HPSP vs USUHS

[EasyEveryoneWouldDoIt]

for people that got accepted to both USUHS and a civilian school why did you choose one over the other. applying this cycle and debating the pros and cons of both. already accepted to a civilian medical school and have my USUHS interview coming up soon

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[militaryPHYS]

#1 I wanted to be a military officer
#2 I wanted to be a military officer and was considering a 20+ year career as a military officer/physician (still am)
#3 I hate having debt and do not like uncertainty (although you trade financial/job security during med school/residency for specialty/GMO uncertainty)
#4 I wanted to be a military officer
#5 I loved the USUHS campus and the impression of comradery I got during my interview there.

Oh yeah....I also wanted to be a military officer

 

[MadDoc21]

I’ve been trying to apply to HPSP but I am finishing up a course of accutane. The representative that I am working with informed me that I have to be off treatment for 6 months before I can apply. I have read elsewhere online and for my usuhs interview I was informed that 3 months was sufficient. Can anyone shed some light on what I can do?

 

[pgg]

USUHS has always made the most sense for people with prior service, who
1) know (sort of) what they're getting themselves into by joining
2) have retirement credit that will put them in a good position to retire when the USUHS obligation is up
3) have a rank that will continue to be paid at a higher rate than O1<2yrs while in school (despite being recommissioned as an O1)

That said, many (most?) USUHS students don't have prior service. I didn't, and it has worked out well for me.

Just be well aware that a 7 yearcommitment works out to be 15 minimum years in uniform since time at USUHS and in residency don't count.

HPSP = being a pseudocivilian during school, possibly a pseudocivilian during residency (if deferred, but don't count on that) and only 4 years of time in uniform.

Something else to consider is that USUHS is an excellent school in its own right. It's likely a superior education compared to some of the newer DO schools which are so expensive (and therefore drive a lot of students to HPSP).

If you want to join the military, I'd probably pick the better school between USUHS and your other acceptance.

 

[AvoidMilitaryMedicine]

for people that got accepted to both USUHS and a civilian school why did you choose one over the other. applying this cycle and debating the pros and cons of both. already accepted to a civilian medical school and have my USUHS interview coming up soon

The honest answer is that neither are very good options unless you want to be a military officer >>>>>> military physican and are willing to sacrifice, professional satisfaction (as a clinician), quality of life, family stability, pay and quite possibly life and limb (these reasons and more have been discussed in "Thinking about HPSP/USUHS," and elsewhere).

Interestingly, in response to the following article (The Army’s Plan To Save The Wounded In Future War) a senior military medical colleague responded with:

It’s interesting- and a huge gamble - putting all the chips on the idea that there will be a large surplus of recruitable future physicians that already know at the time of starting medical school that they will want to work in a narrow field of medicine (operational- for operating surgeons to FP and EM), spend their careers at the operational level, and end up at significant risk of being institutionalized to the point that their skills are not real world applicable at the end of their service time. It could put them at considerable disadvantage to their peers that developed and practiced normally over time. Not impossible, but you are certainly not going to attract the best talent out there with this kind of future livelihood limitation.

The above really encapsulates what I think many prospective military docs really need to think long and hard about before signing on the dotted line.

 

[militaryPHYS]

Welcome back. Hopefully we can be accountable for our own comments and actions from now on.

I agree that the reverse PROFIS idea is backwards and makes little sense. I agree with you as it relates to Reverse PROFIS but not military medicine in general.

What the line cares about is that they know who they have on their team to deploy with when the time comes. They should care that that person or medical team is properly trained with sufficient skills. These are the ONLY things they should care about. When operational those medical assets are operational. When in garrison, those medical assets should be at the MTF or partnered civilian hospital maximizing their practice volume and skill sustainment, not setting up tents all day.

We are working hard to stress this concept to the Marines so we don't fall in a similar backwards trap that the Army has got itself in.

I don't think that DHA changes coincide with Reverse PROFIS. Those two things should be kept to separate discussions. DHA changes are for streamlined, efficient, cost-effective healthcare that maximizes skill sustainment. Reverse PROFIS decreases skill sustainment and sequesters physicians to purely operational assets. We know the effects Reverse PROFIS has/will-have. We don't know yet if DHA changes will be effective and meet their intended goal.

Like I always say... Army medicine is not representative of MilMed as a whole so please be conscious of this as we all discuss the bigger concept

 

[EasyEveryoneWouldDoIt]

Thanks for r

USUHS has always made the most sense for people with prior service, who
1) know (sort of) what they're getting themselves into by joining
2) have retirement credit that will put them in a good position to retire when the USUHS obligation is up
3) have a rank that will continue to be paid at a higher rate than O1<2yrs while in school (despite being recommissioned as an O1)

That said, many (most?) USUHS students don't have prior service. I didn't, and it has worked out well for me.

Just be well aware that a 7 yearcommitment works out to be 15 minimum years in uniform since time at USUHS and in residency don't count.

HPSP = being a pseudocivilian during school, possibly a pseudocivilian during residency (if deferred, but don't count on that) and only 4 years of time in uniform.

Something else to consider is that USUHS is an excellent school in its own right. It's likely a superior education compared to some of the newer DO schools which are so expensive (and therefore drive a lot of students to HPSP).

If you want to join the military, I'd probably pick the better school between USUHS and your other acceptance.

Thanks for the response. I am actually going to go to USUHS. After a lot of thought and taking with physicians who are already in in almost every speciality (I have access to a MTF) and loved ones, it makes the most sense for me being a prior enlisted despite the pit falls. I know with that is going on with DHA that my choice in speciality will be limited. I know about the skill atrophy and the likelihood of having to moonlight to keep skills up, be forced into a command or admin position later etc.

 

[Mace1370]

I don't think that DHA changes coincide with Reverse PROFIS. Those two things should be kept to separate discussions.

DHA changes absolutely coincided with reverse PROFIS. The army instituted reverse PROFIS as a way to maintain control of their assets/prevent DHA from controlling those billets. They explicitly have said as much.

 

[militaryPHYS]

Do you have official correspondence on that?

 

[Gastrapathy]

we discussed that months ago in prior threads. The Army did the obvious thing to protect their control of their doctors from the Borg.

 

[militaryPHYS]

"WE" discussed it. I'm wondering what official policy says so we aren't just speculating.

Reverse PROFIS is in line with what USMC is doing by buying billets from the Navy. It is to have dedicated deployment assets when the time comes. What they don't understand is the implications this has on skill atrophy during time in garrison, hence why we are doing everything we can do unofficially require them to allow their medical assets to return to the hospital when not deployed or training.

Nowhere have I seen that it was in direct defense of upcoming DHA transition. If anything it is contradictory considering DHA is trying to improve our peace time utilization and skill maintenance.

 

[Chonal Atresia]

"WE" discussed it. I'm wondering what official policy says so we aren't just speculating.

Reverse PROFIS is in line with what USMC is doing by buying billets from the Navy. It is to have dedicated deployment assets when the time comes. What they don't understand is the implications this has on skill atrophy during time in garrison, hence why we are doing everything we can do unofficially require them to allow their medical assets to return to the hospital when not deployed or training.

Nowhere have I seen that it was in direct defense of upcoming DHA transition. If anything it is contradictory considering DHA is trying to improve our peace time utilization and skill maintenance.

Oh, “they” understand the clinical implications of reverse PROFIS. They just don’t care. While these “higher ups” are all monkeys on a flagpole kissing each a$$ above them, they’re not bereft of intelligence. All you or any other AD soldier is to the military is a cog in a wheel. Nothing more. If the hole is square and you are round, they’ll pound you in anyway.

You are the only neurosurgeon on post but your name comes up for brigade surgeon? Doesn’t matter - welcome to admin hell for 2 years and clinical skill rot. NO ONE cares about the implications to your post-military clinical career.

I would add being sure that you want to make the military a 20+ year career to your recommendation about wanting to be a military officer first. If everyone who signed up for the “scholarship” had this mindset, there would be a lot less unhappy people. It would also decimate military medicine because no one would be in the pipeline to fill billets.

 

[Mace1370]

We have received so many correspondences over the last few months. I remember it was relayed in an email chain, but some of that stuff might be FOUO so I’m not going to copy paste that here.

I didn’t think this was a controversial thing; the Army wants to maintain a pool of AD docs they can deploy. I wouldn’t expect anything else.

 

[Chonal Atresia]

We have received so many correspondences over the last few months. I remember it was relayed in an email chain, but some of that stuff might be FOUO so I’m not going to copy paste that here.

I didn’t think this was a controversial thing; the Army wants to maintain a pool of AD docs they can deploy. I wouldn’t expect anything else.

Having a cadre of deployable docs with specific skill sets - not controversial.

Cutting 19k medical personnel and instituting a “reverse PROFIS” policy taking docs out of clinical medicine - controversial.

 

[Trefoil]

Tha

Thanks for r


Thanks for the response. I am actually going to go to USUHS. After a lot of thought and taking with physicians who are already in in almost every speciality (I have access to a MTF) and loved ones, it makes the most sense for me being a prior enlisted despite the pit falls. I know with that is going on with DHA that my choice in speciality will be limited. I know about the skill atrophy and the likelihood of having to moonlight to keep skills up, be forced into a command or admin position later etc.

Given your knowledge of the situation, I’m really surprised that you are continuing through with the decision. Is it a matter of finances for the family? Why choose an option that could ruin the rest of your career?

 

[EasyEveryoneWouldDoIt]

Tha


Given your knowledge of the situation, I’m really surprised that you are continuing through with the decision. Is it a matter of finances for the family? Why choose an option that could ruin the rest of your career?

it depends on what career you are taking about. I am prior enlisted with 12 years so after i complete my USUHS requirement I am eligible for full retirement. the math comes out to $4 million difference going to USUSH vs getting out and going completely civilian. extrapolated by 7 years that i owe for USUHS is over 500k a year I would need to make up. Plus despite all the headaches I actually have enjoyed my military career as of date (I don't think I would have had the opportunity to even get into medical school without it). I think being prior enlisted I understand the headaches of the military life and used to it. I remember sequestering a few years back and all the headaches that entailed. so I plan on completing my military career regardless. But at the same time I remember being deployed to Balad Iraq on the medical side and loving the deployment and found that fulfilling.

As for my medical career, i feel like the drawbacks are something I can deal with. I have had the chance to talk to a lot of Air Force doctors in a lot of specialities from EM to Derm to Gastro to RADs to ENT and while a good percentage can't wait to get out after their contract and hate life another good percentage enjoy what they do and would do it again. I am fine with not being able to specialize into surgeon subspeciality or IM subspeciality. I have found that for the most part prior enlisted who get their MD seem more satisfied since they already know what they are getting into rather than someone coming from the civilian side.

So I think "why choose an option that could ruin the rest of your career?" is not really a valid question. I think it will enhance my military career and as for my medical one, I feel like I can deal with the potential setbacks milmed may set force.

 

[Mace1370]

Having a cadre of deployable docs with specific skill sets - not controversial.

Cutting 19k medical personnel and instituting a “reverse PROFIS” policy taking docs out of clinical medicine - controversial.

Sorry, I meant not controversial regarding what was happening and why. I didn’t mean controversial in the sense of good vs bad policy.

 

[pgg]

it depends on what career you are taking about. I am prior enlisted with 12 years so after i complete my USUHS requirement I am eligible for full retirement. the math comes out to $4 million difference going to USUSH vs getting out and going completely civilian. extrapolated by 7 years that i owe for USUHS is over 500k a year I would need to make up.

Can you expand on the math here? I don't follow it.

I put the "cash" value of an O5/20 USUHS grad pension around $1.5M, but you'll retire as an O4/20, so perhaps $1.2M? I base this on the rough cash price of an inflation indexed single premium immediate annuity purchased from a reputable source. Reasonable people can disagree, but they can't disagree by a lot and still be reasonable.

On the high end, the principal + interest for student loans to go the non-military route might be $500-600K for private schools. Pay during a military residency is a little better, perhaps $100K total over a 5 year residency. This advantage to military training is offset to a variable degree by the lower pay during the 7-year payback period ... it's not unreasonable to call it a wash, but some military physicians come out a little ahead.

Also, as a 12-year enlisted member, don't you have GI Bill benefits that could cover the lion's share of a civilian medical school's costs?

I looked at all of these numbers in excruciating detail when I was at my stay/go decision point. The math worked out in favor of me staying, so I did. (Getting funded for a FTOS fellowship during the loophole window of an MSP payback was a significant part of that.)

But $4M to the good seems wildly optimistic. I'm curious to see your math and assumptions.

 

[militaryPHYS]

it depends on what career you are taking about. I am prior enlisted with 12 years so after i complete my USUHS requirement I am eligible for full retirement. the math comes out to $4 million difference going to USUSH vs getting out and going completely civilian. extrapolated by 7 years that i owe for USUHS is over 500k a year I would need to make up. Plus despite all the headaches I actually have enjoyed my military career as of date (I don't think I would have had the opportunity to even get into medical school without it). I think being prior enlisted I understand the headaches of the military life and used to it. I remember sequestering a few years back and all the headaches that entailed. so I plan on completing my military career regardless. But at the same time I remember being deployed to Balad Iraq on the medical side and loving the deployment and found that fulfilling.

As for my medical career, i feel like the drawbacks are something I can deal with. I have had the chance to talk to a lot of Air Force doctors in a lot of specialities from EM to Derm to Gastro to RADs to ENT and while a good percentage can't wait to get out after their contract and hate life another good percentage enjoy what they do and would do it again. I am fine with not being able to specialize into surgeon subspeciality or IM subspeciality. I have found that for the most part prior enlisted who get their MD seem more satisfied since they already know what they are getting into rather than someone coming from the civilian side.

So I think "why choose an option that could ruin the rest of your career?" is not really a valid question. I think it will enhance my military career and as for my medical one, I feel like I can deal with the potential setbacks milmed may set force.

I would just like to highlight your post. It represents someone who has full understanding of the military system, spent the time and effort to investigate and experience the medical side of the military, understands the shortcomings of MilMed and the uncertainties of the current changes and came up with a final conclusion based on weighing pros/cons of clinical, career and personal lifestyle.

It doesn't represent the right decision or the wrong decision. It represents a well-informed decision. That's all anyone should require of you and nobody should tell you that you are wrong or chastise you for making it. Thanks for your service.

There are people who enjoy the military system, understand the pitfalls of Milmed, want and value a career as a military officer first and want to serve that career as a physician...whatever specialty they may end up in.

 

[EasyEveryoneWouldDoIt]

i can go over in PM but don’t forget pay in med school as an O1E is about 100k a year plus the 4 years tacked on after retirement. Plus 03E during residency. I m assuming O5/24 plus 4 year bump at retirement for USUHS. I ran it through a calculator assuming 30 years drawing from.

 

[EasyEveryoneWouldDoIt]

but i made the choice do my unique situation. if i was a traditional student 21/22 just done with undergraduate my choice would probably be different. but i don't think there is a blanket rule. don't do USUHS/HPSP do USUHS/HPSP. i think its unique to everyone and what they want out of their career

 

[Cooperd0g]

I was an officer with 14 years prior service. My math broke down to about even between HPSP and USUHS. I had a spreadsheet as well. You get the retirement from either. It is a bigger pension from USUHS, but you get out 3 years earlier from HPSP and can make up most of the difference with a bigger salary working full time those 3 years. Given that it pretty much came out even I decided on USUHS for the better pay while in school compared to living off quite a bit less during those 4 years.

 

[Atlas Shrugged]

Do you have official correspondence on that?

How gauche.

 

[militaryPHYS]

How gauche.

I love it when I have to google insults directed at me

 

[militaryPHYS]

but i made the choice do my unique situation. if i was a traditional student 21/22 just done with undergraduate my choice would probably be different. but i don't think there is a blanket rule. don't do USUHS/HPSP do USUHS/HPSP. i think its unique to everyone and what they want out of their career

I don't know. I was 21 and fresh out of undergraduate. But I had also been in the USMC reserves, then USN Reserves for a total of 4 years and understood the military somewhat. I enjoyed it, knew I wanted to continue to serve but not as an enlisted person. I was considering a career in the military. I had no preconceived thoughts on specialty, just wanted to serve and figured a good way to do my time was as a physician in whatever the military was going to give me.

To me, the extra 3 year commitment I would have with USUHS seemed insignificant when I considered that I'd be debt free, making 70k a year starting day 1 of med school and establishing myself as an active duty officer right away.

I understand that the time is NOT insignificant. Especially for premeds who couldn't imagine a full career in the military. In fact, I would argue that if you can't ever imagine a full career in the military then you may be barking up the wrong tree with both HPSP and/or USUHS. Its a big red flag because you are already considering yourself a temporary military doc and a deep down civilian doc. This usually leads to frustration/bitterness with the system if you encounter bumps along the way.

Semper Gumby. Hurry up and wait.

 

[Matthew9Thirtyfive]

I was an officer with 14 years prior service. My math broke down to about even between HPSP and USUHS. I had a spreadsheet as well. You get the retirement from either. It is a bigger pension from USUHS, but you get out 3 years earlier from HPSP and can make up most of the difference with a bigger salary working full time those 3 years. Given that it pretty much came out even I decided on USUHS for the better pay while in school compared to living off quite a bit less during those 4 years.

This why I ultimately chose USUHS over HPSP as well. For me though, while I could get out earlier with HPSP my USUHS commitment will take me right to retirement. While I guess I’ll miss out on some bonus money, the difference in pay during med school makes up for it.

 

[haujun]

it depends on what career you are taking about. I am prior enlisted with 12 years so after i complete my USUHS requirement I am eligible for full retirement. the math comes out to $4 million difference going to USUSH vs getting out and going completely civilian. extrapolated by 7 years that i owe for USUHS is over 500k a year I would need to make up. Plus despite all the headaches I actually have enjoyed my military career as of date (I don't think I would have had the opportunity to even get into medical school without it). I think being prior enlisted I understand the headaches of the military life and used to it. I remember sequestering a few years back and all the headaches that entailed. so I plan on completing my military career regardless. But at the same time I remember being deployed to Balad Iraq on the medical side and loving the deployment and found that fulfilling.

As for my medical career, i feel like the drawbacks are something I can deal with. I have had the chance to talk to a lot of Air Force doctors in a lot of specialities from EM to Derm to Gastro to RADs to ENT and while a good percentage can't wait to get out after their contract and hate life another good percentage enjoy what they do and would do it again. I am fine with not being able to specialize into surgeon subspeciality or IM subspeciality. I have found that for the most part prior enlisted who get their MD seem more satisfied since they already know what they are getting into rather than someone coming from the civilian side.

So I think "why choose an option that could ruin the rest of your career?" is not really a valid question. I think it will enhance my military career and as for my medical one, I feel like I can deal with the potential setbacks milmed may set force.

Well if you are going into AF congrats! I was enlisted Army for 4 years before accepting HPSP over USUHS. I was not 100% sure about retiring from US Army so I chose HPSP. Real Pain is there which you never experienced during enlistment (different point of your life with different needs and responsibilities). Good luck!