Chapter Text
Strictly speaking, the first reference to John’s military career is the dream sequence, but I’m going to set that aside for now because it’s hard to discuss without laying some groundwork, and the next reference is actually a good place to start doing that. So we’ll skip to the RAMC mug. I’m going to start with the basics – what the RAMC is, how it acquires medical personnel, and what's actually meant by 'medical personnel'.
The Royal Army Medical Corps is a distinct branch of the British army, responsible for providing specialist medical personnel and their services to the rest of the army, and in some situations to local populations in Afghanistan. Most RAMC personnel function in primarily RAMC-run settings like hospitals and clinics, and a smaller proportion in settings run by the army or local government. The rest of the medical care provided within the army and to the local populations the army is responsible for comes from non-RAMC medical personnel - I'll refer to them as regimental medical personnel.
There are two distinct classes of medical personnel relevant to this discussion:
Medical officers – these are RAMC personnel who have a medical or a higher nursing degree, and who function as doctors, senior nurses, or senior medical administrators.
Medics – these can be RAMC or regimental personnel, with or without a nursing degree or other qualification. Medics can function solely as medical personnel, or almost solely as combat personnel, or as anything in between those two extremes. A corporal with a nursing degree, who spends her days at a huge military hospital assisting a neurosurgeon in the operating room is considered a medic. A corporal with a nursing degree, who spends her days at a district center clinic dispensing care to women and children is considered a medic. A corporal without a nursing degree but with extensive training in emergency medicine, who spends her days at a forward operating base hopefully not being told to grab her gear and jump on the chopper because a section is stuck in a ditch under fire and one of them has been hit badly enough that he needs better help fast is considered a medic. A corporal without a nursing degree and with some very quick and dirty training in field first aid and a wash bag’s worth of gear over and above the regular first aid supplies for an infantryman, who spends her days making sorties against known Taliban positions, and who just did a very credible job of clamping an artery on a guy in a ditch under fire, is considered a medic*.
Okay. Now let’s talk a bit about how the British RAMC acquires its doctors, versus the American AMEDD. Remember, a British medical degree is an undergraduate degree: you go to medical school straight from the equivalent of high school. An American medical degree is a post-graduate degree: you finish four years of college before you go to medical school. .
Typically, an AMEDD medical officer is someone who joined the army before their last year of undergraduate education. Provided they are accepted to one of the medical schools the army has approved, the army will subsidize or completely fund their medical degree; in return, the officer will serve some number of years active duty and some additional reserve duty. The duration of service depends on the degree of support given. An RAMC medical officer, however, typically joins the army after completing their medical degree and at least a year or two’s additional medical training. A medical officer typically signs the same three to five year initial contract as any other kind of officer.
The differences in the two models have some interesting implications for the kind of people who become medical officers. A significant portion of the students I work with are AMEDD cadets. They have been, without exception, non-white, first generation Americans, from families who weren’t able to fund a medical degree by other means. With only one exception, they did not intend to stay in the army past their contractual obligation. The officer retention rate for the AMEDD is about five times higher than for other branches, but the RAMC officer retention rate is almost fifty times higher than the other branches because there’s very little reason to join the RAMC unless you specifically want to practice medicine in the army.
There’s also a difference in how the two bodies use medical officers. Because the AMEDD is paying for most of the medical degrees, it tends to confine medical officers to roles where their medical degree is directly applicable, so they’re more typically functioning as doctors. The RAMC is effectively getting its medical degrees for free, so its medical officers tend to sprawl into the same mix of medical and administrative roles that doctors in the civilian healthcare industry do.
And there's some difference between the RAMC and the AMEDD with respect to medics. An AMEDD medic is much, much more typically the corporal with the nursing degree and the job at a hospital, and relatively few AMEDD medics get close to the fighting. Those roles are filled by regimental medics. RAMC medics can be anything from the hospital nurse to the corporal grabbing her pack to go help the guy in the ditch.
But, at this point, the obvious interpretation is that is John finished his medical degree and a year or two of additional training, and then joined the RAMC as a medical officer.