So you want a civilian deferral

January 2016 Update: This page really talks about the Air Force process for requesting civilian deferral, as well as general considerations in applying for civilian deferral. Another post will be coming soon about the Army process.

 

So you’re a medical student on a military scholarship and you want to train in a civilian residency – you want to defer entry into active duty until after you finish your residency. The first step is to make sure you understand how the military match process works and what you need to do in order to be competitive in the military match. If you haven’t already read my article on the military match then I would strongly encourage you to read it now, because I am going to assume going forward that you know and understand everything that I talk about there, and we are going to focus just on the peculiarities of seeking a civilian training spot in the military match (and the civilian match).

 

The first question that I am often asked is “How hard is it to get a civilian deferral?” If you read the article on the military match then you already know that this largely depends on the number of civilian deferrals that are available in your specialty in the year in which you apply. For example, in the military match for the class of 2014, there were 3 civilian deferrals offered in OB/GYN in the Air Force. The following year, there were 9 civilian deferrals. This is the luck of the draw and there is really nothing you can do about it.

 

But how do you know how many spots there are? In the Air Force, a document called the HPERB comes out in June. I don’t actually know what that stands for – even in writing, I always see it described as just the HPERB. (If you know, leave it in the comments!) Anyway, the HPERB lists every spot that is approved and funded for the following academic year, in each specialty and location. As an example, you can see the 2014 HPERB here.

 

The more spots there are in your specialty, the better your chances. So look at last a few years’ worth of HPERBs and try to get a sense for how many spots there have been lately, bearing in mind that this may change by the time you apply. When the HPERB comes out in the year that you will apply, read it and read it carefully.

 

Things that are going to affect your chances of matching to a deferral in the military match, but that you have no control over:

  • Number of deferrals available for your year
  • Extenuating circumstances (yours or someone else’s). If someone else has a geographically-limited spouse and kids, for example, and you don’t, that could hurt your chances of getting the deferral.

 

Once you have that information, it’s time to develop your plan. Remember that if you rank civilian #1, you have to say why in your personal statement, which is already limited to one page, double spaced. So figure out how you can explain your reasons for wanting a civilian deferral in a sentence or two, so it doesn’t overwhelm the rest of your personal statement. The same thing will happen in your interviews, so be prepared.

 

Things you can do to boost your chances of matching to a civilian deferral in the military match:

  • Good USMLE scores
  • Do military away rotations and perform well
  • Be able to clearly articulate why you want a deferral

 

Now let’s fast-forward for a minute, and assume that you got the deferral that you wanted. Congratulations! Now what? Remember that you still have to match into a civilian program, and that isn’t as easy as you might think! As military students I think we tend to worry about the military match the most, but the civilian match is just as challenging! In fact, 2015 was an extremely challenging year for the civilian match (read more here).

 

While you were going on military away rotations to boost your odds of getting the deferral that you want, your civilian colleagues were doing away rotations at the programs that they want to match to. Now you are behind the curve. If you can find the time in your schedule, it is probably worth trying to do a civilian away rotation at a program that you would like to attend.

 

And here’s the real kicker, and something that they don’t advertise. A few weeks after I received my military match letter, I got my new contract from the Air Force. In this new contract, I had to agree that if I failed to match to a civilian program of the length and specialty that I was assigned, then I would scramble into a PGY-1 only program in general surgery, internal medicine, or transitional year. As I understand it, I would be bumped off the OB/GYN track onto the flight medicine track, essentially, and could end up delaying starting my residency for 5 years (1 year of PGY-1 only, 4 years of active duty commitment as a flight doc, then getting out and starting an OB/GYN residency after that). After all, if I failed to match in OB/GYN once, why should they take a chance on me again?

 

So, in other words, no pressure.

 

The last thing to think about is what to say about the military in your civilian interviews. Remember that the military match results come out in mid-December, and the civilian interview season is October-early January, so you will have to most of your civilian interviews before you have the results of the civilian match. It’s hard to stomach all of the money that you will spend to go on civilian interviews when you don’t even know if you are going through the civilian match, so be prepared! For me, the potential consequences of not matching were bad enough to motivate me to apply to over 50 programs in ERAS and attend 16 interviews (I was offered 4 more that I either declined or canceled).

 

There is a box on the ERAS application that you check to indicate that you have a military commitment after residency, so all of the program directors know. There is absolutely no point in hiding your status. How you approach this topic when it inevitably comes up has a lot to do with how you ranked civilian deferral compared to the other options. For example, in my interviews, I said something along the lines of

 

Yes, I am on an Air Force scholarship so I will owe them 4 years on active duty after residency. I have requested their permission to train in a civilian residency, but they may assign me to a military program or to a PGY-1 only. I will know the outcome of the military match in December, and I will be in touch as soon as I know definitively whether I will be seeking a position in the 2015 civilian match.

 

Of course, that is assuming that I get an interview…

 

Finally, there is some extra paperwork (the Air Force needs an official letter of acceptance from the program, for example), but it’s really no big deal and the coordinators will walk you through it.

 

So that’s it! Everything you need to know about matching into a civilian deferral in the military match. What do you still want to know? Please leave your questions and thoughts in the comments. For people who have been through the military match, what was it like for you?

 

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24 comments

  • Brian

    Have you heard of what happens if someone isn’t able to scramble into a medicine/trans/gen surg spot? Or better yet, are you allowed to scramble into your original specialty? The way I read what you posted above suggested you aren’t allowed to.

    Thanks!

    • admin

      So sorry for the late response! Residency has definitely been keeping me busy 🙂 The letter that I received from the Air Force when I was selected for a civilian deferral says “You must apply to the civilian match in [my specialty] for the dates specified above. If you do not secure a program in your specialty, you are deferred for one-year only in order to complete a clinically oriented year in an accredited civilian program of your choice in Transitional, Internal Medicine or General Surgery.” As I understand this statement, that means that you can SOAP into your chosen specialty or into a PGY-1 only spot in TY/IM/Gen Surg, but you cannot SOAP into a full residency in a backup specialty, or into a research PGY-1 program. Does that make sense?

  • Jessica

    When you say, “be able to clearly articulate why you want a deferral” – what are the logistics of this? Is there a place on the application? Or do you do this during your away rotation/interviews?

    Thanks!

    • Indy

      Thanks for your question! It may change, but as of the December 2014 match, the instructions for the JGSME (military match) application said that if you were ranking civilian as your #1 choice, you needed to explain why in your personal statement. Keep in mind that the military personal statement is very short (one page, double spaced), so you will want to find a way to explain your reasons for wanting to train civilian in as few words as possible – otherwise you won’t have enough room left to talk about anything else!

      It will also come up during your interviews. Some people may ask you which program you ranked first, and this is an opportunity to explain your reasoning. There’s no need to go into great detail here, either, just make sure the reasons you articulate are both true and unlikely to offend your interviewers. For example: “My spouse works for Disney and it would be really hard for him to find a job outside of California.”

      If you rank civilian as anything but #1, there is no requirement to explain anything about your rank list to anyone.

  • Jason

    Hey Indy,

    Do you know how the civilian deferral process works for the Army match? I’ve heard rumors that you can’t actually rank civilian deferral on your rank list. Instead, civilian deferrals are given out based on the Army’s need. Is there any truth to this?

    I really appreciate your help.

    • Indy (admin)

      Thanks for the comment! The information that I have on the Army civilian deferral process is a few years out of date (December 2012 match) but you’re right, it is a VERY different process (with very different odds of success) than in the Air Force. Give me a couple of weeks and I’ll get a post up about the Army’s civilian deferral process.

  • Katherine

    Hello, I had heard that with the civilian deferment, the military still paid for your residency, do you know if this is true, or is someone making things up? I also had heard that after the military match gave you a deferment, you were able to pre-match with a program, but perhaps this was a special case. I am Air Force thinking about civilian deferment due to my fiances civilian match placement. And another, slightly more crazy question, do you think spouse vs fiance looks different to the military, ie should we head to the courthouse before our wedding date so they take me seriously? Thank you for your very helpful blog post!

    • Indy (admin)

      Thanks for your comment! I think there has been some confusion about civilian programs floating around. The military has two ways of sending you out to do a civilian residency. One is deferment. Deferment means that you defer entering active duty until after you finish residency. As a civilian deferred resident, you are paid by your civilian program as a regular civilian resident. You are an inactive reservist, and have no military commitments (or pay, or benefits) until you graduate. You accrue no additional active duty service commitment for training in this status, so you just owe whatever years you would owe already for med school.

      The other option is civilian sponsorship, which means you are on active duty in the Air Force and they “sponsor” your participation in a civilian program. You get full active duty pay and benefits, and you aren’t paid by your civilian program. You have no military commitments, but you get military pay. In exchange, you owe one additional year on active duty for each year of civilian sponsored training. So if you take a 4-year scholarship and you do a 3-year sponsored residency, you owe 7 years of active duty time after residency.

      Spots are listed in the HPERB as either civilian sponsored or civilian deferred. Sponsored is rare for residency, and common for fellowships, as of last year’s HPERB.

      I’m not sure what you mean by pre-matching. If you match to civilian in the military match, you need to go through the NRMP match to match to a civilian program. It’s possible that a program might promise to give someone a spot in the match, but that’s non-binding and technically violates the rules of the match.

      In terms of fiance vs spouse, the Air Force as a whole tends to take the approach that it doesn’t count for anything until it’s legal. Whether that holds true for the military match I can’t really say – it seems to depend on who is sitting on the board this year and how they feel about it. As best I can tell, there is no objective system for deciding who gets a deferral – it just depends on the judgment of the folks on the selection board. I tend to lean towards making it legal for the simple reason that, if I were in your shoes, if we didn’t do that and I didn’t match where I wanted, I would be kicking myself for the next 4 years, regardless of whether it actually made any difference in the decision. It’s also worth considering if your soon to be spouse is going to be part of any extenuating circumstances. For example, are you trying to match to a location where there will be lots of civilian programs for your spouse to match to? Or are you trying to defer so you can couples match?

      Good luck!

      Indy

  • Sion Kim

    Hi, your website has been so helpful in teaching me many different things.
    I wanted to ask you a few questions:
    1. If I don’t want civ. deferred, can I not rank it and not apply via ERAS?
    2.If I am actually interested in flight surgery, can I rank it after my first choice of specialty?

    • Indy (admin)

      What is your branch of service?

      • Sion Kim

        I’m Air Force.

      • Indy (admin)

        Sorry for the delay! To answer your questions,

        1. You are required to apply through ERAS. Even if you don’t rank civilian deferred, you may still be selected by the board for a deferred position. You need to apply both for PGY-1 programs and for programs in the specialty that you rank.

        2. You can rank RAM (residency in aerospace medicine), which is a 3-year program meant to lead to a career in flight surgery. You can also choose to rank just PGY-1, and the typical path is that if you match to a PGY-1 only, you will go into a non-residency-trained flight surgery billet after your internship unless you apply to, and match into, a complete residency after your PGY-1.

        When you say you are interested in flight surgery, are you talking about a 2-3 year assignment after a PGY-1, or are you talking about doing a residency in aerospace medicine and making flight medicine a career?

        Keep in mind that in the JSGME match, you match to a specialty first, and then to a program within that specialty. In other words, you can’t rank, say, internal medicine active duty, then PGY-1 only, then internal medicine civilian deferred.

        Does that answer your questions?

      • Sion Kim

        Ah I see.
        That does explain a lot!
        For question number 2, I wanted non-RAM route. Like PGY-1 and then flight surgery.
        So technically only this can be done:
        IM active duty
        IM Civ def
        and only if I don’t match IM
        will I be considered PGY-1?

      • Indy (admin)

        Sorry for the late response. I have been digging into this, trying to get the best possible answer to your questions.

        From my reading of the JSGME instructions, they don’t specifically address the question of people who want to do a PGY-1 only and then do a flight surgery tour. They basically act as if doing PGY-1 and then flight surgery is a fallback plan in all of their paperwork. I would hope there is a way to ask for a PGY-1 only, but they don’t really say how to do that in the application instructions that I have. I would suggest contacting the Physician Education GME Program Managers. The latest phone number I’ve seen for their office is 210-565-2638, email afpc.dpame@us.af.mil. I’m really sorry that I don’t have a more satisfying answer for you!

        If you don’t want to do an internal medicine residency I would caution you against applying for one, because it is not a competitive specialty in the Air Force, and odds are excellent that you would match and be stuck doing a residency that you don’t want.

        Please let me know what you hear from the Program Managers, and if you don’t get an answer, let me know and I will keep digging!

  • Sion Kim

    No, please thanks for all your help!
    I should be actively looking into it as well.
    I do love IM and I definitely want to get into it but I really wanted the experience for flight surgeon as well for traveling. So I’m kinda torn, but hopefully either way will work out for me.

  • Bentley Michael

    I’ve heard about there being a second choice form in the military application, but is that something that exists? And if it does, how does it work?

    • Indy (admin)

      There is a second choice form on the JSGME (military match) application. I’ll address that in more detail in an upcoming post. Thanks for your question!

  • Mary

    Thanks for this article! I’m a 3rd year med student (Army HPSP) and wondering if you’ve had a chance to look into the civilian deferment for the Army side of things – I’ve tried searching for a while about this and haven’t found anything recent or conclusive. Any help you could provide would be great!

  • Indy (admin)

    On the lighter side, Gomerblog recently had this to say on the subject: http://gomerblog.com/2016/10/medical-student-essays-trying-get-military-service/

  • What I cannot live with is being qualified to do a specialty that I want in the civilian world and having the military not giving me a deferment for it or letting me do it with them.

    • Indy (admin)

      That is absolutely a frustrating position to be in, and it is part of what you agree to if you take Uncle Sam’s money for medical school.

  • Cathy

    Can you give any insight on civilian sponsored residency?

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