The classic TV show and film MASH has given us a distorted view of military doctors. First, it focused on surgeons drafted into a war zone.
Second, it was both comedy and anti-war satire. Third, times change, and the military changes with it: The classic Mobile Army Surgical Hospital no longer exists, having been phased out in 2006 and replaced with a smaller, more efficient system of treating battlefield casualties. And finally, physicians are no longer drafted—physicians in the military want to be there. And many want to be there because it can be a unique situation for a rewarding long-term medical career.
In reality, only a small proportion of military physicians are deployed to war zones. All branches of the military have a need for all medical specialties, from trauma and emergency surgeons to dermatologists, psychiatrists and family practitioners. In the U.S. Army alone, there are over 650,000 soldiers and officers stationed all over the United States, including Alaska and Hawaii. They also have missions in Korea, South America, Africa, and obviously, in Iraq and Afghanistan.
But military physicians not only take care of military personnel but also their families. Frederick Lough, M.D., is the director of cardiac surgery at George Washington University Hospital. He is also a colonel in the Army Reserve. “We have 4 or 5 million people, once you blend in the active duty, the reserves, the dependents and retirees. It’s an immense medical system that takes care of neonates to retirees to the acutely injured in combat. When you start adding those up, it’s an immense mission that goes on every single day.”
Medical specialties needed in the military
Clearly, with such a range of people to take care of, the military needs physicians in all specialty areas. Like any institution, specific needs will vary.
Col. Jeff Vista, M.D., an emergency medicine physician with the Air Force stationed at Fort Sam Houston in San Antonio, Texas, says, “The Air Force’s greatest need right now is primary care, internal medicine and family medicine. We are in need of general surgeons as well. There’s not as much need for emergency room doctors right now.”
He also notes that there’s a fairly significant need for psychiatrists at the moment.
Openings vary from each branch of the military, and over the course of the next few years, the military is undergoing a drawdown as U.S. troops gradually withdraw from Iraq and Afghanistan.
In the Army, Lough says, “Essentially we need everyone—specialties across the entire spectrum, because of the nature of combat operations. The more acute needs are in general surgery, orthopedics, anesthesia, thoracic surgery and neurosurgery.”
Military physicians: Stationed vs. deployed
Essentially, being stationed somewhere is where you will live and work most of the time. For many physicians, that is a military base in the United States, although it could be on a military base somewhere else in the world—Korea or Europe, for instance.
Being deployed typically refers to being sent to an active military zone for a limited period of time. That could mean being deployed to a military base or hospital in a war zone like Iraq or Afghanistan, to one of the surrounding support areas, like Qatar or Saudi Arabia, to a relief effort such as the earthquake in Haiti, or to other areas within the United States. There are nuances to the use of “deployed” and “stationed” that vary from military branch to military branch and to different situations, but these definitions should be considered in understanding where a physician might end up.
Transitioning out of military life
Physicians who have careers in the military may decide for a variety of reasons to leave for civilian careers. Some retire, some have met their military service obligations, some may tire of deployments and the stress and pressures it can place on families.
Mark Lenneville, managing partner for Uniformed Services Health Professional Placement (ushpp.net), says, “Military physicians are highly sought after by civilian health care providers.” They typically have completed their residency and worked in their specialties for several years, which is attractive to employers.
Military physicians also bring more to the table. Leadership is a key advantage. “Most have held leadership positions and have had numerous courses in leadership,” Lenneville says. “In general, they get along with people and have a sense of the value in teamwork where everyone plays a vital role in accomplishing the mission.”
In his experience, Lenneville notes that although there is no typical post-military career path, most military physicians who leave the service enter group practices that are independent or affiliated with a hospital or hospital system. “A few start their own private practice, but this is not the norm,” he says. Some return to government service with the VA or Public Health Service.
The challenges military physicians might find in the transition to civilian life aren’t medical or technical, generally, having trained and served at some of the top medical facilities in the world. The primary challenge is few of them have been employed as civilian physicians.
“The greatest adjustments seem to relate to finding, interviewing, negotiating and securing a position,” Lenneville says. “The whole recruitment and placement environment is often a challenge.”
Plan to start your job search about 12 months before your date of departure from the military, he says.
Lenneville points out that, for the most part, military physicians aren’t in medicine for the money—but to practice medicine and to serve.
“They did it in the uniform and they do it in the white coat,” he says. “The sense of service to others and the greater good are part and parcel to the ethos of military medicine, and these physician patriots live this each day while in uniform and carry it with them when they take off the uniform.”
Length of deployment also varies greatly from branch to branch and will also vary depending on what missions the military is involved in worldwide. Vista, for instance, has been in the Air Force for 20 years and has been stationed in the United States his entire career. He has, however, been deployed three times. Vista’s deployments ranged from three to six months. The first was from November 1996 to February 1997 in Saudi Arabia, where he provided medical support for the Air Force while they enforced the no-fly zone in Iraq.
“My second deployment was right after 9/11, when I deployed to Diego Garcia, a small island in the Indian Ocean, supporting bombers who were doing the bombing runs for Afghanistan,” Vista says. “I was deployed as a Critical Care Transport Team doctor. That’s the flying ICU-type activity, where we provide critical care in the air.” The CCTT deployment lasted about four months. Vista’s third deployment was in 2007, when he was deployed to Iraq for four and a half months with Air Force Special Operations.
Although Air Force deployments are fairly short—at the moment—Army deployments tend to be longer. Part of the reason for that is simply that the U.S.’s involvement in international military operations currently uses the Army and Marines the most in ground battles along with some Air Force support. The nature of the combat missions and resource needs define and determine deployments.
Major Aaron Saguil, M.D., MPH, with the U.S. Army’s Department of Family Medicine, was deployed for four years to Ft. Gordon in Georgia, then for 15 months in Afghanistan. Saguil notes that he went seven years without a deployment, and although it’s fair to say he wasn’t terribly excited about leaving his family for 15 months, it was something he discussed with his commander in terms of his career. “You don’t ask people to do twice what you haven’t done once,” he says. “But the needs of the military outweighed my need to be with my family, so I deployed. Fifteen months anywhere away from your family is a long time. But it was one of the most professionally satisfying things I’ve ever done.”
That is a comment made by every physician interviewed for this article: That although their enthusiasm for a long deployment away from their family was mixed, ultimately it turned out to be an excellent experience.
Lt. Col. Samuel Munro, D.O., a family physician stationed at Randolph Air Force Base in Texas, has been in the Air Force since 2007. He deployed to Qatar as
part of his contract with the Air Force. “I enjoyed the experience. I got to work with some very good people, got to see a part of the world that I probably never would have seen that wasn’t completely terrible. I got to see some things I never would have seen, got to do some medicine I never would have been able to do, like deployment medicine and travel medicine.”
Saguil echoes the sentiment, noting that he spent 15 months in Afghanistan in an Area Support Medical Company. “It wasn’t attached to a specific combat unit. I was supposed to provide health care for a geographic area. One of the things we try to do is work across the different services, with Air Force, Navy, also with coalition partners. I co-located myself within a Canadian hospital—a NATO hospital—which was about 70 percent Canadians, about 20 percent Americans, and a small percentage of U.K., Dutch, Australian, and New Zealanders. It was one of the most rewarding experiences.”
Professional and personal requirements for military physicians
The physicians interviewed for this article illustrate a broad background and history in medicine.
Lough, for instance, attended West Point, completed Airborne and Ranger training, then attended medical school on a military-sponsored scholarship. He stayed in the military for many years, then resigned and went into private practice for about 15 years. He then joined the Army Reserve in 2005.
Munro, on the other hand, was in private practice for about nine years, running a solo family practice in San Antonio, and decided to pursue other medical career opportunities.
He settled on the Air Force. “I would be what you might say coming into the military as a fully qualified physician,” he says. “We’re seeing a little more of it. Not as much as we’d like, but a little more.”
Vista went to college at West Virginia University in the Air Force ROTC program, then attended military medical school at the Uniformed Services University of the Health Sciences in Bethesda, Md.
Professional requirements are typically being board certified or board eligible, although there are educational opportunities through the military as well. There is a requirement for U.S. citizenship.
Capt. David Seelen, an Air Force Health Professions recruiter, says that a physical exam is part of the entry process. “There are some instances when a current or previous medical situation can be a disqualification. A MEPS physician will discuss all past medical history, and make a determination if a member is qualified for entry.”
The Army takes physicians up to the age of 52 with no special requirements. After age 52, waivers are required by the Assistant Secretary to the Army. Each application is approached on a case-by-case basis. The Navy has the same standards.
Capt. James J. Chun, a Navy Medical Corps career plans officer, says, “Physicians with particular critical-need specialties can apply for an age-waiver by way of the recruiting process. . . . The bottom line is a Navy physician must be in good physical shape with no debilitating medical conditions, and he or she must be worldwide assignable and globally deployable.”
Pay and benefits
How does military service compare to equivalent positions on the civilian side in terms of pay and benefits? Surprisingly well for the most part, although it varies from specialty to specialty.
Base pay and allowances are based primarily on rank, time of service and specialty area. Board certification also plays a factor. Vista says, “The Air Force tries to shoot for the median pay for what similar specialists get on the outside. There are still some disparities, particularly with the high-paying specialties on the outside, like surgical specialties. Those are the ones likely to take a significant pay cut coming into the military.”
Vista notes that primary care specialties are very comparable and in some cases, like pediatrics, the average pay may actually be slightly higher than the median pay for a physician. There are, however, significant benefits for a military physician compared to their civilian counterparts, although they are less tangible than a paycheck. First, military physicians don’t have to worry about medical malpractice insurance. Retirement and pension are excellent, as is the physician’s own health care insurance. Retirement is based on half of base pay, which is substantial, and probably slightly better than retirement for the typical federal government employee.
Munro weighs in with one of the key benefits: “Your day is not taken up with a lot of the administrative part of your practice—that is done by the administrators and office managers of the squadron. I can focus on being a physician, not an administrator or an insurance agent. I get to use my craft.”
Munro notes that, for him as a family practice physician anyway, the hours are quite regular—more regular than they were in private practice.
Some pay is also tax-free. This applies to service in a combat zone. According to the IRS: “If you serve in a combat zone as an enlisted person or as a warrant officer (including commissioned warrant officers) for any part of a month, all your military pay received for military service that month is excluded from gross income. For commissioned officers, the monthly exclusion is capped at the highest enlisted pay, plus any hostile fire or imminent danger pay received.”
Another plus is the current GI Bill. Put into effect after 9/11, called the Post 9/11 GI Bill, under some circumstances the educational benefits of the bill can be transferred to dependents. Vista says, “My education is paid for already unless I decide to get an MBA or something, but with this bill, I can pass the benefits of my military service on to my children to help pay for their college.”
Of course, one potential benefit is the patient population. Although it varies greatly depending on your specialty and whether you’re deployed, in general, the population is largely healthy.
Vista says there’s a running joke among military physicians that the most compliant patients on the planet are Marines. “If you tell them to wake up every three hours to take a medication, they’ll do it on the hour every hour all night long.”
For more information: Recruiters for each branch of the military are based regionally. To find a recruiter in your region, visit the following websites.U.S. Army, U.S. Air Force, U.S. Navy.
Do you have what it takes to be a physician in the military?
Aside from being a qualified physician, are there qualities that a military physician needs that might differ from a civilian physician? A military physician has all the same qualities as a civilian physician, presumably: intelligence, a desire to help others, a desire to care for patients. There are a few other traits the physicians interviewed suggested would help.
Lough suggests “a willingness and anxiousness to help others and work with others, an appreciation of the team aspect of the enterprise. It’s not just about the surgeon or even the surgeon and the patient; it’s about the need to take care of people, particularly in dangerous environments.” He also notes that a military physician during deployments needs to be willing to trade personal comfort and one’s own comfort zone.
Flexibility and an ability to change gears are skills also cited by several physicians. Munro says, “One month you might be in a clinic, and the next month involved in leadership activities. The next month you may be working in a deployed situation, so you need to be able to adapt well.”
Vista agrees, particularly in terms of being willing to move regularly and deploy for extended periods of time. “You need to have a flexible family and a certain sort of stability and support to handle the reality that an active-duty member may deploy for six months or longer. You need to be able to know that everything will be OK at home. Not all families are that flexible.”
One thing that crops up in every conversation is the willingness to serve.
“The one trait that I think distinguishes the military physician a little bit more is that commitment to service,” Saguil says. “It certainly requires a fairly developed service orientation to be willing to sign a portion of your life away, as well as a portion of your autonomy. One of the things a military physician does is put themselves at the Army’s need, so if the need coincides with their desires and aspirations, all is well and good. But sometimes the Army needs us to do things we’d just as soon not do, and sometimes that leads to frustration, but oftentimes it leads to opportunities for things we wouldn’t otherwise experience.”
Military physician job satisfaction
Not everyone is suited for a career in the military. However, the physicians interviewed for this article, whose individual experiences vary across the spectrum, all cite a high level of job satisfaction.
Munro notes that it’s been a very good experience for him. “One phrase I’ve used was that I was able to get my life and practice back from the insurance companies. I’m home every night at 5:30 or 6 so I can have dinner with the family, and I’m not spending my evenings on office paperwork.”
But know what you’re getting into. Understand fully what the military represents. The primary purpose of the military is to fulfill our nation’s policies. The basic unit of the military is the infantry soldier. Everything else is focused on helping that infantry soldier do its job, whether it’s medicine, air support or naval activities.
“Medical service is subservient to the infantry soldiers, who are subservient to the goals of the U.S. government,” Saguil says. “If you’re going to make a career in the military, which isn’t for everybody but is for a lot of people, you have to be able to do the ultimate act, which is to support the infantry soldier on the ground fighting our nation’s wars.”
Read about Mark Terry, a frequent contributor to PracticeLink Magazine, on page 12.
June 1, 2009
PracticeLink
