Ask Me Anything: Military Medicine

[militaryPHYS]

I am very curious on the biggest questions that premed students have regarding military vs. civilian route. This can be an Ask Me Anything (AMA) thread or free speak. Intent is to understand current concerns regarding both pathways as well as to answer specific questions that arise. Please avoid "What are my chances" questions. Current interest in military medicine makes it very competitive and therefore I would like to focus on the average applicant's questions regarding lifestyle, income, practice, etc.

I am a current active duty Navy Ortho surgeon who is planning full military career.

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[Matthew9Thirtyfive]

Nice to see another Navy guy who actually enjoys the military. Thanks for doing this. I don’t really have any questions, but I’m going through the EMDP2 through USUHS.

 

[Matthew9Thirtyfive]

Oh, I did just think of a question (two parter, actually): when did you finish residency, and what percentage of your intern class went to gmo land before returning to residency?

 

[aaronrodgers]

If you could go back in time, would you have joined at 22 through USUHS, or 22-26 thorough HPSP, 26-31 through FAP, or 31+ by direct commissioning?

It seems joining later affords more flexibility in regards to medical education but there are less financial benefits.

 

[Perrotfish]

I've heard from various sources conflicting information about the ability to do research in the military. Are there opportunities to do research? After service, is it difficult to move back into academia?

I've heard that on deployment everyone ends up doing trauma or casualty stabilization in some form or another. Maybe this is a question better suited for an Army guy, but if you go into the military, is there a large chance you'll either be part of a forward surgical team or a combat support hospital? If you do ophthalmology stateside but want to do some combat support on deployment (hypothetical), is there opportunity to do so?

Military docs don't have to deal with insurance presumably, so what are some of the other more mundane aspects of working in the military, and how do you compare them to the mundane aspects of civilian medicine?

I am also AD Navy
Research:
My experience is that the military will provide absolutely everything you need for research other than the time or stability to actually do it, which is why very little actually gets done. I have access to a library staff that will do lit searches for me, a clinical research nurse who will write a large portion of my IRBs, a data guy who will help me find and review charts, an associate professorship at USUHS to publish under, and there are internal grants and laboratory spaces that are easily available if you have a project that needs them.

However I have never gotten so much as two weeks to actually devote to a research project in three years of residency and three years of payback. My residency's clinical responsibilities are so overloaded that when I left Interns were down to two golden weekends per YEAR. As an attending I am on Q3 call, have 5 days/week of clinic, work every third weekend and holiday, and I'm on 5 committees. If you want to publish anything meaningful, you really need to give up your Sundays. Also since they move you across the country every 2-3 years you really need to start several projects on the first day you arrive at a new command if you want to have any hope of getting it done.

Deployment
You always have the opportunity to deploy as a medical officer in general support of a mission. Junior docs go as GMOs and provide basic medical care, and if necessary emergent stabilization, to battalions of Marines or for Sailors on ships. Residency trained, more senior doctors serve as regimental doctors/senior medical officers, and provide oversight to several GMOs. Usually regimental doctors/SMOs spend most of their days in meetings. Usually non ER/Family doctors avoid these positions like the plague because you lose a lot of your perishable non-primary care skills when all you do is provide primary/sports med and 5-10 trauma resuscitations over the course of a year. You will NOT do anything that you would normally need a subspecialty for, likely surgery, unless you are actually in that subspecialty. We don't make Family doctors do surgery in the field.

Time Killers:
The military will waste more of your time on nonmedical nonsense than anyone else you could possibly work for. Some of it will be wasted with military specific nonsense: uniform inspections, physical fitness tests, random drug tests, online training modules (I average about 1 per week), and lots and lots of meetings (I average 3 per week). Even more of your time will be wasted on civilian metrics that the military has imported: medical home, HEDIS, Oryx, patient satisfaction, coding for RVUs, time sheets, HRO metrics, etc. If you work for a larger civilian organization you will spend time buffing some of those metrics, but only in the military will you be expected to work on all of them. The only positive is that the insurance is very good and you almost never need to argue with them about coverage. Finally if you move up in the ranks you will need to devote 50% or more of your time to management as you begin to take on responsibilities like department head or director, though if you just do a 4 year payback you will be probably be allowed to keep your time at least 80% clinical until you get out.

 

[Matthew9Thirtyfive]

However I have never gotten so much as two weeks to actually devote to a research project in three years of residency and three years of payback. My residency's clinical responsibilities are so overloaded that when I left Interns were down to two golden weekends per YEAR.

Obviously this is your experience in peds, but how much does that translate to other specialties where you trained? It seems like from my limited experience, the ortho residents at Balboa were pretty prolific from a research standpoint. Maybe that’s a misconception.

 

[militaryPHYS]

when did you finish residency, and what percentage of your intern class went to gmo land before returning to residency?

Congrats on the EMDP2 program! I have heard it is a tough program to get accepted in to. Awesome they are doing that now.

I finished intern year in 2013. Ortho Navy at Portsmouth (4 of us), 3 of us went straight through and 1 went to fleet. Overall numbers I would be speculating, but I'm sure I could go back and find exact numbers. Trouble is, it changes every year. If you are transitional or primary care there is a higher likelihood of going to fleet before finishing residency, but again, not set in stone.

 

[Matthew9Thirtyfive]

Congrats on the EMDP2 program! I have heard it is a tough program to get accepted in to. Awesome they are doing that now.

I finished intern year in 2013. Ortho Navy at Portsmouth (4 of us), 3 of us went straight through and 1 went to fleet. Overall numbers I would be speculating, but I'm sure I could go back and find exact numbers. Trouble is, it changes every year. If you are transitional or primary care there is a higher likelihood of going to fleet before finishing residency, but again, not set in stone.

Interesting. Good to know. I was just curious. By the time I apply even for internship it will be totally different, I know. How was residency? Did you feel adequately prepared? I read some stuff about ortho residents at Walter Reed getting worked like dogs.

Ortho is one of my interests. I did a lot of ortho as an OR tech. It’s super cool.

Is being competitive for ortho in the Navy similar to being competitive in the civilian world? What made you stand out to be one of the three that went straight through?

Sorry for all the questions. I’m super excited to be getting to do this. The EMDP2 is awesome. I’m very blessed to be a part of it. Competition was pretty intense for my cohort, so I definitely thank God every day.

 

[militaryPHYS]

I've heard from various sources conflicting information about the ability to do research in the military. Are there opportunities to do research? After service, is it difficult to move back into academia?

I've heard that on deployment everyone ends up doing trauma or casualty stabilization in some form or another. Maybe this is a question better suited for an Army guy, but if you go into the military, is there a large chance you'll either be part of a forward surgical team or a combat support hospital? If you do ophthalmology stateside but want to do some combat support on deployment (hypothetical), is there opportunity to do so?

Military docs don't have to deal with insurance presumably, so what are some of the other more mundane aspects of working in the military, and how do you compare them to the mundane aspects of civilian medicine?

We had a ton of opportunities and support to do research during residency. It was up to us to make time to get it done. Conversely, at Walter Reed's ortho program everyone is required to do an entire year of research (6 years of residency vs. 5 for me at Portsmouth). It all depends on what you end up doing and where you go. Thankfully, the military is provided sufficient resources to make it happen. If you want to do research you will have the opportunity, you may just have to list your preferences accordingly to maximize your chances of success with research.

As Perrotfish mentioned, the subspecialties are often times farther back as support. There are certain opportunities to be attached to forward operating teams but often times these are UMO's with SEALs or other ER/primary care guys attached to specific units. Most people I have talked to said they "enjoyed" their deployment but were very often bored and losing their clinical skills.

Mundane parts of my current job are the standard computerized training and administrative tasks required of military physicians. I have heard that larger hospital groups often have similar nonsense computer training, but unlikely to the level we see. Regardless it isn't a big deal in my opinion. Just another thing you have to get done and move on. My practice is ideal because I do >80% ortho sports and the rest is basic ortho trauma. I am going in to sports fellowship anyway so it is ideal. It is not always ideal though...i.e. if I were going in to ortho trauma or total joints I'd be twiddling my thumbs...

 

[Perrotfish]

Regardless it isn't a big deal in my opinion. Just another thing you have to get done and move on.

This attitude is easier to have as an active duty surgeon at a small MTF, or alternatively as certain kinds of subspecialists at a large MTF. While most see the very low caseload as a huge negative, it does have the virtue of leaving you with a lot of spare time. On the other hand for the OB/FP/IM/Peds docs seeing a truely full clinic while also taking Q3 night and weekend call the additional admin burden is pretty brutal.

 

[militaryPHYS]

If you could go back in time, would you have joined at 22 through USUHS, or 22-26 thorough HPSP, 26-31 through FAP, or 31+ by direct commissioning?

It seems joining later affords more flexibility in regards to medical education but there are less financial benefits.

I would do USUHS at 22 again any day of the week. No question. I also started at USUHS with no preconceived intentions regarding specialty. Here I am as an ortho surgeon accepted to sports fellowship.

Initially I wanted to be an ER doc on the front lines, then I wanted to be a trauma surgeon via a general surgery residency....eventually I realized that a surgical specialty with a better lifestyle would maximize my own interests while coordinating those interests with what the military had to offer me.

If you enter medical school with a preconceived all-or-none option in medicine (i.e. I want to be a pediatric cardiologist) then you should delay your entry in the military until you have achieved your own goal and reevaluated your decision to sign up. If your primary goal is to just be a physician and specialty will work itself out as you make your way along the normal pathway of an aspiring physician then the military will offer you a great financially responsible option with possibly limited ultimate outcomes.

 

[militaryPHYS]

This attitude is easier to have as an active duty surgeon at a small MTF

I was a surgical resident, mil-mil family with dual residency/research requirements, call every week and we were able to complete all of our required training without issue. Now we are staff with more time on our hands and still not an issue. Just personal opinion I guess.

 

[militaryPHYS]

Is being competitive for ortho in the Navy similar to being competitive in the civilian world? What made you stand out to be one of the three that went straight through?

Quick answer: Yes. Ortho is as competitive as dermatology and neurosurgery whether or not you are in or out of the military. That being said, if you are already within the military system (USUHS or HPSP) and you prove to the interviewing residents/programs that you will be a valuable asset to their team then you can do well with average scores. If your scores are average or below you are likely to get passed over. If your scores are average or above, your utility as a respected member of the military team holds more weight than just raw scores (in my experience). But the default holds true...You need to be a top member of your applicant pool to have a shot. Don't just assume you deserve to be there because of civilian or prior military experience. Your scores need to validate your resume.

How was residency? Did you feel adequately prepared? I read some stuff about ortho residents at Walter Reed getting worked like dogs.

Nothing prepares you for ortho residency. Everything you learned in medical school has little application to your day-to-day function as an ortho resident. If you are accepted to an ortho program then your mentors above you will [hopefully] provide you with the resources to become prepared for the first day of residency, but the majority of the preceding four years of medical school provide little help. The same holds true for neurosurgery, dermatology, etc. Medical school and the scores you receive are a reflection of your ability to learn and comprehend what is required of you as a sub specialized resident. Struggle with step exams and shelf exams and expect to struggle with specialized training and ultimately the board exams. Unfortunately that is the reality.

 

[militaryPHYS]

I read some stuff about ortho residents at Walter Reed getting worked like dogs

When I was a medical student on the ortho team at Walter Reed during 2010-2012 I was worked like a dog, just like many of their residents during that time amidst a heavy casualty period of war. It was brutal, but it was also what made me change from general surgery to ortho residency preference. I was often autonomous, first assist as an MS3 and felt essential during a dark time in the history of our current wars. I cannot speak for the residents because they were subjected to an entire residency of IED blasts, wound washouts and amputation revisions (during this period), but it at least showed me what utility I could have as an orthopedic surgeon in the military. Portsmouth ended up being a better all-around orthopedic educational experience, but the ****ty time I spent at Walter Reed was the reason I chose my path in life. Because of that I could never regret my own busy schedule if it ended up ultimately helping the entire team and Marine Corps during that time.

 

[Matthew9Thirtyfive]

Quick answer: Yes. Ortho is as competitive as dermatology and neurosurgery whether or not you are in or out of the military. That being said, if you are already within the military system (USUHS or HPSP) and you prove to the interviewing residents/programs that you will be a valuable asset to their team then you can do well with average scores. If your scores are average or below you are likely to get passed over. If your scores are average or above, your utility as a respected member of the military team holds more weight than just raw scores (in my experience). But the default holds true...You need to be a top member of your applicant pool to have a shot. Don't just assume you deserve to be there because of civilian or prior military experience. Your scores need to validate your resume.

Awesome. Thanks. Yeah, I would never expect any sort of special treatment because of past experience. All that experience is good for is giving me an idea of what I might like and making it so I don’t have to learn how to act in an OR lol.

Nothing prepares you for ortho residency. Everything you learned in medical school has little application to your day-to-day function as an ortho resident. If you are accepted to an ortho program then your mentors above you will [hopefully] provide you with the resources to become prepared for the first day of residency, but the majority of the preceding four years of medical school provide little help. The same holds true for neurosurgery, dermatology, etc. Medical school and the scores you receive are a reflection of your ability to learn and comprehend what is required of you as a sub specialized resident. Struggle with step exams and shelf exams and expect to struggle with specialized training and ultimately the board exams. Unfortunately that is the reality.

Sorry, should have been more clear. I meant did you feel adequately prepared to be an attending at the end of your residency?

 

[Perrotfish]

I was a surgical resident, mil-mil family with dual residency/research requirements, call every week and we were able to complete all of our required training without issue. Now we are staff with more time on our hands and still not an issue. Just personal opinion I guess.

I actually didn't think the admin burden was that bad during residency. It was really just physical fitness, which I do anyway, and the online trainings, which while stupid and pointless swallowed no more than an hour per week. The real burden of meetings and committees, which swallow more than an hour per day, hit after residency. Working the equivalent of a full day per week doing admin tasks, as an attending, is a big reason not to stay in this organization. I think you might feel it less, though, as an Ortho attending with very few patients.

 

[deleted600623]

What is your opinion on the financial side of going military? I've read where it's not financially beneficial unless you go into primary care because of the salary diff between military and civilian jobs of the higher paid specialties. Also, what is the typical length of deployment for physicians? The physician I used to work for was in the Army for 15 years and said deployment was roughly 6 months and once you completed it, you dropped down to the bottom of the list and likely didn't reach the top again if you completed your required service.

 

[BombsAway]

If I have the VA covering med school tuition + BAH at any of the civilian schools i got in at, and a USUHS acceptance... How do i determine if the financial suicide of usuhs is worth it?

 

[Gilakend]

What would you say is your primary motivator giving up the civilian ortho income for Navy ortho income? Service, patient population, more interesting/fun? I talked to a ortho surgeon who did HPSP and said if he knew he was going to do ortho he would have done reserves instead.

Thanks for doing this and thank you for your service!

 

[T800'sThumb]

If I have the VA covering med school tuition + BAH at any of the civilian schools i got in at, and a USUHS acceptance... How do i determine if the financial suicide of usuhs is worth it?

Whether you're interested in service, honestly.

 

[militaryPHYS]

I meant did you feel adequately prepared to be an attending at the end of your residency?

Yes. We got excellent exposure to all aspects of orthopedic both through our home program in the military and also during outside rotations for things like orthopedic trauma, pediatrics, joints. The trouble is keeping up the skills you learned depending on where your first duty station is

 

[Matthew9Thirtyfive]

Yes. We got excellent exposure to all aspects of orthopedic both through our home program in the military and also during outside rotations for things like orthopedic trauma, pediatrics, joints. The trouble is keeping up the skills you learned depending on where your first duty station is

Is your volume pretty low? I worked in a super rural hospital for a few years that did mostly ortho, but the majority of the cases were ORIFs and total knees/hips with the occasional arthoscopy or rando shoulder. Is it similar to that?

 

[militaryPHYS]

What is your opinion on the financial side of going military? I've read where it's not financially beneficial unless you go into primary care because of the salary diff between military and civilian jobs of the higher paid specialties. Also, what is the typical length of deployment for physicians? The physician I used to work for was in the Army for 15 years and said deployment was roughly 6 months and once you completed it, you dropped down to the bottom of the list and likely didn't reach the top again if you completed your required service.

Great questions. First, if you do primary care you can make just as much, if not more (when factoring in military residency year income) in the military. If you go in to a surgical specialty or other sub specialization with higher salary the income gap does exist. What no formula accounts for is lifestyle. There is no practice that I have heard of as a civilian that affords you the lifestyle that the military does (not factoring deployments). The amount of time that my wife and I get to spend with each other and our son is unheard of with a dual physician couple fresh out of residency. Obviously deployments negate some of that when they happen, but on a regular basis our day to day lifestyle is great. We have been blessed (lucky) so far in our careers, so this is not always the case. Check out my compiled thoughts on this on my website (no ads, no income): IS THE MILITARY RIGHT FOR ME 101 - The Military Physician

Typical deployments are 6 months for physicians. Recurrence of the deployments is dependent on your service, specialty and duty station.

 

[militaryPHYS]

How do i determine if the financial suicide of usuhs is worth it?

Financially USUHS is the best decision. Unfortunately that comes along with a hefty military commitment and income gap as an attending if you are sub specialized. I have a lot of numbers crunched and spreadsheets to look at on the link I just posted above.

 

[militaryPHYS]

What would you say is your primary motivator giving up the civilian ortho income for Navy ortho income? Service, patient population, more interesting/fun? I talked to a ortho surgeon who did HPSP and said if he knew he was going to do ortho he would have done reserves instead.

Thanks for doing this and thank you for your service!

Currently I still owe a lot of payback to the military because of USUHS so I don't have the option of getting out for more income. I still plan to stay past my commitment, but obviously things can change. I enjoy the military system, patient population (young marines) and the practice that I have (primarily orthopedic sports). I also love the family life and overall lifestyle we have currently. I'd be working a lot harder and seeing my family a lot less if I was a brand new civilian orthopedic guy...but I'd also be making a lot more money. Since my wife also works it affords me the benefit of supplementing the income gap making it not that big of a deal for me.

 

[militaryPHYS]

Is your volume pretty low? I worked in a super rural hospital for a few years that did mostly ortho, but the majority of the cases were ORIFs and total knees/hips with the occasional arthoscopy or rando shoulder. Is it similar to that?

Currently I have a steady volume of sports and basic trauma stuff. This is very duty station dependent and you will be happy or miserable based on what path you choose to take in medicine and the military. i.e. I have one colleague who is going to Joints fellowship this summer and he hasn't thought about a joint for the last two years (he is quite miserable and frustrated). If he were stationed stateside he could probably have been doing some joints the last two years, but OCONUS spots don't allow us to do joints.

 

[BombsAway]

Financially USUHS is the best decision. Unfortunately that comes along with a hefty military commitment and income gap as an attending if you are sub specialized. I have a lot of numbers crunched and spreadsheets to look at on the link I just posted above.

Perhaps I wasn't clear. I'd be in the black for all 4 years of med school: no loans, plus a modest income. Attending USUHS, using your numbers i'd be down ~1 million 10 years post med school and ~2.7 million 10 years after that. So back to my question, how do I go about deciding if the mission and patient population are worth those numbers? What are your intangibles? I'm prior service, so no need for any cringey cliches. I was once a patient at an FST overseas, so being able to operate in that capacity might be worth a few million bucks to me. What other opportunities would be unique to active duty?

 

[militaryPHYS]

Perhaps I wasn't clear. I'd be in the black for all 4 years of med school: no loans, plus a modest income. Attending USUHS, using your numbers i'd be down ~1 million 10 years post med school and ~2.7 million 10 years after that. So back to my question, how do I go about deciding if the mission and patient population are worth those numbers? What are your intangibles? I'm prior service, so no need for any cringey cliches. I was once a patient at an FST overseas, so being able to operate in that capacity might be worth a few million bucks to me. What other opportunities would be unique to active duty?

So you are thinking ortho or neurosurgery it sounds like? To be honest I think you are answering your own questions. Being prior service you know what the military healthcare system is like. If you can deal with the nuances and also account for lifetime benefits of a career in the military and the numbers that go along with that, the rest is personal opinion of the value of the lifestyle/patients and your desire to serve vs. make extra money on the civilian side. You have to decide what is most important to you...there aren't calculators for intangibles. I was prior service, can deal with the nuances of military medicine, have a wife to supplement the income gap and really like the ability to practice places I never would have thought about, treat our warfigthers, travel the world with my family and already have a huge log of family adventures while only being 10'ish years in to our military careers. I also really enjoy making clinical decisions solely based on my education and peer reviewed literature. Nothing about my practice is incentive based and I saw a lot of civilian docs make a lot of their decisions because of their anticipated compensation. It's sad, but true.

Sorry if I'm not answering your question. Is there something else specifically you are wondering?

 

[BombsAway]

So you are thinking ortho or neurosurgery it sounds like? To be honest I think you are answering your own questions. Being prior service you know what the military healthcare system is like. If you can deal with the nuances and also account for lifetime benefits of a career in the military and the numbers that go along with that, the rest is personal opinion of the value of the lifestyle/patients and your desire to serve vs. make extra money on the civilian side. You have to decide what is most important to you...there aren't calculators for intangibles. I was prior service, can deal with the nuances of military medicine, have a wife to supplement the income gap and really like the ability to practice places I never would have thought about, treat our warfigthers, travel the world with my family and already have a huge log of family adventures while only being 10'ish years in to our military careers. I also really enjoy making clinical decisions solely based on my education and peer reviewed literature. Nothing about my practice is incentive based and I saw a lot of civilian docs make a lot of their decisions because of their anticipated compensation. It's sad, but true.

Sorry if I'm not answering your question. Is there something else specifically you are wondering?

No, I used 300k/yr thinking EM.
It's a tough call. I wonder if I could have my cake and eat it too as a civilian employee at a military hospital.

 

[militaryPHYS]

No, I used 300k/yr thinking EM.
It's a tough call. I wonder if I could have my cake and eat it too as a civilian employee at a military hospital.

In my experience it is very difficult to get a civilian and/or GS position as a physician at an MTF. Only ones I have seen are prior milphys who retire and the hospital wants to keep them around because they are a high value asset with a proven track record there. But this may change with changes coming from NDAA 2017, but still way too early to know

 

[AsianPersuasion]

Thanks for doing this! Posting this broadly to all the users. I'm planning to go into FM. I'd like to join after I finish residency. What are the things I should be aware about? If it's too much to post here, is there a place you can direct me to check out?

 

[Perrotfish]

What is your opinion on the financial side of going military? I've read where it's not financially beneficial unless you go into primary care because of the salary diff between military and civilian jobs of the higher paid specialties.

Military pay is more complicated than civilian pay. First, unlike civilian physician pay, it rises both with time in service and with promotions. More importantly, a huge percentage of your compensation comes in the form of three big payouts: the scholarship itself, the ability to transfer the GI bill to a dependent (if you stay in for 10 years) and the military's pension plan (if you stay in for 20 -30 years).

Due to the incredibly high/rapidly rising cost of medical school, as well as the insane interest rates on graduate loans, most specialties come out ahead by taking the HPSP scholarship compared to taking civilian loans and then getting out after 4 years. Highly paid surgical specialties now almost break even, and primary care can come out way ahead vs their civilian peers. Full discussion here. The only people who really lose money by taking HPSP are the people who are forced to take a lower paying specialty in the military match than they would have gotten in the civilian match, or people who ruin their working spouse's career by having to move to remote locations for the military. Both are really serious risks of committing to the military.

Almost all doctors will lose money relative to their civilian peers by staying in the military after their initial obligation, unless they stay for a full 20 years to get a pension. Career physicians who stay for the pension usually come out ahead if they are in a lower paid specialty (peds, psych, family, Ob/Gyn) but will generally lose money if they are in a higher paid specialty (ER, Gas, Rads, Surgery). Unless you stay in for 20 years, taking USUHS over HPSP will usually cost you money in the long run.

Keep in mind its not just the money that varies between specialty, but also the quality of life. Generalists like Pediatricians, Ob/Gyns, Family docs, and Psychiatrists may come out financially ahead after 20 years in the military, but they will spend most of those years in really unpleasant, rural locations even when they're not deployed. On the other hand subspecialists like Pediatric Nephrologists and Maternal Fetal Medicine docs might not just come out way ahead financially, but may also spend their entire career glued to a single major hospital in a highly desirable area.

The physician I used to work for was in the Army for 15 years and said deployment was roughly 6 months and once you completed it, you dropped down to the bottom of the list and likely didn't reach the top again if you completed your required service.

There's no predicting this, it will be based on the political situation when you finish training. At the peak of the Iraq war the Army had 15 month deployments. The Navy is currently doing 6-9 month deployments. There are currently rules that dictate that you can't deploy again as soon as you get back but those are military policies, not laws, and can go away at any time. Also you might be surprised to learn that you can get stuck doing something isolated and far away, for example being on a hospital ship, and its not technically a 'deployment', so they're free to both make it last longer than current deployments and to deploy you right after you get back. Basically you need to go in understanding that they are entirely within their rights to deploy you, continuously, for your entire obligation and a 6 month stop loss beyond that. They probably won't, but they can.

 

[Geo16]

Where do Navy Physicians work?
Are you on a ship most of time? Or are you mostly stationed in camps/military hospitals?

 

[militaryPHYS]

Military pay is more complicated than civilian pay. First, unlike civilian physician pay, it rises both with time in service and with promotions. More importantly, a huge percentage of your compensation comes in the form of three big payouts: the scholarship itself, the ability to transfer the GI bill to a dependent (if you stay in for 10 years) and the military's pension plan (if you stay in for 20 -30 years).

Due to the incredibly high/rapidly rising cost of medical school, as well as the insane interest rates on graduate loans, most specialties come out ahead by taking the HPSP scholarship compared to taking civilian loans and then getting out after 4 years. Highly paid surgical specialties now almost break even, and primary care can come out way ahead vs their civilian peers. Full discussion here. The only people who really lose money by taking HPSP are the people who are forced to take a lower paying specialty in the military match than they would have gotten in the civilian match, or people who ruin their working spouse's career by having to move to remote locations for the military. Both are really serious risks of committing to the military.

Almost all doctors will lose money relative to their civilian peers by staying in the military after their initial obligation, unless they stay for a full 20 years to get a pension. Career physicians who stay for the pension usually come out ahead if they are in a lower paid specialty (peds, psych, family, Ob/Gyn) but will generally lose money if they are in a higher paid specialty (ER, Gas, Rads, Surgery). Unless you stay in for 20 years, taking USUHS over HPSP will usually cost you money in the long run.

Keep in mind its not just the money that varies between specialty, but also the quality of life. Generalists like Pediatricians, Ob/Gyns, Family docs, and Psychiatrists may come out financially ahead after 20 years in the military, but they will spend most of those years in really unpleasant, rural locations even when they're not deployed. On the other hand subspecialists like Pediatric Nephrologists and Maternal Fetal Medicine docs might not just come out way ahead financially, but may also spend their entire career glued to a single major hospital in a highly desirable area.

Perrotfish, very well said. I read through most of your original thread you started back in 2013. For starters, that would have been a great way for me to catch up on who is who in the SDN since I re-joined after residency! Second, I think your thoughts then are even more poignant now which you just articulated really well here.

Like you mentioned and what many have said before me...If someone fully understand the unknowns and possibility of being screwed over by something as uncontrollable as your matriculation year, the military affords an incredibly financially positive pathway through the early years of a physician's life (med school, residency, early staff). To stay beyond that is a personal choice based on many factors, but when factoring in just the 4 or even 7 year payback timelines, the military physician is ahead financially in the primary care specialties, and pretty darn close to breaking even when factoring in taxes, GI bill benefits, healthcare, etc for even the highest paying specialities.

When I was signing up for USUHS everyone just assumed whoever was signing up for HPSP/USUHS was accepting a huge pay cut and a bad experience. Just not the case anymore. I think that is why i was so anxious in other posts to focus on the PROs/CONs of military service to provide ideas for premeds to consider but of course I was hit with a large number of CONs based on who is active on SDN currently. Unfortunately all of the cons are the same topics articulated just a bit differently (admin, small MTFs, nurses, deployments, skill atrophy, etc). If you can accept those as possibilities while also believing and making decisions to maximize the PROs that some people discuss then MilMed is a great option.

What gets drowned out by negativity while discussing military vs civilian is who is more commonly happy in the military, why they are happy and how they got ahead. Usually it is chalked up to @$$ kissing or just knowing the right people...but again, just not true. There are certain things that you can do to maximize your lifestyle, psyche and success as a military physician and it isn't ALL luck. Has this been hashed out on here before? I haven't seen a thread like that.

 

[Matthew9Thirtyfive]

Has this been hashed out on here before?

Pretty much every thread on the milmed forum is why you should avoid it like the plague. It’s sad because I’m sure it turns people off to never see any of the positives and to have the negatives either overblown or harped on.

 

[militaryPHYS]

Thanks for doing this! Posting this broadly to all the users. I'm planning to go into FM. I'd like to join after I finish residency. What are the things I should be aware about? If it's too much to post here, is there a place you can direct me to check out?

By coming in after residency you controlled every aspect of your own destiny in terms of location and specialty, but your net worth took a hit relative to a HPSP/USUHS person during that time. At least your training is done and you have more freedom to choose what you want to do now, but your student loan debt is likely quite large.

I think it is a noble thing to do if you want to sign up at that point, but you've missed out on the years of solid income, benefits and time towards retirement that is the true benefit of medicine through the military (when not factoring in all of the Oorah, patriotic and emotional stuff) and what financially separates a military pathway from a civilian going through the same 4-10 years of med school and residency.

For instance. Your average civilian during 4 years of med school and 3 years of residency will only have about 165k of total income during that time and around 200k+ in debt. A USUHS person accrues over 500k in income during the same time and no debt. An HPSP person would have made over 350k bucks total and no debt. Additionally, to use the GI bill fully on yourself you need 36 months of time in. To TRANSFER the GI bill to your kids you need 6 years active, then agree to be around for another 4 years (10 total). So USUHS people definitely will be able to fulfill that by the time they can get out, HPSP can depending on how long their residency was. You will just be starting your clock for things like this, plus time towards retirement and a pension. So yes, the military will help pay back your laons, but you could be doing that on your own now that you are an attending physician.

I don't have a lot of experience or previous discussion on this, but I think you miss out on the real benefits of medicine through the military (good pay/benefits/TSP contributions during med school/residency and accruing time towards GI bill transfer, retirement, etc). Most people would tell you if you are already done with training to just stay a civilian unless you have an insatiable desire to serve your country at that time in your life.

 

[militaryPHYS]

Where do Navy Physicians work?
Are you on a ship most of time? Or are you mostly stationed in camps/military hospitals?

GMO's, FP, Internal Med, General Surgeons and a few others can be assigned to a ship. This is usually for a standard length tour (3 years) and then often followed by a shore assignment (military hospital). Re-assignment to a ship is dependent on op tempo, total numbers and billets available.

Other specialties like Ortho, Derm, peds, optho, etc are rarely ever assigned to a ship and stay assigned to different military hospitals during their careers.

Anyone else with personal experience or more clarification for current shipboard billets please chime in!

 

[Perrotfish]

What gets drowned out by negativity while discussing military vs civilian is who is more commonly happy in the military, why they are happy and how they got ahead. Usually it is chalked up to @$$ kissing or just knowing the right people...but again, just not true. There are certain things that you can do to maximize your lifestyle, psyche and success as a military physician and it isn't ALL luck. Has this been hashed out on here before? I haven't seen a thread like that.

My experience is that truly happy military physicians, as in people who are happier day to day than they would have been in civilian medicine, are extremely rare. The military work enviornment is pretty bad: tons of admin, bad hours, lots of call, inadequate support staff, no feeling of appreciation, etc. Even discounting deployments it's got an office space vibe that no physician really wants to put up with.

Most of the truly happy military docs I have seem to fall into one of two categories:

1) Operational physicians: Some primary care doctors REALLY like being attached to fleet/Marines. They like deploying, and don't mind being away from their families for 9 months out of every 2 years. Operational medicine is also the only environment in the military where you will be treated with some respect as a physician (your own office, control of your staff, etc) and the hours can be good. These guys are generally primary care guys that pick up a RAM, adolescent fellowship, or wilderness medicine fellowship, and who also rotate through war college.

2) 1/1 subspecialists. These guys get to be in the military without most of the problems associated with being in the military. They can usually attach to a major hospital in a desirable area (DC, Hampton Roads, or San Diego for the Navy) and just stay there for a career. Because they're usually 1/1 they usually don't deploy, and because big hospital leadership is mostly made of physicians they generally have a pretty good work environment. Also since their fellowships count towards retirement they only have to really work for the Navy for 14 years. They usually do a full 20 before they get out.

Other than that, though, most military doctors I know really don't like their jobs and really do see it as payback for a loan rather than as a potential career. Military work drags you to underequipped hospitals in bad locations, it is frequently difficult to practice good medicine, each day is filled with dozens of small indignities and unpleasant interactions, and you have no ability to walk away from a bad situation. There is exactly one junior physician at my command who is staying after her initial commitment is up, and its someone who was prior service and is already more than half way to retirement. For the rest of us, 'happy' really just means that we feel that the scholarship was less awful than loans would have been, and that its better to concentrate the misery into 4 years of military payback rather than 20 years of loan payback.

My advice for anyone who is thinking of joining the military is to join via HPSP. Don't commit to more than 4 years to an organization you haven't worked for yet. The only reason to go to USUHS is if its your only acceptance.

 

[Geo16]

GMO's, FP, Internal Med, General Surgeons and a few others can be assigned to a ship. This is usually for a standard length tour (3 years) and then often followed by a shore assignment (military hospital). Re-assignment to a ship is dependent on op tempo, total numbers and billets available.

Other specialties like Ortho, Derm, peds, optho, etc are rarely ever assigned to a ship and stay assigned to different military hospitals during their careers.

Anyone else with personal experience or more clarification for current shipboard billets please chime in!

My dream is about becoming a pirate doctor. Arrr. On board, matey!

 

[Matthew9Thirtyfive]

My dream is about becoming a pirate doctor. Arrr. On board, matey!

It’s come aboard, landlubber.

 

[Geo16]

It’s come aboard, landlubber.

Well, I f'd up

 

[Matthew9Thirtyfive]

Well, I f'd up

That’s what ODS is for. Just don’t f up again or we’ll make yeh walk the plank and send yeh to Davey Jones’ locker. And I’ve met him personally. He’s an arse.

 

[Geo16]

Never been this desperate to press this button...!

 

[militaryPHYS]

The only reason to go to USUHS is if its your only acceptance.

I agreed with everything you were saying until this line. While I agree that someone who isn't 100% sold on the military but who doesn't want the large debt shouldn't commit to more than he or she has to...if an applicant has experienced the military healthcare system (prior service) or if they are well informed (via SDN, personal interactions, etc) and OK with taking on a longer commitment, the payout from the additional years of AD pay/benefits during USUHS plus the ability to transfer GI benefits prior to leaving, PLUS retiring with 24 years when they hit 20 is pretty lucrative.

Most HPSP applicants have to extend past a standard commitment to hit the 10 years total required to transfer Post-9/11 benefits. 3 years of residency, 4 years payback +/- GMO tour still puts you shy of 10 years. Being so close to such a huge inflation-adjusted payout for your kids is a bummer. Plus if you extend and then end up staying, the 4 years of med school still don't count for anything. I am not saying that USUHS is the right answer for everybody by any means, but someone who vets the decision well and is OK with the extra commitment is afforded with a lot more money, benefits and potential future benefits.

 

[Geo16]

Thank you @militaryPHYS !

 

[lancecorpsman]

I am very curious on the biggest questions that premed students have regarding military vs. civilian route. This can be an Ask Me Anything (AMA) thread or free speak. Intent is to understand current concerns regarding both pathways as well as to answer specific questions that arise. Please avoid "What are my chances" questions. Current interest in military medicine makes it very competitive and therefore I would like to focus on the average applicant's questions regarding lifestyle, income, practice, etc.

I am a current active duty Navy Ortho surgeon who is planning full military career.

If I were to go the military route, I want to be working as a part of a STP and/or being with the FMF. What are my chances of getting green side orders as a physician?

 

[militaryPHYS]

If I were to go the military route, I want to be working as a part of a STP and/or being with the FMF. What are my chances of getting green side orders as a physician?

Are you a prior Lance Corporal who then transitioned to a corpsman and now becoming a physician? Ironically that is my exact pathway since 2003. Congrats on the adventure thus far!

Anyway, very easy to get green side orders if you want them in the Navy. After internship you can request to do a GMO tour (not always everyone's first option therefore you will have prime pickings) and you can request a green-side billet from your detailer. If your plans change and you don't necessarily WANT to go out for a GMO tour, you may have the opportunity to go straight through in to residency. If this is the case, and you are still interested in green side work, your specialty really needs to be primary care (ideally FP or ER). There are members of every specialties who have green side billets these days (we even have ortho green-side billets), but they are not necessarily your "operational billets" that GMO's and primary care can fill.

If I can offer my two cents... Don't focus on just one thing, especially if you are entering a pathway through military medicine. Your interests, passions and life can change along the way and you should let that happen naturally. Initially I was in the same boat -- I wanted to be primary care, green side, Oorah doc. I then realized a surgical pathway suited me best and then I realized ortho was where I fit. Still, I was highly considering requesting a FMF billet as a GMO. I landed my ortho internship and was then offered to go straight through in to residency. An offer like that you can't turn down (you can, but it would be a very personal decision). For me it was a career decision, family decision and life decision to finish ortho residency as fast as possible. If you truly want to do something you can almost always make it happen after you are specialized and with more rank on your collar (i.e. if I still want to ground pound with a green-side medical billet I could, even as an orthopedic surgeon).

Hope that helps!

 

[Matthew9Thirtyfive]

After internship you can request to do a GMO tour (not always everyone's first option therefore you will have prime pickings) and you can request a green-side billet from your detailer.

If you are not selected to do residency straight through, how likely are you to get a ship billet as a GMO (assuming you want a ship billet—if I have to do a GMO tour, I’d rather be on a ship).

 

[militaryPHYS]

If you are not selected to do residency straight through, how likely are you to get a ship billet as a GMO (assuming you want a ship billet—if I have to do a GMO tour, I’d rather be on a ship).

General Military Officer (GMO) is a blanket term for intern-trained physician assigned as a general practitioner with a unit somewhere. You can be 1) a generic GMO 2) Flight Surgeon 3) Underseas Medical Officer (UMO). Probably the easiest way to get a ship billet is to request a generic GMO billet at a sea-duty command. If you do Flight Surgery school or UMO school you may be put on a ship, but not necessarily...more often you are the unit doc for a number of aircraft or ships/subs and not directly assigned to a specific ship (though you may deploy one of them).

 

[Matthew9Thirtyfive]

General Military Officer (GMO) is a blanket term for intern-trained physician assigned as a general practitioner with a unit somewhere. You can be 1) a generic GMO 2) Flight Surgeon 3) Underseas Medical Officer (UMO). Probably the easiest way to get a ship billet is to request a generic GMO billet at a sea-duty command. If you do Flight Surgery school or UMO school you may be put on a ship, but not necessarily...more often you are the unit doc for a number of aircraft or ships/subs and not directly assigned to a specific ship (though you may deploy one of them).

Right, I get what it is. Our ship sup was a GMO, though she had a shore billet (both of them, actually, since I was on two small buoys). I’m just wondering how hard it is to get orders to an amphib or a carrier as a general GMO.