Military Medicine: Pros, Cons, and Opinions

[Hans Gruber01]

You are exceedingly likely to be deployed and probably in less danger physically while deployed than you get from your current commute. You'll be an internist, not a hospitalist, in all likelihood. Most military practices are old-school combos of clinic and ward work (far more likely to be in a clinic only job than a inpatient only job). The bigger issue is where you'll be stationed. There are some terrible army bases. That said, if you can get them to promise you a billet for signing up, you'd be likely to be able to stay there for the 4 years. For IM, the pay is pretty good and the job isn't terrible. Lots of petty frustrations but the patient population deserves great care. I guess its a question of what citizenship is worth to you. Your wife will probably hate this decision (you'll deploy right when she's ready to start a family, etc).

What do you mean by "billet" when you say promising you this? Sorry for the ignorance. I am currently trying to find out information on HPSP and whether or not to sign up.

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[Red Lobster Actual]

What do you mean by "billet" when you say promising you this? Sorry for the ignorance. I am currently trying to find out information on HPSP and whether or not to sign up.

In the Navy, billet = job

basically

 

[browneyes124]

Do Military medical students have to go through the match like civilian physicians? Also if you dont get matched into what you want can you apply for a different residency or do they just choose for you?

 

[backrow]

Do Military medical students have to go through the match like civilian physicians? Also if you dont get matched into what you want can you apply for a different residency or do they just choose for you?

There is a military match that is similar to the civilian one. They have "rigged" the match so you essentially have to choose a primary specialty and then a back-up one in case you don't match in the primary one. This is one way they can make the statistics say "everybody matches in a specialty of their choice" for internship. There's a little nuance to it, but that's the gist of it.

 

[browneyes124]

There is a military match that is similar to the civilian one. They have "rigged" the match so you essentially have to choose a primary specialty and then a back-up one in case you don't match in the primary one. This is one way they can make the statistics say "everybody matches in a specialty of their choice" for internship. There's a little nuance to it, but that's the gist of it.

Is surgery specialities harder to get in the military than civilian world since it seems like there are not that many residency spots for surgeons? I would think they had more opening because of all the IED incidents and what not

 

[deuist]

Read this first: http://lukeballard.tripod.com/HPSP.html. It will answer most of your initial questions.

 

[mercutio_05]

I just separated from the Air Force after doing a combined residency (military + civilian) in Internal Medicine and finishing my 4 year HPSP commitment. Have to say... I am extremely happy and grateful for my time in the AF and would make the decision to sign up for the HPSP scholarship again in a heartbeat. That being said, I'm ready to move on but this was a great stepping stone for me professionally, personally, and financially. I remember coming on this website years ago before medical school and wondering if I was making the right decision. I recall there was a lot of negativity. Without taking much time to read recent commentary, I just wanted to share a positive story.

Now the experience was great for me personally but everyone is in a different situation. I can only speak as an Internist... and for that it was pretty great. My patient empanelment was 95% retirees in what would equate to a normal civilian IM clinic that skewed slightly old. For me, this was good: I got to see a lot of pathology and largely avoid the tedious paperwork associated with active duty patients (PT profiles, medical boards). I purposely sought out a location with a hospital (equivalent of a small regional hospital) to maintain inpatient skills. There was an associated residency to maintain some education/teaching. This all led to a nice, well-rounded experience that was a good foundation out of residency. I would see 12-13 internal medicine patients per day instead of scrambling out of IM residency (which is inpatient-heavy) to see 20 patients daily and worry about insurance and coverage. With a relatively light inpatient commitment (approx 15-20% of my schedule was for inpatient duties), most weekends were free. This allowed me to moonlight at a local civilian hospital (though the AF has hour restrictions for off-base employment). Though sacrificing weekends may not be a choice for everyone, this allowed me to further keep up my inpatient skills and make some nice extra $$$. I got to test the water of administrative duties and chairing committees (probably less likely so fresh out of residency in the civilian world) and this was good experience... or at least let me know administration is not my cup-of-tea. Even my 6 month deployment to the desert was a unique experience that I will remember (and be proud of) for the rest of my life. Financially, as a general internist the money wasn't bad (though there are plenty of other forums that do the math more precisely and for other specialties). It was nice to get a regular paycheck without the stressors of workload, metrics, etc while I was just starting out as a new physician. As I see Uncle Sam reach deeper into my civilian paycheck and I have other things to consider (medical/dental insurance), I realize the discrepancy in the primary care world is not monumental. Lastly, I got to take care of some really great patients. Keep in mind, as an internist, most of my patients were retirees so they had the discipline and wherewithal (or in support of their spouse) to put 20+ years in service of our country. Of course you'll always have bad apples but I couldn't have asked for a better group of folks to take care of as a new attending physician.

Of course, this is only one story - but positive stories need told, too. Experience may vary widely in different specialties, different branches (ahem, Army) and different family dynamics (I'm a single male). So why did I get out? The usual. The civilian pay is a draw (though do the math and consider other factors). I want the freedom to live where I wish. Being away from family/friends on deployment is tough. The Air Force's electronic medical record system is atrocious. Stupid/repetitive computer based training or non-clinical meetings are incessant. The longer you stay, the more you are pushed out of medicine and behind a desk (administration is not for me, as above). As with most govt/military/bureaucratic agencies, common sense often does not prevail. Is it perfect? No. Could I personally have put in another 13 years to get to that coveted pension? Probably not without becoming very bitter and irritable. But my time in military medicine was a great decision for me. I hope others find a similar reward.

 

[Ziehl-Neelsen]

Now the experience was great for me personally but everyone is in a different situation. I can only speak as an Internist... and for that it was pretty great. My patient empanelment was 95% retirees in what would equate to a normal civilian IM clinic that skewed slightly old. For me, this was good: I got to see a lot of pathology and largely avoid the tedious paperwork associated with active duty patients (PT profiles, medical boards). I purposely sought out a location with a hospital (equivalent of a small regional hospital) to maintain inpatient skills. There was an associated residency to maintain some education/teaching. This all led to a nice, well-rounded experience that was a good foundation out of residency. I would see 12-13 internal medicine patients per day instead of scrambling out of IM residency (which is inpatient-heavy) to see 20 patients daily and worry about insurance and coverage. With a relatively light inpatient commitment (approx 15-20% of my schedule was for inpatient duties), most weekends were free. This allowed me to moonlight at a local civilian hospital (though the AF has hour restrictions for off-base employment). Though sacrificing weekends may not be a choice for everyone, this allowed me to further keep up my inpatient skills and make some nice extra $$$. I got to test the water of administrative duties and chairing committees (probably less likely so fresh out of residency in the civilian world) and this was good experience... or at least let me know administration is not my cup-of-tea.

Sounds like you were at Travis or Keesler. Would your story be the same if you had been stationed at Mountain Home or Canon?

Of course, this is only one story - but positive stories need told, too. Experience may vary widely in different specialties, different branches (ahem, Army) and different family dynamics (I'm a single male).

This is the operative phrase... My military career has (so far) been similar to yours, but for everyone like you or me there are others who receive orders to godforsaken bases with low volume and acuity or are ordered into other situations that they consider personally trying (for whatever reason) . What medical students need to understand is that their story could be like yours or another one of the posters in the forum who has decidedly less flattering things to say about his military medical experience. And the rub is that whether one ends up in the former camp or the latter is ultimately out of the individual's control with only so much that the individual can do to influence it. Prospective military physicians need to know about the best case and worst case (which recruiters never seem to mention) scenarios and decide whether or not the money is worth the risk of the roulette ball landing on 0 or 00.

Caveat Emptor

 

[soulrider]

Hi,

I am a second year fellow in Pulmonary Critical Care. No student loans. 29 years old. Married, no kids. I've been thinking about joining Military Medicine (reserve or active) - is it too late for me? Is it not worth doing it anymore since I am almost towards the end of my training (only one and a half year left of fellowship)?

 

[Shikima]

Contact the recruiter and ask. Be sure to do it for the right reasons and also plan ahead if you're going to be moving to do the reserves.

 

[Kilgoretrout 65]

Hi,

I am a second year fellow in Pulmonary Critical Care. No student loans. 29 years old. Married, no kids. I've been thinking about joining Military Medicine (reserve or active) - is it too late for me? Is it not worth doing it anymore since I am almost towards the end of my training (only one and a half year left of fellowship)?

No loans, almost done with fellowship? Likely not worth joining especially if your spouse has a career.

 

[a1qwerty55]

Hi,

I am a second year fellow in Pulmonary Critical Care. No student loans. 29 years old. Married, no kids. I've been thinking about joining Military Medicine (reserve or active) - is it too late for me? Is it not worth doing it anymore since I am almost towards the end of my training (only one and a half year left of fellowship)?

Military ICU's are Super Low Acuity and Pulmonary procedure volume way too low to get good at anything. I hate to sound bitter but it is bad, very bad. First hand info here.

 

[a1qwerty55]

I am sad that your military experience has been negative, I am in the Army, a HPSP counselor, nurse and a pre-med major. I would like to say your experience is unique but I know that is not true, I can also say that others have not experienced the same thing. I know nothing of Navy medicine but I know the military in general is a sacrifice at times, I am no different than being a cop in some ways but when it all boils down to it. I made a choice to serve and service in itself is my reward. I didn't do it for pay or prestige but to make a difference. Kind of the same reason I am choosing medicine. I love people.

The main reason that physicians are so esteemed in society is because they have the awesome responsibility of caring for the sick and preserving life. As a nurse I have encountered many physicians that treat patients like their condition, an annoyance instead of treating the patient as a patient. Physicians worrying more about if they are going to get paid rather than whether or not they can preserve life. Military medicine is at least free from the hassles of malpractice and HMOs. It's funny but nowhere in the Hippocratic oath or the Osteopathic oath does it mention making loads of money. The profession of medicine is about one thing to me at least, the patient. Now I know you may believe that junior enlisted members are shown preferential treatment but I also know that in the Army at least, they sometimes live under conditions that officers would never be subjected to and for less pay at that.

Don't get me wrong, I am not attacking you. I believe what you say has merit, however it is not the only experience that military physicians experience. I went to the Downstate College of medicine commencement and the Dean of the school said it best "if you got into the profession of medicine to get rich, you are in the wrong profession, if you think that a physician will make loads of money and go on exotic vacations the on call pager will dispel that illusion."

I know that you have had to make sacrifices, sacrifices in time from family and financially, however, patriotism aside, there is another human being out there willing to take a bullet to preserve our way of life, your way of life. He doesn't care that he is not rich, he pays no mind to the sacrifices he must make as well. he is willing to die so that we can say what we want, make however much we want and live where we want. Army physicians, even the ones deployed will never, NEVER, sleep on the ground next to their weapon or ride along in a convoy they may never return from or stink without a shower for weeks because they are out in the field and definitely not for $24,000 a year.

You may leave the service and you are still my brother Sir because for whatever reason, mercenary, selfish, selfless or compassionate, you made the choice to put on a uniform to defend what we stand for. Bless you sir and thank you for your sacrifice.

Dear nurse recruiter. You have no clue what it is to be a physician and more specifically a military one. I love your idealism but don't try to talk about Hippocratic Oaths etc, you don't really have a clue. The doctors going into medicine to get rich is a bit of a stereotype and not very accurate. Regarding the field/deployments I guess you've never heard of light infantry BN surgeons. I seem to remember freezing my balls off, on the ground with my weapon carrying a ridiculous amount of crap. Oh yes we do go on conveys down range monkey balls. I agree soldiers deserve good care and it is a calling but damn our leaders are bad and thwart care. I was once labelled as a cheerleader but not anymore.

 

[idoitforv]

You guys paint such a rosy picture of military medicine lol... anyways I'm currently an Active Duty Marine with 12 years of active service. Deployments... done it, long schools... done it, terrible duty stations.... way done it, missed births... you get the idea! I know what the military is and what it isn't, I'm actually writing this while on a 24-hour duty post.

I was given the choice of becoming a recruiter or getting out... I decided to get out and spend those 3 years at med school instead. I have a bachelor in business and plan to use 2 years of my post 9/11 benefits to reorient my degree to pre-med and then sitting for the MCAT.

Originally my goal was to attend USUHS as it would make me an O-1E with 12 years of service right away. I read and tried to digest a majority of your grievances but with my feeble jarhead mind, its kind of hard to apply it to my situation. I'm 32, married with 4 kids and planned on retiring before the Marine Corps screwed me over one too many times.

What advice can any of you give me? Am I crazy? Is HPSP or FAP something I should consider if I don't get into USUHS? Marines don't have MO's, I'm not keen on ships but not completely against joining the Navy, which one would suit me best AF, Army, Navy? If I really want to match to a specialty like Radiology or Anesthesiologist should I try to go civilian the entire way till I'm board certified and then join?

 

[Shikima]

You guys paint such a rosy picture of military medicine lol... anyways I'm currently an Active Duty Marine with 12 years of active service. Deployments... done it, long schools... done it, terrible duty stations.... way done it, missed births... you get the idea! I know what the military is and what it isn't, I'm actually writing this while on a 24-hour duty post.

I was given the choice of becoming a recruiter or getting out... I decided to get out and spend those 3 years at med school instead. I have a bachelor in business and plan to use 2 years of my post 9/11 benefits to reorient my degree to pre-med and then sitting for the MCAT.

Originally my goal was to attend USUHS as it would make me an O-1E with 12 years of service right away. I read and tried to digest a majority of your grievances but with my feeble jarhead mind, its kind of hard to apply it to my situation. I'm 32, married with 4 kids and planned on retiring before the Marine Corps screwed me over one too many times.

What advice can any of you give me? Am I crazy? Is HPSP or FAP something I should consider if I don't get into USUHS? Marines don't have MO's, I'm not keen on ships but not completely against joining the Navy, which one would suit me best AF, Army, Navy? If I really want to match to a specialty like Radiology or Anesthesiologist should I try to go civilian the entire way till I'm board certified and then join?

Or take out loans and join on your terms?

 

[idoitforv]

I've actually given serious thought to that idea, at the end of the road I might decide to stay civilian and not have any commitment or if the terms for military service are right I might join at that point.

 

[Koogy]

I've actually given serious thought to that idea, at the end of the road I might decide to stay civilian and not have any commitment or if the terms for military service are right I might join at that point.

Interms of career- chose the one that's fastest route to get you to work. Med school is long. Being a PA is shorter. You pretty much do the same work and it's shorter. With all your years of service, you'll probably be making just as much as an md. My roommate in grad school
Went into the AF at graduation and is a PA at some base. She was single with no dependents and graduating was hard work because of the demands of the program. Med school is worse. She did have an HPSP scholarship funding her however. So that's another option.

Think about your family (how little your been available to them due to marines, and you'll be even less available during school). The less school you do and still get a job Doing what you like, the more time you'll have for your family.

PA's are doing more and more and we psychologists can now prescribe. Navy doesn't allow you to specialize either until you do enough service as a general practitioner. So if you want to be a generalist, you can get away from being a PA. PA's have just as much predige and fanfare as MDs and usually are the first point of contact for patients.

I'm single and 33. Doing grad school with just a full time job and no dependents was barely "manageable". Add a family to that and it becomes almost impossible. So get into a medical field and program that will get out as fast possible. The older we are the harder it is to learn and compete with the young folk. So chose the shortest route possible. My 2 cents.

 

[idoitforv]

Thanks for the input Koogy, I'm pretty set on becoming an MD or a DO. I do understand its going to a long, long road and have accepted that. I've been away from my family alot, so I dont think medical school will pull me away more but I guess I could be wrong. Recruiting would've meant I was away from my family 60-90 hrs per week.

I will not be working, not even a little bit while attending school. My wife is an accountant and will be supporting us, supplemented by my Post 9/11 benefits.

 

[Jaundice101]

I am currently an active duty AF physician paying back my HPSP service commitment. I had the unexpected opportunity to briefly pursue a civilian unfunded fellowship which was given to me while seeking a military fellowship. I think I can fairly confidently say that, having had 7 years of medical practice since medical school now, military medicine (A) comes with a long list of both pros and cons and (B) is highly heterogeneous making the exact calculus of (A) at any specific base in any specific specialty for any specific individual somewhat difficult to calculate. On the whole though I feel that if you are wanting to join military medicine in order to serve in our nation's military, realizing there are significant sacrifices attendant to such a commitment, and actually deploy to a combat zone to provide actual care to our nation's war fighters then you will likely (though not certainly) be satisfied with your decision. If you are going mercenary and doing it to escape loans or through chance or through design happen to never deploy you will very likely (perhaps certainly?) think it a mistake.

Some quick pros - (1) depending where you do your schooling the HPSP scholarship can be relatively generous, (2) resident salary is good, (3) resident hours are good, (4) resident education is decent, (5) generous holidays, (6) some bases are nice, (7) some staff hours are good, (8) freedom from the juggling medical insurance and the impact of medical insurance on care, (9) fewer unsavory social nightmare patients, and (10) the opportunity to serve your country

A number of cons - (1) depending where you do your schooling the HPSP scholarship doesn't add up to that much, (2) staff salary is relatively bad to very bad depending on specialty, (3) no stipend for conference attendance or CME, (4) EHRs are pretty junky, (5) hospitals with a few exceptions are relatively low volume and low acuity, (6) difficulty to do meaningful research outside the realm of military medicine, (7) got to deal with a lot of ridiculous military-specific training and demands, (8) some bases suck, (9) some staff hours suck, and perhaps the least appreciated (10) there is constant turnover of personnel by design such that few people have spent any significant amount of time at their position and have any significant degree of competence.

There are of course many more pros and cons that others have mentioned, but those are just the ones that immediately came to mind. In the end I am happy with my decision to serve in the USAF. If the cards had fallen differently, however, I very well may have felt differently, and I cannot argue with a number of friends who would not have made the same decision were they themselves able to make it again. Even if you're doing it for the 'right reasons' it's a bit of a gamble. I think that's the truest thing in the end that can be said.

 

[Koogy]

I am currently an active duty AF physician paying back my HPSP service commitment. I had the unexpected opportunity to briefly pursue a civilian unfunded fellowship which was given to me while seeking a military fellowship. I think I can fairly confidently say that, having had 7 years of medical practice since medical school now, military medicine (A) comes with a long list of both pros and cons and (B) is highly heterogeneous making the exact calculus of (A) at any specific base in any specific specialty for any specific individual somewhat difficult to calculate. On the whole though I feel that if you are wanting to join military medicine in order to serve in our nation's military, realizing there are significant sacrifices attendant to such a commitment, and actually deploy to a combat zone to provide actual care to our nation's war fighters then you will likely (though not certainly) be satisfied with your decision. If you are going mercenary and doing it to escape loans or through chance or through design happen to never deploy you will very likely (perhaps certainly?) think it a mistake.

Some quick pros - (1) depending where you do your schooling the HPSP scholarship can be relatively generous, (2) resident salary is good, (3) resident hours are good, (4) resident education is decent, (5) generous holidays, (6) some bases are nice, (7) some staff hours are good, (8) freedom from the juggling medical insurance and the impact of medical insurance on care, (9) fewer unsavory social nightmare patients, and (10) the opportunity to serve your country

A number of cons - (1) depending where you do your schooling the HPSP scholarship doesn't add up to that much, (2) staff salary is relatively bad to very bad depending on specialty, (3) no stipend for conference attendance or CME, (4) EHRs are pretty junky, (5) hospitals with a few exceptions are relatively low volume and low acuity, (6) difficulty to do meaningful research outside the realm of military medicine, (7) got to deal with a lot of ridiculous military-specific training and demands, (8) some bases suck, (9) some staff hours suck, and perhaps the least appreciated (10) there is constant turnover of personnel by design such that few people have spent any significant amount of time at their position and have any significant degree of competence.

There are of course many more pros and cons that others have mentioned, but those are just the ones that immediately came to mind. In the end I am happy with my decision to serve in the USAF. If the cards had fallen differently, however, I very well may have felt differently, and I cannot argue with a number of friends who would not have made the same decision were they themselves able to make it again. Even if you're doing it for the 'right reasons' it's a bit of a gamble. I think that's the truest thing in the end that can be said.

Now if only a navy psychologist could give such a thorough review on the psych threads! Thanks so Much for the enlightenment. Even though it comes for a more medical experience, it is still applicable to
Me, and my potential future ( As navy psych). Great overview!

 

[TexDoc81]

There is a military match that is similar to the civilian one. They have "rigged" the match so you essentially have to choose a primary specialty and then a back-up one in case you don't match in the primary one. This is one way they can make the statistics say "everybody matches in a specialty of their choice" for internship. There's a little nuance to it, but that's the gist of it.

Backrow do you have to fly all over and pay out of pocket like the civilians do? And what about Step 1,2, and CS it cost like $2,500, does the military pay for that? I'm a HPSP but I don't really get much info from those that have been thru the program, thanks for the knowledge man!

 

[deuist]

You can do your interviews in person during audition rotations, or you can do telephone interviews.

The military reimburses you for the STEP exams.

 

[flightdocb]

PS that was in reference to the above post not yours but in the Army you don't put off your residency like in the Navy because we do not have General medical Officers like the Navy. Look into it and if you have questions I am in the HPSP business, however I am here as a student not a recruiter.

The Army is full of GMOs and there is a high likely hood that anyone going in will have to put off residency and take am operational position in-lieu of going to residency.

 

[callendm]

The Army is full of GMOs and there is a high likely hood that anyone going in will have to put off residency and take am operational position in-lieu of going to residency.

The army is not full of GMO's. They have few that are reserved for last second changes in choices or the unfortunate bottom 5%. There are plenty of residency and fellowship positions. For fellowships their is some merit based component. However, there is also a time component which is very typical with military service. It is not horrible to have to wait a few years as you perform an operational assignment.

Bottom Line, HPSP is good. I was in from 2004-2015. One deployment. Completed all my training. You can get in and out in a decade. No debit. You can use your post 9-11 GI bill to get a master's degree after you get out. I'd do it again if I had the chance.

 

[notdeadyet]

The army is not full of GMO's. They have few that are reserved for last second changes in choices or the unfortunate bottom 5%.

This is untrue and the match statistics highlight this. Look at the match rate in fields like EM. Those folks who did not match are most typically GMOs. There aren't as many as in the Navy, but the Army has plenty.

 

[AlphaBeta<3]

.

 

[callendm]

This is untrue and the match statistics highlight this. Look at the match rate in fields like EM. Those folks who did not match are most typically GMOs. There aren't as many as in the Navy, but the Army has plenty.

I respectfully disagree. I am fully aware of match rate. GMO is absolutely not the norm. I have held positions in GME for the Army as well as UME for USUHS. I am in a good place to make these comments.

 

[HighPriest]

GMO is not the norm. They are absolutely out there, but not the norm. Those who don't match typically to a transitional year and then reapply to the same or another specialty. Because of the large number of training spots in the Army, most of those guys do match into SOMETHING. It may or may not be what they wanted depending upon their level of competitiveness, but that's true on the outside, too. There are those who choose GMO tours, either because they didn't match and they want to complete their ADSO and reapply as a civilian or because they want to reapply a third time to a competitive specialty, or in some cases because they leave their residency and want to reapply during a different cycle for another specialty (very rare, but I know of a couple of cases).

 

[Abishai100]

Vitruvian Verbatim

It is not enough that you 'like people' or 'care about medicine' for you to be an effective military doctor.

I remember watching the military medicine comedy-drama TV show M.A.S.H. growing up and how the drama of dealing with soldiers wounded in battle required the practitioners to be sensitive to the mental needs of the patients to feel like they were somehow 'extra-resilient' or 'extra-brave' for medical/surgical procedures.

This is a great thread, because it encourages students/practitioners to think about the 'conversational acupuncture' associated with military medicine, and if that sounds too 'rugged' or 'Ichabod Crane-ish,' you may be better suited for standard medicine or something like physiotherapy (which is just as intellectual)...

This kind of topic makes me feel a bit neurotic about the Vitruvian Man!

 

[waterproof013]

Basically what I get out of this feed is: To go into the HPSP and military medicine in general, you MUST have a deep-seated passion to serve your country and its soldiers. If you approach from a mercenary standpoint, the initial bonus/stipends, debt-free status and all the monetary and tax incentives are not worth the bureaucracy, ineptitude, lifestyle/family hindrances and “special” frustrations of working for the government, especially if you are able to land a decent civilian specialty. And, even if you are as honest and true in your desire to serve as they come, you will essentially be playing Russian Roulette between having an overall favorable or bitter late 20's and possibly (probably?) 30's as a military doc, dependent upon a myriad host of completely unpredictable career factors. AND, from what I have read, there appear to be 4 bullets in the six-shooter HPSP is using to play Russian Roulette. Additionally, whether you get put in a nice hospital with a diverse pt population versus a middle of nowhere med center is more or less out of your control, in the hands of the powers that be. There are so many variables based on the branch of the military, the specialty you choose to go into, the job you actually end up in, your family, you as an individual, the med school loan and tuition circus, military bureaucracy and just pure fate that there is virtually no way I, as an entering MS1, can even come close to an informed decision on committing to the military for residency and 4 or more AD years through HPSP. Of course, I am exaggerating in some respects but is this general impression true?

Sincere apologies,
Your typically confused pre-med

 

[WernickeDO]

Bingo. Well summarized.

 

[waterproof013]

Well, I think I've made my decision then. Sorry milmed, you almost had me!

 

[WernickeDO]

Another angel gets her wings...

 

[SeniorWrangler]

My 2 cents: if you have a spouse/SO who is not in the military, it can be brutal. You keep relocating every few years and, at least in my experience, you have no influence about where you go. Your job stays the same, but your spouse has to start over -- if he/she even has job opportunities in the new location. Unless they want to stay home and raise kids, this can put a huge strain on the relationship. This is one of the main things that got me out when I was just getting good at putting on the uniform

 

[Naijaman24]

I am currently an active duty AF physician paying back my HPSP service commitment. I had the unexpected opportunity to briefly pursue a civilian unfunded fellowship which was given to me while seeking a military fellowship. I think I can fairly confidently say that, having had 7 years of medical practice since medical school now, military medicine (A) comes with a long list of both pros and cons and (B) is highly heterogeneous making the exact calculus of (A) at any specific base in any specific specialty for any specific individual somewhat difficult to calculate. On the whole though I feel that if you are wanting to join military medicine in order to serve in our nation's military, realizing there are significant sacrifices attendant to such a commitment, and actually deploy to a combat zone to provide actual care to our nation's war fighters then you will likely (though not certainly) be satisfied with your decision. If you are going mercenary and doing it to escape loans or through chance or through design happen to never deploy you will very likely (perhaps certainly?) think it a mistake.

Some quick pros - (1) depending where you do your schooling the HPSP scholarship can be relatively generous, (2) resident salary is good, (3) resident hours are good, (4) resident education is decent, (5) generous holidays, (6) some bases are nice, (7) some staff hours are good, (8) freedom from the juggling medical insurance and the impact of medical insurance on care, (9) fewer unsavory social nightmare patients, and (10) the opportunity to serve your country

A number of cons - (1) depending where you do your schooling the HPSP scholarship doesn't add up to that much, (2) staff salary is relatively bad to very bad depending on specialty, (3) no stipend for conference attendance or CME, (4) EHRs are pretty junky, (5) hospitals with a few exceptions are relatively low volume and low acuity, (6) difficulty to do meaningful research outside the realm of military medicine, (7) got to deal with a lot of ridiculous military-specific training and demands, (8) some bases suck, (9) some staff hours suck, and perhaps the least appreciated (10) there is constant turnover of personnel by design such that few people have spent any significant amount of time at their position and have any significant degree of competence.

There are of course many more pros and cons that others have mentioned, but those are just the ones that immediately came to mind. In the end I am happy with my decision to serve in the USAF. If the cards had fallen differently, however, I very well may have felt differently, and I cannot argue with a number of friends who would not have made the same decision were they themselves able to make it again. Even if you're doing it for the 'right reasons' it's a bit of a gamble. I think that's the truest thing in the end that can be said.

Thanks for the post. I'm a former AF enlisted vet and I just graduated this year. I'm currently in the Match 2017 cycle and I would love to go back into the AF as a physician.

 

[heartsink]

Hey all; I've been reading the back-and-forth about GMO's recently, and i feel like i keep reading conflicting information.

Within the last year i had read people saying the Army was no longer doing GMO's, that the Air Force still did some, and that the Navy had the most likely chance of it. These more recent posts suggest nothing i've read is accurate. I'm applying to med school next summer and the USUHS is my #1 pick for a variety of non-mercenary reasons (ultimately would be shooting for psychiatry), but my greatest hesitation is that i would end up in one of these GMO tours; or worse, several of them.

I have looked but cannot find the metrics myself: How can i find out, truly, what the stance of each branch of the military has on GMO's and how frequently they utilize GMOs today in 2016?

 

[deuist]

Getting forced into a flight surgery spot in the Air Force is largely dependent upon how competitive of a residency you are looking into. Want to do dermatology, radiology or maybe emergency medicine? Remember to go up one size on your flight suit when you get it fitted. If you want family medicine, psych, or peds, you should be able to go straight through.

 

[WernickeDO]

Hey all; I've been reading the back-and-forth about GMO's recently, and i feel like i keep reading conflicting information.

Within the last year i had read people saying the Army was no longer doing GMO's, that the Air Force still did some, and that the Navy had the most likely chance of it. These more recent posts suggest nothing i've read is accurate. I'm applying to med school next summer and the USUHS is my #1 pick for a variety of non-mercenary reasons (ultimately would be shooting for psychiatry), but my greatest hesitation is that i would end up in one of these GMO tours; or worse, several of them.

I have looked but cannot find the metrics myself: How can i find out, truly, what the stance of each branch of the military has on GMO's and how frequently they utilize GMOs today in 2016?

GMO tours will ALWAYS be a thing. The question is how often or likely you are to do one. Historically, and this holds true today, you are much more likely to do a GMO tour in the Navy than AF or Army. That is not necessarily a bad thing, as Navy GME is set up in such a way that they expect a huge chunk of GMO applicants each year. In the Army, being a GMO is less likely, and therefore you are more of an anomaly than an expected entity. Basically, the Army has no idea what to do with their population of GMOs. Read the forum here for sob-stories of GMOs who have been put out to pasture.

You will always run a risk of being a GMO in the military, no matter what branch you are. If delaying your medical career to serve 2-3 years as a GMO sounds bad, then you should not join. And being part of the USUHS mafia does not preclude you from that possibility.

The Army at least does not publish the metrics on GMO match rates. I suspect this is intentional. The number of slots for returning GMOs is contingent upon what the MS4 class shapes up to be in terms of competition, e.g.-If there are 40 total slots and 45 highly competitive MS4s and 10 GMOs gunning for those slots, guess what: no GMOs are matching that year. The idea that a GMO tour makes you more competitive is a convenient half-truth. Bottom line, if the powers that be want you in a spot, then you are going to that spot, GMO tour or no. The whole points system only works if they want it to work. Another fun wrinkle is that at joint programs you won't know if they are considering applicants from your branch. I wasted my #1 pick last year for a program that was only taking AF applicants. I didn't even know that was a thing, so consider giving a prospective joint program a call and see if you can tease that info out.

 

[deuist]

If there are 40 total slots and 45 highly competitive MS4s and 10 GMOs gunning for those slots, guess what: no GMOs are matching that year.

I am not sure where you are getting this information. In the Air Force at least, a flight surgeon can earn up to 10 extra points through the match's scoring system that are not available to medical students. In essence, a mediocre flight surgeon can earn double the score of an outstanding medical student.

 

[WernickeDO]

I am not sure where you are getting this information. In the Air Force at least, a flight surgeon can earn up to 10 extra points through the match's scoring system that are not available to medical students. In essence, a mediocre flight surgeon can earn double the score of an outstanding medical student.

Maybe the AF operates that way. I have heard it straight from the program director's mouth that this is how it is. This is obviously not advertised and I have no way of ever proving this either. The point system is rigged. It can be skewed any which way they want it based on some unknown calculus. They don't throw everything against the wall and see what sticks; they know who they want and how to get the person they want. So someone who has GMO time and research can be trumped by someone else for a nebulous "potential as an Army officer" rating. I won't even pretend to know the ins and outs of it all. Year after year docs who have done GMO time, deployed, and done everything they were asked get shut out. And they're not always going for ortho and EM either. Additionally, I know both TYs and GMOs who have gotten shut out from their specialty, and then said specialty doesn't fill. There is no way to look at that other than the Army is saying no thanks to those applicants. Maybe they weren't always the best applicants, but my point is that in the Army GMO time does not mean as much on match day as people like to pretend it does. If you hang around long enough you can maybe get what you want, but you will accrue more ADSO and there are still no promises.

My point in all this is to dispel the lie that if you do your GMO time like a man/woman then there will be a residency waiting for you. This is simply not true and potential HPSP applicants need to know this. The Army has absolutely no problem with parking you in a windowless office writing NARSUMs all day. If you want to be a board certified physician, then avoid the military.

 

[WernickeDO]

The Army at least does not publish the metrics on GMO match rates. I suspect this is intentional. The number of slots for returning GMOs is contingent upon what the MS4 class shapes up to be in terms of competition, e.g.-If there are 40 total slots and 45 highly competitive MS4s and 10 GMOs gunning for those slots, guess what: no GMOs are matching that year. The idea that a GMO tour makes you more competitive is a convenient half-truth. Bottom line, if the powers that be want you in a spot, then you are going to that spot, GMO tour or no. The whole points system only works if they want it to work. Another fun wrinkle is that at joint programs you won't know if they are considering applicants from your branch. I wasted my #1 pick last year for a program that was only taking AF applicants. I didn't even know that was a thing, so consider giving a prospective joint program a call and see if you can tease that info out.

You know, @deuist makes me realize that my little assertion above is anecdotal. I stand by it in that it is true within my experience, but maybe it doesn't belong on SDN. I like that this forum is the best place for factual information on milmed, and I don't want to clutter it with my n=1.

@Homunculus I can delete the post if you like.

 

[Gastrapathy]

The GMO gets points compared to current interns for PGY2 selection. Categorical straight thru spots aren't in play at that point and only med studs can compete for those spots. The AF has more spots in that med stud only group than the other services.

 

[DrMetal]

number of slots for returning GMOs is contingent upon what the MS4 class shapes up to be in terms of competition, e.g.-If there are 40 total slots and 45 highly competitive MS4s and 10 GMOs gunning for those slots, guess what: no GMOs are matching that year. The idea that a GMO tour makes you more competitive is a convenient half-truth. Bottom line, if the powers that be want you in a spot, then you are going to that spot, GMO tour or no.

Quite true. Also true in the Navy.

 

[deuist]

Quite true. Also true in the Navy.

Geez, that is one thing that I can count on the AF for. At least if you get passed over the first time, a flight surgeon tour generally locks up a desired residency. I can't think of anyone who was rejected from residency after completing a utilization tour. I'm, sure they exist, I just haven't heard of someone never getting to do a residency ever .

 

[WernickeDO]

Geez, that is one thing that I can count on the AF for. At least if you get passed over the first time, a flight surgeon tour generally locks up a desired residency. I can't think of anyone who was rejected from residency after completing a utilization tour. I'm, sure they exist, I just haven't heard of someone never getting to do a residency ever .

I'm not saying that GMO/FS means never getting a residency. I'm also not saying that doing a tour means a mediocre applicant gets ortho or urology. What I am saying is that doing a tour does not mean you are going to match to a specialty that you are qualified for, and that the tour and points system is not as valuable as the authorities would have you believe. If you are a GMO and you require 3-4 years of service before you finally match to a specialty, then how exactly does the tour help you? HPSP is sold to pre-meds with the idea that if you don't match out of med school or don't get picked up for general surgery then you do a 1 year GMO tour and then come back and write your own ticket. In the Army this may have been the case at one point, but is no longer. In the Army, you have dozens of qualified GMOs who can't match to their chosen field because the Army would rather match MS4's.

Another fun fact is that if you are a 4-year HPSP and you do GMO for 3+ and then return to residency, you will always end up owing more time. You are better off just doing your time and getting out.

 

[Matthew9Thirtyfive]

Quite true. Also true in the Navy.

I thought the conventional wisdom was to expect a GMO tour between pgy-1 and pgy-2 in the Navy, partially because current GMOs get priority with the board. Is that not really true?

 

[DrMetal]

I thought the conventional wisdom was to expect a GMO tour between pgy-1 and pgy-2 in the Navy, partially because current GMOs get priority with the board. Is that not really true?

Read Wernicke's posts. He's hitting the nail on the head. If you're trying to match into a competitive specialty like say radiology, but you don't have the academic prowess to do so, no number of GMO tours is going to get you in. You're just gonna have to settle for something else, or get out and apply to the civilian match.

 

[Matthew9Thirtyfive]

Read Wernicke's posts. He's hitting the nail on the head. If you're trying to match into a competitive specialty like say radiology, but you don't have the academic prowess to do so, no number of GMO tours is going to get you in. You're just gonna have to settle for something else, or get out and apply to the civilian match.

Oh, I read them. I just thought I also read on this forum that GMOs get priority in the Navy. Maybe that's in points only, which may not mean anything. I'm not even in med school yet, but from my own clinical experience (~10,000 hours), I'm pretty sure I want FM. I do know a Navy GMO trying for rads though. Hope she matches, because she's super smart.

 

[DrMetal]

Oh, I read them. I just thought I also read on this forum that GMOs get priority in the Navy. Maybe that's in points only, which may not mean anything. I'm not even in med school yet, but from my own clinical experience (~10,000 hours), I'm pretty sure I want FM. I do know a Navy GMO trying for rads though. Hope she matches, because she's super smart.

There's no letter in any law that states GMOs get priority...there's also no law that states the point system must be in effect and must be utilized. If it's FM (or some other primary care specialty) that you want, you're more likely to match as some point. If you're gunning for a more competitive specialty and you're not a strong academic candidate, you should have a good Plan B, and good Plan C for that matter (Plan C probably being to opt out for the civilian---where a top 15% student can match into a RADS program somewhere...whereas you have to be top 5% to match into one of the 4 Navy GME spots).

The critics of HPSP are very right in pointing out that most recruiters don't understand the above. Hence the disadvantage of doing HPSP......

but the advantage is you don't have a $500K debt, you can GMO your way out and be on your merry way.

 

[Matthew9Thirtyfive]

There's no letter in any law that states GMOs get priority...there's also no law that states the point system must be in effect and must be utilized. If it's FM (or some other primary care specialty) that you want, you're more likely to match as some point. If you're gunning for a more competitive specialty and you're not a strong academic candidate, you should have a good Plan B, and good Plan C for that matter (Plan C probably being to opt out for the civilian---where a top 15% student can match into a RADS program somewhere...whereas you have to be top 5% to match into one of the 4 Navy GME spots).

The critics of HPSP are very right in pointing out that most recruiters don't understand the above. Hence the disadvantage of doing HPSP......

but the advantage is you don't have a $500K debt, you can GMO your way out and be on your merry way.

Thanks for the clarifications. Appreciate it. Going to have to hustle in med school.