Considering HPSP with a Family

[Radtad]

Hey everyone,

I am applying to medical school this year and have been debating on going for the HPSP scholarship or just doing the student loans. I am a nontraditional student that has been working as a nuclear medicine technologist for the last eight plus years. I am 30, married, and have two kids. My kids are 9 and 7. My wife has been able to stay at home with the kids the whole time and that is something that has been important to us. While working I received my undergrad in biology. I have known since my clinical rotations for nuc med, some nine years ago, that I wanted to be a doc. I have been working towards it ever since. Now that my distant dream has come closer to reality I have been stressing which path to choose as far as military (Army) or not. So I was hoping that I could have a few of you who have been in my position help me out, give me some advice, and answer a few questions.

From what I understand the way the scholarship works is you apply, accept, and start receiving benefits throughout the four years of medical school. I am aware of the sign on bonus and monthly stipend, but is there also health insurance? Also is the monthly stipend adjusted for dependents, housing, cost of living for geographical areas etc? Will they repay my undergrad loans like through the GI Bill? I have no prior service, but this is something that I don't know much about. Then after the four years of medical school you do a military match residency where the number of available slots in each specialty can change year to year. From what I gather a person chooses three slots and must accept the one that is given right? Let’s say I am interested in radiology, but there are only two slots available, so for my third I put oncology even though it’s not what I really want. If I am accepted there and not in one of the radiology slots do I have to go? I guess what I’m getting at is how much control does the military have over your specialty choice? While you’re doing your residency you receive a military check as well as a civilian one, or is it all still coming from Uncle Sam? I am also under the impression that the military residencies are a little more relaxed than a civilian one and that you are also allowed a vacation is this true? Then after residency you have to repay your service commitment for the next four years and the military can put you anywhere it needs you. I have also read that it is very likely that I will be deployed and that as a physician that deployment is usually longer than anyone else in the unit right? Also how much does it matter if you are a DO as compared to an MD in the military? Is there limitations in residency match, etc?

I have read many times that doing the HPSP for the money is not worth it, and I am not just considering it for the money, although it is a huge factor, I also have a desire to serve my country. I know that the HPSP in comparison to loans and a civilian route is about a wash in terms of money. The downside to the military is lack of freedom in location, a lot of bureaucracy in practicing medicine, and about half the income during the service commitment as compared to a civilian physician. But for me in my situation it seems really appealing. I would have the security of the stipend, and health insurance for my family during the four years of medical school. I would also bring home a larger check during residency while not having to worry about paying back my student loans. My kids are my number one concern in the pursuit of this dream. I am worried about doing the loan route and having to pay on my loans while in residency making very little. They would be teenagers then and I just want to be able to provide for them the best I can. By the time I would have to repay my service commitment they would be in college or close to it. Not saying that they wouldn’t need me around if I were deployed, but by that age I think they would understand a lot more and be able to cope with it a little better than if they were younger. My wife doesn’t really have any set of skills to where she could provide a decent income during the course of medical school or residency. She has always wanted to be a stay at home mom, and I have been happy to provide her with that. So the responsibility of it all lies on my shoulders. I would just like to consider all of my options and try to make the best decision possible. I’m sorry for the length, but this is a big decision for me and it would be nice to get some questions answered as well as some advice from those who may have been in a similar situation.

---

Members don't see this ad.

 

[HighPriest]

I was also nontraditional, although I did not have children.
You do not get health coverage in the HPSP. You'll need to be covered of your own volition until you actually go on active duty. From that point on, you get Tricare/United Healthcare. My first piece of advice is to immediately sign your family up for Tricare Standard, so that you can actually have them see a physician (rather than a rotating carousel of 30 PAs, none of whom you see more than once), and so that they can actually see a provider in less than 6 weeks without going to the ER.
The HPSP monthly stipend is fixed, unless that has changed since I was in medical school (it may have, I didn't get a sign-on bonus, and the stipend wasn't enough to cover my rent and food, let alone everything else, and now it is better.) They will not repay your undergraduate loans. You're on your own. I had quite a few, PLUS I had to take out some small loans for med school.
You are required to participate in the military match. You are required to rank 5 spots. In some cases, those spots will all be in the same specialty. In my case, i ranked 4 spots in what I actually wanted to do, and then had to rank a fifth slot in another specialty entirely - even though I actually been called for enough civilian intervews to have a reasonable change of matching. What I mean by that is that, had I not been picked by my top four, I would have likely ended up doing something I did not want to do, even though on the civilian side I had a high likelyhood of matching where I wanted to be. In any case, the number of available slots don't change all that much. there is some variation, but it is more about variable competativeness than it is number of spots.

If you match into a military specialty, you must take that specialty, regardless of what it is. That is why you either try to pick a good second choice, or you pick a transitional year internship, and then try again the following year (or go GMO).

How much control the military has over your specialty choice is a debatable and amorphous thing. Technically, they have little control over the match process, but they can certainly limit your choices, and set you up for a specialty you did not want. Being competative and not having a freakish personality obviously helps, but the year before I applied to my specialty, we had a 25% match rate. Meaning that 3/4 people who applied failed to match, and I promise that many of those people were competative and had great personalities. One of my colleagues, in fact, had good scores and is a great person, but just did not match that year. He ended up doing an internship in a completely different field, and then applied again.

While you're in your residency, you're paid as a military officer. You get base pay, BAH, BAS, and some other pay bonuses depending upon your level of credentialling.

Some military residencies might be relaxed. Mine was not. My training was more or less the same in terms of intensity as my civilian counterparts, save that we did less research but much more hands-on training. You are allowed vacation in both military and non-mliitary residencies. This is determined by the ACGME, not the military. In fact, the ACGME takes precidence because they have tighter regulations than the military in terms of training, vacation, work hours, and what not. The military wants to maintain it's ACGME accreditation, and so they follow the guidelines. In fact, most people finish residency with a huge block of built up levae time because you're allowed less vacation through the ACGMe than the military awards you.

Your payback depends upon your training time. In the simplest terms possible: if you took HPSP for all four years of medical school, then you'll owe four years unless your residency was longer than 5 years total (including intermship) or unless you did a fellowship (which also adds time).

Then the Army decides where to put you. That could be anywhere. It could be great, or it could suck terribly. Your deployments as a physician are usually shorter than the guys working the line, but that can change with the wind. Your likelihood of deployment depends upon your specialty, to a great extent. Some people deploy constantly, others rarely. it also depends upon the deployment tempo, which had been downswinging, but may not start to go the other direction.

The military does not care if you are a DO or an MD. All of the residencies are ACGME, MD, residencies. All that being said, i know some program directors do care if you're an MD or a DO.

I think money alone is a bad reason to do HPSP. I used to think serving your country was a good reason, but now I'm not sure thats true. I think depending upon what you do, where you do it, and whether or not you're deployed, you might feel like you're serving your country. I don't feel like I'm doing anything particularly important for my country. I'm doing exactly the same job that I would be outside the military, mostly for family members rather than soldiers. the only difference is that I do a lot more administrative BS. I feel like the work I do helps family members and soldiers, and I like that, but if I had not done HPSP and I had taken a job near a military base, I'd be doing exactly the same work for my country except with more personal freedom and less BS. I have a civilian partner (call sharing) who works 10 minutes away from the military hospital. He does the same job that I do. I think he's serving our country just as much as I am.

The pay is about half of civilian pay depending upon what you do. If you're in the primary care field, you might make more in the military while doing less work. A lot of people on this board talk about how everyone in the military works less than their civilian counterparts. I don't. I see about as many patients/week and I operate more than most of the civilians I know. But that is definitely station-dependent. I also know guys who do next to nothing and make close to what they would on the outside.

Again, you would have to pay for health insurance while in med school. But yes, it is nice to have a bigger paycheck and insurance for your family while in medical school. The security is nice, although as a physician who is presumably not insane, there's plenty of job security out there in the first place. I can see how it would make sense if you were set on going to medical school with a family to take the HPSP scholarship. In that case, it's a sacrifice for your family rather than just a blood letting on the alter of nationalistic BS. That being said, your family will have to sacrifice a lot of it's own personal freedom. You may end up living somewhere that your wife and kids hate. My wife hates where we live currently. We make the best of it, but she's miserable. I am too, mind you, but it's harder to see her unhappy. We knew ending up someplace like this was possible, because we're not *****s, but it's an easier commitment to make when that possibility is 9 years in the future.

 

[Radtad]

Thank you for your reply, answering my questions, and providing your insight. I really appreciate it. I will continue to consider the HPSP as an option, but I think I will try (at least for the first year) to do it with student loans and see how it goes. Especially if I get accepted at my cheaper state school. If I cant go there, but get accepted elsewhere, I feel like the scholarship would make more sense. I guess now I just wait and see where I end up.

 

[sheezy]

As an HPSP in my 4th year, regarding health insurance, the navy covers you for whatever plan you get through the school (because I'm fairly certain it's required). Mine offers BCBS, and they give the option for dependents, as there are plenty of people in med school with families. So as far as I know, I have free health care right now simply because the navy covers it via their payment for my tuition.

*They just changed the application, so now you choose your top 2 subspecialties, and you rank the hospitals separately, as opposed to choosing your top 5 programs.

 

[Atticum]

I have kids and I am Army HPSP with another guy with kids. Another of our classmates is Navy HPSP with kids. None of our wives work. The Army covers health insurance only if it is required by the school. At my school it is highly recommended but not required. I would highly suggest communicating with admissions and/or student affairs about this before making any decision. I doubt you can find many schools that require your entire family to be covered, which is the only way that the army is gonna pay for it. One thing to consider is whether or not you'll be eligible for medicaid.

OTOH, I go to a school that will still let you take out federal loans even when you are HPSP! This is definitely not the case everywhere. Being able to take out these loans is a huge benefit that I may have to use down the road when the bonus runs out. We can also get smaller loans specifically for childcare, auto purchases, etc.

The stipend is fixed but you will get paid more for the 45 days of active time during the summers since you are married with dependents.

 

[NorthernDO]

Do you have to do a military residency with HPSP? or can you do a civilian residency and then do your active duty service?

 

[Atticum]

Do you have to do a military residency with HPSP? or can you do a civilian residency and then do your active duty service?

This is discussed in any of the multitude of HPSP threads.

The army has enough residency programs that you will almost certainly do a military residency. There are a few specialities that you might have a chance of getting a civilian residency... neurosurgery comes to mind. Basically, if you have any desire to do a civilian residency, don't do Army HPSP.

 

[NorthernDO]

This is discussed in any of the multitude of HPSP threads.

The army has enough residency programs that you will almost certainly do a military residency. There are a few specialities that you might have a chance of getting a civilian residency... neurosurgery comes to mind. Basically, if you have any desire to do a civilian residency, don't do Army HPSP.

I was under the impression for some reason (I think someone told me a while ago) if you do a military residency then you must give back service for that residency time as well, in addition to the HPSP service commitment of 4 years (if you get the hpsp for 4 years that is).

 

[Atticum]

No. Residency does not count for or against you, regardless of whether its army or civilian. After residency you pay back whatever was longer: medical school or residency.

http://lmgtfy.com/?q=army+hpsp

 

[colbgw02]

No. Residency does not count for or against you, regardless of whether its army or civilian. After residency you pay back whatever was longer: medical school or residency.

http://lmgtfy.com/?q=army hpsp

This is a mischaracterization. After internship, any GME program during which the military pays you absolutely confers an obligation (i.e. counts against you) at a rate of 6 months for 6 months with a two year minimum. This obligation can be paid back concurrently with another obligation, such as HPSP or ROTC, but not another another GME commitment (fellowship + residency). If you don't have your training interrupted, then you won't ever "notice" the extra obligation, assuming that your residency is 5 years or less. However, it's important to understand how it works if you are, for example, doing a GMO tour, lest you end up owing more years than you originally thought.