Navy HPSP (3yr) and Flight Surgery (Navy) Questions (from an M2)

[PugetPounder]

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Hello everyone,

I'm new here. I am a second year M2 (MD school) seriously considering the 3-year Navy HPSP scholarship and (then paying back through a 3-year tour as a Flight surgeon.) I haven’t signed the contract yet.

Edit: This is a VERY long post. All my thanks in advance to whomever reads this. I'll engage respectfully with anyone who replies with advice.
Edit 2: My PRIMARY goal with HPSP is NOT to get FTOS (although that would be nice). Rather, my PRIMARY goal is to GMO and out. If the Navy makes a serious effort to retain me, then great. If not, I'm GTFO.
- Sorry I didn't make that clear.

Preliminary Info (skip if you don’t care and want to see my questions):

I grew up in a town where the Navy was a very important part of life, and so I’ve always had a strong desire to serve. I’m familiar with the military (Navy) lifestyle. Furthermore, I would like to have the chance to be a flight surgeon and work/treat pilots. Flying in military jets also sounds cool. It seems that FS billets are in no short supply, and I don’t really want to wait until after residency to do it – I’m young (< 23), and I want to have this experience before I get older. Hospital ships are also something I would willingly volunteer for, HPSP or not.

Admittedly, I’m a bit worried of being foisted on pilots without a full residency, even with an internship year. As a medical student, the amount of knowledge and experience needed to keep people healthy is just astounding at times. That is even if the air wing is a relatively healthy group of people and sounds somewhat less daunting to take care of than say, an entire aircraft carrier (famous last words). Obviously, I would have to learn a lot very quickly. But, I’ve grown up around them all my life, so I understand a bit of the culture and a good part of the lifestyle. It's the medical aspect that worries me.

I’m perfectly fine with the needs of the Navy at this point in my life, as I’m not in a relationship or commitment, nor am I looking for anything serious, much less a family. I understand that the Navy thoroughly owns my butt for those 3 years. I’m alright with serving first, then being a doctor second for those years. I’m ok with being deployed every. Single. Time. But, I don’t want to make a 15+ year career out of this (unless I get FTOS at a great residency), which is why I didn’t join USUHS.

My options in M4 (assuming I take the HPSP):

I plan on doing a GMO/FS (dunno when it became OMO) tour as early as possible. I was reading this post yesterday (Which Branch now that the Navy is doing away with intern GMO's?) and @pawprint made it clear that “Flight school was made for people in their mid-20s.” I fit squarely into that category. I would prefer NOT to do an FS/OMO/UMO tour after residency. For that reason, FAP or joining the Navy post-residency won’t work. I worry that the chances I get deployed are too high especially with multiple GMO billets being unfilled.

Now, if I did get straight through training, I would probably assume it’s an act of God and I’ll try to avoid GMO/FS training at that point. But, as it stands, the chances of me either getting NADDS or straight thru Navy FTIS training are quite slim as I have no prior service, and the specialties I’m interested are all represented in the military match (for one-year TYs). I also don’t know how some of these residency utilization tours look like.

My worries (Main Question):

My worry about HPSP is not being sent to faraway lands or dealing with crappy superiors (as long as I can somehow get a nice letter from a superior officer).

I guess my real worry is a question my recruiter (part of the Nurse Corp, so a little unfamiliar with the JSGMESB) couldn’t answer. I'll be blunt: what is my strategy to either match civilian or FTOS after a GMO/FS tour (assuming I don’t get straight through training)? I get it, asking this question is a bit unfitting, but I have good reasons for avoiding an FTIS residency, and as stated above, I don't want to make my HPSP payback turn into a full-blown Navy career. UNLESS, that is, I get FTOS in a great residency of my first-choice specialty.

I found these two helpful threads:

Civilian residency after GMO advice

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

Let me know if there are any other resources to find.

What I understand about the implications of taking the HPSP:

Here’s my thinking (please correct me if I’m wrong):

There would be two pathways I could pursue after the 3 yr HPSP payback (as a FS) - Apply for civilian residency or use the military service to get FTOS. My thought about FTIS residency is that “If it’s not straight through, I don’t want it.” Because, after my HPSP commitment is finished, both FTIS and FTOS incur the same payback time (except for intern year if I must repeat). And as we all know, inservice GME training has been nothing but downhill for the last 3 decades. So, FTOS > FTIS.

My desired specialties would be Ortho, ENT, Gen Surg, and IM. They are in no specific order, and I don’t know which one I would pick. I probably lean Ortho or ENT just cuz dey cool. I would also consider FM or EM depending on how I like it during rotations. These are all available in the Navy.

But this much I do know – I don’t have one iota of interest in Rads, Anesthesiology, Derm, Psych, or Optho. I've shadowed enough docs, talked to enough on them during first-year and second-year practice rotations to know this for sure. I also know I don’t have as competitive an application to go into Plastics or Neurosurg, so there’s that. So, basically Ortho, ENT, Gen Surg or IM.

More Questions:

For those that did serve as military docs – based on what I’ve provided, is pursuing the HPSP marginally a viable path? I don’t have a full idea of the sh*tshow I’m signing up for, but civilian medicine really doesn’t offer the experiences I want at my age.

Secondly, how do residency utilization tours look like (assuming I either get straight-thru training or stay in the Navy post-GMO)? Will I be deployed? Does that depend if I had done a deployment/tour in the past (as a GMO/FS/UMO)? My recruiter can’t answer that for me.

Third, where are Navy FS billets usually stationed at? The reason I’m not considering the Air Force (although I have the grades and stats for it) is because I’m worried about being stationed in the bum-f*ck middle of Alaska (even though it’s beautiful). I found this thread but not much else: GMO positions - how to know what locations are available?

Fourth, how are the civilian matching opportunities post-GMO? What about regular civilian vs FTOS? Any other advice for FTOS? Matching into a desirable residency at a great program seems worth it to me. Would FTOS be viable with specialties like IM, Gen Surg, Ortho, and/or ENT? I even think the Navy has two FTOS gen surg spots at Temple and Penn State (I would owe 5 years after that, though). My grades are good enough for IM and Gen Surg, borderline for Ortho or ENT.

I appreciate any advice, even from those that think I’m stupid for considering the HPSP. Maybe knock some sense into me. Depending on everyone's answers, I might end up having more questions than answers. But ngl, planes and aircraft carriers are cool.

 

[pgg]

It's reasonable to do Navy HPSP with the intent of serving a 3-year GMO tour and getting out. Many many people have done so.

I (and I think a majority of others on this forum) feel that all pre-residency GMO tours are inherently not a great thing, because I think incompletely trained physicians shouldn't be practicing independently. I personally did such a GMO tour and it worked out fine.

You should know that there's no guarantee that you'd get to do a FS tour as a GMO. Odds are quite high it would work out, assuming you're physically qualified, but those positions must be applied for through the GME selection board. It is possible that you'd end up being a non-flight GMO somewhere.

Also be aware that not all FS tours are jets and carriers. There are rotary wing flight surgeons, cargo plane flight surgeons. The Marines need flight surgeons too - maybe with them you'll never see a ship. Maybe that's a pro or con for you. There are plenty of less glamorous gray-aircraft billets out there. I'm not familiar with the selection process for who gets jets and who gets C130s and who gets CH53s, but I suspect quite a few people want jets and there is probably a layer of competition to get though, once you've been selected for FS, before you get to jets.

what is my strategy to either match civilian or FTOS after a GMO/FS tour

Same as it'd be without GMO time: be a strong applicant (grades, board scores, references, interviews).

how are the civilian matching opportunities post-GMO?

Post GMO tour, no real handicap for applying via the civilian match for a civilian residency. It's conceivable that the intern year the Navy matched you to will not suffice as the prelim year for a surgical sub residency, and that you could end up being an intern again. But generally, military service is viewed reasonably favorably by civilian residency programs.

Funded outservice residencies are uncommon. I would not do HPSP expecting that door to be open for you. It probably won't be.

Deferred (unfunded) civilian residencies are more common but absolutely not guaranteed though. I would not do HPSP expecting that door to be open for you. It might be.

It's important to understand that while the civilian match is designed to favor the applicant, the military match is always going to to put the military's needs over the applicant's. What that means, is that you may well be a stellar applicant for a competitive specialty, and have great odds at matching to a great civilian residency program - but if you have a service obligation you FIRST have to apply to the GME selection board and rank a civilian deferral. The military may well decide it doesn't need N people in that specialty and say no.

You can apply to the military match (GME selection board) during your final GMO year, when you will have no service obligation the following year, and choose to accept or decline what that match offers you. (Those results are released in December.) The military match is not binding in the way the civilian match is - you can always say no, and get out (if your obligation is up) or be a GMO another year (if you still have an obligation).

 

[Konigstiger]

what is my strategy to either match civilian or FTOS after a GMO/FS tour (assuming I don’t get straight through training)?

Same as your strategy would normally be, though your GMO tour will likely make you more attractive to civilian residencies. You'll probably have to repeat intern year regardless, which is going to suck.

My desired specialties would be Ortho, ENT, Gen Surg, and IM. They are in no specific order, and I don’t know which one I would pick. I probably lean Ortho or ENT just cuz dey cool. I would also consider FM or EM depending on how I like it during rotations. These are all available in the Navy.

But this much I do know – I don’t have one iota of interest in Rads, Anesthesiology, Derm, Psych, or Optho. I've shadowed enough docs, talked to enough on them during first-year and second-year practice rotations to know this for sure. I also know I don’t have as competitive an application to go into Plastics or Neurosurg, so there’s that. So, basically Ortho, ENT, Gen Surg or IM.

That's quite a wide variety, but at least for IM, you could probably fairly easily get a straight-through spot.

Third, where are Navy FS billets usually stationed at? The reason I’m not considering the Air Force (although I have the grades and stats for it) is because I’m worried about being stationed in the bum-f*ck middle of Alaska (even though it’s beautiful). I found this thread but not much else: GMO positions - how to know what locations are available?

Oh, that's my thread lol. There is no definite way to know without talking to a detailer, and even then, the detailer doesn't truly know because people in those billets can choose to extend or can leave early for whatever reason. This is doubly so for flight surgery because you don't get your billet list until the end of flight school.

But yes, you are correct in your assumption that the billet locations are definitely better than those in the Air Force. That's also one of the reasons why I chose the Navy over the other services.

Fourth, how are the civilian matching opportunities post-GMO? What about regular civilian vs FTOS? Any other advice for FTOS? Matching into a desirable residency at a great program seems worth it to me. Would FTOS be viable with specialties like IM, Gen Surg, Ortho, and/or ENT? I even think the Navy has two FTOS gen surg spots at Temple and Penn State (I would owe 5 years after that, though). My grades are good enough for IM and Gen Surg, borderline for Ortho or ENT.

I feel like IM at least won't allow you to FTOS at all because the Navy itself has spots that go unfilled. It's possible in the others, but it's going to be harder than FTIS.

Doing HPSP with the desire to match FTOS is a very bad idea. But, if you truly are okay with being made to do a GMO tour and just finish out your service obligation that way and then just completely leave the military, then that's a different story.

 

[PugetPounder]

First off, thank you for your detailed response. I took the time to read your response, and I do have a few thoughts and questions.

It's reasonable to do Navy HPSP with the intent of serving a 3-year GMO tour and getting out. Many many people have done so.

That's my primary goal, yes.

I (and I think a majority of others on this forum) feel that all pre-residency GMO tours are inherently not a great thing, because I think incompletely trained physicians shouldn't be practicing independently. I personally did such a GMO tour and it worked out fine.

Yeah, I agree with that. I used to think before med school that an intern year would be enough to treat a “healthy” group of pilots. I now know…it won’t. I’m going to have to learn a lot and really go through the ringer to be an effective FS/GMO.

You should know that there's no guarantee that you'd get to do a FS tour as a GMO. Odds are quite high it would work out, assuming you're physically qualified, but those positions must be applied for through the GME selection board. It is possible that you'd end up being a non-flight GMO somewhere.

Yeah, I mean, needs of the Navy. I’m still ok with non-flight GMO if I get something cool to do. Tbh, I’ll do everything - I'll even do UMO. Heck, if I end up a boomer UMO, deployments are essentially part time from what I hear. I think that chance is low, though, given that most FS billets don’t fill. Then again, needs of the Navy.

Also be aware that not all FS tours are jets and carriers. There are rotary wing flight surgeons, cargo plane flight surgeons. The Marines need flight surgeons too - maybe with them you'll never see a ship. Maybe that's a pro or con for you. There are plenty of less glamorous gray-aircraft billets out there.

Preferably, I would like to deploy onto a FS Shipboard billet for my first deployment. Or something considered a hardship tour, so that I can request easier assignments closer to the time that I start applying for residencies. I would also definitely be happy to volunteer on hospital ships.

Correct me if I’m wrong, but aren’t OMO/GMO billets split into 3 broad categories – Marines, Shipboard, and Seabee? Furthermore, aren’t FS billets split by region? I feel like I’m forgetting something. I really don’t have a regional preference (for Shipboard), although Pacific Northwest would be nice since I’m familiar with it.

If I somehow stayed stateside, that would be good as I would have access to the internet and be able to pursue (clinical) research, attend conferences, and pursue a second professional degree. But I'm not sure how likely you think that may be.

In reality, all I need is access to the internet to hopefully pursue an health-care related masters degree, to keep in contact with physicians and program directors in my intended specialties, and roll out a few pubs.

I'm not familiar with the selection process for who gets jets and who gets C130s and who gets CH53s, but I suspect quite a few people want jets and there is probably a layer of competition to get though, once you've been selected for FS, before you get to jets.

That’s true, lol. If I like jets, everyone likes jets.

Do you know what factors go into FS billet assignments? How much does prior service come into play? I’m willing to take a hardship or non-jet billet for my first and even second deployment as long as I get my preferred billet on third deployment.

I’m assuming that I probably should vie for an FS Shipboard billet for jets in a less desirable location, say Diego Garcia. IDK about the stats on that, though. It’s all speculation.

Same as it'd be without GMO time: be a strong applicant (grades, board scores, references, interviews).

I guess I should clarify what I meant. Obviously, good grades, high board scores, etc. are important. But I was really getting at what should I be doing while I am a flight surgeon to improve my resume and chances of matching post-GMO?

How do I go about pursuing research? I know the Navy has research stations in Dayton (for FS) and New London (for UMO). Do GMOs get any opportunity to use these facilities for data collection and (hopefully) publications?

I personally would like to pursue an MPH (online/distance), even though that’s not going to massively improve my residency app. I’m also pretty sure most schools do have a research requirement, especially the ivies.

What advice is there to get good references from my commanding/senior officers? AKA, how do I perform my job well enough (and kiss up effectively enough) to get them to put pen to paper? How do I stay off their bad side?

How do I stay in contact with physicians in my desired specialty? Can I get the Navy to deploy me stateside (assuming I've already done two hardship tours prior) during my last year so I can keep in close contact with conferences and shadow (though limited) physicians?

Post GMO tour, no real handicap for applying via the civilian match for a civilian residency. It's conceivable that the intern year the Navy matched you to will not suffice as the prelim year for a surgical sub residency, and that you could end up being an intern again. But generally, military service is viewed reasonably favorably by civilian residency programs.

That’s good to hear. I don’t have a problem repeating intern year (at least rn).

The thing is, I’ve just heard some people basically saying that PGY-2 positions (which are much less in number and notoriously harder to compete for) are pretty much the only options as a GMO, since you can apply for those positions in advance.

I was reading this post: Civilian residency after GMO advice | Student Doctor Network

It’s really helpful, and the poster’s advice is to apply for advanced PGY-2 programs. Let me know if you would like to add anything to it.

I should also state for the record that at best, I would be an average to slightly under average candidate for competitive specialties (like Ortho or ENT). My grades are fine, and obviously I’ll have to wait for STEP1 and STEP2 results. My research is average. It’s my extracurricular involvement (leadership etc.) that is pretty much absent. I’m trying to fix that, but it may be a bit too late to do in 1.5 years (especially with rotations).

That’s why I want to make the most out of GMO (or FS) time.

Funded outservice residencies are uncommon. I would not do HPSP expecting that door to be open for you. It probably won't be.

Yeah, I'm tracking with you there, too. In fact, according to the last BUMED note they’re all in the low single-digits for most specialties. 2 for GS, 2 for Ortho, and 1 for ENT last time I checked. But FTOS would be the only thing really keeping me in after a GMO tour.

Like I said above, if a program that is adding future ADSO isn't FTOS (or FTIS in my first-choice), I don't want it. I don’t know why the Navy wouldn’t expand FTOS programs if they’re so lackadaisical about improving Inservice GME. They could get an extra year of ADSO. Then again, what makes sense with O-6 nurses?

Deferred (unfunded) civilian residencies are more common but absolutely not guaranteed though. I would not do HPSP expecting that door to be open for you. It might be.

Yup, like I said in my first post, “…the chances of me either getting NADDS or straight thru Navy FTIS training are quite slim as I have no prior service, and the specialties I’m interested are all represented in the military match (for one-year TYs).”

I’m not counting on getting NADDS or FTOS as an M4 or intern. In fact, I don’t really want it. I just want to GMO (as early as possible) and get out. As mentioned above, FTOS post-GMO would be the only way to really keep me in. That is, or possibly matching Ortho or ENT thru FTIS (although not really preferred and not likely).

It's important to understand that while the civilian match is designed to favor the applicant, the military match is always going to to put the military's needs over the applicant's. What that means, is that you may well be a stellar applicant for a competitive specialty, and have great odds at matching to a great civilian residency program - but if you have a service obligation you FIRST have to apply to the GME selection board and rank a civilian deferral. The military may well decide it doesn't need N people in that specialty and say no.

I agree, from what I've seen, military always comes first. I don’t think that the career progression of physicians is much of a concern for the Navy. The promotion structure itself seems to incentivize MDs and DOs to GMO and out. Nurses and PAs might find better results.

You can apply to the military match (GME selection board) during your final GMO year, when you will have no service obligation the following year, and choose to accept or decline what that match offers you. (Those results are released in December.) The military match is not binding in the way the civilian match is - you can always say no, and get out (if your obligation is up) or be a GMO another year (if you still have an obligation).

Yeah, one of the things that is appealing about the GMO and out is that the military GME assignment isn’t binding like it is in M4 year.

Another worry I have about GMO and out is matching FTIS in my first-choice specialty (like Ortho or ENT) and then having to make the decision whether to decline it in favor of waiting for the results of ERAS. But, I must apply FTIS just to make sure I don’t go unmatched. It’s a big risk and gamble overall.

Like I mentioned in my OP, I want to avoid FTIS because I’ve heard bad things about both caseloads and the variety of cases. I’ve heard resident surgeons (and some non-proceduralists) have caseloads notably lower than comparable civilian residencies. That’s not great for procedural medicine (which you can tell is my main goal)

 

[PugetPounder]

Thanks for taking the time to read my post. I'll respond with some questions and thoughts I have.

Same as your strategy would normally be, though your GMO tour will likely make you more attractive to civilian residencies. You'll probably have to repeat intern year regardless, which is going to suck.

I guess I should clarify what I meant. Obviously, good grades, high board scores, etc. are important. But I was really getting at what should I be doing while I am a flight surgeon to improve my resume and chances of matching post-GMO? I think you’ll get a better picture of my neuroticism while reading the rest of this response.

And yeah, repeating intern year won’t be the best, but I’m ok with it if it’s a competitive specialty or program. But no way I’m repeating intern year for IM.

I’m going to put Ortho and ENT on my sheet for the military match in M4. If they give me straight through training, it’s an Act of God. If they give me a TY or surgery intern year, so be it, I'm happy to GMO/FS, and even UMO (even though that's not likely nor do I prefer it for now). Should I just make my intentions to the JSGMESB clear when I apply, or will they just not care?

That's quite a wide variety, but at least for IM, you could probably fairly easily get a straight-through spot.

Hard to believe, but at one point, pediatric neurosurgery was on there. That fantasy ended by November of M1.

And lol, my least wanted but desired specialty is the only one perennially available for straight through. Go figure. At that point, I’ll just leverage GMO/FS to improve my app for upper-tier IM civ programs. Hopefully they don't make me repeat intern year.

Oh, that's my thread lol. There is no definite way to know without talking to a detailer, and even then, the detailer doesn't truly know because people in those billets can choose to extend or can leave early for whatever reason. This is doubly so for flight surgery because you don't get your billet list until the end of flight school.
But yes, you are correct in your assumption that the billet locations are definitely better than those in the Air Force. That's also one of the reasons why I chose the Navy over the other services.

Yessir.

Yeah, one of the reasons I would like to choose the Navy is to stay close to hospitals and keep in contact with residency and program directors and physicians. I would also like the opportunity to attend conferences stateside when I’m back.

One of the reasons I prefer the aircraft carrier is because communication is simply better on it. I’ve learned over the last year that networking is just as crucial in medicine as it is outside of it. I also hope it'll give me access to research opportunities and let me (hopefully) pursue another degree (those distance MPHs are looking mighty fine rn).

My thought is, if the Navy is going to meet its needs through me (which I’m more than obliged to honor), I need some of my needs met by the Navy, too. I would definitely try to utilize the research facilities (how do I do that lol) and I'm willing to use the TA/top off to pay for an obnoxiously expensive ivy league distance learning "healthcare associated" masters.

Of course, I don’t expect anyone to hold my hand through the process, but it would be helpful as hell to be prepared.

I feel like IM at least won't allow you to FTOS at all because the Navy itself has spots that go unfilled. It's possible in the others, but it's going to be harder than FTIS.

Yeah, I should have made myself clear – I’m NOT looking for FTOS. I’m just saying that I would be willing to leverage it to get a head up on the competition for a really desirable residency, that I would otherwise have had no chance of getting into, especially as a civilian.

If I matched Ortho or ENT at MGH-Harvard because of FTOS (there’s no other way I get it), paying back the military 5-6 years is no problemo for me. I mean, I would feel as if I OWED the Navy at that point. But the chance of that happening is in the low single digits, obviously.

But that’s why I wonder why the Navy doesn’t utilize the FTOS that much. They would get high-quality civilian-trained docs at a minimum of 3 years without spending anything extra (salary is determined by rank). Then again, what makes sense in such a broken system?

Doing HPSP with the desire to match FTOS is a very bad idea. But, if you truly are okay with being made to do a GMO tour and just finish out your service obligation that way and then just completely leave the military, then that's a different story.

I really apologize for not making it clearer; @pgg also thought I wanted FTOS as first priority. I’ll make it clear for the record that I’m NOT counting on getting FTOS. I just want to make the most of intern year, and GMO and out into a high-quality civilian residency of my first (or second) choice. If I got FTOS at a great place and specialty, well, I'll happily sing Needs of the Navy to my grave. But the chance of it happening are very, very low.

That’s why I’m being a bit neurotic about performing my best as a GMO/FS (even UMO if that’s what I’m assigned to) and making the most of my time. I don't want to waste my time in a 40-60hr week desk job and then play video games and goon for the remaining 60-80 non-sleeping hours. Cuz, that's pretty common in the military from what I know.

 

[pawprint]

I did intern year -> FS training year -> 5 years as a flight surgeon (1 two year billet and 1 two and a half year billet) -> civilian residency.

Honestly I loved my path. Got some really great stories and life experience. I extended my time as a flight surgeon because I got selected for a really cool billet. I’m in no debt. My civilian residency counterparts are trying to figure out their half a million dollar debt situations while living off of pennies…don’t know how they do it. Meanwhile, I’m over here getting my civilian residency pay, GI bill monthly pay (you can use your GI bill to get a monthly stipend), and I rated VA disability upon discharge so I get a crap ton of money for that. I make more in VA payments monthly than I do my actual salary.

I decided to repeat intern year for my specialty, which in some way sucks because nobody really knows my story. But as long as you know how to “play the game” of residency by taking feedback well (regardless of your thoughts on it) and moving on to the next thing, it’s cake.

I remember my first day in my continuity clinic they only had me see 1 healthy patient so I could learn how to do a patient encounter on my own. Little do they know I’ve managed hundreds of marines on my own on deployment for 7 months. Or managed my own clinic panels seeing up to 20 patients a day regularly. My program director knows my story but most attendings I work with don’t.

Overall I came out ahead financially, have low stress during residency the second time around, and I got to pick my program. I applied for 20 programs in my specialty, got 20 interviews, and got my top choice. And I got emails from my top 7 or 8 basically telling me they had ranked me first. And then got follow up emails after the match asking why I didn’t pick them.

Totally worth it.

 

[militaryPHYS]

I see an internal medicine future in you based on how much you like to write.

I wasn’t thinking about 95% of what you’re talking about when I signed up. Most satisfied military physicians are not. They just want to serve and want to be a doctor. The rest plays out the way it’s meant to be. During medical school most of what you planned will change of your own choice or because the military says so. Best to accept that now and be confident with whichever direction you take.

 

[PugetPounder]

I did intern year -> FS training year -> 5 years as a flight surgeon (1 two year billet and 1 two and a half year billet) -> civilian residency.
Honestly I loved my path. Got some really great stories and life experience. I extended my time as a flight surgeon because I got selected for a really cool billet.

What FS billet did you get? Was it jets lol?

I’m in no debt. My civilian residency counterparts are trying to figure out their half a million dollar debt situations while living off of pennies…don’t know how they do it. Meanwhile, I’m over here getting my civilian residency pay, GI bill monthly pay (you can use your GI bill to get a monthly stipend), and I rated VA disability upon discharge so I get a crap ton of money for that. I make more in VA payments monthly than I do my actual salary.

Drawing an O-3 paycheck during those 4 years (intern + 3 HPSP payback/GMO) would be great. I could save a hefty sum before heading back into residency.

And dang, now I’m curious what counts as VA disability. And how much does the GI bill provide as a monthly stipend for training?

I decided to repeat intern year for my specialty, which in some way sucks because nobody really knows my story. But as long as you know how to “play the game” of residency by taking feedback well (regardless of your thoughts on it) and moving on to the next thing, it’s cake. I remember my first day in my continuity clinic they only had me see 1 healthy patient so I could learn how to do a patient encounter on my own. Little do they know I’ve managed hundreds of marines on my own on deployment for 7 months. Or managed my own clinic panels seeing up to 20 patients a day regularly. My program director knows my story but most attendings I work with don’t.

Yeah, I’m ok with repeating a year if it’s a longer residency. You did Peds, right? I do expect that my clinical skills will be much stronger and more refined compared to my peers after a 3-year GMO tour.

Overall I came out ahead financially, have low stress during residency the second time around, and I got to pick my program. I applied for 20 programs in my specialty, got 20 interviews, and got my top choice. And I got emails from my top 7 or 8 basically telling me they had ranked me first. And then got follow up emails after the match asking why I didn’t pick them.

From your anecdotal experience, did other GMO folks applying to other specialties have similar results? Or did it really depend on what they did during their time in?

Totally worth it.

Nice. From what I hear, they people dissatisfied with the HPSP somewhat liked the experience itself – they just didn’t like how it affected their life. I would like to hear your thoughts on that.

And thanks for sharing; it's pretty nice to see someone who did this pathway and had a better career for it.

 

[PugetPounder]

I see an internal medicine future in you based on how much you like to write.

Haha, I’ve already crossed out neuro or plastics. Give it another year and Ortho and ENT are probably out of the playing, too – and before surgery clerkship! So true, lol

I wasn’t thinking about 95% of what you’re talking about when I signed up. Most satisfied military physicians are not. They just want to serve and want to be a doctor.

I guess I’m just being neurotic because I read the sentiment (both on SDN and elsewhere) as being that any medical student worth their salt should avoid HPSP or military medicine, even if they are drawn to this aspect of medicine.

But, even without the scholarship, I still would consider a GMO tour/HPSP. The money serves to make that decision easier for me.

The rest plays out the way it’s meant to be. During medical school most of what you planned will change of your own choice or because the military says so. Best to accept that now and be confident with whichever direction you take.

You’re right, most of what I planned in the past has changed. And I’m willing to go with the flow of military medicine. In fact, I’m ok with being an officer first and a doctor second. It’s just that I want to make the most of my GMO time, you know?

I do know that I most likely won’t regret my service. Those are the kind of experiences that I’ll look back on when I’m older and be grateful that I took the plunge. I want to explore the world first, tbh. Haven’t had that chance yet. Getting big FOMO.

Thanks for your words of wisdom. Best not to overthink this.

 

[Helpful Troll]

... Drawing an O-3 paycheck during those 4 years (intern + 3 HPSP payback/GMO) would be great. I could save a hefty sum before heading back into residency.

And dang, now I’m curious what counts as VA disability. And how much does the GI bill provide as a monthly stipend for training? ...

Research the GI Bill eligibility thoroughly. Most don't qualify for full GI Bill unless they serve 36 months beyond their ADSO (Active Duty Service Obligation). The VA disability does change eligibilty.

 

[Helpful Troll]

@PugetPounder Go read the recent post by @j4pac It's regarding the transition from GMO to PM&R but it's still relevant to your questions about the transition from GMO to most civilian residencies.

 

[j4pac]

Only because the post is now ancient and it's really hard to find: Civilian residency after GMO advice

I believe that the majority remains true. You just have to be careful about the specialty that you plan to apply. There are certain residencies that require you to repeat your PGY-1 year (including EM to my knowledge). The timeline gets shifted significantly if that's the case. My timetable works better when you have the ability to enter an advanced program after GMO tour.

 

[PugetPounder]

Only because the post is now ancient and it's really hard to find: Civilian residency after GMO advice

I took a read. Really helpful. I was not aware of the timeline until now.

It looks like none of my interested specialties (ortho, ENT, GS, or IM) have any advanced (or reserved) spots. That’s rough.

At this point, I’m just willing to apply Ortho and ENT in the military. I know I’ll have good board scores. How is the quality of the Navy’s Ortho or ENT GME programs?

GMO to Emergency Medicine: Anecdotal Advice for Getting Out of the Military. | Student Doctor Network

Are there any things that you would like to add to this post?

I believe that the majority remains true. You just have to be careful about the specialty that you plan to apply. There are certain residencies that require you to repeat your PGY-1 year (including EM to my knowledge). The timeline gets shifted significantly if that's the case. My timetable works better when you have the ability to enter an advanced program after GMO tour.

So yeah, I’ll be applying to a civilian residency that requires me to repeat my PGY-1 year. In that case, your timeline doesn’t totally apply, but it’s still helpful to see that outline.

How would your timeline change if someone was applying for a PGY-1 year, e.g. IM or GS?

Lastly, is there a “backtrack” for resignation orders? Let me explain if I’m not using the correct lingo:
Say I match in early March – assuming that I fill out the basic paperwork ahead of time, can I separate by Mid-May? And say I don’t match (early March) – can I extend my time for another year? My nightmare is getting ready to separate by mid-May, and finding out that I didn’t match – I would essentially be out of a job by then. Is that how it works?

 

[PugetPounder]

Research the GI Bill eligibility thoroughly. Most don't qualify for full GI Bill unless they serve 36 months beyond their ADSO (Active Duty Service Obligation). The VA disability does change eligibilty.

So let me get this straight. On top of serving/AD for 4 years (1 intern + 3 GMO payback), I have to be in the military for another 3 years for the GI Bill?? In that case how easy is it to get VA disability lmaooo?

This is straight incentivizing me for FTIS residency for ENT, IM or EM, damn. Never thought I would say that.

Are there any posts about this topic specifically? I was under the impression that 3 years of service would be enough to get most GI benefits, especially for post-service civ residency training.

 

[pawprint]

Not sure what that above poster is talking about. You get full GI bill benefits from your ADSO. How do I know this? It’s because I’m using them right now.

You cannot transfer your GI bill to your dependents unless you commit to serving extra time. But you can use it for yourself anytime.

VA disability is hit or miss. I wouldn’t bank on it but it is a nice thing to get if you develop some medical issues while serving and the VA decides to compensate you for them monthly for the rest of your life.

 

[pawprint]

Research the GI Bill eligibility thoroughly. Most don't qualify for full GI Bill unless they serve 36 months beyond their ADSO (Active Duty Service Obligation). The VA disability does change eligibilty.

This is false information. You absolutely get access to your GI bill from your time serving your ADSO. VA disability does not change eligibility. I am receiving both at the same time, which is legal as they are 2 separate benefits. Please research what you are saying before posting.

 

[PugetPounder]

This is false information. You absolutely get access to your GI bill from your time serving your ADSO. VA disability does not change eligibility. I am receiving both at the same time, which is legal as they are 2 separate benefits. Please research what you are saying before posting.

I think maybe @Helpful Troll was trying to say that while I could use the GI Bill on myself, I couldn’t transfer it to my (future) kids without serving 36 months/3 years after initial ADSO.

The VA thing I can't speak for. I personally couldn't care less (I'll probably care later). I guess I'm more concerned with the how of being a Navy Medical Officer and my future career rather than the financial implications of it.

Here's what I'm thinking:
1. I get to serve and do really cool jobs and have great experiences that frankly almost none of my civilian colleagues can beat.
2. I'm getting medical school paid for and a pretty nice salary as an officer.
3. I also want to make sure that this choice that I’m making won’t impact my career (aka residency opportunities) in the future.

That's about how far I'm thinking financially at the moment.

 

[SirGecko]

I think maybe @Helpful Troll was trying to say that while I could use the GI Bill on myself, I couldn’t transfer it to my (future) kids without serving 36 months/3 years after initial ADSO.

Transferring the post 911 GI bill is also not tied to your initial ADSO. You can initiate the transfer after you have been active duty for 6 years and you have to serve an additional 4 years after initiating the transfer. Its a good benefit but important that you initiate the transfer at your first opportunity and need to serve at a minimum 10 years to actually use it that way.

 

[militaryPHYS]

I guess I’m just being neurotic because I read the sentiment (both on SDN and elsewhere) as being that any medical student worth their salt should avoid HPSP or military medicine, even if they are drawn to this aspect of medicine.

This is selection bias. Are there sacrifices and negative aspects to MilMed? Sure. There are also many positives that a large portion of those who serve prioritize and appreciate…most just don’t choose to go online to talk about.

Continue to investigate and decide for yourself.

I am not trying to convince you to join by any means. I do not recruit because this life is not for everyone. I can say that from my own perspective MilMed is currently at the bottom of a slow decline since ~2017 which is when DHA took over and the DoD services stopped funding defense health to adequate levels to maintain the previous healthcare system we knew. We will see targeted growth at specific MTFs that also align well with the GME programs. We will start to see that as early as this year. So we have learned a lot, restructured and have a clearer vision on where post-contracture growth will occur. This will take time and how the timeline effects current premeds is unknown…

GI bill not tied to service obligation. If you serve less than 36 months you get a tiered percentage of max benefit. Anyone who serves 36 months or more (almost all initial standard service obligations are more than this) you get full benefit. Can’t pass to kids unless you serve 10 years (so long as you opt in to the transfer at the right time).

 

[Helpful Troll]

This is false information. You absolutely get access to your GI bill from your time serving your ADSO. VA disability does not change eligibility. I am receiving both at the same time, which is legal as they are 2 separate benefits. Please research what you are saying before posting.

Pawprint - thanks for the clarification. You are correct regarding HPSP ADSO. My intent was to have the OP research the eligibility as occurred here to some degree... we don't always understand from OP all the relevant facts and scenarios. ROTC and SA Grads do not qualify fully until 36 months after their ADSC/ADSO for those undergraduate scholarships.

My comment regarding disability is that service members released from active duty due to a service connected disability after 30 days or more of continuous service are also eligible for GI Bill benefits. I wasn't implying they weren't eligible.

 

[PugetPounder]

Transferring the post 911 GI bill is also not tied to your initial ADSO. You can initiate the transfer after you have been active duty for 6 years and you have to serve an additional 4 years after initiating the transfer. Its a good benefit but important that you initiate the transfer at your first opportunity and need to serve at a minimum 10 years to actually use it that way.

Yeah, I was just looking online for that. Hmm. I'll reevaluate staying in during my GMO time. Good stuff to know.

 

[PugetPounder]

I am not trying to convince you to join by any means. I do not recruit because this life is not for everyone. I can say that from my own perspective MilMed is currently at the bottom of a slow decline since ~2017 which is when DHA took over and the DoD services stopped funding defense health to adequate levels to maintain the previous healthcare system we knew. We will see targeted growth at specific MTFs that also align well with the GME programs. We will start to see that as early as this year. So we have learned a lot, restructured and have a clearer vision on where post-contracture growth will occur. This will take time and how the timeline effects current premeds is unknown…

Do you think that the Navy is well-positioned to receive/benefit from this targeted growth? I would assume that Walter Reed, NMCSD, NMCP, being some of the larger MTFs, will probably benefit from that.

And yes, if I had not grown up around AD Navy folk I would have not even wanted to be a GMO/FS. That experience is something I want for myself, and I'm ok with the lifestyle for a few years.

 

[militaryPHYS]

Do you think that the Navy is well-positioned to receive/benefit from this targeted growth? I would assume that Walter Reed, NMCSD, NMCP, being some of the larger MTFs, will probably benefit from that.

And yes, if I had not grown up around AD Navy folk I would have not even wanted to be a GMO/FS. That experience is something I want for myself, and I'm ok with the lifestyle for a few years.

Not worth speculating on specifics at this point