Your thoughts.....

[curraheeraiders]

I am going before the board Feb 8th for the Army HPSP and was also just given a complete four year scholarship to the school I will be attending. I'm not part of the "just in it for the money" crowd, and do believe serving as an Army physician will be an valuable experience. Right now my heart is set on EM/Trauma Surg, but I know minds tend to change after the four years of medical school.

My question is, how similar is EM/Trauma Surg in the Army as compared to a civilian job in the same specialties? I know the traumas seen in the military will be on a much different level, but am curious to know the likelihood of being deployed with such a specialty and seeing these traumas first hand. Also, trauma would require a fellowship. What is the likelihood of being granted a straight through fellowship after residency and how does that affect my service obligation after?

I have a tough decision to make in the upcoming weeks and any insight or opinions would be greatly appreciated.

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[colbgw02]

Wait, you're saying that you've been given a full scholarship to medical school? A scholarship that has nothing to do with the military? If so, then this should be an easy decision. You can always join the military after completing your training, and if you can do so without going into debt, then I'm hard pressed to find a downside to taking that scholarship and avoiding HPSP like the plague.

 

[IgD]

The military doesn't have ER/trauma surgery!!! When I think of ER/trauma surgery I think of the level 1 trauma center my medical school had. I don't think the military has any facility like that. Don't mean to be insulting but a lot of times military EM had to deal with acute care, internal medicine type issues. One possibility would be to complete that training first and then join the ranks of military medicine.

 

[AFDuck]

What's the opportunity cost of taking the med school's money and passing up HPSP? You seemingly don't lose financially, and you certainly don't lose the ability to join the military because you could always join later via one of several routes. Also, I'm no surgeon, but from what a lot of surgical folks have said on this board, small caseloads tend to be a problem in the military training programs and thats a bad problem to have (try searching some older posts for more info).

Doesn't seem like that tough of a decision to me, I hope you make the call thats right for you.

 

[Yellowstone]

Forget HPSP and join later via FAP if you're still interested. You get an extra $30k or so per year during residency, owe year per year +1 after training (I think), and get much more freedom to pursue the training you want when you want it. I'm sure military medicine would still love to have you in another 10 years. If you already have a full ride, the only reason I can see for doing HPSP is if you are certain you want to make a career of military medicine (retirement).

 

[IgD]

I would be curious to hear from some of the surgeons. It would seem to me like a "trauma surgeon" is someone sorely needed in the military. How does this need get fulfilled?

 

[colbgw02]

I would be curious to hear from some of the surgeons. It would seem to me like a "trauma surgeon" is someone sorely needed in the military. How does this need get fulfilled?

There is a surgeon at my medcen who recently completed a civilian trauma surgery fellowship. I have no idea how frequently that is allowed, but that would probably be the process.

Also, regarding your first post, Brooke AMC in San Antonio is a level one trauma center and - up until a few years ago - the AF's Wilford Hall in San Antonio was too. I think Wilford Hall has been downgraded since, but I haven't confirmed that. I'm not sure if they have trauma fellowships there (I suspect not), but my understanding is that the training is sufficient. The burn center at BAMC is also supposed to be quite good. Perhaps someone stationed there could provide better/more information?

 

[NateintheED]

The military doesn't have ER/trauma surgery!!! When I think of ER/trauma surgery I think of the level 1 trauma center my medical school had. I don't think the military has any facility like that. Don't mean to be insulting but a lot of times military EM had to deal with acute care, internal medicine type issues. One possibility would be to complete that training first and then join the ranks of military medicine.

Respectfully disagree. As far as trauma goes, as an above poster has said, BAMC in San Antonio is a Level 1 center. Madigan in Washington state is a Level 2, as is Landstuhl in Germany. And when deployed, every general surgeon is a trauma surgeon by default. If you do a fellowship, it will be more likely that you'll be stationed at one of those places. If you aren't though, there's always moonlighting, as one of our docs at Madigan did.

As far as Emergency Medicine is concerned, those "acute care, internal medicine" issues are exactly what the ED is there for. Undifferentiated chest pain, abdominal pain, difficulty breathing, headaches, backaches, all manner of infections, and everything else that walks in the door is what we do. Oh yeah, and don't forget the multitude of pediatric illnesses, orthopedic injuries, and OB/GYN concerns. I've got news for you - these people come to the ER in the civilian sector too. They just may come more often in the military, since they don't have to pay for it. And there are plenty of sick old retirees for military ED's to care for, especially at the larger MEDCENs. And depending on your location, moonlighting opportunities usually abound in EM.

To the OP: While the general public as well as pre-meds and beginning medical students tend to lump Emergency Medicine and Trauma Surgery together, they are two very distinct and different specialties with very different training pathways, scopes of practice, and lifestyles. You will have to make a choice between the two by your 4th year at the latest. Or you may find that you love pediatrics and go that way instead.

As others have said, if you have a full-ride, take it. If you still want to join the military after that, great. I'm sure they'll be happy to have you. Ultimately, you should try and be property of the government for as little time as possible, unless you've already drank the Kool-Aid and are planning a 20+ year military career.

 

[notdeadyet]

As far as trauma goes, as an above poster has said, BAMC in San Antonio is a Level 1 center. Madigan in Washington state is a Level 2, as is Landstuhl in Germany.

True, but I think any EM hopeful with an interest in trauma usually culls their list by choosing residencies with active Level 1 trauma centers. I'm sure Army EM programs are good at many things, but from talking to past folks, it'd be hard to claim trauma is a strong suit.

If you aren't though, there's always moonlighting, as one of our docs at Madigan did.

This is what makes me apprehensive about military residencies. If I had concerns about lack of training in a particular area or skill atrophy via low volume, if a civilian program director or employer said, "well, there's always moonlighting," I'd run...

Good clarification on the Trauma Surgeon thing. At least on the civilian side, a Trauma Surgeon is a fellowship trained general surgeon, not a fellowship trained Emergency Medicine doc. Correct me if the military does it differently. Most EM docs I know would make for very unhappy trauma surgeons and most trauma surgeons I know would make for very unhappy EM docs.

 

[NateintheED]

True, but I think any EM hopeful with an interest in trauma usually culls their list by choosing residencies with active Level 1 trauma centers. I'm sure Army EM programs are good at many things, but from talking to past folks, it'd be hard to claim trauma is a strong suit.

Again, respectfully disagree. All of the Army EM programs rotate their residents to Level 1 centers. Also, most people outside of EM have this belief (probably born from ER the TV show) that trauma is a huge part of what we do in the ED. The reality is that this is not the case. And from an Emergency Medicine perspective, trauma is really pretty algorithmic. Primary survey, stabilizing interventions, secondary survey, imaging, disposition (home, admit, OR). Call surgery if necessary and not already present. Of course, may skip directly to disposition if unstable. A sick medical patient with multiple comorbidities is much more of a challenge. Also, the vast majority of practicing EM physicians are not practicing in Level 1 centers, and those that are have varying involvement in traumas. Some places, if there are no EM residents needing experience, they are handled entirely by surgery and anesthesia.

This is what makes me apprehensive about military residencies. If I had concerns about lack of training in a particular area or skill atrophy via low volume, if a civilian program director or employer said, "well, there's always moonlighting," I'd run...

From my experience, likely more of an issue with surgeons than EM docs. I'm not a surgeon, so cannot comment specifically. Granted, I'm in a small place right now and not seeing tons of sick people on a daily basis in the ED, but the thought processes are still the same.

Good clarification on the Trauma Surgeon thing. At least on the civilian side, a Trauma Surgeon is a fellowship trained general surgeon, not a fellowship trained Emergency Medicine doc. Correct me if the military does it differently. Most EM docs I know would make for very unhappy trauma surgeons and most trauma surgeons I know would make for very unhappy EM docs.

You are correct. EM and Surgery training are the same whether civilian or military because we're all eventually certified by the same boards (ABEM, ABS, respectively). And there is no guarantee for anyone in any specialty of continuous training from residency through fellowship. And I definitely agree that many members of one specialty would be very unhappy in the other. Personally, I might have been happy as a trauma surgeon, but would have been pretty miserable for the 7-8 years of training required to get there. But I know I'm happy as an EM physician.

 

[73BARMYPgsp]

What is a "FAST" team. Is that not roughly like what the OP is asking about in a deployed setting? I really don't know--I'm not "that kind" of doctor!!

 

[curraheeraiders]

I am sorry for the confusion, but I was not meaning EM/Trauma Surg as one specialty. I know the difference between the two. What I was meaning to get across was that I am interested in both specialties at this time, not on one combined specialty.

 

[edmadison]

If you have a full ride scholarship, you would be INSANE to do HPSP. Go to medschool, explore you options and do FAP in residency if you really want to be in the military.

I really mean insane, as in: I would refer you to psychiatry if you were my patient.

Ed

 

[JAZZEYE]

Wait, you're saying that you've been given a full scholarship to medical school? A scholarship that has nothing to do with the military? If so, then this should be an easy decision. You can always join the military after completing your training, and if you can do so without going into debt, then I'm hard pressed to find a downside to taking that scholarship and avoiding HPSP like the plague.

And why is HPSP a plague ??? care to elaborate ?

 

[TheGoose]

And why is HPSP a plague ??? care to elaborate ?

don't take it so seriously. the plague is taking an HPSP scholarship and slapping a free ride to medical school (WITH NO STRINGS ATTACHED <--that's the big issue) in the face.



OP, I have to agree with everyone here. Taking HPSP when you have a scholarship from your school would be bonkers. What do you honestly get out of HPSP as a student anyways? go to officer training and do a couple of active duty rotations in a military hospital. That will be waiting for you whenever you join. HPSP is HPSP because they pay for school. Now, that's not to say that people should join for the money, but that IS the reason that the scholarship exists.

I would say to go ahead and complete medical school with your free ride. If you want to go to the military you can do FAP like people above have been saying and make 30k more than your peers or complete a non-FAP residency/fellowship in something you really enjoy and then direct commission.

 

[colbgw02]

Agree with NateintheED regarding trauma training and practice for most EM docs. EM docs were essentially banished from the trauma bays where I've spent any amount of time, and the vast majority of EDs in this country don't see major trauma routinely (or ever). It's nice to get some exposure to trauma, but it's not like you can't run a decent EM residency without it.

 

[AF M4]

And why is HPSP a plague ??? care to elaborate ?

Gosh, there are like a billion threads on this forum about this. Seriously, just close your eyes and click, you'll hit one.

Also, I wish to play poker with you. Bring money.

 

[DeadCactus]

I simply can't believe that we're understanding the original post correctly. "Should I take free money with no strings attached?" is not a decision. It's a test of basic reasoning abilities...

 

[AF M4]

I simply can't believe that we're understanding the original post correctly. "Should I take free money with no strings attached?" is not a decision. It's a test of basic reasoning abilities...

Shh - you're chasing the fish away...I got myself a pigeon and my car needs new brake pads. I promise that if you wait until after I've fleeced him to question his reasoning abilities then I'll give you a small cut of the profits.

 

[Ziehl-Neelsen]

What is a "FAST" team. Is that not roughly like what the OP is asking about in a deployed setting? I really don't know--I'm not "that kind" of doctor!!

FASTs (forward sugical teams) are specialized mobile surgical units that are able to move with forward deployed units during mobile actions. They consist of 4 surgeons, 3 RNs, 2 CRNAs, 1 administrative officer, 3 LPNs, 3 surgical techs, and 4 medics. They are primarily used in initial assaults when infantry units are highly mobile and logistical supply lines are not yet established. These mobile teams allow for life saving treatment for soldiers who otherwise could not be reliably medivaced within the golden hour.

Most surgeons deploy as part of a CASH where they perform surgical stabilization of all patients medivaced to the CASH. Obviously, >95% of everything that walks through the CASH doors is trauma, hence the statement that every deployed surgeon practices trauma surgery.

To the OP... Every surgery program in the army has its residents rotate in trauma surgery at a level I trauma center, but as state above, the only residents that get to do that at home are the SAUSHEC residents. Residents at WRAMC rotate for 3 months at shock trauma in Baltimore and I assume residents at other programs rotate at similarly busy institutions. Trauma felowships are available at BAMC and through civilian deferral. My friends have told me that trauma is not a popular fellowship because it is a less predictable lifestyle and makes a surgeon more deployable. Thus, residents generally match straight through.

Here I will echo what others have said... If you have a full ride to medical school, do not take an HPSP scholarship. Finish medical school, match to your desired residency, and then make decisions regarding FAP, the reserves, etc.

 

[Homunculus]

If you have a full ride scholarship, you would be INSANE to do HPSP. Go to medschool, explore you options and do FAP in residency if you really want to be in the military.

I really mean insane, as in: I would refer you to psychiatry if you were my patient.

Ed

totally agree. in fact, i have already put the consult in for simply asking the question. of course, after it gets deferred to network it won't get appointed for a few months-- by that time the OP's decision will be made.

seriously though, the money issue should be separate from the "what field of medicine" issue. the military will always be waiting. . . .

--your friendly neighborhood "human capital" caveman

 

[Galo]

You've gotten great advice from everyone here.

I spent 6 yrs as an active duty surgeon. It would be a grave mistake to not take a scholarship, and indenture yourself to the military where its quite possible you will not be able to train in what you want, and then not be able to practice it to the best of your ability.

You'd have to look at the forecasts, and GME selections boards, which I'm not sure how you could, but once you finish a surgical residency, you'd have to do a fellowship for trauma. If you can get it, you'd be adding commitment to your time. YOu think that you may be signing for 4 yrs, but may end up serving more than a decade. Its a bad deal, and you should stay away from military medicine. If after you are trained in whatever you want, the military will always take you, but at least you will be trained in what you want, and depending on your aptitude, at a potentially much higher level than you could get in military medicine.

good luck

 

[NAVYLABTECH08]

what percentage will actually be paid? is it covered 100%? If so, throw up the deuces to HPSP and FAP in my opinion. Just come back as a civilian and pick up shifts at a military hospital as a pt gig.

 

[DrBloodmoney]

To the OP:
If you truly wish to serve, and you already have medical school paid for, you really should consider doing all of your training on the outside, and re-evaluate. You will be in a far better position coming in then.

 

[Gastrapathy]

This thread is like one of those IQ test popup ads.
Question: Should I do HPSP if med school is free anyway?

I just can't believe we're still going with answers two weeks later.

 

[notdeadyet]

This thread is like one of those IQ test popup ads.
Question: Should I do HPSP if med school is free anyway?

I just can't believe we're still going with answers two weeks later.

Ditto.