All Branch Topic (ABT) USUHS Medical training vs civilian training

[shamyaw00]

Hi, I’ve been weighing my options about USUHS vs getting the HSPS scholarship but also just about joining the military in general. My question now is about the medical training, would you say they are roughly the same or do you feel like one prepares you more than the other?

I just saw a comment somewhere else saying that doing military training in the ER wouldn’t be the same as civilian training in the ER and working in the ER.

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[Matthew9Thirtyfive]

Hi, I’ve been weighing my options about USUHS vs getting the HSPS scholarship but also just about joining the military in general. My question now is about the medical training, would you say they are roughly the same or do you feel like one prepares you more than the other?

I just saw a comment somewhere else saying that doing military training in the ER wouldn’t be the same as civilian training in the ER and working in the ER.

That’s more wrt residency. USUHS is medical school, and in my experience my education has been great.

 

[shamyaw00]

That’s more wrt residency. USUHS is medical school, and in my experience my education has been great.

So the medical school part is essentially the same across the board?

 

[Matthew9Thirtyfive]

So the medical school part is essentially the same across the board?

Not entirely. Different schools have different styles of curricula, especially preclerkship. My friends school is a traditional curriculum where path, biochem, phys, etc are all separate. At USUHS we do it systems based so we do all that stuff at the same time for each system followed by a multisystems module. His is a 2 year preclerkship, USUHS is 1.5 years.

But they all have to be LCME accredited which means theoretically they will all teach you the same stuff.

Personally, when comparing what we learn to my couple of friends at civilian schools, it seems like we are learning more stuff that is clinically relevant, but that is only like an N=5. I’m sure there are plenty of great med schools, but I will say that a lot of the common complaints I see on SDN don’t really apply to our school.

 

[DrMetal]

Hi, I’ve been weighing my options about USUHS vs getting the HSPS scholarship but also just about joining the military in general. My question now is about the medical training, would you say they are roughly the same or do you feel like one prepares you more than the other?

I just saw a comment somewhere else saying that doing military training in the ER wouldn’t be the same as civilian training in the ER and working in the ER.

The medical school is fine, great even!

Our GME sucks, or is adequate at best. I'm sorry but it does. In military residencies that require procedures/cases, the trainees are farmed out to civilian programs for almost 30-40% of their program (makes you wonder why the military residency exists in the first place). Those who aren't farmed out and spend most of their time in the actual military program see rather low acuity and volume. On the brighter side, our academics are great! We have high board pass rates. But then again, you don't do a residency to learn how to pass a 300-Q multiple guess test.

 

[Dr. Wexler]

Attend USUHS if you are prior service or if your only other acceptance is to a medical school established in the past 20 years.

Could also consider USUHS if your only other acceptance is to a medical school without a legit relationship* with a teaching hospital.




*Interpret this as you see fit.

 

[Matthew9Thirtyfive]

Attend USUHS if you are prior service or if your only other acceptance is to a medical school established in the past 20 years.

Could also consider USUHS if your only other acceptance is to a medical school without a legit relationship* with a teaching hospital.




*Interpret this as you see fit.

Or you know, you want to serve and also go to a good school.

 

[shamyaw00]

Attend USUHS if you are prior service or if your only other acceptance is to a medical school established in the past 20 years.

Could also consider USUHS if your only other acceptance is to a medical school without a legit relationship* with a teaching hospital.




*Interpret this as you see fit.

I’ve seen a lot of people at this. I’ve been weighting the pros and cons of if I want to do the HSPS scholarship or just say no military (or like guard or reserve military). I really don’t want to get in the military and regret but I also feel like it would be a great experience (+obvious benefits)

 

[Matthew9Thirtyfive]

I’ve seen a lot of people at this. I’ve been weighting the pros and cons of if I want to do the HSPS scholarship or just say no military (or like guard or reserve military). I really don’t want to get in the military and regret but I also feel like it would be a great experience (+obvious benefits)

Probably HPSP would be better if you are set on doing it in med school. USUHS is for folks who aren’t up in the air about it just because it’s a long ass commitment and I’d hate to have someone I’m working with be stuck in a job they hate for 7 extra years.

But you could always just stay a civilian and then do the reserves later if you still want to.

 

[shamyaw00]

Probably HPSP would be better if you are set on doing it in med school. USUHS is for folks who aren’t up in the air about it just because it’s a long ass commitment and I’d hate to have someone I’m working with be stuck in a job they hate for 7 extra years.

But you could always just stay a civilian and then do the reserves later if you still want to.

Very true! Thank you so much for the insight. I know regardless I would love doing medicine but I know with the military, there are a lot of unknowns and things I can’t really control.

 

[Matthew9Thirtyfive]

Very true! Thank you so much for the insight. I know regardless I would love doing medicine but I know with the military, there are a lot of unknowns and things I can’t really control.

Yeah it really helps to have insight into yourself. If you can’t handle things being out of your control at least a bit, the military really isn’t for you. At least not active duty.

 

[Dr. Wexler]

Or you know, you want to serve and also go to a good school.

Sorry, my post was unclear. My point was choose HPSP(or some other pathway such as FAP if that still exists) over USUHS unless you are prior service or are having trouble getting into a good medical school.

 

[Matthew9Thirtyfive]

Sorry, my post was unclear. My point was choose HPSP(or some other pathway such as FAP if that still exists) over USUHS unless you are prior service or are having trouble getting into a good medical school.

Yeah I got that. My point is that USUHS is a good med school (most of them are). Also, do you think we just take everyone who applies?

 

[HighPriest]

As someone who didn’t go to USUHS - I don’t get the hate. The insinuation is clearly that USUHS is a bad medical school, or at least not as good as a “good” medical school. The people I trained with who went to USUHS were at least as good or better than anyone from anywhere else, selection bias of being in the military aside (not a lot of Harvard grads compared to state schools, for example).

If you want a reason not to go to USUHS, the reason is the extra commitment and extra time in service (if either of those are a concern for you), not that it’s a subpar school. I never found that to be true, again, from an outsider perspective. Plenty of bad med school grads out there from all kinds of schools.

I mean, if you can get in to a top ten med school and you can afford it without military assistance, then yes you would be a crazy person to go to USUHS instead. Or to even be involved in the military, for that matter. Serve your country by winning a Nobel prize, not be taking care of sprained ankles and CO egos.

And to be fair, I trained with a lot of people who did graduate from top ten medical schools when I did my away rotations, and to be honest: they weren’t significantly better or worse than anyone else I trained with. They definitely knew more about research. They often lacked clinical acumen.

Finally, and maybe this was mentioned above: not many people care where you went to medical school once you’re done with residency. They really only care when you’re applying for residencies, and if you do HPSP, you’ll probably match in to a military residency anyway.

I do agree, I’m general, that if you can get in to a top tier med school it makes sense to do HPSP and not USUHS simply because it certainly doesn’t hurt to have that on your resume. The trade off of getting a bigger paycheck for a few years just isn’t that big of a deal.

 

[DeadCactus]

USUHS is a solid school. Military residencies are adequate to good. Neither is going to hold you back and frankly what you've been doing the 3-5 years prior matters more than your pedigree once you finish training.

The honest truth is that the vast majority of people in the world will never have an opportunity anywhere near as good as what USUHS and military medicine offer. I bring this up because I think people get tunnel vision focusing on the differences between options and lose track of the fact that life is going pretty damn good if these are the decisions you are making; none of these are bad options. Still, most people looking at USUHS are doing so within the context of comparing it to a solid MD school with HPSP or student loans. The problem is not USUHS, the problem is that a state school with student loans provides better long term financial benefits and more life and career flexibility. The benefits of HPSP and USUHS are outweighed by the loss of control and downstream salary loss for the majority of people. For some people, the intangible benefits justify the other sacrifices.

No one can tell you what the best option is for your specific circumstance because it's all going to come down to the intangible things you value.

 

[DrMetal]

USUHS is a solid school. Military residencies are adequate to good.

Nothing wrong with USUHS or HPSP, our medical school ('undergraduate') pipeline is just fine.

There's everything wrong with our GME. I would not call it 'good'. Adequate, maybe. When you have senior IM residents that have never seen a good STEMI, never taken care of complex COPD/CHF, when you have PGY4 general surgery residents that are still trying to chase down lap choles (while their civilian counterparts are doing bedside emergency ex laps), when you have senior Psych residents that have very little experience with true Axis 1 pathology (b/c they've spent most of their time dealing with 'Adjustment Disorders') . . . . you cannot call that 'good'.

Ironically the only residencies that seem to be good are Peds and Ob/Gyn, and we're trying to get rid of those!

 

[HighPriest]

Nothing wrong with USUHS or HPSP, our medical school ('undergraduate') pipeline is just fine.

There's everything wrong with our GME. I would not call it 'good'. Adequate, maybe. When you have senior IM residents that have never seen a good STEMI, never taken care of complex COPD/CHF, when you have PGY4 general surgery residents that are still trying to chase down lap choles (while their civilian counterparts are doing bedside emergency ex laps), when you have senior Psych residents that have very little experience with true Axis 1 pathology (b/c they've spent most of their time dealing with 'Adjustment Disorders') . . . . you cannot call that 'good'.

Ironically the only residencies that seem to be good are Peds and Ob/Gyn, and we're trying to get rid of those!

Our residencies were good. The only significant ENT pathology that you don’t see as often in younger patients is head and neck cancer (although that is changing), and we saw a lot of it on outside rotations.

Don’t get me wrong, I think the military should get out of GME for all of the reasons you stated.

 

[DeadCactus]

Nothing wrong with USUHS or HPSP, our medical school ('undergraduate') pipeline is just fine.

There's everything wrong with our GME. I would not call it 'good'. Adequate, maybe. When you have senior IM residents that have never seen a good STEMI, never taken care of complex COPD/CHF, when you have PGY4 general surgery residents that are still trying to chase down lap choles (while their civilian counterparts are doing bedside emergency ex laps), when you have senior Psych residents that have very little experience with true Axis 1 pathology (b/c they've spent most of their time dealing with 'Adjustment Disorders') . . . . you cannot call that 'good'.

Ironically the only residencies that seem to be good are Peds and Ob/Gyn, and we're trying to get rid of those!

That's fair, my experience may be biased by working mostly with residents from a few specific programs.

 

[DrMetal]

Our residencies were good. The only significant ENT pathology that you don’t see as often in younger patients is head and neck cancer (although that is changing), and we saw a lot of it on outside rotations.

Don’t get me wrong, I think the military should get out of GME for all of the reasons you stated.

Part of the problem too is that we've gotten so good (so accustomed) to deferring our elderly crowd out to the network, and some civilian networks love to keep 'em (at least in some parts of the country, see southeast Virginia), b/c Tricare is a better payer than medicare (certainly better than 'no insurance'). We lose a lot of our pathology this way too, which is terrible for GME. I spent 2 weeks in a rheum clinic and didn't see one case of chronic RA (the clinic had gone 'Active Duty' only, saw a ton of r/o fibro and lupus, with no actual lupus....it was great).

The military healthcare system clearly isn't all that interested in taking care of the sick and elderly, which may be acceptable. But then you can't have GME.

Also I have nothing against doing outside rotations, even as much as 25%, especially for the sake of seeing some special things, for instance the general surgery resident doing an external transplant rotation b/c her home institution isn't a transplant center. Makes sense. But when your rotating out 30-40% of the time, and doing so just to see bread & butter stuff . . . .that's shady. My home institution during training didn't even have an adequate ICU to teach us real intensive care.

 

[HighPriest]

Part of the problem too is that we've gotten so good (so accustomed) to deferring our elderly crowd out to the network, and some civilian networks love to keep 'em (at least in some parts of the country, see southeast Virginia), b/c Tricare is a better payer than medicare (certainly better than 'no insurance'). We lose a lot of our pathology this way too, which is terrible for GME. I spent 2 weeks in a rheum clinic and didn't see one case of chronic RA (the clinic had gone 'Active Duty' only, saw a ton of r/o fibro and lupus, with no actual lupus....it was great).

The military healthcare system clearly isn't all that interested in taking care of the sick and elderly, which may be acceptable. But then you can't have GME.

Also I have nothing against doing outside rotations, even as much as 25%, especially for the sake of seeing some special things, for instance the general surgery resident doing an external transplant rotation b/c her home institution isn't a transplant center. Makes sense. But when your rotating out 30-40% of the time, and doing so just to see bread & butter stuff . . . .that's shady. My home institution during training didn't even have an adequate ICU to teach us real intensive care.

Oh, for sure. Ultimately that is the issue. The fact is most military residencies can’t support a GME program without significant outside charity. So much outside charity that I’m not convinced they’re saving the civilian world all that much in terms of residency spots. Our outside partners had a military resident present at least half of the time. It wouldn’t have been a huge hurdle to just take them on full time, as long as the federal government continued to foot part of the bill.

 

[Mace1370]

Nothing wrong with USUHS or HPSP, our medical school ('undergraduate') pipeline is just fine.

There's everything wrong with our GME. I would not call it 'good'. Adequate, maybe. When you have senior IM residents that have never seen a good STEMI, never taken care of complex COPD/CHF, when you have PGY4 general surgery residents that are still trying to chase down lap choles (while their civilian counterparts are doing bedside emergency ex laps), when you have senior Psych residents that have very little experience with true Axis 1 pathology (b/c they've spent most of their time dealing with 'Adjustment Disorders') . . . . you cannot call that 'good'.

Ironically the only residencies that seem to be good are Peds and Ob/Gyn, and we're trying to get rid of those!

I think it is hard to generalize to all of military GME. You're absolutely right that many of the programs do not have enough cases/acuity. Some of the military residents are very good, however. Pathology in my experience excellent. I did my fellowship at a major civilian academic center, so I saw the path program there. I also interacted with co-fellows who went to different programs for residency. I rotated at 3 different civilian institutions as a resident and saw their pathology programs first hand. The pathology residencies at Walter Reed and BAMC are very good and better than most of what I have encountered on the outside.

 

[Gastrapathy]

Do military pathology residencies still require a prelim year? They were the only ones still to do so AFAIK a while back.

 

[DrMetal]

I think it is hard to generalize to all of military GME. You're absolutely right that many of the programs do not have enough cases/acuity. Some of the military residents are very good, however. Pathology in my experience excellent. I did my fellowship at a major civilian academic center, so I saw the path program there. I also interacted with co-fellows who went to different programs for residency. I rotated at 3 different civilian institutions as a resident and saw their pathology programs first hand. The pathology residencies at Walter Reed and BAMC are very good and better than most of what I have encountered on the outside.

Noted. I didn't consider Path. Isn't path/rads going to be replaced by AI in 20 years anyway? Will we not laugh one day at the thought of a human being reading a slide or a scan?

Ok, so we do Path, Peds, OB/GYN, and Occ Med really well.

Internal Medicine/General Surgery and all of its sub-specialties be dammed.

 

[TheTruckGuy]

Agree with all the folks above. Residency is generally what makes you a competent doctor. I went to an average civilian med school. When I rotated as a 4th year at away rotations I felt like my USUHS colleagues were generally average compared to me. That is, some were a little better, some a little worse. Don't think any were way better or worse. But I was really impressed with a few when I was working with some as an intern.

I think USUHS is similar to most DO schools - generally speaking the applicants have lower MCAT scores and GPAs, so the school gets a bad rep, but the end product is probably on par with most MD schools.

But some of the above posts really have me reconsidering if I want to go back to military GME or try for FTOS or join the reserves during a civilian residency...

 

[DrMetal]

Agree with all the folks above. Residency is generally what makes you a competent doctor. I went to an average civilian med school. When I rotated as a 4th year at away rotations I felt like my USUHS colleagues were generally average compared to me. That is, some were a little better, some a little worse. Don't think any were way better or worse. But I was really impressed with a few when I was working with some as an intern.

Medical students grading each other is like Tijuana prostitutes critiquing each other's hygeine.

I think USUHS is similar to most DO schools

No, it is not. USUHS is, and always has been, an allopathic school. Not similar in any way to a DO school. If you want to look at GPA/MCAT scores, it's probably on par with the bottom to middle third of allopathic schools (not osteopathic ones).

 

[Mace1370]

Do military pathology residencies still require a prelim year? They were the only ones still to do so AFAIK a while back.

The Navy requires all of their graduates to do an internship, even if they are going into pathology. Army and Air Force waive the intern requirement and you go straight in. I was told this has more to do with the Navy wanting to use interns as GMOs rather than anything about pathology in particular.

Noted. I didn't consider Path. Isn't path/rads going to be replaced by AI in 20 years anyway? Will we not laugh one day at the thought of a human being reading a slide or a scan?

Ok, so we do Path, Peds, OB/GYN, and Occ Med really well.

Internal Medicine/General Surgery and all of its sub-specialties be dammed.

Hopefully it will be just in time for me to sell my share in a group to Google

I think USUHS is similar to most DO schools - generally speaking the applicants have lower MCAT scores and GPAs, so the school gets a bad rep, but the end product is probably on par with most MD schools.

I agree totally with what Dr. Metal said above. The stats are publicly available if you don't believe it. USUHS is and always has been an allopathic school and is not similar in any way to DO schools in regards to admissions criteria or osteopathy.

 

[HighPriest]

Medical students grading each other is like Tijuana prostitutes critiquing each other's hygeine.

If they said “room for improvement,” that is still very accurate.

And to be honest, I bet a Tijuana prostitute is FAR better at critiquing hygiene than a med student is at rating another med student, simply because they have been around the block much more - both literally and figuratively. They probably know how to diagnose the clap on site just from experience. How many med students can say that?

 

[Gastrapathy]

so at least for Navy, wasting an entire extra year that is only required by the Navy seems like a downside to their pathology residency compared to civilian life.

 

[HighPriest]

so at least for Navy, wasting an entire extra year that is only required by the Navy seems like a downside to their pathology residency compared to civilian life.

That all depends upon how you waste it, but if you mean GMO then yeah.

 

[Mace1370]

so at least for Navy, wasting an entire extra year that is only required by the Navy seems like a downside to their pathology residency compared to civilian life.

I think it probably is a wasted year for them, but there are some advantages. When I was a resident, I felt like my Navy colleagues had a better grasp on some clinical things (especially when it came to transfusion medicine).

 

[TheTruckGuy]

Medical students grading each other is like Tijuana prostitutes critiquing each other's hygeine.

I guess that's fair.

No, it is not. USUHS is, and always has been, an allopathic school. Not similar in any way to a DO school. If you want to look at GPA/MCAT scores, it's probably on par with the bottom to middle third of allopathic schools (not osteopathic ones).

Yes, I'm aware USUSH is an MD school. My point is that, at least in my experience, applicants with lower MCATs/GPAs tend to get into DO schools, so they have a bad reputation as producing subpar graduates. However, in reality, at least in the DO schools where I'm from, the curriculum is actually quite rigorous and the end result is a doctor that is probably better than what their MCAT/college GPA might have suggested.

Again, back when I was looking at statistics and applying to med school, USUHS GPA/MCAT was on par with the DO schools I was applying to. Granted, I wasn't looking at any of the for profit, non-academic DO schools, without university affiliation. So maybe if you pull in those numbers USUHS is well ahead of them.

 

[Matthew9Thirtyfive]

I guess that's fair.

Yes, I'm aware USUSH is an MD school. My point is that, at least in my experience, applicants with lower MCATs/GPAs tend to get into DO schools, so they have a bad reputation as producing subpar graduates. However, in reality, at least in the DO schools where I'm from, the curriculum is actually quite rigorous and the end result is a doctor that is probably better than what their MCAT/college GPA might have suggested.

Again, back when I was looking at statistics and applying to med school, USUHS GPA/MCAT was on par with the DO schools I was applying to. Granted, I wasn't looking at any of the for profit, non-academic DO schools, without university affiliation. So maybe if you pull in those numbers USUHS is well ahead of them.

The average mcat here is a 509/510. The average DO school mcat is a 504. Not the same. There are a couple of DO schools with comparable MCATs.

 

[TheTruckGuy]

The average mcat here is a 509/510. The average DO school mcat is a 504. Not the same. There are a couple of DO schools with comparable MCATs.

I'm not trying to compare the MCAT of USUHS with the MCAT of DO schools. I'm comparing the MCAT and GPA of MD schools with the MCAT and GPA of USUHS, and separately with DO schools.

Again, when I was applying, both the MCAT and GPA of USUHS were lower than most MD schools I applied to. Likewise, the average MCAT/GPA of DO schools I applied to was lower. But I'm saying that regardless of the lower GPA/MCAT, the curriculum at DO schools I visited and know graduates from seemed pretty rigorous and produced plenty of residents that went to good programs. I'm saying USUHS is probably the same, lower average MCAT/GPA than MD schools gives it a bad rep, but a quality curriculum still produces quality graduates. Again, all during my application cycle many moons ago. I don't even know what a 510 MCAT means. Average MCAT when I was going through was like a 30 at the schools I applied to.

I'm not trying to insults USUHS here.

 

[Mace1370]

I'm not trying to compare the MCAT of USUHS with the MCAT of DO schools.

I think USUHS is similar to most DO schools - generally speaking the applicants have lower MCAT scores and GPAs, so the school gets a bad rep, but the end product is probably on par with most MD schools.

 

[Matthew9Thirtyfive]

I'm not trying to compare the MCAT of USUHS with the MCAT of DO schools. I'm comparing the MCAT and GPA of MD schools with the MCAT and GPA of USUHS, and separately with DO schools.

Again, when I was applying, both the MCAT and GPA of USUHS were lower than most MD schools I applied to. Likewise, the average MCAT/GPA of DO schools I applied to was lower. But I'm saying that regardless of the lower GPA/MCAT, the curriculum at DO schools I visited and know graduates from seemed pretty rigorous and produced plenty of residents that went to good programs. I'm saying USUHS is probably the same, lower average MCAT/GPA than MD schools gives it a bad rep, but a quality curriculum still produces quality graduates. Again, all during my application cycle many moons ago. I don't even know what a 510 MCAT means. Average MCAT when I was going through was like a 30 at the schools I applied to.

I'm not trying to insults USUHS here.

You literally compared it to DO schools. But yes, USUHS is on par with schools like Loma Linda or Tulane, stats wise.