All Branch Topic (ABT) "Selling" FTOS to Civilian Programs

[scorp_doc]

Greetings,

BLUF: How have those who matched FTOS for civilian residencies leveraged/explained it to programs that are either familiar with it or not?

I'm an intern trained flight surgeon and was picked up for FTOS preselect position to start JUL2025 for ophthalmology residency. As far as I understand, this may be the first time this has occurred (at least in Navy ophtho) or is very rare. Civilian programs I have reached out to do not seem to know/understand what it is/means (although it's entirely possible they may not be interested in the deal, even after an explanation) even though FTOS positions are the norm for ophtho fellowship.

Different issue but it's also unfortunately an aggravating situation because ACGME changes require 39mo of ophtho at the same institution. All these programs match their PGY2's two years before via SF match...so there are essentially never PGY-2 positions unaccounted for, meaning I'll have to repeat intern year.

Looking forward to some advice. Thank you.

V/r,
SD

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[pgg]

The programs that are familiar with it tend to be very enthusiastic. A FTOS resident or fellow is a free body to do labor for them. Since the number of federally funded GME positions has been frozen for a while, a lot of programs are of a size where they don't get cash for every resident or fellow.


If you get a spot there through the match, there's nothing special about it. However, if you find a spot outside the match, the program may need to obtain a temporary complement increase.

I did a 1-year FTOS fellowship. The joint GME selection board result in Dec gave me a next-year start in July - unfortunately the match for that year was long finished, and 100% of the positions in the USA were full. I contacted some of the larger programs about an outside-the-match spot, interviewed at 3 in January. The program I went to gave me a conditional acceptance, pending the outcome of their request for a temporary complement increase to expand their accredited program size by 1 for that year. Huge program, lots of volume, not an issue. I think it was March or April when they gave me the final OK. They'd had military FTOS fellows many times before.


Hopefully you're a competitive applicant that they'd like to have even without the funding. Being free labor might get you the nod, all else being equal. It's probably a stretch to think a prestigious program will take any body, just because it comes with funding. But my experience, as one with competitive numbers, was that they will trip all over themselves to get you there.


For the programs that aren't familiar with the FTOS process, the most important things to emphasize to them are
1) you come fully funded, no cost to them or the institution
2) you are NOT at risk of being pulled from the program prior to completion for other military duties

 

[scorp_doc]

For the programs that aren't familiar with the FTOS process, the most important things to emphasize to them are
1) you come fully funded, no cost to them or the institution
2) you are NOT at risk of being pulled from the program prior to completion for other military duties

Thanks pgg, I have made sure to clearly emphasize the above without much enthusiastic response from programs. I'm thinking a contributing factor is that ophtho is competitive and rarely goes unmatched. I'm wondering if because of the "two-years-ahead" match timeline, the programs have already allocated funds for positions and so the money is less meaningful?

Overall competitive: numbers are very competitive, research is weaker point.

The joint GME selection board result in Dec gave me a next-year start in July - unfortunately the match for that year was long finished, and 100% of the positions in the USA were full.

Exact same position I was in. Results on 15DEC, preselect for JUL25 which shouldn't be a problem except that SF match is two years ahead. I emailed 10ish programs immediately and none were willing to work outside the match, expand their resident class nor had any advice besides keep an eye open for vacancies for PGY2 positions. The volume/numbers issue has been cited a few times.

 

[pgg]

Exact same position I was in. Results on 15DEC, preselect for JUL25 which shouldn't be a problem except that SF match is two years ahead. I emailed 10ish programs immediately and none were willing to work outside the match, expand their resident class nor had any advice besides keep an eye open for vacancies for PGY2 positions. The volume/numbers issue has been cited a few times.

Hard to believe the GMESB still hasn't figured out that the selects and preselects need to line up with the match process.

I know they're playing a prediction game based on "needs of the service" and when they want people coming out of the training pipeline.

 

[j4pac]

There is no selling it. This should be a great honor to the program. Period

 

[usma05]

When I did fellowship I was initially FTOS but later switched (after the match) to not being so due to family considerations.

I can't speak to optho, but in peds anesthesia which fills ~60%, programs were mostly interested in filling in the match and not outside even with FTOS. Part of it was not diluting the fellow experience and the other part was general lack of familiarity of the program given the irregularity it comes available (at least in my specialty) that the staff knew what it was and/or how to deal with it. There was also some agreement w/ fellowships and the match to not operate outside of it. That being said, once I opted not to do it and didn't want to leave the Army hanging I helped my replacement get an outside the spot match by communicating w/ programs and finding one that was big enough and still had a spot available. It takes a lot of networking to accomplish for sure. And some luck finding someone that will take the time to listen and work with you on it from an admin standpoint (both the military side and the civilian institution's admin).

 

[scorp_doc]

There is no selling it. This should be a great honor to the program. Period

Thanks....just not someting being considered by them I guess.

And some luck finding someone that will take the time to listen and work with you on it from an admin standpoint (both the military side and the civilian institution's admin)

This appears to be the problem...admin is such a God awful, thankless task...overworked, underpaid, high turnover, painfully low in expereince most of the time, I wouldnt be surprised if some of the program coordinators I contacted didnt even send it up the chain. Some of the "we dont have any spots and dont match outside the match, but encourage you to apply through the match" type responses came suspiciously quickly.

I think, as there has been some allusion to, that being the first or first few or first in a while to be offered something like this actually brings some drawbacks over just being offered an FTIS. I'm sure FTOS ortho or gen surg or anesthesia applicants are being literally fought over by civillian programs.

 

[Gastrapathy]

Do you have any ophtho mentors from med school? You could also talk to the AD PDs/SL and ask if they have any connections that could help you. You need someone to pick up the phone on your behalf.

 

[Gastrapathy]

There is no selling it. This should be a great honor to the program. Period

Why? It’s a one shot deal. Any work they do to make it happen will only add the one resident. None of them are actually paying resident salaries. They aren’t the ones taking resident call.

The major reason programs like FTOS types is that they tend to be good residents. He doesn’t have that legacy it sounds. Tricky.

 

[scorp_doc]

Do you have any ophtho mentors from med school? You could also talk to the AD PDs/SL and ask if they have any connections that could help you. You need someone to pick up the phone on your behalf.

Thanks. I'm in constant contact with navy ophtho specialty leader and WRNMMC Ophtho department. I have a few navy connections that went to civilian ophtho programs. I havent been in very consistent contact with the ophtho department from med school, I'll do that.