In my “Internship” blog I referred to the doctor draft. In the years before and during the Viet Nam war, the US Selective Service Agency administered a program conscripting (drafting) all recent medical school graduates. We were all 1A meaning we were just waiting for our orders. There were no deferrals. Even if you were married and had children, you still had an obligation to serve. We were deferred to complete med school, but after graduation we were fair game. In fact, vulnerable doctors were drafted right out of their offices.
There was a protective measure, however. It was called the Berry Plan and was a voluntary program that insulated us from the draft. We still had to fulfill our selective service obligation, but we were guaranteed our training would not be interrupted. During my sophomore year I signed up for the Berry Plan. Our options for deferral were:
1. Enter the military immediately after completion of an internship.
2. Enter the military immediately after completion of a residency.
3. Enter the military after completing one year of residency.
Most graduates chose either option 1 or 2. With option one, the military obligation was fulfilled early and the doctor was later allowed to do a residency and enter practice without interruption. Option two permitted the doctor to complete a residency without interruption, and enter the military as a specialist. Option 1 docs started as a captain and option 2’s were majors. The military credited our years in college, med school, and residency toward seniority and officer rank.
In mid-July, 1970, the Defense Department flew me to Sheppard AFB in Wichita Falls, Texas for two weeks of basic training. I was issued two everyday uniforms, fatigues, and a mess dress uniform I wore only once. I learned about proper military attire and the organization of the Dept. of Defense and the USAF. I marched, participated in a disaster drill, spent one night out in the field, and played golf. Happy hour at the Officers Club each evening was not to be missed.
Upon completion of basic training, I flew to Indianapolis, where I joined my wife and 6-month old son. We drove to Kansas City to report to the Richards-Gebaur Air Force base hospital, my work home for the next two years. There was no welcoming party, no pomp and circumstance, and the hospital commander, a full-bird colonel, was not there. The corpsman in the ER told me to show up Monday, report to the Sergeant-Major, and get started. My ego was bruised by the minimal reception I received, but that was the military way.
I was a GMO (General Medical Officer) with the rank of captain. Richards-Gebaur AFB was headquarters for the Air Force Communications Service (AFCS) and had a 35-bed hospital. I had a small office/exam room in the outpatient clinic area. Two other GMO’s and the base pediatrician had offices there, too. The AFCS was commanded by two 2-star generals, and I saw the daughter of one of them the first day I was there. Suddenly, I was a real doctor; or the Air Force said I was. I had my own office, my own patients, my own stresses, and major responsibility for people’s health.
From 7:30 am to 9:00 am each weekday was “military sick call.” Here, active duty military were seen for acute illnesses and follow-ups. I saw a little of everything. If a soldier was too sick to go to work, he had to be admitted to the hospital for care rather than staying in the barracks. That was not permitted. So strep throats, vomiting, diarrhea, and some trauma were hospitalized until they recovered enough to return to duty.
From 9:30 am to noon and 1:00 pm to 4:30 pm were the times for scheduled appointments for retired military and active duty dependents. In Kansas City, there was no shortage of retirees living in the area. I was very busy. When the hospital commander learned I had two months of peds during my internship, he appointed me assistant base pediatrician. Instead of military sick call, in the mornings, I assisted with “pediatric sick call.”
The hospital commander also learned I’d had experience in orthopedics, so he assigned me to run the orthopedic clinic once a week the entire second year. Before I started, he sent me to Scott AFB for three weeks temporary duty to learn how the Air Force handled orthopedic cases.
For two years, the US government paid me the highest salary I had ever made to take care of military folks of all ages. I was an officer and privileged to have all the advantages of that status. My second year, I became eligible for on-base housing, so we moved into a rent free 3-bedroom duplex. Our back yard bordered a field of weeds so we constantly had a problem with field mice in the house.
Several times a month I was Medical Officer of the Day (MOD). Basically, I was on call for our 2-bed “emergency room.” MOD started at 5 pm and ended at 7 am the next day. Air Force corpsmen really ran the ER. I was there to handle more complicated cases. I “slept” in a small call room next to the ER entrance. Everything under the sun came in there—snakebites, kids with a fever, retirees who drank too much at the officer’s club, sprains, lacerations, and an abscessed hand wrapped in bacon! Everyone, excluding the general surgeon and the two OB-GYN’s, took MOD call—even the radiologist. MOD was an equal opportunity position.
Earlier, I mentioned the commanding general’s daughter who I saw my first day. She had a rash that admittedly stumped me. Fortunately, like a lot of medical problems, it got better on its own, but it taught me I still had a lot to learn. One very sad case was the 14 year old daughter of a Master Sergeant who died of a malignant brain tumor. In 1971, CT and MRI technology did not exist so brain tumors were more difficult to diagnose. Today, she would be diagnosed earlier, treatment would be more effective, and her chance of survival would be increased.
In September, 1971, our daughter was born at the base hospital. Our two OB’s took call every other night. One was from Manhattan and the other Virginia. The Manhattan doc and his wife literally expected to see wild native Americans in Kansas City. His mother-in-law had warned them to leave their jewelry and valuables in New York because “you don’t know about the wild west.” But they discovered antiquing, fell in love with the area, and set up practice in a suburb of Kansas City.
The first pediatrician I worked with was from Columbia, Missouri, and trained at the Mayo Clinic. He was great. He was replaced by another Manhattan doctor who didn’t own a car and had to learn how to drive when he came to the base. His wife was also a physician, a radiologist. They loved the area, and ended up practicing in KC, too.
The two general surgeons couldn’t have been more different. Year one’s surgeon was a cocky, arrogant, cigar-smoking fellow from Ohio State, who had the typical surgeon demeanor. The second year surgeon was a quiet man who got upset about absolutely nothing. He was less likely to make a big production out of an operation. He was also supposed to run the orthopedic clinic but declined because he heard I had more orthopedic experience than he did.
The base internist was a man from Buffalo, NY, who was not happy to be in the Air Force. He continually “bucked the system” and tried to be as irritating as possible. He succeeded. He didn’t agree with any military policies or any order from the hospital commander, and treated me and the other GMO’s as idiots. His wife was the same. I don’t know why or how, but his second year was spent on an unaccompanied tour in Thule, Greenland.
The second year, we had two internists. One was an endocrinologist who was a big help with diabetics, and the other, a cardiologist. Why the Air Force sent a cardiologist to our small hospital was a mystery. Here’s a fully trained cardiologist who does heart catheterizations and there’s no cath lab, no Coronary Care Unit (CCU), and no patients. He had patients but few of them had heart problems. Those who did went to local hospitals better equipped than ours. He spent at least one year practicing general medicine and not his specialty. He worked out a deal with a civilian hospital, though, and was granted privileges for limited practice.
I consider my time in the Air Force as additional medical training. The exposure to general medicine, pediatrics, and orthopedics was valuable experience. Although I didn’t have faculty attending physicians to oversee my care, I could ask the other GMO’s or the internist(s) about a tough case. The hospital medical staff became a close community, and we all became friends and socialized often. We had the attitude that we’re all in this together, and helped each other every way possible.
The two career Air Force doctors at our hospital were flight surgeons; a Lt. Colonel and the hospital commander. They had 13 years and 20 years in the service, respectively. Non-career flight surgeons had a three-year commitment rather than two years like us regular docs. Flight surgeons saw only pilots and their dependents. They received extra training that authorized them to do flight physicals and other testing required of pilots. They seemed to have a lot of free time and took trips to other bases regularly. In two years, I only flew in an Air Force plane twice—to and from Oahu, Hawaii, and to and from San Francisco, so I can’t complain.
Some of my fellow docs rebelled against the military—let their hair grow long, wore socks that didn’t match, didn’t salute officers, or like the internist who spent a year in Greenland, caused upheaval all the time. One doctor had been to Viet Nam his first year and spent his second year at Richards-Gebaur. He had a cynical attitude and didn’t take anything military seriously. But there was one fundamental principle everyone took seriously. Every doctor did his absolute best to provide competent care to each person regardless of rank, race, or any other designation. We took good care of people despite having limited resources. Patients requiring services beyond our capability were sent to local full service hospitals or if they were active duty, to a regional Air Force hospital. None of our physicians was a bad doctor.
Professionalism, personality, and character go hand-in-hand. One isn’t professional if he has an abrasive, irritating personality. Without principled character, one’s professionalism suffers. You must be honest and truthful. While it’s true professionalism can be learned, it is much more genuine if it originates from a strong ethical foundation. Having a strong sense of right and wrong, good and evil, and truth and deception strengthens the physician-patient relationship. Success comes to those whose character, personality and professionalism instill trust and confidence in their patients. These characteristics were not part of medical education, but they are inbred if one’s ethical base is strong. Any treatment will work more successfully if the patient believes in his physician.
In July, 1972, my two year military obligation was completed. My aspiration of being an orthopedic surgeon was replaced by a desire to practice family medicine. The Air Force experience taught me I didn’t have the “hands” to be a surgeon, and orthopedic surgery patients took forever to get well, if they did. Fractures that don’t heal or get infected are a nightmare, and unsuccessful back surgeries haunt the surgeon forever. Besides that, it bothered me that I didn’t know what rash that General’s daughter had. I needed to learn more, and the next step was a two-year family medicine residency. That story comes next.
