There are a lot of things that can make this transition a little intimidating beginning with; "Am I worthy?" Other considerations; "Am I good enough?...smart enough?...strong enough?" It's as fundamental as, how to get your resume to 'speak' civilian instead of military terminology. It gets as complex as, how to get along in health care organizations that seem to have no real common cause...other than money that is.
Once you jump in the middle of all this you will very often find a mix of ethics ranging from humanitarian to business and that...can be disturbing when the business ethic transcends all.
In military health care, the vast majority of us are united in a common cause, various versions of "quality health care to maintain maximum readiness." It's all about patients, their families and the overall population-at-risk.
Sure it can often be a madhouse of multidisciplinary purposes...docs, dentists, nurses, technicians, administrators can't always be on exactly the same wave length on the best way to get from point A to point B. But...when "it" hits the fan, we all come together and we have historically done some wonderful things for our fighting men, women and their families.
When you move to a civilian health care environment, particularly in management, you will very often find this "common cause" lacking or even non-existent. The business ethic often dominates the scales, outweighing the humanitarian cause we are so accustomed to in a military environment.
This can do some pretty serious damage to your outlook on things if you are not prepared for it.
When I left the Medical Service Corps, I spent a couple of years working in an HMO, implementing the very first TRICARE - then called CHAMPUS Reform Initiative (CRI) contract. My gang and I were responsible for supporting all MTFs and over 350,000 beneficiaries in Northern California. I can tell you most of us loved the cause of supplementing the military health care system. I can also tell you that encountering the harsh reality of a business environment was difficult. It's not the 'need to make a profit to remain viable' part...it's more the 'need to put increasing EPS over compassionate, quality care.'
A year and a half or so after we successfully implemented the contract, our new CEO did some business process re-engineeering and absorbed all the military contract operations into their commercial counterpart functions. Dozens of people who had worked so hard to successfully implement the federal functions were laid off.
I was the COO of Northern California CRI and was not laid off but put in a token position - my job, to travel to the military medical facilities we supported and reassure them that services they had grown accustomed to would not be diminished.
I slept on that for a night, considering my new responsibility to spin a story I didn't believe was true. The next morning I discussed my predicament with my wife and when I arrived at work, announced my resignation. Almost 30 years later, TRICARE continues successfully and still, I do not regret my decision. After all, it was the great team I was privileged to work with that garnered the accolades in an independent Rand Corporation study...a study that affirmed the benefits of the program and set the stage for its expansion to the rest of the US and overseas.
Shortly thereafter, the former Chairman of the Board of the HMO, Dr. Jim Schubert hired me to help him start a consulting firm. We built it over a seven year period and along the way worked for many health care firms ranging from the largest in the U.S to some of the smallest. After that, I started my own consulting firm, assisting health care organizations in continuing or rolling out new programs in support of state and federal contracts. For me, one of the biggest benefits was being able to walk away from the organizations that had toxic environments fueled by...I guess "greed" would be the right word to use here. I was also fortunate to have several clients for more than 20 years, occasionally assisting many non-profit health care organizations in the pursuit of renewed or new contracts, mostly Medicare and Medicaid.
Along the way, I continued to encounter many instances where the humanitarian cause was subordinate to the business end of things. It is a delicate balance, the one between stakeholders and patients I know, and it is often tilted too far toward the corporate pocketbook. So you need to be prepared for this eventuality as you will likely encounter it at some point in your life after the Corps.
How do you hang on to your sense of ethics? My only advice; follow your heart and help when you can. You will sleep good at night. Plus, you will retain some warm thoughts about your days serving in a bastion of moral code...the Air Force Medical Service Corps.
For excruciating detail, including feeble attempts at humor, click here: The Last Resume.
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