Navy: GMO - why does it still exist?

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Question: Why does the US Navy still have GMOs / FS providing care in 2012?

To have care from an unsupervised physician who has not completed training is not standard of care today, right?

I roughly have a rough idea of an answer and that the reason is about manpower and money, but why is this still the norm? Should this not be illegal? Or am I missing something.

Well, until states stop giving out unrestricted medical licenses after one year of GME training, it won't be illegal.

The real question, in my mind, is one of standard of care. Having an intership-only trained physician practice indepedently isn't the standard of care, nor has it been for a number of years.

GMOs exist, simply, because they can. That's not a knock on GMOs - just a statement of fact regarding the DoD's priorities. The DoD could put an end to it any time it wanted to, but there is neither the administrative nor the legal impetus to do so.

The population being cared for is screened: 18 to 52 years old and healthy. Internship training is probably about the right level to be at. It is a nice way to get some experience before residency, do something different, and be more sure about specialty choice when it is time to go back to residency. It probably will go away when state license rules change (although it would be hard to see VA doing this) but I'm not sure that is a good thing.

Originally Posted by DCM

The population being cared for is screened: 18 to 52 years old and healthy. Internship training is probably about the right level to be at. It is a nice way to get some experience before residency, do something different, and be more sure about specialty choice when it is time to go back to residency. It probably will go away when state license rules change (although it would be hard to see VA doing this) but I'm not sure that is a good thing.

1. They're cheaper - ( I know you seasoned guys could look at the over-referral rate of GMOs to specialists and beg to differ but I doubt anybody did that, they probably just looked at pay and entitlements)
2. The .mil does the same thing with PAs and NPs.
3. Multiple levels of screening of mil members
4. Big push in civilian world to extend autonomy to midlevels
5. Not enough GME spots
6. short GMO tours actually extend physician commitments for whose who go into in-service training, hence keeping specialists in the military.

Originally Posted by kingcer0x

1. They're cheaper - ( I know you seasoned guys could look at the over-referral rate of GMOs to specialists and beg to differ but I doubt anybody did that, they probably just looked at pay and entitlements)
2. The .mil does the same thing with PAs and NPs.
3. Multiple levels of screening of mil members
4. Big push in civilian world to extend autonomy to midlevels
5. Not enough GME spots
6. short GMO tours actually extend physician commitments for whose who go into in-service training, hence keeping specialists in the military.

It's also a very effective way of spreading the misery around. Someone needs to take care of those sevicemen. You can't have someone you just trained in General surgery (or whatever) do it because the skills they just learned will atrophy and they'll be murderous when they get back to their real job. So when you get rid of the GMO, like the Army did, that burden falls almost entirely on your FPs, Generalist Medicine guys, and maybe generalist Pediatricians. In other words, the only guys who had any real chance of staying in an becoming your next generation of leadership if you hadn't just given them such an excellent reason to get out.

Originally Posted by Perrotfish

It's also a very effective way of spreading the misery around. Someone needs to take care of those sevicemen. You can't have someone you just trained in General surgery (or whatever) do it because the skills they just learned will atrophy and they'll be murderous when they get back to their real job. So when you get rid of the GMO, like the Army did, that burden falls almost entirely on your FPs, Generalist Medicine guys, and maybe generalist Pediatricians. In other words, the only guys who had any real chance of staying in an becoming your next generation of leadership if you hadn't just given them such an excellent reason to get out.

Perrot
Not exactly correct regarding specialist doing GMO tours. I know many anesthesiologist whom have done GMO tours after their residency training. Some see it as a sabbatical away from their primary specialty. I have met many residents whom once done with their training and utilization tour will probably do a tour as a UMO or Aerospace doc and doing 1-2 days a week of anesthesia.

Originally Posted by narcusprince

Perrot
Not exactly correct regarding specialist doing GMO tours. I know many anesthesiologist whom have done GMO tours after their residency training. Some see it as a sabbatical away from their primary specialty. I have met many residents whom once done with their training and utilization tour will probably do a tour as a UMO or Aerospace doc and doing 1-2 days a week of anesthesia.

Thats not the usual use of GMO. Although various specialties have been deployed in what were typically GMO roles for months at a time(pathologists, radiologists, etc), a GMO tour is a post-internship operational tour lasting 2-3 years.

The GMO system is basically a way to create midlevels for the price of a physician.

Considering the pay differential between civilian midlevels and active-duty non-boarded GMOs, the GMOs are probably cheaper on the salary side, but not on the acquisition side. Of course, recruiting civilian PAs and NPs to be deployed in a neverending cycle would be a difficult and slow sell.

They have GMOs because no one has forced them to stop having GMOs, despite the myriad of persuasive arguments put forward for ending the practice. Part of the reason is that the HPSP scholarship money is not coming out of operational budgets, so no one deciding how best to use a person with an MD/DO degree and an internship is worrying too much about how much they cost the DOD to train, or whether using them as GMOs or not having adequate training opportunities for their HPSP accessions does longer-term reputational harm to the recruiting service (which I believe it has done, anyway.)

No one from a taxpayer watchdog group has actually counted the costs of this kind of use of personnel and called the services to account for the waste. And none of the national medical organizations--I'm looking at you AMA-- whose charge should be to consider the potential harm to the junior physicians by the military services' forcing independent practice before allowing residency training and object to same has done anything. Maybe that is difficult when one of your main benefactors is the federal government.

Basically they do it out of sloth. They have done it for a long time and no one has been willing to make them stop and they would just not bother. It is a practice that doesn't do anyone any good--patient, doctor, service, taxpayer-- and it costs a lot of money, more than the alternatives.

They are screened at recruiting and for special duties, but they have some of the same risk factors (despite the efforts to inconvenience smokers) as many civilian industrial employers, along with those unique to military life. Sure, the real crazies and substance abusers are screened out, and with that the ED utilization common to those populations, but the average military member is not an aviator or SEAL, not at all.

The "not enough GME spots" begs the question why, and rather starkly demonstrates that the dubious purpose of much of the HPSP program anymore is to create a supply of GMOs who are never expected to remain in the service for GME training, where USUHS graduates, because of their much longer repayment service commitments are more likely to remain and fill those available GME slots. This isn't a new phenomenon; the process got started in the 1980s with the closing of many of the large military hospitals and the discharge of most of the retiree and dependent patient population to civilian care under CHAMPUS and later Tricare. Many residencies closed altogether along with their sponsoring hospitals, others were drastically cut back in class size for want of an adequate volume of patients to treat. What did not change so much was the entry class size for interns, who were being used to staff GMO slots in a relatively larger force, used to obsolete staffing training standards abandoned by civilian practice for more than 30 years.

There is very little I have seen in my GMO tour that I was uncomfortable handling as a flight surgeon. I hope the things that were out of my scope were referred appropriately. I was lucky enough to have two board certified FP flight surgeons working in the same clinic as I and had them as resources.

That said, I in no way advanced my training by being a flight surgeon. My confidence may have grown but my general internal medicine knowledge certainly atrophied. I used the time to read for the residency in which I was interested.

The sort of it is that I did a lot of paperwork and physicals that no one else wants to do. I realized that was the deal going in but it certainly wasn't the highlight of my time as a flight surgeon. I think GMOs are just fine so long as they have the resources to assist them. For the most part you deal with a relatively healthy population and there has not seemed to be enough adverse outcomes to motivate the Navy to eliminate them for standard of care reasons. We established as of yet there are no legal motivators.

The Navy keeping GMO billets has allowed me the ability to pay back my time as soon as possible and move on. Should they get rid of them, my motivation to take a Navy HPSP scholarship may have been different. Some civilian residency programs look at GMO time as a benefit. It certainly has made me a more competitive applicant at a few places that probably wouldn't have looked at me otherwise. Whether this is true or not is much more debateable. I think if the program directors I am interviewing with saw what a GMO really does on a day to day basis rather than how impressive it might look on a CV they would feel differently.

Originally Posted by ravager135

There is very little I have seen in my GMO tour that I was uncomfortable handling as a flight surgeon. I hope the things that were out of my scope were referred appropriately. I was lucky enough to have two board certified FP flight surgeons working in the same clinic as I and had them as resources.

With no disrespect intended, its very hard for someone in your position to assess whether you saw (missed) stuff that a physician who completed training would have caught. The rest of US medicine has decided that this isn't the standard of care anymore. The problem with your statement is that many of us believe your entire scope of practice was beyond your scope of practice. Having residency-trained docs down the hall seeing the same patients only illustrates that point.

Originally Posted by Perrotfish

It's also a very effective way of spreading the misery around. Someone needs to take care of those sevicemen. You can't have someone you just trained in General surgery (or whatever) do it because the skills they just learned will atrophy and they'll be murderous when they get back to their real job. So when you get rid of the GMO, like the Army did, that burden falls almost entirely on your FPs, Generalist Medicine guys, and maybe generalist Pediatricians. In other words, the only guys who had any real chance of staying in an becoming your next generation of leadership if you hadn't just given them such an excellent reason to get out.

Sigh...

Do you believe the Army or the Navy's approach was better?

Does there have to be a choice between the two? There are more and better solutions than those that have been used by any of the military services. The USPHS doesn't do this kind of thing. Neither does the VA, who almost always seem to require board eligibility for their jobs.

Originally Posted by ninjagaiden9876

Sigh...

Do you believe the Army or the Navy's approach was better?

Of the two, Navy.

The best approach would be to have primary care dics at the batallion level, and have mid levels do the GMOs. But no one is doing that

The biggest thing to consider is the money that YOU lose doing a GMO if you serve out your commitment compared to someone who does not. It never really hit me until talking it through with some of the other USU folks with whom I graduated. I did med school, a 4 year residency and am going on my 4th year of both specialty pay checks. My buddy did a 3 year GMO getting the 15000 MASP in July and obviously no ISP check during that time. Now he is in residency getting no specialty pay. If he finishes out his 7 year commitment after residency he will have received MASP + ISP for only 4 years, while I will have received it for 7. I know this is obvious for those of us already going through it, but it is a good point to consider when choosing a service.

You can rationalize the GMO system as a good life experience, it probably is for some people. It seems like my Navy classmates were already using that argument before they graduated from USU. I suspect rampant brainwashing via required powerpoint training, as you all seem to say the same thing. The delay in training and especially the lost money stinks, to put it succinctly.

Originally Posted by Perrotfish

...So when you get rid of the GMO, like the Army did, that burden falls almost entirely on your FPs, Generalist Medicine guys, and maybe generalist Pediatricians. In other words, the only guys who had any real chance of staying in an becoming your next generation of leadership if you hadn't just given them such an excellent reason to get out.

Just for accuracy, the Army sends FM docs, internists and internal medicine subspecialists, pediatricians, and pediatric subspecialists all to do their version of GMO time.

This is meant as an aside that may interest you given your specialty. It's not "maybe" pediatricians either. Take this for what it's worth, but my senior Army sub boss says the Army especially loves pediatricians in the GMO role given how well they have acquitted themselves in the past (apparently it came into vogue in the early 90s). Not only do they have the skill set relatable to a great many of the service members (essentially adolescent medicine) but they also have a tone of critical care time in training in a wide range of ages. They can easily take care of the twenty somethings (and do fine for what they'll get of the older "kids") but they're going to be the only ones comfortable with the longer term care 6 year old casualty or even the stray neonate brought by locals. Again, take it for what it's worth. Interesting, but biased, but also from someone who's been around a long time.

Originally Posted by Gastrapathy

With no disrespect intended, its very hard for someone in your position to assess whether you saw (missed) stuff that a physician who completed training would have caught. The rest of US medicine has decided that this isn't the standard of care anymore. The problem with your statement is that many of us believe your entire scope of practice was beyond your scope of practice. Having residency-trained docs down the hall seeing the same patients only illustrates that point.

Having residency trained folks down the hall is exactly why I know I didn't miss much. They were all doing a flight tour to either get away from their respective fields for an easy 2 or 3 years or for personal family reasons. If there was ever any doubt I went to them, the vast majority of the time we were in agreement. Now if you are going to argue that I could have missed a subtle nuance in a patient's condition that only a specialist in that field would have picked up then... be my guest. Have every specialist review a flight physical for completeness. My point isn't that I am a genius GMO but that rather being a GMO is ridiculously easy when you have a very, very healthy squadron to look after. My care was not perfect by any means but it was certainly adequate and my comments were only my experience. Your comments (no disrespect intended) are just as presumptuous because you have no idea who I saw and didn't. Let's put it this way, what I saw was a complete waste of your time as a residency trained physician. Most of what I saw in acute visits a corpsman could handle, certainly an IDC. Now if you believe I am not even qualified to make that assessment, that's fine. I just wonder what patients are beneath the training of a board certified physician because if one thing is certain IDCs, NPs, and PAs do not seem to be going anywhere.

I am not glamourizing GMO. I was just reflecting on my experience that prescribing blood pressure medications was a big deal and if a guy with an internship can't follow JNC guidelines then there are larger problems. I agree with you that GMO is not an ideal situation so please don't interpret my comments as defending the GMO position.

I think I have pretty good insight. In my career, I was a GMO, a primary care doc and a subspecialist. I spent a lot of time training housestaff including fleet returnees and interacting with complex patients managed by GMOs.

Now, having residency trained folks down the hall did what exactly? If the GMO has the insight that he needs help, its there. That's useful as far as it goes but is not a substitute for being adequately trained. Its very hard to catch the rare complex patient in an environment where nearly everyone is healthy. Hidden amongst the lumbago ,URI, jock itch and work avoiders are real patients. The attitude that medicine is ever "easy" is why HMCs, midlevels and bad GMOs miss the sick patients.

If you want to compare yourself to a midlevel, I agree that you should come out favorably. But midlevels in the .mil do not practice unsupervised (nor should they in any environment). They are good at algorithms and guidelines. You practice as a primary care attending. You should be able to see the difference.

The rest of US medicine has decided that an internship isn't enough. The other services recruit against the Navy by claiming they don't do GMO tours, so premeds seem to agree. I also left my GMO tour thinking I did a good job. 10+ years later I'm less sure.

I agree with your estimation of the experience completely. Again I am emphasizing that my experience was only my experience. I cannot speak for other GMOs who may have been tasked to work a lot more independantly with perhaps more complicated patients.

My only point is that I was not challenged by my GMO tour nor should I be by your estimation. You do have more perspective than I and I was fortunate in the sense that my chosen residency was one in which not much was able to erode during the years of payback. I obviously think of my knowledge base to be superior to a midlevel provider. I was asked to supervise multiple NPs and PAs during my tour. Your point is taken that this might not be appropriate in the greater scope of US medicine and its expectations.

I believe that my day to day experiences and time spent as an FS were appropriate to my level of training. Perhaps with residency behind me I may be less sure as well. The larger question is the solution... I do not pretend to know how the Army and AF function as I spent all of my time blue side Navy. I certainly feel that a trained NP or PA could have accomplished my job but I also do not see most of my colleagues wanted to be FPs only to deal with the paperwork shuffle of physicals.

I guess I just feel lucky I was able to find a way to pay back my time and get out at as early an age as possible.

Love these GMO threads, we should make a scrapbook.

Question: Might it be wise to volunteer for a GMO, if you just want a break from it all???

Here's what I mean:

By the end of my PGY1 (2014), I'll be in my mid-30s, and will have been in academia/training for nearly a decade (having gone the MD/PhD route), and I expect my brain to be utterly fried (feels that way now).

As such, my intentions are to volunteer for a GMO tour (wont even apply for PGY2). My hope is to ride a comfy amphib or carrier for 2 years, or to go out with the Marines (I'm not too crazy about the Flight or UMO paths). And my main motivation for doing this GMO tour would be to obtain a break from education/training, not so much to go out and play hooraah sailor.

Is this an absurd idea? Will it look bad somewhere down the line, that I didn't even apply for PGY2??? (my specialty of choice is Internal Medicine, plus minus subspecialty)

You should do what you want but your path doesn't seem to make much sense. You are far more likely to go with the Marines than ride a ship. This isn't an absolute, just more likely. If you want a break, be my guest, but if you are interested in Internal Medicine you should be able to just move right along. I do not see the career advantage other than taking time off which in the grander scheme of things forces you to prolong your career.

If you decide the Navy is for you then it really makes no difference. If you are in any way unsure it's best to hold as many cards as you can and having the ability to decide if you want to stay or leave earlier may be a better answer.

Just to add, I do not think it will "look bad" or impact you negatively to wait other than attendings might not recall you so easily if you were an outstanding IM intern. Again, that said IM isn't an extremely difficult residency to get.

Originally Posted by ravager135

I guess I just feel lucky I was able to find a way to pay back my time and get out at as early an age as possible.

You earned every dime and congrats on making it work. My opinion of the GMO system has changed (matured?) over time. It doesn't reflect poorly on the people who try to do the right thing.

Originally Posted by DrMetal

Love these GMO threads, we should make a scrapbook.

Question: Might it be wise to volunteer for a GMO, if you just want a break from it all???

Here's what I mean:

By the end of my PGY1 (2014), I'll be in my mid-30s, and will have been in academia/training for nearly a decade (having gone the MD/PhD route), and I expect my brain to be utterly fried (feels that way now).

As such, my intentions are to volunteer for a GMO tour (wont even apply for PGY2). My hope is to ride a comfy amphib or carrier for 2 years, or to go out with the Marines (I'm not too crazy about the Flight or UMO paths). And my main motivation for doing this GMO tour would be to obtain a break from education/training, not so much to go out and play hooraah sailor.

Is this an absurd idea? Will it look bad somewhere down the line, that I didn't even apply for PGY2??? (my specialty of choice is Internal Medicine, plus minus subspecialty)

Not a great plan for several reasons.
1. The amphibs have largely transitioned to residency-trained physicians
2. Carrier GMOs are nearly all flight surgeons
3. Really, really expensive. This costs you at least 2 years of ISP. IM ISP is $20k. $40k buys a nice ride.
4. If you want fellowship, this can increase your obligation (complicated but trust me, this is even true for USUHS types)
5. For fellowship selection, you are at a major disadvantage over someone from the same year group who did a utilization tour post-residency (say, on one of the amphibs you mentioned).
6. Returning to residency from the fleet sucks balls.

So, if you are prepared to be a GMO by choice (questionable ethical decision IMO) despite hurting your chances for getting into fellowship within the first 5 years, costing yourself cash, making your R2 year harder and basically obligating yourself to a career if you want fellowship...go for it. Otherwise, just keep swimming.

Originally Posted by Gastrapathy

Not a great plan for several reasons..

good points. I hadn't thought about the ISP $$ aspect. I had thought of a fellowship incurring more time, but again, I'm not so sure that I want to subspecialize. In any case, I'm in it for the long run. I have prior service time too, so it just makes sense to stay in until retirement.

Originally Posted by J-Rad

Just for accuracy, the Army sends FM docs, internists and internal medicine subspecialists, pediatricians, and pediatric subspecialists all to do their version of GMO time.

This is meant as an aside that may interest you given your specialty. It's not "maybe" pediatricians either. Take this for what it's worth, but my senior Army sub boss says the Army especially loves pediatricians in the GMO role given how well they have acquitted themselves in the past (apparently it came into vogue in the early 90s). Not only do they have the skill set relatable to a great many of the service members (essentially adolescent medicine) but they also have a tone of critical care time in training in a wide range of ages. They can easily take care of the twenty somethings (and do fine for what they'll get of the older "kids") but they're going to be the only ones comfortable with the longer term care 6 year old casualty or even the stray neonate brought by locals. Again, take it for what it's worth. Interesting, but biased, but also from someone who's been around a long time.

That does make sense, I've heard a few of the senior residents refer to their GMO time as an adolescent medicine fellowship.

Anyway I feel like that supports my point. Pediatricians are one of the few groups of physicians that have a good incentive to stay in the military (dismal civilian working conditions and the most reliably busy service in the military). Two of the big three Navy hospitals are commanded by Pediatricans. When you force them to take on a disproportionate amount of the GMO misery you're eliminating of one of your only reliable sources of senior physician leadership.

Originally Posted by Gastrapathy

With no disrespect intended, its very hard for someone in your position to assess whether you saw (missed) stuff that a physician who completed training would have caught.

This is the absolute truth.

Post residency, I look back at some of the things I did as a GMO and realize just how close to the edge of marginal or outright dangerous care I came on some occasions. I've even gone back and read stuff I wrote on SDN about GMO tours right before I left my GMO billet to go back to residency, and thought "yeah, there's a guy who is missing some perspective" ...


Most of the time I had solid backup easily available, and I think most of the time I consulted conservatively enough. And then there was that time I _______ with a _____ while deployed to _____.

I don't think I hurt anyone or made any major errors that resulted in signficicant M&M. But who knows what I missed?


I'll say this: now that I have a better grip on knowing what I don't know, if the Navy ordered me to a GMO billet to do primary care work, I'd be useless to the Navy, because I'd ****ing refer everything, because I'm even less qualified to do primary care today than I was 9 years ago when I headed off to 2MARDIV.

Originally Posted by DrMetal

Love these GMO threads, we should make a scrapbook.

Question: Might it be wise to volunteer for a GMO, if you just want a break from it all???

Here's what I mean:

By the end of my PGY1 (2014), I'll be in my mid-30s, and will have been in academia/training for nearly a decade (having gone the MD/PhD route), and I expect my brain to be utterly fried (feels that way now).

As such, my intentions are to volunteer for a GMO tour (wont even apply for PGY2). My hope is to ride a comfy amphib or carrier for 2 years, or to go out with the Marines (I'm not too crazy about the Flight or UMO paths). And my main motivation for doing this GMO tour would be to obtain a break from education/training, not so much to go out and play hooraah sailor.

Is this an absurd idea? Will it look bad somewhere down the line, that I didn't even apply for PGY2??? (my specialty of choice is Internal Medicine, plus minus subspecialty)

Well Gastrapathy, our resident CPA, might argue the ISP aspect and there is no denying that. There is also no denying that you get absolutely freaking stupid during GMO time. However, there is much to be said for 3 years of an 8hr workday, no call, and evenings/weekends home with the family. Plus it is nice to have the ASP ($15K pre-tax) to pay off debts or use as down payment for big ticket items.

Plus, GMO probability depends on what specialty you want. FP, IM, OB, and peds all have a decent chance to go straight through. Anything else (anes, EM, ortho, gen surg, ENT, ophtho, derm, ortho surg) plan on doing a GMO tour.

Originally Posted by BOHICA-FIGMO

Plus it is nice to have the ASP ($15K pre-tax) to pay off debts or use as down payment for big ticket items.

While I am sure I am looking at a net loss of income in my lifetime, the only positive about GMO as a single guy was being able to afford some nice things sooner in life and put away cash for the civilian resident pay cut that I am looking at with that ASP.

Originally Posted by BOHICA-FIGMO

Well Gastrapathy, our resident CPA, might argue the ISP aspect and there is no denying that. There is also no denying that you get absolutely freaking stupid during GMO time. However, there is much to be said for 3 years of an 8hr workday, no call, and evenings/weekends home with the family. Plus it is nice to have the ASP ($15K pre-tax) to pay off debts or use as down payment for big ticket items.

Plus, GMO probability depends on what specialty you want. FP, IM, OB, and peds all have a decent chance to go straight through. Anything else (anes, EM, ortho, gen surg, ENT, ophtho, derm, ortho surg) plan on doing a GMO tour.

Might argue? I just did.

Not everyone's GMO is that cush. Maybe its better now, but in my time you could count on two deployments and some serious time away for workups. I was around more as a medicine resident.

Originally Posted by BOHICA-FIGMO

Anything else (anes, EM, ortho, gen surg, ENT, ophtho, derm, ortho surg) plan on doing a GMO tour.

Well the scuttlebutt is..... I spoke to a gen. surg resident this morning who claims that it depends on whether East or West Coast. If you're in Bethesda you will more than likely not do a GMO tour. Out of his buddies 1/4 were selected for GMO and the others went straight through to their surgery residency in Bethesda. It seems as though on this side of the Mississippi the Navy is trying to phase out GMO tours but my n=1. I'll keep asking around since I'm back with the Navy now.

Originally Posted by Gastrapathy

Not everyone's GMO is that cush. Maybe its better now, but in my time you could count on two deployments and some serious time away for workups. I was around more as a medicine resident.

Yes. I did a 3 year GMO tour. 14 months deployed + about 3-4 more away for workups. 50% of my time away from home.

It had its rewards, but it was nice to be home for residency.

Originally Posted by Gastrapathy

Might argue? I just did.

Not everyone's GMO is that cush. Maybe its better now, but in my time you could count on two deployments and some serious time away for workups. I was around more as a medicine resident.

I am CERTAIN that everyone's GMO is not that cush!

I am basically begging to deploy, but am unlikely to due to the organization for which I work and the "special training" I have. .

There is a reason I put the phrase "notary doctor" in my avatar. I spend most of my time reviewing certain types of physicals that only a doctor with my "special training" can bottom line. When you are 1/1 in an organization, you are not going anywhere!

Originally Posted by Croooz

Well the scuttlebutt is..... I spoke to a gen. surg resident this morning who claims that it depends on whether East or West Coast. If you're in Bethesda you will more than likely not do a GMO tour. Out of his buddies 1/4 were selected for GMO and the others went straight through to their surgery residency in Bethesda. It seems as though on this side of the Mississippi the Navy is trying to phase out GMO tours but my n=1. I'll keep asking around since I'm back with the Navy now.

Maybe things have changed for the 2010-2011 and 2011-2012 intern classes. I know several gen surg types in the 2009-2010 intern classes at Bethesda and Portsmouth. Most ended up doing GMO tours. I have no clue about San Diego.