Navy 2019 Navy GME Changes

[Gastrapathy]

https://mccareer.files.wordpress.com/2019/07/bumed-notice-1524-jmesb-2019-signed.pdf

Well, the rumors in the radiology thread were true. Major changes to the specialty makeup of this years GME selection opportunities. Who knows how the trend will continue but some early observations from the past.

1. Aerospace moved from FTIS to FTOS/OFI. Changes the payback rules from concurrent to consecutive.
2. Bad news if you want Derm, all IM subs except pulm, neuro, OB, Peds, ENT (particularly if you are a GMO, they shifted to straight through interns) or Rads
3. They increased the cohort of GS and Ortho. Can’t speak to Ortho but for GS, I wonder where they will get the cases.
4. The 8 Pulm/cc spots are silly. They haven’t been able to fill the smaller numbers and now this is the least competitive specialty in the Navy. Not exactly what you want for the ICU. I don’t know where they will find the patients to train these doctors. Competition for the other IM sub spots will be brutal. I wonder if some of the fellowships will close since the numbers have been down for several years. Why have two programs when you train one fellow total.

Overall, 13 fewer slots.

---

Members don't see this ad.

 

[Matthew9Thirtyfive]

Yeah, the aerospace medicine thing confuses me. It’s listed in FTOS with 10 spots. Are they listing the spots there for some reason (maybe an error)?

Also the addition of anesthesiology in the PGY-1 grid is new, I believe. There are no spots listed, so maybe they just wanted to include it because it’s usually a NADDS specialty. But neurology is usually as well, and they didn’t add that. Maybe they are going categorical and just haven’t allocated the spots yet? The complete lack of straight through spots there is a little disappointing though.

 

[Gastrapathy]

I suspect moving aerospace was intentional. The reasons would just be speculation but the impact could be a longer post-training commitment.

Anesthesiology could still select incumbent interns but they all have to compete in the deep end of the pool with the returning GMOs. The straight through slots are only available to interns.

ENT, for example, used to require a GMO tour but now only has one spot for those current GMOs to compete over and two spots for interns who never did a GMO. You can imagine how unfair that feels to the folks in the fleet who went out before the intern-only slots existed. Still, IMO, GMOs are bad so the transition away is the right thing.

 

[Matthew9Thirtyfive]

I suspect moving aerospace was intentional. The reasons would just be speculation but the impact could be a longer post-training commitment.

Anesthesiology could still select incumbent interns but they all have to compete in the deep end of the pool with the returning GMOs. The straight through slots are only available to interns.

ENT, for example, used to require a GMO tour but now only has one spot for those current GMOs to compete over and two spots for interns who never did a GMO. You can imagine how unfair that feels to the folks in the fleet who went out before the intern-only slots existed. Still, IMO, GMOs are bad so the transition away is the right thing.

Oh, gotcha. I was reading it wrong then. I thought current interns could only take incumbent spots, so if there were none then that meant the whole class had to go to GMO land.

But yeah, that probably feels pretty crappy for those folks who are essentially trapped in GMO land if they are ENT or bust.

 

[backrow]

ENT, for example, used to require a GMO tour but now only has one spot for those current GMOs to compete over and two spots for interns who never did a GMO. You can imagine how unfair that feels to the folks in the fleet who went out before the intern-only slots existed. Still, IMO, GMOs are bad so the transition away is the right thing.

They planned for this and haven’t had any ENT interns for past couple years in order to allow time for all those out in the fleet to come back to residency before making it a straight through track. The folks who got hosed a bit were Med students interested in ENT that had no internship available when it was their turn. Those folks will have to go back into the ENT internship after GMO if they want to do military ENT.

 

[Gastrapathy]

I’m glad to hear that. If they are allowed to compete for those intern slots, that’s fair. It’s impossible to transition away from GMOs without impacting some people and that is a noble goal.

Was ENT forced to do this by the ACGME or do they get credit?

 

[militaryPHYS]

What about the additional *** listed in 2019 release?

Enclosure (3) for PGY-1 Selections: *** Pending joint coordination for programs in OB/GYN, PEDS, IM. Will adjust/reduce to ensure maintenance of program redlines.

What I interpret this as is our Navy academic centers (Big 3) are maintaining their GME programs but will be absorbing more Army/Air Force to fill the same number (relatively) of spots. So we see a slight decrease in overall slots (259 --> 246) plus we may be filling more of those spots with other services. It will be good to compare the other services projections with this.

Other big thing I see is pre-selects for FY-22 are down considerably across the board. We've seen this with ebbs and flows before, but sustained decreases in the year+2 pre-selects would show a trend. Plus they wiped out FTOS completely for FM sports, IM, OB/GYN, PrevMed, Rads, Uro. This is with the shift of the Aerospace to FTOS as mentioned previously. Balancing act with shift towards operational? Now we wait for next year's 1524 to compare. Until then all we can do is speculate.

Overall I see this release as expected. Slight decrease in overall numbers, likely consolidation of GME programs DHA-wide (*** noted above) with slight shift towards operational minded selections. I'm actually surprised in the relative maintenance of numbers for the non-operational specialties. Hopefully we stay on a steady glide-path towards consolidation.

 

[Cooperd0g]

Aerospace isn’t really FTOS. The MPH is with an outside school, the University of West Florida. Because of that we deal with BUMED FTOS people for getting the school paid for. The move to show it as FTOS was likely an error because it definitely isn’t incurring a consecutive commitment.

 

[j4pac]

This puts a pretty big damper on the Navy GMO then GTFO plan. As of right now, if you want GMO of some sort it’s yours. There is also a guarantee to do GMO until contract completion. I’d say that this conplicates things a bit. Will you be guaranteed a GMO spot or will you be rushed to return to GME?

The flexibility of GMO was in my opinion a positive of MilMed. This should hurt recruitment.

I remember many moms ago as a FS in API we had the chance to see a presentation by a GME big wig. He explained that it was GMEs goal to reduce the number of scholarship platforms offered to prior service military with the hope of increasing the average USMLE score. It was at that moment I knew that GME was destined to fail. They are so out of touch that it’s not even funny. Clearly, this isn’t a GME directive but it’s in line with a very shortsighted opinion. Retention is going to be absolutely brutal in this environment.

 

[pgg]

This puts a pretty big damper on the Navy GMO then GTFO plan. As of right now, if you want GMO of some sort it’s yours. There is also a guarantee to do GMO until contract completion. I’d say that this conplicates things a bit. Will you be guaranteed a GMO spot or will you be rushed to return to GME?

I didn't read the whole thing carefully. Just looked at the projected numbers for my specialty.

Historically, no one has ever been forced into a residency. There's not even a requirement to apply for GME. No application, no selection, orders to a GMO billet follow. Has this changed in some way? GMO-and-out is the default path of inaction, isn't it?

 

[j4pac]

I didn't read the whole thing carefully. Just looked at the projected numbers for my specialty.

Historically, no one has ever been forced into a residency. There's not even a requirement to apply for GME. No application, no selection, orders to a GMO billet follow. Has this changed in some way? GMO-and-out is the default path of inaction, isn't it?

If they plan on getting rid of tons of GMO billets, I’m not sure what the heck they’ll do

 

[militaryPHYS]

I’d say that this conplicates things a bit. Will you be guaranteed a GMO spot or will you be rushed to return to GME?

What part of the document makes you feel like going GMO and staying GMO isn’t easy anymore? The 1524 doesn’t reflect number of GMO billets

 

[Matthew9Thirtyfive]

What part of the document makes you feel like going GMO and staying GMO isn’t easy anymore? The 1524 doesn’t reflect number of GMO billets

If anything, there are fewer GME spots on the 1524 so there are probably more people going GMO.