Question about Military Residency

Discussion in 'Clinical Rotations' started by johnM, Mar 6, 2002.

  1. johnM

    johnM Senior Member

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    I'm considering going to USUHS next year, and I'm wondering if anyone here knows anything or has an opinion about military residencies. For example, when I leave the military someday, are they well-respected? do they prepare you well enough for civilian practice? I know that I would be a military doc for a long time, and I actually really look forward to it. But I guess I will eventually want a civilian job, and I'm wondering how a military background (both med school and residency training) will affect that.
     
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  3. LomaLindian

    LomaLindian Junior Member

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    I am a fourth year med student, doing the HPSP for the Navy. What I have found out on the interview trail and doing rotations at Naval hospitals is the following (only applies to Navy med)...

    1) You get good training. Not "the best," but good enough that with a little initiative a person can get a great education.

    2) It is a well known fact that military residencies are more cush than thier civilian counterparts. As such, some ppl say that military training isn't as good. I don't believe that. I have interacted with some brilliant ppl that are military residency trained.

    3) USUHS is a good school. They have very well known attendings there--getting letters of recommendation from them means a lot if the letters are good.

    If you are interested in an academic career, the military might not be the best for you. But if you want to do some fun stuff, with a little emphasis on medicine, than it might be a good option.

    Doing GMO tours are fun (or so I've heard). I got a full deferment for Rads, so I hopefully won't be doing a GMO tour (I still need to match to civilian Rads).

    Anyway, I hope this helps.
     
  4. Voxel

    Moderator Emeritus

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    Contrary to your belief GMOs are not fun. I don't know about you. The possibility of being in afghanistan on the battle field or in a ship crusing the persian gulf is not appealing to me. Being stationed overseas, or worse some aweful military base in the middle of nowhere is not my idea of fun. Oh yeah, I hope you don't mind when an officer senior to you says something like "Drop and give me 20" because you will have to do it. It's the military for crying out loud. God bless those who can do it, but think about this long and hard. Unless you are die hard military, the scholarship money IMHO is not worth it.

    PS I have a friend who matched military radiology residency and could not get a civilian deferrment. YIKES. Even if you get a civilian residencyt... after deferrment for civilian residency you have to go back to the military to practice radiology in the military making 80-90K a year for a LONG time (I think 7 years, but I could be wrong on the exact amount). Atleast they have PACS in the military.
     
  5. doc

    doc New Member

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    Think long and hard about going to usuhs. Alot depends on what you want out of life as well as what you want of your medical career. I would not be concerned about how going to USUHS will affect your marketability as a civilian, if you are a good and dedicated physician you will be attractive in most any field. You will have to do 7 years active duty and 8 years of reserve duty. Most of the graduates end up being career military physicians. The curriculum appears to be more rigid than most other medical schools, you have to wear a uniform and since your in the military you have to do what your told. the upside is that you don't have to worry about paying for school. Trust me however, the military will get you in the end. You will probably have to do a GMO tour if you enter the navy, maybe in the army or airforce. If you have to choose a service pick the airforce. They tend to treat their docs better and you'll always be near an airbase where you can hop flights easily.

    Overall, the residency training is solid. It is NOT cush as per (LOMA). One of the unique things about military medicine is that the senior physicians do very little work and pass everything onto the junior personnel and residents. After all you are on a salary and you get paid the same amout whether you see 100 pts per day or only 1. And you can't get fired. Hence very little motivation to be a professional as in the civilian world.

    Also GMO tours are NOT fun. You can get put on ships or remote areas which are understaffed and you and you alone will have to manage complex patients with little or no backup. Also dealing with senior military personnel with no knowledge of medicine is a pain in the [email protected]#.

    In the future military medicine may see some significant manning shortages. They are currently short in the fields of radiology, ortho, optho, etc. What this means is more work for you and worse billet (job assignments). Often the military will hire civilians and put them in very attractive locations such as washington or san diego and put the people who owe them a committment on ships, overseas and in remote locations. Hope this helps
     
  6. LomaLindian

    LomaLindian Junior Member

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    Disclaimer: This is MY experience firsthand--I have only exp with the Navy--I cannot comment on GMO tours in the AF or Army (even though these branches are phasing out GMO tours).

    As with msg boards, opinions and rumors run rampant--here is my PERSONAL experience...

    With consideration to GMO tours...I personally have talked to several GMO's. 90% of them said they had a GREAT time during their GMO tour. While it is true that there is a chance to be sent to Afghanistan, this is not the rule. I have talked to MANY flight surgeons--they basically work 4 half days a week, have weekends off, and have the opportunity to get their pilot or helicoptor lisences. You do as much or as little medicine as you want. The only drawback is that FS need to be with his/her squadron wherever they are stationed at (for single men/women, they said they loved it).

    There are also opportunities to do Undersea medicine, radiation medicine, or just primary care GMO tours (not everyone goes to Afghanistan--many peeps do clinic stuff in SD, Bethesda, Florida, Washington, etc).

    Also, many GMO's said that they liked being able to take a break before residency.

    doc makes a good point. If you go to USUHS, you will basically be devoting many years for military medicine (7 years for ms, then whatever is added on for doing residency, fellowship, etc.) It is a tough decision.

    Monetarily, GMO's make around 80-90k a year--after only one year of internship. It's not that bad.

    Voxel, I personally know of one radiologist (cmdr) that makes more than 130k a year (not 90k). The pay is significantly less than civilian radiologists are making, but it ain't a pittance either. Also, your comment about higher ranking officers telling a person to "drop and give me 20," is funny but baseless. There is a lot of camaraderie amongst medical officers--none of that goes on. There is a HUGE difference in being enlisted and being an officer (that stuff goes on a lot in the former, not the latter).

    Also, I received a civilian def for Rads, and when I go into the Navy, my only payback will be FOUR years, at an attending level status. It will be a great time to hone my skills at either SD or Bethesda before I go into Academic or private practice.

    johnM, if you are sure about wanting to practice military medicine--go to USUHS. If you don't know--apply for HPSP (4 vs. 7 year standard payback). If you are strictly deciding from a monetary standpoint--it all basically equals out in the end. I loved having a stipend during medschool, being able to guitlessly spend money, free books, medical instruments, etc.. I know that I won't make as much money initially early on in practice--but I don't have the medschool debt.

    Hope this helps.
     
  7. Voxel

    Moderator Emeritus

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    Less money early does make a difference. Any basic finance textbook will tell you why. It's the power of compounding intereset/return. :)
     
  8. LomaLindian

    LomaLindian Junior Member

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    Voxel--I can't argue with you, you make a good point :) . But when all is said and done--a civilian rad will still have to pay >150-200k for medschool over 10-15 years--obviously this amount of cash cannot be invested at all. A military doc can invest as much or more--cheap housing, food, travel, etc.. I will only have 4 years payback--then out into the civilian job market. Like I said, it all comes out about even (in the scenario that I currently am in).

    BTW, I have never read a basic economics text--I just use common sense <img border="0" title="" alt="[Wink]" src="wink.gif" />

    Voxel, where are you looking to go for residency?
     
  9. johnM

    johnM Senior Member

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    Thanks for all the info, it's really helpful and interesting for me.

    As for the idea of being sent to Afganistan for a GMO tour, I am looking at the Army, so I guess GMO tours aren't likely to be an issue for me. In any case, I don't particularly have a problem with going to afganistan and I honestly see the stuff that is going on there as very important. I really kinda look forward to the military aspect of either HPSP or USUHS (how cool would it be to learn how to jump out of an airplane with a parachute and a pack of surgical tools? <img border="0" title="" alt="[Wink]" src="wink.gif" /> ) I just don't know if I want to do it forever, and I want to be marketable to the real world, but I guess that shouldn't be a problem.

    Loma, you said that you recieved a civilian def for Rads... I'm kinda curious as to why? I mean, where you do your residency doesn't really affect your commitment right? And I was under the impression that the military residencies paid better, so why would you want to do a civilian one? Also, I'm a little surprised that military radiologists make as much as you say. I've had a really hard time finding out how much they actually get, but I was thinking that military docs make around $90k. Could you eleborate on this? Thanks again!
     
  10. LomaLindian

    LomaLindian Junior Member

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    johnM,

    1) Military Pay: It took me a couple of years to figure out how much military docs make, so don't sweat it. Military pay basically starts from your rank, how many years in service, medical bonus, specialty bonus, fellowship bonus, housing allowance, etc., etc.. All of this gets added together. So a firm number is hard to come by because every military doc will have a slight difference in exp and/or training. But trust me, it is PLENTY to live on.

    2) Reason for Rad Def: I had the opportunity to visit and rotate at both Radiology depts in Bethesda, MD and San Diego, CA. They offer a solid residency experience. Since radiologists are in such high demand, the military predicts that they will need more docs than their own residencies can produce. Thus the civilian deferment. I applied for civilian residency because of the opportunity to go to more prestigious programs (Civ. def. is VERY competitive for Rads, because they will only grant it if the applicant can match to a program that is superior to the residency that the military has to offer) with better training. This will possibly give me more opportunities for a pursuit of academia after the military. I fortunately received a deferment, so I will only have four years of active duty payback after residency. I chose not to do a GMO tour because I don't want to go into primary care--which most tours are comprised of. I have a friend that wants to do Rads, and could match at ANY program that he applied to. He will be doing an Undersea GMO tour because he wants the adventure of being hooked up with possibly the Navy seals. The military offers some unique experiences--just make sure you research them as fully as possible before you commit.

    3) HPSP or USUHS: If you are worried about being "stuck" in the military, DO NOT DO USUHS. Go HPSP. Only four years commitment, plus Army has almost phased out their GMOs. You will be residency trained out in the field (especially if you are interested in Gen Surg).

    Any more questions, plz post.
     
  11. doc

    doc New Member

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    I have to disagree with Loma on several major issues. I will state that I may have had similar thoughts years ago but having been a military doc I now have a better insight.

    I think Loma may have talked to GMOs who were happy but if you pretty much talked to Flight Surgeons they are a small portion of GMOs and a small portion of navy medicine as a whole. They tend to have it the best just because their population loves to do their job (ie. fly) therefore they will not see their medical officer unless they are truly sick. Same with Undersea medicine. Now the rest of the navy is different and there are no barriers to personnel overusing care, since there is no co-payment. Furthermore, there are very few billets (jobs) in truly desirable places. If you search the jobs that are offered on the navy medical websites you will see. The majority of GMOs I have spoke to are not very content and this is probably why the navy's retention rate is so low. However it is true that some do like their job but from my experience this is the minority.

    With regards to deferments the navy and all of the branches are desperate for radiologists. They will grant a fair number of full deferments at their selection board each nov-dec to applicants they think could obtain a civilian residency not solely if you could obtain a better residency the either Balboa or Bethesda. Having rotated there, the pathology of cases is amazing and rads residents who graduate are very well received for their breath of knowledge. Also if you think you'll be going to Balboa or Bethesda once you complete a civilian residency, well Good Luck. Most of the senior staff go to those places after they have done hardship tours (overseas or in isolated areas). For the Navy Yokosuka, Guam, Okinawa, Puerto Rico, 29 Palms, Lemoore, etc are more likely.

    To JohnM is your curious about medical pay, check out the website:

    <a href="http://navymedicine.med.navy.mil/med00mc/" target="_blank">http://navymedicine.med.navy.mil/med00mc/</a>

    Go to the medical corps section and it should explain it pretty good. Also check out the site:

    <a href="http://dfas.mil/money" target="_blank">http://dfas.mil/money</a>

    Essentially if you were a radiologist coming from a civilian training arena you would get base pay of an 0-3 at 4+years (approx 44,000), board certified pay of 2,500. Additional special pay of 15,000. Variable special pay of 5,000. Incentive special pay of 31,000, subsistence of 2,000 and a housing allowance which depends upon where you live. You are not entitled to Multi-year specialty pay until all of your obligations are fulfilled.

    Also check out the site:

    <a href="http://www.persnet.navy.mil/pers4415/index.htm" target="_blank">http://www.persnet.navy.mil/pers4415/index.htm</a>

    This has alot of the job openings for active duty medical personnel who have to try and bargain with the detailers to be sent to a specific places. Hummm... to Loma, I wonder why there is not a section for radiologists on the detailers page. Could it be because they are at running at less than half staff and you have to call the detailer to see what remote station you will be sent to. I wish you luck but I personally know many navy radiologist and they are not happy and they are leaving, and it ain't because of the money. Hope your experience is better.
     
  12. LomaLindian

    LomaLindian Junior Member

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    doc, I appreciate your thoughts. We certainly have been interacting with different ppl. I mostly interacted with radiologists, which tend to be happier than most. I'm glad you spoke up to disagree with me concerning some issues that you are more familiar with. I will always defer to those that are more knowledgable (but not opinionated).

    Also, if you think a fair number of full def for rads is 6-7 out of a class of 320, then you are correct. I PERSONALLY interviewed with the specialty leader for Radiology. She stated that the military needs more radiologist, d/t the civilian job market being so good (they cannot keep the young rads). A person will not get a def if the training that they receive will be inferior to what the Navy has to offer. So only the most competitive applicants will get the deferments--the Navy assuming they will match into good programs (this is also the reason why the Navy will match the lowest 10% of HPSP students into Navy internships and give one year def to average students--its because they will make an effort to bring them up to speed on any weak points the student might have).

    To address another issue, you connote that I think military radiologists are inferior. Not the case. There are a lot of brilliant ppl I interacted with in Beth and SD. But there are always better places to train (unless you are #1).

    As with radiology not being on the detailers list--I have no idea why. I won't have to worry about that for another 5 years.

    I don't know if you intended it, but you have painted a grim picture of military medicine. But if thats what you believe, I think it is great to have a couple of different view points :) .

    BTW, have you had a good experience? What is your specialty? What was your hardship duty?
    TIA
     
  13. johnM

    johnM Senior Member

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    doc, thanks a lot for the breakdown of pay, and the websites really helped. I guess it's going to be pretty similar for the army. So I'm calculating this stuff...

    44,000 base pay
    2,500 board cert. pay
    15,000 add. special pay
    5,000 variable special pay
    31,000 incentive special pay (depending on the field)
    2,000 subsistence
    ~12,000 housing allowance (I'm guessing)
    -------
    $111,500 (for this example, a rad just out of residency)

    Am I missing something here? This seems like quite a bit of money, actually more than I was expecting.

    Loma: you seem really intent (although military residencies are good) on wanting to go somewhere better. Where is it that you wanna go? I'm assuming that you go to LLU for med school, which is actually one of the schools I am waiting to hear from post-interview, so any opinions on that school would be helpful too.
     
  14. edmadison

    edmadison 1K Member

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    I think it is important to note that USUHS students must do their residency in the military (at lease this is what they said at OBC). Another think is that with a few notable exceptions, deferments are quire uncommon.

    Ed
     
  15. LomaLindian

    LomaLindian Junior Member

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    johnM,

    Just to start off. edMadison makes a good point. Deferments in the military aren't common. Especially for competitive specialties. Derm, Rads, Neurosurg, Radonc will only have a few spots per year out of 250-320 HPSP students (USUHS students MUST do a military internship). So these are very competitive. I was fortunate to get a spot. Just don't expect to get one if you do HPSP because it all depends on the military's projected needs for the future.

    I had the opportunity to interview at places like UCLA, USC, UCSD, Vanderbilt, etc.. All are very solid and well-respected programs. They would give me more of an option to go into academics after the military. The main reason for the deferment is to possibly have more options when I enter the civilian world.

    I have to say I'm biased, but I received a great education from LLU. If you want to attend a school that has a bent on Christian ethics, LLU would be a good choice. Read this thread <a href="http://www.studentdoctor.net/ubb/ultimatebb.php?ubb=get_topic;f=2;t=001888;p=2" target="_blank">http://www.studentdoctor.net/ubb/ultimatebb.php?ubb=get_topic;f=2;t=001888;p=2</a> concerning some of my opinions of LLU.

    Hope this helps.
     

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