Does anyone know what the service obligation is per year of fellowship training?

I am currently going into IM as a PGY-1 at BAMC this summer and my current obligation is 2yrs (2yr HPSP). Although I have absolutely no complaints about my military career thus far (albeit a short one), I would just like some opinions on jumping right into an Army fellowship s/p residency versus serving my two years after it then applying to civilian or military fellowships based on the increased military exposure (as it seems by prior posts that some have been less than satisfied). I am currently considering cardiology, and given its competitive nature and my small service obligation, it has also been suggested that I use this as leverage and continually reapply for the fellowship until my ADSO is up. Any thoughts?

Does anyone know what the service obligation is per year of fellowship training?

I am currently going into IM as a PGY-1 at BAMC this summer and my current obligation is 2yrs (2yr HPSP). Although I have absolutely no complaints about my military career thus far (albeit a short one), I would just like some opinions on jumping right into an Army fellowship s/p residency versus serving my two years after it then applying to civilian or military fellowships based on the increased military exposure (as it seems by prior posts that some have been less than satisfied). I am currently considering cardiology, and given its competitive nature and my small service obligation, it has also been suggested that I use this as leverage and continually reapply for the fellowship until my ADSO is up. Any thoughts?

I am looking forward to seeing you at BAMC, though not too much as it will be as a consultant! You will only owe 2 years after residency to the Army. From what I have observed, primary care in the military is not a bad deal. You are not making that much less than your civilian counterparts, and you are not working to bring home the bacon. However, if you specialize, that is a different beast. I would suggest you consider completing your ADSO and getting out to a civilian fellowship. You will owe another 2 years for fellowship and during those two years the amount of $$ you could make on the outside will more than make up for what you will earn during fellowship. If you really have the desire to serve in the military, you can always come back in after you have fellowship trained, sign a year to year contract and that will give you the ability to dictate so terms of service to the Army, location, etc.

Good luck during your internship!

Also, I hate to be the one to break this to you, but if you do an military IM residency, your ADSO will be three years, not two.

I know it sounds like a bait-and-switch, but your commitment is either your length of HPSP scholarship, OR the length of your residency, whichever is longer.... in your case, at the conclusion of your IM residency, you will owe three years of service as a medicine attending. You accrue a ADSO by attending a military residency, but you can pay your HPSP commitment back atthe same time you pay back your residency requirement.

In answer to your original question, to the best of my knowledge, commitment for fellowship is also year-for-year. So, if you were to do IM, and then immediately enter into fellowhip, you would have a six year commitment as a newly-minted cardiologist (umm, cards is three years long, right?)

The reason I say "to the best of my knowledge" is that there was a post here a few weeks ago where someone asserted that fellowship is a 2-1 commitment, but when I checked into it, I found some extracts from the regulations that specified one for one.

Thank you both for your help/advice; always nice to get some input from some people who are actually in the system and can give some real-world information. However, the most recent post raises a point that I have been meaning to discuss on here for a while - that is the significance of the internship year. From what I have been told, the internship year is not supposed to count at all for or against the ADSO. This is what both my recruiter told me (although I'll be the first to admit that he wasn't the brightest) and also some residents at TAMC. However, since that time many HPSPers I've talked to have agreed and disagreed with this. The following is from the HPSP manual:

The First Year of Graduate Medical Education (FYGME), Clinical Psychology Residency Program (CPRP) and Advanced General Dentistry Program 1 (AGDP 1) are performed on active duty (AD). The period of time that is spent on active duty in FYGME and AGDP-1 does not repay the ADSO, but does count toward repayment of the RSO.

When reviewing the Active Duty First Year Graduate Medical Education (“AD FYGME”) column, the total active duty (“TOTAL AD”) column is increased by 1 year because the AD FYGME is performed on active duty after graduation.

...............AD FYGME........CIV FYGME
..YRS.....TOTAL....IRR.......TOTAL...IRR
..SPON.....AD....................AD.........
....1..........3........4...........2..........6
....2..........3........4...........2..........6
....3..........4........3...........3..........5
....4..........5........2...........4..........4

So per the manual, the intership year does not work against you and actually subracts from your RSO. Now, once and for all, let's clear this up - is the manual right or wrong?

I believe the manual is correct. Internship is a wash, so your ADSO is either the length of your scholarship or your residency beginning with PGY-2 - whichever is longer.

I also believe that fellowships are 1-for-1, with a minimum of 2 years. That makes no difference for cards, because those fellowships are either 3 or 4 years. But if you're fellowship is only a year, then you kinda get screwed into an extra year of service.

Well, it's certainly nice to see it in writing.

However, two points:

1. Since IM is now a continuous 3-year program, where you do not need to reapply after your first year, is that going to change the definition of how the army computes the payback? (I'm a USUHS guy w/ a 7-year indentured servitude contract, so it's all a wash for me)

2. I actually asked my Program Director this during my interview. He made it clear that the "internship year not counting" thing is a relic of the past and has not existed for many years. To be fair, Program Directors are not the ones involved in figuring out the payback, they're busy running a residency program, so he might not have been in the best position to know.

My wife is an HPSP graduate now in residency, I'll see if she has her contract lying around somewhere. I mean, it SHOULD be in plain B&W somewhere right? Although you having a "manual" that specifies internship doesn't count should be worth something....

Just to clarify my source, it can be found at the MODS website (for those who have access: http://www.mods.army.mil/medicaleducation) for HPSP under general info --> policy handbook --> Chapter 2-3a.

Moxley,

you are correct, the intern year is not figured into the ultimate payback post residency. You start paying back and accrue additional years of active duty service committment concurrently starting with your PGY2 year...so If your ADSO is currently 2 years, you pay back 2 year during your PGY2-3 years and at the same time accrue 2 years for a net ADSO of 2 years...make sense? :thumbup:

.

is anyone aware of any radiation oncology fellowships in the military?

Best wishes,
Seasons :)

is anyone aware of any radiation oncology fellowships in the military?

Best wishes,
Seasons :)

None, AFAIK. That isn't to say you couldn't cobble one together at the NCI while on active duty. Most are outservice, I think.

The FYGME does not acrue a year of debt. Be careful about the one year fellowships. There are some fellowships which may be one year and you incur a 2 year obligation. Read your contract very well before you sign it. You can see that it actually appears that the Army goes to great lengths to keep people in the dark so that you end up hearing what you want to hear and not what actually happens. I know that I finish residency in 2009 and as of June 31 2014, I am done with the Army.

The FYGME does not acrue a year of debt. Be careful about the one year fellowships. There are some fellowships which may be one year and you incur a 2 year obligation. Read your contract very well before you sign it. You can see that it actually appears that the Army goes to great lengths to keep people in the dark so that you end up hearing what you want to hear and not what actually happens. I know that I finish residency in 2009 and as of June 31 2014, I am done with the Army.

I hope you mean June 30 2014, or you're going to be waiting for a really long time. Sorry, I couldn't help it.

The reason I say "to the best of my knowledge" is that there was a post here a few weeks ago where someone asserted that fellowship is a 2-1 commitment, but when I checked into it, I found some extracts from the regulations that specified one for one.

Could you point me to the military fellowship regulations? I have been looking and cannot find them. Thanks.

is anyone aware of any radiation oncology fellowships in the military?

Best wishes,
Seasons :)

As I understand it, Rad onc isnt a radiology fellowship. It is a separate residency. The ones I see at tumor board did rad onc straight out of med school.

Could you point me to the military fellowship regulations? I have been looking and cannot find them. Thanks.

They are in the process of changing the Navy website, so its all messed up. Can't help ya for the moment.

They are in the process of changing the Navy website, so its all messed up. Can't help ya for the moment.

No prob. Was able to find some army stuff yesterday. Thanks.

As I understand it, Rad onc isnt a radiology fellowship. It is a separate residency. The ones I see at tumor board did rad onc straight out of med school.

Not only is it a separate residency, the two fields aren't really as related as their names might imply.

Match wise, I think that radiation oncology is pretty similar to neurosurgery. In the Army, for example, I think there's only one slot every year (at WRAMC, I believe), but people do get deferred to the civilian match.

I'm about 99% sure there are no military radiation oncology fellowships.

I believe the manual is correct. Internship is a wash, so your ADSO is either the length of your scholarship or your residency beginning with PGY-2 - whichever is longer.

I also believe that fellowships are 1-for-1, with a minimum of 2 years. That makes no difference for cards, because those fellowships are either 3 or 4 years. But if you're fellowship is only a year, then you kinda get screwed into an extra year of service.

or you can do your residency, serve your time, and vie for a spot on the outside... harder, but no service obligation!

Clarification qustion: what is served first, years of concurrent obligation or years of medical school obligation?

For example, suppose I do a 4 year HPSP, 1 year internship, and 2 year IM residency. I now owe 2 years for medical school, and 2 years concurrent for the medical school and the HPSP. I now serve 2 years AD, and then do a 2 year fellowship. At the end of the fellowship, do I owe 2 years, or 4?

Clarification qustion: what is served first, years of concurrent obligation or years of medical school obligation?

For example, suppose I do a 4 year HPSP, 1 year internship, and 2 year IM residency. I now owe 2 years for medical school, and 2 years concurrent for the medical school and the HPSP. I now serve 2 years AD, and then do a 2 year fellowship. At the end of the fellowship, do I owe 2 years, or 4?

You do a 4 years HPSP, 1 year internship and 2 years IM. At the end of all that, your payback remains at 4 years. If you do a 2 year outservice fellowship, your payback will be at a total of 6. If you do a full time inservice fellowship, your payback will remain at 4.

How did you calculate your obligation would be down to 2? Were you thinking residency counts towards payback?

No, sorry, let me try again

I do 4 year HPSP: Obligation is 4 years

I then do a 1 year internship and 2 year residency: Obligation remains 4 years

I then serve 2 years Active duty: Obligation is down to 2 years

I then do a 2 year inservice fellowship.: Is my obligation now 2 years, or 4?

No, sorry, let me try again

I do 4 year HPSP: Obligation is 4 years

I then do a 1 year internship and 2 year residency: Obligation remains 4 years

I then serve 2 years Active duty: Obligation is down to 2 years

I then do a 2 year inservice fellowship.: Is my obligation now 2 years, or 4?

There are a couple pitfalls in that scenario:
1. More likely than not you will complete a 1-3 year GMO tour after completing internship.
2. You estimated a 2-year utilization tour after completing residency. This could end up being 3-years if you are accompanied and sent to an overseas location.

With these considerations, you could see how your payback would end up much longer.

1. More likely than not you will complete a 1-3 year GMO tour after completing internship.
2. You estimated a 2-year utilization tour after completing residency. This could end up being 3-years if you are accompanied and sent to an overseas location.


1) much less likely to come into play if I do IM (I hope), which is pretty much the only specialty where I would consider doing a military fellowship in any event (I think)

2) granted, but I was actually trying to allow for that. In general aren´t utilization tours 1 year, which get ramped up to two? I mean I know that it could last all 4 years if the military wanted it to, but I think my question is one that might come up.

1) much less likely to come into play if I do IM (I hope), which is pretty much the only specialty where I would consider doing a military fellowship in any event (I think)

2) granted, but I was actually trying to allow for that. In general aren´t utilization tours 1 year, which get ramped up to two? I mean I know that it could last all 4 years if the military wanted it to, but I think my question is one that might come up.

I was about to answer your questions and dazzle everyone with my "infinite" knowledge of fellowship service obligations by quoting information from the Navy's GME website and attaching the link to this response, but the website is all FUBARed up at the moment. CRAP!! Never mind, i'll just shut up now. :D

1) much less likely to come into play if I do IM (I hope), which is pretty much the only specialty where I would consider doing a military fellowship in any event (I think)

2) granted, but I was actually trying to allow for that. In general aren´t utilization tours 1 year, which get ramped up to two? I mean I know that it could last all 4 years if the military wanted it to, but I think my question is one that might come up.

You are correct, GMO tour is less likely to be a factor if you do IM, but utilization tours are typically 3 years with the possibility of cutting it to 2.

I was about to answer your questions and dazzle everyone with my "infinite" knowledge of fellowship service obligations by quoting information from the Navy's GME website and attaching the link to this response, but the website is all FUBARed up at the moment. CRAP!! Never mind, i'll just shut up now. :D

Obligation for fellowship is year for year with a minimum time on AD after fellowship of two years. Let's say you have 2 years left on your HPSP obligation and you do a 1 year fellowship, you would need to pay back the 2 years for HPSP and 1 year for fellowship (3 years total). If you did a one year fellowship but had no other prior obligation, you would owe 2 years.