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Uncle Sam wants YOU? The Canadian Forces want me!

June 21, 2009

On several occasions, I’ve been introduced to the idea of a career in the Canadian Forces (CF). In first year of medical school, I met a few of my classmates who had enlisted early. This meant their medical training was paid for in exchange for a 4 year return-of-service contract. Tuition, textbooks, and a stipend. Wow, that’s a lot of bones! Lucky? I wasn’t sure. Guns and war and contracts are not really my thing. Maybe I’ll think about it later.

Three years later, at an Emergency Medicine Update Conference in Whistler, BC, there was a talk about what it is like to practice in Kandahar, Afghanistan. First, the medical officers described the structure of their ranks, the portable operating rooms, and equipment available to them. They showed photos of the Air Base, the horrible pathology, and the dramatic outcomes. I sat and chatted with a recruiter who was a female GP. She spoke frankly about things. “If you like fashion, don’t join. This is the uniform,” pointing to her pretty plain and unflattering garb. Another woman remarked that she sometimes wore he husband’s flight suit, just for variety. “If you have a family, don’t join.” If you want adventure, it’s for you. There are opportunities to jump out of airplanes, get your wings, take a year of French language training, and more. During wartime, these promises are not often kept. But if you keep yourself in line, there may be many rewards. And there is an enormous signing bonus!

A year later, on an elective Radiology rotation, I met a young woman who’d been a GP with the CF for a few years. Healthy young patients on home turf, and really really injured ones overseas. It sounded like a roller-coaster, but by switching professions, maybe she was seeking a more balanced experience. I listened to her, because she was a great teacher and good at her job. She was doing something right. The CF were paying her a regular salary to go back and train as a radiologist. Biiigggg salary, plus no competition with other applicants for ‘re-entry’ positions, since the CF was basically paying for the residency spot in its entirety. In return? 1 year of service for every year of training, to a maximum of 5 years. She’d owe them that, but in so doing, she would creep closer and closer to a higher rank, and with it, a higher salary, and she would also shorten the gap until her pension would start accruing [after 25 years, you become eligible].

Job security, a huge salary, no overhead, and a decent pension. But the real draw would be adventure, tradition, and the experience of working outside the confines of the public system. But I can already see a lot of drawbacks. While I’m not paralyzed with fear, there is obviously an element of danger when working overseas in conflict areas. I would feel safer under the umbrella of the military than I would working with MSF in the same area, but there is a risk regardless of how well-defended the portable clinic may be. Another big hangup is a moral one. I would be lying if I described myself as devoutly pacifist, but I do believe armed struggle should be a last resort  for Canada. We chose to intervene in scenarios where obvious human rights abuses are occurring, and that I can support to a certain extent, but we also get involved sometimes when our intentions are less pure. The problem as a military physician would be this, “Am I supporting the perpetuation of war (killing people) by treating the soldiers and administrators involved?” Well, yes and no. The CF doctors treat Canadian Forces, any allied forces, as well as civilians injured in the fray. Providing aid to the latter is quite a redeeming thing, and one wonders if a war, without medical personnel, might just continue happening anyway. One of the women I mentioned earlier also felt the same moral hangup. But she overcame it by re-framing the situation. Health Care is a human right. Anyone – no matter what good or bad they have done – deserves to have their ailments and injuries attended to. I think that’s a good way of reconciling being a doctor with being part of a war machine, but it still requires some amount of self-convincing to really be satisfactory.

There are personal issues as well that can’t help but be a barrier to application. When joining the CF, one is limited to living and training in one of the domestic CF bases. Those in certain cities are more popular than others. So, for example, someone wishing to be placed in Esquimalt or Comox might instead be located in Ottawa, simply as openings demand it. Likewise, when there are tours overseas, one can’t exactly refuse. You go where you are told. You do what you are told. And there’s not a lot of room to challenge that system. It can also be difficult for those who are married with families, for obvious reasons, but also for the single person who may find it challenging to find or keep a mate with such a geographically fragmented existence.

What am I going to do? Keep it on the back-burner until I finish my residency. Depending on my personal situation, my world views, and the state of armed conflict, I’ll re-evaluate the problems and advantages in the life of a military doc. That, or maybe I’ll be lucky and get to be one of the few non-CF physicians who gets a contract with the CF, and get a taste for what it’s really like ‘out there.’

Never having had a life in the military or being close with anyone who was/is, I obviously don’t know much about it. What do you think would be your biggest worries and greatest rewards?

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15 Comments leave one →
  1. June 21, 2009 3:40 pm

    Hey Jess,

    If you want to hear about military life, you should talk to one of the Video Conference techs on the island down in Victoria. He was in the infantry for a number of years before joining the tank corps. He’s even thinking of going back into the military. If you want, I can always give him a call and you could chat to him about it.

    • June 21, 2009 3:48 pm

      Thanks Jaime, I appreciate it. I’ve got a friend in the Victoria (Esquimalt) base and have heard his take on it; he’s been to Iraq and has quite his own ‘spin’ on things. I think the younger, female doctors would have a perspective that is more in tune with what my experience might be.

      Fortunately I’m pretty sure I won’t think about it much until the end of my residency, so I’m just going to put it to rest now that I’ve written out my current state of thought. Thank you for the offer, though!

  2. Sandra permalink
    June 21, 2009 3:50 pm

    I grew up an Air Force brat, so if you want to talk about what it’s like to live on bases I could help there. I never worked for them, but my childhood was sacrificed to the military.

    My father was always proud that the CAF mostly was involved in peacekeeping and disaster relief efforts (at the time, anyway). Nowadays DND is a more of an American puppet with terrible underfunding for salaries and old equipment that needs replacing.

    I can’t speak to contemporary military culture but living on a base is very insular and you have to be comfortable living and socializing with people who are pro-war and dedicate their entire careers – their entire lives, actually, including their deaths – to it. They also drink a LOT; I doubt that’s changed, and tend to have cognitive inflexibility.

    Nowadays I know there is a lot more concern about PTSD and TBI, and mental health. If you can be a part of that too, wonderful.

    Lots of pros and cons. The woman who told you, “If you have a family, don’t join,” is on the mark, though. You can’t really have a relationship outside the military.

    • June 22, 2009 12:53 pm

      You have some excellent points, Sandra; the culture is something that I’m not sure I could entirely integrate into, and that could be a big barrier. I got the impression that – like in the regular world – doctors shouldn’t ‘hang out’ with their patients. I guess as an officer, the circumstances might be a little bit different, but probably not drastically.

      The psych element is something that continues to be under-addressed. I always loved my rotations in it, and working for the military has the one benefit of being able to spend as much time as needed with each patients (thanks to salary, not fee-per-service billing). That would mean even as a GP, I could better address some of those issues.

    • Tara permalink
      August 21, 2010 1:03 pm

      Sandra’s comment is not only infuriating, but horribly biased and opinionated. Sorry that her childhood was “sacrificed” to the military, but I know many families that have appreciated their military background.

      My husband is a Doctor in the CF. I was in the military, bit now practice Nutrition privately. We have three wickedly bright, charismatic daughters, the oldest of which is heading to University this fall.

      There is no culture of drink and debauchery. Like all neighborhoods, one has the choice of whom they socialize with. It sounds as if your father, perhaps, didn’t make the best choices in that arena. Unfortunate, but that is not unique to the military experience.

      I am definitely not “pro war”, nor is my husband. We have many military friends of like mind who openly discuss their positions. It is not a requirement of the service that one forfeits their intellect, contrary to the implications of your comment.

      We make a concerted effort to socialize outside of any base we ate posted to just as we would if we lived in a small community. A feeling that a base is insular demonstrates a lack of extension into outside activities and interests.

      I certainly don’t think that living in a military community offers benefits over civilian life, but characterizing it with such generalities and sweeping prejudice does a disservice to the many happy, functional families that live within it.

  3. Dustin permalink
    July 15, 2009 7:09 pm

    Just thought I would clarify something. While I don’t have any sources off hand, CF medics (known as Medical Technicians) as well as CF doctors are obliged to treat WHOEVER comes through their doors or into their area of practice, and that within reason can include the enemy.

    That means that once a firefight is over and there’s a dying insurgent, he’ll receive treatment too. Of course, he might end up in an MP’s cell being interrogated by Intelligence Operators but he’ll be alive.

    Medics are still bound by the Geneva Convention, and will respect it even though the enemy doesn’t.

    • July 15, 2009 11:32 pm

      Hi Dustin,

      Thanks for that. Any doctor (regardless of military affiliation) is bound by a code of ethics. The ones I refer to sometimes are those of my national medical association, my provincial association, and the college of physicians and surgeons. We are obligated to treat anyone in need, regardless of their actions/crimes or our personal prejudice.

      While I understand that this applies in principle during military operations overseas, I wonder if in reality the lives of our forces might be prioritized (triaged) above those of the “insurgents.” If so, perhaps this is fitting as it is an exceptional circumstance… just something to think about. There must certainly be some difficult decisions to make and I’ve got a lot of respect for those brave enough to make them.

  4. Jason Bailey permalink
    August 22, 2010 12:01 am

    Hello Jessica,

    Your article is very interesting and I think it is great that it is great that you are trying to look at all the angles. Kudos to you for that!

    I just finished my contract with the military (through the MOTP program) and also grew up in a military family so I have a lot of perspective about what it means to be a doctor in the Canadian Forces.

    To cut to the chase I need to tell you what I think is your best option… DO NOT join the Canadian Forces as a physician. I know that may seem blunt but I have much basis for such a blunt and straightforward statement.

    Firstly, you must keep in mind that the Canadian Forces is nothing but an American pawn at the current time. It is clear that Al-Qaeda was clearly crushed in Afghanistan in 2002, but yet the war kept on going despite no justification to do so. At the same time the US declared war on Iraq and diverted all their resources to that war instead. Now Afghanistan is even worse than before, and there is no way that keeping the war going there will help to make anything better. Anyone currently in the CF has to be prepared to turn a blind eye to this madness otherwise how else could they sleep at night. This is by far the biggest deterrent to being a CF physician (at least for me).

    Secondly, as a physician in the CF, you can expect to do very little medicine, and plenty of administration. From my experience, at least two thirds of your job is admin.

    Thirdly, expect very little respect for you as a professional once you are in the CF. Medicine and good patient care are always placed far secondary to the mission in the CF. Just look at what has happened at Guantanamo and how they have ordered physicians to force feed prisoners with the consequences of being charged if they do not do so (check out the article called `Physician First, Last, Always by George Annas for some more details on that). I know that you would expect that it would be different in Canada, but that is nothing but a false hope. Ultimately, the CF will try to crush anyone who expresses doubts about the mission, and that includes a physician. In the end, professional autonomy is thrown out the window in the CF.

    Fourthly, from a financial perspective, is is clearly hugely disadvantageous to be in the CF once you are outside of residency. Now that I am out of the CF, I make about twice as much as what I did when I was in the military. Definitely, if you are thinking of joining the CF for financial reasons, that would be a huge mistake.

    I know I may seem hugely one sided in my argument, but that is because I have been there and I know how bad being a physician in the CF truly.

    I would be more than willing to answer any questions you have. Please email me if you have any questions.

    All the best,

    Jason

    • August 22, 2010 4:07 am

      wow, thanks for the considered response

      i’m pretty sure I won’t join
      do wonder about doing the reserves/contract thing still though. is that something you would ever consider doing? lots of our Intensivists go overseas to be trauma junkies. I imagine I’d work better in a German hospital treating the recovering as opposed to a field trauma enviro, but I’d certainly learn more in the latter.

  5. Jason Bailey permalink
    August 27, 2010 10:52 pm

    Hello Jessica,

    I do know a few people who have joined as reservists and I must admit their is a lot more flexibility as a reservist. That is definitely true. I’m pretty sure you get to pick and choose your deployments, but you will want to ensure that is truly the case before you sign anything.

    I just warn you to keep in mind though that once you decide to deploy with a unit, even as a reservist, you will fall underneath that unit’s chain of command. This means that you will be subject to the Code of Service Discipline, and when it comes to many units, particularly within the army, they can be very liberal in their application of this code. Something that you do would be viewed as good patient care by any rationale physician could be misconstrued as interfering with the mission by the Commanding Officer, who is often not a physician. I have a physician friend who was almost charged with insubordination in such a situation. This is a serious charge in the military. Even if your chain of command is purely medical, it happens quite often that you end up getting some physician-turned-administrator who hasn’t really seen a patient in several years “supervising” your medical care. This can become quite problematic, particularly if that individual starts interfering with your medical care, which they are more than entitled to do if they are a more senior medical officer to you (in terms of rank or seniority in the medical chain). Seniority in civilian medicine is determined usually by things like level of training and experience, and passing exams, but in the CF seniority is really determined by rank, which has nothing to do with your actual skill, level of training, or amount of experience as a doctor. This whole odd dilemma can become very problematic when you have a supervising physician of a higher rank who doesn’t realize how out of touch they are with clinical medicine. I know this happens in civilian medicine too, but it is taken to a whole new level in the CF. Following the chain of command and the “mission first” mentality always take precedence over everything else. This is definitely something to keep in mind and that you have to be comfortable with before joining the CF.

    This does not even touch on the whole issue of whether supporting our current Canadian Forces (which is really just a US puppet at this point) as a physician is really morally correct or not from a more global perspective. I know that by the Geneva Convention you are obliged to treat everyone, but really your primary focus overseas is the Canadian troops. It all comes down once again to the “mission first” mentality. My belief is that being a physician in the CF currently is providing direct support to the US “War on Terror”, and you have to be comfortable with supporting that cause. I don’t know if you believe whether the current wars in Iraq and Afghanistan are truly helping to reduce the world burden of “terror”, and helping to establish true democracy in the war-torn nations in which these wars are being conducted, but I think you have to believe in that cause in order to sleep well at night wearing the CF uniform. I personally think that the current War in Afghanistan is actually making things far worse in terms of global terror and as well as in terms of peace and democracy for the Afghan people. Even if the American government had no hidden agenda with the War in Afghanistan (which is highly doubtful to me, but I am trying to be hypothetical here), the aim of “creating democracy” in a short time frame that a war takes place in (usually anywhere from 2-8 years say) in a country like Afghanistan that is populated in the large part by Pashtuns, who have followed for hundreds of years their own cultural form of government that is quite unique, but quite different from the Western idea of democracy, as well as highly influenced by the Islamic faith, is just not possible. Changing a culture takes decades. If the Americans expect to evoke such quick change in Afghanistan, they either have a hidden agenda, or they are foolishly optimistic, or just plain foolish.

    As for other more “humanitarian” parts of the CF, even the DART, which everyone thinks is this great humanitarian aid vehicle, is nothing but a “huge political tool” (this is a direct quote from my ex-CO); aid could be delivered much “more quickly, effectively, and cheaply through NGO’s than through DART” (once again a direct quote from my ex-CO, paraphrased but the same essence of what he said).

    I personally think if you look at being in the CF from a more global political and ethical perspective, it evokes a lot of soul searching, especially for a physician. In the Hippocratic oath it says,”In every house where I come I will enter only for the good of my patients”; however, that is often not the reality in the life of a CF doctor, especially during deployed operations. Yes you may learn a lot about trauma care doing field trauma (as you would also if you did a trauma fellowship or emerg rotation in any southern US city), but I just want to encourage you to look at the bigger picture. I didn’t do that when I joined, and I truly regret no doing so. Just something to keep in mind.

    Once again, if you have any questions, please do not hesitate to ask.

    Sincerely,

    Jason

  6. Anonymous permalink
    December 23, 2012 6:29 pm

    I do not think that you, or anyone else for that matter, should join the military. Why? Because any possible rewards you might get from service ARE NOT WORTH THE RISKS. NOTHING, and I do mean NOTHING is worth your life.

    I lost a loved one in Afghanistan several years ago, and I can assure you, that while soldiers think they understand the risks, no one ever really goes to work with the realistic expectation that they won’t come home at the end of the day. Sure, the military offers a good salary and a chance to see the world through adventure, but that money – won’t do you any good if you die (and trust me, the compensation packages offered by the military hardly make the sacrifice financially worth it for your family, who will be left behind…….). Before your join think long and hard about what it would be like to loose your life in service, because it is a real, very real risk…….not a distant possibility. Besides the risk of dying, there is also the risk of developing conditions such as PTSD, TBI, getting physically injured, and you could face both physical and sexual abuse during your time in service as well. It is simply not worth it, and even if you yourself belief in the CF, ask your loved ones if they do as well, because they will be the ones left behind should something happen to you in service.

    The Canadian Military may work out well for some people, but for those it works out for, they are very, very lucky indeed. I’m sure you’ve family that loves you, and for their sake as well as yours, just don’t join. Best of luck in your future career.

Trackbacks

  1. Medical School = Debt That’ll Kill Me « Dr. Ottematic
  2. Uncle Sam wants YOU? The Canadian Forces want me!
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