Dr. Anders Apgar sits down with retired Army Colonel Dr. Aaron Pitney, to unpack what physicians really sign up for in military medicine: debt-free training and real security on one side, loss of geographic and professional autonomy, deployments, and family impact on the other. A candid look at the trade-offs every clinician makes.
What does a physician actually sign up for when they choose military medicine?
Dr. Aaron Pitney made that decision in his early twenties as a West Point cadet, one of only about 20 graduates each year selected for medical school. He received a debt-free education through the Uniformed Services University, a living stipend, and the structured pathway of Army medicine, then discovered, after 9/11, that the career he imagined at places like Walter Reed would be redefined by two decades of conflict in Iraq and Afghanistan.
In this conversation, Pitney walks through the full arc: the cooperative, high-investment training environment of military graduate medical education; the financial security that came with knowing exactly when promotions and specialty pay would arrive; the moment a department chief told the brand-new staff hematologist-oncologist he was deploying; and the family calculus of repeated moves, temporary duty, and a spouse who became the stabilizing force for three children. He contrasts military loss of autonomy with the different bargains civilian physicians make around contracts, RVUs, insurance, and productivity metrics, and reflects on what civilian colleagues often misunderstand about the dual identity of physician and military officer.
The episode also explores moral injury on deployment (standing in an Iraqi hospital with no tools to treat a child with advanced malignancy), the profound impact of humanitarian missions, who thrives in military medicine and who struggles, and the practical advice Pitney would give his younger self: hold the opportunity with an open hand, bloom where you’re planted, and recognize that the circumstances often self-organize toward the life you were meant to live. A rich, honest discussion of security, sacrifice, meaning, and the invisible costs that never appear on a spreadsheet.
Episode Highlights:
About the Show:
Direct Well-Being is hosted by Dr. Anders Apgar, MD, FACOG, M.S., An Ob/Gyn physician leader and nationally recognized voice in clinician well-being. The show is a trusted, peer-driven space for honest conversations about what actually supports physicians, beyond resilience training and surface-level wellness.
Each week, Dr. Apgar sits down with physician leaders, partner organizations, and frontline clinicians to talk about the real drivers of distress: financial stress, mental and emotional health, family dynamics, and the systems in which physicians practice. Conversations are evidence-aligned, research-informed, and grounded in lived clinical experience, never promotional, always physician-first.
Produced as a Direct Self Care production in partnership with the Doctor Podcast Network, the show draws on insight from the Well-Being Index, Champions of Wellness, Tend Health, and the broader Direct ecosystem to move listeners from awareness to agency.
About the Guest:
Dr. Aaron Pitney is a retired U.S. Army Colonel who spent 30 years as a Medical Corps officer. A West Point graduate selected for medical school among only ~2% of his class, he trained as a pediatrician and completed a fellowship in pediatric hematology-oncology. His career spanned Walter Reed, Hawaii, San Antonio, and multiple deployments and leadership roles, including command positions. He now serves as a medical director with Aetna Healthcare. He speaks candidly about the financial security, training excellence, deployments, family impact, and autonomy trade-offs of military medicine.
About the Host:
Anders Apgar, MD, FACOG, M.S., is a physician leader dedicated to transforming clinician well-being. As host of the Direct Well-Being Podcast, he leads honest conversations about the real drivers of distress : financial stress, mental health, family dynamics, and broken systems, for physicians and the organizations that support them.
A trusted voice in health care, Dr. Apgar blends lived clinical experience with evidence-aligned insights. He’s part of the Direct Ecosystem (Direct Self Care, Direct Wealth Care, Direct Practice Care), partnering with organizations like Tend Health, the Well-Being Index, and Champions of Wellness to move the conversation from awareness to agency.
Connect with Dr. Anders Apgar:
Websites:
directwellbeingpodcast.com , dwbpodcast.com
Emails:
[00:00:00] welcome back to the Direct Well-Being Podcast. We've got a fantastic episode for you, and I'm really excited about this, and, I hope you'll get a lot out of this today. Today, we have Dr. Aaron Pittney with us. Aaron is a retired colonel in the military, spent 30 years as a medical corps officer in the United States Army.
Aaron now serves as a medical director with Aetna Healthcare. Aaron, first and foremost, thank you for your service.
Thanks so much, Anders. I appreciate it.
Yeah. many physicians talk a lot about wanting job security, financial security, predictable career, all that good stuff. but you chose a path that offered some of the things in a very concrete way, the military.
but of course, the other side of that bargain is that sometimes somebody else could tell you where to live, where to work, what war to fight in, and potentially where in the world you're going next. So when you chose military medicine, what did you think you were signing up for, and what did you eventually discover you had actually signed up for?
Yeah of course, I made that decision when I was, 20-something years old, and as any pediatrician will tell you that the, late adolescent brain isn't fully [00:01:00] developed until- ... the mid-20s. And probably some of the reasons why I made those decisions weren't exactly the same as they might be a few years later.
But really, what I thought I was signing up for was the opportunity to serve our country, service members as a physician in the United States Army. And my background, I didn't go into medicine and then join the Army. I joined the Army and then went into medicine because I graduated from US Military Academy at West Point.
2% or about 20 cadets each year go, are authorized to go directly to medical school, and I, was fortunate enough to be selected in that group of physicians. And so, that was my career path. I had inspiration for the military from family members and then for medicine with, my sister and my brother-in-law and so that's, all of that merged together in that decision.
and I graduated from the academy in 1992. So this was right after the first Gulf War. [00:02:00] And then there was probably this decade, right? Almost decade where the US was essentially at peace because Gulf War, ended very quickly, and we kind of went back to, in some ways, sort of the status quo for the military for a number of years.
So I thought I was gonna have, kind of a very standard if you will, medical career. I was just gonna be in uniform. I'd be working at a place like Walter Reed. I would be, seeing patients inside of a regular hospital, et cetera. I finished my residency in pediatrics.
I was in my fellowship in pediatric hematology oncology at Walter Reed, when 9/11 happened. Wow. And all of a sudden the dynamics of what was going to occur for the Army for the US Military, changed, literally overnight. So I didn't know necessarily what to expect when that occurred.
Wow. So it sounds like a lot of your decision was, service-based, legacy-based, adventure, opportunity, things like that. But how much of that was financial going into it?
There, that definitely was a [00:03:00] piece. and I would be the first to say that the opportunities and the blessings of, going to, West Point and, going to the Uniformed Services University extended into, the financial realm.
Debt-free for both college and medical school, living stipend, actually paid as a second lieutenant while I was in medical school. the trade-off was, that I, had a service obligation. And, my upbringing, I was a child of two parents who came out of the Depression, and managing money and being very worried about debt and, what impact that would have, you know, long term on me.
I didn't know how I was gonna pay for medical school. this was right before the boom of, hey, if you need school loans, sign for it. You can get as much as you want. And so I thought, "Wow, I, I can get this education and it can entirely be debt-free." Now in retrospect, an amazing decision [00:04:00] for me.
But I think some of it was a little bit out of fear of kind of going into it about, like, I didn't wanna have a significant amount of debt that I was gonna have to deal with, you know, for long term.
That's a really interesting perspective. I've hinted at this, on earlier episodes myself.
A lot of us just put our heads down, signed what we had to sign, you know, and then what you signed for was not only loans, but some living expenses as well. but you knew you had to pay them back, and you knew that they were building up as you continued, not only in that, but compounding as well.
Right. Which was a word not a lot of us knew about compounding, back then. It, they don't teach you that stuff. But to have to be aware of that at such a young age is very interesting. Aside from the finances, what does the military offer a young physician that traditional medicine might not?
it's a great question 'cause I think, early on, when you think of life kind of coming out the gate in medicine because, the Uniformed Services University is accredited just the way any other medical school is, it has to have all of the same attributes and offerings that regular medical, training would have.
so I would [00:05:00] say that... that school which I'm very proud of, one of its hallmarks is that it is very much a cooperative, integrated environment for learning and for people to become physicians. I think then step two or the second piece is that the graduate medical education in the military is top-notch, and I think when you look at how training programs perform on national tests, on in-service exams and board certification and I think a lot of that stems from the fact that you know, the faculty, they are training their future colleagues.
it's not somebody who's gonna finish a residency and then open up a competing practice right across the street. It is the person who's gonna be serving right next to you and eventually replacing you. and so there is a lot of investment in the training of military physicians. And so I think that's probably one of the biggest opportunities that military [00:06:00] medical training offers.
And then, the career piece is probably where you start to see the divergence from civilian medicine versus military medicine.
It sounds like training was fantastic. Not only equivalent, but probably in a lot of places superior to what you might get, in private universities.
Can you give us a sense... you described your upbringing for us a little bit and I appreciate that, transparency, and that vulnerability, but can you give us a sense of what that security meant to you knowing that you were going to have a paycheck, a roof, and a job?
I don't know if I took it for granted, but I thought of myself more as, okay, as a military physician you obviously are in this realm of, all of the training that goes along with being a pediatrician, with getting my training in hematology oncology, but you're also an Army officer and so you're like, "Okay, well,
here's the military pay. This is what it's gonna be, for 1996, 1997. This is when board certification pay starts to add up." So I kind of [00:07:00] knew what the pathway was financially for me in terms of, like, when I expected to be promoted, what type of annual bonuses I would get based off of my specialty.
And so Idefinitely felt secure in that. we had started a family at the end of medical school. By the time I finished fellowship, we had three kids under the age of eight or seven. And life all of a sudden got very busy. and even though, as a major in the United States Army you know, it was, not a challenge, but it was like you had to watch your money even though you're a physician because, you just had a lot of mouths to feed and houses to take care of and cars to pay for and all the same things that everyone else has to do right out the gate as a new physician.
Yeah, and you've been very successful in your career and a lot of that was due to hard work, obviously, and taking advantage of opportunities. But before this becomes a total utopia, okay, let's turn the coin over, right? Yeah. What did you have to give up in return?
you're probably gonna say, "Well, gee, it sounds like a hard choice you had to [00:08:00] make."
But like, for example, I had to go and do my residency in pediatrics in Hawaii. So ... I had to give up skiing for three years. No, I joke. But You know, you do give up choices, right? you do give up and if you say, "Well, I wanna..." not only choices in terms of where you're gonna live, but you might give up some choices in terms of professionally what you wanna pursue.
Because, we do have specialists, we do have subspecialists, but if somebody decides that they want to have a very niche, career in terms of I want to only do this I think that is probably, a little bit more of a challenge inside the context of military medicine.
Now, other opportunities that aren't available to the civilian medical community are very much there for the military. So It's not all lost opportunities, it's new opportunities that are gained as a result. I'm sure we'll talk about it, but I think, one of the biggest things I gave up was, I finished my fellowship.
I mentioned 9/11, and so I was able to finish my [00:09:00] fellowship in 2002. And I headed off to San Antonio to, Brooke Army Medical Center to go on staff as a pediatric hematologist oncologist there. Well, I was, at my first morning report my department chief says, "Hey, we've got a couple of deployments that we're gonna have to, you know, assign people to."
Wow.
And naively I thought, "Oh, those poor guys, I feel bad for them. surely they're not gonna pick the guy that literally just signed in, to the organization a couple of days ago." And then about, four hours later he was outside my door telling me that I was gonna deploy.
Wow.
and so, that all of a sudden changes all of the calculus, dynamics, mindset, whatever it might be when it comes to job security, life security, family security. All of those things are all of a sudden kind of just tossed up in the air as like a pile of sticks.
Right. So you're picking up your entire family again and saying, "Okay, folks, I know the dust hasn't settled on this place, but we're moving somewhere again."
Well, actually [00:10:00] they were staying put. we had a house and I was assigned to an operational unit at Fort Hood Texas, which is about two hours away from San Antonio, and, was given an assignment, to be, there on X date.
And so my family, we finished moving in. we took a short vacation. Kids were, two oldest kids were in school, you know, so their life was just, my wife and I were just trying to make that as normal as possible. And I had to report up to Fort Hood and do all the pre-deployment training and then, in anticipation of, a deployment soon thereafter.
I wanna walk this backwards too. One more question about West Point too. You had mentioned 2% of people are able to become medical students from the military. So 98% or some percentage of those people that wanted to become doctors were like, yeah, you're the third percentile, so, get in line," right?
Y- yeah, it's intimidating because the academies attract very high-achieving individuals, right? Right. I mean, everyone there did [00:11:00] very well in high school. They all had career aspirations, so they said, "Hey, if you're interested in going to medical school, come to this meeting."
And, you walk into the auditorium and there's 100 people there. Wow. And the first thing they tell you is, "We're gonna send 20 of you to medical school," and you kinda look around and you're like, am I part of that 20% that's in this room?" And, you just try, right? You just say, "Well, okay, I gotta take organic chemistry.
I've gotta take biochem.
you gotta start taking those classes, and one by one people are like, "Yeah, not for me. Not for me." so then as you get towards, you know, that junior and senior year, your applications are being developed, you're taking the MCAT, it kind of almost, like, self-organizes into who's going to be able to attend.
So- I had good grades. like I said, organic chemistry was kind of survive and advance type of, class for me. But fortunately, I think if that was your desire, I think there's a way that it was able to come to pass.
Yeah. If it weren't for double bonds and carbohydrates, I would've done great in organic [00:12:00] chemistry.
You know, they always say, what do they call the bottom guy at the class, guy or gal at the class in medical school? They call him doctor.
That's right.
Yeah. So, it sounds really cutthroat. It sounds very challenging and must've been very, intimidating to be in that auditorium.
Moving forward and I appreciate everything you've said. When you're 25 years old, and you brought this up. You said 26. 25 years old, 26 years old, how do you put a value on autonomy when you've never really had it yet? Or how do you put a value on, what you're being told to do, a lack of autonomy, if you may not have had it yet?
Where do you go maturity-wise?
You know, I guess at that point in time you kind of always are trying to compartmentalize, I don't know, your life or your work or whatever it might be. I just viewed myself as I'm a med student. I look like every other med student except I wear a uniform most of the time unless I was doing a civilian, rotation at a civilian hospital.
And then when you're a resident, hey, I'm a resident just like a pediatric resident down at the University of Hawaii or at U- Dub up in Seattle. I wear scrubs, you [00:13:00] know, and I'm seeing patients and I'm going to morning report and I'm doing case presentations and journal club. Except I wear a uniform, I get a haircut every couple of weeks and I'm in medical training mode.
And kind of like that tunnel of training where you're like you come-- you go in at year one, day one as an intern and for pediatrics, you come out three years later at the other end and you're like, "Okay, I'm a trained board eligible, pediatrician."
So I sort of viewed myself as just like everyone else. then getting into fellowship and doing that directly out of training, probably a lot of people who go into, that type of subspecialty training will go directly because probably there's a little bit broader opportunity on the civilian side, because we don't have as many opportunities, not as many fellowship starts every year in the military that you do in the civilian world.
But you know, fortunately there was a demand for a need for additional pediatric hematologist oncologists. It's what I wanted to do and they're like, "Hey, we got a slot for you. Do you want to go and [00:14:00] train now?" I kind of thought, oh, I should go be a general pediatrician for a couple years, get out from attendings and develop my skills and everything, but the opportunity was there, and so you just took it.
for the six years that I was in training, I just viewed myself as, well, I'm the military guy, but I'm just trying to learn just like every other fellow resident that I was around at the time.
Yeah. I'm geographically challenged, so I wanna go back on something you said.
You mentioned that you went to Seattle. You were at UDub while you or your family was in Hawaii?
No, I was just using that as a compar- I was stationed in Washington eventually, and we had, like, UDub residents. But I'm just saying, I just saw myself like any other resident at any other pediatric training program around the country.
You know? Got it. Whether they were at, Children's Hospital of wherever or if they were training at, a university hospital. I mean, my sister she did her residency at the University of Missouri in Columbia. We talked a lot about what residency training was like, being on call every, third or fourth night, that [00:15:00] type of thing.
And it's like, "Oh, it sounds exactly like what I did." You know, it's just kind of a different environment that you're seeing outside the window and different patient population that you're taking care of because- ... you're taking care of service members and their families.
Was there a point at which you realized that being a military physician meant surrendering some control over your life?
Well, I think the biggest time it did is when I got notified of that deployment. And, I think, Because, the people that I trained under, senior Army physicians, they spent multiple years at one medical center.
they were the graybeard sitting in the front row of morning report just like, probably everyone else who, sat in morning report, right? You know, the old guys, the old ladies, I guess, kind of sit in the front row and kind of offer- Great advice and, how to take care of people.
And I'm like, "Hey, that's what I wanna be." and I was fine with wherever that might have been, San Antonio, Washington, DC outside of Seattle, Tacoma or back in Hawaii 'cause that's where the pediatric subspecialists were at the big medical centers. And I'm [00:16:00] like that's my life, and we'll establish life there."
Well, all of a sudden it became, "Hey, we're deploying a lot of the Army," which means we're deploying a lot of medical assets to go with it. And my career, whether I deployed or not, didn't deploy, my career and many, people who spent the early 2000s to up until maybe even today, their career is defined by, the war in the Middle East.
the 20 years of conflict in Afghanistan and Iraq, just the same way Vietnam defines the '60s and Korea defines the '50s. So my military career was touched in multiple ways over the course of, those 20 years by the war and the rotational aspect of deployments.
Eventually becoming a department chief and having to go and tell young physicians, "You're gonna deploy." having that and thinking back, that was me at one point, and now I'm here [00:17:00] 10 years later, I'm telling somebody, it's your turn to deploy." Wow. It's tough.
it's not an easy thing to do. There's a lot of weight to it.
Yeah. And let's sit in that for just a second. ... you've gotta have that open-mindedness and you've mentioned, "Oh, I lived here, I lived there," and it kind of rolls off your tongue. But I think in the moment for some people, if you're not ready for that, if you're not ready for someone to say, "Okay, here, there, and everywhere," I think it's gonna weigh heavily.
And then you put it in the hands of the universe where those military actions may go and where you may or may not be involved in, that you can't even predict at the age of 18, 25.
Right.
you were very resilient through this, and obviously, it sounds like with your family structure and things like that, you went in with eyes wide open and a level of resilience that you may have already known even though we hate to say the word resilience in here, for good reasons.
But how did those decisions, do you think, how did they affect your family?
I think you're in the moment, and then in some manner you kind of then have the benefit of looking back retrospectively and sort of seeing like, okay, did that have long-term [00:18:00] effects on us?
And You know, having our kids and my wife, having to move, when we had like kids in young elementary school age and then middle school and then eventually we got to the point where everyone graduated from the same high school and my son had the most longevity in one school system.
But, as a parent, you're looking for like, hey, I just wanna provide a stable life for my family. In some respects, obviously if you live in one place and you live in one house and so forth and so on, like that provides stability. But I think you've got to be a stable family unit regardless of where you're located and the circumstances.
Now, when I deployed or when I had to go and do what's called temporary duty or TDY at other locations, the stabilizing force in all of that was my wife and her ability to keep the status quo, if you will, going with our kids in school and all of those things was, we couldn't have [00:19:00] managed, the kids would've had a lot more challenges than they did if it weren't for all the things that she did for our family.
You know, I guess, I don't know if I'm kind of going off tangent. ... you tell me if we need to come back. But, you know, our kids deposited themselves sort of around the country a little bit based off where we had been. You know, two of them were born here at Walter Reed, one of them was born in Hawaii, but the two that were born at Walter Reed, they don't see themselves as like East Coast kids.
they lived in Hawaii, they lived in Washington State. one of them graduated from school from Washington State University, one of them from college in, Colorado, and the other one from college in Hawaii. So that's sort of how they sort of see the world just, where they identify as home is a little bit different than home has always been like, "Hey, plan ourselves. This is where we're at. This is the job I've got to do," and you just kind of go from there. So, I don't know if they're as connected. Maybe to answer your question, I'm not sure if they're connected as much, as the way maybe I was or my [00:20:00] wife was, where we grew up in the same house for multiple years.
People that I went to grade school with were the people I graduated from high school with, so maybe a little bit of detachment there, and I think probably any kid who grew up in the military can identify with that.
Sure. let's, pause for just a second to give a shout-out to military house managers, most of whom are military moms, military wives but let's just call it military partners because I'm sure
I have some good folks that I know, very close friends, in the military that could not have done what they're doing from a household standpoint without somebody being the manager of that house. So shout-out to those folks. Absolutely. in your current career at Aetna Healthcare you know, the contrast is that we talk about some of the things that loss of autonomy and stuff in that utopia that sounds like, "Hey, this is great.
Might lose a little autonomy, but I got to be resilient." But when you talk about civilian physicians, don't they make versions of bargains and give up autonomy when it comes to health systems, employment contracts, call schedules, productivity requirements, RVUs? I mean, [00:21:00] isn't loss of autonomy a loss of autonomy?
yeah, and I think that probably military physicians because I think you do have reduced choices of where you're gonna go, and sometimes you're told, "You will go here," right? "This is your assignment." One of probably the best places that people wanna go to when they're assigned as a military physician is they wanna go to Fort Carson, Colorado.
Colorado Springs, right? Great location, lots of great things to do. Well, there's other garden spots in the Army that are less desirable, and I won't name them 'cause I don't wanna insult anyone. But for every person who gets to go to Fort Carson, there's somebody who has to go to Fort X-
which may not be what they wanted. In fact, there were people who didn't wanna come to Hawaii. They're like, I don't wanna be on an island." You know, that's not where I wanna be." And of course, we're like, "You don't wanna go to the beach? You don't, wanna have sunny and 80 degrees every day?
I'm down for that." So I think inside of that military [00:22:00] medical space, there is a sense that it's better out there, right? It's better in the civilian world. They've got it easier. They make more money. They've got more opportunities. But like I was talking about with opportunities, that aren't the same, like, there was a lot of things that I didn't necessarily have to deal with the way civilian physicians have, had to deal with.
I didn't deal with insurance companies. I didn't deal with, length of stay issues or I mean, we were headed in that direction because, you know, there has to be some measure of fiscal responsibility. you just can't do everything that you want all the time.
but I think there was this sense that people on the civilian side, they make more money, they get to do what they wanna do, and here I am stuck at Fort X- I'm not getting paid as well. But, people don't think about, well, hey, you don't have any debt. You don't have malpractice insurance.
[00:23:00] you have a housing stipend. Now trying to compare apples to apples in terms of specialty pay and benchmarks around the country the rates are lower and some instances are significantly lower, and that kind of gets into a question about retention and can we retain high-earning physician specialties inside the military.
But I think, I've started to see a little bit of both sides of it, and even saw some of both sides of it when I was in practice inside the Army and you're like, "Okay, it's not perfect out there either." And I have a lot of friends who are retired and went into private practice and, you hear everybody complains about something.
... it just changes what they complain about. it's just something different than what it was when you're in uniform.
Yeah. So the grass isn't always greener on the other side of the septic tank.
Yeah. A little bit.
All right. You touched on this and foreshadowed it beautifully.
Sometimes being in the military means accepting the possibility of war. And I wanna tread very lightly on this topic, and I'm happy let's move on, do something else."
what do civilian physicians misunderstand [00:24:00] most about physicians who serve?
I think actually there's a tremendous amount of respect for military medicine. And I don't ever consider myself to be a critical care doc or a trauma surgeon, ER doc. But if you look at the advancements that occurred unfortunately on the battlefield- out of necessity, and how those advancements are now standard of care inside of civilian trauma bays and EMT runs and other environments. I think there is a tremendous amount of respect for what military medicine has done for the greater medical community in terms of knowledge base and practices.
What do they not understand? I think they may not understand, you know, the pressures of being not just a physician but also a military [00:25:00] officer. maybe their only reference for military medicine is watching MASH reruns. And I don't mean that as an insult, but for some people that's all they know.
And, honestly, there's no military physician who's walking around with their shirt, you know, their shirt tail out and needing a haircut and, the expectation for military physicians is that you're a military officer, and your profession inside the military is that you are a medical professional, you're a physician.
Mm-hmm.
You know, you'd have to ask them what they think. But I've always had great relationships with civilian colleagues. and when we had, meetings with kind of local pediatric programs in the locations I was at. Because, the common bond
is medicine, and it's patient care, and it's your specialty. That's the common bond. That's the common language that you get to speak with people. And so that's what makes it enjoyable because the preconceived notions are all kind of set aside because you're like, oh, you know, hey, this [00:26:00] person knows that study.
This person Knows how to treat that patient. And so it's just a get those barriers out of the way and you realize we're all doing kind of the same thing.
I love the, reference to language because we talk about languages in medicine, we talk about language in, the world of finance as well, and we're really trying to broach that subject of, finance just being a language, much like anything else, math and everything.
Yeah.
And again, I want to be, very respectful of this and we can move on, but are there experiences from military medicine that changed the way you thought about life or medicine?
Certainly. You know, I think probably just personally getting on the airplane when, at Fort Hood, in, 2003.
You know, it's one of these aircraft, it's one of these like contracted, like 747, right? You're walking across the tarmac up the stairs and onto the aircraft. It's not like a jetway at a regular airport. And I just remember just walking across that threshold like, "Hey,
Is this like my last time, standing in the United States?" And for some- Service members [00:27:00] it was, right? When they got on that plane, they didn't come home, and it's humbling, because little kids and all of that. So I think, those types of experiences challenge you, they humble you they make you rely on your faith and your family to endure.
I think, during deployments especially my first deployment, I was in Iraq and This was really kind of pre, insurgency and things had actually like there was sort of this brief period of time where there was actually some peace after the initial invasion, entry into Iraq.
And we had started to do some of this outreach to sort of like, "Hey, how do we help with this whole concept of nation building?" Well, you know, they're like, "Hey, We'd like for you to come and visit this hospital." And you go to this hospital and it is developing world medicine in Iraq.
An incredibly modern-looking facility, but if you remember what happened I-with the Iraq war and the embargo and everything else, [00:28:00] everything was essentially shut down. And so you had this modern facility that had no resources in it, You actually had Western-trained physicians. Many of their Iraqi physicians had trained in Europe, some had trained in the United States and come back to Iraq, but there was just no resources.
And It was the most kind of surreal environment because you're like, "Hey, this hospital like," if they cleaned it up, they swept it up, put some paint on the wall, it would look like any hospital in any community, but there's like nothing in there that they can use to take care of patients, and there were patients in there with real needs.
And so, they say, "Well, can you come and see this patient?" And, it's a, young child who obviously has like some type of advanced malignancy. I thought, probably leukemia. And it's like, I have nothing I can do for you except tell you what I think your child has .
And that's hard as a physician, right? to be in that setting. It doesn't matter if you're, at the bedside telling somebody that, there's no treatment options left, or if you're in Iraq trying to communicate to a mother and [00:29:00] father that, I can't help your child because we don't have the tools here to take care of them.
So those types of experiences, you don't forget them. I can kind of just see myself back there today, and that was 23 years ago, when that occurred. but then there's other, like, super inspiring opportunities and things that you hang onto. we did a humanitarian outreach to Thailand2009 And it was one of the most incredible experiences to go out into these, very remote villages in Thailand.
And the dentists and the eye doctors were, like, the busiest people on these missions because, they could give people glasses, and they could pull bad teeth and instantly make people's lives better.
but that's a team. That's a team of military physicians are out there taking care of people, and,
those kind of experiences they don't leave you. I mean, there's a lot of civilian physicians, right, who go on humanitarian missions, and they will [00:30:00] say, "Wow, that was the most inspirational, fun thing I've ever done in my medical career- Mm-hmm ... is to go out there and take care of people who have nothing, and have nothing to offer in return."
you brought up a couple great points. That's one thing I've heard. I've not gone on a humanitarian mission myself, and I probably should have or should. but that's another way to get people to pull back and realize how valuable that they are and their career is. and you also mentioned the young child that you remember from Iraq.
And I can't think of a stronger form of moral injury than literally not having the tools to help somebody. And, we're not throwing insurance companies or hospitals or anybody under the bus. it just wasn't there. I think that defines moral injury.
And thank you for that story. That's really impactful. Want to walk it back a little bit, standing on the tarmac with some of your colleagues. when we talk about physician career choices, whether it's civilian or military, do you think we, as clinicians, physicians, do we underestimate [00:31:00] how often our families are
Involuntary participants in those decisions?
yeah, they certainly are. And I try to do as best as I could to not miss things and to be present. You know, and, I had primarily an outpatient-based clinical practice.
And so, for me, a little bit different than being, in the OR and, being on that type of call. But still, I mean, there was, a period of time where all my colleagues were deployed, and I think I spent something like five, four months where I was in the hospital every day because I had inpatients.
you know, literally every weekend I was in the hospital doing rounds. And so I think there's those kind of like day in and day out sacrifices that they make and then with the military they make the sacrifices of, "Hey, we're moving. Didn't think we were moving, but we are."
when you're a 12, 13-year-old girl or a nine-year-old boy and you've felt like, your roots are being pulled out 'cause they are that's, impactful. And you know, is there some guilt as a result of that?
You know, [00:32:00] probably there is, I would say, yeah, I feel bad that's the case. But I can also see how that has woven into their lives and all of the good things that are a result of that. You know, nothing's ever 100% in one box or the other, right?
There's always a little bit of of both, and I would say they would agree with that. They may not, but I think they would.
theoretically counteract everything you've said. But, you mentioned to me too, we talked earlier, that you've retired from medicine, military medicine.
Congratulations on a great career. Is there anything that you miss specifically about military medicine?
I miss the people. I do miss the mission a little bit. I mean, it was very, very focused, right? In terms of, that wartime medical mission.
it's been the big focus over the past, gosh, probably decade plus. not just because of, conflict still exists, but the recognition that our number one mission in military medicine is to increase survivability on the battlefield. And so all of the training and all of the where are we headed, as a [00:33:00] unified medical profession inside the four walls of the military has to be geared towards that.
So I would say my last couple of jobs where I had the opportunity to be in command, essentially the CEO of a couple of organizations, that's where you have the opportunity to really make an impact organizationally wide, at the operational or even strategic level, and there's just great people who are really dedicated to those mission sets, and those are the people that you miss, that you wanna keep in contact with because, you had such a bond in those experiences of being in the command suite and, around the table together making decisions and doing things that's where you would say that's what you end up missing-
Mm-hmm
the most. Yeah.
Amazing. And in some of your exposure or some of your colleagues, is there anything that you discovered that civilian physicians complain about that made you think, "Man, you people have no idea"?
Probably one of the people [00:34:00] that I watch the closest and I just think the most of is my brother-in-law, who's a cardiologist, and he stood up a private practice in a relatively small town in Missouri. And, he ran the whole thing himself.
he was a small business owner, right? And he's filling out his own coding, and he's working a lot of hours for a long time. Very successful and, just a great human being and a great physician. So I saw the sacrifices, you know, that he made, and I think the older I got, the more I've talked about this as a theme, is that hey, we all have those sacrifices that we make in one way or another.
So I don't pretend to either understand or negate the challenges that civilian physicians have, that are just different than what exists in the military side.
Yeah. What do you think, who is military medicine a great fit for?
That's a great question because, you have people that were like me, right?
Who, like, I made this commitment quite literally made a 20-year [00:35:00] commitment to the Army when I was 22 years old.
And there are many people that were like me i- in that, and then you had other people who went to civilian college. They're like, "Hey, man, how am I gonna pay for medical school?
There's this guy who wants to talk to me about a health profession scholarship with the Army or the Navy or the Air Force." They put the uniform on, and off they go. And then you have one of my best friends in the Army was a general pediatrician. he was living in Hawaii, and my old boss essentially, not talked him into it, but inspired him to join the Army.
He had done all of his training. He was living the good life in Hawaii and chose to put the uniform on.
Wow.
And I think you have to have that wiring that I am interested in taking these, skills that I have and serving kind of a greater mission, if you will.
Healthcare in general, being a physician in general is a life of doing good for others, right? And I [00:36:00] would say that's a universal trait that we all can say we agree upon, but I think there's something about patriotism and love of this country, a desire to serve be in service to others, that the Army, the Air Force, the Navy, it offers somebody who is wired in that way to take that on as an additional level of what makes them who they are.
Those are really great points. And so let me turn the question around on you too. Aside from not being mission-oriented or, you know, maybe not being nationalistic, in a sense that you have that patriotism, were there people or there qualities of people who should not choose military medicine?
Yeah.
I guess I would see this, a little bit. You would see people who had become disgruntled with the sense that, like, they really are losing all their autonomy, in terms of either what specialty they wanna go into, where they wanna live those types of things.
Wearing the uniformkeeping your level of physical fitness to [00:37:00] the point where you can pass the physical training requirements. Having to go and do some military-specific training, rather than, you know, having a free Saturday. those kinda things happen.
And I think if those are the kinda things that sort of like get under your skin and you can't just be like, "Ah," suck it up and kinda deal with it, I think those people were challenged. And then not to say that it's, you know, somebody who is complaining at home, but if your family unit is such that, Me and my spouse, we wanna go and live here, and we wanna set up roots here, and we wanna be a family here.
That poses a challenge for somebody who's like "Hey, there's gonna be some moves that you're gonna make." On the other hand, if you're like, "What's the next adventure? Where do we get to go to next?" I think that people are just wired that way.
I mean, for me, I got, fortunately, as much as we moved around, I got to live in places that were great to live in. San [00:38:00] Antonio, Texas. Honolulu Hawaii. Western Washington, south of Seattle. Just great places that people wanna be at regardless. Washington, DC. Couple other garden spots along the way that were a little bit more challenging, but great opportunities.
Each one of them has their own advantage. But if you're not wired that way and you wanna just, "Hey, we wanna build a house. We want our kids to all go to the same school. We wanna live right next to, our brothers and sisters, and grandpa and grandma are right down the street," that, I think you gotta, question, okay, what...
Are you willing to give that up, in order to be in uniform?
Really great points. So some things to take home. Aaron, every physician gives up some autonomy in exchange for something, right? Money, security- Sure ... prestige, opportunity or stability. How do we know when the bargain is worth it or when you say, "You done messed up, A-Aaron"?
Yeah. I think that's such a personal question and a personal decision. I think that, There's probably, in the [00:39:00] military medical career, there's kind of some stepping off points, and it's changed a little bit because the way they do retirement now is a little bit different But, when I was in those formative years of my career, you know, one of the things that gets onto your horizon is, "Hey, I want to have my military pension," right?
And in order to do that, I've got to get to that 20-year mark in uniform in order to get that. If I left at year 14, 15, 16, you don't get that pension. So you start to kind of make some decisions like okay, maybe I'm not super happy in this, but am I willing to give up that financial security of what that pension offers me in order to go somewhere else?"
Now, early, if you only have a three or four-year commitment and you can do that commitment, and then you can leave the military and now you're into your civilian, i- into that civilian [00:40:00] life as a physician, that's a little bit of a different dynamic than the person who's like, "Hey, I'm in my early 40s.
I'm starting to think about retirement at some point. How am I doing financially?" And are you going to give up that pension which, you know, in terms of dollars, people do the equation of How much of an annuity would you have to equal a military, pension?
It's a big number.
It's a big number, and so you start making kind of those decisions like, "Okay, I'm willing to stay." Now, I stayed well beyond that because I was getting to do things that I love to do and opportunities that I thought, "Wow," I mean, this is cool to get to go and do this.
But I think for others, they kind of maybe start looking at it differently, especially if they want to stay very clinical in their post-military career.
Mm-hmm. Thank you for these points. We're wrapping up here. Aaron, is there anything that we're not talking about that we should be?
No. I love the concept of thinking about this because I think, you know, now in my [00:41:00] 50s, thinking about- this concept of security and what that looks like and, having sort of been in pursuit of it for so long and now, not to say that I'm secure, but now entering the phase of where you start thinking about, like, am I secure enough and when can I stop practicing or when can I stop working?
I think it's not well-defined for us, and I think it's a discussion for us to have because, security comes in a lot of different forms. It's not just, a dollars and cents type of, equation. So I applaud you, for having these discussions 'cause I think it's good for us to think about things like this.
Absolutely. I appreciate you being on the show. You bring up a very good point that not every cost is visible on a spreadsheet, so there's a high price of security. Last question, Dr. Aaron Pitney, thank you for joining us. I think I know the answer to this question, but knowing everything you know today, what would you tell the young A.A.
Ron Pitney- ... who was about to sign those papers? What would you say to [00:42:00] him?
I would say just, hold it in an open hand, and, take the opportunities that are presented and kind of bloom where you're at. do a great job. And I like to think that a lot of the circumstances that we find ourselves
they do a great job of self-organizing and getting us to where we wanna be. And I think for me personally it was the best decision I could have ever made in my life was to go to the academy, go to medical school, have that paid for. The opportunities personally, my family, professionally, financially I don't know if they would've happened as well as it did any other way.
So I think... and you don't know that until you look back on your life. And so I'm incredibly blessed and incredibly thankful. So, I think the opportunities are there, if people are willing to open their mind to that as a possibility.
Absolutely incredible stuff. Dr. Aaron Pitney, thank you for the time. Thank you for joining us and, we're learning a lot of wisdom.
thank you. It's been my pleasure.