Military vs. Civilian Surgical Residency

[navy]

I am considering military general surgical residency over civilian residency for the following reasons:

1.) Doing surgical training in the military will provide better preparation for being a general surgeon in the Navy during payback years.

2.) There are no fellows in the Navy, so despite less surgical volume, the operative experience may be better.

Any opinions or suggestions? Thank you.

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[The White Coat Investor]

I am considering military general surgical residency over civilian residency for the following reasons:

1.) Doing surgical training in the military will provide better preparation for being a general surgeon in the Navy during payback years.

2.) There are no fellows in the Navy, so despite less surgical volume, the operative experience may be better.

Any opinions or suggestions? Thank you.

I think you're wrong. You may not have a choice, but if you do I would do a civilian residency if I could, especially in general surgery and emergency medicine. The reasons to do a Navy residency are higher pay, and more time toward retirement.

Reasons not to do a military residency in general surgery are:

1) You don't have to deal with the military crap while trying to learn. Surgery residency is hard enough without having to stand at attention, do fitness tests, do extra paperwork on your off time etc.

2) There are simply fewer surgical cases in military medicine. Surgery residency isn't 5 years long to learn to manage the floor or the unit. You can do that in three. You do 5 years to learn to operate, and if the cases aren't there, you can't learn them, fellows or no fellows.

3) 5 less years spent on active duty. You have to give up a lot of personal freedom to defend freedom.

Good luck with the match.

 

[mitchconnie]

Having been a resident and an attending in both military and civilian surgical training programs, I have strong feelings that most military programs have serious deficiencies in many respects, but just to address your two points.

1.) Doing surgical training in the military will provide better preparation for being a general surgeon in the Navy during payback years.

Surgical residency should provide you with important training for the rest of your career, not just for your Navy payback. Why sacrifice case volume, case complexity, staff stability, etc. The only thing a military residency will teach you that you will not get in a civilian program will be dealing with AHLTA, and other military-specific administrative hassles.

2.) There are no fellows in the Navy, so despite less surgical volume, the operative experience may be better.

There are lots of civilian surgical programs that do not have many fellows. And there is no substitute for case volume.


There are some good reasons to do a military surgical residency. For instance, if you are planning on 20-year military career, the active-duty residency counts toward retirement. But I'm not sure the reasons you listed are valid. They sound like something a military program director made up to hype his program.

 

[navy]

ActiveDutyMD and mitchconnie, thank you very much for your responses.

I need to decide whether or not to apply for a Civilian deferral in the next few days...and would appreciate as much feedback as possible. If you agree (or disagree) with ActiveDutyMD and mitchconnie, please let me know.

Thank you very much.

 

[Ziehl-Neelsen]

I can only speak for the programs at which I have worked and where I know fellow residents (WRAMC, BAMC, and MAMC). There is no shortage of cases at these institutions. The number and complexity of the surgical cases at these institutions compare to any other highly respected civilian programs.

There are minor differences of course (BAMC has a greater trauma component while WRAMC sees the majority of the surgical oncology cases).

The surgical residents that I know at all three institutions are top notch (with the occasional malignant personalities one would find anywhere). These residents have expressed to me their contentment at these institutions and do not feel their residency training will be lacking. Bear in mind that these are probably the three top surgical programs in the army and the residents accepted to them were stellar medical school performers who knew that they would receive their top choice. If they had thought they would end up at Eisenhower or Keesler (as a medical school classmate of mine did) for a surgical residency, their tune may have changed.

 

[Galo]

Having been an attending for 6 years, and at a place where we trained residents, I wholeheartedly agree with mitchconnie and Activeduty MD. Of course my experience in the AF, but despite what many cheerleaders for military medicine print here, the problems are Dod wide.

Certainly the two reasons you gave were fully addressed by mitchconnie. I would reiterate that surgical volume and complexity is something you will be lakcing in the military. Unless someone who trained in the Army in one of the institutions mentioned comes here to give their experience, or gives it to you personally, I would take it like anything else, with some degree of caution. Also you have to look at the future of surgery. The advances that are coming are ususally issues that are hindered by the military mentallity, be it because of ignorance, stupidity of your boss, poor administrative support, but most of all it comes down to $$$.

Based on my experiece, my recommendation is to try and get good civilian training, then hope you have enough to to to keep your skills up, and get out. I would also recommend calling up the 4th and 5th year residents of the programs in the navy you could end up at, and see what they say.

Also, don't forget that you may not be given the choice. Hopefully you can at least get to residency instead of getting stuck being a GMO.

good luck

 

[sethco]

Also, don't forget that you may not be given the choice. Hopefully you can at least get to residency instead of getting stuck being a GMO.

Actually, I got passed up by the JSGME twice (once as a medical student, once as a intern) and I am now serving my time out as a GMO. At first, I was really upset, but after thinking about it, this was the best possible situation. Rather than being subjected to a military residency, which pales in comparison to a lot of University-based civilian residencies, I am just serving out my time and I have a top notch civilian program waiting for me. The only downside (obviously) is the break in training between internship and residency. In fact, I would recommend the route I took sooner than I would recommend certain military residency programs (secondary to case volume, pathology variety, ADSC commitments, fellowships, etc.)

IMO, the best case scenario is a getting a civilian deferment right out of med school (for some specialties, not all). But even then, I have heard a lot of attendings complain once they finish residency and start Active Duty. They seem to have the same problems as above and find they have to moonlight just so they can stay current, especially if they are not stationed at one of the "larger" military hospitals. This becomes a problem if either a) you are deployed frequently, b) your commander or the JAGs do not allow moonlighting, or c) you are stationed in an area where moonlighting is not available.

 

[Mirror Form]

I can only speak for the programs at which I have worked and where I know fellow residents (WRAMC, BAMC, and MAMC). There is no shortage of cases at these institutions. The number and complexity of the surgical cases at these institutions compare to any other highly respected civilian programs.

There are minor differences of course (BAMC has a greater trauma component while WRAMC sees the majority of the surgical oncology cases).

The surgical residents that I know at all three institutions are top notch (with the occasional malignant personalities one would find anywhere). These residents have expressed to me their contentment at these institutions and do not feel their residency training will be lacking. Bear in mind that these are probably the three top surgical programs in the army and the residents accepted to them were stellar medical school performers who knew that they would receive their top choice. If they had thought they would end up at Eisenhower or Keesler (as a medical school classmate of mine did) for a surgical residency, their tune may have changed.

While that may be true for the above locations, keep in mind that if you get stuck at Eisenhower or William-Beaumont you'll get incredibley sh*tty training, while being incredibley miserable for 5 years (speaking only for general surg).

 

[HumptyDumptyMil]

So a more general question about case load...I know that top notch programs always has lots of interesting cases, but i have also heard that you do not get as much hands on experience b/c you will be behind many people while in the OR. You have the fellows, attending, chief resident, resident, intern, etc.

In a speciality like surgery, would it better to go to a smaller size program so you can be hands on from the very beginning, or is it still better in the long run to be the person who looks at the back of other people's head for the first part of training and learn later?? I guess i'm asking about a quality vs. quantity issue here...

 

[USNavy]

I'm a 4th year applying for gen surg internship for 2013. I've read this thread, but am wondering if anyone has any updates as to quality of surgical training at the Naval hospitals (San Diego, Portsmouth, Bethesda). Is it still the best option to try for a gen surg deferment and go civilian for residency... which doesn't seem to be the easiest thing to get the Navy to agree to... but is the best way to become a well trained/experienced surgeon, and also increase your chances of landing a fellowship post-residency. Thanks for any comments.

 

[Aloft085]

Bump. Any other military docs have input on this? Also, how do the hours typically compare in military versus civilian residency?

 

[Doctor Bob]

Bump. Any other military docs have input on this? Also, how do the hours typically compare in military versus civilian residency?

The information in the thread is still accurate.

The medical work hours are the same for military vs civilian... ACGME rules apply in both.
But... the ACGME does not have any say over military obligation time. So you may still have to come in for commander's calls, random drug tests, AHLTA classes, etc, regardless of whether it's on your day off or after a call shift, or whatever.