# Specialist Surgeon Wanting to Join - No Room at the Inn?



## mgc87 (31 Jan 2018)

I'll be a newly minted Otolaryngologist (ENT surgeon, 30 years old) this spring, and recently reached out to the CFMG recruiter to inquire about joining up in some capacity. The 'part-time' option is appealing, but I was told there are is no "current need" for Otolaryngologists on staff. This is understandable, but I wonder if there is a path to join to contribute in other means (performing research, quality improvement initiatives, health resource planning & logistics) and wait in the wings until a clinical need for an ENT is determined. I have substantial experience in academics (40+ peer-reviewed publications), leadership roles on national committee's, etc. I suspect I'd have value to add from these avenues immediately. 

Any advice on how to proceed? All insights are greatly appreciated.


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## medicineman (31 Jan 2018)

You could join a local reserve medical unit as a general duty medical officer - go out on exercises, etc and wait for any interesting gigs to come up with 1 Cdn Fd Hospital.

MM


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## mariomike (1 Feb 2018)

mgc87 said:
			
		

> Any advice on how to proceed?



You may wish to contact our Recruiter, 

https://milnet.ca/forums/members/51867


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## PilotMD (9 Feb 2018)

Hi mgc87, 

  I'd be curious to know what you find out from the recruiter. I am also a specialist surgeon (reconstructive urology) interested in serving. I went the same route you did - tried contacting various individuals but told that my specialty was not a requirement of the Canadian Forces at this time. Let me know if you hear of any other avenues. 

  For MM - can specialist physicians serve as general duty medical officers in the reserves despite not having a CFPC (College of Family Physicians Canada) fellowship?

Regards

PMD


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## medicineman (9 Feb 2018)

PilotMD said:
			
		

> For MM - can specialist physicians serve as general duty medical officers in the reserves despite not having a CFPC (College of Family Physicians Canada) fellowship?
> 
> Regards
> 
> ...



Before I retired the second time, my Reserve Brigade Surgeon was actually a plastics guy, but he still went out on exercises as an MO.  You'd be largely used in that capacity or for helping train young medics, as opposed to seeing patients day to day as a GP in a base clinic.  I guess the other option is to see if there are any reserve positions with 1 Cdn Field Hospital, belong to them, but be affiliated with a local unit.

MM


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## da1root (9 Feb 2018)

mariomike said:
			
		

> You may wish to contact our Recruiter,
> 
> https://milnet.ca/forums/members/51867


Speak my name, and I shall come 



			
				mgc87 said:
			
		

> I was told there are is no "current need" for Otolaryngologists on staff. This is understandable, but I wonder if there is a path to join to contribute in other means (performing research, quality improvement initiatives, health resource planning & logistics) and wait in the wings until a clinical need for an ENT is determined.


The above is correct; the only intake for Medical Officer's are:
1) GDMO's
2) Specialists in the following areas
a) Anaethesia
b) General Surgery
c) Internal Medicine
d) Orthopaedic Surgery
e) Psychiatry
f) Radiology

With the 6 specialties; those are just the ones that are required by the CAF; when a Medical Specialist approaches a Health Services Recruiter we reach out to the OA through H Svcs Gp HQ to determine if there is space for that occupation.

If you're qualified to work as a GDMO (Family Physician) you could enrol that route, but you'd be enrolling as a Captain as a GDMO vice a Major as a Specialist.

My expertise is with the Regular Force side of the house; but as medicineman suggests you way want to reach out to a local Field Ambulance (or 1 Canadian Field Hospital detachment Ottawa - please note the "Ottawa" part is misleading; the admin unit is in Ottawa, but you can be anywhere in Canada and belong to them).

Please feel free to reach out to me if you have other queries.

Cheers


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## Blackadder1916 (9 Feb 2018)

mgc87 said:
			
		

> . . . The 'part-time' option is appealing, but I was told there are is no "current need" for Otolaryngologists on staff. This is understandable, but I wonder if there is a path to join to contribute in other means (performing research, quality improvement initiatives, health resource planning & logistics) and wait in the wings until a clinical need for an ENT is determined. I have substantial experience in academics (40+ peer-reviewed publications), leadership roles on national committee's, etc. I suspect I'd have value to add from these avenues immediately.



Buck's advice should be taken as the most knowledgeable on these means re medical recruiting; he is the resident expert currently working in that field.

To add a little for your benefit.  When Buck et al listed the few types of specialists that the CAF is recruiting for the Regular Force, that is not simply because there are currently openings for those specialists and something in another specialty may open at a later date.  They are the only specialties that are authorized to be paid as specialist medical officers in the Regular Force.  According to CBI 204.216 - Pay – Medical Officers   (this section refers only to Regular Force and Class C)



> clinical specialist means:
> a.  a medical officer in the rank of major, lieutenant-colonel or colonel who holds a fellowship certification through the Royal College of Physicians and Surgeons of Canada in one of the following clinical specialties:
> 
> I.  general surgery;
> ...



Years ago (my personal experience with MOs with other specialties was probably before you were born) there were a wider range of clinical specialists in uniform, including ENT, urology, dermatology, ophthalmology . . ., but we also were larger, operated our own hospitals and had a few locations where we provided care to dependants (and civilians).  We They don't any longer.  Now, the military health services either provide that specialist care through detachments that are located in civilian hospitals or by the same means that every other Canadian gets to see a specialist, by referring CF members to civilian physicians and surgeons and paying the bills.  In fact. that was how we provided a significant portion of our specialist care even back in the old days when we had hospitals. Since the less than seventy thousand who are eligible to receive day to day health care from the CF are spread out across the country (the world?), then it is a better utilization of scarce tax dollars to only have the full-time medical specialists that would most likely be deployed on operations (i.e. those that would be necessary to patch up casualties before returning them to Canada).  When they are not deployed they generally practise their medical specialties in civilian hospitals (as full time Regular Force members) keeping their skills fresh seeing CF and/or civilian patients.

It is admirable that you hope, in the event of not practising your trade, to be able "to contribute in other means (performing research, quality improvement initiatives, health resource planning & logistics)".  However, be aware that the military is a bureaucracy and military health services is both a military and medical bureaucracy.  The preference is that only those who come from within (those who know how the system works) get to do the planning.  While your experience is laudable, compare it to those who may currently be doing the "health resource planning and logistics".  For those in uniform they will be physicians, administrators, pharmacists, nurses, physiotherapists, bioscientists and logisticians who will have had (usually at a minimum) several years of progressive military service experience, often with one or more overseas operational tours, many will have had sub unit and sub-sub unit command experience and previous staff (read "military planning") training and experience as well as several years of clinical experience for those whose occupations require it.  While the CAF does have some facilities that do military related medical research, someone of your qualifications would more than likely be hired as a civilian rather than military (even if there was a requirement for your particular skill set).  Often, medical research that the CAF needs is contracted out or done in conjunction with the clinical practice of serving specialists.

Hopefully, none of my previous comments dissuade you from trying to serve in some capacity.  As suggested in other posts, you should see if the Reserves can satisfy what you wish to do.  While it is unlikely that you will have the opportunity to see patients as an ENT in the Reserves, it is not unheard of for specialists of many stripes to serve in the Reserves.  Even the definition of "specialist" in the CBI that deals with Reservist pay expands the list to include more fellowship certifications.

204.52 - Pay – Officers  (this refers to Reserve only)


> clinical specialist means
> 1.	a medical officer in the rank of major – or lieutenant-colonel or colonel – who holds a fellowship certification through the Royal College of Physicians and Surgeons of Canada in one of the following clinical specialties:
> 2.	General Surgery;
> 3.	Anaesthesiology;
> ...



My experience with reserve medical units is very dated, but years ago I was the commanding officer of a reserve medical unit (I was an HCA, not a doctor).  At that time all the doctors in my unit were specialists, however it mattered not the flavour because they were not employed in their specialities.  On the few occasions that they saw patients (usually only when on exercise), it generally was primary medical care.  Of note, back then (in my unit at least), when those medical officers were at the rank of Captain, they were not paid as specialists.  There was an expectation that there was a "military" learning curve and even doctors were expected to spend time at the Captain level before promotion to Major.  In the clinical specialist pay table there is no Captain scale.

If your desire is to practise your speciality with CAF patients, here is a suggestion.  Try to be the ENT of choice that CF doctors refer to.  If you are located in an area that has a large CAF population (i.e. near a major base), make whatever supporting medical unit aware that you are available to see CF patients.  They do pay outside any provincial health insurance plan.  There wouldn't be enough of a case load to sustain a practise (probably not even enough to justify dedicated days), but it may be a way forward especially if you are also in the Reserves.  I do recall, decades ago, that one of the civilian specialists that we referred to from the base hospital (a primary care clinic actually) would do a few days a month in our MIR seeing referrals.  Since he was also a doctor in the Reserves, he would sometimes show up in uniform, especially when it coincided with days that he also had parade nights.  Of course such an arrangement would depend on what the business circumstances of your civilian practice entails - partnership, association, cost sharing, hospital affiliation. etc.

Of course, take whatever I've provided with a grain of salt.  My military medical experience is, as I previously stated, very dated.  I am now long retired and things may have changed considerably.  If I'm well off track, hopefully one of the other CFMS types will come by and set me straight.


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## PuckChaser (9 Feb 2018)

I'm not sure how the CAF picks specialists it refers people to from the MIR, but perhaps you could offer your services to the CAF that way; take referrals of military members to reduce wait times. I know in Kingston we had an ortho surgeon come by twice a month to run a day-long clinic to handle all the referrals to him, and all military members were on top of his cancellation call list as he knew they could most likely drop everything and show up.

Just trying to think outside the box from outside the CFMS, I very much appreciated the surgeon running that clinic (although he probably made a killing from us breaking ourselves on PT/sports). Saved me a 6 month wait for a referral and a 6 month wait for surgery.


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## Piece of Cake (9 Feb 2018)

Blackadder1916 said:
			
		

> The preference is that only those who come from within (those who know how the system works) get to do the planning.



This is old school C'A'F thinking.  While there are several who think and feel this way - across all CAF trades - there are others who disagree with the above statement.  I can see the value in having a civilian conduct academic research, planning, and logistics. Just because one does not wear a uniform, or have a scroll, does not mean one does not "know how the system works".


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## Blackadder1916 (10 Feb 2018)

Piece of Cake said:
			
		

> This is old school C'A'F thinking.  While there are several who think and feel this way - across all CAF trades - there are others who disagree with the above statement.  I can see the value in having a civilian conduct academic research, planning, and logistics. Just because one does not wear a uniform, or have a scroll, does not mean one does not "know how the system works".



There are lots of civilians who do "academic research, planning, and logistics" within the department and probably do it well, some (most?) probably better than uniformed counterparts.  However, that is not what the OP was talking about (or else that is not what I surmised from his post.)  He was looking to join the CAF as a doctor, in particular in his medical specialty.  And then, when he was informed that there were no openings for otolaryngologists, he wondered if he could be enrolled as a doctor to do those other things because, well, he's a smart guy and feels that he could make a contribution.  However, my response was specific to his situation, not a general comment about the value of civilians doing tasks instead of serving military members.

Without knowing the background of the OP other than he is 30 years old and soon to finish his residency, it is likely that his history has been 3-4 years of undergrad, 3-4 years of medical school and then the 5 years of residency needed to become an ENT, so he has probably been in training to reach this goal since he was 18 years old.  *Well done that man!*  Now, while he is well educated and qualified to provide clinical care in his specialty and would have an easy go to do all those others things (research, quality improvement initiatives, health resource planning & logistics) within a civilian based health organization, there are some differences in the military health system at the level where those planning activities take place.  Would you say the same thing if the occupation we were talking about was, for example, MARS?  How easily would it be for a highly educated (say at the masters level) individual even if he had a civilian master mariners ticket (so he knows how to drive a ship) to join the Navy and immediately be placed in a LCdr's slot at a headquarters.  Would he know what to do on day one?  Probably not, because it takes time to train and season that officer so that he can function at that level.  And if not MARS, how about ARMD?  Would a civilian education in management prepare someone to command a combat team or be a staff officer in an operational HQ?  It is very easy to assume that a military physician can be automatically replaced with a civilian physician, because there are still many out there who don't place much value on the "military knowledge and skill" of military docs.  Not everything that is done in a medical headquarters is clinically focused.

Why do I equate his situation to that of a senior officer?  Well, the pay scale for medical specialist starts at Major, roughly (with additional allowance) just shy of a quarter million a year.  Now this seems a bit generous, but when compared to the potential income of an ENT in the civilian sector (on average more than $400,000 less 30% overhead) it's not too bad.  I think the other benefits (e.g., generous leave and pension) make military and civilian salary more comparable.  My expectation would be that the OP would be looking for salary comparable to what he is giving up, besides he probably has a lot of student debt to pay back.


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## da1root (10 Feb 2018)

Blackadder1916 said:
			
		

> besides he probably has a lot of student debt to pay back.


That's why "we" (the organization) brought back signing bonuses for MO's - starting at $40k working up to $225k


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## RedcapCrusader (10 Feb 2018)

An old co-worker of mine left Public Medicine and moved to the CAF. He gets to do the job he worked hard for and loves, get to do loads of training, a whole bunch for specializing (within the CAF's allowed specialities), a plethora of travel... Without the overhead!


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## daftandbarmy (10 Feb 2018)

mgc87 said:
			
		

> I'll be a newly minted Otolaryngologist (ENT surgeon, 30 years old) this spring, and recently reached out to the CFMG recruiter to inquire about joining up in some capacity. The 'part-time' option is appealing, but I was told there are is no "current need" for Otolaryngologists on staff. This is understandable, but I wonder if there is a path to join to contribute in other means (performing research, quality improvement initiatives, health resource planning & logistics) and wait in the wings until a clinical need for an ENT is determined. I have substantial experience in academics (40+ peer-reviewed publications), leadership roles on national committee's, etc. I suspect I'd have value to add from these avenues immediately.
> 
> Any advice on how to proceed? All insights are greatly appreciated.



You do medicine for your day job. 

You should join the Infantry and learn how to create customers for your day job, during your night job


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## Piece of Cake (10 Feb 2018)

Buck_HRA said:
			
		

> That's why "we" (the organization) brought back signing bonuses for MO's - starting at $40k working up to $225k



This is a great move by the CAF.  Now, time to bring back the paid medical student spots at universities.


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## da1root (10 Feb 2018)

Piece of Cake said:
			
		

> This is a great move by the CAF.  Now, time to bring back the paid medical student spots at universities.


There are paid Medical Spots ... it's MOTP - it's just that we don't have reserved spots at the Universities - MOTP applicants must secure their own seat.
Students get a signing bonus, have their education paid for, receive a salary, receive 100% medical/dental/etc, and are building their pension.
We enrolled 100% of the SIP last year and it's looking like we'll enroll 100% of the SIP this year.


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## mgc87 (10 Feb 2018)

Hi all -
First off, thanks for the insights and opinions. Everyone's willingness to help has been refreshing! Listening in on the debate is fun, too. 
I've had an excellent off-site conversation with one surgeon-reservist member of the forum.  Sounds like my best bet will be to go the Reserve HCA Officer route given my interest in health care admin and leadership. It makes sense that there just isn't the capacity for a full-time ENT on staff. I like the idea of trying to be a preferred provider for CF referrals - I'm going to look into this more.

Please don't take my enthusiasm for arrogance -- I don't presume to be the messiah for all of the CF's health admin needs.  As someone more knowledgeable than I pointed out, I should appreciate that the civilian health care bureaucracy is apples-to-oranges compared to the military. With that said, I'm finishing up a Master's degree through RMC-Kingston, and I've begun to open the book on those differences. I'm going to hit submit on my CF application as soon as I settle in to YYZ. I can update those of you interested in this trajectory later this spring if you wish.


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## da1root (10 Feb 2018)

Hi mgc87,
Not sure what you're getting your Master in, but HCA only allows for certain degrees.
Although HCA is looked at as a Medical Occupation, it doesn't technically fall under the portfolio of occupations that I manage; however I'm 90% certain that the Entry Standards in the following post are still accurate: https://milnet.ca/forums/threads/18135.75/


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## Piece of Cake (10 Feb 2018)

Buck_HRA said:
			
		

> It's just that we don't have reserved spots at the Universities



That is correct.  If I were to use the word 'reserve', the reply back would have been, "we do not have reservist spots for MOTP".  My point was that we should bring back reserve spots at Universities.


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## mgc87 (10 Feb 2018)

Buck_HRA said:
			
		

> Hi mgc87,
> Not sure what you're getting your Master in, but HCA only allows for certain degrees.
> Although HCA is looked at as a Medical Occupation, it doesn't technically fall under the portfolio of occupations that I manage; however I'm 90% certain that the Entry Standards in the following post are still accurate: https://milnet.ca/forums/threads/18135.75/



Thanks for the heads up. At RMC I'm in Public Admin -- I suppose the only way to find out for sure is to submit and see what they think of my application package/portfolio?


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## PilotMD (10 Feb 2018)

I too have enjoyed all of the comments provided by the more experienced members here. Thank-you for your information and perspective. I have been interested in serving in the Canadian Forces for many years - unfortunately, my medical interests did not align with the needs of the Forces (the aforementioned specialties) when choosing a specialty way back in medical school (I did 9 years subspecialty training). 

My plan is to touch base with some local reserve units to determine what possibilities exist for me to serve in some other capacity (combat arms, support, etc) - NCM or officer. 

Thank-you all again for your responses.

ps - all the best to you mgc87 (are you finished your exams yet - if not, best of luck, they are a beast!).


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