HPSP/USUHS/National Guard Experience

[s432000]

I'm really interested in pursuing military medicine in the future because I have always wanted to serve my country. In middle school, we had a career fair and thats where I met Army recruiters and from there on out I thought I was going to enlist as a 68W, do my four years, and leave for undergrad on the GI bill and if I had earned the stats for med school, use the TX Hazlewood Act to my advantage. However, having an extremely late birthday (by the time I turned 18, I was already enrolled in college) and having parents that showed extreme disapproval about enlisting vs commissioning as an officer, my original plan came to an end. I was introduced to the HPSP program by one of my professors that had recently left the Army after 27 years of service and he also went through HPSP and said he highly recommends it. I thought that since I am interested in medicine but I am also interested in the military, the HPSP would be a good choice. However, on SDN, it seems as if most people who took the HPSP scholarship regretted their decision due to various reasons such as skill atrophy, GMO's, etc. I am currently interested in emergency medicine and I've heard it's more competitive in the military than it is in the civilian world, however, I'm just a premed student and I know a lot of things can change. Due to some of the restrictions and competitiveness in residency spots regarding HPSP, my interest in doing the Guard increased since I've read about having more freedom in regard to those areas. I am aware of some drawbacks that I would experience in the military such as deployment, etc. and since I have no experience in the military, I can't go around telling anyone that I am excited and prepared with deploying as a premed student and I know my opinions can change in the future. I am also confused on which branch I would like to serve as I see benefits and drawbacks to each branch. I listed a few basic ones that I'm somewhat knowledgable about and would like your input. As of this moment, I would prefer to do my required payback (4 years or however many years due to residency) but the possibility of a career is open because the majority of officers I know that a 20+ year career and said they enjoyed it despite some of the negatives they experienced. For those of you doing HPSP/USUHS/Guard or did it in the past, do you regret your decision, why did you choose that particular branch, would you recommend it to others? How was your experience being a physician in the military? Thank you in advance!
Army pros:
Most Residency options
Smaller chance of GMO
Being apart of the branch that is very personal to me (Always have looked up to the Army and what they have done in the past)
Pink and Greens coming back? 😀
Army Cons:
I've heard about skill atrophy developing due to be selected for a Battalion Surgeon Tour post-residency or not enough cases
Worse treatment out of the three branches?
Air Force Pros
Best treatment?
Being in the branch with the 8th Air Force (Also personally look up to the Mighty Eighth and especially what they did in WWII)
Pink and Greens coming back? 😀
Flight surgery?
Air Force Cons
Less residency options/most competitive?
GMO (although I'm not sure whether it's really a bad thing as I would rather do it before residency than after like how some in the Army have had to do)
Navy Pros
Best locations (coastal)
Working with Marines?
Flight surgeon?
Navy Cons
GMO's possible (Again, not sure if it's necessarily a bad thing)

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[mslall]

I guess I’m confused as to what you mean by “the Guard.” Are you talking about enlisting in the national guard now while you’re an undergrad? Or talking about joining the reserves vs doing FAP after you’ve completed medical school and/or your residency (ie not doing HPSP and footing the med school bill on your own until after)?

I’m USUHS grad so I can’t really speak to FAP, but my limited understanding was you could take it after residency? Or have you always been able to get it during a civilian residency? Has any of that changed with at least perceived if not very real recruiting woes?

I know a few EM (Army) people who ended up as battalion surgeons of varying degrees after their residency. Some with SF groups by choice, some with line units by told. It can happen for sure.

It still seems like GMO is a very common thing in the navy, especially in more competitive specialties. I feel like EM probably is that way? From what I’ve gathered the difference between most GMOs between the Air Force and Navy is, it seems, Is there is large percentage of GMOs that have matched categorically into a residency program, but have to do a post-intern year GMO prior to returning, whereas in the AirForce, much like the Army, it’s generally people that don’t match out of med school. This is just my perception of what I’ve seen and have no data to back it up so take it for what it’s worth.

I simultaneously do and don’t regret my decision to go to USUHS. The education was phenomenal and I really think for undergraduate medical education it is the most under-rated place in the country. I don’t regret doing my general surgery residency in the Army. I got phenomenal training and would train their again if I had to do it over. Conversely I regret my decision because at 22-23, 7 years didn’t seem like too long. At that time I also had no idea what I wanted to do in medicine. So 6 years of residency, 2 years of fellowship, and 9 years of ADSO (7 USUHS + 2 fellowship) I’m here for a minimum of 17 years in a system where who knows what is going to happen other than, at least for the foreseeable post-fellowship future 4.5 (at best)-9 month deployments q12-16 months.

My experience has been great so far, but with the uncertainty of the future of milmed I’m not sure I’d do it again. It would really be nice to have the freedom to job hunt and have guaranteed pay regardless of the government being open, CME funding, location stability, high case volumes in a setting/location of (some) choice, etc, but none of those are things you think about at 22.

If someone is planning on joining what I generally tell people the safest bet is, is to get all your training commitment free. If you still want to join after that the army will ALWAYS take you, either on AD or the reserves. If I had to do it all over that’s probably what I would have done.

 

[s432000]

I guess I’m confused as to what you mean by “the Guard.” Are you talking about enlisting in the national guard now while you’re an undergrad? Or talking about joining the reserves vs doing FAP after you’ve completed medical school and/or your residency (ie not doing HPSP and footing the med school bill on your own until after)?

I’m USUHS grad so I can’t really speak to FAP, but my limited understanding was you could take it after residency? Or have you always been able to get it during a civilian residency? Has any of that changed with at least perceived if not very real recruiting woes?

I know a few EM (Army) people who ended up as battalion surgeons of varying degrees after their residency. Some with SF groups by choice, some with line units by told. It can happen for sure.

It still seems like GMO is a very common thing in the navy, especially in more competitive specialties. I feel like EM probably is that way? From what I’ve gathered the difference between most GMOs between the Air Force and Navy is, it seems, Is there is large percentage of GMOs that have matched categorically into a residency program, but have to do a post-intern year GMO prior to returning, whereas in the AirForce, much like the Army, it’s generally people that don’t match out of med school. This is just my perception of what I’ve seen and have no data to back it up so take it for what it’s worth.

I simultaneously do and don’t regret my decision to go to USUHS. The education was phenomenal and I really think for undergraduate medical education it is the most under-rated place in the country. I don’t regret doing my general surgery residency in the Army. I got phenomenal training and would train their again if I had to do it over. Conversely I regret my decision because at 22-23, 7 years didn’t seem like too long. At that time I also had no idea what I wanted to do in medicine. So 6 years of residency, 2 years of fellowship, and 9 years of ADSO (7 USUHS + 2 fellowship) I’m here for a minimum of 17 years in a system where who knows what is going to happen other than, at least for the foreseeable post-fellowship future 4.5 (at best)-9 month deployments q12-16 months.

My experience has been great so far, but with the uncertainty of the future of milmed I’m not sure I’d do it again. It would really be nice to have the freedom to job hunt and have guaranteed pay regardless of the government being open, CME funding, location stability, high case volumes in a setting/location of (some) choice, etc, but none of those are things you think about at 22.

If someone is planning on joining what I generally tell people the safest bet is, is to get all your training commitment free. If you still want to join after that the army will ALWAYS take you, either on AD or the reserves. If I had to do it all over that’s probably what I would have done.

Thank you so much! To clarify about the National Guard, I meant joining while in medical school to help pay for my expenses (HPLRP, STRAP) but I'll have to look further into these. Thankfully, my undergrad tuition is pretty much covered by my parents and I will always be grateful for that.

 

[deleted981229]

Thank you so much! To clarify about the National Guard, I meant joining while in medical school to help pay for my expenses (HPLRP, STRAP) but I'll have to look further into these. Thankfully, my undergrad tuition is pretty much covered by my parents and I will always be grateful for that.

Go active, don’t do guard or reserve. The guard and reserve will destroy your residency and civilian practice. I only recommend those who have a strong desire to serve to join the reserve or guard. It’s a bigger commitment to do just one weekend a month.

 

[mslall]

Thank you so much! To clarify about the National Guard, I meant joining while in medical school to help pay for my expenses (HPLRP, STRAP) but I'll have to look further into these. Thankfully, my undergrad tuition is pretty much covered by my parents and I will always be grateful for that.

I have no idea what HPLRP or STRAP are. But again, I’d caution everyone to wait to join until they’re at least in residency in the field they choose and then doing FAP

 

[deleted981229]

I have no idea what HPLRP or STRAP are. But again, I’d caution everyone to wait to join until they’re at least in residency in the field they choose and then doing FAP

Those are reserve component “HPSP” but it’s a loan pay back program. however the obligation is double length as active duty and the candidates are responsible for their own residency.

 

[mslall]

Those are reserve component “HPSP” but it’s a loan pay back program. however the obligation is double length as active duty and the candidates are responsible for their own residency.

Candidates are always responsible for their own residency. For any program. Military or civilian.

 

[DeadCactus]

There is plenty written on this forum about joining the Guard/Reserve as medical student, resident, or physician. There are challenges to balancing a military and civilian career, absolutely. At the same time, those in the Guard/Reserve don't have to beg the military for permission to train straight through, do a fellowship, go on vacation, or change jobs. Your family isn't forced to be uprooted frequently, you have more input into when you go to schools or training, and deployments are generally significantly shorter. You get to keep a civilian job with the acuity you want and the work environment you want. Frankly, I think Guard or Reserve are much better fit for the majority of military physicians and a better model as whole.

I do agree with mslall, I'm against any of the medical student incentives. Take STRAP/FAP as a resident or wait until you're an attending and take a accession bonus. The medical student programs are designed to play off of an irrational fear of smart debt.

 

[s432000]

There is plenty written on this forum about joining the Guard/Reserve as medical student, resident, or physician. There are challenges to balancing a military and civilian career, absolutely. At the same time, those in the Guard/Reserve don't have to beg the military for permission to train straight through, do a fellowship, go on vacation, or change jobs. Your family isn't forced to be uprooted frequently, you have more input into when you go to schools or training, and deployments are generally significantly shorter. You get to keep a civilian job with the acuity you want and the work environment you want. Frankly, I think Guard or Reserve are much better fit for the majority of military physicians and a better model as whole.

I do agree with mslall, I'm against any of the medical student incentives. Take STRAP/FAP as a resident or wait until you're an attending and take a accession bonus. The medical student programs are designed to play off of an irrational fear of smart debt.

Thanks for the info! I will definitely look around the forum more when I have the time.

 

[ShockIndex]

I’m EM-CCM who did Reserve/STRAP from the start of EM residency in 2003 to 2013 (fellowship came later). I also have prior service enlisted time after HS in the early 90s.

Unless you are absolutely sure that you want a career in military medicine, I do not recommend HPSP (or USUHS for that matter). You will simply give up too much flexibility and opportunity to justify the savings unless you are really sure that military medicine is the long-term career for you.

Reserves/STRAP is a reasonable option for those who want to dip their toe in the water but not make it a career. I deployed 3 times after finishing residency, but they were limited to roughly 90 days boots on the ground and no more than 120 days total. Because I was prior service infantry, the deployments were pretty reasonable - 1 CASH deployment to Iraq, 1 field surgeon with TF82nd in A-stan, and another to Martin Army at Benning. For now, the deployment tempo is much less than what I experienced, but you never know whose ass will need to be kicked in 5 years.

Would I do it again, yes. However, my drill requirements were very flexible and my 2 week ATs were a blast (EM attending at Madigan). If you get a commander who wants you there every month no matter what (i.e. a O-6 nurse commander), then the calculus can change quick. I experienced an O-6 nurse commander who wanted me to sit around and do bull**** during my last year and it helped me to decide to hang up my boots. So much of the experience is pure luck.

 

[armytrainingsir]

Go active, don’t do guard or reserve. The guard and reserve will destroy your residency and civilian practice. I only recommend those who have a strong desire to serve to join the reserve or guard. It’s a bigger commitment to do just one weekend a month.

I'm curious what your direct experience is regarding AD vs Reserve as a MC officer, and your experience with residency/civilian practice 'destruction'?

 

[ShockIndex]

I'm curious what your direct experience is regarding AD vs Reserve as a MC officer, and your experience with residency/civilian practice 'destruction'?

I’m assuming they have no experience since reservists on STRAP are non-deployable during their training. In fact, their weekly didactics can count as drills, so there is effectively no drill requirements as residents. The 90-day BOG deployments after residency are very manageable and I’ve never met an emergency physician whose practice was destroyed.

 

[deleted981229]

I'm curious what your direct experience is regarding AD vs Reserve as a MC officer, and your experience with residency/civilian practice 'destruction'?

My experience is that about a neurosurgeon in our reserve unit. I was active duty and he was active duty as well. In the past two years, the neurosurgeon deployed 3 times which totally f up his civilian practice. What I’m saying is active is a 24/7 full time job, there’s no solid disruption of the practice, yes the person can go from a training hospital to a line unit, but no way no ruin his reputation and long term business.

I do agree most reserve medical units are relaxing and there’s no frequent deployment like the neurosurgeon in our unit. But if you want to risk your civilian practice especially those critical specifies, go for it.

 

[armytrainingsir]

Interesting. What year(s) were the deployments?
The odd thing is there are AD neurosurgeons that have never deployed, and I know one of reserve neurosurgeon that I am pretty sure has never deployed.

 

[DeadCactus]

My experience is that about a neurosurgeon in our reserve unit. I was active duty and he was active duty as well. In the past two years, the neurosurgeon deployed 3 times which totally f up his civilian practice. What I’m saying is active is a 24/7 full time job, there’s no solid disruption of the practice, yes the person can go from a training hospital to a line unit, but no way no ruin his reputation and long term business.

I do agree most reserve medical units are relaxing and there’s no frequent deployment like the neurosurgeon in our unit. But if you want to risk your civilian practice especially those critical specifies, go for it.

If you're going to be in the Guard or Reserve as a physician, a small group or solo practice is not the way to go. That being said, I'd personally still rather be a civilian neurosurgeon handling civilian acuity and volume but limited to large groups that can tolerate my deployment.

 

[mslall]

If you're going to be in the Guard or Reserve as a physician, a small group or solo practice is not the way to go. That being said, I'd personally still rather be a civilian neurosurgeon handling civilian acuity and volume but limited to large groups that can tolerate my deployment.

This. All. This.