ARMY HPSP- Internal Medicine and ID Experts Please!!

[bguttery123]

Hi!

HPSP applicant here who has been accepted to his state medical school. I have been doing research out the wazo to find answers to my questions, but have yet to get a solid answer. I thought I would post here for some honest help!

My situation: Accepted to state medical school, which will cost about 150k for tuition over 4 years. Currently working as a nurse so have a lot of experience in healthcare. From this I am fairly confident I want to do IM followed by an ID fellowship. I have seen most of it all and worked with physicians across almost all specialties. I know the good, bad, and the ugly. I am just saying this all to say I am pretty confident in what I want to do. My dream job would be working as an attending at someplace like Emory/working for the CDC or working at USAMRIID. I may be crazy, but I find viruses fascinating (like Ebola) and would love to be an ID physician who dabbles in research and is involved in disease outbreak response. I love the idea of CDC's EIS program or the idea of the potentially training the military can offer. I have read a few books about the awesome stuff that physicians from both programs get to do (Level 4 Virus Hunters of the CDC and The Hot Zone... may be romanticized a bit but that's what I want to do).

I have submitted my application for Army HPSP. My reasoning for this is that I can have my entire schooling paid for, get paid during school, be well supported throughout residency and fellowship, and maybe be on the path to USAMRIID. I am about to get married and the support the scholarship offers would allow my future wife and I to get a solid start to our lives. We are both open to moving and traveling (to residency then fellowship). I will not deny that the financial support is huge for me and my family. I like the idea of the military, and the some of my mentors went through HPSP, pursued ID, and made a career that they loved.

My issues and questions come with getting the ID fellowship. I like IM, but really want to go through and pursue ID. I would rather not spend 2-4 years working in IM in the military then trying to go back to fellowship. I would really like to go IM straight to ID fellowship at Walter Reed then spend my time in the Army working as an ID doc (hopefully at USAMRIID). My recruiter is telling me this would be simple and easy but I am wary of it. I cannot find a straight, up-to-date answer to see if this is possible. I would then like to know the payback, which again my recruiter won't answer. Would I then owe 10 years as an ID doc (4 HPSP plus 6 for fellowship [3 years with 2 year obligation per fellowship year]) or would this compound and I owe 6 or what? I just want a straight answer. The red tape of the military doesn't bother me, but I want to at least know I have a chance on this path.

If I didn't do HPSP, I thought about the National Guard. Pros are I can control my career more, do civilian match, and all of that stuff. I would probably want to do MDSSP and HPLRP, which would require me doing STRAP too. So all in all starting next year I could be in the guard for 20+ years. (4 years med school, 1 intern year, 2 residency (which would be year 1 and 2 of HPLRP and STRAP), 3 years of fellowship (year 3, 4, 5, of HPLRP) the owe 1 year HPLRP and 12 years for MDSSP and STRAP (4 because MDSSP goes to 1:1 with STRAP then 8 for STRAP). I am fine withe short deployments and all, but 20+ years of the Guard schedule (drill weekends and ADT) could be rough and not work with my civilian plan. I don't know if fellowships like Emory would take me with the National Guard stipulation, and I don't know if I could work as an attending or for the CDC with all of that baggage.

Third option is loans :/. Sadly ID is one of the lowest paying specialities so even though I am going to a cheap state school loan repayment would suck. And I would be hard to support my wife anf her educational goals and needs as well as start a family (I guess harder than in the military).

All of this is to ask you SDN experts and military med people for your advice!! Please give me the straight truth that I can't find anywhere else. What would you do?

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[HighPriest]

It is -possible- that you could to IM and go straight to an ID fellowship, but absolutely not guaranteed. In fact, it is probably more likely that you would need to do IM for a period of time and then reaapply to fellowship. That’s just statistics talking. If working IM for a while is a deal breaker, don’t take HPSP. Period.
Also, who knows what the situation will be in 7 years when you’re wrapping up for IM residency? Maybe the military will have cut back the number of ID docs it has. Maybe it will have expanded. Maybe you’ll end up in a brigade surgery spot pushing paper until you get your fellowship. Maybe you won’t get your fellowship at all, and you’ll end up getting out 4 years later and then applying for a civilian fellowship. The problem with HPSP is that just working hard and being a good candidate isn’t enough. You only have so much control over your future....not much, really.

 

[bguttery123]

It is -possible- that you could to IM and go straight to an ID fellowship, but absolutely not guaranteed. In fact, it is probably more likely that you would need to do IM for a period of time and then reaapply to fellowship. That’s just statistics talking. If working IM for a while is a deal breaker, don’t take HPSP. Period.
Also, who knows what the situation will be in 7 years when you’re wrapping up for IM residency? Maybe the military will have cut back the number of ID docs it has. Maybe it will have expanded. Maybe you’ll end up in a brigade surgery spot pushing paper until you get your fellowship. Maybe you won’t get your fellowship at all, and you’ll end up getting out 4 years later and then applying for a civilian fellowship. The problem with HPSP is that just working hard and being a good candidate isn’t enough. You only have so much control over your future....not much, really.

You make some really great points there, thank you! Would you say that you have a lot less control than the civilian route? I know ID is not a super highly competitive fellowship but could I potentially not get the fellowship I want? I am just nervous that doing the Guard would cause competitive ID fellowships to not want me... again thanks for replying!

 

[HighPriest]

You make some really great points there, thank you! Would you say that you have a lot less control than the civilian route? I know ID is not a super highly competitive fellowship but could I potentially not get the fellowship I want? I am just nervous that doing the Guard would cause competitive ID fellowships to not want me... again thanks for replying!

To be fair, I’m not sure how it works with the guard. But if you do HPSP it’s not about your being less competitive. It’s about the military approving you to even apply for a fellowship in the first place. If you got that sweet spot, where they need an ID doc and you’re the best candidate in your service, then you’ll get the best ID position possible. But if they don’t need an ID doc, it doesn’t matter if you’re the best candidate on Earth.

 

[WernickeDO]

Hi!

HPSP applicant here who has been accepted to his state medical school. I have been doing research out the wazo to find answers to my questions, but have yet to get a solid answer. I thought I would post here for some honest help!

My situation: Accepted to state medical school, which will cost about 150k for tuition over 4 years. Currently working as a nurse so have a lot of experience in healthcare. From this I am fairly confident I want to do IM followed by an ID fellowship. I have seen most of it all and worked with physicians across almost all specialties. I know the good, bad, and the ugly. I am just saying this all to say I am pretty confident in what I want to do. My dream job would be working as an attending at someplace like Emory/working for the CDC or working at USAMRIID. I may be crazy, but I find viruses fascinating (like Ebola) and would love to be an ID physician who dabbles in research and is involved in disease outbreak response. I love the idea of CDC's EIS program or the idea of the potentially training the military can offer. I have read a few books about the awesome stuff that physicians from both programs get to do (Level 4 Virus Hunters of the CDC and The Hot Zone... may be romanticized a bit but that's what I want to do).

I have submitted my application for Army HPSP. My reasoning for this is that I can have my entire schooling paid for, get paid during school, be well supported throughout residency and fellowship, and maybe be on the path to USAMRIID. I am about to get married and the support the scholarship offers would allow my future wife and I to get a solid start to our lives. We are both open to moving and traveling (to residency then fellowship). I will not deny that the financial support is huge for me and my family. I like the idea of the military, and the some of my mentors went through HPSP, pursued ID, and made a career that they loved.

My issues and questions come with getting the ID fellowship. I like IM, but really want to go through and pursue ID. I would rather not spend 2-4 years working in IM in the military then trying to go back to fellowship. I would really like to go IM straight to ID fellowship at Walter Reed then spend my time in the Army working as an ID doc (hopefully at USAMRIID). My recruiter is telling me this would be simple and easy but I am wary of it. I cannot find a straight, up-to-date answer to see if this is possible. I would then like to know the payback, which again my recruiter won't answer. Would I then owe 10 years as an ID doc (4 HPSP plus 6 for fellowship [3 years with 2 year obligation per fellowship year]) or would this compound and I owe 6 or what? I just want a straight answer. The red tape of the military doesn't bother me, but I want to at least know I have a chance on this path.

If I didn't do HPSP, I thought about the National Guard. Pros are I can control my career more, do civilian match, and all of that stuff. I would probably want to do MDSSP and HPLRP, which would require me doing STRAP too. So all in all starting next year I could be in the guard for 20+ years. (4 years med school, 1 intern year, 2 residency (which would be year 1 and 2 of HPLRP and STRAP), 3 years of fellowship (year 3, 4, 5, of HPLRP) the owe 1 year HPLRP and 12 years for MDSSP and STRAP (4 because MDSSP goes to 1:1 with STRAP then 8 for STRAP). I am fine withe short deployments and all, but 20+ years of the Guard schedule (drill weekends and ADT) could be rough and not work with my civilian plan. I don't know if fellowships like Emory would take me with the National Guard stipulation, and I don't know if I could work as an attending or for the CDC with all of that baggage.

Third option is loans :/. Sadly ID is one of the lowest paying specialities so even though I am going to a cheap state school loan repayment would suck. And I would be hard to support my wife anf her educational goals and needs as well as start a family (I guess harder than in the military).

All of this is to ask you SDN experts and military med people for your advice!! Please give me the straight truth that I can't find anywhere else. What would you do?

Congrats on acceptance to your state school! That is a tremendous boon and while 150K seems like a lot in loans know that many of your future colleagues who went to expensive private schools often owe more than twice that amount.

My opinion: you are an absolutely HORRIBLE candidate for the HPSP and you should cease and desist immediately. Here's why:

1) You're going to a state school, so you stand to financially benefit much less then the aforementioned private school or DO school applicant. No, you should not join the mil for money, but if you are going to sacrifice control over your medical career and life, then you may as well reap the benefits. Some people are okay with delaying residency for a few years for a 400K benefit, but maybe not so much for a 200K benefit.

2) It's true that most people will shift their choice of medical specialty during med school, and you may be no different, but let's just assume you will go IM and ID for now. High Priest is right that the availability of fellowships is a tenuous thing in the military, and this is something about the nature of the beast that pre-meds with no mil experience need to understand. You are viewing life through the lens of meritocracy, in that if your boards and research is good enough, you will obtain admission, residency, fellowship, movie passes, cake, etc. The mil is different in that the people upstairs may simply decide that they don't need any ID fellows this year, or that the spots will go to someone else because they know someone up high, or that your services are needed as a brigade surgeon in Ft Polk. If you have a clear plan for your career, then joining the military will bring unnecessary risk to that vision.

3) You have an interest in research. If you want to do research, avoid the military. Period. The amount of true clinical research coming out of the military right now compared to what will likely be produced at your state school is minuscule. Someone with more research experience can chime in on this but the consensus is that research is bogged down by lack of funding, lack of interest, lack of resources, and a very slow IRB approval process. Research does happen in the mil but not by clinical docs; you are much more likely to do clinical work than research. Contrast that with civilian institutions, which if you get into the right spot will welcome your research efforts and give you the time and materials to produce publications.

4) Is your recruiter a physician? If not, then they do not have a true understanding of the process and are in no place to extrapolate the likelihood of you placing into a fellowship.

5) When I went through HPSP, the monthly stipend was about $1800, not sure what it is now. That won't change if you get married or start a family. It's really not a lot of money to live very high on the hog while in med school. It's certainly not the same as USUHS pay. Does your future spouse work? If so, it can be difficult to live off of one salary but it is certainly doable. If they can cover living expenses then that will SIGNIFICANTLY decrease your debt burden down the line, which again negates one of the benefits of HPSP.

6) Loans do suck but if you are wise and "live like a resident" as the White Coat Investor advises then you can make good headway on your loans and should be able to pay them off quickly. It will require some delayed gratification but you can do it.

7) Frankly I'm not entirely clear on the fellowship payback rules but if you do HPSP then IM and 3 years of ID you are looking at at least 8 years active duty after all your training is complete (4 years from HPSP and 3+1 from fellowship), someone please correct me if I'm wrong.

I know nothing of the National Guard or other military programs. No comment.

To sum up, you are going to a (relatively) inexpensive medical school and have a fellowship in mind and are interested in doing research. This makes you someone that is likely to be frustrated and ill-rewarded, save satisfaction of serving your country. If service is your interest then there are other avenues to consider that don't include surrendering control over your life and career.

Contrast this with if you stay civilian, and train in civilian hospitals that may very well have ID fellowships in house. You can focus 100% on your career and not have to worry about your research being interrupted to deploy to the latest Suckistan.

Continue to read this forum and get an idea as to what life in milmed is like. It is true that the chips fall well for many people and they are thrilled, but this doesn't happen for everyone. You give yourself a much better chance of obtaining the medical practice you desire by staying civilian. Good luck.

 

[244913]

Congrats on acceptance to your state school! That is a tremendous boon and while 150K seems like a lot in loans know that many of your future colleagues who went to expensive private schools often owe more than twice that amount.

My opinion: you are an absolutely HORRIBLE candidate for the HPSP and you should cease and desist immediately. Here's why:

1) You're going to a state school, so you stand to financially benefit much less then the aforementioned private school or DO school applicant. No, you should not join the mil for money, but if you are going to sacrifice control over your medical career and life, then you may as well reap the benefits. Some people are okay with delaying residency for a few years for a 400K benefit, but maybe not so much for a 200K benefit.

2) It's true that most people will shift their choice of medical specialty during med school, and you may be no different, but let's just assume you will go IM and ID for now. High Priest is right that the availability of fellowships is a tenuous thing in the military, and this is something about the nature of the beast that pre-meds with no mil experience need to understand. You are viewing life through the lens of meritocracy, in that if your boards and research is good enough, you will obtain admission, residency, fellowship, movie passes, cake, etc. The mil is different in that the people upstairs may simply decide that they don't need any ID fellows this year, or that the spots will go to someone else because they know someone up high, or that your services are needed as a brigade surgeon in Ft Polk. If you have a clear plan for your career, then joining the military will bring unnecessary risk to that vision.

3) You have an interest in research. If you want to do research, avoid the military. Period. The amount of true clinical research coming out of the military right now compared to what will likely be produced at your state school is minuscule. Someone with more research experience can chime in on this but the consensus is that research is bogged down by lack of funding, lack of interest, lack of resources, and a very slow IRB approval process. Research does happen in the mil but not by clinical docs; you are much more likely to do clinical work than research. Contrast that with civilian institutions, which if you get into the right spot will welcome your research efforts and give you the time and materials to produce publications.

4) Is your recruiter a physician? If not, then they do not have a true understanding of the process and are in no place to extrapolate the likelihood of you placing into a fellowship.

5) When I went through HPSP, the monthly stipend was about $1800, not sure what it is now. That won't change if you get married or start a family. It's really not a lot of money to live very high on the hog while in med school. It's certainly not the same as USUHS pay. Does your future spouse work? If so, it can be difficult to live off of one salary but it is certainly doable. If they can cover living expenses then that will SIGNIFICANTLY decrease your debt burden down the line, which again negates one of the benefits of HPSP.

6) Loans do suck but if you are wise and "live like a resident" as the White Coat Investor advises then you can make good headway on your loans and should be able to pay them off quickly. It will require some delayed gratification but you can do it.

7) Frankly I'm not entirely clear on the fellowship payback rules but if you do HPSP then IM and 3 years of ID you are looking at at least 8 years active duty after all your training is complete (4 years from HPSP and 3+1 from fellowship), someone please correct me if I'm wrong.

I know nothing of the National Guard or other military programs. No comment.

To sum up, you are going to a (relatively) inexpensive medical school and have a fellowship in mind and are interested in doing research. This makes you someone that is likely to be frustrated and ill-rewarded, save satisfaction of serving your country. If service is your interest then there are other avenues to consider that don't include surrendering control over your life and career.

Contrast this with if you stay civilian, and train in civilian hospitals that may very well have ID fellowships in house. You can focus 100% on your career and not have to worry about your research being interrupted to deploy to the latest Suckistan.

Continue to read this forum and get an idea as to what life in milmed is like. It is true that the chips fall well for many people and they are thrilled, but this doesn't happen for everyone. You give yourself a much better chance of obtaining the medical practice you desire by staying civilian. Good luck.

Would concur with this. Likely your only opportunities for ID research will be as a brigade surgeon investigating fauna indigenous to Syria, Afghanistan, and other middle eastern hellholes.

On the positive side, as a brigade surgeon you would have plenty of time to conduct said research

I went to a state MD school back in the day, with tuition of 15K per year. This was back when the stipend was $900 per month. I don't regret serving, but from a financial standpoint, pulling four years of duty as a flight surgeon was a net negative.

You really need to want to serve to justify this decision- and that service will not be on your terms, or under your control.

- ex 61N

 

[DMBandFan86]

If I didn't do HPSP, I thought about the National Guard. Pros are I can control my career more, do civilian match, and all of that stuff. I would probably want to do MDSSP and HPLRP, which would require me doing STRAP too. So all in all starting next year I could be in the guard for 20+ years. (4 years med school, 1 intern year, 2 residency (which would be year 1 and 2 of HPLRP and STRAP), 3 years of fellowship (year 3, 4, 5, of HPLRP) the owe 1 year HPLRP and 12 years for MDSSP and STRAP (4 because MDSSP goes to 1:1 with STRAP then 8 for STRAP). I am fine withe short deployments and all, but 20+ years of the Guard schedule (drill weekends and ADT) could be rough and not work with my civilian plan. I don't know if fellowships like Emory would take me with the National Guard stipulation, and I don't know if I could work as an attending or for the CDC with all of that baggage. All of this is to ask you SDN experts and military med people for your advice!! Please give me the straight truth that I can't find anywhere else. What would you do?

I'll try to quickly answers some questions about the reserve option...

If you want the straight truth, I think that would be a horrible option to plan getting yourself into a 20+ year contract. Not only because of the insane longevity of the contract, but also if the needs of the army change over time and your specialty starts getting paid extension bonuses you might miss out big time. Also for you to qualify for STRAP, at the time of your graduation, internal medicine would have to be on the critical wartime shortage list (can assume it will be, but you never know what the needs of the army will be in 4 years).

Is the Army Reserve also an option you are considering if going the reserve route? In my opinion, the AR has some stronger benefits over the NG during medical school and in residency. Especially on saving you from to drill while in school and residency. Also, if you are really thinking reserves, I always suggest trying to spend some time with a local unit before signing up so you know whats going on and a little about how it works.

You can't count on only having short deployments. Especially planning a 20+ year contract, you have no idea what's going to happen in the future and you could be deployed for longer times and higher frequency than is the standard right now.

Lastly, I don't understanding all the financial reasons why you would want to sign up for such a long contract as you are planning to. You sound like you have been professionally working for some time, so hopefully you also have some savings as well. You also are getting married so hopefully you will have dual income of some sort. If you are expecting to only have ~150K in student debt over 4 years thats really not all that much compared to other medical students. The current MDSSP stipend amount now is somewhere > ~2,200 a month + monthly drill pay of ~400-500 dollars, so that gives you a total monthly pay of ~2600 minus taxes. So roughly, and being conservative, > $24,000 per year of income from the military while in MDSSP. Even if you do just 3 years MDSSP you could cut your student debt in half which is completely manageable and extremely low for any physician coming out of school. If you do 4 years MDSSP you will have even less debt. Then if you do STRAP you will make ~$50,000 residency pay a year + 500-600 drill pay each month + ~2,200 monthly stipend. Thats quite a bit of money and can easily carry some student loan debt and live comfortably in my opinion.

On the other hand, if you are planning on only taking your MDSSP and drill pay for income and personal expenses and still plan to take out ~150 K in student loans then there is possibly a different story. Maybe talk to a financial advisor or someone to help cut down your budget as much as possible while in school.

I don't know much about HPLRP, but I don't think you are counting everything right. From my memory HPLRP happens after STRAP, but I could be wrong. I have looked into HPLRP in the past and have also had some lectures about it from the Army and it never seemed like a good program in my opinion. Also if you can get your budget down and live efficiently while in med school and as a resident I honestly don't see any reason why you would even apply for HPLRP.

Anyways just trying to help you rethink some things. I am in the AR and very happy with my 3 years of MDSSP (prior service before). I did not take STRAP during residency. I think the program is fantastic and I'd recommend keeping it an option, but I would never sign up for a 20+ year contract for any amount of money, thats just insane. Try working the numbers again financially and see if the reserves would give you what you need.

 

[Gastrapathy]

In the Navy at least for now, ID is one of the only specialties that is better in than out. Some unique opportunities there with NAMRUs/WHO/CDC/STATE.

 

[bguttery123]

Congrats on acceptance to your state school! That is a tremendous boon and while 150K seems like a lot in loans know that many of your future colleagues who went to expensive private schools often owe more than twice that amount.

My opinion: you are an absolutely HORRIBLE candidate for the HPSP and you should cease and desist immediately. Here's why:

1) You're going to a state school, so you stand to financially benefit much less then the aforementioned private school or DO school applicant. No, you should not join the mil for money, but if you are going to sacrifice control over your medical career and life, then you may as well reap the benefits. Some people are okay with delaying residency for a few years for a 400K benefit, but maybe not so much for a 200K benefit.

2) It's true that most people will shift their choice of medical specialty during med school, and you may be no different, but let's just assume you will go IM and ID for now. High Priest is right that the availability of fellowships is a tenuous thing in the military, and this is something about the nature of the beast that pre-meds with no mil experience need to understand. You are viewing life through the lens of meritocracy, in that if your boards and research is good enough, you will obtain admission, residency, fellowship, movie passes, cake, etc. The mil is different in that the people upstairs may simply decide that they don't need any ID fellows this year, or that the spots will go to someone else because they know someone up high, or that your services are needed as a brigade surgeon in Ft Polk. If you have a clear plan for your career, then joining the military will bring unnecessary risk to that vision.

3) You have an interest in research. If you want to do research, avoid the military. Period. The amount of true clinical research coming out of the military right now compared to what will likely be produced at your state school is minuscule. Someone with more research experience can chime in on this but the consensus is that research is bogged down by lack of funding, lack of interest, lack of resources, and a very slow IRB approval process. Research does happen in the mil but not by clinical docs; you are much more likely to do clinical work than research. Contrast that with civilian institutions, which if you get into the right spot will welcome your research efforts and give you the time and materials to produce publications.

4) Is your recruiter a physician? If not, then they do not have a true understanding of the process and are in no place to extrapolate the likelihood of you placing into a fellowship.

5) When I went through HPSP, the monthly stipend was about $1800, not sure what it is now. That won't change if you get married or start a family. It's really not a lot of money to live very high on the hog while in med school. It's certainly not the same as USUHS pay. Does your future spouse work? If so, it can be difficult to live off of one salary but it is certainly doable. If they can cover living expenses then that will SIGNIFICANTLY decrease your debt burden down the line, which again negates one of the benefits of HPSP.

6) Loans do suck but if you are wise and "live like a resident" as the White Coat Investor advises then you can make good headway on your loans and should be able to pay them off quickly. It will require some delayed gratification but you can do it.

7) Frankly I'm not entirely clear on the fellowship payback rules but if you do HPSP then IM and 3 years of ID you are looking at at least 8 years active duty after all your training is complete (4 years from HPSP and 3+1 from fellowship), someone please correct me if I'm wrong.

I know nothing of the National Guard or other military programs. No comment.

To sum up, you are going to a (relatively) inexpensive medical school and have a fellowship in mind and are interested in doing research. This makes you someone that is likely to be frustrated and ill-rewarded, save satisfaction of serving your country. If service is your interest then there are other avenues to consider that don't include surrendering control over your life and career.

Contrast this with if you stay civilian, and train in civilian hospitals that may very well have ID fellowships in house. You can focus 100% on your career and not have to worry about your research being interrupted to deploy to the latest Suckistan.

Continue to read this forum and get an idea as to what life in milmed is like. It is true that the chips fall well for many people and they are thrilled, but this doesn't happen for everyone. You give yourself a much better chance of obtaining the medical practice you desire by staying civilian. Good luck.

Thank you so much this is the type of feedback I am looking for. My recruiter is not a physician so I am just not getting the full picture! Fourtnately my future spouse will be working but she is still in school for the next year. She will be a special ed teacher so we will be flushed with cash haha. She also wants to earn her masters so the stipend would help us do that.... BUT maybe doing something like MDSSP in the Reserves would work... OR just figuring out a solid budget. I am going to start reading about the white coat investor for sure. I feel like I have a strong idea about the path I want to follow and I know the only way to do so for sure is to do it as a civilian.

I have another question for you as well as anyone else if y'all wouldn't mind helping me! You seem obviously knowledgeable about milimed. As I have said, I really want to do ID. My ideal job would be one in which I could be an attending, teach some classes, do some research, and also be involved in public health/outbreak investigation. For this part I have considered doing a preventative medicine fellowship/earn my MPH. I just found that the Army has a PM residency. Would it be just ass backwards if I did a PM residency, 4 year HPSP payback, then pursued ID? I know I want to be a clinical physician who has the solid clinical training of IM. I don't want to only work free clinics, etc that PM docs can do. I also know PM fellowships are like 1-2 years max and the CDC offers an awesome one I am interested in. I just saw the Army PM residency and the job titles you get after (Chief of Infectious Diease Research, Epidemiologist Outbreak Investigations) sound so so so sweet. I'm sure they can just make a title sound cool, but that is the exact type of work I want to do as part of my career. I have doubts tho that an IM residency and then ID Fellowship would want me after all that time... plus again it seems backwards... Again this all may seem really dumb to ask but you and everyone here are the only ones giving me straight answers. I appreciate you!

 

[bguttery123]

Would concur with this. Likely your only opportunities for ID research will be as a brigade surgeon investigating fauna indigenous to Syria, Afghanistan, and other middle eastern hellholes.

On the positive side, as a brigade surgeon you would have plenty of time to conduct said research

I went to a state MD school back in the day, with tuition of 15K per year. This was back when the stipend was $900 per month. I don't regret serving, but from a financial standpoint, pulling four years of duty as a flight surgeon was a net negative.

You really need to want to serve to justify this decision- and that service will not be on your terms, or under your control.

- ex 61N

Yeah I am not too interested in being in any hell holes unless perhaps they were having some sort of interesting outbreak... but still you make a great point. I do want to serve and get a strong sense of pride from it, but I also have my career goals.

If you have time would you mind checking out my reply about preventative medicine and let me know your thoughts? I would really appreciate it. I just want straight answers from people like you who have been in it, not from a recruiter or others. Thank you!

 

[bguttery123]

I'll try to quickly answers some questions about the reserve option...

If you want the straight truth, I think that would be a horrible option to plan getting yourself into a 20+ year contract. Not only because of the insane longevity of the contract, but also if the needs of the army change over time and your specialty starts getting paid extension bonuses you might miss out big time. Also for you to qualify for STRAP, at the time of your graduation, internal medicine would have to be on the critical wartime shortage list (can assume it will be, but you never know what the needs of the army will be in 4 years).

Is the Army Reserve also an option you are considering if going the reserve route? In my opinion, the AR has some stronger benefits over the NG during medical school and in residency. Especially on saving you from to drill while in school and residency. Also, if you are really thinking reserves, I always suggest trying to spend some time with a local unit before signing up so you know whats going on and a little about how it works.

You can't count on only having short deployments. Especially planning a 20+ year contract, you have no idea what's going to happen in the future and you could be deployed for longer times and higher frequency than is the standard right now.

Lastly, I don't understanding all the financial reasons why you would want to sign up for such a long contract as you are planning to. You sound like you have been professionally working for some time, so hopefully you also have some savings as well. You also are getting married so hopefully you will have dual income of some sort. If you are expecting to only have ~150K in student debt over 4 years thats really not all that much compared to other medical students. The current MDSSP stipend amount now is somewhere > ~2,200 a month + monthly drill pay of ~400-500 dollars, so that gives you a total monthly pay of ~2600 minus taxes. So roughly, and being conservative, > $24,000 per year of income from the military while in MDSSP. Even if you do just 3 years MDSSP you could cut your student debt in half which is completely manageable and extremely low for any physician coming out of school. If you do 4 years MDSSP you will have even less debt. Then if you do STRAP you will make ~$50,000 residency pay a year + 500-600 drill pay each month + ~2,200 monthly stipend. Thats quite a bit of money and can easily carry some student loan debt and live comfortably in my opinion.

On the other hand, if you are planning on only taking your MDSSP and drill pay for income and personal expenses and still plan to take out ~150 K in student loans then there is possibly a different story. Maybe talk to a financial advisor or someone to help cut down your budget as much as possible while in school.

I don't know much about HPLRP, but I don't think you are counting everything right. From my memory HPLRP happens after STRAP, but I could be wrong. I have looked into HPLRP in the past and have also had some lectures about it from the Army and it never seemed like a good program in my opinion. Also if you can get your budget down and live efficiently while in med school and as a resident I honestly don't see any reason why you would even apply for HPLRP.

Anyways just trying to help you rethink some things. I am in the AR and very happy with my 3 years of MDSSP (prior service before). I did not take STRAP during residency. I think the program is fantastic and I'd recommend keeping it an option, but I would never sign up for a 20+ year contract for any amount of money, thats just insane. Try working the numbers again financially and see if the reserves would give you what you need.

Thank you so much for this reserve perspective. I think my calculations of years is off too, but regardless 20 years seems insane! I am definitely open to the Reserves. So when you took MDSSP you took it for 3 years in the Reserves while in school? How much payback did you owe and when did that payback start for you? I agree the HPLRP just grabs my attention cause it has the big dollar signs ($240,000!!!) haha. But it gets taxed and all of that. So if I did 3 years of MDSSP and STRAP throughout residency, I would owe 9 years after residency in the Reserves. Do you happen to know if this payback can occur while i am in fellowship? And if so would I be deployable?

I am looking into all of this because I am about to get married, my future wife is in school, and will become a special ed teacher. While she will be making a decent salary, I just want to be sure I can take care of her and my family.

Thank you again for your help!

 

[bguttery123]

In the Navy at least for now, ID is one of the only specialties that is better in than out. Some unique opportunities there with NAMRUs/WHO/CDC/STATE.

Better in than out?? I have heard that. Have you heard anything about the Army?

I considered the Navy but the odds of a GMO tour post intern year seem higher and it deters me. Now if I could get straight through IM, do a 2 year utilization tour, then go to fellowship, I would consider it... but who can guranatee anything right? The woes of milimed I guess

 

[DMBandFan86]

Would it be just ass backwards if I did a PM residency, 4 year HPSP payback, then pursued ID? I know I want to be a clinical physician who has the solid clinical training of IM.

Yes that would be way backwards. Honestly that plan doesn't make any sense to me. If you want to go IM --> ID than that's the route you need to go. I don't think there is a PM --> ID route option (training from IM to PM is vastly different), you would have to do PM --> IM --> ID which is completely unnecessary. Also are you really sure you know what PM is and what the training is like? Also realize with clinical PM you will likely be doing a lot of employee health and BWC, etc. You may get to do some epidemiology, but you won't be doing anything close to clinical infectious disease.

Overall, I think its good to have a plan set in place for the big picture, but I also think you need to step back a little and let the medical school journey take place. Things may change and you might change your plans many more times based on your experiences. The main question you should be considering is Do You Want To Be a Soldier or not? Do you want to bear arms and go to war or not? If you are going to join the Army your needs should be soldier > personal career, otherwise you will be very disappointed when the Army changes or delays your personal career goals. You should be totally okay if the Army creates unexpected delays in your career route. If you can place aside your career ambitions and really want to serve than I think it might be a good route to join the military.

What I would recommend at this stage of the game is to have IM as your #1 specialty going into medical school. Keep the goal of getting into an IM residency. But thats really it. Thinking too much about fellowships and things like that at this stage isn't really all that helpful. You may later down the road realize that general IM is good enough and that you do plenty of clinical ID day-to-day. Only time will tell, but you have a whole lot of time in between to figure that out. But I will tell you that most residents still don't know if they want to do a fellowship or not until their 2nd or 3rd year.

 

[DMBandFan86]

So when you took MDSSP you took it for 3 years in the Reserves while in school? How much payback did you owe and when did that payback start for you? So if I did 3 years of MDSSP and STRAP throughout residency, I would owe 9 years after residency in the Reserves. Do you happen to know if this payback can occur while i am in fellowship? And if so would I be deployable?

#1 you need to decide if you want to go NG or AR, because the answers may change a little.

MDSSP x 3 years = 6 years payback after residency. I did not take STRAP so my payback started day 1 of PGY-1 year in residency (you would need to check with a recruiter to see when the payback period starts now as things may have changed). Then you would still have to meet the minimum service obligation of 8 years since you don't have prior service (possibly in the IRR for the last 2 years). I did have 80K in student loans with this option (I consider this pretty good).

If you took 3 years MDSSP and then did 3 years STRAP with IM you would have 9 years payback. If you want infectious disease to be paid under STRAP it would have to be on the critical wartime shortage list at the time and then you would have to add more time to your payback period, but you would be guaranteed under protected status. You could also just plan for STRAP during IM residency and then apply for protective status with your unit during fellowship. Again this all depends if you go NG or AR. If you don't get protective status then yes you are deployable, expected to drill, be a soldier, etc. It's not the end of the world if you get deployed in residency or have to go to some training event that delays your graduation date a little. Things will happen, but as long as your goals have Army #1 > personal career it shouldn't be a problem for you. Also, FYI, my civilian institution gives me ~1 month of military leave per year (during residency), so depending on where you work you may have some flexibility with the military and your residency.

Finally, if you went for PM residency and then wanted to get into ID, I don't see any reason why the military would continue to pay for you to do this. They would likely use you as a PM specialist and be done with it.

Again at this stage of the game and looking to the future I think you should take a step back and let the medical school journey take in. Only apply to military scholarship if you truly want to be in the military and serve. If thats the case then decide if active duty or reserves best suites your needs. In the case that you chose reserves, then I would personally select the minimal amount of obligation as possible. If feasible then you may want to do 3 years MDSSP versus 4 years. You have a long time until you can apply to STRAP, so at this point I wouldn't think too much about it besides some overall options and senerios.

 

[bguttery123]

#1 you need to decide if you want to go NG or AR, because the answers may change a little.

MDSSP x 3 years = 6 years payback after residency. I did not take STRAP so my payback started day 1 of PGY-1 year in residency (you would need to check with a recruiter to see when the payback period starts now as things may have changed). Then you would still have to meet the minimum service obligation of 8 years since you don't have prior service (possibly in the IRR for the last 2 years).

If you took 3 years MDSSP and then did 3 years STRAP with IM you would have 9 years payback. If you want infectious disease to be paid under STRAP it would have to be on the critical wartime shortage list at the time and then you would have to add more time to your payback period, but you would be guaranteed under protected status. You could also just plan for STRAP during IM residency and then apply for protective status with your unit during fellowship. Again this all depends if you go NG or AR. If you don't get protective status then yes you are deployable, expected to drill, be a soldier, etc. It's not the end of the world if you get deployed in residency or have to go to some training event that delays your graduation date a little. Things will happen, but as long as your goals have Army #1 > personal career it shouldn't be a problem for you. Also, FYI, my civilian institution gives me ~1 month of military leave per year, so depending on where you work you may have some flexibility with the military and your residency.

Finally, if you went for PM residency and then wanted to get into ID, I don't see any reason why the military would continue to pay for you to do this. They would likely use you as a PM specialist and be done with it.

Again at this stage of the game and looking to the future I think you should take a step back and let the medical school journey take in. Only apply to military scholarship if you truly want to be in the military and serve. If thats the case then decide if active duty or reserves best suites your needs. In the case that you chose reserves, then I would personally select the minimal amount of obligation as possible. If feasible then you may want to do 3 years MDSSP versus 4 years. You have a long time until you can apply to STRAP, so at this point I wouldn't think too much about it.

Awesome awesome thank you for all of this. I know I need to just take a step back- I tend to go all in and not let time takes its course (which it does regardless haha). But it's really great to hear about what it's like if I did do the Reserves and had a civilian career. I think between the Guard and Reserves I would choose the Reserves.

My last follow up question to you (I'm sorry) would be: if I went in the army and left as a preventative medicine specialist (residency then 4 years), would it be impossible to go back through IM to ID on the civilian side? I know this would take another 4-5 years. I think this would be a very backwards way of doing it, but I like the preventative medicine opportunities the Army has.

 

[bguttery123]

Awesome awesome thank you for all of this. I know I need to just take a step back- I tend to go all in and not let time takes its course (which it does regardless haha). But it's really great to hear about what it's like if I did do the Reserves and had a civilian career. I think between the Guard and Reserves I would choose the Reserves.

My last follow up question to you (I'm sorry) would be: if I went in the army and left as a preventative medicine specialist (residency then 4 years), would it be impossible to go back through IM to ID on the civilian side? I know this would take another 4-5 years. I think this would be a very backwards way of doing it, but I like the preventative medicine opportunities the Army has.

My bad I didn't scroll up!!! Disregard!!

 

[bguttery123]

Yes that would be way backwards. Honestly that plan doesn't make any sense to me. If you want to go IM --> ID than that's the route you need to go. I don't think there is a PM --> ID route option (training from IM to PM is vastly different), you would have to do PM --> IM --> ID which is completely unnecessary. Also are you really sure you know what PM is and what the training is like? Also realize with clinical PM you will likely be doing a lot of employee health and BWC, etc. You may get to do some epidemiology, but you won't be doing anything close to clinical infectious disease.

Overall, I think its good to have a plan set in place for the big picture, but I also think you need to step back a little and let the medical school journey take place. Things may change and you might change your plans many more times based on your experiences. The main question you should be considering is Do You Want To Be a Soldier or not? Do you want to bear arms and go to war or not? If you are going to join the Army your needs should be soldier > personal career, otherwise you will be very disappointed when the Army changes or delays your personal career goals. You should be totally okay if the Army creates unexpected delays in your career route. If you can place aside your career ambitions and really want to serve than I think it might be a good route to join the military.

What I would recommend at this stage of the game is to have IM as your #1 specialty going into medical school. Keep the goal of getting into an IM residency. But thats really it. Thinking too much about fellowships and things like that at this stage isn't really all that helpful. You may later down the road realize that general IM is good enough and that you do plenty of clinical ID day-to-day. Only time will tell, but you have a whole lot of time in between to figure that out. But I will tell you that most residents still don't know if they want to do a fellowship or not until their 2nd or 3rd year.

You are so right. I appreciate it and please ignore my follow up question. I didn't see it when I scrolled onto this post with my phone. I owe you a beer or your choice of beverage haha

 

[DMBandFan86]

My last follow up question to you (I'm sorry) would be: if I went in the army and left as a preventative medicine specialist (residency then 4 years), would it be impossible to go back through IM to ID on the civilian side? I know this would take another 4-5 years. I think this would be a very backwards way of doing it, but I like the preventative medicine opportunities the Army has.

Sure you could do that. That's a very abnormal route and honestly no sane person would do that. I can't see someone turning down an attending's salary and work schedule to restart residency, work 80 hours a week and take a bunch of call for little pay for 5 additional years. You would also likely run out of PGY years for payment at some point as well and may have to finish without pay doing that route (the gov't has limits on paying resident salary).