Military as a New Grad PA?

[anowww]

I recently finished PA school and was considering the military service as a PA or working in urgent care medicine in the civilian world. I feel like I would get more experience joining the military but am not sure. Did you have good mentors and feel like you get to see more in the military as a PA vs. the civilian world? Trying to make the best decision of which sector would give me the best tools to become an experienced PA. 

Edited June 27, 2019 by anowww

[ohiovolffemtp]

You can certainly learn in both environments.  One limiting factor I've often heard from PA's who've been in the military is that they are dealing with fairly narrow population: young and fairly healthy.  Those that have combat training have great skills.  However, in the civilian world you see all ages, especially older folks with many chronic diseases, which you won't see in the military.

[LT_Oneal_PAC]

42 minutes ago, ohiovolffemtp said:

You can certainly learn in both environments.  One limiting factor I've often heard from PA's who've been in the military is that they are dealing with fairly narrow population: young and fairly healthy.  Those that have combat training have great skills.  However, in the civilian world you see all ages, especially older folks with many chronic diseases, which you won't see in the military.

While part of military experience is dealing with a young healthy population, the majority of Military PAs work in family medicine seeing ages 2 months to 99 years, though I often saw less than 2 months out of necessity for urgent problems. Being deployed sucks, for obvious reasons, but you also have to spend extra time keeping up skills

[ArmyPA]

8 hours ago, LT_Oneal_PAC said:

While part of military experience is dealing with a young healthy population, the majority of Military PAs work in family medicine seeing ages 2 months to 99 years, though I often saw less than 2 months out of necessity for urgent problems. Being deployed sucks, for obvious reasons, but you also have to spend extra time keeping up skills

Be careful of what branch...this is NOT true in the Army. I only saw active duty during my 4.5 years in the Army until I volunteered for extra shifts in family med clinic a few months before I retired. 

[LT_Oneal_PAC]

55 minutes ago, ArmyPA said:

Be careful of what branch...this is NOT true in the Army. I only saw active duty during my 4.5 years in the Army until I volunteered for extra shifts in family med clinic a few months before I retired. 

Good point. I don’t know what the army does and can only speak for the Navy.

[sas5814]

yup... retired Army PA here. I had a very steep learning curve when I went into family medicine after I got out. I was 5 years out of school and had never prescribed or adjusted insulin. Diabetics were discharged. HTN was around but mild and managable and all the lifestyle issues were already taken care of for the most part.

There were specialty residencies available in ortho, ER, and one more I can't remember but this was 1996 when I got out so a lot has changed. PAs mostly stayed in combat arms units with a young healthy patient population.

[ArmyPA]

5 hours ago, LT_Oneal_PAC said:

Good point. I don’t know what the army does and can only speak for the Navy.

From what I hear the Air Force is similar to the Navy in this respect, however with the upcoming changes/DHA taking over all military medicine, I think that there are going to be alot of changes for all services...some of my colleagues who are still in are already seeing this. 

[ArmyPA]

3 hours ago, sas5814 said:

yup... retired Army PA here. I had a very steep learning curve when I went into family medicine after I got out. I was 5 years out of school and had never prescribed or adjusted insulin. Diabetics were discharged. HTN was around but mild and managable and all the lifestyle issues were already taken care of for the most part.

There were specialty residencies available in ortho, ER, and one more I can't remember but this was 1996 when I got out so a lot has changed. PAs mostly stayed in combat arms units with a young healthy patient population.

Thanks, SAS. you make me feel like a young man...I joined in 1996 and just retired this year 

[sas5814]

I joined in 76.. 19 not 18.

[Almortega]

On 6/27/2019 at 9:16 PM, ohiovolffemtp said:

You can certainly learn in both environments.  One limiting factor I've often heard from PA's who've been in the military is that they are dealing with fairly narrow population: young and fairly healthy.  Those that have combat training have great skills.  However, in the civilian world you see all ages, especially older folks with many chronic diseases, which you won't see in the military.

You can always pick up weekend shifts prn to get experience seeing other stuff. 

[LKPAC]

Former Air Force here.  I recommend it.  Keep in mind that military is a different lifestyle, but a good one.

[bovineplane]

Several nice things about the military - 

Don't worry about a paycheck. Don't worry about getting fired. No need to think about clothing options. No issues with insurance coverage. Some complain abouth Ahlta but it works and nearly all your patients will have near complete medical records available during your visit and often times when deployed . Lots others but I'll stop here. 

One of my preceptors told me during school that I would need thousands of normals before you get good at picking up abnormals. Lung, sounds, heartbeats, labs, x-rays. Judging sick vs not sick  The military is nearly all young, healthy and normal. You will get 4 years of nearly normal patients and the rare unhealthy one affording lots of self study time. 

Some say this makes the transition harder. I tend to disagree. Imagine being a new grad and being thrust into dealing with uninsured obese multi co-morbid patients that you may or may not ever see again. Or take 4 years in the military not worrying about those things to learn how to be a PA. You will have a steep learning curve but it is the same learning curve any other new grad has and you will make the transition much easier after 4 years. 

After a year or once you get comfortable in your role as a military PA you can moonlight a few shifts a month in UCC/ER for other experience. There are opportunities for those motivated to rotate or help out in specialty clinics if you have willing preceptors. These are mostly unofficial but as an example our Ortho clinic does injection clinic once a week. They will let any credentialed provider help out. Derm clinic has wart clinic, same. Surgery has small procedure clinic, same although they have more residents so a bit tougher to get hands on. You can always help out in ED or UCC on post. IM teams you can tag along although a bit tougher to get good experience due to the hours but it can be done. 

As a new grad you can get an enlistment bonus l. Army is $60k for a 4 year initial commitment. After 4 years the next bonus is $80k for 4 years. I think they offer some loan repayment and you would earn post 9/11 GI bill which could be used for DSc program or med school if you so choose. Residencies in Ortho, gen surg, ED, education, epidemiology and a few others although they all come with a service obligation which runs consecutive to the initial obligation. 

I could go on but your best bet is to talk with an AMEDD recruiter to get current details. 

Edited July 6, 2019 by bovineplane
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[sas5814]

A good summary. However keep in mind deployments and field problems and being sent off to different military training programs many of which won't have anything to do with medicine. I don't say this to discourage you just to raise the issue to the front. I was already career military when I went to PA school in the Army (before it was all-services) and my extimate is I was gone somewhere 6 of the 12 years I was married and on active duty. 

If you are single it can be a great adventure. If you are married and everyone understands the arrangements it can give you some real appreciation for time together. If you aren't prepared it can break a marraige.

Just food for thought

[bovineplane]

3 hours ago, sas5814 said:

A good summary. However keep in mind deployments and field problems and being sent off to different military training programs many of which won't have anything to do with medicine. I don't say this to discourage you just to raise the issue to the front. I was already career military when I went to PA school in the Army (before it was all-services) and my extimate is I was gone somewhere 6 of the 12 years I was married and on active duty. 

If you are single it can be a great adventure. If you are married and everyone understands the arrangements it can give you some real appreciation for time together. If you aren't prepared it can break a marraige.

Just food for thought

I learned more about medicine in 6 months as a solo provider to 400 Soldiers while deployed than in years working in the clinic. Nothing prepares you for being scared like worrying every day about being alone without xray, labs, limited medications. It forces you to do a good history and PE as that is really all you have. We had urine dipsticks, vitals machine, stethoscope, otoscope, opthalmoscope, few other tools. We were two hours by vehicle to nearest next level of care. I had a radio which I could relay messages which doesn't help at all in an emergency. 

During the deployment I was trained in neutering cats, several dental procedures, lots of random ID and rashes, trauma, ATLS, etc . We had access to an online consult system which allowed me to digitally interact with specialist all over the military and each consult turned into a learning experience. 

Spent a year in Korea at a small clinic. Not nearly as remote. We had a joint partnership with the Korean national University medical system. Monthly meetings and lectures. Lots of learning with specialists trained at some of the world's best universities. 

I attended the international military medical conference in Jordan at the dead sea in 2014. Great time. Docs and providers from all over the world. 4 days of lectures on any and everything you can think of. Original research presentations, demonstrations and of course medical sales. 

Yes, as a PA you will likely deploy. Yes deployments will take you from your family if that is a concern. Deployments will help you grow as a provider in ways that are hard to explain. 

Working in a hospital with 10 other providers grinding through an Ed shift may sound like a learning environment but it pales in comparison to military medicine in certain situations. 

There are drawbacks for sure. I have spent 5-6 years away from my family on deployments. Add in the jrtc, ntc, field training etc and I hate to think how much time I have spent away from home. At the same time I would not trade it for being a new grad thrust into the real world fresh out of school to fend for myself. 

[jeepgirl]

@bovineplane great post. Thanks for sharing. 

[vb315]

This thread has me excited to start my career in Military Medicine. I'm headed to Navy ODS in a month, and then I'll be PCSing to Okinawa, Japan for my first 3 years as a PA. I'm nervous, sure, but full of excitement! Thanks for sharing!

[sas5814]

Congrats! You will find it an experience like no other in the profession.

Its funny reading the post about all the things we are more or less compelled to learn because it was often just me (us) in remote locations and deployments. My oldest and dearest Army bud's wife got her finger tip pinched in a boat motor and it ruptured and had a tuft fracture. They were sitting in the ER after having been seen by a PA waiting for a determination and treatment. He sent me a picture and I said "clean up that fatty tissue a bit, clean it and irrigate it, close it loosely, start antibiotics, see ortho in 24 to 48 hours. 

He replies that the PA is afraid of infection so he did no primary closure. He prescribed antibiotics and they were seen by plastic surgery (!) the next morning where the surgeon did exactly what I said to do. My reply? yeah... he trained for 14 years to lean that. Sheesh.

Plastic surgeon for a 65 year old woman with an uncomplicated open tuft fracture. That is the difference in approaches and experience.

Edited July 12, 2019 by sas5814

[ohiovolffemtp]

The hand surgeons I used to consult would have us ronguer bone ends, loosely close, start pain meds and abx, and arrange for office follow-up in a few days for finger amputations.  In reading their notes they rarely even did a revision.  Usually, they just monitored the healing.  Even for flexor tendon injuries they typically waited a few days to see, usually for the swelling to go down and to get a scheduled slot in the OR.  Pretty much the only things they saw and took to the OR immediately where high pressure injections, compartment syndomes, and massive hand (not just multiple fingers) injuries.

[Kazymedic]

On 7/5/2019 at 10:35 AM, LKPAC said:

Former Air Force here.  I recommend it.  Keep in mind that military is a different lifestyle, but a good one.

Do they take prior enlisted Army as PA's?

[bovineplane]

11 hours ago, Kazymedic said:

Do they take prior enlisted Army as PA's?

If you meet commission standards of ar 40-501 chapter 2 and general admin military requirements for commission, then yes. 

Edited July 12, 2019 by bovineplane
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