Since it seems most posters on here who took the HPSP scholarship hated it...

[BigNavyPedsGuy]

In the last 8 years, my specialty lost exactly one spot from the total, and I think that was 5 years ago What kind of swings have you guys seen?

It swung from 4 resident slots per year (the year ahead of me) to 8 slots per year (the year after me). ACGME accredited for 8, but the Navy chooses a different number of residents each year. That's a 50% swing. It varies significantly. Especially when there's only 19 total accredited slots.

Can you admit you're wrong now?

---

Members don't see this ad.

 

[colbgw02]

FWIW, my specialty and program experiences more closely approximate those of BNPG's than Tired's. Of the 8 residency classes that I personally observed during training, it went 4-7-4-5-5-4-3-4. As staff at a different location, I've seen 7 classes, none of which had the same number two years in a row.

And it's got nothing to do with a program choosing this. These numbers are being dictated from higher. I've seen applicants that the program wanted being sent to GMO land, and I've seen applicants forced upon the program despite the objections of the PD.

 

[Gastrapathy]

Yeah, its not up to the programs at all. The SL will beg for slots in the spring. The numbers will come out in the fall. They won't have anything to do with what was asked for. Pulm/CC keeps getting outservice slots when they can't fill their inservice programs because the specialty is undermanned. They don't want the outservice slots but can't turn them down. I remember a few years ago, Pain had zero slots. I think the corps chiefs office consults the magic 8 ball or maybe they toss 12-sided dice role playing game style.

No reason to be mad at Tired, though. He's in that mid-late residency phase where things really aren't that bad. Let him enjoy it.

 

[HighPriest]

Shouldn't be that difficult to believe. The alternative to training varying numbers of residents is to defer HPSP students to civilian training. In my field, while the number of military trainers don't vary much, the number of deferred trainees varies greatly from year to year. That's likely because the Army trains close to the minimum number it requires to replenish itself, but when it needs to expand it has to go over the ACGME cap. For larger specialties, it's probably cheaper to change the number of trainees.

 

[HighPriest]

I sincerely do hope that things are good for your career. I think you probably have amore conducive outlook overall with the GMO time under your belt.

 

[HighPriest]

Historically this is what my Navy specialty is done. The year that I was selected to internship, we trained 12 deferred residents. For the last few years, it has been zero. This makes more sense to me than varying the number of core spots. But then again, if I were in charge, I would prioritize the needs of the active duty programs over the deferrals, and this doesn't seem to be universal.

I think that is what they're doing. They're filling the number of ACGME-allowed military spots, and just varying the number of deferred trainees for small programs. For lager specialties (lets keep picking on peds as an example), they probably very rarely defer residents but if they don't need 30 pediatricians according to their projections, they just train 22 - or whatever number. They're filling the military spots first, but only to the extent that they need docs.

OVERstaffing, as in just training more residents in military spots rather than deferring, is only an option to the extent that the ACGME allows the military to train residents. It isn't a realistic option to have a residency training site that sometimes doesn't have residents - they'd lose their credentials. Additionally, you can't train more residents than the ACGME allows. Especially for surgical residencies, it can be a struggle to meet case requirements.

 

[BigNavyPedsGuy]

And it's got nothing to do with a program choosing this. These numbers are being dictated from higher. I've seen applicants that the program wanted being sent to GMO land, and I've seen applicants forced upon the program despite the objections of the PD.

And this is why people get "screwed" by not matching. If you're a very competitive applicant and the PD wants you but you end up in GMO land, that's getting screwed, not just "failing to match". There is no civilian equivalent to this level of screwage.

See how I brought that whole thing back around? Pretty nifty.

 

[pgg]

Yeah, in general the location of our MTFs and hospitals are fairly decent. That was actually one of the major reasons I didn't join the Army or Air Force. Our worst duty stations in terms of location are probably 29 Palms, Lemoore, and Pensacola. Those, in my mind, are worlds better than places like Hood and Campbell.

I was happy at Lemoore.


As for the earlier question of whether or not the DOD needs sub specialists ... the answer is a resounding YES ... if we are going to stay in the GME business. Having fellowship trained people involved in the MTF residency programs is hugely important.

And so long as we care for dependent and retirees, we're going to see more than Private Snuffy's sniffles.

 

[idq1i]

... if we are going to stay in the GME business. Having fellowship trained people involved in the MTF residency programs is hugely important.

And so long as we care for dependent and retirees, we're going to see more than Private Snuffy's sniffles.

And why is milmed in the GME business? You will certainly get better (or at least "equivalent" - for the cheerleaders) training in the civilian world. Just sponsor the residents at civilian programs. I had no problems clinically adapting to AD after a civ residency.

 

[BigNavyPedsGuy]

And why is milmed in the GME business? You will certainly get better (or at least "equivalent" - for the cheerleaders) training in the civilian world. Just sponsor the residents at civilian programs.

Agree. Think of all the money and resources spent on training folks when there are already civilian programs doing it.

 

[colbgw02]

I can't tell you the specific motivations of the first people to start a military residency, but I think it's safe to say that both graduate medical education in general and in the military looked a lot different as recently as 25-30 years ago - long after military GME was well entrenched.

I've had the good fortune to know and speak to a number of former military physicians who trained before CHAMPUS or TRICARE existed. As I understand it, the DoD would go to extraordinary lengths (and cost) to keep its beneficiaries' care in-house back then. A result was high -quality and high-volume training. I'm reminded of one anecdote of WRAMC being one of the few places in D.C. in the early 80s where seeing HIV/AIDS patients was routine.

Anyway, when we wonder why the military's in the GME business, it's useful to know that the gap between it and civilian training didn't always exist. The DoD's continued investment ointo GME might be best viewed as an error of perpetuation, rather than one of initial judgment.

 

[HighPriest]

Error of perpetuation is the motto of my hospital, and so that is no surprise.

 

[Homunculus]

What I don't like is that most of the guys that I know who have been stationed at great stations for 10+ years without every having the threat of a move will be the first guys to tell you that "it ain't so bad" at some of the podunk stations in BFE. There are a lot of people in the Army (and likely the other services) who never have and never will have any idea what it's like to practice outside a large MEDCEN.

i should quote this twice. the disconnect between the O-6 and current O-4/O-5 population for this reason i think is as large as it has ever been. it's one of the reasons so many people feel like they are on their own-- there is no one who has been through what they are/will be going through. when it has been 10 years or more since you were "out at the MEDDAC" you really can't assist people heading there. similarly, you can't understand how the threat of moving to a 2 year operational assignment during the time you were afforded homesteading and raising your kids can impact someone's life/career. i didn't get the email mentioned, but if it rattled the walls of the ivory towers a little i think it's great. where i am now, over 75% of the O-5/O-6 population has been here 5 years or more. meanwhile, the O-4's are being raped/pillaged for operational tours and trying desperately to read the tea leaves and try to get their "broadening" assignment out of the way on their terms-- which may look good to big army, but is no different than those with poor draft numbers during vietnam signing up so at least they can go for a desk job instead of trigger puller. hell, even i am looking at the lists to see if there's something i can do to to pre-empt a ****ty assignment by at least getting one in a geographical area where i can still maintain procedural skills.

great thread-- title is misleading to a degree but a lot of valuable and pertinent discussion. maybe this will get cited into another MHA research project, lol.

--your friendly neighborhood closing in on 15 years in the forum (!?!?!) caveman

 

[Homunculus]

Error of perpetuation is the motto of my hospital, and so that is no surprise.

i think i've seen that in an outlook signature right under the obligatory patton or bible quote. is it what "high reliability organization" really means?

--your friendly neighborhood "Errore perpetuitati" (everything sounds better in latin) caveman

 

[pgg]

i think i've seen that in an outlook signature right under the obligatory patton or bible quote. is it what "high reliability organization" really means?

--your friendly neighborhood "Errore perpetuitati" (everything sounds better in latin) caveman

We were recently informed that famous quotes, Bible quotes, slogans, sayings, jokes, whatever, in our official email .sig was unprofessional and verboten.

 

[pgg]

And why is milmed in the GME business?

Inertia, for one.

And because the culture of the US military has been, since round about the time we got rid of the draft, to grow our own [whatever] from a pool of willing volunteers. There's a lot to be said for having our own training pipeline.

And because most of the individual programs are, on the whole, comparable in quality to middling-to-upper-tier civilian programs.

Now now, before anyone gets angry and indignant and says .mil programs can't compare to Top-10'ers like Brigham or Hopkins or UCSF ... you're right, I don't think there are many military residencies that are truly top tier. The days of having truly world-class institutions like AFIP in the military are over and can't/won't return so long as Tricare exists to turf out pathology, CME is unfunded with complete indifference (or outright hostility), and research is something people do on their own time between PCS'ing q2years.

But our residency programs are pretty good. And where they're not so good (ie specific areas of case load and complexity), they tend to compensate by sending residents out to other institutions for rotations. This isn't ideal, but it's not so bad either - it's good to see how things are done elsewhere. I think I really benefited from spending part of my residency at UVA, Brigham, and other excellent places. (Part of that benefit was realizing that I and my residencymates weren't outclassed by the residents at those places.)

We produce pretty good graduates. There was a bit of a drop in quality, partly reflected by a drop in board pass rates over the last 1/2 decade or so, but I attribute that mostly to GIGO. We got a lot of really marginal HPSP grads because of recruitment issues during the height of the Afghan/Iraq wars. The last few years, HPSP has been fairly competitive again, and I bet we'll see that in the quality of students, interns, and residents looking ahead.

I know everyone on SDN is brilliant and handsome and witty and graduated at the top of their class at Best Medical School, and attending anything less than the best residency program in the country is shamefully settling for disappointment. But the truth is that most milmed residency programs are, on the whole, pretty good. Just ask the ACGME people next time they're around for a site visit. Or ask fellowship programs what they think of ex-military applicants.

I trained in the Navy and I've spent enough time working at enough civilian hospitals to feel pretty good about where I came from, and I'd happily put up our graduates against the vast, vast majority of whoever the rest of the US trains.

Until my perception there changes ... yeah, I think we should be in the GME business.

 

[psychbender]

I'll pile on what PGG just said. We did a fair number of out-rotations in residency due to lack of case numbers back home. When at the civilian hospitals, we interacted with residents from the neighboring civilian programs (and some from PGGs), and we were highly regarded. However, when I compare myself to some of the posters on SDN, I feel inadequate, as I haven't done any liver transplants, off-pump double lung transplants, or enough TEE/TTE in residency to sit for the Advanced PTE-exam right out of residency. So, in our specialty, at least, the military probably provides above average training, but we're definitely no CCF, MGH, Duke, etc.

 

[BigNavyPedsGuy]

I do have to agree. One of the surprises to me when I separated was how highly respected my Navy time was. People assumed I was competent and good just because I was a Navy physician.

 

[j4pac]

I'll pile on what PGG just said. We did a fair number of out-rotations in residency due to lack of case numbers back home. When at the civilian hospitals, we interacted with residents from the neighboring civilian programs (and some from PGGs), and we were highly regarded. However, when I compare myself to some of the posters on SDN, I feel inadequate, as I haven't done any liver transplants, off-pump double lung transplants, or enough TEE/TTE in residency to sit for the Advanced PTE-exam right out of residency. So, in our specialty, at least, the military probably provides above average training, but we're definitely no CCF, MGH, Duke, etc.

I wouldn't compare yourself to SDN posters. There is no question that SDN tends to cater to the elite gunners of the medical world. You are likely talking to guys and girls at Harvard, Mayo, Hopkins, etc. You aren't talking to the average joe working at random average medical center.

I think that military physicians are respected...not just for their level of training, but their work ethic, ability to multitask, leadership ability, ability to work as a unit, and many other facets of medicine. Knowledge base and the actual skill of your craft is only a small part that makes up a physician.

As a side note...I think that military GME at the outlining medical facilities have been struggling. The budget crunch has depleted the civilian support staff, and with the cutback on manning, it has put a huge crunch on the physicians. I do not believe that many of our non-major MTFs should have residency programs anymore. They would be better outsources. I think that much bigger problem is that we aren't putting the focus on what we do well in the military...keeping the operational mission afloat. Without question, operational medicine is best done by MILITARY physicians. But care of our retirees could be done BETTER on the outside where resources are better, and hospitals are run by highly competent business people. We should stop dependent and retiree care immediately, and keep the major MTFs open for active duty triage only.

 

[dr zaius]

If we did that then all of military GME would need to close. The majority of patients that come through the urology clinic are retirees/dependapotamuses. It seems the same for gen surg. The already low case numbers would plummet to below ACGME standards.

I agree with your concept, though, but if we focus on what we do best I think we will need to shut down GME completely because it won't be viable.

 

[Gastrapathy]

Anytime you rotate outside, you are free labor, speak English and show up on time. It doesn't take much more to succeed. Military physicians are a predictable and above average commodity. I tend to think that this is because of the quality of the people rather than the quality of the education.

 

[IlDestriero]

Put all of milmed in the reserves and issue kaiser cards or Hillary care cards from the lowest bidder. That's what I'm proposing when I run for congress. How much would that save in one giant swing of the axe? Milmed, the VA, Tricare, all the redundant multi service support staff, all gone. Give them 4 years to work out how to best cover deployments, etc., add more reserve people and then sell it all at auction.

 

[Ziehl-Neelsen]

Put all of milmed in the reserves and issue kaiser cards or Hillary care cards from the lowest bidder. That's what I'm proposing when I run for congress. How much would that save in one giant swing of the axe? Milmed, the VA, Tricare, all the redundant multi service support staff, all gone. Give them 4 years to work out how to best cover deployments, etc., add more reserve people and then sell it all at auction.

Keep 2 or 3 MEDCENs open as tertiary/quaternary care hospitals that care mostly for civilians but maintain dedicated military wards and are staffed by military medical personnel and you are essentially describing the British Military Medical System.

http://www.nhs.uk/NHSEngland/Militaryhealthcare/Pages/Overview.aspx

It has long been my secret belief that US Military Medicine would eventually copy the British model, especially since I believe (much like pgg does) that the US will institute a single-payer (read NHS) medical system in my lifetime (catastrophic intracranial berry aneurysm rupture while I take a dump tonight excluded).

Suffice it to say, if we ever go to an "all Reserves" medical force with care provided through the network only, we'll see how happy the line is dealing with civilian doctors.

As an aside. A few years ago my wife and I went to London and visited the Tower of London. As many of you are well aware, the Tower Guards (aka Beefeaters) are all retired senior NCOs in the British Armed Forces. One of the Tower Guards got to talking with us and discovered we were American military doctors. He proceeded to tell us that the biggest strategic mistake the British Armed Forces made during his career was killing the British, in-house milmed system and that he was envious that the American military continued to maintain a separate in-house military system.

 

[BigNavyPedsGuy]

But yeah, let them do it. Because what would happen is that the people in milmed who are most unhappy would cheer and convert to the Reserves, while the people like me who want to go to the fight and want to serve honorably full-time will simply walk away. I'm not the only person in uniform who isn't willing to be a part-time officer. If they want to toss out the 200+ year tradition of my beloved Medical Corps, thinking that they'll have a couple extra bucks to fund their toys, then they deserve everything that they'll get.

You're my hero Tired. You're much better than the rest of us.

 

[deuist]

You're right, of course. But still, I'm not sure it's reasonable to say that it's a really complicated system and so if you don't get what you want, you got screwed.

My recruiter – the Air Force's representative for premeds considering the military – outright lied to me and said that I would never be forced into a specialty I did not want and that I could pick my training. When I was a fourth-year medical student, a program director at one of the medical centers told me flat out that I would get a civilian deferral to pursue my specialty choice – which is what I wanted. I ended up not matching. Four years later my consultant outright lied to me about getting to do a fellowship. So yeah, some people absolutely get screwed – and it's by the very people I expect to provide the most honesty.

Recruiters are out there telling applicants that you can do any residency/fellowship you want, and that GMO tours essentially never happen (Army), and that no one gets forced to do any specialty that they don't want to do. That's what my recruiter told me many years back, and it was a bold-faced lie.

I'm not the only one who has had this experience.

 

[deuist]

Keep 2 or 3 MEDCENs open as tertiary/quaternary care hospitals that care mostly for civilians but maintain dedicated military wards and are staffed by military medical personnel and you are essentially describing the British Military Medical System

Another option is to embed active-duty physicians into civilian medical centers. The Air Force already does that with the University of Cincinnati and Shock Trauma in Baltimore. I know there are a few others out there. When it comes time for deployment, the military could pull these docs and send them to wherever they are needed. As for everyone who is stateside – active-duty, retirees, and dependents – let the civilian world see them.

 

[pgg]

You're my hero Tired. You're much better than the rest of us.

The Navy has been good to/for some of us. Much of that is probably luck, sure.

I have never been at all interested in serving as a reservist. Caring for this population full time is something that I want to do, and that I couldn't do working in some hybrid or reserve or VA system. If milmed was civilianized I'd just be a civilian full time.

 

[idq1i]

Mocking aside, we all joined for our own reasons, good or bad. We all stayed or left for our own reasons, good or bad. I stayed because I feel like the organization is loyal to me. I get that others feel betrayed or sold out, and left when their time is done. Everyone who has ever worn the uniform matters, and I still have your back in a bar fight.

I'm glad you had a good time. I think the population of this forum can be split into 3 (or 3.5) groups:

1 - loyalists and true believers. They will speak up for milmed no matter what. (tired and the like)
2 - Angry and bitter, short-end-of-the stick receivers. Screwed by milmed, whether professionally or personally (me - both)
3 - The "I don't get it" group. These are people stationed at good places for the duration of their career. They never see BFE, malignant commands, etc. "Hey, milmed is not that bad!"
*3.5 - I love my country and i want an M16 so I can be a special forces flight neurosurgeon psychiatrist. I am also in high school. (Generally clueless and irrelevant. Tend to repeat threads and claim absolutely no financial motivation)

Every thread here can be broken down into these arguments. Each group doesn't really see the other point of view.

 

[IlDestriero]

Nobody can force you into any specialty that you don't want. You always have the option to pay back your obligation and pursue whatever residency or fellowship that you want. Not everyone matches in the civilian world either BTW.

 

[dr zaius]

Nobody can force you into any specialty that you don't want. You always have the option to pay back your obligation and pursue whatever residency or fellowship that you want. Not everyone matches in the civilian world either BTW.

This is true for the 25-26 year olds. I can see, however, how the 35 year old who would have matched as a civilian feels like they were forced into another specialty when they are faced with either applying IM/FP/whatever, reapplying to gen surg/ortho/uro/ENT/insert applicant saturated spexialty here and probably not being picked up, or going out to GMO land and prolonging their training. Technically they aren't forced to go into the specialty, but I can see how they feel coerced. At my med school in gen surg you could be a prelim until PGY-2 and then pick up a spot if a research resident decided to go for the PhD and wasn't returning to PGY-3 clinical duties that year...which wasn't uncommon.


I have been incredibly lucky thus far in my short milmed career. I got a continuous contract in the specialty I wanted at the place I wanted. The staff at my program are great, and the program appears to turn out competent residents. What bugs me to no end is the hospital politics and logistics. The other day we were out of the majority of JP drain sizes. There were a scant amount of 2 sizes left. Two days ago the OR was out of size 7.5 blue undergloves. How do things like this happen at a major medical center?

The majority of providers I have worked with seem to be great and make thoughtful, knowledgeable, and evidence based clinical decisions. Given the patient volume/pathology of even a mediocre civilian medical center I think they would be excellent clinicians. It just seems like a huge amount of wasted talent. We have started a VA sharing agreement on some services, such as vascular, and those are thriving with fantastic pathology. If we could do this with more services the staff would be able to maintain skills and the residents would have a more continuous and robust learning environment. The VA has long wait times, why not kill two birds with one stone? This doesn't address the bull**** aspect of running out of fundamental supplies, or ridiculous OR turnover times, but maybe if the patient volume was higher these things would fall into step as well.

As an aside, what do we do to maintain the wartime medicine skills that have been learned over the last 10+ years of war? From last year as a subI to this year as an intern even I have noticed a huge drop off in the number of blast injuries and GSWs that are medevaced over. The ICU is largely empty. A lot of the staff during those years have left for greener pastures. How do we keep from going 10 steps backwards in casualty care when the next inevitable conflict breaks out? How do we keep all of that knowledge gained as well as pass it down to the future of milmed like me?

Sorry for the likely disjointed and incoherent post. I was on overnight and haven't slept. Feel free to slam me with "you know nothing, intern."

 

[deuist]

Nobody can force you into any specialty that you don't want.

I keep hearing this statement thrown out, but it is somewhat disingenuous. If you get forced into flight medicine and have to do several weeks to months of additional training in flight duties and are given your own MOS or AFSC, that would make you a specialist, no? What if you don't want to be a flight surgeon? You can't say no.

 

[IlDestriero]

That's not a career specialty. Don't match and get sent to GMO land, you're a GMO you can be a dive officer or a flight surgeon or whatever, but they don't make you take a residency you don't want. If they bully someone into it, they have no one to blame but themselves for their career getting derailed.
Plan B is always do a GMO tour, pay back your commitment, and get into a civilian residency.

 

[Cooperd0g]

I think you are reaching a bit. I think most people understand that the "don't force you into a specialty" refers to residency training.

 

[idq1i]

Nobody can force you into any specialty that you don't want. You always have the option to pay back your obligation and pursue whatever residency or fellowship that you want. Not everyone matches in the civilian world either BTW.

If you

1-can't do what you want as far as residency
2-are forced to do GMO/FS
3-you are paid for it
4-you can't say no

Well, that's a career choice made FOR YOU, aka "forced into a career".

It's true that not everyone matches in the .civ world, but you have a lot more choices to make if you are in that boat. Also, it's usually your own fault if you don't match as a US grad. There is no "needs of the military" clause.

 

[IlDestriero]

You could argue that the military can delay your career of choice, that's absolutely true. However, a GMO isn't a career, it's a pit stop. It is a choice that they made for you, but not a career choice.
Nothing's stopping you from doing your 3 or 4 years and getting out to a civilian residency. Many did that during my time in as they were competitive for very competitive programs in the civilian world and didn't want .mil GME. People in my intern class went in with that plan, including Dive medicine or Flight surgery to have a 4 year adventure and unique experience before getting on with their desired specialty. The lure of dive medicine was there for me, but not something I wanted to spend 3 years doing. If I wasn't married, I'd bet I would have pursued it.
A GMO is not a terrible thing, and like everything, most of what you get out of a situation depends on your attitude and what you put in. You are providing a valuable service to a group of volunteer soldiers and their families. That's the reward. If you perseverate on potential lost income and years, etc. the military is probably not for you.

 

[idq1i]

You could argue that the military can delay your career of choice, that's absolutely true. However, a GMO isn't a career, it's a pit stop. It is a choice that they made for you, but not a career choice.<cut>

You are providing a valuable service to a group of volunteer soldiers and their families. That's the reward. If you perseverate on potential lost income and years, etc. the military is probably not for you.

Very Clinton-ian of you. "it depends on the meaning of the word Career." If I had a 4 year "pit stop," I'd fire my pit crew.

Appeal to patriotic emotions is generally not a great argument. Military should not substitute itself for proper, accepted medical training. I question the services you are capable of providing after an internship and a couple of weeks of military "training." True reward is proper medical care provided by adequately trained and certified physicians I'd argue. NOT PAs, NPs or medics practicing independently as in my clinic, or GMOs

/thread diversion over

 

[HighPriest]

All of that may be true except for the fact that Army recruiters are actively telling people that GMO essentially never happens except under unusual circumstances, and that they were going away completely.
Perhaps if they had said "GMO is rare, but it does happen. You can be forced to do it. You can be forced to choose between extending your military commitment by reapplying to a residency or completing a four year GMO tour and then leaving the service. But it's cool, because if you go into it wearing a fake smile you'll get a lot out of it.," I may have chosen a different path to medicine.
I don't necessarily have an issue with the GMO concept. It would have been a huge deal, to me, to have ended up in a GMO slot. At my age, it would have certainly meant that I didn't do a surgical residency. So a little honesty on the part of the recuiters would have probably made a lot of difference for my decision making process. In the end, things worked out just fine, but I understand some of the angst that is out there.
Again, I'll repeat that I do think it is important for applicants to do their own research. That being said, the resources are limited, the contracts are convoluted, and I would have thought (back in my naivity) that I could at least take the recuiter at his word when he told me that GMOs "essentially never happen." Yep. It's not a lie. But it is misleading, unecessary, and it does lead to a lot of very unhappy officers.

 

[HighPriest]

Perhaps if it was sold as "you may be forced to delay your residency training," I'd go with it. That sounds benign, consistant with military service, and accurate. It also would have meant that I didn't do HPSP. My decision was a fairly close one.

 

[idq1i]

Again, I'll repeat that I do think it is important for applicants to do their own research. That being said, the resources are limited, the contracts are convoluted, and I would have thought (back in my naivity) that I could at least take the recruiter at his word when he told me that GMOs "essentially never happen." Yep. It's not a lie. But it is misleading, unnecessary, and it does lead to a lot of very unhappy officers.

Aside from this sub-forum, that even I will admit skews negative, where can a naive pre-med do research that would reveal all these "wonderful" possibilities of milmed? I think milmed (at least in the army) continues to exist because of this continued opaqueness , half-truths with some patriotic overture sprinkles fed by MEDCOM through the recruiters. I think if milmed recruiting becomes transparent and honest, recruiting will fall by 75%

 

[HighPriest]

Aside from this sub-forum, that even I will admit skews negative, where can a naive pre-med do research that would reveal all these "wonderful" possibilities of milmed? I think milmed (at least in the army) continues to exist because of this continued opaqueness , half-truths with some patriotic overture sprinkles fed by MEDCOM through the recruiters. I think if milmed recruiting becomes transparent and honest, recruiting will fall by 75%

Yeah, that is my point. There aren't many good resources. Options might include: physicians in the military, physicians who used to be in the military. If you don't have access to those sorts of people, then you're kind of walking in blind - or at least somewhat limited in vision. If you're willing and able to drink any kool-aid placed before you, then you'll be fine. Otherwise, there's a lot of karma involved and apparently I was a pretty bad person in my former life.

 

[idq1i]

Yeah, that is my point. There aren't many good resources. Options might include: physicians in the military, physicians who used to be in the military. If you don't have access to those sorts of people, then you're kind of walking in blind - or at least somewhat limited in vision. If you're willing and able to drink any kool-aid placed before you, then you'll be fine. Otherwise, there's a lot of karma involved and apparently I was a pretty bad person in my former life.

Because of the location of my HOR, none of the milmed environment was available to me. Interview with a milmed physician fell through twice in the process of applying to HPSP...should have set off alarms. I was told that my record was so good that I didn't need to, even though I asked. At that time, I was flattered...

Now I am stuck in a clinic run by MSCs and ANs. Right now, I'm down to about 15% utilization of skills, and about 30% of MOS-expected productivity even if I do all the work for the day by myself. If my colleague is in-house, I am down to 20% productivity as s/he is part time

 

[j4pac]

It's funny how people throw out, "Do your time as a GMO, get out, and match to a civilian residency" so haphazardly. There are very real challenges for those who choose to go down that route.

First, military applicants applying civilian typically have to apply to ONLY advanced programs, because resignation paperwork has to be submitted about 12 months prior to separation, which takes categorical and physician-only slots off the table. It also takes matching military off the table because the military don't do match two years in advance to PGY-2 slots like the civilian sector.

Second, applicants typically do NOT have the opportunity to perform audition rotations like their civilian counterparts. This is a huge disadvantage.

Third, applicants typically have very little time to interview. I was very fortunate that I was at a shore command and was able to get coverage, but even still, my coverage was limited to 10 interviews. I am sure that for many other commands, the opportunity to interview much less. If you don't interview, you don't match.

Fourth, there are programs who are smart and can sniff out the weaknesses of an applicant who has been outside of inpatient medicine for 4+ years. It is a question that I encountered on interviews, and it is a question that I had a weak answer for. The truth is that my inpatient skills HAVE atrophied. There is no denying it...and it was inevitable by being out of a hospital for so long. Will I be able to relearn the material? I believe so...but to say that it isn't a weakness of mine is utter bull****. About of a third of the programs I applied to have interviews who also had concerns about skills atrophy.

Fortunately, GMOs/UMOs/FSs are generally highly regarded by the majority of civilian residency programs. But for how long? We may get to the point where civilian programs are hesitant to take military applicants because of skills atrophy. When that day comes, and it may come any day now, military applicants essentially will be funneled toward military primary care. I was very fortunate that I matched...I know of military applicants who DIDN'T, one specifically because he couldn't get enough coverage for interviews.

 

[idq1i]

It's funny how people throw out, "Do your time as a GMO, get out, and match to a civilian residency" so haphazardly. There are very real challenges for those who choose to go down that route.

First, military applicants applying civilian typically have to apply to ONLY advanced programs, because resignation paperwork has to be submitted about 12 months prior to separation, which takes categorical and physician-only slots off the table. It also takes matching military off the table because the military don't do match two years in advance to PGY-2 slots like the civilian sector.

Second, applicants typically do NOT have the opportunity to perform audition rotations like their civilian counterparts. This is a huge disadvantage.

Third, applicants typically have very little time to interview. I was very fortunate that I was at a shore command and was able to get coverage, but even still, my coverage was limited to 10 interviews. I am sure that for many other commands, the opportunity to interview much less. If you don't interview, you don't match.

Fourth, there are programs who are smart and can sniff out the weaknesses of an applicant who has been outside of inpatient medicine for 4+ years. It is a question that I encountered on interviews, and it is a question that I had a weak answer for. The truth is that my inpatient skills HAVE atrophied. There is no denying it...and it was inevitable by being out of a hospital for so long. Will I be able to relearn the material? I believe so...but to say that it isn't a weakness of mine is utter bull****. About of a third of the programs I applied to have interviews who also had concerns about skills atrophy.

Fortunately, GMOs/UMOs/FSs are generally highly regarded by the majority of civilian residency programs. But for how long? We may get to the point where civilian programs are hesitant to take military applicants because of skills atrophy. When that day comes, and it may come any day now, military applicants essentially will be funneled toward military primary care. I was very fortunate that I matched...I know of military applicants who DIDN'T, one specifically because he couldn't get enough coverage for interviews.

Your post should be stick-ied.

 

[deuist]

A GMO is not a terrible thing

But it can be for the physician who did not choose it, and it can certainly be for the patient.

You are providing a valuable service to a group of volunteer soldiers and their families.

… who deserve better than a one-year wonder. When flight surgeons send home patients with broken ankles without ever bothering to do an x-ray or place a splint because they think that their physical exam skills can rule out a fracture, that's a real problem for our war-fighting force. In this day and age I just can't see anybody justifying why general medical officers still exist. Maybe if the Air Force were to place family physicians into flight surgery billets, things might be better.

 

[j4pac]

But it can be for the physician who did not choose it, and it can certainly be for the patient.



… who deserve better than a one-year wonder. When flight surgeons send home patients with broken ankles without ever bothering to do an x-ray or place a splint because they think that their physical exam skills can rule out a fracture, that's a real problem for our war-fighting force. In this day and age I just can't see anybody justifying why general medical officer still exist. Maybe if the Air Force were to place family physicians into flight surgery billets, things might be better.

You crap on Flight Surgeons...but the truth is that I would take the sports med ability of someone coming off of a FS tour over someone coming out of an FP residency.

Just saying

 

[Gastrapathy]

I'm not so sure. The farther I get from my GMO tour, the more sure I am that I missed things and I'll never know. It's not crapping on GMOs (and FS are not special), it's the perspective brought by my subsequent decade of practice and countless interactions with other versions of me.

I'll take that FP doc. He'll be more likely to know what he doesn't know than the self taught GMO.

 

[BigNavyPedsGuy]

You crap on Flight Surgeons...but the truth is that I would take the sports med ability of someone coming off of a FS tour over someone coming out of an FP residency.

Just saying

I would take a residency trained FP over someone who did an OB/GYN internship any time.

 

[pgg]

You crap on Flight Surgeons...but the truth is that I would take the sports med ability of someone coming off of a FS tour over someone coming out of an FP residency.

Just saying

Maybe, but that FS wasn't "coming off" the FS tour for the previous 2 1/2 years. Maybe he was an ex-OB or psych intern who left the 6-month FS course having not done an ankle exam since that 2-week block in the ER in August of his intern year.

THAT'S the guy practicing sports med in the FS arena, as much as your seasoned about-to-leave FS.

If you're going to compare GMOs to board-eligible FP grads, compare the GMO who's early in the tour, has perhaps had bare minimum ortho clinic time, and has just as much responsibility as the "seasoned" end-of-tour GMO who's slogged his way through a 3-year OJT-o-rama while referring to that big yellow ortho book on a daily basis.

I'll take the FP grad. He's more likely to know what he doesn't know, I think.

Nothing but respect for the GMOs out there - I was there too, and did (I think) a fine job - but let's not pretend that glorified interns on their own are superior to someone residency trained in a primary care field.

 

[j4pac]

Don't get me wrong...I think that an FP grad is superior to a 2-yr GMO in most ways. I just don't think that Sports Med is one of them.

I probably had as many Sports Med cases in my first 4-months as a FS as an FP resident had through their entire residency. Have I made mistakes? Sure...but I don't think that they were mistakes unavoidable by a recent FP grad. Don't poo poo self learning. I have always learned best by reading and doing...and there is always a SMO available somewhere to bounce ideas off of. I am very confident that I could enter a Sports Med fellowship tomorrow, without a residency under my belt, and do very well amongst FP grads. I couldn't say that about most specialities...but Sports Med, absolutely.

Sorry if I have offended FPs out there. That absolutely wasn't my intent.

 

[Gastrapathy]

See, that's the don't know what you don't know. Self learning is critical but has to built on the foundation of a complete curriculum. You don't know where the gaps are.