Budget Cuts/HPSP?

[doodle4210]

Hey everyone!
I'm new to this area of SDN so I apologize if this question has already been posted.
I've recently been considering applying for the Army HPSP and I've been trying to research it as thoroughly as possible before working through that 51 page application. Yesterday I came across some articles saying that the DoD wants to reduce the number of medical personnel by a 15,000 or more in 2020 (see here). I was just curious how this would affect me as an HPSP recipient? I imagine they'll probably reduce the number of residency spots, right? I don't really want to go through with this if it will be meaningless by the time I graduate. I'm planning on asking my recruiter about this next time we talk, but I figured it might be more helpful to hear from some people on here as well.

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[Cooperd0g]

You have asked the million dollar question (probably literally). Unfortunately no one knows the answer. Despite what the DoD wants, Congress has said they can’t do it without a study on how it will, or will not, disrupt care. But it is a major point of uncertainty.

Also, I wouldn’t even bother asking the recruiter about it. They will have no clue either.

 

[militaryPHYS]

As @Cooperd0g said, nobody can guarantee anything at this point.

If they are keeping the flood gates opened (still accepting same number of HPSP and USUHS spots) then we should expect those students to have a pathway for training in medicine. The specifics of what that means nobody knows. Will there only be residencies for Operational specialties by the time you start residency? Will there be no active duty residencies at all and everyone is deferred to the civilian world? Will you get trained as an intern and be a GMO for the remainder of your time in the military? Nobody knows.

As with most changes in the military, those who are "grandfathered" in to the original system which they signed up for will be OK. You'll become a doctor, but specialty training is anyone's guess right now. At this time DHA is claiming to continue to value and prioritize active duty GME training. But with the uncertainty of the policies and changes they are implementing, sustainability of active duty GME programs is in question. Again...none of us laypeople can guarantee anything right now.

 

[haujun]

I cannot in a good conscience recommend anyone join Army right now. I refused to give a talk to HPSP students. Lower pay and deployment are acceptable as part of military life. Doubt regarding training opportunities? I don’t know about this. You worked hard to get into medical school. I cannot understand why anyone would take chance in the military right now?!

 

[madiso30]

@haujun would you suggest going Air Force or Navy then? I am not deadset on any branch as I have begun thinking about HPSP (again).

 

[pgg]

I cannot understand why anyone would take chance in the military right now?!

@haujun would you suggest going Air Force or Navy then? I am not deadset on any branch as I have begun thinking about HPSP (again).

 

[madiso30]

Lol fair. I forgot about that comment.

 

[pgg]

Lol fair. I forgot about that comment.

The worst-case scenario is that GME isn't available, or isn't what you want, and you do a 4-year GMO tour and get out to do a civilian residency.

It's tough to advise anyone to accept HPSP or USUHS right now. There's too much we don't know about what GME and the tri-service DHA-led medical corps will look like in 5 years. How can I recruit for a job I'm in the dark about? And I write that as a guy who is generally an optimist at heart, and has had most pieces fall my way over the years. I've had a good run with the Navy, all things considered. I don't regret joining, and I've had some great experiences along the way. Some parts of it have been extremely rewarding on both a personal and professional level. Some of the non-medical things I've been able to do on the side came from unique opportunities. I'm doing workups for deployment #5 right now and I expect it will be a good one. It's not all gloom and doom, despite the usual tone on this forum.

I understand being debt averse. Just realize that 98% of medical students in the US get through school without HPSP, and in the long run they tend to do just fine. FAP exists, direct accession exists. This isn't your only opportunity to join. Be wary of commitments when nobody can honestly tell you what that commitment consists of.

 

[madiso30]

The worst-case scenario is that GME isn't available, or isn't what you want, and you do a 4-year GMO tour and get out to do a civilian residency.

It's tough to advise anyone to accept HPSP or USUHS right now. There's too much we don't know about what GME and the tri-service DHA-led medical corps will look like in 5 years. How can I recruit for a job I'm in the dark about? And I write that as a guy who is generally an optimist at heart, and has had most pieces fall my way over the years. I've had a good run with the Navy, all things considered. I don't regret joining, and I've had some great experiences along the way. Some parts of it have been extremely rewarding on both a personal and professional level. Some of the non-medical things I've been able to do on the side came from unique opportunities. I'm doing workups for deployment #5 right now and I expect it will be a good one. It's not all gloom and doom, despite the usual tone on this forum.

I understand being debt averse. Just realize that 98% of medical students in the US get through school without HPSP, and in the long run they tend to do just fine. FAP exists, direct accession exists. This isn't your only opportunity to join. Be wary of commitments when nobody can honestly tell you what that commitment consists of.

Yea all the nonsense I keep reading about has me leaning towards one side of the fence pretty heavily. FAP seems like it may be the better option.

 

[notdeadyet]

Yea all the nonsense I keep reading about has me leaning towards one side of the fence pretty heavily. FAP seems like it may be the better option.

Another option is to wait out and take the accession bonus.

Given uncertainty in milmed currently, taking a single bolus bonus for signing up is another route that can decrease your anxiety. And the last time I saw the bonuses, they paid out pretty comparably or more favorably to FAP.

 

[TheEarDoc]

Another option is to wait out and take the accession bonus.

Given uncertainty in milmed currently, taking a single bolus bonus for signing up is another route that can decrease your anxiety. And the last time I saw the bonuses, they paid out pretty comparably or more favorably to FAP.

Yep if it were me I'd complete my medical degree and residency and then if I felt like serving sign up for some nice bonuses and use it to pay off any remaining loans.

Just what I would do given the current uncertainty of things and if you have your mind set on a certain specialty (which we know often changes during medical school)

 

[Trefoil]

Yea all the nonsense I keep reading about has me leaning towards one side of the fence pretty heavily. FAP seems like it may be the better option.

If you had asked me a couple of years ago, my answer would be different, but they have already started cutting residency spots, and once one falls it creates a chain reaction that takes multiple down. I’m not saying that is going to happen, but it is a real fear among program directors. If that happens, you may be floating around without residency training until you get out...which doesn’t seem worth it.

 

[militaryPHYS]

If MilMed truly collapses then those in the pipeline will likely have a free exit strategy. Could it delay people's ultimate time to residency completion? Yes, but they were expecting that anyway because they understood the pitfalls of the current MilMed system when they were signing up.

Worst case scenario in my mind: The only specialties left available to train are Anesthesiology, Emergency Medicine, Family Practice, General Surgery, Orthopedic Surgery, Psychiatry, Pulm/Critical Care and Urology. For the Navy these represent the only specialties offered the new 6 year Retention Bonus option in the most recent special pays release. It also coincides with other services mentions of "Bucket 1" specialties, except for urology...not sure about that one? If you are OK training in one of those specialties then you will likely be able to. If MilMed GME deteriorates (much more likely than a complete MilMed collapse) I'd imagine that would mean civilian residencies for the above mentioned specialties and then come back in to serve out your commitment.

So either the above happens or it stays how it is for the most part, the fat is trimmed, we consolidate resources, consolidate hospitals and GME programs, add civilian partnerships for training as well as peacetime practice cooperation and continue to live to see another day. During war there will likely be higher deployment rates due to less total available physicians, but our theaters and logistics of war will be different in the next fight, just like it has been for every fight. Who knows.

Yes. A lot of uncertainty. If it scares you then don't sign up. If I had to guess though, the people who were signing up for more than just the free education will likely still sign up so long as they are OK with the limited specialty options. Numbers overall will be down, but that's what they want right now. The people that do sign up will be pipelined in to the specialties above to keep the numbers of those specialties about the same as they are right now.


My honest off-the-wall opinion/idea/conspiracy theory? MilMed will be the forefront of the US's inevitable nationalized healthcare system. We will either be put in civilian hospitals to care for Medicare/Medicaid patients and the earliest enrollees of the new system or we open MTF doors for that same group(s) of civilians to come in and get some free healthcare. Doesn't matter what party is in office, healthcare will continue to drift away from the old and continue to creep closer and closer to model Canadian/European systems. Do I agree with this? Not necessarily, but I still think it is inevitable.