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Will I be able to choose my profession?

Discussion in 'Military Medicine' started by AmyBass2011, Apr 3, 2004.

  1. AmyBass2011

    AmyBass2011 Member
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    Doing the HPSP and matching to a residency... will I be able to go to an ob/gyn residency? Meaning, they wont stick me in a FP residency if they wanted to would they? I want to do the HPSP, I just want to make sure I will be able to reach my ob/gyn goal... Amy
     
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  3. militarymd

    militarymd SDN Angel
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    You will never be "forced" to do a residency that you don't want, however, depending on the needs of the military, and there is a possibility that you will not get to train WHEN you want....meaning a GMO....meaning the alternatives are so bad that you will want to train in FP...does that make sense? (not to say being a GMO is bad, just that you would rather train in FP than be a GMO)

    There may be a delay in completing training(GMO), or you will have to train in a field you don't want to.

    Remember, once you sign, there are no guarantees for ANYTHING.....especially your personal wants and needs. They own you for the duration.
     
  4. edmadison

    edmadison 1K Member
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    The "current" policy in the Army is automatically to grant a residency deferral for anyone in HPSP who does not match in his or her chosen specialty.

    Ed
     
  5. militarymd

    militarymd SDN Angel
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    Do you have a reference for that policy? Specialty slots in the military as a whole is a tri-service affair. Each year, GMESB board meets in December....and it is tri-service...all the specialty/program directors from all 3 services meet in DC to determine who gets what and how many of each....actually the numbers may be determined a little before the board..

    If what you say is true, then the military as a whole, may have too many of certain specialties and not enough of another...totally not what is needed....or the other services have to suck up and make up the differences by decreasing slots or increasing slots.

    Did a recruiter tell you this? Please post the instruction for this policy.
     
  6. edmadison

    edmadison 1K Member
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    Unfortunately I have not seen it in writing (as in a regulation). I was personally told this by the head of undergraduate medical education for the Army prior to her retirement. She also said this at an OBC Q & A session. I also verified it with several residency directors. I try to be careful when mentioning it to note that it is "policy" rather than a quarentee. Note, this does not apply to USUHS folks.

    Ed
     
  7. militarymd

    militarymd SDN Angel
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    Sounds like recruiter propaganda to me....unless it is in writing with an instruction number somewhere in the military medicine bureacracy, I would not count on that.

    After 11 years in, I know that unless it is written, it is probably not true, and even when it is written, it can be changed, when they realize that all of a sudden they have 20 neurosurgeons for 2 billets.
     
  8. s42brown

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    Military MD for someone who is in the KNOW you routinely give bad advise. I do have a quote about the automatic deferral her name is COL Raines and that is exactly what she told us when she met us in person. In addition, I have an email for the DOD stating the exact same thing. If you do not match into a specialty you will automatically be given a deferral. The army is no longer in the business of producing GMOs.
     
  9. Mirror Form

    Mirror Form Thyroid Storm
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    I've been told the same policy stuff by all the administrators. However, I've never seen it in writing.
     
  10. r90t

    r90t Senior Member
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    On our side we have a set number of physicians per specialty. EM has 115 navy wide billets. They project gains/losses to match this number.

    If you don't match for a military residency, and there is a shortage of certain physicians, then a certain number will be allowed to do a civilian EM residency. However, all 100 or so people that don't match military can't do the EM residency without prior approval. This is to make sure all billets are filled and we aren't overmanned in a given specialty.

    We still have GMOs. Unmatched people usually do a civilian residency, then a GMO tour while applying for residency. People that do an outservice residency match for it 4th year.
     
  11. s42brown

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    What I said previously was for the Army only. COL Raines is the head of the Army's HPSP program. She did say that although Congress passed the bill in the late 1990s the Navy still uses GMOs and is going to continue to use GMOs. She also mentioned that the Navy, Airforce, and Army never agree on the health care field due to the vast difference in missions of the different branches. As the Army goes, if you don't match army you get a deferral.
     
  12. militarymd

    militarymd SDN Angel
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    Please find the written instruction and show me.

    I'm not giving bad advice. I'm only telling you that what you describe sounds very fishy to me. I've had "senior officers" in senior leadership positions tell me similar things to what you're saying....things that sound too good to be true....then have it change....that I won't believe it unless it is written as an instruction somewhere...and once again...instructions can be changed.....especially when they find out that they have 100 emergency medicine physicians completing training in 2007 and they only have billets for 20.

    It is in YOUR best interest to find out if this is a written instruction or not....you wouldn't want to wind up like me....bitter about the military:laugh: !!! It doesn't matter to me anymore...I've got a cush private practice job lined up making way too much money. Be careful about what they tell you.

    Amy, I would recommend investigating what everyone is saying about the Army program. It doesn't sound right to me. I know Col Raines may have said so, but she may be wrong, she may be lying, or she may just not know.....all of the above can be true. Once you leave HPSP and become an active duty physician (intern), you enter a completely different program. HPSP administrators have very little to do with GME....they deal with undergraduate medical education. I know and work with Program directors for several surgical specialties in different services, and this just doesn't sound right.
     
  13. idq1i

    Physician 15+ Year Member

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    :thumbup: Same exact thing that she said to my school's group
     
  14. HooahDOc

    Physician 15+ Year Member

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    Or she could be telling the truth and the military isn't the horrible heathen beast you attempt to convey to everyone. Why did you even sign up? Free medical education?

    Here's an excerpt from a form deferred people must complete:

    "As an HPSP/ROTC obligor, APPLYING FOR ARMY FYGME, I understand this form will be utilized by the board ONLY in the event that I am not selected for an Army First Year Graduate Medical Education (FYGME) Training Program.


    1. I understand that deferment for civilian training is granted only to those not selected for Army FYGME at the selection board. If not selected for Army FYGME, my preference is to enter active duty after: Completion of a full civilian deferred residency training program in the specialty of (list ONE specialty goal ONLY!): __________________________ (must be the same specialty goal indicated on Preference Priority List). I understand that I will be called to active duty at the completion, withdrawal or termination of this specialty program, or failure to comply with the delay program and its administrative requirements."

    Source: http://meded.amedd.army.mil/pages/fygme/fygme-docs/dif.doc

    I haven't considered the Army, but it seems it may be more physician friendly than the Navy or AF. Perhaps I will be rethinking to which branches I apply.
     
  15. Navy Dive Doc

    Navy Dive Doc Senior Member
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    I have to come to my bitter colleague's defense here, people. MilitaryMD is simply trying to help you, so listen to him, don't blast him for questioning the source. We're on the other side, we live this system every day, and we know that it's broken and people often give out bad information. They might be lying, or they might just be without a clue.

    From the Navy standpoint, people are trained to fill projected spots (billets). There is no way the Navy will allow everyone to defer into any specialty they want...we could end up 500% manned in PM and R or Pediatrics. Therefore, this doesn't make sense for the other services.

    JKDMed, what you quote talks about "if I am not selected for Army GME, I wish to defer in_________". Remember, all services have one year internships that are "Army/Air Force/Navy GME", so that's an easy out for them if they don't want the specialty that you wish to train in. They may not be in the business of churning out lots of GMOs, but I guarantee they can find a spot to fill with one. You're a licensed physician after one year of internship, you can go to work in the DOD equivalent of a Doc-in-the-box.

    I hope everyone get's the specialty they want, but that quote doesn't say that. The military will get what it wants out of you. You won't have to specialize in something you don't choose, but you may be practicing general medicine for a few years first. Not necessarily a bad thing, as I've said before...

    Anyway, stop pissing on the bear. MilMD is a good resource, you folks need him around here. Remember, we have no vested interest in your military career, our's are already in progress or done. We just want you to be informed, and I stick around to make sure it doesn't get too lopsided. Good luck to all.
    DD
     
  16. militarymd

    militarymd SDN Angel
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    Thanks for the support DiveDoc. The administrative head of HPSP really has nothing to do with the triservice GME Selection Board that meets in DC in December.

    One is responsible for bringing in a group of medical school graduates, the other is for actually training the physicians into a variety of specialists that the army/airforce/navy will need in the projected future.

    They are different commands, and for those of you who have been in the military, you know how different commands can have very little to do with each other.

    It would not surprise me that Colonel R was told something which she mis-interpreted.....intention to do something is not the same as actually doing it.

    Bottom line....investigate this 100% deferral policy before joining and finding out that it is bogus.

    It is very easy to hear what you want to hear when you're a medical student and not ask the tough questions.....I did that when I was a med student....I asked the questions, but I believed my recruiter, and never investigated further......now I'm a bitter old man.
     
  17. Rudy

    Rudy Member
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    I agree, as usual, with MilitaryMD. I would like all of you medical students who have not even put on a uniform outside of officer training to save his emails in a file and read them after you have spent a couple of years on active duty. Believe me, you will understand a lot better where he is coming from and hopefully some of you will have benefited from his perspective.

    As far as getting your residency goes, I can speak from the Air Force perspective. You have to compete for deferrals, just like you have to compete for active duty slots. The are NOT given out automatically, and yes, plenty of people end up doing GMOs. In fact, about 75% of the Wilford Hall general surgery 1st year residents in 2002-2003 were HPSP guys that got stuck doing a PGY-1 surgery year (even though they didn't even rank surgery), and they are now all out in the field doing GMOs to either fulfill their time and get out or apply for a different residency.

    The other thing to keep in mind is that air force dermatology, for example, is not even offered to medical students straight out of school. You have to do a GMO first to "pay your dues" and be worthy to even apply for derm. Other highly sought after fields like rad onc, optho, etc are available but only one or two slots.
    In radiology last year, supposedly there were 40-50 applicants for 5 active duty slots and around 10-15 deferral slots, so as you can see, many applicants did not get the "automatic deferral" that you are talking about.

    In my experience as a USUHS grad with lots of army friends doing GME, the system is pretty similar except that the army may have a couple more training slots available because it has a larger medical corps than the AF. The bottom line is that lots of people still do GMOs; they still play a major role in providing operational medicine as well as helping to distribute more competive residencies.

    My advice, as I have said before, is to skip the recruiters entirely. They have no role in the specialty selection process. You should take the initiative to contact the physicians serving as the "consultants" to the surgeon general for their respective specialties and ask them directly about how the system works. You will get the best information this way and you will know that the information you are getting is reliable. Most of the consultants that I know are very approachable, so don't be afraid to approach them.

    And please, all of you idealistic, though inexperienced 2Lt's, stop flaming MilitaryMD. I wish I had had the benefit of his advice prior to signing up.
     
  18. EvoDevo

    EvoDevo Forging a Different Path
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    Oh man, I have no experience with being a military physician, but I do have oodles of experience with "promises." Guys, we used to say in the Marines: "Don't believe it until your boots are on the ground. And even then....."

    People with good intentions aren't necessarily the ones that make the decisions, and even if the decision makers have good intentions, don't ever forget that THE NEEDS OF THE SERVICE ALWAYS WIN. So if they need GMO's more than they need FP or Peds, you might end up doing that GMO thing.
     
  19. idq1i

    Physician 15+ Year Member

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    FWIW, according to Colonel Raines, you aren't even allowed to select a GMO tour in the Army.

    Most of the complaints seem to be coming from the Navy (and 1 from the AF)
     
  20. HooahDOc

    Physician 15+ Year Member

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    Why would the Army have a form to fill out for those who were not accepted to an Army GME program to defer if they wanted them in GMO duties? Did you guys even read the form I posted? I also don't buy your conspiracy theory-ish notions that there is some sort of hidden loophole in this form that can still usher people into a GMO tour. It's not that complicated.

    I'm also sure Colonel Raines knows quite a bit about the GME selection process. It would be stupid of her not to if she's going around answering questions about HPSP. Do you think the Army would expect her never to be asked about the GME?

    I think you guys are just bitter and pissed off because you signed the dotted line hoping to get the money, thinking of nothing else. Don't spread your bitterness and "conspiracy theory" bull**** to try to disuade others who may have a desire to serve their country. I don't doubt there have been some problems, but I really think MilMD et al represent an extreme.
     
  21. r90t

    r90t Senior Member
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    If you do HPSP to become a military physician, you won't be making the wrong choice. However, if you do it solely for the monetary benefits, you are probably joining it for the wrong reasons and won't be happy.

    I am enjoying my time as a GMO and I matched for the residency that I wanted without any problems. The enlisted guys/gals are some of the best people that you will meet. It is a great experience to see how they have to work/live and the hardships they endure. You will see your troops in a different light after being operational with them, rather than sitting in a hospital for your entire career. Don't judge a person by lack of education or job position. We had 30% of our ship's force turn out for a blood drive last month, to support US troops in Iraq. Even the dirtbags were in line. You won't see that at a college campus.

    If you join the military, expect to deploy, possibly to some hot areas of the world. That is what we do. Expect to be gone from home for months at a time. Expect some risks. Keep those things in mind and you will not be bitter about joining any branch of service. If going AF, think about all of their nice golf courses....
     
  22. militarymd

    militarymd SDN Angel
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    Oh boy, you sure sound like you're getting hot under the collar. I'm only passing out information that will not be available to the newly initiated until you get to the other side(meaning starting internship). It would be totally consistent with the way the military does business to have someone talk and tell about things that they are misinformed about. Just wait and see...ok? Like I've been saying, I think only individuals who are adequately informed should be entering the military.....that is the only way for our forces to be strong and cohesive. I sound bitter here, but I've volunteered for the some of the *****iest duties while I watch colleagues whine their way out of responsibilities using a variety of excuses....medical problems, pregnancies, etc. The only way to get rid of the whiners is to have informed consent before joing.

    Having said that, that form you linked for us above....I signed that exact form 12 years ago....wording is almost exactly the same. It is only an application for deferral....not a guarantee for deferral....Also if you will note the abbreviation "FYGME"...that stands for First Year Graduate Medical Education..code word for internship and internship only...

    This thread was started by Amy, so again to answer your question. Make sure you investigate this 100% deferral policy. It does not sound right....I discussed this with some of my colleagues in DC, and they are unaware of this.

    Most Army HPSP who apply for military FYGME will be accepted, so the numbers who will be "deferred" is relatively low....and whether you get a full deferral will be based on projected billets.

    Once again, I would investigate this policy with the program directors of the military training institutions of your choice.
     
  23. Navy Dive Doc

    Navy Dive Doc Senior Member
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    I'll let folks check out my prior posts and decide whether I fit the description of the bitter Navy Doc. I wouldn't trade my experiences in the military for anything, I have had and continue to have a great time everyday. As I've said before, I think my experience is not typical, but is also not unique. Do your research and you can at least steer the system toward what you want. I went to a state school on the HPSP scholarship, and have decided to stay in, so let's give the "just for the money" thing a rest.

    JKDMed, don't whine about that form again, it means absolutely nothing. MilMD just restated my point that the referral to GME in that form includes internship only positions. If you think your needs and desires will overide what the Army wants, you'll have a long payback tour. "This form will be used ONLY IN THE EVENT I AM NOT SELECTED FOR FYGME". There are plenty of internships to stuff people into if they list their deferment in a non mission-critical specialty. For those who get a deferment, I'm sure you'll be allowed to do your residency. Our point has been, good luck getting a deferment. Get angry, incensed, pissed off, whatever at the messenger, we're just saying it doesn't fit the military we know and work within. No one will care about that form when you are selected for your active duty internship, except you.

    As far as "not even allowed to select a GMO tour", I'm sure that the HPSP student is not allowed to make this decision, per se. But I guarantee the Army retains the right to make that decision for you.

    Once again, it is not in anyone's best interest to flame the active duty Docs. Do what you want, ignore us, call us dried up, bitter has-beens who grubbed money out of Uncle Sam and regret being his whipping boys. We don't care, we made our decisions. I've always tried to be honest about my experiences and give a balanced view. I'd do it again, and I encourage others who want to serve to sign the line. But the reality is different than Colonel Raines or anyone else with an interest in recruiting and retention says.

    As far as the extremes, I'd say that Military MD, myself and the other active duty Docs are a good cross section of the military medical system. I hate to tell you, but in my experience there are more bitter folks than happy ones. Maybe by our commentary here, we can weed out some of you malcontents up front, and inspire those who want to serve. Those of us in the system would love that, and for those who are proud enough to serve, realize that the system is not set up with your interests in mind. That doesn't mean you can't enjoy the experience. Flexibility is key. And the GMO tour is not the horrific experience it seems in medical school. Believe me, a few years to kick back, work with some great people and put together your priorities in life is a good thing. As someone else said, most GMOs decide that the specialty they were hard charging for in med school isn't what it seemed at the time. Probably 3 out of 4 of the fleet Docs I know are heading back to something different than they planned as interns or 4th years.

    Bottom line, if you don't want our help or don't believe us, fine. We know the system better than you, and you have been warned.
    DD
     
  24. EvoDevo

    EvoDevo Forging a Different Path
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    Well said. :thumbup:

    *edit* Thank you for verbalizing much of my attitude about active duty service. Back when I was in, much bitterness was had by the younger Marines (and myself too) because "It wasn't supposed to be this way," or "My recruiter said it'd be different." Well, the service is what it is, and you can either adjust or be bitter. Either way, the Corps gets what it wants from ya.

    And thanks for the GMO information..I've been really worried about being "stuck" in a GMO tour should I go HPSP, but now I'm not necessarily so worried. Can you declare to the detailer that you'd like to "go green" as a GMO?

    Thanks.
     
  25. HooahDOc

    Physician 15+ Year Member

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    So being in the Navy gives you the authority to generalize your experiences to the Army?I don't know how the process works, but what irritates me is you guys using personal experience from the Navy to generalize how the process works in the Army, despite a higher-ranking and probably more knowledgeable person telling several people otherwise. I seriously doubt this person would go around lying to everyone and continue to get away with it.
     
  26. EvoDevo

    EvoDevo Forging a Different Path
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    Duuuuude, just listen to them, okay? They're not trying to bust your ass, but give you a heads up on what being in the service really entails.

    I'm not a military physician, so I can't comment on that specifically. However, don't forget that Uncle Sam's always has a trick up his sleeve. I have been in the service, and I can tell you that everyone gets hosed in some way, at some time, officer and enlisted both. Forewarned is forearmed.

    Peace
     
  27. HooahDOc

    Physician 15+ Year Member

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    I understand that, but these guys are in the Navy, not the Army. What applies in the Navy may not apply in the Army. I think the people reading this board should realize this.
     
  28. Navy Dive Doc

    Navy Dive Doc Senior Member
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    You've convinced me JKD, I'm now 100% sure you are correct. I'm sure everyone who states that they want a deferment to pursue their residency in Neonatal Respiratory PM and R or Experimental Molecular Genetics will get what they request, because the Army no longer has a stated need for GMOs or any reason to shape their force structure. I'm humbled before your vast experience speaking with one Colonel, and I apologize for daring to generalize my Naval experience to the vastly different world of the U.S. Army. When I applied to residency, I directed my application to the JSGMESB, which stands for Joint Services Graduate Medical Education Selection Board. So did everyone else from the Navy, AF and ARMY. I think we've beaten this horse enough.

    Evo Devo - You absolutely can request to "go green" to the GMO detailer, and he'll likely cut you orders on the spot. There are about 25 billets on each coast each year for USMC GMO spots. There were about 10 people in my internship class who genuinely wanted those spots, and they all got their orders early. Most HPSPers are looking for a quick buck for school and a short payback away from weapons. Thus, USMC spots aren't coveted by many. I was going to do a USMC tour, but decided to do the DMO route instead. The marines treat their Docs very well, and as long as you attempt to be squared away and act like the officer you are, you'll do fine. Of course, I imagine you already know that...Semper Fi, thanks for your time as a grunt.

    Some regret their time as a GMO, but it was the best decision I ever made. I turned down a residency spot offered during internship to go to the fleet. Not returning for that specialty and really glad I won't be doing it when I'm 50. Priorities change.

    To all in the pipeline for the right reasons, welcome to Military Medicine. There are those of us who love it, those who don't. I may switch camps in a few years, who knows. For a few years out of your life, you can get experiences that are unobtainable in civilian life for any sum.

    To those thinking about smaller loans in a few years, "how bad can it be?", sign those loan forms. You'll hate it. Already signed and regreting your decision. Sorry, but don't blast away at those of us trying to help.

    Enough, need to rest up. Command run on the beach in the morning tomorrow, some Helo OPS later in the week and a little diving thrown in for good measure. I might even have to practice a little medicine...
    DD
     
  29. HooahDOc

    Physician 15+ Year Member

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    :rolleyes:

    I never said if I was right or wrong -- I don't know. What I do know is that you're in the Navy, not the Army. If they do work the same way, which is what you assume since you use the same central service, then why would the Army allow a Colonel to travel around the country and lie to everyone? Last I checked, recruiters could bend the truth or omit things, but they still can't blatantly lie. What's your take on this? (I really want an answer)
     
  30. GMO_52

    GMO_52 Senior Member
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    JKD,
    As someone who has often played devil's advocate with our more negative members and who came from that glorious triservice school in Bethesda, I have to come to their defense here. Military medicine is not this happy place in which Army and Air Force docs walk around glad they avoided the Navy. In fact, one of the AF FPs at USU did a big FP satisfaction study and found his AF brethren to be the least happy. Go figure.

    The only issue I have with the points made before is MilMD's thought that GMO life is so bad that people would change specialty choice rather than be a GMO. I chose to do my GMO tour, could have gone straight-through in IM. I'm out in the fleet for a few reasons. 1. to extend my time in the local area for my wife's career, 2. to improve my chances for straight-through fellowship and avoid a general medicine utilization tour 3. career-type stuff (get a warfare pin, etc) 4. because I did join the Navy after all and parts of this are pretty fun.
     
  31. militarymd

    militarymd SDN Angel
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    Hold your horses GMO!! I never said GMO life is so bad that people would change their specialties. I was never a GMO, so I don't know. I have only posted that I think GMOs are undertrained, and that the military in general should probably get rid of that position.....and I'm sticking to that.

    In answering Amy's questions about choosing a desired specialty, I stated that the military won't make you train in something that you don't want, but may delay you by sending you on a GMO, and some people will opt for any kind of training rather than doing a GMO....I think that is silly, but some people will opt for that, and the military in general probably plans on that to fill some of their billets.

    JKD, and yes, the military will let some of their officers go around the country telling things that are incorrect or about things they know little to nothing about. Military medicine is a huge bureacracy, and there are many officers in this bureacracy who are misinformed. You may think that a colonel is high ranking, but they are a dime a dozen.
     
  32. Navy Dive Doc

    Navy Dive Doc Senior Member
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    JKD and everyone.
    I'm going to quote the letter that you posted about deferrals on here and try to show why I believe MilMD and I are correct and Colonel Raines was not lying at the same time. I think it comes from a true lack of understanding of what you posted and what the system actually does

    "As an HPSP/ROTC obligor, APPLYING FOR ARMY FYGME, I understand this form will be utilized by the board ONLY in the event that I am not selected for an Army First Year Graduate Medical Education (FYGME) Training Program.


    1. "I understand that deferment for civilian training is granted only to those not selected for Army FYGME at the selection board."

    This is really the money statement, the first line. There are many internships offered in every service. Every one of those internship spots is going to be filled by someone. Everyone thinks USUHS is a great deal because they are always given a military internship. This may actually be a problem for them, though, because that internship does not have to be in something they want. All of the internships can essentially be used as a base year and are fairly broad. Thus, someone with a psych internship could do anesthesia, etc. (seen it happen). Anyway, when you apply as a 4th year, you are only applying for an internship. You can express a preference for straight through training, and the Army/AF do give these promises to some people as 4th years (the Navy does not). However, you are not assured a full residency with that application, only an internship. They don't have to give you a promise of straight through training. You can request a deferment, and if the service has a projected need for that specialty, but all of the active duty spots are full, they'll likely give you the deferment. Adult primary care, emergency medicine, surgery, etc. are likely candidates for deferment, and are quite popular choices, so you'll see a fair number of deferments. However, just because you asked for a deferment doesn't mean you'll get it. Like I said before, you are matching for an internship. You can apply to the next year's board as an intern if you're only selected for PGY1 and try again.
    However, if the Army doesn't need another pediatrician, you aren't getting a deferral. This does not contradict anything that has been posted to date.


    "If not selected for Army FYGME, my preference is to enter active duty after: Completion of a full civilian deferred residency training program in the specialty of (list ONE specialty goal ONLY!): __________________________ (must be the same specialty goal indicated on Preference Priority List). I understand that I will be called to active duty at the completion, withdrawal or termination of this specialty program, or failure to comply with the delay program and its administrative requirements."

    Again, the first line is the winner. IF NOT SELECTED, my preference... If the Army selects you for their internship, you will not be considered for a deferral. The Army doesn't really care about your preference, unless it is also theirs. You will lose if what you want doesn't fit what they need. Just like the civilian world, not everyone matches in the specialty they want. If they automatically gave deferrals for anything, they wouldn't bother to ask what specialty you wanted. The military plans to projected vacancies, period.

    I don't think Colonel Raines was lying, I just think people have heard what they wanted to hear and not what was really said. If this letter is all you have to go on, you need to read it with full knowledge of how the GME selection process works. I've tried to explain this here.

    As for GMOs, that's another topic, but I will say I also saw people apply to specialties that they knew would allow them to train straight through rather than do a GMO tour. I can't imagine a worse way to pick a life's work, but it happens.

    I hope this clarifies things a bit.
     
  33. HooahDOc

    Physician 15+ Year Member

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    Any idea what the chances are of going straight through if I was interested in surgery? Would the branch I was in likely determine if I was able to do this? I haven't really decided if I want to do a GMO tour or not.

    I also realize I'm not in med school yet, but I want to know what life is like after signing the dotted line. I would rather decide if I want to do HPSP before I even bother going to talk with the recruiters. Serving my country is something I want to do, but not at the expense of a career I would enjoy (or my wife for that matter).
     
  34. Mirror Form

    Mirror Form Thyroid Storm
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    Hey, I definitely agree that the words of MilitaryMD should be taken to heart. That said, JKDMed has some good points that the Army "claims" to be changing in some of these respects. Col Raines has been extremely vocal about the deferment thing. So vocal in fact, that I'd like to hope she isn't just flat out lying. Also, the army is definitely moving in the direction of applying directly for continuous training as a 4th year b/c I've heard that from program directors as well as col raines.

    Keep in mind though, Raines has been known to seriously sugar coat things in the past. For example, at on speech of hers I was at (during the tri-service selection night thing) she posted stats of "applicants to GME speciality x versus slots available." It looked like almost everybody who applied to the competitive fields was getting in! All the med students in the room where like "wow, how great!" Although I quickly noticed that she was using GME stats, not FYGME stats. Since the army pre-selects most people when then apply for transitional years during FYGME, that's where the real bottleneck for getting into the tough specialties is. She knows that, and was basically just giving people BS information.

    If I had to bet money, I'd say that army 4th years will be much more likely to get deferrments then not if they don't match in their desired specialty. However, I'll definitely continue to be skeptical of this new policy until I see it in action.
     
  35. Mirror Form

    Mirror Form Thyroid Storm
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    There's always the FAP route if you're really worried! Although in the army I'd say you have a very very very high chance of going straight through. I haven't heard of many Army people getting forced into GMO's against their will after intern year.

    EDIT: Keep in mind that the army's gmo policy could change any second after you sign the contract and you won't be able to do a thing about it!
     
  36. HooahDOc

    Physician 15+ Year Member

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    Is there really a huge difference in the quality of living and treatment of medical officers between the three services? Everyone tells me not to do Army, but this is coming from prior enlisted guys.
     
  37. Navy Dive Doc

    Navy Dive Doc Senior Member
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    Nice that this has turned civil again.
    You will not train straight through in General Surgery in the Navy, there are simply too many returning GMOs. I haven't seen many deferments granted, either. I have seen a couple of interns get ENT spots, simply due to a lucky year where no qualified GMOs wanted the spots.

    I agree with everyone that the Army will likely give out deferments for most specialties. Many billets could be filled by an ER Doc, IM, FP, etc. so these are very likely to get the nod. My main point, which stands, is that a deferment is by no means guaranteed, especially if you want an undesirable specialty. The Army, or any other service, simply will not allow everyone to become pathologists, PM and R, neonatologists, etc. I don't think any Colonels are lying to you, but they will certainly stretch the truth. Remember, she is evaluated on her numbers...filling HPSP spots and stats like average MCATs, etc. Her incentive is to recruit, and she'll be long gone before you're disgruntled. Any physician who took that billet is looking for a star. Her aim is to make General, not make you happy.

    I have heard that lifestyle boils down to AF>NAVY>>>>>Army. The AF bases are certainly nicer, they really do have the best golf courses and the best housing. I like the Navy due to the proximity of the ocean, and our bases are pretty nice. The Army bases I have been to have all been absolute S***holes. I travel to many Army bases with my EOD unit, because they have lots of land in the middle of nowhere and therefore let us light some really big explosions. All of the bases look like they haven't been updated since the Korean war. I have not seen many of the hospitals to adequately comment.

    The AF does some interesting things. Apparently, the Navy BOQ in Puerto Rico was considered substandard by the AF. So, they would fire up a plane, fly to St. Thomas and stay in a hotel there. Excellent use of gov't resources. In Kuwait, the Army was in tents with cots. The AF had flown over tents with wood floors, AC actual bunk beds, had set up miniature golf and a Burger King. Apparently, the AF has figured out how to negotiate the money system better than the rest of us. They pay for housing, utilities, morale gear, etc. with their allowed funds for the year. Then, when they run out of money, they put in an urgent request for more funding or the planes won't fly...they get the money. The Navy and Army fund all of their gear first, then lifestyle issues. When the money's burned up, the supplemental request for the gym, housing, etc. is turned down until the next fiscal year, when the cycle repeats itself.

    I'm glad I joined the Navy, if you go AF you'll take a ration from everyone else, but it would seem that the lifestyle is better. Any AF guys care to comment?
    DD
     
  38. militarymd

    militarymd SDN Angel
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    This is a story that I heard and experienced:

    An army medical unit shows up in Kuwait and finds that they are staying in tents with dirt floors and no windows, and because of the dusty conditions they need to keep the tent buttoned up in 100+ degree weather, and use lights to see during daylight. They had to use Porta-Potties situated about 0.5 miles away and upwind. They had to wait usually about 45 minutes in line to eat any meal. There is absolutely nothing to do. They claim that their living condition sucks.

    A similar navy medical unit is in the gulf at the same time. The officers live in officer country on the ship. Most of the O-4 and up had to share a 2 man stateroom with their own private john. They ate in the wardroom with pretty good food. The ship is air conditioned. The lounge has satellite TV. There is a sailor phone to call home. Internet is available. There is an outstanding gym available 24 hours a day. They said"This isn't bad, but it looks like it really sucks over in Kuwait where the army guys are"

    The air force unit shows up in Bahrain and were shown to their rented apartments. This is what they said "What??!! No room service???!!...This SUCKS!"
     
  39. idq1i

    Physician 15+ Year Member

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    Do you have any MDs working with you that enjoy their work/think that their made the right choice/would make the hpsp choice again?
     
  40. HooahDOc

    Physician 15+ Year Member

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    Certainly sounds like Air Force to me :D
     
  41. Navy Dive Doc

    Navy Dive Doc Senior Member
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    Depends what you're after. If you just want to work in a hospital as a board certified___________, then the AF is the one. For those looking to get things paid for, do their time and move on, the AF is perfect.

    My own opinion, as I've stated before, is that all HPSP recipients should do things in the military that they cannot do in the civilian world. That's why I'm actually in favor of the GMO tour, and would do Navy over all of the others. As a DMO, I spent 6 months getting in the best shape of my life, I'm a fully qualified Navy Deep Sea Diver (Hard hat, mixed gas/heliox, etc.) I dove the USS Monitor recovery as a working diver, filmed by the Discovery Channel. I dove for NOAA at their habitat in Key Largo. I've been across the world on various Submarines, I've fast-roped, rappelled and jumped from Helos. I was headed to Airborne school, but the funding got yanked. I've shot machine guns and grenade launchers, and been around a lot of big explosions. I've worked with some incredibly fine people. That's what I'll remember about my Navy time, not the days I read films in the hospital. A DOD hospital looks just like a civilian except for the uniforms (and everyone speaks English). I have my whole life to read film, but the 3 years as a DMO can't be purchased in the civilian world.

    The vanilla GMOs can have great times as well. Yes you are separated from your family and there's a lot of boredom. These are not insignificant factors. The Navy is a great place for single people without significant attachments at home, but if you actually want to be a "military Doc", then your GMO tour is the closest you'll get.

    The AF does treat their people better, but I think the Navy is close enough that the other factors win out. From what I can tell, the Army is a distant third. Remember, too, that the Navy supplies the USMC with their Docs, so if you want to be with the Ground pounders, all you have to do is ask. From talking with my friends deployed to Iraq, the USMC is by far the better force to be with. Morale is higher, the Marines are hard charging and squared away, and they're better armed and organized. Again, no first hand experience to back this up, but my DMO/GMO friends were very happy they weren't with Army units.

    idg1i - I'd do it again, and so would 75% of my DMO colleagues. Most of the specialists that have been in awhile say they would not. Who knows, maybe I'll agree with them in a few years. For now, though, it's been quite a ride.

    Dive Doc
     
  42. edmadison

    edmadison 1K Member
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    The army is switching over to straight through programs. My Peds contract is for three years not one. I believe that medicine, FP, OB/GYN are the same. Ortho was just changed to straight through as well with the exception of a dedicated alternate spot.

    Ed
     
  43. HooahDOc

    Physician 15+ Year Member

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    DiveDoc, I was actually referring to the comment about the deployed AF guys whining about having no room service :D

    My brother in law is an Airman in the AF, so I hear plenty of similar things. Coming form a pseudo-Navy background I am obligated to give him **** for it.

    I am really torn between having an actual military experience (Navy) and compromising to go easy on my family (Air Force).
     
  44. militarymd

    militarymd SDN Angel
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    To Amy,

    By the way, I just noticed that you are still quite a ways away from medical school. Planning to start 2007?

    Everything said here will probably change by then. I think there are going to significant changes in military medicine in the next few years, so just wait and see what things will be like.

    PBD 712 may have signifcant impact....or not....Rumsfeld seem intent on getting rid of a lot of military physicians.....may be he'll be successful...or not....but I think you'll have to reinvestigate everything again when your time comes.
     
  45. AmyBass2011

    AmyBass2011 Member
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    Yes I plan to start med school in 2007. I am just one of those people that like everything planned out... Thanks, Amy
     
  46. Navy Dive Doc

    Navy Dive Doc Senior Member
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    Everything planned out is not the rule with Miltary medicine. Type A's do OK if they can learn to accept this reality, but "max flex" is the rule. I received an order modification 2 days before I was set to move to my next command, after having orders in hand for 3 months. I had even signed a contract to buy a house, so you really never know until you show up at a command and activate those orders.

    I agree with MilitaryMD, PBD712 looks like it will have far reaching consequences for force structure, though I'm not sure exactly how they'll actually implement the plan. If Rumsfeld is gone next year, we'll probably ride it out but if he's around for many more years, the significant downsizing is likely. We'll all be waiting to see. Good luck.

    DD
     
  47. Hi guys, thanks for the info. Back to the civilian defferments. I was on the phone with a couple of recruiters and am getting some conflicting info.
    1. If you do get a full civilian defferment, I heard that since the af pays the training costs at the civilian hospital, they add on extra active duty years=to the length of your civilian residency. In other words for a fp civilian residency and a four year hpsp, you have a seven year payback instead of four?

    2. How much of your income is tax free in the military? and how much savings do you get from it. I heard some guy say that a doc earning 180,000 in the civilian world would pay about 30-40,000 in taxes. A military doc earning 130,000 in the military would pay less taxes so the differential wouldn:t be that much. Please help out.
     
  48. Mirror Form

    Mirror Form Thyroid Storm
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    There are programs like that in place for some specialty areas, but those are different from pure deferments where you and your program aren't paid anything by the military.

    I'm not sure of all the specific tax breaks, but I know there are quite a few. You at least don't pay taxes on your basic housing allowance and stuff like that (I think). Also, try to learn a little bit more about civilian taxes before comparing them to the military. Somebody making 180k in the civilian world will usually be paying A LOT more then just 40k in taxes!
     
  49. Masonator

    Masonator Senior Member
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    There is alot of confusion on this site about the GMO thing. The army does defer those who don't match in a chosen specialty, but... it is not foolproof. They still have 50+ GMO slots that they keep for special circumstances. These cirucmstances are USUHS students who don't match in their specialty. They have to do an army residency and have to GMO. There are also slots for operational folks. If you piss off the brass they can also ship you into a GMO just because. This is what they do to people who try and scam a deferment for bogus reasons.

    The navy and airforce use GMOs alot more and will assign those who don't match into a GMO. The airforce is sometimes nice with civillian deferments as long as all of their GMO slots are filled and all their residency slots are filled.
     
  50. Masonator

    Masonator Senior Member
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    The army has 20 surgery residency slots. This year they had 30+ applicants, so some were deferred. They seem to have a high demand for surgeons so none were forced to do a GMO. The exception is USUHS. They have to do a military residency so if they don't match in their specialty they do a generic military internship and then a GMO tour. Military surgical residencies weed out one intern before moving on to PGY2. This weeded out intern could get deferred or could get GMO'd. I don't understand how this works. The army has the best prospects for specialization as they have the most slots, the most specialists, and the biggest hospitals. I would listen to what the attendings have to say. These are major level attendings who have seen it all.
     
  51. Navy Dive Doc

    Navy Dive Doc Senior Member
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    PRlester I'll try to clarify:
    A full deferment for residency is just that, a deferment without any military pay or benefits. The service says "see you in ___years" as a specialist. This time counts neither for nor against your payback, it also doesn't count toward time in service for pay or toward retirement.

    A full time outservice spot means the service is paying your salary, not the civilian training institution. Time counts for time in service and retirement. At least in the Navy, these are never given to med students and are generally reserved for a few specialties who need more people than can be trained by military residencies. It's also used extensively for fellowships. These FTOS spots do incur an additional obligated service period in addition to any residual HPSP or USUHS time (Yes, USUHS people can get FTOS, but only in programs that the DOD doesn't offer, i.e. Pediatric surgery).

    Hope this helps
     

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