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Confused

Discussion in 'Military Medicine' started by babelfish, Nov 21, 2005.

  1. babelfish

    babelfish Junior Member
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    I don't understand the general sentiments on these threads (i.e. militarymd, island doc). Joining the military HPSP is certainly a big commitment, but if made for the right reasons, or perhaps if one is taking a risk, how is it THAT bad? There are certainly pros and cons to military and civilian life, but they seem to even out. For example: terrible paperwork in military is similar to the HMO bureacracies today. You all also seem upset that you were forced to move, but what if someone enjoys a more transient lifestyle? seeing new places and new bases? And most of all, I fail to see how a 200K debt can be laughed at. That is a serious commitment just like joining the military is, and it will be on your shoulders for the upwards of 10-20 years. It is possible that 1. there is no other way to finance medical school other than HPSP or a National Health Corps Scholarship (which also restricts residency choice and location) 2. the financial stress and burden during medical school could be serious distractions from doing well in studies.

    To end, I'd like to say that I'm honestly just confused. I've been accepted to medical school for next year and seriously considering Navy HPSP. I'm seriously interested in orthopedics, but working as a DMO or flight surgeon for 4 years before residency seems like not such a bad idea. I also think the military lifestyle would push me to the max of my ability (PT is not something valued in the civilian world, and all too many docs are overweight, smoking, and depressed). Any thoughts on seriously comparing the pros and cons of military v. civilian?
     
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  3. usnavdoc

    usnavdoc Senior Member
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    I thought alot along the same lines as you mention when I signed up. The debt relief was huge factor in my mind at the time. But if you weigh out the numbers based on the loss of salary you would make as a civilian orthopedic surgeon as compared to years as a GMO and then finally getting to residency just to make about 30-50% of what you would be making as a civilian. The numbers dont add up. Many people have said over and over dont let money be your primary reason to join through HPSP. If you want to ignore advice that is your decision. But there are several other means of debt relief available through the civilian sector and military after you have finished residency.

    In terms of military medicine I can only talk from the perspective of a GMO who served with the Marines for the last 4 years. The administrative constraints on myself have been huge. I have all the paperwork that a civilian would have in dealing with an HMO but add to that all the operational administrative paperwork and meetings that destract from patient care. Oh and I havent completed anything beyond internship.

    Now life as a GMO is not that bad for what I do. Pay is fair especially in combat where you pay minimal taxes. But thats just it. Combat! Are you prepared for that. Nope. No one is that comes from a background like ours. And you will recieve NO training prior to deployment that will aid you. How is that for the Navy taking care of its sailors.

    You say well you dont have call as a GMO. True for the most part while in the states. You will take call at an acute care clinic within a MTF a few days every six months or so. But deploy and you are on call 24/7 the entire deployment. Dont forget the workups prior to deployment when you arrive before the sun and go home after the sun has well set. But people in residencies do this all the time. Oh yeah that reminds me I now have to go back and start that all over as well.

    As far as PT is concerned. Dont use the military to give you a kick in the but. Do that on your own. People will do what is a priority for them. If exercising is a big priority then you will make time for it. If not then you simply wont regardless of what the military says.

    In terms of a transient lifestyle. Yes I have seen a good part of the world. Some good some terrible. Dont regret that in the least. But I like every other medical officer have been screwed over by our detailors when looking at other billets. It was not by choice that I have been in my current duty station for four years. Now with the Current FP/GMO detailor there is even less freedom to make up your mind about where to pcs. And it seems that returning GMOs are recieving no preferential treatment with respect to next duty station. But this is not new, detailors have used and abused unsuspecting doctors for years and years. Just let them tell you that Camp lejeune is the only billet that is open. Then your buddy(who mind you wants to work with Marines b/c he was one in a former life) gets told that he has to go to a ship. It makes no sense because they do not try at all to please the individual. Needs of the Navy!!!

    So you are right there are Pros and Cons of the military just like everything else in this world.. You need to figure out what is right for you personally and forget about the money when making this decision.

    After everything I did in the military I dont regret this decision at all especially after 9/11. Would I do it over again. Not as an HPSP student. I would finish residency and then decide what I wanted in life. That keeps the ball in your court rather than the Navy's. And believe me control is what this decision is all about. This may sound contradictory but there are many emmotions that roll through ones head and heart after doing this and sacrificing friends and family to be gone for as long as I was gone. And dont forget about the little parts of your soul you will leave along the way. Some events just change you. Especially when you are never prepared for them to occur as they do.
     
  4. MoosePilot

    MoosePilot Y Bombardier
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    Ultimately, loss of freedom is a big demotivator. If you stay a civilian and realize it was a mistake, you can fix it by joining. If you join, you're committed. I graduated from a pilot training and incurred an 8 year committment. Two years into that, I realized that I had probably made a mistake in not continuing to press to get into med school. Four years in, I *knew* I had made a mistake, but there were still 4 years left before I could correct it. From this experience, I can understand what they're upset about.
     
  5. FliteSurgn

    FliteSurgn This space for rent.
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    I have several friends that are orthopods entering private practice. They are getting offers for $700,000+ per year to start. You can pay off $200,000 in loans pretty fast with that kind of loot.
     
  6. babelfish

    babelfish Junior Member
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    now these replies are really helpful. thankyou so much!!!!!
     
  7. militarymd

    militarymd SDN Angel
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    I don't want people to join a system that is harmful for everyone except for the paper pusher and which does its job poorly.

    Military medicine needs to rebuild from the ground up....from scratch. As long as hpspers join up, it will continue in its deplorable fashion....breaking the spirit of young physicians while giving the military members (the most deserving people in our country) crappy care.
     
  8. USAFdoc

    USAFdoc exUSAFdoc
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    The biggest "CON" if you choose to join will be your being "tied" for 4+ years to a "sinking ship". In my enlisted as well as officer years in the military, I have seen the good and bad sides. I am currently enjoying the absolutely BEST job of my life, as a civilian Family Doc.

    Medicine (Civ and Mil) are under a great deal of pressure and scrutiny, and UNFORTUNATELY, for both the docs and patients, military medicine is not designed to deal with this. As MilMD states in a response below, military medicine needs to be rebuilt from the ground floor up. Now if you want to enter the "condemned" building that is Mil med, enter at your own risk. But DO NOT say that you were not warned.
     
  9. Croooz

    Croooz Senior Member
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    You mentioned two things in your post: money & fitness. Neither one of which are good reasons to join. In regards to the money, $200k is NOTHING!! You may come from a low income background or perhaps have never had any sort of debt but $200k in school loans at say 26 years old is nothing. You have plenty of time to pay it off and make money. 35+ years old is a different story because you don't have the oppurtunity of compounding interest. So I believe money should be covered...if joining for financial reasons...don't.

    Fitness? Let me take a minute to compose myself...... Are you serious? Do yourself a favor and go to military bases and take a look around. You will be surprised what you see. There are programs like the "Fat boy program" which is remedial PT. The military is no more fit than the civilian world. What the military does is give you time to PT. However it comes down to a personal choice. There are plenty of overweight, over fat military members...especially in the Navy.

    If you're interested in getting into some awesome shape check out crossfit.com. This is better than anything the military can put you thru.

    So basically for you, if you get over your fear of good debt and your need to have external forces motivate you to PT you'll be fine. If not, join but don't complain when you're not making as much as your civilian counterparts and are as out of shape as they are. :smuggrin:
     
  10. Aberfly

    Aberfly Member
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    Before I signed up for the Navy HPSP program, I thought along the same lines as you. I was unattached. My family did not have much money and I had never gone into debt for anything in my life; I worked myself through college with academic scholarships and a job. I paid straight cash for my car. I really didn't want what seemed like the massive debt of medical school and felt I would be serving my country if I accepted the HPSP scholarship.

    Now I am married. In three weeks, the Navy will decide our fate for who knows how many years. My civilian friends from medical schools are hearing about residency programs and jobs beyond that with loan repayment options. I did very well on the boards and am sure I would have had multiple cicilian residency options had I gone that route. But now I have no say where I go. As was said above, (and like Janet said) this is a story about control. The truth is that you don't know where you'll be in your life in 4 years. Think about that before you join. There are indeed pros and cons to joining and I hope you make the right choice for yourself. If I had to do it all over again, there is simply no way I would have signed that contract, even if they doubled my stipend.
     
  11. Mirror Form

    Mirror Form Thyroid Storm
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    Yep, and the thing about the hpsp route is that "four year" committment is very deceptive. This is b/c you will probably be forced to do a military residency. So, it's actually more of an eight year loss of freedom.
     
  12. RichL025

    RichL025 Senior Member
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    Your "loss of freedom" is the same whether you do a military or civilian residency.

    Oh, wait, I guess you _do_ give up some freedom. When doing a military residency, they make you do PT tests and cut your hair. I guess if you were a HPSP'er doing a civilian residency you could grow dreds and a beer belly...
     
  13. island doc

    island doc Senior Member
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    What loss of freedom in the private sector???

    As a civilian medical school graduate one is free to choose the specialty they desire to enter, if not "matched", then they are free to choose for themselves what they will do in the alternative. Military graduates, however, may only apply to specialties which are selected by the Integrated Forecast Board (IFB). If they do not "match" into one of those specialties, then they are only guaranteed an internship, after which they can apply again for continued residency training, if unsuccessful they are then compelled to enter military practice as a GMO.

    Considering this, please explain to me just how an HPSP/USUHS student has as much or more freedom than a civilian medical school graduate???
     
  14. RichL025

    RichL025 Senior Member
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    My comment was regarding the difference -espescially overall time commitment - between civilian and military residencies, not medical school. I thought that was rather clearly stated.
     
  15. bustbones26

    bustbones26 Senior Member
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    Personally, forget the military, I for one am fed up with medicine. I figured out by the end of my MS-2 year that I just plain suck at medicine and its not a field for me. Now I am an intern, I get up every day and hate going to work. I am performing well academically and getting good reviews from staff, I just hate medicine and hate my job.

    So, if I figured out that I hated medicine back in my MS2 year, why didn't I quite medical school. Worse yet, now that I am a physician seeing patients, writing order and making some staff guided decision, why don't I quite residency?

    BECAUSE I CAN'T I WAS STUCK IN MED SCHOOL BECAUSE OF HPSP, NOW STUCK IN RESIDENCY BECAUSE OF THE COMMITMENT. HOw is that for losing your freedom? If I was civilian, I can guarantee that by the end of this internship year I'd be gone!

    Forget the military and having to be fit and yadda yadda yadda BS!

    So, I think what people here are eluding to is this. There is something said for never being able to get out when you want. Now I am not talking about getting out because you hate the military, decided it wasn't for you, yadda yadda yadda BS. I am talking about getting out for good reason, burned out, frustrated, I have heard of residency inducing mental breakdowns in some individuals
     
  16. island doc

    island doc Senior Member
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    You are in a pitiful +pity+ situation indeed. And things will get worse for you before they get better.

    If I could advocate GMO's, I would recommend that you not enter PGY-2, so that you can finish your ADSC ASAP as a GMO and then leave medicine altogether ASAP, but I do not concur with practicing medicine after only one year of postgraduate training, so cannot advocate this, even though it is an option for you.
     
  17. Two Fingers

    Two Fingers New Member

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    I agree with much of what has been written in the previous posts: don't do HPSP for money or fitness, and that crappy paperwork/limited options/deployments/combat are all downsides of military medicine. However, I have been through all of that and I enjoyed it and I think I am the better for it.

    I was AF ROTC+HPSP (ie 8 year obligation). I wanted to do ortho out of med school but nobody in my year group got to do ortho. So, I did a general surgery intern year on active duty, 6 months as a GMO in the basic trainee clinic (arguably as bad as USAFdoc's experience) then went to Korea as a flight surgeon. Early in my tour in Korea I decided I enjoyed it so much I'd wait on reapplying for ortho. I ended up staying for an extra 6 months so I could get my next assignment as a flight surgeon in Italy. Now I'm an ortho resident at a civilian program. I have about 3 more years of obligation, and I fully expect to be in Iraq or Afghanistan within a year of finishing my residency.

    I dealt with all of the crap island doc and USAF doc are always complaining about and (recognizing that there's some variation based on location/commanders/etc) I respectfully disagree with their overall assessment. I'd certainly be willing to do it all over again.

    I had a good enough education in med school and residency that I was a competent physician as a GMO. I think anyone contemplating HPSP should consider that they could be a GMO (or even a residency trained FP) and put in a situation where their training will not have provided them with all of the answers. I felt like it was my responsibility to learn what I needed to in order to take good care of my patients or at least get them to someone who could. I believe that is the nature of military medicine and any military physician must accept that responsibility.

    The rewards for accepting that responsibility can be awesome, but certainly don't include money or fitness, babelfish. Here are the things that made my time in the AF worth all of the crap:
    - Working every day with outstanding people. Most of the people in the military are very proud of their jobs. Many of them risk their lives every day, whether in combat or not. It was an honor to know them. It was my privilege to be their doctor, especially in combat.
    - 5 years as the "country doctor". Even though I knew I would eventually do ortho, all of that time made me much better doctor.
    - Unrivaled early responsibility compared with the civilian world. I was running the medical clinic in Kuwait within 5 years of finishing med school.
    - Unique responsibilities: flight medicine, combat medicine. I also got to go to jump school at Ft Benning and do medical support for space shuttle launches.
    - Flying in F-16s and living in Italy didn't hurt either.

    I'm sure island doc, USAFdoc and others will continue to fill this board with their opinions and bad feelings about military medicine. I will never post as much as they do--just realize that there are others with equally strong opinions and feelings, and that the posters on this site might not be a representative sample. (I've read enough to know that USAFdoc is out of the military and now has the "best job of his life", but I'd bet he's not posting his positive opinions/feelings about it on the family practice board).

    Military medicine is not for all, but it is not all bad.

    Two Fingers

    Disclaimers:
    -I am not a HPSP recruiter.
    -None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Two Fingers.
     
  18. island doc

    island doc Senior Member
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    I think few would concur that a general surgery internship is adequate preparation to practice primary care or occupational medicine. If that were the case, general surgery residents who transition to family medicine would not have to repeat the PGY-1 year as they are currently required to do by the ABFM.

    The fact that you may have enjoyed practicing with incomplete graduate medical education does not make it right, nor does the fact that you did not have any adverse outcomes mean that patients were receiving optimal care. Nothing against you personally, but in general GMO's provide suboptimal medical care. The DOD itself recognized this when it committed to Congress in 1997-98 that it would eliminate the use of physicians with less than three years of GME, the fact that it has yet to do so is a disturbing failure to improve the healthcare delivery system.

    Just because one can become licensed after an internship, does not mean that they are fully prepared to enter the independent practice of medicine, all this means is that the statutes allowing licensure after only one year of GME are outdated/antiquated. How many civilian US medical graduates choose transitional years or preliminary years and then enter practice? None. They cannot get staff privileges in most hospitals, because most hospital by-laws require board eligibility as a condition of obtaining staff privileges, etc. Board Eligibility/Certification is now the medical community standard.
     
  19. Mirror Form

    Mirror Form Thyroid Storm
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    Obviously the hair has nothing to do with the loss of freedom I was referring to. When I was applying for residency, there was only one program of my specialty that was located in a city which I wanted to live in. Many people have no programs of their chosen specialty in a city in which they want to live in. Having to live in a location that you hate is what I would call a loss of freedom. Yet that loss of freedom lasts for 8 years, not 4.

    Furthermore, if during internship you decide that you hate medicine and want to quit . . . that's too bad b/c your life doesn't belong to you anymore. Or if you don't match into your field in the civilian world, you're free to do whatever you want afterword. For example, you could do research and reapply, do internship and reapply, reapply for something else, scramble for something else, etc etc etc. Whereas, in the military your options are severaly limited and have to be approved by 50 people before you can act on them (as usual).

    But if you'd prefer to ignore those facts and make little snide remarks about haircuts, thats fine with me. Hopefully you won't ever end up getting screwed and hating the military like many people on here.
     
  20. USAFdoc

    USAFdoc exUSAFdoc
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    some good points; you are correct, I do NOT spend my extra time letting everyone know how GREAT my current civilian FP job is. I do not think that is as important as telling people how poor some USAF situations are, especially in light of the committment given by med students to a military career.

    You mentioned you are better off with having experienced military medicine, I might be able to say the same........I appreciate oh so much the life I have now having had gone through 3 years of the worst clinic I could imagine, but I would not wish it on my worst enemy and would never volunteer to put myself or my family through that again.

    Are my opinions (and island doc) representative of the USAF in general? As far as USAF primary care, I strongly beleieve they are. I have spoken first hand to docs coast to coast, some friends I did residency with, others I met at TDYs etc. Again, only overseas and the Academy seemed better off. My concern for other specialties and other services, is that the USAF continues to tout it's "OPTIMIZATION" plans as great success stories, when in fact, they are failures. "Optimization" is just another name for "do more with less", and in my clinics experience, it meant take care of 300% more patients with the same staff. If and when that kind of overoad hits subspecialties, they and their patients will feel the crunch too.

    Happy Thannkgiving everybody!
     
  21. HooahDOc

    Physician 15+ Year Member

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    I think HPSP is, at times, the only way for some people to even pay for school, especially at DO schools. Stafford barely covers the cost of tuition and the rest depends upon private loans -- something not everyone can get.

    I don't really see how I can pay for school without hpsp.
     
  22. MoosePilot

    MoosePilot Y Bombardier
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    Don't the schools work an estimated cost of living into the budget? Would you not get loans due to an existing credit rating?
     
  23. USAFdoc

    USAFdoc exUSAFdoc
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    You probably CAN'T go through a medical career and NOT be in debt unless you do something like HPSP.......but believe me, there are worse things than debt, like 4 years at a USAF primary care clinic.

    Whatever you choose, best wishes for you, but the more freedom you can keep, the better you and your family will be off. It used to be that military may have been a good option, balancing less money and freedom, with a better quality of life and serving your country. Serving your country is still an option, the quality of life is in the toilet. That quality of life for you and your family, quality of care for your patient.
     
  24. HooahDOc

    Physician 15+ Year Member

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    It's not the debt I'm trying to avoid -- I would gladly finance my education with loans. The problem is getting them. There's no way I can get a private loan to cover the difference between costs of living/tuition and what stafford allows without a cosigner, and I do NOT want someone else to have a $80,000 loan on their credit report.

    The only way I can do it is if (1) Tuition at whichever school I choose is lower or equal to what stafford pays per year and (2) my wife can find a hospital nearby to work at (She's a RN), but then I'd feel pretty crummy having her support both of us.


    It's possible, but ultimately depends upon the school and location I choose.
     
  25. bustbones26

    bustbones26 Senior Member
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    LAW #1:

    NEVER EVER, EVER, EVER take an HPSP committment just for the money!!!

    Don't get me wrong, its a plus, but not the best reason to sign the dotted line.

    I took out loans for my MS1 year, 38K in stafford, which everybody with a pulse gets. and I think I got about another 4K in private loans. I did not have a cosigner either but the private loans set up at my school did not require this, just needed to have a credit check (and of course you had to have good credit).

    Now I understand your position, some DO schools can be quite expensive for out of state residents, Michigan and WV come to mind, so avoid those schools.

    Now I don't know you personally or your situation but be rest assured, if your in medical school, your wife is going to support you on her RN salary. HPSP doesn't give you a whopping stipend despite being free money, just swallow your pride and face up to the fact that she is going to be the breadwinner in your household. You can certainly contribute to the family finances with either loaned money or scholarship money, but she is still going to be supporting you.

    Talk to any medical students that goes through school married, they will all tell you that they lived in poverty for four years, its just part of the game. And trust a guy who did it, even with HPSP, you still struggle financially.

    Every time you go out and do an ADT, yes you might get paid as a 2LT for 45 days, but you have to fork out about 3-5K up front to pay for airfare, hotel (nobody, except EL Paso ever has free BOQ available), food, etc. Yes, you get this reimbursed to you after the ADT, but you usually slap all of this on your credit card or cash out before you do ADT and pay it back 3 months later when the army actually reimburses you. Trust me, it hurts your pocket book every time you do this.

    And lets not forget payback time. IF you want to do any specialty other than primary care, you might as well forget about ever thinking that you are gonna pay back yoru four years after residency and get out. I personally do not hate the military, despite negative reviews here, there are some advantages, but I do have to say, there is something to be said about practicing medicine for the military because you want to versus because you have to.

    Okay so enough ranting, I think what I am trying to say here is this, with or without a scholarship, you have to tighten your belt in medical school and live below what you are used to. Its part of the game. So, a scholarship, HPSP, National Health corp, or whatever, never take these for the money only.
     
  26. HooahDOc

    Physician 15+ Year Member

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    I've read this forum quite a bit and have been pretty gung-ho about doing HPSP. After 6 months of marriage, however, I think I'm going to try to finance my education without it.

    Who knows how things will be in 4 years? Most likely I will have children by then, and a looming commitment to the unknown probably isn't the best idea.

    I'll keep my mind open for FAP but I don't want a 10+ year commitment to anything before I even start school.
     
  27. Globus P

    Globus P Senior Member
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    Nice work, bustbones26, I wholeheartedly agree. Good advice.
     

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