Oncology and Mil Med

[Barcu]

Hey guys,

I am a 2nd year HPSP student interested in Oncology. I was wondering about how to navigate the residency and fellowship aspect of mil med.

Couple notes:

I would like not to add extra obligation if necessary (I know the fellowship would be neutral toward payback at best if I go the mil fellowship route)

And I am Air Force. And yes, I get it. I don't need generic comments about how mil med sucks and the Air Force is the worst. I've read enough of this board to know that. At this point, I'm just trying to navigate the system best.

Finally, my goal post-military (whenever that is) would be academic medicine as opposed to private practice. I'm guessing that may affect which option is best.

Onto the options:

The first options involve doing a military residency (since I should have no trouble with IM) and then a military fellowship. As a general rule, how are fellowships in the military for oncology? Would doing one and practicing in the military hurt chances for academic medicine afterwards?

- Straight-through training...yeah right.

-Residency, 2 years IM, maybe get fellowship, and owe two years post-fellowship

-Residency, 4 years IM, then get fellowship and stay in

Any other options besides a military-sponsored civilian (which would add more time)?

The other options involve waiting to do a fellowship after leaving the military.

-Residency, 4 years IM, leave and pursue fellowship- would civilian programs even want me 4 years out of residency? I know for some IM subspecialites, this is more important than others, not sure about oncology.

-GMO tour for 2 years, residency, 2 years IM, leave and pursue fellowship- again, would I run into the continuity problem or any ill will toward military residency and experience (in terms of not good quality)?

-GMO tour 4 years, get out and do my residency and fellowship the civilian route- I didn't sign up to do four and out, but if it's my best chance of getting an academic job, then I may take it if no other option is better. General consensus on this board seems to be that GMO tours can get you into a better civilian residency than coming right out of school would. Is this still true?

Thanks for reading my long, long post. I hope it's not too jumbled. I really do appreciate any (constructive) comments you can provide. Again, I know that not everyone is a fan of mil med. If you feel the need to do some bashing, can you at least make it oncology-specific? Thanks.

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[Barcu]

Ok, I may try and bump this again. I see people have viewed it, but maybe were scared by a wall of text. I'll try a different approach.

tl;dr: If you are interested in pursuing a subspecialty (in my case Oncology after IM), how is the best way to do this in the military system?

Should I try for fellowship in the military? If I don't do the military fellowship, should I even do a residency first (due to time lapse between residency and civilian application for fellowship)? Or should I GMO and get out? My goal will probably be academic med once I get out, not private practice.

Thanks for any input you can provide.

 

[tiredmildoc]

Well... your initial post seemed to indicate you didn't actually want any truthful info.

So you want to do Oncology in the AF... could you point out the AF hospital which is providing Oncologic care approximating what a civilian cancer center is doing?

You don't want to add an obligation but you want to do an Oncology fellowship in the USAF, a service which has done everything possible to jettison the demographics which get cancer. Doesn't compute - Do your IM time, get the hell out and then pursue a civilian Oncology fellowship.

 

[Barcu]

Well... your initial post seemed to indicate you didn't actually want any truthful info.

So you want to do Oncology in the AF... could you point out the AF hospital which is providing Oncologic care approximating what a civilian cancer center is doing?

You don't want to add an obligation but you want to do an Oncology fellowship in the USAF, a service which has done everything possible to jettison the demographics which get cancer. Doesn't compute - Do your IM time, get the hell out and then pursue a civilian Oncology fellowship.

Thanks for the reply.

In terms of service obligation, I know I will do extra time doing a fellowship, but doing a military fellowship versus a civilian could impact how much more obligation I incur. Maybe I was misinformed but it seemed to me that getting a civilian fellowship is more likely than getting a civilian residency (and if I was, that's ok because I don't really want a civilian fellowship and then return to the military).

You alluded to what I was getting at. Namely, I don't know how good oncology fellowships are in the military and how good practicing oncology is in the military. You imply bad on both fronts, so my suspicions were correct that it would be better to pursue a fellowship after my obligation.

My only question is this: will I be competitive for a civilian fellowship? And one that would allow academic medicine to be an option? I should have no problem matching into IM, so it could potentially be 2-4 years (depending if I decide/am forced to do a GMO tour first) post-residency before I apply for fellowship. Does that have a major impact?

Trust me, I am looking for truthful info. You can't come on this board without being smacked in the face with it. I know that there are possibilities of delays in training, malignant/underfunded sites, and the potential to increase my obligation. I'm not looking for a way around that. I'm looking for advice about how to best handle it.

 

[tiredmildoc]

Without knowing anything of your specifics, like med school (DO vs MD), GPA, board scores etc, it is hard to give you an precise estimate of how hard a civilian Oncology fellowship might be to get. Assuming you don't have any glaring red flags, doing a couple of years as an Internist should not hurt your chances for a civilian fellowship and actually may help them. My recommendation would be to go civilian but take a look at what the AF has to offer.

 

[jabreal00]

The Airforce still allows civilian deferred residencies or fellowship. I'd suggest doing IM residency in the Air Force and then trying for a civilian deferred fellowship. This way you incur no more time for the fellowship and you'd just owe the HPSP years.

 

[Ziehl-Neelsen]

So you want to do Oncology in the AF... could you point out the AF hospital which is providing Oncologic care approximating what a civilian cancer center is doing?

SAMMC (granted it's not technically a USAF hospital; however, the vast majoriy of SAUSHEC GME takes place there unless you are a dermatologist).

The USAF has 2 protected Oncology spots at SAMMC. The heme/onc training there is very good--the equivalent of what you'd get at any civillian university heme/onc fellowship (outside of name places like MD Anderson, MSKCC, or Dana Farber). The training is geared more toward general hematology/oncology practice (which is the type of hematologist/oncologist the military needs). This is something that is rapidly changing in the civillian world as more and more civilian fellowships are moving to straight hematology and straight oncology fellowships.

SAMMC has a dedicated bone marrow/stem cell transplant unit with dedicated Heme/Onc staff, and while the USAF may be trying to get beneficiaries into Tricare at the smaller MEDCENS, that is not the case at SAMMC. Plus the Army has never tried to get beneficiaries into Tricare--believe me, there are more than enough GOMERS with the standard cancers at SAMMC and rare birds that fly in from all over the world to provide a case volume strong on the basics with exposure to rare disease.

The USAF issues as I see them (for aspiring Heme/Oncs) are matching and post-fellowship career. The USAF has only one training location with a maximum of two spots for year. Some years I have seen people go straight through (last year). Some years there will be many disappointed applicants practicing general IM elsewhere (this year). I haven't heard of any recent civilian deferred spots, but the military is traditionally pretty bad at planning for future manning and in my experience multiple civilian slots in a particular subspecialty are offered in a single year when the military realizes an imminent number crunch. I don't know what a staff Heme/Onc practice would be like away from SAMMC (I'm not in the USAF).