Very Competitive Specialties and chances of residency in the military

[JamesSink]

Say that you are an average or slightly above average medical student at a DO school. There is a pretty slim chance of you landing a residency in a competitive field such as derm, ortho, etc. However lets say that you really want to do a residency of this type. Would one be better served to do the HPSP scholarship and probable GMO and eventually (because of your time served) have a better chance of landing a competitive residency post deployment. (Yes I know you will have an increase in total service time) Or are you just kidding yourself and even with a GMO tour you really still have a very slim chance of landing a competitive residency spot?

Also is anyone aware of if the army has switched to 6 month deployments for physicians or are they still deployed for 12 to 13 months.

Thanks everyone.

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[a1qwerty55]

Say that you are an average or slightly above average medical student at a DO school. There is a pretty slim chance of you landing a residency in a competitive field such as derm, ortho, etc. However lets say that you really want to do a residency of this type. Would one be better served to do the HPSP scholarship and probable GMO and eventually (because of your time served) have a better chance of landing a competitive residency post deployment. (Yes I know you will have an increase in total service time) Or are you just kidding yourself and even with a GMO tour you really still have a very slim chance of landing a competitive residency spot?

Also is anyone aware of if the army has switched to 6 month deployments for physicians or are they still deployed for 12 to 13 months.

Thanks everyone.

I think you have a better chance in the military as GMO time does increase your chances -

deployments 6 months to a combat support hospital, 12 months is deploying as a GMO to a line unit.

 

[J-Rad]

The problem is this: at least in the Navy*, those competetive specialties (Ortho, ENT, EM [which is far more competetive in the .mil than in civ], derm, etc.) take almost no one out of medical school. An extraordinarily high number do an almost-requisite GMO tour to get a position. So now you're just competing with people who also did a GMO and came in with stellar stats. While the Army might be less inclined to make almost everyone in a certain specialty go GMO first, my bet is that the applicant pool will still contain plently of returning GMOs who were just under the "superstar" class to get a spot out of med school, but were still exceptionally good students. My educated guess would be that the .mil only makes it nominally "easier" to get a competetive spot. Just the sheer number of programs that exist outside (both MD and DO) in excess of those in the .mil probably would make up for and exceed that nominal benefit. I would speculate that, for competitive specialties, the .mil only provides substantial benefit for the exceptional student, i.e. the one who would have a shot at all DO programs, some of the MD programs, but not the MD programs that would routinely circular-file apps from DO candidates. This would lead to another tier of necessary thinking: for those specialties in which the .mil has well respected training programs on par with good civ residencies (e.g. ortho in the Navy and Army seems pretty well respected; know less of AF), this might make sense. But for EM (which many would argue does not have anywhere near the quality of good civilian programs in all branches)? But this thinking may be too far in the weeds, so leaving it behind...

*Disclosure: this is only meant as a speculative opinion and my knowledge of Navy specialties is based on interactions with those in the specialties while training as an AF resident in a Navy hospital.

 

[orbitsurgMD]

Would one be better served to do the HPSP scholarship and probable GMO and eventually [. . .] have a better chance of landing a competitive residency post deployment. [ . . . ] Or are you just kidding yourself and even with a GMO tour you really still have a very slim chance of landing a competitive residency spot?

Hard to tell. On one hand, the GMO time will give you some leg up over applicants wanting straight-through training, but for derm and ortho and anything similar, the overwhelming number of applicants will have done GMO time as well. So the advantage is limited, and relative to the typical military applicant field, possibly nil. The HPSP will relieve you of large educational debts. Depending on the service branch, you may or may not have a high probability of having a GMO assignment. If Navy, the chances are probably greater than with the AF or Army.

If your objective is getting a derm residency, for instance, your chances in or out of the military depend on the strength of your overall application. As an osteopathic graduate, you will probably have a relatively better chance in the military as an applicant than as an allopathic graduate, where there are many more programs in the civilian community relative to those in the military (understanding that as a D.O grad, you still can apply to both osteopathic and allopathic programs, but doing research or clerkships with an allopathic program will be more difficult for you, and in fields like derm, these things can help)

 

[AF M4]

I echo the above, and will add one significant thing. The .mil, particularly the AF, is slowly but surely trying to extricate itself from the whole healthcare moneypit and that means closing down large hospitals and by extension military residencies. For instance, most of the military residencies at Wilford Hall in San Antonio have to spend significant time rotating through civilian hospitals to get adequate training.

What this means is that the AF puts more and more emphasis on civilian-deferred residencies. Works like this:

Say the AF forecasts that it wants 20 orthopods in a few years. So it looks at the .mil residencies, and it has space to train 5 orthopods in those slots next year. There are 30 AF applicants for ortho.

The AF then takes its top 20 applicants for ortho (by the points system) and tosses 5 into those .mil residencies.

To the other 15 it says, ok, you guys get a 4 year pass from active duty. Go into the regular ERAS match and find a spot in the civilian world. See you when you get back. (Oh and if you don't find a spot, either pick a different residency or back to GMO world).

So to a very important extent, if your application is not good enough for a particularly competitive residency in the civilian world then GMO time in the .mil isn't going to help you because the military is simply farming out most of its applicants to the civilian world anyway.

In general, you are much better off taking a transitional year, research or something similar in the civilian world and reapplying in a year rather than committing yourself to the military for the better part of a decade and for no significant change in your chances.

 

[Gastrapathy]

Some people who are less competitive manage to get competitive residencies in the Navy due to sheer relentlessness. Multiple GMO tours and application cycles. No guarantees though.

The competitive IM subs will sometimes take people this way too (but that = GMO tour + residency + utilization tour or two before fellowship).

 

[AF M4]

Some people who are less competitive manage to get competitive residencies in the Navy due to sheer relentlessness. Multiple GMO tours and application cycles. No guarantees though.

The competitive IM subs will sometimes take people this way too (but that = GMO tour + residency + utilization tour or two before fellowship).

Exactly.

One gets the impression that there are people out there trying to recruit docs into the military with the promise that they'll get into residencies that they wouldn't get into in the civilian world. This is, for the most part, a myth and medical students should not join the military believing that it's their guaranteed route to a derm residency or something similar.

 

[Ziehl-Neelsen]

It's a dicey proposition... You will be relying on tenacity and a (supposed) love of a specialty you may not match into to sustain you during some lean times. If you are smart and a hard worker who just happens to test poorly, you may have a better shot at impressing as a GMO and getting a spot, but many convince themselves that they posess these qualities when in reality they are just not as able as their peers.

I worked with a resident who wanted radiology and spent 2 GMO tours in Korea to make it happen. Radiology blithely denied his application each time and he ended up in another specialty. I have also had the chief of derm at my institution tell me to my face that he would rather have and unfilled spot in his program than take an "inferior candidate who found a backdoor into derm."

Furthermore, if you join the 2 services that give the best shot at a competetive residency (Army and Navy) you deploy only as a unit attached GMO, i.e. there is no spot at a CSH for an internship trained GMO. Thus, your deployment will last as long as your unit is in country. And as long as you stay a non-board certified GMO you'll never move beyond O-4.

People who join the med corps without a serious desire to be in the military and serve the line generally aren't happy with their obligation and GTFO at the earliest opportunitty. And these are the ones who have everything go their way; the ones who spend extended time in GMO-land and repay their obligation there are exceptionally bitter.

Think long and hard about this please.

 

[AF M4]

Smart people in derm getting snitty about their specialty always cracks me up. Yes, it's a lifestyle specialty and you have to rock the boards to get in, but then once you're in you learn a thousand and one different names for a rash followed by the following treatment algorithm:

If you can cut it off, cut it off.

If not, try rubbing antibacterial/antifungal/steroid cream in some order on it. If you get bored, try different potencies of steroid creams for awhile. Then go to ointments.

If that doesn't work, try Eucerin.

If none of that works, treat for syphilis and call it a day.

 

[orbitsurgMD]

It's a dicey proposition... You will be relying on tenacity and a (supposed) love of a specialty you may not match into to sustain you during some lean times. If you are smart and a hard worker who just happens to test poorly, you may have a better shot at impressing as a GMO and getting a spot, but many convince themselves that they posess these qualities when in reality they are just not as able as their peers.

I worked with a resident who wanted radiology and spent 2 GMO tours in Korea to make it happen. Radiology blithely denied his application each time and he ended up in another specialty. I have also had the chief of derm at my institution tell me to my face that he would rather have and unfilled spot in his program than take an "inferior candidate who found a backdoor into derm."

Furthermore, if you join the 2 services that give the best shot at a competetive residency (Army and Navy) you deploy only as a unit attached GMO, i.e. there is no spot at a CSH for an internship trained GMO. Thus, your deployment will last as long as your unit is in country. And as long as you stay a non-board certified GMO you'll never move beyond O-4.

People who join the med corps without a serious desire to be in the military and serve the line generally aren't happy with their obligation and GTFO at the earliest opportunitty. And these are the ones who have everything go their way; the ones who spend extended time in GMO-land and repay their obligation there are exceptionally bitter.

Think long and hard about this please.

To the OP:

If your purpose is to get a very competitive residency slot, like derm, and you are wanting to sign up without a scholarship as a middling D.O. graduate, I would have to tell you that the odds are quite low that your plan will work out like you hope. Your desire and enthusiasm are not going be enough, I'm afraid, and adding a GMO tour or two won't likely change your competitiveness all that much. I really think joining the military is not going to give you the opportunity you would want if you are not also competitive as a civilian. I may have misled you above by suggesting your chances might be relatively better in the military; that is true as long as you also understand that I don't think your chances are necessarily very good, in absolute terms. The downside of doing GMO duty when it doesn't really add to your chances of getting the training slot you want, and you aren't getting HPSP payoff in the process is really significant.

To Z-N

As for the observation about "bitterness" among those who spent their repayment as GMOs, that is really relative to when many were recruited to the program. Pre-SDN, the information and feedback was pretty scant, and a lot of recruiters really did sell the scholarship on the training opportunities which, at one time, were more certain and more plentiful, at least in the Navy, than they now are. For those recruited, honestly or not, and were present during the substantial reductions in residency training slots that followed the advent of CHAMPUS and Tricare, when retirees were turned away from the milmed system, the disappointment was very real and the bitterness justifiable; they were sold a bill of goods. The scholarship money wasn't the only thing offered in the deal; the training was also, until it was effectively taken away.

 

[DoctaJMa]

Smart people in derm getting snitty about their specialty always cracks me up. Yes, it's a lifestyle specialty and you have to rock the boards to get in, but then once you're in you learn a thousand and one different names for a rash followed by the following treatment algorithm:

If you can cut it off, cut it off.

If not, try rubbing antibacterial/antifungal/steroid cream in some order on it. If you get bored, try different potencies of steroid creams for awhile. Then go to ointments.

If that doesn't work, try Eucerin.

If none of that works, treat for syphilis and call it a day.

 

[backrow]

And as long as you stay a non-board certified GMO you'll never move beyond O-4.

But who the heck would stay around the 4-6yrs of O3 and then the 6yrs or so as an O4 and not go to a residency. I've never heard of someone staying for 9-10yrs as a GMO, you'd have a better shot at that point of going RAM and then reapplying for the competitive specialty and that would take less time.

 

[Ziehl-Neelsen]

Smart people in derm getting snitty about their specialty always cracks me up.

They crack me up too with their preening about about the skin being the largest organ in the body and skin cancer being the most common malignancy, but there is a method to their madness. They keep demand for their specialty high by not overtraining and accept smart, well-spoken, gregarious, and pulchritudinous residents. The result is a specialty populated by intelligent, political docs who defend and expand the specialty's turf while ensuring that it will remain at the top of the heap in the upcoming reimbursement wars.

You can be sure dermies would never stand for the hatchet job the NY Times recently pulled on my specialty, midlevel derm providers, or MOHS usurpation by surgeons.

I find their specialty tedious and their rationilizations (regarding their specialty's importance) amusing, but I am thoroughly impressed by their PR coups.

 

[Ziehl-Neelsen]

But who the heck would stay around the 4-6yrs of O3 and then the 6yrs or so as an O4 and not go to a residency. I've never heard of someone staying for 9-10yrs as a GMO, you'd have a better shot at that point of going RAM and then reapplying for the competitive specialty and that would take less time.

Agreed. This is not a common scenario.

Yet I know a resident who spent a significant amount of time in GMO-land, left a specialty he felt was a bad fit as an upper level resident, spent more time in GMO-land as pennance, decided to match to a different specialty in the military due to family/financial issues, and has been passed over twice for O-5 due to not being board certified in anything.

Under the Navy's up or out policy he'll probably serve out his commitment as a terminal O-4. Just something for the OP to consider.

 

[orbitsurgMD]

But who the heck would stay around the 4-6yrs of O3 and then the 6yrs or so as an O4 and not go to a residency. I've never heard of someone staying for 9-10yrs as a GMO, you'd have a better shot at that point of going RAM and then reapplying for the competitive specialty and that would take less time.

I knew a couple of people like that. Usually their motivation is geographic, they are homesteading and don't want to move and probably aren't all that professionally ambitious (you would have to be not to want to do a residency.)
It can be not so much fun to be working with these people because they become vulnerable to the threat of relocation orders, which can make them at once somewhat senior and at the same time treacherously compliant.

 

[orbitsurgMD]

They crack me up too with their preening about about the skin being the largest organ in the body and skin cancer being the most common malignancy, but there is a method to their madness. They keep demand for their specialty high by not overtraining and accept smart, well-spoken, gregarious, and pulchritudinous residents. The result is a specialty populated by intelligent, political docs who defend and expand the specialty's turf while ensuring that it will remain at the top of the heap in the upcoming reimbursement wars.

You can be sure dermies would never stand for the hatchet job the NY Times recently pulled on my specialty, midlevel derm providers, or MOHS usurpation by surgeons.

I find their specialty tedious and their rationilizations (regarding their specialty's importance) amusing, but I am thoroughly impressed by their PR coups.

They are eventually going to be made vulnerable as surgeons devise alternative pathway methods to encroach on selected areas of their practice. Mohs is probably the most likely, as it will take only an enterprising pathology and surgery or plastic surgery department to construct a Mohs fellowship that isn't under the American Board of Dermatology control but instead under the American Board of Surgery or the American Board of Plastic Surgery instead.

No one will fight them for rashes and acne. But oncology will be different, as there is already an established alternative community that deals with skin cancers.

Derm can advocate as they wish. Their main card to play is they don't need hospital affiliation to enjoy the full range of their practice, and they have so effectively exercised their professional family planning that many dermatologists can fill their schedules while accepting neither Medicare nor any other carrier's plans and their credentialing requirements. It is about as good and independent a setup as you can have in medical practice.

 

[Chonal Atresia]

Dermatologists calling themseleves "skin surgeons" is an absolute joke. I am a board-certified ENT and member of the ACS. These doctors have NO clue how to perform local reconstructive flaps to reconstruct defects on the head and neck. Representing themselves otherwise is a disgrace. Anybody can make a hole and whack ouit a skin cancer. On top of that, they're lazy. The derms at my institution see 1 patient an hour with a 3 month wait! Meanwhile, I see a patient every 15 minutes and gladly "steal" their skin cancer cases. Pathetic.

 

[AF M4]

They crack me up too with their preening about about the skin being the largest organ in the body and skin cancer being the most common malignancy, but there is a method to their madness. They keep demand for their specialty high by not overtraining and accept smart, well-spoken, gregarious, and pulchritudinous residents. The result is a specialty populated by intelligent, political docs who defend and expand the specialty's turf while ensuring that it will remain at the top of the heap in the upcoming reimbursement wars.

You can be sure dermies would never stand for the hatchet job the NY Times recently pulled on my specialty, midlevel derm providers, or MOHS usurpation by surgeons.

I find their specialty tedious and their rationilizations (regarding their specialty's importance) amusing, but I am thoroughly impressed by their PR coups.

Ha! I always hated that Riddler-esque question of what's the largest organ of the body. The people who spout that gibberish are the same ones who like to tell you about how Greenland is really icy and Iceland is really green.

It takes a special type of person to smugly advertise their treasure trove of random factoids as actual knowledge while truly believing that other people buy their charade and don't think that they're a d-bag.

Also, congrats on the successful use of the word "pulchritudinous." Respect.

 

[AF M4]

I knew a couple of people like that. Usually their motivation is geographic, they are homesteading and don't want to move and probably aren't all that professionally ambitious (you would have to be not to want to do a residency.)
It can be not so much fun to be working with these people because they become vulnerable to the threat of relocation orders, which can make them at once somewhat senior and at the same time treacherously compliant.

They also tend to be quite dangerous because they're typically lazy and know all the shortcuts.

For instance, had this one guy at my clinic, some O-5 select who was perfectly happy not doing a residency. He'd been seeing this pilot for hypertension for the past couple of years; I saw him one day because I was covering clinic.

BP: 155/90, medications: HCTZ 100mg TID.

Thinking this was a misprint, I asked confirmed both the meds and the dosage with the patient. The O-5 had been increasing his HCTZ from 25mg daily to the current dose for the past 18 months. The patient had also been noticing some significant side effects.

Why was the O-5 doing this? Because if you put a pilot on two anti-hypertensive medications, you have to write a new waiver for him to fly with the meds. Takes about 15-20 minutes. But the perma-GMO didn't want to go to the trouble, so he just kept cramming HCTZ down the poor dude's throat.

This O-5 is gone now, but last I heard he was bucking for O-6 below the zone.

 

[orbitsurgMD]

. . . use of the word "pulchritudinous." Respect.

Heck, they got some good lookin' women, too.

 

[orbitsurgMD]

. . . but last I heard he was bucking for O-6 below the zone.

I knew one who went all the way to 0-6 never having done anything else but a squadron flight surgeon job. He got backdoor grandfathered to board-eligibility status from having done two years of a surgery residency in a friendly northerly neighboring country that rendered him eligible to sit for the EM boards in that same cheerful, orderly land, which was recognized by the USN, so he got board-certification pay, too.

 

[skatertudoroga]

It's a dicey proposition... You will be relying on tenacity and a (supposed) love of a specialty you may not match into to sustain you during some lean times. If you are smart and a hard worker who just happens to test poorly, you may have a better shot at impressing as a GMO and getting a spot, but many convince themselves that they posess these qualities when in reality they are just not as able as their peers.
.

Hey can u tell a little more about these qualities? Let's say I have a very high step1. But I don't interview well or there is something that makes people dislike me. I feel if I just go to a DO school, or even MD, I might not have the charisma or confidence to match as a civilian. Perhaps I could gain some confidence and people skills by doing a GMO tour. But what during the GMO tour would demonstrate that you are "smart" or whatever? Also I understand the minimal tour for dive or flight surgeons is 3yrs. While working as a GMO on some frigate in Italy or Spain is 2yrs. Would those assignments be rated equally when you try to match into ortho residency? Are you supposed to get a glowing recommendation from some ship commander during your GMO or are you supposed to get some time at a hospital and get a recommendation from some big shot doctor? I understand if you serve a tour in some war zone you can do something heroic and get points that way but what if there is no war when I apply. How are you evaluated then? Do most successful ortho applicants in the navy have 2yrs or 3 or 4 as GMO?

 

[orbitsurgMD]

Hey can u tell a little more about these qualities? Let's say I have a very high step1. But I don't interview well or there is something that makes people dislike me. I feel if I just go to a DO school, or even MD, I might not have the charisma or confidence to match as a civilian. Perhaps I could gain some confidence and people skills by doing a GMO tour. But what during the GMO tour would demonstrate that you are "smart" or whatever? Also I understand the minimal tour for dive or flight surgeons is 3yrs. While working as a GMO on some frigate in Italy or Spain is 2yrs. Would those assignments be rated equally when you try to match into ortho residency? Are you supposed to get a glowing recommendation from some ship commander during your GMO or are you supposed to get some time at a hospital and get a recommendation from some big shot doctor? I understand if you serve a tour in some war zone you can do something heroic and get points that way but what if there is no war when I apply. How are you evaluated then? Do most successful ortho applicants in the navy have 2yrs or 3 or 4 as GMO?

How old are you?