HPSP questions

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[NavyFP]

Hi, I'm currently applying to medical schools and considering the HPSP option. I've decided if I want to do the military route, I'd like to join the AF. I was hoping some of you who took that route could give me some insight into what it's like.

Thank you in advance for your help.

1. Did you decide to do residency independently or through AF?

2. [For those who went back to civilian work after serving] After you finished your residency, did you find it disadvantageous since your co-workers got to advance in their specialty while you had to serve?

3. Does the commitment really correspond to years received scholarship? For example, if you received scholarship for 3 years, your obligation to serve post-residency is exactly 3 years? I'm not sure if I understand the following posted in the HPSP FAQ section:


4. What kind of bases do you get sent to? Do you have much of a choice? I'm wondering if I can request international locations.

8 years is the minimum. If you only took 1 year of scholarship, you would owe a total of 8 years.

 

[Perrotfish]

Hi, I'm currently applying to medical schools and considering the HPSP option. I've decided if I want to do the military route, I'd like to join the AF. I was hoping some of you who took that route could give me some insight into what it's like.

Thank you in advance for your help.

1. Did you decide to do residency independently or through AF?

2. [For those who went back to civilian work after serving] After you finished your residency, did you find it disadvantageous since your co-workers got to advance in their specialty while you had to serve?

3. Does the commitment really correspond to years received scholarship? For example, if you received scholarship for 3 years, your obligation to serve post-residency is exactly 3 years? I'm not sure if I understand the following posted in the HPSP FAQ section:


4. What kind of bases do you get sent to? Do you have much of a choice? I'm wondering if I can request international locations.

1) Alright, this is the single most important thing to understand about the military scholarship. When you take their money, THEY decide if you do residency as a civilian with them or in the civilian world. If you want a civilian residency you apply for the opportunity to apply for one during the military match, and normally the military says no. If you take the money expect to do your residency within the military. The only time they say yes is when they need more of a particular type of physician than their own training can produce. Alternatively if they have too many applicants for the military match they can shunt you into a civilian deferment despite your request for military training, though that is historically less likely.

Its also important to understand that the military match is different than the civilian match. Some kinds of training are much more competitive than in the civilian world: for example you would need a much better application to get Pediatrics, or EM, than you would in the civilian world. The odds also fluctuate more from year to year. When the numbers are so small, half a dozen really talented medical students developing an interest in your specialty of choice can make it drastically harder for you to match. Finally you need to understand that many people in the military don't match for an entire residency. After Intern year you reapply for the rest of residency. Many AF physicians will go from Intern year to a 2-3 year flight surgery tour, where they provide a very basic form of primary care to airmen as well as perform flight physicals on pilots. Many people seek out these opportunities, but understand that a percentage of each year's flight surgery class consists of physians who would have preferred straight through training. Its an order you need to be prepared to accept.

3) When you sign a contract you sign a contract for one year of active duty time in exchange for each year of the scholarship that you accept. However you also sign an 8 year TOTAL contract, the remainder of which is served in the IRR. The IRR is the 'individual ready reserve', its not the reserves in the sense that you think of them. You're not attached to a unit, you don't drill, you're not subject to the uniform code of military justice, and your only responsibility is to keep the military updated concerning you address. The military, however retains the option to call you up as a last resort in the event of war. They also retain the option to not to let you separate at the end of your active duty commitment, which is called a stop loss. Of course, they also retain the option to draft you if you never sign anything at all, and both the IRR and stop loss were arguably designed for a situation where they were in the process of drafting everyone else (the Russian fleet just landed in San Francisco, etc). However during the Iraq war Bush began to use both IRR callus and stop loss as a supplement to the regular reserves and in lieu of a draft. Both were used briefly and sparingly and neither was ever used on physicians but you can argue that the precedent is now set.

4) You request what you want and they assign you as they need you. As a general rule the quality of the base you're assigned to is based on your seniority and your history of having done your share of less desirable assignments, and of course there are no guarentees of any kind. For example in the Navy the odds are high that you can get your choice of less desirable east coast bases (Marine bases in swamps), west coast bases (Marine bases in Deserts) and International locations (Guam and other isolated islands) but the odds are low that you will request a desirable east coast base (Pensacola), west coast base (San Diego) or International location (Naples/Sigonella).

This is not to say that there aren't good reasons to join. Besides the scholarship (which is substantial) and the ideal of serving the world's best patient population (which is extremely satisfying) my experience with the residency training within the military has been excellent, and the GMO system does arguably act as a second chance if you don't get the residency of your choice. Also the variability in the odds of getting a residency vs the civilian world doesn't always work against you. That being said, know what you're getting into before you sign on the dotted line. Once you take a check you cannot choose to separate until the end of your commitment.

 

[deuist]

Hi, I'm currently applying to medical schools and considering the HPSP option. I've decided if I want to do the military route, I'd like to join the AF.

You clearly did not read enough of this forum

2. [For those who went back to civilian work after serving] After you finished your residency, did you find it disadvantageous since your co-workers got to advance in their specialty while you had to serve?

I'm not sure what you mean by "advance." In both you are accumulating years of experience. If you are talking about fellowships and advanced degrees, not all civilians pursue these routes.

 

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[Special Delivery]

Psswrd:
You can go to any med school you get accepted to. I don't believe this applies to the international med schools in the Caribbean, but I've never checked. Upon graduating from med school, you usually do a military residency. There are civilian deferments, but they are rare and only given as the Army sees fit. Can you request to be stationed OCONUS? Yes, but again, the Army will only send you if it thinks it's in it's own interests to do so.

You say you've decided on AF. Based on what? The possibility of being stationed internationally? If you do decide to take the HPSP route, there are more important things to consider than post-residency locations.

When deuist is saying you've clearly not read enough of the forum, he's saying the answers are already here, and to use the search function.

Lastly, don't listen to your recruiter. Most of them have very little understanding of how HPSP really works. Use the search function and go through old threads, do your due diligence, then come back for clarification.

 

[Perrotfish]

I asked about the residency because I thought with the Air Force you can freely do any civilian residency. At least that's what my recruiter told me. With HPSP, am I not allowed to go to any medical school of my choice/acceptance and do residency of my choice/match??.

You can go to any US medical school on the HPSP scholarship, you apply for the scholarship once you have an acceptance to medical school. You can't go to an international (Caribbean) medical school on the HPSP scholarship.

Just to make sure you know how the match works: you can't do just any residency, you have to apply for residencies just like you applied for college and medical school. Some residencies are easy to get (like Pediatrics) others are so hard to get that only the absolute best medical students will get accepted (like Dermatology). The military has almost every kind of residency that the civilian world has. They have their own match, in December. If you're on the scholarship you have to apply to the military match. If you want to do a civilian residency you put 'civilian deferment' as your top choice IN the military match. If you get the deferment you get to apply again to the civilian match. However most people don't get the deferment, and get assigned something in the military match.

The military match works just like the civilian match: you apply to a specialty you want and rank all the locations you want to go to. The only difference is the odds, some things are more competitive in the military compared to the civilian world and some are less. Also they can't force you to do a full residency you don't want to do. The worst case scenario is that you don't get what you want, do an Intern year, serve out your time as a GMO, and then do a residency as a civilian.

Recruiters are often unclear about this. I don't think they're lying to get you to join since they don't lie about things they do know (I've never heard one say physicians were non-deployable, for example) but they're not physicians and are often unfamiliar with how the match works, in the civilian world or in the military.

So I'm guessing as a doc fresh out of residency I have close to zero chance of getting assigned to an international base.... I was hoping the AF bases are a bit better than Navy/Marine bases...

It depends what base you're talking about and how many other people want to go. Most people actually don't want to live in another country for years on end. I have no idea about what is available in the AF but in the Navy its extremely easy to get an assignment to an island or Korea, and a lot of new graduates/GMOs get assigned to Japan and Okinawa. Only Italy is really competitive to go to as an international location, and even then I know people who have gotten to go there straight out of residency.

Remember doctors tend to be old (by military standards), they often have families and marry professionals who need to stay in the US to keep their jobs. International adventures are not generally what senior Commanders and Captains want to do.

 

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[Special Delivery]

Do recruiters need to make certain quota for recruitment?

I don't know. I do know that some recruiters are (willfully?) ignorant of the finer points of HPSP. Remember, their job is to sell the scholarship. The onus is on you to kick the tires before you sign papers and drive it off the lot. Always.

 

[Perrotfish]

Thank you everyone for all your great advice. At this point, I'm starting to lean more toward not doing HPSP. If I still want to do military medicine, I can always inquire post-graduation. I still think it is a great honor to be a military doc. I also have a serious uniform envy, hah. I'd just like to do it on better terms, I guess.

Just in case you really do have your heart set on doing military medicine and you're just waiting for better terms I will warn you that, at least if you end up paying private school tuition, HPSP and USUHS are arguably the only practical ways into Uniform if you want to serve full time active duty. New Military physicians are not paid well. Which is not to say we are not compensated well, but the compensation that usually comes in the form of pay comes in the form of the scholarship (which is worth hundreds of thousands) and higher pay during residency (worth another 100K). If you join by the residency financial assistance program (120K paid over three years) or just join when you're done with residency (no additional bonus money) you'll still get the crappy pay but not the other compensation that makes up for it. A brand new board certified Navy physician makes about 100-130K/year depending on specialty. That's really not a bad salary if you get to keep all of it, but if you need to put 40-60K/year of after tax income towards your loans on that salary you might feel more than a little shortchanged.

That being said, committing to doing your residency with the military is a huge deal, and its a perfectly good reason to shy away from the scholarship. There are definitely options to serve part time in the reserves after residency which also might be appealing to you.

 

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[laughandatear]

Well, to be honest, I just like AF to begin with. AF also seems to have better conditions in term of lifestyle/bases/culture.



Starting to realize this! Do recruiters need to make certain quota for recruitment?

Recruiting is their job, and they need to recruit to prove they are good at it. Recruiters get a bad rep for selling lies, but they are a great resource for information. Never be intimidated by a recruiter. Realize he/she is your customer; you are not his/hers. Make the recruiter earn your business. Ask your recruiter to take you to the nearest large AFB near your town, even if hours away. Spend as much of that time as you can in the MTF talking to real doctors who work there. Politely knock on doors, and ask to speak with the senior physician in 3 or 4 specialties you are considering. Ask the 1 or 2 that you best connect with how they ended up in that room. Ask them if they knew what they were getting into. Ask them if they'd do it all over again. Ask them about the consequences on their spouse/kids if they have them. Ask them when they can next get out of the military and if they will leave or not. Then ask them why. Ask them about their last high school reunion, and what it was like to come home as an Air Force physician. Ask them about the happiest and most miserable AF doc from their peer group. Be curious, respectful, interested, and dress well while you're at it. Get emails and/or phone numbers and ask if they'd mind you calling them later when you remember you have more questions. Whether or not you come up with any questions (you will), see if they return your calls. Whether you decide to join the military or not, doing this will serve you well when you interview for medical school/residency/future jobs. Due diligence.

You get one chance to interview the military, so don't go in blind. If you like what you see, sign up. Once you "hire" them, you write that blank check and they own you.

16 years ago I did a modified version of the above and it became a great experience for me. My military time helped me grow up and become much more than just a doctor. I squeaked into a great post-residency assignment, and once there I squeaked into some great aerospace medicine experiences. But I also got drafted into a demanding deployment with the Army in Iraq that will forever be the pinnacle of my career. It was too hard for my family, so I left when I could after my 8 years.

Post-military medicine is easy. The pay is better, the lifestyle is better, and your military pedigree will say to your future employer that you can follow orders, show up, and just do your job. Even in medicine, even in 2013, it's amazing how basic the needs of many physician organizations are.

Post-military medicine is hard. The patient population is more demanding, productivity rules the day, and you may for a long time look up whenever an aircraft flies overhead thinking "I used to fly in those/I used to take care of the people who made that possible."

Curses and blessings--Such is life.

Good luck OP, you'll figure it out.
Cheers--

 

[laughandatear]

Well, to be honest, I just like AF to begin with. AF also seems to have better conditions in term of lifestyle/bases/culture.



Starting to realize this! Do recruiters need to make certain quota for recruitment?

Recruiting is their job, and they need to recruit to prove they are good at it. Recruiters get a bad rep for selling lies, but they are a great resource for information. Never be intimidated by a recruiter. Realize he/she is your customer; you are not his/hers. Make the recruiter earn your business. Ask your recruiter to take you to the nearest large AFB near your town, even if hours away. Spend as much of that time as you can in the MTF talking to real doctors who work there. Politely knock on doors, and ask to speak with the senior physician in 3 or 4 specialties you are considering. Ask the 1 or 2 that you best connect with how they ended up in that room. Ask them if they knew what they were getting into. Ask them if they'd do it all over again. Ask them about the consequences on their spouse/kids if they have them. Ask them when they can next get out of the military and if they will leave or not. Then ask them why. Ask them about their last high school reunion, and what it was like to come home as an Air Force physician. Ask them about the happiest and most miserable AF doc from their peer group. Be curious, respectful, interested, and dress well while you're at it. Get emails and/or phone numbers and ask if they'd mind you calling them later when you remember you have more questions. Whether or not you come up with any questions (you will), see if they return your calls. Whether you decide to join the military or not, doing this will serve you well when you interview for medical school/residency/future jobs. Due diligence.

You get one chance to interview the military, so don't go in blind. If you like what you see, sign up. Once you "hire" them, you write that blank check and they own you.

16 years ago I did a modified version of the above and it became a great experience for me. My military time helped me grow up and become much more than just a doctor. I squeaked into a great post-residency assignment, and once there I squeaked into some great aerospace medicine experiences. But I also got drafted into a demanding deployment with the Army in Iraq that will forever be the pinnacle of my career. It was too hard for my family, so I left when I could after my 8 years.

Post-military medicine is easy. The pay is better, the lifestyle is better, and your military pedigree will say to your future employer that you can follow orders, show up, and just do your job. Even in medicine, even in 2013, it's amazing how basic the needs of many physician organizations are.

Post-military medicine is hard. The patient population is more demanding, productivity rules the day, and you may for a long time look up whenever an aircraft flies overhead thinking "I used to fly in those/I used to take care of the people who made that possible."

Curses and blessings--Such is life.

Good luck OP, you'll figure it out.
Cheers--

 

[notdeadyet]

Just in case you really do have your heart set on doing military medicine and you're just waiting for better terms I will warn you that, at least if you end up paying private school tuition, HPSP and USUHS are arguably the only practical ways into Uniform if you want to serve full time active duty.

Definitely not true.

If you join by the residency financial assistance program (120K paid over three years) or just join when you're done with residency (no additional bonus money) you'll still get the crappy pay but not the other compensation that makes up for it.

Also not true. This is bad info. HPSP and USUHS are definitely the only practical way to secure a military residency, if that is your goal. But the FAP numbers are wrong and the idea of no bonus for new accessions is wrong as well.

FAP is not $120k. You are paid $45k annually each year, plus you are given a monthly stipend which is the same as those on HPSP (just over $2k, last I heard). So this would be about $210k for a three year residency, obviously more for longer ones.

And there are bonuses for folks who join after residency. It varies by specialty, with primary care type specialties being paid out the least, and sub specialties paid out the most. For primary care, it is somewhere around $250k. I know for Psychiatry, last time I checked, it was $272k.

Whether FAP and the new accessions bonus is sufficient to pay off med school loans is going to depend on how expensive your medical school was and what kind of budget you lived on while there. If your goal is to pay off the mailing balance while in or shortly after your time in the military, this can certainly be done, particularly if you're planning on going the IBR route. Even if you aren't, continuing payments on an $50k or $100k loan is not hardship if you can swallow the delayed gratification pill.

HPSP and USUHS are perfect for folks who want to do military residencies. If you don't (and since you don't know what specialty you want at this point, OP, you probably don't know if you want a military specialty), the idea that there is no other practical way to serve active duty is just plain wrong. Speaking to a military medicine recruiter as a board eligible physician, you'll have the benefit of wisdom and you might have more wiggle room than when you join before you've ever set foot in a medical school.

 

[Perrotfish]

Definitely not true.

Also incorrect. This is terrible information for folks trying to make N educated choice.

Anything in particular that you're calling out as not true? You think it IS practical to have to pay down 450K of loans at 8% with 120K of FAP money and a military physicians salary?

People on this board always point out these programs like they're reasonable alternatives to the HPSP scholarship. They're not. They don't pay enough. Civilian medicine is a reasonable alternative to the HPSP scholarship, FAP is not.

FAP is not $120k. You are paid $45k annually each year, plus you are given a monthly stipend which is the same as those on HPSP (just over $2k, last I heard). So this would be about $210k for a three year residency, obviously more for longer ones.

And there are bonuses for folks who join after residency. It varies by specialty, with primary care type specialties being paid out the least, and sub specialties paid out the most. For primary care, it is somewhere around $250k. I know for Psychiatry, last time I checked, it was $272k

Interesting, I stand corrected on the numbers. It doesn't really change my point, though. A student from a private school would expect to owe over 350K when they hit residency and nearly 450K when they hit the end of residency (75K/year of education principal accumulating interest at 7.5% a year). Whether its 210K through FAP or a 250K bonus for primary care direct accesscion (and all taxable income!!) that doesn't come close to covering the loans and a military salary isn't enough to make up the difference.

 

[notdeadyet]

People on this board always point out these programs like they're reasonable alternatives to the HPSP scholarship. They're not. They don't pay enough. Civilian medicine is a reasonable alternative to the HPSP scholarship, FAP is not.

You're a bit binary on this, no? No military program that I know of will completely cover your tuition like HPSP. Check. But stating that every other program not a "reasonable alternative" because it doesn't completely wipe out your debt is a bit concrete.

For most of us, there's a bit of grey in there. I'd LOVE to have zero debt. But not at the cost of having my residency options determined by the military and the high likelihood of being limited to military residencies. For people like this, FAP or accessions bonus, while not wiping out loans, can take a big enough bite out of them to make them tolerable and allow you to serve in the military.

Wiping out $100-200K of loans is definitely enough for some people to allow them to join the military in active status. It will bring down debt to the point they can pay it off while in the military or continue payments to the point they'll only have a few years post-active status. Military physicians qualify for IBR and if you did payments while in residency, you're on path to pay off the balance of your debts either while in the military or shortly after (depending on specialty).

FAP and new accessions bonuses are definitely not enough for folks who went to a $400K medical school and want zero debt, but that doesn't describe all or even most potential applicants.

You're welcome to your point of view, but the opinions you gave in your post were presented as blanket facts and they were incorrect. It's basically another example of more bad recruiting, and there's too much of that already.

OP and others- You CAN practically join the military in active status without taking HPSP. How viable these options will be for you (FAP and accessions bonus) will depend on your financial aid, your specialty, and how much of your loans you want to delete. If recruiters or others give you the "it's now or never" speech to you as a medical student about military service, run the other way and spend some time with a spreadsheet. You might be getting played.

 

[Perrotfish]

Wiping out $100-200K of loans is definitely enough for some people to allow them to join the military in active status. ). .

If you think that shaving 100-200K off an average, private unsubsidized medical school loan makes it manageable on a military salary I think you have a poor understand of either military salaries or grad laons. An average private school loan these days is 300-350K (my school was over 350K with very modest loans for living expenses). That's not the rare exception, that's just what it costs these days if your family isn't footing the bill (and tuition is STILL going up 8% a year). Those loans accumulate interest through medical school so the average after medical school is 350-400K. FAP is (your numbers) 210K of pretax income, about 170K after tax, and the loans accumulate interest through residency too. So if you put ALL the FAP money towards the loans (basically starting a 10 year repayment plan), at the end of residency you owe 250K accumulating interest at 8%. That's about $3000 a month in payments from a salary that's 120K before taxes in a job where you can't necessarily moonlight. That's just to stay on a 10 year plan (where the loans aren't even paid off when you're done with your obligation).

Is that doable? Yes, if you don't mind having less discretionary income less than Lance Corporals and civilian residents. Is it a real, viable option? No, no its not. Hence my advice: if you want the uniform, you need the scholarship. You can be a civilian instead and that's fine too, but FAP is not a viable option for most students.

 

[notdeadyet]

An average private school loan these days is 300-350K (my school was over 350K with very modest loans for living expenses).

This is the problem. You're generalizing your experience to everyone.

$350K in student loans is not the norm. It's WAY over average loan burden. It's on the high end even for private medical schools. Pretending this burden (and my condolences, by the way) is normal for everyone is why your advice isn't on point.

That's not the rare exception, that's just what it costs these days if your family isn't footing the bill (and tuition is STILL going up 8% a year).

Untrue. It's the norm if you go to an expensive private school. Not everyone does. In fact, most people don't. Your situation is far from unique, but your burden is far over the average. Pretending it's "what it costs these days" is disingenuous.

FAP is (your numbers) 210K of pretax income, about 170K after tax, and the loans accumulate interest through residency too. So if you put ALL the FAP money towards the loans (basically starting a 10 year repayment plan), at the end of residency you owe 250K accumulating interest at 8%. That's about $3000 a month in payments from a salary that's 120K before taxes in a job where you can't necessarily moonlight. That's just to stay on a 10 year plan (where the loans aren't even paid off when you're done with your obligation).

Wow, $3K? That would suck, but you'd be a fool for paying the straight payment 10 year plan.

What you would actually be doing is making IBR payments through residency and then on your attending salary as a military physician. If you did a three year residency, you'd have 7 years of this paid by the time you finished your initial active duty obligation. IBR is (obviously) income based. It's not insignificant, but it doesn't break the bank, either. You would NOT be paying $3K throughout your military career.

Is it a real, viable option? No, no its not. Hence my advice: if you want the uniform, you need the scholarship. You can be a civilian instead and that's fine too, but FAP is not a viable option for most students.

And this is why your advice is bad: you don't seem to be able to step back and look at this objectively.

You had a $hitty amount of loans, a WAY higher burden than your average student. You took HPSP and are now obligated. You are unable to see the potential for any other route, because you do not have these options available to you.

IF an applicant has $350K in student loans and plans on a 10 year straight payment plan, they would be living a Lance Corporal lifestyle (per Perrotfish's math).

IF an applicant has $350K in student loans and plans on the 10 year IBR/PSLF plan, they would be paying back loans off of a military attending's salary. This would not knock you down to a Corproal lifestyle, but you would not be fancy free like you would with HPSP. You'd write a check every month and you'd feel it. If you had done a three year residency and planned on leaving after 4 years of active duty, you would have to continue with your IBR payments and work at a qualifying agency for 3 years and be debt free, or just structure your own payment plan to take care of the balance.

This is why the "now or never" advice you get primarily from recruiters looking to make their HPSP numbers (or from some HPSP recipients who only crunched their own numbers) is bad advice. The answer, like most things, is it depends.

HPSP is not the only option, even for those who unfortunately attended the priciest of schools. HPSP definitely makes the most sense financially for those folks, without a doubt, but they can (and do) end up in uniform via FAP and post-residency direct accession.

I'm sure you made the right call, Perrotfish, and hope you're happy with your decision. But thinking what was right for you is therefore right for everyone is a bad assumption and bad advice. Folks need to look at their own situation.

Anyway, we are abviously of different minds on this. I just wanted to make sure the OP understood what's available to him instead of thinking HPSP really is thE only way he'll wear a uniform.

 

[Perrotfish]

This is the problem. You're generalizing your experience to everyone.

$350K in student loans is not the norm. It's WAY over average loan burden. It's on the high end even for private medical schools. Pretending this burden (and my condolences, by the way) is normal for everyone is why your advice isn't on point.
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The median cost of attendance at a private medical school, which is where most students go, is 280K. . Source: https://www.aamc.org/download/152968/data/.

That principal loan 280K accumulates interest in medical school, it's about 330K when you graduate. Again, if you do FAP, and put all of your FAP money towards the loans the second you get it, when you're a military attending you'll likely to need to come up with just shy of 3K a month to stay on the 10 year plan (my numbers above were for someone who borrowed 300K). That's for anyone who attended a private school above the median (and there's not much variation within the first two standard deviations of the median).

If the OP goes to a private school I maintain he has reached a decision point. HPSP or civilian.

What you would actually be doing is making IBR payments through residency and then on your attending salary as a military physician. If you did a three year residency, you'd have 7 years of this paid by the time you finished your initial active duty obligation. IBR is (obviously) income based. It's not insignificant, but it doesn't break the bank, either. You would NOT be paying $3K throughout your military career.

The numbers make more sense with IBR. However I think that doing IBR/PSLF is a bad plan. A terrible plan. A plan that, as yet, has never paid down a cent of debt for anyone. A plan where your debt gets bigger and bigger while you're making IBR payments, and where the government specifically says they have made no legally binding promise to pay off your debt at the end of the road. Keep in mind at the end of the road you'll likely have paid more than the principal back but will, because of interest, likely owe a seven figure debt. This program seems custom designed to offend everyone: Conservatives can rage that art history majors are borrowing half a million for ten years of finding themselves and are then seeing their debts forgiven with no consequences while Liberals get to see Neurosurgeons making 500K getting government debt assistance. If you use this plan you're trusting a government that changed the student loan rules on my class three time during the 4 years we were in medical school to leave this idiotic program untouched until 2040. Not saying it couldn't happen, I might even give it 50:50 odds (actually I probably wouldn't), but I DEFINITELY wouldn't bet my family's financial future on it. Pay the money you borrowed.

On the plus side, if you did do IBR, you could put that FAP money towards a shiny new house or some nice vacations. If you're committing to never paying down your loans there's no reason to waste income partially paying them down.

 

[deuist]

Perrotfish, you come across as a recruiter some times on these boards by stating that HPSP is the only deal in town and only a fool would not take the money. Your numbers are way too high compared to what else is out there. I went to a private school and people were graduating with $212,000 in debt. I just checked the tuition and fees webpage and in the worst case scenario, the total debt would run $232,000 if you were to go there today. If I were a civilian EM doc I could pay off all of my loans in 3 years and still live better than a military physician. Civilians also get to chose their residency, chose where they live, where they practice, how long they stay there, get to keep their spouses employed by not moving, etc... What do you place the value on those things? As notdeadyet mentioned, there are other ways to join that still work financially. In 2008 the Air Force's accession bonus for general surgeons was $400,000. Surely even you could pay off debt with that kind of coin.

 

[Perrotfish]

Perrotfish, you come across as a recruiter some times on these boards by stating that HPSP is the only deal in town and only a fool would not take the money. Your numbers are way too high compared to what else is out there. I went to a private school and people were graduating with $212,000 in debt. I just checked the tuition and fees webpage and in the worst case scenario, the total debt would run $232,000 if you were to go there today. If I were a civilian EM doc I could pay off all of my loans in 3 years and still live better than a military physician. Civilians also get to chose their residency, chose where they live, where they practice, how long they stay there, get to keep their spouses employed by not moving, etc... What do you place the value on those things? .

232K Total debt or total tuition and fees? If its the later than the total debt is 300K (living expenses) and the debt you graduate with is 350K (Interest). If its 232 K total then, as per my link above, its just barely average for a public school and 50K below the median for a private school and you would still owe about 270K when you graduate from medical school from the interest.

I don't think HPSP is the only option, civilian salaries in many fields are high enough that you can feasibly pay down medical school debts. I think we have gotten to the point where HPSP is the only viable program for private school students to enter the military without relying on IBR, because the other accession programs don't pay enough. I do also think that the military is no longer the only way to close off options. It used to be that civilians just had more options that military medical officers in terms of planning their career. Now I think that, unless you go to a cheap public school (and there aren't many left) civilian medicine might actually close more doors than military medicine. There is no way someone with the kind of loan burden I was facing could have could responsibly choosn Peds, PM&R, FM, ID, or academic medicine. Even IM and OBGYN would be financially difficult.

The other things you mentioned, where and how you practice, are also influenced by debt. Even assuming that you have the numbers to really 'choose' your residency and fellowship, and you don't just get shunted off to the ass end of nowhere for each because you had the audacity to get a step one below the median, debt can still influence not just the field you choose but how and where you practice as an attending. I don't just want to practice in my field, I want to practice in a particular way (reasonable appointment times, reasonable hours, good location, etc). I'm going to trade salary for all of those lifestyle choices. Doctors on the debt treadmill are often consigned to rural sweatshops which push for a profitable, rather than correct, standard of care. I've rotates with them, I've talked to them, and I have no desire to live in the swamps of Louisiana and see a new patient every 7 minutes to pay of Sallie Mae.. At least with the military you know that, in 4 years, even if you don't like them you're done and debt free. Debt treadmill doctors can practice in an environment they feel is unfulfilling or unsafe for a decade or more.

Its not that the grass is always greener on the military side of the fence, but I think that people on this board underestimate how crappy civilian medicine is getting for students who need to take out loans.

As notdeadyet mentioned, there are other ways to join that still work financially. In 2008 the Air Force's accession bonus for general surgeons was $400,000. Surely even you could pay off debt with that kind of coin

Nope, not even close. My school had approximately a 350K Principal debt. That means I would owe 410K at the end of medical school (interest) and nearly 550K at the end of a 5 year surgical residency if I did IBR (a simple rule of thumb for grad school debt is that it doubles every 10 years). And the bonus is taxed and paid over 4 years. Even if I put every dime of my after tax bonus towards my debt I would have a ton left over. Actually the after tax bonus value of my annual bonus disbursement (75K) is almost exactly what I would owe each year if I was trying to stick to a 10 year payment plan on my 550K of debt. So at the end of my four years of bonus money, I would have six more years of repayment to go. The numbers aren't that different if I use a more average 280K principal debt.

7.5% Interest is f-ing horrifying.