UO > Feature > Doing Double Duty

Kenneth Lee, MD, has more on his mind these days than just treating patients. Of course, he’s concerned that he and his colleagues deliver high quality care. That’s what medical professionals do, but, with fire fights erupting around them and homemade detonating devices too, he worries as much about security as he does patient health. “Every time my soldiers are on assignment, I have trouble concentrating, even eating and sleeping, until they’re back,” he says. “But it comes with the job.”

The “job” Lt. Col. Lee refers to is as commander of Company B, 118th Medical Battalion, a 70-member Wisconsin Army National Guard unit deployed to Iraq since February. Its mission? To staff a troop medical clinic in the Baghdad area and five other satellite sites around Iraq.

Leading soldiers into a war zone would tax any physician. But with 18 years of guard service, Lee certainly has the credentials. Yet, he didn’t have to go to Baghdad to know about battles. As civilian director of the spinal cord injury (SCI) service at Milwaukee’s Clement A. Zablocki VA Medical Center, he treats paralyzed or otherwise injured veterans every day. “Taking care of them is a unique opportunity,” he says. “It’s a privilege.”

With such dedication, it’s easy to see why this physical medicine and rehabilitation specialist practices an avocation tied so fundamentally to his vocation, but what prompts other full-time doctors to become part-time “citizen soldiers?” And what do they find if they’re called up for war?

First and foremost, they’re part of a force that—at least in philosophy—dates back to the colonies. Ever since the founding fathers organized state militias, which are the forerunner of the National Guard, citizen soldiers have defended this country both here and abroad. What sets guardsmen and reservists apart from active-duty soldiers is that they leave their communities only when the nation needs them to serve and protect. Their role in the meantime is to prepare—just in case.

“It’s a little bit like being a forest ranger,” says Robert Singler, MD, a Napa Valley, California, anesthesiologist and air reservist. “You’re spending all that time against the chance that you might eventually get called.”

To civilians, the programs offering medical corps opportunities—the Navy Reserve, the Army National Guard or Reserve, and the Air (Force) National Guard or Reserve—look very similar. Indeed, the money, benefits, and regular time commitments are the same. But it’s the cultures and missions that separate them. Reservists, for example, provide each branch of service a federally-mandated back-up crew for its active-duty force. They’re trained to step in when additional manpower is needed anywhere in the world.

National Guardsmen perform similar roles, but with a dual state-federal focus, they march to the beat of two drummers: First, to the governor of a particular state in protecting its communities; and second, to the President, in protecting the entire country. The state mission is probably most visible to Americans, since guardsmen are on the scene every time a natural disaster—fire, flood, tornado, or hurricane—threatens local citizens.

Ronald Renuart, DO, a Ponte Vedra Beach, Florida, internist, was in the midst of his residency when Hurricane Andrew devastated south Florida. As a member of the Florida Army National Guard, he was the only physician assigned to one of three facilities set up to care for soldiers and citizens in the clean-up. Renuart’s later service would take him to faraway places like Iraq, (and since then to the
latest 2004 Florida hurricane disasters.) But for those two weeks in 1992, he made sure the first aid and health needs of fellow Floridians were met. “Our job was to maintain the troops so they were available to do their duty.”

“Duty” in a post-9/11 world can be anytime, anywhere. True, the majority of doctors won’t serve in hot zones like Afghanistan and Iraq. But then again, more physicians than ever before (about 10 percent more, according to some figures) are being activated at any given time these days to answer the latest mid-east surge. That means joining the military could take more out of a doctor’s schedule than just a monthly weekend drill or annual two-week camp. “I’m not going to kid you,” says Randall Falk, MD, MPH, the Air National Guard Surgeon General, “it’s a huge commitment, because you could be pulled out of your practice at any given time to help the country. Luckily, we have physicians willing to take that risk, to broaden their horizons and skills to respond to the call of the nation.”

But what about others? Recruitment and retention have remained relatively stable over the past 10 years, even though Department of Defense statistics indicate a decrease overall in the ranks of National Guard and Reserve doctors, from 5,749 in 1993 to 4,644 in 2003. Officials cite various reasons, including some mandatory downsizing. But it’s still a challenge, they admit, to turn fresh interest into fresh sign-ups, especially when existing soldiers are volunteering extra effort during trying times.

The upside is that the perception of reservists as just weekend warriors is changing. When Brett Wyrick, DO, a Hilo, Hawaii, general surgeon and Hawaii Air National Guard commander, signed-on, it was even difficult to get time off for drills. But since 9/11, and even after Desert Storm, he and others find more acceptance among their colleagues. “They’ve seen that we aren’t just camping out,” says the state air surgeon. “We’re playing an active role in defending the country.”

So what intrigues Wyrick and other physicians? It’s certainly not the money—they could do better moonlighting. Doctors coming into service at the lowest physician-pay grade, for instance, make $402.52 per drill weekend plus $1,408.82 for 14 annual camp days. Obviously, many variables—e.g. rank and years of service plus credit for active duty and other experiences—can increase a part-time soldier’s paygrade, however modest the subsequent paycheck looks in comparison to normal earnings. For instance, a 10-year veteran who has moved up two grades, can expect a stipend of $722.12 for each monthly weekend, plus $2,527.42 for those yearly training camps. Of course, if she is deployed, the money gets better. There is full-time active-duty compensation, along with add-ons, such as combat pay, all of which can boost the bottom line substantially. Likewise, other perks, such as bonuses and the promise of lifetime health insurance and a stipend upon retirement, can make the package just attractive enough that some physicians stay on for 20-plus years.

But the real reasons doctors come on board have to do with concepts like patriotism, camaraderie, and payback for a life well led. Lee picked the military when his father, a former Korean Army lieutenant colonel, told him that he should volunteer to give back for his college aid. Of all the endeavors the elder Lee suggested, none involved a uniform. “The army was my father’s life,” he says, “but he didn’t want his only son to go into it.” Obviously, Lee, who emigrated to this country from Korea at age 10, wasn’t deterred, but ask other physicians and they invariably mention following in someone’s footsteps or wanting a new perspective on medicine and the world.

“Whether you’re treating an Iraqi soldier or civilian or an American, you have this feeling that you’re participating in what medicine is meant to be,” says Singler. “But even if you serve 20 years on a base in the US, never going anywhere, you still come away very fulfilled that you’ve done a good thing.”

And it’s educational and exciting as well. The doctor who’s fascinated by hyperbaric or dive medicine might choose the Navy, because he likes the idea of working with soldiers involved in air, land, and sea. The practitioner who recalls her childhood love of airplanes might select the Air Force, since she wants to make sure that pilot crews are fit to fly. The physicians who love the rough and tumble, might go Army because they’re looking for survival training in the great outdoors.

“You could consider it almost a paid camping trip,” says Major General Kenneth Herbst, MD, the deputy surgeon general, US Army mobilization, readiness and reserve affairs. “Obviously, it’s more complex than that, but the opportunity to be in a rugged environment, with rugged soldiers, is invigorating. The person we’re recruiting has a sense of doing the tougher things—because they’re worthwhile.”

Of course, there are variations on each program theme, but one constant since 9/11 is a commitment to protect the country against a possible terrorist attack. By sharpening their critical care skills, physician reservists and guardsmen are prepping to go overseas at a moment’s notice, as they’ve done to places like Bosnia and Kosovo. Back home, however, they’re preparing to be a “force multiplier,” ready to integrate manpower and resources into communities facing possible biological, chemical, or nuclear attacks.

Wyrick’s unit spends much of its time these days bringing civilian practitioners up to speed on triaging and managing terrorist-type casualties. “You have to believe in what you’re doing and that you’re making a difference,” he says. “For me, it’s pretty simple: The United States is the first, best, and only hope for democracy in this world. By me doing the things that I do, I hope one day my children won’t have to do the same.”

Lee came to Iraq with a full, but varied, plate. As a manager, he’s dealing with many of the same issues he’d have back home. Is staff trained sufficiently? Are supplies adequate? Is everyone performing up to par? But as a clinician he is maneuvering through a specialty—trauma medicine—that’s not his normal forte. “That’s what makes the guard so great for me. I get to do things I can’t do on the civilian side.”

In fact, chances are good or even better that reservists who wear specialty hats in their everyday jobs will practice other medical skills in the military. That doesn’t mean a dermatologist won’t be welcome or a nephrologist can’t find a niche. The truth is, doctors of all types are represented, but they may have to bone up on their general medicine skills before their specialty skills are required. As one gastroenterologist says, “It’s kind of a breath of fresh air.”

As an emergency room psychiatrist for the Charlotte, North Carolina-based Carolinas HealthCare System, Jill Hendra, DO triages and treats patients in distress. But when she evaluates the readiness of flight crews—one part of her job as North Carolina Air National Guard’s State Air Surgeon—she uses the hands-on maneuvers of a general practitioner, even though her psychiatry skills come in handy, too. “Being a flight surgeon definitely keeps me rounded as a physician,” she says.

Others, like Peter Matsuura, MD, join knowing their specific skills are in high demand. The fact is, with state-of-the-art body armor limiting lethal belly and chest wounds, battle injuries have shifted to the extremities—his stock and trade as an orthopaedic surgeon. So when Matsuura’s department chief, a Navy man himself, suggested there’s no better way to practice their specialty than in the service, Matsuura eventually signed on. The Hilo, Hawaii practitioner had one condition, however: If called, he didn’t want to “back-fill” at another physician’s post while that doctor went overseas. “If boys are putting their lives on the line,” he says, “I want to go first.”

Deployed to Ramstein-Landstuhl Air Base in Germany earlier this year, Matsuura worked around the clock, repairing bone, nerve, and muscle damage so shattering it bore little resemblance to the gun and knife wounds he treated in training or the wear-and-tear injuries he fixes back home. “Not even close,” he says. Bad fractures…missing limbs…gaping holes where structures once supported arms and legs. “These young kids will carry the scars for a lifetime, but they’re still gung ho,” he says. “They want to get better so they can go back to their buddies.”