I’m a senior year premed, and I’m looking into the HPSP (I’ve met with an Air Force recruiter, but would be open to any branch). I’ve been trying to read up on the forums here, but would like some clarification with things. So, what concerns me with going the military route is a lot of the negative stories I’ve read with people doing GMOs, and overall getting little experience when compared to a civilian route.
1) Correct me if I’m wrong here... is a GMO just something you do if you don’t match in a residency?
Old-timer here (was graduated from USU 1990; was graduated from Wilford Hall anesthesiology [which no longer exists] 1994). I am only chiming in to give a historical perspective; I look forward to hearing from my younger colleagues with more recent experience.
I was the only member of my Air Force anesthesiology residency class who went directly from internship into residency. Part of this was that I was fortunate enough to work for the Consultant for Anesthesiology, both as a medical student and intern at Andrews AFB. He wrote me a glowing recommendation letter that definitely greased the wheels of the system. Part of this was because I saw what the flight surgeons at Pope AFB did 90% of the time while I was doing FP at Ft. Bragg during medical school: arguing with pilots about DNIF for URIs, dealing with the dreaded jock itch, and prescribing IM ceftriaxone for STDs.
It didn't seem as glamorous as the AF recruitment videos make it out to be. Sure, there were a few who stuck around as RAM graduates to fly desks a lot, planes a little, and Retire on Active Duty a lot. Pilots are among the healthiest humans on earth...maybe even healthier than Olympic athletes, many of whom (interestingly enough)
have asthma. Spending three years dealing with paperwork, politics, and testosterone-fueled arguments about flying status didn't appeal to me.
Moreover, as with many things in military medicine, changes can happen overnight without warning, based on what the voices in Pentagon functionaries' heads tell them. Example: the AF Surgeon General in 1997 thought incorrectly that there were too many anesthesiologists in the service. Accordingly, he slashed Air Force residency slots from 10/year to 4/year to zero. At the same time, he forced an entire crop of newly graduating interns who wanted to go into anesthesiology to do GMO/FS stints instead. Many of the HPSP folks just did their four years and punched out, rather than deal with a system that didn't want them. Shockingly, 4 years later, when 9/11 hit, we had gone from 10 anesthesiologists at Andrews AFB to 3, only two of whom actually did any meaningful work
vs. staying home for 200 days/year to watch Barney with her twins. And yet the AF expected us to continue the same ops tempo with 2 anesthesiologists taking every other night call (the boss refused, as she hadn't managed an anesthetic in the OR for ten years, and didn't know how to use medications that had been around for that decade) as we had with 10 anesthesiologists (OK, 9, not including her).
Note that the cushy ACGME rules for resident work hours don't apply to you as an attending. We got tired of all the interns going "peace out, my shift is done" at 1900, while the untrained FP physician ordered to act as if she were an intensivist for intubated, severely wounded people continued her 24-36 hour shift, while calling us every hour on the hour to ask questions a trained intensivist would know the answers to (IF patient bucking on tube THEN turn up sedation END).
Bottom line: don't count on being able to do any residency directly out of internship in the Air Force. I will defer to my Army and Navy colleagues to comment about the current state of their branches.
2) Once you match in a residency and are in your specialty, are you doing more medicine? Do you find it difficult to get experience? (for reference I would be interested in emergency medicine)
One of the general surgeons I worked with at Travis referred to the entire military residency system as undergoing "apoptosis". When the Air Force started shunting every retiree over age 65 into Medicare and cutting back on all services at MTFs in favor of punting active duty and retirees to TRICARE, he complained that his residents were unable to get enough experience to be proficient surgeons on graduation
vs. their civilian peers.
Since then, many military residencies have, as others pointed out, worked out MOUs with civilian trauma centers,
etc., to improve the case mix that their residents see. I personally did the required rotation at UT Galveston for comp-OB (which almost doesn't exist in the military, since most active duty and dependents know they are pregnant, for example, before term), as well as a extra experience at UT San Antonio.
Remind me to tell you my anecdote about "bald shrimp" at 0300 in the OR at Galveston...
Again, my remembrances are from 15 years ago, but it seems as though
the military is determined to cut out the number of
dependents and retirees you see going forward at MTFs during and after training (thus reducing your experience to the healthy, young, motivated cohort of active duty troops, which will not prepare you for civilian practice in any specialty when you bail out as a junior O-4 after being micromanaged by a CCRN* one last time).
*Clipboard-carrying Registered Nurse
3) I’m currently a firefighter-emt would be interested in pre-hospital-ish type medicine (I realize you wouldn’t be a medic though). Something like the SOST and SORT look really interesting. Is this something you can apply to do or is it more being in the right place at the right time?
Don't know about SOST or SORT. If you want to fill that role in the USAF, CCATT Air Evac physician may be the way to go. Of course, you will spend 80% of your time sitting around inventorying band-aids in the hangar, deconning your SMEED, or mopping the AEOT while your clinical skills rust like grandpa's rake left out in the rain, if the experience of my friend currently deployed with an AE team overseas holds true. While on Bravo call for up to seven days per week, you won't be able to drink alcohol, no matter how excellent the local libations may be. Of course, 20% of the time you may or may not be dealing with life-threatening illnesses and injuries at 30,000 feet with zero physician backup, green techs, nurses that outrank you, and antiquated equipment, so that may appeal to you.
May I point out that there is a
thread here on SDN by people with more GMO/FS experience than myself that may be of interest to you.
Hope the above helps.
