HPSP - Risk of GMO tour after Peds Residency? Other Options?

[WhadduppDoc]

Hi all, I've been considering HPSP (either army or AF) and military medicine for a while now and find myself drawn to spending a few years serving, especially if it comes with the benefit of paying for my medical school, which is looking at about 85k/year between tuition and living expenses. Racking up 600k of debt after interest is daunting and I'd be afraid of choosing a higher-paying specialty to help pay that off, rather than because it's the best fit. Though I'm scared of the lack of geographic flexibility, four years doing something I'm proud of seems much better than spending 10+ years trying to pay off all of my loans.

I'm primarily interested in doing EM or Infectious Diseases, but part of me wonders if I'd rather go into a Pediatric sub-specialty (pediatric infectious diseases or pediatric emergency medicine), especially for the quality of life being a pediatrician would offer me during the later stages of my career. My long term goals would be practicing and teaching at an academic center and participating in global health initiatives. Since there aren't a ton of peds fellowship options in the military, I'd be happy to work as a pediatrician during my time in the Army and apply to a civilian fellowship afterwards if that's a viable option.

That said, reading around on this forum about being a military pediatrician is worrisome. Lots of people talking about getting sent on GMO tours after peds residency and having all of their skills atrophy. Is this quite common? If I end up deciding on peds, would it be smarter (and manageable) to do my four years as a GMO/battalion surgeon and then head to a civilian residency? I'd imagine it would be easier to get a peds residency after a GMO tour than a peds sub-specialty fellowship (which would probably want a lot of research and other activities). Is this true?

Please let me know what you all think and whether HPSP seems like a good option for me. Thanks!

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[militaryPHYS]

It is good to analyze what your current preferences and passions are but there is a >75% chance of changing during medical school. Therefore, think of the military vs civilian decision more in general terms as you discussed in your first paragraph and last paragraph. Would you still be happy with your decision if, based on needs of the military and possible changes in your specialty/sub-specialty, you had to delay residency, be a unit general practitioner for 4 years (possibly professionally satisfied or possibly not)?

If answer is yes then keep considering MilMed as an option and own your decision. If the answer is no then it is better to take on the student loans and then modify your lifestyle and spending for as long as it takes to pay them off post-residency.

 

[WhadduppDoc]

It is good to analyze what your current preferences and passions are but there is a >75% chance of changing during medical school. Therefore, think of the military vs civilian decision more in general terms as you discussed in your first paragraph and last paragraph. Would you still be happy with your decision if, based on needs of the military and possible changes in your specialty/sub-specialty, you had to delay residency, be a unit general practitioner for 4 years (possibly professionally satisfied or possibly not)?

If answer is yes then keep considering MilMed as an option and own your decision. If the answer is no then it is better to take on the student loans and then modify your lifestyle and spending for as long as it takes to pay them off post-residency.

Thanks for your reply! That is an excellent point. While not ideal, spending four years as a unit GP and then heading to a civilian residency sounds OK to me - assuming that civilian residencies will still be interested in me after four years without research in that field. Taking care of soldiers (and their families) is pretty much the motivation for even considering military medicine anyways.

The truly unattractive option for me has to do with completing residency and then being sent on a GMO tour where I likely wouldn't be using any of my specialty's skills. The skill atrophy and potential career implications, not the time, is what worries me. Am I correct in assuming that is a real risk?

 

[militaryPHYS]

The truly unattractive option for me has to do with completing residency and then being sent on a GMO tour where I likely wouldn't be using any of my specialty's skills. The skill atrophy and potential career implications, not the time, is what worries me. Am I correct in assuming that is a real risk?

This is a risk. Much more common with Army. Navy not so much as we typically utilize non-residency trained physicians to fill those spots. If you have to do a GMO tour and would rather have the ability to do it right after internship to "GMO and out" then Navy would be my choice.

I am biased, but Army would be last on my list. I might even consider Air Force over Navy if I could go back in time. Majority of Navy and Air Force people I talk to are happy or OK with their status. I find many more unhappy Army physicians. This is completely anecdotal evidence, but just make sure you consider and talk to people in all branches.

 

[TheTruckGuy]

I've never heard of a residency trained physician in the Navy taking a GMO/FS/UMO position on a non-voluntary basis. They usually will do their internship, then GMO, then finish residency.

It is true that the Army does utilize board certified physicians in the role of a GMO, usually as a battalion/regimental surgeon. But often times they still moonlight, or continue to work part time at their nearest MTF to maintain their skills.

Being a GMO is also pretty awesome. Yeah, it's a delay in your career, but you get to do stuff you'll likely never get to do at any other point in your life. Some people find that appealing, others don't. Personally, I'm glad I didn't even apply to go straight through residency.

 

[orbitsurgMD]

I've never heard of a residency trained physician in the Navy taking a GMO/FS/UMO position on a non-voluntary basis. They usually will do their internship, then GMO, then finish residency.

It is true that the Army does utilize board certified physicians in the role of a GMO, usually as a battalion/regimental surgeon. But often times they still moonlight, or continue to work part time at their nearest MTF to maintain their skills.

Being a GMO is also pretty awesome. Yeah, it's a delay in your career, but you get to do stuff you'll likely never get to do at any other point in your life. Some people find that appealing, others don't. Personally, I'm glad I didn't even apply to go straight through residency.

[Bolds mine]

I have. The Navy has been willing to order recent residency graduates in specialized surgery fields, people whose skills require regular procedural practice to remain good, to billets as GMO flight surgeons, even after having already served tours as a flight surgeon. This most definitely was done non-voluntary and despite protest. You cannot presume that because you did service once as a GMO that you can't be required to do so again. The fact that other active-duty doctors may never have done a day of service as a GMO and you have doesn't protect you. It is a crappy and indecent way to treat a fellow professional, reprehensible really, but the Navy could not care less about that. So be warned.

 

[TheTruckGuy]

[Bolds mine]

I have. The Navy has been willing to order recent residency graduates in specialized surgery fields, people whose skills require regular procedural practice to remain good, to billets as GMO flight surgeons, even after having already served tours as a flight surgeon. This most definitely was done non-voluntary and despite protest. You cannot presume that because you did service once as a GMO that you can't be required to do so again. The fact that other active-duty doctors may never have done a day of service as a GMO and you have doesn't protect you. It is a crappy and indecent way to treat a fellow professional, reprehensible really, but the Navy could not care less about that. So be warned.

Interesting. Must be pretty rare. I haven't been around that long though.

 

[starbuck2]

I've never heard of a residency trained physician in the Navy taking a GMO/FS/UMO position on a non-voluntary basis. They usually will do their internship, then GMO, then finish residency.

It is true that the Army does utilize board certified physicians in the role of a GMO, usually as a battalion/regimental surgeon. But often times they still moonlight, or continue to work part time at their nearest MTF to maintain their skills.

Being a GMO is also pretty awesome. Yeah, it's a delay in your career, but you get to do stuff you'll likely never get to do at any other point in your life. Some people find that appealing, others don't. Personally, I'm glad I didn't even apply to go straight through residency.

Interesting last paragraph—care to share any examples of your GMO experiences?

 

[militaryPHYS]

It is a crappy and indecent way to treat a fellow professional, reprehensible really, but the Navy could not care less about that. So be warned.

Sorry if that happened to you, but this is not a universal statement which can be applied to Navy medicine as a whole. Majority of my colleagues (regardless of specialty) have had decent interactions with their detailer or specialty leader who have tried to balance clinical/career/family/lifestyle to try and get the physician an agreeable assignment. Getting screwed surely still happens but I would say it is a minority of individuals.

 

[orbitsurgMD]

Sorry if that happened to you, but this is not a universal statement which can be applied to Navy medicine as a whole. Majority of my colleagues (regardless of specialty) have had decent interactions with their detailer or specialty leader who have tried to balance clinical/career/family/lifestyle to try and get the physician an agreeable assignment. Getting screwed surely still happens but I would say it is a minority of individuals.

This did not happen to me but to an internship classmate of mine. It was definitely the wrong thing to do to a fellow professional who had done service as a GMO and who should not have been required to serve again in that capacity merely because the Navy had failed to adequately project its force needs and was too lazy and indifferent to consider the cost of that demand on the individual professional. This had nothing to do with the quality of interaction with a detailer.

The point is that the Navy was utterly indifferent to the effect that type of assignment would have on the skill set of the person affected. In fact, the Navy operational medical leadership behaved quite poorly toward this person with evidently no appreciation for the effect of its assignment, with a "we hear you aren't too happy about this" attitude (only a complete idiot would expect someone to be happy with those circumstances, but there you go.)

There were other better options available, I am certain. The Navy did what they thought was easy. Ultra low quality leadership there, courtesy of the Navy Medical Corps.

 

[militaryPHYS]

They don't have to care. We are all just widgets. Office chairs, right? Or was it staplers? We are the very definition of an expendable employee and the leadership of our employer is constantly changing and sometimes not great. It also just so happens that we have advanced degrees which would be better respected by any other employer.

I understand this and I'm OK with it right now in my career. Many are not. Everyone joining should understand the paragraph I just wrote because it is the root cause for many of the horror stories people discuss about MilMed. Accept the truth about what you are signing up for. If you can't accept it....don't sign up. Don't hope for the best and come up with a justification about why you still signed up. You could very well get screwed and you will be miserable unless you fully accept the position in which you are entering.

 

[orbitsurgMD]

They don't have to care. We are all just widgets. Office chairs, right? Or was it staplers? We are the very definition of an expendable employee and the leadership of our employer is constantly changing and sometimes not great. It also just so happens that we have advanced degrees which would be better respected by any other employer.

I understand this and I'm OK with it right now in my career. Many are not. Everyone joining should understand the paragraph I just wrote because it is the root cause for many of the horror stories people discuss about MilMed. Accept the truth about what you are signing up for. If you can't accept it....don't sign up. Don't hope for the best and come up with a justification about why you still signed up. You could very well get screwed and you will be miserable unless you fully accept the position in which you are entering.

You are rationalizing something that is not acceptable and should not be made to seem so. It is wrongful, unless your assessment of the military experience is "plan to be screwed and be happy when you are not." An outfit that behaves this way deserves to be criticized and shunned and it deserves the recruiting problems it has.

Treating valuable people poorly is not acceptable policy, ever.

 

[militaryPHYS]

Because I have to, lets be clear: It isn't actual policy. In fact, the written policy for the services is the exact opposite (something along the lines of utmost consideration and care for the warfighter and their family). Unfortunately, when war happens, or policies/obligations/commitments are made by politicians, budget cuts happen, etc., it can FEEL like we are being treated poorly. In reality we are just feeling the effects of orders coming down from the top. It's the military. We have to do it. It's what we signed up for...good or bad. We might have to take a crappy job for a while. We might have to fill a IA spot at a bad time in our career.

Don't want to take the risk of feeling like you're being treated poorly?! Don't sign up! Super simple!

 

[orbitsurgMD]

Because I have to, lets be clear: It isn't actual policy. In fact, the written policy for the services is the exact opposite (something along the lines of utmost consideration and care for the warfighter and their family). Unfortunately, when war happens, or policies/obligations/commitments are made by politicians, budget cuts happen, etc., it can FEEL like we are being treated poorly. In reality we are just feeling the effects of orders coming down from the top. It's the military. We have to do it. It's what we signed up for...good or bad. We might have to take a crappy job for a while. We might have to fill a IA spot at a bad time in our career.

Don't want to take the risk of feeling like you're being treated poorly?! Don't sign up! Super simple!

Ok, then I am sure you would be fine with a tour as a battalion surgeon or flight surgeon when your next orders come up? Even if there are a few people who have never done an operational medical tour and you have done one already? Even if it comes at the expense of seriously eroding your hard-earned skills as an orthopedic surgeon. (You won't be doing too many total knees or hips for a while.)

If you think that is fair and good treatment, then you've gone full Stockholm.

 

[militaryPHYS]

Hey man. I signed up to me a military officer. Ortho just happened to work out for me.

I already haven't done a total hip or knee in 3 years being stationed overseas. Will I be rusty on my totals when I start sports fellowship this summer? Sure. Will I relearn them quickly? Yes.

If I wasn't going to fellowship and just PCS'ing to a place where I needed to do totals I would probably self-FPPE myself with one of the joints guys until I felt comfortable again. Personally I'd be happy never doing another total in my life

But sure. If the navy needed me Primary Caring for Marines instead of operating I wouldn't be too upset. I need my FMF pin anyway. Apparently actually being an enlisted Marine as prior service doesn't earn you an FMF pin. Makes no sense to me. Anyway....I'd figure out a way to operate somewhere and if I couldn't then I'd FPPE myself again at my next hospital billet.

 

[Perrotfish]

Unfortunately, when war happens, or policies/obligations/commitments are made by politicians, budget cuts happen, etc., it can FEEL like we are being treated poorly. In reality we are just feeling the effects of orders coming down from the top. It's the military. We have to do it.

So if a surgeon, now, is being assigned to SMO/regimental surgeon roles straight out of residency or fellowship, the ARE being treated poorly. Its not a feeling, its poor treatment. No one is arguing that you don't have to do it if told, but it is poor treatment and its a good reason to complain. Hearing about it is a good reason not to join in the first place.

We all understand that joining the military means that the military can do anything they like to you. That is absolutely necessary to give the military the flexibility to deal with the crises it is designed for. However a necessary counterbalance to that is the incredible weight that the military places on custom. Very few individuals worth retaining are willing sign over their independence to an organization that does things to them at random, so the military as a whole has traditionally done everything they can to foster confidence that while they CAN do anything to anything to you, in the absence of a real national crisis, they WILL act in ways that are very predictable.

One of the biggest problems facing military medicine is leadership's loss of respect for military custom and continuity. Will surgeons have to provide primary care? Will you get your bonuses this year? Will your subspecialty exist next year? Will the hospital you're in be open next year? When the answer to all of those questions and more is basically a shoulder shrug then the physicians worth keeping run screaming to the private sector where they find, if not more stability, at least the opportunity to renegotiate in response to changes made by their employers.

You were an enlisted Marine. How many Gunnery Sergeants do you think the Marine Corps would have if they sometimes gave random sergeants and staff sergeants 2 year tours where their primary responsibility was to assist in managing a preschool class at the CDC? Do you think those NCOs would stick around after two years of non stop toddler care because 'it's the military?' How many people would even stick around to hit E5 if they knew that was a possibility? Would you think the military was better without them, because there are still plenty of lance corporals who can be assigned to their jobs?

 

[DrMetal]

Any operational tour---call it a GMO tour, a SMO tour, Battalion Surgeon, MEF, HMFIC whatever have you---is usually boring, and usually doesn't involve that much medicine/surgery (unless you're in the thick of an actual war). Operational medicine is pretty boring to be honest. So if you're asked to do an operational tour, you should expect some degree of skills atrophy, no matter what your specialty.

I'm not even bothered by this so much any more. We know the 'operational beast'.

What astonishes me is how empty our MTFs and clinics are, how we're constantly deferring everything out to the civilian network. Civilianize military medicine? Sure, why not? It's already halfway there.

 

[militaryPHYS]

So if a surgeon, now, is being assigned to SMO/regimental surgeon roles straight out of residency or fellowship, the ARE being treated poorly. Its not a feeling, its poor treatment. No one is arguing that you don't have to do it if told, but it is poor treatment and its a good reason to complain. Hearing about it is a good reason not to join in the first place.

We all understand that joining the military means that the military can do anything they like to you. That is absolutely necessary to give the military the flexibility to deal with the crises it is designed for. However a necessary counterbalance to that is the incredible weight that the military places on custom. Very few individuals worth retaining are willing sign over their independence to an organization that does things to them at random, so the military as a whole has traditionally done everything they can to foster confidence that while they CAN do anything to anything to you, in the absence of a real national crisis, they WILL act in ways that are very predictable.

One of the biggest problems facing military medicine is leadership's loss of respect for military custom and continuity. Will surgeons have to provide primary care? Will you get your bonuses this year? Will your subspecialty exist next year? Will the hospital you're in be open next year? When the answer to all of those questions and more is basically a shoulder shrug then the physicians worth keeping run screaming to the private sector where they find, if not more stability, at least the opportunity to renegotiate in response to changes made by their employers.

We are saying the same thing. Premeds should expect the worst. Expect to be treated like the people who present their negative experiences on here. That way if/when it happens you won't be disappointed...you'll at least be mentally prepared to accept it. My point is, if you expect the worst and are still OK signing up (which some of us were, and some will continue to be) then just own your decision. Any doubts at all? Better to not sign up and accept the student loans.

My issue (Personal. No moderation) is when we blanket statement entire services branches or all of MilMed with insults based on our own personal feelings. You should be as pissed off as you want about X person in X specialty in X service branch at X duty station on X date. Your experience is valid and important to discuss with premeds and active duty so that we can prepare for the worst and/or help mitigate it if we see it occurring locally at our commands. It just isn't necessarily universal to MilMed as a whole, or more importantly, it isn't necessarily how a different person may feel about the same situation. We are all different animals and every situation is different.

I never tell people to join or to stick around. That is totally their decision. I just provide the information that I know while trying to avoid subjective opinions. I recommend that if there are any doubts DON'T SIGN UP. If the Military isn't what you expected or if it isn't serving a positive experience for you in your life then GET OUT ASAP. Is this any different than what you guys do?

You were an enlisted Marine. How many Gunnery Sergeants do you think the Marine Corps would have if they sometimes gave random sergeants and staff sergeants 2 year tours where their primary responsibility was to assist in managing a preschool class at the CDC? Do you think those NCOs would stick around after two years of non stop toddler care because 'it's the military?' How many people would even stick around to hit E5 if they knew that was a possibility? Would you think the military was better without them, because there are still plenty of lance corporals who can be assigned to their jobs?

Can't say. Also I don't care. Some SSGT's might like playing with toddlers. Who knows. It isn't for me to decide. As long as the new people signing up know that there are a lot of unknowns (one of which is possibly playing with toddlers for 2 years) then they are signing up with informed consent.

That is our job. Make it known what the positives and real negatives are. Whether or not people sign up or not after learning these things is completely up to them. It isn't for us to say that playing with toddlers for 2 years is bad. That is a personal opinion.

 

[DrMetal]

I just wish I had more to do (sicker patients, better volume). It's crazy that we have to beg to work in this business.

We just need to turn the entire (or nearly entire) MC into a reserve force. There's really no point in all of us being active duty. Same is true of other supportive communities (engineers, JAG, etc).

 

[militaryPHYS]

I just wish I had more to do (sicker patients, better volume). It's crazy that we have to beg to work in this business.

I hear ya. I guess its technically a good thing since that means the majority of our patients are young and healthy but this is bad for sustainment.

All reserve force makes sense. I worry that our active duty and other beneficiaries will get lost in the civilian system due to Tricare reimbursement issues. They won't feel like they are getting the access or attention they need. That is the one thing about an active duty force...We are there for our patient's whenever they need us.

 

[Gastrapathy]

A board certified Navy gastroenterologist spent 8 months at a BAS in an Afghan mountain pass as a GMO right before I got out. There are plenty more examples where that came from.

 

[DrMetal]

A board certified Navy gastroenterologist spent 8 months at a BAS in an Afghan mountain pass as a GMO right before I got out. There are plenty more examples where that came from.

He was one my preceptors (if we're thinking of the same guy). Good guy, good teacher, was a great GI too.

Look, again, you can't blame the military for being the military. Most operational assignments (deployments or permanent billets) completely under-utilize our skills. But that fact hasn't changed much. Operational medicine is slow and not very exciting.

It's whats going on back home in our MTFs/clinics that's ridiculous. That we have no IR capability and have to transfer the patient to a 'real hospital', that's what hurts.

 

[Gastrapathy]

So I agree to a point but its a myth that these roles are only filled by one year wonders.

 

[obgflightdoc]

Please let me know what you all think and whether HPSP seems like a good option for me. Thanks!

@WhadduppDoc - your post was highjacked...
Have you checked out the public health service corps options? My general advice would be, if you're ONLY doing HPSP for the money, it's nice, but not worth it... there are easier ways to pay for medical school, for example: https://www.usphs.gov/student/nhsc.aspx.
Also, if you are def set on Peds, I would definitely discourage you from Navy HPSP- there may not be any PEDS GME spots by the time you graduate- seriously. There is a lot of GME upheaval in Navy Medicine right now and non-operational specialties are the first to go.
As someone said above- if you'd be willing to do Intership, then 4 years GMO/FS/UMO and out t civilian residency, that can be a good deal.