Pros and Cons of the Army Kindergarten

Gwen and I are no longer speaking after our latest Pat Benatar riff. (See her blog for details). We've painted a line down the middle of the house; her side has its walls adorned with the best posters of Pat that 1982 has to offer. My side has protest-style banners with lines like "Hit me with your only three hits" and "Both of us knowing - Pat is a three-hit wonder!" But I digress. In all honestly, we've actually decided to stop talking about the issue which we both agree is for the best. Who knew Pat Benatar could arouse such passion?

In other news, I've had an annoying couple of weeks with the Army. I've never liked the Army to be sure, but often things are tolerable if nothing else. There have been several events over the past three or so weeks which have made life in the Army less than tolerable, however. Given the public nature of this forum, I won't elaborate because it's probably not appropriate (though again, I reference any readers to Gwen's blog as she expands on one such incident in a recent post). I will say, however, that my recent spat with Army life is based on the premise that I'm simply tired of being treated like I'm five years old, something the Army seems to do to everyone, even its highly educated, highly functional members, incessantly. Lately it has been driving me nuts, and certain occurrences the past few weeks have caused me to nearly sprint to the nearest calendar and assess my remaining time to the day.

The sad thing is that I would consider going on in an Army venue because of some of the specialization opportunities it offers. I say this because, unfortunately I've come to realize, I do not LOVE being a general internist. There are times when it's pretty good, and times when it's OK, but there are perhaps more times than I would like to admit when I want to slam my head in a car door repeatedly after a day of clinic. Currently, it pays the bills. But I do not love it. Which is sad, right? Aren't we supposed to love what we do?

The point is that I might be happier going on to do sub-specialty training, and becoming an "expert" at one smaller field of internal medicine rather than continuing to deal with the more obtuse primary care issues that arise in general internal medicine. If I choose to do this, I could probably walk in to whatever fellowship I like as long as I choose to do it in the Army. By having deployed and by merely hanging around, I have "done my time" and I've been told that if I wanted to sub-specialize it would be no great feat. Unlike the civilian world, where applying to a fellowship is difficult, and you have to come with a golden resume and a catalog of personal publications and research experience, the Army - fighting a horrible physician retention rate - allows you to simply "get in" and still get top notch training.

What are the pros of sub-specialization? Well, it pays more, for one. I don't need to make millions, but I will say the idea of working less (say four days a week?) for a comfortable salary is appealing to me. Also being a sub-specialist, as the name implies, significantly narrows the scope of what you're supposed to do, as such you can master something rather than being a jack-of-all-trades. I kind of like that idea. Also sub-specialty brings an increase in procedures (at least for the sub-specialties I am considering). I would love to spend more time using my hands in medicine. (Otherwise all that video game training is going to waste.)

The downside? Well the obvious - it adds Army time. Two to three years of training (based on the specific fellowship) followed by two to three years of additional commitment after said training. (An exception might be a "sleep medicine" fellowship, which is only one year and which is something I have been contemplating.) Also, I do not know how willing I am to thrust myself back into training mode. With the increased pay check down the road I suppose the end would justify the means here - but in many ways a fellowship is like residency-lite and I certainly did not enjoy residency nor do I have any wish to go back to it or something similar. Also, I don't know that I would enjoy being a sub-specialist more, I only think that I might. (My current interests are cardiology, gastroenterology, and the aforementioned sleep medicine.) Furthermore, all this extra time is just more time I'm not back on the west coast living the dream; it remains a top priority of mine to return to San Diego to be near the 'boys and begin my "settled life". I suppose I could extend that return date further, but sometimes I just get giddy when I think of being done with the Army and free to do whatever back in California. If I'm going to delay that, I feel like I better be damn sure it's the right thing to do.

There are a few other question marks. I may like civilian general internal medicine more than Army general internal medicine, but I don't know. Perhaps academic medicine? Again, not sure. I simply don't have the exposure to make a proper judgment. Also, it might be worse. I simply don't know.

Time will tell all this stuff, but if I want to sub-specialize in the Army, I probably have to decide in the next 4-6 months. One option is to apply for a fellowship and then consider turning it down should I get further on down the road and decide it's not for me. I'm still not sure. But I will say that after weeks like I just had in the Army, it's simply all too easy to throw up my hands and say to hell with it - I'm getting out, and everything after that is just gravy.