Navy First Job

[Perrotfish]

So I am very excited to have orders (pending my graduation) for my very first attending job as a Pediatrician at a small MTF in the middle of nowhere.

Any advice for how to hit the ground running and make the next 3-4 years as painless as possible? Best way to introduce myself to the command? Best way to introduce myself to the nurses/RTs/corpsmen? Secondary billets that are worth doing/are important to avoid? Things to make sure the hospital has in stock? Procedures to familiarize myself with? Thoughts?

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[Red Lobster Actual]

Congrats Perrotfish! I've been reading many of your posts and responses for the past few years. I just wanted to thank you for your thoughts and time about mil med. It helped me greatly. All the best on the next phase of your life!

 

[jabreal00]

So I am very excited to have orders (pending my graduation) for my very first attending job as a Pediatrician at a small MTF in the middle of nowhere.

Any advice for how to hit the ground running and make the next 3-4 years as painless as possible? Best way to introduce myself to the command? Best way to introduce myself to the nurses/RTs/corpsmen? Secondary billets that are worth doing/are important to avoid? Things to make sure the hospital has in stock? Procedures to familiarize myself with? Thoughts?

As someone who has PCSed 4 times in my time in the Army it's not something I'd overly concern myself at this point. My advise is to touch base with the provider you are either replacing or working with. They'll give the the skinny on the culture there in the clinic and expectation as well as the surrounding area. It's not a bad idea to also touch base in advance via email with who ever the chief of the clinic or your immediate OIC to introduce yourself. Otherwise your primary concern should be getting ready for you PCS move (house hunting etc) and studying for your boards. Once you sign into the post and hospital, part of the inprocessing will be meeting with the deputy commander of clinical services (or equivalent for other branches) and the hospital commander. You will meet the nurses and corpsmen in your respective clinic (or wards) when you also inprocess. I am not quite sure what you are asking with your second question since you already have orders unless you are asking in regards to your next duty assignment in 3-4 years.

 

[Perrotfish]

I am not quite sure what you are asking with your second question since you already have orders unless you are asking in regards to your next duty assignment in 3-4 years.

I mean that I've been told that I'll be expected to take on at least a few secondary responsibilities (PALS coordinator for the command, QI chair, etc). Are there any that you guys would recommend I try to get? Any that are inordinate time sucks?

 

[pgg]

PALS coordinator is a good one (I did ACLS out of residency) because you can basically do it without a bunch of other people in meetings.

Typically being a member of some committee is a small job.

The time sucks tend to be committee chair positions where you have to herd other people into meetings you run.

 

[Perrotfish]

PALS coordinator is a good one (I did ACLS out of residency) because you can basically do it without a bunch of other people in meetings.

Typically being a member of some committee is a small job.

The time sucks tend to be committee chair positions where you have to herd other people into meetings you run.

How many secondary responsibilities would you recommend a new attending take on? How many committees should I expect to join, and how many projects/committees should I expect to lead?

 

[Perrotfish]

Another question: As a new attending, do I have any role in managing the corpsmen? I know they're there to assist us, but will I actually be in their chain of command and responsible for things like FitReps and career development? Or do I have the same relationship to them I had as a resident?

 

[Perrotfish]

Third question: How long should I wait before I ask to moonlight? Ideally I'd like to start as soon as I'm done with my boards, but I don't want to ask too soon and offend everyone.

 

[psychbender]

At your new job, how many other Pediatricians are there, and are you just replacing one, or have several recently left? If you are replacing one person, chances are, you'll take over whatever responsibilities that person had (unless someone else picked those up, in which case, you'll take over what that other person previously did). When I arrived at my current duty station, I was assigned a secondary duty without any input. Now that two in our department are leaving, and we will be getting some replacements, I'm going to pick up some of their collateral duties (which sound more impressive, but actually require less work), and give my current one (with its quarterly meetings that I have to chair, plus chart audits, plus thrice-yearly reports to the Medical Staff Exec Committee) to one of the newbies. Thus, the circle of BS will continue.

 

[Perrotfish]

At your new job, how many other Pediatricians are there, and are you just replacing one, or have several recently left? If you are replacing one person, chances are, you'll take over whatever responsibilities that person had (unless someone else picked those up, in which case, you'll take over what that other person previously did). When I arrived at my current duty station, I was assigned a secondary duty without any input. Now that two in our department are leaving, and we will be getting some replacements, I'm going to pick up some of their collateral duties (which sound more impressive, but actually require less work), and give my current one (with its quarterly meetings that I have to chair, plus chart audits, plus thrice-yearly reports to the Medical Staff Exec Committee) to one of the newbies. Thus, the circle of BS will continue.

There is going to be a ton of turnover. I think I will have my pick of secondary duties, if I act quickly.

 

[psychbender]

When you arrive at your duty station, check out what the ODE regs say. ODE is entirely command-dependent. At my current duty station, moonlighting seems to be fairly common, so it was not too difficult to obtain permission to work outside of the Army. As for when to ask permission, it is best to wait until you are no longer just the FNG, and have integrated into your department (read: your department head likes you, and knows that you're not going to shirk your military duties for civilian work).

 

[Kingfisher]

So I am very excited to have orders (pending my graduation) for my very first attending job as a Pediatrician at a small MTF in the middle of nowhere.

Any advice for how to hit the ground running and make the next 3-4 years as painless as possible? Best way to introduce myself to the command? Best way to introduce myself to the nurses/RTs/corpsmen? Secondary billets that are worth doing/are important to avoid? Things to make sure the hospital has in stock? Procedures to familiarize myself with? Thoughts?

How small are we talking about? If they have peds you probably have more resources than we do.

1. You should charter a large helicopter and buzz the building while mounted speakers blast "flight of the valkeries". When enough of a crowd has gathered, you land next to the building. Switch tracks to "ode to joy" or "welcome to the jungle" (the volume cannot be understated). You should exit the helo in a full length mink coat with oversized sun glasses. (Joe Namath style). You should be flanked by a squad of either Dallas Cowboys Cheerleaders or Hooters girls.

 

[Kingfisher]

How many secondary responsibilities would you recommend a new attending take on? How many committees should I expect to join, and how many projects/committees should I expect to lead?

Don't volunteer for anything. You do not need anything to pad your fitrep at this point. They will find you with collateral duties. Let the MSCs (or whatever the Air Force equivalent is) take up all of those duties. They have to fight to get 0-4. Its automatic for you. You wont have to worry about all that stuff.

Just fly under the radar and solidify your clinical skills. Enjoy being out of residency.

You can fill your time with meaningless jobs later.

 

[colbgw02]

Don't volunteer for anything. You do not need anything to pad your fitrep at this point. They will find you with collateral duties. Let the MSCs (or whatever the Air Force equivalent is) take up all of those duties. They have to fight to get 0-4. Its automatic for you. You wont have to worry about all that stuff.

Just fly under the radar and solidify your clinical skills. Enjoy being out of residency.

You can fill your time with meaningless jobs later.

Agree with this. I was happy to spend my time practicing my craft. It was nearly a year before they started heaping administrative duties on me. Now, despite never having volunteered for anything, I've got more titles and non-clinical duties than I care to think about. And this is at a pretty rank-heavy place where someone like me should be relatively protected; I would imagine that the admin hounds will find you sooner at a smaller MTF. Besides, you don't need anything to pin on O4, meaning you could theoretically spend nearly half a decade as "just a doctor" before flipping the admin switch to look good for the O5 board, if it gets that far.

 

[pgg]

Agree with all of the above.

If you're already an O4 and within a couple or three years of being in zone for O5, you may wish to look for higher profile collateral duties. If you're an O3 or new O4, it's probably best to dodge timesink responsibilities as best you can and just practice your field. The learning curve is still pretty steep right out of residency ... residency made you safe, practice will make you good.

Ask the people you're joining or replacing what the command's moonlighting culture is like there. There's nothing evil or subversive about looking for extra work to augment your skills, experience, and income. Keep in mind that a lot of newly arriving staff (near 100% in some specialties) will file ODE paperwork as soon as they arrive. It's not unusual. Don't be timid or apologetic about it. Get the forms off the intranet when you arrive, fill them out, and route them. Let the clock-punching admin weenies think what they want.

 

[Maverick87]

So I am very excited to have orders (pending my graduation) for my very first attending job as a Pediatrician at a small MTF in the middle of nowhere.

Any advice for how to hit the ground running and make the next 3-4 years as painless as possible? Best way to introduce myself to the command? Best way to introduce myself to the nurses/RTs/corpsmen? Secondary billets that are worth doing/are important to avoid? Things to make sure the hospital has in stock? Procedures to familiarize myself with? Thoughts?

Do everything that any colonel tells you to do. They have the power to ruin your life and your career.

Remember that in the military, making a colonel look bad is worse than poor patient care. Learn early on what makes them look bad and kiss a lot of a** and your 3-4 years will be painless and possibly even enjoyable.

Either keep your opinions to yourself or find a way to voice them in a way that doesn't annoy your superiors.

 

[BigNavyPedsGuy]

Your first 90 days, try to lay low. There will be plenty you want to change/update, etc. In general it's better to become a working part of the team and then make changes. You might or might not be in the direct chain of command for the corpsmen, depends on structure of the department/directorate. Generally unless you're the dept head, then you won't need to worry about it.

Learn where crash carts are, learn where emergency nursery supplies are. Learn your referral resources. How do you transfer a sick kid? Where to? What if there a little sick or really sick? How long is an average transport, etc. All of these are important for knowing when to pull the trigger on moving someone.

Feel free to PM for questions. As you know, I was in Oak Harbor and now am a civilian pediatrician a 4 hour drive from the nearest children's hospital.

 

[BigNavyPedsGuy]

Oh, I almost forgot: the hardest transition after finishing residency is not being a resident. When your'e a resident, it's kind of all you do. It's your thing. It's your identity. Once you're staff, you have more time and work is less all-encompassing. Find a hobby, plan some travel, etc.

It's a big shift in frame of mind and for me, it was a tough transition.

Have fun

 

[HighPriest]

Don't volunteer for anything. You do not need anything to pad your fitrep at this point. They will find you with collateral duties. Let the MSCs (or whatever the Air Force equivalent is) take up all of those duties. They have to fight to get 0-4. Its automatic for you. You wont have to worry about all that stuff.

Just fly under the radar and solidify your clinical skills. Enjoy being out of residency.

You can fill your time with meaningless jobs later.

There isn't a button for "really, really like." The amount of extraneous BS amplifies extraordinarily after residency, and that is without any additional, optional workload. Get used to the water first, then try swimming.

Agree with BNPG as well. I had no idea what to do with myself in terms of my free time after residency. It was actually really hard to deal with not having large amounts of work to do at all times. That being said, now is your chance to use that time to make yourself more than just a career. Spend time with your family, as BNPG said, get a new hobby. Those things will make you happy. Additional duties will just make you spend more time at work.

Disagree with the idea that making a COL angry is worse than poor patient care. While the COL may make your life harder, hurting a patient will make you doubt everything you're doing for many years to come, may result in your losing your license, and may still piss off the COL. So there is often a balancing act between keeping the command happy and making patient care your first priority (at least I have found that to be true). Not that they're asking me to do something unethical....(save 1 specific case), but that they will find ways to make you choose between spending time with patients and spending time doing routine military work. Especially during your first year our, you want to do the former - even if it irritates someone. Again, you don't try to irritate anyone. Be political. But put patient care first. That seems like it is obvious coming out of most residencies, but I have found it to be a point of confusion at a small MTF.

 

[BigNavyPedsGuy]

There isn't a button for "really, really like." The amount of extraneous BS amplifies extraordinarily after residency, and that is without any additional, optional workload. Get used to the water first, then try swimming.

Agree with BNPG as well. I had no idea what to do with myself in terms of my free time after residency. It was actually really hard to deal with not having large amounts of work to do at all times. That being said, now is your chance to use that time to make yourself more than just a career. Spend time with your family, as BNPG said, get a new hobby. Those things will make you happy. Additional duties will just make you spend more time at work.

Disagree with the idea that making a COL angry is worse than poor patient care. While the COL may make your life harder, hurting a patient will make you doubt everything you're doing for many years to come, may result in your losing your license, and may still piss off the COL. So there is often a balancing act between keeping the command happy and making patient care your first priority (at least I have found that to be true). Not that they're asking me to do something unethical....(save 1 specific case), but that they will find ways to make you choose between spending time with patients and spending time doing routine military work. Especially during your first year our, you want to do the latter - even if it irritates someone. Again, you don't try to irritate anyone. Be political. But put patient care first. That seems like it is obvious coming out of most residencies, but I have found it to be a point of confusion at a small MTF.

Very good points. Now that I'm on the outside, it seems ridiculous to read this, but it is SPOT ON! Very accurately describes the fustration of non-patient care and often myopic veiws of command leadership. Not always, but definitely in my case.