Q&A: Seasoned DO guardsman lauds militia’s personal, career opportunities
Shown in Kuwait, where he served as a flight surgeon during the Iraq War, Terry D. Hashey, DO, now serves in the Florida Army National Guard and runs a family practice. (Photo courtesy of Dr. Hashey)
A lieutenant colonel and brigade surgeon in the Florida Army National Guard’s Medical Corps, Terry D. Hashey, DO, for years has split his time between military and civilian medicine. Patriotism, a penchant for leadership and adventure, and the financial and educational benefits of life in uniform explain his more than 22 years of service in the armed forces. At the same time, strong views on wellness, preventive medicine and health care policy drive the Jacksonville, Fla., family physician’s dedication to primary care and osteopathic manipulative medicine.
Serving for eight years in the U.S. Coast Guard Reserve in the 1990s, Dr. Hashey trained as an emergency medical technician, which stoked his interest in a medical career. He learned about osteopathic medicine while earning a master’s degree in health science education.
Enrolling at the University of North Texas Health Science Center—Texas College of Osteopathic Medicine (UNTHSC/TCOM) in Fort Worth, Dr. Hashey soon enlisted in the Texas Army National Guard. After graduating with his DO degree in 2003, he joined the U.S. Army Reserve as a captain and flight surgeon while serving a family medicine residency at Mayo Clinic in Jacksonville.
Deployed to Afghanistan for four months in 2006, Dr. Hashey cared for injured Americans, coalition forces and local nationals as part of a trauma response team. He also conducted flight physicials for helicopter pilots, aircrew and support staff.
Dr. Hashey said he often used osteopathic manipulative treatment on troops to lessen the need for pain medication and return them to full duty faster.
He opened his now two-physician practice, First Coast Family Medicine, after coming home from Afghanistan. In late 2009, he volunteered for overseas active duty once more. As part of Operation Iraqi Freedom, he served as a flight surgeon for a U.S. Army Aviation Task Force that deployed to Kuwait for four months.
Following is an edited interview with Dr. Hashey.
Why did you choose to join the Coast Guard Reserve?
I had gotten my associate’s degree in business and was looking for a way to pay for the rest of my college education. First I considered the U.S. Navy Reserve, but the only jobs available to me involved painting ships. In the U.S. Air Force Reserve, I would have been fixing aircraft. But in the Coast Guard, I would be involved in maritime law enforcement and search-and-rescue activities, which really excited me.
When did you become interested in medicine?
In the Coast Guard, I was providing emergency assistance without having had any medical training. When one of my “patients” died—a victim of carbon monoxide poisoning on a boat—that inspired me to pursue EMT training. Getting my EMT certificate and experience is what sparked my interest in medicine.
Why did you become an osteopathic physician?
After majoring in biology at Jacksonville University, I was working on a master’s degree in health science education at the University of Florida. The program emphasized that the leading causes of death and disability in America today are all behavior-related; they’re not infectious disease-related anymore. My education in health science instilled in me that doctors do a disservice to their patients when within seconds of beginning a patient interview, they write prescriptions for medications. Physicians don’t do enough to promote behavior change.
While I was getting my master’s degree, I read an article describing osteopathic medicine in the American Medical Student Association’s New Physician magazine. Previously, I didn’t know anything about osteopathic physicians. I learned that DOs treat the whole person and the entire family and are more focused on preventive medicine than MDs are. Osteopathic medicine meshed perfectly with what I was learning at the University of Florida.
After enrolling at UNTHSC/TCOM, why did you enlist in the Texas Army National Guard?
I had been out of the military for about nine months and really missed it. What’s more, the Texas Army National Guard offered a very attractive financial package that would help defray the cost of my medical education.
In each state, the National Guard is a militia that reports to the governor, who can deploy it to help with law enforcement, disaster relief or other emergencies. Because the guard is federally funded, the president can federalize those troops and send them overseas for humanitarian missions and for combat. I did not serve overseas while in the Texas Army National Guard, though I volunteered to go to Afghanistan right after Sept. 11. I was told that I needed to complete my medical training first, that I would be more valuable as a physician.
You have served in four separate reserve components of the armed forces. What motivates you to keep enlisting in the military?
The military offers physicians leadership opportunities and experience you can’t get in civilian life. For example, in my current position with the Florida Guard, I’m a lieutenant colonel and a brigade surgeon for the 53rd Infantry Combat Brigade, which has approximately 3,500 troops. I advise the brigade commander on all things medical—anything that has to do with treating or preventing injuries, preventing illness or promoting wellness. In my previous position, I was a battalion flight surgeon and an air ambulance medical director.
Military service brings added meaning to my life. I am part of something more important and bigger than myself. It’s also exciting. How many people can say they’ve ridden in the back of a helicopter or in a tank or trudged through the mud with troops? In addition, my military training is useful beyond the battlefield. If I come upon a car crash, I’m much more qualified to help people out than I would be if I just had civilian medical training.
Because I am in the reserves rather than full time in the military, I have control over where I live and set up my medical practice. But when called to active duty, I must go wherever I’m sent. In the National Guard, you raise your right hand and swear allegiance to the flag, the governor and the president and do whatever is expected.
Most of your involvement in organized medicine has been with allopathic medical organizations. Do you consider yourself an emissary for osteopathic medicine when you are among MDs?
Absolutely. One reason I served an allopathic residency at the Mayo Clinic in Jacksonville was to model the behavior that makes us osteopathic physicians, so that not only do our patients see what makes us different but our colleagues do as well—much as those of us who are Christians meet with non-Christians to model our behaviors and showcase our beliefs so people know who we are and what we are all about.
I think it is very important for DOs and MDs to find common ground and work together because we are the voice of medicine. If we speak as osteopathic physicians independent from MDs, our voice will never be heard over the collective insurance industry and the collective hospital industry.
At a time when many young physicians are starting their careers as employees of large organizations, what made you open your own practice?
I’ve had a vision of how I think medicine should be practiced, having analyzed best practices in various medical settings during my training—everything from small rural practices to large educational-based organizations. I decided that the only way I could try out my ideas for improving the quality of care was to do it on my own.
Does your practice have electronic health records?
I’ve had an EHR system since Day 1. I took the plunge and made the investment. But in addition to “meaningful use,” there are requirements for becoming a patient-centered medical home. I brought my staff to a conference on this topic hosted by the Florida Academy of Family Physicians. We discovered that we are already doing all of the things required of certified patient-centered medical homes and have been doing so for years. But how do we prove it? We would have to spend extra time, money and resources creating protocols and reports to verify what we’ve been doing all along. This is what is driving more and more physicians to become employed—so that the expense of meeting the requirements is spread across more people.
What you give up when you become part of a larger organization is the incentive to excel in your quality and improve your profitability.
Does that mean you are committed to remaining a small practice for the foreseeable future?
That’s the million-dollar question. I can definitely see the value of joining a larger organization and having someone else worry more about the day-to-day business details so that I can focus on being a physician and caring for patients. However, although the work is harder and more demanding, the fulfillment you get from building an organization makes it all worth the effort.
What do you think of the Affordable Care Act overall as a small business owner and a physician?
Certainly, health care in America is broken by every metric. But the Affordable Care Act aims to fix everything that is broken overnight, creating a lot of repercussions that people haven’t thought through.
I believe I have a moral obligation to provide health insurance for my employees, so the concept of the employer mandate doesn’t bother me. However, the Affordable Care Act has made health insurance more expensive and more complicated.
“Because I am in the reserves rather than full time in the military, I have control over where I live and set up my medical practice.”
The only thing I liked about the health reform law was its mandating health insurance for everyone. I thought that was a great idea because so many people aren’t taking responsibility for their health and will just go to the emergency room when they’re sick. If you own a house and have a mortgage, you must have homeowners’ insurance. And if you drive a car on public roads, you must have automobile insurance. So I don’t understand the objections to the individual mandate, which is based on the premise that if more people pay into the pool, including younger and healthier people, health insurance will be less expensive.
But since health reform passed, health insurers have been raising their rates while reducing coverage. The only plans I can afford to offer my staff have deductibles of $5,000 a year or $10,000 a year. Most people who work in a doctor’s office don’t make enough money to pay a $5,000 deductible.
Given your military background, what do you think about federal and state attempts to limit the ability of physicians to ask patients about gun ownership?
Even though I am a proud gun owner and support the Second Amendment, I balance that right with the need to advise parents of the safety aspects of gun storage. Keeping our children safe is paramount to everything else. To say that a physician can’t ask about a gun in the home is silly. To say that you can’t note the answer in a chart is even sillier. How else are we going to remember whether we asked the question?
In the context of safety, we talk about car seats, seat belts, bicycle helmets, swimming safety and smoke detectors in the home. We also need to be able to talk about gun safety and how the gun owner is responsible for properly securing any guns in the home.
How do you and your wife strive to achieve balance between your careers and family life?
We are passionate about what we do, so balance isn’t part of our vocabulary. Sometimes it seems more like crisis management. I’m raising four children and trying to keep my wife happy, as well as my governor and my president. I take care of 4,500 patients in my practice and run an office. That’s all a little bit daunting right now.
I have cut back on my involvement in organized medicine to have more family time. And my wife, who is a veterinarian, works two part-time jobs for greater flexibility.
Will you encourage your children to serve in the military?
At ages 11, 9, 5 and 9 months, my kids are still young. I start off teaching them how to take care of themselves and be responsible and be the best at whatever they want to be. We do talk about military service, and a couple of them are interested. My kids are being brought up to be patriots whether they serve in the military or not.
What does patriotism mean to you?
I didn’t really understand patriotism until my wife and I moved to Texas. We were impressed by how much Texans love their state and their country, and we couldn’t figure out why. But when we left four years later, we both loved Texas and the United States.
What patriotism means to me is the understanding that we are part of a community. This is something that is lacking in America today. The prevailing attitude seems to be “Ask not what you can do for your country but what your country can do for you.” That is the antithesis of patriotism. There is this trained helplessness that I see in many of my patients every single day. They think they deserve handouts.
Patriotism is an allegiance to something that is important, an allegiance to values, an allegiance to doing the right thing for others. When a community pulls together and cares for itself, whatever the adversity, it is stronger than if people hole up in their houses looking out for themselves.