The skyrocketing value of the HPSP scholarship

[Perrotfish]

So I've been reading a lot about the civilian side of finances lately, and I've begun to get an idea of just how much the relative value of the HPSP scholarship has risen in just the last few years. More accuretly, I've begun to get a good idea of just what a royal screwing the graduate loan system has turned into vs the almost static value of the HPSP scholarship. In the last 7 years alone:

1) medical school tuition has risen at approximately 8% a year. A moderately expensive private school, with bare minimum living expense in a cheap city, used to be about 200k, It now involves students borrowing a principal debt of 350K or more.

2) Unsubsidized loans have been eliminated in 2010, debt now compounds continuously through medical school and residency. And because of the rising tuition rates half of loans are now at the grad plus rate of 7.9% a year. If you do a short (7 year) residency and medical school and stay in IBR during residency you will owe 1.5 times the cost of your tuition when you start paying it down as an attending. So most attendings who took out 350K in loans are staring down the barrel of 500+K of debt charging an average interest rate of 7.3% the first year they can even start to pay it off. You need to come up with 40K after tax dollars just to pay the f-ing interest! If you pay it down over (an insanely optimistic) 10 years you will end up paying 750K, vs the 350K old school attendings would have paid for their 200K way back in 2007.

3) The value of the HPSP scholarship has increased by a modest $100,000 with a significant stipend increase and the introduction of the signing bonus in 2006.

So in 7 years the value of the HPSP scholarship relative to grad loans has risen by half a million after tax dollars. (100K rise in stipend and bonus, 400K lifetime difference in what attendings need to pay down their debt then vs now in a standard 10 year repayment plan). There doesn't seem to be any indication that we have reached the peak of the grad school tuition bubble so every 5 years until it bursts means another 40% increase in medical school tuition and therefore another increase in the relative value of not having the debt.

Its really made me thing that maybe the old logic, that this is a bad financial investment for anyone not doing Pediatrics, might be getting a little dated. Not saying that you should join for financial reasons, but it certainly isn't the best reason to stay away any more.

Thoughts? Is it time to start calling this scholarship a good deal?

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[dwb8p]

Your math looks pretty accurate, and I agree with your point on a financial basis. I would also include the pay advantage during military residency which goes along with HPSP. That is an extra $30k+ per year (including tax advantages, lack of medical insurance costs, etc), which means a minimum of $90k (and up to $180-$210k) of additional savings/income by taking HPSP instead of loans and civilian residency.

 

[Kilgoretrout 65]

Doing jumping jacks with your pharmacist boss instead of patient care? Priceless.

 

[deleted480308]

There is also an opportunity cost to knowing you could face years of your life without seeing children, or getting paid military pay grade in a high paying specialty instead of civilian rates. It all depends on your situation

 

[TheGoose]

I'd also like to see an analysis of the benefit of being able to max out a Roth IRA or contribute modestly into any form of retirement account (+/- TSP, etc...) during med school and early residency rather than scrounging on ramen noodles through school prior to starting payback of civilian loans. I'll leave that breakdown to better mathematical minds than my own, though it seems from my perspective (admittedly already living that situation) that this adds a lot of value as well.

 

[jabreal00]

I think it's all dependent on one's specialty and situation. My wife and I are both 3 year HPSP recepient. We are in two different services. My medical school was fairly cheap. I came out with $45K in loans after medical school. I cut cost by living at my parent's house during medical school. She went to an expensive private school in DC. After graduating from medical school she had about $100K of loans. After 5 years of training she has $150K in loans.

Now the rub is that we are both in high paying specialty. The military screwed us in our first assignments. One there's the geographic separation. Two I am in an awful location in a MTF run by nurses. No one in my department is happy. There is skill atrophy. There is now the push from HRC for board certified physicians of all specialties to enter operational assignments (FST, Brigade or Flight surgeon). There's no funding for any CME activity. The expectation to do more with less. Milmed is not a good environment now especially outside of the big Medcen (Walter Reed, SAMMC, MAMC etc).

I would not recommend any prospective student to do the military primarily for financial reasons. There are just too many variables where one can end up really unhappy. Sure if one is married with kids and a spouse who is willing to stay at home and doesn't mind being sent to rural locations or doesn't mind the prospect of being tasked for a primarily administrative assignment then a military life is not a terrible option. One can skate by in the military, strolling into work around 8am and out by 4pm if they want to be lazy.

In the current climate of austerity, one shouldn't have any fantasy that they are entirely in control of their career if they stay in the military. There's a board certified doc who in my MTF who basically got voluntold that he'll be starting a flight surgery assignment. A buddy of mine who graduated was voluntold that he'd be starting a brigade surgery assignment for two years at a busy location. These guys will not have any time to keep their skills up. It's just a complete waste and travesty.

 

[GMO2003]

So I've been reading a lot about the civilian side of finances lately, and I've begun to get an idea of just how much the relative value of the HPSP scholarship has risen in just the last few years. More accuretly, I've begun to get a good idea of just what a royal screwing the graduate loan system has turned into vs the almost static value of the HPSP scholarship. In the last 7 years alone:

1) medical school tuition has risen at approximately 8% a year. A moderately expensive private school, with bare minimum living expense in a cheap city, used to be about 200k, It now involves students borrowing a principal debt of 350K or more.

2) Unsubsidized loans have been eliminated in 2010, debt now compounds continuously through medical school and residency. And because of the rising tuition rates half of loans are now at the grad plus rate of 7.9% a year. If you do a short (7 year) residency and medical school and stay in IBR during residency you will owe 1.5 times the cost of your tuition when you start paying it down as an attending. So most attendings who took out 350K in loans are staring down the barrel of 500+K of debt charging an average interest rate of 7.3% the first year they can even start to pay it off. You need to come up with 40K after tax dollars just to pay the f-ing interest! If you pay it down over (an insanely optimistic) 10 years you will end up paying 750K, vs the 350K old school attendings would have paid for their 200K way back in 2007.

3) The value of the HPSP scholarship has increased by a modest $100,000 with a significant stipend increase and the introduction of the signing bonus in 2006.

So in 7 years the value of the HPSP scholarship relative to grad loans has risen by half a million after tax dollars. (100K rise in stipend and bonus, 400K lifetime difference in what attendings need to pay down their debt then vs now in a standard 10 year repayment plan). There doesn't seem to be any indication that we have reached the peak of the grad school tuition bubble so every 5 years until it bursts means another 40% increase in medical school tuition and therefore another increase in the relative value of not having the debt.

Its really made me thing that maybe the old logic, that this is a bad financial investment for anyone not doing Pediatrics, might be getting a little dated. Not saying that you should join for financial reasons, but it certainly isn't the best reason to stay away any more.

Thoughts? Is it time to start calling this scholarship a good deal?

IMHO..even if it does make financial sense...don't do it solely for the financial gain...you will realize like thousands before you that it's not worth it...I was guilty as the next guy for b@#$%#$ and moaning during my time in the military...Nonetheless, in retrospect I would not have traded the experience in for anything...It truly was the people and the friendships made that made it all worthwhile...No amount of money can ever replace that

 

[bulldogmed]

I'd also like to see an analysis of the benefit of being able to max out a Roth IRA or contribute modestly into any form of retirement account (+/- TSP, etc...) during med school and early residency rather than scrounging on ramen noodles through school prior to starting payback of civilian loans. I'll leave that breakdown to better mathematical minds than my own, though it seems from my perspective (admittedly already living that situation) that this adds a lot of value as well.

Albert Einstein said, “Compound interest is the eighth wonder of the world. He who understands it, earns it ... he who doesn't ... pays it.”

Being able to contribute to a Roth IRA while in school and residency is huge. A 7 year difference for the HPSP student versus someone on loans towards contributing to an IRA is really big, particularly if you have sound investments, like in Vanguard's Total Stock Market Index fund.

http://whitecoatinvestor.com/

The author of this blog is a former military EM doc. I highly recommend his website. It's extremely educational on personal finance, investing, and retirement planning.

 

[idq1i]

It doesn't matter what the financial value of the scholarship is.

The total and complete skill atrophy at most of the holes milmed can send you to should deter anyone who values medicine and patient care more than PT score, green APEQS status, and saluting your MSC or AN desk jockey boss.

I am desperately looking for moonlighting spots, not even for the money, but just to keep up my skills. As I am literally in the middle of nowhere, this is very difficult.

Assignment to desirable, high volume hospitals depends on who you know and how good you are at *****kissing, and not on your physician skills. Very sad.

 

[Mirror Form]

The military will screw you in other ways financially. If your spouse has a career, the frequent PSC moves will completely screw that up. How's having your spouse's career messed up factor into your equations? And oh yeah, lets not forget the cost of either buying / selling homes frequently versus having to piss money away as rent. And then there's the many thousands of dollars (and wasted time) that I spend on travel that I wouldn't be paying if I could live where I wanted (i.e., close to family). And then there's the fact that most private practice's and civilian hospitals reimburse for at least one CME conference per year . . . unlike the military.

And that's just the financial side of things. Let's not even get into all the other BS that's not worth any amount of money.

 

[Textbookversion]

The value of HPSP has skyrocketed stupendously in just a short amount of time but only if you assume IBR/PAYE/PSLF doesn't work out. Because if PSLF does actually pan out, then HPSP is a huge money loser in comparison. Most graduates are going to end up spending 6 years in residency and fellowship so the number of years of attending salary you are paying 10% on is relatively few.

I mean compare someone who goes straight through residency and fellowship in let's say, GI, versus someone in the civilian world that does PSLF, and the differences in pay/hassle/etc are going to be absolutely gigantic. Way better gig going non military.

 

[a1qwerty55]

HPSP analogy- I have a deal for you.... I'll crush you balls with a hammer and you will get $1000 for each hit... any takers? This is closer to what you really receive for the money.

 

[StevenRF]

Having not done the math, my suspicion would be it makes more sense financially to get in as early as possible if pursuing a primary care residency and probably direct commissioning if you have something more competitive (the multiyear signing bonus and residency taking up most of your PSLF years)?

 

[idq1i]

If you are doing:

Neurosurg, rads, derm, ENT, ophtho, ortho, anesthesia, HPSP makes no financial sense. Your skills will rot, you will continually be angry and miserable while explaining to your command that their demands are not supported by any medical literature, and you will get paid 1/3 of what you can easily make on the outside. You also be highly resented by everyone at the MTF once they see how much you make

Unless you are of the the hooahh army, (or any other branch) starch-my-uniform-even-though-I-don't have-to, deploy me to Afghanistan now, sign me up for all committees, let me be in charge of something instead of seeing patients types, STAY AWAY from HPSP. There is nothing wrong with being one of the above types. You just need to have an honest conversation with yourself, and decide: Milmed, or Patient Care. Unless you are one of the downrange people, the two are mutually exclusive.

 

[Perrotfish]

So there have been three kinds of replies to this thread:

The first reply that most of you all have had is that HPSP is not worth it because of military specific requirements and culture. Having to move all the time, non physician chains of command, a high burden of administrative work, etc. I wasn't trying to argue about that. There are lots of good reasons why this scholarship may not be for everyone.

The second reply, which several people have made so far, is that HPSP screws you if you end up in a higher paying subspecialty because you end up making only a fraction of what your civilian peers are making. That is the argument that I think is no longer true. When I do the math, I think we have reached the point where for anesthesia, EM, and even Gen-Surg, from a strictly financial standpoint, is now a better deal to in the military than outside of it and have to repay loans. If your alternative was to attend a moderately priced private school on loans what you pay for loans will dwarf the after tax difference between your income and a military physician's. For those of us in Peds/IM/FP/Psych (which is still the majority of medical school graduates) the HPSP scholarship is an enormous windfall, equivalent to a house and a couple of college funds. The insanely fast increase in the cost of attending medical school on loans has made the scholarship a much better deal by comparison.

The third reply, the point about public service loan forgiveness, was interesting. However, its important to note that in PSLF 100% of the benefit happens when you repay your loans at the end of a 10 year period, and it requires you to trust the government to forgive your loans in 10 years. Your debt is meanwhile compounding at 8% a year (so you'll be a million in the hole when its time for forgiveness) and the program very specifically states that the government if free to withdraw funding from the program or change the terms of your agreement at any time. I feel like if you're willing to trust the government that much, you might as well join the military anyway.

Again, not saying that you guys aren't right that there are lots of other reasons to consider the civilian path rather than the military one, but my point was that, financially, at this point anyone who isn't doing plastics could probably have higher lifetime earnings taking HPSP rather than not taking it.

BTW, A1, WTF is the Army doing to you? You Ok?

 

[orbitsurgMD]

So there have been three kinds of replies to this thread:

The first reply that most of you all have had is that HPSP is not worth it because of military specific requirements and culture. Having to move all the time, non physician chains of command, a high burden of administrative work, etc. I wasn't trying to argue about that. There are lots of good reasons why this scholarship may not be for everyone (you might argue it might not be for anyone)

If you don't like military life or "culture" then HPSP is pretty much a non-starter. Still, some seem to ignore this.

The second reply, which several people have made so far, is that HPSP screws you if you end up in a higher paying subspecialty because you end up making only a fraction of what your civilian peers are making. That is the argument that I think is no longer true. When I do the math, I think we have reached the point where for anesthesia, EM, and even Gen-Surg, from a strictly financial standpoint, is now a significantly better deal to be in the military than outside of it. If your alternative was to attend a moderately priced private school on loans what you pay for loans will dwarf the after tax difference between your income and a military physician's. For those of us in Peds/IM/FP/Psych (which is still the majority of medical school graduates) the HPSP scholarship is an enormous windfall, equivalent to a house and a couple of college funds. The insanely fast increase in the cost of attending medical school on loans has made the scholarship a much better deal by comparison.

With the leveling of some specialty payments against ever rising medical school costs, the scholarship does become relatively more valuable. But this isn't a new trend, and for a long time the scholarship has suffered in its appeal despite its rise in value as med school tuitions increased and Medicare and other civilian payer reductions have eroded civilian medical incomes. In the 1980s, HPSP was actually competitive, and there were applicants from all the top medical schools (and HEAL loan rates were in double-digits and interest was not deductible).

Since then, tuition costs have regularly exceeded inflation rates, even if interest rates have declined. And while many high-paying specialties have suffered steep declines in payments (mine both early and very steeply and then continuously) the scholarship lost substantial appeal at the top schools, even before 9/11, Afghanistan and Iraq.

I suspect one main reason for the loss in appeal was the contraction of the mission of the medical departments that started in the late 1980s, resulting in release of retirees from the military medical system, the establishment of CHAMPUS and then Tricare, the loss of available patients to support robust training programs and the closure of many military hospitals and reduction in training at the remaining centers. It pretty much gave everyone watching the signal the military didn't care much about medical training, quality of hospitals (except for JHACO stuff) or the members of the medical department, particularly junior medical officers. That was a lesson that stuck, fast.

The third reply, the point about public service loan forgiveness, was interesting. However, its important to note that in PSLF 100% of the benefit happens when you repay your loans, and it requires you to trust the government to forgive your loans in 10 years. Your debt is meanwhile compounding at 8% a year (so you'll be a million in the hole when its time for forgiveness) and the program very specifically states that the government if free to withdraw funding from the program or change the terms of your agreement at any time. I feel like if you're willing to trust the government that much, you might as well join the military anyway, since you know that the good politicians in DC will take care of you.

Agree.

Again, not saying that you guys aren't right that there are lots of other reasons to consider the civilian path rather than the military one, but my point was that, financially, at this point anyone who isn't doing plastics could probably have higher lifetime earnings taking HPSP rather than not taking it.

BTW, A1, WTF is the Army doing to you? You Ok?

It depends on where you go to school and what you specialize in.

 

[Perrotfish]

With the leveling of some specialty payments against ever rising medical school costs, the scholarship does become relatively more valuable. But this isn't a new trend, and for a long time the scholarship has suffered in its appeal despite its rise in value as med school tuitions increased and Medicare and other civilian payer reductions have eroded civilian medical incomes.

My main point was that, while the decreasing financial value of a medical education is not a new trend, I don't think military physicians yet appreciate the suddenness and magnitude of the cost increase when graduate loans changed from subsidized to unsubsidized two years ago. If you look at the cost of attending medical school on loans it basically increases at a steady 8% a year, then effectively doubles in cost all at once in 2010 when grad loans become unsubsidized, and then continues to rise at 8% again since then. For most physicians that sudden change in the structure of their loans means a difference of almost half a million of lifetime earnings. HPSP overnight went from begin a good deal for generalists and an otherwise financially neutral/crappy deal to being a good financial deal for the higher paying professions and a truly amazing deal for generalists.

I actually think as the enormous cost of the new loan rules sinks in we might actually see the quality of the average HPSP applicant rise significantly. The JAG corps went through this a while ago as the civilian legal profession collapsed. They now boast 20 applications for every JAG position. If loans stay as they are the medical corps could easily take the same trajectory.

 

[notdeadyet]

I actually think as the enormous cost of the new loan rules sinks in we might actually see the quality of the average HPSP applicant rise significantly. The JAG corps went through this a while ago as the civilian legal profession collapsed. They now boast 20 applications for every JAG position. If loans stay as they are the medical corps could easily take the same trajectory.

The only way to compare them is to compare milmed accessions who come via FAP with folks who come to JAG Corps. And as long as they offer the $200-$400K accession bonuses, I wouldn't be surprised at lots of folks entering after residency given the rising debt of most medical students.

But HPSP will always be somewhat restrictive because of the requirement that applicants be willing to do a military residency. Given the quality of most and lack of selection, particularly for the non-primary care specialites, this will immediately exclude a lot of applicants. This is compounded by the issue of skills atrophy for many specialties that require a nice chunk of personal time to even keep up, let alone progress.

It'll be interesting if active corps starts following the lead of reserve corps, which has seen some success in targeting physicians rather than medical students. It's not a bad move, not least of all for morale, because you're not basing the lions' share of your recruits from folks who don't know the first thing about what they're looking for (most applicants end up in a completely different speciality than the one they envisioned). And given the trajectory of milmed GME over the past 20 year, I think you could make a case for moving that direction.

 

[idq1i]

It'll be interesting if active corps starts following the lead of reserve corps, which has seen some success in targeting physicians rather than medical students.

Doubt it. Active milmed needs "versatile" physicians - ones they could deploy out of their specialty for a year at a time (Battalion "surgeon", Brigade "surgeon", Flight "surgeon", some other variant, etc). I am not sure how many quality US graduate, subspecialty-trained physicians would sign up for that.

 

[pgg]

Perrotfish,

I completely agree with you that the financial standing of HPSP vs loans has changed dramatically in the last 5 years. It's one of a few reasons the recruiting shortfalls are over.

Of course, this forum's favorite mantra "don't join for the money" isn't any less true.



I do have a couple of other specific comments, just food for thought mostly -

The third reply, the point about public service loan forgiveness, was interesting. However, its important to note that in PSLF 100% of the benefit happens when you repay your loans at the end of a 10 year period, and it requires you to trust the government to forgive your loans in 10 years

All courses of action require a leap of faith.

HPSP recipients must trust the government to maintain an acceptable level of commitment to inservice GME ... in 10 years. Because if Joe Premed applies and accepts HPSP in 2013, enters med school in 2014, graduates in 2018, internship done in 2019, two year GMO tour through 2021, then does a two year residency ... he's done in 2023. He's accepting HPSP in 2013 and trusts the military to not gut or outsource inservice residency programs circa 2023. 10 years.

Not to mention, that Joe Premed realistically doesn't even know what specialty he'll end up wanting to do. He might think he knows, but he doesn't. Presently, there are specialties in the Navy that offer excellent residency training - and some that are not so excellent.

This - not money - is what concerns me most about HPSP, simply because it's an unknowable and unguessable unknown. I'm not that old and I haven't been in that long (class of 2002) but I've seen the change Tricare etc has wrought since I started paying attention as an undergrad in the mid 1990s. What's next?

How will billet realignments from MEDMACRE affect GME? Does anybody know? Will anybody pretend to know?


FAP might be the best way to enter the military, since it postpones the moment when one has to commit. But even that's not perfect. It's less money than HPSP and one still has to grind through med school on loans.

And ... it too requires a leap of faith and hope that the military will decide it needs your particular specialty at the precise moment you're in the window to apply for FAP.

I actually think as the enormous cost of the new loan rules sinks in we might actually see the quality of the average HPSP applicant rise significantly.

Average MCAT scores of HPSP matriculants are up from 28 to 30 over the last two years. Not that 30 is something to do a round of celebratory jumping jacks with your non-physician department head over, but it's at least an increase from poor to low-average. And it offers hope that the days of HPSP scrambling for any warm body are gone.

HPSP offers more money now. Student loan interest rates and tuition are up. Civilian medicine is facing lower reimbursements across the board. Iraq is over and done with. Afghanistan is winding down.

We shouldn't be surprised to see that the quality of HPSP applicants has increased. Expected or not, it's nice to see the numbers are ticking up.

 

[pgg]

I'll also add that HPSP benefits from a timeless truism - money now is always better than money later.

For me personally, there was a lot to be said for the military pay and quality of life during medical school. (I came in via USUHS not HPSP but the same principle applies.) The paycheck and absence of debt allowed me to comfortably choose to have kids and a stay-at-home wife during those years. My first kid was born Nov of my MS1 year; my 3rd (and last) was born August 4 years later. Could we have done that on Stafford loans? Sure, but it would've been a lot harder than it was on O1 pay and benefits with no tuition/books/etc.

 

[Kilgoretrout 65]

If you are doing:

Neurosurg, rads, derm, ENT, ophtho, ortho, anesthesia, HPSP makes no financial sense. Your skills will rot, you will continually be angry and miserable while explaining to your command that their demands are not supported by any medical literature, and you will get paid 1/3 of what you can easily make on the outside. You also be highly resented by everyone at the MTF once they see how much you make

Unless you are of the the hooahh army, (or any other branch) starch-my-uniform-even-though-I-don't have-to, deploy me to Afghanistan now, sign me up for all committees, let me be in charge of something instead of seeing patients types, STAY AWAY from HPSP. There is nothing wrong with being one of the above types. You just need to have an honest conversation with yourself, and decide: Milmed, or Patient Care. Unless you are one of the downrange people, the two are mutually exclusive.

Not a dermatologist but... it seems way easier to get into derm via military than pure civilian; maybe true for ENT and urology as well and rad-onc in the AF 2 years ago had zero applicants, they had to give a supplemental board. The typical military dermatology applicant might not admit they are borderline qualified for a civilian residency but after decent training and four year payback you are golden, right?

 

[DrMetal]

So I've been reading a lot about the civilian side of finances lately,

Wow, the real headline here is the astonishing cost of medical education, and for what reasons? We know the for-profit DO schools are in it for the $$$ (hell, at they're honest about being "for profit"). For the non-profit public/private schools though, I'd love to see a cost analysis and justification for these rising numbers (doubt we'll ever get it). It's a wonder why any one goes to medical school!

 

[psychbender]

Wow, the real headline here is the astonishing cost of medical education, and for what reasons? We know the for-profit DO schools are in it for the $$$ (hell, at they're honest about being "for profit"). For the non-profit public/private schools though, I'd love to see a cost analysis and justification for these rising numbers (doubt we'll ever get it). It's a wonder why any one goes to medical school!

So, just to quibble, the private DO schools are also not-for-profit entities, just like all US MD schools. While tuition is high at many of these, a few MD schools like Brown and Georgetown still surpass them by thousands per year. There is only one for-profit DO school (unless more opened up in the last two years), which is owned by the same corporation that owns and operates several of the larger Carribean MD schools.

 

[DrMetal]

So, just to quibble, the private DO schools are also not-for-profit entities, just like all US MD schools. While tuition is high at many of these, a few MD schools like Brown and Georgetown still surpass them by thousands per year. There is only one for-profit DO school (unless more opened up in the last two years), which is owned by the same corporation that owns and operates several of the larger Carribean MD schools.

Point well taken. Suffice it to say all of medical education is too expensive. Its a shame.

 

[Silent Cool]

So, just to quibble, the private DO schools are also not-for-profit entities, just like all US MD schools. While tuition is high at many of these, a few MD schools like Brown and Georgetown still surpass them by thousands per year. There is only one for-profit DO school (unless more opened up in the last two years), which is owned by the same corporation that owns and operates several of the larger Carribean MD schools.

Yeah, Rocky Vista is for-profit.

 

[idq1i]

McTouro.

as a side note, why are DOs so over-represented in milmed? 60% of my obc class was DO

 

[Textbookversion]

McTouro.

as a side note, why are DOs so over-represented in milmed? 60% of my obc class was DO

DO's tend to be more likely to be interested in primary care, and their schools tend to be more expensive. Recipe for lots of DO's doing HPSP because it's a better deal if you do a low paying specialty or have high tuition costs.

Great posts by pgg in this thread.

 

[Perrotfish]

Wow, the real headline here is the astonishing cost of medical education, and for what reasons? We know the for-profit DO schools are in it for the $$$ (hell, at they're honest about being "for profit"). For the non-profit public/private schools though, I'd love to see a cost analysis and justification for these rising numbers (doubt we'll ever get it).!

The funny thing is its not its not really the cost of medical school that's going up all that much. What's really going up is the cost of borrowing money. Those who can afford to go to school on the family dime, or even on family loans, aren't paying all that much more than students a decade ago. Since no voter seems to be willing to either cut government spending or raise taxes the government has, reasonably enough, turned to other sources of revenue.

 

[MEDUSA23]

Do you think there is also a value added for job security and experience post-residency? It seems that the job market for several specialties is getting tighter, and I wonder if it would be easier to find a civilian position after serving AD as a physician. For example, diagnostic medicine (pathology and radiology) has a tight job market and pathology residents are going after multiple fellowships. Additionally, starting salaries out of residency do not seem that much higher on the civilian side compared to military compensation especially considering non-taxable income in the military.
It seems a doctor shortage has been "promised" for a long time but has never actualized. Physicians retire later and maybe technology has increased efficiency? Or budgets are tight and hospitals don't hire physicians even when they are needed putting unreasonable pressure on a few. This is something I am currently witnessing in the gyn-onc department at my institution. It seems like there are plenty of negatives outside of military medicine, and I would like to feel more secure about future job prospects.
I am trying to decide whether I should apply for a 3-year HPSP scholarship. Military medicine takes away career flexibility, but I also think having a huge debt load on my shoulders and fewer job opportunities down the road can have the same effect. The prospect of having a reduced debt burden and job experience after the military is weighing heavily on me.

 

[idq1i]

Do you think there is also a value added for job security and experience post-residency? It seems that the job market for several specialties is getting tighter, and I wonder if it would be easier to find a civilian position after serving AD as a physician. For example, diagnostic medicine (pathology and radiology) has a tight job market and pathology residents are going after multiple fellowships. Additionally, starting salaries out of residency do not seem that much higher on the civilian side compared to military compensation especially considering non-taxable income in the military.
It seems a doctor shortage has been "promised" for a long time but has never actualized. Physicians retire later and maybe technology has increased efficiency? Or budgets are tight and hospitals don't hire physicians even when they are needed putting unreasonable pressure on a few. This is something I am currently witnessing in the gyn-onc department at my institution. It seems like there are plenty of negatives outside of military medicine, and I would like to feel more secure about future job prospects.
I am trying to decide whether I should apply for a 3-year HPSP scholarship. Military medicine takes away career flexibility, but I also think having a huge debt load on my shoulders and fewer job opportunities down the road can have the same effect. The prospect of having a reduced debt burden and job experience after the military is weighing heavily on me.

1 - Military income is NOT non-taxable. Only a small percent is. Common recruiter BS.

2-I can speak for rads. Rads is in the dumps because of several reasons:
-Shrinking reimbursements are keeping more rads working longer to keep their standards of living
-Grandfathering of lifetime board certifications allows some of these gomers to work into 70s, not freeing up positions for new people. These people don't need CME, MOC, re-cert tests
-Our board lets too many foreigners get certified, making the pool of available employees too large. This lets the hospitals call the shots, and lowball new hires
-Our board lets other specialties invade and take over our bread and butter procedures and studies

That being said, the worst case scenario, out of milmed, I would make at least double what I make here. I may have to be geographically flexible, but the $ is still there.

I would not be subject to specialist skill rot endemic to most milmed MTFs.

My boss wouldn't be more concerned with PT than with patient care. This may seem like a minor point, but when you are told that showing up to PT is more important than having an operational department, as a medical professional, I am incredibly frustrated.

CME would be encouraged, and moonlighting would not be discouraged.

3 year scholarship is not a good option, unless you know you want a 3 year residency. Let's say you want to do rads. First, you are on the hook for 1 yr of med school tuition.

Then, you are potentially in line for a GMO slot after a year of residency. If you are GMOed, you do a year of internship which doesn't count for your commitment. Then, you do 1-2 years of GMO. This means you are on the hook for 1-2 year remaining commitment. Then, if you do a milmed residency, your commitment increases to match the length of the residency

If you get to go straight thorough, you do a year of internship, then 4 years of residency. This means that you now have a 4 year commitment for a 3 year scholarship. If you are loving it, great. If not, you will have been in uniform for 5 years, and still have 4 years to go.

 

[Kilgoretrout 65]

You will be trading potential future flexibility for current financial peace of mind. In some specialties the job market is getting tight. In the future I think residency spots for specialty care will get tight. On the bright side, if you do HPSP you have a future job whether you want it or not. If you have a family to support now that changes things as well.

 

[MEDUSA23]

You will be trading potential future flexibility for current financial peace of mind. In some specialties the job market is getting tight. In the future I think residency spots for specialty care will get tight. On the bright side, if you do HPSP you have a future job whether you want it or not. If you have a family to support now that changes things as well.

I was also reading about the GME cuts and how that will affect residency positions. Medical schools are being opened but there is a bottleneck due to limited residency positions. I don't see any sign that more residency positions are going to be created in the near future and this would only cause more issues in terms of the job market.
I am a nontraditional student with a family. As an older student, it is difficult when you feel you are delaying your life. I have had salary jobs, and you start to get used to a standard of living. My husband is from England, and it is financially impossible for him to visit his family. I have one daughter and would like 2 more children. I would also like my husband to be a stay at home dad during residency if possible. It is too stressful having us both working all the time, and a lot of time goes into maintaining a household.

 

[deuist]

Additionally, starting salaries out of residency do not seem that much higher on the civilian side compared to military compensation especially considering non-taxable income in the military.

Total bull****! I am finishing civilian residency in a month and can say that I will be making barely more as an attending in the Air Force than I did as a resident at one of the highest paying residency programs in the country. My graduating co-residents will be making double what I will, and they won't have to wait a year to pass the boards in order to get the board certification bonus.

I would like to feel more secure about future job prospects.

You would feel more secure as a GMO in bum-fukenstan than a residency trained doctor?

I also think having a huge debt load on my shoulders and fewer job opportunities down the road can have the same effect.

I have only one job opportunity: the Air Force. My co-residents all got their top picks for location and practice environment. Hell, I get daily civilian job offers by mail, email, and phone. I have no say in where I practice or the acuity of the hospital.

The prospect of having a reduced debt burden and job experience after the military is weighing heavily on me.

I know it's scary, but take the loans and never look back.

 

[JuliusSeizure]

Under Obamas plan physicians (and other graduate programs etc) only have to pay 10% of their salary per year for 15 years. Then the rest is forgiven. So civilian is the way to go. This law was passed in 2012 but goes in effect 2014. It's to boost primary care docs I think.

 

[MMADoc]

Under Obamas plan physicians (and other graduate programs etc) only have to pay 10% of their salary per year for 15 years. Then the rest is forgiven. So civilian is the way to go. This law was passed in 2012 but goes in effect 2014. It's to boost primary care docs I think.

If you are referencing the "Pay as you earn" loan repayment plan, payments are capped at 10% of household discretionary income regardless of the outstanding balance for 20 years than loan forgiveness at the end. The potential problem is that any amount of the loan that is forgiven is currently a taxable event and the remaining balance would be considered as regular income (and taxed as such).

 

[Perrotfish]

If you are referencing the “Pay as you earn” loan repayment plan, payments are capped at 10% of household discretionary income regardless of the outstanding balance for 20 years than loan forgiveness at the end. The potential problem is that any amount of the loan that is forgiven is currently a taxable event and the remaining balance would be considered as regular income (and taxed as such).

That's the small problem. The big problem is that the loan forgiveness is not incremental and the program isn't guaranteed. Your debt compounds every day you're in the program, so at the end if 20 years if you started by owing a modest 250k you likely now owe almost a million. Which is fine, if the program.is there, but do you want to bet your financial future that it will be?

 

[Mirror Form]

You will be trading potential future flexibility for current financial peace of mind.

You won't find much peace of mind as a physician in the military. Sure, you know you'll have a "job." But that job might be horrible. I don't know any civilian doctors who are completely out of work and would want to be a GMO in the middle of nowhere. Nor would any want to risk losing their skills and knowledge during a 2 year brigade surgeon tour.

In some specialties the job market is getting tight. In the future I think residency spots for specialty care will get tight. On the bright side, if you do HPSP you have a future job whether you want it or not. If you have a family to support now that changes things as well.

Residency slots for specialty care have been competitive for a long time. If you have a family they'll thank you for being poorer but getting to live where you choose to live and not moving around all the time. And oh yeah, they'll be happy to not have you deploy for a year either.

 

[Mirror Form]

I was also reading about the GME cuts and how that will affect residency positions. Medical schools are being opened but there is a bottleneck due to limited residency positions. I don't see any sign that more residency positions are going to be created in the near future and this would only cause more issues in terms of the job market.

The residency slots have ALWAYS been what determines how many doctors we have, NOT medical school slots. In the past, we imported physicians from overseas to fill our residency slots. Now those slots will simply be filled by more US grads. It doesn't change anything in terms of the physician job market.

 

[DocArmy]

The value of HPSP has skyrocketed stupendously in just a short amount of time but only if you assume IBR/PAYE/PSLF doesn't work out. Because if PSLF does actually pan out, then HPSP is a huge money loser in comparison. Most graduates are going to end up spending 6 years in residency and fellowship so the number of years of attending salary you are paying 10% on is relatively few.

I mean compare someone who goes straight through residency and fellowship in let's say, GI, versus someone in the civilian world that does PSLF, and the differences in pay/hassle/etc are going to be absolutely gigantic. Way better gig going non military.

Why wouldn't PSLF work out for a milmed resident? What if a student maxed their available loans during med school, then did AD residency and IBR. After ADSO, you'd have 7 years of qualifying PSLF/ IBR loan payments. Three more years gets your loans forgiven.

And IBR payments are based off of your Adjusted Gross Income, which, per IRS publication 3, do NOT count BAH, OCONUS COLA, etc. They only count base pay, bonuses and CONUS COLA.

But you should still want to be in the military to make it a good idea.

 

[BOHICA-FIGMO]

Average MCAT scores of HPSP matriculants are up from 28 to 30 over the last two years. Not that 30 is something to do a round of celebratory jumping jacks with your non-physician department head over, but it's at least an increase from poor to low-average.

Whoa, since when did a 30 MCAT become low average? Maybe if you go to a top 20 US News rated research school. But a 30 MCAT and 3.7 GPA will get you accepted into a LOT of quality schools.

Essentially, what I am implying is, measuring the "quality" of HPSP applicants by MCAT alone is questionable. USMLE scores would be a better measure, but numbers still do not tell the whole tale.

 

[pgg]

Whoa, since when did a 30 MCAT become low average? Maybe if you go to a top 20 US News rated research school. But a 30 MCAT and 3.7 GPA will get you accepted into a LOT of quality schools.

Maybe scores have declined since I took it. Then, you needed "double digit" scores on each section to be even modestly competitive, so 30.

*googles*
Per the AAMC the average MCAT for matriculants was 31.1 in 2011. So I'd still call a 30 low average.

Essentially, what I am implying is, measuring the "quality" of HPSP applicants by MCAT alone is questionable. USMLE scores would be a better measure, but numbers still do not tell the whole tale.

I'd agree with that. Would be really interesting to see the trend of Step 1 scores over the last 20 years.

 

[Special Delivery]

Essentially, what I am implying is, measuring the "quality" of HPSP applicants by MCAT alone is questionable. USMLE scores would be a better measure, but numbers still do not tell the whole tale.

I couldn't agree with this more. I knew a Fine Arts major who was on the low end with a 24 MCAT. They went on to trounce med school (top 5% of their class, excellent board scores, etc).

 

[Gastrapathy]

Anecdote as evidence.

 

[Perrotfish]

'

The value of HPSP has skyrocketed stupendously in just a short amount of time but only if you assume IBR/PAYE/PSLF doesn't work out. Because if PSLF does actually pan out, then HPSP is a huge money loser in comparison. Most graduates are going to end up spending 6 years in residency and fellowship so the number of years of attending salary you are paying 10% on is relatively few.

I mean compare someone who goes straight through residency and fellowship in let's say, GI, versus someone in the civilian world that does PSLF, and the differences in pay/hassle/etc are going to be absolutely gigantic. Way better gig going non military.

Just in case anyone missed it, Obama has proposed a 2015 budget that essentially eliminates any meaningful student loan forgiveness for medical students. PSLF is capped at $57,000, and PAYE now takes 25 years and costs a lot more for people who borrowed large amounts. Also if you're married your minimum payment would have to be based on your combined income.

I foresee the military scholarships getting more competitive going forward.

http://forums.studentdoctor.net/threads/pslf-proposed-cap-of-57k-2015-budget.1058539/#post-14993588

Wall Street Journal article

 

[Snowdon48]

'


Just in case anyone missed it, Obama has proposed a 2015 budget that essentially eliminates any meaningful student loan forgiveness for medical students. PSLF is capped at $57,000, and PAYE now takes 25 years and costs a lot more for people who borrowed large amounts. Also if you're married your minimum payment would have to be based on your combined income.

I foresee the military scholarships getting more competitive going forward.

http://forums.studentdoctor.net/threads/pslf-proposed-cap-of-57k-2015-budget.1058539/#post-14993588

Wall Street Journal article

YES! I knew SDN would eventually make me feel better about taking an HPSP scholarship. It only took reading 10,000 posts to find the one encouraging one!

 

[Chonal Atresia]

'


Just in case anyone missed it, Obama has proposed a 2015 budget that essentially eliminates any meaningful student loan forgiveness for medical students. PSLF is capped at $57,000, and PAYE now takes 25 years and costs a lot more for people who borrowed large amounts. Also if you're married your minimum payment would have to be based on your combined income.

I foresee the military scholarships getting more competitive going forward.

http://forums.studentdoctor.net/threads/pslf-proposed-cap-of-57k-2015-budget.1058539/#post-14993588

Wall Street Journal article

Hate to rain on your parade, but Barry's budget is DOA in congress. It has NO chance to pass. To all prospective medical students, do NOT take this "scholarship." It is a wolf in sheep's clothing.

 

[DermViser]

I foresee the military scholarships getting more competitive going forward.

 

[DermViser]

So, just to quibble, the private DO schools are also not-for-profit entities, just like all US MD schools. While tuition is high at many of these, a few MD schools like Brown and Georgetown still surpass them by thousands per year. There is only one for-profit DO school (unless more opened up in the last two years), which is owned by the same corporation that owns and operates several of the larger Carribean MD schools.

Yes, but you get all the guts and none of the glory by going to a DO school. High tuition, without the access that an MD candidate has.

 

[Perrotfish]

Hate to rain on your parade, but Barry's budget is DOA in congress. It has NO chance to pass. To all prospective medical students, do NOT take this "scholarship." It is a wolf in sheep's clothing.

A Democrat president's budget has a line item to remove an entitlement: its probably getting removed. I'm not sure which other points in his budget will get negotiated into existence (a Paul Ryan budget is going anywhere either, so its going to be a negotiation), but when a Democrat says a program called 'public service loan forgiveness' needs chopping its like when a baseball player gets called out by someone on their own team. The program is probably getting chopped.

The loans have enormous downsides just like the scholarship. Both involve signing your life over to the government, and both are incredibly crappy deals relative to the deal that doctors received 20 years ago. However the scholarship is reigned in by the fact that people look at military 'deals' and don't trust them. Recruiters have always been equivalent to used car salesmen in our minds. Therefore the finances of the military have actually improved significantly during a period when almost every other white collar American saw significant declines (see my first post). However the loans? Everyone you've ever met tells you not to worry about those things, which led to a tremendous opportunity for abuse. Now they're worse than having half a million in credit card debt, you have to go back to pre-American Revolution England to find debt this abusive. At least with the military if you hate it you can wait it out, and if you get sick or go crazy they probably let you go without charging you anything. With the loans you are indentured for life. You could be 50 years out from the loans and they're still following you. And since the government reserves the right to change the conditions of your repayment at any time the feds basically own you.