GMO/FS: Discussion

[179466]

I'd like to get everyone's take on GMO's, FS's, and standard of care.

I, for one, am a believer. Some of this is vested interest, I know. But I think there will always be a place for GMO's in the military.

In the Army, GMO's and FS's are operational billets, and generally with Combat Arms units. These soldiers are extremely healthy, much more so than any comparable civilian cohort.

Also, the role of the BAS is changing from what I'm told. With improved medevac and triage downrange, most wounded troops can be at higher echelons of care within minutes, limiting the GMO's role in front line emergency care.

So, it seems GMO's and FS's do admin, sick call, and bread and butter primary care most of the time. To me, this sounds like an ideal situation for an intern-trained Doc.

I like the idea of GMO and FS because it can get you operational and out with the troops. It will test me, but I hope it will sharpen my medical skills for eventual re-entry into the civilian world.

I think it is a travesty to put Board-certified Docs in these positions. Almost across the board, I believe skills atrophy and people get bored and bitter.

You can point out the mistakes that GMO's sometimes make and argue that this is the reason these positions need to be filled by BC docs. But how many patients are missing out on the care they need wherever because hospitals, clinics and the like are undermanned after having their Docs plucked out to do GMO?
How much has retention dropped because BC Docs are sick of being underutilized and scutted out to do GMO?

Leave GMO to internship trained Docs if you can. I'm excited and motivated to do it. I know other young single guys who feel the same way.

Finally, GMO is not going away. An increased OP tempo means increased demand for operational docs. If things keep up the way they are, the pool of GMO's and FS's across the services will only get bigger.

Anyways, my .02. I'd like to hear what everyone else thinks. Hopefully we can have a decent discussion.

GB

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[orbitsurgMD]

I'd like to get everyone's take on GMO's, FS's, and standard of care.

I, for one, am a believer. Some of this is vested interest, I know. But I think there will always be a place for GMO's in the military.

In the Army, GMO's and FS's are operational billets, and generally with Combat Arms units. These soldiers are extremely healthy, much more so than any comparable civilian cohort.

Also, the role of the BAS is changing from what I'm told. With improved medevac and triage downrange, most wounded troops can be at higher echelons of care within minutes, limiting the GMO's role in front line emergency care.

So, it seems GMO's and FS's do admin, sick call, and bread and butter primary care most of the time. To me, this sounds like an ideal situation for an intern-trained Doc.

I like the idea of GMO and FS because it can get you operational and out with the troops. It will test me, but I hope it will sharpen my medical skills for eventual re-entry into the civilian world.

I think it is a travesty to put Board-certified Docs in these positions. Almost across the board, I believe skills atrophy and people get bored and bitter.

You can point out the mistakes that GMO's sometimes make and argue that this is the reason these positions need to be filled by BC docs. But how many patients are missing out on the care they need wherever because hospitals, clinics and the like are undermanned after having their Docs plucked out to do GMO?
How much has retention dropped because BC Docs are sick of being underutilized and scutted out to do GMO?

Leave GMO to internship trained Docs if you can. I'm excited and motivated to do it. I know other young single guys who feel the same way.

Finally, GMO is not going away. An increased OP tempo means increased demand for operational docs. If things keep up the way they are, the pool of GMO's and FS's across the services will only get bigger.

Anyways, my .02. I'd like to hear what everyone else thinks. Hopefully we can have a decent discussion.

GB

You post as a resident. Have you done a GMO tour yourself, or is this your idea of what would be great for someone else to do?

 

[notdeadyet]

I like the idea of GMO and FS because it can get you operational and out with the troops. It will test me, but I hope it will sharpen my medical skills for eventual re-entry into the civilian world.

I would think that your medical skills will actually atrophy during the course of a GMO tour. Folks who've done them for two or four years and then applied for residency have stressed the need to take time to build up clinical skills to get them back up to where they were as a PGY-1 before they go on to PGY-2 post-GMO tour.

In fact, several posters have mentioned having to repeat PGY-1 for their residency after four years in GMO land.

 

[179466]

You post as a resident. Have you done a GMO tour yourself, or is this your idea of what would be great for someone else to do?

I'm an Army PGY-1 not reapplying for residency, so I will be doing one after this year, partly by choice.

I understand GMO leaves a bad taste in people's mouths.

Does anyone think GMO/FS has a place in MilMed now and in the future?

Who had a positive experience and why?

Hearing the negatives are cool too, I'm just trying to get some perspective.

GB

 

[orbitsurgMD]

I'm an Army PGY-1 not reapplying for residency, so I will be doing one after this year, partly by choice.

I understand GMO leaves a bad taste in people's mouths.

Does anyone think GMO/FS has a place in MilMed now and in the future?

Who had a positive experience and why?

Hearing the negatives are cool too, I'm just trying to get some perspective.

GB

As you can see if you read the posts on the board, experiences can vary, significantly.

Some have posted that their GMO time was beneficial. Others, including myself, think that on balance it was not so beneficial. The one year of training you will have is not meant to make you a functioning independent practitioner, at least on the terms set by any standards-setting organization--ABMS specialty board--that is relevant to present-day practice standards. The fact that you don't find yourself in a situation where you are in over your head professionally does not mean that the concept of GMO assignment is valid from a professional ethics perspective. The fact that no certifying board finds you adequately trained after completing only PGY 1 to meet their standards for eligibility, and that several states (at least 11) won't license you, and most civilian hospitals and insurance carriers would not find you fit by your credentials should tell something about having only one year of residency training, no matter how well you performed. The GMO concept is archaic and except for the military is a practice relegated to the developing world.

Getting "out with the troops" is a nice sentiment. Presuming that the troops deserve no better than an incompletely trained doctor, no matter how enthusiastic, is another matter altogether.

 

[The White Coat Investor]

My only beef in the thread is with the idea of "sharpening skills" by doing a GMO tour. In my experience, a GMO tour gives you some different skills (how the military works etc) but the skills acquired in med school and internship, as a rule, generally deteriorate.

 

[edmadison]

GMOs experiences vary greatly. I can tell you that during my one year of deployment with 3 months to go I have experienced NOTHING (outside of my own CME) that has enhanced my skills. In fact, I could have done about 95% of my job via telephone from the US if I had a good medic. Back pain, shoulder pain, knee pain, testicular pain. I'm the biggest naproxen pimp in Asia. My deployment has been a huge waste of resources. That being said, one of my buddies was in Afghanistan at a remote base running codes, throwing in chest tubes and what not. So it all depends.

Ed

 

[FNU LNU]

I hope this isn't completely hijacking the thread, but does anyone have advise on how to become the guy in Afghanistan running codes and throwing in chest tubes? I decided to rejoin the military because I am excited about the prospect of doing operational medicine. I really want to be a DMO, but I am also interested working with the Marines.

 

[orbitsurgMD]

I hope this isn't completely hijacking the thread, but does anyone have advise on how to become the guy in Afghanistan running codes and throwing in chest tubes? I decided to rejoin the military because I am excited about the prospect of doing operational medicine. I really want to be a DMO, but I am also interested working with the Marines.

Try for an EM residency.

 

[BomberDoc]

So, it seems GMO's and FS's do admin, sick call, and bread and butter primary care most of the time. To me, this sounds like an ideal situation for an intern-trained Doc.

I like the idea of GMO and FS because it can get you operational and out with the troops. It will test me, but I hope it will sharpen my medical skills for eventual re-entry into the civilian world.

Finally, GMO is not going away. An increased OP tempo means increased demand for operational docs. If things keep up the way they are, the pool of GMO's and FS's across the services will only get bigger.

Replies on a few points...

You are correct that GMO/FS do admin > sick call >> bread and butter primary care. However, this is not an ideal situation for an intern-trained doc. The one-year-wonder (I was one) lacks the single most important thing that an independently practicing physician needs... knowing what you don't know. Yes, the sniffles and sprained ankles are easy... but recognizing and appropriately treating or referring the not so easy/uncommon stuff takes experience and experience takes years of seeing a lot of cases.

GMO/FS sharpening your skills for eventual re-entry into the civilian world... simply laughable. GMO/FS erodes so much medical knowledge in such a short time. The rate of atrophy is amazing. Your medical skills will suffer. Period.

You are absolutely correct to say that GMO/FS is not going away. You are also quite astute to recognize that the need for operational docs is only increasing which leads to more and more newbie docs being forced down this path. Most of us end up bitter and do our 3-4 year commitment and punch out at the earliest opportunity. You may be excited and motivated to be an operational doc at the moment. It sounds a lot cooler than it is. The fun wears off pretty quickly but your contract does not.

BTW, it is great seeing these discussions. This is the kind of stuff I wish I had been exposed to while making my decision a decade ago.

 

[179466]

Try for an EM residency.

Agreed. Applying for a military EM residency is an excellent way to ensure you'll become a GMO.

It's depressing to hear about the skill atrophy. Is GMO/FS that mundane that even the skills you learn during a 1 year rotating internship (emphasis on breadth, not depth) deteriorate?

Hey BD. Good to hear from you brother.

I'll raise this question: Can anyone actually forsee the end of the military's use of GMO's?

Barring a massive overhaul of GME or an end to wars, I just can't even fathom it.

Which makes the services' party lines "end of GMO in...1998, 2005, 2012" all the more non-sensical.

GB

 

[Mirror Form]

I'm excited and motivated to do it. I know other young single guys who feel the same way.

Oh really? From my experience the vast majority of gmo's did not want to do a gmo tour.

 

[AF M4]

I'll raise this question: Can anyone actually forsee the end of the military's use of GMO's?


GB

The GMO will end when all states require the completion of a full residency before issuing a medical license. No sooner.

 

[orbitsurgMD]

The GMO will end when all states require the completion of a full residency before issuing a medical license. No sooner.

It could happen if a majority of states imposed a licensing requirement that increased the required training beyond one year but possibly less than completing a full residency. Or it could happen if the AMA, as the largest general body of physicians in the US (even if not representing a majority) condemned the practice nationally and also through all the individual states' association bodies. As yet, only 11 or so states require more than one year of training to get an unrestricted license.

The relevance in civilian practice is debatable. Hospitals and insurance companies generally set a higher training standard for active staff membership and plan participation, board-eligibility at a minimum. Perhaps the VA or the Bureau of Prisons look the other way, but neither represents a worthy standard if that is true.