Military Medical Practice: Options Plentiful for Physicians

Career Resources articles posted on NEJM CareerCenter are produced by freelance health care writers as an advertising service of the publishing division of the Massachusetts Medical Society and should not be construed as coming from the New England Journal of Medicine, nor do they represent the views of the New England Journal of Medicine or the Massachusetts Medical Society.

March 2012

Physicians who thrive in diverse settings, have a desire to lead, and derive satisfaction from caring for our courageous service members, and may find military medicine a good fit. Added benefits include loan-repayment programs, no overhead, billing, or malpractice worries, and excellent benefit and retirement plans. The military also offers many research opportunities, but the tradeoff includes possible disruption to family life, being placed in harm’s way, and the requirement to remain in top physical shape. Military physicians’ desire to serve their country usually trumps these issues.
—John Fromson, MD

Physicians who practice in the military counter some misconceptions about limitations.
By Bonnie Darves, a Seattle-based freelance health care writer

For prospective physicians or those in training, a key attraction of military medical practice is the generous education funding and loan-repayment programs — especially now that six-figure medical education debt is commonplace.

However, physicians who remain beyond their required service often discover another benefit: the opportunity to practice in widely diverse settings — from small combat-zone hospitals to state-of-the-art medical centers on shore, and from foreign bases throughout the world to ship- or air-based care facilities. Military physicians are also called upon to care for victims of disasters, at home and abroad. One common misconception about military practice, some physicians claim, is that the specialty practice opportunities and the overall range of positions are far more limited in the military than in the civilian sector. That’s hardly the case, claims Capt. Joel Roos, MD, MBA, deputy chief, Navy Medical Corps. “In Navy medicine there are opportunities in more than 30 specialties and subspecialties, including unusual ones like undersea and aerospace medicines. The Navy even maintains 3 neonatal ICUs,” said Dr. Roos, an emergency medicine physician who’s spent 23 years in the Navy. “I’ve gotten to do everything I wanted to do, and then some.”

That’s pretty much how Dr. Roos’ C.V. reads. He went to dive and submarine schools. He practiced on the coast of Japan for a few years. He also served as deputy commander of the Naval Medical Center in San Diego and later as an advisor to the U.S. Surgeon General. “You can take a traditional clinical-practice pathway or pursue senior administrative positions — or a combination,” he said. “There are many opportunities for leadership, and our physicians tend to be exposed to those opportunities earlier in their careers than civilian physicians do.” It’s not unusual, for example, for a young physician to be tapped for a senior medical officer position on a ship or to direct medical services in a remote location.

The diversity of practice experience also has proved a drawing card to Cdr. Joseph Perez, MD, a family physician with the U.S. Coast Guard in New London, Connecticut. Dr. Perez earned his medical degree at Cornell University before serving four years in the U.S. Navy to repay his education loans. Now 40 years of age, he never expected to land at the U.S. Coast Guard Academy or that his practice life would be so varied there.

“When I was due to rotate in the Navy four years after residency, I was going to be sent across the country. But my wife was pursuing an MD-PhD degree, and we didn’t want to move,” he recalls. “I was at a conference when I heard about the opportunity at the Coast Guard Academy and said, ‘wow, that sounds like a good fit.’ And it is.”

Today, Dr. Perez serves as the college doctor for the academy’s cadets and directs the Health, Safety, and Worklife (HSWL) Regional Practice, which serves Coast Guard members in several states. He also conducts disability reviews, and is actively involved in clinical initiatives such as a new concussion-management program.

“I thought I’d just come into the military and pay off my loans, but I decided that I really like the leadership part of it — and the patients,” he said. “I’ve watched people who barely finished high school go on to become physicians.”

Of the services, the Coast Guard, staffed by U.S. Public Health Service physicians, is the smallest of the military medical groups. On average, only 60 physicians — most of them primary care physicians — serve in the Coast Guard.

Despite their small numbers, Coast Guard physicians have a potentially broader range of practice locales than might be expected, Dr. Perez notes. Stations are situated in such desirable locations as Cape Cod, Boston, Seattle, and Miami, and in such far-flung ones as northern Alaska or aboard the USCG Cutter Eagle. “Because there are so few of us, there is a lot of variety in our work,” said Dr. Perez, whose newest role is medical oversight of a center that serves special needs children.

Specialists See Diverse Opportunities
Some physicians who join the military to pay for their education end up staying beyond their required service out of interest. For others, it’s a conscious career choice from the start. That’s how Maj. Vincent Capaldi II, ScM, MD, a fifth-year internal medicine-psychiatry resident at Walter Reed National Military Medical Center in Bethesda, Maryland, describes his path. Dr. Capaldi, who completed his undergraduate, master’s and medicine degrees at Brown University in Rhode Island, was attracted by the education benefits and the training opportunities the U.S. Army afforded.

“The education funding was a draw, but the range of opportunities also attracted me,” said Dr. Capaldi, who is 31 years of age. “If you want to do research, teach in the medical school or pursue clinical practice, you can do it all.”

At present, Dr. Capaldi is conducting research on sleep, in particular how sleep deficits or disruption affects service members’ performance. His next move may be a fellowship in sleep medicine. “The Army is generous about funding our educational interests,” he said. “And when you look at compensation, for trainees anyway, there is no comparison. The military, hands-down, will give you more in compensation than you’ll receive in the civilian sector.”

Another upside that Dr. Capaldi and other physicians cite is that physicians coming out of training have essentially a “built-in” practice — and no worries about overhead, malpractice premiums or insurance companies. “Basically, you’re coming into a practice that’s all set up, and the quality of life is a huge benefit,” Dr. Capaldi said. “If you’re an attending, it’s a 40- to 60-hour-a-week job, a nice lifestyle. Of course, you have to weigh that quality of life here versus if you’re deployed.”

There are other challenges to military practice, Dr. Capaldi and others acknowledge. One is geographical constraints — practice options limited primarily to places where the military operates medical facilities or staffs medical care operations. Further, military physicians may cite their preferred practice locations but must go wherever they’re sent while they’re on active duty.

“If you want to go to a place that’s highly sought after, it goes by seniority,” Dr. Capaldi explained. “So if you want Washington, D.C., you may have to wait. On the flip side, you might end up at a small fort right out of residency and become the chief of outpatient psychiatry.”

“You can put in your preferences, but part of being in the Air Force is putting the Air Force needs above your own,” said Maj. Renee Matos, MD, an Air Force pediatrician who is completing a pediatric critical care fellowship at Children’s Hospital of Pittsburgh. “You go where you’re needed.” Dr. Matos, a Princeton University graduate who earned her medical degree at University of California–San Francisco, completed her residency at San Antonio Uniformed Services Health Education Consortium in Texas. She will return to San Antonio after completing her fellowship, but recognizes that deployment abroad is a distinct possibility.

In some specialties, military medicine offers a very broad range of practice options. For orthopedic surgeon Lt. Col. Philip Belmont Jr., MD, the practice opportunities within the Army have been diverse and challenging. He has performed life-saving surgeries on soldiers in Iraq combat hospitals and treated patients aboard aircraft, and authored an orthopedics textbook on combat surgery. Dr. Belmont, age 42, has also served as chief of aviation medicine and is now chief of adult reconstruction at the William Beaumont Army Medical Center/Texas Tech University Health Sciences Center in El Paso, where he also directs the large orthopedic surgery residency program.

“Regardless of where I have served, the most gratifying aspect of my career has been caring for our brave soldiers. There’s just an intrinsic satisfaction in the work,” said Dr. Belmont, who received his medical degree from Duke University in Durham, North Carolina “The other major benefit is that I’ve had so many opportunities to develop leadership skills and to effect change.”
He is particularly proud of his recent endeavor in the academic realm: recruiting and training six female residents, in a specialty and practice sector long dominated by men. “There is a lot of discussion about the need to bring more women into military practice, so it’s been exciting to actually succeed in that,” Dr. Belmont said.

Dr. Belmont acknowledges that subspecialists in the military do not earn as much as their civilian counterparts. But in his view, the many pluses — from the sophisticated practice resources and rich education-funding opportunities, to the G.I. Bill benefits and the retirement plan — make up for the difference.

Weighing the Challenges
Military physicians are effectively “in service,” and as such must go where they are required. For example, in the U.S. Navy, approximately nine percent of physicians are deployed abroad on any given day.

In addition, deployment or frequent moves can be challenging to family life, especially when spouses have “place-based” careers. Lt. Kevin Bernstein, MD, MMS, a family medicine resident at the Naval Hospital in Pensacola, Florida, admits that he and his wife engaged in several conversations about the pros and cons before they came to a decision.

“The big issue for us was not knowing when or if I would be deployed, and the effect that might have on my wife’s teaching career,” said Dr. Bernstein, who started medical school as a civilian and later took advantage of the military’s Health Professions Scholarship Program (HPSP) to fund his remaining years. “The pros were being able to travel, and knowing that there are naval bases and stations throughout the world. But I didn’t come from a military family, so I didn’t really know what the realities were,” he said. “But I now realize that I’d probably have chosen the option right away had I known about the loan-repayment program and the practice benefits.”

Those benefits, for family medicine physicians, are substantial in Dr. Bernstein’s view. He cares for a far more diverse patient population than he expected — from infants to retirees — and he often has the opportunity to do deliveries. “We’re not competing for those, like many family medicine physicians in the civilian sector do. And financially, because we also don’t have to worry about the practice management and malpractice issues, I think the pay in primary care is a bit better than in the civilian sector,” he said.

In addition, the Pensacola Naval facility is at the forefront of the medical-home model, and has been designated as a Level 3 medical home by the National Commission on Quality Assurance (NCQA). It received the top accreditation ranking from the Joint Commission in 2011. “We have a lot of resources and technology at our disposal, and we don’t have to worry about whether our patients have insurance. That’s a big plus in family medicine,” he said.

Civilian Opportunities Largely Unknown
Most physicians who pursue medical practice within the military enlist or serve in the reserves. What civilian physicians may not realize, however, is that practice options exist even for medical professionals who choose to remain civilians.

Amy Weintrob, MD, an infectious disease specialist, was surprised to find what turned out to be an ideal opportunity at the Walter Reed Army Institute of Research in Silver Spring, Maryland, where she conducts clinical and vaccine-development research in HIV and also participates in research on combat-associated or -acquired diseases. “I had no idea that so many positions were available [to civilian physicians], or that the research programs were so large,” said Dr. Weintrob, whose work is funded by the Henry M. Jackson Foundation, which supports military medicine research.

Despite her status as a contractor, Dr. Weintrob has a broad job description that encompasses not only research and patient care at Walter Reed National Military Medical Center but also teaching; she is an associate professor of medicine at the Uniformed Services University of the Health Sciences in Bethesda. The varied responsibilities remain a key attraction of the position Dr. Weintrob has held since 2005. But other benefits have emerged, she notes, including constant exposure to a broad range of diseases.

“I am always surprised at the variety of things we see here. We deal with a lot more tropical diseases than I did in the civilian sector, from malaria and dengue fever to unusual ones, like leishmaniasis,” said Dr. Weintrob, who practiced at Emory University in Atlanta before moving to Maryland. “I also appreciate the resources. At Emory it was sometimes difficult to get patients the medicines or care they needed, but that’s not the case here. If I write a prescription or refer a patient to a specialist, I know they’ll get what they need.”

Assessing Suitability for Military Medicine
It goes without saying that physicians who choose to practice in the military — whether they’re taking advantage of the generous education funding and loan-repayment benefits or eyeing a lifelong career — must be willing to put themselves in harm’s way just as their patients might. They also must be, and stay, in peak physical shape. More importantly, they should also be not only willing, but actually seeking, to serve their country first and foremost, advises Col. Scott Dingle, commander of the Medical Recruiting Brigade for the U.S. Army in Fort Knox, Kentucky.

“It takes a special person to be a military medicine physician. You should have a desire to serve but also, ideally, a desire to lead and to provide care for our military service members and their families,” Col. Dingle said. Although physicians may elect a largely clinical career or academic path if they choose, a “command track” could someday culminate in running a hospital or commanding a large medical unit, for which leadership aptitude is a prerequisite.

Physicians who practice in the military are also expected to be team players — under the best and the most challenging of circumstances, Col. Dingle notes. For example, those who trained in large academic centers or even in top military medical facilities, such as Walter Reed National Military Medical Center, might find the transition to remote-location or combat-zone practice — and the stressful conditions those entail — trying. “Some physicians, of course, find that [latter prospect] very exciting, but it’s not for everyone,” he said, but cautioned medical students and trainees to consider their ability to function under duress when assessing their suitability for military medical practice.

The following online resources may be helpful for physicians or medical students considering military practice:

U.S. Navy

U.S. Army

U.S. Air Force

U.S. Public Health Service

Office of the Surgeon General

Uniformed Services University of the Health Sciences

Henry M. Jackson Foundation for the Advancement of Military Medicine

Today’s Military (general information about life in the military)


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