I have been selected for USAF HPSP. I am coming up on my commissioning and am having some major concerns.
- What are the chances of not getting a residency in the specialty you want?
- As of right now, for example, I want an IM residency. How does matching work for that?
- What if I do not get selected for a IM spot? and ONLY want an IM spot (of course this could change)?
- Do you always go straight into residency after medical school? If not, what is the alternative?
- I saw on the HPERB for IM residencys there is a PGY1, what is that? Then I also saw that there is a 36mo and 24 mo (pgy2) residency, could you help me understand this? Internship year?
- After completion of residency, what are the paths taken?
- What I mean is, how do you determine if you are able to complete a fellowship right away? If not completing a fellowship, what are the next steps?
- Does a fellowship count towards years you owe or does it add or is it neutral?
- Both of my parents were Air Force, so I did not hear a lot about how placement for married couples where one is not military?
My concerns right now are that I could be pushed into a specialty I do not want, that I could be 33 (post med school, 3 year residency and 4 year commitment) before getting around to my subspecialty and how having a non-military spouse works. I think as I write these questions I am realizing that my nerves are coming from an uncertainty about my career path. I know that I want to be military and a doctor. I also know that I want to be in control of the specialty I go into, is that possible?
Also, I am female: Is being female and going through this 10+ year commitment going to make it impossible to have a family?
The match:
In the military you, by default, have to go through the military match for Internship. It works just like the civilian match in the sense that you are selected for a residency based on your board scores and interviews. It is different in that you are applying only to military residency sites. Unfortunately I can't tell you the odds of matching because they change dramatically year to year, which is a downside of having only a few dozen spots. You can apply during the military match (in December) to be allowed to apply through the civilian match, but they will likely say no. They can also force you into the civilian match, but that's also rare. Finally in the military you don't apply for a full residency, just an Intern year. In the middle of Intern year you have to apply to yet another match to be allowed to continue for the rest of residency, and there is at least an even chance you won't match and won't be allowed to continue.
If you are not selected for the Internship of your choice you will be forced into an Internship in something (hopefully transitional, maybe FM/Psych). If that happens, or if you get an IM internship but don't match into an IM residency, then after you complete intern year you do a 'GMO tour' as a flight surgeon, which means you provide primary care to everyone attached to a wing and also do flight physicals to ensure that your pilots are actually able to fly. Those last 3 years, and then you either reapply for residency in the military, or extend for one more year and start your residency in the civilian world 5 years after graduating from medical school
Under no circumstances can you be forced to complete a residency in a specialty you do not want to train in. They cannot force you to, for example, complete a residency in psychiatry. The worst case scenario is that you start the residency of your choice as a civilian 5 years after finishing medical school
Fellowship:
After residency almost all physicians will have to work for 2-3 years in a utilization tour before moving on to fellowship. Fellowship odds are even harder to predict than residency odds: They need to have an opening, and the military only needs 1-2 total people in most specialties (with some exceptions like ICU). If they train you and pay for your salary it adds a year of obligation for each year you train, if you get funding to train on your own its obligation neutral.
Co-locating:
If your spouse is military they are obligated to co-locate you. They can legally stretch the definition of co-location (I think 2 hours diving distance technically counts) but I only know one person who wasn't actually co-located in the same city and she had her orders changed after one year. If your spouse is not in the military they are under no obligation to worry about his career. Usually the detailer (the person who decides where you go) will try to make reasonable accommodations like trying to keep a physician spouse on US soil or trying to keep a lawyer where he is licensed. However they don't always do that, and even when they do there are limits. They will not keep you in one city forever because your spouses job can't move.
Families:
Female military physicians do have families. Actually I think its somewhat more possible to have a family than in a traditional residency pathway, because you can have one between Internship and residency, or between residency and fellowship, while having a family during your training is much more difficult (though still possible) but that's a medicine problem rather than a military problem.
