Note: I've been a surgeon's wife through the many reincarnations of medical practice management. From large corporate group practices, to medium size groups to solo practice. I have always had a very keen awareness of what works and what doesn't in the world of practice management. I have never hesitated to share it --even with CEO's of major medical centers. All the opinions herein are mine, and mine alone gleaned from years of experience in the field. -K.F.Years ago, when The Hubs was starting his internship in surgical training, it was understood that the program would start with 5 and graduate only 3 after a five year training. This practice was standard in medical training programs, especially at universities. It was understood that they had to prove themselves to be of value
not only to the institution but to the patients. If they didn't, they would be cut.
Inevitably, a cut was made. The intern in question just didn't have what it took. He wasn't going to get the stamp of approval or be offered to the public as a surgeon. Over the years, another was let go, as were others from intern and residency groups above
and below. Residents left on their own accord or were cut --as late as their fourth year. The training program was a privilege not a right, and those who hung in there were worked to the bone. At the end of The Hubs' fifth year, only three of the five graduated and earned the title of "surgeon."
Apparently, Nidal Malik Hassan went through a less demanding program. It was revealed shortly after the tragedy at Fort Hood that Hassan had gotten not one bad review, but several. The negative reports about him stretched back to his
internship (first) year.
The entire physician-patient relationship is based on trust. The decision to keep Hassan constituted a breach of public trust. It's imperative in any training program to cut undesirables out
early. Anyone unable to make the grade is an uneasy prospect to imagine with patients either in the military
or on the civilian side. Tragically, this proved to be true in a most extreme and deadly way at Fort Hood.
Just because the military pays someone's tuition,
shouldn't guarantee entry into
or completion of internship or residency. To be a soldier/doctor is a very high order. If the medical student gets poor grades, or doesn't pass stringent reviews as an intern
or resident, he or she should be cut
--just as they would at the best training programs in the U.S. The money provided to them for their medical school tuition and living expenses would then convert to a loan. Just like their civilian counterparts.
Unless the military upholds the same standards found in university and many other programs, they should stop offering internship and residencies altogether. This might not be a bad idea, since many (not all) military-paid students circumvent
the match; a national process of elimination that all other US medical students must go to in order to gain entry into a medical training program.
"The Match." Let me explain the process. In a medical student's last year, he or she decides on an area of interest to pursue (Family Practice, OB-GYN, Psychiatry, Surgery, etc). They find programs and apply to them. They send in their grades, get recommendations, put together a list of accomplishments and at least with their top five, they interview in person.
This is a national process and extremely competitive.When the time comes, the students submit their list of choices. At the same time, the training programs also submit their choices of who they want in their program. It's all tossed into a magic computer and hopefully, there is a "match." If you get one of your top 3 choices, you've done well. Some students get a different one, but nevertheless, that's where they're going to do their training.
Then there are those who don't "match" at all. In other words, they have no place to go for training once they get their medical school diploma. These are the ones who must phone around the country to see if there are any slots available for a first-year intern. It's an awful scramble.
But the value of "the match," is that it winnows out those who probably shouldn't be there in the first place.To give you an idea of how competitive it is, twenty students in The Hubs' graduating medical class applied for surgical training programs. Only
four matched. The remaining sixteen were left to scramble.
From my understanding, military medical students may choose to go through a match and train at a university,
or they can choose to "match into" a military residency program. But since the pool of military medical students is much smaller, it's far less competitive. While it's speculative whether or not Hassan might have matched into a university program, his bad reviews as an intern and residency would've resulted in a cut. However, this wasn't the case at Walter Reed. Hassan's graduation by the military psychiatric residency program at Walter Reed does give the appearance of a guarantee of completion.
Through the military internship and residency programs, these doctor/soldiers are being paid
double what their civilian counterparts are receiving at university training programs. Doctors in training must prove
why the military should keep them, or face having the entire financial package converted to a ticket out and a loan. The military must not flinch when it comes to cuts in
any of the medical training programs. It's what their counterparts at universities do every day.