In 2024, is it true that the HPSP should be avoided like the plague?

[pokjoko]

I am starting medical school in the fall and have been weighing my options in terms of which medical school I will attend and how I will finance my education. I've interviewed at (and been accepted to a couple) T20 schools, which I am very grateful for, but they are all super expensive. One of them is 1hr away from my hometown and all of my family and would be a perfect fit for me. However, I predict I will likely be paying full price for this school. I've always toyed with serving in the military and almost did ROTC for undergrad (ultimately didn't bc of a good scholarship). Now I find myself in a similar situation and have been considering the HPSP.

I've been perusing recent posts here regarding the current climate of military medicine, and overall it seems like it's a sinking ship. I love the idea of serving in the military and caring for military families, but it seems like my idea is not congruent with the actual reality of being a military physician. I'm wondering if I should just kinda give up on this idea, or if maybe I should pursue it further.

My interests primarily lie in either FM, Peds, or Gen Surg, and I would love to do some global health/medical mission work at some point in the future. I think it would be nice to stay close to family for medical school, but I'm not sure what I would wanna do down the line in residency.

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[DrMetal]

When talking about avoiding something, why do people so frequently use the expression "avoid like the plague"?

Have people really read about and understand the circumstances of the Plague? It was truly horrific. Tens of millions died, shtting their guts out and bleeding out of their eyeballs.

So no, HPSP should not be avoided like the Plague. You could make the argument that it should be avoided like COVID-19 (a much lesser pandemic, but still, something you might chose to avoid).

 

[pokjoko]

When talking about avoiding something, why do people so frequently use the expression "avoid like the plague"?

Have people really read about and understand the circumstances of the Plague? It was truly horrific. Tens of millions died, shtting their guts out and bleeding out of their eyeballs.

So no, HPSP should not be avoided like the Plague. You could make the argument that it should be avoided like COVID-19 (a much lesser pandemic, but still, something you might chose to avoid).

Ok fair enough, it was a dramatic choice of words. But I will have to ask why it should be avoided like a much-lesser pandemic if you don't mind

 

[Correlate Clinically]

You'll see and hear similar advice from just about any currently serving, active duty attending: If you don't want to be a military officer first, then military medicine isn't a good choice.

HPSP comes with the same caveats as USUHS (although less of a commitment): namely, you will have very little control over what "kind" of doctor you become, where you live/practice, and a lot of other things.

Hypothetically, if you took the HPSP scholarship and did Gen Surg, you wouldn't be an attending for a decade. There is absolutely no way to predict what it will be like when you graduate medical school or finish training. Things have whipsawed around and vary widely by service.

Keep in mind: It's not really a scholarship. It's an exchange. The military is paying for your medical school now, and then they own you for a set period of time afterwards. It's kind of an indenturing agreement. If you weigh the pros and cons, decide that on balance you come out ahead based on your goals - then it can be a reasonable choice.

Don't do it just for the money and expect to be happy with your decision.

At the end of the day, a 4 yr commitment isn't terrible. The bigger risk is availability of residency spots, and there's no way to predict that. You roll the dice that what you want to do will be available. The risk is falling in love with something like Rad Onc, and the military will tell you "tough luck, go be a GMO in the clinic for 4 years". It's not like everyone gets the short end of the stick, but it does happen.

If you aren't sure but still interested, consider the reserves or something like the FAP program as well. The VA also has a program where you can do loan repayment as well as their own scholarship program (I don't know much about it, other than that it exists).

 

[orbitsurgMD]

So like most who haven't started, you are undecided on what you will do after med school. The issue with HPSP is that you won't get to decide alone where you will do an internship or start the rest of your residency. Civilian match isn't entirely your choice either, but there are an order of magnitude more choices to rank in the civilian match. You might ponder the value of that choice, but in fact it is a huge difference. The majority of med students don't do HPSP and match and pay off their loans without the military services telling them where they have to go or what they have to do.

 

[pokjoko]

You'll see and hear similar advice from just about any currently serving, active duty attending: If you don't want to be a military officer first, then military medicine isn't a good choice.

HPSP comes with the same caveats as USUHS (although less of a commitment): namely, you will have very little control over what "kind" of doctor you become, where you live/practice, and a lot of other things.

Hypothetically, if you took the HPSP scholarship and did Gen Surg, you wouldn't be an attending for a decade. There is absolutely no way to predict what it will be like when you graduate medical school or finish training. Things have whipsawed around and vary widely by service.

Keep in mind: It's not really a scholarship. It's an exchange. The military is paying for your medical school now, and then they own you for a set period of time afterwards. It's kind of an indenturing agreement. If you weigh the pros and cons, decide that on balance you come out ahead based on your goals - then it can be a reasonable (if not really a good) choice.

Don't do it just for the money and expect to be happy with your decision.

At the end of the day, a 4 yr commitment isn't terrible. The bigger risk is availability of residency spots, and there's no way to predict that. You roll the dice that what you want to do will be available. The risk is falling in love with something like Rad Onc, and the military will tell you "tough luck, go be a GMO in the clinic for 4 years".

If you aren't sure but still interested, consider the reserves or something like the FAP program as well. The VA also has a program where you can do loan repayment as well as their own scholarship program (I don't know much about it, other than that it exists).

Thanks for your response. I suppose it really does come down to whether or not I am ready to make the commitment at this stage in my career. The fact that I have some doubts in the first place may be an indication that this path isn’t for me, although perhaps I could still join later through one of those other programs.

 

[pokjoko]

So like most who haven't started, you are undecided on what you will do after med school. The issue with HPSP is that you won't get to decide alone where you will do an internship or start the rest of your residency. Civilian match isn't entirely your choice either, but there are an order of magnitude more choices to rank in the civilian match. You might ponder the value of that choice, but in fact it is a huge difference. The majority of med students don't do HPSP and match and pay off their loans without the military services telling them where they have to go or what they have to do.

It’s true, I really don’t have a concrete idea on where I wanna end up. I wouldn’t wanna close any doors prematurely, but some part of me would regret not serving in some capacity at some point in my life.

 

[Correlate Clinically]

It’s true, I really don’t have a concrete idea on where I wanna end up. I wouldn’t wanna close any doors prematurely, but some part of me would regret not serving in some capacity at some point in my life.

There's nothing wrong with joining the military because you want to. Just do it with your eyes wide open, understand what you are getting into, and acknowledge the risks you are accepting. If it's still something you want to do, that's fine. There are also those other programs to look at, if that's a better fit (Reserves or FAP, probably some others out there as well).

It's also ok if the military isn't for you. It does have it's occasional moments, but there are significant downsides.

 

[armytrainingsir]

When talking about avoiding something, why do people so frequently use the expression "avoid like the plague"?

Have people really read about and understand the circumstances of the Plague? It was truly horrific. Tens of millions died, shtting their guts out and bleeding out of their eyeballs.

So no, HPSP should not be avoided like the Plague. You could make the argument that it should be avoided like COVID-19 (a much lesser pandemic, but still, something you might chose to avoid).

Lighten up Francis, it’s a 400+ year old idiom. And plague is not a synonym for The Plague or Black Death of 14th century infamy.

'Avoid Like the Plague': A History

Heading straight toward its origins

www.merriam-webster.com

 

[DrMetal]

Thanks for your response. I suppose it really does come down to whether or not I am ready to make the commitment at this stage in my career. The fact that I have some doubts in the first place may be an indication that this path isn’t for me, although perhaps I could still join later through one of those other programs.

Yep. You just answered your own question. Join later, consider the reserves.

 

[DOswag]

As someone who started civ practice after separating this past summer, gotta say it makes me really ponder the question of "If I had it to do over again...?". I won't say that I just absolutely regret my decision to do HPSP, but there are times where I really wonder if my life for all of those years would've been different. I'd say my stress level was muuuuuuuch higher and for a several year chunk of my life, not being happy with my job, making much less money etc. Medicine in the military isn't just "being a doctor taking care of active duty people or their families". The military makes sure that that is about 50% of what you do and the other 50% is being a "military officer", going to unnecessary meetings, conversing with commanders and 1st Sgts about if your patient is fit to perform his duties, filling out profiles, determining if someone is unfit/unsuited for continued military service and writing up iRILO's to submit for MEB or separation memos to give to commanders, dealing with malingerers who just want to get medically retired despite sitting behind a desk all day at the age of 25, higher ups bothering you on why you're behind on x, y, z thing that is not patient related but you've just barely caught up on a, b, c that might have something to do with patient care, fielding phone calls and tcons from patients, CBTs, more CBTs, oh and you're delinquent on CBT's so the Sq commander is going to threaten not approve any leave time until you get caught up on those, higher ups who only have to see about a week's worth of patients in an entire calendar year to stay "current" by the military standards asking why wait times in the clinic are so backed up. The list goes on and on with grievances of practicing medicine within the military.

But I worked with some awesome people and I was stationed in a cool place that I never would've lived had I not been in the military. But not add "possible cool places to be stationed" as a pro because there's just as many not cool places to be stationed and you only have a faint subjective feeling of any control because you get to fill out a list of places you want to go, then the military crushes that subjective feeling by deciding where you'll go no matter what you put down on the paper.

You will make less money (far less if you end up being anything pretty much outside of primary care), you have less control over what you want to specialize in unless you're willing to delay your training by being flight surgeon/GMO with only an intern year of post grad training until you're thrown into the fire, military medicine is 'see above', possibility of deployment, possibility of not so great places to be stationed that is out of your control... If you want to serve and absolutely cannot see yourself being fulfilled in life without it then sign up for HPSP but give strong consideration to post residency options such as guard, reserves etc. Otherwise you run a big risk of setting yourself up for a lot of years of disappointment, frustration, feeling trapped, with possibly a lot of regret and resentment after you separate. There is the possibility that you enjoy it to the point of making a career out of it, retire after 20 years and draw a pension then go on to a second job. I'm currently working with another physician that just got out after 20 years 1-2 years ago and draws about 90K per year pension, has tricare for life, and is working a job that has potential to make 3-400K. To me, I couldn't make it to 20 years so I separated with 8 years of active duty time (4 years residency, 4 years staff physician for USAF). The ones that make a career out of it are faaaaaar less than those who do their time and separate though.

 

[SeniorWrangler]

If you've got a spouse already, talk to them, they're going to be living with the military too; my wife did not enjoy getting sent to Kansas with me for my first duty station and it took a while for her to get her career back on track.

 

[j4pac]

I wanted to serve, so I did. The scholarship program was just lagniappe. If you’re doing it (or anything, for that matter) for money, then I’d at least reconsider and weigh your options. There are tons of people who did HPSP and loved it. It wasn’t without significant sacrifices, but there are still those of us that wouldn’t trade the experience and ability to serve for anything in the world. Are you that type of person?

 

[Baron Samedi]

The good:
- less debt, can start building wealth early
- amazing lifelong friends
- fulfill desire to serve
- tricare

The bad:
- can end up behind (sometimes badly) financially compared to civ counterparts
- low patient volumes can hamper your skills and pacing
- staffing woes

The ugly:
- you might be a subspecialist that gets assigned to a MEPS station
- toxic commands
- dealing with problematic GS employees

 

[orbitsurgMD]

So much depends on chance. While some branches claim to be selecting HPSP graduates for straight-through training, many don't. There aren't enough PGY2 slots for all of the people who have been doing duty as GMOs. It is a fiction--and untrue--to believe that those not chosen are less deserving, as so many factors, competitiveness of particular specialties, attrition to the civilian sector, prior service, scarcity of slots, and politics, have a place in the selection process. It can seem fair and it can seem unfair at the same time. When you take HPSP, which is years before you have enough medical learning and experience to be comfortable with a specialty choice, you have already limited your chances to a military-run process that works differently than the much more replete civilian residency application process. The military match is subject to institutional considerations for use of manpower and willingness to budget funds that may be very much alien to your interests. Considering that choice of residency is the critical step that shapes your career trajectory, limiting yourself to an uncertain and even capricious match is not a trivial thing. Hearing cool sea stories is great, if for nothing else but to pass the time. But expecting a fulfilling and valuable work experience in the military after HPSP is unrealistic. I can say that less than 10% of the class of my internship and of my flight surgery class stuck around. Even those who got good residency opportunities punched out.

 

[pokjoko]

So much depends on chance. While some branches claim to be selecting HPSP graduates for straight-through training, many don't. There aren't enough PGY2 slots for all of the people who have been doing duty as GMOs. It is a fiction--and untrue--to believe that those not chosen are less deserving, as so many factors, competitiveness of particular specialties, attrition to the civilian sector, prior service, scarcity of slots, and politics, have a place in the selection process. It can seem fair and it can seem unfair at the same time. When you take HPSP, which is years before you have enough medical learning and experience to be comfortable with a specialty choice, you have already limited your chances to a military-run process that works differently than the much more replete civilian residency application process. The military match is subject to institutional considerations for use of manpower and willingness to budget funds that may be very much alien to your interests. Considering that choice of residency is the critical step that shapes your career trajectory, limiting yourself to an uncertain and even capricious match is not a trivial thing. Hearing cool sea stories is great, if for nothing else but to pass the time. But expecting a fulfilling and valuable work experience in the military after HPSP is unrealistic. I can say that less than 10% of the class of my internship and of my flight surgery class stuck around. Even those who got good residency opportunities punched out.

It's been some weeks since I made this post and you've pretty much summed up why I don't think it would be a good fit for me. Although the idea sounded nice at first, the realities of military medicine + the fact I don't know what specialty I want to do yet makes taking the HPSP too much of a risk

 

[j4pac]

It's been some weeks since I made this post and you've pretty much summed up why I don't think it would be a good fit for me. Although the idea sounded nice at first, the realities of military medicine + the fact I don't know what specialty I want to do yet makes taking the HPSP too much of a risk

If you are debating whether or not it’s a good fit…then it’s not a good fit. You’re either all in or all out.

 

[armytrainingsir]

If you've got a spouse already, talk to them, they're going to be living with the military too; my wife did not enjoy getting sent to Kansas with me for my first duty station and it took a while for her to get her career back on track.

Sage advice.

The mil is still very much oriented to single folks or married men with a trad wife, despite what all the commercials tell you.

Can other folks thrive? Absolutely. But they will find themselves swimming upstream at times.

😉