Family Medicine in the Navy

[Ratava]

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Hi all,

MS2 in Navy HPSP here, and I'm strongly considering FM (although I'll keep my mind open during clerkships). I've searched the threads for the following issues but would like updated opinions if possible:

1) How strong are Navy FM residency programs (particularly on the East Coast) compared to the average civilian FM program (eg variety of procedures taught)? Any opinions on the Jacksonville or Pensacola programs?

2) Although I'm currently favoring FM, I haven't eliminated IM. Any opinions on the advantages that Navy FM has over Navy IM?

3) What's the likelihood that I'd be doing a GMO instead of getting a straight-through FM residency?

That's all, thanks in advance.

 

[Hootenanny]

Hello Ratava and all SDN-ers,

I was thinking of posting a new topic concerning your #3 question and I think it comes down to this:

There are 44 unopposed FM residency slots through the Navy spread throughout 5 different hospitals (Pendleton, Bremerton, Jacksonville, Pensacola, and Lejeune)
http://www.med.navy.mil/sites/navmedmpte/gme/Pages/NavyInserviceGME-1programsandPositions.aspx

I think the better question is how many people are vying for those 44 spots. Now, I've read that FM residency isn't that hard to get into but I haven't heard any numbers. Does any know of this data (even generalized to a degree) of people applying for the "44" or point me in the direction of where I could access this kind of statistics? I might end up calling the GME coordinators and getting the scoop from each hospital. Those people know what is up.

The reason I ask this is b/c I am interested in the HPSP program but have yet to sign the "dotted line." I come from a Navy family, so the military is nothing new to me though I was very hesistant to even think about HPSP. But one year into medical school and 50K in loans later - that 3 year service obligation doesn't look so bad.

The way I figure it, Ratava, the best thing to do is go straight into Naval FM residency out of school and complete your duty as a doc after residency. But GMO in a cool place like Diego Garcia wouldn't be half bad either - as long as I got to surf. (By the way, anybody know of a sure fire way to get to Diego Garcia as a GMO?)

 

[NavyFP]

While I am a bit biased, I would rate Navy FM above most civilian programs. We do full spectrum FM to include OB. You will be able to do a ton of procedures if you work at it.

Straight through? FM is one of two specialties that currently offer guaranteed continuous training. About 25% know they will go straight through prior to starting internship. The others will more than likely go straight through, but percentages vary from year to year.

Odds of matching. If you want FM, you will get FM. Over the past 4 years there have been roughly an equal number of applicants to positions. Will you get your first choice? About 80% get their top choice. Bremerton tends to be the most popular and Camp LeJeune the least. Jacksonville and Pendleton are the largest programs with 12 per year.

 

[Gastrapathy]

I'll take on the IM versus FM discussion. FM is a vast field. You have to be comfortable practicing Peds, OB, and IM. Is it possible for one physician to do all of that well? Maybe. You'll have to be comfortable with a certain level of uncertainty. You also will have to realize that there will always be some skepticism (justified or otherwise) of your knowledge base from the physicians who practice each of these core FP specialties. I spent 3 years learning IM and FPs spend 3 years learning all three (with some surgery, derm, urology, etc thrown in). Couple this with the fact that some folks are in FP because they couldn't get anything else and you can see why the bias exists.

All that being said, my wife and kids see an FP and that is probably the biggest endorsement anyone can give.

IM is also a gateway to the IM subspecialties. While there are a few subs that FPs can do, the diversity of the IM subs is a major plus. Its very hard to predict where primary care is going and the subspecialties provide an ejection seat if you (like me) figure out that you don't like primary care as much as you thought you did.

Finally, FPs in the Navy are going to have it increasingly tough as we get rid of GMOs and convert these to primary care billets.

 

[notdeadyet]

We do full spectrum FM to include OB. You will be able to do a ton of procedures if you work at it.

NavyFP- From what I've seen rotating at military facilities and talking to FM residents there, military FM folks do a lot more inpatient stuff than the typical civilian programs I've seen. This is Army/AF folks, Navy might be different. I can't help but think that this would make for some solid training, but might be a minus for folks hoping to do family to avoid as much inpatient as possible.

 

[Hootenanny]

Well, you said it NavyFP:

"If you want FM, you will get FM."

And coming from a guy actually doing it, that's what I needed to hear. And I've heard it's pretty complete training and again you have seen it, you say it is - I'll take it (and I should be seeing this if I rotate through Bremerton, Pendleton, etc.).

By the way, if you rotate through a military program on the HPSP, what kind of reimbursement do you recieve? Or am I comparing apples to oranges here - in the sense that - if you go on a military rotation, you can activate the 45 active duty days you are allowed per year (hence that would be similar to reimbursement) ?

Also NavyFP, since I have an opportunity to ask from a legitimate source - why is Lejeune least? Maybe some reasons why Bremerton and other are more desired? I know that it is quite broad, and you've probably explained it before on other posts (if you'd like to hyperlink one, that's cool), but I figured since you are here and present,

Things are looking up boys, where's that dotted line....

Thanks for all the help.

 

[mohody]

Lejeune is least mainly because its not near a major city. We have made great improvements over the last couple of years. This year was the first time GMOs applying for 2nd year spots were turned down for a spot. around 20 applicants applied for 6 spots.

 

[Hootenanny]

Lejeune is least mainly because its not near a major city. We have made great improvements over the last couple of years. This year was the first time GMOs applying for 2nd year spots were turned down for a spot. around 20 applicants applied for 6 spots.

Interesting, so let me get this straight:

After medical school, you have to do at least an internship year / you couldn't just go straight into GMO right out of school...right?

Okay then, Pendleton has 12 spots for the FM residency - say you get in straight out of school, are you guaranteed three consectutive years of residency then, or is there the possibility that you will get yanked after internship and a GMO who is applying for the 2nd year takes your spot (and you inturn follow in their footsteps) ?

That may sound like a obviously possible scenario, but it is one I have not come across. I thought once you were in the residency, you were there to stay. I am sorry if I sound like a MS1 but I need to get these things straight.

So, mohody, that means 6 people got yanked after their internship year? Who gets yanked and based on what?

 

[mohody]

2 interns got selected to go straight through at Lejeune because the navy has a trial program were some medical students are offered residencies were they are guaranteed to go straight through.

 

[Hootenanny]

So 4 had to go into GMO?

To quote The Dude, "That's a bummer, man."

 

[SeminoleFan3]

Interesting, so let me get this straight:

After medical school, you have to do at least an internship year / you couldn't just go straight into GMO right out of school...right?

Okay then, Pendleton has 12 spots for the FM residency - say you get in straight out of school, are you guaranteed three consectutive years of residency then, or is there the possibility that you will get yanked after internship and a GMO who is applying for the 2nd year takes your spot (and you inturn follow in their footsteps) ?

That may sound like a obviously possible scenario, but it is one I have not come across. I thought once you were in the residency, you were there to stay. I am sorry if I sound like a MS1 but I need to get these things straight.

So, mohody, that means 6 people got yanked after their internship year? Who gets yanked and based on what?

Thanks, Scott

Yes, it's quite possible to go do a GMO tour after your internship. It's my understanding that this is more rare in the FP arena than in most of the others. However, I would suggest that you not sign on the dotted line if you're not comfortable with that possibility. Plus, while you might be thinking FP now, things change in med school, and you might find yourself wanting a field that virtually requires a GMO tour after internship but before the completion of residency (i.e. ER or Anes). Be prepared for all possibilties.

 

[Hootenanny]

Yes, it's quite possible to go do a GMO tour after your internship. It's my understanding that this is more rare in the FP arena than in most of the others. However, I would suggest that you not sign on the dotted line if you're not comfortable with that possibility. Plus, while you might be thinking FP now, things change in med school, and you might find yourself wanting a field that virtually requires a GMO tour after internship but before the completion of residency (i.e. ER or Anes). Be prepared for all possibilties.

Good call, seminolefan3 - yeah, I am okay with doing a GMO on the condition that I would do a 1 year (probably hardship).

Can FP's do hardships? Where?

Because:
- I am doing a 3 year HPSP
- Therefore, if I did a 2 year GMO, after I finished internship - I would (HPSP-wise) only have to serve a year.
- But, b/c of ADSO (I think?) minimum service after residency is 2 years, right? Am I understanding that correctly?
- That would be 4 years of service which isn't that big of a deal, but I would prefer to go straight through residency.

 

[NavyFP]

NavyFP- From what I've seen rotating at military facilities and talking to FM residents there, military FM folks do a lot more inpatient stuff than the typical civilian programs I've seen. This is Army/AF folks, Navy might be different. I can't help but think that this would make for some solid training, but might be a minus for folks hoping to do family to avoid as much inpatient as possible.

Navy does do a comparable amount of inpatient to Army/AF programs. If you want to avoid inpatient, you hve to wait until you are a staff doc and choose your assignments carefully. Long term, you could still end up doing inpatient.

Well, you said it NavyFP:



By the way, if you rotate through a military program on the HPSP, what kind of reimbursement do you recieve? Or am I comparing apples to oranges here - in the sense that - if you go on a military rotation, you can activate the 45 active duty days you are allowed per year (hence that would be similar to reimbursement) ?

Also NavyFP, since I have an opportunity to ask from a legitimate source - why is Lejeune least? Maybe some reasons why Bremerton and other are more desired? I know that it is quite broad, and you've probably explained it before on other posts (if you'd like to hyperlink one, that's cool), but I figured since you are here and present,

Things are looking up boys, where's that dotted line....

Thanks for all the help.

You can do 2 rotations on the Navy's dime. They pay for the hotel, rental car, and give you a food allowance. They are typically 4 weeks and the rest of the time is spent at school.

I think a big reason for program popularity is location.

 

[SeminoleFan3]

Good call, seminolefan3 - yeah, I am okay with doing a GMO on the condition that I would do a 1 year (probably hardship).

Can FP's do hardships? Where?

Because:
- I am doing a 3 year HPSP
- Therefore, if I did a 2 year GMO, after I finished residency - I would (HPSP-wise) only have to serve a year.
- But, b/c of ADSO (I think?) minimum service after residency is 2 years, right? Am I understanding that correctly?
- That would be 4 years of service which isn't that big of a deal, but I would prefer to go straight through residency.

I was under the impression that those one year hardship tours were being phased out (at least for post-internship folks), so I wouldn't plan on that either.

 

[Hootenanny]

Because:
- I am doing a 3 year HPSP
- Therefore, if I did a 2 year GMO, after I finished residency - I would (HPSP-wise) only have to serve a year.
- But, b/c of ADSO (I think?) minimum service after residency is 2 years, right? Am I understanding that correctly?

Any ideas?

 

[|2idicu|ous]

Any ideas?

see chart.

 

[IlDestriero]

Any ideas?

That is not correct. If you finished FM residency and were than billeted to a gmo tour that was transitioned to an FM spot, you would only owe 1 more year. If you had an interruption in training after internship and than returned from a gmo tour and completed 2 more years of residency, than you would owe 2 more years.
The chart is confusing as some "gmo" spots are now filled with FP trained MDs and count as payback. Those spots are really not "GMO" spots any longer, but FP spots, until the navy puts a gmo in, making it a gmo billet again.

 

[Perrotfish]

You can do 2 rotations on the Navy's dime. They pay for the hotel, rental car, and give you a food allowance. They are typically 4 weeks and the rest of the time is spent at school.

To clarify: you can do one rotation per fiscal year on the Navy's dime. The fiscal year starts in October, so if you can get a rotation in before October of your second year you can actually do 3.

Also, while the rotations are generally 4 weeks, you can use all 45 days. At my school they let us use military Family medicine as a core class, so we use 6 weeks.

 

[Hootenanny]

Because:
- I am doing a 3 year HPSP
- Therefore, if I did a 2 year GMO, after I finished internship - I would (HPSP-wise) only have to serve a year.
- But, b/c of ADSO (I think?) minimum service after residency is 2 years, right? Am I understanding that correctly?
- That would be 4 years of service which isn't that big of a deal, but I would prefer to go straight through residency.

I edited this quote: I meant to say internship instead of residency (which is what was there before I changed it to a bold internship). I think now my question makes more sense.

If you want to take on the edited form, cool, just wanted it for the record.

Thanks for all the info.

 

[Gastrapathy]

Lejeune is least mainly because its not near a major city. We have made great improvements over the last couple of years. This year was the first time GMOs applying for 2nd year spots were turned down for a spot. around 20 applicants applied for 6 spots.

That and the water😱.