Before you read further, I want to offer a few mandatory disclaimers. What you are about to read represents my own personal thoughts and in no way reflects the thoughts or opinions of anyone else in the United States Military – past, present or future. It further does not represent the official policy of the United States Navy, the Department of Defense or the United States Government.
My other disclaimer is the following. I have dearly loved my time in the Navy. I had the most incredible residency training experience at a military hospital during a time of war. I have experienced neurosurgery in a way that I will not be able to reproduce when I retire to civilian practice. I would not trade the last 17 years for anything. With that said …
On any given day I arrive at the hospital around 06:30, looking forward to what I have to do that day as a neurosurgeon. Then, I open my email and that plan disappears. One email contains a new training requirement just mandated by the military that must be completed yesterday. Another reminds me that I have to provide a urine sample, presenting in uniform, by noon today. Another is a long line of email communications concerning an upcoming uniform inspection, which will technically occur before the provision of patient care begins, but will almost certainly run into the operative day. In this case, there is a serious debate raging about whether nametags will be necessary or not. There follows emails reminding us about our upcoming physical fitness test, command requests for officers to sit on disciplinary or medical boards and a whole host of additional communication that means something to someone, but does not apply to me (delete). It is only then that I can start my day.
We all have responsibilities, administrative or otherwise, that seem to shift focus away from what is most meaningful to us. While these additional responsibilities are important and necessary in their own way, they can drain your spirit, if you are not prepared.
I spent the beginning of my military career operating under a false premise. When I came on active duty in 2002, I was told that I was an officer in the United States Navy first, a doctor second. My delusion then – and for many years after – was that that was simply not true. I am a doctor. The military needs me as a doctor. I am an officer, because in the military that is what doctors are. For eight years, protected by my status as a resident trainee and then fellow, I sincerely believed this was true. My wake-up call came in April 2010, when the specialty leader for Navy neurosurgery, my boss and mentor, called me to her office to discuss my first duty assignment. I made it known that my intention was to transition to faculty at Walter Reed after training. I was informed that a neurosurgeon was needed in Okinawa, Japan.
“Can we discuss this?”
“Sure shipmate, and after we discuss, you will go to Okinawa, Japan. . .”
Officer first, doctor second.
It has been nine years since my first assignment and, after a deployment to Afghanistan and several other overseas assignments, I would say that it is not as simple as officer first, doctor second or vice versa. How do I switch gears between my military and surgical responsibilities now? It took me 16 years to fully realize that, while they seem like different responsibilities, being a military officer and neurosurgeon are just two sides of the same coin. While often painful and rarely an efficient use of time, completion of my military administrative responsibilities is necessary for me to function as a credible physician within this system. I have to provide a urine sample in a scheduled and proficient military manner. I have to complete my military training modules and sometimes repeat that training when the system misplaces it or decides that it must be completed on a fiscal, rather than annual, basis. It is sometimes necessary to put on my uniform for inspection. I must pass my physical fitness test biannually. While it seems painful, I must do all of this and more, not only because the military says I must, but also because many of my patients have to complete the same administrative requirements every day and still do their job. Sometimes that job is to take a bullet or an IED fragment in service to their country. The administrative burden is required for me to credibly and effectively care for my patients. Both sides of the coin, military and medical, are important. Officer first, doctor first.
For those of you who astutely recognize the “acceptance stage” of the Kubler-Ross stages of grief, you are not wrong. While your existence may not be as proscribed if you are not in the military, you may find parallels in your practice.
- You may be the chair of a program whose day is largely composed of meetings, hospital administrative requirements and occasional patient care.
- You may be fresh from training just starting out, trying to establish yourself as a surgeon with incredible call and operative volume, while also trying to start a lab.
- You may be in charge of a residency program in addition to your clinical responsibilities.
- You may be running your own practice, dealing with your clinical, operative and business management responsibilities simultaneously.
Whatever your background, to be an effective neurosurgeon in today’s environment, you must be able to switch gears and deal with aggravations and aspects of life that seem unrelated to patient care. Being a great clinical neurosurgeon is rarely enough. Effectively navigating these challenges, completing, fixing and modifying what you can along the way, rather than decompensating because of them, is what helps to avoid burnout and maximizes the outcomes for our patients.
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