Matching after HPSP repayment time.

[bustinbooty]

Does the completion of a GMO tour for Navy HPSP make me more competitive for civilian residency? Or does it only make me more desirable for military residency?

---

Members don't see this ad.

 

[Flea]

It depends. If you sat in a clinic in the States for your entire payback, it probably won't help much. But, I think being a Department Head and traveling the world, has to have an advantage or at least stand-out over a new Med School grad. I've heard of people getting into some fairly sought after programs/residencies afterwards.
The Program directors/attendings I've talked to have been fairly encouraging and think it's a set up for a Chief Resident position eventually. Just expect to do a little "remedial" resi-tern time.

 

[bustinbooty]

Where does your voice of knowledge/experience come from, Flea? If you have firsthand insight into these types of questions, I would have more of them for you if you don't mind.

 

[Flea]

I'm applying for civilian residencies this fall after 4 yrs of payback as a GMO and most of my other GMO friends are doing the same.
.....FYI they're converting some GMO billets to FP/Prev med. Just what you want after a Residency... a tour on the USS Neverhome and treated/worked like an intern... I definately don't regret paying back my commitment as a GMO.
Of my friends that have crossed over to civilian land they range for one got the Optho program of his choice to chief resident at an Ivy League. The only one that has had a problem getting in wants to go Derm(that is hard IN or OUT of the military). Derm has one of the highest retention rates (50%)-therefore fewer are needed. By the way- FP has a retention rate of 12%. Check out the Provider Satisfaction Survey on the BUPERS website-- http://navymedicine.med.mill.navy/med00mc/
I have talked to several civilian attendings/Residency Program directors/ Chief Residents (IM, of course), they were VERY encouraging and without prompting mentioned that the experience was probably a good set up for Chief Resident followed by a . I'm not too worried about finding a good spot as a civilian.

 

[bustinbooty]

Flea, Thanks for the scoop. That is the kind of stuff I like to hear. As an MS1 the only thoughts running through my head are the aprehensible "Am I doing the right thing?" ---Helps to hear that yours and others' experiences have been good and beneficial. Where did you do your GMO Tour?

 

[Flea]

I was with the Seabees (mobile construction workers) for 25 months, 9 days, and 10 min . 80-90% of the GMO's with them get out (over 2 years only 1 took a Residency), then went into a clinic to finish my payback.
Take note, I appears as though many of the "clinic" tours are being converted to FP positions (probably because they are short GMOs). Both my billet and the other GMO here will be replaced c FPs when we get out.
This increases the chance that you'll end up on a ship.
The Navy's goal is to "Match" the number of interns with the number of GMO spots by 2003...they are currently short GMOs. That may indirectly increase the chances of getting a residency spot directly after internship since many GMOs choose to do an "extra" tour to complete their payback.

 

[jephyboy]

I've got a question for the previous posters. So, after you finish medschool, you went straight into a GMO to finish the payback years? You didn't do a residency in the Military. So, are you an intern during the GMO; that is, there are physicians that supervise over you, or is this wrong? Any input would be great. Thanks.

 

[Flea]

For me there was NOBODY, I was it. I think I had 5-10 charts reviewed over the 2 yrs. Most of the time if I had a question, it was answered from a book(that I bought from Amazon.com myself ), the internet, or a long distance call to a specialist (most are very receptive to questions from GMOs). The only "library" availible had books with copyright dates in the 1970's (the last time there was any funding). However, this can be billet dependent- the carriers and clinics have FPs avalible to ask and chart reviews are done. In general as a GMO, if you don't know what to do (ie the patient is beyond your scope)- you consult them to a specialist or MEDIVAC them (when your in a remote location)-- IF your skipper agrees and isn't a physician wannabe. It's amazing how some lay people can tell how sick someone is just by looking.

 

[bustinbooty]

Flea...How confident were you as a new doc on a ship calling all the shots yourself with a staff of (how many?) looking to you for all the answers. How prepared did you feel for that situation? I definitely want to be on a boat, but I'm aprehensible about being the Chief MO on a ship as a rookie.
Did you like the sea or the clinic better?
Best of luck.

 

[Flea]

I was with the Seabees- land based, but I spent 18 of 25 months overseas or in the Field. Of course your not prepared for solo practice after just an internship (most of which was spent in the hospital), but take comfort neither is anyone else-- Your often told, "don't worry they're all 18 and healthy", not very true in my case- there was lots of psych/etoh/suicidal, HTN, A.fib, cholestrol problems, Diabetics, cancer, multi-trauma victims (ok just 3 of those)... 1/3-1/2 of the cases are ortho- fractures, ACL tears, blown shoulders/knees/ankles, etc.. They are definately less strict about who they take and keep with the shortages.......
I'm very glad that I did an IM internship with extra ortho/Derm in 4th year AND internship. In addition, I took a course in Global Medicine/ Infectious Disease- I was the only one doing any medical planning for our overseas/field trips.
The Peds and surgery interns seem to have the most difficulty..with the primary care aspect of it..PID, abnormal paps, DUB, sinusitis, "my little pinky hurts" type of complaints. They just end up doing some referrals sooner then later- I didn't need to refer the diabetics, but the surgery people generally did-- Then again I refused to touch the pilonidal cyst (they're always worse then they look) and referred them on to the General surgeon.
Your so accustomed to seeing the very sick in internship it does take some time to be more comfortable making that Sick/not-sick call- especially when the only easy access lab was only able to check HCG, RPR, and UAs But if you a competent physician you'll eventually get there- just try not to kill anyone along the way.
I didn't have any bad outcomes, but I fixed a lot of things the person before me missed- neurosyphilis, diabetic c no F/U, uncontrolled/severe HTN, etc........
I had a staff of 10- including prev med techs, lab tech, radiology tech (it's amazing what they can do with dental x-ray equipment ), general duty corpsmen, and 3 IDCs-- initally most of my staff was incompetent-- but after firing/tranferring half of them , it got MUCH, MUCH better and in the end I worked with some really great/smart people.
When your "it", you'll realize that these people deserve the best care possible- like it or not, it's you- even when it means getting up at 2am to talk to a suicidal seamen or the alcoholic that collapsed in the Chemical drill-- If that doesn't motivate you to go the extra mile, don't knowingly take a solo billet

 

[Popoy]

Flea,

I've been reading your feedback on this thread and was wondering if you'd personally recommend the HPSP for someone that's married..... I ask because it seems that there's a lot of moving around....

Thanks in advance

 

[bustinbooty]

Flea...Great Info!!!
You have no idea how many of my questions you have answered.
Thanks for your time!
BustinBooty

 

[Flea]

Personally, if I was married to someone in my position, I would have already divorced myself . I couldn't leave my spouse or kids for the period of time required, nor do I want to move again (and it's part of the reason I'm not married). There's a ALOT of dysfunctional families here and I think the lifestyle breeds it. There are some people that have had better experiences than I have, but not many.
If you want a serious relationship see how long it lasts when your going half way around the world every 6-8 months and working 70hours/wk when your home----then exclude all of the enlisted, any one you work with, officers <O-2 or >O-5, and guys missing >1 front tooth (it's pretty rural out here ), or have a complex about females that don't sit home and "pop out the pups"---Who needs BCGs (Birth Control Glasses)???

 

[Popoy]

Flea,

As been said before, thanks for all your suggestions and comments. I'm sure everyone interested in the HPSP can benefit from what you've shared.

I'm really going to have to ponder a lot of things before possibly committing to the HPSP....

Thanx

 

[jephyboy]

This question is not to start any kind of trouble. I'm just curious: What kind of salaries do military physicians see during residency and beyond? I would like to stress again: I think this is a legitimate question and is NOT intended to start anything resembling an argument.

 

[bustinbooty]

Here is the info I have received. In genereal, military residents make a little more than civilian residents. (Approx. 10,000 more/yr.) To put it between 40-50/yr. As a junior doc, I have heard around 90-110 depending on many things.
I have posted a PDF link somwhere in the analogs of the osteopathic threads giving comparisons of Navy physician incomes to civilian incomes. It is in the Navy HPSP discussion forum.

 

[Flea]

The #1 dissatifier and reason for separating from military service for physicians is PAY !!!!!! No one ever expects to make it rich joining the military, but when you look at the surveys closely you'll find that pay becomes a BIG dissatifier when there are already multiple other dissatisfiers --TRICARE, lack of properly trained support staff- ie nurses,corpsmen,etc, lack of continued educational funding for physicians (no CME money), overwhelling amount to paperwork/hassel, .

Look at your source for the salary estimates .......... The medical corps has not recieved a pay raise in 10 YEARS- specialty pays have not increased since I signed up 10 years ago. This means that I've lost 3-4% per year in cost of living--the average pay raise per year only includes a small portion of the pay (a 0.5% payraise per yr). Then add in all the expenses the military doesn't cover-- Medical Licenses, USMLE III (and the travel that goes with that if your overseas), ALL of my medical books (several thousand dollars), CMEs required to maintain your licence (yes, they're suppose too, but there's no money). I've bought many office supplies out of my own pocket...no money or it would take 3 months for a box of pens.
They pad the numbers many ways... with "commissary priviliges"- but fail to mention the it's never open when your off or have what you want- You'll move every couple of years (they never give you enough money to cover the househunting/moving expenses, your things will break/ get wear&tear, you can't buy a house (big tax deduction). Only 85% of your rent is covered- oh by the way they only made 1 cost of living adjustment in the past 5+ years, so as the rent goes up-your money shrinks. You'll make $500 too much to take ANY tax deduction for your loans... then there's the "wardroom dues" you'll pay ($100-200/month)when your with an operational group, etc, etc,etc...I still had to pay rent on an empty apartment
The "30 days of paid vacation" you get MUST include any adjacent weekend- even if your in town and NOT scheduled to work...if they let you take it....
I get what averages out to $25/hr BEFORE taxes after 5 years of service- the contracted nurse practioner down the hall makes $75/hour.....FYI I will be making MORE money as an INTERN (when you add in my GI bill)- more if I moonlight 1-2 days/month. Friends of my mine made more money working 5 days/month, then full time in the military.

5-10 years ago, the pay was a tad more during residency and only a few percentage points less (specialty dependent of course)
after residency-- but pay has not changed in so long, it is no longer true .
Sorry if I sound a little bitter, I just wish someone had told me.

 

[Popoy]

Originally posted by Flea:
•The #1 dissatifier and reason for separating from military service for physicians is PAY !!!!!! No one ever expects to make it rich joining the military, but when you look at the surveys closely you'll find that pay becomes a BIG dissatifier when there are already multiple other dissatisfiers --TRICARE, lack of properly trained support staff- ie nurses,corpsmen,etc, lack of continued educational funding for physicians (no CME money), overwhelling amount to paperwork/hassel, .•

Just wanted to say that I hear this all the time specially from friends in the armed forces already.... Saying that many of them would rather use their skills in the civilian sector and get paid more.... think this is the reason why the military has a hard time retaining their recruits after they've serve their time...

 

[Flea]

Sorry my link to the Provider (ie physician) satisfaction Survey didn't work.

To sum it up, the retention rates are in the teens (12-18%) for most specialties(except Derm, but it was a very small sample size) when you look at the people that CAN get out.

When you see higher rates (70-80%) it's because they are padding physicians that still owe time on their contracts and could not get out if they wanted.

 

[jephyboy]

Has anyone ever done anything like this: Take the HPSP for the four years of medschool. Then instead of doing a residency, go do the GMO for four years. And then get out of the military. Does it work like that? Because, from reading past posts, it seems like the GMO can't hurt you for a civilian residency, so you could shorten the actual time in armed services by not doing a residency and go straight to the payback. If my logic is way off, please advise. Thanks.

 

[bustinbooty]

JephyBoy...that is exactly my plan. 4 years of school, 4 years of GMO (I'm having no hopes of escaping a GMO tour, but I am actually looking forward to it as well) and then off to a civilian residency. I grew up in the military...both parents are AF officers, and I have no interest in making a career out of it myself. Military is a means to an end for me...much like others. A good way to pay for school and avoid a second mortgage when I'm done. However, many students that go in with this attitude have a lot of trouble during their GMO I have heard. THe main thing to remember during your GMO is that you are an officer first, then a physician. While a GMO, you have to be prepared to do "officer" and leadership types of things as well as physician work (or intern/scutwork) You can't set yourself above the beauracracy of the military. Nevertheless, I plan on completing my repayment time before starting a civilian residency....still a means to an end.
BTW Flea, am I correct in saying that the 1 year military internship does NOT count towards repayment time? Also feel free to correct anything i have said... I would rather learn that I am wrong that ignorantly think I'm right.
Thanks!
Bustin

 

[scottlaws]

Hello everyone,
Could you tell me what to expect with respect to time added onto payback for military residencies. also, if you don't match for a military residency, can't you match for a civ residency before being commited to a gmo spot?
Thanks in advance

Scott

 

[jephyboy]

scottlaws, I can answer your first question. I think that you looks at the number of years that you took the scholarship and compare that with the number of years you do a residency; which ever one is the longest, you do that amount of time. EX: 4 years of HPSP for medschool. you match into a residency for 3 years. You owe 'the man' 4 years.
EX2: 4 years of HPSP for medschool. You match into a residency that lasts 5 years. You owe them 5 years.

I think this is how it works. If anyone knows otherwise, please correct.

 

[Kirk]

The Pay situation is the sad sad part of the entire military world. Unfortunatly it hurts all levels of those in the military, and will contuniue to do so until the pay rates are brought up to thier civilian counterparts.

I enlisted in the Army when I was 17 as an Avionic communication equipment Tech. I did bench work on aircraft radios for 6 years. During the time I was in I saw the smartest and best technicians leave the service. They left because they knew they could get MUCH more money in the civilian field. The people that stayed in where of three groups. Those that truley loved the army (Very small amount of people), those that were scared they could not make it (worried about finding jobs/taking care of thier famalies, etc) and those that were bad technicians and knew that they could not get a job in the outside world. So sadly, most of the long time people in the military tech fields are the scared and incompetent ones- just the people you do not want to work for.

When I left the military and went into the civilian aircraft industry I actually doubled my yearly income, and I have better benefits. 30 days of vacation sounds like a lot, but as mentioned above all holidays and weekends are counted as part of your vacation if you are on leave at that time.

Also, the military "benefits" are evaporating at a high rate. When I went in it was work 20 years and get 50% retirement starting then. Now its work 20 years to get %30 retirement or work 30 years to get a %50 retirement. There is talk of moving the retirement age to 65, so even if you retire you will not get paid until you are 65 years old.

When my father retired from the military he was promised full healthcare and full dental for him and his family for the rest of his life. Well, the dental part dissappeared long ago, and now they are attempting to make retirees pay for health care insurance.

If I sound bitter, its because I am. I spent a long time in the Army and I feel that I was taken advantage of, not compensated and generally all around screwed by Uncle Sam.

 

[bustinbooty]

Here is the Navy Physician Salary comparison I mentioned before:
http://navymedicine.med.navy.mil/med00mc/Internet%20Information/provtxt.pdf

Kind of long reading, but you can sift through to find what you want.

 

[Flea]

Has anyone ever done anything like this: Take the HPSP for the four years of medschool. Then instead of doing a residency, go do the GMO for four years. And then get out of the military

Most of my Friends (and myself) have done/are doing this--just remember, you'll have to do an internship prior to a GMO tour

I think that you look at the number of years that you took the scholarship and compare that with the number of years you do a residency; which ever one is the longest, you do that amount of time

Thats probably the best description I've heard !!! You make it sound so simple

THe main thing to remember during your GMO is that you are an officer first, then a physician

.

Yeah- the line officers put that out...just remember--it's you a$$, license, and peace of mind-- none of them give a ---- about anyone but themselves. If you don't look out for the welfare of your patients- no one will. If they don't agree c your medical opinion--- DOCUMENT DOCUMENT DOCUMENT-- it will piss them off (because then it makes it the skippers problem/responsibity) but you may be the only thing between someone living and dying (or missing a leg, lossing their vision, being permenently disabled, etc).

I correct in saying that the 1 year military internship does NOT count towards repayment time?

YES, you are correct

, if you don't match for a military residency, can't you match for a civ residency before being commited to a gmo spot?

Not unless the military says you can-- MOST of the time, they "let" you do a civilian INTERNSHIP/Preliminary, then placed as a GMO-- RARELY will you be "permitted" to do a full residency (depends on their projected shortages) . Several yrs ago the only people allowed to do a civilian residency were mostly Peds, but as they place contractors into these positions that will probably change, especially since they're currently going to be short GMOs for the next several yrs.

 

[Popoy]

Flea does it again.... YOU THE MAN!!!

I hope you hang out here for some time and help HPSPers or wannabe HPSPer get their questions answered.....

 

[Flea]

Try wo-man, see what 2 yrs c construction workers does for your "sweetness" . I used to be really nice and innocent...and naive
Hopefully I'll get some of it back next year, it was much easier

 

[Popoy]

Originally posted by Flea:
•Try wo-man, see what 2 yrs c construction workers does for your "sweetness" . I used to be really nice and innocent...and naive
Hopefully I'll get some of it back next year, it was much easier •

Oppsss.... YOU THE WOMAN!!!!
Nonetheless you've been a great help and hope to continue to do so....

Here's a question: If you'd do the HPSP again would you?

 

[bustinbooty]

Flea..
I must again express my thanks for providing information that would take all of my energy to drag out of my recruiter. Man they are full of more bulls**t than I ever even expected. Your curtness is appreciated.
BTW Popoy asked a great question (see above).

 

[Flea]

The more time I've spent in the more I realize that:
A- I really dislike seeing patients in a clinic (including the paperwork/routine-it will take the military 10+yrs to jump on the hospitalist bandwagon)
B-I want to be closer to family and friends
C- I never want to move again.
D- I was very naive when I was 20 .

Did I learn alot? YES

Could I have learned these similar (less painful) lessons as a civilian resident? YES

Did it short change me professionally (as a physician)? Yes

Can I make up for this "dumbing down"? YES- I read journals ALOT, I pay for as many CME's (continuing education classes) as I can reasonably afford, and I'm going to repeat part of my internship.

Was it worth it? Not for me, the only comfort I get is the "thank you"s and knowing that there were cases where people would have died/disabled if I was not such a pain in the a$$.

Can this be beneficial for anyone? Probably,
I have a few (very few) that actually enjoyed there time/experiences .. PS they are still getting out.

 

[Marinedoc2]

This thread is very informative and very good at maintaining it's objectivity. Flea- glad you can give advice and not damper enthusiasm. I had a very positive experience during my 5 year payback time. No, not all of it, but overall I thoroughly enjoyed myself. It takes alot of self discipline to continually read journals and do CME stuff, but it is necessary. In the long run if/when you get the residency of your choice it is all worth it. I switched from FP/Sports Med when I got in to the service, to now doing a Rad residency. Yes, I got out. I grew up alittle and got a good taste of clinic medicine and what I liked most about it. Family was the number one reason I left the service- needed to be closer to home on a predictable basis.

 

[Liljoe2002]

Hey Flea,
Stayed up late last night reading your messages on your post, all I can say is wow....speechless!! I'm a 4th year HPSPer and getting ready to apply for internship with the Navy. Your honesty to what it is "really" like to be a Navy physician made me open my eyes...what did I get myself into. I guess I had this idealistic view about being a GMO ie saving lives, seeing the world so on. You should write a book on your experiences as a GMO, it would probably be a best seller. It sounds to me like Flight Surgery is the way to go, but I've heard its hard to get. Well thanks for your messages.

Liljoe

 

[platinumdoc]

"Hello everyone,
Could you tell me what to expect with respect to time added onto payback for military residencies. also, if you don't match for a military residency, can't you match for a civ residency before being commited to a gmo spot?
Thanks in advance
Scott "

Payback for military residency is year for year. If you get a deferrment, you still only owe year for year for medical school. Keep in mind, if you get a deferrment, you will enter as a LT depending on the length of residency. Your pay will be based on rank and number of years in service. You could potentially make only 34-38k plus your specialty bonus (varies by specialty, peds is about 8 k and ortho is about 40-50k), your additional special pay (about 416 dollars/mo and will increase at 6 year mark to 1000) and your professional pay ($15000 minus taxes). You will notice that if you did a deferrment, you will definitely make a financial mistake in the long run. You may also lose a lot of experience (lack of variety of cases, since your duties may include more administrative roles). You may end up overseas, being the only specialist in town (limiting your ability to 'jet off' for the weekend or being worked to death alone or limiting your chances to set up for a civilian position when you get out). If you are in primary care, your skills as a specialist may atrophy since you may deal with minor/nonurgent cases.

If you do not match for a military residency, there is a slim chance that you can apply for FULL TIME OUTSERVICE. This allows you to complete residency training while being paid as a military officer. The disadvantage is that you cannot MOONLIGHT, many of your fees are not paid for (eg. books, boards), and your payback is NOT CONCURRENT with medical school payback. For example, you did a 2 year GMO TOUR. You owe 2 years. You do an ophthalmology residency, you pay back year for year (4 for ophthal plus 2 for medical school). The advantage, if you get accepted for FTOS, is you can apply to any program in the nation and probably get in. You have to tell the program that you are FULLY FUNDED. This can either open an additional spot for residents at the program or the funding for the slot that an FTOS takes is put back into the residency position. So, you want to go to Hopkins, Duke, Harvard? This is best way to go. If you want to get into a very competitive residency such as ophthal, dermatology, or ENT, apply for this. Keep in mind, that these positions for FTOS are based on 'the needs of the navy'. HOwever, retention in the highest paid specialties are extremely low. 'The needs of the navy' will in most cases supercede your needs and career goals.

One last comment...fellowships. If you desire a fellowship, you will have to do a payback tour. You will also incur additional obligation if you wish to have fellowship training.

If you decide to stay in for a career, you may find yourself doing more administrative duties and less clinical duties ensuring your failure in the private sector. Keep in mind, your RETIREMENT 'BENEFIT' only consists of your BASE PAY (rank and years in service without bonuses). If you are considering a lucrative field, you are better off leaving after your obligation.