career advice wanted

[seekingadvice23]

So my ultimate goal is to complete anesthesia residency and predominately practice anesthesia. However, I am currently tied to the military residency system. My options are to run out my military time as a GMO or switch to internal medicine to finish military time with an actual residency and delay starting anesthesia residency a couple more years-5 likely. Grades and scores not great at all. Simply waiting to complete a civilian residency in anesthesia right after GMO time will have greatly limited programs available due to limitations on location due to family reasons. Possibly only 1-2 programs near me. Fear is that I wait to finally apply in my last year of payback as a GMO and when the match rolls around I don't get selected which really forces my hand to figure something out. If waited till after doing IM residency and that payback then pretty much every anesthesia program becomes available.

Any advice on pursuing IM and then later anesthesia would be appreciated. Would applying as a board certified IM guy with a couple years of experience be looked at positively or negatively when going after anesthesia civilian residency?
thanks

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[smb4]

Your choice is not an easy one. I was in a similar situation took a gamble and it worked, thank god.
Several questions for you
1) Any options on doing anesthesia in the military? Have you tried talking to anesthesia surgeon general consultant about your desire for specialty? Any field/combat time under your belt?
2) IM in the military sucks *ss big time. You will be a geriatrician and taking care of folks that nobody else wants to touch with 10ft pole. The whole hospital will crap all over you and you'll have to take it while asking for seconds. Another aspect that's missing in military IM is not seeing sick young people. They are just not there, for the most part military folks are healthy .

I don't want to post too much on this forum as the world of military (Army) medicine is small and folks may recognize me. PM me and I will try to advise you.

 

[pgg]

Which service?

I think I'd have gone insane in an IM residency. (Or any other predominantly-clinic field.)

GMO-and-out is probably your best plan, unless you're REALLY uncompetitive for residency. People who apply for residency after finishing GMO time in the military typically match very well and do very well. I know you said you're geographically limited for family reasons, and you didn't say why, but you may wish to give that some serious rethinking. Consider

1) Most every applying med student is willing to move anywhere for a shot at med school. Residency in your chosen field is just as big a deal and should probably be approached with the same mindset.

2) You're in the military now, so clearly you've accepted and are dealing with living wherever the military tells you to live, or deploying away from family.

Anesthesia residency is only 3 more years. It's not that long, though it seems like an eternal grind whild you're doing it. Be wary of settling for a specialty you don't want for the remaining 30 years of your professional life, because of geographic preferences for a short period. Obviously this is a very personal judgment, but IMO a dependent/invalid parent or a spouse with a high power immobile job might be good reasons to geographically tie yourself to an area ... wanting to be near the in-laws or a favorite cousin is not. (And I love my in-laws.)

 

[seekingadvice23]

answers to the smb questions-
1) Any options on doing anesthesia in the military?
of course but after applying previously and being shut down doesn't give me the warm and fuzzies. From my year of GMOs I know of at least 4-5 that will be applying for the 1-2 spots that are ever available for the non-medical student applicant. Factor in the occasionally already board certified and maybe even fellowship trained attending who decides- "hey, i am going for the 20 for pension and switching to another specialty costs me nothing other than I have to be a resident again and coast through residency, I still get to wear that oak leaf on my chest, pay stays the same, secure a period of no deployments, get to stay at a desirable MTF, and move to a more lucrative specialty."

Have you tried talking to anesthesia surgeon general consultant about your desire for specialty? I haven't contacted the consultant, though I have been told that anesthesia is over staffed in the military by an associate program director.

Any field/combat time under your belt? no deployments and foreseeable future looks like not too many available with higher ups asking wanting to do them now for their future promotion board.
2) IM in the military sucks *ss big time. You will be a geriatrician and taking care of folks that nobody else wants to touch with 10ft pole. The whole hospital will crap all over you and you'll have to take it while asking for seconds. Another aspect that's missing in military IM is not seeing sick young people. They are just not there, for the most part military folks are healthy .
I completely agree that as IM the entire system just ****s on you. Typical understaffed hospital falls onto shoulders of the FM and IM and then there is a arm wrestling match forcing IM to bend over since they have more experience than FM.
I would only have to deal with that as an attending for 2.5 years, maybe I could score a MTF spot with residents fresh out of the gate but who knows.

 

[seekingadvice23]

I completely agree that getting desired specialty trumps everything and in most cases if possible you should move anywhere required to achieve it. But my spouse does have one of those high power immobile job that locks us into a relatively isolated area with only 1-2 programs available to pursue while I would be free from my military time ( post 3 years after completing the GMO and out plan). After those 3 years then every anesthesia residency geographically opens up though because my wife could pursue a new job anywhere.

"2) You're in the military now, so clearly you've accepted and are dealing with living wherever the military tells you to live, or deploying away from family."

Completely familiar and aware of the "fun" living arrangements while in the military. I could always just apply to every residency available and be separated possibly from my spouse for my entire 3 year anesthesia residency but this would be extremely last resort.

If I could foresee my future that I had to choose between doing IM for a mere 2.5 residency and then 2.5 payback so that I am always with my wife unless military screws that up and then finally be free to apply to any anesthesia program in the country vs doing GMO time for 3 more years and then be separate from my wife a majority of those 3 years while in anesthesia residency, I would choose the IM route every day of the week because near my spouse>then becoming an anesthesiologist 3 years faster. But I don't have that crystal ball yet.

In terms of doing the IM route and then doing anesthesia in the future I compare it to those who go IM and pursue cards, plum critical care, GI. Had to suffer through IM to then do that 3 year fellowship for what they ultimately wanted, which for me would just be doing another residency vs going into a fellowship.

Any one or worked with someone who did the IM thing and then did anesthesia have any positive reflections on doing both?