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dimatteo.md

Medicine is a lifestyle
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I'm a HPSP applicant (waiting to hear back from boards whether I will be offered an acceptance). I have already been accepted to several private medical schools so saving money in addition to serving my country is rather appealing. Hesitant about HPSP only because of potential skill atrophy (seems to be significant for surgeons) and the potential for being stuck in something non-surgery related.

I've read posts from the past but am curious if things/policies have changed.

I have a list of questions to those who are in/have done HPSP with the Army:
  1. Were you able to do rotations during your med school clinical years in military surgery/orthopedics? Did it help you get set for residency?
  2. Were you able to get your top choices for military residencies? Do MEDCEN residencies make the most sense (to prevent atrophy)?
  3. Did/are you experiencing skill atrophy at your residency/station currently? When you discharge and move into civilian life do you think you'd be at a significant disadvantage skillwise?
  4. Is it true that ortho and other surgery specialties are a 5 yr program therefore requiring 5 years of active duty service?
  5. Were you forced to be in a residency or specialty that you did not want to be in?
  6. Are you able to moonlight at civilian posts in order to get more skill/practice more medicine?
  7. Is deferment of military residency (in order to get a civilian residency) worth it?

If you could reply to the post or email me (inbox for email) that would be greatly appreciated.

I've looked at more posts than I can count but still would like to get a more perspective.
 
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5. They cannot force you to accept a residency that you don’t want. If you apply for ortho and don’t match, that’s fine. You can do internship and be a GMO and apply again, or GMO until your commitment is complete and apply in the civilian world. They can offer you a spot in gen surg, etc. but you don’t have to take it. Of course that means that you’re delaying your training, but that’s one of the risks you take. Sometimes it’s easier to match into specialties in the .mil and sometimes it’s harder than the civilian programs.
6. You can moonlight during active duty, but it has to be approved by your commanding officer and is subject to rules that they establish. (Must be off for at least 8 hours before the start of your military shift, etc.). When I was in the CO said no moonlighting in your 1st year. That was that. There was also some scandal about people not following the rules, trying to tie it to some errors, and a threat to cancel all moonlighting, but it didn’t happen. I imagine you could still take vacation and do a week or two of locums or local moonlighting work and try to skirt the regulations, but your leave is always subject to cancellation.
7. Most .mil residencies seem very average. If you’re a superstar and can get rockstar training somewhere the .mil probably isn’t your best training program. Of course that depends on your long term goals, your rockstar status, your ability to network on your own, etc. Not everyone is destined to be Chair of xxxxx at MGH, or even an MGH faculty, so that may or may not affect you very much.


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Il Destriero
 
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HighPriest

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Check the thread a bit. There are a lot of posts that answer these questions already.

I'm not Ortho, but I was a surgeon in the Army.

1 - You can do rotations in your chosen field, generally. This is usually more up to your school than it is the military. Military is happy to have you, as long as there's room for you. Sometimes it's hard to coordinate that with the school, but theoretically that is the way it is supposed to work. i think it definitely helps get an Army residency. If they don't know you, you're usually shuffled to the bottom of the pile. This is Ortho. It's competitive. Everyone looks good on paper (at least, all the realistic candidates). So knowing that you're a guy they might want to be around at work or outside of work is huge. That being said, if you're a DB, then you can sink yourself. A big key is the timing of your rotation. You gotta get in there before SEPT-OCT of the year you're going to potentially match, because any later than that and they'll have already made choices. But if you go during your first rotation of your third year of med school, they don't remember who you are....unless you're really terrible....

2 - There aren't THAT many training programs in the Army for subspecialty surgery. So if you're competitive, and you match into Ortho, you'll get one of your choices by default, as it's a short list. Whether you end up in your first choice or your fifth choice depends upon how competitive you are and how competitive things were that year. In ENT, at least, if you didn't rotate at a particular program then your chances of matching there were much more slim.

3 - Definite skill atrophy for ENT. Maybe less for Ortho due to the nature of the patient pop? I dunno. I did a ton of bread-and-butter, but very little meat (complex cases) at my first duty station. It was much better at my second, but I had to fight like hell to get there. Even then, it was much less than a civilian practice. The skill atrophy is definitely something I've had to train myself out of, to an extent, now that I'm out. But it didn't really cause any trouble getting a job, because we still have the civilian community fooled into thinking that milmed trains great docs and keeps them trained. (They do the former, they're not great at the latter). I did NOT feel like I was at a SIGNIFICANT disadvantage skill-wise, but I was only in the military 4 years. If I had been in 10 or 20?.....maybe a different story.

4 - Not entirely sure about Ortho. ENT was 5 (1 internship and 4 residency). Gen Surg was definitely 6 for residency. But a 5 year residency doesn't accrue 5 years of payback. There are a lot of threads about this. I encourage you to check them out. But in a nutshell, think of it like this for residency: your internship doesn't count. Fellowship is a whole other thing.

5 - Answered above.
6 - answered above
7 - Deferment would be GREAT. IF you can get it. That is entirely NOT up to you. It depends upon the demands the Army has of your chosen specialty, and the competitiveness of that specialty in the year that you apply. They may defer a bunch, they may defer no one. VERY difficult to predict, unless the specific specialty has a history of deferment, but even then not guaranteed. And the problem with being REALLY good is that the military residency is probably going to try to keep you. YOu need to be in that fine line between not being one of the top 15-20 or so candidates, because they'll all get military spots, but you also want to be competitive enough that they still think you should do Ortho and that you should get a civilian deferment IF they offer one that year. Don't count on deferments. Personally, I thought my military residency was very good with regards to surgical training. I felt more capable as a resident than the civilian ENT residents I often worked with. Research? We sucked at research. They'd swim circles around us in that lane. But in the OR I really felt like we were better. I also felt like we were clinically much better. Primarily because they spent so much more time doing research. BUT school name does mean something when and if you choose to do a fellowship. If you do a fellowship in the military, you actually become very competitive because you're free labor. But if you're out, I think that having graduated from an ivy league school probably looks better than having graduated from Tripler. Maybe I'm wrong there.
 
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