Thinking about HPSP/USUHS? READ THIS.

[924782]

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Members don't see this ad.

 

[d2305]

Military psychiatrist have lots of medical boards to write . I would think they are necessary, but a contractor could write them too.

 

[militaryPHYS]

**ABSOLUTE MUST READ FOR PROSPECTIVE HPSP/USUHS STUDENTS: More Than 17,000 Uniformed Medical Jobs Eyed for Elimination

Featuring such ill omens as..

"If the goal is to tear down the military health system, this would be a reasonable way to do it," warned one service health official who asked not to be identified.

“....goal is to deepen the workload of remaining medical billets at base hospitals....”

"One said he is worried that staff cuts this deep could leave hospitals short of personnel to deploy or to receive patients if old wars escalate or new ones break out in Korea, Eastern Europe or the South China Sea. He also worries about finding civilian replacements when needed, noting chronic staff shortages within the Department of Veterans Affairs medical system that can't be filled even in peacetime."

Under-paid? Check.
Under-supported? Check.
Under-appreciated? Check.

Factor in reverse-profis with its emphasis on spreading out an already thin and beleaguered medical corps and the government has well-positioned itself for the slow, painful death of the military medical corps.

Serious question -- has anyone here heard of someone buying out the remaining years of their ADSO? Asking for a friend

Speaking of friends.

Remember.

Friends don't let friends join military medicine.

You regret your decision. Mine was the best thing I think could have happened for myself and my family. I would tell my friends everything I know about how to maximize their chance of happiness and to go in with 100% understanding of risks vs. benefits. It is not for everyone and many people end up disappointed.

BUT....I am less than 2 years post-residency (yes, I am a dual mil physician couple) and have a 700+ k net worth and a for-profit rental property. All of this started Day 0 at USUHS. We had no handouts or pre-existing wealth. Cut that number in half if you want an idea of what a USUHS person can reach if they are smart with their money. I now rent a house on a cliff overlooking the Pacific Ocean on a multi-million dollar property in a foreign country which makes me feel happier and safer than any day I ever lived in the U.S.

I owe 5 more years (8 now that I accepted my FTOS spot). Some of those years won't be as good as these years. We know that. But we also know that we can stop working completely at age 47 (45 for my wife) and be set for life. Or I can locums and make ridiculous money. Or I can consult and make ridiculous money. Sucking it up and accepting what we chose for ourselves is better than being miserable and complaining about what could be better (could it be?).

Yes, we have been lucky. We are the exception, but to tell those of us who have made decisions with intention to maximize chances of success, wealth and security for our families that there is no hope for those who choose military medicine really fires me up. Nobody will achieve exactly what we have. Many will not...some will outpace us. At the end of the day it is up to you. Never blame the university. Don't blame the system. You make your own decisions and are responsible for what you achieve or fail at.

Go Navy. It's better than Army Medicine regarding satisfaction every day of the week. Plus we are better at football (usually). Next 10 years?....anybody's guess.

 

[AvoidMilitaryMedicine]

You regret your decision. Mine was the best thing I think could have happened for myself and my family. I would tell my friends everything I know about how to maximize their chance of happiness and to go in with 100% understanding of risks vs. benefits. It is not for everyone and many people end up disappointed.

BUT....I am less than 2 years post-residency (yes, I am a dual mil physician couple) and have a 700+ k net worth and a for-profit rental property. All of this started Day 0 at USUHS. We had no handouts or pre-existing wealth. Cut that number in half if you want an idea of what a USUHS person can reach if they are smart with their money. I now rent a house on a cliff overlooking the Pacific Ocean on a multi-million dollar property in a foreign country which makes me feel happier and safer than any day I ever lived in the U.S.

I owe 5 more years (8 now that I accepted my FTOS spot). Some of those years won't be as good as these years. We know that. But we also know that we can stop working completely at age 47 (45 for my wife) and be set for life. Or I can locums and make ridiculous money. Or I can consult and make ridiculous money. Sucking it up and accepting what we chose for ourselves is better than being miserable and complaining about what could be better (could it be?).

Yes, we have been lucky. We are the exception, but to tell those of us who have made decisions with intention to maximize chances of success, wealth and security for our families that there is no hope for those who choose military medicine really fires me up. Nobody will achieve exactly what we have. Many will not...some will outpace us. At the end of the day it is up to you. Never blame the university. Don't blame the system. You make your own decisions and are responsible for what you achieve or fail at.

Go Navy. It's better than Army Medicine regarding satisfaction every day of the week. Plus we are better at football (usually). Next 10 years?....anybody's guess.

To be honest, for personal reasons, I don't regret joining the military -- it's always been an itch I've wanted to scratch and I did. And now I am ready to move on. I know the military is not a healthcare organization, nor should it be, and it shows. Many docs feel the same way.

It seems to be the overwhelming consensus that the system is changing for the worse and I can personally attest to the fact that every year I've been in, rather impressively, has gotten exponentially worse, despite my own gains in skills/knowledge/etc. Unfortunately, the complete control the military has over lives bleeds into nearly every aspect of our personal lives as well, its tiresome, old and beyond the point of frustrating.

Congrats on your financial moves -- something I'm definitely trying to aspire to as well. Bravo!

 

[d2305]

Sometimes even staff officers are in harms way. In the Med in *86 on a DDG and my squadron medical officer was LT Parker. Hell of a nice guy and helpful in what to do with my problem sailors. He was killed in a helo crash a year later. Your GMO tour can be dangerous.

 

[militaryPHYS]

To be honest, for personal reasons, I don't regret joining the military -- it's always been an itch I've wanted to scratch and I did. And now I am ready to move on. I know the military is not a healthcare organization, nor should it be, and it shows. Many docs feel the same way.

It seems to be the overwhelming consensus that the system is changing for the worse and I can personally attest to the fact that every year I've been in, rather impressively, has gotten exponentially worse, despite my own gains in skills/knowledge/etc. Unfortunately, the complete control the military has over lives bleeds into nearly every aspect of our personal lives as well, its tiresome, old and beyond the point of frustrating.

Congrats on your financial moves -- something I'm definitely trying to aspire to as well. Bravo!

Agree that changes are happening. It will be for the worse for those who get passed over, pushed out and not retained. Hell, it may even effect my wife or I some day. Who knows. Thankfully we are set up for transitioning to a good alternative...making more money and given more freedom in the civilian world. But we have not felt the same progressive negative changes that you mention. Unfortunately everyone's experience is different and transient based on location/specialty/service.

The changes which are being made are aimed towards providing a more efficient MilMed system while also integrating it more within the civilian system to maximize skill maintenance. These are things all of us agree should happen. Now that its happening we are all crying foul and heading for the hills. Not every decision has been perfect. Everything is an unknown right now, sure. People will have less options based on specialty. Sometimes the big military makes budget cuts without thinking about the impact felt on the ground. But not everyone will be negatively impacted. I've said it before, those of us who remain to see the new final product will probably like it better than what we have right now...it is just going to take a while to get there. If the risk of being affected negatively by MilMed during this process or even after it is too much, just don't do it. Easy answer.

But my point was that you can make the most of it and it can be a good thing if we go in to it with the right mindset and maximize our chances of success. Only 1% of our nation serves the military. I have no idea what percentage of Premeds end up going military but hopefully it mirrors the general military numbers because MilMed is DEFINITELY NOT FOR EVERYONE. To be happy and successful it is for very few people. But for those few people it is a great calling, service and experience, so let's not forget about them.

I put my numbers out there as an example. Not to gloat. Not a rule of what to expect. We haven't been living mustachian lives either. We spend way more than we probably should and still ended up with an early solid footing for the future. Plus we have two 9/11 GI bills for our two kids. Good things are possible, but they can be transient, mixed with horrible deployments or duty locations with skill atrophy...even ultimate sacrifice as @d2305 mentioned. Nobody should stay longer than they have to if they are miserable. They should get out when they reach their saturation point but should stay positive and productive until that time.

 

[backrow]

The changes which are being made are aimed towards providing a more efficient MilMed system while also integrating it more within the civilian system to maximize skill maintenance.

That’s what MEDMACRE was. The current changes annotated POM20 for Navy have absolutely nothing to do with efficiency or skills maintenance and everything to do with being able to shift billets to the Line. From all the briefs I have been in the medical side was not involved in the initial decision to make the billet changes, but rather only when it became a “how are you going to do execute this decision” where they consulted. This is despite the stuff that was put out in the recent news article saying something to the contrary.

I've said it before, those of us who remain to see the new final product will probably like it better than what we have right now...it is just going to take a while to get there.

Remind me to come back to this in 5 years. You may be right, but I figure it is going to take at least that long for things to settle into a new normal.

In my opinion the next three years will be a time of staff reduction, billet re-allocation, and facility reduction/closures. You will see those at retirement get out and you will see many in the younger year groups bail at the first opportunity. You will see a generational gap as those who can get out do and those currently in long obligations stick around probably leaving what the lone calls a T-notch in the lineal order. Over these three years people’s orders will be running out that currently sit in to-be stricken billets and you will finally see the bottom as DHA tries to start to fill in with civilian staffing. In the meantime there will be drastic leakage to the market of non-active duty care. This will make skills sustainment difficult for those who need those patients to maintain KSA’s which will force them to look for other ways to keep those skills. Sharing agreements and MOU’s will be attempted where available, but because there won’t be enough staff to cover the active duty demand they won’t be as fruitful as could. Folks will look to moonlighting to maintain skills (already do) and people will be forced to use their leave to maintain their skills (Can you imagine if pilots were forced to take leave so they could go fly for American or Delta to get enough hours in a cockpit?).

Finally at about year 4 we may start to see the way up. Civilian hires will start to be made and those folks will start to fill in the loss of active duty folks. The AD docs left behind will be going on deployments and humanitarian missions where it will be feast or famine and about half will actually be used in ways that maintains their KSA’s. They will also have increased PCS demands as we now have fewer docs to cover the overseas locations.

Eventually by year 5 we start to see a rebalancing out and a new normal is close. How to maintain GME has been somewhat figured out, but the product coming in is not as strong a quality because recruiting has taken a big hit and there is a four year lead time on the “purchase” of a medical student to them arriving for GME. This will lead to more struggles within GME for remediation, extensions of trainings, and eventually Board difficulties.

Finally at the end of year 5 we see what the outcome of the decision being made actually looks like.

For someone looking to sign up for HPSP right now you are really looking at coming into the Service when all the dust has settled. An issue is that because nobody has a clue what it is going to look like it is difficult to give solid advice. We are all coming from our own biases and worlds.

My personal bias (at least one I recognize) is that I don’t like making a decision until I have all the data (or as much as possible) unless not making a decision at a certain point precludes one of the options. In this instance there are always ways to join in the future so one doesn’t have to make a decision right now when so much is up in the air.

(Well that turned into a wall of text, apologies)


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[mr11]

Maybe this has been posted in the thread, but can anyone say what specialties are within each “bucket”? Obviously gen surg, EM, and psych I presume would be in bucket 1 but I haven’t seen an actual breakdown. Is there one?


Sent from my iPhone using SDN

So we received this as guidance last year. Perhaps it correlates to the buckets but I kinda doubt it given how many tier 1 there are.

 

[Cavalry]

The MTFs will remain some of the best funded, most efficiently run hospitals with some of the best outcomes and graduate medical education programs in the country (Madigan and San Antonio were top ten in surgical residency programs). What will decrease are the number of empty billets, redundantly-parallel health systems in a geographic area between the three medical services corps, and contractors in areas with a low density of providers (by shifting some of those military physicians and support staff from high-density areas with over-redundancy of nearby airforce/navy/army clinics to those with lower densities). It will help reduce costs, and overall the caseload per provider will go up and more closely mirror their civilian counterparts to avoid articles like this one: https://www.usnews.com/news/nationa...military-surgeons-skills-preparedness-for-war

If you're a good pre-med student and you feel called to become a uniformed services physician (military or public health service) - don't let this deter you. Read up about it, ask the USUHS/HPSP people in the trenches (not the recruiters) about your concerns, and make an informed decision. Don't let one article headline or statistic mentioned by one person color your whole decision.

 

[Gastrapathy]

@Cavalry Please educate us on these "best funded, most efficiently run hospitals" and the metrics you believe demonstrate those claims.

Please educate us on these top-ten residency programs and the metrics you believe demonstrate those claims.

Which "one article headline" and "one person" are you referring to?

Look, you're a USU MS1. I get that hope is important. But there is no one outside of the your bubble (and truthfully, few senior folks inside it) that believe those claims about government run hospitals or low-volume surgical residencies. They can't keep the ORs open. That's what matters. Its not about board pass rates or quiz bowl championships.

 

[Atlas Shrugged]

I would have considered pursuing a surgical specialty a lot more had ORs not been run like they are at MTFs. Everyone actively works against you to actually perform surgery, turnover takes forever, and there is so much PCSing and turnover that none of the ancillary staff know what they are doing. By the time they do they're on to their next assignment or ETS.

 

[HighPriest]

I would have considered pursuing a surgical specialty a lot more had ORs not been run like they are at MTFs. Everyone actively works against you to actually perform surgery, turnover takes forever, and there is so much PCSing and turnover that none of the ancillary staff know what they are doing. By the time they do they're on to their next assignment or ETS.

This was 9 years of my life.

 

[HighPriest]

The MTFs will remain some of the best funded, most efficiently run hospitals with some of the best outcomes and graduate medical education programs in the country (Madigan and San Antonio were top ten in surgical residency programs). What will decrease are the number of empty billets, redundantly-parallel health systems in a geographic area between the three medical services corps, and contractors in areas with a low density of providers (by shifting some of those military physicians and support staff from high-density areas with over-redundancy of nearby airforce/navy/army clinics to those with lower densities). It will help reduce costs, and overall the caseload per provider will go up and more closely mirror their civilian counterparts to avoid articles like this one: https://www.usnews.com/news/nationa...military-surgeons-skills-preparedness-for-war

If you're a good pre-med student and you feel called to become a uniformed services physician (military or public health service) - don't let this deter you. Read up about it, ask the USUHS/HPSP people in the trenches (not the recruiters) about your concerns, and make an informed decision. Don't let one article headline or statistic mentioned by one person color your whole decision.

It’s not just a river in Egypt.

 

[Setih]

The MTFs will remain some of the best funded, most efficiently run hospitals with some of the best outcomes and graduate medical education programs in the country (Madigan and San Antonio were top ten in surgical residency programs). What will decrease are the number of empty billets, redundantly-parallel health systems in a geographic area between the three medical services corps, and contractors in areas with a low density of providers (by shifting some of those military physicians and support staff from high-density areas with over-redundancy of nearby airforce/navy/army clinics to those with lower densities). It will help reduce costs, and overall the caseload per provider will go up and more closely mirror their civilian counterparts to avoid articles like this one: https://www.usnews.com/news/nationa...military-surgeons-skills-preparedness-for-war

If you're a good pre-med student and you feel called to become a uniformed services physician (military or public health service) - don't let this deter you. Read up about it, ask the USUHS/HPSP people in the trenches (not the recruiters) about your concerns, and make an informed decision. Don't let one article headline or statistic mentioned by one person color your whole decision.

Who is this directed to?

USU/HPSP students would not be people in the trenches, sorry.

 

[militaryPHYS]

Remind me to come back to this in 5 years. You may be right, but I figure it is going to take at least that long for things to settle into a new normal.

I'm happy to be a case study, or guinea pig...or voluntary tribute? I have to be around for the next 8 years or so. By then we should know something. For better or for worse I will report on how it's going.

"Day 674. DHA watch. The mood is tense!"

 

[D.O.Camolf]

Like most people I want to serve my country and become a great physician so I applied for the Air Force HPSP and based off of what my recruiter has told me I'm in the final review part of the application. After reading all these posts (which thank you to everybody cause you could be helping me from making a huge mistake or the best decision ever) I have a couple questions if y'all wouldn't mind answering them. I just ask that if you respond please answer all of my questions so I do not have to hunt through multiple replies to get the full answer.

My questions are:

1. I am currently more-so interested in becoming a pediatrician, based off of the upcoming changes what are the chances (low, medium, high) that the air force will not have a residency position for me since they are trying to lower the number of pediatricians they have? If the answer is low, would I have a chance of doing a civilian deferral for a peds residency?

2. Same questions as above but for the following other types of specialties that I have an interest in: family medicine, ICU, PICU, Neurology, Emergency Medicine (would you mind answering for each one specifically so I have a clear answer for each one).

3. If I was able to do a pediatric residency through the air force, would the job with the air force be worth it? I don't mean that in the sense of I am doing this only for the money, but in the sense that I want to serve my county and the families of the men and women who are fighting for my freedom but I don't want to be in a pediatrician that has skill atrophy and does nothing all day due to this upcoming change the military has coming?

4. If based off of the responses I get for all of the questions above would I still be able to opt out of the HPSP application since I'm still under final review and haven't signed any contracts regarding I accept the scholarship?

I understand that some of these residency and fellowship spots are competitive and you need not only high board scores but other things as well, I'm just trying to get a grasp on this before I make any decisions. Like I said above it has been my dream to serve, but based off of this thread I am not sure if I can do a military first, physician second approach if I am going to be (kinda) forced to do GMO (which if it came down to it I wouldn't cry and throw a temper-tantrum it is just not my ideal desire to do that for I would rather become the type of physician I want to become then serve).

Thank you!

 

[HighPriest]

Like most people I want to serve my country and become a great physician so I applied for the Air Force HPSP and based off of what my recruiter has told me I'm in the final review part of the application. After reading all these posts (which thank you to everybody cause you could be helping me from making a huge mistake or the best decision ever) I have a couple questions if y'all wouldn't mind answering them. I just ask that if you respond please answer all of my questions so I do not have to hunt through multiple replies to get the full answer.

My questions are:

1. I am currently more-so interested in becoming a pediatrician, based off of the upcoming changes what are the chances (low, medium, high) that the air force will not have a residency position for me since they are trying to lower the number of pediatricians they have? If the answer is low, would I have a chance of doing a civilian deferral for a peds residency?

2. Same questions as above but for the following other types of specialties that I have an interest in: family medicine, ICU, PICU, Neurology, Emergency Medicine (would you mind answering for each one specifically so I have a clear answer for each one).

3. If I was able to do a pediatric residency through the air force, would the job with the air force be worth it? I don't mean that in the sense of I am doing this only for the money, but in the sense that I want to serve my county and the families of the men and women who are fighting for my freedom but I don't want to be in a pediatrician that has skill atrophy and does nothing all day due to this upcoming change the military has coming?

4. If based off of the responses I get for all of the questions above would I still be able to opt out of the HPSP application since I'm still under final review and haven't signed any contracts regarding I accept the scholarship?

I understand that some of these residency and fellowship spots are competitive and you need not only high board scores but other things as well, I'm just trying to get a grasp on this before I make any decisions. Like I said above it has been my dream to serve, but based off of this thread I am not sure if I can do a military first, physician second approach if I am going to be (kinda) forced to do GMO (which if it came down to it I wouldn't cry and throw a temper-tantrum it is just not my ideal desire to do that for I would rather become the type of physician I want to become then serve).

Thank you!

The truth is, I’m not sure if anyone can answer 1 or 2 yet simply because the changes that are occurring are so early in the process. It’s very difficult to know where things will be in 4 years. Traditionally, with good scores you could match peds without too much difficulty. Being deferred really depends upon service, specialty, and manpower at the time you apply. Very difficult to predict deferments for most specialties.
Not being a pediatrician, it seems like you can have a fairly satisfying outpatient peds practice in the military. Lots of families, lots of kids. The more subspecialized you become, the harder it will be to maintain your skills. At many small facilities, maintaining inpatient peds skills could also be difficult.
You can opt out right up until you sign the contract, and my understanding is right up until you’ve actually spent a certain amount of time on active duty (but I’m not 100% clear on that second part, as I never did it).

Your recruiter will throw a fit. That’s his problem.

 

[D.O.Camolf]

The truth is, I’m not sure if anyone can answer 1 or 2 yet simply because the changes that are occurring are so early in the process. It’s very difficult to know where things will be in 4 years. Traditionally, with good scores you could match peds without too much difficulty. Being deferred really depends upon service, specialty, and manpower at the time you apply. Very difficult to predict deferments for most specialties.
Not being a pediatrician, it seems like you can have a fairly satisfying outpatient peds practice in the military. Lots of families, lots of kids. The more subspecialized you become, the harder it will be to maintain your skills. At many small facilities, maintaining inpatient peds skills could also be difficult.
You can opt out right up until you sign the contract, and my understanding is right up until you’ve actually spent a certain amount of time on active duty (but I’m not 100% clear on that second part, as I never did it).

Your recruiter will throw a fit. That’s his problem.

So are they not entirely getting rid of residency positions like peds, just cutting down the number of available spots? Or is this one of those we don't entirely know until it happens.

 

[Mace1370]

So are they not entirely getting rid of residency positions like peds, just cutting down the number of available spots? Or is this one of those we don't entirely know until it happens.

We don’t know.

 

[backrow]

We don’t know.

This may seem like a curt response, but it’s really the truth right now. I’m not even sure the people making decisions at the highest levels have a full answer yet.


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[militaryPHYS]

@militaryPHYS you have a 10 year badge. Who did you used to be?.

I can see it now. USNcorpsman. I got one response from you back in 2007....it was an eyeroll emoji and a "sigh". Thanks for your help so long ago, @Gastrapathy !

 

[Gastrapathy]

Ok. Funny that you couldn’t remember that before but can now. If I rolled my eyes, based on your current persona, I can live with that.

Look, I’m been trying just to ignore post after post from you but it’s hard when a mod and “expert” is spewing away. My recent favorite was that you were too busy to respond because you’re in seventh fleet doing serious things then followed by another 100 posts. My deployments included actual combat zones.

The best part is that every time you argue with one of us, you push the truth back to the top on google. You are singlehandedly insuring that this thread stays at the top and your latest shot at me did it again. Well done shipmate. You saved another person from making a huge mistake today.

 

[militaryPHYS]

Whoa, sorry. That was supposed to be a lighthearted post. I thought you would appreciate the irony. Wasn't trying to take shots at you nor bump anything since it is still active. Thought we could finally laugh at something together. My mistake.

The old name shows up now in my profile as a name change so I just got vis on it.

Any reason I am too busy at my current location is milmed administrative overload as department head and/or traveling around the Pacific on vacation with the family. I don't think I have ever tried to overstate my role or inflate my negligible importance as it relates to anything strategic or operational. Thanks for your service before, during and after your deployments. I'm not sure why we are headed down this defensive rabbit hole since I would never take credit for something I haven't done nor discredit anybody's tours that they have done.

Everyone should read this thread. It has continued long after yours and my last back-and-forth.

 

[DD214_DOC]

So we received this as guidance last year. Perhaps it correlates to the buckets but I kinda doubt it given how many tier 1 there are.
View attachment 247386 View attachment 247387 View attachment 247389

I'm not sure what this relates to, but this isn't the actual, "buckets", recently put out. I'm not going to upload the actual capture of the document since it's FOUO, but from the list I have:

Bucket #1
60A (not a primary specialty)
60C Prev Medicine (???)
60D Occupational medicine (???)
60F Pulm/CC
60N Anesthesia
60W Psychiatry
60S Opthalmology
61H Family Med
61F Internal Medicine
61J Gen Surg
61K Thoracic Surg
61M Orthoped Surg
61N Aerospace Med
61Z Neurosurg
62A EMed
62B "Field Surgeon"

 

[DD214_DOC]

Maybe this has been posted in the thread, but can anyone say what specialties are within each “bucket”? Obviously gen surg, EM, and psych I presume would be in bucket 1 but I haven’t seen an actual breakdown. Is there one?


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See my previous post.

Psych falls into bucket #1 not because of, "writing MEBs", as mentioned above (which we don't actually do, by the way; we refer but not write them) but because of utilization in COSC units and deployability. Psych-related issues are one of the primary things that get people out of theather, and having a shrink downrange -- in theory -- prevents worsening of issues and having to evac a soldier out. Some thought that treating in-theater also keep them in the fight, but I'd argue most probably don't need to stay in the fight if it's progressed to that level.

As far as getting contractors to do the work, this is the same inaccurate argument that is being used to justify the rapidly-increasing loss of psychiatrists and indifference in improving retention. MTFs are more heavily planning to rely on the, "network", of copious psychiatrists and psych subspecialists to fill an increasing need and demand without realizing such networks -- outside of DC -- don't exist. Hiring actions for psychiatrists have gone unfilled for years because the DoD simply cannot compete with the private sector. Why would I remain in the system as a civilian GS making $220k/yr, or maybe $290k as a contractor, while dealing with most of the same bull**** when I can deal with significantly less bull**** for $350k/yr or more?

 

[Matthew9Thirtyfive]

I'm not sure what this relates to, but this isn't the actual, "buckets", recently put out. I'm not going to upload the actual capture of the document since it's FOUO, but from the list I have:

Bucket #1
60A (not a primary specialty)
60C Prev Medicine (???)
60D Occupational medicine (???)
60F Pulm/CC
60N Anesthesia
60W Psychiatry
60S Opthalmology
61H Family Med
61F Internal Medicine
61J Gen Surg
61K Thoracic Surg
61M Orthoped Surg
61N Aerospace Med
61Z Neurosurg
62A EMed
62B "Field Surgeon"

Thanks for that. As someone locked into mil med, it’s nice to know what bucket 1 specialties actually are.

 

[militaryPHYS]

I'm not sure what this relates to, but this isn't the actual, "buckets", recently put out. I'm not going to upload the actual capture of the document since it's FOUO, but from the list I have:

Bucket #1
60A (not a primary specialty)
60C Prev Medicine (???)
60D Occupational medicine (???)
60F Pulm/CC
60N Anesthesia
60W Psychiatry
60S Opthalmology
61H Family Med
61F Internal Medicine
61J Gen Surg
61K Thoracic Surg
61M Orthoped Surg
61N Aerospace Med
61Z Neurosurg
62A EMed
62B "Field Surgeon"

Nice, thanks! We still haven’t heard of any buckets on the Navy medicine side. Most of the chatter about specialties which are safe vs not is related to what is reflected in medmacre and POM20. I’ve also seen slides which acknowledge that to have a functional hospital you also need specialties that support tier 1 specialties but might not be operationally valuable. (I.e radiology, pathology). Common sense but it is nice people are actually talking about it. Whether or not congress is listening is the concern.

 

[Mace1370]

@HooahDOc could you post the bucket 2 and 3 lists also?

 

[dwb8p]

@HooahDOc could you post the bucket 2 and 3 lists also?

i can assure you dermpath is bucket 4 of 3

 

[HighPriest]

What if I'm in a bucket 3 specialty, but I'm willing to do gender reassignment surgery? Because command came by and specifically asked me if I was willing to do gender reassignment surgery for my country. Would that bump me up to a bucket 1? You know how critical that is for our national defense, and it is in no way a political issue.

 

[deuist]

The MTFs will remain some of the best funded, most efficiently run hospitals with some of the best outcomes and graduate medical education programs in the country (Madigan and San Antonio were top ten in surgical residency programs).

In what fantasy world are military hospitals considered efficiently run? They usually suffer from lack of patient load, a frequent overturning of staff every few years, and constant deployments/TDYs for the active duty providers.

Also, what top 10 list are you referring to? If military residency programs were considered so competitive, every civilian out there would be throwing themselves at the Department of Defense to join its GME.

 

[Nmidge]

What about PM&R in army? do they still have pm&r residency?

 

[militaryPHYS]

In what fantasy world are military hospitals considered efficiently run? They usually suffer from lack of patient load, a frequent overturning of staff every few years, and constant deployments/TDYs for the active duty providers.

Also, what top 10 list are you referring to? If military residency programs were considered so competitive, every civilian out there would be throwing themselves at the Department of Defense to join its GME.

I think we are all waiting for a little more elaboration from @Cavalry.

 

[Apollyon]

I think we are all waiting for a little more elaboration from @Cavalry.

Wouldn't that be irony, though, or direct? That is, if the cavalry comes over the hill to save the day?

 

[Gastrapathy]

 

[DD214_DOC]

@HooahDOc could you post the bucket 2 and 3 lists also?

Sure, why not

Bucket #2
OB/GYN, Urology, Pediatrics, ENT, Neurology, Nephrology, Medical Onc/Heme, Infectious Disease, Plastic Surg, Rads, Pathology, Vasc Surg

Bucket #3
Derm, Cards, Allergy/Immuno, Gastro, Endo, Rheum, PM&R, Pediatric Subspecialties, Child Neuro, Clinical Pharmacology, Nuclear Medicine, Rad Onc

 

[HighPriest]

Wow. Vascular is a bucket 2. as is ENT. Not what I would have predicted, for opposite reasons. Also, keep medical heme-onc, but ditch rad onc. Because we need to be able to do everything half-@$$ed.

 

[backrow]

Wow. Vascular is a bucket 2. as is ENT. Not what I would have predicted, for opposite reasons.

In a damage control situation in a resource-limited area is there anything that a vascular surgeon or ENT could provide to save life, limb, or eyesight over a surgeon from a bucket 1 specialties? I’m honestly asking, because I don’t fully know where the general surgeon ability stops in that type of situation and you would absolutely have to have that level of care.

That’s my guess as to how they developed some of these buckets.



Sent from my iPhone using SDN mobile

 

[orbitsurgMD]

Wow. Vascular is a bucket 2. as is ENT. Not what I would have predicted, for opposite reasons. Also, keep medical heme-onc, but ditch rad onc. Because we need to be able to do everything half-@$$ed.

They don't want to have to build/buy the facilities needed to support rad-onc, if I were to guess.

 

[HighPriest]

In a damage control situation in a resource-limited area is there anything that a vascular surgeon or ENT could provide to save life, limb, or eyesight over a surgeon from a bucket 1 specialties? I’m honestly asking, because I don’t fully know where the general surgeon ability stops in that type of situation and you would absolutely have to have that level of care.

That’s my guess as to how they developed some of these buckets.



Sent from my iPhone using SDN mobile

A vascular surgeon can deploy as a general surgeon, and could probably do more to save life or limb (or at least would be better qualified if nothing else). I met a guy once who was on guard duty in front of a physical hospital in Iraq when a car bomb detonated in front of him. Chain link fence lacerated both carotid arteries. But, there was a vascular surgeon in the building. The guy not only survived, but no real neurologic injury. Pretty amazing.

I suppose a general surgeon could do a major vascular repair in a pinch, and to be honest I'm not sure how much more a vascular surgeon would be inclined to do. But they would definitely be qualified to do more if necessary.

ENT: no. Absolutely nothing an ENT doc could do down range that you're not already prepared to do, or that couldn't be sent back stateside for care.

I would have thought vascular would be bucket 1 and ENT would be bucket 3.

 

[HighPriest]

They don't want to have to build/buy the facilities needed to support rad-onc, if I were to guess.

I'm sure. I'm just not sure why you would keep med-onc if that's the case. It's like keeping the bathwater and throwing out the baby. (except for a few situations where things are treated with chemo alone)

 

[militaryPHYS]

I would have thought vascular would be bucket 1 and ENT would be bucket 3.

I would think anything requiring subspecialization (Fellowship) will always be Bucket #2 or #3 because it costs more to DHA to obtain. But Thoracic surgery is listed as Bucket #1? Is that cardiothoracic? Sorry, dumb orthopod here. Why do we need a thoracic surgeon if we have lots of general surgeons trained in basic thoracic surgery for wartime penetrating injuries?

 

[HighPriest]

I would think anything requiring subspecialization (Fellowship) will always be Bucket #2 or #3 because it costs more to DHA to obtain. But Thoracic surgery is listed as Bucket #1? Is that cardiothoracic? Sorry, dumb orthopod here. Why do we need a thoracic surgeon if we have lots of general surgeons trained in basic thoracic surgery for wartime penetrating injuries?

I'm not sure that bird flies. I hear what you're saying, but if you need a specialty you need it. And they're already training them. And I agree, if a vascular surgeon doesn't offer anything new, then neither does a thoracic surgeon.

 

[Gastrapathy]

It just shows how nonsensical this is. Med Onc is never practiced on the battlefield. Someone in the room was an oncologist. Thoracic is CT surgery except the Navy has closed its CT programs due to volume/outcomes.

 

[HighPriest]

It just shows how nonsensical this is. Med Onc is never practiced on the battlefield. Someone in the room was an oncologist. Thoracic is CT surgery except the Navy has closed its CT programs due to volume/outcomes.

For sure. The Army CT guys are suffering basically everywhere. I'm sure they're doing a lot of hearts down range though...

 

[militaryPHYS]

It just shows how nonsensical this is. Med Onc is never practiced on the battlefield. Someone in the room was an oncologist. Thoracic is CT surgery except the Navy has closed its CT programs due to volume/outcomes.

I wonder if these Buckets are what was requested by Army SG going up to DHA vice DHA pushing it down. Because honestly, if it were official guidance from DHA pushing down it would be across all services and not just being talked about in the Army. Plus I heard that congress/DHA isn't even listening to the service SG's....so who knows if these buckets hold any weight. Again, we (Navy) haven't seen anything "official" except for the changes witnessed with MEDMACRE push and POM20.

In other news...ADM bono is starting to get replies on her tweets that are less than supportive. One was about CBD oils so I didn't think much of it, the other was from an Army anonymous-type which was a direct jab at DHA. Waiting to see if she responds and also to see if this is a new trend. I will be keeping my mouth shut of course.

 

[Trefoil]

Like most people I want to serve my country and become a great physician so I applied for the Air Force HPSP and based off of what my recruiter has told me I'm in the final review part of the application. After reading all these posts (which thank you to everybody cause you could be helping me from making a huge mistake or the best decision ever) I have a couple questions if y'all wouldn't mind answering them. I just ask that if you respond please answer all of my questions so I do not have to hunt through multiple replies to get the full answer.

My questions are:

1. I am currently more-so interested in becoming a pediatrician, based off of the upcoming changes what are the chances (low, medium, high) that the air force will not have a residency position for me since they are trying to lower the number of pediatricians they have? If the answer is low, would I have a chance of doing a civilian deferral for a peds residency?

2. Same questions as above but for the following other types of specialties that I have an interest in: family medicine, ICU, PICU, Neurology, Emergency Medicine (would you mind answering for each one specifically so I have a clear answer for each one).

3. If I was able to do a pediatric residency through the air force, would the job with the air force be worth it? I don't mean that in the sense of I am doing this only for the money, but in the sense that I want to serve my county and the families of the men and women who are fighting for my freedom but I don't want to be in a pediatrician that has skill atrophy and does nothing all day due to this upcoming change the military has coming?

4. If based off of the responses I get for all of the questions above would I still be able to opt out of the HPSP application since I'm still under final review and haven't signed any contracts regarding I accept the scholarship?

I understand that some of these residency and fellowship spots are competitive and you need not only high board scores but other things as well, I'm just trying to get a grasp on this before I make any decisions. Like I said above it has been my dream to serve, but based off of this thread I am not sure if I can do a military first, physician second approach if I am going to be (kinda) forced to do GMO (which if it came down to it I wouldn't cry and throw a temper-tantrum it is just not my ideal desire to do that for I would rather become the type of physician I want to become then serve).

Thank you!

I can’t speak to what it is like being a pediatrician; however, the rumor is that specialties not necessary for deployment will no longer be filled with uniformed personnel. The idea is that these support positions will be filled with civilians. That is just a rumor of course, but at my program, there has been a lot of talk that specialties that are not tier one are no longer part of GME. Refer to the list above from HooahDoc. The word is that those tier one specialties are all that will be left (truthfully, you will not be able to support even those residencies without the others).

The general feeling is that this will be the end of military GME for the most part. I’m not sure if that is true, but that is how everyone feels.

 

[Gastrapathy]

The lack of communication is a major failure from senior leadership. The flags have to know that the herd is restless but people are learning more here and at military.com than through the chain. And what they don’t know, they are just making up.

 

[155HE]

I can’t speak to what it is like being a pediatrician; however, the rumor is that specialties not necessary for deployment will no longer be filled with uniformed personnel. The idea is that these support positions will be filled with civilians. That is just a rumor of course, but at my program, there has been a lot of talk that specialties that are not tier one are no longer part of GME. Refer to the list above from HooahDoc. The word is that those tier one specialties are all that will be left (truthfully, you will not be able to support even those residencies without the others).

The general feeling is that this will be the end of military GME for the most part. I’m not sure if that is true, but that is how everyone feels.

GME programs in the military (and anywhere else in the US) will only exist if they adhere to the requirements set forth by the ACGME--including having access to subspecialist faculty members who are interested and engaged in resident education. The new policies seem to move the military away from being able to meet the requirements for some specialties. The change will be difficult.

I haven't posted on this thread yet and have sat watching on the sidelines for a while, but I am in agreement with the title. These are very uncertain times and I would counsel any interested future medical student to think carefully about their priorities before going into military medicine.

 

[pgg]

GME programs in the military (and anywhere else in the US) will only exist if they adhere to the requirements set forth by the ACGME--including having access to subspecialist faculty members who are interested and engaged in resident education. The new policies seem to move the military away from being able to meet the requirements for some specialties. The change will be difficult.

The residency program where I am faculty already sends residents out for about 40% of their clinical experience, mostly subspecialty blocks. We have a solid pediatric and OB case load at the MTF, which includes a fair amount of complicated cases. If we lose some or all of the cases coming from peds/OB/NICU, it will likely create a need for additional away rotations.

I.B.3. The majority of rotations for the anesthesiology program must occur at the sponsoring institution. (Core)

Majority = 51%+

Use of the word "must" and not "should" - this is not a negotiable requirement or a deficiency that can be mitigated beyond correction and compliance.

We are concerned that any significant loss in case load - particularly case load from peds & OB - will leave us unable to meet ACGME minimums.

Moreover,

II.B.6. The members of the faculty must have varying interests, capabilities, and backgrounds, and include individuals who have specialized expertise in the subspecialties of anesthesiology, including critical care, obstetric anesthesia, pediatric anesthesia, neuroanesthesia, cardiothoracic
anesthesia, and pain medicine, and also in research. (Core)

II.B.6.a) Didactic and clinical teaching should be provided by faculty members with documented interests and expertise in the subspecialty involved. (Detail)

as noted here, ACGME has specific requirements (again they use the word "must") for there to be faculty members with fellowship training. With the decision to reduce or eliminate certain fellowships available at the GMESB, this is another looming deficiency.