What's going on with the OMO/GMO situation?

[layman_3]

Been hearing rumors that 50ish flight surgery billets went unfilled last year and lots of current GMOs are now being pushed toward returning to residency to get their board certifications...which doesn't do anything for decreasing the number of GMOs because now interns are still going out to fill those billets. How does this line up with having fewer GMOs and more OMOs? Or is there some bigger plan not publicized yet?

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[MillertimeUSNA]

Would also like to know.

Is there any plan for all of the medical students this year who are taking TY years then going to GMO land? Will they be left in the lurch in 4 years when they return to ostensibly a world where all medical students in the Navy are straight through?

 

[orbitsurgMD]

Would also like to know.

Is there any plan for all of the medical students this year who are taking TY years then going to GMO land? Will they be left in the lurch in 4 years when they return to ostensibly a world where all medical students in the Navy are straight through?

Unless they are willing to shake the piggy bank and turn over the couch cushions and fund a bunch of FTOS for GMOs who are close to fulfilling their payback, what do you think?

 

[pgg]

Unless they are willing to shake the piggy bank and turn over the couch cushions and fund a bunch of FTOS for GMOs who are close to fulfilling their payback, what do you think?

It's not really a cost issue - it doesn't cost the military anything at all to defer people for civilian residency.

The question is whether or not they'll do it. How many deferral or FTOS positions the GMESB hands out each year is impossible to predict in advance. The numbers are always in flux, even between the annual announcement of intentions and the actual board meeting.

Anyway. I agree with your larger implied point - it's something I'd sure be anxious about if I was a GMO applying for FTIS GME, knowing that I was in the pool with the interns applying as straight-through-wannabes.

 

[pawprint]

For similar reasons, I think outpatient peds is pretty busy just about everywhere too.

Outpatient peds is busy, but a lot of the places with high volume billets are being replaced with civilian staff, the low volume overseas billets are filled by the active duty that are left, unfortunately.

 

[orbitsurgMD]

It's not really a cost issue - it doesn't cost the military anything at all to defer people for civilian residency.

The question is whether or not they'll do it. How many deferral or FTOS positions the GMESB hands out each year is impossible to predict in advance. The numbers are always in flux, even between the annual announcement of intentions and the actual board meeting.

Anyway. I agree with your larger implied point - it's something I'd sure be anxious about if I was a GMO applying for FTIS GME, knowing that I was in the pool with the interns applying as straight-through-wannabes.

Deferment costs nothing, but not many GMOs approaching EAOS would settle for a deferment even if it came a year before their end of obligated service. FTOS, meaning a service-funded outservice residency means money, just like funded fellowships.

I don't think the Navy would ever do that. They would let the GMO crowd figure out they have nothing coming and make other plans.

 

[flightdoc09]

Navy has been doing a number of NADDS billets for general surgery, emergency medicine, and I'm sure others.

They're also doing more straight through contracts (no reapplying for a PGY2 spot). Fleet returnees that were categorical are given preference for returning to their specialty (unless they burned bridges while there). Depending on the year and competitiveness, some TYs are sneaking into competitive residencies with categorical internships (EM, ENT, etc). But many TYs are still going for anesthesia, rads, ophto, and other non-categorical intern year residencies. There do appear to be an increasing amount of categorical interns that are actually interested in GMOing out and not even reapplying once they find out they're going to the fleet.

I think the hope for the Navy is that they're going to get the non-critical wartime specialists to stick around and take on the OMO type billets if they want to stay for 20. I still think it's going to cause problems when a pediatrician or OBGYN wants to keep up their skills and spends half the week at the nearest MTF or moonlighting, and the other half barely with their unit/in clinic. The actual GMOs are going to end up picking up the slack, and there's going to be less of a connection between medical and the line.

Lucky I got to (and chose to) do my FS tour as a junior LT.

 

[pawprint]

The whole situation is very frustrating. 4 years ago, I was told I couldn’t continue through my categorical residency because the navy needed flight surgeons, and operational experience was what big navy valued the most. So even though I was intern of the year, I wasn’t selected straight through. During my most recent fitrep debrief, I was told that the biggest red flag in my record was that I am not yet board certified…even though the Navy was the one who sent me out to the fleet instead of letting me finish what I started at the program I began my training at.

All the more reason to get out and start over on the civilian side. Military medicine can’t make up its mind with what it values, and the constant pendulum swinging makes it difficult to get ahead unless your career matches up perfectly with the pendulum swing. I’m glad there’s an off ramp at least. It’s just unfortunate that Big Navy Medicine doesn’t care to try and retain its personnel it has already invested in.

 

[Nontrad_FL_LGBT]

I'm in the process of looking into HPSP at the moment. Given that it seems like GMO isn't happening as much anymore, does it seem likely that the Air Force or Army will be sending a ton of people through civilian residency soon? (Best guesses)

 

[orbitsurgMD]

The whole situation is very frustrating. 4 years ago, I was told I couldn’t continue through my categorical residency because the navy needed flight surgeons, and operational experience was what big navy valued the most. So even though I was intern of the year, I wasn’t selected straight through. During my most recent fitrep debrief, I was told that the biggest red flag in my record was that I am not yet board certified…even though the Navy was the one who sent me out to the fleet instead of letting me finish what I started at the program I began my training at.

All the more reason to get out and start over on the civilian side. Military medicine can’t make up its mind with what it values, and the constant pendulum swinging makes it difficult to get ahead unless your career matches up perfectly with the pendulum swing. I’m glad there’s an off ramp at least. It’s just unfortunate that Big Navy Medicine doesn’t care to try and retain its personnel it has already invested in.

Unless you have extended well beyond your first tour as a GMO, by what process of wormhole-traveling do they think you could have become board certified while doing a fleet tour? (We'll leave aside the dubious machinations of a certain Navy Surgeon General who seemed to acquire all manner of curious degrees while not actually in attendance at said degree-granting institutions and did get promotion credit.)

Idiocy laid bare for all to see. I wouldn't want to train in a system that took no notice of where I had been when the very same system sent me where I went. That is just shamefully poor leadership. Inexcusable. [What a******s!]

Best wishes on your exit to civilian training.

 

[layman_3]

The whole situation is very frustrating. 4 years ago, I was told I couldn’t continue through my categorical residency because the navy needed flight surgeons, and operational experience was what big navy valued the most. So even though I was intern of the year, I wasn’t selected straight through. During my most recent fitrep debrief, I was told that the biggest red flag in my record was that I am not yet board certified…even though the Navy was the one who sent me out to the fleet instead of letting me finish what I started at the program I began my training at.

All the more reason to get out and start over on the civilian side. Military medicine can’t make up its mind with what it values, and the constant pendulum swinging makes it difficult to get ahead unless your career matches up perfectly with the pendulum swing. I’m glad there’s an off ramp at least. It’s just unfortunate that Big Navy Medicine doesn’t care to try and retain its personnel it has already invested in.

Certainly paints a confusing picture about what Navy Medicine is going for. Do they want board certified physicians or not?

 

[Correlate Clinically]

I'm in the process of looking into HPSP at the moment. Given that it seems like GMO isn't happening as much anymore, does it seem likely that the Air Force or Army will be sending a ton of people through civilian residency soon? (Best guesses)

The AF always has civilian sponsored or civ deferred residency spots. It varies year to year and by specialty. If you are looking at HPSP now, it's really hard to predict what will be available 4-5 years out. There hasn't been a big push to increase civilian training spots. Some AD residents have actually been filling Navy positions (or at least training at Naval facilities) in the last few years.

It may be available, but likely just one option and hard to say how many spots. There are still plenty of GMO/flt med positions, although in general the AF isn't forcing a lot of people into them at the moment.

I can't speak as well to the Army, but I haven't heard of any wholesale changes.

 

[SirGecko]

The whole situation is very frustrating. 4 years ago, I was told I couldn’t continue through my categorical residency because the navy needed flight surgeons, and operational experience was what big navy valued the most. So even though I was intern of the year, I wasn’t selected straight through. During my most recent fitrep debrief, I was told that the biggest red flag in my record was that I am not yet board certified…even though the Navy was the one who sent me out to the fleet instead of letting me finish what I started at the program I began my training at.

All the more reason to get out and start over on the civilian side. Military medicine can’t make up its mind with what it values, and the constant pendulum swinging makes it difficult to get ahead unless your career matches up perfectly with the pendulum swing. I’m glad there’s an off ramp at least. It’s just unfortunate that Big Navy Medicine doesn’t care to try and retain its personnel it has already invested in.

Who was even doing the debriefing there? Board certification is really only a thing they care about for CDR anyway (and I’ve know several people that picked up CDR in residency) and you should be able to go back to residency prior to commander board.

I'm in the process of looking into HPSP at the moment. Given that it seems like GMO isn't happening as much anymore, does it seem likely that the Air Force or Army will be sending a ton of people through civilian residency soon? (Best guesses)

So the OMO change is more of a navy thing. I wouldn’t anticipate any changes related to more people going to civilian residency anytime soon. (Certainly not “a ton” of people) Assume you will have to train in the military if you sign up for HPSP.

 

[Nontrad_FL_LGBT]

Thanks to you both for the guidance! I don't mind training in either capacity, I'm more just curious about how this is all shifting around as someone on the outside right now. It def seems like a little bit of a mess to navigate at the moment.

Good luck to everyone trying to sort it out.

 

[pgg]

The whole situation is very frustrating. 4 years ago, I was told I couldn’t continue through my categorical residency because the navy needed flight surgeons, and operational experience was what big navy valued the most. So even though I was intern of the year, I wasn’t selected straight through. During my most recent fitrep debrief, I was told that the biggest red flag in my record was that I am not yet board certified

If you're 4 years out of internship I'm assuming you're talking about the O4 board (unless you have significant commissioned prior service?) and none of this matters. You'll select for O4 provided you're not pending a felony trial. Everyone makes O4 on time. Or early if they have prior commissioned service credit.

If you're talking about the O5 board I have no insight into that black box.

 

[Trefoil]

Thanks to you both for the guidance! I don't mind training in either capacity, I'm more just curious about how this is all shifting around as someone on the outside right now. It def seems like a little bit of a mess to navigate at the moment.

Good luck to everyone trying to sort it out.

The Army hasn’t cut its residency positions very much yet, and the Army had more residency positions to begin with. It’s less common to see civilian deferment in the Army.

The one thing to consider is that military sponsored civilian residencies increase your ADSO. I’ve met people who did this who owe more time than me after HPSP+DoD sponsored Civilian residency. I owe a lot of time, so that is impressive.

There is a push in the Army to start downsizing, but it seems there is hesitancy. Once you close a GME program, it is very hard to rebuild, and the Army MC cuts are smaller than the AF or Navy…

Furthermore, all of the talks of defunding have people getting out faster and fewer people staying until 20.

It’s not really clear what the effect of all of this will be. It’s definitely increased uncertainty.

I would also argue that at this point in time, with the federal government expanding public service loan forgiveness, the HPSP scholarship has lost a lot of value. Physician pay in the military hasn’t been increased since like 1990…we had 7% inflation last year, so you can do the math.