Second Residency through the Military - Possible?

[Leukocyte]

Hi guys,

I am a cilivian, who is only few months away from finishing his PGY-3 year in Family Medicine. I have no military experience, but I am very interested in joining the military (any division, but preferably the Navy or Air Force). I am also interested in doing a second residency in a non-clinical specialty.

My questions are:

If I join the military (Army/Navy/or Air Force) as a new active duty officer in Family Medicine, can I later apply for a second residency in say, Pathology or Radiology?

I am a US Citizen who is a foreign medical graduate. Can I still apply for a second resideny if I am an active duty officer in Family Medicine? Do you have to be a graduate of a US school to apply for a military residency, even though you are an active duty officer?

If I joined as a new active duty officer in Family Medicine, for how long do I have to wait (work in my specialty - Family Medicine) before I can apply for a second residency in an another specialty?

Thank you very much for helping me answer some of these questions. I am interested in working in the military primarily because I like/want to serve my country. Also the benefits (student loan repayment, ect. ) seem to be wonderful. I am not sure how the pay is (compared to the civilian counterpart), but I think that the experience, the benefits, and privilege of serving this great country makes joining the military sound like a sweet deal, at least for me.

Again thank you very much for your help.

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[NavyFP]

Hi guys,

I am a cilivian, who is only few months away from finishing his PGY-3 year in Family Medicine. I have no military experience, but I am very interested in joining the military (any division, but preferably the Navy or Air Force). I am also interested in doing a second residency in a non-clinical specialty.

My questions are:

If I join the military (Army/Navy/or Air Force) as a new active duty officer in Family Medicine, can I later apply for a second residency in say, Pathology or Radiology?

I am a US Citizen who is a foreign medical graduate. Can I still apply for a second resideny if I am an active duty officer in Family Medicine? Do you have to be a graduate of a US school to apply for a military residency, even though you are an active duty officer?

If I joined as a new active duty officer in Family Medicine, for how long do I have to wait (work in my specialty - Family Medicine) before I can apply for a second residency in an another specialty?

Thank you very much for helping me answer some of these questions. I am interested in working in the military primarily because I like/want to serve my country. Also the benefits (student loan repayment, ect. ) seem to be wonderful. I am not sure how the pay is (compared to the civilian counterpart), but I think that the experience, the benefits, and privilege of serving this great country makes joining the military sound like a sweet deal, at least for me.

Again thank you very much for your help.

1) Yes. Typically after a utilization tour (2-3 years) as an FP, you can apply.

2) If you are an FMG and licensed in the US, you can join up. Makes no difference once you are in. (your grades and board scores do though.)

 

[Leukocyte]

Thanks NavyFP....

I heard, from medical students who where going through the military match, that the military match actually favors higher ranking officers...meaning that the military match actually favors those who have done a residency already, and are applying for a second residency over the MS-4s who are applying for their first residency. This is because the ones who are applying for a second residency are for some reason "higher ranking", is that true?

Also, as a FM trained physician, do I have to work a "typical FM job"? Meaning, do I have to be in the typical inpatient/outpatient setting. Can I do ONLY Urgent Care for example? Or Can I only do outpatient?

Thank you again.

 

[IgD]

I heard, from medical students who where going through the military match, that the military match actually favors higher ranking officers...meaning that the military match actually favors those who have done a residency already, and are applying for a second residency over the MS-4s who are applying for their first residency. This is because the ones who are applying for a second residency are for some reason "higher ranking", is that true?

I think the opposite is probably true. My sense is the military medicine selection board will look at an applicant who wants to do a second residency with extreme scrutiny. Like anyone else, they will wonder why an applicant wants to change specialties. They will also want to know what mitigating circumstances are present that would justify the government the extra expense of retraining someone.

I think like NavyFP implied you've got to be in a position where the military "owes" you training like after a difficult utilization tour, deployment, etc. The other thing to consider is your board scores and academic performance. If an applicant has a mediocre record they might not get selected regardless of how many GMO tours they have done...

 

[J-Rad]

You most likely will have to do what best meets the needs of your resepctive service. "Urgent care"comprises quite a bit of all primary care specialties, but UCC as you probably imagine it is the fast track at the ED, manned by PAs and NPs. I think the thing you would probably enjoy the most would be some flight medicine slot in the AF or USN (or UMO in the USN) given that it generally narrows your patient population down to a generally healthy group and would at least bring a novelty to your career (I've seen your previous posts about your discontent in FM).

One huge word of caution: if you find FM soul-crushing, just remember (straight) FM in the military is FM+multiple layers of military-specific bureaucracy and training minutiae with what is widely considered one of the worst EMRs to drag you down while you strive for the next metric (but you'll get a nice bullet on your performance report if you come up with some novel "workaround" to AHLTA's myriad inefficiencies and frustrations). I wouldn't sign up thinking that this is the Great Escape for you.

 

[Leukocyte]

Thanks IgD, J-Rad, and NavyFP for your wonderful input.

I think the thing you would probably enjoy the most would be some flight medicine slot in the AF or USN (or UMO in the USN) given that it generally narrows your patient population down to a generally healthy group and would at least bring a novelty to your career (I've seen your previous posts about your discontent in FM).

You are ABSOLUTELY right! I would sacrifice my left testicle (and probably the right one too if my fiancee does not mind) to get a job doing Flight Medicine / Aerospace Medicine only. I would not even need to do a second residency if I end up liking it. Did I mention that I LOVE planes/jets/aviation. I mean If I had the choice between sleeping with a hot chic or flying (even working next to) a plane/jet...I will abolutely go for the plane. Call me crazy, or a guy with a "jet fetish"....I love jets and aviation.

Coming fresh out of a Family Medicine residency, can I just go up to a recruiter and tell him I want to join the AF/Navy with the condition that I work only in Flight Medicine? Sounds too good to be true. As a FP with no prior training in Aviation Medicine, will the military train me to work as a full time Flight Medicine doctor? Or do I need to have had formal training/ residency in Aerospace Medicine BEFORE joining the military to work as a full time flight medicine doctor?

Thank you all again.

 

[AF M4]

Thanks IgD, J-Rad, and NavyFP for your wonderful input.



You are ABSOLUTELY right! I would sacrifice my left testicle (and probably the right one too if my fiancee does not mind) to get a job doing Flight Medicine / Aerospace Medicine only. I would not even need to do a second residency if I end up liking it. Did I mention that I LOVE planes/jets/aviation. I mean If I had the choice between sleeping with a hot chic or flying (even working next to) a plane/jet...I will abolutely go for the plane. Call me crazy, or a guy with a "jet fetish"....I love jets and aviation.

Coming fresh out of a Family Medicine residency, can I just go up to a recruiter and tell him I want to join the AF/Navy with the condition that I work only in Flight Medicine? Sounds too good to be true. As a FP with no prior training in Aviation Medicine, will the military train me to work as a full time Flight Medicine doctor? Or do I need to have had formal training/ residency in Aerospace Medicine BEFORE joining the military to work as a full time flight medicine doctor?

Thank you all again.

Ok, the jet fetish thing is a little weird. Don't repeat that. You always take the hot chick. A better solution is that you take the girl into or on top of the plane, and then you get both. Also never volunteer your balls for sacrifice.

Hells yes you can do this. There might be some hemming and hawwing from the recruiter, but this is the kind of thing you'll want to have him getting you some further contacts to speak with. I can't speak for the Navy, but if you get the flight medicine people down at Randolph AFB in San Antonio on the phone - AFPC (AF Personnel Center) - and tell them that you're a board-certified FP doc who will only join the AF under the condition that you'll be a flight doc....well, the next sound you hear over the phone might be one of them falling out of their chair due to paroxysms of delight.

No you don't need a residency in Aerospace Med. Lol. In the AF you do a six week course down in San Antonio, then you get your wings. I think the Navy is a much more extensive course where they actually have you do a lot of flying. So you might like that more.

One more word: get your flight physical done - and approved! - BEFORE you sign on the dotted line. That way you don't get screwed into being stuck in some FP clinic somewhere.

 

[J-Rad]

Agree with AF M4. The USAF has been so desperate for flight docs that they actually backtracked on their goal of residency trained docs only (they had gotten much further along with this than the Navy) and were forcing GMO FS tours for those that matched only PGY-1 (as opposed to allowing them to reapply to the JSGME during their PGY-1. I'm not sure where that policy stands right now, but I suspect that it is still in effect in some form). In part to try to get BE/BC docs out as flight surgeons, each year there are an allotted batch of FM residency-->flight medicine tracks in the AF match (~eight this year). If you talk to someone who actually knows what they're talking about, I agree that they would salivate over a BE/BC doc requesting flight medicine. I think in one of your past posts I might have mentioned prev med/occ med as a possible career. If you end up loving flight med, the RAM may be what you are looking for down the career line: 1 yr MPH (with a certain #reserved for high-cost schools) then (further) training in aerospace medicine and either a prev med or occ med track. Doing the RAM, while getting you a second residency also puts you on a less clinical track, in general (often it's a preening for leadership positions). Having read a lot of your past posts I really think, if after weighing the +/- of milmed, this would be the only avenue in which you could find some degree of happiness in milmed (I think you will compound your misery in FM as someone who already dislikes the field).
As an aside: I always try to be upfront about the +/- of milmed and the AF in particular. I will say, that when I did the intro to aerospace medicine course at Brooks (this was a summer tour for those on HPSP) all the flight surgeons (RAM-trained and those that were just flight med after residency*) seemed genuinely happy doing the job. Multiple had trained in other fields (the commander at the time was trained in peds, a psychiatrist-by-training guy spoke) and found great satisfaction in the field.

*Now the glaringly obvious: I don't think they trucked in too many people who were actively doing a GMO after doing PGY-1 (though some of the RAM trained folk had gone down this path, initially). These, I would think, would be the most likely to be unhappy with the field as they've had a significant disruption to their training timeline. Also obvious: they weren't going to truck in people vocally unhappy with the job. But neither of these things would really affect your decisions. You have the residency training and are doing this by your own volition.

 

[Jet915]

I don't see a problem w/you joining to be a flight surgeon in either Air Force or Navy. I would caution that I wouldn't sign on the dotted line until you have talked to someone high up either at NAMI (for Navy) or the equivalent at the Air Force to ensure that they will accept you for training instead of just taking the word of a recruiter. The Navy is a longer (6 month) training period for flight surgery but you get actual cockpit front seat flight time. Since you are a jet guy, you probably would get a better shot at attaching to a fixed one billet w/the Air Force. I'm not sure how much they would let you fly, my assumption is it's the same as the Navy jets, if there are two seats, you will get to fly. In the Navy, there is a good chance you would be attached to a rotary wing billet as a first time flight doc but since you are already residency trained, who knows...

 

[NavyFP]

Thanks IgD, J-Rad, and NavyFP for your wonderful input.



You are ABSOLUTELY right! I would sacrifice my left testicle (and probably the right one too if my fiancee does not mind) to get a job doing Flight Medicine / Aerospace Medicine only. I would not even need to do a second residency if I end up liking it. Did I mention that I LOVE planes/jets/aviation. I mean If I had the choice between sleeping with a hot chic or flying (even working next to) a plane/jet...I will abolutely go for the plane. Call me crazy, or a guy with a "jet fetish"....I love jets and aviation.

Coming fresh out of a Family Medicine residency, can I just go up to a recruiter and tell him I want to join the AF/Navy with the condition that I work only in Flight Medicine? Sounds too good to be true. As a FP with no prior training in Aviation Medicine, will the military train me to work as a full time Flight Medicine doctor? Or do I need to have had formal training/ residency in Aerospace Medicine BEFORE joining the military to work as a full time flight medicine doctor?

Thank you all again.

If flying is something you love, you would be a great candidate RAM (Residency in Aerospace Medicine) It is half prev med/ half flight medicine and after you finish you go off to a Carrier as SMO (Senior Medical Officer). The best way to do that would be to tell the recruiter you want to join and be a flight surgeon. You should be welcomed with open arms and get plugged into the 6 month flight surgery training. Yes, you would learn to fly. From there you would go to a squadron as the doc. Since you are FP, you would likely take care of the families as well. (small town doc style) When the sqadron deploys, so do you. 2 years later, you could do the RAM and off to a Carrier.

 

[Gastrapathy]

FS slots are selected through the GMESB. I'm not sure there is a process to get one without applying. Best bet if you want Navy FS would be to contact the FS specialty leader directly (google NAMI and give 'em a call). You could do a FS tour, followed by a RAM and a post-RAM tour. Wouldn't be a bad gig if you don't mind spending >50% of your time away from home.

 

[pgg]

One huge word of caution: if you find FM soul-crushing, just remember (straight) FM in the military is FM+multiple layers of military-specific bureaucracy and training minutiae with what is widely considered one of the worst EMRs to drag you down while you strive for the next metric (but you'll get a nice bullet on your performance report if you come up with some novel "workaround" to AHLTA's myriad inefficiencies and frustrations). I wouldn't sign up thinking that this is the Great Escape for you.

Yeah, if you join up, seriously consider chasing an operational billet for the obligatory utilization tour. FP in a clinic or hospital looks like a grind.

I never considered FP and generally disliked most of my outpatient primary care time as a student and intern, but even I was (mostly) happy as a grunt infantry GMO. The Navy is working on transitioning most of those GMO billets to primary care residency trained, so if you asked for one, I'm sure they'd give it to you. It's not a bad life, for a couple years anyway, and you'll never get closer to the actual warfighters, which is a reward all its own.

If airplanes are your thing, and you can swing a flight surgery billet despite not being 'in' for the selection board, great. But consider going Navy, not Air Force - you'll get actual flight instruction and more flight time, believe it or not. (And the Air Force medical system has certain problems that haven't fully reached the Army or Navy ... yet.)

 

[DeadCactus]

This thread took a turn more toward flight surgery, but I was hoping to get some clarification on getting training in a second residency through the military.

What stops a BC/BE physician with no military obligation from being able to just enter directly into a PGY-2 slot in a residency?

 

[Gastrapathy]

This thread took a turn more toward flight surgery, but I was hoping to get some clarification on getting training in a second residency through the military.

What stops a BC/BE physician with no military obligation from being able to just enter directly into a PGY-2 slot in a residency?

Nothing stops them from applying but I think this is pretty rare . Anyone can apply to the GMESB, and if selected, go through the commissioning process.

The reality, though, is that most people doing second residencies are looking to do something competitive. There are lots of applicants for those slots and they are all known quantities who (at least in the Navy) have taken their turn as grist to the GMO mill.

As for PGY1 versus PGY2, that would depend on the prior internship and how much credit can be applied.

I know a couple of folks who joined as staff physicians, served a tour and then applied successfully for a second residency (an IM to pathology and an IM to EM). But that wasn't guaranteed.

 

[edmadison]

My understanding (and this is second hand) is that if you have already completed a residency then you cannot be higher on the OOM list than someone who has not completed a residency. However, there have been years in the army match where even some highly sought after specialties did not fill.

Ed

 

[DeadCactus]

Makes sense. So to get a little more specific about going through the military to get a second residency:

My primary interest right now is going into Peds EM. I'm still investigating the three training paths to that goal, but I'm curious about doing a military Peds residency after finishing a civilian EM program (given the limited number of slots in the three EM/Peds residency programs).

I realize there are a lot of issues relating to whether that's a wise choice but I'm just curious if it's even a realistic option.

Additionally, I'll have finished 6 to 8 years with the Guard by the time I reach that point. Between the prior service and wanting one of the less competitive specialties, is it reasonably likely to make it happen?

 

[Apollyon]

My primary interest right now is going into Peds EM. I'm still investigating the three training paths to that goal, but I'm curious about doing a military Peds residency after finishing a civilian EM program (given the limited number of slots in the three EM/Peds residency programs).

Just a note - doing EM, then doing peds doesn't make "Peds EM". People that do the 5 year EM/Peds combined programs are peds and EM board eligible, but not Peds EM BE. That goes back 30 years to some deals made to get EM recognized - ABIM and ACS and AAP, among others, all put the EM folks through the ringer to get their own ends.

If you are doing EM, and want to do peds EM, you can do the peds EM fellowship (half are 2 years for EM grads, and half are 3 years for EM just as for peds grads, for equality's sake).

 

[DeadCactus]

Just a note - doing EM, then doing peds doesn't make "Peds EM". People that do the 5 year EM/Peds combined programs are peds and EM board eligible, but not Peds EM BE. That goes back 30 years to some deals made to get EM recognized - ABIM and ACS and AAP, among others, all put the EM folks through the ringer to get their own ends.

If you are doing EM, and want to do peds EM, you can do the peds EM fellowship (half are 2 years for EM grads, and half are 3 years for EM just as for peds grads, for equality's sake).

I'm under the impression that (outside a few exceptions like CCM and Tox) fellowships in EM are more about a deeper pursuit of clinical/academic interest already within the scope of EM (versus opening the door for a new kind of practice like many IM fellowships do). Granted Peds ED's may have a hiring preference toward fellowship trained physicians - I'm not sure. The point being that either the EM/Ped route and EM/PedEM route both lead to being an EP whose developed an expertise in pediatric patients.

Either way, I'm not sure which route I want to aim for yet. I'm just curious about the options available through the military...

 

[notdeadyet]

I'm under the impression that (outside a few exceptions like CCM and Tox) fellowships in EM are more about a deeper pursuit of clinical/academic interest already within the scope of EM (versus opening the door for a new kind of practice like many IM fellowships do). Granted Peds ED's may have a hiring preference toward fellowship trained physicians - I'm not sure.

I think you'll find that most ED's try to staff folks with fellowship training in Peds EM, whether they come from a Pediatrics or EM background.

The EM folks have the benefit of being able to work anywhere in the ED, but don't hold a private practice. The Peds folks can't work in the ED outside of the Peds area, but can hold clinic/office/etc.

As an EM/Peds combined residency doc, you can get ED work and likely Peds ED work, but you won't be as attractive to the Peds ED as someone fellowship trained.

The point being that either the EM/Ped route and EM/PedEM route both lead to being an EP whose developed an expertise in pediatric patients.

I wouldn't equate the two. The Peds or EM + Peds EM fellowship person is the Pediatric EP specialist. They have two to three years of fellowship specifically in treating pediatric patients in the EM context.

The EM/Peds person is an EM doc who is cross-trained in pediatrics. The peds residency includes only have a few months of emergency pediatrics training and a whole lot of outpatient and chronic inpatient training that will make them excellent pediatricians but are not directly applicable to the ED.

I'm not sure I see the point of doing the EM/Peds residency unless you're also interested in practicing pure pediatrics. Otherwise, the fellowship is more suitable training. I'd talk with some Peds EPs at big locations to get their thoughts.

 

[DeadCactus]

Come on guys, you're killing me. There are multiple routes to a career involved in both EM and Pediatrics.

I understand that the Peds EM fellowship route benefits from a true expertise in a specific niche. This is actually the route I'm leaning toward for that a number of other reasons. But EM/Peds certification is another possible option and it benefits from trading the niche for an increased breadth in knowledge, practice setting, and future training options. I admit, it would have been more accurate if I had said I was interested in a career involving both Peds and EM rather than saying I'm interested in going into Peds EM.

But this is all tangential to the actual question I was asking. 😛