on a ship

[lions75]

Advertisement - Members don't see this ad

For anyone who has been on a ship of any kind for a medical officer tour, please share some of your experiences. 🙂

 

[gmonavydoc]

If at all possible avoid it..it sucks. the work the people the lifestyle suck.

GMO is an outdated concept and I suggest anyone in Navy HPSP avoid it at all cost. They will get their pound of flesh out of you. If you are married and with a family you get double ganked plan on not seeing them for 12 of your 24 months. I'm shipboard now and hate it. 👎

 

[Spang]

If at all possible avoid it..it sucks. the work the people the lifestyle suck.

GMO is an outdated concept and I suggest anyone in Navy HPSP avoid it at all cost. They will get their pound of flesh out of you. If you are married and with a family you get double ganked plan on not seeing them for 12 of your 24 months. I'm shipboard now and hate it. 👎

How is GMO an "outdated concept?"

I think I understand the concept and the rationale behind the GMO tour, that is the need for general medical care for a large, confined, mostly healthy patient population, and would agree based on that understanding that the level of training GMO's have may result in less than optimal care for the troops, but how is it "outdated?"

r/
Spang

 

[militarymd]

No other organization in the United States (HMO, single specialty or multi-specialty group, for profit, not-for-profit hospitals, etc....) utilizes a internship trained only physician to deliver healthcare.

So, it would appear that the GMO concept is outdated.

There are Doc-in-a-box type clinics that still has doctors like that, but do we want to compare the healthcare for the pointy tip of our spear with that delivered in the backwaters of the United States?

xmmd

 

[Spang]

I don't disagree that it is perhaps less than optimal, or even less than the troops deserve, I just don't get the "outdated" adjective. Was it ever appropriate for a time? See what I'm asking?

xmmd: How's the civilian world treating you? Did you get to move back closer to family or find a practice you like?

Don't stop posting your views just cause you're out. Though I don't always agree wholely with what you say, I think a lot of people who frequent this board need a dose of your healthy skepticism!

r/
Spang

 

[militarymd]

In years past, the GP with only internship training is fairly common, so perhaps that's what is meant by "outdated".

Right or wrong, the GMO is something that is probably past its time in terms of the state of medicine as it exists in North America.

Private practice is great!!! I love it!!! I'm sure there are down sides, but I have yet to see it.

My partners complain about a lot of stuff, but they're anthills complained to what I'm used to.

 

[Swiper]

If at all possible avoid it..it sucks. the work the people the lifestyle suck.

GMO is an outdated concept and I suggest anyone in Navy HPSP avoid it at all cost. They will get their pound of flesh out of you. If you are married and with a family you get double ganked plan on not seeing them for 12 of your 24 months. I'm shipboard now and hate it. 👎

What kind of ship?

 

[r90t]

I had the reverse experience on my ship, except for the deployment, where I flew out to the Middle East and left my family in a hotel while awaiting our household goods. My CO was supportive and I my patient population was 18-50, previously screened for sea duty. My ship was a supply ship with lots of fresh water, fresh food and a big one man stateroom for the medical department head.

The bad point...if I arrived 1 year earlier I would have caught a 7 month and a full 8 1/2 month deployment. Then, I would likely be very disgruntled.

 

[Dr. Wexler]

r90t,

a pt. population of 18-50? What did you do all day?


What kind of recreational amenities were available aboard? How long were you at sea for?

 

[r90t]

I mean a patient age population 18-50. We had 500-600 guys/gals on board, plus support to the smaller ships. Most of the time was routine primary care medicine with the occasional zebra thrown in.

The ship was gone for 8 1/2 months from homeport, while, I caught about 1/2 that deployment.

Daily recreation: Inport, we had overnight libs in Singapore and Dubai. Both great cities, very western. One port call in Bahrain. HI on the way out and back. We were in port every 3 weeks or so, and the carrier was in ever 4-6 weeks. Underway, we had a decent size gym to lift. The Gulf region is very smooth sailing, so jogging on the deck wasn't too difficult. We had movies running from 1600-0700 on site tv and there was always the poker game with either the chiefs or the aviatiors. The days run together like Groundhog Day and the time passes quickly. Some of our aviators were doing network gaming in their significant free time.

 

[GMO_52]

r90t and I have similar experiences. I've had one lousy CO and one great one. This dictates much of your experience. I've played around, qualifying in various SWO positions for kicks (I get to sink the ship during amphib ops, etc) and done a fair bit of medicine. Not a bad tour in all.

There are basically 2 flavors of shipboard GMO. On a smaller ship, you will technically be the SMO (Senior Medical Officer) since you are alone with an IDC. With that comes Department Head responsibilities, including running a shipwide training team, prev med programs and a bunch of other stuff. The pluses are your relatively senior status, private stateroom and ability to run your own life. The downside is all the admin. Also, my ship is 50% women, so get ready to do some gyn.
The second flavor of shipboard GMO is GMO on a ship that has a residency-trained SMO. Certainly an easier existence. Plan on seeing tons of sick call but not having as many shipwide responsibilities.

As for the "GMO's are unsafe" argument, I have a couple of thoughts. The same people that make that statement would bemoan the waste of placing a residency trained physician in my job. So, the real question is whether a GMO is better trained than an IDC. I respect my corpsmen and especially my IDC, but there is an enormous difference. They have no inpatient experience and have never really seen sick people. My threshold for MEDEVAC is lower than it will be in the future, I consult more frequently than I should for routine stuff and I try to guard against becoming jaded to the constant stream of malingerers in our population. Overall, I think GMOs are a benefit when compared with the realistic options.

 

[militarymd]

I don't think anyone expressed that the GMO concept is unsafe.....just that it was outdated, and not meeting the standards of 21st century medicine standards.

As to whether it is practical.......well, since when was the military about being practical??

 

[gmonavydoc]

outdated and unsafe are worlds apart, doctors, please buy a dictionary.

It is outdated and just a means for the Navy to get its pund of flesh payback. 😎

 

[doctor07]

Here is another viewpoint for everyone who thinks a GMO tour is outdated. Say for instance that the Navy does away with the GMO program. How many of you board certified physicians would be willing to go to a small ship to practice medicine in support of the fleet? My guess is that would merely provoke more of you to complain about something else, except this complaint would be that you are specialty trained and not being utilized in your specialty.

The fact is the GMO tour works in it's intended environment. What happens when an orthopedic surgeon has a female sailor with a GYN problem? The training they have to deal with this comes from their clinical years in med school and their PGY-1 year, just like the traditional GMO. Would your solution be to only put GP's or similar docs on ships? Well, when everyone decides that they don't want to be on a ship and want to specialize, then we cannot support our sailors. By the way, is there any EVIDENCE (and I don't mean opinions or observations by those who have practiced in the military, you know who you are) that GMO's are hurting or neglecting patients based on their supposed lack of training?

My advice to people is to NOT sign up for the military if you don't plan on making some sacrifice. Granted (and I know this will be a point of attack by some on my opinion) I am not a physician yet, and have not practiced in the military yet. But I also have learned (believe it or not I actually know something even though I don't have MD or DO after my name) that when you commit yourself to something, it may not always turn out exactly how you planned it to be. I am still going to do the job though, and not complain about it. Before anyone says it, I am a non-traditional student, so I do know more about the world than just going to school.

 

[militarymd]

Board-Certified Emergency Medicine physicians are perfectly suited for the GMO slot.

In the military, you go where the military sends you...period.

I have first hand received patients that were directly harmed by GMOs because of lack of knowledge/experience.

xmmd

 

[doctor07]

The fact still remains that not everyone would want to specialize in Emergency medicine. What do we do if there is not enough ER physicians around to adequately staff the necessary billets? You said it yourself, "In the military, you go where the military sends you...period." Lets say the GMO system is abolished, physicians who are board certified in a specific field are now going to be doing general practice. I personally, and I am sure many others, would be more unhappy about doing that than doing a GMO tour in the beginning. Furthermore, the "anti-GMO" folks argue that this tour causes a break in training, and they lose some skills they had gained in clinical and residency years. So lets say I am a board certified surgeon, and I am now working on a supply ship as the ship's doctor. My training is all done, I didn't have a break. But now my surgery skills will degrade because I am not using them daily. I would say that I am more concerned about getting rusty in these skills than fading on internship skills.

Knocking the GMO tour is an easy thing to do, and even more so if you are a disgruntled physician. However, I can't seem to find anyone who seems to have any advice on how to change it so it still completes the intended mission.

If anyone out there doesn't have the scholarship yet, if you join the Navy, you very likely will end up on a ship. It's the NAVY. So don't be surprised when you hear this.

 

[doctor07]

On another note, a great deal of medical mistakes and injuries to patients are also attributed to experienced physicians who have been practicing for years. If you look at the numbers, I imagine you would find the incidence is no higher for GMO's vs. all others. But I wouldn't know because no evidence has yet been presented.

 

[militarymd]

Do you think the Navy is going to publish/advertise the mistakes of its poorly trained doctors on ships???? Of course not.

And if you think that internship training is enough to allow you to practice primary care as safely as a residency trained physicain, then why do residencies exist at all????

As far as lack of ER physicians......you recruit what you need.....That's how the military decides on the number of deferrements/training slots in each specialty.....What the military has decided is that they don't want to pay for it....they have decided that the GMO concept is "good enough" for it's sailors/soldiers.....right or wrong...that's up to how each individual feels.

I'm simply pointing out that a GMO is not a standard of care physician in North America in the 21st century.

 

[DrBloodmoney]

Even in such a patently non-patient-care specialty, like pathology, the majority (>90%) of the docs and residents in the Navy had to do a GMO tour. This means that they had to:

1. Do an intern year.
2. Do 2-3 years of clinical medicine (the practical application of this experience to pathology is debatable, but the overwhelming consensus is that it unnecessary).
3. Then reapply for pathology residency, which is a competetive specialty for the Navy since they have only a handful of positions.

Then if you balance this with the Army which:

1. Allows you to go straight to residency from medical school.
2. Has a congressional mandate to limit GMO positions.
3. Has a larger medical infrastructure, which means you have more options for future postings.
4. Many more residency positions for most specialties.

I think that for some people, especially those who are interested in specialty medicine, or non-clinical medicine that the Navy is a poor choice. Unfortunately, most folks don't find out this info until they have already signed up.

 

[thenavysurgeon]

But wait a second y'all...there is help for all of those hapless GMO's with only one year of post-graduate training!!!

Yes, its the board-certified General Surgeon aboard the aircraft carrier that is asked to take sick call...he's there to help that GMO out, anytime!

Better believe it.

In all seriousness, the GMO aboard my aricraft carrier was outstanding, but I think he was a unique individual.

My expeiences aboard ship: just about everything else, besides anything to do with medicine, was fun and interesting. Definetely get you surface warefare pin (SWO) if you go out on cruise...you'll meet just about every department on the ship and see some cool stuff.

thenavysurgeon

 

[biss506]

How long does it usually take to qualify for the surface pin?

 

[GMO_52]

How long does it usually take to qualify for the surface pin?

It depends entirely on your command. If you're deployed and on a large ship, it can happen fairly quickly (I've seen it take 4 months). On a smaller ship as the only MO, they tend to make it more challenging (more like what they expect from the JOs) and it can take about a year.

 

[doctor07]

Do you think the Navy is going to publish/advertise the mistakes of its poorly trained doctors on ships???? Of course not.

And civilian organizations do? Read the book "Internal Bleeding", it gives an interesting look at medical errors in the civilian population.

And if you think that internship training is enough to allow you to practice primary care as safely as a residency trained physician, then why do residencies exist at all????

As already stated, residencies originally were devised to train physicians for specialty care. With the advent of technology, a GP was not adequately equipped to deal with this wave of modernization taking over every specialty. Only recently in the history of medicine has it become determined that EVERY field of medicine needed further training in a residency. Is it because the physicians were doing bad jobs before this? Not really. However, a GP cannot be expected to do a complex surgical procedure, rebuild a hip, and diagnose a rare kidney disorder.. That is why there are specialists in the specific areas of care that are needed.

It appears that you are stating that residency programs were developed to train physicians further because internship only physicians cannot SAFELY practice medicine. That is not why the concept of a residency was developed. It was not a standard of care issue in the sense you are making it to be. There weren't poor clinicians running around and someone decided they needed more training. Rather, the clinicians were being thrown into situations that they hadn't had formal training in. Look up the history behind Emergency Medicine for example, and this is perfectly evident.

Now, I don't know about what a GMO tour is like, and I admit that. Maybe someone (with GMO experience) can give me some information about acuity aboard the ship. Are cases that complex? How often do patients have to be transferred elsewhere emergently? Thanks.

 

[militarymd]

I don't think anyone expressed that the GMO concept is unsafe.....just that it was outdated, and not meeting the standards of 21st century medicine standards.

As to whether it is practical.......well, since when was the military about being practical??

As I had previously stated, I don't think GMO's are unsafe.....just outdated for the 21st century in North America.

Knowledge and understanding of all areas of medicine has advanced to the point that residencies are necessary except in the most underserved areas. When internship trained only physicians were abundant there just wasn't enough medical knowledge to require additional training, but we have moved on.....Standards of care evolve.


Civilian institutions don't use GMOs, so if errors are committed, it is not because of lack of training.

 

[UCBShocker]

Hey sorry to side track the issue but can one of you answer a couple questions about GMO for me? My first choice has been and still is the Air Force, but the Navy just called and said that if I apply for HPSP through them I will be automatically accepted because of GPA and MCAT ( I thought the Army only did this?). Now if I do not get accepted to the Air Force it is nice to know there is something to fall back on. But the GMO is a little erie to me...

1.) Do all Navy Docs have to tour as a GMO, is there any way to not?
2.) How long is this Tour as a GMO?
3.) I hear it does not count towards payback.. is this true? And how can that be? Isn't pay back a specific amount of years on contract? The Air Force is 4 medical school, 4 residency, 4 payback period = 12 years, they can not just say, "Oh nevermind we want 2 more years... enjoy =)"
4.) Is there a comprehensive website on GMO tours?

Now I do not mind doing the service where they put me, but no matter how much I am excited about joining the military I have to realize that I may not like it (despite thinking of the possibility of going career), so an extra 2 years (if GMOs last that long) could potentially be disasterous. Thanks for all your time in advance.

 

[militarymd]

Now, I don't know about what a GMO tour is like, and I admit that. Maybe someone (with GMO experience) can give me some information about acuity aboard the ship. Are cases that complex? How often do patients have to be transferred elsewhere emergently? Thanks.

Depending on what type of platform you're on, you will either be alone or have people on board with advanced training.

On an platform where you are alone, your responsibilities include preventive medicine (vaccinations, medical record reviews, cleaniness inspections, etc.)

As far as patients you see, you see the garden variety walk-in ER stuff. I have a cold, my back hurts, I have diarrhea, I hear voices telling me to kill my bunkmate(and in this day and age) my period has not come in 2 months......and then you manage whatever chronic medical problems that those on board may have....hypertension, diabetes (non-insulin requiring).

And than some of the more scary stuff....people who develop chest/MI, alcohol intoxication/withdraw after liberty, the required fights after liberty, occasional trauma....broken arms, fingers, legs or sprains strains ....what not.

Can a GMO do this? yes. Can a GMO do this and meet all standards of care in North American? meaning following all practice guidelines to maximize patient outcomes (have read JNC VII, and ADA practice guidelines, etc....and have experience under supervision)....Absolutely not (along with a number of physicians who have residency training)

 

[GoSteelers]

Any thoughts on what type of internship better prepares you for a GMO tour.

One at one of the Big Three hospitals or one in a FP program?

Regardless of what helps my career in the long run, if I'm going to be given the huge responsibility of caring for people after that one year I would like to know where to go for the best training.

 

[thenavysurgeon]

'Any thoughts on what type of internship better prepares you for a GMO tour'

A combined ENT/phych year would be ideal...

You'll see a ton of runny noses and deal with folks aboard ship with personality disorders.

I think USHSU has got one. Check it out!