Another GMO and GTFO Thread

[Dr.RickSanchez]

Gentlemen,

Some background: Army, HPSPer, 2021 med grad, didn't make it into my desired specialty, TY'd, GMO'd

Long time since I've posted, been a wild ride. I did my Transitional Year internship, became a flight surgeon and have had some amazing experiences, but ultimately I do not plan on being a lifer. Welp matched into residency this year and its time for me to sign the contract for my Active Duty Service Obligation (ADSO) that I will receive for residency training. My timeline, or so I thought, would be the following:

HPSP - 4 years (adds 4 years)
TY - 1 year (intern year +1/-1 = 0, still 4 years)
1 year FS GMO (removes 1 year, total 3 left)
1 year FS GMO (removes 1 year, total 2 left)
Return to 3 year residency
1 year internship (intern year +1/-1 = 0)
2 year residency (doesn't add anything because my ADSO from HPSP is already 2 years)

So lo and behold, I talk to the folks at GME and they explain to me that I "used up my ADSO free intern year", and that my 3 year residency program will in fact accrue a 3 year ADSO. Not only have they screwed me out of my TY intern year not counting for piss towards my intern year in my residency, they now are telling me I will also owe them one more year. Is it irrational for me to be pissed about this situation? I am considering telling them to shove it and GMO/GTFOing. My desired residency will not be hard to get on the outside.

Appreciate any advice gentlemen

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[ArmyTiger]

I guess the question is would you rather be a GMO for another year, or a residency trained physician in the military for an extra year? And a second part, do you want to be in the military an extra 6 years? I don't know what specialty you're going into, but I'd imagine the financial portion of the decision is likely close to even, after you compare 3 years of residency salary as a civilian to what you'll make in the military. It's a hard question.

 

[Dr.RickSanchez]

I guess the question is would you rather be a GMO for another year, or a residency trained physician in the military for an extra year? And a second part, do you want to be in the military an extra 6 years? I don't know what specialty you're going into, but I'd imagine the financial portion of the decision is likely close to even, after you compare 3 years of residency salary as a civilian to what you'll make in the military. It's a hard question.

Thanks for your reply Tiger. I don't care in the slightest what I would be doing with my remaining time in the Army but something tells me if I finish residency they would expect me to go into a billet in that specialty. That being said it'd be easy as hell to wear the flight surgeon hat and FM hat at a location that needs both.

I do want to emphasize that my decision right now is:

1. Finish my remaining ADSO of 2 years as a GMO, apply civilian residency
2. Go to residency in the Army, accrue an additional bull**** year to my ADSO (which really is two bull**** years because my TY should count as an intern year anyway)

Edit: Regarding the finances, it seems not particularly close as the extra year in the military would equate to some $250,000 forfeited, and if I could find a program that would recognize my TY as my intern year (a year filled to the brim with redundant training and being bottom on the totem-pole) then it would be closer to $500,000 forfeited. That combined with the fact that the Army still hasn't paid me my specialty incentive pay for being a flight surgeon - the Army doesn't come anywhere close to being competitive financially.

 

[pawprint]

Your programs assessment is correct.

You owed 2 years of hpsp coming back from GMO.

You will payback your 2 remaining hpsp years while in your 2nd intern year and your pgy-2 year. Meanwhile, you gain obligated payback for intern year, pgy-2, and pgy-3, so at the end of residency, you now owe 3 years.

All pgy training incurs payback. Including intern year.

typically, you are paying back 1 year of Hpsp while in your first intern year, so you wouldn’t see the difference as you pay back a year and then gain a year at the end. However, your circumstance where you are repeating a pgy-1 year shows a circumstance where you will see that incurred obligation in action.

 

[Dr.RickSanchez]

All pgy training incurs payback. Including intern year.

I don't think that is the case. Directly from my contract:

"f. Graduate Medical Education (GME). Accredited, post-doctoral doctor of medicine (M.D.) and doctor of osteopathy (D.O.) programs more than 26 weeks in duration that comprise “internships” (the first postgraduate year (PGY-1) of accredited training), “residencies” and “fellowships” (subsequent postgraduate years (PGY–2 or above) of accredited training leading to eligibility for certification by an American specialty board). GME may occur in Federal medical facilities, civilian medical facilities, and colleges or universities. While the first year of graduate medical education (PGY-1) is included in the definition of GME, it is obligation neutral; i.e. an ADO is neither incurred nor discharged during PGY-1."

typically, you are paying back 1 year of Hpsp while in your first intern year

The legal-ese may be up to interpretation. Does it refer to the first year of GME in my career or the first year of the program? Regardless, my TY should not have taken anything from my 4 yr HPSP ADSO.

 

[pawprint]

From your contract, it makes sense to me then that you shouldn’t incur an additional year for repeating PGY-1.

 

[Barrel Proof]

Why do you think you should stay in? Seems like you stand to gain financially by getting out. And it also seems like you may be bitter over the additional year to your ADSO if you were to stay in (can’t blame you, I would be too). So what do you see as a reason for staying in?

 

[Dr.RickSanchez]

Why do you think you should stay in? Seems like you stand to gain financially by getting out. And it also seems like you may be bitter over the additional year to your ADSO if you were to stay in (can’t blame you, I would be too). So what do you see as a reason for staying in?

I guess there's the "feeling like a quitter" aspect. I also have a lot of things in motion, both at my current assignment and at the MTF I'd be going to, and it'd be a huge pain for them to change course now. I'd like to make O-4. I wanted an assignment in W. Europe.

Also applying for civilian residency while working sounds like a PITA. I remember seeing an awesome thread about it though so I'll be sure to use that if I decide to go that route

 

[orbitsurgMD]

If you don't plan on a career and you are financially much better off leaving after minimum ADSO and getting a desirable residency won't be a difficulty, why exactly would you consider staying?

 

[Centurion38]

Only reason to stay in would be if you were a non-competitive applicant and Military GME offers you a shot at a desirable residency.

Military GME- by and large- seems woeful these days. It wasn't much better when I was in 15 years ago. I did my 4 years as a flight surgeon, got out and never looked back. I got promoted to O4 while in the IRR.

I've never understood why people are mystified post facto about service obligations.

They are training you for three years, they want their pound of flesh from you as an attending. It's not that hard to understand.

Just leave and get civilian training.

 

[Apollyon]

I got promoted to O4 while in the IRR.

That makes me laugh for a very specific reason. My medical director in residency was in the Navy early 90s. One day, in his office, I asked him about his flight helmet. He told me he got rotary wing qualified (right seat) when he was in, as ship's surgeon. He said it was a really good time to be in.

Well, at another time, for some reason, the IRR came up, and he told me that he had moved 2 or 3 times, and hadn't updated his address, so, if they wanted him, they would have to send NIS to find him! Now, you say you were promoted! I wonder if he picked up O-5 "on the lam"!

 

[armytrainingsir]

That makes me laugh for a very specific reason. My medical director in residency was in the Navy early 90s. One day, in his office, I asked him about his flight helmet. He told me he got rotary wing qualified (right seat) when he was in, as ship's surgeon. He said it was a really good time to be in.

Well, at another time, for some reason, the IRR came up, and he told me that he had moved 2 or 3 times, and hadn't updated his address, so, if they wanted him, they would have to send NIS to find him! Now, you say you were promoted! I wonder if he picked up O-5 "on the lam"!

I had a friend make 05 in the IRR years after he left the guard and went IRR (and did nothing,lol)

 

[TheGoose]

Their math is correct. Bummer but still correct

 

[Dr.RickSanchez]

I don't think that is the case. Directly from my contract:

"f. Graduate Medical Education (GME). Accredited, post-doctoral doctor of medicine (M.D.) and doctor of osteopathy (D.O.) programs more than 26 weeks in duration that comprise “internships” (the first postgraduate year (PGY-1) of accredited training), “residencies” and “fellowships” (subsequent postgraduate years (PGY–2 or above) of accredited training leading to eligibility for certification by an American specialty board). GME may occur in Federal medical facilities, civilian medical facilities, and colleges or universities. While the first year of graduate medical education (PGY-1) is included in the definition of GME, it is obligation neutral; i.e. an ADO is neither incurred nor discharged during PGY-1."



The legal-ese may be up to interpretation. Does it refer to the first year of GME in my career or the first year of the program? Regardless, my TY should not have taken anything from my 4 yr HPSP ADSO.

Their math is correct. Bummer but still correct

I still do not understand how they get to cherry-pick which intern year counts and doesn't count, by the wording of their own contract they're obligation neutral. Someone please explain this to me.

Food for thought: when someone does a transitional year there is not a single instance where a 1 year TY-gained-ADSO is greater than any of their HPSP scholarships ADSO, ie it does **** all. This is a roundabout way of saying that TY's are not entitled to the "First year of PGY-1 is obligation neutral" from above, which is a crock of ****.

My board scores were below average, but I'm also trying to match FM in a rural state which I plan on living in, and grew up in. Do I fall into the damnable GMO category?

 

[Chonal Atresia]

I still do not understand how they get to cherry-pick which intern year counts and doesn't count, by the wording of their own contract they're obligation neutral. Someone please explain this to me.

Food for thought: when someone does a transitional year there is not a single instance where a 1 year TY-gained-ADSO is greater than any of their HPSP scholarships ADSO, ie it does **** all. This is a roundabout way of saying that TY's are not entitled to the "First year of PGY-1 is obligation neutral" from above, which is a crock of ****.

My board scores were below average, but I'm also trying to match FM in a rural state which I plan on living in, and grew up in. Do I fall into the damnable GMO category?

Bummer....you could have easily secured 100% loan forgiveness (complete debt repayment with you not owing a dime) if you wanted to work family medicine in a rural region and not had to deal with selling your soul to the devil....I mean military.

Sorry you have to deal with this situation. It is such a terrible, broken system.

 

[steveo1012]

I am matriculating into med school this summer, and I am 42. I'm currently working through HPSP selection for the Navy. My main objective at this point of my life is straight-through training (likely FM, IM, or EM). I have gathered quite a bit of information from here and reddit regarding the various experiences of people, but I am still confused about the likelihood of straight-through training in the Navy. I understand the Army to be the most likely route for this. My cousin just graduated from USUHS (Navy) and will be completing a 6 year surgery residency at Walter Reed. I don't know if USUHS grads are less likely to do GMO tours or if she just lucked out. Is there anything I can do to increase the probability of straight through training, or is this just part of the risk we take when we sign on the dotted line? Thank you for any insight you can provide!

 

[afteranesthesia]

I am matriculating into med school this summer, and I am 42. I'm currently working through HPSP selection for the Navy. My main objective at this point of my life is straight-through training (likely FM, IM, or EM). I have gathered quite a bit of information from here and reddit regarding the various experiences of people, but I am still confused about the likelihood of straight-through training in the Navy. I understand the Army to be the most likely route for this. My cousin just graduated from USUHS (Navy) and will be completing a 6 year surgery residency at Walter Reed. I don't know if USUHS grads are less likely to do GMO tours or if she just lucked out. Is there anything I can do to increase the probability of straight through training, or is this just part of the risk we take when we sign on the dotted line? Thank you for any insight you can provide!

Mother of God...why. Please get loans and do not do HPSP.

 

[steveo1012]

Mother of God...why. Please get loans and do not do HPSP.

If you want to write me a check for $550,000, I'd gladly accept it

 

[Helpful Troll]

I am matriculating into med school this summer, and I am 42. I'm currently working through HPSP selection for the Navy. My main objective at this point of my life is straight-through training (likely FM, IM, or EM). I have gathered quite a bit of information from here and reddit regarding the various experiences of people, but I am still confused about the likelihood of straight-through training in the Navy. I understand the Army to be the most likely route for this. My cousin just graduated from USUHS (Navy) and will be completing a 6 year surgery residency at Walter Reed. I don't know if USUHS grads are less likely to do GMO tours or if she just lucked out. Is there anything I can do to increase the probability of straight through training, or is this just part of the risk we take when we sign on the dotted line? Thank you for any insight you can provide!

Has the AMEDD recruiter started an Age Waiver? Has the recruiter indicated they will pursue a waiver? At best you'll be 46 when starting an active duty residency. Worst case, even if straight through, you're deferred for civilian residency and won't hit active duty until 49.... I'm not sure they'll process the age waiver.

 

[afteranesthesia]

If you want to write me a check for $550,000, I'd gladly accept it

so many other choices. At 42, I expect you to be less naive than a 22 yr old. You should be able to put the work into finding solutions other than this one.

 

[armytrainingsir]

so many other choices. At 42, I expect you to be less naive than a 22 yr old. You should be able to put the work into finding solutions other than this one.

Meh.

On paper, medical school followed by a career in primary care is such a poor financial choice at 43, HPSP probably is the best option apart from being among the idle rich.

CRNA or PA are the only two things I can imagine making any sort of $ sense at 43.

Imagine 6 figure student debt and just being board eligible at 50? In FP? Spend 7 years in school, and take on 300+k of debt,not earn any meaningful income those 7 years, and lose the time value of money by not being able to save for retirement from 43-50? All for a 275k job that hasn’t kept up with inflation the past 20 years and is being taken over by nurses?



IMO, the worst part of HPSP at that age would be spending your last middle age years on AD and no retirement carrot, as there is no remotely certain way to get 20 when starting medical school at 43. Too many stars have to line up for that lottery ticket.

 

[afteranesthesia]

Meh.

On paper, medical school followed by a career in primary care is such a poor financial choice at 43, HPSP probably is the best option apart from being among the idle rich.

CRNA or PA are the only two things I can imagine making any sort of $ sense at 43.

Imagine 6 figure student debt and just being board eligible at 50? In FP? Spend 7 years in school, and take on 300+k of debt,not earn any meaningful income those 7 years, and lose the time value of money by not being able to save for retirement from 43-50? All for a 275k job that hasn’t kept up with inflation the past 20 years and is being taken over by nurses?



IMO, the worst part of HPSP at that age would be spending your last middle age years on AD and no retirement carrot, as there is no remotely certain way to get 20 when starting medical school at 43. Too many stars have to line up for that lottery ticket.

Again, no one is using their brain. Plenty of options. He can do the VA HPSP and never serve on active duty. He could contract with a hospital and in return have his loans paid off - they do this in rural areas. National Health Scholarship program if he wants primary care. Loans plus PSLF. HPSP is the last thing I'd do. I'd probably not go if that was the only option and loans were 500K.

 

[Atlas Shrugged]

I am matriculating into med school this summer, and I am 42. I'm currently working through HPSP selection for the Navy. My main objective at this point of my life is straight-through training (likely FM, IM, or EM). I have gathered quite a bit of information from here and reddit regarding the various experiences of people, but I am still confused about the likelihood of straight-through training in the Navy. I understand the Army to be the most likely route for this. My cousin just graduated from USUHS (Navy) and will be completing a 6 year surgery residency at Walter Reed. I don't know if USUHS grads are less likely to do GMO tours or if she just lucked out. Is there anything I can do to increase the probability of straight through training, or is this just part of the risk we take when we sign on the dotted line? Thank you for any insight you can provide!

Join any branch that is not the navy. I will echo others sentiment that this is a terrible decision.

 

[armytrainingsir]

Again, no one is using their brain. Plenty of options. He can do the VA HPSP and never serve on active duty. He could contract with a hospital and in return have his loans paid off - they do this in rural areas. National Health Scholarship program if he wants primary care. Loans plus PSLF. HPSP is the last thing I'd do. I'd probably not go if that was the only option and loans were 500K.

Ha.

Forgot about the VA HPSP.

If he has kids, post 9/11 GI bill transfer could make mil a better deal. As would VA loan eligibility, veteran status, Tricare savings vs fed insurance, tax free value of bah and bas and any VA disability payment it seems everyone on AD seems to get.

I wonder where the VA sends their HPSP folks? The best available slots or the hardest to fill? Or if the individual has much, if any, say. The VA app process does require you sign a slip saying they can move you anywhere.

It all really depends on VA vs AD pay differential to compare apples to apples on best $ deal.

Best of both worlds would be mil then VA job, buy back time and press on to VA retirement.

 

[DOswag]

Yeah I'd recommend looking into VA HPSP, PSLF, or some other way to pay back those loans. HPSP would be at the bottom of my list of options especially if considering primary care. VA you can make solid money with great benefits.

 

[DrMetal]

Yeah I'd recommend looking into VA HPSP, PSLF, or some other way to pay back those loans. HPSP would be at the bottom of my list of options especially if considering primary care. VA you can make solid money with great benefits.

What does the VA HPSP entail??? Can they stick you at any VA Hospital?! No thank you. I'll take my chances in the Navy.

 

[xffan624]

What does the VA HPSP entail??? Can they stick you at any VA Hospital?! No thank you. I'll take my chances in the Navy.

I think you have some choice in location, but still based on VA needs.

 

[DOswag]

What does the VA HPSP entail??? Can they stick you at any VA Hospital?! No thank you. I'll take my chances in the Navy.

Umm the Navy can send you pretty much anywhere they want as well. I don't know what all it entails I'd have to look that up but even with not knowing right now, gun to my head, and I had to choose (I guess this is to say if I had the knowledge of what being in the military was like lol) I'd pick the VA HPSP 13 times out of 10. I've only really worked with 1 VA so I know I've seen 1 VA, and I was in the Air Force so I really only know the Air Force. But no thank you to the military.

 

[Barrel Proof]

Umm the Navy can send you pretty much anywhere they want as well. I don't know what all it entails I'd have to look that up but even with not knowing right now, gun to my head, and I had to choose (I guess this is to say if I had the knowledge of what being in the military was like lol) I'd pick the VA HPSP 13 times out of 10. I've only really worked with 1 VA so I know I've seen 1 VA, and I was in the Air Force so I really only know the Air Force. But no thank you to the military.

That’s a blanket statement that while technically true, is very speciality dependent.

Where the Navy stations physicians is based on what clinical environments we staff with their speciality. Within that, location opportunities are impacted by the greater needs/movements of their speciality as a whole within the Navy. Forward deployed/operational activities are also largely speciality driven. So while you’re right, the Navy can technically send you anywhere, it’s an odds game that is very speciality dependent. We have specialities that have physicians all over the world with significant deployment opportunities or risk (depending on how you look at it). We also have specialities that only base out of our big 3 (San Diego, Bethesda, Portsmouth) with much less of a deployment risk.

 

[DOswag]

That’s a blanket statement that while technically true, is very speciality dependent.

Where the Navy stations physicians is based on what clinical environments we staff with their speciality. Within that, location opportunities are impacted by the greater needs/movements of their speciality as a whole within the Navy. Forward deployed/operational activities are also largely speciality driven. So while you’re right, the Navy can technically send you anywhere, it’s an odds game that is very speciality dependent. We have specialities that have physicians all over the world with significant deployment opportunities or risk (depending on how you look at it). We also have specialities that only base out of our big 3 (San Diego, Bethesda, Portsmouth) with much less of a deployment risk.

Yes you are correct. I guess I was just saying that in my opinion, it's somewhat of a wash that the VA can send you to any VA as the Navy can send you wherever as well. Ultimately (I would assume as I haven't researched the VA HPSP in detail) it's up to the needs of the VA just as it is up to the needs of the Navy but yes specialty dependent also. My view of milmed vs VA med though is overall I feel milmed is slightly worse, but I acknowledge that it is dependent on the individual VA as well just as your leadership wherever you are in the Navy can have a big impact on your experience in the military. Also DHA taking over milmed seems to be trending it down even further.

 

[narcusprince]

Umm the Navy can send you pretty much anywhere they want as well. I don't know what all it entails I'd have to look that up but even with not knowing right now, gun to my head, and I had to choose (I guess this is to say if I had the knowledge of what being in the military was like lol) I'd pick the VA HPSP 13 times out of 10. I've only really worked with 1 VA so I know I've seen 1 VA, and I was in the Air Force so I really only know the Air Force. But no thank you to the military.

The real question between the Navy and the VA is which is paying more money as an attending. My guess the VA pays more than the military.

 

[DOswag]

The real question between the Navy and the VA is which is paying more money as an attending. My guess the VA pays more than the military.

I know for a fact the VA where I live pays quite a bit more than I made in the Air Force as a psychiatrist and I think the pay is pretty standard across all the branches from speaking to Navy psychiatry colleagues.

 

[steveo1012]

Join any branch that is not the navy. I will echo others sentiment that this is a terrible decision.

Just to be clear, you are specifically referring to Navy and not HPSP in general? I do have an opportunity with the Army as well that I am exploring because straight through training is more likely in the Army

 

[Atlas Shrugged]

Just to be clear, you are specifically referring to Navy and not HPSP in general? I do have an opportunity with the Army as well that I am exploring because straight through training is more likely in the Army

For your situation HPSP is terrible. Navy is the worst option as it is the most likely to have a GMO. Read: assume you will do a GMO.

You really should not join the military. You should only join if you have multiple dependents that rely on you financially and you do not care if they see you as their family member.

 

[militaryPHYS]

For your situation HPSP is terrible. Navy is the worst option as it is the most likely to have a GMO. Read: assume you will do a GMO.

You really should not join the military. You should only join if you have multiple dependents that rely on you financially and you do not care if they see you as their family member.

There are many reasons NOT to join. There are a few reasons to join and the one listed here is not one of them.

Wanting to serve regardless of your job is the first one. Operational opportunities for your future medical career being the second. Financial stability during medical school / residency is a 3rd and should never be ranked 1st or 2nd.

Navy switched to a straight through training model. What this means is that you are now more likely to go straight through like Army/AF, but more likely to be "pushed/forced" in to an operational billet after you become board certified like the Army/AF. General Medical Officer (GMO) is replaced by Operational Medical Officer (OMO, i.e. board certified). This makes skill atrophy post-residency/fellowship more likely but can be mitigated.

The nuances of service are now really based on op tempo for deployments and duty station location.

 

[Res Rehab]

Made a video about it. Want to hear it? Here it goes

 

[narcusprince]

Made a video about it. Want to hear it? Here it goes

Hey man I would love to connect you with someone who has his own podcast another ex military doc.

 

[j4pac]

Docs aren’t on street corners begging for change. Regardless of the route you take you’ll be fine. Only go military if you truly want to serve and would do it without consideration of perks.