Another GMO and GTFO Thread

[Dr.RickSanchez]

Gentlemen,

Some background: Army, HPSPer, 2021 med grad, didn't make it into my desired specialty, TY'd, GMO'd

Long time since I've posted, been a wild ride. I did my Transitional Year internship, became a flight surgeon and have had some amazing experiences, but ultimately I do not plan on being a lifer. Welp matched into residency this year and its time for me to sign the contract for my Active Duty Service Obligation (ADSO) that I will receive for residency training. My timeline, or so I thought, would be the following:

HPSP - 4 years (adds 4 years)
TY - 1 year (intern year +1/-1 = 0, still 4 years)
1 year FS GMO (removes 1 year, total 3 left)
1 year FS GMO (removes 1 year, total 2 left)
Return to 3 year residency
1 year internship (intern year +1/-1 = 0)
2 year residency (doesn't add anything because my ADSO from HPSP is already 2 years)

So lo and behold, I talk to the folks at GME and they explain to me that I "used up my ADSO free intern year", and that my 3 year residency program will in fact accrue a 3 year ADSO. Not only have they screwed me out of my TY intern year not counting for piss towards my intern year in my residency, they now are telling me I will also owe them one more year. Is it irrational for me to be pissed about this situation? I am considering telling them to shove it and GMO/GTFOing. My desired residency will not be hard to get on the outside.

Appreciate any advice gentlemen

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[ArmyTiger]

I guess the question is would you rather be a GMO for another year, or a residency trained physician in the military for an extra year? And a second part, do you want to be in the military an extra 6 years? I don't know what specialty you're going into, but I'd imagine the financial portion of the decision is likely close to even, after you compare 3 years of residency salary as a civilian to what you'll make in the military. It's a hard question.

 

[Dr.RickSanchez]

I guess the question is would you rather be a GMO for another year, or a residency trained physician in the military for an extra year? And a second part, do you want to be in the military an extra 6 years? I don't know what specialty you're going into, but I'd imagine the financial portion of the decision is likely close to even, after you compare 3 years of residency salary as a civilian to what you'll make in the military. It's a hard question.

Thanks for your reply Tiger. I don't care in the slightest what I would be doing with my remaining time in the Army but something tells me if I finish residency they would expect me to go into a billet in that specialty. That being said it'd be easy as hell to wear the flight surgeon hat and FM hat at a location that needs both.

I do want to emphasize that my decision right now is:

1. Finish my remaining ADSO of 2 years as a GMO, apply civilian residency
2. Go to residency in the Army, accrue an additional bull**** year to my ADSO (which really is two bull**** years because my TY should count as an intern year anyway)

Edit: Regarding the finances, it seems not particularly close as the extra year in the military would equate to some $250,000 forfeited, and if I could find a program that would recognize my TY as my intern year (a year filled to the brim with redundant training and being bottom on the totem-pole) then it would be closer to $500,000 forfeited. That combined with the fact that the Army still hasn't paid me my specialty incentive pay for being a flight surgeon - the Army doesn't come anywhere close to being competitive financially.

 

[pawprint]

Your programs assessment is correct.

You owed 2 years of hpsp coming back from GMO.

You will payback your 2 remaining hpsp years while in your 2nd intern year and your pgy-2 year. Meanwhile, you gain obligated payback for intern year, pgy-2, and pgy-3, so at the end of residency, you now owe 3 years.

All pgy training incurs payback. Including intern year.

typically, you are paying back 1 year of Hpsp while in your first intern year, so you wouldn’t see the difference as you pay back a year and then gain a year at the end. However, your circumstance where you are repeating a pgy-1 year shows a circumstance where you will see that incurred obligation in action.

 

[Dr.RickSanchez]

All pgy training incurs payback. Including intern year.

I don't think that is the case. Directly from my contract:

"f. Graduate Medical Education (GME). Accredited, post-doctoral doctor of medicine (M.D.) and doctor of osteopathy (D.O.) programs more than 26 weeks in duration that comprise “internships” (the first postgraduate year (PGY-1) of accredited training), “residencies” and “fellowships” (subsequent postgraduate years (PGY–2 or above) of accredited training leading to eligibility for certification by an American specialty board). GME may occur in Federal medical facilities, civilian medical facilities, and colleges or universities. While the first year of graduate medical education (PGY-1) is included in the definition of GME, it is obligation neutral; i.e. an ADO is neither incurred nor discharged during PGY-1."

typically, you are paying back 1 year of Hpsp while in your first intern year

The legal-ese may be up to interpretation. Does it refer to the first year of GME in my career or the first year of the program? Regardless, my TY should not have taken anything from my 4 yr HPSP ADSO.

 

[pawprint]

From your contract, it makes sense to me then that you shouldn’t incur an additional year for repeating PGY-1.

 

[Barrel Proof]

Why do you think you should stay in? Seems like you stand to gain financially by getting out. And it also seems like you may be bitter over the additional year to your ADSO if you were to stay in (can’t blame you, I would be too). So what do you see as a reason for staying in?

 

[Dr.RickSanchez]

Why do you think you should stay in? Seems like you stand to gain financially by getting out. And it also seems like you may be bitter over the additional year to your ADSO if you were to stay in (can’t blame you, I would be too). So what do you see as a reason for staying in?

I guess there's the "feeling like a quitter" aspect. I also have a lot of things in motion, both at my current assignment and at the MTF I'd be going to, and it'd be a huge pain for them to change course now. I'd like to make O-4. I wanted an assignment in W. Europe.

Also applying for civilian residency while working sounds like a PITA. I remember seeing an awesome thread about it though so I'll be sure to use that if I decide to go that route

 

[orbitsurgMD]

If you don't plan on a career and you are financially much better off leaving after minimum ADSO and getting a desirable residency won't be a difficulty, why exactly would you consider staying?

 

[Centurion38]

Only reason to stay in would be if you were a non-competitive applicant and Military GME offers you a shot at a desirable residency.

Military GME- by and large- seems woeful these days. It wasn't much better when I was in 15 years ago. I did my 4 years as a flight surgeon, got out and never looked back. I got promoted to O4 while in the IRR.

I've never understood why people are mystified post facto about service obligations.

They are training you for three years, they want their pound of flesh from you as an attending. It's not that hard to understand.

Just leave and get civilian training.

 

[Apollyon]

I got promoted to O4 while in the IRR.

That makes me laugh for a very specific reason. My medical director in residency was in the Navy early 90s. One day, in his office, I asked him about his flight helmet. He told me he got rotary wing qualified (right seat) when he was in, as ship's surgeon. He said it was a really good time to be in.

Well, at another time, for some reason, the IRR came up, and he told me that he had moved 2 or 3 times, and hadn't updated his address, so, if they wanted him, they would have to send NIS to find him! Now, you say you were promoted! I wonder if he picked up O-5 "on the lam"!

 

[armytrainingsir]

That makes me laugh for a very specific reason. My medical director in residency was in the Navy early 90s. One day, in his office, I asked him about his flight helmet. He told me he got rotary wing qualified (right seat) when he was in, as ship's surgeon. He said it was a really good time to be in.

Well, at another time, for some reason, the IRR came up, and he told me that he had moved 2 or 3 times, and hadn't updated his address, so, if they wanted him, they would have to send NIS to find him! Now, you say you were promoted! I wonder if he picked up O-5 "on the lam"!

I had a friend make 05 in the IRR years after he left the guard and went IRR (and did nothing,lol)

 

[TheGoose]

Their math is correct. Bummer but still correct

 

[Dr.RickSanchez]

I don't think that is the case. Directly from my contract:

"f. Graduate Medical Education (GME). Accredited, post-doctoral doctor of medicine (M.D.) and doctor of osteopathy (D.O.) programs more than 26 weeks in duration that comprise “internships” (the first postgraduate year (PGY-1) of accredited training), “residencies” and “fellowships” (subsequent postgraduate years (PGY–2 or above) of accredited training leading to eligibility for certification by an American specialty board). GME may occur in Federal medical facilities, civilian medical facilities, and colleges or universities. While the first year of graduate medical education (PGY-1) is included in the definition of GME, it is obligation neutral; i.e. an ADO is neither incurred nor discharged during PGY-1."



The legal-ese may be up to interpretation. Does it refer to the first year of GME in my career or the first year of the program? Regardless, my TY should not have taken anything from my 4 yr HPSP ADSO.

Their math is correct. Bummer but still correct

I still do not understand how they get to cherry-pick which intern year counts and doesn't count, by the wording of their own contract they're obligation neutral. Someone please explain this to me.

Food for thought: when someone does a transitional year there is not a single instance where a 1 year TY-gained-ADSO is greater than any of their HPSP scholarships ADSO, ie it does **** all. This is a roundabout way of saying that TY's are not entitled to the "First year of PGY-1 is obligation neutral" from above, which is a crock of ****.

My board scores were below average, but I'm also trying to match FM in a rural state which I plan on living in, and grew up in. Do I fall into the damnable GMO category?

 

[Chonal Atresia]

I still do not understand how they get to cherry-pick which intern year counts and doesn't count, by the wording of their own contract they're obligation neutral. Someone please explain this to me.

Food for thought: when someone does a transitional year there is not a single instance where a 1 year TY-gained-ADSO is greater than any of their HPSP scholarships ADSO, ie it does **** all. This is a roundabout way of saying that TY's are not entitled to the "First year of PGY-1 is obligation neutral" from above, which is a crock of ****.

My board scores were below average, but I'm also trying to match FM in a rural state which I plan on living in, and grew up in. Do I fall into the damnable GMO category?

Bummer....you could have easily secured 100% loan forgiveness (complete debt repayment with you not owing a dime) if you wanted to work family medicine in a rural region and not had to deal with selling your soul to the devil....I mean military.

Sorry you have to deal with this situation. It is such a terrible, broken system.