Best Route to Become Military Doctor

[DrBeethoven]

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[Perrotfish]

Hello, I am currently an undergraduate student who is almost finished his premedical curriculum and will be looking ahead to take the MCAT and apply to medical schools in the near future. However, my aspiration ultimately when all is said and done is to join the Armed Forces and serve in the capacity of a military physician. I've done some extensive reading through old posts on this forum (which spurred me to join myself) and really appreciate how comprehensively you guys have explained the protocol and process behind joining and serving in the military as a physician because it truly is a complex procedure. Many of my initial questions have now been answered thanks to old posts so I'll save you the trouble of bothering you with those, but I still had a handful of inquiries remaining that if anyone had the time to help answer and point me in the right direction I would be incredibly grateful.

1) Let's say I go to and graduate from a civilian medical school, would it be smartest to join the military while I'm still in medical school or to join after I have earned an MD? In other words, if I join the military with a medical degree in hand, will they compensate me for my educational costs retroactively or would it be most financially viable to enlist as a medical student and have my education paid for concurrently.

2) Similarly, if after I graduate from medical school, should I pursue a residency/+fellowship as a civilian and then join the military, or should I already be in the service before I do these things. I've heard it can be difficult to secure the residency of your choice (and sometimes a residency at all) while serving in the military which definitely concerns me, so are there any benefits to seeking out a residency match while a member of the military or is it recommended I join the forces only once I have completed my desired level of post-graduate education?

3) As for as retirement is concerned, would I be at a disadvantage if I joined the military after completing med school/residency/fellowship in the civilian sector as opposed to enlisting while still in medical school? If I joined the military having already finished med school/residency, would I begin at a higher rank than I would if I enrolled as a first year med student?

4) Lastly, from a completely different perspective, does anyone have any intriguing anecdotal information about their life as a military doctor/med student? Do you think it is more likely that I would be stationed at one of the military hospitals in the states or spend the majority of my career deployed overseas? Additionally, what kind of housing should I expect (would I be staying in something barracks-style on a base, or do we receive some sort of stipend to purchase a small house in the neighboring area) and how often should I anticipate being relocated?

I'd like to culminate my post by explaining that it is my intention to serve as a military doctor until retirement and I am aware that the lifestyle contrasts pointedly from doctors working in the civilian field and that the pay happens to be significantly less as well, however my motivation is to serve my country in the manner that I can best contribute and I think being a physician offers me a tremendous opportunity to make a difference in this regard. However, I ask these questions just to try to ensure I make the most educated decision possible, and though finances are not my primary impetus, with the costs of college and med school these days I simply cannot afford to just leave money on the table. Thank you immensely for your time and help in clearing up these questions of mine and I apologize if anything I asked should have been blaringly obvious to me from the get-go. Thanks again!

There are four major routes into the military: HPSP (during medical school), USUHS (during medical school), FAP (during residency), and direct asscession (after residency). The Navy also has a program call HSCP that's worth knowing about. The disadvantage to joining during medical school is that, when you do so, you agree to apply to the military match, which often has different odds than the civilian match. The disadvantage to the other two ways of joining is that, generally, they pay less and also cost you time towards retirement.

What is each scholarship worth?:

HPSP is worth: all of your tuition and fees for school, plus about 100K in stipend and signing bonus. Also if you do a military residency the pay in residency is worth another 100K. You owe 4 years after residency.

USUHS: free tuition and full active duty pay during medical school. Again, another 100K for the military residency. You owe 7 AD years after medical school

HSCP: Very small (5/year) Navy program. You get paid as an E-7 for all of medical school, you have to participate in the military match and you (again) get the extra 100K if you do a military residency. The pay is all you get, you have to pay for medical school out of the pay they give you. However (this is important) your medical school time counts towards retirements just like your residency time. You owe 4 years after residency.

FAP: approximately 75K/year between signing bonus and stipend, paid out for each year of residency. Your obligation equals the total number of years you do FAP + 1

Direct Accession: Depends on specialty. 200-400K paid over 4 years in exchange for (usually) a 4 year obligation. I've never met anyone who did this so I'm fuzzy on the details.

What about the match, and retirement?:

Retirement: If you do your residency and fellowship IN the military those years count towards retirement. If you do HSCP medical school counts towards retirement. It doesn't count with HPSP. If you join via HPSP and then get a civilian deferment for residency it doesn't count towards retirement. If you do a civilian residency or fellowship on FAP none of that time counts towards retirement. If you join after fellowship via Direct accession you start of with zero years towards retirement.

The match as an HPSP/HSCP applicant: If you want a civilian residency you apply for the opportunity to apply for one during the military match, and normally the military says no. If you take the money expect to do your residency within the military. The only time they say yes is when they need more of a particular type of physician than their own training can produce. Alternatively if they have too many applicants for the military match they can shunt you into a civilian deferment despite your request for military training, though that is historically less likely.

Its also important to understand that the military match is different than the civilian match. Some kinds of training are much more competitive than in the civilian world: for example you would need a much better application to get Pediatrics, or EM, than you would in the civilian world. The odds also fluctuate more from year to year. When the numbers are so small, half a dozen really talented medical students developing an interest in your specialty of choice can make it drastically harder for you to match. Finally you need to understand that many people in the military don't match for an entire residency. After Intern year you reapply for the rest of residency. Many AF physicians will go from Intern year to a 2-3 year flight surgery tour, where they provide a very basic form of primary care to airmen as well as perform flight physicals on pilots. Many people seek out these opportunities, but understand that a percentage of each year's flight surgery class consists of physians who would have preferred straight through training. Its an order you need to be prepared to accept.

So what's the best way to join?

It depends on three things:

A) What you're going to owe at the end of medical school/residency/fellowship. This is probably the biggest thing. If you go to private school you will take out an average of 280K of debt. Public school is closer to 200K If you can borrow that from your parents or have it in savings FAP/direct accession is comparable, financially, to HPSP/HSCP/USUHS. If you borrow from the government (at an average rate of 7.5%) and you went to a private school you're going to owe more than 500K at the end of six years of residency and fellowship. Not only does that make FAP/DA not comparable to HPSP, your debt load would be high enough that there's basically no way you could survive on a military physician's salary.

B) Your feelings about the military match: The military match has weird odds. It might be easier to be some kinds of surgeon. Its definitely harder to be a Pediatrician. Its WAY harder to be an EM doctor. You might have to work for 2 or even 4 years between Internship and the rest of residency. And of course the odds of anything vary significantly year to year. Signing up for the military match is the major sacrifice you make by taking HPSP/HSCP/USUHS

C) If you really are going to stay until retirement. If you're determined to put in 20 years, those 3-9 years you accumulate in residency and fellowship (plus 4 of medical school, if you do HSCP) suddenly become much more valuable.

Your other lifestyle questions (question 4):

In almost all US locations and most overseas locations you receive a separate part of your pay to buy housing. The likelihood is that your career will consist of a mix of crappy US bases, overseas assignment (in safe, US controlled areas), deployments (warzones), and nice US bases. The nicer assignments generally happen later in your career. You should anticipate relocation every 2-4 years, though some physicians, especially subspecialists, manage to stay in one place for much longer. How often you deploy is completely up to the President and Congress. We just came off a horrible period where doctors were deploying every other year for years at a time. Before that a physician might have deployed, on average, for 6 months in a decade.

Advice:
Think through this very carefully before signing the papers as there is no way to back out once you sign. Don't assume that you will work for an organization for 20 years if you haven't worked for them yet. Don't assume that joining will make you money: all physicians get paid less in the military than in the civilian world, and the physicians who are paid the most as civilians lose money in the military even when you factor in the savings from their tuition and the value of their GI bill and retirement. Remember that, between now and retirement, you might marry someone whose job can't move with you ever 3 years. If you plan to join via FAP or Direct Accession do the math on your med schools tuition. If you can't pay off your debt with the bonus, for practical purposes its not a path for you to join the military. Finally if you get into a cheap state school and you're gunning for retirement at 20 years HSCP is an option you really need to consider.

BTW, one more point of etiquette: enlisted personnel enlist, officers commission. You want to commission in the medical corps.

 

[DrBeethoven]

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[Perrotfish]

I also appreciate your explanation on the process of military matching and I'm glad you did not sugarcoat the procedure because unfortunately it sounds like there is a more limited selection of paths for a doctor to take in their career and perhaps more competition to attain one's desired residency as a consequence of having less military match options as compared to civilian match options.

To be clear, its not fewer options, its different odds. The only residencies that we don't have at all (I think) are PM&R and dual board residencies like IM/Peds. Its just that the grades and board scores you need for any given residency are usually different than the civilian world, and vary more from year to year.

(I would imagine aspiring dermatologists would probably not have much opportunity in the military while there is most likely a healthy field for, I dunno, orthopedic surgeons).

If you guess what specialties the military would want, odds are you would guess wrong. We do have derm programs and, arguably, the military is one of the best opportunities for a mere mortal to obtain a derm residency spot (less than one civilian applicant per medical school gets into derm, it ties plastics as the most competitive specialty). You probably also wouldn't guess that we have a relatively high demand for neonatologists and Ob/Gyns, and a relatively small demand for Emergency Medicine physicians. It is what it is.

Remember, we support military families and retirees, not just Servicemen in combat. Most of what we do isn't about warzoes. There is a place in the military for a board certified Pediatric Nephrologist, the odds of getting the fellowship are just different than in the civilian world.

Do you know of many examples however of individuals who were proverbially shoe-horned into residencies and specialties that they were not interested in but simply had to because of a lack of available choices or switch from their desired field to something of more practical value to the military?

I know people who didn't get the Internship they wanted. They can make you do an Internship you don't want (which is rare) but they can't make you take a residency you don't want: for example they can't make you complete a full psych Residency if what you really wanted was to be a surgeon. Residents who don't get the Internship/residency they want can do a GMO tour with just an Internship and try again, or just do a GMO tour and get out and train in the civilian world. Arguably this is a good reason to avoid USUHS: If you owe 7 years, decide you really want EM, and find out you're not competitive enough in the military even though you are in the civilian world, odds are you'll need to do something else. If you only owe 4 years serving out your time as a GMO is a practical option.

Its important to remember that even in the civilian world people get shoe-horned into residencies they don't want. In my class I knew several great students that weren't quite great enough for derm and got IM. I knew some very good students who weren't quite good enough for EM/Anesthesia and scrambled into family/psych. Students with multiple failures sometimes don't even get family anywhere they applied to and needed to scramble into whatever insanely malignant programs are left over. The military, like the civilian world, is an application process, its just the odds of getting any given specialty with a given set of stats are different. Also the military match places more emphasis on published research and prior military service.

Are most military doctors permitted to do a fellowship, or is it common to be capped out at residency.

This is tricky. To do a fellowship, first it is usually (though not always) expected that you do a 2-3 year 'utilization tour' where you do whatever your residency trained you to do first. However, when it comes time to apply, your service also needs to want someone to do the fellowship you're applying for. A few fellowships like neonatology and Critical care might reliably need at least one fellow every couple of years, but for others like Pediatric Gastroenterology the entire fleet might only need two or three fellowship trained doctors. So if there are already three gastroenterologists, and they're all young, you might be out of luck.

And in your informed opinion does there appear to be adequate demand for neurosurgeons or anesthesiologists in the military such that they would have the channels available to them to pursue a residency and fellowship?

There are anesthesiologists and neurosurgeons in the military. I don't know how their average step 1 score compares to the civilian world.

 

[DrBeethoven]

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[Kilgoretrout 65]

The way the military match works, the couple years as a GMO or flight surgeon will give you points and preference towards the residency you want. If you have decent test scores, have tried to rotate in the departments, and have not alienated the decision makers along the way, by and large you should be able to get the residency you want, even ortho and EM. If you are careless during internship, have anger management issues, don't answer pages, etc. then you may have more trouble. You need to be prepared to sell yourself to future employers, meaning be prepared and know as much about the field of study you want to go into as is reasonable for a trainee.

 

[corpsman33]

There are four major routes into the military: HPSP (during medical school), USUHS (during medical school), FAP (during residency), and direct asscession (after residency). The Navy also has a program call HSCP that's worth knowing about. The disadvantage to joining during medical school is that, when you do so, you agree to apply to the military match, which often has different odds than the civilian match. The disadvantage to the other two ways of joining is that, generally, they pay less and also cost you time towards retirement.

What is each scholarship worth?:

HPSP is worth: all of your tuition and fees for school, plus about 100K in stipend and signing bonus. Also if you do a military residency the pay in residency is worth another 100K. You owe 4 years after residency.

USUHS: free tuition and full active duty pay during medical school. Again, another 100K for the military residency. You owe 7 AD years after medical school

HSCP: Very small (5/year) Navy program. You get paid as an E-7 for all of medical school, you have to participate in the military match and you (again) get the extra 100K if you do a military residency. The pay is all you get, you have to pay for medical school out of the pay they give you. However (this is important) your medical school time counts towards retirements just like your residency time. You owe 4 years after residency.

FAP: approximately 75K/year between signing bonus and stipend, paid out for each year of residency. Your obligation equals the total number of years you do FAP + 1

Direct Accession: Depends on specialty. 200-400K paid over 4 years in exchange for (usually) a 4 year obligation. I've never met anyone who did this so I'm fuzzy on the details.

What about the match, and retirement?:

Retirement: If you do your residency and fellowship IN the military those years count towards retirement. If you do HSCP medical school counts towards retirement. It doesn't count with HPSP. If you join via HPSP and then get a civilian deferment for residency it doesn't count towards retirement. If you do a civilian residency or fellowship on FAP none of that time counts towards retirement. If you join after fellowship via Direct accession you start of with zero years towards retirement.

The match as an HPSP/HSCP applicant: If you want a civilian residency you apply for the opportunity to apply for one during the military match, and normally the military says no. If you take the money expect to do your residency within the military. The only time they say yes is when they need more of a particular type of physician than their own training can produce. Alternatively if they have too many applicants for the military match they can shunt you into a civilian deferment despite your request for military training, though that is historically less likely.

Its also important to understand that the military match is different than the civilian match. Some kinds of training are much more competitive than in the civilian world: for example you would need a much better application to get Pediatrics, or EM, than you would in the civilian world. The odds also fluctuate more from year to year. When the numbers are so small, half a dozen really talented medical students developing an interest in your specialty of choice can make it drastically harder for you to match. Finally you need to understand that many people in the military don't match for an entire residency. After Intern year you reapply for the rest of residency. Many AF physicians will go from Intern year to a 2-3 year flight surgery tour, where they provide a very basic form of primary care to airmen as well as perform flight physicals on pilots. Many people seek out these opportunities, but understand that a percentage of each year's flight surgery class consists of physians who would have preferred straight through training. Its an order you need to be prepared to accept.

So what's the best way to join?

It depends on three things:

A) What you're going to owe at the end of medical school/residency/fellowship. This is probably the biggest thing. If you go to private school you will take out an average of 280K of debt. Public school is closer to 200K If you can borrow that from your parents or have it in savings FAP/direct accession is comparable, financially, to HPSP/HSCP/USUHS. If you borrow from the government (at an average rate of 7.5%) and you went to a private school you're going to owe more than 500K at the end of six years of residency and fellowship. Not only does that make FAP/DA not comparable to HPSP, your debt load would be high enough that there's basically no way you could survive on a military physician's salary.

B) Your feelings about the military match: The military match has weird odds. It might be easier to be some kinds of surgeon. Its definitely harder to be a Pediatrician. Its WAY harder to be an EM doctor. You might have to work for 2 or even 4 years between Internship and the rest of residency. And of course the odds of anything vary significantly year to year. Signing up for the military match is the major sacrifice you make by taking HPSP/HSCP/USUHS

C) If you really are going to stay until retirement. If you're determined to put in 20 years, those 3-9 years you accumulate in residency and fellowship (plus 4 of medical school, if you do HSCP) suddenly become much more valuable.

Your other lifestyle questions (question 4):

In almost all US locations and most overseas locations you receive a separate part of your pay to buy housing. The likelihood is that your career will consist of a mix of crappy US bases, overseas assignment (in safe, US controlled areas), deployments (warzones), and nice US bases. The nicer assignments generally happen later in your career. You should anticipate relocation every 2-4 years, though some physicians, especially subspecialists, manage to stay in one place for much longer. How often you deploy is completely up to the President and Congress. We just came off a horrible period where doctors were deploying every other year for years at a time. Before that a physician might have deployed, on average, for 6 months in a decade.

Advice:
Think through this very carefully before signing the papers as there is no way to back out once you sign. Don't assume that you will work for an organization for 20 years if you haven't worked for them yet. Don't assume that joining will make you money: all physicians get paid less in the military than in the civilian world, and the physicians who are paid the most as civilians lose money in the military even when you factor in the savings from their tuition and the value of their GI bill and retirement. Remember that, between now and retirement, you might marry someone whose job can't move with you ever 3 years. If you plan to join via FAP or Direct Accession do the math on your med schools tuition. If you can't pay off your debt with the bonus, for practical purposes its not a path for you to join the military. Finally if you get into a cheap state school and you're gunning for retirement at 20 years HSCP is an option you really need to consider.

BTW, one more point of etiquette: enlisted personnel enlist, officers commission. You want to commission in the medical corps.

Perrotfish,
What 100K are you referring to while in residency? After you graduate from HPSP/HSCP/USUHS and you begin your military residency you should be paid as an O3 plus time in service (which is worth significantly more than 100K over the course of 3-4 years when you factor in BAH and bonuses as well).

 

[Cooperd0g]

Perrotfish,
What 100K are you referring to while in residency? After you graduate from HPSP/HSCP/USUHS and you begin your military residency you should be paid as an O3 plus time in service (which is worth significantly more than 100K over the course of 3-4 years when you factor in BAH and bonuses as well).

I think he meant that you will earn about $100k more than you would have earned in a civilian residency program.

 

[Cooperd0g]

HSCP is a neat little program and I'll sum up real quick if it is worth it for you or not: Do you have a full scholarship to med school? If yes, then HSCP is awesome. If no, then it is only decent if you are going to a cheap in-state school. Private school with loans? Better off with HPSP than HSCP. If you want more info read this blog article from The White Coat Investor:

http://whitecoatinvestor.com/health-services-collegiate-program-military-medicine-series/

USUHS years, while not counting directly towards your retirement like HSCP does, do increase the retirement multiplier once you reach retirement eligibility. Typically a 20 year retirement is worth 50% of the average of your final three year base salary. For each your over 20 you get an additional 2.5%. USUHS grads, once they hit 20 years, get the four years of their time at school added to their multiplier so that means their retirement is actually 60%. And you'll max out the 75% retirement at 26 years instead of 30.

If you are convinced that you want to make a career of it then USUHS is the best option - most exposure to military stuff while in school, better networking development amongst classmates and classes (I think they say USUHS makes 1/4 of the military docs, but is about 3/4 of the O-5 and up docs), better pay and benefits while in school, added multiplier for retirement. The major downside is the longer commitment if you later decide it isn't for you.

 

[Perrotfish]

Perrotfish,
What 100K are you referring to while in residency? After you graduate from HPSP/HSCP/USUHS and you begin your military residency you should be paid as an O3 plus time in service (which is worth significantly more than 100K over the course of 3-4 years when you factor in BAH and bonuses as well).

The 100k is the difference between O3 pay and normal resident pay in the civilian world. Sorry if that wasn't clear.

 

[corpsman33]

The 100k is the difference between O3 pay and normal resident pay in the civilian world. Sorry if that wasn't clear.

I understand what you are getting at now. However, you really can't apply a blanket statement like that to everyone. For instance in my case I will have 10 years prior service time when I graduate so I will make on average $80-100K more during those 3-4 years than a standard HPSP candidate who has no prior service and is starting with "0-2 years" pay grade.

But in the OP's case I think you would probably be correct in stating that he/she will make somewhere around $100K more than if they did a civilian residency.

 

[BigNavyPedsGuy]

I understand what you are getting at now. However, you really can't apply a blanket statement like that to everyone. For instance in my case I will have 10 years prior service time when I graduate so I will make on average $80-100K more during those 3-4 years than a standard HPSP candidate who has no prior service and is starting with "0-2 years" pay grade.

But in the OP's case I think you would probably be correct in stating that he/she will make somewhere around $100K more than if they did a civilian residency.

What a really long and annoying way to say, "Oh I understand, thanks"

 

[corpsman33]

What a really long and annoying way to say, "Oh I understand, thanks"

More of a clarification in case anybody else was in a similar situation and trying to calculate their future pay. But I agree after I re-read my post it did seem trivial so I digress.