end of gmo tours

[wingbowlchamp3]

hey everyone,

we were briefed during track day last week at ois about hpsp. the gentleman who spoke to us said that the navy is in the process of completely getting rid of the gmo. he called my class (class of 2010) the transition class because we'll probably be the first group that won't be looking at a gmo after internship. he said they're doing it primarily because they're getting killed in recruiting by the other services where students can go straight through. most people i think will be happy about this...but i'm sure there are a few of us who wanted to do four years of gmo and get out. also...some people were excited about being on a ship and getting involved in the wars going on throughout the world. there's also an anxiety about how the navy will suddenly place all these extra students into residencies. i'll try to be optimistic and hope things run smoothly and i don't end up being a ent guy because all the residencies i wanted were filled.

this info. has been discussed on here...but this sounded definite and it came from a reliable source so i figured i'd post.

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[Gastrapathy]

hey everyone,

we were briefed during track day last week at ois about hpsp. the gentleman who spoke to us said that the navy is in the process of completely getting rid of the gmo. he called my class (class of 2010) the transition class because we'll probably be the first group that won't be looking at a gmo after internship. he said they're doing it primarily because they're getting killed in recruiting by the other services where students can go straight through. most people i think will be happy about this...but i'm sure there are a few of us who wanted to do four years of gmo and get out. also...some people were excited about being on a ship and getting involved in the wars going on throughout the world. there's also an anxiety about how the navy will suddenly place all these extra students into residencies. i'll try to be optimistic and hope things run smoothly and i don't end up being a ent guy because all the residencies i wanted were filled.

this info. has been discussed on here...but this sounded definite and it came from a reliable source so i figured i'd post.

The Chief of the Medical Corps newsletter promulgated today had 4 things in it that were interesting. First, he said that the 500+ GMO billets Navy-wide were all being converted to staff primary care jobs over the next 4 years and that the first 20% had already been converted for the next billeting cycle. These first 20% were all of the clinic and hospital-based jobs. Second, he wrote that this year, Navy HPSP has only filled 60%. Third, he wrote that they have now officially funded the $20k bonus for FY2007 and FY2008 accessions (and that we are the only service to have done so). And finally, he wrote that the FY2008 special pay plan hasn't been finalized because they are considering increasing the bonuses for primary care specialties in hopes of improving retention of these physicians in light of their impending increased operational responsibilities.

 

[The White Coat Investor]

I wonder how much our anti-recruiting efforts here are responsible for the change?

 

[BOHICA-FIGMO]

If they say "all" gmo billets will be deep-sixed by 2011, I would expect it to happen by 2012-2013. Government (esp. Navy) inertia is HUUUUGE. Things never change quickly.

 

[DiveMD]

Finally the Navy is getting it. The GMO idea simply sucks....

 

[NavyFP]

hey everyone,

we were briefed during track day last week at ois about hpsp. the gentleman who spoke to us said that the navy is in the process of completely getting rid of the gmo. he called my class (class of 2010) the transition class because we'll probably be the first group that won't be looking at a gmo after internship. he said they're doing it primarily because they're getting killed in recruiting by the other services where students can go straight through. most people i think will be happy about this...but i'm sure there are a few of us who wanted to do four years of gmo and get out. also...some people were excited about being on a ship and getting involved in the wars going on throughout the world. there's also an anxiety about how the navy will suddenly place all these extra students into residencies. i'll try to be optimistic and hope things run smoothly and i don't end up being a ent guy because all the residencies i wanted were filled.

this info. has been discussed on here...but this sounded definite and it came from a reliable source so i figured i'd post.

I'm guessing that despite its best efforts, there will always be 50-100 "GMO" (I include GMOs who become FS/UMOs) billets. There will always be a few individuals who don't get the internship/residency they want, have a huge desire to be a FS/UMO, or want to do their time as a GMO and get out. I do believe the majority will go away and there will be increased opportunities for straight through training. Is this good? Yes, it is. I still see some benefit in GMOs, but agree an all board eligible force is desirable.

 

[mitchconnie]

I'm guessing that despite its best efforts, there will always be 50-100 "GMO" (I include GMOs who become FS/UMOs) billets. There will always be a few individuals who don't get the internship/residency they want,

I agree. There is no possible way to completely eliminate the GMO unless you do one of three things.

1. Allow everyone to match into their residency of choice regardless of the needs of the military.

2. Force specialty-trained personnel to do primary care

3. Force people to complete primary-care residencies who do not want them.

As an example, say you have 8 students who want to start urology residency in a given year and a projected need for only 4 urologists (not an unreasonable scenerio at all). What do you do with the other four students? Options are either let them all do urology and have way to many urologists, make them practice as primary care docotors after urology training, or force them to do FP or IM residencies. None of these options are reasonable. There will always be some GMO's who wanted to do a specialty that the military just doesn't need.

Although I do think it is a welcome development that the drop in recruiting has led directly to some positive changes.

 

[Gastrapathy]

I agree. There is no possible way to completely eliminate the GMO unless you do one of three things.

1. Allow everyone to match into their residency of choice regardless of the needs of the military.

2. Force specialty-trained personnel to do primary care

3. Force people to complete primary-care residencies who do not want them.

As an example, say you have 8 students who want to start urology residency in a given year and a projected need for only 4 urologists (not an unreasonable scenerio at all). What do you do with the other four students? Options are either let them all do urology and have way to many urologists, make them practice as primary care docotors after urology training, or force them to do FP or IM residencies. None of these options are reasonable. There will always be some GMO's who wanted to do a specialty that the military just doesn't need.

Although I do think it is a welcome development that the drop in recruiting has led directly to some positive changes.

Good points, but I'm not so sure. That newsletter pointed to the need for more primary care docs and made it sound like an absolute requirement that the Navy get rid of GMO's. It sounded to me like they might force people into primary care residencies prior to going to flight or dive (in fact, I know there is discussion about which residencies will be allowed to apply for flight or dive in the future).

 

[NavyFP]

Good points, but I'm not so sure. That newsletter pointed to the need for more primary care docs and made it sound like an absolute requirement that the Navy get rid of GMO's. It sounded to me like they might force people into primary care residencies prior to going to flight or dive (in fact, I know there is discussion about which residencies will be allowed to apply for flight or dive in the future).

Forcing people into primary care residencies will NOT happen. Absolutely, positively NOT. I read the OOMC update, and yes that is the party line, but there is the ideal and the possible. Complete elimination of the GMO is just not possible. Even the Army and AF still have small numbers of them.

 

[cyclegirl]

There was a federal law passed several years back that said GMO slots had to be filled with board certified Docs. The Army and Air Force made that change right away and the Navy has been holding out as long as possible. The GMO slots are not completely going away. They are now called PMO slots and will be filled with board certified Docs in a primary care field (FP, IM, Peds, ER...). They have already started the change over and by 2010 they say there there will no longer be Docs with just an internship filling the slots.

 

[Gastrapathy]

Forcing people into primary care residencies will NOT happen. Absolutely, positively NOT. I read the OOMC update, and yes that is the party line, but there is the ideal and the possible. Complete elimination of the GMO is just not possible. Even the Army and AF still have small numbers of them.

Why isn't it possible? If the bosses decided that no one goes to an unsupervised, non-GME billet without completing a residency, why couldn't they dictate that? I'm not sure why you are certain they wouldn't force people into PGY2-3 years they don't want. We already force people into PGY1 years they don't want. I'm sure as a primary care attending, it isn't an appetizing thought and, believe me, the prospect of being a ward attending for IM residents who wanted to be urologists is terrifying. But, I guess I don't see a major difference between telling a wannabe pathologist that they have the pleasure of a surgery internship (when most path programs require NO internship anymore) and telling that same person they didn't get selected and have to do 2 more years of primary care training.

 

[edmadison]

Why isn't it possible? If the bosses decided that no one goes to an unsupervised, non-GME billet without completing a residency, why couldn't they dictate that? I'm not sure why you are certain they wouldn't force people into PGY2-3 years they don't want. We already force people into PGY1 years they don't want. I'm sure as a primary care attending, it isn't an appetizing thought and, believe me, the prospect of being a ward attending for IM residents who wanted to be urologists is terrifying. But, I guess I don't see a major difference between telling a wannabe pathologist that they have the pleasure of a surgery internship (when most path programs require NO internship anymore) and telling that same person they didn't get selected and have to do 2 more years of primary care training.

The problem is that they don't have the docs to fill the billets. Well, they do, but if they start forcing senior people (people without obligations) into GMO billets, they will have a huge retention problem. What they'll do is phase it in. The net result of all this is that rather than have surgical and preliminary interns fill the billets, they're going to fill them with FP, IM, Peds and maybe EM fresh out of residency. Another victory for the "haves" (e.g. surg, rads, gas). This is what's happened in the Army.

Ed

 

[NavyFP]

Why isn't it possible? If the bosses decided that no one goes to an unsupervised, non-GME billet without completing a residency, why couldn't they dictate that? I'm not sure why you are certain they wouldn't force people into PGY2-3 years they don't want. We already force people into PGY1 years they don't want. I'm sure as a primary care attending, it isn't an appetizing thought and, believe me, the prospect of being a ward attending for IM residents who wanted to be urologists is terrifying. But, I guess I don't see a major difference between telling a wannabe pathologist that they have the pleasure of a surgery internship (when most path programs require NO internship anymore) and telling that same person they didn't get selected and have to do 2 more years of primary care training.

Point well taken, but the current way Navy GME is run, it can't happen. You have to apply for pgy-2 slots and can decline. Yes, they could change those rules too, but I don't see that happening. My view is that if they start forcing people to do residencies they don't want, today's recruiting problems will seem minor. Internship is different in that you need one to get a license and be a GMO. And eeeeewww a pathology wannabe as an FP/IM doc? Not a good idea.

 

[almostfamous]

Forcing people into primary care residencies will NOT happen. Absolutely, positively NOT. I read the OOMC update, and yes that is the party line, but there is the ideal and the possible. Complete elimination of the GMO is just not possible. Even the Army and AF still have small numbers of them.

It does happen in the Army and AF, perhaps more so than the Navy, and that may be why they have less GMOs. Multiple people in this year's intern draft were very competitive in the civilian world, got denied a specialty (mostly Army ones i know of) and "offered" i.e. forced - into a primary care residency. that sucks that they are Army and are stuck w/ an entire residency, since at least all the Navy interns that didn't match into anything (specialty or location) that was on their list can GMO out and do what they want later. And those navy interns were basically forced into that internship. There were no phone calls this year with a headsup that you weren't getting something on your list... just a sweet little surprise that December morning... and the feeling like you just got kicked in the gut.

 

[Gastrapathy]

Point well taken, but the current way Navy GME is run, it can't happen. You have to apply for pgy-2 slots and can decline. Yes, they could change those rules too, but I don't see that happening. My view is that if they start forcing people to do residencies they don't want, today's recruiting problems will seem minor. Internship is different in that you need one to get a license and be a GMO. And eeeeewww a pathology wannabe as an FP/IM doc? Not a good idea.

I hear you about the current process and how hard it would be to get rid of all GMOs. Part of me suspects that, after converting the easy, clinic billets, they may lose their stomach for the harder part. But, the conspiracy theorist in me suspects that the new internship matching process (whereby every intern has to put down a general choice at the end to ensure they match somewhere) has this change in mind. It's not too far a leap to having a single PGY1 match.

 

[almostfamous]

I hear you about the current process and how hard it would be to get rid of all GMOs. Part of me suspects that, after converting the easy, clinic billets, they may lose their stomach for the harder part. But, the conspiracy theorist in me suspects that the new internship matching process (whereby every intern has to put down a general choice at the end to ensure they match somewhere) has this change in mind. It's not too far a leap to having a single PGY1 match.

supposedly the billets that will be converted first are with FMF.
matching a fresh GMO with a PA that was a prior IDC or the like.

 

[Mirror Form]

Good points, but I'm not so sure. That newsletter pointed to the need for more primary care docs and made it sound like an absolute requirement that the Navy get rid of GMO's. It sounded to me like they might force people into primary care residencies prior to going to flight or dive (in fact, I know there is discussion about which residencies will be allowed to apply for flight or dive in the future).

Residency is FAR FAR FAR too hard to ever be able to force someone to do a residency that they didn't want. Can you imagine someone who wants surgery or psychiatry (and has the ability to get it on the outside) being forced into an FP residency? That system would not last, especially if they're getting rid of GMO's for "recruiting" reasons.

There will always be some GMO's out there, as there still are in the army. There are just less, and they won't be required in order to get into a good residency. These days in the army you don't have to do a GMO tour, and most people don't, but we still have plenty of them. I suspect that the navy will become similar.

 

[BomberDoc]

The Air Force is putting more and more people into GMO tours, instead of the other way around. The one-year-wonder is here to stay and don't let anybody fool you otherwise. Yeah, it sounds great as a recruiting tool, but we all know how much truth is contained within recruiters and the military propaganda machine.

 

[NavyFP]

I hear you about the current process and how hard it would be to get rid of all GMOs. Part of me suspects that, after converting the easy, clinic billets, they may lose their stomach for the harder part. But, the conspiracy theorist in me suspects that the new internship matching process (whereby every intern has to put down a general choice at the end to ensure they match somewhere) has this change in mind. It's not too far a leap to having a single PGY1 match.

The general choice was for less competitive students applying for competitive residencies. I had not looked at it from the conspiracy outlook, but I can assure you that the change was money driven. The intern selection process supposedly was costing upwards of $100K. This will be much cheaper.

 

[orbitsurgMD]

Residency is FAR FAR FAR too hard to ever be able to force someone to do a residency that they didn't want. Can you imagine someone who wants surgery or psychiatry (and has the ability to get it on the outside) being forced into an FP residency? That system would not last, especially if they're getting rid of GMO's for "recruiting" reasons.

There will always be some GMO's out there, as there still are in the army. There are just less, and they won't be required in order to get into a good residency. These days in the army you don't have to do a GMO tour, and most people don't, but we still have plenty of them. I suspect that the navy will become similar.

The smarter thing would be to recruit through FAP and similar programs. They could recruit post-residency doctors by giving loan buyouts for reserve commissions, sweetening the deal by giving more buyout for varying amounts of risk of activation (e.g. no callup guaranteed for three years vs for one or two years.) They could offer FP or ER docs wanting a change of pace a guaranteed GMO slot limited to two years with a back-end no-callup guarantee and loan buyout. They could offer end-of-tour startup practice loans as a sweetener for GMO-type service with no-callup guarantees and startup loan "forgiveness" based on the number of months of GMO duty served.

The GMO deal as they have understood it is dying for want of new HPSP accessions, as they should expect since that program has been so misused and misrepresented. That doesn't mean there is no way to fix the problem of filling deployable medical officer billets.

The services need to acquaint themselves with the notion of enticement as applies to medical officers. That shouldn't be so hard. They are throwing money at everyone else.

 

[jb2]

As an example, say you have 8 students who want to start urology residency in a given year and a projected need for only 4 urologists (not an unreasonable scenerio at all). What do you do with the other four students? Options are either let them all do urology and have way to many urologists, make them practice as primary care docotors after urology training, or force them to do FP or IM residencies. None of these options are reasonable. There will always be some GMO's who wanted to do a specialty that the military just doesn't need.

QUOTE]

In the Army, it is possible to get deferment for civilian training so those other four should have also registered through the NRMP and gotten applications to civilian programs in through ERAS to participate in the Match. What happens if they don't match, I don't know.

 

[psychbender]

In the Army, it is possible to get deferment for civilian training so those other four should have also registered through the NRMP and gotten applications to civilian programs in through ERAS to participate in the Match. What happens if they don't match, I don't know.

But if the Army projects that they will only need 4 Urologists, do you think they'll train 8? Whether they train through the Army, or are granted civilian deferral, the Army is still going to have 8 Urologists on its hands, when they only wanted 4. As things have been explained to me on this board and through others, it's the needs of the Army first, and they will only grant deferral if they believe they will have a need that cannot be filled with their own programs. Ergo, those unlucky four would be SOL, and probably off to GMO-land.

 

[a1qwerty55]

There will always be some GMO's out there, as there still are in the army. There are just less, and they won't be required in order to get into a good residency. These days in the army you don't have to do a GMO tour, and most people don't, but we still have plenty of them. I suspect that the navy will become similar.

Where else are we going to put the residents we fire?

One funny/scary military piece of logic follows. The doc is failing in a supervised setting (residency), I know the solution, take them out of a supervised setting, make them independant and responsible for Army troops and their families.

 

[mitchconnie]

In the Army, it is possible to get deferment for civilian training so those other four should have also registered through the NRMP and gotten applications to civilian programs in through ERAS to participate in the Match. What happens if they don't match, I don't know.

Sorry if my example wasn't clear. I am well aware that you can get civilian deferments for residency, but that wasn't the point. What I was trying to illustrate is that if you let every student match into whatever specialty they want, the military totally loses control of the specialty mix that they need to run a healthcare system. If you only have four urology jobs open in the Army, then you don't want to train eight urologists and have four sitting around doing nothing (or doing primary care).

I'm guessing that the larger problem will be finding all the new primary care doctors to fill the billets that get converted from GMO to FP or IM. Are there just tons of excess primary care people out there with nothing to do? Are there lots of people who desparately wanted to do FP but didn't match and ended up doing a GMO? I don't think so. Seems to me that a lot of the GMO billets are filled by people who fail to match in more competitive fields, or just want to do their time and get out. There is no doubt that you can get rid of some or perhaps most GMO's, but without a major change in the way the military recruits physicians it's hard to see how you could completely eliminate the GMO.

I think that the statement "ALL GMO's will be gone by 2011" is probably a recruiting smokescreen. Take a look at the USAF. It sells itself to prospective students as largely GMO-free, and yet last years AF match sent about 25% of graduating students to GMO-land. I sure hope completely eliminating the GMO works out for the Navy, but I am skeptical.

 

[orbitsurgMD]

Sorry if my example wasn't clear. I am well aware that you can get civilian deferments for residency, but that wasn't the point. What I was trying to illustrate is that if you let every student match into whatever specialty they want, the military totally loses control of the specialty mix that they need to run a healthcare system. If you only have four urology jobs open in the Army, then you don't want to train eight urologists and have four sitting around doing nothing (or doing primary care).

I'm guessing that the larger problem will be finding all the new primary care doctors to fill the billets that get converted from GMO to FP or IM. Are there just tons of excess primary care people out there with nothing to do? Are there lots of people who desparately wanted to do FP but didn't match and ended up doing a GMO? I don't think so. Seems to me that a lot of the GMO billets are filled by people who fail to match in more competitive fields, or just want to do their time and get out. There is no doubt that you can get rid of some or perhaps most GMO's, but without a major change in the way the military recruits physicians it's hard to see how you could completely eliminate the GMO.

I think that the statement "ALL GMO's will be gone by 2011" is probably a recruiting smokescreen. Take a look at the USAF. It sells itself to prospective students as largely GMO-free, and yet last years AF match sent about 25% of graduating students to GMO-land. I sure hope completely eliminating the GMO works out for the Navy, but I am skeptical.

The GMO is gone.

Welcome the new Combat Medical Officer. We will call him the CMO. Treat him as you would your GMO; he is every bit as well-trained.

 

[i want out]

The GMO is gone.

Welcome the new Combat Medical Officer. We will call him the CMO. Treat him as you would your GMO; he is every bit as well-trained.

I laughed out loud when I read this, If it weren't so likely, it wouldn't be nearly as funny.

I also think that the recruiters and MILMED in general are going to start trying to cast GMO as a personal choice that was made by the individual. This also gives them more reason to blame the GMO for thinking they were well trained enough to do the job.

So, in 2012 they will offer residency training to all graduating medical students, but many of the available slots will be FP with FTOS (to indenture you further).
Then if you choose to take a GMO because you want to do a specialty that the .MIL doesn't project a need for, then its your own choice, or at least thats what they will say. The truth will be, that you were forced into that choice by the lack of desired training, but they won't bother to mention that part.

They will further use this "personal choice' to do GMO as ammunition when they are railroading you for not providing the standard of care that an FP would have provided.

The question will likely sound something like this: "When you "volunteered" to be a GMO, and didn't accept further training (FP residency you didn't want) you were saying that you felt qualified to do the job."

I want out

 

[PROAmerica]

What happens when a civilian medical student doesn't match into civilian residency compared to when an HPSP student doesn't match military or approved civilian deferred and goes GMO? Does a civilian go GMO as well but as the civilian equivalent.

Does anyone know the average civilian student match rate vs. military student each year?

Does everyone expect 100% select rate in the military? Why isn't it 100% in civilian?

I just looking at my options and would like to know how to go about doing med school...civilian or military HPSP?

 

[CD08]

I can tell you that is exactly the scenario in AF now. Very few specialty docs needed per the GME projections with several new GMO's coming on and serving as fully trained FP's, carrying a patient load of 1500 with 24-28 appts per day, complete management of all patients without supervision or back-up. It is a nightmare.

I am out this June, and the above report is my story. I am thankful I had strong training in my TY prgm. During the 1st month as GMO I felt like a jackass. With a lot of reading and hard work 4 years later, with deployments under my belt, I am as strong or stronger than some of my residency trained counterparts. Nothing like trial by fire. Some of my fellow GMO's did not make it and have been bumped to less stressful/less medical positions.

There is no doubt that military medicine is terrible and you pay the price for signing on the dotted line, especially now with retention dropping even lower. I suspect an increase in GMO's but it will appear that the route was chosen on paper. I can tell you mine was not. I got a call in April after passing Step 3 the caller told me I needed to report to work in July at a base in another galaxy, in uniform ready to work. In all seriousness I did not go to grad school, med school, thru the match, pass Step 3 to work as a GMO. It is what it is. Anybody thinking about military medicine (HPSP or FAP) - STOP. Do not take the bait, resist the temptation from the MAN, he is a liar!!!

 

[IgD]

Wonder if this thread will still be applicable in 2018

 

[i want out]

Wonder if this thread will still be applicable in 2018

The congressional mandate came out in 1998 (the year I signed my contract, and raised my hand) and I still completed my four years as a GMO in 2007.

I doubt that GMO's will go away.

i want out (of IRR)

 

[AFmedic2PAC]

supposedly the billets that will be converted first are with FMF.
matching a fresh GMO with a PA that was a prior IDC or the like.

From the SL report:
"There were originally 27 GMO 2 PA conversions which have grown to 53 including the BISOG initiative and MARSOC. Currently 23 FMF billets exist with 8 gapped. The remaining billets will be phased in over FY09-FY11..."


GMO 2 PA conversions...bet some are loving us now, lol.


-Prior AF medic 2 Navy PA