I’m applying to medical school in the next cycle (former lawyer hence the username lol) and I’m interested in USUHS, hoping to be in the Navy. A lot of the resources I’ve been able to find to learn more about military medicine are focused on the financial pros/cons, etc. I’m having trouble getting a realistic sense of some more day-to-day questions— am I going to get to go on a ship? How much of my career? What is EM in the military like vs what I’ve seen in my civilian hospital work? I guess I’m looking for information geared toward someone who’s excited about the military side of things instead of wanting to know whether it can be avoided 😂. Any suggestions for resources?
Learning about Navy medicine
- Thread starter joelawyer
- Start date
- Joined
- Aug 16, 2020
- Messages
- 88
- Reaction score
- 128
Do you mind if I PM you as well? I was recently accepted to USU in the Navy, and am having a tough time deciding about that vs another school. There’s a lot that appeals to me, but I have some uncertainties.
Also looking more at the lifestyle and work perspective.
- Joined
- May 17, 2011
- Messages
- 152
- Reaction score
- 87
- Joined
- Dec 15, 2005
- Messages
- 16,637
- Reaction score
- 25,665
@chlrbwls, please post here, vs discussing via PMs - unless you think that posting would expose you to identification and retaliation in some way.
The benefit of these forums is that they're forums that anyone can read and learn from.
Possibly, but it's not super common. There aren't a lot of physicians on board ships. Most of the smaller ones are covered by independent duty corpsmen (IDCs), maybe a general medical officer (GMO) which is a physician who's completed internship but hasn't done a residency yet.
Some of the larger ships have residency-trained physicians on them. How busy they are depends on many factors. In general, surgeons are bored and not operating much at all, while primary care types do a little more - but all of them have significant non-medical, administrative duties.
I'm an anesthesiologist, and have spent a grand total of about 2-3 weeks on board a ship in the last 20 years, and that's Just Fine with me because there just isn't any surgery happening on ships.
EM at military hospitals is heavily, heavily tilted toward low acuity "sick call" kinds of case load. It's actually a significant problem for skill growth and maintenance after residency. (Residents augment the poor case load by rotating at outside civilian hospitals.)
The gates with the guards and the guns are generally impermeable to civilian ambulances. Some efforts are being made at some Navy hospitals to bring in civilian trauma, though I confess ongoing skepticism that it'll result in significant volume or acuity. I suppose anything is better than nothing, however. I don't see any Navy hospital ever being better than the average L1 or L2 civilian trauma center in terms of case load, though.
The low hanging fruit there is being a GMO. You can get 2 or 3 year orders out of internship to be a flight surgeon, dive medical officer, or ordinary GMO with the fleet or the Marines. I spent 3 years with a Marine infantry battalion and deployed to Afghanistan and Iraq with them. There are downsides to the whole GMO phenomenon but on the whole I loved my 3 years with the Marines.
There are some opportunities for residency-trained physicians to get involved with operational commands - just be fully aware that such work plus your clinical work is a zero sum game. There are only so many hours in a day, only so many days in a week. Every day you spend doing military stuff is a day you aren't practicing medicine. That's OK if that's what you want. But even for full-time clinicians in the military, the case load and acuity can be a little weak. Many of us in non-primary-care specialties feel it is necessary to moonlight at civilian hospitals to meet minimum case numbers. (This was especially true for me, as a subspecialist after the Navy got rid of my subspecialty.)
As for special stuff to do in small doses, there are some things out there, but they're not advertised. I've spent the last 7 or 8 years as part of the Navy Marksmanship Team. A few weeks per year I go shoot with the Navy's rifle and pistol teams at Navy, interservice, and national competitions. Plus from around March - October local members of the team are fairly active and we have informal matches and other training events. I imagine there are other similar things that I don't know about, because they're not advertised. 🙂
The benefit of these forums is that they're forums that anyone can read and learn from.
Possibly, but it's not super common. There aren't a lot of physicians on board ships. Most of the smaller ones are covered by independent duty corpsmen (IDCs), maybe a general medical officer (GMO) which is a physician who's completed internship but hasn't done a residency yet.
Some of the larger ships have residency-trained physicians on them. How busy they are depends on many factors. In general, surgeons are bored and not operating much at all, while primary care types do a little more - but all of them have significant non-medical, administrative duties.
I'm an anesthesiologist, and have spent a grand total of about 2-3 weeks on board a ship in the last 20 years, and that's Just Fine with me because there just isn't any surgery happening on ships.
EM at military hospitals is heavily, heavily tilted toward low acuity "sick call" kinds of case load. It's actually a significant problem for skill growth and maintenance after residency. (Residents augment the poor case load by rotating at outside civilian hospitals.)
The gates with the guards and the guns are generally impermeable to civilian ambulances. Some efforts are being made at some Navy hospitals to bring in civilian trauma, though I confess ongoing skepticism that it'll result in significant volume or acuity. I suppose anything is better than nothing, however. I don't see any Navy hospital ever being better than the average L1 or L2 civilian trauma center in terms of case load, though.
The low hanging fruit there is being a GMO. You can get 2 or 3 year orders out of internship to be a flight surgeon, dive medical officer, or ordinary GMO with the fleet or the Marines. I spent 3 years with a Marine infantry battalion and deployed to Afghanistan and Iraq with them. There are downsides to the whole GMO phenomenon but on the whole I loved my 3 years with the Marines.
There are some opportunities for residency-trained physicians to get involved with operational commands - just be fully aware that such work plus your clinical work is a zero sum game. There are only so many hours in a day, only so many days in a week. Every day you spend doing military stuff is a day you aren't practicing medicine. That's OK if that's what you want. But even for full-time clinicians in the military, the case load and acuity can be a little weak. Many of us in non-primary-care specialties feel it is necessary to moonlight at civilian hospitals to meet minimum case numbers. (This was especially true for me, as a subspecialist after the Navy got rid of my subspecialty.)
As for special stuff to do in small doses, there are some things out there, but they're not advertised. I've spent the last 7 or 8 years as part of the Navy Marksmanship Team. A few weeks per year I go shoot with the Navy's rifle and pistol teams at Navy, interservice, and national competitions. Plus from around March - October local members of the team are fairly active and we have informal matches and other training events. I imagine there are other similar things that I don't know about, because they're not advertised. 🙂
- Joined
- May 17, 2011
- Messages
- 152
- Reaction score
- 87
Oh sure i assumed there was some personal questions so i directed that way but this was the response i gave and the question pertained to USUHS vs Civ program w/o scholarship
==========================
Yeah, so then speaking to your concerns/cons (i will only talk to you about the path if you were to choose the USUHS path),
You are already fighting an uphill battle by picking a surgical specialty (having to be competitive) so whatever you decide a majority of your career depends on you to be able to perform well throughout med school. Regardless, with a surgical specialty, because the pay is so much significant than a typical primary care provider, you have better chance of paying off your debt sooner than those specialties so the scholarship free ride and paid medical training might not weigh much. (again given that you keep your mind about matching into the surgical specialty)
Then, talking to your possible route after med school:
1. Matched into Military Residency
- you will then concurrently payback your med school years but will accrue your payback time for your specialty training thus makes your military obligation that much longer.
- this will then after specialty training you will be sent to what the Navy requires of you to be at pending on your specialty training.
- Skill atrophy does exist but the Navy tries to minimize that by keeping you in those locations to 2 years. While that still may be considered long time, you can also now try to moonlight in those said locations at a civilian hospital to keep your skill maintained given that your chain of command (bosses) let you - this is the bureaucracy that you may have to fight and more state licensing to do for each state/credentialing at the hospital you may be in close proximity to.
- But the nice thing is that you are also the most paid resident/intern in the US (with full benefits) this can be a perk if you have family to take care of. PTO is definitely a plus.
2. Matched into civilian residency (Deferred status)
- same thing as the top applies. The Navy let you do a specialty training but with civilian deferment. then you are like everyone else in the match and will delay your payback to the navy for your medical school years and possibly your residency training so the payback is even much longer than Military match. But again the benefits kick in once you start as an attending and may not make as much as the civilian counter part.
Another downside is that if you get really interested in a fellowship, you may not get to do that right away because the needs of the Navy comes first. Ths is another reason people get out of the navy because there was not enough fellowship opportunities.
3. Didn't match and have to do GMO tour.
1. If you were not competitive and did not get to match, you will do 1 year of intern year first. And then will be asked to GMO - General Medical Officer tour (after intern year, you do a GMO tour to shave off your payback time may that be flight surgeon, underwater dive medicine, or simple primary care). The con with this is it delays your desire to start residency right away and defer your training so you may not favor that outcome. But it will pay back your time with the Navy and you will have the option to either stay in the Navy for your residency or to apply civilian programs to start your career debt free as a resident once matched.
Bottom line is in the medical corps (MD, DO trained providers), the pay difference creates much desire to be outside in the civilian sector as quickly as you can with surgical specialty. But if you have some patriotism and love the idea of serving, then many people opt to stay in. Also with any hospital enterprise entity, (same goes for military medicine), there will be some administrative duties to perform which takes you away from clinical duties. Now, there is a bit more than the civilian sector due to military duties as well but pending on the person they either appreciate or abhor the experience/requirement outside of clinics.
To add to this, I have also encountered EM trained docs being tightly attached to seal teams if that floats your boat, while youll get very low acuity from day to day (mainly sick calls and annual physicals,) but when **** goes south you are the go to person to patch/stabilize people up
Also No docs on Submarines if that was also a concern (just IDC). UMOs typically stay homeport as a liaison to subpac with boats out in sea
- Joined
- Aug 16, 2020
- Messages
- 88
- Reaction score
- 128
I’ll just keep things on this thread. Here are a couple questions I have about military medicine, for anyone who can answer. Thanks.
1) Vacation time (I read it is 2.5 days/month accrual)
When can you go, where can you go - what restrictions apply?
2) Typical day civilian vs Navy doctor. I think I saw somewhere that you finish the workday sooner as a military physician. Is this true, and if so, is it a significant difference?
3) How often do you relocate? Chances of staying somewhere you like? (The answer I’ve seen so far is that this is unlikely. I would like to stay on the West Coast, if possible)
4) Other than pay, why do doctors leave?
1) Vacation time (I read it is 2.5 days/month accrual)
When can you go, where can you go - what restrictions apply?
2) Typical day civilian vs Navy doctor. I think I saw somewhere that you finish the workday sooner as a military physician. Is this true, and if so, is it a significant difference?
3) How often do you relocate? Chances of staying somewhere you like? (The answer I’ve seen so far is that this is unlikely. I would like to stay on the West Coast, if possible)
4) Other than pay, why do doctors leave?
- Joined
- Feb 27, 2008
- Messages
- 1,359
- Reaction score
- 191
1. Leave is accrued at a rate of 2.5 days a month. Leave works a little differently than civilian vacation. If you leave the area you have to be on leave. So say you decide to go somewhere starting Saturday and getting back the next Sunday. As a civilian that would be 5 days of vacation, as a military member that’s 7. (They wouldn’t charge you the first and last day if they were otherwise not a working day). Restrictions are whatever the military tells you they are. Could be that you aren’t allowed to leave the immediate area (they did this for a long time at the start of COVID but have relaxed some now), could be that they say you can’t go on leave because the command can’t spare you. You also have to ask for special permission for things like leaving the country.
2. Typical day will vary depending on command and specialty. I think mostly you are probably working more reasonable hours than your equivalent as a civilian, unfortunately it may also be more inefficient. My wife winds up finishing notes at night a lot because the clinic is so inefficient that she doesn’t have time to write them at work.
3. Generally you relocate every three years. Could be as few as one or two years in some situations, could be four or longer if you ask for an extension and they grant it. You may or may not luck into getting a specific location. The more limited you are in where you want to go the less likely that you will be upset about where they put you. So when you say stay on the west coast: if the definition of that is more expansive to include anywhere close to the west coast (i.e. 29 palms or Lemore, not just San Diego) you are more likely to get that.
4. People leave for a lot of reasons. Pay is a big one. Frustrations with the system can be another big one. Not wanting to deploy or continue to move their families. Inability to manage your career they way you want it (you want to do fellowship but it isn’t available).
- Joined
- Aug 16, 2020
- Messages
- 88
- Reaction score
- 128
Thank you. This is incredible helpful, and I really appreciate it.
- Joined
- Sep 16, 2008
- Messages
- 3,270
- Reaction score
- 2,875
Sure, it's the Navy, the Navy has ships.
"Jesus Christ, Kaffee, you're in the Navy, for crying out loud."
How much or your career? Likely very little. We don't have that many sea billets in the MC.
