GSACEP Career Corner: LCDR Stuart, Succeeding with the Marines and More

Welcome to our first episode of the GSACEP Career Corner! We will highlight an individual's career path, with tips on how to succeed in varied military/federal assignments!

Lieutenant Commander Stuart earned his Bachelor of Science degree in Microbiology at the Georgia Institute of Technology, where he commissioned through the Navy ROTC program. He received his Doctor of Osteopathic Medicine from the Philadelphia College of Osteopathic Medicine in 2009. After graduation, he reported to Naval Medical Center Portsmouth, VA as a transitional intern, completing the program in 2010.

LCDR Stuart reported to 3rd Battalion, 3d Marines where he served as the Battalion Surgeon from 2010 to 2013. During this time he deployed twice in support of Operation Enduring Freedom. He also served as the Director of Medical Readiness and Immunizations for 3d Marines. LCDR Stuart was then assigned as the Deputy Regimental Surgeon at 3d Marines where he coordinated medical support for the development of Marine Rotational Force – Darwin and RIMPAC exercises. Additionally, he pioneered the development of a combat training curriculum, the creation of a training tactical simulation laboratory and served as the Director of Operational Training.

In 2014, LCDR Stuart returned to Naval Medical Center Portsmouth to begin his emergency medicine residency training. His involvement in combat trauma research resulted in 18 presentations and publications, numerous awards, including 2nd place at the American Academy of Emergency Medicine’s research competition and was recognized for creating the largest scholarly output in the program’s history.  In addition, he also oversaw the expansion of the Simulation, Vivarium and Biotechnical Skills programs.

After graduating, LCDR Stuart assumed the role of MEU Surgeon for the 13th Marine Expeditionary Unit and deployed in support of WESTPAC 18.2 and Operation Inherent Resolve.

In 2019, LCDR Stuart returned to Naval Medical Center Portsmouth as academic faculty. He served as the Interim Chair and now concurrently as the Senior Medical Officer for the Emergency Department where, in addition to serving as the medical director, he is responsible for their COVID-19 responses, and the Director of the Combat Trauma Research Group, which was awarded the 2019 Military Health System’s Team Award. 

LCDR Stuart is board-certified in Emergency Medicine, holds a faculty appointment as Assistant Professor of Military and Emergency Medicine at the Uniformed Services University of the Health Sciences, and is a Fellow of the American College of Emergency Physicians, American Academy of Emergency Medicine and the Academy of Wilderness Medicine. His military decorations include two Meritorious Service Medal and two Navy and Marine Corps Achievement Medals.

LCDR Stuart is married to Lisa Stuart and has a daughter, Lily and son, Benjamin. 

Transcript

Narrator: 1:09

Welcome to the government services chapter of the American College of Emergency Physicians podcast. GSACEP represents emergency physicians who work in the federal government, including active duty military, National Guard, and military reserves, as well as the Veterans Administration, Indian Health Service and other federal agencies. Our mission is advancing emergency care for America's heroes. In this podcast, we bring you lectures and conversations with leaders in federal emergency medicine, to help you better care for your patients and lead your departments. The views expressed on this podcast are personal views, and do not represent the views of the Department of Defense, any branch of the military or the federal government, and they do not constitute endorsement of any product by any of these entities.

Andrea Austin: 2:07

Welcome to the GSA CEP career corner. I'm your host, Andrea Austin, and it is my pleasure today to have with me Lieutenant Commander Sean Stewart, soon to be commander Stewart. He is currently stationed at Fort Smith. He's the medical director and also the director of research. And we're very happy to have him on the GSA sub board as a counselor. Welcome to the career corner. It's always great to talk to Andrew. So this is a new segment that we're doing on the podcast. And the purpose is really to look at someone's career and provide hopefully some inspiration, different perspective, give people a sense of all the different things that people can do with their military career. So let's start with your story. Where are you from? And how did you end up entering the military?

Sean Stuart: 3:01

Yes, so my story is pretty straightforward. I never really had to deal with that challenge of what do I want to be when I grow up? I just kind of always knew I was gonna do military medicine. My family is multi generational military with members serving in all different branches. So you just kind of grew up in that kind of family mentality. So the biggest influence was probably my father for sure. He is a marine. And honestly, he would be far more entertaining interview than anything you're going to get out of me today. He actually enlisted in the Marine Corps, he was 14. And yes, I said, 14 not a mishap. Back in the 40s. guidelines were a little looser back then. And things were a little easier to slip in. And he was, you know, Colossus of a man. So they kind of managed to slip his way into the Marine Corps at the age of 14. So, in fact, September 15 1950, was his 16th birthday. And the military bros out there will recognize this really important data military history. This is actually the date of the in China invasion during the Korean War. And so in his 16th birthday, my father was part of the team that first hit green beach to capture wamu Island at the entrance to Incheon harbor and kind of kick off that invasion. So growing up around stories like that, it's not really too hard to see how I came to be in the military. So not surprisingly, I went on and did a Navy jrtc in high school, then did a little debate between the academy versus an ROTC scholarship and ended up electing to go to the Georgia Institute of Technology, otherwise known as Georgia Tech go jackets, and was a midshipman there. So interesting fact the RTC program was established in 1926 by the Department of Navy, and Georgia Tech was one of the original units set up at that period of time. So nice little trivia fact. Then after graduating from Tech, I went through the hpsp to medical school. And fast forward a couple years. Here we are.

Andrea Austin: 5:05

Wow. So for our listeners, I'm just curious. So how many years did you Oh, between ROTC and hpsp,

Sean Stuart: 5:14

all of them. Nine in total, so I did double that Georgia Tech. So I got five year commitment out of that, and then four out of hpsp, so nine years in total.

Andrea Austin: 5:25

So let's hear about what your most interesting and rewarding assignment has been in the military

Sean Stuart: 5:33

guy who's been a lot. I mean, the nice thing is, if you don't like doing something in the military, wait, and you'll get another assignment. There's been a lot but the most award was actually a more junior one. Be probably my first or second deployment in Afghanistan. I was a transitional intern and then went out and did a GMO with Third Battalion, third Marines out of K Bay in Hawaii. And really, the deployment to Afghanistan in 2010 11 would probably be the most rewarding. Not a whole Have fun, per se, but great rewarding experiences, it really gave me a chance to do everything I thought I should do as a military physician, both as a as a leader as an officer, the medical cases we saw and took care of the actions we serve these young Marines and officers. That bravery, the amazing contributions of Navy Corpsman in the battlefield and the people I met, were just, again, that was two years into my career. And this probably nothing I've done sense has been quite as rewarding. As the things I've seen, and the people I've got to meet in a combat zone.

Andrea Austin: 6:44

So let's back up because the general medical officer tour is becoming less common, and is certainly less common among the Army and Air Force currently. So let's back up and explain what the general medical officer tour is. And then what what it was what your responsibilities were, when you were with the Marines?

Sean Stuart: 7:10

Oh, yeah, you're absolutely right, they are more or less kind of been phasing them out. And most of the services to GMO or general medical officers kind of just that you complete an internship and so medically are deemed a generalist. And then the billets they generally go to includes the FMF, that'd be the Marine Corps on the shipboard assignments, or some people like to do either flight or die becoming a flight surgeon, or a UML undersea medical officer. And really, the roles are not that different from what a lot of other medical roles are, in terms of things you might do even as a Board Certified emergency physician now that you go straight through. And really, it's a great scope, I just gave a talk to our fourth year, seniors and told them scope of practice, emergency medicine is huge, but scope of practice of his general medical officer, or really a medical officer in the operational fleet is really just massive. You are to whatever unit you're attached to, even as a GMO, you are the subject matter expert for medical, I mean, you are advising a CEO of a ship a plane, a tire marine Battalion, on what to do on medical matters. You also in charge, everything from the medical readiness to the more routine injuries all the way up to the combat care. I was later a new surgeon and it wasn't that dissimilar, my scope was a little bit bigger, but the same concept, you just have a phenomenal amount of responsibility. But also with that a phenomenal opportunity for just very rewarding experiences to really go from being yours in school and yours and training to really go out there and really be able to, to own a piece of something. And that's what I think makes really any military operational experience so much more rewarding, is the fact you really feel like you own the group you're with you're not just a doctor, you're the physician, the medical expert. Yeah, I

Andrea Austin: 9:08

think about it almost in the sense of being a small town doctor, because you do know all of your patients, you know, a frequently you are the physician for the commanding officer and there's so much trust placed in you because you know, everybody so well, and you're their doctor. So I mean, that's the closest as far as like the relationship goes that I can explain to somebody that's doesn't have a concept of what a GMO is.

Sean Stuart: 9:38

Absolutely a small town doc that relationships again, that is that is what makes our community. Yeah, it's it's phenomenal.

Andrea Austin: 9:47

So you brought up another career or job you've had in the military, which is very common, also on the Navy side. And you said a new surgeon and I know several of our listeners are in their fourth year of residency or third year of residency, and then they may go straight to a new billet and that's especially hard. In my opinion, if you're coming from a civilian program, walking into a new billet, I've had a couple of friends that have had that, that challenge, and they and they succeeded. But let's talk a little bit about what what the mu assignment is what that platform is, and then maybe a couple of tips for integrating with the Marines because I actually think in my experience when I deployed at the Marines, I wish I had had a little bit more advice before I had been assigned to a marine unit. I mean it really I was deer in headlights. It was a bit of a challenge. So let's talk about the new assignment and then what your tips would be. Yeah, so

Sean Stuart: 10:52

I was the 13th Marine Expeditionary Unit out of first Marines out at Pendleton. So the Murray mu or marine stationary unit is the marine contingency. So like all marine units is always structured around a combination of ground air and supporting elements that a boards a amphibious readiness group or a argh basically ships who goes out as a basically forward readiness force. And it really is a hallmark of the marine Navy team. Because what the Meuse really serve as while they have some direct admissions is really they are the Ford Response Force, you will kind of out there ready to react in different news certainly have stories from combat operations to humanitarian aid, because when things pop up in the world, you're out there because of that, and to your question of what you do is, again, like the GMO you kind of everything the Muse surgeon is a very common em Bella. In fact, to my knowledge, only em physicians hold mu nu billets, and you're really responsible for that entire marine unit, which can range in the 1000s of Marines, you're looking at doing everything from again, making sure they're ready to deploy both medically in terms of their health, but also the medical assets in terms of training. And you also be have leadership responsibility of several GMOs often, again, Marines are a combination. So you'll have the ground units, and they'll have the battalion surgeons, which is the GMO title for those, you'll have flight surgeons under you. And so really, you're the the centerpiece for this fairly massive medical infrastructure that can usually span three ships and several 1000 people. In terms of tips. Gosh, it is hard, I was thinking five generations and my first marine bellet was still different. I did three deployments before my mew and the mu were still a learning curve. So tip number one is don't feel overwhelmed. Because no matter what job you do, you're not going to know everything go in, and it's going to be a growing opportunity. And I think that's kind of one of the fun parts is you're going to go in, you're going to be board certified, hopefully avoid words, metaphysician, you know the medicine, but you're going to get to grow into the leadership opportunities with that I think that's really kind of special in a way. So tip one would be just don't, don't worry, you'll grow into it. Tip two actually is back to your I guess, previous communists, it is a small town get to know everybody. To me again, this is what made it rewarding. People don't realize, you know, we're all around ourselves. Even though I'm a little bit envious of you as a almost like a mentor and some of the great projects you've done, but what you see on other doctors, and we don't think of ourselves as that special, and I certainly don't, but when you go out and find the corpsman or, or that young marine machine gunner and ask him what you know, Hey, tell me about your weapon. Or tell me about this aircraft? What do you do? And can you show me this, the look on their face is I tell people is probably the biggest ego boost because they're just so excited that I doctor and this this can be a junior officer, I've gone to our Kelly offices, she thinks it's the coolest thing that doc wants to know how the artillery works. And you just get to meet so many interesting people. And you build that relationship, I think it's really important to really integrate the the medical with the operational piece and really get them to see you not just as doc in the side, but they're there. As you said, the dark is there my dark when you do that they're very protective of you. It's just again, I cannot possibly explain to you how great those relationships are. I still have you know, everyone knows WhatsApp or signal now chats with people I've deployed with 10 years ago, I had my chief now a master chief and several corpsman from deployments coming to my wedding back in the day, I mean, it just you build these relationships and so use those opportunities. Tip number two is to use those to build relationships meet the kind of people that make the military happen. And I guess the last tip I can tell you is don't be afraid to ask for help em, we're kind of self sufficient. If there's any group that's probably very will find a way it's us but to ask for help. I know at Portsmouth, we all tell all our residents, we have the orthopedic phone and the EM phone to call us back. I certainly call colleagues and they call by colleagues in remote settings for Hey, how did you handle the situation, be a medical or militarily, so use our network like GSA Sep, and we were a group of people who you know 90% of everything you're going to do one of us has done or been in a similar situation. So feel free to reach out. Get in via GSA, GSA separate the boards and things like that, use that as the collective knowledge, because a lot of us have done a lot of things. And you can learn from my many mistakes as opposed to repeating them. That is

Andrea Austin: 15:46

so wonderful. And I distinctly remember calling back twice on deployments and probably more than that, but two situations stood out. There were some weird requests about how we were going to handle a snake by and So I called back to one of the toxicologists and and then another situation was a leadership thing. It was an interaction with the commanding officer that I was really just struggling with. And I called back for advice on how to handle it because man, talk about it. Again, that culture shock of the Marines and I was still a lieutenant, because I had gone straight through so I was an O three. And in my opinion, he just really didn't was very skeptical of me, I think, because most emergency physicians had interacted with had been ofourse. So I think he just felt that I was extremely, extremely green, but not in the green way that he wanted.

Sean Stuart: 16:48

No, that's, you're absolutely right. We were all Taipei's. But we think we can't call back and ask him again. That's why I love the gssf. Putting out, you know, what, the website everything, just trying to make that centerpiece because we all have so many experiences. And again, you don't have to suffer through them alone, you have people that can reach out to you just a wealth of information, so completely understand. And believe me, even five generations, I'm not as green as some Marine Corps officers would like me to be. They're a very tight knit group, but they do love their dogs. I'm sure you had a lot of great experiences from that story, too.

Andrea Austin: 17:22

Oh, absolutely. Absolutely. You know, I always tell people that, you know, honestly, I think Marine Corps culture is a culture shock. But once you find your way in and have that credibility, there is not a more dedicated group of individuals. And frankly, you want you want Marines on your side. I was definitely my lesson from deployment. So let's go and turn back to your deployments. I mean, with the emphasis on the s. So you've had several where where have you been and what were your roles?

Sean Stuart: 18:01

Yeah, so I've did I've done four operational assignments so far, in 2010, to 11 and 11 to 12. I again was the battalion surgeon for Third Battalion, third Marines, America's battalion. And so both times deployed to Afghanistan, both times Helmand Province, then later Afghanistan kind of wound down for third Marines. And I operated a what's called Marine, the murf D or marine rotational force Darwin and that was the beginning of some specific exercises, taking us to places like Darwin, Australia hence the name Thailand, Singapore, Indonesia, Philippines as a group or that kind of rotational force. At the time we were out of Hawaii moved to Okinawa for the deployment just kind of build relationships with partner nations in the Pacific and so did that that was a great experience can join the Navy see the world and so was the first time I got to see something outside of Afghanistan. So lots of interesting cultures again, great relationships very interesting to meet partner nations. See how they operate both military and their culture. And then the fourth and last would be getting the 13th mou out of Camp Pendleton back in 2017 2018.

Andrea Austin: 19:16

So I want to turn to the Australia experience because it seems like we are growing that relationship and more people are going to have assignments working with the Australian military so what what was your experience like were you on an Australian military base or out in the field?

Sean Stuart: 19:39

Yeah, so phenomenal people so much fun to work with we were we did feel ops when I was there. Again, they rotated through Darwin there so we did some field ops with them for a brief period of time again a great group of engineers obviously culture very similar to us but have some uniqueness to them. Just again, phenomenal people I don't know what else to really say about as a field up I definitely agree with you the Australians and several those, that region of the world certainly Indo paycom is the new focus and you're going to get to I think most people are going to get some assignments out there and so I really think learning those cultures and being familiar that area is going to be key for all of us in the future

Andrea Austin: 20:17

boy I got out too soon I would have really liked that Australian assignment I'm making some friends down in Australia right now and I agree there's just a really fun group of people and I just and I love the accent

Sean Stuart: 20:34

was a very fun competitive group. Like you said, that's that's the greatest part. It's whether it's directions or anyone to work with. It's I can't emphasize enough how great is to meet the culture, then you just have these fun, but it's kind of competitive, very collegial and it just, again, it makes for great times.

Andrea Austin: 20:49

So I think you're probably past your nine year commitment. I don't know for sure. But it is my prediction that if you're not past the nine year you're close to it, and we've had a separate conversation in which you said you're definitely going to be career, we'll get to in a minute about some of the challenges. But what has kept you in because, you know, I think a lot of people, people tend to be negative. And there are challenges, and we'll talk about that. But you seem to have this joy TV, you're still very excited about being in the military. So what what keeps it special for you?

Sean Stuart: 21:27

Well, the contract kept me in for at least the first time, but I am past my initial commitment. And it's really kind of like I said before the relationships but just the scope of what I get to do, again, I grew up military. I don't have any physicians, not since a great grandfather. So we were a military family and just knowing what we do, as physicians, as emergency physicians, we are the tip of the spear, certainly in the healthcare community, and there's amazing awards I get out of that. But for me, I really get and I told the residents, my biggest joys, what I do, or not my patient encounters, I mean, I like to think of had a couple of good catches here, there. But the relationships, the leadership opportunities in the military, that constant kind of like all the amdocs you know, the the joke wall, ADHD, the concept getting to do and try something new. It's really been what's kept me around. So my fourth use asked me kind of a question you did, what's your mission, one experience, and I told them, it's never a patient encounter. It's the call, I get that being invited to a wedding of a corpsman to a corpsman who was going to get out but stayed in is asked me to come for them be pinned on Chief, the one who gets into med school who gets into nursing school, when it gets into Harvard like the corpsman callback, and you realize that certainly they did the work not me by any means. But then the think callback, and thank you, that is if I had some small role in shaping them to do something bigger than they would have otherwise. Again, I almost feel bad. I almost feel like it sounds corny, but the that feeling is better than any any patient save, it's knowing you positively influence someone to be more than they thought they could have. And those opportunities to work with this kind of people to have that kind of impact has kept me in despite as you mentioned, the the innumerable challenges and frustrations that do occasionally rise in military medicine.

Andrea Austin: 23:22

I think what you said is just so important, and one of my interests is how do we prevent burnout in emergency medicine because we have, you know, really high rates and you can you hit on a lot of key components that are protective against burnout. So one is relationships and after being out of the military for a year and now coming back to a military contracting position, I instantly felt the camaraderie in that emergency department again, which has been vastly different than any civilian emergency department. So that's huge camaraderie. The other thing you touched on is the variety of assignments and I really think this is my personal opinion that the the track we're on in civilian emergency medicine is not sustainable for probably 70% of us since 70% of us are burned out and we have something to learn from the military that there is a lot of variety built in pretty much to any billet there's a lot of variety but like you said you don't like your job it's going to change in two to three years that's you know, I think something that cannot be overlooked and should at least give people pause when they're making the decision which clearly you're staying in and and I got out after nine years so there's different different perspectives but here I am as a civilian coming back around because I just couldn't couldn't stay away

Sean Stuart: 24:55

well we're glad you didn't by the way so but no it is I mean it I won't say it's not hard to move sometimes to be honest with you and there are definitely times and you know there are disadvantages everything so certainly there's times I think if I could have stated a billet three four years that have to I could have done more good so no I think it's I think the big thing is that's what keeps me and I don't somebody asked and they were going to get out How did I feel about that I don't hold it against anybody it's it's a different you know every there's so many options especially as emergency medicine Doc's I mean, you can be a clinician and academic researcher you can be a teacher I mean there's so many options so you know I think the military is good for some of those better than others and it's about finding what makes you happy I mean again plug for you I've seen your website and teaching you doing the podcast and you're doing these great things and and that's clearly what you're meant to be and as long as you stay in connection with us I'm okay you're out of the military but you know you're still doing these things because you found what makes you happy and and that's you have to do in the military is you know, we can suffer burnout to our uptempo certainly high I mean, I'm not not gonna pretend is not moments that I've, I feel drained with, you know, our staffing and the deployment and stuff. It can get busy and I think the key that like you said is is their relationships that's that's the only thing that gets me out when I'm exhausted after you know a 36 hour day and a lot going on it's it's the people that's really that's that's been my safety net when I get tired is the people I work with. That's my back and Portsmouth for the third time because we know people here and my wife's a West Coast there. But she's okay come back here because again, it's it's the people you meet not those that great West Coast people. But we know we know friends out here. Well, let's

Andrea Austin: 26:30

pivot to you've now had Well, you've had many leadership assignments throughout your career, but most recently, you've been the medical director, will you are the medical director at Portsmouth. I mean, we've talked about all the positive things happening with the military, but to be realistic to our audience, and we've got medical students and residents there, there are some big challenges, the DHS has created a lot of anxiety. So from where you're sitting, you know, what, what do you think are the biggest challenges right now? And if you had your magic wand available, you know, what, what do you think we we need to be doing to make make Military Health better, and I'm a big proponent of you make it better for physicians, you always make it better for patients. And we cannot be creating these false dichotomies because the two are linked.

Sean Stuart: 27:20

No, no, absolutely. And I do love what I do. I, as you said that I don't want to pretend sugarcoat it is this challenges, i da che, hopefully not give myself too much trouble with a magic wand. He has a good concept, the idea that we hopefully standardize certain things come together as a joint services is good. It should, in theory, as you said, help the physician kind of streamline things. And I think it's a good intention. It certainly is. It's not there yet. So it's certainly been more challenging than it has been a help at this point in time. And I think that's really the biggest challenge in a nutshell, is, we're in a time of huge change. And we've been, as long as I've been in Iraq, Afghanistan, you know, what, pivot to the Pacific, but there's not the same amount of active conflict. Certainly, we have, you know, that COVID pandemic, we have a lot of other things we're dealing with. So it's lots of challenges, lots of events going on, but we're still trying to morph what we are in the future, right? We're pivoting from these Afghan kind of conflicts to how do we shape the war, or potential conflicts in Indo paycom? How do we adapt to the post we'll call war period where they're often monetary cuts, and we see this all the time, you know, the funding goes down. And the problem is, medicine, unfortunately, always becomes a low priority. And so we become probably the most stretched group during this period of times, you know, that they got to cut ships, they got to cut, you know, Marines, but they're always going to kind of tighten the noose on medicine more. And that's what the challenge is here right now is, you know, I don't like the phrase, and I never used the phrase do more or less, because I joke, it's a mathematical possibility. I've told my team, you, you do the best you can, with what you can, we certainly become more efficient in order to make up for those gaps. But it's sometimes it means we have to prioritize. And that means, much to my chagrin, that means sometimes giving up things we want. To me, I'll get them uses brief soap boxes, usually training, education is often one of the first things that gets hit, you know, we have patient care, we have certain administrative requirements and responsibilities. And, you know, when you get tight things to fall off, oftentimes or training, there's other great opportunities to kind of push the ball down the field. And I think the challenge, you know, again, we're dealing with right now is, what is our future look like? What are we trying to become under da che with the shift of Pacific? How is that look, I've talked to I've been in place with us and flag officers involved, too. You know, there's a concept, but even they give us a lot of uncertainty of what exactly the next five or 10 years are going to look like. And I think, you know, as humans uncertainty inherently, is the thing we fear the most. And there's a lot of uncertainty right now, you know, do I think things are going to work out, I think, as a community, we're going to figure out solutions. But it doesn't mean that's not going to be a challenge. It doesn't mean we're not going to need to be very proactive, to make sure we're shaping things the way it needs to be for physicians, and hence our patients.

Andrea Austin: 30:23

If people are wondering if the grass is greener on the outside, you know, there's a lot of challenges in the civilian emergency medicine community as well. And I think people are seeing that with the EM workforce report. And I think we're in a period of flux for across everything in America and the world right now. I think this is a period of history, similar to the 1960s, early 70s, as far as just so much uncertainty, and so much change happening. So yes, there's challenges inside the military, but You know cautionary tale, there's a lot of challenges when when we get out. So this is about the ability to adapt and overcome. And if there's any group of physicians that I think are up to the task, it's emergency medicine. I mean, that's, that's what we do. So I'm very confident that our community will continue to rise that challenge, and I hope we have more people in our community rise up the ranks, you know, in the flag level, to be able to have I think we're inherently good leaders, because we see the health care, especially in the military, through just so many different vantage points from being out, as you say, at the tip of the spear. Back at the hospital, no, I,

Sean Stuart: 31:45

I agree completely. I mean, we were a dynamic group, by by definition. And I think in times of change, the best thing you can be as flexible, and I think through COVID, which is, again, I don't think anyone has not been personally and professionally affected. One thing I've really seen is em step up. Again, there's a lot of fear associated early with that. And I think the key is, as these challenges happen in these times of flux, know, even a civilian girl, em is the safety net of the healthcare system. And in times of challenges, things slip through the cracks. And it's really been the good component, our specialty to kind of lead the way and kind of help guess help provide quality health care in a time where, again, there's a lot of challenges that healthcare system, military and civilian and so we really need to be, again, continue to be in the front of shaping that, as I think we're just probably maybe bias, the most appropriate specialty to help kind of see the big picture.

Andrea Austin: 32:44

So I want to change gears a little bit. And so it's my understanding that the physical fitness assessments are back. I think, what a year and a half break because of COVID. And I actually, you know, my career ended right, as the COVID pandemic was happening. So I, you know, missed the my last prt. So, how like, I mean, I know how many hours Why have a sense of how many hours you work as the medical director and research director, and it's a lot, what are your tips and like medical students and residents like you were hpsp, eventually they're going to have to come in and being fit is part of the job. So what do you do personally?

Sean Stuart: 33:30

Well, good thing, if you work enough, you run around enough to get your step count in and that helps, but it's probably not an officially sanctioned fitness plan. Honestly, I'm probably not the best example I've gotten better into it. That being said, I have made a conscious pack to myself, and I encourage everyone else to the same, you do have to stay in shape. It's not just about athleticism or the PRT, it really is, I think good for your sanity and your physical health. Again, during the COVID em, at least I know at Portsmouth and I know, our colleagues, bow bow is the same thing. Em really once they took a hit, but really had to step up and bear a lot of burden. And that, that took away from my time to do physical fitness. And I, I felt the impact of that, you know, I do enjoy runner, I'm a runner myself, and I didn't realize I missed it until I was getting tired. I started getting back into and realize just how much that did for me. Both kind of helped me clear my head, but also, again, just physically me right now we do work long hours, things are hard. And I think taking care of yourself physically, mentally are important. I think everyone does something different. So I've got COVID brought out the peloton, Colt here at Portsmouth, so different strokes for different folks. But I do think it's important to to not just focus on yourself. As for the med students, the medical part of it is you will be an officer you are going to have to take prts you're going to be in physically demanding environments, whether it's an emergency room, which again, long shifts and stuff can be physically draining on the combat environment. So I really encourage people to find a way to work that time in every day, even if it's only a 30 minute workout. Just for your own sanity.

Andrea Austin: 35:05

Yeah, I think that's a really important point. And I think we could do a better job preparing our medical students and residents for the actual realities. Because, you know, when I was with the Marines, you know, we we'd have to do hikes with a 60 pound pack. Honestly, I have an injury in my neck that is probably would have been preventable with increased strength training, but that wasn't talked about you know, nobody said to me, like hey, when you go with the Marines, you're gonna have to carry a 60 pound pack and you're gonna have to carry litters and, and do all this physical stuff. I mean, it was all about how to get you know how to be a good doctor and all the mental and cognitive issues related to that, but I think if I had to go back and tell younger Andrea, I'd be like, hit the weights. Build that that strength because I always put a big emphasis on cardio, but I think that would have been would have been helpful. And as you know, like to build muscle mass takes time. It's not like something you can just, you know, do a week before you go and deployment. It's just, I mean, you will get in shape and on deployment, if you don't, you're doing something over record. But I think that's something that we could do a better job because a lot of physicians, let's be honest, aren't natural athletes. I mean, some are and probably more that go into the military. But for the people that aren't, I think having more coaching and support on that would be helpful and prevent injuries,

Sean Stuart: 36:35

three 100% of I think it's something we literally don't do a great job of, we focus on people as doctors, I think, particularly if you come in through hpsp, or us civilian residency, we focus on them as doctors, oftentimes even a residency. I know, we have a military unique curriculum we do at ours to kind of help with that. But there's a lot more to being a military physician than just being a doctor. And you're 100%, right, I don't think have historically done a great job. We've made great doctors, but forget the leadership, the fitness these other things, and it's a huge learning curve. So you had to drop you into a marine unit. Yeah. How would you know, how would you know you're ever going to be asked to wear a 60 pound pack, which, again, once you get used to it is great, it's good fitness. I enjoyed the night hikes, but it is very physically demanding. And we just don't like again, to your point, we don't do a good job of telling people the full breadth of what's going to be going on sometimes.

Andrea Austin: 37:31

Well, I think we're reaching the end of our time, but this has been so much fun. What advice would you have for a medical student or resident out there, you know, maybe they're, you know, hpsp and they're getting nervous about the prospects of being on active duty, what should they be doing right now,

Sean Stuart: 37:53

talk to people find out again, it is a fathomless pit of opportunities. You know, the scope is so big that talk to people who have been where you're going to be, you know, I did get advice once someone is look the person one and two spots ahead of where you want to be and ask them. So if you're a med students, you would talk to the interns, the residents, the junior Doc's, really just soak in as much as you can to kind of have some base understanding of what's going to be going on. And then to your previous question is just kind of work on building yourself up as a doctor, your health, just really kind of make yourself the most flexible, most capable person you can be to, to kind of be able to flex to the changes, we talked about coming up in the future. And enjoy it for the love of goodness, this is a great thing to do. You love opportunities. So look forward to with it with excitement, not with fear.

Andrea Austin: 38:50

So that is that's a wonderful point. And I think for our listeners, being involved in GSA SAP is a wonderful way to grow your, your community in your network. And one of the things I loved most about my deployment was working with Air Force and Army and I really get that try service feel being with our colleagues through the government services chapter. I hope that we'll see many of our listeners at ASAP scientific assembly we've got some wonderful GS ASAP events Sunday night will be our reception and Monday will be our board meeting and if you have any questions about how to get involved, check our website and email. Liz mez Berg our executive director and she'll get you hooked up with all the schedule and we have a lot to celebrate. Jillian Schmitz is a past president of government services ASAP and, and she will become the president of the American College of Emergency Physicians at ASAP so we are going to have a very great time celebrating Jillian and really connecting. You know, the last year and a half it's been all zoom, and I really can't wait to see everybody in person.

Sean Stuart: 42:52

You know, do I think things are going to work out I think as a community we're going to figure out solutions but it doesn't mean that's not going to be a challenge, it doesn't mean we're not going to need to be very proactive to make sure we're shaping things the way it needs to be for physicians and hence our patients.

Andrea Austin: 43:12

Right. And I think there if people are wondering if the grass is greener on the outside, you know, there's a lot of challenges in the civilian emergency medicine community as well. And I think people are seeing that with the EM workforce report. And I think we're in a period of flux for across everything in in America and the world right now. I think this is a period of history, similar to the 1960s, early 70s as far as just so much uncertainty, and so much change happening. The other thing you touched on is the variety of assignments and I really think this is my personal opinion that the the track we're on in civilian emergency medicine is not sustainable for probably 70% of us since 70% of us are burned out and we have something to learn from the military that there is a lot of variety built in well pretty much to any billet there's a lot of variety, but like you said you don't like your job it's going to change in two to three years. And that's you know, I think something that cannot be overlooked and should at least give people pause when they're making the decision which clearly you're staying in and and I got out after nine years so you know there's different different perspectives but here I am as a civilian coming back around because I just couldn't couldn't stay away.

Sean Stuart: 44:46

We're all glad you didn't by the way so but no it is I mean it I won't say it's not hard to move sometimes to be honest with you and there are definitely times and you know, there are disadvantages everything so certainly there's times I think if I could have stated a billet three four years that have to I could have done more good So no, I think it's I think the big thing is that's what keeps me and I don't somebody asked if they were going to get out, you know, how did I feel about that? I don't hold it against anybody. It's it's a different you know, every there's so many options, especially as emergency medicine doctors, I mean, you can be a clinician, an academic researcher, you can be a teacher, I mean, there's so many options. So, you know, I think the military is good for some of those better than others and it's about finding what makes you happy. I mean, again, I plug for you.

Narrator: 45:33

GSA CEP is proud to be the premier continuing medical education source for military and federal emergency physicians. To purchase CME for the episode you just listened to please click on the link in the show notes. The government services chapter of the American College of Emergency Physicians promotes quality emergency care and enhances the development of emergency physicians who serve our nation from training through retirement. Learn more about our chapter www.gs ac ep.org