Editor in Chief

In an Age of Incompetence

by Chester Buckenmaier III, MD COL (ret), MC, USA

September 13, 2019

“I am, as I’ve said, merely competent. But in an age of incompetence, that makes me extraordinary.” ~Billy Joel

Like many others who pursue a career in medicine, I invested my early years as a 20-something in a seemingly endless effort to obtain the necessary education and training requirements to place an MD at the end of my name. Yes, I would find part-time work in the summer for extra beer money but did not need to work while in school. I was fortunate to have parents willing to financially support my educational efforts and “Uncle Sugar” (the U.S. Government) was willing to pay for my collegiate and medical school expenses in exchange for Army services in defense of the Constitution.

Even graduate school between college and medical school was not too tricky economically (Thanks, Mom and Dad.) since I was on educational delay from active duty in the Army, resulting in inexpensive credit hours that allowed my graduate teaching assistant remuneration to last. Of course, when you are living on instant noodles, hot dogs and beer with no responsibilities beyond the next class, life is easy and inexpensive. There was no doubt that I had a wealth of formal education when I finished my surgical internship at William Beaumont Army Medical Center and even less doubt concerning the fact that I had no real practical experience in the world where people work every day. In every sense of the definition, I was a professional student.

Nobody was more acutely aware of my appalling lack of practical life and medical experience than I was at that time. Although I had earned the title “Doctor,” I much preferred referring to myself as Captain Buckenmaier because, at that time, I did not feel like a competent physician, although I did believe I had the prerequisites to become one. My father-in-law called me out on this issue during this period of my life by asking why I avoided calling myself a doctor when that was what I was. I explained I felt more competent and less a fraud as an Army captain then I did as an actual doctor.

It was with this deep sense of inadequacy that I arrived as the new flight surgeon to the 228th Aviation Regiment at Fort Gordon, Panama, following my internship. I must have thoroughly looked like an incompetent to my first commander who had me introduce myself to his command staff and then politely inquired into my work experience. What work experience? I proceeded to provide the group of experienced pilots and staff officers with my educational curriculum vitae. When I had finished the commander guffawed exclaiming, “Hell you have never had a job! By the way, your mustache is out of regulation. Somebody get a razor and hold this pup down so I can shave him.”

I smartly and sheepishly said nothing, since he was right on both counts, and sat back down to allow the briefing to continue which, blessedly, it did. I resolved at that moment to be the best damned flight surgeon they had ever experienced, and I threw myself into the job. Fortunately, I had an excellent physician assistant and medics backing me up, and together we reinvented the Army aviation clinic. We improved scheduling of physicals for pilots, worked to upgrade our deployable assets, and I regularly read to keep up with the latest in primary care medicine as I supported multiple aviation commanders as their medical staff officer. In short, I was doing my job as best I could and gaining confidence in my abilities as I worked to develop competence in my field.

While I never did get my mustache under control, the attitude of my commander and other staff officers toward their aviation medical asset changed dramatically. My first commander who wanted to shave me was soon referring to me as his doctor, the best flight surgeon in the Army. Through sheer force of will, after being tricked into signing up for the Expert Field Medical Badge training when I first arrived, I completed the training and practicum for the badge out of spite to the pranksters. This achievement afforded me credibility and competence with my medics. This striving for competence among my peer group took additional effort on my part, but it afforded me the right to be confident in my position within the unit. It also allowed me, in time, to thoroughly enjoy the job which I look back upon now as one of the most fulfilling professional experiences of my career.

Mark Twain has said, “Obscurity and a competence—that is the life that is best worth living.” Without knowing it at the time, I believe I was quietly following Twain’s example. I was not gunning for notoriety or accolades. I was striving for competence in my profession among my peer group. By just doing my job and trying to do it well, the notoriety and accolades took care of themselves. Just showing up on time expressing enthusiasm (even though I might not feel that way) for the mission and doing my best to support that mission often was all that was needed to satisfy my superiors.

It may seem like a stupefyingly simple secret for success at work. Be competent at your job, whatever it is and do the job to the best of your ability. My three daughters will be rolling their eyeballs when they read this, as I have verbally beaten the idea into them. All too often in our cumbersome bureaucracy, I am plagued by those who are quite confident in their positions with little competence in their actual jobs to warrant said confidence. Quiet competence in the performance of any job, regardless of how lowly the task or job position, I find truly beautiful. I strive to recognize those individuals practicing quiet competence when given the opportunity.

Our servicemembers and their families assume our competence as they depend on it. As federal healthcare providers, we should always be working to ensure our personal confidence in our positions is backed up by our competence. This pathway can be challenging and difficult, but the benefits of this approach are undeniable. By the way, I refer to myself as Doctor Buckenmaier, confidently, today.



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