Residency Application State Of Maryland Specials: Fill & Download for Free

Without knowing which state it is that you live in it's hard to say the specific reason, but the general reason would be that there are many states that have severe restrictions on the interstate transfer of alcohol. Some states don't allow it at all, unless you're a distributor, others require that you have an in-state license to ship items into the state, and others have various other regulations.Best bet is to check out your state legislature or liquor control board's site to find out what the legal requirements are to have beer or wine shipped in-state.Here's some information I was able to find, by state:Alaska (http://www.dps.state.ak.us/abc/trade.aspx)Alaska does not limit or tax alcoholic beverages brought into this state for personal use and not for resale. Out-of-state suppliers may ship alcoholic beverages to Alaska residents but may not make an offer for sale of alcoholic beverages with-in the state of Alaska. This statutory prohibition extends to print and electronic media intended to be viewed by Alaska residents as well as direct solicitation. This prohibition does not extend to information on web-sites located on ISP servers outside of Alaska. Over 75 Alaska communities have by local option banned the importation or possession of alcoholic beverages. It may be a felony crime to ship alcoholic beverages to those communities. A list of those communities can be found on the Damp/Dry Communities pages of this web site.Arkansas (http://www.dfa.arkansas.gov/offices/abc/rules/Pages/title2SubtitleC.aspx) - closest I could find:Any person holding a permit to sell controlled beverages at wholesaleunder any alcoholic beverage control law of the State of Arkansas shallsell such beverages only to a person holding a permit to sell suchbeverages at retail.Delaware (http://regulations.delaware.gov/AdminCode/title4/regulations-10.shtml)A licensed Delaware importer shall not import alcoholic liquor into theState of Delaware unless said alcoholic liquor is delivered directlyfrom a Delaware licensed supplier by either the supplier, the importer,or common carrier to a licensed Delaware warehouse or warehouses.Hawaii (http://www.co.hawaii.hi.us/liquor/rules.pdf)Any unlicensed adult person desiring a permit to allow the importation of liquor from outside the State pursuant to Chapter 281-33.1, Hawai'i Revised Statutes, shall file an application which shall include an inventory of the liquor to be imported.A fee shall be submitted to the department by the applicant with the application as prescribed in Rule 3-3. This section shall not apply to residents of the state who participate in direct shipments of wine pursuant to state law.residents of the state who participate in direct shipments of wine pursuant to state law.Kansas (http://www.ksrevenue.org/pdf/abckararticle5.pdf)Alcoholic liquor (except beer) transported into state or federal area only by bonded carriers. (a) All alcoholic liquor, except beer, shipped into the state of Kansas shall be transported only by common, contract or private carriers that hold liquor carrier permits issued by the director.Kentucky (http://www.lrc.state.ky.us/KRS/244-00/165.PDF)(1) Except as provided in subsection (2) of this section, it shall be unlawful for any person in the business of selling alcoholic beverages in another state or country to ship or cause to be shipped any alcoholic beverage directly to any Kentucky resident who does not hold a valid wholesaler or distributor license issued by the Commonwealth of Kentucky.(2) A small farm winery located in another state may ship wine to a customer in Kentucky if:(a) The wine is purchased by the customer in person at the winery;(b) The wine is shipped by licensed common carrier; and(c) The amount of wine shipped is limited to two (2) cases per customer per visit.Maine (http://www.maine.gov/dafs/bablo/alcohol_bev/index.shtml)Maine is one of 19 states that regulates beverage alcohol within itsborders. By controlling this product, the State is the only entity thatmay bring liquor into the state.Maryland (http://compnet.comp.state.md.us/Motor_Fuel__Alcohol_and_Tobacco_Tax/Alcohol_and_Tobacco_Tax/Consumer_FAQs_about_Alcoholic_Beverages.shtml)While I'm traveling on vacation, how much alcohol can I have shipped back to me?None, except nationally sold wine whereby you must make arrangements to ship the wine to you through a Maryland wholesaler, using a Direct Wine Sellers Permit. Internationally, no alcohol may be shipped back to you, including wine. See Article 2B, Section 16-506 and Section 7.5-104.Massachusetts (http://www.mass.gov/abcc/faqs.htm)Can an out-of-state supplier/manufacturer (a Certificate of Compliance holder) sell directly to a retailer?No. An out-of-state supplier/manufacturer (a Certificate of Compliance holder) can only sell his or her alcoholic beverages to a wholesaler.Michigan (http://www.michigan.gov/documents/dleg/FAQs_Illegal_Importation_224505_7.pdf)What is the legal allowance for alcohol products being brought into Michigan?State liquor laws require persons who wish to bring any type of alcoholic beverage into Michigan for personal consumption to obtain prior written approval of the Commission with the following exceptions:- A person of legal age who has been outside the U.S. territorial limits for at least 48 hours and has not brought alcoholic liquor into Michigan during the past 30 days, may bring up to one liter into Michigan without prior approval.- A person of legal age may bring up to 312 ounces of alcoholic liquor that contains less than 21% alcohol by volume (about 24 –12 ounce containers of beer or 12 – 750ml containers of wine) from another state without prior approval.Mississippi (http://www.dor.ms.gov/info/faqs/TobaccoBeerandAlcohol.html#w)Can I order wine over the internet to be delivered to my home?No. It is illegal to bring wine into Mississippi and such products will be considered contraband.Note: I'm presuming beer falls into the same category, but wasn't called out specifically in the FAQ.Montana (http://data.opi.mt.gov/bills/mca/16/3/16-3-213.htm)16-3-213. Brewers or beer importers not to retail beer -- small brewery exceptions.(1) Except as provided for small breweries in subsection (2), it is unlawful for any brewer or breweries or beer importer to have or own any permit to sell or retail beer at any place or premises. It is the intention of this section to prohibit brewers and beer importers from engaging in the retail sale of beer. This section does not prohibit breweries from selling and delivering beer manufactured by them, in original packages, at either wholesale or retail.(2) (a) For the purposes of this section, a "small brewery" is a brewery that has an annual nationwide production of not less than 100 barrels or more than 10,000 barrels.(b) A small brewery may, at one location for each brewery license, provide samples of beer that were brewed and fermented on the premises in a sample room located on the licensed premises. The samples may be provided with or without charge between the hours of 10 a.m. and 8 p.m. No more than 48 ounces of malt beverage may be sold or given to each individual customer during a business day.New Hampshire (http://www.nh.gov/liquor/direct_ship.shtml)The New Hampshire State Liquor Commission permits spirits, wine and beer to be shipped into New Hampshire so long as the direct shipper has obtained a permit from the Commission. The permit allows out of state companies to ship alcoholic beverages to citizens as well as Liquor Commission licensees.Oklahoma (http://www.ok.gov/able/documents/T37.pdf)37-505.C.1. Except as otherwise authorized by law, it is unlawful for any manufacturer, wholesaler or retailer of alcoholic beverages, located and doing business from outside this state, to make retail sales of alcoholic beverages to purchasers located in this state or to ship alcoholic beverages sold at retail to persons located in this state.Pennsylvania (http://www.portal.state.pa.us/portal/server.pt/community/direct_shipping/17491)Under the law, only wines that are not available in Pennsylvania may be purchased from a licensed Direct Wine Shipper via the Internet. The PLCB offers approximately 25,000 different wines through its Regular, Specialty, and Special Liquor Order (SLO) merchandise. Before going to a Direct Wine Shipper to order, please check our catalog using the Product Search first.Note: There is no mention of beer in this FAQ; I'm presuming lack of mention in direct shipping means it's not permitted at all.Rhode Island (http://www.dbr.state.ri.us/documents/divisions/commlicensing/liquor/Commercial_Licensing_Regulation_8.pdf)Rule 19(b)(1): All alcoholic beverages brought into the State of Rhode Islandfor resale shall be consigned and delivered to a licensed Rhode Islandwholesaler.South Dakota (http://www.state.sd.us/drr2/propspectax/alcohol/licenses/misc.htm)State law prohibits on/off-sale licensees from making any delivery of alcoholic beverages outside of the premises described in the alcohol license.Tennessee (http://www.state.tn.us/abc/llicensing%20-%20lead%20page.shtml)Non-resident sellers license is for wineries or distillers/manufactures inside or outside of Tennessee borders, shipping alcoholic products to Tennessee wholesalers.Note: As another three-tier state, TN requires that manufacturers sell only to wholesalers, who in turn sell through distributors.Texas (http://www.tabc.state.tx.us/poe/buying_alcohol_from_out_of_state.asp)It is not legal for a person in Texas to order/purchase malt beverages or distilled spirits from an individual or entity outside of Texas and have it shipped into Texas.Utah (http://abc.utah.gov/laws/law_faqs.html)May I bring alcoholic beverages into Utah?No. Under Utah law "alcoholic beverages" include all hard liquor, spirits, wine and beer. Beer and other malt beverage products that exceed 3.2% alcohol by weight or 4.0% by volume are considered "liquor", and beer with an alcohol content of 3.2% or less is defined as "beer".Washington State (http://liq.wa.gov/licensing/direct-shipping-laws)There is no limit on the amount of wine that can be shipped to a Washington consumer. Beer cannot be shipped to consumers.West Virginia (http://www.legis.state.wv.us/WVCODE/ChapterEntire.cfm?chap=60&art=6&section=13#06)§60-6-13. Restrictions on importing into, and transporting liquors in state.Except as permitted by section six of this article and article eight of this chapter, a person shall not import into, or transport in this state, any alcoholic liquors, unless it is:(1) Consigned to the commission;(2) Transported upon the direction of the commission directly to persons licensed to receive alcoholic liquors at wholesale; or(3) Transported into the state or through the state to persons outside the state upon transportation permits issued by the commissioner.Note: The above is intended for educational purposes only, and is not intended as legal advice. Please contact a lawyer licensed in your state and experienced with your area of interest to obtain legal counsel.

Your question needs clarification. I will answer: How hard is it to get accepted into an allopathic American medical school?Objectively, it’s very hard. All you need to do is conduct a cursory glance at U.S. News statistics to see the low admissions rates.A better resource as an applicant, however, is the med school registry put out by the AAMC. It can help you decide where to apply.My advice for any applicant is to apply to all of their in-state medical schools, both public and private. From there, add a select group of out-of-state institutions you like and at which you have a reasonable chance of at least making the interview stage, which is heavily decided by your GPA and MCAT score. Throw in a few “reach” or “dream” schools as well.You may get some respondents who write that they applied to only one school, got in, and matriculated. That’s an incredibly foolish approach that can put you in a very demoralizing position of having to reapply and then answer “why didn’t you apply to more schools?” when you finally get interviews.My advice to even the 4.0 GPA, 40 MCAT Harvard kid with research publications and a great personality is to apply broadly and to apply to as many schools as you can afford!Read on for my personal vignette:I applied many times. This includes having tried direct admission through high school at programs such as Michigan’s now-defunct Inteflex Program. I recall interviewing at Boston University at age 15 and not being able to articulate what “residency” was. Needless to say I didn’t get in.As a Princeton sophomore, I applied and interviewed for Mount Sinai’s Humanities in Medicine program and got to the finalist stage. The main concern was that I hedged by bets by enrolling in a full premed science courseload, which did not seem fully committed to a humanities track (which for me would have been music). Again, didn’t get in.After that, despite an ‘ok’ MCAT score of 3.0, I pretty much threw in the towel, became an economics major, did poorly (final 2.9 GPA), and opted to go to law school instead, where I similarly had a lackluster 3 years.Living through 9/11 and its aftermath inspired me to go back to medicine and not have any career regrets. Finished law school and passed the New York Bar, enrolled in a master’s program at NYU and pulled a 3.8, and retook the MCAT where I (again) got a 30. I applied to 20 schools, obtained interviews at Vanderbilt (where my brother graduated) and SUNY Upstate (where my father teaches visiting medical students to his surgery practice). I was waitlisted at Vandy and rejected at Upstate.By then I was really about to give up again and try for a different career altogether. I had a phone interview with a CIA recruiter for an Operations Officer position, passed the first few hoops of the FBI Special Agent process, and seriously considered taking the patent bar. My best friend at Harvard Med, however, convinced me to work at his former lab, which was the best thing I could have done.In my two years in biomedical research, I got my name on 5 peer-reviewed publications, which helped me later as a plastic surgery residency applicant. I took the MCAT - yes, a 3rd time - and with help from a Princeton Review course pulled a 39. I met my wife along the way, which probably would never have happened had I gone down a more conventional path.On reapplication, I applied to 50 (FIFTY) schools, interviewed at 12, and was admitted to 3 (THREE) - Rochester, EVMS (in Virginia), and USUHS (the military’s school in Maryland).So to answer your question most directly, it’s really effin’ hard!!!However, your question doesn’t differentiate among American, Carribbean, and other foreign schools (like those in Ireland and Israel). You don’t specify between allopathic (MD) and osteopathic (DO) tracks.If you have a great GPA, great MCAT score, evidence of sustained research, evidence of teaching, evidence of leadership, evidence of voluntarism, and you’re not a complete psychopath, then no, it’s not hard to get into more than one medical school.More importantly, ask yourself what kind of drive and determination you have. How do you respond to adversity? If I were interviewing you for medical school, these would be the personal traits I’d want to see…While there’s a famous adage that says “the hardest thing about medical school is getting in,” you have a massive journey ahead of you including residency, fellowship, and board certification. In retrospect, getting into medical school has become less and less impressive to me!Good luck…

Q. I want to be a doctor. Should I do ROTC in undergrad or med school?If i do ROTC as an undergrad, I would have to do service for 3 years before entering med school. If I do ROTC in med school, then I can finish school before I’m 30 and even work for the military as a doctor. But I don’t know if I will get into med school because it’s still far away. What is wiser?A. If you want to be in the military, doctor or not, then do college ROTC or get into a military academy. If you want the military to pay for your medical education, then apply for the scholarship once accepted or apply to the Uniformed Services Medical School. Do not prolong your military commitment beyond required. This makes most financial sense.ROTC undergrad and/or medical schoolHealth Professions Scholarship Program (HPSP) and Uniformed Services University of the Health Sciences (USUHS)Military Match, Residency and CareerUnofficial ExplanationHow the Military Match works as of 2014MILITARY VS CIVILIAN RESIDENCY FOR HPSP STUDENTSSo You Want a Civilian DeferralFighting For Life - Uplifting Documentary about USUHSI was in the Army Medical Corps Reserve for eight years. (Became naturalized during medical school, wanted to serve but not active duty). Did not have much loan from college or medical school.Do read Michael O'Brien’s terrific post about the four different paths.Colleges have ROTC programs that you can enroll as freshman and sophomore. You do not commit until your junior year, when you get commissioned, undergo Officer Training and get a scholarship.The challenge is getting into medical school. Do you want to go into the military if you fail? The Uniformed Service Military Medical School is a great option, but admission is competitive. Once in the Health Professions Scholarship Program (HPSP) or Uniformed Services University of the Health Sciences (USUHS), you will have to apply for the military match when you graduate. The military (esp. Navy) needs General Medical Officers, who get only one year of residency training. It is competitive to gain a coveted military specialty residency position. If you did not match in the military match, you must get permission to enter the civilian match. Time in a civilian residency program (Individual Ready Reserve) counts toward your promotion, service longevity and retirement, but not your service commitment. So your career options may be limited.You need to explore whether a military medical career is right for you. While the salary is lower, you do get to retire at a relatively young age (20 years of service) with pension and benefits. We regularly have military physicians moonlight in our department. They enjoy the lifestyle and public service, they do mind the bureaucracy, even coming from high ranking officers and medical chiefs of staff. (Talk to a recruiter, get a mentor).Medicine + The MilitaryRESIDENCY + MATCH DAYHealth Professions Scholarship Program (HPSP) and Uniformed Services University of the Health Sciences (USUHS) students have the same chances of getting their residency of choice as civilian students, and the Military will never dictate which specialty you choose. In general, the more competitive you are as a student, and the more programs you apply to, the better your chances of matching. The availability of residency slots, however, depends on the Military's need at that particular time and how competitive the residency is overall.Students who do not receive their first specialty choice may elect to take a transitional year internship and reapply for their first specialty choice in the following years. Unlike students in the civilian match, HPSP and USUHS students will receive internship training.If you have a specialty in mind and are wondering about the chances of getting the residency of your choice, contact a recruiter.ROTATIONSDuring your rotations, you will need to start thinking about where you would like to do your residency. You will need to choose your rotations wisely and think of them as auditions. HPSP students should perform at least one rotation at a military medical facility where they think they may want to do their residency, while USUHS students will perform all of their rotations at military medical facilities.MILITARY RESIDENCIESThe process of matching to a residency is slightly different for military medical students than it is for civilian students. HPSP and USUHS students must apply to both the military Joint Service Graduate Medical Education Selection Board (JSGMESB) and the civilian Electronic Residency Application Service, and they must rank their residencies by preference. Keep in mind that all military residency programs are approved by the Accreditation Council for Graduate Medical Education.The military match takes place first, and students are most likely to be matched at that time.Originally built as an oil tanker, the USNS Comfort was converted into a vast hospital ship by the US Navy in 1987. One of two in the Navy .Aircraft carrier size USNS MercyThe military match takes place first, in December of the fourth year of medical school, and students are most likely to be matched at that time. If you do not match into a military residency or Post Graduate Year 1 program, you will be authorized to participate in the civilian match.If you are selected for a military residency, you will start working at a military health care facility as an active-duty physician, and you will be paid as a captain in the Army and the Air Force, or as a lieutenant in the Navy. Keep in mind that your time in residency will not count toward your service commitment, but it will count toward your eventual promotion, pay longevity and retirement.CIVILIAN RESIDENCY OPTIONSThe Military may allow you to attend a civilian residency if there are not enough military slots available in the specialty you want and the Military still has a need for physicians in that specialty. Even if you believe you will be allowed to participate in a civilian residency, you must apply to the JSGMESB and enter a civilian deferred residency as your first choice. You should plan on interviewing for military residencies just in case you are not selected for civilian training.If you do become a civilian resident, you will work at a civilian health care facility and the civilian facility will pay your salary. During your residency, you will still be an officer in the Individual Ready Reserve, which means your time in the civilian program will count toward promotion and pay longevity. As soon as you are finished with your residency and come on Active Duty, you must begin paying back your service commitment, and you will start receiving military benefits.IF YOU DO NOT MATCHIf you do not match into the military or civilian residency of your choice, you will still have options. In some cases, you could switch to a military residency in another field if a slot is available. Otherwise, you should plan on doing a one-year civilian or military internship. After the internship, you will be able to get your license to practice medicine. Then you can either reapply for a residency, or you can serve as a General Medical Officer (GMO).GENERAL MEDICAL OFFICERS (NAVY AND AIR FORCE ONLY)The position of GMO offers a wealth of opportunity. GMOs provide primary-care medicine to active-duty personnel, which means you will get military-specific medical training. GMOs serve as Flight Surgeons and Undersea Medical Officers, and they may be attached to a specific air wing, ship or submarine. Also, time served as a GMO fulfills your active-duty service obligation for participation in a medical scholarship program.GMOs provide primary-care medicine to active-duty personnel, which means you will get military-specific medical training.Since the number of military residency slots can fluctuate from year to year, you may need to serve as a GMO before you can participate in the residency of your choice. When your GMO term ends, you can reapply for your residency, or you can continue to serve as a GMO until you complete your full service commitment. Also, service as a GMO may give you an edge if you are applying to a competitive residency.Unofficial Explanation THE JSGME (MILITARY) MATCHHow the Military Match works as of 2014As a graduating medical student on a military scholarship, I get a lot of questions about how military scholarships and the military match work. I plan to write another post in the near future that explains how the military scholarships work in general, but since it’s match season, let’s talk about the military match process first.I’m going to assume that you don’t know a whole lot about the military match and explain it from square one, so please forgive me if I’m saying a lot of stuff that you already know. I figured better to explain too much than too little! I am coming from an Air Force background, so I know more of the details of the Air Force system than the Army or Navy. If something is specific to the Air Force, I will indicate that.We will start with some terms:NRMP: The civilian National Residency Matching Program (aka the “main match” and the SOAP or scramble), which matches students into positions at the civilian residency programsERAS: The Electronic Residency Application Service, the civilian residency application used by all programs. Think of this like the AMCAS service that you used to apply to medical schools. The difference between AMCAS and ERAS is that there is no “secondary” application in ERAS. Remember those 5 pages of essays that you had to write for every single school that you applied to? Not this time!JSGME: Joint Services Graduate Medical Education. This division runs the military match, and the military residency application is submitted to them. Think of JSGME as the military equivalent of NRMP. Each service also has its own office responsible for the match.MODS: This is the military equivalent of ERAS, where you submit your application electronically. As of 2014, all three branches which have residencies (Army, Navy, and Air Force) are using MODS. In September, you submit your application and rank list (the list of which specialties and programs you are interested in, in order of preference) into MODS.HPERB (Air Force): The list of how many residency training slots will be available in each specialty and location that year. This is released by the Air Force Physician Education Branch in June each year. A similar list is released by the other services around the same time.Civilian deferral/deferred: This refers to a resident on a military scholarship who has been granted permission to train in a civilian program. In deferred status, you remain an inactive reservist. You collect no military pay or benefits (though you still have an ID card and can use the commissary, etc) and you have no military obligations until you complete residency. Training in this status does not increase your military commitment after residency graduation compared to training in a military program. However, you will be paid less than a military resident (usually starting around $50k/yr for a civilian vs $70k/yr for a resident in a military program). The number of military training slots in a particular specialty tends to be pretty stable from year to year, but the number of civilian deferrals varies greatly. This means that one year it may be very easy to get a civilian deferral, and the next year it might be nearly impossible.Civilian sponsored: I haven’t seen too many of these appear recently, but this status is a hybrid between an active duty residency and a civilian deferral. You train in a civilian program, but you are on active duty and collect full military pay and benefits. As with civilian deferral, you have no military commitments during your residency. Training in this status accrues an additional year of active duty “pay-back time” after residency per year of training. For example, if you receive a four-year scholarship and complete a 4-year residency in a civilian sponsored status, you will owe 8 years on active duty after you complete your residency.Let’s assume that, in a given year, there are 9 military training slots and 3 civilian deferrals in your specialty of interest. So that makes 12 total people who will train in that specialty. The board, which is made up of all of the military program directors in that specialty, sits down at a big table and looks at all of the candidates. First, they decide which 12 are going to train in that specialty. Then they look at who wants to go where. Who gets what they want depends on whether your top choice program wants you, and whether you have extenuating circumstances such as a spouse in residency in a certain area, family in a certain area, etc.So how do you get the spot that you want, whether that is in a military program or a civilian deferral? There are two basic things that you need to do. The first is that you need to be selected to train in your specialty of choice, period. To do this, you need to pass Step 1 and Step 2, obviously, but what really matters to the board is whether they want to work with you. They don’t really care about your actual Step 1 or Step 2 CK scores, or your grades. To prove that they want to work with you, you have to do military away rotations and perform well. You are required to do one military away rotation as a condition of your scholarship, but it’s a good idea to “save” your active duty tour from your third year so you can do two military away rotations (if your specialty of choice has at least two military programs in your branch of service). Interview at some of the others in person if you can. In a specialty like OB/GYN where there are only a few programs, it is a good idea to at least telephone interview everywhere. If your specialty of choice has 15 programs, you may not need to interview everywhereEither way, you want as many people at that table rooting for you as possible.Then it comes down to two things: whether the program that you want, wants you, and whether you have a convincing reason why you need a particular location, or a deferral. When you submit your military rank list, if you rank civilian deferral first, you have to give an explanation for why (family, etc) as part of your personal statement. If you rank it second or lower, you don’t have to explain your choice, but if you have a good reason for it, it would be wise to explain that to the military program directors during your interviews.It is important to be aware of another idiosyncrasy of the military match. The Army and the Air Force match people to a full residency, PGY-1 (intern) through graduation. The Navy initially matches everyone to a PGY-1 (intern) year only, and you must re-apply to continue in training. The majority of interns are, instead, sent out to the fleet to serve as general medical officers (GMOs) (primary care doctors) for a few years between their intern year and their PGY-2 year. I will talk about this in more detail in another post.Is that all clear as mud? Please feel free to post your questions and I will answer them as best I can. Also keep an eye out for the other posts in this series – I will be writing about how military scholarships work while you are in school, how to apply for military scholarships, and ways to decide if a military scholarship is the right choice for you. Thanks for reading!MILITARY VS CIVILIAN RESIDENCY FOR HPSP STUDENTSA reader recently asked me a question about choosing residencies. Specifically, he wanted to know about the reasons why I chose to request civilian deferral for residency. I have also received several questions about the actual process of applying for a civilian deferral and going through the military and civilian match, and I wrote a post on that subject here.For the purposes of this post, I will be using a hypothetical resident who is completing a four-year residency and who has a four-year active duty service commitment, such as someone who received a four-year HPSP scholarship.If you aren’t sure whether you want a civilian deferral, there are several things to considerMoneyCareer plans after your minimum active duty commitmentSpecialty choiceFamily considerationsFirst, let’s talk money. If you enter a civilian residency, as of 2015, you can expect to make about $50-55k/year. As a new O-3 (new medical school graduate) in a military residency, your total compensation is closer to $70-75k/year. In other words, you will make about $20k less per year in a civilian residency than you will in a military residency. You also pay more for your family’s medical care (and for child care) as a civilian than if you are in the military, making the effective pay difference bigger if you have a family.Then there is the money you will make during your active duty service commitment. If you complete a military residency, you will accrue years of service. This means that you will make more money per year during your active duty service commitment (4 years for most HPSP students) if you complete a military residency than if you complete a civilian residency. If you complete a 4-year residency, that means you will make $1,300 more per month in the beginning of your active duty commitment if you complete a military residency.These years of service also qualify you for promotion during your active duty service commitment which would be otherwise unavailable to you, and promotions also come with a pay raise.The combination of additional years of service for pay, and a promotion to major, means that a resident on a 4-year scholarship who has completed a 4-year residency will make about $50k more during their 4 years of active duty service if they complete a military residency.Overall, this means that, for a resident completing a 4-year residency and with a 4-year active duty commitment, the choice to do a civilian deferred residency will cost you about $130k over those eight years. Keep that number in mind as you read the rest of this post.Next, it’s important to consider your career plans after your initial active duty service commitment. Those lost years of service will continue to hurt your paycheck as long as you stay in the military. If you plan to stay in until you reach retirement, that lost pay will continue to sting to the tune of $1k per monthuntil you retire. Ouch.If, on the other hand, you plan to leave the military at the end of your active duty commitment, it may be helpful to complete your residency in a civilian program. Why?To get experience working in a civilian hospital. Civilian hospitals work differently than military hospitals in terms of staffing, reimbursement, charting, and some other aspects of patient care.To build relationships and connections with civilians who you might want to work for in the future. If, for example, you know that you want to work in northern California after you leave the military, it may be helpful to do a residency in that area. That way, when you are getting ready to find a civilian job, you will have local connections who can vouch for you.To see patients and pathologies that you may not see in a military program. Depending on your specialty, your patient population may be very different in the military than it will be in civilian practice. In my field (OB/GYN), for example, I found that certain diseases were much more common in the patients I saw at the civilian hospitals than in the military patients. In the civilian hospital where I am currently completing my residency, I regularly have patients roll into labor and delivery on an ambulance stretcher, screaming, with no prenatal care and a history of heavy cocaine use throughout pregnancy. That doesn’t really happen in the military programs. Since I am planning to spend most of my career in the civilian world, I wanted to gain practice and experience treating these patients for when I come across them as an attending.Specialty choice also matters. Pediatrics may not be terribly different in the military vs in the civilian world – I don’t know. I mean, in general, kids are pretty healthy, right? In OB/GYN, civilian patients have a nasty habit of neglecting their medical care if they don’t have insurance (or are doing naughty things like shooting up heroin), and reappearing only when they have advanced cancer or are in labor. That’s less of an issue in the military, where people tend not to be smoking crack during their pregnancies (and medical care is free.)And, of course, the pay difference between military and civilian work after residency depends on your specialty, which might influence your choice about whether to stay in. ENTs and neurosurgeons make a lot less money in the military than they do as civilians, but that difference is much smaller for, say, pediatricians.Think about your family obligations. Is your spouse limited to big cities by his job? Is your fiancee going through the civilian match and you want to couples match? Are your parents elderly and ill? Do you have a child with special medical or educational needs? Is your whole family in Texas and you really want to stay there? All of these are worth considering. Sometimes, civilian residencies can give you more geographic flexibility – for example, there are no Air Force OB/GYN residencies on the west coast, but there are plenty of civilian residencies. Just remember to balance this against the pay cut that you are taking. Maybe you want to live in New York City, but is it worth $130k? Is being in the same state as your parents (when you’re working 80 hours a week and have no time to socialize anyway) worth the cost of a small house?If you train civilian, you will have to pay for the move from med school to residency on your own. If you do a military residency, the military will pay for it.And, of course, remember that you may not have much of a choice in the matter. The Air Force tends to hand out a fair number of civilian deferrals (depending on the specialty and the year), while the Navy almost never sends people out to the civilian world for training. Even in the Air Force, you may be selected for a civilian deferral if you ask for it (see this post for more on that).So, what’s the bottom line? Should you pursue a civilian deferral?It may be worth seriously considering a civilian deferral ifYou are going into a highly-paid specialtyYou plan to leave the military as soon as your commitment is upYou are going into a specialty where your work will be very different as a civilian doctorYou have serious family considerations (geographically limited spouse, special needs kids, etc)It probably makes more sense to do a military residency ifYou have prior military service (you get paid more)You are planning to stay in the military until retirementYou are going into a specialty where you get paid the same or less in the civilian world (mostly primary care specialties)You are single, or have a spouse who can easily relocate with youYou have other debts like undergraduate loans, car loans, etc., and the extra money makes a big differenceSo You Want a Civilian DeferralJanuary 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 yearExtenuating 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 scoresDo military away rotations and perform wellBe able to clearly articulate why you want a deferralNow 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 ofYes, 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?Fighting For LifeDirected by Terry SandersExecutive Producer: Tammy Alvarez89 MinutesFighting for Life is a powerful, sobering and emotional feature documentary portrait of American military medicine interweaving three stories:Military doctors, nurses and medics, working with skill, compassion and dedication amidst the vortex of the Iraq War.Wounded soldiers and marines reacting with courage, dignity and determination to survive and to heal.Students at USU, the “West Point” of military medicine, on their journey toward becoming career military physicians.Trailer for Fighting for LifeA powerful, sobering and emotional feature documentary portrait of American military medicine interweaving three stories: Military doctors, nurses and medics, working with skill, compassion and dedication amidst the vortex of the Iraq War. Wounded soldiers and marines reacting with courage, dignity and determination to survive and to heal. Students at USU, the “West Point” of military medicine, on their journey toward becoming career military physicians. The film follows 21 year-old Army Specialist Crystal Davis, from Iraq to Germany to Walter Reed Hospital in Washington DC, as she fights to recover and “bounce back” from the loss of a leg.The filmmakers had extraordinary access to combat support hospitals in Iraq, medevac flights with wounded soldiers, and military hospitals in Germany and the United States."They are all heroes..."Tom Hanks,interview in Rolling Stone"This is Americans at their best...marvelously uplifiting"Robert MacNeil, journalist and TV news anchor,The MacNeil/Lehrer Report"Staggeringly affecting."Nick Pinkerton,The Village Voice"...an unforgettable portrait of suffering, courage and resilience."Ann Hornaday, Washington PostReview of Movie: Fighting For LifeOnly one medical school in the United States specializes in training doctors to treat combat casualties. One quarter of all uniformed U.S. Armed Forces doctors and 80% of all doctors who complete a 20-year military career are graduates of that one school, yet it has repeatedly been threatened with closure by federal budget cuts. That school is the Uniformed Services University of the Health Sciences (USU), located in Bethesda, Maryland.Two-time Oscar-winner Terry Sanders (Maya Lin: A Strong Clear Vision) spent two years making Fighting for Life which blends coverage of the USU class of 2010 in classroom and field training environments with coverage of USU graduates treating casualties at a combat field hospital in Iraq, a surgical center in Germany, and a rehabilitation center in Maryland.Fighting for Life is an apolitical documentary that takes no stance on the Iraqi war itself. Sanders' only apparent agenda is to make a persuasive case for the importance of the USU's mission by detailing some of the sacrifices made by the young American soldiers in blood and limbs, and the heroic efforts of the USU-trained doctors who save those soldiers' lives and try to restore them as best they can.Sanders and his crew enjoyed great access to locales and personnel throughout, from a concrete-hardened triage center in the combat zone, to state-of-the-art operating rooms in Germany, to a gymnasium-sized rehabilitation center in the States.Sanders shows us the horrors of war in graphic detail. Many of the wounded have been disfigured by road-side bombs which mangled limbs and burned skin. The wounded are American and Iraqi soldiers, but also Iraqi civilians caught in the crossfire.Fighting for Life is presented without narration and the camera work is loose and spontaneous. This is both the film's strength and its weakness. The documentary is refreshingly guided by the events and people with a minimum of contrivance, but there's also a sense that the pacing and editing don't fully succeed.The film starts strongly enough with medical students at the OSU campus, but once the film has moved on to the twisted and broken bodies of war, returning to the OSU students doing mock field exercises drains away much of the film's emotional charge.Final Thoughts:Fighting for Life is first and foremost an advocacy film for the importance of the Uniformed Services University of the Health Sciences' mission of training military doctors, but it also offers very fine coverage of the men and women who serve in the American Armed Forces - those who risk their lives on the battlefield, and those caregivers dedicated to saving lives and restoring health, often under arduous conditions.Refreshingly apolitical, Fighting for Life is recommended viewing for everyone.Package about the advanced capabilities of Craig Joint Theater Hospital in Bagram, Afghanistan. Produced by Mark Leahy. Includes soundbites from Col. Chris R. Benjamin - commander.C-17 perform its aeromedical mission in this "Aboard the Flying Hospital" video produced by the San Francisco Chronicle.Behind-the-scenes tour of the USNS Mercy Hospital Ship. The Mercy is a floating hospital staffed by nurses, doctors, and medical professionals.U.S. Naval Hospital Rota