GMO qual disappearing

[pawprint]

Current Navy flight surgeon here,

Apparently line side has received a notification that essentially states that the Navy will stop approving internship-only-trained GMO’s/UMO’s/Flight Surgeons from being allowed to practice medicine independently in approximately 2 years. Navy will only recognize board certification to fill billets. My CO mentioned it to me but didn’t forward along what he had received. Other flight docs in my clinic/around the fleet also say there CO’s were notified of the same thing.

Any other GMO’s out there having anything more concrete? If this is true, sounds like this is an attempt to force folks to either go back to residency or get out…also looks like this will force a lot of residency trained docs out to the fleet to fill the huge gap this will cause.

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[DrMetal]

Current Navy flight surgeon here,

Apparently line side has received a notification that essentially states that the Navy will stop approving internship-only-trained GMO’s/UMO’s/Flight Surgeons from being allowed to practice medicine independently in approximately 2 years. Navy will only recognize board certification to fill billets. My CO mentioned it to me but didn’t forward along what he had received. Other flight docs in my clinic/around the fleet also say there CO’s were notified of the same thing.

Any other GMO’s out there having anything more concrete? If this is true, sounds like this is an attempt to force folks to either go back to residency or get out…also looks like this will force a lot of residency trained docs out to the fleet to fill the huge gap this will cause.

There's certainly been talk of this, but nothing really concrete has happened. The problems is, we still have too many GMO billets (on the order of hundreds), we can't just turn them all off overnight.

And of course, we don't have enough Navy GME spots for all of our PGY1 MCs. Most would have to be deferred out.

I wonder what this 'notification' was to your CO. Something verbal, something written?

 

[orbitsurgMD]

If this is the case, residents in training and those about to start training will have to be told that their first set of orders may be to the fleet as operational medical officers. That will be popular.

Those in GMO/FS/UMO billets right now will have some time to decide, maybe two years, whether to take a Navy offer for supported training, if there are any, or punch out to do civilian residency. I would expect the same numbers to do each as have been the case in the past.

If the messaging means that after two years, no non-board certified doctor will be certified for independent practice going forward, that carries many implications. They will be non-deployable. They will not be able to receive special pays either unless rules are changed governing eligibility.
Medical officers completing internship this year will be the last class to be able to take 2-year orders as GMOs, and flight surgeons and UMOs, because of their operational medicine schools taking at least 6 months, will not likely receive any orders except for less than 2 years. The flight surgeons who are able to complete EAOS this year and next year will probably have gapped billets unless those billets will be filled with fresh residency grads being sent to operational assignments. Given how many PGY1s outnumber the PGY2s, there is mathematically no way to make up the operational billet shortfall over the next three years. Radiologists and pathologists will be taking sick call.

I predict strong pressure on HPSP and USUHS grads, but particularly HPSP, to find a civilian residency and complete said residency before reporting or expect to be assigned to an outpatient clinic station somewhere as a junior clinician under multi-year supervision which would probably work adversely against promotion and certainly against pay. At one point, when HPSP was a more attractive program, before the long degradation of Navy hospital training capacity, HPSP grads would have been a shoo-in for competitive residencies in the civilian sector. I am not sure they are getting the same cohort of medical students as then and residency application has become relatively more competitive.

This may be the end of HPSP as it exists. The Navy can't train the numbers it needs in its own hospitals to meet the combined need for operational medical officers and practicing specialists and it can't guarantee civilian training spots for its USUHS and HPSP accessions either.

 

[DrMetal]

If this is the case, residents in training and those about to start training will have to be told that their first set of orders may be to the fleet as operational medical officers. That will be popular.

Those in GMO/FS/UMO billets right now will have some time to decide, maybe two years, whether to take a Navy offer for supported training, if there are any, or punch out to do civilian residency. I would expect the same numbers to do each as have been the case in the past.

Problem is, we're still making too many medical officers. USU graduates 60 per year (just for the Navy), HPSP takes in at least twice as much, so we have 150+ new junior medical officers who get at least internship training, but then what? Some go on to Navy PGY2+, but those that don't (by their own decisions, or who cant match civilian), we have to do something with them. So in that sense, the GMO model is never going to go away completely, unless . . . we cut down on the recruiting. USU and HPSP can (should) each lose say 20% (USU graduates 40 per year, HPSP only 50-75). Then, and only then, might our expectations (of completely abolishing the GMO model) come to fruition.

We gotta turn off the spigot.

That doesn't seem to be happening. USU has strong political lobbying for itself; it's not going to cut itself down. HPSP has never been more popular with the rising costs of medical school (I'm interviewing at least 1-2 applicants per week, all DO-school bound).

 

[orbitsurgMD]

Problem is, we're still making too many medical officers.

The problem is twofold. They still need operational docs but they don't have enough residencies under their control to ensure having enough board-eligible doctors to take the soon-to-be-vacant operational slots and have the numbers needed to take non-operational MTF billets. The elephant in the room is the need to fill the operational billets with people hired off the street, doctors with debt who are being recruited by civilian hospitals and medical groups who pay competitively. Better check the couch cushions, because this could get expensive.

We gotta turn off the spigot.

That doesn't seem to be happening. USU has strong political lobbying for itself; it's not going to cut itself down. HPSP has never been more popular with the rising costs of medical school (I'm interviewing at least 1-2 applicants per week, all DO-school bound).

How does turning down the supply of doctors fill vacant billets? If they do this, they will have to hire off the street at market rates for doctors to take billets not covered by the diminishing numbers of USU and HPSP accessions. They are trying to pull rabbits from hats.

 

[DrMetal]

How does turning down the supply of doctors fill vacant billets?

It doesn't. You would need to turn down the supply and get rid of the billets. Doing one but not the other would make no sense.

There are a ton of unnecessary GMO/operational billets (some of which I've occupied) that either a) don't need to be done by a physician or b) don't need to exist at all.

Great examples are medical officers on LSD/LPDs (sailors can be seen in regular clinics when ashore and their IDCs can take care of only acute issues when underway, as is done on DDGs, CGs, and SSNs) and FSTs (you don't need an extra team of doctors, that works out of a Starbucks when ashore, and become gym rats when underway).

 

[Onefellswoop87]

I’m not calling your CO a liar, but I’m very skeptic that such an notification come via the line side. I’d even wager that the line (much like the general public) has no idea of the difference between internship, residency, board eligible/certified, or even all the types of physician extenders that BUMED is also talking about using to replace GMOs.
If it deal with credentials of medical corps, that’s a BUMED issue not directly a line issue, and they aren’t going to effectively close or not fill all those billets overnight (2 years is essentially overnight in the eyes of the federal government). Good or bad policy, and that’s a topic in and of itself, GMOs are legally licensed physicians. Many states require 2+ years of GME and until all states go that way and then force the DoD to not use internship trained physicians, I don’t see it greatly changing anytime soon. The OMOs are filling mostly SMO billets. They aren’t fully replacing GMOs anytime soon.

 

[orbitsurgMD]

It doesn't. You would need to turn down the supply and get rid of the billets. Doing one but not the other would make no sense.

There are a ton of unnecessary GMO/operational billets (some of which I've occupied) that either a) don't need to be done by a physician or b) don't need to exist at all.

Great examples are medical officers on LSD/LPDs (sailors can be seen in regular clinics when ashore and their IDCs can take care of only acute issues when underway, as is done on DDGs, CGs, and SSNs) and FSTs (you don't need an extra team of doctors, that works out of a Starbucks when ashore, and become gym rats when underway).

That would take some powerful wishful thinking. I understand the Navy is working toward a new and leaner component afloat, not necessarily tasking with the same numbers and types of vessels as have traditionally been deployed, and potentially with a reduced need for medical officers in some roles. That said, there is the counter-trend that demands a larger force in numbers of ships to meet the considerable growth of China's blue-water navy. Those ships will still require sailors and the Navy will still require medial officers, and that is presuming a peacetime op-tempo.

 

[DrMetal]

That would take some powerful wishful thinking.

It certainly is. I don't think it's going to happen. This is the quagmire we run into every time we talk about getting rid of GMOs.

I’m not calling your CO a liar, but I’m very skeptic that such an notification come via the line side.

Agree. Some of the line do understand the meaning of internship, residency, BC, etc (some even have a medical background), but most don't.

 

[pgg]

Every line commander I've ever known would drop a litter of kittens if they lost "their" doc(s).

They have always been a powerful lobbying force for the status quo. And there's some merit to honoring their wishes - after all, it's us supporting them, not the other way around. But mostly it's just the medical corps leadership not doing the right thing.

When I was at the great Navy metropolis of Lemoore and we did do the right thing and closed down the inpatient OB services, forcing dependents to drive a whole 9 miles to neighboring metropolis Hanford, the line units collectively lost their ****. They were so wrapped up in "quality of life" and convenience for their people that they just didn't want to hear about the cost and safety issues associated with a L&D floor that only did 20 or 25 deliveries per month.

I wonder if or how they'll ever substantially reduce the number of physicians in operational billets, unless they cut the line units themselves, in an early 90s BRAC style.

Remember that not long ago the Marine Corp's response to the prospect of not getting all the surgeons and anesthesiologists they wanted was to buy a ****load of billets, park those people at the line unit, and "loan" them back to the MTFs for some skill maintenance.

The line gets what it wants, and it wants what it wants.

I definitely favor replacing interns with BC/BE physicians. But I'd hate to actually be one of those people sentenced to skill rot and knowledge atrophy. Merely bad for primary care docs, but catastrophic for everyone else.

I don't think the intern GMO will vanish completely until they actually can't get licenses. They absolutely won't hire BC/BE people off the street at $3-400K+ market wages when they can buy an HPSP body for $250K up front and then pay them $100K/year during the ADSO years.

It's a hard problem and the system isn't set up to accept or pay for the right solution.

 

[armytrainingsir]

It will be quite some time before you can’t get a license with only one year of GME. And if and when that happens, expect a wave of a hand from DoD and non licensed MDs will be ‘supervised’ remotely and allowed to practice on AD folks. Or the DoD will create their own version of a medical license.

 

[DrMetal]

The line gets what it wants, and it wants what it wants.

Probably true.

But it could be done. I could propose to the O-5 commander of an LSD, that we need to take away his medical and dental officers as per other manning needs. In return, we'll make sure all of his sailors are set up at a branch medical clinic for q 12 months (or q 6 month) visits with an actual PCM, and the IDC will take care of only acute things while underway. Anyone who gets sicker and needs more care, goes LIMDU and off your ship (as is done in many other operational units).

He would grunt and be upset for 5 minutes, then he'd move on to the plethora of other problems a SWO CO faces these days.

Problem is, we don't have the leadership nor the impetus (from the medical corps) to make such drastic changes. And, while we still have a ton of junior medical officers running around, we need that GMO billet on the LSD. Hell, we might even double stuff it.

It will be quite some time before you can’t get a license with only one year of GME. And if and when that happens, expect a wave of a hand from DoD and non licensed MDs will be ‘supervised’ remotely and allowed to practice on AD folks. Or the DoD will create their own version of a medical license.

Scary and dumb enough that it might actually happen.

 

[Brouillet2017]

Not sure how this could possibly be true considering how many interns they are sending out to GMO land this year, and plenty with the 3ish year timeline of FS/UMO. They are having enough trouble filling non-FS/UMO operational with graduating PGY3s, let alone supplying the FS/UMO pipeline to meet their numbers on that end, hence tons of interns going out this summer despite long-winded promises of fewer people going GMO from internship. Logistically not plausible for this to be done in 2 years with what's happening in the pipeline

 

[DrMetal]

It's fun (and by fun, I mean maddening) how this discussion pops up here every 2-3 years. And the more we discuss it, the more we conclude that nothing is really going to change.

 

[militaryPHYS]

Things are definitely changing. But 2 years and done? I doubt that.

The way we train Ortho GME has shifted already to bring back people in fleet and not send out any more. This year we have 1 intern so that 3 can return next year and send none out. We have 2 next year and none will be sent out.

The interns now have a 5 year categorical straight through spot when accepted.

 

[orbitsurgMD]

Not sure how this could possibly be true considering how many interns they are sending out to GMO land this year, and plenty with the 3ish year timeline of FS/UMO. They are having enough trouble filling non-FS/UMO operational with graduating PGY3s, let alone supplying the FS/UMO pipeline to meet their numbers on that end, hence tons of interns going out this summer despite long-winded promises of fewer people going GMO from internship. Logistically not plausible for this to be done in 2 years with what's happening in the pipeline

The GMOs going out will overtasked as the existing GMOs pop smoke over the next two years and the only relief coming will be from IDC replacements (probably not enough of those) or from recent residency grads assigned to operational billets (probably not enough of those, either.) Look for some lucky folks doing port-and-starboard deployments with combat units as TAD.

 

[LTMCUSN]

Every line commander I've ever known would drop a litter of kittens if they lost "their" doc(s).

They have always been a powerful lobbying force for the status quo. And there's some merit to honoring their wishes - after all, it's us supporting them, not the other way around. But mostly it's just the medical corps leadership not doing the right thing.

Exactly. Seems to me, it’s our own fault for not educating the line commanders on why so many of these operational medical billets don’t have to be MOs. I understand that the “Line gets what it wants” -I’ve seen plenty of situations when COs insist their Battalion train with a full STP/FRSS, when the requirements calls for a BAS- but that’s on us for not pushing back and saying “no sir, this is the wrong medical asset for this situation. What we need is X”.

The same can be done by insisting we use PAs/NPs/IDCs instead of physicians when the situation warrants it. Policy dictates process though, so it needs to start being formalized in writing in order to start changing this belief that every unit needs to have their docs as a security blanket, when midlevels would do just as well.

 

[Trajan]

This thread could be from 2003 when I went through OIS. We listened carefully when the O-6 from BUMED visited and explained how GMOs were being phased out.

It reminds me of the political debate about universal health care in America.

 

[layman_3]

This thread could be from 2003 when I went through OIS. We listened carefully when the O-6 from BUMED visited and explained how GMOs were being phased out.

It reminds me of the political debate about universal health care in America.

I wonder how many times the pendulum will swing as the Navy pretends to get rid of GMOs. What I don't get is how the Army and Air Force have managed to transition through this and have come up with solutions decades ago (for better or worse) and yet the Navy insists that it can't be done. Clearly, this is a matter of willpower and refusal to think outside the box

 

[flightdoc09]

Exactly. Seems to me, it’s our own fault for not educating the line commanders on why so many of these operational medical billets don’t have to be MOs. I understand that the “Line gets what it wants” -I’ve seen plenty of situations when COs insist their Battalion train with a full STP/FRSS, when the requirements calls for a BAS- but that’s on us for not pushing back and saying “no sir, this is the wrong medical asset for this situation. What we need is X”.

The same can be done by insisting we use PAs/NPs/IDCs instead of physicians when the situation warrants it. Policy dictates process though, so it needs to start being formalized in writing in order to start changing this belief that every unit needs to have their docs as a security blanket, when midlevels would do just as well.

Just want to say that IDCs are nowhere near as qualified as midlevels. And the average entry level midlevel is nowhere near as qualified as an intern trained physician. Some IDCs I've worked with are truly brilliant, and could have easily become physicians had their fortunes/maturity aligned just right in life.

But I've also seen the converse. And while IDCs are generally good at sick call and trauma, the Navy has put them in positions to practice actual medicine. I'm sure any medical student can identify a painless fixed hard lymph node as something concerning, yet I've seen that ignored. Same for an exquisitely tender and painful testicle that was treated with ibuprofen. And then the young and healthy patient that gets $10,000 worth of labs and studies due to a borderline elevated blood pressure (or other similar minor issue). Then again, there are some really dumb interns.

I agree that putting a GMO on a DDG probably isn't the best use of that GMO. Or taking a GMO out to every field event. But the quality of care a IDC provides is overall inadequate. It probably wouldn't be an issue if those IDCs had adequate support and branch clinics that supported the fleet had adequate manning, but as it stands right now it's months to be able to see a PCP in clinic. So the spillover ends up in the ER.

Further, GMOs are so inundated with mundane PHAs and other pointless/useless administrative burdens, that their ability to practice medicine further has to be shunted to non-physicians.

The entire system is so broken.