Military Medical Obligations....

This issue has been brought up a couple of times but I have been left with some questions after talking to Jennifer...

Jennifer,
Did your husband do a sort of military scholarship thing where they pay you extra during residency and then you are committed post-training for a certain number of years or did he go to a military school? I was always curious as to how that worked. How many years will be obligated to serve in the military?

Has anyone else here taken advantage of the military's offers to pay extra during training?

My husband has been contacted by a recruiter who has offered him the possibility of going to Heidelberg post-training for a few years...it would be an interesting adventure because he is from Germany and it would give us the chance to be close to his family....but we are hesitant for several reasons....particularly we are fearful of signing a contract with the military and then being told...."oops, no openings in Germany....we'll send you to Japan instead" or something.

Kristen

Here's the scoop on us (though I am sure there are other ways to go about it):
When Jon first got accepted to UTSW he knew I was pregnant so he had a family to feed. He decided to take a year of absence from med school before he started so he could finish his BS and apply very early for an Air Force scholarship (the earlier he applied the more likely he was to get it).

The Air Force scholarship essentially pays all school tuition and fees and gives Jon reserve pay every month. He is considered in the reserves while in school and was commissioned as an officer as soon as the scholarship was accepted. He is required to do month long active duty tours every year (because he is in the reserves). That is what he is doing now in San Antonio at Lackland AFB. These active duty tours (with the exception of Officers Training Camp which all officers must go through regardless of specialty) are just medical rotations like you have in medical school. You get to pick when you go, the specialty you want to do (and you do get credit for it at school) and the military usually pays for travel.

After he graduates it gets tricky. He has to go through a military match before the normal match. He has to interview at bases and submit resumes just like normal match. Military match is very early (you know where you are by Dec). One of the choices for this match is "deferment" which means you want to have a civilian residency and go through the normal match. There are a certain number of slots that the Air Force has for every specialty. Their need is often greater than their ability to train, however. So, in the specialty Jon will be interviewing for, radiology, there are 4or5 resident positions open in the Air Force and 17 deferments available. When there are only a couple of hundred AF 4th years these numbers don't look quite as bad. Those who went to the military medical school are on active duty while in school and get first choice with the military residencies.

If you get a deferment you can proceed with the civilian match (which you should apply for even before the military match). It is also possible to get snatched up as a General Medical Officer, but I am not quite sure how this works and I know Jon doesn't want it.

During residency you are active duty if you are in a military residency. You also get a higher pay in a military residency than a civlian one. The deferred people have to muck through like all other civilians. I believe a deferred resident is still considered in the reserves, so I assume they still get reserve pay. As you progress through residency, you move up the ranks. So, Jon will be a Captain by the time residency ends.

After residency you must "pay back" the military for the number of years of medical school that they paid for. So, four years is the general rule and then you can get out if you want (I think most do since the pay is MUCH less in the military for a doctor than in the real world). Sally knows more about the pay during residency and after than I do so I will let her explain the rest if she reads this.

Our experience with the Air Force scholarship has been over all positive. The upsides are that you get a small but steady income during medical school to cover those dry periods before you get more financial aid. You also don't have as high a debt because your tuition is paid and you have the little income to cover some living expenses. Our debt is about a third to half what our friends with children have in med school! Believe me $40,000 is a lot easier to pay off than six figures! You also get access to the bases and some of the perks of being an officer. The downsides are the uncertainty with the military match (but it's the same thing with the normal match) and the possiblity of not having as much control over your career in the short term.

You just have to remember that nothing comes for free! But, in our experience, officer's families get priority (which leaves a lot of enlisted men's wives very bitter) and that usually means you get what you want. The military needs doctors, lawyers, nurses, etc. and they know that people are leery of them. That is why they offer as many perks as they can and compared to the other servicemen, bend over backwards for the docs. Also, I heard that doctors get courtmarshalled more than any other group in the Air Force because they ignore a lot of the rules (like fraternization). Just some gossip my husband heard at OFTC!

I hope that might answer some people in medical school's questions.

Another thing to remember as far as where you get stationed is that the more highly specialized the doc, the less likely they are to be moved around at all. So, an internal med can count on moving around, whereas a cardiothoracic surg probably will stay put at one of the major med facilities the military operates.

And lastly, if it's not in writing, don't believe it!!!

Jennifer

My hubby will hopefully be doing a fellowship in interventional (since that is the goal). This throws another kink into the whole process. I am really not sure how the military handles that since we haven't even matched for residency, yet! I know that the Air Force has a big need for the "new" specialty of interventional radiology but I don't know if that improves Jon's chances of getting a fellowship. Again, Sally or someone else who has gotten that far would be the best people to answer these questions.

One more thing, recruiters don't always understand all of these things, so watch out what a recruiter tells you and do your homework! (like reading what people who have done it say). And read contracts very carefully BEFORE agreeing to anything!

Jennifer

Thanks for the feedback....it certainly gives us something to think about. I don't want us to end up signing up for something and then regretting it.

I think that you will enjoy the "military life" for a few years anyway...it might be tough on the kids so I hope he gets to stay put while he is in. I always enjoyed the friendships that I made "on base". I grew up military because my dad was in the army...and it really is a unique experience.

Kris

By the way, what is interventional radiology?
Edited by kmmath  at: 8/12/00 2:32:46 pm

Interventional radiology started out as angiography where you inject contrast into blood vessels and take xrays to either come up with a diagnosis or to assist with planning surgeries. With the advent of newer technology the scope of the field has increased. So now, interventionalists will do CT guided biopsies, in addition to a large array of intravascular therepeutic interventions. Examples would be being able to dialate and stent an occluded blood vessel, being able to place filters to prevent pulmonary emboli, even repairing an aortic aneuyrism all by inserting catheters and other instruments over guidewires within the blood vessels themselves. All of this is under the guidance of new imaging like fluoroscopy (real time imaging).

Another thing that they do is get acces for patients that have difficult veins to access. Like if a patient is a "difficult stick" and needs a central line, an interventionalist will use sonogram to find a good vein. The "Whipple" (for those of you with surgeon husbands you know that this is most difficult procedure in surgery and is a badge of honor to perform) of the interventional radiologists is the "Tips" procedure. This is the trans-jugular intrahepatic portal shunt. Which is shunting blood from the portal to the systemic circulation in patients with severe liver disease.

This is what my husband dictated to me when I asked him the definition. Now, from my point of view this is what it is: a combination of radiology and surgery. They basically do vascular procedures while using radiology equipment to guide them. Some procedures performed by vascular surgeons are now being done by interventional radiologists. (At some hospitals apparently this is a sore spot and the surgeons resent it). In fact, interventional radiology is viewed as the surgery of the future by some in the field. It is a relatively new field and I had never heard of it before about a year ago when my husband came home and announced that was what he wanted to be.

The lifestyle seems to be a combo of the laid back atmosphere of radiology with the pay of surgery. Where we are the interventionalists take call at home and usually go home around 6pm. Not bad from my view! Some hospitals are not as nice timewise to this specialty because they view it more like surgery (which fuels antagonism between the surgeons and the interventionalists).

Anyway, that is the long, boring answer to your question!

Jennifer

What an interesting field...I had never heard of it before. I have a friend whose husband did a fellowship in body imaging? How did your husband stumble upon that field?

Another thing that I have wanted to ask you, Jennifer...are you considering a career in medicine yourself once the children are grown? I have been toying with the idea once my children are much, much older.....not to re-start a flame war with you ...I am just curious as to your goals....

I have always had the problem of wanting to be a billion things when I "grow up". For a very long time I was torn between architecture and law (architecture since I was ten and law in high school because I had a crush on my debate coach). Then there was music (strings) but that just doesn't pay very well and I am not an "artiste". College confused it all and I discovered I was good at math and science. So, by the time I met my husband I was premed. The problem is I have now had time to think about it and I really don't want to have the same career as my husband and I am just not very good dealing with people as a job. I like objects much better (I thought I might hate motherhood, but luckily I was wrong).

So, now I have decided to stay with my first great love - architecture. But I will also get a degree in mechanical engineering. Let me explain that as a baby my father read me Popular Science as a "storybook" - now that's weird! But I guess being quizzed on astronomy and the concept of infinity with quantum mechanics as a child stuck and I love physics. I did well premed - better than Jon. But I think "three dimensionally" pretty well and enjoy structure and loooove very boring topics so I think I will go the nerdy engineer/architect route. I might do something in astronomy when I get older because astrophysics is simply amazing, but there I go again wanting to be a zillion things!

I know the feeling! It seems like there are so many interesting things out there doesn't it! When I did my undergrad....many, many moons ago, I got a dual degree in German and Psychology.....then I later went on to do a post-bach program in Biology. Right now, I am really into looking at the distance education stuff and I am amazed at all of the different things that are offered....wondering what my next academic "adventure" should be.

Have you ever thought of enrolling in a distance ed course or program? I guess I like the flexibility....you download the notes when the kids are in bed and do the work at your convenience....it is kind of interesting. I have even been looking into distance ed opportunities in germany just to do something different....

By the way...are you guys still in San Antonio?


Kris

I did think about doing some distance ed a few years ago thru BYU which has a pretty large distance ed program. I am an "intense" person. When I decide to do something it absorbs my time and life. I found myself having really big difficulties when I went back for an arch/engin degree a few years back. I had a hard time not resenting my son wanting so much attention, my husband being gone, and my house needing cleaning. I decided instead of having a nervous breakdown not to kill myself and just patiently wait my "turn" at being the center of my life. I guess as spouses of medical students and residents we get a healthy dose of delayed gratification, I guess I just tapped into that same state of mind (it's hard to do that though and avoid feeling like a martyr - perhaps the biggest pitfall for me to avoid).

I know and feel that I have within me the capability to do outstanding things. One day I will have the opportunity to pursue these goals. But when I do it, I want to do it a certain way. After Jon is done our kids should all be school age. (Actually by the time he's really done - with the Air Force - they'll be teens!) I have demanded and gotten his cooperation that at that time he will have to find a job in a city with top notch architecture and engineering university programs (which usually means good physics program as well). I don't have the goal of making a huge bundle of money. My goal is more difficult - I want to make a name for myself in history; wouldn't it be great to be in textbooks someday? Or have my works admired my future generations? It sounds egocentric, but I really want to change the world in some way.

My husband understands this (after I have pounded it in enough) and has been enthusiastic towards my goals. I guess I can never know what the future is, but I feel like I can't give my "all" to everything at once. I just fall too easily into finding my children to be hindrances in my life if I start trying to accomplish my personal interests aggressively (and for me and arch/engin I am aggressive).
Now, if I were to take courses just to satisfy immediate interests - like learning Spanish, YES I would be very interested in taking long distance ed courses.
I don't know if any of that makes sense, I know I'm rambling. It's just hard to articulate this set of goals because they are so personal.

I forgot, we're still in San Antonio. My family (mom, sister with hubby, and two brothers) are coming to visit and alleviate my lonliness. Perhaps out of that crew we can find some sucker to watch our kids while Jon and I celebrate our anniversary! It's two weeks until CA.
Jennifer

I can really relate to your feelings of resentment and wanting to absorb yourself. That has been the hardest part for me in settling back into studying....accepting less in terms of grades, etc...and that really is hard! It is also hard for me to go part-time and to not be able to totally focus on my studies. I have found myself feeling resentful of Thomas or the children at times...but I don't know that waiting is the answer for me because you just don't know what life will bring your way...I can't be certain that my husband will eventually end up where I need to be in terms of the University and I also don't know if my children's needs will be different by then. It is also quite hard even at my age (30) in the science world. I am really viewed as "over the hill" for the most part...which I find ridiculous, but a pervasive attitude nonetheless.

I really struggle to find a balance for my family and myself. To do this I have settled for the less prestigious MS right now. I am grateful to have something to keep my mind occupied though...to keep me thinking and questioning. Perhpas when the children are older I will go after my PhD or MD....but who knows what the future brings?

I am looking forward to my semester starting on Wednesday. Andrew and Amanda are in school from 9-2 and I have a nanny coming from 9-2 MWF to stay with Alex. I will stay only as long as I need to and will do a lot of the research in the evening/on weekends. The only doubts that I have are for Alex...but I also recognize that I am so lonely with Thomas working so much and am so isolated that the time will be good for me....at least I hope so.

Well, I will keep you posted.

Kristen

OK, I'm going to rant now. All who wish to (particularly men) please pass over this message.

I am SO tired of women being considered old when a man the same age would be in his "prime". I know men who didn't start their careers until their thirties and no one blinked. I know men who switched careers in their 50s and everyone congratulated them (even though they were starting out at ground zero in another career). Why can't women seem to get the same respect? I think a woman who is forty, a mother, and has just completed a degree is much more capable than some young twenty two year old who has never had real life experience. Her boobs may not be as saggy but she's not going to have the stressful life experiences that the older woman will have had. These experiences teach integrity, commitment to a task, problem solving, cooperation, patience, etc, etc. I am twenty five and I know that every woman I have met who is under 23 has been self absorbed and flaky (nice, but flaky). College doesn't teach about the real world. The real world is often a culture shock to the people who get there from college. I also know that a woman of thirty, forty, fifty has more wisdom than me and experience and NOT less intelligence.

I am so proud of my mom for bucking this preconceived idea that women can't start a career at an older age. I think I'd like to skewer any man who would tell me that her age was a deterrent to hiring her. I know there are some excuses like pricier med insurance for employers, but most of these employers are old men - HELLO! I guess it's not just a sexist perception but also a bad attitude towards aging with women. Witness that a woman in Hollywood is too old at 35! Or that the young, perky actress in the latest movie is paired with an old geezer with 5 grandchildren! (Now that is arguably pedophilia).

I do have a feeling that my mother's success has been due in part to the fact that she looks young. She has been mistaken for being thirtyish. That may be nice for her, but what if she happened to be as wrinkled as a raisin? Same brain, same capabilities, just looks older.

If you really think about it, there are a number of role models who didn't accmplish their historic feats until they were older. And who's to say that those who intensly accomplish much at the age of 30 couldn't do the same at 50? I think age IS relavent, in that it is a plus in a person's character. I am so disturbed by this lack of respect for women and older women in particular in our society.

Someday I'll be an older woman with more skills and equal education to my college aged daughters. Even if we have exactly the same intelligenc, I'll have more wisdom, more developed talents and more "life experience". I'll also know more about deadlines, the value of hard work, and how I function under extreme stress. But, I guess I'd trade it all for those perky boobs!

Okay, I'm going to throw in a funny since you said men in their "prime". All you have to remember is men hit their "prime" sexually when they are 18 to early 20's. Need I say more about men and their primes!!! They just have a hang up with women and my husband is one of the worst! When he starts in with women all I say is remember our 20's dear, he gets the message loud and clear.

I agree...I sometimes feel like I am treated as if I delivered by brain with the placenta or something...I am not kidding. I recently had a talk with one of my professors about my research project for the Fall Semester. I got into a bit of trouble last year for doing most of my research at night and on the weekends so that I could be at home with my children as much as possible...I got my work done, but because I wasn't "visible" this was a big issue. Another lab worker who had classes during the day often did his work in the evenings/weekends as well...he received funding for the summer...I did not. So this semester, I told my professors that I had arranged to be "visible" three days a week from 9-2 but made it clear that I would still be doing a majority of my work evenings and weekends and that the other two days I would be spending at home with my 18 month old. The response from my prof?: I feel sorry for your children! I can't win. I don't think that anyone would have the balls to say something like that to a man with children who was making the choice to be away from home 15 hours a week to educate himself and prepare for a different career.

I understand that we all have differing opinions on the subject of how many hours at home constitutes "good" mothering...but I have made a choice that I feel good about and that I think works for my family.

I am 30, Jennifer and I know exactly what you are talking about when you discuss the attitudes of the younger ones. ...I find it frustrating to work with many of these students who do not share the same maturity and life experiences.....I was on campus once with my youngest who at the time was about 14 months old and I ran into a group of the other students. They oohed and ahed over Alex and then one of the girls spoke up "Oh, I know how you feel...I just got a PUPPY and it is sooo much work!" : I couldn't bite my tongue on this one...I am afraid that I would have offended half of the posters here! I told her basically that she was totally clueless!

I am curious about your husband's attitudes, Devera...because I am experiencing some of the same "stuff" with my own spouse...who seems to be developing more of the "good ole boy" mentality himself!

Kristen

Kristen,
My hubster has so many male opinions I just sit and stare! He is a good guy but sometimes I need to slap him around and make sure he knows who is in charge of this here circus.

I don't really ever get into his male/medicine ideas. He has very set lines of what medicine is and how it should be handled. There are no gray areas to him in patient care. Part time physicians really get on his nerves be it male or female. He just has a hard time with doctors that practice 9 to 5 because people don't get sick only between those times. Just a hang-up he has, plus it gives me another reason to slap him around. If you could see the two of us you would laugh. He is 200 pounds and I'm 110. I'd need a big whip to slap him around ~ Devera