HPSP...a vets perspective

[Croooz]

Hx:
32yo, 12 year Navy hospital corpsman vet working as federal contractor. Collaborate with military, civilian, & contracted researchers at NIH, AFIP, AFRRI, NNMC, NMRC, USAMRIID, USAMRAA, and the acronyms go on & on & on...

I've PM'd xMilMD in the past and hard for many to believe I was encouraged by him to go back in the military. With me having so many years it would be foolish to lose those years since after my payback I would have the required time to retire. He discussed 401k's, thrift savings and general savings for a traditional student at my age. With my history, military medicine would not be the culture shock it will be for most of those who take the HPSP...

"The point?"

Even me...a "hardened" veteran still has my doubts. My concern is even though I have not entered into medical school I have had a realization that like the majority of people I am not 100% what it is I want to specialize in. Ask me last week and I would have said surgery, ortho, or EM nothing else. Out of the blue, reproductive endo has grasped me in a choke hold. I, who never even considered OB/GYN for myself and felt as though a man doing this was merely a theorist...I have been giving it much thought....

"...and the point is?"
I know the military and am still approaching it with concern. How can any medical student lock themselves into a contract such as HPSP? HPSP is great for the military and for those who want to fulfill some patriotic or Rambo'ish fantasy about the military but for 95% of you out there it's a gamble. If you aren't sure about what specialty you want why would you ever sign? If your desires or rotations awaken you to a sub-specialty which just fits you to a T why on earth take the HPSP? There is very little...minimal...miniscule need in the military for many sub-specialists. Cheaper to subcontract or Triscare you to them.

I now see that the majority of applicants are doing this for the quick money. There is no other way to see it. If you sit down and really think about the fact that you will very likely not be allowed to pursue your specialty/sub then what other reason? Forget patriotism and all that? I can see those, crazy as it sounds. What I see is the recruiters feeding into a student's unhealthy fear of debt. No one wants the debt so you take out one hell of a credit card loan? The interest in this case is your time, which is your life...8-10 years to be precise. 8-10...kinda sounds like a prison term...

Understand, for those who have a family, have a mortgage/s, car loans, undergrad loans, child care, spouse loans, and the many other bills, debts, and money issues that come with being a low-middle class citizen....think long about the HPSP consequences on your family. For those still in school I would say not to even consider HPSP. Just say NO. Finish school, get into your residency and then if the itch to "do your duty" is still there go FAP. Knowing what I know there is absolutely no way, in good conscience that I can recommend to someone to accept the HPSP.

Feel free to flame, bash, agree, disagree...I know what I know. Medicine is too broad to limit yourself at such an early age and point in your career. Most of the HPSP recipients haven't even taken a med school class and are already signed up for the military...just seems crazy to me. Everyone would like to think they will know exactly where their life will take them 10 years from now...once you accept HPSP give this illusion up because not even the military will know where they're gonna put you.

As for me...I'll probably have 2-3 kids and will have to weigh how much time I'm willing to give up in their lives to join the military. Will the time I give up be worth it in the end? Will the time away be worth the $4-5k/month once I reach retirement? Do I just give up the 12 years of service? Should I then waste my time in a GS position to recoup the time? I know plenty of people who wished they had stayed in and gotten the retirement, officer & enlisted.

Bottom line: Life is too short to bind yourself to a contract such as HPSP. FORGET THE MONEY...and focus on what it is YOU want. The military will always be there and regardless what the recruiters say the military has made it without you and will manage if you don't sign up. If you feel a personal debt to pay for the freedoms you enjoy...volunteer your time, money, and skills at a VA clinic/hospital. You'll see first hand how the "military takes care of their own".

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[Mirror Form]

There is very little...minimal...miniscule need in the military for many sub-specialists. Cheaper to subcontract or Triscare you to them.

Have you looked at all specialties and fellowships available in the army? The vast majority of areas, minus a few fellowships, are available. And if your particular fellowship isn't available, then it wouldn't be the end of the world to just do your four year committment and then go do a fellowship in the civilian world. However, when I did my army ophthalmology rotation, practically every single attending I worked with had done a fellowship somewhere in a specialized area (granted this was at major army hospitals, not out in the middle of nowhere). And keep in mind that ophtho is a pretty specialized area in and of itself.

 

[qqq]

Hey Crooz,

what if you were say 26, had 4 more years. You would rather be a civilian doc. At the same time, you dont want to put off med school for another 4 years. you want to do it now because you've been pushing it off for 4 years now and, while starting at 30 is realistic, you really just want to be in school and get the ball rolling. Also, if you waited 4 years to get out, you'd have to give up the acceptance you currently have, and then there is the possibility that you wouldn't get in next time you apply. And you want nothing more than to be a doctor. You don't necessarily love the military, but you're used to it. you understand the military and the uncertainties in HPSP. Do you wait it out 4 more years and hang up the uniform and apply all over again, or do you go for the HPSP, having done your research and knowing what you're getting into.

here, going the HPSP route has nothing to do with the money. in fact, if the gov't would cut you free right now you'd gladly pay for med school yourself. but obviously that's not going to happen.

 

[Rudy]

Conservatively speaking, I would guess that at least 50% of those who sign up for HPSP/USUHS will regret it later and wish they hadn't. You are just too early in your medical careers to understand or appreciate the thousands of variables and changes in perspective that will happen during medical school and beyond. If I could do it over again, I never would have gone to USUHS. I did not realize when I signed up how much I would later want to live near family so that my wife could have support during residency/practice and so that my children could spend more time with grandparents, cousins etc. The problem is that at 24 when I signed up, these things weren't the major priority that they are now, but now it is too late and it is impossible to get out of the contract. It is just something that I will have to deal with until 2014 when my USUHS contract is up.

The other major challenge for families is deployment. All signing up for HPSP and USUHS need to realize that in this current time of war, you will deploy frequently, sometimes up to 3-6 months every year. Your families need to understand this before you sign and you need to speak with them about it. The thing that the military capitalizes on in recruiting pre-med students is that many of you reading this board do not yet have families and do not yet understand the pain that deployments will bring to family life.

So here are four key facts you have to think long and hard about before signing on the dotted line:

1) You can't get out once you sign up (for USUHS folks, this means 10-12 years depending on specialty)
2) You have little control over where you will live during your military career
3) You will regularly spend several months away from family on deployment.

Bottom line: unless you derive tons of joy and satisfaction from the hard-core military stuff (playing Rambo in the woods, jumping out of planes, diving off of ships, etc), then it flat out is not worth it to sign up.

 

[Rudy]

I was going to write a fourth key point, which is that medical student debt is usually not a big deal for most physicians. I then realized that while this has been my experience, it may be somewhat debateable, so I deleted from the list, I just did not change the four to three in my prior post.

So here is my opinion (for what it is worth) about who should sign-up for military medicine (HPSP/USUHS):

1) Those who already have significant prior military service (6-10 years or so) that will be creditable toward retirement.
2) Those who love playing Rambo, jumping out of planes, diving off ships, etc. and would pursue those types of activities weather in the military or not.
3) Those who come from a LONG line of military officers and want to follow in the footsteps of fathers, mothers, grandparents, etc.

For the rest of you, it likely does not make sense, financially or otherwise, to join HPSP or USUHS. Think long and hard about it before you sign up.

 

[DCM]

I posted a similar statement on another thread.

If I was 22 and graduating college again, I would definitely go to a private school on Navy HPSP. Go off with the marines or flight surgeon for four years and then get out and do residency. You can do all that and still complete training relatively young. The GMO time is great for maturity and adventure and may even make you more competitive for residency or at least help in interviews. And you have accomplished something great that you will carry with you for the rest of your life.

I guess that meets one of Rudy's criteria. However, since I will have 7 years prior service when I begin med school and be 28, I am LESS likely to take HPSP/USUHS. I have already done what I described above and now am readly to move on and get settled.

 

[qqq]

Hey Crooz,

what if you were say 26, had 4 more years. You would rather be a civilian doc. At the same time, you dont want to put off med school for another 4 years. you want to do it now because you've been pushing it off for 4 years now and, while starting at 30 is realistic, you really just want to be in school and get the ball rolling. Also, if you waited 4 years to get out, you'd have to give up the acceptance you currently have, and then there is the possibility that you wouldn't get in next time you apply. And you want nothing more than to be a doctor. You don't necessarily love the military, but you're used to it. you understand the military and the uncertainties in HPSP. Do you wait it out 4 more years and hang up the uniform and apply all over again, or do you go for the HPSP, having done your research and knowing what you're getting into.

here, going the HPSP route has nothing to do with the money. in fact, if the gov't would cut you free right now you'd gladly pay for med school yourself. but obviously that's not going to happen.

so if any of you were in the situation described above you would simply wait it out and start med school at 30 without hpsp, rather than start at 26 with hpsp?

 

[Croooz]

Hey Crooz,

what if you were say 26, had 4 more years. You would rather be a civilian doc. At the same time, you dont want to put off med school for another 4 years. you want to do it now because you've been pushing it off for 4 years now and, while starting at 30 is realistic, you really just want to be in school and get the ball rolling. Also, if you waited 4 years to get out, you'd have to give up the acceptance you currently have, and then there is the possibility that you wouldn't get in next time you apply. And you want nothing more than to be a doctor. You don't necessarily love the military, but you're used to it. you understand the military and the uncertainties in HPSP. Do you wait it out 4 more years and hang up the uniform and apply all over again, or do you go for the HPSP, having done your research and knowing what you're getting into.

here, going the HPSP route has nothing to do with the money. in fact, if the gov't would cut you free right now you'd gladly pay for med school yourself. but obviously that's not going to happen.

Why wait any longer? Are you seriously telling me that the only way you can afford medical school is with HPSP? If so, then you apparently have no choice...I would disagree. There is federal money, state money, grants, loans...so what da problem is???? Did you use up your GI Bill?

I'm having trouble with why you would have to wait. Besides still needing the prereqs why would you have to wait?

 

[qqq]

Why wait any longer? Are you seriously telling me that the only way you can afford medical school is with HPSP? If so, then you apparently have no choice...I would disagree. There is federal money, state money, grants, loans...so what da problem is???? Did you use up your GI Bill?

I'm having trouble with why you would have to wait. Besides still needing the prereqs why would you have to wait?

I have to wait because I still have to serve out my commitment. So it is a choice between serving out my commitment as a non medical officer or serving my commitment by going into medicine. If I go into medicine now, I don't have any choice but to take HPSP because otherwise the military won't let me go into medicine, right? Maybe I am not understanding something, so please correct me. Is it possible, once I get my orders to school from the Air Force (which would be issued under the assumption that i'm going hpsp because that is what I'm applying to now as an active duty member), to turn down the gov't money, still go to school, and then defer my current service commitment until after I grad without incurring any extra military service for the deferment? I don't think it is. If so please shed some light. The money, like you are saying, is absolutely not the issue. What is the issue is that I want to go to school asap, and I don't want to wait 4 more years (the lenght of my remaining service commitment), because then I'd have to apply all over again, mcats and all, and i already have an acceptance, and truthfully, it was not the easiest thing in the world for me to get. Thanks.

 

[DCM]

I wouldn't wait and risk not going later. Four years from now as you are getting out to start school you could already be a doctor.

One benefit for you will be that after med school you will owe 8 years (4 from now and 4 from HPSP) so doing a GMO tour or long residency isn't a big deal because it won't add to your commitment.

 

[Croooz]

I have to wait because I still have to serve out my commitment. So it is a choice between serving out my commitment as a non medical officer or serving my commitment by going into medicine. If I go into medicine now, I don't have any choice but to take HPSP because otherwise the military won't let me go into medicine, right? Maybe I am not understanding something, so please correct me. Is it possible, once I get my orders to school from the Air Force (which would be issued under the assumption that i'm going hpsp because that is what I'm applying to now as an active duty member), to turn down the gov't money, still go to school, and then defer my current service commitment until after I grad without incurring any extra military service for the deferment? I don't think it is. If so please shed some light. The money, like you are saying, is absolutely not the issue. What is the issue is that I want to go to school asap, and I don't want to wait 4 more years (the lenght of my remaining service commitment), because then I'd have to apply all over again, mcats and all, and i already have an acceptance, and truthfully, it was not the easiest thing in the world for me to get. Thanks.

Thanks qqq. Now you're in a totally different situation. You need to use the military to get out of active service so you can go to medical school now and not when your tour is over. Get to it! You're situation is definitely not money but time. I would do whatever I could to get to school. No one should fault you. Your taking a step forward (school) to PERHAPS take a few back (service). You know full and well the military isn't the end of the world and your decision is sound. Why wait? Take the HPSP and enjoy your 4 years of freedom. I made the ASSumption that you were a civilized person....I know...I know..."reading is fundamental"

 

[tscottturner]

I have to wait because I still have to serve out my commitment. So it is a choice between serving out my commitment as a non medical officer or serving my commitment by going into medicine. If I go into medicine now, I don't have any choice but to take HPSP because otherwise the military won't let me go into medicine, right? Maybe I am not understanding something, so please correct me. Is it possible, once I get my orders to school from the Air Force (which would be issued under the assumption that i'm going hpsp because that is what I'm applying to now as an active duty member), to turn down the gov't money, still go to school, and then defer my current service commitment until after I grad without incurring any extra military service for the deferment? I don't think it is. If so please shed some light. The money, like you are saying, is absolutely not the issue. What is the issue is that I want to go to school asap, and I don't want to wait 4 more years (the lenght of my remaining service commitment), because then I'd have to apply all over again, mcats and all, and i already have an acceptance, and truthfully, it was not the easiest thing in the world for me to get. Thanks.

Maybe it's just me, but as someone that was in the same position you are in, the decision was a little more obvious. I was 24 when I decided I wanted to go to med school, but my commitment kept me in the Army until I was 28. I am no longer on active duty, but my active duty experience made me considerably more desirable to med schools than the typical guy coming out of college. Don't worry about losing any acceptance that you have now - schools LOVE former military. Since I left active duty in an IRR status, I can join a local guard unit and defer any deployments until after residency (typically, the guard allows med students to do this). This way I don't lose my military experience, I still get promoted with my peers, and I don't have to do a military residency. It's the best of both worlds.

 

[qqq]

Maybe it's just me, but as someone that was in the same position you are in, the decision was a little more obvious. I was 24 when I decided I wanted to go to med school, but my commitment kept me in the Army until I was 28. I am no longer on active duty, but my active duty experience made me considerably more desirable to med schools than the typical guy coming out of college. Don't worry about losing any acceptance that you have now - schools LOVE former military. Since I left active duty in an IRR status, I can join a local guard unit and defer any deployments until after residency (typically, the guard allows med students to do this). This way I don't lose my military experience, I still get promoted with my peers, and I don't have to do a military residency. It's the best of both worlds.

I'm going to check out this whole ambiguous and secret world of going into the reserves or guard while in med school without being sponsored by HPSP. The Air Force has this Palace Chase Force Shaping thing, so hopefully I can get my active duty commitment switched to a reserve commitment, and then serve out all of my time as a reserve doc instead of an AD doc. Even though it is 1:2 years, at least I could do a civilian residency and have much more freedom than HPSPers. If they won't let me exchange my active duty commitment for reserve or guard, I'm just going to go HPSP. I think it's best if I go to school as soon as possible.

 

[qqq]

Maybe it's just me, but as someone that was in the same position you are in, the decision was a little more obvious. I was 24 when I decided I wanted to go to med school, but my commitment kept me in the Army until I was 28. I am no longer on active duty, but my active duty experience made me considerably more desirable to med schools than the typical guy coming out of college. Don't worry about losing any acceptance that you have now - schools LOVE former military. Since I left active duty in an IRR status, I can join a local guard unit and defer any deployments until after residency (typically, the guard allows med students to do this). This way I don't lose my military experience, I still get promoted with my peers, and I don't have to do a military residency. It's the best of both worlds.

You may get to do a civilian residency, but are you looking at being deployed all year around after residency? And then won't your civilian practice suffer?

 

[Mirror Form]

and I don't have to do a military residency. It's the best of both worlds.

Doing a military residency is often to your advantage. As a medical student in a state university that happens to be relatively close to Walter Reed, I know many of civilian residents and attendings that have worked with the Walter Reed staff and attendings. Whenever I mention Walter Reed, I almost always hear good things. One ICU phsycian told me that he that the Walter Reed surgical residents with were some of the best residents he ever worked with. My ophthalmology department also mentioned that they thought the training program there was very good. In general, most military residents I've talked to seem to think their programs, while not tier I, are on par with typical tier II programs. Plus, you get paid FAR more as a military resident and don't have to spend those years being broke.

Granted, there are a few exceptions. Some departments in the military do sometimes suffer from lack of cases. However, the same issue plagues a number of reputable civilian departments. I think the lack of cases for surgeons is more of a major issue after residency.

 

[MoosePilot]

I'm going to check out this whole ambiguous and secret world of going into the reserves or guard while in med school without being sponsored by HPSP. The Air Force has this Palace Chase Force Shaping thing, so hopefully I can get my active duty commitment switched to a reserve commitment, and then serve out all of my time as a reserve doc instead of an AD doc. Even though it is 1:2 years, at least I could do a civilian residency and have much more freedom than HPSPers. If they won't let me exchange my active duty commitment for reserve or guard, I'm just going to go HPSP. I think it's best if I go to school as soon as possible.

I think the Palace Chase thing is insane. All the reservists I know have been activated as much as the law will allow. They're pretty much like active duty (except they get out of some of the BS). So a 2:1 deal is really just buying double the time, most of which you'll do on active duty because your reserve unit has been activated. No thanks.

 

[tscottturner]

You may get to do a civilian residency, but are you looking at being deployed all year around after residency? And then won't your civilian practice suffer?

I think that docs in the guard aren't called up nearly as often as docs in the reserves, although I don't have any evidence to back me up on that. I would think that a major factor is the type of unit you join. Any reserve unit will be gone significantly more than a guard unit, and Army NG probably will be deployed quite a bit more (and for longer periods) than Air NG, which is the way that I am leaning. As far as worrying about a civilian practice suffering - if that is a huge concern, then you would seriously have to consider whether you want to be in the military in any status at all. Deployments are no longer a question of IF, but WHEN.

 

[tscottturner]

Doing a military residency is often to your advantage. As a medical student in a state university that happens to be relatively close to Walter Reed, I know many of civilian residents and attendings that have worked with the Walter Reed staff and attendings. Whenever I mention Walter Reed, I almost always hear good things. One ICU phsycian told me that he that the Walter Reed surgical residents with were some of the best residents he ever worked with. My ophthalmology department also mentioned that they thought the training program there was very good. In general, most military residents I've talked to seem to think their programs, while not tier I, are on par with typical tier II programs. Plus, you get paid FAR more as a military resident and don't have to spend those years being broke.

Granted, there are a few exceptions. Some departments in the military do sometimes suffer from lack of cases. However, the same issue plagues a number of reputable civilian departments. I think the lack of cases for surgeons is more of a major issue after residency.

I am sure that all of the Walter Reed programs are great, but I feel that the military residencies are geared as much towards introducing fresh meat to the military (healthcare) culture as they are towards learning medicine. Most mil docs don't have any military experience prior to starting a residency. Sure, some do, but most don't. As far as getting paid - yes, on paper military residencies pay more. But, since civilian resident's usually have their hours capped at 80 hours a week, more programs are letting residents moonlight which can easily double your annual income.

 

[Croooz]

I am sure that all of the Walter Reed programs are great, but I feel that the military residencies are geared as much towards introducing fresh meat to the military (healthcare) culture as they are towards learning medicine. Most mil docs don't have any military experience prior to starting a residency. Sure, some do, but most don't. As far as getting paid - yes, on paper military residencies pay more. But, since civilian resident's usually have their hours capped at 80 hours a week, more programs are letting residents moonlight which can easily double your annual income.

You are assuming that you are taught the "military" during residency. This doesn't occur because the hospital isn't the "military". Military medicine as practised in the hospitals and clinics isn't the "real" military. The chain of command is very...fuzzy. The hierarchy of medicine is sometimes adhered and other times the military hierarchy is followed. This is one of the major problem with military medicine...which hierarchy to follow? Common sense would dictate you follow the one which would best suit the patients....rank supercedes common-sense in the military.

With the capped hours...that too is on paper. While "officially" you are capped at 80 hours that doesn't stop any resident from doing more "volunteering". I don't personally know of any residents moonlighting. I know of a few who thought about it till the cost of malpractise slapped them in the face.

Your first post is also a bit assuming in regard to the guard deploying versus the reserves. In my experience in the reserves and with close friends in the guard...we saw no difference. I agree the air guard is less likely to deploy and would be the better of 2 evils. However that too will go the way of the dodo bird in a couple of years. The military is getting smaller and smaller and smaller...these conflicts, "peacekeeping" missions, democracy revolts or whatever they're called will continue. Someone has to take up the slack and the reserves and guard will get activated more and more.

 

[tscottturner]

You are assuming that you are taught the "military" during residency. This doesn't occur because the hospital isn't the "military". Military medicine as practised in the hospitals and clinics isn't the "real" military. The chain of command is very...fuzzy. The hierarchy of medicine is sometimes adhered and other times the military hierarchy is followed. This is one of the major problem with military medicine...which hierarchy to follow? Common sense would dictate you follow the one which would best suit the patients....rank supercedes common-sense in the military.

With the capped hours...that too is on paper. While "officially" you are capped at 80 hours that doesn't stop any resident from doing more "volunteering". I don't personally know of any residents moonlighting. I know of a few who thought about it till the cost of malpractise slapped them in the face.

Your first post is also a bit assuming in regard to the guard deploying versus the reserves. In my experience in the reserves and with close friends in the guard...we saw no difference. I agree the air guard is less likely to deploy and would be the better of 2 evils. However that too will go the way of the dodo bird in a couple of years. The military is getting smaller and smaller and smaller...these conflicts, "peacekeeping" missions, democracy revolts or whatever they're called will continue. Someone has to take up the slack and the reserves and guard will get activated more and more.

As far as docs learning the "military", I think we are saying the same thing. It's just coming from opposite perspectives. As a former grunt, I know that West Point and ROTC don't teach future officers/doctors anything about military healthcare other than maybe a little about Tricare. I don't think (although I don't know for sure) HPSP students have any requirement to learn about the military prior to graduation. USUHS grads probably have the best idea of what it's like. While how the "real" military and military healthcare system works may not be taught, it certainly must be learned at some point - which is probably during residency for non USUHSers.

Concerning capped hours, I was simply trying to state that the opportunity was there for a civilian resident to make up the income difference between them and their military counterparts. Whether or not they want to do it is up to them, the opportunity is there. Personally, I don't think that the pay difference is big enough to really be considered a significant advantage- especially if you consider the pay after residency.

I still stick by my original statement- "...I don't have any evidence to back me up on that." Activation and deployment is really more of a unit dependent issue. Locally, we have a C-17 Air NG wing (yes, there is a C-17 wing in the Air NG) that doesn't deploy, but they do receive missions all over the world. There is also an Army NG medical unit that doesn't deploy. When I was in Kuwait/Iraq, Air NG and Reserve units seemed to be pretty good about sticking to rotations of 120 days or shorter. Army NG and Reserve units were typically looking at 6-12 months minimum. The other side of the coin though is that deploying unit's that are short can request individuals from a non-deploying unit. I am sure that this caused a few WTF moments from many docs that didn't think they were going to the Middle East.

 

[MoosePilot]

I still stick by my original statement- "...I don't have any evidence to back me up on that." Activation and deployment is really more of a unit dependent issue. Locally, we have a C-17 Air NG wing (yes, there is a C-17 wing in the Air NG) that doesn't deploy, but they do receive missions all over the world.

You live near Jackson?

 

[tscottturner]

You live near Jackson?

Yes. Over in Clinton.

 

[MoosePilot]

Yes. Over in Clinton.

Cool. Don't let the Jackson guys tell you they're working hard. They came out to Germany when I was running the schedule there. They're still a gentleman's flying club and may always be. I dont' know how Guard airlift would work. I'm surprised they put C-17s in the guard, but it's going to be awesome for disaster help.