Military medicine: right for me?

[Packersfan5]

Hi all,

First off, thanks for taking the time to read my post. I’ll jump straight to it, after years of reading as much as possible on military medicine, the time will soon come for me to begin making decisions for fall 2019 matriculation.Please bare with my long first SDN post.

Clearly, HPSP and USUHS are not right for everyone and certainly not worth it financially, even with the skyrocketing cost of medical school. However, I’ve had a strong desire to serve since I was a young boy. The financial aspect really does not deter me-I grew up in a middle class family and presume that I would do about the same until I got out of the military. With my dad as a police officer and my brother a Marine Corps officer, service is really my largest draw factor to military medicine. While most of my friends grew up about playing in the NFL, I thought about the day when I’d be wearing my boots and utes and carrying my M16. However, I understand that being a military physician will likely not give me the “military experience” I always thought about. Nonetheless, caring for military members would be a tremendously rewarding experience.

My trepidation comes from researching military medicine online, particularly on SDN. While I understand that people rarely jump on these forums to share positive experiences, the amount of overall negativity on the topic is incredible. I am posting in hopes to glean some insight from current military physicians, as I understand that experiences have changed significantly in the past decade. Also, I currently want to go into EM, but I understand that this will probably change in medical school. The military loves to boast about their high first-choice match rates, but I have read about a lot of people not being able to train in the specialty they want. How can this be? Army HPSP boasts match rates higher than civilian, and USUHS says 90% of their graduates get their first choice in specialty and location.

Trying the predict what my future will look like with military medicine seems to be much like trying to hit a moving target, only I have no idea what direction it’s going in. The “who knows” factor seems to be incredibly high-how many GME spots will be open in my specialty of choice? Will they make me do a GMO tour? What are the odds of skill atrophy? Unfortunately, I know there is no way to answer these questions, I just have to do the best with the information currently out there.

My biggest question: could it really be that bad? Especially considering I would only do my minimum commitment and get out (4 years HPSP or 7 years USUHS). I understand that everybody’s military experience is different, but are military docs really as miserable as they all seem on SDN? Is it really a toxic work environment filled with people counting down the seconds to their ADSO?

I am trying to decide between Army and Navy HPSP and USUHS (no real interest in the Air Force). I’d certainly rather be in the Navy (grew up in a large Navy town, better living locations, etc.), but it seems like the Army would be a better choice for a medical career (no GMO tours, many more GME slots, etc.). I’ve made some pro/con lists below and would truly value your input. Please focus on things other than financials, as there is plenty of information on that all over SDN (and with a little moonlighting can easily make 150k/year- 3 times the US median).

Overall military pro: compensation and benefits while in residency. Could support my spouse even if it took her a long time to find a job where we were stationed. Also, there’s no guarantee that I would match into my dream GME program and location as a civilian (I think often overlooked by negative SDNers).

Army HPSP pros: Largest medical branch, most GME slots, highest chance of training in the specialty I want.

Cons: living locations-this is a giant consideration for me and my future spouse. I would hate to kill her career being stationed somewhere like Fort Leonard Wood. Chances of Brigade Surgeons tour and skill atrophy-but what are the chances of this if I only have a 4 year payback after residency? Would they really take a young doc, fresh from residency and make them do this? Or is this something to do later in a career when trying to get promoted (make 0-5) etc.?

Army USUHS: Same as above, only with higher chances of Brigade Surgeons tour. Also, potentially higher chances of matching into my first choice GME program coming from USUHS. The 7 year commitment does take the “who knows what this will bring” factor to a whole other level…

Navy HPSP: Pros: living locations, chance to support Marines, draw to the Navy overall (everyone except my HPSP recruiter has told me not to join the Army, I’ve never read/heard anything positive about it, could be due to growing up in large Navy town).

Cons: chance of GMO tour and timing with my commitment. Say I have to do a 2-3 year GMO then they offer me my first-choice GME. At that point I accrue more time during residency-might as well have gone to USUHS. Really wouldn’t want to GMO and GFTO-seems like a waste of time.

Navy USUHS: Same as above except the 7 year commitment. It’s a double-edged sword: yes, longer commitment, but also allows for an attitude of “who cares?”-Even if they made me do a GMO tour, it wouldn’t lengthen my commitment. Afterwards, I could most likely train in my #1 GME program. Thus, I feel as though it’d be easier to take a leap of faith to the military. Also coming from USUHS may boost my chances of matching into first choice residency.

In sum, I am would not be doing this for the money (though not having to worry about 300k in loans +compound interest would be a giant weight off my shoulders). I have a very strong desire to serve, but the amount of negativity makes me cautious. As the saying goes, “smart people learn from their mistakes, really smart people learn from other people’s mistakes.” But, I suppose if my most irresponsible decision is to allow the government to pay for medical school in return for the opportunity to serve my country for 4 a years, that’s not so bad.

I’d really appreciate your input on this. Thank you for taking the time to read my thoughts.

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[militaryPHYS]

are military docs really as miserable as they all seem on SDN?

A lot to digest there. First, I applaud you for having done the homework investigating milmed pros/cons. To answer this first question, ALL military docs are not as miserable as how it seems on SDN. Some are. Many are not. Your initial expectations and motivations to serve often are the main driving force for this as you go further along in your career and as the pitfalls of milmed pile up around you.

As you said, there are a lot of unknowns and variables. A lot can change personally for you (choice of specialty, family, kids, motivation for medicine, etc) and a lot can change in milmed (GMO spots, specialty billet numbers, DHA overhaul, war, etc.). Therefore, I will default to my usual answer to questions like this: If you are willing to accept the cons of military service in general (outside of milmed) and really want to serve your country then you can likely remain neutral to happy even if your medicine Plan A doesn't happen. If you do not understand the cons of the military and sign the contract hoping to avoid large debt, if your Plan A does not work out you will likely be miserable and your practice intolerable.

In my opinion Navy docs seem happier than Army docs despite what you listed above. I am slightly biased, but from personal experience and even discussing it on SDN, Navy seems to anecdotally beat Army in terms of satisfaction as an attending.

If you really like the military atmosphere/lifestyle, want to lead others and can envision a 20 year career in the service then USUHS is a great option for the reasons you listed above. It does improve your networking within milmed, military practice experience and therefore improve your chances of getting your specialty and location of choice. This is not universal though. If you are hesitant at all about a career in the military then it is best to go HPSP (or not milmed at all) in case you get royally screwed somehow and want to leave ASAP.

I am USUHS Navy Ortho so reach out for specific questions. I have a series of posts pending on the website which are aimed at this specific discussion. They are pending local military PA and JAG review. Jacksonville OB department really put a damper on social media usage for active duty members. Lots of restrictions on what we can do and say online now.

 

[HighPriest]

I also applaud your background research, and to answer your first question: not all military docs are as miserable as they sound on SDN. MANY are, some are not. Experiences vary based upon location, specialty, mindset, and luck. The problem, as you pointed out yourself, is that there is literally no way to determine ahead of time where your experience would fall. I would argue, contrary to what some may tout, that you also can't always compensate for bad experiences with a good attitude. A good attitude goes a very long way, but it doesn't surmount everything. Wanting to join primarily to serve in the Armed Forces is one of the best mental frameworks to have if you want to try to climb the Everest that is happiness in milmed. But I will tell you from experience and anecdote that joining because you think you really want to serve and actually living that life aren't always congruent. Meaning a lot of guys want to experience the life of service that they have in mind, rather than the actual, real-life version of that service. What I mean is: it will probably not be what you think it will be. So expecting things to be worse than you think they'll be, but being ok with that simply because the act of service - whatever that might entail - is meaninful to you, it really the best mindset you can have.

Think of it like this: "I've always wanted to eat at this restaurant. I hear that about 70% of the time they'll serve you a plate of raw, infected donkey @$$ instead of food, but if I end up getting the plate of donkey @$$ I'll still eat it and be ok with that because all I really care about is that I'm eating at the restaurant."

Navy docs are happier. That seems to be a good, general rule.

I think USUHS does definitely help your networking skills. Mo co-resident know freaking everyone from day 1. I didn't know anybody. But USUHS will not beat good grades and a good interview. Like it was mentioned above, do USUHS if you might want a career.


To answer some of your other ponderings:

Yes, the Army would ABSOLUTELY put you in a brigade surgery slot right out of residency. Without hesitation and they'd think they were doing you a favor to boot. That doesn't mean it WILL happen, but don't ever think it can't, or that they would understand why it would be a bad idea for the $500,000 doctor they just bought. They blow up equipment worth more than you every single day.

The reason some people don't match into their specialty is because year-to-year the match rate varies. For some specialties it varies considerably. For others, it's always understaffed and it never fills. ENT, for example has been 0.75:1 match rate or 4:1 match rate. There are general trends you can follow, but it isn't easy to predict. It really all depends upon how many applicants they get in a year. The general trend I mentioned is that, when the match rate is 0.75:1 one year, it'll probably be 4:1 the next year because everyone thinks they have a great chance of matching. If you want to do family medicine, yeah, you'll match.

Skill atrophy issues are entirely luck-driven, or inevitable, depending upon what specialty you do. If you're a family doc, you're probably in good shape. If you're a pediatric neuroopthalmologist, then you're screwed. It'll all depend upon where you're stationed, and how long you're stationed there. This is also related to overall happiness. If you end up somewhere with a good regional experience, and good partners, and a relatively good command, and a good patient demographic, then you're likely to be happy. If you end up at Fort Polk....well, I hope you like solitude and mosquitoes.

I think it's very important to mention something you said: if location is very important to you or your spouse....well, that can very easily be a problem in the military. You really do have very little control over where you're going to end up beyond which branch you join and where they have hospitals. You can control it a little more depending upon which specialty you join (because they don't have certain specialties everywhere), but beyond that its a total crapshoot. So if location is really very important, you really shouldn't join. period.

 

[Packersfan5]

A lot to digest there. First, I applaud you for having done the homework investigating milmed pros/cons. To answer this first question, ALL military docs are not as miserable as how it seems on SDN. Some are. Many are not. Your initial expectations and motivations to serve often are the main driving force for this as you go further along in your career and as the pitfalls of milmed pile up around you.

As you said, there are a lot of unknowns and variables. A lot can change personally for you (choice of specialty, family, kids, motivation for medicine, etc) and a lot can change in milmed (GMO spots, specialty billet numbers, DHA overhaul, war, etc.). Therefore, I will default to my usual answer to questions like this: If you are willing to accept the cons of military service in general (outside of milmed) and really want to serve your country then you can likely remain neutral to happy even if your medicine Plan A doesn't happen. If you do not understand the cons of the military and sign the contract hoping to avoid large debt, if your Plan A does not work out you will likely be miserable and your practice intolerable.

In my opinion Navy docs seem happier than Army docs despite what you listed above. I am slightly biased, but from personal experience and even discussing it on SDN, Navy seems to anecdotally beat Army in terms of satisfaction as an attending.

If you really like the military atmosphere/lifestyle, want to lead others and can envision a 20 year career in the service then USUHS is a great option for the reasons you listed above. It does improve your networking within milmed, military practice experience and therefore improve your chances of getting your specialty and location of choice. This is not universal though. If you are hesitant at all about a career in the military then it is best to go HPSP (or not milmed at all) in case you get royally screwed somehow and want to leave ASAP.

I am USUHS Navy Ortho so reach out for specific questions. I have a series of posts pending on the website which are aimed at this specific discussion. They are pending local military PA and JAG review. Jacksonville OB department really put a damper on social media usage for active duty members. Lots of restrictions on what we can do and say online now.

Hi militaryPHYS,

Thanks for your insightful reply. A few follow-up questions:

Can you comment on the proportion of your navy USUHS classmates who had to do a GMO tour? I know the Navy has been claiming to be in the process of "phasing them out" for decades. I'd imagine going to USUHS would make a candidate more competitive for GME programs and therefore less likely to have to do a GMO. Is this flawed logic?

Do you know the proportion of Navy HPSP students who have to do a GMO? Or do you know where I could find such data? As I mentioned before, taking Navy HPSP and then doing a GMO would put my commitment near 7 years (same as USUHS).

If I could have my cake and eat it too (I know far from guaranteed) I would take Navy HPSP, go straight through an EM residency, and then get out after serving as an attending for 4 years. However, I know the odds of that are low (EM is more competitive in the military and may have to be a GMO).

Did you do a GMO tour? If so, how was it? It seems like it would either be 1:boring medically due to low acuity, but may have cool opportunities unparalleled in the civilian sector (possibly more of the military experience I am seeking) or 2: scary in the sense that if ever presented with a high acuity situation, I wouldn't know how to handle it because I would essentially be a glorified intern. Can you comment on this?

Thanks again.

 

[Packersfan5]

I also applaud your background research, and to answer your first question: not all military docs are as miserable as they sound on SDN. MANY are, some are not. Experiences vary based upon location, specialty, mindset, and luck. The problem, as you pointed out yourself, is that there is literally no way to determine ahead of time where your experience would fall. I would argue, contrary to what some may tout, that you also can't always compensate for bad experiences with a good attitude. A good attitude goes a very long way, but it doesn't surmount everything. Wanting to join primarily to serve in the Armed Forces is one of the best mental frameworks to have if you want to try to climb the Everest that is happiness in milmed. But I will tell you from experience and anecdote that joining because you think you really want to serve and actually living that life aren't always congruent. Meaning a lot of guys want to experience the life of service that they have in mind, rather than the actual, real-life version of that service. What I mean is: it will probably not be what you think it will be. So expecting things to be worse than you think they'll be, but being ok with that simply because the act of service - whatever that might entail - is meaninful to you, it really the best mindset you can have.

Think of it like this: "I've always wanted to eat at this restaurant. I hear that about 70% of the time they'll serve you a plate of raw, infected donkey @$$ instead of food, but if I end up getting the plate of donkey @$$ I'll still eat it and be ok with that because all I really care about is that I'm eating at the restaurant."

Navy docs are happier. That seems to be a good, general rule.

I think USUHS does definitely help your networking skills. Mo co-resident know freaking everyone from day 1. I didn't know anybody. But USUHS will not beat good grades and a good interview. Like it was mentioned above, do USUHS if you might want a career.


To answer some of your other ponderings:

Yes, the Army would ABSOLUTELY put you in a brigade surgery slot right out of residency. Without hesitation and they'd think they were doing you a favor to boot. That doesn't mean it WILL happen, but don't ever think it can't, or that they would understand why it would be a bad idea for the $500,000 doctor they just bought. They blow up equipment worth more than you every single day.

The reason some people don't match into their specialty is because year-to-year the match rate varies. For some specialties it varies considerably. For others, it's always understaffed and it never fills. ENT, for example has been 0.75:1 match rate or 4:1 match rate. There are general trends you can follow, but it isn't easy to predict. It really all depends upon how many applicants they get in a year. The general trend I mentioned is that, when the match rate is 0.75:1 one year, it'll probably be 4:1 the next year because everyone thinks they have a great chance of matching. If you want to do family medicine, yeah, you'll match.

Skill atrophy issues are entirely luck-driven, or inevitable, depending upon what specialty you do. If you're a family doc, you're probably in good shape. If you're a pediatric neuroopthalmologist, then you're screwed. It'll all depend upon where you're stationed, and how long you're stationed there. This is also related to overall happiness. If you end up somewhere with a good regional experience, and good partners, and a relatively good command, and a good patient demographic, then you're likely to be happy. If you end up at Fort Polk....well, I hope you like solitude and mosquitoes.

I think it's very important to mention something you said: if location is very important to you or your spouse....well, that can very easily be a problem in the military. You really do have very little control over where you're going to end up beyond which branch you join and where they have hospitals. You can control it a little more depending upon which specialty you join (because they don't have certain specialties everywhere), but beyond that its a total crapshoot. So if location is really very important, you really shouldn't join. period.

Hi HighPriest,

Thanks for your honesty. A few follow-up questions:

I've read about the variable year-to-year match rates. My Army HPSP recruiter showed me their specialty match rates from last year, but I've had trouble finding Navy match data online (all seem to be protected military docs I can't open). Do you know where I can access this data?

Regarding specialties, I think I'd be happy in many disciplines (though probably not FM or peds). I'm not going into this thinking, "I absolutely need to train in XYZ ultra-competitive specialty to have a good experience." Could you please let me know where I can find more info on where different branches station certain specialties? I imagine most of the medicine I am interested in would be at most reasonably-sized military hospitals.

That brings up another point: location isn't necessarily as important to me as just living in a reasonably-sized city. I fully realize that I will have to move multiple times. Could be a cool experience if I don't have to be stationed at tiny bases in the middle of nowhere. It seems like this interest would be better served in the Navy.

 

[HighPriest]

I do not know for the Navy. The Army does release this information annually, or thereabouts, but you need to know someone with access to their MODs site, if I'm not mistaken (it's been a long time since I needed to access that information). I assume the Navy has something similar, but again, I'm not sure.

Same thing is true for which specialties are stationed where. Each service has a list of how many practitioners are billited for each duty station. Those can change, but they do not often do so. But my experience was always that this wasn't very transparent until you were actually getting ready to go to your first duty station. Maybe I just wasn't looking at that sort of information until that time in my career. I still to this day have no idea how many people they station in other specialties at each duty station, so I have to imagine it would be very difficult, if not impossible, to get that information for all specialties. Your better bet is asking how many of each specific type of practitioner are located at a specific facility. Or "are there and Xs at station Y?"

You can definitely get stationed in the middle of nowhere with no actual reasonably-sized anythings nearby. I can tell you this from experience, and I wasn't even at the most remote station the Army had to offer. And I desperately did not want to go there, but that's where I went anyway. Location wasn't super important to be going in, but I realized that it was semi-moderately important to me all too late.

 

[d2305]

The physicians who have the most fun are the flight surgeons. One has to delay gme training, however.

 

[lobster_taco]

4th year Navy HPSP student/prior service Army officer here. I am mid-residency application process right now so hopefully I can answer some of your questions.

As far as Army vs Navy: I branch transferred to the Navy for a reason. I feel like the Navy take better care of their physicians, has better duty locations, and a more family-like organizational culture. I do not regret my time in the Army at all, but I am definitely happy I made the choice to transfer. The Army is notoriously terrible at communication and it seems like they don't have many resources to assist HPSP students, you can even see it on the HPSP facebook group...no one in the Army side of HPSP seems to know whats going on.

What % of residents do GMO/Flight/Dive?: About half. We had a briefing on this at ODS. However, the point system is weighted so that a returning GMO doc will have a really, really high chance of getting the residency spot they want. In the Army, there is a chance of going a GMO tour but it actually hurts your chances of getting the residency spot of your choice. Aside from that, GMO time seems pretty fun to me. One of my friends just finished his time as a flight surgeon and he had the time of his life.

Going straight through residency: There has been talk of getting rid of GMO tours for years. It isn't going to happen. Heard it straight from the mouth of the man who oversees GME for the entire DOD. It's too good of a deal for the military. I'm also interested in EM and just got the BUMED note for this year's application. There are 20 total EM spots divided between NMCP and NMCSD. Unknown # of civ deferrals. 4 total straight through spots. By my estimate roughly 40-45 people applying for EM.

 

[DeadCactus]

Another kudos for putting in some ground work and then asking for input.

I'm going to cut to the chase and throw out another option to consider: join the reserve or National Guard for a branch of your choosing. You have much more control over where you train and live, still get to serve, have more control over how you serve, and your family will not be uprooted every few years which will help facilitate your wife's career and a general better family life. You also get to keep a civilian job which while somewhat specialty dependent generally means less skill atrophy and higher pay.

USUHS is for someone fully committed to a military career and best suited for those with a significant prior service history. Yes, you will almost certainly have a largely administrative, skill atrophying tour but if you're doing USUHS you should begrudgingly want one of those to facilitate your career progression.

HPSP is best for someone who wants to spend a few years doing the military thing to satisfy a desire and then get out. It's great if you want to spend a few years as a flight surgeon or dive medical officer or doing operational medicine.

For branch, if I was going to join to do operational medicine, I would join the Army. Otherwise, the Navy generally has more comfortable locations and deployments. The Air Force is sort of a middle ground and seem to get farmed out to the other branches a lot anyway.

I think you'll find that happiness in military medicine is a combination of good luck, a desire to practice military medicine, and realizing that military medicine is its own thing and not just practicing specialty X in a uniform.

Your post gives me the impression that Navy HPSP might be a good fit for you but that your family considerations might make the Reserve or Guard a better option. I wouldn't look into USUHS and probably wouldn't let GME concerns push me toward the Army.

 

[John1513]

Strong work doing your homework.

You have the key ingredients for success - a heart to serve and situational awareness.

No, it is “not that bad.”

I think you will do fine.

Hope to see you as a colleague soon.

Semper Fi

 

[Black Coffee 24/7]

Hi all,

First off, thanks for taking the time to read my post. I’ll jump straight to it, after years of reading as much as possible on military medicine, the time will soon come for me to begin making decisions for fall 2019 matriculation.Please bare with my long first SDN post.

Clearly, HPSP and USUHS are not right for everyone and certainly not worth it financially, even with the skyrocketing cost of medical school. However, I’ve had a strong desire to serve since I was a young boy. The financial aspect really does not deter me-I grew up in a middle class family and presume that I would do about the same until I got out of the military. With my dad as a police officer and my brother a Marine Corps officer, service is really my largest draw factor to military medicine. While most of my friends grew up about playing in the NFL, I thought about the day when I’d be wearing my boots and utes and carrying my M16. However, I understand that being a military physician will likely not give me the “military experience” I always thought about. Nonetheless, caring for military members would be a tremendously rewarding experience.

My trepidation comes from researching military medicine online, particularly on SDN. While I understand that people rarely jump on these forums to share positive experiences, the amount of overall negativity on the topic is incredible. I am posting in hopes to glean some insight from current military physicians, as I understand that experiences have changed significantly in the past decade. Also, I currently want to go into EM, but I understand that this will probably change in medical school. The military loves to boast about their high first-choice match rates, but I have read about a lot of people not being able to train in the specialty they want. How can this be? Army HPSP boasts match rates higher than civilian, and USUHS says 90% of their graduates get their first choice in specialty and location.

Trying the predict what my future will look like with military medicine seems to be much like trying to hit a moving target, only I have no idea what direction it’s going in. The “who knows” factor seems to be incredibly high-how many GME spots will be open in my specialty of choice? Will they make me do a GMO tour? What are the odds of skill atrophy? Unfortunately, I know there is no way to answer these questions, I just have to do the best with the information currently out there.

My biggest question: could it really be that bad? Especially considering I would only do my minimum commitment and get out (4 years HPSP or 7 years USUHS). I understand that everybody’s military experience is different, but are military docs really as miserable as they all seem on SDN? Is it really a toxic work environment filled with people counting down the seconds to their ADSO?

I am trying to decide between Army and Navy HPSP and USUHS (no real interest in the Air Force). I’d certainly rather be in the Navy (grew up in a large Navy town, better living locations, etc.), but it seems like the Army would be a better choice for a medical career (no GMO tours, many more GME slots, etc.). I’ve made some pro/con lists below and would truly value your input. Please focus on things other than financials, as there is plenty of information on that all over SDN (and with a little moonlighting can easily make 150k/year- 3 times the US median).

Overall military pro: compensation and benefits while in residency. Could support my spouse even if it took her a long time to find a job where we were stationed. Also, there’s no guarantee that I would match into my dream GME program and location as a civilian (I think often overlooked by negative SDNers).

Army HPSP pros: Largest medical branch, most GME slots, highest chance of training in the specialty I want.

Cons: living locations-this is a giant consideration for me and my future spouse. I would hate to kill her career being stationed somewhere like Fort Leonard Wood. Chances of Brigade Surgeons tour and skill atrophy-but what are the chances of this if I only have a 4 year payback after residency? Would they really take a young doc, fresh from residency and make them do this? Or is this something to do later in a career when trying to get promoted (make 0-5) etc.?

Army USUHS: Same as above, only with higher chances of Brigade Surgeons tour. Also, potentially higher chances of matching into my first choice GME program coming from USUHS. The 7 year commitment does take the “who knows what this will bring” factor to a whole other level…

Navy HPSP: Pros: living locations, chance to support Marines, draw to the Navy overall (everyone except my HPSP recruiter has told me not to join the Army, I’ve never read/heard anything positive about it, could be due to growing up in large Navy town).

Cons: chance of GMO tour and timing with my commitment. Say I have to do a 2-3 year GMO then they offer me my first-choice GME. At that point I accrue more time during residency-might as well have gone to USUHS. Really wouldn’t want to GMO and GFTO-seems like a waste of time.

Navy USUHS: Same as above except the 7 year commitment. It’s a double-edged sword: yes, longer commitment, but also allows for an attitude of “who cares?”-Even if they made me do a GMO tour, it wouldn’t lengthen my commitment. Afterwards, I could most likely train in my #1 GME program. Thus, I feel as though it’d be easier to take a leap of faith to the military. Also coming from USUHS may boost my chances of matching into first choice residency.

In sum, I am would not be doing this for the money (though not having to worry about 300k in loans +compound interest would be a giant weight off my shoulders). I have a very strong desire to serve, but the amount of negativity makes me cautious. As the saying goes, “smart people learn from their mistakes, really smart people learn from other people’s mistakes.” But, I suppose if my most irresponsible decision is to allow the government to pay for medical school in return for the opportunity to serve my country for 4 a years, that’s not so bad.

I’d really appreciate your input on this. Thank you for taking the time to read my thoughts.

I can only speak for the Army bc I got out 2.5 years ago.

If you go into EM and join the Army, there is a very high chance that you will be in a Brigade or BSB slot after your training. You will get like 4-5 days per month in the hospital to diminish skill atrophy. The positive thing is that you will get at least a 4 day weekend once a month. A lot of EM docs moonlight in order to keep their skills fresh.

However, you will also go to NTC for 4-5 weeks once a year in order to be deployable at 24-72 hrs notice.

If you really want to serve and make a difference in the sandbox, I highly recommend for you to join the Reserve in order to stay away from the daily bs, but still have the opportunity to make a huge difference in the Middle East when they really need you.

 

[militaryPHYS]

I don't have the specific numbers of my class nor do I have a great resource for validated info on the topic since it varies so much year-by-year and specialty. I say again... GMO rate is entirely specialty specific. i.e. my ortho intern class at NMCP (for just my year) had a 75% straight through percentage (1 of 4 of us went out as a GMO). The next year was 100% straight through. The following year was 50%. This percentage is completely dependent on your specialty (transitional interns usually have a 50%+ rate of GMO time) and year that you apply (we were in a cool off following Iraq/Afghanistan invasions).

Your line of questioning (GMO specific, ways to decrease chances of GMO, etc.) plus your "plan A" being....

If I could have my cake and eat it too (I know far from guaranteed) I would take Navy HPSP, go straight through an EM residency, and then get out after serving as an attending for 4 years.

All of these really makes me think that you are better off either going HPSP or just staying civilian.

There are too many variables, unknowns, changes of heart, etc. in MilMed to have such a specific plan so early and have so many hesitancies to GMO tours. GMO tours are great...if you signed up for the right reasons and not just a free education.

I am one of the more naively positive people on the milmed forum and even I would urge you to re-evaluate your primary goal. Is it to serve in the military or to become a badass ED doc as soon as possible with no debt? Very easy to join the military...not so easy to guarantee a fastpass to ED attending in the military.

 

[Packersfan5]

I don't have the specific numbers of my class nor do I have a great resource for validated info on the topic since it varies so much year-by-year and specialty. I say again... GMO rate is entirely specialty specific. i.e. my ortho intern class at NMCP (for just my year) had a 75% straight through percentage (1 of 4 of us went out as a GMO). The next year was 100% straight through. The following year was 50%. This percentage is completely dependent on your specialty (transitional interns usually have a 50%+ rate of GMO time) and year that you apply (we were in a cool off following Iraq/Afghanistan invasions).

Your line of questioning (GMO specific, ways to decrease chances of GMO, etc.) plus your "plan A" being....



All of these really makes me think that you are better off either going HPSP or just staying civilian.

There are too many variables, unknowns, changes of heart, etc. in MilMed to have such a specific plan so early and have so many hesitancies to GMO tours. GMO tours are great...if you signed up for the right reasons and not just a free education.

I am one of the more naively positive people on the milmed forum and even I would urge you to re-evaluate your primary goal. Is it to serve in the military or to become a badass ED doc as soon as possible with no debt? Very easy to join the military...not so easy to guarantee a fastpass to ED attending in the military.

Hi MilitaryPHYS,

Thanks for sharing your insight on GMO tours.

To answer your point about motivations for military medicine, it really is specifically my desire to be in the military. Honestly, when I think about my future, I would be much more excited to wear my uniform and serve than my white coat (insert groans from SDNers here). I need to do more research about the types of GMO tours available, as they might actually provide more of the military experience that I am looking for. Currently, most of my knowledge about them comes from people complaining about them online-that's on me.

One of my draws to USUHS is to be in the military, and have my curriculum geared towards the military, from day 1. HPSP feels as though I might have to balance "2 worlds"- civilian med school+military. (This one foot in, one foot out phenomenon is why I really would not want to be in the reserves). From your experience at USUHS, can you comment on the ways this fully-committed approach helped (beyond networking)? I've read a few posts that say USUHS is essentially a civilian med school where students wear uniforms and that there really isn't much opportunity for military-specific training. If this is really true, and there isn't much military benefit, HPSP would probably be better for me (esp considering the fact that I don't think I would want a 20 yr military career (24 if I count USUHS years).

Thanks again.

 

[John1513]

One foot out, one foot in - you nailed it.

If your heart is to serve, it would better for you to go USHUS and milmed GME residency.

The disdain for civilian residency trained greenhorns is real - from your Nurse Corps clinic managers to the ones running utilization management.

Even Detailers place higher value on a milmed residency than a civilian one. They know of exactly what your training is if done via milmed, they can only guess that civilian ones are subpar.

Thank you for seeking advice and synthesizing them on your own.

Good job.

 

[Perrotfish]

Strong advice: if you are going to do this, take HPSP. No one should go to USUHS unless it's the only school they get into, and then it's a coin toss whether it's a good idea to reapply rather than matriculate.

You don't know this organization. You can't, not from the outside. So minimize your commitment. If you sign up for 4 years and you don't like it you will be one of the millions of Americans who served a single contract with with more honor than happiness. If you do like it you won't have hurt your career at all: the military still promotes pretty much any doctor willing to subject themselves to director jobs and other admin nonsense, and if you're not willing to do those things your medical school will not help you.

For f--ks sake don't agree to sign more than 4 years to any organization before you have even taken it for a test drive.

The disdain for civilian residency trained greenhorns is real - from your Nurse Corps clinic managers to the ones running utilization management.

I promise a military residency would not have made these people any easier to deal with.

 

[Dr. Wexler]

To answer your point about motivations for military medicine, it really is specifically my desire to be in the military....
One of my draws to USUHS is to be in the military, and have my curriculum geared towards the military, from day 1. HPSP feels as though I might have to balance "2 worlds"- civilian med school+military.

I think military medicine is best for people who otherwise would wanted to join the military. So I think potentially you are a good fit.

I'd argue HPSP is the way to go. You will have to do less balancing the military and medicine pieces vs. USUHS and I would argue get a better overall education.

I think USUHS is the way to go for:
-people with families who need the AD pay and benefits in med school
-prior service who are already going to stay in past when their USUHS commitment would end
-those who can't get into a decent medical school otherwise

Understand the military is going to pay for your education in exchange for limiting your choices (w/ respect to specialty selection, work location, other personal freedoms, etc.). I think most people match into what they want. I think fewer people match into what they want compared to the civilian world. Yes, you might get everything you want. But more than likely you will at some point have to sacrifice something in exchange for all the $ the military throws your way up front.

 

[militaryPHYS]

it really is specifically my desire to be in the military

I am glad that you clarified this. Your initial responses/questions made me think you were trying to avoid GMO time, not seek it. If you really want to serve and fully understand what you are signing up for then good on you. Keep the questions coming.

From your experience at USUHS, can you comment on the ways this fully-committed approach helped (beyond networking)?

Let me first start by saying that I think USUHS is only a good option for people who could consider sticking around for 20 years. If a career in the military is a NO WAY then don't do USUHS. This is an easy way to quickly rule it OUT as an option. If you fully understand what the military and milmed entails and can also see yourself maybe sticking around for 20 years then keep it on your list of options.

I would also say that applying to USUHS because it might be the only acceptance that you get is horrible idea. Most don't understand the military and also struggle academically if accepted. They often fail out or voluntarily leave before graduation. Then you are stuck paying the government back via a generic admin job in the military (probably serving your time deployed in the sand).

USUHS was great for me because I was prior service and already had some military experience so it was easy for me to feel comfortable right away. I also had a head start on resiliency to the military BS and "hurry up and wait" mentality.

By far the BEST PART about USUHS was the lack of nasty competition, gun decking or gunners. Everyone was working together as a team to maximize our learning efficiency. i.e. I used to create high-yield study sheets and then e-mail them to everyone to help them study. Most of the time this is unheard of at a civilian school. Even the grumpiest of SDN'ers would agree that the team/camaraderie within the military is the one thing that they miss.

USUHS also offers funded travel opportunities for your 3rd and 4th year clinical rotations. You can choose to rotate at any of the military MTF's with GME programs, or choose to stay close to D.C.. You get to rotate at civilian hospitals, trauma centers and even overseas if you want. Hawaii, San Diego, Seattle, Germany, Japan, etc. are all potential rotation sites for rotations. This gives you time to get used to frequent moves/travel and also provides more exposure to different areas of milmed. You even get paid EXTRA (per diem) if you choose to travel for your rotations. Some single friends of mine got rid of their apartments all together and just traveled for 2 years doing their rotations. Their bank accounts were loaded.

No one should go to USUHS unless it's the only school they get into, and then it's a coin toss whether it's a good idea to reapply rather than matriculate.

100% disagree with this. I would argue that if you are prior service and considering a career in the military anyway, or even if you are a civilian and understand military life and want to possibly make a career out of it then NOT going to USUHS is horrible mistake. You would be forfeiting a ridiculous amount of money and potential retirement benefits during medical school and residency. Also, do NOT go to USUHS if you are otherwise considered a poor academic candidate for reasons I listed above.

 

[Perrotfish]

By far the BEST PART about USUHS was the lack of nasty competition, gun decking or gunners. Everyone was working together as a team to maximize our learning efficiency. i.e. I used to create high-yield study sheets and then e-mail them to everyone to help them study. Most of the time this is unheard of at a civilian school. Even the grumpiest of SDN'ers would agree that the team/camaraderie within the military is the one thing that they miss.

Are you seriously arguing that USUHS, uniquely put of all medical schools, doesn't have any dinguses?

 

[militaryPHYS]

Not none, but not many.

 

[DeadCactus]

USUHS is special network just like the Academies and yes, you would have some opportunities to go to training while at USUHS and a military residency that would be harder or not available to students and residents in a civilian program. The curriculum is going to be 90% the same and the differences certainly don't justify an additional 3 year obligation and the associated financial loss. If you stick with EM or a similarly compensated specialty, you are easily losing $500k - $1million dollars in income through a USUHS contract compared to half that for an HPSP contract. USUHS makes sense if you are planning a career in the military and in few other situations.

 

[Packersfan5]

I am glad that you clarified this. Your initial responses/questions made me think you were trying to avoid GMO time, not seek it. If you really want to serve and fully understand what you are signing up for then good on you. Keep the questions coming.



Let me first start by saying that I think USUHS is only a good option for people who could consider sticking around for 20 years. If a career in the military is a NO WAY then don't do USUHS. This is an easy way to quickly rule it OUT as an option. If you fully understand what the military and milmed entails and can also see yourself maybe sticking around for 20 years then keep it on your list of options.

I would also say that applying to USUHS because it might be the only acceptance that you get is horrible idea. Most don't understand the military and also struggle academically if accepted. They often fail out or voluntarily leave before graduation. Then you are stuck paying the government back via a generic admin job in the military (probably serving your time deployed in the sand).

USUHS was great for me because I was prior service and already had some military experience so it was easy for me to feel comfortable right away. I also had a head start on resiliency to the military BS and "hurry up and wait" mentality.

By far the BEST PART about USUHS was the lack of nasty competition, gun decking or gunners. Everyone was working together as a team to maximize our learning efficiency. i.e. I used to create high-yield study sheets and then e-mail them to everyone to help them study. Most of the time this is unheard of at a civilian school. Even the grumpiest of SDN'ers would agree that the team/camaraderie within the military is the one thing that they miss.

USUHS also offers funded travel opportunities for your 3rd and 4th year clinical rotations. You can choose to rotate at any of the military MTF's with GME programs, or choose to stay close to D.C.. You get to rotate at civilian hospitals, trauma centers and even overseas if you want. Hawaii, San Diego, Seattle, Germany, Japan, etc. are all potential rotation sites for rotations. This gives you time to get used to frequent moves/travel and also provides more exposure to different areas of milmed. You even get paid EXTRA (per diem) if you choose to travel for your rotations. Some single friends of mine got rid of their apartments all together and just traveled for 2 years doing their rotations. Their bank accounts were loaded.



100% disagree with this. I would argue that if you are prior service and considering a career in the military anyway, or even if you are a civilian and understand military life and want to possibly make a career out of it then NOT going to USUHS is horrible mistake. You would be forfeiting a ridiculous amount of money and potential retirement benefits during medical school and residency. Also, do NOT go to USUHS if you are otherwise considered a poor academic candidate for reasons I listed above.

Hi MilitaryPHYS,

Lot's of good info here. Some follow up points/questions:

Do you know any ballpark figures on the proportion of Navy people who don't match into a military residency and have to go civilian? From my research, it seems like all military personnel should want to do a military residency. Can you think of any reasons to pursue a civilian program instead (besides simply not matching into the desired military GME program)? Also, coming from USUHS, would I be guaranteed a Navy residency (not have to do civilian differed)?

Army HPSPers are guaranteed an Army residency, which I think is a giant plus. If for whatever reason they granted a civilian deferment, there were 2 options for compensation: 1) get paid as a civilian resident or 2) the army would pay as though doing a military GME (O-3 pay). This also somehow affected ADSO, but I didn't completely understand that. Do you know if the Navy is the same way? I know-very specific question. Maybe should just ask my recruiter.

I'm disappointed to hear that USUHS has a reputation for people only attending because the couldn't get into any other decent schools. I have a 3.95 GPA and a 506 MCAT, along with really solid experiences, so I think I'll be competitive at most of the mid and lower-tier MD programs I applied to (and certainly all of the DOs).

As you mentioned, camaraderie is one of my major driving forces to USUHS. I think I'd be 100 times happier at USUHS than just about any other school. Not just because of the $$ (little time to spend on anything meaningful anyways) but the overall attitude there seems far superior to civilian programs, which all seem competition-rich. Also, as a kid who always dreamed about the military, it would be instant gratification to be be able to jump in and fully commit from day 1(alluded to that in my previous reply).

I realize that I'm trying to see the forest through the trees right now. I think it's important to keep in mind that all of options I listed in my first post are good options, and I could be happy with any of them. From everyone's advice, Navy HPSP or Navy USUHS sound like really good fits for me personally. I'll just have to keep thinking about what would be best.

The HPSP vs. USUHS debate also depends on what other schools I decide between, as I obviously haven't even been accepted anywhere yet for 2019 matriculation. MilitaryPHYS, if a few months from now I am blessed to be offered admission to USUHS and a few other schools, could I PM you for your input?

Thanks everyone for your input.

 

[pgg]

Are you seriously arguing that USUHS, uniquely put of all medical schools, doesn't have any dinguses?

I'm 16 years post graduation from USUHS now, so maybe my memory is foggy. I was pretty busy with my newborns and toddlers and wasn't a regular on the school social scene. And maybe the school is different now that the Army has more thoroughly polluted the sacred soil of what used to be NNMC. But I can't think of any real jerks in my class. A couple of oddballs and knuckleheads. It was a very friendly, team oriented, non-competitive place.

Of course, I didn't go to any other medical schools, so maybe everywhere is like that. (SDN suggests that's not the case.) All I know for certain is that there was none of the outright malicious hypercompetitive behavior I put up with as a pre-med undergrad. USUHS was a wonderful place to be a medical student.

 

[HighPriest]

I had competitive, gunner-types at my med school. None of them were @$$holes, per say, but I also had no need to get in their way. I did fine on my own, without needing their help or input, and I had plenty of friends who weren't that way. So in the end having gunners made little to no difference.

That being said, most of the USUHS guys I've met were very good people. The ones who were Westpoint first are 50% good people and 50% serious weirdo, so I know not everyone at USUHS is a normal, well-adjusted person.

I also have had no issues with USUHS grads professionally. Some of the smartest guys I've known have been USUHS, and some of the average-est guys I've known have been USUHS, but I can't recall any truly bad docs. I do agree that signing on without any prior military experience is a really risky maneuver. You don't know what you're getting in to, no matter what you think now, and you're signing up for a really extended period of time. But, that's a choice you'll have to make. 40 years ago some people willingly bought Ford Pintos. People make bad decisions in hindsight all of the time.

@Packersfan5 Being "Guaranteed" a military internship isn't necessarily a huge plus. It is if you graduate in the higher echelon of your medical school and apply to a specialty for which you're competitive and then match. It isn't if you don't do any one of those things, and end up matching into a TY year and then going GMO when you don't want to do that. I have known competitive applicants who would almost certainly have matched on the civilian side who got their "guaranteed" TY spot and then never got in to the specialty they wanted.

 

[militaryPHYS]

MilitaryPHYS, if a few months from now I am blessed to be offered admission to USUHS and a few other schools, could I PM you for your input?

Of course

Do you know any ballpark figures on the proportion of Navy people who don't match into a military residency and have to go civilian?

Again, this is very specific to year applying and specialty applying to. The year I applied ortho there were 12 deferments given which is pretty unheard of. But there were a lot of quality applicants and the Navy needed Orthopods at the time. Therefore, I wish I could give solid numbers but there are too many variables to even try to give a real answer.

Can you think of any reasons to pursue a civilian program instead (besides simply not matching into the desired military GME program)?

. To be honest. NO. If you are HPSP or USUHS your ultimate goal should be to train within the military. If it isn’t your primary goal then you probably shouldn’t have signed up in the first place. The training is just as good, you are gaining experience and networking within the military healthcare system, you are earning valuable active duty years towards your retirement and other benefits (GI bill transfer, etc.) and makes the transition in to attending life a breeze.

Also, coming from USUHS, would I be guaranteed a Navy residency (not have to do civilian differed)?

. You are guaranteed a Navy internship. Not necessarily residency. i.e. You will be given an internship because you need it to practice as a GMO or any other real physician role. Residencies are not guaranteed. If you are denied straight through the first time you will go out as a GMO, flight surgeon, UMO. Even on re-application you are not guaranteed a residency if you are a sub-par performer.

 

[j4pac]

I went to a DO school. The competition was high, but we have incredibly few throat slashing gunner types. I think we all felt we had yo do our best to succeed, but I think that most of us were very appreciative for being in medical school. DOs are often fringe medical student types to begin with...so you don’t get a ton of students who think they are hot ****.

I compare this to a MD school about an hour away from me. Most of the student there were still good people, and two of my best friends even came from that school. But absolutely no question that the MD school had a higher percentage of gunner-types, arrogant dingus types, entitled types, and most surprising lazy types.

The military is largely filled with docs who are good people. It’s definitely a different crowd and isn’t pretty rare to find someone with overwhelming negative qualities in milmed.