GMO Tour: Not Advantageous

[island doc]

It is important to avoid a GMO Tour if at all possible.

GMO Tours are not advantageous for the following reasons:

1. The modern medical education model is geared toward the seamless completion of residency training.

2. The rotating internship only model is a relic of the past and is no longer relevant or sufficient in today's increasingly complex medical environment.

3. Board Certification, a vitally important quality indicator, requires completion of residency training.

4. A GMO Tour creates stagnation, clinically, professionally, and financially.

5. A GMO tour is not in the best interest of patients.

6. A GMO tour does not provide increased opportunities for residency training, and may have the opposite effect.

With the ever present risk of a GMO tour associated with HPSP, one more reason to consider FAP as a better alternative, or avoiding military service altogether.

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[militarymd]

hear, hear...listen to the man...he is one smart dude.

 

[IgD]

Trollin' down the river...

 

[island doc]

hear, hear...listen to the man...he is one smart dude.

Thanks. I don't know if I am all that smart , these are just a few of the things I learned after 4 years (HPSP ADSC) as a GMO.

 

[r90t]

6. A GMO tour does not provide increased opportunities for residency training, and may have the opposite effect.

I'd argue this one. With the military's GME selection in December, many programs have selected their interviewees. I matched for a FTOS Rad Onc spot. I sent out letters to all of the program directors and got 8 interviews at name brand schools even before my transcripts were released from my med school.

The interviews went like this...why rad onc...what did you do on the ship....how do you like the navy....

Get my point? The program directors were interested in my operational experience because it was something than none of them had the slightest experience of doing. I got back into residency as fast as possible because I agree that being a long term GMO is not a career enhancing move, but a 2 year break in training won't kill you.

 

[island doc]

Good for you, you are the exception, not the rule.

I spent 4 years as an AF GMO despite my best efforts to obtain residency training. I worked with two other AF GMO's who spent 3 years, before separating. I was recently PM'd by an AF Flight Surgeon who has been "suffering" in place for 5 years, with four to go, before being eligible for separation... No military residency for any of us...

 

[omnipotentx]

If you're pulled out of a civilian residency after the first year (internship), do GMO for 2 years, and go back and finish residency in 3 years (if you get in)... is it true that you then owe 3 more years of active duty (5 years total)?

-Jeff

 

[island doc]

If you're pulled out of a civilian residency after the first year (internship), do GMO for 2 years, and go back and finish residency in 3 years (if you get in)... is it true that you then owe 3 more years of active duty (5 years total)?

-Jeff

The 2 years spent as a GMO would count as payback for 2 years HPSP obligation, leaving 2 years to go. A 3 year active duty residency would then incur another 3 year active duty service commitment. (A deferment for civilian residency incurs no additional commitment.) Then there would be 5 years of active duty commitment, but the two commitments would be fulfilled concurrently, so the actual active duty commitment remaining would be 3 years. Total time as active duty staff physician after HPSP would still be 5 years though. Hope this answers your question and is not too confusing. I am confused.

 

[r90t]

I had a 4 year HPSP payback. I did 2 as a GMO, then I am in a 4 year FTOS training program with a 4 year payback. My time in residency does not count towards my HPSP. My contract I just signed committed me through 2015.

Someone correct me if I am wrong, but if I did an in service residency, my HPSP payback would continue to go, but I would incur payback for residency. This is what my older physician friends (late 90s residents) were committed to in an in service program.

 

[island doc]

I had a 4 year HPSP payback. I did 2 as a GMO, then I am in a 4 year FTOS training program with a 4 year payback. My time in residency does not count towards my HPSP. My contract I just signed committed me through 2015.

Someone correct me if I am wrong, but if I did an in service residency, my HPSP payback would continue to go, but I would incur payback for residency. This is what my older physician friends (late 90s residents) were committed to in an in service program.

Were we talking AF, can't speak for Navy, but I would think it the same. Being one of those "older" folks you speak of myself, I can say that back then an active duty residency incurred a year for year obligation, civilian sponsored two year for one obligation, and deferred no additional obligation.

 

[Mirror Form]

I had a 4 year HPSP payback. I did 2 as a GMO, then I am in a 4 year FTOS training program with a 4 year payback. My time in residency does not count towards my HPSP. My contract I just signed committed me through 2015.

Someone correct me if I am wrong, but if I did an in service residency, my HPSP payback would continue to go, but I would incur payback for residency. This is what my older physician friends (late 90s residents) were committed to in an in service program.

If you owed 2 years, then did a 4 year military residency (not including internship), you'd graduate from residency with a total of four years committment left. That's b/c your 4 year residency would pay off the 2 years you owed initially, but it would rack up another 4 years commitment on top of it.

 

[pescaDr]

It is important to avoid a GMO Tour if at all possible.

GMO Tours are not advantageous for the following reasons:

1. The modern medical education model is geared toward the seamless completion of residency training.

2. The rotating internship only model is a relic of the past and is no longer relevant or sufficient in today's increasingly complex medical environment.

3. Board Certification, a vitally important quality indicator, requires completion of residency training.

4. A GMO Tour creates stagnation, clinically, professionally, and financially.

5. A GMO tour is not in the best interest of patients.

6. A GMO tour does not provide increased opportunities for residency training, and may have the opposite effect.

With the ever present risk of a GMO tour associated with HPSP, one more reason to consider FAP as a better alternative, or avoiding military service altogether.

Let me preface by saying that I DO think the GMO (FS and DMO included) model should be phased out. BUT since it still exists (along with the rotatining internship), I'll put in a positive plug for doing the FS thing (Flight Surgery)...can't comment on GMO or DMO (Dive Medicine) since I didn't go that route.

Having just finished a 2 year Navy FS tour (with the Marines), I can't fully agree with all the above points. Appears that island doc may have had a bad experience...and that is an important factor when taking advice on this subject. I thoroughly enjoyed my time, but not everyone can say the same. Regarding the 6 points above:

1. not a huge deal. Seamlessness is a non factor. The break is great.

2. the rotating internship: for me, a wonderful time to experience different medical specialties. Probably not the most effecient use of time if you are not going to do primary care. It was good for exposure and helped me realize what I didn't want to do.

3. Board cert will come along eventually.

4. Have to agree with the professional stagnation and clinical regression. Financially, I'd say it is a wash. For me, I was able get ahead financially (bonuses plus home sale proceeds)...which would not of happened during residency. Granted, getting done with residency 3 years earlier would make up for it, but in my case it wouldn't be a big difference.

5. This is the biggest truth of this whole discussion. Delivery of quality health care is the biggest challenge. Daily, my job would be arranging specialty consults for my patients because the standard of care warranted more than I had at my disposal. Part of the problem where I worked was lack of support from the Navy. I was a FS with the Marines and funding for a building, supplies, meds, etc was sorely lacking...we couldn't even suture a lac. But that is a Marine doc issue. Another issue is not having a residency trained physician trying to manage a whole spectrum of medical problems...this creates overburdened, under trained physicians trying to do the best they can with a limited arsenal of knowledge/experience. Fortunately for me the patient populaiton was not that diverse.

6. From my perspective, it made me more competitive for residency, but didn't create or take away opportunites.

Take this for what's it's worth. Everyone has an opinion and it is best to consider them all based on your needs/desires.

 

[orbitsurgMD]

Let me preface by saying that I DO think the GMO (FS and DMO included) model should be phased out. BUT since it still exists (along with the rotatining internship), I'll put in a positive plug for doing the FS thing (Flight Surgery)...can't comment on GMO or DMO (Dive Medicine) since I didn't go that route.

Having just finished a 2 year Navy FS tour (with the Marines), I can't fully agree with all the above points.

You had a good GMO/FS tour. Congratulations. Enjoying your assignment is a good thing, but you delayed a very important part of your formation as a physician, a part that you have not yet done. I'd like your perspective once you have finished your training and have behind you the sort of formal training your specialty thinks you should have before starting to practice.

Appears that island doc may have had a bad experience...and that is an important factor when taking advice on this subject. I thoroughly enjoyed my time, but not everyone can say the same. Regarding the 6 points above:

You said it (bolds mine).

1. not a huge deal. Seamlessness is a non factor. The break is great.

So is a vacation. Maybe that is all you should need, instead of a three year hiatus with no set plan for returning to training, which is what most Navy interns are forced to accept. And it isn't what they were sold or what most would have elected, either. Funny thing, if the break is so great, why is the military the only institution in all of medicine to practice this? You shouldn't need a break; you should want to finish your training; you should be excited about doing medicine, not so weary of it as to need a break that takes you away for three years, or longer. Sorry, but seamlessness is a factor, whether you appreciate that or not.

2. the rotating internship: for me, a wonderful time to experience different medical specialties. Probably not the most effecient use of time if you are not going to do primary care. It was good for exposure and helped me realize what I didn't want to do.

That was the purpose of your rotating clinical clerkships when you were in medical school. That was the purpose of your clinical electives in medical school. When in training, you should be moving on from that into an area you select, not that the Navy selects for you.

3. Board cert will come along eventually.

It will come along only when you complete your residency training and sit for and pass your board examinations, and not one minute before then. Time is valuable. You should not trivialize the time the Navy appropriates for its use that really doesn't allow you to progress professionally.

4. Have to agree with the professional stagnation and clinical regression. Financially, I'd say it is a wash. For me, I was able get ahead financially (bonuses plus home sale proceeds)...which would not of happened during residency. Granted, getting done with residency 3 years earlier would make up for it, but in my case it wouldn't be a big difference.

Pretty subjective, there. Depending on your specialty, Navy could be a huge hit financially. And as for making money, that is a highly speculative issue.
Not every housing market is booming. A lot of JOs in my unit couldn't unload their properties at all. I met an AF doc who lost his shirt when the local base closed under BRAC and the local housing market tanked.

5. This is the biggest truth of this whole discussion. Delivery of quality health care is the biggest challenge. Daily, my job would be arranging specialty consults for my patients because the standard of care warranted more than I had at my disposal. Part of the problem where I worked was lack of support from the Navy. I was a FS with the Marines and funding for a building, supplies, meds, etc was sorely lacking...we couldn't even suture a lac. But that is a Marine doc issue. Another issue is not having a residency trained physician trying to manage a whole spectrum of medical problems...this creates overburdened, under trained physicians trying to do the best they can with a limited arsenal of knowledge/experience. Fortunately for me the patient populaiton was not that diverse.

So why endorse an employer that forces you to work in such an undersupported professional environment? They are professionally hazarding you and they are putting the patients locked into that system at risk for having to be treated by undertrained and undersupported staff. That is morally indefensible and the Navy and any other branch that does this sort of thing--really for no better reason than they are too slothful to create a better alternative--is deserving of outright condemnation.

6. From my perspective, it made me more competitive for residency, but didn't create or take away opportunites.

It makes you competitive for some residencies in the military. Since the GMO experience is commonplace, I'm not sure it narrows the applicant pool by much for some specialties, most of which you could get much more easily on the outside without the GMO tour. It might have given you something to talk about at interviews, and maybe in your assessment it made you different, but since you are doing a military residency, it probably just made you at home with your residency classmates (unless you are doing neurosurgery, where you are in a class of one).

Take this for what's it's worth. Everyone has an opinion and it is best to consider them all based on your needs/desires.

The opinion of someone who has just done a FS tour but hasn't finished a residency or passed boards. That is not meant to put your POV down, but you aren't really able to judge the importance of training that you haven't yet done.

 

[r90t]

I think my GMO tour made me more competitive than my peers when I interviewed at civilian programs against 4th year med students, including many MD/PhDs that our in my field. Experience (good or bad), making my career decision with substantial thought and time, and being a few more years mature than the others, was IMO, a plus.

3 PDs basically said "rank us high because we have a spot for you." It wasn't my Step I/II/IIIs or GPA or lack of MD/PhD that got me through the interviews.

 

[orbitsurgMD]

I think my GMO tour made me more competitive than my peers when I interviewed at civilian programs against 4th year med students, including many MD/PhDs that our in my field. Experience (good or bad), making my career decision with substantial thought and time, and being a few more years mature than the others, was IMO, a plus.

3 PDs basically said "rank us high because we have a spot for you." It wasn't my Step I/II/IIIs or GPA or lack of MD/PhD that got me through the interviews.

You are talking about a 3-year difference. There is as wide--even wider-- a range in ages in most graduating medical school classes these days, and that isn't including those who did another 2-3 years for the PhD. I just don't see how the extra time alone is going to signify all that much. Sure, having the experience of independent practice--whether properly trained and supported for that tasking or not--will give you a perspective on medical practice other applicants might not have. That could distinguish you, but I don't think the marginal advantage is worth the cost. You may differ.
That you were resourceful in your use of GMO time may be to your credit, but consider the possibility that you were smart enough to get a good residency slot without the GMO detour.

 

[pescaDr]

You had a good GMO/FS tour. Congratulations. Enjoying your assignment is a good thing, but you delayed a very important part of your formation as a physician, a part that you have not yet done. I'd like your perspective once you have finished your training and have behind you the sort of formal training your specialty thinks you should have before starting to practice.




You said it (bolds mine).



So is a vacation. Maybe that is all you should need, instead of a three year hiatus with no set plan for returning to training, which is what most Navy interns are forced to accept. And it isn't what they were sold or what most would have elected, either. Funny thing, if the break is so great, why is the military the only institution in all of medicine to practice this? You shouldn't need a break; you should want to finish your training; you should be excited about doing medicine, not so weary of it as to need a break that takes you away for three years, or longer. Sorry, but seamlessness is a factor, whether you appreciate that or not.



That was the purpose of your rotating clinical clerkships when you were in medical school. That was the purpose of your clinical electives in medical school. When in training, you should be moving on from that into an area you select, not that the Navy selects for you.



It will come along only when you complete your residency training and sit for and pass your board examinations, and not one minute before then. Time is valuable. You should not trivialize the time the Navy appropriates for its use that really doesn't allow you to progress professionally.



Pretty subjective, there. Depending on your specialty, Navy could be a huge hit financially. And as for making money, that is a highly speculative issue.
Not every housing market is booming. A lot of JOs in my unit couldn't unload their properties at all. I met an AF doc who lost his shirt when the local base closed under BRAC and the local housing market tanked.



So why endorse an employer that forces you to work in such an undersupported professional environment? They are professionally hazarding you and they are putting the patients locked into that system at risk for having to be treated by undertrained and undersupported staff. That is morally indefensible and the Navy and any other branch that does this sort of thing--really for no better reason than they are too slothful to create a better alternative--is deserving of outright condemnation.



It makes you competitive for some residencies in the military. Since the GMO experience is commonplace, I'm not sure it narrows the applicant pool by much for some specialties, most of which you could get much more easily on the outside without the GMO tour. It might have given you something to talk about at interviews, and maybe in your assessment it made you different, but since you are doing a military residency, it probably just made you at home with your residency classmates (unless you are doing neurosurgery, where you are in a class of one).



The opinion of someone who has just done a FS tour but hasn't finished a residency or passed boards. That is not meant to put your POV down, but you aren't really able to judge the importance of training that you haven't yet done.

OrbitsurgMD, to address the "endorsement" of Navy Medicine...as I said in the beginning, the whole concept should be dumped. But, many will be/are in the situation I just left. This is simply my experience. Overall, was this the best route professionally? No. So far, would I do it again? Yes. My perspective may change down the road, but I can't say rignt now that it was a poor choice. I had great line commanders, phenomenal aircrew that respected my job, traveled the US and Europe, had ample flight time and enjoyed the flight surgeon lifestyle. Were there drawbacks? Damn skippy. Clinically, my skills have atrophied (but don't worry, my numchuck and bowstaff skills are prime). I have worked hard to maintain some semblance of competence, but the regression is unavoidable. 2 moves in 3 years--horrible on the family. What I said of the Navy not being supportive is actually much more convoluted: the politics of the Navy and Marine Corps is very hard to deal with at times. In my situation, I fell under the Marine Corps squadron CO, as do most all FS assigned to the Marines. Since we worked under the fiscal restraints of the USMC, medical funding for day to day clinic operations came through the USMC. So when we needed minor supplies/OTC meds, instead of being able to call the MTF down the street and ask for what we needed, we had to route a request via medical logistics (USMC side) to get what we needed...usually weeks to months later, if at all. Navy didn't/couldn't pony up because of money issues. Anyway, it was more of a time burden/extra hoops to jump through. Did it impact care, a little. But the biggest problem is undertrained docs...but I already addressed that earlier. Anyhow, 20 years down the road, I hope I can still look back and remember the good times: LOTS of family time, endless golf and the Harrier rides I had in North Carolina.