Residency and Beyond

This page was authored by a former Army physician who did not match into his dream specialty in the Army and chose to serve out his commitment as a GMO. He then matched into a civilian program after he separated from the Army. I appreciate his perspective and thought you might enjoy it! If you have any questions about the content of this page, you may ask me here or contact the author at "WernickeDO" via StudentDoctor.net.

A word from the author

This section is intended to give you a snapshot of what to expect when it comes time to apply to residency. My intention is to give you a blueprint to reference, as well as give some advice regarding transitional years and operational years. My experience is Army HPSP, so there will be some differences between the services, those that I am aware of and those that I am not. Like everything else on this website, please note that this is intended to be general information based on one person’s experience and is not intended to be the official policy of the military, and should not replace any military regulation or changes in policy. This post is my opinion only, and does not endorse or reflect Army policy. Because this is my experience, I will be speaking primarily about Army GME (graduate medical education).

Transitional year

So you didn’t match to a specialty. Bummer. Most likely you will have been placed in a transitional year (TY) internship. This is a traditional type of internship that was more commonplace back in the 1970’s. You will rotate through the major medical services, like IM, peds, OB/GYN, general surgery, and will have time for electives, too. You can apply to a specialty in the fall of your TY. A TY may be preferable to someone who is unsure of what they want to specialize in, but there are some caveats here. If, after your TY, you are not picked up for residency, then you are headed out for a general medical officer (GMO) tour.

GMO Tours

GMO tours are spent with an active duty unit, be it aviation, or infantry, or support. You will be responsible for ensuring the medical readiness of that unit, meaning keeping your guys ready to deploy. You are the medical officer of the unit, but make no mistake, this is not a medical job. Your time will be split between the clinic and doing paperwork. The clinic population that you have will be young and healthy, so >90% of what you will see is minor musculoskeletal injuries that are managed conservatively. If you enjoy primary care, then this might not be so bad, but if you like sick patients and procedures, you will not find them here. When the unit deploys, you deploy with them and will maintain the aid station. You may see some sick patients and battlefield injuries in the deployed setting, or you may not, depending on where you are and what you’re doing. In 2016 there are a limited amount of deployments available to combat zones, but this can change overnight, like it did on 9/11. An “unaccompanied” GMO tour is typically 1 year, and will be to a place like Egypt, Honduras, or Korea. You will not be able to take family with you on these tours, hence the “unaccompanied” qualifier. Assignments in the continental United States (CONUS) are typically 2 years. The Army instituted a new rule in 2013 that requires a doc to have at least 2 years in the same location before moving again, so if you do your TY at Walter Reed in DC and then get assigned to an aviation unit at Ft Hood in Texas, you are looking at a 2 year stay.

In the fall of your 2nd GMO year, you may reapply to go back to residency. This is where things get tricky. There are two separate pools of applicants for residency: MS4s and TY/GMO docs. The lion’s share of residency slots are reserved for MS4s, and there may or may not be slots available for TY/GMO applicants. That availability can vary from year to year, especially at sites where there is joint training with the Air Force. Let’s look at numbers that I have obtained either from the 2016 GME slide show or directly from people very high up in the food chain that are in the know about the selection process. The slide show does not report on the success rate of TY/GMO applicants, only MS4s. For emergency medicine, there were 40 MS4 applicants for 30 spots, which translates to a 75% success rate. Conversely, there were 28 TY/GMO applicants for 6 spots, which is closer to a 21% success rate. This bears mentioning because typically when pre-meds are recruited, they are told that doing a GMO tour will make them more competitive for a specialty when they reapply to it, which is not necessarily true. You can clearly see that TY/GMO applicants are at a disadvantage when compared to MS4s in certain specialties. Competitiveness varies from year to year, but traditionally the most competitive specialties in the Army are EM and surgical specialties. It is very important that you understand how this plays out because this will alter your medical career significantly. If you choose to not reapply, you can serve out your obligation of 4 years active duty time for HPSP and apply civilian. Former mil docs have success in the civilian match as long as they have used their time wisely. Docs who have used their GMO to stay active in the medical community, who have published, deployed, or otherwise made friends within the specialty tend to do well. If you put your feet up for 4 years and are overall an average type of applicant, then don’t expect Mass General to come recruit you because you were a military doc.

I could write and write about GMO tours but I would encourage you to visit the military medicine forum on StudentDoctor.net (SDN), which is really the best source for information on military medicine. If you are a pre-med reading this and you think that GMO tour doesn’t sound so bad, please understand that some people are very unhappy while they are on their GMO tour. This is because most docs want to complete residency and practice medicine, rather than treat scrapes and bruises, and spend a lot of time shuffling paperwork. Please take a look at my “Reasons to Join” post for more information on this. One piece of advice that I will offer is that you try to stay close to a program that you want to match to. For example, let’s say you really want to do orthopedics but did not match as a MS4. During your GMO, you can request to be stationed at a fort that has an ortho program at the hospital. You can make time to get over to the hospital for education day, try to be around the staff, and keep your hand within your medical interest. TY/GMO applicants who have had success on re-application almost always have close ties to the program that they are applying to. Please note that this may not always be possible to swing.

Beyond

So you have graduated from residency, now what? I will not comment too much on this subject because I, myself, have not yet experienced it. For more information on post-residency life, including Brigade Surgeon positions, Staff Hospital positions and Fellowships, please look to SDN for information from more experienced physicians.

Fellowships

This information comes from a presentation I received from the GME program manager during BOLC. You may find more information on this by searching SDN.

These may be performed at a number of military and civilian-sponsored locations. The opportunities vary year-to-year. Fellowships entail a 2-year on-station requirement and incur a minimum of 2 years additional payback time.

The way payback works is that if you have a 1 year fellowship, you owe 2 extra years. If you have a 2-year fellowship, you owe 2 extra years. 3 for 3, etc.

There is a whole long list of potential fellowships that exist for each specialty in the Army - this is actually one of the major selling points of the Army HPSP as opposed to the Navy or Air Force, which have significantly less. I would be more than happy to list them out on request, but like I said, their availability shifts year-to-year based on the needs of the Army.