Army HPSP Payback time

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Stormin'

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Stormin'I have been awarded the Army HPSP and an now in the struggle of deciding to take it or not. A lot of my hangups are residency and GMO related. I've looked at quite a bit of the stuff on SDN, but the one thing I couldn't find was if you do a military residency, does if count as payback to your obligation, or does it increase the time that you owe the military?
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This is actually in there, believe you me. There is the complicated way that they describe it in the contract, and then there is the easy way to get your answer. The easy way is as follows:

Take the total residency training time (3 years IM, 5 or 6 years surgery, 7 years neurosurg, etc.). Take away one year for your internship. If the number you're left with is less than the number of years you owe from med school (typically 4), then you end up owing however many years you owed when you started your residency. If the number of years you're left with is greater, then that is the number of years you owe after residency (eg: 4 years owed for med school, did a 5 year surgical residency, 5-1 = 4, so it's a break even. 4 years owed).

Again, the actual explanation is far, far more complicated and irritating. But this is accurate. Fellowships are calculated different, BTW.
 
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imadome said:
Is this also how the Air Force works? I talked to a recruiter and specifically asked about a 7 year neurosurgery residency (just as an example) and I was told 4 years is all I'd owe.
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It's the same for all services. Shockingly, the recruiter is either ill informed or lying.

ETA: There's only one military neurosurgery residency, meaning many people get deferred. So there are some permutations where you might only end up paying back four, but only if you don't get paid by the military while in residency.
 
imadome said:
Is this also how the Air Force works? I talked to a recruiter and specifically asked about a 7 year neurosurgery residency (just as an example) and I was told 4 years is all I'd owe.
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Your recruiter just has absolutely no idea what a neurosurgery residency is, or how long it is, or what a neurosurgeon does....
Always remember that even the most well-meaning recruiters know little to nothing about medicine. That's just part of the game...
 
imadome said:
Thanks for your response. So if I were to get deferred to a civilian residency, I would only owe back 4 years? Even if the residency was longer than 4 years? I'm assuming that's how it works since the military wouldn't pay you during a civilian residency.
Thanks for the input! I specifically asked him "So if I do a longer residency, say a 7 year neurosurgery, I would only owe back 4 years?" and I got an immediate "yes". I have record of it FWIW but the lack of accurate information is turning me away from HPSP.
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1- depends on whether is is a completely deferred residency. Then, you would only owe the length of your scholarship. There is also a "sponsored deferred"/FTOS where your paycheck still comes from the gov't even though you are civilian. Then, see above for rules, same as in-service/FTIS.

2- think about this - if they are lying (and selling something as a fact when you don't actually know is still LYING) when they are trying to recruit you, think about how it will be on the other end, after you sign.
 
imadome said:
Thanks for the input! I specifically asked him "So if I do a longer residency, say a 7 year neurosurgery, I would only owe back 4 years?" and I got an immediate "yes". I have record of it FWIW but the lack of accurate information is turning me away from HPSP.
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As I said earlier, your recruiter is either ignorant of the rules or he is flat out lying to you. Either way, he sucks at his job and you should not trust him.
 
Recruiters can't know our system. You have to understand medical education from a physician perspective and then layer over that our arcane and arbitrary "rules"(which they can break if they want).

They go to training and I'm convinced that many think they do know. But they can't. Just explaining the process for getting trained in my one specialty and all the various scenarios is too complex for a recruiter. Yet, they are supposed to explain all of it.

Fundamentally they have no shot at understanding medical education and that doesn't get at payback at all.
 
[QUOTE="

Thanks for the input! I specifically asked him "So if I do a longer residency, say a 7 year neurosurgery, I would only owe back 4 years?" and I got an immediate "yes". I have record of it FWIW but the lack of accurate information is turning me away from HPSP.[/QUOTE]

Then he is lying or fabricating.
 
HighPriest said:
[QUOTE="

Thanks for the input! I specifically asked him "So if I do a longer residency, say a 7 year neurosurgery, I would only owe back 4 years?" and I got an immediate "yes". I have record of it FWIW but the lack of accurate information is turning me away from HPSP.
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Then he is lying or fabricating.[/QUOTE]

Like others have said, this is not true.

If your residency is less than 4 years, then you pay back the 4 years of scholarship. But if your residency is LONGER than 4 years, then you pay back the number of years you spent in residency.
 
I am getting totally confused by the quote boxes. My fualt.

If your residency is less than 4 years, you will owe 4 years, unless you did HPSP for less than 4 years for some reason. If the residency is longer than 4 years, then you'll owe however many years your residency lasts. That is correct. Keep in mind that they do not include your internship year as a residency year (so IM is 3 years - 1 year internship = 2 years residency, General Surgery in the Army is 6 years - 1 year internship = 5 years).
 
How common do you think it is to do four years GMO in the Navy to fulfill your obligation, and then just get out and do a civilian residency? That way it seems to me one could avoid the lack of security that comes with trying to match into military residencies and if you wanted to make sure you don't spend more than four years in the military it would eliminate the possibility of having to do 2 year GMO and then residency and then 4 years after residency (if it's a longer residency) for a total of six years.
 
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yonderson said:
How common do you think it is to do four years GMO in the Navy to fulfill your obligation, and then just get out and do a civilian residency? That way it seems to me one could avoid the lack of security that comes with trying to match into military residencies and if you wanted to make sure you don't spend more than four years in the military it would eliminate the possibility of having to do 2 year GMO and then residency and then 4 years after residency (if it's a longer residency) for a total of six years.
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To clarify: four years non-residency military time
 
yonderson said:
How common do you think it is to do four years GMO in the Navy to fulfill your obligation, and then just get out and do a civilian residency?
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Rather common. Several of my mentors have done this. And I'm sure plenty of posters here on this sub-forum have done this as well. Just be aware you might have to repeat intern year.
 
Red Lobster Actual said:
Rather common. Several of my mentors have done this. And I'm sure plenty of posters here on this sub-forum have done this as well. Just be aware you might have to repeat intern year.
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So does the intern year count towards your obligation or no? Would it be 1+3 or 1+4?
 
Intern year is obligation neutral. So in reality with your plan, if you take the 4 year scholarship, you'll be in uniform for 5 years. 3 year scholarship, 4 years in uniform. Not counting the time spent while in medical school.
 
Red Lobster Actual said:
Intern year is obligation neutral. So in reality with your plan, if you take the 4 year scholarship, you'll be in uniform for 5 years. 3 year scholarship, 4 years in uniform. Not counting the time spent while in medical school.
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Ok. Hmm not sure if that's for me. I would like to serve but I'm not sure about that long. Then again $500,000 in debt is pee-your-pants scary.
 
Red Lobster Actual said:
Rather common. Several of my mentors have done this. And I'm sure plenty of posters here on this sub-forum have done this as well. Just be aware you might have to repeat intern year.
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what are the advantages of doing this?
 
asdf123g and every future person considering the allure of HPSP please remember that any year not completing residency and spent as a GMO is overall a lost year and should not be anyone's goal at all. The average applicant will pay back 5 years of military time and basically be medical school debt free and have possibly nothing to apply towards future residency progress except your lone intern year if you do the GMO and out plan. It might save you 6 months, it might save a year, it might not save anything when you apply to future civillian programs. Regardless you have additional training that is needed to acheieve board certification. Your fellow classmates will be signing contracts to start their first job or in their first job and you will be applying to start a residency finally.
 
I'm on record as stating the GMO antiquated and, well, frankly, dumb, but even I think that's a pretty narrow view of being a GMO. There is a subset of people who are committed to serving but aren't interested in a military residency or a nearly decade long military stint for whom the GMO-and-out plan works. I've also known some reluctant GMOs who retrospectively described it as a great experience.

I think I agree with your overall point, which is that being a GMO may inaccurately seem like no big deal to a pre-med student, which is a misguided thought. But I would say that this issue isn't confined to this point, but rather it's emblematic of a larger phenomenom. To wit, there are far too many pre-medical students considering military medicine because they think that it's no big deal. A single 22 year old college senior is going to look at his military obligation a lot different than the married 27 year old GMO or the 31 year old father and new attending.
 
yonderson said:
How common do you think it is to do four years GMO in the Navy to fulfill your obligation, and then just get out and do a civilian residency? That way it seems to me one could avoid the lack of security that comes with trying to match into military residencies and if you wanted to make sure you don't spend more than four years in the military it would eliminate the possibility of having to do 2 year GMO and then residency and then 4 years after residency (if it's a longer residency) for a total of six years.
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When I was in, things were different. The scholarships were competitive, my intern class was full of people that went to great medical schools. They had high expectations and a lot of potential. Many served out their 4 years as a GMO and left to go to highly regarded civilian residencies. I still keep in touch with several of them. It was also war time and the desire to serve when needed is real and a strong draw. Schools were 1/2 the cost, so joining only for the money had less appeal.
Military training isn't bad, but it isn't MGH. However if you shine in residency, you can score a competitive civilian fellowship and get your career back on track.
 
IlDestriero said:
It is the fastest way out of your service obligation and frees you up for the civilian match.
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sooo...does doing 4 GMO years help you land a civilian match? arent your board scores really old by then (are there no reprecussions to this)? If you wanted, could you apply milmatch, get the residency you want, and upon completion be done with your payback (since you did 4 year GMO and granted you picked a specialty that doesnt have a really long residency)
 
asdf123g said:
If you wanted, could you apply milmatch, get the residency you want, and upon completion be done with your payback (since you did 4 year GMO and granted you picked a specialty that doesnt have a really long residency)
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No. You incur obligation with your years in residency. There have been many threads on this topic, if you want details I recommend you use the search bar on this forum.
 
asdf123g said:
sooo...does doing 4 GMO years help you land a civilian match? arent your board scores really old by then (are there no reprecussions to this)? If you wanted, could you apply milmatch, get the residency you want, and upon completion be done with your payback (since you did 4 year GMO and granted you picked a specialty that doesnt have a really long residency)
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Yes, it absolutely can help you land a choice residency spot. All that bull Shiite that you can't stand doing, reports, staffing schedules, planning, deployment preparedness, enlisted counseling, supply chain, etc. that's all leadership activities. You absolutely can spin that all as proof of leadership. Only physician for xxx deployed troops, medical director of your dirty tent clinic, etc. new policies that your line commander made you create, all of it. You are competing with new grads that usually have little to no leadership opportunities at all. Use it to crush them. You didn't get dumber being a leader of men and clinic supervisor. Everyone wants someone who is going to be a superior resident. One that won't cause problems, will get the work done and can be relied upon. Your GMO time was training for all that. They will teach you the medicine you need to know.
Your board scores still stand, hopefully you did well.
As noted above, military residency incurs additional obligation.
And don't forget that there are a lot of us veterans out there in mid to senior level positions all over the country in every specialty to make sure you get what you deserve for your time in uniform. Vets take care of vets.
 
IlDestriero said:
Yes, it absolutely can help you land a choice residency spot. All that bull Shiite that you can't stand doing, reports, staffing schedules, planning, deployment preparedness, enlisted counseling, supply chain, etc. that's all leadership activities. You absolutely can spin that all as proof of leadership. Only physician for xxx deployed troops, medical director of your dirty tent clinic, etc. new policies that your line commander made you create, all of it. You are competing with new grads that usually have little to no leadership opportunities at all. Use it to crush them. You didn't get dumber being a leader of men and clinic supervisor. Everyone wants someone who is going to be a superior resident. One that won't cause problems, will get the work done and can be relied upon. Your GMO time was training for all that. They will teach you the medicine you need to know.
Your board scores still stand, hopefully you did well.
As noted above, military residency incurs additional obligation.
And don't forget that there are a lot of us veterans out there in mid to senior level positions all over the country in every specialty to make sure you get what you deserve for your time in uniform. Vets take care of vets.
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Ill have to keep all of this in mind.

@Red Lobster Actual : Okay, Im confused. Earlier you said many of your mentors did 4 yrs GMO and then left and did a civilian residency...does this mean they are all done serving in the military and have no more time to pay back? From what I am gathering, the answer is yes. However...IF one chooses to go onto a milresidency after 4 yrs GMO, they will owe an additional length of time spent at the residency...correct? Im just trying to wrap my head around all of these options.
 
If you do a 4 year GMO, your active duty service obligation is over and you can go back to civilian life. If you then do a residency in the military you will owe a year for each year of residency of new active duty obligation. If you get lucky and go straight through military residency training, the residency time does not add any time to your obligation unless the residency is longer than what you owe.
 
I have a question about fellowships. What if I did a IM residency through the military, then wanted to do a 3 year cardiology fellowship. How long would my ADO be? Also, do I pay back my ADO practicing cardiology or as a GMO? I can imagine that it's possible to lose some cardiology skills if I am forced to practice general medicine for 4 years. Does anyone have experience with this here? anything would be much appreciated. thanks.
 
Hans Gruber01 said:
I have a question about fellowships. What if I did a IM residency through the military, then wanted to do a 3 year cardiology fellowship. How long would my ADO be? Also, do I pay back my ADO practicing cardiology or as a GMO? I can imagine that it's possible to lose some cardiology skills if I am forced to practice general medicine for 4 years. Does anyone have experience with this here? anything would be much appreciated. thanks.
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couldn't you just leave the military after your time and pursue a civ fellowship?
 
Slevin said:
ADSO following residency and fellowship is 7 years. You can payback as a cardiologist or a brigade surgeon stint. Maybe a mix of the two
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This isn't necessarily correct. Its complicated and depends on when you get to do residency and fellowship. Assuming the most fortunate route (bad plan), a 4 year HPSP followed by 3 years of IM and 3 years of cards would yield a 5 year payback. Internship is neutral, IM+Cards = 5. 5>4. So 5. You will finish fellowship with a 3 year commitment minimum. So, lets say you took a more typical Navy path. HPSP. Internship. 2 year GMO. IM residency. 3 year utilization tour. 3 year fellowship. 3 year payback. 14 years to the end of fellowship obligation.

So, its 11-14 years from med school graduation (so Slevin's answer could be correct but could be short or could be long). Ballpark.
 
See why we pillory recuiters who claim to understand this?

BTW, this all presumes inservice training. Throw on an FTOS interventional year and add 2 years to your obliserv. Do outservice fellowship via NADDS and decrease your obligation by 3 years (but theres a catch, no government cheese for those 3 years).
 
[QUOTE="
And don't forget that there are a lot of us veterans out there in mid to senior level positions all over the country in every specialty to make sure you get what you deserve for your time in uniform. Vets take care of vets. [/QUOTE]

This comes around again come hiring time. A vet or two in a group and it becomes almost automatic that they will take you over other applicants. There was no other reason I got the offers I did.
 
So assuming that I am a 4 year HPSP student. I go into IM, then 3 years cards. My payback would be 5 years? (3 years IM (1 of which is the neutral internship) + 3 year cards).

Also, I would see this as reasonable if I am paying back my time as a cardiologist, practicing my skills and not losing them (this is my main concern, not necessarily the years of payback). I see this as more advantageous than paying back 4 years after IM, then doing a civ fellowship.
 
I'd most likely would want to go straight through for the reasons mentioned above. Any advice on the best way to do this?
 
what exactly is this internship year? It counts as pay back right?
 
Hans Gruber01 said:
I'd most likely would want to go straight through for the reasons mentioned above. Any advice on the best way to do this?
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Yea...don't join the military. Just go civilian all the way and you get what you want assuming you will be a competitive enough applicant. The rule of thumb is the more specific your plan is for medicine the more you should NOT join the military simply because you are at the mercy of Uncle Sam.
 
asdf123g said:
what exactly is this internship year? It counts as pay back right?
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Young padawan learner, you must do more research in the medical training system in general. 🙂

Internship year is the year right after graduation from medical school. Due to your neophyte status, you are a physician but not quite fully licensed until passing one more board exam and completion of this year. This is a feature of medical training in general.

For the military it does NOT count as payback but neither will it add to your obligation. It basically boils down to just one more year in the military.
 
Another question, what will the active duty obligation requirement be like? Is it possible to do the entire thing in the US at a military hospital? or will it most likely be abroad at a base somewhere?
 
Hans Gruber01 said:
Another question, what will the active duty obligation requirement be like? Is it possible to do the entire thing in the US at a military hospital? or will it most likely be abroad at a base somewhere?
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Hans Gruber, have you read through the stickies on top of this sub-forum? Particularly "Pros, Cons, Opinions"? Make sure to also read the "HPSP, USUHS, FAP threads" thread and follow the links. Once you grind through the 100+ pages of topics it should answer essentially all your questions. Since the answer to your questions basically boils down to:

1) Depends
2) Depends
3) Depends

Good luck buddy.
 
Gastrapathy said:
This comes around again come hiring time. A vet or two in a group and it becomes almost automatic that they will take you over other applicants. There was no other reason I got the offers I did.
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This is generally the case, but it cuts both ways. Every ex-mil doc is only about 1-2 degrees of separation from another doc who was a colleague of the applicant, and as alluded to above, the network is extensive and unvarnished opinions are freely exchanged behind closed doors.

It's actually been kind of funny to watch the ****bag O6s who are past 20 put out "covert" feelers to all the ex-mil groups over the past couple years. And when COL ****bag's ineptitude or sloth screws a colleague, smile with the knowledge that there is a text on your phone from an old residency buddy asking you to call him to talk about COL ****bag, who recently applied for the open spot in your buddy's group.
 
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