Navy Current Navy Flight Surgeon- Stay or Go?

[obgflightdoc]

BLUF: Stay Navy? Lat Transfer to USAF? Go Civilian? If civilian, Reserves (which reserves?)?

Background: I'm a Navy Flight Surgeon, currently deployed on the USS Reagan and my HPSP commitment is up JUL2021. I completed an OBGYN PGY-1 at NMCSD and was offered a residency spot but declined so that I could pursue operational medicine. My wife is an Air Force Osprey pilot and was are currently both stationed in Japan, although unaccompanied, at bases 8 hours apart. I still want to be an OBGYN but the DHA is currently slashing Navy OBGYN GME spots in unpredictable ways (Walter Reed was removed from the list altogether, unexpectedly, this year).

I am faced with three choices:
1. Stay Navy. Go to navy OBGYN GME (if they still have spots). Pros: I don't have to repeat internship. I feel confident in getting a spot (if available) as I left on good terms and am still very much involved in the Navy OBGYN community. If I stay active duty my wife and I can still request colocation even though it's far from guaranteed. 12 weeks paid maternity leave, even during residency. Cons: Guaranteed separation during residency (no Air Force bases near SD or Portsmouth). Likely separation for 3 more years additional obligation after. OBGYN billets are being slashed and job satisfaction is down.

2. Lateral transfer to the Air Force as a FS. Complete another FS tour. Apply for Air Force OBGYN GME (challenging?). Pros: Better chance of being colocated/join spouse as we will both be Air Force. Maternity leave. Cons: Another FS tour (I don't like primary care and I feel like I'm getting dumber by the day), no guarantee of OBGYN GME and would have to repeat internship

3. Get out. Go civilian residency. Pros: Choice of programs better suited to me than military OBGYN program. Freedom. Cons: No pension. No Tricare for life. No maternity leave. Repeat internship. 4 years (likely) separated. Risk of additional time separated after residency because I need to case-collect and can't do that if wife gets OCONUS billet again. Risk of not being able to work, period, wherever we go, because the military doesn't give a hoot about civilian spouses.

I am leaning toward getting out. I really, really, really don't want to do the Match (also I'll deployed on board ship during interview season next year). I would like to "gun" for a couple of programs where my wife could most likely be stationed- is it even possible to pursue civilian residency spots outside of the Match?
Also, I have read up on the GI Bill benefits during residency, but I'm baffled by the Reserves options. I'm not afraid of reservist time- I could do it as a FS and it's really not so bad. A deployment here and there really doesn't scare me- I can imagine that it breaks up to monotony on the outside, a bit.

Can I do the reserves during residency after already having done HPSP? After separating, can you re-join as a board-certified civilian and still get sign-on bonuses, etc? Getting a pension is a priority for me, and I don't mind serving; honestly, if I could be guaranteed colocation I wouldn't get out, but I'm sick of being separated and I don't want to do it over and over again.

Seriously open to any advice/suggestions. I've gone through all the official channels I have access to and gotten little sound advice. I turn this over in my head on a constant basis (ship life...) and can talk myself into and out of each one, repeatedly.

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[d2305]

I remember the longest we could stay inport over there was 21 days. As fare as the Navy or AF goes, it depends on what they offer.

 

[DrMetal]

BLUF: Stay Navy? Lat Transfer to USAF? Go Civilian? If civilian, Reserves (which reserves?)?

Go civilian. Being a dual military couple is hard, being dual and of different services, and of different communities (one a line officer, the other MC) is even harder. There's no telling when you'd be together again in the same geographic location. That'll ultimately hurt your relationship. Throw kids into the equation and it becomes even harder.

At least one of you should go civilian, and it sounds like you'd have more to gain (choice of civilian residencies, anywhere in the country, better training etc etc). The pay would suck as a civilian resident, compared to what you're making now, but you can make up for that later. And if you budget yourself correctly, your finances should be fine.

 

[Cooperd0g]

Langley isn't that far from Portsmouth, but I don't know what the Osprey opportunity is there.

If you transferred to the Air Force and then applied to their GME after a flight surgery tour with them, you have very high odds of ending up at Portsmouth ... so that doesn't help a lot.

When does your spouse PCS? If they get orders before you have to submit for the civilian match you can focus your interviews and efforts as close as possible to their upcoming duty station. If they won't get orders until after you apply you can apply to the places where there are the highest chances your spouse will get stationed.

"Competing" demanding careers is extremely hard.

 

[obgflightdoc]

Thanks for the responses- civilian seems to be the obvious choice, really. I'm fighting it, I think.

One other factor- can anyone speak to having kids sooner vs. later? I'm 30. A lat transfer to the USAF for another FS tour is the "kids now" option for us (outpatient hours, paid maternity leave, high likelihood of co-location) and going civilian is the "kids later" option (after residency). I'll be 36 when I finish residency (ugh!).

Thoughts? Does this change the calculus?

 

[backrow]

There is no “good” time to having kids when you are in the medical field and having kids is a “young persons game” so I would recommend having kids whenever you are ready. It’s going to be tough no matter when and you’ll find a way to make it work.

 

[Cooperd0g]

The best option for being able to stay together would actually be to do a follow on tour as a Navy flight surgeon at Whiting and have your spouse get orders to VT-3 as an instructor pilot. Have a kid (or two) and then decide who is getting out and who is staying in, or both getting out.

You may need to consider a different specialty as well that may have more compatible locations for training. Not to try and sound too harsh, but you both have serious commitments that make this difficult. This is a good lesson for those not yet in the military on how restrictive it can be.

 

[obgflightdoc]

Thank you, both. (By now it's obvious how and why I flip-flop on this decision every day). We have definitely discussed getting her a billet at a training squadron- it's not what she wants, but she would do it if it comes to that.

Technically speaking, is there a "limit" to how long you can be out of training before you have to repeat Step exams (or something else equally terrible)?
Obviously, I'm aware that the less time you spend putting off residency, the better, but are there any "hard" cut-offs?

 

[Cooperd0g]

Individual states have hard cutoffs for how many years to complete the Steps, but that doesn’t pertain to residency. Given you are a GMO, you have a state license and must be Step 3 complete.

The only specialty that I am currently aware of with set rules on timing is Emergency Medicine. They require PGY2 to start no more than 36 months after PGY1 completion or you have to repeat PGY1.

 

[TheTruckGuy]

I'd say unless you really want to be in the Navy, or in the military, just get out. You'll take a pay cut, but with all the crap going on in military GME with the non-wartime critical specialties, it'll be a gamble staying in. And like others said, dual military is difficult, dual military in different services is even harder, and then throw in a physician on top of that, and that won't be fun.

You can also always join back up later, after they realize they screwed up and start backfilling all the re-opened billets they cut. You'll also not have to deal with AHLTA/Genesis, with constant turnover of corpsmen, and stuff that just doesn't work half the time. Then again, the grass is always greener...

 

[Per5everance]

3. Get out. Go civilian residency... Cons: ... No maternity leave... Risk of additional time separated after residency because I need to case-collect and can't do that if wife gets OCONUS billet again.

Just wanted to address these points, but most programs give some sort of leave. Example our program gives 3 weeks of vacation plus 1 week of other so you can plan to work right up to pregnancy and get 4 weeks off. I know other programs do this. Obviously residents won't be happy but we suck it up so our colleagues can spend time with the family. Also I do not get what you mean with case collect. Do you mean not meeting ACGME required case volumes? If so, that is a rarity because programs that routinely do that can't support a residency.

 

[JCJ_Surgery]

Some civ programs will do up to 12 weeks maternity or paternity leave - but be aware that ACGME accredited residency programs require a certain number of weeks for a “good year“. For General Surgery, it’s 48 weeks. Any weeks of training less that that for a year have to be made up - which eventually delays the end of your residency. Since this is usually an ACGME requirement, this is probably applicable to .mil programs as well.

one other thing - if you are into moonlighting, since you are a FS you might consider becoming a FAA AME. A colleague and friend of mine does a good business doing FAA exams one night a week at a local urgent care. FAA flight exams are much less complicated than mil flight exams.

 

[obgflightdoc]

All- thanks for the info on maternity leave- so for the programs that allow 12 weeks, do you just tack the extra ~2 rotations onto the end of your last year to meet ACGME requirements, or do you have to repeat the whole year?

I had not heard about Walter Reed being deleted from the list. Can you post the list?

The only OBGYN PGY-1 Navy spots this year were at NMCSD and NH Portsmouth, and there were much fewer spots than previous years. WR did not get any Navy PGY-1 spots this year, but still had Army and AF PGY-1 spots. I don't have the Navy GME list, sorry, but someone on here may have it...

 

[obgflightdoc]

Also I do not get what you mean with case collect. Do you mean not meeting ACGME required case volumes? If so, that is a rarity because programs that routinely do that can't support a residency.

Thanks- what I mean is, after graduation, OBGYNs collect cases for up to 2 years (I think? Have to double check) prior to their oral board exam, which allows them to be officially boarded. I wouldn't be able to work OCONUS, so...that would be impossible- I'd have to stay stateside until I had enough cases.