Very Important Information for HPSP Medical Students

[The White Coat Investor]

This link was provided in another thread, but I thought it sufficiently important to point out on its own link. It links to the scoring system used in the military match. This is very important for you to understand as you go through the process so you have the highest possible chance of getting to do what you want. The link is found here:

http://airforcemedicine.afms.mil/id...nEducation&doctype=subpage&docname=CTB_047647

Click on 2007 Sample Scoring Sheets

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[West Side]

I've never seen that sheet before. But the math is pretty illuminating.

For instance, ceteris paribus, a candidate with "good" ratings for med school and steps 1&2 is the equivalent of a person who's done a good job in their operational tour, but was completely unsatisfactory in med school and on their USMLE 1&2.

Similarly, someone whose med school and test prep was a haze of bong water and Tanquaray, but did great in a GMO is the equivalent to a kid who rocked the socks off their four years.

I didn't realize how much more important the military considered post-intern year work. Very interesting.

 

[AF M4]

Bingo.

 

[sethco]

I've never seen that sheet before. But the math is pretty illuminating.

For instance, ceteris paribus, a candidate with "good" ratings for med school and steps 1&2 is the equivalent of a person who's done a good job in their operational tour, but was completely unsatisfactory in med school and on their USMLE 1&2.

Similarly, someone whose med school and test prep was a haze of bong water and Tanquaray, but did great in a GMO is the equivalent to a kid who rocked the socks off their four years.

I didn't realize how much more important the military considered post-intern year work. Very interesting.

Amazingly well said.

 

[sethco]

This link was provided in another thread, but I thought it sufficiently important to point out on its own link. It links to the scoring system used in the military match. This is very important for you to understand as you go through the process so you have the highest possible chance of getting to do what you want. The link is found here:

http://airforcemedicine.afms.mil/id...nEducation&doctype=subpage&docname=CTB_047647

Click on 2007 Sample Scoring Sheets

Question about that scoring sheet...

I thought people that were given a 1 year deferment for transitional year (i.e Applied previously to the JSGME and was not given residency), had to complete a minimum 2 year FS/GMO tour. Has this changed? I don't think it has.

 

[IgD]

For instance, ceteris paribus, a candidate with "good" ratings for med school and steps 1&2 is the equivalent of a person who's done a good job in their operational tour, but was completely unsatisfactory in med school and on their USMLE 1&2.

I suggest a fairer analogy would be a physician who has done a good job on a operational tour and had average academic performance. Such a candidate might be perceived as more competitive than someone fresh out of internship with great academics and no operational tour.

 

[monkeybaronjr]

Does the Army use the same scoring system or a similar one?

Along those same lines, would you expect the Army's more "competitive" residency slots to be mostly filled by returning GMOs? Or, since there are relatively less Army GMOs in general, AND there are typically more Army residency slots available, then there would be multiple competitive residency slots left open? Does this make sense?

 

[Gastrapathy]

The link won't last forever and this is absolutely critical information for applicants (great catch). I've had the numbers explained to me but never seen the scoresheet beore. This illustrates that as a current resident, you lose 9 potential points when compared to a staff (max 7 pts on residency for current residents vs 10 for staff) on fellowship applications.

Is there any way to upload that text file and make it a sticky with a more specific thread title? Also, can anyone get the "guidance" link to work? It would be interesting to see what parameters exist for the different scores.

To the last poster, yes the Army uses the same system, this is the Joint GMESB scoresheet. Of note, its not just GMOs that get points for operational or utilization tours, you can get those points as a staff physician prior to fellowship application.

 

[Gastrapathy]

Question about that scoring sheet...

I thought people that were given a 1 year deferment for transitional year (i.e Applied previously to the JSGME and was not given residency), had to complete a minimum 2 year FS/GMO tour. Has this changed? I don't think it has.

At least for the Navy, you can apply but are unlikely to be selected. See section 5(b) of BUMEDNOTE 1524 on this webpage:
http://nmmpte.med.navy.mil/gme/INSTRUCTIONS1.htm

 

[West Side]

I suggest a fairer analogy would be a physician who has done a good job on a operational tour and had average academic performance. Such a candidate might be perceived as more competitive than someone fresh out of internship with great academics and no operational tour.

Uh, not according to this scoring sheet.

Good performance on an operation tour gets you 3 points, which is the same as "good" performance on both "pre-clinical years of med school (including Step 1/COMLEX)" and "Clinical years of med school (including Step 2/COMLEX)". Unsatisfactory academic performance results in no points. So, to review:

Good GMO = 3 points
Unsatisfactory med school and USMLE = 0 points
Total = 3

Good Pre clinical/Step 1 = 1 point
Good Clinical/Step 2 = 2 points
Total = 3

What you've said is correct, but it is staggering that two candidates with these two backgrounds would be considered equivalent.

 

[sethco]

Uh, not according to this scoring sheet.

Good performance on an operation tour gets you 3 points, which is the same as "good" performance on both "pre-clinical years of med school (including Step 1/COMLEX)" and "Clinical years of med school (including Step 2/COMLEX)". Unsatisfactory academic performance results in no points. So, to review:

Good GMO = 3 points
Unsatisfactory med school and USMLE = 0 points
Total = 3

Good Pre clinical/Step 1 = 1 point
Good Clinical/Step 2 = 2 points
Total = 3

What you've said is correct, but it is staggering that two candidates with these two backgrounds would be considered equivalent.

On your GMO example, this assumes that this person was a total F*ck Up ALL 4 years of med school and the JSGME was particularly harsh and gave them NO points because of this (Which would not happen). Your scoring also does not take into account "Potential to be a good officer". You better believe that somebody that has already done an operational tour will get more points EVERYTIME than someone without any prior military service besides a couple of Active Duty Tours during med school rotations.

In other words...The Total F*CK UP GMO will almost always beat out the genious HPSP student with no prior military experience

Anybody disagree with this assessment?

 

[West Side]

In other words...The Total F*CK UP GMO will almost always beat out the genious HPSP student with no prior military experience

That's the crux of what I'm saying, and it's absolutely crazy.

For the sake of argument, I am holding constant the potential for career officer score, which is where I'm sure the fudge factor comes in. But there, again, the genius student would have to be "outstanding", while the GMO f-**** would have to be but "acceptable", and that's just in order for them to be equal.

So the numbers are in and the survey says: if you're willing to marshall a goat rodeo for two years, you can visit your vengence on some poor sap that actually studied hard and did well in school!

On the flip side, HPSP students, go have a cocktail. Every night.

 

[FNU LNU]

For the Navy side, is there any advantage in points in doing a three-year FS/DMO tour over a two-year GMO tour?

 

[HumptyDumptyMil]

That's the crux of what I'm saying, and it's absolutely crazy.

For the sake of argument, I am holding constant the potential for career officer score, which is where I'm sure the fudge factor comes in. But there, again, the genius student would have to be "outstanding", while the GMO f-**** would have to be but "acceptable", and that's just in order for them to be equal.

So the numbers are in and the survey says: if you're willing to marshall a goat rodeo for two years, you can visit your vengence on some poor sap that actually studied hard and did well in school!

On the flip side, HPSP students, go have a cocktail. Every night.

So what is the possibility that a poor performing student during medical school will make a great GMO/FS officer? I've always heard how the top third of med students make the best researchers, the middle third best residents, and the bottom third the best physicians.

 

[BOHICA-FIGMO]

So what is the possibility that a poor performing student during medical school will make a great GMO/FS officer? I've always heard how the top third of med students make the best researchers, the middle third best residents, and the bottom third the best physicians.

If that's the case, then I should be one helluva a doc when I graduate!

 

[West Side]

So what is the possibility that a poor performing student during medical school will make a great GMO/FS officer? I've always heard how the top third of med students make the best researchers, the middle third best residents, and the bottom third the best physicians.

Well, all kidding aside, I wonder what exactly they DO use as a metric. I mean, is it purely based on one's capabilities as a physician?

I suspect it is not, but I don't know. Anyone have better information?

"What's this I hear about you having problems with your TPS reports?"

 

[colbgw02]

That's the crux of what I'm saying, and it's absolutely crazy.

There's another component here that the scoring system doesn't take into account - that the GMOs and medical students are not always in direct competition.

I'll speak to my specialty and branch (Army radiology), since that's what I know. Seventy-five % of residency slots are ear-marked specifically for medical students. So, in an oddly intelligent move, the Army prevents lower caliber GMOs from beating out too many super studs.

 

[AF M4]

Agreed.

 

[West Side]

There's another component here that the scoring system doesn't take into account - that the GMOs and medical students are not always in direct competition.

I'll speak to my specialty and branch (Army radiology), since that's what I know. Seventy-five % of residency slots are ear-marked specifically for medical students. So, in an oddly intelligent move, the Army prevents lower caliber GMOs from beating out too many super studs.

That does quite a bit to level the playing field, admittedly.

Still F's with the free market meritocracy that something as important as medical care should be. It cuts both ways, if you're earmarking: what if you have a particularly weak crop of students, and a few studs that were forced into a transitional year due to a numbers crunch in past years?

 

[edmadison]

It's very important for everyone to realize that this scoring form is only for PGY-2 applications and fellowships -- unless something has changed in the past few months. It doesn't not apply to med students applying for PGY-1 and it does not apply to those who have straight through contracts. In the Army, almost all residency positions are continuous with not reapplication required, thus the form doesn't apply.

Those factors are important for fellowship, thus you are at great disadvantage if currently in residency versus someone who has done a few years out -- especially if they did operational.

Ed

 

[sethco]

It's very important for everyone to realize that this scoring form is only for PGY-2 applications and fellowships -- unless something has changed in the past few months. It doesn't not apply to med students applying for PGY-1 and it does not apply to those who have straight through contracts. In the Army, almost all residency positions are continuous with not reapplication required, thus the form doesn't apply.
Ed

Absolutely False. Think about it. How many Emergency Med positions are there? Who do you think are competing for these positions? Just med students? Absolutely not (At least, in the Air Force). They are competing against GMOs, Staff physicians (who want to switch specialties), among others (including prior service individuals). This is just one example. What about Opthamology? Ortho? Pathology? Urology?

That scoring form is for EVERYONE. BTW, in the AF you have to keep on applying to the JSGME over and over again if you are not successful the first time (I am surprised it is not the same way in the Army)

 

[orbitsurgMD]

On your GMO example, this assumes that this person was a total F*ck Up ALL 4 years of med school and the JSGME was particularly harsh and gave them NO points because of this (Which would not happen). Your scoring also does not take into account "Potential to be a good officer". You better believe that somebody that has already done an operational tour will get more points EVERYTIME than someone without any prior military service besides a couple of Active Duty Tours during med school rotations.

In other words...The Total F*CK UP GMO will almost always beat out the genious HPSP student with no prior military experience

Anybody disagree with this assessment?

I think any points awarded on the basis of "potential to be a good officer" has more to do with expected length of service following residency than anything else. An Academy grad or a candidate with a long commitment from USUHS or a strong motivation to complete a career to retirement, say from prior line service, represents a larger ROI than someone without those obligations or motivations, ceteris paribus, as W-S said.

It also gives a means to throw the selection the way the committee wants.

 

[dtn3t]

Absolutely False. Think about it. How many Emergency Med positions are there? Who do you think are competing for these positions? Just med students? Absolutely not (At least, in the Air Force). They are competing against GMOs, Staff physicians (who want to switch specialties), among others (including prior service individuals). This is just one example. What about Opthamology? Ortho? Pathology? Urology?

That scoring form is for EVERYONE. BTW, in the AF you have to keep on applying to the JSGME over and over again if you are not successful the first time (I am surprised it is not the same way in the Army)

While I can't speak for ER and the other Army residencies specifically, I know many residencies have blocked out certain spots for graduating med students (such as Derm). For example, in my intern class 2 of the 3 Derm spots were to be filled by those already preselected from med school, and the last one was left for a GMO coming back.

Therefore, students are still competing against students.

 

[sethco]

I think any points awarded on the basis of "potential to be a good officer" has more to do with expected length of service following residency than anything else. An Academy grad or a candidate with a long commitment from USUHS or a strong motivation to complete a career to retirement, say from prior line service, represents a larger ROI than someone without those obligations or motivations, ceteris paribus, as W-S said.

It also gives a means to throw the selection the way the committee wants.

Exactly. This "potential officership" is the board's fudge factor to swing the results to create maximum time commitment from HPSP participants. Think about, if an HPSP is made to do a GMO tour and serves only 2 years and then reapplies for a four year military residency, that person is serving 6 "operational years" (not including residency). BTW, GMOs are less likely to get a deferment because the board knows that if they give them a deferment for a 4 year residency, they will only have to serve 2 more years, instead of the 4 if that person was i8n a military residency

 

[Gastrapathy]

Exactly. This "potential officership" is the board's fudge factor to swing the results to create maximum time commitment from HPSP participants. Think about, if an HPSP is made to do a GMO tour and serves only 2 years and then reapplies for a four year military residency, that person is serving 6 "operational years" (not including residency). BTW, GMOs are less likely to get a deferment because the board knows that if they give them a deferment for a 4 year residency, they will only have to serve 2 more years, instead of the 4 if that person was i8n a military residency

Sorry, this is too cynical even for me. Most specialties want the best people they can get, period. These points are one way that they can ensure they get the people they want. Believe me, the specialty leaders know that if they don't take someone now, there's a better than 50% chance that person will get out post-GMO or staff tour (for fellowship apps) and be lost to them. As for "GMO's are less likely to get a deferment," what is your evidence for this beyond anecdote (because, off the top of my head, I can think of a couple, one in ophtho and another in urology)? Also, you have to understand the difference between military-sponsored civilian training and unsponsored. Its only in the latter case that their committment doesn't increase.

 

[sethco]

Sorry, this is too cynical even for me. Most specialties want the best people they can get, period. These points are one way that they can ensure they get the people they want. Believe me, the specialty leaders know that if they don't take someone now, there's a better than 50% chance that person will get out post-GMO or staff tour (for fellowship apps) and be lost to them. As for "GMO's are less likely to get a deferment," what is your evidence for this beyond anecdote (because, off the top of my head, I can think of a couple, one in ophtho and another in urology)? Also, you have to understand the difference between military-sponsored civilian training and unsponsored. Its only in the latter case that their committment doesn't increase.

You are right. I am purely speculating based on prior GMOs that I know. However, you said that they strive to put their best applicants into their own residencies. According to the point system, wouldn't the best applicants be GMOs and therefore be placed into military residencies? While it is true that civilian deferred residencies do not extend your commitment, military residencies (post-GMO) along with civilian sponsored residencies will. Believe me, I fully understand this concept in detail and got confirmation from the big wigs in charge of the process. This is exactly why I came to the decision that I am just going to finish up my military career as a GMO. I was told if I applied I would be more likely to get a military residency than civilian deferred (which are usually given to medical students, unless there are limited spots). It's OK if you want to disagree with me because I don't have any studies to point to. I only have MY prior experience in dealing with these matters and GMO/FS friends of mine that have already gone through/going through the process.

While you may view me and others as cynical, I view myself as a realist. I can't even begin to tell you the shock I was in during my 4th year when I was told I did not get a residency position and would have to interrupt my medical education to do an operational tour. I just want all the 4th year medical students to realize that doing a GMO tour prior to entering residency is a very real possibility (and more likely than some people think).

 

[NavyDMO]

Most navy interns have to do a GMO/FS/DMO tour. The exceptons traditionally are FP, IM and maybe a few surgical slots. I guess that puts us all back on a level playing field.

 

[Gastrapathy]

You are right. I am purely speculating based on prior GMOs that I know. However, you said that they strive to put their best applicants into their own residencies. According to the point system, wouldn't the best applicants be GMOs and therefore be placed into military residencies? While it is true that civilian deferred residencies do not extend your commitment, military residencies (post-GMO) along with civilian sponsored residencies will. Believe me, I fully understand this concept in detail and got confirmation from the big wigs in charge of the process. This is exactly why I came to the decision that I am just going to finish up my military career as a GMO. I was told if I applied I would be more likely to get a military residency than civilian deferred (which are usually given to medical students, unless there are limited spots). It's OK if you want to disagree with me because I don't have any studies to point to. I only have MY prior experience in dealing with these matters and GMO/FS friends of mine that have already gone through/going through the process.

While you may view me and others as cynical, I view myself as a realist. I can't even begin to tell you the shock I was in during my 4th year when I was told I did not get a residency position and would have to interrupt my medical education to do an operational tour. I just want all the 4th year medical students to realize that doing a GMO tour prior to entering residency is a very real possibility (and more likely than some people think).

3 points. First, I couldn't agree more that people MUST know about the possibility of a GMO tour. For Navy applicants, there are many specialties for which one simply cannot hope to compete without having done one (less so in the other services, but the only spots med studs can compete for are either PGY-1 only or full deferments/ftos, which are hard to come by). In a sense, Navy-wise, this levels the playing field, so that instead of all the examples above about the GMO dirtbag competing with the stellar med stud, its really the GMO dirtbag competing with the stellar med stud who also had a successful GMO tour.

Second, the specialty leaders are the ones who make the selections, not the PDs and their primary focus is on the overall health of their specialty. So, they want to fill their inservice slots, but they also want to train every good person they can. If you want IM, for example, there are so many inservice slots, that you aren't likely to get outservice training (seen it, just not likely), whereas, if you want urology, about half the total trainees are on deferments/ftos, etc. So, yes, they want good people for their programs, but they also want good people in general.

Third, you comment that the "best" applicants are GMO's because they have the most points. I can only comment on one specialty leader's view on this but he absolutely does not believe that. They have the most points because the system favors people who have done their time, not because they would make the best specialist. That doesn't mean he was always able to avoid taking those people. In my subspecialty, there are always enough highly-qualified applicants with lots of points that they still get folks they want.

 

[edmadison]

Absolutely False. Think about it. How many Emergency Med positions are there? Who do you think are competing for these positions? Just med students? Absolutely not (At least, in the Air Force). They are competing against GMOs, Staff physicians (who want to switch specialties), among others (including prior service individuals). This is just one example. What about Opthamology? Ortho? Pathology? Urology?

That scoring form is for EVERYONE. BTW, in the AF you have to keep on applying to the JSGME over and over again if you are not successful the first time (I am surprised it is not the same way in the Army)

I'm sorry, but you are wrong. First, the JSGME doesn't consider PGY-1 positions. They are done by each branch separately and are based on a "civilian-like" match. Second, in the ARMY (as I noted in my post) your listed specialties, opthalmology, orthopedics, pathology and emergency medicine are straight through positions. I think urology is as well, but I'm not sure.

Ed

 

[colbgw02]

I'm sorry, but you are wrong. First, the JSGME doesn't consider PGY-1 positions. They are done by each branch separately and are based on a "civilian-like" match. Second, in the ARMY (as I noted in my post) your listed specialties, opthalmology, orthopedics, pathology and emergency medicine are straight through positions. I think urology is as well, but I'm not sure.

Ed

I don't know, man. I had a program director tell me how many points I would be getting for this and for that, etc. This was when I was a student applying for internship (and residency, because of continuous contracts).

I guess you're thinking that I wasn't actually applying for internship - I was actually applying for a PGY-2 slot with an attached internship?? That could be, but how do specialties (i.e. Army general surgery) without continuous contracts select their interns then? Anybody know?

 

[Gastrapathy]

I'm sorry, but you are wrong. First, the JSGME doesn't consider PGY-1 positions. They are done by each branch separately and are based on a "civilian-like" match. Second, in the ARMY (as I noted in my post) your listed specialties, opthalmology, orthopedics, pathology and emergency medicine are straight through positions. I think urology is as well, but I'm not sure.

Ed

Actually, they use the same scoresheet and this year will be the first time the rank order list business comes into play. We'll see how that changes things.