An Unconventional Route through Military Medicine

[Strategy]

Hello friends,

I am writing to you today in regard to my ideas towards an unconventional route to pass through military medicine. I would like to hear your thoughts, concerns, and feedback based on your experiences for what I have in mind. I'd also like to thank you for taking the time to do so. I am very grateful.

Just a little background:
I am currently accepted to a 4 year MD program and will be matriculating in 2016. I am interested in specializing however I'm not sure exactly what just yet. I am not attracted to HPSP for the money, I have other stable ways to fund my medical education if I choose not to accept the scholarship.

My idea:
I am interested in military medicine for itself and for nothing else. I want to experience being part of something much bigger than me and being held to high standards of duty and respect. I want to be able to go places and do things others normally don't get the chance to. I want to do all of the above but not for the rest of my life. So, therefore, what I am proposing is to take a HPSP scholarship (preferably 3 year) and after PGY-1 internship year, blindly go for a GMO tour to complete all of my payback time and then get out. With a GMO tour under my belt, I then hope to land a solid civilian residency position and resume my training while having had the chance to experience the military. The idea is that the GMO tour gives me the opportunity to live military medicine but only for a short period of time and it also gives me a chance to hone my fundamental primary care skills as well as practice things like patient communication, etc. before I enter the civilian residency.

I would like to know what you think in general. But also I have a few specific questions:

1) Is there any risk I am taking? Can anything go wrong in the above plan or do you see any drawbacks?
2) Will most civilian residency programs accept my Military Internship training and therefore allow me to enter as PGY-2?
3) Is there any specialty for which this may not work?
4) If I want to do only a GMO after internship, is it guaranteed I can do so? (I do not want to do a military residency under any circumstances). In other words, can I force them to assign me a GMO tour?

Thanks and I look forward to hearing from you!

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[Gastrapathy]

That's a conventional Navy plan. Be a flight surgeon.

 

[notdeadyet]

If the money of HPSP is no attraction, go to medical school, finish residency, then join on your own terms. You will have much more voice in terms of job and location.

That's how it helps you. It will help servicemenbers by having a fully trained physician supporting them instead of an intern.


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[Ziehl-Neelsen]

It's not all that unconventional of a plan. It's colloquially referred to as "GMO and out" and it's utilized by people like you who want a short military sojourn (but not a career), those who get totally screwed in the military matching process, and those who realize early on that they despise the military and want out at the earliest opportunity. In response to your specific questions...

1. You could die in a training accident or in combat. If you have or accumulate a family before then, you could end up divorced due to the operational tempo of an operational physician. You will take a pretty significant paycut when you go back to residency (though government cheese in the form of the GI Bill may mitigate some of that). If you are extremely unlucky and cavalier as a GMO, you could feasibly make a catastrophic medical mistake that led to a bad outcome and superiors could decide to run it all the way up to a state licensing board which could impact your ability to ever get a residency (unlikely but possible).

2. You should do a transitional internship in preparation for GMO with no slack-off rotations like gas, rads, or path. Whether or not you have to repeat internship totally depends on what specialties you apply to in the future. Specialities like gas, rads, derm, etc. will almost certainly accept your internship. Primary care specialties may or may not require some remediation of internship. Surgical subs (and I include OB/GYN here) will almost certainly not accept an internship performed 3 years ago and will make you repeat.

3. Neurosurgery, Rad-Onc any of the highly competetive specialities that require a ton of research and networking as the price of admission. I'm not saying it would be impossible to match these specialties, just less likely as you won't be able to schmooze, complete audition rotations, or be an attending's research scut monkey while you're lancing pilonidal cysts and performing musculo-skeletal exams. In general though, a military hitch is a massive plus on a residency application.

4. Nothing is guaranteed. If you wash out during internship they may stash you in the medical service corps where you'll send reminders to soldiers to get their HIV test. In all likelihood, barring some type of force majeure event, you will be able to complete you plan. You can apply only for transitional internships under the guise that you haven't decided on a specialty. When you don't apply for a residency during internship the only place for you is GMO-land.

As was mentioned above, the widest variety of alpha-male operational stuff exists through the USN (operators, Marine infantry, flight, dive, etc.), though you will have to wear shirt-stays and buy white shoes.

 

[Strategy]

It's not all that unconventional of a plan. It's colloquially referred to as "GMO and out" and it's utilized by people like you who want a short military sojourn (but not a career), those who get totally screwed in the military matching process, and those who realize early on that they despise the military and want out at the earliest opportunity. In response to your specific questions...

1. You could die in a training accident or in combat. If you have or accumulate a family before then, you could end up divorced due to the operational tempo of an operational physician. You will take a pretty significant paycut when you go back to residency (though government cheese in the form of the GI Bill may mitigate some of that). If you are extremely unlucky and cavalier as a GMO, you could feasibly make a catastrophic medical mistake that led to a bad outcome and superiors could decide to run it all the way up to a state licensing board which could impact your ability to ever get a residency (unlikely but possible).

2. You should do a transitional internship in preparation for GMO with no slack-off rotations like gas, rads, or path. Whether or not you have to repeat internship totally depends on what specialties you apply to in the future. Specialities like gas, rads, derm, etc. will almost certainly accept your internship. Primary care specialties may or may not require some remediation of internship. Surgical subs (and I include OB/GYN here) will almost certainly not accept an internship performed 3 years ago and will make you repeat.

3. Neurosurgery, Rad-Onc any of the highly competetive specialities that require a ton of research and networking as the price of admission. I'm not saying it would be impossible to match these specialties, just less likely as you won't be able to schmooze, complete audition rotations, or be an attending's research scut monkey while you're lancing pilonidal cysts and performing musculo-skeletal exams. In general though, a military hitch is a massive plus on a residency application.

4. Nothing is guaranteed. If you wash out during internship they may stash you in the medical service corps where you'll send reminders to soldiers to get their HIV test. In all likelihood, barring some type of force majeure event, you will be able to complete you plan. You can apply only for transitional internships under the guise that you haven't decided on a specialty. When you don't apply for a residency during internship the only place for you is GMO-land.

As was mentioned above, the widest variety of alpha-male operational stuff exists through the USN (operators, Marine infantry, flight, dive, etc.), though you will have to wear shirt-stays and buy white shoes.

Thanks for your detailed post. It was very informative. I do very much like the Navy route above the other two. I also had two followup questions:

1. Where does EM fall among the lists in #2? Would they accept the internship?

2. So the best way to guarantee a GMO would be to apply for a transitional internship and then just not apply for a residency under the guise that I haven't decided?

 

[WernickeDO]

1: Most EM programs will not accept a TY into a PGY-2 spot. Other specialties, like derm, ophtho, and rads, will require a TY year and then take you in as a PGY-2.

2: The military is more than happy to take you as a GMO. Simply do a TY and then don't apply to residency.

That said, I will give the same warning I give to all pre-meds who are considering HPSP: You are not able to make an informed decision about joining the military at this time in your career. I know that right now you want to go GMO and have an adventure, but you cannot possibly predict if you will feel the same way in five years. You may find that you are passionate about surgery and want to operate 24/7 and live the workaholic surgeon life. You may find you want to do pediatrics, work 7-5 in a rural clinic, and go home to your spouse and children. You may find you want to do administrative work. The military does not care about any of that. You would be signing a contract now, before you have even started med school, and you are surrendering a lot of autonomy in doing so. When you graduate, and decide on what specialty you want to train in, you can always do FAP and have your military adventure as a fully trained board-certified doc, rather than languishing as a frustrated intern as so many GMOs have done before you.

 

[Red Lobster Actual]

2. So the best way to guarantee a GMO would be to apply for a transitional internship and then just not apply for a residency under the guise that I haven't decided?

Haha you really do not need any subterfuge...many people have done what you are planning and there is absolutely nothing wrong with it.

In the very beginning of MS-4 you will be applying to the Navy's match but only for intern year. Towards the beginning of intern year you will once again apply for the Navy's match but now you have the choice and can actually apply to one, a combination, or all of the following paths:

1) A residency
2) Straight up GMO
3) Flight Medicine
4) Undersea Medicine

 

[sonofva]

The above posters have been far more eloquent and complete in their responses. I will just throw in my two cents:

Just bear in mind that since you're a Ty trained GMO, a lot of the "sweet" special ops billets will go to residency trained guys. If that's not your goal, you could still end up somewhere awesome. I got my first choice of overseas billets. But you could also get hosed and spend three years somewhere totally crappy against your will.

As far as the family front... You never know what the future will hold. I was fired up about my tour and thought I was golden. Wife stays at home with a sweet job and plenty of opportunities to come visit. but turns out that now I have a baby due in the middle of my tour. So just be prepared for things to change and be "semper gumbi," as they say.

 

[IlDestriero]

Thanks for your detailed post. It was very informative. I do very much like the Navy route above the other two. I also had two followup questions:

1. Where does EM fall among the lists in #2? Would they accept the internship?

2. So the best way to guarantee a GMO would be to apply for a transitional internship and then just not apply for a residency under the guise that I haven't decided?

It doesn't have to be a guise, apply for flight and/or dive, talk to the detailer about a SeeBee or marine GMO back up. They couldn't care less about your future plans.

 

[dab14]

Unless things have changed getting a GMO spot is easy. I also wanted to do 4 and out, but after two years of being a GMO, I wanted to go back to surgery. I applied for a deferment and was granted. Finishing up my residency now in a civilian program which was a ton better than anything the navy could offer. Will have two years left of my contract and then out after that.

 

[asdf123g]

Unless things have changed getting a GMO spot is easy. I also wanted to do 4 and out, but after two years of being a GMO, I wanted to go back to surgery. I applied for a deferment and was granted. Finishing up my residency now in a civilian program which was a ton better than anything the navy could offer. Will have two years left of my contract and then out after that.

are deferments hard to come by? did doing GMO help or something with that?

 

[backrow]

are deferments hard to come by? did doing GMO help or something with that?

The number of deferments will fluctuate yearly and are based on required end strength and number of inservice positions. For example, If they only need 8 general surgeons 5 years from now and there are say 8 residency slots then there will be zero deferments that year. If they need 10 there will be 2, etc. The other factor is number of applicants overall. If the number of total applicants is greater than the number of in service slots then they have to offer deferments (either one year or full) for the excess. If there aren't enough applicants to fill all the slots (across all specialties) then it is possible that even though general surgery says we need 10 they still don't get any deferments because they need those extra two bodies for the other programs.

This is the general gist of how it works, there can be slight variations.

 

[sonofva]

My first match year the army gave out two deferments. One was truly based on an exceptional family situation, and the other was merit based

 

[asdf123g]

My first match year the army gave out two deferments. One was truly based on an exceptional family situation, and the other was merit based

that doesnt sound like a lot...

 

[HighPriest]

It isn't. You should never bank on deferral.

 

[pgg]

Another thing to keep in mind is that deferrals are given out with the best interest of the service in mind.

You might think that being an ultra-competitive applicant with awesome grades and board scores would put you 1st in line for a deferral ... but remember that the program directors at the GMESB want the best people for their programs. It's not inconceivable that they'll see how awesome you are, want to place you in their inservice program, and let the 12th guy on their rank list have the deferral.

That's not to say that great applicants can't get deferrals. Just that the system works differently than the civilian match.

A civilian superstar WILL match to his #1 choice if that program ranked him high enough to match. He won't wind up at his #3 choice if that program wanted him too.

A military superstar can rank deferral #1 but he'll get what the GMESB gives him. If you want a deferral to got to Duke, Duke doesn't send their PD to the GMESB to fight for you.