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No problem, tone is hard to pick out on the internet.
You are welcome here, and I hope you get something useful out of this thread.
Army Army Medicine- Anything Positive to Say?
- Thread starter SequesterGrundleplithMD
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No problem, tone is hard to pick out on the internet.
You are welcome here, and I hope you get something useful out of this thread.
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Thank you pgg, this is exactly the type of response I was looking for. I'm not looking for someone to coddle me or say everything is sunshine and lollipops. I think most of us newbies are just seeking answers to questions we cannot answer ourselves from experienced individuals who aren't going to ridicule us because we haven't been there.
This sounds like a very time-consuming endeavor and also an incredibly useful one. I (and I'm sure all potential milmed candidates) really appreciate you taking the time to make a program like this.
The 50k thing was a generality about myself. I currently make around 25k/yr and am perfectly happy financially, just bored to death with the actual job. Though if I had a family to support I would obviously want to be making more than 50k, that was more of a generality of supporting myself as an individual. I'll also have to read through the thread you posted. I've read a decent amount of the HPSP posts on here, but I hadn't come across that one yet. Thank you again for taking the time to provide constructive guidance to someone just starting their medical education.
This sounds like a very time-consuming endeavor and also an incredibly useful one. I (and I'm sure all potential milmed candidates) really appreciate you taking the time to make a program like this.
The 50k thing was a generality about myself. I currently make around 25k/yr and am perfectly happy financially, just bored to death with the actual job. Though if I had a family to support I would obviously want to be making more than 50k, that was more of a generality of supporting myself as an individual. I'll also have to read through the thread you posted. I've read a decent amount of the HPSP posts on here, but I hadn't come across that one yet. Thank you again for taking the time to provide constructive guidance to someone just starting their medical education.
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If money is not a motivator don't worry about calculators and confusing paycharts/bonuses, the military pay will be fine.
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LOL, I hope you either plan on never getting married and having kids, or living in a very rural area. Otherwise you'll find that 50k for a family doesn't go very far.
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I meant to support myself only. I'm sure it supporting a family is more expensive, but I would assume that a physician in any field wouldn't struggle to support a family unless they had 10 kids or something like that
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If you didn't mean it. You shouldn't have said it. You repeated a naive trope on a public forum and I called you out on it. If what you wrote is "not what you meant" and you're hurt by the way I (and others) responded, resolve to write a better question next time. Take your lumps like a man; don't be petulant. There is much to be learned about how to respond to criticism from pgg's anecdote about residency: I spend a lot of time teaching residents and they sometimes make ridiculous mistakes. My corrections are resolute and ungentle but (IMO) not malicious. Sometimes residents get petulant about their mistakes. I give them the benefit of the doubt the first time (and give them my lecture about pride and sloth being the 2 great sins of the student). If they do it a second time, I write them off.
I guess this oblique ad hominem is directed at me. LOL! If you don't like analogies about communism, don't state that you'd exchange your labor for the provision of your "needs". Middle school level book. Are you serious? I'm cut to the quick. I was reading Maniac Magee while Stagg737 was reading Animal Farm.
I've never told anyone to stay as far away as possible from the military. I merely try to give a realistic assessment to 20-somethings (who generally have no experience with the military) of military medicine before they sign a binding contract that involves the next 12 years of their lives. I do it because I've worked with (a few) colleagues who, embittered by the situation they find themselves in, provide sloppy care for patients (multiple generations of my family among them) and cause more work for me as they do as little work as possible while fulfilling their commitment. If you are truly dead set on delivering care to service members, retirees, and their dependents (as you indicate by saying you'd consider VA and DOD contract jobs after residency), you should go to USUHS. You'll make much more as a student and your pay will be adjusted for the cost of living in D.C. I did HPSP before the sign-up bonus and was able to make it through medical school without additional loans (due to attending medical school in a city with a relatively low cost of living), but my wife was good friends with a fellow intern who had to take out an additional 50k in loans during medical school because she attended a school in a city with a high cost of living. When you sign up for the scholarship you trade debt for freedom. Students in their early 20s are appropriately wary of debt, but do not understand what the loss of 12 years of freedom for themselves (and in many cases the families that arise during that time period) will mean in the future. Most doctors (even those who do primary care) have no problem paying off their debts provided they are not spendthrifts. http://whitecoatinvestor.com/ is a blog by a former military physician who has compared the financial consequences of taking an HPSP scholarship vs. taking loans to fund medical school. In the end only you can decide whether the debt is worth your freedom.
I started as an intern making about 57k and finished residency making about 65k though this will vary based on what part of the country you're in. As an attending in the group of specialties with the lowest bonus level (http://www.dfas.mil/militarymembers/payentitlements/militarypaytables.html) I made about 130k last year. My wife is also a physician and makes slightly more than I do. We are certainly comfortable from a financial standpoint, and though we certainly make less than our civilian counterparts, we will probably stay beyond our commitment because we both come from multi-generation military families and for the immediate and forseeable future the satisfaction of taking care of military patients and doing our part for our nation slightly outweigh the military bureaucracy that crushes my spirit on a weekly basis (though I am by nature a recalcitrant and am less able to "let go" of all the instances of military stupidity than my wife).
I believe this is at the crux of the "grousing" about pay that comes from military physicians. Certainly we make less than our civilian counterparts (and for some specialties much less) and certainly we make more than most other military officers and the general population as a whole. I think that complaints about pay really stem from what we endure for the pay we receive in comparison to our civilian counterparts. Will the pay be enough for you after you graduate a general surgery residency and you are sent to a far-flung hospital where the only surgeries you can perform are appendectomies, cholcystectomies, and panniculectomies because your hospital doesn't have the resources for you to perform anything more complicated? Will the pay be enough for you as while you work twice as hard covering for your worthless colleague with the knowledge that he will be payed the same as you? Will the pay be enough for you when you finish your highly specialized medical sub-specialty fellowship and you're told that you'll spend the next 2 years doing an administrative job where you will almost never practice clinical medicine and you'll watch the skills and knowledge you earned through toil and sacrifice wither on the vine? Will the pay be enough when both you and your spouse miss your son's first year of life due to deployment? Will the pay be enough when you are not granted a residency in the medical specialty you desire and you spend the next 2 years doing a mostly administrative job while desperately trying not to kill someone as an internship-trained GMO? Will the pay be enough when you're told to cancel your clinic for the day because your commander wants you to lead a trash detail to beautify the clinic in preparation for the change of command ceremony tomorrow? Will the pay be enough when you're told that you must take personal vacation and pay out of your own pocket to attend national meetings that allow you to refine your skills and knowledge and provide the educational credits that you need just to maintain your license? Will the pay be enough when your commander crucifies you in the national press and in front of a congressional panel because you carried out the directives that she instituted a few years prior?
All of these are things that have personally happened to me or my close friends/colleagues. If some of the more ridiculous things I've described had happened to me there would be almost no amount of money that would keep me in. As I said before, at this moment in time, in my specific situation, the satisfaction of caring for military patients slightly outweighs the other stuff. For many of my colleagues, however, the other stuff outweighed the satisfaction they received from taking care of their patients and doing their part for the nation. These friends and colleagues have left the military and gone on to civilian jobs. When they mention pay as a reason for leaving on their exit interviews what they are really saying is "I am not being paid enough to put up with this", or "I can't imagine that a civilian job would require that I make the same sacrifices or put up with the same amount of B.S., but even if it did, at least I'd be paid more for it."
#it'saboutautonomy
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I'd like make a point regarding his lifestyle and opportunities in his life that everyone has skipped over: He went to a service academy... West Pointers get the best of everything - because West Pointers sit in desirable positions and send other West Pointers to the best positions. Doesn't matter if your talking Medicine or Infantry.
Regardless of the state of Military Medicine after you graduate residency, you still won't have a degree from West Point and you won't get the best postings.
Not that the second point wasn't already made via other avenues already...
Regardless of the state of Military Medicine after you graduate residency, you still won't have a degree from West Point and you won't get the best postings.
Not that the second point wasn't already made via other avenues already...
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To echo some things noted above:
I came into the residency just about the time OIF was warming up and people almost forgot that we were in Afghanistan at the time. In fact, a TY that year was getting sent out as a GMO and I clearly remember him saying, "I'm gonna try to get in with a unit going to Afghanistan, the lesser of two evils". Funny, how that flip flopped in the past few years?
Anyways, at that time, yes, there were O6s that held prominent positions: chief of a service at an MTF, residency program director, DCCS, surgeon general consultant, etc. All had bronze stars, legions of merit, etc and NONE of them every seen a day outside of an MTF, had an operational job, or ever seen a deployment. They all had "golden" retirements. Hey, more power to them, but those days are now gone!! I was under the impression before I left the Army that no longer where we going to see doctors pinning on colonel just because they stayed in for a long time, they now expected your to earn it (e.g. deployments, ILE, leadership positions, etc).
Whenever I was at cheif of a clinic, my civilian counterpart ended up taking off 6 to 8 weeks per year because he maxed out his contact hours, refused to see medevacs, refused to do stat SRP evals, etc. etc. because he was not in the military and did not deem this as part of his responsibilities. His contract information is available online, it was last renewed for $385,000. As an O4, I barely made $140,000 my last year (of course, I did not take my October bonus, but even then, still pathetic in comparison).
Now, the idea of this post is "positive things to day"
I learned a lot while in the Army. I did not do residency at the Mayo clinic but my training was at least solid. I am proud of my career and will have stories to tell for the rest of my life. I would like to think that I had amicable departure. That being stated, I did not kid myself whenever I signed up way back as an MS1. I knew that there would be a time and day that my life would have some inconveniances due to the Army. I did my best to make lemonade out of lemons whenever required. I always wanted to serve in the military and HPSP gave me the opportunity to do so. I did consider staying in, but the largest motivating factor for getting out was for family reasons, as well, I wanted more control of my career options.
I came into the residency just about the time OIF was warming up and people almost forgot that we were in Afghanistan at the time. In fact, a TY that year was getting sent out as a GMO and I clearly remember him saying, "I'm gonna try to get in with a unit going to Afghanistan, the lesser of two evils". Funny, how that flip flopped in the past few years?
Anyways, at that time, yes, there were O6s that held prominent positions: chief of a service at an MTF, residency program director, DCCS, surgeon general consultant, etc. All had bronze stars, legions of merit, etc and NONE of them every seen a day outside of an MTF, had an operational job, or ever seen a deployment. They all had "golden" retirements. Hey, more power to them, but those days are now gone!! I was under the impression before I left the Army that no longer where we going to see doctors pinning on colonel just because they stayed in for a long time, they now expected your to earn it (e.g. deployments, ILE, leadership positions, etc).
Whenever I was at cheif of a clinic, my civilian counterpart ended up taking off 6 to 8 weeks per year because he maxed out his contact hours, refused to see medevacs, refused to do stat SRP evals, etc. etc. because he was not in the military and did not deem this as part of his responsibilities. His contract information is available online, it was last renewed for $385,000. As an O4, I barely made $140,000 my last year (of course, I did not take my October bonus, but even then, still pathetic in comparison).
Now, the idea of this post is "positive things to day"
I learned a lot while in the Army. I did not do residency at the Mayo clinic but my training was at least solid. I am proud of my career and will have stories to tell for the rest of my life. I would like to think that I had amicable departure. That being stated, I did not kid myself whenever I signed up way back as an MS1. I knew that there would be a time and day that my life would have some inconveniances due to the Army. I did my best to make lemonade out of lemons whenever required. I always wanted to serve in the military and HPSP gave me the opportunity to do so. I did consider staying in, but the largest motivating factor for getting out was for family reasons, as well, I wanted more control of my career options.
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Well, back up a bit. The contract price is what goes to the contracting company, not the contractor. The actual person makes less than the contract ... often a LOT less. And it's 1099 pay ... and they may have a whole 15 days worth of job security. It's not all groovy.
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Positive thing: I feel like my residency training was excellent. There is obviously a lot of variability in terms of what residency you match into, and where. I graduated feeling very comfortable with any of the core procedures I'm expected to know and a large handful of advanced procedures that many of my civilian friends and colleagues did not feel comfortable performing (some did, but many did not). My residency was extremely hands on, and you were performing entire procedures (with supervision, of course) as soon as you were felt up to the task. I feel like there are a few reasons for this: 1) Liability issues, 'nuff said. 2) Smaller, but well differentiated staff at the military hospital. They got to know each resident very well, and therefore felt more comfortable letting them man the helm. That's harder to do at a large institution with 100 staff docs. 3) Far more time spent training in terms of resident directed lecture and simulation labs. We had a lot of autonomy, but a lot of support as well. When we rotated to outside institutions, literally every staff doc I worked with pulled me aside and stated that they felt more comfortable with our residents working alone than they did with their own (group to group, not necessarily individual to individual).
We spent half of our training at a highly rated civilian university, and my experience was that we were at least as good if not better than their residents in terms of medical knowledge, efficiency, and surgical technique. We were far shy of them in terms of research. Plain and simple, it's hard to compete with a billion dollar university research program, but there were plenty of opportunities to hook up with their staff on projects.
If you're in a military residency that does not provide a good opportunity for outside rotations, then you probably won't see all the zebras. After residency, you won't safari very often, but it's nice to know what a zebra looks like. I strongly recommend it.
I can complain about Army medicine until the sun explodes, but I can't complain at all about my residency training.
We spent half of our training at a highly rated civilian university, and my experience was that we were at least as good if not better than their residents in terms of medical knowledge, efficiency, and surgical technique. We were far shy of them in terms of research. Plain and simple, it's hard to compete with a billion dollar university research program, but there were plenty of opportunities to hook up with their staff on projects.
If you're in a military residency that does not provide a good opportunity for outside rotations, then you probably won't see all the zebras. After residency, you won't safari very often, but it's nice to know what a zebra looks like. I strongly recommend it.
I can complain about Army medicine until the sun explodes, but I can't complain at all about my residency training.
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Positive thing #2 (obvious one): taking care of soldiers is extremely rewarding. That comes with enough baggage to down a zepplin, but when you are able to help someone recover from a post-IED injury, or get an SF guy tuned up for deployment, there is a lot of instant gratification. That's the only kind of gratification I recognize as significant.
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Positive thing #3: If you want to visit family overseas, you get to take a mandatory level I SERE training. This is important, because if you get lost in the wilds of Japan, the most densly populated first world country on Earth, you need to know how to survive on pine cones and grub worms and how to evade the local population until rescue arrives. You never know when your in-laws Mitsubishi will get hit en route, resulting in the entire family being taken hostage by Japanese extremists.....
Sorry, it's hard to come up with more than 2 positive things.
Sorry, it's hard to come up with more than 2 positive things.
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The off-the-top skim the contracting companies take is ridiculous. I've heard of percentages as high as 30%.
FWIW, my department contracts directly with the individual. In fact, some of them actually talked the government into contracting with the LLC/S-corporation owned by the individual. So, at least in one corner of the DoD, that $385K really is $385K. Of course, that doesn't account for the 1099 income advantages/disadvantages vs. getting a W2.
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The analysis of contract pay above also leaves off the scholarship money, all bonuses, 1099 social security tax, any acknowledgement of the periodic raises we receive, our benefits, the insane tax shelter that is military pay, and the lifelong annuity that the military gives you at 'retirement' (halfway throughout your working life) that is in and of itself nearly a third of what the military ultimately pays you. The correct analysis takes the value of all the benefits you get at what they would cost to purchase, and then adds that to total after tax pay, and compares that number to civilian after tax pay.
From that analysis
1) HPSP and 4 years commitment, or a 20 year commitment, will usually earn you more total career after tax dollars than a civilian unless you are in an extremely well compensated specialty. Its not just Peds and FM that come out ahead, EM/IM subspec/Gas do just fine.
2) If you leave more than 10 years through a career, but before 20 years, you generally lose money. The closer to retirement the more you lose
From that analysis
1) HPSP and 4 years commitment, or a 20 year commitment, will usually earn you more total career after tax dollars than a civilian unless you are in an extremely well compensated specialty. Its not just Peds and FM that come out ahead, EM/IM subspec/Gas do just fine.
2) If you leave more than 10 years through a career, but before 20 years, you generally lose money. The closer to retirement the more you lose
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Might want to work on being humble first.
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Okay, lets back up a bit.
Somehow, this contactor is an independent contractor. What that means is that he started up "billy bob's medical service LTD" and bid for his contract under his one corporation. I briefly, and I will place emphasis on the word briefly, considered doing this myself. I checked with the contract office and they said that I could do so.
NOW WAIT!
As this contractor pointed out to me, because he was an independent contractor, he did not have a lot of protection as say some of the other big contracting companies offer their employees.
Now, true, not all $385,000 went into his pocket. Because he was the president of his own corporation and paid himself as an employee, he had to do his own IRS footwork (he was too cheap to hire an accountant). I am currently in business for myself and I can tell you all, it is sickening to watch a "fat" paycheck get slashed after taxes are deducted.
He did not have health insurance, life insurance, eye, dental, 401K, etc etc. If he wanted any of that stuff, well it came out of that big figure.
You yes, he did not take the whole $385,000 for himself.
That being stated, even after he paid his taxes, paid his healthcare premiums, neurotically stockpiled gold bars, paid his dental bills, and gave the government their cut, he STILL made more than I ever did, yet did not have near the responsibilities.
On a related but different note. Contracting can be a good gig; however, they can decided to not renew your contract at any time for any reason. GS will pay much less than contracting, but will provide you with a benefits package. BOTH suck if there is a government shut down!!
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Hi everyone!
I appreciate everyone's informative responses. I'm still deciding where I'll go to med school next year. Some days I wake up and I'm 110% committed to USUHS, other days not so much (usually the days I read SDN lol). My dad's already making me study the latest edition of Tortora's Anatomy and Physiology and testing me on it periodically (yay helicopter parents).
Do you guys think brigade surgeon spots will decline as we move out of the middle east? Any predictions on how the landscape of milmed looks in 10 years? Since this conversation has gravitated towards civilian contractors, I asked my dad what he thinks about it, and he thinks in the coming years, milmed will undergo an effective downsizing and do away with many of the civilian contractors. Keep in mind that he sees the world through rose-colored glasses though.
Thanks again everybody!
I appreciate everyone's informative responses. I'm still deciding where I'll go to med school next year. Some days I wake up and I'm 110% committed to USUHS, other days not so much (usually the days I read SDN lol). My dad's already making me study the latest edition of Tortora's Anatomy and Physiology and testing me on it periodically (yay helicopter parents).
Do you guys think brigade surgeon spots will decline as we move out of the middle east? Any predictions on how the landscape of milmed looks in 10 years? Since this conversation has gravitated towards civilian contractors, I asked my dad what he thinks about it, and he thinks in the coming years, milmed will undergo an effective downsizing and do away with many of the civilian contractors. Keep in mind that he sees the world through rose-colored glasses though.
Thanks again everybody!
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I think I know where I would tell my dad to put that anatomy and physiology text. Seriously though, stop studying. Your retention right now won't be for crap, there's no guarantee that you're studying high-yield material, and your time is much better spent relaxing.
This brigade surgeon nonsense doesn't necessarily track with operational tempo. The first set of subspecialists were tagged with this in the fall of 2012, which was after we were out of Iraq and a deadline (end of 2014) for withdrawal from Afghanistan had been set. If they reduce the number of brigades, like they're claiming to want to do, then it may work out. But only if the medical corps doesn't also downside (I've known a couple of excellent physicians selected for elimination). Overall, I have found that a truism of the military is that stupid garrison BS is inversely proportional to op-tempo. Nobody was paying attention to APEQS training or taking away training holidays to "increase productivity" back in 2005/06. Now that things are slowing down, it's like someone looked around and thought, "we have O5s that never went to CCC! This travesty cannot stand!"
Only time can tell about the contracts. I'll just say that it's not as simple as: work goes up/hire more contractors and work goes down/fire contractors. As I said, I know of a couple of active duty physicians being eliminated (we used to call this being SERBed), but all of our contractors are still working with no mention of losing one.
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Pick a school that's at least a plane ride away from dad, for starters.
Predicting the size and form of milmed 10-15 years from now is kind if like predicting the price of AAPL in 10-15 years.
Predicting the size and form of milmed 10-15 years from now is kind if like predicting the price of AAPL in 10-15 years.
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I think I worked for daddy. Sounds like a familiar archetype.
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My dad's already making me study the latest edition of Tortora's Anatomy and Physiology and testing me on it periodically (yay helicopter parents).
God I hope you are kidding. On the other hand, in the future maybe dad can write your OER's for you.
God I hope you are kidding. On the other hand, in the future maybe dad can write your OER's for you.
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Quit sickening isn't it? Always amazing to me people who say they would do something for free - 9 times out of 10 they're coddled grownups still supported by their parents who have never held a real job.
