Saturday, July 24, 2010

Having the Military Pay for Med School

    I write this having originally joined the Navy via NUPOC.  I did one junior officer tour on the USS Charlotte and then a shore tour teaching NROTC at SUNY Maritime where I took organic and biology at Columbia at night.  During this time I also spent five months at Kandahar Air Field with a small 82nd Airborne logistics task force.  As of writing this I'm a MSIII at USUHS.  I'll accept that I've gotten almost everything I've ever asked the Navy for.  Thus, when I haven't gotten what I asked for, it's been relatively easy to accept that my desires did not fit with the needs of the Navy even when those needs were noticeably in part due to individuals poorly managing human resources.  I think that it helps that I've generally tried to have a positive attitude about accepting that the needs of the Navy come first although the Navy tries to keep its people happy by giving them what they want.  One also must accept that as a massive institution the military has plenty of faults.  However, even with all its faults, I think it is one of the best, if not the best, institutions in the world due to the nature of its social contract.  
    The rest of this is just my opinion based on my experience and the asking of lots of people lots of questions about how things actually work.  You are free to disagree and comment if you think differently.  Further, you will find lots of people on the internet who will disparage the military and the military medical system.  Many of their critiques are valid, but nonetheless, I think the rest of the options are worse.  In military healthcare system no doctor will even make a clinical decision based on its financial benefits to him or her despite its negative health, welfare, and financial benefits to the patient.  I've written this for one friend who specifically asked about HPSP, but it could be useful to lots of other people, so I've posted it here.  
    The active duty commitment is only one year of each year you get the DOD to pay for medical school, so if you have them pay for all four, you owe four years of active duty not counting residency.  Any contract with military is for an eight year stint, with the number of active years specified.  So if you owe four, you get out with owing four years of inactive reserves.  This means that you are on a list of people who don't drill and the secretary of defense can force you to return to active duty, usually for one deployment, without actually drafting you.  Traditionally, this has been nothing, but in the last few years some Army and Marine trigger pullers have had it done to them.  I don't believe any doctors have had it done to them.  If you do a longer residency and/or fellowship than four years, you also add time on for that, usually on a one for one basis.  So if you do an ENT residency, five years, you then owe five years, plus the four for medical school, but they can be served concurrently, so you've really only added one year to your commitment.  Also, the time spent in residency or fellowship, if on active duty, counts towards your twenty for retirement.  If you do a civilian residency/fellowship, then you stay inactive duty, pushing your four year commitment for medical school to the right.  So if you owe four for medical school, and do a five year residency, you only must serve for four years afterwards.  The downside is that you received civilian residency pay of ~$40K while a military resident is paid based on his or her rank.  I expect to make about ~$100K as a resident no matter what my speciality.  You can also do a residency, then a tour as that speciality, and then go do fellowship or another residency without facing any pay cut.  Of course, you do extend your time where Uncle Sam gets to tell you where to live.   
    I would recommend the Navy over the Air Force or Army.  I think I've got good logically reasons, which I'll explain, but I'm certainly a bit biased by a relatively good ten years in the Navy.  If you really want to run around in the dirt, the Army is a good choice.  For instance I have a classmate at USUHS, who is not the super strongest academically.  (I'm not saying he's dumb; he's a perfectly good medical student, but no one considers him neurosurgery material.)   Although I haven't seen it, I wouldn't be shocked to notice him snacking on old shoe leather in the library because he likes the taste.  He plans to become a special forces doctor, likely via family medicine, and he'll be a better special forces doctor than someone who is neurosurgery material any day.   If you really want that, the Army is the best option.  The Navy and the Air Force can both give you that, but there are a whole lot fewer opportunities for it.  Another significant traditional difference in the Army is that it's been a stronger promotor of research by physicians.  This has been possible because of the shear greater size of the Army and may or may not change with Walter Reed closing and moving to Bethesda to combine with the Navy.  The move could make the Navy, and even Air Force, more supportive of research or could make the Army less supportive of research.  I've heard different opinions.  A third advantage of the Army is that its size and need for surgeons probably offers the best chance for someone academically weak to obtain a surgery residency.  If you don't match, you'll be assigned a residence based upon the needs of the service.  My understanding is that the biggest amount of unfilled residencies have recently be in surgery.  The big disadvantage of the Army is that, if a war is going on, you will likely have the greatest chance of spending a year living in a tent.  Conversely, if there are no wars, the worst you'll experience will be some weeks of field exercises and perhaps a one year unaccompanied tour to Korea.  I know one CNRA who never deployed from her commissioning as a nurse in about 1994 to about 2004.  She then did two six month deployments to Iraq as a CNRA, where she saw some pretty serious stuff and faced rocket and mortar attacks.  
    The Air Force is traditionally considered the best option if your number one concern is quality of life.  You will have to deal with people pointing out to you that you're really in just a world wide country club than actually the military.  Its also known for being strong in family medicine.  Not that family medicine is more competitive in other services, but that in the Air Force other specialities are more competitive because the Air Force wants lots of family medicine docs.  With family medicine you can be stationed anywhere, and I have heard of people getting places like England whereas a its almost impossible to get stationed there in the Army or Navy.  The Army does still have a bit in Germany, but not like during the Cold War.  The Navy has plenty of billets in the Pacific such as Hawaii, Guam, and Japan.  
    I think the Navy offers the best option of playing in the dirt if you want it, with the Marines, but then the option of not doing that if you don't want to anymore.  Because we're on the coast we generally have the best places to live.  Our big three hospitals are in San Diego, Bethesda, and Portsmouth.  San Diego and Bethesda both have great quality of life, and even Portsmouth, about which I had low expectations when stationed at the shipyard there, was way better than I had expected.  There are a few more out of the way possible duty stations, but if you'd like to avoid them, it's probably possible.  Although you could be a flight surgeon after internship, but before the rest of residency in the Army of Air Force, they have few enough, that you likely won't.  You will likely go straight through residency like in the civilian world.  The Navy still has many many general medical officer (GMO) billets.  This is like a general practitioner in years gone by.  For years there has been talk of ending the billets, but so far note much has changed.  In a straight up GMO billet you do physicals and sick call.  Quality of life is good, but interest of medical practice is low.  Some people can go straight through from internship to residency, but this is only determined during PGY-1, when you apply to PGY-2 onward and GMOs at the same time.  Besides basic GMO at some place like boot camp, you can also do Marine battalion surgeon, undersea medical officer with the submarine force or divers, flight surgery, and shipboard medical officer.  In all these billets you'll do physicals and sick call and serve as the medical officer, the person who advises the commanding officer of medical issues amongst his troops.  Any thing the commander thinks is medical, such as pest control, is likely to be assigned to your responsibility.  Think of these billets as you being a military officer first, who must be a qualified doctor to adequately perform your duties.  This is in contrast to a pediatric general surgeon in Bethesda, who is primarily surgeon, but wears a uniform when not in scrubs.  Many people want to do GMO because it gives them a chance to see the Navy and potentially deploy.  If you deploy with the Marines currently you'll fly on an airplane to Afghanistan, but traditionally you would float on a ships for six months pulling in to liberty ports waiting for the president to need some big guys with guns in a third world country moving towards chaos.  The battalion surgeon is responsible to make sure the minimal number of Marines come back to the ship with STDs and other more innocent infectious diseases such as malaria.  For some competitive subspecialties, such as ophthalmology and dermatology, it is de facto that you must do a GMO tour first because their competitiveness necessities the extra points in being accepted.  
    I won't detail the points system, partially because I don't really understand it, but it's the system by which the military formally weighs candidates for residency programs.  Each applicant is give certain points for grades, boards, research, GMO, and the such.  It's pretty opaque to us, but it is what it is.  Unlike the civilian match the military match is not done by a computer.  It is done by all the program directors sitting in rooms and deciding where each person will go.  It is done in December, so that those people who don't match in military programs can then enter the civilian match.  
    All branches require you to go to some form of initial accession training, akin to boot camp, but not.  As a doctor you will be commissioned either before you show up or when you show up.  You've earned your commission by being physical qualified and being in medical school.  You can go anytime during medical school that you can fit it in your schedule or you can go when you finish medical school prior to starting you career.  In the Army you'll have to do things like field exercises.  In the Navy you do some PT and learn what the ranks are in an air conditioned classroom in Newport, Rhode Island.  You may initially get yelled at, but after a bit you'll relax because the people running it are not really interested in expending enough energy to yell all the time.  It is not hard.  If you have trouble making it through, it is a safe assumption that you are trying to not make it through.  The Navy will then either cause you pain to stop being stupid or make things easier so you can't not make it.  Other than the scare tactics at the beginning, you will not be treated like feces.  
    In general as a doctor you chances of being hurt or killed in the military are pretty pretty low.  I believe that four doctors have been killed in Iraq and Afghanistan.  I don't know how many man-months doctors have spent in country, but four doctors in that many man-months could have died from anything.  I doubt the risk of being a western military doctor in Afghanistan is higher than that I accept by riding the notoriously unsafe Washington Metro to work most days.  

Sunday, June 6, 2010

DIY U, But Pay for Ms. Kamenetz's Book

So a book about the future of information being free, but individuals are expected to pay for a hard copy.
No free copy online? Plenty of people have proven that a free creative commons version online still supports the sale of books. I will only point to my own hard copy of Against Intellectual Monopoly that I bought after reading the entire book for free online. Thank you professors Boldrin and Levine.
Ms. Kamenetz, I will not be bothered to even read your generous chapter 6.

in reference to: Read the Book! » DIY U (view on Google Sidewiki)

Sunday, May 30, 2010

Are these people serious?

Do people really pay the American Antiquarian Society actual money to "license" images that are in the public domain, and thus can be used for free? If anyone does, please email me as I have a bridge between Brooklyn and Manhattan to sell you.

in reference to: Rights and Reproductions at the American Antiquarian Society (view on Google Sidewiki)

Thursday, April 29, 2010

Mantle of Leadership

    I recently came across this fine example of leadership by COL A. G. Pushmin of the Soviet Air Force.  It is from 1987, but it serves to remind any reader how a good leader might act.  I hope that I might utilize appropriate judgment as COL Pushmin does. 
    A warning that it is not suitable for small children or others who may be easily offended as COL Pushmin uses vulgar language to express himself.  The first page is the Russian original; the second page is the direct English translation

Wednesday, March 17, 2010

Why Intellectual Monopoly Matters

I just found this great research group that is actively looking at how intellectual monopoly hurts people. How it doesn't serve the public good.

in reference to: The Copy/South Research Group - Grupo de Investigacion Copy/South (view on Google Sidewiki)

Saturday, February 20, 2010

Kaplan Sucks

I would caution against purchasing any product from Kaplan. They have terrible customer service, and will not respond if you have trouble with their online service despite your spending of hundreds of dollars for their products.

in reference to: Welcome to Kaplan Test Prep and Admissions (view on Google Sidewiki)

Update: 27Feb2010

It turns out nothing is formally wrong with their site. What is wrong is that if you've entered your username wrong, rather than inform you that there is no user with that username, it merely logs you in to a new account. However, it doesn't tell you that you're in a new account without a paid subscription. Perhaps some savants are capable of keeping track of all their usernames and passwords. I am not, nor do I think most people are.

Wednesday, February 17, 2010

Great elimination of wasted time/effort

What do the teachers' unions think of this plan? It will certainly result in thousands of teachers made redundant. Many students will be able to go to community college at 16. Community colleges, with both more flexibility in hiring/firing instructors and more flexible terms for students, are a far better place for actually learning. Relative to high school there will be few people who don't want to be there wasting time on discipline.

in reference to: New Plan Would Let High Schoolers Graduate Early - (view on Google Sidewiki)

Tuesday, February 16, 2010

My first published article:

My first published article:

    Color Blindness and Military Fitness for Duty: A New Look at Old Standards. Military Medicine. 2010;175(2):84-85.

    As my two coauthors and I wrote this on government time, in accordance with our duties as either medical students or as a physician, one can safely ignore the copyright notice.  It really doesn't make sense that Military Medicine even bothers to copyright their journal as so much of the content is not legally copyrightable.  If for some reason you come across this post and think that I am wrong, please contact me, so we can work things out. 

MD SHA Needs to Learn Consideration for Pedestrians

    I understand that the Maryland State Highway Administration has been working very hard lately to clear snow.  I'm further sure that it's a difficult job that many are willing to quickly find fault with despite SHA working on limited resources.  Very few people would actually think that the Maryland SHA should invest in snow removal resources as much as the Vermont Agency of Transportation.  (I wonder if the Vermont agency actually accepts responsibility for more than just roads, as the name implies; that they recognize that transportation is more than just moving vehicles?)  Further, anyone is free to review this post in which I complimented SHA for a job well done.  So, as displeased as I might be about today's incident and SHA's proposal for a supposed multimodal underpass for the Medical Center Metro, I am not inherently an SHA hater, but when things like this happen, I have no choice but to publicize them.  I would much rather be studying. 

    With my acknowledgment of the above constraints, I still must put forth my displeasure regarding SHA's snow removal along Wisconsin Avenue in Bethesda this morning.  You can see in the geotagged photos the exact spots that I'm discussing.  As I proceeded north on my walk to work this morning, I was dismayed to find that in the process of removing some of the mounds of snow on the corners, the walk ways through the mounds had been filled in.  See picture to the above right.  Further, the one corner between my house and work on Wisconsin that hadn't had any snow removed, was the one that the owner of the property had failed to clear a path through.  Thus, all pedestrians are forced to climb over a three or four foot mound.  Further, in this process one can see, in the second photo, that SHA's equipment created a packed slick surface on the road that was more slippery than ice.  Why was no salt put down on these surfaces? 

    I thought this was the worst of it until I proceeded further north towards Jones Bridge Road, where I found SHA workers awaiting the return of dump trucks to haul away the snow.  Here I found a cleared sidewalk that had been nearly fully filled with ice chunks in while clearing the right turn lane onto Jones Bridge Road (see left photo).  I then sought out the supervisor (sitting in the truck) who declined to speak with me and asked me to contact SHA communications department.  I certainly understand such an action as I'm sure such is the guidance he has received from his superiors.  Prior to declining to comment though, he did respond to my question regarding when the sidewalks would be cleared from the debris they've just put there.  He told me that the sidewalks would be cleared "eventually".  When is "eventually"?  What if all of Wisconsin Avenue or another major road was not cleared of snow until "eventually"?

    Again I will state that I understand and accept that the SHA has limited resources.  Further, I accept the those of us who don't regularly drive our commute will not receive anywhere near our proportion of resources for infrastructure maintenance.  However, is it too much to ask that, in providing for snow removal for cars and trucks, that the poor state of affairs suffered by us pedestrians not be further added to?

Sunday, February 14, 2010

Thomas J. Donohue, great businessman

So this guy is doing everything he can to make Washington support pro-business policies. (The policies may or may not actually be pro-business, but that Mr. Donohue thinks they are, is what matters.) Has he every actual worked in business, or only trade associations? Does the guy actually know anything about running a successful enterprise? More likely he is an ideologue pushing his agenda under the rubric that it's better for business.

in reference to: Tom J. Donohue - Wikipedia, the free encyclopedia (view on Google Sidewiki)

Saturday, February 13, 2010

Not yet

I just thought about getting Netflix, but too much content is not available via streaming. I don't have a DVD player and don't want one. I would be willing to pay for content, but only if it's convenient and what I want is available.

I guess I will have to continue using BitTorrent. I don't mind ignoring copyright since it is not a net economic benefit to society and impinges on individuals' freedom without a corresponding benefit. However, I would be happy to pay for the creation of content at a reasonable price. Too bad the studios fail to accept the modern era.

It's the same with BBC iPlayer. We pay £10 a month for a UK proxy server in order to watch iPlayer. I would gladly give that money to the BBC in order to fund the creation of their programs, but they do not offer such an option.

in reference to: Netflix DVD Rental, Movies Streamed Online, DVD & Blu-Ray Movie (view on Google Sidewiki)

Wednesday, February 10, 2010

Thursday, February 4, 2010

My Political Views

My Political Views
I am a center-left moderate social libertarian
Left: 2.51, Libertarian: 3.17

Political Spectrum Quiz

Great Comment

My favorite comment on this thread.

in reference to:

"“My post wasn’t about what copyright meant when it was created…” You might as well be announcing that you’re an utterly clueless fucktard."
- Conventional Folly » Piracy. Is. Stealing. (view on Google Sidewiki)

Tuesday, January 26, 2010

The entirety of How to Frame an Athel...

The entirety of How to Frame an Atheletic Policy by Mason W. Gross.  Fifty years old and still the best piece ever written on the role of sports in the American university.

NY Times to charge in 2011

I've read the Times since I started reading the paper in middle school. It will be sad to stop reading it next year when they begin to charge. Although it once was worth it, in today's plethora of media options, it is not. Sorry NY Times that the 21st century isn't so kind to you. You will only drive more readers to NPR by charging.

in reference to: The New York Times - Breaking News, World News & Multimedia (view on Google Sidewiki)

Wednesday, January 20, 2010

Glory Days of Medical Education

    Reinforcing the public's adulation of medical research was the attitude of the researchers themselves; their view that medical research was a call­ing. their conspicuous disdain for commercialism, and their lack of inter­est in personal financial reward, provided that their laboratory and department were well supported. Medical scientists were hardly without ego or ambition. However, they sought nonmonetary rewards: approval and recognition from their peers and, for a lucky few, from society. The currency of academic medicine was not dollars but publications, appoint­ments, titles, memberships, and awards.

    Here was no better indication of the antipathy of medical schools toward commercialism than their attitude toward patents. In their view, the objective of medical research was to promote the public welfare, not to enable individuals or institutions to profit financially from inventions or discoveries. Most medical schools would not hold patents or accept royalties from patents that arose from university work. At the University of Rochester, for instance, neither George Comer nor the school's dean gave any thought to patenting Comer's discovery of the hormone prog­esterone. It was their position that no medical discovery should be com­mercially restricted, even for the benefit of a university.

    Although there were a few exceptions to this pattern, this was the policy at the two most important schools, Johns Hopkins and Harvard. At Hopkins, the dean declared that "universities (and particularly med­ical schools) do not belong in business. Any commercialization of the institutions will in the long run do the institutions great harm. Universities being supported by philanthropy and by State grants should not sell themselves in any way."  Neither the school nor individual faculty members owned patents, and the school refused royalties from patents growing out of medical school research." Harvard Medical School went further. Not only were patents by faculty members prohibited, but the school offered to provide legal advice to faculty members who desired help to prevent others from patenting their discoveries or inventions. When Harvard Medical School dedicated its patent on liver extract for the treatment of pernicious anemia to the public, it engaged in a "ven­omous discourse" with the "burned up" Eli Lilly Company, which had invested more than $1,000,000 in the work. Ully wanted "a special 'in'," but the school refused "in the belief that Harvard professors worked for the public interest." In research, as well as in education, American med­ical schools acted as a public trust.

The above is from p38 and 39 of Time to Heal by Dr. Kenneth M. Ludmerer.  There may be some OCR issues with the original because of our unjustifiable intellectual monopoly laws Google won't let me just cut and paste.  Those were really the glory days of medical education.

Tuesday, January 5, 2010

Medical 203, the precursor to the DSM...

Medical 203, the precursor to the DSM ungated.  This is not copyrighted despite Wiley's putting a copyright on it.  It was written by military officers, and is thus in the public domain.

Monday, January 4, 2010

As an American I sometimes disagree w...

As an American I sometimes disagree with my wonderful British wife about the absoluteness of freedom of speech.  I firmly believe that one's freedom of speech should never be diminished by someone else's offense.  That is, I can say whatever I want to offend anyone else no matter what. 

This does not include treason, which is what Islam4UK would be guilty of with their proposed march.  Not only should they not be allowed to march, but any attempt to should be meet with criminal charges of treason. 

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