DHA changes impacting Army Residencies

[fishdoctor0225]

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I'm currently trying to weigh my options regarding HPSP. Say I decide to pursue a residency like neurology (the Army typically has 5 spots). With the DHA cuts, is there any chance that the Army may do away with certain residency programs like neurology? I know this is difficult to predict, but basically I'm trying to choose between crippling debt (500k+) or an uncertain choice of residency programs. If it means anything, I'm also really interested in serving in the military as a doctor. If I don't do HPSP, I'll do FAP. Is FAP as financially worth it as HPSP?

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[SirGecko]

Pure fear of debt is not a good reason to sign up with HPSP. The military is always going to be the best fit with someone who is more flexible in their expectations from their job/ life. If you are interested in serving but only want to do it as a neurologist wait till you are a neurologist and the sign up.

That said the party line from DHA right now is that they aren’t looking to cut specialties whole cloth just put downward pressure on manning but that could definitely change. No one can give you a true prediction of what that will be like four years from now.

 

[TheEarDoc]

Be a civilian through medical school. If you become a neurologist you'll have no problem living cheap a few years and paying that debt off. If you want to do military to serve then you can do so in the reserves or guard.

 

[Atlas Shrugged]

Run. I can’t believe people are still interested in the military with all of the nonsense going on. Buckets. Navy 2 year contracts. The Air Force has been closing things for years.


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[Per5everance]

I'm currently trying to weigh my options regarding HPSP. Say I decide to pursue a residency like neurology (the Army typically has 5 spots). With the DHA cuts, is there any chance that the Army may do away with certain residency programs like neurology? I know this is difficult to predict, but basically I'm trying to choose between crippling debt (500k+) or an uncertain choice of residency programs. If it means anything, I'm also really interested in serving in the military as a doctor. If I don't do HPSP, I'll do FAP. Is FAP as financially worth it as HPSP?

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500k? Sounds high. Also debt 2-3x your salary is not crippling, high but manageable.

 

[armytrainingsir]

500k? Sounds high. Also debt 2-3x your salary is not crippling, high but manageable.

IMO, 500k of debt, non dischargeable in bankruptcy, with little hope of forgiveness, essentially not tax deductible, and unknown future earning potential is pretty dang onerous.

 

[deleted480308]

IMO, 500k of debt, non dischargeable in bankruptcy, with little hope of forgiveness, essentially not tax deductible, and unknown future earning potential is pretty dang onerous.

With almost every doctor job paying >200k and it being very easy to find loan forgivenss on top of that, it’s a big deal but not impossible

 

[armytrainingsir]

Oh, its certainly doable, but certainly onerous.

 

[Falcon12]

IMO, 500k of debt, non dischargeable in bankruptcy, with little hope of forgiveness, essentially not tax deductible, and unknown future earning potential is pretty dang onerous.

Also, any debt is going to be paid for with after tax income in a much higher tax bracket, negating much of the big paycheck in the civilian world for the first few years.

I would still say don't do it if choosing your training is more important.

 

[Per5everance]

Oh, its certainly doable, but certainly onerous.

Tens of thousands of physicians do it every year.

 

[TheEarDoc]

Also, any debt is going to be paid for with after tax income in a much higher tax bracket, negating much of the big paycheck in the civilian world for the first few years.

I would still say don't do it if choosing your training is more important.

Which is why if any of our glorious lawmakers had any desire to "fix" the student loan debt crisis, they would allow students loans to be paid out directly pre-tax from income thus lowering income tax brackets and making sure Uncle Sam gets his cut, but they enjoy the extra tax money and extra interest charged on student loans.

 

[pgg]

Tens of thousands of physicians do it every year.

Oh, I don't know about that. $500K is a couple sigmas right of the mean physician student loan debt. It's not typical at all. And for a person entering a specialty that doesn't pay at the higher end, it's a millstone around the neck. Let's not pretend it isn't.

I generally agree with the usual forum advice to not do HPSP for the money, but there are certain debt burdens where doing it for the money becomes rational. $500K is a freakishly large amount of student loan debt.

 

[TheEarDoc]

Oh, I don't know about that. $500K is a couple sigmas right of the mean physician student loan debt. It's not typical at all. And for a person entering a specialty that doesn't pay at the higher end, it's a millstone around the neck. Let's not pretend it isn't.

I generally agree with the usual forum advice to not do HPSP for the money, but there are certain debt burdens where doing it for the money becomes rational. $500K is a freakishly large amount of student loan debt.

I agree. I am interested in hearing the story of how someone could amass that much student loan debt?

 

[fishdoctor0225]

I agree. I am interested in hearing the story of how someone could amass that much student loan debt?

My scholarships only covered tuition and a little more during undergrad. Plus, I live in a high cost-of-living city. Being a first-generation college student, my parents didn't have the money to contribute to my education. So I had to take out some loans for undergrad and will have to fully rely on loans for medical school. My med school financial aid office calculated the cost of attendance to be approx 80000/yr. Multiple that by 4 and you have 320,000. Plus 40k from undergrad unfortunately brings the number to 360k. After calculating capatilized interest and deferring debt through residency, I got approx 500k in debt POST-RESIDENCY (even though I slightly inflated my loan interest rates when calculating). Of course I can scrape by during med school, take out less loans, etc, and try to pay interest during residency, but ultimately I will be well-above the average med student debt of 180k after I complete residency. While I do see the financial benefits to military (in my case), I ultimately have a desire to serve and will regret not serving otherwise. Thanks for everyone's responses so far!

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[HighPriest]

For some reason we always end up in this circular argument when someone asks something like this. It goes like this:

OP: I’m going to have a lot of debt.

#1: Don’t join. It’s dumb to join for the money.

#2: That’s not true. That’s a lot of debt. You can’t just blow it off.

#1: Nah, you can pay that off. You’ll make a lot of money.

#2: yeah but it’s super hard.

Here’s the thing, it all depends upon a ton of factors. Some of those factors you know now. Others you won’t know until you’re done with school. It’s a lot of money. You need to consider it. You need to put it on the scale, and you need to counter balance it with the number of cons (and pros) inherent to military medicine.

The problem that I think people have on the “don’t do it for the money” side is that it is generally far easier to see the pros of military medicine at the top of the slide, whereas they have either been down the slide already, or are currently sliding, and they’ve seen how many cons just aren’t readily apparent when you’re deciding whether to join. So what they really mean to say is that the weight you’re adding to the scale that says “$” may not by as heavy as you think it is. I doubt (hope) that they aren’t just ignoring the validity of debt as a deciding factor altogether. It’s just very hard to explain all of the possible pitfalls of military medicine without actually experiencing it. And as we have all said many, many times how many pitfalls you experience is so very much up to chance. It’s really difficult to express all of the variables.

So you need to weigh debt against where you’ll do residency, whether you’ll do GMO, where you’ll be stationed, whether you’ll be deployed, what specialty you match in to (because I have to agree if you end up in Ortho doing joints, $500,000 out of residency is extremely manageable, but if you’re a family doc it’ll suck a lot more). Lots of factors.

On the other hand, if you were $1,000,000 in debt (I’m just picking an unrealistically high number), then really nothing else matters, you’ve painted yourself in to a corner. I think most people would say “well, I hope it doesn’t suck too much for you, man, because you don’t have a choice.”

So like most people you’re in that gray area where your debt might be a big deal or it might be a manageable amount. Depends upon a lot of things.

Everyone says they have a desire to serve. That’s an important weight for the scale too. But it only weighs so much. Look through the forum more, read about experiences. Just be as prepared as you can be, and be very wary of anything your recruiter says.

 

[fishdoctor0225]

For some reason we always end up in this circular argument when someone asks something like this. It goes like this:

OP: I’m going to have a lot of debt.

#1: Don’t join. It’s dumb to join for the money.

#2: That’s not true. That’s a lot of debt. You can’t just blow it off.

#1: Nah, you can pay that off. You’ll make a lot of money.

#2: yeah but it’s super hard.

Here’s the thing, it all depends upon a ton of factors. Some of those factors you know now. Others you won’t know until you’re done with school. It’s a lot of money. You need to consider it. You need to put it on the scale, and you need to counter balance it with the number of cons (and pros) inherent to military medicine.

The problem that I think people have on the “don’t do it for the money” side is that it is generally far easier to see the pros of military medicine at the top of the slide, whereas they have either been down the slide already, or are currently sliding, and they’ve seen how many cons just aren’t readily apparent when you’re deciding whether to join. So what they really mean to say is that the weight you’re adding to the scale that says “$” may not by as heavy as you think it is. I doubt (hope) that they aren’t just ignoring the validity of debt as a deciding factor altogether. It’s just very hard to explain all of the possible pitfalls of military medicine without actually experiencing it. And as we have all said many, many times how many pitfalls you experience is so very much up to chance. It’s really difficult to express all of the variables.

So you need to weigh debt against where you’ll do residency, whether you’ll do GMO, where you’ll be stationed, whether you’ll be deployed, what specialty you match in to (because I have to agree if you end up in Ortho doing joints, $500,000 out of residency is extremely manageable, but if you’re a family doc it’ll suck a lot more). Lots of factors.

On the other hand, if you were $1,000,000 in debt (I’m just picking an unrealistically high number), then really nothing else matters, you’ve painted yourself in to a corner. I think most people would say “well, I hope it doesn’t suck too much for you, man, because you don’t have a choice.”

So like most people you’re in that gray area where your debt might be a big deal or it might be a manageable amount. Depends upon a lot of things.

Everyone says they have a desire to serve. That’s an important weight for the scale too. But it only weighs so much. Look through the forum more, read about experiences. Just be as prepared as you can be, and be very wary of anything your recruiter says.

Thank you for your thoughtful reply, these answers help a great deal in the decision-making process.

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[militaryPHYS]

If you want to know exactly how much debt you will have and how much money you will make every year for the next 10 years the military is a reliable way to do that. What will you not know based on this trade-off? Possible training interruption and possibility of not training in your current specialty of choice.

I preferred money and life now vice money and life later. Others don't mind the delayed gratification and accumulation of large debt.

You have to decide for yourself what option will give you the least stress, best sleep and most happiness over the next 10 years. Every person is different.

 

[Per5everance]

Oh, I don't know about that. $500K is a couple sigmas right of the mean physician student loan debt. It's not typical at all.

Yeah you are correct about the 500k. I was referring to the 200-300k range that most physicians carry. Not sure where OP got 500k.

 

[Per5everance]

My scholarships only covered tuition and a little more during undergrad. Plus, I live in a high cost-of-living city. Being a first-generation college student, my parents didn't have the money to contribute to my education. So I had to take out some loans for undergrad and will have to fully rely on loans for medical school. My med school financial aid office calculated the cost of attendance to be approx 80000/yr. Multiple that by 4 and you have 320,000. Plus 40k from undergrad unfortunately brings the number to 360k. After calculating capatilized interest and deferring debt through residency, I got approx 500k in debt POST-RESIDENCY (even though I slightly inflated my loan interest rates when calculating). Of course I can scrape by during med school, take out less loans, etc, and try to pay interest during residency, but ultimately I will be well-above the average med student debt of 180k after I complete residency. While I do see the financial benefits to military (in my case), I ultimately have a desire to serve and will regret not serving otherwise. Thanks for everyone's responses so far!

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Not gonna doubt your numbers but 80k seems super high. Also you can make payments during residency.

 

[RE-Tired]

With 100% certainty, no one including myself knows what it will be like in the MHS once you start residency after medical school. Things look bleak now, but there are always cycles. Only you know what comfort level you can have with all of that debt hanging over you. The best advice I can give you is, that if you make the decision to go HPSP, NEVER LOOK BACK and have no regrets about your decision. In my 20 yr career the doctors who constantly complained about their "bad" decision were miserable and made every one else miserable. I had zero sympathy for them. Once you commit, you will be owned for at least seven years. If you understand and accept that fact you will learn to cope with whatever the military throws you. Best of luck.

 

[militaryPHYS]

With 100% certainty, no one including myself knows what it will be like in the MHS once you start residency after medical school. Things look bleak now, but there are always cycles. Only you know what comfort level you can have with all of that debt hanging over you. The best advice I can give you is, that if you make the decision to go HPSP, NEVER LOOK BACK and have no regrets about your decision. In my 20 yr career the doctors who constantly complained about their "bad" decision were miserable and made every one else miserable. I had zero sympathy for them. Once you commit, you will be owned for at least seven years. If you understand and accept that fact you will learn to cope with whatever the military throws you. Best of luck.

This is sage advice and well articulated.

@RE-Tired I see you just joined SDN or at least started fresh with a new account. Welcome! I look forward to your input on topics in MilMed.

 

[starbuck2]

In case anyone’s wondering, here’s my situation:

$82k loans from undergraduate

I will be attending a private school and relying on loans to finance (unless I get HPSP, still in the process of applying). Cost of attendance is
M1 $94k ($65k tuition)
M2 $94k
M3 $101k
M4 $93k

The extra money comes from estimated rent, books, supplies, parking, health insurance, and misc. expenses. Total is $382k. I plugged this in to a 10 year repayment plan calculator, and the interest estimate was $145k. So the total is $527k. I know this isn’t perfect but it’s a good rough estimate for how much interest will accumulate during med school and residency.

Add both my loans together and I’ll be looking at close to $600k debt.

 

[DocSurgeon]

A wise military attending once told me, "You either owe time or you owe money. Everyone owes something." I think most people going/gone through military medicine have come to appreciate that there are always opportunities for more money but you can't get back your kids first birthday that you missed because you're stuck in the sandbox sitting on your butt so you can fill a checkbox on a pentagon spreadsheet.

 

[militaryPHYS]

A wise military attending once told me, "You either owe time or you owe money. Everyone owes something." I think most people going/gone through military medicine have come to appreciate that there are always opportunities for more money but you can't get back your kids first birthday that you missed because you're stuck in the sandbox sitting on your butt so you can fill a checkbox on a pentagon spreadsheet.

Totally agree.

Devil's Advocate approach: Some might think that missing a birthday or two is a better tradeoff than missing every afternoon and lots of weekends for a few years chasing RVU minimums and $$ to pay back excessive amounts of debt.

Every person needs to fully understand their own financial risk tolerance and incorporate how it impacts their specialty/career/lifestyle risk tolerance.

 

[armytrainingsir]

600k

Day-um.

At 5%, that is 6300/month for 10 years or 4000/month for 20.

And that is after taxes and before having a place to live.

Most of the loan forgiveness incentives hospitals hand out seem to top out at 100k, and that is taxable, so only about 75k of real debt relief. And that is rarely in a lump sum, so interest digs into the 75k. Still, much, much better than nothing.

Likewise, relocating to underserved areas seems to generate bonuses that max out at 100k as well.

Im sure there are exceptions to the 100k, likewise, I personally know CEOs in less desirable areas that won't even consider offering loan forgiveness. And 150k or so is real money, but loses its luster next to 600k of debt.

The average salary in the US for physicians is around 300k, so about a 24% actual tax bracket, so that leaves you with 18.5k per month, before state income taxes.

So you are looking at about a third of your take home for 10 years, or a fourth of it for 20.


Like I said,

Day-um.

Good luck (and try to find a cheaper school!)

 

[armytrainingsir]

Tens of thousands of physicians do it every year.

The average debt is 250k or so.

About 1% of medical students generate >500k of debt.

Average Student Loan Debt for Medical School for 2023 | Credible

Medical school students graduate with an average of $215,900 in debt. Learn more about the average medical school debt and how to manage it here.

www.credible.com

So, no, tens of thousands of physicians DON'T do that every year. Less than a thousand do.

 

[DocSurgeon]

Devil's Advocate approach: Some might think that missing a birthday or two is a better tradeoff than missing every afternoon and lots of weekends for a few years chasing RVU minimums and $$ to pay back excessive amounts of debt.

I'll give you that. Expanding on your point; pay sucks, sure, but it is absolutely commensurate on my day to day workload. The vast majority of nights I'm able to put my kids to bed. Can't argue that that hasn't been nice.

 

[Falcon12]

Like I mentioned before, when I calculated the cost on both sides, I came up with a fairly commensurate number between the 2 for the first four years. It's a sweeter deal for me since with 5 years Active Duty the pay boost is even greater during Med School and Residency. However, even then after the initial commitment it is still no comparison to the civilian sector for potential pay or potential lifestyle.
What made the difference for me was that I was married and starting a family. Having my pay front loaded during medical school and residency seemed attractive. The studies I've read show more money does increase happiness up to around $70k/year. I wanted to maximize happiness and minimize marital and family stress during medical school and residency. 3 years in - we have lived modestly and for all the stress that med school has been doing it married with 2 kids, I can honestly say financial stress has not been a huge stressor.

 

[pgg]

Like I mentioned before, when I calculated the cost on both sides, I came up with a fairly commensurate number between the 2 for the first four years. It's a sweeter deal for me since with 5 years Active Duty the pay boost is even greater during Med School and Residency. However, even then after the initial commitment it is still no comparison to the civilian sector for potential pay or potential lifestyle.
What made the difference for me was that I was married and starting a family. Having my pay front loaded during medical school and residency seemed attractive. The studies I've read show more money does increase happiness up to around $70k/year. I wanted to maximize happiness and minimize marital and family stress during medical school and residency. 3 years in - we have lived modestly and for all the stress that med school has been doing it married with 2 kids, I can honestly say financial stress has not been a huge stressor.

One of the reasons I chose to go to USUHS was that the paycheck and benefits made it possible for us to have kids early. We had 3 while I was a med student. There are definitely factors beyond compound interest, loan amortization schedules, and attending-level pay disparities that can argue for taking the money now vs deferring it to later.