Relative Quality of Navy GME

[emceenicholas]

If this information is found somewhere else, let me know where I can access it but please don't direct me to the Navy HPSP/GME "Wiki"; I defy anyone to find information about Navy GME beyond points of contact on that site. As the thread title suggests, I'm interested in learning how GME programs in the Navy (any specialty, any site, but I'm primarily interested in the Big 3 hospitals) stack up to their average civilian counterparts.

Not to make the thread too much about me, as I'd like other students to be able to use this information, but I am asking this question specifically because I have highly diverse interests (could easily see myself in a surgical or medical specialty/subspecialty), and I believe I have and will continue to achieve numbers that are competitive for most programs. Given the potentially large number of options, I'd really like to learn some information about the relative strengths and weaknesses of specific training programs in the Navy.

As you all know, students have a very limited exposure (by way of AT clerkships) to the many training programs the Navy has to offer, so there's little opportunity for a student to ascertain adequate information firsthand, and I feel the best way to fill in the gaps is by posing questions to the people in the know -- you guys.

A few disclaimers:

• I realize this is a really broad question. All I'm asking is for current or former residents to give a brief synopsis of the pros and cons of their GME experience.

• I realize that the desired comparison to "average" civilian programs is ambiguous, and perhaps in that way lacks meaning. No need to beat this to death, I'm a second year student looking for broad-stroke descriptions.

• I've read other threads where students/residents from top tier medical schools who hint at their excellent board results complain about how Navy GME doesn't hold a candle to MGH, UCSF, JH, Mayo, etc. Look at my profile -- I go to a DO school. By virtue of that fact alone I am not interested in comparing Navy GME to elite civilian programs. Even if others are interested in that specific comparison, the response is predictable and already exists in many other threads. Please feel free to criticize programs, but in my opinion the specific comparison of Navy GME to hyper-elite civilian GME is neither useful nor productive.

Thanks to all who contribute.

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[emceenicholas]

This topic has been covered over...and over...and over in this forum (see pros and cons in the sticky thread). There is also the "search" box for more info if you need it. Please don't "defy" me

Apologies, I'm relatively new to searching these forums. I looked in the pros and cons article you named, and there were hundreds of posts on almost as many topics. Many people angry about the Air Force, lots of debating on whether folks in the Army do GMOs or not, pre-health kids asking "what does HPSP mean?", people upset with military nurses, etc.

This is hardly the kind of information I was looking for. I did a "search this thread" and entered in "Navy GME" which effectively searched for "Navy" OR "GME", and I still found mostly off-topic information.

Please help me out, if you can point me to a thread that's dedicated to the quality of NAVY GME programs (I'm a Navy HPSP student so I'm not interested in AF or Army), please do.

I'm not interested in hearing about clipboard-carrying cows, lazy O-6 "physician"/admin types, the woes of AHLTA, etc, unless it is directly related to the quality of the training. Now, of course, the above mentioned complaints do affect the quality of training, but I'd like the information to be a little more focused if possible, as those complaints probably affect Navy GME training programs broadly.

And honestly, I'm not trying to be cute here. I did a fair amount of searching (~15 min) and couldn't find the kind of on-target information that would be helpful in discriminating between different training programs. If you can help me find what I'm looking for, I'd really appreciate it.

 

[IgD]

...As the thread title suggests, I'm interested in learning how GME programs in the Navy (any specialty, any site, but I'm primarily interested in the Big 3 hospitals) stack up to their average civilian counterparts...

I'm not sure that is an answerable question. I'm not sure you could even compare civilian programs objectively. How would you compare the Internal Medicine program at Harvard compared to the one at Washington Hospital Center in Washington, D.C.?

Every program civilian or military has good and bad aspects. What is important is that all the military programs are accredited.

Generally speaking I think the fundamental problem with military programs is the main patient population is healthy. Whether you do IM, surgery or psych you aren't going to see many homeless patients with chronic substance abuse, HIV and other medical problems. Working with the sickest of the sick makes you a more well rounded physician.

I think there are good aspects to the Navy programs too.

Can you ask a more specific question?

 

[emceenicholas]

I'm not sure that is an answerable question. I'm not sure you could even compare civilian programs objectively. How would you compare the Internal Medicine program at Harvard compared to the one at Washington Hospital Center in Washington, D.C.?

Every program civilian or military has good and bad aspects. What is important is that all the military programs are accredited.

Generally speaking I think the fundamental problem with military programs is the main patient population is healthy. Whether you do IM, surgery or psych you aren't going to see many homeless patients with chronic substance abuse, HIV and other medical problems. Working with the sickest of the sick makes you a more well rounded physician.

I think there are good aspects to the Navy programs too.

Can you ask a more specific question?

IgD, so glad you replied. I'm a longtime lurker and have always enjoyed your perspective. Of course, in your infinite sagacity you have exposed me -- I know absolutely nothing! This is actually the real problem at hand.

I guess what I was looking for was something like the following:

Balboa Radiology PGY-2: "TY at Balboa is _____, there were lots of opportunities to _____ but I found that I _____ was missing from my training. Radiology has been _____ so far, I see a lot of _____ and I feel the senior residents are/n't as well-trained as the average civilian judging by overall results on the ABR exam."

NMCP Orthopaedics PGY-3: "I do/n't feel good about my training so far here. I have a lot of experience doing ____ but I feel didactics are weak" etc.

I'm basically looking for any and all information that a medical student would want to know about a training program so that he might reasonably discern between the overall quality of the programs he applies to versus "other" training programs. So far in my experience at medical school, it seems most medical students are primarily concerned with brand-name recognition in their residency hunts. However, I've been advised by several practicing physicians on useful information in selecting hospitals for clinical clerkships. For example, one doc said the best rotation he ever had was a general surgery clerkship at a small, community hospital in rural Pennsylvania. The program had recently lost its general surgery residency, but the teaching faculty were still present. He said there was loads of excellent one-on-one training. If there is similar subjective information that residents can provide, this is the kind of thing I'm looking for.

Perhaps you can help me rephrase my question to return more meaningful responses? How did you go about evaluating military training programs and sites? How would you do it differently if you had it to do over again? I realize there are problems with the military match, and that I don't have as much of a say in the matter as civilians do, but I'd still like to have a goal.

 

[Ziehl-Neelsen]

All of the questions that you ask are entirely dependent on the medical specialty. My wife and I both consider our respective military residencies to be excellent, but the reasons for that are completely different. You will receive no meaningful input on the quality of individual residencies until you decide what specialty you wish to pursue and what traits make training in the specialty "good" or "bad".

Beyond that, only generalities apply to your questions. Good residencies are ones that offer autonomy while also having appropriate oversight. They are filled with pleasant attendings that enjoy teaching and have research opportunities should they be wanted. They are filled with pleasant fellow residents who do not shirk their work and will take up for you as a member of "the team". They have numeous and varied patients that represent the common human maladies and the complex as to provide experiences in managing all types of disease.

But you already knew this stuff didn't you...

 

[emceenicholas]

All of the questions that you ask are entirely dependent on the medical specialty.

I realize this, and it is why I opened up the floor for individuals such as yourself to offer whatever you're willing to share. I don't need you to give me an overall picture of Navy GME. What I'm hoping is that you might tell me a little bit about how and why you feel the way you do about your site and specialty.

My wife and I both consider our respective military residencies to be excellent, but the reasons for that are completely different.

Great! Please comment! I would love to hear the many reasons you and your wife are happy with your programs.

You will receive no meaningful input on the quality of individual residencies until you decide what specialty you wish to pursue and what traits make training in the specialty "good" or "bad".

Ok, then for the sake of discussion I am interested in hearing about the residency program you are a part of at the site where you currently practice.

But you already knew this stuff didn't you...

Yes.

 

[SeminoleFan3]

Sorry to get all paranoid on you, but i think you're going to have a hard time getting people to throw out the info you want.

For one, Navy programs are very small. If someone identifies their program and site, it's probably pretty easy for someone to figure out who they are. And if you were going to post something negative about said program, you obviously don't want that happening.

Once you figure out a specialty or two to pursue, the forum might be of more help to you (when you can identify people in that field and PM them). However, given that you really have no idea what you want to do yet, it doesn't really matter right now.

 

[emceenicholas]

Sorry to get all paranoid on you, but i think you're going to have a hard time getting people to throw out the info you want.

For one, Navy programs are very small. If someone identifies their program and site, it's probably pretty easy for someone to figure out who they are. And if you were going to post something negative about said program, you obviously don't want that happening.

Once you figure out a specialty or two to pursue, the forum might be of more help to you (when you can identify people in that field and PM them). However, given that you really have no idea what you want to do yet, it doesn't really matter right now.

Ok, I'm starting to get it. Feeling a bit naive here... I wasn't giving credit to the small size of the community and the harm one might suffer if identified after criticizing a program.

I sort of feel like one shouldn't be hanged for saying he thinks that his program could incorporate more X, or needs to work on the quality of Y... but I guess that's an idealistic viewpoint.

I still feel a bit like I'm trying to pull myself up from my bootstraps, though. Like I said before, I would feel comfortable in the ER/OR/clinic/etc, and one of the main determinants, for me, at least, in trying to pinpoint what I'd like to specialize in would be the overall quality/satisfaction reported by residents.

I guess I'll have to wait till I get a few rotations (and a board score) under my belt to start asking more directed questions, but by that time I'll have to move very quickly.

Thanks to SeminoleFan3 for the honest assessment, and thanks to rotatores for the peds insight.

Of course, if anyone is willing to talk about their training experiences, please PM me. My interests at this point are shared about equally between general surgery, EM, IM, gas, and rads. I'll be spending the 2nd two years of medical school in San Diego so I'll likely do my AT clerkships there, unless, of course, some kind resident discretely tells me that program X at portsmouth/bethesda is > program X at balboa.

 

[IlDestriero]

Read my posts in here:
http://forums.studentdoctor.net/showthread.php?t=705756
also read this:
http://forums.studentdoctor.net/showthread.php?t=701140&highlight=ildestriero
There are many more.

Some is Navy specific, some is not.
I don't know what it is like to train at an "average program", but I know that NMCSD is not where you want to train if you want to be a superstar.

 

[IlDestriero]

It's probably also worth noting that most of the military fan boys/girls that post all the love, and say threads like mine are not a true representation of military GME are either military residents/interns with little perspective or medical students, with no perspective at all. You don't find people that trained at civilian programs who went on to be staff at the big military training hospitals telling you how strong, or even average, the programs are. And there are plenty of staff and former staff physicians reading/posting here.
Are they accredited? Yes. Don't you hope for something more than the minimum?

 

[emceenicholas]

It's probably also worth noting that most of the military fan boys/girls that post all the love, and say threads like mine are not a true representation of military GME are either military residents/interns with little perspective or medical students, with no perspective at all. You don't find people that trained at civilian programs who went on to be staff at the big military training hospitals telling you how strong, or even average, the programs are. And there are plenty of staff and former staff physicians reading/posting here.
Are they accredited? Yes. Don't you hope for something more than the minimum?

Thanks for the info on NMCSD anesthesia. It's extremely helpful because anes is an idea I find myself coming back to repeatedly. I admire your tenacious pursuit of the best from yourself and from your training. I'm not too far along in my medical education but for what it's worth, with 3 semesters down I can say with reasonable certainty that I'm in the top 10% of my class. But I'm at a DO program, so there is a distinct possibility that my step 1 won't be 99th %tile. So while I may not have the same license you do to demand GME training of a caliber equivalent to a top-ranked university, I still want the best from myself and from my training program.

This is precisely the reason why I started the thread: I want to know what's good in Navy GME. I've heard the lack of training in general surgery is tragic, and I'm now aware of your experience with anesthesia. I didn't want to phrase it that way because I'm a medical student, not an attending, not a resident, not even an intern. I didn't want to offend anyone, and I wanted to keep the discussion open without bashing someone's program based on anecdotes I read on the internet.

Do you see where I'm coming from? I'm looking to maximize myself and my training, and I think I'm flexible enough to thrive in any of the specialties. So, naturally I'd like to know which programs currently have the best reputation and the strongest clinical training.

What would you do in my shoes? Any insight is greatly appreciated.

 

[BOHICA-FIGMO]

Okay. I will try to provide a more realistic and less cynical opinion than some like Il Destro. Keep in mind, people's expectations are different. After reading some of Il Destro's posts I suspect he is a guy who was wanting Mass General/Johns Hopkins/UCSF kind of experience. And he is right in one respect: if you are in the top 1% in medical school and want a top 1% residency, military programs are not for you. Take your 4.0 GPA and 260 board scores and go elsewhere. On the other hand, the military WILL give you solid training in many programs. I will speak to IM and anesthesia, and ER because that is where my interests and experience lie.

I did an IM internship at one of the big three. The deficits as I saw them were: (1) ICU acuity and census were relatively low (2) getting adequate number of procedures (e.g., central lines, a-lines, etc.) was difficult (3) You don't see many stroke cases (4) you don't quite get the full spectrum ID experience if you are looking for lots of homeless HIV patient with weird presentations. (5) ward census is WIDELY variable. Some days, a team might have 20 patients on other days you might have 3. I actually "won the game" once during internship.

Otherwise, I would say it probably compares reasonably well to many civilian programs. The attendings are a good mix of experience and all are very knowlegable, and some are EXCELLENT teachers.

Anesthesia. The peds experience is probably not quite as bad as Il Destro makes it out to be. During the months I was on, we had plenty of peds cases and at least two anesthesiologists specializing in pediatric anesthesia. deficits here (1)cardiac. Only 2-3 CABG per week makes getting those cases kinda tough. (2)trauma. None. All of this must be obtained outservice through agreements with the local Level 1. (3) vascular. Didn't see too many bi-fems, fem pops, fem-fems, etc. Pluses, lots of OB, fair amount of regional anesthesia, and good mix of ENT, Neuro, gen surg, gyn surg, ortho, etc.

EM. Probably not the strongest of the military residencies relative to civilian counterparts. Statistics show Navy ED have about 1/2 the admit percentage and about 1/2 the ICU admit rate of most civilian ED. Volume is HUGE; comparable to any civilian ED but acuity is LOW. Many of the statistics cited include fast track visits. Even a lot of stuff that makes it back to the main ED is pretty low acuity. No trauma. Very few chances for conscious sedation or airway management. MANY outservice rotations (8-9 months I think). Pluses are some of the best didactic programs I have seen in any specialty, but unfortunately they need it to make up for the lack of acuity in day to day experience.

Anyway, that is my $0.02. I tried to present as accurate a presentation as I could of the only 3 specialties I feel comfortable talking about. As always, I would get multiple opinions and don't put too much weight in any one person's opinions. Good luck!

 

[emceenicholas]

Okay. I will try to provide a more realistic and less cynical opinion than some like Il Destro. Keep in mind, people's expectations are different. After reading some of Il Destro's posts I suspect he is a guy who was wanting Mass General/Johns Hopkins/UCSF kind of experience. And he is right in one respect: if you are in the top 1% in medical school and want a top 1% residency, military programs are not for you. Take your 4.0 GPA and 260 board scores and go elsewhere. On the other hand, the military WILL give you solid training in many programs. I will speak to IM and anesthesia, and ER because that is where my interests and experience lie.

I did an IM internship at one of the big three. The deficits as I saw them were: (1) ICU acuity and census were relatively low (2) getting adequate number of procedures (e.g., central lines, a-lines, etc.) was difficult (3) You don't see many stroke cases (4) you don't quite get the full spectrum ID experience if you are looking for lots of homeless HIV patient with weird presentations. (5) ward census is WIDELY variable. Some days, a team might have 20 patients on other days you might have 3. I actually "won the game" once during internship.

Otherwise, I would say it probably compares reasonably well to many civilian programs. The attendings are a good mix of experience and all are very knowlegable, and some are EXCELLENT teachers.

Anesthesia. The peds experience is probably not quite as bad as Il Destro makes it out to be. During the months I was on, we had plenty of peds cases and at least two anesthesiologists specializing in pediatric anesthesia. deficits here (1)cardiac. Only 2-3 CABG per week makes getting those cases kinda tough. (2)trauma. None. All of this must be obtained outservice through agreements with the local Level 1. (3) vascular. Didn't see too many bi-fems, fem pops, fem-fems, etc. Pluses, lots of OB, fair amount of regional anesthesia, and good mix of ENT, Neuro, gen surg, gyn surg, ortho, etc.

EM. Probably not the strongest of the military residencies relative to civilian counterparts. Statistics show Navy ED have about 1/2 the admit percentage and about 1/2 the ICU admit rate of most civilian ED. Volume is HUGE; comparable to any civilian ED but acuity is LOW. Many of the statistics cited include fast track visits. Even a lot of stuff that makes it back to the main ED is pretty low acuity. No trauma. Very few chances for conscious sedation or airway management. MANY outservice rotations (8-9 months I think). Pluses are some of the best didactic programs I have seen in any specialty, but unfortunately they need it to make up for the lack of acuity in day to day experience.

Anyway, that is my $0.02. I tried to present as accurate a presentation as I could of the only 3 specialties I feel comfortable talking about. As always, I would get multiple opinions and don't put too much weight in any one person's opinions. Good luck!

Thank you, this is right on the money. Exactly the kind of overview I was looking for. Hopefully this will encourage others to share.

Much appreciated.

 

[IlDestriero]

After reading some of Il Destro's posts I suspect he is a guy who was wanting Mass General/Johns Hopkins/UCSF kind of experience.

I had the benefit of that experience to compare with NMCSD, so I know what residents at NMCSD are missing out on.

The deficits as I saw them were: (1) ICU acuity and census were relatively low (2) getting adequate number of procedures (e.g., central lines, a-lines, etc.) was difficult (3) You don't see many stroke cases (4) you don't quite get the full spectrum ID experience if you are looking for lots of homeless HIV patient with weird presentations. (5) ward census is WIDELY variable. Some days, a team might have 20 patients on other days you might have 3. I actually "won the game" once during internship.

Anesthesia. The peds experience is probably not quite as bad as Il Destro makes it out to be. During the months I was on, (you spent months in anesthesia as an intern? Interesting.) we had plenty of peds cases and at least two anesthesiologists specializing in pediatric anesthesia. deficits here (1)cardiac. Only 2-3 CABG per week makes getting those cases kinda tough. (2)trauma. None. All of this must be obtained outservice through agreements with the local Level 1. (3) vascular. Didn't see too many bi-fems, fem pops, fem-fems, etc. Pluses, lots of OB, fair amount of regional anesthesia, and good mix of ENT, Neuro, gen surg, gyn surg, ortho, etc.

EM. Probably not the strongest of the military residencies relative to civilian counterparts. Statistics show Navy ED have about 1/2 the admit percentage and about 1/2 the ICU admit rate of most civilian ED. Volume is HUGE; comparable to any civilian ED but acuity is LOW.

The complex cases are what separates the men from the boys. High volume healthy patients are of limited utility. Repeated exposure to the full range of complex pathology is critical to success in anesthesia. Having sick people go south, providing anesthesia for technically complex cases, detecting and correcting problems, etc is part of quality comprehensive training. No trauma, no transplant, limited vascular, cardiac, neuro, complex peds, etc is hugely detrimental to training in anesthesia. That is where you get exposure to complications and learn how to skillfully handle emergencies. Relying on going to other facilities for 4 weeks for exposure to the above, with surgeons and attendings that don't know you and have limited investment in your success is not an answer. Having to try to make up for multiple significant weaknesses in your program should raise some giant red flags. This training is your future. Reading all about things, and having nice morning lectures ain't the same. After a few years at the "outpatient training center", you're alone on call in your PP paradise when the ruptured AAA comes through the door... oh boy. Get to work tiger.
Regional may be better now, I wouldn't know. It was dominated by the S/CRNAs when I was there. The residents had very limited block experience, and if it was not for the pain clinic, they would have no way of making their minimum block numbers. All the staff were part of this problem. I don't really like regional, so I wasn't doing any more than necessary. As I said in another post, the staff were all talented and friendly, supportive of each other and the program, but few benefited from civilian training, none had fellowships in anything (excluding pain and peds). That's a military wide problem that they seem to be trying to fix. When I was there, not one cardiac anesthesiologist had CV training, and none were TEE certified. OJT can only get you so far, especially when you are perfecting your skills while simultaneously training others.
Your post actually supports mine quite well WRT problems at NMCSD. There were plenty of relatively healthy patients and healthy peds there, just very limited complex pts. It's not uncommon to have limited complex peds exposure during a residency with an affiliated Children's Hospital. It is uncommon to have a 1/2 empty ICU (that is also 1/2 the size of a similar sized hospital) and limited complex pathology going to the OR. They did have my personal favorite, complex OB. Complex OB with staff that had limited complex OB training, and personality disorders. God forbid I wanted to put in a swan, or even an aline, they had a hissy fit. Like they really care what we do. It's not my fault they don't understand why I want a swan in their obese, edematous, severe preeclamptic patient with pulmonary edema. But I digress.

I think my eval was quite realistic, particularly in comparison to what one can expect from a top tier training program, though not the top 1% but perhaps the top 20 or 25% of programs. What should you do if you're an average DO student? Average MD? I couldn't say, other than go FAP vs HPSP, or try to get a deferral and get the best civilian training you can find.
If you are HPSP, kill your internship rotations, go GMO, be a superstar, and leverage your unique experience to get into top notch residency.
BTW, if you are Mr. HPSP great med school 4.0 240, you can ask for civilian training, but you're probably not going to get it. Most don't. You will face GMO vs. Substandard training. That's a tough choice to face, delaying your career vs mediocrity.

 

[BenHoganFan]

I completed a Radiology Residency and my fellow residents consistently performed in the upper quartiles of inservice exams. We consistently passed physics and written boards. We were better prepared for oral boards than a majority of our counterparts. Given the well rounded training, we will and do perform well above the civilian counterparts in ALL modalities.

Residency is what individuals make their training out to be. People who excel will do so in any setting, civilian or military.

 

[IlDestriero]

By the way, here's a recent thread about Army surgical residency quality. People on the board frequently say it's the Mil GME exception. Guess again. But what would he know? He's only a current Army surgical resident.
http://forums.studentdoctor.net/showthread.php?t=745940
PS residency is not simply what you make of it. Reading and passing tests doesn't make up for marginal clinical experience. Congrats, you passed the boards, too bad you're slow, clumsy and nervous. It should only take a couple years to make up for that. Maybe it's not an issue in Rads. It is in the surgical realm.

 

[Coastie]

QFT. Avoid military anesthesia if you can get a decent civi program.

I don't think there are any military GME programs that would be in the top 10% of any civi field..maybe not even top 20%..most are mediocre to average.

The complex cases are what separates the men from the boys. High volume healthy patients are of limited utility. Repeated exposure to the full range of complex pathology is critical to success in anesthesia. Having sick people go south, providing anesthesia for technically complex cases, detecting and correcting problems, etc is part of quality comprehensive training. No trauma, no transplant, limited vascular, cardiac, neuro, complex peds, etc is hugely detrimental to training in anesthesia. That is where you get exposure to complications and learn how to skillfully handle emergencies. Relying on going to other facilities for 4 weeks for exposure to the above, with surgeons and attendings that don't know you and have limited investment in your success is not an answer. Having to try to make up for multiple significant weaknesses in your program should raise some giant red flags. This training is your future. Reading all about things, and having nice morning lectures ain't the same. After a few years at the "outpatient training center", you're alone on call in your PP paradise when the ruptured AAA comes through the door... oh boy. Get to work tiger.
Regional may be better now, I wouldn't know. It was dominated by the S/CRNAs when I was there. The residents had very limited block experience, and if it was not for the pain clinic, they would have no way of making their minimum block numbers. All the staff were part of this problem. I don't really like regional, so I wasn't doing any more than necessary. As I said in another post, the staff were all talented and friendly, supportive of each other and the program, but few benefited from civilian training, none had fellowships in anything (excluding pain and peds). That's a military wide problem that they seem to be trying to fix. When I was there, not one cardiac anesthesiologist had CV training, and none were TEE certified. OJT can only get you so far, especially when you are perfecting your skills while simultaneously training others.
Your post actually supports mine quite well WRT problems at NMCSD. There were plenty of relatively healthy patients and healthy peds there, just very limited complex pts. It's not uncommon to have limited complex peds exposure during a residency with an affiliated Children's Hospital. It is uncommon to have a 1/2 empty ICU (that is also 1/2 the size of a similar sized hospital) and limited complex pathology going to the OR. They did have my personal favorite, complex OB. Complex OB with staff that had limited complex OB training, and personality disorders. God forbid I wanted to put in a swan, or even an aline, they had a hissy fit. Like they really care what we do. It's not my fault they don't understand why I want a swan in their obese, edematous, severe preeclamptic patient with pulmonary edema. But I digress.

I think my eval was quite realistic, particularly in comparison to what one can expect from a top tier training program, though not the top 1% but perhaps the top 20 or 25% of programs. What should you do if you're an average DO student? Average MD? I couldn't say, other than go FAP vs HPSP, or try to get a deferral and get the best civilian training you can find.
If you are HPSP, kill your internship rotations, go GMO, be a superstar, and leverage your unique experience to get into top notch residency.
BTW, if you are Mr. HPSP great med school 4.0 240, you can ask for civilian training, but you're probably not going to get it. Most don't. You will face GMO vs. Substandard training. That's a tough choice to face, delaying your career vs mediocrity.