Army GMO and out to ENT chances

[hurricane2011]

Alright, here are the facts, I'm a current Army HPSPer (MS3) interested in ENT. I will be getting married next year to a current intern in a 4 year residency program (civilian). I want to start a family at some point, but also don't want to destroy her chances of establishing a practice after residency in her home state by making her move around every couple of years. If I go ENT in the military I'm looking at 10 years (5 residency + 5 payback) of either being out of state or moving around, that's no life to raise, or let alone have, a family.

So I guess I'm asking, is my only solution to just go straight to internship and GMO and out, applying to civilian residencies in our home state during my last two years of GMO? I'd be delaying residency 5 years, but at least after that I'd be a free agent to do whatever. I'm a pretty average applicant for ENT in terms of scores, but am working on research and plan to do so in GMO land too. So I'm also weighing my chances of actually getting a civilian residency after being 5 years out from medical school. No idea if it hurts me or helps me taking this route.

Please be kind. I was single when I first applied to HPSP and had no idea I'd meet the love of my life while in medical school, or that she'd be in medicine as well. Part of me still wants to serve, but eventually having kids and a stable family life is very important to me as well. Thank you for any insight!

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[HighPriest]

Life happens, so don't apologize for getting married.

Firstly, your payback would be 9 years with a military residency if you're an "HPSPer." 5 years residency and 4 years payback. I know that's not a game changing statistic, but it's true nonetheless.

You'll find that, during that time, most of your colleagues have wives and families that do just fine even though they're....out of state....which doesn't seem like that big a deal unless you're living in shangri la...Believe it or not, people have kids in all 50 states and even the district of Columbia. Also you generally don't move during residency. You generally do move after residency, but it isn't very hard to stay at your first duty station for four years until you're out.

You're going to find it very, very difficult to do meaningful research in the military, and even more difficultly doing it as a GMO. The Army has fairly few opportunities for research once you're out of internship/residency. If you got lucky, and you were stationed near a major MEDCEN, and you found a project that wasn't being eaten up by residents, then maybe. If you have an outside source for research, maybe you can make that work, or maybe you'll be stationed in Korea and that'll fall apart.

I think you're taking a risk being an average applicant and delaying your application until after your GMO time. Anything is possible, but not only do you have the odds stacked against you from a performance standpoint, delays between training and residency aren't usually good and you're also looking to match in your home state. So unless you live someplace where you have a large number of training programs nearby (Chicago, New York, etc.), you're really putting a lot of your eggs in one basket.

Keep in mind that, while it is nice for your wife to get out and start a practice locally while you do your GMO thing, it is also usually very possible or likely that your wife can find employment in the military system as a civilian physician while you're completing your training and then working (depending upon what she does).

 

[hurricane2011]

Life happens, so don't apologize for getting married.

Firstly, your payback would be 9 years with a military residency if you're an "HPSPer." 5 years residency and 4 years payback. I know that's not a game changing statistic, but it's true nonetheless.

You'll find that, during that time, most of your colleagues have wives and families that do just fine even though they're....out of state....which doesn't seem like that big a deal unless you're living in shangri la...Believe it or not, people have kids in all 50 states and even the district of Columbia. Also you generally don't move during residency. You generally do move after residency, but it isn't very hard to stay at your first duty station for four years until you're out.

You're going to find it very, very difficult to do meaningful research in the military, and even more difficultly doing it as a GMO. The Army has fairly few opportunities for research once you're out of internship/residency. If you got lucky, and you were stationed near a major MEDCEN, and you found a project that wasn't being eaten up by residents, then maybe. If you have an outside source for research, maybe you can make that work, or maybe you'll be stationed in Korea and that'll fall apart.

I think you're taking a risk being an average applicant and delaying your application until after your GMO time. Anything is possible, but not only do you have the odds stacked against you from a performance standpoint, delays between training and residency aren't usually good and you're also looking to match in your home state. So unless you live someplace where you have a large number of training programs nearby (Chicago, New York, etc.), you're really putting a lot of your eggs in one basket.

Keep in mind that, while it is nice for your wife to get out and start a practice locally while you do your GMO thing, it is also usually very possible or likely that your wife can find employment in the military system as a civilian physician while you're completing your training and then working (depending upon what she does).

Thanks @HighPriest for the response. I was under the impression that any residency above 4 years would tack on the extra years to your payback. Is the 9 years because intern year counts as a neutral year?

Getting her a job as a civilian physician with the military was something we floated, she will be an OB/Gyn, so don't know how high demand they are in a male dominated military. The main concern was the constant moving, so there definitely is a route to stay put at a station for the majority of payback?

I was going to look at research projects that can be done with little physical contact (case reports, systematic reviews, etc.) with my outside contacts back home. So hopefully getting something published shouldn't be impossible.

The risk of not matching after 5 years is what's scary, especially in a competitive specialty such as ENT. From other posts on SDN, it sounds like you have the greatest chance of matching straight out of medical school, but also doing GMO tours isn't necessarily a death sentence since PDs may like someone with a proven track record. But you're right about all the eggs in one basket, not exactly saturated with ENT programs around here..

 

[HighPriest]

Thanks @HighPriest for the response. I was under the impression that any residency above 4 years would tack on the extra years to your payback. Is the 9 years because intern year counts as a neutral year?

Getting her a job as a civilian physician with the military was something we floated, she will be an OB/Gyn, so don't know how high demand they are in a male dominated military. The main concern was the constant moving, so there definitely is a route to stay put at a station for the majority of payback?

I was going to look at research projects that can be done with little physical contact (case reports, systematic reviews, etc.) with my outside contacts back home. So hopefully getting something published shouldn't be impossible.

The risk of not matching after 5 years is what's scary, especially in a competitive specialty such as ENT. From other posts on SDN, it sounds like you have the greatest chance of matching straight out of medical school, but also doing GMO tours isn't necessarily a death sentence since PDs may like someone with a proven track record. But you're right about all the eggs in one basket, not exactly saturated with ENT programs around here..

Yes. 9 years. Having just finished doing exactly that, I can confirm.

OB-GYNs are in high demand. The males dominate the military, but a huge number of them are married and have spouses who need medical care. The military offers everything from GYN-Onc to infertility to MFM. The more specialized your wife becomes, the harder it will be for her to find a job, but if she's a general OBGYN, they'll need them basically everywhere you would go as an ENT. There are far fewer ENTs than there are OBGYNs. We delivered literally 4x as many babies at my first duty station post-residency than the two local civilian hospitals combined.

If you can get your hands on some case reports to fill out, you can probably swing that in the military.

Here's the thing with GMO tours: They aren't a bad thing on a resume. That's not the issue. Most people, especially outside the military, are going to look at a GMO tour and think that you served your country and developed leadership skills, and that you're probably an all-around good guy. If you're applying to a military residency after a GMO tour, it helps even more. But the question isn't whether a GMO bullet on your resume is good or bad. The question is whether it makes up for being 4 years out of medical school. I don't think it does. Not for ENT. I think if you are a PD and you have two applicants who are otherwise completely equal, but one just finished med school and the other did 4 years of GMO, you're likely to go for the recent grad. That's just my opinion. It's a known quantity, whereas they don't know what you've been doing for four years as a GMO -even if they think it's a good thing.

I think you're better off applying for ENT in the military. If you get accepted, I think you'll be able to find something for your wife nearby. If you get deferred (which I wouldn't count on, but which does happen) you can still apply to someplace in your home state. But just keep in mind that ENT is very competitive. You're not comparing yourself to the other people in your med school class when you apply, you're comparing yourself to the top 1/3 (at least, more likely top 10%). Everyone who is applying, who has a realistic chance of matching, is very competitive. So it's possible that you go through all of this and still don't match into the local ENT program in your home state. I think it's not a good idea to not apply, do a GMO, and then apply solely based upon the chance that you're going to match locally so that your wife can get a local job. What if you don't match there? Now you're 4 years out of med school with a bunch of nonsensical ENT treatments drilled into your head from 3 years as a GMO and you're still having to go to another state to do your residency.