Pearls for those considering an HPSP scholarship

[passin'gas]

I think that those considering taking an HPSP scholarship could benefit from some of the insight gained by those who have gone through the process.

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[passin'gas]

This is an unquantifiable entity that needs explanation.

Here is a classic example:
When you are at OIS you will be told that "If you do well and are at the top of your class, you will have your choice between a full deferment, a Navy GME-1 year leading to a GMO tour, or a Navy GME-1 year leading to a military residency" We were told that in general there is a standard distribution curve and if you fall 1+ standard deviation above the mean you have a very good chance of getting whichever path you choose.

BUT . . .
The needs of the Navy means that even if you are the top ranked applicant in a given specialty's application pool, you may not get your first choice. The PD's reserve the right to choose you as someone they want in their program and NOT give you a full deferment.

THE BOTTOM LINE?
The needs of the Navy are an important consideration for HPSP scholarship recipients. You may think that if you kick butt in school and on the boards you will be able to write your own ticket. Not quite. If you aren't comfortable with being able to determine which path you will take through your training, you will want to think twice about this scholarship program

 

[bobbyseal]

THats a good point. I can't substantiate this story, but I heard a rather sad tale through the rumor mill.

Apparently some guy out there this year was a kick butt student with all the grades, letters, etc. H wanted a full deferment for ENT. He went on well over 10 interviews and then found out he didn't get the deferment. Unfortunately, interview expenses aren't reimburseable.

Moral of the story is buyer beware!

 

[Homunculus]

best advice is don't join the navy.

--your friendly neighborhood non-navy caveman

 

[passin'gas]

I can substantiate the story because it happened to me. AOA, USMLE Step 1 239/97, USMLE Step 2 254/99, top 10% of my class, great letters. I had been on 12 interviews at the top programs in the nation, but a full deferment was denied because I received the top score in my specialty for the Navy applicants as per the chief of my specialty full deferment committee.

 

[virilep]

this is pretty scary....i'm trying to figure out stuff between HPSP and USUHS...

 

[edmadison]

I can substantiate the story because it happened to me. AOA, USMLE Step 1 239/97, USMLE Step 2 254/99, top 10% of my class, great letters. division. I had been on 12 interviews at the top programs in the nation, but a full deferment was denied because I received the top score in my specialty for the Navy applicants as per the chief of my specialty full deferment committee.

See, this is what I don't understand. The army defers its worst candidates while the Navy defers its best (at least that's my impression from reading the notes in this forum). Why on earth would you let your best people train elsewhere. It really says alot about what the Navy thinks of its program. If you keep your good people, then your program will get better and better.

Ed

 

[KungPOWChicken]

What I want to know is what track they're handing you??? Are they sending you on a GMO? I thought anyone doing a Navy residency did a GMO tour?

 

[passin'gas]

I'm being sent to an internship, that's the only thing set in stone right now. I don't know if I'll have to do an GMO tour or whether I'll even have the opportunity to go straight through into a Navy residency.

In all fairness, I was well aware of this eventuality. The Navy reserves the right to retain anyone that they see fit for any reason they want. I'm not disgruntled or bitter, it's well within their rights.

My point is that you must take this likelyhood very seriously, because no matter what you may think about the strenght of your candidacy determining your path through HPSP, the needs of the Navy take precedence.

 

[DaveB]

See, this is what I don't understand. The army defers its worst candidates while the Navy defers its best (at least that's my impression from reading the notes in this forum). Why on earth would you let your best people train elsewhere. It really says alot about what the Navy thinks of its program. If you keep your good people, then your program will get better and better.

Ed

As it was explained to me, the Navy system is set up to ensure that there are quality people spread across everything: all the Navy programs, full deferments, 1-year deferments. This way, all the top applicants won't wind up in one spot (San Diego). Aparently, there was also a point in time where the Line community was complaining about all the crappy GMOs they were getting, because all the best people were getting full deferments or going straight through their Navy training. So, they shuffled the system to ensure that good GMOs would be turned out.

I've talked with a lot of people about this (dealing with my own situation) and my take on this all is that the big difference between the Navy match (or at least the GME-1 match) and the other military matches is that the Navy system is focused on producing good GMOs, and is not about matching qualified applicants to residency spots. The fact that some people get residencies is only a secondary thing.

 

[KerleyB]

All right, here is my Army HPSP pearl.

Know what you want, and agressively seek it. The Army is good at saying no, but if you continue to ask, continue to submit the many seemingly useless forms, and politely refuse to accept no, you often get what you want. Not always mind you, but often. I have a couple of personal stories to back this up.

BOTTOM LINE.... HPSP is a great deal, but you have to use it, and work within a system that sometimes seems difficult. Above all else, dont whine and complain because it doesnt accomplish anything, and you make yourself and everyone around you miserable.

 

[J123]

Sad, but true...
The Navy takes the top applicants, but it is also in the precept that they also take a certain number of those in the bottom 10% into residencies. The theory is that by taking the bottom 10% they ensure that they get some training. I'm not sure I get the whole thing really, but this comes from someone who went to the selection board.

 

[flighterdoc]

best advice is don't join the navy.

--your friendly neighborhood non-navy caveman

It seems that the navy is the least friendly of the services, requiring their GMO tours and all. I'd bet though that if a number of people selected out of the navy as a program, they'd change their staffing policies to allow people to finish residency first.

Discuss?

 

[Trajan]

Everyone always complains about the GMO factor in Navy HPSP. However, I look at it as simply another option in starting a career and serving in the military. If you do a Navy internship, you can spend four years serving in direct support of operational forces as a GMO/FS/UMO, fulfill the obligation, and then apply for a civilian residency as a much more mature, experienced, and competitive applicant.

My attitude is that I want to serve in the military and move on. The GMO option makes that possible, and may open doors that otherwise wouldn't be open in the civilian world. Every physician I have asked has said that someone applying in the civilian match with a Navy internship and four years of GMO or flight surgeon experience would have a huge advantage over a typical fourth year medical student -- especially in emergency medicine, which is where I'm leaning.

On the other hand, if you are someone who has wanted to be a pediatric cardiothoracic surgeon since age eight and have taken that goal into consideration in every major decision you have ever made, by all means, don't join the Navy. The uncertainty and delay in your training will probably drive you mad. But for those who have a desire to serve, are willing to deploy for a time (or two these days), but want to return to civilian life after a few years in the Navy, the GMO/FS/UMO option makes the Navy the way to go. It also gives you a few more years to figure out what you really want to do in medicine for the next 30 years.

There are plenty of people who go to OCS after college, serve four years as a line officer, and then head to law or business school. There is no shame in that. In fact, a lot of people have served America very admirably with these relatively brief, though significant, committments to military service. Many point out that GMO's are inexperienced, which is true, but I'm not convinced that GMO's are completely on their own, and, if aware of their limitations, can provide valuable care to sailors and marines. The military can't always wait for everyone to get an ideal level of experience relative to their responsibility, and that's not just in the Medical Corps --the guy with two months at OCS starts in the same place as an Annapolis graduate.

 

[Neuronix]

It seems that the navy is the least friendly of the services, requiring their GMO tours and all. I'd bet though that if a number of people selected out of the navy as a program, they'd change their staffing policies to allow people to finish residency first.

Discuss?

As much as it gets me flamed for saying this--I've met several Navy HPSPers who didn't even know about the GMO until they signed. Occasionally one will post on here to say that. They didn't know to ask about it, because they didn't fathom such a thing existed! That might account for the fact that they aren't experiencing a disproportionate decline in HPSP applications.

Maybe since this forum has become so prolific that "Military Medicine" on a search engine takes you right here, such a thing will begin to happen... Or then again maybe not, as even the worst of policies can be justified in various ways. i.e. see the "Am I Crazy?" thread thread reason (paraphrasing): "Well GMO is good cause I'm a pre-med and I don't know what I want to specialize in yet!" If the military had to recruit only 4th year medical students, I wonder how many would sign...

 

[edmadison]

Once again, I find it difficult to understand what is good about forcing doctors to provide medical care which they are grossly unqualified to provide. There is no way I want 99% of GMOs treating my family. This is not me being elitists, I would also not want to treat anyone having only one year of experience. Unless you are a resident or attending you probably don't know why: with the exception of pediatics (we do five months in my program), internships don't focus on outpatient medicine. How many hours do the transitional interns do? Not many. Neither to medicine or FP because most of their outpatient medicine comes in year 2 and 3. The Navy is choosing to provide sub-standard medical care. There is a reason that the armed forces were directed by congress to eliminate this. All the Navy needs to do is start assigning their graduating PGY-3s in Medicine, Peds and FP to these GMOs and they can phase out the problem.

Ed.

 

[Trajan]

I think that the Navy is changing some of the clinic based GMO tours to FP billets for the good reasons you just stated. However, I'm not convinced that you need a board certified internist to care for a marine batallion deployed in a forward position. If the Navy were to put them there, many on this board would cry that their skills were going to waste by doing sick call and STD counseling.

The military has always put inexperienced leaders/professionals in important positions. Most platoon commanders in Vietnam and WWII had a mere two months of training before being entrusted with 27 mens' lives. Yes, it's far from ideal, but that's the reality, and people in these positions need to be conscious of their limitations and do their best. That goes for GMO's too.

PS -- substantial numbers of people are killed every year by inexperienced residents in civilian teaching hospitals, so don't suggest that inexperienced doctors are an issue unique to military medicine.

 

[edmadison]

PS -- substantial numbers of people are killed every year by inexperienced residents in civilian teaching hospitals, so don't suggest that inexperienced doctors are an issue unique to military medicine.

Sure, but those residents have supervision. Even the PGY-5 surgery residents. When you go off to do GMO you are the equivalent of a PGY-2 without supervision. Inexperienced doctors are not unique to the military. However, the practice of SYSTEMATICALLY placing physicians into positions with inadequate training is unique to the military. As I mentioned before, this practice so alarmed Congress that it ordered the military to stop. The Army and Air Force have largely complied while the Navy refuses to do so. I wouldn't take a famility member to the equivalent of an unsupervised recently graduated intern, I don't see why the Navy expects its sailors and marines to do so.

Ed

 

[passin'gas]

My understanding is that the Navy GMO operates under the premise that the majority of the people you will be treating are age 18-30 and in good health. Honestly, the majority of the treatment in the military population are health maintenance and sports medicine complaints. Granted there is the bread and butter pathology, but the reality is that this population is healthy.

At Navy hospitals things are different. You're treated by residents and attendings, just like anywhere else.

 

[militarymd]

I can substantiate the story because it happened to me. AOA, USMLE Step 1 239/97, USMLE Step 2 254/99, top 10% of my class, great letters. I had been on 12 interviews at the top programs in the nation, but a full deferment was denied because I received the top score in my specialty for the Navy applicants as per the chief of my specialty full deferment committee.

who was the chief?

 

[passin'gas]

who was the chief?

CDR Lesnick

 

[AF_PedsBoy]

Air Force too, I've heard from program directors and the residents that the top people typically get military slots which makes sense: military wants the best for its program; amusingly this is antithetical to the med student mindset that "if I kick ass I can go wherever I want!"

On a side note: flight surgeon is the AF equivalent of Navy GMOs? I thought they were tough to get since you "got" to fly with a squadron which I think is pretty nifty!