Pros/Cons of military residency

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lizzers729

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I'm a rising 4th year HPSP student and am having second thoughts about my life plan, so I'm looking for some input. Right now, my plan is do to a Navy PGY-1 year in internal medicine, and then apply for anesthesia (yes, I'm planning on those GMO years). I am completely fine with this plan and thought I was looking forward to it- having a few years where I'm out practicing and making sure I know what I want to do before completing my residency. However, I feel like a lot of people I talk to (civilian program directors, deans, etc) really look down on military residencies, and people on this forum don't always exactly have the best things to say. I've been strongly encouraged to look into deferment, which I initially just assumed I wouldn't get, but I think anesthesia might be a specialty where they are more available, and I think I'm fairly competitive. I guess any input anyone might have as to the pros/cons of either would be helpful.

So far-
Navy match- I like that I only have to apply/interview to 3 places, seems like a lot less stress and money. And I like having a pretty narrow idea of where I will end up. Also, the thought of GMO doesn't really bother me right now, and in a weird way, I'm looking forward to it? (I also owe 4 years for NROTC in college- so yes, I have at least been on a ship for a little while).

Civilian- I guess the main advantage could be better programs? Also the fact that I could train straight though, but I don't really think that a couple years away would really mess up anything. I also feel like I'd be more guaranteed to end up in anesthesia this way, considering I've heard that only around 50% of post-GMO LTs actually match to anesthesia.

And theoretically, which path do you think might be easier for the whole starting a family thing? I'm not even close to being married or anything, but just out of curiosity.

Thanks for any advice in advance!! Let me know if I'm totally mistaken about something.

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I'll share a couple of thoughts......

It sounds as if you are not completely committed to Anesthesia. For those who are not sure what they want to do when they grow up, a GMO tour is not a terrible thing. I have known many who have "found" their callings while on a GMO/FS/UMO tour. So there is some advantage to doing that.

You owe 8 years. This is not an insignificant period of time. It does limit your choices a bit. Let's face it, you are not going to do 8 years as a GMO to get out to do a civilian residency. Not really reasonable.

Inservice GME. The primary complaint I have heard of Navy Anesthesia programs is that your level of acuity is on the low side. We have managed to farm out our over 65 really sick patient population and it diminishes your experience level for the really tough cases. On the flip side, I have never had an Anesthesia friend have any difficulty finding a job when they decided to get out.

Deferment. Anesthesia is overmanned in the Navy at present. While there might be one or two deferments, it is not likely to be more than that (and the number may be zero). Your real chances of a deferment are small, so it may be a moot point all together.

Long term. You owe 8 years. If you do internship and an Anesthesia residency in the Navy you will be at 12 years when your time is up. With the rise of CRNAs and the overall future of health care in flux, staying for a 20 year career may be desirable. If you do a deferment, that will add four years before you can retire.

I won't say which choice is best. That is really for you to decide. Once you figure out what you want to do (or a close approximation) ask for it. Don't think about odds. Don't over plan. But in the end if you ask for what you want, the worst they can do is say...no.
 
Thanks for your reply! I hadn't really thought about the years in service point before, so that was definitely helpful. I think owing 8 years and not being able to get out to do a civilian residency, and therefore not really being guaranteed to do anesthesia is something that worries me. I guess I'll just have to wait and see until the updated list of deferment slots comes up for this year (I'm guessing sometime soonish?)
 
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If you really want to do anesthesia (and are at least somewhat competitive), you should be able to do that. It may be after a GMO tour, but that is OK. The deferment list will come out in late September or early October. At this point, don't lose a lot of sleep over this. What will be, will be.
 
I am an HPSPer, deferred in anesthesiology with NADDS and extended my deferment for a fellowship. I'll give you my take on your original email.

I'm a rising 4th year HPSP student and am having second thoughts about my life plan, so I'm looking for some input. Right now, my plan is do to a Navy PGY-1 year in internal medicine, and then apply for anesthesia (yes, I'm planning on those GMO years). I am completely fine with this plan and thought I was looking forward to it- having a few years where I'm out practicing and making sure I know what I want to do before completing my residency. However, I feel like a lot of people I talk to (civilian program directors, deans, etc) really look down on military residencies, and people on this forum don't always exactly have the best things to say.

I think a lot residency is what you make of it. The Navy programs have all the pieces you need to get a good anesthesiology education. It just isn't all packed up at a man's best hospital. If the programs are missing pieces they have outside rotations set up.


I've been strongly encouraged to look into deferment, which I initially just assumed I wouldn't get, but I think anesthesia might be a specialty where they are more available, and I think I'm fairly competitive. I guess any input anyone might have as to the pros/cons of either would be helpful.

I'm guessing there will be no deferments in anesthesiology for the next several years. As NavyFP said, we're a bit up on our numbers. Some of our residency programs are actually taking less than their accredited numbers until we fall closer to our allotted number of billets. That may change by the time you did a GMO tour.


So far-
Navy match- I like that I only have to apply/interview to 3 places, seems like a lot less stress and money. And I like having a pretty narrow idea of where I will end up. Also, the thought of GMO doesn't really bother me right now, and in a weird way, I'm looking forward to it? (I also owe 4 years for NROTC in college- so yes, I have at least been on a ship for a little while).

Another thing to think about, if you deferred, with the NADDS program, you'd still owe 8 years when you get done, and have zero on the books toward retirement. If you did a Navy internship, GMO, and a military residency. You'd knock 2-3 years off of your education obligation and have all those years credited towards retirement. You may not stick it out for 20, but with that much time it would be nice to make all of your years count if you did stay for 20.

Civilian- I guess the main advantage could be better programs? Also the fact that I could train straight though, but I don't really think that a couple years away would really mess up anything. I also feel like I'd be more guaranteed to end up in anesthesia this way, considering I've heard that only around 50% of post-GMO LTs actually match to anesthesia.

Better is in the eye of the beholder :) Only you can decide what is better for you. If you don't match, you can always GMO another year and reapply.

And theoretically, which path do you think might be easier for the whole starting a family thing? I'm not even close to being married or anything, but just out of curiosity.

Dude, you picked medicine that was your first mistake on taking care of that one :D
 
I did an inservice Navy anesthesiology residency fairly recently. I agree with everything MTGas2B wrote, this especially:

MTGas2B said:
I think a lot residency is what you make of it.

Just about anywhere you go, if you work hard, seek out the big cases ... you'll do fine.



The primary complaint I have heard of Navy Anesthesia programs is that your level of acuity is on the low side. We have managed to farm out our over 65 really sick patient population and it diminishes your experience level for the really tough cases. On the flip side, I have never had an Anesthesia friend have any difficulty finding a job when they decided to get out.

This is true on all counts.

Acuity is low. The over-65 patient exodus is a big part of it (eg, low cardiac & major vascular numbers), but not the whole story. Trauma is a young patient game, and trauma is arguably the biggest hole in every military GME program in every specialty. However, these shortcomings are overcome (quite well I thought) with 'out rotations' at other institutions.

I was a resident at Portsmouth, and spent probably 1/3 of my residency at the Univ of Virginia, Brigham & Womens, Washington Hospital Center in DC, and the childrens hospital in Norfolk - all of which offered excellent experience.

The travel kind of sucked, and there are some other disadvantages to being a guest resident someplace. There are some real advantages too it though also, not the least of which is exposure to multiple practice setups with varied institutional / local-dogma influences.

On the whole the Navy offers solid anesthesia training. Admittedly not top tier - but of course 90% of the non-military programs in the US aren't "top tier" either. FWIW, neither I nor any of my residency classmates ever felt outclassed by the residents we encountered on our out rotations at various highly regarded institutions.

I'm a few years out of residency now, and moonlight a fair amount with a couple of civilian practices. In general ... even allowing for a bias on the side of thinking highly of myself :D ... the civilian trained people I work with there don't outclass me, and the ones that I consider very strong don't have sterling residency pedigrees. The young ones are no better than me (IMO :D) and I turn to the old ones for advice not because of where they trained, but because they've got 10 or 20 years on me.

I've never heard anyone tell me that a .mil career or residency is a problem when looking for a post-.mil job - notable exceptions maybe being academic appointments at major institutions. But in those cases, fellowship training is probably a given, and with .mil funded FTOS fellowships the sky's the limit on where you go. Or places where networking or connections are key to getting a foot in the door ... but you know what, there are a lot of ex-military doctors out there, and that's a connection in and of itself.


Deferment. Anesthesia is overmanned in the Navy at present. While there might be one or two deferments, it is not likely to be more than that (and the number may be zero). Your real chances of a deferment are small, so it may be a moot point all together.

Agreed, deferments are not only hard to predict, they aren't necessarily awarded to the most qualified person who asks for one - to an extent, the Navy wants the superstars in its own programs. It is a bad idea to make plans that hinge on an expected deferral.
 
Agreed, deferments are not only hard to predict, they aren't necessarily awarded to the most qualified person who asks for one - to an extent, the Navy wants the superstars in its own programs. It is a bad idea to make plans that hinge on an expected deferral.

So you're saying I'm not a superstar since I was deferred? :)


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So incredibly informative. Would anyone also care to make similar comments on orthopedic surgery?

I'm currently a rising M2. I'm female, married, no kids yet and am about as sure as an M2 can be about wanting to go into ortho... I really want to avoid a GMO tour if possible, and wish my recruiter hadn't told me that there was a slim to none chance of my going on one (I've learned since then that it is apparently not the case).

So, let's say I manage to stay pretty competitive throughout school (and I have no prior service). Any thoughts on the outlook of getting a straight through ortho residency, or a deferment?
 
So you're saying I'm not a superstar since I was deferred? :)

:laugh:

I'm saying superstars shouldn't count on the military GME selection board giving them a deferral if it's not judged to be in the best interest of the Navy. Sometimes being great isn't enough.

My intern program director was an endocrinologist and involved in the int med residency selection board. As he was advising those of us who were GMO-bound on the GME2+ application process, he specifically said that in years when the overall applicant pool to his program was on the weak side, he'd lobby to keep strong applicants in the Navy programs, even if their rank list had deferral up top.

Certainly the best way to maximize your odds of getting what you want (whether a deferral or not) is to be the best applicant you can be. There's a semi-regular poster on the anesthesia forum that I remember rotating through Portsmouth as a student - solid applicant in every way, requested a deferral and got it, and is finishing residency at a second-to-none :) program this month. I've also known a couple stars that didn't get deferrals and were a little disgruntled about it.

There's a lot of luck and timing (more luck) involved ...
 
:laugh:

I'm saying superstars shouldn't count on the military GME selection board giving them a deferral if it's not judged to be in the best interest of the Navy. Sometimes being great isn't enough.

My intern program director was an endocrinologist and involved in the int med residency selection board. As he was advising those of us who were GMO-bound on the GME2+ application process, he specifically said that in years when the overall applicant pool to his program was on the weak side, he'd lobby to keep strong applicants in the Navy programs, even if their rank list had deferral up top.

Certainly the best way to maximize your odds of getting what you want (whether a deferral or not) is to be the best applicant you can be. There's a semi-regular poster on the anesthesia forum that I remember rotating through Portsmouth as a student - solid applicant in every way, requested a deferral and got it, and is finishing residency at a second-to-none :) program this month. I've also known a couple stars that didn't get deferrals and were a little disgruntled about it.

There's a lot of luck and timing (more luck) involved ...
Thanks PGG
 
I'm thinking about applying for this scholarship but I don't know what branch yet. I have read the threads and seems like army gives the best shot at straight through training, navy not so much, and airforce is now starting to eliminate GME and handing out lots of deferments. Are these points true???
 
Could we possibly place "quality of life as a resident" in the "pro" column for military residency?

I am ignorant on this issue, and thus seek clarification.

As a service-member on active duty who's spent some time around military medicine, I know the quality of life for my medical colleagues -- at least anecdotally and based on conversation/observation -- seems to be less strenuous than that of my college classmates now in civilian practice (this is a sweeping generalization, of course). Is the same true for residency, as well? It's one thing to be a singleton in your late 20s working 80 hour weeks; quite another to be in your late 30s, with a family and a not-so-ageless body (as I would be).

As a gross oversimplification, I would imagine being a surgical resident at Naval Base San Diego (Balboa) is not as strenuous as life as a surgical resident at UC San Diego?
 
You'll get paid much better (esp. as prior service). While at Balboa you may have smaller case volume, so in that sense there might be some degree less stress, But you will have a smaller number of residents to divide the work. My observation of surgical residents at the Naval hospital in which I trained was that they didn't seem "un-stressed". I think the quality of life plus in milmed is the better pay, but as a whole, I doubt that stress is substantially less intra-specialty military compared to civilian.
 
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