AMA: So I woke up...

[MaximusD]

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And it's been 11 years since I applied to medical school.

Enjoy your youth! Don't waste it all by anxiously worrying away your entire 20s.

Also, I am a PCOM grad (Class of 2011) who served three years as a flight physician with the USAF. Now I'm completing Anesthesiology residency at an ACGME/MD program and will hopefully match into an interventional pain medicine fellowship with a little (read: A LOT OF) luck.

I have spent the past 14 years bumping my way around; muddling my way through as I have progressed into this profession.

I'd definitely do it all again. Probably not much differently.

How can I help?

 

[YayPudding]

Hi OP! Soon to be PCOM student and I'm considering HPSP. Any major pros/cons? How do you feel about your time and training at PCOM?

 

[Matthew9Thirtyfive]

I'm active duty Navy applying through the EMDP2 program. Two questions:

1) This program lets me apply to civilian med schools and can attend them if I desire, but I will not receive O-1E pay as I would if I went to USUHS. Is there anything about civilian schools that you think would outweigh that loss of income? The 7 year commitment is not an issue, as I plan on doing at least 20 (I have been in the surface Navy for 5 years already).

2) What was it like being a flight surgeon? I'm thinking about applying for that after intern year, since the specialties I'm interested in mostly are competitive in the Navy.

Thanks and good luck.

Oh! Quick third question: why anesthesiology?

 

[NecrotizingFasciitis]

Just a general question I like to ask those with experience: when do you recommend to start preparing for Step/COMLEX 1?

I've heard beginning of year 1 to start annotating First Aid, and I've heard to not do that until year 2. What worked for you?

 

[MaximusD]

Hi OP! Soon to be PCOM student and I'm considering HPSP. Any major pros/cons? How do you feel about your time and training at PCOM?

The HPSP decision requires a pro-con list that is very specific to you.

Pros for me were service to country, opportunity for discipline and self-improvement, reduced student loan burden, desire to be a part of something incredible and to give back to society. I grew a lot from my leadership experience, truly. Run a flight Med clinic in a deployed environment in my 20s, sure! In this regard, it's exactly what I wanted.

Cons for ME were deployment away from my family, ****ty/lazy/micromanaging O5s, the fact that the military could give zero ****s about what YOUR personal career goals are... but that's sort of what you sign up for. Hate the military "match"... the JSGMESB is opaque and does not favor the applicant like the NRMP.

Training varied for the USAF:

COT: obnoxious but life-changing
AMP: Didactics boring, flying and tons of free time FUN.
Flight training: FUN, especially parachute and water survival training.
Deployment training: serious but also fun at times.

(Just realized your training question was specific to PCOM...)

As for PCOM, it was a mixed bag. The real strength of PCOM is the location in a major medical city with a 100+ year history of being there (contrast this to touro-NY, for instance). There is real tradition at the institution and a real pride in training well-rounded m, solid physicians. That's why we rotate with the best in Philly and still are standouts. The didactics were strong but did not focus on the boards enough. However, after my class, they overhauled the curriculum and instituted standardized board prep for all. It remains safe to say that it's a great program with some great clinical sites.

Certainly, I would still bet PCOM remains one of the best DO schools, without question. Stay away from the new schools. Don't be suckered and don't believe premeds or Med students. It matters which DO school you go to, because EXPOSURE is what counts. This is a 300K decision, don't buy a Kia with that money.

 

[MaximusD]

Just a general question I like to ask those with experience: when do you recommend to start preparing for Step/COMLEX 1?

I've heard beginning of year 1 to start annotating First Aid, and I've heard to not do that until year 2. What worked for you?

Focus on your studies. Make a good foundation of fundamental knowledge. I would wait until second year. I don't want to relate what I did... it was ineffective. While I passed on first attempt, COMLEX Level 1 and I aren't on speaking terms . I can relate what's worked for me on subsequent exams -- read through high yield stuff one or two times THEN DO QUESTIONS. Passive studying had never been effective for me.

 

[MaximusD]

I'm active duty Navy applying through the EMDP2 program. Two questions:

1) This program lets me apply to civilian med schools and can attend them if I desire, but I will not receive O-1E pay as I would if I went to USUHS. Is there anything about civilian schools that you think would outweigh that loss of income? The 7 year commitment is not an issue, as I plan on doing at least 20 (I have been in the surface Navy for 5 years already).

This is a very personal question. Let me describe how I approached a similar question --

When I signed up for HPSP, the Air Force was offering a $20K (2007 money) signing bonus for a four year commitment. However, I only took a 3 year scholarship. I chose to not take the signing bonus as I thought I might value the freedom to choose whether to stay in... keep in mind you are eligible for additional bonuses only once you are out of contract/commitment and these can be sizable. I've learned that choice is a coveted commodity.

2) What was it like being a flight surgeon? I'm thinking about applying for that after intern year, since the specialties I'm interested in mostly are competitive in the Navy.

Fun, frustrating, exciting, boring. Loved flying and met a ton of wonderful people, many of whom I took care of medically. The flying community is small and tight-knit. It was a real blessing that I was able to take care of flyers, space and missile operators and their families.

That said, the administrative requirements were a source of great frustration at times. For me, this is what made this a wonderful a one-tour gig. Again, for me, doing this as a career would have been insufficient. I did meet excellent physicians who DID choose it as a career, but for me it was not in line with my career goals

Oh! Quick third question: why anesthesiology?

It's what fit for me. Rotated as a third year and enjoyed it and thought I was similar to anesthesiologists. Relaxed job with lots of critical thinking on a daily basis, periodic emergencies to work through. Lots of procedures to keep it fun -- I like DOING things but I don't like cutting and sewing. Anesthesia was a good fit.

 

[Matthew9Thirtyfive]

This is a very personal question. Let me describe how I approached a similar question --

When I signed up for HPSP, the Air Force was offering a $20K (2007 money) signing bonus for a four year commitment. However, I only took a 3 year scholarship. I chose to not take the signing bonus as I thought I might value the freedom to choose whether to stay in... keep in mind you are eligible for additional bonuses only once you are out of contract/commitment and these can be sizable. I've learned that choice is a coveted commodity.



Fun, frustrating, exciting, boring. Loved flying and met a ton of wonderful people, many of whom I took care of medically. The flying community is small and tight-knit. It was a real blessing that I was able to take care of flyers, space and missile operators and their families.

That said, the administrative requirements were a source of great frustration at times. For me, this is what made this a wonderful a one-tour gig. Again, for me, doing this as a career would have been insufficient. I did meet excellent physicians who DID choose it as a career, but for me it was not in line with my career goals



It's what fit for me. Rotated as a third year and enjoyed it and thought I was similar to anesthesiologists. Relaxed job with lots of critical thinking on a daily basis, periodic emergencies to work through. Lots of procedures to keep it fun -- I like DOING things but I don't like cutting and sewing. Anesthesia was a good fit.

Thanks for your perspective! Good luck in residency.

 

[MaximusD]

Here to field questions. I remember it was hard to find honest answers when I was a premed. If not, I'll let this thread sink into the abyss.

 

[Matthew9Thirtyfive]

You probably would get more questions if AMA was in the title.

 

[MaximusD]

You probably would get more questions if AMA was in the title.

Not familiar with the designation.

 

[Matthew9Thirtyfive]

Not familiar with the designation.

AMA = ask me anything. Tends to get more attention.

 

[MaximusD]

Done

 

[YeezyQ]

Hi OP,
If a pre-med was shadowing you what would be the best way to ask for a rec-letter?

 

[Wcm21]

@MaximusD were you/what kind of research were you involved in during medical school? How important do you believe research is to have on your CV for residency placement? Obviously for the more competitive residencies it's more needed but right now I'm leaning most towards obgyn or IM

 

[MaximusD]

Hi OP,
If a pre-med was shadowing you what would be the best way to ask for a rec-letter?

It's less important how they ask and more important if they are an active participant in their shadowing. What I mean by that is -- do you seem interested and ask meaningful questions? I would ask after you think you've had a good day. It may be beneficial to have a CV prepared for the occasion.

There is no shame in making it clear right up front that you are applying and would be interested in a letter if/when they (the physician) thinks it is appropriate. It certainly is a more bold approach.

Hope this helps.

 

[MaximusD]

Duplicate

 

[MaximusD]

@MaximusD were you/what kind of research were you involved in during medical school? How important do you believe research is to have on your CV for residency placement? Obviously for the more competitive residencies it's more needed but right now I'm leaning most towards obgyn or IM

I did an elective in research with a department of anesthesiology. Worked out well. I do think it's important, especially for major academic centers. It would certainly be a differentiating factor. It also would be a good opportunity to get face-time with an attending who you can ask for a letter of recommendation.

For matching into IM/OBGYN, it's not necessary but definitely won't hurt your application.

Then again, I had NO IDEA that I would like anesthesia. There is something to be said for keeping options open and being as competitive as possible so you aren't out-of-position if your plans change.

 

[Wcm21]

I did an elective in research with a department of anesthesiology. Worked out well. I do think it's important, especially for major academic centers. It would certainly be a differentiating factor. It also would be a good opportunity to get face-time with an attending who you can ask for a letter of recommendation.

For matching into IM/OBGYN, it's not necessary but definitely won't hurt your application.

Then again, I had NO IDEA that I would like anesthesia. There is something to be said for keeping options open and being as competitive as possible so you aren't out-of-position if your plans change.

Thanks! Yeah I'm completely open to any options, but realistically don't see myself pursuing a super competitive field. I don't believe there will be many opportunities for research at the school I'll likely be attending, but due to your advice I'll make sure to try and find opportunities so as not to limit myself.

 

[deleted831695]

Certainly, I would still bet PCOM remains one of the best DO schools, without question. Stay away from the new schools. Don't be suckered and don't believe premeds or Med students. It matters which DO school you go to, because EXPOSURE is what counts. This is a 300K decision, don't buy a Kia with that money.

What schools would you say are the "best" (like a top 5 or 10), alongside PCOM?

 

[MaximusD]

Thanks! Yeah I'm completely open to any options, but realistically don't see myself pursuing a super competitive field. I don't believe there will be many opportunities for research at the school I'll likely be attending, but due to your advice I'll make sure to try and find opportunities so as not to limit myself.

I wouldn't let it govern your choice of school unless it's something you're passionate about.

Best of luck!

 

[Geo16]

Questions!
1) If you have undergrad loan, does the U.S. military (any branch) pay it off for you? (HPSP pays off your med-school tuition, thought it would pay off your previous student loan... kinda wondering because I might transfer to USC and take out some loan to pay for its tuition..)
2) Why did you choose Airforce?
3) Is it okay to mention (in Primary, Secondary or Interview) that I want to be a Military Physician to med schools? It is my dream.

 

[MaximusD]

Questions!
1) If you have undergrad loan, does the U.S. military (any branch) pay it off for you? (HPSP pays off your med-school tuition, thought it would pay off your previous student loan... kinda wondering because I might transfer to USC and take out some loan to pay for its tuition..)

To my knowledge there is no traditional way the military pays off past past debt... FAP comes the closest. (Financial assistance program)

Disclaimer: the best answer to these questions can be found in the military medicine subforum in the resident/physician area of SDN.

To my knowledge, there are three primary programs for entry into the US military as a physician.

1. FAP - you go to Med school, pay/finance your way through, match into residency and contact a recruiter. You sign up and they give you a fixed amount per year of residency for a year-for-year active duty payback afterwards. Keep in mind all commitments carry a mandatory service obligation of 8 years, so if you did a three year residency you would do 3 active (minimum) and 5 inactive/nondrilling.

2. USUHS - military Med school. Apply, gain acceptance. Get paid as an O-1 throughout medical school but wear uni everyday. Paid to go to Med school but at a steep price in time-debt: 7 years of active duty service.

3. HPSP - the military scholarship. Must be enrolled in civilian Med school or have acceptance letter in hand when you contact the recruiter. 4 years schollie for 4 years payback, 3 years schollie for 3 years payback or 2 years schollie for 3 years payback (don't do this last option). In Med school you will do milmed rotations and training and get paid to do them. Tuition paid directly to school, insurance paid directly to school. Stipend paid to you. Book allowance paid to you if you submit receipts.

For all options, you will also need to apply through the JOINT SELECTION BOARD where they decide if you match into a military residency if you are allowed to apply through the civilian match. This is not a military match but rather an arbitrary closed-door selection process. If you are a non-select and do not want to do a different specialty, you may have to do a utilization tour as a General Medical Officer (GMO) or Flight Surgeon (FS).

2) Why did you choose Airforce?

Had always wanted to do USAF. Loved flying and jets since I was a little kid. Almost attended USAFA after visiting in CO but chose a state school instead. Was a gut decision for me. And I loved it, for the most part, although it did significant slow my career progression when I was an non-select at the board when I first applied anesthesia.

The Air Force can also be a bureaucratic monster and there were occasions when I was buried in awful administrative crap. I was also given incredible positions of responsibility and leadership early in my career which were very valuable to me and to my personal growth.

3) Is it okay to mention (in Primary, Secondary or Interview) that I want to be a Military Physician to med schools? It is my dream.

unlikely to make a significant difference. I would say in most instances it won't hurt and in a few it may help (if you mean it).

Best of luck!

 

[MaximusD]

What schools would you say are the "best" (like a top 5 or 10), alongside PCOM?

I'm afraid my knowledge of this is dated with all the new blood out there.

The best schools, in my opinion, are the ones that expose you to major hospitals where you rotate with other highly motivated and talented students. DO school recognition is also regionally/locally dependent. In that regard, I still recommend established schools in metropolitan areas such as PCOM, CCOM, NYCOM... followed by some others like UNECOM, LECOM, western, NSU, formerly UMDNJ (Rowan?) to name a few. Obviously these are just a few examples. If you provided a comprehensive list, I could give a more comprehensive response. That said, I am severely biased toward the "old guard" in the osteopathic world.

 

[Geo16]

To my knowledge there is no traditional way the military pays off past past debt... FAP comes the closest. (Financial assistance program)

Disclaimer: the best answer to these questions can be found in the military medicine subforum in the resident/physician area of SDN.

To my knowledge, there are three primary programs for entry into the US military as a physician.

1. FAP - you go to Med school, pay/finance your way through, match into residency and contact a recruiter. You sign up and they give you a fixed amount per year of residency for a year-for-year active duty payback afterwards. Keep in mind all commitments carry a mandatory service obligation of 8 years, so if you did a three year residency you would do 3 active (minimum) and 5 inactive/nondrilling.

2. USUHS - military Med school. Apply, gain acceptance. Get paid as an O-1 throughout medical school but wear uni everyday. Paid to go to Med school but at a steep price in time-debt: 7 years of active duty service.

3. HPSP - the military scholarship. Must be enrolled in civilian Med school or have acceptance letter in hand when you contact the recruiter. 4 years schollie for 4 years payback, 3 years schollie for 3 years payback or 2 years schollie for 3 years payback (don't do this last option). In Med school you will do milmed rotations and training and get paid to do them. Tuition paid directly to school, insurance paid directly to school. Stipend paid to you. Book allowance paid to you if you submit receipts.

For all options, you will also need to apply through the JOINT SELECTION BOARD where they decide if you match into a military residency if you are allowed to apply through the civilian match. This is not a military match but rather an arbitrary closed-door selection process. If you are a non-select and do not want to do a different specialty, you may have to do a utilization tour as a General Medical Officer (GMO) or Flight Surgeon (FS).



Had always wanted to do USAF. Loved flying and jets since I was a little kid. Almost attended USAFA after visiting in CO but chose a state school instead. Was a gut decision for me. And I loved it, for the most part, although it did significant slow my career progression when I was an non-select at the board when I first applied anesthesia.

The Air Force can also be a bureaucratic monster and there were occasions when I was buried in awful administrative crap. I was also given incredible positions of responsibility and leadership early in my career which were very valuable to me and to my personal growth.



unlikely to make a significant difference. I would say in most instances it won't hurt and in a few it may help (if you mean it).

Best of luck!

Thanks! Whoa. These are really good info! I really appreciate it. I think I will go with HPSP since the benefit fits with what I would like to do. I can handle UG loans.. Also, am I able to skip specialization and become a GMO? That is nice!! Dont you get most of training as phycisian during residency? If so, can you GMO and come back later to residency? I should do some research on my own!
Also, I like your reason for AF. I thought you would tell me some hidden benefits in AF that drew you in. Not sure which branch I want to serve.. Perhaps Navy.

And yeah, I dont think dreaming of military doctor should penalize me.. Asked in case should they(DO adcom) want a civilian doctor primarily..

 

[Geo16]

Also.... thank you for serving our country!! 🙂

 

[deleted831695]

If you provided a comprehensive list, I could give a more comprehensive response. That said, I am severely biased toward the "old guard" in the osteopathic world.

Thoughts on MSUCOM, AZCOM, and ATSU-KCOM?

 

[MaximusD]

Thoughts on MSUCOM, AZCOM, and ATSU-KCOM?

AZCOM is a/w CCOM and has been established for a 10+ years. Nothing bad to say about it.

ATSU-KCOM is a very old and established program. Nothing bad to say about it. I recall rotating with a KCOM student as a M4 at PCOM -- seemed highly competent. I think they are very heavy on OMT, which I personally would have not liked.

MSUCOM is a great school. Shouldn't have left it out of my list. Top choice due to state association.

 

[MaximusD]

Thanks! Whoa. These are really good info! I really appreciate it. I think I will go with HPSP since the benefit fits with what I would like to do. I can handle UG loans.. Also, am I able to skip specialization and become a GMO? That is nice!! Dont you get most of training as phycisian during residency? If so, can you GMO and come back later to residency? I should do some research on my own!
Also, I like your reason for AF. I thought you would tell me some hidden benefits in AF that drew you in. Not sure which branch I want to serve.. Perhaps Navy.

And yeah, I dont think dreaming of military doctor should penalize me.. Asked in case should they(DO adcom) want a civilian doctor primarily..

One negative of the AF is that it's the smallest branch with the least opportunities for in-service residency training. You are more likely to be deferred for civilian training or denied a residency when compared to the army. That said, Air Force deployments classically are the shortest... 4-6 months for most specialties.

You can become a GMO without residency -- you will do an internship first. If you plan to do this, I would choose a medicine or transitional internship. I did a GMO/FS tour before going back to residency. I am completely out now.

 

[CCmetal94]

What Step score would give a DO a reasonable chance at a ACGME Gas residency?

 

[Geo16]

One negative of the AF is that it's the smallest branch with the least opportunities for in-service residency training. You are more likely to be deferred for civilian training or denied a residency when compared to the army. That said, Air Force deployments classically are the shortest... 4-6 months for most specialties.

You can become a GMO without residency -- you will do an internship first. If you plan to do this, I would choose a medicine or transitional internship. I did a GMO/FS tour before going back to residency. I am completely out now.

Niice. Thank you very much.
So still, there is am internship! Thought it was straight out of school (which doesnt sound ideal).
Thank you! I have gained so much info!!

 

[MaximusD]

What Step score would give a DO a reasonable chance at a ACGME Gas residency?

Working on this answer...

 

[MaximusD]

What's your opinion of the golden hour rule? I spoke with a few surgeons who had mentioned this led to groups to setting up small facilities with gas, gen surg and ortho (1 each) and saw only 3 cases a day. They felt this rule has lead to decrease in volume and subsequent decrease in skills. Any thoughts on this?

You mean the work hour restrictions? I think they are a god-send and anyone who thinks otherwise is a surgery automaton. You can get plenty of cases within reasonable work-hours.

 

[MaximusD]

Golden hour to my understanding is a requirement that physicians must be less than an hour from a war zone. So they dispersed out.

I'm not familiar with this, and it would be poor form to speculate. My apologies.

 

[MaximusD]

Daily bump.

 

[Beezlebub]

What systematic changes do you think can be made in the health system that can promote better patient access?

 

[TheaterOfTheme]

Do you feel the field of anesthesiology is threatened by NPs?


Sent from my iPhone using SDN mobile

 

[MaximusD]

What systematic changes do you think can be made in the health system that can promote better patient access?

Single payer system? Less complexity to billing. More coherent funding for preventive medicine.

I don't know.

 

[JB50]

Are you finding that you are being extremely biased against as a DO?

 

[Beezlebub]

Single payer system? Less complexity to billing. More coherent funding for preventive medicine.

I don't know.

yea, I wish. definitely not under Trump admin. #EliminateMiddlemanInsuranceCompanies

 

[MaximusD]

Are you finding that you are being extremely biased against as a DO?

Not really. I get obnoxious questions sometimes.

Lots of DOs in anesthesia and in the northeast in general. Even more in military medicine... could have something to do with it.

 

[JB50]

Not really. I get obnoxious questions sometimes.

Lots of DOs in anesthesia and in the northeast in general. Even more in military medicine... could have something to do with it.

Exactly what I wanted to/thought I would hear🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄

 

[JB50]

yea, I wish. definitely not under Trump admin. #EliminateMiddlemanInsuranceCompanies

I personallyyyyyfavor a cash-only healthcare plan

 

[MaximusD]

It gets to the point where I don't even know why, but I am extraordinarily proud of and identify with being a DO. Never really set out to be a DO... applied to both MD and DO institutions. But I wouldn't trade my DO in on an MD. I like being a DO. I like being as qualified as an MD but of a different flavor. When I was deployed and didn't want to DNIF ("duties not including flying") flyers, OMT was a God-send. It did get tiring when the other flyers found out, LOL.

I can tell you right now, the likelihood of me using it if I specialize in pain is minimal, but the palpatory and diagnostic skills with my hands will be very useful (and already has been). My approach to physical rehabilitation and holistic approach to recovery will also be of benefit.

Not sure this helped anyone, but perhaps to understand that someone like myself, who initially did not set out to become a DO as a premed, still is proud of his career pathway even when training in a traditionally-allopathic specialty. I digress.

Moar questions?

 

[MaximusD]

Do you feel the field of anesthesiology is threatened by NPs?


Sent from my iPhone using SDN mobile

No, although CRNAs (not NPs) will certainly take some ground over the next decade or two. This will result in independent practice at low levels of acuity and/or large supervision ratios between physician anesthesiologists and nurse anesthetists.

 

[67552931811]

Working on this answer...

Waiting on pins and needles over here

 

[MaximusD]

Waiting on pins and needles over here

Honestly I can't find a reliable answer to this question. SDN word of mouth isn't all that reliable. I looked at the NRMP results and to my review it doesn't give an avg step score.

Appreciate input on this one.

 

[NecrotizingFasciitis]

You mentioned you used a rotation to get your research in for gas, was this during 3rd year or 4rth year?

I'm considering using an elective for clinical research as well.. but I don't know which year it would be best utilized (w/ regards to timeline for ERAS application.)

 

[Matthew9Thirtyfive]

What's your opinion of the golden hour rule? I spoke with a few surgeons who had mentioned this led to groups to setting up small facilities with gas, gen surg and ortho (1 each) and saw only 3 cases a day. They felt this rule has lead to decrease in volume and subsequent decrease in skills. Any thoughts on this?

Apologies to @MaximusD for stepping on his toes.

There are Navy docs on this forum that can give you more information, but skill atrophy is a problem for some specialties from what I've been told and seen. Surgeons on deployment can find themselves on a CVN or an amphib with really low numbers and low acuity stuff. Some appies, gallbladders, minor trauma, vasectomies, and lumps and bumps. Boots on ground can also see skill atrophy when you're not seeing the sort of cases you'd see at a medcen. There are ways to mitigate it, but it seems to be a problem.

I don't know if there is an actual "Golden Hour" rule, but the Navy does have surgical teams out there waiting to be used. Hope that helps a little.

Edit: I still want to be a Navy doc. That's an aspect of Navy medicine that I know can be frustrating, but right now I'm willing to deal.

 

[Matthew9Thirtyfive]

Thanks man. Honestly if I wasn't married I'd really consider military too. Glad there's people like you and OP around

I'm married with two kids. There are times when it's hard, but there are plenty of times where it's just another job (a hard job that is dangerous a lot of times, but a job). I serve with many people who are happily married and have good relationships with their kids.