HPSP and Surgery

[ParamagicCCP]

Hi all,

I have been kicking around the idea for going for MD/PhD and then onto cardiothoracic surgery (big endeavors I know). The school I am matriculating into will allow me to apply to PhD program in house (no guarantees though) and I have been accepted for HPSP (Army) with a pending ETP where they will allow me to get my PhD on MD PhD Schedule (ETP pending). However, I am sitting at 100k in loans from undergrad (8 % interest...) and the PhD will add another 4 years (scheduled maybe longer) before I can start paying those off.

The real worry is though will the military be a good avenue to get my training for cardiothoracic surgery. I really cannot find any literature on the quality of the training (not bashing on it), or anyone's personal experiences going through that program. From what I have gathered, there appears to only be 2 thoracic surgery fellowships the that Army offers per year, and again I am curious as to the quality of the programs.

Also I am slightly worried about the possibility of skill degredation in the military.

Any insight into any of these issues/concerns would be greatly appreciated.

-ParamagicCCP

---

Members don't see this ad.

 

[psychbender]

The military doesn't train CT surgeons within the Army anymore. There is too little in-house CT volume at any center to justify a fellowship. The last one they had at Walter Reed shut down over a decade ago. The last several were trained at civilian programs, then came back.

Also, a few things to realize: 1. HPSP does not allow MD/PhD. If you enter this program, you will have to graduate and enter GME in the usual timeframe, with no time off for other pursuits (MPH, PhD, etc).
2. The payback for general surgery residency plus CT surgery fellowship (the Army will not approve a straight CT residency, as they want the option of deploying CT surgeons as general surgeons) is huge. The pay difference between civilian CT and military CT is immense. You will definitely lose out financially in the long run if you do HPSP, especially with the change in the retirement system.

Sent from my SM-G920V using SDN mobile

 

[armyvascsurg]

Hi all,

I have been kicking around the idea for going for MD/PhD and then onto cardiothoracic surgery (big endeavors I know). The school I am matriculating into will allow me to apply to PhD program in house (no guarantees though) and I have been accepted for HPSP (Army) with a pending ETP where they will allow me to get my PhD on MD PhD Schedule (ETP pending). However, I am sitting at 100k in loans from undergrad (8 % interest...) and the PhD will add another 4 years (scheduled maybe longer) before I can start paying those off.

The real worry is though will the military be a good avenue to get my training for cardiothoracic surgery. I really cannot find any literature on the quality of the training (not bashing on it), or anyone's personal experiences going through that program. From what I have gathered, there appears to only be 2 thoracic surgery fellowships the that Army offers per year, and again I am curious as to the quality of the programs.

Also I am slightly worried about the possibility of skill degredation in the military.

Any insight into any of these issues/concerns would be greatly appreciated.

-ParamagicCCP

I believe the Army dropped their last CTS program a while ago (BAMC killed theirs over 10 years ago and WRAMC's GME site doesn't list CTS). So, the 2 offered training spots are going to be civilian sponsored. You are right to be concerned about skill degredation. You will have pitifully low surgical volumes. Take a look at this study :

https://www.google.com/url?sa=t&sou...wI8Yx-U-GLNQe-qXQ&sig2=I9J5wS-z85EGV-6r8sGdkg

Busy civilian centers are doing 450 CABG's per year. Insurance companies consider 100-250 per year as adequate. In the year of the above study, the busiest military facility for CABG's (DDEAMC) did 64. Now, some military facilities have partnerships with local VA's which may increase surgeon volume. Bottom line is that you are going to be in the bottom 10th percentile of surgical volume compared to your civilian peers. As the study shows, CTS is not unique. All surgical specialties, especially subspecialties are suffering. I did 84 vascular cases in the OR the last calendar year. That represents about 20-25% of the volume of my civilian peers.

The most likely scenario if you do CTS in the military is that you will get excellent training at a high-volume civilian program which will only lead to profound frustration when you're languishing at a low-volume Army center. Buyer beware.

 

[jabreal00]

Hi all,

I have been kicking around the idea for going for MD/PhD and then onto cardiothoracic surgery (big endeavors I know). The school I am matriculating into will allow me to apply to PhD program in house (no guarantees though) and I have been accepted for HPSP (Army) with a pending ETP where they will allow me to get my PhD on MD PhD Schedule (ETP pending). However, I am sitting at 100k in loans from undergrad (8 % interest...) and the PhD will add another 4 years (scheduled maybe longer) before I can start paying those off.

The real worry is though will the military be a good avenue to get my training for cardiothoracic surgery. I really cannot find any literature on the quality of the training (not bashing on it), or anyone's personal experiences going through that program. From what I have gathered, there appears to only be 2 thoracic surgery fellowships the that Army offers per year, and again I am curious as to the quality of the programs.

Also I am slightly worried about the possibility of skill degredation in the military.

Any insight into any of these issues/concerns would be greatly appreciated.

-ParamagicCCP

You will end up behind the 8-ball with your plan. HPSP will only cover 4 years of medical school max. If you are allowed to pursue the PhD this will not be covered, the time you extend in your program. At 8% those extra years of non-payment will add up. In addition you'd have to take out loans for the years not covered. CT surgery fellowship after general surgery is not guaranteed. The Army does forecast every year as to what fellowship they'll allow for civilian sponsored or deferred positions and it varies year to year. Honestly, there's not a whole lot of demand for CT surgery. Most CT surgeons are at the big MEDCENs and struggle to get cases. Most Tricare beneficiaries who need CT surgery care are deferred to the network. I know a couple who do the partnership with the VA and the affiliated university based program. There was a CT surgeon I know about of who was stationed at Ft Campbell but worked primarily at Vanderbilt/VA. Not entirely sure what the Army gets out of this arrangement because the bulk of the patients he'd be caring for are not Tricare beneficiaries rather they are civilians or VA benefits patients.

 

[68PGunner]

Hi all,

I have been kicking around the idea for going for MD/PhD and then onto cardiothoracic surgery (big endeavors I know). The school I am matriculating into will allow me to apply to PhD program in house (no guarantees though) and I have been accepted for HPSP (Army) with a pending ETP where they will allow me to get my PhD on MD PhD Schedule (ETP pending). However, I am sitting at 100k in loans from undergrad (8 % interest...) and the PhD will add another 4 years (scheduled maybe longer) before I can start paying those off.

The real worry is though will the military be a good avenue to get my training for cardiothoracic surgery. I really cannot find any literature on the quality of the training (not bashing on it), or anyone's personal experiences going through that program. From what I have gathered, there appears to only be 2 thoracic surgery fellowships the that Army offers per year, and again I am curious as to the quality of the programs.

Also I am slightly worried about the possibility of skill degredation in the military.

Any insight into any of these issues/concerns would be greatly appreciated.

-ParamagicCCP

http://www.thenewstribune.com/news/local/military/article26279503.html

This is your future should you become a CT surgeon for the US Army. You will end up not doing your job and be stuck at a desk job near the twilight of your career. Finally, you will be shamed and humiliated by a nurse who's your superior based on rank.

 

[jabreal00]

http://www.thenewstribune.com/news/local/military/article26279503.html

A commander can get away with being a hard charger or demanding as long as they don't belittle or demean people in public. Flying off the handle and belittling subordinates publicly as a leader is not going to cut it anymore. The same applies to the clinical setting. Years ago when I was medical student and resident, Attendings, fellows or even senior residents would lay into interns or junior residents if they missed one minor detail during presentation. Today, an intern could not know the patients name or where they were located, if you acted anyway but with kid gloves in trying to remediate you'd get written up. Cho seemed to think it was the old Army or like it was his West Point days.

 

[HighPriest]

Why would anyone want to get an MD/PhD and then join the Army? You might as well strikethrough that PhD on your nametag. I mean, I get the desire to have an MD/PhD (not for me, but I get it), and I understand that you're trying to avoid debt. But the two are, in my opinion, not conducive. If you want to avoid debt, and you want even more than being a doctor to be an officer, join the Army. If you want to do things that someone with a PhD might do, stay the hell away from the Army. Research in the DoD is s joke, regardless of what anyone says. Yes, it's better than some high school science fairs, but it's definitely a joke compared to any real research center.

And as stated above: if you really want to be a CT surgeon, that is another reason not to join the Army. It is a 100% guarantee that you will be underworked in your specialty, and you will have skill rot.

 

[68PGunner]

A commander can get away with being a hard charger or demanding as long as they don't belittle or demean people in public. Flying off the handle and belittling subordinates publicly as a leader is not going to cut it anymore. The same applies to the clinical setting. Years ago when I was medical student and resident, Attendings, fellows or even senior residents would lay into interns or junior residents if they missed one minor detail during presentation. Today, an intern could not know the patients name or where they were located, if you acted anyway but with kid gloves in trying to remediate you'd get written up. Cho seemed to think it was the old Army or like it was his West Point days.

Actually, I've heard that these accusations are straight up bs, fabricated by nurses in order to take down Cho.

 

[Shikima]

Perhaps the PhD is an inclination towards someone pursuing management options.

 

[jabreal00]

Actually, I've heard that these accusations are straight up bs, fabricated by nurses in order to take down Cho.

It's hard to believe that the accusations were completely fabricated. I am sure there's some exaggerations. However, there has to be some truth to it if he was removed from command.