PSLF is pretty good, but combining PSLF with EDRP is even better! There many, many ways to get your loans wiped pretty quickly after graduation that don't involve the military.
Thank you for this insight and honestly the main reason I am entertaining USUHS is because I am prior Navy. It does certainly concern me that I could not be in a clinical setting for potentially years if I take this path.I had a great career, split between AD and reserve time. But my AD experience was a looong time ago, and isn’t relevant in 2025. My AD friends are mostly miserable and or resigned to their fate. Folks with prior mil time are about the only folks I think who should entertain AD medicine. Hopefully more folks in the specialties you’re interested in can chime in.
This is no doubt great advice in all aspects of life. It is something I have lived by during my career as an engineer and will certainly take forward no matter what path I take.Never close a door you don’t have to close.
Although your service time was a long time ago, would you say that your AD time provided you with anything that enhanced your capabilities as a physician that you otherwise would not have gotten if you had not served?
I don’t say this to be inflammatory in any way, because I agree with everything you’ve said here but:Absolutely. My philosophy of leadership. While the army is far far from perfect, leading from the front is a standard by which I judge all leadership.
The ideal is your boss and your boss’s boss at one point we’re in your shoes and technically understand your job and your place in time. And they are thus able to make sound decisions and lead well based on that past experience. Does it break down? Of course it does but that doesn’t mean we toss that ideal aside. It’s probably why I have such poor opinion of most hospital leadership. They have no clue about what we do. Hell, they don’t have any clue about healthcare. It’s all just widgets to them. And they certainly have no qualms telling people to do what they themselves would be either completely incapable or completely unwilling to do themselves. They tend to be self-serving, first in line, narcissistic dinguses.
Thankfully, I never had the ‘pleasure’ of nurse commanders on ADI don’t say this to be inflammatory in any way, because I agree with everything you’ve said here but:
This system breaks down in both the civilian and military worlds. It is for the most part a bit better in the military for two reasons:
1-most of the leadership structure is physicians
And
2-there’s essentially no realistic expectation for performance, so you can easily stand on ideals. (Which is not entirely bad)
Where it breaks down is
1-lots and lots of nurse commanders who have no idea, frankly, what it is like to actually practice medicine as a physician no matter how much they think that they do.
2-physician or nurse commanders who have spent so much time away from clinical practice that they barely remember what it was like, and they’re mostly concerned with what their next OER is going to say. Clinical medicine for some of them is like remembering what the third grade was like and equally relevant to them.
But, in the civilian world having disconnected leadership is the standard rather than the exception in most systems (physician lead systems or private practice systems aside). I definitely judge my leadership based upon how much I feel they try to understand what I do and why I do it.
For me, personally, I find it easier to work with a non clinical hospital CEO than I do with a nurse commanders who because I know what motivates the hospital CEO - optics and finances. If you can define what you want to do in one of those two ways, they get it. Nurse commanders? Who knows. It’s whatever they think will get them promoted, and that could be anything.
You are a lucky guy. That’s the majority of what I had to work with.Thankfully, I never had the ‘pleasure’ of nurse commanders on AD
No doubt. Around the time I left AD was when Tripler was blessed with its first nurse commander. And they received a perfect JCAHO score. I knew then the fix was in and the future was bleak. The medical corps could stave off the medical service corps guys, but when all of AMEDD is salivating to be your boss, all bets were off.You are a lucky guy. That’s the majority of what I had to work with.
I don’t think anyone denies the personal and professional growth in GMO roles but personal growth=/= patient safety. I have often found myself down a similar line of thinking and I agree that, on balance, a gmo is likely better than a new grad PA and most IDCs but that doesn’t take away from under trained physicians serving in these roles. I know it’s not practical but ideally we shouldn't have undertrained PAs or IDCs in any of these roles. The Navy has made a judgment call and accepted the risk. Let’s increase the number of primary care docs. It is a little straw man to say these roles will be filled by surgical subspecialists.I disagree here with some of the negative assertions about General Medical Officers. As a prior GMO myself, I think it was a good experience for me personally and professionally, and helped me mature quickly as a physician. There is a learning curve, but I believe I was absolutely an asset to my unit. It is all relative. There are not enough board-certified physicians to fill all the operational needs. Do you really want to send your fellowship trained subspecialists out to do GMO work and have their skill set atrophy? No. Is a GMO generally just as good, if not better, than a PA or an independent-duty corpsman? Yes. I think Navy Medicine would be better off if more people still did a GMO tour. It would certainly help ensure more medical officers understand the way the military actually works.
Patient safety considerations left the building long ago with the proliferation of NPs.I don’t think anyone denies the personal and professional growth in GMO roles but personal growth=/= patient safety. I have often found myself down a similar line of thinking and I agree that, on balance, a gmo is likely better than a new grad PA and most IDCs but that doesn’t take away from under trained physicians serving in these roles. I know it’s not practical but ideally we shouldn't have undertrained PAs or IDCs in any of these roles. The Navy has made a judgment call and accepted the risk. Let’s increase the number of primary care docs. It is a little straw man to say these roles will be filled by surgical subspecialists.
Agreed, we have to find a way for physicians to get exposure to the line. I think it gives context to the role and our purpose. We aren’t the only show in town like civilian hospitals. We are stagehands for the war fighter, a supporting element to keep the machine running.
For the record, I wouldnt trade my experience for anything.
Agree, but these aren’t mutually exclusive and there are essentially zero NPs in an operational roles.If you’re truly worried about patient safety, go after nurse practitioners and other mid-level practicing on their own and not GMO physicians.
I disagree here with some of the negative assertions about General Medical Officers. As a prior GMO myself, I think it was a good experience for me personally and professionally, and helped me mature quickly as a physician.
There is a learning curve, but I believe I was absolutely an asset to my unit. It is all relative.
There are not enough board-certified physicians to fill all the operational needs.
Do you really want to send your fellowship trained subspecialists out to do GMO work and have their skill set atrophy? No.
Is a GMO generally just as good, if not better, than a PA or an independent-duty corpsman? Yes.
I think Navy Medicine would be better off if more people still did a GMO tour. It would certainly help ensure more medical officers understand the way the military actually works.
Didn't expect to come across this background browsing the forum - I'm also a former nuke ET, currently M1. Would be happy to discuss options other than USUHS with you if you want more info from someone currently using it or the differences between nuke school and med school, just shoot me a DM and i'm happy to talk specifics. TLDR: VR&E is paying for my medical school and I owe no obligations to anything or anyone.Of course. I am not someone who takes steps in a direction without considering options. I have narrowed things down to a few options at this stage, and USUHS is one of those paths.
Where do you go to school? lurker of this thread lolDidn't expect to come across this background browsing the forum - I'm also a former nuke ET, currently M1. Would be happy to discuss options other than USUHS with you if you want more info from someone currently using it or the differences between nuke school and med school, just shoot me a DM and i'm happy to talk specifics. TLDR: VR&E is paying for my medical school and I owe no obligations to anything or anyone.
As an aside- I served from 2011-2021 (went to MARF in Ballston Spa in 2012 for prototype) so it's very likely we were at NNPTC together as students!
Finally - someone using their past service benefits and not simply signing up for more! Intelligent solution to medical school debt. Well done!Didn't expect to come across this background browsing the forum - I'm also a former nuke ET, currently M1. Would be happy to discuss options other than USUHS with you if you want more info from someone currently using it or the differences between nuke school and med school, just shoot me a DM and i'm happy to talk specifics. TLDR: VR&E is paying for my medical school and I owe no obligations to anything or anyone.
As an aside- I served from 2011-2021 (went to MARF in Ballston Spa in 2012 for prototype) so it's very likely we were at NNPTC together as students!
From what I gather, this solution only applies to people who have some disability from their prior service, creating a barrier of entry to the career path that their military service trained them for. I have no disability rating from my time in service, and I've already been working as a nuclear engineer, making this not applicable to me or others in a similar situation. I understand that many other paths do not require military service, such as NHSC, grants, scholarships, loans, GI Bill, PSLF, or other state-specific VA support. I have thoroughly researched my options. The point of my post is to gather as much information as possible on one of the options I have in front of me that fits my circumstances.Finally - someone using their past service benefits and not simply signing up for more! Intelligent solution to medical school debt. Well done!
I will add that disability and VRE CAN BE applicable to you and others in similar situations. I didn't apply for disability after I got out because I ignored my seemingly minor ailments at the time and didn't think I needed it. With the rigors of med school and residency these minor ailments started to get worse and after much persuasion by my military friends finally applied to the VA for disability more than 10 years after I separated. After a long process I was able to get disability, though, which has been a huge help to my financial situation (residency pay barely covers expenses with a family particularly in the early years). If you don't have documentation from your time in service it is more difficult to get approval, but it is possible (I was often my own medic so nothing ever got documented). It was too late for me to get VRE but if you can get your disability rating at least during med school you should still apply for VRE. I'd recommend contacting DAV for help with your application if you do decide to apply.From what I gather, this solution only applies to people who have some disability from their prior service, creating a barrier of entry to the career path that their military service trained them for. I have no disability rating from my time in service, and I've already been working as a nuclear engineer, making this not applicable to me or others in a similar situation. I understand that many other paths do not require military service, such as NHSC, grants, scholarships, loans, GI Bill, PSLF, or other state-specific VA support. I have thoroughly researched my options. The point of my post is to gather as much information as possible on one of the options I have in front of me that fits my circumstances.
Also, being condescending and assuming that anyone considering this path isn't intelligent enough to fathom other options to pay for medical school is very off-putting and does nothing to help your "mission" of steering premeds away from using the military to pay for medical school.
Do GMOs in the navy see only active duty, or do they see dependents as well?
I'm curious, and somewhat playing devil's advocate, as I only saw active duty as a psychiatrist in the Air Force and much of my work was military admin bs that didn't have much or anything to do with actually caring for a psychiatric patient. I'm only asking because, if GMO's only see active duty folks, my assumption is that even only after 1 yr of post grad training I wouldn't think they'd be that underqualified to care for a preselected healthy population of people that are required to maintain some amount of physical fitness and health standards to keep their job. Board certified fully trained primary care docs on the civ side would kill to have that level of standard for their patients lol.
Interesting responses here. I realize that there is wide variety in the kinds of experiences people may have had as GMOs. But based on my own experience, I am not convinced that the use of GMOs is blanket "unsafe" for patients and should be banned forever.
When I was a GMO (with USMC infantry), I needed to be good at the following:
-acute care
-minor procedures
-musculoskeletal injuries
-knowing what I could handle, how to effectively manage at my level, and when I to send to somebody else (medical judgment)
-familiarity with common emergencies and how to manage them (emergency preparedness)
-communicating health risk accurately to leadership (risk communication)
-determining what issues posed a risk to deployability and how to overcome them
-maximizing getting Marines back to work quickly with narrowly tailored duty restrictions as necessary, while not exacerbating their condition or prolonging healing
-basic mental health
-talking to the Marines in ways they could understand and act on
-developing the medical skills of my corpsmen (medical education/training) and employ them effectively to meet the health needs of the unit
-being able to thoughtfully plan for medical contingencies in austere environments with limited resources (wilderness medicine)
-engendering the trust and confidence of the line officers and senior enlisted in the unit
-fundamentals of preventive medicine/basic public health
-understanding common risk factors, work tasks, injury patterns, occupational hazards/exposures of those in my unit (a basic tenet of occ med)
-working with specialists to help maximize potential for Marines to return to work quickly (case management)
-knowing how and when to utilize the myriad medical resources available to me
I was at least decently good at all of these things, and very good at a number of them. I do think my Navy internship was reasonable preparation for my job as a GMO. I thrived in that environment enough that I extended my tour to do a second deployment. I saw specialists with much higher levels of training than me, working in the operational environment, that lacked the ability to do some of these things. This caused predictably significant problems for their units. Understanding the military, the way it works, and what your mission is as unit medical officer is absolutely critical and cannot be overstated. Many do not get that, and struggle in operational medicine even though they may be quite competent working in a hospital.
As a GMO I did not need to know much of anything about:
-OBGYN
-pediatrics
-advanced procedures
-care of chronic medical conditions
-complex medical conditions that typically require subspecialty care
-hospital medicine
-navigating the EHR
-dealing with hospital bureaucracy
In summary, I think that my skill set and level of medical knowledge and experience was appropriate for what I did as a GMO. I think that GMO experience is quite beneficial for most of the GMOs that do it (anecdotally, it seems that most prior GMOs I have worked with agree on that), that GMOs are a reasonably good fit for meeting the needs of many military units, and that they are not an inherently flawed concept for the Navy. There are legitimate reasons why the GMO system has worked as it has for many decades.
That said, everyone gets that there are tradeoffs as well as external pressures that give us good reasons to reconsider the model. I think the problem is that the alternatives also have their own drawbacks and tradeoffs, which haven't been discussed as much here on these boards but nonetheless are important to consider. As the Navy has and does.
I saw two ~50 year olds (one senior enlisted and one officer) present in theater with acute coronary syndromes. A 22 year old (or maybe he was 19? it's been 20+ years since that day) came into my BAS with ALL. Another guy (22 yo also?) seen by my co-GMO didn't have the usual NSAID gastritis but rather an esophageal adenocarcinoma. There's pathology out there.
My opinion that HPSP is not worth it or a good choice for anyone is my opinion, and you don't have to like it. I wasn't being condescending. The person using VR&E is really smart. I'm impressed, and it's a great utilization of a military benefit.From what I gather, this solution only applies to people who have some disability from their prior service, creating a barrier of entry to the career path that their military service trained them for. I have no disability rating from my time in service, and I've already been working as a nuclear engineer, making this not applicable to me or others in a similar situation. I understand that many other paths do not require military service, such as NHSC, grants, scholarships, loans, GI Bill, PSLF, or other state-specific VA support. I have thoroughly researched my options. The point of my post is to gather as much information as possible on one of the options I have in front of me that fits my circumstances.
Also, being condescending and assuming that anyone considering this path isn't intelligent enough to fathom other options to pay for medical school is very off-putting and does nothing to help your "mission" of steering premeds away from using the military to pay for medical school.
It primarily needs to be mid levels rendering care with board certified physician support at and above the regimental level with clear parameters for communicating with the (more senior) physician. For large training exercises a board certified physician should go but PA/NP types should be be most of the team. The physician's clinical schedule should be populated with more complicated patients or those where higher level decision making is needed. The strategy of elevating mid levels to senior clinical leadership positions doesn't solve this problem, as they are missing the training (KSAs) to navigate situations where the midlevels are in too deep. The challenge will be identifying the cases where early physician involvement is necessary, but our systems and training can overcome this.Can I ask a simple question and limit responses to maybe two or three sentences…?
Assuming we consolidate a bit so the operational medical assets are only what they need to be, who is going to cover the medical care for these warfighters when training or deployed? You don’t want interns doing it, you don’t want board certified doing it. So it will be another IDC or a midlevel so how is that going to be any better medical care?? Sure it “protects” these physicians from having to do the job but the care rendered will suffer.
Thanks!
It primarily needs to be mid levels rendering care with board certified physician support at and above the regimental level with clear parameters for communicating with the (more senior) physician. For large training exercises a board certified physician should go but PA/NP types should be be most of the team. The physician's clinical schedule should be populated with more complicated patients or those where higher level decision making is needed. The strategy of elevating mid levels to senior clinical leadership positions doesn't solve this problem, as they are missing the training (KSAs) to navigate situations where the midlevels are in too deep. The challenge will be identifying the cases where early physician involvement is necessary, but our systems and training can overcome this.
To me, this is what makes the most sense if you could start the system over from the beginning. Basic operational billets should be covered by PAs/NP’s. This is all GMO/Flight/Dive billets. Then have a board certified doc oversee them on the next echelon up the chain. We are using interns as GMO’s functioning as PA’s/NP’s already. Sure, I’d argue that an intern has a little more training than a PA, but we can augment those gaps to get our military PA’s trained up to be able to provide good first level care at the squadron level.
I mentioned this upthread, but the solution isCan I ask a simple question and limit responses to maybe two or three sentences…?
Assuming we consolidate a bit so the operational medical assets are only what they need to be, who is going to cover the medical care for these warfighters when training or deployed? You don’t want interns doing it, you don’t want board certified doing it. So it will be another IDC or a midlevel so how is that going to be any better medical care?? Sure it “protects” these physicians from having to do the job but the care rendered will suffer.
Thanks!
I mentioned this upthread, but the solution is
1) in garrison, operational units get their medical care at MTFs staffed by BC/BE physicians (+/- appropriately supervised midlevels)
2) when deployed (or in the field for training ops like CAX), BC/BE physicians get assigned to accompany them for 90-180 day periods
The physicians in (2) could be anyone. Probably the best fit would be a primary care specialty, but even other specialists wouldn't be terribly harmed by a few months away from their specialty. Before you dismiss this a as a crazy thought, it was the standard model for the Air Force during much of the Iraq/Afghanistan conflicts. While the Army was abusing reservists with 12-18 month deployments with a 2 week R&R break in the middle, the Air Force was rotating people in and out of theater on 90-180 day trips. It was Just Fine.
#1 - You can’t run a productive primary care product line at the MTF when you have operational units coming and going. Your MTF BC/BE staff are allocated based on empanelment for primary care. For MTF specialty care it is based off of average referrals. MTF primary care cannot constantly flex up and down for operational patients unless the operational BC/BE physician becomes part of the MTF access to care equation when in garrison. This mandate for operational MD/DO to the MTF doesn’t exist and it hurts MTF access to care and operational physician skill sustainment.
MTF primary care cannot constantly flex up and down for operational patients unless the operational BC/BE physician becomes part of the MTF access to care equation when in garrison.
Whether deployed or in garrison the front line basic medical care for OPFORCES has to be their assigned operational assets (IDC/PA with MD/DO backup). If and when care exceeds this system then referral to specialty care at MTF is made and priority for AD referrals should exist.
#2 when deployed the minimum number of required operational BC/BE physicians would already be established and will go with their assigned operational unit. When not deployed or in training environment they would supplement MTF primary care staff to maintain skills and ensure access to care for empaneled patient plus operational assets in garrison.
BC/BE physicians should be owned by the MTFs and lent to the operational units when they deploy.
GMOs have to exist
At this point in MilMed history, If you don’t understand why we can’t, at the operational command’s will, “lend” out MTF assets then we have a much more basic healthcare business discussion to have first.
Enlighten me
(With something more than "the line gets what the line wants and the line wants what the line thinks it needs" please. Obviously milmed exists to support the warfighter and the tail shouldn't be wagging the dog.)
Is there truly any realistic path toward combining the VA and DOD MTF systems?
It always shocks me how many services are not available at the MTF, so we have to transfer folks down the literally a short distance down the road to a VA hospital, which uses a completely different medical record and has a completely different set of resources. The fact that VA clinicians can't just drive to the MTF and practice their specialty to render these services is frankly bizarre.
Sorry, dumb, new-person question. But what is a BC/BE physician?1) in garrison, operational units get their medical care at MTFs staffed by BC/BE physicians (+/- appropriately supervised midlevels)
2) when deployed (or in the field for training ops like CAX), BC/BE physicians get assigned to accompany them for 90-180 day periods
So, I don't have a very clear understanding of the military's structure when it comes to physicians. You say here that OPFORCES has too many GMOs. I'm assuming OPFORCES is a DoD entity and not specific to any one branch when I read this, but I could be way off. I'll try to boil this down to a question.Right now OPFORCES have too many GMO’s and they are poorly utilized giving commanders the impression they don’t have support and physicians the impression their skills are being wasted.
Minimize number of OPFORCES physicians, expand IDC and mid-level control of basic healthy active duty military care.
When in garrison, commit a specific number of FTE from OPFORCES medical assets to the MTF to manage the influx of OPFORCES warfighters.
MTF FTEs remain constant and rely heavily on permanent civilian staff so that volume/complexity remains constant regardless of uptempo. Open MTF gates to civilian care just like BAMC and don’t bend the knee to local state politicians who don’t allow it because of negative impact on income of private hospitals. Oh yeah, and VA and DOD will be combined into one federal healthcare system.
Why would combining the DoD MTF and VA systems make more sense?Before DOGE, no. Now, maybe, because we seem to be making big drastic changes very quickly. Someone just needs to catch the right ear at the top to tell how much more sense it makes to combine them.
Sorry, dumb, new-person question. But what is a BC/BE physician?