HPSP AF or HPSP Army

[asdf123g]

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Im currently picking between the two. I'm not sure what each will offer me honestly post graduation. While navy I've read has the best locations, I dont think I wanna be stuck in GMO land forever.

I consider myself a pretty average person however I am enthusiastic about service and have wanted to do military for the while now. While I could get stationed at Fort No-where and it would suck, it wouldnt be the end of the world for me. I also have no family as far as spouse/kids go. My immediate family is very supportive. I dont plan on dating but I may end up dating in medschool (you never know), but most relationships have like a 90% fail rate anyways.

I know HPSP isn't a bad deal if one does primary care but im not entirely sure what I want to do yet. Either way, I still need to get into medschool first before I seriously start thinking about that.

thoughts on which would be a better fit or just better in general in your opinion? obviously everyone has a different experience but some insight will help. thank you!

 

[68PGunner]

I'll break out the main differences for you:

AF: nice bases w a worse chance of being promoted on time and getting your desired reaidency.

ARMY: a lot of crappy bases w a few hidden gems and a higher chance of being promoted on time and getting your residency. The worst part is that you can pretty much count on a Batallion of Brigade Surgeon slot in your 1st 2 years after residency. This means 20% clinical time and 80% admin time. You will be in the field a lot setting up Role 2 and Role 1 clinics. It sucks major balls.

 

[asdf123g]

I'll break out the main differences for you:

AF: nice bases w a worse chance of being promoted on time and getting your desired reaidency.

ARMY: a lot of crappy bases w a few hidden gems and a higher chance of being promoted on time and getting your residency. The worst part is that you can pretty much count on a Batallion of Brigade Surgeon slot in your 1st 2 years after residency. This means 20% clinical time and 80% admin time. You will be in the field a lot setting up Role 2 and Role 1 clinics. It sucks major balls.

Thanks for the reply! that doesnt sound too good for army.. You make airforce sound better.

 

[HighPriest]

The worst part is that you can pretty much count on a Batallion of Brigade Surgeon slot in your 1st 2 years after residency. This means 20% clinical time and 80% admin time. You will be in the field a lot setting up Role 2 and Role 1 clinics. It sucks major balls.

This depends heavily upon your field. However, the threat of a mandatory brigade surgeon slot is ever-present, potentially career-ending, and definitely a check in the cons column.

 

[68PGunner]

This depends heavily upon your field. However, the threat of a mandatory brigade surgeon slot is ever-present, potentially career-ending, and definitely a check in the cons column.

There is an interventional cardiologist coming to our brigade to be the new Brigade Surgeon. No specialty is safe.

If you sign up for the army, you must embrace the suck and make lemonade out of lemons.

 

[HighPriest]

There is an interventional cardiologist coming to our brigade to be the new Brigade Surgeon. No specialty is safe.

If you sign up for the army, you must embrace the suck and make lemonade out of lemons.

I have yet to meet a specialist in my field who was forced into a brigade surgeon spot in their first or second year after residency. That may be true for some specialties, but not for all. That is the portion of your comment to which I was referring. It is not an automatic. The decision is made based upon whether or not your field is generally overstuffed or understaffed. If the Army suddenly finds itself with too many of your ilk, then you are a major target for a BS spot.
So no one is safe, yes, but for the moment understaffed specialties are not being targeted.

Now if you ask me whether I would bet my career on that, my answer would be absolutely not. You cannot trust the DoD to look out for your interests - ever. And the BS thing is a primary reason I'll complete my remaining ADSO and get out.

 

[Gastrapathy]

There's GI who was sent 5 months after fellowship.

 

[jabreal00]

I have yet to meet a specialist in my field who was forced into a brigade surgeon spot in their first or second year after residency. That may be true for some specialties, but not for all. That is the portion of your comment to which I was referring. It is not an automatic. The decision is made based upon whether or not your field is generally overstuffed or understaffed. If the Army suddenly finds itself with too many of your ilk, then you are a major target for a BS spot.
So no one is safe, yes, but for the moment understaffed specialties are not being targeted.

Now if you ask me whether I would bet my career on that, my answer would be absolutely not. You cannot trust the DoD to learn ok out for your interests - ever. And the BS thing is a primary reason I'll complete my remaining ADSO and get out.

GI is undermanned this year and going forward but the specialty has been tasked heavily over the last 2-3 years with Brigade Surgeon billets.

 

[asdf123g]

Is there a way to find out what specialties are undermanned/staffed for the year or projected to be?

 

[Snowdon48]

I saw that you ruled out Navy due to threat of GMO land. Don't forget that the threat of a flight surgery tour is very real in the AF if you want anything competitive. I am AF HPSP that picked AF over Navy to avoid the GMO mess. After 2 years of med school I realized I wanted a specialty that will likely require a FS tour first. Just something to think about.

 

[HighPriest]

GI is undermanned this year and going forward but the specialty has been tasked heavily over the last 2-3 years with Brigade Surgeon billets.

They must have a terrible consultant. I assume you're saying that they were also undermanned over the last 2-3 years.

Regardless, the fact remains that not every specialty has people plucked for brigade surgeon slots right out of residency. Yet.

 

[HighPriest]

Is there a way to find out what specialties are undermanned/staffed for the year or projected to be?

There isn't a simple way, and it's a moving target. Ultimately I would support the idea that there's little way to know if you're at risk, but it is safe to say that while the level of risk is variable between specialties, everyone is at risk to some extent.
It is simply untrue that you're guaranteed a brigade surgeon spot across the board, as was stated above. But I think the most prudent measure is to assume that you'll get one. Otherwise you're setting yourself up for disappointment. Always plan for the worst, and military medicine is it.

 

[asdf123g]

I saw that you ruled out Navy due to threat of GMO land. Don't forget that the threat of a flight surgery tour is very real in the AF if you want anything competitive. I am AF HPSP that picked AF over Navy to avoid the GMO mess. After 2 years of med school I realized I wanted a specialty that will likely require a FS tour first. Just something to think about.

I thought in AF you just get deferred to the civilian route

 

[Chonal Atresia]

I have yet to meet a specialist in my field who was forced into a brigade surgeon spot in their first or second year after residency. That may be true for some specialties, but not for all. That is the portion of your comment to which I was referring. It is not an automatic. The decision is made based upon whether or not your field is generally overstuffed or understaffed. If the Army suddenly finds itself with too many of your ilk, then you are a major target for a BS spot.
So no one is safe, yes, but for the moment understaffed specialties are not being targeted.

Now if you ask me whether I would bet my career on that, my answer would be absolutely not. You cannot trust the DoD to look out for your interests - ever. And the BS thing is a primary reason I'll complete my remaining ADSO and get out.

The "brigade surgeon initiative" is just another way for the army to push out all the docs that they don't want (because of budgetary issues) since the big wars are over. They got their pound of flesh out of them with deployments and now don't want to pay them anymore. It doesn't make any sense why these positions would be forced upon all specialties at the same time the army has decreased the number of brigades to 32 from 45. If anything, there should be less need for warm bodies.

As it always does, it will come back to bite them when the next major conflict erupts.

BTW HighPriest, did any docs in our specialty get tasked with this career-killing assignment?

 

[HighPriest]

The "brigade surgeon initiative" is just another way for the army to push out all the docs that they don't want (because of budgetary issues) since the big wars are over. They got their pound of flesh out of them with deployments and now don't want to pay them anymore. It doesn't make any sense why these positions would be forced upon all specialties at the same time the army has decreased the number of brigades to 32 from 45. If anything, there should be less need for warm bodies.

As it always does, it will come back to bite them when the next major conflict erupts.

BTW HighPriest, did any docs in our specialty get tasked with this career-killing assignment?

According to our current consultant, while we have had a couple of volunteers, no one has been selected against their will since - well, you know since when.

We are still undermanned. Although the push now is to eliminate our specialty at all of the one-doc shops, consolidating at larger facilities.
Having been on that list of changes this summer, I can say that the workload is considerably less per surgeon (although broader in scope) at the larger facilities. I wonder if that consolidation will ultimately result in our being a bigger target.

It still amazes me that brigade surgeon billets haven't been re-defined to allow PAs or NPs to fill the spots. It's exactly the kind of head-in-a$$ thinking that makes Army Medicine what it is. We'll allow PAs and NPs to practice essentially on par with a residency-trained FP, but we need to pull that FP away from patient care because for some reason you need a real doc to jockey a desk in a BS slot.

It's mis-allocation of resources resultant from a failure to understand the capabilities of your resources. If they did the same thing with artillery, we'd be in big trouble.

 

[haujun]

In Korea...BN surgeons were physician assistants and they were remotely located. I was still responsible for them as BDE Surgeon. I remember O-7 asked during meeting why would Army allow physician assistant practice independently in remote areas and instructed me that a physician needs to work as OIC in the clinic esp in remote areas. I told him that given shortage of physicians we delegate responsibilities to physician assistants. He did not like my answer...

I saw patients every day as BDE Surgeon and I also went to meeting twice a week. If BN Surgeons are physician assistants then I think you cannot have NPs or physician assistants to occupy BDE surgeon. If something were to go wrong they want a physician to explain or take responsibility...

 

[HighPriest]

In Korea...BN surgeons were physician assistants and they were remotely located. I was still responsible for them as BDE Surgeon. I remember O-7 asked during meeting why would Army allow physician assistant practice independently in remote areas and instructed me that a physician needs to work as OIC in the clinic esp in remote areas. I told him that given shortage of physicians we delegate responsibilities to physician assistants. He did not like my answer...

I saw patients every day as BDE Surgeon and I also went to meeting twice a week. If BN Surgeons are physician assistants then I think you cannot have NPs or physician assistants to occupy BDE surgeon. If something were to go wrong they want a physician to explain or take responsibility...

They never have a problem finding someone on which to arbitrarily place blame. The fact is that in most Army settings, PAs and NPs operate entirely without supervision. While there might be someone somewhere who the Army would ultimately (and unfairly) hang out to dry if a mistake was made, its no different from most clinical settings. No one is minding the mid-level providers in most clinics in the Army system. Why should BDE surgeon slots be any different? Your line officer is either upset because he realizes the Army fails to see a difference between a PA and an MD, or he's upset because he doesn't really know the difference himself. There simply isn't a good argument for pulling surgical and subspecialty trained physicians into these sorts of billets. It's a tremendous waste of resources, and it's no better than burning the Army's investments.

 

[68PGunner]

I hate to be the bearer of bad news, but that O7's opinion mirrors the thought process of current Army leadership. Our BN and BDE surgeons are both MDs.

 

[HighPriest]

I hate to be the bearer of bad news, but that O7's opinion mirrors the thought process of current Army leadership. Our BN and BDE surgeons are both MDs.

But the truth is that the O-7's opinion does NOT reflect the current MEDCOM opinion (at least not in practice), to include to opinion of our Nurse General. NPs and PAs function with near-complete anonimity in the primary care setting, or at least they do at the facilities I'm familiary with. That's only four instillations, but I have to imagine that I'm not just winning the lottery every time.

The truth is, I agree that we give PAs and NPs too much freedom in the military system in the first place. So, to some extent my saying that they should take BDE surgeon billets is playing Devil's Advocate. What I don't understand is how we can allow them to essentially practice as FPs on one hand (in the outpatient setting), and yet say that they aren't good enough to fill an operational spot on the other. Or, I should say, I understand why that is the case but I also think it's new-level ******ed.
Neither Army leadership nor MEDCOM leadership as a whole (striking certain specific individuals) know what the capabilities of their assets are, and they're making independent and arbitrary decisions as to how to utilize those assets.


To continue the discussion beyond "because they say so":
Can anyone give examples of some way in which a physician is absolutely necessary in either a BN or BDE surgeon slot? "To monitor the PAs/NPs doesn't count, because that's not happening on the clinical level. Can anyone give an example as to why it makes sense to involuntarily pull subspecialists into these positions ("career advancement" and "to be fair to the FPs" are not reasonable explanations).

 

[HighPriest]

In a practical manner, I honestly agree with the idea of having physician oversight of NPs and PAs, and so I do understand haujun's commander's concern. My point is that while his opinion makes sense, it isn't the way MEDCOM runs it's clinics. They've painted themselves into a corner by allowing terrible retention standards, and then needing to fill those spots with mid-level providers to such an extent that real supervision simply isn't practical. Additionally, if you don't take into consideration the cost of pulling subspecialists into those positions, then you're not really evaluating the risk/benfits of filling those spots with an MD/DO. If you pull a microvascular surgeon out of practice to fill a BDE surgeon billet because he's able to oversee NPs, but you essentially eliminate his ability to continue to perform the microvascular surgery in which you invested, that's a bad trade-off. Especially since he's not going to be able to start up again in 2 years - you've destroyed that asset - unless you want to invest in sending him back to repeat his fellowship.

 

[Snowdon48]

I thought in AF you just get deferred to the civilian route

Each specialty has a certain number of mil residency slots and civilian deferred slots. Let's take EM for example. Last year there were about 16 mil slots and 16 civilian deferment slots but close to 90 applicants. All the people who didn't get one of those 32 slots have to do a transitional year often followed by a 2 yr FS tour.

That data was from a friend that matched AF EM last year so take it with a grain of salt but you get the point.

 

[haujun]

In MEDCOM clinic I am sure there are physicians who are there who can provide supervision if needed even though no real supervision takes place...

Military wants some kind of physician to fill the slot as BDE surgeon whether that is family medicine or radiologist. Military does not care or take consideration of speciality as long as he/she is a physician who can provide some kind of indirect supervision over BN surgeons. This position (physician) is likely assigned into MTOE and this needs to be modified if things going to change by someone much higher than my pay grade.

I encountered a fellowship trained surgeon who were working BDE surgeon who told me that he is getting out ASAP. I am sure in the past these BDE surgeon slots were filled by primary care physician (CPT) but now Army is filling them with physicians (MAJ or higher) who are tend to be fellowship trained sub specialist etc...

 

[HighPriest]

But the truth is that the O-7's opinion does NOT reflect the current MEDCOM opinion, to include to opinion of our Nurse General. NPs and PAs function with near-complete anonimity in the primary care setting, or at least they do at the facilities I'm familiary with. That's only four instillations, but I have to imagine that I'm not just winning the lottery every time.

The truth is, I agree that we give PAs and NPs too much freedom in the military system in the first place. So, to some extent my saying that they should take BDE surgeon billets is playing Devil's Advocate. What I don't understand is how we can allow them to essentially practice as FPs on one hand (in the outpatient setting), and yet say that they aren't good enough to fill an operational spot on the other. Or, I should say, I understand why that is the case but I also think it's new-level ******ed.
Neither Army leadership nor MEDCOM leadership as a whole (striking certain specific individuals) know what the capabilities of their assets are, and they're making independent and arbitrary decisions as to how to utilize those assets.

No bad decision made on the part of MEDCOM leadership will surprise me, but at the same time "because they say so" is not an argument in-and-of itself.

To continue the discussion beyond "because they say so":
Can anyone give examples of some way in which a physician is absolutely necessary in either a BN or BDE surgeon slot? "To monitor the PAs/NPs doesn't count, because that's not happening on the clinical level. Can anyone give an example as to why it makes sense to involuntarily pull subspecialists into these positions ("career advancement" and "to be fair to the FPs" are not reasonable explanations).

In MEDCOM clinic I am sure there are physicians who are there who can provide supervision if needed even though no real supervision takes place...

Military wants some kind of physician to fill the slot as BDE surgeon whether that is family medicine or radiologist. Military does not care or take consideration of speciality as long as he/she is a physician who can provide some kind of indirect supervision over BN surgeons. This position (physician) is likely assigned into MTOE and this needs to be modified if things going to change by someone much higher than my pay grade.

I encountered a fellowship trained surgeon who were working BDE surgeon who told me that he is getting out ASAP. I am sure in the past these BDE surgeon slots were filled by primary care physician (CPT) but now Army is filling them with physicians (MAJ or higher) who are tend to be fellowship trained sub specialist etc...

i get all of that. No offense meant here at all, but that isn't new information. It also doesn't address the concerns I'm raising. Yep, the Army wants a doc. And to an extent I get that. Nope, they don't care what kind - and that's exactly my point when it comes to a misunderstanding of your assets.

They did, in fact, used to fill those positions with primary care. Then the primary care docs became frustrated with the amount of time they as a group were expected to fill those billets. Even though, I might add, it makes the most sense to put them there. So OTSG made the completely irrational decision to fill those slots with people who are the least qualified and who have the most to lose from a clinical standpoint.

I understand the facts of the situation quite well. That unfortunately doesn't explain the rationale.

And I'll add that while I'm sure there's a "supervising physician" for the purposes of scapegoating, most PAs that I've talked to in the primary care clinics have absolutely no idea who that is. They wouldn't know who to turn to even if they wanted to do so. About every 2-3 months I'll see a referral in which a patient was managed so inappropriately that I'll call the provider to discuss it with them. It's almost always a mid-level, they're almost always in a box with no MDs, and they almost always tell me that they don't have a supervisor. Again, on paper I'm sure that they do. But practically they don't - and that's what matters to the patient.

In any case, I suppose what I was interested in was: besides having someone for the command blame, is there something a BDE surgeon does that a PA with some experience couldn't do? I ask because I honestly don't know.

To me, a BDE surgeon billet is somewhere you go when you're ready to stop operating or when the Army is ready for you to stop operating. It involves a lot of very basic primary care for which I am no longer qualified to practice, and it involves filling the command in regarding things about which I have no interest or base knowledge. Am I missing something? Does it actually make SENSE to send a subspecialist to these places involuntarily?

 

[HighPriest]

I also think it's great that O-4 is a requirement. There are CAPTs out there with so much more real military experience than me that it's funny. It seems to me like a case of obeying the letter of the law without regard to its intent, which I think is also the MEDCOM mantra.

 

[asdf123g]

Each specialty has a certain number of mil residency slots and civilian deferred slots. Let's take EM for example. Last year there were about 16 mil slots and 16 civilian deferment slots but close to 90 applicants. All the people who didn't get one of those 32 slots have to do a transitional year often followed by a 2 yr FS tour.

That data was from a friend that matched AF EM last year so take it with a grain of salt but you get the point.

holy crap that SUCKS. Does the trans. year count towards pay back at least?

 

[Red Lobster Actual]

holy crap that SUCKS. Does the trans. year count towards pay back at least?

Nope. But that year does not accrue obligation either.

 

[Shikima]

In a practical manner, I honestly agree with the idea of having physician oversight of NPs and PAs, and so I do understand haujun's commander's concern. My point is that while his opinion makes sense, it isn't the way MEDCOM runs it's clinics. They've painted themselves into a corner by allowing terrible retention standards, and then needing to fill those spots with mid-level providers to such an extent that real supervision simply isn't practical. Additionally, if you don't take into consideration the cost of pulling subspecialists into those positions, then you're not really evaluating the risk/benfits of filling those spots with an MD/DO. If you pull a microvascular surgeon out of practice to fill a BDE surgeon billet because he's able to oversee NPs, but you essentially eliminate his ability to continue to perform the microvascular surgery in which you invested, that's a bad trade-off. Especially since he's not going to be able to start up again in 2 years - you've destroyed that asset - unless you want to invest in sending him back to repeat his fellowship.

What you've described is pretty much at every echelon of federal service.

 

[HighPriest]

What you've described is pretty much at every echelon of federal service.

Yup. But that doesn't make it reasonable either, does it? This is the type of crap that people need to understand before they sign.

 

[Shikima]

Yup. But that doesn't make it reasonable either, does it? This is the type of crap that people need to understand before they sign.

Agreed. Just wanted to point out that it's a lot larger than a particular service branch and is a top-down phenomena.

 

[jabreal00]

But the truth is that the O-7's opinion does NOT reflect the current MEDCOM opinion (at least not in practice), to include to opinion of our Nurse General. NPs and PAs function with near-complete anonimity in the primary care setting, or at least they do at the facilities I'm familiary with. That's only four instillations, but I have to imagine that I'm not just winning the lottery every time.

The truth is, I agree that we give PAs and NPs too much freedom in the military system in the first place. So, to some extent my saying that they should take BDE surgeon billets is playing Devil's Advocate. What I don't understand is how we can allow them to essentially practice as FPs on one hand (in the outpatient setting), and yet say that they aren't good enough to fill an operational spot on the other. Or, I should say, I understand why that is the case but I also think it's new-level ******ed.
Neither Army leadership nor MEDCOM leadership as a whole (striking certain specific individuals) know what the capabilities of their assets are, and they're making independent and arbitrary decisions as to how to utilize those assets.


To continue the discussion beyond "because they say so":
Can anyone give examples of some way in which a physician is absolutely necessary in either a BN or BDE surgeon slot? "To monitor the PAs/NPs doesn't count, because that's not happening on the clinical level. Can anyone give an example as to why it makes sense to involuntarily pull subspecialists into these positions ("career advancement" and "to be fair to the FPs" are not reasonable explanations).

The Brigade Surgeons role is as the medical consultant to the Brigade Commander. They are suppose to help with the operational planning from a medical standpoint. They are also suppose to have a reasonable medical fund of knowledge to help determine the suitability of troops to deploy or leave theater for an acute or chronic medical condition. I agree that the administrative portion, anyone can do it to include an RN, let alone NP or PA. However, having been deployed as a Batallion Surgeon, the medical fund of knowledge most mid-levels who were deployed with me were like a MSII. Are there some senior and experienced mid-levels who can function (medically speaking) as a resident or junior staff, yes but these are far and few between. Most PAs deploying are lieutenants and maybe captains.

Primary care (IM, FP, Peds) and most medicine based sub-specialty can do this job. The fallacy is requiring other specialties (radiology, pathology, dermatology etc) to do this job.

 

[HighPriest]

That's a reasonable answer. To be fair, I'm not sure that I could make a lot of decisions regarding soldiers deploying with chronic illness to any capacity superior to a junior resident at this point. But I don't work a primary care clinic either.

The rank, frankly, doesn't mean as much to me. There are plenty of junior officers who know more about Army function than I do.

In an unrealistic world where each hand knows what the other is doing, I'd like to see the Big Army and MEDCOM come to some kind of consensus as to what mid-level providers are capable of doing, however. My personal opinion is that we do give them far too much practical anonymity. I find it conflicting that we allow them to treat the chronic diseases of soldiers at home without any real supervision, but yet not in the operational setting. Logic would dictate that discrepancy be rectified...but after the 7+ years active I'm not even sure I know what logic sounds like anymore.

 

[huskygirl123]

I'm thinking of applying for the army scholarship. I understand this is relative, but generally speaking what are the chances of being deployed to a war zone during a EM or IM residency?

 

[Clap MD]

I'm thinking of applying for the army scholarship. I understand this is relative, but generally speaking what are the chances of being deployed to a war zone during a EM or IM residency?

Regardless of branch, you won't deploy during residency.

 

[bcmcCormick]

I saw that you ruled out Navy due to threat of GMO land. Don't forget that the threat of a flight surgery tour is very real in the AF if you want anything competitive. I am AF HPSP that picked AF over Navy to avoid the GMO mess. After 2 years of med school I realized I wanted a specialty that will likely require a FS tour first. Just something to think about.

I just read this and I was also curious as to how this whole GMO/FS system works for competitive subspecialties. It sounded to me to be something like a transitional program that helps beef up your application for more competitive residency programs, although I'm sure it's not that cut-and-dried.