Navy Anesthesiology Residency Advice

[AbbaZabba85]

Hello, I'm a 3rd year HPSP student and was interested in doing a residency in anesthesiology. Given the pros and cons of doing a military residency - which have been mentioned multiple times on this board - I was thinking of doing four years as a flight surgeon and getting out and doing civilian training. I realize that a residency is what you make of it, but I'd rather have the acuity and breadth of pathology under my belt that comes with training on the civilian side.

However, residencies are quickly getting more competitive across the board and I'm wondering if this is a risky strategy and I should stay in the military to do my training, especially since I'm a DO wanting to do an MD residency and the gold-standard ABA board certification that comes with it. I understand it's hard to predict the competitiveness of residencies years down the road, especially for a politically-charged field like anesthesiology, but I figured it'd be worth getting the opinion of the people on this site.

I consider myself a fairly competitive applicant: USMLE 235, COMLEX 679, all honors/high pass first two years, working on research now and hoping to publish, involved with the ASA, anesthesiology club president, etc.

Thanks in advance for the advice! This forum has been incredibly useful to me over the years.

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[IlDestriero]

Hello, I'm a 3rd year HPSP student and was interested in doing a residency in anesthesiology. Given the pros and cons of doing a military residency - which have been mentioned multiple times on this board - I was thinking of doing four years as a flight surgeon and getting out and doing civilian training. I realize that a residency is what you make of it, but I'd rather have the acuity and breadth of pathology under my belt that comes with training on the civilian side.

However, residencies are quickly getting more competitive across the board and I'm wondering if this is a risky strategy and I should stay in the military to do my training, especially since I'm a DO wanting to do an MD residency and the gold-standard ABA board certification that comes with it. I understand it's hard to predict the competitiveness of residencies years down the road, especially for a politically-charged field like anesthesiology, but I figured it'd be worth getting the opinion of the people on this site.

I consider myself a fairly competitive applicant: USMLE 235, COMLEX 679, all honors/high pass first two years, working on research now and hoping to publish, involved with the ASA, anesthesiology club president, etc.

Thanks in advance for the advice! This forum has been incredibly useful to me over the years.

Your USMLE score will open doors for you. I think the average step 2 at Stanford was 237. You're better than average, don't settle for astoundingly average Navy training. Do something interesting with your GMO time, volunteer for extra duty. Something that, while not technically challenging, proves your superior leadership and problem solving skills. Sell that in your letter when you apply. You could say you sat on your duff for 4 years pushing paper around and trying to dodge a second deployment, OR you could discuss how you were the responsible physician for an active combat ready flight squadron, responsible for coordinating, training, and scheduling a 12 man medical clinic, etc.etc.
You will get the strong residency spot, your leadership skills will impress. What you offer will decimate the straight out of medical school guys. And, if that's not enough, there are tons of vets out there at fantastic academic programs and we look out for each other.😉
Good luck!

 

[Perrotfish]

Your USMLE score will open doors for you. I think the average step 2 at Stanford was 237. You're better than average, don't settle for astoundingly average Navy training. Do something interesting with your GMO time, volunteer for extra duty. Something that, while not technically challenging, proves your superior leadership and problem solving skills. Sell that in your letter when you apply. You could say you sat on your duff for 4 years pushing paper around and trying to dodge a second deployment, OR you could discuss how you were the responsible physician for an active combat ready flight squadron, responsible for coordinating, training, and scheduling a 12 man medical clinic, etc.etc.
You will get the strong residency spot, your leadership skills will impress. What you offer will decimate the straight out of medical school guys. And, if that's not enough, there are tons of vets out there at fantastic academic programs and we look out for each other.😉
Good luck!

You're advising this poster to sacrifice 4 years of attending income, and to wait an extra 4 years before having a stable, family friendly lifestyle, for the theoretical hope that he will get into a better civilian training program at the end of his obligation with a DO degree (there is a bias out there) and less than a 240 on step 1. In a field where the income level is in tremendous flux. That's nuts.

By all means, the OP should try for a civilian deferment. And making the best of a GMO tour if you have to is great. Bit there is nothing so bad about military residency that its worth an extra 4 years of waiting for life to start.

 

[IlDestriero]

Rethink your math.
He would do his payback and be out in 5 years, free to pursue his life free of further deployments and military entanglements. He can happily go off to a nice stable civilian residency, and get on with his life. 8 years until civilian payday. He can also use the gi bill to supplement his income for his 36 months of residency. If he stays in, he will not be selected for civilian training, almost certainly, and will likely have to do a GMO to match into anesthesia at all. If he does flight surgery, as he indicated he's thinking about, he will be in the military for 10 years. 10 years to civilian pay day, and a graduate of a pretty average residency as well.👍
Yes he will always be a DO, and it won't do him any favors, but he could be applying for residency with his strong board scores and significant and impressive documented leadership skills and years of maturity over the average applicant. That will get him the hard to get interviews.
Nobody has any idea what will happen with incomes, CRNAs, etc. getting out a couple years early won't make any real difference.
I think he'd be a fool to stay in and accept average training when he has a real chance of impressing the faculty at a superior training program. After his GMO time, if anesthesia is taking a beating, he may not even want to pursue it anymore. And he's likely to need a GMO tour anyway to match.
Where's the tremendous income flux? My income has gone up.
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Il D

 

[pgg]

Navy anesthesia was downsized this year. 12 slots divided among the big 3, because we're overmanned. That may increase in the future. Or it may not.

 

[Perrotfish]

Rethink your math.
He would do his payback and be out in 5 years, free to pursue his life free of further deployments and military entanglements. He can happily go off to a nice stable civilian residency, and get on with his life. 8 years until civilian payday. He can also use the gi bill to supplement his income for his 36 months of residency. If he stays in, he will not be selected for civilian training, almost certainly, and will likely have to do a GMO to match into anesthesia at all. If he does flight surgery, as he indicated he's thinking about, he will be in the military for 10 years. 10 years to civilian pay day, and a graduate of a pretty average residency as well.👍
Yes he will always be a DO, and it won't do him any favors, but he could be applying for residency with his strong board scores and significant and impressive documented leadership skills and years of maturity over the average applicant. That will get him the hard to get interviews.
Nobody has any idea what will happen with incomes, CRNAs, etc. getting out a couple years early won't make any real difference.
I think he'd be a fool to stay in and accept average training when he has a real chance of impressing the faculty at a superior training program. After his GMO time, if anesthesia is taking a beating, he may not even want to pursue it anymore. And he's likely to need a GMO tour anyway to match.
Where's the tremendous income flux? My income has gone up.
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Il D

If he does residency with the Navy he has 4 years of mediocore (not bad) training where he's paid 80K/year. Then he gets subspecialty pay and, in all probablility, the ability to moonlight for his remaining 4 years while working in a medical center big enough to support a surgical staff. Doing what he wants to do and gaining experience in his field.

If he waits, he's going to spend an Internship with the Navy and then 4 years as a GMO. With no special pay he'll be stuck below or near 100K that entire time. With no board certification there is no moonlighting so that doesn't work either. A much greater percentage of his potential duty locations will be low Marine corps camps in the middle of nowhere. He'll be doing 100% admin and primary care for healthy adolescents. And assuming that his step 1 score and military service record can overcome the fact that he neither has an MD nor has practiced medicine for 4 years, the light at the end of the tunnel will be that he will get a chance to start a 'top' residency with people 4 years his junior barking orders at him as he wallows in poverty wages for another half a decade. And he'll probably have to repeat his Intern year. So a potential lost year a 4 extra years of poverty for an improved quality of training that might not materialize.

Don't get me wrong, I see your point about waiting for top training. But I do think you're minimizing the sacrifice he'd be making here.

 

[IlDestriero]

It's not 4 extra years, as he will almost certainly have to do a GMO tour to match. Can't hurt to try though. He could try for a one year marine tour, if they're still available. That's not for everyone. Navy anesthesia might be very competitive now BTW secondary to cutting back training spots even more as PGG posted. Of course things can change in just a few years.
I understand what you're saying.

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Il D

 

[244913]

Rethink your math.
He would do his payback and be out in 5 years, free to pursue his life free of further deployments and military entanglements. He can happily go off to a nice stable civilian residency, and get on with his life. 8 years until civilian payday. He can also use the gi bill to supplement his income for his 36 months of residency. If he stays in, he will not be selected for civilian training, almost certainly, and will likely have to do a GMO to match into anesthesia at all. If he does flight surgery, as he indicated he's thinking about, he will be in the military for 10 years. 10 years to civilian pay day, and a graduate of a pretty average residency as well.👍
Yes he will always be a DO, and it won't do him any favors, but he could be applying for residency with his strong board scores and significant and impressive documented leadership skills and years of maturity over the average applicant. That will get him the hard to get interviews.
Nobody has any idea what will happen with incomes, CRNAs, etc. getting out a couple years early won't make any real difference.
I think he'd be a fool to stay in and accept average training when he has a real chance of impressing the faculty at a superior training program. After his GMO time, if anesthesia is taking a beating, he may not even want to pursue it anymore. And he's likely to need a GMO tour anyway to match.
Where's the tremendous income flux? My income has gone up.
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Il D

Right on, agree 100%.

I did exactly this. Family life in the military? I've been deployed/on out of state training for 26/48 months of my commitment. Good luck trying to have any semblance of domesticity with that OPTEMPO. Your wife will either divorce you or express her displeasure by gaining 80-120 lbs and developing cluster B/bipolar traits.

OP, do your GMO time and GTFO. Civilian residencies will recognize and reward your sacrifice. Don't settle for subpar-average Navy training when you could have so much more. You made a mistake (perhaps) by taking the "scholarship" but don't compound this mistake by doing military GME. You'll have do do at least 1 GMO tour to get picked up by Navy Gas, perhaps 2, and if you go back into training, these GMO years will avail you nothing.

Flight surgeon tours and GMO stints with the Marines are lost years, professionally. Personally, they may be the best years of your life. You will be serving with the best of the best, the men on the front lines whose accolades are rarely cited and recognized. You will store up a lifetime of memories, both good and bad and in the end you will emerge as a more mature person.

Use the strength of your GMO experiences to gain competitive civilian training, and leave the military in your rear-view mirror forever.

PM me for questions.

-61N

 

[AbbaZabba85]

Thanks to everyone for weighing in with advice! I just want to have the best training possible, both for personal and professional fulfillment. When a ruptured AAA comes rolling in I want to feel comfortable handling it, and it's hard to imagine getting that sort of exposure to truly sick patients with a generally young and healthy patient population in the military.

It seems that doing my four years and getting out for civilian training would be the best course of action for me. With the upcoming changes in healthcare it'd also be nice to "weather the storm" in the military and see what the practice and reimbursement climate is like when I get out and the dust has settled a bit. I joined the military because I've always been interested in the unique aspects of military medicine: Delivering healthcare under challenging and austere environments, trauma, tactical medicine, aerospace medicine, etc. Navy flight surgery is something I won't be able to do on the civilian side.

I knew that if I didn't serve I'd always spend the rest of my life asking "What if?" I'm young and single with no kids so I'm looking forward to the "adventure" of being a flight surgeon, however sparse the actual adventure may be. As a previous poster mentioned I'm willing to take a 4 year detour in my professional career to have the personal satisfaction of working with a great patient population and experiencing things I wouldn't get to on the civilian side. I'm sure I'll be eating my words when I'm stuck in a small clinic seeing UTIs all day with a nurse commander breathing down my neck expecting me to meet arbitrary metrics, but I'm not expecting to be a gung-ho Delta Force doctor who kicks down doors and does surgery in a cave with a Swiss Army knife. Over the years I've found that going into situations jaded and cynical and expecting the worst has worked well in mitigating disappointment . With that said I'll try to stay well-read, moonlight if possible, and give my Sailors and Marines the best care I'm capable of delivering given the constraints.

On the subject of getting the best training possible, I've heard varied opinions on which internship provides the best training for a future anesthesiologist or EM doc. One of my friends from ODS just finished up a surgical internship in San Diego and told me "You'll hate your life for a year but this internship is hands-down the best, most intense, and most well-rounded internship in the Navy. You'll be comfortable handling sick patients after this internship." I understand that he's obviously biased, but I was wondering if there was any merit to this statement. I'm willing to undergo a bit of temporary pain if it means that I'll be a more knowledgeable and effective doctor in the end.

Thanks again for taking time out of your busy schedules to give me advice! 👍

 

[bobbyseal]

I'm not an anesthesiologist, but I think if you get stuck doing a GMO tour, you might as well do residency in the Navy. Fellowship opportunities are there. Honestly, residency trains you well, but if you really want subspecialty training where you're going to be taking care of ruptured AAAs you need to do a fellowship. The Navy will FTOS you to do that. Just my 2 cents.

 

[pgg]

Don't settle for subpar-average Navy training when you could have so much more.

I know this is SDN where everybody has 240+ step 1 scores, top 1/10th of their med school class, physical beauty, and concert violin skills or an equivalent extracurricular talent ...

But even if Navy anesthesia training was just "average" - and I think it's better than that - that's still better than 50% of the civilian programs out there.

4 years of GMO time and easily impressed interviewers won't be enough, on their own, to land a top tier residency. So I think we should back off on the blanket advice to EVERYONE that they'll be able to get better training on the outside. Not every ex-Navy ex-GMO did-four-and-got-out prodigy is going to wind up at a top program.

One of my fellow GMOs got out after 4 and didn't match ... had to scramble into another field.


I trained in the Navy, and I do all right on my own these days, in and out of Navy hospitals. As a resident, I did out rotations at several highly regarded programs on the east coast, and the only place I thought the residents and training were something special was at Brigham & Womens. At one specific well-regarded institution I won't name, I was thoroughly UNimpressed with the lazy gaggle of attendings, the really poor didactics, and the overal mechanics and logistics of the OR.

There ARE weaknesses with Navy anesthesia programs, some of which are mitigated by out rotations (which has its own set of drawbacks). But overall it's solid training. Despite the overall sentiment on SDN, you can do a hell of a lot worse than residency at Bethesda, Portsmouth, or San Diego.

 

[IlDestriero]

PGG, As you probably know, I've seen the best of the best and NMCSD. The difference is quite striking. As I've not seen other places, I can't say for sure what's really average or not. Where I am on the faculty now, the difference between the three residencies we have rotating through is obvious, and with occasional exceptions you can usually guess where someone trained by the end of the day. Though when I ask, i always ask if they're from the big name program.😉
San Diego has a lot of weaknesses, and considering how small the residency is, it had a lot of written board first time failures. Maybe that's been addressed. It certainly was a problem a while back when I was there, and it wasn't a new problem. Though the residents in question passed on the second attempt. I honestly don't know if they all got board certified or not. I wouldn't pick NMCSD if I thought I had any chance at a superior program, and I think there are many many many programs that have to be better. My average day at the big house was/is roughly equivalent to my worst days in San Diego, and I'm covering two rooms now, not one. The routine high acuity cases are just not there, and as you know, that's what puts hair on your chest and ice in your veins. Maybe the east coast is significantly better, but I'd bet a lot that it's not.
This guy May be exaggerating, but he says has a high score on step1, is involved in research, many honors, etc. Sounds like a very strong applicant to me. Throw in some maturity, documented leadership, etc. and he should match well. Maybe not the elite few, but well. The DO is the real wild card here.
I'm not sure the program i think you're referring to is actually all that great either.
The longer I'm out, the more critical I am of Navy medicine. Something to look forward to.😀 BTW, If you come out my way for a fellowship interview, I'll take you out for some good whisky.👍

 

[i want out]

I did my time as GMO and left for civilian training with a less impressive CV than the OP.

I trained at one of the best programs in the south, did transplants (liver, heart, and lung).

I don't regret for a minute getting out as soon as I possibly could.

I didn't spend any time at the Navy residencies but was assured by some who did that they had all the depth of the kiddie pool.

If you want practice civilian medicine train civilian, if you want to retire .mil then train .mil.

Just my opinion.

 

[pgg]

PGG, As you probably know, I've seen the best of the best and NMCSD. The difference is quite striking. As I've not seen other places, I can't say for sure what's really average or not. Where I am on the faculty now, the difference between the three residencies we have rotating through is obvious, and with occasional exceptions you can usually guess where someone trained by the end of the day. Though when I ask, i always ask if they're from the big name program.😉
San Diego has a lot of weaknesses, and considering how small the residency is, it had a lot of written board first time failures. Maybe that's been addressed. It certainly was a problem a while back when I was there, and it wasn't a new problem. Though the residents in question passed on the second attempt. I honestly don't know if they all got board certified or not. I wouldn't pick NMCSD if I thought I had any chance at a superior program, and I think there are many many many programs that have to be better. My average day at the big house was/is roughly equivalent to my worst days in San Diego, and I'm covering two rooms now, not one. The routine high acuity cases are just not there, and as you know, that's what puts hair on your chest and ice in your veins. Maybe the east coast is significantly better, but I'd bet a lot that it's not.
This guy May be exaggerating, but he says has a high score on step1, is involved in research, many honors, etc. Sounds like a very strong applicant to me. Throw in some maturity, documented leadership, etc. and he should match well. Maybe not the elite few, but well. The DO is the real wild card here.
I'm not sure the program i think you're referring to is actually all that great either.
The longer I'm out, the more critical I am of Navy medicine. Something to look forward to.😀 BTW, If you come out my way for a fellowship interview, I'll take you out for some good whisky.👍

Your points are well taken. The acuity level at NMCP where I trained was definitely on the low side. I did, however, spend almost 1/2 of my residency at other hospitals. This is both a legit criticism of NMCP for being unable to meet training needs, and a mitigating factor because good training was available elsewhere.

I don't want to name the civilian programs that didn't impress me because I think that'd be kind of rude and I don't want to go there. 🙂

At the time I finished at NMCP, there hadn't been a single written board failure in something like 10 or 12 years. I'm aware of a few oral board failures in that same period. It's a small program, but figure 60-odd residents in that time frame with a 100% written pass rate and 95%-ish oral pass rate.


Thanks for the whiskey invite. 🙂 I'm finishing up my Navy FTOS application today. No projected funded slots for next year, but I'm asking for a 2014-15 pre-select anyway. We'll see what happens. If they find funding and a "need" for me, it'll be hard to turn down a spot earning $250K+ to be a fellow anywhere I want ...


I've actually been more concerned about the post-residency (and post-fellowship) practice environment in the Navy. If not for moonlighting, I'd definitely have warmer veins and a less hairy chest than I'd like ... Since the "privilege" of moonlighting is always subject to the whim of your CO at the moment, abruptly losing access to good cases is an ongoing source of concern for me.

Presently I'm at a very small command (by choice ... mainly family and geographic reasons). If I stay the few extra years for retirement eligibility, I'll go back to NMCP.

 

[narcusprince]

Guess who is back?
As a current attending in at a naval residency program. Here are a few of my observations. The teaching here is very good. The supervisory ratio of 1 room 1 attending 1 resident provides an environment of teaching. Are the residents good yes, the ones I have worked with are motivated to learn. Are their sick patients in the system yes. I definitely feel their is a mutual respect between the residents and the attendings perhaps this is the military. Will you become a proficient anesthesiologist coming from the Navy yes. Will you see every zebra in the book probably not.

 

[kingcer0x]

Thanks for the whiskey invite. 🙂 I'm finishing up my Navy FTOS application today. No projected funded slots for next year, but I'm asking for a 2014-15 pre-select anyway. We'll see what happens. If they find funding and a "need" for me, it'll be hard to turn down a spot earning $250K+ to be a fellow anywhere I want ...
.

FWIW, I went AF, almost done with my 4 from HPSP as an FS, getting out to do Anesthesia which I've already matched to. I had plenty of interviews at 'top' programs on the east and west coast and everybody asked about my military experiences. Plenty we ex-mil med themselves. Ultimately I matched at my #1 choice (family reasons included in decision process), which is a good program on the west coast that will give me good training. I should add that my application as it was directly from med school was competitive for anesthesia, but I was going for something else at the time and saw the err of my ways.

Big part of getting out was the fellowship game. I was not going through another JSGME for a fellowship spot for another let down. Absolutely want to and might need to do a fellowship to stay ahead of the CRNA game and incorporate critical care into my skill set.

The money is better if you stay in. In the AF the quality of training in San Antonio is quite good, I dont think there is anesthesia GME elsewhere. However the GI bill can help. If you see me if/when you come interview at my place i'll give you a warm welcome, and thank you for your service.

 

[kingcer0x]

I knew that if I didn't serve I'd always spend the rest of my life asking "What if?" I'm young and single with no kids so I'm looking forward to the "adventure" of being a flight surgeon, however sparse the actual adventure may be. As a previous poster mentioned I'm willing to take a 4 year detour in my professional career to have the personal satisfaction of working with a great patient population and experiencing things I wouldn't get to on the civilian side. I'm sure I'll be eating my words when I'm stuck in a small clinic seeing UTIs all day with a nurse commander breathing down my neck expecting me to meet arbitrary metrics, but I'm not expecting to be a gung-ho Delta Force doctor who kicks down doors and does surgery in a cave with a Swiss Army knife. Over the years I've found that going into situations jaded and cynical and expecting the worst has worked well in mitigating disappointment . With that said I'll try to stay well-read, moonlight if possible, and give my Sailors and Marines the best care I'm capable of delivering given the constraints.


Thanks again for taking time out of your busy schedules to give me advice! 👍

FS is what you make of it. Opportunities will present itself; its up to you to choose harder routes versus easier ones. I was probably middle of the road; I had a good and bad experiences and won't miss any of the admin queepy bs. Regardless, I would go out of your to take care of your folks and that will serve you well.