70% Navy get GME-1 1st choice!!!

Discussion in 'Military Medicine' started by BOHICA-FIGMO, Jan 6, 2009.

  1. BOHICA-FIGMO

    BOHICA-FIGMO Belt-fed Physician
    10+ Year Member

    Joined:
    Dec 7, 2004
    Messages:
    785
    Likes Received:
    4
    Status:
    Resident [Any Field]
    This was released today by the wonderful Navy HPSP folks. Wonder if they put that on the recruiting posters in Mumbai/Bombay :rolleyes:

    "For the GME board, I am pleased to state over 70% of student got their
    first choice in program and location. This is great considering the
    shortfall of applicants for positions. The class of 2009 is the
    smallest in the history of the program. For those who did not get
    exactly what they wanted, please be assured that every effort was made
    to meet the needs of both the students and the Navy."
     
  2. IgD

    IgD The Lorax
    10+ Year Member

    Joined:
    Jul 5, 2005
    Messages:
    1,901
    Likes Received:
    6
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  3. notdeadyet

    notdeadyet Still in California
    Moderator 10+ Year Member

    Joined:
    Jul 23, 2004
    Messages:
    11,658
    Likes Received:
    1,789
    Status:
    Attending Physician
    Hmmm. That sounds odd.

    The Army actually releases the information of how many folks were per position and it showed that about 25% of folks had to do GMO tours.

    If Army, which has the reputation of having a lot less forced GMOs than Navy, has only a 75% match rate AT ALL, I find it very suspicious that the Navy matches 70% in first choice and location.

    I'd like to see the actual numbers that show applicants per specialty and how many were given deferrals. Until they release that data, I'll believe the 70% figure as much as I'll believe that GMO tours will be gone by 2008 (whoops, already missed that).
     
  4. BigNavyPedsGuy

    BigNavyPedsGuy Junior Member
    10+ Year Member

    Joined:
    Apr 11, 2006
    Messages:
    1,267
    Likes Received:
    147
    Status:
    Attending Physician
    That's a GME1 match rate. It has nothing to do with GMO tours
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  5. Mirror Form

    Mirror Form Thyroid Storm
    10+ Year Member

    Joined:
    May 8, 2003
    Messages:
    7,529
    Likes Received:
    22
    Status:
    Attending Physician
    Ah ha, so that 70% number doesn't actually refer to residency! This is the same old BS method all 3 branches have been using to mislead people about their match for quite some time.
     
    #5 Mirror Form, Jan 7, 2009
    Last edited: Jan 7, 2009
  6. IgD

    IgD The Lorax
    10+ Year Member

    Joined:
    Jul 5, 2005
    Messages:
    1,901
    Likes Received:
    6
    So you are excluded from the 70% if you do a GMO tour?
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  7. NavyFP

    NavyFP Senior Member
    10+ Year Member

    Joined:
    May 18, 2006
    Messages:
    2,718
    Likes Received:
    10
    Status:
    Attending Physician
    How is this misleading? If your first choice for internship is General Sugery at San Diego and you get it, that's a match for your number one choice.

    I still think that is pretty good.
     
  8. The White Coat Investor

    The White Coat Investor Practicing Doc and Blogger
    Physician Partner Organization 10+ Year Member

    Joined:
    Nov 18, 2002
    Messages:
    5,160
    Likes Received:
    2,251
    Status:
    Attending Physician
    You might not understand if you've never been through the regular match. ;) In the NRMP, you not only match for your internship, but you also match for your residency at the same time. Few people who matched for their desired internship, but not their desired residency, would say they "got their number one choice." So when the military uses this number to show how good their match is, it is misleading unless you publish the "GME-2" number right alongside. The other reason it is misleading is that applicants in the military match are limited to applying to military programs. When I was applying to residency, I applied to 32 programs. Number 31 and 32 were the two military programs in my specialty. On my military match, I ranked 1) Deferred, 2) Military Program # 1, 3) Military Program #2. You can be assured that if I had gone to military program #2 the military wouldl have included me in statistics of "people who matched into their top 3 choices" when in reality, I didn't get any of my top 30 choices for residency programs.

    There are lots of good things about military medicine. The military match, however, is not one of them. It is the single worst part of the HPSP program.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  9. notdeadyet

    notdeadyet Still in California
    Moderator 10+ Year Member

    Joined:
    Jul 23, 2004
    Messages:
    11,658
    Likes Received:
    1,789
    Status:
    Attending Physician
    I think more folks are concerned about their ability to get their residency of choice straight out of med school, which is the way it works in the civilian world. When folks celebrate that they got into their Anesthesia program of choice at University of Chicago, I don't think they're too fixated on whether or not they got the internal med internship they were pining for.

    Folks (including me) should have done a closer read. Some of us took it to read 70% Navy got the match of their choice, forgetting that it's not like in the civilian world where you train straight through.

    But you're right, it isn't particularly misleading. It's just underwhelming.
     
  10. NavyFP

    NavyFP Senior Member
    10+ Year Member

    Joined:
    May 18, 2006
    Messages:
    2,718
    Likes Received:
    10
    Status:
    Attending Physician
    While I understand the arguement, I disagree with the premise.

    One thing I believe this forum has made abundantly clear is that there are no guarantees for full deferments. In fact, I counsel applicants to expect to do a Navy internship. Even in good years when we are flush with deferments less than 25% of graduates will be given deferments. That means 3 out 4 (or more) will end up in inservice training. It is almost delusional to EXPECT to be given a full deferment. I will concede that recruiters will oversell the possiblilities of deferments, but with the current availability of less partisan information, any current applicant should be able to see through that smokescreen if they choose.

    The bottom line for any HPSP applicant should be this. If your intent is to train in the civilian sector prior to completing your military obligation DO NOT go HPSP. The Vegas odds are that you will be disappointed. Realistic expectations are that you will end up at one of the big 3. (unless you go FP)
    If that option is not palatable, STAY AWAY. Go FAP or enter the service after you have completed all desired training if you still want to join the Navy.

    As far as the GME2+ issue, again, not exactly concealed. If you go Navy there is a significant possiblity you will be a GMO. Is the Navy trying to change this? Yes, but again, if this possibility is not palatable, STAY AWAY.
     
  11. notdeadyet

    notdeadyet Still in California
    Moderator 10+ Year Member

    Joined:
    Jul 23, 2004
    Messages:
    11,658
    Likes Received:
    1,789
    Status:
    Attending Physician
    This actually brings up something I hadn't thought of before.

    It sounds like you have a good shot of getting the internship and location of your choice in the Navy. Is there any risk of not getting the internship of your choice at all (e.g. a neuro-hopeful who can't land an internal med internship and gets slotted for surgery instead)?

    I'm thinking not, as this would add another year of training as the individual would have to repeate intern year if they went civilian for training. But I've learned not to make assumptions on this kind of thing...
     
  12. NavyFP

    NavyFP Senior Member
    10+ Year Member

    Joined:
    May 18, 2006
    Messages:
    2,718
    Likes Received:
    10
    Status:
    Attending Physician
    There is always a risk. Although 70% matched for program AND location, more matched for program in total. The intern selection board works very hard to put graduates into internships that are compatible with future goals. Those who don't get a spot that is compatible (and I am sure there are a few)are weak students who have over inflated goals.
     
  13. notdeadyet

    notdeadyet Still in California
    Moderator 10+ Year Member

    Joined:
    Jul 23, 2004
    Messages:
    11,658
    Likes Received:
    1,789
    Status:
    Attending Physician
    Does the Navy release the figure of what % match in program for internship? The risk of having to repeat internship year is something I think most applicants would want to know.
    Pardon my ignorance, but what are "inflated goals" in terms of internship? Are medicine or surgery "competitive" internships in which lower end candidates should expect a good chance of not matching and being forced into family or psych?

    This is very much unlike civilian sector. Getting an internship in a particular field is not a problem if you're not fussy about locale. If the Navy forces applicants not only to do GMO tours but also possibly repeating internship year, this is a pretty big flag for some.
     
  14. notdeadyet

    notdeadyet Still in California
    Moderator 10+ Year Member

    Joined:
    Jul 23, 2004
    Messages:
    11,658
    Likes Received:
    1,789
    Status:
    Attending Physician
    Good advice. Recruiters should pay mind to this, but if they don't, applicants sure as heck should. I was very close to taking HPSP except for the military GME system and GMO tour problem, so I went National Guard instead.
     
  15. IgD

    IgD The Lorax
    10+ Year Member

    Joined:
    Jul 5, 2005
    Messages:
    1,901
    Likes Received:
    6
    What I would really be interested in seeing is the GME2 selection rate with those deferred for GMO tours included in the percentages.

    I'd also be interested in seeing what percentage of categorical interns graduate from a military residency of the same specialty including those who completed a GMO tour. For example, how many medicine interns actually complete a medicine residency in the military?
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  16. backrow

    backrow 60% of the time it works everytime
    Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Apr 16, 2005
    Messages:
    1,659
    Likes Received:
    290
    Status:
    Attending Physician
    This is not necessarily true. About two years ago getting a pediatrics internship slot in the Navy was very difficult and I know of a few more than qualified people who did not get the internship slot. In the "real world" this would never happen, there is simply not that supply side limitation in pediatrics residencies. In the military there is more of a supply side (internship/residency slot numbers) limitation for many residencies. This also happens more than one would think in OB/GYN, Peds, and sometimes even Transitional internships. In the NRMP system these are all internships that are not that difficult to match into if you aren't picky.

    Having a very limited number of slots in certain specialties can lead to overinflated competition that has nothing to do with being a weak/strong student, but rather a supply/demand competition.
     
  17. NavyFP

    NavyFP Senior Member
    10+ Year Member

    Joined:
    May 18, 2006
    Messages:
    2,718
    Likes Received:
    10
    Status:
    Attending Physician

    By inflated goals, I mean students with below average students applying for internships in Ortho, ENT, Neurosurg, and sometimes Gen Surg. Not going to happen.
     
  18. NavyFP

    NavyFP Senior Member
    10+ Year Member

    Joined:
    May 18, 2006
    Messages:
    2,718
    Likes Received:
    10
    Status:
    Attending Physician
    True Peds tends to be an anomoly and OB runs hot and cold.
     
  19. notdeadyet

    notdeadyet Still in California
    Moderator 10+ Year Member

    Joined:
    Jul 23, 2004
    Messages:
    11,658
    Likes Received:
    1,789
    Status:
    Attending Physician
    I didn't realize that folks interested in things like ENT and neurosurgery had their own internship program. I thought they would do a general surgery internship, which are dime a dozen civilian.
     
  20. coureurdubois

    coureurdubois Junior Member
    5+ Year Member

    Joined:
    Dec 18, 2004
    Messages:
    41
    Likes Received:
    0
    I think to enter the HPSP progam and expect a civilian residency is a bit unreasonable. This scholarship is a 2-way proposition. The recipients enjoy many benefits including excellent financial support throughout medical school and residency. By the time a student enters his or her internship year, the Navy has already heavily invested in that student. It is not unwarranted that they require some return (i.e. service).

    I hear GMO tours are being phased out though it is still part (albeit a diminishing one) of the 'give and take' of the HPSP program. There are some participants that prefer and even request GMO tours. Many, if not most, interns go straight through residency. Serving one's country isn't necessarily an intolerable burden; in some corners it's considered a privilege:)
     
  21. The White Coat Investor

    The White Coat Investor Practicing Doc and Blogger
    Physician Partner Organization 10+ Year Member

    Joined:
    Nov 18, 2002
    Messages:
    5,160
    Likes Received:
    2,251
    Status:
    Attending Physician
    The only thing different about the information available compared to ten years ago is this website and the one or two dozen mililtary attendings who voluntarily post here to tell people what it is really like. The recruiters are no better than they were. The military websites are no better than they were. There are a couple of other sites out there like Luke Ballard's, but that was never helpful to me because he was in my same year. I wonder if he's ever had any negative repercussions at work due to the site. A quick search shows not much else.

    http://lukeballard.tripod.com/HPSP.html

    This site looks promising:

    http://navyhpsp.net/wiki/index.php?title=Main_Page

    This one is garbage:

    http://www.goarmy.com/amedd/hpsp.jsp

    I mean, look at this:

    YOUR OBLIGATION
    Your active duty service obligation to the U.S. Army is one year of service for every year you receive the scholarship. Your minimum obligation depends on your health care field. For example, the minimum obligation for medical students is two years. Dental, psychology, optometry and veterinary students are obligated to serve no fewer than three years. There is an additional obligation for residency and fellowship training.



    The PDF with more info doesn't even come up.


    This site doesn't even mention the match:


    http://www.navy.com/careers/healthcare/physicians/


    But you can just click on a link for a recruiter to call you.

    The Air Force site is even worse:

    http://www.airforce.com/pdf/hpsp_scholarship.pdf

    It just says you begin your payback after you're done training. While technically true, not mentioning the military match (or worse, describing it as just like the civilian one) is a crime.

    There's no excuse for it. There's no defense for it. It's just bull****. Among prospective applicants who really understand how it works, I've found less than 1 in 10 actually are still willing to sign up. The problem is most of them don't understand the civilian match, so they have no idea how badly they're getting screwed over by being forced into the military match.

    I find I don't have to lie or even share negative experiences to prevent applicants from signing up. All I have to do is explain how the civilian match works, then explain how the military match works. That's enough right there for most of them.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  22. BOHICA-FIGMO

    BOHICA-FIGMO Belt-fed Physician
    10+ Year Member

    Joined:
    Dec 7, 2004
    Messages:
    785
    Likes Received:
    4
    Status:
    Resident [Any Field]
    This is a good point. Many probably got their 1st choice of specialty, but not location and vice versa. Me, for instance, didn't get my first specialty choice but got my first location which was WAAAY more important to me and I let the board know it.
     
    #22 BOHICA-FIGMO, Jan 7, 2009
    Last edited: Jan 7, 2009
  23. BOHICA-FIGMO

    BOHICA-FIGMO Belt-fed Physician
    10+ Year Member

    Joined:
    Dec 7, 2004
    Messages:
    785
    Likes Received:
    4
    Status:
    Resident [Any Field]
    Not sure they can even do that because many (at least 50%) IM end up doing something else like EM, anesthesia, or rads. That might make it hard to generate those numbers. And too, how do you count the transitionals? Theoretically, they could do FM, IM, EM, Rads, anesthesia, etc.
     
  24. BOHICA-FIGMO

    BOHICA-FIGMO Belt-fed Physician
    10+ Year Member

    Joined:
    Dec 7, 2004
    Messages:
    785
    Likes Received:
    4
    Status:
    Resident [Any Field]
    ENT has their own, very small, internship. I think all neurosurgery are deferred. (at least in the navy)
     
  25. Mirror Form

    Mirror Form Thyroid Storm
    10+ Year Member

    Joined:
    May 8, 2003
    Messages:
    7,529
    Likes Received:
    22
    Status:
    Attending Physician
    When I first started responding to you I wrote some rather nasty things. Suffice to say that I vehemently disagree.

    The vast vast vast vast vast majorty of medical students do not apply just for internship!!!!!!!!!!!! They apply for residency, and when they say they got their first choice they are referring to residency, NOT INTERNSHIP!

    To say most navy hpsp students got their first choice when it refers only to internship and not residency is absolutely misleading. And it's certainly not done innocently either. The navy (and army) intentionally make the numbers misleading b/c they don't want people to know the truth.
     
  26. NavyFP

    NavyFP Senior Member
    10+ Year Member

    Joined:
    May 18, 2006
    Messages:
    2,718
    Likes Received:
    10
    Status:
    Attending Physician
    But if you Google HPSP this forum pops up in the first five hits every time. It is not hard to find and frequently used. I am actually happy that there is a counterpoint for applicants to find. I hate to see anyone blindsided. I find that unmet expectations is one of the biggest detractors for those in the system.

    The military medical system is by no means perfect. Far from it. But the bottom line is that those in the GME system are not out to screw the graduates.
     
  27. The White Coat Investor

    The White Coat Investor Practicing Doc and Blogger
    Physician Partner Organization 10+ Year Member

    Joined:
    Nov 18, 2002
    Messages:
    5,160
    Likes Received:
    2,251
    Status:
    Attending Physician
    I agree with that. It isn't personal by any means. All the program directors and most of the faculty I know are very good people. But it's a systems issue. The military simply trains what it needs. But the needs of the military don't align well with the desires of medical students. That's fine if they had a 1 year commitment or something, but every HPSP student is making a commitment that will last at least a decade and a half, all told (from med school through IRR time.) That's way too long to sacrifice your career. The military should find a way to let everyone do what they want (assuming they're qualified) and if they need something else, well, they can hire contractors. It would work better if they only recruited staff level docs, or at least residents, but few of those are willing to sign on because they can already see the light at the end of the tunnel, aren't quite so idealistic as pre-meds, and understand their alternatives better. I can still remember how mad and scared I was to arrive at my first ADT, in September of my MSIV year, and learn how the military match really works and that I had only a 25% shot of getting what I wanted out of it. Lucky for me I had good grades and board scores, but at least half of the people who were on that rotation with me (all with at least average board scores) went on to GMO tours. One was forced into a military surgical internship.

    Well, rant over. My biggest beef with the military now is the lack of acuity, but that's just part of being a military doc. (When you only let healthy people in, and you kick out unhealthy people, and you put the retirees onto medicare, there isn't anyone sick to take care of.) But overall, the worst part of the entire HPSP/military experience so far has been the military match.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  28. The White Coat Investor

    The White Coat Investor Practicing Doc and Blogger
    Physician Partner Organization 10+ Year Member

    Joined:
    Nov 18, 2002
    Messages:
    5,160
    Likes Received:
    2,251
    Status:
    Attending Physician
    1) People only expect a civilian residency because they're TOLD they can get one. I'm definitely not the only one who was told this by my recruiter. The point isn't to get a civilian one, but simply to have some choice in the process. In most fields and services there is only 1-3 different options for military residency. At best, the overall residency experience is average (usually better academics and worse patient experience.) I do not know of any EXCEPTIONAL military residencies in any service.

    2) "Excellent financial support?" It was $930/month in 1999. We would have never made it without loans if my wife hadn't been working, and that was in a cheap city (and we're cheap people.) I can't imagine going to a school in New York or California and trying to live on an HPSP stipend. It's more now, which is good, but I hardly view it as "excellent." HPSP students aren't rolling in cash. They'd be better off with E-1 pay and BAH/BAS.

    3) The Navy isn't "invested." They make their money back and more by paying the physicians less than they're worth during their payback time. Example: Emergency medicine. Average pay ~$270K. Military pay $125K. Multiply the difference by four years and you can pay pretty damn high tuition and still come out ahead. They're preying on debt-averse pre-meds. They're not training fighter pilots here.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  29. BOHICA-FIGMO

    BOHICA-FIGMO Belt-fed Physician
    10+ Year Member

    Joined:
    Dec 7, 2004
    Messages:
    785
    Likes Received:
    4
    Status:
    Resident [Any Field]
    Yep. That's a pretty slick trick. Until they do something with the pay and bonus system, recruiting and retention will stay in the toilet. HPSP only makes sense for anyone going to a very high cost school and going into a very low pay specialty. If you are interested in EM, Derm, Ortho, Neurosurg, Anesthesiology, Radiology, Opthomology, Urology or any other high paid specialty, joining HPSP is like throwing Ben Franklins into the fireplace.

    And, isn't it strange how it takes only about 1.5-2 yrs to crank out a fully trained fighter pilot from scratch, yet the military values them far more than a physician who requires 7-11 years to make?
     
  30. NavyFP

    NavyFP Senior Member
    10+ Year Member

    Joined:
    May 18, 2006
    Messages:
    2,718
    Likes Received:
    10
    Status:
    Attending Physician
    This is one of primary problems that military medicine faces. The line does not get medical. As you note in 18 months we could have a fully qualified F/A - 18 pilot. The line doesn't grasp that what we do today may not be felt for a decade. That is way beyond any of their timelines. The failure to fully recruit in 2005 is going to result in a shortage of Orthopods in 2014. In that time we may well have 4 Surgeon Generals and 3 Presidents. We don't even contemplate budgets for those outyears. Doctors are expensive and while the bonus situation has improved some in the past 5 years, there is still room to grow.
     
  31. IgD

    IgD The Lorax
    10+ Year Member

    Joined:
    Jul 5, 2005
    Messages:
    1,901
    Likes Received:
    6
    Regardless of the cause, the reality of the military medicine situation is that what you described is what is occurring. Junior physicians see the writing on the wall, maybe even feel "screwed" and exit after their GMO tour or after their first tour just like me.

    I think the warfighters I came in contact with would disagree with you. The Generals I worked with understood medical care very well. It was a constant hassle and headache including for the spouses. There was a general feeling of dissatisfaction and disappointment surrounding medical.

    I'm thinking it would be interesting to have a hospital commander be a line officer. We ought to have a Marine General running the naval hospital at Camp Lejeune with a Navy physician working for him similar to a CEO/Chief Medical Officer Relationship.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
    #31 IgD, Jan 8, 2009
    Last edited: Jan 8, 2009
  32. Perrotfish

    Perrotfish Has an MD in Horribleness
    Physician 10+ Year Member

    Joined:
    May 26, 2007
    Messages:
    8,027
    Likes Received:
    3,759
    Status:
    Attending Physician
    Don't military residencies pay significantly more than civilian residencies? As in, full pay + full benifits + BAH/BAS for an O3 with 4 years in? Significantly higher pay, I think, bumps an average residency to an above average residency. Just personal opinion.

    I'm pretty sure we're above the E-1 level. Between the bonus (20K lump sum) and the stipend we pull down just short of 30K/year plus full covereage health insurance (for ourselves, not families). You're right that that's not exactly luxery living, but it's a good salary for a liberal arts grad right out of college and more than enough for a family to survive or a single person to live well.

    That's what investment means. You put something in to get more out when your investment matures. If they paid for all of your training and then paid you at a rate commisurate with your civilian colleagues that wouldn't be an investment, that would be a gift.

    Also I think your comparing the average salary of an EM halfway through his/her career with the average salary of a military doctor right out of residency. It's not qute as bad as you're making it out to be.
     
    #32 Perrotfish, Jan 8, 2009
    Last edited: Jan 8, 2009
  33. NavyFP

    NavyFP Senior Member
    10+ Year Member

    Joined:
    May 18, 2006
    Messages:
    2,718
    Likes Received:
    10
    Status:
    Attending Physician

    The day to day headaches and hassles of medicine they experience. What they don't understand is the manning issues. Many feel a doc is a doc is a doc. They don't get the needed specialty breakdowns and training pathways. They don't get that if you need a neurosurgeon, you just can't go get one or make one. They see 3800 physicians on active duty and 3700 billets and ask why do you need bigger bonuses? You have more docs than you need? Yet we only have 80% of the orthopods we need or 85% of the FP docs but have 110% of the ophthalmologists we need and 150% of the GMOs. (numbers are for example only and do not necessarily reflect current numbers :cool:) It is those issues they have difficulty with.
     
  34. IgD

    IgD The Lorax
    10+ Year Member

    Joined:
    Jul 5, 2005
    Messages:
    1,901
    Likes Received:
    6
    I think there is some truth to what you said. However, my experience was the senior officers understood the manning problems all to well because they were often left holding the bag. It seemed like the warfighters and the medical types were always locking horns about staffing, readiness or some type of infrastructure problem. My impression was that the warfighters would set the operational requirement and it was up to the medical community to meet it. Why isn't it reasonable for the medical corps to take action to meet manning goals? I remember once going to a national medical meeting. Navy medicine had a recruiting booth with an index card that said "Navy Medicine" on it and nothing else except a Chief. It was almost like they were trying to scare people away!
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
    #34 IgD, Jan 8, 2009
    Last edited: Jan 8, 2009
  35. deuist

    deuist Stealthfully Sarcastic
    Physician Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Jun 14, 2004
    Messages:
    4,429
    Likes Received:
    303
    Status:
    Attending Physician
    What about a person with above 230 on the boards who doesn't get an EM spot? Was he a below average student with inflated goals?
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  36. BigNavyPedsGuy

    BigNavyPedsGuy Junior Member
    10+ Year Member

    Joined:
    Apr 11, 2006
    Messages:
    1,267
    Likes Received:
    147
    Status:
    Attending Physician
    That's the point, by the time you finish, you will be halfway through your career.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  37. NavyFP

    NavyFP Senior Member
    10+ Year Member

    Joined:
    May 18, 2006
    Messages:
    2,718
    Likes Received:
    10
    Status:
    Attending Physician
    No, but that is residency and there are a host of other issues with that.
     
  38. The White Coat Investor

    The White Coat Investor Practicing Doc and Blogger
    Physician Partner Organization 10+ Year Member

    Joined:
    Nov 18, 2002
    Messages:
    5,160
    Likes Received:
    2,251
    Status:
    Attending Physician
    #1) Military residencies don't allow moonlighting. Add in moonlighting and you can make more in the civilian residency if you so desire. Yes, it is a benefit that military residencies pay more, but residency isn't about making the bucks, it is about quality of training. Post-residency is about making bucks. The military has it all backwards.

    #2) E-1s are paid $1400 per month. BAH is $1200 in my area (quite average BTW.) BAS is $326.87. Total is $2926.87. Multiply by 12 months and you get $35,122. E-1s not only get free health care, but they get to shop at the BX and the commissary too, benefits not available to the HPSP student. I stand by my original comment. And that $20K bonus is pretty damn new. Even today's MS2s never saw that.

    #3) Yes, it's a great investment for the military. And Bernie Madoff made great investments for himself. But investing like that will result in the same problems in the end for both of them.

    #4) Just out of residency, I was offered a typical attending position at $150 per hour. $150/hour*12 hours per day*15 days per month* 12 months= $324,000. $270K is more than realistic. Trust me on EM salaries, I read the surveys every year. EPs have a very flat "salary curve." The guys 20 years out don't make much more than the guys 2 years out. But even if EPs only made $220K? That's still $100K more than the military pays.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  39. SeminoleFan3

    SeminoleFan3 Senior Member
    10+ Year Member

    Joined:
    Mar 3, 2006
    Messages:
    1,270
    Likes Received:
    15
    Status:
    Attending Physician
    Well, maybe today's MS3s didn't. I'm currently a MS2, and I got the bonus when I signed up before MS1.
     
  40. NavyFP

    NavyFP Senior Member
    10+ Year Member

    Joined:
    May 18, 2006
    Messages:
    2,718
    Likes Received:
    10
    Status:
    Attending Physician
    This is one of those areas where I have to shake my head.

    There is considerable criticism that having only one year of training does not qualify a physician to practice independantly yet residents have been moonlighting forever. They are paid to function in the stead of a residency trained physician. Not so different from a GMO.

    Just an observation.
     
  41. orbitsurgMD

    orbitsurgMD Senior Member
    10+ Year Member

    Joined:
    Dec 27, 2005
    Messages:
    1,920
    Likes Received:
    52
    Status:
    Attending Physician
    Except the moonlighter is working by choice, and can choose the venue. The GMO can't.

    Just an observation.
     
  42. IgD

    IgD The Lorax
    10+ Year Member

    Joined:
    Jul 5, 2005
    Messages:
    1,901
    Likes Received:
    6
    I would argue that one of the differences is that the patients deserve better. I still think there is a better way. Not exactly sure what that is.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
    #42 IgD, Jan 9, 2009
    Last edited: Jan 9, 2009
  43. Mirror Form

    Mirror Form Thyroid Storm
    10+ Year Member

    Joined:
    May 8, 2003
    Messages:
    7,529
    Likes Received:
    22
    Status:
    Attending Physician
    I'm not an expert on residents moonlighting, but I met a lot of residents doing it while I was a med student. It seemed to me that residents who are moonlighting have back up and do not function just like a residency trained physician.

    For example, surgical residents often moonlight by covering in house call at a hospital. However, if there was an emergency they would contact the attending (eg., if acute appendicitis came in the resident wouldn't just do the appy; they'd evalute the patient and call in the attending).
     
  44. Perrotfish

    Perrotfish Has an MD in Horribleness
    Physician 10+ Year Member

    Joined:
    May 26, 2007
    Messages:
    8,027
    Likes Received:
    3,759
    Status:
    Attending Physician
    My understanding was that the 80 hr rule had made it much harder to moonlight, since the hours moonlighting count against the 80 hour limit the same as if you were working with the hospital. Didn't we just have a thread about a guy who basically got sh!tcanned for moonlighting in a way that put his program's accreditation at risk?

    Anyway, I know that the point of residency is training, but I just meant that if you're comparing adequate training from a civilian residency with adequate training from a higher paid military residency I think the military residency wins out. If you had a residency in the civilian world that paid twice as much as all the other residencies, I think you'd see it would rapidly become one of the most competitive residency programs as long as it maintined accreditiation. Again, this hasn't happened yet so it's all personal opinion.
     
  45. deuist

    deuist Stealthfully Sarcastic
    Physician Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Jun 14, 2004
    Messages:
    4,429
    Likes Received:
    303
    Status:
    Attending Physician
    $35,000?!? Holy crap we're getting screwed in medicine. An HPSP student makes $27,000. And that's significantly better than the pay was a few years ago.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  46. pgg

    pgg Laugh at me, will they?
    Moderator Physician Faculty 10+ Year Member

    Joined:
    Dec 14, 2005
    Messages:
    11,615
    Likes Received:
    6,761
    Status:
    Attending Physician
    You'd have to moonlight an awful lot as a civilian resident to earn as much as a military resident. And I'll point out that moonlighting isn't "free money" ... they do have to actually work those extra hours, and therefore sleep, study, or goof off less. Someone earning the average civilian resident paycheck would have to moonlight an extra 11 hours/week, 52 weeks a year, at $100/hour to catch up to what the Navy paid me in 2008. They'd have to fit those 11 hours into the 80-hour limitation.

    The financial analysis of HPSP vs USUHS vs civilian that periodically shows up on this forum consistently neglects a very important point: there is an advantage, beyond the raw $ numbers, to getting paid more sooner. Medical school & residency consumes nearly a decade, and your standard of living during that time matters.

    I know some poor, destitute civilian residents. I've seen their cars, I've seen their homes (apartments), I've heard them gripe about the crappy pay and their huge loans, I've heard their wives gripe about putting off children until the attending money rolls in. And each day I drive to work at the naval hospital in one of our two paid-cash-for cars, leaving a house I own and 3 kids my stay-at-home wife & I had (beginning with one my first semester in medical school). I have bank & retirement accounts with positive cash flow.

    There's a lot to be said for the military way of no/minimal debt during medical school, a good wage during residency, and less money for a few years as staff.

    You can't just write that off by saying, well, civilian residents can moonlight so it's a wash.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  47. BOHICA-FIGMO

    BOHICA-FIGMO Belt-fed Physician
    10+ Year Member

    Joined:
    Dec 7, 2004
    Messages:
    785
    Likes Received:
    4
    Status:
    Resident [Any Field]
    Can I get the name of your broker? :laugh:
    My retirement accounts were bleeding cash this year.
     
  48. DrMetal

    DrMetal To shred or not shred?
    Physician PhD Lifetime Donor Classifieds Approved 10+ Year Member

    Joined:
    Sep 16, 2008
    Messages:
    1,439
    Likes Received:
    177
    Status:
    Resident [Any Field]
    Abso-frickin-lutely!!! Great post, you hit the nail right on the head.

    from a med school applicant's point of view (yours truly):

    It's easy to do the civilian route when you're by yourself. But if you have dependents, it's pretty hard to force your wife/kid to live frugally while you plow through med school and residency. Are you going to deprive your kid of pre-school (~$500/month), deprive them of decent food (sure, you can slave away on Top Ramen). I'm sure as hell not. In addition to my prior history with the Navy and desire to serve, this concern (for my family's welfare) is at the top of my list of reasons to attend USUHS. Now, I'm happy to say that I'm a flexible person. I can see myself going into a few different things (haven't zeroed in on anything yet), and I don't mind having breaks in my training if need be. The way I look at it, the Navy's taking care of my family as I pursue medical education & training. In turn, I might have to do a GMO and/or utilization tours before I complete all of my training; that's a good deal in my book.

    For those of you that have done utilization/GMO: Who's to say you still can't "train" during these time periods? Do you have enough downtime? I had a friend who said that he had enough downtime during his GMO to read/study almost all of Harrisons IM (so when he showed up for his IM residency, he was way ahead of the power curve). Is such downtime common? (I guess it depends on the job, but I'd imagine it is, especially if you're on a ship!)
     
  49. orbitsurgMD

    orbitsurgMD Senior Member
    10+ Year Member

    Joined:
    Dec 27, 2005
    Messages:
    1,920
    Likes Received:
    52
    Status:
    Attending Physician
    Sorry, but that is no way to make the case for allowing GMOs with one year of training. So there is one supposedly well-supported billet with the Marines somewhere. What does that prove exactly?

    Believe me, there are plenty of GMO billets not so well supported, where there isn't someone to call at 3:00 a.m., where there isn't lab or radiology support after hours, where there isn't a hospital full of specialists available ten minutes away, where the facilities are open 24/7 for anyone with anything to come in but without any of the support or training necessary or expected of even an urgicenter, let alone an E.R.

    It is a bankrupt idea. It is totally out of date. Hopelessly so. It does not deserve justification, and in fact anyone who tries to justify the 1-year-GME GMOs in this day and age has poor clinical and professional judgment.
     
  50. IgD

    IgD The Lorax
    10+ Year Member

    Joined:
    Jul 5, 2005
    Messages:
    1,901
    Likes Received:
    6
    How about 29 Palms? MCB Hawaii? Okinawa, Japan? How does the Naval hospital at Lejeune compare to the one at Pendleton?

    Are you participating in a chart review/peer review process?
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...

Share This Page