Monday, June 7, 2010

Relative scarcity

I cannot complain about deployments amidst helicopter pilots here for their 5th 12-15 month tour in the past 8 years.  That said, that is the nature of being a helicopter pilot.  They are most valuable to the world – as helicopter pilots – in this war in the middle east.  Back in the states, they may be in demand to shuttle a CEO from Manhattan to JFK, or to help fire jumpers in the west, but here, they save lives daily, and provide essential transportation services where there are no roads, roads are unsafe, or roads to sanctuary are too long.  Likewise, the trauma or orthopedic surgeons are the war-theater rock stars.  They are in demand all over, but here, at least when the violence was greater, they operated here more frequently and to greater effect than ever before in history.

By contrast, the nature of my job is to diagnosis and treat malignant blood disorders.  Since most of the diseases I care for occur in less than 1:10,000 people, I almost never make a new diagnosis here in theater.  More importantly, and to the point, the capacity to confirm diagnosis through laboratory methods, and initiate treatment is only available at higher levels of care, for obvious reasons, and there is no intent to have me here to perform this role.  In the States, I am one of 3 people who do what I do in the Department of Defense, servicing all active duty and beneficiaries via TriCare, while here, I serve as a hospitalist, just as every other medical subspecialist and general internist who comes here.  That doesn’t diminish the gravity of our jobs here, or take away from the value of care provided by hospitalists whatsoever.  In fact, if anything, it emphasizes the value of their inpatient critical care skills, which, for me, required some dusting and freshening prior to re-use.  It rather emphasizes the nature of deployment patterns and violations of the laws of supply and demand, or scarcity, in the military, or at least, in the medical corps, in order to acheive parity.

In order to keep sending the much needed critical care specialists, they send me to pretend to be one.  In addition, I am pretending to be a pediatrician right now.  [God forbid we get another obstetric case (had an etopic pregancy months ago dealt with by the general surgeons)].  The parity principle is fair in some ways, but then again, those who chose to train in trauma surgery or critical care in the military should have known what they were in for, no?  Interestingly, the parity principle is commonly violated by those puppeteers who steer we pawns around the globe.  The USAF, for example, never deploys radiation oncologists or dermatologists, and just recently started deploying pediatricians.  I fail to see how a dermatologist has less to offer burn patients than I do, especially, those trained in plastic surgery techniques.

Again, the glass is half full; it could be worse.  The urgent care clinic across the street is manned by my army colleagues to help the family practitioners: a neonatologist, a rheumatologist, a pediatric neurosurgeon, and an infectious disease specialist.  If you have MD after your name, the army does not see a difference among you.

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