what if....

after reading all the posts about assignments and getting the "wish list" in the mail- with very little direction- it all begs the question- what if you say "no" to an assignment? is this completely crazy? ever been done and lived to tell about it?

follow up- question- does the military care what the spouse does for a living? - i think i know from reading some of the posts but...

thanks-
j

[DCJenn]

Hmmm, ever said no. Can't even fathom how well that would go over. After the assignments people picked themselves up from the floor after laughing hysterically, you'd probably then get sent to the absolute worst possible location. and it potential career damage is huge. Nope, can't even imagine.

"No" is not an option. It's pretty much "we paid for your education and now we get to use you where WE need you". Which, as far as I'm concerned is a fair trade. There are risks with all paths to the medical world, the miltary one is that you end up someplace horrible (but you can end up someplace horrible in the civilian world, too), your spouse may be deployed, etc. But, I personally am quite happy with the fact that my husband earned a full salary as an officer while in medical school, graduated with NO debt, and is making a VERY nice salary now. So he owes seven years after he finishes with fellowship? No big deal. He's specialized enough that we won't end up anyplace too small (actually there's really only five places we CAN go). Then, he retires and makes beer.

As for whether the miltary cares about the professional needs of the spouse- well, only if the spouse is in the military and even then, things can get weird. There's a whole world of military spouses who have had their careers interrupted every three years (or more often) to move. Most people that I know who have spouses have either military medical spouses or are married to people like me who have extremely portable careers (lots of nurses, teachers, and social worker types) (or the spouse is a stay at home parent- a career of it's own)

Hope this helps-

Jenn

[mommax3]

I agree with Jenn. If there was a way we could have said no to where we are now, we would have found it, trust me. The best advice I have is to rank to the best of your ability the places that you think you can stand, and then pray. Look at it as an adventure if you can.....you can always go back to life as you planned it after the four years are up.

Which places do you have in mind? What do you do for a living?

There is something to be said for being forced out of your comfort zone....it isn't all negative.

Keep us posted.

Sally

[Rapunzel]

You know, it WOULD be funny if most of the physicians in the military got together and collectivelly said, "No," to their assignments. Kind of hard to throw that many necessary personnel into the brig.... But, yeah, if you did it on your own you'd get the shaft - big time.

Jennifer

Wow- you guys never even thought of it! And yes the military is a pretty good deal but then again recuiters do not always tell the whole story. In fact, many are either lying or stupid.

Personally I think the assignments process is so murky because the physicians being assigned by in large leave the military after their assignment so they take no action. I mean why isn't the process open. That is not right, and the assignments people not answering e-mails or phone calls after assignments-what?. It really makes you wonder or is everyone so afraid of debt that we lose all prospective.

As for what I do- I am an attorney. Lets just say I am not highly mobile. In addition, it would be nice to have a little more lead time to find a job. And from what I have read here, even when you get an assignment it is not official until you are there-- and maybe not still.

I know the JAG recruiters some how only talk about the great locations- I think it is the same for the medical types. I really think everything should be more open- the medical corps deserve it and should demand it... but I guess that is why I turned down the military. I could not turn down falling in love with someone who did not.

Anyway will work on the praying part- that I can do-j

[DCJenn]

Well, in defense of "the system" as sucky as it is...

There are a LOT of people to coordinate and the people who have been in the longest get priority- so, if Major so-and-so decides he wants to go to Wilford Hall in San Antonio- and Sally's husband- newly graduated from residency Captain so-and-so wants to go- well, lets just say Sally now lives in Wichita Falls.

In my experience it's not MOST of the physicians who leave after they have paid back their time- a lot do- but the reality is these days that you can often make as much on the military side as you can in the civilian side and not have to deal with malpractice insurance.

It's pretty clear you have some issues with the location possibilities. Like I have said before 12/14 graduating residents with my husband got EXACTLY what they wanted. So- it can and does happen. (and it was a combined program so that was 6 Army and 8 Air Force and one person from each service didn't get something on their lists)

As for careers- well, you're right- as an attorney, you have a few more transferring issues. There are a couple ways to go- my friend's husband who retired from the JAG Corps took the bar in every state where they might end up. He also took advantage of the time to go back to school and get an advanced training of some sort in his area of law. Another possibility is to ensure that your spouse lets the assignments officer know that you do have a career where you are. That happened to two of my husband's co-workers one whom's husband is Chief Resident at a civilian hospital and the other's wife is a newscaster in San Antonio. They both were able to be assigned to an Army Post not too far away from SA and have figured out the commuting and living scenarios. My point is that the assignments officers will do what they can to make people happy.

Don't be discouraged. Be prepared. When we come here to complain, it's just that- there are lots of good people who really do care what happens to the physicians and their families. The key point to remember though is that these same people are trying to take care of 1.6 Million people spread out across 40 plus countries- plus their families.

We have plenty of civilian co-horts on this list who ended up going places that they dreaded, hated on sight, and have all lived to tell about it. Kelly and Kris certainly didn't have Minnesota on their list of possibilities at the beginning, that's for sure!

Do keep us posted.

Jenn

PS- It's not that we haven't thought about saying "no, I don't want to go there"- it's truly not an option. Look at the contract.

[Rapunzel]

Well, in defense of "the system" as sucky as it is...
In my experience it's not MOST of the physicians who leave after they have paid back their time- a lot do- but the reality is these days that you can often make as much on the military side as you can in the civilian side and not have to deal with malpractice insurance.

I think that the statement that "Most physicians leave the military after they have paid back their time," should be a qualified one. I think it might be an incorrect statement for those medical specialties whose pay in the military is on par with civilian pay for their specialty. However, for specialties such as radiology the military is literally hemmorraghing (ignore my sloppy spelling ) radiologists. The military pay is about a third what a radiologist can bring in during the first year post-residency and about a quarter to a fifth of what can be earned in the civilian world five years post-residency. My understanding is that the military is having the same issues with other specialties that have this incredibly huge pay disparity. Unfortunately the military does not keep up with the "market price" of certain specialties and it costs them. Apparently the Air Force is farming out their radiology positions to civilian contractors (civilian radiologists) that they pay the civilian rates because they can't attract or keep enough radiologists in-house. I think it could be rather galling to be working for $130K as a radiologist in the military while a contracted radiologist working next to you is being payed by the same employer upwards of $300K+. I predict that situations such as this are going to lead to a gradual farming out of all radiology work to civilian groups/individuals as the military continues to lose radiologists.

That's what I know about that particular specialty, I am sure there are other medical specialties with similar experiences in the military beauracracy....

Jennifer

[mommax3]

In DH's specialty (OB/GYN) I personally only know of *one* doctor who is staying in past his owed time. (I am only talking about docs who didn't sub-specialize and don't owe so much time that getting out before retirement doesn't make sense.....i.e. those who only owe 4 to 7 years.) This is based on the classes of residents that we knew during DH's time there (about 40 residents from the Army and Air Force) --- all of them are either out, or plan to get out soon, except for two....one went to UHSUS and is finishing a GYN/ONC fellowship, and the other went to the Academy, UHSUS, and is doing a fellowship. They are both lifers, for obvious reasons. The guy we know who is staying in did a civilian residency and based on his experiences, he decided that he didn't want to practice medicine in the civilian world. He actively "marketed" himself as being interested in teaching, and he had some kind of connections as well, so he got a spot at Wilford Hall. It is very hard for the training programs to find OB/GYN generalists for their teaching programs because the generalists get out after paying back their time, leaving only the sub-specialists to teach, which causes some problems at the training level. So far this guy is happy, and very excited about hanging out to retirement, but he is still in his last "owed" year. I will be very surprised if he is able to stay at Wilford Hall, despite the fact that he is a great doctor and teacher. I can totally see the Air Force sending him remote or deploying him when he has just a few years left til retirement. Two years ago, when we received our first assignment to Mountain Home, Idaho, the only reason it was open was because there were docs there that loved it there and were willing to extend to stay there, but the Air Force told them that if they extended, they would be sent to Japan......so they lost three OB/GYNs at that point, at a time when the Air Force knew they were facing a shortage of docs in that specialty.

If someone who outranks DH gets a spot that he wants, it sucks but I can understand that. However, much of what goes on in the assignments process defies explanation and seems to depend on whims and how the assignments officer is feeling that day. You can look at two identical situations and see completely opposite outcomes, and you can see great doctors get screwed and horrible ones pampered and protected.

There is another OB/GYN that I know of that was sent to backfill here.....he is in his late 50s and was a Lt. Col., but his skills were......suspect......to say the least. Obviously he stayed in past his owed time, but he fits the rule of thumb that DH and I go by......if they stay in past their owed time and aren't within 5-8 years of retirement by the time their payback is over, be careful!

The salary differential for OB/GYNs is not as large as it is for radiologists, but DH's partner just signed a contract to make more than twice as much as he makes now when he gets out next year.......why WOULDN'T you get out when the difference is that much? I know very well that our tax bracket will change dramatically when we get out, and liability insurance will become an issue as well, but factor in the autonomy and being treated like a professional and not having to move every 3 to 4 years or living with the possibility of being deployed.......civilian life looks better and better.

I've said it before and will say it again.....the only way to "guarantee" that you will be happy with your assignments as a military physician is to sub-specialize, thus assuring that you will be assigned to large medical centers for the rest of your career. Otherwise you risk being assigned to small bases, which doesn't have to be bad, but it is definitely a crapshoot at best.


Sally

[DCJenn]

Jennifer,

You're absolutely right in that the areas that have shortages nationally are the ones that typically have people leaving the service- i.e. radiology, anesthesiology, surgical specialties, etc. The people who tend to stay are pediatricians, Internal Medicine, Family Practice, etc., for whom the salaries are more on-par.

There are plenty of people who owe so much time for their paybacks that they'll be in forever, despite their field. We know a quite few people who went to the Academies and then to USUHS or ROTC then USUHS or the Academies then HPSP- I think the longest I've heard is 15 years owed in payback. (pediatric nephrology), 13 years (orthopedic surgery) and 11 years (without any speciality!)

So- there's always going to be a mixed bag.

Jenn