Possible or Fruitless?

[Hopeful_Doc123]

Hello,

I have read through the forums on SDN, Reddit, other military medicine advice sites, and have found difficulty in narrowing down answers or finding relevant information to my situation. Any help you could give would be very much so appreciated:

I am an undergraduate pre-med looking to apply to medical school next year. I go to a private university, have good standings, and believe I am a capable and driven individual.

I want to go through HPSP, and eventually become some sort of surgeon (ENT ideally, but I understand how sparse these positions are).

Here is my hopeful timeline, please let me know if you have seen this before/if it is possible:

Age 22: Enter medical school through HPSP

Age 26: Graduate medical school, enter internship year

Age 27: Apply for both civilian and military surgery residencies

Age 33: Finish residency, serve active duty military and see where it goes.

I have weighed the odds in regards to money/service/relocation/family, but what additional road blocks may I meet?

1) What determines whether I obtain a civilian or military residency? Can I voluntarily defer to civilian if I feel I would be better trained, as it appears military residency offers lower quality training? I would accept lower pay if it ensures better education.

2) If, instead, I choose to do IM, and do a cardiology residency/fellowship- would I have to do multiple GMO years to obtain this position? And would this time count towards payback?

2a) Only in the occasion that I cannot match in either a military or civilian residency would I do a GMO year, correct?

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[militaryPHYS]

First, Based on your questions I don't feel like you have read as much as you say on the basics on what a military pathway entails. Please read the following webpage for a quick run down on the basics. Military Service Options For Every Step of the Aspiring Physician's Path - The Military Physician No ads, no profit. My opinions do not reflect those of the DOD or any other government agency.


I would offer that people who commit to HPSP or USUHS with a hope for a civilian deferment are often times better off just being a civilian 100%. I say this because anecdotally it shows that they are not 100% committed and therefore run the risk of being disappointed at some point in their career and becoming bitter/unhappy. People who are happy as military physicians, more often than not, fully commit themselves to the military and think of a civilian deferment as a let down. HPSP and USUHS students are expected to, and compete for military residency spots. Once these are full, deferments are then given to accommodate for an additional need for numbers in a certain specialty.

I would like to know what sources you have to show that military residency offers lower quality training.

 

[narcusprince]

First, Based on your questions I don't feel like you have read as much as you say on the basics on what a military pathway entails. Please read the following webpage for a quick run down on the basics. Military Service Options For Every Step of the Aspiring Physician's Path - The Military Physician No ads, no profit. My opinions do not reflect those of the DOD or any other government agency.


I would offer that people who commit to HPSP or USUHS with a hope for a civilian deferment are often times better off just being a civilian 100%. I say this because anecdotally it shows that they are not 100% committed and therefore run the risk of being disappointed at some point in their career and becoming bitter/unhappy. People who are happy as military physicians, more often than not, fully commit themselves to the military and think of a civilian deferment as a let down. HPSP and USUHS students are expected to, and compete for military residency spots. Once these are full, deferments are then given to accommodate for an additional need for numbers in a certain specialty.

I would like to know what sources you have to show that military residency offers lower quality training.

A lot of this is malarchy. The problem with doing a civilian deferment is you may match and do residency at a fantastic hospital outside the militarys system and realize how limited and handicapped it is. The military hides behind the ignorance of superiority when clearly these other institutions are doing things cheaper smarter and faster then the .mil. Could you see someone saying man I should have went to NMCP versus hopkins or Mayo. No way! Your drinking too much of the koolaid! As a resident all I had to worry about is my patients and learning I never focused on system failures. This is the prime focus of many of the military residents.

 

[HighPriest]

Hello,

I have read through the forums on SDN, Reddit, other military medicine advice sites, and have found difficulty in narrowing down answers or finding relevant information to my situation. Any help you could give would be very much so appreciated:

I am an undergraduate pre-med looking to apply to medical school next year. I go to a private university, have good standings, and believe I am a capable and driven individual.

I want to go through HPSP, and eventually become some sort of surgeon (ENT ideally, but I understand how sparse these positions are).

Here is my hopeful timeline, please let me know if you have seen this before/if it is possible:

Age 22: Enter medical school through HPSP

Age 26: Graduate medical school, enter internship year

Age 27: Apply for both civilian and military surgery residencies

Age 33: Finish residency, serve active duty military and see where it goes.

I have weighed the odds in regards to money/service/relocation/family, but what additional road blocks may I meet?

1) What determines whether I obtain a civilian or military residency? Can I voluntarily defer to civilian if I feel I would be better trained, as it appears military residency offers lower quality training? I would accept lower pay if it ensures better education.

2) If, instead, I choose to do IM, and do a cardiology residency/fellowship- would I have to do multiple GMO years to obtain this position? And would this time count towards payback?

2a) Only in the occasion that I cannot match in either a military or civilian residency would I do a GMO year, correct?

For starters, just get in to med school. Secondly, you'll apply for residencies (especially in ENT) before internship. ENT residencies all include internship now-a-days. At least, if you want to be board eligible, that's what the academy wants. Something about standardization or some-such.
You can certainly apply for both civilian and military surgery residencies. But make sure that you understand how HPSP works. If you're chosen for a military residency, you will do a military residency. When I applied, you had to rank 5 programs in the military - HAD to do it. There are only 4 Army ENT residencies. So my fifth choice was something other than ENT. Now, fortunately, I matched. There was at least one guy who was deferred to civilian residency. If you don't match into a military residency, and you aren't deferred (and deferral is absolutely not guaranteed), then you will match in to whatever you ranked last - a transitional internship or what-have-you. You will then have to decide whether you want to re-apply for ENT (which usually doesn't work out, with a few exceptions) or go out as a GMO and then leave the military and get out and apply for a civilian residency, or do something other than ENT. Also keep in mind that your chances of still wanting to do ENT once you're applying for residencies is actually pretty low. That's not saying anything about you personally, it's just that statistics say you'll probably change your mind.

As to what additional road blocks....well, aside from the above, there's a slew of them. Read the threads more carefully. Even if your plan comes to glorious fruition all the way through residency, there's a lot of potential pitfalls that are unique to the military. Maybe you want to get a fellowship, and you get denied. Maybe you end up stationed someplace where skill atrophy is a major problem. Maybe you get a brigade surgery spot right out of residency, and that torpedoes your career. Maybe none of this happens.

What determines if you get a civilian or military residency: the "needs of the Army," your competitiveness, and the number of applicants that year. Basically, the consultant (guy in charge of ENT for whichever service) looks at the number of ENT docs he has, projects who's staying and who's leaving and who's finishing residency within the next few years, and then decides how many ENT docs they're going to need in 5 years when you're projected to finish residency. Lets say that year the Army is training 8 ENT docs internally, but they have a projected shortfall and they need 10. Then they'll defer two people to civilian residencies. Now lets say that they only need 6 to keep up their numbers. Then they'll defer zero people to civilian residency. And in ENT its pretty variable. Many years they don't defer anyone. ENT is not a hugely necessary specialty in the military, as most facial trauma is actually managed by OMFS and most vascular/neck trauma is managed by vascular and general surgeons. ENT is qualified to manage it (save for, perhaps, a carotid injury that needs something other than ligation), but ENT has just not traditionally managed those roles in the military. So they don't need that many. On the other hand, the retention rate is essentially zero. But that could change at any time. What's really gonna cook your goose is the number of applicants. If you apply when the match rate is 1:2, then your chances of matching are pretty good and if they defer that year, your chances are better. If the match rate is 8:1, then you're more likely to do a GMO tour than you are to match in to ENT. Finally, how good of an applicant you are makes a difference. And how many USUHS students there are (because they don't defer). Theoretically, if you're a stellar candidate, you have no chance of deferring because the military is going to retain you in to a military residency. You want to ride the line between being good enough to match, but not in the top 7-8 for whatever reason. Maybe you're an excellent candidate, but you just never rotated anywhere in the military so they don't know you. Which is a dangerous proposition, because if they don't defer that year, you're going to be a stellar GMO.

You do NOT get to choose to defer. You can roll the dice at best.

2 - Not necessarily. and fellowship adds to your ADSO rather than subtracting. There are many threads regarding this on the forum.

2a - Not necessarily. If you don't match military, and they don't defer that year, then you may end up doing a GMO tour, or at the very least a TY internship and then trying to reapply.

 

[HighPriest]

I do agree that military residencies (at least, from my experience in ENT) aren't necessarily inferior to civilian programs, on average. There are definitely better civilian programs. I mean, of course there are, there are massive institutions with millions of dollars dedicated solely to research and training residents. Their mission is to do nothing but those two things. But, there are fairly crappy civilian residencies as well. What I found is that military residency trains you to be a very good community surgeon. What I mean by that is that you'll be very well equipped to do bread-and-butter cases with a little meat on the side. And, if you want to be mostly a meat-eater you can try to do a fellowship. If you get selected for a fellowship, you'll go basically anywhere you want because you're free labor and they love that. The big key, for ENT at least, was what -outside- rotations you do. Think of them as back doors in to what are usually very good civilian programs. They make up for the weaknesses that military residencies have in complex cases, and they're great. Of course, it all does suggest that the military residency is faulty because they need the outside rotation. But, the outside rotation is a part of the deal. So saying it's a deficiency to do outside rotations is like saying that football players are weak because they wear padding. No reason to be tough AND stupid, just get the job done.

I'm not sure about the 100% committed thing. I 100% agree that if you're set on the idea of a deferment, you'd be better off just doing a civilian residency. You can't count on deferment. what I'm not sure about is the idea that you need to have red-white-and blue blood to consider HPSP. To be honest, I don't think anyone can possibly be 100% on board with what being a military physician is like, unless you've done it. I don't care how much research you've done, you're going to max out somewhere around 80% understanding what it's like. If you're a military doc, and everything was what you expected it to be, that's pure coincidence. Or you might be at least a little insane.

 

[Hopeful_Doc123]

First, Based on your questions I don't feel like you have read as much as you say on the basics on what a military pathway entails. Please read the following webpage for a quick run down on the basics. No ads, no profit. My opinions do not reflect those of the DOD or any other government agency.


I would offer that people who commit to HPSP or USUHS with a hope for a civilian deferment are often times better off just being a civilian 100%. I say this because anecdotally it shows that they are not 100% committed and therefore run the risk of being disappointed at some point in their career and becoming bitter/unhappy. People who are happy as military physicians, more often than not, fully commit themselves to the military and think of a civilian deferment as a let down. HPSP and USUHS students are expected to, and compete for military residency spots. Once these are full, deferments are then given to accommodate for an additional need for numbers in a certain specialty.

I would like to know what sources you have to show that military residency offers lower quality training.

Sorry, I do not want to speak negatively regarding a program I do one day hope to join. Most of the information I received was initially at a session held at my school that explained military medicine, followed by reviewing the posts on SDN and other websites. It appears most physicians and residents on these sites complain about certain aspects of the military system. Obviously healthcare reform can and should occur at both the civilian and military level, but the primary complaint I have come upon has been with military residency programs. Personally, I would love nothing more than to be a well-trained physician and serve my country in a speciality I wish to join, but I am not sure if this is possible given the current system. Again, it is less about training quality/skill atrophy, and more about the choice to choose a speciality that I want to join.

I will go through the site you linked, and am happy to read any other sources you may have available that shines more light on military medicine. Unfortunately, I do not come from a military family, so it has been hard to come by primary sources that are unbiased in either direction.

 

[Hopeful_Doc123]

For starters, just get in to med school. Secondly, you'll apply for residencies (especially in ENT) before internship. ENT residencies all include internship now-a-days. At least, if you want to be board eligible, that's what the academy wants. Something about standardization or some-such.
You can certainly apply for both civilian and military surgery residencies. But make sure that you understand how HPSP works. If you're chosen for a military residency, you will do a military residency. When I applied, you had to rank 5 programs in the military - HAD to do it. There are only 4 Army ENT residencies. So my fifth choice was something other than ENT. Now, fortunately, I matched. There was at least one guy who was deferred to civilian residency. If you don't match into a military residency, and you aren't deferred (and deferral is absolutely not guaranteed), then you will match in to whatever you ranked last - a transitional internship or what-have-you. You will then have to decide whether you want to re-apply for ENT (which usually doesn't work out, with a few exceptions) or go out as a GMO and then leave the military and get out and apply for a civilian residency, or do something other than ENT. Also keep in mind that your chances of still wanting to do ENT once you're applying for residencies is actually pretty low. That's not saying anything about you personally, it's just that statistics say you'll probably change your mind.

As to what additional road blocks....well, aside from the above, there's a slew of them. Read the threads more carefully. Even if your plan comes to glorious fruition all the way through residency, there's a lot of potential pitfalls that are unique to the military. Maybe you want to get a fellowship, and you get denied. Maybe you end up stationed someplace where skill atrophy is a major problem. Maybe you get a brigade surgery spot right out of residency, and that torpedoes your career. Maybe none of this happens.

What determines if you get a civilian or military residency: the "needs of the Army," your competitiveness, and the number of applicants that year. Basically, the consultant (guy in charge of ENT for whichever service) looks at the number of ENT docs he has, projects who's staying and who's leaving and who's finishing residency within the next few years, and then decides how many ENT docs they're going to need in 5 years when you're projected to finish residency. Lets say that year the Army is training 8 ENT docs internally, but they have a projected shortfall and they need 10. Then they'll defer two people to civilian residencies. Now lets say that they only need 6 to keep up their numbers. Then they'll defer zero people to civilian residency. And in ENT its pretty variable. Many years they don't defer anyone. ENT is not a hugely necessary specialty in the military, as most facial trauma is actually managed by OMFS and most vascular/neck trauma is managed by vascular and general surgeons. ENT is qualified to manage it (save for, perhaps, a carotid injury that needs something other than ligation), but ENT has just not traditionally managed those roles in the military. So they don't need that many. On the other hand, the retention rate is essentially zero. But that could change at any time. What's really gonna cook your goose is the number of applicants. If you apply when the match rate is 1:2, then your chances of matching are pretty good and if they defer that year, your chances are better. If the match rate is 8:1, then you're more likely to do a GMO tour than you are to match in to ENT. Finally, how good of an applicant you are makes a difference. And how many USUHS students there are (because they don't defer). Theoretically, if you're a stellar candidate, you have no chance of deferring because the military is going to retain you in to a military residency. You want to ride the line between being good enough to match, but not in the top 7-8 for whatever reason. Maybe you're an excellent candidate, but you just never rotated anywhere in the military so they don't know you. Which is a dangerous proposition, because if they don't defer that year, you're going to be a stellar GMO.

You do NOT get to choose to defer. You can roll the dice at best.

2 - Not necessarily. and fellowship adds to your ADSO rather than subtracting. There are many threads regarding this on the forum.

2a - Not necessarily. If you don't match military, and they don't defer that year, then you may end up doing a GMO tour, or at the very least a TY internship and then trying to reapply.

I appreciate your detailed response. I know the first step is always to get into a medical school and go from there, but I would like to stay as informed as possible regarding future options. Much like civilian residency, I am sure there are residencies that are more competitive than others, but I just was not sure if military residency matches operated in the same way that civilian residency matches do. I am generally indifferent with regards to most of the negative aspects of military medicine that people complain about, but I take my potential training and specialty more seriously. I understand if I match into a military residency, I would go through that program, but that is fine so long as I am able to practice the speciality I wish to join.

If you don't mind- could you elaborate more on your journey as an ENT? Are you still practicing with the military? Did you do any fellowships?

 

[Hopeful_Doc123]

I do agree that military residencies (at least, from my experience in ENT) aren't necessarily inferior to civilian programs, on average. There are definitely better civilian programs. I mean, of course there are, there are massive institutions with millions of dollars dedicated solely to research and training residents. Their mission is to do nothing but those two things. But, there are fairly crappy civilian residencies as well. What I found is that military residency trains you to be a very good community surgeon. What I mean by that is that you'll be very well equipped to do bread-and-butter cases with a little meat on the side. And, if you want to be mostly a meat-eater you can try to do a fellowship. If you get selected for a fellowship, you'll go basically anywhere you want because you're free labor and they love that. The big key, for ENT at least, was what -outside- rotations you do. Think of them as back doors in to what are usually very good civilian programs. They make up for the weaknesses that military residencies have in complex cases, and they're great. Of course, it all does suggest that the military residency is faulty because they need the outside rotation. But, the outside rotation is a part of the deal. So saying it's a deficiency to do outside rotations is like saying that football players are weak because they wear padding. No reason to be tough AND stupid, just get the job done.

I'm not sure about the 100% committed thing. I 100% agree that if you're set on the idea of a deferment, you'd be better off just doing a civilian residency. You can't count on deferment. what I'm not sure about is the idea that you need to have red-white-and blue blood to consider HPSP. To be honest, I don't think anyone can possibly be 100% on board with what being a military physician is like, unless you've done it. I don't care how much research you've done, you're going to max out somewhere around 80% understanding what it's like. If you're a military doc, and everything was what you expected it to be, that's pure coincidence. Or you might be at least a little insane.

Outside rotations are interesting, and I appreciate your analogy. I am honestly just trying to decide what the implications of my decision are to join the military. If I went in blindly, I have a better chance of being dissatisfied with certain aspects that I may not have been prepared for. That is why I am trying to gauge experience from various sources. I love many, many aspects of military medicine, but viewing these forums has painted a somewhat unfortunate view of the system. While the most vocal are typically not representative of the majority, it is hard to get unbiased information from those who have been through the program.

 

[militaryPHYS]

Sorry, I do not want to speak negatively regarding a program I do one day hope to join. Most of the information I received was initially at a session held at my school that explained military medicine, followed by reviewing the posts on SDN and other websites. It appears most physicians and residents on these sites complain about certain aspects of the military system. Obviously healthcare reform can and should occur at both the civilian and military level, but the primary complaint I have come upon has been with military residency programs. Personally, I would love nothing more than to be a well-trained physician and serve my country in a speciality I wish to join, but I am not sure if this is possible given the current system. Again, it is less about training quality/skill atrophy, and more about the choice to choose a speciality that I want to join.

I will go through the site you linked, and am happy to read any other sources you may have available that shines more light on military medicine. Unfortunately, I do not come from a military family, so it has been hard to come by primary sources that are unbiased in either direction.

Well beware, I am very thankful for the opportunities the military has given my family and I and I don't trend negative when I discuss military medicine as the majority of active members on SDN do. Take everything I say with a grain of salt. I also speak specifically for Navy orthopedic related things. You can not universally apply these opinions to other branches or specialties. That being said, I am also very realistic about people's expectations. You do not have to bleed Red, White and Blue to do well in the military, but joining with the hope/plan of a civilian deferment because you think you will get universally better training as a civilian is not a good place to start if you want to be a "happy milmed physician". If that is what you think at the end of your own research in to military medicine then that is totally fine, but pass on the HPSP and USUHS applications and stay a civilian.

Skill atrophy is a real thing within the military system. BUT, this occurs after residency. When/if you are placed at a small MTF with low volume or low acuity cases for your chosen specialty you may not be able to maintain the training you learned in residency. This is a very real possibility and must be factored in to your decision. BUT, the residency programs, ON AVERAGE, are at par or above civilian residencies. Sure, there is Mayo, or Hopkins or whatever you want to use an example of what may be considered better than a military residency, but it depends on how you define "better", and each person has their own definition. For every Mayo or Hopkins there are 2x or 3x more brand new, non-ACGME accredited DO residencies (for example) that may or may not train you well. I define a good residency as one which produces a specialty trained physician who passes their boards and is a competent provider at the institution they will likely be working. I have worked along side ortho residents from "well known, fancy-named" programs who barely know an 11-blade from a 15-blade because they are often 2nd, 3rd or 4th in line to scrub a case until very late in their program. I also have seen similar poorly trained candidates within the military, but not because they didn't have the opportunity to excel. Even within the military there are better places to do certain specialty training. i.e. I felt like there was more of a blue-collar, hands-on feel for ortho at NMCP vs. Walter Reed which is why I chose to rank NMCP first. For these reasons, and because I chose a long time ago to commit to the military, I would have chosen NMCP over a civilian deferment to Hopkins any day of the week because I knew it would train me to be a well-trained and competent military orthopedic surgeon at any MTF or civilian hospital for that matter.

Watch, everyone will try to tell me that my own opinion is wrong because it is not how they feel. On many levels this is true because what I say does not necessarily translate to every specialty within every branch of service. But, the premise of your OP I felt was based on preconceptions of military residencies AS A WHOLE that is just not true. ON AVERAGE, military residencies are very good and produce a great product. The trouble and bitterness from people comes AFTER residency when they are placed somewhere where they cannot maintain their skills, PLUS the addition of system failures which can and often will be real.

What specialty are you interested in?

 

[Hopeful_Doc123]

Well beware, I am very thankful for the opportunities the military has given my family and I and I don't trend negative when I discuss military medicine as the majority of active members on SDN do. Take everything I say with a grain of salt. I also speak specifically for Navy orthopedic related things. You can not universally apply these opinions to other branches or specialties. That being said, I am also very realistic about people's expectations. You do not have to bleed Red, White and Blue to do well in the military, but joining with the hope/plan of a civilian deferment because you think you will get universally better training as a civilian is not a good place to start if you want to be a "happy milmed physician". If that is what you think at the end of your own research in to military medicine then that is totally fine, but pass on the HPSP and USUHS applications and stay a civilian.

Skill atrophy is a real thing within the military system. BUT, this occurs after residency. When/if you are placed at a small MTF with low volume or low acuity cases for your chosen specialty you may not be able to maintain the training you learned in residency. This is a very real possibility and must be factored in to your decision. BUT, the residency programs, ON AVERAGE, are at par or above civilian residencies. Sure, there is Mayo, or Hopkins or whatever you want to use an example of what may be considered better than a military residency, but it depends on how you define "better", and each person has their own definition. For every Mayo or Hopkins there are 2x or 3x more brand new, non-ACGME accredited DO residencies (for example) that may or may not train you well. I define a good residency as one which produces a specialty trained physician who passes their boards and is a competent provider at the institution they will likely be working. I have worked along side ortho residents from "well known, fancy-named" programs who barely know an 11-blade from a 15-blade because they are often 2nd, 3rd or 4th in line to scrub a case until very late in their program. I also have seen similar poorly trained candidates within the military, but not because they didn't have the opportunity to excel. Even within the military there are better places to do certain specialty training. i.e. I felt like there was more of a blue-collar, hands-on feel for ortho at NMCP vs. Walter Reed which is why I chose to rank NMCP first. For these reasons, and because I chose a long time ago to commit to the military, I would have chosen NMCP over a civilian deferment to Hopkins any day of the week because I knew it would train me to be a well-trained and competent military orthopedic surgeon at any MTF or civilian hospital for that matter.

Watch, everyone will try to tell me that my own opinion is wrong because it is not how they feel. On many levels this is true because what I say does not necessarily translate to every specialty within every branch of service. But, the premise of your OP I felt was based on preconceptions of military residencies AS A WHOLE that is just not true. ON AVERAGE, military residencies are very good and produce a great product. The trouble and bitterness from people comes AFTER residency when they are placed somewhere where they cannot maintain their skills, PLUS the addition of system failures which can and often will be real.

What specialty are you interested in?

Sure- I should not have offered the uncorroborated statement that military residency is somehow worse. I really meant to compare whether civilian or military physicians are better at their craft, and I appreciate your insights. I am not trying to compare the highest of civilian to military, seeing as most physicians do not work there. It seems, though, that you are saying the average trained physician both in the military and in the civilian hospitals are equally trained, depending on each individual physician.

I am still deciding which branch I want to apply through. Why did you specifically choose Navy?

In regards to specialty, I am interested in cardiology and ENT, but that is because those are two fields I have been exposed to. I often find interest in each aspect of medicine, from endocrinology to surgery, and everything in between. I am sure I will not be able to decide until I go through my medical training, but definitely have a leaning towards my aforementioned two.

 

[HighPriest]

I appreciate your detailed response. I know the first step is always to get into a medical school and go from there, but I would like to stay as informed as possible regarding future options. Much like civilian residency, I am sure there are residencies that are more competitive than others, but I just was not sure if military residency matches operated in the same way that civilian residency matches do. I am generally indifferent with regards to most of the negative aspects of military medicine that people complain about, but I take my potential training and specialty more seriously. I understand if I match into a military residency, I would go through that program, but that is fine so long as I am able to practice the speciality I wish to join.

If you don't mind- could you elaborate more on your journey as an ENT? Are you still practicing with the military? Did you do any fellowships?

I requested a fellowship in the Army, but they didn't approve anyone in that subspecialty field that year. They did almost every year prior, and they have every year since. But not that year. So I didn't do a fellowship. In hindsight, I'm happy I didn't, but I wasn't very happy at the time. If you take your training seriously, you should be very worried about the most common thing that military surgeons care about, which is skill atrophy. If you'd like more information about me and my experience, you can PM me.

 

[HighPriest]

Outside rotations are interesting, and I appreciate your analogy. I am honestly just trying to decide what the implications of my decision are to join the military. If I went in blindly, I have a better chance of being dissatisfied with certain aspects that I may not have been prepared for. That is why I am trying to gauge experience from various sources. I love many, many aspects of military medicine, but viewing these forums has painted a somewhat unfortunate view of the system. While the most vocal are typically not representative of the majority, it is hard to get unbiased information from those who have been through the program.

I don't blame you for getting information. That's definitely the right thing to do.

As discussed on separate threads, my opinion is that this thread isn't actually all that misrepresentative of the general feeling towards milmed in the Army. Others disagree. But most of the people I knew (many of which were ENT) were very unhappy for a variety of reasons. If your primary goal is to get the best training, do a fellowship, and maintain your skills with a wide variety of complex cases within your field....I would reconsider military medicine. Those are just not good reasons to join. Just the contrary. If you really want to be in the military, and serving as a doctor seems like an ok way to do that, then you have the right mindset.

 

[HighPriest]

Well beware, I am very thankful for the opportunities the military has given my family and I and I don't trend negative when I discuss military medicine as the majority of active members on SDN do. Take everything I say with a grain of salt. I also speak specifically for Navy orthopedic related things. You can not universally apply these opinions to other branches or specialties. That being said, I am also very realistic about people's expectations. You do not have to bleed Red, White and Blue to do well in the military, but joining with the hope/plan of a civilian deferment because you think you will get universally better training as a civilian is not a good place to start if you want to be a "happy milmed physician". If that is what you think at the end of your own research in to military medicine then that is totally fine, but pass on the HPSP and USUHS applications and stay a civilian.

Skill atrophy is a real thing within the military system. BUT, this occurs after residency. When/if you are placed at a small MTF with low volume or low acuity cases for your chosen specialty you may not be able to maintain the training you learned in residency. This is a very real possibility and must be factored in to your decision. BUT, the residency programs, ON AVERAGE, are at par or above civilian residencies. Sure, there is Mayo, or Hopkins or whatever you want to use an example of what may be considered better than a military residency, but it depends on how you define "better", and each person has their own definition. For every Mayo or Hopkins there are 2x or 3x more brand new, non-ACGME accredited DO residencies (for example) that may or may not train you well. I define a good residency as one which produces a specialty trained physician who passes their boards and is a competent provider at the institution they will likely be working. I have worked along side ortho residents from "well known, fancy-named" programs who barely know an 11-blade from a 15-blade because they are often 2nd, 3rd or 4th in line to scrub a case until very late in their program. I also have seen similar poorly trained candidates within the military, but not because they didn't have the opportunity to excel. Even within the military there are better places to do certain specialty training. i.e. I felt like there was more of a blue-collar, hands-on feel for ortho at NMCP vs. Walter Reed which is why I chose to rank NMCP first. For these reasons, and because I chose a long time ago to commit to the military, I would have chosen NMCP over a civilian deferment to Hopkins any day of the week because I knew it would train me to be a well-trained and competent military orthopedic surgeon at any MTF or civilian hospital for that matter.

Watch, everyone will try to tell me that my own opinion is wrong because it is not how they feel. On many levels this is true because what I say does not necessarily translate to every specialty within every branch of service. But, the premise of your OP I felt was based on preconceptions of military residencies AS A WHOLE that is just not true. ON AVERAGE, military residencies are very good and produce a great product. The trouble and bitterness from people comes AFTER residency when they are placed somewhere where they cannot maintain their skills, PLUS the addition of system failures which can and often will be real.

What specialty are you interested in?

100% agree with all of this, with the exception of comparing ortho residencies, simply because I have no knowledge on that subject. I think our residents were better surgeons and better clinicians than the local university residents, and that was a well known university. More importantly, the University STAFF felt like we were usually better in the OR than their residents of equivalent training year. I mean, they'd actually say that. The civilian residents were not dumb (very much the opposite), they just spent most of their time being on call, doing research, and assisting. We spent most of our time operating and seeing clinic.

militaryPHYS isn't wrong because I don't agree with him about milmed. I'm sure there are lots of other reasons he's wrong . But in this case he's right. Most of the bitterness comes after residency, and all of the skill atrophy. That was also my experience, and so militaryPHYS is right in this case.

 

[narcusprince]

Militaryphys
Who were your best attendings at nmcp? Who challenged you the most? Where did they come from? Where did they train? I knew all the ortho guys who were staff there. The best were the ones whom came from outside.

 

[militaryPHYS]

I often find interest in each aspect of medicine, from endocrinology to surgery, and everything in between.

This statement is a positive predictor of doing well and being happy in milmed, just like hope for a deferment would be a negative predictor.

Basically if you sign up with pre-conceived thoughts on where YOU want to go you may end up being disappointed. Not to say that you shouldn't have goals, but if your goals are so specific that you get tunnel vision and then life (or the military) kicks you out of your tunnel, you will be a fish out of water.

When I signed up for USUHS I knew I wanted to be a doctor and I wanted to serve my country. From there I like to think my interests and military medicine molded each other. What I mean is that I knew I wanted to be surgical but didn't like the personalities, lifestyles, military practices of the general surgeons. Never fell in love with ENT or neurosurg procedures. Didn't like the OB side of OB/GYN (or their lifestyle). Ultimately I realized that the older military guys in ortho, specifically ortho-sports were happy and well fed when it come to case load and complexity. Ended up being a win-win. I would encourage you to keep your open mindset and approach every rotation as something you may want to do for the rest of your life. Ask why the happy ones in that field are happy and why the miserable ones are miserable, then apply it to your personal life to give you a realistic expectation.

I chose the Navy because I was prior marine corps enlisted and wanted to continue to be close to Marines. Plus Navy is universally better than Army.

I don't agree with him about milmed

HighPriest has more experience with life after residency in milmed and therefore will give you a better idea of the blunt realities of milmed attending life, which I do appreciate. For me, I am a long-time serving military member but newly released in to milmed attending life. I try to maintain my optimism that Navy Ortho will continue to serve me well, even as a staff, but I understand I am likely to be "over-the-hill" and can expect increasing frustrations through these next years. Hopefully the awesome last 10 years of my life (military medical school and residency) is enough to keep me happy if the negatives of milmed keep adding up. Time will tell

 

[HighPriest]

Plus Navy is universally better than Army

Boy, is that ever true. It’s amazing what having bette funding, better posts, and an entire force of meathead pawns to take shots for you will do for morale.

Honestly, I’ve met a lot of happy Navy docs, and not very many happy Army docs. I joined the Army because 1-there were simply more residencies, and I wanted to maximize my chances of matching where I wanted, 2- Many of my relatives would have shot me on sight if I joined the Navy, and 3 - The Navy has great dress uniforms, but the blueberry jumpsuit and the white uniform? I actually preferred the old Army dress greens and that’s saying something.

 

[militaryPHYS]

Who were your best attendings at nmcp?

The best attendings in my opinion were the 15+ year milmed guys. To be honest, I couldn't tell you where they did residency because none of their decision making processes in 2016 were based off of what they did in residency (military or civilian) in the 90's. I'm sure you know the two main hand guys, the one older pediatric (now retired and GS), newly retired sports guys and current O6 sports guy as well as a previous Foot and Ankle guy (hilarious, now in HI). There were two younger sports guys who had deferments and were incredible, but they were more a product of their fellowship (Vail and PITT) and didn't really speak of their residency when training us.

In ortho I feel like residency makes you a good junior staff and milmed residencies do that just fine. Your ability to continue to excel and then ultimately mentor comes from experience as a staff and fellowship...which, as we all know, can be a hindrance in milmed. But when they both work out in someone's favor they can be very rewarding (lifestyle, practice and financially).

 

[Hopeful_Doc123]

Boy, is that ever true. It’s amazing what having bette funding, better posts, and an entire force of meathead pawns to take shots for you will do for morale.

Honestly, I’ve met a lot of happy Navy docs, and not very many happy Army docs. I joined the Army because 1-there were simply more residencies, and I wanted to maximize my chances of matching where I wanted, 2- Many of my relatives would have shot me on sight if I joined the Navy, and 3 - The Navy has great dress uniforms, but the blueberry jumpsuit and the white uniform? I actually preferred the old Army dress greens and that’s saying something.

Would you be able to direct me to where I could get more information regarding available residencies between AF/Navy/Army? I was not aware that people had more opportunities in one, rather than the other; I thought the decision came from more of a personal basis.

 

[Hopeful_Doc123]

This statement is a positive predictor of doing well and being happy in milmed, just like hope for a deferment would be a negative predictor.

Basically if you sign up with pre-conceived thoughts on where YOU want to go you may end up being disappointed. Not to say that you shouldn't have goals, but if your goals are so specific that you get tunnel vision and then life (or the military) kicks you out of your tunnel, you will be a fish out of water.

When I signed up for USUHS I knew I wanted to be a doctor and I wanted to serve my country. From there I like to think my interests and military medicine molded each other. What I mean is that I knew I wanted to be surgical but didn't like the personalities, lifestyles, military practices of the general surgeons. Never fell in love with ENT or neurosurg procedures. Didn't like the OB side of OB/GYN (or their lifestyle). Ultimately I realized that the older military guys in ortho, specifically ortho-sports were happy and well fed when it come to case load and complexity. Ended up being a win-win. I would encourage you to keep your open mindset and approach every rotation as something you may want to do for the rest of your life. Ask why the happy ones in that field are happy and why the miserable ones are miserable, then apply it to your personal life to give you a realistic expectation.

I chose the Navy because I was prior marine corps enlisted and wanted to continue to be close to Marines. Plus Navy is universally better than Army.



HighPriest has more experience with life after residency in milmed and therefore will give you a better idea of the blunt realities of milmed attending life, which I do appreciate. For me, I am a long-time serving military member but newly released in to milmed attending life. I try to maintain my optimism that Navy Ortho will continue to serve me well, even as a staff, but I understand I am likely to be "over-the-hill" and can expect increasing frustrations through these next years. Hopefully the awesome last 10 years of my life (military medical school and residency) is enough to keep me happy if the negatives of milmed keep adding up. Time will tell

Thank you for all your help! I will definitely keep all of this in mind going forward with my decision process.

 

[narcusprince]

Mil by all means stay positive. Especially if your specialty you seem to get the respect and support you need from leadership. Perhaps medical students who are more mil med minded should consider which specialities have a less then higher milmed burnout. For my specialty we seem to be the bain of the existence we tend to be on the recieving end of leadership with us labeled as gate keepers, and then labled by the nurse corps as less then doctors. When I moonlight we are viewed as valued members of the team. Medical students please remember the specialty you choose from your civilian rotations may be different then the practice in the navy.

 

[deleted480308]

Well beware, I am very thankful for the opportunities the military has given my family and I and I don't trend negative when I discuss military medicine as the majority of active members on SDN do. Take everything I say with a grain of salt. I also speak specifically for Navy orthopedic related things. You can not universally apply these opinions to other branches or specialties. That being said, I am also very realistic about people's expectations. You do not have to bleed Red, White and Blue to do well in the military, but joining with the hope/plan of a civilian deferment because you think you will get universally better training as a civilian is not a good place to start if you want to be a "happy milmed physician". If that is what you think at the end of your own research in to military medicine then that is totally fine, but pass on the HPSP and USUHS applications and stay a civilian.

Skill atrophy is a real thing within the military system. BUT, this occurs after residency. When/if you are placed at a small MTF with low volume or low acuity cases for your chosen specialty you may not be able to maintain the training you learned in residency. This is a very real possibility and must be factored in to your decision. BUT, the residency programs, ON AVERAGE, are at par or above civilian residencies. Sure, there is Mayo, or Hopkins or whatever you want to use an example of what may be considered better than a military residency, but it depends on how you define "better", and each person has their own definition. For every Mayo or Hopkins there are 2x or 3x more brand new, non-ACGME accredited DO residencies (for example) that may or may not train you well. I define a good residency as one which produces a specialty trained physician who passes their boards and is a competent provider at the institution they will likely be working. I have worked along side ortho residents from "well known, fancy-named" programs who barely know an 11-blade from a 15-blade because they are often 2nd, 3rd or 4th in line to scrub a case until very late in their program. I also have seen similar poorly trained candidates within the military, but not because they didn't have the opportunity to excel. Even within the military there are better places to do certain specialty training. i.e. I felt like there was more of a blue-collar, hands-on feel for ortho at NMCP vs. Walter Reed which is why I chose to rank NMCP first. For these reasons, and because I chose a long time ago to commit to the military, I would have chosen NMCP over a civilian deferment to Hopkins any day of the week because I knew it would train me to be a well-trained and competent military orthopedic surgeon at any MTF or civilian hospital for that matter.

Watch, everyone will try to tell me that my own opinion is wrong because it is not how they feel. On many levels this is true because what I say does not necessarily translate to every specialty within every branch of service. But, the premise of your OP I felt was based on preconceptions of military residencies AS A WHOLE that is just not true. ON AVERAGE, military residencies are very good and produce a great product. The trouble and bitterness from people comes AFTER residency when they are placed somewhere where they cannot maintain their skills, PLUS the addition of system failures which can and often will be real.

What specialty are you interested in?

As a small note, o-gme is going away and by the time OP graduates there shouldn’t be any programs that aren’t acgme

 

[IlDestriero]

Militaryphys
Who were your best attendings at nmcp? Who challenged you the most? Where did they come from? Where did they train? I knew all the ortho guys who were staff there. The best were the ones whom came from outside.

This was my experience as well in San Diego.
The Navy trained guys were fine but for the most part the attendings that were exceptional trained (or did fellowships) at well known civilian programs.
Not everyone can train at the best programs, but if you can, the .mil isn’t your best choice. If you are going to do a fellowship it might not matter, but lack of serious research may limit you there as well.


--
Il Destriero

 

[Armyhealth]

So this is coming from a Army healthcare recruiter. I think @HighPriest explained the matching process the best. Like he said you will have to rank 5 programs, as long as you do well on your step exams and in your rotations you will have a good chance to match into what you want.

However, you have to plan for the best and the worst. Build your pros and cons list weigh out which is the most important factor for you. The military is not easy and anyone that tells you that it is a glide free path vs civilian is selling you something. If your goal is to serve your country and get a debt free medical degree then the military is a great path for you. You have to understand in the military you are a doctor/soldier/officer/leader/administrator some like the challenge and thrive under that system. Others fade with the pressure and become critics on SDN (just kidding).

For the army ENT match rate last year was 1.14 applicant per position but in 2014 and 2015 it was about 1.5 applicant per position so really depends on your class group. Also IM is a 100% match rate for the Army for as far back as I can see the matching numbers. So if ENT is your first choice and IM is second you will not be going GMO unless you just do poorly on the step exams.

 

[HighPriest]

doctor/soldier/officer/leader/administrator

eehhhh.... administrator/officer/lecture attendee/professional urinator/leader/soldier/............./doctor.

 

[Armyhealth]

eehhhh.... administrator/officer/lecture attendee/professional urinator/leader/soldier/............./doctor.

ha, but professional urinator stands out on a resume!