Episode 307: Military Reserve Opportunities
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Hello and welcome back to ACRAC. I'm Jed Wolpaw and we have a great show for you today. This is a little different than anything we've done before, but I think it's really important and I'm really excited to both learn a lot and for all of you to learn a lot about military careers in medicine and in anesthesia. And, you know, as a program director, every year I've got some folks coming in through the match who have an affiliation with the military. Maybe they've already served. Maybe they're currently serving. Maybe...

As we will hear from one of my current residents, in the midst of their training, they decide to get involved with the military. And I never really understood all the ins and outs, what was possible, and really, to be honest, how best to support these folks. And so this is going to be an opportunity for us to hear from four people who are in these different roles, who are going to tell us about their role and what they do and kind of what we, being the people around them, and especially anybody in leadership,

can do to help support them and make these careers both possible and to make them ones that are well supported, as well as to give you all, if you're out there as a medical student or a resident and you're thinking, oh, I might be interested in this, you'll get to learn a little bit about how you might go about doing that. So I'm really excited to welcome Commander Dr. Mark Cannon, Commander Dr. Nick Poulos, Lieutenant Dr. Joey Seeger, and Lieutenant Commander Erica Spencer, all of whom are going to take a turn talking to us a little bit. So all of you, welcome to the show.

Thank you. Thank you. Thanks. Fabulous to have you. All right. Let's start with you, Dr. Cannon. You are a commander in the U.S. Navy Reserves. And tell us a little bit about first that. What does that mean? What do you do? What does your career look like?

Well Jed thanks again for having me. You know my career path is a little convoluted I'll be the first to say so I started off in the reserves. I am on active duty now. I am currently the deputy force surgeon for U.S. Marine Forces Central Command which I guess translates and kind of doctor talk is I'm the basically the CMO for the Marine Corps in the Middle East.

Had a midlife crisis about age 40 and decided instead of buying a new car, I decided to join MAPE. I'm a cardiothoracic anesthesiologist clinically. I'm also an intensivist. So nowadays I'm doing a lot more administration than clinical, but you have a pretty big depth of clinical experience in my past.

My reserve path was, again, a little bit on the different side. There's not too many folks joining at age 40. And it was just something that I kind of always wanted to do and decided to go there. And as you can imagine, the

the Navy as an enterprise is quite the large behemoth. And so I spent several years just learning about what the Navy was all about. And, and honestly showing up with the correct uniform and both shoes on was like a big thing for me and an initial mouth. So, man,

If I'm going to be talking to a resident or someone just coming out as far as the reserves, et cetera, it really is a personal choice. And it's something that you have to align yourself in the values of the organization to say this is really what you want to do. Of course, from the resident side, you know, there's significant financial advantages to it. But really, all in all, it comes down to your heart and soul.

Thanks, Mark. And tell me a little bit, first of all, thank you. And I should have said up front, thank you all for your service. Um,

When you made this cut, so you were first an anesthesiologist and a practicing anesthesiologist, cardiothoracic anesthesiologist. And then, as you said, you kind of had a midlife crisis and decided this was how you were going to do it. But tell me a little bit about, I mean, did you already know about this as an option? And then you were kind of, all right, where do I take this next leg of my career? Or was it, you know, you had never thought about it and then kind of did some searching. How did you end up choosing that as your branch point for your midlife crisis? Yeah.

That's a great question. So like many of us, I actually looked toward the military to pay for medical school. And so to make a very long, convoluted story, they rushed me to get a physical. And despite playing four years of college soccer, I failed the physical. Why? Because at the time that that was interesting, you could not have orthotics in your shoes. And so I happened to be wearing a set of those, which today the military makes them for you.

And so what happened is that just due to the long paperwork it would have taken, I lost two years of financial support, which then would have translated to having the same commitment, but only two years of tuition. So I went ahead and declined that and then started my career. So I was not new to the Navy as a whole in the process itself. Having a good friend who was Navy Medicine West CMO was

was someone who just started talking to me about it at age 40. Hey, would you like to join the Navy? Is this something we would like you to do? And so I started contemplating it and asking where I wanted my career to go.

And obviously, the decision that I made is here it is today. But I did know something about it. But having someone like Lieutenant Commander Spencer can ask and answer every question you could possibly have in that direction and, you know, provide you with that pathway if that's what you want. Yeah, absolutely. Now, you...

Again, I'm very these may be really ridiculously basic questions here, but you joined the Navy Reserves. Is it is that like when you're looking at the options is one to say, I'm going to join the actual. And again, I'm sure this terminology is not right, but the actual Navy and other ones, the Navy Reserves, maybe there's a third, you know, or can you not really actually join the Navy? Because that would mean completely giving up your your job. You know, how does that work when you choose the reserves? Is that just the choice or are there other options?

Yeah, no, great question. So there is the active duty arm, which is a 100% commitment. So you join, you are now placed at a military facility. You may be moved from a different place in the country, but your life now is 100% military. On the reserve side, it has been always a part-time thing. So for my sake, I was coming from a hospital that...

Did lots of transplants and artificial hearts, if you will, et cetera. So then the reserve part wasn't really an adaption of my clinical skills. It was me learning the name. And so it was a part-time. For me, I transitioned later on to go on to active duty because I was just at a point in my career that this I thought was a great choice for me. But as a reservist, you're definitely a part-time person. And if you will, donning the uniform once a month.

becoming that Navy person, and then come Sunday afternoon, removing it and going back to whatever your clinical or personal world may be. And so that's how you, so now you are full-time 100%, is that right? That is correct. Okay. But when you were in the Reserves, you know, what was that balance like between your civilian job and your Navy Reserve job?

Well, as all of us as clinicians trying to balance our schedules for a year are always difficult. I know probably all of us look at our quote unquote vacation planning a year in advance. And so it's typically one week in a month, two weeks a year. There's, of course, lots of

enterprise changing within the reserves as we speak, but it's still pretty consistent to that. And so the schedules are made a year in advance. So your ability to look like, hey, are these my call weekends? Where can I unload some of my work so I can have a Navy weekend? It's something very doable. And of course, interesting enough,

When you look across the Navy Medicine Reserve side, the amount of senior physicians who are in the Navy is almost astronomical. You know, guys coming with 15, 20 years experience, ortho, neurosurgery, anesthesia, et cetera. And so obviously they're making it work.

But I'll go back one more time and say this is a personal and choice of what you want to do. Yeah, fabulous. Now, let's say I just one thing. Yeah, please. While he is on active duty, he is only on a set amount of orders for one year or two years.

he will not forever be on active duty. So just he's still a reservist right now. He's just an activated reservist. So he gets to play active duty Navy, but then he gets to come back to his reserve job, which is kind of complicated. So, okay. So that's different than if somebody says, listen, I'm, I'm, I want to only do Navy a hundred percent. That is correct. Okay. That is definitely, you were living that dream 100% by staying on the active duty side.

I've been really fortunate. I've been able to kind of go back and forth on both sides. And just like Commander Spencer said, is play to my schedule, if you will. But, you know, if things were to heat back up in the United States, obviously we would all be probably a little bit more concerned by those world activities. Great. Mark, anything else you want to add from your experience that you've had?

In my experience, I've been on a deployed 10-person surgical team. I've been throughout the Middle East from Iraq to Kuwait to Jordan. And again, it's, if you will, austere wilderness medicine that we got to talk about. And it's so unique for us because unlike a hospital where you have everything available, resources are unlimited,

You're not only using all your clinical skills, you're using all your logistical, all your MacGyver, everything you could ever imagine came down the pike. It's something you get to experience and work through. Going out on the ships, the same thing. And when we look at people who are interested and you've asked the question, who are the folks who are interested in this kind of thing? I'll be the first to say it's quite the adventure.

But, you know, you're not doing it for a financial commitment. You're doing it because it means something to you and you are a person who wants to give back. And that may be to your fellow Americans. It may be the services, whoever that may be. I'm very fortunate. I go, when I say fortunate, sometimes unfortunate. I go back to the Middle East quite a bit and I'm interacting with our operational teams, which again, you know, it's not just the clinical medicine part. I have to be incredibly well prepared for that.

But it's all the unimaginable things that could come up is, as I always say, every best plan falls apart in about five minutes. And you have to be able to work through that. And that is a unique personality.

Great. Thanks so much, Mark. So, Nick, let's turn to you. You are an orthopedic surgeon and also in the Navy Reserves. So tell me a little bit about your path. How did you get involved? Was it also a midlife crisis or what got you in the reserves and what do you do now?

Yeah, I appreciate it. And thanks for having me on. So I'm an orthopedic surgeon. I'm a pediatric hand surgeon as my subspecialty. I always knew I wanted to be in the Navy since I was a little kid. And particularly, I think, as I got towards college, the Navy Reserves. So a little bit like Mark, I had in my idea that when I finished my med school training or residency, I wanted to join the Reserves. I think one thing that's a little bit unique is that

Mark pointed out he sort of joined as this midlife crisis. And that's a pretty actually common time, I think, for people to join the reserves. They sort of their kids have grown up. They've done the career. They kind of have the money and now they want to give back a little bit. So I know a lot of people who are reservists who are sort of in his situation. I also know a lot of people who.

did the HPSP program, which we'll talk about in a little bit, right? They had the Navy pay for med school, they did their active duty payback, and they kind of missed it a little bit, or they go straight into the reserves and continue. It's a little bit unusual, I would say, to start your reserve career at the exact same time that you're starting your civilian practice.

But nevertheless, I found this program, it's called TMS, Training and Medical Specialty. And what it does is it kind of takes those kinds of people, the people that think, hey, I want to join the reserves once I start my practice, and it tries to capture them a little bit earlier when they're in residency

And it says, why don't you join the reserves as a resident? And you can kind of understand the uniforms, putting on the shoes on the correct feet, like we just heard from Commander. You'll get some credit for your time and training. We won't interfere with your residency training to the best of our abilities. And then once you're done with your training and you're ready to start your practice, you can also start as a reservist. And so that's

That's sort of my story. So I joined the month after I graduated from medical school. I've been in was a reservist all through residency and through my fellowship and then have been a reservist now 13 years in total, of which about half was in my training and half of it has been in my practice.

Like Commander, I have done two sort of stints on active duty as a reservist through orders. So I spent six months in San Diego at the Naval Medical Center, and then I mobilized to Afghanistan for a year, which can be disruptive for sure to your practice, especially a young practice. So it's something to think about, but it's an incredibly rewarding program. And now I'm honored to be the Training and Medical Specialty, TMS, specialty leader.

Fabulous. So just a couple of questions about that, Nick. So I assume that if you're in the reserves as you were, it's not like you said, you know, I want to like they said, who's willing to go to San Diego? Who's willing to go to Afghanistan? You said, sure, I'll go right. Like you basically don't have a choice. You get I mean, tell me if I'm wrong, but do you get told you're going and you have to go or do you have any say at all?

I think it's a little bit of both. I think that there are people in the reserves who really, really want to have these experiences like you just heard. I mean, being the deputy for surgeon down there is a really probably fun opportunity and job. If they're

If there was nobody who volunteered, then the Navy, of course, would have the right to say, hey, well, we're going to select someone to go. But there's enough people, I think, who are interested in these activities based on their time in their life that they can do it. For me, it actually worked out really, really well. The opportunity in San Diego worked as I was sort of transitioning from fellowship and waiting to start my second fellowship. That kind of filled that gap a little bit.

And the mobilization, you know, I think for a lot of people on this call, I was a senior in high school when 9-11 happened. Right. So every person I know in the military had some experience in Iraq and Afghanistan. And you could kind of tell that the Afghan war was coming to an end around the time that that deployment was coming up for me. So I was.

ecstatic, don't tell my wife that, that that opportunity came up. And it was incredibly rewarding. And a lot like residency, actually, you know, you kind of finish it or while you're in it, you'd say, man, I never want to do that again. And then like residency, the further and further away you get from it, you think, oh, man, if I could just go back to residency, life would be so, so much easier. So both rewarding experiences. And I think there is

I don't want to pretend like there's a lot of flexibility in it, but I think it's not as cut and dry and I think twisting people's arms as you might think. Yeah. Okay. That's great. So you are, it sounds like,

you know, you do have to go in with the knowledge that it's possible you'll get some send somewhere and you may not have a choice in the matter, but it sounds like it's, you know, a reasonable amount of flexibility and that there's enough people who most of the time are willing to go to a given, you know, place in a given situation that you, you probably would be, you know, it's not, it wouldn't be a slam dunk that you'd have to go if you, if it wasn't a good time for you, you might have to, but you'd have some say potentially. Yeah.

Yeah, you have to understand where we are in the current world events. So as things are kind of winding down from Iraq and Afghanistan, there's sort of this relative peace. So there's a lot of people who never mobilized that want to mobilize.

At the same time, you know, you never know when another conflict arises, whether it's in the South Asian Sea or whether it's in Eastern Europe. And so all of a sudden that situation may change. But at the current moment in the current environment, there's probably a surplus of people who want the experiences for the number of experiences that there are.

Great. So I asked Mark, you know, the same question I'll ask you, how do you kind of balance? Obviously, if you go spend a year in Afghanistan or six months in San Diego, then you're there, right? That's all you're doing. But when you're not, when you're kind of on the reserve part of the reserves, what does that look like in terms of the balance between your civilian job and your reserve job?

I think that's the trickiest part if you join the reserves at the beginning of your career, which is that you need to find an employer, especially if you have a commitment. You need to find an employer who's going to be amenable to that. I think there are lots of employers like that. I'm fortunate to work at one of them. Academic medicine, I think, lends itself to that. So do other federal jobs like working at the VA. And

In terms of balance, it is one weekend a month, two weeks a year. The weekends, I think, are in the beginning, especially as you're trying to understand what's happening. They can be relatively rigid, and they're not the most rewarding part, for sure. But the two weeks are very, very rewarding. Why aren't the weekends as rewarding? Well, the weekends are really to make sure that you're always ready to do something. So it's not about doing something on the weekends. It's about being ready to mobilize, to have the experiences that Commander Cannon has. And so that can be a little bit...

Similar to the, gosh, the webinars that you have to do, that we all have to do to work in the hospital, making sure we're up to date on our requirements, our physical fitness, our medical readiness, the

The two weeks in general, probably most commonly, you would go to a Navy medical center and you would do your job at that center. And that's incredibly rewarding because we all bring experiences from our private job, private or academic positions, and we bring them to a military practice and we learn from each other. Great. Let me go back to the TMS for a second.

When you joined it, so I mean, obviously for you, you knew you wanted to be in the reserves. So this was an obvious way in. Is there, you know, do they at the time you join, is there any kind of benefit in terms of them helping defray costs of anything or anything like that? Or no, it's just a way to get to the reserves?

There are financial incentives to doing it. So without overcomplicating it, the first piece that I think is probably the best is that you get what we call good years. So you get to count that as a year of being a reservist. And for someone like myself who wanted to join the Navy, it's all about at this point, it's not about money. It's about pride and experiences for sure. So it helps you get to that 20 years. Now, 20 years of retirement in the reserves means something different than 20 years of active duty, which is a total aside.

But you get credit for those good years. So I got six years in the Navy when I was doing my medical training that I wanted to do anyway. So that, for me, is the biggest perk. We also give opportunities for drill pay. So we pay the same pay that I get for going on the weekends you would get as a resident when you're in TMS, even though you're not physically going there more than twice a year.

for the most part. There are other options for getting stipends and larger amounts of money. And the more money you take from the Navy or any of the military branches, all these branches have this opportunity, the more time you're going to owe them. So, for example, if you don't take a stipend and you just take drill pay, the current payback is three years of reserve time, which is just really enough to test it out and see if you want to do it.

If you want to take a stipend, which is the same stipend that the medical students get who are committing to active duty, so it's a fair amount of money, you end up paying back or you owe two years of reserve time for every one year you take the stipend. And you can do the math if you're an anesthesia resident and you do it for four years, you're going to owe eight years of reserve time. That's a pretty big commitment for something that you haven't quite sampled yet. And if you pick something like general surgery, that's seven years. Now you're talking about

by the time you pay it back you've already done 21 years in the navy by the time you've paid back your your stipend so it's a it's a personal decision for everyone and i think as a specialty leader that's really my job which is to talk with the recruiters and the people who are thinking about it and say hey what works best for you what's your level of interest how can we make this successful for you and then for the people who are in tms already hey what are we doing to make sure this is the experience that you were hoping to get out of it

Great. So I'll ask you what I asked Mark, if you could go back to your self when you were just joining the reserves, any advice you'd give things to do things to avoid? What would you say?

I love this program, so I wouldn't change a thing about how I got into this. I think I joined it as the moment I could, which was great. It takes a long time to get through the recruiting process. So I think starting it in your last year of medical school, if that's something that you want to do as soon as you hit the ground running as a resident.

The one thing that I would give myself advice I would give myself is a little bit of grace in terms of the how the process plays out. You know, I think all of us are hard charging people. We all did really well in school. We're in the hospital, especially as anesthesiologists and surgeons. It says, you know, someone needs something. We get it done immediately.

The Navy is really, really efficient at some things, but it takes time for these processes to unfold, right? You're getting your credentials, you're going through your physicals like we heard Dr. Cannon talk about. So I think most of the people, when they join TMS, want to know exactly what they can do as soon as they join. And the reality of it is,

It's a little bit of a process and just take your time and be patient. And eventually it's incredibly rewarding. But I remember those first few months being, I think, frustratingly slow in terms of how much I wanted to do for the Navy and how little I thought the Navy understood how enthusiastic I was to join. Interesting. What about from a program side? You were a resident in the reserves. Are there things, and you know, you don't have to

speak specifically about your program, but just in general, are there things that a residency program can or should do to support and make this process easier for their residents who are in the reserves? So the nitty gritty of TMS is that what we ask the TMS members to do or what they're required to do is two weekends at the Navy Reserve Center. Now there's a Navy Reserve Center in every state and there's some flexibility about where you go.

Two weekends can be challenging when you're an intern. It's probably easier when you're a PGY-4 as you kind of have more control over your call schedule. So understanding those requirements is helpful. You don't have to do the two weeks. You don't have to do the other, you know, 10 weekends. So I think for the program directors, that's the piece to note. It says, hey, I got to get this guy here for two, or gal here for two weekends to do their physical training, to do their in-person, face-to-face, as we call, trainings.

The other thing I would advise probably the residents who are in the program is to look for CME opportunities in

their specialty that are military based. So I don't know on the anesthesia side, but there's a society of military orthopedic surgeons. It's a one week course or one week CME event in December. So once I found that, that was great because then I went to my program director. I said, hey, I want to submit this paper to this conference. I know it's not one of the big ortho conferences, but it's super important to me. And it was a really great place where all of these Navy ortho residents were presenting their research. So I got to present research. I was really the first podium I did.

Um, and it took just a little bit with my program director to say, Hey, no, this is a legitimate conference that I want to go to. Um, it's worth funding, you know, if, if the Navy didn't fund it. Yeah. Fabulous. Now, what do you think, if you're kind of advising folks, which I know is part of what you do, what type of person would benefit from TMS? Uh, you know, who do you think is, would, would really want to think about doing this?

Well, I think the Navy would benefit from almost everybody listening to your podcast. Joining the Navy, we want people, we need people. What kind of people should go into TMS was your question? Yeah. Who do you think are the doctors who would benefit most from it themselves? I mean, the Navy, of course, would love to have lots of people, I assume. Great people. But, you know, from if you're advising the doctor, the resident, the medical student, who do you think would benefit from this the most?

I think the person who knows for sure that they want to do the reserves, because there is a commitment on the back end and life changes. Think about yourself at 26 when you graduate medical school and to 30, a lot changes in that time for people. People have kids in that time. They might meet their significant other. They might have geographic constraints about what they want to do. So you really have to like the idea of the commitment, I think.

The person who this program is perfect for is actually someone who has prior military service. I did not before I joined medical school, but that person is a home run because they already have years towards retirement. They may want to get back into the military. This gives them an opportunity to get years of service while they're in residency that then they can continue in the reserves and they're going to get to their retirement stage pretty quickly, which is really nice.

So that's the top notch. But I think you have to be careful when you commit yourself at 26 and you don't know what your 31-year-old or 30-year-old self is going to be in or what your spouse is. My person that the orthopedic surgeon I deployed to Afghanistan with, he said that he volunteered, but his wife got drafted. That was the way he phrased it. I think that's pretty good, right? Like our loved ones are just along for the ride because of the decisions that we made when we

when we were younger. Yeah, that's a great point. All right. Fabulous. Joey, I want to turn to you. So obviously, I know a little bit more about your story because we were involved together in your thought process here, but I know that listeners don't. So I'm going to let you tell it. Talk a little bit about your decision point of getting involved in TMS and how you got there.

Sure. Well, I'd always known that I wanted to do military medicine of some kind. I thought in earlier years that I wanted to do active duty. I applied initially for the HPSP scholarship, but then ended up going down the MD-PhD route instead, so didn't do that. Ultimately left the PhD, still had this goal in mind, this initial motivation of wanting to still be involved in the Navy. For me, it was heavily a family thing. I mean,

The thought process towards this is heavily cultural, of course, but just my concept of social responsibility is just something very personal to me as wanting to do it. So I've been looking for a long time and I had before finding the specifics of the program, I had a hard time getting meaningful contact with recruiters who understood like the needs of medical school and being in residency. So it wasn't until I guess during PGY2 when I finally got connected with the program and then

Um, that's when you and I had our first conversations about it. And then from there, it was about 10 months until I actually commissioned. And my recruiter said it was the fastest anyone had ever gone through that process. So the average, the average journey through the recruitment to commissioning processes, it takes time. There's a lot of different ways in which you're, um, beating the thumbs up from a bunch of different people, but,

Yeah. So then I ultimately commissioned back in July and then had my first concrete involvement starting back in December. So like three or four months ago. Stay with us. We'll be right back.

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All right. And we're back with Dr. Seeker. Yeah. Great. Okay. Well, so now you are a resident in, you know, I'm not biased here at all, but I hear the best residency program in the country and you also are now in the reserve. So we've heard a little bit from Nick about how he balanced it. That was a while ago. You're doing it now. We know you're just getting into this, but how are you finding that balance with being a resident in a rigorous residency program and then being in the Navy reserves? I think it's workable. I mean, I've,

And you know a lot about my story, but I've always liked to be involved in lots of different things at the same time. And whether that means lots of hobbies or being involved in research, it's meant different things in different phases of life. But right now, this is a big piece of that. And I think that the time management to live a full life during residency, I mean, here at Hopkins, y'all put in incredible effort to try and make that viable for us overall. But

I think that it's been a very welcome addition to that for me in one, just enjoying the fact that this goal I'd had for so long is finally here, at least in part, because like Commander Pulo said, it's not,

yeah, being a reservist is not the same as being active duty and being a reservist in TMS. Like we've alluded to is not even the same as being, I quote, full on reservist, I guess. Um, but even just those pieces of it that I've been able to have access to, I've, I really enjoyed. And to me, that's the beginning of something that I'm finding very fulfilling. And the time commitment that's required has also been completely workable. I've been in person, uh, twice at this point so far, um,

I've been able to be involved in this. I'll be able to be involved in giving some wilderness medicine presentations at USHIFS, the military medical school, which I'm excited to get to do. And

Yeah, it's just been an enjoyable piece of life. That's great. And I'm glad it's been doable and manageable for you. When you think, you said, you know, you've got some military background in your family. You had this interest from early on. Plus, as you said, and I completely agree, you're somebody who has, you know, multi-talented interests in a variety of different areas. So it doesn't at all surprise me that this has been successful for you. I'm wondering who...

Who you think, other than you, you know, what are, what are, who are people you think would really do well in TMS or who you would reach out, you know, reach out to and say, hey, I think you should think about this.

Like Commander Pula said, I think that the biggest thing is the hearts and minds piece. It has to be something that you wanted to begin with. If you were, if it's something where it never even crossed your mind, it could very well just be something great that you hadn't known about. But I think that your desire to be involved with the military is kind of the cornerstone to that, to being able to do this effectively and doing this in a way that you find rewarding. Yeah.

Because if you were to come into it just kind of hearing about it as a relatively low commitment thing, you might be surprised a few years down the line when your life is concretely affected by that commitment.

Thankfully, in anesthesia, it tends to be a discipline in which to get lifted out for three months for some sort of activation. That's okay. You didn't have a panel of patients who are now without their anesthesiologist. No one has an anesthesiologist, right? But if you were a family medicine doc or something who got involved in this program, being pulled away for three months could completely change.

explode your patient panel. Right. Uh, and that can be an incredibly hard thing to come back from. So I think that we're lucky in this, in, in our discipline and anesthesia, um, to have that level of flexibility. So understanding that there, there will be times in life where it looks different than this, but at this time where we already have so much being drawn from us by residency, fellowship, whatever stage people are training around, um,

that there are people with huge amounts of understanding and the ability to help you there. Like I've been going back and forth with Commander Poulos, Commander Cannon at various points over the last few months, and then Commander Spencer as well in terms of advocacy within my unit who largely don't know what this program is because there's something, there's a relatively small number of us. So we have advocates to help make it work, which is a great compliment to the other things we've mentioned about making it viable.

Yeah. Fabulous. Um, you mentioned that the, uh, process for you 10 months, you know, was fastest, you know, on the fast end. Um, so other than, you know, start early, if you're interested in this, is there other lessons you took away from the application process that you think other people should be aware of if they're thinking about doing this? I, I mean, I think I won't, I don't think it's probably terribly surprising to say the faster you turn things around, the more people can help you. Um,

I'm someone who struggles with paperwork. So I think that that was something that I had to try and learn a new system for in my head. I think it's been good in that sense of trying to get more disciplined about that kind of stuff. And so even for someone who finds paperwork mentally taxing, I've still found this to be a net positive experience, which I think should be an encouraging takeaway. But yeah, I mean, it's just,

Stay active, advocate for yourself, reach back out to people. And not just to re-challenge your own motivations in the sense of like, let, let those steps be confirmation or, or,

to yourself about whether this is the right fit for you. Yeah. I love that you said, you know, don't be afraid to reach back out to people. That's such a good life lesson. You know, I have medical students, for example, all the time who come to me and they say, oh, you know, I emailed such and such an attending about this thing I was hoping to get involved in with them. I never heard back. So, you know, I guess that won't work. And I was like, do you mean just once? You just emailed, right? Like, you know,

You can't assume from that that they weren't interested or that they aren't going to – I mean they're just getting a million emails a day. So do it again, right? Yeah, like this is your life. To them, it was a random email. Right, absolutely, absolutely. And so I think that people are afraid of – they either misinterpret it. They think, oh, well, I didn't hear back. Therefore, the person isn't interested. Or –

they feel bad. They're like, I don't want to pester them. And if it's a day later, obviously you probably are pestering them. But if you've sent an email or turned in some paperwork or whatever it is and you haven't heard back and it's been a week or whatever, following up, sending another one, just checking in, if you phrase it in a respectful way. In real life, in all things, in work and in your personal life, I think is really, really not only okay but important. And so I would bet

even though I don't have any personal experience, that the same applies for the process you went through. All right. Well, let's turn to you, Erica. And, you know, tell us a little bit about your role. Unless I'm wrong, I think you are not a physician. So tell us what you do and then we'll go from there.

All right. Thank you. So I'm Lieutenant Commander Erica Spencer. I'm a naval flight officer by trade. I went to the Naval Academy and then I flew for eight years in a P-3 Orion, at which point I got out of the Navy and I never wanted anything to do with it. I didn't want to go to the reserves. I didn't want to. I wanted to have kids and do nothing. But unfortunately, after having a relatively exciting and arduous career,

Flight career for eight years, a few years down the line, I realized I wasn't really fulfilled doing nothing. And I remembered fondly those deployments and mostly the people that I worked with that I.

I was too young to really understand the value of that teamwork and understanding and camaraderie that you build when you're doing a mission and mission focus with a group of people that are not like you at all, but yet you come together, you learn from each other, and you get it done. And so I went out to the civilian workforce, and boy, it just wasn't the same. And so after eight years, I was contacted by...

a senior CB captain who sat me down at a table and says, you need to come back to the reserves. And on one sheet of paper, he wrote all of the math, all of the reasons, all of the points, what I was walking away from. And I had no idea. So, uh, that was the end of it for me. I joined the reserves again as a Naval flight officer. I started drilling and then, um,

I came back from an overseas tour with my family and I realized, oh, goodness, I need a job. And the reserves picked me right up and they put me on active duty because that's what I wanted. That's what I needed. And from there, I was able to create an entire new name for myself in recruiting.

And it just opened this whole new world for me. And so I guess I like the reserve so much because it meets you where you are and where you need to be. And it has opportunities at all different levels. So at times in my career where I only wanted to do one weekend a month and that was it.

And it was fine. They're fine with that. As long as I maintained my readiness and stayed active with my, you know, physical fitness and my dental and everything else, they were good with that. But if I wanted to do more and go full time and really expand my horizons, learn new skills,

And so I loved recruiting and I would have to say the reserve kind of saved my career because I had no mojo after three kids and staying home for that time. And so I was able to do that.

And the beautiful thing about the reserve is they see a lieutenant with so many years on active duty. And that's what they see. They don't see that, oh, well, you haven't worked for five or six years. So you're not valuable to us. So it was a wonderful point in my life where I could off ramp to have my family and enjoy that for a time. And then there was a time when I needed to get back on the ramp and start something new. So

I've been on the ride of my life since then in medical recruiting, trying to get the word out that this is also an option on the medical side to get out of the hospital, maybe get out of your daily routine and shake it up a little bit and then go back to your daily routine, which you'll now find more rewarding because you've been doing something else.

So, um, so I've just, uh, I've enjoyed my time and I'm almost at my 20. Um, my husband's an anesthesiologist at Walter Reed and he's really opened up so many opportunities with the, the value of military medicine that I didn't know. Uh, so he's like my secret weapon, which is why we have this podcast going. And, um, I just can't,

talk any better about military medicine when it works the way it should. There are always times when someone falls in a crack, it doesn't work as well, but that's why we have powerful mentors like the commanders on this podcast because they've been there, they've done that, and they're always willing to mentor, support, and provide training for anybody, especially a junior officer that needs that mentorship.

Well, fabulous. Thank you for sharing that. So there are, I think, a variety of programs. And the one people know about, I'm sure, is you can join and you'll have to tell me the name of it. But kind of when you're starting medical school, I think the military will pay for medical school and then you owe time to the military. What is that called? That's called HPSP. HPSP. OK. And what does that stand for? Health Professionals Scholarship Program.

Okay. And so that's one program. We have not focused on that today, but that is a program people can obviously do. The one we're focused on is TMS. And that is, tell us just again, I know we've gone over it, but maybe just summarize for us the difference there.

So HPSP is geared towards medical school. And at that point, when you leave medical school, you will match with the Navy and do a Navy residency. Or you could possibly do an outside residency as well. There are there are multiple paths there, but you will be doing a residency with the Navy. TMS, you you have to match on your own.

And not every type of residency is covered under the training and medical specialties program. But if it's under one of the specialties that the Navy needs, then the Navy will supply you as a resident with a stipend or loan repayment and the benefits of being a reservist while you're in school. And then you pay time back as a reservist. So one is active, one is reserved. Gotcha. Okay. And I do want to mention, Nick is mentioning here that, um,

you know, we've said a lot, this kind of 20 year, right? Like you get to 20, but Nick, that isn't necessarily where everyone stops. Right. Yeah. I think for me, I have young kids and, you know, I'm at sort of 13 years. So 20 seems like I'll meet if I can get there, but for sure, there's people who do 30 years and more and there's age waivers for,

For physicians, for sure, and the Navy. So for some people, you know, 20 isn't the end. The Navy doesn't usually kick us out. We're extremely valuable to them. And there's people who just can't get enough of it. I think Lieutenant Commander Spencer, you hear it in her voice. For sure, the connections you make to people and kind of the experiences that you can't get on the civilian side make people. I think a lot of people are sad when they finally, you know, especially the people who get up in years into the 30s. They're sad when the Navy finally says, you know, it's probably time for you, probably time for you to hang it up.

The other thing I'd add to her, too, because I think HPSP is certainly the more common thing that we hear about, you know, oh, the Navy paid for your med school, now you're in the Navy. And TMS is a sort of all-reserve program. But there's sort of an in-between program, too, called FEPP for people who are in residency and say, you know what, actually, reserve isn't enough for me. I want to go active duty right out of residency. And that kind of gives them the similar commitment that the HPSP students have, but they might have

HPSB didn't think they wanted to do it. Now they're in residency and they want to do it. So I think at any point, the message there is at any point in your medical training, if you said, I want to be in the military, you figure out what commitment you want for the military and the military, thanks to Commander Spencer, she'll help you figure out which program fits that level of commitment with where you are in your life. Right.

Great. Fabulous. Thanks for clarifying that. So let's go back to you, Erica. When we think about the TMS program, we've talked a little bit, we've kind of hit here and there, but can you summarize for us what are the benefits that this provides? And there's some options we already heard about. You can take a stipend, you cannot take a stipend, but what are the options in terms of benefits this can provide to doctors in training?

Right. So the standard benefits for any reservist, including a TMS reservist, would be you get health care for a fairly affordable price for yourself and your family, includes dental care, includes life insurance, and kind of an all-perspective, I guess, family, military family to join for whatever assistance you might need.

So there is that overlying support for you and your family. So that's just in general for reservists, including TMS. Now, the beautiful thing about TMS is that

the obligation to drill every weekend is not there. It's an incredibly flexible program. Yes, we do need to see the resident to make sure that they are fit and that they're staying physically healthy with their life and their weight and their physical fitness. And so that's why the touch points for twice a year. But we love if our residents can come more often and start supporting as a physician in the reserve setting because the doctors create

On their weekends, they do support all of the active duty, not active duty, but active reservists that need medical administration and physicals. And we do annual PHAs, which are, you know, physical health assessments, and

So there's always a place for the resident doctor, for the attending doctor to support these thousands of reservists across the country. So it's not like they're cloistered in their medical units.

So that gives them a sense of belonging if they're able to put that kind of time and effort in. If not, then that's quite all right. And that's where Dr. Poulos comes in. If we need to help the resident with that kind of administration, they have the support to do that.

Other than that, the Navy Reserve is a relatively low thumbprint on that resident until they finish their program. And that's the purpose of TMS. We don't want to be overtaxing. We don't want to, you know, be demanding. Their residency is their military service at this point. And so in that sense, once they become an attending and then they can start drilling and then they can fully be utilized in their specialty for the Navy Reserve.

Great. And is there any loan repayment for folks who have medical school loans? Yes. So the stipend right now, if they take the stipend, is $2,870 a month.

And then the loan repayment is $40,000 a year up to $250,000. And those are paid directly to, you know, to the loan. Yeah, fabulous. And so the stipend, right, if you take the stipend, that means you owe some more time. Is that true also for the loan forgiveness or is that different?

So it's a fairly complex formula. And if you take one and not the other, so I really don't even want to get into the specifics of that. Yes. Anytime you get paid, there will be added commitment for that. And that's why it's so valuable to have a mentor to really lay down. Okay. This is how many years you have left. This is the monetary value. This is what you're giving up for that monetary value. And then this is the commitment. So I think it's best if someone's interested in,

to really take their personal situation into account. And then we can lay out the time commitment, the money and everything based on their program. Great. All right. Fabulous. Well, let's turn to the portion of our show where we make random recommendations. I'm going to ask each of you to share something with the audience that would be fun for them to check out. Let's start with you, Mark, since you're on the mic.

Okay, so my fun thing when I first arrived here at MacDill Air Force Base was looking across the parking lot, and there went an alligator walking across the runway. And I remember saying to myself, well, that's kind of interesting. Maybe you should just go over and pet that thing. Maybe not. And so one of the things I have realized being in Florida, there are all kinds of things that fly, slither, crawl that may not be good for you. So even though it may look very interesting from the zoo,

Keep your distance. Well, that is good advice, I'm sure. Keep your distance from wild animals. All right, awesome. Nick, how about you?

I'm a big reader, and I think one way to stay connected to the Navy, especially if you're a resident and you're not getting as much time interfacing with the reserves, is there's a Navy reading list that the Chief of Naval Operations puts out, which is really helpful and kind of makes you feel like you're reading towards the specialty or towards what it is that you're interested in. But I'm going to pick a book way off that list from one of my favorite authors, Matthew Quick. He's from Philadelphia. He wrote Silver Linings Playbook, and he wrote a great book called

called The Reason You're Alive. And I was seven years or eight years too late in reading it because it came out seven or eight years ago. And it's about a dad who comes back from Vietnam and his son never really understands him. And I think that that's such a great story for our time and age today where we prejudge kind of people based on their experiences. So just a really sweet book by a really fun author that everyone's familiar with, at least the movie version of his favorite book. Fabulous. Thank you. Joey, how about you?

I wasn't intentionally going to list a Navy related book, but there's this great one that came out relatively recently called Surf When You Can by Brett Kersher that I thought had some wonderful life lessons in it. Surf When You Can. Okay, awesome. Erica, how about you?

You know, I don't normally watch TV because I've had kids and I've been in the military for so long, but I finally like binged watched a show called Younger. And I know it sounds really silly, but it's talking about the generational differences between, you know, just different age groups, age groups working with each other. And it was just so enlightening to me about how different generations see each

and deal with information and communication. And I think it really helped me become a leader because my kids' generation and even Dr. Seeker's generation really has had a totally different upbringing when it comes to technology and just interpersonal communications. And I see in the Navy Reserve too, right? We've gone to a self-service organization where you do everything on the computer, right?

And for some of us that are, you know, didn't go to college with a computer necessarily, it's relearning totally different skills that come very natural to a younger generation. So I think it's just, you know, that it just happened to bring up

This multi-generational work together type of teamwork situation. And I see it all the time in the military. So kind of a silly show, but it did bring it did have some intricate or interesting meaning. That's great. What what channel is it on?

Netflix. Netflix, probably. Okay. Awesome. Well, I'm going to do a couple updates on things I've mentioned before, and then I'll recommend something new. So I had in the past, listeners will know, recommended the fourth wing books. I had kind of read the first and was into the second and was very into them. And then the third that came out more recently, I've now finished, and I'll say that they –

I'm not as positive about it as I was. So, you know, I think if you really are looking for a kind of fun, easy vacation type fantasy book read, sure, you can check out the trilogy. But do know that I think it falls off in quality toward that third book and gets a little old. And then I will say that I think I had recommended the Scythe, S-C-Y-T-H-E, the Scythe books.

I was in the middle of them, I think, last time I mentioned them. Finished that trilogy. It's fabulous. So I highly recommend that, the Scythe trilogy. And then I'll say that the other thing that my wife and I just finished is the new season of Severance, season two. If you haven't watched that, it's a great show, really fun and interesting. So check that out on Apple TV+.

All right. Again, I want to thank you all, four of you, for your service to our country and for taking the time to come on today and talk about your different roles in the military and especially about TMS. I think this is something that a lot of people just don't know about. And so maybe a good option for some people to think about. And I really appreciate talking to each and every one of you today. Thanks for being here. Thank you so much. Thank you again.

All right. Hopefully you got as much out of that as I did. That was really fantastic. Let us know what you thought. Go to the website, akrak.com, where you can leave a comment. Others can learn from what you have to say.

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