I am currently getting ready to apply to medical school and am seriously considering the Navy HPSP scholarship. I am interested in doing a pediatric residency and a fellowship in critical care pediatrics. I do understand that as I go to school and do rotations my interests can change and I will maintain an open mind. However, my current question is does the Navy offer a pediatric critical care fellowship or would I have to get permission to do an out of service fellowship? Also, if I do have to do a civilian fellowship how likely is it that I can get a spot?
Navy Navy Pediatric fellowships
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You would have to do an out service fellowship. If you plan to sub specialize in pediatrics then the Navy isn't a great way to do it. If you manage to get a spot it can be a nice gig, but I know more people (myself included) that were denied the opportunity to pursue a fellowship than those who were allowed to.
You need to keep in mind that the military is geared towards an adult population. Of course there will always be a need for pediatrics but the military will not invest too much into pediatric subspecialties. One these specialists are of no use in an operational setting. Two it's easier just to farm out to the civilian network for service members who require pediatric specialty care for their children dependents.
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Oddly, at least during the last two wars, PICU was one of the most deployable specialties. They required one to be at the major tertiary care center in each warzone at all times, and there just weren't that many of them. Every military PICU doc I've met has deployed multiple times.
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Oh man, that sucks.
The above poster was correct, they don't have much need for specialists and send those kids to the local full service Children's Hospital.
Deploy? Maybe for hearts and minds type goodwill show geared towards the local population. However it's not for US or NATO troops. I think the only two GME subspecality fellowships in the military are adolescent an peds-GI.
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That's still a deployment in my book when you are stuck at the Role 3. It's also not unheard of to see a pediatrics trained person as a SMO on a ship.
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I am sure pediatric subspecialist deploy as GMOs. When I was deployed, plenty of pediatricians were treating adult and young adult deployed service members. My original point is that the military doesn't have much need for pediatric subspecialist since most of the need can be farmed out to the civilian network CONUS. There is not much need in ANY deployed setting apart from some hearts and mind type stuff for the local population to treat pediatrics. The last time I checked, pediatrics (<17) weren't allowed to joined the armed services unless there's been some major changes and I've been under a rock.
The Navy contains a lot more than just adults. Sure, the children of Navy service members can't be deployed, but they are just as much a part of the Navy as the actual service members. Many people wouldn't have even joined the military if it weren't for their spouses or kids. Therefore, the Navy has a great need for pediatric sub specialists, to take care of the kids who are in their system. It costs the military a ton of money to farm out to local children's hospitals. In pediatric hem/onc, for example, Navy families can choose to send their kids to the local children's hospital for treatment and have their Navy insurance pay for it, however the Navy has pediatric hematologist/oncologists that they are already paying to treat those kids. Treating cancer kids at children's research hospitals costs a heck of a lot more than inside their own system. The Navy benefits financially from having pediatric subspecialists, and they know this.
Are peds sub specialists as useful as EM docs in an operational setting? Of course not. But we still need them in the Navy.
Are peds sub specialists as useful as EM docs in an operational setting? Of course not. But we still need them in the Navy.
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Who are you trying to convince? The pediatricians who've seen the GMESB process? The Navy NEEDS physicians to staff forward hospitals and that's it. Everyone else can be replaced by a GS, contractor or any physician who takes Tricare. They didn't quite kill Peds Residencies 10 years ago but they were close. You remove the GME mission and there is very little reason left.
This applies to my adult subspecialty too. And it's why they've hardly trained any for 5 years.
This applies to my adult subspecialty too. And it's why they've hardly trained any for 5 years.
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Both sides are correct here.
The reason we likely won't see Peds go away for quite some time though is the poor reimbursement offered by Tricare. If the military tried to farm out all Peds care there would be significant shortages of available doctors (in my opinion). It would be akin to the Medicaid population unless there were substantial changes.
If things head down the no GME, bare bones operational only care model then Peds would definitely be one of the first to go.
The reason we likely won't see Peds go away for quite some time though is the poor reimbursement offered by Tricare. If the military tried to farm out all Peds care there would be significant shortages of available doctors (in my opinion). It would be akin to the Medicaid population unless there were substantial changes.
If things head down the no GME, bare bones operational only care model then Peds would definitely be one of the first to go.
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My understanding is that the 'hearts and minds stuff', for more than the last 10 years, was significant enough that they felt they needed a Peds ICU doc in each warzone at all times. It wasn't a short, limited medical mission, it was a capability that our medical staff was expected to have for all of the critically injured Pediatric patients that we took care of, throughout at least a large chunk both wars.
Other Peds subspecialists are not necessary in a warzone. There were no developmental Pediatricians in Iraq/Afghanistan, at least not in the role of a developmental Pediatrician. However we were talking about PICU specifically. PICU doctors deploy, they do it frequently, and they deploy to fill the role of a PICU doctor.
As for the broader debate of if/how many Peds subspecialists we need, other than PICU I agree its pretty much linked to our need for GME. If we ever decide to end military GME that should be the end of pretty much every Peds subspecialty. Maybe Devo will hang on so that they can have someone active duty running the EFMP program, and maybe they'll keep a handful of neonatologists to rotate through the bigger Island bases, but that's about it. If we do decide to keep military GME I hope they keep the subspecialists in house.
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just to chime in on a couple of issues. 1) peds deploy. along with FP and surgeons it's the most deployed specialty. as long as all the specialties pitch in, I'm ok with that.
on the broader notion of "peds in the military" @Gastrapathy is correct. I was in residency when the navy (probably some admiral with a good idea fairy moment) one weekend decided they no longer wanted to be in the peds residency business. mass chaos ensued, the AAP and others (ACGME I suspect) got involved, and over that same weekend the course was reversed. literally was an email Friday "bye bye navy folks, nice knowing you" then one Monday of "nevermind." big sigh of relief I suppose but it was a wakeup call and a shot over the bow that definitely got people's attention. so much so that pediatricians (especially army) were offered up on a platter as GMO's post residency as a sacrifice to the military gods to justify our existence. good or bad, politically it was a good move-- and this "operational usefulness" became a central argument for keeping peds GME in house.
actually there are several more. the army has Endo, GI, devo, heme-onc, NICU, ID, adolescent and neuro. but adolescent and neuro are odd because their training billets are not centralized via peds (they have their own slots). and now you know
in keeping in context of the story, the eventual cost cutting nature of the biz eventually targeted these programs. with the sequester and attempt to reign in the massive defense health budget military GME peds fellowships moved into the OTSG crosshairs as some low hanging fruit. the army programs were essentially asked to justify their existence-- most recently as a year ago there was a strong, almost inevitable sense that army in house subspecialty fellowships (endo, GI, ID, devo, nicu, heme-onc) were going to be closed and these fellowships routed civilian instead. it made it so far as an OML was created detailing which programs sat where in regards to jettison-ability.
this created much wailing and gnashing of teeth, and there was a lot of scrambling to look at *why* in house fellowships should continue. O-6's drafted letters, memos, cited numbers and had all angles covered. the strongest arguments I believe were cost containment (we are much cheaper than our civilian colleagues-- but not as much as our adult counterparts) and, surprisingly, the training of the pediatricians in our residency programs who need the exposure. so as much as we may complain about GME activities, without them 18 fellowship programs would have died on the vine this year. and if you think they would end with just fellowships and not gone after peds residencies next you may be a little naïve.
to get to the OP's question-- if you are 100% set on a peds subspecialty, the military is a much bigger crapshoot. I know several highly qualified people who, due to no fault of their own, won't get the "approval" to do a fellowship. yes, the eventually can probably do it, but unless you are willing to wait 1-2 or even 3-4 years (if at all) to train the military is not an efficient way to go.
--your friendly neighborhood residents are job security I guess caveman
on the broader notion of "peds in the military" @Gastrapathy is correct. I was in residency when the navy (probably some admiral with a good idea fairy moment) one weekend decided they no longer wanted to be in the peds residency business. mass chaos ensued, the AAP and others (ACGME I suspect) got involved, and over that same weekend the course was reversed. literally was an email Friday "bye bye navy folks, nice knowing you" then one Monday of "nevermind." big sigh of relief I suppose but it was a wakeup call and a shot over the bow that definitely got people's attention. so much so that pediatricians (especially army) were offered up on a platter as GMO's post residency as a sacrifice to the military gods to justify our existence. good or bad, politically it was a good move-- and this "operational usefulness" became a central argument for keeping peds GME in house.
actually there are several more. the army has Endo, GI, devo, heme-onc, NICU, ID, adolescent and neuro. but adolescent and neuro are odd because their training billets are not centralized via peds (they have their own slots). and now you know
in keeping in context of the story, the eventual cost cutting nature of the biz eventually targeted these programs. with the sequester and attempt to reign in the massive defense health budget military GME peds fellowships moved into the OTSG crosshairs as some low hanging fruit. the army programs were essentially asked to justify their existence-- most recently as a year ago there was a strong, almost inevitable sense that army in house subspecialty fellowships (endo, GI, ID, devo, nicu, heme-onc) were going to be closed and these fellowships routed civilian instead. it made it so far as an OML was created detailing which programs sat where in regards to jettison-ability.
this created much wailing and gnashing of teeth, and there was a lot of scrambling to look at *why* in house fellowships should continue. O-6's drafted letters, memos, cited numbers and had all angles covered. the strongest arguments I believe were cost containment (we are much cheaper than our civilian colleagues-- but not as much as our adult counterparts) and, surprisingly, the training of the pediatricians in our residency programs who need the exposure. so as much as we may complain about GME activities, without them 18 fellowship programs would have died on the vine this year. and if you think they would end with just fellowships and not gone after peds residencies next you may be a little naïve.
to get to the OP's question-- if you are 100% set on a peds subspecialty, the military is a much bigger crapshoot. I know several highly qualified people who, due to no fault of their own, won't get the "approval" to do a fellowship. yes, the eventually can probably do it, but unless you are willing to wait 1-2 or even 3-4 years (if at all) to train the military is not an efficient way to go.
--your friendly neighborhood residents are job security I guess caveman
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