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Are research opportunities more abundant at places like Walter Reed, working with residents, and close by to the NIH?A lot of these issues are addressed elsewhere in this forum, and so I'll just touch on a couple of issues.
1 - I can't off the top of my head think of any surgical specialty that isn't available through the military. However, it can be more difficult to get into some specialties (and easier in others) than it is on the civilian side. You will also require approval to do fellowships, but ultimately it is -possible- to do them. probability is another metric entirely.
2 - You can find ways to pay off your debt, no matter what. You can find ways to do it now or after you're finished with your training. I would strongly encourage you to look at your decision in two lights: finances entirely aside, and then with finances included. If, in both cases, you feel that HPSP is a good option then do HPSP. The other combinations, I would argue, should direct you away from HPSP.
3 - Skill atrophy is very real. It doesn't necessarily mean that you won't be able to find a job, however. The truth is that the only one who knows how atrophic your skills are is you. With some surgical specialties, and depending upon what armpit in which you get stuck, you may possibly have trouble with getting credentialed for procedures that you haven't done in 2+ years. In fact, Joint Commission is heading towards requiring retraining on any procedures you haven't done in 48 months or more.
4 - Military service, as mentioned above, looks great on a resume. It's not a reason to join, however. I don't see or hear from too many docs who are living on the streets because they didn't have military service on their resume. That, in and of itself, is NOT a reason to join. It's just a perk of having done so.
5 - Research in the military, at least in the Army, sucks. It is not, and will never be, anywhere near comparable to a moderately-funded university-based civilian research center. If you really want to do research, don't do HPSP. You can do research in the military, don't get me wrong. You can do good research. But it'll be harder and less efficient to be certain.
I would think that Reed would have similar opportunities to the other major MEDCENs that are located near research institutes (university or otherwise). You can usually arrange research with outside institutions, but bear in mind that unless there is a pre-existing pathway for that, you will be doing all of the legwork yourself to get it set up. It is not a small amount of legwork. Also, at least when I was a resident and at least at MAMC, any IRB with which you are associated will need to be approved by your MEDCEN IRB as well as the outside IRB. In other words, lets say NIH agrees to let you in on a project, and they have an IRB review of their study and it gets approved - you will still need to get the military IRB to approve the study before you will be allowed to participate. That is a huge pain in the @$$. Again, that may very institution to institution, but it was definitely that way at MAMC back in the day. I knew a lot of people who had to go through that to do research with the UW system or some of the research centers in Seattle.Are research opportunities more abundant at places like Walter Reed, working with residents, and close by to the NIH?
The problem with doing meaningful research in the military generally isn't that there's something fundamentally lacking at the large MTFs ... it's more that the staff rolls over and changes every 2-3 years, and people abruptly disappear for chunks of 7 or 12 or 18 months at a time.Are research opportunities more abundant at places like Walter Reed, working with residents, and close by to the NIH?
I would agree with this, but I would also say that I feel that there is something fundamentally lacking in terms of research at large MTFs: a focused dedication to research. While it might be argued that the military has that from time to time, or that great research has come from the Army (it has), research is not prioritized in the military like it is at most large University programs, places like Mayo, or NIH (which is obviously just research). There will always be a difference between a place that has a lot of research opportunities and a place that wants to be a research center.The problem with doing meaningful research in the military generally isn't that there's something fundamentally lacking at the large MTFs ... it's more that the staff rolls over and changes every 2-3 years, and people abruptly disappear for chunks of 7 or 12 or 18 months at a time.