Army GMO and TY Match Clarification and Military Medicine Track in Medical School

[SergeantBuzzKill]

I am a bit confused about something my recruiter told me regarding GMOs in the army. He basically said that GMO tours are no longer a thing of the army and also referenced that the GMO info section on the "official" military medicine website (medicineandthemilitary) specifically says "(Air Force and Navy only)". Is this true or is this just a play on words? That is, is it really that you don't do GMO tours anymore or you still do, but they are called something different like Brigade Surgeon tour? After doing some research on SDN about brigade surgeons, I haven't been able to find a hard answer to this question, but I am inclined to think the latter. If this is the case, I have a couple questions about the whole brigade surgeon thing.

1. What exactly are the duties of a brigade surgeon? Will I be practicing medicine or is this more admin work?

2. Let's say you do not match into your specialty of choice and then do a TY at an AMC. Is this basically a guarantee that you are on your way to a brigade surgeon tour or do you have a realistic chance of having the opportunity to apply for your specialty of choice a second time like they advertise?

3. After looking at the 2018 Army Directorate, it says 85% of HPSP students match into their specialty of choice (slide 10). I find this number very hard to believe given the ample amount of complaints I have read on SDN about army GMOs. However, those posts were anywhere from 2006-2010, so maybe things have changed since then.

4. If I do go through with HPSP, I plan to go to KCUMB and enroll in their military medicine track. Does anyone have any insight if this will improve my chances of matching? Of course, if I get **** board scores and low GPA, it won't compensate for that, but assuming I am somewhat competitive, will this give me an edge at all?

*Edited because I forgot a word.

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[ArmyTiger]

I am a bit confused about something my recruiter told me regarding GMOs in the army. He basically said that GMO tours are no longer a thing of the army and also referenced that the GMO info section on the "official" military medicine website (medicineandthemilitary) specifically says "(Air Force and Navy only)". Is this true or is this just a play on words? That is, is it really that you don't do GMO tours anymore or you still do, but they are called something different like Brigade Surgeon tour? After doing some research on SDN about brigade surgeons, I haven't been able to find a hard answer to this question, but I am inclined to think the latter. If this is the case, I have a couple questions about the whole brigade surgeon thing.

1. What exactly are the duties of a brigade surgeon? Will I be practicing medicine or is this more admin work?

2. Let's say you do not match into your specialty of choice and then do a TY at an AMC. Is this basically a guarantee that you are on your way to a brigade surgeon tour or do you have a realistic chance of having the opportunity to apply for your specialty of choice a second time like they advertise?

3. After looking at the 2018 Army Directorate, it says 85% of HPSP students match into their specialty of choice (slide 10). I find this number very hard to believe given the ample amount of complaints I have read on SDN about army GMOs. However, those posts were anywhere from 2006-2010, so maybe things have changed since then.

4. If I do go through with HPSP, I plan to go to KCUMB and enroll in their military medicine track. Does anyone have any insight if this will improve my chances of matching? Of course, if I get **** board scores and low GPA, it won't compensate for that, but assuming I am somewhat competitive, will this give me an edge at all?

*Edited because I forgot a word.

That's weird, as someone who knows plenty of current GMOs, both those that are newly minted and those who have been around for a while. And brigade surgeons are typically jobs for O-4s or O-5s, not new captains.

1. It's 50/50 medicine versus admin work for most. It's not much medicine, though. Lots of profiles and MSK.

2. Experiences vary wildly based on applicant and specialty. Ortho and surgery used to be get in as an MSIV or 4 and out, and I know of at least four people picked up in the last 3 years, either as TYs or GMOs.

3. Those numbers are hard to interpret. I would take them with a grain of salt. Most military briefing slides get edited to paint a more rosey picture than actually exists.

4. Won't matter one bit. Do well on boards, do well on rotations, interview well. Half of your competition goes to the military medical school.

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[WernickeDO]

I am a bit confused about something my recruiter told me regarding GMOs in the army. He basically said that GMO tours are no longer a thing of the army and also referenced that the GMO info section on the "official" military medicine website (medicineandthemilitary) specifically says "(Air Force and Navy only)". Is this true or is this just a play on words? That is, is it really that you don't do GMO tours anymore or you still do, but they are called something different like Brigade Surgeon tour? After doing some research on SDN about brigade surgeons, I haven't been able to find a hard answer to this question, but I am inclined to think the latter. If this is the case, I have a couple questions about the whole brigade surgeon thing.

1. What exactly are the duties of a brigade surgeon? Will I be practicing medicine or is this more admin work?

2. Let's say you do not match into your specialty of choice and then do a TY at an AMC. Is this basically a guarantee that you are on your way to a brigade surgeon tour or do you have a realistic chance of having the opportunity to apply for your specialty of choice a second time like they advertise?

3. After looking at the 2018 Army Directorate, it says 85% of HPSP students match into their specialty of choice (slide 10). I find this number very hard to believe given the ample amount of complaints I have read on SDN about army GMOs. However, those posts were anywhere from 2006-2010, so maybe things have changed since then.

4. If I do go through with HPSP, I plan to go to KCUMB and enroll in their military medicine track. Does anyone have any insight if this will improve my chances of matching? Of course, if I get **** board scores and low GPA, it won't compensate for that, but assuming I am somewhat competitive, will this give me an edge at all?

*Edited because I forgot a word.

Your recruiter is wrong. Remember what George Costanza said: It's not a lie if you believe it. Kidding, your recruiter (probably) isn't lying, they just don't know anything about military medicine. I can promise you that Army has intern-trained GMOs and there is no plan moving forward to dissipate that number. There is a slight play on words here too: technically a GMO is a "general medical officer", read: intern trained doc. We fill operational slots, but IM/EM trained docs fill these slots too. If the question is: does the Army put people in TY slots and then push them to operational jobs without completing a residency, then the answer is 100% YES.

1: The duties of a brigade surgeon are mostly administrative, even more so than a battalion surgeon. Depending on the command climate and how many briefings they want you at, and how many slide shows they want you to put together, it's not unheard of for a brigade surgeon to see 2-3 patients a month. FWIW brigade jobs are not something that a fresh out of internship typically does. You will go to a battalion first.

2: If you do a TY and are going for something super competitive like rads or ortho, then chances are you are headed for a GMO. You can avoid this by volunteering to be considered for the unfilled specialties, which are usually things like IM, psych, or FM, although you never quite know what will be available. If you are ride or die for a particular specialty and you don't get it out of med school, you are facing a very steep climb to get it as a GMO.

3: The Army likes to trumpet that 85% but does not reveal the numbers or methodology used to obtain it. Contrast that with the annual NRMP data which is laid out in black and white. I wouldn't put too much stock in it.

4: That will do nothing for you. You will get more than enough military via DCC and BOLC, which you will be attending while your civilian colleagues study for boards.

As I am wont to say, if your goal is to practice medicine in a specific specialty, then you are usually better off avoiding the military. There are just too many pitfalls that can potentially divert you from true patient care, unless you want to do FM and see healthy soldiers.

 

[psychbender]

MilMed tracks at med schools just mean that you are able to spend some of your core rotations at a few military hospitals, as training agreements have already been set up. This may be a positive, in that you may get more face time at programs, if your school has an existing agreement with a facility that features your desired residency program. It also may be a positive, if the rotation at the military hospital is set up in such a way that you get a better experience than if you went through your school's regular hospitals. Doing Peds at Womack, though, will do nothing positive for you if you desire Ortho at Reed.

Published military match data is bull****. I have no idea where they get their numbers, but they are not accurate (at least, were not when I was in residency, and actually knew how many applicants we had each year from talking to our staff that dealt with interviewing students).

Some unmatched TYs can manage to get a spot in their desired specialty. Sometimes, the transition is flawless. One of my co-interns decided late in med school that he wanted anesthesiology, so applied when we were interns, and he was able to match into my class. A guy I knew, though, wanted ENT, didn't match, did a TY intern year, reapplied, and was able to get ENT for residency on the second go around. However, since he didn't do a surgical PGY1, his residency had to be extended, as he had to be a "resitern" for a while to meet the training requirements on which he missed out. I knew another that was in a similar boat for OB.

 

[SergeantBuzzKill]

I was a GMO flight surgeon for 4 years. Operational Medicine. Helicopters, two tours in AFG. There are plenty of Army GMO's. I think my class was 10-15%. This was in 2008.

It was rare when I was in for TY's to get picked up into competitive specialties, but it happened. Usually these guys had to do a rotation with the troops and then re-apply. I've heard most of the competitive specialties these days want M4's not ex GMO's.

TY's were "encouraged" to fill vacant slots in primary care or face the alternative of the operational world. I laughed at them and had a pretty good experience with the troops

When I was in, very rare for a GMO to get a BDE surgeon slot. This usually went to O4's and above. All the physically qualified went to flight and the rest got dumped into hellhole clinics and TMC's

I was offered an Infantry BDE slot after two years in as a squadron guy but I didn't want leave my guys preparing for second deployment.

- ex 61N

That doesn’t sound like a bad time at all. Why do so many complain about GMO tours? I know people say it’s a lot of “wiping runny noses, and scraped knees” but that doesn’t sound all that different from a PCP

 

[SergeantBuzzKill]

How likely is it to do a GMO after completing your residency? I would think they want their BC’s in hospitals but I wouldn’t know

 

[ArmyTiger]

That doesn’t sound like a bad time at all. Why do so many complain about GMO tours? I know people say it’s a lot of “wiping runny noses, and scraped knees” but that doesn’t sound all that different from a PCP

There are few GMOs by choice. Most wanted to train in a residency, and it usually wasn't primary care. It's a 1-4 year delay in training, sometimes more. And you can't really find a job as an internship trained doc nowadays.

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[psychbender]

That doesn’t sound like a bad time at all. Why do so many complain about GMO tours? I know people say it’s a lot of “wiping runny noses, and scraped knees” but that doesn’t sound all that different from a PCP

Would you enjoy doing basic primary care of you wanted to be a neurosurgeon or a radiation oncologist? A four year delay in training is huge, when you consider that it's an extra four years of not practicing your desired specialty, four years of not working towards partnership in a practice, four years of making **** pay.

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[psychbender]

How likely is it to do a GMO after completing your residency? I would think they want their BC’s in hospitals but I wouldn’t know

The Army calls those Brigade Surgeon tours. Board certified subspecialties are tasked for those all the time right now. I've seen cardiologists, pediatric neurologists, and ENTs all tasked these billets for two years. That's two years in which they rarely practice medicine, and very rarely practice their own specialty. Recovering from that, especially early in your post-residency or fellowship career can be quite difficult.

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[WernickeDO]

That doesn’t sound like a bad time at all. Why do so many complain about GMO tours? I know people say it’s a lot of “wiping runny noses, and scraped knees” but that doesn’t sound all that different from a PCP

I would not compare being a GMO to being a PCP, which I assume you mean family doc. Understand that being a soldier in an active duty unit means that you are relatively free from major medical problems. If you do have major medical problems, you are removed from service. While there is a primary care aspect to being GMO, the majority is minor MSK that can be handled by a PA. Don't forget that as an intern trained doc you are not aware of what you don't know. Some would argue, myself included, that intern trained docs should not be practicing independently for this very reason.

And to piggyback on what @psychbender said: if your interest lies in fields beyond primary care, you are going to be supremely frustrated and bored seeing the BS that GMOs typically deal with. If your goal is family medicine then maybe it's not so bad.

I know you haven't yet started medical school but be advised that PCPs and family docs do a lot more than wipe stuffy noses and see scraped knees. They see children, the elderly, manage chronic illness, deliver babies, work in hospitals, monitor ICU patients. They are board certified and in high demand. They make a very comfortable salary. A GMO can claim few to none of these things.

Keep reading this forum about why people complain about GMO tours. It might not seem bad to you now but chances are after 4 years of medical school you are going to want to practice medicine, not sit through powerpoints on not raping people, pissing in a cup in front of an 18 year old, or go to the field to sit in a tent and do nothing.

 

[SergeantBuzzKill]

A couple questions for the seniors:

What is an operational GMO tour?

I have recently discovered that physicians can (if I'm not mistaken) participate in special operations medicine and serve a SF unit. Is this true or did I misunderstand what I read?

If physicians can indeed serve a SF unit for a GMO tour, what are the steps taken in order to accomplish this?

How likely is one to be assigned to a SF unit if they request it? Or does that depend on having other qualifications like being airborne certified?

As much information about this topic as possible would be appreciated! I was selected for Army and was a little concerned about the possibility of not matching and having to do GMO time, but the idea of doing special operations medicine with a SF unit as a GMO (if this is how it works) is particularly appealing.

 

[deleted480308]

A couple questions for the seniors:

What is an operational GMO tour?

I have recently discovered that physicians can (if I'm not mistaken) participate in special operations medicine and serve a SF unit. Is this true or did I misunderstand what I read?

If physicians can indeed serve a SF unit for a GMO tour, what are the steps taken in order to accomplish this?

How likely is one to be assigned to a SF unit if they request it? Or does that depend on having other qualifications like being airborne certified?

As much information about this topic as possible would be appreciated! I was selected for Army and was a little concerned about the possibility of not matching and having to do GMO time, but the idea of doing special operations medicine with a SF unit as a GMO (if this is how it works) is particularly appealing.

I was told by an sf guy that their docs when he was in were all board certified but that was just a team guy talking anecdotes, I don’t know if it was policy

 

[244913]

I was told by an sf guy that their docs when he was in were all board certified but that was just a team guy talking anecdotes, I don’t know if it was policy

No GMO's in SF or Ranger Battalion or SOAR. ER = FP >> IM preferred

 

[Ziehl-Neelsen]

What is an operational GMO tour?

A GMO tour where you are assigned to an operational unit instead of a base clinic. Colloquially called a battalion surgeon.

I have recently discovered that physicians can (if I'm not mistaken) participate in special operations medicine and serve a SF unit. Is this true or did I misunderstand what I read?

It's true. I know a few (including a classmate from medical school), but they are all board certified physicians within their various specialties.

If physicians can indeed serve a SF unit for a GMO tour, what are the steps taken in order to accomplish this?

As stated above, it will not happen as part of a GMO tour. Operators rule the roost and there's no way they'd except an internship trained one-year-wonder as their doc.

How likely is one to be assigned to a SF unit if they request it? Or does that depend on having other qualifications like being airborne certified?

Even for board certified docs its unlikely. The community is kind of closed off, and honestly most of their docs were former operators, infantrymen, etc. in a past life who went to medical school and became emergency physicians or FPs specifically to go back to the operator community. Operators (like pretty much everybody else in the world) want known entities.

My medical school classmate had no prior military experience but was a marathoner, Eagle Scout, All-American type (though he is quiet and unassuming which is generally not the norm). He did and FP residency and was immediately tagged for a Brigade Surgeon tour out of residency during which time he qualified for a bunch of badges and deployed with his unit. His next tour was in a dumpy Army Community Hospital as a staff FP where he realized he liked operational stuff and being a medical advisor more than the actual practice of clinical medicine. He asked to go back to the operational side and specifically to the SF community, and because he was badged out and vetted from his previous operational time was selected. Last I heard he was with 1st group.

As much information about this topic as possible would be appreciated! I was selected for Army and was a little concerned about the possibility of not matching and having to do GMO time, but the idea of doing special operations medicine with a SF unit as a GMO (if this is how it works) is particularly appealing.

You may not match to your desired specialty and instead end up in GMO land after internship.

Some people really enjoy their operational GMO tour--it gives them a break from the traditional medical grind and the chance to do cool things with excellent people. Maybe it even burnishes a lackluster CV and allows one to match to a more competitive civilian spot upon ETS or allows a young doctor to discover which specialty is truly his passion.

Some people hate their GMO tour because they wanted to do urology, or radiology, or whatever and didn't match. They don't like primary care type medicine and their spouse, who was counting on 4+ years in a specific location for residency gets dragged to Fort Leonard Wood and isn't particularly happy about it. They continue to reapply for their specialty of choice but are turned down, so they ETS at the end of their ADSO and feel like the last 4 years was a professional waste.

It's a crap shoot. Attitude matters a lot. Family circumstances matter a lot. But the truth is that individual experiences are so varaible that we can't really make predictions for or advise the people who come on this forum and want certitude.

Regardless, this bridge is 4 years in the future, so while its good to know the possibilities and prepare yourself for the unexpected, your time would be much better spent controlling what you can control--concentrating on your studies and observing the forum rather than trying to make specific plans right now.

 

[pgg]

That doesn’t sound like a bad time at all. Why do so many complain about GMO tours? I know people say it’s a lot of “wiping runny noses, and scraped knees” but that doesn’t sound all that different from a PCP

There were excellent answers from others already, but I'll add mine.

I spent three years as a GMO with Marine infantry battalion between my internship and residency. The Navy sends a much higher % of interns out to GMO tours than the Army or Air Force - the flip side of that is the Navy has far fewer "brigade surgeon" equivalents sent out to operational tours post residency.

Being a GMO delayed my residency, the field I wanted to practice, by several years. It cost me a bit over $100K in medical pay because I spent those 3 years as a GMO and not a specialist.

Broadly speaking, it was not medically interesting, challenging, or rewarding time. There was a great deal of administrative work, which is not what anyone dreams of when they step into their first class in medical school.

There was risk. I'm not talking about the risk of getting shot because you're with or near an operational unit. I mean the risk of practicing medicine independently, despite having only an internship behind you. You'll hear a lot of people dismiss this risk, because active duty servicemembers are generally young, healthy, well screened ... and there is usually a more senior person you can consult. But this is false security. There is real pathology hiding out there, and the sea of health and normalcy is camouflage for it. It's simply untrue that the level of support and supervision a GMO gets is anything like that of an intern or even a PGY3 or PGY5 resident with years more training and experience. Feres Doctrine makes it a medicolegally forgiving practice, but every prospective and current GMO needs to keep that risk firmly in mind at all times.

Many states won't even license physicians with only a single year of post-graduate training. It's my opinion that GMOs should have much closer supervision, and should not be placed in positions where independent practice is likely.

All that said, I enjoyed my time with the Marines, including two 7 month deployments to Iraq and Afghanistan, and look back on it as some of the most rewarding work I've ever done. I'll never again be part of a small, tightly knit group of warfighters in harm's way; friendships and memories from that kind of work are different than from anything else. If you wind up a GMO, go in with a positive attitude about it, a healthy level of caution and anxiety, don't let seniors bully or shame you into independently handling things you're not comfortable with, and take advantages of opportunities that present themselves.

 

[Philly21]

Hi all,
I am gonna piggyback on this question. I am in undergrad and thinking about going through HPSP. I have been considering serving back my time as a GMO then applying for a civilian surgical residency.
1. Does doing 4 yrs as a GMO hurt my chances for getting a civilian residency later ( I am a good student and hope to have all the right scores and the other things that make me a good applicant).

2. Also, when doing the military match can I just decide to do a GMO and not try to match to a military residency?

 

[j4pac]

Your recruiter is wrong. Remember what George Costanza said: It's not a lie if you believe it. Kidding, your recruiter (probably) isn't lying, they just don't know anything about military medicine. I can promise you that Army has intern-trained GMOs and there is no plan moving forward to dissipate that number. There is a slight play on words here too: technically a GMO is a "general medical officer", read: intern trained doc. We fill operational slots, but IM/EM trained docs fill these slots too. If the question is: does the Army put people in TY slots and then push them to operational jobs without completing a residency, then the answer is 100% YES.

1: The duties of a brigade surgeon are mostly administrative, even more so than a battalion surgeon. Depending on the command climate and how many briefings they want you at, and how many slide shows they want you to put together, it's not unheard of for a brigade surgeon to see 2-3 patients a month. FWIW brigade jobs are not something that a fresh out of internship typically does. You will go to a battalion first.

2: If you do a TY and are going for something super competitive like rads or ortho, then chances are you are headed for a GMO. You can avoid this by volunteering to be considered for the unfilled specialties, which are usually things like IM, psych, or FM, although you never quite know what will be available. If you are ride or die for a particular specialty and you don't get it out of med school, you are facing a very steep climb to get it as a GMO.

3: The Army likes to trumpet that 85% but does not reveal the numbers or methodology used to obtain it. Contrast that with the annual NRMP data which is laid out in black and white. I wouldn't put too much stock in it.

4: That will do nothing for you. You will get more than enough military via DCC and BOLC, which you will be attending while your civilian colleagues study for boards.

As I am wont to say, if your goal is to practice medicine in a specific specialty, then you are usually better off avoiding the military. There are just too many pitfalls that can potentially divert you from true patient care, unless you want to do FM and see healthy soldiers.

+1 for the George Costanza reference

 

[j4pac]

1. It's 50/50 medicine versus admin work for most. It's not much medicine, though. Lots of profiles and MSK.

So MSK isn’t medicine? I’ve fought men for saying less things!

 

[HighPriest]

Hi all,
I am gonna piggyback on this question. I am in undergrad and thinking about going through HPSP. I have been considering serving back my time as a GMO then applying for a civilian surgical residency.
1. Does doing 4 yrs as a GMO hurt my chances for getting a civilian residency later ( I am a good student and hope to have all the right scores and the other things that make me a good applicant).

2. Also, when doing the military match can I just decide to do a GMO and not try to match to a military residency?

1 - Depends upon the program. I think if you're going to shoot for a top tier place, they're going to look at a break in training and a break in clinical research as a very bad thing. However, other programs will look at your military time as a good thing. If you're a good candidate otherwise, I think you'll find a spot somewhere. If you're a bad candidate and you're doing a GMO to try to look better, then I think you'll have trouble matching.

2 - You can apply for a TY year and then go straight to GMO. Not sure how that, specifically, would look on a surgery application.

 

[Philly21]

1 - Depends upon the program. I think if you're going to shoot for a top tier place, they're going to look at a break in training and a break in clinical research as a very bad thing. However, other programs will look at your military time as a good thing. If you're a good candidate otherwise, I think you'll find a spot somewhere. If you're a bad candidate and you're doing a GMO to try to look better, then I think you'll have trouble matching.

2 - You can apply for a TY year and then go straight to GMO. Not sure how that, specifically, would look on a surgery application.

Thanks so much! Just to clarify, with the TY year I would be technically paying back five yrs?

 

[HighPriest]

You'd pay back four (after your internship) if you took four years of HPSP.

Plus a portion of your immortal soul.


* edited for accuracy.

 

[pgg]

1. Does doing 4 yrs as a GMO hurt my chances for getting a civilian residency later ( I am a good student and hope to have all the right scores and the other things that make me a good applicant).

Probably not. Be aware that depending on the specialty you choose, and the type of internship you did before the GMO time ... you may be required to repeat part or all of the internship. This might influence the selection process of the civilian programs you apply to.

2. Also, when doing the military match can I just decide to do a GMO and not try to match to a military residency?

The short answer is yes. After you've done an internship year and can get an unrestricted state license, the military can't force you to do any particular residency. They will park you in a GMO position somewhere until your service obligation is up.

The long answer is that if you were in a categorical (internship + residency) military slot from the start, and you voluntarily leave after internship to be a GMO, you're doing a couple things that might not be helpful. One, you're likely burning your bridge to that military program, which you will eventually ask to provide documentation and a recommendation/reference to the future civilian program. Two, civilian programs you apply to later going to want a compelling answer to why you left a residency program (this is a fairly red flag).

 

[j4pac]

Probably not. Be aware that depending on the specialty you choose, and the type of internship you did before the GMO time ... you may be required to repeat part or all of the internship. This might influence the selection process of the civilian programs you apply to.



The short answer is yes. After you've done an internship year and can get an unrestricted state license, the military can't force you to do any particular residency. They will park you in a GMO position somewhere until your service obligation is up.

The long answer is that if you were in a categorical (internship + residency) military slot from the start, and you voluntarily leave after internship to be a GMO, you're doing a couple things that might not be helpful. One, you're likely burning your bridge to that military program, which you will eventually ask to provide documentation and a recommendation/reference to the future civilian program. Two, civilian programs you apply to later going to want a compelling answer to why you left a residency program (this is a fairly red flag).

I don’t think that it would be a big deal. I think “wanting to do a GMO tour” is a very valid reason for not going through with your training. It happens yearly to TONS of Navy applicants and they typically leave their GMO tour more competitive than they came in. In regards to LORs...I think that having a recommendation from your internship PD is a good idea. But it’s not essential. I used LOR’s from my GMO tour and did just fine. I think that GMO and GTFO is a legitimate strategy...it’s nout typically a good financial strategy, but if someone wants a taste of military life before returning to reality...knock yourself out.

 

[Philly21]

Thank you so much for all the responses!