Walter Reed IM

[DocMcGillicuddy]

Long post so here it goes:

I am interested in doing IM and since my choices are limited because I am engaged to a civilian med student Walter reed offers the best chance of us being together with the plethora of programs in the DC area. Anyway, I called to schedule my audition rotations/adt today and MICU and IM general were booked up at walter reed. I know they are in transition with/ bethesda and have less teams full but still, this worried me quite a bit. Is walter reed IM that competitive? Also, does anyone know how many spots they have open/fill each year. And do you think I should still do a couple months in say heme onc/ or another inpatient services vs applying somewhere else? are madigan IM and BAMC IM really competitive as well? Thank you for any input

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[Gastrapathy]

Yes a subspecialty consult month is helpful. I would not choose H/O. Try to do a consult month that has a significant inpt responsibility (ID, consult Cards, etc). In fact, it looks like the PD is a pulmonologist...

Also, is NNMC full? Rotating there might accomplish the same thing.

 

[psychbender]

The Heme/Onc ward is actually a pretty good rotation, with a team census that is uaually about the same as those of the general medicine teams (with some actual sick patients). Also check out Pulm or the CCU, or try your luck at Bethesda, since everyone will be over there by September, anyway.

 

[DocMcGillicuddy]

I think they only have outpatient cards but do the do have med consult whatever that is....can army hpsp rotate at bethesda for ADT? Thanks for the input!

 

[DocMcGillicuddy]

Does anyone know how many IM spots they have/fill each year?

 

[Ziehl-Neelsen]

This information applies only to the old WRAMC IM department at WRAMC. Nobody but the program director or the commander of GME can realistically determine how many spots will be at the new WRNMMC or how those spots will be divvied up amongst the 3 services.

The current WRAMC program is qualified to accept 20 IM residents per year but generally accepts somewhere between 10-12. They have not filled their desired number of residents for the past 4 years. The trickiest part of matching Army IM these days is the ranklist. Army has to ensure there are enough interns at each hospital to move the meat, and that has led to some creative accounting among the placement of residents.

Matching to your first preference is unpredictable because it depends on where your classmates apply. If your choice is unpopular that year, matching is nearly guaranteed. If your choice has excess applicants, then some of those applicants may end up at less desirable programs.

 

[DrMetal]

This information applies only to the old WRAMC IM department at WRAMC. Nobody but the program director or the commander of GME can realistically determine how many spots will be at the new WRNMMC or how those spots will be divvied up amongst the 3 services.

The current WRAMC program is qualified to accept 20 IM residents per year but generally accepts somewhere between 10-12. They have not filled their desired number of residents for the past 4 years. The trickiest part of matching Army IM these days is the ranklist. Army has to ensure there are enough interns at each hospital to move the meat, and that has led to some creative accounting among the placement of residents.

Matching to your first preference is unpredictable because it depends on where your classmates apply. If your choice is unpopular that year, matching is nearly guaranteed. If your choice has excess applicants, then some of those applicants may end up at less desirable programs.

Can you go TY PGY1 --> IM PGY2 (possibly GMO in between)??? (Or do you nec have to do an IM PGY1 to do an IM res?)

 

[Ziehl-Neelsen]

Can you go TY PGY1 --> IM PGY2 (possibly GMO in between)??? (Or do you nec have to do an IM PGY1 to do an IM res?)

Again, I speak only for Army GME. I work with Navy and Air Force docs at a combined facility and so know a bit about their GME, but I don't presume to know all the ins, outs, and what-have-yous.

I seriously doubt that IM would allow a TY to substitute for an IM intern year after a GMO tour. There just aren't enough ward months for the experiences to be commensurate. They may not require one to repeat the entire year but repeating at least some part of the year with an IM focus and graduating off-cycle is almost guaranteed.

More to the point, why would one want to interrupt an IM residency with a GMO tour? IM residency is relatively short, and you are guaranteed to be in a battalion surgeon slot within 6 months of graduation. If your heart is set on being a GMO, complete residency, attain the more thorough training, and deploy with a larger, tax-free salary

 

[DrMetal]

More to the point, why would one want to interrupt an IM residency with a GMO tour?

I wouldn't do so by my own choice. It seems that at least 50% of IM PGY1s had to do a GMO tour (in the Navy), and that number may grow.

Here's why I'm asking: Suppose you want to do IM at a particular location (say San Diego). When you apply for PGY1, you'd have to rank the 3 locations for IM, for instance: 1-IM San Diego 2-IM WR 3-IM Portsmouth. Your fourth choice could be 4-TY San Diego, and I think somewhere in a Comments box you can state, "I prefer my choice #4, over 2,3", right??? Obviously the applicant here has a preference for San Diego.

But, if you're really interested in IM, you shouldn't do this. If what you're saying is correct, doing a TY PGY1 would work to your detriment in securing IM PGY2. And you wouldn't want this, if in fact IM is what you really want to do. Do I have this right?

 

[Ziehl-Neelsen]

Once you choose a specialty in MODS, you are obligated to rank all the locations that train that specialty (as you alluded to). If your goal is IM and state as such on MODS, GME doesn't allow the type of finagling you are suggesting. They are going to go straight down the line and try and place you at Balboa, then Bethesda, and then Portsmouth. Only if you fail to match in IM will choices 4 and 5 come into play (which as you alluded to can be whatever you want), but the game is set up to give you the highest chance to match into your desired specialty, not to your desired location.


As for the IM PGY-1s who head out to GMO-land... In my experience at Bethesda there were categorical IM interns and preliminary IM interns. The categorical ones obviously went straight into their PGY-2 year while the preliminaries headed out to GMO-land unless they could secure themselves a PGY-2 slot in some residency. It was a caste system if you catch my drift: the categoricals wanted to do IM and go straight through; the prelims were weak derm, radiology, gas, pm&r etc. applicants who couldn't get their preferred residency and so were herded into prelim IM internships to move the meat. Not every IM or surgical intern is in his position because he wanted IM or surgery... Everybody has to do an internship and sometimes people get stuck. I would bet that these unlucky few are the source of the IM PGY-1s who head out to the fleet.

If being at Balboa is more important to you than your chosen specialty, I would put in MODS that I was undecided and rank every internship there before ranking ones at the other locations with the understanding that there was no guarantee that I would find a PGY-2 position at Balboa or that there would be a GMO slot in Diego. Your best bet is to try and shine on your rotations there, rank it first, and hope for the best.

 

[MSS07]

I wouldn't do so by my own choice. It seems that at least 50% of IM PGY1s had to do a GMO tour (in the Navy), and that number may grow.

Here's why I'm asking: Suppose you want to do IM at a particular location (say San Diego). When you apply for PGY1, you'd have to rank the 3 locations for IM, for instance: 1-IM San Diego 2-IM WR 3-IM Portsmouth. Your fourth choice could be 4-TY San Diego, and I think somewhere in a Comments box you can state, "I prefer my choice #4, over 2,3", right??? Obviously the applicant here has a preference for San Diego.

But, if you're really interested in IM, you shouldn't do this. If what you're saying is correct, doing a TY PGY1 would work to your detriment in securing IM PGY2. And you wouldn't want this, if in fact IM is what you really want to do. Do I have this right?

So is IM a very competitive residency in the Navy? So I have a 50% chance of doing a GMO tour if I apply for IM in 2013?

 

[backrow]

As for the IM PGY-1s who head out to GMO-land... In my experience at Bethesda there were categorical IM interns and preliminary IM interns. The categorical ones obviously went straight into their PGY-2 year while the preliminaries headed out to GMO-land unless they could secure themselves a PGY-2 slot in some residency. It was a caste system if you catch my drift: the categoricals wanted to do IM and go straight through; the prelims were weak derm, radiology, gas, pm&r etc. applicants who couldn't get their preferred residency and so were herded into prelim IM internships to move the meat. Not every IM or surgical intern is in his position because he wanted IM or surgery... Everybody has to do an internship and sometimes people get stuck. I would bet that these unlucky few are the source of the IM PGY-1s who head out to the fleet.

There is no categorical/prelim delineation for most internships in the Navy. In medicine you will get a couple groups as mentioned in regards to those who really want to do medicine vice those who want to do something else; however, it makes no difference when it comes time to decide who gets to stay for PGY2-3 yrs and who goes out into GMO land.

Also for the Navy you can't even apply for those other specialties as an medical student anyway, so you don't have the "I applied for Rads and instead got IM" people. Every once in a while you may hear of someone who applied for a transitional year and got IM, but in general the people who are in whatever internship are there because they applied for that internship to prepare themselves for whatever residency they are going to apply to at the GME2 board.

Overall for IM in the Navy, it seems the historical percentage of those going straight through is around 40-50%.

 

[MSS07]

Overall for IM in the Navy, it seems the historical percentage of those going straight through is around 40-50%.

So what determines whether one will go straight through in IM or do a GMO in the Navy? Is it Board scores, letters of recommendation?

 

[MSS07]

So what determines whether one will go straight through in IM or do a GMO in the Navy? Is it Board scores, letters of recommendation?

Where do I find this information about how many people go straight through vs how many people do GMO in each specialty, is there published statistics I can get a hold of?

Thank you

 

[DrMetal]

If being at Balboa is more important to you than your chosen specialty

Nahh its not (makes no sense to prioritize temporary geography over a career choice that could affect the rest of your life). Geography is a close 2nd for me, but specialty is more important. Screw it, grandparents can travel. Anyway, thanks for the advice.

 

[dillydally]

Where do I find this information about how many people go straight through vs how many people do GMO in each specialty, is there published statistics I can get a hold of?

Thank you

I just asked my recruiter for this info, I'll let you know what he comes up with

 

[DrMetal]

Where do I find this information about how many people go straight through vs how many people do GMO in each specialty, is there published statistics I can get a hold of?

Thank you

You don't really need a reference, take his word, that's a good ballpark range. I've heard that range (40-50%) from several people now, including from faculty (at USUHS) and people that've sat on recent GME selection boards. The percentage can fluctuate of course, depending on the needs of the Navy, number of medical officers, etc.

Probably best to just assume you are going to do a GMO, plan accordingly (think about what you might like to do, go green vs blue, ship vs aviation, etc etc), then apply for PGY2, if you get it great. If not, you're not surprised, go do your GMO. Have some fun. Try to get a book deal out of it.

 

[Gastrapathy]

I wouldn't do so by my own choice. It seems that at least 50% of IM PGY1s had to do a GMO tour (in the Navy), and that number may grow.

Here's why I'm asking: Suppose you want to do IM at a particular location (say San Diego). When you apply for PGY1, you'd have to rank the 3 locations for IM, for instance: 1-IM San Diego 2-IM WR 3-IM Portsmouth. Your fourth choice could be 4-TY San Diego, and I think somewhere in a Comments box you can state, "I prefer my choice #4, over 2,3", right??? Obviously the applicant here has a preference for San Diego.

But, if you're really interested in IM, you shouldn't do this. If what you're saying is correct, doing a TY PGY1 would work to your detriment in securing IM PGY2. And you wouldn't want this, if in fact IM is what you really want to do. Do I have this right?

If you rank the three IM programs first, you won't get to your fourth choice. You will be doing IM internship.

If someone does a TY internship and an IM residency, their internship only partially counts. Exactly how many months credit is variable and complicated but, basically, your PD petitions the ABIM for x months of credit and you get some amount of that (think 6 months, on average). That being said, there is no downside from a post-GMO competitiveness perspective. If you want any chance of going straight-through out of internship, you need to be an IM intern.

 

[MSS07]

You don't really need a reference, take his word, that's a good ballpark range. I've heard that range (40-50%) from several people now, including from faculty (at USUHS) and people that've sat on recent GME selection boards. The percentage can fluctuate of course, depending on the needs of the Navy, number of medical officers, etc.

Probably best to just assume you are going to do a GMO, plan accordingly (think about what you might like to do, go green vs blue, ship vs aviation, etc etc), then apply for PGY2, if you get it great. If not, you're not surprised, go do your GMO. Have some fun. Try to get a book deal out of it.

Just curious, How often do people just do a 4 year GMO and get out of the Navy and just do a Civilian internship, is this common?

 

[a1qwerty55]

Just curious, How often do people just do a 4 year GMO and get out of the Navy and just do a Civilian internship, is this common?

Never. You have to complete an internship and have a license to be a GMO. I imagine some go back and redo a civilian internship if the prior one didn't count for their desired residency (i.e. did FP but now want to do GS)