Transplant Surgery in the Military

[greg.house1408]

Questions about Transplant Surgery sub-specialty in the Army:
1) I know the Army does have a Transplant Surgery fellowship, but so far I have not been able to get any info on the number of spots they have, or whether this is a civilian or military fellowship (partnership between UMB and Walter Reed, so is it civ or mil?).

2) If, after repaying your dues to the Army (6 years for a gen. surg. residency), is it nearly impossible to gain entrance to a civ fellowship, i.e. are you considered competitive or is there a downer on mil. med. candidates, specifically in the surg. sub-specialties?

At this point, I am only looking at a HPSP scholarship, but I want to make sure that there are at least two avenues for me to achieve my goal of transplant surgery in the future, either through a military fellowship or exiting the military after my obligation is up and joining a civilian fellowship. I have contacted several fellowship directors and have gotten mixed opinions on the matter. Anyone who has achieved this would be especially helpful.

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[pgg]

Are there any MTFs that do transplants?

 

[WernickeDO]

Questions about Transplant Surgery sub-specialty in the Army:
1) I know the Army does have a Transplant Surgery fellowship, but so far I have not been able to get any info on the number of spots they have, or whether this is a civilian or military fellowship (partnership between UMB and Walter Reed, so is it civ or mil?).

2) If, after repaying your dues to the Army (6 years for a gen. surg. residency), is it nearly impossible to gain entrance to a civ fellowship, i.e. are you considered competitive or is there a downer on mil. med. candidates, specifically in the surg. sub-specialties?

At this point, I am only looking at a HPSP scholarship, but I want to make sure that there are at least two avenues for me to achieve my goal of transplant surgery in the future, either through a military fellowship or exiting the military after my obligation is up and joining a civilian fellowship. I have contacted several fellowship directors and have gotten mixed opinions on the matter. Anyone who has achieved this would be especially helpful.

If you have a very specific goal for your career, you are always better off avoiding the military. Bear in mind too what is applicable today may not be applicable in 10 years.

 

[psychbender]

Are there any MTFs that do transplants?

Kidney only. You can look up individual hospitals on the Organ Procurement and Transplantation Network for yearly numbers by transplant type. We did a few at Reed and Bethesda while I was a resident there.

I think the fellowship is technically an in-service fellowship, but most of the time is spent at civilian hospitals (like many FTIS fellowships). Regarding getting civilian training after a military surgery residency, if you get selected for FTOS training, programs will likely fall over themselves to get you, as you're free labor. I really don't see why anyone would intentionally join the military and seek this subspecialty. Your skills will be barely utilized during your very long payback, and good luck getting a good transplant surgery job after the military, when you've done only one or two dozen kidneys a year for most of a decade.

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[155HE]

Are there any MTFs that do transplants?

Walter Reed has a transplant service but the volume is generally low and the Transplant Surgeons augment their numbers by practicing at the transplant center in DC (WHC).

 

[Gastrapathy]

Transplant Surgery fellowship is not competitive in the civilian world. The fellows are mostly FMGs. There aren't many desirable jobs though and most graduates don't end up in transplant programs. Plus it sucks. I remember a 4 day period on the liver transplant service where I got to go home and sleep each night and the surgical fellow (from India) never left.

Doing transplant thru the .mil is not going to make you happy. N=2 that I know couldn't get a transplant job when they separated (but they are great general surgeons).

 

[greg.house1408]

I know transplant isn't competitive and that a lot of FMGs apply. I was thinking both of those factors would make it easier to get a fellowship post-military. I've contacted several fellowship directors for their opinion and only Columbia said that they would not consider me competitive if I take a military route.
So the Walter Reed programs generally only see kidney? How much time can you spend at another hospital moonlighting to fill in the case hours?

 

[psychbender]

I know transplant isn't competitive and that a lot of FMGs apply. I was thinking both of those factors would make it easier to get a fellowship post-military. I've contacted several fellowship directors for their opinion and only Columbia said that they would not consider me competitive if I take a military route.
So the Walter Reed programs generally only see kidney? How much time can you spend at another hospital moonlighting to fill in the case hours?

Not generally only kidney, ONLY kidney. They did 48 in 2016 (which is a lot for them), 28 in 2015 (which is still more than I remember doing when I was there a few years ago). Washington Hospital Center actually does fewer kidneys than Reed (18 for both 2016 and 2015), Inova Fairfax does more (88 and 76). In the DC/MD area, anything else would get done at Georgetown, University of Maryland, or Johns Hopkins.

Off-duty employment is at the discretion of your hospital commander and department chief. If, for whatever reason, you piss off one of those two people, you will have requests to moonlight denied. Also, you have no idea what the op-tempo will be like when you complete residency, but at the moment, the directive is that at any given time, 30% of the general surgeons (which is the billet you'd fill) should be deployed. When you're downrange, you will not be winning hearts and minds building a transplant system for the host nation, you will be doing trauma and general surgery. Additionally, transplants don't happen on a predetermined schedule. Even if you were stateside, got ODE approved, and took a couple of days here or there covering transplant call at Georgetown, you might not get anything. If you took a solid week off to cover, you would likely get two livers and four kidneys (they did 117 livers, 205 kidneys, 14 pancreas, 21 kidney/pancreas, and 20 small bowel in 2016), but I do not know how realistic taking a week off and covering call at G-town would be.

Answer these two questions: Why have you decided this early in your training that you want to do transplant surgery? Why do you want to be in the Army?

The Army is a terrible place to be if you want to be a non mission-critical subspecialist. You will put in a lot of time refining your chosen skillset only to see it atrophy as you are under utilized.


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[DeadCactus]

Terrible career plan for the reasons listed above, though the odds of an interest in surgery let alone transplant surgery persisting are slim so I guess it doesn't matter...

 

[greg.house1408]

Answer these two questions: Why have you decided this early in your training that you want to do transplant surgery? Why do you want to be in the Army?

I want to do transplant because my dad died waiting for a liver, I like transplant surgery that I've seen so far, I'm doing transplant research, and I think the compensation helps with the lifestyle demands.
I like the Army for the opportunity to serve my country and for the financial security of having med school paid for and higher residency pay.

 

[psychbender]

Answer these two questions: Why have you decided this early in your training that you want to do transplant surgery? Why do you want to be in the Army?

I want to do transplant because my dad died waiting for a liver, I like transplant surgery that I've seen so far, I'm doing transplant research, and I think the compensation helps with the lifestyle demands.
I like the Army for the opportunity to serve my country and for the financial security of having med school paid for and higher residency pay.

So, which do you value more, serving your country (always vague desire, can be achieved multiple ways), early financial support, or doing transplant work? Sacrificing your long term career for short term financial benefits is a rather poor decision. If you really want to do transplant surgery, do not join the military. Train as a civilian, work at a transplant center, live modestly, pay back your debt. If you still have a burning desire to be in the military, join the reserves. If you want to practice transplant surgery on former soldiers, see about a job at one of the VA medical centers affiliated with a university system that actually does transplant work.

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[ArmyTiger]

If I recall, the army recently stated that it'll no longer train transplant surgeons. The fellowship gives no deployable skills, and no center other than Walter Reed would be able to get enough volume to maintain itself as a transplant center. It made more sense to send transplants to the community instead of pretending that military facilities would be able to maintain competency.

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[greg.house1408]

If I recall, the army recently stated that it'll no longer train transplant surgeons. The fellowship gives no deployable skills, and no center other than Walter Reed would be able to get enough volume to maintain itself as a transplant center. It made more sense to send transplants to the community instead of pretending that military facilities would be able to maintain competency.

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Do you have a source for that? I ask so that I can question the recruiter on it, as that was something I discussed with him a great deal. Also, I am waiting to talk to the program director.

 

[psychbender]

Don't believe a damn thing a recruiter tells you. They either lie, or have no idea what they're talking about.

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[greg.house1408]

Don't believe a damn thing a recruiter tells you. They either lie, or have no idea what they're talking about.

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Well aware, however, in order to refute their source saying that there is and will be a fellowship, I have to have a source to bring to their attention that says otherwise. No good saying that a commenter on SDN said something I can't back up with a source, as I have tried that previously.

 

[backrow]

Well aware, however, in order to refute their source saying that there is and will be a fellowship, I have to have a source to bring to their attention that says otherwise. No good saying that a commenter on SDN said something I can't back up with a source, as I have tried that previously.

There is now way a recruiter would know if there is going to be a particular fellowship available beyond the next year. Fellowship directors don't even know what's going to be offered until the planning committee meets each year and they all agree we need "xyz" doctors. There can be a general idea based on past results, but even things that seem certain aren't. This is especially true given the current NDAA and the feelings that Congress would really like to see drastic changes to military medicine, with some wishing we were out of the GME world all together.



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[SirGecko]

Also remember that nothing that is true about the state of military medicine is ever guaranteed not to change going forward. (And the changes can potentially take effect pretty much overnight sometimes) With the way the most recent NDAA is worded and the DHA has been talking I would hesitate to make a commitment to military medicine if you aren't looking to do something directly related to supporting deployment.

 

[greg.house1408]

Then where did Army Tiger get his information? If there is a source, a meeting of Generals or budgetary staff, I want to know it. But if that's just an impression, then it holds no more weight than what the recruiter's opinion is. My assumption is that Army Tiger has a source, because he seems like a good commentator on SDN.
My goal is not to catch a recruiter in a lie; rather, to ask them about information I have found and see if they have an answer or if I can even educate them. Both of these instances have already occurred, i.e. they were not as aware as I was about the Army even having a transplant fellowship, let alone someone who went through HPSP and received deferments for both residency and fellowship to become a transplant surgeon. I'm not counting on deferments, by the way.

 

[greg.house1408]

Also remember that nothing that is true about the state of military medicine is ever guaranteed not to change going forward. (And the changes can potentially take effect pretty much overnight sometimes) With the way the most recent NDAA is worded and the DHA has been talking I would hesitate to make a commitment to military medicine if you aren't looking to do something directly related to supporting deployment.

But aren't there ways to support deployment or personnel without being a trauma/general/orthopedic surgeon, radiologist, or anesthesiologist? The military has funded a great deal of research into artificial organ development for IED recoveries, which isn't mission critical. Docs over at UCLA have big defense contracts to research and produce artificial urethras and other urogenital structures, but none of those would be mission critical. I hope I'm not coming across as difficult, I just want to make sure that the military isn't a valid option for only orthopedic/trauma/general surgeons, rads, and anesthesiologists. Specifically, what parts of the NDAA and actions from the DHA make it less appealing or beneficial for non-mission critical specialties?

 

[Ziehl-Neelsen]

If I recall, the army recently stated that it'll no longer train transplant surgeons.

I hadn't heard that. It makes sense--the military needs no more than 1-2 transplant surgeons and its easier and simpler to just hire civilians for that job than train military surgeons. The AD military transplant surgeons all did fellowship at civilian institutions and were brought back to Walter Reed. Occasional transplants were done at WRAMC (as is mentioned above) but a lot of their work came from MOUs with Georgetown and U of Maryland Hospital where they were allowed to operate. Here is the link for Walter Reed's GME programs--please note that there is no transplant surgery fellowship listed: Graduate Medical Education Programs - Walter Reed National Military Medical Center

The fellowship gives no deployable skills

Eh. I disagree. Watching an abdominal transplant surgeon perform a redo liver on coagulopathic ESLD patient is pretty impressive. I was in the OR on a case where there was catastrophic graft failure after implantation of the graft on a redo liver and watching the surgeon do an emergent partial hepatectomy with vascular revision on a coagulopathic anhepatic patient in an attempt to save the patient's life was pretty impressive. A lot of the things a transplant surgeon does don't add any tools to the surgical toolbox of a deployed military surgeon, but you can't tell me the above scenario doesn't make a surgeon better equipped to deal with penetrating shrapnel embedded in a soldier's liver. I'm not saying a transplant fellowship is an efficient way to make a surgeon better equipped to operate in a deployed setting, but some of it translates.

no center other than Walter Reed would be able to get enough volume to maintain itself as a transplant center.

SAMMC refers more beneficiaries to transplant than WRAMC and has a higher surgical volume. If the military really wanted to run a transplant program, SAMMC would be the best place. The reason the program is at WRNMMC is because you can't have a transplant program without a histocompatibility laboratory. There is exactly 1 histocompatibility lab in the military and 1 doc board certified in histocompatibility and immunogenetics. The lab and doctor are at Walter Reed--that's why any transplants happen there.

It made more sense to send transplants to the community instead of pretending that military facilities would be able to maintain competency.

Agree. And that would be my decision too, if I ran the world, but as I said above, I have not heard that this is the case. I find it especially ridiculous that the military maintains a transplant program when 1. organ transplantation make a ServiceMember non-deployable and generally leads to a medical discharge and 2. AD Service Members are not allowed to donate organs without the military's permission because it would render a Service Member non-deployable.

So, which do you value more, serving your country (always vague desire, can be achieved multiple ways), early financial support, or doing transplant work? Sacrificing your long term career for short term financial benefits is a rather poor decision. If you really want to do transplant surgery, do not join the military. Train as a civilian, work at a transplant center, live modestly, pay back your debt. If you still have a burning desire to be in the military, join the reserves. If you want to practice transplant surgery on former soldiers, see about a job at one of the VA medical centers affiliated with a university system that actually does transplant work.

This all the OP needs to read. If being a transplant surgeon is the most important thing, steer clear of the military. If military service and government cheese during medical school are more important, then join the military with the knowledge that your plan to be a transplant surgeon may work out, but likely not. There are some pretty good readers of the tea leaves who have replied to you on this thread and told you that your plan is unlikely--I agree with them.

But aren't there ways to support deployment or personnel without being a trauma/general/orthopedic surgeon, radiologist, or anesthesiologist? The military has funded a great deal of research into artificial organ development for IED recoveries, which isn't mission critical. Docs over at UCLA have big defense contracts to research and produce artificial urethras and other urogenital structures, but none of those would be mission critical. I hope I'm not coming across as difficult, I just want to make sure that the military isn't a valid option for only orthopedic/trauma/general surgeons, rads, and anesthesiologists. Specifically, what parts of the NDAA and actions from the DHA make it less appealing or beneficial for non-mission critical specialties?

Dude. Read the forum. The military takes radiation oncologists and sends them to duty stations 200 miles away from the nearest accelerator. If you have specific, subspecialized medical dreams (and transplant surgery is such a dream) and are dead set on these dreams, the military is not for you. If you are flexible and ok with a meandering medical path that may not be exactly what you envisioned, then by all means sign up.

Did any of the old Walter Reeders on the thread find it weirdly disconcerting that the former chair of the transplant surgery department at WRAMC rode a motorcycle (a Ducati if I remember correctly) into Rumbaugh every morning?

 

[Helpful Troll]

@greg.house1408 - Ask your Army AMEDD recruiter how many HPSP DO's matched to General Surgery from Med School in 2016 - Let us know his answer **. Ask your Army AMEDD recruiter how many military obligated Med School graduates in recent years applied to General Surgery but had to choose an alternate residency or TY - you can calculate this number by researching the GME Slideshows from recent years.

If you aren't flexible in specialty options and the timeline to pursue your specialty of choice then don't serve as a Military doctor. Take the loans to retain your options.

Here is the 2016 slideshow. Previous years are still available with a google or SDN search. 2017 is not yet available. https://education.mods.army.mil/MedEd/HPSP/Powerpoint/GMESlideshow2016.pdf

 

[SirGecko]

But aren't there ways to support deployment or personnel without being a trauma/general/orthopedic surgeon, radiologist, or anesthesiologist? The military has funded a great deal of research into artificial organ development for IED recoveries, which isn't mission critical. Docs over at UCLA have big defense contracts to research and produce artificial urethras and other urogenital structures, but none of those would be mission critical. I hope I'm not coming across as difficult, I just want to make sure that the military isn't a valid option for only orthopedic/trauma/general surgeons, rads, and anesthesiologists. Specifically, what parts of the NDAA and actions from the DHA make it less appealing or beneficial for non-mission critical specialties?

I agree, there are tons of ways to support the mission without being in one of the specialties you mention. However that research you are talking about is a defense contract. It's not being done by MILMED doctors. The fact that we can get that research done through contracts is actually more of a point in favor of the position that the military doesn't strictly need their own transplant surgeons.

As for what is concrete in the NDAA I am referencing: Section 749. They want the SECDEF to implement a process to evaluate and eliminate GME programs that do not directly support readiness. Now how much change will actually happen is yet to be seen. They have apparently said before that we need to get rid of GMOs and yet those billets don't seem to be going anywhere anytime soon. My understanding is that the example that the senate committee used to introduce that point was that the military takes care of kids/babies and they don't really see why that needs to be done by military physicians. Listening to Admiral Bono (director of the DHA) talk it sounds like she may agree. The example occupation she threw out there when I hear her talk as a "do we really need this in the military?" was pediatric endocrinology. Are they right? Do we need every type of doctor in uniform to run an effective medical corps? I don't know. There are plenty of people ready to argue the other point (that the military does need things like uniformed pediatrics or OB, etc) but I don't know if I personally have the experience to say what the military should do. The whole takeover of the medical corps by the DHA thing is still very much in flux and uncertain. From my position I can't really say how much change there will actually be. Could be a lot, could be essentially nothing changes. The main point is that you should assume that something could very well change and I would bet if it does it won't be going in the direction of having more sub-specialization.

 

[greg.house1408]

I agree, there are tons of ways to support the mission without being in one of the specialties you mention. However that research you are talking about is a defense contract. It's not being done by MILMED doctors. The fact that we can get that research done through contracts is actually more of a point in favor of the position that the military doesn't strictly need their own transplant surgeons.

As for what is concrete in the NDAA I am referencing: Section 749. They want the SECDEF to implement a process to evaluate and eliminate GME programs that do not directly support readiness. Now how much change will actually happen is yet to be seen. They have apparently said before that we need to get rid of GMOs and yet those billets don't seem to be going anywhere anytime soon. My understanding is that the example that the senate committee used to introduce that point was that the military takes care of kids/babies and they don't really see why that needs to be done by military physicians. Listening to Admiral Bono (director of the DHA) talk it sounds like she may agree. The example occupation she threw out there when I hear her talk as a "do we really need this in the military?" was pediatric endocrinology. Are they right? Do we need every type of doctor in uniform to run an effective medical corps? I don't know. There are plenty of people ready to argue the other point (that the military does need things like uniformed pediatrics or OB, etc) but I don't know if I personally have the experience to say what the military should do. The whole takeover of the medical corps by the DHA thing is still very much in flux and uncertain. From my position I can't really say how much change there will actually be. Could be a lot, could be essentially nothing changes. The main point is that you should assume that something could very well change and I would bet if it does it won't be going in the direction of having more sub-specialization.

Thank you, that was really helpful. I've only been investigating for the past month and a half, so I'm not aware of all these proposed changes. Seems that my wife and family have more to talk about before our decision.

 

[IlDestriero]

Think about it like this...
You want to be a bad ass transplant surgeon, master your skills at place with great training, and then hone your craft working with experts at a center with good volume, and maybe do some research to grow your career and advance the specialty with a big multidisciplinary team.
That's 4 things a hardcore transplant surgeon probably wants.
The .mil will give you zero of those things. You won't get superior training during residency, you may get a super wiz bang civilian fellowship, but you'll suffer skill atrophy as an attending doing low volume kidneys and you won't be working with great mentors and engaging in quality research. Assuming you can augment key skills moonlighting at some other facility over a period of years is a fallacy. Not to mention they may just send you somewhere for a year or longer that offers zero transplant and zero moonlighting opportunities. You're always a general surgeon first, and 2nd, and 3rd in the eyes of the .mil. Transplant guru is around 6th on their list for you, after trauma surgeon, paper pushing administrator.
You don't want to join the .mil if you aspire to be a great transplant surgeon, unless your plans include getting out as fast as you can and going civilian for a fellowship.


--
Il Destriero

 

[dr zaius]

I spent 2 months as a PGY-2 on transplant at WR. Do not do transplant surgery in the military. The transplant surgeons currently in the military will tell you this (except for the ones who care more about being in the military/climbing Admin Mountain than they do being a competent surgeon). One recently got out at 17 years because he could no longer stand it.

The main transplant surgeon at WR is a very good surgeon. He did residency at WR and fellowship at Georgetown. Unlike many people in the military he actually wants to maintain the skills he gained in fellowship. Because of this desire he works- FOR FREE -as essentially a full time transplant attending at GU while managing the WR transplant service. This is an incredibly exhausting lifestyle and taxing on your family life, but he is the best overall surgeon at WR hands down. I had many discussions about this with him and if given the opportunity again he would not have gone the mil route.

The other transplant surgeon that got out had a similar agreement at JHU where he kept his skills up. Again, this is worse than even the standard transplant surgeon lifestyle. He would not do it again either.

WR does only kidney transplants, and they're pretty low volume at that. Liver transplants generally go to GU because our ICUs can't handle a patient with the potential to get as sick as they can get. The only operations I did on transplant at WR were kidneys, AV fistulas, some incisional hernias on post transplant patients, a couple of liver resections, and a smattering of other odds and ends. I was able to go on multiple procurements with the GU fellow which was awesome, and scrub livers/small bowel transplants at GU. Seeing how GU functions compared to WR was eye opening. Do not do transplant in the military.

There is also the potential for deployment- I've seen both of those guys deploy. They are gone for an extended period of time and they are not doing transplants. They are hardly doing any cases on deployment these days overall, with the last general surgery attending who came back performing around 6 total operations. I don't know about any non-deployable status for transplant, but I have seen them deploy in the recent past. Honestly I'd rather have the transplant surgeon in the trauma bay down range than the bariatric surgeon if I came in with an intra-abdominal catastrophe.

Overall, do not do transplant in the military. In order to maintain skills to be a legitimate transplant surgeon you're going to have to work even more hours/week than a normal transplant surgeon. You're going to have a bad time.

 

[greg.house1408]

I spent 2 months as a PGY-2 on transplant at WR. Do not do transplant surgery in the military. The transplant surgeons currently in the military will tell you this (except for the ones who care more about being in the military/climbing Admin Mountain than they do being a competent surgeon). One recently got out at 17 years because he could no longer stand it.

The main transplant surgeon at WR is a very good surgeon. He did residency at WR and fellowship at Georgetown. Unlike many people in the military he actually wants to maintain the skills he gained in fellowship. Because of this desire he works- FOR FREE -as essentially a full time transplant attending at GU while managing the WR transplant service. This is an incredibly exhausting lifestyle and taxing on your family life, but he is the best overall surgeon at WR hands down. I had many discussions about this with him and if given the opportunity again he would not have gone the mil route.

The other transplant surgeon that got out had a similar agreement at JHU where he kept his skills up. Again, this is worse than even the standard transplant surgeon lifestyle. He would not do it again either.

WR does only kidney transplants, and they're pretty low volume at that. Liver transplants generally go to GU because our ICUs can't handle a patient with the potential to get as sick as they can get. The only operations I did on transplant at WR were kidneys, AV fistulas, some incisional hernias on post transplant patients, a couple of liver resections, and a smattering of other odds and ends. I was able to go on multiple procurements with the GU fellow which was awesome, and scrub livers/small bowel transplants at GU. Seeing how GU functions compared to WR was eye opening. Do not do transplant in the military.

There is also the potential for deployment- I've seen both of those guys deploy. They are gone for an extended period of time and they are not doing transplants. They are hardly doing any cases on deployment these days overall, with the last general surgery attending who came back performing around 6 total operations. I don't know about any non-deployable status for transplant, but I have seen them deploy in the recent past. Honestly I'd rather have the transplant surgeon in the trauma bay down range than the bariatric surgeon if I came in with an intra-abdominal catastrophe.

Overall, do not do transplant in the military. In order to maintain skills to be a legitimate transplant surgeon you're going to have to work even more hours/week than a normal transplant surgeon. You're going to have a bad time.

Thank you, that was a really helpful reply. I'm glad I found someone who did a rotation through WR. It's starting to look more negative on the mil decision. Sounds like I'd basically have to be a gen surg only and try to get a residency out of military after payback is done if I took the mil route

 

[Homunculus]

The example occupation she threw out there when I hear her talk as a "do we really need this in the military?" was pediatric endocrinology. Are they right?

which is interesting because that's the fellowship (along with peds neurology) that was labeled to be axed after their recent GME review. somehow other peds subspecialties survived-- but for who knows how long. they've threatened for years to close down more. endo and neuro aren't totally dead (apparently some kind of review must occur) but like princess bride, are mostly dead once their current fellows graduate. I think the model is going to be toward civilian fellowships-- if they are paid don't these give them extra obligated years?

my view is either do dependent care or don't. this half-@ss system we have at the moment is the most expensive and least efficient option. just cut all peds loose- many would come back as GS or contract anyway. but, that would eliminate a large pool of battalion and brigade surgeons.

and just a heads up, but at Arifjan the surgeons don't even have a capable OR. they can do emergency laparotomies but otherwise things like appys and GBs are going to host nation. great use of resources. and that is at a CSH no less.

--your friendly neighborhood sprained ankles and back pain treating caveman

 

[Gastrapathy]

and just a heads up, but at Arifjan the surgeons don't even have a capable OR. they can do emergency laparotomies but otherwise things like appys and GBs are going to host nation. great use of resources. and that is at a CSH no less.

--your friendly neighborhood sprained ankles and back pain treating caveman

wait what?

 

[Homunculus]

wait what?

i **** you not. i'm as dumbfounded as you are. apparently it has to do with the OR at Arifjan not being up to standard. our deployed surgeons can do "dirty" procedures-- incision/drainage, seton placement, fistulotomy, exam under anesthesia, testicular torsion and laparotomy for perforated hollow viscous. ortho and OB are similarly hamstrung. we've evac'd out gallbladders and appys and they go host nation. i don't want to know how much money that costs. and i can't imagine to understand the frustration of the surgeons who are deployed and literally can't do their job. i think there's something in the works for an MOU for them to use host nation OR, but that's probably a logistical nightmare when it comes to staffing, sterilization, equipment, etc.

you'd never guess we've been over here 15 years. it is madness.

i'm submitting an exception to policy memo to try to split my deployment for skill atrophy and my hospital hemorrhaging all new consults to the network (my partner is booked solid with followups now) along with a few other reasons. and while i do this, soldiers are routinely going into/out of theater for schools, PCSing, high school graduations, paternity, leave, etc etc. the line doesn't really care-- they view us like MEDCOM selectively views us-- a doc is a doc. but for some reason there's this insecurity or wanting to "look good" so they've made splitting an ortho/ent/surgical sub thing only. you know, the "some are more equal than others" argument, lol.

--your friendly neighborhood ingrown toenail removing caveman

 

[deleted707454]

@greg.house1408 - Ask your Army AMEDD recruiter how many HPSP DO's matched to General Surgery from Med School in 2016 - Let us know his answer **. Ask your Army AMEDD recruiter how many military obligated Med School graduates in recent years applied to General Surgery but had to choose an alternate residency or TY - you can calculate this number by researching the GME Slideshows from recent years.

If you aren't flexible in specialty options and the timeline to pursue your specialty of choice then don't serve as a Military doctor. Take the loans to retain your options.

Here is the 2016 slideshow. Previous years are still available with a google or SDN search. 2017 is not yet available. https://education.mods.army.mil/MedEd/HPSP/Powerpoint/GMESlideshow2016.pdf

That slideshow is really helpful. Do you know where I could find other branches' information like this?

 

[Helpful Troll]

That slideshow is really helpful. Do you know where I could find other branches' information like this?

Google nmetc note 1524 for 'some' Navy information. It is last years guidance and does not indicate the fill rate or test scores.

Here is an AMSUS webinar document that provides some data for AF. http://www.amsus.org/wp-content/uploads/2016/01/WebinarPresentation_pdf.pdf This does appear to have fill rates and test scores.

 

[greg.house1408]

The overall recommendation is to stay away from military for any sub-specialty surgical fields that are not mission critical, i.e. critical care and trauma. The idea of getting out of the military after completing your obligation and then going for a surgical fellowship in civilian practice is also a no go?

 

[Gastrapathy]

The overall recommendation is to stay away from military for any sub-specialty surgical fields that are not mission critical, i.e. critical care and trauma. The idea of getting out of the military after completing your obligation and then going for a surgical fellowship in civilian practice is also a no go?

Not a no-go. Just hard. You'll owe ~5+ years after residency and by the time you finish that, most people aren't excited about going back to fellowship (particularly one as excruciating as transplant).

 

[HighPriest]

People do go to surgical fellowships after their ADSO, but I can attest that it is harder to cling to that idea the more time that passes. Plus, while the military experience does seem to help on a resume, once you're out you lose that "free labor" quality that all but guarantees a military doc a fellowship wherever he wants to go.