Civilian Residency HPSP?

[Silence in ER]

Hi,
I just want to see if the navy recruiter at my school gave me a piece of misinformation.
I am a junior in college, considering HPSP, anyway, the point is the Navy recruiter at my school said that if I don't want to do a military residency, and preferred a civilian residency instead, if I got into one of the top three residency programs in the specialty I liked, I could go into a civilian residency. I just wanted to know if this was true. Any help would be appreciated. Thank you.

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[HighPriest]

I think that may be at least a "little" bit of a complete fabrication, but maybe the Navy has some kind of special rule that the Army certainly doesn't have.

Somebody who gets their paycheck from DN please correct me if I'm wrong, but as far as I know the situation is the same throughout. You are required to apply for a residency in the military. If you match into that residency, you are required to take said residency. If you do not, then someone with a crowded lapel decides whether or not the service you've joined with will require more docs in your chosen field than they are able to train. If the answer is yes, then the service will defer an appropriate number of candidates to the civilian match. If you happen to fall into that group, and you get picked up by one of these "top three" residencies (however you're measuring that), then you win the game.

 

[HighPriest]

As a med student, and again as a young resident, I spent a lot of time talking to potential HPSP students like yourself. I was less...cynical isn't the right word, so let's say biased... at the time.
The recruiters I worked with weren't cold blooded vampires, but they we're run of the mill soldiers who got picked up to recruit people with more education than they had, to go into fields about which they were ignorant, through match processes that they didn't really understand, using a complex and lengthy contract that was briefly explained to them by a CO or NCO who really didn't understand it either. Most of them were either just arriving or on their way to another assignment. They did their best to explain things to the best of their knowledge, but many times the fine details were lost or mistranslated. Most of them really did believe in the Army and in Army medicine, but they were just in over their heads.

I have to assume the other services are similar. But maybe somebody from the Navy will be able to tell me that they have the system licked. I actually hope so.

 

[colbgw02]

Hi,
I just want to see if the navy recruiter at my school gave me a piece of misinformation.
I am a junior in college, considering HPSP, anyway, the point is the Navy recruiter at my school said that if I don't want to do a military residency, and preferred a civilian residency instead, if I got into one of the top three residency programs in the specialty I liked, I could go into a civilian residency. I just wanted to know if this was true. Any help would be appreciated. Thank you.

The recruiter is, at best, distorting the truth and, at worst, outright lying.

Each service goes about granting civilian deferments differently, but the idea that you will automatically be given one if you match at a top three residency is patently false. First of all, there is no ranking system for residency programs, so if you ask 10 different people what the top three programs are for a specialty, you'll get 10 different answers. Secondly, the military match occurs earlier than civilian matches, so there is no way the Navy would even know whether or not you would match at a top civilian program when they were deciding to grant you a deferral. Lastly, and most importantly, the idea that the Navy really gives a crap about what you want or prefer is largely a myth. If your goals are aligned with the needs of the Navy, then things can work out, but often times it doesn't.

 

[Special Delivery]

Hi,
I just want to see if the navy recruiter at my school gave me a piece of misinformation.
I am a junior in college, considering HPSP, anyway, the point is the Navy recruiter at my school said that if I don't want to do a military residency, and preferred a civilian residency instead, if I got into one of the top three residency programs in the specialty I liked, I could go into a civilian residency. I just wanted to know if this was true. Any help would be appreciated. Thank you.

It is possible to get a civilian deferment for residency, however it's not really based on your academic performance. Military match is 2-3 months before AOA and ACGME matches, so they would have no way of knowing whether or not you would get one of those "top three". Military does what it wants for its own reasons. I've heard that AF and Navy grant civilian deferments more often than Army (Army gave out 5 deferments out of 350ish HPSP grads this year), but it's year-by-year, based on what the military projects it needs to be, and whether or not they think they can meet their goals with the residency programs they have.

So... no, your recruiter probably doesn't have a good idea how things work, and no one has a good idea of what the military will want/need 4-5 years from now. Go into HPSP with the expectation of doing your residency in a military hospital, but also interview at several civilian programs fourth year on the off-chance you get a deferment (they require everyone to fill out deferment papers pre-match).

 

[redsquareblack]

Hi,
I just want to see if the navy recruiter at my school gave me a piece of misinformation.
I am a junior in college, considering HPSP, anyway, the point is the Navy recruiter at my school said that if I don't want to do a military residency, and preferred a civilian residency instead, if I got into one of the top three residency programs in the specialty I liked, I could go into a civilian residency. I just wanted to know if this was true. Any help would be appreciated. Thank you.

The recruiter did, indeed, give you a piece of misinformation. The military match is 3 months ahead of the AOA and ACGME matches, as Logistics mentioned, so there's no "if you match at one of the top three residency programs" (whatever that means).

I will part ways with Logistics, however, when he says "it's not based on your academic performance". That's not the only consideration, sure, but academic performance is hugely important in determining who gets deferments. After all, why waste a deferment on someone who's not likely to match in the civilian world?

 

[Silence in ER]

Ugh. I was really all gung ho about HPSP.
I guess I was stupid to believe the recruiter, after all recruiters lie.
I'd prefer not to do a military residency. But, weirdly enough, I'd still like to join the military.
Anyway, I've been reading through blogs like Half-md to learn more about HPSP. And what I'd like to know is: which hpsp ( army , navy, air force) should I apply to maximize my chances of not being a gmo. I really don't want to waste 4 years before I go to residency.

 

[colbgw02]

My impression is that the Army, as a percentage, tends to send fewer people out to be GMOs. However, they also typically give out fewer deferrals. Their deferral selection format is also not necessarily meritocratic.

If you don't want to be a GMO or do a military residency, then your path is pretty clear: don't join the military.

 

[Special Delivery]

I will part ways with Logistics, however, when he says "it's not really based on your academic performance".

I should have said "not solely based". The OP was under the impression that if they worked really hard and made top of the class etc, they would get exactly what they wanted. Sure, good grades never hurt, but again, the military does what it wants for its own reasons.

I guess I was stupid to believe the recruiter, after all recruiters lie. I'd prefer not to do a military residency.

Milmed is confusing, and HPSP even more so. Your recruiter just might not understand how it works, and is probably just repeating the misinformation he'd heard. I think it's not too hard to avoid GMO... do well in school and rotations. But if you can't stomach military residency, don't join, because that's where 99% of people end up (yes, I'm hyperbolizing, no one fact check me, please).

 

[Kilgoretrout 65]

I'd prefer not to do a military residency. But, weirdly enough, I'd still like to join the military.

I think a lot of us have had decent military residency training experiences. Most frustration comes from being staff afterwards.

The AF defers a fair amount of training but it depends on the specialty. If you are a really good candidate, you are more likely to be drafted into
a military residency. Do you want to role the dice by appearing to be a mediocre candidate? Do you want to do something to aggravate the military
program director? Might work, or you might be doing a one year internship where you don't want to be on your way to GMO land.

 

[idq1i]

Today, you have the best chance of not being GMOed in the Army. When you graduate, who knows. Depends on circumstances at the time. Mind that the army has also been essentially GMOing (brigade surgery) their staff, whether clinical or not over the past few years, 0-2 years into their ADSO payback.

 

[IlDestriero]

If you don't want to do GMO time, don't join the Navy.

 

[deuist]

And what I'd like to know is: which hpsp ( army , navy, air force) should I apply to maximize my chances of not being a gmo.

Sallie Mae. That's the organization you should apply through to avoid GMO. If you sincerely desire to be in the military, but want to guarantee a civilian residency, use loans to pay for med school initially and then join FAP while in residency.

 

[Akr]

It is possible to get a civilian deferment for residency, however it's not really based on your academic performance. Military match is 2-3 months before AOA and ACGME matches, so they would have no way of knowing whether or not you would get one of those "top three". Military does what it wants for its own reasons. I've heard that AF and Navy grant civilian deferments more often than Army (Army gave out 5 deferments out of 350ish HPSP grads this year), but it's year-by-year, based on what the military projects it needs to be, and whether or not they think they can meet their goals with the residency programs they have.

So... no, your recruiter probably doesn't have a good idea how things work, and no one has a good idea of what the military will want/need 4-5 years from now. Go into HPSP with the expectation of doing your residency in a military hospital, but also interview at several civilian programs fourth year on the off-chance you get a deferment (they require everyone to fill out deferment papers pre-match).

About this deferment thing. I've heard vaguely that they're going to change things up this year and NOT require everyone to rank deferment as one of their 5 allowed Navy match choices??

We (MS-3s in Navy HPSP) have recently been emailed some projected numbers, etc. related to the 2015 PGY-1 match, and were promised some more info to come. So I'm waiting on that, just wondered if anyone else out here had more specific knowledge or comments to make about it. There will be deferments but not many, and they already have chosen several specialties to prioritize for those few deferments. The specialty I want to do is not among those prioritized for deferment... Anyway, I'm hoping to gain enough understanding to come up with a good strategy for applying, and not have to scramble/SOAP or whatever the Navy equivalent is It seems like any of the sparse guidance we do get right now is outdated or vague at best.

Anyone that has civilian-deferred, especially Navy, I would love to hear from you! Please post or PM me!

 

[Gastrapathy]

Akr...not sure you understand the process. You want a strategy to help you get a full deferment in a specific specialty that probably won't offer one? There is no strategy for that. You have to apply to the GMESB and they will defer you if they feel like it (sometimes you can be too good to get a deferral, sometimes not good enough). There are no policies on who to defer, even if there is a spot, so its totally SL dependent. If there is no spot on the precept, they are extremely unlikely to just make you one. There is no guidance because there isn't a process for making this work. Is your specialty of interest one that has a categorical internship?

 

[Akr]

Akr...not sure you understand the process. You want a strategy to help you get a full deferment in a specific specialty that probably won't offer one? There is no strategy for that. You have to apply to the GMESB and they will defer you if they feel like it (sometimes you can be too good to get a deferral, sometimes not good enough). There are no policies on who to defer, even if there is a spot, so its totally SL dependent. If there is no spot on the precept, they are extremely unlikely to just make you one. There is no guidance because there isn't a process for making this work. Is your specialty of interest one that has a categorical internship?

Yeah I don't feel like I understand the process very well! I guess the only strategy is to rank deferment, and hope for but not expect to get it. Realistically I just want to match in the specialty, period (so most likely at a Navy program) rather than TY or whatever my 'plan B' would be... I've been advised to apply for a 'plan B' specialty within the Navy. I have my 2 Navy ADT aways confirmed, so hopefully I will also learn some more specific advice from within that dept.

And yes I believe there is categorical internship for what I'm looking at.

 

[ANGSFS]

Some few thoughts on residencies in general -- the quality of the training, not the affiliation, is the important thing. If the program has good results, meaning the grads pass their boards on the first try, then it isn't really that important what the name on the diploma is. The exception to that is for those who aspire to a career in high-level academic medicine -- there it is ALL about the branding, and the quality of your performance, as an attending, will barely matter. These attendings survive because the quality of the residents is usually exceptional, and the attendings can actually be quite clinically weak, as long as they generate papers and lectures and carry the right titles. More importantly to community-oriented docs is the location of your residency -- if you know where you want to eventually live, having a local network of contacts to tap into for job leads will possibly be critical to your future happiness. Never underestimate the power of networking -- the good jobs go to the connected, not necessarily to the most capable.

You need to consider the option of the Reserve forces, including the Air and Army Guard, for service. They have programs that will happily take you in as a medical student or resident, with no impact on your selection of training, and will offer you a chance to serve in a useful, challenging and meaningful capacity. You won't get your med school paid for completely, but you also won't have the restrictions or obligations of HPSP.

 

[deuist]

If the program has good results, meaning the grads pass their boards on the first try, then it isn't really that important what the name on the diploma is.

Except one of the complaints about certain residency programs is that education relies on books and simulation---so that grads can pass the boards, but are clinically weak due to lack of patient encounters.

 

[notdeadyet]

Some few thoughts on residencies in general -- the quality of the training, not the affiliation, is the important thing. If the program has good results, meaning the grads pass their boards on the first try, then it isn't really that important what the name on the diploma is.

Disagree. The military residencies are about the only ones to tout this. "Teaching to the boards" is not a particular strength, as another poster mentioned. And most residency programs don't have problems with folks not passing their boards.

The exception to that is for those who aspire to a career in high-level academic medicine -- there it is ALL about the branding, and the quality of your performance, as an attending, will barely matter.

Also untrue. Branding of the program doesn't as much matter as the actual quality of the program itself. And this isn't a vacuum, it's because academic jobs are competitive and attending a good program is a nice litmus test. Residents with poor reputations/clinical skills from great programs don't get far in academia regardless of where they trained.

More importantly to community-oriented docs is the location of your residency -- if you know where you want to eventually live, having a local network of contacts to tap into for job leads will possibly be critical to your future happiness. Never underestimate the power of networking -- the good jobs go to the connected, not necessarily to the most capable.

Agree with this...




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[IlDestriero]

Except one of the complaints about certain residency programs is that education relies on books and simulation---so that grads can pass the boards, but are clinically weak due to lack of patient encounters.

Exactly. Be cautious about training in programs where your high acuity case volume is low to non existent and they rely on you getting significant training in month long electives at other hospitals. That is death for anesthesia and procedure based specialties.
Not everyone can train at one of the best of best programs in their field, but there are many, many programs that provide full service care with very solid reputations. For many specialties, the Navy is pretty average at best.

 

[notdeadyet]

Not everyone can train at one of the best of best programs in their field, but there are many, many programs that provide full service care with very solid reputations. For many specialties, the Navy is pretty average at best.

This. And the challenge is that an MS1 doesn't really know what field they are going into, let alone whether the residency training options in the military for that specialty are going to be good.


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[Silence in ER]

How does the reserve work? Where can I get good information on it? Will they pull me out of undergrad or med school to go serve in Afghanistan if a war breaks out? I hope I don't sound too uninformed here.....