I survived HPSP...barely

[EMDoc0411]

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I was commissioned Navy during college in April 2001. I remember an Army CRNA saying that things were starting to heat up in the world and he wouldn't join. I dismissed this thinking that I would be getting a nice stipend each month of med school ($1200). Plus I would get to travel the world. I was sitting on the fence after having read up on SDN back in the day, but it was my wife, always the penny pincher, who pushed me over the edge.
HPSP was great during med school. I loved the TADs to different rotations. I stayed in some nice hotels, got rental cars and a nice check. I even remember getting paid to study my 2nd year. I loved buying every required book and then getting on Amazon right away an making even more money. I laugh now thinking about photocopying all of my book receipts and mailing them in. Do they still do it that way?
During my last year of med school I had decided on EM and knew after reading through SDN that a deferral was the way to go. It would prevent an extra year of training and the wasted years of GMO time. The deferment was granted and it turned into the best and the worst thing for me. Best because I was practicing as a specialist in the least amount of time and worst because I knew how real medicine is practiced. Navy medicine is a strange thing and most of my eventual colleagues and consultants had no idea how bad off they were. As they say, ignorance is bliss. I was shipped with my family to Guam. This was my number one choice for a couple of reasons: it is far away(more travel options) and it has the highest acuity of any Navy EDs. It took about 30 seconds for the specialty leader to grant my request. Not a lot of people actually chose Guam. Fortunately I had one other colleague who had trained civilian and had seen the light. We had regular therapy sessions over the three years we were together. We would mostly complain about the dysfunctionality of Navy medicine. I won't get into the specifics at this time.
Now over 11 years since I was commissioned in my in-laws living room in my bare feet, I am done.
Throughout the last four years of AD time I have thought that it was the worst decision I ever made. Now that I am out, I still feel the same way.
If you are planning on taking the HPSP "scholarship" make sure you are prepared to suffer.

 

[MaxillofacialMN]

I get that think your experience was poor, but that's all. I'm not sure if you're posting just to relieve stress or as a warning beacon to those of us applying. If it is the latter, you gave no reasons as to why it was awful other than "navy medicine sucks."

If you want to warn people, can you be more specific to the problems? Maybe it was Guam? Paperwork? Who knows!

 

[bustbones26]

I get that think your experience was poor, but that's all. I'm not sure if you're posting just to relieve stress or as a warning beacon to those of us applying. If it is the latter, you gave no reasons as to why it was awful other than "navy medicine sucks."

If you want to warn people, can you be more specific to the problems? Maybe it was Guam? Paperwork? Who knows!

I think that we could all just sit here and draft out a lengthy laundry list of reasons as to why we would not do it again, and there of course are many similar threads out there. However, doing so requires time, sometimes hard to get your point across as you just might come out sounding like a whiner, and some stories are just not worth mentioning. I think that this doc just wanted to get to the point, he didn't want to go on and on with the same type of thread that you all have seen in the past. Just one more tally mark for the "don't do it" column, that is meaningful enough.

I myself went the Army route. I agree with the OP, great HPSP financial benefits but at the end of it all, I do not think it was worth it either.

 

[Lui Kang]

I was commissioned Navy during college in April 2001. I remember an Army CRNA saying that things were starting to heat up in the world and he wouldn't join. I dismissed this thinking that I would be getting a nice stipend each month of med school ($1200). Plus I would get to travel the world. I was sitting on the fence after having read up on SDN back in the day, but it was my wife, always the penny pincher, who pushed me over the edge.
HPSP was great during med school. I loved the TADs to different rotations. I stayed in some nice hotels, got rental cars and a nice check. I even remember getting paid to study my 2nd year. I loved buying every required book and then getting on Amazon right away an making even more money. I laugh now thinking about photocopying all of my book receipts and mailing them in. Do they still do it that way?
During my last year of med school I had decided on EM and knew after reading through SDN that a deferral was the way to go. It would prevent an extra year of training and the wasted years of GMO time. The deferment was granted and it turned into the best and the worst thing for me. Best because I was practicing as a specialist in the least amount of time and worst because I knew how real medicine is practiced. Navy medicine is a strange thing and most of my eventual colleagues and consultants had no idea how bad off they were. As they say, ignorance is bliss. I was shipped with my family to Guam. This was my number one choice for a couple of reasons: it is far away(more travel options) and it has the highest acuity of any Navy EDs. It took about 30 seconds for the specialty leader to grant my request. Not a lot of people actually chose Guam. Fortunately I had one other colleague who had trained civilian and had seen the light. We had regular therapy sessions over the three years we were together. We would mostly complain about the dysfunctionality of Navy medicine. I won't get into the specifics at this time.
Now over 11 years since I was commissioned in my in-laws living room in my bare feet, I am done.
Throughout the last four years of AD time I have thought that it was the worst decision I ever made. Now that I am out, I still feel the same way.
If you are planning on taking the HPSP "scholarship" make sure you are prepared to suffer.

After reading stuff like this over and over again, and having numerous attendings and residents in HPSP say "I wouldnt do it again" or "think very carefully " I'm really considering just taking out the loans. I already have 60k from undergrad, add another 200+ on top of that, and Im looking at almost 300k. I don't know what the future salary of primary care docs ( or any doc at all) will be, but I hope it's enough to pay off loans.

 

[yappy]

Look to 1st world countries with socialized health care programs for a worst case projection.

After reading stuff like this over and over again, and having numerous attendings and residents in HPSP say "I wouldnt do it again" or "think very carefully " I'm really considering just taking out the loans. I already have 60k from undergrad, add another 200+ on top of that, and Im looking at almost 300k. I don't know what the future salary of primary care docs ( or any doc at all) will be, but I hope it's enough to pay off loans.

 

[IlDestriero]

Congrats on getting out! Feels awesome doesn't it.😀
I agree 100% with the ignorance is bliss part. They'll understand when they're finally out. I've posted on it before.
Have one on me
View attachment uploadfromtaptalk1342479041640.jpg
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"The truth is incontrovertible, malice may attack it, ignorance may deride it, but in the end; there it is."

 

[MaxillofacialMN]

I think that we could all just sit here and draft out a lengthy laundry list of reasons as to why we would not do it again, and there of course are many similar threads out there. However, doing so requires time, sometimes hard to get your point across as you just might come out sounding like a whiner, and some stories are just not worth mentioning. I think that this doc just wanted to get to the point, he didn't want to go on and on with the same type of thread that you all have seen in the past. Just one more tally mark for the "don't do it" column, that is meaningful enough.

I myself went the Army route. I agree with the OP, great HPSP financial benefits but at the end of it all, I do not think it was worth it either.

I get what you're saying, but it does no good to just post a thread complaining about something. Maybe he hated Guam, but I would love Guam. Maybe he hated the paperwork, but I love paperwork! People are different so saying things like "it was awful" doesn't help anyone except to say that the OP's individual experience was something he didn't like.

I just went for a run, and it was awful. (therefore no one should ever go on a run)

 

[bobbyseal]

Congrats on getting out! Feels awesome doesn't it.😀
I agree 100% with the ignorance is bliss part. They'll understand when they're finally out. I've posted on it before.
Have one on me
View attachment 20551
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“The truth is incontrovertible, malice may attack it, ignorance may deride it, but in the end; there it is.”

Macallan Fine Oak 21 is indeed a nice scotch. How we tricked an equipment rep into buying us 3 rounds of the fine oak 21 one meeting! He was scratching his head at the end of the meal!

 

[i want out]

I get what you're saying, but it does no good to just post a thread complaining about something. Maybe he hated Guam, but I would love Guam. Maybe he hated the paperwork, but I love paperwork! People are different so saying things like "it was awful" doesn't help anyone except to say that the OP's individual experience was something he didn't like.

I just went for a run, and it was awful. (therefore no one should ever go on a run)

Go ahead and join up then bookmark this thread and come back and read it over the next few years.

We could explain all day, and until you have lived it yourself you would never understand.

 

[i want out]

I was commissioned Navy during college in April 2001. I remember an Army CRNA saying that things were starting to heat up in the world and he wouldn't join. I dismissed this thinking that I would be getting a nice stipend each month of med school ($1200). Plus I would get to travel the world. I was sitting on the fence after having read up on SDN back in the day, but it was my wife, always the penny pincher, who pushed me over the edge.
HPSP was great during med school. I loved the TADs to different rotations. I stayed in some nice hotels, got rental cars and a nice check. I even remember getting paid to study my 2nd year. I loved buying every required book and then getting on Amazon right away an making even more money. I laugh now thinking about photocopying all of my book receipts and mailing them in. Do they still do it that way?
During my last year of med school I had decided on EM and knew after reading through SDN that a deferral was the way to go. It would prevent an extra year of training and the wasted years of GMO time. The deferment was granted and it turned into the best and the worst thing for me. Best because I was practicing as a specialist in the least amount of time and worst because I knew how real medicine is practiced. Navy medicine is a strange thing and most of my eventual colleagues and consultants had no idea how bad off they were. As they say, ignorance is bliss. I was shipped with my family to Guam. This was my number one choice for a couple of reasons: it is far away(more travel options) and it has the highest acuity of any Navy EDs. It took about 30 seconds for the specialty leader to grant my request. Not a lot of people actually chose Guam. Fortunately I had one other colleague who had trained civilian and had seen the light. We had regular therapy sessions over the three years we were together. We would mostly complain about the dysfunctionality of Navy medicine. I won't get into the specifics at this time.
Now over 11 years since I was commissioned in my in-laws living room in my bare feet, I am done.
Throughout the last four years of AD time I have thought that it was the worst decision I ever made. Now that I am out, I still feel the same way.
If you are planning on taking the HPSP "scholarship" make sure you are prepared to suffer.

Congrats on your survival!

 

[AF M4]

Congratulations!

 

[AF M4]

Maybe he hated the paperwork, but I love paperwork!

Remember the day you wrote these words.

 

[MaxillofacialMN]

Go ahead and join up then bookmark this thread and come back and read it over the next few years.

We could explain all day, and until you have lived it yourself you would never understand.

Do you get it though? I WILL join up because no one has given me any reason not to. Maybe the OP posted the thread just to tell everyone hes pumped about being out, and not as a warning. I am merely suggesting that IF it were meant as a warning, it was not effective without specifics.

 

[bustbones26]

Does anybody remember the old cartoon Deputy Dogg? Never got too worked up did he? But he had one catch phrase:

" I wouldn't do that if I were you".

Hey, you know if I started to post some experiences I had, and it got back to certain individuals, they can still affect my career. Yes, anybody can get cute and draft a letter to my state medical board for unprofessional behavior if I wrote a rant on here that could possibly offend anybody. I would pay dearly. To this very day, hospitals, insurance companies still want to hear references from my former residency staff that are still on active duty. Boy, it sure would be a stupid idea to go on this forum and tell a story or two that might make them appear to be *****holes now wouldn't it?

If you want to scoop, simple, whenever somebody says they wouldn't do it again,ask them why in privacy. If they hesitate, make sure they understand that you are making a really big decision and value their honesty.

On a side note, my career had its highlights too, it was not all bad, I just simply would not do it again and that is all. I have my reasons, and my reasons are probably similar, yet different from many others on this forum.

Walter Reed, Madigan, Tripler, SAMMC, etc, these are all fine institutions and great training grounds for Army docs. But its what happens afterwards that bogs you down. Yes, there are some "golden children" out there who continue on at these fine institutions as staff, maybe have to suffer a few months at a major airbase in theater deciding which of the five DFACS to eat at or if they will attend Karoake night, get offered choice fellowships, etc. But that is not the norm!!

 

[IgD]

I learned a lot from the Navy time but I'm glad I'm out. Have had some recent dealings with Navy medicine and am scratching my head. It's hard to describe unless you are there. I would say "200 years of tradition unhampered by progress" best illustrates my current thinking.

Thanks for your service. I'm confident you help thousands of active duty folks and their family on that lonely island. I'm certain you even saved some lives. Enjoy your freedom and cherish the memories!!!

 

[EMDoc0411]

Thanks for the congrats.
To the person who questioned the reason for the post, it's just another doc who needed to let it all go. I remember in the past reading similar posts and being envious. I have been looking forward to this post for a long time. In terms of specific reasons why military and medicine don't mix, you can read hundreds of posts by others that tell my same story. I have nothing new.

 

[oneyearwonder]

I WILL join up because no one has given me any reason not to.

that's cute. really a good reason to join.

the wheels of .milmed continue to churn. 90+% get out at the first possible second.

enjoy

keep us posted on your progress, okay!

 

[Perrotfish]

that's cute. really a good reason to join.

the wheels of .milmed continue to churn. 90+% get out at the first possible second.
!

I feel like this is more due to finances than dysfunction, though. The fact is that the civilian world pays more. The few specialties that don't pay more in the civilian world (like peds) have a much higher retention rate in the Navy.

The other issue, of course, is acuity and the independence to really run your service. Again, I feel like that's better for some specialties (peds, family) and worse for others (surgery, EM) relative to the civilian world. I'm not sure you can make a decision to join or not based on that.

FWIW so far my Internship is drastically less dangerous, dysfunctional, and toxic than any of the five hospital systems I rotated through in med school.

 

[244913]

OP, Congratulations!

Quick, somebody hyperlink the final scene in Shawshank Redemption when morgan freeman crosses the border.

I hope(I know) that you find well deserved happiness on the civilian side.

Fair winds and following seas...

-61N

 

[MaxillofacialMN]

that's cute. really a good reason to join.

the wheels of .milmed continue to churn. 90+% get out at the first possible second.

enjoy

keep us posted on your progress, okay!

I know you're being sarcastic, but that is not the reason I want to join. I do want to serve, I want the financial benefits during school, I want the chance to live somewhere(s) I probably wouldn't otherwise, I'm guaranteed a residency (pod residency shortage...), and financially with podiatry the HPSP comes out as nearly a fiscal wash (civilian will make MAYBE 0-50k more in lifetime). Pods have the highest loan default rate of any medical specialty, so i think financially if makes anlot more sense for pods than for ortho, plastics, derm, etc. The OP has responded why he posted, and I can respect that it was more of a celebratory post than a "heed my warning" post.

And also, I'm really excited to check 3 bags for free when flying.

 

[bustbones26]

OP, Congratulations!

Quick, somebody hyperlink the final scene in Shawshank Redemption when morgan freeman crosses the border.

I hope(I know) that you find well deserved happiness on the civilian side.

Fair winds and following seas...

-61N

Its funny that you should use this reference because I always use that movie to describe what my career in the Army was like. Whenever I got out, I sort of felt like Brooks Hatlen, but did not hang myself of course. Morgan Freeman crossing the border, well that feeling is just great.

To the OP, I am in the same boat as you now, just starting up my own gig. As I was telling a colleague yesterday, I still have to see crappy patients with pseudopsychiatric issues, I still have to play politics to hospital administrators, I still have administrative crap to do, but somehow, it is just less intense, both physically and mentally, then it was in the military. Somehow, its just more enjoyable.

If you are an ER doc, I hope that you find that job where you work 16 shifts per month and spend the rest of the time doing whatever it is you enjoy, with your family, friends, and finally relax.

 

[pgg]

I've had good experiences with the Navy. Much of that has been specialty choice ... and luck with people and billets.


I've done quite a bit of moonlighting at civilian hospitals. My guess is that anyone who rages against the .mil medical machine hasn't watched CMS crawl over a hospital with a microscope, handing out fines because the BLUE sharps containers are for sharps with drug waste and the RED sharps containers are for sharps without drug waste.

The grass may not be greener in the civilian world. The pay is better and money goes a long way to soothe frustrations. God knows I wouldn't put up with some of those .civ ass clowns if they didn't pay me $4500 for a weekend of pager call.

I'm deploying again in a few months and honestly looking forward to it. It's been 6 years (3 years of which I've been an attending) since my last deployment (pre-residency as a GMO) so it's not like the war op-tempo is much of a burden for my specialty. There's something to be said for the AD/family/retiree patient population, especially compared to the general public and its meth heads, self/no-pay scammers, non-English-speaking undocumented self/no-pay workers, incarcerated ****bag lifers out to the hospital on a surgery day-pass, entitled obese smokers with their self-inflicted disease ...

As someone who owed about double the usual HPSP four, when I'm eligible to get out there won't be a financial incentive. Given the value of a .mil retirement, the pay difference between a civilian fellowship vs a FTOS fellowship in the midst of a MSP contract ... the correct $ decision will be to stay in for a few more years. An O5 or O6 pension with 24 years of creditable service is a lot of money to walk away from.


All that said, I wouldn't want to be an EM physician in the military. I'm not the least bit surprised the OP is delighted to get out.

 

[Kingfisher]

All that said, I wouldn't want to be an EM physician in the military. I'm not the least bit surprised the OP is delighted to get out.

Agree, especially in Guam and other smaller overseas locations. Things there are DEFINITELY not like an American standard ED. Resources, I hear, are limited and you do alot of things that would be especially frightening in the US because of this (ie managing active MI for a days due to inability to get them transferred). Larger MTFs with actual EDs are a little more similar to typical US standards with a few exceptions. Trauma, at least at my hospital, wont make it to the ED unless it happens outside the front door.

 

[Perrotfish]

Agree, especially in Guam and other smaller overseas locations. Things there are DEFINITELY not like an American standard ED. Resources, I hear, are limited and you do alot of things that would be especially frightening in the US because of this (ie managing active MI for a days due to inability to get them transferred). Larger MTFs with actual EDs are a little more similar to typical US standards with a few exceptions. Trauma, at least at my hospital, wont make it to the ED unless it happens outside the front door.

I think you may be overestimating how good resources are in civilian centers, especially for patients with inadequate insurance.

 

[notdeadyet]

I think you may be overestimating how good resources are in civilian centers, especially for patients with inadequate insurance.

Huh? You can't possibly be comparing civilian ERs to military ERs. Even the county programs that cater to the understaffed have way better resources. The military sends people to LAC specifically because there's no high acuity volume at military ERs.

There are many good features to military med, but I'd put the good civilian county ERs (Cook, SFGH, LAC, etc.) several light years ahead of the capabilities of the best military ERs. And most military ERs would be the equivalent of most civilian fast tracks...

 

[jabreal00]

I've been in the Army for 7 years (6 years of training and one pay back). I have 4 years of obligation. From the year I was staff the milmed bureaucracy can be a killer. I'll grit my teeth and try to slog through. I do envy those getting out.

 

[Perrotfish]

Huh? You can't possibly be comparing civilian ERs to military ERs. Even the county programs that cater to the understaffed have way better resources. The military sends people to LAC specifically because there's no high acuity volume at military ERs.

There are many good features to military med, but I'd put the good civilian county ERs (Cook, SFGH, LAC, etc.) several light years ahead of the capabilities of the best military ERs. And most military ERs would be the equivalent of most civilian fast tracks...

I think you're confusing patient volume for the residents w/ resources for the patients. Military ERs have resources and no patients. County ERs have patients and no resources. I don't argue with the observation that the military has low ER patient volume. However the idea that military ERs do things that would be 'especially frightening' at a public ER shows, I think, a poor knowledge of just how bad even relatively good public ERs can be.

 

[pgg]

I think you're confusing patient volume for the residents w/ resources for the patients. Military ERs have resources and no patients. County ERs have patients and no resources. I don't argue with the observation that the military has low ER patient volume. However the idea that military ERs do things that would be 'especially frightening' at a public ER shows, I think, a poor knowledge of just how bad even relatively good public ERs can be.

That was well put.

 

[notdeadyet]

I think you're confusing patient volume for the residents w/ resources for the patients. Military ERs have resources and no patients. County ERs have patients and no resources.

You might be confusing resources with equipment. An EDs resources are also its personnel and their training. A low acuity ED staffed by nurses and physicians with training in low acuity centers leads is an ED with poor resources to handle anything that isn't low acuity.

You might also be underestimating many of the county programs. I don't know the small community rural ones, but the urban county programs have better facilities than military ERs. Take a walk through USC's new ER and find me a military counterpart.

I don't argue with the observation that the military has low ER patient volume. However the idea that military ERs do things that would be 'especially frightening' at a public ER shows, I think, a poor knowledge of just how bad even relatively good public ERs can be.

In fairness, the "especially frightening" comment was not mine.

If I sprained an ankle (and I was sure it was a sprained ankle), I'd have no problem with you taking me to the military ER. If I got shot or had a medical issue of any complexity, I would drive well out of my way to go to the county ER instead. If I was in a rural county, I might have a different answer, but for the populations living near the major metropolitan areas, the county ERs are a better bet. Yes, they smell. But all those smelly people make for great training and well-trained staff.