Civilian Sponsored Residencies?

[NoMoreAMCAS]

I was looking at the Air Force's HPERB for 2009 and noticed that several residencies are civilian sponsored. Do you maintain all of the pay/privileges of being a military doctor during civilian sponsored residencies? Or are you sort of released for your residency then have to come back and finish up your commitment when it's over?


Thanks for any info.


Oh, and for fellowships: If I owed 5 years going into a 2 year fellowship, would i still just owe 5 years when i was finished, or would i now owe 7 years?

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[NoMoreAMCAS]

No AF doctors in here?

Working all the time FTMFL!!!!!

 

[J-Rad]

Umm, sometimes you have to wait for more than 1/3rd a day to get a response...

If you are civilian sponsored for residency or fellowship you are still on active duty. You will be assigned to AFIT with whom you will deal for most things. The nearest base to your residency/fellowship will do your inprocessing for PCS (since you are on AD) and will be your official MPF. If you are at an institution far from the base but near a AFROTC detachment you will have some administrative attachment to them as well for things like PT tests. You don't need to wear your uniform in the hospital, but you are AD and will get all pays you are eligible for (base, BAH, BAS, VSP for internship/residency). This is different than "civilian deferred" during which you are temporarily released from the service with the expectation that you will come back on AD after completion of your residency. No pay and no accrued ADSO during residency.

http://forums.studentdoctor.net/showthread.php?t=682788&page=2
has a relevant discussion (read posts 75-85ish)

 

[NoMoreAMCAS]

Umm, sometimes you have to wait for more than 1/3rd a day to get a response...

If you are civilian sponsored for residency or fellowship you are still on active duty. You will be assigned to AFIT with whom you will deal for most things. The nearest base to your residency/fellowship will do your inprocessing for PCS (since you are on AD) and will be your official MPF. If you are at an institution far from the base but near a AFROTC detachment you will have some administrative attachment to them as well for things like PT tests. You don't need to wear your uniform in the hospital, but you are AD and will get all pays you are eligible for (base, BAH, BAS, VSP for internship/residency). This is different than "civilian deferred" during which you are temporarily released from the service with the expectation that you will come back on AD after completion of your residency. No pay and no accrued ADSO during residency.

http://forums.studentdoctor.net/showthread.php?t=682788&page=2
has a relevant discussion (read posts 75-85ish)

Awesome, sounds like a great deal.

Thanks for the info. And yeah, I'm pretty impatient.

 

[J-Rad]

Awesome, sounds like a great deal.

Not all would consider it a great deal. I didn't get to look at the match list this year so I don't know how many CS residencies were listed, but there are usually very few in a given year (CS fellowships are more common for specialties without "in-house" training) so hoping for one is a bit of a long shot for most. The biggest downside is that the accrued ADSO for a CS residency is additive to the med school ADSOs unlike an active duty residency (concurrent ADSO to the med school ADSOs) or civilian deferred (no incurred ADSO. As an aside, some would consider civilian deferred the best deal in the sense that while pay is worse vs. AD residency the flexibility and potential better quality of civ. residency combined with X less years of active duty administrative BS [X being the duration of residency] make up for the pay. Particularly true for those not intending to stay for more than one hitch).

 

[AFDuck]

The couple of friends I have that matched into CS residency slots did not ask for them, and were frustrated to incur the extra ADSO (especially since they were 5 year residencies). I don't think many would agrue that the AD pay is worth the extra obligation and the years of a relative salary cut while on AD relative to civilian docs.

 

[NoMoreAMCAS]

The couple of friends I have that matched into CS residency slots did not ask for them, and were frustrated to incur the extra ADSO (especially since they were 5 year residencies). I don't think many would agrue that the AD pay is worth the extra obligation and the years of a relative salary cut while on AD relative to civilian docs.

Oh alright, i didn't know it added the years of residency onto your obligation. I suppose it's not that bad if I choose to stay for 20+, but until i've locked in that decision i'd rather avoid a civilian sponsored residency. I'd take it if I got it, but it doesn't sound like such a great deal anymore.

 

[J-Rad]

The couple of friends I have that matched into CS residency slots did not ask for them, and were frustrated to incur the extra ADSO (especially since they were 5 year residencies). I don't think many would agrue that the AD pay is worth the extra obligation and the years of a relative salary cut while on AD relative to civilian docs.

Oh alright, i didn't know it added the years of residency onto your obligation. I suppose it's not that bad if I choose to stay for 20+, but until i've locked in that decision i'd rather avoid a civilian sponsored residency. I'd take it if I got it, but it doesn't sound like such a great deal anymore.

I'd imagine there is a mechanism to turn down the CS residency, but I'm sure it would be at the cost of having to take a PGY-1 only slot. This is a real damned if you do/don't scenario. To come out owing 7-9 years post residency would kind of suck. I think when you get fellowship training out of the deal it's a better deal, but residency only...

 

[AFDuck]

The folks I was referencing matched into surgical subspecialty fields in the AF in which there were very few spots available. I know they both tried to get deferred positions instead, but when told "no" repeatedly by lots of people they were left without other options. You may be right, had they been willing to vacate the CS residency in their field for an intern year (likely with GMO to follow) they may have been allowed to do so. I'm not 100% sure, but I don't think they were willing to go that far to avoid the committment. I guess it was at least some consolation that they would get to practice in their chosen field during their entire payback, and that they got to match at good civilian training programs.

By the way, does anyone have a good answer as to why the AF defers most residency spots they need except for a seemingly random few that are CS? My guess is that there are some specialties every year which someone determines will be an area of need in the future, so they use CS spots to rope these trainees into a long committment. Its a tough call for the residency applicant.

J-rad, why do you think a CS fellowship is a better deal?

 

[NoMoreAMCAS]

So how does a fellowship work then? If you go into it with 5 years left on your obligation do you come out of it with 5 years left on your obligation? Or do you owe the original 5 + the time spent doing the fellowship?

 

[J-Rad]

By the way, does anyone have a good answer as to why the AF defers most residency spots they need except for a seemingly random few that are CS?...

...J-rad, why do you think a CS fellowship is a better deal?

In re your first question: no I don't have a good answer. But if I were very cynical I'd say that there is an incentive to "trap" certain fields into a longer commitment. Especially those that have historically had a high rate of leaving after first commitment for inordinately higher paying civ. jobs. I'd imagine neurosurgery to be one of those. I believe that retention for NSG approaches zero in the AF and there are few AD residencies (one?). There would be a strong incentive to have a new NSG be obligated to 11 years (med school+residency ADSO) vs four (MS only).

As for your second question, the answer is somewhat pragmatic if a little individual-dependent. I think you've gotten more in return when you have the chance to do fellowship after either an AD or deferred residency. Yes, the fellow owes more time than originally, but the CS money opens a lot of doors and the individual has gotten to the highest level of training they (are likely to) want. The CS resident will come out of residency only with the same increase of commitment as the person who got a fellowship out of it. But if they want to do fellowship they can 1)try for a CS fellowship and incur even more ADSO 2)try for a deferred fellowship (if it's available) which won't incur more ADSO (but they still already owe as much as the CS trained fellow) but will be an huge pay cut which can be painful for some (esp. if with family) or 3) wait until their (now-extended) ADSO is up and train as a free civilian-7-11 years after residency taking an even more enormous paycut (probably minimum $50-60,000/yr) and being that much older (even the straight through college-->med school grad is going to be 35-36 years old by the time they're back in fellowship. I'm mid 30s in fellowship, which is OH, but had I done a CS residency in my specialty and waited, I'd have been early 40s at the start of fellowship. Uggh). And speaking of pay, both the CS resident and fellow have the same 1:1 obligation, but the resident only gets base pay, BAS, BAH, and VSP. The CS fellow will have accrued more TIS and is alos eligible for ASP ($15K/yr), single-year ISP (min. $20K/yr), and board cert pay after passing the certifying exam. The fellow is more handsomely compensated (up front) for their incurred ADSO.
Sorry, that last part may have been a little convoluted. Make sense?

 

[J-Rad]

So how does a fellowship work then? If you go into it with 5 years left on your obligation do you come out of it with 5 years left on your obligation? Or do you owe the original 5 + the time spent doing the fellowship?

Go back to that link I posted to the other thread and read the posts I mentioned. Does that answer?

 

[NoMoreAMCAS]

Go back to that link I posted to the other thread and read the posts I mentioned. Does that answer?

My bad, i totally missed that the first time.

Fellowships sound like a great deal. According to that post a person with plenty of obligation left wouldn't occur any additional time after the fellowship (as long as the length of the fellowship does not exceed the length of remaining obligation).

Thanks again.

 

[J-Rad]

My bad, i totally missed that the first time.

Fellowships sound like a great deal. According to that post a person with plenty of obligation left wouldn't occur any additional time after the fellowship (as long as the length of the fellowship does not exceed the length of remaining obligation).

Thanks again.

No, I think you read that wrong (not that it isn't a decent deal, in its own way, for the right person). CS (FTOS for Navy) incur additive obligation. As opposed to an active duty residency/fellowship incurs a 1:1 obligation that is "paid off" concurrently with med school ADSO (active duty service obligation, if not written out previously).

 

[NoMoreAMCAS]

No, I think you read that wrong (not that it isn't a decent deal, in its own way, for the right person). CS (FTOS for Navy) incur additive obligation. As opposed to an active duty residency/fellowship incurs a 1:1 obligation that is "paid off" concurrently with med school ADSO (active duty service obligation, if not written out previously).

I feel like that's what i wrote about fellowships: "According to that post a person with plenty of obligation left wouldn't occur any additional time after the fellowship (as long as the length of the fellowship does not exceed the length of remaining obligation)".

So if you owe 5 years of service going into a 2 years fellowship, you'd still just owe 5 years of service when you finished the fellowship. That correct?

And yeah, the civilian sponsored residencies being additive is pretty weak unless you're dam sure you want to retire from the military.

 

[J-Rad]

I feel like that's what i wrote about fellowships: "According to that post a person with plenty of obligation left wouldn't occur any additional time after the fellowship (as long as the length of the fellowship does not exceed the length of remaining obligation)".

So if you owe 5 years of service going into a 2 years fellowship, you'd still just owe 5 years of service when you finished the fellowship. That correct?

And yeah, the civilian sponsored residencies being additive is pretty weak unless you're dam sure you want to retire from the military.

Unless I have a wire crossed I still think you're only getting 1/2 way. Someone who owes 5 years and does a 2 year fellowship CS/FTOS will owe 7 years of payback. Had their fellowship been in-service or deferred they would pay back (only) the 5 years.

 

[NoMoreAMCAS]

Unless I have a wire crossed I still think you're only getting 1/2 way. Someone who owes 5 years and does a 2 year fellowship CS/FTOS will owe 7 years of payback. Had their fellowship been in-service or deferred they would pay back (only) the 5 years.

Ok, we're definitely on the same page then. I was thinking of fellowships as being all in-service. So there would be no additional time pay back if you're already obligated for a time period longer than the fellowship. I didn't know fellowships could also be CS. Thanks for the heads up.