Military vs civilian family medicine residency

[MadScientist95]

Hey guys, incoming OMS I and airforce HPSP recipient here. So I know one should usually at least apply for civilian deferment for residency for diversity of cases and to avoid adding any additional years to their commitment as well as skill atrophy. Also from my own understanding, the only benefit of military residency is higher pay. However, family medicine is only a three year residency. In addition it is primary care. Does this mean I won’t have to worry as much about diversity of cases and skill atrophy and should thus, only apply military so I can take advantage of the extra pay? Thanks!

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[Oo Cipher oO]

I can only speak for Navy but the family medicine residencies are all perfectly adequate to good. All are unopposed programs at smaller MTF which means you will not be fighting other residents for cases. Most seriously ill people will be moved to larger MTFs so your outservice rotations at other institutions will be critical to gaining exposure to serious Peds and ICU cases. At my current operational job we have Navy trained family med and some individuals that received civilian deferments for FM residency. The military trained docs clinically are comparable or exceed the capabilities of their civilian trained counterparts. I would not be worried about training FM in the military. They seem to produce good quality FM physicians.

 

[militaryPHYS]

Skill atrophy mainly takes effect AFTER residency if you are placed at a location which does not have a high volume/acuity of cases for your specialty. For the most part, as @Oo Cipher oO mentioned, the residencies will give you a solid education. They are all ACGME accredited. Are they the best? No. Good? Yes.

My advice for all HPSP or USUHS students is that you focus on doing an active duty residency. It best prepares you clinically and professionally for a military practice during your payback time or future military career.

 

[Perrotfish]

Hey guys, incoming OMS I and airforce HPSP recipient here. So I know one should usually at least apply for civilian deferment for residency for diversity of cases and to avoid adding any additional years to their commitment as well as skill atrophy. Also from my own understanding, the only benefit of military residency is higher pay. However, family medicine is only a three year residency. In addition it is primary care. Does this mean I won’t have to worry as much about diversity of cases and skill atrophy and should thus, only apply military so I can take advantage of the extra pay? Thanks!

I would be cautious in choosing a civilian FM program. Many civilian FM programs these days are geared to produce providers of adult outpatient care, with obstetric, inpatient, and pediatric exposure that is more designed to prepare you for a later fellowship than immediate practice. If you do FM in the military you may need to manage patients birth through death, outpatient and inpatient, including on the labor deck, with no additional training beyond your residency.

There are civilian programs that are compatible with that, you just need to do your research. If you are not doing a lot of L&D its probably the wrong residency. Any military residency would prepare you appropriately for the military's practice model.

 

[MadScientist95]

Gotcha! Right now, the plan is to do my four years and then get out into civilian practice. I do not plan to make a career of the military. Would you guys sti

I would be cautious in choosing a civilian FM program. Many civilian FM programs these days are geared to produce providers of adult outpatient care, with obstetric, inpatient, and pediatric exposure that is more designed to prepare you for a later fellowship than immediate practice. If you do FM in the military you may need to manage patients birth through death, outpatient and inpatient, including on the labor deck, with no additional training beyond your residency.

There are civilian programs that are compatible with that, you just need to do your research. If you are not doing a lot of L&D its probably the wrong residency. Any military residency would prepare you appropriately for the military's practice model.

gotcha! Right now, the plan is to do my four years and then get out into civilian practice. I do not plan to make a career out of the military. Would you still suggest choosing to do my residency in the airforce and not worry about asking for civilian deferment?

 

[militaryPHYS]

It doesn’t matter if you are doing 4 years or 24 years. An active duty residency will train you the best (all around) for those 4 or 24 years.

Whenever it is that you decide to get out, if you feel you are lacking in certain clinical areas you can moonlight or train TAD to freshen up. This would be because you were lacking in those areas as staff.

As a resident you will get what you need in an active duty program and in my opinion an active duty program (not a deferment) should always be the goal for any HPSP or USUHS student.

If you really feel like your application is lacking to the point you wouldn’t be offered an active duty residency then of course you should put deferment on the list. This is because deferments are usually given to the weaker applicants. It is never given as an award for being the best in your class.

 

[backrow]

As a resident you will get what you need in an active duty program and in my opinion an active duty program (not a deferment) should always be the goal for any HPSP or USUHS student.

I disagree with you a little on this. Yes, you will usually get what you “need” in an active duty program; however, one should strive to go to the best program they can. In some/many/most instances this is a military program. (have to remember that residency selection is a two way street in that not every applicant is a superstar who would get into some top tier civilian program so their “best” program may be on a different tier than someone else)

In other cases where you have an outstanding applicant who could match “anywhere” it may actually be more beneficial for them to end up at “THE” place for residency. Not only does this benefit that resident, but it also benefits their future community by bringing in different perspective on care (we tend to be a bit “inbred” in military programs), and their future patients. Sure, they will miss out on some of the military aspects of care during those years, but those are attainable at any point in a career whereas residency is a time limited point.