All Branch Topic (ABT) Questions about HPSP

[pinkcurry]

Hello all,

I would first like to thank everyone that has posted in this forum for future HPSPers to learn from. It has been informative, to say the least, to see all the opinions throughout the years on this forum. I am a pre-med in a guaranteed program that is interested in and exploring the Navy scholarship(mainly because it seems to be that they are the most prepared to accept GMO's into a residency in my naive opinion)and I have some questions that I have not found conclusive answers for and was wondering if this forum might be able to answer some of them.

1. First, I am interested in possible dual degree programs such as MD/MPH or MD/MBA. After extensively searching, I have not found a conclusive answer and it seems that it might be based on the merit of your application if the scholarship would be given for 5 years or not. Would someone be able to clarify this? Furthermore, many medical schools that offer dual degrees often ask you to apply not at the time of the application but rather during your 1st or 2nd year. This being the case, would being an HPSP recipient forbid me from applying to these programs once I have started medical school?
2. If I was to choose to specialize in ophthalmology or urology as a civilian, I would normally apply by September for a match in February due to the different matching service utilized. If I was in the program, would I end up doing the military and civilian residency match applications at the same time? Do you believe that would detract from the quality of the applications?
3. It seems that skill atrophy is a real concern in the military. If I end up applying and taking the scholarship and during medical school decide to do a competitive specialty and do not match, it almost seems the better option is to do GMO for four years and get out rather than applying in the middle as that not only increases obligation time but it also might cause skill atrophy. Is this true?
4. Regarding GMO's, if I was to pick a billet I would like it to be flight surgery: is this currently competitive to obtain? I read that with some effort(such as rotating in Pensacola) it is easily obtainable.
5. I read that HPSP recipients who followed the GMO and get out strategy often note that having GMO time is seen as a positive for residency applications by PD's. Is this true even for competitive specialties like dermatology or radiology? Looking at match statistics I saw the match statistic for graduated MD's is around 50-60% for some competitive specialties like ophtho or derm and so I wanted to inquire about the experience you may have had. I understand that the graduated MD pool includes seniors who fail to match and soap or otherwise uncompetitive people which may bring down that statistic. I plan to email a few program directors to gather their opinions on military applications so hopefully, I will be able to gain an additional opinion after this forum.
6. I live in DC and go to college in Florida allowing me relatively close access to military bases. Are there any military bases, in particular, that might be suggested to shadow at in order to gain a comprehensive practical understanding of the life and responsibilities of a military doctor?
7. Finally, I would enter the military, if taking the scholarship, and potentially become GMO, at the earliest in 2029: are there any thoughts about how the military might be then? I understand that the military is volatile right now and is rapidly changing with the plans to cut GMO billet and it is hard to predict but any opinions you might have might be interesting to read.

Thank you for your time and please free to leave any other advice you might have not only as a potential HPSP'er but also as a future doctor!

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[manotter]

Excellently worded questions, many are difficult. I only have a few anecdotes to some of the questions, but here are at least my answers:

1. I have had friends do this route. I am not sure what the by the book answer is; however, I have seen 3 and 4 year scholarships. If your medical school takes longer, they do not extend the scholarship to 5 or more years. This ultimately delays the start of active duty time, and you will be on your own for financing the additional year.

2. The military and civillian match are applied to simulataneous. Upon acceptance of a military GME position, you are removed from the civillian match. If you are awarded a civillian deferrment, then you continue on to the civilian match. It is possible (but unlikely) to match military, then convince them civillian options might be better. Then you can do the scramble. I am not sure doing this causes detraction from the applications, just up to you on how much to spend on the civillian applications.

3. This one depends on your specialty and timeline for carrer. GMO options may not exist in this pathway, by the time you would be eligible. Many people who do GMO tours really enjoy them, which is why they are probably in the military to begin with. If you don't want to do military medicine (much of which is in an operational capacity), then it may not be wise to try and plan a get out strategy early on. Four years is a long time, to be GMOing if you just want to get out.

4. Flight surgery and UMO are always in flux for their enrollment. Currently they are looking for more people, and so it is easy to get a position. You don't need to do anything more special than pass the corresponding physical and apply. I cannot even begin to predict what the future need would be.

5. People who have prior medical experience make better PGY-1's because they don't have to figure out what it means to be a doctor. With competitive specialties, it all depends on how many points you have on their applications. Each specialty and program will define what is important to them. Maybe it is an MBA, or publications, or a LOR from someone at the program.

6. Ultimately most military doctors spend the first 6 months of their tour figuring out what their own job is. I am not sure you can reliably get a good sense of what a military doc's life is by shadowing. Most billets are so different, and sometimes the job is made up on the spot, and has never been done before. I would recommend probably chatting with a few military docs, but hanging out with someone on their job, shows you one job.

7. I love the guessing game, an activity anyone currently in is playing with. This is completely my opinion and will be wrong, but if I were to guess: I will say that in the next 3-5 years their will be a crisis in Navy Medicine. The GMEs are all going under with understaffed billets, low volume and care being deferred to the network. Currently the ACGME is evaluating programs for meeting minimum requirements, which will cause the academic or hospital based billets to evaporate. Without new board certified physicians, I am not sure who will be doing Navy Medicine. Maybe just transitional year programs to run GMOs? Ultimately it will probably be PAs doing all of Navy Medicine, and doctor's won't have a place anymore.

 

[DOcSto]

I love the guessing game, an activity anyone currently in is playing with. This is completely my opinion and will be wrong, but if I were to guess: I will say that in the next 3-5 years their will be a crisis in Navy Medicine. The GMEs are all going under with understaffed billets, low volume and care being deferred to the network. Currently the ACGME is evaluating programs for meeting minimum requirements, which will cause the academic or hospital based billets to evaporate. Without new board certified physicians, I am not sure who will be doing Navy Medicine. Maybe just transitional year programs to run GMOs? Ultimately it will probably be PAs doing all of Navy Medicine, and doctor's won't have a place anymore.

If it does play out as you have described, what would become of HPSP recipients that were already in and receiving funding. Will they have to pay that money back? Or will they, like you guessed, be put through a TY and shoved into a GMO tour? Then that brings to question, if there are no room for Docs, then do those Docs not have the dual role as an officer and physician? They would just perform a job different than that the military (Navy in this case) just financed for them?

I, myself, really like the operational experiences the military has to offer. However, cutting out the physician part and solely being an officer in the military kind of defeats the entire purpose of what I was hoping to accomplish by taking HPSP.

I know there is no good answer to any of this and that there's no way to predict. But man, it's very frustrating to think I could potentially be receiving funding for an education that I won't get to use and build upon after graduating from med school.

 

[manotter]

I certainly hope things don't play out like this, but it is what I see. I am not entirely sure, but since the world still has the capacity for compromise, my speculation is that HPSP will become entirely civillian deferred and all current GMO billets will go to PAs. During the transition, there may be an opportunity for some people to get out of their contract. Doctors will then come in from their civillian residenies and figure our military medicine.

I cannot imagine a scenario where they would perfom a different role.

The military is pumping out PAs fairly quickly. They operate entirely as individual practioners. There are entire operational clinics run by PAs, and the senior medical officer is a PA. I imagine this trend will continue as more doctors get out of the military and the PA continues to advocate for more positions.

 

[Atlas Shrugged]

7. Under no circumstance should you join military medicine. There is a very real chance graduate medical eduction collapses in the next 5-10 years, and once that happens, military medicine as we know it will be over.

Unfortunately, as manotter has posited, the military will increasingly use midlevels inappropriately. There are cycles of doom and gloom, however with the mission of the Defense Health Agency to civilianize everything, I think there is a fairly reasonable chance military medicine implodes.

Eventually, if they don't correct course and military medicine as we know it dies, they might move to a mostly reserve force or just institute a medical draft if they need to.

 

[militaryPHYS]

Isn’t an all reserve force a common recommendation from the group? Civilianizing creates more consistent care with less turnover, allocates actual admin people to do admin work and allows us as military providers to focus on military clinical work…in theory.

Increasing numbers and responsibility for mid levels is not isolated to the military. This is happening in all aspects of US healthcare.

Military medicine cannot disappear. It can change to all reserve or a hybrid, but it cannot go away.

Military GME could disappear unintentionally which is what they are figuring out now. Civilian training programs currently cannot support theoretical volume increase if military sites went away.

Are there an unthinkable amount of unknowns if you join MilMed? Of course. One big transition always gives way to partial stability followed by more changes. You aren’t signing up for the most ideal independent clinical practice with autonomy. You are signing up for government run socialized medicine. Be happy joining as just another worker bee and follow orders otherwise don’t join and stay civilian.

 

[MCCareer.org]

Hello all,

I would first like to thank everyone that has posted in this forum for future HPSPers to learn from. It has been informative, to say the least, to see all the opinions throughout the years on this forum. I am a pre-med in a guaranteed program that is interested in and exploring the Navy scholarship(mainly because it seems to be that they are the most prepared to accept GMO's into a residency in my naive opinion)and I have some questions that I have not found conclusive answers for and was wondering if this forum might be able to answer some of them.

1. First, I am interested in possible dual degree programs such as MD/MPH or MD/MBA. After extensively searching, I have not found a conclusive answer and it seems that it might be based on the merit of your application if the scholarship would be given for 5 years or not. Would someone be able to clarify this? Furthermore, many medical schools that offer dual degrees often ask you to apply not at the time of the application but rather during your 1st or 2nd year. This being the case, would being an HPSP recipient forbid me from applying to these programs once I have started medical school?
2. If I was to choose to specialize in ophthalmology or urology as a civilian, I would normally apply by September for a match in February due to the different matching service utilized. If I was in the program, would I end up doing the military and civilian residency match applications at the same time? Do you believe that would detract from the quality of the applications?
3. It seems that skill atrophy is a real concern in the military. If I end up applying and taking the scholarship and during medical school decide to do a competitive specialty and do not match, it almost seems the better option is to do GMO for four years and get out rather than applying in the middle as that not only increases obligation time but it also might cause skill atrophy. Is this true?
4. Regarding GMO's, if I was to pick a billet I would like it to be flight surgery: is this currently competitive to obtain? I read that with some effort(such as rotating in Pensacola) it is easily obtainable.
5. I read that HPSP recipients who followed the GMO and get out strategy often note that having GMO time is seen as a positive for residency applications by PD's. Is this true even for competitive specialties like dermatology or radiology? Looking at match statistics I saw the match statistic for graduated MD's is around 50-60% for some competitive specialties like ophtho or derm and so I wanted to inquire about the experience you may have had. I understand that the graduated MD pool includes seniors who fail to match and soap or otherwise uncompetitive people which may bring down that statistic. I plan to email a few program directors to gather their opinions on military applications so hopefully, I will be able to gain an additional opinion after this forum.
6. I live in DC and go to college in Florida allowing me relatively close access to military bases. Are there any military bases, in particular, that might be suggested to shadow at in order to gain a comprehensive practical understanding of the life and responsibilities of a military doctor?
7. Finally, I would enter the military, if taking the scholarship, and potentially become GMO, at the earliest in 2029: are there any thoughts about how the military might be then? I understand that the military is volatile right now and is rapidly changing with the plans to cut GMO billet and it is hard to predict but any opinions you might have might be interesting to read.

Thank you for your time and please free to leave any other advice you might have not only as a potential HPSP'er but also as a future doctor!

This is way too many questions to answer in print. If you e-mail me at [email protected], I'll link you with someone to talk to.