What I Wish I Knew Before Military Medicine

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Military medicine allows you to serve your country, see the world, and accomplish things you never thought possible. That being said, it is not for everyone.

Here’s what Dr. Vivina Napier, a practicing military physician, said she wishes she knew before taking the plunge.

 

The Importance of Flexibility

The first thing to know before becoming a military physician is the importance of flexibility.

There is no such thing as “part-time” military.

During your commitment, you are the military’s business asset. Your annual physical, eye, dental, and mental visits are mandatory, and any medical issues must be addressed to keep you “fit for the fight.” You will have to keep up with your workout schedule and eat a healthy, balanced diet to pass your physical fitness tests. You’ll have to disrupt your schedule to complete mandatory urine drug screenings at the most inconvenient of times. You’ll have to reschedule patients due to last-minute deployments, commander’s calls, and training exercises.

Essentially, the needs of the military will often dictate the “if” and “when” of your daily tasks as well as your professional career goals. If you aren’t flexible, you’ll quickly become frustrated. But if you can learn to embrace the suck, the military will make you into an incredibly resilient and flexible physician.

You will also have to be flexible with where you live, so be prepared to travel a lot.

Whether it is a short temporary duty assignment, or TDY; a deployment for four to twelve months; or packing up and moving overseas to practice medicine in another country, you will become accustomed to traveling often.

That being said, traveling as a military physician can actually be quite enjoyable. It gives you the chance to experience a different standard of care and gain a first-hand perspective of what practicing medicine is actually like in another country. You can really immerse yourself in the mission of the base and the culture that you are in – but only if you’re willing to do so.

Physicians who are rigid and unwilling to break out of their normal routine usually find themselves unhappy with their assignments. If you can break out of that mindset though and remain flexible, you will gain a wealth of experience that is hard to find anywhere else.

 

Unique Military Medicine Challenges

There are many unique challenges that you will face as a military doctor that you won’t experience in the civilian setting.

The most apparent difference is the additional training you will receive. That means extensive trauma training, learning to load and shoot an M9 pistol, and training for chemical, biological, radiological, nuclear, and explosive emergencies. You will practice putting on and taking off Mission Oriented Protective Posture, or MOPP, gear until you can do it in your sleep. And you will complete a variety of drills including active shooter, bomb threat, mass casualty, and field medicine.

This all may sound like a lot, but it is what separates military medicine from “regular” medicine.

Each military base and its associated hospital also comes with its own protocols, resources, and limitations. Some bases have a high deployment tempo and task physicians with deployments outside their usual capabilities. Other bases are smaller and give physicians the opportunity to wear multiple hats. Almost all bases though will require even fellowship-trained physicians to maintain all their basic skills so they can use them while deployed.

The culture in the military is also very different from the civilian sector, so finding a physician mentor and an enlisted mentor early can help you adjust to the nuances of being in the military. They will help you perfect your military speak and, hopefully, protect you from making a fool of yourself.

Additionally, taking the time to learn your chain of command and understand their roles is important so you can better understand any orders and instructions that are given to you.

 

Career Pyramids

There are several “career pyramids” in the military. These are career tracks that prepare you to go into different areas of practice as a physician after medical school. If you have a clear vision of where you want your medical career to go, these career pyramids will help clarify what additional roles you should take on.

The four main career pyramids are the command pyramid, the academic pyramid, the master clinician pyramid, and the operational pyramid.

Command Pyramid

The command pyramid positions you for hospital administration and hospital commander roles. To position yourself for this career pyramid, you should take leadership positions in your scientific fraternities, or take on positions in medical student and resident councils.

Academic Pyramid

The academic pyramid positions you for a career in research and education. It allows you to enter into assistant professor, assistant program director, residency program director, project director, and lab research director roles. To position yourself for this career pyramid, you should participate in research projects and take on roles such as “education chief.”

Master Clinician Pyramid

The master clinician pyramid, also known as the fellowship track, positions you to become a subject matter expert in your field of interest. It opens the door to roles like Chief of Medical Staff or Consultant for the Surgeon General. To position yourself for this career pyramid you should not only pursue research experience and publications but also take on leadership roles in your anticipated specialty’s medical student group.

Operational Pyramid

Lastly, the operational pyramid positions you for careers in the special forces such as aerospace, dive, and flight medicine. To position yourself for this career track you should pursue extracurriculars with an emphasis on the field that you wish to enter. Volunteering for humanitarian medical trips can also be helpful in positioning you for this track.

 

Relationships as a Military Doctor

Relationships are complicated as a military physician. You are considered an officer and, as such, you are prohibited from dating other enlisted personnel. Doing so can be grounds for disciplinary action; so unless you are already married to enlisted personnel before you join, you should consider them off-limits romantically.

That being said, if you and your spouse are both officers, there are some things to consider. First off, you should try to stay within the same branch of the military. If you are in different branches, such as the Army and the Air Force, then one of you should consider switching to the other’s service. This will increase the likelihood that you can be stationed together in a “joint spouse assignment.”

Additionally, if you are both physicians, most medical specialties can find some common bases to be assigned together. You will have to consider hospital-based versus clinic-based specialties though. If you work in a specialty that is primarily hospital-based, then you are limited to only bases that have hospitals. By comparison, specialties that are clinic-based have more flexibility and can go to any base that has a clinic or a hospital.

This applies to dating between career designations as well. If you are dating a pilot, for instance, there are only about 5-10 bases that a pilot can go to. These bases may or may not have a hospital but will typically have a clinic.

Being aware of these limitations can help you tailor your medical training to increase your chances of being stationed with your spouse. Regardless, if you are in this position, it is best to contact your specialty consultant early to maximize your chances of being assigned together.

You and your spouse will also need to consider whether you want to start a family during your commitment. If you do, you will have to set up an emergency plan for your children in case your child care plan falls through. This outlines how your kids will be taken care of if there is a disaster that requires a short notice deployment for both parents.

 

Should You Choose Military Medicine?

While much of this might be perceived as “negative,” becoming a military doctor also has a lot of positives that you should consider when deciding if this is the path for you.

First off, you will be in a much better financial position during your training compared to civilians. The military will pay for your education and provide you with a stipend to cover any additional costs.

If you go the USUHS route, you will not only get free tuition but also serve as an active-duty 2nd lieutenant and be compensated as such.

The rationale is that your medical training is your one and only job. The military wants you to be able to focus solely on your studies and become the best physician that you can be.

The military education system also gives a solid educational foundation and exposure to some of the most cutting-edge experimental technologies and research available.

The patient volume in the military is also lower than in the civilian setting allowing you to spend more time learning and studying. If you’re worried about not gaining enough experience with the lower patient volume, there are also combined civilian/military residency programs available. These will provide you with more volume and give you experience with pathologies that are more common in the civilian sector.

The match process in the military also has a few key differences to be aware of. To begin with, the military match starts in December which is significantly earlier than the civilian match which starts in February. There are also additional factors to consider with the military match. Having prior active duty and service commitments, for example, grants you additional points towards your overall ranking as a candidate.

You are still able to apply for civilian residencies as a military physician as well. If you choose to do so, you will have to look at whether they have matched a prior military or USUHS student in the last 6 years. This will give you a better idea of your odds.

If you are planning on applying mainly to civilian residencies, you should still, at the very least, rank some military programs as well. Depending on the military’s current needs relative to the number of students in the military match for a specific specialty, you could get assigned to a military residency.

It is also to your benefit to do at least one interview over the phone so you can know which program you can tolerate if you do not get civilian sponsored or deferred.

Huge thanks to Dr. Vivina Napier for helping with the creation of this article.

If you’re thinking of pursuing a career in military medicine, be sure to check out our So You Want to Be a Military Doctor piece.

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