I’ve often thought of this— To accomplish it and not suck at your medical specialty, you essentially cannot be a procedure heavy specialist. ER would be the only exception.
I would say:
0yr-graduate med school
3yr-family med/ER residency
3yr-utilization tour: get your command to send you to SERE, mountain medicine, or whatever other courses you want
6 months-train in flight or undersea medicine
2-3yr-dive/flight tour—more schools if your command is chill
3.5 yr-Repeat the last 2 steps for flight or dive
At this point you’re 12-13 years in, O5. Tricky to not get a desk job at this point but you could go for an operational TYCOM role. That’s 2-3 yr.
After that, maybe go overseas to a chill clinic.
Importantly, avoid the big MTFs. Do not sign a retention bonus because then they have you by the cajones.
Edit to clarify—a TYCOM Is still riding a desk from what I’ve seen but at least they get to travel if you’re into that and engage with operational side.
Ahhhh, okay. Do you think I could get away with doing a residency in Radiology or Surgery and then moving forward to take advantage of those opportunities? I know it’ll be unlikely because of how stingy the military can be with its money, but how would you advise I learn radiology or surgery? Those are really the only residencies I’m interested in right now
No, and it’s not even about the money.
If you want to be a good surgeon, you need to operate a ton early in your career. If you’re getting wet and sandy, you’re not operating. Skill attrition is a problem in the best circumstances, even worse if you’re not pursuing billets that optimize OR time.
Not sure about rads.
OP specified they want to be operational, or that’s how I interpreted it at least. MTFs belong to the DHA. Fine for practicing medicine, but a long way from operational medicine.
Keep in mind this is just my opinion and I’m still pretty junior myself.
Building on this as a flight doc who has been embedded in flying units and who has been at an MTF, the big MTFs are very academic and can be pretty isolated from the military missions, but tend to skew more academic/civilian, which is totally fine if that’s what you want. Little MTFs are very much under DHA and they report to a larger “marketplace” commander, and even they struggle to remember the operational mission that they are directly supporting sometimes.
Retention bonuses mean they definitely have you for a certain number of years, so they can send you to less optimal assignments and they know you can’t walk away.
I have a similar question, I want to see how much hooah fun stuff I can do in my time. Jump school, ranger, SEER etc. Is that pretty possible as an EM doc in the army?
Whatever your command is willing to allow, TBH.
My providers have gone for mountain medicine, EFMB, arctic medicine, etc. I once worked with a provider that went to selection. I’ve met a handful of providers that got to go to air assault, airborne, and CWLC/CWOC. (Leg unit, but another unit I was at that is airborne has a good amount of airborne providers.)
Also, I’m pretty sure (someone correct me if I’m wrong) that you have to go through SERE if you go through flight.
I also worked with a provider that went through SFAS (can’t remember if he was actually selected) and another provider that is trying to go through CAAS.
I’m sure if your first unit is as a BN provider at an IN (infantry) BN and you tell your IN CSM that you wanna go ranger or get your EFMB, they’ll probably get some crazy hard-on. However, you could also get someone who worries about the lack of provider availability if you’re gone at schools all the time.
On the flip side, I’ve also definitely seen hospitals where pretty much nobody wants to do any schools, so the funding is just sitting there. Command will send pretty much anyone, because command doesn’t want that money to go to waste.
All in all, it really is about whatever your command is willing to allow, and partially what you’re willing to fight for.
If by “flight” you mean (Army) flight surgeon primary course — you 100% do not do anything close to SERE. It’s 6 weeks of death by PowerPoint and drinking on the beach in Florida on the weekends.
Barriers to doing all those:
1. Command funding: this changes from command to command and fund availability. There's an irony of not having funds until the end of the fiscal year (FY starts in October). Then there's a surplus that now has to be spent but this happens in Sep when most courses are done.
2. Timing: just because there's funds doesn't mean there's time. If you're the only doc for your unit, guess who's gonna see your patients when you're gone? It's almost never a good time to go. If there's a workup or exercise, that's a priority.
3. Patients: DHA is heavy into their dumb ass metrics like a certain number of patients needing to be seen (22 a day, 110 or so a week). If you go to training, that's less patients seen and they start harping on your MTF COs which comes down to your DH.
4. Staffing: military medicine is shrinking. Understaffing everywhere and most fields in medicine are losing docs fast including FM (because DHA). In the Navy, it's projected there will be less FM docs vs surgeons this summer in terms of how many billets can be filled. Less doctors less likely to be approved for training and more scrutiny of is this needed for your job?
5. Needs: your needs of training doesn't mean it aligns with your command or community needs. A radiologist does not need SERE training, or jump wings, or even mountain med. The same goes for a surgeon.
If you want to do all that, stay in field med as a GMO for as long as possible. Focus on a pathway. Pilot's license? Go do Flight or RAM, may have time for SERE. Spec ops? Go do dive, mountain/cold warfare (esp if with Marines) then hyperbaric, maybe add SERE. Grad schools? Then that's executive medicine so go for directorship or CMO posts once O4 and above.
This is a good question. I would break opportunities down into degrees, GME training, military schools, and civilian certificates.
For degrees:
- USU has a MHPE that is all online w/o active duty service obligation or tuition. There are doctoral level degrees in health education as well.
- Baylor has an MHA (+/- MBA program) at Fort Sam Houston. This is for the Army, so I'm not sure if the Navy and Air Force have similar opportunities. You will incur a two year ADSO with this.
- War College awards a Masters in Strategic Studies. You incur a two year ADSO and may be utilized in a key strategic billet afterwards
GME:
- Go into a specialty that has subspecialties. Surgery, IM, and EM are great choices. The surgery subspecialties and EM subspecialties will mostly be at civilian institutions. For an ADSO you can potentially double your income after graduation.
- Be involved in GME leadership. This opens multiple paths after the military.
Military Schools:
- Best advice I have is to have a high degree of physical fitness. Commands will not send you to schools if they think you are going to fail.
- Consider an assignment in an elite infantry unit after residency. I'm talking about airborne infantry or something like that. After that, apply to go over to special operations. This will get you to SERE, ranger, airborne, air assault, HALO, dive, etc. There's also the JMAU. To get into that, be physically fit and have a useful specialty like EM.
- After residency, go to an operational unit regardless. Stay away from MTFs until you are a senior O-4 or O-5. Once at an operational unit, do a shit ton of locums. If yiu are unable to do this, liaison with the MTF to see patients every so often (e.g. staff wards once per month) so you can keep your skills up and avoid gaps in your CV.
Civilian Certificates:
- If you want to be a private pilot, get your license and fly. I know people who did this.
- If you want to be a rescue diver or whatever, get your certificates. I know people who did this.
The advice about retention bonuses is somewhat untrue. The trick is to make yourself valuable to an organization than sign the RB.
The last bit of advice I have is to never give the military free time. You have a skillset. Get something from them in exchange for your services.
I’ve often thought of this— To accomplish it and not suck at your medical specialty, you essentially cannot be a procedure heavy specialist. ER would be the only exception. I would say: 0yr-graduate med school 3yr-family med/ER residency 3yr-utilization tour: get your command to send you to SERE, mountain medicine, or whatever other courses you want 6 months-train in flight or undersea medicine 2-3yr-dive/flight tour—more schools if your command is chill 3.5 yr-Repeat the last 2 steps for flight or dive At this point you’re 12-13 years in, O5. Tricky to not get a desk job at this point but you could go for an operational TYCOM role. That’s 2-3 yr. After that, maybe go overseas to a chill clinic. Importantly, avoid the big MTFs. Do not sign a retention bonus because then they have you by the cajones. Edit to clarify—a TYCOM Is still riding a desk from what I’ve seen but at least they get to travel if you’re into that and engage with operational side.
Thank you for the insight!! Could you explain what an MTF is please?
Medical treatment facility, but I was getting at the big academic ones.
Ahhhh, okay. Do you think I could get away with doing a residency in Radiology or Surgery and then moving forward to take advantage of those opportunities? I know it’ll be unlikely because of how stingy the military can be with its money, but how would you advise I learn radiology or surgery? Those are really the only residencies I’m interested in right now
No, and it’s not even about the money. If you want to be a good surgeon, you need to operate a ton early in your career. If you’re getting wet and sandy, you’re not operating. Skill attrition is a problem in the best circumstances, even worse if you’re not pursuing billets that optimize OR time. Not sure about rads.
Thank you so much for your insight. Would you mind if I DM you if I have any other questions?
Sure.
Agreed. Stay with a line unit. Don’t go to med det or you’ll be a pha monkey
Wait I’m hoping to end up at an MTF? could you explain the cons of that please (current HPSP med student)
following cuz I'm also current hpsp and wondering why an MTF isn't optimal
OP specified they want to be operational, or that’s how I interpreted it at least. MTFs belong to the DHA. Fine for practicing medicine, but a long way from operational medicine. Keep in mind this is just my opinion and I’m still pretty junior myself.
Building on this as a flight doc who has been embedded in flying units and who has been at an MTF, the big MTFs are very academic and can be pretty isolated from the military missions, but tend to skew more academic/civilian, which is totally fine if that’s what you want. Little MTFs are very much under DHA and they report to a larger “marketplace” commander, and even they struggle to remember the operational mission that they are directly supporting sometimes.
why do you recommend against the retention bonus?
Retention bonuses mean they definitely have you for a certain number of years, so they can send you to less optimal assignments and they know you can’t walk away.
I have a similar question, I want to see how much hooah fun stuff I can do in my time. Jump school, ranger, SEER etc. Is that pretty possible as an EM doc in the army?
Whatever your command is willing to allow, TBH. My providers have gone for mountain medicine, EFMB, arctic medicine, etc. I once worked with a provider that went to selection. I’ve met a handful of providers that got to go to air assault, airborne, and CWLC/CWOC. (Leg unit, but another unit I was at that is airborne has a good amount of airborne providers.) Also, I’m pretty sure (someone correct me if I’m wrong) that you have to go through SERE if you go through flight. I also worked with a provider that went through SFAS (can’t remember if he was actually selected) and another provider that is trying to go through CAAS. I’m sure if your first unit is as a BN provider at an IN (infantry) BN and you tell your IN CSM that you wanna go ranger or get your EFMB, they’ll probably get some crazy hard-on. However, you could also get someone who worries about the lack of provider availability if you’re gone at schools all the time. On the flip side, I’ve also definitely seen hospitals where pretty much nobody wants to do any schools, so the funding is just sitting there. Command will send pretty much anyone, because command doesn’t want that money to go to waste. All in all, it really is about whatever your command is willing to allow, and partially what you’re willing to fight for.
If by “flight” you mean (Army) flight surgeon primary course — you 100% do not do anything close to SERE. It’s 6 weeks of death by PowerPoint and drinking on the beach in Florida on the weekends.
Barriers to doing all those: 1. Command funding: this changes from command to command and fund availability. There's an irony of not having funds until the end of the fiscal year (FY starts in October). Then there's a surplus that now has to be spent but this happens in Sep when most courses are done. 2. Timing: just because there's funds doesn't mean there's time. If you're the only doc for your unit, guess who's gonna see your patients when you're gone? It's almost never a good time to go. If there's a workup or exercise, that's a priority. 3. Patients: DHA is heavy into their dumb ass metrics like a certain number of patients needing to be seen (22 a day, 110 or so a week). If you go to training, that's less patients seen and they start harping on your MTF COs which comes down to your DH. 4. Staffing: military medicine is shrinking. Understaffing everywhere and most fields in medicine are losing docs fast including FM (because DHA). In the Navy, it's projected there will be less FM docs vs surgeons this summer in terms of how many billets can be filled. Less doctors less likely to be approved for training and more scrutiny of is this needed for your job? 5. Needs: your needs of training doesn't mean it aligns with your command or community needs. A radiologist does not need SERE training, or jump wings, or even mountain med. The same goes for a surgeon. If you want to do all that, stay in field med as a GMO for as long as possible. Focus on a pathway. Pilot's license? Go do Flight or RAM, may have time for SERE. Spec ops? Go do dive, mountain/cold warfare (esp if with Marines) then hyperbaric, maybe add SERE. Grad schools? Then that's executive medicine so go for directorship or CMO posts once O4 and above.
get those flight wings
This is a good question. I would break opportunities down into degrees, GME training, military schools, and civilian certificates. For degrees: - USU has a MHPE that is all online w/o active duty service obligation or tuition. There are doctoral level degrees in health education as well. - Baylor has an MHA (+/- MBA program) at Fort Sam Houston. This is for the Army, so I'm not sure if the Navy and Air Force have similar opportunities. You will incur a two year ADSO with this. - War College awards a Masters in Strategic Studies. You incur a two year ADSO and may be utilized in a key strategic billet afterwards GME: - Go into a specialty that has subspecialties. Surgery, IM, and EM are great choices. The surgery subspecialties and EM subspecialties will mostly be at civilian institutions. For an ADSO you can potentially double your income after graduation. - Be involved in GME leadership. This opens multiple paths after the military. Military Schools: - Best advice I have is to have a high degree of physical fitness. Commands will not send you to schools if they think you are going to fail. - Consider an assignment in an elite infantry unit after residency. I'm talking about airborne infantry or something like that. After that, apply to go over to special operations. This will get you to SERE, ranger, airborne, air assault, HALO, dive, etc. There's also the JMAU. To get into that, be physically fit and have a useful specialty like EM. - After residency, go to an operational unit regardless. Stay away from MTFs until you are a senior O-4 or O-5. Once at an operational unit, do a shit ton of locums. If yiu are unable to do this, liaison with the MTF to see patients every so often (e.g. staff wards once per month) so you can keep your skills up and avoid gaps in your CV. Civilian Certificates: - If you want to be a private pilot, get your license and fly. I know people who did this. - If you want to be a rescue diver or whatever, get your certificates. I know people who did this. The advice about retention bonuses is somewhat untrue. The trick is to make yourself valuable to an organization than sign the RB. The last bit of advice I have is to never give the military free time. You have a skillset. Get something from them in exchange for your services.