Fellowships in the Military?

[RussianJoo]

Which ever specialty I choose I want to complete a fellowship after my residency. My question is if I choose to apply and go to a military residency program will I be able to complete a fellowship after my residency or will I have to pay off my time to the military before I can apply for fellowships. Does the military offer fellowships in either anesthesia or surgery? I am specifically interested in cardiothoracic for both anesthesia and surgery.

I spoke to a recruiter and he told me that for every year you spend in a military residency you owe a year of service as an attending physician. If I do an anesthesia residency in the military for example that's 3 years (not counting the intern year) so will I have to first work as an attending for 3 years before I can apply for a fellowship in ct anesthesia or will I be able to complete the fellowship (1 extra year) and then work for the military after?

Also if a CT anesthesia fellowship doesn't exist in the military will the military allow me to complete my training by attending a civilian fellowship and then comeback to the military to work as an attending physician, or will i have to pay off my time to the military and then apply for a civilian fellowship after?

I am using the term military because I would like to hear about all branches of the armed service. I know that Army, Air Force and Navy have residencies at some of their basis and I believe I would have to apply to each separately, but I would like to hear comments about all of them if possible.

Thank you in advance for your comments and suggestions.

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[psychbender]

This post pertains to the Army.

You do not have to complete your active duty service obligation before being allowed to apply for fellowship. While it is certainly true that many docs are required to do utilization tours (1-3 years) in their specialty before being allowed to continue on to fellowship, there are definitely some that go straight through.

The Army does offer Anesthesiology fellowships in Pain, Cardiac, Critical Care, and Regional (and, I think, Peds). If they decide that there is a need for a particular subspecialty, and decide that it would be in their best interests to send you to the civilian world for training, then they can do that, too. There are, however, very few cardiac anesthesiologists (about a half-dozen?) in the Army, as the case load is not that high.

 

[RussianJoo]

This post pertains to the Army.

You do not have to complete your active duty service obligation before being allowed to apply for fellowship. While it is certainly true that many docs are required to do utilization tours (1-3 years) in their specialty before being allowed to continue on to fellowship, there are definitely some that go straight through.

The Army does offer Anesthesiology fellowships in Pain, Cardiac, Critical Care, and Regional (and, I think, Peds). If they decide that there is a need for a particular subspecialty, and decide that it would be in their best interests to send you to the civilian world for training, then they can do that, too. There are, however, very few cardiac anesthesiologists (about a half-dozen?) in the Army, as the case load is not that high.

thank you very much for your post. it was very helpful. the way you make it sound is that once you sign a residency contract with the army they own you, and you have to do what they tell you, is that the case? I know in the civilian world residency contracts are for one year and are renewed every year thus giving the resident or residency program the option to not renew a contract, does the same apply for military residencies? You also said that in the army you can complete your active duty obligation after you complete your fellowship. Does this mean that once you've completed your anesthesia residency you can choose to leave the army and do a civilian CT fellowship in anesthesia and then comeback to the army and do your active duty as a CT anesthesiologist or even as a general anesthesiologist if there aren't too many CT cases at the base where you're stationed?

if anyone else would like to answer these q's feel free to comment as well.

as always thank you in advance for your comments.

 

[NavyFlightDoc]

IF the Army needs a CT anesthesiologist (or plans on needing one, provided they planned) they will allow someone to do that fellowship in their system. If they think they need more than they can train, they might allow someone to do a civilian fellowship, and this will more likely, but not always, be a currently practicing anesthiologist who has been applying for his/her CT fellowship for the past 4 years, only to have it finally granted, the way you dangle a treat for your dog to get him to come when he is called.

The FTOS (full-time-out-service) program for doing civilian fellowships actually incurs more obligation for you, the physician.

At no time can "you choose to leave the army and do a civilian CT fellowship." Unless you've already completed your active duty obligation, in which case you would be coming BACK to the army of your own volition, and more power to you.

 

[RussianJoo]

ok so what you're saying is chances of me doing a CT fellowship right after my residency are slim to none, and if I do an anasthesia residency at an army hospital then to really have a good shot at completing a fellowship I would first have to complete my active duty obligation and then apply to civilian fellowships because there are just many more of them and my chances of getting a civilian fellowship will be much greater.

Another question on the same topic. Is there any research oppertunity for anesthesia residents in the military? I don't want to be an acedemic MD but I know that research can help to get a fellowship, and since a CT fellowship is probably a competitive fellowship to get research through out resdiency sounds like a good idea to gain an edge on the other applicants. So how is the research oppertunity in the military residencies?

thank you all for the great replies. very helpfull!

 

[NavyFlightDoc]

slim but not none, every year some residents pre-match to fellowships that are starting right after they finish residency. I'm just saying that the needs of the Army are going to come first, which very well might work out for you.

If you are dead set on a fellowship, then active duty MilMed might not be for you, at least HPSP, possibly later on via a different accession program.

On the other hand, MilMed sometimes helps you get a competitive fellowship (ie @ a place you don't quite deserve to do a fellowship (not referring you personally, of course)) because the military compensates the program. Many of the fellowships that AD physicians do are highly desirable fellowships, like Joint Replacement at HSS, and at other top-of-th-heap, HSS-type places.

 

[RussianJoo]

slim but not none, every year some residents pre-match to fellowships that are starting right after they finish residency. I'm just saying that the needs of the Army are going to come first, which very well might work out for you.

If you are dead set on a fellowship, then active duty MilMed might not be for you, at least HPSP, possibly later on via a different accession program.

On the other hand, MilMed sometimes helps you get a competitive fellowship (ie @ a place you don't quite deserve to do a fellowship (not referring you personally, of course)) because the military compensates the program. Many of the fellowships that AD physicians do are highly desirable fellowships, like Joint Replacement at HSS, and at other top-of-th-heap, HSS-type places.

I am definitely set on doing a fellowship, that's for sure. However I am new to the military medicine forum and thus don't know what most of the acronyms you used mean.. What's MilMed? I know that HPSP is the scholarship program, I am not in it so I don't have any obligation to any military service once I graduate medical school. I am just asking about fellowships because if I don't match into a civilian anesthesia residency I will be applying to a military residency the fallowing year. From what I understand it's easier to match into a military residency than a civilian one, please correct me if I am wrong.

And as always thanks for the help.

 

[NavyFlightDoc]

Sorry,

MilMed = Military Medicine
AD = active duty
HSS = Hospital for Special Surgery, a well respected joint in New York City. That's a medical acronym, not a military one.

as for it being easier to match to a military residency than a civilian one, that's a completely different thing, and it is discussed ad nauseum on this forum, let's keep this thread off that topic, and keep it on fellowships, like you started it.

 

[RussianJoo]

thank you.. so just to clearify. basically when you join a military residency the military owns you. So at the end of your residency if you want to do a fellowship but the military has no need for that fellowship trained physician then they simply won't allow you to do it, or there will be a very limited number of spots and it will be extremely competitve to get that fellowship. This would leave only one choice for you, and that is to finish your active dute requirement (which is 1 year for every year of residency) and then to become a civilian and apply for the fellowship of your choice through ERAS.

On the other hand if the military needs more fellowship trained physicians in the fellowship that you want to persue then not only will it be easy to gain that fellowship but the army might even pay a civilian hospital to accept you into their program.

Is this correct?

So basically you have to get lucky and pick a fellowship that's in great demand.

 

[NavyFlightDoc]

sounds like you grasp the basics young Padawan.

 

[RussianJoo]

thank you very much for your help..

 

[narcusprince]

Russian Joo
Their are some groundrules about military match that you must know. First, the military match is not a "back up" match system that you can back door your way through. If you did not match civilian you would likely not match in the military. Your board scores are competitive for civilian match, however you are from a carib medical school which more or less is an inhibitor. Third, to match in the military for anesthesia which is one of the most competitive fields in the military you would need to do an fourth year clerkship with the branch and impress likely difficult coming from a carib school. Fourth, If you did not match civ and applied to the military they are going to get some sweat out of you as a GMO for 2-3 years than reapply for anes residency. It would be worth it to you to see how the military grades you as a residency applicant, future potential as an officer, class rank, board scores, extra points for GMO tours. As someone whom matched deferred for anesthesia residency in the military your work is cut out for you. Just my two cents.

 

[RussianJoo]

Russian Joo
Their are some groundrules about military match that you must know. First, the military match is not a "back up" match system that you can back door your way through. If you did not match civilian you would likely not match in the military. Your board scores are competitive for civilian match, however you are from a carib medical school which more or less is an inhibitor. Third, to match in the military for anesthesia which is one of the most competitive fields in the military you would need to do an fourth year clerkship with the branch and impress likely difficult coming from a carib school. Fourth, If you did not match civ and applied to the military they are going to get some sweat out of you as a GMO for 2-3 years than reapply for anes residency. It would be worth it to you to see how the military grades you as a residency applicant, future potential as an officer, class rank, board scores, extra points for GMO tours. As someone whom matched deferred for anesthesia residency in the military your work is cut out for you. Just my two cents.

Thank you for your post. There's a lot that I don't know about military residencies. That's why I am here asking questions.. I have read on other recent threads that you can only apply to military programs if you're in the military i.e. you have the HPSP or graduated from a military medical school, however this is not the case (for army that is) since I have spoken to not only recruiters but admission personal at a hospital and they knew I will be a caribbean grad. Basically as a caribbean grad I have to complete all three steps, a civilian internship, and become ECFMG certified. this is not a problem since there are a many prelim medicine or surgery spots that go unfilled. I would then apply for pgy2 spots in the military. Wouldn't this by pass my GMO tour since from what I understand GMO tours are done after your internship or transitional year.

Also will this the GMO tour count towards the active duty requirement? Basically I was told that for every year of residency in the military I have to do at least 1 year of active duty as a physician, will the GMO tour count towards that, even if it's done before I start my residency?

Lastly you said that I shouldn't think of military residencies as a back up, and in a way I agree with you, however I have a family friend who is now a practicing dermatologist and she would have never become a dermatologist if it wasn't for the army. She is a russian immigrant and completed medical school in russia, her board scores were very low when compared to US civilians that apply for derm yet she gained acceptance and now has a very successful practice. Also when talking to the recruiter he told me that the Army helps get a residencies, also from my understanding there's a huge shortage of doctors and extra residency spots can be created by the military if they think they will need more doctors in a certain specialty. So with all that it's hard not to think of the military as a back up. I have great respect for those that fight for my country and serve in the military and I would fight as well if the need emerged, however, with residency I feel that the military will help me out by giving me the opportunity to be the type of doctor i want to be and i will help them by working for them the required years after my training, i simply see it as one hand washing the other. Now a lot of civilians wouldn't do this because they don't want to spend 4 years or however long working in the military and would think that is a waste of time, thus they don't apply and spots are left unfilled and if the military needs physicians than one would assume that as long as you fit the criteria you should gain acceptance much easier than in the civilian world where the number of residency spots seems like it's more fixed.

this is just my take on things if i am wrong please correct me.

 

[mslall]

Thank you for your post. There's a lot that I don't know about military residencies. That's why I am here asking questions.. I have read on other recent threads that you can only apply to military programs if you're in the military i.e. you have the HPSP or graduated from a military medical school, however this is not the case (for army that is) since I have spoken to not only recruiters but admission personal at a hospital and they knew I will be a caribbean grad. Basically as a caribbean grad I have to complete all three steps, a civilian internship, and become ECFMG certified. this is not a problem since there are a many prelim medicine or surgery spots that go unfilled. I would then apply for pgy2 spots in the military. Wouldn't this by pass my GMO tour since from what I understand GMO tours are done after your internship or transitional year.

Also will this the GMO tour count towards the active duty requirement? Basically I was told that for every year of residency in the military I have to do at least 1 year of active duty as a physician, will the GMO tour count towards that, even if it's done before I start my residency?

Lastly you said that I shouldn't think of military residencies as a back up, and in a way I agree with you, however I have a family friend who is now a practicing dermatologist and she would have never become a dermatologist if it wasn't for the army. She is a russian immigrant and completed medical school in russia, her board scores were very low when compared to US civilians that apply for derm yet she gained acceptance and now has a very successful practice. Also when talking to the recruiter he told me that the Army helps get a residencies, also from my understanding there's a huge shortage of doctors and extra residency spots can be created by the military if they think they will need more doctors in a certain specialty. So with all that it's hard not to think of the military as a back up. I have great respect for those that fight for my country and serve in the military and I would fight as well if the need emerged, however, with residency I feel that the military will help me out by giving me the opportunity to be the type of doctor i want to be and i will help them by working for them the required years after my training, i simply see it as one hand washing the other. Now a lot of civilians wouldn't do this because they don't want to spend 4 years or however long working in the military and would think that is a waste of time, thus they don't apply and spots are left unfilled and if the military needs physicians than one would assume that as long as you fit the criteria you should gain acceptance much easier than in the civilian world where the number of residency spots seems like it's more fixed.

this is just my take on things if i am wrong please correct me.

1.) As far as fellowships go, its not like you have to go straight from residency to fellowship OR you have to finish your payback then go to fellowship. Lets say you owe 4yrs, maybe right out of your residency you couldn't get a fellowship, but say the next year the army realizes they need more CT anesthesiologists, you could then apply at that point. Or every year thereafter (i think).

2)Don't believe a word out of a recruiter's mouth (maybe this should be number 1). Sure they could help get you a residency......who knows if it would be in anesthesia. If its not in anesthesia would you mind doing a GMO tour before reapplying?

3) The army, and military in general, is short on physicians, however, I believe the biggest shortages are in primary care specialities.....FP, IM, probably Ob/Gyn too. I would feel very confident in saying that I doubt many anesthesia residency slots go unfilled, like one of the posters put earlier, its one of the most competitive residencies to come by in milmed.

 

[RussianJoo]

thank you for your insight.

as for number 2, I didn't realize that army recruiters would lie to you as much as car salesmen, that's good to know I guess I'll just ask for everything in writting from them. As for the GMO tour, I wouldn't do a GMO tour unless it counted towards my active duty, that I would owe after completing a residency. Also it would be very tough for me to do a GMO tour without some sort of written gaurantee of residency placement (which I know I wouldn't get). As you know I am a civilian and thus have no obligation to do a GMO tour, so if I failed to gain admission I would probably reapply for civilian match and this time apply for something less competitive as a back up. I want to be an anesthesiologist and I am willing to work hard for it and put in extra time by working in the military in return for a residency, but I don't plan on making military medicine my career and would be simply using military residency to gain excellent training and experience.

As for the competitiveness of anesthesia, you make it sound like it's harder get an anesthesia residency in the military than in the civilian world, because although anesthesia is getting more competitive it's still nowhere near as competitive as ortho, ENT, derm, or urology.

Hopefully I match into a civilian residency from the start and can avoid this all together.
The military just seems like a nightmare with broken promises and misrepresentations.

thank you all that replied.

 

[psychbender]

Duder, seriously, with the current state of milmed, and the competitiveness of Anesthesiology, it will be nigh impossible for you, as a civilian from a Caribbean medical school, to match into a PGY-2 position in Anesthesiology in the Army. There are only about 8 or 9 spots at Walter Reed, with a further 4-6 at Brooke. Of these 12-15 spots, all except for MAYBE 1-3 are reserved for 4th year medical students with service obligations (HPSP, USUHS, or ROTC). The remaining 1-3 are kept for Medical Corps officers; those would be returning GMOs, or residency-trained physicians in the military that want to be retrained in a new specialty. Unless you have absolutely amazing board scores, tons of research, and look like the reincarnation of George S Patton, you will not be able to accrue enough points in the military system to beat these guys out for a spot. If you had those attributes, you would have succeeded in the civilian match, and would have no need of trying with the Army.

Recruiters will tell you whatever they think you want to hear in order to get you to sign the dotted line (and initial in 14 other places). What would likely happen, if they allowed you to participate in the match, is you'd end up matching some unfilled spot (FM, Peds, IM, Psych, etc), or be told "damn, tough luck...you know, if you accept this stint in the desert for 2-3 years, you can come back and reapply; I'm sure you'll get a spot then!" To recruiters, you are nothing but a pound of flesh that can be sold to the Army for whatever use is desired.

Just focus on doing your best, and maximizing your chances in the civilian match. If you fail to match in the civilian world, grab a transitional or prelim year, then reapply for a PGY-2 spot the next year. Don't go to the military thinking that you can find an easy back door into specialty training, as you will only end up being used, abused, and unhappy.

 

[RussianJoo]

Duder, seriously, with the current state of milmed, and the competitiveness of Anesthesiology, it will be nigh impossible for you, as a civilian from a Caribbean medical school, to match into a PGY-2 position in Anesthesiology in the Army. There are only about 8 or 9 spots at Walter Reed, with a further 4-6 at Brooke. Of these 12-15 spots, all except for MAYBE 1-3 are reserved for 4th year medical students with service obligations (HPSP, USUHS, or ROTC). The remaining 1-3 are kept for Medical Corps officers; those would be returning GMOs, or residency-trained physicians in the military that want to be retrained in a new specialty. Unless you have absolutely amazing board scores, tons of research, and look like the reincarnation of George S Patton, you will not be able to accrue enough points in the military system to beat these guys out for a spot. If you had those attributes, you would have succeeded in the civilian match, and would have no need of trying with the Army.

Recruiters will tell you whatever they think you want to hear in order to get you to sign the dotted line (and initial in 14 other places). What would likely happen, if they allowed you to participate in the match, is you'd end up matching some unfilled spot (FM, Peds, IM, Psych, etc), or be told "damn, tough luck...you know, if you accept this stint in the desert for 2-3 years, you can come back and reapply; I'm sure you'll get a spot then!" To recruiters, you are nothing but a pound of flesh that can be sold to the Army for whatever use is desired.

Just focus on doing your best, and maximizing your chances in the civilian match. If you fail to match in the civilian world, grab a transitional or prelim year, then reapply for a PGY-2 spot the next year. Don't go to the military thinking that you can find an easy back door into specialty training, as you will only end up being used, abused, and unhappy.

thank you for the honest post. I just wanted to see what else was out there. I kind of figured that I wouldn't be able to simply apply and get whatever I wanted, but after chatting with a recruiter this is what was implied. Now I know better. I guess when you're talking to a man in uniform you don't think he would tell you what you want to hear or lie to you just to get you to sign. I now know better.. Thanks again!

 

[Perrotfish]

I thought it was impossible for him as a Carib grad to match into any military residency. Aren't FMGs no-gos for the military residency system? I thought that, while they could receive FAP, they couldn't apply for a milimed residency slot.

I thought I remembered this from another thread. I very well could be wrong. Anyone here know of a Carib grad getting accepted into the milimed system?

 

[RussianJoo]

I thought it was impossible for him as a Carib grad to match into any military residency. Aren't FMGs no-gos for the military residency system? I thought that, while they could receive FAP, they couldn't apply for a milimed residency slot.

I thought I remembered this from another thread. I very well could be wrong. Anyone here know of a Carib grad getting accepted into the milimed system?

I was told by recruiters that I can do a residency as long as i pass all 3 steps, become ECFMG certified and complete a civilian internship. Then I can apply for pgy2 spots. And this is because I am a US citizen.

And now I saw an article that says they'll recruit aliens on visa...

http://www.militarymedicine.com/node/137

 

[pgg]

Something else to consider about fellowship training while in the military -

The level of acuity at most MTFs is very low. Subspecialists out of fellowship may find themselves with a light case load that may not let them take full advantage of their new skills and knowledge, or worse, let those new skills and knowledge atrophy.

You mention CT anesthesia specifically; in the Navy at least, there's not much room or need for such a specialist. Smaller hospitals don't do hearts at all, so you'd probably spend your ADSO at one of the big three. Even then, your case load (shared with the other cardiac providers) would be a case or two per week at most.

I've given a fair amount of thought to a CT anesthesia fellowship, and have (almost) ruled out doing it while on active duty for this reason. The Tricare/outsourcing/rightsizing movement has not been kind to military physicians who want to take care of sick people.

 

[clinicallabguy]

Awesome thread! I am considering HPSP, and I have a question regarding fellowships in the military as well:

How in demand are IM subspecialties from what any of you can tell?

Of course I don't know what I'll end up doing b/c I start med school next year, but currently my interests are IM, Heme/Onc, and pathology. IM and pathology should be fairly in demand, right?

What about Heme/Onc? Any Heme/Onc fellows out there that can answer this?

 

[BigNavyPedsGuy]

Awesome thread! I am considering HPSP, and I have a question regarding fellowships in the military as well:

How in demand are IM subspecialties from what any of you can tell?

Of course I don't know what I'll end up doing b/c I start med school next year, but currently my interests are IM, Heme/Onc, and pathology. IM and pathology should be fairly in demand, right?

What about Heme/Onc? Any Heme/Onc fellows out there that can answer this?

One thing about the military that it's very important that you grasp is that there is literally no way to know what's going to be available or what's going to be competitive from one year to another. There's definitely no way that anyone can give an answer as to how things will be in 7 years after you finish your residency.

 

[Gastrapathy]

Awesome thread! I am considering HPSP, and I have a question regarding fellowships in the military as well:

How in demand are IM subspecialties from what any of you can tell?

Of course I don't know what I'll end up doing b/c I start med school next year, but currently my interests are IM, Heme/Onc, and pathology. IM and pathology should be fairly in demand, right?

What about Heme/Onc? Any Heme/Onc fellows out there that can answer this?

Do a search, I know I've answered this question before. IM is noncompetitive. IM subspecialties are competitive and usually require a general medicine tour first.