fingers the number of patients I've seen in the last week. I've seen exactly one sick patient at my BAS in the last month, and I referred him immediately (to the ER physician 20 feet away, who in turn referred him to Balad, where he was then referred to Germany).

A PA could do my job. A PA should be doing my job.

My point is just this: a GMO's job is admin-intensive; it has a remarkably healthy patient population; it is in an environment that (at least for 2MARDIV GMOs) invariably has support close by.

If there's a place for a mid-level provider any place on earth, this is it.

the point is not that there is NO place for a PA or inexperienced provider, just that in my experience, the USAF was using inexperienced PAs and interns in our clinic to take care of retirees, complex patients, new patients etc. This was and continues to be reckless. Now is there an approrpraite use of these valuable providers?; YES, but definietely not in that enviroment. It is no good for the patient or the provider. This poor practice continues ONLY because those with a different agenda, and those without responsibility for the outcome have been given FULL authority.

 

[pgg]

the point is not that there is NO place for a PA or inexperienced provider, just that in my experience, the USAF was using inexperienced PAs and interns in our clinic to take care of retirees, complex patients, new patients etc. This was and continues to be reckless. Now is there an approrpraite use of these valuable providers?; YES, but definietely not in that enviroment. It is no good for the patient or the provider. This poor practice continues ONLY because those with a different agenda, and those without responsibility for the outcome have been given FULL authority.

I won't argue with that, but I will point out that I was replying to:

With that said, scrap IDCs/PAs/NPs/GMOs and get a board certified/eligible FP in all deployable primary care positions in the military. That would provide a higher standard of care at all levels.

Retirees and new patients are few and far between here in Iraq.

I don't know the first thing about how the Air Force uses/abuses GMOs other than what you've posted here, and what you describe sounds inappropriate and reckless. That's not what I'm talking about though.