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- Sep 6, 2018
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Several months after my internship ended I had found myself located on a secluded Japanese base, standing half a football field away from a cleared patch of grass that had been designated as our landing zone for a Japanese bird (a.k.a. Huey/UH-1 Helo). The last week had been spent planning with the Japanese Ground Self-Defense Force, utilizing their interpreters and our half-Japanese Marine to coordinate an air casualty evacuation drill. After several painful meetings, helicopter safety briefs, and practice runs, we finally had our notional patient, a lucky Lance Corporal, strapped in only by the feet on one of our litter beds, and his arms free in case we were to drop him.
In the interest of fidelity, we called in our 9-Line over the radio, a standardized CASEVAC/MEDEVAC request used by the military, and moments later the Japanese bird touched down. With our bodies crouched low and the Marine strapped into the litter bed, myself and my Corpsman ran our patient towards the gusts of the rotor blades, loading first our “casualty” and then ourselves into the cramped back of the CASEVAC bird. We shared the space not only with our notional patient, but with the Japanese civilians that were in charge of PR for the event. After 30 minutes of flying, the bird landed on yet another grassy field nearby a Japanese hospital. The Japanese pilot gave us the go-ahead to continue, and we offloaded our patient. From the helicopter we ran in our crouch towards an ambulance a few hundred feet away, where Japanese EMS, cameras, and more Japanese PR folk awaited us.
“Are you doctor?” a Japanese female in a white suit asked.
“Yes, I’m the doctor.”
Understandably, a huge knowledge gap exists regarding what a GMO is, stemming largely from our non-uniform trajectory through the practice of medicine. The breadth of the responsibilities I have had were difficult to fit into small ERAS boxes allowed for the CV.
Often times the military exposure that civilian programs get are in the form of Health Professions Scholarship Program (HPSP) students, medical students that owe four years of service for four years of their medical tuition paid. These individuals interview with programs with a chance of being allowed to match in the civilian world (a fate that is determined in December with the military match), as long as their respective branch allows it. These individuals have two options to pay back their commitment: they may fulfill their four-year service obligations after their residency as an attending, or they may fulfill it after their intern year, as a Medical Officer. It is to the latter that I would like to speak.
This smaller pool of applicants will complete an intern year to obtain a medical license, practice independently for approximately four years, and hope to return to the civilian match, unshackled from the military or with a foot in the door with the reserves. This tends to be the pathway of most resistance, often traveled alone, and one that requires frequent re-trailblazing. I would like to speak to the general qualities of GMO’s using anecdotal stories from my own life and those of my colleagues, and speak to how it relates to residency (but skewed towards Emergency Medicine).
There are several types of GMO’s. Our jobs are uniquely uniform, in that many of our duties are identical. We exist as Lieutenants, we often end up deployed or stationed overseas, we become the heads of a medical department on land or on a ship, and we see patients. We may end up predominantly with the “Blue-side” Navy, in which case you will be attached to a ship or a shipyard. The “Green-side” GMO’s, such as myself, are placed with a Battalion or Squadron with the Marine Corps, and our experiences range from firing tanks, spending weeks living out of tents, or surveying hospitals in foreign countries. An intern might opt for six months of extra training to become an Underwater Medicine Officer, and attach with Navy SEALS or Reconnaissance Marines. These individuals’ stories often encompass Artic Expeditions, parachuting out of planes, and undersea dives. If you decide to spend an extra six months to learn how to be a flight surgeon, your job may require mandatory flight time in a jet or a helicopter. You may encounter medical officers that have practiced in austere settings, some that were called to be ready for traumas while in Iraq, and others may have performed actual aeromedical evacuations, all with a solitary year of training under their belt.
Speaking for GMO’s embedded with the Marines, we are the unit’s fully licensed primary care provider catering to anywhere from 300-800 Marines and Sailors. At my busiest, I was the PCM for approximately 1,000 patients in Japan due to manning gaps. I worked at the busiest clinic on Okinawa, Japan, where I would fulfill a minimum 0.5 FTE’s per week, treating a full spectrum of primary, urgent, and emergent cases. With chronic low back pain and chlamydia infections filling the normal clinic days, our acute care area would routinely see victims of Okinawa’s humidity, and leading resuscitations of Marines with temperatures greater than 107oF became second nature.
It is here that we became experts of the ESI 4’s and 5’s. We act autonomously in the creation of treatment plans for our patients for a variety of primary care issues: sprains, strains, coughs, sore throat, abscess I&D, ingrown toenail removals, chronic joint pains, fracture immobilization, chronic musculoskeletal pains, hypertension, diabetes, etc. This occurs in conjunction with being ever fearful of missing the zebras, with more insidious diagnoses creeping in such as cancer, autoimmune diseases, dysrhythmias, endocrinological disorders, and acute psychoses also falling into our purview. The flies on the walls of our clinics frequently hear “you’ll never believe what I found,” from the mouths of Medical Officers swapping stories.
Despite the Department of Defense Budget that seems to be creeping towards $800 billion, at the level of the GMO, it certainly doesn’t seem like it. We frequently worked in underfunded and understaffed clinical environments. GMO’s in Hawaii would speak about the converted Brig (military jail) that they were working out of. “Disarray” would be a kind word to describe the state of the medical supply rooms. We often worked with limited medications and supplies, and most frequently, we were short personnel. We always seemed to have “the nurse(s) we were promised” on the way, only to find that a contract lapsed, or that they only tentatively accepted a job at our clinic before going on to accept a more lucrative offer elsewhere. These experiences create a culture where innovation is necessary. Military medicine is a no-fail mission: if we do not do our jobs, our volunteer force suffers. As is human nature, we complain frequently, but only after we do what is necessary to help our patients. GMO’s are great at problem identification, but most do not pause at that step. My experience interviewing found that county Emergency Medicine programs were proud of the fact that residents learn how to perform the skills that are classically considered nursing skills. As a GMO, I have started countless IV’s, pushed medications, drawn labs, cycled vital signs, acted as a social worker, and in doing so we develop a healthy appreciation for not only the importance of knowing those skills, but that it also helps bond us with our patients.
The other treatment setting is that of “The Field.” The field is the epitome of the austere low-resource setting, with field exercises for the medical team being preparatory for going to war without a standing hospital nearby. It is where we spend 10-90 days taking showers with baby wipes, experience new and exciting bowel habits with our Meals-Ready-to-Eat (MRE’s a.k.a. Meals-Refusing-to-Excrete), and become well versed in quickly setting up expensive tents. Medical practice in the field is a Battalion Aid Station (BAS- big medical tent) with a smorgasbord of medical supplies, some that may or may not be helpful.
In order to get our medical supplies, we travel to a large medical warehouse and it is here that I would walk away with an odd assortment of supplies, which sometimes included AED’s without pads, IV lidocaine as my only ACLS drug, but also IV cefazolin, IV metronidazole, and 25 boxes of cepacol. The field can feel like an understaffed emergency department at times. There are often lulls, where we treat primary care issues, but at any given moment, an emergent concern might rush in. I have sat in my BAS reading, only to have Marines rushed in with the likes of hypothermia, hyperthermia, fractures, blunt trauma, and chemical exposures. The rural hospital with a small Emergency Department that ATLS courses put you in? This is basically it. In Emergency Medicine they frequently talk about being able to pass “the 2AM test,” and I promise the same skills required to pass that test, are sharpened and perfected by the “sitting in the same tent for a month” test.
As an applicant, we have acted in an attending role for as little as four years prior to asking you to consider us for a residency position. Traveling between interviews, there seemed to be lurking horror stories regarding individuals that turned to Emergency Medicine after having completing another residency and having acted as an attending in another field, only to find it difficult to return to the role of a junior learner.
With rare exception, the job of a GMO is taken with the understanding that it is temporary, a means and not an end, and that a residency is required at the end of the road. It is as natural of a pitstop as residency is to the medical student that one day hopes to be an attending. We know that we don’t know quite a bit, and the subspecialists and specialist at our respective supporting hospitals can testify to this fact. We frequently turn to them to compensate for incomplete or underdeveloped patient scrips. The conversations we have about the future are drenched with one underlying theme: a need to go back to residency. The culture is such that we humbly acknowledge that perfect practice makes perfect, and the road to clinical competency in medicine is through a residency.
I also understand the concern that it may be difficult to adjust from the hierarchy of the military back into a more relaxed civilian setting. I would challenge that the military medicine culture is similar to civilian medicine, just with more “Sir’s” and “Ma’am’s.” We use a frustrating EMR to provide the best healthcare that we can with a within a huge and sometimes confusing bureaucracy; I do not believe this is dissimilar to practicing civilian medicine. At the end of the day, most GMO’s joined the military to help people and to serve, and these are the people drawn to our ranks. We are as affable as any other medical professional, and I do not believe the military culture changes that.
My Lieutenant Colonel and Commanding Officer at the time was referencing my rank worn on my right collar that indicated my status as a Lieutenant. Anyone who has completed an internship is probably more aware of how much medicine they do not know, but the point remained the same, and as a GMO, we are thrown into the fire, as most non-doctor Lieutenants in the Navy have at least 4 years of experience in leadership roles. We are made responsible as the officer in charge of the success and proper functioning of a hierarchical system full of junior and senior enlisted personnel.
We learn early how to be organized, as your GMO’s have existed in a world of meetings. Pre-planning meetings. Meetings to prepare for the pre-planning meetings. Nightly commanders update briefs during missions. After action report meetings. Mid-term counseling for Sailors. Mid-term counseling for ourselves. 0.5FTE (minimum) of clinic. Weekly staff meetings. Monthly clinic meetings. Time management skills are expanded further beyond “hospital, study, test, repeat,” as success and sanity hinge on the ability to juggle the health of hundreds of Marines with the administrative duties that are required to maintain the medical component of an operational and deployable unit.
We learn tact, as we exist in a world of strong personalities. As a staff officer in the command, you need to co-exist along military experts outside of the field of medicine. I found myself sitting across the table from Marine Corps Captains, Majors, Lieutenant Colonels, and Colonels that I collaborated with, and at times, disagreed with. As doctors, we walk a fine line in these interactions, in that these leaders and colleagues hold another important role in the life of a Medical Officer: that of the patient. A burned bridge in a meeting could translate to a broken therapeutic relationship, and vice versa. If you are looking for an individual that has an even keeled temperament, you can be certain that trait has been developed in a GMO applicant.
We are charged with the personal and professional development of anywhere from five to 25 Sailors. We sit with our senior enlisted leaders and provide feedback to our Sailors, both good and bad, on a routine basis. We talk about goals for the future and how they plan on achieving those goals, present awards, offer Oaths of Re-enlistment, and pin their new devices on when they promote to a new rank. Likewise, when Sailors do wrong, we are charged with providing the negative counseling, which sometimes involves difficult discussions about paperwork that may become a permanent mark in their record. As applicants, we are primed to receive feedback as an intern (especially since this is our second time doing it), and to provide it when we step into a senior resident role.
I wanted to just comment on what may have been my greatest source of anxiety, obtaining an eSLOE while on active duty, especially as I found Emergency Medicine a little bit later, and had 1 month as an intern and 1 month as a MS3 in a “student” capacity in the Emergency Department.
I had initially sent emails to the programs I was interested in regarding my predicament, and their preference for SLOEs. CORDEM’s position was “ask the programs.” The program’s preferences answers included: “We understand, you will not need a SLOE.” “Do not submit a SLOE, as it won’t have much meaning.” “We will not consider you unless you have two SLOE’s.” “We will look at your application without a SLOE, but we strongly encourage you have one.”
The military medical system has a SLOEless match process, and our Emergency Medicine faculty do not routinely use the form or the eSLOE system. I found myself fortunate in that I was able to get my preferred duty station located between Naval Hospital Camp Pendleton, which has an unchallenged Family Medicine residency, and Naval Medical Center San Diego, which has an Emergency Medicine residency. My supervisor in the Navy was well respected in the Emergency Department at Naval Medical Center San Diego, and was able network me some time in the Emergency Department while the residents were at their didactics. Together with my previous intern New Innovations evaluation and their collective observations of me on several months of Thursdays, they were able to piece together an eSLOE.
While it may have worked out, it was only by luck, as the ED in San Diego had a “no GMO” policy, and my presence was not welcomed by all, and I had initially been told “No, but we have lectures on Thursdays.” I turned to Camp Pendleton’s ED that was infrequently staffed by FP interns with the hopes of getting a non-faculty SLOE by working on the weekends; it was only after my supervisor had spoken with an old colleague that had happened to be an APD at a well-regarded EM program, and he explained how important it was to see an eSLOE if I were to have a competitive application.
The time spent in these ED’s was in addition to the 60-hour weeks I spent as a medical officer taking care of my primary care patients and performing my administrative duties, and the fact that I was able to obtain an eSLOE or a SLOE was a byproduct of the stars aligning in terms of my placement in Southern California, my supervisor, and his relationships with other people. I understand that it is a standardized form that is used to help compare your MS4 apples to MS4 apples, but hopefully, for the reasons mentioned above, you understand that the GMO is a pretty cool orange, and if they don’t have a SLOE or an eSLOE, it’s not for a lack of trying or because of apathy, or because we didn’t want it. It’s because it is really, really hard.
In the interest of fidelity, we called in our 9-Line over the radio, a standardized CASEVAC/MEDEVAC request used by the military, and moments later the Japanese bird touched down. With our bodies crouched low and the Marine strapped into the litter bed, myself and my Corpsman ran our patient towards the gusts of the rotor blades, loading first our “casualty” and then ourselves into the cramped back of the CASEVAC bird. We shared the space not only with our notional patient, but with the Japanese civilians that were in charge of PR for the event. After 30 minutes of flying, the bird landed on yet another grassy field nearby a Japanese hospital. The Japanese pilot gave us the go-ahead to continue, and we offloaded our patient. From the helicopter we ran in our crouch towards an ambulance a few hundred feet away, where Japanese EMS, cameras, and more Japanese PR folk awaited us.
“Are you doctor?” a Japanese female in a white suit asked.
“Yes, I’m the doctor.”
The General Medical Officer
Understandably, a huge knowledge gap exists regarding what a GMO is, stemming largely from our non-uniform trajectory through the practice of medicine. The breadth of the responsibilities I have had were difficult to fit into small ERAS boxes allowed for the CV.
Often times the military exposure that civilian programs get are in the form of Health Professions Scholarship Program (HPSP) students, medical students that owe four years of service for four years of their medical tuition paid. These individuals interview with programs with a chance of being allowed to match in the civilian world (a fate that is determined in December with the military match), as long as their respective branch allows it. These individuals have two options to pay back their commitment: they may fulfill their four-year service obligations after their residency as an attending, or they may fulfill it after their intern year, as a Medical Officer. It is to the latter that I would like to speak.
This smaller pool of applicants will complete an intern year to obtain a medical license, practice independently for approximately four years, and hope to return to the civilian match, unshackled from the military or with a foot in the door with the reserves. This tends to be the pathway of most resistance, often traveled alone, and one that requires frequent re-trailblazing. I would like to speak to the general qualities of GMO’s using anecdotal stories from my own life and those of my colleagues, and speak to how it relates to residency (but skewed towards Emergency Medicine).
Flavors of Medical Officers
There are several types of GMO’s. Our jobs are uniquely uniform, in that many of our duties are identical. We exist as Lieutenants, we often end up deployed or stationed overseas, we become the heads of a medical department on land or on a ship, and we see patients. We may end up predominantly with the “Blue-side” Navy, in which case you will be attached to a ship or a shipyard. The “Green-side” GMO’s, such as myself, are placed with a Battalion or Squadron with the Marine Corps, and our experiences range from firing tanks, spending weeks living out of tents, or surveying hospitals in foreign countries. An intern might opt for six months of extra training to become an Underwater Medicine Officer, and attach with Navy SEALS or Reconnaissance Marines. These individuals’ stories often encompass Artic Expeditions, parachuting out of planes, and undersea dives. If you decide to spend an extra six months to learn how to be a flight surgeon, your job may require mandatory flight time in a jet or a helicopter. You may encounter medical officers that have practiced in austere settings, some that were called to be ready for traumas while in Iraq, and others may have performed actual aeromedical evacuations, all with a solitary year of training under their belt.
Clinical Experience
Speaking for GMO’s embedded with the Marines, we are the unit’s fully licensed primary care provider catering to anywhere from 300-800 Marines and Sailors. At my busiest, I was the PCM for approximately 1,000 patients in Japan due to manning gaps. I worked at the busiest clinic on Okinawa, Japan, where I would fulfill a minimum 0.5 FTE’s per week, treating a full spectrum of primary, urgent, and emergent cases. With chronic low back pain and chlamydia infections filling the normal clinic days, our acute care area would routinely see victims of Okinawa’s humidity, and leading resuscitations of Marines with temperatures greater than 107oF became second nature.
It is here that we became experts of the ESI 4’s and 5’s. We act autonomously in the creation of treatment plans for our patients for a variety of primary care issues: sprains, strains, coughs, sore throat, abscess I&D, ingrown toenail removals, chronic joint pains, fracture immobilization, chronic musculoskeletal pains, hypertension, diabetes, etc. This occurs in conjunction with being ever fearful of missing the zebras, with more insidious diagnoses creeping in such as cancer, autoimmune diseases, dysrhythmias, endocrinological disorders, and acute psychoses also falling into our purview. The flies on the walls of our clinics frequently hear “you’ll never believe what I found,” from the mouths of Medical Officers swapping stories.
Despite the Department of Defense Budget that seems to be creeping towards $800 billion, at the level of the GMO, it certainly doesn’t seem like it. We frequently worked in underfunded and understaffed clinical environments. GMO’s in Hawaii would speak about the converted Brig (military jail) that they were working out of. “Disarray” would be a kind word to describe the state of the medical supply rooms. We often worked with limited medications and supplies, and most frequently, we were short personnel. We always seemed to have “the nurse(s) we were promised” on the way, only to find that a contract lapsed, or that they only tentatively accepted a job at our clinic before going on to accept a more lucrative offer elsewhere. These experiences create a culture where innovation is necessary. Military medicine is a no-fail mission: if we do not do our jobs, our volunteer force suffers. As is human nature, we complain frequently, but only after we do what is necessary to help our patients. GMO’s are great at problem identification, but most do not pause at that step. My experience interviewing found that county Emergency Medicine programs were proud of the fact that residents learn how to perform the skills that are classically considered nursing skills. As a GMO, I have started countless IV’s, pushed medications, drawn labs, cycled vital signs, acted as a social worker, and in doing so we develop a healthy appreciation for not only the importance of knowing those skills, but that it also helps bond us with our patients.
The other treatment setting is that of “The Field.” The field is the epitome of the austere low-resource setting, with field exercises for the medical team being preparatory for going to war without a standing hospital nearby. It is where we spend 10-90 days taking showers with baby wipes, experience new and exciting bowel habits with our Meals-Ready-to-Eat (MRE’s a.k.a. Meals-Refusing-to-Excrete), and become well versed in quickly setting up expensive tents. Medical practice in the field is a Battalion Aid Station (BAS- big medical tent) with a smorgasbord of medical supplies, some that may or may not be helpful.
In order to get our medical supplies, we travel to a large medical warehouse and it is here that I would walk away with an odd assortment of supplies, which sometimes included AED’s without pads, IV lidocaine as my only ACLS drug, but also IV cefazolin, IV metronidazole, and 25 boxes of cepacol. The field can feel like an understaffed emergency department at times. There are often lulls, where we treat primary care issues, but at any given moment, an emergent concern might rush in. I have sat in my BAS reading, only to have Marines rushed in with the likes of hypothermia, hyperthermia, fractures, blunt trauma, and chemical exposures. The rural hospital with a small Emergency Department that ATLS courses put you in? This is basically it. In Emergency Medicine they frequently talk about being able to pass “the 2AM test,” and I promise the same skills required to pass that test, are sharpened and perfected by the “sitting in the same tent for a month” test.
“You’ve been acting independently for the last four years, are you okay with becoming a resident again?”
As an applicant, we have acted in an attending role for as little as four years prior to asking you to consider us for a residency position. Traveling between interviews, there seemed to be lurking horror stories regarding individuals that turned to Emergency Medicine after having completing another residency and having acted as an attending in another field, only to find it difficult to return to the role of a junior learner.
With rare exception, the job of a GMO is taken with the understanding that it is temporary, a means and not an end, and that a residency is required at the end of the road. It is as natural of a pitstop as residency is to the medical student that one day hopes to be an attending. We know that we don’t know quite a bit, and the subspecialists and specialist at our respective supporting hospitals can testify to this fact. We frequently turn to them to compensate for incomplete or underdeveloped patient scrips. The conversations we have about the future are drenched with one underlying theme: a need to go back to residency. The culture is such that we humbly acknowledge that perfect practice makes perfect, and the road to clinical competency in medicine is through a residency.
I also understand the concern that it may be difficult to adjust from the hierarchy of the military back into a more relaxed civilian setting. I would challenge that the military medicine culture is similar to civilian medicine, just with more “Sir’s” and “Ma’am’s.” We use a frustrating EMR to provide the best healthcare that we can with a within a huge and sometimes confusing bureaucracy; I do not believe this is dissimilar to practicing civilian medicine. At the end of the day, most GMO’s joined the military to help people and to serve, and these are the people drawn to our ranks. We are as affable as any other medical professional, and I do not believe the military culture changes that.
“I know that you know the medicine, but what I want you to work on is what’s on the other side of your collar, how are you going to do that?”
My Lieutenant Colonel and Commanding Officer at the time was referencing my rank worn on my right collar that indicated my status as a Lieutenant. Anyone who has completed an internship is probably more aware of how much medicine they do not know, but the point remained the same, and as a GMO, we are thrown into the fire, as most non-doctor Lieutenants in the Navy have at least 4 years of experience in leadership roles. We are made responsible as the officer in charge of the success and proper functioning of a hierarchical system full of junior and senior enlisted personnel.
We learn early how to be organized, as your GMO’s have existed in a world of meetings. Pre-planning meetings. Meetings to prepare for the pre-planning meetings. Nightly commanders update briefs during missions. After action report meetings. Mid-term counseling for Sailors. Mid-term counseling for ourselves. 0.5FTE (minimum) of clinic. Weekly staff meetings. Monthly clinic meetings. Time management skills are expanded further beyond “hospital, study, test, repeat,” as success and sanity hinge on the ability to juggle the health of hundreds of Marines with the administrative duties that are required to maintain the medical component of an operational and deployable unit.
We learn tact, as we exist in a world of strong personalities. As a staff officer in the command, you need to co-exist along military experts outside of the field of medicine. I found myself sitting across the table from Marine Corps Captains, Majors, Lieutenant Colonels, and Colonels that I collaborated with, and at times, disagreed with. As doctors, we walk a fine line in these interactions, in that these leaders and colleagues hold another important role in the life of a Medical Officer: that of the patient. A burned bridge in a meeting could translate to a broken therapeutic relationship, and vice versa. If you are looking for an individual that has an even keeled temperament, you can be certain that trait has been developed in a GMO applicant.
We are charged with the personal and professional development of anywhere from five to 25 Sailors. We sit with our senior enlisted leaders and provide feedback to our Sailors, both good and bad, on a routine basis. We talk about goals for the future and how they plan on achieving those goals, present awards, offer Oaths of Re-enlistment, and pin their new devices on when they promote to a new rank. Likewise, when Sailors do wrong, we are charged with providing the negative counseling, which sometimes involves difficult discussions about paperwork that may become a permanent mark in their record. As applicants, we are primed to receive feedback as an intern (especially since this is our second time doing it), and to provide it when we step into a senior resident role.
Getting the eSLOE
I wanted to just comment on what may have been my greatest source of anxiety, obtaining an eSLOE while on active duty, especially as I found Emergency Medicine a little bit later, and had 1 month as an intern and 1 month as a MS3 in a “student” capacity in the Emergency Department.
I had initially sent emails to the programs I was interested in regarding my predicament, and their preference for SLOEs. CORDEM’s position was “ask the programs.” The program’s preferences answers included: “We understand, you will not need a SLOE.” “Do not submit a SLOE, as it won’t have much meaning.” “We will not consider you unless you have two SLOE’s.” “We will look at your application without a SLOE, but we strongly encourage you have one.”
The military medical system has a SLOEless match process, and our Emergency Medicine faculty do not routinely use the form or the eSLOE system. I found myself fortunate in that I was able to get my preferred duty station located between Naval Hospital Camp Pendleton, which has an unchallenged Family Medicine residency, and Naval Medical Center San Diego, which has an Emergency Medicine residency. My supervisor in the Navy was well respected in the Emergency Department at Naval Medical Center San Diego, and was able network me some time in the Emergency Department while the residents were at their didactics. Together with my previous intern New Innovations evaluation and their collective observations of me on several months of Thursdays, they were able to piece together an eSLOE.
While it may have worked out, it was only by luck, as the ED in San Diego had a “no GMO” policy, and my presence was not welcomed by all, and I had initially been told “No, but we have lectures on Thursdays.” I turned to Camp Pendleton’s ED that was infrequently staffed by FP interns with the hopes of getting a non-faculty SLOE by working on the weekends; it was only after my supervisor had spoken with an old colleague that had happened to be an APD at a well-regarded EM program, and he explained how important it was to see an eSLOE if I were to have a competitive application.
The time spent in these ED’s was in addition to the 60-hour weeks I spent as a medical officer taking care of my primary care patients and performing my administrative duties, and the fact that I was able to obtain an eSLOE or a SLOE was a byproduct of the stars aligning in terms of my placement in Southern California, my supervisor, and his relationships with other people. I understand that it is a standardized form that is used to help compare your MS4 apples to MS4 apples, but hopefully, for the reasons mentioned above, you understand that the GMO is a pretty cool orange, and if they don’t have a SLOE or an eSLOE, it’s not for a lack of trying or because of apathy, or because we didn’t want it. It’s because it is really, really hard.
