Feb 17, 2013
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Just thought I'd pay it forward for all the times I used StudentDoctor.net. If anyone has any questions about the military HPSP or Navy specific let me know. I was also on the admissions committee at my school so I have some experience with the application and interveiw process. Ask away!
 

KS FightinIrish

KS FightinIrish
Jun 30, 2012
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I actually recently completed my application for the Navy HPSP. Did you do any operational tours (flight surgery, undersea medicine, GMO) before you went into residency? How did you decide between Army, Navy, and Air Force?
 

Gerudo

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Dec 23, 2010
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I have heard opposing 'opinions' or claims about the future of GMO's and from sources across the entire spectrum of credibility (current Captains, random statistics online, SDN itself, my peers, etc.).

What do you know about the near future (~3+ years form now) with regards to the Navy's policy on who goes straight through versus serving as a GMO before their residency? I've heard such differing opinions that perhaps this is something you cannot really know for sure until its the year of...

Thanks in advance, I'm sure I'll ask more questions in this thread.
 

tehrevenant3

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Do you have any regrets about HSPS or military medicine in general? I was very highly considering the scholarship, but I read some horror stories about the lack of control regarding training/lifestyle/etc. If you could do it all over again, would you choose to sign up after residency or would you still choose the scholarship?
 
OP
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Hopefully I answer everything:

1. I absolutely do not regret my decision to join. In fact I wish I had joined from day one instead of during my second year. I advise everyone to seriously look into the scholarship. That being said there are a few caveats. You will be an active duty member of the United States Military with all the good and bad that entails. You will have the oppurtunity to see the world and do things that your civilian counter parts could never dream of doing (fly a V-22 Osprey for instance...more on that later). That being said there will be a time in your life as a military physician when you will be ordered to go someplace that you might not want to go to, but that in a nutshell is part of the sacrifice you give by joining.

2. You training path might be a little more convoluted in the military but if you have the qualities, scores, and determination you have the ability to do any of the training available to your civilian counterparts. The other good thing about the military is that you have a safety hatch after internship to change course. I for instance was dead set on Surgery, but after finishing internship and spending time in the fleet I'm changing to FM/Aerospace Medicine. So in this case your actually have more freedom and flexibility in the Military.

3. Here is my 2 cents on GMO's that I've been telling prospective applicants for several years now. The Navy will likely never fully get rid of the operational tours after internship. The reason for this is the Navy takes care of the Marine Corps which does not have its own doctors. Because the bulk of the military work through out the world is done by the Navy and USMC there will always be a need for GMO's, Flight Docs, and Dive Docs. If you have zero interest in doing one of these three then you should absolutely not join. Now that being said, they are in fact decreasing the number that go out to the fleet after internship, but it will never be 0.

4. To go along with #3, my experience as a Naval Flight Surgeon has been amazing. Getting to be a direct advisor to the CO of an operational Marine squadron is awesome. Not to mention getting to actually fly active duty military aircraft. My CO not only lets me fly, but orders that I get both front seat and back flight time. If that sort of thing isn't for you then you should likely stay civilian.

5. There is really no difference between the branches as far as the actual HPSP benefits and pay back. The reason I chose Navy was partly becuase of the location of it's major bases and also becuase they take care of the Marine Corps and my father is a former Marine. When it comes to choosing a branch I'd say the majority choose either because of personal/family history, or becuase of location of future duty stations. I know I will never be stationed in Omaha, NE or Topeka, KS...no offense, only chose those two becuase I'm from KS and went to school in NE...lol

Hopefully I answered your questions, but feel free to PM me or ask for clarification. Good luck!
 
Oct 4, 2012
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I have been looking into doing an HPSP scholarship with the Navy, and it seems like a GMO/Dive/Flight tour is essential to being competitive for desirable residencies. (The Dive tour definitely interests me). How difficult is it, though, to transition back into a residency once that is finished?

Also, how difficult is it to pursue a fellowship in the military? (Aside from the usual competitiveness that is a given).

Finally, what would you say are the biggest cons of doing doing residency/practicing medicine in the military?

Thanks for your time.
 

Gastrapathy

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Hiding out in the premed forum. Folks, this person has a worm's eye view of the .mil, hasn't completed a residency, and has chosen to take care of healthy people for a living. Ask yourself why he didn't post in the milmed forum.

I too was a flight surgeon. It was fun but its not a career if you want to be challenged.
 
Nov 8, 2012
68
11
Ignorant here, so please excuse me if I misspeak.

I hear that the military basically controls what residencies you get placed in. What is your opinion on this subject?

It is the biggest reason why I have difficulty pulling the trigger on military medicine. I don't even know what residency I want to pick yet, and it is daunting having someone make life altering decisions for me when I don't even know what I want to do.
 
Jul 17, 2010
2,149
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Ignorant here, so please excuse me if I misspeak.

I hear that the military basically controls what residencies you get placed in. What is your opinion on this subject?

It is the biggest reason why I have difficulty pulling the trigger on military medicine. I don't even know what residency I want to pick yet, and it is daunting having someone make life altering decisions for me when I don't even know what I want to do.
The simple answer is that the military cannot force you to do a residency you don't want to. Just wanted to make that clear.

However, they do have quite a bit of control over your career path in several ways. When you do HPSP, you must apply for military residencies (civilian deferment is rare, so don't listen to recruiters that make it seem like a viable option). The number of spots for each residency vary each year. If you apply for a residency, and you don't get it, you will have to do an internship and probably a GMO tour. They may let you apply civilian but I wouldn't count on it. After your 2 year tour, you can apply for residency again. From what I've heard, to not get a residency again is pretty unlikely. Or you can choose to just do another two year GMO tour and get out and pursue a civilian residency (as your obligation will be up).

One tricky part I've heard is that there is a part on the application for residency that allows you to list a second residency choice if you don't match the first one. DO NOT list anything and assume you won't get it. Take the GMO tour if you are set on one specialty.

The control that the military exerts over your residency is the timing. You may not train straight through (and the same thing usually happens with fellowships too). If this is a deal-breaker, DO NOT join. If you are interested in military service (and not just the money), and you think you can put up with some unpredictable delays and base locations, then you should pursue the option further. Find some current docs to talk to, check out the forum here (there aren't too many positive posters, but their advice and experiences are good to know), and then decide if you want to apply.
 
Oct 4, 2012
69
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Hiding out in the premed forum. Folks, this person has a worm's eye view of the .mil, hasn't completed a residency, and has chosen to take care of healthy people for a living. Ask yourself why he didn't post in the milmed forum.

I too was a flight surgeon. It was fun but its not a career if you want to be challenged.
I would think you would be welcome to answer throw your 2 cents in. We pre-meds are just trying to make informed decisions. I have been reading threads on the military site and it seems like there are some very vocal individuals that advice NOT to do military medicine (USAFdoc, militarymd, etc). Whether their experience is representative of military medicine on a whole is a little more difficult to tell.
 
OP
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Hiding out in the premed forum. Folks, this person has a worm's eye view of the .mil, hasn't completed a residency, and has chosen to take care of healthy people for a living. Ask yourself why he didn't post in the milmed forum.

I too was a flight surgeon. It was fun but its not a career if you want to be challenged.
I definitely don't have the "5+ year member" experience in online forums that you have, but I believe you are what's referred to as a "troll"...

Considering how you are an attending "hiding out" in pre-med forums why don't you enlighten us with your vast experience with the military and the HPSP.
 
OP
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Feb 17, 2013
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I would think you would be welcome to answer throw your 2 cents in. We pre-meds are just trying to make informed decisions. I have been reading threads on the military site and it seems like there are some very vocal individuals that advice NOT to do military medicine (USAFdoc, militarymd, etc). Whether their experience is representative of military medicine on a whole is a little more difficult to tell.
Look, I'll be the first to say that you should not view my experience and opinions as Gospel. However as is typically the case with online forums, most people who take the time to post are those that are not happy with their experiences and want to vent about it. I just wanted to give an alternate view and let those looking into the program know that there ARE in fact people that have had great experiences with doing military medicine and some that even want to make it a career. Is it for everyone, obviously not, but I remember from my time as a pre-med student on these forums, a lot of the older people on here have very negative opinions on things.
 
Nov 8, 2012
68
11
The simple answer is that the military cannot force you to do a residency you don't want to. Just wanted to make that clear.

However, they do have quite a bit of control over your career path in several ways. When you do HPSP, you must apply for military residencies (civilian deferment is rare, so don't listen to recruiters that make it seem like a viable option). The number of spots for each residency vary each year. If you apply for a residency, and you don't get it, you will have to do an internship and probably a GMO tour. They may let you apply civilian but I wouldn't count on it. After your 2 year tour, you can apply for residency again. From what I've heard, to not get a residency again is pretty unlikely. Or you can choose to just do another two year GMO tour and get out and pursue a civilian residency (as your obligation will be up).

One tricky part I've heard is that there is a part on the application for residency that allows you to list a second residency choice if you don't match the first one. DO NOT list anything and assume you won't get it. Take the GMO tour if you are set on one specialty.

The control that the military exerts over your residency is the timing. You may not train straight through (and the same thing usually happens with fellowships too). If this is a deal-breaker, DO NOT join. If you are interested in military service (and not just the money), and you think you can put up with some unpredictable delays and base locations, then you should pursue the option further. Find some current docs to talk to, check out the forum here (there aren't too many positive posters, but their advice and experiences are good to know), and then decide if you want to apply.
Wow! Thank you for the well thought-out response.

I was wondering, is there any way for me to serve after I am done with medical school and residency without going into USHUS or doing HPSP?

I don't want to ask a recruiter in person because I don't want them to know that I have a few qualms about military medicine.

Sorry again about my ignorance and thanks for your advice.
 
Nov 8, 2012
68
11
Look, I'll be the first to say that you should not view my experience and opinions as Gospel. However as is typically the case with online forums, most people who take the time to post are those that are not happy with their experiences and want to vent about it. I just wanted to give an alternate view and let those looking into the program know that there ARE in fact people that have had great experiences with doing military medicine and some that even want to make it a career. Is it for everyone, obviously not, but I remember from my time as a pre-med student on these forums, a lot of the older people on here have very negative opinions on things.
Are there opportunities to do disaster relief?

This is something that I have always admired about our serving men and women.
 

nysegop

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Are there opportunities to do disaster relief?

This is something that I have always admired about our serving men and women.
Or you could join the peace corps.

I might want to doctors without borders when I'm older.
 

Gastrapathy

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OP, your PM was entertaining (especially in light of the name calling here). But a quick post review would reveal that I'm a gastroenterologist, not a mean old surgical attending. And, we tend to be happy people. My time in the Navy wasn't bad. I got the training I wanted, deployed only 3 times and had a good case volume when I was home.

But anyone who has any perspective can see HERE BE DRAGONS!

Since you wanted specifics, here you go:

Military medicine is in a deep decline and rose-colored posts like yours should draw ridicule. Premeds signing up now are obligating themselves to the .mil system for a decade and you simply cannot know what is coming in that time. One doesn't have to be an embittered surgical attending to see that. The sequester and CR situations are the tip of the iceberg. My prediction is that you will face the elimination of contract physicians and most of the over-65 population being moved back to Medicare and TFL. Surgical volumes, inpatient admissions, cancer cases, and most complex care will dry up. Residencies will have to close or combine (the AF has already done this to a large extent). I think its going to be a rough 10 years.

For perspective, I would invite you all to read through the posts of NavyFP and A1Qwerty. Over the years, their perspectives have become decidedly more negative about the future and about their own personal treatment within the system. pgg is another poster who has expressed his reservations despite his intention to remain within the system.

My issue with you OP is specifically that you see nothing wrong with being a GMO. I believe that anyone calling himself a physician and providing care to our servicemembers should have completed a residency. For them to deserve less than the 30 year old schoolteacher who is enrolled at Kaiser is infuriating to me. I believe you lack the perspective on what completing a residency brings to a physician. You may not miss much but you won't know it when you do. Our system forces young doctors into that position and then hangs them out to dry when they mess up. Its unfair to the physician but moreso to the patient.

You state that the majority of the military work in the world is done by the DON. This is false. The Army is bigger. The USMC using Navy medical services does not obligate us to send them non-residency trained physicians. On the contrary, the people who do the actual work of the military (ie the grunts), deserve the very best. This is a thin justification for an unethical decision by senior leaders. I don't hold you responsible for taking the orders, but to talk about how fun it is to play warrior really spins the situation in far too positive a light.

You've gotten to fly a lot. I did too. That's fun but not doctoring. Its also luck of the draw and depends on the unit to which you are attached. I'm sure you know FSs that don't get to fly (you'll justify it that they aren't as cool and popular with the guys as you, but its not that simple).

The point of my original post is that this is a complex system and there is an entire forum devoted to it. You didn't post there because you knew this was coming if you did.

Oh, and the EMR is absolutely terrible.
 

Gastrapathy

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Are there opportunities to do disaster relief?

This is something that I have always admired about our serving men and women.
Kinda. The hospital ships deploy every couple of years (maybe not now with the budget but I bet they will because they are such good PR). IMO, its all PR and a minimal benefit. Relief work requires you to stay longer if you are going to make a real impact. That said, it was way more fun than Iraq.
 
OP
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OP, your PM was entertaining (especially in light of the name calling here). But a quick post review would reveal that I'm a gastroenterologist, not a mean old surgical attending. And, we tend to be happy people. My time in the Navy wasn't bad. I got the training I wanted, deployed only 3 times and had a good case volume when I was home.

But anyone who has any perspective can see HERE BE DRAGONS!

Since you wanted specifics, here you go:

Military medicine is in a deep decline and rose-colored posts like yours should draw ridicule. Premeds signing up now are obligating themselves to the .mil system for a decade and you simply cannot know what is coming in that time. One doesn't have to be an embittered surgical attending to see that. The sequester and CR situations are the tip of the iceberg. My prediction is that you will face the elimination of contract physicians and most of the over-65 population being moved back to Medicare and TFL. Surgical volumes, inpatient admissions, cancer cases, and most complex care will dry up. Residencies will have to close or combine (the AF has already done this to a large extent). I think its going to be a rough 10 years.

For perspective, I would invite you all to read through the posts of NavyFP and A1Qwerty. Over the years, their perspectives have become decidedly more negative about the future and about their own personal treatment within the system. pgg is another poster who has expressed his reservations despite his intention to remain within the system.

My issue with you OP is specifically that you see nothing wrong with being a GMO. I believe that anyone calling himself a physician and providing care to our servicemembers should have completed a residency. For them to deserve less than the 30 year old schoolteacher who is enrolled at Kaiser is infuriating to me. I believe you lack the perspective on what completing a residency brings to a physician. You may not miss much but you won't know it when you do. Our system forces young doctors into that position and then hangs them out to dry when they mess up. Its unfair to the physician but moreso to the patient.

You state that the majority of the military work in the world is done by the DON. This is false. The Army is bigger. The USMC using Navy medical services does not obligate us to send them non-residency trained physicians. On the contrary, the people who do the actual work of the military (ie the grunts), deserve the very best. This is a thin justification for an unethical decision by senior leaders. I don't hold you responsible for taking the orders, but to talk about how fun it is to play warrior really spins the situation in far too positive a light.

You've gotten to fly a lot. I did too. That's fun but not doctoring. Its also luck of the draw and depends on the unit to which you are attached. I'm sure you know FSs that don't get to fly (you'll justify it that they aren't as cool and popular with the guys as you, but its not that simple).

The point of my original post is that this is a complex system and there is an entire forum devoted to it. You didn't post there because you knew this was coming if you did.

Oh, and the EMR is absolutely terrible.
You know what I'm not going to take your troll bait. I think the people who read this forum can decide for themselves what to think and who to believe. You elegantly made my point for me. Considering I am currently on active duty and actually a part of the system first hand, I'll leave it to the people reading to decide who better has a handle on the current state of military medicine.
 
OP
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Wow! Thank you for the well thought-out response.

I was wondering, is there any way for me to serve after I am done with medical school and residency without going into USHUS or doing HPSP?

I don't want to ask a recruiter in person because I don't want them to know that I have a few qualms about military medicine.

Sorry again about my ignorance and thanks for your advice.
There are definitely programs that are available for people to join the military after residency that help with loan payback. As far as disaster relief goes, its a little hit or miss. In most deployments you do get some experience with humanitarian work, but if you want to focus on that I would second the suggestion for doctors without borders or some other non-profit once you are board certified.
 
OP
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You know what I'm not going to take your troll bait. I think the people who read this forum can decide for themselves what to think and who to believe. You elegantly made my point for me. Considering I am currently on active duty and actually a part of the system first hand, I'll leave it to the people reading to decide who better has a handle on the current state of military medicine.
Ok I lied, I will take the bait.

I never claimed that being in the military was perfect nor that the program was without flaws, but the arguments you make about the CR and sequestration should not discourage patriotic Americans from serving in the armed forces. As I stated earlier, I joined during my second year of medical school after my father was deployed to Iraq. No amount of negative rhetoric like what you posted would have disuaded me from that decision.

As far as what the "grunts" deserve. I am just as capable with one year of internship to treat the bulk of what I see on a daily basis as the board certified FP doctor that you seem to think we have in enough surplus to send to every FOB in the world. For the small percentage of cases that are above my level of training I refer, that's how the system works. To claim it is unethical for me to be treating my Marines is offensive and simply not true. As far as what branches medical corps is doing the bulk of the work, I know several Navy attendings who have been "IAed" to Army units, so you might have a point, though only on semantics.

My ability to fly or not fly has nothing to do with how "cool I am with the guys" but more on availability of flight time and the willingness of your CO to push for you to fly. Regardless this argument is irrelevant to taking the HPSP or not...if you are joining solely to fly a military aircraft then you are going to be sorely dissappointed.

Finally, I posted on this forum soley to answer valid questions from prospective applicants. I wasn't trying to avoid the trolls that I somehow managed to attract anyway. I'm sure the readers appreciate views from both sides of the debate, but they could do without the hyperbole.
 

NontradCA

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OP, your PM was entertaining (especially in light of the name calling here). But a quick post review would reveal that I'm a gastroenterologist, not a mean old surgical attending. And, we tend to be happy people. My time in the Navy wasn't bad. I got the training I wanted, deployed only 3 times and had a good case volume when I was home.

But anyone who has any perspective can see HERE BE DRAGONS!

Since you wanted specifics, here you go:

Military medicine is in a deep decline and rose-colored posts like yours should draw ridicule. Premeds signing up now are obligating themselves to the .mil system for a decade and you simply cannot know what is coming in that time. One doesn't have to be an embittered surgical attending to see that. The sequester and CR situations are the tip of the iceberg. My prediction is that you will face the elimination of contract physicians and most of the over-65 population being moved back to Medicare and TFL. Surgical volumes, inpatient admissions, cancer cases, and most complex care will dry up. Residencies will have to close or combine (the AF has already done this to a large extent). I think its going to be a rough 10 years.

For perspective, I would invite you all to read through the posts of NavyFP and A1Qwerty. Over the years, their perspectives have become decidedly more negative about the future and about their own personal treatment within the system. pgg is another poster who has expressed his reservations despite his intention to remain within the system.

My issue with you OP is specifically that you see nothing wrong with being a GMO. I believe that anyone calling himself a physician and providing care to our servicemembers should have completed a residency. For them to deserve less than the 30 year old schoolteacher who is enrolled at Kaiser is infuriating to me. I believe you lack the perspective on what completing a residency brings to a physician. You may not miss much but you won't know it when you do. Our system forces young doctors into that position and then hangs them out to dry when they mess up. Its unfair to the physician but moreso to the patient.

You state that the majority of the military work in the world is done by the DON. This is false. The Army is bigger. The USMC using Navy medical services does not obligate us to send them non-residency trained physicians. On the contrary, the people who do the actual work of the military (ie the grunts), deserve the very best. This is a thin justification for an unethical decision by senior leaders. I don't hold you responsible for taking the orders, but to talk about how fun it is to play warrior really spins the situation in far too positive a light.

You've gotten to fly a lot. I did too. That's fun but not doctoring. Its also luck of the draw and depends on the unit to which you are attached. I'm sure you know FSs that don't get to fly (you'll justify it that they aren't as cool and popular with the guys as you, but its not that simple).

The point of my original post is that this is a complex system and there is an entire forum devoted to it. You didn't post there because you knew this was coming if you did.

Oh, and the EMR is absolutely terrible.
Hey Gas, I appreciate your service and input here. I know I'm a lowly pre-med but I found our MO in batallion to be very knowledgeable in dealing with the cases presented to him. After all, it is a healthy population; and he never missed anything major that may have been outside the bread and butter of Marine pathogenicy. That being said, he was the most compassionate doc I'd met in the service (perhaps because of the nature of the unit and level of training.). This went a long way in terms of trust, which is very comforting given the nature of the beast.

You're belittling someone for being optimistic? Sure, take what people say with a grain of salt, but you're absolution that med.mil is a terrible route should also be looked at as the rule.
 

thesauce

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As far as what the "grunts" deserve. I am just as capable with one year of internship to treat the bulk of what I see on a daily basis as the board certified FP doctor that you seem to think we have in enough surplus to send to every FOB in the world. For the small percentage of cases that are above my level of training I refer, that's how the system works. To claim it is unethical for me to be treating my Marines is offensive and simply not true.
This plays right into his argument, which was "you may not miss much but you won't know it when you do." I don't know if you know what you're doing or not, but you didn't really make your point. Practicing unsupervised after only one year of GME does seem a little dicey.
 
Jul 17, 2010
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Wow! Thank you for the well thought-out response.

I was wondering, is there any way for me to serve after I am done with medical school and residency without going into USHUS or doing HPSP?

I don't want to ask a recruiter in person because I don't want them to know that I have a few qualms about military medicine.

Sorry again about my ignorance and thanks for your advice.
Yes there is. It's called FAP (financial assitance program I think).

You apply to it after you get into a civilian residency (so you do the regular match and everything). During your residency, you are a civilian at a civilian institution and train like everyone else. The military will provide you with some money for loans and living. There is a limit to the amount of loan repayment that I do not know off-hand, but it's pretty substantial. The benefit to this route is that you get to do a civilian residency before military service. It also gives you some extra time to decide if mil med is what you want to do with your life. Things may change in med school (change career paths, meet a spouse) and the military may look less appealing.

The biggest potential con to FAP is that you may not get it. The program is used to fill in gaps in the physician workforce that aren't filled by HPSP or USUHS. So, depending on your specialty, you may not get into the program if they don't need you.

I'm sure there are some other options too: reserves or national guard. I'm not sure how those work, but I"m sure you can find some info here on SDN. Have you been to the mil med forum? It's under Physician/Residents forums.
 

Gastrapathy

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Increasing numbers of state medical boards, hospital credentialling committees, malpractice insurers, and obviously, professional societies view one year of GME as inadequate. You believe you can do primary care well after completing a single year of surgical training. Perhaps you can. Most learners require more time in training that is focused appropriately to their future practice.

Ask yourself this about the ethics of the GMO. Where do we send residents who fail out of residency post-internship? That's right, we send them out to care for our sailors and marines as GMOs.

Look, I did it too. In hindsight, I regret that choice and I hope I didn't hurt anyone too badly. I am a patriot and proud American. If the system can hide its faults and continue blithely onward, it won't change. Congress directed the navy to get rid of GMOs in 1997. The power of bureaucracy is extraordinary. You are exactly right that there aren't enough primary care physicians in the Navy to provide for all the operational forces. That's been the excuse for a decade. It was valid back then but we've made no effort to fix it. Medicine is a marketplace, incentivize primary care enough and we will get what we need. But that would cost money and GMOs are dirt cheap. They spend several years in undesirable jobs, getting far less pay than other physicians in the .mil. They almost all get out, so they don't cost a retirement. You are far cheaper than a midlevel that might stick around and is often a higher paygrade.

The leadership knows what it's doing and isn't going to stop unless the civilian medical community makes them.
 

Gastrapathy

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I have been looking into doing an HPSP scholarship with the Navy, and it seems like a GMO/Dive/Flight tour is essential to being competitive for desirable residencies. (The Dive tour definitely interests me). How difficult is it, though, to transition back into a residency once that is finished?

It sucked for a good 6 months before the work hour rules were in place. Might take a little longer now. The attendings were generally tolerant of the adjustment period.

Also, how difficult is it to pursue a fellowship in the military? (Aside from the usual competitiveness that is a given).

For IM subs, it can vary year to year dramatically but, as long as you are willing to wait (2-6 years) after residency, almost anyone can get cards/gi/allergy.

Finally, what would you say are the biggest cons of doing doing residency/practicing medicine in the military?

There's a thread on the 40-something reasons not to join. Go through that thread, the stickies, and the rest of the milled forum.

Thanks for your time.
Answers above
 

Gastrapathy

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Hey Gas, I appreciate your service and input here. I know I'm a lowly pre-med but I found our MO in batallion to be very knowledgeable in dealing with the cases presented to him. After all, it is a healthy population; and he never missed anything major that may have been outside the bread and butter of Marine pathogenicy. That being said, he was the most compassionate doc I'd met in the service (perhaps because of the nature of the unit and level of training.). This went a long way in terms of trust, which is very comforting given the nature of the beast.

You're belittling someone for being optimistic? Sure, take what people say with a grain of salt, but you're absolution that med.mil is a terrible route should also be looked at as the rule.
I'm glad you trusted your doc and he projected competence. You just can't know what he missed, diagnosed later than he should of, referred inappropriately, etc. you will see from the other side of the curtain that patient satisfaction and good medical care are different (see the recent paper that showed that higher press gainey scores were associated with increased mortality). My unit thought I was great too. 5.0 fitreps, multiple NCMs as a LT and other similar nonsense. i had a good haircut, decent BMI and made myself available. But, I wasn't great and I'm not sure it's possible to be truly competent as a postinternship independent provider.

BTW, that view was no secret and it did keep me off the credentialling committee at my MTF, which was awesome.
 

alpinism

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Are there opportunities to do disaster relief?

This is something that I have always admired about our serving men and women.
Very few and far between for most.

In addition, you'll have to deal w/ all the red tape and massive bureaucracy that is .mil med.

For example, during katrina, my unit (AF flight medics, nurses, docs) didn't receive orders to deploy till 3 days later and then just stood by at the staging area doing nothing for the next 3 days (basically watching the whole thing unfold on tv) instead of going out and doing SAR and disaster relief. By the time they actually were allowed to "help" there was nothing left to do...

Luckily, I was on leave at the time and just went down there on my own to help out. I was already leaving the New Orleans by the time they finally left the staging area.

Same thing happened w/ the Japan earthquake.

Even if you do get to help, there is also a good chance that you won't be used in a professional manner (ie doing other jobs than the one you were "trained" to do) But that's a whole other story...

If you want to travel the world or do disaster relief, your best options would be to join a well-respected NGO or work in academic medicine at universities w/ international partnerships.
 

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Just an FYI: you can't become a FS if you have terrible eyesight. I'm correctable to 20/20 in both eyes, but the military doc said after a certain power, you're prohibited from things like that.

I'm in the process of applying to the Army HPSP. Hopefully my packet goes before the boards later this month:xf:
 
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There are definitely programs that are available for people to join the military after residency that help with loan payback. As far as disaster relief goes, its a little hit or miss. In most deployments you do get some experience with humanitarian work, but if you want to focus on that I would second the suggestion for doctors without borders or some other non-profit once you are board certified.
Thanks again for your help.

I am already participating with an organization like doctors without borders. It is very rewarding helping those who are medically underserved.

I am really interested in partaking in disaster relief and being first responders (like helping out Haiti.) It is my understanding that the US military is the first large scale organization to provide relief to help out. I believe (and I could be wrong) that the military is one of the few organizations with the manpower and resources to lend a helping hand and to provide healthcare to massive amounts of people in need.

Seriously. I have major respect for you guys. Thanks again for serving.

After reading your posts, I feel more confident on the track that I am on currently.
 
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This plays right into his argument, which was "you may not miss much but you won't know it when you do." I don't know if you know what you're doing or not, but you didn't really make your point. Practicing unsupervised after only one year of GME does seem a little dicey.
The notion that I'm turned loose with no supervision to practice on unwitting Marines is ludicrous. There is still most certainly a hierarchy in place with senior medical officers, chart reviews, and instant communication with both the local Naval Hospital and the specialists at NAMI. I'm not sure where/how Gastro practiced as a medical officer but he makes it sound like GMO's were missing things left and right...this is simply not the case. If we trust PAs and Nurse Practitioners to practice mid level primary care then why exactly does Gastro think its unethical and dangerous for an MD with 1-2 years of post graduate training to do the same.
 
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Increasing numbers of state medical boards, hospital credentialling committees, malpractice insurers, and obviously, professional societies view one year of GME as inadequate. You believe you can do primary care well after completing a single year of surgical training. Perhaps you can. Most learners require more time in training that is focused appropriately to their future practice.

Ask yourself this about the ethics of the GMO. Where do we send residents who fail out of residency post-internship? That's right, we send them out to care for our sailors and marines as GMOs.

Look, I did it too. In hindsight, I regret that choice and I hope I didn't hurt anyone too badly. I am a patriot and proud American. If the system can hide its faults and continue blithely onward, it won't change. Congress directed the navy to get rid of GMOs in 1997. The power of bureaucracy is extraordinary. You are exactly right that there aren't enough primary care physicians in the Navy to provide for all the operational forces. That's been the excuse for a decade. It was valid back then but we've made no effort to fix it. Medicine is a marketplace, incentivize primary care enough and we will get what we need. But that would cost money and GMOs are dirt cheap. They spend several years in undesirable jobs, getting far less pay than other physicians in the .mil. They almost all get out, so they don't cost a retirement. You are far cheaper than a midlevel that might stick around and is often a higher paygrade.

The leadership knows what it's doing and isn't going to stop unless the civilian medical community makes them.
I again challenge you to produce evidence of the epidemic of injured military personnel caused by "untrained" medical officers. I'll say it again, the bulk of my patients have issues that can be treated with OTC medications and rest. For those that are outside my comfort level I simply walk two steps across the hall to the MAG surgeon who is a board certified FP with years if civilian practice under his belt. I see no difference between what I do and what a NP or PA does. If I view military medicine through rose colored glasses then you view it through sunglasses. Is it perfect? Of course not, but to make it sound like it consists of a bunch of dangerous untrained residency dropouts is absurd and couldn't be farther from the truth.
 
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Just an FYI: you can't become a FS if you have terrible eyesight. I'm correctable to 20/20 in both eyes, but the military doc said after a certain power, you're prohibited from things like that.

I'm in the process of applying to the Army HPSP. Hopefully my packet goes before the boards later this month:xf:
Not true at all...at least not in the Navy. I do flight physicals daily. As long as you are correctable to 20/20 you can be a flight surgeon. Also both LASIK and PRK are waiverable so that is an option as well.
 

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I again challenge you to produce evidence of the epidemic of injured military personnel caused by "untrained" medical officers. I'll say it again, the bulk of my patients have issues that can be treated with OTC medications and rest. For those that are outside my comfort level I simply walk two steps across the hall to the MAG surgeon who is a board certified FP with years if civilian practice under his belt. I see no difference between what I do and what a NP or PA does. If I view military medicine through rose colored glasses then you view it through sunglasses. Is it perfect? Of course not, but to make it sound like it consists of a bunch of dangerous untrained residency dropouts is absurd and couldn't be farther from the truth.
You aren't qualified to have a comfort level as a primary care physician after 1 year of postop checks and suture removals. You lack the insight to see that and I believe that is dangerous. Of course there is no quality data on GMOs, that would require the Navy to want that data. Egregious mistakes are probably infrequent but quality is about more than that.

The difference between what you do and what a midlevel does is based in your standard of care. You are credentialed for independent medical practice. You are a physician and if you have to justify your abilities as "no different than an NP", that should give you pause. I'm not sure anything I wrote could crystallize the problem better than the fact that you see no difference between yourself and a midlevel.
 

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The notion that I'm turned loose with no supervision to practice on unwitting Marines is ludicrous. There is still most certainly a hierarchy in place with senior medical officers, chart reviews, and instant communication with both the local Naval Hospital and the specialists at NAMI. I'm not sure where/how Gastro practiced as a medical officer but he makes it sound like GMO's were missing things left and right...this is simply not the case. If we trust PAs and Nurse Practitioners to practice mid level primary care then why exactly does Gastro think its unethical and dangerous for an MD with 1-2 years of post graduate training to do the same.
If you have oversight, that's a totally different story. That part was unclear from any prior posts.
 

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If you have oversight, that's a totally different story. That part was unclear from any prior posts.
He's a LIP. Oversight is the same as it is for any board-certified physician (ie a paperwork drill). While many GMOs will seek out more support, it isn't required. Some practice in environments where there isn't anyone down the hall for many months at at time.
 
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You aren't qualified to have a comfort level as a primary care physician after 1 year of postop checks and suture removals. You lack the insight to see that and I believe that is dangerous. Of course there is no quality data on GMOs, that would require the Navy to want that data. Egregious mistakes are probably infrequent but quality is about more than that.

The difference between what you do and what a midlevel does is based in your standard of care. You are credentialed for independent medical practice. You are a physician and if you have to justify your abilities as "no different than an NP", that should give you pause. I'm not sure anything I wrote could crystallize the problem better than the fact that you see no difference between yourself and a midlevel.
I'm not qualified to have a comfort level? You are nuts. I'm not sure what school you went to but most US medical graduates can handle basic midlevel primary care issues and can certainly decide when something is outside their comfort level. Have you worked with any NPs or PAs? They are most definitely independent practitioners who don't run their patient's by anyone. You contradict yourself by railing against me because I am supposedly a dangerous unethical doctor that practices whatever level of medical care I happen to feel like but then complain because in reality I, along with the Navy, consider myself at this point in my training to be similar to a midlevel provider. As far as "while many GMOs will seek out more support, it isn't required", do you actually practice in a teaching hospital? How many senior residents, or any residents for that matter run every patient decision by you as the attending? Of course there are the rare nut job GMO's that try to do things they aren't credentialed or trained to do, but that goes for all physicians across all fields and levels of training. Are interns and residents allowed to have a comfort level? As a surgical intern I was trusted to make decisions on the floor regarding patient care and fluids/feeding/vent settings while in the SICU, yet suddenly I'm outside the hospital and I can't make a comfort level call because I haven't done 2 more years of OBGYN, geriatrics, and peds rotations for a FP residency? Finally, I'm a little unclear as to what GMO's find themselves completely alone with no phone/email/senior MO. Where did you deploy to again? I'll leave it up to the people who read this forum to make the judgment call on who is closer to reality here. Your posts do make an excellent teaching point though. You will all come in contact with negative attendings in your future life as med students and residents. Just remember to try and seek out positive people to balance the negative. Being a doctor is awesome! Practicing safe responsible primary care in the Navy is awesome! Being a Flight Surgeon is super awesome!
 

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I am just as capable with one year of internship to treat the bulk of what I see on a daily basis as the board certified FP doctor
No, you're not. And neither was I, when I was in your position as a GMO.

I used to feel exactly as you do, and indeed if you search the archives of SDN you can surely find a post or three from me, circa late 2005 or 2006, in which I wrote something very similar to this:

I again challenge you to produce evidence of the epidemic of injured military personnel caused by "untrained" medical officers. I'll say it again, the bulk of my patients have issues that can be treated with OTC medications and rest. For those that are outside my comfort level I simply walk two steps across the hall to the MAG surgeon who is a board certified FP with years if civilian practice under his belt. I see no difference between what I do and what a NP or PA does. If I view military medicine through rose colored glasses then you view it through sunglasses. Is it perfect? Of course not, but to make it sound like it consists of a bunch of dangerous untrained residency dropouts is absurd and couldn't be farther from the truth.
Yep, here I am, posting almost exactly what you just wrote, on Jan 1st, 2006:
That's an interesting perspective, but one that doesn't mesh with the experiences I've had personally. I have been adequately prepared for the responsibility I have - hell, a PA could do my job (and should, IMO, if the Navy had any sense).

The crux of your argument seems to be that it's unethical to stick a non-residency-trained physician in a GMO's job because of the lack of backup in some cases. I've never been without reasonable support, and I make use of it frequently.

[...]
There I was, arguing with orbitsurgMD. He was right, I was wrong.



I too had good resources and help available locally most of the time when my unit was at home. But there are two issues here:

1) As someone incompletely trained, knowing when to ask for help is not always easy. In retrospect, looking back at my own GMO days, there were times when I should've referred patients. It's also impossible to know what I may have missed due to incomplete training because by definition, when you miss something you don't know it. That's why it's a miss.

2) MOST of the time is not ALL of the time. When deployed, I spent significant periods essentially alone. Looking back, I did things that were unwise and I was lucky. They seemed like reasonable options at the time; sometimes they were my only option. On a handful of occasions I did things way outside my appropriate scope of care on local nationals who were denied CASEVAC but needed someone to step up. I caught a few big issues in my Marines that I came close to missing. I don't think I missed anything big. I hope I didn't, anyway.


Don't get defensive or angry; I'm not criticizing you. You're doing your best with the training you have, as gastrapathy and I and every other GMO did and does. GMOs are fortunate to have a healthy patient population, but there is real pathology out there, and expecting a bunch of glorified interns to catch and refer it all is asking a lot. Too much, in fairness to everyone involved.

I'm now a few years out of residency, board certified in a non primary care field. I excelled as a resident and unless I'm missing some snickers behind my back, I'm a solid attending with the respect of my colleagues. If I got orders to serve as a GMO tomorrow, I would not feel competent to step into that kind of practice. Part of that is rust - it's been a very long time since I've seen a clinic patient. But part of it is simply recognition of how important residency is. I don't have enough primary care training.

It's not just a specific body of knowledge. For GMOs, one of the biggest gaps the absence of residency training creates is simply that they miss out on gradually increasing autonomy over time in a safe environment. Good judgment develops over time, with supervision, coaching, and mentorship. The board certified guy down the hall or across the base as your backup consultant in GMO-land is not there to teach, supervise, coach, or mentor you. They're not the same safety net attendings are during residency.
 
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No, you're not. And neither was I, when I was in your position as a GMO.

I used to feel exactly as you do, and indeed if you search the archives of SDN you can surely find a post or three from me, circa late 2005 or 2006, in which I wrote something very similar to this:



Yep, here I am, posting almost exactly what you just wrote, on Jan 1st, 2006:There I was, arguing with orbitsurgMD. He was right, I was wrong.



I too had good resources and help available locally most of the time when my unit was at home. But there are two issues here:

1) As someone incompletely trained, knowing when to ask for help is not always easy. In retrospect, looking back at my own GMO days, there were times when I should've referred patients. It's also impossible to know what I may have missed due to incomplete training because by definition, when you miss something you don't know it. That's why it's a miss.

2) MOST of the time is not ALL of the time. When deployed, I spent significant periods essentially alone. Looking back, I did things that were unwise and I was lucky. They seemed like reasonable options at the time; sometimes they were my only option. On a handful of occasions I did things way outside my appropriate scope of care on local nationals who were denied CASEVAC but needed someone to step up. I caught a few big issues in my Marines that I came close to missing. I don't think I missed anything big. I hope I didn't, anyway.


Don't get defensive or angry; I'm not criticizing you. You're doing your best with the training you have, as gastrapathy and I and every other GMO did and does. GMOs are fortunate to have a healthy patient population, but there is real pathology out there, and expecting a bunch of glorified interns to catch and refer it all is asking a lot. Too much, in fairness to everyone involved.

I'm now a few years out of residency, board certified in a non primary care field. I excelled as a resident and unless I'm missing some snickers behind my back, I'm a solid attending with the respect of my colleagues. If I got orders to serve as a GMO tomorrow, I would not feel competent to step into that kind of practice. Part of that is rust - it's been a very long time since I've seen a clinic patient. But part of it is simply recognition of how important residency is. I don't have enough primary care training.

It's not just a specific body of knowledge. For GMOs, one of the biggest gaps the absence of residency training creates is simply that they miss out on gradually increasing autonomy over time in a safe environment. Good judgment develops over time, with supervision, coaching, and mentorship. The board certified guy down the hall or across the base as your backup consultant in GMO-land is not there to teach, supervise, coach, or mentor you. They're not the same safety net attendings are during residency.
I'm not going to get defensive or angry but I'm still not sure what the point either of you are trying to make. The military uses multiple independent providers to care for the huge number of service members. These include IDCs, NP, and PA's. All of which can and do practice independently with some occasional physician oversight. Would you suggest they are replaced by board certified physicians? Your inability to know when and how to seek guidance or a referral doesn't mean the whole system is broken, it means someone should have done a better job teaching you how to be a GMO. I am privileged and credentialed for a select set of skills, if I practice outside those skills I am breaking the law. This is no different than if a PA decides to do something outside their scope of practice. You practicing outside your scope on the locals, however well intentioned, is most definitely unethical and wrong, as would I be if I did the same on my Marines. I operate within a set of rules and guidelines, those that don't certainly don't prove the system is wrong, but rather that person is mistaken. I'm still unsure exactly what population you both saw on a daily basis that was loaded with House type pathology that you missed. It doesn't take a board certified doctor to do a thorough H&P, lab/X-ray, treatment and realize that if something doesn't fit you need backup. If a NP can operate in this setting why can't an internship trained MD? My 3rd and 4th year rotations at least equal a PA's clinicals, especially since I see no children, elderly, or OB...why is that so hard to believe? Where exactly were you deployed with no communication capabilities whatsoever? And if you were indeed in such an austere environment for long periods of time, I'm sure your patients were glad to have a doctor vs no doctor or a corpsman only. In an ideal world every patient would have access to a board certified doctor, but that is not only unrealistic it's absurd. That will never happen even in the civilian world. No offense, but I'll also point out that both of you chose to specialize but now criticize a system for not manning all billets with primary care docs. Your negative and skewed comments in this venue will also only work to dissuade future students from joining which will have the end result in ensuring more of our troops will be cared for by non-MD/DOs of any level of training.
 

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I think my point is clear but I will restate it since you say you still don't get it.

The ongoing use of GMOs to staff operational primary care roles is an ethical failure of the navy healthcare system. With appropriate incentives, the gmo could be eliminated. I don't believe navy leadership will do so without pressure from outside. Threads that glorify the gmo experience are almost always started by current GMOs who I believe lack the necessary perspective.

Outside pressure can come from a number of places but the most meaningful is recruiting. Our prospective physicians have more power before signing up than they will again in their careers.

I hope that's clear enough.
 

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Again, I was once in your shoes and felt exactly the same as you. I spent 3 years as a GMO with a USMC infantry battalion - a 2 year tour that I voluntarily extended for a year in order to deploy with them a second time. I still look back at that time as some of the most rewarding work of my life. But since then I have changed my opinion on how qualified I was to do that job.

In time, I suspect you will too.


Overall, I have been quite satisfied with my time in the Navy. I went to USUHS, interned at Bethesda, spent 3 years as a GMO in Camp Lejeune, residency for 3 years at Portsmouth. I'm now 3 1/2 years into a staff tour at a smaller Navy command, and am presently deployed to a Role 3 in Afghanistan. Not long after I return, I'll PCS back to Portsmouth where I'm going to attempt to dig in my heels and homestead until I have enough retirement credit. I have few complaints and take pride in giving good care to a wonderful and deserving patient population. I've extended my contract beyond my educational obligation, despite the lower pay and some other BS factors, largely because of the AD/dependent/retiree patient population. And it's because of them that I think the Navy can and should do better than put glorified interns into GMO billets.
 
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I think my point is clear but I will restate it since you say you still don't get it.

The ongoing use of GMOs to staff operational primary care roles is an ethical failure of the navy healthcare system. With appropriate incentives, the gmo could be eliminated. I don't believe navy leadership will do so without pressure from outside. Threads that glorify the gmo experience are almost always started by current GMOs who I believe lack the necessary perspective.

Outside pressure can come from a number of places but the most meaningful is recruiting. Our prospective physicians have more power before signing up than they will again in their careers.

I hope that's clear enough.
So let me get this straight, you feel that having operational billets staffed by internship trained MD/DOs is so unethical and dangerous that you plan on dissuading pre-meds from joining in an effort to force the military to re-evaluate how they man their billets. Sounds like a great plan, meanwhile overall recruiting numbers drop and not only are the billets not manned by board certified doctors they aren't manned by doctors at all. You really need to re-evaluate your motives and methods as real people pay the price.
 
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Again, I was once in your shoes and felt exactly the same as you. I spent 3 years as a GMO with a USMC infantry battalion - a 2 year tour that I voluntarily extended for a year in order to deploy with them a second time. I still look back at that time as some of the most rewarding work of my life. But since then I have changed my opinion on how qualified I was to do that job.

In time, I suspect you will too.


Overall, I have been quite satisfied with my time in the Navy. I went to USUHS, interned at Bethesda, spent 3 years as a GMO in Camp Lejeune, residency for 3 years at Portsmouth. I'm now 3 1/2 years into a staff tour at a smaller Navy command, and am presently deployed to a Role 3 in Afghanistan. Not long after I return, I'll PCS back to Portsmouth where I'm going to attempt to dig in my heels and homestead until I have enough retirement credit. I have few complaints and take pride in giving good care to a wonderful and deserving patient population. I've extended my contract beyond my educational obligation, despite the lower pay and some other BS factors, largely because of the AD/dependent/retiree patient population. And it's because of them that I think the Navy can and should do better than put glorified interns into GMO billets.
So at the time you were a GMO you felt comfortable and confident enough to not only finish your tour but extend and voluntarily stay to do more. Why didn't you go back to training ASAP if you were constantly left alone with no resources and practicing outside your scope? I'm confused at what point you came to realize your 3 years as a GMO was a negative and dangerous experience?
 

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So at the time you were a GMO you felt comfortable and confident enough to not only finish your tour but extend and voluntarily stay to do more. Why didn't you go back to training ASAP if you were constantly left alone with no resources and practicing outside your scope? I'm confused at what point you came to realize your 3 years as a GMO was a negative and dangerous experience?
I don't know how else to explain this. It's as if you're deliberately not getting it.

When I was a GMO, I felt qualified (overqualified!) to do the job.

Now post residency, I have a better grasp of what I didn't know. Looking back I can point to specific instances in which I did things that that were suboptimal, and I wonder if there were other things that I missed, because I lacked training and experience. With the benefit of hindsight, I feel lucky to have dodged the bullet of malpractice.

My GMO tour was not a negative experience. I've said a couple times in this thread that it was extremely rewarding work. It was a good time for me.


Just take a step back and look at the big picture for a second. If you stepped into a FM or IM residency tomorrow, and saw a patient identical to the last one you saw as a GMO, you would have orders of magnitude more supervision. You'd be on an attending's short leash. You'd discuss your assessment and plan with an attending. The attending might also talk to or examine the patient. The attending would review your notes within minutes or hours. What's different? Not you. Not the patient. Why does resident-you need that kind of supervision, but GMO-you doesn't?


I'm not here to dissuade pre-meds from joining. I think FAP is a better entry point than HPSP, but that's mostly because I favor hedging bets concerning the state of inservice GME 10+ years down the road. HPSP is a good choice for some people.
 
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pgg

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*cough* brigade surgeon *cough*
Usually filled by residency trained, board certified or eligible physicians.

Which itself may be a different sort of problem - if the physician is a non primary care specialist, a year or two as a brigade surgeon carries the risk of skill atrophy. I don't have any skin in that game and I never will, but I feel bad for the subspecialists who get sent to rot in those billets.

The solution is more primary care physicians to share the burden of those operational billets, which the Army and Navy could have, if leaders thought it was important enough. Instead it's Feres Doctrine this, fog o' war that, better any doctor than no doctor strawman this, healthy pre-screened patients that.



It will be interesting to see what happens when the last state stops issuing unrestricted medical licenses to physicians with only a single year of GME ... and GMOs can't get licenses. That is the trend, and that day is coming.
 
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I don't know how else to explain this. It's as if you're deliberately not getting it.

When I was a GMO, I felt qualified (overqualified!) to do the job.

Now post residency, I have a better grasp of what I didn't know. Looking back I can point to specific instances in which I did things that that were suboptimal, and I wonder if there were other things that I missed, because I lacked training and experience. With the benefit of hindsight, I feel lucky to have dodged the bullet of malpractice.

My GMO tour was not a negative experience. I've said a couple times in this thread that it was extremely rewarding work. It was a good time for me.


Just take a step back and look at the big picture for a second. If you stepped into a FM or IM residency tomorrow, and saw a patient identical to the last one you saw as a GMO, you would have orders of magnitude more supervision. You'd be on an attending's short leash. You'd discuss your assessment and plan with an attending. The attending might also talk to or examine the patient. The attending would review your notes within minutes or hours. What's different? Not you. Not the patient. Why does resident-you need that kind of supervision, but GMO-you doesn't?


I'm not here to dissuade pre-meds from joining. I think FAP is a better entry point than HPSP, but that's mostly because I favor hedging bets concerning the state of inservice GME 10+ years down the road. HPSP is a good choice for some people.
You're right, I don't get it. As a graduate of a US medical school you weren't able to realize when something was outside of your comfort level and/or scope of practice? As a lowly intern there were plenty of times when I knew I was out of my depth and needed backup. Why would I suddenly become this careless, clueless doctor when they tell me I'm a GMO. Exactly what FP residency would require their second year residents to formulate a plan, pass it by the attending, and have the attending examine the patient for a cough and runny nose? We handled that type of patient on our own as 3rd year med students. We are talking about minor sick call issues here, not open heart surgery. How much more pure outpatient medicine would I get doing another 2 years of FP residency once you take out all the OBGYN, PEDS, INPATIENT, ICU, etc...all of which I not only do not do, but am not licensed or credentialed to do. I'm starting to think you are deliberately trying not to understand. I practice at the level of a NP, PA, or IDC what part of that don't you understand? If these mid-level providers can practice independently then why the heck can't I with an MD and one year of internship? Will I possibly miss things, perhaps, but you try and make it sound like once you have a couple more years of FP residency you are infallible. Do you not think that both you and Gastro will miss things as new attendings that you wouldn't have after 5-10 years of practice? Should we make you pass your decisions by a senior attending?

You still haven't actually given any specific recollections of situations that you now look back on and realize you were actually out of your depth. I'm curious to hear an example of something that at the time your felt totally safe and confident to do, yet now you look back and view it as dangerous and unsafe. Also where were you and for how long when you had absolutely no back up for advice available through any means of communication as a GMO? While you and Gastro may very well feel you were unprepared and thrown into situations that were unsafe and unethical that is certainly not the norm in my experience actually currently being in the system and having friends as battalion surgeons, dive docs, and flight surgeons on both coasts and around the world. Now is when you say you felt the same way but it all changed after becoming an attending...