Read This thread was locked, why?

[HighPriest]

I don't know if you've been there, but Thule is an interesting place: wild Arctic foxes that have no fear of humans and will walk right up to you, everything built on stilts or with cold air ducts underneath to prevent melting of the permafrost and a 24-hour a day club, (the Top of the World Club). You can walk across the bay even in spring (in April, 23.5 hours of light with a token sunrise/sunset). It's a Danish home rule territory and nominally a Danish air base (with a long one-way runway painted white with orange markers to reduce heating of the permafrost beneath the pavement.)

Right. See, if this was an Army post, you'd be living in a tent on the ground in a sleeping bag rated for 30 degrees that you share with a rat for warmth and the club would be a latrine that is consistently the warmest place on post.

---

Members don't see this ad.

 

[HighPriest]

Too bad they didn't have this come to fruition haha

Project Iceworm - Wikipedia

Right....too bad it didn't.....

 

[DrMetal]

There’s nothing wrong with 29 Palms. 1 hr or less to Palm Springs, 2 1/2 hours to Los Angeles, San Diego, or Vegas.
There are way worse places to be trapped for a few years.

Have you been? If so, can I PM you some questions?

 

[d2305]

I would love to go to Greenland, in the summer.

 

[orbitsurgMD]

I would love to go to Greenland, in the summer.

Yeah. I was told when I was there that in winter, the darkness, snow and wind can sometimes cause whiteout conditions during which you are locked down wherever you happen to be for safety. Apparently visibility can be so bad at times that even with flood lighting, it is possible to become disoriented and be unable to navigate to shelter.

 

[johnnyscans]

What FB group is the med corp one that seems to have all the discussion? I can't seem to find it.

 

[dwb8p]

"Army Medical Corps"

 

[Setih]

For the record, DG is a great billet, I guess it depends on the perspective, but it is very nice.

DG = Diego Garcia

So I am told.

 

[Setih]

Need to visit that FB page, seems there are a lot toxic folks.

 

[Trefoil]

Yeah probably. I think coming in fresh with no .mil experience really puts one at a disadvantage wrt satisfaction from a .mil career because of how many things are outside your control.

To be honest, I’m fine with things being out of my control if they are being done well. The problem is that all of the recent changes have decreased our ability to deliver safe care. They have also decreased the ability of training programs to maintain volume. Too many patients are going to the network. Once they are gone, you will not get them back.

GMO for 4 years is fine, but you shouldn’t expect that going to a residency program afterwards will be enjoyable or easy. You will need to obtain rec letters from people in your specialty of choice. I’m just saying, the path is far less logical and direct now. People who really want to be physicians first should really consider the consequences early on rather than wasting 4 years as a GMO.

That’s just my two cents. Like I said. Things are working out pretty well for me at the moment. I like my job. I like my patients. I am happy with my pay, but I might also be one of the last people who has a smooth trip. I just want to encourage people to pause before taking a deal with uncertain terms attached to it.

 

[militaryPHYS]

About — CMIRR | Collaboratory for Musculoskeletal Injury Rehabilitation Research

I don't think USU is going anywhere for a while. DHA pumping money in to stuff like this.

I was hoping that they would ultimately keep USU around and use it as the go-to place for MilMed training (which it already is, but HPSP provides the majority of new accessions). As MilMed GME and HPSP are consolidated, I think USU will continue to pump out "x" number of highly qualified MilMed docs with 4 years of Milmed experience before even starting PGY-1 year. Trouble is, 7 year commitment is tough to stomach.

 

[Matthew9Thirtyfive]

To be honest, I’m fine with things being out of my control if they are being done well. The problem is that all of the recent changes have decreased our ability to deliver safe care.They have also decreased the ability of training programs to maintain volume. Too many patients are going to the network. Once they are gone, you will not get them back.

GMO for 4 years is fine, but you shouldn’t expect that going to a residency program afterwards will be enjoyable or easy. You will need to obtain rec letters from people in your specialty of choice. I’m just saying, the path is far less logical and direct now. People who really want to be physicians first should really consider the consequences early on rather than wasting 4 years as a GMO.

That’s just my two cents. Like I said. Things are working out pretty well for me at the moment. I like my job. I like my patients. I am happy with my pay, but I might also be one of the last people who has a smooth trip. I just want to encourage people to pause before taking a deal with uncertain terms attached to it.

Totally agree about needing to really stop and think about what all this uncertainty means before signing up. I will only be four years shy of retirement when I finish my commitment, so honestly I will probably stick it out unless it becomes absolutely unbearable.

The Navy SG just released (or I just saw it) a thing saying they are going to create Navy training and readiness facilities so that doctors stationed with units or ships can focus on maintaining readiness with their units rather than working at MTFs when in port. That scares me because it essentially makes me think that being assigned to a ship or unit will essentially be a death sentence for skills even more than it already is.

 

[militaryPHYS]

Totally agree about needing to really stop and think about what all this uncertainty means before signing up. I will only be four years shy of retirement when I finish my commitment, so honestly I will probably stick it out unless it becomes absolutely unbearable.

The Navy SG just released (or I just saw it) a thing saying they are going to create Navy training and readiness facilities so that doctors stationed with units or ships can focus on maintaining readiness with their units rather than working at MTFs when in port. That scares me because it essentially makes me think that being assigned to a ship or unit will essentially be a death sentence for skills even more than it already is.

False. What he said is that we will continue to be assigned to platforms, but with DUTY AT THE NMRTC (MTF). The NMRTC CO is responsible for readiness of the docs and ASSIGNING THEM WHERE THEY CAN BEST MAINTAIN THEIR OPERATIONALLY-RELEVANT SKILLS and COMPETENCIES...If the MTF cannot provide what is required...duty may be somewhere else (i.e. civilian partnerships).

Currently those assigned to units are overloaded with train-ups, two chains of command and a lot of BS pulling them away from their skills maintenance at the hospital. I think they are trying to make this better, not worse (as everyone is so convinced it will be) with the NMRTC idea.

Understand that my interpretation is an optimistic view on the current facts that we have. Everyone should understand the transition, learning curve and implementation is probably going to be crazy, worse or about the same. Hopefully we will be left with something better than what we have currently.

 

[Matthew9Thirtyfive]

False. What he said is that we will continue to be assigned to platforms, but with DUTY AT THE NMRTC (MTF). The NMRTC CO is responsible for readiness of the docs and ASSIGNING THEM WHERE THEY CAN BEST MAINTAIN THEIR OPERATIONALLY-RELEVANT SKILLS and COMPETENCIES...If the MTF cannot provide what is required...duty may be somewhere else (i.e. civilian partnerships).

Currently those assigned to units are overloaded with train-ups, two chains of command and a lot of BS pulling them away from their skills maintenance at the hospital. I think they are trying to make this better, not worse (as everyone is so convinced it will be) with the NMRTC idea.

Understand that my interpretation is an optimistic view on the current facts that we have. Everyone should understand the transition, learning curve and implementation is probably going to be crazy, worse or about the same. Hopefully we will be left with something better than what we have currently.

I like your interpretation better than mine. Note I said that I was afraid that it would mean skill rot because they wouldn’t be at an mtf or seeing patients other than the crew, not that I was sure that would happen.

 

[militaryPHYS]

I like your interpretation better than mine. Note I said that I was afraid that it would mean skill rot because they wouldn’t be at an mtf or seeing patients other than the crew, not that I was sure that would happen.

I know. Unfortunately you might be right. I imagine if it got worse than the current situation our green-side partners are dealing with then that would be a very poor change of policy. But in our line of work you can never be too sure.

 

[Matthew9Thirtyfive]

I know. Unfortunately you might be right. I imagine if it got worse than the current situation our green-side partners are dealing with then that would be a very poor change of policy. But in our line of work you can never be too sure.

Yes, that’s pretty much exactly what I am afraid of. I am OK with being an officer first, but I still want to practice medicine.

 

[orbitsurgMD]

For the record, DG is a great billet, I guess it depends on the perspective, but it is very nice.

DG = Diego Garcia

So I am told.

It might appeal to those generally unattached with a spirit of adventure. Supposedly it is generally casual, as in uniform of the day is shorts and t-shirt, and the mode of transport is bicycle. It was treated as a one-year unaccompanied hardship billet and there was usually a "pick your location" privilege for those who went there for their follow-on billet. One of my Portsmouth internship classmates went there and went to California (SD, IIRC) after, which is what he wanted.

 

[DondeEstaElBano]

GAO just released its report on Military Medicine personnel requirements, which essentially says that the DOD cannot currently reliably estimate their requirements. Awesome. So we’re pushing to cut staff that we have no reliable way of knowing if we need or not?

Especially illuminating was the section on OSD ignoring the military services reports on their own requirements which were submitted in September 2017 (then redone with comments about taking jointness into account in May 2018), and making up their own numbers instead. In light of the commentary of how OSD’s push to civilianize in the early 2000s based on their estimates that medical was too fat was a cluster and was disallowed by Congress in 2008, it becomes even more unbelievable to me.

GAO did also comment on the fact that DOD had not accounted for retention and MTF capabilities in their estimates, making them inaccurate. Interesting.

I haven’t done a deep dive read, so probably missed some other interesting stuff.

https://www.gao.gov/assets/700/697009.pdf

 

[ArmyTiger]

GAO just released its report on Military Medicine personnel requirements, which essentially says that the DOD cannot currently reliably estimate their requirements. Awesome. So we’re pushing to cut staff that we have no reliable way of knowing if we need or not?

Especially illuminating was the section on OSD ignoring the military services reports on their own requirements which were submitted in September 2017 (then redone with comments about taking jointeness into account in May 2018), and making up their own numbers instead. In light of the commentary of how OSD’s push to civilianize in the early 2000s based on their estimates that medical was too fat was a cluster and was disallowed by Congress in 2008, it becomes even more unbelievable to me.

GAO did also comment on the fact that DOD had not accounted for retention and MTF capabilities in their estimates, making them inaccurate. Interesting.

I haven’t done a deep dive read, so probably missed some other interesting stuff.

https://www.gao.gov/assets/700/697009.pdf

Favorite part was the Navy said that all of their positions were necessary for operational readiness on the first inquiry. They were told that wasn't possible and they needed to revise their estimate. Second try? The exact same estimate!

 

[ArmyTiger]

The last thread ended by asking if GMOs were asked to see dependents, and most seemed to think no. As a fairly recent GMO, I'll say I had to see dependents regularly, as well as retirees (to include a prior liver transplant patient!), as a part of my job. I had qualified people around to ask if I was doing the right thing, but man, was I unqualified to be in that position.

 

[Gastrapathy]

Interesting document. My favorite part is being listed as a nondeploying specialty. That will be news to my wife. Guess I'll have to come clean about those 8 month vacations.

My second favorite part was the discussion that most specialties skills don't degrade if they aren't seeing complex patients.

 

[militaryPHYS]

Use scalpel, not cleaver on medical billets, USUHS chief urges

“Because Congress and the Defense Department prize USUHS graduates, the medical school is set to expand over the next several years to produce at least 30 more doctors annually. A new building of almost 500,000 square feet will be constructed, starting in 2021 to add classrooms, research labs and offices.”

Looks like USUHS has already gotten the reassurances it will be sticking around for a while.

 

[d2305]

What's the difference if you see patients on a ship or at the BMC? One gets pretty good at sports medicine, but that's about it. If a member does develop a significant illness, they're boarded out.

 

[Gastrapathy]

That 80% statistic is old and misleading. 50% of USU students have prior service so 20 isn’t really 20. There was a GAO report where they stated that USU refused to determine the per student cost to allow comparison to HPSP.

He wants to fold all GME under USU. Create another headquarters to generate work for the folks at the local sites.

 

[Matthew9Thirtyfive]

That 80% statistic is old and misleading. 50% of USU students have prior service so 20 isn’t really 20. There was a GAO report where they stated that USU refused to determine the per student cost to allow comparison to HPSP.

He wants to fold all GME under USU. Create another headquarters to generate work for the folks at the local sites.

Do service academies count toward retirement? USUHS doesn’t (they tack it on at the end when you retire). If you remove the grads whose “prior service” involves graduating from West Point or USNA, the number of USUHS students with prior service is ~19%.

 

[Gastrapathy]

Do service academies count toward retirement? USUHS doesn’t (they tack it on at the end when you retire). If you remove the grads whose “prior service” involves graduating from West Point or USNA, the number of USUHS students with prior service is ~19%.

It was much higher when that 80% statistic was calculated years ago. It was 80% of folks who started in the 80s. They can’t even say what an education costs the taxpayer let alone measure retention to retirement.

 

[BunsenBeaker]

Do service academies count toward retirement? USUHS doesn’t (they tack it on at the end when you retire). If you remove the grads whose “prior service” involves graduating from West Point or USNA, the number of USUHS students with prior service is ~19%.

The 4 years at an academy do not count towards your 20, but there are rumors I’ve heard over the years that it gets tacked on the end like USUHS. I’ll try to remember to ask the next academy grad I know who retires.

 

[pgg]

To be clear, for those readers who aren't familiar with the terms, when they say the USUHS years are "tacked on" at the end after retirement, they're referring to the multiplier only.

There are three separate issues:
1) years until retirement eligibility
2) pay scale for the "high 3" years
3) the multiplier used to calculate retirement pay

Simplest example, a person who enters the military via OCS as an O1 line officer after college, and retires as an O5 at 20.
1) it took 20 years from the day of commissioning to be eligible for retirement
2) his high 3 pay average is (O5>16 + O5>18 + O5>18) / 3
3) his multiplier is 20 years x 2.5% per year
= 50% of high 3 average = retirement pay

(The multiplier under the new Blended Retirement System is 2% per year.)

A USUHS grad's eligibility clock starts at graduation, 4 years after commissioning. The pay scale clock starts then too, so despite having been on active duty for 4 years already, they graduate as O3 with 0 years. Then, 20 years later, our retiring USUHS grad (assuming O5 rank) has the same high 3 numbers as the line officer above.

The only difference is the USUHS grad's multiplier counts the USUHS years: 24 years x 2.5% per year = 60% of the high 3 average.

 

[Matthew9Thirtyfive]

To be clear, for those readers who aren't familiar with the terms, when they say the USUHS years are "tacked on" at the end after retirement, they're referring to the multiplier only.

There are three separate issues:
1) years until retirement eligibility
2) pay scale for the "high 3" years
3) the multiplier used to calculate retirement pay

Simplest example, a person who enters the military via OCS as an O1 line officer after college, and retires as an O5 at 20.
1) it took 20 years from the day of commissioning to be eligible for retirement
2) his high 3 pay average is (O5>16 + O5>18 + O5>18) / 3
3) his multiplier is 20 years x 2.5% per year
= 50% of high 3 average = retirement pay

(The multiplier under the new Blended Retirement System is 2% per year.)

A USUHS grad's eligibility clock starts at graduation, 4 years after commissioning. The pay scale clock starts then too, so despite having been on active duty for 4 years already, they graduate as O3 with 0 years. Then, 20 years later, our retiring USUHS grad (assuming O5 rank) has the same high 3 numbers as the line officer above.

The only difference is the USUHS grad's multiplier counts the USUHS years: 24 years x 2.5% per year = 60% of the high 3 average.

Well said.

 

[backrow]

The 4 years at an academy do not count towards your 20, but there are rumors I’ve heard over the years that it gets tacked on the end like USUHS. I’ll try to remember to ask the next academy grad I know who retires.

This is incorrect for service academy grads for military retirement.

 

[BunsenBeaker]

This is incorrect for service academy grads for military retirement.

You’re saying that 4 academy years does count towards retirement, then? Or did you mean the rumor I’d heard was wrong? Just trying to get the facts straight...

 

[militaryPHYS]

He wants to fold all GME under USU. Create another headquarters to generate work for the folks at the local sites.

I mean, this kind of makes sense, right? USU is the only static entity we have that is already tri-service coordinated (and has been for some time).

 

[backrow]

You’re saying that 4 academy years does count towards retirement, then? Or did you mean the rumor I’d heard was wrong? Just trying to get the facts straight...

Sorry. The Academy years don’t count for anything for a military retirement.

 

[HighPriest]

Use scalpel, not cleaver on medical billets, USUHS chief urges

“Because Congress and the Defense Department prize USUHS graduates, the medical school is set to expand over the next several years to produce at least 30 more doctors annually. A new building of almost 500,000 square feet will be constructed, starting in 2021 to add classrooms, research labs and offices.”

Looks like USUHS has already gotten the reassurances it will be sticking around for a while.

Well, that all depends upon when they got the funding. Before they decided to cut 12,000 medical personnel or after? And even if it was after, I would wonder if it wasn't the proverbial"stuffing the mattress" that every branch of the federal government does when it knows cuts are coming. My first duty station built a $400 million dollar hospital and did most of that work after they were told the whole area was to be closed because they thought if they got it done AMEDD would change their tone and let them stay open. In that case, it worked.

Also, Thomas doesn't really give any new information in this article. He has no idea what's going to happen, but he's hopeful they'll change their minds to a degree. Which makes sense. A phase-out makes sense as well, but the end result of a phase out could be the same. No discredit there to Thomas, he just doesn't know any more than anyone else.

Also, I'm just a lowly head and neck guy but if I'm not mistaken: if you have a rotten leg you'll eventually need a cleaver or at least a saw to get it off. Not just a scalpel. So I'm not sure using a cleaver is the wrong choice for this rotten leg.

It would make sense to channel all Milmed through USUHS if the changes go through as proposed. Join, accrue years towards retirement (or the multiplier or whatever), get paid and trained as an officer, but know when you go in that your specialty choices are limited. But they should still do civilian residencies, in my opinion. Especially if these changes go through. I find a lot of military docs, frankly, don't know what they're missing from a case-load and complexity standpoint simply because they've only ever known the military system. I think some perspective would be helpful. If you do a civilian residency and you come back and feel like your case load is adequate, so be it. But I think it would be a motivator for more change towards skill maintenance.

 

[pgg]

Military residency programs train a substantial percentage of physicians in the US. I'm not sure there are enough places to put residents if we outsourced all of GME. Already the squeeze is starting to affect IMGs, FMGs, and the lower ends of US MD and DO graduates. Right now we have a growing number of new physicians without a GME chair to sit in.

Part of that is the federal funding cap, which the military could overcome by paying hospitals to take some military residents. But I'm not sure there are really enough sufficiently capable teaching hospitals that could absorb all of our people, even if we tried to shift them out gradually.

 

[HighPriest]

Military residency programs train a substantial percentage of physicians in the US. I'm not sure there are enough places to put residents if we outsourced all of GME. Already the squeeze is starting to affect IMGs, FMGs, and the lower ends of US MD and DO graduates. Right now we have a growing number of new physicians without a GME chair to sit in.

Part of that is the federal funding cap, which the military could overcome by paying hospitals to take some military residents. But I'm not sure there are really enough sufficiently capable teaching hospitals that could absorb all of our people, even if we tried to shift them out gradually.

That will be a problem the system will have to combat, to be sure. But the military won’t be able to run GME if they’re cutting out most of their sub specialty care, and asking the DoD to foot the bill to supplement a physician shortage isn’t reasonable if they don’t need the support structure to keep the war machine viable.

 

[militaryPHYS]

But they should still do civilian residencies, in my opinion. Especially if these changes go through. I find a lot of military docs, frankly, don't know what they're missing from a case-load and complexity standpoint simply because they've only ever known the military system. I think some perspective would be helpful. If you do a civilian residency and you come back and feel like your case load is adequate, so be it. But I think it would be a motivator for more change towards skill maintenance.

I know we have hashed this out before, but it is worth continuing to revisit so thank you to @HighPriest and @pgg.

Military residencies are something that the military does really well but it is only because of collaboration with civilian residencies via MOU's in areas that aren't perfect. This is because the volume and acuity of patients within certain specialties or sub-specialties at MTF's is not high enough to sustain the training. (I know you and I know this but I'm rehashing for Newbies). Currently, once you finish residency and become staff you lose the ability to continue to operate or see patients at these civilian centers with MOU's...hence we have skill atrophy and waste. This is what is currently trying to be changed.

Many civilian programs also have specialties/sub-specialties which they are deficient in but they are able to collaborate with other surgery centers or clinics within their health system to pick up the slack. For example, every great Level I trauma center with a residency program has residents who get burned out with trauma skills while other skills are lacking. We see this very often with civilian trained Ortho. They can't scope a knee or shoulder for the life of them but they are great at nailing femurs and washing out puss. If they then come in to the military they are like PGY-2's again because all we do are scope knees and shoulders and have much less high-energy trauma. I have already had to do multiple extended FPPE's with people for bread and butter MilMed ortho cases.

I think there is a happy medium, but IMO maintaining active duty military residencies (in specialties that make sense) is vital. Continue to do what we are currently doing which is shutting down the smaller programs at the outlying smaller MTF's (Pensacola, etc.) and consolidate at the larger centers where volume of AD and beneficiaries is higher while also being surrounded by higher-volume/acuity network hospitals to maintain good relationships and MOU's. (D.C., San Diego, San Antonio, Norfolk, etc.). The quality of physician that comes from an active duty residency from a professional, maturity and military-focused care perspective is invaluable. I was universally disappointed with the civilian residents I worked along side during my civilian ortho rotations. It was like a whole other world with people who's personalities and mindsets were not aligned with what it would take to be successful and happy within MilMed. I would worry that if you are training MilMed docs exclusively at civilian programs you are training them to all be civilian docs who have to wear a military uniform for a few years. It's a recipe for disaster.

If we want a meaner, leaner MilMed core then create and maintain the ideal MilMed GME system to produce said product while enhancing the ability to collaborate with the same civilian hospitals once we become staff. IMO that means consolidated programs at big MTF's in/around big cities with excellent civilian partnerships available. Continue to restrict overseas billets to 2 or 3 years and only staff them with experienced docs who just came from a CONUS billet which hopefully in the future will mean exclusively higher volume with good skill sustainment.

We will never be out of the beneficiary care business completely. I agree that maintaining small clinics with low volume/acuity all over the country is a waste. Fix Tricare reimbursement for those far removed from a big center or pay for them to travel to the closest big center for their procedures.

Just my two cents

 

[notdeadyet]

Military residency programs train a substantial percentage of physicians in the US. I'm not sure there are enough places to put residents if we outsourced all of GME.

Hmmmm. How many residency spots does milmed GME have overall? For instance, overall there are about 1700 anesthesia slots, 1400 psych, and 7400 internal medicine. How many of each of those are milmed? I may have milmed a smaller piece of the pie in my mind than it actually is?

Already the squeeze is starting to affect IMGs, FMGs, and the lower ends of US MD and DO graduates. Right now we have a growing number of new physicians without a GME chair to sit in.

We have a ways to go. There are a LOT of IMGs/FMGs who end up in residency slots. With growing sizes of medical schools domestically, there is PLENTY of room. For the three residencies mentioned above, for instance, only 63% of anesthesia, 48% of internal medicine, and 67% of psych residency slots had U.S. senior applicants.

I don’t have a dog in the hunt with regard to military residencies, but I have a hunch the civilian GME system can absorb it. It’ll just make competitive specialties that much more competitive.

It also reinforces advice I constantly give applicants: Go MD/DO for medical school. Go international and your chances of not matching into a residency is going to continue to go up.

 

[HighPriest]

I would also think that, given the chance to hire an FMG student or a USUHS student, most GME programs would take the USUHS student. So I don't think there's a huge competition there.

You can take Cock-eye Terry, who failed 1/3 or his college classes, came out with a major in Ancient Sumerian Gender-bias in Communications with a minor in hydroponics, retook the MCAT four times and just barely found his way into the Caribbean school for medicine and rehab center (and by the way, he's already being sued by a bereaved family).....or you can take LT Worksalot who was at the top of his class in college, has a strong work ethic and a history of leadership experience and a military commission and who is ostensibly paid for already so no cash out of your pocket......

Yeah, not much of a competition.


If there's an issue, it's an ACGME issue. You can't say out of one side of your mouth that we have a doctor shortage and out of the other that we can't train more doctors because we don't have enough residency spots. Seems like the federal money saved not managing a healthcare administration could be redirected towards incentives to train residents. If we're that short on residencies, and we're that short on doctors, the volume to train is out there. And yes, they may have the volume of patients to train within the military, but it has always been clear that we don't have the breadth of pathology.

 

[pgg]

Hmmmm. How many residency spots does milmed GME have overall? For instance, overall there are about 1700 anesthesia slots, 1400 psych, and 7400 internal medicine. How many of each of those are milmed? I may have milmed a smaller piece of the pie in my mind than it actually is?

Someone here in my dept told me it was about 5% of all residency positions nationwide. I've never actually done the math.

Inservice Navy anesthesia = 18 per year, I assume Army is probably 25ish, Air Force maybe 10? 53/1700 = 3%

Maybe it's less than I thought.

 

[pgg]

If there's an issue, it's an ACGME issue. You can't say out of one side of your mouth that we have a doctor shortage and out of the other that we can't train more doctors because we don't have enough residency spots. Seems like the federal money saved not managing a healthcare administration could be redirected towards incentives to train residents. If we're that short on residencies, and we're that short on doctors, the volume to train is out there. And yes, they may have the volume of patients to train within the military, but it has always been clear that we don't have the breadth of pathology.

Volume isn't enough. There's plenty of private practice volume and pathology out there. But a busy PP with with volume can't just be flipped into an academic teaching hospital. For one thing, the people working PP jobs don't want to be teaching. If they did, they'd be in academics. They want to be working, moving the meat, billing for procedures and encounters. Not writing lectures, not watching an intern turn a 4 minute closure into a 24 minute closure.

Judging from the way a number of DO schools without affiliated teaching hospitals have to scramble to find places to send their students to do their 3rd and 4th year clerkships - and the marginal places a lot of them end up going - I have a hard time believing that there's an abundance of hospitals capable of running ACGME residency programs that have room to accept a big wave of people displaced from the military.

 

[pgg]

I would also think that, given the chance to hire an FMG student or a USUHS student, most GME programs would take the USUHS student. So I don't think there's a huge competition there.

I'm sure 95% of USUHS grads would have little trouble.

However, would they leap to take all of the DO HPSP'ers? DOs are next in line to feel the squeeze after IMGs and FMGs. HPSP has a very high percentage of DOs, largely because most DO schools are very expensive and HPSP is a blank check for tuition.


One more thought, just as a sidebar. I don't think it's really relevant these days, but when USUHS opened up back in the 70s one of its features was the capability of accelerating the curriculum and graduating medical students in 3 years if WWIII broke out and there was a desperate need. (Why anyone ever thought this would be a better plan than simply drafting a bunch of doctors never made a lot of sense to me.) That capability doesn't mean much if the military doesn't have GME programs to take the 3 year wonders.

 

[Vandalia]

One more thought, just as a sidebar. I don't think it's really relevant these days, but when USUHS opened up back in the 70s one of its features was the capability of accelerating the curriculum and graduating medical students in 3 years if WWIII broke out and there was a desperate need. (Why anyone ever thought this would be a better plan than simply drafting a bunch of doctors never made a lot of sense to me.) That capability doesn't mean much if the military doesn't have GME programs to take the 3 year wonders.

A 3 year medical school was actually somewhat common in the 70's. It was considered to be the "wave of the future", but it didn't really pan out. Basically the 4th year of medical school was also the internship year for residency. One of my in-laws graduated from Northwestern around 1970 and did a surgery residency there, and he received dual credit for his 4th year and internship, i.e., 3 years of medical school.

 

[HighPriest]

Volume isn't enough. There's plenty of private practice volume and pathology out there. But a busy PP with with volume can't just be flipped into an academic teaching hospital. For one thing, the people working PP jobs don't want to be teaching. If they did, they'd be in academics. They want to be working, moving the meat, billing for procedures and encounters. Not writing lectures, not watching an intern turn a 4 minute closure into a 24 minute closure.

Judging from the way a number of DO schools without affiliated teaching hospitals have to scramble to find places to send their students to do their 3rd and 4th year clerkships - and the marginal places a lot of them end up going - I have a hard time believing that there's an abundance of hospitals capable of running ACGME residency programs that have room to accept a big wave of people displaced from the military.

Volume isn't enough. But, there are plenty of county hospitals that could start programs if the incentive to do so was there. Same with PP - they often don't want to do it simply because it costs them money. My point is: training shortages are an ACGME issue. So far as how much a limited military force of bucket 1 specialties would overwhelm the system: I don't know. Shooting from the hip, it doesn't seem like that much. Maybe I'm wrong. I don't have that data. It will really depend upon how many physicians and of what type the military decides to keep around.

I think there are a lot of DO schools without affiliated hospitals because the people building DO schools are only concerned with tuition, and not really at all concerned with actual training. They build them and enroll students first, and let the pieces fall as they will. That, in my opinion, is a different ( ethical) issue.

If the military trained everyone at USUHS, and limited HPSP to MD schools due to a decreased in the needed physicians (because of force cuts), then the DO thing would sort itself out to a large extent.

 

[HighPriest]

One more thought, just as a sidebar. I don't think it's really relevant these days, but when USUHS opened up back in the 70s one of its features was the capability of accelerating the curriculum and graduating medical students in 3 years if WWIII broke out and there was a desperate need. (Why anyone ever thought this would be a better plan than simply drafting a bunch of doctors never made a lot of sense to me.) That capability doesn't mean much if the military doesn't have GME programs to take the 3 year wonders.

I don't see this as an issue at all. let me know when it comes up.

 

[militaryPHYS]

Should we make the original "READ THIS..." thread Sticky? Even though it is locked it can still be read through by new members.

I would also recommend if we do make it sticky it should be titled "THINKING ABOUT HPSP/USUHS? READ THIS FIRST"

 

[Matthew9Thirtyfive]

Should we make the original "READ THIS..." thread Sticky? Even though it is locked it can still be read through by new members.

I would also recommend if we do make it sticky it should be titled "THINKING ABOUT HPSP/USUHS? READ THIS FIRST"

Seems reasonable to me.

 

[pgg]

There's some good discussion in that thread but it's a 362-post, contentious, and speculation-heavy thread with a deleted/edited OP.

The best stickies are usually FAQs, rules, and neutral sources of factual information. Stickies are "welcome to the forum" threads. I don't think that we want our welcome to be that particular morass of argument, edited posts, confusion, and speculation.

 

[HighPriest]

I can't disagree with pgg. THe only reason to sticky it would be to highlight the current uncertainty in milmed. And I think that uncertainty is fairly clear in basically every thread at the moment. Maybe when we're not sure that someone will bringt up the current confusion in the DoD when a potential applicant asks, then we can sticky it. But that time will never come.

 

[militaryPHYS]

I hear you...but the "Compilation" sticky that @Lee created has a link to a "Military Medicine thoughts/opinions" which is from 2006. Maybe keeping current stickies as-is but with appropriate updates to relevant threads?