HPSP and Surg

[cavaor]

Quick question...
I was told that a 2yr HPSP student is less likely to get a surgical residency spot due to the minimum committment that they owe. Is this true? How difficult is it to get a civilian deferrment for surgery? Whats the process? I understand that one must apply to at least the 5 army surgery residency programs....but then what else must be done?

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[NavyFP]

Quick question...
I was told that a 2yr HPSP student is less likely to get a surgical residency spot due to the minimum committment that they owe. Is this true? How difficult is it to get a civilian deferrment for surgery? Whats the process? I understand that one must apply to at least the 5 army surgery residency programs....but then what else must be done?

In the Navy, a 2 yr HPSP is no more or less likely to get a residency than other applicants. Civilian or otherwise. And if you think about it, it makes sense. Even if you go straight through, you are going to owe a 4 for the standard Gen Surg residency. You would pay that back concurrently with the HPSP obligation, so the payback is still 4 years even with a 4 yr HPSP.

One additional note. There is a minimum active duty obligation of 3 years. If you do an internship in the military that year counts towards the minimum obligation, but if you do a civilian internship/residency you still owe a total of 3 years active time even though you only owe 2 years as payback for HPSP.

 

[mitchconnie]

Unfortunately, you are in a bad situation with a 2-year HPSP commitment if you want to do general surgery. The Army has defferred only a couple people a year the last few years for general surgery (by which I mean straight-through general surgery residency--not single-year internship). There is also likely to be a new surgical training program opening up at Ft. Bragg soon. If you want to go straight into a five-year deferred civilian program, it is very unlikely.

When you do a five-year Army general surgery program, this will add two years to your committment and you will end up owing four years total on active duty (internship doesn't add or pay off any time). 2 and 3-year HPSP people really get screwed this way. Not only do you have loans to pay off from 2 years of med school, but you STILL owe a full four years to the army.

My suggestion would be to do surgical intership, pay back your two-year obligation as a GMO and then get out of the Army and do civilian surgical residency. If you are a strong candidate from an MD school, I would HIGHLY recommend this route. There are a variety of reasons why I feel military surgical training programs may not be viable in the future, and I can share these with you if you wish. I've taught residents at several military surgery programs and know the issues first-hand.

I had a three-year HPSP, then got extended to 6 years total payback when I got picked up for general surgery residency and then fellowship with the military instead of the deferment I wanted.

But to answer your original question--No, you are not at a disadvantage. The Army would actually get more commitment out of you if you did their training program.

 

[Galo]

Unfortunately, you are in a bad situation with a 2-year HPSP commitment if you want to do general surgery. The Army has defferred only a couple people a year the last few years for general surgery (by which I mean straight-through general surgery residency--not single-year internship). There is also likely to be a new surgical training program opening up at Ft. Bragg soon. If you want to go straight into a five-year deferred civilian program, it is very unlikely.

When you do a five-year Army general surgery program, this will add two years to your committment and you will end up owing four years total on active duty (internship doesn't add or pay off any time). 2 and 3-year HPSP people really get screwed this way. Not only do you have loans to pay off from 2 years of med school, but you STILL owe a full four years to the army.

My suggestion would be to do surgical intership, pay back your two-year obligation as a GMO and then get out of the Army and do civilian surgical residency. If you are a strong candidate from an MD school, I would HIGHLY recommend this route. There are a variety of reasons why I feel military surgical training programs may not be viable in the future, and I can share these with you if you wish. I've taught residents at several military surgery programs and know the issues first-hand.

I had a three-year HPSP, then got extended to 6 years total payback when I got picked up for general surgery residency and then fellowship with the military instead of the deferment I wanted.

But to answer your original question--No, you are not at a disadvantage. The Army would actually get more commitment out of you if you did their training program.

I agree with this wholeheartedly. I also taught military residents, and I and them were in the unique situation that this specific residency program was primarily civilian, with only a few a few months of their actual training in the military. If it was all military, no way in hell they would graduate.

I agree you should take the hit, and go GMO or anything else that will let you get out ASAP, and then start your career right with civilian training.

 

[Galo]

Unfortunately, you are in a bad situation with a 2-year HPSP commitment if you want to do general surgery. The Army has defferred only a couple people a year the last few years for general surgery (by which I mean straight-through general surgery residency--not single-year internship). There is also likely to be a new surgical training program opening up at Ft. Bragg soon. If you want to go straight into a five-year deferred civilian program, it is very unlikely.

When you do a five-year Army general surgery program, this will add two years to your committment and you will end up owing four years total on active duty (internship doesn't add or pay off any time). 2 and 3-year HPSP people really get screwed this way. Not only do you have loans to pay off from 2 years of med school, but you STILL owe a full four years to the army.

My suggestion would be to do surgical intership, pay back your two-year obligation as a GMO and then get out of the Army and do civilian surgical residency. If you are a strong candidate from an MD school, I would HIGHLY recommend this route. There are a variety of reasons why I feel military surgical training programs may not be viable in the future, and I can share these with you if you wish. I've taught residents at several military surgery programs and know the issues first-hand.

I had a three-year HPSP, then got extended to 6 years total payback when I got picked up for general surgery residency and then fellowship with the military instead of the deferment I wanted.

But to answer your original question--No, you are not at a disadvantage. The Army would actually get more commitment out of you if you did their training program.

I agree with this wholeheartedly. I also taught military residents, and I and them were in the unique situation that this specific residency program was primarily civilian, with only a few months of their actual training in the military. If it was all military, no way in hell they would graduate.

I agree you should take the hit, and go GMO or anything else that will let you get out ASAP, and then start your career right with civilian training.

 

[colbgw02]

Just wanted to remind everyone that Army general surgery programs are now 6 years because of a research year. I'm not sure if that research year would further obligate an individual who had a 2-year scholarship, because, if it did, it would also further obligate 4-year scholarship recipients as well.

Bottom line, you're looking at an ADO of upwards of a decade, minimum, if you go the surgery route.

 

[orbitsurgMD]

Just wanted to remind everyone that Army general surgery programs are now 6 years because of a research year. I'm not sure if that research year would further obligate an individual who had a 2-year scholarship, because, if it did, it would also further obligate 4-year scholarship recipients as well.

Bottom line, you're looking at an ADO of upwards of a decade, minimum, if you go the surgery route.

And many general surgery residencies go begging now, something that was unthinkable before. The "research" year is a canard. Basically squeezing a year of call coverage out of you while charging the government for your work and getting a lab/research slavey to boot. This practice should be ended. If they want researchers, they should create and fund research fellowships for postgraduates, just like any other academic field. These kinds of requirements are going to hurt general surgery which, at this time, can't afford that.

 

[cavaor]

I certainly dont mind taking a surgical residency in the Army... and would be happy to play out my 20 yrs for retirement.. but given my personal situation, I dont think I am a strong candidate and will likely not get a res. spot but I have some good connections in the civilian world.

 

[colbgw02]

I certainly dont mind taking a surgical residency in the Army... and would be happy to play out my 20 yrs for retirement.. but given my personal situation, I dont think I am a strong candidate and will likely not get a res. spot but I have some good connections in the civilian world.

What exactly do you mean by your "personal situation"? If you mean simply that you are a 2-year scholarship recipient, then I think you are selling yourself short.

Program directors want the best applicants to come to their program, and I doubt they would care for how many years your scholarship obligated you. That's especially true since, as already mentioned, a surgical residency would "reset" every resident's ADSO to at least 4 years (depending on the research year obligation).

If you're still unsure about your chances of matching, then make sure you schedule some rotations at your programs of choice. Also take some time, on rotation or otherwise, to speak directly to the program directors. In my experience, PDs are very candid and open about giving applicants an idea of their competitiveness, and the insight tends to be relatively accurate because Army GME is comparatively small.

Civilian general surgery isn't as easy to get into as it once was, not that it was ever that easy. The 80-hour work week has pushed a lot of folks toward surgery who might have otherwise stayed away. As evidence, for the 2006 match, there was only one scramble position for GS in the entire nation. Of course, this year's results could be an outlier, or it could be the start of a trend to move surgery back to the top of the most-competitive residencies list. In short, you might have a better shot in the Army than out.

 

[cavaor]

What exactly do you mean by your "personal situation"? >If you mean simply that you are a 2-year scholarship recipient, then I think >you are selling yourself short.

No, not by being a 2 yr recipient but by not having a strong 1st 2 years with a strong clinical 3rd yr is all I meant. Additionally, do to school schedule likely unable to do an away and will have to waiver for Step II to not be finished do to all cores not being completed.

>Program directors want the best applicants to come to their program, and I >doubt they would care for how many years your scholarship obligated you. >That's especially true since, as already mentioned, a surgical residency >would "reset" every resident's ADSO to at least 4 years (depending on the >research year obligation).

True True.

>If you're still unsure about your chances of matching, then make sure you >schedule some rotations at your programs of choice. Also take some time, >on rotation or otherwise, to speak directly to the program directors. In my >experience, PDs are very candid and open about giving applicants an idea of >their competitiveness, and the insight tends to be relatively accurate >because Army GME is comparatively small.

I wish my school schedule would afford that option (an away) but it does not. How do you get the name of the PDs for programs? I have only seen Tripler's folks listed on the websites.

>Civilian general surgery isn't as easy to get into as it once was, not that it >was ever that easy. The 80-hour work week has pushed a lot of folks >toward surgery who might have otherwise stayed away. As evidence, for >the 2006 match, there was only one scramble position for GS in the entire >nation. Of course, this year's results could be an outlier, or it could be the >start of a trend to move surgery back to the top of the most-competitive >residencies list. In short, you might have a better shot in the Army than >out.

Agreed. not easy at all. I have a couple of really good contacts I am relying on (one being an assistant PD who is a LOR) and worst case I normally would have taken a surgical prelim and worked my way into a categorical spot, but its not quite that easy with the military system from what I have been told. Oh the decisions to make in the coming months To go ahead and apply to 30+ programs mostly being civilian or to save my money thinking of a negative inevitable of no deferrment granted. How would you hedge your bets?

 

[colbgw02]

Agreed. not easy at all. I have a couple of really good contacts I am relying on (one being an assistant PD who is a LOR) and worst case I normally would have taken a surgical prelim and worked my way into a categorical spot, but its not quite that easy with the military system from what I have been told. Oh the decisions to make in the coming months To go ahead and apply to 30+ programs mostly being civilian or to save my money thinking of a negative inevitable of no deferrment granted. How would you hedge your bets?

I think the real choke point for you right now is speaking with PDs. Personally, the number of civilian programs to which I applied changed drastically after I spoke with some PDs, which was nice because it saved me about a grand in ERAS application money. They can also give you a better idea about the number, if any, of general surgery deferments awarded recently.

Admittedly, getting in touch with the PDs isn't always easy, but I suggest you contact the Army GME office in Falls Church. In my experience, Janna Cox in the FYGME office is the best person to go to. In fact, she often times appears to be the only one to know up from down.

There's always hope, but you probably want to prepare yourself for not getting a deferment. At the very least, you'll likely get picked up for a transitional internship followed by a GMO tour. That's no reason to not do everything you can to try to get into a categorical slot though, as both a student and an intern, because you might be pleasantly surprised.

 

[cavaor]

Ive contacted Janna to try to get more information, especially the number of deferrments given, etc. Still waiting till hear back. When you spoke to PDs, did you specifically discuss your chances, etc? Im in the same position where I will likely spend alot of $$ if there is a civilian possibility..and since things open up soon, time is an issue.

Anyone have any ideas on factors they look at for deferrment determination (other than the special circumstances people)?

I had planned on only applying to categorical surgical programs with the military programs so not sure how the transitional would work. Talk about things to figure out. If anyone has insight, pass it on. Im the only HPSP at my site and my recruiter...well, he is a nice guy but really learning along with me.

I think the real choke point for you right now is speaking with PDs. Personally, the number of civilian programs to which I applied changed drastically after I spoke with some PDs, which was nice because it saved me about a grand in ERAS application money. They can also give you a better idea about the number, if any, of general surgery deferments awarded recently.

Admittedly, getting in touch with the PDs isn't always easy, but I suggest you contact the Army GME office in Falls Church. In my experience, Janna Cox in the FYGME office is the best person to go to. In fact, she often times appears to be the only one to know up from down.

There's always hope, but you probably want to prepare yourself for not getting a deferment. At the very least, you'll likely get picked up for a transitional internship followed by a GMO tour. That's no reason to not do everything you can to try to get into a categorical slot though, as both a student and an intern, because you might be pleasantly surprised.

 

[colbgw02]

Ive contacted Janna to try to get more information, especially the number of deferrments given, etc. Still waiting till hear back. When you spoke to PDs, did you specifically discuss your chances, etc? Im in the same position where I will likely spend alot of $$ if there is a civilian possibility..and since things open up soon, time is an issue.

Anyone have any ideas on factors they look at for deferrment determination (other than the special circumstances people)?

I had planned on only applying to categorical surgical programs with the military programs so not sure how the transitional would work. Talk about things to figure out. If anyone has insight, pass it on. Im the only HPSP at my site and my recruiter...well, he is a nice guy but really learning along with me.

Stay on top of the folks at GME, especially if you're communicating by email. I've sent emails there in regards to important stuff and never gotten a reply.

I was lucky in that one of the program directors pretty much told me my chances without really being prompted. From there, it kinda made it easy to ask other PDs because I already had a good idea from a source a trusted.

Regarding internship, if you don't match in one of the categorical surgery positions, I'm not even sure if the Army has preliminary surgery internships. So it's possible, even likely, that you'll get a transitional internship even if you didn't rank one. From there, you'll reapply to surgery as a PGY-1. Keep in mind that you may have to repeat part or all of your surgery internship, because not all of the rotations for a transitional internship will fulfill the requirements for a surgery residency. If that's the case, remember to pick your electives to fulfill as many surgical requirements as possible.

There are no set factors that go into getting a deferment in the Army, per se, or at least none that I know about. Remember that the catch all reasoning is "the needs of the Army", which can be used to justify any decision irrespective of common sense or logic.

Depending on what you want, what will get you a deferment will often lessen your chances of matching with the Army. All other things being equal, a PD will choose the known quantity, i.e. applicants who have rotated at or interviewed with a progrm in person. If you want a deferment, then the typical mechanism is to not do any rotations and don't interview with anyone, not even over the phone. But even then, you still might be picked up for an internship or otherwise.

Unfortunately, the only way to cover all your bases is to go all out for Army surgery AND apply to 40+ civilian programs, which will cost you a cool thousand, at least. Good luck.