Army HPSP Rotation quesiton

[Treehun]

HPSP Candidate...


The Army Graduate Medical website says that students who want to go to a residency should try and rotate there. As a student attending a DO school, how hard is it to get those rotations? How necessary is it to rotate at a hospital to get a residency there?

Do military residency's prefer particular medical schools?

KCUMB has a special "Military Track," What would be the benefit of going to that school and doing that track?

thank you

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[Treehun]

Also does doing a GMO year help you get a desired residency? are GMO's easily obtained? What am I missing about GMOS...r they bad?

 

[colbgw02]

HPSP Candidate...


The Army Graduate Medical website says that students who want to go to a residency should try and rotate there. As a student attending a DO school, how hard is it to get those rotations?(1) How necessary is it to rotate at a hospital to get a residency there?(2)

Do military residency's prefer particular medical schools?(3)

KCUMB has a special "Military Track," What would be the benefit of going to that school and doing that track?(4)

thank you

(1) Not hard at all. DOs rotate at MTFs all the time.

(2) Person and program specific. On the whole, I'd say it's more important than in the civilian match when controlled for specialty.

(3) Probably. This is no different than in civilian medicine.

(4) No clue. Although I'm curious what this is, I'm skeptical that it has any real value.

Also does doing a GMO year help you get a desired residency?(5) are GMO's easily obtained?(6) What am I missing about GMOS...r they bad?(7)

(5) Yes, it helps.

(6) Yes. The Army will be happy to permit you to serve as GMO.

(7) What you're missing is the rest of this forum, where this and many other relevant topics have been discussed extensively.

 

[ProudMD]

From what I've heard, it is rare for Army individuals to do GMO tours.

 

[backrow]

From what I've heard, it is rare for Army individuals to do GMO tours.

At least until after you complete your residency and then get voluntold to go do what is essentially a GMO tour.

Pick your poison in this regard: Navy = GMO before residency, Air Force = maybe GMO before residency, Army = GMO after residency

(A little bit of oversimplification there, but not much)

 

[ProudMD]

At least until after you complete your residency and then get voluntold to go do what is essentially a GMO tour.

Pick your poison in this regard: Navy = GMO before residency, Air Force = maybe GMO before residency, Army = GMO after residency

(A little bit of oversimplification there, but not much)

Could you elaborate a bit more on the Army "GMO"?

Are you deployed as a general medical officer, or do you get to practice what you trained for in residency?

 

[backrow]

Could you elaborate a bit more on the Army "GMO"?

Are you deployed as a general medical officer, or do you get to practice what you trained for in residency?

The current state of affairs has many residency trained physicians serving in a GMO role, essentially being a paper pusher without necessarily practicing the skills in which one was trained. For example, I know of a neuro - ophthalmologist who was put in one of those billets. I seriously doubt he did anything close to his specialty.

 

[ProudMD]

I thought that the military is phasing out GMO tours across the branches? Is that actually happening?

 

[colbgw02]

I thought that the military is phasing out GMO tours across the branches? Is that actually happening?

Said many people, incorrectly, for at least the last twenty years. The desmise of the GMO has long been predicted, but has yet even to sniff fruition. Personally, I think it's naive to believe GMOs are going anywhere in the nearby future. And with respect to the Army, I would plan on them becoming increasingly common, if claims from CCC and touring higher-ups are to be believed. It's just that they won't be done by "GMOs", nor will they be called "GMO tours". Nope, they'll just be called "operational tours". They'll be performed by fully-trained, post-residency physicians, and they'll become increasingly necessary (perhaps mandatory?) for promotion beyond O-4.

 

[ProudMD]

Said many people, incorrectly, for at least the last twenty years. The desmise of the GMO has long been predicted, but has yet even to sniff fruition. Personally, I think it's naive to believe GMOs are going anywhere in the nearby future. And with respect to the Army, I would plan on them becoming increasingly common, if claims from CCC and touring higher-ups are to be believed. It's just that they won't be done by "GMOs", nor will they be called "GMO tours". Nope, they'll just be called "operational tours". They'll be performed by fully-trained, post-residency physicians, and they'll become increasingly necessary (perhaps mandatory?) for promotion beyond O-4.

Thanks for the info. Could you elaborate a bit more on the purpose of these operation/GMO tours? Does the military have a surplus of physicians that not everyone is needed to practice in their chosen specialties?

 

[colbgw02]

Thanks for the info. Could you elaborate a bit more on the purpose of these operation/GMO tours? Does the military have a surplus of physicians that not everyone is needed to practice in their chosen specialties?

The military very rarely ever does anything sensical, rational, or logical. I suggest you stop assuming they're doing anything of the sort. Even if you become a general officer one day, a healthy dose of cynicism will serve you well. Sorry, but this is about as gently as I can put it, because the wording of your posts strike me as incredibly naive. At least you're asking, though.

To my knowledge, the military doesn't have a surplus of any type of physician (although I think Navy neurosurgery may be an exception. IIRC, they have something like double the number of the Army and Air Force combined). If they did, then it wouldn't employ hundreds (maybe thousands?) of civilian physicians. Sometimes, it thinks it has too many of a type of doc based on poorly updated/neglected Congressionally-mandated budgeting allowances.

The Army has shifted focus onto these operational assignments because it believes that it is the real way to both 1) take care of warfighters and 2) develop the leadership potential of its physicians. Most physicians think that #1 is just plain wrong because sitting in meetings and tracking metrics doesn't strike anyone as real healthcare. It's not that the meetings are useless, per se, but rather it doesn't really involve patient care and a lot of it can be accomplished by non-physicians. This is especially true of a residency and/or fellowship trained physician, when the opportunity cost of removing that physician from the hospital/clinic must also be considered. As for #2, well the Army's concept of "don't just be a doctor" is sort of beyond the scope of this thread. I'll just say that if practicing medicine is your primary goal, then your goals do not match with the Army's.

 

[ProudMD]

The military very rarely ever does anything sensical, rational, or logical. I suggest you stop assuming they're doing anything of the sort. Even if you become a general officer one day, a healthy dose of cynicism will serve you well. Sorry, but this is about as gently as I can put it, because the wording of your posts strike me as incredibly naive. At least you're asking, though.

To my knowledge, the military doesn't have a surplus of any type of physician (although I think Navy neurosurgery may be an exception. IIRC, they have something like double the number of the Army and Air Force combined). If they did, then it wouldn't employ hundreds (maybe thousands?) of civilian physicians. Sometimes, it thinks it has too many of a type of doc based on poorly updated/neglected Congressionally-mandated budgeting allowances.

The Army has shifted focus onto these operational assignments because it believes that it is the real way to both 1) take care of warfighters and 2) develop the leadership potential of its physicians. Most physicians think that #1 is just plain wrong because sitting in meetings and tracking metrics doesn't strike anyone as real healthcare. It's not that the meetings are useless, per se, but rather it doesn't really involve patient care and a lot of it can be accomplished by non-physicians. This is especially true of a residency and/or fellowship trained physician, when the opportunity cost of removing that physician from the hospital/clinic must also be considered. As for #2, well the Army's concept of "don't just be a doctor" is sort of beyond the scope of this thread. I'll just say that if practicing medicine is your primary goal, then your goals do not match with the Army's.

Thanks for the good info.

So in a very general sense, do military physicians typical fill the following two roles?

1) GMO/deployment/operational tours - in which the physician is send with a unit and deployed and focuses primarily on more operational things than just the pure practice of medicine

2) send to a military hospital in the United States and does basically the same things as civilian physicians

I understand that military physicians are officers first, physicians second. Naturally, there will be a lot of responsibilities outside the pure practice of medicine. But as a whole, do most military doctors still dedicate a significant portion of their days practicing medicine in their trained specialties?

 

[colbgw02]

Thanks for the good info.

So in a very general sense, do military physicians typical fill the following two roles?

1) GMO/deployment/operational tours - in which the physician is send with a unit and deployed and focuses primarily on more operational things than just the pure practice of medicine

2) send to a military hospital in the United States and does basically the same things as civilian physicians

I understand that military physicians are officers first, physicians second. Naturally, there will be a lot of responsibilities outside the pure practice of medicine. But as a whole, do most military doctors still dedicate a significant portion of their days practicing medicine in their trained specialties?

I would not categorize it with such a dichotomy.

For one, while there are GMOs who deploy, physicians that deploy as GMOs, and physicians that deploy in primarily administrative positions, most deployments for medical corps officers are to provide medical care in their specialty. Now, the acuity and volume of that care can vary widely, but if you're deployed as a surgeon, they're typically not going to make you DCCS just because there aren't many operations to perform. So, it's not really correct to lump deployment in with being a battalion or brigade surgeon.

Secondly, physicians assigned to MTFs (or better generalized as TDA units) will have varying degrees of administrative duties. Some people will have light duty, in which case their practice may closely resemble a civilian's. Others will have a heavy administrative burden, in which case they are no longer really functioning as a physician. It's a spectrum, and where you fall on it will depend on a number of factors, such as your specialty, your seniority, your location, your bosses, and your willingness to participate/desire for promotion.

It's easy to say that you understand being a physician second and officer first. It's quite a different thing to live it. I was commissioned through ROTC, so I understand fully the idea of officership. I can also tell you that for me, and I dare say most physicians, medical school and residency were transformative experiences that changed me irrevocably. I worked damned hard for a full decade in order to become a board-certified physician, so I see my degree and board certification as necessary tools in order to practice my craft. The Army sees them as framed diplomas on a wall, necessary only in order to have a career as an MC officer. This fundamental disagreement in priorities is probably the primary reason why they'll no longer have access to my services in a just a few months.

 

[ProudMD]

I would not categorize it with such a dichotomy.

For one, while there are GMOs who deploy, physicians that deploy as GMOs, and physicians that deploy in primarily administrative positions, most deployments for medical corps officers are to provide medical care in their specialty. Now, the acuity and volume of that care can vary widely, but if you're deployed as a surgeon, they're typically not going to make you DCCS just because there aren't many operations to perform. So, it's not really correct to lump deployment in with being a battalion or brigade surgeon.

Secondly, physicians assigned to MTFs (or better generalized as TDA units) will have varying degrees of administrative duties. Some people will have light duty, in which case their practice may closely resemble a civilian's. Others will have a heavy administrative burden, in which case they are no longer really functioning as a physician. It's a spectrum, and where you fall on it will depend on a number of factors, such as your specialty, your seniority, your location, your bosses, and your willingness to participate/desire for promotion.

It's easy to say that you understand being a physician second and officer first. It's quite a different thing to live it. I was commissioned through ROTC, so I understand fully the idea of officership. I can also tell you that for me, and I dare say most physicians, medical school and residency were transformative experiences that changed me irrevocably. I worked damned hard for a full decade in order to become a board-certified physician, so I see my degree and board certification as necessary tools in order to practice my craft. The Army sees them as framed diplomas on a wall, necessary only in order to have a career as an MC officer. This fundamental disagreement in priorities is probably the primary reason why they'll no longer have access to my services in a just a few months.

Thank you for the helpful response.

Since you are separating from the Army soon, do you think that the experiences you have gained while in uniform will help you secure a great civilian position? Do you already have job offers lined up?

 

[colbgw02]

Since you are separating from the Army soon, do you think that the experiences you have gained while in uniform will help you secure a great civilian position? Do you already have job offers lined up?

Actually, I already have my job lined up. I really don't think being in the Army helped or hurt me when it came to my job search. What helped was having a few years of experience, which I would have had at this point in my career irrespective of whether or not I served. In my mind, the real question is: what would my first job right out of GME looked like if I hadn't been in the Army? That's a really difficult thing to answer because there are so many variables that I can't account for. My pedigree would have been different, my contacts in the field would have been different, and the timing would have been different - just to name a few. I can't say I regret my decision to be in the Army, but if I had it to do over again, I think I would have taken the civilian route.

 

[sonofva]

Thanks for the info. Could you elaborate a bit more on the purpose of these operation/GMO tours? Does the military have a surplus of physicians that not everyone is needed to practice in their chosen specialties?

As a military physician you are there to support war fighters and make sure that they have medical and medico-logistical resources to fight. The military is letting you specialize in pediatric gastroenterology (or whatever) essentially as a favor to you. The military higher ups, by their way of thinking, already have too many sub specialists. What they never have enough of is run of the mill GMOs to evaluate sprained ankles and advise line officers about medical issues...

 

[ProudMD]

Actually, I already have my job lined up. I really don't think being in the Army helped or hurt me when it came to my job search. What helped was having a few years of experience, which I would have had at this point in my career irrespective of whether or not I served. In my mind, the real question is: what would my first job right out of GME looked like if I hadn't been in the Army? That's a really difficult thing to answer because there are so many variables that I can't account for. My pedigree would have been different, my contacts in the field would have been different, and the timing would have been different - just to name a few. I can't say I regret my decision to be in the Army, but if I had it to do over again, I think I would have taken the civilian route.

During your service in the army, did you have enough opportunities to practice your field of medicine such that when you embark on a civilian career, you'll have no problem adjusting? I've heard a problem with some surgeons who, as a result of skill atrophy, have difficulty securing a position in the civilian sector. Did you experience anything similar?

 

[sonofva]

During your service in the army, did you have enough opportunities to practice your field of medicine such that when you embark on a civilian career, you'll have no problem adjusting? I've heard a problem with some surgeons who, as a result of skill atrophy, have difficulty securing a position in the civilian sector. Did you experience anything similar?

Didn't you already sign a contract for usuhs?

 

[ProudMD]

Didn't you already sign a contract for usuhs?

Of course I did, and I am excited for what lays ahead.

That doesn't mean I can't/shouldn't ask questions.

 

[colbgw02]

As a military physician you are there to support war fighters and make sure that they have medical and medico-logistical resources to fight. The military is letting you specialize in pediatric gastroenterology (or whatever) essentially as a favor to you. The military higher ups, by their way of thinking, already have too many sub specialists. What they never have enough of is run of the mill GMOs to evaluate sprained ankles and advise line officers about medical issues...

This is true, to a point. It doesn't represent the whole truth because, if it did, then why does the military even have pediatric gastroenterologists in the first place? Or to carry it further, why does it require its physicians to be licensed by the state? Why does it want its physicians to be certified by a private board and participate in MOC and CME supervised by civilian institutions? Why does it want its hospitals to my accredited by The Joint Commission? And why are its malpractice cases ajudicated in local civilian courts? If military medicine is really just about force maintenance and multiplication, then why do we bother with all these other things?

My answer is that military medicine is still trying to be all things to all parties. As someone said (maybe pgg?) quite cogently on another thread, there is no other organization on the planet as adept at providing state-of-the-art, first-world medical care in an austere environment than the U.S. military. Yet, that same organization is expected to turn around, while in garrison, and function with similar quality, breadth, and efficiency as the local private, for-profit hospital. It's a totally unrealistic expectation. On an individual level, it means that the physician is saddled with a litany of military-specific requirements (or sometimes lack of resources - e.g. CME funding, patient load) that detract from the civilian standards he is expected to maintain.

If the military isn't going to rewind the clock to when they basically let doctors be doctors, then I think we would be much better off taking a few lessons from the British, who freely rotate their military physicians back and forth from governmental civilian positions to the deployed environment. Obviously, it's not totally analogous because our federal healthcare institutions (IHS, VA) are not as robust as the NHS, but I think the idea is sound. Maybe we're starting to see some of that in the proposed changes to Tricare.

 

[colbgw02]

During your service in the army, did you have enough opportunities to practice your field of medicine such that when you embark on a civilian career, you'll have no problem adjusting? I've heard a problem with some surgeons who, as a result of skill atrophy, have difficulty securing a position in the civilian sector. Did you experience anything similar?

Mostly, yes. I am lucky for a number of reasons. For one, I was assigned to a large MTF, which has provided me with a volume, acuity, and breadth of patients not afforded to most people right out of training. Secondly, I dodged the brigade surgeon bullet a couple of years ago. Had I not dodged it, I would have spent my final years in uniform not practicing my specialty. I won't say that would have been a career killer, but it would have been devastating from a skill atrophy standpoint. Lastly, I am in a field that lends itself to moonlighting rather easily, which will make my transition to civilian practice smoother as compared to my colleagues who practice solely within the .mil. The one think that irks me is that the miliary still considers a fellowship in my specialty as a "reward", while completing one in the civilian world is industry standard. Then again, this is an organization that still routinely thinks it's acceptable for internship-only trained physicians to be left out on an island, so I can't be too surprised about their stance vis-a-vis fellowship.

 

[backrow]

The military is letting you specialize in pediatric gastroenterology (or whatever) essentially as a favor to you.

Sorry, have to call you out on this line. I did laugh really though.

The military does no "favors" for anyone. Signing for the military is really a one way contract. They get to determine everything (heck they can change their mind whenever they want) sometimes things work out for the best, other times they don't.

The only reason they have these types of subspecialists is to "support" the warfighter. That support extends to their family as we are tasked (currently) to provide care to all beneficiaries, not just the soldier/sailor/airman/marine/coast guardsman. Until the day comes that all dependent and retiree care is farmed out to the civilian world it will be much cheaper to train a handful of subspecialists that aren't needed in an operational environment than it is to pay for that care to be received in the community. This is the exact reason you see pediatrics take a hit every handful of years. Someone new gets in charge, decides we don't need pediatricians, the peds depts take hits, all the sudden they realize it wasn't such a good idea and things go back to the way they were.

 

[sonofva]

Of course I did, and I am excited for what lays ahead.

That doesn't mean I can't/shouldn't ask questions.

It does not mean you shouldn't ask questions. All I'm saying is that the questions you are asking in your recent posts probably should have been asked before you "took the pill", so to speak. Additionally, by the time you're ready to practice (8-10 years), things will most likely have changed significantly. My advice is to just focus on enjoying your time until medical school starts, and then on succeeding in your M1 year.

 

[sonofva]

Sorry, have to call you out on this line. I did laugh really though.

The military does no "favors" for anyone. Signing for the military is really a one way contract. They get to determine everything (heck they can change their mind whenever they want) sometimes things work out for the best, other times they don't.

The only reason they have these types of subspecialists is to "support" the warfighter. That support extends to their family as we are tasked (currently) to provide care to all beneficiaries, not just the soldier/sailor/airman/marine/coast guardsman. Until the day comes that all dependent and retiree care is farmed out to the civilian world it will be much cheaper to train a handful of subspecialists that aren't needed in an operational environment than it is to pay for that care to be received in the community. This is the exact reason you see pediatrics take a hit every handful of years. Someone new gets in charge, decides we don't need pediatricians, the peds depts take hits, all the sudden they realize it wasn't such a good idea and things go back to the way they were.

This is a nice sentiment, but largely untrue. The way military PEDS justifies its existence to the brass is by being the most deployed speciality, in largely a GMO Capacity (at least in the army)...also I know they don't do any favors, I just couldn't think of another way to phrase it...

 

[backrow]

This is a nice sentiment, but largely untrue. The way military PEDS justifies its existence to the brass is by being the most deployed speciality, in largely a GMO Capacity (at least in the army)...also I know they don't do any favors, I just couldn't think of another way to phrase it...

That claim didn't sound right to me so here's a source I found that covers 2002-2009:

http://www.rand.org/content/dam/rand/pubs/technical_reports/TR1200/TR1227/RAND_TR1227.pdf

In the top seven, five corps are represented: physician assistants (65D) are the most likely to be deployed, followed by health care specialists (combat medics) (68W), and then general surgeons (61J), family medicine physicians and their substitutes,1 nurse anesthetists (66F), health care administrators (67A and 70 series2) and behavioral sciences, social work, and clinical psychologists (67D, 73A and 73B).

1 Family medicine physicians and their substitutions include family physicians (61H), pediatricians (60P), emergency physicians (62A), internists (61F), flight surgeons (61N), and field surgeons (62B).

And pg 44 shows a chart that graphs who filled battalion surgeon jobs with FP doubling pediatrics and general internists nearly matching peds.

For the Navy I can assure you that Peds is not the most deployed specialty.

 

[Baron Samedi]

You could easily land yourself in a GMO if you wanted to in the Army. Just rank nothing but Transitional Years and/or apply for something you know you have no chance of getting. The myth of "Army doesn't do GMOs" is completely wrong -- many of my cohorts are doing just that.

 

[sonofva]

That claim didn't sound right to me so here's a source I found that covers 2002-2009:

http://www.rand.org/content/dam/rand/pubs/technical_reports/TR1200/TR1227/RAND_TR1227.pdf




And pg 44 shows a chart that graphs who filled battalion surgeon jobs with FP doubling pediatrics and general internists nearly matching peds.

For the Navy I can assure you that Peds is not the most deployed specialty.

Well touché. May not be fact, but that's the way Army PEDS advertises itself. All the leadership I've talked to say "we're most deployed, and that's why the army keeps us"

 

[asdf123g]

@colbgw02 : would you recommend doing another branch instead of army?

 

[colbgw02]

@colbgw02 : would you recommend doing another branch instead of army?

No way I could make a recommendation either for or against any branch. There are too many variables at play. Army was an "easy" choice for me, mostly because of a multi-generational history of service in the Army.

 

[asdf123g]

No way I could make a recommendation either for or against any branch. There are too many variables at play. Army was an "easy" choice for me, mostly because of a multi-generational history of service in the Army.

hmm..okay. Well, from what I can take from SDN, Army gives you the best chance to specialize (most residency's), Navy gives you the best location, and AF sucks. Agree? Disagree? Anything you wanna add? I have a hard time picking between the branches (should I go the military route) because I cant find the difference(s) between them.

 

[colbgw02]

hmm..okay. Well, from what I can take from SDN, Army gives you the best chance to specialize (most residency's), Navy gives you the best location, and AF sucks. Agree? Disagree? Anything you wanna add? I have a hard time picking between the branches (should I go the military route) because I cant find the difference(s) between them.

Speaking in generalities:

Army - greatest chance of continous training, largely because it's the biggest service with better match between number of applicants and number of positions. I think the Army probably treats its physicians the worst. The locations of the major teaching hospitals are pretty good (D.C., Seattle-ish, Honolulu, and San Antonio), but there are a lot of low cards in the deck regarding post-training locations. Definitely the biggest into "operational medicine", meaning that you will be expected to not "just be a doctor".

Navy - greatest chance of doing a GMO and probably best overall locations, when including both training and post-training possibilities. My impression is that the Navy tends to treat its physicians pretty well, but I'm basing that mostly on the fact that most Navy physicians I know are pretty happy.

Air Force - somewhere in the middle on likelihood of a GMO tour. Frankly, even after years of working with them, I don't have a good read on what it's like to be an AF medical corps officer. Sometimes, they seem to treat their people pretty well, then other times they make decisions that make the Army look like a bunch of geniuses.

 

[asdf123g]

@col

Speaking in generalities:

Army - greatest chance of continous training, largely because it's the biggest service with better match between number of applicants and number of positions. I think the Army probably treats its physicians the worst. The locations of the major teaching hospitals are pretty good (D.C., Seattle-ish, Honolulu, and San Antonio), but there are a lot of low cards in the deck regarding post-training locations. Definitely the biggest into "operational medicine", meaning that you will be expected to not "just be a doctor".

Navy - greatest chance of doing a GMO and probably best overall locations, when including both training and post-training possibilities. My impression is that the Navy tends to treat its physicians pretty well, but I'm basing that mostly on the fact that most Navy physicians I know are pretty happy.

Air Force - somewhere in the middle on likelihood of a GMO tour. Frankly, even after years of working with them, I don't have a good read on what it's like to be an AF medical corps officer. Sometimes, they seem to treat their people pretty well, then other times they make decisions that make the Army look like a bunch of geniuses.

If your family is close to said locations (a major teaching hospital), does this increase your chance of landing a residency there or (I presume) post-training deployment....or do they simply just not care?

 

[colbgw02]

@col

If your family is close to said locations (a major teaching hospital), does this increase your chance of landing a residency there or (I presume) post-training deployment....or do they simply just not care?

They don't care. In the civilian world, a family's location might marginally help you inasmuch it would help a program distinguish betweeen a serious applicant and one just rounding up to the magic number of programs to which to apply. That is, if you're a California medical student applying to MGH with family in Boston, then MGH might want to know that so that they know you're serious about coming there, rather than just applying because MGH is a big name. But in the military, the number of total programs is generally so small that you'll be applying to all or nearly all of a specialty's programs irrespective of location.