I’m currently deployed in the primary care billet with Fleet Surgical Team 5 (FST-5) onboard the USS Boxer as part of the Boxer Amphibious Ready Group (ARG)/11th Marine Expeditionary Unit (11th MEU). This role within the FST is as the trauma resuscitation lead and critical care provider, as the mission of the team is to provide Role 2 surgical and critical care capability to the ARG. If that sounds foreign to a general internist, you’re right. I’ve had numerous experiences outside the expected role of an internist, including refreshing ATLS, learning to design and enact casualty receiving protocols, and have been lucky enough to train at Shipboard Surgical and Trauma Training (S2T2) and the Naval Trauma Training Center (NTTC) in LA. I’ve even recovered those vague memories of my USUHS Operation Bushmaster skills!
An FST is always preparing and training for trauma “doomsday.” Daily, however, that role translates into practicing high-volume primary care for sailors and embarked Marines, a more comfortable responsibility than being a non-specialty trained intensivist. Building on experience gained as a GMO and internist, this job has forced me to broaden my scope yet again to learn clinical skills that can’t be gained practicing internal medicine in an MTF, but would be essential to practice in the community or outside a major MTF. Austere operational medicine is a humbling reminder that we cannot be a jack of all trades, and a good reminder to be sympathetic to the administrative and clinical limitations of our operational teammates.
Despite all the providers of varying levels of expertise onboard and in the local area of operations, I’ve found that being an internist afloat as made me the default hospitalist and consultant even off-ship and outside the ARG. I work with about a dozen GMOs, IDCs, and a PA within the ARG, who reach out with varying frequency, with a spectrum of clinical queries and angst. Having the opportunity to guide them to be stewards of smart medicine no matter how remote we are or what operational challenges are in our way has been rewarding.
I’ve found that a background in internal medicine allows me to be comfortable with a complexity of case management that many of our colleagues are not. Having an internist afloat allowed us to temporize some patients until a safer or more reliable transfer of care could be arranged, or avoid costly overseas consults or MEDEVACs entirely. Of course, numerous times I’ve been saved by the grace of my colleagues (internists, subspecialists, and others) by phone and email- as long as you stay in the Navy, never take that Orthopedics friend from intern year off your Christmas card list!
A shipboard tour is the quintessential Navy Medicine opportunity. You have the opportunity to become as salty of a sailor as you’d like to be- as with all warfare devices, earning the SWMDO qualification was a valuable exercise in learning about the community we serve. I’m sure anyone who has had a similar operational tour would agree that being a member of a small team is the best way to know and value your nurses and corpsman, and to understand the communities that support us. The FST primary care role is unique among waterfront medical roles in that it offers the ability to stay clinically active as an internist when in home port. When not deployed, the operational obligations are limited to a few days per week and the expectation is set that physicians maintain clinical skills without their specialty.
(This job is an FP billet and is going back to an FP next found, but if it comes up again, is a great opportunity for a mid-level O4 to get a break from the MTF and have an interesting operational experience. Along with that, the CATF-Surgeon job (my boss) is a great job for and O-5 or O-6 who wants a break from the MTF or needs an operational boost for promotion! Probably a less painful job than as an amphib SMO!)