Hidden Catch #5: Due entirely to addle headed policies advocating "nursing/PA/housekeeper empowerment" in all three branches, you will be subject to two separate chains of command while on active duty: the military chain of command, which wields UCMJ (Uniform Code of Military Justice) power over your life; and the emasculated, vestigial medical chain of command, which only carries "advisory" power to the all-mighty military chain. You WILL be commanded by a nurse, pharmacist, physical therapist, or non-clinical M.D. who last touched a patient when you were in 6th grade. Some of these will leave you alone, except for incessant e-mails to keep up your productivity numbers, get your shots, do your after-hours or before-clinic mandatory exercise, and make sure you have hankies in your deployment bag. Others will mistake their military rank for medical competence and second-guess your medical judgment regarding your personal patients. The first time you are ordered to kill a 2 year old child by giving them sedation despite a life-threatening brain hemorrhage because the politically-powerful but clinically-ignorant Vice Commander of the hospital tells you to, you will not be a happy doctor (yes, this happened to a friend of mine). Appeals to your medical chain of command (through your specialty chief, to the SGH [chief of clinical services], to the Consultant for your specialty) will fall on deaf ears...because the OPRs (Officer Performance Reports) of your medical superiors are written by the very fiends who are ordering you to commit what you deem to be malpractice.
Hidden catch #7: You may have heard that the military shields you from the "red tape" of the civilian world. In the words of one poster at SDN, the military only replaced "red tape" with "red barbed wire", such as endless computer based training, mandatory meetings on a daily basis, workload metrics, patient care coding by docs without any support, mindless short notice/no notice taskings (medicolegal reviews, readiness, questionnaires, etc.). I have experienced far less "red tape" by a factor of 1000 in my 1.5 years as a civilian than I experienced during my 15 years as a military doc.
Hidden catch #8: You will be ordered to allow non-physicians to practice essentially independently under the fig leaf of your medical license. In violation of civilian Federal and State law, the military has actively encouraged the independent (mal)practice of CRNAs, NPs, and PAs with inadequate or absent physician supervision. This has been seen as necessary because the current retention rate of M.D.s hovers around the 8% range...while advanced practice nurses, PAs, and other non-M.D. "providers" get a good deal in the military: pay commensurate or better than the outside world, PLUS the ego-boosting chance to gain life or death, UCMJ Command authority over the cowering, low-ranking physicians under them (a situation which essentially never occurs in the outside world). Remember: if a patient dies because of malpractice committed by a PA/CRNA/NP working independently, but your name is on the chart, guess who is going to be reported to the National Practitioner Databank? And do you think that your appeal to the Chain of Command that you never saw the patient, because the system is set up to encourage the independent practice of non-physicians by forcing you to sign charts of patients you were never consulted about, will be grounds for your exoneration, or used as a club to destroy your military career, life, and family in retribution for your "unbecoming conduct" of speaking out in violation of the military medical omerta (code of silence)?
Rob
