Would you do military medicine again?

[Perrotfish]

What in the world makes you think he's actually in the Navy? Or an adult? I mean, when someone has 13 posts and every one of them is trying to cause/contribute to an argument you really think they're for real?

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[Perrotfish]

That may have changed recently. Generation Kill had an awful lot of viewers.

 

[pgg]

Not to mention what it's doing to the reputation of the corpsmen among our young Medical Corps officers.

Personally, I have been singularly impressed with the professionalism, willingness to learn, and general hoo-rah spirit of my greenside corpsmen. They are better Marines than most of the Marines, with pretty reasonable medical knowledge and skills to boot. I have learned quite a bit, both military and medical, from the IDCs I have encountered, and most would make excellent physicians if they were ever foolish enough to want to do that.

What I have not encountered is corpsmen and IDCs turning minor disagreements into hot-headed personal conflicts and threatening behavior.

This poster is pathetic and is a poor representative of your average enlisted Navy personnel. It is equally sad that he thinks so poorly of his fellow corpsmen that he assumes they would participate in UCMJ violations over an internet spat.

You are absolutely right.

 

[pgg]

So if you'll only making $250K as a specialist, figure in malpractice insurance, that's nearing the equivalent pay of a milmed specialist . . .no?

No. Your typical specialist in the military, right out of residency, even assuming the largest ISP ($36K) and O4 rank and 6+ years in (not unreasonable for the Navy path that includes some GMO time), will make about $150K, give or take. Some variability for housing depending on locale.

Once your ADSO is up, MSP could potentially bump that significantly ... IIRC the biggest jump is for anesthesiology where ISP of $36K increases to ISP+MSP of $110K for a net increase if $74K if you sign a 4 year extension contract.

There are good reasons to join and serve, but competitive pay is not one of them - unless you're in primary care (maybe).

 

[crazybrancato]

No. Your typical specialist in the military, right out of residency, even assuming the largest ISP ($36K) and O4 rank and 6+ years in (not unreasonable for the Navy path that includes some GMO time), will make about $150K, give or take. Some variability for housing depending on locale.

Once your ADSO is up, MSP could potentially bump that significantly ... IIRC the biggest jump is for anesthesiology where ISP of $36K increases to ISP+MSP of $110K for a net increase if $74K if you sign a 4 year extension contract.

There are good reasons to join and serve, but competitive pay is not one of them - unless you're in primary care (maybe).

ok. so what do you guys think has to happen to bring milmed pay up to speed with civilian pay? I know changing BAH/BAS takes an act of Congress (literally). What about increasing the SPs? Can the milmed establishment do that on its own, or does that take an act of Congress too? And if they increased it, by how much (x2, x3?) to make thing comparable?

 

[orbitsurgMD]

ok. so what do you guys think has to happen to bring milmed pay up to speed with civilian pay? I know changing BAH/BAS takes an act of Congress (literally). What about increasing the SPs? Can the milmed establishment do that on its own, or does that take an act of Congress too? And if they increased it, by how much (x2, x3?) to make thing comparable?

There is much institutional resistance to paying more; the line hates it, no matter how compelling the reasons or how great the need.

Instead of paying so much more for specialists, more should be done to capture more of the potential time a specialist might have to practice as a specialist. One way to do that is to increase the deferments directly from medical school to full residency training. Another way is to remove the sting from operational (heretofore GMO) duty by incentivizing that duty both by bonus payments to those who volunteer for assignment and by offering post-assignment incentives in the way of choice of billets and funded outservice fellowships that don't add more payback time. Also, since you mention an act of Congress, you might suggest they repeal some of the changes made by DOPMA by giving back the time spent as a medical student so that that time counts toward the first 20 years toward retirement and toward time in grade. If you gave some specialists on the fence about departing active duty another four years less toward retirement, some of them might just think it worthwhile to stay.

It would all cost money, but maybe not as much as trying to match military with civilian specialty pay.

 

[pgg]

ok. so what do you guys think has to happen to bring milmed pay up to speed with civilian pay? I know changing BAH/BAS takes an act of Congress (literally). What about increasing the SPs? Can the milmed establishment do that on its own, or does that take an act of Congress too? And if they increased it, by how much (x2, x3?) to make thing comparable?

There's a pay thread here that discusses recent changes and non-changes.

In summary, it is likely that

• only MSP will ever increase, because it's the one pay available exclusively to those physicians who are at their stay-in/get-out decision point (why give raises to the people paying back their scholarship years)
• the military doesn't really want many career physicians, because retirement benefits are expensive (better to spend a pile of money to recruit a new junior replacement than a massive pile of money to retain a senior physician AND pay retirement benefits).

 

[crazybrancato]

There's a pay thread here that discusses recent

• the military doesn't really want many career physicians, because retirement benefits are expensive (better to spend a pile of money to recruit a new junior replacement than a massive pile of money to retain a senior physician AND pay retirement benefits).

Ok. good point

I have a crazy idea . . . but what the hell, this country was founded on crazy ideas

Seriously . . . .

Why don't a few of you get together (PM each other, find out who you are), especially those of you that are near getting out (or better yet, those of you that have gotten out) . . . draft up a letter explaining all of your grievances (pay, deployments, GMOs, etc). I'm sure you'd have no problem doing so . . .you all seem well thought-out and articulate. Sign the letter (the more signatures the better, a petition of sorts) , and send it the Surgeon Generals of each service. Frick it! See what happens?! (If you're already out, you don't have anything to lose).

I know change is almost impossible sometimes in the military . . . but it does happen! I've seen it, I swear. You may not benefit from such change, but your successors will.

Oh and send a copy of the letter to the Navy/Army/AF/USMC Times, and to '60 Minutes'. (Change seems to occur a lot more quickly in the military when the media gets involved).

Seriously . . . what do you think?

 

[orbitsurgMD]

Ok. good point

I have a crazy idea . . . but what the hell, this country was founded on crazy ideas

Seriously . . . .

Why don't a few of you get together (PM each other, find out who you are), especially those of you that are near getting out (or better yet, those of you that have gotten out) . . . draft up a letter explaining all of your grievances (pay, deployments, GMOs, etc). I'm sure you'd have no problem doing so . . .you all seem well thought-out and articulate. Sign the letter (the more signatures the better, a petition of sorts) , and send it the Surgeon Generals of each service. Frick it! See what happens?! (If you're already out, you don't have anything to lose).

I know change is almost impossible sometimes in the military . . . but it does happen! I've seen it, I swear. You may not benefit from such change, but your successors will.

Oh and send a copy of the letter to the Navy/Army/AF/USMC Times, and to '60 Minutes'. (Change seems to occur a lot more quickly in the military when the media gets involved).

Seriously . . . what do you think?

I think this is a public forum. I think some senior medical dept read this as it is. These problems have been petitioned and white-papered before.

If you go to U.S. Medicine, another public forum, Admiral Koenig, then the Navy SG, published the many gathered letters from individual doctors electing to leave service. They brought up these and many other points. This stuff isn't new.

That it continues to exist and demoralize as it does with the inevitable results that follow demonstrates there isn't much interest in the alternatives. At least as long as there is a stream of fresh replacements coming in through HPSP, there is little reason to consider change (the source of the majority of new accessions, not the same percentage as those that stay, USUHS grads make up a larger number of the AD census for several reasons, longer commitments among them.) If you reduce quality and then sheer numbers of HPSP concessions, then the services take notice. That is what is happening now. And any efforts made to improve the numbers have been grudging. Most of the response has been directed at attracting more accessions, not at retention.

Money is the big driver. Seeing the larger picture, making a professional culture that is attractive and inspirational to the people already in the service, a culture that keeps military practice as an attractive alternative to those with the choice of leaving or staying, is unfortunately not seen as all that important. That is too bad, as making the work culture satisfying does a lot for making recruitment easier. The Silicon Valley companies like Google know that.

 

[Mace1370]

These posts have been very helpful for me (a premed who just got invited to interview at USUHS). However, there is a lot of military jargon. I would appreciate if you guys could clear up a few questions I have:

1) Skill Atrophy - how serious is this? If your skills atrophy are you screwed for life or just a few years?

2) GMO Tour - what exactly is this? From what I've gathered, it is not elective and can interrupt your residency?

3) If it came down to USUHS being the only school you were accepted to, would you still go?

Thanks for the information

 

[orbitsurgMD]

These posts have been very helpful for me (a premed who just got invited to interview at USUHS). However, there is a lot of military jargon. I would appreciate if you guys could clear up a few questions I have:

1) Skill Atrophy - how serious is this? If your skills atrophy are you screwed for life or just a few years?

2) GMO Tour - what exactly is this? From what I've gathered, it is not elective and can interrupt your residency?

3) If it came down to USUHS being the only school you were accepted to, would you still go?

Thanks for the information

1) Pretty serious unless you plan to exit clinical practice for administrative work for the rest of your career. Most doctors want to be good and seen as good in the work that they do. That takes regular and intensive exposure to to your field of expertise in patient care.

2) GMO tour is generally involuntary breaking of the usual course of postgraduate residency training and assignment of post-internship doctors to operational clinical duties on ships, with forces in the field and in special-duty environments like flight and diving. The term of these assignments is two years at a minimum. For desirable in-service residency programs, not having done a GMO tour is a disadvantage on applicaton.

3) No.

 

[Mace1370]

1) Pretty serious unless you plan to exit clinical practice for administrative work for the rest of your career. Most doctors want to be good and seen as good in the work that they do. That takes regular and intensive exposure to to your field of expertise in patient care.

2) GMO tour is generally involuntary breaking of the usual course of postgraduate residency training and assignment of post-internship doctors to operational clinical duties on ships, with forces in the field and in special-duty environments like flight and diving. The term of these assignments is two years at a minimum. For desirable in-service residency programs, not having done a GMO tour is a disadvantage on applicaton.

3) No.

Thanks for the reply. Regarding skill atrophy, how practical is it to moonlight to keep up your skills? I think that it would take a toll over a significant amount of time.

Also, from what I understand about military medicine you have to do a military residency if you attend USUHS, correct? If this is the case, how can a GMO tour both "interrupt the usual course of postgraduate residency training" and also be a hurt your application for a residency program (if you haven't done one)?

Sorry if that a little confusing, I'm just trying to figure out exactly when the GMO tour takes place.

 

[Kingfisher]

Thanks for the reply. Regarding skill atrophy, how practical is it to moonlight to keep up your skills? I think that it would take a toll over a significant amount of time.

Also, from what I understand about military medicine you have to do a military residency if you attend USUHS, correct? If this is the case, how can a GMO tour both "interrupt the usual course of postgraduate residency training" and also be a hurt your application for a residency program (if you haven't done one)?

Sorry if that a little confusing, I'm just trying to figure out exactly when the GMO tour takes place.

1. You are required to do a military internship if you attend USUHS.
2. The break happens when you leave the residency program for a few years as GMO, FS, or whatever. You then finish residency a few years after your classmates that go straight through.
3. It shouldn't hurt your residency application. It should strengthen it if you take the time to better yourself. Although, not everyone is excited about the break in training (myself included).

 

[Rudy]

been prior to signing up to go to USUHS almost 11 years ago. I didn't know what any of this stuff meant, either. I had no prior service and no family members that had ever served in the military. It is not possible to fully understand what you are getting yourself into by simply talking with a recruiter or reading some message boards, especially when it comes to nuances of military medicine only learned after years of experience.

I always tell people that unless you are prior service and already know the military culture and have multiple years accumulated toward retirement, do NOT sign up. I turned down acceptances to several relatively inexpensive MD schools because my patriotism and abject poverty clouded my judgement. I have regretted the decision to go to USUHS ever since.

You seem sincere in wanting to know the truth about military med. The truth is that it is in bad shape right now, and for about 80% of my physician colleagues, it is a miserable place to work. Do yourself a favor and don't sign up now. Go civilian, and if you still want to join down the road, the military will always take you.

 

[Mcrap]

Seeing as the match just finished coming up I want to see who still would sign up again and who would not.

Thanks

 

[NavyFP]

There's a pay thread here that discusses recent changes and non-changes.

In summary, it is likely that

• only MSP will ever increase, because it's the one pay available exclusively to those physicians who are at their stay-in/get-out decision point (why give raises to the people paying back their scholarship years)

• 
  
  Agree that MSP is the bonus most likely to increase because that is exclusively a retention tool. (not that the others are not, they are just less so.) ISP however just got a boost to a minimum of $20K. For lowly FPs like me, that was a $7K raise.