Air Force - Cuts to HPSP

[radiologay]

Hi all - just wanted to get some crowd sourcing going on this site. A bunch of the AF HPSP people across non-critical wartime specialities were told last week that there are no longer positions available for them in the Air Force. They were given 3 options: try to join the Army, go into IRR, or pay back their obligation. It's unclear how final this decision is, because no one has gotten any information on how much would have to be repaid. I think someone said the decision would be finalized in 6-9 months.

No one on the active duty side has heard anything about this - it looks like it was just for HPSP people approaching the end of their residency. That being said, have any of you heard about this? I am a little confused why this came out of nowhere, when it seemed like no changes were going to be made.

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[didja]

I've heard rumblings about this as well but heard that they will actually just pay back their time in the IRR with no other monetary payback. As a taxpayer and future patient as a retiree decisions like this are dubious.

 

[TheEarDoc]

I've heard rumblings about this as well but heard that they will actually just pay back their time in the IRR with no other monetary payback. As a taxpayer and future patient as a retiree decisions like this are dubious.

Wow that's a good gig! No drilling and in the IRR with no actual obligation unless things really hit the fan! Those folks lucked out!

 

[deuist]

I would say they caught a lucky break on this one. Join the IRR and never look back.

 

[Chonal Atresia]

I would say they caught a lucky break on this one. Join the IRR and never look back.

Agreed. These fortunate few have been awarded Willy Wonka’s golden ticket. Take it and run far away. Military medicine is in complete disarray (to put it kindly).

USUHS Class of ‘02

 

[Gastrapathy]

As a taxpayer, this would be incredibly offensive. I presume you mean prior HPSP who are now deferred for residency? Or are these current residents at AF residencies?

 

[Gastrapathy]

The mythical palace chase returns

 

[DrMetal]

Hi all - just wanted to get some crowd sourcing going on this site. A bunch of the AF HPSP people across non-critical wartime specialities were told last week that there are no longer positions available for them in the Air Force. They were given 3 options: try to join the Army, go into IRR, or pay back their obligation. It's unclear how final this decision is, because no one has gotten any information on how much would have to be repaid. I think someone said the decision would be finalized in 6-9 months.

No one on the active duty side has heard anything about this - it looks like it was just for HPSP people approaching the end of their residency. That being said, have any of you heard about this? I am a little confused why this came out of nowhere, when it seemed like no changes were going to be made.

Just for the sake of comedy, would you mind elaborating exactly how many (what's a 'bunch': 2, 3, 47?) physicians got this notice? And what specialties are we talking about here? And the source of this announcement was an official Air Force line of communication?

So how is it that 4 years ago, they were allowed to matriculate in that Ophthalmology residency, at that time it was a 'critical wartime specialty', and now it's not?!

What does it take for the IG fairy to grace the medical corps with its presence?!

 

[radiologay]

Just for the sake of comedy, would you mind elaborating exactly how many (what's a 'bunch': 2, 3, 47?) physicians got this notice? And what specialties are we talking about here? And the source of this announcement was an official Air Force line of communication?

So how is it that 4 years ago, they were allowed to matriculate in that Ophthalmology residency, at that time it was a 'critical wartime specialty', and now it's not?!

What does it take for the IG fairy to grace the medical corps with its presence?!

This was a discussion on the AF HPSP facebook page - the Air Force told people that they made the decision to let 48 people be released from their contracts. There has not been an official announcement that I have seen, but at least 15 people had to submit rank lists and personal statements for what outcome they would like (transfer to Army, IRR, or recoupment). So it seems to be an official action, since someone is collecting those rank lists and personal statements. From the conversation, it appears everyone is a Civ Deferred HPSP resident in their final year of residency. The specialities affected are IM, FM, Peds, EM, Neurology, Path (from what I have seen on the post and in the group).

 

[Volatile]

Surprised to see EM on that list. The few conversations I have been privy to mentioned only peds. Sounds about right for the military, those that deploy constantly (my specialty) cont to do so, those that don’t, here’s your free ride. Lol you have to laugh at it or you’ll go insane!

 

[DrMetal]

This was a discussion on the AF HPSP facebook page - the Air Force told people that they made the decision to let 48 people be released from their contracts. There has not been an official announcement that I have seen, but at least 15 people had to submit rank lists and personal statements for what outcome they would like (transfer to Army, IRR, or recoupment). So it seems to be an official action, since someone is collecting those rank lists and personal statements. From the conversation, it appears everyone is a Civ Deferred HPSP resident in their final year of residency. The specialities affected are IM, FM, Peds, EM, Neurology, Path (from what I have seen on the post and in the group).

I swear, if I cared enough, I would file an IG complaint against I dunno who . . .knowing that almost 50 physicians---who we may have spent nearly a half a million dollars on each, thus ~$25M total---will never spend a day on active duty.

If they're not 'wartime' critical specialties (by the way, this is a crock of sht, and most of the people making these decisions have no idea what warfare posturing is really like), then don't let them train it it. But once you've let 'em train, use them! We still have MTFs and clinics that need to be manned.

I take some solace/comfort in that you got this from a Facebook page. Maybe it's not true. My FB page makes me look like a rock star (some truth to that, I do play guitar).

 

[Gastrapathy]

Even having them pay back at a VA hospital would be more reason than letting them walk. I hope this isn’t accurate

 

[orbitsurgMD]

In the HPSP contracts, there were terms specified at least at one point that allowed the DOD to assign a scholarship beneficiary to another U.S. government activity for the purpose of service in repayment of their scholarship obligation, and those terms specifically mentioned assignment to activities under the direction of the secretary of the HHS. Presumably that might include government service with the USPHS and the IHS, but I believe other assignments were allowed. A free ticket seems wasteful. Contract repayment service at a standard civilian GS civil service wage at the Department of Veterans Affairs (didn't exist at that time as a cabinet department) would have been an option as well, IIRC.

Not that I have any ill will, but the Air Force is squandering personnel resources if these are in fact board-eligible physicians they are cutting loose on IRR.

 

[orbitsurgMD]

This just as wasteful as ordering a few hundred military vehicles or a couple of planes and deciding you didn't want to field them after all and sending them to scrap because you don't want to store or maintain them either.

Alternatively, cutting them loose to work, earn, and pay taxes on civilian incomes is probably the fastest way to recoup the HPSP expenditure.

 

[orbitsurgMD]

A long time ago, the Navy apparently had a similar problem with medical officers completing cardiothoracic surgery fellowships when it decided to close down its cardiothoracic divisions due to low patient census and concern about low volumes causing higher-than-average complication rates, which they wanted to avoid, for obvious reasons. The question was what to do with these people who had done seven or eight years of postgraduate training. One proposal was to just cut them loose. I don't think I ever heard how that was resolved.

 

[Volatile]

Is the IRR commitment for 8 years? How often are physicians called back from IRR?

Rarely. During the covid peak a few IRR docs were asked if they would be interested in helping out, but it was still voluntary. So you could say it would take a pandemic worse than we just experienced to get close

 

[In4thelonghaul]

Even having them pay back at a VA hospital would be more reason than letting them walk. I hope this isn’t accurate

Sadly it is true. One of the individuals affected is a good friend who served as a Flight Surgeon with me. He called me a couple weeks ago to tell me. I was particularly perplexed because of his specialty (EM).

 

[Brouillet2017]

The specialities affected are IM, FM, Peds, EM, Neurology, Path (from what I have seen on the post and in the group).

I'm slightly surprised they would actually do that for any specialty, but I am downright baffled as to how in the world this would happen to someone in EM. Supposedly the military is clamoring up and down for EM physicians...

 

[orbitsurgMD]

This makes the intern to GMO path seem all the more starkly unfair. Some get a green light to do full residencies and a lucky IRR ticket out with no active duty, and the others, well, get what they get.

If there were negative bullet points to hand out, the brain trust that programmed this wasteful fiasco should receive a few. In most businesses, if you cause a $25M loss, you get shown the door.

 

[DrMetal]

$25 million is not even a drop in the bucket when you consider the administration is pushing through a $1.9 trillion spending bill.

Many drops eventually make a full bucket . . . but ok, never mind the monetary aspect of things, this is also wrong in principle.

In most businesses, if you cause a $25M loss, you get shown the door.

Or go to jail!

 

[militaryPHYS]

I'm sure the calculations they are looking at are going to save them much more than 25 million over the next "x" years. Just depends on the way they want to spin it.

I find this news very unsettling. I am happy for those who going IRR is a net positive or at least neutral for them. For some this will have been a waste of years of their life. Please continue to provide as much direct information as possible as it evolves.

 

[TheEarDoc]

Even having them pay back at a VA hospital would be more reason than letting them walk. I hope this isn’t accurate

OR a DOD facility as a DOD provider.

 

[orbitsurgMD]

A big question is how much recoupment will HPSP scholars that go into IRR have to pay?

Probably nothing. They aren't refusing service and they aren't ineligible to serve. If they were made to repay, they have a bad faith counter-claim against the USAF. The Air Force just doesn't want them.

 

[Gastrapathy]

For this to “save” money on paper, it does so by simply not providing care. It shifts the burden or makes it hard enough for people to get in that they give up. AF medicine has been closing hospitals and passing the buck for years but this is particularly egregious.

 

[orbitsurgMD]

Probably nothing. They aren't refusing service and they aren't ineligible to serve. If they were made to repay, they have a bad faith counter-claim against the USAF. The Air Force just doesn't want them.

They might have a bad faith claim even if they don't seek repayment. Part of the HPSP contract is the term of expected employment on completion of the residency, such that a contractee would not be seeking alternate employment and potentially declining offers of employment under the reasonable expectation of full-time active duty assignment with the Air Force. As their residencies draw to closing this June, that becomes ever more urgent, and delays by the Air Force cause harm. Suppose you get an offer for $350K/yr for a job you would like and some USAF clown dawdles and you lose the offer, only to have them decide not to cut you orders. Harm done.

 

[pgg]

This isn't any less egregious than current schemes to forgive student loan debt.

AF to HPSP residents: "We don't really need you, because we can't plan our way out of a paper bag, our bad, bye"

vs

Federal Government to America: "Aw, you owe money, that's so sad, here have some money"

 

[armytrainingsir]

Sounds about right for .mil medicine and interservice rivalry.

AF should have cut a deal with the navy and army and sent them over to those services. Esp with FM and EM. Absolutely no excuse to cut those folks loose. And IRR? Puh-lease. Give them a choice of finishing their time in the PHS,INS or 16 years of TPU reserves.

And, on a related note, why is AF medicine still even a thing? 30 years ago is it was a rinky dink distant 3rd compared to Army and Navy medicine.

Army should take over the role, just like the Navy covers the Marines.

Heck, just stop pretending we have three branches of the military, scrap the Air Force, bring back the Army Air Corps, and be done with it!

 

[TheEarDoc]

Sounds about right for .mil medicine and interservice rivalry.

AF should have cut a deal with the navy and army and sent them over to those services. Esp with FM and EM. Absolutely no excuse to cut those folks loose. And IRR? Puh-lease. Give them a choice of finishing their time in the PHS,INS or 16 years of TPU reserves.

And, on a related note, why is AF medicine still even a thing? 30 years ago is it was a rinky dink distant 3rd compared to Army and Navy medicine.

Army should take over the role, just like the Navy covers the Marines.

Heck, just stop pretending we have three branches of the military, scrap the Air Force, bring back the Army Air Corps, and be done with it!

I like your style.

When I get the smug Air Force patients who see my Army lanyard and talk smack about the Army being inferior to the Air Force I say "you mean the Army Air Corps?".

 

[ValeRx]

Service budget offices at the Pentagon had to rework their budgets/manpower recently due to the change in presidential administration. They had one budget pre-planned in case Trump won re-election and recently had to replace them. This is most likely why.

 

[Apollyon]

Heck, just stop pretending we have three branches of the military, scrap the Air Force, bring back the Army Air Corps, and be done with it!

There's just no SPACE for that force!

 

[backrow]

Service budget offices at the Pentagon had to rework their budgets/manpower recently due to the change in presidential administration. They had one budget pre-planned in case Trump won re-election and recently had to replace them. This is most likely why.

This presidential transition is not related to what transpired. I’m not at liberty to discuss the limited background information I’m aware of that caused this AF “fiasco” but I can say it wasn’t political in nature.

(I hate to be one who says “I know more than I can say, but in this instance I haven’t really had clearance to publicly discuss so have to restrain myself a bit. For those AF folks I’d recommend they reach out to their Program Directors and Specialty Consultants who can likely comment and provide additional information)

 

[backrow]

I was asked if I could comment as to if I thought this AF issue is something we would see in other services.

I think this would be ok to answer as it’s not really divulging any of the discussion.

No, this seemed to be a uniquely AF issue.

 

[DrMetal]

(I hate to be one who says “I know more than I can say, but in this instance I haven’t really had clearance to publicly discuss so have to restrain myself a bit.

Then . . . why bother saying anything at all?

 

[pgg]

Many drops eventually make a full bucket . . . but ok, never mind the monetary aspect of things, this is also wrong in principle.

No raindrop ever thinks it's the one responsible for the flood.

 

[backrow]

Then . . . why bother saying anything at all?

I’ll bite...

Because I had information that I could discuss that was relevant to the topic.

I would argue it was more useful than some of the other speculative posts.

 

[armytrainingsir]

I would argue it was more useful than some of the other speculative posts.

Hey, I resemble that remark.

 

[Septimusseverus]

edited

 

[backrow]

Hi backrow,

I know you said much of this is classified, but can you at least say if you anticipate similar issues arising in the future? ie more cuts next year to USAF resident docs

Please allow me to clarify: none of this is classified in any way. I was simply a fly on a wall for a meeting that I do not feel comfortable disclosing what was said since I was not part of the decision making process or part of the chain in which it involves (aka AF GME).

I actually don’t know the answer to if it would happen again. I would recommend that anyone within the AF world reach out to their recruiter, HPSP office, or GME leadership (Program Director, Specialty Consultant) as I can almost guarantee they have more information (and would probably even feel fine discussing all the details). I’m sure someone could get the skinny and come back and post.

 

[DeadCactus]

Good for them, glad they hit the jackpot (granted the job market is crap). They stepped up and were willing to do their part and it seems to have worked out for them. Hell, the taxpayer is probably still getting plenty of bang for their buck just having them in the community and with the specter of a recall over their head for 7 years.

 

[Brouillet2017]

Maybe I'm missing something, but if they were going to do this, why wouldn't the AF do this with docs who served a military residency? At least that way the docs spent 3-5 years treating servicemembers (for lower than attending pay) before they got let out. But this way, they get nothing from them.

Not that it makes sense to do it in the first place...a waste of money no matter how you shake it

 

[didja]

Sorry for bumping an old thread but any updates on how this all went down? Was this incompetence? How much did it cost the DHA?