The Military Medicine Route: Our Experience and What I Can Tell You

The Military Medicine Route: Our Experience and What I Can Tell You

Before I tell you what I know, let me first tell you a little bit about my husband and I’s medical journey. I tell you this to demonstrate that I do not have an exhaustive knowledge of how to join the military and have medical school paid for, nor do I have complete knowledge of ALL THINGS MILITARY RESIDENCY. Our way is one of many ways and I know what I know because of my husband. For us, there was never a question of should we go civilian or military? It was always military. He loves this country and he loves the Army. It was going to be military whether medicine was involved or not. Lucky for us, it is.

C (he prefers me to not use his name) went to undergrad on a full Army ROTC scholarship. This means that the Army paid for his education in full and in return he would owe them 4 years of his life after college. During ROTC he learned pretty much all you would want to know about the Army. He’s the guy to go to in his residency if you have a question. He can carry himself well in a circle of regular Army guys who are talking about training and military operations. He is very HOOAH (an Army thing, trust me on this). He knew he wanted to go to medical school however, so when the time came he began applying. He applied to civilian programs and to what we’ve come to call “the military medical school.” He was accepted to both a civilian school (and waitlisted on a couple), and Uniformed Services University of Health Sciences (USUHS). He and I sat down and weighed the cost:benefit ratio of both options. He could go civilian on an Army scholarship. The cost of school would be paid for, and I think he might have received a living stipend (HPSP pros, correct me if I’m wrong here).  He would only owe 4 years post-residency, adding up with ROTC to a total of 8 years obligation time when all was said and done. He would commission as a 2LT (second lieutenant) in the Reserves, and become active duty upon graduation.

If he went to USUHS he would commission as an Active Duty 2LT, which in effect, means he would be PAID 2LT pay throughout medical school in addition to having all of his school costs covered- books, everything. At the beginning of each semester, they would literally hand out stacks of books. Books they got to keep.  So basically, he wouldn’t have to pay for any part of medical school. In fact, he instead would be paid to go to medical school. In return, the payback time is a heftier 7 years. So added to ROTC time, he would owe 11 years of his life in service to this country POST-residency.  Your obligation time- regardless of which path you choose- does not begin until after completion of residency.

There’s a million other finer details in differences between USUHS and getting a military scholarship to civilian medical schools, like the extra 900 hrs USUHS students spend in classes specifically dedicated to the history of military medicine, military medicine in general, combat care, and actual field exercises during the summers after MS1 and MS3, or the fact they wear a uniform to class every day instead of whatever they want. That’s another post for another day, I suppose.  Let me be clear though: One is not better than the other. Everything depends on what is best for your family, your situation, and what you really want out of this. Ultimately, C chose to attend USUHS and has been grateful for this choice every day since, for a lot of reasons.

So let’s talk about military residency, which is why I’m here to begin with.

Prior to residency (ideally, though one of our HPSP friends never went and is having to complete this sometime during 3^rd year of residency or shortly after), you have to attend Basic Officer Leader Course (BOLC) (it was just Officer Basic Course when my husband went- OBC). Here you learn the basics of how to be a military officer. This is a CRITICAL difference in military residencies and civilian residencies. In a military residency, you are not just a resident. You are an Officer in the United States military. That MEANS something.  At it’s most basic it means you need to know how to put a uniform on and where all the pieces on your uniform go (sounds a whole lot easier than it really is, my friends). At it’s most complex it means you are technically a leader, a military leader, which means you should probably know something about how to do that.

To be fair, we don’t often feel the military aspect of things during residency. Aside from the fact my husband gets dressed in ACUs (Army Combat Uniform) every single day, and that he is paid better than the average resident since he is paid as a military officer and not a resident physician, we are currently in a place where our life is a lot more medicine than it is military. Except when it isn’t. My husband sees injuries sustained from soldiers jumping out of helicopters and airplanes- sometimes carrying 60lb backpacks- every day (and night), and navigating thickly forested areas in the black of the night. He sees severe PTSD in soldiers who have watched their friends blow up, or dragged their bodies- missing limbs- out of harm’s way.  These are hard reminders of what real military medicine is going to entail one day, outside the safety of the hospital.

There are other, less heavy things, of course.  The electronic medical records system, for instance. The military- ALL of the military- uses the same one, and it’s something that new residents have to learn during orientation. It can take them awhile to get it down. It’s August, the second rotation of the medical year, and my husband is on night float with a brand new intern. He has spent a good chunk of time helping him navigate AHLTA (this is one of those finer details about going to USUHS… they already know the system when they get there), even though this intern was taught AHLTA during his month of orientation and has already spent a whole month using it. That’s not to say it’s hard. I hear it’s just cumbersome.

Another thing is the C4 course: Combat Casualty Care Course. I’m not sure if this applies to other services (please chime in down below in the comments!), but this is how it is for Army. If you didn’t go to USUHS, you have to spend something like a week or 10 days (can’t be sure since C didn’t have to do it) down in San Antonio at Camp Bullis doing combat care training. Basically you get specific combat medical training and play Army in the Texas heat learning how to care for casualties in combat situations. The reason USUHS graduates do not have to do this is because they do something called Operation Bushmaster summer before their fourth year of medical school. Theirs is 72 hours of continuous operations out in the woods (the location may have changed since C’s time there). “Continuous operations” means that during those 72 hours, ANYTHING can happen- day or night- and they have to manage it, just like if they were deployed. That experience culminates with a mass casualty simulation in the middle of the night where all the first year medical students (they go out in rounds though, so it’s not all 150 MS1s, but more like 50), decked out in the most realistic stage makeup you’ve ever seen, are laying in the woods moaning and yelling and groaning and being injured like a massive IED has been set off. The MS4s are dropped some distance away and have to navigate their way to them, assess the situation, set up triage, care for the ones who need care on the spot, decide who to put on a helicopter, and who is a lost cause. All while being shot at with paintball guns and yelled at by the faculty who are acting as enemy combatants or just bystanders who hate Americans or curious well-meaning bystanders who do nothing but get in the way and impede the situation. They receive a grade based on how well the situation is handled overall and how well they individually play their part.

Beyond these obvious differences, I don’t know exactly what a civilian residency is like, so I can’t be sure exactly what’s different and what isn’t about a lot of things- particularly the day to day. I imagine the inprocessing is different in some ways. For the military you have a get a lot of things in order- all of which are done through your command, which is NOT the same as the residency program director. So you have to learn and know about a whole other chain of command. The staff and faculty of the residency are not the only people who have control over what you can and can’t do.

You can’t leave. Haaa. Kidding! You can, but it has to go through several levels of command before you can. If you want to travel outside the 250 mile radius from your duty station, you have to fill out a request for it. You can either get a pass, or take leave. Both of these have specific requirements and regulations in the military. I’m not listing details here because I imagine it varies depending on which service (Army, Air Force, Navy), and also by particular duty station.

I guess what I’m trying to say is that there a million little subtleties about being in a military residency, but the bottom line is that the actual residency part is just like any other residency. They have to follow the ACGME guidelines. They work the same as any other civilian resident would. Not a single thing is different about the medical aspect, aside from the fact you have a very specific kind of patient population, and that it’s probably best if your husband learns the ranks, because I will tell you- a soldier is a lot more likely to be compliant with his doctor’s orders if he believes his doctor really knows what his/her life in the military is like and what that means to them.  Showing that you know their military life begins by addressing a soldier by their rank. It says to them, “I’m not just here because I wanted my loans paid off, or because I got my medical school paid for. I’m here because I care about YOU, and I know YOU. You have a title and I respect you enough to recognize that.” Rank says a lot about a soldier’s level of experience and the kind of experiences they’ve had. The tabs and patches on their arms say a whole lot more.  To be able to talk to your soldier patient on their level genuinely helps them respect you- and listen to you- a lot more. I know that sounds crazy. It sounds so superficial and shallow. But the military population is a very specific beast, and to really connect with that beast you have to speak its language.

Finally, the biggest and most important difference in military and civilian residencies is what happens when you’re done. When you finish a civilian residency you’re a free agent, so to speak. You have to interview and negotiate and work out contracts. You don’t ever have to go serve in a place where you might get blown up. When you graduate from a military residency, they own you. They bought you for the price of your education, and then paid you pretty nicely throughout residency, so you owe them. There are several ways in which you can pay them back- clinical spots, operational spots (as in, with an actual military unit serving in any of several medical officer capacities), but you do owe them. The nice thing is that you don’t have to worry about job security.  In terms of pay, you receive pay based on your rank + years of service. Your years of service begin at the start of residency. Currently, my husband is a CPT (captain, pay grade: O3, which reminds, pay grades are a whole other important topic to learn if you’re going to go military…) with 2 years of service. Next May he will be an O3 with 3 years, which is a raise in pay. Once you graduate from residency and become board certified, you receive two lump bonuses- unfortunately I cannot remember what they’re called right now- and you receive them every year.  They vary in amount based on specialty. These bonuses are designed to help compete with what civilian physicians earn since military physicians are not actually paid as physicians but as military officers. This fact means they earn more money in residency, but eventually less money in the long run than their civilian counterparts, thus… incentive pay bonuses. Sounds pretty sweet, yes?

But let’s not forget the elephant in the room. Military doctors deploy. It doesn’t matter what your specialty is and whether or not you think it will be useful in combat. The Army will not hesitate to put a board certified cardiologist in the position of Brigade Surgeon (heads up: not actually a surgeon. This is Army speak for Head Doctor for this Set of Soldiers). Or a pediatrician in an emergency room in a combat hospital. Or a gynecologist as a Battalion Surgeon.  They will deploy. Even with our presence in the current conflict winding down, they will likely deploy. Four years owed is a long time, and the military is hurting for physicians in a big way. The men and women fighting over there? They need competent care. They need doctors who can save their lives if they need it. They deserve that. The military has paid for your training; it’s only fair that you repay that debt by using all that training to care for those who are in harm’s way. The only way to really do that is to be over there with them, ready to act on a moment’s notice.

There’s so much more, but I’ve gone on long enough. I’m not even sure that this has been tremendously helpful or if I’ve told you anything you don’t already know.  I would love for HPSP wives to share their experiences in the comments below, since my knowledge of the HPSP track is very limited.

Here are some resources I’ve found to be helpful and informative in our military medical journey:

Books:

On Call in Hell: A Doctor’s Iraq War Story, by CDR. Richard Jaddick

(phenomenal, phenomenal book. Really. And so important. Particularly the one of the last chapters on how the military recruits physicians. He recognizes the need for the military to have physicians who really WANT to be in the military because they are going to do the MOST good for those soldiers.)

Paradise General: Riding the Surge at a Combat Hospital in Iraq, by Dr. Dave Hnida

(also a great book, written by a family medicine physician who volunteered in 2003 after the war started. His stories really encapsulate what military medicine is really like.)

Websites

http://www.dfas.mil/militarymembers/payentitlements/militarypaytables.html

Obviously download the pay table from January 1, 2013. This shows the current pay amounts for all pay grades, and if you scroll down you see the medical special pay. It’s complicated, but it’s all right there.

Movie

This one is obviously specific to USUHS, BUT! This documentary really highlights the need for military physicians. This is a link to the trailer. If you have any interest in military medicine or USUHS, I HIGHLY recommend watching this movie.

http://www.fightingforlifethemovie.com/trailer.html

Even better than the trailer:

http://www.fightingforlifethemovie.com/makingof.html

This link shows behind the scenes from the movie. If you ever wanted to see what a combat hospital looks like- you'll see it in here. Great footage of what military medicine looks like in the day to day. Not only do you see footage from a combat hospital in Iraq, you also see the chain of transport from Iraq to the US. They are following the story of a soldier who lost one of her legs. If you watch until the later parts, you actually see footage of the USUHS training exercises and Operation Bushmaster, which I mentioned above. Good stuff here.