Bummer

[bobbyseal]

Advertisement - Members don't see this ad

I apologize for the generalities here, but I don't want to be too explicit on this board. Also, this is just more fuel in the ol' Military MD's tank...

So, I went and talked with a faculty member who is trained in a surgical subspecialty today. Frankly, this faculty member runs one of the best programs in his/her field in the country. S/He was once a member of the ACGME board for approving programs in his/her particular field.

S/He was quite frank and said that if you want to be a sub-standard (insert adjective here) surgeon, go ahead and do a military residency. Otherwise, if you want to be good, defer and go civilian.

This is kind of a bummer to me, because I was seriously considering doing a Navy residency. But now, I'm just not sure if it's worth it.

Who knows? I might not even get accepted for a deferment.

 

[Mirror Form]

I apologize for the generalities here, but I don't want to be too explicit on this board. Also, this is just more fuel in the ol' Military MD's tank...

So, I went and talked with a faculty member who is trained in a surgical subspecialty today. Frankly, this faculty member runs one of the best programs in his/her field in the country. S/He was once a member of the ACGME board for approving programs in his/her particular field.

S/He was quite frank and said that if you want to be a sub-standard (insert adjective here) surgeon, go ahead and do a military residency. Otherwise, if you want to be good, defer and go civilian.

This is kind of a bummer to me, because I was seriously considering doing a Navy residency. But now, I'm just not sure if it's worth it.

Who knows? I might not even get accepted for a deferment.

If you're that concerened, you can always just do your four years as a gmo and then apply to a surgical residency afterward.

 

[r90t]

If you are thinking about a Navy GS program, talk to the program directors. Ask about board passing rate and average scores for the residents. That is an objective way to grade a program. Also inquire about patient volume to ensure adequate cases. Talk to the residents to see if they are happy. Look at staff physicians and see how many are from out service programs vs in house. Each program differs in quality. San Diego sends their residents to other facilities outside of the navy for a broader experience for the GS residents.

 

[militarymd]

....... this is just more fuel in the ol' Military MD's tank...

I have never said that military physicians are of poor quality...except for a certain class...and we all know who I'm talking about.

I said that the military treats its physicians poorly, and doesn't want or allow its physicians to practice good medicine....they want military medicine which mis-utilizes physicians.

As for training...it is not substandard....it is adequate (not Mass General, but good enough)....and everyone passes their boards...if you believe in that benchmark.

 

[FliteSurgn]

If you want a good pseudo-military residency, the Air Force has a civilian integrated residency at Wright-Patterson AFB. The Wright State University surgery program takes 7 residents a year...3 military and 4 civilian. The AFB has the typical low volume that one can expect from most bases these days, but fortunately you only spend 6 months there out of your whole 5 year residency. The rest of the 5 years is spent at the civilian hospitals and the VA. I've known some of their graduates and they loved it there. It seems like they had good volume, instruction, and a broad case load.

 

[edmadison]

I mentioned this in an earlier thread, but the OP might not have seen it. I rotated at two army hostpitals this past summer in surgery. The low volume of cases was very noticeable. One program had 25% fewer residents than my institution and 1/2 to 1/3 of the number of cases. I spoke to one attending who said that his co-fellow in a civilian fellowship had 3 times as many cases logged in 5 years of residency 😱 That being said, I felt the quality of the teaching was good (although a bit confrontational). However, you can only learn a small amount of surgery from lecture and textbooks.

In the end, I opted not to do surgery for mostly other reasons. Doing peds in the Army I will get great clinic and NICU, but a little short on the wards. In Medicinesque specialties you can learn a great deal from your peers cases and from lectures and books. In surgery you must perfect the technical process -- you must learn most of it by doing.

I feel that I will get adequate training in Peds. I feel somewhat relieved because I'm skeptical about the surgical volume. I would be reluctant to sign up today if I knew I was going to do surgery.

Ed

 

[militarymd]

This is to no one in particular.

You are fooling yourself if you think you can become competent without seeing many patients just because you chose a non-technical field. For a surgeon, what happens in the OR is only a fraction of everything that goes into taking care of a patient...although the OR is where most surgeons would like to spend their time.

Examining a patient, taking a history, seeing a patient progress through the clinical course of a disease process and seeing how your interventions have altered the course of disease, seeing how laboratory, imaging studies change throughout the course of a disease process.....all of the above requires the experience that comes from seeing many patients.

Now, if you just want to see clinic and adjust blood pressure and diabetes meds, treat common colds and muscle sprains, give immunizations, then you don't need to see that many patients to become competent.

Actually, that's all that the military wants from its physicians.....I couldn't help myself with the last sentence 😀

 

[Rudy]

Finally!!! Someone has taken me up on my recommendation to speak with program directors and consultants to the Surgeons General in their fields of interest. The bottom line is that military medicine is hurting for patient volume now like never before, and it is having a major impact on military GME. The whole foundation of GME in America is based on diverse and thorough exposure to cases in one's specialty. Though textbooks and other educational media are continuing to improve, there is no replacement for patient/case volume. I have personally spoken with program directors in the AF for about a half dozen programs across various medical specialties, and this is a serious problem across the board. Again, this has nothing to do with being negative or unpatriotic; these are simply the facts about military medicine. So, if your primary goal is operational medince and you want to jump out of planes, run with the special forces or become a navy dive doc, then the military will be a great career for you. If your primary goal is to become a well-trained physician, then you need to think carefully about your choice. The military is now at the point where someone needs to decide if they can honestly stay in the business of military GME; the problem is that no one wants to change the status quo. And remember, getting adequate training is only half the battle; it may be even harder to maintain your residency skills during your payback assignments.

 

[denali]

So, if your primary goal is operational medince and you want to jump out of planes, run with the special forces or become a navy dive doc, then the military will be a great career for you. If your primary goal is to become a well-trained physician, then you need to think carefully about your choice.

I see. So these two are mutually exclusive?

 

[r90t]

Hmmm, Look at what MilMD posted, as a staff physician, his opinion states that programs turn out good (enough) physicians. As a staff physician, he is very unhappy about the treatment of his peers by the higher ups, the nonphysician staff personnel and some old timers that haven't retired.

You can do operational medicine and then do your specialty training. I'm finishing my GMO tour, then going to USC for my residency on navy funds. I hope it turns out a quality navy physician that can train interns/residents in house.

As for patient volume, with the newly implemented/required 80 work weeks, no working late post-call, etc. has anyone noticed complaints of patient volume decreases in the civilian programs?

 

[Rudy]

Although many on this board will probably do their residencies in civilian programs, I think the key issue is how long the military can justify GME based on the current dwindling caseloads. Smoke and mirrors (along with supplemental educational materials, of course) only go so far to replace a broad, diverse patient exposure. In the military, not only has the quanity of cases gone down, but also the complexity and variety has suffered tremendously as well. This is an issue that affects all military doctors, regardles of where they trained, because if GME goes away, then the whole military medical system will need to be restructured.

I just want to drive the point home to those considering signing up for USUHS/HPSP partly because they anticipate "cushier" residencies with higher salaries than their civilian counterparts that the little bit of extra money earned during residency is a large price to pay if the quality of your residency training suffers. Again, talk with program directors, consultants, etc. Don't be intimidated or timid about calling them and asking the hard questions, even if you are still a pre-med student. You need to confirm for yourselves the direction that military GME is going to go; and you have the right to get straight answers from the people that actually know.

 

[Mirror Form]

Most of the military personel I've heard c/o inadequate case loads do so after residency while on active duty when they're away from the big military hospitals. Do large hospitals like Walter Reed/NCC, BAMC, and Madigan really have tiny caseloads and poor training compared to a middle tier civilian program? One general surg intern I know at Walter Reed seems to be busy as hell.

 

[The White Coat Investor]

If you are thinking about a Navy GS program, talk to the program directors. Ask about board passing rate and average scores for the residents. That is an objective way to grade a program.

This is the worst way i can think of to grade a program. This is like saying medical students from this medical school all pass their boards...so what. Taking care of patients is much different from taking standardized tests. The high scores coming out of military programs are a result of selection bias. The military preferentially takes those with high board scores, so the results, 1-5 years later, are that their residents have high board scores.

 

[Mirror Form]

The military preferentially takes those with high board scores, so the results, 1-5 years later, are that their residents have high board scores.

What programs don't preferentially take those with high board scores? They a strong factor in most program's decisions.

 

[r90t]

I said objective way to rate a program, not the best way to rate a program. If a program has a proven record of residents being unable to pass boards, that would be an indication that something is wrong with that program. It is the one thing that all programs have in common. The board scores are a predictor of the test taker, not a definitive answer to how he will perform. Certain USN residencies will not take people below an xxx score on their boards, because it has been shown that people who are below their minimum scores, traditionally don't pass their boards, i.e. waste of time for the staffers.

Talk to the program directors, residents and staff. They will give you a better feeling of each program for your fit, even if they don't say this is a good/bad program.