Armed Service HPSP/other loan repayment options?

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I don't think the comment from ndn11 was an extreme or even unusual opinion at all. I'm on active duty in the Air Force and talk to active-duty docs all the time. I think ndn11 expressed the sentiments of almost every specialist I have talked to at my medical center and from most people at other centers.
I agree with optho_MudPhud that many people who spent 20years in the military will sing its praises to the heavens--or at least to any impressionable pre-med. But the key thing is, these guys were in the military in the 80's and early 90's--the heyday of the military medical system. The stories from that time are unbelievable but true--doctors right out of training with complex referral cases from all over the world--Huge medical centers that were the equal of any University Hospital--Fairly competitive pay--minimal administrative hassles--few overseas deployments--the most modern equipment--automatic promotion. I saw it as a medical student and I know it was real. But know this--all that is GONE!
The Air-evacuation system that brought the referrals is gone. The generous funding is gone. The medical centers have been gutted. Tri-care (the military HMO) took away the patients.
I tell you again that military medicine has undergone RADICAL change from the perspective of the average doc. The ONLY way to find out the real story is to talk to a non-career medical officer who is currently practicing where you want to be. Guy's who went to the military academy, then military medical school, then military residency and are planning on staying for 20 years are stuck in the system. They will quote the party line about how great it is in the military.
ndn11's comments are closer to the feelings of most doc's than the leadership would ever admit. Granted, I know only a few specialists at a few bases in one branch of the service, so it may be different elsewhere.
Good luck all of you in your career choices.

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Just found this thread, so I figured I'd give it a little bump...

... I'm a college senior holding a pair of acceptances and currently considering Army HPSP vs. Air Force HPSP vs. student loans... it seems like there are tons of different opinions on each option, and I'm trying to figure out what will work for me.

A few points:

~several people (note, affiliated with the armed forces) I have spoken with recently claim that the army and air force (not navy) have done away with GMO tours. They also claim that 80-90% of people match into their military residency specialty of choice, and that they no longer pull students from residencies, allowing for completion of training. This seems to be at odds with several people's experiences here. Are these changes new, or are the recruicters shading the truth? Any comments on this would be most welcome.

~anyone care to comment on the quality of residency in the military? teaching, facilities? I hear that Walter Reed, for example, is the equal of any hospital in the country facility-wise (this from both military and non military docs)

~how does it work if you want to pursue advanced fellowships after residency?take, for example, if one wanted to work in Interventional Cardiology.... after an internal medicine residency, there would be fellowships in cardio and interventional training... would one perform these fellowships after active duty payback?

FYI, I am not set on only one specialty (although anesthesia and orthopedics seem appealing). It seems that those of us who want to 'keep the doors open' so to speak until we work clinical rotations are putting ourselves at a disavantage with the HPSP. ANyone care to comment?

sorry for the long post... I'm hoping to continue this fruitful discussion.

all the best and happy holidays,

Tom
 
Tom,

I'm active-duty AF (HPSP) and have heard about doing away with the GMO tours. They are trying to do away with people having only one year of training and then treating patients completely independently. Apparently studies showed a very high number of bad mistakes were being made by undertrained doc's (Duh!).
It's not happened yet, and very unclear how it will be implemented. For instance, what do you do with someone who wants to do urology when no urology training slots are available? They are VERY rigid on the number of people that they let start training in a given specialty. Pessimists are saying people will be forced to do an entire residency in a specialty which is not their first choice. Obviously this would be a total disaster from a recruiting standpoint, but I don't see any other way to get rid of the GMO/flight surgery tours.
Yes, I would believe that 80% of people match in their specialty of first choice. But remember that this includes people going into FP, Internal medicine, psychiatry, and general surgery--all of which have chronically unfilled spots. If you're going into primary care, the military will love you and you can do what you want. In the more specialized areas (like ortho), it will be a LOT more dicey. 80% odds sounds good when you're just starting, but how about when you finish top of your class and want to go into ENT?
For fellowships, you usually complete residency and then go through the applications process for them to let you do fellowship. Or you can do your time and get out. It's just like the residency applications process. If you want to do something that they don't need you are screwed.
Don't let anyone tell you that military facilities and residency are the equivalent of civilian programs. Historically, the major hospitals have been top-notch, but all that has changed in the last 4-5 years. Down-sizing and outsourcing have gutted the medical centers. I have no personal experience at Walter Reed, but the place I trained went from 300 to 30 beds. They still train the same number of residents. You tell me if the training is still good. Combining with civilian programs has saved some places, but doing away rotatations at different hospitals is a sub-optimal way to train. The hierarchy no longer places much importance on GME and programs have consequently suffered. Some programs are reasonable, some are questionable, but the future is cloudy. Where you train is a HUGE deal and I would not gamble on the military.
 
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300 to 30 beds?? How does that happen? And that's precisely what I'm so worried about--what if I want to do a specialty that the AF doesn't need at the time? I don't think I like the idea that my future is so unclear if I join the AF. btw, what happens after the 4 year payback of active duty? Is it easy to get a job in the civilian sector? Also, is it a good idea to, say, take flight training and become a pilot on the side?
 
Anybody know if HPSP school time and residency counts toward reserve retirement?
 
So what was the consensus? Military good for primary care I got, but is it not good for surgery? :confused: I really don't want to wind up doing primary care.

Oh, and also, does HPSP take care of dependents WHILE u're in school? Like, can my daughter go thru Tricare while I'm in school, or only while I'm on ADT during the summer?
 
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