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HPSP
- Thread starter libertyyne
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Ive done a lot of research on HPSP, being former military, so you can PM me about it if you have questions.
Personally I plan on using IBR to pay back my loans, at least the first few years. Pretty good system. From what I've read, monthly payments are capped at 15% of your monthly income above 150% of the poverty level, until your income rises above a certain threshold, at which you are switched to a standard 10 year plan...
Personally I plan on using IBR to pay back my loans, at least the first few years. Pretty good system. From what I've read, monthly payments are capped at 15% of your monthly income above 150% of the poverty level, until your income rises above a certain threshold, at which you are switched to a standard 10 year plan...
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I wasn't a doc in the army, but I'm friends with many and they are very vocal. Only do HPSP if you really want to do military medicine. Do not do it for the financial incentives. There are many spreadsheets and charts that show the lifetime earning differences between taking student loans and taking the HPSP.
Also, please do not discount the profound lack of control you will have over your life (and potentially your career). You will move often, mostly to places very few people find appealing, and your input/preferences will rarely be considered.
The patient population is pretty cool tho, and working on a FST would be pretty hard to beat.
A new option I've heard about, is like the HPSP, but with the VA. They would have less (total) control over your life and have more (lots more) locations, in much better places.
Also, please do not discount the profound lack of control you will have over your life (and potentially your career). You will move often, mostly to places very few people find appealing, and your input/preferences will rarely be considered.
The patient population is pretty cool tho, and working on a FST would be pretty hard to beat.
A new option I've heard about, is like the HPSP, but with the VA. They would have less (total) control over your life and have more (lots more) locations, in much better places.
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Ibr seems like a good deal except for the large tax bills at the end.
Only if you take the loan forgiveness. In most cases, doctors make enough money at some point to switch over to standard repayment.
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It's a bad deal for the money alone. Any doc in any speciality will be able to repay loans without a problem.
The only ones who fall into the hpsp are the 20 year olds without any work experience or perspective when it comes to money.
The only ones who fall into the hpsp are the 20 year olds without any work experience or perspective when it comes to money.
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68PGunner
You make about $110-120K after residency as a military doc. Your buddy who is for example family med makes about $180-220k. It's not worth it. If you are in a surgical specialty, you lose about 200k a year during your payback year. It's a bad financial decision.
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High cost of attendance plus previous school debt. Coupled with the fact that interest accrued over the span of debt plus insurance costs add complexity to the issue. Couple all that with uncertainty around match and a passion for primary care and the line starts blurring.
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68PGunner
Why is my post complicated for you to understand? The lowest salary difference is as a family med doc. That's a difference of about 100k a year. I doubt that your COA is close to 400k for four years.
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Because it is absolute. You are saying there is not a single edge case where it makes financial sense.
I'm looking into it because I'm already enlisted and would like to probably finish my 20. I like the military. I get the feeling that people who hated their HPSP experience 1. didn't know anything about the military 2. didn't know anything about military medicine or 3. were in the military, but didn't like it and thought commissioning would fix it.
edit: 4. thought it would save them financially.
edit: 4. thought it would save them financially.
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68PGunner
It's absolute. Uncle Sam doesn't forgive your undergrad loan so that point is mute. The highest COA is $80,000/yr. With accruing interest it will be around $400K by the time you're attending doc. So you break even as a family doc but are screwed over in any other specialty, while signing off your freedom and life for four years.
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1. http://myarmybenefits.us.army.mil/H...ge_Loan_Repayment_Program_(LRP).html?serv=147
2. I know for a fact that there is a COA for USC and TUC is close to the federal maximum of 89K.
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68PGunner
You don't get college loan repayment under HPSP.
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Ahh thank you. This is the kind of info that I was unsure of.
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I think astrostellar's points are spot on. Don't do it just for the money, make sure you actually want to serve, full stop. The people that seem to be happiest with the mil med route are called to serve and have at least some understanding of the military's unique benefits and frustrations. It's definitely a choice to make with your eyes wide open.
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All calculated at year 2015 rates
Taxed
Base Pay at O-4 with 4 years: $5571
Variable Special Pay: $416
Board Certified Pay: $208
Additional Special Pay: $1250
Incentive Specialty Pay: $1666
Monthly Gross Pay: $9111
Take Home Pay (I took off 33% for simplicity): $6074
Not Taxed
BAH (Assuming San Antonio with dependents): $1833
BAS: $253
Monthly Pay: $8160
Annual take home: $97920
(This is equivalent to about 150K civilian income)
According to Medscape 2015 on physician salaries FM makes around 195k, but I will take your lowball of 180k since no fresh attending should make that much. However, those numbers are of course pretax dollars. So take home is about 120k assuming a 33% tax. Now add in having to pay loans with after tax dollars and all of a sudden the playing field has leveled. (Plus living on $5000/month take home pay during military residency is nice while civilian residents take home $3000/month).
The amount of loan burden that currently graduating medical students and new attendings have is almost unprecedented. 300k with 6-7% compounding interest with a quarter of that starting on day 1 of medical school is no joke anymore. It is a far cry from the <100k tuition costs with 3% interest rates that most senior doctors had. FOR PRIMARY CARE, this is not a bad financial decision. Make it into ortho however and you've just dog gone screwed the pooch financially. Since we are all medical students here, who knows where we will end up. Which of course is another dice rolling aspect of HPSP.
Here is a link to the thread that a bunch of military doctors were debating over on this very topic back in 2013 but the general consensus still holds true now.
http://forums.studentdoctor.net/thr...f-the-hpsp-scholarship.1003915/#post-14019190
With that being said, @libertyyne I agree with everyone else that your desire to serve should be the top of the list for joining up. The only other alternative to that reasoning is if you are poor, truly poor. Like Harry Potter living with the Dursleys poor. Across 110th Street poor. Zack Mayo poor. If military service is a one of the sacrifices that must be made to break the chains of poverty and make the dream come true then so be it. Of course I do not know your life story so this might not be applicable. Anyways, consider HPSP if you want to serve or you are poor. Probably optimal if you want to serve and are poor.
Go to North Dakota or Alaska and negotiate with potential employers to include loan payback as part of your compensation. You don't actually have to go to those places but the theme will hold true. Be willing to practice in an absolutely awful location so you will have the leverage when negotiating your compensation. If you are seeing the common theme here, it is life is gonna suck whether you take the loans or HPSP.
For more practical advice, if in the near future you decide for HPSP, just get the ball rolling and contact the recruiters. The application takes a darn long time and you are obligated to nothing until you take the Oath of Office and receive the money from Uncle Sam. Also, don't believe any of the honeyed words coming from the recruiter. You want the hard salty truth you go to the military medicine sub forum here and start reading.
I also recommend the Navy HPSP since you can do the GMO and out plan which means you'll only be in the active duty military for 5 years total.
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68PGunner
Docs don't pay 35% of your income in tax. If you do, you need to get an actual accountant to do your tax. If you max out for retirement contributions from multiple accounts including yours and your wife's, you should only be paying 18-20% if you are making less than 200K a year. If you make over 300K a year, you should only pay about 25-30% in tax.
The whole $97K being equivalent to $150K in civilian income is straight up bs unless you have a terrible accountant.
Honestly, I have heard from multiple accounts of fam doc getting a starting salary of $190K out of residency, with their second year being $240-250K and their third year being $270-300K due to their increased in efficiency. Of course, you don't get paid for your efficiency in military medicine.
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So many questions here, where were they working? Employed? Private practice? Are they getting this type of income bumps in desirable locations? Or were they working in Alaska?
I don't doubt your accounts but Medscape 2015 had a little over 2000 accounts of family medicine practitioners saying on average they make 200k (too bad they don't publish standard deviations, that would've been better). Some might make a little more, some a little less, but I have this feeling your accounts of family medicine making 300k are some cream of the crop physicians. Since if everyone can make 300k 3 years out of residency and maintain this level for their careers why isn't the average closer to 300k?
Ah, here's a nice table from AAFP, from 2014 unfortunately but I think the numbers have not changed that drastically.
http://www.aafp.org/about/the-aafp/family-medicine-facts/table-4.html
For the doctors 7 or fewer years post residency (n = 80) their median salary is 170k. Half are making more, half are making less. For those practicing longer it only goes to 200k. Hence why I low balled your number earlier.
Well what I did was an over simplification like I mentioned. Worst case scenario if you will. I applied a flat rate because there are so many variables out there like you mentioned. Much simpler for this thought experiment in general.
Let's see, let's say the OP got really lucky and landed a 200k job right out of residency. Match contribution for a 401k is $18k in 2015. Let's include a wife so $36k. Include the spouse's Traditional IRA so that's another $10k. For a 200k salaried FM doc you are taxed at the $154k salary level? Assuming nothing else that's about 25k in federal taxes plus another 7.5K in state taxes (5%, figured that was kinda the norm across the country, of course none in Texas or really fricking high in California). End with about $120k take home. Great, tax rate just like you said. Now we have to consider the 300k OP has taken out for his education and was somehow able to stave off the 6% interest during medical school and residency. For his family he'll need...what...60k/year to live? So he will pay back 60k every year to his loan. Assuming his loans compound daily while making $5000/month payments it will take him a little over 6 years to fully pay off his debt. If he follows White Coat Investor's advice of living like a resident then he'll be living on $3000/month while paying back $7000/month will take him a little over 4 years. 4 years. 4 years of living on $3000/month with a wife maybe even kids on the way. That might be fun when the couple is 23 years old but hardly fun when they are still in their 30s making $3000/month.
What if he landed the 170k job like most people did according to AAFP? Or maybe he can convince his employer to pay back some of his loans on top of his salary? Still, I think I'm being optimistic with him landing a 200k job out of residency as a FM.
Now if he takes Uncle Sam's money. Let's say he takes the Army's money. Which means he'll be in for at least 7 years including FM residency and payback. Say he has 50k in undergrad loans. He does the responsible thing and takes the sign on bonus of 20k and takes off 15k of the loans. He then lives the next 4 years on $1800/month and he is able to use some of that money to stave off interest. He goes off to residency. Makes maybe about approximately ~$6000/month take home (O-3 over 2 years). He can now max out TSP (government 401k for people that don't know) and his IRA by contributing ~$2000/month. He still has $4000/month to live and maybe even pay off that laughable 35k in loans. By the time he hits an attending he now has $8000/month except now he has no loans. So now, he has 4 years of suck at Ft. Bragg, Ft. Hood, and maybe he pissed off his nurse CO and is now in Outpost Restrepo.
It will be 4 years of suck. You are either a slave to loans or a slave to Uncle Sam. Either way it will be 4 years to freedom. (Approximately for civilian, absolutely for military)
Read the military medicine forums closely OP. If you truly choose and walk primary care you will have years of suck as an attending regardless of which path you choose. Either the $3000/month suck or the military suck. However, if you truly want to serve, it'll make the military's missile up your exhaust a little bit smaller.
tl;dr I still maintain approximate financial equivalence between FM civilian with FM military.
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Awesome. This is the kind of thing I was looking for!
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68PGunner
Here's the breakdown for salary when it comes to family med:
18-22 pts a day = 180-190K/yr
25-27 pts a day = 230-250K/yr
30-34 pts a day = 300K/yr or more
Most docs can def see about 4 pts/hr without any diminished quality of care. That would put his or her salary at around $240-250K by year 2 or year 3.
I haven't even break down the salary of surgical specialist here. But, you will def lose about 200K of gross income per year if you're a military doc vs your civilian peers. The bottom line is that HPSP is for suckers.
Let's also not forget that the many opportunities for loan forgiveness programs from the civilian side for primary care. The bottom line is that if your primary motivation is financial, you're going to hate your life when you give up your life for Uncle Sam.
18-22 pts a day = 180-190K/yr
25-27 pts a day = 230-250K/yr
30-34 pts a day = 300K/yr or more
Most docs can def see about 4 pts/hr without any diminished quality of care. That would put his or her salary at around $240-250K by year 2 or year 3.
I haven't even break down the salary of surgical specialist here. But, you will def lose about 200K of gross income per year if you're a military doc vs your civilian peers. The bottom line is that HPSP is for suckers.
Let's also not forget that the many opportunities for loan forgiveness programs from the civilian side for primary care. The bottom line is that if your primary motivation is financial, you're going to hate your life when you give up your life for Uncle Sam.
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Do not do it for the money. Only join the military if you want to serve. There are many vets on this board, and we can all tell you the realities of military life. I happen to like the Navy and am trying to stay active while I go to med school. But that doesn't mean it's all rainbows and unicorns. There's a reason they call NWUs our sex clothes.
I'd make a terrible recruiter, because I'd tell the good with the bad, and many people wouldn't sign up if they knew the bad ahead of time. Just so happens for me that the good outweighs the bad.
I'd make a terrible recruiter, because I'd tell the good with the bad, and many people wouldn't sign up if they knew the bad ahead of time. Just so happens for me that the good outweighs the bad.
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You guys keep talking about the financial loss and forget about the freedom(s) lost.
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68PGunner
You know... you take freedom for granted until you voluntarily give it up for four years.
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6
68PGunner
They lock you in for life by sending you to an admin role after residency. Your skills degraded severely by the time that you're done with your four years. By that time, your clinical skills are gone and you become a danger to pts. You will have a hard time gaining employment in the real world forcing you to reup for four years to get an assignment at a hospital in order to rebuild your clinical skills. By the end of that contract, you're in the service for 12-14 years. At this point, you just endure the suck in order to get that 20 yr retirement check.
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PM sent.
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68PGunner
The free healthcare is hardly excellent. Ridiculous wait time of like 1-2 hrs when you're on time for your appointment. 4-5 weeks out to see a specialist especially after a referral. I use Tricare Standard nowadays in the civilian side and it's awesome. 10-15 mins wait time at most, allowing me and my family to get in and out in like 30-45 mins.
They treat you like you're privileged to get healthcare especially since it's free. In summary, they look and treat you like garbage most of the times, especially the healthcare provided to soldiers by hooah PAs and docs.
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Never had that experience. My wife has used prime and standard and had great experiences with both. My kids never have an issue either.
I've also had nothing but great care for myself. Maybe it's just San Diego and Oahu, but it's been great here.
Edit:
Just as an example: my wife was on Prime and needed a referral to ortho. Had her appointment the next week and then had her first PT appointment a week or two later. My daughter needed a dermatologist when they were on Standard. We made an appointment and took her the next day.
My experience with military healthcare has actually been pretty great, with the exception of my terrible PCM who didn't know the first thing about vaginas, turned all reproductive health issues over to someone else, and due to religious restrictions, wouldn't even look at birth control (I had all of my procedures done by someone else until I eventually switched. How I even got that man is beyond me.) Beyond that, family medicine clinics only see you for 15-20 minutes. But dental, OB/GYN, mental health, physical therapy? All great experiences for me.
Hey man, go over the the Military Medicine forum. They offer great advice, also considering similar routes, along with USUHS.
6
68PGunner
I like dental and PT. But the BN and BDE clinics are straight up trash. They tell me to arrive 20-30 mins before my appointment and then they don't see me for 60-90 mins past my appointment time. The main hospital is usually pretty good bc the commander of the hospital is actually there. However, clinics especially for line soldiers are garbage.
I paid about 20-30% copay nowadays and the quality of care is like heaven on the civilian side.
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That sucks. It's way nicer in the Navy. The docs and PAs I've seen have all been super nice and competent.
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Yeah, we wouldn't know what thats like, haha.
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