Navy HPSP Payback Clarification

[Detective SnowBucket]

Hi all, rising undergrad senior about to apply for Navy HPSP and I can't get a good answer from my recruiter about payback. After med school you owe 4 years period. The issue is that I want to go into a more competitive surgical specialty with a long-ish residency and hear that that can make you rack up more years of payback. Additionally I am interested in doing a fellowship; so, do you really rack up more time if you do a long residency, does it make any difference if it is a civilian or military one and if you don't go straight into fellowship after residency and pay back the time, does that make it harder to get into one later on? Thanks

Edit, for clarification, I have no problem doing a military residency if I must but, I don't want to have to limit myself, I'd rather have more residencies open to me and go to the best one I can. Don't say 'worry about getting into med school first' because getting the HPSP will decide which school I go to, if I have to pay for it myself or not.

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[SirGecko]

These questions has been answered a lot on this forum so maybe try looking at some old posts if you this doesn’t answer your question.

Basically, yes you will have more years of payback added if you go for a long residency. The answer is actually a bit more complicated than that but if you have a specific scenario your are wondering about someone can probably answer that.

Payback works like this: you owe four years for hpsp. You also owe one year for every year of gme training except intern year which is a wash where you neither pay off nor acrue time owed. Now assuming you go straight through with a surgery residency you would still owe four years at the end of residency. If you did nuerosurgery or a six year ortho program you would owe five.

Now you said navy so that might mean you wind up doing a gmo tour between intern year and residency which complicates it some as that time is payback but you would still owe the one for one for residency. (I think they generally try to keep the ortho guys straight through nowadays though, someone please correct me if I’m wrong)

As for fellowship you are unlikely to go straight from residency to fellowship in the Navy. This varies depending on the specialty though and who knows what the will be doing in 9 plus years when that will effect you. To that same end I know it sounds cliche but you are likely to change your mind on specialty sometime in Medical school so try not to make a big commitment assuming that you will be the same person you are now in ten years. Just be flexible and look into all scenarios. Don’t join assuming your best case scenario.

 

[militaryPHYS]

Ortho Navy still not guaranteed straight through but at least half of the intern classes are going straight through over the last few years...usually even more.

I will echo SirGecko. You are very likely to change your desired specialty at least once during medical school and rates of straight-through vs GMO change constantly so do not let specialty predominate your decision to sign up. You must be flexible and willing to accept all possible worst case scenarios within MilMed before signing the dotted line.

 

[pgg]

Edit, for clarification, I have no problem doing a military residency if I must but, I don't want to have to limit myself, I'd rather have more residencies open to me and go to the best one I can. Don't say 'worry about getting into med school first' because getting the HPSP will decide which school I go to, if I have to pay for it myself or not.

Well, there's the rub.

If you go HPSP then you're almost certainly going to have to choose between
1) doing an inservice residency
2) doing NO residency, serve your 4 post-internship payback years as a GMO, getting out, and then doing a civilian residency

There are relatively few civilian deferments for residency given each year, and it is very unpredictable which specialties they will be in. What's more, they're not exactly given out according to the applicants' merit, so one can't count on high performance opening that door.


In general, for persons who don't have prior military service, or who don't have a strong desire to serve in the military (i.e. HPSP money is the primary motivating factor), it is this exact issue that leads me to tell them that HPSP might not be for them. The training pipeline uncertainty is an important thing to consider. Whatever specialty you, as a pre-med, think you will choose probably won't be where you end up. Most medical students change their mind at some point, and many simply have paths closed off because they lack the grades and board scores.

Naturally you expect to finish ranked highly in your med school class, but so does everybody else.


Your post implies you're doing well enough as an undergrad to possibly have some choices of where you go to medical school (vs the "wherever I get in, hopefully" kind of circumstances that the majority of us were in). If that's the case, here's the best answer: attend a public allopathic school that offers you in-state tuition, pay for it with student loans, graduate, do your residency and fellowship, and then decide if you still want to be in the military.

 

[backrow]

I want to clarify something @SirGecko said above.

except intern year which is a wash where you neither pay off not accrue time owed

This is incorrect per DODI 6000.13. (I’m pulling the instruction number out of memory so may be slightly off)

Time spent in graduate medical education does not pay off anytime owed (Active Duty Service Obligation or ADO) from what they call undergraduate medical education (aka HPSP/HSCP/USU).

The ADO for in service GME (FTIS) is six months for any portion of six months and is served CONCURRENTLY with the HPSP obligation. In other words, do a 5 year surgery residency and you will owe 5 years at the end. The first 4 years of that payback you will be paying back both the HPSP and the residency ADO and the 5th year is for the last year of Residency payback.

There is nothing special about intern year, you gain a year of concurrent payback for FTIS training.

Now here’s a real rub. For Navy they have drastically increased the number of full time outservice (FTOS) opportunities for some specialties. Those folks will get to serve their payback CONSECUTIVELY. Meaning that same general surgery resident would owe 9 years upon completion of residency. First 4 years paying of HPSP and then the next 5 paying off the residency obligation.

There are also deferred residencies (NADDS), but these aren’t as common now that they have increased FTOS. NADDS is a civilian residency opportunity, but does not serve consecutively.


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