As we once again find ourselves in December, I’m reminded of what a busy time this is at all the DoD psychology training programs. It is interview time for next year’s internship applicants! I spent well over a decade at Brooke Army Medical Center (BAMC) being armpit deep in this process, and each year I am reminded of my own journey as a military psychologist. I, too, went through the national match system, even interviewing at BAMC and eventually became an intern there. So, this year I’m writing to share some of my insights on becoming a military psychologist and food for thought for anyone considering this path.
If you are considering becoming a behavioral health provider with the military, there are two avenues – become a civilian employee (GS or contractor) or join the military. I’ve been blessed with working on both the active duty and civilian sides of this coin, so will give a bit of advice for both.
What does it take to work for the DoD vs. civilian agencies? What might be some differences?
Regardless if you are considering being a civilian employee or active duty, first and foremost you need to be aware that you are entering a culture that is vastly different from the U.S. mainstream. While those in uniform definitely feel this to an extreme, civilians will also experience some cultural broadening. You don’t have to know a lot about military culture before you start, but it can be helpful. I had zero exposure, but was able to adapt rapidly. The military is used to acculturating new people, so they have this process down. I’ve been directly involved with acculturating new interns for many years and have also helped new civilian providers. I am amazed with how rapidly the culture gets picked up. However, it can be quite a shock to those who are completely unaware of some of the cultural differences.
Working for the DoD means you are entering a large, bureaucratic organization. For those knowledgeable about industrial-organizational psychology, that is a large part of what working in this system is like. Your client is the government, while the patient is the person sitting in session with you. These are two separate entities and you must meet the needs of both. You will need to be a very good team player, flexible, have exceptional frustration tolerance, be able to handle bureaucracy, and know how to pick your battles. There is stress and frustration working in such a large, government run organization, but the pay-off is being able to work with some of the best patients and colleagues ever! These are people dedicated to each other and willing to do what it takes to help others. There are different rules working with active duty, many of which give you choices for helping them that you do not have in the civilian sector, such as having someone in a person’s unit go check on a patient who missed an appointment or being able to intervene at the first sign of partner abuse. You also aren’t billing active-duty patients when you work in the DoD, meaning there are no financial or insurance restrictions on what interventions you use. That isn’t to say there aren’t restrictions, though, usually around access to care. So it is a balance….. pros and cons, like with any job.
The above applies to anyone considering becoming a DoD provider. But what about the more specific step of joining the military to be a provider in uniform?
After working for a year as a civilian for the military, I thought I knew what it would be like to be on active duty. I hadn’t been part of that in-group, but I had worked alongside them for a year and heard their tales. So, on a Friday I wore my purple suede skirt and jacket for the last time and came back on Monday as an officer, hoping I had dressed in my uniform correctly. I came back to the same clinic, even the same office. That is when I got a hard truth: there is a huge difference between looking in a window and living in a house. Sure, I can see what it is like in the house through that window, but I have no clue about the totality of the atmosphere within. No clue if it is hot, cold, smelly, noisy….. nothing. Civilian providers work within certain cultural expectations, but those expectations are nothing close to the ones for military providers. The cliché statement “it isn’t just a job, it’s a lifestyle” is absolutely true. It’s a lifestyle with rules, regulations, and cultural expectations that can’t be truly appreciated until you live it. It is a crash-course and on-the-job training. To make it as a military provider, you not only need to be a good behavioral health provider, but you also need to have personal insight, humility, exceptional frustration tolerance, and be able to make a stand but differentiate when to do so and when it just let things go. You must be the epitome of flexibility and patience in the face of chaos. You also need to be good with people and able to manage others well, given you will be in leadership positions. It is likely you will be in charge of a small or large clinic at some point, so you need to be administratively savvy and well-organized or at least able to learn.
None of this is to say that you must be all of this upon entering the military. Goodness knows that I had no clue what all was in me when I entered, nor have many of the students I’ve worked with over the years. When asked by prospective interns what we most look for in applicants, what I’ve aways said is the military is looking for someone who is teachable. It has streamlined the process for shaping young men and women to become stellar service members. If you have an open mind, patience, and willingness to learn, you absolutely can do well.
Why go through it all? Regardless of any of the stress, missteps, and harsh learning moments, I can honestly say that joining the military was the best decision I ever made. Hands down. You will be challenged and get opportunities like nowhere else. In my short five years, I ran a clinic, worked general outpatient, crisis management, was assigned to an aviation school, designed coursework, did resiliency outreach work, deployed with the cavalry, learned how to drive a tank, learned land navigation and a whole host of other field skills. I got to meet the widest variety of people I’ve ever been around in my life. My confidence in my skills, my flexibility, and my leadership abilities grew exponentially. There is a lot expected of you, and through this you learn quickly just how much you can rise to any occasion.
I ended up having my time in the Army cut short by a medical retirement. If I had been able to stay in, I would be past the 20-year mark. Would I have stayed in, given the option? I don’t know. There is a lot of stress in the current military medical system with the “do more with less” expectation. But I think that we are seeing some of that everywhere. There is so much positive that is gained once you can see past the stress. Even now, sitting here for the past few minutes pondering this question, I still have no clue how long I would have chosen to stay on active duty. I do know that regardless of the stress and downside of the military, I cried a bit when I learned I had to leave it. Even now, I tear up a bit missing the amazing comradery, close bonds, and adventure and variety that being a psychologist in the military offered. As I remember a military mentor once telling me, you have to pile on a lot of manure to get the most amazing roses. I’m just happy that I got a chance to smell those incredible roses during my professional career. It shaped me like nothing else would.
If you are considering working with the military, consider my thoughts. Seek out those who have worked in the system, either as civilians or active duty. (If you know none, feel free to reach out to us at CDP) And know that a choice to try it out isn’t a forever commitment. Even if you join the military, it is only an obligation of a few years. And it will seem like forever that goes by in a flash. I’ve never met a behavioral health provider that left the military system and did not say that it was one of the most worthwhile professional experiences.
Editor's Note: Registration is currently available for the 2023 Pathways to Military Internships: The Summer Institute. This five-day course is designed to raise doctoral students’ awareness of what it would be like to serve as a psychologist in the Armed Forces and to increase their competitiveness for a military internship. For more information, please visit The Summer Institute home page here.
The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.
Debra Nofziger, Psy.D., is a Military Behavioral Health Psychologist and certified Cognitive Processing Therapy Trainer with the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Located in San Antonio, TX, she develops, maintains, and conducts virtual and in-person training related to military deployments, culture, posttraumatic stress, and other psychological and medical conditions Service members and veterans experience.