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Hello all,
I am a current HPSP student and I am considering general surgery. I noticed that the Army general surgery residencies are 6 years total due to a year of research in between PGY2 and PGY3. How does this research year affect payback time, how many years would be required as an attending? Do any current general surgery residents or attendings have any input on surgery in the Army? Are the horror stories of atrophied skills true?
 

HighPriest

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The research year would add one year of ADSO after residency. So, assuming you have no other obligations, 6 years residency plus 5 years ADSO. The horror stories about atrophy are all true.
 
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didja

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With very rare exception, the really happy surgeons I've met in almost 20 years were ex-surgeons working in administration (many of whom I assumed had malpractice cases or some drama that took them out of clinical practice). The prior academy and USUHS surgeons with long paybacks have little hope of remaining on the top of their game during payback (but then again, DHA apparently thinks we can have a bunch of stateside hospitals with a bunch of trauma surgeons running around and call that a medical corp).
 
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I hope you don’t mind me adding to your question OP. I am super interested in anesthesia, and I always read about skill atrophy regarding military surgeons and ER physicians. I think I have seen a few anesthesiologists on this forum, and I would love if any of them would give their opinion. Is the risk of skill atrophy as severe for military anesthesiologists as it is for surgeons?
 

Detective SnowBucket

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I hope you don’t mind me adding to your question OP. I am super interested in anesthesia, and I always read about skill atrophy regarding military surgeons and ER physicians. I think I have seen a few anesthesiologists on this forum, and I would love if any of them would give their opinion. Is the risk of skill atrophy as severe for military anesthesiologists as it is for surgeons?
I think the real question is, is the atrophy the same in all branches, with GMO tours more common in Army/Navy, while the AF tends to send you straight through residency.
 

militaryPHYS

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Atrophy (fewer reps/complexity than civilian counterparts) is different based on Branch of Service, Duty location, Specialty, Sub-Specialty, Year, Month, Day.
The one common thread about atrophy is that EVERYONE will experience it at some point in their Military Physician career after graduating residency.

Expect it. Plan for it. Mitigate it. If you don't want to worry about skill atrophy then do not sign up for Military Medicine. Then also make sure you don't go to crappy civilian residency and then work at a low volume community hospital.

"Atrophy" does not guarantee that you will be a worse physician than your civilian counterparts. It does require you to be proactive about maintaining skills/knowledge by seeking out ways to mitigate effects of lower volume or lower complexity cases during portions of your Military career. There are a few niches within Military Medicine which have little to no atrophy but this is not a majority.

If you decide you are OK with the chances of skill atrophy via the Military (already signed HPSP, USUHS, HSCP, etc.) and you want to mitigate their effects then you need to be talking to people CURRENTLY ACTIVE within your branch of service who are within the specialty you are inquiring about. They will discuss with you moonlighting options, CME, etc. which can help you maintain during time with lower volume or complexity of cases. If you do not seek out persons with first hand knowledge of your situation then you will get generic answers which likely have no actionable tips for you to execute.



All Active Duty physicians or those within a year after separating/retiring please list your Branch of Service and Specialty so we can compile an updated list for Pre-Meds or Studs to utilize.

@militaryPHYS can discuss Navy Orthopedics (self) and Internal Medicine (wife)
 
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Detective SnowBucket

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Atrophy (fewer reps/complexity than civilian counterparts) is different based on Branch of Service, Duty location, Specialty, Sub-Specialty, Year, Month, Day.
The one common thread about atrophy is that EVERYONE will experience it at some point in their Military Physician career after graduating residency.

Expect it. Plan for it. Mitigate it. If you don't want to worry about skill atrophy then do not sign up for Military Medicine. Then also make sure you don't go to crappy civilian residency and then work at a low volume community hospital.

"Atrophy" does not guarantee that you will be a worse physician than your civilian counterparts. It does require you to be proactive about maintaining skills/knowledge by seeking out ways to mitigate effects of lower volume or lower complexity cases during portions of your Military career. There are a few niches within Military Medicine which have little to no atrophy but this is not a majority.

If you decide you are OK with the chances of skill atrophy via the Military (already signed HPSP, USUHS, HSCP, etc.) and you want to mitigate their effects then you need to be talking to people CURRENTLY ACTIVE within your branch of service who are within the specialty you are inquiring about. They will discuss with you moonlighting options, CME, etc. which can help you maintain during time with lower volume or complexity of cases. If you do not seek out persons with first hand knowledge of your situation then you will get generic answers which likely have no actionable tips for you to execute.



All Active Duty physicians or those within a year after separating/retiring please list your Branch of Service and Specialty so we can compile an updated list for Pre-Meds or Studs to utilize.

@militaryPHYS can discuss Navy Orthopedics (self) and Internal Medicine (wife)
Thanks for the help. I am actually interested in taking AF HPSP this cycle and am interested in ortho down the line. Do you think USAF has an advantage here? From my understanding, they have the highest rate of deferring to civilian residency and of sending you straight through after med school. I don't know about atrophy over a career with them, but at least you won't forget med school by doing 2 years of GMO as a battalion surgeon.

If you do get deferred into a civ residency, do you have any say as to what program/where you go?
 

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I hope you don’t mind me adding to your question OP. I am super interested in anesthesia, and I always read about skill atrophy regarding military surgeons and ER physicians. I think I have seen a few anesthesiologists on this forum, and I would love if any of them would give their opinion. Is the risk of skill atrophy as severe for military anesthesiologists as it is for surgeons?
@pgg
 
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HighPriest

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I think the real question is, is the atrophy the same in all branches, with GMO tours more common in Army/Navy, while the AF tends to send you straight through residency.
Atrophy becomes a problem after residency. So GMO tours aren't really the issue.
 

HighPriest

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I can't speak for Ortho or Gen Surg, but I can say that at least for some specialties there is only so much you can do to combat atrophy. It depends upon where you are (some places you can moonlight locally, and in others you have to take leave) and it depends upon what skills you're trying to maintain (for example: you can moonlight in ENT, but if you are short on cancer cases (which everyone in military ENT is), there really isn't much of an opportunity to do those while moonlighting.)

That being said, there are things you can do, in a general sense, to combat atrophy and you should be prepared to do them regardless of service branch.
 
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pgg

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I hope you don’t mind me adding to your question OP. I am super interested in anesthesia, and I always read about skill atrophy regarding military surgeons and ER physicians. I think I have seen a few anesthesiologists on this forum, and I would love if any of them would give their opinion. Is the risk of skill atrophy as severe for military anesthesiologists as it is for surgeons?
I'm a Navy anesthesiologist. The answer is that it varies, but the risk is significant.

At the smaller hospitals - particularly overseas - the case load is dismal. The up side, at least for those stationed in CONUS, is that anesthesiology is very well suited to off-duty employment (moonlighting). We don't have ongoing responsibility for patients before or after they're in the OR, it's shift work, and there's a need for coverage at night and on weekends which can sometimes minimize the amount of leave one needs to take to do it. Most commands permit it with minimal hassle.

Anesthesiologists stationed at one of the large MTFs can generally practice something approaching the full spectrum of cases, albeit skewed heavily toward routine general surgery and orthopedics, with ENT urology OB/GYN etc thrown in. Case load is low. Not a lot of intracranial neurosurgery (but a good number of necks and backs), major vascular. No cardiac.

The lack of cardiac surgery is relevant to my interests, since less than a year after I finished an adult cardiac fellowship, my MTF closed its cardiac surgery program. I've been able to continue doing cases at a VA (on Navy time for my usual Navy pay) and at a local civilian hospital (on my time for locums pay). I was deployed just a few weeks ago, but until that point for 2019 I was on a pace to do somewhere around 75 pump cases, which isn't great but it certainly isn't cripplingly bad either. I'm aggressive with CME on my own time. I think I'm solid if not excellent ;) and don't think I'll have significant catchup or remediation to do when I leave the Navy and join a busy high acuity practice. But I'd be lying if I said that risk doesn't weigh on me a little.

I would say a Navy practice for an anesthesiologist is fine for a generalist. Case volume isn't great, but most of us moonlight and I know many many active duty anesthesiologists who've left the Navy after their time was up, or after retirement, and they all do Just Fine as civilians.

Our pediatric fellowship trained anesthesiologists are pretty busy. They have a good and varied case load. Whether that will be the case in 5 or 10 years, after we've shifted priorities to operationally relevant specialties and perhaps lost the peds and OB/NICU pipeline to the pediatric ORs ... is anybody's guess. I just don't know.

CCM fellowship trained anesthesiologists are pretty welcome in military hospital ICUs. A hybrid OR/ICU practice is something that can be tough to make happen in private practice, so this is perhaps OK in the military. The problem, of course, is that nearly all of our ICUs are very low acuity, low volume places. But CCM-trained anesthesiologists can probably at least keep their fingers in the ICU while they're on active duty. We have some anesthesiologists who do 100% CCM.

Pain fellowship trained anesthesiologists have plenty of work to do. I didn't like pain at all, and I don't really keep tabs on what they're doing. But I get the impression they have a pretty good practice. Good volume of procedures, good patient population, relatively low number of opioid-related headaches compared to many civilian practices.

Bottom line, it's worse than it was 10 years ago, but I still think it's OK, though my opinion is that moonlighting to supplement case volume ranges from merely important ... to absolutely critical (as in my own case).


As a final point, I will add that I burn the majority of my Navy vacation time moonlighting in order to maximize my case load. This is a recipe for burnout. I admit I was starting to feel it a little this summer, after a block of ~2 years in which I took almost no leave for personal time off. (I did have a ~3 month block of overseas TAD that was a welcome change of pace despite being somewhat traumatic for other reasons.) I left for deployment last month, and honestly had been looking forward to a little bit of time doing nothing.
 
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I'm a Navy anesthesiologist. The answer is that it varies, but the risk is significant.

At the smaller hospitals - particularly overseas - the case load is dismal. The up side, at least for those stationed in CONUS, is that anesthesiology is very well suited to off-duty employment (moonlighting). We don't have ongoing responsibility for patients before or after they're in the OR, it's shift work, and there's a need for coverage at night and on weekends which can sometimes minimize the amount of leave one needs to take to do it. Most commands permit it with minimal hassle.

Anesthesiologists stationed at one of the large MTFs can generally practice something approaching the full spectrum of cases, albeit skewed heavily toward routine general surgery and orthopedics, with ENT urology OB/GYN etc thrown in. Case load is low. Not a lot of intracranial neurosurgery (but a good number of necks and backs), major vascular. No cardiac.

The lack of cardiac surgery is relevant to my interests, since less than a year after I finished an adult cardiac fellowship, my MTF closed its cardiac surgery program. I've been able to continue doing cases at a VA (on Navy time for my usual Navy pay) and at a local civilian hospital (on my time for locums pay). I was deployed just a few weeks ago, but until that point for 2019 I was on a pace to do somewhere around 75 pump cases, which isn't great but it certainly isn't cripplingly bad either. I'm aggressive with CME on my own time. I think I'm solid if not excellent ;) and don't think I'll have significant catchup or remediation to do when I leave the Navy and join a busy high acuity practice. But I'd be lying if I said that risk doesn't weigh on me a little.

I would say a Navy practice for an anesthesiologist is fine for a generalist. Case volume isn't great, but most of us moonlight and I know many many active duty anesthesiologists who've left the Navy after their time was up, or after retirement, and they all do Just Fine as civilians.

Our pediatric fellowship trained anesthesiologists are pretty busy. They have a good and varied case load. Whether that will be the case in 5 or 10 years, after we've shifted priorities to operationally relevant specialties and perhaps lost the peds and OB/NICU pipeline to the pediatric ORs ... is anybody's guess. I just don't know.

CCM fellowship trained anesthesiologists are pretty welcome in military hospital ICUs. A hybrid OR/ICU practice is something that can be tough to make happen in private practice, so this is perhaps OK in the military. The problem, of course, is that nearly all of our ICUs are very low acuity, low volume places. But CCM-trained anesthesiologists can probably at least keep their fingers in the ICU while they're on active duty. We have some anesthesiologists who do 100% CCM.

Pain fellowship trained anesthesiologists have plenty of work to do. I didn't like pain at all, and I don't really keep tabs on what they're doing. But I get the impression they have a pretty good practice. Good volume of procedures, good patient population, relatively low number of opioid-related headaches compared to many civilian practices.

Bottom line, it's worse than it was 10 years ago, but I still think it's OK, though my opinion is that moonlighting to supplement case volume ranges from merely important ... to absolutely critical (as in my own case).


As a final point, I will add that I burn the majority of my Navy vacation time moonlighting in order to maximize my case load. This is a recipe for burnout. I admit I was starting to feel it a little this summer, after a block of ~2 years in which I took almost no leave for personal time off. (I did have a ~3 month block of overseas TAD that was a welcome change of pace despite being somewhat traumatic for other reasons.) I left for deployment last month, and honestly had been looking forward to a little bit of time doing nothing.
Thank you SO much. I have been looking for more info regarding military anesthesia for a long time and have never found anything as detailed as you have just written. I am prior service infantry + nurse(lpn), premed, and getting close to having to decide whether I want to go back in for med school(wife and kids). If the military had a higher volume of patients it would be my top choice 100%, but getting out and being behind all my civilian peers scares me a lot. What you wrote is very reassuring especially that certain subspecialties are seemingly super active. I think it’s crazy taking certain specialties off the table like gen surg or ER before even going to medical school, but after all the horror stories I have read, I am terrified of having 7 years of doing close to nothing valuable. Anesthesia sounds promising, and I would definitely be okay with moonlighting during leave(maybe not for all 30 days of it lol).
 

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As a final point, I will add that I burn the majority of my Navy vacation time moonlighting in order to maximize my case load. This is a recipe for burnout. I admit I was starting to feel it a little this summer, after a block of ~2 years in which I took almost no leave for personal time off. (I did have a ~3 month block of overseas TAD that was a welcome change of pace despite being somewhat traumatic for other reasons.) I left for deployment last month, and honestly had been looking forward to a little bit of time doing nothing.
This was true for me as well. I spent most of my vacation chasing complex cases while moonlighting. Which meant that I was burned out when working my primary, military, job mostly because of all the arbitrary, non-clinical BS that I dealt with. Then I would go on "vacation" and purposefully hunt for complicated, and inherently stressful, cases to do. So it was very easy to burn your fingers with that kind of fire on both ends. But the alternative was having to either stop doing certain types of cases due to lack of experience, or possibly hurting a patient because I did them anyway.
 
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Per5everance

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I am not in the military but had a strong desire to join after I complete general surgery residency +/- fellowship. Skill atrophy has got to be a thing. After much research trying to find vascular case surgery volumes, I stumble upon this article regarding general surgery case volume. The average case volume was 108 cases per year or not even 1 case every 3 days! That is crazy. On top of that, the article does not even mention what type of the cases those are. I would imagine a good chunk are hernias, breast, appy, chole cases. Hopefully that number does not include scopes. Also, it does not seem that Brooks or Walter Reed was included which I assume have higher operative volumes. After finding that article, there is no way I could join unless something changes (like 300 cases/year which is still below the average general surgeon).
 
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From my understanding, they have the highest rate of deferring to civilian residency and of sending you straight through after med school. I don't know about atrophy over a career with them, but at least you won't forget med school by doing 2 years of GMO as a battalion surgeon.
The Military is not a free ride for a civilian pathway in medicine.

Expect to be (and be OK with the possibility of) doing a GMO tour. Aim for and hope for an Active Duty residency. If you don't check these two boxes then I would say you are not a good candidate for Military Medicine.

GMO tours are not the problem for atrophy. Starting residency (either after med school or after GMO tour) is a whole new ballgame. Sure some of your academic rote memorization stuff wanes during GMO, but for the most part you're just as stressed and just as fire-hosed your first year of residency no matter where you come from. You will level off with your peers quickly. Atrophy is CLINICAL atrophy that you experience after finishing residency. These payback years as staff are when you can lose some clinical ground on those with higher volume or higher complexity cases.

If you do get deferred into a civ residency, do you have any say as to what program/where you go?
Yes. You apply through AMCAS just like any other civilian resident
 
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militaryPHYS

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I am not in the military but had a strong desire to join after I complete general surgery residency +/- fellowship. Skill atrophy has got to be a thing. After much research trying to find vascular case surgery volumes, I stumble upon this article regarding general surgery case volume. The average case volume was 108 cases per year or not even 1 case every 3 days! That is crazy. On top of that, the article does not even mention what type of the cases those are. I would imagine a good chunk are hernias, breast, appy, chole cases. Hopefully that number does not include scopes. Also, it does not seem that Brooks or Walter Reed was included which I assume have higher operative volumes. After finding that article, there is no way I could join unless something changes (like 300 cases/year which is still below the average general surgeon).
First and foremost: I agree that volume and complexity is lower in the military healthcare system. I agree with the NDAA and DHA changes focused on opening up partnerships to increase clinical activity of our active duty surgeons by letting them practice outside of just the military healthcare system. Clinical atrophy is real and we should be fixing it.

This article was written specifically as leverage to fix the problem. So in a way I'm in support of it. On the other hand this is oversimplifying an immensely complex professional skill. I love the Outliers book. It's a great book. Applying only the time between cut and close to the 10k hours and using this as a metric for surgical mastery? Give me a break.
 

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Atrophy becomes a problem after residency....
This.

The big untold secret is skill atrophy happens in private practice too, and is very dependent where you end up.
Do you think all those thyroids and parathyroids just show up the day you roll into town because everyone heard from the hospital head hunter your such a great guy? And I'm sure your senior partners just can't wait to give you those sweet cases they've been getting only after years of wooing referring docs!
Depending on referral patterns and historical turf battles, it could be years before certain cases come your way.
Will you be ready????
 

HighPriest

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This.

The big untold secret is skill atrophy happens in private practice too, and is very dependent where you end up.
Do you think all those thyroids and parathyroids just show up the day you roll into town because everyone heard from the hospital head hunter your such a great guy? And I'm sure your senior partners just can't wait to give you those sweet cases they've been getting only after years of wooing referring docs!
Depending on referral patterns and historical turf battles, it could be years before certain cases come your way.
Will you be ready????
They just showed up on my door. My partners just sent me a lot of them, because they were overbooked.
Skill atrophy is almost a guarantee in the military. It is true that I’m certain civilian practice settings, you may need to build up your reputation and market yourself somewhat. But, in many places there’s a major physician shortage, and a lot of baby boomers getting older and waiting for a doctor. The good thing is that, with time and effort, you can build a practice in the civilian world. But you can’t I’m the military. Not in a meaningful way. Because it’s a closed system.

I hear what you’re saying. I just have yet to hear about anyone in my field getting out and then have trouble finding work to do.

I was as busy as I could possibly want to be, doing everything I was missing in the Army, within 6 months or less of starting work.
 

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The Military is not a free ride for a civilian pathway in medicine.

Expect to be (and be OK with the possibility of) doing a GMO tour. Aim for and hope for an Active Duty residency. If you don't check these two boxes then I would say you are not a good candidate for Military Medicine.

GMO tours are not the problem for atrophy. Starting residency (either after med school or after GMO tour) is a whole new ballgame. Sure some of your academic rote memorization stuff wanes during GMO, but for the most part you're just as stressed and just as fire-hosed your first year of residency no matter where you come from. You will level off with your peers quickly. Atrophy is CLINICAL atrophy that you experience after finishing residency. These payback years as staff are when you can lose some clinical ground on those with higher volume or higher complexity cases.



Yes. You apply through AMCAS just like any other civilian resident
You said you're in ortho. I know much of the issue with atrophy is simply not seeing the cases in the military that you would in the civilian world. This is largely due to the patient population being young, healthy and no underlying issues, no? I don't expect that to be the case for ortho as I imagine that this is a population specifically prone to the injuries ortho would treat.

ALso, am I wrong in stating "[USAF has] the highest rate of deferring to civilian residency and of sending you straight through after med school." You didn't really answer that one.
 
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You said you're in ortho. I know much of the issue with atrophy is simply not seeing the cases in the military that you would in the civilian world. This is largely due to the patient population being young, healthy and no underlying issues, no? I don't expect that to be the case for ortho as I imagine that this is a population specifically prone to the injuries ortho would treat.

ALso, am I wrong in stating "[USAF has] the highest rate of deferring to civilian residency and of sending you straight through after med school." You didn't really answer that one.

Not sure if you have seen this. It is a pretty helpful document if you haven’t. If I am reading this correctly, the Air Force has 14 ortho spots, and 10 of those spots are deferred to civilian. They also have an agreement with UC Davis for some residencies, including ortho. 1 person is training there. I imagine it is pretty competitive.
 

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Not sure if you have seen this. It is a pretty helpful document if you haven’t. If I am reading this correctly, the Air Force has 14 ortho spots, and 10 of those spots are deferred to civilian. They also have an agreement with UC Davis for some residencies, including ortho. 1 person is training there. I imagine it is pretty competitive.
Had not, thanks. No doubt its still competitive.
 

militaryPHYS

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ALso, am I wrong in stating "[USAF has] the highest rate of deferring to civilian residency and of sending you straight through after med school." You didn't really answer that one.
# of deferments changes every year and is different for every specialty in every branch of service. I do not track these numbers. The numbers also don't change my overall main educational piece I try to provide to premeds. That is, do not join MilMed in hopes of avoiding a GMO tour or obtaining a deferment. It is a recipe for disaster.

@vom- provided a good resource to look at for projections. Each service releases something similar. These projections can change before match day and will most definitely change by the time you reach the year you will be applying.

You said you're in ortho. I know much of the issue with atrophy is simply not seeing the cases in the military that you would in the civilian world. This is largely due to the patient population being young, healthy and no underlying issues, no? I don't expect that to be the case for ortho as I imagine that this is a population specifically prone to the injuries ortho would treat.
You are correct. And this is exactly the reason I chose Orthopedics. Exactly the reason I chose Sports Medicine fellowship as well. Sports sub-specialty within Ortho is probably one of the few MilMed sub-specialties that comes close to mirroring a civilian practice. But I did NOT join with this goal in mind. My pathway in MilMed showed me how I could be the most useful to the military while also aligning with my personal aspirations. Both of these things were constantly changing. I didn't even have Ortho on the radar until the summer between 3rd and 4th year medical school

Initially I wanted to do Family Med and go operational. Then I realized I like surgery during my 2nd year. Then I realized I did not like General Surgery and Ortho fit better with my personality. Thankfully my scores were good enough to get me there. Then after graduating I realized I like Sports a lot and it provided the best utility back to the military to keep me the most relevant and useful.

Bottom line: If you sign up for MilMed as a Premed in hopes of joining the Air Force and getting a deferment for Ortho you are mentally creating a very specific difficult pathway to fulfill. You might get it and I hope you do if that is what will be the right thing for you at that time. Unfortunately it doesn't change the concern I have about the mental framework you are establishing now which can cause you to be miserable if even one piece of that puzzle falls apart. Change in specialty choice is not unique to the military. I think over 80% of med studs change after starting first year. Regardless of MilMed or Civilian, keep your mind open to any and all possibilities. Otherwise you'll be the wannabe ortho jock who is full of himself rotating on the pediatric service during 3rd year. You want to be a solid medical student considering everything. Your preceptors will pick up on this stuff.

When I joined I wanted to serve my country as a physician. It was in that order. I didn't care where the military needed me or what they wanted me to do, I just knew I wanted to serve my country and I might as well be doing it as a physician. This allowed me to go where the MilMed path wanted to take me as opposed to me trying to take MilMed where I wanted to go. The latter is impossible and many physicians become mentally destroyed trying.
 

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This allowed me to go where the MilMed path wanted to take me as opposed to me trying to take MilMed where I wanted to go. The latter is impossible and many physicians become mentally destroyed trying.
Is there something specific about the military that does this? Would these people be happier as civilians? (Would they be able to reach their goals better, has the military prevented them from going into the specialty they wanted that they could have matched as civilians?)
 

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Is there something specific about the military that does this? Would these people be happier as civilians? (Would they be able to reach their goals better, has the military prevented them from going into the specialty they wanted that they could have matched as civilians?)
In the civilian world, you are working to attain your goals. In the military, you are working to attain the military’s goals. If you have the same goals as the military, or if you are ok with the military telling you what your goals are, then it’s easier to be happy in the military.
 

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In the civilian world, you are working to attain your goals. In the military, you are working to attain the military’s goals. If you have the same goals as the military, or if you are ok with the military telling you what your goals are, then it’s easier to be happy in the military.
I've talked to HPSP recruiters and current recipients and they're all said the military won't push you into a specialty you don't want. Can you just hold out until you get it (if you can reasonably assume you are a good match for it?). Don't just say 'no one can assume they'll match a given specialty', I'm talking ceteris paribus.
 

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They won't push you in to a specialty. That doesn't mean you'll necessarily get what you want. You join. You finish med school. You apply for a military residency. You can apply for whatever you want, assuming the military is offering the specialty. There's a match. If you match in to the specialty, you go to residency. If you do not match, you generally go in to what's called a "transitional" internship, which is a hodgepodge year of rotations through various specialties like IM, FM, and sometimes surgical specialties. Once you're done with the TY year, some people will go GMO and some will reapply for residency. If you don't match again, you're probably going GMO.

Some of this is service dependent, as some services do GMO more frequently than others.

But keep in mind that when a recruiter tells you the military won't force you to do a certain residency, they're not saying or even insinuating that you'll necessarily get what you want either.
 

Per5everance

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First and foremost: I agree that volume and complexity is lower in the military healthcare system. I agree with the NDAA and DHA changes focused on opening up partnerships to increase clinical activity of our active duty surgeons by letting them practice outside of just the military healthcare system. Clinical atrophy is real and we should be fixing it.

This article was written specifically as leverage to fix the problem. So in a way I'm in support of it. On the other hand this is oversimplifying an immensely complex professional skill. I love the Outliers book. It's a great book. Applying only the time between cut and close to the 10k hours and using this as a metric for surgical mastery? Give me a break.

Yeah, I don't really care much for the 10k hrs either. I was just looking at it as a purely case volume thing. Just over 100 cases is not enough IMO, especially immediately after residency. Maybe when you are like 5-10 years down the road it is okay (not ideal). I am just a resident though, not an attending so who knows what my opinion is worth. Thanks for the response.
 
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pgg

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They won't push you in to a specialty. That doesn't mean you'll necessarily get what you want. You join. You finish med school. You apply for a military residency. You can apply for whatever you want, assuming the military is offering the specialty. There's a match. If you match in to the specialty, you go to residency. If you do not match, you generally go in to what's called a "transitional" internship, which is a hodgepodge year of rotations through various specialties like IM, FM, and sometimes surgical specialties. Once you're done with the TY year, some people will go GMO and some will reapply for residency. If you don't match again, you're probably going GMO.

Some of this is service dependent, as some services do GMO more frequently than others.

But keep in mind that when a recruiter tells you the military won't force you to do a certain residency, they're not saying or even insinuating that you'll necessarily get what you want either.
I would clarify that transitional internships are usually more competitive than that, since historically they've been the preferred path for people entering very competitive specialties that don't or didn't have their own categorical intern year (e.g. derm). In the military you're more likely to be stuffed into an unfilled internal medicine or surgery internship than transitional if you're not a strong applicant.

USUHS grads are guaranteed an inservice internship year. HPSP grads are not. An HPSP grad who doesn't match to a military program needs to find a home in the civilian world.
 
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Hello all,
I am a current HPSP student and I am considering general surgery. I noticed that the Army general surgery residencies are 6 years total due to a year of research in between PGY2 and PGY3. How does this research year affect payback time, how many years would be required as an attending? Do any current general surgery residents or attendings have any input on surgery in the Army? Are the horror stories of atrophied skills true?
Could not help in commenting on your post. I was hpsp and finished 6 yr residency in 2016. My ADSO would have been June 2021. 5 years. But I did a fellowship which pushed me to 2025. If I can convince one person to stay away from surgery in the army, I consider that a success. If you really want surgery, do a GMO, pay your time and get out. Go train civilian. Trust me. Army surgery is a disaster. Worst decision a person could make. We are all unhappy and miserable in this system with deployment after deployment back to back to back. You will not find one surgeon who is happy to be here unless they are lazy
 
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Detective SnowBucket

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Could not help in commenting on your post. I was hpsp and finished 6 yr residency in 2016. My ADSO would have been June 2021. 5 years. But I did a fellowship which pushed me to 2025. If I can convince one person to stay away from surgery in the army, I consider that a success. If you really want surgery, do a GMO, pay your time and get out. Go train civilian. Trust me. Army surgery is a disaster. Worst decision a person could make. We are all unhappy and miserable in this system with deployment after deployment back to back to back. You will not find one surgeon who is happy to be here unless they are lazy
Thank you so much for this! there's no one more valuable on this thread than people who've done it.
Would you say its the same with other branches? With non-surgical specialties in the army? Does paying back all your time as GMO then going civilian make you less competitive?
 
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I would clarify that transitional internships are usually more competitive than that, since historically they've been the preferred path for people entering very competitive specialties that don't or didn't have their own categorical intern year (e.g. derm). In the military you're more likely to be stuffed into an unfilled internal medicine or surgery internship than transitional if you're not a strong applicant.

USUHS grads are guaranteed an inservice internship year. HPSP grads are not. An HPSP grad who doesn't match to a military program needs to find a home in the civilian world.
TY's remain default non-matched internship for the Army.
Not the case in the Navy/AF.

HighPriest is former Army, and you're Navy, hence the differences in perspective.
 
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militaryPHYS

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Could not help in commenting on your post. I was hpsp and finished 6 yr residency in 2016. My ADSO would have been June 2021. 5 years. But I did a fellowship which pushed me to 2025. If I can convince one person to stay away from surgery in the army, I consider that a success. If you really want surgery, do a GMO, pay your time and get out. Go train civilian. Trust me. Army surgery is a disaster. Worst decision a person could make. We are all unhappy and miserable in this system with deployment after deployment back to back to back. You will not find one surgeon who is happy to be here unless they are lazy
Important Tip for anyone already in the system: Use your 6 years of residency to decide whether or not you are happy or will continue to be happy in MilMed. If there is any question about your ability to remain happy in MilMed do NOT sign on for additional time.

@mil surgeon please try to avoid generalizing your opinion to your entire government institution. You might be right regarding deployment schedule and case volume/complexity but either way please keep your advice to personal objective data please.
 

Chonal Atresia

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Important Tip for anyone already in the system: Use your 6 years of residency to decide whether or not you are happy or will continue to be happy in MilMed. If there is any question about your ability to remain happy in MilMed do NOT sign on for additional time.

@mil surgeon please try to avoid generalizing your opinion to your entire government institution. You might be right regarding deployment schedule and case volume/complexity but either way please keep your advice to personal objective data please.
I don’t know what you’re reading, but @mil surgeon did not make any generalizations. To the complete contrary, he said and I quote “if I could convince just one person from avoiding surgery in the army, I would consider it a success.” That’s pretty freakin’specific.

FWIW, I know/knew many general surgeons in the army. My best friend’s brother is a West Point grad and full-bird at a major MEDCEN. He just left on his 7th deployment ! He drank the kool-aid as much as anybody I ever met and even he has had enough. Another one of my general surgeon buddies is on his 3rd marriage. I could go on, but I’m sure you catch my drift.

BTW, you can add army ENT to this list. Don’t know anyone who is happy right now.
 
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militaryPHYS

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but @mil surgeon did not make any generalizations.
This is how the post ended: "You will not find one surgeon who is happy to be here unless they are lazy"

Like I said, he might be right and his opinion needs to be shared. I'd like to hear about what program he trained at, the specific reasons Army Surgery is not what he expected when he volunteered, and then also why, if it is so bad, did he agree to add additional time to his commitment.
 

Chonal Atresia

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This is how the post ended: "You will not find one surgeon who is happy to be here unless they are lazy"

Like I said, he might be right and his opinion needs to be shared. I'd like to hear about what program he trained at, the specific reasons Army Surgery is not what he expected when he volunteered, and then also why, if it is so bad, did he agree to add additional time to his commitment.
Pretty sure when he said “surgeon” he was referencing the situation he had described in the previous paragraph.

I think he would have mentioned orthopod, ENT, urology, etc if he was extrapolating to those specialties but I guess that is my assumption.
 
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militaryPHYS

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Would you say its the same with other branches? With non-surgical specialties in the army? Does paying back all your time as GMO then going civilian make you less competitive?
It is different in every specialty and every branch of service. The only way for you to understand it is to experience it. EVERY premed considering HPSP/USUHS, etc. MUST find and shadow someone within the system in which they seek. SDN is not a surrogate for actual experience, nor is it meant to be the gold standard for information on this stuff. It is a vehicle to provide resources to find the information you seek. Shadowing and seeing the MilMed system is the only way to truly hold yourself accountable for what you are signing up for. Otherwise you are risking unhappiness/regret 10 years down the road.

So long as you continue to improve yourself personally and professionally during GMO time (research, CME, courses, etc.) your application for residency will be solid. Independent time practicing, even if volume and complexity is low, builds character and can be looked upon favorably if presented as a character building opportunity for your future specialty trained self.
 
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Detective SnowBucket

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It is different in every specialty and every branch of service. The only way for you to understand it is to experience it. EVERY premed considering HPSP/USUHS, etc. MUST find and shadow someone within the system in which they seek. SDN is not a surrogate for actual experience, nor is it meant to be the gold standard for information on this stuff. It is a vehicle to provide resources to find the information you seek. Shadowing and seeing the MilMed system is the only way to truly hold yourself accountable for what you are signing up for. Otherwise you are risking unhappiness/regret 10 years down the road.

So long as you continue to improve yourself personally and professionally during GMO time (research, CME, courses, etc.) your application for residency will be solid. Independent time practicing, even if volume and complexity is low, builds character and can be looked upon favorably if presented as a character building opportunity for your future specialty trained self.
Thanks, I actually did get to shadow a Navy orthopod, he was really happy with the system and I didn't see anything among the residents or med students to say otherwise.
 

HighPriest

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It is different in every specialty and every branch of service. The only way for you to understand it is to experience it. EVERY premed considering HPSP/USUHS, etc. MUST find and shadow someone within the system in which they seek. SDN is not a surrogate for actual experience, nor is it meant to be the gold standard for information on this stuff. It is a vehicle to provide resources to find the information you seek. Shadowing and seeing the MilMed system is the only way to truly hold yourself accountable for what you are signing up for. Otherwise you are risking unhappiness/regret 10 years down the road.

So long as you continue to improve yourself personally and professionally during GMO time (research, CME, courses, etc.) your application for residency will be solid. Independent time practicing, even if volume and complexity is low, builds character and can be looked upon favorably if presented as a character building opportunity for your future specialty trained self.
Agree with all of this.
I have to add, however; had I shadowed someone where I did residency, I would have thought “things seem pretty good. No issues here.” And I still wish I had not taken HPSP, all-in-all. Things are very different depending upon where you’re stationed.
But you can’t shadow everywhere. Just take the experience with a grain of salt.
 
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militaryPHYS

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Agree with all of this.
I have to add, however; had I shadowed someone where I did residency, I would have thought “things seem pretty good. No issues here.” And I still wish I had not taken HPSP, all-in-all. Things are very different depending upon where you’re stationed.
But you can’t shadow everywhere. Just take the experience with a grain of salt.
This is a good point. If you can't get to a small MTF somewhere to see what life is like after residency I would recommend you bring up post-residency life, practice, atrophy with the senior attendings whom you know/trust. If you are concerned with what they tell you then seek out ways to verify or refute what you are hearing so you can make a well-informed decision for yourself.

Trouble is, over 80% change specialties. But the goal is to just understand and truly comprehend the risks of signing up regardless of what specialty you end up in.
 

HighPriest

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Why do you wish that?
That is a very long story that I have mentioned in bits here and there over the thread. I suppose I should add some kind of summarized explanation at some point.
 

Detective SnowBucket

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That is a very long story that I have mentioned in bits here and there over the thread. I suppose I should add some kind of summarized explanation at some point.
Maybe do that soon, it's almost time for this year's class to sign ;)
 

HighPriest

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Maybe do that soon, it's almost time for this year's class to sign ;)
Just hold off until I get to it. Maybe next year. I thought we used to have a sticky specifically for that sort of thing, but it's gone now.
 
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