Military docs sound off

[Fuzz]

These two guys would probably disagree with that sentiment:

Doctor joins Army at 64, inspired by wounded son:

https://www.military.com/daily-news/2012/07/03/doctor-64-joins-army-for-afghan-duty.html

Doctor still serving at 79:

https://www.army.mil/article/36749/

As a civilian, he retired in 1998 from the University of Maryland Shock Trauma Center, where he directed anesthesia for 10 years.

In the military, he has retired four times - once from the National Guard in 1998 and then again after a 2005 deployment to Iraq, a 2006 deployment to Afghanistan and a 2007 rotation in Germany, which he extended four times.

Bernhard continues to work part time as a civilian flight surgeon for the Maryland Army National Guard and wasn't surprised when he received orders to report to Fort Benning last month. His orders are for 171 days.

The head of Flight Doc at Vance was a Lt Col. who recently joined after his son joined the service and had been a private practice doc for 20+ years. Also the best military doctor I have ever worked with was O-6. There are good apples and bad apples.

[Gravedigger]

I had knee surgery when I was stationed in COS by an orthopedic surgeon at USAFA that specialized in sports injury/surgery. He went into great detail on my options and what the consequences of each of those options would be. He advised me to go with a surgery with a lower likelihood of success but a much better long-term result. Others told me not to take the chance with a military doctor. I ignored those people, and the doctor did a fantastic job. On top of that, everything was paid for by the government, including months of rehab at a civilian PT office right next to my house.

Oddly enough, the surgeon had been a KC-135 pilot prior to going into the medical field. I guarantee you Dr. James Andrews himself wouldn't have done a better job.

ETA: Lest we forget the numerous service members that are alive today because of the skill and bravery of medical professionals willing to take on the challenges of combat medical care in deployed locations.

Edited December 8, 2014 by Gravedigger

[jazzdude]

The head of Flight Doc at Vance was a Lt Col. who recently joined after his son joined the service and had been a private practice doc for 20+ years.

You mean Dr DNIF?

[yatalpan]

AADs are such a sham.

Do ITZ Lt Col boards required this too?

no, just a pulse

[MSCguy]

My wife's uncle was an AF lawyer before switching to the Reserves and having a successful civilian career. His advice: refuse to be seen by any active duty doctor with silver leaves or chickens on his shoulders. His very sound reasoning was if the doc could have gotten out and gone to private practice, he would have.

I could refute this in several different ways (I'm medical but not a doc) but will make the simplest argument there is. If you take the ROTC or USAFA to MD route the ADSCs for all that school will keep you around for 16 years or so. Thus there are some silver leaf docs out there still on their initial ADSCs. Palace Chase or VSP is almost never an option for docs so they have to complete their ADSCs to separate. For someone in that boat it's a no brainer to hang around a little longer to get the pension.

[Fuzz]

You mean Dr DNIF?

I never said he was one of the good Flight Docs...

[McDonut]

He was a douche and had it out for pilots. I wouldn't be surprised if people have hidden medical issues from him due to lack of trust.

Back on topic, there are some really good docs who do their job well and try their hardest to keep pilots flying. There are also some good docs that stay in the military to avoid the private bs, but now those will be inclined to leave because of too much military bs. Which is a problem.

Edited December 9, 2014 by McDonut

[Dupe]

He was a douche and had it out for pilots. I wouldn't be surprised if people have hidden medical issues from him due to lack of trust.

Back on topic, there are some really good docs who do their job well and try their hardest to keep pilots flying. There are also some good docs that stay in the military to avoid the private bs, but now those will be inclined to leave because of too much military bs. Which is a problem.

I think there's a fair number who stay because the military BS may actually be less than the BS of running an office, dealing with insurance, and trying to grind out 14-16 hour days to make a profit. There are many good physicians who like the military because it offers decent pay while having reasonable hours.

[Guest]

Below is an article in the last Flightlines Newsletter (https://www.sousaffs.org/FLarchives/FL-2014Spring.pdf) from The Society of United States Air Force Flight Surgeons (SoUSAFFS). I've added some bolding for emphasis in the article body, but it is otherwise verbatim. If you want to really understand the medical concepts of BOMC discussed in these pieces, you can read it on pages 5-7 of the previous newsletter here:https://www.sousaffs.org/FLarchives/FL-2014Winter.pdf. Otherwise, all you need to know to understand the content below is that BOMC is a reimagining and re-structuring of medical resources within the Medical Group to make the servicemember's experience and the medic's duties less onerous. It is currently in the test and development phase but will hopefully be adopted AF-wide in the next few years.

Train Like You Fight

Dave "Indy" Prakash, Capt, USAF, MC, FS

B-52 Pilot-Physician

I read the articles by Gen Travis and Gen Cornum about BOMC and it echoed thoughts I've had since first joining the AF. The decomposition of the AME into the BOMC is long overdue and addresses a plague across the AF-inefficient and ineffective utilization of manning.

Back when I was a bright-eyed, bushy-tailed 31-year-old 1Lt and fresh out of pilot training, I joined my first operational flying squadron. I was surprised at how pilots spent their days in the squadron. We were in a perpetual struggle to schedule jets, aerial refueling tankers, and all the other training activities needed by pilots to maintain mission-ready status. The training flight and PRP shop were always in a thrash trying to get records ready for the next inspection. Every 6-9 months, we rotated new people into all of these shops. Why? Because we needed to do more with less. That, and everyone needed OPR bullets to show career progression through additional duties. There was never any stable expertise.

I used to half-jokingly propose that we cut 2-3 pilots every year. We could use the money saved in pilot training and operational flight expenditures to hire a few enlisted personnel or civilians who could become permanent experts in scheduling, PRP, and security. The rest of us could then focus on being better pilots. This is what the Reserves and Guard do.

As the "new guy" in the squadron, I used to take out the trash, vacuum floors, and stock the snack bar. But within a few months I was also responsible for PRP, safety, and security. I became the Life Support Officer, SABC instructor, and COMSEC Manager. These are important functions within a squadron. But as I spent hours managing Excel sheets and pushing paperwork, it was obvious a college degree was not necessary to do any of this, nor was pilot training.

I kept hearing... "We need to do more with less."

Then I started working as a flight surgeon. In my opinion, the purpose is simple-keep jets safely airborne. You do this by being competent, being available, and being ready to help a pilot back to flying status after you ground him. Your time should be spent primarily with the patient or researching the patient's problems. But I spent most of my time on administrative processes-documenting PDI for PRP, maximizing RVUs, and tracking metrics. I understand proper documentation is essential to patient care and that RVUs justify costs and future investments. I get it; we need to do more with less. But there comes a tipping point, when LOOKING good becomes more important than BEING good. And we begin to do LESS with LESS. All these metrics may fatten an OPR and get you promoted but they don't necessarily help get a jet off the ground.

I contrast my experience as a pilot and flight surgeon with what I did as a civilian intern before joining the AF. I worked 6-7 days a week carrying out a long list of "less than glamorous" tasks demanded of an intern. There was a lot of grunt work, but it was work that could only be done by a physician. I never scheduled patients, made beds, replaced oxygen tanks, or distributed medications. That's what social workers, clerks, and nurses do best...Doctors should be doctors. You can't win a Super Bowl when your quarterback has to play left tackle, too.

In the flying world, we say "Train like you Fight." We need to utilize people in the way we trained them. Flight surgeons need to focus on patient care over patient administration. THIS is how you do more with less. But identifying and complaining about the problems is the easy part. Getting BOMC off the ground is the hard part!

Which brings me to my parting shot...We reap what we incentivize. How can we incentivize the innovations that Gen Travis and Gen Cornum have prioritized when we have to operate within an enterprise that rewards patient administration over patient care? Maintaining the status quo will get you promoted faster than implementing a novel idea that may falter. "No" is always the default answer in a bureaucratic system.

In the nuke world, there is a zero-defect policy. "If one person poops the bed, we all have to wear diapers." If a commander implements BOMC but fails an inspection, subsequent commanders will add back layers of unnecessary reporting and documentation.

This is the military, I get it. You do what you're told no matter what. And if you don't like it, you can get out when your commitment is up. GMO flight surgeons are a renewable resource anyway. For every great FS that decides to separate from the AF, there are 10 medical students who are looking for a way to pay for medical school. The unmeasurable hidden cost of the current system is all the great leaders who have already left the AF.

Without identifying the purpose and rewarding both efficiency AND effectiveness, the streamlined BOMC construct will quickly decay back into AME.

Capt (Dr.) Prakash is a B-52 pilot-physician and Advanced Systems Project Officer with the 49th Operational Test & Evaluation Squadron, 53rd TEG, ACC at Barksdale AFB. He also maintains clinical proficiency in Aerospace Medicine with the support of the 2nd Medical Group, AFGSC.