The decline of military medicine

[AF_PedsBoy]

Actually we're still only there until 8PM or so charting, but only because you have to train yourself to keep a razer edged focus; for instance, I have to force myself not to see if their age appropriate screening is done at acute appointments, even when I know odds are that they won't be back for at least a year or two. The two minutes devoted to checking and the three minutes telling them about it used to push me back so I was half an hour late by the time I was three or four patients in (because you know the 5 and 10 minute patients aren't going to settle for the 2 and 7 minute face time after screening and vitals - forget it if they're even 5 minutes late). Then I'd feel guilty and try and take care of maybe ONE more problem than their initial concern. I was there every night and weekends too, charting, until I realized everyone was pissed off because their appointment was half an hour late, even if all their issues were met, and I was paying for it with my free time.

Now since I ignore it (unless I'm VERY ahead) I stay on time and even have the day's notes, T-cons, and labs followed up by 6-7 PM and weekends are mine Just means they need to come back for three or four appointments and everyone is happy - well at least *I* am!

...as an aside I found out one reason we're even more shortmanned is there are some people who work in our med group who are not actually working IN family medicine, but since they need to be accounted for in the organization, they come out of our spots. So our ancillary staff is already one man short of allotted, but in addition, two people counted against our allotment don't even work in our clinic, and we start at 5/8 BEFORE deploying and other taskings. I have a feeling this is not exclusive to our base.

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[AF_PedsBoy]

Oh yah - one thing to keep in mind, however, is that I don't go through the whole day hating life; I actually find it somewhat rewarding, the majority of the time, but it's easy expressing in clinic how good some things are - however it takes a lot of effort when you're getting crapped on and you still have to look pleasant!

 

[Galo]

I think there is a shortage, but I also think that the system is designed to have that shortage. The "Network Referral" is not just a method to deal with overflow, but is an integral part of the system. The number of billets is low, but I haven't decided if that is by design (to keep overall system cost down?) or inadvertent.

I also still insist that it benefits some specialties by allowing them to cherry pick which cases stay with them, and which get farmed out.

If you do become an orthopod in the Navy, this may be detrimental to your career if you end up in a base where joint replacements are ALL sent downtown, because the hospital can't affort the joints from their budget, and sends them out to tricare. Or if the OR is booked out months in advance, urgent stuff that you need to learn will also get sent out. Ortho trauma........forget it, unless you are at a major medical center that also happens to be a trauma center, or deployed. When you are a surgeon, you need to do volume, not cherry pick cases unless you are 70+, and just finishing out your career. Controlling cost by making surgeons wither their skills is a rotten way to run medicine.

 

[BigNavyPedsGuy]

In addition, our residents spent months at places like Shock/Trauma, Washington Hospital Center, as well as major civilian Peds facilities. I continue to argue that Bethesda's Ortho training was on par with any civilian program, though I can't speak to the quality of other MTFs, and of course there were older residents who didn't agree.

It's great that they rotate out, but people that train in other facilities see that stuff all the time. Each and every time they are on call they have a chance to see a high level trauma or peds case. In the military MTF case, they only get those chances either 6-9 months out of their 5 year residency. There's no way they get as much exposure and therefore training. I'm not saying they aren't adequate, they just see less cases.

 

[AF_PedsBoy]

WHMC I think the main complaint from the surgery service was each team was carrying around 35 patients, of which 33 were civilian traumas and 2 were real surgical cases. Most of them fell into A) Drunk/High MVA-85%, B) Truck full of illegals running and flipping over-5% (no really, this happened fairly regularly), and C) Other (e.g. gangbanger shot 4-5 times, gay guy beaten with a baseball bat, etc) Believe me, Ortho was very busy when I was there!

 

[Galo]

This is all true, though I question whether the cost of the implant actually results in off-base referrals. My understanding, and correct me if I'm wrong, is that when patients are deferred to the network, the cost of the visit/procedure is still drawn from the hospital budget. Hence the push by every MTF to keep patients within their system where it is cheaper.

Trauma is a problem everywhere, though in my case coming from Bethesda, our trauma/reconstruction program remains very strong. The quieting of Iraq has reduced numbers somewhat at the time I left, but Afghanistan is only going to get hotter, so I'm not too worried. In addition, our residents spent months at places like Shock/Trauma, Washington Hospital Center, as well as major civilian Peds facilities. I continue to argue that Bethesda's Ortho training was on par with any civilian program, though I can't speak to the quality of other MTFs, and of course there were older residents who didn't agree.

The skill atrophy will always be a concern for our young attendings at smaller facilities. Volume-wise though, Ortho has it pretty good. If you've ever been at a command where Ortho wasn't overloaded, let me know, because I haven't. I don't know how diverse their cases are, of course.

Actually when I was in, it was exactly opposite of what you are saying. ANYTHING that leaves the hospital gets funded by a the TRICARE budget, which is TOTALLY separate from the hospital budget. So everytime something is sent out, it benefits the hospital commander's budget, and they are therefore more prone to allow these cases to go out:

IF ANYONE knows for sure that I am wrong, please say so! This is just the way I remember it.

Furthermore, you will find that having to operate as an outside rotator, is nothing like being in that program. Just in November 03, rotators to shock trauma from the AF were being allowed to actually function as attendings, and I don't know to what degree. But imagine if your trauma experience comes from a month rotation. Your exposure will be severely limited. I would venture to say that you'd have to wait and see how well rounded the program is and what deficiencies it has when you get there, but I'm concerned that you will find the problems of milmed creeping in.

 

[Mirror Form]

See? That's what I mean about getting badgered and turned around. As soon as Galo finds out that I'm an MS-1 and don't know how to do an H&P (How the f&ck is that relevant?),

It's relevant b/c you have zero experience practicing medicine, be it in the civlian world or military.

I don't blame your for not wanting to accept what galo says. I didn't want to accept all the negative things I heard when I was a med student. In fact, I often told myself money was the big difference. But it's not, you'll find out for yourself in about 10 years.

We'll see how you feel when your civilian counterparts are seeing more patients and doing more surgery/procedures then you. Meanwhile you're seeing less patients, but working similar hours doing things like computer data entry (AHLTA), various secretarial jobs, pointless military webpage training, etc.

We'll see how you feel when a patient you were operating on had a bad outcome b/c the scrub tech you were with handed you a syringe with the wrong concentration of stuff. I have seen this happen twice now (neither patient had too bad of an outcome, but they could have). It can be easily avoided in the civilian world by having well trained competent techs. But in the military you don't have that luxury.

 

[Mirror Form]

Right it seemed like the Navy barely had enough billets to function at peace time. All of the sudden we are fighting a real war. Demand for services is increasing, mil-civ conversion is backfiring, staffing is decreasing and all of the sudden you've got the perfect storm.

Your forgetting one of the main elements of the perfect storm: the internet. Back when I was applying for a military scholarship there was ZERO information of this sort available. The only way to get any information was call a military doc that the the recruiter would hook you up with, and that info wasn't exactly fair and balanced.

Churn rate went up, but recruiting also when down b/c a lot of students were getting more of the negative information that the recruiters had been hiding (or just ignorant of).

 

[crazybrancato]

Your forgetting one of the main elements of the perfect storm: the internet. Back when I was applying for a military scholarship there was ZERO information of this sort available. The only way to get any information was call a military doc that the the recruiter would hook you up with, and that info wasn't exactly fair and balanced.

Churn rate went up, but recruiting also when down b/c a lot of students were getting more of the negative information that the recruiters had been hiding (or just ignorant of).

Fair enough, you're certainly right in that it's much easier to do the research today, with the advent of the internet.

But you could've done the necessary research using the research media of your day, ie telephone and face-to-face conversations. You could've sought out military doctors on your own (not those tied to a recruiter) in order to obtain more well-rounded opinions. I had a family friend (living in L.A.) that went in in the mid-90s. He drove down to San Diego to talk to a handful of mildocs that he made contact with on his own. Some had positive opinions, some had negatives. He also contacted a handful of AF docs up at Travis and talked to them over the phone. All of this helped him make his decision (he eventually went AF).

Further, if you thought it was just about the money, you could've done a quick cost analysis to see how the numbers play out. Computers certainly existed when you were coming in, as did spreadsheets (albeit not as advanced as today's)

Why didn't you do all of this?

So then, with the existence of this forum and others like it, would you agree that now everyone has been given fair warning? That anyone who goes it shouldn't have (10 years from now) the complaint, 'I had no idea what I was getting myself into?'

 

[notdeadyet]

So then, with the existence of this forum and others like it, would you agree that now everyone has been given fair warning? That anyone who goes it shouldn't have (10 years from now) the complaint, 'I had no idea what I was getting myself into?'

If you think that the military medicine environment is going to be the same in 10 years as now, you might be a little shortsighted here.

I have a hunch that those who joined in 1998 are serving in a very different milmed than the one they signed up under. Noting how things have changed is just evidence of perspective.

Folks who are hypersensitive to any critique of milmed make me picture the kid who covers his eyes and ears in the hopes that things will be magically better when he opens them again.

 

[BigNavyPedsGuy]

But you could've done the necessary research using the research media of your day, ie telephone and face-to-face conversations. You could've sought out military doctors on your own (not those tied to a recruiter) in order to obtain more well-rounded opinions. I had a family friend (living in L.A.) that went in in the mid-90s. He drove down to San Diego to talk to a handful of mildocs that he made contact with on his own. Some had positive opinions, some had negatives. He also contacted a handful of AF docs up at Travis and talked to them over the phone. All of this helped him make his decision (he eventually went AF).


Why didn't you do all of this?

'

Because I lived in Ruraltown, Fly-Over State. There was one military physician in the state. There were spreadsheets, but how could one find the numbers? If you're a college kid in a small land-locked state, that info is hard to come by. Also, how can someone figure out ISP, ASP, MSP, BAH, VSP and base pay all by themselves if they ask on this forum how it's supposed to work?

That whole argument you just posted is ******ed.

I don't think the military is all bad, but just stop being a cheerleader!

 

[crazybrancato]

If you think that the military medicine environment is going to be the same in 10 years as now, you might be a little shortsighted here.

I have a hunch that those who joined in 1998 are serving in a very different milmed than the one they signed up under. Noting how things have changed is just evidence of perspective.

good point, agree.

Folks who are hypersensitive to any critique of milmed make me picture the kid who covers his eyes and ears in the hopes that things will be magically better when he opens them again.

I wasn't commenting on anything milmed related really. I was commenting on the research process, and how one comes to terms with making that decision.

im not cheer leading. i've stated many times that there are several reasons not to join the military and not to join milmed. All I was commenting about was the process of collecting information to make a good decision.

 

[notdeadyet]

im not cheer leading. i've stated many times that there are several reasons not to join the military and not to join milmed. All I was commenting about was the process of collecting information to make a good decision.

Yeah, that makes sense. The problem is that the best research will tell you accurately how things are now; it won't give any indication of how things will be.

That's why I find the old timers (both pro- and con-) very useful. If you want the best guess as to how things are going to be in 10 years, the safest bet is to take a look at where they were 10 years ago, take a look at where they are now, and extrapolate. Any sudden turns of good fortune should be a pleasant surprise. Expecting unexpected good fortune is just plain tempting fate.

 

[crazybrancato]

Yeah, that makes sense. The problem is that the best research will tell you accurately how things are now; it won't give any indication of how things will be.

That's why I find the old timers (both pro- and con-) very useful. If you want the best guess as to how things are going to be in 10 years, the safest bet is to take a look at where they were 10 years ago, take a look at where they are now, and extrapolate. Any sudden turns of good fortune should be a pleasant surprise. Expecting unexpected good fortune is just plain tempting fate.

agree. truth is we don't have a crystal ball for anything, military, medicine, or otherwise. if we wanted monotonous, non-changing careers, we could find such mundane jobs, but I don't think anyone here is looking for that.

you're a good example of someone who did his homework and made a well-informed decision. and you decided that you still want to serve, although in a different capacity (ANG, right?). i hope others follow your example.

really, with this forum and the wealth of information it provides, there is no excuse . . .it'll be interesting to see who's on here in 10 years complaining about having too little information back when they signed up!

 

[Dissected]

really, with this forum and the wealth of information it provides, there is no excuse . . .it'll be interesting to see who's on here in 10 years complaining about having too little information back when they signed up!

I wont be one of them! I just spent the whole day getting excited about my loans being paid for and serving my country for a little while, then spent 3 hours reading these forums and decided that the HPSP will never have my signature on it. This was the dealbreaker: http://forums.studentdoctor.net/showthread.php?t=324400

good luck to all of you finishing up..Ive read some less than heart warming stories tonight

 

[Galo]

I wont be one of them! I just spent the whole day getting excited about my loans being paid for and serving my country for a little while, then spent 3 hours reading these forums and decided that the HPSP will never have my signature on it. This was the dealbreaker: http://forums.studentdoctor.net/showthread.php?t=324400

good luck to all of you finishing up..Ive read some less than heart warming stories tonight

Great example of what information can do for you. I would add, if you are whatsoever in the least with any doubt left, start calling up current AD docs to hear it from the horse's mouth!

That way you can be 100% sure what the majority of us have experienced is not only validated but getting worse.

 

[crazybrancato]

I wont be one of them! I just spent the whole day getting excited about my loans being paid for and serving my country for a little while, then spent 3 hours reading these forums and decided that the HPSP will never have my signature on it. This was the dealbreaker: http://forums.studentdoctor.net/showthread.php?t=324400

good luck to all of you finishing up..Ive read some less than heart warming stories tonight

first, nice avitar! funny as hell. well good on you, seriously, you did your homework and you made a better decision. It sounded like you were more interested in the money aspect of things, and you realized that it isn't just about the money; your interests have to go beyond that.

and should you decide later that you wanna do military medicine, you might do so through a reserve component or FAP. Or not at all, practicing medicine is a form of public service, whether your in uniform or not, so you can do great things either way.

well done . . .

OOPS! I almost forgot my obligatory weekly knock on Galo: You see DoktorB, the best part about your decision is that you wont become a jaded crotchety old man like Galo, who seems to think all mil docs are as lost as he was. My guess is that if you did call up some of them, I think at least one or two would be happy about what they're doing and more than happy to tell you about it. But that's neither here nor there, you have to do what you feel is right for yourself. Good luck!

 

[Galo]

OOPS! I almost forgot my obligatory weekly knock on Galo: You see DoktorB, the best part about your decision is that you wont become a jaded crotchety old man like Galo, who seems to think all mil docs are as lost as he was. My guess is that if you did call up some of them, I think at least one or two would be happy about what they're doing and more than happy to tell you about it. But that's neither here nor there, you have to do what you feel is right for yourself. Good luck!

Not all of them! Some decide to go to the dark side and become pencil pushing weanies who are neither good doctors or good pencil pushers. Belive me, they feel anything but lost. So the best part about his decision will be not having to put up with ethically challenged *****S like those. Since when is 42 old? And as crotchety as I may be, I still surf, board, ride with the best. See my avatar?

 

[Mirror Form]

Fair enough, you're certainly right in that it's much easier to do the research today, with the advent of the internet.

But you could've done the necessary research using the research media of your day, ie telephone and face-to-face conversations. You could've sought out military doctors on your own (not those tied to a recruiter) in order to obtain more well-rounded opinions.

Really? FYI, I've been asked in person by several pre-med students what my opinions are on military medicine. Guess what? I don't tell them anything negative. That's b/c I'd have to be smoking crack to be stupid enough to non-anonymously say anything negative about mil med to potential recruits while I'm still active duty.

Regardless, the army owned me long before I ever thought about applying to medical school. So even though I tried researching military medicine, in the end I knew it wouldn't have made any difference b/c I had no other options. Fortunately, my research showed me that every single person I talked to gave me completely different and conflicting information. So that was enough to convince me not to extend my comitment by applying to USUHS.

 

[Devil Doc]

I wont be one of them! I just spent the whole day getting excited about my loans being paid for and serving my country for a little while, then spent 3 hours reading these forums and decided that the HPSP will never have my signature on it. This was the dealbreaker: http://forums.studentdoctor.net/showthread.php?t=324400

good luck to all of you finishing up..Ive read some less than heart warming stories tonight

Well it's obvious that you've done some thorough research then... You not joining just ensures that there will be one less impotent complainer around here. Enjoy

 

[dr93534]

We'll see how you feel when a patient you were operating on had a bad outcome b/c the scrub tech you were with handed you a syringe with the wrong concentration of stuff. I have seen this happen twice now (neither patient had too bad of an outcome, but they could have). It can be easily avoided in the civilian world by having well trained competent techs. But in the military you don't have that luxury.

What an idiotic thing to say. No offense, I've read a lot of your posts and usually think they make sense and don't come off whiny like a lot of people here.

However, to say that milmed techs aren't trained properly because you've seen something happen twice is *****ic. I'm sure civilian techs never make mistakes and kill people or cause the hospital to be sued.

I think Dennis Quaid might have something to say about that. I'm pretty sure his kids weren't born at a military hospital. You would think those infallible civilians would be extra careful with a celeb.

 

[edinOH]

What an idiotic thing to say. No offense, I've read a lot of your posts and usually think they make sense and don't come off whiny like a lot of people here.

However, to say that milmed techs aren't trained properly because you've seen something happen twice is *****ic. I'm sure civilian techs never make mistakes and kill people or cause the hospital to be sued.

I think Dennis Quaid might have something to say about that. I'm pretty sure his kids weren't born at a military hospital. You would think those infallible civilians would be extra careful with a celeb.

My advanced NEC (or MOS) when I was enlisted was that of an ophthalmic surgical technician. Considering we went to school full time for six straight months to learn the job, I can tell you we were exceptionally trained. When I got out and worked in the field prior to medical school, my training proved to be far superior to that of my on the job trained counter parts.

You take the natural inclination of attention to detail found in military training systems and apply them to a technical medical field, you tend to get pretty well trained individuals. At least in my experience.

 

[Creflo]

After pre med I worked full time as a scrub tech in the womens center of a for profit hospital. They were hiring pre med sons of attendings and although my father was not a doc, I was fortunate enough to get in. We were paid about one or two dollars an hour more than McDonalds pays, but we didn't care because we were right in the thick of the OR. So, to the point, our training - as I recall we were taken into a room and the trainer put out the instruments that are routinely used in a vaginal hysterectomy, abdominal hysterectomy, and laparoscopy. They drilled us on the names of the instruments for a couple of days, gave us a small handbook to take home and study, then let us go into the OR to learn how to scrub in and we watched a case. Then we did a case or two with another scrub tech there to help, then boom, you're thrown in the fire. I was totally shocked at how fast they took us in off the street, then in a week or so we were literally a key element of the or team. If you are scrubbing in on a laparoscopy and the patient develops a bleeder, its up to you, as the only scrub tech in there, to request the appropriate tray, get it opened and give the doc what is needed to do an emergency laparotomy, etc. It was pretty intimidating and scary, but seemed to work out. And this was at a very nice hospital in a nice part of town.

 

[Dissected]

Well it's obvious that you've done some thorough research then... You not joining just ensures that there will be one less impotent complainer around here. Enjoy

win-win

first, nice avitar! funny as hell. well good on you, seriously, you did your homework and you made a better decision. It sounded like you were more interested in the money aspect of things, and you realized that it isn't just about the money; your interests have to go beyond that.

Haha thanks. Merry christmas to you and all your HO HO HO's ...oh wait, minus all of you that are deployed

 

[a1qwerty55]

Not all of them! Some decide to go to the dark side and become pencil pushing weanies who are neither good doctors or good pencil pushers. Belive me, they feel anything but lost. So the best part about his decision will be not having to put up with ethically challenged *****S like those. Since when is 42 old? And as crotchety as I may be, I still surf, board, ride with the best. See my avatar?

Yes, a common refrain from my buddy Galo. Those that stay in are of course "*****S", "neither good doctors, or good pencil pushers", "ethically challenged".

Your words. Offensive as always and intellectually primitive.

I work with 4 of the finest colleagues I could have, all of us are 100% clinical, and experts in our field. We all incidentally have either decided to stay past our initial obligation, or are strongly considering doing so.

Don't be too proud of your wave machine avatar. I think is suggests someone a bit on the lower self esteem side of the bell curve. A bit of a look at me, I told you I'm cool.

 

[a1qwerty55]

I wont be one of them! I just spent the whole day getting excited about my loans being paid for and serving my country for a little while, then spent 3 hours reading these forums and decided that the HPSP will never have my signature on it. This was the dealbreaker: http://forums.studentdoctor.net/showthread.php?t=324400

good luck to all of you finishing up..Ive read some less than heart warming stories tonight

If I forwarded you to a 60 reasons not be a physician in general forum, would that dissuade you from medicine in general? I'm sorry about your decision but to me is suggests you weren't that serious to start with. Being a military physician is a profession and should not only be a way to fund medical school. There is much which is good, and you will not read about it on this site.

 

[mitchconnie]

However, to say that milmed techs aren't trained properly because you've seen something happen twice is *****ic. I'm sure civilian techs never make mistakes and kill people or cause the hospital to be sued.

I'm not so sure why the quality of the OR staff is even being debated here, since it's a bit off topic, but what the heck, I'll bite.

I've worked as a surgical attending in the VA, active duty military hospitals (x2), an inner-city county hospital, a university medical center, and a suburban private hospital. I feel that the quality of the help in the OR is the worst (but not by much) in the setting of an active-duty military hospital. I would rank them as follows: suburban private>university>VA>inner-city>military.

It's not so much the training or the enthusiasm, which seem to be fine in the military, but the fact that the military rotates everyone around so much that the techs never really learn to do the job well. After a few months learning about my subspecialty and my preferences, they are off to the ward for six months to change bed pans, or pulled over to brigade to do a desk job, or deployed as a field medic, or PCS'd or whatever. I once deployed with a scrub tech who had been working in the motor pool for the past two years--what a disaster.

It's an environment where the OR staff is literally ALWAYS inexperienced at their job and I find it to be one frustrating (but by no means the MOST frustrating) aspect of my job. It's my feeling that the military OR is more dangerous then average because literally EVERYONE is inexperienced--newly trained surgeon, newly trained anesthesiologist, neophyte OR tech, nurse right out of school, etc. Even the civilian contractors seem to come and go quickly, and the only people that stay long-term are the few remaining GS employees.

I don't know that there is level I data to back up my observations, and obviously there are some notable exceptions to the rule, but the anecdotal evidence is quite suggestive.

 

[crazybrancato]

Your words. Offensive as always and intellectually primitive.

Don't forget 'immature', I'd add that to your list. Galo was probably the guy that got picked on a lot in grade school. Now that he's in a position of power (or so he thinks), he logs on here to assume the 'bully' role and tries to thwart anyone's aspirations to serve. He also gets very agitated when someone stands up to him. As if his opinion is the only one that matters; very childish.

I work with 4 of the finest colleagues I could have, all of us are 100% clinical, and experts in our field. We all incidentally have either decided to stay past our initial obligation, or are strongly considering doing so.

What's this? an AD doc who's happy in milmed and enjoys his job? The heck you say! That kind of thwarts Galo's and MirrorForm's logic that all mil docs are piss-asses like them and that the only people with positive insight are pre-meds. Of course, they'll retort that they're right b/c the majority of opinions on this forum are negative, as if this forum is the be-all and end-all of opinions in the mil med community.

Don't be too proud of your wave machine avatar. I think is suggests someone a bit on the lower self esteem side of the bell curve. A bit of a look at me, I told you I'm cool.

is that what that is? I was wondering how one gets any surfing done in the mid-west. Lame. Try hitting Northshore, say in February, and living to tell about it, then that'll impress me.

 

[Dissected]

If I forwarded you to a 60 reasons not be a physician in general forum, would that dissuade you from medicine in general? I'm sorry about your decision but to me is suggests you weren't that serious to start with. Being a military physician is a profession and should not only be a way to fund medical school. There is much which is good, and you will not read about it on this site.

I was never super duper serious about it in the first place. I did some research and recalled some advice that some ex-military ER docs told me while I was shadowing a surgeon (they told me not to do it ). I am excited to become a physician, but I don't think that the military is the place for me to practice. I've heard all of the reasons not to become a physician, but I still feel like its where Im supposed to be (hell, i lived with a surgeon for a month...big eye opener ). Im sure some enjoy mil-med, but it just doesn't feel right for me. I was looking into it because of the financial benefits and the idea of serving my country for a little while, but I wouldn't be committed enough to go the long haul. I would always be looking long into the future to when I could practice in the civilian world.

 

[Galo]

Yes, a common refrain from my buddy Galo. Those that stay in are of course "*****S", "neither good doctors, or good pencil pushers", "ethically challenged".

Not an unexpected carefully edited rebuke from the leading cheerleader of military medicine who always feels the need to show his true colors by being offensive, and as always unprofessional. Of course, you left out the very first word of my sentence which was SOME! Yes, again, SOME higher ranking military physicians are clearly *****S, INCOMPETENT, UNETHICAL, UNPROFESSIONAL, and choose to stay in because they would not survive civilian medicine. SOME, are very good doctors who fight a loosing battle, and are able to make changes immediately around them. They are in the minority. Which are you?

Your words. Offensive as always and intellectually primitive.

Oh, your mastery of the English language leaves me spellbound, were you an English major?

I work with 4 of the finest colleagues I could have, all of us are 100% clinical, and experts in our field. We all incidentally have either decided to stay past our initial obligation, or are strongly considering doing so.

Don't be too proud of your wave machine avatar. I think is suggests someone a bit on the lower self esteem side of the bell curve. A bit of a look at me, I told you I'm cool.

Well if this is not a classic example. I have NEVER tooted my own horn as "the finest", "expert in our field", (though I am), but just because I can surf a little, and pointed it out as a joke that I am not crotchety, you take it to a whole other level. As usual, you are pathetic, insecure, and I'm fairly certain most people will see just who you are whether your are wearing a uniform, or a white coat.

 

[Galo]

Don't forget 'immature', I'd add that to your list. Galo was probably the guy that got picked on a lot in grade school. Now that he's in a position of power (or so he thinks), he logs on here to assume the 'bully' role and tries to thwart anyone's aspirations to serve. He also gets very agitated when someone stands up to him. As if his opinion is the only one that matters; very childish.


What's this? an AD doc who's happy in milmed and enjoys his job? The heck you say! That kind of thwarts Galo's and MirrorForm's logic that all mil docs are piss-asses like them and that the only people with positive insight are pre-meds. Of course, they'll retort that they're right b/c the majority of opinions on this forum are negative, as if this forum is the be-all and end-all of opinions in the mil med community.



is that what that is? I was wondering how one gets any surfing done in the mid-west. Lame. Try hitting Northshore, say in February, and living to tell about it, then that'll impress me.

Crazy, you're pushing to be the leading milmed cheerleader and you've yet to do one day as a doctor in the military. Talk about immature! Don't follow A1s psychotic behavior. You know I think milmed is crap, but find a quote where I say ALL, 100%, etc is bad. I think a major portion of milmed is bad, I think there are lots of higher ranking docs that are extremely poor, I know that the really good ones who try hard, get tired really fast and get out at first chance. I, many others, reporters, articles, etc, have outlined why that is so at this time. Its not a conspiracy, its just what's happening. I hope you survive it, and try to make it better, but most of all, I hope you keep posting, so we can see if the exuberant, (though relatively naive) attitude you exhibit for military medicine stays with you, or you come to a hard realization that you are in a poor place to practice medicine. And no, I am in no position to bully, just to tell you what I experienced, so that you may benefit from it, if you are not too hard headed to listen.

You got any covershots of your surfing, I'd love to see them. When you live landlocked, you do the best you can. I'm sure you'd love the flowrider if you really can surf.

 

[Mirror Form]

My advanced NEC (or MOS) when I was enlisted was that of an ophthalmic surgical technician. Considering we went to school full time for six straight months to learn the job, I can tell you we were exceptionally trained. When I got out and worked in the field prior to medical school, my training proved to be far superior to that of my on the job trained counter parts.

Times have apparently changed because currently our OR scrub techs get rotated to a different service every 6 months. The logic of this is so that "all scrub techs will be trained in all fields." So by the time we have anyone trained well, they get replaced by someone who doesn't know anything. Some of them are motivated fast learners who catch on quick and actually are attentive to detail. Others are NOT AT ALL attentive to detail, and frequently have attitudes b/c they knew everything about their last service that they liked better, and now don't like to have their mistakes pointed out repeatedly.

Poorly trained scrub techs have been an enormous problem for our service. So much so that we frequently train our clinic techs to be scrub techs and bring them to the OR just so we'll have someone around who knows what the hell they're doing. Unfortunately they also have a high turn over rate though.

Whereas, when I was in the civilian world during med school, their main scrub tech had worked at that hospital for longer then our 21 year old E4's have been alive.

You take the natural inclination of attention to detail found in military training systems and apply them to a technical medical field, you tend to get pretty well trained individuals. At least in my experience.

Not in my experience!

 

[Mirror Form]

What an idiotic thing to say. No offense, I've read a lot of your posts and usually think they make sense and don't come off whiny like a lot of people here.

However, to say that milmed techs aren't trained properly because you've seen something happen twice is *****ic. I'm sure civilian techs never make mistakes and kill people or cause the hospital to be sued.

I think Dennis Quaid might have something to say about that. I'm pretty sure his kids weren't born at a military hospital. You would think those infallible civilians would be extra careful with a celeb.

Two questions:
1. Are you a surgeon?
2. Do you know what it's like to be trying to operate during a case that has become dicey, while also trying to supervise your inexperienced scrub tech who continually hands you the wrong things?

 

[dr93534]

I'm not a surgeon, but I understand the frustration for the situation you described. However, there are good and bad techs in both military and civilian arenas. I'm sure that civilian scrub tech with 21+ years is awesome, but it's a snap shot. My point is to not make isolated incidents seem the norm.

Your Med group CC should re-evaluate the tech rotation, hopefully someone is voicing this concern. Not every facility does it the same. It does make sense to have well rounded techs, but not if it jeopordizes patient care.

 

[edinOH]

Times have apparently changed because currently our OR scrub techs get rotated to a different service every 6 months. The logic of this is so that "all scrub techs will be trained in all fields." So by the time we have anyone trained well, they get replaced by someone who doesn't know anything. Some of them are motivated fast learners who catch on quick and actually are attentive to detail. Others are NOT AT ALL attentive to detail, and frequently have attitudes b/c they knew everything about their last service that they liked better, and now don't like to have their mistakes pointed out repeatedly.

Poorly trained scrub techs have been an enormous problem for our service. So much so that we frequently train our clinic techs to be scrub techs and bring them to the OR just so we'll have someone around who knows what the hell they're doing. Unfortunately they also have a high turn over rate though.

Whereas, when I was in the civilian world during med school, their main scrub tech had worked at that hospital for longer then our 21 year old E4's have been alive.



Not in my experience!

Yes, I see how this could be a problem. We were specifically trained in eyes and I worked at the leading tertiary Naval center for ophtho. at the time. I can see how if you took a general scrub tech (who also trained full time for six months) and rotate him or her through General, Uro, Thoracics, etc every several months that would make for a steep learning curve as well as frustration for the surgeons.

I'm by no means a milmed apologist but I do believe, at least when I was in (been ten years now since I left) the technical staff was very well trained and generally well motivated. I do agree it is different than the hand full of veteran civilian scrub techs you find in the community hospitals who have been working in the same hospital and with the same surgeons for several years.

 

[mitchconnie]

However, there are good and bad techs in both military and civilian arenas. I'm sure that civilian scrub tech with 21+ years is awesome, but it's a snap shot. My point is to not make isolated incidents seem the norm.

It's self-evidently true that all hospitals, civilian or military, will have good and bad employees. But I hate it when people say things like the above to justify a totally unacceptable status quo. So yes...I'm sure that somewhere, in some run-down inner-city ghetto hospital the OR staff is consistently worse than in the military. But is being better than the absolute worst case really what we aspire to?

The problem is not that there are a few bad apples, but that the system is DESIGNED to produce a bad outcome--in this case incompetent OR techs. I think that this is a nice specific example of a recurring theme.

 

[IgD]

Your Med group CC should re-evaluate the tech rotation, hopefully someone is voicing this concern. Not every facility does it the same. It does make sense to have well rounded techs, but not if it jeopordizes patient care.

The med group commander is a nurse. He is the one who orchestrated the policy change. He seems to take any feedback personally and rambles on about lack of discipline.

The XO is a physical therapist. She is riding the CO's coat tails and doesn't want to do anything to make the CO look bad. What will people think if the CO has to reverse his policy decision?

The Director of Surgical Services doesn't care. He only wants to be in a protected position from deployment and is willing to let anything slide to accomplish this. Besides, he is an academy grad with a 12 year payback. If the surgeon wouldn't have whined about it maybe he would have acted on it.

 

[IgD]

Yes, I see how this could be a problem. We were specifically trained in eyes and I worked at the leading tertiary Naval center for ophtho. at the time. I can see how if you took a general scrub tech (who also trained full time for six months) and rotate him or her through General, Uro, Thoracics, etc every several months that would make for a steep learning curve as well as frustration for the surgeons.

I'm by no means a milmed apologist but I do believe, at least when I was in (been ten years now since I left) the technical staff was very well trained and generally well motivated. I do agree it is different than the hand full of veteran civilian scrub techs you find in the community hospitals who have been working in the same hospital and with the same surgeons for several years.

In Navy psychiatry, a lot of the techs were relegated to answering phones and booking appointments. I observed this resulted in skill atrophy.

 

[Devil Doc]

It's self-evidently true that all hospitals, civilian or military, will have good and bad employees. But I hate it when people say things like the above to justify a totally unacceptable status quo. So yes...I'm sure that somewhere, in some run-down inner-city ghetto hospital the OR staff is consistently worse than in the military. But is being better than the absolute worst case really what we aspire to?

The problem is not that there are a few bad apples, but that the system is DESIGNED to produce a bad outcome--in this case incompetent OR techs. I think that this is a nice specific example of a recurring theme.

I was a military trained surgical technologist that scrubbed and assisted for 7 years before dental school. I worked in military hospitals, civilian hospitals (level I and II), surgery centers, private hospitals, and as a lead organ and tissue harvester. I worked anywhere between 10 - 36 hour shifts in the OR everyday for those years. I can tell you that military OR techs are the finest trained techs in the world. Most of us go through medic school, paramedic school, and surgical technologist school before we ever start working. In my experience in civilian hospitals, many of the techs are OJT trained or from a community college 4-6 month program. In the civilian communities where there are military hospitals near by, military techs are highly sought after for employment. About half the techs I worked with also had second jobs in these hospitals as well as attended college concurrently. While there are different tiers of skill level and motivation, it is my experience that we are the best because I've been told this so many times by outstanding surgeons who have been in practice 20 + years. I take it with a grain of salt if some fresh meat resident is complaining because he doesn't even know what a good OR tech does. Is it possible that you all are projecting your own incompetence onto the OR techs out of frustration? The surgeons I worked with allowed me to fashion all types of orthopaedic grafts on a regular basis, use power equipment to drill/saw, and suture sub q on up which are all well within the scope of practice of a surgical technologist.

Why don't you give some specific examples of what they are or aren't doing to screw you up so bad? Are you asking for a kelly and they hand you a weighted speculum? If you don't like them just do anything other than hand you instruments. It doesn't really make sense that your techs rotate services so often, because we are trained in all surgical services in our 7 month OR tech school. They should already be ready to scrub and assist anything that walks through the door right out of school or shortly after. Now granted there is a steep learning curve in more intense surgical services such as ortho spine, but the run of the mill ex lap, fracture, hysterectomy should be pretty straight forward. In my ten years of working in the OR, many times the surgeon will take out his frustrations on us when they are the ones sucking themselves. Ok, off my soap box and back to q2 free flap checks...

 

[goodjuju]

Hey bro, I hope you can get somewhere with these slack jaw crybabies. I'm not a tech so I won't chime in but I have been following this thread and haven't learned a thing yet.



The only thing that would keep me from going back now is these jokers who claim to be military physicians.

 

[mitchconnie]

I take it with a grain of salt if some fresh meat resident is complaining because he doesn't even know what a good OR tech does. Is it possible that you all are projecting your own incompetence onto the OR techs out of frustration? The surgeons I worked with allowed me to fashion all types of orthopaedic grafts on a regular basis, use power equipment to drill/saw, and suture sub q on up which are all well within the scope of practice of a surgical technologist.

Why don't you give some specific examples of what they are or aren't doing to screw you up so bad? Are you asking for a kelly and they hand you a weighted speculum? If you don't like them just do anything other than hand you instruments. It doesn't really make sense that your techs rotate services so often, because we are trained in all surgical services in our 7 month OR tech school. They should already be ready to scrub and assist anything that walks through the door right out of school or shortly after. Now granted there is a steep learning curve in more intense surgical services such as ortho spine, but the run of the mill ex lap, fracture, hysterectomy should be pretty straight forward. In my ten years of working in the OR, many times the surgeon will take out his frustrations on us when they are the ones sucking themselves. Ok, off my soap box and back to q2 free flap checks...
Yesterday 03:33 PM

Whoa...looks like I touched a nerve. No need to get bent out of shape, though. I have no doubt that you are a total wizard in the OR. And god bless my surgical techs. I love 'em. I like to teach them and they like to learn. They are some of the brightest and most enthusiastic people in the hospital. My point is not that you and your fellow techs are dumb, but that the current system sets you up to fail.

And just so you don't feel like I'm picking on the OR techs, let me say that I see analogous problems with nurses and physicians. In the case of many surgeons, they will do 1/4 to 1/2 of the case volume of their civilian counterparts. Some are stationed at locations where they have minimal inpatient facilities and do no major cases at all. Skill atrophy is a major problem. I've only been a attending surgeon for about six years and have probably done less than half of the case volume of a typical civilian surgeon in my field. Am I going to be as sharp as my civilian counterpart, who has been doing big cases every day for the last 15 years? Of course not.

I once deployed with an attending general surgeon who told me that he "didn't feel comfortable" doing an appendectomy by himself, and wanted some supervision. He had been in a low-volume practice where he had not done a laparotomy in years, and had lost both his skills and his confidence. And this is the person who is expected to deal with some of the most horrific blast trauma on the planet?! Not good. Then I had the OR tech who had been assigned to a non-clinical job for the past two years, and was so out of practice that he literally did not know the names of basic instruments like Mayo Scissors or Mosquitos. I was reduced to calling the instruments descriptive names like "the curvy scissors with the blunt tips and heavy blades." Now say you put Dr. Incompetent together in the operating room with Sgt. Out-of-Practice. What have you got? Total disaster.

Again...not dumb people, but a dumb system.

But lets call a halt to this argument, shall we. Because as our good friend goodjuju points out, it's kind of an arcane topic and best relegated to the Military Surgery sub-forum.

 

[Devil Doc]

Whoa...looks like I touched a nerve. No need to get bent out of shape, though. I have no doubt that you are a total wizard in the OR. And god bless my surgical techs. I love 'em. I like to teach them and they like to learn. They are some of the brightest and most enthusiastic people in the hospital. My point is not that you and your fellow techs are dumb, but that the current system sets you up to fail.

And just so you don't feel like I'm picking on the OR techs, let me say that I see analogous problems with nurses and physicians. In the case of many surgeons, they will do 1/4 to 1/2 of the case volume of their civilian counterparts. Some are stationed at locations where they have minimal inpatient facilities and do no major cases at all. Skill atrophy is a major problem. I've only been a attending surgeon for about six years and have probably done less than half of the case volume of a typical civilian surgeon in my field. Am I going to be as sharp as my civilian counterpart, who has been doing big cases every day for the last 15 years? Of course not.

I once deployed with an attending general surgeon who told me that he "didn't feel comfortable" doing an appendectomy by himself, and wanted some supervision. He had been in a low-volume practice where he had not done a laparotomy in years, and had lost both his skills and his confidence. And this is the person who is expected to deal with some of the most horrific blast trauma on the planet?! Not good. Then I had the OR tech who had been assigned to a non-clinical job for the past two years, and was so out of practice that he literally did not know the names of basic instruments like Mayo Scissors or Mosquitos. I was reduced to calling the instruments descriptive names like "the curvy scissors with the blunt tips and heavy blades." Now say you put Dr. Incompetent together in the operating room with Sgt. Out-of-Practice. What have you got? Total disaster.

Again...not dumb people, but a dumb system.

But lets call a halt to this argument, shall we. Because as our good friend goodjuju points out, it's kind of an arcane topic and best relegated to the Military Surgery sub-forum.

My post had no hint of hostility. I was actually being nice. It is just that you and your other buddies post about how much military medics and OR techs suck DEFIES COMMON KNOWLEDGE! You can go to any city with a military hospital and I guarantee any civilian hospital within the area will be trying to employ the active duty and separating technicians. One example of a technician turned administrator does not mean that the system has failed all the medics and that they all suck. I am still having trouble believing that any general surgeon on the frickin planet would not feel comfortable doing an appy or even an OR tech that doesn't know what a pair of Mayo's or Metz are. I think you should attend one of your enlisted techs meetings and tell them how much they suck, and how the system has failed them, and how a ghetto hospital system would even be better then the services they provide. You wouldn't do it, but you have no shame in running your cock holster on the www under the protection of a screen name. Hopefully people aren't naive enough to really believe what you are saying.

 

[Mirror Form]

My post had no hint of hostility. I was actually being nice. It is just that you and your other buddies post about how much military medics and OR techs suck DEFIES COMMON KNOWLEDGE! You can go to any city with a military hospital and I guarantee any civilian hospital within the area will be trying to employ the active duty and separating technicians.

Sure, after the techs are trained by the military they'll get hired by a civilian who will further train them and then keep the tech in a single position for a long time. The problem isn't just the tech's themselves, it's the system of how they frequently change. Furthermore, the techs themselves in the civ world can also choose what field to specialize in. So if they're good at ortho and like ortho, they won't be forced to do ENT or something.

In regard to bad apples, there's a big difference b/w military and civilian. That's because I can choose to fire my scrub tech in the civilian world, and find a good one (who will then be kept for as long as possible). In the military you're basically forced to operate with whoever the scrub tech is, meanwhile it's still your medical license on the line if something goes wrong.

 

[IgD]

I am still having trouble believing that any general surgeon on the frickin planet would not feel comfortable doing an appy or even an OR tech that doesn't know what a pair of Mayo's or Metz are.

Where are you in the military medicine pipeline? BTW, I was a FMF qualified medical officer.

 

[mitchconnie]

I am still having trouble believing that any general surgeon on the frickin planet would not feel comfortable doing an appy or even an OR tech that doesn't know what a pair of Mayo's or Metz are. I think you should attend one of your enlisted techs meetings and tell them how much they suck, and how the system has failed them, and how a ghetto hospital system would even be better then the services they provide. You wouldn't do it, but you have no shame in running your cock holster on the www under the protection of a screen name. Hopefully people aren't naive enough to really believe what you are saying.

I'm surprised to hear that you don't enjoy the format of an anonymous internet forum. I find this sort of argument very stimulating. Not because I can secretly deride the support staff, but because it removes the rank hierarchy from the discussion. In the hospital, we'd never have this exchange, because a tech would just mumble "yes, Colonel" and the conversation would end. But here, you can call me a shameless liar and/or a total a-hole with impunity. Isn't that great!?

I'm also curious about what good it would do to "tell the OR techs how much they suck." Problem is not with them, it's with the leadership (typically in the nursing chain of command). In the past, we've tried to address our issues to the OR managers directly--with decidedly mixed results.

And I agree that those stories are darn near unbelievable, but how shall I confirm them? Names must changed to protect the innocent. I sure wish that I had made it all up and that those deployment disasters never happened. But hang around awhile longer and you may see a lot of unbelievable things too. It's the nature of the business.

Happy Holidays.

 

[Gastrapathy]

We all incidentally have either decided to stay past our initial obligation, or are strongly considering doing so.

Don't believe the hype. Lets see how that works out.

Plus, you've never revealed your specialty, which makes this a pointless claim.

For everyone who continues to engage Galo, mitchconnie, et al, the real irony is that you are the ones hurting recruiting. These debates sit on the front page of the forum only because you continuously engage. When a premed who does know/care what 8404 means shows up here, they see premeds arguing with attendings. Who do you think they believe? So, for all your chest-thumping pride, just know that you are making it easier for the naysayers to dissuade many a poster and lurker here from HPSP. It gets boring to argue without a foil.

BTW, the surgical discussion is germane to many of us. Try this one, there is no rating for endoscopy tech so we train 0000's. Then they get sent to other 0000 jobs and we start over. Our techs play a somewhat less important role but a good, experienced tech who knows how to deploy more than a bx forcep (ie enteral stents, etc) will never exist in our system. I have to call in the rep or another doctor to tech for me for anything complex.

 

[crazybrancato]

Don't believe the hype. Lets see how that works out.

Plus, you've never revealed your specialty, which makes this a pointless claim.

For everyone who continues to engage Galo, mitchconnie, et al, the real irony is that you are the ones hurting recruiting. These debates sit on the front page of the forum only because you continuously engage. When a premed who does know/care what 8404 means shows up here, they see premeds arguing with attendings. Who do you think they believe? So, for all your chest-thumping pride, just know that you are making it easier for the naysayers to dissuade many a poster and lurker here from HPSP. It gets boring to argue without a foil.

BTW, the surgical discussion is germane to many of us. Try this one, there is no rating for endoscopy tech so we train 0000's. Then they get sent to other 0000 jobs and we start over. Our techs play a somewhat less important role but a good, experienced tech who knows how to deploy more than a bx forcep (ie enteral stents, etc) will never exist in our system. I have to call in the rep or another doctor to tech for me for anything complex.

you certainly have a point, in the sense that we keep refreshing this thread, but so be it. its a good discussion, whether you're pro or con milmed, and it deserves attention. Now, of those engaging the nay-sayer attendings, i think i'm the only pre-med. but i'm not just a "pre-med", I'm older, have extensive military experience, extensive corporate-America experience, am a family man, etc etc. So althought i don't know as much about milmed as you guys (i certainly don't claim to be an expert), i can offer some introspective opinions about the military in general.

These other guys are corpsmen, OR techs or otherwise. I value their opinions more than my own, b/c at least they're in milmed, in some capacity. they have positive opinions, and they're very welcome here. it's nice to see the other (happier) side!

And I'm not exactly sure that this forum is influencing recruiting. HPSP numbers are back up (I've heard this from multiple sources, though I don't have a reference) and USUHS just had the largest volume of applicants ever. So apparently, people still see some value in milmed and are still signing up. it's unfortunate that you don't see the same value. do your time, get out, no worries.

 

[Galo]

This is a question I found asking myself soon after joining this forum. Initially, (and still sometimes), I find myself wondering what kind of day a so called professional has had to react with such personal retribution. Why a medical student, college student, or someone who has been in the military in an entirely different field can react to our experiences with such disbelief and anger. Are these people insane?

Although I think some of them have deep personality problems, I can understand some of the reactions, but not the personal attacks. I can see that our horrible experiences in military medicine clearly mistaken or assumed as personal attacks on them. How could the organization that they fit so well in be as bad as we describe? So they conclude it must be that we were defective in some way, and not the organization that they have so much faith in. I think its a bad way to have a discussion when it keeps breaking down to personal attacks. Although I am guilty of it as well, I'd like to think I do this as a defense. Yes, I have bad mouthed and called horrible names to people in leadership roles, but I doubt I have have named a single one by an identifiable moniker. I have also make some generalizations based on my experience which may be why these people react so hurt and with such hostility.

Although HPSP and USHUS #'s may be up, I have lost count of the number of prospectives that I or this forum has helped make an informed decision, not one based only on what some uninformed recruiter, or a doc saddled for life tells them.

I wish I could resolve to cut down my calling people *****S, or IDIOTS, or UNETHICAL, but what do you do about people who care nothing more than about their personal gain over taking care of an active duty member or their dependents. What do you call the nurse hospital commander whose order did not allow all those army soldiers to get the drug counseling treatment they needed, the guy who knowlingly used bogus degrees to help his chances of getting promoted, the surgeon/colonel who KILLED an 80 yr old veteran when he had not done a case of that complexity for a long time and had only 7 days of active duty left, or the Col who could not have his path reports released unless they were signed by his junior pathologist taking up valuable time and energy.......... The bad experiences in military medicine are countless, and will continue to pile up as long as the leadership continues to ignore the endless problems, and doctors continue to reinforce a service that has major pitfalls, as something that one should aspire to serve in. Yes, our soldiers deserve quality care, and dare I say the best care, but based on my experience, those of many other physicians, the media, etc, that is something that is not currently happening, and I think to promote continued mediocrity, and decline is not the best way to make changes.

I hope we can continue discussions here without the rabid personal attacks that do nothing more than invalidate some of the most fervent advocates of military medicine's points of view.

Happy Holidays.

 

[crazybrancato]

Lovely post, as always.

I'll tell you what gets my blood boiling, and this is just my $.0.02.

It's not that I disagree with the nae-sayers about their negative experiences and opinions. Hell, even the docs that I've talked with that are positive about milmed echo the same concerns.

And it's not that I doubt people are being truthful here, nor do I doubt that these events (like the laundry list you just described) actually occured. I believe all of it.

And I'm certainly no 100% military apologist, but nor am I a 100% military/gov't basher. I encourage people to toggle between the two extremes. Dish out the criticism, but also give praise when/where it's due.

What really gets my blood boiling is this notion--that you, Galo, and others seem to hold--that there is no hope, there is no room to change, there is no progress, and nothing can be done about it. That notion is what I whole-heartedly disagree with.

I'm a firm believer that good things can be done, if there's a will there's a way, if you work hard then good things will come to you . . . in the milmed community and wherever else you may land. Now yes, sometimes, the 'way' is a lot harder to find in the military and it's tough to sort through the bs . . .but it is not beyond hope nor human capabilities.

now excuse me, my in-laws are here for xmas eve, I need to get heavily drunk.

happy holidays.

 

[Galo]

I'm a firm believer that good things can be done, if there's a will there's a way, if you work hard then good things will come to you . . . in the milmed community and wherever else you may land. Now yes, sometimes, the 'way' is a lot harder to find in the military and it's tough to sort through the bs . . .but it is not beyond hope nor human capabilities.

now excuse me, my in-laws are here for xmas eve, I need to get heavily drunk.

happy holidays.

I can understand your will to try. I've been there. I too believed I could make a change. The way I reacted was not the military way. I hope you can also see that there are many here who have tried with all their might. Many with much more finesse than I, yet they get the same results. You can only take so much banging your head before it starts to hurt. Alot of times, the changes that need to be made are way above our paygrades, as they love to say.

I hope you have better results than we did, and I hope you document them here.

Now I'm at my in-laws, and I too need to put on a xmas bender, and have fun.

Here's hoping to your success in view of our failures.