HPSP_review
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Hello all - I am an active duty physician. I received a military-funded scholarship that paid the cost of medical school called the Health Professions Scholarship Program (HPSP) upon being granted acceptance into medical school. Likely many of you have heard of the program, but despite its existence for the last few decades there still is a lack of information about the program. I wanted to write a real “review” of the HPSP scholarship and touch on life as a military medicine physician.
For background, the medical school I attended was one of the most expensive in the country, and the HPSP program pays for tuition, books, exams, and provides a yearly stipend. It sounded like a pretty great deal - so after searching SDN, speaking to the recruiter, and then an active duty physician via telephone, I decided to accept the scholarship. For obvious reasons, none of those sources portrayed the program accurately, and all conveniently left out many major details that could easily be life-altering to a prospective applicant.
In this post I hope to lay out the reasons for and reasons against the HPSP program and scholarship. I am going to lay out facts – these points are what I have seen and learned to be true. Full disclosure - I regret taking the HPSP scholarship – but I do think I am able to lay out the points in a relatively unbiased way. I welcome comments from other active duty folks to correct anywhere I am misinformed.
The way I am organizing this post is in chronological order of medical training and the corresponding HPSP hurdles. The first of which is:
Specialty deferment after Medical School
Once you are a medical student you will eventually settle on a specialty you want to pursue. For the vast majority of medical students, the specialty they thought they would pursue during their first year is not the one they will eventually match into. As people are exposed to new fields, most change their minds – that’s normal.
Every year, the military allocates a finite number of spots for each specialty. These allocated spots vary by branch. For example, if 10 people want to do ENT, but there are 2 spots, 8 of you will not be able to enter into an ENT residency in the year you graduate residency. For specialties like emergency medicine, ENT, neurosurgery, radiology, dermatology, anesthesiology, and more, the military match rates are SIGNIFICANTLY worse than their civilian counterparts – in several cases 2 to 5 times harder to match in the military than in the civilian world. For background, the military match uses a point system which rewards several areas including: previous service in the military, grades/test scores, away rotation performance, and research.
The military will tell you that if you want to start residency at the time of graduating, you should apply for a secondary, or backup, specialty. If you do not want to do a different specialty (most people don’t), and you unfortunately do not match into your chosen field, you will serve as a general medical officer (navy) or flight surgeon (air force and army). This is essentially a family medicine doctor many extra duties thrown in.
After two years of flight surgery, the minimum duration allowed, you can reapply to your chosen field. As I mentioned earlier, previous service will give extra points towards matching, so your second round of matching should give you a higher likelihood of obtaining a spot – but the match rates are still extremely competitive. If you fail to match a second time, you will repeat 2 more years of flight surgery until your 4 year commitment (incurred by the HPSP program) is paid back, and then you can apply to civilian residencies.
The two aspects of these general medical officer/flight surgeon commitments that I want to point out:
Training Disparities
The three branches all have residencies built into the MTFs (military training facilities). Some branches, particularly the air force, don’t have enough military residency spots for the number of physicians it needs. In these cases people are allowed to do civilian residencies. However, the overwhelming majority of HPSP scholarship recipients will be required to complete a residency that is coordinated by the military at one of the MTFs.
As training facilities, military residencies are unable to offer equal experiences to their civilian counterparts. In the past, military hospitals were larger than they are now – they had more diverse pathology, with more challenging and complex patient populations. Over the last decades things have changed. The military is slowly reducing the size of their MTFs, and the average patient being seen in MTFs is generally under 50 years old with relatively few comorbidities. Open heart surgery, vascular, and neurological surgeries are no longer done at most facilities, and number of pregnant women delivering at military facilities has dropped dramatically. Complex patients are more frequently being sent out into the civilian world.
These facts are to the detriment of military residents who, as a result, are not seeing complex patients – the ones they will inevitably see in the civilian world. Residents should be exposed to the most complex patients so that they are prepared for attending life, but more and more residents are not getting exposure they need to be competent and confident attendings.
To the credit of the military, the programs try to remedy their lack of volume and patient complexity by sending residents to out-service rotations – in some cases they spend up to half of their residency in different cities and states – working in new hospitals and with unfamiliar attendings.
In summary, HPSP recipients will largely be trained in military hospitals. These hospitals are unable to provide equal training to the civilian world. One cannot place a value on great training. It is the bedrock for your entire career.
Fellowships
You may or may not be allowed to do a fellowship in your desired area. If you are allowed, you may end up incurring two extra years of payback time. Many one-year long fellowships require two additional years of payback.
Pay and attending Life
Pay varies by specialty. This year the maximum an HPSP graduate will make around 185k. The lowest around 165k. You will graduate residency as an O-3 and you will make around 110-120k per year plus the military specialty pay found at this link. This pay scale has not been changed in many, many years. Many specialties pay less than half of what their civilian counterparts are paid. The fact that the military paid for medical school does not close this gap. Defense Finance and Accounting Service > MilitaryMembers > payentitlements > Pay Tables > HPO4
Early career issues
New attending physicians need to practice medicine. The first several years out of training are extremely important to the development of a new attending physician. The military often has other plans in store for the new graduate – often times these take the shape of permanent change of station (eg long term move) to places that have VERY low patient volume.
Imagine you’ve just learned to golf. Its difficult but with constant practice you will become an expert. But instead of being allowed to practice daily you are told you maybe get to practice once a week – and only at the putting green. This is what happens to military physicians who are sent overseas after they graduate. Their skills atrophy and they are done an incredible disservice to their early careers. They return to the USA and are in some instances are uncomfortable practicing medicine in the “real world”.
Attending Pay
If we assume all of the best case scenarios are met: you were allowed to match right out of medical school into the specialty you wanted, you were granted a civilian residency and you received excellent training. Last, we’ll assume you are NOT going to be deployed for a long period of time or sent overseas as a new attending. Congrats – you absolutely got the best scenario out of HPSP.
However the reality remains: you will make at most around $185,000. Your civilian counterparts will be making civilian salaries and as a result you still lose money. Most surgical and procedural subspecialties will have a net loss of about 1 million dollars. The disparity for the non-procedural specialties is less, but still is very likely a net negative. You easily could’ve taken loans and paid for your schooling and not had the headache of military medicine to deal with.
If you are planning on going into a low paying field like some of the primary care specialties it may be a better deal. Refer to my first point about changing specialties in medical school. You do not know what you want to do.
Being in the Military
Last, being in the military isn’t for everyone. Expect a lot of bureaucratic busy work, 4 weeks of vacation per year (many civilian specialties get 6-10 weeks), and inability to easily travel.
The majority of military doctors will have to deploy for at least 6 months (not the case of pediatricians, etc). For surgical specialties they generally will not operate for those 6 months, and instead sit in a base overseas and watch movies and have skill atrophy will they are away from their family and friends.
I will say that the job in the military is much easier than the civilian world. The work is commensurate to the pay. If you don’t want to work hard, military medicine may be a great fit for you.
In summary – it is my firm belief that no one should accept the HPSP scholarship. I’ve heard it said that you should only take scholarship if you have a desire to serve the military. If this describes you, become an attending physician via the classic civilian route and then join. Don’t do it via the HPSP scholarship.
For background, the medical school I attended was one of the most expensive in the country, and the HPSP program pays for tuition, books, exams, and provides a yearly stipend. It sounded like a pretty great deal - so after searching SDN, speaking to the recruiter, and then an active duty physician via telephone, I decided to accept the scholarship. For obvious reasons, none of those sources portrayed the program accurately, and all conveniently left out many major details that could easily be life-altering to a prospective applicant.
In this post I hope to lay out the reasons for and reasons against the HPSP program and scholarship. I am going to lay out facts – these points are what I have seen and learned to be true. Full disclosure - I regret taking the HPSP scholarship – but I do think I am able to lay out the points in a relatively unbiased way. I welcome comments from other active duty folks to correct anywhere I am misinformed.
The way I am organizing this post is in chronological order of medical training and the corresponding HPSP hurdles. The first of which is:
Specialty deferment after Medical School
Once you are a medical student you will eventually settle on a specialty you want to pursue. For the vast majority of medical students, the specialty they thought they would pursue during their first year is not the one they will eventually match into. As people are exposed to new fields, most change their minds – that’s normal.
Every year, the military allocates a finite number of spots for each specialty. These allocated spots vary by branch. For example, if 10 people want to do ENT, but there are 2 spots, 8 of you will not be able to enter into an ENT residency in the year you graduate residency. For specialties like emergency medicine, ENT, neurosurgery, radiology, dermatology, anesthesiology, and more, the military match rates are SIGNIFICANTLY worse than their civilian counterparts – in several cases 2 to 5 times harder to match in the military than in the civilian world. For background, the military match uses a point system which rewards several areas including: previous service in the military, grades/test scores, away rotation performance, and research.
The military will tell you that if you want to start residency at the time of graduating, you should apply for a secondary, or backup, specialty. If you do not want to do a different specialty (most people don’t), and you unfortunately do not match into your chosen field, you will serve as a general medical officer (navy) or flight surgeon (air force and army). This is essentially a family medicine doctor many extra duties thrown in.
After two years of flight surgery, the minimum duration allowed, you can reapply to your chosen field. As I mentioned earlier, previous service will give extra points towards matching, so your second round of matching should give you a higher likelihood of obtaining a spot – but the match rates are still extremely competitive. If you fail to match a second time, you will repeat 2 more years of flight surgery until your 4 year commitment (incurred by the HPSP program) is paid back, and then you can apply to civilian residencies.
The two aspects of these general medical officer/flight surgeon commitments that I want to point out:
- GMOs/FS make around $120,000 a year. If one had to do four years at this position, he or she would, in effect, be losing four years of peak earning potential. If your chosen field would have made $400,000 for those years, you have around a $1 million dollar loss. Two years of flight medicine is likely at least a $500,000 dollar loss. The navy in particular has very high rates of GMO requirements, so keep that in mind.
- These tours generally require you to move, and often overseas. It is up to you if you think a move is a negative or positive.
Training Disparities
The three branches all have residencies built into the MTFs (military training facilities). Some branches, particularly the air force, don’t have enough military residency spots for the number of physicians it needs. In these cases people are allowed to do civilian residencies. However, the overwhelming majority of HPSP scholarship recipients will be required to complete a residency that is coordinated by the military at one of the MTFs.
As training facilities, military residencies are unable to offer equal experiences to their civilian counterparts. In the past, military hospitals were larger than they are now – they had more diverse pathology, with more challenging and complex patient populations. Over the last decades things have changed. The military is slowly reducing the size of their MTFs, and the average patient being seen in MTFs is generally under 50 years old with relatively few comorbidities. Open heart surgery, vascular, and neurological surgeries are no longer done at most facilities, and number of pregnant women delivering at military facilities has dropped dramatically. Complex patients are more frequently being sent out into the civilian world.
These facts are to the detriment of military residents who, as a result, are not seeing complex patients – the ones they will inevitably see in the civilian world. Residents should be exposed to the most complex patients so that they are prepared for attending life, but more and more residents are not getting exposure they need to be competent and confident attendings.
To the credit of the military, the programs try to remedy their lack of volume and patient complexity by sending residents to out-service rotations – in some cases they spend up to half of their residency in different cities and states – working in new hospitals and with unfamiliar attendings.
In summary, HPSP recipients will largely be trained in military hospitals. These hospitals are unable to provide equal training to the civilian world. One cannot place a value on great training. It is the bedrock for your entire career.
Fellowships
You may or may not be allowed to do a fellowship in your desired area. If you are allowed, you may end up incurring two extra years of payback time. Many one-year long fellowships require two additional years of payback.
Pay and attending Life
Pay varies by specialty. This year the maximum an HPSP graduate will make around 185k. The lowest around 165k. You will graduate residency as an O-3 and you will make around 110-120k per year plus the military specialty pay found at this link. This pay scale has not been changed in many, many years. Many specialties pay less than half of what their civilian counterparts are paid. The fact that the military paid for medical school does not close this gap. Defense Finance and Accounting Service > MilitaryMembers > payentitlements > Pay Tables > HPO4
Early career issues
New attending physicians need to practice medicine. The first several years out of training are extremely important to the development of a new attending physician. The military often has other plans in store for the new graduate – often times these take the shape of permanent change of station (eg long term move) to places that have VERY low patient volume.
Imagine you’ve just learned to golf. Its difficult but with constant practice you will become an expert. But instead of being allowed to practice daily you are told you maybe get to practice once a week – and only at the putting green. This is what happens to military physicians who are sent overseas after they graduate. Their skills atrophy and they are done an incredible disservice to their early careers. They return to the USA and are in some instances are uncomfortable practicing medicine in the “real world”.
Attending Pay
If we assume all of the best case scenarios are met: you were allowed to match right out of medical school into the specialty you wanted, you were granted a civilian residency and you received excellent training. Last, we’ll assume you are NOT going to be deployed for a long period of time or sent overseas as a new attending. Congrats – you absolutely got the best scenario out of HPSP.
However the reality remains: you will make at most around $185,000. Your civilian counterparts will be making civilian salaries and as a result you still lose money. Most surgical and procedural subspecialties will have a net loss of about 1 million dollars. The disparity for the non-procedural specialties is less, but still is very likely a net negative. You easily could’ve taken loans and paid for your schooling and not had the headache of military medicine to deal with.
If you are planning on going into a low paying field like some of the primary care specialties it may be a better deal. Refer to my first point about changing specialties in medical school. You do not know what you want to do.
Being in the Military
Last, being in the military isn’t for everyone. Expect a lot of bureaucratic busy work, 4 weeks of vacation per year (many civilian specialties get 6-10 weeks), and inability to easily travel.
The majority of military doctors will have to deploy for at least 6 months (not the case of pediatricians, etc). For surgical specialties they generally will not operate for those 6 months, and instead sit in a base overseas and watch movies and have skill atrophy will they are away from their family and friends.
I will say that the job in the military is much easier than the civilian world. The work is commensurate to the pay. If you don’t want to work hard, military medicine may be a great fit for you.
In summary – it is my firm belief that no one should accept the HPSP scholarship. I’ve heard it said that you should only take scholarship if you have a desire to serve the military. If this describes you, become an attending physician via the classic civilian route and then join. Don’t do it via the HPSP scholarship.
