GMO Possible Without Going HPSP/USUHS?

[LBB2031]

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I've been admitted to medical school and am interested in military medicine. Specifically, I'm interested in serving my time as a GMO or flight surgeon. (My reasoning: I want to serve in an operational setting, and I've done enough reading on this board to be concerned about the present/future of milmed and military GME--it seems that serving as a GMO/FS is the wisest route for me). I was initially considering HPSP, but then I was awarded a renewable, full tuition scholarship by one of the medical schools that accepted me. I still really want to serve, but I want to do my due diligence and figure out which route to the military puts me in the best position to serve operationally and also which route makes the most sense financially given my scholarship situation. With that backstory in mind, I'd appreciate any help answering the following questions:

1) Can I do a GMO/FS tour after an internship year without doing HPSP? That is to say, is it possible to join after med school graduation but pre-GME (so you'd do a military internship before embarking on a GMO/FS tour)? Or is it possible to join after a civilian internship just so you can do a GMO/FS tour? I know you can do FAP during residency or join post-residency and get a GMO/FS billet after a utilization tour in your specialty, but I presume I'd have a lot more knowledge to lose and skills to deteriorate at that point. It seems to me, if I'm going to serve operationally, it would make more sense to do it pre-GME. Holding off on joining also has another benefit: even though joining seems like a great idea to me now, I realize that circumstances in my life might change, and if I can afford to keep my options open, I might as well do so.

2) If the above isn't possible, I was looking into a 3-year HPSP with the intent of serving my obligation as a GMO/FS before pursuing a civilian residency (as I understand it, a 2-year scholarship would incur a 3 year commitment anyway, so I might as well do the 3-year scholarship, correct?). Would a FS tour (with all its associated training) fill the entire 3 years? If I did a GMO tour instead, would I have the chance to fill a different billet once my initial 2-year tour was up, or would I just be extended in the same billet for a 3rd year?

3) I've read before on this board that if you go Navy and want a greenside GMO billet, you will get it. Is this still accurate? With the recent policy changes, are women now eligible for all battalion surgeon roles with the Marines? If so, has anyone heard of any women being able to take advantage of these new opportunities (serving with Division, for example)?

 

[Oo Cipher oO]

I've been admitted to medical school and am interested in military medicine. Specifically, I'm interested in serving my time as a GMO or flight surgeon. (My reasoning: I want to serve in an operational setting, and I've done enough reading on this board to be concerned about the present/future of milmed and military GME--it seems that serving as a GMO/FS is the wisest route for me). I was initially considering HPSP, but then I was awarded a renewable, full tuition scholarship by one of the medical schools that accepted me. I still really want to serve, but I want to do my due diligence and figure out which route to the military puts me in the best position to serve operationally and also which route makes the most sense financially given my scholarship situation. With that backstory in mind, I'd appreciate any help answering the following questions:

1) Can I do a GMO/FS tour after an internship year without doing HPSP? That is to say, is it possible to join after med school graduation but pre-GME (so you'd do a military internship before embarking on a GMO/FS tour)? Or is it possible to join after a civilian internship just so you can do a GMO/FS tour? I know you can do FAP during residency or join post-residency and get a GMO/FS billet after a utilization tour in your specialty, but I presume I'd have a lot more knowledge to lose and skills to deteriorate at that point. It seems to me, if I'm going to serve operationally, it would make more sense to do it pre-GME. Holding off on joining also has another benefit: even though joining seems like a great idea to me now, I realize that circumstances in my life might change, and if I can afford to keep my options open, I might as well do so.

2) If the above isn't possible, I was looking into a 3-year HPSP with the intent of serving my obligation as a GMO/FS before pursuing a civilian residency (as I understand it, a 2-year scholarship would incur a 3 year commitment anyway, so I might as well do the 3-year scholarship, correct?). Would a FS tour (with all its associated training) fill the entire 3 years? If I did a GMO tour instead, would I have the chance to fill a different billet once my initial 2-year tour was up, or would I just be extended in the same billet for a 3rd year?

3) I've read before on this board that if you go Navy and want a greenside GMO billet, you will get it. Is this still accurate? With the recent policy changes, are women now eligible for all battalion surgeon roles with the Marines? If so, has anyone heard of any women being able to take advantage of these new opportunities (serving with Division, for example)?

Or how about this option: You take the full tuition scholarship and drop the HPSP right now. Complete medical school, match into the best residency you can. Then if you really really want to serve you can join the military as a fully trained physician. I can understand your desire to serve, honestly I can. But you can serve the needs of the men and women in uniform better as a residency trained physician. You are in the enviable position of being able to have your cake and eat it too. Don't waste that.

 

[UltimateDO]

I've been admitted to medical school and am interested in military medicine. Specifically, I'm interested in serving my time as a GMO or flight surgeon. (My reasoning: I want to serve in an operational setting, and I've done enough reading on this board to be concerned about the present/future of milmed and military GME--it seems that serving as a GMO/FS is the wisest route for me). I was initially considering HPSP, but then I was awarded a renewable, full tuition scholarship by one of the medical schools that accepted me. I still really want to serve, but I want to do my due diligence and figure out which route to the military puts me in the best position to serve operationally and also which route makes the most sense financially given my scholarship situation. With that backstory in mind, I'd appreciate any help answering the following questions:

1) Can I do a GMO/FS tour after an internship year without doing HPSP? That is to say, is it possible to join after med school graduation but pre-GME (so you'd do a military internship before embarking on a GMO/FS tour)? Or is it possible to join after a civilian internship just so you can do a GMO/FS tour? I know you can do FAP during residency or join post-residency and get a GMO/FS billet after a utilization tour in your specialty, but I presume I'd have a lot more knowledge to lose and skills to deteriorate at that point. It seems to me, if I'm going to serve operationally, it would make more sense to do it pre-GME. Holding off on joining also has another benefit: even though joining seems like a great idea to me now, I realize that circumstances in my life might change, and if I can afford to keep my options open, I might as well do so.

2) If the above isn't possible, I was looking into a 3-year HPSP with the intent of serving my obligation as a GMO/FS before pursuing a civilian residency (as I understand it, a 2-year scholarship would incur a 3 year commitment anyway, so I might as well do the 3-year scholarship, correct?). Would a FS tour (with all its associated training) fill the entire 3 years? If I did a GMO tour instead, would I have the chance to fill a different billet once my initial 2-year tour was up, or would I just be extended in the same billet for a 3rd year?

3) I've read before on this board that if you go Navy and want a greenside GMO billet, you will get it. Is this still accurate? With the recent policy changes, are women now eligible for all battalion surgeon roles with the Marines? If so, has anyone heard of any women being able to take advantage of these new opportunities (serving with Division, for example)?

Totally agree with the above poster's response. As a board certified physician who just deployed into a busy part of Afghanistan with several GMOs in the BCT, I can tell you that you MUCH better serve the warfighters with additional training. There were several instances where unnecessary Medevacs were called into non-secure HLZs by people who felt like they were in over their head. Wasting very valuable dustoff resources in the middle of fighting season is bad enough without putting flight crews in jeopardy. As to your questions:

1) You can join if you have a medical license. I can speak to the Army side in that you can deploy as a BN surgeon role if you volunteer for it. If you are truly interested in operational med then BN surgeon should be the only role you should look at for deployment. Brigade and above is admin. If you are interested in trauma medicine then the Role 3 should be your target. As someone who is used to working in the MICU with all kinds of cool equipment, I felt slightly more capable than one of my medics when dealing with trauma in a dismounted environment. In a mature theater most of the injuries are evacuated point of injury, temporized by a Role 2 FST, further stabilized by the Role 3 then flown out of theater. Skill deterioration is very real and I am still knocking some rust off. Your specialty interest should guide where your operation role is.

2) Not sure you understand what a flight surgeon does. Lots of paperwork is generally what it entails. Your job is to keep your pilots and crews flight worthy and generally amounts to clinic time. You can do more, ie I have to go to FS school for the group slot I am moving to but that is just so I can keep my jumpers up to speed. From your question you are asking about Navy slots, which I cannot comment on.

3) Can't comment on non-Army roles. The marine docs I have talked to though generally give the same impression re my comments on BN surgeon vs higher levels. The higher you go (and this is true back home too) the more you add admin and take away from your patient care time.

 

[LBB2031]

Thanks for the thoughts. I appreciate where both of you are coming from when you emphasize that one can better serve our servicemen and women as a residency-trained doc.

1) You can join if you have a medical license. I can speak to the Army side in that you can deploy as a BN surgeon role if you volunteer for it. If you are truly interested in operational med then BN surgeon should be the only role you should look at for deployment. Brigade and above is admin. If you are interested in trauma medicine then the Role 3 should be your target. As someone who is used to working in the MICU with all kinds of cool equipment, I felt slightly more capable than one of my medics when dealing with trauma in a dismounted environment. In a mature theater most of the injuries are evacuated point of injury, temporized by a Role 2 FST, further stabilized by the Role 3 then flown out of theater. Skill deterioration is very real and I am still knocking some rust off. Your specialty interest should guide where your operation role is.

UltimateDO: The info you provided on operational opportunities was really helpful. Does the BCT acronym denote a Brigade Combat Team? If so, does that just refer to a deployable group of the combat arms MOS's? I'm interested in the surgical specialties (especially ortho), but I understand that there is a strong possibility that I may change my mind during med school. I did some reading on the Role 3 in Kandahar, and that would be the type of opportunity I'd be hoping for if I joined the military. But with the U.S. drawdown in Afghanistan, will U.S. military docs continue to deploy to the Role 3? I'm assuming it is unlikely that it would still be an option in 10 years or so when I finish residency. A peacetime military doesn't have theatre-level hospitals like this, correct (because, as I understand it, they exist to treat combat casualties)? Thanks again for your perspective on this. Thanks also for your service.

Or how about this option: You take the full tuition scholarship and drop the HPSP right now. Complete medical school, match into the best residency you can. Then if you really really want to serve you can join the military as a fully trained physician. I can understand your desire to serve, honestly I can. But you can serve the needs of the men and women in uniform better as a residency trained physician. You are in the enviable position of being able to have your cake and eat it too. Don't waste that.

Totally agree with the above poster's response. As a board certified physician who just deployed into a busy part of Afghanistan with several GMOs in the BCT, I can tell you that you MUCH better serve the warfighters with additional training. There were several instances where unnecessary Medevacs were called into non-secure HLZs by people who felt like they were in over their head. Wasting very valuable dustoff resources in the middle of fighting season is bad enough without putting flight crews in jeopardy.

The line of thinking below is what has me interested in a GMO tour. Please help me see the light or set me straight if I'm way off base:

As I understand it, there would be operational opportunities galore for a battalion surgeon even in a peacetime military. I'm less sure about what operational opportunities might exist for a residency-trained doc in a post-Afghanistan/Iraq world. The opportunities to deploy as part of a FST or to deploy to a Role 3 won't be there anymore. That leaves the battalion surgeon role as your best option to be operational (since as UltimateDO alluded to, brigade surgeon and above is mostly admin and flight surgeon is mostly paperwork). If one is a non-primary care specialist, I'm worried about whether one can, with a clear conscience, take a battalion surgeon billet given how poorly prepared you'd be (you're years removed from any primary care training) and the potential harm you could do to your medical career by leaving your specialty for a year or two. But I suppose one could use the same two arguments to question how one could, with a clear conscience, take a GMO billet as an internship-only trained doc (you're ill-prepared and you're going to forget things you have to re-learn when you return to residency). So the question is, which is preferable: going operational as a GMO or as a residency-trained doc? It seems neither is an ideal option. Is there a middle road I'm missing? (The cynical among us might point out that it is naive of me to be projecting a peacetime military...all of the thinking outlined above would be rendered moot if the U.S. puts boots on the ground in another country).

Thanks again for the thoughts and insights.

 

[UltimateDO]

UltimateDO: The info you provided on operational opportunities was really helpful. Does the BCT acronym denote a Brigade Combat Team? If so, does that just refer to a deployable group of the combat arms MOS's? I'm interested in the surgical specialties (especially ortho), but I understand that there is a strong possibility that I may change my mind during med school. I did some reading on the Role 3 in Kandahar, and that would be the type of opportunity I'd be hoping for if I joined the military. But with the U.S. drawdown in Afghanistan, will U.S. military docs continue to deploy to the Role 3? I'm assuming it is unlikely that it would still be an option in 10 years or so when I finish residency. A peacetime military doesn't have theatre-level hospitals like this, correct (because, as I understand it, they exist to treat combat casualties)? Thanks again for your perspective on this. Thanks also for your service.

Yes, the army has shifted from division sized deployment units to brigade sized elements with all support units organic. So each of our BNs had a physician and a PA then there was the Brigade Support Battalion (BSB) that established a Role 1+ at the brigade HQ FOB that was two docs and two PAs. If you are interested in surgery then it will be FSTs or Role 3s for you. Medical will be one of the last assets out of theater, I am not sure if anyone knows in the current environment what the KAF Role 3's future is. Have faith...between Mali, Somalia, Syria, Iran and North Korea someone is going to forget how ****ty war is by the time you finish training. Not sure what MilMed is going to look like by then though 🙄


The line of thinking below is what has me interested in a GMO tour. Please help me see the light or set me straight if I'm way off base:

As I understand it, there would be operational opportunities galore for a battalion surgeon even in a peacetime military. I'm less sure about what operational opportunities might exist for a residency-trained doc in a post-Afghanistan/Iraq world. The opportunities to deploy as part of a FST or to deploy to a Role 3 won't be there anymore. That leaves the battalion surgeon role as your best option to be operational (since as UltimateDO alluded to, brigade surgeon and above is mostly admin and flight surgeon is mostly paperwork). If one is a non-primary care specialist, I'm worried about whether one can, with a clear conscience, take a battalion surgeon billet given how poorly prepared you'd be (you're years removed from any primary care training) and the potential harm you could do to your medical career by leaving your specialty for a year or two. But I suppose one could use the same two arguments to question how one could, with a clear conscience, take a GMO billet as an internship-only trained doc (you're ill-prepared and you're going to forget things you have to re-learn when you return to residency). So the question is, which is preferable: going operational as a GMO or as a residency-trained doc? It seems neither is an ideal option. Is there a middle road I'm missing? (The cynical among us might point out that it is naive of me to be projecting a peacetime military...all of the thinking outlined above would be rendered moot if the U.S. puts boots on the ground in another country).

If you get into the right unit there are operational medicine opportunities like the one you are looking for. You are right, peacetime operational medicine is basically outpatient clinic with the occasional FTX or humanitarian mission thrown in. That said, I work alongside surgeons who are attached to JSOC that will disappear for a couple of weeks every now and then. Draw your own conclusions. 😀
As to your other question...you clearly provide better care for your patient with more than an internship of training but definitely take a skills hit (even more so with specialists / surgeons) when residency trained. Again it depends on the op tempo...there definitely has been greater focus on remediating us when we return but that policy could go byebye too. As long as you go into it with open eyes you can't really complain when the things you were warned about occur.

Your best option is still stay on the civilian side until you get your training done. You should have the perspective at that time to make an intelligent decision based on the facts. No one should be able to tell you with a straight face what MilMed is going to look like in 5+ years.