All Branch Topic (ABT) HPSP question. These never get old, right?

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Ho0v-man

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I'm considering HPSP. Non-trad with a wife and kid accepted to a very expensive DO school at 31 years old. I don't have a problem with making less while paying the military back or being wherever they tell me to while in. My only apprehension is the military telling me what specialty I'll go in to. Most of my interests lie in primary care which I guess won't be a problem, but if I become interested in something like radiology or anesthesia or EM and I'm actually competitive for it on the civilian side, can the military make me do something else anyway?

If it helps, I have zero interest in surgery and I'm not too keen on the idea of doing an IM fellowship. Also, without HPSP, I'm going to be about 330k in debt upon graduation.

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If there were a crystal ball that could predict what it is you want to go into, then the military can be a good option for someone who wants to be an officer first and a doctor second, and who's family doesn't mind being moved to the terrible parts of the world. You may not make less, frankly, than your civilian counterparts. If you choose to do something like radiology or anesthesia, etc., then yes the military can very indirectly make you do something else. They get away with saying that they don't do that because technically its up to you to match into the specialty of your choice. So if you're the absolute most competitive person applying to your chosen specialty, then you'll certainly get in. If you don't match into your specialty of choice, then you'll either end up in a transitional program followed by a GMO tour, followed by reapplying to residency either in or out of the military - or you could end up in a second choice specialty.

See, the recruiters will tell you that the Army won't force you to do something, and that is true in the most technical sense. As long as you're ok with doing a 4 year GMO tour and then applying as a civilian (in a worst-case scenario), then no one is forcing you to do anything. It's kind of like throwing a grenade at someone and then making it clear that they blew themselves up because they caught it.
 
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This question comes up frequently, and I really want to know who's telling people that the military will force you into a different specialty. If you list specialty choice as anesthesiology, and only rank anesthesiology prelims, the Army is not going to tell you on match day, "Congratulations, you matched Pediatrics!" If you fail to match your chosen specialty, you're going into a TY internship. During intern year, you'll reapply. Now, since the Army offers almost only continuous contracts, you probably won't match as a PGY1 applicant (unless you're awesome, in which case, why didn't you match initially? Or someone dropped out, opening a spot). So, having not matched, a GMO tour is now your future. Someone may approach you, though, and go "Hey, you want a RAM or Psych spot?" You'll refuse, and spend two years in GMO land. During your second year, you'll try again, and probably fail again for the sane reasons as before (unless that year happened to have poor med student applicants, or other interns/GMOs didn't apply). Again, someone will come at you with an offer for an unfilled spot in some other specialty like FM or IM. You'll refuse again, and do a second GMO tour. During your last year, you'll decide to leave this far behind, and reapply for the civilian match.

I have heard many four-and-out success stories on this forum, as a creative applicant can spin their time in the military favorably. However, I have also heard stories of people trying to apply for the civilian match, and having their commander, or clinic chief denying leave requests for interviews, as they were not submitted at least thirty days in advance (because we usually don't get 30+ days advance notice for interviews).

TL;DR, listen to High Priest. You can't be forced into a specialty, but you can be made to choose between something you didn't want, and being a GMO for your payback.

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It works the same as the civilian match. You choose what you apply to and if you don't get it you do something else whether that is putter around for a bit or accept a back-up speciality. The disadvantage is you may have to wait longer before you reapply and can run into hurdles while reapplying (deployment, idiot commanders, etc). The benefit is that a military "pre-lim and GMO/FS/DMO tour" is a lot better than the worst case civilian "SOAP into a malignant program and finish the year with no ongoing job prospects besides hoping to match this time" outcome. I also argue that pre-lim + GMO is a detour but a solid opportunity to come back as a stronger applicant and match well in your chosen specialty. The SOAP to pre-lim year is frequently a downward spiral people are desperately trying to pull out of.

Summary: Higher risk of not matching into your specialty of choice initially but likely better odds of matching long-term.
 
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It works the same as the civilian match. You choose what you apply to and if you don't get it you do something else whether that is putter around for a bit or accept a back-up speciality. The disadvantage is you may have to wait longer before you reapply and can run into hurdles while reapplying (deployment, idiot commanders, etc). The benefit is that a military "pre-lim and GMO/FS/DMO tour" is a lot better than the worst case civilian "SOAP into a malignant program and finish the year with no ongoing job prospects besides hoping to match this time" outcome. I also argue that pre-lim + GMO is a detour but a solid opportunity to come back as a stronger applicant and match well in your chosen specialty. The SOAP to pre-lim year is frequently a downward spiral people are desperately trying to pull out of.

Summary: Higher risk of not matching into your specialty of choice initially but likely better odds of matching long-term.

Hmmm. I would have assumed you'd be too busy to improve your app in that time. You mean you're able to do things like research, etc during your prelim/gmo purgatory?
 
Hmmm. I would have assumed you'd be too busy to improve your app in that time. You mean you're able to do things like research, etc during your prelim/gmo purgatory?

You are unlikely to be able to participate much in research. You can try to do that kind of stuff on your own time for sure, but you may be doing a GMO tour in the middle of no where and that can make it difficult. You may also be very busy with your GMO job which could limit your free time. However there are many GMOs who also have ample free time. Some of them are productive with that time and some of them just chill. If you have that free time it will depend on how motivated you are.

What you can do is highlight your experience working independently as a physician; all the staff you have been in charge of and had to supervise, how many patients you have had under your care all by your lonesome. People on this forum who have shared their GMO to civilian match success stories highlight these aspects of their experience as being very positive on the interview trail.

The other thing you, and anyone else who reads this, is to wrap your head around the power of your own attitude. If you think that going GMO is purgatory then you will be a miserable person that no one enjoys being around. You will likely wallow in your misery and not be productive at work or with figuring out the best way to match civilian. If you get stuck out in the middle of nowhere expecting to be miserable you will be miserable. If you are heading out to the desert with the attitude of "well, I guess I'm going to get into [dirt biking, side by sides, coyote hunting, rock climbing, artifact hunting, the potential list is endless] for a few years" then you will likely make the most of your time. The secret to happiness in the military is the ability to roll with the punches and figure out how to have fun anywhere.
 
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You are unlikely to be able to participate much in research. You can try to do that kind of stuff on your own time for sure, but you may be doing a GMO tour in the middle of no where and that can make it difficult. You may also be very busy with your GMO job which could limit your free time. However there are many GMOs who also have ample free time. Some of them are productive with that time and some of them just chill. If you have that free time it will depend on how motivated you are.

What you can do is highlight your experience working independently as a physician; all the staff you have been in charge of and had to supervise, how many patients you have had under your care all by your lonesome. People on this forum who have shared their GMO to civilian match success stories highlight these aspects of their experience as being very positive on the interview trail.

The other thing you, and anyone else who reads this, is to wrap your head around the power of your own attitude. If you think that going GMO is purgatory then you will be a miserable person that no one enjoys being around. You will likely wallow in your misery and not be productive at work or with figuring out the best way to match civilian. If you get stuck out in the middle of nowhere expecting to be miserable you will be miserable. If you are heading out to the desert with the attitude of "well, I guess I'm going to get into [dirt biking, side by sides, coyote hunting, rock climbing, artifact hunting, the potential list is endless] for a few years" then you will likely make the most of your time. The secret to happiness in the military is the ability to roll with the punches and figure out how to have fun anywhere.
Thank you. Every thread I read likens the whole process to a date with a sandpaper colonoscope. It's nice to know attitude counts for something.
 
The secret to happiness in the military is the ability to roll with the punches and figure out how to ha

It's like prison rape. You just go to your happy place and hope the guards come before you bleed out.
 
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Don't get me wrong, sometimes it really sucks. Having a positive attitude will help you get through those times. That can be challenging at times for sure. But you know what? Sometimes civilian life really sucks and sometimes civilian life can be really challenging. Military life is definitely more limiting though so a positive attitude is what can keep you sane.
 
We shall see how far the power of positive thought carries you once you're a staff doc somewhere. I hope very well. I won't argue that a positive attitude helps - its better than the alternative. But you can only trick yourself so many times that the $#!T sandwich you're eating is roast beef. You really do have to love the military to keep taking bites and just be happy you're not starving. "It could be worse" and "things can be bad on the civilian side too" are institutionalized thought processes. They are technically true, but miss the points that "it could be worse" doesn't make it better and that the general flow of talent over time is away from the military not towards it.

My opinion is there are only two ways to stay sane:

1 - Fight every single minute of your military career to do the right thing for your patients and your career. If you have the energy to do that against the backwards tide of the Army, you're some kind of superman.
2 - Put your head down, get institutionalized, and weather the storm. Which is almost equally as difficult if you want the right things for your patients and your career.

There are some things that don't have a silver lining like skill rot.

For the other things (like being stationed somewhere up satan's @$$) looking for the bright side does help.

Anyway, in the most general sense I don't disagree with you. I just don't put as much stock in wishing myself to contentment.
 
I've been in the mil for 22 years already so I'm not speaking hopefully, but from experience. I have lived in some not so great locations and been deployed with less than 30 days notice. I have been in malignant commands. I have had skill atrophy in my previous skill set due to certain demands/deployments, etc. These problems are not unique to physicians and these are the things that have gotten me this far with the military and still relatively happy.

Having said that I will retire at the earliest opportunity in order to gain my precious freedom.
 
I would argue that while some issues are the same, some are quite unique to medicine - especially the skill rot. I don't know what your previous skillet was, but unless it took you 13 years and half a million dollars to even get off the ground, I can't imagine it compares. Talk to me if you end up as a cardiothoracic surgeon who can't safely perform half of the surgeries you trained a third of your life to do because someone thinks you should be able to walk away for two years and then just go back to cracking open chests. Or maybe you can't do your job simply because your hospital's ICU doesn't want to support it. Or maybe your command decides they just don't think CT is worth it, but also you can't PCS. The fact is, I can't think of another MOS in the military that compares to that kind of wasted potential.
And so you are speaking hopefully. You're hoping, expecting, that your 22 years in the military will translate into being content as a physician. Or perhaps willing it to be the case with positive thoughts. And maybe you'll be right. I do think that knowing how to institutionalize oneself seems to make military life easier for people. There's no doubt that being used to being screwed routinely makes it hurt less. It's why we're all offended that kids in sweatshops in Malaysia make $1.50 a week, but they're still walking in to those jobs. I had a career before med school, and a decent one. Not as good as medicine, but better than the Army. So it's harder to pretend things are good on this side of the line. But, I try.
In any case, maybe you'll end up in primary care or at a MEDCEN. Or maybe you'll be a pediatrician at a small MEDDAC in a backwards part of the country and you'll be able to ignore the bad stuff and be happy. No one knows. But until you're that CT guy, it's still hopeful thinking.

Anyway, I don't mean to say that hunting the good stuff isn't a good idea, or isn't helpful. It is. My point is that for someone considering HPSP, it is important to understand that depending upon where the cards fall, that might not cut it. Is that true on the civilian side? Sure. But from my experience, and as represented by the general tide of ETSing, it's much less common or at least more avoidable.
 
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These problems are not unique to physicians and these are the things that have gotten me this far with the military and still relatively happy.

they're actually pretty unique to military physicians. i'm sure you have civilian colleagues. i get tired of explaining the concept of a BDE surgeon to them. at least on the civilian side they know the money train is pulled by the physicians. the military is 5 different priorities pulling 5 different directions.

the point of making the best of a GMO tour is a good one. it can definitely be spun in a positive way, and it some instances may help people decide on an eventual career if they are on the fence. there's also a good discussion to be had on how being a little institutionalized can be protective and in some situations is necessary for the job.

to the OP-- as has been stated, they can't "force" you to do a specialty you don't want. just like you can't "force" a toddler to eat their vegetables when they want nuggets. but, if you don't offer anything other than peas with the promise of maybe nuggets later, they eventually have to eat something. not the hand grenade analogy but i'm sure you get the point, lol.

--your friendly neighborhood 37% institutionalized caveman
 
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Dr. Highpriest, Cooperd0g mentioned he was a naval aviator in past posts.

in which case the BDE surgeon thing may be moot. but man, do they still use the **** outta GMOs, lol.

aviation is probably a very similar career feel. gradual push to admin and desk jobs as you progress until at some point they put you to pasture. (unless you are viper in top gun)

--your friendly neighborhood highway to the danger zone caveman
 
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A Brigade Surgeon position for me was not a GMO position. As an operational assignment I learned a lot from it with respect to leadership, system planning, mentorship, etc. A quality professional must have Knowledge, Skills, Attitude. The last point many people need to work on...
 
I would argue that while some issues are the same, some are quite unique to medicine - especially the skill rot. I don't know what your previous skillet was, but unless it took you 13 years and half a million dollars to even get off the ground, I can't imagine it compares. Talk to me if you end up as a cardiothoracic surgeon who can't safely perform half of the surgeries you trained a third of your life to do because someone thinks you should be able to walk away for two years and then just go back to cracking open chests. Or maybe you can't do your job simply because your hospital's ICU doesn't want to support it. Or maybe your command decides they just don't think CT is worth it, but also you can't PCS. The fact is, I can't think of another MOS in the military that compares to that kind of wasted potential.
And so you are speaking hopefully. You're hoping, expecting, that your 22 years in the military will translate into being content as a physician. Or perhaps willing it to be the case with positive thoughts. And maybe you'll be right. I do think that knowing how to institutionalize oneself seems to make military life easier for people. There's no doubt that being used to being screwed routinely makes it hurt less. It's why we're all offended that kids in sweatshops in Malaysia make $1.50 a week, but they're still walking in to those jobs. I had a career before med school, and a decent one. Not as good as medicine, but better than the Army. So it's harder to pretend things are good on this side of the line. But, I try.
In any case, maybe you'll end up in primary care or at a MEDCEN. Or maybe you'll be a pediatrician at a small MEDDAC in a backwards part of the country and you'll be able to ignore the bad stuff and be happy. No one knows. But until you're that CT guy, it's still hopeful thinking.

Anyway, I don't mean to say that hunting the good stuff isn't a good idea, or isn't helpful. It is. My point is that for someone considering HPSP, it is important to understand that depending upon where the cards fall, that might not cut it. Is that true on the civilian side? Sure. But from my experience, and as represented by the general tide of ETSing, it's much less common or at least more avoidable.


HighPriest,

Who are you and where do you work? Would love to provide you some far less bitter mentorship. Bottom-line to everyone, come into the military with a plan, modify your plan along the way as fit, and if it tips towards getting out then get out and move on. A decade or fifteen years is professionally not that horrible in my mind.
 
You say bitter, I say realistic. It all depends upon how much kool-aid you're drinking. I couldn't agree more with having a plan and modifying it as needed. Unfortunately, most HPSP applicants don't come in to the military with enough information to even formulate a plan. I can't think of a single recruiter who mentioned the possibility of a brigade surgeon billet to me, and I can think of two specifically who told me that GMOs just didn't happen in the Army.

If I knew then what I know now, and I still signed on the line, I wouldn't be bitter about it at all. I don't get bitter about the stuff that the Army was forthright about. And while I can adjust fire for a great many curve balls, the career-destroying ones are harder to accept. I just feel that a little transparency is warranted.

So far as whether spending 12-15% of your life doing something you don't like is a big deal or not - well, that's going to be very dependent on the person. But yes, you deal with it, then you get out and move on. I imagine its kind of like getting a divorce or spending a few years in the clink.

And I don't need any mentorship at this point. The light of the end of the tunnel is near enough that it is a moot point. For whatever it's worth, all of the positive mentors that I've had in my field have actually switched sides since I went on AD.
 
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My discussion of attitude is directly in relation to the possibility of being forced into a GMO tour because one didn't select for their desired residency and some general military stuff. I completely agree with everyone that sending sub specialists out to do battalion surgeon billets is a big waste of training and huge risk of skill atrophy. I also agree that being stuck in a tiny hospital with few patients as a sub specialist is also not going to be great for your skills. However, doing a GMO tour after a surgical internship isn't exactly causing a ton of atrophy because you didn't exactly have the greatest skill set to begin with.
 
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My discussion of attitude is directly in relation to the possibility of being forced into a GMO tour because one didn't select for their desired residency and some general military stuff. I completely agree with everyone that sending sub specialists out to do battalion surgeon billets is a big waste of training and huge risk of skill atrophy. I also agree that being stuck in a tiny hospital with few patients as a sub specialist is also not going to be great for your skills. However, doing a GMO tour after a surgical internship isn't exactly causing a ton of atrophy because you didn't exactly have the greatest skill set to begin with.
Yeah, roger that. Sorry to pull your intended message out of context.
 
A Brigade Surgeon position for me was not a GMO position. As an operational assignment I learned a lot from it with respect to leadership, system planning, mentorship, etc. A quality professional must have Knowledge, Skills, Attitude. The last point many people need to work on...

just to clarify, that's not directed here is it? more toward the general AMEDD? the "leadership, planning, professional" line of BS has been the "selling point" of BDE surgeon tours for years. if that's the case why aren't people volunteering left and right for these amazing opportunities? it's all spin. to argue a BDE surgeon assignment makes you a better physician (not officer) unless you are prev med is spurious at best. i've yet to run across someone who was medically better off. more likely to get promoted, have good things happen to you-- i'd damn well expect that to be the case. and if they are so great, why is there so much mystery and smoke filled room shenanigans going on when they are assigned?

that being said, my attitude when deployed or at my 2 recent NTC rotations could not have been better. i don't blame the medics, the BDE staff, or the commanders for the failings of the AMEDD. you do what you can with what you have, and in those cases i agree attitude makes or breaks it. but sometimes "you need to have the right attitude" is a thinly veiled "just accept it and move on." like a recent article i read stated-- we don't need more training in resiliency, we need training on how to be resistant to abuse.


HighPriest,

Who are you and where do you work? Would love to provide you some far less bitter mentorship. Bottom-line to everyone, come into the military with a plan, modify your plan along the way as fit, and if it tips towards getting out then get out and move on. A decade or fifteen years is professionally not that horrible in my mind.

like @HighPriest mentioned, there is no plan. i have tried to "plan" for the last 12 years and other than when i been in training status during residency or fellowship, can't plan. at our captain's career course one of the instructors talked about a "career map"-- making it sound so simple. the problem is the original "career map" we signed up for (pre 9/11) had at least 4 career tracks that were all ways to have a satisfying career. those have all been pruned to a single doublewide track of clinical/operational. if you are allowed to do clinical it is with operational hovering over your head until you retire or ETS. to be able to plan you have to have some transparency and trust the people running the show-- which currently doesn't exist.

not to say i haven't had mentors. i've had great mentors-- mentors not only in medicine but in their family life as well, ones i that i will have relationships with until we die. the problem i have is my mentors have a totally different set of experiences to draw from. they have not been BDE surgeons, or had to worry about being forced to an unaccompanied tour to korea as a flight surgeon for no real reason other than they needed a body. they may have deployed, but only for 4-6 months. the current senior O4/O5 group is in uncharted territory, and we are the ones breaking ground in how to navigate the "new" AMEDD, and are relying on each other to figure out the system because no one really knows what the system is. look at promotions. everyone knows someone passed over for no reason, and people who get "rewarded" with promotions and choice assignments who have never deployed, are non-deployable, haven't PCSd in a decade, are lazy clinicians, etc. look at assignments. i make the best of it because the alternative is i go crazy, lol.

lastly-- 10-15 years of arguable the *prime* of your life to me is a big deal. 10-15 years "professionally" in some cases is 30+% of your career. sure, it can be overcome, but it's not an excuse for the abuse.

sorry for the mini cathartic spewage. i'm really a pretty easy going guy, and all in all am ok with my situation. but occasionally i get riled up. plus it's friday. :D

--your friendly neighborhood pizza and beer time caveman
 
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and now i feel bad derailing the thread. boo to me. ummmmm.... no, you can't be forced to a residency you don't want. yes, the military can be good for some people, and difficult to tolerate for others, sometimes both for the same people at the same time.

--your friendly neighborhood closing the laptop now caveman
 
So talked to an army recruiter yesterday. I was told that they don't make you do gmo tours like the other branches and you will definitely go straight from school to internship to residency. Is that actually true?


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So talked to an army recruiter yesterday. I was told that they don't make you do gmo tours like the other branches and you will definitely go straight from school to internship to residency. Is that actually true?


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Not true. Did you read the posts above from High Priest, Psychbender, Deadcactus, Cooperdog.... ? Not all new doctors in the Army go straight from school to internship to residency.
 
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Not true. It is LESS common to do GMO tours in the Army, but it absolutely happens.
 
Echoing above. Though under the assumption that you are an average medical student and did not shoot for the moon in terms of what residency you want then you will train straight through. Of course the Army can make you a battalion surgeon (ie GMO) after you sub-specialized and all that...
 
So talked to an army recruiter yesterday. I was told that they don't make you do gmo tours like the other branches and you will definitely go straight from school to internship to residency. Is that actually true?


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You may go straight through your training, but you can always then be assigned to a brigade surgeon slot in which you will promptly stop doing clinical medicine and handle paperwork instead. Read this forum for life as a brigade surgeon, one of the fun surprises recruiters don't tell you about have no knowledge of or ability to explain.
 
Bottom line. I got out after a decade. I never complained once. Maybe it was because I knew I could get out if I needed to. After my Brigade Surgeon position I was able to work in academic medicine which I would not have been able to do at that point in my career as a civilian. My military experience set the conditions for me to be able to obtain my position. I strongly feel that I would not have been able to get where I am now without having been in the military. Did I miss the birth of my son because I was deployed. Yes. Did I move to nowhere USA for awhile. Yes. Am I better for it. Yes (I am but that is just me personally). Anyhow, I still would like to add perspective to this group. Good luck to all!
 
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So talked to an army recruiter yesterday. I was told that they don't make you do gmo tours like the other branches and you will definitely go straight from school to internship to residency. Is that actually true?


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Talk to all the CPTs fresh out of internship and attending the Flight Surgeon Primary Course with orders to Korea/Fort Drum/Fort Irwin/etc.


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You couldn't have worked in academic medicine right out of training? Why not?
Some academic jobs, coincidentally the most efficiently run and highest paying, are extremely difficult to get. I'm guessing that he, like me, leveraged leadership skills he developed in the .mil to break into one of those jobs in a desirable city. I can only speak about my current job with certainty, but you need to be bringing something extra to the practice to get an interview let alone an offer. The only time it's easier to get a job is when there is a significant expansion of services and they need to hire more than the usual number of people. Many of the surgical practices may only hire one person every few years, we hire more because of the nature of the anesthesia services, but we still get dozens of CVs every year from new fellows and experienced anesthesiologists. Many of our hires in the last 5-10 years had experience elsewhere and were offering some unique skills. The other thing about academia is that it's easy to slowly fade away by cutting down to 80% then 50% clinical time, stop taking overnight call, etc. That can add several more years to your career.


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Il Destriero
 
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You couldn't have worked in academic medicine right out of training? Why not?

Thanks for the question. More specifically in my case appointments as an APD and a 100% teaching service especially in a city you did not go to medical school or complete residency.
 
Some academic jobs, coincidentally the most efficiently run and highest paying, are extremely difficult to get. I'm guessing that he, like me, leveraged leadership skills he developed in the .mil to break into one of those jobs in a desirable city. I can only speak about my current job with certainty, but you need to be bringing something extra to the practice to get an interview let alone an offer. The only time it's easier to get a job is when there is a significant expansion of services and they need to hire more than the usual number of people. Many of the surgical practices may only hire one person every few years, we hire more because of the nature of the anesthesia services, but we still get dozens of CVs every year from new fellows and experienced anesthesiologists. Many of our hires in the last 5-10 years had experience elsewhere and were offering some unique skills. The other thing about academia is that it's easy to slowly fade away by cutting down to 80% then 50% clinical time, stop taking overnight call, etc. That can add several more years to your career.


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Il Destriero
Your post is exactly what I am referring to. I am also glad to hear of others who come out much for the better as I have!
 
Your post is exactly what I am referring to. I am also glad to hear of others who come out much for the better as I have!

Everyone loves a veteran, and the real world leadership you have thrust on you as a new graduate in the military exceeds the opportunities available to many mid career faculty. You can spin all the collateral duties right around as unique skills you're bringing to the table on day 1.
These are the kinds of things that are often overlooked and can't really be quantified.


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Il Destriero
 
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