GMO to Emergency Medicine: Anecdotal Advice for Getting Out of the Military.

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2+ Year Member
Sep 6, 2018
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  1. Attending Physician
First and foremost, congratulations on making it to the end. I would look at:

Civilian residency after GMO advice
That’s more of a detailed list of your wickets to hit to make a smooth transition out of the Navy.

Your Last Duty Station:
I tried to make sure that I was as close to a Naval Hospital with an EM residency as possible. I chose the area in SoCal:
  • For BAH, as I knew I could probably find a cheaper apartment and pocket the extra cash so that I could fly around for interviews and pay for hotels. O3 BAH without dependents is like 3100, and I pay 1100 to live with a roommate.
  • Proximity to NHCP and NMCSD- I had figured I’d be able to work in the NMCSD ED as a GMO, and I was the exception (after my boss emailed the dept head)- they had a no GMO policy. When I was in Oki there was a push to have GMO’s spend time in the specialty they wanted to return to, and I figured NMCSD would be the same. Fortunately, NHCP only has a FP residency, and I was able to easily get credentialed in their department (they’re under I MEF, which is what the MAW was under anyways), and given full access to see patients (especially kids and the elderly), while going to didacts at NMCSD.
  • CONUS v OCONUS- Hawaii/Oki is expensive to fly from, so just something to keep in mind.
  • Opportunities to moonlight- I never did, but other GMO's I worked with did, so if you'd like to add non-military clinical job experience to your CV and pick up extra cash while you're at it.
I picked up a GMO billet at the MAW, and there are exclusively non-deploying billets (Headquarters, Logistics, Squadron Support). Flying squadrons go on UDP/dets, and GMO’s are the surgeons for the support squadrons composed mostly of non-fliers. I ALMOST went on a field exercise…once, and they had offered me a Kuwait deployment, and I declined as it was during interview season, and they ended up finding a first time GMO to go on it.

I don’t think it would be a bad idea to contact the OMBUDSMAN of the ships that might be on your GMO billet list, as you can find out which ships are going to dry dock, and which are getting ready to deploy. I did this with almost every ship on the list, and the GMOs and SMOs I was put in touch with were happy to give me the details. The only anecdotal cautionary tale is that a ship I had on my short list to attach to if the MAW billet fell through, ended up not going to dry dock as planned and was out to sea for another year.

Other bougie billets: SERE school MO, SWMI school at NMCSD, 8th & I Marines in DC, I had a friend stationed at a shipyard near DC for the duration of his GMO career, and he never deployed.

Do understand that this is the pathway of most resistance.

It would be easier to take your 2 GMO tours and use your accrued points and hop in at NMCSD or Portsmouth. They still have to compare you to other applicants with your scores and your medical school grades, so if you weren’t competitive in medical school, I would be weary of assuming that just because you did time in the military, they would look past a failing step exam. You’ll have plenty of sea stories and leadership experiences to make the interview go smoothly, but your big hurdle is going to be getting them to send you an invite. EM in the military might be your best bet as it’s becoming more competitive all over (ALIEM defined this as more LCME allopathic Seniors occupying residency spots).

Don’t be a sh*tbag.

We all know that everyone in the military can be grossly divided into a sh*tbag or a Rockstar. Be a Rockstar.

You’re still going to be a primary care doctor for 300-800 individuals. While this is temporary for you, they still expect you to take care of them like this is your primary duty, and chronic diseases, cancers, and chronic injuries are still going to walk into your clinic. Your Sailors certainly will expect you to continue to support them, write letters for them, and provide them with opportunities to succeed. This is their profession, and sometimes their career. Regardless of why you joined, military service is just that: service. Be proud of what you do, and don’t drop your pack until you’re checking out.

Getting time off from the clinic and getting your colleagues to cover you for last minute interviews is much easier if they like you, and they know you’re a good person that’s trying to get out.

Plus, if you don’t match, you might as well keep your 6 figure salary in the military, extend a year, and return to the military match (my plan B).

Do plan ahead and accrue leave.

I was lucky in that my command supported me through my interview season (see the above point about not being a turd). Everyone in my squadron had my number, my patients liked me, and they were very happy to let me go without burning leave throughout the interview season, and they filled out no-cost TAD for me. This is 100% command specific, and I would anticipate needing to possibly burn leave to go on these interviews. I also made sure to be present at least one or two days a week, which was definitely a huge drag in terms of being jetlagged, and cramming a 5 day work week into 2 days definitely made it harder. My interview season spanned from November through mid/late January. Unfortunately, none of the interviews are on weekends, so it’s all work-week time. Fortunately, these were the cheaper flights. I DO regret red eyeing almost every one of my flights to make the pre-interview dinner, and then the interview, and then flying out immediately after my interviews, especially as I’m sitting here with >60 days of leave at the end of my EAS (my command wouldn’t let me take >30 days).

Regarding the SLOE, I did have a friend that was a chief at a NYC program that offered to let me rotate, so if you’re in a position where you cant get a SLOE, this might be something you have to save up for.

You’ll also want to make sure you have a good amount of leave for terminal based off of your financial situation. I preferred to smoothly transition from my BAH as an O3 to my GI bill, but I would check with your detailer to see when your time is up. I was very surprised to find out my obligation actually ended in November 2019, when I thought I would be running into a mandatory EAS date of Aug2020 (I reported Aug2018). I preferred to keep getting a paycheck for the last 6 months prior to residency.

Look at Southwest, as you can cancel their flights and use points. I definitely fell into the trap of booking flights, getting more interviews, and then only taking one leg of a United flight because the return trip didn’t fit with my updated schedule.

Do look at getting the AMEX/Chase Sapphire if you haven’t already.

They wave the annual credit card fees, and between applications (>$1000), flights, and hotels, you’ll definitely hit the $4000/3mo limit for them to kick you a $750 travel credit. Chase Sapphire also gives you $300 in travel credits every year, which can be placed towards your actual flight purchases. Also Centurion lounges. Priority pass lounges.

Do understand that you need to stand out:

You may have been a GMO for the last 4 years, but people have no idea what that means (U MD had a PD that was a prior GMO, Yale’s PD retired as a Colonel after being the PD at Madigan, so some folks will have an idea of what you’ve done, but many did not). Try to capture and breakdown your duties with the understanding that the people reading your ERAS CV will LIKELY not have military experience. They’ve seen the HPSP kids applying (and then potentially declining a position because they were accepted by military GME), but I would start the process assuming that no one really understands what four years as a GMO develops, and if you were a PD, you would probably have an easier time comparing apples to apples, vs. apples to GMO oranges. I joined some volunteer groups in the area, and accrued leadership positions while in service, and I took advantage of the free courses through the MTF (ATLS/ACLS/BLS/PALS,etc). Become an instructor of one of them if you can. If you don’t do well on it the first time, just take it again and do better, its free.

Do try to go to TRS/TGPS 12 months before your EAS.
TGPS is the Navy version that's only 3 days, TRS is the USMC version that goes on for 5 days.
At 12 months out, this should put you before the match sometime, but I attended it afterwards. The first two days were the most valuable, with them talking about finances (if you aren't a whitecoatinvestor junkie already), and VA benefits. The last day talks about translating military verbiage into civilian speak and how to create a resume/interview. In hindsight, I could have better used the tools they gave to create an application that better put military roles and responsibilities into civilian terminology. If you print out your VMET (Verification of Military Education and Training) and your JTS (Joint Service Transcripts), the roles of the GMO/FS have been eloquently written for you, and it might help you remember some of the courses you've done that you can throw into your ERAS (again, hindsight, I wish I did this before I submitted my ERAS CV).

Don’t leave anything blank on ERAS.

Don’t have much research? Me neither. I have given about a thousand safety briefs, clinical lectures, tobacco cessation talks, etc. throughout my tenure in the military, and oral presentation is an option for research on ERAS. Leadership- too easy because you’re the head of a department (maybe 2 at this point), and I’m sure you’ve held a collateral or two. Volunteer- I was on the USNHO hospital’s ethics committee. There are usually MEF MEC committees. Find something or volunteer somewhere and have it to talk about. You’ve had four years to make the Navy a better place, and if you’re looking to go back to a residency, and the only thing you’ve done is see 0.5 FTE’s of clinic and go on a deployment, you might be in trouble.

Do Network (maybe):

I have heard anecdotal stories of getting residency interviews because of connections in the military or because at this point, all of your friends are attendings. I certainly did name drop while I was at my interviews (“Oh yeah I graduated with so and so in 2015!”), and this made interview conversations smoother, but my affiliations quite literally got me 0 interviews. The places I had friends put in a good word, I never heard from. I didn't even get rejection letters from these programs, I was just silently ghosted. I am only slightly butthurt about this.

I reached out to two friends that were in EM and they helped me through the process, and it was helpful to have them just to ping ideas off of. It’s definitely hard without an advisor to make decisions about residency, especially while you’re trying to do your Navy job at the same time.

ACEP Residency Fair:

I personally went to ACEP when it was in SD, and again in Denver. I thought it gave me a better perspective on the process, and as I had already gotten interview invitations, I met some of the PD’s prior to actually interviewing, which I think made for an easier interview day. I had a friend say he had received an interview invitation after going to this, however, anecdotally, I did not. The new ACEP dates are well into the application season, so this may have also played a role. After trolling SDN, I would say that it’s useful, but not mandatory for you to match/get interviews. I did meet some GMO’s getting out along the way, but again, I can’t say that it added much.

Do Try to Get an eSLOE:

This parts the worst, but I get it. They need something to compare you to everyone else. The writers at NMCSD took comments from my old TY evaluations, and I spoke to another successful prior ex-GMO, and he had reached back to his medical school. Hopefully you did an EM rotation as an intern that they can build it from, and hopefully you left your intern year in good standing and can get a LOR from your old PD or APD (my PD had retired and never responded to my messages). I had obtained 1 eSLOE and 1 SLOE from a NHCP EM doc I had worked closely with, but I would just be weary and plan ahead. I spoke to an APD that was the prior PD at NMCSD’s EM program and he more or less said the NHCP SLOE’s would be useless. At this point, whose to say? His program never gave me an interview, but plenty of others did. I spoke with a former GMO who said the eSLOE was absolutely necessary, now that he is on the other side of the process. I thought I was going to walk in with 2-3 eSLOEs and 2-3 non-faculty SLOEs, and I had them trickling in as late as November, after the due date. Ask more people than you think you’ll need it from, as the LCDR’s and CDR’s aren’t familiar with the system, and while in my case they were able to write them, there was a bit of “Good afternoon Sir! I just wanted to follow up about that SLOE! Thanks for your time and consideration. V/r.” Don’t fall into the classic rooky mistake of providing them the real due date for the eSLOE/SLOE (I did and it gave me heartburn).
I personally wrote an email to CORDEM asking what I should do regarding the SLOE's, and they told me to ask the programs. I sent an email to the residency coordinators of each program I was interested in, and received the following opinions:
Do not include an SLOE, it will not be helpful as you are not an MS4.
We will not look at your application without SLOEs.
We will look at your application without a SLOE, we totally get that you're in a rough spot.
We will look at your application without a SLOE, but we highly encourage you to have it as part of your application.
Just know that there really isn't a homogenous answer.

Do spend time in the ED:

I was asked frequently if I felt like I was ready to return back to a residency/learning position from acting independently as a GMO, and I think there was a lot of power in me saying that I had been acting as a PGY-1 in the NHCP ED and going to didactics at NMCSD. Also, if you want to be an EM physician, work in a military ED. They know what you're capable of (most were GMOs) so you'll have a longer leash than you'd think.

Do keep up with the requirements ahead of time:

Plan ahead. A colleague of mine had no idea that the SVI was a requirement this year, and had no idea what a SLOE was. They got 1 interview. Do your homework. Who knows what might be coming up, but an unfinished application is no bueno.

Do/don’t wear your uniform to interview:

I didn’t wear my uniform, other GMO’s I talked to did. The pro argument was “it’s part of who I am, and I thought it completed the application.” The con was “Dress for the job that you want,” and “I didn’t want them to think I was a funded spot.” I would argue that the people who interview you are doing so because of your application, not because they wanted to see you in uniform. If you’re more comfortable/confident in yourself with it on, I’d do it, if you’d feel awkward, then don’t.

Do try to add some instructorships to your name:

You can do a lot as a GMO. ATLS instructor, ACLS instructor, BLS instructor, etc. Show a program that they’re going to be taking in a mature adult in something they are familiar with and that you will be willing to teach (it’s what the word “doctor” means, after all).

Do understand ACGME funding:

This is my understanding of the funding issue, but just be aware: there is a funding issue. If you are like me, you did an intern year in not EM. EM is allocated 3 ACGME funding years, and as a TY, I ate up a year of funding already. As such, any hospital that took me, would be accepting the fact that they would have to pay for 1/2 the cost of my residency education for my last year of residency, instead of GME. This would hold true for anyone coming from a 3-year residency like IM. I believe surgeons may have a leg up, as they typically get allocated 5-6 years of ACGME funding, so technically switching out would not use up the rest of their funding.

In any case, know this is a thing that may limit your responses from programs, especially if they have less funding, or if they don’t want to spend extra money on you as an applicant and they have >2000 MS4’s that aren’t going to cost them extra money to choose from.

Do get your Montgomery GIB and increase benefit squared away:

Assuming you did your intern year in the Navy, you will be eligible for the post 9/11 and the MGIB. There’s more on this in the above link, but I would just make sure that you get this squared away. The MGIB will pay you back the money you invested if you never use it (sans a $600 kicker), and you’ll be glad you paid into it if it ends up being a better deal than the post-9/11. In 2020 it will be $2200 a month (if you paid the extra $600), and increases by 4% every year, which is more competitive than the BAH in Chicago and Baltimore (both around 2140), but not as much as NYC/LA (>3000/month).

I was ready with the argument that I was improperly counseled at ODS when I declined it (I was, they told me that they only reason I would ever need it is if I wanted to become a pilot or something, and never mentioned anything about BAH for 3-4 years residency). It turns out, they never filed any of my MGIB documents anyways from ODS, so I had a clean slate to say yay/nay.

Do keep an eye on what the VA STEM program is doing for the post 9/11 GI Bill.

It’s in its first year, 2019, and we’ll see what happens. It should pump out another 9 months of benefits, which could be significant if you get into a 3 year program and want to do a fellowship, or if you get into a 4 year program- dividing up 36 months of BAH over 4 years vs 45 over 4 years. The wording is weird, because it references undergraduate degrees in medical residencies, but lists health professions residency programs as a covered benefit, and at this time I’m not sure if anyone/prior GMO has had a chance to apply for it.

Do apply broadly.

Know who you are as an applicant for sure. I’m an MD that graduated middle 20% in med school, had 236/249/235 step scores, no AOA/GSSH, no red flags, 1 eSLOE, 1 non-faculty SLOE, 1 LOR from my old APD, and 1 from my O-6 Wing Surgeon. I applied to 50ish programs, and heard back from 20 for IVs (2 from Penn came in NYE and 02Jan lol), predominantly from NYC (where I went to school), and Chicago (where I am from). Everyone is applying like madmen as EM is becoming more competitive, so many areas are weeding folks out based off of geography (the entire state of Pennsylvania ignored me until January), but some aren’t (I got 1 invite from Cali and 1 waitlist, 2 invites for Penn,1 in CT, 1 invite for Baton Rouge, University of MD). Other people have the luxury of rotating at institutions to display interest, and you do not. If you have a personal fix for this, then that’s awesome. I think I saw a GMO posting on SDN about how they had only gotten 10 interviews, so “Defending freedom and democracy” for 4 years doesn’t necessarily mean that a PD will do you any special favors (I’m not a PD, but I would presume as much).

Hopefully this is helpful to any who need it, certainly this is my AAR for my adventure through match, and all I had was 1 former GMO who had called me to help out, which was very frustrating to say the least. Feel free to PM for questions.
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Prior Flight Surgeon PM&R attending guy
15+ Year Member
Aug 22, 2005
Thank you for doing this. I’ll post a link to your post in my thread. My guide is very broad and it may not be directed toward everyone, so it is really nice to see specialty specific insight.
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