HPSP Match Outlook

[btsbaby]

Hi!

I'm a rising MS2 at a school with 67k/yr tuition. I have been offered the 3-year army HPSP scholarship which I planned to sign within the next few weeks. I have done pretty extensive research for myself so I am aware of the many negatives of committing to HPSP. Despite all those concerns, I was still okay with going the HPSP route bc:

1. I believed that I was committed to primary care (i know, pretty silly of me to think that I knew what I wanted to do so early in my medical education) so the relatively low military pay wouldn't have affected me as much (and therefore only would have to give back 3 years post-residency)
2. Financial situation for my parents who are immigrants and always stressed about money so even though I was never too pressed about being 400k in debt, they could barely sleep at night thinking about it (even though I've made it clear they are in no way responsible for helping me with my debt) so I wanted to alleviate their concerns and let them retire without worrying about me (they are in their 70s and should retire soon)
3. I believe that I am extremely flexible with my life and wouldn't mind the annoying things that you have to put up with in the military as much as the average doc would.
4. I do have a desire to serve others and feel that a short 3-4 year spurt as a military doc would give me some great life experiences without needing to commit a massive chunk of my life

HOWEVER, my specialty aspirations have changed and my priority as of now is anesthesia and second is an IM fellowship route (considering Heme onc). My main concerns are the match possibilities which I know are notoriously unpredictable. My ability to match into the specialty of my choosing is pretty important to me so I was wondering the outlook for matching into army anesthesia and how much harder that will be than civilian matching. I believe I have the chops to be a competitive applicant for anesthesia, but I don't wanna risk that opportunity. The idea of extending my service time to 8+ years post-med school also does not seem appealing, which I know is very possible if I cannot match into gas immediately and have to do GMO years or if I do a heme-onc fellowship through the army (which the payback is my residency and fellowship years +1). I also hear there is a good chance the army will straight up deny me the opportunity to do a fellowship??

I definitely should have more seriously considered the possibility of me switching my specialty before I committed this far into the application, I really regret not preparing more. However, I am making sure to do my due diligence now before I sign anything. If the chance of matching anesthesia through HPSP is not markedly lower than matching civilian, I honestly don't mind HPSP route. However, if there is a very noticeable difference in match rates historically, I likely will decline the scholarship. Open to any thoughts!! Thank you so much))

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[Special Delivery]

Don't do it.

Counterpoints...
1. You don't know what specialty you want. You won't start clinical rotations for another year. You can't make that decision now.
2. Tell your parents you're a grown adult and can take care of yourself, and they don't need to worry. Come up with a reasonable plan to manage your student loans like most everyone else has, without selling your soul.
3. You have no idea what annoying things in the military are.
4. It is a massive chunk of your life, though. And it's your training.

Saying you don't mind the HPSP route at your stage of career is like a woman 20 weeks pregnant with her first saying she doesn't mind contractions and wants a natural birth, no epidural thanks.

Sounds like a great idea. Let us know how it goes.

 

[afteranesthesia]

Sigh. No one reads anything. It's this post after this post over and over and over again.

 

[Nontrad_FL_LGBT]

Hi!

I'm a rising MS2 at a school with 67k/yr tuition. I have been offered the 3-year army HPSP scholarship which I planned to sign within the next few weeks. I have done pretty extensive research for myself so I am aware of the many negatives of committing to HPSP. Despite all those concerns, I was still okay with going the HPSP route bc:

1. I believed that I was committed to primary care (i know, pretty silly of me to think that I knew what I wanted to do so early in my medical education) so the relatively low military pay wouldn't have affected me as much (and therefore only would have to give back 3 years post-residency)
2. Financial situation for my parents who are immigrants and always stressed about money so even though I was never too pressed about being 400k in debt, they could barely sleep at night thinking about it (even though I've made it clear they are in no way responsible for helping me with my debt) so I wanted to alleviate their concerns and let them retire without worrying about me (they are in their 70s and should retire soon)
3. I believe that I am extremely flexible with my life and wouldn't mind the annoying things that you have to put up with in the military as much as the average doc would.
4. I do have a desire to serve others and feel that a short 3-4 year spurt as a military doc would give me some great life experiences without needing to commit a massive chunk of my life

HOWEVER, my specialty aspirations have changed and my priority as of now is anesthesia and second is an IM fellowship route (considering Heme onc). My main concerns are the match possibilities which I know are notoriously unpredictable. My ability to match into the specialty of my choosing is pretty important to me so I was wondering the outlook for matching into army anesthesia and how much harder that will be than civilian matching. I believe I have the chops to be a competitive applicant for anesthesia, but I don't wanna risk that opportunity. The idea of extending my service time to 8+ years post-med school also does not seem appealing, which I know is very possible if I cannot match into gas immediately and have to do GMO years or if I do a heme-onc fellowship through the army (which the payback is my residency and fellowship years +1). I also hear there is a good chance the army will straight up deny me the opportunity to do a fellowship??

I definitely should have more seriously considered the possibility of me switching my specialty before I committed this far into the application, I really regret not preparing more. However, I am making sure to do my due diligence now before I sign anything. If the chance of matching anesthesia through HPSP is not markedly lower than matching civilian, I honestly don't mind HPSP route. However, if there is a very noticeable difference in match rates historically, I likely will decline the scholarship. Open to any thoughts!! Thank you so much))

Army match, like 85% of people get their top choice program and 95% get their specialty with a less desired program.

Honestly, the only people posting in these forums are old salty dudes that retired 10+ years ago and hated being in the military or med students/residents that don't have much mil med experience to advise you adequately. I'm in the second camp.

You only get one shot at life, do what feels right to you. No doctor is on food stamps or living in a cardboard box, you'll be fine.

 

[Special Delivery]

You only get one shot at life, do what feels right to you.

Or you could listen to your amygdala.

 

[afteranesthesia]

Army match, like 85% of people get their top choice program and 95% get their specialty with a less desired program.

Honestly, the only people posting in these forums are old salty dudes that retired 10+ years ago and hated being in the military or med students/residents that don't have much mil med experience to advise you adequately. I'm in the second camp.

You only get one shot at life, do what feels right to you. No doctor is on food stamps or living in a cardboard box, you'll be fine.

Or people like myself who recently separated. My experience is current. Especially for anesthesiology. People are dumb for not listening, but then - so was I when I posted in here years and years and years ago....What I've seen - you are going to assume a lot and do what you want. You will most likely regret except if you are one solitary Navy orthopod who posts here. Then you will post here after lamenting the fact that you weren't smart enough to listen to folks like me and then will repeat the pattern this time you will be posting as we do. Sigh. It's exhausting to watch happen.

 

[militaryPHYS]

Or we as a system could ensure applicants have the opportunity to meet and interact with a variety of active duty docs to get a true understanding before signing.

To the OP. If you’re worried about matching a specific specialty I would stay civilian. But the differences between anesthesia and heme/onc couldn’t be larger so you have no idea what you want to do which is normal.

If you’re having second thoughts you should listen to them. You can always join later if you want

 

[Gastrapathy]

Army match, like 85% of people get their top choice program and 95% get their specialty with a less desired program.

Honestly, the only people posting in these forums are old salty dudes that retired 10+ years ago and hated being in the military or med students/residents that don't have much mil med experience to advise you adequately. I'm in the second camp.

You only get one shot at life, do what feels right to you. No doctor is on food stamps or living in a cardboard box, you'll be fine.

Think critically for a moment. How is it possible that 85% of applicants get their top choice for both specialty and location in the Army? These are medical students who want to match and so they tailor their rank lists to accommodate their situation. Do you really believe that more people wanted to be FM residents in Killeen than wanted to do Derm at Tripler?

Current doctors don’t post because 1)message boards are so 2005 and 2)it’s not worth the risk/energy. The current attendings I know are adamant that things are so much worse than they were when I left. I’m not sure if that’s true or if their perspective has changed as they bear the brunt of their earlier decisions.

 

[MedicalCorpse]

HOWEVER, my specialty aspirations have changed and my priority as of now is anesthesia and second is an IM fellowship route (considering Heme onc).

Hi. Please allow me to stop you right there.

Anesthesiology and Heme-onc are about as diametrically opposite as you can get in medicine (second only to orthopedics).

As Special Delivery and MilitaryPhys stated, you have no idea what specialty you even want, let alone what you can get in the military. If it seems as though I am repeating the wisdom others have already given to you, it's because I am. Repetition is the mother the mother of learning, and all that jazz.

It's OK to be unsure of your eventual specialty at your stage of training. It's even expected.

From age five until my anesthesiology (note, not "anesthesia" or "gas") rotation at Naval Hospital Bethesda at the beginning of my MS-3 year in 1988, I was certain I wanted to be a family practitioner like the kind physician who had cared for me from age 5 through high school. When I walked into the preop area on day one of my third year, I had no idea what being an anesthesiologist was even about. Those few weeks completely changed the course of my life.

Yes, I left the military almost twenty years ago, but I have been in touch with attendings who served for many years later. Every single one of them attests that things have only gotten much worse than when I left. I mean, back then, we actually had the military (not DHA) in charge of what was then military medicine but which, sadly, is no longer.

For your convenience, I have curated on my web site a number of threads here on SDN regarding Reasons Not to Stay In (or Join) this putrefacting military "health care" abomination which puts CRNAs in command of anesthesiologists, nurses in command of other physicians, and profit for civilian insurance executives who run TRICARE over the health and well-being of our troops, their dependents, and our retirees, the latter of whom remain cruelly neglected and underserved until they get orders to return to active duty involuntarily at age 86.

I hope you make the right decision with the information that all of us (including the optimists) give you here on SDN and elsewhere.

PS As MilitaryPhys said, before you sign (a good chunk of) your life away, you may want to look into visiting a DHA hospital near you to talk to some of the active duty physicians there. I have no idea about the logistics thereof; perhaps some of our currently-active duty docs could help you out.

Best of luck.

 

[btsbaby]

Thanks everyone for their advice! I really appreciate everyone's insight. I have decided against signing the contract and I am confident and happy with my decision!

 

[Chonal Atresia]

Thanks everyone for their advice! I really appreciate everyone's insight. I have decided against signing the contract and I am confident and happy with my decision!

A career saved! A small battle won in the war to fix military medicine.

 

[militaryPHYS]

Can you elaborate on how this is fixing military medicine?

 

[Chonal Atresia]

Can you elaborate on how this is fixing military medicine?

Destroying Medical Corps recruitment one person at a time so the pipeline dries up and a massive physician shortage ensues. This is the only way to get these 0-6/0-7 *****s attention.

 

[militaryPHYS]

Destroying Medical Corps recruitment one person at a time so the pipeline dries up and a massive physician shortage ensues. This is the only way to get these 0-6/0-7 *****s attention.

Got it. Just wanted to confirm.

When there are no MilMed physicians and there is no capacity out in town, how will these tricare patients receive care?

 

[Chonal Atresia]

Got it. Just wanted to confirm.

When there are no MilMed physicians and there is no capacity out in town, how will these tricare patients receive care?

They’ll always be debt-ridden students at for-profit DO schools that take this “scholarship.”

The only way change has any real chance of being enacted is if the doctor pipeline dries up…everyone knows this is a fact.

As stated in another thread, DHA wants patients to give up on getting care as it will save them $$$ to buy super-expensive jets and weapons that the Pentagon does not want or need.

 

[militaryPHYS]

The only way change has any real chance of being enacted is if the doctor pipeline dries up…everyone knows this is a fact.

Right, so who is going to take care of your fighting force and their families?

As stated in another thread, DHA wants patients to give up on getting care as it will save them $$$ to buy super-expensive jets and weapons that the Pentagon does not want or need.

Actually, right sizing the MilMed force was the goal. Utilizing care out in town was part of the process but was met with poor access and the issues with tricare reimbursement were realized. Now adjustments have been made but will take some time to see the effects.

Everyone knows that if/when the pipeline dries up, new incentives and shorter contracts will sweeten the deal enough to fill the void. Then we get less qualified applicants who know even less about MilMed before signing up because the incentives are so high. They won’t even think twice before signing.

Why not work on fixing the system while we identify well qualified and well informed applicants to take care of our people and their families? Or we could hope there are no physicians left so our warfighters and families are left out to dry as your plan suggests.

 

[afteranesthesia]

Right, so who is going to take care of your fighting force and their families?

Actually, right sizing the MilMed force was the goal. Utilizing care out in town was part of the process but was met with poor access and the issues with tricare reimbursement were realized. Now adjustments have been made but will take some time to see the effects.

Everyone knows that if/when the pipeline dries up, new incentives and shorter contracts will sweeten the deal enough to fill the void. Then we get less qualified applicants who know even less about MilMed before signing up because the incentives are so high. They won’t even think twice before signing.

Why not work on fixing the system while we identify well qualified and well informed applicants to take care of our people and their families? Or we could hope there are no physicians left so our warfighters and families are left out to dry as your plan suggests.

Because we shouldn't have this pipeline or system. Most of the military med system should be reserves. We shouldn't hoodwink premeds into a longterm hostage situation before they even know what specialty or family situation they will have under false pretenses as we know the recruiters do. We shouldn't act like these problems are fixable either in the current system - I believe - like many other people in this forum have stated - that military med should be dismantled and largely should be reserves. That's the fix. No one wants to do it, though.

 

[militaryPHYS]

Because we shouldn't have this pipeline or system. Most of the military med system should be reserves. We shouldn't hoodwink premeds into a longterm hostage situation before they even know what specialty or family situation they will have under false pretenses as we know the recruiters do. We shouldn't act like these problems are fixable either in the current system - I believe - like many other people in this forum have stated - that military med should be dismantled and largely should be reserves. That's the fix. No one wants to do it, though.

But we do have this system and we will always require an active duty force for the reasons I laid out in a separate thread.

Having a pipe dream about how you wish a multi trillion dollar system should be structured doesn’t really help those who are already in or who are considering joining.

 

[afteranesthesia]

But we do have this system and we will always require an active duty force for the reasons I laid out in a separate thread.

Having a pipe dream about how you wish a multi trillion dollar system should be structured doesn’t really help those who are already in or who are considering joining.

And saying things have to be a certain way demonstrates a key point of why we find the military so frustrating. The inability to consider a different way is a literal example of the brokenness of the system.

 

[usma05]

Because we shouldn't have this pipeline or system. Most of the military med system should be reserves. We shouldn't hoodwink premeds into a longterm hostage situation before they even know what specialty or family situation they will have under false pretenses as we know the recruiters do. We shouldn't act like these problems are fixable either in the current system - I believe - like many other people in this forum have stated - that military med should be dismantled and largely should be reserves. That's the fix. No one wants to do it, though.

Have you been in the USAR? There's host of issues with it too. The answer should be a mixed system of AD and Reserves, but will likely be chronic understaffing till WW3 breaks out and then quick transition to the Doctor's Draft. I used to think the Reserves model would work too, but after two years of it I don't.

 

[afteranesthesia]

Have you been in the USAR? There's host of issues with it too. The answer should be a mixed system of AD and Reserves, but will likely be chronic understaffing till WW3 breaks out and then quick transition to the Doctor's Draft. I used to think the Reserves model would work too, but after two years of it I don't.

No, I was active duty, but I separated. That's why I know the active duty model doesn't work, but I'm not surprised punting it to the Reserves doesn't work. Sorry for being short sighted on that. The model that is currently in place is completely broken, and the real solution is coming up with a rework of the entire system.

 

[militaryPHYS]

And saying things have to be a certain way demonstrates a key point of why we find the military so frustrating. The inability to consider a different way is a literal example of the brokenness of the system.

Ha! I have considered. Even advocated for it on here just like you. Then I learned more, experienced more and understood why an all reserve will never work for the US or any other large ally.

A larger ratio of reserve? Maybe a bit more… but the real key is the military/civilian blend and finding those sustainable partnerships.

The model that is currently in place is completely broken, and the real solution is coming up with a rework of the entire system.

We are literally in the middle of them reworking it. It is actively happening. Yet you use the shortcomings and active problems of this gigantic overhaul/rework as a reason to advocate for just burning it to the ground.

This will take decades to rework. During the process our military leaders (non medical) will never allow MilMed to dry up and fail. There are too many important things that are constantly happening around the globe for it to go away.

 

[Onefellswoop87]

No, I was active duty, but I separated. That's why I know the active duty model doesn't work, but I'm not surprised punting it to the Reserves doesn't work. Sorry for being short sighted on that. The model that is currently in place is completely broken, and the real solution is coming up with a rework of the entire system.

From the top’s perspective, it does work.
And screaming to the void that it doesn’t makes you and @MedicalCorpse sound like telling young whipper snappers to get off your lawn or the Simpson’s Grandpa screaming at the clouds. I’ve been active duty of 11 years, not all of those as an attending, which means MedicalCorps says my opinion isn’t valid, but the system does reasonably work for what it’s intended. We are a supporting unit to support the line community. The fact that line commanders get docs and medical teams and people aren’t dying along rates of Desert Storm or longer ago means a low bar that it works to them. And they matter to DC. We are cogs in a big wheel.

Medical assets integrated with operational and line communities and with air superiority had medical response times and survivability that we as a nation should be proud of. (Will it work for a near peer adversary? That’s a bigger question with a different focus, but generals plan the last battle) Thus, to the people that cut the checks and sit in front of Congress, it works. We support the supported assets. Does DC care that a sub-specialist is a battalion surgeon? Not if the associated battalion commander and his/her admiral/generals above don’t care or don’t know. If it was a problem, then we wouldn’t have non-speciality specific billets.

As @pgg has outlined many times before, even before the blended retirement system, having you get frustrated and leave at 8-14 years is great for the fiscal bottom line. If the recruitment pipeline is relatively full, who cares if the retention sucks. If HPSP recruitment drops like in 2007, they’ll throw another sign on bonus and that’ll last for a while.

Should medical students understand as much as they reasonably can before they sign? Absolutely. But counterpoint, did you even really understand what it was like to be an attending or how the civilian match worked before you applied to HPSP scholarship, if that didn’t work out?
But is the system not working? Not really. It might not have worked for you. But for what it’s built for (hint, it’s not with medical as a primary thought), the system works, with bloat and some added fraud/waste/abuse as with any system.

 

[Chonal Atresia]

From the top’s perspective, it does work.
And screaming to the void that it doesn’t makes you and @MedicalCorpse sound like telling young whipper snappers to get off your lawn or the Simpson’s Grandpa screaming at the clouds. I’ve been active duty of 11 years, not all of those as an attending, which means MedicalCorps says my opinion isn’t valid, but the system does reasonably work for what it’s intended. We are a supporting unit to support the line community. The fact that line commanders get docs and medical teams and people aren’t dying along rates of Desert Storm or longer ago means a low bar that it works to them. And they matter to DC. We are cogs in a big wheel.

Medical assets integrated with operational and line communities and with air superiority had medical response times and survivability that we as a nation should be proud of. (Will it work for a near peer adversary? That’s a bigger question with a different focus, but generals plan the last battle) Thus, to the people that cut the checks and sit in front of Congress, it works. We support the supported assets. Does DC care that a sub-specialist is a battalion surgeon? Not if the associated battalion commander and his/her admiral/generals above don’t care or don’t know. If it was a problem, then we wouldn’t have non-speciality specific billets.

As @pgg has outlined many times before, even before the blended retirement system, having you get frustrated and leave at 8-14 years is great for the fiscal bottom line. If the recruitment pipeline is relatively full, who cares if the retention sucks. If HPSP recruitment drops like in 2007, they’ll throw another sign on bonus and that’ll last for a while.

Should medical students understand as much as they reasonably can before they sign? Absolutely. But counterpoint, did you even really understand what it was like to be an attending or how the civilian match worked before you applied to HPSP scholarship, if that didn’t work out?
But is the system not working? Not really. It might not have worked for you. But for what it’s built for (hint, it’s not with medical as a primary thought), the system works, with bloat and some added fraud/waste/abuse as with any system.

If what you say about the system being designed to support the line community (and not medical education, dependents, retirees, etc) is actually true, explain why DHA is doing an about face and trying to "recapture" outsourced Tricare referrals for dependents, retirees and even active duty being shunted to the civilian world? The answer is that your superiors are a bunch of self-serving idiots trying to get the next bullet point on their OERs. Military medicine is a rudderless boat taking on water at a rapid rate. Grab the popcorn....

In Reversal, Defense Department Now Wants to Bring Tricare Beneficiaries Back to Military Health System

After seven years of reforms that included sending non-active-duty patients to civilian Tricare networks, the Pentagon wants to bring them back to military medical care.

www.military.com

 

[Onefellswoop87]

If what you say about the system being designed to support the line community (and not medical education, dependents, retirees, etc) is actually true, explain why DHA is doing an about face and trying to "recapture" outsourced Tricare referrals for dependents, retirees and even active duty being shunted to the civilian world? The answer is that your superiors are a bunch of self-serving idiots trying to get the next bullet point on their OERs. Military medicine is a rudderless boat taking on water at a rapid rate. Grab the popcorn....

In Reversal, Defense Department Now Wants to Bring Tricare Beneficiaries Back to Military Health System

After seven years of reforms that included sending non-active-duty patients to civilian Tricare networks, the Pentagon wants to bring them back to military medical care.

www.military.com

Any system can have more than one directive. But I stand by that primary goal of DoD is to be the physical/military arm of external policy. You can disagree with how that arm is flexed but that’s the purpose of any military over history, boiled down to one sentence. It’s to put warheads on foreheads. And medical is a supporting element, (almost) never the supported, as we are not the primary mission for the DoD. Other minor goals include research, training, hearts and minds missions (e.g. USNS Comfort and Mercy), military and medical education, etc. It doesn’t many any less valid in its own microcosm, just not the primary mission, so it does make them less of a need for allocation of money as t he big picture.
That’s one of the reasons the VA is a separate budget and entity, so that budget line item doesn’t get swallowed by the need for tanks, jet fuel, another ship, whatever. Separate department, completely separate budget. Again, a completely separate focus and mission to take care of veterans than for operational requirements and then taking caring of active duty persons. It’s not an unreasonable question for why are we, as the DoD, taking care of my family as dependents, except for the fact that it would be political suicide for a member of Congress to promote rolling back medical care for families.
And that leads to my short answer your question: because when DHA has the resources allocated (physical infrastructure, persons, equipment, etc.) to care for patient populations, it is cheaper to recapture and keep them in network. We have pediatricians through GME and other reasons, so might as well recapture patient populations and keep in-network. We have surgical oncologists that we’ve sent out for fellowship, might as well recapture veterans who need that subspeciality. (Just two examples that popped to my mind, I don’t have specifics of the exact number or need for those two). That’s all generally true for in network care whether it’s TriCare, Kaiser, Blue Cross Blue Shield, Aetna, etc

 

[comp1]

So you see a little of it with ChampVA, but I'm unclear as to why every military medical issue not immediately related to deployability isn't delegated to the VA.

 

[MedicalCorpse]

From the top’s perspective, it does work.
And screaming to the void that it doesn’t makes you and @MedicalCorpse sound like telling young whipper snappers to get off your lawn or the Simpson’s Grandpa screaming at the clouds.

That's rather ad hominem, don't you think, sonny?

I’ve been active duty of 11 years, not all of those as an attending, which means MedicalCorps says my opinion isn’t valid,

I never said that someone needed to be an attending for 11 years as I was when I punched out to have a valid opinion. I merely stated that I would like to hear back from these med students, interns, residents, and (by civilian standards) junior attendings after they have survived the broken military "health care" system for a decade or more as I did, because I predict that their opinions will have changed by then to be more similar to my own.

but the system does reasonably work for what it’s intended. We are a supporting unit to support the line community.

We are also physicians who care for patients. When we sacrifice our first duty as doctors to our second duty as officers, people die and/or are subject to crimes against humanity (torture, poisoned pizzas, etc.).

The fact that line commanders get docs and medical teams and people aren’t dying along rates of Desert Storm or longer ago means a low bar that it works to them. And they matter to DC. We are cogs in a big wheel.

So, a military physician should drive into work every day (or leave her tent) with the primary goal of making line commanders happy, rather than trying to heal the sick and injured. That's an interesting and terrifying point of view.

By the way, how would you, the public, or anyone know if bad (or zero) health care is causing or contributing to the deaths of our troops and their families when all Sentinel Events, Medical Incident Investigations (MIIs), and healthcare-related Command Directed Investigations are covered up under the non-discoverable rug of QA, immune to Freedom of Information Act (FOIA) requests? I should know, since I was director of anesthesia flight QA for most of my eleven years as staff. Remind me again what the government does to whistleblowers, regardless of the so-called party in power?

Medical assets integrated with operational and line communities and with air superiority had medical response times and survivability that we as a nation should be proud of. (Will it work for a near peer adversary? That’s a bigger question with a different focus, but generals plan the last battle)

So, we are in agreement that the Pentagon cannot plan its way out of a wet paper bag? That's swell.

The scary truth is that we as a nation need to modernize our antiquated, 20th century Cold War huge, immobile hospital/giant floating missile target focus five years ago in order to prevent 100% of our tertiary and secondary "medical" care capability from being wiped out in the first few minutes of a conflict with any future adversary that can pilot a few drones, let alone launch dozens of hypersonic missiles. If the DHA gives me enough money and retroactive promotion to O-6, I'll act as a consultant to walk them through this.

The core problem with DHA and the other mouth-breathers at the Pentagon above O-5 is that they remain supremely convinced that they are experts in identifying bad ideas. To paraphrase the comic strip "Dilbert": bad ideas come from other people, as defined by "anyone outside our inbred clique of melanin-challenged service academy graduates".

Thus, to the people that cut the checks and sit in front of Congress, it works. We support the supported assets. Does DC care that a sub-specialist is a battalion surgeon? Not if the associated battalion commander and his/her admiral/generals above don’t care or don’t know. If it was a problem, then we wouldn’t have non-speciality specific billets.

Ignorance is bliss.

As @pgg has outlined many times before, even before the blended retirement system, having you get frustrated and leave at 8-14 years is great for the fiscal bottom line.

I've been saying this here since 2006. It is one of many reasons why nobody asked me to reconsider leaving as a LtCol and resigning my commission, thus depriving the USAF of an asset whom they had spent literally hundreds of thousands of dollars to train. Having more money to make it rain on shiny boondoggles (see: Littoral Combat Ship) was a plus. However, the main reason was that they just wanted a mouthy troublemaker to shut up and go away, so they could continue counting down the seconds until retirement on their phone apps in peace and quiet without doing anything useful.

If the recruitment pipeline is relatively full, who cares if the retention sucks. If HPSP recruitment drops like in 2007, they’ll throw another sign on bonus and that’ll last for a while.

More green physicians without any gray-hairs to mentor them. What's the worst that could happen?

Should medical students understand as much as they reasonably can before they sign? Absolutely. But counterpoint, did you even really understand what it was like to be an attending or how the civilian match worked before you applied to HPSP scholarship, if that didn’t work out?

I was committed to a military career after raising my right hand at age 17 to join ROTC. Since I wanted to be a physician, and HPSP didn't accept me (long story), USU was the only way. I was completely happy with my Air Force career from 1986 until late 1998, as I've said many times. Prospective HPSP and USU students should know that your mileage and happiness as a military doctor may vary wildly based on, among other things:

1) Luck (having benign vs. malignant superiors)
2) Specialty, if any (see my post on your military healthcare "family")
3) Local political decisions beyond your control (nepotism vs. fair play)
4) Service-specific political decisions beyond your control (cheap "mid-level" non-physicians > expensive physicians)
5) National political decisions beyond your control (wars and rumors of wars)
6) More luck (getting your number one assignment choice vs. number infinity in the backwoods of nowhere)
7) Even more luck (getting deployed to sunny and peaceful Incirlik as I was vs. almost anywhere else)

It's all a roll of the dice. The main and simple reason (old-timer reference from a 1916 book) that military service is different from a civilian medical career path is that you cannot quit until your time is up, no matter how unhappy you and your family are.

But is the system not working? Not really. It might not have worked for you. But for what it’s built for (hint, it’s not with medical as a primary thought), the system works, with bloat and some added fraud/waste/abuse as with any system.

So, if I may rephrase, the military "health care" system is purposely designed to bamboozle the ignorant non-physician Mor0ns In Charge (both military and civilian) that we can do more with less while doing everything with nothing, and any casualties of this nefarious plot such as dead or brain-damaged patients from bad (or no) care are unimportant, because "medical" is not the "primary thought". Also, in order to keep up with the Joneses, let's not forget to add some delicious Government Mirepoix(TM) to our bubbling soup stock. Rather than using traditional but boring celery, onions, and carrots in our dish, let's toss a few handfuls of fraud, waste, and abuse into the pot for that certain je ne sais quoi you can never untaste, no matter how hard you try.

Reading you loud and clear on channel 16, good buddy.

Now, would you please get off my lawn. Thankee kindly.

 

[MedicalCorpse]

And that leads to my short answer your question: because when DHA has the resources allocated (physical infrastructure, persons, equipment, etc.) to care for patient populations, it is cheaper to recapture and keep them in network.

My short question to your answer: do you have any estimate what decade that will happen? Will it be the same decade when TRICARE's reimbursement rates will not be laughably inadequate, leading to prevention of care for our troops and their families because no physicians "downtown" will agree to LOSE money by accepting TRICARE?

After all, it took a good thirty years from the 1990s until now to destroy military medicine as I knew it...

 

[militaryPHYS]

If what you say about the system being designed to support the line community (and not medical education, dependents, retirees, etc) is actually true, explain why DHA is doing an about face and trying to "recapture" outsourced Tricare referrals for dependents, retirees and even active duty being shunted to the civilian world? The answer is that your superiors are a bunch of self-serving idiots trying to get the next bullet point on their OERs. Military medicine is a rudderless boat taking on water at a rapid rate. Grab the popcorn....

In Reversal, Defense Department Now Wants to Bring Tricare Beneficiaries Back to Military Health System

After seven years of reforms that included sending non-active-duty patients to civilian Tricare networks, the Pentagon wants to bring them back to military medical care.

www.military.com

If the local market can support the beneficiary population and cost for care is cheaper than maintaining the DoD hospital/clinic then long term solution found.

If local market care not adequate based on specialist availability or nobody taking tricare due to poor reimbursement then DoD hospital/clinic must remain.

If large hospital center had deferred patients during right sizing and now is ready to recapture to increase volume/complexity based on current assets, bring them back.

This part has little to do with the line.

 

[Chonal Atresia]

Flip flop, flip flop….great way to take care of patients.

Unbelievable! But at least brigade commanders have board-certified physicians filling out paperwork.

 

[Onefellswoop87]

My short question to your answer: do you have any estimate what decade that will happen? Will it be the same decade when TRICARE's reimbursement rates will not be laughably inadequate, leading to prevention of care for our troops and their families because no physicians "downtown" will agree to LOSE money by accepting TRICARE?

After all, it took a good thirty years from the 1990s until now to destroy military medicine as I knew it...

Nope, no clue. They never asked my opinion nor gave me their estimated timeframe. But I’ll let you know when I know.

Sorry for the ad hominem. I figured after your AI generated post making fun of everyone your feelings wouldn’t get hurt so easily.

I never said my goal was to jerk off any line commander or to just make them happy. I said the system’s goal was to make the military war-fighting apparatus’ mission its priority and everything else is a downstream secondary, tertiary, or beyond goal. My goal is to take the best care of my patients within the system I work in, affecting positive change within my sphere of influence. And that sphere is quite small in the cog I work in. No one asks me about TriCare reimbursement rates or how I’ll handle recapturing of patients.

Sorry my tongue-in-cheek “who cares” comment about recruitment and retention missed its mark. I meant it as individuals care about persons’ satisfaction (and maybe retention/recruitment metrics) but the system only cares about numbers not individuals.

Oversimplification of arguments that the Pentagon can’t plan out of a wet bag just reminds me of The Big Lebowski “Your not wrong Walter, your just an dingus” (not an ad hominem, but sorry in advance). To continue with using quotes, but as a more reputable source of Eisenhower, "Plans are worthless, but planning is everything.” Modernizing war delivery and medical delivery is important. But we haven’t fought a near-peer adversary in generations. We haven’t had a ship-to-ship battle since WW2. Reconciling the need for ingenuity but also forces of the status quo isn’t proof the system is failing.

 

[Onefellswoop87]

Nope, no clue. They never asked my opinion nor gave me their estimated timeframe. But I’ll let you know when I know.

Sorry for the ad hominem. I figured after your AI generated post making fun of everyone your feelings wouldn’t get hurt so easily.

I never said my goal was to jerk off any line commander or to just make them happy. I said the system’s goal was to make the military war-fighting apparatus’ mission its priority and everything else is a downstream secondary, tertiary, or beyond goal. My goal is to take the best care of my patients within the system I work in, affecting positive change within my sphere of influence. And that sphere is quite small in the cog I work in. No one asks me about TriCare reimbursement rates or how I’ll handle recapturing of patients.

Sorry my tongue-in-cheek “who cares” comment about recruitment and retention missed its mark. I meant it as individuals care about persons’ satisfaction (and maybe retention/recruitment metrics) but the system only cares about numbers not individuals.

Oversimplification of arguments that the Pentagon can’t plan out of a wet bag just reminds me of The Big Lebowski “Your not wrong Walter, your just an dingus” (not an ad hominem, but sorry in advance). To continue with using quotes, but as a more reputable source of Eisenhower, "Plans are worthless, but planning is everything.” Modernizing war delivery and medical delivery is important. But we haven’t fought a near-peer adversary in generations. We haven’t had a ship-to-ship battle since WW2. Reconciling the need for ingenuity but also forces of the status quo isn’t proof the system is failing.

Just replying to myself cause SDN auto-changed my Big Lebowski quote. Dingus is not the correct word. If you did not know the quote was wrong, stop what you are doing and go watch it. That’s a lawful order, so if you don’t, I’m gonna assume I outrank you and it’s insubordination.

 

[MedicalCorpse]

Just replying to myself cause SDN auto-changed my Big Lebowski quote. Dingus is not the correct word. If you did not know the quote was wrong, stop what you are doing and go watch it. That’s a lawful order, so if you don’t, I’m gonna assume I outrank you and it’s insubordination.

"Yeah, well, you know, that's just, like, your opinion, man." ​

--Jeffrey "The Dude" Lebowski

PS: You cannot outrank me because you're not a nurse.

 

[MedicalCorpse]

Any system can have more than one directive. But I stand by that primary goal of DoD is to be the physical/military arm of external policy. You can disagree with how that arm is flexed but that’s the purpose of any military over history, boiled down to one sentence. It’s to put warheads on foreheads. And medical is a supporting element, (almost) never the supported, as we are not the primary mission for the DoD. Other minor goals include research, training, hearts and minds missions (e.g. USNS Comfort and Mercy), military and medical education, etc. It doesn’t many any less valid in its own microcosm, just not the primary mission, so it does make them less of a need for allocation of money as t he big picture.

(Somehow my beautiful, perfect picture got erased when I replied to a later post. Technology.)

Please let me know if you want me to update the picture with your forum user name. It would only take seconds.

 

[MedicalCorpse]

We haven’t had a ship-to-ship battle since WW2. Reconciling the need for ingenuity but also forces of the status quo isn’t proof the system is failing.

Sorry (not sorry) to have an ex-Air Force puke (myself) school you on naval history that I remember from when I was at USU:

Operation Praying Mantis - Wikipedia

And, since you younguns like videos so dang much, this here's a link to a YouWhatever thingamabob:



...and this here's one from the Department of the Navy:



(you gotta feel perty manly to have JOCS as your official title)

(PS: according to Wikipedia, there were four other surface engagements since WWII, not even counting the ongoing mess with the Houthis. Go figure.)

 

[Onefellswoop87]

Sorry (not sorry) to have an ex-Air Force puke (myself) school you on naval history that I remember from when I was at USU:

Operation Praying Mantis - Wikipedia

And, since you younguns like videos so dang much, this here's a link to a YouWhatever thingamabob:



...and this here's one from the Department of the Navy:



(you gotta feel perty manly to have JOCS as your official title)

(PS: according to Wikipedia, there were four other surface engagements since WWII, not even counting the ongoing mess with the Houthis. Go figure.)

I stand corrected then. I thought the last ship to ship combat was in Battle of Leyte Gulf, 1944. Despite my best intentions, I learned something

 

[militaryPHYS]

My goal is to take the best care of my patients within the system I work in, affecting positive change within my sphere of influence.

Well said. Very succinct description of how I imagine most MilMed physicians who have stuck around feel.