Opinions re: AF and USN FAP programs

[BUmmedic]

I'm a first-year civilian ortho resident contemplating taking advantage of the Air Force or Navy FAP (albeit, mostly for short-term financial gain during residency). I have more in educational debt than most ($$$ undergrad, med, and graduate years), and a wife and two children to support on a single income. I have both a large federal consolidated loan with a great interest rate, and a few private loans with horrible rates (and climbing). My family and I are barely making it on my salary as it is, and my loan payments haven't even kicked in yet. The annual grants (~ $27K/yr) during residency will go toward eliminating these high interest loans and paying off other debts (credit card, car payments perhaps, etc.), while the monthly stipend will aid in making month to month living much easier, and hopefully towards a rather large savings account balance by the time residency is done. I have four years of residency left, will try to do a fellowship either prior to active duty or sometime during, and am planning (for now) to specialize in general ortho/trauma with sub-specialization in hand surgery.

I've spoken with one ex-USN orthopod who had a great experience (HPSP track) and presented both sides of the story. His opinion was that disenchanted Navy ortho guys complained primarily of three things: 1) fellowship opportunity (or lack thereof), 2) overseas billet when they wanted to stay stateside, or 3) deployment to combat. I have also been reading numerous opinions about not joining military medicine on forums and websites; however, most of these opinions seem to come from those who participate in the HPSP side of things. Anyone who participated in FAP have anything to add?

A general surgery colleague of mine just got commissioned in the Navy through FAP, and from his experience with signing up, these are my understandings of the progam (at this early stage):

1. Commission as O-3, and financial aid during residency
2. No training commitment until residency complete (OIS and orders immediately upon completion)
3. No GMO (at least not for GS or Ortho) since will have no training until an attending-level orthopaedist post-residency
4. May or may not have the option of a fellowship prior to service
5. May or may not have the option of a fellowship deferment during service with an additional year added to commitment if taken
6. Total active duty service commitment = # of years of aid plus one (five for me without fellowship, six with)
7. Possibility of overseas billet and deployment (neither is a negative)

For me... basically doubling my salary during residency and the opportunity to get rid of my high interest loans/debt is key. Never mind that I'll still have an approx. $1K/month federal loan payment (30 year extended repayment) to start repaying during my active duty years. Without housing, medical malpractice, healthcare insurance, etc. to worry about, I think my family and I can make do on the reduced salary and still pay this off until I get out and can really take care of it with a civilian income.

I grew up as part of a military family for the first 14 years of my life, and I'm excited to be able to possibly give my family the opportunity to travel and experience what I did as a youngster while my wife and I are still young and our children are still in grade school (I would complete my commitment prior to age 40 and before my children are in high school). I loved my DODDS schools, and I loved growing up while experiencing life overseas.

I understand that there are disenchantments with the way military medicine is run, and that there are many parallels to civilian medicine problems, but with less recourse and more potential negative impact on future and career. The way I see it, it's only 5-6 years of my potential 30+ year career.

Please, any experienced FAP participants please chime in... thanks.

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[IgD]

I think you would commission as an O4 since ortho is a 5 year residency.

As soon as you graduate your residency you will "come online" and be required to do a utilization tour. This is where they send you somewhere no one else wants to go. I'd say the chance of being permitted to do a fellowship is likely slim or none.

The other thought I have is you will be taking a huge pay cut after you graduate your residency. As an active duty orthopedic surgeon you would probably make $150k annually while as a civilian you would be making double that. The critics here would be quick to point out that you could make up all the extra FAP pay you got in one or two years as a civilian.

If you can live with all that it might a good choice. I did a military residency and my family had an improved quality of life because of it. Everything worked out great for us. We also made money off of real estate using the VA home loan.

 

[BUmmedic]

$150K is more than I was anticipating to make anyway (that's $12,500/month gross... which makes my $1K/month loan payment look like nothing, considering that housing, health care, school, etc. are all taken care of at no expense). I was thinking about $80-100K max. That extra $50K would be sweet. I just think in the long term, it's not that bad given the financial stability and security it would afford us during residency. My wife is a stay-at-home mom, and I couldn't ask her to do any more, any better than she's doing now with our two little boys. I hate stressing financially during residency, and if I can alleviate that while taking care of my high interest loans, I think I can serve proudly for 5-6 years in return. I'm even excited when I think about the mobile surg units and "pure" medicine that can be experienced in the combat field.

I don't have any real estate to speak of, but nonetheless, utilization tour and all, I think financially it has real possibility of being a great decision. I appreciate your opinion... thank you.

 

[g293]

$150K is more than I was anticipating to make anyway (that's $12,500/month gross... which makes my $1K/month loan payment look like nothing, considering that housing, health care, school, etc. are all taken care of at no expense). I was thinking about $80-100K max. That extra $50K would be sweet. I just think in the long term, it's not that bad given the financial stability and security it would afford us during residency. My wife is a stay-at-home mom, and I couldn't ask her to do any more, any better than she's doing now with our two little boys. I hate stressing financially during residency, and if I can alleviate that while taking care of my high interest loans, I think I can serve proudly for 5-6 years in return. I'm even excited when I think about the mobile surg units and "pure" medicine that can be experienced in the combat field.

I don't have any real estate to speak of, but nonetheless, utilization tour and all, I think financially it has real possibility of being a great decision. I appreciate your opinion... thank you.

Just be careful using short term finances as your compass. As was pointed out above, as an orthopod you can make pretty good money out of residency, and can probably find a practice/HMO to pay off some or all of your loans.

The extra money during residency is great, but when you are out and stationed somewhere you may not want to be, that money during residency seems pretty far off. I can't speak for the Navy, but as a active duty AF surgical specialist, military surgery is not the same as civilian. you don't get near the case load, you don't see trauma or a varied case load in many areas, and you have limited equipment and personnel support to do what you want to do. Being deployed sounds great, but if you are at a smaller hospital with limited support, you are going to be packing up all the seriously injured patients and sending them to someone else to fix.

I'm not saying don't do it, just make sure you really know what you'll be getting into after residency.

 

[Croooz]

Deployments okay with your family? The money you provide during FAP will seem like a deal with the devil come deployment time. I'm not a doctor but I was in the Navy and we all had the same problems coming home from deployments. The worst thing the fathers had was in being treated like a stranger by their own kids and even the family dog.

I can't offer medical career advice nor financial. What I can say is to think long and hard about deployments. They are hardest on the family. We have a group of guys and 18h days to keep us busy.

Your basically getting into a different kind of debt. You are using time in the future to pay for your expenses now. To sum it up, are the deployments going to worth it?

I believe in FAP over HPSP. However do not discount the impact deployments will have on your family.

 

[The White Coat Investor]

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[BUmmedic]

If I didn't want to become a military officer or serve my country, then you bet your a$$ that I wouldn't even be considering FAP as an option. I owe a lot of who I am to the service that my father gave to this country and the experiences that I had growing up, and I see this as a chance to repay some of that by taking care of those, like my father, who have dedicated so much (these days, literally risking life and limb... hey I'll specialize in limbs).

I see the money as a great short-term financial relief, because I can honestly say that we will probably be in serious financial trouble (barring a winning lottery ticket or some other miracle) in the next year or two without another source of income (and with two children needing babysitting/child care, my wife working won't even be an option to break even). I think financial security during residency, the opportunity to travel as a young family, and the opportunity to serve and take care of our servicemen and women is a fair trade for 5-6 years of a sub-civilian salary.

No HMO or private practice is going to offer me a similar aid package while still a resident (in other words, when I'm going to need it most). With approx. $300K in educational loan debt, you can also bet your a$$ that money has become (it wasn't always) a major deciding factor. How can it not be? If I were single (well, first off, I probably wouldn't have so much debt), I wouldn't have a problem financially, but with a family, there are so many other dimensions added to your financial portfolio (education costs, additional cost of living increases, clothing/food/etc., etc.). I'm just saying that I can't completely neglect the "money" as a contributing factor to my decision.

Believe me, I preached a lot of what you're saying about duty and service to my best friend, who is AF HPSP. He did it purely for the money, and he's coming to learn a little about military life that I already knew growing up, and he's having his doubts.

Again, I don't mean to sound like I don't appreciate the advice, because I truly do. Thanks.

 

[Croooz]

I can't fault you for doing FAP for the money. If there is no way out of your financial situation which I imagine there isn't then sign away. My point is, like Faust's deal, the military will demand their pound of flesh. You're obviously joining the military to support your family. This is no different than what many enlisted men do. If there is no other way to find support I say welcome aboard!


Make 100% sure you can not be pulled during your training. Now you should look into which branch would be best. One small correction...the military has you for 8 years. However many years you repay in active duty time and then IRR. So your 5 + 3 IRR.

If I didn't want to become a military officer or serve my country, then you bet your a$$ that I wouldn't even be considering FAP as an option. I owe a lot of who I am to the service that my father gave to this country and the experiences that I had growing up, and I see this as a chance to repay some of that by taking care of those, like my father, who have dedicated so much (these days, literally risking life and limb... hey I'll specialize in limbs).

I see the money as a great short-term financial relief, because I can honestly say that we will probably be in serious financial trouble (barring a winning lottery ticket or some other miracle) in the next year or two without another source of income (and with two children needing babysitting/child care, my wife working won't even be an option to break even). I think financial security during residency, the opportunity to travel as a young family, and the opportunity to serve and take care of our servicemen and women is a fair trade for 5-6 years of a sub-civilian salary.

No HMO or private practice is going to offer me a similar aid package while still a resident (in other words, when I'm going to need it most). With approx. $300K in educational loan debt, you can also bet your a$$ that money has become (it wasn't always) a major deciding factor. How can it not be? If I were single (well, first off, I probably wouldn't have so much debt), I wouldn't have a problem financially, but with a family, there are so many other dimensions added to your financial portfolio (education costs, additional cost of living increases, clothing/food/etc., etc.). I'm just saying that I can't completely neglect the "money" as a contributing factor to my decision.

Believe me, I preached a lot of what you're saying about duty and service to my best friend, who is AF HPSP. He did it purely for the money, and he's coming to learn a little about military life that I already knew growing up, and he's having his doubts.

Again, I don't mean to sound like I don't appreciate the advice, because I truly do. Thanks.

 

[Galo]

I can understand your money situation, and even your desire to want to serve out of patriotism, giving back, etc.

Who knows what the world will be like in 5 yrs, but I can tell you that the orthopods at Wright Patt, were doing NO major ortho trauma. Harldy any joints, and little to no hand. During deployments, the majority of injuries will be orthopedic, but in theater, its mostly for stabilization and transfer.

All in all, you will be trading off some comfort now, for alot of potential frustration in the future. Especially if you have good civilian training, and you want to continue to build on it. The military will frustrate you to no end when you find yourself not able to practice what you've been taught. The chances for a fellowship are likely not good.

Unfortunately, alot of the frustrations you will read on this forum by experienced physicians, are frustrations that you will encounter. Although its difficult to be in your situation, I'd wait till you are fully trained, see where your are practicing, and how much you are making, and then see if the military has a place for you to give back. Its likely now that if you join, you will not be able to give back in the way that you think will be best, as a physician.

Good luck

 

[muberrymolar]

wow this is news to me,i thought you pay you IRR while you are in residency and then just repay your AD when you are done with residency.
someone please clarify this.
if i went the FAP route with a 5 year residency how many years payback do i have?



[ One small correction...the military has you for 8 years. However many years you repay in active duty time and then IRR. So your 5 + 3 IRR.[/QUOTE]

 

[BUmmedic]

wow this is news to me,i thought you pay you IRR while you are in residency and then just repay your AD when you are done with residency.
someone please clarify this.
if i went the FAP route with a 5 year residency how many years payback do i have?

[ One small correction...the military has you for 8 years. However many years you repay in active duty time and then IRR. So your 5 + 3 IRR.

[/QUOTE]

Your AD + IRR commitment will be for a total of 8 years. I.e, in your situation of FAP for 5 years of residency, you'll have a 6 year (5+1) AD commitment and a 2 year IRR commitment following that. The only part of the equation that I don't know, and I've heard different things from different people, is the indefinite recall commitment as an officer (i.e., the military can recall you at any time after you've served your 8 years via congressional mandate... in this case, we'd have to be in major **** and they probably will also be instituting a draft). In any case, it goes AD, reserve, IRR, and then you.

As a side note, I am no longer considering FAP as a viable option. I played around with the numbers and figured out that I would be automatically shifted into the 25% tax bracket, and by the end of my residency, I may well be in the 28-30% bracket. I enjoy living in my current 15% bracket. I initially calculated out the numbers using this, and the program looked like a great option. Not so much with the additional 10% taken out of both the military benefits and my current resident salary. It was enough to shift me out of any true financial benefit (basically took away my projected savings account and would prevent my complete high-interest private loan payoff) in the long-run when weighed with my military commitment. So sad, because I was all psyched about it and was preparing the Navy application for submission. Man, them taxes really do take quite a slice.