HPSP Neurosurgery

[alpha2716]

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If I go to medical school for 4 years of the hpsp and do a military neurosurgery residency which is 7 years, what is my payback commitment

 

[backrow]

7 years after residency

 

[alpha2716]

7 years after residency

Why would it not be 4 years?

 

[Slevin]

Basically you owe either the 4 years of Ned school or the length of residency whichever is longer

So if you took the 4 years of scholarship you owe 4 years if you did a 3 year residency such as IM, FM, Peds

If you did something like urology or gen surgery then that's 5 years, etc etc

 

[colbgw02]

If I go to medical school for 4 years of the hpsp and do a military neurosurgery residency which is 7 years, what is my payback commitment

Six years. Six years after finishing residency, that is. You would owe 4 years for HPSP and 6 years for residency (for every year in GME after internship). Those obligations are paid back concurrently.

If you don't already know, the DoD only operates one neurosurgery residency. In my experience, most neurosurgeons are deferred for training. The type of deferment you receive can affect your commitment length.

 

[DrMetal]

If I go to medical school for 4 years of the hpsp and do a military neurosurgery residency which is 7 years, what is my payback commitment

Heed the advice that you're getting above. This is a common misconception that most applicants and recruiters don't understand.

And for what it's worth, neurosurgery is a terrible specialty to practice in the military. The case volume is low, the acuity is low, and there's only one residency spot in the entire military healthcare system. If you're really serious about it, I would go the civilian route and come in as a fully trained neurosurgeon

 

[ArmyNeuroGuy]

The above isn't completely true. For many years the Army has been sponsoring Neurosurgery Residents at both University of Florida and University of Texas Health Science Center San Antonio. The spots are fully funded and the commitment is the same as for completing your residency at Walter Reed.

Additionally, the acuity and case numbers are going up because they are pulling in everyone who has Tricare Prime and under age 65. They are also starting to take over some VA patients also. All of these led SAMMC to have over 800 Neurosurgical cases last year.

 

[j4pac]

Know the difference between "deferment" and "full time out service".

Deferment doesn't count toward retirement...FTOS does. That is significant when you are looking at a seven year residency.

Not to mention that your pay is significantly higher doing FTOS...because you will be paid for your rank by the military and not a resident.

 

[colbgw02]

The above isn't completely true. For many years the Army has been sponsoring Neurosurgery Residents at both University of Florida and University of Texas Health Science Center San Antonio. The spots are fully funded and the commitment is the same as for completing your residency at Walter Reed.

Additionally, the acuity and case numbers are going up because they are pulling in everyone who has Tricare Prime and under age 65. They are also starting to take over some VA patients also. All of these led SAMMC to have over 800 Neurosurgical cases last year.

I'm not sure you're really refuting Metal's points. In fact, sponsoring slots at civilian hospitals speaks to Metal's point of low volume and acuity within the .mil.

I wouldn't be surprised if the volume is increasing by recapturing patients previously lost to the network, but I don't think citing SAMMC's numbers proves anything. The prime mover in neurosurgical volume there is civilian trauma.

 

[DrMetal]

The above isn't completely true. For many years the Army has been sponsoring Neurosurgery Residents at both University of Florida and University of Texas Health Science Center San Antonio. The spots are fully funded and the commitment is the same as for completing your residency at Walter Reed.

Additionally, the acuity and case numbers are going up because they are pulling in everyone who has Tricare Prime and under age 65. They are also starting to take over some VA patients also. All of these led SAMMC to have over 800 Neurosurgical cases last year.

Not many folks in Tricare Prime < 65 yo are in need of a neurosurgeon. And it's hard to believe that we're taking over any VA patients . . if said VA hospital is tied to an academic institution, (VA Lajolla w/ UCSD, VA-SF w/UCSF etc etc), their faculty takes most if not all cases. I don't see them asking active duty neurosurgeons for any help (they might welcome the help if you volunteer it, or if you're trying to get your residents cases).

In any case, the problem (from a student's perspective) with highly competitive surgical residencies, is that the military only has one (or at best, 2 or 3 spots) to offer. You have to be literally be in the top 1% of your cohort to get it. Via the civilian route, since you can compete all across the country, you still have to be good but it might suffice to only be in the top 5 to 10% (if all you want is to match somewhere). I would still advise the OP to go the civilian route if he/she is actually serious about NS. If he/she does go hpsp, would advise having a good plan B.

 

[ArmyNeuroGuy]

I would disagree, the trauma numbers that come into SAMMC do not increase their numbers that much. Its not like they are only doing 100 cases and then 600 emergent craniotomies and spine fractures.

Additionally, the SAMMC has already taken over a fair amount of the VA in San Antonio. There is no ENT at the VA because all those patients are absorbed by SAMMC. The VA employs no CT surgeons because those cases are all taken by the active duty CT surgeons, and the SAMMC neurosurgeons already get consults/patients from VA's in south Texas that never make it to the VA in San Antonio, and this VA is associated with UTHSCSA and has residents rotating through from all surgical specialties. Your acuity and cases in the military system can go up if you want to work to get the cases.

Also, the last couple of years there have not been that many medical students interviewing for an Army Neurosurgery spot, it has been around 4 for 2 usually 3 spots, which I think is much higher odds than a civilian match because programs are more likely to take a lower quality military applicant who comes funded than two in the civilian match

 

[jabreal00]

You'll owe 6 years after residency. If you do a fellowship after residency, especially if it is funded by the military that's another 2 years added. Neurosurgery in the Army is mostly doing spine cases.

 

[Handsome1]

The individuals in military neurosurgery are excellent and well respected when done. Lots of leaders in neurosurgery have had a military background. The reality is it is variable in terms of selectivity; you have to live with that. There are some years where it's 6:1 and some years it's 2:1. It depends. There are unique experiences to a DOD residency ( I am not in one) some are great some not so great just like any other residency. Fellowship is not guaranteed which can be tough. Neurosurgery anywhere is doing mostly spine cases. Getting back to the point 1) no one can predict what's going to happen 4 years from now 2) I switched my "would be" specialty 3 times so I wouldn't bank all your cards on what specialty you pick 3) Numbers of cases are wonderful and objective but the education you receive from them is just as important

 

[Gastrapathy]

#3 is only ever trotted out by low volume programs.

 

[bustbones26]

The above isn't completely true. For many years the Army has been sponsoring Neurosurgery Residents at both University of Florida and University of Texas Health Science Center San Antonio. The spots are fully funded and the commitment is the same as for completing your residency at Walter Reed.

Additionally, the acuity and case numbers are going up because they are pulling in everyone who has Tricare Prime and under age 65. They are also starting to take over some VA patients also. All of these led SAMMC to have over 800 Neurosurgical cases last year.

I recall back in my residency days I had to do a month of a neurosurgery rotation. After rounds, I was forced to go to the cafeteria and eat breakfast with the team, which consisted of myself, a surgery intern, an active duty neurosurgeon, and a reservist neurosurgeon that was actived on a backfill, but happened to work as an attending at a university program. The breakfast conversation went something like this:

Intern: Dr. X, when you did your training at Walter Reed, did you get a lot of autonomy?

Dr. X.: When I was a chief resident, I did about 300 surgeries all by myself without an attending (in a cocky arrogant tone).

Backfilling Reservist: Huh, is that all? My resident do at least 1000 or more in their chief year, hell they do so much surgery in their chief year that they get sick of the OR.

Dr. X: (who is now taken aback and had the smiled wiped off his face): Well-----, well-----, ugh, do they do them alone without an attending?

Backfilling Reservist: Yeah

Dr. X: (now stunned and shut up, for once)

 

[Gastrapathy]

No procedural service will compete with the real world. I don't think NS is any different.

 

[Homunculus]

#3 is only ever trotted out by low volume programs.

ouch. lol.

No procedural service will compete with the real world. I don't think NS is any different.

i completely agree. i'm not sure i can come up with a specialty that does the equivalent number of procedures as a civilian program. because the civilian model is based on volume, and the military cost containment (and subsequently not providing resources or staffing to even do the volume if you wanted to) i don't see this ever really changing. in the civilian world i could do 6-7 procedures and be done by lunchtime by the time our military hospital could do 2-3. the cultural difference is remarkable-- and a reason why i think USUHS students need to "cross pollinate" more.

-- your friendly neighborhood endoscopy loving caveman

 

[Cooperd0g]

Unfortunately the school makes it difficult for us to do "outside" rotations. One or two is okay, try setting up more than that and you get real pushback. Mostly because they think you are trying to set up a super slacker rotation or something. I'm sure some people are doing that, but at civilian med schools people seem to do all of their rotations at non-military facilities and end up not being labeled total slackers because of it.

 

[Homunculus]

don't get me wrong-- i don't blame the USUHS students at all. it's the administration that needs to recognize the difference in their teaching hospitals. it's hard to swallow, sure, but it will make better doctors. i had a telling conversation with one of our peds residents who was civilian who went to a decent civilian school with a top peds residency and he has been shocked at volume and cultural differences. i'm at a MEDCEN and the peds average census is barely enough to meet inpatient requirements. now throw a student onto that service who never sees the "real" world, and you can see where the USUHS blinders may limit their potential.

--your friendly neighborhood just admit them all caveman

 

[Handsome1]

#3 is only ever trotted out by low volume programs.
- my residency does 3000+ cases per year

Of course, low volume plagues all the military surgical specialty programs and that's a big problem but the NS program supplements their training nicely. They do endovascular at a well known busy private hospital WHC, they do pediatrics at Children's National Medical Center, they do trauma at Shock Trauma. The points are well taken as NCC NSGY program has uniquely positioned itself outside of the military to obtain this training. My point is simply that the program is well respected in neurosurgery. The biggest problem is fellowship training. There is no match in neurosurgery fellowships (except peds) so spots "fill" during residency. More competative spots get taken early by word of mouth and the military can't guarantee he or she will be available.