Does the military actually provide a good education?

[Jolie South]

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I know everyone's jumping on the "what about X specialty?" bandwagon, but I'm going to ask anyways.

How are the IM programs? AF in particular.

 

[The White Coat Investor]

I know everyone's jumping on the "what about X specialty?" bandwagon, but I'm going to ask anyways.

How are the IM programs? AF in particular.

Don't know much about the programs, although they do suffer some I'm sure from the fact that the over 65 crowd is often sent out on the town rather than to the big tertiary care center.

After residency, your inpatient work is VERY limited at most AF hospitals. If you plan to spend your life doing clinic, that's probably not a big deal.

 

[The White Coat Investor]

Chill dude, we get it, you're the big dog. If it's your goal here to intimidate people, such that they don't come back to read/post anything, then you might be succeeding in that light. Otherwise, if you want to convince people of your viewpoint, it would behoove you to take up a gentler tone.

Frankly I don't care if you're convinced. I'm months away from my DD214. I want you to be informed. No one who spends an hour on this forum can say they weren't informed. Most of the docs in my hospital NEVER found a resource like this before signing up. Of my "class" that came into the hospital when I did, 1 is staying in....to do a derm residency. The rest are out this summer...OB....Gen Surg....IM....FP.....Peds....anesthesia (well, he owes a little more time, but has decided not to stay for 20)...radiology...you get the picture. Before you sign up you need to ask yourself....what do these guys know that I don't? Why would they ALL be leaving? Why doesn't ANYONE think this is a good deal?

I've never been diehard military, but when I see diehard military folks getting out....that's bad. Academy grads. ROTC guys. Prior service. People who joined for the RIGHT reason (hint-not money)...still leaving. These docs are good people, good docs, patriotic folks.

So quit with the insults, just think, "Thanks for your perspective" and move on. Hopefully you have an enjoyable career either in or out of the military.

Sincerely,

DUDE, the big dog

 

[IgD]

Frankly I don't care if you're convinced. I'm months away from my DD214. I want you to be informed. No one who spends an hour on this forum can say they weren't informed. Most of the docs in my hospital NEVER found a resource like this before signing up. Of my "class" that came into the hospital when I did, 1 is staying in....to do a derm residency. The rest are out this summer...OB....Gen Surg....IM....FP.....Peds....anesthesia (well, he owes a little more time, but has decided not to stay for 20)...radiology...you get the picture. Before you sign up you need to ask yourself....what do these guys know that I don't? Why would they ALL be leaving? Why doesn't ANYONE think this is a good deal?

It's interesting how military medicine generates so much negative emotion. I wonder what the organizational climate was like in the past. It's not right to me. It would be interesting to look at the retention numbers over the course of several decades. Hey big dog, I'm looking forward to hearing your story. I miss working with service members and their families but not the mind numbing chaos we all face(d) on a daily basis.

 

[Jolie South]

Don't know much about the programs, although they do suffer some I'm sure from the fact that the over 65 crowd is often sent out on the town rather than to the big tertiary care center.

After residency, your inpatient work is VERY limited at most AF hospitals. If you plan to spend your life doing clinic, that's probably not a big deal.

I'm planning on doing a civilian fellowship post payback anyways. I was just curious.

 

[Galo]

I'm planning on doing a civilian fellowship post payback anyways. I was just curious.

Jolie South, let me play devil's advocate, in other words, likely reality esp for AF and Navy. Lets say you encounter the last 3 cycles approximate 25% or higher placement into a GMO/FS position for a minimum of 2 yrs. You then reapply for military residency, and lets just say for goodness sake you get what you want. If you do a medical specialty, its 3 yrs, 4??maybe, (not up on that), lets say its 3. Well, you've done 2 yrs payback as a GMO, then you add up 3 more yrs in the military while you're doing your residency. Then, you have to pay back the 2 you owned for your HPSP commitment. So now you've spent 2 plus 3 plus 2, so that's 7 yrs to the point you can get out. So 7 yrs from now you want to do a fellowship. Throw a marriage and kids into the mix. Now you're going to take the salary of a fellow for 1-2 yrs after being paid the salary of a typical civilian pediatrician/family practitioner?

Here's another scenario not involving signing your life away. You go to residency of your choice, then fellowship of your choice, (granted that you have the ability and competitiveness), THEN, you join the military on more your terms, (that being you're a trained physician in what you want).

I just do not see the benefit to closing the doors of opportunity for what the goverment has to offer, especially having experienced it and its massive mediocrity.

If any of the numbers I put above are WAY off, please someone with current knowledge let me know without any vociferous or psychotic personal attack.

 

[orbitsurgMD]

Jolie South, let me play devil's advocate, in other words, likely reality esp for AF and Navy. Lets say you encounter the last 3 cycles approximate 25% or higher placement into a GMO/FS position for a minimum of 2 yrs. You then reapply for military residency, and lets just say for goodness sake you get what you want. If you do a medical specialty, its 3 yrs, 4??maybe, (not up on that), lets say its 3. Well, you've done 2 yrs payback as a GMO, then you add up 3 more yrs in the military while you're doing your residency. Then, you have to pay back the 2 you owned for your HPSP commitment. So now you've spent 2 plus 3 plus 2, so that's 7 yrs to the point you can get out. So 7 yrs from now you want to do a fellowship. Throw a marriage and kids into the mix. Now you're going to take the salary of a fellow for 1-2 yrs after being paid the salary of a typical civilian pediatrician/family practitioner?

Here's another scenario not involving signing your life away. You go to residency of your choice, then fellowship of your choice, (granted that you have the ability and competitiveness), THEN, you join the military on more your terms, (that being you're a trained physician in what you want).

I just do not see the benefit to closing the doors of opportunity for what the goverment has to offer, especially having experienced it and its massive mediocrity.

If any of the numbers I put above are WAY off, please someone with current knowledge let me know without any vociferous or psychotic personal attack.

The vast majority of med students do not join the military and also do not have a problem with paying off their loans.

Avoiding debt is a common reason to consider HPSP, in fact for many, it is the principal reason (sure, desire to serve is a reason too, but then you could serve just the same without joining HPSP, so debt avoidance is really the primary reason most will join.)

To be certain, you close many more doors to training opportunities than you open by taking a contract. So if you are going to take the contract, it should be with a clear understanding of that fact and with some understandable reason why you are sacrificing the liberty to obtain your residency training without allowing the government to exercise control over your plans. As an exercise, you ought to be able to make a convincing argument to another rational person why taking an HPSP contract is clearly better than taking loans. If you can't convince, then you probably ought to think things over a little longer before picking up a pen to sign and raising your right hand to swear.

Choosing a path of completing your payback as a GMO at the outset is really not a good idea at all. That path is one that should be followed as a last resort, and not as a first choice for your professional career development. If you think that waiting four years to start your PGY2 year is a good idea, then you really betray a lack of understanding of the value of residency training, and just as importantly of the timeliness of that training. The military services, and particularly the Navy, behave as if that were of little consequence. They are wrong to do so, and equally wrong to perpetuate a professional staffing system that so wildly departs from the expectations and standards of modern medical training and practice.

 

[Jolie South]

Jolie South, let me play devil's advocate, in other words, likely reality esp for AF and Navy. Lets say you encounter the last 3 cycles approximate 25% or higher placement into a GMO/FS position for a minimum of 2 yrs. You then reapply for military residency, and lets just say for goodness sake you get what you want. If you do a medical specialty, its 3 yrs, 4??maybe, (not up on that), lets say its 3. Well, you've done 2 yrs payback as a GMO, then you add up 3 more yrs in the military while you're doing your residency. Then, you have to pay back the 2 you owned for your HPSP commitment. So now you've spent 2 plus 3 plus 2, so that's 7 yrs to the point you can get out. So 7 yrs from now you want to do a fellowship. Throw a marriage and kids into the mix. Now you're going to take the salary of a fellow for 1-2 yrs after being paid the salary of a typical civilian pediatrician/family practitioner?

Here's another scenario not involving signing your life away. You go to residency of your choice, then fellowship of your choice, (granted that you have the ability and competitiveness), THEN, you join the military on more your terms, (that being you're a trained physician in what you want).

I just do not see the benefit to closing the doors of opportunity for what the goverment has to offer, especially having experienced it and its massive mediocrity.

If any of the numbers I put above are WAY off, please someone with current knowledge let me know without any vociferous or psychotic personal attack.

Well, that's fine and dandy, but I'm already HPSP and as far as I'm aware, IM is one of the easier specialties to train straight through.

 

[Gastrapathy]

Well, that's fine and dandy, but I'm already HPSP and as far as I'm aware, IM is one of the easier specialties to train straight through.

IM is noncompetitive and training straight through is reasonably likely (and its 3 years, as I'm sure you know). Actually, doing IM fellowship within the military is quite a good deal if you can get it straight-through and the training is adequate, by and large. You are paid about 3 times what other fellows are paid and you end up with only an extra year of commitment (assuming a 3 year fellowship) if you get to go straight through fellowship.

Personally, if you're already in, I'd recommend applying for IM fellowship (unless you want a sub-subspecialty like Interventional Cards or Liver transplant). If you don't get it first try, get out and do it but if you do get it, its probably worth it. Plus, payback as a subspecialist is definitely better.

 

[Galo]

The vast majority of med students do not join the military and also do not have a problem with paying off their loans.

Avoiding debt is a common reason to consider HPSP, in fact for many, it is the principal reason (sure, desire to serve is a reason too, but then you could serve just the same without joining HPSP, so debt avoidance is really the primary reason most will join.)

To be certain, you close many more doors to training opportunities than you open by taking a contract. So if you are going to take the contract, it should be with a clear understanding of that fact and with some understandable reason why you are sacrificing the liberty to obtain your residency training without allowing the government to exercise control over your plans. As an exercise, you ought to be able to make a convincing argument to another rational person why taking an HPSP contract is clearly better than taking loans. If you can't convince, then you probably ought to think things over a little longer before picking up a pen to sign and raising your right hand to swear.

Choosing a path of completing your payback as a GMO at the outset is really not a good idea at all. That path is one that should be followed as a last resort, and not as a first choice for your professional career development. If you think that waiting four years to start your PGY2 year is a good idea, then you really betray a lack of understanding of the value of residency training, and just as importantly of the timeliness of that training. The military services, and particularly the Navy, behave as if that were of little consequence. They are wrong to do so, and equally wrong to perpetuate a professional staffing system that so wildly departs from the expectations and standards of modern medical training and practice.

This statement should be stickied somewhere. I still fail to comprehend how so many people sign up with such enthusiasm. I bet the vast MAJORITY DO NOT KNOW THIS TO BE FACT!!

 

[Jolie South]

IM is noncompetitive and training straight through is reasonably likely (and its 3 years, as I'm sure you know). Actually, doing IM fellowship within the military is quite a good deal if you can get it straight-through and the training is adequate, by and large. You are paid about 3 times what other fellows are paid and you end up with only an extra year of commitment (assuming a 3 year fellowship) if you get to go straight through fellowship.

Personally, if you're already in, I'd recommend applying for IM fellowship (unless you want a sub-subspecialty like Interventional Cards or Liver transplant). If you don't get it first try, get out and do it but if you do get it, its probably worth it. Plus, payback as a subspecialist is definitely better.

Thanks for the thoughts. Right now, I'm most into GI and ID. We'll see what happens when I start rotations.

 

[DeadCactus]

I still fail to comprehend how so many people sign up with such enthusiasm.

Really? I mean the HPSP isn't for me, but it's not hard to see why people sign up for it.

a) The majority of people making the decision are doing so before MS1.

That's long before they have (if they even will) stumble across SDN, let alone the Military Medicine forum under the Physician/Resident heading. Add onto this that those who do find SDN are assaulted by just any many voices telling them not to go into medicine at all. Grqanted that at least medicine has a sizeable number of proponents, but ultimately the SDNers in a position to accept HPSP have basically been conditioned to tune out the "nay-sayers" on SDN and label them (whether accurately or not) as "whiners".

b) It's a population of 22 year olds with college degrees facing another decade of no income and mounting debt.

As an MS1, I've yet to have a single day where the academic load made me question medical school. Realizing that I'm driving around on worn out break-pads because I can't bring myself to part with the $100 to get them replaced while people I graduated with are posting on facebook about their trip to pick up their new BMW is a pretty regular kick in the balls though.

You can talk about how in the long run you are worse off financially, but there is something to be said for being 22 and knowing you now have an income and health insurance. Even more attractive is the knowledge that at 26 you will have an income high enough to comfortably support a family on especially without loans to be concerned with. The point is, there is an emotional value to the extra money and lack of debt that isn't accounted for in a simple NPW analysis.

c) In the grand scheme of things, the worst case scenario is a 4 year period as a GMO which isn't that bad. To your pre-med just eager to be a physician and used to having no-income, four years of being a physician for decent money and getting to do a few "cool" military things isn't that bad of a scenario. Sure once you're there, that perspective changes because your baseline is now being a physician. The perceived difference between being a GMO and being a residency trained physician making civilian money is much greater from the GMO perspective than from the pre-med perspective.

d) All of this is often tempered by a personal desire to serve in the military.

In short, people take HPSP because they are willing to trade (either from ignorance or personal preferences) financial security in the present for financial gains and professional freedom in the future. It wasn't the right path for me, but I can see why it appeals to others. Financially and professionally it doesn't make sense. The same can be argued about medicine as a career, though. On a personal level, it probably makes a lot of sense to a lot of people...

 

[IgD]

c) In the grand scheme of things, the worst case scenario is a 4 year period as a GMO which isn't that bad. To your pre-med just eager to be a physician and used to having no-income, four years of being a physician for decent money and getting to do a few "cool" military things isn't that bad of a scenario. Sure once you're there, that perspective changes because your baseline is now being a physician. The perceived difference between being a GMO and being a residency trained physician making civilian money is much greater from the GMO perspective than from the pre-med perspective.

Put that in an envelope, seal it and open it up again half way through your internship.

 

[BigNavyPedsGuy]

Really? I mean the HPSP isn't for me, but it's not hard to see why people sign up for it.

a) The majority of people making the decision are doing so before MS1.

That's long before they have (if they even will) stumble across SDN, let alone the Military Medicine forum under the Physician/Resident heading. Add onto this that those who do find SDN are assaulted by just any many voices telling them not to go into medicine at all. Grqanted that at least medicine has a sizeable number of proponents, but ultimately the SDNers in a position to accept HPSP have basically been conditioned to tune out the "nay-sayers" on SDN and label them (whether accurately or not) as "whiners".

b) It's a population of 22 year olds with college degrees facing another decade of no income and mounting debt.

As an MS1, I've yet to have a single day where the academic load made me question medical school. Realizing that I'm driving around on worn out break-pads because I can't bring myself to part with the $100 to get them replaced while people I graduated with are posting on facebook about their trip to pick up their new BMW is a pretty regular kick in the balls though.

You can talk about how in the long run you are worse off financially, but there is something to be said for being 22 and knowing you now have an income and health insurance. Even more attractive is the knowledge that at 26 you will have an income high enough to comfortably support a family on especially without loans to be concerned with. The point is, there is an emotional value to the extra money and lack of debt that isn't accounted for in a simple NPW analysis.

c) In the grand scheme of things, the worst case scenario is a 4 year period as a GMO which isn't that bad. To your pre-med just eager to be a physician and used to having no-income, four years of being a physician for decent money and getting to do a few "cool" military things isn't that bad of a scenario. Sure once you're there, that perspective changes because your baseline is now being a physician. The perceived difference between being a GMO and being a residency trained physician making civilian money is much greater from the GMO perspective than from the pre-med perspective.

d) All of this is often tempered by a personal desire to serve in the military.

In short, people take HPSP because they are willing to trade (either from ignorance or personal preferences) financial security in the present for financial gains and professional freedom in the future. It wasn't the right path for me, but I can see why it appeals to others. Financially and professionally it doesn't make sense. The same can be argued about medicine as a career, though. On a personal level, it probably makes a lot of sense to a lot of people...

This is one of the most thoughtful, well written posts I've ever seen on this forum. I'm sure you care about how I judge your post so I made sure to tell you. 🙂

 

[orbitsurgMD]

Really? I mean the HPSP isn't for me, but it's not hard to see why people sign up for it.

a) The majority of people making the decision are doing so before MS1.
< . . . >

b) It's a population of 22 year olds with college degrees facing another decade of no income and mounting debt.

< . . . >

You can talk about how in the long run you are worse off financially, but there is something to be said for being 22 and knowing you now have an income and health insurance. Even more attractive is the knowledge that at 26 you will have an income high enough to comfortably support a family on especially without loans to be concerned with. The point is, there is an emotional value to the extra money and lack of debt that isn't accounted for in a simple NPW analysis.

c) In the grand scheme of things, the worst case scenario is a 4 year period as a GMO which isn't that bad. . . .

d) All of this is often tempered by a personal desire to serve in the military.

In short, people take HPSP because they are willing to trade (either from ignorance or personal preferences) financial security in the present for financial gains and professional freedom in the future.

[Bolds mine]

Proven to work, at least it was for awhile. It is surely what they are counting on down at BUMED for more warm bodies in the GMO pipeline.

 

[dsdoc15]

So my question is this. If state side we constantly here about the IED explosions and MCI's occurring, and having seen 15 alumni from my alma mater dead from similar blasts, where do all these trauma type of cases go? With what appears to be a high incidence of attacks on American troops, who performs the procedures on our soldiers and sees these cases?

The questions stems from what appears to be a pretty consistent statement from previous AD physicians that being deployed doesn't necessarily correlate to more procedures. I am another pre-med facing the civilian/USUHS/HPSP decision currently who is currently applying for a fall '10 slot. Thanks

 

[BigNavyPedsGuy]

So my question is this. If state side we constantly here about the IED explosions and MCI's occurring, and having seen 15 alumni from my alma mater dead from similar blasts, where do all these trauma type of cases go? With what appears to be a high incidence of attacks on American troops, who performs the procedures on our soldiers and sees these cases?

The questions stems from what appears to be a pretty consistent statement from previous AD physicians that being deployed doesn't necessarily correlate to more procedures. I am another pre-med facing the civilian/USUHS/HPSP decision currently who is currently applying for a fall '10 slot. Thanks

There aren't that high of a percent of incidents. Look at Iraq: if there are say 5 roadside blasts in a week that's a huge amount these days (it wasn't a couple years ago, but today it is). There are ~130000 troops in Iraq if 20 guys were injured in each of these blasts, that makes about 100 casualties/week. That's less than 0.01% of the population of troops that's affected. You might get some trauma action, but statistically you won't.

 

[Galo]

Really? I mean the HPSP isn't for me, but it's not hard to see why people sign up for it.

a) The majority of people making the decision are doing so before MS1.

That's long before they have (if they even will) stumble across SDN, let alone the Military Medicine forum under the Physician/Resident heading. Add onto this that those who do find SDN are assaulted by just any many voices telling them not to go into medicine at all. Grqanted that at least medicine has a sizeable number of proponents, but ultimately the SDNers in a position to accept HPSP have basically been conditioned to tune out the "nay-sayers" on SDN and label them (whether accurately or not) as "whiners".

b) It's a population of 22 year olds with college degrees facing another decade of no income and mounting debt.

As an MS1, I've yet to have a single day where the academic load made me question medical school. Realizing that I'm driving around on worn out break-pads because I can't bring myself to part with the $100 to get them replaced while people I graduated with are posting on facebook about their trip to pick up their new BMW is a pretty regular kick in the balls though.

You can talk about how in the long run you are worse off financially, but there is something to be said for being 22 and knowing you now have an income and health insurance. Even more attractive is the knowledge that at 26 you will have an income high enough to comfortably support a family on especially without loans to be concerned with. The point is, there is an emotional value to the extra money and lack of debt that isn't accounted for in a simple NPW analysis.

c) In the grand scheme of things, the worst case scenario is a 4 year period as a GMO which isn't that bad. To your pre-med just eager to be a physician and used to having no-income, four years of being a physician for decent money and getting to do a few "cool" military things isn't that bad of a scenario. Sure once you're there, that perspective changes because your baseline is now being a physician. The perceived difference between being a GMO and being a residency trained physician making civilian money is much greater from the GMO perspective than from the pre-med perspective.

d) All of this is often tempered by a personal desire to serve in the military.

In short, people take HPSP because they are willing to trade (either from ignorance or personal preferences) financial security in the present for financial gains and professional freedom in the future. It wasn't the right path for me, but I can see why it appeals to others. Financially and professionally it doesn't make sense. The same can be argued about medicine as a career, though. On a personal level, it probably makes a lot of sense to a lot of people...

I have to agree with others, very well put, and very insightfull. I see alot of myself in that, except when I signed up, I still had a sick desire to go to flight school, (and was actually offered it), plus the medical centers were actually medical centers that were run by department head PHYSICIANS, where it appeared excellence was demanded, and things seemed great all around. I certainly needed the $$$$.

The only thing that kept me from going to UPT was the fact I was not guaranteed a fighter slot. I thought I would go insane flying a heavy. It was the same for medicine. I knew I was going to be a surgeon. If someone told me today that I had a 25-30% chance of having to wait 4 yrs, I doubt I would do it.


The only thing I don't get, is how these premeds are not finding this site?? In this days of the internet, how could you not try and search a little.

Anyways, you've hit the military's recruitment strategy square on the head. Keep you keen insight, it will serve you well, especially since you are not going into military medicine.

 

[NK1Positive]

Really? I mean the HPSP isn't for me, but it's not hard to see why people sign up for it.

a) The majority of people making the decision are doing so before MS1.

SDNers in a position to accept HPSP have basically been conditioned to tune out the "nay-sayers" on SDN and label them (whether accurately or not) as "whiners".

b) It's a population of 22 year olds with college degrees facing another decade of no income and mounting debt.


You can talk about how in the long run you are worse off financially, but there is something to be said for being 22 and knowing you now have an income and health insurance. Even more attractive is the knowledge that at 26 you will have an income high enough to comfortably support a family on especially without loans to be concerned with. The point is, there is an emotional value to the extra money and lack of debt that isn't accounted for in a simple NPW analysis.

This is exactly where I am, I couldn't have said it any better. I've been talking to the BAMC Anesthesia PD and he seems to make it sound pretty good. But going with my instincts, avoiding HPSP, will probably serve me right 8 years down the road... Thanks guys!

Now hopefully healthcare reform doesnt kick anesthesia salaries down 67% which has been mentioned in the Anesthesiology forum...

 

[notdeadyet]

Now hopefully healthcare reform doesnt kick anesthesia salaries down 67% which has been mentioned in the Anesthesiology forum...

Going by that forum, anesthesia salaries have been going down 67% for years. Before healthcare reform being the culprit that was going to bring down the specialty, it was nurse anesthesists. The skies always falling over there.

 

[psychbender]

Going by that forum, anesthesia salaries have been going down 67% for years. Before healthcare reform being the culprit that was going to bring down the specialty, it was nurse anesthesists. The skies always falling over there.

While it is always falling over there, there are some legit concerns this political season. It seems that time and time again, someone presents a version of their healthcare bill which includes a public option tied to Medicare rates, which reimburse Anesthesiology services at 33% market rates (no other specialty comes close to that kind of a drop). Each time it comes up, that part gets negotiated out of the bill, but it is still a valid concern (though should not be enough of a concern to make you decide to join the military).

 

[narcusprince]

While it is always falling over there, there are some legit concerns this political season. It seems that time and time again, someone presents a version of their healthcare bill which includes a public option tied to Medicare rates, which reimburse Anesthesiology services at 33% market rates (no other specialty comes close to that kind of a drop). Each time it comes up, that part gets negotiated out of the bill, but it is still a valid concern (though should not be enough of a concern to make you decide to join the military).

As a resident at a civi program. My classmates are fielding jobs in the 350-300 range. From the most recent legislation the public option wont even be set by medicaire medicaid rates and will be based on market rates. I am currently rotating at a private practice hospital and had some talks with the big wigs. And they state that most anesthesia services in hospital's are subsidized by the hospital. If you look at anesthesia services based on base units you could never clear a profit, without fast surgeons. Also a lot of the talk comes from supply and demand. Many of the old farts in the forum see a lot of young residents going into anesthesia and would like to see our numbers decline, in order to maximize profits for themselves. If you know anything about the surgical boom in the late 90's, which overnight created a need for anesthesia services, salaries skyrocketed. This could be the scenario if the public option is enacted in the next couple of years, even with CRNA's AA's MD's we ALL cannot provide enough services to cover everyone. My belief is anesthesia is clear for the foreseeable future.

 

[psychbender]

My belief is anesthesia is clear for the foreseeable future.

As is mine. I was just trying to explain the rationale behind the 67% decrease reported, as most people are not aware of that issue, and would understandably be confused.

 

[Mace1370]

I'm currently an MS1 at USUHS. This thread has been very helpful to me, but it has raised a few questions:

1) People keep mentioning that it is likely USUHS grads have to do GMO tours. I am Army, and was told by many people that I will not have to do a GMO tour. I realize that since this is the military anything can be done with me, but the impression I got was that 99% of USUHS Army grads are not forced to do a GMO (assuming they match). How true is this?

2) My commitment after residency is 7 years. I'm a little confused about how fellowships play into this. I think that fellowships increase your commitment, but by how much? Right now I'm interested in either IM (with a fellowship) or Radiology (maybe with a fellowship). The IM residency is 3 years and does not extend my commitment (I think), but doing a fellowship will?

3) I've talked to a good number of 4th year students and none of them can give me a straight answer regarding competitiveness of Army residencies. Is that because they change drastically each year?

 

[psychbender]

I'm currently an MS1 at USUHS. This thread has been very helpful to me, but it has raised a few questions:

1) People keep mentioning that it is likely USUHS grads have to do GMO tours. I am Army, and was told by many people that I will not have to do a GMO tour. I realize that since this is the military anything can be done with me, but the impression I got was that 99% of USUHS Army grads are not forced to do a GMO (assuming they match). How true is this?

OK, you've got two contradictory statements there. In the Army, you generally do a GMO tour if you do not match for continual training, or after you finish training (Peds, IM, EM, etc folk being deployed as "Battalion Surgeons"). If the USUHS grads match, then they should, by default, not do a GMO tour. The issue is whether or not they stand a higher or lower chance of matching. For that, you have to look at the JSGMESB rubric. Most all students will earn the same number of points, with a few outliers for things like prior service (likely more prevalent in USUHS than HPSP) and research. Further, USUHS students do almost all of their rotations in the military medicine network, so should have more face time with the programs and residents/attendings. This may have some effect on residency selection.

2) My commitment after residency is 7 years. I'm a little confused about how fellowships play into this. I think that fellowships increase your commitment, but by how much? Right now I'm interested in either IM (with a fellowship) or Radiology (maybe with a fellowship). The IM residency is 3 years and does not extend my commitment (I think), but doing a fellowship will?

Fellowship payback is year-for-year, minimum 2 years. So, if you do a 3 years fellowship, then you will incur three additional years of educational service obligation. If your fellowship is only 1 year, then you incur 2 years ADSO. This is added to the ADSO for residency training, and concurrent with your USUHS obligation. Let's say you get IM, and manage to get Cards straight through. You incur a 2 year ADSO for IM (remember, intern year does not add to your obligation), plus a 3 year ADSO for Cards, making your total obligation 5 years. Your USUHS obligation is 7 years, so it does not effect your post-training payback (total time in service 13 years). Even if you do a 2 year utilization tour after residency, it remains the same. Your utilization tour removes 2 years from your USUHS obligation (down to 5), while concurrently paying back your full obligation from the IM residency. Now, you incur an additional 3 years for the fellowship, which is still less than 5, so your overall obligation is not extended (total time in service still 13 years). Due to your longer base service obligation, you essentially get a "free" fellowship, without extending the amount of time that you spend in the military.

3) I've talked to a good number of 4th year students and none of them can give me a straight answer regarding competitiveness of Army residencies. Is that because they change drastically each year?

Yes, competitiveness changes drastically each year. There should be a powerpoint on MODS that shows the applicant:acceptance ratio for each specialty for the past several years. Based on information I have been told by certain attendings, I have reason to doubt the true validity of those numbers, they can at least give you a general idea of the trends.

 

[Mace1370]

OK, you've got two contradictory statements there. In the Army, you generally do a GMO tour if you do not match for continual training, or after you finish training (Peds, IM, EM, etc folk being deployed as "Battalion Surgeons"). If the USUHS grads match, then they should, by default, not do a GMO tour. The issue is whether or not they stand a higher or lower chance of matching. For that, you have to look at the JSGMESB rubric. Most all students will earn the same number of points, with a few outliers for things like prior service (likely more prevalent in USUHS than HPSP) and research. Further, USUHS students do almost all of their rotations in the military medicine network, so should have more face time with the programs and residents/attendings. This may have some effect on residency selection.

Ah ok, I think I was a little confused about how GMOs worked. I was under the impression that it was possible for someone to match but then be told "go do a GMO for 2 years first" anyways.

How commonly are Army students who finish their IM or radiology residency sent off to be battalion surgeons? If you wanted to do a fellowship, is there a chance you would be told you have to be a battalion surgeon first? Or are all fellowships "straight through"?

Fellowship payback is year-for-year, minimum 2 years. So, if you do a 3 years fellowship, then you will incur three additional years of educational service obligation. If your fellowship is only 1 year, then you incur 2 years ADSO. This is added to the ADSO for residency training, and concurrent with your USUHS obligation. Let's say you get IM, and manage to get Cards straight through. You incur a 2 year ADSO for IM (remember, intern year does not add to your obligation), plus a 3 year ADSO for Cards, making your total obligation 5 years. Your USUHS obligation is 7 years, so it does not effect your post-training payback (total time in service 13 years). Even if you do a 2 year utilization tour after residency, it remains the same. Your utilization tour removes 2 years from your USUHS obligation (down to 5), while concurrently paying back your full obligation from the IM residency. Now, you incur an additional 3 years for the fellowship, which is still less than 5, so your overall obligation is not extended (total time in service still 13 years). Due to your longer base service obligation, you essentially get a "free" fellowship, without extending the amount of time that you spend in the military.

This explains it very well. Thanks. Is the ADSO for all residencies 2 years, or does it vary with length of residency?

EDIT: Wait, I think I figured it out. The 3 years for IM includes internship, right? So that's how you came up with 2 years ADSO for IM? So I assume that means that each year of residency adds 1 year ADSO, but you pay it off concurrently with your USUHS obligation. IIRC, Radiology is 5 years, so that's 4 years ADSO. Assuming you do a 2 year fellowship (say interventional) that is a total of 6 year ADSO paid off concurrently with the 7 year USUHS commitment. So interventional is a "free" fellowship, too? I may have the numbers all wrong, though.

Yes, competitiveness changes drastically each year. There should be a powerpoint on MODS that shows the applicant:acceptance ratio for each specialty for the past several years. Based on information I have been told by certain attendings, I have reason to doubt the true validity of those numbers, they can at least give you a general idea of the trends.

I have been wary of military power points ever since they showed us one at BAMC that showed totals about how much money you would be making once you had your specialty and 25 odd years in service. These numbers were touted to be "way huge" and a "great reason" for joining the military. They obviously didn't show comparative civilian numbers.

 

[J-Rad]

Fellowship payback is year-for-year, minimum 2 years. So, if you do a 3 years fellowship, then you will incur three additional years of educational service obligation. If your fellowship is only 1 year, then you incur 2 years ADSO. This is added to the ADSO for residency training, and concurrent with your USUHS obligation. Let's say you get IM, and manage to get Cards straight through. You incur a 2 year ADSO for IM (remember, intern year does not add to your obligation), plus a 3 year ADSO for Cards, making your total obligation 5 years. Your USUHS obligation is 7 years, so it does not effect your post-training payback (total time in service 13 years). Even if you do a 2 year utilization tour after residency, it remains the same. Your utilization tour removes 2 years from your USUHS obligation (down to 5), while concurrently paying back your full obligation from the IM residency. Now, you incur an additional 3 years for the fellowship, which is still less than 5, so your overall obligation is not extended (total time in service still 13 years). Due to your longer base service obligation, you essentially get a "free" fellowship, without extending the amount of time that you spend in the military.

Though coming from the Air Force perspective, there is something suspect about the above. I am aware of variability in the way the individual services may structure ADSOs, but this seems to run pretty far afield. At a minimum it overly simplifies in not breaking down the three routes that one may complete a fellowship and their different "cost" to the member. One may complete a fellowship while on active duty and at a civilian institution ("civilian sponsored" in the AF or "full time outservice [FTOS]" in the Navy), deferred (temporarily released) from active duty training in a civilian institution, or active duty at a military training program. Each is likely to have different payback (though the specifics may vary per service). In the AF a civilian sponsored fellowship ADSO is additive. So, for example, someone doing 4 year HPSP followed by 3year military residency and a CS fellowship will pay back seven years. There will be four years payback for med school which will run concurrent with both the 3 year [other] ADSO everyone on HPSP accrues in med school [why even 2yr HPSP owes three years] and the three year ADSO accrued from residency done in the military. Additive to that is the three years accrued from the CS fellowship. I believe that had the fellowship been done active duty in a military facility then there would be a 1:1 ADSO for the years of fellowship but this ADSO is concurrent with the others (so this hypothetical person will pay back in four years, paying off four concurrent ADSOs). A deferred civilian fellowship incurs no ADSO and so the payback after completion of training is also four years (paying off three concurrent ADSOs). As for the USUHS grads, where I think the above diverges from fact would be someone who completes a CS/FTOS fellowship; I'm pretty sure their ADSO would be additive to their up-front 7 year payback (the other two scenarios would not change payback time). I claim no expertise here, but may someone with more experience on the Army side, like A1Qwerty could weigh in.

 

[Jolie South]

Though coming from the Air Force perspective, there is something suspect about the above. I am aware of variability in the way the individual services may structure ADSOs, but this seems to run pretty far afield. At a minimum it overly simplifies in not breaking down the three routes that one may complete a fellowship and their different "cost" to the member. One may complete a fellowship while on active duty and at a civilian institution ("civilian sponsored" in the AF or "full time outservice [FTOS]" in the Navy), deferred (temporarily released) from active duty training in a civilian institution, or active duty at a military training program. Each is likely to have different payback (though the specifics may vary per service). In the AF a civilian sponsored fellowship ADSO is additive. So, for example, someone doing 4 year HPSP followed by 3year military residency and a CS fellowship will pay back seven years. There will be four years payback for med school which will run concurrent with both the 3 year [other] ADSO everyone on HPSP accrues in med school [why even 2yr HPSP owes three years] and the three year ADSO accrued from residency done in the military. Additive to that is the three years accrued from the CS fellowship. I believe that had the fellowship been done active duty in a military facility then there would be a 1:1 ADSO for the years of fellowship but this ADSO is concurrent with the others (so this hypothetical person will pay back in four years, paying off four concurrent ADSOs). A deferred civilian fellowship incurs no ADSO and so the payback after completion of training is also four years (paying off three concurrent ADSOs). As for the USUHS grads, where I think the above diverges from fact would be someone who completes a CS/FTOS fellowship; I'm pretty sure their ADSO would be additive to their up-front 7 year payback (the other two scenarios would not change payback time). I claim no expertise here, but may someone with more experience on the Army side, like A1Qwerty could weigh in.

Just to make sure I understand, a 4 year HPSP + <4 year residency + say a 3 year military fellowship would accrue 4 ADSO years because all obligations are concurrent. Whereas, if a 3 year civilian fellowship is done instead, the 3 year ADSO is added to the 4 year payback for a total ADSO of 7 years?

 

[IgD]

Just to make sure I understand, a 4 year HPSP + <4 year residency + say a 3 year military fellowship would accrue 4 ADSO years because all obligations are concurrent. Whereas, if a 3 year civilian fellowship is done instead, the 3 year ADSO is added to the 4 year payback for a total ADSO of 7 years?

The problem is you will have to do a GMO and utilization tour. So it is more like internship then GMO tour then residency then utilization tour then fellowship then payback.

 

[Jolie South]

The problem is you will have to do a GMO and utilization tour. So it is more like internship then GMO tour then residency then utilization tour then fellowship then payback.

ok, gotcha. That's what I thought, but he made it sound so simple.

 

[IgD]

ok, gotcha. That's what I thought, but he made it sound so simple.

One military medicine official described it as a dirty little secret. Let's say you finish residency with a 4 year payback. You do a 3 year utilization tour and now your obligation is down to 1 year. However you do a 2 year fellowship and your payback is up to 2 again. What do you think?

 

[orbitsurgMD]

One military medicine official described it as a dirty little secret. Let's say you finish residency with a 4 year payback. You do a 3 year utilization tour and now your obligation is down to 1 year. However you do a 2 year fellowship and your payback is up to 2 again. What do you think?

I think it is one reason scholarships aren't competitive to get anymore.

 

[DrMetal]

I think it is one reason scholarships aren't competitive to get anymore.

Well, I mean look, the military is trying to get its bang for the buck here too, right? They can't just allow you to do a fellowship and GTFO after only a year post-fellowship? That would be poor utilization of a specialist and a loss to the AD community.

Suppose I'm an internist with 1 year payback left, and I do a inservice cards or GI fellowship (3 years, during which I'd get paid as a staff, senior O-4 at around ~16 yrs service, with high BAH in either San Dog or Bethesda, = civilian equivalent of a ~$150-$200K salary, for a fellow!). That's a pretty sweet deal for training.

So of course they're going to up my payback to 3 or 4 years (i forget what is it exactly). They're not just going to allow me to payback 1 year as a GI and GTFO! (If they did, that'd be the scam of a lifetime). So this makes sense. Or am I missing something here???

 

[BigNavyPedsGuy]

Well, I mean look, the military is trying to get its bang for the buck here too, right? They can't just allow you to do a fellowship and GTFO after only a year post-fellowship? That would be poor utilization of a specialist and a loss to the AD community.

Suppose I'm an internist with 1 year payback left, and I do a inservice cards or GI fellowship (3 years, during which I'd get paid as a staff, senior O-4 at around ~16 yrs service, with high BAH in either San Dog or Bethesda, = civilian equivalent of a ~$150-$200K salary, for a fellow!). That's a pretty sweet deal for training.

So of course they're going to up my payback to 3 or 4 years (i forget what is it exactly). They're not just going to allow me to payback 1 year as a GI and GTFO! (If they did, that'd be the scam of a lifetime). So this makes sense. Or am I missing something here???

The problem isn't really the payback, it's the gap (utilization tour) before the fellowship. People pay back most of their time and then WHAM! If I had been an HPSP student that went straght through Peds residency (3yr) and then right to a FTOS fellowship (3 yrs), my payback would've been 5 years total b/c GME and school run concurrently. But with GMOs and utilization tours that payback time can easily get stretched out to 7-8 years because people pay back most of the their school obligation AND THEN add more GME obligation; in effect making the payback consecutive rather than concurrent.

In the civilian world about 90% of people roll strait from GME to fellowship. That's rare in the military.

 

[J-Rad]

ok, gotcha. That's what I thought, but he made it sound so simple.

One military medicine official described it as a dirty little secret. Let's say you finish residency with a 4 year payback. You do a 3 year utilization tour and now your obligation is down to 1 year. However you do a 2 year fellowship and your payback is up to 2 again. What do you think?

The problem is you will have to do a GMO and utilization tour. So it is more like internship then GMO tour then residency then utilization tour then fellowship then payback.

Sorry, I should have specified that I was doing a little simplification of my own (not unjustified, however, since you can get into an infinite number of combinations of X years GMO, X years utilization tour, then Y fellowship on A, B, or C funding). The structure of my example is that of one who does fellowship right after residency. The ultimate point was that some paths to fellowship accrue an additive (time) debt and others don't. Certainly it's reasonable to keep in mind that, for those who do not go straight through to fellowship, that time-debt can be re-accrued after some paydown.
Tangentially, I'd like to mention a few service-specific things: in my anecdotal experience it seems as if the likelihood of getting fellowship right after residency (at least from the less competitive primary specialties like IM or peds) is much higher in the AF than the Navy (no clue about Army). Likewise, as of recently, the likelihood of getting a civilian sponsored/FTOS fellowship is far more likely in the AF than Navy (with Navy putting out more deferred positions and encouraging use of the FAP for additional funding [luring into more ADSO😉]. I do wonder if the Army and AF will follow suit in the future as from a purely financial standpoint it makes sense. Last service-specific item, since Jolie is AF (correct?), while there is a substantially higher likelihood of GMO tours than in years past, it is still far less than in the Navy and for many is not a great factor in payback.

Caveat to my tangent: while upfront there seem to be some advantages to pursuing the AF route over Navy, that comes at a cost. I agree with those that criticize the robustness of AF GME (in my personal experience both Navy's [firsthand experience] and Army's [secondhand experience] GME is more robust. I would also agree that the AF has a well deserved reputation for officiousness. Then there is the Keesler issue, which is beyond the purview of this tangent.

 

[ftrflyr29]

One military medicine official described it as a dirty little secret. Let's say you finish residency with a 4 year payback. You do a 3 year utilization tour and now your obligation is down to 1 year. However you do a 2 year fellowship and your payback is up to 2 again. What do you think?

The military loves the 4 year commitment in terms of PCS'ing as well. Say you take HPSP for 4 years, do your 3 year utilization tour, then owe 1 year. If they decide not to extend you at your current duty location and PCS you, you will owe 2 years for the PCS also.

An issue I've seen here a lot is, if you don't want to PCS because you are getting out, the Navy is happy to extend you for your last year, but that rockets you to the top of the short list for the IA. And since you can't drop your letter to get out until 9-12 mos prior, you will have most likely declined your orders before that, sharing with the detailer that you are getting out. One would think if I'm getting out in say.....14 months there's not much they can do with me, but alas there's so much they're happy to do with you! There's a first class ticket to any 'Stan out there for 6,9, even 12 months. Yes, they will send you for 12 months just prior to getting out. A guy I know was told, "we are only required to have you back within 7 days of your EOAS (end of obligated active service)."

So, I'm thinking on the 1-to-suck scale that would definitely suck for doing residency interviews and/or job hunting. 👎

 

[J-Rad]

The military loves the 4 year commitment in terms of PCS'ing as well...

This is an excellent point as well. This can be a particularly nasty thing to deal with for those who are biding their time to get out while simultaneously serving their time at a duty station they hate. And it seems that there are plenty of duty stations to hate (esp. smaller bases/commands).

 

[ftrflyr29]

This is an excellent point as well. This can be a particularly nasty thing to deal with for those who are biding their time to get out while simultaneously serving their time at a duty station they hate. And it seems that there are plenty of duty stations to hate (esp. smaller bases/commands).

in my community we call it.....getting hooked up the Navy way, they shove a 20-foot pole up your ass, pull it out 1 foot at a time and you think you're getting a good deal

 

[Gastrapathy]

Fellowship obligation often causes confusion.

You basically have two obligations that run concurrently, your pre-GME2 obligation and your GME2+ obligation. Whichever is longer becomes the one that matters.

Inservice residency and fellowship accrue a year for year obligation (minimum of 2 years) that is concurrent with your pre-GME2 obligation. So, if a USUHS student is lucky enough to train straight-through inservice residency and fellowship, its true that they don't increase their obligation beyond the 7 years they already owe. Outservice sponsored fellowships are added to the pre-GME2 obligation and served consecutively. Deferment doesn't add committment but you aren't paid to do it.

The issue is that almost no one trains straight-through both residency and fellowship without a utilization tour. I heard that my specialty had twice as many applicants currently on utilization tours as spots, let alone resident applicants (who I would assume are hosed).

BTW, the rules for fellowship commitment used to be much friendlier. The law didn't change but the interpretation did around 2004.

 

[Gastrapathy]

Well, I mean look, the military is trying to get its bang for the buck here too, right? They can't just allow you to do a fellowship and GTFO after only a year post-fellowship? That would be poor utilization of a specialist and a loss to the AD community.

Suppose I'm an internist with 1 year payback left, and I do a inservice cards or GI fellowship (3 years, during which I'd get paid as a staff, senior O-4 at around ~16 yrs service, with high BAH in either San Dog or Bethesda, = civilian equivalent of a ~$150-$200K salary, for a fellow!). That's a pretty sweet deal for training.

So of course they're going to up my payback to 3 or 4 years (i forget what is it exactly). They're not just going to allow me to payback 1 year as a GI and GTFO! (If they did, that'd be the scam of a lifetime). So this makes sense. Or am I missing something here???

What you are missing is that very few people bide their time as an internist waiting to do fellowship just for the civilian opportunities. People who want GI fellowship, want it now. And that guy with a year left on his ADSO (who is usually a senior LT or junior LCDR BTW) has been applying the whole time. Remember, you can't apply every year because each set of orders has minimum activity. So, lets say you have a 4 year obligation and do IM residency straight-through (not impossible anymore). You aren't selected for GI the first time and get 3 year orders. You apply again after 2 years and get to start training after 3 years. This is, by far, the most likely scenario and increases your obligation by a couple of years.

Any specialty with a required GMO or utilization tour (read: anything competitive) will increase time owed. It's misleading when you consider how we advertise the obligation for the scholarship.

You are correct that, from the Navy's perspective, this is "only fair" and slows turnover in the subspecialties down quite a bit. GI is going to be overmanned as a result of the new rules.

 

[244913]

Good points all around. This is why I would not reccommend that anyone take HPSP. There are just so many unforseen hurdles, barriers, and blockships that the 22 yo just accepted med stud cannot understand.

I've done some thinking about this and the only person I'd advise to take the "scholarship" would be someone who has a military sized hole in their chest, is ok with being an officer more than a doctor and intends to serve as a GMO for their entire committment.

I guess the other group might be D.O's who have a lot more debt and are given better access to training, esp in the Army.

Otherwise it seems to me that you are unknowingly steering your professional future into a minefield.

61N

 

[DrMetal]

What you are missing is that very few people bide their time as an internist

Got it, thanks. How hard is it to get the COR job as a utilization tour after IM res?

 

[Gastrapathy]

Got it, thanks. How hard is it to get the COR job as a utilization tour after IM res?

Highly variable. Historically, if interested, the COR always gets selected for fellowship. On the other hand, most people don't find the job all that appealing. I would say that typically there are 2-4 candidates, of whom usually one or two are clearly at the top of their class. But on any given year, who knows.

 

[J-Rad]

...
The issue is that almost no one in the Navy trains straight-through both residency and fellowship without a utilization tour. I heard that my specialty had twice as many applicants currently on utilization tours as spots, let alone resident applicants (who I would assume are hosed)...

Just to not confuse things for the multi-service posters in this thread I've adjusted the above. BTW, for my own pseudo-naval edumucation: what's "COR"?

 

[J-Rad]

Oh wait, is that "Chief Of Residents"?

 

[DocArmy]

Sorry, rando HPSP already getting the money question:

For the long run, if I do military residency (we'll say 4 years) then do payback (4 years), how long do I have until I am eligible for retirement? Is it 12 more years of Active Duty or 16? Does the AD time spent in residency training count toward retirement?

Thanks.

 

[J-Rad]

Yes, residency will count toward retirement.