Navy GMO tours

[mpatel1080]

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Does anybody know where I can find a list of all the navy GMO tours????


Thanks
Manish

 

[iwakuni_doc]

It's not a complete list, but it's a list of all projected spots for summer 2004:

Navy GMO Billets 2004

 

[DrMetal]

I was interviewed by a Navy CAPT this past week at USUHS. I asked him what the current status of the Navy GMO program was. He provided a very eloquent and frank explanation. I thought I'd share it here with the rest of you, as I'm sure many are interested.

Here's what he said:

1. The idea of completely replacing forward-deployed MDs with PAs or NPs is not going to happen. The line won't allow it. The line is very adamant about having forward-deployed MDs caring for the warfighters; and since they're in charge, this is the way it's going to be.

2. The Navy has no issue with assigning a non-BC MD to a GMO billet, as long as he/she is under the direct supervision of a staff or senior medical officer (like the situation on a ship, or at a MTF). In other words, if the non-BC GMO has a go-to BC'd MD that he/she can consult, then that's similar to an internship or residency situation...and that'll fly. So the Navy is likely to continue filling these GMO billets (those that have staff supervision) with junior non-BC docs.

3. The Navy does recognize the problems (both medical and possibly legal) in deploying non-BC GMOs without any staff supervision, with forward-deployed units (Spec Ops, Marines, etc). The Navy would like to cease this practice and instead send out BC'd GMOs to fulfill these roles. In other words, the Navy does recognize that a BC'd GMO is more beneficial to the line than a non-BC'd one. So the Navy is contemplating how to fix this. If it allowed all of its current physicians in training to continue their
GME without doing a GMO tour, then staff BC'd docs would have to step up to fill in these gapped GMO billets. And this would have to happen across all specialties. Of course, the staff docs don't want to do this, b/c they've already done a GMO tour, have already been overseas, and/or have already deployed as a forward senior medical officer. Hence, the Navy is at a stalemate here. (Having said that, some staff docs have unselfishly offered to do GMO tours, to allow a new cycle of training to begin. But if
such volunteerism doesn't happen all across the board, then it's not going to work)...So this endeavor of eliminating some non-BC'd non-supervised GMO tours is a work in progress.

4. Navy GMO tours are not going away completely. They will probably be reduced in numbers (especially those positions that have no direct staff supervision), but that number will never go to zero.

 

[IgD]

I was interviewed by a Navy CAPT this past week at USUHS. I asked him what the current status of the Navy GMO program was. He provided a very eloquent and frank explanation. I thought I'd share it here with the rest of you, as I'm sure many are interested.

It sounds good but do you really think that was a frank explanation? Sounds like military medicine politico-speak to me. If I were you I would have got up and walked out.

 

[IgD]

...Of course, the staff docs don't want to do this, b/c they've already done a GMO tour, have already been overseas, and/or have already deployed as a forward senior medical officer.

I had a different experience. There were a number of senior O5 and O6's I worked with who never had been on a deployment or even an overseas tour. They did everything in their power to make sure that didn't change.

 

[DrMetal]

It sounds good but do you really think that was a frank explanation? Sounds like military medicine politico-speak to me. If I were you I would have got up and walked out.

well, I meant he was being frank, in the sense that he wasn't blowing smoke up my *****, making claims that GMOs are going away all-together (as some recruiters might state). He admitted that GMOs aren't going away entirely, and he admitted that although the Navy sees the problem with some GMO situations, the Navy doesn't quite know how to fix the problem yet.

I thought this was a pretty fair and honest explanation.

Why would you have "walked out"? What about this explanation is so strikingly-awkward?

It wasn't quite medicalcorp-politico speak. If he wanted to go that route, he could've avoided my original question, pretended like there wasn't a problem with the current system, and then he could've painted a rosy picture about how wonderful the GMO experience is. He did none of this.

 

[Gastrapathy]

2. The Navy has no issue with assigning a non-BC MD to a GMO billet, as long as he/she is under the direct supervision of a staff or senior medical officer (like the situation on a ship, or at a MTF).


About half the ships are solo GMO's


3. The Navy does recognize the problems (both medical and possibly legal)
in deploying non-BC GMOs without any staff supervision, with forward-deployed units (Spec Ops, Marines, etc). The Navy would like to cease this practice and instead send out BC'd GMOs to fulfill these roles. In other words, the Navy does recognize that a BC'd GMO is more beneficial to the line than a non-BC'd one. So the Navy is contemplating how to fix this. If it allowed all of its current physicians in training to continue their
GME without doing a GMO tour, then staff BC'd docs would have to step up to fill in these gapped GMO billets. And this would have to happen across all specialties. Of course, the staff docs don't want to do this, b/c they've already done a GMO tour, have already been overseas, and/or have already deployed as a forward senior medical officer. Hence, the Navy is at a stalemate here. (Having said that, some staff docs have unselfishly offered to do GMO tours, to allow a new cycle of training to begin. But if
such volunteerism doesn't happen all across the board, then it's not going to work)...So this endeavor of eliminating some non-BC'd non-supervised GMO tours is a work in progress.

A lot to comment on in this paragraph.
1.What potential legal problems?
2. The idea that doctors "across all specialties" will fill these former GMO billets is total fiction. No radiologist, anesthesiologist or otolaryngologist is going to be deploying as the doc on an amphib out of little creek. This burden will fall on the primary care specialties.
3. I'm personally waiting to see whether IM subspecialists get lumped with the radiologists or internists. I don't know any of these volunteers you mentioned; O5s looking to make O6 will sometimes take operational billets but they are the kind of billets that supervise GMOs not the kind that replace them

 

[IgD]

I want to clarify something. In your original post you said:

...in deploying non-BC GMOs without any staff supervision, with forward-deployed units (Spec Ops, Marines, etc). The Navy would like to cease this practice and instead send out BC'd GMOs to fulfill these roles."

"Non-BC" implies that a physician graduated a residency. The issue I have is that non-residency trained physicians aka "GMOs" are practicing medicine in independent settings. A related issue is that military internships across the board are basically preliminary years. Unlike in the civilian world, military interns have to re-apply for PGY2 positions. A third issue is that non-physicians are using rank to cross professional boundaries. For example, I witnessed a CDR from the medical service corps use his rank to dictate medical policy on an inpatient unit.

Why would you have "walked out"?

The bottom line for me is that the issues described above are too important to explain away or accept a compromise on. Ask your physician mentors what they think of the three issues I just described. Do you really want to entrust your welfare and professional development to an organization with those core values?

The Navy and DoD have been dealing with the non-residency trained physician issue for at least a decade if not two. Would you want to work for an organization that has been unable to fix an issue like this for over such a long period of time?

 

[DrMetal]

About half the ships are solo GMO's

ok, then this would fall under point #3 above.

1.What potential legal problems?

I think he meant the legal/malpractice type of issues that could arise from a non-resid. trainined doc working on a pt.

2. The idea that doctors "across all specialties" will fill these former GMO billets is total fiction. No radiologist, anesthesiologist or otolaryngologist is going to be deploying as the doc on an amphib out of little creek. This burden will fall on the primary care specialties.

yeah, the CAPT recognized this problem. he actually used a couple of your examples (radiologist, anesthesiologist)

I don't know any of these volunteers you mentioned;

I don't know them either, the CAPT didn't drop any names, just said there were a few that would do it.

 

[DrMetal]

I want to clarify something. In your original post you said:



"Non-BC" implies that a physician graduated a residency. The issue I have is that non-residency trained physicians aka "GMOs" are practicing medicine in independent settings.

yes, that's what i meant. I was presuming that once one finishes resid. they take their boards and become bc soon thereafter. but yes, everywhere i wrote "non-BC" i meant non-resid trained above.

The bottom line for me is that the issues described above are too important to explain away or accept a compromise on. Ask your physician mentors what they think of the three issues I just described. Do you really want to entrust your welfare and professional development to an organization with those core values?

The Navy and DoD have been dealing with the non-residency trained physician issue for at least a decade if not two. Would you want to work for an organization that has been unable to fix an issue like this for over such a long period of time?

i have been talking to several mil docs (some retired, some still in). they've described similar situs as the one you pointed out above. one (a civi now) actually claims to have the same problem at his civi hosp with an MPH/MBA health care administrator! In any case, all of them agreed that you have to know how to play the political game, so you can influence said O-5 MSC commander to bow your way. And all agreed that this political game may/may not exist in the civi world. But if you encounter it there, it helps you better prepare for it.

I dunno, that's a tough issue. Admittedly, I'm no expert. I'm hoping that I'll know how to deal with such situations when I encounter them.

 

[BigNavyPedsGuy]

About half the ships are solo GMO's


Actually, there are only 8 billets that are on large deck amphibs where you have a GMO and a SMO. The rest are smaller amphibs which just have a GMO or Carriers that don't have GMOs.

So much more than half of ths ships are solo GMOs - further debunking this explanation.

 

[BigNavyPedsGuy]

Here's what he said:

1. The idea of completely replacing forward-deployed MDs with PAs or NPs is not going to happen. The line won't allow it. The line is very adamant about having forward-deployed MDs caring for the warfighters; and since they're in charge, this is the way it's going to be.

Standard of care also dictates that our servicemembers be afforded the same or better care than some guy off the street. They don't get one year trained doc-in-a-box care

2. The Navy has no issue with assigning a non-BC MD to a GMO billet, as long as he/she is under the direct supervision of a staff or senior medical officer (like the situation on a ship, or at a MTF). In other words, if the non-BC GMO has a go-to BC'd MD that he/she can consult, then that's similar to an internship or residency situation...and that'll fly. So the Navy is likely to continue filling these GMO billets (those that have staff supervision) with junior non-BC docs.

See my point on previous post about how rare these "supervised" billets are

3. The Navy does recognize the problems (both medical and possibly legal) in deploying non-BC GMOs without any staff supervision, with forward-deployed units (Spec Ops, Marines, etc). The Navy would like to cease this practice and instead send out BC'd GMOs to fulfill these roles. In other words, the Navy does recognize that a BC'd GMO is more beneficial to the line than a non-BC'd one. So the Navy is contemplating how to fix this. If it allowed all of its current physicians in training to continue their
GME without doing a GMO tour, then staff BC'd docs would have to step up to fill in these gapped GMO billets.

Also, everyone is already getting out. If they did this the retention rate would fall even farther . . . oh wait, it already is. . .

And this would have to happen across all specialties.

Right, a pathologist takes better care of sick call then a guy s/p Family Practice internship . . .

Of course, the staff docs don't want to do this, b/c they've already done a GMO tour, have already been overseas, and/or have already deployed as a forward senior medical officer. Hence, the Navy is at a stalemate here. (Having said that, some staff docs have unselfishly offered to do GMO tours, to allow a new cycle of training to begin. But if
such volunteerism doesn't happen all across the board, then it's not going to work)...So this endeavor of eliminating some non-BC'd non-supervised GMO tours is a work in progress.

Volunteerism. The Navy is a complicated entity. We are one team, but there is no reward for stepping up to do the tough thing - billet wise. You can jump on the grenade and take the bad billet, then get screwed with your next billet. Especially if you're the only guy that didn't get out at first opportunity.

4. Navy GMO tours are not going away completely. They will probably be reduced in numbers (especially those positions that have no direct staff supervision), but that number will never go to zero.

Again, define "direct staff supervision"

This answer is worse than "We're trying ot get rid of them but can't find a good way logistically to make it work". He lost me at "volunteerism"

It sounds like he was trying to actually be frank, but some of the ideas just don't work. At least he acknowledged the problems.

 

[IgD]

The obvious, and likely best, solution for the current GMO "problem" (if you view it as such) will be ramping up the training of Navy PAs and moving them into current GMO billets. This is exactly what the Army did.

I'm not so sure that this violates any civilian standard of care.

I teach PA students and they tell me they aren't supposed to practice independently only along side a physician.

 

[IgD]

I dunno, that's a tough issue. Admittedly, I'm no expert. I'm hoping that I'll know how to deal with such situations when I encounter them.

Well you'll have plenty of time to practice during your 7 year payback😛

 

[DrMetal]

About half the ships are solo GMO's


Actually, there are only 8 billets that are on large deck amphibs where you have a GMO and a SMO. The rest are smaller amphibs which just have a GMO or Carriers that don't have GMOs.

So much more than half of ths ships are solo GMOs - further debunking this explanation.

ok, point taken, that was my bust. I made that example, not the CAPT. I just wasn't completely aware of the GMO situ on ships, thanks for the clarification.

 

[BigNavyPedsGuy]

ok, point taken, that was my bust. I made that example, not the CAPT. I just wasn't completely aware of the GMO situ on ships, thanks for the clarification.

See, that's the point. IT's a misrepresentation of what's out there. Did the CAPT use the term "supervision"? If so, what did that mean? Someone to review charts and staff out cases or someone to call with questions, or what? I've had over 800 sick call encounters in the last 3 months. There's no way that my SMO could review each of those encounters and still be a SMO. I can't be directly supervised or the job won't get done.

 

[notdeadyet]

Out of curiosity to those who have been in a while:

How long has the Navy been talking about resolving the GMO issue now? When I was looking at Navy HPSP, I read the old threads quite a bit. It seems that the sentiment of "GMOs tours are going to be radically reduced in number over the next couple years" has been a story going around for years and years and years.

Since it hasn't really happened yet, I'm wondering about the credibility of the sentiment now.

 

[DrMetal]

See, that's the point. IT's a misrepresentation of what's out there. Did the CAPT use the term "supervision"? If so, what did that mean? Someone to review charts and staff out cases or someone to call with questions, or what? I've had over 800 sick call encounters in the last 3 months. There's no way that my SMO could review each of those encounters and still be a SMO. I can't be directly supervised or the job won't get done.

Yes he did. By supervision, he meant a staff BC'd doc within your physical reach, that you could go to if you had a question, or needed help w/ a procedure, or wanted to have look at a pt

 

[BigNavyPedsGuy]

Out of curiosity to those who have been in a while:

How long has the Navy been talking about resolving the GMO issue now? When I was looking at Navy HPSP, I read the old threads quite a bit. It seems that the sentiment of "GMOs tours are going to be radically reduced in number over the next couple years" has been a story going around for years and years and years.

Since it hasn't really happened yet, I'm wondering about the credibility of the sentiment now.

They have been talking about it for a long long time (i hear ten years). However, they are reducing the number albeit slowly. The RRC has really been critical of the system. If programs start to lose accreditation, then heads will roll.

 

[Two-Bit]

Out of curiosity to those who have been in a while:

How long has the Navy been talking about resolving the GMO issue now? When I was looking at Navy HPSP, I read the old threads quite a bit. It seems that the sentiment of "GMOs tours are going to be radically reduced in number over the next couple years" has been a story going around for years and years and years.

Since it hasn't really happened yet, I'm wondering about the credibility of the sentiment now.

The subject of replacing the GMO has been talked about for many years. I even asked a senior officer in 2001 what the GMO 'landscape' would be like in the future. I was told that Navy Medicine had a 5 year plan to phase out GMO's and replace with board certified physicians, primarily FP's (no pun intended). Obviously 7, now almost 8 years later, that has not happened. I have not seen the statistics on GMO vs. 'straight through', but I would like to. I would also like to see the number of active duty Nurse Practicioners and Physician's Assistants across the armed forces, especially in the last 5 years. That might give you more insight into how GMO billets will be manned in the future.

 

[Gastrapathy]

That's not what is meant by "supervision" in a medical setting.

Well, actually, I would argue that it is. Its not supervision in a surgical setting but that is pretty typical for the way a primary care trainee is supervised in a clinic environment. After internship, I could count on one hand the number of my clinic patients that I asked staff to see.

I'd have no problem with a GMO serving as a clinic monkey on a large deck amphib or aircraft carrier. I'd feel bad for him but I'd have no problem with it from a clinical standpoint.

 

[Gastrapathy]

They have been talking about it for a long long time (i hear ten years). However, they are reducing the number albeit slowly. The RRC has really been critical of the system. If programs start to lose accreditation, then heads will roll.

The RRC aspects of this are really only specific to Peds. They don't seem to care elsewhere. NavyFP can comment if this is not an accurate sentiment, but from what I've seen, it comes up every time on the Peds side and no one else even comments. Not sure why.

The pressure to decrease the number of GMOs has built over a LONG time, but it seems pretty strong now. I think its going to continue to happen.

 

[BigNavyPedsGuy]

The RRC aspects of this are really only specific to Peds. They don't seem to care elsewhere. NavyFP can comment if this is not an accurate sentiment, but from what I've seen, it comes up every time on the Peds side and no one else even comments. Not sure why.

The pressure to decrease the number of GMOs has built over a LONG time, but it seems pretty strong now. I think its going to continue to happen.

It comes up in peds because I haven't seen a patient less than 18 years old in 7 months. There's no way that's not harming my training. I'm curious what EdMadison or the caveman think about it and why it always comes up with peds

 

[almostfamous]

About half the ships are solo GMO's


Actually, there are only 8 billets that are on large deck amphibs where you have a GMO and a SMO. The rest are smaller amphibs which just have a GMO or Carriers that don't have GMOs.

So much more than half of ths ships are solo GMOs - further debunking this explanation.

there is at least one carrier that has a GMO as of right now.

 

[almostfamous]

That's not what is meant by "supervision" in a medical setting.

At our place I think our "supervision" is meant to be over the telephone. But when we do need some advice beyond the regimental surgeon (another GMO), and actually call staff at the nearest hospital (almost an hour away) or a duty doc, the answer is almost always condescending and it's like we are wasting their time. Lots of guys don't even call anymore, which has created some bad situations over the last few months.

 

[NavyFP]

The RRC aspects of this are really only specific to Peds. They don't seem to care elsewhere. NavyFP can comment if this is not an accurate sentiment, but from what I've seen, it comes up every time on the Peds side and no one else even comments. Not sure why.

The pressure to decrease the number of GMOs has built over a LONG time, but it seems pretty strong now. I think its going to continue to happen.

RRC applies across the board. I hear that it is some of the surgical specialties that have given the most grief, specifically ENT and Ortho.

You are absolutely right that there are a large number of external forces which are driving the GMO conversion. The line will have to adjust.

 

[IgD]

The line will have to adjust.

I'm confused by what you said. Are you saying the Marine Corps will have to conform to what Navy medicine wants to push as the optimal staffing model or the other way around🙂

 

[BigNavyPedsGuy]

I'd have no problem with a GMO serving as a clinic monkey on a large deck amphib or aircraft carrier. I'd feel bad for him but I'd have no problem with it from a clinical standpoint.

You just described my life

 

[Gastrapathy]

You just described my life

Sorry bro. It'll get more fun once you get some greensiders aboard.

 

[NavyFP]

I'm confused by what you said. Are you saying the Marine Corps will have to conform to what Navy medicine wants to push as the optimal staffing model or the other way around🙂

I think the former. If you complete a 3 year residency you would still be a LT.