Navy Ophthamology

[ActiveDutyNavy]

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Anyone have any new data/opinions concerning navy ophthalmology? How competitive? Chance for straight through training? Precent of postGMO MDs accepted? Avg Board Scores? Program Director at NMCSD? Any chance for civilian deferment? And in general life as a naval ophthalmologist?

I know there's 4 spots a year available at NMCSD.

In 2007 there were 17 applicants for 3 spots.


Any help would be greatly appreciated


I apologize for the misspelling of Ophthalmology in the title thread

 

[orbitsurgMD]

Anyone have any new data/opinions concerning navy ophthamology? How competitive? Chance for straight through training? Precent of postGMO MDs accepted? Avg Board Scores? Program Director at NMCSD? Any chance for civilian deferment? And in general life as a naval ophthamologist?

I know there's 4 spots a year available at NMCSD.

In 2007 there were 17 applicants for 3 spots.


Any help would be greatly appreciated

Beats 45 applicants for three spots, in the day.

You will not be competitive unless you have a GMO tour. Straight-through training is rare.

The reason there are three spots and not the eleven that there used to be (Oak Knoll closed, nix 3, Bethesda closed, nix four, Balboa went down to 3 from 4, the sad history there) is that since ophthalmology procedures have been radically trimmed in CMS Medicare payments, the incentive for many military doctors to leave the military as soon as possible has gone away; that and the fact that most retirees are sent out to the community through TRICARE and not seen in the .mil anymore. So ophthalmology billet vacancies are fewer and, unfortunately, so are the incentives to select residency graduates for fellowships.

I think there is little chance for residency deferment. The only case I know of is a guy from my med school who asked for a deferment for anesthesia during the military match, got the deferment, applied for civilian ophthalmology knowing the early ophtho match would be over and done before the Spring main match for civilian anesthesia, got a spot in ophthalmology in a Big Southern State, and went back to the Navy told them he had "changed his mind" and asked if he could still have his deferment, but for ophthalmology instead. And they let him. He cleverly must have known that by then the Navy's internship billets were already filled up (and also the GMO replacement slots, which really is what drives the internship numbers) and that they really didn't need him right away. So if I were to suggest a means by which you might get a deferment, that would be it, because it is the only way I have seen it work.

Count on the GMO tour. You can apply without one, but there will be very well qualified people applying with one.

 

[Gastrapathy]

Beats 45 applicants for three spots, in the day.

You will not be competitive unless you have a GMO tour. Straight-through training is rare.

The reason there are three spots and not the eleven that there used to be (Oak Knoll closed, nix 3, Bethesda closed, nix four, Balboa went down to 3 from 4, the sad history there) is that since ophthalmology procedures have been radically trimmed in CMS Medicare payments, the incentive for many military doctors to leave the military as soon as possible has gone away; that and the fact that most retirees are sent out to the community through TRICARE and not seen in the .mil anymore. So ophthalmology billet vacancies are fewer and, unfortunately, so are the incentives to select residency graduates for fellowships.

I think there is little chance for residency deferment. The only case I know of is a guy from my med school who asked for a deferment for anesthesia during the military match, got the deferment, applied for civilian ophthalmology knowing the early ophtho match would be over and done before the Spring main match for civilian anesthesia, got a spot in ophthalmology in a Big Southern State, and went back to the Navy told them he had "changed his mind" and asked if he could still have his deferment, but for ophthalmology instead. And they let him. He cleverly must have known that by then the Navy's internship billets were already filled up (and also the GMO replacement slots, which really is what drives the internship numbers) and that they really didn't need him right away. So if I were to suggest a means by which you might get a deferment, that would be it, because it is the only way I have seen it work.

Count on the GMO tour. You can apply without one, but there will be very well qualified people applying with one.

I know one post-GMO who was deferred for ophtho a number of years ago. Probably harder now. While the above strategy may have worked for one guy, it could easily have backfired. All it would take is for one other future intern to have an issue that precluded continued service and he could have been slotted into any internship. Pulling the tail of the tiger is a little risky.

 

[backrow]

Gastrapathy nailed it on pretty much anything.

They are now taking one resident per year at Bethesda as well. At least they did last year and I think they are planning on continuing this.

Most people need at least one GMO tour to be selected, I have heard of people being selected after two and even three GMO tours.

 

[orbitsurgMD]

I know one post-GMO who was deferred for ophtho a number of years ago. Probably harder now. While the above strategy may have worked for one guy, it could easily have backfired. All it would take is for one other future intern to have an issue that precluded continued service and he could have been slotted into any internship. Pulling the tail of the tiger is a little risky.

That was back when HPSP was actually competitive and the services weren't hurting for people.

 

[Gastrapathy]

That was back when HPSP was actually competitive and the services weren't hurting for people.

Yup.

And before the work hour rules...and back when the wards were designed like Escher prints so the interns always walked up hill.

Oh well, time to bust out the donut of misery again. It can't look worse than last time I checked.

 

[Mirror Form]

The reason there are three spots and not the eleven that there used to be (Oak Knoll closed, nix 3, Bethesda closed, nix four, Balboa went down to 3 from 4, the sad history there) is that since ophthalmology procedures have been radically trimmed in CMS Medicare payments, the incentive for many military doctors to leave the military as soon as possible has gone away; that and the fact that most retirees are sent out to the community through TRICARE and not seen in the .mil anymore. So ophthalmology billet vacancies are fewer and, unfortunately, so are the incentives to select residency graduates for fellowships.

That is partially correct, but it's not the only reason there are so few Navy Ophthalmology training slots. Unlike many other military medical specialties, Navy ophthalmologists have traditionally not gotten out as soon as their obligations are up. The higher up Navy ophthalmologists built up very nice (and in some respects "cush") departments at Bethesda and San Diego. The result is that Navy ophtho has become extremely top heavy with tons of colonels hitting 20 year marks at Bethesda and just never retiring.

This is beginning to change. With AHLTA and now the "big merger," more Navy ophthalmologists are leaving when they finish their obligations.

 

[movax]

.

 

[ActiveDutyNavy]

so how does military match and the SF match interact?

I'm assuming you apply, interview and find out for both around the same time of year. correct?

And if (or when) the military denies your civilian deferment you just wasted a lot of time and money.

 

[Mirror Form]

so how does military match and the SF match interact?

I'm assuming you apply, interview and find out for both around the same time of year. correct?

And if (or when) the military denies your civilian deferment you just wasted a lot of time and money.

Yep, this is correct. For specialties that use the NRMP, you don't have to go on interviews b/c you'll find out whether you're deferred before that point. However, for the San Fran Match, you'll have to spend lots of money and time both applying and going on interviews.

 

[ActiveDutyNavy]

Since NMCSD is the only naval hospital with an ophthalmology residency, would it be remise if I were to do one and only one 4th year clerkship rotation there in Ophthalmology?

Or should I keep my additional clerkship rotation I currently have set up at NMCP in a different specialty? (IMO, it has already been scheduled)

Trying to keep cost down (HSCP student with family and will be on "no cost TAD orders" - one of the real disadvantages of the HSCP program vs HPSP, fyi)

To my understanding the benefits of keeping the additional clerkship rotation, is the interview for my intern year...is that correct? are there more?

I'm still unsure how exactly interviews are handled on a clerkship rotation. Do I interview with the Ophthalmology PD as a MS4 even though my application will only be for GME-1?
Do I interview with the TY PD (if there even is one)?
Does the TY and Ophtho PDs discuss their interviews (for instance if I perform above the Ophtho PD expectations would he be inclined to request that the TY program accept me)


Do I need to have Step II CK done before my rotation? Step II CS?

How exactly do you get accepted for straight-through training? (i know it's rare) Do you get accepted to intern and residency all in the same orders/contract? or Do you only get accepted to your intern year with a verbal understanding for acceptance into your desired residency at GME-2?


I know, LOTS of questions, but I'd appreciate any help

EDIT: I think I've decided that a civilian deferment, unfortunately, isn't in my cards. Growing family to take care of.

 

[Mirror Form]

Since NMCSD is the only naval hospital with an ophthalmology residency, would it be remise if I were to do one and only one 4th year clerkship rotation there in Ophthalmology?

There will soon be another slot at Bethesda, which will be combined with the Walter Reed army ophthalmology residency (so they'll have three army residents and one navy resident per year). So it wouldn't be a bad idea to rotate there as well.

 

[ActiveDutyNavy]

http://www.med.navy.mil/sites/navmedmpte/gme/Pages/ACGMEapprovedpositions.aspx

This is where I'm getting my information. Is this not accurate? I see on NNMC website that they are accepting 1 student at time for clerkship, but according to the above website NNMC isn't accepting Ophtho residency spots. (Although, maybe the above website hasn't been updated. The date at the top of the webpage is AUG2008)

Addendum: Just looked at NNMC website for residencies and they don't even have Ophtho listed.

Where can I get the most up-to-date information concerning this topic?


If NNMC does have an Ophtho residency, then I need to know so I can cancel my NCMP clerkship and switch it to NNMC before it's too late.

 

[Mirror Form]

If NNMC does have an Ophtho residency, then I need to know so I can cancel my NCMP clerkship and switch it to NNMC before it's too late.

Well, NNMC definitely now has one navy ophtho slot per year b/c they've combined with Walter Reed's residency program. I'm not sure of any links I can give you to prove it. You could always call either WRAMC or Bethesda's ophtho dept's though.

 

[ActiveDutyNavy]

NNMC definitely has 1 spot. Thank you Mirror Form.

New question:
Looking at the SF Match data from recent years, matched applicants "average" step I scores have been steadily increasing. To the tune of:
2004 - 228
2005 - 229
2006 - 230
2007 - 231
2008 - 232
2009 - 235
2010 - to be determined, though I foresee an increase, hopefully, not another 3 point increase

Since GMO land is almost assured for those pursuing Navy Ophthalmology, this made me start thinking about board scores and competitiveness.

For those of us applying in 2010, Will we be compared with 2010 Matched Applicants or with the applicants and data of 2014 once we return from GMO land. This could greatly affect those of us that are deemed "competitive" currently, but would likely not be competitive after 4 years as the "average" step I of matched applicants continues to rise.


This could likely influence my carrer decision.

 

[AFDuck]

The fact that you would have completed an internship and GMO tour when applying to the 2014 match would make you extremely competitive for a residency against any medical student. Even one with high Step scores. Also, don't you think its kind of short-sighted to base your career decision on a theoretical increase in Step scores?

 

[ActiveDutyNavy]

i don't think it's short-sighted at all; actually I think it's dealing with reality.

Say I don't match at GME-2 and head to GMO land. When I return and reapply for GME-2 there's no guarantee I'd match this time around. At that point I'd be done with my initial obligation, which would leave me with a choice to make. Do I leave the military and pursue Ophtho as a civilian or do I sign on again as a GMO?

If I went the civilian Ophtho route, those increasing step I scores are sure to hamper my application.

If I went sign-on for another GMO, by the time I complete the tour, get accepted for an Ophtho residency, and complete the residency my 3 year old will be making college plans. That's a lot of time without a specialty and not to mention a lot of lost income that could go to my kids education and college fund.

So I think I'm actually looking at this with pretty good foresight.

 

[orbitsurgMD]

i don't think it's short-sighted at all; actually I think it's dealing with reality.

Say I don't match at GME-2 and head to GMO land. When I return and reapply for GME-2 there's no guarantee I'd match this time around. At that point I'd be done with my initial obligation, which would leave me with a choice to make. Do I leave the military and pursue Ophtho as a civilian or do I sign on again as a GMO?

If I went the civilian Ophtho route, those increasing step I scores are sure to hamper my application.

If I went sign-on for another GMO, by the time I complete the tour, get accepted for an Ophtho residency, and complete the residency my 3 year old will be making college plans. That's a lot of time without a specialty and not to mention a lot of lost income that could go to my kids education and college fund.

So I think I'm actually looking at this with pretty good foresight.

You are doing the right thing. With ophtho, given the early match for a start year one and a half years after the ophth match, you will need to be planning well in advance for both civilian and military matches.

You may have to anticipate applying both to the military and to the civilian side.

My particular case: the Navy was cutting ophthalmology residency slots so that for the year I would have been eligible to start training, one year before my EAOS and at the end of my first flight surgery tour, there were something like eight total slots (down from 11) and forty or more applicants. (The year following, they were down to about half of that, with the same numbers applying.) I had to decide whether waiting and reapplying made sense versus applying civilian and leaving. I applied civilian since the Navy would not guarantee any starts beyond the following year (and for good reason, they tried giving guaranteed slots to people just leaving internship and starting flight surgery and GMO tours; all that did is pi*s off the people who weren't told to apply that far in advance.)

Even with the rising step 1 score trend, your odds of getting a residency as a civilian the equal or better to a Navy residency are much greater than applying in-service. And you won't have to live with the whims of BUMED or your PD to decide to do a fellowship or not; if you want to do fellowship as a civilian, you just go ahead and apply.

 

[AFDuck]

To clarify, what I meant by saying short-sighted is that I don't think that your choice of specialties should change just because you're forecasting an uptrend in Step 1 scores over the next few years. However, from the subsequent posts I have gotten the sense that you might have meant that your "career decision" with regards to staying in the military or not. If that's the case, sorry about the confusion.

Anyway, I just wanted to point out that this overall trend is fairly obvious, especially with the NBME increasing the score needed to pass Step 1 just this week. I would hope that if you're applying to civilian programs down the road with a 6 or 7 year old Step 1 score they would take that score in context with this known trend. Also, over the few years I've followed this board there have been more than a couple frequent posters that have gotten the residencies of their choice after completing their committments as GMO tours. No matter how much milmed bashing goes on around here, I think that the unique experience of your years as a GMO would help you to stand out among a bunch of Med4s with great Step 1 scores.