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Fellowship or no fellowship for trauma surgery?

Discussion in 'Military Medicine' started by Racer77, Jul 30, 2011.

  1. Racer77

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    I have been speaking with my recruiter about what it takes in the Army to be a trauma surgeon. I understand that in the civilian world you go through general surgery and then a fellowship in critical care surgery. My recruiter has told me that you get enough trauma experience in the Army in residency that I pretty much would be a trauma surgeon afterwards. Can anyone confirm this? I have heard of civilian general surgeons taking jobs as trauma surgeons, but I don't know if they can really call themselves trauma surgeons.

    I have read though, on this forum where someone said a few years back that the Army would send you to do a fellowship in civilian, critical care surgery. That leads to my other question about Army fellowships in general. I was told by my recruiter that the Army is the only branch that if you do a fellowship you wont need to pay that back. Can anyone confirm this? I assume if this is true, that a person would not be payed your salary from the Army, but a normal civilian salary, and thats how you would not owe any extra time. But I have also read somewhere that BAMC does have a critical care fellowship. So if you went there you would end up owing back another 2 years ( plus the 5 for residency) for taking a fellowship in the Army?

    I am confused lol.
     
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  3. colbgw02

    colbgw02 Delightfully Tacky
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    Your recruiter is either a dirty liar, severely misinformed, or both.

    I'm not a surgeon, but I'm confident enough to say that there is no way that, categorically, an Army general surgery resident gets enough trauma exposure to forego a fellowship. That's just crazy talk. Maybe an experienced OEF/OIF general surgeon from the middle of the last decade can make that claim, but there's no way any residents are getting enough exposure to replace a fellowship.

    I believe you are correct regarding civilian trauma surgeons. Fellowship-trained trauma surgeons are pretty rare because, among other things, the lifestyle is horrible. That opens the door for others, like general surgeons, to fill the need. I'm sure many of these general surgeons are excellent at what they do, but they're not "trauma surgeons" in the sense that you're thinking.

    In theory, if selected, the Army can send you to a civilian fellowship as either sponsored or unsponsored. With the former, you are still on active duty, are paid accordingly, and are required to payback that fellowship time. With the latter, you are in a reserve status, are paid by the civilian institution, and may not owe any additional time due to the fellowship. In 5+ years on active duty, I have never heard of the Army allowing anyone, from any specialty, for any subspecialty, do an unsponsored fellowship. I suppose it could happen; I've just never heard of it.

    My suspicion is that the surgery critical care fellowship at BAMC to which you're referring is more ICU oriented. I wouldn't be surprised if you get some additional exposure to trauma surgery, but it doesn't look to be a trauma surgery fellowship in the traditional sense.

    My understanding of active duty fellowships is that they don't add time to your obligation, provided that they're at least two years in length. The formula for fellowship payback that I've been told is 6 months of payback for 6 months of fellowship, 2-year minimum. If you were to do a 3-year civilian sponsored fellowship, for example, then you would owe post-residency obligation + three years after finishing the fellowship. A 1-year civilian sponsored fellowship would mean a 2-year payback. Active duty fellowships typically pay off and incur obligation simultaneously.

    Lastly, *paid*.
     
  4. Gastrapathy

    Gastrapathy no longer apathetic
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    This used to be true but hasn't been since ~2005. The rules didn't change, just the interpretation of the statute. Inservice fellowship obligation is identical to inservice residency obligation with a couple of subtleties related to special pays.

    Trauma surgeons in the .mil have done trauma fellowships. They are generally not my favorite surgeons as it can be hard to get them to operate on patients with difficult medical/surgical intraabdominal disease.
     
  5. AF M4

    AF M4 Junior Member
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    That's awesome. I agree with colby. This is Exhibit #542 in why recruiters don't know s$&*% about the medical field.

    Saying that you'll get enough trauma experience in general surgery residency that you'll "pretty much" be a trauma surgeon is like saying that if you watch enough CSI you can "pretty much" be a forensics detective. I mean, except for the actual formal training, you pretty much know everything there is to know about the field, right?

    I was "pretty much" an attending for 3 years in my GMO clinic before I got out. During that time I figured out that being "pretty much" of anything means that you will be given the same level of responsibility as the real version without the commensurate training or pay. I don't recommend it.
     
  6. colbgw02

    colbgw02 Delightfully Tacky
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    I'm not tracking. It's also true that active duty residencies simultaneously incur and pay off a service obligation, so I'm not following how a fellowship would be different.

    For example, since 2005, it seems like I've known 4-year HPSP internal medicine residents finish their residency owing 4 years. They went to 3-year active duty fellowships, during which they simultaneously paid off and incurred 3 years (much like residency), resulting in an ADO post-fellowship of 4 years.

    Is that not the case? Explicame, por favor.
     
  7. AF M4

    AF M4 Junior Member
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    Oh yeah, I know that general surgeons do basic surgical trauma stuff all the time and a fellowship-trained trauma surgeon is not needed for everything. But the OP's description of what the recruiter said did not make that distinction: it said that he would "pretty much" be a trauma surgeon. That's false advertising by the naive to the naive.
     
  8. Gastrapathy

    Gastrapathy no longer apathetic
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    Physician recruiting is difficult and SDN is a major reason for that. SDN is front page on google if you search for HPSP.
     
    #7 Gastrapathy, Jul 31, 2011
    Last edited: Jul 31, 2011
  9. AF M4

    AF M4 Junior Member
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    Nah dude, that's an idealized version of what a recruiter should be. It's like believing that a stockbroker is out to make the guys who invest with him money. Not really true: the stockbroker makes his money as a salesman, not an advisor. His job is to get investors to buy as many different stocks as possible, so as to run up commissions for the company who signs his paycheck. If the investors fall backwards into some extra cash along the way, great, they can re-invest that with him. If not, oh well, not a problem for the broker so long as he finds new people to sell to.

    Same with recruiters. Recruits don't sign their paychecks; Uncle Sam does. And Uncle Sam says, sell as many people on HPSP as possible. It doesn't matter if physicians are unhappy later on and get out, so long as you can keep finding new people to recruit.

    So why should the recruiters spend their time figuring out the ins and outs of the match and what happens to med students and docs after they sign on? One look at the retention numbers gives them the gist. So from the recruiter's perspective, they're MUCH better off playing the game and keeping their salesman skills sharp rather than diving into the arcane minutiae of physician training requirements.
     
  10. AF M4

    AF M4 Junior Member
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    More idealism on having your recruiter double as your career counselor.

    Saw a few posts here awhile back about how the services were actually turning down some HPSP applicants. So from their perspective, recruiting is going fine. If isn't broke, don't fix it.

    And for the typical HPSP applicant, the above decisions are many years in the future. It is impossible for even the most hyper-OCD of pre-meds to make any kind of decent decision on stuff like residencies and fellowships. For one, the student doesn't even know if they like medicine yet - people do drop out of med school and residencies to pursue other careers. This is a major reason why I advocate against HPSP: one should make sure that he/she likes being a doctor first before obligating themselves to being a doctor in the military.

    Second, the numbers and/or policies regarding residencies and fellowships may and can dramatically shift depending on a variety of factors beyond the student's control. For instance, my graduating med school class was the year that had all the deferments cut so that we could be jammed into all the empty AF GMO slots. The next year the deferments came back. But for my class, it was impossible for a med student to match into Derm, Rads, Gas, ER, or anything really besides primary care.

    And so why would a recruiter want to learn about all of this? To educate potential recruits? As we've seen on this board, the more that potential recruits learn about HPSP, the less they find to like about it. No, if you're a recruiter, you will be much more successful in your job if you forego learning about physician education issues completely and simply focus on appealing to the typical pre-med's combination of patriotism, naivete, and fear of debt.

    After all, if you start spouting off about fellowship match rates and so on, then you've just encouraged the recruit to go home and Google whatever the heck it was you were talking about which, as Gastrapathy mentioned, brings them straight here.
     
  11. Racer77

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    Thank-you all for your replies. What you have said mostly makes since, although I can say I am more confused now about payback for fellowship training.

    She is actually a medic and knows a trauma surgeon in the Army who she is going to put me in touch with. She does her research, but yes I can see she dosen't know that much about what a fellowship is.

    So one year of an Army sponsored fellowship will add two years to your payback, correct? I find that part odd as I remember her telling me that the Army is the only branch that a fellowship does not count.

    The other question I have that she skated by without giving me an answer. What happens in a GMO tour? It isnt very likely in the Army to do one of these though? The reason is that if you dont't match and do not get a defferment to do a civilian residency, you do a transition year. After that transition year you would be at the top of the list to get an Army residency?
     
  12. Racer77

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    The Army actually has had trouble this year filling their quota. There are still spots open for this year.
     
  13. colbgw02

    colbgw02 Delightfully Tacky
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    Correct. A 1-year civilian sponsored fellowship will add 2 years to your obligation.

    Ummm...sorta? The Army match system is based on points. Doing a GMO tour gives you more points, which helps, but it doesn't put you "at the top of the list". A ****bag GMO won't necessarily get a spot over a superstar intern. Also, most Army residency programs set aside the lion's share of their slots for continuous contracts to 4th-year medical students. A program that takes five residents per year may only give one of those slots to a GMO, for example.

    Civilian deferments for residency training are rare in the Army. So yes, if you do not match into a categorical residency spot then you will match into an internship - usually a transitional internship. You will have the opportunity to apply again as an intern, and if you don't match the second time then you'll head to GMO land. I believe general surgery is still the exception to this, because they still require all of their interns to reapply in order to continue to the PGY-2 year.
     
  14. deuist

    deuist Stealthfully Sarcastic
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    I think derm might be easier in the AF, but anesthesia and rads where the two most competitive specialties when I was a 4th year medical student. If you do a GMO tour, then I can see matching becoming easier.
     
  15. Gastrapathy

    Gastrapathy no longer apathetic
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    Sorry, didn't notice this before. This is a confusing area. It's all about which obligations are consecutive versus concurrent.

    What I was referring to was that, until ~2005, residency and fellowship obligations could be served concurrently. Now they are not.

    A 4 year HPSP IM trainee who does 6 straight years of GME via residency and fellowship owes 5 years at the end of that time (internship doesn't add obligation, only PGY2+). The HPSP obligation has no bearing because it is concurrent with the PGY2+ obligation(s).

    Its not accurate to think of accruing and paying off simultaneously. What happens is that your residency obligation is concurrent with your pre-GME obligation.
     

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