Jboss01

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Hello -

I was wondering what people think about delaying fellowship until after completing ADSO? Given all the planned changes to military medicine, GME, and reverse profis.

The concerns I have with regards to delaying fellowship - are primarily in regards to competitiveness following working as a staff for 3-4 years.

My concerns with going through fellowship are primarily related to the new "trimming of the fat" discussed by DHA where the military will be focusing on operational specialties (EM/Surg/Pulm crit). What will happen to the people who spent several years training in heme onc? Will they be forced to work as internists etc?

I appreciate any input!
 
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militaryPHYS

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I think this is a relatively easy answer. If you get the go-ahead from the military to do fellowship and you are OK with the additional commitment it gives you then do it. You military service will not hurt your application. It can be neutral effect or be a positive addition based on what I have heard and experienced.

Now, the real question is: Will the Navy be offering training for these IM sub-specialties in the near future? It seems that based on the most recent 1540, NDAA changes and POM2020 that IM sub-specialties will be going away. So you might not even have the opportunity even if you want to do it.

PROS of doing it while still active duty: #1 Full Time Out-Service (FTOS) maintains full AD specialty pay while in fellowship #2 you are looked favorably upon because you are a funded fellow (the program doesn't have to pay you) so they like that.

CONS of doing it while still active duty: #1 Additional service commitment #2 Additional service commitment. #3 if you do it early and still owe 4 to 7 years of payback your skills learned at said fellowship may atrophy depending on specialty choice, MTF placed at post-fellowship and changes within MilMed upcoming. All of these are very unpredictable but to be honest are not looking good for IM subspecialists right now.
 
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psychbender

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If you wait until your ADSO is complete, you can use your GI Bill to at least get BAH to offset the paycut.

I waited until I left the military, as I was told that the Army had no current need for my desired subspecialty (Anesthesia-Critical Care). Also, I didn't want to have the real possibility of facing new skill rot from underutilized subspecialty skills. On the interview trail, my experience in the military was favorably received, as PDs liked having an experienced applicant. It also showed dedication and genuine interest in the field, as not many people will go from independent practice back into training, and the not insignificant paycut that comes with that.
 

HighPriest

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Conversely, I decided to wait (like psychbender, because the Army decided they didn't need any more subspecialists in my field), and after 4 years I decided not to pursue the fellowship. That could be good or bad, depending upon how you look at it. I'm actually very happy I didn't do it, now that I've been a generalist for a while. But, I may have felt differently if I had trained up front. Hard to say. i would DEFINITELY have had skill rot had I done a fellowship up front. Just speculating, i think I'd have been happier if I'd have waited and then trained after my ADSO. I don't think I'd have had trouble matching into a good position. I wouldn't have to fear coming back to practice at an MTF where I could then watch my skills degrade. I know a guy in my field who did the fellowship I had considered who ultimately ended up practicing as a generalist after his ADSO because he did so little work in his sub-field the last few years that he no longer felt comfortable.
 

absolutdokta

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If you wait until your ADSO is complete, you can use your GI Bill to at least get BAH to offset the paycut.

I waited until I left the military, as I was told that the Army had no current need for my desired subspecialty (Anesthesia-Critical Care). Also, I didn't want to have the real possibility of facing new skill rot from underutilized subspecialty skills. On the interview trail, my experience in the military was favorably received, as PDs liked having an experienced applicant. It also showed dedication and genuine interest in the field, as not many people will go from independent practice back into training, and the not insignificant paycut that comes with that.
i didn't even think of this!! I've been seriously considering doing a pain addiction fellowship after my contract is up but the pay cut always brought a few tears to my eyes
 

teacherman84

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I think on it depends on the fellowship,
i didn't even think of this!! I've been seriously considering doing a pain addiction fellowship after my contract is up but the pay cut always brought a few tears to my eyes
Like anything VA, the process is a pain, especially if the institution hasn't already gone through the process with the VA so start early. It was 2k/month BAH and 1k up front for books. It definitely softens the blow. Add in a little moonlighting and you're prob not far off your mil salary.
 
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militaryPHYS

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Don't just spend your GI bill willy-nilly. If you have the ability to transfer (post-9/11) without incurring more time than you already have committed then the value of it passed on to your child is many times more than what you will get from it personally during fellowship.
 
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teacherman84

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Don't just spend your GI bill willy-nilly. If you have the ability to transfer (post-9/11) without incurring more time than you already have committed then the value of it passed on to your child is many times more than what you will get from it personally during fellowship.
Yes, definitely worth more of you can hang on to it for kids...but if your commitment is HPSP only (like the vast majority are) and get out after your initial 4, like many do, then at least you're using it.
 

absolutdokta

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Excellent info. I am HPSP and will be getting heck out at 4 years. Very likely going to do a pain fellowship


Sent from my iPhone using SDN mobile
 

pgg

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Don't just spend your GI bill willy-nilly. If you have the ability to transfer (post-9/11) without incurring more time than you already have committed then the value of it passed on to your child is many times more than what you will get from it personally during fellowship.
My son is using my GI Bill at an expensive private college right now. Between the direct tuition payments, the Yellow Ribbon supplements, the book allowance, and the BAH payments it comes to nearly $50,000 per year.

All for 30 minutes spent doing paperwork and agreeing to stay on active duty for 4 years that I was already obligated to do anyway. It's tax-free money that literally fell out of the sky and hit me.
 
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Mace1370

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Is there any possible implication of the additional 4 year commitment with the impending DHA changes?
 

j4pac

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Fellowship for IM was incredibly competitive (and often unavailable for some subspecialties) while I was in about 5 years ago. So yeah...there’s no way that I’d PLAN on fellowship. You could be the most competitive applicant in the world and do all of the right things and there’s still a good chance of getting fellowship through the Navy...especially in what looks like an even more difficult climate.

Like others have said, be competitive apply often, and know all your avenues of reaching your goal. I’ve known many people who have served their commitment and were insanely competitive for the civilian sector
 

pgg

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Is there any possible implication of the additional 4 year commitment with the impending DHA changes?
What do you mean?

The two have nothing to do with each other. Are you asking if it's a good idea to elect to stay for 4 more years with the DHA changes on the horizon? I don't know, but that's not related to the GI Bill.

FWIW, the ADSO for transferring GI Bill benefits is served concurrently with any other commitment. Many physicians are able to transfer the benefits without incurring additional time.
 

Mace1370

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What do you mean?

The two have nothing to do with each other. Are you asking if it's a good idea to elect to stay for 4 more years with the DHA changes on the horizon? I don't know, but that's not related to the GI Bill.

FWIW, the ADSO for transferring GI Bill benefits is served concurrently with any other commitment. Many physicians are able to transfer the benefits without incurring additional time.
Sorry, I should have clarified. There is a lot of uncertainty right now with changes coming through DHA. Many specialists are being told that their active duty numbers are going to be reduced in the years ahead. I was wondering if this type of additional, yet concurrent, commitment could affect what might happen to you in the future. Would someone with multiple concurrent commitments be treated differently than someone with a single commitment (assuming equal years owed)? I assume the answer is no, but was curious if anyone else had any insight into the matter.
 

Gastrapathy

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Boy, that would require a level of coordination and logic that I never saw. I’d say it’s unlikely anyone will be let out of their commitment. Attrition solves the problem pretty quickly. For the GS and IM subs, they can always fill general billets until quitting time.
 

Jboss01

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What do you mean?

The two have nothing to do with each other. Are you asking if it's a good idea to elect to stay for 4 more years with the DHA changes on the horizon? I don't know, but that's not related to the GI Bill.

FWIW, the ADSO for transferring GI Bill benefits is served concurrently with any other commitment. Many physicians are able to transfer the benefits without incurring additional time.
How do we start the concurrent process so that we are eligible to transfer the GI Bill without incurring additional commitment?
 

Jboss01

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That 30 min of paperwork needs to be done right and verified. So many people screwed this up.
Would you mind elaborating - how do we do this paperwork, and what about it needs to be done right :). Thanks!
 

buffdoc

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How do we start the concurrent process so that we are eligible to transfer the GI Bill without incurring additional commitment?
When you transfer your GI bill benefits, you automatically incur 4 years of ADSO. The ADSO starts at the time of transfer but can be served concurrently with time already owed.

The other main requirement is that you must have already served for 6 years before requesting the transfer. Most HPSPers serve 7 years (3 years residency + 4 years ADSO) and do not want to incur the extra ADSO to transfer the benefits at 6 years. However, if you are planning on staying in, owe more time due to ROTC/military academy/USUHS, or incurring more ADSO through fellowship, etc, then it is easy to time it so that you do not incur additional commitment.
 

Perrotfish

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Boy, that would require a level of coordination and logic that I never saw. I’d say it’s unlikely anyone will be let out of their commitment. Attrition solves the problem pretty quickly. For the GS and IM subs, they can always fill general billets until quitting time.
I really wonder if they are going to start kicking some of the subspecialists out into the small hospitals or the fleet. I really don't see how else they would make the numbers work by 2020. Has anyone heard any rumors?
 

Matthew9Thirtyfive

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When you transfer your GI bill benefits, you automatically incur 4 years of ADSO. The ADSO starts at the time of transfer but can be served concurrently with time already owed.

The other main requirement is that you must have already served for 6 years before requesting the transfer. Most HPSPers serve 7 years (3 years residency + 4 years ADSO) and do not want to incur the extra ADSO to transfer the benefits at 6 years. However, if you are planning on staying in, owe more time due to ROTC/military academy/USUHS, or incurring more ADSO through fellowship, etc, then it is easy to time it so that you do not incur additional commitment.
Question about that. I asked this on the benefits subforum, but just wanted to clarify. I've got 6 years enlisted time right now and will have 7 years when I go into IRR for med school (HPSP). When I come back on active duty, I'll be able to transfer them immediately upon returning to active duty so that I don't acquire more than my 4 years of payback, right?
 

Perrotfish

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Question about that. I asked this on the benefits subforum, but just wanted to clarify. I've got 6 years enlisted time right now and will have 7 years when I go into IRR for med school (HPSP). When I come back on active duty, I'll be able to transfer them immediately upon returning to active duty so that I don't acquire more than my 4 years of payback, right?
You're already planning to get out at 14 years?
 

Matthew9Thirtyfive

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You're already planning to get out at 14 years?
No, but it would be nice to know I have the option while still being able to transfer my benefit. I like having as many options as possible.
 

buffdoc

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Question about that. I asked this on the benefits subforum, but just wanted to clarify. I've got 6 years enlisted time right now and will have 7 years when I go into IRR for med school (HPSP). When I come back on active duty, I'll be able to transfer them immediately upon returning to active duty so that I don't acquire more than my 4 years of payback, right?
It depends on when you served those 6 years (must qualify for post-9/11 GI bill), but in general, yes. Unless you already used or plan to use your post-9/11 GI bill benefits after your enlistment.
 

Matthew9Thirtyfive

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It depends on when you served those 6 years (must qualify for post-9/11 GI bill), but in general, yes. Unless you already used or plan to use your post-9/11 GI bill benefits after your enlistment.
Sweet. Yeah I qualify for post-9/11 and haven’t used any of it. I’m planning on saving it for my kiddos.