Army USUHS with no prior military exp and a family

[iamjvc]

So I've read about 60-100 pages here, and it has been very helpful but I'm still looking for something more specific to my situation. I'm a 30 y/o married woman with a 2 y/o. No experience with the military, though my husband was Navy (and loved it) before we met. I'm currently in my 2nd year of pre-med and thinking a great deal about applying/going to USUHS. Since I'm the 1st person in my family to attend college and would be the 1st to serve I don't have anywhere to go for advice, besides you lovely people.
I like the idea of serving in the military and helping soldiers, and I also like the idea of not having to worry about being unable to provide care because an insurance company does not want to pay for it. Since I have a family the money and lack of debt is really enticing, and I am set on Family Practice, so even after residency I think the money is great. Plus, help with childcare is a huge thing. Additionally, I don't feel like being a doctor makes me a super human who deserves to have all the mere mortal crawling at their feet. It's a calling, I want to do it to help people and hopefully prevent unnecessary suffering and death, not to feel like the big (wo)man on campus. Finally, my husband does not have a career where moving around would be an issue, he is an exceptional salesmen, and I'm pretty sure there is stuff to sell everywhere, and for the short term we love the DC area.
I have seen a lot of people mention that sh*tty bases are a reason to not join, but we moved from Southern California to North Dakota for my school, and are managing to deal with that, so I'm optimistic Ft. Polk is something we can handle.
Is all the complaining about having nurses and NPs boss you around a prestige thing, or something else? Because I would think a boss is a boss, they usually are all out of touch, at least in every job I've ever had (though they were not medical jobs).
I don't love the idea of deploying in that I've never left my son overnight, however, it is something I would not hesitate to do. I just have no experience with it.
I suppose I'm just hoping for some guidance that isn't geared to a single 22 year old who can just live off of ramen noodles for med school and residency. Thanks!

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[Gastrapathy]

We can't make the decision for you. There is truth here. Your situation is not unique. Do you have any specific questions? If you want a generic answer, mine is don't do it.

 

[BigNavyPedsGuy]

It sounds like you want us to agree with you. I had a LOT of parents in their 03s in my civilian med school class. They are all doing fine and none of them wish they could go back in time and join the military. Most of them saw my experience and are glad they kept their options open.

I put family first, and the military is a terrible way to do that. I know a lot of parents (both genders) that work less than full tiem to see their kids grow up. I actually took a job like that. That is impossible in the military.

I agree with Gastrapathy, what's your question?

 

[logos1226]

You have great, positive attitude which I am sure will serve you well anywhere you go. That being said, no one can tell you how YOUR military experience is going to be like. Military is quite heterogeneous environment. Depending on your duty assignment, branch of service, speciality, leadership above you, and LUCK, your experiences will vary from great to "OMG I want to GTFO". Currently, there seem to be more military docs with negative experiences than those with positive experiences especially on SDN. I would advise you to talk to as many as military physicians as possible to get a broader idea, keeping in mind that no one person's experience will be representative of the military medicine as a whole. By the way, USUHS is super friendly to married students with kids and people's experiences with the school have been mostly positive. It is the life after USUHS that many people have problems with.

 

[TurtleDO2012]

I will present two stories- A female IM physician I have met has loved her experience in the military for the most part. She used HPSP, did IM and a fellowship, and was lucky enough to be stationed at a large MTF. She utilizes the full healthcare benefits with her kids having great access for autism care. She estimates she gets about a couple thousand dollars worth of care specifically for them monthly. She works no more than 40 hours a week typically. Usually out of the clinic by 4-:430. Her appointments are usually 30 minutes a day. Occasionally works wards overseeing residents a couple weeks a year and during this time is the only time her schedule sucks. She has loved her experience and is very grateful that the ride has worked well so far. Her fears/annoyances are moving. Her kids have a great support system at her current location that has developed over a couple years and she hates the thought of having to move and restart the entire process all over again and likely there will be gaps between getting everything resumed. She intends to stay all for as long as possible. She also hasn't deployed but understands it is apart of the process. She doesn't feel that she could make enough in a civilian practice that matches her current work and stress level and also provide the same amount of care for her kids.

I compare that to another friend who is also a mother, FM doc. She did HPSP, FM at a smaller MTF. Loved her program. First assignment she does clinic regularly and call on the wards is shared across the providers. Her MTF's wards are predominately ran by FM like most small MTFs. Schedule and call during these times are crazy time consuming. She hates the way the patients project a sense of entitlement. She has little control over her clinic and schedule and as a FM doc majority of her appointments are 20 minutes and currently usually sees about 18-22 patients depending on walk-ins that have to be seen. She usually is done with clinic around 5. She is looking forward to getting out as soon as possible and looking for more control over her schedule, may take time off completely and just take care of her kids since all the big bills are taken care of and her spouse works. She has never deployed but understands it could happen.

You're going to get varied stories of joy and angst with joining.

 

[Gastrapathy]

Both of those are positive stories.

 

[TurtleDO2012]

Completely agree with those being positive stories. From my own bias I wouldn't join again. Maybe if I was in my chosen residency instead of a GMO I would feel different but I am not staying beyond my current ADSO.

 

[jabreal00]

I agree that military medicine is fairly heterogeneous in people's individual experience. However, one thing is for certain is the direction the military is moving, especially Army. There is a emphasis on operational assignments. These are mainly administrative roles that a physician is employed in advising line military officers on the readiness of the troops. It's not glamorous and it takes away time from clinical work. These assignments are generally 2 years. Deployments are a reality. With the turmoil in the middle east deployment tempos are actually ramping up rather than winding down. Kuwait, Iraq and Afghanistan are seen a lot of troop movements. Unless one can finagle some sort of non-deployable medical condition expect to deploy every 3-4 years.

So if one does USUHS, they generally are going to stay in for 20 years. Assuming one does a 3 year residency, over the course of 17 years of pay back expect to deploy at the minimum 3-4 times (4.5-9 months). Expect to have an operational assignment for at least 2 of those years. Expect to move locations 5 or more times. I will have been in the military 11 years (including my training years) before I get out. I had a three year HPSP scholarship. I had 5 years of pay back after my training. I moved 4 times during my time in the military and deployed once. The moves were relatively easy for me in the beginning because I was single. Now that I am married it is more disruptive.

I don't want to dash dreams and I generally don't dissuade anyone from joining. For me I felt my training has been good. My payback time has been mixed. I've had crappy assignments and one good one. If I had a time machine, knowing what I know now, I probably wouldn't have joined. I say this comparing me to friends who stayed the civilian route and did the same type of specialty I did. They seem happier and more fulfilled. They've been able to start families and establish roots. For my wife and I it's always been the looming deployment or PCS move over our heads.

 

[deleted480308]

Unless you just really want to be a soldier (and assuming you really are truly convinced about FM) you could also look in the NHSC. The stipend is less ($2k/month) but they also pay tuition. You are bound to a primary care specialty but you do civilian match and work a civilian job for a few years to pay off the debt.

Assuming you are just dead set on being a soldier, consider the pros/cons of doing the HPSP instead as the time pay off is significantly less than UHUHS. The national guard MDSSP has a longer pay off but you are paying it off in guard (doesn't pay tuition but you get the stipend)

The other thing to consider is that with only one child, if your husband has even a mediocre job, you can pay your bills without either program. and with a physician's salary, you can pay off your loans without either program.

You have a lot of things to weigh and some of those choices require putting some pretty big signatures on some pretty hefty obligations

 

[Ziehl-Neelsen]

I like the idea of serving in the military and helping soldiers, and I also like the idea of not having to worry about being unable to provide care because an insurance company does not want to pay for it.

Helping soldiers, retirees, and their families is the best part of the job. FPs aren't in the position of having insurance companies "deny care". FPs do basic things like treat URIs, evaluate basic musculoskeletal injuries, perform well-woman exams, and manage uncomplicated pregnancies (they are undercompensated for these duties and it takes great skill to pick out serious pathology presenting as a basic complaint, but no insurance company "denies" an EKG, a pap, or a physical exam). It is nice however to provide care for a patient and not have to worry about the whether they are insured or not (but FPs who are employees of Kaiser are similarly protected from the business aspects of medicine).

Since I have a family the money and lack of debt is really enticing, and I am set on Family Practice, so even after residency I think the money is great. Plus, help with childcare is a huge thing.

The lack of debt is very enticing in this day and age. The superior pay at USUHS and during residency allows for a much better standard of living and can really help someone get a head start on investing for retirement if the money is not frittered away. The money as an FP attending would be pretty comparable once you make O-4 and the multi-year bonus could be signed for, but the USHUS commitment and multi-year bonus contract would obligate you for a long time.

What do you mean by help with childcare? Military bases have daycares but one still has to pay for them. And one gets what they pay for--the hours, facilities, and educational program were sub-par at our military CDC. My wife took one look at the military daycare and told me that it was not an option. The military doesn't provide extra money for a nanny or an au pair. If your husband is on a business trip and the hospital commander calls a mandatory formation on Saturday morning (as was done at Travis Air Force Base last weekend), there is no private who comes to your house to watch your kids. You shell out for a babysitter so you can dress up in your "A's" and sit in an auditorium on a Saturday morning while a colonel/general dresses you down for something that you didn't do.

Additionally, I don't feel like being a doctor makes me a super human who deserves to have all the mere mortal crawling at their feet. It's a calling, I want to do it to help people and hopefully prevent unnecessary suffering and death, not to feel like the big (wo)man on campus...
Is all the complaining about having nurses and NPs boss you around a prestige thing, or something else? Because I would think a boss is a boss, they usually are all out of touch, at least in every job I've ever had (though they were not medical jobs).

The difficulty with being a doctor in the military is that the military's priority is the military while the doctor's priority is generally taking care of the patient. That's how you end up cancelling a morning of clinic or surgery to attend anti-rape training, being told to decrease the time you spend with patients to increase RVUs, or being told that you should pay for CME out of your own pocket. Being a good physician is supremely hard. Nurses and allied health professionals do not understand how hard the job truly is. In order to get promoted these nurses and allied health professionals must make the military's priorities their own priorities, so they heedlessly make demands, institute policies, and set objectives that are at odds with one being a good and efficient physician who can balance his tremendous medical responsibilities with some semblance of a family life. I have certainly known lickspittle physician bosses who approve every whim that comes from "the good idea fairy", but in virtually every case where I have seen a boss truly stand up to the "powers that be" about an issue that would help doctors deliver better care or maintain some semblance of a family life that boss has been a physician.

In the civilian world the priority is money. Hospital and HMO CEOs know that you make money by delivering high quality care that leaves patients satisfied and happy. For doctors this means that most every decision is made with the goal of enabling physicians to deliver high quality care that leaves patient's satisfied and happy. No clinics are cancelled for suicide-awareness training, nobody makes you complete 10 online training modules and submit 20 pieces of paperwork to take a week of much-deserved vacation, and nobody tells you can't fire the rude or incompetent administrative staff because of the federal union.

Finally, my husband does not have a career where moving around would be an issue, he is an exceptional salesmen, and I'm pretty sure there is stuff to sell everywhere, and for the short term we love the DC area.
I have seen a lot of people mention that sh*tty bases are a reason to not join, but we moved from Southern California to North Dakota for my school, and are managing to deal with that, so I'm optimistic Ft. Polk is something we can handle.

Having a spouse with a mobile career is important. Would he be able to sell things in Korea? What if he had done a bang-up job with a company and they wanted to make him a regional manager? Would he be ok with moving again and taking another entry-level sales job? Will your kids be ok with the moves? My wife's sister still resents their parents because they PCS'd right before her senior year of high school. Will you be ok with the opportunities for your children at Fort Polk? While Leesville high school has sent many athletes to Baton Rouge to play for the Bayou Bengals, I can assure you they have no youth symphony or international baccalaureate program.

I don't love the idea of deploying in that I've never left my son overnight, however, it is something I would not hesitate to do. I just have no experience with it

As an FP you will deploy. You are also virtually guaranteed to complete at least one (and probably multiple) operational assignments at the battalion or brigade level (make sure you understand what these operational assignments entail). Deployments are difficult on families and I think especially difficult for mothers. My oldest son does not remember his mom's deployment, but toward the end of her deployment my wife could not Skype with our son because it was too emotionally painful. I know from colleagues that the older children get the more difficult deployments are on them. I know many physicians who have left the military because the deployments were too hard on their families. I also know physicians whose families broke up under the strain of multiple deployments.

I suppose I'm just hoping for some guidance that isn't geared to a single 22 year old who can just live off of ramen noodles for med school and residency.

I agree with other responders that you seem to be seeking reassurances from us that USHUS will be a good decision for you and your family and you will enjoy serving as a military physician. I can't offer such assurances. Single 22 year olds without military experience who go to USUHS are not committing their families to 14 years in the military, you are. Make sure you consider your family in this process. Your husband may have been in the military but he does not know what its like to be married to a doctor in the military. Caveat Emptor.

 

[HighPriest]

Agree with everything ZN said. I only wish to include one point (or accentuate it if it was mentioned in another post):

You're in your second premed year. Other than your emphasis on family, most of the opinions you've stated above are likely to change by the time you're in your third year of medical school, and your stance on those opinions once you're done with residency is nigh unpredictable.

You may be the single star who's light shines unhindered throughout your training, but that is not the norm. So when trying to make decisions, always consider whether the decision will still be a good decision if your stance on some of those issues change. I'm not saying you should plan all decisions based upon all possibilities, but while you might not be concerned with being in charge of your own destiny now - that may be an issue as you progress. If you think you could still live with being a soldier before a physician, then so be it.

 

[j4pac]

I didn't read your scenario...I just read the first two sentences of your post. If you have a child...you are a mother first and a physician/officer second. Or at least that is the way that it should be. The answer is that you absolutely shouldn't join the military. Being a physician mommy is going to be enough strain on your child as it is. Be responsible and don't go into the military.

 

[notdeadyet]

If everyone who applied to med school with the intent of going into primary care actually ended up applying to primary care residencies, they would be as competitive as derm.


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[iamjvc]

First of all thanks to everyone who responded. I appreciate you all taking time from your own lives to do so. Being new to this format I thought when someone replied I would receive an e-mail, opened the website and realized I was wrong and that I've been ignoring all you fine folks. Apologies.
I want to address a few commonalities to your replies before going into specifics: I'm looking for confirmation and validation in this decision in as much as any person looks for those things in something they are thinking about doing. Did I expect people to come on here and write "the military is a magical fairytale land made of cotton candy and sunshine where unicorns fly around shooting rainbows out of their a**es!" No. But it does seem as though Army folks are less common on here and I was hoping to hear from some more of them with extra bonus points to any of them who may have done this in a situation at all similar to mine. As for FM, I am dead set on it. I'm well aware of the stats on the number of people who go into medicine for primary care- as well as all altruistic, save the world types, who then come out jaded and going into plastic surgery or what have you. I've actually done quite a bit of reading on these phenomenons, which doesn't necessarily render me immune, but it does make me aware. Ideally I would like to practice in a very old school way, house calls a few day a week, clinic the rest, I'd even accept bartering instead of cash if I could keep a clinic open that way. Unfortunately with malpractice insurance, etc... it is not really possible. Finally, if I was not clear than that is my fault, but deployments and moving are not huge issues. I planned on taking the family for several months of the year to provide medical care in underserved/impoverished areas anyways. In fact, that is the reason I decided against being a PA. If I'm in the middle of the country in Pakistan (husband's family lives there, already been twice) and someone needs emergency care, I want to have as much training and knowledge as possible, rather than being just a PA. If it were not for that I likely you be on the website for PAs instead of here.

More specific to some people:
Gastrapathy: What you write usually makes me sad/disappointed, however every time I see your name I remember going to the Rally and Colbert in that jumpsuit and I cannot help but smile. Just wanted to let you know.

SB247: I have heard of the NHSC and am actually very interested in it too, however it seems really hard to get, so in looking for alternatives I stumbled upon USU. Thank you for mentioning it though.

ZN:

What do you mean by help with childcare? Military bases have daycares but one still has to pay for them. And one gets what they pay for--the hours, facilities, and educational program were sub-par at our military CDC. My wife took one look at the military daycare and told me that it was not an option. The military doesn't provide extra money for a nanny or an au pair. If your husband is on a business trip and the hospital commander calls a mandatory formation on Saturday morning (as was done at Travis Air Force Base last weekend), there is no private who comes to your house to watch your kids. You shell out for a babysitter so you can dress up in your "A's" and sit in an auditorium on a Saturday morning while a colonel/general dresses you down for something that you didn't do.

This was just insulting. I'm not 10 and I don't think I like in a military dictatorship where officers are treated like gods with all kinds of special perks. What I meant was the info I found on the USU website:

Child Development Center at WRNMMC, Bethesda

Childcare is available at the Child Development Center (CDC) at Walter Reed National Military Medical Center (the same base as USU) for children aged 6 weeks to 5 years. There is currently a waiting list at this location, so contact them ASAP. For an application and more information, call (301) 295-0167 or click here.

Child Development Center at Walter Reed Forest Glen Annex, Silver Spring

Childcare is available at the Forest Glen Annex for children aged 6 weeks to 5 years. Care is available on an hourly basis, Monday through Friday, 0700-1600, not to exceed 20 hours per week. Registration is $10.00 and must be paid by check or money order. Must have shot records to register. Hourly fee is $2.00. Call (202) 782-0565 for more information.

Subsidized Childcare
If you are not able to get into the on base daycare, the military will subsidize any daycare to make it the same price until you can. The amount of money that they will subsidize is dependent on total family income and childcare cost. To get an estimate you can call 1 (800) 424-2246.​

I respect your opinion that the childcare was subpar. That is helpful. But it is also definitely cheaper than what is available for most folks in a metro area where you can spend more on daycare than your mortgage. Which was my point. If I may ask, you are/were AF, right? Just curious.

Again, thanks to everyone who took the time to reply.

 

[BigNavyPedsGuy]

As for FM, I am dead set on it. I'm well aware of the stats on the number of people who go into medicine for primary care- as well as all altruistic, save the world types, who then come out jaded and going into plastic surgery or what have you. I've actually done quite a bit of reading on these phenomenons, which doesn't necessarily render me immune, but it does make me aware. Ideally I would like to practice in a very old school way, house calls a few day a week, clinic the rest, I'd even accept bartering instead of cash if I could keep a clinic open that way. Unfortunately with malpractice insurance, etc... it is not really possible.

....

If I'm in the middle of the country in Pakistan (husband's family lives there, already been twice) and someone needs emergency care, I want to have as much training and knowledge as possible, rather than being just a PA. If it were not for that I likely you be on the website for PAs instead of here.

You realize that your desired model for practice will NEVER happen in the military, right? There are some civilian models like that (direct care plans, concierge docs, etc), but NEVER in the military. In the military you'll be in clinic 5 days a week seeing 20-30 patients/day. You'll hve a daily pressure to see more to drive up whatever random metric they're using by then.

Also, if you're goal is to be able to handle emergency care, I would argue that family medicine is not the best choice. Emergency Medicine would be. I know in civilian world, sleepy ERs are sometimes staffed with FP docs, but that's changing. And it's absoutely not the case in the military.

 

[iamjvc]

You realize that your desired model for practice will NEVER happen in the military, right? There are some civilian models like that (direct care plans, concierge docs, etc), but NEVER in the military.

Yes, I realize that. I also realize that without winning the lottery that style of medicine is impossible in the regular world too since I would not make enough to keep an office open/staffed and pay my bills. So sadly it is not going to happen either way.

Also, if you're goal is to be able to handle emergency care, I would argue that family medicine is not the best choice. Emergency Medicine would be. I know in civilian world, sleepy ERs are sometimes staffed with FP docs, but that's changing. And it's absoutely not the case in the military.

My goal is not specifically to be able to handle emergency care. All I meant was that in magical fairy land I would be able to have my own practice and then leave for 2-3 months out of the year and practice in Timbuktu providing 99+% basic primary care and teaching people basic healthcare but if someone came in with an emergency that I had to handle (because I'm in the middle of nowhere) I would want more training and experience than a PA in order to do so. That entire thing is separate from the military though, it's just what I would like to do in a perfect world. I know the military does not work like that, nor should they. Anywhere there is access to specialized care it should absolutely be utilized and always preferred as it is beyond unrealistic to expect any one person to know/do everything.

 

[BigNavyPedsGuy]

I had similar goals of working in developing countries. That is much more feasible as a civilian. If you join the military, they will likely forbid you from visiting Pakistan on leave due to security concerns.

I had to get flag level approval to spend a month at an HIV clinic in Africa. Now that I'm a civilian, I'd just have to buy a ticket and take my passport.

 

[iamjvc]

My husband had to leave the Navy to go to Pakistan and visit his mother when she got cancer. Otherwise he'd probably still be there and we would never have met. I figured any travel done overseas while in the military either needed to be through the military (ie they deploy you) or to Canada/Europe.

 

[Gastrapathy]

I travelled plenty while in the military. I got permission for almost all of it (Africa, Asia, South America, Eastern Europe). Not an issue. I found the local CDC quite good.

If you find my posts sad, I don't know what to tell you. I wasn't disgruntled day to day but the grass is sooo much greener.

 

[haujun]

This was just insulting. I'm not 10 and I don't think I like in a military dictatorship where officers are treated like gods with all kinds of special perks. What I meant was the info I found on the USU website:

Child Development Center at WRNMMC, Bethesda

Childcare is available at the Child Development Center (CDC) at Walter Reed National Military Medical Center (the same base as USU) for children aged 6 weeks to 5 years. There is currently a waiting list at this location, so contact them ASAP. For an application and more information, call (301) 295-0167 or click here.

Child Development Center at Walter Reed Forest Glen Annex, Silver Spring

Childcare is available at the Forest Glen Annex for children aged 6 weeks to 5 years. Care is available on an hourly basis, Monday through Friday, 0700-1600, not to exceed 20 hours per week. Registration is $10.00 and must be paid by check or money order. Must have shot records to register. Hourly fee is $2.00. Call (202) 782-0565 for more information.

Subsidized Childcare
If you are not able to get into the on base daycare, the military will subsidize any daycare to make it the same price until you can. The amount of money that they will subsidize is dependent on total family income and childcare cost. To get an estimate you can call 1 (800) 424-2246.​

I respect your opinion that the childcare was subpar. That is helpful. But it is also definitely cheaper than what is available for most folks in a metro area where you can spend more on daycare than your mortgage. Which was my point. If I may ask, you are/were AF, right? Just curious.

Again, thanks to everyone who took the time to reply.

USUHS understands that many medical students have families and will gladly accommodate your short-term needs during school. In fact USUHS have most happy medical students in the country...only lasting 4 years like fairy tale. BUT after training military has one most dissatisfied physicians in the country for seven long years. Just look at the retention for military physicians.

USUSHS physicians have to endure additional years of obligation and most regret their decision to go to USUHS and even though they received pay and so many other benefits while attending medical school. My friend who attended USUHS had very grateful wife who appreciate pay, lack of debt, day care, benefits etc during USUHS but during his payback his wife told him that she regret his decision to attend USUHS.

 

[TurtleDO2012]

My last 2 cents on this-
For USUHS I would try to confirm or evaluate the ability that you would be able to complete the majority of your rotations in DC mainly for sanity and family life. I have never met anyone who had a bad experience at USUHS but personally for me it got old living out of a suit case and hotel for just my two ADTs back to back. USUHS has there students hitting rotations I believe now as early as the second half of MSII year so there are even more students they are spreading out on rotations then previously. I am sure your situation would be relevant in managing rotations but I don't know.