HPSP Accession Bonus Change Timeline

[SplitAtom_]

H.R. 5009, section 612 changed the HPSP accession bonus from $20k to $100k. This was signed into law by Biden December of 2024. However, no one seems to be talking about it online, and I can’t find any confirmation from the military online about the change.

I know it will take some time, but I was wondering how long these things typically take to update? I’m applying for the HPSP this year and I don’t want to sign on until I’m sure I can get the 100k amount.

https://www.congress.gov/bill/118th-congress/house-bill/5009?q=

---

Members don't see this ad.

 

[armytrainingsir]

Can you copy and paste the applicable part of that. I don’t think most people have the time or inclination to go trying to find an answer your question. My guess is the law is worded that the bonus may be up to that much but doesn’t have to be that much.

 

[comp1]

Okay, yes, the above poster is right. The new text of 10 USC 2128a reads:

The Secretary of Defense may offer a person who enters into an agreement under section 2122(a)(2) of this title an accession bonus of not more than $100,000 as part of the agreement.

So, it could mean that nothing changes at all. This might be why you don't see anything about it (because it probably won't). Has the OP considered any other possible options to pay for medical school?

 

[usma05]

I wouldn't hold your breath for the increase. The language says "of not more than 100k," which means it can also be less than 100k.

Also, these changes have to be funded in some sense and have to be approved or interpreted by those who dispurse the funds. A small potatoes example: USAR regs increased the allowable funds from $500 to $750 monthly for those who don't have units within 50 miles and have to travel effective 1Jan. When I brought it up with my command they said it wasn't happening and they we were waiting on JAG to interpret the new rule. It's not 100k, but it adds up $3500/yr I'm supposedly entitled to by regs that I'm not getting.

 

[pgg]

I'm a few years post retirement now so I don't have any first hand knowledge, but I will say the $100K is extremely unlikely to actually be offered.

Some years back everyone got excited when the physician special pay language was updated to include similar verbiage authorizing a large increase.

Just because the DOD is authorized by Congress to pay up to $X for something, doesn't mean that they will choose to, or be able to allocate a portion of their budget to do so (at the expense of something else - it's a zero sum game).

It's going to be a hard (impossible) sell to convince the line to spend more money on recruiting medical students so long as the program is filling and all billets are manned.

 

[backrow]

Great comments have already been made. The medical services pushed to get this increased verbiage approved; however, as noted above the actual appropriation for that money wasn’t expected to happen. One of the reasons this was wanted was for the increased speed and flexibility that this allows. If recruiting drops or a need for physicians increases the reaction time of being able to increase the bonus is now drastically increased because it’s already been approved. They basically have “half the battle” in their pocket.

I agree with the above posters that 100k is unlikely to be seen anytime soon, but there very well may be some increase coming if overall physician manning doesn’t improve.

 

[SirGecko]

I'm a few years post retirement now so I don't have any first hand knowledge, but I will say the $100K is extremely unlikely to actually be offered.

Some years back everyone got excited when the physician special pay language was updated to include similar verbiage authorizing a large increase.

Just because the DOD is authorized by Congress to pay up to $X for something, doesn't mean that they will choose to, or be able to allocate a portion of their budget to do so (at the expense of something else - it's a zero sum game).

It's going to be a hard (impossible) sell to convince the line to spend more money on recruiting medical students so long as the program is filling and all billets are manned.

With HPSP recruiting hitting its numbers I agree that I wouldn’t expect to see much of a change.

Even with retention being terrible they don’t really seem to care to increase pay. There are a bunch of specialties that are drastically undermanned right now and I would honestly be surprised if they ever change the IP amounts to that larger amount which is a shame if they actually want to retain people. (Which again they don’t actually seem to want to do despite some statements to the contrary)

I see the argument to be made that increasing retention bonuses is the way to do that (since it is a *retention* bonus) but I think that won’t do much to move the needle without attempting to fix the pay, quality of life and work differential with the civilian medical fields. By the time people are able to sign a retention bonus that ship has likely sailed and it would take a lot more money to make someone think otherwise that was already inclined to get out.

 

[pgg]

The elephant in the room is that retention is an explicit anti-goal.

Senior doctors on retention special pays cost a lot more money than junior doctors in their initial ADSO.

Senior doctors who stay until 20 are fabulously more expensive than junior doctors in their initial ADSO. Retirement costs are an enormous burden to the military - so much so that every so often they slash the benefit as much as they can get away with. High pay, high 3, the new "blended" scheme, they aren't done.

Barely enough senior-ish docs to do the paperwork while new grads do the work is the goal. Hey, even residency program faculty could all be guys 0-4 years out of residency, on their initial ADSOs, right?

The purse holders (ie the line) are being absolutely rational about this, at least from their point of view. There are enough doctor widgets. The doctor widget training pipeline is full. Survival of casualties that reach a role 2 or higher has been 98%+ for decades. Why spend more money on a system that is working perfectly?

If anyone ever tells them that the manning needle won't move if they quit paying ANY medical special pays to doctors under ADSOs ...

Have you ever point-blank asked a line officer why the military gives bonus money to newly graduated doctors who got free tuition and still owe years of service? Major Infantry and Lieutenant Shipdriver will blink at each other and ask why their doc is getting a penny more than O3 pay. And there's actually no real compelling answer to that, beyond what we subjectively think they deserve.

 

[backrow]

If anyone ever tells them that the manning needle won't move if they quit paying ANY medical special pays to doctors under ADSOs ...

Have you ever point-blank asked a line officer why the military gives bonus money to newly graduated doctors who got free tuition and still owe years of service? Major Infantry and Lieutenant Shipdriver will blink at each other and ask why their doc is getting a penny more than O3 pay. And there's actually no real compelling answer to that, beyond what we subjectively think they deserve.

The immediate effect would be negligible; however, the applicant pipeline would dry up pretty quick if applicants knew the pay disparity was going to be even greater for their entire ADSO.

 

[pgg]

The immediate effect would be negligible; however, the applicant pipeline would dry up pretty quick if applicants knew the pay disparity was going to be even greater for their entire ADSO.

I'm not so sure - the only thing we've ever seen actually dry up the HPSP pipeline was Iraq/Afghanistan quagmire around 2006 and all it took to refill it was a little bit more cash up front.

HPSP takers are very debt averse.

Various premed threads over the years have convinced me that they'll do anything to have a shot at a MD or DO degree, with little regard for what comes after. Plenty of threads full of premeds waxing philosophic about how the only salary they'll need is $100K (because they've only known a household earning 1/3 of that, or altruism, or naivete). Or the infamous poop hotdog thread - free tuition is a lot more palatable than a footlong, and ADSO is a future me issue.

They're still signing up despite the decline of inservice GME over the last 20 years.

 

[afteranesthesia]

I'm not so sure - the only thing we've ever seen actually dry up the HPSP pipeline was Iraq/Afghanistan quagmire around 2006 and all it took to refill it was a little bit more cash up front.

HPSP takers are very debt averse.

Various premed threads over the years have convinced me that they'll do anything to have a shot at a MD or DO degree, with little regard for what comes after. Plenty of threads full of premeds waxing philosophic about how the only salary they'll need is $100K (because they've only known a household earning 1/3 of that, or altruism, or naivete). Or the infamous poop hotdog thread - free tuition is a lot more palatable than a footlong, and ADSO is a future me issue.

They're still signing up despite the decline of inservice GME over the last 20 years.

THIS. They have absolutely no clue, and the military preys on that. I think it's criminal, honestly, because their naivete is signing them up for years and years and years of service (residency, fellowship maybe, payback years, potential stop loss if we are in a war), and they just have no clue what they are signing up for and think they'll be fine with whatever is thrown at them. I just wish there was a little less complete and total ignorance with them, but no matter what attempts are made to prevent said ignorance here, they don't listen. Sigh.

 

[armytrainingsir]

THIS. They have absolutely no clue, and the military preys on that. I think it's criminal, honestly, because their naivete is signing them up for years and years and years of service (residency, fellowship maybe, payback years, potential stop loss if we are in a war), and they just have no clue what they are signing up for and think they'll be fine with whatever is thrown at them. I just wish there was a little less complete and total ignorance with them, but no matter what attempts are made to prevent said ignorance here, they don't listen. Sigh.

As someone mentioned earlier or in another thread, HPSP is moving to being a predominantly DO program for those whose only choice is a criminally expensive, for-profit DO school.

 

[afteranesthesia]

As someone mentioned earlier or in another thread, HPSP is moving to being a predominantly DO program for those whose only choice is a criminally expensive, for-profit DO school.

That's still not a DO's only choice. It's just the only one they know about bc they are so ignorant. I wish schools were better at hunting out all the options for med students for paying. Like the VA HPSP or the gobs of jobs out there that will pay your loans off for you for working for them for X years. There are actually many options - the military for money is just the worst one.

 

[armytrainingsir]

That's still not a DO's only choice. It's just the only one they know about bc they are so ignorant. I wish schools were better at hunting out all the options for med students for paying. Like the VA HPSP or the gobs of jobs out there that will pay your loans off for you for working for them for X years. There are actually many options - the military for money is just the worst one.

I haven’t heard of too many places paying off 300k+ loans other than the military. Most seem to top out at 80-120k.

 

[militaryPHYS]

The elephant in the room is that retention is an explicit anti-goal.

Senior doctors on retention special pays cost a lot more money than junior doctors in their initial ADSO.

Senior doctors who stay until 20 are fabulously more expensive than junior doctors in their initial ADSO. Retirement costs are an enormous burden to the military - so much so that every so often they slash the benefit as much as they can get away with. High pay, high 3, the new "blended" scheme, they aren't done.

Barely enough senior-ish docs to do the paperwork while new grads do the work is the goal. Hey, even residency program faculty could all be guys 0-4 years out of residency, on their initial ADSOs, right?

The purse holders (ie the line) are being absolutely rational about this, at least from their point of view. There are enough doctor widgets. The doctor widget training pipeline is full. Survival of casualties that reach a role 2 or higher has been 98%+ for decades. Why spend more money on a system that is working perfectly?

If anyone ever tells them that the manning needle won't move if they quit paying ANY medical special pays to doctors under ADSOs ...

Have you ever point-blank asked a line officer why the military gives bonus money to newly graduated doctors who got free tuition and still owe years of service? Major Infantry and Lieutenant Shipdriver will blink at each other and ask why their doc is getting a penny more than O3 pay. And there's actually no real compelling answer to that, beyond what we subjectively think they deserve.

What are you even talking about?! No line officer I have worked with has ever once cared that the special pays for doctors exists… just like any other special pay (flight, nuke, etc. etc.).

If you removed special pay for physicians it would absolutely hurt numbers. Look at PA’s right now. It wouldn’t take long for people to realize. And, dare I mention this and start another standard MilMed SDN firestorm, but if you actually crunch numbers when accounting for cost of living adjustments, loan payback, taxes, VA loan, GI bill, malpractice…many specialties would be close to break even during their first 4 to 7 years out of training.

I agree that MilMed has little interest in retaining, but maintaining is absolutely necessary. They don’t have to work very hard because with increasing costs of med school, lower physician reimbursement and hassles with insurance, etc…they all hurt the allure of the alternative these days. More and more physicians are becoming widgets on the civilian side too.

 

[pgg]

What are you even talking about?! No line officer I have worked with has ever once cared that the special pays for doctors exists… just like any other special pay (flight, nuke, etc. etc.).

If you removed special pay for physicians it would absolutely hurt numbers. Look at PA’s right now. It wouldn’t take long for people to realize. And, dare I mention this and start another standard MilMed SDN firestorm, but if you actually crunch numbers when accounting for cost of living adjustments, loan payback, taxes, VA loan, GI bill, malpractice…many specialties would be close to break even during their first 4 to 7 years out of training.

I don't see anything in your post that actually disagrees with anything I wrote.

If we disagree about retention goals, it's that you think they don't care about retention, and I think they intentionally discourage retention (of clinicians).

The line doesn't care what doctors are paid because they're largely unaware. And the scale ... aviation incentive pay tops out at what, $800 per month or so? If you sat down in a room full of USMC battalion commanders and XOs and asked them if they knew their O3 GMOs were earning as much (or more) than them, they'd have an opinion to share.


Anyway, my point was simply that removing special pays for physicians serving ADSOs would not affect staffing numbers. The proof for this is self-evident: they've changed the names of the special pays (ISP/ASP/VSP to IP/RP etc) but the absolute dollar amounts paid to these physicians hasn't changed at all in the last 30 years. Not a bit. Accounting for inflation, they've been cutting that pay for three straight decades and it hasn't impacted recruitment or manning.

HPSP'ers aren't joining with any understanding at all of the O3 physician pay scale. If you quizzed 10 HPSP MS3s rotating through your hospital about the pay and benefits they'll get upon graduating internship, 8 of them won't have any idea.

If they completely cut special pays to everyone on ADSOs and added even 1/4 of the money saved to retention contracts, it might actually improve numbers. But again, retention is an anti-goal, so they won't shift money from the pool everyone gets to a pool only offered as a retention tool.


The GI bill isn't really a benefit for most military physicians, since transferring it requires a period on AD well beyond the usual HPSP payback. (They've also reduced the benefit that can be transferred to dependents, but that's another discussion.)

10-15 years ago the military-civilian physician pay gap was much smaller, and some of the primary care specialties were on par or even better than civilian. That just isn't the case any more. Primary care pay has made a lot of progress on the civilian side.

I agree that MilMed has little interest in retaining, but maintaining is absolutely necessary. They don’t have to work very hard because with increasing costs of med school, lower physician reimbursement and hassles with insurance, etc…they all hurt the allure of the alternative these days. More and more physicians are becoming widgets on the civilian side too.

We agree! Except perhaps one quibble -

More and more physicians are becoming fabulously well-paid widgets with on the civilian side too.

FTFY 🙂

Don't get me wrong, it isn't perfect out here. Hardly a week goes by that I don't feel like kicking some administrator square in the gonads, and there's one particular department of pseudo-surgical proceduralists I hate with the heat of a supermassive black hole ... 🙂

 

[afteranesthesia]

I don't see anything in your post that actually disagrees with anything I wrote.

If we disagree about retention goals, it's that you think they don't care about retention, and I think they intentionally discourage retention (of clinicians).

The line doesn't care what doctors are paid because they're largely unaware. And the scale ... aviation incentive pay tops out at what, $800 per month or so? If you sat down in a room full of USMC battalion commanders and XOs and asked them if they knew their O3 GMOs were earning as much (or more) than them, they'd have an opinion to share.


Anyway, my point was simply that removing special pays for physicians serving ADSOs would not affect staffing numbers. The proof for this is self-evident: they've changed the names of the special pays (ISP/ASP/VSP to IP/RP etc) but the absolute dollar amounts paid to these physicians hasn't changed at all in the last 30 years. Not a bit. Accounting for inflation, they've been cutting that pay for three straight decades and it hasn't impacted recruitment or manning.

HPSP'ers aren't joining with any understanding at all of the O3 physician pay scale. If you quizzed 10 HPSP MS3s rotating through your hospital about the pay and benefits they'll get upon graduating internship, 8 of them won't have any idea.

If they completely cut special pays to everyone on ADSOs and added even 1/4 of the money saved to retention contracts, it might actually improve numbers. But again, retention is an anti-goal, so they won't shift money from the pool everyone gets to a pool only offered as a retention tool.


The GI bill isn't really a benefit for most military physicians, since transferring it requires a period on AD well beyond the usual HPSP payback. (They've also reduced the benefit that can be transferred to dependents, but that's another discussion.)

10-15 years ago the military-civilian physician pay gap was much smaller, and some of the primary care specialties were on par or even better than civilian. That just isn't the case any more. Primary care pay has made a lot of progress on the civilian side.




We agree! Except perhaps one quibble -



FTFY 🙂

Don't get me wrong, it isn't perfect out here. Hardly a week goes by that I don't feel like kicking some administrator square in the gonads, and there's one particular department of pseudo-surgical proceduralists I hate with the heat of a supermassive black hole ... 🙂

IR or Interventional Cardiology - either or or both I'd bet double or nothing here....

Also, residency pay on the civilian side is about equal to military pay for residents many places. Minus the savings of healthcare costs you can't argue that a military residency is a more stable financial choice anymore. You just can't.

 

[comp1]

So the VA EDRP is $200k for five years and is prorated, so you can leave at any time. Further, you qualify for PSLF (in addition to EDRP) which you can take to another non-profit or government job and any remaining loans are paid off in 10 years. And this is all without even doing the VA's HPSP which at least has a somewhat lower risk of deployments.

 

[militaryPHYS]

I don't see anything in your post that actually disagrees with anything I wrote.

If we disagree about retention goals, it's that you think they don't care about retention, and I think they intentionally discourage retention (of clinicians).

The line doesn't care what doctors are paid because they're largely unaware. And the scale ... aviation incentive pay tops out at what, $800 per month or so? If you sat down in a room full of USMC battalion commanders and XOs and asked them if they knew their O3 GMOs were earning as much (or more) than them, they'd have an opinion to share.


Anyway, my point was simply that removing special pays for physicians serving ADSOs would not affect staffing numbers. The proof for this is self-evident: they've changed the names of the special pays (ISP/ASP/VSP to IP/RP etc) but the absolute dollar amounts paid to these physicians hasn't changed at all in the last 30 years. Not a bit. Accounting for inflation, they've been cutting that pay for three straight decades and it hasn't impacted recruitment or manning.

HPSP'ers aren't joining with any understanding at all of the O3 physician pay scale. If you quizzed 10 HPSP MS3s rotating through your hospital about the pay and benefits they'll get upon graduating internship, 8 of them won't have any idea.

If they completely cut special pays to everyone on ADSOs and added even 1/4 of the money saved to retention contracts, it might actually improve numbers. But again, retention is an anti-goal, so they won't shift money from the pool everyone gets to a pool only offered as a retention tool.


The GI bill isn't really a benefit for most military physicians, since transferring it requires a period on AD well beyond the usual HPSP payback. (They've also reduced the benefit that can be transferred to dependents, but that's another discussion.)

10-15 years ago the military-civilian physician pay gap was much smaller, and some of the primary care specialties were on par or even better than civilian. That just isn't the case any more. Primary care pay has made a lot of progress on the civilian side.




We agree! Except perhaps one quibble -



FTFY 🙂

Don't get me wrong, it isn't perfect out here. Hardly a week goes by that I don't feel like kicking some administrator square in the gonads, and there's one particular department of pseudo-surgical proceduralists I hate with the heat of a supermassive black hole ... 🙂

I absolutely disagree that cutting special pays wouldn’t hurt numbers. Even the most gung-go MilMed folks factor in expected pay during their time in…especially during residency, fellowship and payback. Significantly higher pay during residency is a big deal, especially for long residencies. That is the early earnings portion of a career and has a huge impact on quality of life and more importantly growth on investments during that time…especially if you are someone who doesn’t want/need to earn 350k+.

This forum has a lot of contributors who also happen to be in high paying specialties who want to make the most amount of money possible. Nothing wrong with that and it makes a ton of sense! BUT that isn’t everyone and the perspectives between the two groups are vastly different.