Air Force State of Plastic Surg in Military for D.Os?

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Blunt Dissection

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I was wondering if any of our military physicians can chime in on the state of plastics in the military. I'll be a first year Air Force HPSP D.O student this upcoming Fall.

Being a D.O student, I'm aware that plastics is up there with being one of the specialities least friendly to D.Os - so I'm aware that my best bet at getting into plastics is going to be via General surg into a plastics fellowship. Even then it will be a struggle. I've looked at the 2014 HPERB and saw that there is one lone military plastics fellowship. Has there historically been any D.Os accepted to the military plastics fellowship or is it just as unfriendly to D.Os as civilian programs are?

And yes - you might be wondering why on earth if I was interested in a field like plastics would I consider taking HPSP. In the long run, if I make it to plastics, I'll be missing out on a sizable income, but military service has been something that I've been wanting to do for the longest time and what better than to use my future skills as a physician to help the men and women that protect our country? By the time my commitment is up, I'll be in my 40s - if I stay on for the 20 year retirement pension, I'll probably be near 50. My military uniform is something that I'll be proud of to have in my closet and will probably bring me more pride than having an Aston Martin in the garage...though I could probably still afford a used one :p

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Well, considering the military will not train Plastic Surgeons through Plastics residencies (because they want the option to be able to deploy you as a general surgeon), you would have to go through General Surgery residency and Plastics fellowship. I cannot attest to attitudes toward DOs from the Plastics fellowship, as I don't even know where it is, but there is very little anti-DO-bias in the military, and I have encountered DOs in nearly all medical and surgical specialties.

If you want to be a Plastic Surgeon and have soldiers/sailors/airmen/marines as patients, you can always be a civilian contractor, as we have civilians working in military hospitals across the country. Pay for a GS employee is going to be nowhere near private practice pay for that specialty, but will be much higher than active duty, and you would not owe time to the military, could leave when you wanted, and not deploy.

Additionally, do not count on the current pension system existing for much longer. The DoD has been trying to get rid of that for some time now, and in this era of cost-cutting, looks like they finally will.
 
Well, considering the military will not train Plastic Surgeons through Plastics residencies (because they want the option to be able to deploy you as a general surgeon), you would have to go through General Surgery residency and Plastics fellowship. I cannot attest to attitudes toward DOs from the Plastics fellowship, as I don't even know where it is, but there is very little anti-DO-bias in the military, and I have encountered DOs in nearly all medical and surgical specialties.

If you want to be a Plastic Surgeon and have soldiers/sailors/airmen/marines as patients, you can always be a civilian contractor, as we have civilians working in military hospitals across the country. Pay for a GS employee is going to be nowhere near private practice pay for that specialty, but will be much higher than active duty, and you would not owe time to the military, could leave when you wanted, and not deploy.

Additionally, do not count on the current pension system existing for much longer. The DoD has been trying to get rid of that for some time now, and in this era of cost-cutting, looks like they finally will.

I'm all for fiscal responsibility - but it's a huge shame that one of the first things that's always on the chopping block is taking care of the people that serve. It makes the meat grinder metaphor ever more true.

I've considered being a civilian contractor - a lot actually. It would make having a family significantly easier and my income would probably be 5 fold greater than it would be in the military. By the end of it, I'd probably be near a million dollars under my civilian classmates I'm sure.

But maybe the romance of wearing the uniform and the thought of service is what's kept me intrigued. It's kinda like the romance associated with wearing my white coat or when I donned my first pair of scrubs. Does this romance go away? I'm sure that's person specific, but I'd appreciate your thoughts on how you've felt working for the military.
 
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It's kinda like the romance associated with wearing my white coat or when I donned my first pair of scrubs. Does this romance go away? I'm sure that's person specific, but I'd appreciate your thoughts on how you've felt working for the military.

WTF, yes and I'll let the first 100 posts answer that
 
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WTF, yes and I'll let the first 100 posts answer that

I've read through the downsides that many milmed physicians on this forum talk about - the one most concerning to me is the inherent skill atrophy following residency. How real was this for you? As you're finishing up, do you feel that because of milmed, you're going into the civilian world a worst physician than had you just been civ from the beginning?
 
I'm all for fiscal responsibility - but it's a huge shame that one of the first things that's always on the chopping block is taking care of the people that serve. It makes the meat grinder metaphor ever more true.

I've considered being a civilian contractor - a lot actually. It would make having a family significantly easier and my income would probably be 5 fold greater than it would be in the military. By the end of it, I'd probably be near a million dollars under my civilian classmates I'm sure.

But maybe the romance of wearing the uniform and the thought of service is what's kept me intrigued. It's kinda like the romance associated with wearing my white coat or when I donned my first pair of scrubs. Does this romance go away? I'm sure that's person specific, but I'd appreciate your thoughts on how you've felt working for the military.

I assure you that your income as a civilian contractor would not be 5x what your salary would be as an active duty military physician. The contracting firm takes a 25-30% cut right off the negotiated salary. Likely you actual salary would be 300-350K, more like double AD salary and nowhere near private practice numbers.

As a surgical subspecialist, I can assure you that there is a bias against DOs. That doesn't mean that you can't match or shouldn't try, but it would be more difficult. Don't hate the messenger.
 
I assure you that your income as a civilian contractor would not be 5x what your salary would be as an active duty military physician. The contracting firm takes a 25-30% cut right off the negotiated salary. Likely you actual salary would be 300-350K, more like double AD salary and nowhere near private practice numbers.

As a surgical subspecialist, I can assure you that there is a bias against DOs. That doesn't mean that you can't match or shouldn't try, but it would be more difficult. Don't hate the messenger.

No hate for the messenger at all. Surgical subspecialties will be an uphill battle for many D.Os - especially things like Plastics, ENT, NSG.

This is part of why I considered HPSP. Now please correct me if I am wrong, I would really much appreciate it, but from my understanding, because there's such a bias against us in these competitive surgical specialties, a D.O cannot simply do well on boards. Even if we scored a 245 on our steps, if that was the only thing on our package, chances are we'd be outed. For a D.O to get into something like plastics would require a combination of board scores, excellent connections, publications, community service, and awards.

HPSP and military service from a financial perspective is a terrible deal for a surgical specialist, but in terms of being an applicant, it could only help your competitiveness, not hinder it right?
 
You need a golden ticket...a letter in hand stating that you have full-time outservice for a plastics fellowship. If you get one...there will be a plastics program out there who will take you.

Otherwise...you are probably toast. A plastics fellowship is just about impossible as a DO. Perhaps there will be a pro-military PD out there being willing to give you a shot in spite of the initials behind your name. But money speaks...get the full time outservice.
 
You need a golden ticket...a letter in hand stating that you have full-time outservice for a plastics fellowship. If you get one...there will be a plastics program out there who will take you.

Otherwise...you are probably toast. A plastics fellowship is just about impossible as a DO. Perhaps there will be a pro-military PD out there being willing to give you a shot in spite of the initials behind your name. But money speaks...get the full time outservice.

Hahaha between HPSP and FTOS, I better try to get Uncle Sam to pay for a facelift before my commitment is up. If I'm not mistaken, the process would go something like:

1st+2nd year -> score high on boards/research publications/faculty recs
3rd+4th year -> Rotations/Clinician recs/Request Civ Gen. Surg Match
Residency -> Request FTOS towards end of residency?

I definitely have a hard time understanding the AF Match vs Civilian Match. My understanding is that while I can request to be part of the civilian match, if the AF gen surg. residencies aren't filled then they'll automatically place me in there. But if AF gen surg fills, then I get the option to apply via ERAS and go through the whole NRMP just like everyone else. If I fail to match, then I'm forced to be a flight doc.
 
You'll have little trouble getting into gensurg is you're competitive. I think you can easily overcome the MD bias there. You then may or may not be selected to do a plastics fellowship. You have very little control over that, as it depends almost entirely upon whether or not your service branch needs a PRS guy in three years. If they do, then of course you'll need to be competitive. I'm unaware of any military PRS programs, meaning even if I'm wrong you'll likely need to apply for a civilian PRS position after your six year gensurg residency or your five year ENT residency. You cannot apply after 3 years, or to a combined program like your civilian colleagues. If the civilian fellowships are MD biased, they will still be that way towards you, with the one benefit being that you will look more competitive as free labor.
Once you finish a PRS residency, you'll spend most of your time doing abdominoplasties, breast recon, and the occasional wound care. You will have the opportunity to do some facial plastics and recon, but at least in the Army your ENT colleagues are going to do most of that. They will also do the majority of the microvascular work at any large MEDCEN.
 
Patients who seek out plastic surgeons still have bias against DOs. Not much you can do about that but I'm not sure if a civilian DO plastic surgeon can make near as much as an MD in most cases. Of course there are exceptions though. Plastics in general is over saturated in most urban and certainly coastal areas so many don't earn near as much as you think they are earning.
 
I've read through the downsides that many milmed physicians on this forum talk about - the one most concerning to me is the inherent skill atrophy following residency. How real was this for you? As you're finishing up, do you feel that because of milmed, you're going into the civilian world a worst physician than had you just been civ from the beginning?
VERY REAL, and maybe.

I did a civ residency, did 2 years at a sort-of a hospital, and currently finishing up my second year in a rinky dink clinic that should have been shut down a decade ago. I get to use 10% of my skills at best on a daily basis due to scope of practice availability. Kind of dreading going back to an intense civ fellowship in 3 months - hopefully I haven't become too dumb over the past 2 years, but I do anticipate problems.
 
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