life after payback

[peggyfromwastate]

Hi- I just wanted to ask a question about life after payback. If a doc is promoted to an O-5 or higher, does that doc usually spend all of the time doing administrative work, or is that a choice? I have read some complaints from some very angry and bitter people who were dying to get out of the military, and what they say is that at a certain point you get promoted out of practicing medicine...

Another complaint that seems to pop up is that the military has had a hard time with retention of doctors, and when a doc decides to retire or to leave after completing payback, the docs who are left over at the site are made to work unending hours to cover for whoever may have left. These complainers made it sound like a replacement is sent only after about 6 months of unpaid overtime and huge hassels.

In general, I am curious as to how docs enjoy it after payback. Is everyone dying to get to retirement?

Another question- I know that flexibility is not the military's mantra, but is there any way to make a deal with the military for my husband to work in a certain area (say where he does residency) for a few years before beginning payback so that I could finish my education (pharmacy school) if I were to agree to work in a military facility as a pharmacist?

I know that may be a confusing question, but I'd appreciate any input! As always, thanks!

Peggy

[mommax3]

I can't speak about life after payback because my husband will get out as soon as he can, but there can be lag time before replacements are sent, depending on the specialty area you are talking about. My husband's clinic was short one physician for about 4 months, and while their work day was not any longer, the call schedule was horrible (every other night and every other weekend) and no one could take leave because they might be needed to back up the other one during emergency surgeries.

It does seem to me that the higher ranking docs spend more time on military and administrative junk.

As far as I know, the only way to get the military to give preference to a spouses' career in regards to assignments is if the spouse is also currently active duty. DO NOT believe any reassurances you may get about this from a recruiter.

Sally

[DCJenn]

There can be a lag in replacing doctors that leave, but it's partially because once they are finished with payback and have no further obligations, they can pretty much leave whenever they want to. That can seriously impact the specialty because assignments are usually July-July. There's a domino effect that also takes time to play out as well. For example, our friend was just accepted in to an er residency, his plan b was flight surgery. His co-worker is now applying for the flight surgery slot. If she gets it then Lackland AFB will have two fewer GMO's on the training side. Who they fill those slots with then depends on who is coming to Lackland. who is available to come to Lackland, which HPSP grads don't have a residency... so there's a lot that can impact filling one job.

As for the military guaranteeing you anything- only if you're in the military- and then pretty much you're guaranteed a job- location unspecified! But, as we have said, they do try to keep people happy as much as they can while filling their needs first. Depending on what your husband chooses to do after medical school, he may well have a four year residency. We have several residents here who are married to civilians both in and out of medicine who are trying to figure out how to stay here to stay with their spouse who has a job here.

We will stay in after the payback is up- although since my husband was accepted for a three year fellowship, now, after payback he'll already have 21 years in! (4 (enlisted) +4 USUHS+3 residency+3 fellowship+7 payback.) So we'll probably stay for 30 if they want him. If they don't, then we're that much closer to brewing beer for a living!

As for angry and bitter people- well, there are angry and bitter people everywhere. There are increasing administrative tasks as one is promoted. But there are some pretty distinct career tracks that people take- adminsitration is one, medicine is one, teaching is one- and those who want to exclusively practice medicine must make that choice clear. Some of the doctors here have forgone promotion in order to continue to practice medicine exclusively. Some people aren't even considered for promotion. Like everything else in life- it can be a crapshoot. I've seen people who are very happy as military staff docs. I've seen some pretty miserable people as well. Most of the miserable people aren't miserable because of their job tasks, but because of the politics involved with their jobs. As with any job, a bad boss can ruin your day.

Jenn

[peggyfromwastate]

Thanks all for your remarks! I have a question about what happens when a dr leaves and the other docs have to work extra until the replacement arrives. Are the docs paid for this extra work?

Also, do you think the GMO tour will still be something that docs do after finishing med school prior to residency, or will that be phased out for the army within 4 years?

Also, if I may ask, Mommax, why are you planning on getting out as soon as you can? Was that your original plan? I know that you have kids also. Maybe you could enlighten me on some of the hardships on families that you've (or anyone else) experienced.

I am very grateful for any help and advise you all give. I think the wives (and boyfriend, significant other, etc) probably know the whole story, as usual!!! 8)

Peggy

[DCJenn]

Peggy-

They're salaried employees, just like the rest of us! so, no there's no overtime although hopefully the dept heads realize what is going on and make it up somehow.

Jenn

[peggyfromwastate]

If there is no overtime pay or other compensation, if docs "give up" their leave time to make up for a vacancy in the department, do they lose that leave time forever? Or can they still take it, just after a replacement doc has been found? Are the 30 days of annual leave "untouchable", or can those be taken away if need be?

[DCJenn]

Those leave days accumulate- up to 90 days. You will lose them after you've accumulated 90 days leave.

For example, as a resident, your husband will earn 30 days but chances are won't be able to take them due to residency restrictions. My husband took 14 days leave internship year plus had a week off at Christmas that didn't count as leave. We have found here that the powers that be work very hard to make sure that everyone takes as much leave as they can. This year we're allowed three weeks plus the Christmas week. Whether it works in to the schedule with the new 80 hour work week remains to be seen.

Personally, I think 30 days annual leave is a dream, having never had more than 10 days, ever in my entire career. I'm the one that always limits us! I'm the Mistress of Leave without Pay.

Peggy- relax, you guys have four years of medical school plus your residency to get through first. Take it one step at a time. And remember, by the time you guys get there, things could have changed drastically!

Jenn

[peggyfromwastate]

Thanks Jenn!

I know I need to relax! Right now we're feeling pressure in a big way from my family to stay here at our state school and take on the loans, etc. I'm not entirely comfortable with that because I believe it limits what area of medicine my husband goes into. In order to pay down our med school debts as well as pay for college for our kids, etc. But more importantly than money, my husband has always been drawn to military service. Anyway, I don't know how long until those kinds of idealistic-type feelings wear off, or maybe they don't. I am glad that he's waiting a while before deciding for sure between U of Washington and USUHS. He's going to go to Madigan and visit with an ER resident and hopefully anybody else willing on that end. Hopefully that trip will illuminate a little bit for him about what military medicine is like. But from all we can tell, it's basically the same machine as civilian, just that there's only one HMO to deal with the military route. And since my dad is a doc in the civilian world, I am not naive as to the administrative tasks that take the time up of docs in the civilian sector, not to mention the difficulty in dealing with 400+ different insurance plans. I mean, docs in civilian are constantly arguing with insurance pinheads. Oh well- thanks for your advise Jenn! We're just feeling a lot of pressure from my family to stay "close to home", even if it's only for 4 years and then we're off! Off to independence!

Peggy

[DCJenn]

Peggy-

The one thing that I can say about military medicine is that in my experience the people are excellent doctors who really care about their patients. I blew out my leg doing a marathon and I swear, I saw every department even remotely related to legs. They were all caring and considerate. Now, I've only ever been treated at a large military hospital so I have no idea what life is like at the smaller ones.

It's a big decision but for my husband, the ability to graduate debt free was a huge selling point. We both are able to fully invest in our respective retirement plans (FYI- that's something else nice- there's a returement plan for governemnt employees that the uniformed services can now participate in- on top of pensions!) and we have certainly enjoyed not having to worry about a debt load bigger than our combined salaries!!

Another positive for us is not having to deal with malpractice insurance. Malpractice insurance in its current form is one of the primary reasons that my beloved has said he will never practice medicine as a civilian. It just costs too damned much!

My family was really upset when we left for Texas. I had never lived anywhere else but the DC area. I didn't even go to college far away- it was a whopping hour and a half drive from my parent's house! I have to say though, I'm really glad we did it. (I'm also really glad we're going home) I had to make my own friends, find my own activities, and most importantly, we were able to focus on us, rather then him trying to blend in to my already existing circles. The situation is different for you guys, of course, butfor us, I think it was a valuable growth experience.

Feel free to PM me, anytime you want.

Jenn

PS- remind your family that this is your husband's career!! Everyone we knew had about a million opinions for us, too.

[mommax3]

Peggy,

We are Air Force, not Army, but my husband's residency was a combined program, (as is Jenn's husband's) and I know that except for one guy, none of the army residents did any GMO time before residency. I think it depends on the specialty you choose -- the military may have you do GMO time (or flight surgery, for the Air Force) if they project that they will have too many of a particular specialty -- after spending a couple of years waiting, there becomes room for more docs to go into training for a particular specialty, and then you can start residency. It's all supply and demand.


We will get out as soon as possible because we only owe four years and the salary differential between military and civilian OB/GYNs is substantial. Also, we really want to have some autonomy over where we live and how long we live there, and my husband would like to have some authority over his support staff, (nurses, techs, and receptionists) and office/clinic policies. He has none of that now. When patients are frustrated, he often agrees with them, but can do nothing about it. His support staff outranks him and in some ways are considered his "bosses" even though they are not physicians. The threat of deployment looms large for us, although it is not as likely in his specialty as in some others. He could also be sent TDY for months to make up for shortages overseas. With three young boys at home and no family anywhere near us, it would be very hard if he were away, even for three months. We are not bitter, because this is what we signed up for, but we are looking forward to not having to deal with these particular challenges......I am sure there will be others to deal with in civilian life. We did not know enough to ask the right questions when we were considering the military scholarship. In hindsight, we would have investigated some of the other options that were available in our home state, like agreeing to serve in an underserved area for four years in return for tuition.

Since you have kids, (I can't remember their ages) I will share that moving is much harder when they are in school. Our oldest will have just finished fourth grade when we get out and I am so glad that he will not have to be moving during the middle school years. Finding good schools has been a challenge for us, as well.

There are times that I miss my family unbearably and we just can't fly to see them -- it is prohibitively expensive for the five of us. Driving doesn't make sense unless we can take a huge chunk of time off, and once kids are in school, the summer is the only time that is possible.

So those are the drawbacks as I see them. I would agree with Jenn that the medical care you will receive adjacent to a training center is excellent. It is much more spotty at mid-sized and smaller bases/posts. Pursuing a fellowship is a good way to guarantee that you will always be stationed at a larger place, if you don't mind the added owed time. Moving away from our families was good for us in a lot of ways -- but it has been six years since we were close and I am at the point of "enough already!"

It is good that your husband is going to talk to some residents. It would be even better if he could talk to some docs who are at smaller posts doing their payback. If he asks, I am sure he could get some names. Like Jenn said, there are bitter people in every profession, but it is always good to see the whole picture before you sign on the dotted line.

I wish you and your husband the best as you make your decision! It is a stressful time.

Sally

[peggyfromwastate]

Thanks a lot for the input! We'll keep exploring it all, and I'll let you know when we decide something. I will ask my husband to try to track down the names of some Army docs stationed at smaller hospitals- I think that's a great idea!

Also, does anyone know of anybody pursuing two different residencies in the military? My husband was told at USUHS that the military allows you to enter a second residency if you didn't like the first one you went through. Any thoughts on that?

Thanks again!

Peggy

[mommax3]

We have a friend from residency who is also boarded in Family Practice. He is army. He did his Family Practice residency and was finishing the last year of his payback (four years) when he decided he wanted to do OB/GYN. He didn't have to re-do intern year, so he spent three more years doing an OB/GYN residency. He will then owe the army two more years because they supported him through more training. I think his wife is a saint and have told her so on several occasions. So yes, it happens, but I think it is rare because few people have the fortitude to go through residency twice.

Sally

[DCJenn]

There was a pediatrician who had 20 years in and decided to do anethesia! Back he went to residency- but like Sally said, he didn't have to do internship year again.

My husband will be eligible to be double boarded because he did his residency in peds but his fellowship is in neuro. So... there's lots of options. And once he's done, as Sally mentioned- we can only be sent to large Army hospital- DC, here, Madigan, Tripler and Germany. (and none of those suck!!)

Jenn

[peggyfromwastate]

Thanks guys! You say that pursuing a fellowship is a way to guarantee that you'll be stationed at a large hospital/medical center- I'm assuming that's because you are so specialized that they don't have those docs at the smaller bases? I looked up the website to Fort Irwin, since Jenn had mentioned it, and I see how that may not be the most exciting place to be based, for a city girl!

BTW- about fellowships (before y'all pull your hair out because I'm worrying about things way out in the future, just humor me and call it being thorough please!) Is life in a fellowship like a residency? Do they work you to death there too? And do you get paid the same as residents?

Anyway, thanks for all the advice! My husband will try to get out to Madigan and talk with more pros in military med before he makes a final decision. The pendulum swings on...

Peg

[DCJenn]

Peggy-

Fellowship is a paid position at a staff salary, which is more than a resident's salary which is more than an interns salary, which is more then a 2nd Lt's salary. So, they do try to keep you motivated! Also, as we have mentioned, there are annual bonus' (with some strings but if your husband goes to USUHS his payback is long enoguh that the strings won't even matter until year 6!)

I've heard that fellowships can be difficult. But, in my mind , it's sort of like when I got my Master's degree. On one level, it was harder than anything I'd ever done, but on another, because I was genuinely interested in the subject, I was more motiviated and interested in everything I was learning.

So, to answer your question, yes, it is because of the specialization that they work at the large medical centers!

Jenn