HPSP: Army/Air Force Residencies

[Lance Uppercut]

Hey, I've been accepted for the Army and Air Force HPSP. It's starting to turn to decision time and I'm trying to weigh all of my factors. I have a question about the residency selection and then I wouldn't mind some more input on each branch.

The Army has a lot of facilities and residencies for nearly every specialty. The Air Force is geared a lot more towards primary care and thus they even have civilian deferment as one of their options, correct? Whereas in the Army you would have to fail to be selected for the military residencies to get a civilian deferment, right? And with the purported demise of the GMO, failure to get a military residency in any branch should mean a transitional year and then civilian deferment.

If I have that right, then I'd love to know your opinion on which branch has the better option. Are the Army (and Air Force for that matter) residency programs all strong enough to compete with their civilian counterparts? There is a lot of talk in these threads about life after residency in the military. I would like to hear more about your experiences in a military residency.

Also, could the lack of military residency slots for Air Force actually be a benefit as you would have a better chance of deferring to the civilian residency of your choice and essentially turning their HPSP into a better version of the FAP? If I'm wrong about the residencies then of course I'd like to be corrected.

There is also that "needs of the military" clause present in all three branches which is very intimidating. All of the information brackets all contain "iffy" phrases like "if you don't match for one of your 5 program choices you normally go to a civilian residency" or "often... you get to defer"[emphasis mine]. I can never seem to get a straight answer. Have there been people forced to go into a specialty that they did not choose based "on the needs of the military"? I hope your experience can help me on this point.

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[Lance Uppercut]

Also, this is a general impression that I've felt from these threads. It seems that there are a lot of threads by Air Force bashers even though they are the smallest branch. I get the impression that the Air Force has a lot of problems despite its reputation as the cushiest branch.

Since the Army is so much bigger, why the seeming lack of input from Army docs? This forum seems like it’s filled with Air Force and Navy physicians. My gut feeling has me leaning more toward the Army and I would love to hear more in general from the Army side of things if anyone has the experience and time to share.

 

[USAFGMODOC]

What specialty are you leaning towards? Do you have a family? Are you Ok with being in Iraq?--- lots of other things will likely affect your decision...

If you are going into primary care, I think the USAF is the best lifestyle, but if you are trying for a competative specialty (ortho, rads) and don't want to do a GMO tour, likely the Army would be a better choice..

Consider Army = more deployment time vs the USAF
If married, army life may be more stressfull

Just a few thoughts... Good luck in whichever you choose... You will have many tell you to run away from HPSP (see many of the prior posts).

I suggest you spend the next week reviewing all the pros/cons before you make a decision which will definitely be a major factor in your future professional and personal life!

 

[mitchconnie]

The Army has a lot of facilities and residencies for nearly every specialty. The Air Force is geared a lot more towards primary care and thus they even have civilian deferment as one of their options, correct? Whereas in the Army you would have to fail to be selected for the military residencies to get a civilian deferment, right? And with the purported demise of the GMO, failure to get a military residency in any branch should mean a transitional year and then civilian deferment.

There is also that "needs of the military" clause present in all three branches which is very intimidating. All of the information brackets all contain "iffy" phrases like "if you don't match for one of your 5 program choices you normally go to a civilian residency" or "often... you get to defer"[emphasis mine]. I can never seem to get a straight answer. Have there been people forced to go into a specialty that they did not choose based "on the needs of the military"? I hope your experience can help me on this point.

As you suggest, the Air Force IS mainly into primary care these days. In fact, by the time you finish residency there will not be ANY major medical centers within the AF capable of supporting comprehensive GME (Well…maybe Keesler…sort of). The BRAC will have eliminated them all. Smaller hospitals/clinics can certainly support Family Practice training, but not Surgery, Urology, Ortho, Cardiology, etc. Some programs have closed or will close, others will be folded into nearby civilian programs. Good for you if you get to train civilian, not so good if you have to do residency at a dying hospital with no patients. The Army seems to be hanging onto more of its GME, and sends less people for civilian deferment—good if you are a career military man, not so good if you wanted top-tier training in a technical field (i.e. Surgery at the Mass. General). There may be some debate on this point, but I feel training at military facilities is vastly inferior to a quality civilian institution in highly technical/procedural fields--anesthesia, ENT, Gen. Surg, etc.

You are right to be concerned that you may not get your specialty of choice. A person will never be forced to complete a residency which they do not want, but they CAN be forced to do internship only and practice primary care for your entire commitment (GMO/flight surgery). This is a very real possibility in the AF, as training opportunities shrink. Do not believe Army propaganda that they do not have GMO’s. There are plenty of people on this forum who are living proof that there are still LOTS of army GMO’s—check out posts from ‘I want out.’ Unfortunately it is impossible to assess your chances of doing a GMO this far in advance, since no one knows what specialties will be competitive, how many GMO’s will be needed, or how many residency spots will exist four years form now.

At this point I would say that the AF offers a relatively high chance of training civilian, but also a high chance of not getting what you want and being forced into GMO/flight surgery. Army with less GMO and less chance for civilian training.

 

[The White Coat Investor]

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[StarboardMD]

If you apply for the civilian deferment, is this something you sort of "match" into? And is it specific for a given specialty? Like if they want more anesthesiologists than they have spots for, you get a civilian deferment for anesthesiology? How do they determine who gets a deferment? What would happen if you got a deferment and then failed to match into a civilian program?

 

[Lance Uppercut]

At this point I would say that the AF offers a relatively high chance of training civilian, but also a high chance of not getting what you want and being forced into GMO/flight surgery. Army with less GMO and less chance for civilian training.

I think you summed up my dilemma better than I did. That is exactly how I have come to understand the residency differences between the two branches. I never had any exact residency statistics or data on either branch though and that's what I came here to find out from more experienced members.

Part of the problem is that I don't know what specialty I will end up in. I have an interest in ophthalmology but it is far from certain in my mind. From that point, would you have any advice on which branch?

 

[Lance Uppercut]

You don't have that right. And if you sign with this understanding you will be pissed off like the rest of us with how it really is.

Civilian deferrment is not an "option" in the usual sense of the word. You don't get to choose it. You can apply for it, pray for it, and hope for it, but you certainly don't get to choose it. The single biggest problem with HPSP is the military match. You should be afraid of those words "according to the needs of the military" because they WILL use it. Your post makes it clear to me that your level of understanding of what you are getting into is insufficient for you to be making such a huge decision in your life and your career. Please do not sign anything until you know much more. I suggest you talk to some active duty docs/residents to get the straight scoop.

First off, I did have it right. I realize that you don't get to "choose" civilian deferment in the traditional sense, but I wanted to know about the tendencies each branch had toward granting those deferments. I was looking more towards finding out about residency trends between the branches as I couldn't find any hard data (numbers who defer, who are forced into GMO, how good the "lesser" army programs are, etc...) available.

Secondly, why don't you tone down the condescension, okay chief? My level of understanding is just fine. Someone with less of an attitude answered my question just fine without it. A condescending post like yours is precisely what makes people tune you and some of the other nonstop soapbox preaching posters in this forum out.

Finally though, this is partly my fault in my original post. I should have stated that by Friday I have to choose which branch I want to reserve my scholarship offer for as I am currently occupying two slots. I have not made any firm committment and I have no immediate plans to. But that is not what this thread is supposed to be about.

 

[mitchconnie]

Finally though, this is partly my fault in my original post. I should have stated that by Friday I have to choose which branch I want to reserve my scholarship offer for as I am currently occupying two slots.

If residency training is the make-or-break factor for you, then try this advice on for size:

If you are a hard-charging, academic type who wants to go into a surgical subspecialty (optho) and be an academic medicine superstar, then hold the Air Force offer. You may get deferred and match to Johns Hopkins. You also may get forced into flight surgery, but you can always go to Hopkins afterward and get the training you really wanted. The last thing you need is to get forced into a tiny Army community hospital program with minimal research opportunities and zero prestige in the civilian world.

If you aren’t as strong academically, don’t care about a big-name program, aren’t interested in academic medicine, or maybe are prior service, then hold the Army offer. Not getting that civilian deferment would not be as big a deal in that case. The military match is a totally different game than the civilian match and if you play the game right, you’ll probably eventually be allowed to train somewhere in your chosen specialty, even if you need those points from a GMO tour to do it. That Army residency also counts toward retirement, if that is important to you.

If you are gung-ho primary care and don’t give a crap about where you train, then either branch is about the same. You’ll probably get that FP residency straight out of med school.

Hard decision—virtually impossible to get a handle on all the variables involved. Either way there are a lot of life-changing factors that are just out of your hands.

 

[Lance Uppercut]

Hard decision—virtually impossible to get a handle on all the variables involved. Either way there are a lot of life-changing factors that are just out of your hands.

Tell me about it. It's this period of uncertainty that seems so tough because so much is out of my control. I don't even have acceptances to medical schools yet (I was auto-granted the scholarships based on GPA/MCAT) so I can't even base my decision on what medical school I would go to. All I have to go on is that I'd probably take the scholarship for the private schools and just get loans (and possibly FAP later on) for the SUNY schools. It's a tough call to make with so many variables out there.

All the same though, thank you very much for responding to my inquiries. I really appreciate you taking the time out to answer my questions.