Military residencies

[globaldoc31]

I've tried to find an unbiased residency ranking system which includes military residencies as well as civilian residencies but so far, I've been unable to do so. I looked at Doximity, which appears to have pretty accurate ranking criteria but I don't think they included military residencies. I'm primarily inquiring because I've been researching the HPSP scholarship and was told by an Air Force recruiter that the AF has "the best residencies in the world." Having been told to never trust a recruiter when it comes to things like this, I want an actual ranking to substantiate this claim.
If anyone has any input on AF vs Army residency quality and placement rate, it would also be appreciated.

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[BigNavyPedsGuy]

You won't find the list you're looking for. Also, the residencies vary wildly among services, specialties and locations.

Example: You would think trauma and surgery would be the best. I trained in San Deigo and the surgical program was cited there for too few cases and too many work hours (those two should never go together). Our hospital wasn't a trauma center so our ED and surgical specialties really missed out.

Peds and OB were VERY busy at this same hospital. The training was on par with good civilian programs (obviously I'm biased).

But it defies common sense that any military hospital would be great at babies and moms but not as great at trauma, but that's how the system works.

The only concrete answer to your question is that the Air Force (or any branch) does not have "the best residencies in the world". That's a really dumb statement. They range from good to bad with lots of variables and unpredictability in between.

If you want a top notch residency, you're best odds are NOT to join the military.

 

[afteranesthesia]

Doximity did rank military residencies. They are there. Fwiw.

 

[BigNavyPedsGuy]

I need to add one caveat: when I was searching for my civilian job, I was surprised by the near universal assumption that I was competent and qualified because I had been in the Navy. *shrug*

 

[IlDestriero]

I agree 100% with what the BigGuy said.
I've had the good fortune to spend some time at the NMCSD and a couple world class referral centers. It's night and day for surgery/anesthesia. Don't settle for average training when you could get great training in the civilian world.
There may be some above average programs, but most likely none have any leaders in the field, and patients aren't coming from all over the world to have the most complex cases done there. Anyone can do routine cases. For procedural specialties, regular exposure to very complex patients and challenging cases are where you learn new tricks, disaster management, etc.
That's one of the things that separates the men from the boys.

 

[colbgw02]

I need to add one caveat: when I was searching for my civilian job, I was surprised by the near universal assumption that I was competent and qualified because I had been in the Navy. *shrug*

I've encountered the same, but I wonder...how much of this is a vestige of when military residencies used to be much higher-quality (pre-Tricare) and when a much higher percentage of the population served in the military (Vietnam era)? And how much of it is just a reflection of what employers are really looking for? That is, in my experience, it really is true that employers care much, much more about a potential hire being reliable, friendly, and hard-working than they do about pedigree. Whether perceived or real (I think it's probably the latter), people with military experience have the reputation for have their heads screwed on right, which probably goes a long way with private practices.

I won't speak to the surgical specialties, because I know volume is so important there, but I liken the remainder of military residencies to attending a very large state university. To wit, you can get a good education, but you need to be highly motivated and an independent learner. I feel like my training was pretty good, but retrospect and being residency faculty has made me realize that there are too many people who have been able to skate by and who, frankly, I'm saddened to have as a member of my profession.

 

[globaldoc31]

Doximity did rank military residencies. They are there. Fwiw.

Thanks. I went back to the Doximity website and found them. It didn't seem like they were ranked very high. I'm getting the sense that, on average, military residencies are somewhere in the middle and definitely not near the top, as I was told.

 

[BigNavyPedsGuy]

Thanks. I went back to the Doximity website and found them. It didn't seem like they were ranked very high. I'm getting the sense that, on average, military residencies are somewhere in the middle and definitely not near the top, as I was told.

Yes, that's what we're telling you. Don't "get the sense" hear the facts.

Good for you for finding answers and not just believing a recruiter.

 

[globaldoc31]

Thanks for the responses. I'm not exactly sure which field I want to go into but I've been thinking about doing cardiology or possibly nephrology. Could anyone shed some light as to how difficult it would be to get a fellowship while doing the HPSP?

If I wasn't able to get a fellowship and went ahead and completed my four years and then got out, would it be likely that I could get a fellowship at that time?

 

[j4pac]

@BigNavyPedsGuy "too few cases and too many work hours"

Malignancy quotient = work hours / case volume

Obviously...the lower the number the better

 

[BigNavyPedsGuy]

Thanks for the responses. I'm not exactly sure which field I want to go into but I've been thinking about doing cardiology or possibly nephrology. Could anyone shed some light as to how difficult it would be to get a fellowship while doing the HPSP?

If I wasn't able to get a fellowship and went ahead and completed my four years and then got out, would it be likely that I could get a fellowship at that time?

Nobody can tell you this because it's completely random and varies year to year. There are not reliable numbers or odds to know. The best way to make sure you can do that fellowship is to stay a civlian.

You could do 4 years and then get out and pursue a fellowship. That was my plan. But with a family and established career, the option of going back to 3 more years of training at a 50% paycut was less than appealing.

You're asking a question about what will happen 8 - 12 years from now. 12 years ago "Anger Management" was the #1 movie in America and 50 Cent's song "In Da Club" was #1. A lot happens in 12 years.

Side note: that song is totally stuck in my head now.

 

[Clap MD]

In Da Club is 12 years old now? I guess time flies when you're pumpin jams. On a sadder note, if only the recruiter had been right about 10% of the things he said...

Also, +1 for the extreme variability in training programs. Granted, I only spent one year in one program, but that program was paired with a strong civilian institution and residents were completely integrated. The only way to tell us apart were the haircuts. On the other hand, guys I met at AMP (school for flight surgeons) had very different experiences at other AD locations.

 

[globaldoc31]

In Da Club is 12 years old now? I guess time flies when you're pumpin jams. On a sadder note, if only the recruiter had been right about 10% of the things he said...

Also, +1 for the extreme variability in training programs. Granted, I only spent one year in one program, but that program was paired with a strong civilian institution and residents were completely integrated. The only way to tell us apart were the haircuts. On the other hand, guys I met at AMP (school for flight surgeons) had very different experiences at other AD locations.

So you recently served a GMO tour? I was told that after spending a year doing a GMO, your residency application gets bumped up a few points and you have a much better chance of landing the residency that you want. Considering that it sounds like you just went through this process, can you confirm?

 

[Clap MD]

So you recently served a GMO tour? I was told that after spending a year doing a GMO, your residency application gets bumped up a few points and you have a much better chance of landing the residency that you want. Considering that it sounds like you just went through this process, can you confirm?

*am serving GMO tour. The application has a few more points for the JSGME following an AD assignment, but I was told by residents that it seems things are shifting to favor MS4s coming straight out of school (for obvious reasons... 9 months in and whatever skills/knowledge I had to start with are atrophying). Hoping that staying in touch with the PDs that knew and liked me, as well as getting back into the mix sooner rather than later, will result in a favorable match. One potential bonus of this little detour in training is that depending on your assignment/station you may have some free time to pad your CV with some research.

FWIW, a GMO I am stationed with was (allegedly) competitive for NSG coming out of med school, to the point he had PDs disappointed when the military gave him an intern->gmo track (again, per him). This same guy, 3 years later, didn't get an interview in gen surg programs and is going to do fam med in a pretty rural setting.

So all that to say this, and I hope it answers your question: depends on the residency you want, but better to do everything to match straight into what you want, and then maybe use what you were told to maintain some optimism during your GMO tour. That's how I'm approaching it.

 

[globaldoc31]

*am serving GMO tour. The application has a few more points for the JSGME following an AD assignment, but I was told by residents that it seems things are shifting to favor MS4s coming straight out of school (for obvious reasons... 9 months in and whatever skills/knowledge I had to start with are atrophying). Hoping that staying in touch with the PDs that knew and liked me, as well as getting back into the mix sooner rather than later, will result in a favorable match. One potential bonus of this little detour in training is that depending on your assignment/station you may have some free time to pad your CV with some research.

FWIW, a GMO I am stationed with was (allegedly) competitive for NSG coming out of med school, to the point he had PDs disappointed when the military gave him an intern->gmo track (again, per him). This same guy, 3 years later, didn't get an interview in gen surg programs and is going to do fam med in a pretty rural setting.

So all that to say this, and I hope it answers your question: depends on the residency you want, but better to do everything to match straight into what you want, and then maybe use what you were told to maintain some optimism during your GMO tour. That's how I'm approaching it.

Thanks for the response. You said that your skills/knowledge are starting to atrophy so if you don't mind me asking, what is your main duty during the day if you aren't doing a lot with medicine?

Also, were there quite a few AF students who didn't match into a residency and subsequently placed in a GMO tour? I had heard that the AF was cutting down on this and that there are hardly any GMOs in the Army.

 

[Clap MD]

Clinical encounters are pretty run-of-the-mill FP/sports med. Which is cool, but as a guy who spent fourth year busting his hump for a surg subspecialty, then spent last year in a gen surg intern year, it had been a while since I'd seen a patient in a primary care setting (it was probably Step 2 CS actually, if you can count that...) By my own account, I was a solid fourth year on my away rotations, but now probably have a fraction of that knowledge, having not really used much of it for close to two years now. Even with all the great gen surg learning and skills that I developed last year, I'd be apprehensive about going into a PGY2 spot in July and expected to function like I'd just finished an intern year. The pace and academics just aren't there in GMO land, at least where I am (and I'm sure this can be generalized to across the board).

Some flight docs/GMOs are assigned to the medical group and these guys see patients 4-5 days a week. Others are assigned to operational units and might only see patients in clinic 2-3 half-days a week. Main duties during the day for those assigned to ops are to support the flyers in their specific mission, which can vary widely based on their mission.
So you're probably wondering "how do I get one of those sweet gigs assigned to an ops squadron?" Well, this is kind of luck of the draw, but during intern year some tactful comm with the placement officer can go a long way.

I don't really know much about the numbers of matched vs unmatched, or even the unmatched that were sent straight GMO vs those of us who were selected for flight med.

And I have no idea how they are doing things over with the Army. A buddy of mine from school is Navy and their whole med school to intern to GMO process was pretty different from ours in the AF, so nothing would surprise me.

 

[IlDestriero]

FWIW, a GMO I am stationed with was (allegedly) competitive for NSG coming out of med school, to the point he had PDs disappointed when the military gave him an intern->gmo track (again, per him). This same guy, 3 years later, didn't get an interview in gen surg programs and is going to do fam med in a pretty rural setting.

That sounds like a load of bs.
Nobody is competitive for NSGY and suddenly is not competitive for GS and has to settle for FM, unless he derailed his career with a dui conviction, regularly f'ing up at work, etc.
His superior usmle scores, good LORs from his med school Neuro faculty, etc would still be there, as well as a new one from a command guy saying he is a solid citizen with leadership skills, managing the clinic, mentoring the enlisted, etc. etc. deserving of further training in his desired field.
If he got passed over for .mil residency, he could do a 4th year and go to a civilian program, assuming he was ever competitive.
I actually know someone that quit NSGY and did a FM residency, but he was an unusual case and independently wealthy. Getting married and anticipating a family made him rethink his career and what NSGY would mean.

 

[TurtleDO2012]

GMOs exist in army and other branches. They are alive and well, filled yearly. GMO time is suppose to improve your points but thing to consider is that you are not being compared to medical students. You are being compared to all the other GMOs and everyone else who isn't a medical student. So if a specialty fills from all medical students then obviously there won't be any spots for GMO applicants. Some specialties set aside spots for the GMO pool but it is a mixed bag from year to year. In terms of the board PDs have said med students get first look and they are only compared against each other.
In army world currently seems to really favor students due to the GMO time usually causing the residents to have a steeper curve getting back to being a resident. Some people have been dropped from their training for performance.
Army is also staying committed to time on station rules. So typically GMO time will be 2 years before returning to residency.
From my experience GMOs usually end up in a primary care specialty predominately after GMO time, few exceptions to other specialties that were mostly based on unique situations.

 

[Clap MD]

That sounds like a load of bs.
Nobody is competitive for NSGY and suddenly is not competitive for GS and has to settle for FM, unless he detailed his career with a dui conviction, regularly f'ing up at work, etc.
His superior usmle scores, good LORs from his med school Neuro faculty, etc would still be there, as well as a new one from a command guy saying he is a solid citizen with leadership skills, managing the clinic, mentoring the enlisted, etc. etc. deserving of further training in his desired field.

Yeah I tried to include enough qualifiers in my telling of his story to imply that I questioned its accuracy... He isn't really the get-drunk-and-burn-down-the-strip-club type so I question the initial assertion of his being competitive in the first place.

 

[globaldoc31]

ClapMD and TurtleDO: I'm guessing both of you did the HPSP? Would you still do it if you had to do it over again?

 

[TurtleDO2012]

I am a GMO, I did HPSP, I will very likely pursue civilian residency. Overall I am glad I have used HPSP for what it's worth and the experience I have had so far. I am "delayed" compared with my fellow classmates and that is annoying/frustrating but end of the day I am content to glad that I did HPSP. Once your a doctor you're forever a doctor hopefully and I have come to terms with the belief that it's not a race to get there. There's trade offs and consequences but for me 4 years of payback is small compared to a long and hopefully diverse medical career.

 

[TurtleDO2012]

Globaldoc31 sounds like a recruiter....

 

[globaldoc31]

Globaldoc31 sounds like a recruiter....

I started this post because I was trying to sift through some of the questionable claims that I was told by a recruiter.

 

[Clap MD]

I am a GMO, I did HPSP, I will very likely pursue civilian residency. Overall I am glad I have used HPSP for what it's worth and the experience I have had so far. I am "delayed" compared with my fellow classmates and that is annoying/frustrating but end of the day I am content to glad that I did HPSP. Once your a doctor you're forever a doctor hopefully and I have come to terms with the belief that it's not a race to get there. There's trade offs and consequences but for me 4 years of payback is small compared to a long and hopefully diverse medical career.

^what he said. If I could have known I'd end up with my current assignment and know I was going to eventually do what I love, I'd do it again. That being said, I have friends in much unhappier places and eventually doing what you love is not a given.

 

[jkmasterson]

Easiest way to determine how effective a residency is, is to look at board passing rates stratified by residency program for your desired specialty. Military residencies do ok compared with civilian residencies. Some do really well. None are horrible.

-2 of the 6 general surgery programs with 100% pass rates for the past 5 years are Army (Madigan and Beaumont). Not even Johns Hopkins and Stanford have 100% pass rate. Navy surgery in NMCSD being on probation is old news. They are doing really well at 86%, better than UCSD and UCSF and the same as Wake Forest.
http://www.absurgery.org/xfer/5yr_summary.pdf

-Internal med may not do as well, but still respectable.
https://www.abim.org/pdf/pass-rates/residency-program-pass-rates.pdf

Peruse at your leisure.

 

[notdeadyet]

Easiest way to determine how effective a residency is, is to look at board passing rates stratified by residency program for your desired specialty.

Disagree. Low acuity, low volume, low experience programs can skew high on board pass rates because these programs can hammer in study for the test. Board exams pass rates are not a good indicator of the hands-on experience of residents.

If you want to determine how effective a residency is, look at your dream jobs and see where people went who currently work them. It's not as skewed towards academic powerhouses as you'd think (unless your dream job is an academic gig), but the results may surprise you. It ain't going to correlate to a scan tron (am I betraying age?)....

 

[DrMetal]

Disagree. Low acuity, low volume, low experience programs can skew high on board pass rates because these programs can hammer in study for the test. Board exams pass rates are not a good indicator of the hands-on experience of residents.

If you want to determine how effective a residency is, look at your dream jobs and see where people went who currently work them. It's not as skewed towards academic powerhouses as you'd think (unless your dream job is an academic gig), but the results may surprise you. It ain't going to correlate to a scan tron (am I betraying age?)....

Absolutely true.

Jkm: what are you thinking? Do you want your cholecystectomy done by someone who's barely done any by himself but happened to pass his boards on the first shot? Or would you rather have the guy thats very skilled. but not the best test taker? Clearly the latter. Dont be delusional.

 

[sonofva]

Absolutely true.

Jkm: what are you thinking? Do you want your cholecystectomy done by someone who's barely done any by himself but happened to pass his boards on the first shot? Or would you rather have the guy thats very skilled. but not the best test taker? Clearly the latter. Dont be delusional.

I was kind of hoping that after I passed step 3 I wouldn't have to worry about how well I did on boards so long as I passed, then I could just learn for the sake of learning

 

[backrow]

Absolutely true.

Jkm: what are you thinking? Do you want your cholecystectomy done by someone who's barely done any by himself but happened to pass his boards on the first shot? Or would you rather have the guy thats very skilled. but not the best test taker? Clearly the latter. Dont be delusional.

I would bet there is a difference between the way people think about boards when comparing medical to surgical specialties. In my, somewhat small experience, those in surgical specialties think much higher of Boards than those in medical specialties. Surgical boards tend to be taken after residency and sometimes include an oral exam. These Boards may require surgical case logging, etc. Medical specialty boards tend to be completed during (or very shortly after) residency and usually include a written portion only.

I could be completely wrong, but just my hunch. And I do think that board passing rate plays a role in figuring out which programs are better than others. It wouldn't be my primary data point, but in general a program with a historically good pass rate is in general going to be better than one with a historically low pass rate. This can't be taken down to a micro, singular, level though because a smart person going to a bad program is still going to be a smart person.

 

[DrMetal]

I would bet there is a difference between the way people think about boards when comparing medical to surgical specialties. In my, somewhat small experience, those in surgical specialties think much higher of Boards than those in medical specialties. Surgical boards tend to be taken after residency and sometimes include an oral exam. These Boards may require surgical case logging, etc. Medical specialty boards tend to be completed during (or very shortly after) residency and usually include a written portion only.

I could be completely wrong, but just my hunch. And I do think that board passing rate plays a role in figuring out which programs are better than others. It wouldn't be my primary data point, but in general a program with a historically good pass rate is in general going to be better than one with a historically low pass rate. This can't be taken down to a micro, singular, level though because a smart person going to a bad program is still going to be a smart person.

I hear you, you're probably right with respect to all of the above.

Here's who cares: us, we're academics, we've been academics our entire lives.

Here's who doesn't care: the general public, our patient population. They only care about one thing: the work that we produce. I'm a junior guy. Between my sick call and the clinic I moonlight at, I've probably had about 1500 patient encounters, that I've managed independently +/- consults. I have yet to have a patient ask me where I've gone to medical school, how I did on my tests, etc, whether I'm board certified anything (I am not, have only had PGY1). I have had plenty ask me "when are you going to order my xray? what was the result? what do we do next?"

Surgeons? I want the guy who can do the procedure, submit the specimen cup to Pathology correctly, actually read the path report and do something with the result (it's good to note that you have positive margins and a revision is necessary . . . . .it's sad when a GMO has to bring that to your attention). Find me the residency program that produces that surgeon.

 

[notdeadyet]

And I do think that board passing rate plays a role in figuring out which programs are better than others. It wouldn't be my primary data point, but in general a program with a historically good pass rate is in general going to be better than one with a historically low pass rate. This can't be taken down to a micro, singular, level though because a smart person going to a bad program is still going to be a smart person.

This rings true. If I saw a program I was raising an eyebrow about, looking at whether or not people were passing the boards would be a good litmus test for programs that are of unknown or dubious quality. It's one of the few quantitative data points that you have. I just hear a lot of "we have a 100% pass rate" from low volume EM and Surgical programs. I don't hear this from the nearly universally respected programs in these fields.

I guess my takeaway would be that you can't be a really bad program if you have great board pass rates, but great board pass rates doesn't necessarily mean you're a good one.

 

[dab14]

Agree with the above. Started at SD as a general surgery resident (navy denied my deferment) and hated it. Low volume, no complex cases. Chief residents were barely making a 900 cases at the end of their residency. Empty beds = empty heads... Did two years as a GMO, which was an incredible experience (deployments, travel etc). DO recommend doing a GMO tour, yes it is a delay but a unique experience and you have the rest of your life to work. Applied again for deferment and got it. Much happier a civilian program. Ton better training.