Best way to do EM

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Trevorphilips

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I am dead set on EM. I've been reading this forum and the EM forum. I am also (despite the great insights here) pretty set on military medicine. I am a senior and I have been accepted to med school. My question is what is the best way to do this?

Which service gives u the greatest chance to get an EM spot? I know as far as my research the army's programs constantly rank in the top 10 every year. How realistic is it to get a spot right out of med school? What exactly would you need to do? grades? rotations? research? is a deferrment possible?

What could I do to better my chances? What should I do over the summer (before OBC)? etc... Does it matter? I figure starting early with some advice would be great before I sign my life away.

Would it be better (and realistic the army would sponsor) a FAP schloarship and match in EM out of the military?

My leaning right now is to take a 3 year Army HPSP (since the residency is 2 or 3 years it would be only be a 3 year commitment), work my tail off, and hopefully land myself in one of those top notch programs.

sorry I know thats alot of stuff but i want to fully research my desicion; it's a big one

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Per Desperado, and I cannot emphasize this enough:

DO NOT take HPSP if you want the freedom to choose your specialty. Just don't do it. You could have phenomenal scores on your boards, you could be top of your class, you could own any interview you went to, but if your branch of military needs you more in a different specialty, you're screwed.

DO NOT do it.

Go FAP if you have this burning desire to be in the miltary, but don't do HPSP.
 
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Question: I noticed on our Navy site that no one got straight into EM on the GME-1 board (I assume because they had to a Transitional first?), but it does show 8 full deferments given out for EM. Are those returning GMOs who are now going back to repeat internship and do residency through a civilian programs? Or are these med students who scored the full deferments?

hpsp students who want em usually get a t yr. the 8 are hpsp students who got deferments.

ditto. if you want EM, stay the hell out of the military.
 
HPSP offers you nothing loans+FAP doesn't, except uncertainty and fewer choices.

It's great that you want to serve. I've been absolutely happy in the Navy, and I'd love to push you toward HPSP ... but if you're sure you want ER then HPSP is a risky path.

The GMOs who aren't getting into ER are not lazy slackers; they're competitive applicants who are victims of circumstance. It can happen to you. If you don't have the advantage of prior service, it probably will happen to you. The selection board for military residency programs places substantial weight on non-academic factors.

Give yourself the safety net of a more forgiving civilian match. Train in an ER where acuity doesn't mean "my sniffling kid needs a z-pak before we drive to Disneyworld" ... and then join us via FAP.

You'll get better training, you'll skip the GMO time, you'll still get med school paid for by FAP, and you'll still get to serve.
 
As per previous comments: I am an MSIV who LUCKILY matched into a full deferrment for EM training (one of the lucky 8). Keyword is lucky. If I knew I was planning on EM eventually I would NOT have taken the scholarship. Its simply not worth it. I have also done a rotation at NMCP and the acuity level is nothing compared to my home institution or other ED's I seen as a student. If this sounds like a repeat of what Desparado said, its b/c the truth needs to be "outed".

I remember discussing my options with my PD @ my home institution: hope for the full deferral vs. 4 years payback as a GMO and civilian training. The PD was worried about 1) how competitve I would be in 5 years vs now 2) what happen if deployed to Iraq as GMO and 3) possible limited options after doing a military internship (e.g. how many civilian programs would be interested in me as an applicant).
 
As per previous comments: I am an MSIV who LUCKILY matched into a full deferrment for EM training (one of the lucky 8). Keyword is lucky. If I knew I was planning on EM eventually I would NOT QUOTE]

You're a Navy MSIV this year who matched directly into a full deferrment? I must confess, I am very surprised. My understanding was that none of the Navy EM slots were given to med students. For some reason I thought there were no deferred slots this year either, but I'm not as sure about that as I was about the GMOs.

8 deferred slots were given out in the GME-1 match. I admit I just re-checked to be sure!
 
Alrighty then oldtimers ;) what if the question were raised by a former enlisted man. I had 12 years (10 active + 2 reserve), on 6 pubs and still debating whether or not to join after acceptance to school. I'm 99.9999% sure I'm going into EM. Does the same advice given to the OP hold true for me? I have a few friends who are applying or begin med school next year and are dead set on EM and possibly rejoining the military.......so what should this merry band of prior service derelicts do? BTW what is it with damn near every prior service guy going into EM? :smuggrin:
 
Still if you want EM: use FAP to get into the military. If you are selected for training, a GMO will be necessary to get an EM residency (at least navy). Almost every american grad matches into a civilian residency if he/she chooses. I believe Desparado mentioned 1/3 to 1/2 the GMO's actually get a EM spot. Better odds outside of the military. So FAP your way in...serve the 20 and retire :)
 
I know as far as my research the army's programs constantly rank in the top 10 every year.

Sorry to digress from the OP a little, but I hear similar statements statements bandied about by military GME big shots all the time, and it would be extremely irritating if it were not so amusing.

A military Program Director touting his program as “one of the best in the country” is like your local greasy spoon restaurant claiming that it has the “World’s best chicken sandwich.” It’s ridiculous hyperbole—totally unsubstantiated and not to be taken seriously.

Obviously it’s a subjective judgment which programs are truly the “top ten” in the country, but at a minimum they should be well-known as leaders in their field, with nationally respected faculty, a strong research program, exceptionally broad clinical experience, and national name recognition. Ask your civilian program director or department chair, and they will be able to give you a rough idea of the “top programs in the country” for your chosen specialty. For many specialties, you'll recognize the names--Hopkins, Mass. General, Stanford, etc.

Let me go way out on limb (drawing the ire of the resident audience) and say that NO military residency program in ANY specialty is currently recognized as one of the “top programs in the country.” I know…I know…the in-training exam scores are uniformly spectacular. But let me reiterate that no one outside the military cares about this at all. The only test-related thing programs care about is that their graduates pass the certification exam. It’s very embarrassing to programs when a graduate repeatedly fails the final exam.

If you were to ask the board members of the ABEM what the best EM residencies are in the country, does anyone seriously believe that they would list BAMC and MAMC in the top ten? I’m not saying they aren’t great places to train—I’m sure that they are wonderful community-hospital programs, and the residents probably love it. Military program directors can legitimately boast about a ‘great lifestyle’ or ‘solid didactic program’ or ‘extensive exposure to chronic management of blast injury.’ But any faculty or resident who is telling students that his military residency is “one of top programs in the country” is delusional.
 
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Alrighty then oldtimers ;) what if the question were raised by a former enlisted man. I had 12 years (10 active + 2 reserve), on 6 pubs and still debating whether or not to join after acceptance to school. I'm 99.9999% sure I'm going into EM. Does the same advice given to the OP hold true for me? I have a few friends who are applying or begin med school next year and are dead set on EM and possibly rejoining the military.......so what should this merry band of prior service derelicts do? BTW what is it with damn near every prior service guy going into EM? :smuggrin:


Why go back into the navy unless you just love haze gray?

I too was a corpsman like you. I'm now an EM attending (going on six months now). Why, oh why, go back?

Stay the hell away from the military. You will again be the same guy as you were as an enlisted, just with alittle more rank and alot more knowledge.

Unless you are just so high-and-tight and dying to be haze gray and underway, you should pursue your career as a civilian.

At the very least you should put off the decision until you are a few years into medical school. The FAP will always be available to you. The farther along in the process you are the more perspective and negotiating power you will have.
 
If you're dying to be a military doc, there are ways to do that AND be an EP... but you should do them in the proper order. that's the ONLY way to realize your dream.

EP first... military second. DO NOT do HPSP.
 
Don't love being hazy grey or anything else. However it was recommended that since I am so much "more senior" than trad applicants that I will not have time to save much afer only becoming an attending at the AARP age of 44. Going back in would give me the pension which would make up for the genius of compunding interest.

That more than anything else would be the reason. So I've already gone in for patriotic reasons so now it would be to take advantage of the pension at the end. Crazy how things work out. :cool:
 
WOW!!!!!!!!!!!!!

I am really amazed!! Are things finally beginning to sink in?? 100% of the responces to the OP have been to stay away from military medicine to achieve his stated goal. Multiple and varied true reasons from multiple attendings of different fields, and not yet one single attack at their personality, or patriotism. Are the crazy people taking a break for the holidays?

Once again, it cannot be ovemphasized how much choice you give up in joining military medicine right now, to include most importantly your desired specialty, and equally and maybe more important, the training you receive.

Prospective HPSP students who have a single burning desire to do any specialty other than GMO/FS, should take this thread to include any specialty of medicine. Especially when it comes to the quality of training they will get, and the ability to apply that training.

I'd like to think things are changing, but I think there will be many more HPSP'ers who learn the hard way.
 
Don't love being hazy grey or anything else. However it was recommended that since I am so much "more senior" than trad applicants that I will not have time to save much afer only becoming an attending at the AARP age of 44. Going back in would give me the pension which would make up for the genius of compunding interest.

That more than anything else would be the reason. So I've already gone in for patriotic reasons so now it would be to take advantage of the pension at the end. Crazy how things work out. :cool:

No sarcasm here at all, but is the pension really worth that much? If you avoid the military all together and make say $100,000 a year more on the outside, I would think that with a little investing you'd be way ahead of the military pension. Am I wrong?
 
No sarcasm here at all, but is the pension really worth that much? If you avoid the military all together and make say $100,000 a year more on the outside, I would think that with a little investing you'd be way ahead of the military pension. Am I wrong?

There's the new proposal which is supposed to increase specialty pay by $100k/year. So now we're talking about the same pay but not necessarily for the same job.

Not sure about way ahead. How much would I need invested to earn $50k/year that adjusts for inflation?
 
No sarcasm here at all, but is the pension really worth that much? If you avoid the military all together and make say $100,000 a year more on the outside, I would think that with a little investing you'd be way ahead of the military pension. Am I wrong?

Depends how long you live. :)

Current base pay for an O-5 with 20 years is about $7K/month. 40% of that for the rest of your life is about $34K annually or $1.34 million if you collect for 50 years. Add in the lifetime of medical benefits for you and your dependents ...

I'll be eligible to get out with 11 years of service. For me it probably won't make financial sense to miss out on 9 years of much higher pay in the civilian world for an extra $34K/year for as long as I might live.

But for someone with prior service, who's already got 4 or 8 years behind him, who'd be eligible to retire shortly after finishing his residency obligation?

Croooz said:
Not sure about way ahead. How much would I need invested to earn $50k/year that adjusts for inflation?
Where do you get $50K/year? Is my math wrong, or are you assuming retirement at O6 with 24+ years?
 
Although Army is the best chance of getting an EM residency out of med school, in the the last few years they are being used more and more as GMOS. I am good friends with a 3rd year EM resident in the Army who told me up to 60% of EM docs are being used as GMOs after residency. Army ER facilities are being run more and more by civilians. To improve his chances of getting an EM spot after graduation he volunteered to go overseas. Doesnt sound to great to me. As mentioned above. Get your schooling and training done in the civilian world and if you want to join do it and get a nice sign on bonus, but atleast you have a choice when the time comes. Good luck.
 
Where do you get $50K/year? Is my math wrong, or are you assuming retirement at O6 with 24+ years?
Depends on which path I take. If USUHS and EM I will have 24 years in. If HPSP then similar. So I'm looking at 60% retirement. If FAP then it would be the typical 50%. In neither scenario am I looking at O6. O5 would be the highest I figure I will acheive......that's if I reenter the military.
 
Sorry to digress from the OP a little, but I hear similar statements statements bandied about by military GME big shots all the time, and it would be extremely irritating if it were not so amusing.

A military Program Director touting his program as “one of the best in the country” is like your local greasy spoon restaurant claiming that it has the “World’s best chicken sandwich.” It’s ridiculous hyperbole—totally unsubstantiated and not to be taken seriously.

Obviously it’s a subjective judgment which programs are truly the “top ten” in the country, but at a minimum they should be well-known as leaders in their field, with nationally respected faculty, a strong research program, exceptionally broad clinical experience, and national name recognition. Ask your civilian program director or department chair, and they will be able to give you a rough idea of the “top programs in the country” for your chosen specialty. For many specialties, you'll recognize the names--Hopkins, Mass. General, Stanford, etc.

Let me go way out on limb (drawing the ire of the resident audience) and say that NO military residency program in ANY specialty is currently recognized as one of the “top programs in the country.” I know…I know…the in-training exam scores are uniformly spectacular. But let me reiterate that no one outside the military cares about this at all. The only test-related thing programs care about is that their graduates pass the certification exam. It’s very embarrassing to programs when a graduate repeatedly fails the final exam.

If you were to ask the board members of the ABEM what the best EM residencies are in the country, does anyone seriously believe that they would list BAMC and MAMC in the top ten? I’m not saying they aren’t great places to train—I’m sure that they are wonderful community-hospital programs, and the residents probably love it. Military program directors can legitimately boast about a ‘great lifestyle’ or ‘solid didactic program’ or ‘extensive exposure to chronic management of blast injury.’ But any faculty or resident who is telling students that his military residency is “one of top programs in the country” is delusional.


Actually, the Military is the proud owner of the Armed Forces Institute of Pathology in Wash. DC., for many years probably the best pathology center in the world, and publisher of the then-golden standard "AFIP Fascicles".

Unfortunately, it's currently all but disintegrated, as seems to be the case with many other military medicine institutions. It's currently headed by some unknown Polish lady with a medical degree from the "Pomeranian Medical Academy" (which is in Poland, I assume), and virtually all their previous gold-studded (in terms of reputation) faculty is gone with the wind.

So no, I'd have to agree that I can't really come up with ANY military medical institution that's top ten anything (at least not in terms of quality and reputation).
 
Alright, now how about those of us that are already HPSP students but want to go into EM?

I'm an MS3 in the AF and it seems impossible to get an EM residency, not to mention get a deferrment. What's the best choice then? Should I bite the bullet and go into something like Peds or Internal Medicine and come back to EM once I get on the outside?

Also, It seems like those who got deferrments this year were all transitional students. this might be a dumb question, but I thought the transitional spots were just for those people going into surgery or radiology, which a require a transitional year. If you still need some time to decide what specialty you want, do you just do a transitional year?
 
Alright, now how about those of us that are already HPSP students but want to go into EM?

I'm an MS3 in the AF and it seems impossible to get an EM residency, not to mention get a deferrment. What's the best choice then? Should I bite the bullet and go into something like Peds or Internal Medicine and come back to EM once I get on the outside?

Also, It seems like those who got deferrments this year were all transitional students. this might be a dumb question, but I thought the transitional spots were just for those people going into surgery or radiology, which a require a transitional year. If you still need some time to decide what specialty you want, do you just do a transitional year?

Good luck. Last i heard from one of my AF EM buddies they expected to eliminate virtually all deferred spots and the career field is going to shrink. My base is already using civilian contractors in the emergency room, and Walter Reed is as well.

I wouldn't do a residency in something you aren't interested in, but you could do something like peds then do EM on the outside and market yourself as a pediatric ER doc. It's just hard to take that pay cut after your active duty time to be a civilian resident.

Transitional deferments = GMO or flight surgeon. They will do their intern year and then come in to do the primary care scut work and deployments that the AF needs right now. Some of those selected for transitional years may have selected that route, but many were people who did not match in the specialty of their choice.
 
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