Army National Guard and Surgery Residency

[DeadCactus]

I'm looking at joining the National Guard out of a mix of personal desire and financial incentives. One of my major concerns is that I may have a year or two of commitment left by the time I make it to residency. I'm only an MS1, but Ortho and GS are two fields that I'm interested in exploring and possibly entering. Would having an outside commitment such as being in the Guard be looked upon negatively by surgical residencies? I can see them weary of having to deal with weekend drill requirements and possible deployments (however infrequent or unlikely the two would be).

I'ld appreciate any input. Thank you.

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[JackADeli]

...National Guard... One of my major concerns is that I may have a year or two of commitment left by the time I make it to residency. I'm only an MS1, but Ortho and GS are two fields that I'm interested in exploring and possibly entering. Would having an outside commitment such as being in the Guard be looked upon negatively by surgical residencies? I can see them weary of having to deal with weekend drill requirements and possible deployments...

I suspect folks with first hand information can reply and/or correct my understanding if I'm wrong. I knew a GSurgery resident with army commitment...

1. She had no weekend drill. rather, filled out some form, it was signed by program director, submitted monthly. Got paycheck as if actually did weekend "drill", and got "points".
2. Some residencies are quite leary about military commitments for fear you will be taken out of residency for GMO. This can in itself be a headache as it leaves an empty categorical.... But, they are then obligated to accept you back whenever your tour completes, meaning they need to bump someone else out.... Now, the army apparently has some statement against this sort of thing (i.e. residents exempt from deployment). I don't know if this scenario has actually played out in recent years. However, numerous residencies remember the days of "GMO". They also have numerous military attendings that have been deployed in recent years, heightenening their concerns and perceptions.
3. Some programs will label you "military" (personality/etc...) if you are commissioned... even if you have not served a day in your life and just have a future obligation...
4. Army medical corp obligation during med-school I think would require application to army residencies first...
5. I think you will have some commitment.... I was told there is some sort of minimal 8 year commitment to start.

How does all this play out? I don't know. You may have to do military residency over standard/public residencies. Beyond that, the truth is that if you are a solid applicant, from a solid school, competitive to apply to ortho/GSurge, you will likely have little problem in the match based on a future military obligation. But, it will be looked at, you will be asked. If the "letter"/"general order" from army surgeon general exempting residents from deployment exists, you should have a copy and provide it to interviewer if asked.... You should ask recruiter about the drill obligations and/or "letter" of exemption. Also, not sure of differences in NG vs army reserve. Again, you should really speak with military medical recruiter and get papers and actual information.... This would impact your ability to communicate with interviewers.

JAD

 

[Pilot Doc]

Well, the thing to understand is that the perfect surgical resident is he who eats, sleeps, lives and breathes surgery with no thought for anything else in life.

As a practical matter, these residents only come along occasionally, so programs know they must settle for imperfect residents. But the farther you are from perfect, the less desirable you are.

Put yourself in a program director's perspective - all else being equal, would you want a resident who has significant other obligations that can interfere with his work schedule and are protected by federal law?

Will it keep you from being a surgeon - probably not, but go into it with your eyes open - it's not going to make your life easier.

The military forum will be a better place to figure out exactly what your drill obligations are likely to be.

 

[maxheadroom]

My information was gathered by observing, so take it with a grain of salt . . .

One of the other surgical programs at my residency had a couple of guys who joined the Guard during residency. They had to do something like a weekend of drill per month. Mostly it consisted of them doing H&Ps of guys at other Guard units. I know it was a pain in the ass for both them and their co-residents at times because of scheduling.

HPSP residents are an entirely different animal. I can't speak to that, but I've been told by the guys who were in the Guard that it's a pretty different animal. As was mentioned, there is the risk of being assigned a GMO tour. There is also the risk that your chosen specialty is not available in the military and that you won't be allowed to go outside of the military match.

 

[Dimoak]

The Military Medicine forum here on SDN has a fairly lengthy thread on the Army National Guard and medicine. You may want to check it out as it may help answer your questions.

http://forums.studentdoctor.net/showthread.php?t=550134

 

[DeadCactus]

I've done a ton of reading on the Military Medicine board. I just wanted to make a post here to see what surgery specific information I could get and to get some insight into the views and concerns of people outside the military. Thanks for the input everyone.

 

[deleted89854]

Everyone I know who took military assistance for med school (Army and Navy) had to apply to military residencies unless you are able to get an exemption (which is difficult). There are fewer spots for the more competitive specialties, and if you do not match you may be put on a GMO tour for a few years. Anyone who has gone through the process feel free to correct me . . .

 

[JackADeli]

...and if you do not match you may be put on a GMO tour for a few years...

Is that true about "GMO"? I heard from some army commitment residents that the army (at least) had phased out GMO and there was apparently some standing order to completely eliminate it as the concept was hurting their recruitment efforts as well as messing up their residencies..... i.e. GMO for 2-3 years, achieve awards, rank, special schools and thus out rank new "categorical" resident and so push out PGY1/2 into GMO and you as major enter.....

JAD

 

[deleted89854]

All of my info on this is second-hand, but if you are applying for a specialty like ortho and are unable to match or achieve an exemption allowing you to participate in the regular match AND are unwilling to apply to another specialty like family medicine then you get put on GMO tour. Their ranking of applicants is a points system based on board scores, grades, letters, etc. However, a GMO tour also counts toward that total, so they are given an advantage in the process. I'm not sure if the tour counts towards time served or not. However, this was around three years ago so they may have changed it.

 

[Pilot Doc]

Disclaimer: no military experience at all

You guys need to read the OP's post more carefully. he is talking about joining the NATIONAL GUARD not the ACTIVE DUTY military. The NG has no hospitals, no residencies, no GMO tours, etc. It's the weekend warrior thing - one weekend a month, two weeks a year. The only way he would get pulled out of residency is if he/his unit were activated. The military board can give more details, but my impression is that residents in civilian residencies don't get deployed.

 

[JackADeli]

...The NG has no hospitals, no residencies, no GMO tours, etc. It's the weekend warrior thing - one weekend a month, two weeks a year. The only way he would get pulled out of residency is if he/his unit were activated. The military board can give more details, but my impression is that residents in civilian residencies don't get deployed.

again, i defer to folks with military knowledge....but the medical/physician officers actually fall under different category including NG. If i'm not mistaken, physician in NG will often get taken over by "army" reserve medical command. I also think, benefits as md in NG are less then army reserve.... in any event, the confusion by us non-militaries makes it quite obvious should discuss with medical recruiter to get actual facts... then report back to us and relieve us of our ignorance.

JAD

 

[DeadCactus]

Well the GMO thing everyone is reffering to is an issue related to the active duty military programs. They give you money for school and you owe them active duty time after you graduate, which includes applying to the military match. If you fail to match to your satisfaction in the military, you can try for a defferal to attend a civilian residency or you do an intern year and a tour as a GMO. You then either try again to match or just complete your obligation as a GMO.

The specific National Guard program I am looking at involves a 6 year obligation to the Guard beginning when I enter the program (so half-way through MS1). Protection from federal deployment while a medical student or intern. Unlikely to be deployed as a resident, though I believe the formal protection is not as extensive as the protection as an MS1 and intern. Once deployable, deployments are limited to 90 days on the ground every 2 years (though this is current policy, not a contractual obligation and subject to change). Drill for physicians and medical students is once every three months.

So the question is:

a) would surgery residency programs have a problem with an applicant who has a remaining obligation of one weekend every three months and a very unlikely possibility of being deployed and

b) is it likely that the programs would even look at the specifics of the military obligation (if they care at all) or just see it as a lot of residency unfriendly obligations and be inclined to pass

I can see potential concenrs of a program director, but the risks are relatively small with this specific program. Not ideal, but enough to cause me problems?

 

[Pilot Doc]

a) probably yes
b) probably no

The thing you have to keep in mind is that programs are not interested in being fair to candidates, they are interested in minimizing risk to themselves. So if you have a 3% chance of making things difficult, that is a negative. No way around it. There's no risk/benefit calculus to them - it's all risk.

Is it a major issue - I don't think so. If I were a PD, this would push you lower on my rank list but not eliminate you from consideration.

 

[dpmd]

The specific National Guard program I am looking at involves a 6 year obligation to the Guard beginning when I enter the program (so half-way through MS1).

One comment and one question.

I was an army reservist at the time I applied for residency (joined in undergrad, ended up deployed my third year of med school for 14 months, then returned with just a few months to get letters and an application for residency going-not fun). There is a spot on ERAS where you have to tell the programs, and I was asked about it at every interview. My situation was a little different since my obligation was going to be done before my residency would have begun. When I informed them of that they seemed to like that better. Ended up not matching, but I was applying to ortho with a step 1 that hurt me more than anything else.

What program are you looking at? The only medical programs I know of want a year for every year or a year for every six months they give you money. They typically don't count the time you are still in training (med school and residency) to your payback.

 

[JackADeli]

...The specific National Guard program I am looking at involves a 6 year obligation to the Guard beginning when I enter the program (so half-way through MS1)...

So, I ask out of ignorance and being told by other folks in the military...

1. I would check and be quite specific on the claimed time of obligation. ALL the folks I know in the military report a minimu 8yr first time enlist/commission obligation. The "active" (i.e. active reserve/part time drilling or active duty/fulltime) obligation maybe less then 8 yrs. But, I have been told you would be on "innactive reserve" obligation until the 8yrs is concluded. In decades before, folks were not called up from innactive reserve. However in recent yrs folks have been called out of innactive reserve (IRR I believe is what they call it). The vast majority of IRR call ups have been from the medical fields....
2. You will need to declare your military obligation
3. ALL I have spoken to have said the payback does NOT begin until you are qualified to practice... and thus perform the job you are paying back....

JAD

 

[DeadCactus]

Thank you everyone for all the input.

My main concern is that right now I have a strong-interest in going into surgery and there are several specific residencies that really appeal to me due to specific programs related to research they host. Unfortunately, these residencies are at some of the top institutions. Is it possible that everything else about my application could be fantastic and I would be denied from this sort of program based only the military obligation?

If I e-mailed the directors of some of these programs with this question, is it likely they would a) take it seriously from an MS1 and b) give an honest answer?

The program I am looking at is the ArNG ASR program. The basic outline is at the bottom of this post. Essentially you join the guard for 6 years as an officer, you are protected by contract from deployment as as a student and intern, and for the first three years you get full-time pay and benefits to act as a student recruiter. Being a student recruiter basically entails taking care of school and reffering any medical personell interested in the guard to your commanding officer.

I did mispeak and it is the standard 8-year MSO with 6 years being active drill and 2-years being IRR. For this particular program, because it is set up as recieving a special duty and extra pay vs recieving a scholarship or bonus, payback begins when you enter the program.

I don't know about healthcare personell in general, but I have not found anything to suggest physicians (let alone residents) are frequently (if at all) being called up from IRR. The closest I've found is a reserve physician who was going to be stop-lossed, but the military then changing it's mind and letting him go. I can see with the current physician shortage and two wars being waged why it seems physicians would be at risk for being called up, but I think the military realizes that keeping a physician on for two extra years is not worth scaring a dozen other physicians from joining. If you have evidence to the contrary, however, I would definately appreciate seeing it.

When you swear in and everything for the ASR, you:
a) accept a commission in the NG, incurring a 6 year drilling obligation and 8 year total MSO
b) enter into the ASR program
c) contractual protection from deployment as a medical student and intern

The ASR program:
a) Gives you active duty (ADSW) status as a student recruiter for up to three years
b) Stipulates that if the program is cancelled, you are released from the rest of your obligation

Then current NG/AMEDD policy (which can be changed, theoretically):
a) Allows for flex-training (one weekend every three months)
b) Provides protection from deployment as a resident
c) Stipulates a 120 days (90 days "boots-on-ground") every 2 year limit on deployments

 

[JackADeli]

...The program I am looking at is the ArNG ASR program. ...Essentially you join the guard for 6 years as an officer, you are protected by contract from deployment as as a student and intern, and for the first three years you get full-time pay and benefits to act as a student recruiter...

...it is the standard 8-year MSO with 6 years being active drill and 2-years being IRR. For this particular program ...payback begins when you enter the program.

...I have not found anything to suggest physicians ...are frequently (if at all) being called up from IRR...

So, based on what you have stated and what my GI friends have and continue to tell me, I think you need a little more research....

1. Does it make any logical sense to you that the ARNG/Army Reserves will pay you to attend school and bump into a couple of med students and send them to a trained recruiter and count that time that they are paying you (for basically nothing) as payback? You are essentially not able to be a real "soldier" during 4+ yrs of your six year active contract and that time of uselessness counts as payback.... Maybe true, and maybe why military budgets are so whacked.
2. You should look into the Reservist & IRR activation of recent years. Yes, the medical folks have been heavily activated (not med-students or residents). This again raises the question of number 1. If you are not activated and/or are protected from activation during medical school (pretty sure this is the case) and protected from activation during residency (I have been told this is the case), where is the benefit in the state or federal government paying you while you are supposedly paying back your obligation? It surely is not in your being a "recruiter" for the recruiters. It surely is not for the occasional drills in which I'm guessing you mostly get together on a weekend and pitch a tent...
3. If the incredulous interpetation as outlined in 1 & 2, and you then hurt yourself pitching a tent, you are now on VA benefits as a disabled Vet?

Not being military, it is my understanding that reserves are meant to maintain a cadre of deployable assets (it is kind of like a retainer fee). Your description suggests you are never really a deployable asset but are paid and then when you are finally deployable you are out of the military.... Again, you have outlined a pretty win/win lucrative scenario. I think there is a pragraph you are missing somewhere. It may be in fine print somewhere.

JAD

 

[DeadCactus]

I have no idea on the answer for 3.

For 1 and 2, I can only speculate. The number of slots for the program are limited (200/yr for 3 years with this being the last year), so it is a relatively controlled financial risk and because it is pay and not tuition, probably a much lesser expense than HSPS.

It still raises the question of "why?" I can think of a few benefits to the Guard which they may have decided warrants the program in a time when the need for medical personell seems to outweigh financial constraints.

1) They have 600 extremely happy medical professionals to try and turn the opinion of military medical programs around and possibly even recruit a few. Word of mouth and general distrust of the military is killing recruitment from what I can tell.

2) Free money is addictive. The program gives you good money for three years and then cuts you off to regular guard drilling pay (even less, because most will only be drilling 1/3 of the months). I wouldn't be surprised if a substantial number of participants end up taking other incentives and increasing their obligation out of being accustomed the the extra income and having a good experience in the guard so far.

3) As with all military commitments, once you sign on the line you're in the system. They are essentailly buying 600 physicians who they can go to after recruiting fails but before a civilian draft occurs.

My overall take on the situation is that the participants get decent money to provide marginal recruiting benefits and help with physicals or whatever during drilling weekends. Our largest risk is doing a single deployment before ending out obligation though if things go to hell, we're infront of the civilians in terms of getting called up.

The NGs get the marginal benefits and the decent chance that obligations will be extended with the worst case being they pay out and don;t get a single deployment, but have a list of names to go to before having to resort to something like a draft.

 

[dpmd]

Yes, if you injure yourself pitching a tent during a drill weekend (which is considered active duty), and your injury results in a certain level of disability, and you go through the paperwork needed to file a claim you will be assigned a certain percentage level which would entitle you to payment (anywhere from $123 bucks a month for a 10% disability, up to $2673 for a childless, unmarried soldier).

I imagine you would be expected to take time off for basic training, as well as training for the job they want you to do. After that I wonder how much the would be expecting from you during school, especially during third/fourth year. What if they need you to give a presentation right before some exam.

I don't know. It just sounds a little too good to be true. Bottom line, read your contract. Any promises made which you don't see in writing mean absolutely nothing.

As an aside. Only enlisted folks have a designated length of commitment. Commissioned officers belong to the service forever, unless you formally resign your commission (and your resignation is accepted. When I was deployed, I worked with a doctor who had been retired for a long time until they decided they needed someone with his training. Since he was drawing retirement pay he hadn't resigned his commission (or they would quit paying him).

Not trying to talk anybody out of anything, it just pays to know what you are getting in to before doing it.

 

[Surgeon4]

Hi DeadCactus: I'm a new M1 in a similar position with the same questions you had 3.5yrs ago - interested in GS or ortho and the ARNG. I wondered if you joined the ARNG, and what your experience has been like. And now you're approaching residency....any new thoughts or advice you could give a newbee?

much appreciated!

 

[DeadCactus]

Hi DeadCactus: I'm a new M1 in a similar position with the same questions you had 3.5yrs ago - interested in GS or ortho and the ARNG. I wondered if you joined the ARNG, and what your experience has been like. And now you're approaching residency....any new thoughts or advice you could give a newbee?

much appreciated!

Yes, I ended up joining. The ASR program I joined under doesn't exist anymore, so you'll have to do your own cost-benefit analysis in deciding to join under one of the current programs. Some of the pros and cons are discussed at length in the military medicine forum. Just make sure you understand your obligations and the 95% confidence interval of what your commitment will entail.

In specific regards to residency, I decided that I think most PDs would overlook the military obligation as long as I emphasize that deployment is all but impossible and that I'll make the weekend drilling obligations my own problem and not dump it on the program or my fellow residents. For the few that will hold it against me, I probably wouldn't want to match there anyway and they'd be countered by the few that would look positively on military service.

I still have a year to go before I'm interviewing and matching, so I guess I'll see if my viewpoint was naive. In the end, numbers and letters pose a larger danger to matching or not matching than a military obligation...

The last thing I'll add is that the residency concern is really a rather small concern in the big picture. I think it's much more important to be cognizant of the implication a reserve obligation have on your career after residency. Small groups and solo practices are a non-option. You'll need to be willing to work for larger practices that are willing and able to absorb the impact of you deploying for 120 days or worse. If you know a solo practice is your goal, getting tied up in an 8 year post-residency obligation would be a poor choice.

 

[rollinstone23]

Yes, I ended up joining. The ASR program I joined under doesn't exist anymore, so you'll have to do your own cost-benefit analysis in deciding to join under one of the current programs. Some of the pros and cons are discussed at length in the military medicine forum. Just make sure you understand your obligations and the 95% confidence interval of what your commitment will entail.

In specific regards to residency, I decided that I think most PDs would overlook the military obligation as long as I emphasize that deployment is all but impossible and that I'll make the weekend drilling obligations my own problem and not dump it on the program or my fellow residents. For the few that will hold it against me, I probably wouldn't want to match there anyway and they'd be countered by the few that would look positively on military service.

I still have a year to go before I'm interviewing and matching, so I guess I'll see if my viewpoint was naive. In the end, numbers and letters pose a larger danger to matching or not matching than a military obligation...

The last thing I'll add is that the residency concern is really a rather small concern in the big picture. I think it's much more important to be cognizant of the implication a reserve obligation have on your career after residency. Small groups and solo practices are a non-option. You'll need to be willing to work for larger practices that are willing and able to absorb the impact of you deploying for 120 days or worse. If you know a solo practice is your goal, getting tied up in an 8 year post-residency obligation would be a poor choice.

@DeadCactus , I'm currently deciding on whether or not to join the ARNG as a medical student. I will be an MS1 in august. I'm not positive what specialty I would like to enter, but I am interested in surgery and other competitive specialties. I'm worried that having 2 years of drilling obligation left during residency will make me a less desirable candidate to top tier programs, much like other posters on this thread. I was just wondering, what was your match experience like being in the ARNG? Did you have any trouble with PDs and matching into a top program of your choice? I am itching to serve but don't want to limit my opportunities down the road. Thank you!
t

 

[DeadCactus]

@DeadCactus , I'm currently deciding on whether or not to join the ARNG as a medical student. I will be an MS1 in august. I'm not positive what specialty I would like to enter, but I am interested in surgery and other competitive specialties. I'm worried that having 2 years of drilling obligation left during residency will make me a less desirable candidate to top tier programs, much like other posters on this thread. I was just wondering, what was your match experience like being in the ARNG? Did you have any trouble with PDs and matching into a top program of your choice? I am itching to serve but don't want to limit my opportunities down the road. Thank you!
t

Overall I had no issues with it on the interview trail and would say it was positively perceived at a number of interviews. I did not end up going into any form of surgery however so the experience there may be different. Ultimately, you make drill and AT by using your days off and vacation time and I think most programs are content with that. I think carefully considering if the money is worth the extra hassle and obligation of a second commitment during residency is far more of an issue. Most units are understanding and will work with you but it is a whole lot of extra schedule conciderations, e-mails, and work-days which take away from extremely precious time off. I'm overall very happy with my decision and experience but it's difficult to extrapolate my experience with ASR in a non-surgical residency to today's MDSSP and a surgical residency. If you're not prior service or dead-set on a full 20 years in the military, I would be cautious.

 

[pre-med444]

If you take mdssp and strap can you still qualify for the loan repayment (hplrp) and bonuses (special pay program)? Thanks. Basically in what way can I get the most incentives overall. I am not afraid of a large obligation. Could I do just strap and get hplrp + special pay after etc. What combinations works the best? Also, if I join regular guard during med school can I go into strap program no problem?