Will the Navy ever force us to do Navy residencies? What does doing away with GMOs mean for people planning to do four years GMO and out?
If they take GMO's away.....
- Thread starter Trajan
- Start date
As I have said before, there will always be some GMOs. The Navy will NEVER force you to complete a residency you do not want. If you want to do your time as a GMO, they will probably stick you in one of the operational primary care spots.
- Joined
- Sep 25, 2001
- Messages
- 255
- Reaction score
- 53
How can you be so sure? They certainly train personnel(both officer and enlisted) for non-medical military occupations that they don't want to be in. I don't see forcing a doc to take a certain navy residency much differently. Of course I hope this never happens, but I think assuming it will never happen is a big mistake. Or is there some other reason the Navy can't/won't do this that I am missing?
I have many reasons to believe it won't do it. One is that the negative impact it would have on recruiting is soooo tremendous that to do so would be tantamount to suicide. While many may be annoyed at the prospect of doing a GMO tour, it is not a show stopper. A pre-med can look at it and say, "Eventually, I can train in the specialty I want." That is a farsight better than "I may end up a psychiatrist when I want to be a pathologist." The perception of limitations is a very negative factor in recruiting. You can see a lot of that in this forum and the impact it has. Increase that perception and there will be an even smaller pool of applicants.
Second, if you train someone in an area where they lack aptitude or interest it will produce a poor outcome. Let's face it, the overall medical risk in a GMO's practice is small. They deal with generally young healthy populations and treat minor ailments and injuries. Many have said that a physician assistant could handle the job. I feel that a phyician with an internship is better trained than a PA. You could argue the point, but I would stack the broader range of medical knowledge of a GMO over a PA 9 times out of 10. (five years of training to two.) My opinion. If you force someone into Internal Medicine, Psychiatry or Family Medicine, you increase the overall practice risks as the population they could be forced to deal with is of greater complexity. We have enough problems with perception of poor care. We do not need to compound it with a disinterested physician.
Lack of GMO billets will not mean a lack of GMO opportunities. Those same operational billets will still be there, they will merely be slated for a residency trained primary care doc. We currently have a number of GMOs filling gapped Family Medicine billets. That is why we have more GMOs than GMO billets. This truth is unlikely to change.
- Joined
- Jan 11, 2006
- Messages
- 2,034
- Reaction score
- 0
Participation in a military residency program incurs an additional obligation - they cannot force you to participate in something that requires you to stay in longer - you must volunteer for that!
That's not true on two accounts. I'm at a military residency that I certainly don't want to be in- but at the same time I haven't incurred any additional obligation.
If you want to do something other than GMO, you run the risk of doing a military residency, unless the military doesn't have any training programs in that field (e.g. fellowship in minimally invasive surgery).
If you are not incurring an obligation, you are an intern and I never said they would not put you in an internship you don't want. An internship is a requirement for a license and you need a license to practice. Then you can be a GMO. If you don't want to be a GMO then you can accept a residency you are not particularly interested in, but that would be your choice.
- Joined
- Sep 25, 2001
- Messages
- 255
- Reaction score
- 53
I think what Bubblehead means is that by doing a military residency (not just an internship) you end up being on active duty for a longer period, even though it doesnt extend your obligation per se.
For example:
3 year FP residency+4 year obligation(as attending)=7 years on AD
1 year FP internship+4 year obligation(as GMO)= 5 years AD
So by doing a military residency you are extending your time on active duty, even though your original obligation may only be 4 years. Buddblehead makes a good point and one that I hadn't thought of before. However, my follow-up question would be, if this is true, how does the military force everyone to do an internship? Because it seems to me that even internship is extending your AD time from 4 years to 5 years.
The military has a certain amount of residency/intern spots it must fill. So if they need 20 people for internal med, but only 15 people want to do it, they WILL find the additional five, particularly if there are some people who want to do internal med but at a civilian institution.
I am in the residency but not the institution of my choice. The military's primary purpose during their match is to fill their spots. So if they get rid of GMOs, meaning you must choose a residency, you will stand a chance to do a military residency, whether you want to or not. In certain specialties you may not even have a choice, i.e. there are no civilian deferments granted.
While doing a military residency does extend your AD time, it doesn't extend your obligation (i.e. payback), and it's payback that counts. Your time in residency does not count as payback, hence you can be stuck in whatever residency the military wants. Hell, I know interns in 'military' residencies who won't spend one day at a military hospital... hard to call that real military service. Total years of active duty does not matter, it's how much you do after completing residency.
So what if you get the residency you want but you're placed at a military institution? Well, you could refuse to go... and not get to do that residency at all. And if you can't do the 4 year GMO option and must choose a different residency, well, you can see you may have to delay your plans for several years, with no guarantee that you'll get a civilian residency anyway. Yeah, it's a choice, but Soviet elections had choices as well.
In short, be prepared to do what the military wants you to do.
- Joined
- Jan 11, 2006
- Messages
- 2,034
- Reaction score
- 0
I think there are some misconceptions here:
As NavyFP stated in his most recent post in this thread, internship is not the same as residency. As a military intern, you incur no further obligation and pay no time back. However, every military residency has an associated service obligation (payback) associated with it. The misconception that they do not likely stems from the fact that the obligation is served concurrently with any other obligation that you have. So, if you do not do a GMO tour, and go directly into residency following your internship, the obligation incurred for the military residency will likely be awash. However, if you do a military residency following your GMO tour, after you have already fulfilled your prior service obligation, you will incur a new obligation by completing the military residency (i.e. you will not be able to get out of the military immediately after completing a residency program - they're going to get back that time and money invested in training you).
Check out this link:
http://nmmpte.med.navy.mil/gme/NAVMEDGME.htm#Summary%20of%20Active%20Duty%20Obligation%20for%20GME
Bottom Line - You CANNOT be forced to do a military residency. You may not get your ideal location. You may even be asked to consider completing a residency in a specialty that was not your first choice if your ideal specialty is full, and they have a shortfall in another specialty. However, you do not have to do it.
As NavyFP stated in his most recent post in this thread, internship is not the same as residency. As a military intern, you incur no further obligation and pay no time back. However, every military residency has an associated service obligation (payback) associated with it. The misconception that they do not likely stems from the fact that the obligation is served concurrently with any other obligation that you have. So, if you do not do a GMO tour, and go directly into residency following your internship, the obligation incurred for the military residency will likely be awash. However, if you do a military residency following your GMO tour, after you have already fulfilled your prior service obligation, you will incur a new obligation by completing the military residency (i.e. you will not be able to get out of the military immediately after completing a residency program - they're going to get back that time and money invested in training you).
Check out this link:
http://nmmpte.med.navy.mil/gme/NAVMEDGME.htm#Summary%20of%20Active%20Duty%20Obligation%20for%20GME
Bottom Line - You CANNOT be forced to do a military residency. You may not get your ideal location. You may even be asked to consider completing a residency in a specialty that was not your first choice if your ideal specialty is full, and they have a shortfall in another specialty. However, you do not have to do it.
- Joined
- Dec 27, 2005
- Messages
- 2,186
- Reaction score
- 280
True, they cannot compel you to train in a residency you do not want. That is the equivalent of forcing you to sign a contract, which inherently undermines the validity of the contract.
The upshot is likely to force the military to allow all HPSP and even some USUHS applicants to seek and complete residencies of their choosing, in or out of the services. They can incentivize the choice with money either way. Need surgeons? Give them aditional living stipends while they do their training.
As for filling operational billets, that really isn't a problem if you see those billets as just jobs that need filling. Sure, you could order doctors to take them, even if they don't want to, but then they would have to deal with the resentment and likely increased attrition. Or they could incentivize those billets with money or accelerated retirement time credit or other benefits like choice of follow-on assignment, supported fellowship training without added payback required, or even something like a paid sabbatical of substantial length. Fixing that so-called problem takes a little money and some imagination, that's all. Oh yeah, and the will to actually do something (forgot about that).
The biggest problem the services will have to overcome is their tendency to
try to get results by being bullies and cheapskates.
- Joined
- Oct 22, 2006
- Messages
- 557
- Reaction score
- 1
Choice of follow-on assignment is a great lie that they currently use to dupe the naive into staying longer. I personally know two docs who fell for this ruse, signed for additional time, and suddenly their sweet assignments to European bases disintegrated. One ended up doing a long tour to Korea and the other went to the desert for 2 years straight. If you are foolish and think you hold all the cards because you are past your commitment and can separate, think again. Once the military has your ass for another few years, they renege on the sweetener and send you back to the salt mines. Don't fall for it.
I got nailed again for giving my "You too can separate from the military" speech today. They try to delude young people into thinking that the civilian world is so scary and unpredictable. It is truly the other way around. The only scary thing is being in the military and not being able to exercise your inalienable rights.
I did a separation physical on one of my patients today who is getting out to go to med school next fall. I'm glad I had the opportunity over the last couple of years to impress upon this young, talented individual that doing medicine via the military is the worst mistake one can ever make. I recommended talking to several military physicians. The response was unanimously negative. My patient thanked me today and left with a smile to embark on a new career. One less soul to harvest for the grim reaper of military medicine. Another save for me.
