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.

 

[revaew]

I know this is a bit of an older thread, but I just got a FTOS position through the regular military match and was wondering how this ended up working out for you?

Also, did you just essentially "cold call" programs with your FTOS selection information?

Lastly, the Navy's GME website states:

If you are selected, consider asking the FTOS program manager at the Navy GME office for a Letter of Support. This will document the fact that you were selected for GME training and that the Navy will provide you financial support during your GME training. Your interviewing PD’s will be interested in knowing about this financial support.

Did you follow a process similar to this at all/did it help?

Thanks

 

[militaryPHYS]

Cold calling only required if you were given a slot for this year and have to scramble in to a spot instead of applying through normal match. If you are not scrambling just apply like normal and when you interview have your letter of support and let the program know you are FTOS funded. They really like it!

 

[revaew]

Cold calling only required if you were given a slot for this year and have to scramble in to a spot instead of applying through normal match. If you are not scrambling just apply like normal and when you interview have your letter of support and let the program know you are FTOS funded. They really like it!

I am applying for the normal civilian match for this year. If I have already completed all of my interviews, is the letter of support something I should send to programs as an update?

thanks

 

[militaryPHYS]

I am applying for the normal civilian match for this year. If I have already completed all of my interviews, is the letter of support something I should send to programs as an update?

thanks

Yes, I would let the PD’s know your updated status

 

[revaew]

Minor update on letting programs know about FTOS status: Most programs did not reply when updated. Most that did reply did not know what I was talking about. A couple, including my top 2 choices, thought I was trying to commit a match violation and I am pretty sure it hurt me in the match. So potential warning to those who read this later.

 

[afteranesthesia]

I trained civilian. I didn't really disclose anything to programs. Just went through it like a normal person. I didn't have funding, though. It was a completely civilian deferred spot. Programs mostly didn't really know I was military.

 

[pgg]

I trained civilian. I didn't really disclose anything to programs. Just went through it like a normal person. I didn't have funding, though. It was a completely civilian deferred spot. Programs mostly didn't really know I was military.

Civilian deferred is worlds different than FTOS.

FTOS are funded by the military - salary, benefits, malpractice, everything. Programs get a free body to do work. When they understand this gift, they fall over themselves to get the military FTOS body ... assuming the person is reasonably competitive for the program. (Top programs aren't going to take an obvious problem child or underperformer just because it's free labor.)

Civilian deferred is just an ordinary resident. They don't need to know and wouldn't care if you have a deferred military obligation.


When I did my FTOS fellowship 2016-2017, I got the slot from the GMESB in mid December of 2015. I sent out cold emails to programs the next day, and barely a month later I'd already interviewed and been offered positions at two programs (with a 3rd conditional offer based on their ability to get a temporary complement increase of 1). I was a good applicant but it was the free labor that opened the door.

 

[DeadCactus]

I would imagine FTOS works better outside of the match. Free additional body in the training program is great. In the match, you're just part of the normal class. Yes, you represent hundreds of thousands of dollars in funding but the siloing of funding/accounting in large institutions probably makes it so that program directors don't really care. It's not like they'll get the extra money to spend somewhere else and from the overall institution/GME perspective it's just a blip in the budget.

 

[usma05]

I would imagine FTOS works better outside of the match. Free additional body in the training program is great. In the match, you're just part of the normal class. Yes, you represent hundreds of thousands of dollars in funding but the siloing of funding/accounting in large institutions probably makes it so that program directors don't really care. It's not like they'll get the extra money to spend somewhere else and from the overall institution/GME perspective it's just a blip in the budget.

Yeah that's been my experience too. Was an FTOS fellow that ultimately went through civilian match (as fellowships mostly had an agreement to go in match only) and ultimately decided once matched to not accept FTOS and transition to USAR instead of continue with a new AD obligation. The place I matched didn't understand or really care. I think ultimately it specifically takes a fellowship program director having familiarity with what that person offering and an institution valuing or having a need for an extra body. Some don't like it because it can potentially dilute fellow experience. Not at a civilian center with a fellowship program I believe this even more now. It extends to FTOS residents too...I'm good friends with the AD Army consultant who is expanding anesthesia slots to FTOS. He asked me to see if my civilian institution was interested in free labor....the residency program director declined due to dilution of resident experience (and we"re a large tertiary care center).

 

[militaryPHYS]

You guys aren’t even talking apples to apples.

“Extra body”, “diluting the program” shouldn’t be associated with your typical FTOS applicant. Most go through the match like anybody else and get offered a spot or not. Their military service comes up during interviews and with it usually details of FTOS are discussed. Up to the program on how they feel about it.

Now, if you’re talking about applicants who have to scramble, the primary goal is to find a program who didn’t fill or lost an applicant during the process and want to fill the empty slot. I would highly discourage any FTOS scramblers from cold calling and asking programs to take you because you are free labor. You reach out to let them know that the military awarded you a list minute authorization to train during the academic year in question and ask if there are any remaining opportunities to train at the program. Let them come back to you with the option to be an extra body.

 

[usma05]

You guys aren’t even talking apples to apples.

“Extra body”, “diluting the program” shouldn’t be associated with your typical FTOS applicant. Most go through the match like anybody else and get offered a spot or not. Their military service comes up during interviews and with it usually details of FTOS are discussed. Up to the program on how they feel about it.

Now, if you’re talking about applicants who have to scramble, the primary goal is to find a program who didn’t fill or lost an applicant during the process and want to fill the empty slot. I would highly discourage any FTOS scramblers from cold calling and asking programs to take you because you are free labor. You reach out to let them know that the military awarded you a list minute authorization to train during the academic year in question and ask if there are any remaining opportunities to train at the program. Let them come back to you with the option to be an extra body.

So what you describe in your first paragraph was my exact experience...but I know plenty of FTOS applicants that are not that. They cold called, went outside the match, had to explain what they were to programs...and some programs had no interest because they didnt want an extra fellow for experience dilution reasons. The historical norm for the fellowship trained surgeons and anesthesiologists that I worked with was not going through the match process. All the advice i got when i applied to fellowship was from folks who went outside the match. And when I declined my FTOS spot, I helped my replacement match outside the match for the fellowship spot at a place that knew what he brought to the table (because they had offered me an outside the match spot as they had prior military trainees). So even though the norm was to go through the match, they still had mechanisms to operate outside it.

I know things are changing to push people through the match now, but this was 3 years ago so it's not that remote of an experience to know so many people that didn't go through the match for fellowship.

Also, the anesthesia resident availability at my civilian institution that the Army AD consultant for anesthesia asked me about was in the last 6 months. So, maybe not your reality but it is mine.

 

[militaryPHYS]

What is the difference of a spot in or out of the match? It sounds like you’re implying the better applicants match somehow outside the match?? Also. I’m not talking about dilution (being an extra body). I’m talking mainly about matching based on normal match process and beating out your peers in the normal process.

Ortho is all match except for what I described…persons who get a late approval to train that year and have to scramble. Ortho FTOS (active duty applicants) are typically very well respected based on knowledge base, discipline, attitude…not just because they are funded (but that is also a plus). I trained fellowship 2020 so applied/matched 2018/2019. All residents or junior staff I have worked with are typically going through match and well respected within applicant pool.

But you are right. Not your reality but it was mine. Thanks for letting us know how anesthesia does things. Are there typically a lot of last minute additions to the numbers so a bunch have to scramble? I think I still don’t understand.