Avoid Military Medicine

[AvoidMilitaryMedicine]

Prospective med students,

I've used this forum many years ago to help me make a decision about going the military medicine route (I did) and I've decided to create a new account to come back with a warning: If you value any aspect of your professional/personal life -- AVOID MILITARY MEDICINE (HPSP/USUHS) at ALL COSTS.

I went the USUHS route and I am currently staff at Fort Nowhere, USA. To date, the mind-numbing level of incompetency, administrative and otherwise, is the stuff of nightmares.

Before I proceed -- a few points: USUHS was actually a great experience..the students, training, travel, education -- was for the most part, fun and unique, and something I will always remember fondly.

There are also some residency programs that are rock solid, however, some of military GME is also very hit or miss and if it was so-so before, it will become infinitely worse in the very near future. Here's why..

- The military GME system is being dismantled by the DHA (Defense Health Agency), which will lead to complete elimination of certain specialties and almost all non-essential fellowships. From strictly a military readiness perspective, this does make some sense, for example, does the Army really need more pediatric cardiologists than trauma surgeons? Obviously, no. The ramifications on training, retention and individual aspirations, however, will be significant. If you are HPSP/USUHS and want to go into pediatrics? Forget it. If you are Internal Medicine and want to become a cardiologist -- I hope you don't mind waiting 4-7 years until Uncle Sam has gotten his pound of flesh first. This initiative will gut an already under-staffed GME pool and somehow lower, already, abysmally low retention rates among senior physicians while simultaneously discouraging new, qualified applicants from considering the HPSP/USUHS route. If there are hundreds of vacancies for physicians in major metropolitan areas like DC, good luck trying to get a civilian physician and his/her family to take ~$100k less and move out to a rural/isolated/impoverished areas with high rates of crime and nothing to do.

- Starting December, a "reverse PROFIS (Professional Filler)," system will have us (active-duty military docs) assigned to additional units full-time while actually living/working, possibly hundreds/thousands of miles away. We will also be loaned out to plug holes across the country (and world) weeks-months at a time and also be assigned to deploy, months-to-years a time, to fight wars which have no end in sight. Family life disruption? Check. Practicing outside of specialty? Check. Risking life/limb? Check. A small sample of the absurdity we are subjected to on a daily basis: assign board certified physicians to inspect Humvees, inventory warehouses, and my absolute favorite: track and produce tons of meaningless data which amounts to absolutely nothing <= we do this one ALL the time. Meanwhile, this is going on while there are critical shortages across almost every specialty.

I've worked in both the civilian and military sector and believe me when I tell you, the military is FAR WORSE. It's not even close and it's only going to get worse. There is so much waste, fraud and abuse, it's frightening. On a daily basis, we need to overcome an astonishing level of stupidity to accomplish even the most minor tasks that it is almost impressive in a soul crushing sort of way.

Almost every physician I've talked to at the Captain/Major rank is getting out as fast as they can. Many have decided to forego applying for fellowships (the government wants 3 years in return for 1 year of fellowship?!??!) just to get out ASAP. I've had other docs show me counters on their phone counting down hundreds of days in advance to when their contract is up and an other doc who's written her letter of resignation years in advance. Morale is very low.

There is an almost unanimous consensus in the Medical Corps, from Captains all the way to Colonels that military medicine (education, GME, practice) is going to get hammered in the next few years, even moreso than it already has been.

If you want to be under-appreciated, under-supported, under-utilized (in your specialty) and under-paid, military medicine is the place for you.

It really is a shame, however, as the mass exodus of talented physicians is going to have serious impact on our county's ability to fight wars. Many specialties are already significantly under-staffed. The few docs that are forced to remain will be asked to do more and more until they are pushed beyond the breaking point. It's already happening.

If you are thinking about going the military medicine route, don't. Ironically, I never really valued my freedom until I joined the Army, and essentially lost mine. I still have a few years left to go on my contract, but you don't have to hurl yourself into this dumpster fire.

Friends don't let friends go into military medicine. Make the right call.

---

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[Matthew9Thirtyfive]

Curious what @militaryPHYS thinks.

 

[Goro]

What's the wise @Gastrapathy when you need him?

 

[militaryPHYS]

First, it sounds like someone who got passed over for something or denied a fellowship. Whatever happened must have been really bad for them and I bet it sucked. Can’t say much more aside from I feel sorry for them. Hopefully they can adapt to something else or try again the following year. Depending on specialty, they may just have to wait until they get out to pursue it. Unfortunate, but this can happen.

The main issue I have with the overall rant is it’s lack of specificity for specialty. There were broad generalizations that are dangerous and invalid when trying to have a real discussion/argument. USUHS and Army is about all I learned. Sure, we want to remain anonymous, but specialty choice plays a large role in likelihood of being disappointed by the military.

The second issue is the amount of time he or she spent talking about all of the well known “pitfalls” of Milmed that are known possibilities and should be understood before signing up. Disappointment can happen. Frustration with the system will happen. You accept that risk when you sign a military contract. If they are so upset now I imagine they weren’t in full understanding before USUHS gave them a spot. They need to be specific on how they got screwed to pass on useful experience to someone else. Venting about well known pitfalls is just that...venting.

More to follow. Just my first impression.


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[Gastrapathy]

What do you want me to say? I’m too removed to assess the DHA piece. The rest of it has been reality for some time. Required utilization tours before subspecialization (IM or otherwise) and the reinterpretation of outservice fellowship obligation rules are old news. Retention rates are terrible and the good ones either leave or have such a long obligation that they stay begrudgingly.

But, much like the OP didn’t believe what he read here, so will the next generation provide grist to the mill. The information is here and well documented. If folks still sign up, so be it.

 

[Dr. Donezo]

First, it sounds like someone who got passed over for something or denied a fellowship. Whatever happened must have been really bad for them and I bet it sucked. Can’t say much more aside from I feel sorry for them. Hopefully they can adapt to something else or try again the following year. Depending on specialty, they may just have to wait until they get out to pursue it. Unfortunate, but this can happen.

The main issue I have with the overall rant is it’s lack of specificity for specialty. There were broad generalizations that are dangerous and invalid when trying to have a real discussion/argument. USUHS and Army is about all I learned. Sure, we want to remain anonymous, but specialty choice plays a large role in likelihood of being disappointed by the military.

The second issue is the amount of time he or she spent talking about all of the well known “pitfalls” of Milmed that are known possibilities and should be understood before signing up. Disappointment can happen. Frustration with the system will happen. You accept that risk when you sign a military contract. If they are so upset now I imagine they weren’t in full understanding before USUHS gave them a spot. They need to be specific on how they got screwed to pass on useful experience to someone else. Venting about well known pitfalls is just that...venting.

More to follow. Just my first impression.


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@militaryPHYS do you happen to know roughly how many HPSP students (airforce or army) get accepted to their first choice of specialty? A recruiter gave me information that said this number was around 60%, but that seems really high. They do seem to offer a wide range of more competitive specialties (including derm and neurosurgery), and apparently there is not much preference given between MDs and DOs, so if this were true it sounds like a pretty good deal.

 

[AvoidMilitaryMedicine]

First, it sounds like someone who got passed over for something or denied a fellowship. Whatever happened must have been really bad for them and I bet it sucked. Can’t say much more aside from I feel sorry for them. Hopefully they can adapt to something else or try again the following year. Depending on specialty, they may just have to wait until they get out to pursue it. Unfortunate, but this can happen.

The main issue I have with the overall rant is it’s lack of specificity for specialty. There were broad generalizations that are dangerous and invalid when trying to have a real discussion/argument. USUHS and Army is about all I learned. Sure, we want to remain anonymous, but specialty choice plays a large role in likelihood of being disappointed by the military.

The second issue is the amount of time he or she spent talking about all of the well known “pitfalls” of Milmed that are known possibilities and should be understood before signing up. Disappointment can happen. Frustration with the system will happen. You accept that risk when you sign a military contract. If they are so upset now I imagine they weren’t in full understanding before USUHS gave them a spot. They need to be specific on how they got screwed to pass on useful experience to someone else. Venting about well known pitfalls is just that...venting.

More to follow. Just my first impression.


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Gents, I didn't get too specific, partly in order to remain anonymous, but also because my complaints are easily generalizable across specialties -- this isn't specific to my specialty (please refer to the "specialty buckets," email that outlines all the specialties likely getting the axe in the near future... the email has been circulating among the consultants and will surely make it's way to the rest of MC in due time).

A couple of other quick rebuttals, I also have not (nor will I) apply for a fellowship in the military (will re-evaluate once I'm out) and I did get my specialty of choice (no sour grapes in that regard). It feels like ever since I've become staff there has been nothing but obstacle after obstacle (e.g., pay/bonuses, personnel shortages, assignments, deployments/profis, etc.) with no end in sight.

I made my bed, so I will lie in it -- I knew what I was getting into to some extent although I could not have anticipated the recent DHA changes when I first signed on the dotted line 10+ years ago, but after everything I've experienced, I'd be a fool if I stay around for even 10 days beyond the end of my ADSO. I don't want others to make the same mistake I made.

 

[militaryPHYS]

Gents, I didn't get too specific, partly in order to remain anonymous, but also because my complaints are easily generalizable across specialties -- this isn't specific to my specialty (please refer to the "specialty buckets," email that outlines all the specialties likely getting the axe in the near future... the email has been circulating among the consultants and will surely make it's way to the rest of MC in due time).

A couple of other quick rebuttals, I also have not (nor will I) apply for a fellowship in the military (will re-evaluate once I'm out) and I did get my specialty of choice (no sour grapes in that regard). It feels like ever since I've become staff there has been nothing but obstacle after obstacle (e.g., pay/bonuses, personnel shortages, assignments, deployments/profis, etc.) with no end in sight.

I made my bed, so I will lie in it -- I knew what I was getting into to some extent although I could not have anticipated the recent DHA changes when I first signed on the dotted line 10+ years ago, but after everything I've experienced, I'd be a fool if I stay around for even 10 days beyond the end of my ADSO. I don't want others to make the same mistake I made.

False. Your complaints are not easily generalizable across all specialties or services. Your complaints are yours and yours alone. Many likely have similar complaints, many don't have the same complaints. You are complaining about common things known about Military Medicine and which thousands of providers know, accept, and deal with it. Nobody is saying it is a perfect system and everyone realizes that things can be improved, but nothing you are talking about is hidden "insider" information you are providing. Everything is well known.

Even the new DHA guidance and MEDMACRE numbers for billet/specialty realignment are well known now and discussed previously on threads, blogs, etc. Pediatrics, OB/GYN, ENT, pathology are probably going to see decreased numbers in the coming years. This isn't a big cover-up. Your "obstacles" as a new staff are all very common complaints amongst Milmed providers. Even the happy ones.

Please don't pretend that this is true: "I made my bed so I will lie in it". If that were the case you wouldn't be on here trying to start a crusade about stuff the veteran MilMed SDN'ers have been talking about for decades. Sure, DHA is new but over the last 20 years there have been plenty of ebbs and flows of available billets/specialties, etc. that have stood the test of time. Your complaints are valid and understood by all of us but your generalizations and assumptions are dangerous.

Would love to hear your specialty to contribute to objective discussion on here. You can provide service and specialty without giving away your identity.

 

[militaryPHYS]

@militaryPHYS do you happen to know roughly how many HPSP students (airforce or army) get accepted to their first choice of specialty? A recruiter gave me information that said this number was around 60%, but that seems really high. They do seem to offer a wide range of more competitive specialties (including derm and neurosurgery), and apparently there is not much preference given between MDs and DOs, so if this were true it sounds like a pretty good deal.

There is no preference to MD or DO, just transcripts, scores and performance.

Depending on service (Army vs. Navy vs. Air Force), getting your first choice and competitive specialties has different connotations. I say this because, lets say for the Navy, to do Derm you have to do a generic internship (transitional year) and then apply again for PGY-2 training in Derm. Therefore, just because they got their first choice of PGY-1 year (transitional year) doesn't necessarily mean they matched in to continuing on in DERM PGY-2, PGY-3 etc. They may have had to go out and do a GMO tour after PGY-1 year and then come back to do Derm or had to roll in to a different specialty all together for PGY-2+.

In the Navy, most specialties have categorical internships now meaning you do, for example, Ortho internship in preparation for PGY-2 through PGY-5 in Ortho. But again, no guarantee that you can roll right in to PGY-2 ortho after PGY-1 year.

The one thing the OP got right is that MilMed is adjusting their number of people within each specialty. If a specialty is required to fight a war (surgery, ortho, primary care, neurosurgery, etc) you can expect opportunities to stay the same or increase. If you don't need a specialty to fight a war (Pediatrics, OB/GYN, derm, etc.) then the opportunities for residency and fellowship may be decreasing. (google NDAA2017, DHA, MEDMACRE, etc. for more information)

The Army/Air Force has fewer to no GMO tours after PGY-1 and therefore matching and first choice are a bit different. I will look in to obtaining the actual data for HPSP matching first choice, but again, this is just first choice for PGY-1 year and not necessarily final specialty. Anecdotally I have heard and seen a majority of people get what they want for PGY-1 year so I wouldn't be surprised by the 60%, but can't say for sure yet.

 

[Gastrapathy]

His complaints are entirely generalizable and disparaging his service because you don’t like the message is unfair. You spent many words demonstrating why they are generalizable after saying they aren’t. DHA, MEDMACRE, obstacles that are common complaints. You acknowledge all of it so it’s clearly generalizable and true. What assumptions in his post are “dangerous” and untrue?

Also, the Army and AF have plenty of GMOs. Not sure where you got that idea. They just have no route back because the match favors med studs so they almost all get out for residency.

In 2018, 73% of US seniors matched into one of their top 3 programs so 60% for just specialty is terrible even if it’s accurate.

I do agree that the facts are there already presented in many a thread. If someone joins now after spending a few hours here, they need to be prepared to accept the realities of that choice and serve their time honorably. Caveat Emptor indeed.

 

[militaryPHYS]

His complaints are entirely generalizable and disparaging his service because you don’t like the message is unfair. You spent many words demonstrating why they are generalizable after saying they aren’t. DHA, MEDMACRE, obstacles that are common complaints. You acknowledge all of it so it’s clearly generalizable and true. What assumptions in his post are “dangerous” and untrue?

Also, the Army and AF have plenty of GMOs. Not sure where you got that idea. They just have no route back because the match favors med studs so they almost all get out for residency.

In 2018, 73% of US seniors matched into one of their top 3 programs so 60% for just specialty is terrible even if it’s accurate.

I do agree that the facts are there already presented in many a thread. If someone joins now after spending a few hours here, they need to be prepared to accept the realities of that choice and serve their time honorably. Caveat Emptor indeed.

It is dangerous because he is telling everyone not to do Military Medicine because of the way that he feels. For some, Military Medicine is a great opportunity that they will enjoy. Some of his complaints are generalizable to Milmed (i.e. common pitfalls) but his specialty, his service choice likely have a large influence on his current feelings and are NOT generalizable to everyone.

There is an almost unanimous consensus in the Medical Corps, from Captains all the way to Colonels that military medicine (education, GME, practice) is going to get hammered in the next few years, even moreso than it already has been

The only Captains I know are O6 and the only Colonels I know and deal with are in the Marine Corps. "almost unanimous consensus", "getting hammered"....these are all subjective, and opinionated and not generalizable across services. Lament, voice your opinions but be specific and stay in your lane.

To that effect I am out of my lane when discussing GMO tours for Army/Air Force so please correct me with objective numbers and information.

 

[SterlingMaloryArcher]

Is it easier to get into a military med school?

 

[Dr. Donezo]

There is no preference to MD or DO, just transcripts, scores and performance.

Depending on service (Army vs. Navy vs. Air Force), getting your first choice and competitive specialties has different connotations. I say this because, lets say for the Navy, to do Derm you have to do a generic internship (transitional year) and then apply again for PGY-2 training in Derm. Therefore, just because they got their first choice of PGY-1 year (transitional year) doesn't necessarily mean they matched in to continuing on in DERM PGY-2, PGY-3 etc. They may have had to go out and do a GMO tour after PGY-1 year and then come back to do Derm or had to roll in to a different specialty all together for PGY-2+.

In the Navy, most specialties have categorical internships now meaning you do, for example, Ortho internship in preparation for PGY-2 through PGY-5 in Ortho. But again, no guarantee that you can roll right in to PGY-2 ortho after PGY-1 year.

The one thing the OP got right is that MilMed is adjusting their number of people within each specialty. If a specialty is required to fight a war (surgery, ortho, primary care, neurosurgery, etc) you can expect opportunities to stay the same or increase. If you don't need a specialty to fight a war (Pediatrics, OB/GYN, derm, etc.) then the opportunities for residency and fellowship may be decreasing. (google NDAA2017, DHA, MEDMACRE, etc. for more information)

The Army/Air Force has fewer to no GMO tours after PGY-1 and therefore matching and first choice are a bit different. I will look in to obtaining the actual data for HPSP matching first choice, but again, this is just first choice for PGY-1 year and not necessarily final specialty. Anecdotally I have heard and seen a majority of people get what they want for PGY-1 year so I wouldn't be surprised by the 60%, but can't say for sure yet.

Thanks! This was super helpful.

 

[militaryPHYS]

Is it easier to get into a military med school?

There is only one military medical school. The Uniformed Services University (USUHS). It is an allopathic program (MD) and here is the 2019 matriculation data. Uniformed Services University.

Average cumulative GPA was 3.62 and average MCAT for acceptance was 31.4. It isn't easier because it is the military's medical school but it does have lower averages than the top MD programs in the country.

The other main route to MilMed is an HPSP scholarship which pays for you to attend a civilian medical school and come on active duty once you are done.

 

[Gastrapathy]

Have you never deployed around the Army? There were GMOs everywhere, long after the no GMO myth was being touted by recruiters to compete with the Navy.

Here’s a good story:

"Discharge" Summaries. . Transition to Civilian life

If there wasn’t so much truth to his opinion, it would be easy to dismiss. I guess it is dangerous to recruiting because even the most full throated defense has to start with conceeding how many things suck for so many people.

 

[militaryPHYS]

Have you never deployed around the Army?

Nope, most Army exposure I had was while I was at USUHS

 

[Gastrapathy]

Nope, most Army exposure I had was while I was at USUHS

It’s a different level of crazy than the Navy. The HMCM I was with used to tell me it was to make me appreciate the Navy...but it was the Navy that sent me.

 

[militaryPHYS]

It’s a different level of crazy than the Navy

I keep saying we need to do more compartmentalizing discussions by service since many of us are discussing things we aren't 100% on and then we are arguing about opinions that might not even apply to us in a different service.

 

[Goro]

There is only one military medical school. The Uniformed Services University (USUHS). It is an allopathic program (MD) and here is the 2019 matriculation data. Uniformed Services University.

Average cumulative GPA was 3.62 and average MCAT for acceptance was 31.4. It isn't easier because it is the military's medical school but it does have lower averages than the top MD programs in the country.

According to MSAR, the median GPA of matriculants is 3.67 and MCAT is 509; it's a tad higher for acceptees (3.7 and 510) and is a tad below the national avg 3.76 and 511.

 

[pgg]

@militaryPHYS do you happen to know roughly how many HPSP students (airforce or army) get accepted to their first choice of specialty? A recruiter gave me information that said this number was around 60%, but that seems really high.

In 2018, 73% of US seniors matched into one of their top 3 programs so 60% for just specialty is terrible even if it’s accurate.

The odds may be worse in the military, but I don't think it's entirely clear. I think stats on "got their first choice of specialty" are perhaps not that meaningful, either in or out of the military, for the simple reason that there is tremendous self-selection amongst applicants. The world is full of MS2 ENT and derm hopefuls who eventually recognize that their first choice isn't attainable because of board scores or grades, and then end up ranking something else first.

In the military this is confounded by the skewed odds presented by GMO tours, the odd point system used for ranking at the selection board, and a different balance of choices in the first place. Some competitive specialties are sometimes easier to match to in the military, and some are disproportionately hard (EM is the perennial example there).

 

[Gastrapathy]

@pgg agreed but it’s hardly a selling point particularly when you factor in the inability to subspecialize directly (which may not be a big deal in anesthesia but changes your job entirely for IM subs). Most allopathic IM residents go straight into subs and had that intent when they picked medicine. That path is very unpredictable in milmed. Overall, there may be exceptions where it’s easier in the military (Derm and Rads maybe?) but generally there are more roadblocks to training and it’s less predictable.

If you are a DO who strongly desires a highly competitive ACGME residency which is essentially closed to you outside the military, it’s probably better. Otherwise not so much.

 

[Dr. Donezo]

@pgg agreed but it’s hardly a selling point particularly when you factor in the inability to subspecialize directly (which may not be a big deal in anesthesia but changes your job entirely for IM subs). Most allopathic IM residents go straight into subs and had that intent when they picked medicine. That path is very unpredictable in milmed. Overall, there may be exceptions where it’s easier in the military (Derm and Rads maybe?) but generally there are more roadblocks to training and it’s less predictable.

If you are a DO who strongly desires a highly competitive ACGME residency which is essentially closed to you outside the military, it’s probably better. Otherwise not so much.

@Gastrapathy wouldn't the odds also be better for general surgery as well? Most DO schools I've interviewed as have said their students have a more difficult time matching into general surgery, and that seems to be high in demand for the military right now (at least for the air force and army).

 

[Gastrapathy]

Probably? I’m not really sure. I think it’s safe to say that surgical programs are likely to survive the culling.

 

[militaryPHYS]

General Rule of Thumb:

1. You should NOT sign up for military service because you anticipate it being EASIER for you to get something that you want. Even if the trends show availability and high likelihood of you getting it NOW, by the time you are done with med school everything can change (September 11th, DHA, etc.). Sign up because you want to serve your country, not because you want an easy route to (x).

2. You SHOULD use negative trends (i.e. fewer chances of pediatrics, ENT spots, etc.) as reasons why maybe MilMed is not for you.

If you follow these rules you will (1) avoid disappointment later in your Milmed career and (2) not have the military to blame for why you maybe don't match (x) later in your civilian career.

 

[TheRealCookieMonster]

Sign up because you want to serve your country

 

[Matthew9Thirtyfive]

Lol that’s funny, but he’s not wrong. There is a certain drive to serve that some people have, and I really think that if serving isn’t the top priority, you shouldn’t sign up for mil med. The Navy/Army/Air Force has to come first before specialty choice, whatever. If there’s even a question that it doesn’t, you should avoid it or try to come in later either reserves or active once you’re already in your specialty.

 

[militaryPHYS]

Every graduating ODS student should get a personalized meme like this

 

[Angus Avagadro]

Just like medicine is not for everybody, military medicine is not for everybody. I have friends who repaid their commitment, and got out, and know several with fantastic careers. 3 still in after 25 yrs. One oral surgeon enlisted in his 50s and is still in. Another 25 + years. Another base commander, another former white house physician in a prior administration.
They would do it again. What they told me, you dont make deep friendships as you move frequently. You dont accumulate many possessions as you move frequently. Having money during med school is a big help as wife and I went the poverty owe the bank route, which was no picnic. If you choose militarymedicine, go in with your eyes wide open. The military will change the rules to suit their needs. Thanks to all for their service!