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Navy HPSP, being a GMO and Residency

Discussion in 'Clinical Rotations' started by DaveB, Jul 25, 2001.

  1. DaveB

    DaveB Slave to The Man

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    I just came across the last string about HPSP and GMOs... as someone who is just starting out down the path toward my HPSP fate I now have a bunch of questions:

    How inevitable is a tour of duty as a GMO?

    Anybody have any thoughts or input on doing flight surgery or undersea medicine for a GMO tour?

    From what I understand there are no comprehensive residency programs in the military coming straight out of school - I'm stuck with applying to one of their GME-1 programs. For example: I can't go do a 6-year urology residency - I have to do a year of surgery, then re-match to a 5-yearurology residency. Am I correct on my understanding here?

    What the heck did I get myself in to!?!?

    Any input greatly appreciated here. :confused:
     
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  3. bustinbooty

    bustinbooty Senior Member

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    I will tell you that you are going to do a GMO tour, given the current shortage of GMOs, and that it will most likely not be flight surgery or undersea medicine. Other than that, I can't say much else. I got turned down due to asthma and I haven't decided yet whether that was a blessing in disguise or not. However, there is such a shortage of GMO's that my recruiter suggested that I reapply next year and may get accepted, despite my history of asthma!! Which is funny, because over the next year, my medical history isn't exactly going to "change". Apparently, there is quite a need for GMO's For more info, "Flea" has been a great resource for HPSP info, as she is just finishing her GMO tour. She has been posting in the "Matching after HPSP Repayment Time" thread.
    Best of Luck!!
     
  4. Popoy

    Popoy SDN Super Moderator

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    I agree w/bustinbooty.... FLEA where are you???? There's a need for info about HPSP and GMO info.... YOU DA WOMAN on this topic!!! :D

    bustinbooty, you never.... you might be right.... it might have been a blessing in disquise.... Good luck to you....
     
  5. DaveB

    DaveB Slave to The Man

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    I'm suprised they wouldn't take you because of childhood asthma.... when I got checked out it seemed like they were willing to gloss over most problems just to get eager bodies to fill slots. I'm sure a lot has to do with who does your physical. If you think HPSP is for you I'd try again. I got to talking to my recriuter a while back (it was amazing how much more informative he was after I got sworn in) and he said that they are increasing their HPSP spots by something like 1/3 this coming year, and they are going to have to push hard to fill everything.

    I wouldn't get too negative about Navy medicine.... I've talked to lots of docs who put their commitment time in and loved it. It can also be a huge boost professionally - I know more than a few people who have put their time in and now are residents/attendings in very prestigious civilian programs. I'm even kind of excited about the possibility of being a GMO. Flea has had the most negative comments out of anyone I've heard about. I wonder if a lot of her problems stem from the fact that she's a women... I've been told that shipboard duty is very tough as a female (this is the military we are talking about).

    All of this is just kind of frustrating because they definitely played down the whole GMO thing when I signed up....
     
  6. Flea

    Flea Member

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    I hope this is not too negative :D.....

    Very...there's a good reason for the increase in HPSP slots-- from some good resources (US Medicine - a military physician newspaper) the military wide retention rate after HPSP payback (ie the first voluntary extention) is 5% :eek:
    This means the 'GMO pipeline' is shrinking.
    Ask the recruiter this year's GMO numbers/ture retention rate, I'll be surpised if he gives them to you..

    There's alot of talk about how to manage this...They are currently shrinking the number of shore billets for GMOs.
    Personally- if my payback had been just 2 years, I'd have probably like it alot better-the light at the end of the tunnel would have been closer and less like a train.

    Most of my friends who went this route had a much better time...both these areas are alittle better funded/supported/regulated.
    Both flight and undersea medicine have extra "school" - which does count towards payback, therefore your total 'payback' tour is usually 3 years- at that point you can stay in/goto residency or get out. If your planning on getting in a compeditive navy residency this is a good route---IF you pass the physical (it's stricter) AND get pick (they are relatively compeditive).

    Bustin'-- I've had several patients that were "told" by there recruiter (the recuiter's all deny it of course) "don't worry I'm sure you don't need that HALDOL (lithium or anti-psychotic of your choice), just quit taking it before you get to boot camp". There a tremendous amount of pressure on the recruiters to make the "numbers"
    I had some childhood orthopedic problems that were "blown off" in the recruiting process- as a pre-med I didn't know that it would reoccur with running in formation (alot).. after surgery/steroids I can still walk at the end of the day (now), but I'll have pain for the rest of my life (I really don't mean that to sound bitter- I pushed myself too far). This is another reason I'm getting out- I will never be able to pass, never mind get outstanding, on the physical readiness standards again.

    I DO NOT want to give the impression that testosterone was a major part of my dissatifaction.. I would call a small annoyance. :D I do think you have a small point .... I was one of the first female physicians to take that postition with the Seabees (they just started to take women as enlisted/officers in '95). I was one of 1-3 women out of 17-20 people in the wardroom (it varied). Many did not know how to relate to women as "cohorts"--most were engineers and did not even work with many in college (I think most women there were dates or competition). I think the fact that 95% of the male officer's wives did not work outside the home only added/emphasized this... :confused:...
    The enlisted (construction workers) were initally unsure of what to expect, but after treating a few "personal" problems (ie asking the diabetics about erectile dysfunction--AND treating it with viagra) they were probably the most accepting after that ....
    Of all the people I had problems with, it was actually the officer's wives- for people that I never did anything to, they were VERY cold and rude. :confused: That was something I was not expecting. :(

    Testosterone/Estrogen aside :D,......have only met 1 CAPTAIN (a reservist) that recommended staying in-over the past 3-4 years!! MANY,MANY other physicians have told me (male and female) that if given the chance they would get out !!
    Military Medicine is going though a VERY painful "growth' period.. to the HMO mind set. Overwhelming Paperwork (for every 2 patients there's 1 hours worth of forms/notes/consults- most must be hand written/rewritten), poorly trained support staff, the demand for more work- with less support and money, poor business practices(outdated information managment,lack of CMEs etc), lack of control of your schedule (NON-medical people make the appointments- so your new diabetic c HTN and CHF has a 20 min appointment AND oh by the way he's having chest pain :eek :) and little to no pay raise in 10 years all contribute to significant portion of physicians being dissatified.

    There are people out there that had better experiences as a GMO, but most are STILL getting out. Of the people that are staying, most are afraid of civilian residencies/life or too close to retirement (ie 2-3 yrs or less)- there are ones staying because they like it, but they are in a small minority (I have met 2).

    AGAIN- I did gain some maturity, experience, and leadership skills- YOU WILL still get a benefit from being a GMO (staying in or gettin out) and if you planning on making the military a career it's still VERY improtant-you WILL get NO respect if you havn't been on the operational side-- AND you will be at the bottom of the residency canidate list.
     
  7. DaveB

    DaveB Slave to The Man

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    And my guess is that those 5% were people with prior service before they entered the HPSP program. I wasn't expecting to put in more than my 4 years, and the more I hear it seems like thats definitely going to be the case.

    Well.... it looks like I have to resign myself to the fact that my career path (at least early on) is going to be a lot different that the career paths of my classmates :eek: . Is this how all the service branches work? I mean, I expect the paperwork and beuracracy to be everywhere, but are the Army and Air Force better about residencies and not railroading people into operational medicine? I wonder if I can jump to another branch....

    The strange thing is that I actually think that operational medicine might be kind of fun, I just am concerned about what kind of havoc all of this is going to bring on my personal life..... not to mention the fact that by the time I finish school, do my 4 years service, finish a residency and get into practice I'll be almost 40 years old. Is all of this worth avoiding a $300K debt?

    So if I'm looking at not even doing a real residency until at least 4-5 years out of school, is it even worth busting my butt to honor all my classes, get AOA and all that stuff? It sounds like all I'm competing for are a bunch of 1 year internship slots that the Navy can't even fill, and that even if I want to do a residency with the Navy I'm stuck putting shipboard time in anyway. Maybe I should just hit the gym and make sure I can pass the flight surgery physical :D . I'm just trying to figure out how to position myself so that I can make the most of this experience...

    Is there any other advice you think I need to know before I sail away in a few years to scrape SeeBees off the ocean floor? ;) Are there any resources or stuff I can read that will help me out with making decisions about all of this?

    I appreciate your input and advice with all of this. :)
     
  8. Flea

    Flea Member

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    As much as I bitch, I do think GMO was the way to go- staying in or getting out :D.

    If you getting out...
    1. It shortens that total time you under military control.
    2. The military residency did not thrill me (not that they're bad, but not the focus/pt population I wanted)
    3. You get valuable leadership/"on-your-own" education. I know after Residency I'll be way ahead of the "traditional" pathway residents
    4. If your permitted to do a civilian residency instead, you STILL are in for another 4 years after that... :)

    If you staying in...
    1. I would much rather be a GMO on the USS Neverhome, then doing doing those type of hours/travel AFTER residency (there's still no guarentee that you won't)
    2. You NEED to check the Operational box to make rank (ie get paid more)- YOUR in the NAVY how can you justify parking your butt in a clinic your whole career (some do it, but do not get ANY repect-and rarely make it past Commander).
    3. The Navy is (somewhat, not totally) different from the other services- ships, subs, marines, and Seabees tend to depoly in smaller,isolated groups, for long periods- this would be a waste/deterioration of skill for an FP (no Peds, OB(well not alot), or Geriatrics) and the same for IM or ER- but too isolated for PAs/IDC's
    4. Accept it, your career is going to take a different path :D
     
  9. platinumdoc

    platinumdoc Member

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    If you are considering an HPSP scholarship, consider it for the patriotic and altruistic motivation to serve the US military. If you are considering this as a financial motivation, you may be making the worst mistake of your life. It could even mean losing your life if you are put right into the heat of battle.

    The current track of military residency training still involves doing a GMO/Flight surgery/Undersea Medicine tour. Flight surgery, although easier in lifestyle, makes you clinically dull and your brain tends to atrophy. The premise of doing 50% time in the clinics and 50% time in the squadron will make a lazy practioner out of you. If you wanted to become a pilot, you shouldn't have sacrificed to become a physician. I have seen many flight surgeons very weak on the clinical side, even though they are given a 6 month indoctrination on aviation physiology. Why? Because much of the patients they examine are healthy and without disease. As a undersea medical officer, you can get the opportunity to be a medical officer for the SEALs but you can also end up on a submarine squadron seeing a bunch of kids wanting to get out of submarine life (a psychiatric nightmare). Being a GMO, you can end up with several possible tracks: GMO on a carrier (2-3 flight surgeons, a PA, and corpsmen), GMO on an amphib (you act as Dept Head and practitioner, with an independent duty corpsman), GMO on a amphib (where you are the butt boy and answer to a senior medical officre who sits on their ass, while you see patients), GMO in a clinic (where you can end up seeing patients ages 8 to 65 in 15 minute intervals), GMO with the SEABEES, GMO with the marines.

    GMO tours will eventually fade away. Other branches still use them to some degree. A majority of Air Force train their officers straight through.

    If you are interested in anything other than Peds, Family Prac, or Psych, you will have to do a GMO tour. Keep in mind that before you decide on doing back to back tours, that you are working on still being competitive for residency. It is quite hard trying to ask time off from Yokoska, Japan to do a rotation stateside for Dermatology, or whatever. It is also quite hard to go back to the O.R. if you have been out of it for so long. Keep in mind, the navy will try to sucker you into staying by asking these questions:
    1) How competitive are you? No, really.
    2) You realize that your pay will be cut in half, don't you?

    Another word of advice, TAKE THE GI BILL DEDUCTION DURING YOUR FIRST YEAR. You have ONE CHANCE, NO EXCEPTIONS TO THIS. If you do a civilian residency after your committment, you are entitled to the GI bill which is currently $650 / mo for 36 months during residency training. That is a pretty good investment for a $1200 contribution.

    Good luck. Fare winds and calm seas, young Ensigns. :D
     
  10. DaveB

    DaveB Slave to The Man

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    I take it you are a GMO yourself?

    Well, I've already signed my name on the dotted line and gotten sworn in, so I'm in whether I like it or not. Fortunately there are reasons other than money that drove me to do it, so I think it'll be something I'll get a lot out of.

    I'm just wondering how I can get the most out of all this professionally. So the gist of what you're saying is that doing a standard GMO tour is the best way to go, right?

    I know I don't want to be a general practitioner, so I will be doing some sort of operational tour. I'm not sure if I want to make a career out of Navy, so I'm not sure if its worth doing a Navy residency, but I'd still like to set myself up for that if I decide to do it. Flight surgery and undersea medicine are really appealing to me because it seems like those expose you to the operational Navy the most, but you've brought up some very good points that I hadn't thought about.

    What stage of everything are you at? Whats your career plan and the thoughts behind it? I'm interested to hear how others on a similar career track think through all this.

    Thanks for your input.
     
  11. Flea

    Flea Member

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    FYI :eek: For an extra $350 now---you'll now get $850 :eek: per month during CIVILIAN Residency !!!!!!!

    After 1yr of internship and 4 yrs as a GMO --I'll be getting the SAME pay when I'm a civilian resident (PGY-1) :eek:

    If I did a Navy residency-- I would take a $15,000 pay cut :( ........

    What's wrong with that? :confused: I wonder why retention is so low? :rolleyes:
     
  12. Homunculus

    Homunculus SDN Caveman Administrator
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    just to make sure everyone knows... the navy HPSP and Army HPSP are different monsters. :)

    take it easy

    homonculus
     
  13. platinumdoc

    platinumdoc Member

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    I am a GMO, myself. I am currently at a mainside clinic seeing Tricare Prime patients. The motto from the Hospital Commander is "You areTRICARE". I did a two year operational tour on an aircraft carrier. The tour was not bad initially since we had an excellent surgeon. The next year, the surgeon wasn't so hot. I ended up doing a lot of post operative exams on his/her (to save the person's name) patients.

    Now, I am in a clinic expected to see 25 patients a day with 15 minute slots. There are nightmare patients since I see everyone from 8 yo to 65 yo. They end up being things like med refill on 6-10 meds, or a fibromyalgia patient allergic to 20 meds, or a spouse with a dependent personality disorder whose servicemember is going on a deployment. I also have duties in acute care which would prepare me if I wanted to do E.M.

    My current plan is to apply through the match this year for 2003 for Radiology. I am also applying outside of the match for 2002, when I get out. Luckily, I have two research presentations and 2 pending publications which should get me some interviews in competetive programs.

    I have seen well over 9000 patient encounters and have decided that patient contact is not the area for me. One year to go.... :)
     
  14. Liljoe2002

    Liljoe2002 Member

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    Platinum doc,

    Point well taken, your post was hilarious...I don't know if you were trying to be funny or not! The more I hear about these GMO horror stories the more it makes want to do Flight Surgery. Where exactly are you right now, the States or overseas?

    Liljoe
     
  15. Scots_Wha_Hae

    Scots_Wha_Hae New Member

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    Why on earth would anyone even consider the Navy when the Air Force is available? ;) I feel for you guys though. It may not be too late to pull yourself out of your committment if they haven't given you any money or sent you to training. Technically, they own your ass and if war broke out next week , could yank you out of med school. However, you could trying weeping, wailing , and gnashing your teeth until they let you go. If all you have done is signed and raised your hand, there may be a chance. BTW, I went with the Air Force and I'm pumped about the opportunities we have. They really have their crap wired together.
     
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  17. Ludy

    Ludy Senior Member

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    There is a chance.
    I went to OBC (the Army HPSP summer program) and immediately realized that I was not an Army person and had no desire to spend the next 12 years of my life in such an inefficient, frustrating system. It took a little pleading and a lot of time, but I did eventually manage to get out. I went before my first year, however, so they hadn't actually put down any money for me. Given the resistance I was met with when I decided to get out, I think it would be next to impossible once they've started paying your tuition.
    One good reason to try to go to OBC before your first year (or to just be better-informed about the Army lifestyle before you sign on the dotted line...).
     
  18. Homunculus

    Homunculus SDN Caveman Administrator
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    12 years? how would you owe the army 12 years, unless you had some prior obligation?
    And when did you go to OBC?-- I went this year, and even I was dissappointed in the way it was done...

    take it easy

    homonculus
     
  19. platinumdoc

    platinumdoc Member

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    LilJoe

    I am on the East Coast in VA.

    You need a little humor but those patients were real. The surgeon is real...really scary. If you don't look at the light side, you can go crazy...There is one person who just went U/A to the other coast, after dealing with his/her superior officer. There is a rumor that one GMO who medevac'd herself off of the ship for neck pain.

    Flight surgery is probably the best deal of them all. I am not a fan of flying so I wouldn't consider it myself. There are too many MISHAPS with helo's crashing all the time. The Marine Ospreys are the same way. When every there is any kind of mishap, it could get very stressful since you conduct medical investigations. However, you do get a lot of reading time and fun with the pilots. Your patient load is light and consists of very minor problems and physical exams; however, your brain may atrophy if you lack motivation. Before you start Flight Surg school you may still do 3-6 months of GMO time in wonderful places like Great Lakes or Sewell's Point Branch Medical Clinic.

    I am one of the few GMOs who get the privilege of seeing TRICARE patients (80% are dependents/retirees). At least I have an office with two windows and I have no call or weekends to complain about. I will soon be replaced by an FP next year. :)
     
  20. Liljoe2002

    Liljoe2002 Member

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    Platinum Doc,

    Interesting...so it is true that GMO's are being replaced by docs who have completed their residency. So I guess I can assume that this means now that more interns will get to go straight through residency? What happens if your trying to get into a competitive spot like Radiology where doing something like a GMO will make you more competitive?

    Liljoe :)
     
  21. platinumdoc

    platinumdoc Member

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    Undersea is the only one of the three that gives additional clinical training: Hyperbaric medicine. This is an advantage for any E.R. docs out there. I hear that the moonlighting opportunities for Hyperbaric chambers are excellent, also. ;)
     
  22. Ludy

    Ludy Senior Member

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    Homonculus,
    I said 12 years, meaning the four in med school, assuming an average 4-year residency (unless I had been one of the lucky few to escape to the civilian world) and then my 4-year repayment time. Sure, you're not on active duty all that time, but you are for at least part of each year and you still have to deal with the insane paperwork and phone calls to a million different people to get each question answered.
    I went to OBC last summer (2000). There were several of us that decided to get out about midway through, but we weren't allowed to leave until we had completed the course... at the risk of being considered AWOL. At least we still got paid, though :)
     
  23. platinumdoc

    platinumdoc Member

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    The word is out that GMOs in Branch Medical Clinics are going to be phased out. PAs are hungry for operational tours but won't be practicing independently - although an indepedent duty corpsman with less 'schooling' can practice 'independently' as long as their records are checked periodically. The Senior Medical Officers are being filled by Board Certified physicians in specialties like FP, EM, IM. I doubt that Carrier GMOs will be replaced by anyone board certified. Marine Units are another section that I doubt will have GMOs replaced by FPs. Amphibious ships have will also have GMOs, except where there are SMOs. Most overseas billets will probably go to FPs/PAs and some GMOs. So the answer to your question is probably not in your lifetime. GMO life is still very possible.

    Even with Flight Surgery and Undersea Medicine, they are moving towards Residency in Aerospace Medicine (RAM-which is a GMO with a MPH) or Residency in Undersea medicine. These programs incur additional obligation since they are considered 'training'. Some of the flight surgeons that I knew neither flew nor operated so it was considered an oxymoron, in my book.

    Some Hospitals (MTFs - Military Tx facilities) are going through realignments. They are decreasing the number of directorates and are standardizing clinic appts and clinic schedules. Specialists are leaving the onus for patient care to the PCMs (Primary care manager). Tricare is intercalating into the very essence of military medicine like a malignant metastatic cancer. It seems this system which has taken so long to come online is here for a LONG time. The medical admin officers (twigs) are running the show. The senior officers in the medical field are supporting some changes to increase productivity (ie. UTI clinic where a doctor is responsible for an uncomplicated UTI based on sx and lab values without examining a patient, or URI clinic where nurses who have limited training in physical exam or history taking will do the Subj,Obj and Assessments but you have to write for meds). Folks it is coming. What do you ask? Hell I don't know but there is some bad JUJU that is going to explode and I am glad that I am going to be gone before it happens.

    PCMs are assigned patients and write for consults for people who have never been seen in clinic. Patients are randomly assigned to you and are not, obviously, taking into account the level of your training. How can a 'PCM by name' system work, if people are leaving the area every 2 - 3 years and the providers are moving in and out in a stepwise fashion?

    Disclaimer:
    -the opinions expressed are not in any way any views of the navy-
     
  24. Flea

    Flea Member

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    Platinium Doc is COMPLETELY on the mark :(
    It's the same s---, different location for each MTF. My story is the same here and it's NO exaggeration.

    This is happening at ALL MTFs :(

    The focus is on "the numbers" you see and off the 'quality' of care you give and MOST Admins will tell you this to you face. :mad:

    Hold on to your medical license it's going to be a bummpy ride!! :D I work 11-12 hour days and on weekends just trying to make sure I haven't missed (ie killed) anybody-- and watch the MSCs/nurse corps go home at 4pm every night (5 nights a week)...While at the same time forcing us to be responsible for all of the paperwork and barriers they've created :mad:
    Why do I work that long? 'Cause the system's broke and I'm not willing to put my patients and my liscense at more risk- and they've Admins have removed themselves from responsibility. :(

    There's alot of burnout in the military, because the reality is you have NO control over the situation and there is no solution in the near future-- just keep your head low and hope you don't get screwed (more) before you can get out with your license intact... Hence the lesson "never sign a contract without 2 lawyers and a 1 year "out"clause"
    :D

    Just in case your confused-- this does not necessarily reflect the views of the navy :)
     
  25. platinumdoc

    platinumdoc Member

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    After looking at the posts on this website, I noticed that a flight surgeon posted here. He or she did make a good point, if you want to do a military residency, you need a leadership role. Flight Surgery and Undersea Medicine definitely do this. As you will see when applying to military GME, you are given a higher priority based on prior military experience (eg prior pilot, navy SEAL, etc) and on rank (ie if you are a CDR or CAPT - you are likely to get chosen). The longer you stay in, and the higher your rank, the more likely you'll eventually get picked up for residency.

    However, while administrative duty and department head roles are good for the military, you are not practicing medicine to the degree that a GMO (in a purely clinical setting) will practice. GMOs do not have to spend 50% of their time with their squadron so they are immersed (not by choice) in clinical duties. Flight surgery does prepare you well for fields in Emergency medicine and ophthalmology, even in the civilian world.
     

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