Navy GMOs

[Perrotfish]

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Does anyone have an update on the Navy´s promise to eliminate GMOs in 5 years? Have they actually been reducing the number of slots for GMOs?

 

[BigNavyPedsGuy]

They reduced a good number of GMOs this last year- something like 80-100ish. Unfortunately, most of the ones they got rid of were the "hidden gems" branch clinics, one year billets, etc. Most of what's left are the standard, 2year Marine or ship billets (mostly Marines).

That being said, about 80% of San Diego's intern class in NOT going straight through.

 

[Kingfisher]

That being said, about 80% of San Diego's intern class in NOT going straight through.

Are these peds, IM, ortho, etc. or all of the above?

 

[IgD]

The Navy promised this when I was in medical school 10 years ago. If anyone tells you that GMO tours are phased out, ask them to show you the doctrine. I think its good that there is discussion about it but to me talk is meaningless. The credentialing, selection board and other instructions need to be updated to remove GMOs and non-residency trained physicians from the process. If they are serious about it why wouldn't they update the doctrine for an issue as critical as this?

 

[Perrotfish]

The promise they´re making to recruits. The Navy recruiters have been told to tell the recruits that Navy GMOs are being phased out over a 5 year period. No maybes, no conditions, and the other Navy recruits I know had the same thing told to them by their various recruiters in other locations. Not that I expect it happen, nowhere near 100% elimination of GMOs in any event, but it would be nice if they at least reduced the numbers to AF levels. Also it would be a very nasty lie on the part of Navy recruiting if they´re really not planning to eliminate GMOs at all.

That being said, I´m glad to hear that they are, in fact, getting rid of some of the GMO slots, hidden gems or not. Any is better than none. Maybe they´ll actually follow through.

 

[Perrotfish]

*sigh*

While I get your point, I can tell you that it made my conversations with the detailer this year far less pleasant.

"All I got is the Marines. You want West Coast Marines or East Coast Marines?"

Well I´m probably less depressed about that than the usual applicant, since wanting to do a tour with the Marines was one of the reasons I decided on Navy.

 

[Perrotfish]

•
Found it. The following is from the standard "recruiter´s presentation" on the Navy HPSP ascencions website (I was surprised at how honest it was, they even have a slide devoted to making it clear that civilian deferments are very rare). anyway:

Navy Medicine is working to convert GMO billets to Primary Care billets
•

Moving towards an all board eligible force
•By 2011 GMO/FS/UMO billets will be drastically reduced

I´ve seen another memo that said something about 100 GMOs eliminated per year over the 5 years leading up to 2011, but I couldn´t find that one. Still, definitely tied to a timetable here. So, by 2012, it looks like the navy could be almost GMO free.

On an unrelated note, the Mayans thought the world was going to end in 2012

I'm not depressed about it, I'm sure it will be an interesting experience. But as I've mentioned before, I joined the Navy because I love the big ships. It is likely that this is the only period in my career I had the opportunity to serve on one. That's kind of disappointing

You could always apply for the Comfort or the Mercy once you finish residency.

 

[J123]

Well, FWIW, I attended a staff meeting within the past month where this issue was addressed. We were told that the Navy is moving forward with plans to phase out interns being sent out as GMOs and wants to have everyone complete residency in the 'straight through' fashion (Like the AF and Army). The problem, however, is that ultimately, GMOs won't go away -- yes they're gapping low-volume billets (as they should) -- but the needs of the fleet won't change. So, many will end up doing a GMO tour after their residency -- no matter what you are residency trained in. The Army does this currently. In fact, there are a number of pediatricians acting as SMOs in the fleet right now. We were told that the current plan is to have graduating residents do a 'utilization tour' in their area of training, then they'd be eligible for a GMO tour. It was suggested that from here on out, a GMO tour will be essentially required for promotion at the higher levels (O-5/O-6). Not sure how solid that is. Haven't seen this in writing.

 

[Perrotfish]

Huh, apparently this is a presentation TO recruiters. Interesting read. This is a direct quote from the powerpoint:

Fat students!?? We take ‘em anyway!!

but the needs of the fleet won't change. So, many will end up doing a GMO tour after their residency -- no matter what you are residency trained in. The Army does this currently. In fact, there are a number of pediatricians acting as SMOs in the fleet right now. We were told that the current plan is to have graduating residents do a 'utilization tour' in their area of training, then they'd be eligible for a GMO tour.

The key thing here is that this wouldn´t extend your obligation, while GMO before residency effectively does extend your obligation. I would be absolutely thrilled with this system (and in fact, minus the extended obligation, I would very much like to do a GMO tour).

 

[trail doc]

Converting a GMO billet to a residency trained billet is totally doable within the 5 year window they have planned. All that requires is erasing GMO on a piece of paper, and writing in FP.
Actually putting a residency trained physician in that billet is another matter altogether. Where there is not a residency trained physician available, they will put what is around in it (intern graduates that don't want to go straight through navy or deferment for primary care), or gap it. This is basically how the Army and Air Force has "eliminated" the GMO. It's similar to what detailers do all over the military when filling an O-4 billet with an O-3, because that's what's available.
That being said, a colleague of mine who recently spoke to the FP detailer said there are 50 FP billets projected to be gapped this next year. This probably only takes into account the 100 GMO billets that have been converted this year.
It will make congress happy, but not really change very much.

 

[trail doc]

We were told that the current plan is to have graduating residents do a 'utilization tour' in their area of training, then they'd be eligible for a GMO tour. It was suggested that from here on out, a GMO tour will be essentially required for promotion at the higher levels (O-5/O-6). Not sure how solid that is. Haven't seen this in writing.

I saw it in writing... or at least a powerpoint slide as part of a presentation given at the Naval Aerospace medicine conference in January. This is exactly what the guys who are responsible for pulling this off said. Good news is, if you're a career type, you'll get credit for your GMO tour whether you did it pre or post residency.

 

[Kingfisher]

Just FYI, here is what Navy FP's are being told by their charter organization for the AAFP. It was in the USAFP's fall 2007 newsletter.

http://www.usafp.org/Word_PDF_Files/2007-Fall-Newsletter.pdf Page 13

"One of the biggest concerns I hear from people around the
community is in regards to the General Medical Officer (GMO)
conversions, which start this new fiscal year. There are 553 GMO
billets currently, with 2011 the projected timeframe to convert
these to billets filled by board eligible specialists. This will create
the all “board eligible force.” The driving forces are Congress
demanding GMO conversions and fewer states allowing licensure
following internship. On October 1st, 106 billets will be converted
for Primary Care Specialists (PCMO). Of these, three are with
the Marines, 16 are with the Fleet, and 11 are with BUMED Sponsored
Organizations (BSO 18). The fair share of these for Family
Medicine officers is likely to be around 12-15. The other 76
are Flight Surgery/Undersea Medical Officers. Because all these
GMOs aren’t suddenly going to disappear, there will still be a need
to fill billets with GMOs for years. There will be a gradual change​

as GMOs rotate out of their current billets."
Bruce Stinnett, M.D.

 

[almostfamous]

Speaking of GMO s-

can anyone tell me a little about LPDs. A quickipedia search really only shows that the west coast ones were built in the 60's and they haul around some helos and devil dogs.
Any more info as far as what GMO life would be like-- lots of admin, typical deployment and shore schedule, ship resources (amenities like a/c, computers), etc.
thx

 

[Dr. Wexler]

...fewer states allowing licensure following internship.,,

I don't believe this is really part of the "driving force". Especially since the federal government doesn't care what state you are licensed in, just that you have a license. Unless a large plurality of states start requiring more than PGY1 to get a license, I don't see it being a problem for GMOs. Not to mention that CA, VA, MD, and DC only require 1 year. Most navy residents train in one of those states and/or reside there.


PS. Is this really true anyway? Are fewer states allowing licensure after internship?

 

[DiveMD]

In my opinion, anyone in favor of independent medical practice after a single post graduate year is out of touch. The GMO concept is dangerous and outdated. 👎

 

[orbitsurgMD]

So what exactly has changed in medicine that now makes this unsafe? A few decades ago, a single post-graduate year was the norm. Now it's dangerous?

Yes. Is that hard to understand?

See what kind of civilian hospital will give you unrestricted staff privileges (or any, for that matter) with just one year of postgraduate training. There actually is a reason people do residencies in what were once generalist practice activities: FP, IM and EM.

 

[DiveMD]

So what exactly has changed in medicine that now makes this unsafe? A few decades ago, a single post-graduate year was the norm. Now it's dangerous?

The scope of the internship year changed. A PGY-1 is now intended to get you ready for residency, not for independent practice. Medicine evolves over time and so does GME. Not a very difficult concept to grasp IMHO...

 

[Perrotfish]

The scope of the internship year changed. A PGY-1 is now intended to get you ready for residency, not for independent practice. Medicine evolves over time and so does GME. Not a very difficult concept to grasp IMHO...

Just curious, what has changed in the 1st year cirriculum? Also do you think that these changes in civilian PGY-1 have carried over to the military Internships? My impression from this message board is that military takes longer to change than in the Civilian world, were they faster about changing residencies?

 

[orbitsurgMD]

I have been told by countless staff and GMOs: the purpose of the medical officer is not to manage complex medical conditions, or admit patients to the hospital.

It is to maintain the medical standards set forth in the OPNAV instructions, and to know when something is serious enough to refer on.

Which is exactly what you learn in internship.

Personally, I think there's just a lot of tertiary-care bias on this board.

Easy to say, but not true.

The reality is that the military does leave you in lots of situations where the benefit of complete training is necessary to understand and provide the level of care needed. Internship just doesn't get you to that place anymore. And it isn't meant to either. In fact, only the military pretends otherwise.

Internship is meant to make you ready to be a second year house officer, not an independent practitioner. It isn't meant to make you ready to staff an E.D. by yourself. It isn't meant to make you staff an E.D.--open to the public 24/7-- without any ancillary support services like x-ray and laboratory or without any senior and better-trained backup on the premises.

Internship makes you ready? I spent mine in a general surgery program, in the military. I had no trauma month, because only half of the surgery interns were allowed to go to the civilian level I center to rotate on trauma and the other half had to stay at the naval hospital that had no trauma. And good luck trying to get that changed, because I tried and it was useless. Cardiology? I didn't get to rotate on the CCU, only the medicine 'terns did. Too bad that is where all the MIs went and at the time was the only place where any thrombolytic drugs were allowed. So I didn't get to learn to use TPA in my internship. I didn't get to learn acute management of MI there either. That didn't keep me from wishing I had the first and having to do the second once I was alone in the E.D. as a GMO, with no backup. Psychiatry? Someone at our hospital probably got the big chill from the RRC because we got pulled from our peds rotation to do work in the outpatient psych service. I received exactly one day of outpatient psych training during my internship. After I became a GMO, I was glad I stayed awake in medical school.

Anyone who thinks internship prepares you for anything anymore besides PGY2 is fooling themselves. Any organization that forces doctors at that level of training and experience to practice independent of a training setting is committing a crime.

OPNAVINST? That is laughable. Since when did that have anything to do with the real world?

 

[orbitsurgMD]

That's really sad. I had a month of adult trauma and a month of pediatric trauma at local Level 1s. I can't imagine any surgical internship not doing at least that.



And here's where I think the tertiary care bias comes in. I'm not sure what your GMO consisted of, but based on what I've been told by the guys who have come back, it is really erroneous to describe ours as "opening the ED doors". There's nothing ED about sick call, routine audiology/vision screening, making sure everyone has the required vaccinations, and adsep/MEB work. If you have any questions about what you're doing, you call the MTF residents on call. If you're concerned at all, you put them in an ambulance and send them off the real hospitals.

Thrombolytics? Psychiatry? The whole idea of GMO (or, again, the type I'm heading off to) is that you're running a small Primary Care clinic. Why would I ever give thrombolytics? Or even have them around? And do you really think any residency-trained FP would give them in the office either? No way. They'd do the same thing I would; MONA and call an ambulance.



Who's talking about the real world? I'm talking about being the medical officer for a bunch of healthy Marines aged 20-35. And from what my seniors tell me, being the GMO for that groups of patients is a lot more about following the OPNAVINST on medical readiness than it is practicing clinical medicine.

If you get assigned to work in little overseas military hospitals, you can't expect to see only healthy Marines. You get all comers: not-so-healthy sailors, really not-so-healthy civilian contractors, locals who come for care by way of treaty and status-of-forces agreements, American visitors (Granny with all her heart meds), retirees with their unstable angina who won't see a civilian doctor on their CHAMPUS but who will drive forty miles after hours to present at the base mini-clinic with MI-in-progress, kids that are brought in after falls AMS who should have been stabilized on the scene but whom Mom had just scooped and run to the base clinic with (again after hours, when the radiology tech and all support staff had gone), drunks that have flipped their cars on the slopes of Mt. Etna and were extracted by the base ambulance crew and brought to you where you have no scanner, no on-base backup, no translator to help you find an off base facility with a radiologist (at 3 a.m., no less), R/O DVTs , where I had to shoot and read the venogram and twist the arm of the ready aircrew when I thought it was positive (it was.) All this in a NATO country.


Oh yeah, and I forgot about all the pregnancy emergencies. No ultrasound.

It was three times worse when I was dockside in the AOR.

 

[BigNavyPedsGuy]

If you get assigned to work in little overseas military hospitals, you can't expect to see only healthy Marines. You get all comers: not-so-healthy sailors, really not-so-healthy civilian contractors, locals who come for care by way of treaty and status-of-forces agreements, American visitors (Granny with all her heart meds), retirees with their unstable angina who won't see a civilian doctor on their CHAMPUS but who will drive forty miles after hours to present at the base mini-clinic with MI-in-progress, kids that are brought in after falls AMS who should have been stabilized on the scene but whom Mom had just scooped and run to the base clinic with (again after hours, when the radiology tech and all support staff had gone), drunks that have flipped their cars on the slopes of Mt. Etna and were extracted by the base ambulance crew and brought to you where you have no scanner, no on-base backup, no translator to help you find an off base facility with a radiologist (at 3 a.m., no less), R/O DVTs , where I had to shoot and read the venogram and twist the arm of the ready aircrew when I thought it was positive (it was.) All this in a NATO country.


Oh yeah, and I forgot about all the pregnancy emergencies. No ultrasound.

It was three times worse when I was dockside in the AOR.

I'm trying to stay out of this argument; however, I do feel that it's worth mentioning that the GMOs that got cut this year were most of the little ED slots. Almost all of them now are operational- assigned to a Marine unit or on a ship. While there are still dozens of situations that could come up, it does reduce the odds of the elderly, heart failing folks. I'm not saying Orbitsurg or Tired is wrong, but I think you guys are discussing different things.

 

[orbitsurgMD]

Yeah, I realize that now.

Dunno how things are in San Diego, but at NNMC the non-operational billets are so rare that they're not even mentioned in our countless GMO orientation & information sessions.

I was describing "operational" billets. I was a flight surgeon attached to a squadron. When you are deployed, you can be attached to the local MTF, the MTF clinic, ER and other local medical activities.

This kind of experience is not just limited to claimancy 18 billets.

 

[BigNavyPedsGuy]

I was describing "operational" billets. I was a flight surgeon attached to a squadron. When you are deployed, you can be attached to the local MTF, the MTF clinic, ER and other local medical activities.

This kind of experience is not just limited to claimancy 18 billets.

You would know. I stand corrected. (seriously- no sarcasm here)

 

[Perrotfish]

I was describing "operational" billets. I was a flight surgeon attached to a squadron. When you are deployed, you can be attached to the local MTF, the MTF clinic, ER and other local medical activities.

Huh, that's sorta scary. Is there anything you would recommend doing to get ready for a possible GMO? EMT certs? Lots of clinical electives? Or is it just impossible to prepare for this sort of thing before medical school?

 

[narcusprince]

First bub you have to go to medical school. Once u graduate med school and internship. After that u should be ready just as the thousands of others who have done it before u.

 

[Perrotfish]

First bub you have to go to medical school. Once u graduate med school and internship. After that u should be ready just as the thousands of others who have done it before u.

Um, thanks for that, fellow medical student. However the point of the discussin on this thread is that one of the "thousands of others" was saying that he didn't feel particularly ready for what got thrown at him. I was wondering if there was anything I could do during medical school to improve my preparedness, since I'm not going to have any free time once I hit Internship year, whereas during medical school I'll at least have summers and electives.

 

[orbitsurgMD]

Huh, that's sorta scary. Is there anything you would recommend doing to get ready for a possible GMO? EMT certs? Lots of clinical electives? Or is it just impossible to prepare for this sort of thing before medical school?

The point is that to be ready for that kind of work, you really should do a whole residency. There isn't any substitute that is adequate or appropriate. And pretending that there is by trying to juice a categorical or transitional internship year is feeding the lie.

 

[narcusprince]

Hey Perrot
Was not trying to be condescending or rude to you. Just wanted to state that their have been thousands of people before you that went to a good medical school's studied hard and focused on medical school and became good GMO's(remeber the standard of care years ago was one year internships for medicine). Right now the best thing you can do before medical school is reflective, find yourself, spend time with friends and family. Hindsight being 20/20 I would have done that before I started medical school because once your in and working thats it nothing else exists. Who knows you may not even go the GMO route. I thought I was for sure but didn't and landed a good civ residency. Once your a fourth year I would find you general medicine weaknesses and work from there. Your a long way away from being a GMO. Anything you learn pre-med school in my mind will be replaced by the knowledge you push into your brain. Focus on medical school that would be the key to becoming the best GMO be the best medical student!!!
Good Luck
Narc

 

[trixmd]

Interesting info. I work under a lot of former flight surgeons, and none have ever described a situation like this. Hopefully your experience is uncommon.

Unfortunately, it's not. Perhaps the trials of flight surgery have been supplanted by the trials of residency and actual practice.

Trix, not so long ago a flight surgeon at sea, in port, in garrison, and (yes) in the clinic.

 

[bouspret]

hello all,


I'm a pre-med, prior service, but I have some information that might be helpful. I posted a pretty lenghty document on the navy HPSP Wiki about my experience with this. As such, the intended audiance was Navy HPSP students.

background:

Before matriculating to medical school this fall on the HPSP scholarship, I was fortunate to meet Rear Admiral William Roberts (Current Chief of the Medical Corps) and the Medical Officer of the Marine Corps. Essentially, he is the head physician in the US Navy’s medical corps.

He agreed to have me work for him temporarily for a few weeks in April, 2008 as I complete my obligation as a line officer. While there, he allowed me to sit in on staff meetings, his meetings with his deputies, and several events with the Navy Surgeon General at the Navy annex to the Pentagon, Pentagon, BUMED, etc. My goal was to get a decent grasp on how the navy medical corps works.

While there I sat on a GMO conversion board at BUMED. Here are my notes on the subject:

About the GMO/residency:

Will I be doing a GMO tour and what will I likely be doing if so? –

It depends when you graduate. I sat in on a GMO conversion board while I was TDY at BUMED. There are approximately 500 GMO billets, and the first 100 were converted about a week ago (from FY 07 [I wrote this in early April 2008]. They are planning on converting an additional 100 Billets every fiscal year until they're gone (e.g. four years from now). I actually saw the list and can verify that the billets were coded for board elligible docs, PAs, etc.

If you're graduating soon, you're more likely to be doing a GMO. It also depends on your specialty choice. If you're thinking OB/GYN, Psych, or Family medicine you will likely go through without a GMO tour because these are critical specialties. Essentially, your chances of doing a GMO tour this year are 20% less than last year and will continue to go down 20% every year after this one until they're all gone. This is to align with the 1999 House Resolution that mandated all GMO billets be converted to board eligible physicians. As we all well know, the AF and Army accomplished this. The navy pushed back and was ultimately told to complete this under the "migration" plan I outlined above.

However, if you WANT to do a GMO tour, you will be able to. They will be able to put you in to a GMO tour if: (1) you want to do a GMO tour (2) You don't select your top choice and want to improve your package (GMO is weighted heavily) and try again, rather than taking your second or third choice. (3) you decide that you don't like your specialty/ get dropped from the residency program and need some place to tred water until you figure out what the next step is.

As far as GMO options: (1) Undersea medicine (including SEALs, EOD, Marine Force Recon, but the majority are Nuclear Submarine related billets). (2) Flight surgeon (some shore tours (e.g. Pensacola), some deploy with squadrons on carriers (3) GMO on a carrier, amphib (4) With the Marine Corps as a Battalion Surgeon, etc. You rank your choices and the navy makes the final decision.

 

[Perrotfish]

I'm a pre-med, prior service, but I have some information that might be helpful. I posted a pretty lenghty document on the navy HPSP Wiki about my experience with this. As such, the intended audiance was Navy HPSP students.

background:

Before matriculating to medical school this fall on the HPSP scholarship, I was fortunate to meet Rear Admiral William Roberts (Current Chief of the Medical Corps) and the Medical Officer of the Marine Corps. Essentially, he is the head physician in the US Navy’s medical corps.

He agreed to have me work for him temporarily for a few weeks in April, 2008 as I complete my obligation as a line officer. While there, he allowed me to sit in on staff meetings, his meetings with his deputies, and several events with the Navy Surgeon General at the Navy annex to the Pentagon, Pentagon, BUMED, etc. My goal was to get a decent grasp on how the navy medical corps works.

While there I sat on a GMO conversion board at BUMED. Here are my notes on the subject:

About the GMO/residency:

Will I be doing a GMO tour and what will I likely be doing if so? –

It depends when you graduate. I sat in on a GMO conversion board while I was TDY at BUMED. There are approximately 500 GMO billets, and the first 100 were converted about a week ago (from FY 07 [I wrote this in early April 2008]. They are planning on converting an additional 100 Billets every fiscal year until they're gone (e.g. four years from now). I actually saw the list and can verify that the billets were coded for board elligible docs, PAs, etc.

If you're graduating soon, you're more likely to be doing a GMO. It also depends on your specialty choice. If you're thinking OB/GYN, Psych, or Family medicine you will likely go through without a GMO tour because these are critical specialties. Essentially, your chances of doing a GMO tour this year are 20% less than last year and will continue to go down 20% every year after this one until they're all gone. This is to align with the 1999 House Resolution that mandated all GMO billets be converted to board eligible physicians. As we all well know, the AF and Army accomplished this. The navy pushed back and was ultimately told to complete this under the "migration" plan I outlined above.

However, if you WANT to do a GMO tour, you will be able to. They will be able to put you in to a GMO tour if: (1) you want to do a GMO tour (2) You don't select your top choice and want to improve your package (GMO is weighted heavily) and try again, rather than taking your second or third choice. (3) you decide that you don't like your specialty/ get dropped from the residency program and need some place to tred water until you figure out what the next step is.

As far as GMO options: (1) Undersea medicine (including SEALs, EOD, Marine Force Recon, but the majority are Nuclear Submarine related billets). (2) Flight surgeon (some shore tours (e.g. Pensacola), some deploy with squadrons on carriers (3) GMO on a carrier, amphib (4) With the Marine Corps as a Battalion Surgeon, etc. You rank your choices and the navy makes the final decision.

Thank you for the information, that's great to hear

 

[Kingfisher]

Good info, thank you.

 

[sethco]

Essentially, your chances of doing a GMO tour this year are 20% less than last year and will continue to go down 20% every year after this one until they're all gone. This is to align with the 1999 House Resolution that mandated all GMO billets be converted to board eligible physicians. As we all well know, the AF and Army accomplished this. The navy pushed back and was ultimately told to complete this under the "migration" plan I outlined above.

What!?!?!? 😕