Navy and AF GMO inquiry

[Sthpawslugger]

I've read through this forum quite a bit lately as well as talked to a couple of AD medical. I understand a GMO is pretty much guaranteed in the Navy and a possibility for the AF. As someone who would be almost 41 at graduation and at the start of a GMO, would the powers-that-be take that into consideration when I am applying for my desired residency(ortho) vs the traditional med student on HPSP? Assuming I am a competitive applicant with strong board scores, LORs, etc? I can accept having to do 1 GMO...but a 2nd? I would then feel that I'm wasting my time and skills. I'm not looking for feedback regarding a financial analysis of HPSP or civilian all the way as I've had that discussion and understand the pros and cons there.

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[Gastrapathy]

No one can answer what will happen when you apply for a competitive residency. That being said, one GMO tour makes you as competitive as you'll ever be. After that, you are just reapplying and hoping there's less competition by staying out in GMO land.

 

[Cooperd0g]

Do not expect your age to count for much. There were 4 interns over 40 at Portsmouth this year, all with over 10 years of prior service, and all were alternates.

If you have to do a GMO and still don't get picked up then your commitment is up after the second tour. Just go civilian at that point.

 

[Sthpawslugger]

No one can answer what will happen when you apply for a competitive residency. That being said, one GMO tour makes you as competitive as you'll ever be. After that, you are just reapplying and hoping there's less competition by staying out in GMO land.

Thank you for letting the response.

 

[Sthpawslugger]

I did speak with one of my ER docs a moment ago...he did Navy 3 yr HPSP long ago...is he correct in saying that with a 1 yr GMO, you go alone but if family comes with, then it will be a 2 yr tour?

Do not expect your age to count for much. There were 4 interns over 40 at Portsmouth this year, all with over 10 years of prior service, and all were alternates.

If you have to do a GMO and still don't get picked up then your commitment is up after the second tour. Just go civilian at that point.

 

[Cooperd0g]

I did speak with one of my ER docs a moment ago...he did Navy 3 yr HPSP long ago...is he correct in saying that with a 1 yr GMO, you go alone but if family comes with, then it will be a 2 yr tour?

Yes, he is correct. But I only know of one person this year who got a 1 year GMO (full disclosure: I don't know everything). I would not count on that as a plan. But if you had a 3 year HPSP you could do flight or dive for 3 years and be done.

 

[Sthpawslugger]

Yes, he is correct. But I only know of one person this year who got a 1 year GMO (full disclosure: I don't know everything). I would not count on that as a plan. But if you had a 3 year HPSP you could do flight or dive for 3 years and be done.

Hmm...graduation at 41, 3yr GMO until 44, residency until 49, followed by 1 yr fellowship...not so appealing when looking at it that way...

 

[backrow]

A lot of those 1 year positions no longer exist. There might be 1 or 2 left, but I'm not even sure about that


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[Sthpawslugger]

Bummer...

A lot of those 1 year positions no longer exist. There might be 1 or 2 left, but I'm not even sure about that


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[Helpful Troll]

A lot of those 1 year positions no longer exist. There might be 1 or 2 left, but I'm not even sure about that


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@Sthpawslugger
Most, if not all, one year GMO positions would be dependent restricted tours and not even allow accompanied dependents for a two year accompanied tour - see appendix Q OCONUS Tour Lengths. To be designated for a one year unaccompanied designation - "1) Locations lacking adequate family support facilities or with potential threat to the safety or security of families or 2) Remote and arduous locations with limited family support facilities or with economic conditions not supporting a quality of life reasonably comparable to U.S. standards."

Maybe a clinic in Bahrain, Turkey, or JTF GTMO? Unless there is a MedCom or service specific directive allowing curtailment of tour length to return for GME, GMO's will have to meet Time on Station (TOS) and tour length requirements before they return for residency. TOS requirements exist for CONUS GMO assignments and PCS too.

The GME application criteria in the NMETCNOTE 1524 2016 required TOS, projected rotation date, and DOD tour rotation length to be met. CONUS TOS is two years minimum. Applicants that did not meet the criteria were rejected.

There is no guarantee you will have Step/Comlex scores to qualify you for a military Ortho residency. A GMO tour won't provide enough 'points' to overcome other weaknesses in an application. Are you ok with completing your service as a GMO or compromising your specialty of choice if not selected? Army Ortho 2016 step1/comlex mean was 256/651 and 2017 was 247/633. I can't imagine Navy or AF applicant scores would be lower. Isn't that 91st-94th percentile for comlex? Go look at the 2017 NRMP Charting outcomes to confirm the likelihood of matching civilian ortho is higher than in a military match. Just based on the small number of military ortho residency positions compared to ACGME/AOA ortho positions, civilian chances are higher.

Do you have confirmation you meet the age criteria? Have you submitted your application or completed the required physical exam? You might not meet the criteria to commission.

 

[DrMetal]

Hmm...graduation at 41, 3yr GMO until 44, residency until 49, followed by 1 yr fellowship...not so appealing when looking at it that way...

That's not appealing at all. Don't do it, stay civilian, you can think about joining the military after completely trained in whatever specialty you go into. Consider the reserves or the Army National Guard

 

[Sthpawslugger]

At the risk of appearing fickle, I have on occasion considered the possibility of EM as a career(Reading and "sleeping on it" has giving me more insight). Having spent the past 5 yrs in a very busy ED, and forging good relationships with many ED physicians, I've had the good fortune of knowing what I'd be getting myself into by choosing this route, good and bad. Graduating just before I turn 41, finishing residency by ~44. When comparing 3 yrs EM training to 6 yrs ortho when considering family, lifestyle, job satisfaction, etc, it might be tempting to go with the former...
EM in Milmed would still be competitive as I've heard and read. Possible outcomes of choosing HPSP as I've come to understand
***as much as I've read and learned here, I'm sure to be incorrect on something, so forgive me and by all means correcthat me where I'm wrong ***
1) a 4 yr Navy HPSP then 2 yr GMO, doing EM pushes me back to finishing up residence at 46, then commitment of 4 yrs, so I can get out at 50.

2) a 3 yr Navy HPSP then 2 yr GMO, followed by 3 yr residency and 3 yr commitment means I'm out by 49.

3) a 3 yr AF HPSP(would have to wait until next year to apply) no GMO, 3 yrs EM residency, then 3 yrs payback I'd be 47 and can get out. *depending on likelihood of civilian deferral for EM residency*

Anyhow...just my thoughts... while not the intentions of my original posts, I would like to address the financial advantage/disadvantage here with EM milmed and get feedback...
Assuming #3 is accurate, I would lose 3 yrs civilian pay vs milmed, yet at ~500k total loan debt, I'm beginning to think I'd come out a little bit ahead going milmed. May not be the case as the EM salaries quoted online vary so greatly due to region, full or part-time etc, and Im not sure which numbers to use (I live in a southeast metro of ~400k people). Also, while I would not be joining milmed solely for money (I'd want to experience of being in milmed), perhaps this could be a case where joining would make sense financially?

That's not appealing at all. Don't do it, stay civilian, you can think about joining the military after completely trained in whatever specialty you go into. Consider the reserves or the Army National Guard

 

[River Rat]

At the risk of appearing fickle, I have on occasion considered the possibility of EM as a career(Reading and "sleeping on it" has giving me more insight). Having spent the past 5 yrs in a very busy ED, and forging good relationships with many ED physicians, I've had the good fortune of knowing what I'd be getting myself into by choosing this route, good and bad. Graduating just before I turn 41, finishing residency by ~44. When comparing 3 yrs EM training to 6 yrs ortho when considering family, lifestyle, job satisfaction, etc, it might be tempting to go with the former...
EM in Milmed would still be competitive as I've heard and read. Possible outcomes of choosing HPSP as I've come to understand
***as much as I've read and learned here, I'm sure to be incorrect on something, so forgive me and by all means correcthat me where I'm wrong ***
1) a 4 yr Navy HPSP then 2 yr GMO, doing EM pushes me back to finishing up residence at 46, then commitment of 4 yrs, so I can get out at 50.

2) a 3 yr Navy HPSP then 2 yr GMO, followed by 3 yr residency and 3 yr commitment means I'm out by 49.

3) a 3 yr AF HPSP(would have to wait until next year to apply) no GMO, 3 yrs EM residency, then 3 yrs payback I'd be 47 and can get out. *depending on likelihood of civilian deferral for EM residency*

Anyhow...just my thoughts... while not the intentions of my original posts, I would like to address the financial advantage/disadvantage here with EM milmed and get feedback...
Assuming #3 is accurate, I would lose 3 yrs civilian pay vs milmed, yet at ~500k total loan debt, I'm beginning to think I'd come out a little bit ahead going milmed. May not be the case as the EM salaries quoted online vary so greatly due to region, full or part-time etc, and Im not sure which numbers to use (I live in a southeast metro of ~400k people). Also, while I would not be joining milmed solely for money (I'd want to experience of being in milmed), perhaps this could be a case where joining would make sense financially?

You should assume the worst case scenario for yourself and not make a decision based on the pretty scenarios that you think may occur. Meaning, what do you do if you're not competitive for EM or Ortho, both pretty competitive in the military. It's kind of pointless to make a decision based on what scenarios you find tolerable because:

a) you have no say in the matter. if they want you to do a GMO tour, you will do a GMO tour, maybe even more than 1, 2 or even 3. That does not guarantee that you will even get picked up for the specialty of your choice via the military training system (I know a USUHS grad who did 4+ years as a FS before he couldn't take it anymore and gave up on a competitive specialty. Had to go civilian sponsored (longer commitment) for something else which I'm sure the military was licking their chops at.) To say "I can just do one GMO tour and then go back and do ortho by year x and get out by year x" is kind of presumptuous and ignoring the very likely reality that the worst case scenario can and often will happen to you. Plan for the worst case scenario. Are you okay with the worst case scenario? The fact that you're talking about being able to take just 1 GMO tour over 2 tells me that you're not. You have very little choice in this matter.

b) the needs of the military change on a year to year basis. There are no guarantees that you may even have the scores to have a shot at those competitive residencies that we're talking about, here. Compound this on top of the fact that some years the military may just decide they need very little of whatever field you want to go into. I'm not too familiar with the Navy but I'm under the impression that even if you do "match" the first time around and allowed not to do a GMO tour, you have to apply again as a PGY1 to continue. Meaning even if you did get ortho, you'll have to do the whole applying thing over again just to make sure you can continue your training, otherwise it's off to GMO land for you.

Assume that you'll have to do all your years of payback as a GMO, and try to match as a civilian (at the age of 44 or 45.) If for some reason that is NOT okay with you, match into a civilian residency and then sign up for the FAP program or join the reserves if you're still compelled to serve. Everyone's telling you the same thing here. Really sensing that you might be someone who will become extremely unhappy with the military down the road.

 

[Sthpawslugger]

I'll reevaluate where I am in life once residency is complete. The decision to do milmed would have been a much easier one 15 or even 10 years ago. Having to do GMO tours then would be a non-issue with more time on my side. Thank you and everyone else for your input.

You should assume the worst case scenario for yourself and not make a decision based on the pretty scenarios that you think may occur. Meaning, what do you do if you're not competitive for EM or Ortho, both pretty competitive in the military. It's kind of pointless to make a decision based on what scenarios you find tolerable because:

a) you have no say in the matter. if they want you to do a GMO tour, you will do a GMO tour, maybe even more than 1, 2 or even 3. That does not guarantee that you will even get picked up for the specialty of your choice via the military training system (I know a USUHS grad who did 4+ years as a FS before he couldn't take it anymore and gave up on a competitive specialty. Had to go civilian sponsored (longer commitment) for something else which I'm sure the military was licking their chops at.) To say "I can just do one GMO tour and then go back and do ortho by year x and get out by year x" is kind of presumptuous and ignoring the very likely reality that the worst case scenario can and often will happen to you. Plan for the worst case scenario. Are you okay with the worst case scenario? The fact that you're talking about being able to take just 1 GMO tour over 2 tells me that you're not. You have very little choice in this matter.

b) the needs of the military change on a year to year basis. There are no guarantees that you may even have the scores to have a shot at those competitive residencies that we're talking about, here. Compound this on top of the fact that some years the military may just decide they need very little of whatever field you want to go into. I'm not too familiar with the Navy but I'm under the impression that even if you do "match" the first time around and allowed not to do a GMO tour, you have to apply again as a PGY1 to continue. Meaning even if you did get ortho, you'll have to do the whole applying thing over again just to make sure you can continue your training, otherwise it's off to GMO land for you.

Assume that you'll have to do all your years of payback as a GMO, and try to match as a civilian (at the age of 44 or 45.) If for some reason that is NOT okay with you, match into a civilian residency and then sign up for the FAP program or join the reserves if you're still compelled to serve. Everyone's telling you the same thing here. Really sensing that you might be someone who will become extremely unhappy with the military down the road.

 

[Helpful Troll]

...
1) a 4 yr Navy HPSP then 2 yr GMO, doing EM pushes me back to finishing up residence at 46, then commitment of 4 yrs, so I can get out at 50.

2) a 3 yr Navy HPSP then 2 yr GMO, followed by 3 yr residency and 3 yr commitment means I'm out by 49.

3) a 3 yr AF HPSP(would have to wait until next year to apply) no GMO, 3 yrs EM residency, then 3 yrs payback I'd be 47 and can get out. *depending on likelihood of civilian deferral for EM residency*

I think your calculations in scenarios 1 and 2 are off by a year. You don't have an intern/TY training in those scenarios which is required for an unrestricted license to be a GMO.

You do realize you aren't guaranteed a 'full' residency, right? EM has a larger number of applicants per opening than Ortho though test scores are slightly lower for EM. Both military Ortho and EM mean matched scores are higher than civilian matched residents. You really should consider taking out loans for Med School for specialty flexibility. You are backing yourself in a corner -

Did you get confirmation you are eligible to commission without a waiver?

 

[CrystalArrowhead]

Yes, he is correct. But I only know of one person this year who got a 1 year GMO (full disclosure: I don't know everything). I would not count on that as a plan. But if you had a 3 year HPSP you could do flight or dive for 3 years and be done.

So Cooperd0g, you're saying with a 2 or more year GMO tour family can come along?

 

[Cooperd0g]

So Cooperd0g, you're saying with a 2 or more year GMO tour family can come along?

In general most GMO tours are two years and do allow your family to move with you. There are not many one year positions anymore, but generally the Navy won't pay to move your family for those.