%AF HPSP forced --> flight surgeon/GMO?

[SmarmyIguana]

I will be entering med school next year and am considering signing the AF HPSP papers... and am generally optimistic about having a military career: my parents are both civilian doctors, so perhaps I'm hyper-aware of the downsides of the 'normal' medical career and willing to forgive the military some of its flaws. I can see it working out for me... hopefully I'm not horribly wrong.

Anyway, I am hoping to go into neurology, or maybe psychiatry, and was wondering whether I should anticipate difficulties with the match. How likely am I to serve as a flight surgeon/GMO? If I have to take this route, and do my time as a flight surgeon, will I be able to try for a neuro residency again afterwards, or will my options be to either leave the military and start over in the civilian world, or to go into aerospace/preventative medicine program? I will be 22 years old starting med school, so the former wouldn't be the end of the world, but I don't think I'll want to be denied my specialty of choice forever.

Alternately, if I had on hand the money to pay back the AF the scholarship and stipend, and I didn't match as desired, how difficult would it be to 'buy myself out' and terminate the contract then?

If anyone has statistics on any of this, that would be super... otherwise, any insight is appreciated.

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[sethco]

I was in your shoes a number of years ago. They told us at the time that 95% of HPSP applicants get their first choice of specialty and 98% get their first or second choice. This was a load of crap. Over the past 4 years I have been paying attention to the "unmatch rate" for HPSP 4th year med students and have noticed the rate fluctuates between 25-30%. This rate is higher for certain specialties such E Med, Anesthesia, Rads, Ortho, etc.

This number will probably only get worse with downsizing of hospitals and ops tempo increasing with more need for flight surgeons. However, this will also be almost impossible to predict, as the needs of the AF change almost yearly.

I thought I had a very good chance of getting a deferment to pursue residency training (and was told this by the PD), but was denied two years in a row. Now, I am just going to finish up my Flight Surgery tour, leave active duty, and go into a civilian residency. I will probably then go into the Gurad for my remainder time. After that, since I will have 12 years in, I will consider remaining in the Guard depending on how it goes during residency.

You can go this route if you don't match or reapply after 2 years of your GMO/Flight Surgery tour. The Aerospace/Preventative Med residencies are generally for docs that are previous residency trained, although I think it is possible to do a GMO tour and then go into this.

YOU CAN NOT BUY OUT YOUR CONTRACT. Get this out of your head and don't even think about it. Once you sign the contract and start taking the stipend, you are committed to the military for 8 years

Best advice I can give is avoid the HPSP like the plague.

If you are serious about military service, go through the FAP program, that way you get to pick your own specialty and location (for the most part)

PM if you have any more questions. I am neither PRO nor ANTI Military Medicine.

 

[deuist]

Last year, about 25% went into flight surgery. While some people choose this path, most definitely did not.

Can you give a clear reason for wanting to be in the miltary, other than "downsides" of the civilian medical world?

 

[SmarmyIguana]

Last year, about 25% went into flight surgery. While some people choose this path, most definitely did not.

Can you give a clear reason for wanting to be in the miltary, other than "downsides" of the civilian medical world?

I wish I could... I think that would make my decision easier. I will be honest and say that at the beginning of the process, when I didn't know about the potential for 'deviating from the direct route,' it was about money. I thought, "Hey, they'll pay for med school, so I'm willing to give them a try... if all it entails is working as a neurologist on a base for four years, then it can't hurt... and maybe, if I like it, I'll stay in and get that nice retirement package, start a whole new career when I'm 50, not have to worry about security in old age, etc." Then I learned more about what could 'go wrong.'

... but you know, the thing is that my brain keeps rationalizing all of these potential downsides away. I am normally a fairly pessimistic person and yet right now even being a flight surgeon seems to have up sides, "hey, when I get around to doing my residency, I'll have had a bunch of clinical experience... it may be even more useful if I go into a specialty like neurology, because I otherwise won't have much of a chance to do general practice... and I'll get to travel around a bit... which is vaguely adventurous and new... not to mention that I'm still young--never took time off before high school or college--what's the rush?" Things of that nature. Part of me still wants to do this.

The reason that I started off with the downsides of the civilian world is that I've yet to think of a military downside that doesn't have a civilian counterpart.

I guess I want to understand what kinds of situations have the potential to make this an unsatisfying job... because, from where I stand now, I think that if it came to it, I would be okay putting off residency for a while if it came to it.

Sorry if that wasn't coherent!

 

[deuist]

Start reading these forums. There are many more downsides than a GMO tour.

 

[AF_PedsBoy]

You know except for having to do the hideous AMP course, being a flight surgeon is really cool, but even going GMO is actually pretty great. Yes the learning curve is high with only a year under your belt and terrifying because suddenly you become the one making the decisions, but it really makes you think about the plans, and gives you all sorts of opportunities for leadership and growth (what? I got tired of leaving the leadership and awards section blank all the time on my CV...) I gripe all the time about the current idiocy I'm hitting in clinic, but overall I'm really having a fantastic time

 

[buffdoc]

Start reading these forums. There are many more downsides than a GMO tour.

Did you condsider that maybe he already has?

 

[deuist]

Did you condsider that maybe he already has?

Nope, never did. Thank you for pointing that out to me.

 

[SmarmyIguana]

You know except for having to do the hideous AMP course, being a flight surgeon is really cool, but even going GMO is actually pretty great. Yes the learning curve is high with only a year under your belt and terrifying because suddenly you become the one making the decisions, but it really makes you think about the plans, and gives you all sorts of opportunities for leadership and growth (what? I got tired of leaving the leadership and awards section blank all the time on my CV...) I gripe all the time about the current idiocy I'm hitting in clinic, but overall I'm really having a fantastic time

That's encouraging, thanks! ... and thanks, buffdoc for pointing out that I may have read the forums: I have indeed done so. I posted here because I had yet to find something that I thought I couldn't live with. Many complaints seem to be coming from surgeons who have a low case load and worry that their skills are wasting away. That's a totally valid point, and one that may have made me change my mind had I thought that I would someday want to be a surgeon. Not being able to relate to that group, I thought I'd see if anyone had input more specific to my future situation.

 

[Hardhack]

Being a flight surgeon is definitely the best kept secret in medicine. Less than 2 years out of med school and I've flown over 10 types of aircraft including supersonic jets and helicopters. I've been paid to parasail. I've been trained to egress an inverted helicopter underwater. I've spun on the centrifuge. I've deployed twice to awesome locations supporting two squadrons. I take care of patients who take care of themselves - who are willing to work hard to stay healthy and in excellent physical condition. I prevent illnesses and injuries before they occur. I've had almost 10 great training TDYs. I have my own office and supervise two troops. I chair a base wide committee. I'm constantly learning aspects of medicine never even mentioned in medical school. My job has excellent variety - I'm in clinic about 1/2 of my time and performing other duties the rest of the time - industrial shop visits, emergency response training and exercises, safety briefings, etc. I got to spend 24 hours with our fire department - suiting up in their gear and carrying a hose into their burning training building. I was taught to shoot a 9mm pistol. Don't dread a GMO flight surgeon assignment - it's an awesome opportunity!

 

[Galo]

Being a flight surgeon is definitely the best kept secret in medicine. Less than 2 years out of med school and I've flown over 10 types of aircraft including supersonic jets and helicopters. I've been paid to parasail. I've been trained to egress an inverted helicopter underwater. I've spun on the centrifuge. I've deployed twice to awesome locations supporting two squadrons. I take care of patients who take care of themselves - who are willing to work hard to stay healthy and in excellent physical condition. I prevent illnesses and injuries before they occur. I've had almost 10 great training TDYs. I have my own office and supervise two troops. I chair a base wide committee. I'm constantly learning aspects of medicine never even mentioned in medical school. My job has excellent variety - I'm in clinic about 1/2 of my time and performing other duties the rest of the time - industrial shop visits, emergency response training and exercises, safety briefings, etc. I got to spend 24 hours with our fire department - suiting up in their gear and carrying a hose into their burning training building. I was taught to shoot a 9mm pistol. Don't dread a GMO flight surgeon assignment - it's an awesome opportunity!

Wow!!

That all sounds very cool. However, I did 14 yrs of education to become a surgeon, and for me diversions like that did not help my medical career. While some aspects of being a flight surgeon may be cool, I've heard others who get stuck in heavies and get to sit and look out a window for a few hours every week. Plying potential students with all this who-wha stuff I think smacks of creative recruitment that may rarely happen. Please do not take offense, as it may have worked out great for you, but will not for everybody else. Giving up 2-4 years of your early medical career may not be what everyone is looking for. Certainly a neurologist on the outside would make so much more money, in those 2-4 yrs, that the money argument is just plain wrong.

Military medicine is broken. Most people need to realize that the leadership is doing nothing to try to make things better, and signing up at this time can lead to potential severe letdown in what you've been promised, or lead to believe.

With the advent of the Internet, and the telephone, most people today have no excuse if they do not do their homework and call up as many AD physicians they can get a hold of.

I hope the OP has read this forum thoroughly, as there are many more problems facing military medicine today, than civilian medicine.

Feel free to PM me if you like.

BomberDoc was a flight surgeon also for 4 yrs, and I'm not sure he got to ride in supersonic aircraft.

 

[deuist]

Being a flight surgeon is definitely the best kept secret in medicine.

That's a line right out the recruiter's manual.

Less than 2 years out of med school and I've flown over 10 types of aircraft including supersonic jets and helicopters.

Hard to believe that you flew them personally considering each one of those aircraft takes over a year to train. Do you mean that you flew "in" those aircraft and maybe got to hold the stick for a few minutes? In that case, any civilian doc can do the same simply by paying a fee.

I've been paid to parasail. I've been trained to egress an inverted helicopter underwater. I've spun on the centrifuge. I've deployed twice to awesome locations supporting two squadrons.

Good thing you went through all of that medical training so that you'd never have to practice medicine.

I take care of patients who take care of themselves - who are willing to work hard to stay healthy and in excellent physical condition.

That's certainly a dream for some, but not for everyone. For those of us who wanted sick patients, flight surgery is the total opposite of what we're looking for.

I'm constantly learning aspects of medicine never even mentioned in medical school.

Residency tends to have the same effect.

My job has excellent variety - I'm in clinic about 1/2 of my time and performing other duties the rest of the time - industrial shop visits, emergency response training and exercises, safety briefings, etc.

Again, I went to medical school so I could be a doctor.

I was taught to shoot a 9mm pistol.

You can join a civilian gun club and get the same training.

 

[sethco]

Being a flight surgeon is definitely the best kept secret in medicine. Less than 2 years out of med school and I've flown over 10 types of aircraft including supersonic jets and helicopters. I've been paid to parasail. I've been trained to egress an inverted helicopter underwater. I've spun on the centrifuge. I've deployed twice to awesome locations supporting two squadrons. I take care of patients who take care of themselves - who are willing to work hard to stay healthy and in excellent physical condition. I prevent illnesses and injuries before they occur. I've had almost 10 great training TDYs. I have my own office and supervise two troops. I chair a base wide committee. I'm constantly learning aspects of medicine never even mentioned in medical school. My job has excellent variety - I'm in clinic about 1/2 of my time and performing other duties the rest of the time - industrial shop visits, emergency response training and exercises, safety briefings, etc. I got to spend 24 hours with our fire department - suiting up in their gear and carrying a hose into their burning training building. I was taught to shoot a 9mm pistol. Don't dread a GMO flight surgeon assignment - it's an awesome opportunity!

I really don't want to come off condescending or questioning, but you said that you are less than 2 years removed from med school, meaning that you graduated in 2007, right? That means you did your internship and have been doing flight med for 3 months now after completing AMP, right?

In these 3 months, you have gone on 10 TDYS and you have deployed twice???? Do you have any time to be in clinic doing your primary duty (i.e. Seeing patients)?

I am happy that you take such great pleasure in seeing patients that "take care of themselves". Is this what you wanted to do out of med school? If so, great, but most flight docs I know hate their clinic duties because there is such a lack of pathology.

Did you want to do Primary Care with your life and not do a residency? If so, then Flight Med is great.

The other duties you mention are not "fun"!!! Shop visits, disaster team training, waivers, MEBs, etc. suck

You have flown in 10 different airframes in only 3 months time since finishing AMP??? That is quite impressive. How did you get qualified on all of them? Did you go to different bases on TDYs and ask to fly? Did your Commander have any problem with this?

Now, I will be the first to admit that FS tours are highly variable. A person stationed with the Thunderbirds at Nellis is going to have a much different experience that somebody flying tankers at Minot. Once again, I am sorry if I came up condescending in anyway, but for every one person with a positive experience, I can point to 4 others that are counting down the days until their GMO tour is done and they can go back into residency.

 

[BOHICA-FIGMO]

Being a flight surgeon is definitely the best kept secret in medicine. Less than 2 years out of med school and I've flown over 10 types of aircraft including supersonic jets and helicopters. I've been paid to parasail. I've been trained to egress an inverted helicopter underwater. I've spun on the centrifuge. I've deployed twice to awesome locations supporting two squadrons. I take care of patients who take care of themselves - who are willing to work hard to stay healthy and in excellent physical condition. I prevent illnesses and injuries before they occur. I've had almost 10 great training TDYs. I have my own office and supervise two troops. I chair a base wide committee. I'm constantly learning aspects of medicine never even mentioned in medical school. My job has excellent variety - I'm in clinic about 1/2 of my time and performing other duties the rest of the time - industrial shop visits, emergency response training and exercises, safety briefings, etc. I got to spend 24 hours with our fire department - suiting up in their gear and carrying a hose into their burning training building. I was taught to shoot a 9mm pistol. Don't dread a GMO flight surgeon assignment - it's an awesome opportunity!

:troll: Unless of course I detect a hint of sarcasm in this post...

 

[Hardhack]

It is less than 3 years out of med school - I graduated in 2006. My mistake.

I've flown in over 10 types of aircraft. I've had significant stick time in only 2 - but I've been at the controls flying low levels and aerobatics in a jet and I've taken off, hovered, and landed a helo.

You won't get rich as a flight doc, but you'll do just fine financially.

If you have your heart set on surgery or you want to discover a cure for some rare disease or you enjoy the daily challenge of trying to break through to that noncompliant diabetic, then I can definitely see how you'd hate being a flight doc. This isn't just a 2-4 year delay for me though - I'm in flight med for good.

 

[afdoc77]

SmarmyIguana,
I have to agree with most of the posts on here. While I'm sure Hardhack does love his job, the majority of us in flight med are pretty miserable.

Take the loans out, forget about the military and move on with your life. You'll pay the loans off with your salary as a neurologist/pychchiatrist in less years than you would be in the military as a doc. Financially, therefore, it doesn't make sense to join. Socially, you'll be put in a place you may not want to live. And, academically the medical part of the job is mind numbingly boring, see upper respiratory tract infections... So you'll just get stupid while you sit in Fargo ND, waiting to deploy to Ali Air Base Iraq for 6 months taking care of runny noses, only to return to a base devoid of any girls, do a 4 hour computer course on how to wear a gas mask and then get sent for a month to some dumb course on air plane crashes that have no significance to your life as a physician. This all seems overblown, but it's the life of flight surgeon.

 

[The White Coat Investor]

Being a flight surgeon is definitely the best kept secret in medicine. Less than 2 years out of med school and I've flown over 10 types of aircraft including supersonic jets and helicopters. I've been paid to parasail. I've been trained to egress an inverted helicopter underwater. I've spun on the centrifuge. I've deployed twice to awesome locations supporting two squadrons. I take care of patients who take care of themselves - who are willing to work hard to stay healthy and in excellent physical condition. I prevent illnesses and injuries before they occur. I've had almost 10 great training TDYs. I have my own office and supervise two troops. I chair a base wide committee. I'm constantly learning aspects of medicine never even mentioned in medical school. My job has excellent variety - I'm in clinic about 1/2 of my time and performing other duties the rest of the time - industrial shop visits, emergency response training and exercises, safety briefings, etc. I got to spend 24 hours with our fire department - suiting up in their gear and carrying a hose into their burning training building. I was taught to shoot a 9mm pistol. Don't dread a GMO flight surgeon assignment - it's an awesome opportunity!

Sounds like you had a particularly good experience. I echo Galo that most flight docs don't have quite the experience you did. Of the two or three dozen I've met, only two have actually flown a jet, neither in the last 10 years.

Let's tone down a few of the other items as well:

1) Every doc who deploys will learn to shoot a 9mm.

2) I am on about 8 base-wide committees, none of which I want to be on. I can't seem to give away membership/chairmanship of these committees. And no one would think twice if I wanted to make up two or three more and call myself the chair.

3) Those who care for active duty docs don't "prevent injuries before they occur", they simply don't do anything because the guys are so healthy. I mean, there is some value in occ-med, but how many injuries/illnesses do you REALLY think you've prevented doing your "shop visits" (cool, let's hang out in the hanger today.)

4) Supervising two troops? I was asked to be flight commander 1 year out of residency, 4 years out of med school, in a flight with 50 people in it. I turned the job down. At no time at work do I supervise less than 8 troops. I mean, for crying out loud, you're an O-3 and you're bragging about supervising 2 people? In the army a captain supervises a unit of what, 100 people?

5) You got your very own office? That's a benefit of being a flight doc? I thought the benefit was you wouldn't have to ever be in the office.

6) I paid $20 on a beach in Mexico to parasail. I didn't even have to do a GMO tour to do it.

7) Underwater egress training? Centrifuge trainingOh wait, I did that too as a medical student (and got paid for it) in a flight medicine course. I think we got to swim under a parachute too. Highlight of my career.

Now I'm being really cynical. I have met a number of flight docs that were glad they did a GMO tour, but few of them (okay none) had your enthusiasm and most were quite bitter about it.

 

[orbitsurgMD]

Being a flight surgeon is definitely the best kept secret in medicine. Less than 2 years out of med school and I've flown over 10 types of aircraft including supersonic jets and helicopters. I've been paid to parasail. I've been trained to egress an inverted helicopter underwater. I've spun on the centrifuge. I've deployed twice to awesome locations supporting two squadrons. I take care of patients who take care of themselves - who are willing to work hard to stay healthy and in excellent physical condition. I prevent illnesses and injuries before they occur. I've had almost 10 great training TDYs. I have my own office and supervise two troops. I chair a base wide committee. I'm constantly learning aspects of medicine never even mentioned in medical school. My job has excellent variety - I'm in clinic about 1/2 of my time and performing other duties the rest of the time - industrial shop visits, emergency response training and exercises, safety briefings, etc. I got to spend 24 hours with our fire department - suiting up in their gear and carrying a hose into their burning training building. I was taught to shoot a 9mm pistol. Don't dread a GMO flight surgeon assignment - it's an awesome opportunity!

You would have to prove to me you aren't a recruiter.

You call yourself an "attending"; did you actually do a residency you completed before you achieved "attending" status, or are you referring to the "staff" status you have as a GMO with only an internship, not in training but with "privileges" and not a resident, that kind of "attending?"

You were "taught" to shoot a 9mm pistol. A real 007. Dr. +P+. Well if that isn't a reason to postpone residency training, I don't know what is.

I give you the benefit of the doubt--I figure your post is purely tongue-in-cheek--soaked in irony. You seem smarter that way.

 

[IgD]

(2) Whatever, this is annoying but not a huge deal, I'll just do it and get back to my real passion in a couple years

Most of us are #2's.

The problem with what you are saying is there is no objective evidence that is the case. In another thread, someone pointed out that the Navy has twice as many interns as residency positions. I think it is something that could easily be studied but do you think such a study would obtain command/IRB approval? Everyone would say "how will this make us look"?

 

[orbitsurgMD]

The reason there are so many more interns than residency positions is that many decide to do their GMO time and get out. The Navy graduates more interns than it accepts residents in order to hedge their bets and keep GME running.

More likely they program the numbers of interns to meet the need for available operational GMO slots that must be filled. The numbers of PGY-2 slots are not related. The numbers of residents are driven by ACGME requirements, at least on the maximum side, and the numbers of projected staff billets for residency graduates on the minimum side. The excess of interns to PGY-2 slots is a result of decreased patient census and a downsized medical deparment--more dependents and retirees sent out on CHAMPUS/Tricare than in the past and less need for military medical staffing and therefore less need for housestaff (and less case load for training them).

Whenever the rate of attrition drops in certain specialties, the branches have cut training spots in response. The numbers of PGY-2 slots is not driven by the numbers of interns or vice-versa.

 

[orbitsurgMD]

This is definitely a possibility, but if this were true, one would expect a declining number of interns over the last 5-10 years as the overall number of GMO billets have decreased. It is my understanding that this has not occurred.

I think that varies by service branch. The GMO slots are being shifted to residency grads, not because they prefer this end but because reducing the numbers compelled to work as GMOs after internship has been made necessary by the drop both in numbers and quality of HPSP applicants.

Also a valid theory. However, if GME slots were determined based on the patient load, and the patient load (as you claim) has decreased, one would expect a concurrent decrease in the number of residency positions. Are you aware of any program in the Navy decreasing their residency slots?

General Surgery. Ophthalmology.

 

[IgD]

What do you want to study? The reason there are so many more interns than residency positions is that many decide to do their GMO time and get out. The Navy graduates more interns than it accepts residents in order to hedge their bets and keep GME running.

Survey interns/GMO. Obtain hard numbers from Navy medicine about attrition, % residents who complete a residency. Write a paper looking at the results.