Making the Transition From Military to Medicine
JULY 03, 2018
At 23 years-old, Christopher Bell had convinced himself he was on the right path. He was a young, up-and-coming financial manager who spent his free time bodybuilding. The combination of fitness and financial success seemed more than enough to keep him motivated.
But one day, as Bell sat through yet another monotonous meeting at his firm’s Baltimore office, things changed. He looked around the room and saw about 30 colleagues, twice his age, with matching blank expressions and decades of wear and tear glazing over their eyes. In that single moment, Bell lost satisfaction with his path forward. His colleagues’ expressions convinced him he would need something more fulfilling than a career full of never-ending meetings.
Later, during a pickup basketball game, Bell became friendly with a Navy recruiter who convinced him to take a preliminary service placement test. Bell, the son of a military veteran, did well enough to be offered entry-level work in virtually any field of the military. Within 2 months, he had quit his job, sold his car, packed his belongings, and headed to boot camp. He was going to be a hospital corpsman—the Navy’s version of a medic.
The 20-year path that led Christopher Bell, DNP, RN, EMT-P, from finance to instructional field work with the Navy, then eventually to the position of president of Chamberlain University College of Nursing, Indianapolis Campus, was distinct among health care providers. In detailing the intricate process of transitioning from serving his country to training the next generation of nurses, Bell described at least 10 different jobs that stood between the bookends.
The number of military veterans who pursue a career in civilian medicine is great enough for institutions and agencies to exist solely to manage that process. But the path that leads an individual veteran to medical school — and, eventually, the healthcare field — is not as well-tread as that of the average student.
Turning Soldiers into Nurses
The University of North Carolina (UNC) School of Medicine was born out of necessity. In the years following World War II, the state still had no available 4-year medical school program—despite also reporting the greatest rate of men rejected for wartime service due to medical issues. North Carolina had an exceptionally poor physicians-to-patients ratio, and veterans flocked to the state to fill the gaps in care.
It’s a phenomenon that Paul Chelminski, MD, MPH, can recall from as long as he’s been practicing medicine.
“Even when I was in medical school, there were plenty of houses being built to accommodate veterans pursuing degrees after their service,” Chelminski, director of the UNC Physician Assistant Program (PAP), told MD Mag.
Now, Chelminski is among those providing room and board to veterans. The PAP program, which first began enrolling patients in 2016, makes a conscious effort to ensure placement for qualified veterans. Of the 20 students accepted annually, about 9 have served in the military, Chelminski said. About 5% of the average US medical school program student body consists of veterans. In UNC’s first 2 PAP classes, 45% have been veterans.
To Chelminski’s memory, the very first PAP to directly cater to veterans came from UNC regional rival Duke University, which created a certification program for veteran Navy corpsman like Bell in the 1960s. UNC originally instituted a nurse practitioner (NP) program for incoming veterans with medical experience, but the past 2 decades’ wars in Iraq and Afghanistan led them to reconsider a PAP in 2010.
“If someone has been a special forces medic in Afghanistan, they don’t need to go to medical school,” Chelminski explained. “UNC finally had the rationale to renew its servant mission to the military.”
Programs like PAP that aid veteran medics pursuing careers in civilian healthcare tend to be focused on the field of nursing. For example, 5 years ago, the Health Resources and Services Administration (HRSA) established the Veterans’ Bachelor of Science in Nursing (VBSN) program to deliver grants to collegiate institutions that address the unique needs of veterans pursuing RN positions. In 2015, as part of a $94 million-plus health care grant, the administration provided $3.4 million to 11 such institutions.
By Chelminski’s count, the average veteran admitted into the UNC PAP has completed roughly 2200 clinical hours before taking their first course. The duration of their experience sets veterans apart, he said—but the quality of their medical work is why institutions exist to tailor education to veterans.
“They have a lot of field experience, but not as much education or continuity of care,” Chelminski said. “They can’t treat diabetes or heart disease. We have to retool them in these areas and help acclimate them to the civilian world.”
Military Medicine 101
At just 23, Bell was among the oldest in his boot camp class. He spent his first year of a 6-year contract with the Navy completing his hospital corpsman core training at a base in Illinois. He learned how to suture wounds, and conduct basic dental procedures and surgeries—skills necessary for a hospital-based physician, Bell said.
Once he completed basic training about a year later, Bell had his pick of Navy “C schools” for advanced training. Much like a specialty in medical school, the military offers medics the opportunity to pursue work as a lab technician, psychiatrist, or any other position relevant to their service. Bell chose to become an aviation medical technician. He was assigned to a flight squadron, and for the next year he provided direct care and managed medication prescriptions to the group.
A year later, he was approached about taking another step to specialize his work, this time in aviation physiology. He relocated to Pensacola, FL, and became an instructor in the health aspects of flight, teaching colleagues about the impact of Gulfstream IV aircrafts, altitude changes, and improper hydration.
Because of progression towards the Gulf War, Bell also had to teach newcomers survival skills. He ran courses that brought servicemen into the wilderness and forced them to make the most of their basic gear.
There were several perks to the job, Bell said. His training in aviation health qualified him for work with the Blue Angels, a famous Navy flight demonstration squadron stationed in Pensacola. He would join guests in the back of participating fighter jets and provide instructions prior to takeoff. Among the more notable guests, he shared rides with former NASCAR driver Rusty Wallace and professional golfer Greg Norman.
About midway through his contract, Bell was finally deployed to Puerto Rico on the request of a close flight squadron physician who was in need of a corpsman. For 6 months, he provided medical support for a training squadron, all while continuing his education. A year after applying to a program that would provide him an RN education and return him to service as an officer, the program finally sent him an acceptance letter.
“I went from full-time instructor to full-time student,” Bell said. “I studied for another 3 years, and had to balance my service training regimen with my own education.”
It might seem like a tall order, but such tasks are commonly expected of servicemen.
From Boot Camp to Campus
When Chelminski describes the worth of military medics in healthcare as being greater than that of just 1 person, he’s only slightly exaggerating.
“The fact they’ve been trained as force multipliers in the military gives them a big benefit in the clinical field,” Chelminski said. “These people, in the educational environment, we find out they don’t complain much. They’re very resilient.”
That said, there are gaps in experience. The average veteran student in the PAP—in their early-to-mid-30s—has never experienced an institution without a distinct chain of command. At UNC, they’re tasked with 5 simultaneous courses during their first year to help them adapt to the expected independent work. Without it, they may feel aimless.
“It’s a paradox,” Chelmisnki said. “They don’t have objectives at all times to meet in their daily lives.”
Many students also struggle to adapt to campus living. Most veterans only experience college-like activities through online or remote courses. The introduction of administrative services and counselors is often met with confusion—what are they to do with such resources? What are their extracurricular opportunities?
There are also very distinct social adjustments that Chelminski never had to account for in civilian students. He recently talked with a Green Beret veteran-turned-student who admitted he had never worked with a woman before.
It isn’t until their second year, when clinical rotations begin, that the field-savvy veterans begin to stand out. When the class begins lessons on how to suture, it’ll be the same Green Beret who confided in Chelminski who will lead the class.
“This is really when they’re in their zone,” Chelminski said. “Where I see the military people having an advantage in the model, is in them having past completions in the field.”
Bell sees similar traits in his students at Chamberlain University. The campus accepts active duty, National Guard, Reserve, veteran, retired military, and even spouses of service members for its military and veteran nursing program. The program’s students are often dedicated to their education in a way that stands out from their traditional classmates.
“The discipline part is huge,” Bell said. “There’s not calling out sick. If you’re sick in the military, you have to come in anyway, and go to the ‘sick call’ to prove it. That’s totally different on the civilian side.”
Service members are also far less likely to skip class, Bell said. The sense of following a strict, regimented schedule—down to the use of the Military Clock—is carried over into Chamberlain’s program, as is a reliance on acronym-heavy vernacular and expectations for proper attire. As his commanding officers enforced, Bell requires students cover tattoos with clothing.
“We’re trying to get them ready for the real world,” Bell said. “When you work for a hospital, you don’t get there when you want to. You don’t get to go where what you want to be.”
Bell retired from the Navy in 2006, a full 20 years after he first enlisted. His retirement included stints moonlighting at local hospitals, becoming a licensed paramedic, working on a helicopter rescue squad in rural Florida, earning a Master’s degree in nursing education, and returning to an instructional position for aspiring nurses. He landed a full-time teaching gig at a Florida community college, which eventually led to his administrative role with Chamberlain in January 2017.
It’s interesting to Bell: As a corpsman, he was taught by civilian nurses how to deal with trauma and emergency care. While he was raised in a system that valued their perspective, the general population seemed to have a different perspective at the time. He couldn’t stop patients from calling him “doctor” simply because he’s a man.
As a veteran, he respected the chain of command between physicians and nurses—noting there’s a difference between a nurse fearing their physicians and a nurse respecting a physician’s decision. But as a civilian, Bell longed to see mutual respect between the 2 professions. One of his proudest medical stories is how in 2012, he walked into a Tampa hospital and immediately overheard physicians asking for their nurses’ opinions. Bell reminisces on the dynamic he shared with his squadron’s physician in Puerto Rico.
“Because I had such a great relationship with physicians and other doctors there, I sort of expected it when I transitioned to the civilian side,” Bell said. “Now, I try to remind students that just because they chose a different field than you did, that doesn’t mean they’re better.”
Chelminski still sees himself as helping fix North Carolina’s health care problem from a lifetime ago. He noted that many of the PAP veteran students come from regions around the state with high military activity. He hypothesized that, more often than not, they’ll return home and provide care to their old community, full of fellow veterans in need.
The itch to go back is ever present in Bell, who recently took his family to visit his old base in Pensacola. He misses the structure, the discipline, the intangibles that he tries so hard to pass on to his civilian students. But some things can’t be taught in a classroom.
“That bond is so hard to explain to my students,” Bell said. “It’s a different environment.”