Reader Q: Why Did You Sign with the Army?

Hi Dr. SW101,

Enjoyed reading some of your blog posts both older and the newer army related ones today. Lots of smiles and chuckles, Thanks.

Laughter? In response to this blog? That’s TERRIBLE. This was supposed to be serious stuff. Like taxes. This is information. Data. Recommend re-read.

I’m curious to know why you signed up?

I signed up for the Army for one major reason and one minor reason.

The major reason was the craven want of money. I wish it was something more patriotic, but the primary motivation was an offer of a loan repayment grant and monthly stipend during my years in residency. The Army required nothing in return during my training years. Faced with sneaking my 6-member family into a 2-bd apartment that allows only 4 people, I took the money. Instead of the apartment, I was able to put my family in a cute 3-bd home on a quiet corner two blocks away from my training hospital.

The second reason was patriotic. Despite my vehement opposition to the war in Iraq, and moderate opposition to the war in Afghanastan, I was fully aware that primary care was severely lacking in the U.S. Army at a time when young Americans were throwing themselves into war. Irrespective of how I felt about those conflicts, I remain an American. News of my countrymen dying or suffering partially due to lack of good medical care was something I couldn’t tolerate.

I have always been taken with depictions of how our nation pulled together and sacrificed during the second world war. Back then, those war efforts were truly a national affair. Virtually everyone gave to the effort in some fashion. And, I think a huge reason for the wealth and power we have enjoyed for the past 60 years are a direct result of those sacrifices made by our Greatest Generation.

Pretty Sure I Woulda Deserted

“Earn this,” CPT John Miller, dying from a mortal wound during the Battle of Ramelle, implored Private Ryan in the Spielberg movie. The message, as I took it, was our generation (and the Boomers before us) must understand that great sacrifices were made to allow us to live on the top of the world as we have as Americans. It remains our mandate to earn that sacrifice; it was made before we even deserved it.

So I signed.

I saw posts about officer training and an earlier one about trying to figure out the military scheme as a civilian. What got you in? 

I think you’re referring to how I got into the Army as a civilian. If so, the answer is website: http://www.usajobs.com. Everything runs through this site. I applied to this site in the winter of my senior year of residency, and forgot about it. Literally. When I was called by the clinic here in Germany for an interview in MARCH the following year, I had no idea why.
If you want to get a job overseas, however, this is one of THE best routes. You can’t work for the State Dept as a doctor until you’ve been in practice out of residency for 5 years. You can’t get a job with any of the aid organizations unless you know someone AND don’t need money. So, this is a good option because the pay is steady, only slightly beneath the national average, and comes with perks that don’t usually accompany private-sector jobs.
There’s lots of archane goofiness that come with Army medicine. There’s lots of unusual quirks that are a result of non-medical “commanders” decreeing all kinds of demands from on-high.
But, in reality, every managed care organization functions like this these days. I wouldn’t put Army medicine behind or beneath any of the major HMO’s (in principle, I haven’t worked with any of them). I think Army Med is about on-par with most of American medicine…approximately 18th best in the world.
Also wondering why Olympia was your first choice? You’ve said elsewhere that Ventura is probably the best FM program in the US. I’ve heard of a number of graduates going to Tacoma Family Medicine and lots of interest in Alaska, too. Can you comment on them?
I am very proud of my FP training program, and maintain the belief that it is one of the best programs on Earth, and THE best on all outlying planets. I firmly believe that Providence is one greatest healthcare organizations anywhere.
But in all honesty, I have to say that Olympia is not the best. Just MY best.
English: Statue of Father Junípero Serra. Vent...
Father Ventura, surely a surfer
Ventura is better. Better than anywhere else I know of (and I practically got a PhD in FP residency research during med school). The hands-on experience they allow there, assuming times haven’t changed, is second to none. The faculty are top-notch; some are dual-certified, etc. Facilities suck, too, which is great. I can think of no better means of preparing an FP to deal with a crappy, under-funded, under-supplied environment where the only thing you have to give to patients is your training.
I was told I had a shot there. What they told me likely sounded MUCH like what they tell EVERY short-white coat wearing minion worshipping at the altar of VCMC during their exit interview. But I still like believing I coulda made it in there. I never ranked them, however, because my large family would have needed to live in a box on the beach to afford the cost of living in Ventura. And, truth be told, since I could have reasonably placed that box at the point at Fairgrounds (read: KILLER surf spot), residency would have been AWESOME for me. Just not for my kids waking up with sand fleas in their eyes and facing yet another breakfast of seaweed and/or Wonderbread bologna plus peanut butter sandwiches at the local Rescue Mission.
One nuance Ventura is the dual FP/MPH program at Dartmouth which is as good as it gets if policy and health system design is your calling. Love it or hate it, the Obama Health Care plan wisely referred to the health resources utility research out of Dartmouth. Although barely ranked, I am of the opinion that Dartmouth is actually one of the best – if not THE best – MPH program in the country because the research and work they do is prescient, unassailable, repeatable, tested and longstanding.
Tacoma is a great program, but they have nothing on Olympia. Their city smells weird, their facilities aren’t any better than ours, and we do rotations at the Peds ER up there anyway. So I recommend ranking them 1/2 with the top choice going to the town you like best.
Alaska is probably a lot like Ventura. Sans wicked right point-break and unfortunate box.
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Yesterday O’Clock

Special Forces Sniper
This guy was dead asleep in his underwear exactly 33 seconds ago.

Doing Army stuff is awesome.  Except that it starts so early, the time is best described as “yesterday.” 

It’s not uncommon to hear (through my ears), something along the lines of “Formation at Yesterday O’Clock, soldiers!  Then we head to the range for M-16 qualifying.” 

I assume he means we will be qualifying with the rifles by the light of Orion’s belt, since that will be the major source of target illumination for the next 5 hours.

My particular training class has a group of Army Rangers in it, along with some Special Forces guys too.  They all decided to hang up the guns and take up stethoscopes as P.A.’s and pursue things in life, like hobbies and families.  As you might expect, these guys can handle Yesterday O’Clock better than anyone. 

It’s a bit mystical, really.  In our tent of 30 men, someone starts to stir at the ungodly prescribed hour, and everyone just organically follows suit.  Soon every guy in the tent is methodically working step-wise to primp themselves (Army-style, more on that later) for another dimly lit Army morning. 

Everyone except the 4 Rangers.  They stay there, still as statues, enshrouded in their sleeping bags while the tent becomes a kicked anthill of activity.  The minutes tick by, the spectre of arriving to formation suffusing the humid tent’s air. 

Maybe these Ranger guys so easily stare down scary things like being late to formation because they’ve stared down much scarier things, like death via hot shrapnel.  Whatever.  Fine. But here in our little AMEDD training world, being late to formation is scary.  And being late is easy, because it’s scheduled so freaking early, it’s yesterday o’clock.

As the appointed “time” (more of a philosophical concept, this early in the morning) approaches, a frantic rush ensues.  In desperation, we huff out to stand in our little box of humans, also called “formation.”  And guess who’s standing there, looking sharp and ready to plant a spear in a saber-tooth bear? 

The Rangers.  2 minutes ago these guys were lined up on their cots like 3-toed sloths on an ativan drip.  The rest of us have been running around for 45 minutes. 

“Where you guys been?”  One of them asks, as I run up, wild-eyed and still priffing with my uniform.  “We’ve been here since yesterday.”

Smarching

Sprinkler03
Me, spinning in formation

“1st Platoon!  Atten-SHUN!”

We all throw our shoulders back and stare straight ahead into nothing.  And we don’t move.  Leaders mill about, thinking about things, looking over their retirement accounts, playing Tetris on their phones. 

But we, the little people, just stand there.  Sweating.  Sweat runs in what feels like lightning patterns down my face.  Down my neck.  My back.  My rear…and down my legs.  I stand there taking a sweat-shower.  Spin me around fast enough and I’d fling so much water in every direction I think I could personally ease the drought problem in Texas.

“SMAAAARCH!”

Well, he actually say ‘march,’ but, really, you just can’t call it that.  No nuance.  We aren’t marching.  We’re walking around in 104 degree F heat, with sweat pouring from our bodies on par with your average Bangladeshi monsoon.  So we’re sweating.  With a little marching thrown in. 

It’s smarching.