Fellowship After Commitment

[mslall]

How common is it for physicians to complete a fellowship post payback? Is it feasible? Will you be a competitive applicant to fellowship programs? Has anyone out there taken this route?

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[DogFaceMedic]

How common is it for physicians to complete a fellowship post payback? Is it feasible? Will you be a competitive applicant to fellowship programs? Has anyone out there taken this route?

I know several people who have or are doing this. Their competitiveness had more to do with themselves rather than how recently they finished residency. But, each service and specialty is different. Examples are USAF trauma surgery, and 2 buddies who did Peds-ER, one in Navy and the other Army.

 

[DrMetal]

How common is it for physicians to complete a fellowship post payback? Is it feasible? Will you be a competitive applicant to fellowship programs? Has anyone out there taken this route?

I think if you wanna do FTIS, it's a really good idea to get into a fellowship while you have some payback left (say like a 1 year or 2 balance). B/c in this case, your FTIS period will not incur (nor pay back) any obligated service.

If your payback balance = 0, and you do an FTIS (say one of the IM specs), then that increases your balance, right?

If you do FTOS, you incur more time whether your present balance is >= 0. So i don't think it matters so much in the case of FTOS.

 

[J-Rad]

I know several people who have or are doing this. Their competitiveness had more to do with themselves rather than how recently they finished residency. But, each service and specialty is different. Examples are USAF trauma surgery, and 2 buddies who did Peds-ER, one in Navy and the other Army.

The Army Peds ED dude, did he just finish up at CHKD in Virginia in the last couple of years?

 

[DogFaceMedic]

The Army Peds ED dude, did he just finish up at CHKD in Virginia in the last couple of years?

No. I forget where he went, but he is an attending at Madigan now. I knew a CHKD fellow who was former Army with the 3rd ID during the Iraq invasion. He did his fellowship after he was out. I don't think his fellowship was Army sponsored.

 

[colbgw02]

I'm pretty sure the debt incurred by fellowship is served consecutively, not concurrently.

It depends on whether or not it's active duty or not. For Army internal medicine, for example, they can do a 3-year AD fellowship and come out on the other end without any additional obligation. In my specialty, all fellowships are civilian-sponsored, so 2 years get tacked on to the ADO (even though the fellowships are typically only 1 year).

 

[J-Rad]

I knew a CHKD fellow who was former Army with the 3rd ID during the Iraq invasion. He did his fellowship after he was out. I don't think his fellowship was Army sponsored.

No, it wasn't. He was civ. Nice guy.

 

[edmadison]

It depends on whether or not it's active duty or not. For Army internal medicine, for example, they can do a 3-year AD fellowship and come out on the other end without any additional obligation. In my specialty, all fellowships are civilian-sponsored, so 2 years get tacked on to the ADO (even though the fellowships are typically only 1 year).

Tis true and I don't really understand why. In-service fellowship incurs additional obligation, but is served concurrantly. Civilian sponsored fellowship incurs obligation, but is served consecutively.

Ed

 

[Gastrapathy]

Not quite right.

Inservice fellowship does not add to your pre-GME commitment but does add to your GME commitment (these are calculated separately and run concurrently, so what matters is whichever is longer). So if you did a 4 year HPSP, followed by an IM residency and 3 year IM fellowship, you would owe 5, not 4 years. But, if you went to USUHS, you would still only owe 7.

Outservice fellowship gets added to whichever commitment is longer (so you would owe 7 for an HPSP and 10 for a USUHS student in that scenario).

After any period of training (even just a year), you owe a minimum of 2 years.

One VERY important catch. If you have no obligation prior to starting fellowship, you can take MSP and have it run concurrent to your fellowship obligation. However, if you take an MSP while already a fellow or with obligation remaining, the MSP contract is added to the end of your obligation.

 

[edmadison]

Not quite right.

Inservice fellowship does not add to your pre-GME commitment but does add to your GME commitment (these are calculated separately and run concurrently, so what matters is whichever is longer). So if you did a 4 year HPSP, followed by an IM residency and 3 year IM fellowship, you would owe 5, not 4 years. But, if you went to USUHS, you would still only owe 7.

Outservice fellowship gets added to whichever commitment is longer (so you would owe 7 for an HPSP and 10 for a USUHS student in that scenario).

After any period of training (even just a year), you owe a minimum of 2 years.

One VERY important catch. If you have no obligation prior to starting fellowship, you can take MSP and have it run concurrent to your fellowship obligation. However, if you take an MSP while already a fellow or with obligation remaining, the MSP contract is added to the end of your obligation.

Thank you for the correction. I knew that, I had just forgotten. The net effect of this is that USUHS folks in primary care can do a "free fellowship" while those of us who did HPSP don't.

Ed

 

[Gastrapathy]

Thank you for the correction. I knew that, I had just forgotten. The net effect of this is that USUHS folks in primary care can do a "free fellowship" while those of us who did HPSP don't.

Ed

Quite right and its definitely confusing. Although if you happen to get a fellowship right out of straight-through residency, then a 3 year fellowship "only" adds a year. Its the utilization tour between residency and fellowship that really makes the HPSP obligation and the USUHS obligation essentially the same (minus all the money the USUHS folks got).

 

[BigNavyPedsGuy]

Let me get this straight: FTIS is just like residency commitment and runs concurrently with medschool commitment. So if i owe two years ( 1yr residency and 2 yrs chool commitment) and do a FTIS fellowship then I would owe four years? (1yr residency +3yr fellowship served concurrently with my 2years of school commitment left)

I feel like a pre-med running the numbers . . . .

 

[Gastrapathy]

Let me get this straight: FTIS is just like residency commitment and runs concurrently with medschool commitment. So if i owe two years ( 1yr residency and 2 yrs chool commitment) and do a FTIS fellowship then I would owe four years? (1yr residency +3yr fellowship served concurrently with my 2years of school commitment left)

I feel like a pre-med running the numbers . . . .

Yes (but how will you only have a 1 year residency committment?).

 

[psychbender]

Yes (but how will you only have a 1 year residency committment?).

I'm thinking he meant one year left of residency committment, and 2 years left of HPSP committment. If you had a 4-year HPSP scholarship, and a 2 year (after internship) residency, and paid back one year after internship as a GMO, then one further year after residency, you would end up with 2 years left on your committment (1 from residency, served concurrently with 2 from scholarship). Maybe?

 

[BigNavyPedsGuy]

Psychblender's right. If I did a one year stint either overseas or as a chief, etc.

 

[stonewall22]

If you do a sponsored fellowship or residency do you receive the same pay you would in a military fellowship/residency? During a fellowship, do you maintain the same pay (BE/BC pay, etc) or does it drop during the fellowship since you're training. If you keep the same pay and benefits seems like a military sponsored fellowship would be a pretty sweet financial deal.

 

[J-Rad]

If you do a sponsored fellowship or residency do you receive the same pay you would in a military fellowship/residency? During a fellowship, do you maintain the same pay (BE/BC pay, etc) or does it drop during the fellowship since you're training. If you keep the same pay and benefits seems like a military sponsored fellowship would be a pretty sweet financial deal.

You are paid all the pays you are eligible and sign up for (BC pay, ASP, ISP, etc.) during a sponsored fellowhip.

 

[Gastrapathy]

Psychblender's right. If I did a one year stint either overseas or as a chief, etc.

Cool, just wanted to make sure I understood your example. So, if I understand your specific situation correctly, this is how it would play out:

4 year HPSP, 1 year internship, 1 year(ish) GMO, 2 year residency...then
straight into a 3 year fellowship = 5 year obligation post fellowship (total AD time = 12)

4 year HPSP, 1 year internship, 1 year(ish) GMO, 2 year residency...then 1 year chief year, 3 year fellowship = 4 year obligation p fellowship (total AD time = 12)

4 year HPSP, 1 year internship, 1 year(ish) GMO, 2 year residency...then 2 year payback tour (BNPG goes back to a ship p residency), 3 year fellowship = 4 year obligation p fellowship (total AD time = 13 years)

4 year HPSP, 1 year internship, 1 year(ish) GMO, 2 year residency...then 3 year payback tour, 3 year fellowship = 3 year obligation p fellowship (total AD time = 13 years)


Or...4 year HPSP, 1 year internship, 1 year GMO, 2 year residency, 3 year payback tour and out.

Bottom line, doing a 3 year fellowship buys you 12 or 13 total years.

BTW, you'll be the best paid peds fellow in the US for those 3 years. Its a sweet deal to get paid as staff to be a fellow. If you wait until you aren't obligated prior to starting fellowship (the last scenario), you're eligible for MSP without increasing your obligation.

 

[BigNavyPedsGuy]

Bottom line, doing a 3 year fellowship buys you 12 or 13 total years.

BTW, you'll be the best paid peds fellow in the US for those 3 years. Its a sweet deal to get paid as staff to be a fellow. If you wait until you aren't obligated prior to starting fellowship (the last scenario), you're eligible for MSP without increasing your obligation.

Yeah, the only option you didn't factor in was a possible deferment for fellowship (the trend these day) and then tehre's the FAP or no FAP question.

The money us just too good for me to ignore . . . .

That should generate flames.

 

[mdmed2012]

Suppose you did a 3 year IM residency and completed the obligation and no longer had a commitment. Does anyone know how you would be viewed by a civilian fellowship program if you were to apply as an IM doc 3-4 years out of residency?

I guess what I'm trying to ask is would a civilian fellowship program prefer a fellow fresh out of residency or does it not matter? Or would you be better off trying to do the fellowship with the military and avoid this situation altogether?

Also, I understand that deferments are hard to come by for civilian residencies. Is the same true for fellowship?

 

[glamqueen]

I'm curious about doing an OB/GYN four-year residency, then a four year committment to pay back, and then applying to civ fellowships after getting out? Would the civ world take a fellow who had been practicing in the military post-residency for about four years?

 

[BigNavyPedsGuy]

I've asked a few civilian docs what they thought of this and none of them thought it would be detrimental. Most people realize how it works for people who took military scholarships.

That being said, the tough part might be to stay competitive for four years. It's hard to do research in Guam or Cuba.

 

[mdmed2012]

I've asked a few civilian docs what they thought of this and none of them thought it would be detrimental. Most people realize how it works for people who took military scholarships.

That being said, the tough part might be to stay competitive for four years. It's hard to do research in Guam or Cuba.

Thanks for the response. That's about what I figured.

Regarding this situation, as an IM doc would you be able to do a GMO tour or do they only take the interns? For example, if you trained straight through in IM and owed a few years after, would you be able to get attached to the Marines or do flight surgery, or do they generally keep the board certified docs in the hospitals?

 

[BigNavyPedsGuy]

Thanks for the response. That's about what I figured.

Regarding this situation, as an IM doc would you be able to do a GMO tour or do they only take the interns? For example, if you trained straight through in IM and owed a few years after, would you be able to get attached to the Marines or do flight surgery, or do they generally keep the board certified docs in the hospitals?

My impression is that if you want an operational spot, you can most likely get one. You wouldn't be a "GMO" but you could be part of a Fleet Surgical Team (FST) or try to get attached to another operational platform.

Some of the IM guys on here (i.e. Gastrapathy) would probably know more about it than me.

 

[Gastrapathy]

Thanks for the response. That's about what I figured.

Regarding this situation, as an IM doc would you be able to do a GMO tour or do they only take the interns? For example, if you trained straight through in IM and owed a few years after, would you be able to get attached to the Marines or do flight surgery, or do they generally keep the board certified docs in the hospitals?

Its becoming increasingly common for people to do operational jobs after IM residency. FS is probably not an option at that point.

 

[IlDestriero]

.

 

[AFDuck]

Sorry to bring up an old thread, but I was hoping to get more thoughts on the topic, especially regarding pediatric fellowships. I'm wondering what civilian fellowship programs will think of military-trained pediatricians. The pediatric residency programs in the DoD seem to be mostly focused on training good general pediatricians, which makes sense, but is this a problem for an subspecialty-minded residents? I know that civ-sponsored fellows do very well at matching into great programs, but I'd probably rather fulfill my obligation after residency and then apply to start a fellowship as a civilian. Thanks for your help!

 

[J-Rad]

...I was hoping to get more thoughts on the topic, especially regarding pediatric fellowships. I'm wondering what civilian fellowship programs will think of military-trained pediatricians...

In general they are fine with them. I think the majority of pediatric residencies are general peds focused, not just military. So most fellowships are going to have plenty of applicants from primary care focused residencies.

 

[bguttery123]

Cool, just wanted to make sure I understood your example. So, if I understand your specific situation correctly, this is how it would play out:

4 year HPSP, 1 year internship, 1 year(ish) GMO, 2 year residency...then
straight into a 3 year fellowship = 5 year obligation post fellowship (total AD time = 12)

4 year HPSP, 1 year internship, 1 year(ish) GMO, 2 year residency...then 1 year chief year, 3 year fellowship = 4 year obligation p fellowship (total AD time = 12)

4 year HPSP, 1 year internship, 1 year(ish) GMO, 2 year residency...then 2 year payback tour (BNPG goes back to a ship p residency), 3 year fellowship = 4 year obligation p fellowship (total AD time = 13 years)

4 year HPSP, 1 year internship, 1 year(ish) GMO, 2 year residency...then 3 year payback tour, 3 year fellowship = 3 year obligation p fellowship (total AD time = 13 years)


Or...4 year HPSP, 1 year internship, 1 year GMO, 2 year residency, 3 year payback tour and out.

Bottom line, doing a 3 year fellowship buys you 12 or 13 total years.

BTW, you'll be the best paid peds fellow in the US for those 3 years. Its a sweet deal to get paid as staff to be a fellow. If you wait until you aren't obligated prior to starting fellowship (the last scenario), you're eligible for MSP without increasing your obligation.

I am sorry to reply to this since I know it has been so long, but you seem like an expert in Army med and IM so I have to ask...

Quickly, I am accepted to my state school and have applied Army HPSP. I have a decent amount of experience as a nurse so I am confident that I want to do IM and an ID fellowship.

So from this post, I could do 4 years of school, 3 years IM residency, straight into 3 years of ID, and would owe 5 years after fellowship?

If I did service time between residency and fellowship, each year would subtract from that 5?

And if I were to do all 4 years of payback prior to residency (say a chief resident year, then 3 year utilization tour), I could start an ID fellowship in the Army and owe them nothing afterwards?

Thank you for your help and again sorry to bring up an old thread!

 

[psychbender]

I am sorry to reply to this since I know it has been so long, but you seem like an expert in Army med and IM so I have to ask...

Quickly, I am accepted to my state school and have applied Army HPSP. I have a decent amount of experience as a nurse so I am confident that I want to do IM and an ID fellowship.

So from this post, I could do 4 years of school, 3 years IM residency, straight into 3 years of ID, and would owe 5 years after fellowship?

If I did service time between residency and fellowship, each year would subtract from that 5?

And if I were to do all 4 years of payback prior to residency (say a chief resident year, then 3 year utilization tour), I could start an ID fellowship in the Army and owe them nothing afterwards?

Thank you for your help and again sorry to bring up an old thread!

First scenario, yes. Your ADSO would be 5 years after fellowship ((2 + 3) > 4). Total time in uniform, 11 years.

Second scenario, kind of, but not really. You finish IM residency after a four year HPSP scholarship, you owe 4 years (2 < 4). Each year you function as staff decreases that ADSO by a single year. However, once you go back into fellowship, you incur additional training obligation, increasing your ADSO.

So, if you paid back your entire 4 year ADSO after residency, then did a three year fellowship, you would owe an additional 3 years after fellowship completion (with total time in uniform, 13 years, if all training was in-service).

If you fulfilled your entire ADSO straight after internship, then did residency, followed by fellowship, you would spend even more time in the Army (15 years in uniform).

 

[bguttery123]

First scenario, yes. Your ADSO would be 5 years after fellowship ((2 + 3) > 4). Total time in uniform, 11 years.

Second scenario, kind of, but not really. You finish IM residency after a four year HPSP scholarship, you owe 4 years (2 < 4). Each year you function as staff decreases that ADSO by a single year. However, once you go back into fellowship, you incur additional training obligation, increasing your ADSO.

So, if you paid back your entire 4 year ADSO after residency, then did a three year fellowship, you would owe an additional 3 years after fellowship completion (with total time in uniform, 13 years, if all training was in-service).

If you fulfilled your entire ADSO straight after internship, then did residency, followed by fellowship, you would spend even more time in the Army (15 years in uniform).

Finally, the exact clarity I have been looking for and needed. For real thank you so so much! You are the best!

 

[Perrotfish]

First scenario, yes. Your ADSO would be 5 years after fellowship ((2 + 3) > 4). Total time in uniform, 11 years.

Second scenario, kind of, but not really. You finish IM residency after a four year HPSP scholarship, you owe 4 years (2 < 4). Each year you function as staff decreases that ADSO by a single year. However, once you go back into fellowship, you incur additional training obligation, increasing your ADSO.

So, if you paid back your entire 4 year ADSO after residency, then did a three year fellowship, you would owe an additional 3 years after fellowship completion (with total time in uniform, 13 years, if all training was in-service).

If you fulfilled your entire ADSO straight after internship, then did residency, followed by fellowship, you would spend even more time in the Army (15 years in uniform).

I thought fellowship just added to your ADSO. So after an IM residency you owe 4 years, but if you tack on a 3 year fellowship you then owe that inital ADSO + length of fellowship, so 7 year. So you would have 13 years in uniform either way.

 

[bguttery123]

I thought fellowship just added to your ADSO. So after an IM residency you owe 4 years, but if you tack on a 3 year fellowship you then owe that inital ADSO + length of fellowship, so 7 year. So you would have 13 years in uniform either way.

This is where I have been confused. I thought Fellowship was 1 year:2 year payback so I initially thought it would be 4 ADSO then 3 fellowship then 6 ADSO. But psychbender said 5 which I have heard as well... who really knows beside the Army GME office I guess. But I am taking psychbenders word for it for now...

 

[teacherman84]

This is where I have been confused. I thought Fellowship was 1 year:2 year payback so I initially thought it would be 4 ADSO then 3 fellowship then 6 ADSO. But psychbender said 5 which I have heard as well... who really knows beside the Army GME office I guess. But I am taking psychbenders word for it for now...

Fellowship payback is 1:1 with a minimum of 2 years. 1 year fellowship, 2 year payback. 2 year fellowship is a 2 year payback.

 

[Ziehl-Neelsen]

I thought fellowship just added to your ADSO. So after an IM residency you owe 4 years, but if you tack on a 3 year fellowship you then owe that inital ADSO + length of fellowship, so 7 year. So you would have 13 years in uniform either way.

This is where I have been confused. I thought Fellowship was 1 year:2 year payback so I initially thought it would be 4 ADSO then 3 fellowship then 6 ADSO. But psychbender said 5 which I have heard as well... who really knows beside the Army GME office I guess. But I am taking psychbenders word for it for now...

It's an extremely confusing contract, and psychblender gave you the nuts and bolts without going into the vagaries. You owe your longest ADSO. Medical school payback is done concurrently to other obligations; residency/fellowship payback is consecutive.

So after a straight through residency, you owe 2 years for IM residency (internship doesn't count either way) and 4 years for med school. Payback is 4 years.

Go straight to 3 year IM fellowship, and after fellowship you owe 5 for residency and fellowship (the 3 for fellowship are added to the 2 from residency) and 4 for school. You pay back the school and training debt concurrently and are out in 5.

Do a 2 year general IM utilization tour before fellowship, and after fellowship you owe 3. Your 2 year utilization tour concurrently pays back 2 of school and your entire training commitment. Complete fellowship and you owe 3 more because the training debt(3) is greater than the remaining school debt(2).

Do internship, serve as a GMO for 4 years, get back into IM residency and go straight to ID fellowship--you owe 5 years. You paid back your entire school debt with the GMO tour, but you've accrued 2 training debts with 2 years of IM residency added to 3 years of ID fellowship.

And so on and so forth.

 

[pgg]

Maybe it was mentioned upthread and I didn't see it, but I would caution anyone, in any branch of service, in any specialty, thinking about any fellowship ... your odds of going straight from residency to fellowship without an intervening utilization tour are a lot lower now than they were 10 years ago. Probably approaching zero for most values of "any".

Don't make career path choices that depend on this happening for you.

 

[psychbender]

A lot of things can change between now and when the OP applies for fellowship. The military may get out of GME entirely, may shutter fellowship programs that are not mission critical, may require two year utilization tours, or maybe even decide to go back to being a large, full service provider of medical care, and allow everyone to train in their desired specialty and subspecialty right out if medical school. Ok, maybe not the last one.

Sent from my SM-G930V using SDN mobile

 

[bguttery123]

Ziel Neelsen thanks so much for further clarification!!

I am definitely getting the sense that a fellowship straight through is pretty highly unlikely. Maybe the dream would come true and I could go straight through, but who knows? In reality it's unlikely.

I think I have come to terms and am definitely okay with a utilization tour as an internist. I absolutely love ID but I want to be a great doctor. And I would need to be to do ID. I would hope that working 3-4 years as an internist in the military could do just that. Then I can pursue fellowship. Idk that's just my thoughts now.... I appreciate everyone's help and input!

 

[militaryPHYS]

I've got DOD Instruction 6000.13 amongst many others and I can't find the instruction or exact verbage to help me provide solid information to people. Anyone have it?