HPSP For Specific Reasons

[sylvester500]

Good evening.

I am considering USAF HPSP. However, upon thinking a bit harder, I realized I would really only be happy with one outcome: General Surgery / Emergency Medicine residency, followed by time split between air force base practice peppered with deployments on a Critical Care Air Transport Team (CCATT) or Special Operations Surgical Team (SOST).

I don't see any other outcomes with which I would be happy as a physician / surgeon in the military. How unrealistic is it for me to be this dead-set? And, does anybody have suggestions for alternative paths?

Thank you very much.

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[armytrainingsir]

Well, for starters you pick either general surgery OR emergency medicine.
Second, the AF is the smallest of the three, so fewer opportunities.
And lastly, trying to plan such a narrow path when you have very very little control is a fool's errand. You are almost guaranteed to be unhappy.
Happy .mil physician careers are more Forrest Gump than anything else.

Alternative path?
Army or Navy HPSP, hope for the best while expecting and planning for the worst.
OR
Reserves after your residency and have more control over your life.


I'm sure others will be along with more suggestions

 

[sylvester500]

Well, for starters you pick either general surgery OR emergency medicine.
Second, the AF is the smallest of the three, so fewer opportunities.
And lastly, trying to plan such a narrow path when you have very very little control is a fool's errand. You are almost guaranteed to be unhappy.
Happy .mil physician careers are more Forrest Gump than anything else.

Alternative path?
Army or Navy HPSP, hope for the best while expecting and planning for the worst.
OR
Reserves after your residency and have more control over your life.


I'm sure others will be along with more suggestions

Right right. EM OR Gen Surg. You gave me the answer I was kind of expecting. Disappointing, but this forum paints a much less sunshine and rainbows picture than any other online or personal resource.

Do you know, if one is to pursue reserve duty, do they do loan repayment? Also, is this option pursued after graduating from medical school, or after finishing residency?

 

[armytrainingsir]

Not trying to be discouraging. i have had a great time, but I am not naive enough to think everybody will have a good go like me.
I just want folks to think a bit and be ready for to get what they signed up for, not what they wanted.
And, to be a bit selfish, I don't want to be deployed for months with some whiny, bitchass prima donna that didn't think THEY would ever be deployed.

Looking back, my career has been fun and rewarding, both civilian and military, but I could have never dreamed, let alone planned any of it.

Look around here for a basic understanding of what is out there for you:

Thinking of joining the military? An overview of what is available (Army) at every stage of training.

So, you want to join the military? Its is tough as a civilian to figure out what the military offers. All the acronyms get confusing. And even the healthcare recruiters don't know the ins and outs of the programs they are pushing. IME, most have no knowledge of army medicine other than going...

forums.studentdoctor.net

 

[Helpful Troll]

I don't see any other outcomes with which I would be happy as a physician / surgeon in the military. How unrealistic is it for me to be this dead-set? And, does anybody have suggestions for alternative paths?

It's unrealistic to be dead-set and narrowly focused on anything in MILMED. Alternative path? - don't join the military. Take out loans and go civilian. Do a civilian side gig as a County Health Officer leading the relationships between EMS and local/regional hospitals - like life flight operations.

 

[DeadCactus]

It's great that you are thinking forward and have a clear goal in mind that you can work to. That being said, everyone wants to be a special operations trauma surgeon or globe trotting public health hero. Then the option of making six-figures working 4 days a week, spending off time with family, and self-funding just about any imaginable adventure shows up and suddenly they disappear like all those college freshman who started out as pre-meds.

This isn't to call into question your dedication to your goal, just the reality and the importance of flexibility. If you're not going to be able to carve out some happiness doing something like 4 years at a podunk base with a deployment to Qatar, then HPSP probably isn't the best option. The Guard or Reserve would be a better option, and both have paths to CCAT and SOST, where you'll have more flexibility to pursue back-up plans and avoid what you don't want.

The military is full of units that do interesting work and there are plenty of paths to them from both active duty and the Guard/Reserve. The opportunities that exist now may not exist when you finish training and new ones may emerge so this is all very much putting the cart before the horse. Your decision right now is pretty straightforward: are you willing to accept the loss of control that comes with HPSP? It doesn't sound like it to me. So go the civilian route through medical school and residency and then re-evaluate what you want and what your options are. It'll be easier to pursue specific goals at that point.

To touch on alternative paths, all the branches have opportunities for operational medicine with the Army having the most in quantity and diversity. There are opportunities on the Active Duty side and the Reserve/Guard side. To be honest, this makes your focus on SOST/CCAT so oddly specific that it's hard to provide advice because it's not clear what makes that specific endpoint so desirable to you.

 

[pgg]

This is a bad time for anyone[1] to be joining via HPSP. So much is changing with the Defense Health Administration (DHA) taking over. A great deal is in flux. The future of military GME (residency programs) is very uncertain. Joining now is committing yourself to training at a military residency program 5-10 years from now. Depending on your eventual chosen specialty, that training may be good, poor, or non-existent.

The trend over the last 20 years has been for great programs to become good, good programs to become OK, and OK programs to become poor. It's mainly an issue of declining case volume and complexity. I don't see any reason for this trend to reverse, given DHA's emphasis on operational and war-critical specialties at the expense of other specialties.


[1] People who have significant prior military service might be an exception to this, since they have years creditable toward retirement, and possibly rank if their prior service was as an officer. They also have an idea of what they're getting themselves into, culturally speaking.

 

[sylvester500]

It's great that you are thinking forward and have a clear goal in mind that you can work to. That being said, everyone wants to be a special operations trauma surgeon or globe trotting public health hero. Then the option of making six-figures working 4 days a week, spending off time with family, and self-funding just about any imaginable adventure shows up and suddenly they disappear like all those college freshman who started out as pre-meds.

This isn't to call into question your dedication to your goal, just the reality and the importance of flexibility. If you're not going to be able to carve out some happiness doing something like 4 years at a podunk base with a deployment to Qatar, then HPSP probably isn't the best option. The Guard or Reserve would be a better option, and both have paths to CCAT and SOST, where you'll have more flexibility to pursue back-up plans and avoid what you don't want.

The military is full of units that do interesting work and there are plenty of paths to them from both active duty and the Guard/Reserve. The opportunities that exist now may not exist when you finish training and new ones may emerge so this is all very much putting the cart before the horse. Your decision right now is pretty straightforward: are you willing to accept the loss of control that comes with HPSP? It doesn't sound like it to me. So go the civilian route through medical school and residency and then re-evaluate what you want and what your options are. It'll be easier to pursue specific goals at that point.

To touch on alternative paths, all the branches have opportunities for operational medicine with the Army having the most in quantity and diversity. There are opportunities on the Active Duty side and the Reserve/Guard side. To be honest, this makes your focus on SOST/CCAT so oddly specific that it's hard to provide advice because it's not clear what makes that specific endpoint so desirable to you.

This is super helpful. I certainly would be interested in serving overseas independent over a special operations team.

However, I do have serious reservations regarding freedom to specialize, the culture of the military, and, yes, general lack of control.

What I have basically concluded now is this: I want to practice medicine in the military for fairly specific reasons and in fairly specific capacities. I do not want to get "caught up in the military machine" and have all my efforts and goals cast to the wayside as I am incorporated into this machine as the military sees fit. I can defer the financial rewards up front, have the freedom I want come residency / fellowship selection, join the reserves / guards if I still want to pursue the specifics I want to pursue, and perhaps pursue to repayment options after the fact (HPLRP).

 

[sylvester500]

This is a bad time for anyone[1] to be joining via HPSP. So much is changing with the Defense Health Administration (DHA) taking over. A great deal is in flux. The future of military GME (residency programs) is very uncertain. Joining now is committing yourself to training at a military residency program 5-10 years from now. Depending on your eventual chosen specialty, that training may be good, poor, or non-existent.

The trend over the last 20 years has been for great programs to become good, good programs to become OK, and OK programs to become poor. It's mainly an issue of declining case volume and complexity. I don't see any reason for this trend to reverse, given DHA's emphasis on operational and war-critical specialties at the expense of other specialties.


[1] People who have significant prior military service might be an exception to this, since they have years creditable toward retirement, and possibly rank if their prior service was as an officer. They also have an idea of what they're getting themselves into, culturally speaking.

Yeah — this is what I am most reserved about. Most of my interests are critical wartime specialties (Gen Surg, EM / CCM), but I also know me. I analyze almost to a fault. So, I can totally see myself suddenly turning on a dime in med school and choosing Peds, Rad Onc, Uro, ID instead. There's just too much uncertainty in the future of a matriculating medical student such as myself to not have control when there will eventually be certainty. Bummer.

 

[orbitsurgMD]

Good evening.

I am considering USAF HPSP. However, upon thinking a bit harder, I realized I would really only be happy with one outcome: General Surgery / Emergency Medicine residency, followed by time split between air force base practice peppered with deployments on a Critical Care Air Transport Team (CCATT) or Special Operations Surgical Team (SOST).

I don't see any other outcomes with which I would be happy as a physician / surgeon in the military. How unrealistic is it for me to be this dead-set? And, does anybody have suggestions for alternative paths?

Thank you very much.

[Bolds mine]

You should find another way. The military services do not make physician training, never mind specific physician training for particular individuals, a priority. If anything, the trend has been consistently one that is moving away from training generally and, despite the latest lip-service made toward acquiring a trained cohort of "Bucket 1" wartime-essential specialists, the resource commitments are consistently shifting against supporting the necessary enterprises to produce and sustain those specialists. Reducing hospital numbers, converting facilities to outpatient-only status, reducing numbers of training slots, increasing the amount of outservice rotations for residents, none of that serves the core needs of a medical school graduate who needs to find a way into and through residency training. The decades of kiting HPSP accessions with one year of internship as GMOs of different flavors doesn't look to be stopping.

It is time to call the recruitment process what it really is, a grift.

 

[GreenHousePub]

Special Operations Surgical Team (SOST).

Not to piss in your cornflakes, but the guys I knew (for the Navy at least) in this were all former seals/special ops themselves.

I'm a podiatrist so my experience is different but I really loved the military experience and got great surgeries and experience out of it.

 

[sylvester500]

Thank you all very much for your feedback. Actually found a cool, niche civilian route — Tactical EMS (TEMS). Leaning more toward civilian training with reserve duties post-training alongside TEMS duties.

On an semi-unrelated note, has anybody heard of joining National Guard during medical school? I want to do fire control within NG. Just not sure if it's worth it in the grander context of my career goals.