Thinking about HPSP/USUHS? READ THIS.

[TheEarDoc]

Well I guess I will throw out my opinion since we all are.

I see a lot of similarities to this with what we in the VA have experienced with CHOICE.

Rather than have every subspecialty under the sun we don't fill open vacancies and instead send people out to other private sector providers. Is it cheaper? Not that I can tell always, but some for specialties yes it probably is.

Is it better for the patient? Depends on how good the doc is they see. I've seen CHOICE work well (rare!) and I've seen it go horribly wrong (people waiting months almost as long as a VA appointment to see a provider who is almost as far from their home as the VA and then the provider doesn't even do the correct tests of treat them for the problem they were initially sent for!), then said patient comes back to the VA pissed off the VA and we take the brunt of it and end up seeing the patient and fixing the CHOICE provider's mess who still ends up pocketing his reimbursement for his horrible work.

I see on paper how removing specialists that are not required as often and then farming folks out to civilian facilities looks great. Yes this would work great if you are in a great base location with a big city, but what about those that are not? I'm thinking many of the Army bases in the south for instance. What happens then? I've also been a contractor many places moonlighting and I've worked many places that had contractors. I've reviewed many a record from contract providers. Unfortunately quality is usually severely lacking and it's like they could care less if they even do the work right, let alone help the patient. They just want the cash and move on to the next warm body. I feel like in mil med a provider in the military can see that soldier or their family member and do the right thing and take care of them the way they would want to be taken care of. I feel like they actually care whereas many contractors they are punching the clock, plowing through patients, and then heading for the door. Nothing more.

I think for this to work they are going to need a lot more reservists in specialties so when they do need one they can pull one off the backfill unit list and deploy them for a rotation. Cost wise it will be better, but if you start doing an uptempo in deployments then I think you'll see those specialists dropping like flies from the reserves.

So I hope it all works out well. I know if I was a student getting ready to go to medical school I would not be choosing mil med right now. It's just too up in the air.

Again like everyone else. Just my two cents.

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[backrow]

Would you still not recommend if you're exclusively interested in bucket 1 specialties (ortho spine/trauma, gen surg w/sub specialty, EM, anesthesia are my picks in order). I ask this as a UG senior matriculating in the fall and have been in talks with a Navy recruiter for a while, planning on 4 year HPSP. Would it make a significant difference if I did 3 yr HPSP?

Right now there is just way too much in flux to be able to give a recommendation in my opinion. When this gets settled in however many weeks/months then I may be able to recommend again.

If things shake out the way I think they will then your situation may be reasonable.

If someone is interested then it’s okay to go ahead and apply. By the time you’d actually have to accept this should be at least a little more settled.


Sent from my iPhone using SDN mobile

 

[Perrotfish]

So here's where we have a legitimate disagreement. Respectfully, I think you can definitely run a system without having a complete cadre of subspecialists. It's done all of the time. Oil companies hire and deploy necessary medical personal to places like Qatar. I know docs who work there. They pay them well, but they work hard while they're there. The same thing happens with a lot of companies that are headquartered in Puerto Rico. The question is: is it cheaper to pay a few people well to be where you NEED them, or is it cheaper to have a bunch of docs who you pay less working everywhere all of the time? I could definitely see myself towards the end of my practice being willing to take a year and go to Guam to work at 1/4 speed for reasonable pay. Plus, again, you can have people in a reserve unit and deploy them to Guam without having them twiddling their thumbs the other 330 days of the year. I'd love to see the schedule of a urologist or ENT doc in Guam, just to see how much their doing and how much of it really needed to be done there.

But again, it's a cost issue. Would it be more expensive to pay well and get the necessary specialists to go to Guam on annual or bi-annual contracts, or is it cheaper to just run a nationwide, full sized hospital network?

And you can get consultants on the phone without actually training and hiring them. I work for a private, completely independent practice yet somehow (miraculously, I guess) I can get a CT surgeon on the phone if I need one. If you're in guam, and you need a CT surgeon, you're evacuating that patient anyway and you can call the hospital in Honolulu just as easily as you can Tripler. In a perfect world, we'd just have specialists all over the place all of the time waiting to hear from us. But this is reality, and cost is a factor.

So, ultimately it comes down to: what do you actually NEED in guam? It's not a full tertiary referral center.


Everything else you've mentioned here could be managed by a smaller stable of necessary physicians. No reason to get rid of general surgeons, etc. You don't need to have an ENT doc waiting around for 20 years to take a non-clinical leadership role.

We are going to need to agree to disagree here. I think you are underestimating both the difficulty and the cost of converting the military to a civilian staffing model. Considering the size of our remote and OCONUS healthcare needs I don't think we could find enough civilian physicians to staff our hospitals at any price, let alone at the salaries that the military currently pays for a GS employee

 

[HighPriest]

We are going to need to agree to disagree here. I think you are underestimating both the difficulty and the cost of converting the military to a civilian staffing model. Considering the size of our remote and OCONUS healthcare needs I don't think we could find enough civilian physicians to staff our hospitals at any price, let alone at the salaries that the military currently pays for a GS employee

Perhaps. Perhaps not. But, they'll need to come up with some kind of solution beyond just doing "what we've always done," because the system is $%&ed.
Or we'll end up in another active conflict, the money floodgates will open, and like Frankenstein's monster this thing will get enough of a jolt to keep wandering around terrorizing the villagers.

Again, I can only comment with any certainty about Army medicine and ENT in particular. If they completely eliminated ENT as a service, every post that currently has an ENT provider either is currently manned by a civilian or has a civilian ENT within a short distance except for Landstuhl and Korea (in both cases there are ENT docs very close by, they're just foreign docs, and currently we are sending patients to those guys). You could eliminate Army ENT with essentially no major blowback other than that the system would have to change is referral process. In fact, patients would probably be seen faster in many cases. Now, I think that Army ENT is probably on the easy side of things, when it comes to converting to a civilian provider base. But it's awfully easy.

 

[Perrotfish]

Perhaps. Perhaps not. But, they'll need to come up with some kind of solution beyond just doing "what we've always done," because the system is $%&ed.
.

Again we'll agree to disagree. I don't think the system if f--ked right now. Its inefficient and unpleasant to work in. However the care delivered is, in every study we've done and also in my personal experience, at a minimum on par with good civilian medical care. The physicians involved mostly get out with the licenses and skills intact.

I've seen f---ked, in my interactions with the civilian medical world. Meaning hospital systems where the care is terrifyingly out of standards or communities where important components of care (like Obstetrics) just don't exist. The military isn't there. One of the dangers of massively reorganizing the military's healthcare system is that we could push it from merely having room for improvement to being truly bad. I'm not saying that we shouldn't change anything ever, but the system is good enough that before I moved forward with any sweeping changes I would want to feel pretty confident that the change was going to be positive .

 

[HighPriest]

Again we'll agree to disagree. I don't think the system if f--ked right now. Its inefficient and unpleasant to work in. However the care delivered is, in every study we've done and also in my personal experience, at a minimum on par with good civilian medical care. The physicians involved mostly get out with the licenses and skills intact.

I've seen f---ked. Meaning hospital systems where the care is terrifyingly out of standards or communities where important components of care (like Obstetrics) just don't exist. The military isn't there. One of the dangers of massively reorganizing the military's healthcare system is that we could push it from being merely average to being truly bad. I'm not saying that we shouldn't change anything ever, but the system is good enough that before I moved forward with any sweeping changes I would want to feel pretty confident that the change was going to be positive .

You feel like the studies demonstrating higher-than-standard surgical complication and infection rates are on par with good civilian medical care? These have all been discussed in other threads.


And, again, there's cost to be considered. If it could be demonstrated that milmed were, overall, a truly lower cost option than using the civilian system I would come to bat for it. I'm not sure that's the case. I doubt that it is. But that is my opinion.

 

[Perrotfish]

You feel like the numerous studies demonstrating higher-than-standard surgical complication and infection rates are on par with good civilian medical care? These have all been discussed in other threads.

The New York times did a big expose on MTF surgical complication and infection rates. While there were some outliers with poor outcomes the average was... average. I'm not sure what you're talking about.

 

[militaryPHYS]

Just FYI, Primary care doesn't earn anything even close to an equivalent salary in the military. They were pretty close when I joined, but primary care salaries then increased at nearly 10% per year while military pay actually decreased in real value because the bonuses aren't indexed to inflation. If you count medical school tuition primary care still comes out ahead, but once you get out of the initial payback for HPSP the military is a huge money loser for pretty much everyone now.

Respectfully disagree. I crunched the numbers in 2017. If you look at the first 10 years post-residency and account for loan repayment (even REPAYE, etc.), taxes, insurance, healthcare costs, benefits, etc. your AVERAGE civilian primary care person falls out at about the same total compensation as a military PCP. I'll update my numbers for the last 12 months and post in a separate thread. Then you can dissect it as you wish.

 

[HighPriest]

I'm speaking of the NYT article. I guess we interpret that differently. I don't think it shows "average" results. It shows some hospitals are doing fine, while others are doing very poorly. If you break it down further to maternal complication rates, it's worse yet.

In Military Care, a Pattern of Errors but Not Scrutiny

Comparing Military Hospitals

Military Hospital Care Is Questioned; Next, Reprisals
(I especially like this quote: "During an examination of military hospitals this year, The New York Times asked readers to recount their experiences via a private electronic portal. Among more than 1,200 comments were dozens from medical workers about how the system thwarted efforts to deliver superior care." Maybe those were just us negative SDN posters e-mailing the NYT...I didn't, though).

This is, admittedly, US News which I normally wouldn't quote. But Scott Steele is a good resource with many years in Army medicine and frankly no reason to be anything other than genuine with his comments:

https://www.usnews.com/news/nationa...military-surgeons-skills-preparedness-for-war


Not about complication rates, specifically, but it is about transparency.
Service Members Are Left in Dark on Health Errors

There is a whole thread about this subject. It's a bit old now, but I'm sure the military cleaned all this up....No wait, they failed to diagnose a lung cancer on a guy with a clear mediastinal mass just this year.

 

[Perrotfish]

Respectfully disagree. I crunched the numbers in 2017. If you look at the first 10 years post-residency and account for loan repayment (even REPAYE, etc.), taxes, insurance, healthcare costs, benefits, etc. your AVERAGE civilian primary care person falls out at about the same total compensation as a military PCP. I'll update my numbers for the last 12 months and post in a separate thread. Then you can dissect it as you wish.

I think we're saying the same thing. With the tuition that HPSP covers primary care comes out way ahead of their civilian peers at the end of their initial obligation. However the military salary for primary care is now much, much lower than for a civilian, so signing up for any additional years beyond the initial 4 year obligation is now a money loser for even for Pediatrics.

 

[bossypants]

I am in general surgery. I was in HPSP. We did have a meeting several months back about all the changes. I guess I'll put in my 2c.

My specialty requires a certain volume and constant exposure to a variety of cases to maintain skill. Unfortunately, I do not get the experience I need. After I get out, I will have to do basically repeat my residency as my skills will have degraded to a point that I will be a danger to my patients. This is my biggest issue with military medicine. The military population is just a younger and healthier population than the general population. Further compounding the issue is that many small military hospitals have lost the ability to take care of the complex surgical patient due to budget cuts. I don't see the new changes addressing this problem.

In the end, HPSP is a patriotic duty. You sacrifice the most productive years of your life for your country. Maybe this is different for people in family medicine, EM or other bucket 1 specialties I don't know.

 

[pgg]

Would you still not recommend if you're exclusively interested in bucket 1 specialties (ortho spine/trauma, gen surg w/sub specialty, EM, anesthesia are my picks in order). I ask this as a UG senior matriculating in the fall and have been in talks with a Navy recruiter for a while, planning on 4 year HPSP. Would it make a significant difference if I did 3 yr HPSP?

You should be aware that the majority of matriculating pre-meds don't end up choosing the specialty they thought they would choose when they were pre-meds.

I don't know how you formulated that preference list, or what your background is. But it's simply impossible for pre-meds to get meaningful exposure to some of the more obscure specialties before they start living in a hospital during parts of medical school. The day-to-day working reality of most specialties can be very different from how they're advertised, imagined, or seen from the outside. Lots of pre-meds think know where they're going, but the truth is most don't at that point, and odds are you're one of them too.

Consider the possibility that midway through your 3rd year of medical school you'll discover that you love pediatrics, or that you'll get seduced by the rivers of money that flow from colonoscopies.


In any case ... this week we're talking about "buckets" as if these "buckets" have specifications, have been manufactured, are currently holding something, and are being lifted and carried around by people with a sense of purpose and some level of understanding of what a "bucket" is. A few years ago the plan had a Name, and it was MEDMACRE. Now MEDMACRE is unimplemented ancient history. I shall now commence holding my breath over this bucket business.

 

[HighPriest]

I am in general surgery. I was in HPSP. We did have a meeting several months back about all the changes. I guess I'll put in my 2c.

My specialty requires a certain volume and constant exposure to a variety of cases to maintain skill. Unfortunately, I do not get the experience I need. After I get out, I will have to do basically repeat my residency as my skills will have degraded to a point that I will be a danger to my patients. This is my biggest issue with military medicine. The military population is just a younger and healthier population than the general population. Further compounding the issue is that many small military hospitals have lost the ability to take care of the complex surgical patient due to budget cuts. I don't see the new changes addressing this problem.

In the end, HPSP is a patriotic duty. You sacrifice the most productive years of your life for your country. Maybe this is different for people in family medicine, EM or other bucket 1 specialties I don't know.

Agree with both points. I think the first point (skill atrophy) is actually the biggest reason milmed is (*&ed, but I'm not aware of any actual measurement of that kind of $()*kiness beyond everyone experiencing this problem.

 

[Chonal Atresia]

Well I guess I will throw out my opinion since we all are.

I see a lot of similarities to this with what we in the VA have experienced with CHOICE.

Rather than have every subspecialty under the sun we don't fill open vacancies and instead send people out to other private sector providers. Is it cheaper? Not that I can tell always, but some for specialties yes it probably is.

Is it better for the patient? Depends on how good the doc is they see. I've seen CHOICE work well (rare!) and I've seen it go horribly wrong (people waiting months almost as long as a VA appointment to see a provider who is almost as far from their home as the VA and then the provider doesn't even do the correct tests of treat them for the problem they were initially sent for!), then said patient comes back to the VA pissed off the VA and we take the brunt of it and end up seeing the patient and fixing the CHOICE provider's mess who still ends up pocketing his reimbursement for his horrible work.

I see on paper how removing specialists that are not required as often and then farming folks out to civilian facilities looks great. Yes this would work great if you are in a great base location with a big city, but what about those that are not? I'm thinking many of the Army bases in the south for instance. What happens then? I've also been a contractor many places moonlighting and I've worked many places that had contractors. I've reviewed many a record from contract providers. Unfortunately quality is usually severely lacking and it's like they could care less if they even do the work right, let alone help the patient. They just want the cash and move on to the next warm body. I feel like in mil med a provider in the military can see that soldier or their family member and do the right thing and take care of them the way they would want to be taken care of. I feel like they actually care whereas many contractors they are punching the clock, plowing through patients, and then heading for the door. Nothing more.

I think for this to work they are going to need a lot more reservists in specialties so when they do need one they can pull one off the backfill unit list and deploy them for a rotation. Cost wise it will be better, but if you start doing an uptempo in deployments then I think you'll see those specialists dropping like flies from the reserves.

So I hope it all works out well. I know if I was a student getting ready to go to medical school I would not be choosing mil med right now. It's just too up in the air.

Again like everyone else. Just my two cents.

Nice rant on civilian providers.

Good thing most of us have stopped accepting the “choice” program because the government doesn’t pay. That’s right - they don’t pay late, they just don’t pay.

We have the largest VA in the state of NC 25 miles from our clinic and no ENT practice will accept VA choice within 100 miles of the facility.

Ya wonder why you get the s$&@bags seeing these patients?

 

[Perrotfish]

Now MEDMACRE is unimplemented ancient history. I shall now commence holding my breath over this bucket business.

Did MEDMACRE really die? It seems like it was negotiated down but the bucket 3 specialties (or whatever) still lost a good number of billets.

 

[Gastrapathy]

@Perrotfish A physician who practiced primarily outpatient peds probably didn't see the quality issues that the inpatient higher acuity docs lived. There's a reason there is no longer cardiac surgery at the navy MTFs and its not (just) lazy O6s.

@pgg I feel like the AF has always talked about these mysterious buckets but I thought it had to do with deployment. Also, there are no rivers of money for colonoscopy. There's a pot of gold in the cecum.

 

[bossypants]

I had several patients who deteriorated and required transfer to a higher level of care (facility with an ICU). I could not get a single civilian hospital physician to take the patients. They all got shipped off to a military facility even if that facility ended up being several hours away by ambulance.

I understand that nobody wants to take the train wreck from another facility. But in my civilian training, even these train wrecks from outlaying rural facilities were routinely if grudgingly accepted. Is this because the nearby civilian physicians know they will not be appropriately compensated by the government? I wonder.

 

[Gastrapathy]

TRICARE is a money loser for all the local health systems. There’s only one left that takes it and they know they are alone holding the bag.

 

[Gastrapathy]

That ship has already sailed.
Our society has signed off that a nurse with a mostly online degree is a PCP.
So a medical school graduate most certainly meets the new standard.

Right or wrong, like it or not, agree or disagree , that’s the new standard for primary care.

I disagree. You can choose to work for an organization that won’t replace PCPs with mid levels. You can own your own business and make the same choices.

Dr. Jeffrey Weisz Has Big Plans for Kaiser Permanente | The Lund Report

You won’t find a midlevel PCP at KP or many of their SoCal competitors. The largest anesthesia group in San Diego has zero CRNAs.

Or you can work in the .mil where a corpsman who took a yearlong course that was 20% clinical can be MY PCP with no recourse.

 

[AvoidMilitaryMedicine]

Would you still not recommend if you're exclusively interested in bucket 1 specialties (ortho spine/trauma, gen surg w/sub specialty, EM, anesthesia are my picks in order). I ask this as a UG senior matriculating in the fall and have been in talks with a Navy recruiter for a while, planning on 4 year HPSP. Would it make a significant difference if I did 3 yr HPSP?

Absolutely not.

If you do it, all the bad things in life will happen to you, and nobody else, but you.

 

[militaryPHYS]

I disagree. You can choose to work for an organization that won’t replace PCPs with mid levels. You can own your own business and make the same choices.

Dr. Jeffrey Weisz Has Big Plans for Kaiser Permanente | The Lund Report

You won’t find a midlevel PCP at KP or many of their SoCal competitors. The largest anesthesia group in San Diego has zero CRNAs.

Oh no...somehow we've gone so far down the rabbit hole we are fighting the NP's and PA's again.

Anecdotally my father has seen just about every subspecialist in and around the Richmond area in the last year or two and everywhere he goes he is seen by a "niche midlevel". Rarely is he scheduled to see the actual subspecialist. I'm not saying that is right nor am I saying that alienating them is right either.

Anyway...I don't want to get back in to that battle again, but I don't think that NP's and PA's are the source of skill atrophy or anything related to the discussion that has come from this thread.

Did MEDMACRE really die? It seems like it was negotiated down but the bucket 3 specialties (or whatever) still lost a good number of billets.

As far as I know MEDMACRE is alive and well and still fueling the ongoing adjustment in billets as it pertains to everything OUTSIDE of POM20. So we are seeing a realignment of MC billets based on MEDMACRE plus we have the cuts from POM20.

 

[Gastrapathy]

If you didn’t want to discuss it, why did you? You aren’t required to.

Your dad can choose another physician.

Our AD members have no rights and we don’t even pretend to give them the same standard of care. We don’t let GMOs see civilians and I had a IDC as my primary care.

 

[militaryPHYS]

Our AD members have no rights and we don’t even pretend to give them the same standard of care. We don’t let GMOs see civilians.

They have every right to a second opinion. If the patient is still not satisfied with their second opinion from another military doc they can be seen out in the network if approved. Our AD members often do not exercise their rights because they don't understand they have said rights due to their military mentality and not being properly informed. If we aren't providing proper informed consent and information regarding a second opinion then we are the ones who are failing, not the system.

GMO's can moonlight if they want and it is available where they are stationed. Confused on how this relates to the discussion currently?

-------

We got sucked in to discussing the basic pitfalls of Milmed again, not the recent big changes coming down the pipeline that are leaving even more unknowns for all of us...especially incoming premeds. i.e. DHA, wartime billet realignment, major billet cuts coming, PROFIS, dissolution of medcens, etc.

Sounds like we are all agreeing that it is tough to recommend HPSP or USUHS to anyone right now given so many unknowns. Anyone disagree?

 

[HighPriest]

Midlevels do have something to do with quality of care, which for better or worse did come up on the thread. I’m not saying they can’t provide adequate care in some areas. I am saying that they’re not physicians, and therefore not as qualified overall. But that’s not a military-specific issue to be sure.

 

[Trefoil]

My fiancée and I have been currently applying to the HPSP for dental (her) and medical corps (me). The main reason is after talking to military docs/dentists we know personally, we like what mil-med can entail. I have a lot of military history in my family as well so I like that aspect. And I’m not going to lie, coming out of school NOT $500,000+ in debt (both of us combined) sounds really nice. However, I’m not 100% sure what I want to specialize in. I believe primary care (IM or FM) isn’t for me...leaning mostly towards neuro/ortho spine surgery. Or PM&R or even MSK neuro.

Is HPSP a viable option at this point? We’re in the process of applying right now and this post has me worried about the future of military med. Any thoughts would be seriously appreciated!


Sent from my iPhone using SDN mobile

I would strongly encourage you to turn away. I am in a bucket one specialty, and they are downsizing us as well. They made a decision to close all of the smaller locations despite us being fairly busy even in remote areas. The reality is that the military is shifting away from subspecialists that aren’t needed for deployment. With all of these small shop closures, I don’t see that they will have enough space for the docs who are already in which will compound the low volume problem.

Even if you ar considering primary care, you will be affected by the changes as well. The word is that the higher ups of the medical corps are fighting hard to convince the rest of the military of our relevance. It sounds like they are making a reasonable argument, but I don’t see this going in any positive direction for the foreseeable future. You will be better off figuring out the debt. You both will make more than enough to pay it off. Don’t subject yourself to this uncertainty.

 

[Gastrapathy]

[QUOTE="militaryPHYS, post: 20528179, member]

Sounds like we are all agreeing that it is tough to recommend HPSP or USUHS to anyone right now given so many unknowns. Anyone disagree?[/QUOTE]

/thread

 

[TheEarDoc]

Nice rant on civilian providers.

Good thing most of us have stopped accepting the “choice” program because the government doesn’t pay. That’s right - they don’t pay late, they just don’t pay.

We have the largest VA in the state of NC 25 miles from our clinic and no ENT practice will accept VA choice within 100 miles of the facility.

Ya wonder why you get the s$&@bags seeing these patients?

Oh no trust me I know why we get what we get. I read the forums about people never getting paid by CHOICE for care provided. It's a %^& show of epic proportions.

 

[Detective SnowBucket]

Absolutely not.

If you do it, all the bad things in life will happen to you, and nobody else, but you.

wow wow wow, can you clarify on this. I know service is required so that's not a downside to me. Military family so I know how it works too. Now, if I know I want nothing to do with bucket II then what's the problem? Even if I simply don't match, I would have very little problem being a GMO for the entire 4 years. (<- this is predicated on the 4 years not having a significant negative impact on civilian residency chances, as I have gathered). SO, what's the issue for someone like me?

 

[Matthew9Thirtyfive]

wow wow wow, can you clarify on this. I know service is required so that's not a downside to me. Military family so I know how it works too. Now, if I know I want nothing to do with bucket II then what's the problem? Even if I simply don't match, I would have very little problem being a GMO for the entire 4 years. (<- this is predicated on the 4 years not having a significant negative impact on civilian residency chances, as I have gathered). SO, what's the issue for someone like me?

I mean, I'm not going to tell you you're good to go because I'm still applying and my knowledge of military medicine is limited to being enlisted Navy. But consider the source. The dude created an account with the username "AvoidMilitaryMedicine" just to come on here to tell people not to join. What do you think he's going to say to you?

 

[bossypants]

wow wow wow, can you clarify on this. I know service is required so that's not a downside to me. Military family so I know how it works too. Now, if I know I want nothing to do with bucket II then what's the problem? Even if I simply don't match, I would have very little problem being a GMO for the entire 4 years. (<- this is predicated on the 4 years not having a significant negative impact on civilian residency chances, as I have gathered). SO, what's the issue for someone like me?

As long as you tailor your expectations, you will do fine. If you are in it for the money or for the career, then no it's not worth it. Do it if you have the calling to serve; it's that simple.

 

[HighPriest]

wow wow wow, can you clarify on this. I know service is required so that's not a downside to me. Military family so I know how it works too. Now, if I know I want nothing to do with bucket II then what's the problem? Even if I simply don't match, I would have very little problem being a GMO for the entire 4 years. (<- this is predicated on the 4 years not having a significant negative impact on civilian residency chances, as I have gathered). SO, what's the issue for someone like me?

Yeah, that is kind of Shakespearean hyperbole. All that I would say is that no one knows for sure what bucket they're going to end up in until they're trying to get in to it as a 3-4th year student.

 

[Chonal Atresia]

I mean, I'm not going to tell you you're good to go because I'm still applying and my knowledge of military medicine is limited to being enlisted Navy. But consider the source. The dude created an account with the username "AvoidMilitaryMedicine" just to come on here to tell people not to join. What do you think he's going to say to you?

Yeah, what does he know? He is only an attending active duty physician and you have zero experience with the physician/provider side of military medicine.

His screen name may give away his opinion, but he has some real-world experience shaping said opinion.

Do it ONLY if you REALLY want to serve, don’t mind getting jerked around by lazy/incompetent O-6s hiding out in military medicine and don’t care what field you specialize in. If those things don’t bother you, than “you’re good to go.”

Buyer beware. This meal stinks.

 

[Matthew9Thirtyfive]

Yeah, what does he know? He is only an attending active duty physician and you have zero experience with the physician/provider side of military medicine.

His screen name may give away his opinion, but he has some real-world experience shaping said opinion.

Do it ONLY if you REALLY want to serve, don’t mind getting jerked around by lazy/incompetent O-6s hiding out in military medicine and don’t care what field you specialize in. If those things don’t bother you, than “you’re good to go.”

Buyer beware. This meal stinks.

Wow, defensive much? Try not to get so emotional. It leads to logical fallacies.

I didn’t discount his experience. I said consider the source. He came to this forum specifically to warn people away from milmed. Of course he’s going to be biased. That doesn’t mean you should ignore his advice. Just take it in context.

As for only joining if you really want to serve, I agree. I’ve said that all over this website. I have several years of active duty service doing extremely ****ty jobs in extremely ****ty circumstances and have been given my share of short ends of the stick. I am well aware of the negatives and would never tell someone to join unless they wanted to serve above all else.

Edited to fix an autocorrect.

 

[Detective SnowBucket]

I am interested in serving and would never live it down if I didn't. That being said, I know people change their specialty of choice by the time they graduate all the time, that's why I'm considering the whole range of bucket I in this case, even if I switch, I cannot see myself going for anything outside of bucket I.

 

[HighPriest]

You'd live it down just fine. But, wanting to be in the military first with a secondary interest in medicine is the right attitude for HPSP.

 

[psychbender]

People do GMO-and-out all of the time, but do you really want to plan on it? Do you want to push back training in your desired specialty for for years? Push back getting your first attending job? Starting our becoming partner in a practice? Requirement? For many specialties, it is entirely possible to pay back med school debt in less than four years. For every one of those, you are worse off doing HPSP, followed by a 4 year GMO tour. Every year that you're a GMO is one less that you're an attending.

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[Detective SnowBucket]

Sure, I'd rather not do 4 years of GMO but if I don't get the specialty I want at that time for 4 years in a row, that's how it'll go.

 

[militaryPHYS]

Informed consent. When you sign the contract make sure you have the knowledge to be making a well-informed decision.

You obviously seem like you understand the limitations of MilMed and current unknowns and despite these you still wish to serve. Never listen to anyone who tells you YES DO IT or NO, DEFINITELY NOT. The decision is yours and yours alone to make after doing your own research and hearing the opinions of others.

At the end of the day MilMed will exist in some form. If you are OK with the worst case scenario (WWIII, GMO x4 years, not being able to practice in your preferred specialty, etc.) then sign away!

I've said this before so forgive me if anyone has already heard it....When I signed up I wanted to be a military doctor. PERIOD. I had ideas of what I wanted to specialize in but no preconceived plans or requirements. I was signing up to follow orders and do what the military wanted me to do.

Once I was in and based off of good timing with peacetime, money, billet availability and personal preferences I was able to morph that in to a pretty sweet gig and was able to train in a competitive specialty that has a wartime need. I got lucky. Many did not.

What you decide you want to do during your clinical rotations may line up with what the military has to offer you when match time comes, perhaps it won't. Unfortunately there is no way to know this before signing the contract. If you are OK with this unknown and are OK possibly having to serve 4 as a GMO and get out then sign up. If you are not OK with it or maybe not OK with it then don't. It is really that simple.

 

[HighPriest]

* you know the risks as well or better than anyone joining. But no one knows all the risks until they're doing it.

True of a lot of things, but basically the rule for military medicine.

 

[Gastrapathy]

It’s the future you who has to be ok with it 10 years from now. After you’ve paid the price to become a MD.

 

[militaryPHYS]

Truth to last two statements. Good thing is, if you have the right resources and understand what you're signing up for then you only have yourself to blame. You can't blame the system if everyone understands how and where the system is broken.

I've got a pretty exhaustive list...almost like a disclaimer that I hope everyone will read and agree to (at least mentally) before they sign up. Trouble is I'm having roadblocks publishing since it relates to military recruiting/retention. Lots of regional and Big Navy policy on this that needs to be signed off on.

 

[Dr. Anonymouss]

Although you did state more problems than just choice of speciality, that is one of the biggest concerns to me. Should I feel fairly safe to match general surgery, EM, or family medicine in the military based on their desire to push military medicine???

 

[CsHead]

Even if I simply don't match, I would have very little problem being a GMO for the entire 4 years.

How do you know that?

 

[militaryPHYS]

How do you know that?

How does a premed know if they will still like medicine and be OK working long enough as a civilian to pay off the loans? How do they know if they will even have the scores to match in what they want to do causing them to have to do a specialty they weren't planning on?

I understand where you are going with your question, but we can only predict so much based off of our understanding today. In the military, if you end up being unhappy you have the military to blame. In the civilian world you only have yourself to blame...and nobody wants to do that.

 

[CsHead]

How does a premed know if they will still like medicine and be OK working long enough as a civilian to pay off the loans? How do they know if they will even have the scores to match in what they want to do causing them to have to do a specialty they weren't planning on?

I understand where you are going with your question, but we can only predict so much based off of our understanding today. In the military, if you end up being unhappy you have the military to blame. In the civilian world you only have yourself to blame...and nobody wants to do that.

Where do you think I was going with it?

 

[militaryPHYS]

How do you know if you'll be OK as a GMO for 4 years if you've never been there or done that before

 

[CsHead]

How do you know if you'll be OK as a GMO for 4 years if you've never been there or done that before

Very well then.

 

[HighPriest]

How does a premed know if they will still like medicine and be OK working long enough as a civilian to pay off the loans? How do they know if they will even have the scores to match in what they want to do causing them to have to do a specialty they weren't planning on?

I understand where you are going with your question, but we can only predict so much based off of our understanding today. In the military, if you end up being unhappy you have the military to blame. In the civilian world you only have yourself to blame...and nobody wants to do that.

I think it’s easier to know if you are likely to want to continue practicing medicine as opposed to being on as a GMO. You can go shadow a doc. You can see what the day-to-day is like. There’s no way to do that with a GMO. I spent 9 years active and I still have no idea what it’s like to be a GMO. I have a pretty good idea what it’s like to be a psychiatrist. Maybe not an exact picture, but a good idea. Plus, you do rotations, right? You can change your mind basically at any time it’s regards to what you’re doing. I don’t think they Navy will let you out after 2 months as a GMO I’d you decide it isn’t for you.

 

[HighPriest]

Although you did state more problems than just choice of speciality, that is one of the biggest concerns to me. Should I feel fairly safe to match general surgery, EM, or family medicine in the military based on their desire to push military medicine???

You shouldn’t feel safe to match into gen surg or EM. They’re highly competitive. If you have great scores, you should feel good about it. But not safe.

 

[Matthew9Thirtyfive]

I think it’s easier to know if you are likely to want to continue practicing medicine as opposed to being on as a GMO. You can go shadow a doc. You can see what the day-to-day is like. There’s no way to do that with a GMO. I spent 9 years active and I still have no idea what it’s like to be a GMO. I have a pretty good idea what it’s like to be a psychiatrist. Maybe not an exact picture, but a good idea. Plus, you do rotations, right? You can change your mind basically at any time it’s regards to what you’re doing. I don’t think they Navy will let you out after 2 months as a GMO I’d you decide it isn’t for you.

I agree that a civilian and a lot of active probably don't have any clue what a GMO tour is like, but I was able to work pretty closely with our GMO and have a pretty good idea what it's like. There are ways to shadow them and see what their day-to-day is like, but I agree that a civilian probably has no real idea what that means.