Hpsp

deleted357625 · Jan 13, 2012

Don't know much about this, but have researching lately, I'm having trouble understanding the 4 years active and inactive duty part. I understand the contract is 8 years so 4 active, and 4 inactive

HPSP covers 4 years tuition, so you have to pay back 4 years. So if someone does 4 year military residency does this cover the inactive 4 years? Then you do 4 years active. And when your active do you work as a physician at an army base?

I heard some people do the 4 years active then pursue the a civilian residency.
After your done with 4 years active can you move on with your life in the civilian world as 4 years "inactive" ha i have no idea.

If someone can clarify, I've been searching and I saw some good explanations but still don't comprehend the whole thing.

BTW: I'm applying to medical school this coming cycle at the age of 19 if everything goes well MCAT wise etc (I heard the 3.5 GPA 29 MCAT deal), so I thought it would be a good idea to serve.

dr zaius · Jan 13, 2012

You're very young to be making such a decision. I don't mean to sound condescending, but you're probably better off taking out loans and seeing if you're still interested in the military following residency. Read through the pro/con threads thoroughly. Deciding to go to medical school is a tough decision in and of itself. Adding the commitment for active duty to the situation makes it even harder.

Sorry to derail. Your age caught me off guard.

deleted357625 · Jan 13, 2012

dr zaius said:
You're very young to be making such a decision. I don't mean to sound condescending, but you're probably better off taking out loans and seeing if you're still interested in the military following residency. Read through the pro/con threads thoroughly. Deciding to go to medical school is a tough decision in and of itself. Adding the commitment for active duty to the situation makes it even harder.

Sorry to derail. Your age caught me off guard.

I understand it's a tough decision. I've been reading the Pro's/Con's for a while now, also have researched this topic. I see it as a better opportunity to do it while I'm young, and by the time I'm done with medical school I'll be in my 20's like everyone else. I'm only a few years younger than most applicants, not a big detriment in my view. Age in my opinion doesn't define my actions.
So please don't see my age as a deterrent, my mindset and mentality is far from a young individual, and getting through school almost applying to medical school has matured me more quickly than my peers.

If anyone can answer my question, I'd appreciate it, but I understand most people's standpoint regarding my age.

J-Rad · Jan 13, 2012

Here's the best way I can explain it: the active duty service obligation (ADSO) is the time debt you accrue equal to the number of years the .mil payed for your school (2, 3, or 4 years). The payback clock starts ticking when you are done with training (after residency or after internship if doing the PGY1-->GMO-->out thing). Years of residency after your intern year also accrue another time debt, but this is paid off concurrently with your ADSO so, functionally, adds no additional time debt for anyone doing a residency that is 5 years or less (presuming a 4-year HPSP ADSO in this scenario).

As you correctly stated, everyone who is not prior-service who enters the military (officeRs and enlisted, medical or not) owes an initial obligation of eight years. Some of that time is active duty (or active reserve for people outside the purview of this discussion) and the remainder will be served in the Individual Ready Reserve (IRR). The only obligation to the military you have in the IRR is to keep them apprised of your contact information and you may need to report somewhere once a year. There is no active reserve unit drilling or anything like that. Contact info is kept current in the unlikely event of an IRR call up. Now the clock on this "eight-year obligation" (for lack of a better term) starts as soon as you come on active duty (for anyone with an active duty commitment). So say you have a four-year ADSO and enter AD to do a three year primary care residency. When you complete your residency, you begin paying back your four-year ADSO. At the end of it, you decide to get out. You have now been on active duty for seven years. You will now be in the IRR for one more year. If you did a five-year surgical residency, followed by a four year ADSO payback and got out, you would spend no time in the IRR (unless you wanted to) since you have already exceeded your eight-year obligation.

Most people will work on a base within their service. If you are Army, you'll be on an Army base. Navy-->Navy base. Air Force-->AF base. Because of the last round of BRAC, bases from different services that are nearby to each other have consolidated many services, including medical, so that alters some of the prospects of being in another service's hospital. Should you be in San Antonio and DC your will see much mingling of the services at the medical centers (Army & AF and Army & Navy, respectively).

And, of course, comes the requisite caution: spend some time reading this board to see if it is really a "good idea to serve" (in the medical corps). You'll find a lot of negative, a few positive, and a good few ambivalent folk here who have laid out a wealth of info over the years.

***For the sake of simplifying the explanation I have ignored the other three year time debt from medical school, issues related to officers never really being totally off the hook until they've resigned their commissions, and people doing fellowships.

deleted357625 · Jan 13, 2012

J-Rad said:
Here's the best way I can explain it: the active duty service obligation (ADSO) is the time debt you accrue equal to the number of years the .mil payed for your school (2, 3, or 4 years). The payback clock starts ticking when you are done with training (after residency or after internship if doing the PGY1-->GMO-->out thing). Years of residency after your intern year also accrue another time debt, but this is paid off concurrently with your ADSO so, functionally, adds no additional time debt for anyone doing a residency that is 5 years or less (presuming a 4-year HPSP ADSO in this scenario).

As you correctly stated, everyone who is not prior-service who enters the military (officeRs and enlisted, medical or not) owes an initial obligation of eight years. Some of that time is active duty (or active reserve for people outside the purview of this discussion) and the remainder will be served in the Individual Ready Reserve (IRR). The only obligation to the military you have in the IRR is to keep them apprised of your contact information and you may need to report somewhere once a year. There is no active reserve unit drilling or anything like that. Contact info is kept current in the unlikely event of an IRR call up. Now the clock on this "eight-year obligation" (for lack of a better term) starts as soon as you come on active duty (for anyone with an active duty commitment). So say you have a four-year ADSO and enter AD to do a three year primary care residency. When you complete your residency, you begin paying back your four-year ADSO. At the end of it, you decide to get out. You have now been on active duty for seven years. You will now be in the IRR for one more year. If you did a five-year surgical residency, followed by a four year ADSO payback and got out, you would spend no time in the IRR (unless you wanted to) since you have already exceeded your eight-year obligation.

Most people will work on a base within their service. If you are Army, you'll be on an Army base. Navy-->Navy base. Air Force-->AF base. Because of the last round of BRAC, bases from different services that are nearby to each other have consolidated many services, including medical, so that alters some of the prospects of being in another service's hospital. Should you be in San Antonio and DC your will see much mingling of the services at the medical centers (Army & AF and Army & Navy, respectively).

And, of course, comes the requisite caution: spend some time reading this board to see if it is really a "good idea to serve" (in the medical corps). You'll find a lot of negative, a few positive, and a good few ambivalent folk here who have laid out a wealth of info over the years.

***For the sake of simplifying the explanation I have ignored the other three year time debt from medical school, issues related to officers never really being totally off the hook until they've resigned their commissions, and people doing fellowships.

Thank you for the clarification, and I've noticed that as well, the cons tend to outweigh the pro's. I'll continue my research.

dr zaius · Jan 13, 2012

torshi said:
I understand it's a tough decision. I've been reading the Pro's/Con's for a while now, also have researched this topic. I see it as a better opportunity to do it while I'm young, and by the time I'm done with medical school I'll be in my 20's like everyone else. I'm only a few years younger than most applicants, not a big detriment in my view. Age in my opinion doesn't define my actions.
So please don't see my age as a deterrent, my mindset and mentality is far from a young individual, and getting through school almost applying to medical school has matured me more quickly than my peers.

If anyone can answer my question, I'd appreciate it, but I understand most people's standpoint regarding my age.

I understand. I grappled with the decision to do HPSP for a long time. I was very gungho about it and didn't think about many of the situations the future might bring me. Now I'm going to be going into the military match while my soon to be wife will be in the civilian match, hoping that we end up in the same area. If I could do it again I would take out loans and pursue FAP. You never know who you will meet in medical school. Just be sure to think about situations like this, because I sure as hell didn't.

deleted357625 · Jan 14, 2012

I understand with HPSP, the medical students might not have a choice in their residency due to the military possibly forcing you into a specialty in much dire need.

But after med school, if you do your intern year, GMO and active duty years, how come you can't do any residency you want if your active duty is up, then after your residency you have another 4 inactive years? I would think after your active duty, go apply to a civilian residency then your back in the civilian world with 4 years inactive duty.

--Also, does your intern year count as AD? Or does AD only count during GMO tour and the rest before residency
--Another question; when doing your GMO, can you do it more than once during AD and transition from flight to battalion?
Someone correct me if I'm wrong.

orbitsurgMD · Jan 14, 2012

torshi said:
I understand with HPSP, the medical students might not have a choice in their residency due to the military possibly forcing you into a specialty in much dire need.

Not quite correct. You may not have the choice of your internship, as in the service branch may assign you to an internship that is not one of your preference or not in a location of your preference. The services cannot make you do a residency in a field not of your choice. If they do not give you something you want, and have not deferred you for civilian training, your alternative is to do a GMO assignment having done only an internship.

torshi said:
But after med school, if you do your intern year, GMO and active duty years, how come you can't do any residency you want if your active duty is up, then after your residency you have another 4 inactive years?

You can. Those inactive years would be concurrent with whatever you did after leaving active duty, whether it be residency or anything else. (I knew one former navy flight surgeon who went to law school after leaving active duty; it doesn't matter what you do.)

torshi said:
I would think after your active duty, go apply to a civilian residency then your back in the civilian world with 4 years inactive duty.

Exactly what many do.

torshi said:
--Also, does your intern year count as AD? Or does AD only count during GMO tour and the rest before residency

An active duty internship counts as a year of active duty toward promotion and retirement. It accrues a year of obligation of service, but at the same time repays a year, so nets zero toward your HPSP obligation.

torshi said:
--Another question; when doing your GMO, can you do it more than once during AD and transition from flight to battalion?
Someone correct me if I'm wrong.

You can have more than one tour, if that is what you mean. If you do a 2-year tour at one station then move to another station for a second tour, you might be required to serve that whole tour before either leaving active duty or going into a service residency, depending on where you have been moved. Expensive transfers, like overseas accompanied tours usually require completion of the entire term of the orders--three years not uncommonly--before being allowed to take new orders or leave the service. You need to know that going in. Also, accepting any special pays given on an annual basis obligates you to serve the whole period before leaving active duty, even if that means serving longer than you would otherwise be obligated to serve.

J-Rad · Jan 14, 2012

torshi said:
I understand with HPSP, the medical students might not have a choice in their residency due to the military possibly forcing you into a specialty in much dire need.

Residency: no. But, you can be non-selected for the residency you want (maybe you're trying for a field that you don't have the stats for). If you don't have a back up specialty that you have a shot at, there are people on this board who've reported knowing people who were forced into an internship they didn't want (e.g. someone who'd have rather do a transitional year being forced into a surgical-prelim year.)

But after med school, if you do your intern year, GMO and active duty years, how come you can't do any residency you want if your active duty is up,

Should you do PGY1-->GMO but desire residency training in the .mil your ADSO need not be up before being able to reapply for residency. You can reapply anytime you want but there may be external factors that limit the time when you can realistically be selected (here's an example: in the Navy, it is uncommon-though not unheard of-to be able to get back in residency before completing two years of GMO time.)

then after your residency you have another 4 inactive years? I would think after your active duty, go apply to a civilian residency then your back in the civilian world with 4 years inactive duty.

You need to go back and read my explanation of how the IRR stuff works. But the other key thing you need to understand is that active duty (AD) residency training (after intern year) incurs a 6 month:6 month ADSO. Example: individual does PGY1 (which is time-neutral for debt or payback in re ADSOs) followed by a four-year tour as a GMO. They've now wiped out their ADSO from a four-year HPSP. They applied and were accepted to train in an AD residency that requires them to train for another three years. At completion of this training, they owe a new three year ADSO (others more expert in GMO/residency issues, please chime in: if they had to repeat internship due to time out in GMO land, is the second internship ADSO-time neutral or does it now incur time debt?).

--Also, does your intern year count as AD?

As active duty? Yes. This is applicable to the eight-year obligation. I.e. Someone who does a PGY1 followed by a four-year-GMO tour and then gets out (five years total AD time), will be in the IRR for three years. This will functionally not affect being able to train in a civilian residency afterwards. OTOH, it does not count as payback time for the original ADSO. The internship is time-neutral in that regard: doesn't incur time debt, but does not pay back time owed either.

Or does AD only count during GMO tour and the rest before residency

See above

--Another question; when doing your GMO, can you do it more than once during AD and transition from flight to battalion?

There are people who choose to do more than one GMO tours in more than one field. One of my residency mates was formerly a Navy Flight Surgeon followed by a Navy Dive Medical Officer. Unless you want to specialize in occupational or preventive medicine and want to spend the rest of your career in those fields, this would be a pretty dumb idea (oddly, this guy I speak of was quite smart and a good doc. I haven't an earthly idea why he did what he did).

Someone correct me if I'm wrong.

My second and third responses kind of mixed up the respective paragraphs being responded to. I should also note that orbitsurgMD is probably more of a subject matter expert in this area and has clarified my understanding of issues related to internship in the past.

Hpsp

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dr zaius

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