The skyrocketing value of the HPSP scholarship

[colbgw02]

Let me see if I am understanding you correctly. The 4 years of residency that counts towards payoff will only erase the 2 years that you owed BEFORE starting residency? But the 4 years you accrue during residency will all still have to be payed back which is why you come out owing 4 years?

It seems like the time accrued and time payed off during residency should simply cancel out.

It's a common misconception that time in residency (or any training status) pays off commitment. It was a misconception that I previously held and parroted on this website over the years. It continues, in large part I think, because the numbers work out the same almost all of the time irrespective of how one conceptualizes of the payback.

A 4-year HPSP student, who does an internship followed by a 2-year GMO tour and a 4-year residency (PGY-2 through PGY-5) will owe four years after training. During the first two years, the HPSP and GME obligations are paid off concurrently. During the last two years, only the GME commitment remains.

RE: Bolded - I should add that the MSP/fellowship loophole is an exception to this, which is why - of course - it's called a loophole.

---

Members don't see this ad.

 

[Snowdon48]

It's a common misconception that time in residency (or any training status) pays off commitment. It was a misconception that I previously held and parroted on this website over the years. It continues, in large part I think, because the numbers work out the same almost all of the time irrespective of how one conceptualizes of the payback.

A 4-year HPSP student, who does an internship followed by a 2-year GMO tour and a 4-year residency (PGY-2 through PGY-5) will owe four years after training. During the first two years, the HPSP and GME obligations are paid off concurrently. During the last two years, only the GME commitment remains.

I see. So essentially you owe whichever obligation is longer, HPSP or GME.

 

[HighPriest]

Yes.
I think the reason it is a misconception is that the wording in the contract has something to do with concurrently working off at the same time as you accrue during each post-intern year. It was confusing when I read it, and I'm sure it is confusing to recruiters, most of whom aren't sure what a residency is in the first place.

 

[Special Delivery]

most of whom aren't sure what a residency is in the first place.

Yes, that.

I've been thinking about this post off on and since it was made last year. My wife (graduates in 10 weeks) got into an expensive OOS school, and the timing/relocation had me leaving my job of 15 years to stay home with our 3 kids. The scholarship was a HUGE factor in our decision. I won't go so far as to say she wouldn't have gone to medical school, but it would have been a lot different. From the money angle, HPSP was nice because it leveled the financial road for someone with a family. By the time she graduates, military will have paid $310k (bonus, tuition, reimbursements, stipend, ADTs). That's not counting any compounding interest during med school, since loans are all un-sub now, which would put the number closer to $350k.

Is it a good deal? From the money angle, absolutely. And for those that say civilian route will come out ahead, when you have a family, the financial hit of med school/residency stings a bit more. The problem is, HPSP isn't just about money, and the further along we go, the more we realize that.

 

[idq1i]

I see. So essentially you owe whichever obligation is longer, HPSP or GME.

Here's something to consider. While your post is technically true, let's look at a surgeon's training. One year of internship (which they say is obligation-neutral, but you are still subject to milmed nonsense), 4 years of residency (4 years of milmed nonsense), then a 4 year payback. How that's called a 4 year obligation, is beyond me.

If you enjoy the rules and imposed constraints, and being sent to 6 different training sites to "supplement" your education, more power to you. Otherwise, it's 1+4+4=9 years in uniform, plus 4 years IRR (yes I know that people haven't yet been called up in the past). All premeds should consider this math, if only to be aware of the actual time in uniform. If you are having a great time in the military, great. If not, you got 9 years of survival techniques to learn.

This doesn't take GMO time into consideration, where the best case scenario is Internship year + GMO time means at least 5 years in uniform+4 years IRR. If after having been GMOed, you decide to do a residency before your ADSO is up, the math goes like: 1 year of internship, + 2 (let's say) years of GMO + 4 years of residency = 1+2+4+4 payback=11 years in uniform

Re-quoted for truth content

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.

Summary of post: Consider your Total Time In Uniform, not FYGME, ADSO, etc

 

[Snowdon48]

Here's something to consider. While your post is technically true, let's look at a surgeon's training. One year of internship (which they say is obligation-neutral, but you are still subject to milmed nonsense), 4 years of residency (4 years of milmed nonsense), then a 4 year payback. How that's called a 4 year obligation, is beyond me.

If you enjoy the rules and imposed constraints, and being sent to 6 different training sites to "supplement" your education, more power to you. Otherwise, it's 1+4+4=9 years in uniform, plus 4 years IRR (yes I know that people haven't yet been called up in the past). All premeds should consider this math, if only to be aware of the actual time in uniform. If you are having a great time in the military, great. If not, you got 9 years of survival to do.

This doesn't take GMO time into consideration, where the best case scenario is Internship year + GMO time means at least 5 years in uniform+4 years IRR. If after having been GMOed, you decide to do a residency before your ADSO is up, the math goes like: 1 year of internship, + 2 (let's say) years of GMO + 4 years of residency = 1+2+4+4 payback=11 years in uniform

Re-quoted for truth content


Summary of post: Consider your Total Time In Uniform, not FYGME, ADSO, etc

Yeah I never meant to infer that HPSP and GME payback is the only part of your obligation or time in uniform. I was simply trying to understand mathematically why a GMO tour followed by a mil residency doesn't cut down on the ADSO.

Plus I signed on the HPSP dotted line a year ago so my balls are already sold and scheduled to be crushed .

 

[idq1i]

Yeah I never meant to infer that HPSP and GME payback is the only part of your obligation or time in uniform. I was simply trying to understand mathematically why a GMO tour followed by a mil residency doesn't cut down on the ADSO...

I wasn't trying to say that you were wrong. I meant my post to be an FYI for the uninitiated

 

[colbgw02]

These 4 years of IRR, are they supposed to be the years in medical school? Because if you spend nine years on active duty, then you can completely resign your commission and not stay in the IRR.

 

[idq1i]

These 4 years of IRR, are they supposed to be the years in medical school? Because if you spend nine years on active duty, then you can completely resign your commission and not stay in the IRR.

I'm pretty certain that IRR time is tacked on the back end of the ADSO, and is independent of school, residency, GMO time

 

[colbgw02]

I'm pretty certain that IRR time is tacked on the back end of the ADSO, and is independent of school, residency, GMO time

IRR only comes into play if you have not held your commission for at least 8 years, which is the minimum amount of time to be "in" the U.S. Military as an officer. This is almost always a non-issue for medical corps people because they're typically commissioned before medical school and then spend at least 4 years on active duty. The important thing to remember is that when you resign your commission, the system often defaults you into the IRR, meaning you have to make sure that completely resign your commission and not just resign from the Regular Army.

 

[idq1i]

IRR only comes into play if you have not held your commission for at least 8 years, which is the minimum amount of time to be "in" the U.S. Military as an officer. This is almost always a non-issue for medical corps people because they're typically commissioned before medical school and then spend at least 4 years on active duty. The important thing to remember is that when you resign your commission, the system often defaults you into the IRR, meaning you have to make sure that completely resign your commission and not just resign from the Regular Army.

My contact specifically states that I have 4 years IRR after ADSO completion. You are right about the commission but I think other standards are applied to us while we are 2LTs in school. It's 8 years after graduation. Particularly painful for me because I trained civilian

 

[met19]

reservist time during med school does not count towards the 8 years as a officer- it used to be a loophole, but they closed it. If you spend 8 years on AD- you owe no IRR time. I also trained in the civ world. I wonder if the reserve time during civilian training will count toward the 4 years IRR time.

 

[colbgw02]

My contact specifically states that I have 4 years IRR after ADSO completion. You are right about the commission but I think other standards are applied to us while we are 2LTs in school. It's 8 years after graduation. Particularly painful for me because I trained civilian

I see met19 has filled me in about the HPSP loophole; I didn't know about that. Having not done HPSP, my time in IRR during medical school counts toward the 8-year commitment. Your case is atypical because of you maintained that unique IRR status all the way through training. For most people, they will spend at least 7 years on active duty, meaning their IRR time on the backend is either a year or nonexistent.

 

[244913]

I see met19 has filled me in about the HPSP loophole; I didn't know about that. Having not done HPSP, my time in IRR during medical school counts toward the 8-year commitment. Your case is atypical because of you maintained that unique IRR status all the way through training. For most people, they will spend at least 7 years on active duty, meaning their IRR time on the backend is either a year or nonexistent.

Yeah the med school time doesn't count towards IRR commitment. Interestingly, when I was out-processing to go on terminal leave, the civilian doing the paperwork initially cut orders that discharged me, because she was under the impression that my med school IRR time did indeed count towards the MSO. Being a foolhardy type, I corrected her error and thus am a Captain (IRR) until 2016.

My buddy, who got out to do civilian residency about a month later than I did, said nothing and now has an honorable discharge certificate hanging on his wall.

So I guess that loophole is still open, though only accessible vis a vis the sloth, indolence and ignorance of civilian contract personnel.

ex- 61N

 

[deuist]

It's 8 years after graduation. Particularly painful for me because I trained civilian

and

I wonder if the reserve time during civilian training will count toward the 4 years IRR time.

My recent understanding is that if you do a civilian deferred residency, that time counts toward the IRR commitment.

 

[IlDestriero]

Other than the fact that you're a physician, they're nurses, and you're supposed to be the leaders of the healthcare system... are they at least good managers?

Hahahahaha.
Oh man, that's funny.
They can and do implement poorly thought out changes which directly and indirectly negatively affect you, your clinic, workload, flow, staffing, etc. in order to generate positive changes in questionable metrics that they track and take credit for when they need fitrep bullets.

 

[HighPriest]

Hahahahaha.
Oh man, that's funny.
They can and do implement poorly thought out changes which directly and indirectly negatively affect you, your clinic, workload, flow, staffing, etc. in order to generate positive changes in questionable metrics that they track and take credit for when they need fitrep bullets.

On the nose.

 

[TLAD123]

Hahahahaha.
Oh man, that's funny.
They can and do implement poorly thought out changes which directly and indirectly negatively affect you, your clinic, workload, flow, staffing, etc. in order to generate positive changes in questionable metrics that they track and take credit for when they need fitrep bullets.

Alrighty then. That's a no.

 

[idq1i]

My recent understanding is that if you do a civilian deferred residency, that time counts toward the IRR commitment.

I wish i could get a clear answer to this. HRC is of no use. It would seem that using deferred civ residency as IRR fulfillment violates the spirit of the law if not the actual verbiage.

 

[HighPriest]

I wish i could get a clear answer to this. HRC is of no use. It would seem that using deferred civ residency as IRR fulfillment violates the spirit of the law if not the actual verbiage.

Just ask yourself: Is it the most unreasonable possibility? If the answer is yes, then that is what the DoD is doing. It's like having your own internal compass.

 

[JumpDiveDuck]

Deep dive into the FINANCIAL value of the HPSP
Conclusion: The HPSP student is ahead about $775,000 as compared to his/her civilian counterpart over the course of 14 years (4 years of med school, 5 years military gen. surgery residency, 5 years payback).
I have read may posts on SDN (not necessarily on this thread) stating that the HPSP is a financial loss, especially when specializing. However, my numbers show a tremendous financial advantage to the HPSP.

I was looking at the Army HPSP with a specialty in general surgery. I used Tripler Army Medical Center in Hawaii for the BAH (housing allowance).

The main reasons for this are:
1. Compounding interest is a biatch:
Tuition = 50000/year, living expenses = 20,000/year (Yes, my school is expensive. If your school is cheaper, the value will change dramatically)
Stafford loans = 6.8%, GradPlus = 7.9% (THESE LOANS ACCUMULATE INTEREST DURING SCHOOL + RESIDENCY)
2. Military tax advantage (pre/post tax salaries listed below)
State of IL (my residency) = 0% state tax for military members (http://usmilitary.about.com/library/milinfo/statetax/blil.htm)
Allowances (housing, subsistence) = 0% federal tax (Allowances represent a solid chunk of military salary) (http://militarypay.defense.gov/pay/tax/01_allowances.html)
3. Military residency salaries are very solid
1st year residency: $85000/year + Tax advantage (civilian = 50000: UCSD Gen. surgery program) (http://surgery.ucsd.edu/residency/generalsurgery/Pages/salary.aspx)
5th year residency: $100000/year + Tax advantage (civilian = $59000, UCSD Gen. surgery program)

Military salaries during 14 years: (Military Pay Table, 2014) (PGY = post graduate year = residency)
Role/Rank-------------Pre-Tax Income---Post-Tax income
M1 2nd Lt. O-1----------51590 (bonus)-----43714.15
M2 2nd Lt. O-1----------25590--------------22736.25
M3 2nd Lt. O-1----------25590 ------------- 22736.25
M4 2nd Lt. O-1----------25590--------------22736.25
PGY1 Capt. O-3-------- 85021.68-----------77243.88
PGY2 Capt. O-3---------85021.68-----------77243.88
PGY3 Capt. O-3---------91231.68-----------81901.38
PGY4 Capt. O-3---------95411.28-----------85036.08
PGY5 Capt. O-3---------100548.48---------88888.98
PayBack1 Capt. O-3-----135848.36----------115089.2656
PayBack2 Maj. O-4------155034.44---------130082.6032
PayBack3 Maj. O-4------155034.44--------130082.6032
PayBack4 Maj. O-4------158598.8----------132648.9424
PayBack5 Maj. O-4-------158598.8----------132648.9424

Post-Tax Income (Civilian)
M1 0
M2 0
M3 0
M4 0
R1 39342
R2 40546.7
R3 41978.9
R4 43593.1
R5 45219.2
Y1 158244.68
Y2 160254.68
Y3 162264.68
Y4 164274.68
Y5 166284.68

 

[kyu1q84]

Deep dive into the FINANCIAL value of the HPSP
Conclusion: The HPSP student is ahead about $775,000 as compared to his/her civilian counterpart over the course of 14 years (4 years of med school, 5 year military gen. surgery residency, 5 years payback).
I have read may posts on SDN (not necessarily this thread) stating that the HPSP is a financial loss, especially when specializing. However, my numbers show a tremendous financial advantage to the HPSP.

I was looking at the Army HPSP with a specialty in general surgery. I used Tripler Army Medical Center in Hawaii for the BAH (housing allowance).

The main reasons for this are:
1. Compounding interest is a biatch:
Tuition = 50000/year, living expenses = 20,000/year (Yes, my school is expensive. If your school is cheaper, the value will change dramatically)
Stafford loans = 6.8%, GradPlus = 7.9% (THESE LOANS ACCUMULATE INTEREST DURING SCHOOL + RESIDENCY)
2. Military tax advantage (pre/post tax salaries listed below)
State of IL (my residency) = 0% state tax for military members (http://usmilitary.about.com/library/milinfo/statetax/blil.htm)
Allowances (housing, subsistence) = 0% federal tax (Allowances represent a solid chunk of military salary) (http://militarypay.defense.gov/pay/tax/01_allowances.html)
3. Military residency salaries are very solid
1st year residency: $85000/year + Tax advantage (civilian = 50000: UCSD Gen. surgery program) (http://surgery.ucsd.edu/residency/generalsurgery/Pages/salary.aspx)
5th year residency: $100000/year + Tax advantage (civilian = $59000, UCSD Gen. surgery program)

Military salaries during 14 years: (Military Pay Table, 2014) (PGY = post graduate year = residency)
Role/Rank-------------Pre-Tax Income---Post-Tax income
M1 2nd Lt. O-1----------51590 (bonus)-----43714.15
M2 2nd Lt. O-1----------25590--------------22736.25
M3 2nd Lt. O-1----------25590 ------------- 22736.25
M4 2nd Lt. O-1----------25590--------------22736.25
PGY1 Capt. O-3-------- 85021.68-----------77243.88
PGY2 Capt. O-3---------85021.68-----------77243.88
PGY3 Capt. O-3---------91231.68-----------81901.38
PGY4 Capt. O-3---------95411.28-----------85036.08
PGY5 Capt. O-3---------100548.48---------88888.98
PayBack1 Capt. O-3-----135848.36----------115089.2656
PayBack2 Maj. O-4------155034.44---------130082.6032
PayBack3 Maj. O-4------155034.44--------130082.6032
PayBack4 Maj. O-4------158598.8----------132648.9424
PayBack5 Maj. O-4-------158598.8----------132648.9424

Post-Tax Income (Civilian)
M1 0
M2 0
M3 0
M4 0
R1 39342
R2 40546.7
R3 41978.9
R4 43593.1
R5 45219.2
Y1 158244.68
Y2 160254.68
Y3 162264.68
Y4 164274.68
Y5 166284.68

I think it's a terrible idea to join with the mindset of coming out financially ahead.

 

[IlDestriero]

If you join for the money alone you will likely find yourself unhappy and may find your career delayed, stunted, or worse. If you get married to someone with their own lofty educational and/or professional goals, the military may interfere with them as well.
If you join because you WANT TO SERVE, when bad things happen, you don't get lucky or things don't go your way, you won't care as much because that is the price you pay for being in the military.
And it absolutely, positively, undeniably is a money loser for highly compensated specialist physicians, of which there are MANY.
Keep that in mind when you are signing your 8+ year commitment before you have decided on a desired specialty, usually before even a single day in medical school.

 

[colbgw02]

This thread is starting to be redundant with the similarly named "HPSP is worth more than what people say thread", so I won't reiterate all of my points in full, but...

1) You didn't "show your work", so to speak, so how you compounding that interest? If you're compounding the full cost of a $70K/year medical education beginning on day 1 of medical school, then you're doing it wrong.

2) Choosing Tripler as a duty station is a poor example. Specifically, I'm not aware of any other residencies OCONUS and, therefore, no others that involve COLA. This artificially inflates the military salary, particularly as COLA is intended to be a zero-sum game.

3) Similar to #2, but less egregious, is the overinflation to military pay that TAMC's BAH provides. Tripler isn't unique in this regard, as there are other high-cost-of-living GME locations (D.C, San Diego), but - once again - this money is supposed to be a zero-sum game as compared to BAH elsewhere. Ergo, the benefit of the BAH "principle" is really nonexistent, leaving only BAH's tax benefit.

 

[deuist]

Y1 158244.68

You are running into the same problems that so many other premeds and medical students have whenever they tried to perform a financial analysis of HPSP. You are looking at only one scenario and assuming that one route works for everyone. For starters, on what planet are general surgeons making only $158,000 a year? You should look into the real civilian salaries of different specialties and try re-running your numbers. For example, what happens when the annual pretax salary is $350,000?

How about the cost of medical school? The average debt for someone graduating from my alma mater was $220,000. And when I was in medical school, the interest rate for student loans was only 2%. Given this low number, there is no reason to ever pay off your student loans as you could make more money by investing whatever you have remaining after paying off your monthly bills.

Allowances definitely do NOT account for a solid chunk of the military salary. As another poster has mentioned (I think on this thread) allowances account for only 3% of the physician salary. Everything else we make is taxable.

You are comparing residencies in two different states and then assuming that everyone gets paid the same as a general surgery resident from the University of California. At North Shore Hospital in New York, interns start at $70,000 and go up from there. Also, what happens is the military orders you to take a civilian deferral for residency and you end up making that lower civilian salary anyway?

I think that as you rerun the numbers you will find out that in many scenarios you're going to come out behind by taking HPSP. Your numbers also do not account for hidden benefits and hidden costs of being in the military such as the military retirement, the G.I. Bill, a GMO tour, a spouse who loses her job because of constant moving, the price of a PCS (the military is not going to pay for the new curtains that need to go on the windows).

Finally what is the price of happiness? Your calculations do not account for things like having a nurse as a commander, not being allowed to do CME, not being allowed into the specialty of your choice, forced moves every few years, almost daily computer-based training, skill atrophy, deployments, and the list goes on. So even if you do come out financially ahead by taking the scholarship, what is the true cost of happiness?

Edit: I just ran the numbers for my life's situation.

1. I did a civilian deferral for residency – so all the benefits that you listed for military residency were a wash anyway.

2. The location where I have started moonlighting would triple my military salary if I went there full-time.

3. My medical school ran a total cost of $220,000.

In the end I would've come out $300,000 ahead by not taking the scholarship. And I would've had the added perks of having a spouse that is still working, going into the fellowship that I wanted, and choosing where I want to live. Sorry to burst your bubble, but HPSP is not the financial panacea that you thought it was.

 

[ortnakas]

Sorry if these have been answered before-- I've dug through the threads and I've had a hard time finding current answers.

I have two questions regarding Air Force HPSP:
1) What are the chances of getting the residency/specialty you want? As an incoming OMS-1, I don't have something set in stone at the moment (tentatively interested in EM and IM), but it would be sad to fall in love with something during rotations and then not be able to pursue training in it as a resident.
2) Any idea on the percentage of people who get to go into their residency, and then pay back time vs. people who end up doing GMO tours after internship?
3) Pros and cons of civilian deferral for residency, if that's even an option?

Help is appreciated!

 

[JumpDiveDuck]

You are running into the same problems that so many other premeds and medical students have whenever they tried to perform a financial analysis of HPSP. You are looking at only one scenario and assuming that one route works for everyone. For starters, on what planet are general surgeons making only $158,000 a year? You should look into the real civilian salaries of different specialties and try re-running your numbers. For example, what happens when the annual pretax salary is $350,000?

How about the cost of medical school? The average debt for someone graduating from my alma mater was $220,000. And when I was in medical school, the interest rate for student loans was only 2%. Given this low number, there is no reason to ever pay off your student loans as you could make more money by investing whatever you have remaining after paying off your monthly bills.

Allowances definitely do NOT account for a solid chunk of the military salary. As another poster has mentioned (I think on this thread) allowances account for only 3% of the physician salary. Everything else we make is taxable.

You are comparing residencies in two different states and then assuming that everyone gets paid the same as a general surgery resident from the University of California. At North Shore Hospital in New York, interns start at $70,000 and go up from there. Also, what happens is the military orders you to take a civilian deferral for residency and you end up making that lower civilian salary anyway?

I think that as you rerun the numbers you will find out that in many scenarios you're going to come out behind by taking HPSP. Your numbers also do not account for hidden benefits and hidden costs of being in the military such as the military retirement, the G.I. Bill, a GMO tour, a spouse who loses her job because of constant moving, the price of a PCS (the military is not going to pay for the new curtains that need to go on the windows).

Finally what is the price of happiness? Your calculations do not account for things like having a nurse as a commander, not being allowed to do CME, not being allowed into the specialty of your choice, forced moves every few years, almost daily computer-based training, skill atrophy, deployments, and the list goes on. So even if you do come out financially ahead by taking the scholarship, what is the true cost of happiness?

Edit: I just ran the numbers for my life's situation.

1. I did a civilian deferral for residency – so all the benefits that you listed for military residency were a wash anyway.

2. The location where I have started moonlighting would triple my military salary if I went there full-time.

3. My medical school ran a total cost of $220,000.

In the end I would've come out $300,000 ahead by not taking the scholarship. And I would've had the added perks of having a spouse that is still working, going into the fellowship that I wanted, and choosing where I want to live. Sorry to burst your bubble, but HPSP is not the financial panacea that you thought it was.

The Y1 general surgeon salary I posted is POST-TAX (from $226ooo, which is the average starting salary for general surgeons in the US. Link at bottom of post). I posted post-tax numbers to account for the military tax advantage, which is significant. I clearly labeled the salaries as post-tax. I posted only post-tax because formatting was a biatch as I tried to copy/paste from my Excel document and post-tax was more relevant for comparisons. You're absolutely right, this financial breakdown is DEFINITELY subject to change. This specific scenario is based off a student from my school who just matched into Tripler this year. Attaining a salary of 350000/year as a general surgeon is unrealistic 5 years into practicing. Of course it is possible, but salary data does not back this up so early in a career. Current interest rates are not 2% like they were when you would have potentially been borrowing. The Stafford loans (up to 40500/year) are at 6.8% and the GradPlus loans (anything beyond 40500) are at 7.9%. This is the main reason why the HPSP came out so financially beneficial in my analysis.

Can you elaborate on the allowances only accounting for 3% of total salary? If I am understanding you correctly, I think you are very wrong on this point (typo maybe?). As long as physicians earn BAH (which I have never read or heard otherwise), then BAH does indeed account for a very significant portion of salary at around 45% of total Captain's salary. Of course, this is assuming I am using the pay scale correctly (BAH + BAS = 37334.88/year for captains with under 2 years service time). Please correct me if I am wrong.

Thank you for taking the time to look at my post and give your 2 cents. I realize this is only one path of many. However, pursuing a civilian career also has its unknowns. For instance, I know many civilian M4s who matched at other locations and will be forced to move as well. In these cases, their spouses will have to find new work and go curtain shopping. Please keep in mind, this is simply a financial analysis. The price of happiness should NOT be included in such an analysis.

http://www.valuemd.com/physician-salary-first-year.html (this is the site where I found the $226000/year starting salary for general surgeons)

 

[IlDestriero]

Looking at those posted numbers for some specialties I am familiar with, they seem quite low. However, they claim to be base salary only. One ophthalmology fellow I know was guaranteed $180k to start. Horrible right?
BUT, he was told that based on history and current need, his incentives would make him 2x that by the end of his 1st year and 3x by the end of his 2nd year. After his 3rd year, he got his partner share worth even more.
These tables can be extremely deceptive.
Call compensation can be very high as well and will not be reflected in base salary, but would be in MGMA data, which is the gold standard for PP.

 

[colbgw02]

The Y1 general surgeon salary I posted is POST-TAX (from $226ooo, which is the average starting salary for general surgeons in the US. Link at bottom of post). I posted post-tax numbers to account for the military tax advantage, which is significant. I clearly labeled the salaries as post-tax. I posted only post-tax because formatting was a biatch as I tried to copy/paste from my Excel document and post-tax was more relevant for comparisons. You're absolutely right, this financial breakdown is DEFINITELY subject to change. This specific scenario is based off a student from my school who just matched into Tripler this year. Attaining a salary of 350000/year as a general surgeon is unrealistic 5 years into practicing. Of course it is possible, but salary data does not back this up so early in a career. Current interest rates are not 2% like they were when you would have potentially been borrowing. The Stafford loans (up to 40500/year) are at 6.8% and the GradPlus loans (anything beyond 40500) are at 7.9%. This is the main reason why the HPSP came out so financially beneficial in my analysis.

Can you elaborate on the allowances only accounting for 3% of total salary? If I am understanding you correctly, I think you are very wrong on this point (typo maybe?). As long as physicians earn BAH (which I have never read or heard otherwise), then BAH does indeed account for a very significant portion of salary at around 45% of total Captain's salary. Of course, this is assuming I am using the pay scale correctly (BAH + BAS = 37334.88/year for captains with under 2 years service time). Please correct me if I am wrong.

Thank you for taking the time to look at my post and give your 2 cents. I realize this is only one path of many. However, pursuing a civilian career also has its unknowns. For instance, I know many civilian M4s who matched at other locations and will be forced to move as well. In these cases, their spouses will have to find new work and go curtain shopping. Please keep in mind, this is simply a financial analysis. The price of happiness should NOT be included in such an analysis.

http://www.valuemd.com/physician-salary-first-year.html (this is the site where I found the $226000/year starting salary for general surgeons)

The 3% number reflects my calculation from another thread for my own salary.

Once again, using Tripler is not a reasonable way to calculate these numbers, either vis-a-vis BAH percentage of income or for total salary. As I tried to explain above, BAH is obviously pegged to cost-of-living, so your calculations indicate a relatively high gross salary, which artificially paints HPSP in a more reasonable fiscal light. However, the discretionary income won't be appreciably different from a military resident in Texas, Georgia, etc.

 

[aklark]

I'm sure these links have been posted here before, but White Coat Investor has a similar analysis from a few years ago that I think is more accurate numbers-wise. Best value is with an expensive school and a low-paying specialty.

http://whitecoatinvestor.com/personal-finance/should-i-join-the-military-to-pay-for-medical-school/

I also like his post about the value of of a military retirement. Interesting way of viewing it in terms of how much extra you'd have to save to come out equal:

http://whitecoatinvestor.com/should...inancial-implications-of-military-separation/

 

[BorntobeDO?]

You're only a medical student so I'm going to give you the benefit of the doubt about how woefully ignorant this post is. First of all, if I had done a civilian residency and gone straight to work as an attending, I could have easily paid off a $200,000 loan in four years. I would have also have been able to afford a mortgage, and because I chose the location of my practice and wouldn't have to frequently move across the country, my spouse would also have a job. So no, HPSP students cannot "walk away much earlier."

But... why would you walk away from student loan debt so quickly anyway? If your loans carry a 2.4% interest rate---as my undergraduate and grad school loans do---and the stock market is going at 5%, don't ever pay off the loans quickly. Use that cash to invest.

Second, as beaten to death on this board, you give up lots of freedoms when you join the military. You can't do the residency of your choice, you might not be allowed to pursue a fellowship, you can't practice in an environment that best suits you, and if you do get forced into flight medicine or a GMO tour, you will need to repeat internship and go through a residency later, meaning that you will be years behind your peers.

I'm sure for some people HPSP makes financial sense, but for me, it's been a financial, professional, and personal disaster.

That is a rate from ten years ago, whitecoat investor had a great article on this on the 2nd post I believe. As of 2012+ the rates are around 6.8/8% of student loans, and interest is no longer subsidized or deferred. Using the rule of 72 (72/ interest percentage *100), we find that an 8% loan doubles in 9 years, a 6.8 loan takes 10.5 years to double. Its nearly impossible even for a 'quick' family residency guy to avoid paying double what he took out, especially if you are among those who actually have to pay themselves for school.

This is not even taking into account declining reimbursement rates d/t Obamacare. The first post is spot on in this situation. And as someone strongly considering primary care (2nd career for me), it would be stupid not to evaluate HPSP. I appreciate these threads as they have shown me how bad off I am, as someone who will probably have to pay full cost (no financial aid due to my current nurse salary, and MCAT not good enough for scholarship).

Of course, you should never do anything just for the money. But as someone who does have some interest in serving, I think the pro's and con's from the financial point of view have never been stronger than they are now.

 

[BorntobeDO?]

For those who want it here's a compound Interest Excel Sheet that you can fool with to see what is right for you. I also put repayment at "10%" of income for upto 25 years for those who want to imitate the loan forgiveness. In my particular scenario as primary care I can never catch up paying less than 19-20% a year :/
At the 10% IBR I would have to ask Uncle Sam to forgive a cool million after 25 years. Seems real likely.

You can also use it to manipulate Tuition, Cost of Living, Scholarships/Salary, Percent you are paying back. Now you can break it down with ease (and compound interest!). One Caveat, I wrote it as evenly splitting the percentage of salary paid toward costs as long as both are there. It would not let me write in a way to make double payments on Stafford loans if gradplus paid off, but would let me do it for Gradplus if Stafford paid. Weird. Kept saying circular logic.
I think the excel has the sense o humor, no?

 

[kalat]

I'm going DO and considering HPSP. As of right now I don't intend to pursue a high-paying specialty. After reading through this thread there are a lot of good arguments, but something that always strikes me as particularly odd is how people claim "everything else aside you could end up hating your job in military" is not taking into account that the first few years as a "fresh" civilian physician are usually filled with long hours and a lot of work as well. There's loan payments that need to be made, and maybe you won't have to go Iraq, but most people will probably also move a significant distance too (especially if you're money-seeking in a sub-specialty).

Another thing is these discussions are always too highly polarized. I talked to a physician in-person recently (neurologist) that did HPSP (finished very recently - as opposed to old experiences) and he had mostly good things to say but just noted you need to have a sense of adventure and a tolerance of military lifestyle. He has a family and wife and said it has been a good experience for them as he was stationed in Europe. He said he was fine with the quality of the programs he had available to him and although some of the HPSP recipients aren't the best they usually come out more competitive for the experience. Maybe he was just lucky? I never see middle-of-the-road people in these threads, and it always makes me think about all the people that stay silent and get it over with - are they really that bad off?

Of course there has to be downsides. For most taking it, it's a couple hundred thousand dollars. People smart enough to go to any medical school should be able to realize you won't get it for free, but I think it's too easy to say "Well, in the military you don't have any freedom!" So, let's say you don't have any freedom for 4 years (worst case scenario). What's being broke, unsure about prospects, having no free time, working as much as you can to eliminate debt? That's not freedom either, and it can last a hell of a lot longer time depending on the situation. A lot of the loan forgiveness programs are toss-ups or also involve you in some sort of location-based practice (e.g. rural, inner-city, etc.) similar to what you'd find in the military if not a little closer to home.

The other thing is obviously if you want to do a long internship and long fellowship and all this other prolonged advanced training you don't want to go into the military. It's obviously designed to produce physicians that aren't sub-specializing and blazing frontiers unless they just like the military anyways.

 

[idq1i]

I'm going DO and considering HPSP. As of right now I don't intend to pursue a high-paying specialty. After reading through this thread there are a lot of good arguments, but something that always strikes me as particularly odd is how people claim "everything else aside you could end up hating your job in military" is not taking into account that the first few years as a "fresh" civilian physician are usually filled with long hours and a lot of work as well. There's loan payments that need to be made, and maybe you won't have to go Iraq, but most people will probably also move a significant distance too (especially if you're money-seeking in a sub-specialty).

Another thing is these discussions are always too highly polarized. I talked to a physician in-person recently (neurologist) that did HPSP (finished very recently - as opposed to old experiences) and he had mostly good things to say but just noted you need to have a sense of adventure and a tolerance of military lifestyle. He has a family and wife and said it has been a good experience for them as he was stationed in Europe. He said he was fine with the quality of the programs he had available to him and although some of the HPSP recipients aren't the best they usually come out more competitive for the experience. Maybe he was just lucky? I never see middle-of-the-road people in these threads, and it always makes me think about all the people that stay silent and get it over with - are they really that bad off?

Of course there has to be downsides. For most taking it, it's a couple hundred thousand dollars. People smart enough to go to any medical school should be able to realize you won't get it for free, but I think it's too easy to say "Well, in the military you don't have any freedom!" So, let's say you don't have any freedom for 4 years (worst case scenario). What's being broke, unsure about a career, having no free time, working as much as you can to eliminate debt? That's not freedom either, and it can last a hell of a lot longer time depending on the situation.

Consider this:
If you are a single FP DO without a family, you may have a decent experience.
If you are a subspecialized MD interested in teaching, research, etc, things get worse.
-if you have a spouse +/- kids, and the spouse is a resident in a competitive field, your situation gets MUCH worse

No amount of money and no tax advantage will save you from the damage that the military can cause in your relationships. If your spouse is not AD, s/he may as well not exist as far as assignments work.

This only looks at the social/family aspects of serving. See the rest of the threads for the other downsides.

 

[MirrorTodd]

Why does it seem like so many people are doing GMO tours? Are people being forced into them? Are they just deciding to forgo residency for a while? Do they pick the wrong specialties and then have to wait to apply? Seriously, why the hell would anyone do 2 years of GMO, unless they were forced into it?

 

[deuist]

Largely forced into it.

 

[deleted444089]

I would argue that it's easy to 'have a sense of adventure' and tolerate the military lifestyle if you are in a non-deploying, non-operational gig in Europe. You are right in that discussions here on SDN on this topic are very polarized, but that is because the spectrum of milmed experiences are so varied you can never guess how yours will turn out. You could one of the lucky few that trains straight through both residency and fellowship (in someplace like Hawaii or San Diego), then get accepted to ANOTHER fellowship at a premier civilian institution (IM --> Cards --> EP) and spend your first 7 years on active duty getting excellent training without hardly ever doing anything remotely military related, then when you're done, be so specialized that there is no chance you would be assigned anywhere but one of the larger MTFs. (I know someone who is doing this right now) On the other hand, you could face a GMO tour or two trying to get back into training, while getting no support from your own branch's medical HQ (AFMOA, BUMED, etc) in a remote location with the same responsibilities as staff.

Yes, the first years as a civilian attending must be stressful, and people have to move, but you don't have the additional burdens that the military places on you and your family.

I'm going DO and considering HPSP. As of right now I don't intend to pursue a high-paying specialty. After reading through this thread there are a lot of good arguments, but something that always strikes me as particularly odd is how people claim "everything else aside you could end up hating your job in military" is not taking into account that the first few years as a "fresh" civilian physician are usually filled with long hours and a lot of work as well. There's loan payments that need to be made, and maybe you won't have to go Iraq, but most people will probably also move a significant distance too (especially if you're money-seeking in a sub-specialty).

Another thing is these discussions are always too highly polarized. I talked to a physician in-person recently (neurologist) that did HPSP (finished very recently - as opposed to old experiences) and he had mostly good things to say but just noted you need to have a sense of adventure and a tolerance of military lifestyle. He has a family and wife and said it has been a good experience for them as he was stationed in Europe. He said he was fine with the quality of the programs he had available to him and although some of the HPSP recipients aren't the best they usually come out more competitive for the experience. Maybe he was just lucky? I never see middle-of-the-road people in these threads, and it always makes me think about all the people that stay silent and get it over with - are they really that bad off?

Of course there has to be downsides. For most taking it, it's a couple hundred thousand dollars. People smart enough to go to any medical school should be able to realize you won't get it for free, but I think it's too easy to say "Well, in the military you don't have any freedom!" So, let's say you don't have any freedom for 4 years (worst case scenario). What's being broke, unsure about prospects, having no free time, working as much as you can to eliminate debt? That's not freedom either, and it can last a hell of a lot longer time depending on the situation. A lot of the loan forgiveness programs are toss-ups or also involve you in some sort of location-based practice (e.g. rural, inner-city, etc.) similar to what you'd find in the military if not a little closer to home.

The other thing is obviously if you want to do a long internship and long fellowship and all this other prolonged advanced training you don't want to go into the military. It's obviously designed to produce physicians that aren't sub-specializing and blazing frontiers unless they just like the military anyways.

 

[pgg]

Why does it seem like so many people are doing GMO tours? Are people being forced into them? Are they just deciding to forgo residency for a while? Do they pick the wrong specialties and then have to wait to apply? Seriously, why the hell would anyone do 2 years of GMO, unless they were forced into it?

The Navy orders the majority of interns to a GMO tour. It's not a reflection of the quality of the intern. Uninterrupted training is unusual for most specialties.

Few people choose it. Everyone tries to make the best of it.

The Army and Air Force train most people straight through, but then fill their operational billets with residency trained people who may or may not experience some skill rot, depending on what specialty they trained in and what their billet turns out to be.

 

[MirrorTodd]

The Navy orders the majority of interns to a GMO tour. It's not a reflection of the quality of the intern. Uninterrupted training is unusual for most specialties.

Few people choose it. Everyone tries to make the best of it.

The Army and Air Force train most people straight through, but then fill their operational billets with residency trained people who may or may not experience some skill rot, depending on what specialty they trained in and what their billet turns out to be.

Could you expand on this a little bit? I take it to mean (as an extreme example) a neurosurgeon serving as a battalion surgeon for an infantry unit for their first duty station. Is it something like that? Or do they try to get mainly primary care specialties to fulfill those billet roles?

 

[colbgw02]

Historically, yes, it's been primary care. That all changed in the summer of 2013, when the Army sent a bunch of other specialists and subspecialists out to be brigade surgeons. Now, no specialty is safe; it's just a numbers game. There's some piece of paper somewhere, which in no way reflects reality, that says the Army is supposed to have X number of physicians for Y specialty. If you happen to be in a field that's "overstrength", then your name gets put on a short list for reassignment as a brigade surgeon.

 

[TheTruckGuy]

The Navy orders the majority of interns to a GMO tour. It's not a reflection of the quality of the intern. Uninterrupted training is unusual for most specialties.

Word on the street is that the Navy is trying to get rid of GMOs. I was told by someone who was HPSP 15 years ago that they heard the same thing back then. But, based off what I heard, the numbers I was presented while at ODS, and a few calculations I made, and assuming my memory is correct, it would seem that the Navy is reducing the number of GMO billets by roughly 5% a year (over the last 20 years or so).

Could you expand on this a little bit? I take it to mean (as an extreme example) a neurosurgeon serving as a battalion surgeon for an infantry unit for their first duty station. Is it something like that? Or do they try to get mainly primary care specialties to fulfill those billet roles?

I shadowed an Army dermatologist that just retired who was a "battalion PROFIS doctor" in Iraq a few years ago. He was a major at the time, so he'd apparently been in for some time. And I hear he did a really good job from someone that deployed with him. And PROFIS apparently stands for professional filler system, and is used to stick folks where they're needed, although might not be exactly their specific area of expertise.

 

[pgg]

Word on the street is that the Navy is trying to get rid of GMOs. I was told by someone who was HPSP 15 years ago that they heard the same thing back then. But, based off what I heard, the numbers I was presented while at ODS, and a few calculations I made, and assuming my memory is correct, it would seem that the Navy is reducing the number of GMO billets by roughly 5% a year (over the last 20 years or so).

They told me the same thing in 1997. I did a GMO tour 2003-6, pre residency. It worked out OK.

They have converted some billets to residency-trained physicians. Some progress has been made. I think they've made about all the progress they CAN make though, unless they expand the pool of post-residency physicians assigned to these billets. Ie, take the Army/AF route. There just aren't enough FP and IM docs to do it all.

Join the Navy - count on doing a GMO tour pre residency.
Join the Army/AF - count on doing a GMO tour post residency.

 

[az19]

Word on the street is that the Navy is trying to get rid of GMOs. I was told by someone who was HPSP 15 years ago that they heard the same thing back then. But, based off what I heard, the numbers I was presented while at ODS, and a few calculations I made, and assuming my memory is correct, it would seem that the Navy is reducing the number of GMO billets by roughly 5% a year (over the last 20 years or so).

According the Bumed Note 1524:
http://www.med.navy.mil/directives/ENotes/1524.pdf

In the 2015 fiscal year, there are 248 Interns without straight thru contract (10 with straight thru) of which 171 will be going GMO,UMO,FS. In other words, 69% or almost 7 of every 10 interns will be not be doing some form of residency after internship. These are the numbers today.

 

[TheTruckGuy]

Based off the notes I took at ODS, there are the following billets for 2014: 234 flight surgery, 154 GMO, 104 UMO, total of 492. I didn't write down the number, but I want to say that in the early 90's there were close to 1500. So I guess they're making progress towards reducing the billets (if my memory serves me correctly).

 

[colbgw02]

I shadowed an Army dermatologist that just retired who was a "battalion PROFIS doctor" in Iraq a few years ago. He was a major at the time, so he'd apparently been in for some time. And I hear he did a really good job from someone that deployed with him. And PROFIS apparently stands for professional filler system, and is used to stick folks where they're needed, although might not be exactly their specific area of expertise.

To clarify, this is not the same thing that I was referencing early. The PROFIS, which is actually a pretty good system, IMO, assigns a physician to a unit, but permits that physician to continue practicing at the MTF. If the unit deploys, then so does the physician. And yes, occasionally the physician's duty with the operational unit will be outside the field that they practice.

The brigade surgeon spots are full-time positions, which take you away from your specialty 100% or nearly 100%. An example would be a pediatric radiologist serving as a GMO, doing various administrative tasks and seeing adult sick call.

 

[Gastrapathy]

There's an Army GI serving as s battalion surgeon in his first job post fellowship.

 

[Slevin]

Where I'm at now as individuals who are either BDE, BSB or in other operational billets we have an interventional cardiologist, GI x 2, Cards, Onc, FM, EM, IM and that's the ones I know about off the top of my head. Crazy what a waste it is

 

[backrow]

I'm pretty sure the Army has a neuro - ophthalmologist and I think, but less certain, a pediatric ophthalmologist in a brigade surgeon position as well

 

[BlackFrancis33]

In addition to 1 neuro-ophthalmologist (cause we have so many of those around), the peds subspecialties are really being hit hard. Due to being over strength, significantly, based on whatever equation they use, I know a peds cardiologist and Developmental peds who got hit with this recently. As an outsider, it appears all the sub specialists are lumped together. Don't forget the plan to cut fellowship training programs. The peds fellowships are waiting for the boom right now with expectations some/many will be cut. I know that is off topic, but I guarantee that the retention in these specialties being forced into Brigade slots is going to drop precipitously. Again, that is probably the goal.

 

[Kilgoretrout 65]

They told me the same thing in 1997. I did a GMO tour 2003-6, pre residency. It worked out OK.

They have converted some billets to residency-trained physicians. Some progress has been made. I think they've made about all the progress they CAN make though, unless they expand the pool of post-residency physicians assigned to these billets. Ie, take the Army/AF route. There just aren't enough FP and IM docs to do it all.

Join the Navy - count on doing a GMO tour pre residency.
Join the Army/AF - count on doing a GMO tour post residency.

Being assigned an internal medicine spot as a brand new internist does not equal a GMO tour. I don't know any residency trained Air Force docs doing GMO's after residency. Being deployed doesn't count.
I know of one graduating fellow who was RIF'd and got separation pay but a civilian tour in Nashville isn't a GMO either.