MDSSP / STRAP / HPLRP and my situation

[coolrunnings22]

Hi all

I have done a decent amount of research so forgive me if any of these have been answered elsewhere.

I am 28 years old and will be hopefully embarking upon a pre-med post bacc in two years. The post-bacc has a linkage to a medical school (private: $42k / yr) so I would hopefully be matriculating there in 2017 at the age of 31. I have always been interested in serving so this would be a natural fit for me. I would have considered HPSP if it wasn't for the much higher chance of not getting the speciality you want / GMO / etc. I am married and will likely have a kid or two while in school (again, hopefully). Here is my understanding of how it all works:

Med School - MDSSP

- c.$28k / yr (drill pay, stipend, annual training)
- 6-12 drill weekends a year (depending on flexible arrangements)
- leave with 8 year commitment

Residency - STRAP (assuming your specialty is on the critical skills shortage list)

- c.$30k / yr (drill pay, stipend, annual training) in addition to civilian residency pay
- can do any residency program you like

Residency (after PGY2) - HPLRP

- Pay off $40k FEDERAL loans per year for up to 6 years

After Residency

- Could work anywhere you wanted
- 12 drill weekends a years
- Potential for 3-4 month deployments every 2-5 years
- Assuming I did all the above, including 4 years MDSSP, 4 years STRAP, and had $240k loans paid off, my commitment would be 20 years

Obviously, this could all change in an instant, but am I understanding this all correctly? If not, please let me know where I have gone wrong.

Here are my questions:

1. Could I join the national guard during my post-bacc year and utilise the GI Bill to help pay tuition? If so, would I be able to switch across to "Medical Student" when enrolling in medical school?

2. Could you also claim 3 years of c. $365 / month GI Bill while in medical school, in addition to the drill pay and stipend?

3. When applying for residency programs and then full time jobs, would being tied to the national guard make you a less attractive applicant? Are there any specialties that are better / worse in this respect?

4. What are the current critical skills shortage specialties, and where can I find these? Would doing a fellowship disqualify you? For example, if you were to general surgery and then critical care, would you still be considered a general surgeon for these purposes?

5. Given I would be around 38-40 when I finish my residency, would I be able to do all of this, assuming a 20 year payback? Wouldn't I be forced to retire at a certain age?

6. Are any private schools eligible for Tuition Assistance? Or is this just public schools? Will this vary by state?

7. How do the army and air national guards compare for the programs above? Are there big differences?

8. I would love to start the post bacc next year and matriculate to medical school at the age of 30, however I am going to spend another year working to pay off my $60k private undergrad loans and save enough money to pay for the post-bacc tuition and living expenses. Is there any way the national guard could help me make it work without having to spend this extra year working in a job I hate just to save up money? I guess there are no programs that will help pay off private loans? How about programs that would help fund a post-bacc?

Many thanks all.

J

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[notdeadyet]

Hey, coolrunnings. Let me touch on the first part, then I'll take a stab at your particular questions... Nice summary, by the way...

For MDSSP and STRAP- The salaries (+/- $1-2K) is assuming that you go to every drill. You may need to, depending on your command, but most are good about the flexible drill schedule of roughly every other. This is especially true in medical school and intern year, when you can't really do anything. Once you're licensed, you can get pulled into more activity and missing drill can sometimes be harder. But in some states, you will be underutilized and folks won't much are when or how often you show up. National Guard's counterintuitively have a very different culture from state to state.

For HPLRP- you are not technically eligible until you finish residency UNLESS you are also taking STRAP. HPLRP could technically be cancelled or changed from its $240K ceiling back to its $50K ceiling. This is a policy, it's not in contract.

After Residency

- Could work anywhere you wanted
- 12 drill weekends a years
- Potential for 3-4 month deployments every 2-5 years
- Assuming I did all the above, including 4 years MDSSP, 4 years STRAP, and had $240k loans paid off, my commitment would be 20 years

Let's clarify the commitment part...

MDSSP incurs a commitment of 2 years of drill status service for every year you take the money. It's called a 2:1 obligation. So if you take MDSSP for 4 years, you owe 8 years of service. This 8 years starts ticking after residency (even though you drill while in medical school and residency, these don't count towards your obligation.

STRAP also incurs a 2:1 obligation, which begins after residency. However, if you take MDSSP followed immediately by STRAP, your MDSSP obligation changes from 2:1 to 1:1. So if you did what you describe (4 years of MDSSP + 4 years of STRAP), you would owe 12 years of obligation starting after residency.

So if you signed up and joined the Guard in 2017 when you matriculated medical school and did 4 years of MDSSP and 4 years of STRAP, you would be in the Guard a total of 8 years before paying off your obligation, which would start after residency for 12 years. So you would be in 20 years before you could leave, or by 2037.

Keep in mind that this does not take into account HPLRP. You are not paying back obligations when you are incurring them, and HPLRP incurs an obligation of 1 year for each $40K payment (the only exception is for the PGY-3/4 years in which you can take it if you are on STRAP). The way it works is that you submit paperwork applying, and one year later, if you are still in the Guard as a doc, $40K is wiped from your federal student loans.

So in your scenario, if you wanted all $240K, you would take it during your PGY-3/4 years, then you would take it your first four years out of residency (to avoid continuing to rack up interest on your loans). But this would mean that you would not start paying back that 12 years of obligation until 4 years post-residency. So in this scenario you would be in the military a total of 24 years, or eligible to leave by 2041.

EDITORIALIZING:
I think MDSSP + STRAP is a terrible plan.

If you sign up for MDSSP and on your first day you decide you don't like the Army or Guard, you will still find yourself in uniform and required to drill and provide service for the next 16 years. This is because when you sign up for MDSSP, you are committed to take it from date of signature to completion of medical school. Unless folks have prior service and are certain of what they are getting into, I strongly advise against MDSSP. Your career goals are not very clear and it's not a decision you can back out of.

This is particularly true because if you find yourself going into a speciality the Guard doesn't use (radiology, anesthesia, etc.) you will be transferred to the Reserve Corps. In the past, the Guard and Reserve Corps have had slightly different benefits and they can have very different cultures.

And keep in mind that this opinion is coming from someone who is coming up on his date he can resign and is planning on continuing on. I enjoy my time with the Guard. But even so I'd warn anyone away from MDSSP + STRAP. In fact, even with all my years in and even with my having loved the experience, you couldn't offer me $100K cash in hand to sign a commitment for 16 years to anything.

 

[notdeadyet]

1. Could I join the national guard during my post-bacc year and utilise the GI Bill to help pay tuition? If so, would I be able to switch across to "Medical Student" when enrolling in medical school?

Terrible plan. For one thing, you will have to go through all sorts of training you do not need and schedule it around your post-bac (or more realistically, schedule your post-bac around it). You will not be on flex-training during your post-bac and you will not be excused from drill because you have finals or a big test. You will also be deployable during post-bac.

Lastly, you will not be eligible for the Post-911 GI Bill (aka the good one). You will only be eligible for a Guard flavor one which is only good for a couple hundred bucks. Not worth it.

If you did this, you would likely be able to switch to medical student status once you got in to medical school. If you don't get in to medical school, look forward to 6 years of....

2. Could you also claim 3 years of c. $365 / month GI Bill while in medical school, in addition to the drill pay and stipend?

If you did the above, yes. Think long and hard about it, though. Doing #1 ultimately will jeopardize your chances of getting in to medical school and has a strong chance of deferring starting your career as a doctor by a year. The opportunity cost is not worth the risk or $365/mo.

3. When applying for residency programs and then full time jobs, would being tied to the national guard make you a less attractive applicant? Are there any specialties that are better / worse in this respect?

It has the potential. You can not feasibly work in a solo or small practice. You will need to restrict your career to large employers. Even in these large employers, NG duty is a turn-off because it's still traumatic to have to cover for you while you're away. It can lead to resentment among colleagues (everyone is very hooah at first... until they have to cover for you yet again because you're gone on Guard duty).

4. What are the current critical skills shortage specialties, and where can I find these? Would doing a fellowship disqualify you? For example, if you were to general surgery and then critical care, would you still be considered a general surgeon for these purposes?

You can ask for a copy from your recruiter. The last one I have is from the 2012-2013 year. The list had gotten cut way short on the Guard side that year and I'd expect it hasn't gotten any better. It was limited to Field Surgeon, Flight Surgeon, and Psychiatrist. Not a big deal, as in the Guard, almost anyone is qualified to be a Field Surgeon (think primary care doc) but it does exclude certain specialties (radiology, nuclear, anesthesia, or pathology).

What does this mean to you? You would be filling a primary care type role for a unit for the Guard for the duration of your commitment regardless of specialty (unless you were a psychiatrist). If you were in one of the four specialties that couldn't, you'd be transferred over to the Army Reserve.

In the Guard, the role is primarily combat and combat support. So you will not find slots for neurosurgery and the like. This is largely a function of the Army Reserve.

5. Given I would be around 38-40 when I finish my residency, would I be able to do all of this, assuming a 20 year payback? Wouldn't I be forced to retire at a certain age?

Unless it's changed, mandatory retirement age was 62yo for the Army. And the policy allows for a few exceptions and one is specifically for officers providing healthcare.

6. Are any private schools eligible for Tuition Assistance? Or is this just public schools? Will this vary by state?

Hard to say. Tuition Assistance was suspended for us a couple of years back. Don't count on it.

7. How do the army and air national guards compare for the programs above? Are there big differences?

The Air Guard has almost no financial enticement programs for docs. I've tried to help folks look into this in the past and always pull tumbleweeds. It's just not there.

8. ...I guess there are no programs that will help pay off private loans? How about programs that would help fund a post-bacc?

Nope. You're on your own for private loans. No programs to help fund a post-bac. And HPLRP is limited to medical school loans.

Hope this helps...

 

[coolrunnings22]

Incredibly helpful, thank you. Although not what I wanted to hear haha.

In terms of career goals, I'm not fully sure but it would hopefully be something involving a lot of procedures, either: Emergency Medicine, General Surgery + Critical Care, Neurosurgery.

I wouldn't consider any of these military options just for the money - I almost applied for the Naval Academy out of high school and then for OCS out of college. I would not want to support my wife and future children through medical school on loans alone. Perhaps I should look into HPSP.

Food for thought, anyway. Thank you for your time.

 

[coolrunnings22]

Looking into the HPSP and if it would be feasible to speed up my application by a year...

If I started post bac in 2015, I would incur the following debts:

- Undergrad personal loans: $60,000
- Post Bacc Tuition: $25,000
- 1 year cost of living, minus any part time job I could hold down: $15,000
- TOTAL DEBT ENTERING MS1: $100,000
- POST TAX HPSP signing bonus: $15,000

Leaving $85,000 of mostly personal loans to pay off.

During medical school would have an income of approximately $30k and no debt whatsoever.

Could be an interesting option.

Thanks

 

[notdeadyet]

In terms of career goals, I'm not fully sure but it would hopefully be something involving a lot of procedures, either: Emergency Medicine, General Surgery + Critical Care, Neurosurgery.

I thought EM too and ended up in psychiatry. It's really hard to guess from the outside what specialty you'll be in.

That said, if I was interested in those specialties, I would definitely avoid HPSP. The EM programs don't hold a candle to the good civilian counterparts, surgery tends to suffer from low volume of cases, and neurosurgery has very few slots so applying is a crapshoot. Also, for someone who has finances in mind, neurosurgery is far and away the biggest financial loss you could face by entering an HPSP commitment.

I would not want to support my wife and future children through medical school on loans alone. Perhaps I should look into HPSP.

Then I would think long and hard about working hard and defering medical school until you are in a better financial situation. I looked long and hard at HPSP, but the loss of control over decent residency training was way too big a factor. And with HPSP, the lengthy period of time in which you will be doing who-knows-what who-knows-where was more of an impact for folks who enter medicine late as you are deferring your civilian career that much further.

Anyway, I hope the Guard stuff helps. I'd strongly recommend spending some time on this forum and reading through the FAQs and Pros/Cons articles that talk about HPSP in great detail. I looked at it long and hard when I was strongly considering signing up for it, and now a few years down the road and finishing residency, I can say that I could not be happier that I didn't go that route.

Best of luck in your path. For what it's worth, I matriculated at an older age than you'll be and still have no regrets about my decision.

 

[CoolRunnings]

Thanks again for the advice.

What exactly did you do, if you don't mind me asking?

I have spent a load of time today researching all of this. The idea of a GMO actually appeals to me so I may look into that. Medical school with HPSP, then an intern year, then 4 year GMO. Obviously this puts you back 4 years, but the pros/cons:

PROS
- stipend through med school
- graduate debt free
- decent pay through internship and GMO years
- GMO would be an excellent life experience, especially navy diving medical officer or flight surgeon
- get to pick a civilian residency of your choice. General consensus is that military GMO service would be good for your application

CONS
- puts you 4 years back. Wouldn't be starting PGY2 until 40.
- skills may atrophy during GMO years
- the rest of the military cons: lack of freedom, having to move, etc

Thanks

 

[idq1i]

PROS
- get to pick a civilian residency of your choice. General consensus is that military GMO service would be good for your application

CONS
- puts you 4 years back. Wouldn't be starting PGY2 until 40.
- skills may atrophy during GMO years


Thanks

You need to reconcile point 5 of the PROS and point 1+2 of the CONS.

I have not been GMOed, and I have (technically) worked within my specialty since going on AD 2.5 years ago. As someone who is currently applying to a competitive fellowship in a competitive geographic area, I can unequivocally say that my military service is NOT doing me any favors beyond the perfunctory "thank you for serving our country". I graduated from an average US MD school, top rank, top board scores, chief resident in residency, etc.

The only consensus is in the eyes of people that don't know any better (not directed at the poster, just in general)

 

[CoolRunnings]

Thanks for sharing.

What specialty are you in? Did you do military residency?

You say military medicine hasn't done you any favors...but has it done any harm?

 

[idq1i]

Thanks for sharing.

What specialty are you in? Did you do military residency?

You say military medicine hasn't done you any favors...but has it done any harm?

If I include all the info, that would make me rather identifiable for the curious. I trained civilian, and I am a part of the ROAD specialties

Harm? Well, kind of - indirectly. Case volume and variety is laughable, even by the standards of a sleepy community program. In a heavily procedure-focused subspecialty field, I can't produce a serious case log that a 1st year resident wouldn't laugh at. My location did not allow for moonlighting. I have to rely on superlatives of reference letters from residency, 2.5+ years ago. My boss is a nurse, and doesn't actually know what I do. I can't ask this person for a recommendation, as generally required by the fellowship programs as 1) it wouldn't contain anything of interest to a PD, and 2) it would emphasize the limited scope of my daily practice.

Why would a fellowship program gamble on someone who graduated 4 years ago and who barely touched the area of interest in which he is applying? Plus, there is always a question of if I'll be available by 7/2016, and concern about re-integration into the PGY-X world where you are no longer an attending.

Admittedly, an IM or FP doc is not likely to have most of these issues, so YMMV.

Also, I am trying to limit my responses to your assertion that military service improves your chances at quality GME. If you mean "harm" in a broader sense, there are plenty of other threads from current/former service members that addresses this question.

 

[Homunculus]

If I include all the info, that would make me rather identifiable for the curious. I trained civilian, and I am a part of the ROAD specialties

Harm? Well, kind of - indirectly. Case volume and variety is laughable, even by the standards of a sleepy community program. In a heavily procedure-focused subspecialty field, I can't produce a serious case log that a 1st year resident wouldn't laugh at. My location did not allow for moonlighting. I have to rely on superlatives of reference letters from residency, 2.5+ years ago. My boss is a nurse, and doesn't actually know what I do. I can't ask this person for a recommendation, as generally required by the fellowship programs as 1) it wouldn't contain anything of interest to a PD, and 2) it would emphasize the limited scope of my daily practice.

Why would a fellowship program gamble on someone who graduated 4 years ago and who barely touched the area of interest in which he is applying? Plus, there is always a question of if I'll be available by 7/2016, and concern about re-integration into the PGY-X world where you are no longer an attending.

Admittedly, an IM or FP doc is not likely to have most of these issues, so YMMV.

Also, I am trying to limit my responses to your assertion that military service improves your chances at quality GME. If you mean "harm" in a broader sense, there are plenty of other threads from current/former service members that addresses this question.

good post and excellent points. and you can thank the military for teaching you self restraint, lol.

to expound to a degree on idq1i's last point-- i've found it depends on the applicant and situation. 4 years is a long time as a GMO, and you are assuming they'd let you slide into a PGY2 slot. for primary care (which is what GMO's do, if they do any medicine at all) this may fly. i can't see it working for some of procedural specialties. someone may take you, but i'm not sure if you'd have your pick of the litter. it's hard to be competitive traditionally, and you will be taking a hit on LoRs, research (as a GMO kiss that goodbye) and other things a well rounded applicant has. you'll have some good stories, but your CV will stagnate.

when people leave service, however, even in specialties where we have lower numbers, i've not seen anyone not get a job they wanted or be forced into a crappy job someplace. most have done very well with the transition.

i think the best situation for your strategy to work is someone interested in family medicine with a 3 year obligation. i'm not saying your plan is impossible but for the stars to align it will take a lot more work.

--your friendly neighborhood "well, i spent 4 years prescribing ibuprofen-- i'm ready for the OR" caveman

 

[CoolRunnings]

Thanks for the responses guys - invaluable to hear from some BTDTs.

The situation would be slightly different from idq1i's, although I appreciate there are parallels. One thing that is almost universally accepted on these boards is that military residences, unless you get lucky, are pretty poor training experiences. Hence my (and many others') thought of completing an intern year then a 4 year GMO tour, something which I think I would enjoy more than the average med student given my long standing desire to serve and accepting all the negatives that entails.

The question becomes, assuming competitive board scores, med school performance, research, etc (again, all big assumptions), would someone who is competitive for a residency program pre GMO be competitive to the same degree (or less, or more so) following a 4 year GMO tour?

Homunculus suggested one would become less competitive due to CV stagnation, which makes sense. Anecdotal evidence on here, however, suggests candidates remain as competitive, if not more, due to a more rounded CV and life experience that sets them apart from the average med student during interviews. The hardest part, according to most BTDTs, is arranging time off for interviews and making the timing of exiting from the military work.

Thanks for your thoughts guys and girls - please do keep them coming.

 

[deleted480308]

Mdssp is not a 16yr commitment day one, it's a 2:1 paybaack on top of you initial 8yr sign up but you only accpet the mdssp in 6month blocks. You can decline to take additional blocks. So a day 1, holy crap I messed up, would cost you total of 9 years assuming you are out of residency by 8.

 

[deleted480308]

Also (and this shouldn't change a decision) but my understanding is we aren't eligible for the gibill select reserve until we graduate bolc, but then we are eligoble for the bill and the kicker (~700/month) for up to three years

 

[notdeadyet]

Mdssp is not a 16yr commitment day one, it's a 2:1 paybaack on top of you initial 8yr sign up but you only accpet the mdssp in 6month blocks. You can decline to take additional blocks. So a day 1, holy crap I messed up, would cost you total of 9 years assuming you are out of residency by 8.

Per regs, if you take MDSSP for a only a portion of medical school, it must be taken until conclusion. In other words, you can take it for 2-1/2 years, but then it must be from halfway through MS-2 to graduation.

 

[notdeadyet]

Also (and this shouldn't change a decision) but my understanding is we aren't eligible for the gibill select reserve until we graduate bolc, but then we are eligoble for the bill and the kicker (~700/month) for up to three years

I don't know about the kicker for the reserve flavor, but check the commitment for the reserve GI bill.

 

[deleted480308]

Per regs, if you take MDSSP for a only a portion of medical school, it must be taken until conclusion. In other words, you can take it for 2-1/2 years, but then it must be from halfway through MS-2 to graduation.

$&@$ing recruiters...they showed me ngb810 which is resigned every six months and said to get out of additional mdssp time, all you had to do was not file ngb810. I did some searching on policies and found that you are right. You can take it for only a portion of med school (start mdssp late for whatever reason) but once the checks flow you are bound until graduation

 

[coolrunnings22]

I could spend another year working (2.5 years until starting post-bacc, 3.5 until med school) and save another $140k or so towards medical school which would significantly lower the loan burden. But I would almost rather start a year earlier, have more loans, but have another year ultimately doing what I want to do. I would also be afraid that doing this for another 2.5 years I would lose my way, be attracted to the money, and end up doing this forever.

 

[Homunculus]

. One thing that is almost universally accepted on these boards is that military residences, unless you get lucky, are pretty poor training experiences.

depends. "poor" is a relative term give the wide varieties of civilian programs. for primary care and some other specialties, i would put the military residencies firmly into average to above average depending on the program.

4 years is a long time-- and the things you do as a GMO are interesting for sure, but how do you list those interesting experiences in a meaningful way on an application that a civilian cares about? military awards are in a similar boat. most of the time they will be listed in "other" if listed at all. an ARCOM or MSM or BSM means squat to the civilian world. it may be helpful to poll some PD's in the field you are interested in and gauge their enthusiam or acceptance of this type of scenario before you commit.

--your friendly neighborhood where do I list my PT scores on my CV caveman

 

[idq1i]

4 years is a long time-- and the things you do as a GMO are interesting for sure, but how do you list those interesting experiences in a meaningful way on an application that a civilian cares about? military awards are in a similar boat. most of the time they will be listed in "other" if listed at all.

THAT.

In addition, even avoiding the thole GMO thing:

So I have already been a division chief/"chairman" of a fair-sized department. If I put that on a CV, it looks to a civilian PD that I won't play nice as a fellow/won't take directions. If I omit this, it looks like I've been twiddling my thumbs when asked about my case load. Damned if I do, damned if I don't.

 

[notdeadyet]

I could spend another year working (2.5 years until starting post-bacc, 3.5 until med school) and save another $140k or so towards medical school which would significantly lower the loan burden. But I would almost rather start a year earlier, have more loans, but have another year ultimately doing what I want to do. I would also be afraid that doing this for another 2.5 years I would lose my way, be attracted to the money, and end up doing this forever.

If you're worried about those kind of changes of heart over the next three years, that's more reason not to sign a contract for 20...

Med school debt is intimidating but so is opportunity cost. This cuts both ways: the cost of putting off med school and the cost of doing a GMO for four years and then doing a civilian residency. I didn't do a military residency (and am glad) but the folks above are giving you good food for thought....

But there are MANY ways to pay off debt later. You could pay off med school largely just by signing up after residency and drilling for 6 years in the Guard and paying back via HPLRP or going active and taking an accession bonus then. My point is that there are a lot of ways to skin this cat.



Sent from my iPhone using Tapatalk

 

[coolrunnings22]

You could pay off med school largely just by signing up after residency and drilling for 6 years in the Guard and paying back via HPLRP or going active and taking an accession bonus then. My point is that there are a lot of ways to skin this cat.

So if you take HPLRP during residency you have to take STRAP also, but if you take HPRLP after residency you can do it by itself? And the payback is only incurred while they are paying you the $40k / year. So if you do 6 years of payback to total $240k the payback would be the 6 years while you were being paid? So after you stop getting paid, there is no further service requirement?

 

[coolrunnings22]

Another option that does get me to medical school as soon as possible:

2015: Begin post bacc, taking out loans to cover it. End this year with $100k of debt total.
2016: Begin M1, taking HPSP (20k bonus + c.30k / yr)
2020: Begin military PGY1
2021: Begin 4 year GMO tour
2025: Begin civilian PGY2 (age 39)

This works out financially slightly worse than going straight through and taking out loans rather than serving, but has the effect of smoothing income so I'm not incredibly poor and reliant on loans for 4 years, which is a benefit as I am married and will likely (hopefully) be having a child in medical school. I also have a desire to serve and frankly think a GMO tour sounds like an amazing experience.

One question: if one were to complete a surgical internship, then do a 4 year GMO tour, then apply to civilian residencies for specialties with straight through residencies (like neurosurgery or ortho), would you be able to come in as a PGY2, or start over as a PGY1?

Thanks

 

[notdeadyet]

So if you take HPLRP during residency you have to take STRAP also, but if you take HPRLP after residency you can do it by itself? And the payback is only incurred while they are paying you the $40k / year. So if you do 6 years of payback to total $240k the payback would be the 6 years while you were being paid? So after you stop getting paid, there is no further service requirement?

Correct.

 

[notdeadyet]

This works out financially slightly worse than going straight through and taking out loans rather than serving, but has the effect of smoothing income so I'm not incredibly poor and reliant on loans for 4 years, which is a benefit as I am married and will likely (hopefully) be having a child in medical school. I also have a desire to serve and frankly think a GMO tour sounds like an amazing experience.

A few thoughts on this:

1. Like I said above, it's a toss up what specialty you go in to as your choices may (and are likely to) change during medical school. That said, if you do end up going into neurosurgery or ortho, you will end up losing hundreds of thousands of dollars ($600-800K?) by going the route you propose above due to the pay differential between what a GMO makes vs. what an ortho or neurosurgeon makes. You would be much better off taking high interest loans and live on a comparable salary to what you'd make in HPSP over four years and pay that back with your first year's salary and still come out hundreds of thousands of dollars ahead.

2. A GMO tour sounds much more amazing before you actually learn how to become a doctor. Doing sick call for PA-level stuff sounds amazing before you start medical school, but by the time you enter residency, this will not sound appealing and you will worry about skill atrophy. The fun of riding shotgun in a jet, blowing bubbles, or going out to sea sounds awesome but for most of us, this does not make up for the time spent working below your ability. To say nothing of potentially leaving your wife and young child or two for a year while you deploy. If your interest is truly service, you can do a lot more for the military as a residency-trained doc than an intern as a GMO.

One question: if one were to complete a surgical internship, then do a 4 year GMO tour, then apply to civilian residencies for specialties with straight through residencies (like neurosurgery or ortho), would you be able to come in as a PGY2, or start over as a PGY1?

In general, it appears that the more procedural the specialty, the more likely you will have to repeat an intern year (which sounds like not much now, but after you've finished an intern year the idea of doing it again sounds horrrrrrrible).

Also, the impact of having a GMO on your residency will likely get you a lot more play in a family practice or internist residency than for something highly competitive like neurosurgery or ortho. To many of those programs, you are someone who has been doing something non-related for four years as your potential skills atrophy. You will likely get traction at a few programs, but overall it would be hard to argue that your odds would be better than if you'd applied straight out of medical school. Primary care and psychiatry programs like folks who stand out and are different from the pack, but you'll find programs like neurosurgery are not as interested in the fact that you got to ride in an F-14.

I'd strongly recommend reading through the FAQs about GMO tours.

 

[DeadCactus]

Hey, notdeadyet, what's the HPLRP contract look like? I'm tempted to do the STRAP + HPLRP thing, I'm curious if you lock in the $40k/year or if you leave yourself open to the loan repayment decreasing while you're locked into STRAP...

 

[coolrunnings22]

A few thoughts on this:

1. Like I said above, it's a toss up what specialty you go in to as your choices may (and are likely to) change during medical school. That said, if you do end up going into neurosurgery or ortho, you will end up losing hundreds of thousands of dollars ($600-800K?) by going the route you propose above due to the pay differential between what a GMO makes vs. what an ortho or neurosurgeon makes. You would be much better off taking high interest loans and live on a comparable salary to what you'd make in HPSP over four years and pay that back with your first year's salary and still come out hundreds of thousands of dollars ahead.

2. A GMO tour sounds much more amazing before you actually learn how to become a doctor. Doing sick call for PA-level stuff sounds amazing before you start medical school, but by the time you enter residency, this will not sound appealing and you will worry about skill atrophy. The fun of riding shotgun in a jet, blowing bubbles, or going out to sea sounds awesome but for most of us, this does not make up for the time spent working below your ability. To say nothing of potentially leaving your wife and young child or two for a year while you deploy. If your interest is truly service, you can do a lot more for the military as a residency-trained doc than an intern as a GMO.

In general, it appears that the more procedural the specialty, the more likely you will have to repeat an intern year (which sounds like not much now, but after you've finished an intern year the idea of doing it again sounds horrrrrrrible).

Also, the impact of having a GMO on your residency will likely get you a lot more play in a family practice or internist residency than for something highly competitive like neurosurgery or ortho. To many of those programs, you are someone who has been doing something non-related for four years as your potential skills atrophy. You will likely get traction at a few programs, but overall it would be hard to argue that your odds would be better than if you'd applied straight out of medical school. Primary care and psychiatry programs like folks who stand out and are different from the pack, but you'll find programs like neurosurgery are not as interested in the fact that you got to ride in an F-14.

I'd strongly recommend reading through the FAQs about GMO tours.

Thanks for this. I have spent a significant amount of time researching GMOs and military medicine in general. I really appreciate your help.

I understand that military medicine may not be a good choice for an aspring ortho or NSG, but how about general surgery? Would it be difficult to go back to a civilian residency program as a PGY2 in general surgery after a 4 year GMO tour?

Also, how about EM? What sort of internship would be recommended for someone who wanted to do EM and would it be difficult to go back to a civilian EM residency as a PGY2 in EM after a 4 year GMO tour?

Thanks

 

[notdeadyet]

Hey, notdeadyet, what's the HPLRP contract look like? I'm tempted to do the STRAP + HPLRP thing, I'm curious if you lock in the $40k/year or if you leave yourself open to the loan repayment decreasing while you're locked into STRAP...

The "contract" is a very basic form. You sign it and it basically says if you're still in the Guard in drilling status as a doc one year from signature date, $40K in student loans will be wiped out.

It's a one year contract that you keep signing each year. If they get rid of HPLRP, my read is that you'd get the money for the year you already signed for, but they wouldn't keep it rolling.

 

[notdeadyet]

I understand that military medicine may not be a good choice for an aspring ortho or NSG, but how about general surgery? Would it be difficult to go back to a civilian residency program as a PGY2 in general surgery after a 4 year GMO tour?

Also, how about EM? What sort of internship would be recommended for someone who wanted to do EM and would it be difficult to go back to a civilian EM residency as a PGY2 in EM after a 4 year GMO tour?

Whether or not you have to repeat intern year (assuming you did the appropriate intern year) is a case-by-case and varies by program and specialty. In general, the more procedural the specialty, the more likely you'll repeat intern year. So after four years as a GMO, I would expect to repeat intern year and be surprised/delighted if I didn't have to.

EM is its own beast. I entered med school thinking that was my path and after researching HPSP, I all but ran from the scholarship based this specialty choice. Military EM programs are not as good as a good civilian counterpart, are more competitive, and your work post-residency in the military is limited to much lower acuity than most civilian jobs. That's a bad combination. As to whether or not you'd have to repeat intern year after a four year GMO, see above. The thought of someone coming off of 4 years of a GMO tour stepping into your average PGY2 role in an ER makes me shudder.

Folks can make a decent financial and professional case for HPSP (meaning, if you leave out the stressors you place on your partner and children) if you know you are going into a primary care specialty. This is because primary care specialities in the military have training, post-residency work, and salary more comparable to their civilian counterparts. But as soon as you start talking about other specialties, this goes out the window. And the ones you are talking about (neurosurgery, ortho, EM) are quite literally the career paths that would make me most avoid the military.

 

[CoolRunnings]

Whether or not you have to repeat intern year (assuming you did the appropriate intern year) is a case-by-case and varies by program and specialty. In general, the more procedural the specialty, the more likely you'll repeat intern year. So after four years as a GMO, I would expect to repeat intern year and be surprised/delighted if I didn't have to.

EM is its own beast. I entered med school thinking that was my path and after researching HPSP, I all but ran from the scholarship based this specialty choice. Military EM programs are not as good as a good civilian counterpart, are more competitive, and your work post-residency in the military is limited to much lower acuity than most civilian jobs. That's a bad combination. As to whether or not you'd have to repeat intern year after a four year GMO, see above. The thought of someone coming off of 4 years of a GMO tour stepping into your average PGY2 role in an ER makes me shudder.

Folks can make a decent financial and professional case for HPSP (meaning, if you leave out the stressors you place on your partner and children) if you know you are going into a primary care specialty. This is because primary care specialities in the military have training, post-residency work, and salary more comparable to their civilian counterparts. But as soon as you start talking about other specialties, this goes out the window. And the ones you are talking about (neurosurgery, ortho, EM) are quite literally the career paths that would make me most avoid the military.

Thanks for the input. I guess you would also consider GS one of these specialties? Even though you could do a surgery pgy1 in the military?

 

[notdeadyet]

Thanks for the input. I guess you would also consider GS one of these specialties? Even though you could do a surgery pgy1 in the military?

It will vary, but in general, the likelihood for having to repeat an intern year will depend on how far you are from intern year and how procedural the specialty is. Surgery is procedure heavy. Like I mentioned above, plan on repeating intern year and being happy if you don't.

Also, sit down with a spreadsheet and come out with a number for what the costs of doing HPSPS will be based on different specialties. It's one thing to say "I need the money now," it's another say, "I want the money so badly now that I am willing to lose $800K on the deal..."

 

[CoolRunnings]

It will vary, but in general, the likelihood for having to repeat an intern year will depend on how far you are from intern year and how procedural the specialty is. Surgery is procedure heavy. Like I mentioned above, plan on repeating intern year and being happy if you don't.

Also, sit down with a spreadsheet and come out with a number for what the costs of doing HPSPS will be based on different specialties. It's one thing to say "I need the money now," it's another say, "I want the money so badly now that I am willing to lose $800K on the deal..."

Yeah I've done discounted cash flow analyses of all the different paths. I will share tomorrow when I'm at work!

 

[notdeadyet]

And you don't need to feel compelled to share… Just so long as you do the crunching, so you can make an informed decision…

Best of luck with your choices...


Sent from my iPhone using Tapatalk

 

[pointodr]

Hi all

Does anyone know how different the army reserves are in comparison to NG? I thought the benefits would be the exact same but have just seen this, suggesting a cap of $50k for HPLRP:

http://m.goarmy.com/amedd/health-care/benefits.m.html

Thanks

 

[notdeadyet]

That link is either really old or really new.

The I have a hunch it's the former, but I can't be sure, as I'm not reserve. I know the Reserve was a little slow to bump up their HPLRP, trailing behind the Guard. I live in fear of the Guard lowering its HPLRP with the wars dying down, so this could feasibly be the Army starting to do that.

HPLRP is a program, it's not in contract, so even if you're in the midst of it, they can change the total dollar amount the following year. You sign it year to year,. I mention this because folks need to view HPLRP, special pay, and other stuff as nice-to-have, since they could be gone by the time you're ready to receive them.

Guard is still $240k HPLRP. I know that much.

 

[afewquestions]

Hi all and thanks for all the great info. I have a few questions regarding what's been written.

Notdeadyet had written that the MDSSP obligation doesn't begin until after residency - which seems to agree with pg. 77, middle column of this document: http://www.usarec.army.mil/im/formpub/REC_PUBS/R601_37.pdf - but then s/he also writes one must drill during residency? I thought drilling and 2 weeks training were only required during the MDSSP obligation phase (ie, post-residency). Any thoughts? If you can drill during residency, can you also be deployed/mobilized?

The reason why I ask is because I graduate this May and have matched into a 4 year civilian emergency medicine program. I took MDSSP incentives for M3 and M4 (4 year obligation) and don't plan to do STRAP. However, while I can probably mange the drilling and 2 week trainings during residency, I don't want to be deployed/mobilized. This is a little concerning especially since my recruiter and the APMC are saying:

"MDSSP Officers - For those officers that does not match for one of the specialty on the critical list (see attach list) [or choose not to take STRAP], you will be retained in the APMC for 1 year to receive your license. Once received, we will submit paperwork to have specialty Field Surgeon (62B) awarded, then you will be transferred out of the APMC to a Army Reserve unit for the remainder of your residency program. You will have to seek protection from mobilization with your new Commander. While you are retained in the APMC for 1 year, you can continue to turn in student activities on DA Form 1380 for processing."

Are you no longer protected after your intern year? Or is it up to the whim of the commander? I can't reconcile the regulations I listed above (MDSSP payback post residency) and what APMC is saying.

I'm now considering sticking with APMC for my intern year and then take STRAP for years 2 and 3. It's my understanding that this would bring my MDSSP obligation to 2 years and allow me to pay it back during PGY-2 and PGY-3. I still end up with 4 years of army reserve payback post residency, just approx. $48,000 richer. Is my logic correct?

Thanks!

 

[deleted480308]

you do have to drill during residency, but policy is you can't be deployed during residency

 

[notdeadyet]

I'm now considering sticking with APMC for my intern year and then take STRAP for years 2 and 3. It's my understanding that this would bring my MDSSP obligation to 2 years and allow me to pay it back during PGY-2 and PGY-3. I still end up with 4 years of army reserve payback post residency, just approx. $48,000 richer. Is my logic correct?

No. I would look over the last 10 or so pages of the National Guard thread where this was covered in detail, but here goes.

MDSSP incurs a 2:1 obligation that is paid back after residency. So if you take it for two years in medical school, you will owe 4 years of active drilling status after residency. This does not include the time you spend drilling in residency and/or medical school.

STRAP incurs a 2:1 obligation that is paid back after residency. So if you take it for four years of residency, you will owe 8 years of active drilling status after residency. This does not include the time you spend drilling in residency.

If you take BOTH MDSSP and STRAP, MDSSP changes from a 2:1 obligation to a 1:1 obligation but STRAP does not. MDSSP is then paid back during residency as long as you are in STRAP. So if you took 2 years of MDSSP and 4 years of STRAP, you would owe 8 years of drilling time after residency. You pay MDSSP and STRAP obligations back consecutively, not concurrently. You can not take HPLRP or Special Pay while you are paying these back.

Read the above carefully. You will owe more years drilling obligation than you are expecting in your plan above.

 

[koruca]

Hi notdeadyet,

I spoke to my state's NG AMEDD recruiter and he told me that if I signed up as an MS-1 with no incentive (not taking MDSSP) then when I finished my PGY-2, I wouldn't be able to take advantage of STRAP+HPLRP. I guess he was saying that to be eligible for STRAP+HPLRP I have to take MDSSP? Do you know if this policy has changed or perhaps was he just mistaken/misinformed? I am meeting up with him next week but I have a feeling it was the latter since it was a phone conversation and maybe he was distracted or something.

Thanks for any info!

 

[notdeadyet]

I spoke to my state's NG AMEDD recruiter and he told me that if I signed up as an MS-1 with no incentive (not taking MDSSP) then when I finished my PGY-2, I wouldn't be able to take advantage of STRAP+HPLRP. I guess he was saying that to be eligible for STRAP+HPLRP I have to take MDSSP? Do you know if this policy has changed or perhaps was he just mistaken/misinformed? I am meeting up with him next week but I have a feeling it was the latter since it was a phone conversation and maybe he was distracted or something.

I think he is mistaken, but I haven't seen the latest policy doc. Ask him to forward you the AMEDD Officer's Incentives policy document. He should know what it is. If you get it and want me to walk you through it, let me know via PM.

HPLRP is only open to board eligible docs (those who've completed residency) with the EXCEPTION of folks who are currently taking STRAP, who can take HPLRP in their PGY-3 year and beyond. So if you wanted to take STRAP (and were in a specialty eligible for it), in your PGY-3 year and beyond you could take HPLRP. But when you finish residency, each year you are taking STRAP is a year that doesn't count as payback for STRAP. Keep that in mind.

They may have changed the policy and I don't have the latest document. But your recruiter should have it. Ask him/her to send you a soft copy. If they don't have one, your fear that he/she is mistaken/misinformed should go up dramatically.

 

[koruca]

I think he is mistaken, but I haven't seen the latest policy doc. Ask him to forward you the AMEDD Officer's Incentives policy document. He should know what it is. If you get it and want me to walk you through it, let me know via PM.

HPLRP is only open to board eligible docs (those who've completed residency) with the EXCEPTION of folks who are currently taking STRAP, who can take HPLRP in their PGY-3 year and beyond. So if you wanted to take STRAP (and were in a specialty eligible for it), in your PGY-3 year and beyond you could take HPLRP. But when you finish residency, each year you are taking STRAP is a year that doesn't count as payback for STRAP. Keep that in mind.

They may have changed the policy and I don't have the latest document. But your recruiter should have it. Ask him/her to send you a soft copy. If they don't have one, your fear that he/she is mistaken/misinformed should go up dramatically.

Thanks for the reply, notdeadyet. I will ask him for that and let you know if I need some help walking through the document.

Do you have a sense for the future of HPLRP? I think it sounds like a great loan repayment option but AFAIK the Army Reserve has already reduced their equivalent loan repayment program from $250k to $50k? I guess it is impossible to predict the nature of these things, though.

Also, have you heard any word on if the ASR is coming back?

 

[wxman393]

Please see the attached files. Didn't know if that would help out with any future considerations!

 

[wxman393]

Hi notdeadyet,

I spoke to my state's NG AMEDD recruiter and he told me that if I signed up as an MS-1 with no incentive (not taking MDSSP) then when I finished my PGY-2, I wouldn't be able to take advantage of STRAP+HPLRP. I guess he was saying that to be eligible for STRAP+HPLRP I have to take MDSSP? Do you know if this policy has changed or perhaps was he just mistaken/misinformed? I am meeting up with him next week but I have a feeling it was the latter since it was a phone conversation and maybe he was distracted or something.

Thanks for any info!

I think he is mistaken, but I haven't seen the latest policy doc. Ask him to forward you the AMEDD Officer's Incentives policy document. He should know what it is. If you get it and want me to walk you through it, let me know via PM.

HPLRP is only open to board eligible docs (those who've completed residency) with the EXCEPTION of folks who are currently taking STRAP, who can take HPLRP in their PGY-3 year and beyond. So if you wanted to take STRAP (and were in a specialty eligible for it), in your PGY-3 year and beyond you could take HPLRP. But when you finish residency, each year you are taking STRAP is a year that doesn't count as payback for STRAP. Keep that in mind.

They may have changed the policy and I don't have the latest document. But your recruiter should have it. Ask him/her to send you a soft copy. If they don't have one, your fear that he/she is mistaken/misinformed should go up dramatically.

Please see the attached documents for different scenarios. If you want to speak to the source, email: [email protected]

 

[wxman393]

Hot off the presses! See pages 11 and 12 ref your question about STRAP and HPLRP.

 

[notdeadyet]

Thanks for the reply, notdeadyet. I will ask him for that and let you know if I need some help walking through the document.

Good stuff. Look over the document wxsman393 uploaded last. This contains the language about MDSSP and STRAP that you're interested in. It looks at first pass like it hasn't changed much. Thanks, wxsman393!

Do you have a sense for the future of HPLRP? I think it sounds like a great loan repayment option but AFAIK the Army Reserve has already reduced their equivalent loan repayment program from $250k to $50k?

Source? Someone mentioned this already but their evidence was a link to an out-of-date recruiting site that still showed the old numbers. AFAIK, it hasn't been reduced.

I don't see HPLRP going away. I also think it would be MUCH more in their favor to reduce an incentive like MDSSP to recruit new rather than retain existing. That said...

Also, have you heard any word on if the ASR is coming back?

It is dead. My very strong hunch is that it will never come back again. It was a poorly designed program that didn't produce much and most folks were able to get all the money and leave prior to finishing residency without recruiting anyone. A very unpopular program with leadership.

Mind you, I was ASR, am still in past my initial obligation, and recruited six doctors. But this was not the norm.

 

[inthelibrary]

Hot off the presses! See pages 11 and 12 ref your question about STRAP and HPLRP.

On page 5, it states that the HPLRP will repay "DOD-recognized" loans. I'm assuming federal student loans are DOD recognized, but are loans through a private bank also recognized?

 

[notdeadyet]

On page 5, it states that the HPLRP will repay "DOD-recognized" loans. I'm assuming federal student loans are DOD recognized, but are loans through a private bank also recognized?

Federal loans only, regardless of servicer. If you took out a private loan while in medical school (e.g.: directly from a bank rather than via FAFSA and federally funded), you can not use HPLRP.

 

[inthelibrary]

Federal loans only, regardless of servicer. If you took out a private loan while in medical school (e.g.: directly from a bank rather than via FAFSA and federally funded), you can not use HPLRP.

Thanks for the info. I keep that in mind as I start school next fall.

 

[afewquestions]

No. I would look over the last 10 or so pages of the National Guard thread where this was covered in detail, but here goes.

MDSSP incurs a 2:1 obligation that is paid back after residency. So if you take it for two years in medical school, you will owe 4 years of active drilling status after residency. This does not include the time you spend drilling in residency and/or medical school.

STRAP incurs a 2:1 obligation that is paid back after residency. So if you take it for four years of residency, you will owe 8 years of active drilling status after residency. This does not include the time you spend drilling in residency.

If you take BOTH MDSSP and STRAP, MDSSP changes from a 2:1 obligation to a 1:1 obligation but STRAP does not. So if you took 2 years of MDSSP and 4 years of STRAP, you would owe 10 years of drilling time after residency. You pay MDSSP and STRAP obligations back consecutively, not concurrently. You can not take HPLRP or Special Pay while you are paying these back.

Read the above carefully. You will owe six more years drilling obligation than you are expecting in your plan above.

Thanks for getting back to me. However, I think there seems to be some confusion for MDSSP payback (at least there was for me) if one elects to take STRAP. I think everyone gets the MDSSP 2:1 --> 1:1 change if STRAP is taken. But what I've been made aware of is that the resident pays back his/her MDSSP obligation DURING residency if you're also taking STRAP. In the above example, 4 years of STRAP (ie, 8 year payback post residency) for someone who took 2 years of MDSSP incentives (ie, 4 years of payback pre-STRAP, 2 years if STRAP is taken) results in an 8 year payback total post residency (since the MDSSP obligation is eaten up during residency), not 10 years. wxman393's attachments (thanks by the way!) list a similar example of MDSSP reduction & payback during residency if STRAP is taken.

In my case, I got into the game late. I took 2 years of MDSSP and plan on taking STRAP for PGY3 and PGY4. That will reduce my MDSSP payback to 2 years, to be paid back during my residency years when I'm on STRAP. So then I'll just owe 4 years payback post-residency due to STRAP.

 

[notdeadyet]

I get what you're saying, afewquestions. My numbers didn't calculate the in-residency payback of MDSSP for subsequent STRAP (I'll go back and edit the numbers to make it more clear).

But here's the hitch: the MDSSP converting to 1:1 payable during residency assumes you take STRAP immediately after MDSSP. This is why the language of J.2 in the incentives document mentions:
When an MDSSP participant enters a subsequent agreement under STRAP to complete a training program on the current Critical Wartime Shortage List...

I'd been told that the language "MDSSP participant" who then enters an agreement "under STRAP" indicates that you need to sign up for STRAP while under MDSSP (i.e.: while still a medical student), so that there is no break in stipend phase. This is to avoid anyone who knows they are going to take STRAP to just take partial MDSSP (since it would then be free money). This is also why partial MDSSP is allowed, but only if the partial program concludes on medical school graduation: to allow direct entry into STRAP for those looking for the service. The language is chosen intentionally.

So for someone in your shoes (with MDSSP in MS 3 and MS 4 year), your options are this:

1. You enroll in STRAP while covered under MDSSP. You will pay off your two years of MDSSP obligation while in residency. You will then owe 8 years from STRAP, paid post-residency. This is explicitly allowed in the program language.

2. You do not enroll in STRAP at all. You will owe 4 years drilling time from MDSSP, paid post-residency. This is explicitly allowed in the program language.

3. You enroll in STRAP only during PGY-3 and PGY-4. What happens next can be debated. It basically amounts to option A or option B.
- Option A: The policy language is that if you do not enroll in STRAP while in MDSSP (e.g.: if there is a break in service), you are not covered by J.2 in the incentives policy document. As such, you will owe 4 years from MDSSP and 4 years from your two years of STRAP for a total of 8 years after residency. This is explicitly allowed in the program language.
- Option B: Your interpretation is that you pay back your MDSSP during your PGY-3/4 year of residency under STRAP and will owe 4 years drill post-residency.

I would NOT sign up for STRAP without getting Option B agreed upon in writing. The Army has the timing set up very specifically with its incentives to prevent gaming it. There is not really any permutation in which you get free money. Option B is free money. Maybe it's a loophole the Army didn't consider, but I'd be damn sure that I got it in writing that it's okay, because the language and Army policy doesn't support it. And if the Army won't agree to your Option B plan in writing, you can bet they will hold you to the Option A plan when payback comes. Caveat emptor....