Trauma Surgery appeals to me-HPSP the right choice?

[NightGod]

For starters, I'm a 38 year old (obviously) non-trad prior (Army Reserve-92-00) service pre-med who's very interested in trauma surgery. Yes, I understand that these desires often change during the MS-3/4 years, but I also have come to appreciate how my learning curve and interests have changed over the past ~20 years of my life. Even if I decide I hate surgery, I know myself well enough to understand that I would likely pursue emergency medicine instead. So, assuming I can meet physical standards (not an issue I feel I will face by the time I'm ready to enter med school (~50 pounds lost in the last year due to diet and exercise and planning to start the Shaun T Insanity workout in the next week or so) and assuming my strong personal desire to enter into trauma surgery, would HPSP be the right choice? Honestly, I have often thought that I would want to pursue a civilian contractor career in trauma surgery even if I went a more traditional route (in fact, HPSP has only occurred to me the last couple of weeks) due to my strong desire to return to my service to the country-leaving the reserves has been one of my bigger regrets in life (and was based more upon the political climate of the late 90s and my personal financial situation than any personal dislike of the military itself-I love the fact that I served and proudly salute rather than cover my heart when the national anthem is sung at sports events and wore my red, white and blue cords with honor at my community college graduation). So, assuming the academic and physical sides become a non-issue, and my personal conviction to serve my country remains just as strong, how good of an idea is HPSP for someone who's interest lies in the field of trauma surgery? My gut tells me that few places in the world would give the kind of trauma field experience like a year in, say, Kandahar would, but my head wonders what the chances of a 44ish year old PGY1 getting assigned to a war zone would be (or even the chances of the current 'War on Somebody Deserving/Politically Expediting An American Boot in the Face" extending that long). While I would LOVE to say finances aren't a concern, in reality I know that for anyone who's parents can't pay for med school out of pocket (and my retired parents including a (medically controlled) bone cancer stricken mother can't), they are. But I also realize that a medical career (especially a surgical specialty) offers financial options that reduce those concerns in the long term. My biggest concerns here revolve around my chances of getting into a trauma surgery residency with secondary concerns about being able to help out my (military) brothers and sisters based on that residency. I honestly see myself doing everything I can to return to military service in one way or the other when I finish residency. In terms of GPA, I realize that, due to some immature mistakes in the early 90s, I am more likely to be a strong DO candidate than an MD candidate (but, to be fair, some of the best treatment in my life has been at the hands of DOs, including one who integrated OMM into his practice, so I have zero issue with the philosophy), but I want to pursue the academic and school choices that are most likely to align with my desire to pursue trauma surgery. On the personal front, I'm (very happily) divorced with two children who will be college aged by the time I'm ready to start med school, with zero plans to get into any sort of long-term personal relationship in the next few years (in fact, that's one of the things I tell women I date up front). My daughter (who will be 18 in September-GAH!- and graduating from high school early in December) is planning to enlist Army (despite my efforts to talk her into Air Force) and is hoping to ship to BCT early next year. My son will be graduating high school in 2015, the same year I am hoping to start med school. So family is a a secondary factor in my relocation/possible deployment concerns.

tl;dr Would I be better off (in terms of residency options) going with a civilian trauma surgery career or with a HPSP career, given my strong personal desire to return to military service as either an O3 or a civilian contractor? Let's leave finances out of the equation for the moment. Maybe add a secondary "MD vs DO school" option to the mix.

---

Members don't see this ad.

 

[notdeadyet]

A few thoughts:

- An interest in either Trauma Surgery or Emergency Medicine is always a red flag with me that the poster doesn't have a good handle on the jobs. These fields look like they have a lot of crossover mostly if you aren't familiar with them. I'm not throwing stones here, just saying it as something to keep in mind as you move forward. Applicants who talk about a passion for trauma surgery or EM usually elicit sighs during med school interviews. You're 38yo, which is a great asset in knowing who you are, but you may not appreciate the specialties well enough to really make a rational choice yet.

- How good HPSP would be for you financially depends on if you're looking to stay in the military for a long time or a short time. If you enter Surgery or EM, HPSP will likely be a financial loss over the long run. This shouldn't dissuade you, as money isn't everything, but it's something you should keep in mind.
- Your comment that:

my gut tells me that few places in the world would give the kind of trauma field experience like a year in, say, Kandahar would....

is a little worrisome. Surgery residencies in the military tend to be below average compared to civilian counterparts. Same for EM residencies. You can google the site to get a lot more information, most of it has to do with volume and diversity. And keep in mind that you will be a surgeon roughly 13-16 years from now. As a trauma surgeon, your odds are arguably much higher that you'll be sitting in a low volume service in rural America rather than in some battlezone.

- If your main motivation is to serve your military siblings, you could make a damn good argument for foregoing HPSP, working as hard as possible in medical school and then attending the best residency possible in your specialty before serving. There are programs such as FAP that allow for this.

- DO vs. MD is much less of an issue in the military match than the civilian one. For many civilian specialties, DO will not be very limiting (in fact, DOs seem quite well represented in allopathic EM programs, despite their competitiveness). But for keeping options open (who knows if you'll decide you love neurosurgery or the like?), attending an MD program will kick open more doors than DO. Again, no interest in the MD vs. DO debate (which is much more a pre-med fixation than in the real world), but more competitive specialties tend to scrutinize pedigrees more heavily and MD programs tend to be considered stronger by allopathic residencies.

- Don't sweat the age thing for getting into medical school too much, it's actually considered an asset at most schools. But you may find some prejudice from program directors for surgery residencies. Not insurmountable, but it may torpedo you at a few programs. But this is a concern for waaaaaay later. Pre-meds should fixate on getting into medical school. Odds are very high you'll end up in a specialty you don't indicate when you start.

 

[Perrotfish]

A few thoughts:

- An interest in either Trauma Surgery or Emergency Medicine is always a red flag with me that the poster doesn't have a good handle on the jobs. These fields look like they have a lot of crossover mostly if you aren't familiar with them. I'm not throwing stones here, just saying it as something to keep in mind as you move forward. Applicants who talk about a passion for trauma surgery or EM usually elicit sighs during med school interviews. You're 38yo, which is a great asset in knowing who you are, but you may not appreciate the specialties well enough to really make a rational choice yet.

+1. EM and Trauma Surgery attract about as diifferent a set of personalities as humanly possible. It's like hearning someone say 'if I don't make it as an impressionist painter, I guess I could always paint houses'.

 

[NightGod]

+1. EM and Trauma Surgery attract about as diifferent a set of personalities as humanly possible. It's like hearning someone say 'if I don't make it as an impressionist painter, I guess I could always paint houses'.

To be more concise, from what I know of EM and TS (a fair amount (for someone not professionally involved in medicine) in the case of EM, after a couple hundred hours of ER volunteering and talking with EM docs, as much as I can learn from reading in the case of TS, since there are no major trauma centers in my area, though I did discuss TS with one of the EM docs who had a good friend who was a practicing TS, which is about as close as I've been able to come), I *believe* my interests align more with TS, but I also am realistic enough to know that there are many people who believe they want to be surgeons only to actually experience it during rotation and realize they hate it. I don't think that will be me, but who does?

Yes, I know saying TS/EM is cringe-worthy, I honestly cringe a little myself when I mention it to friends who ask. It took me about a year of contemplation to even tell close friends who have no idea about medicine beyond watching episodes of ER and House that I was considering those fields, and I always preface the comment with "of course, most people change their minds a half-dozen times during clinicals before they settle on a choice"

I also realize that there is zero guarantee that the military will be involved in any sort of war footing by the time I am ready to be a practicing physician. Hell, our politicians could announce a full withdraw of our overseas military presence and a closing of our borders tomorrow (not that they WILL...).

The money aspect is honestly of secondary importance to me. Yes, it holds some weight, anyone who says it doesn't is likely lying, but even the lowest paid practicing physicians make enough money for my life goals. I'm not saying I have no desire to be rich, but I also have no pressing need to be a millionaire.

All of that said, I really appreciate the information about civilian vs military residencies and the knowledge that programs like FAP could offer a better way to serve. I've got a solid two years to really think about this before it starts to become pressing and three years to make a final decision (assuming I get an acceptance letter my first cycle, of course). This is exactly the sort of info I was hoping for.

On the comment that pre-meds need to worry about getting into med school first, I get that. My pattern the last couple of years has been to give myself a month or two in the summer to become a bit neurotic about the whole process and the review where I stand in my progress and revise my basic plan for the coming few years and then I drop the subject so I can enjoy my time off from school and focus on my studies when the school year starts back up.

 

[orbitsurgMD]

A lot of "trauma surgery" is postoperative care. Many patients admitted to a trauma "surgery" service never even go to the O.R., they go to the unit or are in some other monitoring inpatient status. Of course the surgery part is important, but once stabilized, patients go to whatever subspecialty services they may require: ortho, neuro, vascular, thoracic, general, plastics, etc., so the trauma service is only part of the picture.

You should realize that trauma is the antithesis of a lifestyle surgical specialty, with niceties like in-house call all through GS residency and fellowship and lots of call when an attending. You will likely be employed by a hospital as trauma does not pay well enough to attract private consultants. It is also a high-liability and high-burnout field, which isn't surprising.

 

[MTGas2B]

To echo orbitsurgMD, the board certification that comes with a general surgery trauma fellowship is surgical critical care. Also, many programs offer MPH options with an additional year.

 

[pgg]

My gut tells me that few places in the world would give the kind of trauma field experience like a year in, say, Kandahar would

Once upon a time a famous guy said "war is the only proper school of the surgeon" so there's some merit to what you say, but trauma in Kandahar is not like trauma in Los Angeles, for lots of reasons.

Also ... you're 38. Older nontrads have in many ways a harder path through med school (my brother started med school at 37). They don't generally gravitate toward the more brutal surgical subspecialties for a reason.

 

[jabreal00]

ER is basically shift work primary care. Most ER aren't level one trauma centers. The ones that are, when a "trauma" is radioed in, the trauma team often meets the patient down in the ER. Occasionally the ER resident or staff will through in a central line or two. During residency, I rotated on ER for one month, it was a level one trauma/burn center. Most days were mundane, UTIs, back pain, preggers, cough/cold/flu-like symptoms and abdominal pain. All ER docs now do is triage and consult. It's not like the tv 90s melodrama "E.R."

In the military, it's even worse because BAMC is the only level on trauma center in the military. Most of the other ER are low volume and low-acuity centers especially at the MTFs.

Trauma surgery is what one makes of it. Most have critical care training. If they are in a level one with a burn center and SICU they can be busy with floor work and wash-outs for wounds.

ER and TS are very different animals.

 

[NightGod]

That pretty much sounds like my impression of ER vs TS. Similar to life in the military: days and months of sheer monotonous 'boredom' interspersed with brief moments of panic and/or interesting events. As I mentioned, I *believe* my mindset/personality lean far more towards TS, but I'm also acutely aware that I don't have the real-world experience to know that for certain and understand that almost everyone who goes to med school with one idea in mind ends up changing it before the match for residency. But I also believe your better off making an assumption or two and planning towards that possible outcome than jumping in completely blindly and finding yourself on a less than ideal path because of a decision you should have made five years prior. I have a friend who went HPSP and she asked about my plans for med school and if I had considered it, but she's an Ob/gyn specializing in fertility, so she could only speak from that experience. Hence this thread.

 

[BOHICA-FIGMO]

Simple reply: given the lack of Level 1 trauma centers in the military across all the services (BAMC and Landstuhl I think are the only ones) I would not recommend becoming a full time active duty trauma surgeon. However, if you still want to serve, there may be a niche for you in the reserves. Just my $0.02

 

[NightGod]

Simple reply: given the lack of Level 1 trauma centers in the military across all the services (BAMC and Landstuhl I think are the only ones) I would not recommend becoming a full time active duty trauma surgeon. However, if you still want to serve, there may be a niche for you in the reserves. Just my $0.02

Reserves/FAP are seeming like more solid choices at this time if my desires remain the same. Those both also have the advantage of letting me see what my desires are in MS3/MS4 (and knowing a little better what the political climate I'll be looking at when I do serve is like, rather than jumping in a decade out).