Prospective USU/Navy Candidate

[bostonu2019]

I recently interviewed at USUHS and really enjoyed my visit there. The school seemed very impressive and I felt that the students and faculty were passionate, friendly, genuine, and transparent. The school's mission is unique and exciting. The chance to receive a top-tier medical education while training to become an officer in the military truly would be extraordinary. Even though I most likely won't hear back from the admissions committee for a couple months and even still I'm not guaranteed to receive a place on the waitlist or a conditional offer, I have been, over the past week, trying to figure out if going to USUHS and a career in military medicine is right for me because I really want to try to answer as many questions as I possibly can so I am well educated on the topic if and by the time I have to make a decision.

My civilian option right now is KCUMB (DO school) and I have considered HPSP there but I believe strictly the medical education at USU is far better (not just because its an MD school) and the prospect of serving in the military is awesome and USU would more facilitate that.

I have poured over many threads here in the MilMed forum on SDN and have found answers to some but not all of my questions (although it's probable that the answers to the following questions do exist and I just wasn't able to find them). Also, these questions are mostly aimed at former HPSP/USU students who are currently ortho residents or are on their way to that residency (currently an intern or a GMO). Even better still would be a navy guy. I know this is a lot but I've been pretty anxious about these things and I haven't found concrete answers to these questions anywhere.

1. Is every navy ortho resident a former intern that had to spend 2-3 years as a GMO before getting into an ortho residency (Portsmouth, Walter Reed, San Diego)? I am skeptical about the whole GMO tour thing and would rather do flight surgery after my internship then spend those years without doing something exciting and educational unless it was only for a year (I read that 1 year GMO tours in the navy have been done away with/afraid of atrophy).

2. Do you see navy ortho residency spots being diminished in the near future?

3. What ortho subspecialty fellowships are reasonable to obtain in the navy? Are ortho subspecialists paid the same as generalists (mid 100s)?

4. I keep reading that if you get into and go to USUHS, you must commit to do 20+ if you want to maximize your benefits (military experience, profitability, pension, etc.). If internship and a 3 year flight surgery tour counts towards ADSO (4/7 years), wouldn't it be reasonable to get out after 3 years (7/7 years) as an attending post-residency/fellowship and go into the civilian sector to catch up with those who end up staying in?

Thank you in advance for your help.

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[danielslee]

I could be wrong, but I am fairly certain that the intern year is null (you accrue a year but pay it back in real time).

As for being reasonable to get out, that entirely depends on you. What is your main goal? Is it to make money? Then many here would suggest to avoid milmed entirely. If you want to practice military medicine then obviously it wouldn't be reasonable for you to get out. It truly depends on your goals and what you enjoy and are trying to achieve.

What do you mean by getting out after 3 years as an attending post-residency/fellowship? When you do a flight surgery tour, yes you pay back your time. However, when you go to residency, you incur an additional obligation for your time in residency. It looks like you're assuming you can do a flight tour, then residency, and still get out at 7 years total obligation, but as I understand it, that would not be possible.

Please take everything I said with a block of salt. I'm just someone keenly interested in milmed and am responding since no one has yet.

 

[militaryPHYS]

I recently interviewed at USUHS and really enjoyed my visit there. The school seemed very impressive and I felt that the students and faculty were passionate, friendly, genuine, and transparent. The school's mission is unique and exciting. The chance to receive a top-tier medical education while training to become an officer in the military truly would be extraordinary. Even though I most likely won't hear back from the admissions committee for a couple months and even still I'm not guaranteed to receive a place on the waitlist or a conditional offer, I have been, over the past week, trying to figure out if going to USUHS and a career in military medicine is right for me because I really want to try to answer as many questions as I possibly can so I am well educated on the topic if and by the time I have to make a decision.

My civilian option right now is KCUMB (DO school) and I have considered HPSP there but I believe strictly the medical education at USU is far better (not just because its an MD school) and the prospect of serving in the military is awesome and USU would more facilitate that.

I have poured over many threads here in the MilMed forum on SDN and have found answers to some but not all of my questions (although it's probable that the answers to the following questions do exist and I just wasn't able to find them). Also, these questions are mostly aimed at former HPSP/USU students who are currently ortho residents or are on their way to that residency (currently an intern or a GMO). Even better still would be a navy guy. I know this is a lot but I've been pretty anxious about these things and I haven't found concrete answers to these questions anywhere.

1. Is every navy ortho resident a former intern that had to spend 2-3 years as a GMO before getting into an ortho residency (Portsmouth, Walter Reed, San Diego)? I am skeptical about the whole GMO tour thing and would rather do flight surgery after my internship then spend those years without doing something exciting and educational unless it was only for a year (I read that 1 year GMO tours in the navy have been done away with/afraid of atrophy).

2. Do you see navy ortho residency spots being diminished in the near future?

3. What ortho subspecialty fellowships are reasonable to obtain in the navy? Are ortho subspecialists paid the same as generalists (mid 100s)?

4. I keep reading that if you get into and go to USUHS, you must commit to do 20+ if you want to maximize your benefits (military experience, profitability, pension, etc.). If internship and a 3 year flight surgery tour counts towards ADSO (4/7 years), wouldn't it be reasonable to get out after 3 years (7/7 years) as an attending post-residency/fellowship and go into the civilian sector to catch up with those who end up staying in?

Thank you in advance for your help.

1. No. Many go straight through to residency without GMO time, but this is variable. FYI, Ortho does require a categorical internship. This means that you must do an ortho-specific intern year to continue on as a PGY-2 resident and beyond. So if you don't match to an ortho internship and do a transitional year, or general surgery year, you will have to reapply and be accepted to an ortho internship and repeat intern year before you can continue on as an ortho resident.

I had an ortho intern class of 4. 3 of us went straight through in to residency, the last one went out for a GMO tour. Unfortunately there is no way to know or predict how many will be going straight in to residency and how many will go out for a GMO tour. This varies year by year and by location. You'll get an idea once intern starts (i.e. "expect 2 of you to be going straight through"), but even that can change.

2. They may decrease overall as we realize we don't need as many active duty orthopedic surgeons, but relative to other specialties it will continue to be a necessity as it is a critical wartime specialty.

3. I would focus on getting in to medical school first. Over 70% of people change their mind regarding specialty by the time they apply for internship. You also don't want to be the "ortho dude/dudette" during med school and rotations. It is a label that can be a hindrance until you are actually accepted to train as an orthopedic surgeon. Still...the specialties that stay busiest in Ortho in the military are Sports, Hand, pediatrics (if they keep training them), joints (if they keep taking care of retirees) and likely trauma (if more civilian partnerships come along for us to practice in the civilian world). No extra bonus for sub-specialty training in Ortho.

4. Not sure what you mean about getting out to catch up to those who stayed in. Also, internship is not a payback year.

You definitely do not need to stay for 20. Some people value the pension and healthcare for life more than others. I personally want those things and I enjoy my time so I'd like to stay for 20, but only if the Navy is being good to me. The best financial benefit of USUHS (in my opinion) is getting an O1 salary day 1 of medical school plus full benefits. This allows you to stay out of debt and start saving hardcore for retirement day 1 of medical school. But the money is NOT a reason to join.

 

[pgg]

Re: questions 1, 2, and 3 -

It is harder than usual to predict what GME opportunities there will be in the Navy. Even in ye olden days without the cloudiness of DHA and POM20 and "war-critical buckets" etc, it was difficult to predict what the state of GME would be 10 years in the future.

There's the risk - right now, you're a pre-med. Your timeline might be

summer 2020: start medical school
summer 2024: finish medical school
summer 2025: finish internship
summer 2028: finish a GMO flight surgery tour
summer 2032: finish a 4 year residency

So you could conceivably be embarking on 4 years of a surgery residency + possible fellowship ambitions, 8 years in the future, finishing around 12 years in the future.

In the year 2000 I'd have said SURE of course inservice residencies in everything will be here and SURE of course there will be fellowship opportunities in 2010. Now in 2020 I suspect that will be less true in 2030, but neither I nor anybody else really knows. There is more uncertainty than usual these days.

That said - the reasons you noted in your post are good ones for going to USUHS. You just have to be aware that if you fall in love with a specialty the Navy won't allow you to train in, 7 years is a long time to be a GMO and get out to do a civilian residency. Ortho will almost certainly be available, but just remember that 1) most med students change their mind about specialties and odds aren't bad you will too, and 2) ortho is competitive and of course you plan on graduating in the top 1/4 of your med school class but 1/4 of the class is the bottom 1/4 and that might be you.

If internship and a 3 year flight surgery tour counts towards ADSO (4/7 years)

Residency does not count towad ADSO payback.

Graduate USUHS, owe 7
Finish internship, owe 7 (internship is a neutral year)
Do a 3 year GMO tour, owe 4
Do a 4 year inservice residency, owe 4 (ADSO is the greater of residency length or existing med school ADSO)

That works out to 16 years in uniform and 12 years creditable toward retirement before you're eligible to leave. Hence why so many USUHS grads stay for retirement.

(Incidentally, the dirty little secret of HPSP is that the ADSO in this common scenario works out exactly the same, even though HPSP is just a 4 year ADSO. The catch is that the 4 year residency bumps the 1 year of HPSP ADSO remaining after GMO time back up to 4.)