GMO tours going away

NAVYLABTECH08 said:

I heard a little rumor that the Navy was going away from GMO tours and sending medical students straight into their residency training. Although I am all for this and it makes complete sense to me, why would the military do it? What will they gain?

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They haven't been able to fill scholarships for the past 4+ years. They won't have enough interns to fill all those billets. They are now making primary care docs (FP, IM, Peds) fill those billets instead.

Also, the RRC (accrediting body) doesn't like the interruption in training.

And even though they cut down the number of GMO spots, there are still plenty of folks who ended up with them without wanting them.

BigNavyPedsGuy said:

They haven't been able to fill scholarships for the past 4+ years. They won't have enough interns to fill all those billets. They are now making primary care docs (FP, IM, Peds) fill those billets instead.

True, True and not completely related. The change to an all board eligible force is not because of the lack of recruiting and more with the modern notion that one year of training is not ideal for practice. Will this lead to more straight through training opportunities and improve recruiting? I believe it will.

Also, the RRC (accrediting body) doesn't like the interruption in training.
Very True. Some RRCs have discussed cutting accreditation if the interupted training continues.

And even though they cut down the number of GMO spots, there are still plenty of folks who ended up with them without wanting them.

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There will always be some. But those numbers should decrease.

NavyFP said:

There will always be some. But those numbers should decrease.

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You're right the number is going down. I'm just bitter that I fell prey

BigNavyPedsGuy said:

You're right the number is going down. I'm just bitter that I fell prey

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Ahhhh, but someday you can bump an intern for your PGY-2 spot.

That'll be the day . . . . . . .

hey everyone,
i'm applying for navy HPSP, and while I know some recruiters can feed you crap, i asked mine to be completely serious about the whole GMO thing, and he said the navy is phasing them out completely within the next two years. i don't know who else is heard this, but he was very serious about it. i however, don't want to interrupt my training to do a gmo tour... so if you all have better information please let me know. thanks!!!

also- side question which probably does not belong in this forum- but as you can tell from my sdn name i'm a little obsessed with fitness. say i was working on a ship... are there nice gyms on them? i'm sorry that sounds so shallow! just a quality of life thing

fitnesspremed said:

while I know some recruiters can feed you crap

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No need to continue the rest of your statement.

As an aside: I'm sure this has been said before, but the problem I see with HPSP recruiters is that they are not medical corps officers and usually do HPSP in combination with a number of other officer recruiting duties. With that they take what they are told and have little else to balance that with. I wonder what would happen if they took MC officers to become HPSP recruiters. (Would be difficult as I don't know many docs who would want to go do recruiting for a year or whatever) But an interesting idea.

There is currently a way that MC officers can be funded to travel to speak for recruiting efforts, but is a pain to get put through. Requires working through BUMED in the Navy. (not sure about other services)

i'm applying for navy HPSP, and while I know some recruiters can feed you crap, i asked mine to be completely serious about the whole GMO thing, and he said the navy is phasing them out completely within the next two years.

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There is no question that this is what the recruiters have been told, and that they have no reason to believe otherwise. Unfortunately, apparently, several docs on here heard the same promise from their recruiters when they signed up over a decade ago, so once you know that suddenly what the recruiter said doesn't sound so certain.

fitnesspremed said:

i however, don't want to interrupt my training to do a gmo tour... so if you all have better information please let me know. thanks!!!

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There will be the possibility of a GMO tour NO MATTER WHAT. Nothing you can do can prevent it. Seriously, if you're not willing to do it, don't sign up. I can't say it any plainer than that. You might think "well, I'll just do a great job and I'll end up with what I want (going straight through)" I did. IT DOESN'T MATTER HOW GOOD OF A JOB YOU DO. YOU ARE JUST AS LIKELY TO DO A GMO. If you're not willing to do it, then don't sign up.

BigNavyPedsGuy said:

There will be the possibility of a GMO tour NO MATTER WHAT. Nothing you can do can prevent it. Seriously, if you're not willing to do it, don't sign up. I can't say it any plainer than that. You might think "well, I'll just do a great job and I'll end up with what I want (going straight through)" I did. IT DOESN'T MATTER HOW GOOD OF A JOB YOU DO. YOU ARE JUST AS LIKELY TO DO A GMO. If you're not willing to do it, then don't sign up.

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thanks for the info everyone, im meeting with him on wednesday so we'll see what happens. i'm a pretty flexible person and have had family do the hpsp so i'm weighing a lot of options... once again though, i appreciate all of your input, it just sucks that no one seems happy

fitnesspremed said:

It just sucks that no one seems happy

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There is quite a bit of good information that you can find in this forum to make sure that you are more informed with your decision. There is also a large amount of negative posts from a very vocal group of docs. Some advice:

1. Don't do HPSP for the money, there are better ways to pay for your education. The military is not for everyone, period. Make sure you want to serve for the right reasons.
2. The opinions in this forum are only a representation of the experiences from a reletively few number of individuals. Some had a good time, and some would rather just move on (to put it politely). Moral can change from command to command and even at the same command over time. Just because someone had a bad experience at their command, or their branch of the military, does not mean that you will have the same experience. The reverse is also true. With that said, you should look for and pay attention to posts that have a good amount of evidence to back up their claims (good specific examples, etc..). Even then, you may need to rotate at those places to see for yourself. All inclusive statements like: "Military medicine is in shambles", or "Navy radiology sucks", should be discarded due to the fact that they are blanket statements that actually only cover the experiences of a few people and simply are not true.
3. If you want to know what life is like as a military physician, don't waste your time with the recruiter. They historically have a poor knowledge base and honestly are not looking out for your best interest. Their job is to help you put in your paperwork for the program. When you are ready for that, then go talk to them. In the meantime, try to speak to a few actual military physicians and get their advice.

P.S. With an increased emphasis on physical fitness most ships put a bit of money into their workout equipment (at least the ships that I have been on have). From my experience, the equipment is usually decent but usually not used much by the crew unless you have spec ops guys, marines, or a few fitness nuts onboard (they tend to use the gym facilities more than most).

Say you survive and are able to go straight through your residency, can you be sent to do a GMO tour after your residency, even though the have already spent the money to train you in some speciality?

fitnesspremed said:

thanks for the info everyone, im meeting with him on wednesday so we'll see what happens. i'm a pretty flexible person and have had family do the hpsp so i'm weighing a lot of options... once again though, i appreciate all of your input, it just sucks that no one seems happy

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There are plenty of people who are happy or at least not unhappy who have taken the scholarship. They do not tend to post on this forum.

LauraDO said:

Say you survive and are able to go straight through your residency, can you be sent to do a GMO tour after your residency, even though the have already spent the money to train you in some speciality?

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That would depend on your specialty. If you do a primary care residency (the ones most likely to go straight through at this moment in time), yes it is possible and perhaps likely with the current conversions. Considering that a GMO is essentially a primary care doc, that would be appropriate. If you are in a non-PC specialty, there are other opportunities for you.

I'd like to see the GMO stuff removed from the doctrine. If this thread is true, the military should have no problem putting it in writing.

IgD said:

I'd like to see the GMO stuff removed from the doctrine. If this thread is true, the military should have no problem putting it in writing.

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Where would you want it written?

NavyFP said:

Where would you want it written?

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Perhaps in the HPSP contract, for starters?

IgD said:

I'd like to see the GMO stuff removed from the doctrine. If this thread is true, the military should have no problem putting it in writing.

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Dude, do you not see just a little inconsistency in getting all worked up at the theoretical prospect of the military choosing residencies and demanding that GMO tours be completely abolished? These two positions taken together mean that everyone must be trained in the specialty of their choice. We'd be a system of dermatologists and radiologists.

GMO tours may not provide a standard of care that everyone is comfortable with. I'm a little conflicted about that. But they allow people who want specialties that are not otherwise available to them inside the system to complete their obligation prior to residency.

I don't see how you can have it both ways.

NavyFP said:

Where would you want it written?

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There would be a large number of instructions that would have to be updated. I think the credentialing instruction would be a good place to start. We could specify that a physician may practice medicine outside of a training environment only after graduating a residency. Isn't this what some states have done with licensing?

fitnesspremed said:

thanks for the info everyone, im meeting with him on wednesday so we'll see what happens. i'm a pretty flexible person and have had family do the hpsp so i'm weighing a lot of options... once again though, i appreciate all of your input, it just sucks that no one seems happy

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There are lots of happy people in military medicine. They just don't post on this forum that much. This forum is NOT an accurate sampling of what's out there. I was not trying to dissuade you. I think that anyone who signs up should go in with their eyes wide open. A GMO is not the end of the universe (which I'm learning). But you should be willing to do one if you sign up.

IgD said:

There would be a large number of instructions that would have to be updated. I think the credentialing instruction would be a good place to start. We could specific that a physician may practice medicine outside of a training environment only after graduating a residency. Isn't this what some states have done with licensing?

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No, not possible. What about the people who want to go out and be GMOs? What about people not selected for PGY2+ training in an area they choose? What about people who drop out of residency because they don't like what they are training in? All of these people will need a place to go. Should they be unable to practice any kind of medicine as a GMO, it would lead to people being forced into training the do not want. That would be a worse situation and get us back to the top of the other thread you posted.

Gastrapathy said:

Dude, do you not see just a little inconsistency in getting all worked up at the theoretical prospect of the military choosing residencies and demanding that GMO tours be completely abolished? These two positions taken together mean that everyone must be trained in the specialty of their choice. We'd be a system of dermatologists and radiologists.

GMO tours may not provide a standard of care that everyone is comfortable with. I'm a little conflicted about that. But they allow people who want specialties that are not otherwise available to them inside the system to complete their obligation prior to residency.

I don't see how you can have it both ways.

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How would the process be any different from the NRMP? The military MS4 (USUHS or HPSP) would have to scramble for a position if they didn't match.

The big question is what do you do with someone who doesn't match in the residency of their choice? This is also applicable to someone who quits a program during PGY2.

The individual either scrambles, pays back service obligation in the Medical Service Corps or walks (pays back scholarship money with a 10% penalty). The USUHS student is in a different boat maybe.

For this to work, the number of HPSP / USUHS students has to be in tune with the the number of physician billets. Would the availability of specialty billets roughly approximate those in the civilian world? For example for every x primary care physicians you have 1 surgeon and 1 dermatologist.

I'm enjoying this discussion especially the civility which is unusual for this forum

IgD said:

The big question is what do you do with someone who doesn't match in the residency of their choice? This is also applicable to someone who quits a program during PGY2.

The individual either scrambles, pays back service obligation in the Medical Service Corps or walks (pays back scholarship money with a 10% penalty). The USUHS student is in a different boat maybe.

For this to work, the number of HPSP / USUHS students has to be in tune with the the number of physician billets. Would the availability of specialty billets roughly approximate those in the civilian world? For example for every x primary care physicians you have 1 surgeon and 1 dermatologist.

I'm enjoying this discussion especially the civility which is unusual for this forum

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Dealing with the unmatched medical student does not need to be the problem it seems. Modify the contract under HPSP to require service once having completed residency or within a set period of time, say one year, demand a full repayment of all monies paid plus all accrued interest at prevailing commercial rates or the rate that prevailed at signing, whichever is higher. That would take care of the problem of accessions of HPSP graduates, and it would give appropriate incentive for the HPSP recipient to find a specialty quickly where the graduate could match, even if it wasn't the candidate's first choice. These are choices that all graduates, military and non-military must make.

As for filling fleet medical slots formerly occupied by GMOs with one year of GME, appropriate supplemental training has to be given those board certified/eligible doctors taking those billets. I think the jobs should be made attractive to take by substantial bonus payments and by preferential selection for follow-on billets, fellowship training selection or reduction of active-duty repayment obligation, or some combination of all of these incentives.

This problem is fixable. It can't be fixed on the cheap nor should it be, but doing the right thing now would significantly reduce the problems the Navy and other services are having in recruiting doctors.

IgD said:

The big question is what do you do with someone who doesn't match in the residency of their choice? This is also applicable to someone who quits a program during PGY2.

The individual either scrambles, pays back service obligation in the Medical Service Corps or walks (pays back scholarship money with a 10% penalty). The USUHS student is in a different boat maybe.

For this to work, the number of HPSP / USUHS students has to be in tune with the the number of physician billets. Would the availability of specialty billets roughly approximate those in the civilian world? For example for every x primary care physicians you have 1 surgeon and 1 dermatologist.

I'm enjoying this discussion especially the civility which is unusual for this forum

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As a general idea, I see merit in your proposal. We do plan for graduates to meet billets. I would suspect our PCM/specialist ratio is different from the outside, but I cannot confirm that. The problem we face is what do the people in the program want? The way the system works, we have no control over that and it varies from year to year. What would have to happen is that we would contract for x type of doc at the beginning of med school and I don't think that would be very successful either.

I've been thinking about this HPSP thing through the USAF for a long long time. I've been researching this since last summer and I have talked to a USAF retired surgeon, a USAF retired endocrinologist, a AD family practice doctor at Ellsworth AFB, other family practice doctors and PA's who got in then finished up their obligation and got out for all kinds of different reasons (mostly family), a retired Navy dentist, many current HPSP medical students (Army & Air Force), the Chief Resident of Family Practice at Offutt AFB, and of course this site.

When it really came down to it, the main reason I have been hesitant about joining the USAF through the HPSP is because I'm afraid I will find the speciality that completely fits me, and will not be able to match into it through the AF. When speaking to the chief resident in Offutt, he told me that he didn't start medical school until he was 27. At the time he had 2 daughters and a beautiful wife, and now 7 years later he was just finishing his residency and felt like he still had his whole life ahead of him. He asked me at 21 years old, if I had to do a flight surgeon tour for four years ended my obligation then entered a civilian residency in what I really wanted to do, would it really be the end of the world? What's my hurry? Isn't the reason I was considering to join the AF, to help my country and experience things that I would have never other-wised experienced? I think that really opened my eyes. But that's just my two cents.

IgD said:

The individual either scrambles, pays back service obligation in the Medical Service Corps or walks (pays back scholarship money with a 10% penalty).

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People would be leaving in droves. The single digit retention rate that we currently have would be driven even further down. Even at my 3 year point with just one to go, I would have walked and paid back the whole schmeer. It is that bad. I am in a one-deep position with 6 physician billets. The geniuses upstairs decided to revise the manning document to only show 4 billets because 25% manned looks so much better to MAJCOM than 17% manned. I would rather stock shelves at a supermarket than continue to be told how I don't work hard enough (by the nurse who walks around all day with a clipboard looking busy because they hired a civilian nurse to do her real work) and should be able to single-handedly run an entire clinic mon-fri AND still find time to do all of the occ health/prev med programs AND meet flying hours AND be on call 24/7 indefinitely. Not feasable. It already destroyed my marriage.

So, everybody that is at a base with more than one doc, be happy. Just remember that your next PCS could be to my base when I leave in a few months. I would probably even walk today and pay the whole damn thing back if I could. The only thing I'm living for at this point is to get out of the military and never look back. Have a great Air Force day!

BomberDoc said:

Even at my 3 year point with just one to go, I would have walked and paid back the whole schmeer. It is that bad.

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The situation you described sounds bad. You would rather pay 100-200k than wait a year? That sounds indefensible

now 7 years later he was just finishing his residency and felt like he still had his whole life ahead of him. He asked me at 21 years old, if I had to do a flight surgeon tour for four years ended my obligation then entered a civilian residency in what I really wanted to do, would it really be the end of the world? What's my hurry? Isn't the reason I was considering to join the AF, to help my country and experience things that I would have never other-wised experienced? I think that really opened my eyes

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I understand that perspective, and it sure seems like the non-traditional pathway folks like to hype how much they “grew personally” during their time on the GMO tour or as an army ranger or whatever. But let me give another perspective.

I signed up for a three year HPSP when I was 22 and figured, “what the heck, three years is no big deal even if it totally sucks.” Unfortunately, the training path I ended up on was all active duty, and my commitment doubled—to six years. I’ll soon get out after 13 years on active duty working for an organization that I intensely dislike. I’ll be 40 years old, decidedly middle-aged, and never lived where I wanted or had a practice I felt good about. Spent a lot of time away from family and very young kids in a lot of desert crap holes, and really pissed off my wife. So I would say that it's very easy to end up with way more than you bargained for.

And while the guy at Offutt was asking "what's your hurry?" I would ask you this--why wait to be the kind of doctor and have the kind of practice you want?

IgD said:

The situation you described sounds bad. You would rather pay 100-200k than wait a year? That sounds indefensible

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I calculate each year of my life wasted in the military takes one away from my productive years as an attending partner earning at least half a mil. People commonly make the mistake of thinking that 4 years of GMO in exchange for no med school debt is a good deal, or at least a wash. Incorrect. That 4 years is time that you are behind your peers, 4 years less that you have as a productive adult, 4 years that you won't be earning a real salary. Therefore, my 4 year jaunt as a GMO cost me at least 2 million dollars and that isn't even considering the compound interest on wasted time when I could have been investing significant amounts of money. Financially, it would make good sense to walk with a year left. Truly the most sense is in not signing up at all. The military preys on fear of debt and it profits from lies.

BomberDoc said:

I calculate each year of my life wasted in the military takes one away from my productive years as an attending partner earning at least half a mil. People commonly make the mistake of thinking that 4 years of GMO in exchange for no med school debt is a good deal, or at least a wash. Incorrect. That 4 years is time that you are behind your peers, 4 years less that you have as a productive adult, 4 years that you won't be earning a real salary. Therefore, my 4 year jaunt as a GMO cost me at least 2 million dollars and that isn't even considering the compound interest on wasted time when I could have been investing significant amounts of money. Financially, it would make good sense to walk with a year left. Truly the most sense is in not signing up at all. The military preys on fear of debt and it profits from lies.

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This is very much how I felt, and there was nothing I would not do to get out. The money situation is compounded depending on your specialty. Also there is the factor of staying power. Staying 6 years as a surgeon in one place is very stabilizing, and would allow you to have a good set practice. The money I lost in 6 yrs of being paid just under a 100K, is way more than 2 million. Other untangibles that you cannot put a price on, is the stress that the system can take on your life and your marriage. Mine was to the breaking point, and I'm so happy that I did not have my kids while I was in.

The post above about how you can grow and mature in those 4 yrs is a way to reconcile 4 wasted yrs. Why not grow and mature in the specialty that you want to do? Four years of experience as a surgeon is invaluable. Although it was not the norm when I was interviewing, I'd say 35% of the places I went to looked at my dismal operating record and wondered why I had done so few cases. One place wanted to pay me as if I had just left residency!!

Money wise, experiece wise, sanity wise, military medicine can make your life a misery.

There is no reason to get trained well in what you want, and if you still feel like participating, then do so with a tiny bit more control than you will have if you go through HPSP/USHUS. Its too much of a gamble unless your priority is to be a military officer.

Offutt AFB, once a regional full service hosptial, is now not much more that a "super " clinic with no inhosptial beds, no ER, and Family Practice as the only residency there. How they learn about any of the subspecialties has to be by traveling to outside facilities for every rotation (Am I wrong??). Not the ideal way to have a well rounded residency.

BomberDoc said:

I calculate each year of my life wasted in the military takes one away from my productive years as an attending partner earning at least half a mil. People commonly make the mistake of thinking that 4 years of GMO in exchange for no med school debt is a good deal, or at least a wash. Incorrect. That 4 years is time that you are behind your peers, 4 years less that you have as a productive adult, 4 years that you won't be earning a real salary. Therefore, my 4 year jaunt as a GMO cost me at least 2 million dollars and that isn't even considering the compound interest on wasted time when I could have been investing significant amounts of money. Financially, it would make good sense to walk with a year left. Truly the most sense is in not signing up at all. The military preys on fear of debt and it profits from lies.

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I never thought I'd be happy that pediatricians make so little . . . . .

I guess I'm lucky to love a specialty that pays well. Indeed, the primary care folks are paid terribly on the outside and in the military. It is truly a disservice across the entire sector of primary care medicine.