parisyedda

2+ Year Member
Jun 29, 2016
8
0
Status
Pre-Medical
4th year med student, looking for advice on pursuing military medicine. I am going into Internal medicine with the ultimate aim of a pulm/crit care fellowship. I choose the guard/reserve route after considering HPSP, and ultimately rejecting it, prior to M1. For most of medical school, I had assumed I would finish pgy1, and then join the local army national guard, as all of the service websites say they take MDs with 1 year of GME training. My understanding of this role is as an outpatient-style clinician who doesn’t get hospitalist-style work at home and possibly not on deployment. I tried to find information on what military medicine looks like deployed, but struggled to find clarity. It is my understanding that I would serve in a CSH as a possible internist/intensivist, or in a battalion aid station (not sure what they do), or hang out on “base” (not sure about any of this terminology) and do primary care.

I then stumbled upon the CCATT and TCETT roles in the Air Force and they really caught my eye, as it seems like they are definitely practicing ICU medicine. The concept of learning to apply my trade in a non-traditional setting with unique challenges is particularly attractive.

All of that being said, I have many questions and I would appreciate any amount of clarification.

  • The internet says there are slots in the air guard/air force reserve for CCATT/TCETT physicians, but nothing about the chances of getting selected. Is it likely that if I make this my goal, I can work towards this and eventually end up in that capacity, or is it highly probable that I end up atrophying my critical care skills in clinic (as the general negative-military SDN paradigm usually suggests)
  • Can anyone speak to CCATT/TCETT as a job? ive never met anybody even peripherally associated with it, although ive read basically everything I can find on the internet.
  • Was my initial interpretation of medical service in the army national guard correct? After research, it seemed unlikely that I would get a lot of ICU time.
  • Any clarification of the guard vs reserve role for a physician? I understand the dual mission of the guard, but I mean more practical stuff. Likelihood of going overseas, icu vs clinic, proximity to combat etc.
  • How do people that go into the guard/reserve time their commissions? The residency training pipeline seems unlikely to facilitate a month or more to go to COT/BOLC, even if you don’t have to worry about deploying.
  • If you join any part of the service as a resident, what is the chance it prevents you from getting accepted/finishing a fellowship? I don’t want to tank my lifelong goal of being a critical care doc. if this risk is too real to join in residency, would you suggest joining as a fellow or just waiting until im a board-certified intensivist?
  • Any obvious misconceptions y’all see from my hideously naïve point of view? advice on whether or not to take STRAP, experience with the lifestyle, pros/cons etc.
thanks for the time
 

DMBandFan86

7+ Year Member
Aug 5, 2011
209
60
Status
Attending Physician
The reserve route you are in charge of your own career. You may get deployed some times and do missions that don’t exactly fit your interests. But when you go home it’s back to mostly civilian life. So I wouldn’t really put too much focus on skills atrophy.

there are missions you can volunteer for that some may be more ICU based. Some people like the reserves because it gets them out of their standard environment a bit.

if you go federal in the reserves you will be in the APMC and they have a fellowship application that you have to fill out to stay protected during fellowship. I encourage you to ask your recruiter to look into which fellowships are accepted before you join. The NG is a different beast and more unit dependent. I don’t know anything about the Air Force or air guard.
 
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armytrainingsir

2+ Year Member
Jun 15, 2017
203
139
Status
Attending Physician
A review of Army offerings here


Guard docs, regardless of specialty, fulfill primary care and admin medicine (battalion surgeon) roles from what I have seen.
Reserve docs run the gamut of specialties and have a much greater chance of deploying in their specialty (within reason).
Reserve is the only way to go these days IMO
The later you commit, the more control you have, but likely a lessor financial 'benefit'.
 
Jul 11, 2019
47
11
Status
Attending Physician
I am air National guard and heading to CCATT initial training in September. I am currently a hospitalist but am applying for critical care fellowship this year (fingers crossed). I started the process to join the guard during the last year of my residency and finally commissioned a few months after graduation. When I met with my commander before deciding to join he talked to me about the CCATT mission and I was hooked right away, as I love critical care. As a member of the guard I was also Able to serve on title 10 orders for two months to help with COVID response, which was a nice change from my day job as a hospitalist. Overall been a good experience so far.
 
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parisyedda

2+ Year Member
Jun 29, 2016
8
0
Status
Pre-Medical
I am air National guard and heading to CCATT initial training in September. I am currently a hospitalist but am applying for critical care fellowship this year (fingers crossed). I started the process to join the guard during the last year of my residency and finally commissioned a few months after graduation. When I met with my commander before deciding to join he talked to me about the CCATT mission and I was hooked right away, as I love critical care. As a member of the guard I was also Able to serve on title 10 orders for two months to help with COVID response, which was a nice change from my day job as a hospitalist. Overall been a good experience so far.
Wow, how incredibly fortunate to find the perfect n of 1 study. If you do start that critical care fellowship, are you allowed some deployment protection in order to complete it? And, is the path you took the path you would recommend -- just focus on residency for the first couple years before joining?

Thanks, and best of luck in your endeavors in both medicine and the military!
 
Jul 11, 2019
47
11
Status
Attending Physician
Wow, how incredibly fortunate to find the perfect n of 1 study. If you do start that critical care fellowship, are you allowed some deployment protection in order to complete it? And, is the path you took the path you would recommend -- just focus on residency for the first couple years before joining?

Thanks, and best of luck in your endeavors in both medicine and the military!
I think it will probably be program and commander specific. I don’t know if I will have to deploy if I start fellowship next year. Hopefully if I am asked to, my PD will be okay with it. Before I commissioned I asked my commander about that kind of a situation and he said they would work with me if fellowship was not okay with it. It’s probably very situational though depending on your program and what unit you join.

I would say if you are able to get some aspect of your loans paid for go for it, whatever that means. I plan on being a member of the guard for at least my initial 6 year contract and can see myself staying on for the long run. Unfortunately I am an IMG so I wasn’t eligible for a lot of the programs offered.

also... find a unit where you feel like you fit in. I love my unit. I love my CCATT team.
 
Jul 11, 2019
47
11
Status
Attending Physician
Wow, how incredibly fortunate to find the perfect n of 1 study. If you do start that critical care fellowship, are you allowed some deployment protection in order to complete it? And, is the path you took the path you would recommend -- just focus on residency for the first couple years before joining?

Thanks, and best of luck in your endeavors in both medicine and the military!
also I can’t really speak to the active duty side of things as I am air guard. From my understanding active duty they have a large say in where and what you train in. So I think maybe the guard offers you more freedom in that regard?
 

nvdoc

10+ Year Member
Mar 25, 2010
12
0
Status
Attending Physician
I'm an Army Guard FS, Pulm Crit Attending on the civilian side. Am thinking of either getting out completely or joining AF Reserve for CCATT. I know deployment length varies, but the Army for the most part tries to adhere to 90 days BOG .

Have you heard from docs in your unit what the tempo/ length has been on average? And as for fellowship (in the Army at least) fellows were protected from deployment unless wartime and then it was a case by case basis.
 
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