Military Medicine: Pros, Cons, and Opinions

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Actually, I'd have to say that post is right on the money. One of the great flaws with military medicine is that you have little to no say in how you do business while in garrison. While you may stay filling out AHLTA charts til 8pm, your civilian staff will depart promptly at 4:30. Got an extra 20-hour block of power-point training to do? No problem, just squeeze it in somewhere. Office staff that's incompetent? Too bad, they're on contract. CME conference to go to? Ummm, no, maybe next year. The military has a tendency to treat you like an asset that's bought and paid for, which is all fine and good while that's the case. After our obligation is up, though, they continue to treat us that way, so it's no wonder we leave in droves. It's a shame, too, because I've seen many providers who were gifted and devoted to the troops just have to give it up because they just couldn't take it anymore.

And about that AHTLA....so is it standardized across all Army MTFs?

haven't seen it m'self yet, but sounds like it's designed by monkeys. why's it so bad -- cluttered interface? redundant? crashes on you?

Originally Posted by Ascultator

And about that AHTLA....so is it standardized across all Army MTFs?

haven't seen it m'self yet, but sounds like it's designed by monkeys. why's it so bad -- cluttered interface? redundant? crashes on you?

All of the above. Tends to be slow, down 5% of the time (particularly if you're not at a base that houses a main server), randomly delete notes, and was designed more for use as a tool to collect metrics (i.e., how many people have shellfish allergies in the AF?) than to be used as an EMR by clinicians.

Originally Posted by ArmyFltDoc

While you may stay filling out AHLTA charts til 8pm, your civilian staff will depart promptly at 4:30. Got an extra 20-hour block of power-point training to do? No problem, just squeeze it in somewhere. Office staff that's incompetent? Too bad, they're on contract. CME conference to go to? Ummm, no, maybe next year.

Reading this reminds me of most higher-up civilian job. Maybe it isn't the same for doctors, but my dad works 10-12 hour days as a sales executive and my father-in-law works anywhere from 9-12 hours as a head planner/manufacturing engineer. They complain about these same things in their jobs - too much to do and not enough time to do it, tons of incompetent people or newbies out of college that don't know what hard work is, and so on. Even in my job now as a dietitian I feel like these issues exist, since I am the only dietitian on when I work and I do inpatient, outpatient, long-term care, and community, depending on the day. I am not a doctor yet so I don't know what a civilian doctor's day is like aside from what I have seen in job shadowing and working with them on the floors of the hospital, but in comparison to what I have seen working in a hospital and the business world, it doesn't seem like this is much different that anywhere else.

The civilian doctors mentioned in the post are working in a gov't facility, so I am wondering if this is different than working in a civilian hospital? I was thinking that maybe since they are contractors they are held to x hours per week whereas in a civilian hospital you are done when the work is done - is this true?

Hi there,

I am applying to med school right now and strongly, strongly considering HPSP. I've read a ton on these forums, but have yet to post anything re: mil med. I have no military background or loyalty to any one branch and am trying to decide which, if any, branch would be the best match for me. At this point, I've all but ruled out the army - while its higher chances of being able to train straight through are tempting, the longer and (seemingly) more hazardous deployments, along with the notion that the army 'doesn't treat its people as well' (mostly with regards to when i serve AD time) as the other two branches have sort of pushed me away from them

Now, I'm trying to decide whether navy or af would be a better match. The AF recruiter I've spoken with seems less-than-trustworthy, though I do have a personal friend that has helped clarify some of the discrepencies (HPSP AF guy, 5th year at a great civilian residency - he was granted a deferral for gen surg, and is now about to start his AD). The Navy recruiter I spoke with was very nice, but unfortunately was actually a nursing and dentist recruiter and had slim-to-no idea of the match process/GMOs - which is what I am most in-need of details on.

SO...

1) I know Army has higher match rates and have seen the numbers for 2010 (ratio of applicants to spots)...but for the AF and Navy I haven't been able to acquire these numbers...anyone have ANY notion of about how many applicants/year (percentage-wise?) DON'T match, and therefore funnel into FS/GMO or Transition Years?

2) IF I were to end up as a FS for the AF, what are the different tracks for flight surgery, and how does one apply to them/how are people selected for them? How long are the minimum FS commitments?

3) IF I were to end up as a GMO for the Navy, same questions as above.

ps, by "tracks" i mean flight med, dive med, with seals or marines or special forces, etc etc...apologies if I am making up random 'tracks', again NO military background here, just a bf whose father/grandfather were marines and who would flip their s if i ended up as doc for a marine battalion...

I have tons-o-questions...but figured I'd start with these and see if I get any useful feedback. Thanks in advance to anyone who tries to help!

Originally Posted by girl1234

Hi there,

I am applying to med school right now and strongly, strongly considering HPSP. I've read a ton on these forums, but have yet to post anything re: mil med. I have no military background or loyalty to any one branch and am trying to decide which, if any, branch would be the best match for me. At this point, I've all but ruled out the army - while its higher chances of being able to train straight through are tempting, the longer and (seemingly) more hazardous deployments, along with the notion that the army 'doesn't treat its people as well' (mostly with regards to when i serve AD time) as the other two branches have sort of pushed me away from them

Now, I'm trying to decide whether navy or af would be a better match. The AF recruiter I've spoken with seems less-than-trustworthy, though I do have a personal friend that has helped clarify some of the discrepencies (HPSP AF guy, 5th year at a great civilian residency - he was granted a deferral for gen surg, and is now about to start his AD). The Navy recruiter I spoke with was very nice, but unfortunately was actually a nursing and dentist recruiter and had slim-to-no idea of the match process/GMOs - which is what I am most in-need of details on.

SO...

1) I know Army has higher match rates and have seen the numbers for 2010 (ratio of applicants to spots)...but for the AF and Navy I haven't been able to acquire these numbers...anyone have ANY notion of about how many applicants/year (percentage-wise?) DON'T match, and therefore funnel into FS/GMO or Transition Years?

2) IF I were to end up as a FS for the AF, what are the different tracks for flight surgery, and how does one apply to them/how are people selected for them? How long are the minimum FS commitments?

3) IF I were to end up as a GMO for the Navy, same questions as above.

ps, by "tracks" i mean flight med, dive med, with seals or marines or special forces, etc etc...apologies if I am making up random 'tracks', again NO military background here, just a bf whose father/grandfather were marines and who would flip their s if i ended up as doc for a marine battalion...

I have tons-o-questions...but figured I'd start with these and see if I get any useful feedback. Thanks in advance to anyone who tries to help!

As you pointed out, the majority well over 50%, probably now more like >70% do not do GMO's. The Army has a much more robust medical department with more opportunity to use your skills/training. Ask the USAF surgeons how satisfied with the case volume (not very). I also wonder where you got the idea that the Army treated it people worse than the AF and Navy? I would disagree with this basic premise at least with regards to medical personnel. Lastly, I would also argue that the deployments (at least hazardwise) aren't different between the Army and Navy.

I'm not selling the Army but I do think you may want to reassess some of your assumptions about the various services.

I am a second year who was very close to doing HPSP but decided after reading these forums that I would rather wait until residency and do FAP so I would be a licensed physician before I served. I don't have previous military experience, but I come from a family with a strong military background and want to serve my country. I know I am still early in the game but I am leaning towards EM or Trauma Surgery and wanted to know what specialties are more favored than others when funding is considered? Also, I have a young family and want to know if there will be constant deployments or probably 1 or 2 max? I am open to anything, but now that I am a little older and have other responsibilities, I want to make sure that I am still able to be a part of my children's lives while I serve. Any input would be appreciated, especially from those that have actually done the FAP. Thank you!

Originally Posted by terimadi12

I am a second year who was very close to doing HPSP but decided after reading these forums that I would rather wait until residency and do FAP so I would be a licensed physician before I served. I don't have previous military experience, but I come from a family with a strong military background and want to serve my country. I know I am still early in the game but I am leaning towards EM or Trauma Surgery and wanted to know what specialties are more favored than others when funding is considered? Also, I have a young family and want to know if there will be constant deployments or probably 1 or 2 max? I am open to anything, but now that I am a little older and have other responsibilities, I want to make sure that I am still able to be a part of my children's lives while I serve. Any input would be appreciated, especially from those that have actually done the FAP. Thank you!

Both EM and Trauma would be desirable to the .mil. I would imagine that FAP would be available either way. Although, because trauma sx is a fellowship (are there direct trauma sx programs?), FAP might require you to serve as a general surgeon.

As for deployment, you are interested in two highly deployable specialties. I think counting on ~3 deployments during your 5ish years of obligation would be about right.

Originally Posted by AF M4

All of the above. Tends to be slow, down 5% of the time (particularly if you're not at a base that houses a main server), randomly delete notes, and was designed more for use as a tool to collect metrics (i.e., how many people have shellfish allergies in the AF?) than to be used as an EMR by clinicians.

It was also designed to make the life of the “bean counters” easier. Also, it provides a sense of RVU output per MD which provides the necessary information needed to civilianize certain positions.

Hi,

First off, thank you for your service and your input on the various threads in this forum. I've been reading this board for the past few months, but I still have some questions concerning military life, specifically if I were to go through via HPSP or USUHS. Your insight will be greatly appreciated.

Concerning ADT#1/COT/ODS/OBLC
1.) When is the earliest someone can be commissioned before starting medical school? Does this vary by branch?
2.) Going along with #1, when is the earliest an incoming M1 can complete officer training? It seems as this may vary by branch (Navy and AF before start of M1, but usually before M2 for Army). Does anyone know of any scenarios were officer training was completed in the Spring prior to M1? If so, were officers then given orders to do nothing for the summer months before school starts? Or is it policy for officer training to be held only during the summer months?
3.) For those that completed Navy ODS prior to starting medical school, I've read that a research or clinical rotation can be completed the next summer (between M1 and M2). How do these rotations differ from the ones offered for 3rd and 4th year ADTs? For example, is a four week rotation at NAMI done the summer before M2 the same as the Flight Surgery clinical rotation at NAMI done as a 3rd or 4th year ADT? If not, how are they different?
4.) Is there more information about Army summer ADTs available to the few who completed OBLC before starting medical school?

Concerning ADTs
1.) HPSP: I understand that at some civilian schools, students are allowed to do international rotations/electives. Does status as a reservist preclude HPSP students from doing international rotations? Or is this permissible so long as you complete the yearly ADT?
2.) HPSP: ADTs aside, how often are you on "military mode"? I.e., will you be given orders to check in with your CO during spring break? Will you be voluntold to do the HPSP pitch to your alma mater's pre-med society?
2.) USUHS: No international electives, correct? Any chance of doing a rotation at military hospitals non-CONUS, say at Tripler or Ramstein?

Concerning MGME and beyond
1.) If there's a research component to your residency, must it be done at your site? Or can you conduct research at another military medical center?
2.) Would you be allowed to attend special training courses or symposia at non-military facilities? For example, if you are Neurology resident would command allow you to attend the Penn Conference on Clinical Neuroscience and Society held at UPenn?

[My gut feeling: "no", since I've got the impression that getting permission to complete CME credits is akin to pulling teeth]

3.) Is a graduate more likely to have friction with a nurse commander as a resident or as an attending?
4.) How much does the electronic medical records system really slow you down?

Miscellaneous
1.) What are the automatic health disqualifiers? I've read that many things can be waived, but can someone point me to the definitive list of conditions that absolutely cannot be waived? Are the health qualifications more stringent for flight surgery?
2.) While on the topic of disqualifies, has anyone been denied commission because of tattoos? I've read that there's a no-more-than-25%-of-a-body-part policy, yet a family member of mine who served had a half sleeve on one arm and a quarter sleeve on the other arm (then again, he was an enlisted member).
3.) Social networking policy: besides the obvious things--such as troop location or mission details-- what are the other no-nos when it comes to things like facebook and twitter? Can my fiancé post pics of me in my uniform? Can I leave a status update saying, "Gone for SERE training, wish me luck"?

Sorry for the lengthy post, but I'm trying to get as much information as possible as I weigh my near-future options.

Originally Posted by NeuroJ

Concerning ADT#1/COT/ODS/OBLC
1.) When is the earliest someone can be commissioned before starting medical school? Does this vary by branch?

Up to a year in advance, although doing so might be difficult given that you have to apply, take your physical, etc.

2.) Going along with #1, when is the earliest an incoming M1 can complete officer training? It seems as this may vary by branch (Navy and AF before start of M1, but usually before M2 for Army). Does anyone know of any scenarios were officer training was completed in the Spring prior to M1? If so, were officers then given orders to do nothing for the summer months before school starts? Or is it policy for officer training to be held only during the summer months?

No such policy. Most people go through the summer because of timing. You should be able to go through whenever.

Concerning ADTs
1.) HPSP: I understand that at some civilian schools, students are allowed to do international rotations/electives. Does status as a reservist preclude HPSP students from doing international rotations? Or is this permissible so long as you complete the yearly ADT?

Doesn't matter so long as you avoid countries that appear on the list of state-sponsored terrorists.

2.) HPSP: ADTs aside, how often are you on "military mode"? I.e., will you be given orders to check in with your CO during spring break? Will you be voluntold to do the HPSP pitch to your alma mater's pre-med society?

You have to do yearly ADT's and check-in once a year. There are occasional PowerPoints on safety you have to click through. No other requirements.

Miscellaneous
1.) What are the automatic health disqualifiers? I've read that many things can be waived, but can someone point me to the definitive list of conditions that absolutely cannot be waived? Are the health qualifications more stringent for flight surgery?

Several, including amputations of any kind. Do a search for the full list. For flight surgery, you need to pass a flight physical, which I assume entails checking vision, etc.

3.) Social networking policy: besides the obvious things--such as troop location or mission details-- what are the other no-nos when it comes to things like facebook and twitter? Can my fiancé post pics of me in my uniform? Can I leave a status update saying, "Gone for SERE training, wish me luck"?

Can't imagine that being a problem.

You have a lot of questions for things that really aren't that important. What you should really be concerned about are things like getting into a specialty of your choice, avoiding GMO/FS billets, having adequate equipment and appropriately trained staff. Other than GME selection, the military is very benign to medical students. As I am deferred for residency, it's still very benign.

Thanks, deuist!

I agree with your last, poignant statement. My questions were more of the "little-things-I-might-want-to-know" variety.

I've already accepted the fact that I'll probably be a one-man clinic post-residency. As for the GMO/FS issue, my attitude is that these billets will offer me the chance to do something I really wouldn't be able to do on the civilian side. I understand that serving as a boat's GMO or a squadron's FS isn't the most glamourous or clinically-challenging position, but these are necessary roles. Am I scared of skill atrophy? Yes. However, I think every doctor should be b/c complacency slowly breeds incompetence.

As for the residency of my choice, I really do not see myself competing for a competitive slot. I've been involved in neuroscience/psychiatry research since I was a high schooler........these fields still fascinate me, so I wouldn't be surprise if I ended up as a psychiatrist (isn't there a major need for them in .mil?) or neurology (which is slightly more competitive than psychiatry, but nowhere near as competitive as EM, right?).

Originally Posted by NeuroJ

Hi,
2.) HPSP: ADTs aside, how often are you on "military mode"? I.e., will you be given orders to check in with your CO during spring break? Will you be voluntold to do the HPSP pitch to your alma mater's pre-med society?

I'm AF and several years removed from HPSP, so bear that in mind with these responses that there are obviously service-dependent variables and that things obviously change over time. As a med student, you're quite detached from the regular military. Although I suppose you do technically have a CO, you will never see/hear from that person. You will be in touch with the civilian HPSP program coordinator via email a couple of times a year.

2.) Would you be allowed to attend special training courses or symposia at non-military facilities? For example, if you are Neurology resident would command allow you to attend the Penn Conference on Clinical Neuroscience and Society held at UPenn?

[My gut feeling: "no", since I've got the impression that getting permission to complete CME credits is akin to pulling teeth]

Residents from my program attend national conferences and seminars every year. They're not going to send everybody to Hawaii for some BS, and true it's not always the easiest thing to coordinate logistically (not only funding but in terms of general scheduling and coverage also), but it's definietly not a categorical 'no'. Depends on the program, certainly neuro is probably more conducive to this kind of thing than say orthopedic surgery. BTW you don't need special CME courses as a resident, you get more than enough through your regular training schedule to satisfy any state medical board.

3.) Is a graduate more likely to have friction with a nurse commander as a resident or as an attending?

Again, even though you're active duty you're a bit separated from the regular military as a resident. Your 'commanders' are your chief resident and PD. During residency I interracted with the actual command of my wing exactly twice, once during intern orientation and once to get some paperwork signed. If you've got a crappy chief or PD as a resident then your education will suffer greatly; if you don't get along with your crappy nurse commander as an attending then you'll be getting pissed on because of failed inspections, picking up ****ty evals, having your leaves/TDYs/funding requests denied, etc. Not sure if that answers your question.

4.) How much does the electronic medical records system really slow you down?

AHLTA blows, can't really give you a 'it slows me down x minutes per patient' since I don't have any other DoD-wide outpatient records systems as a basis of comparison. I can tell you that the inpatient EMR system at Wilford Hall/Brooke Army (where the AF neuro residency is currently located) is quite excellent, and I know of other .mil inpatient systems that are very good as well.

1.) What are the automatic health disqualifiers? I've read that many things can be waived, but can someone point me to the definitive list of conditions that absolutely cannot be waived? Are the health qualifications more stringent for flight surgery?

If there is a universal list I'd like to have it as well, my gut says it's service-specific and circumstances-specific. I could name you a few things like sickle cell disease and psychotic disorders, but it would be no way all-inclusive and there'd probably be exceptions. In general if you're functional enough to make it through 4 years of med school you're functional enough for uniformed service. Flight surgery and other specialized billets are of course a bit more stringent on some things, but again in general it's not difficult to get a waiver for nearly everything.

3.) Social networking policy: besides the obvious things--such as troop location or mission details-- what are the other no-nos when it comes to things like facebook and twitter? Can my fiancé post pics of me in my uniform? Can I leave a status update saying, "Gone for SERE training, wish me luck"?

I'd DELETE my facebook account prior to going to SERE

.

.

Tic, thanks you so much for your response. It definitely shed light on things!

Wow, that was a nice 4 hour read. So I don't think that I will be do the HPSP anymore.

^ wise choice. I know this after the fact.

I am new to this forum and this is my first post to this blog. I wanted to share my experience as a military officer in the USAF. I was enticed in residency to join via the FAP program. It all sounded great at the time as I was in dire need of money to make my student loan payments. Making over 80k a year as a resident was great. However, I wasn't prepared to continue making that as a fully licensed BC physician.

The money issue was known ahead of time, but I was calculating that future salary including the yearly bonuses. The yearly bonuses as currently paid in lump sums and max taxed. So instead of dividing annual salary/12, you should really calculate the annual salary/12 without the bonuses. This will give you a better idea of your monthly salary. By the time the bonus time arrives and hoping that congress approves them each year, you find that you had to accumulate alot of Credit Card debt to keep up monthly. So usually the bonuses are spent before they arrive. Also you are not entitled to the bonuses in your last year, ie: the + 1 year for FAP. So your last year is where they really get you.

To me the lack of control of my patients, my staff is really a major drawback. The military leave system and their 30 days of leave a year is accumulated at 2.5 days a month. So when you first start out, you have zero. So if you were hoping to use any leave time initially, you wil not have any. Also as everything military related it is subject to approval. Also, even if you don't work on weekends, if you take leave and go out of the area which is 2 to 6 hours from your base, again this depends on commander, those days also count as leave. So if you decided to have a weekend getaway and leave Thursday night and return to work Tuesday, you just cost yourself 5 days leave because you left Thursday before midnight, and did not return until Tuesday even though technically you only missed work on Friday and Monday. So you just spent 5 days of your yearly 30 that took you 2 months to accumulate for missing 2 workdays.

It is very unchallenging and most patients are very entitled. You will find yourself dealing with angry patients who are upset you didn't refill their aspirin in a timely manner when they called and left a phone consult. Yes aspirin folks. As a physician was no prior military experience, I was thoroughly shocked at the amount of OTC medications available by prescription on base. I can go on and on, but basically if you are thinking of doing FAP because you need help to make your student loan payments. Remember that the FAP money will only be enough to make low interest only loan payments throughout your residency. After you finish you will not have made a dent in your loan balance and now will be severely underpaid compared to your civilian colleagues in your respective specialty. You will then have to moonlight to supplement your income. Oh yea, you need permission from the commander for this as well. So my only advice would be to think twice, and do your homework. Most physicians get out once their commitment is up.

I just applied for my loans and took the time to do a little math. My school cost a lot ~74000 for everything. at the end of 4 years it will be ~350000 with interest at 6.8%. If I have the loan for 10 years I will end up paying 133000 in interest. If I do hsps I will end up making ~90,000 while in medical school. and when in residency if you account for them paying for medical school it is like getting another 98,000 a year on top of what I would be paid.

The money is a big pull to put up with the bs of the military as well as a desire to serve. Does the payoff out weigh the four years in the military? My fiance isn't keen on the idea. any advice regarding kids, deployment, bouncing from different bases, how it worked out for you, and the worst thing that happened to talk me out of it please share. thanks

Originally Posted by UncleSam7176

I just applied for my loans and took the time to do a little math. My school cost a lot ~74000 for everything. at the end of 4 years it will be ~350000 with interest at 6.8%. If I have the loan for 10 years I will end up paying 133000 in interest. If I do hsps I will end up making ~90,000 while in medical school. and when in residency if you account for them paying for medical school it is like getting another 98,000 a year on top of what I would be paid.

The money is a big pull to put up with the bs of the military as well as a desire to serve. Does the payoff out weigh the four years in the military? My fiance isn't keen on the idea. any advice regarding kids, deployment, bouncing from different bases, how it worked out for you, and the worst thing that happened to talk me out of it please share. thanks

Hmm. Let me put it this way: at the 18 month mark of my first duty station, if a magical genie had shown up and piled all the money I'd thought I'd "saved" via the HPSP on a table in front of me and said "if you burn all of this money then you will be free of your contract today", then I would have doused the cash with gasoline, set a match, and danced around the infernal lucre like a wild man.

Good luck.

Money should NEVER be the reason to join the military, especially as a doctor. You should only join the military if you actually WANT to be in the military first. If you happen to want to do it as a doctor, great, then you might as well let them pay for it. But you better be damn sure you want to be in the military first and foremost.

My case isn't unique, but it is different. With over 10 years of active duty in the Navy (now in the reserves) as an O-4 if I get off the waitlist for USUHS I will not only be tuition free, but also get a salary of over $100k during school and residency. Sure I might have to do a GMO, but as a pilot I'll most likey get to be a dual designator. "Oh, no, I might have to fly airplanes again for a few years!" Sounds like a good deal, huh? But if I HATED the military it still wouldn't be worth it.

In the military you don't always get what you want. You don't always know what you'll be doing. You don't always know where you will be in six months. But you will work with very healthy 18-30 year olds that are mostly good people. Perhaps your skills won't be as sharp because of that so you'll have to put in more effort on your own time. You WILL get experiences (maybe not medically related) that few other people get to have. I like dealing with the unknown, I like dealing with change. If you don't like those things then stay the hell out.

Originally Posted by UncleSam7176

I just applied for my loans and took the time to do a little math.

6.8% is awfully high for a student loan. Mine were less than 3% from undergrad. Here's the math from my medical school:

When I graduated, my classmates were reporting debts of $220,000. If the interest rate is 5% (still too high) and the loans are deferred for 3 years of residency, then the total climbs to $237,000 by the time residency ends. An EM attending in the military makes ~$120,000 to start, and may reach as high as $140,000 when the commitment ends. An EM attending in central Texas makes $200,000 more that that each year. Paying off the debt in 4 years with payments of $65,000 a year is certainly possible when you're making that kind of money.

In summary, I took a loan from the Air Force for less than $250,000 and my repayment was a loss of salary and benefits over $800,000. That's loan sharking.

Originally Posted by UncleSam7176

I just applied for my loans and took the time to do a little math. My school cost a lot ~74000 for everything. at the end of 4 years it will be ~350000 with interest at 6.8%. If I have the loan for 10 years I will end up paying 133000 in interest. If I do hsps I will end up making ~90,000 while in medical school. and when in residency if you account for them paying for medical school it is like getting another 98,000 a year on top of what I would be paid.

The money is a big pull to put up with the bs of the military as well as a desire to serve. Does the payoff out weigh the four years in the military? My fiance isn't keen on the idea. any advice regarding kids, deployment, bouncing from different bases, how it worked out for you, and the worst thing that happened to talk me out of it please share. thanks

What you are not taking into account is the opportunity costs and the time in practice that you would be making alot more money than in the military. Especially if you end up in a high paying field. Even for peds and primary care, you could argue that you would end up financially better off. Even if you were't, the negatives are so much that its a no brainer.

Read the forum thoroughly and you will see that consitently, even amongst what I like to call cheerleaders of the system, joining for the money is the single worst reason.

Read on.

thanks for all the post. I know mine was based on money but serving is important to me. I guess what i should do take the loans on the chin and find another alternative to pay back my country.

Originally Posted by UncleSam7176

thanks for all the post. I know mine was based on money but serving is important to me. I guess what i should do take the loans on the chin and find another alternative to pay back my country.

You will not regret that.

If you get good training, and then you feel compelled to serve, at least you can do it with the training you wanted, and may have slightly more control of your career.

so I've done a little more reviewing... Basically the majority of post military docs say they hated: bouncing locations, low to no work load for training to hone and maintain you skills, poor physicians hiding in the military because they can, people not knowing what they are signing up for and complaining, bureaucracy, and having to be obligated to a broken system.

On the flip side they loved it: patient population, no malpractice insurance, never have to worry about if your patients can afford it, availability of technology and chix dig uniform.

This probably will change but my outlook right now for fields are ortho if i can specialize (very competitive and unlikely) so i can improve people's lives with mobility and activity; plus there will be no reason to worry about loans. If i don't specialize then peds because kids usually get better after interventions you made but the loans then get scary.

I have a buddy who is in his 3rd year of hpsp and loves it. Easy living and got to shoot guns (I LOVE GUNS). but I have heard there is a fall from grace once the honeymoon of medical school is over.

The quiz i took to get my loans stated in almost ten places that the rate was 6.8 or higher (Government is strapped for cash more now i guess). I was screwed with the recession and have been bar tending instead of collecting unemployment (grind my teeth when i think of my Biochemistry degree) so I have learned to have a thick skin and get the job done while letting s**t slide. My parents thankfully have paid my undergrad and i always paid cash for my ****ty cars so i have never gone into debt before which is why the loan thing is a huge issue. I have envied my friends from high school who have deployed as marines and a green beret and want to be able to do more than just buy them shots at the bar. I just got engaged and my fiance can't bounce around jobs because she has a lot of student loans. If at the end of residency i will be paying off my loans for four years it sounds similar to the equivalent to the four year obligation. Also there is the possibility of getting a civilian residency so I won't have to moon light like galo and get screwed.

A lot of gripping but I will be the first doc in my family and have had nobody to shine the light ahead of me. So I needed to vent this huge decision about getting from point A (med school) to B (practicing physician) to somebody being you and I am truly sorry.

Originally Posted by UncleSam7176

Easy living and got to shoot guns (I LOVE GUNS).

You're a non-combatant as a doc. You won't be shooting many guns in the military. Go find a civilian range close to your house and you can shoot all you want.

This is with particular regard to the Navy, but if you have a similar experience with another branch I would welcome your response too.

I'm currently a 2nd year in the Navy HPSP with a 4 year contract, about to start 3rd year. Right now I'm debating whether or not to try my hardest to get a deferment, or just to do a 4 year GMO and then be done with my obligation so I can go on to do a civilian residency.

I'm thinking about going into EM or Anesthesia right now (although that could change once I finish my 3rd year core clerkships). I've heard that it's easier to get a deferment for EM, but that EM/Anesthesia will get deployed most often.

What do you all think?

Originally Posted by coffeeeandtea

This is with particular regard to the Navy, but if you have a similar experience with another branch I would welcome your response too.

I'm currently a 2nd year in the Navy HPSP with a 4 year contract, about to start 3rd year. Right now I'm debating whether or not to try my hardest to get a deferment, or just to do a 4 year GMO and then be done with my obligation so I can go on to do a civilian residency.

I'm thinking about going into EM or Anesthesia right now (although that could change once I finish my 3rd year core clerkships). I've heard that it's easier to get a deferment for EM, but that EM/Anesthesia will get deployed most often.

What do you all think?

Just to clarify a point for you. There is no "try my hardest" to get a deferment. You ask for it and they say yes or no. You can lay some ground work by talking to the appropriate specialty leader (they decide who gets one) but aside from that, it will be based on need for that specialty and your academic record. I doubt you will try less hard to have a good academic record if you were not trying for a deferment, so that point is moot. The rest is outside of your control or influence.

Originally Posted by NavyFP

Just to clarify a point for you. There is no "try my hardest" to get a deferment. You ask for it and they say yes or no. You can lay some ground work by talking to the appropriate specialty leader (they decide who gets one) but aside from that, it will be based on need for that specialty and your academic record. I doubt you will try less hard to have a good academic record if you were not trying for a deferment, so that point is moot. The rest is outside of your control or influence.

haha i see. thanks for the clarification.

Originally Posted by deuist

You're a non-combatant as a doc. You won't be shooting many guns in the military. Go find a civilian range close to your house and you can shoot all you want.

While you are in a non-combat status, if deployed to Afghanistan or Iraq (or some other hotbed of mess), you are still issued a side arm and required to carry with you. You'll also have to be somewhat capable in shooting that thing, too...hence docs can still be quall'ed out in the rifle and pistol.

In fact, you can shoot all the time you want to if you have a range on base.

Originally Posted by Gatorman

While you are in a non-combat status, if deployed to Afghanistan or Iraq (or some other hotbed of mess), you are still issued a side arm and required to carry with you. You'll also have to be somewhat capable in shooting that thing, too...hence docs can still be quall'ed out in the rifle and pistol.

In fact, you can shoot all the time you want to if you have a range on base.

True. Currently in theater. Have a 9 on my hip and a 16 locked to my rack.

Hey all-

I am a female 23 yo who just finished my 1st year of med school, and I have applied to the 3 year Navy HPSP and am awaiting a decision. I have yet to sign anything, and I just read through this entire thread in the last couple of days. I'm seeing a lot of this stuff for the first time... and seriously questioning my decision, so I need some advice.

1. A lot of the info here was aimed at Surg, EM, Anesthesia, and Ortho people. Can anyone speak to the personal happiness and quality of training received by physicians in Peds or IM?

2. As with the other person interviewing at USUHS, I was told by my recruiter that 70-80% of Navy HPSP graduates would not serve as GMOs, and only those who wanted that experience or to increase their competitiveness for certain residencies (or failed to match) would do a tour. Truth check?

3. I really want to do this because I've always been interested in serving the people who sacrifice so much for our country... I won't go into all the details, but I promise I'm not doing it just for the money.

That being said, I also thought that it made sense financially for me to do this, and instead of a shut-the-hell-up-little-girl-you-don't-know-what-you're-talking-about, hear me out and explain to me why I'm wrong, if I am.

I attend a private medical school on full loans, and after I graduate, I will owe the government ~$300-350K. 6.8% percent interest is a reality that is here to stay, friends, and on some loans I have 9% interest. If I take a 3 year scholarship, followed by a theoretical 3 year peds/IM residency (barring GMO), I will only have a 3 years post-residency AD obligation, and as a pediatrician or internist, the pay-cut compared to civ practice is pretty seriously overshadowed by the lack of debt, especially since I want a family.

Any logical and well thought out answer would be much appreciated

Originally Posted by RhodonMD

Hey all-

I am a female 23 yo who just finished my 1st year of med school, and I have applied to the 3 year Navy HPSP and am awaiting a decision. I have yet to sign anything, and I just read through this entire thread in the last couple of days. I'm seeing a lot of this stuff for the first time... and seriously questioning my decision, so I need some advice.

1. A lot of the info here was aimed at Surg, EM, Anesthesia, and Ortho people. Can anyone speak to the personal happiness and quality of training received by physicians in Peds or IM?

2. As with the other person interviewing at USUHS, I was told by my recruiter that 70-80% of Navy HPSP graduates would not serve as GMOs, and only those who wanted that experience or to increase their competitiveness for certain residencies (or failed to match) would do a tour. Truth check?

3. I really want to do this because I've always been interested in serving the people who sacrifice so much for our country... I won't go into all the details, but I promise I'm not doing it just for the money.

That being said, I also thought that it made sense financially for me to do this, and instead of a shut-the-hell-up-little-girl-you-don't-know-what-you're-talking-about, hear me out and explain to me why I'm wrong, if I am.

I attend a private medical school on full loans, and after I graduate, I will owe the government ~$300-350K. 6.8% percent interest is a reality that is here to stay, friends, and on some loans I have 9% interest. If I take a 3 year scholarship, followed by a theoretical 3 year peds/IM residency (barring GMO), I will only have a 3 years post-residency AD obligation, and as a pediatrician or internist, the pay-cut compared to civ practice is pretty seriously overshadowed by the lack of debt, especially since I want a family.

Any logical and well thought out answer would be much appreciated

If you have a true desire to serve, great, could be a decent choice for you. You mention a family, but do you have a current SO. If you do, how does he feel about you joining? Look at the various locations the services have hospitals. Are there any dealbreakers?

If indeed you end up in the Peds/IM arena, they are likely to skip the GMO tour but there is no guarantee. Pay for the primary care arena is not hugely different between the military and civilian world. Internists make less, but peds can make more. (historically peds gets paid crap in the civilian world).

Expect to deploy during your payback time, although where and for how long is changing. Who knows what it will look like in 6 years.

I have learned alot reading these posts. Now I have a question for anyone who wants to answer...I am a DA Civilian, Board Cert Psychiatrist, and work at a large Army installation. I spent most of my career in the civilian sector, and just as an aside, this is the best job I've ever had. (The grass is NOT greener on the other side of the fence - the grass is DEAD. )

And by the way, AHLTA has it's disadvantages but compared to alot of other EMR'S I've used, it's really not that bad, and you have to take into account that the system is up and running 24/7/365 GLOBALLY, not just in one office or hospital.

And I do not hit the road at 1630. It's usually more like 1830 or 1900 as a rule. Some of my military colleagues are finishing up the first nine holes at that point...

So here's the question. The Army has a deal where if you can finish a two year obligation before you reach the age of 62, you can come on active duty. I'm seriously thinking about this - and since about half the people I've talked to ask if I've finally lost it, I'd be interested in your opinions. My reasons? There is a serious shortage in my specialty and a growing need that will outlast the current conflicts. Military service is a family tradition and I have always felt a duty to serve. And, finally, to better help my patients - as a psychiatrist it DOES make a difference to the soldiers that you know what it's like to be a green suiter.

So - I'm about a week away from submitting my application - anyone have any thoughts about coming on active duty at age 59? I'd love to hear from you.

Thanks

Originally Posted by ShrinkDAC

I have learned alot reading these posts. Now I have a question for anyone who wants to answer...I am a DA Civilian, Board Cert Psychiatrist, and work at a large Army installation. I spent most of my career in the civilian sector, and just as an aside, this is the best job I've ever had. (The grass is NOT greener on the other side of the fence - the grass is DEAD. )

And by the way, AHLTA has it's disadvantages but compared to alot of other EMR'S I've used, it's really not that bad, and you have to take into account that the system is up and running 24/7/365 GLOBALLY, not just in one office or hospital.

And I do not hit the road at 1630. It's usually more like 1830 or 1900 as a rule. Some of my military colleagues are finishing up the first nine holes at that point...

So here's the question. The Army has a deal where if you can finish a two year obligation before you reach the age of 62, you can come on active duty. I'm seriously thinking about this - and since about half the people I've talked to ask if I've finally lost it, I'd be interested in your opinions. My reasons? There is a serious shortage in my specialty and a growing need that will outlast the current conflicts. Military service is a family tradition and I have always felt a duty to serve. And, finally, to better help my patients - as a psychiatrist it DOES make a difference to the soldiers that you know what it's like to be a green suiter.

So - I'm about a week away from submitting my application - anyone have any thoughts about coming on active duty at age 59? I'd love to hear from you.

Thanks

You'd be in a completely different boat from most of us. You'd come in as a senior officer and probably get to stay at a large med cen. So it wouldn't be a terrible idea. Although it's probably smarter to stay on a civilian contractor.

Originally Posted by Mirror Form

You'd be in a completely different boat from most of us. You'd come in as a senior officer and probably get to stay at a large med cen. So it wouldn't be a terrible idea. Although it's probably smarter to stay on a civilian contractor.

Yeah, I guess it would be nicer. It seems though that you would be sacrificing substantial freedoms in your career and life to...what? Make less money and wear different clothes to work every day? You're already serving active duty troops my friend, and ironically if you come onto active duty you will be able to do a lot LESS for those troops you like to help.

If you came in at O-5 (doubt O-6, though not impossible), you're entering a political arena that you may or may not be able to adapt to. I've personally sat in some meetings that made the Mad Hatter's tea party seem sane. But you'll still have to attend many of these meetings which you didn't have to as a civilian. Also, these senior level jobs require lots of supervising and paper-pushing for your subordinates. That adds up, and you will be doing well to have even half your time to devote to actually being a psychiatrist.

There's also a strong chance that you could spend a good amount of time in Afghanistan. No offense dude, but you're almost 60.

So to tally up:
You would:
- Give up your freedom in where you live, work, how you dress, etc
- Make equivalent or possibly less money
- Have to take on O-5 type admin duties, which would force you to spend less time working with the troops. Which accomplishes the opposite of one of the major reasons you want to do this.
- Possibly get deployed to some godforsaken place where because of your age you stand an increased chance of getting injured and/or needing a med-evac. Do you want to be the guy in this story?: "Yeah, I can't believe the Army let a 60 year old doc out here. Big surprise, he's having chest pain. Now we have to fly out there and maybe get shot at so we can drag him back home."

I'm having a reeeeaaaalllly hard time seeing any upside for you, the military or your troops in all this.

Originally Posted by AF M4

So to tally up:
You would:
- Give up your freedom in where you live, work, how you dress, etc
- Make equivalent or possibly less money
- Have to take on O-5 type admin duties, which would force you to spend less time working with the troops. Which accomplishes the opposite of one of the major reasons you want to do this.
- Possibly get deployed to some godforsaken place where because of your age you stand an increased chance of getting injured and/or needing a med-evac. Do you want to be the guy in this story?: "Yeah, I can't believe the Army let a 60 year old doc out here. Big surprise, he's having chest pain. Now we have to fly out there and maybe get shot at so we can drag him back home."

And what about BOLC, C4, CCC, etc? Would he have to do those?

Originally Posted by Mirror Form

And what about BOLC, C4, CCC, etc? Would he have to do those?

If he was to be deployable, I imagine so. And usually they don't accept accessions when they know the person isn't going to be deployable. I was at C4 and SERE with a guy in his early 40's (Air Force), so I say yes, he would have to go to similar.

Originally Posted by AF M4

If he was to be deployable, I imagine so. And usually they don't accept accessions when they know the person isn't going to be deployable. I was at C4 and SERE with a guy in his early 40's (Air Force), so I say yes, he would have to go to similar.

LOL, how funny would it be if he signed up for 2 years, and then spent the first 6 months doing BOLC, C4, and CCC?

Originally Posted by Mirror Form

LOL, how funny would it be if he signed up for 2 years, and then spent the first 6 months doing BOLC, C4, and CCC?

And then VFR direct to Kandahar. Crap!

Pro: military patients can give a coherent history. Finishing up my first AD rotation and I'm still in shock that people can remember the drugs they're taking, when symptoms started and resolved, etc. I never realized how motivating it could be to have patients that are actually motivated.

Originally Posted by Perrotfish

Pro: military patients can give a coherent history.

Con: ... but few are really that sick.

Originally Posted by notdeadyet

Con: ... but few are really that sick.

Less of a con in Peds. The % of military kids who are sick probably isn't that much below the average.

Originally Posted by AF M4

There's also a strong chance that you could spend a good amount of time in Afghanistan. No offense dude, but you're almost 60.

Do you want to be the guy in this story?: "Yeah, I can't believe the Army let a 60 year old doc out here. Big surprise, he's having chest pain. Now we have to fly out there and maybe get shot at so we can drag him back home."

I'm having a reeeeaaaalllly hard time seeing any upside for you, the military or your troops in all this.

Thanks, all, for your input. You give me a lot to think about.

A 76 (or so) year old surgeon came through our SRP site not too long ago...

Certainly giving up one's freedom is a big consideration. At this stage of my life and career, though, I'm not looking at what I would get out of this - I'm looking at what I can give to the situation. But there is a lot to consider...
I'm already doing O5 admin stuff so no change there...(I'm GS - not a contractor) That's really funny though about doing the CCC, etc - if I played it just right I could stay TDY the whole time. But seriously I'm fairly sure that aside from required medcom pre-deployment courses and officer basic, that would not be a burden.

But you make good points, worth consideration. Thanks again.

ShrinkDAC (dudette, pushing 60 and doing 100 push ups a day)

Originally Posted by ShrinkDAC

Thanks, all, for your input. You give me a lot to think about.

A 76 (or so) year old surgeon came through our SRP site not too long ago...

Certainly giving up one's freedom is a big consideration. At this stage of my life and career, though, I'm not looking at what I would get out of this - I'm looking at what I can give to the situation. But there is a lot to consider...
I'm already doing O5 admin stuff so no change there...(I'm GS - not a contractor) That's really funny though about doing the CCC, etc - if I played it just right I could stay TDY the whole time. But seriously I'm fairly sure that aside from required medcom pre-deployment courses and officer basic, that would not be a burden.

But you make good points, worth consideration. Thanks again.

ShrinkDAC (dudette, pushing 60 and doing 100 push ups a day)

Will you deploy when asked? Regardless of the job, duration or location? Even if you have an excuse that could be used to get you out of deployment? If so, sure, come on in. You have a better understanding of mil med than most people making that decision.

Originally Posted by Gastrapathy

Will you deploy when asked? Regardless of the job, duration or location? Even if you have an excuse that could be used to get you out of deployment? If so, sure, come on in. You have a better understanding of mil med than most people making that decision.

There are also civilian contractor jobs at most of those locations. So you could pick one that you wanted and serve that way too.

Originally Posted by Gastrapathy

Will you deploy when asked? Regardless of the job, duration or location? Even if you have an excuse that could be used to get you out of deployment? If so, sure, come on in. You have a better understanding of mil med than most people making that decision.

Of course I would deploy if asked. That goes with the territory. Thanks.

Originally Posted by ShrinkDAC

Of course I would deploy if asked. That goes with the territory. Thanks.

Every base has "that guy/gal" who doesn't seem to understand the above, and every time they get tasked for a deployment they come down with some ailment that prevents them from going thus putting their colleague who's already deployed 3 times in 4 years back on the plane. I'm sure you've met a few of them in your job; it's good to hear that you are OK with deploying.

Originally Posted by DiveMD

It was also designed to make the life of the “bean counters” easier. Also, it provides a sense of RVU output per MD which provides the necessary information needed to civilianize certain positions.

It's also what drives the decisions as to how many providers can be hired per department, and ultimately (when we start seeing defense budgets cut) who is pulling their weight and who isn't.

For those of you who don't know what RVU's are - about thirty years ago, Satan and his minions sat down and decided they would assess a "relative" value associated with each "procedure" done by a provider. I still can't figure out who gets to decide where something falls on the value scale but very little value is placed on the thought process that goes into providing care or the time it takes to be thorough. Or to be compassionate or to help your patients understand their care etc.

The practice of medicine is NOT a business.

The saving grace for Army medicine is that so far, the DOCTORS retain control. That's why I don't mind doing a certain amount of admin work. If you forfeit the responsibility of managing the admin side of your practice (and civilian docs have gone in that direction) then your professional life will be controlled by bean counters and not people whose primary interest is rendering quality patient care.

Originally Posted by ShrinkDAC

The saving grace for Army medicine is that so far, the DOCTORS retain control. That's why I don't mind doing a certain amount of admin work. If you forfeit the responsibility of managing the admin side of your practice (and civilian docs have gone in that direction) then your professional life will be controlled by bean counters and not people whose primary interest is rendering quality patient care.

Uhm yeah, I wouldn't be so sure of that. Most civilian doctors are in private practice. They hire admin people to do the admin, but they retain control as owners of the business.

Whereas, in the military, you have zero control. You get assigned admin that is pointless for a physician to be doing. Sure, your hospital commander will probably be a physician, but your immediate supervisor might not be.