- Joined
- Dec 17, 2015
- Messages
- 6
- Reaction score
- 21
I've been off/on this forum for 20 years, and SDN was helpful as I went through med school and residency. To give back, I've got one piece of advice for those wanting to do surgery in the military- don't join the military. Why?
Technically, I joined in 1999, but with undergrad + med school + 6 yrs of general surgery (mandatory, superfluous research year), I didn't start real service until 2013. Initially, I was posted to a small hospital overseas. This hospital wouldn't exist in the civilian USA due to lack of volume and support (no IR, no gastro, no ICU). It wouldn't even be a same day surgery center because it couldn't get enough patients. The worst setup for a freshly graduated resident who trained in an ivory-tower academic medical center (ironically, that was officially a military program which was ~95% civilian training). I couldn't provide the treatment I wanted to for patients, nor accumulate / sustain skills. In 8 months, I did 40 cases, counting every tiny umbilical hernia that got a primary repair. My presence made little sense since a legit community hospital existed ~20 minutes away with surgical sub-specialists, and a major academic center (trauma, transplants, aortic stents) was ~60 minutes away by ground.
Eventually, the military sent me to Afghanistan for 6 months. That was a 'good' surgical experience. Philosophically, after Kabul fell nearly 2 years ago, you wonder what it was all about, seeing dead and disabled soldiers (US military, Afghan National Army, NATO, Afghan civilians (especially the women and kids)), but that's another discussion. In any case, I briefly considered extending another 6 months rather than return to my 'home' base, but I did want to see my family in CONUS so just did my obligation. Returning to my 'home' station, I did meet my future spouse, and that was probably the only truly good, unique event of my military career.
Seeing how general surgery was a dead end, I sub-specialized and went back to CONUS. After fellowship (not a good one), the military sent me to a major MTF. All in all, I 'liked' working there. Despite all the bureaucracy and inefficiencies, you eventually learn to play the game. We had daVinci Xi robots, and nobody bugged me too much for ordering a MRI. The hospital was large enough that you could 'sneak' in a case if you wheeled-and-dealed enough with the schedulers (the daytime ones were awesome) and said something like cancer or urgent (which was true). Even during the pandemic, we could play these legit games, though elective cases went to nil. Though I never amassed enough volume to keep a civilian happy, I still had enough complexity to feel like I wasn't totally rusting away. Moonlighted for a few shifts, but it was a crummy gig, and sometimes I was the only sub-specialist at the MTF so couldn't really keep it up. I also liked working with military residents- generally highly motivated, dutiful, competent, and a few brilliant.... some of the interns could've been replaced by placid chimps, but the categoricals were reliable.
Despite these positives, the deployments and other BS did me in. The military humanely skipped over one deployment for me (extended family medical emergency where the military provided excellent care at the big MTF), but came for me again. We had a good deal set up where I would go 3 months, and someone else 3... I was OK with this. This was a peacetime deployment with nothing to do. The other person, however, bugged out with an 'injury' (this person possessed certain skills..), and I got stuck 6 months in the Middle East doing 10 cases. ~30 minutes away was a metropolis where they took the odd person who got in an off-duty accident and did a satisfactory job. We went to the big city a few times, there were American chain restaurants... yeah, this was a waste of time. It wasn't just the OCONUS time, though, that hurt. It was all the nonsensical pre-deployment training that took ~2 months, spinning down clinic, and then spinning up clinic, and heaven forbid taking time off to reconnect with family.
Muddling through CBTs, mandatory calls / formations, trying to fit in a drug test with the add-on ex-lap, fighting over ever decreasing OR time, working with a different scheduler every 2-3 months, trying to maintain skills, seeing others docs coast (coasting doesn't bug me, but dumping stuff on others does), threats of 1-3 month non-surgical taskings (COVID, Afghan refugees), repeated and redundant deployment training (at least a month of nonsense away from family and the real hospital)... I hated the game, and I left after fulfilling the minimum obligation. I didn't care about the math and retirement money- the outside world has enough to make any reasonable person content.
Aside from meeting my spouse, I wouldn't have joined the military. Sometimes I wonder about medicine in general, but every jobs has it flaws, and hopefully I've found a gig where I can be content. If I hadn't been at a very large MTF, however, there was no way I could've gotten this outside employment. The surgeons I see staying for 20 are at 17-18 years anyway with their obligation, and there are a few of those... well, you wonder where they are getting hired when they submit their case logs (mine isn't awesome by civ standards, either).
I don't think military surgery will fix itself. The same problems (mainly volume) have existed for over 20 years. Command proposes the same solutions like mil-civ partnerships. Aside from trauma, these don't work out well. 'A house divided cannot serve two masters'- the trauma surgeons usually serve the civilians aside from deployments. Some of the non-trauma, active duty surgeons working mainly civ... their perspectives and situations are sometimes really out-of-whack, and I think if the lay person knew about it, they'd be unhappy where their tax dollars are going...
The only way out is to cut off the supply of surgeons. I hope the military lacks enough fresh grads to fulfill their spots. This would force them to shut down the small, superfluous MTFs (like my first assignment), improve the situation at large MTFs, and curtail the worthless deployments. Actually, they probably wouldn't do any of this, so I'm out. If you're wondering if you should do military surgery, please don't do it... and if you can't help yourself, do the absolute shortest obligation possible.
Technically, I joined in 1999, but with undergrad + med school + 6 yrs of general surgery (mandatory, superfluous research year), I didn't start real service until 2013. Initially, I was posted to a small hospital overseas. This hospital wouldn't exist in the civilian USA due to lack of volume and support (no IR, no gastro, no ICU). It wouldn't even be a same day surgery center because it couldn't get enough patients. The worst setup for a freshly graduated resident who trained in an ivory-tower academic medical center (ironically, that was officially a military program which was ~95% civilian training). I couldn't provide the treatment I wanted to for patients, nor accumulate / sustain skills. In 8 months, I did 40 cases, counting every tiny umbilical hernia that got a primary repair. My presence made little sense since a legit community hospital existed ~20 minutes away with surgical sub-specialists, and a major academic center (trauma, transplants, aortic stents) was ~60 minutes away by ground.
Eventually, the military sent me to Afghanistan for 6 months. That was a 'good' surgical experience. Philosophically, after Kabul fell nearly 2 years ago, you wonder what it was all about, seeing dead and disabled soldiers (US military, Afghan National Army, NATO, Afghan civilians (especially the women and kids)), but that's another discussion. In any case, I briefly considered extending another 6 months rather than return to my 'home' base, but I did want to see my family in CONUS so just did my obligation. Returning to my 'home' station, I did meet my future spouse, and that was probably the only truly good, unique event of my military career.
Seeing how general surgery was a dead end, I sub-specialized and went back to CONUS. After fellowship (not a good one), the military sent me to a major MTF. All in all, I 'liked' working there. Despite all the bureaucracy and inefficiencies, you eventually learn to play the game. We had daVinci Xi robots, and nobody bugged me too much for ordering a MRI. The hospital was large enough that you could 'sneak' in a case if you wheeled-and-dealed enough with the schedulers (the daytime ones were awesome) and said something like cancer or urgent (which was true). Even during the pandemic, we could play these legit games, though elective cases went to nil. Though I never amassed enough volume to keep a civilian happy, I still had enough complexity to feel like I wasn't totally rusting away. Moonlighted for a few shifts, but it was a crummy gig, and sometimes I was the only sub-specialist at the MTF so couldn't really keep it up. I also liked working with military residents- generally highly motivated, dutiful, competent, and a few brilliant.... some of the interns could've been replaced by placid chimps, but the categoricals were reliable.
Despite these positives, the deployments and other BS did me in. The military humanely skipped over one deployment for me (extended family medical emergency where the military provided excellent care at the big MTF), but came for me again. We had a good deal set up where I would go 3 months, and someone else 3... I was OK with this. This was a peacetime deployment with nothing to do. The other person, however, bugged out with an 'injury' (this person possessed certain skills..), and I got stuck 6 months in the Middle East doing 10 cases. ~30 minutes away was a metropolis where they took the odd person who got in an off-duty accident and did a satisfactory job. We went to the big city a few times, there were American chain restaurants... yeah, this was a waste of time. It wasn't just the OCONUS time, though, that hurt. It was all the nonsensical pre-deployment training that took ~2 months, spinning down clinic, and then spinning up clinic, and heaven forbid taking time off to reconnect with family.
Muddling through CBTs, mandatory calls / formations, trying to fit in a drug test with the add-on ex-lap, fighting over ever decreasing OR time, working with a different scheduler every 2-3 months, trying to maintain skills, seeing others docs coast (coasting doesn't bug me, but dumping stuff on others does), threats of 1-3 month non-surgical taskings (COVID, Afghan refugees), repeated and redundant deployment training (at least a month of nonsense away from family and the real hospital)... I hated the game, and I left after fulfilling the minimum obligation. I didn't care about the math and retirement money- the outside world has enough to make any reasonable person content.
Aside from meeting my spouse, I wouldn't have joined the military. Sometimes I wonder about medicine in general, but every jobs has it flaws, and hopefully I've found a gig where I can be content. If I hadn't been at a very large MTF, however, there was no way I could've gotten this outside employment. The surgeons I see staying for 20 are at 17-18 years anyway with their obligation, and there are a few of those... well, you wonder where they are getting hired when they submit their case logs (mine isn't awesome by civ standards, either).
I don't think military surgery will fix itself. The same problems (mainly volume) have existed for over 20 years. Command proposes the same solutions like mil-civ partnerships. Aside from trauma, these don't work out well. 'A house divided cannot serve two masters'- the trauma surgeons usually serve the civilians aside from deployments. Some of the non-trauma, active duty surgeons working mainly civ... their perspectives and situations are sometimes really out-of-whack, and I think if the lay person knew about it, they'd be unhappy where their tax dollars are going...
The only way out is to cut off the supply of surgeons. I hope the military lacks enough fresh grads to fulfill their spots. This would force them to shut down the small, superfluous MTFs (like my first assignment), improve the situation at large MTFs, and curtail the worthless deployments. Actually, they probably wouldn't do any of this, so I'm out. If you're wondering if you should do military surgery, please don't do it... and if you can't help yourself, do the absolute shortest obligation possible.