Increased Medical Bonuses and Stipends

[DNA Helicase]

I found this: http://www.afa.org/magazine/sept2006/0906congress.pdf

"An incentive package approved by the Senate would: Double, to $30,000 a year, the stipend for HPSP scholarships. Increase to $60,000,from $22,000, the maximum student loan repayment, to entice more medical and dental school graduates into service. Increase to $45,000, from $15,000, the maximum annual grants for doctors who choose to complete residency training in the civilian sector before military service. Increase to $25,000, from $10,000, the amount of special pay offered to selected reserve health professionals trained in critically short wartime specialties. Enhance dental accession bonus authority. Allow a new accession bonus of up to $400,000 for physicians and dentists in war-critical specialties. Enticed from civilian life, the doctors would promise to serve at least four years. Specialists who might qualify include maxillofacial surgeons, thoracicsurgeons, andorthopedic surgeons. The House version of the 2007 defense authorization bill had not endorsed most of these adjustments."

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Members don't see this ad.

 

[Droopy Snoopy]

I found this: http://www.afa.org/magazine/sept2006/0906congress.pdf

"An incentive package approved by the Senate would: Double, to $30,000 a year, the stipend for HPSP scholarships. Increase to $60,000,from $22,000, the maximum student loan repayment, to entice more medical and dental school graduates into service. Increase to $45,000, from $15,000, the maximum annual grants for doctors who choose to complete residency training in the civilian sector before military service. Increase to $25,000, from $10,000, the amount of special pay offered to selected reserve health professionals trained in critically short wartime specialties. Enhance dental accession bonus authority. Allow a new accession bonus of up to $400,000 for physicians and dentists in war-critical specialties. Enticed from civilian life, the doctors would promise to serve at least four years. Specialists who might qualify include maxillofacial surgeons, thoracicsurgeons, andorthopedic surgeons. The House version of the 2007 defense authorization bill had not endorsed most of these adjustments."

Yeah, this was discussed a lot around the time it was happening, but that's it in a nutshell. The gov't authorized the increases but didn't set aside the money for it. Boooo!

 

[megadon]

Above and beyond it being figured into the budget, the DOD has to authorized it. Since we are still pre-crisis (everyone knows the problem is looming, but the major effects are just starting to show in the press) they ain't going to do it. For example, when I left the nuke community, the maximum authorization for retaining nuclear trained submarine officers was much higher than what was being paid, cause the crunch wasn't felt yet. We were well compensated, don't get me wrong, but not to the level authorized in the budget. Meanwhile, at least the Navy is doing everything to trim costs to support the war, which means they are minimizing PCS moves to max extent possible in order to divert funds to the Army and Marine Corps (ironically the Corps is under the Navy budget). So being Navy HPSP, I'm not expecting my AGI to increase next tax year.

 

[basicscikills]

Yeah, this was discussed a lot around the time it was happening, but that's it in a nutshell. The gov't authorized the increases but didn't set aside the money for it. Boooo!

Second on that BOOOO. But still, I haven't given up. I've written my senators and congressman about that problem and hope that it might get swept up in the current focus on the milmed system. I encourage other HPSP recipients and other interested parties to do the same...it won't solve any problems, certainly, but it just might result in happier docs down the line.

 

[NavyFP]

Second on that BOOOO. But still, I haven't given up. I've written my senators and congressman about that problem and hope that it might get swept up in the current focus on the milmed system. I encourage other HPSP recipients and other interested parties to do the same...it won't solve any problems, certainly, but it just might result in happier docs down the line.

Keep hoping, but don't hold your breath. Congress has not even bothered to pass a budget for this fiscal year.

 

[Ex-44E3A]

Don't hold your breath on this deal for one second... I don't think there's anywhere near enough political pressure to overcome the Robin Hood mentality that so many of our legislators seem to carry.

The congress is not going to just "give" more money to doctors, military or not, deserving or not. They're much more likely to wait until the furor passes and default right back to the status quo. Even if somebody cries foul, they'll simply fall back on the "greedy rich doctors don't need more money" class-warfare gambit that they always use.

These guys all think we're overpaid, and so does the majority of the electorate... and they'd be happy as clams to eventually see every physician paid less than what military docs make now.

Sorry... but I have a relentless cynicism about this.

/rant off

 

[HumptyDumptyMil]

the article states we currently can get 22,000 for student loan repayment. Is that true for HPSP or are they talking about FAP? If for HPSP, when can we get the money and can we use it for undergrad loans as well?

 

[BigNavyPedsGuy]

the article states we currently can get 22,000 for student loan repayment. Is that true for HPSP or are they talking about FAP? If for HPSP, when can we get the money and can we use it for undergrad loans as well?

They're not talking to HPSPers

 

[BigNavyPedsGuy]

Don't hold your breath on this deal for one second... I don't think there's anywhere near enough political pressure to overcome the Robin Hood mentality that so many of our legislators seem to carry.

The congress is not going to just "give" more money to doctors, military or not, deserving or not. They're much more likely to wait until the furor passes and default right back to the status quo. Even if somebody cries foul, they'll simply fall back on the "greedy rich doctors don't need more money" class-warfare gambit that they always use.

These guys all think we're overpaid, and so does the majority of the electorate... and they'd be happy as clams to eventually see every physician paid less than what military docs make now.

Sorry... but I have a relentless cynicism about this.

/rant off

You can complain all you want but you are still wealthier than 90+% of the world.

 

[pgg]

You can complain all you want but you are still wealthier than 90+% of the world.

If my wife, three children, and I lived in a three-room cinder-block hut with four more relatives and running water that was "usually" free of disease, I'd still be wealthier than people in much of the world.

What's your point? That the salary and lifestyle of a physician in the US military only has to be better than that of a starving refugee beating off angry hordes of ethnic-cleansers with a stick?

 

[BigNavyPedsGuy]

If my wife, three children, and I lived in a three-room cinder-block hut with four more relatives and running water that was "usually" free of disease, I'd still be wealthier than people in much of the world.

What's your point? That the salary and lifestyle of a physician in the US military only has to be better than that of a starving refugee beating off angry hordes of ethnic-cleansers with a stick?

I'm saying that the idea of someone making 6 figures and whining about not making enough money is ridiculous, selfish and shows a complete lack of perspective.

 

[g293]

I'm saying that the idea of someone making 6 figures and whining about not making enough money is ridiculous, selfish and shows a complete lack of perspective.

Give me a break--I'm so sick of people talking down the money side of medicine. Now no one made me do it, but I gave up 10 years (between med school and residency) of making any real money, now I have to make up that opportunity cost by saving even more. My friends have all been paying into their kids college funds and paying on mortgages while I saved nothing. You gotta make that up somehow and somewhere.

I'll just say it--the money does matter to me. It certainly ranks high on my list for wanting to get out. Graduating residents in my field start at $100,000 more a year than I make. How can I honestly make that kind of financial sacrifice with young kids to save for, no permanent home (since I have PCS'd twice since 2005) and still have residual debt from med school and residency?

Everyone's entitled to an opinion, and this is mine. I joined voluntarily and I understand what I signed up for but to want to be paid what your
counterparts are making while you deploy, etc isn't selfish or a lack of perspective in my book.

 

[orbitsurgMD]

Give me a break--I'm so sick of people talking down the money side of medicine. Now no one made me do it, but I gave up 10 years (between med school and residency) of making any real money, now I have to make up that opportunity cost by saving even more. My friends have all been paying into their kids college funds and paying on mortgages while I saved nothing. You gotta make that up somehow and somewhere.

I'll just say it--the money does matter to me. It certainly ranks high on my list for wanting to get out. Graduating residents in my field start at $100,000 more a year than I make. How can I honestly make that kind of financial sacrifice with young kids to save for, no permanent home (since I have PCS'd twice since 2005) and still have residual debt from med school and residency?

Everyone's entitled to an opinion, and this is mine. I joined voluntarily and I understand what I signed up for but to want to be paid what your
counterparts are making while you deploy, etc isn't selfish or a lack of perspective in my book.

BNPG must not have considered these very real extra costs to a career in medicine relative to other professions. You lose the opportunity to earn and through thrift save and invest funds which over the course of your career will grow the most. It takes a lot of extra downrange earning to even make up that difference, never mind get ahead. And for the most of us, the pension is 100% on the guy in the mirror.

And "six figures", while it sounds great from the perspective of medical school BNPG, comes with a five-figure tax bill and doesn't automatically land you in the neighborhood of your dreams. You will someday figure that out.

The compromises of the developing-world are not the living standards anyone should be seeking. They are hardships and to be avoided.

No, money isn't everything, but it is very important to yours and your family's future security and only the foolish and clueless will believe otherwise.

 

[deliverer]

Give me a break--I'm so sick of people talking down the money side of medicine. Now no one made me do it, but I gave up 10 years (between med school and residency) of making any real money, now I have to make up that opportunity cost by saving even more. My friends have all been paying into their kids college funds and paying on mortgages while I saved nothing. You gotta make that up somehow and somewhere.

I'll just say it--the money does matter to me. It certainly ranks high on my list for wanting to get out. Graduating residents in my field start at $100,000 more a year than I make. How can I honestly make that kind of financial sacrifice with young kids to save for, no permanent home (since I have PCS'd twice since 2005) and still have residual debt from med school and residency?

Everyone's entitled to an opinion, and this is mine. I joined voluntarily and I understand what I signed up for but to want to be paid what your
counterparts are making while you deploy, etc isn't selfish or a lack of perspective in my book.

I agree with you. It is not a lack of perspective on our part. However, society's perspective is totally lacking. People believe in entitlements and they feel healthcare should be free. Additionally, they want it on demand and with guarantees. My colleague and I were having a conversation on society's view of medicine and my comment was people would rather pay $100 for a pair of shoes or dinner, than pay their doctor's bill. A woman seated in front of me turned around and said, "you damn right I would rather pay for shoes or dinner or anything else than pay a doctor's bill."

We have sacrificed immensley and should be rewarded based on our skills. Also a low 100k salary isn't all what its cracked up to be.

 

[BigNavyPedsGuy]

BNPG must not have considered these very real extra costs to a career in medicine relative to other professions. You lose the opportunity to earn and through thrift save and invest funds which over the course of your career will grow the most. It takes a lot of extra downrange earning to even make up that difference, never mind get ahead. And for the most of us, the pension is 100% on the guy in the mirror.

And "six figures", while it sounds great from the perspective of medical school BNPG, comes with a five-figure tax bill and doesn't automatically land you in the neighborhood of your dreams. You will someday figure that out.

The compromises of the developing-world are not the living standards anyone should be seeking. They are hardships and to be avoided.

No, money isn't everything, but it is very important to yours and your family's future security and only the foolish and clueless will believe otherwise.

I never said money didn't matter. I'm not an idiot. I know about financial obligations (see wife and mortgage during med school). I know military subspecialists make a fraction of what their civilian counterparts do, and that should be unnacceptable. Income is one of the reasons I don't plan to stay in.

I just think that a lot of the time people aren't complaining because they can't pay for kids' college. They complain because they can't pay for their toys AND the college fund.

My whole point started b/c a poster said that the congress had too much of a Robin Hood mentality. He was complaining about taxes and the government not increasing his salary. My personal views on this are tainted from some rough experiences I had while growing up. I don't want this to spiral into an emotional grudegematch. Just let me say, I've seen poor and trust me sir, we are not poor. There are people out there much worse off than we are - through no fault of their own. I'm not passing a judgement here - it was just a comment.

 

[DNA Helicase]

I never said money didn't matter. I'm not an idiot. I know about financial obligations (see wife and mortgage during med school). I know military subspecialists make a fraction of what their civilian counterparts do, and that should be unnacceptable. Income is one of the reasons I don't plan to stay in.

I just think that a lot of the time people aren't complaining because they can't pay for kids' college. They complain because they can't pay for their toys AND the college fund.

My whole point started b/c a poster said that the congress had too much of a Robin Hood mentality. He was complaining about taxes and the government not increasing his salary. My personal views on this are tainted from some rough experiences I had while growing up. I don't want this to spiral into an emotional grudegematch. Just let me say, I've seen poor and trust me sir, we are not poor. There are people out there much worse off than we are - through no fault of their own. I'm not passing a judgement here - it was just a comment.

While it's accurate that military physicians are paid more than the average american, they are paid less than civilian physicians. This is the complaint. Civilian physicians are not getting deployed. So why does someone who, on average, is required to take more risks, is paid dramatically less? I guess that's the source of the complaint (among others). If congress were to pass legislation so that military physicians salaries matched up with those in the civilian world, it would dispell much of this.

To say "you're not poor" is also untrue, but kind of irrellevant given the kinds of sacrifices physicians make, and the further sacrifices made my military physicians.

 

[megadon]

I made roughly 80k a year when I got as a sub officer and made the same as a defense contractor. Yeah, that's a lot of money compared to what make now as a student, and I feel it. Keep in mind that it always feels like you can't make enough money, but going from have it to have not has really help shape my decisions. Do I regret it, no. I have a house that hasn't sold in Norfolk, so I am covering a mortgage and rent, thank God for tax returns and my wife's six month employment bonus, and parents. But let me tell you, I plan on doing another 13 years and retiring with a pension and going private practice. Where else in the US do you get a pension after 20 years?
Pensions are going away, and I'm the first to argue they should.
So what's my story? I've learned that six figures is more than enough to live on. It will enable me to give a sizeable contribution to charity (through my church, not through my gov't taxes) and live comfortably. Personally, I feel helping our military families (job satisfaction) offsets what I would make as a civilian packing away personal savings. That's a really personal decision, and no judgement on which you make.
For me it comes down to this, how much money do you need? The answer varies, and that's okay. What do you want to do, do you want to work in one hospital pulling clinic for twenty years? That's fine too. Or do you want the opportunities to deply, both wanted/unwanted and see parts of the world you may have never seen before? These are all questions that realistically we should have asked before signing the dotted line. I had seven years experience is getting screwed, so I knew what I was up against. My wife and I have been married seven years, the first four stationed apart, (Marine Corps fault, or so I tell myslef). But I don't think either of us regret it for getting to go where we did. She went to liberia and the gulf, I went to the Northern Atlantic. I've been to Norway when the sun doesn't set and beer is seven bucks. She's been to Liberia where no one would go on vacation. What did we both learn, America is the place to be. We've both been to the UK, and I still am glad that I'm an American, hands down.
Do I belive that everyone should have military experience, absolutely not. I greatly enjoy the fact we are all volunteer. That means most people want to be there. Is it all good, absolutely not. You will sit through hours of mindless "professional training" that you sat through a year ago to meet a requirement. There are tons of beaucracy just like any large corporation, perhaps more so since the government is involved. You will make less money as a physician, it's just a question of what you want to do with your life. If you want the opportunity to jump out of planes with Marines, the opputinity is there. If you want to travel on a ship and see new places, your clothes will smell like the ship, and that ain't good. But I think it's worth it. Like I said, it's your choice.

 

[DeepCowboy]

My research mentor, S. Ward Casscells, will likely be the next Assistant Secretary of Defense for Health Affairs. He completed his Senate confirmation hearing yesterday and would take the post in May or June. We have discussed the HPSP stipend issue and issues of pay inequity at USUHS and I have given him the relevant documents (the law, the cost estimate, calculation of opportunity cost to attend USUHS, etc.). He was receptive to pursuing the issue and realizes the positive impact it would have on recruiting, retention, and quality of life. His immediate question was, "If they didn't give out all of the scholarships, how can they not have money in the budget?" If this doesn't make it happen, I don't know what will.

I am a former submarine officer and nuclear engineer from the Navy, switched to the Army, now on HPSP scholarship in my 2nd year at Univ. of Texas Medical School at Houston, receive zero help from my deadbeat parents, married and my wife stays home to take care of our 22 month old with another on the way in September. It would actually cost us money for her to work due to day care costs and the reduction in my financial aid that would occur from her salary. Crazy. But those troops are gonna get the surgeon they deserve. And my brother is in the Navy serving with a combat unit in Iraq with the Marines.

 

[Ex-44E3A]

My apologies for getting to this discussion late... I was on vacation

I'm saying that the idea of someone making 6 figures and whining about not making enough money is ridiculous, selfish and shows a complete lack of perspective.

Say what?

Where did I complain that I'm not making enough money? I'm a civilian ER doc, and a full partner in a private democratic group... apart from my 50% medicaid and self-pay rate, I have few complaints about what I make (it's head-and-shoulders above what military ER docs make).

Talking about military docs in general, I think most are underpaid (except maybe pediatricians)... but there is no way active duty MDs are going to be brought in line with their civilian counterparts until the system collapses, or the HPSP pipeline dries up.

I've said it before, and I'll say it again: there is no such thing as a labor shortage. There are only jobs that employers fail to make sufficiently attractive with pay/benefits/lifestyle to bring in the applicants they want. If the military paymasters are unwilling to stick a freakin' crowbar in their wallet sufficient to pay physicians what they're worth, then they'll just have to lump it (which will probably result in a doctor draft, since nobody tells the federal government "no.")

My whole point started b/c a poster said that the congress had too much of a Robin Hood mentality. He was complaining about taxes and the government not increasing his salary. My personal views on this are tainted from some rough experiences I had while growing up. I don't want this to spiral into an emotional grudegematch. Just let me say, I've seen poor and trust me sir, we are not poor. There are people out there much worse off than we are - through no fault of their own. I'm not passing a judgement here - it was just a comment.

I'm not trying to make this an emotional grudge-match either, but what's up with the "ridiculous" "selfish" and "doesn't appreciate how wealthy he really is" labels? It's fine if we simply disagree on how much income is "fair" or "enough," but that's no reason to call me a fat-cat skinflint.

Incidently, congress absolutely DOES have a Robin Hood mentality... and so does plenty of the general electorate. With the attitudes I see in my ER every single shift, I make no apologies for that characterization.

I don't think it's the Federal Government's job to tell me what I should be making as a private physician. If my care is good (and it is), and my patients are satisfied (and they are), then I should be eligible to receive whatever the market will bear. Unfortunately, since CMS (medicare and Medicaid) are about 40% of the healthcare dollar (and everybody else indexes their rates off of medicare rates), the federal government effectively has wage/price controls in place that artificially limit all physicians. Wage and price controls also increase demand, decrease supply, and negatively affect quality... but that's a discussion for another time.

Physician incomes have been flat to declining for over a decade now (despite everyone working harder, seeing more patients, grouping up for economies of scale, etc)... and while you may be OK with that ("Hey, I'm not as bad off as a doctor in Djibouti! Woohoo!"), I think it's worth a bit of discussion in the context of military physician salaries. How many years has the ASP gone unchanged? All while simple inflation dictates that you're losing 3% per year?

Nobody cares about your paycheck, of course... and you absolutely proved my point. Just as in the case of your military commanders and military leadership, the general public (and congress) absolutely do not care about your financial state, or how hard you work to get that check. Your military commanders don't care, because they own you, body and soul... and there's a slab of fresh HPSP meat coming down the conveyor belt right behind you. Congress doesn't care, because doctors are divided politically (and our ethics prevent us from striking, so we have zero leverage). The public doesn't care, because some resent your status and reputed wealth (all doctors are rich, doncha know), and others simply feel entitled to your labors (without paying a dime) whenever they get a sniffle.

 

[DeepCowboy]

My research mentor, S. Ward Casscells, will likely be the next Assistant Secretary of Defense for Health Affairs. He completed his Senate confirmation hearing yesterday and would take the post in May or June. We have discussed the HPSP stipend issue and issues of pay inequity at USUHS and I have given him the relevant documents (the law, the cost estimate, calculation of opportunity cost to attend USUHS, etc.). He was receptive to pursuing the issue and realizes the positive impact it would have on recruiting, retention, and quality of life. His immediate question was, "If they didn't give out all of the scholarships, how can they not have money in the budget?" If this doesn't make it happen, I don't know what will.

Dr. Casscells has been confirmed by the Senate as of last Thursday 3/29/07, so he will be the new Asst. Secretary of Defense for Health Affairs in about 3 weeks. The Major who recruited both of us into the Army (Dr. Casscells is a reserve Colonel) has also given his opinion to Dr. Casscells on how the stipend increase would positively affect recruiting. Obviously, the Walter Reed fiasco will be at the top of his agenda for a while, but I think there is a good chance he will make this happen. Don't know when.

 

[HumptyDumptyMil]

Dr. Casscells has been confirmed by the Senate as of last Thursday 3/29/07, so he will be the new Asst. Secretary of Defense for Health Affairs in about 3 weeks. The Major who recruited both of us into the Army (Dr. Casscells is a reserve Colonel) has also given his opinion to Dr. Casscells on how the stipend increase would positively affect recruiting. Obviously, the Walter Reed fiasco will be at the top of his agenda for a while, but I think there is a good chance he will make this happen. Don't know when.

As always, we can only pray things will get better (hasnt really worked so far though )

 

[BigNavyPedsGuy]

My apologies for getting to this discussion late... I was on vacation



Say what?

Where did I complain that I'm not making enough money? I'm a civilian ER doc, and a full partner in a private democratic group... apart from my 50% medicaid and self-pay rate, I have few complaints about what I make (it's head-and-shoulders above what military ER docs make).

Talking about military docs in general, I think most are underpaid (except maybe pediatricians)... but there is no way active duty MDs are going to be brought in line with their civilian counterparts until the system collapses, or the HPSP pipeline dries up.

I've said it before, and I'll say it again: there is no such thing as a labor shortage. There are only jobs that employers fail to make sufficiently attractive with pay/benefits/lifestyle to bring in the applicants they want. If the military paymasters are unwilling to stick a freakin' crowbar in their wallet sufficient to pay physicians what they're worth, then they'll just have to lump it (which will probably result in a doctor draft, since nobody tells the federal government "no.")



I'm not trying to make this an emotional grudge-match either, but what's up with the "ridiculous" "selfish" and "doesn't appreciate how wealthy he really is" labels? It's fine if we simply disagree on how much income is "fair" or "enough," but that's no reason to call me a fat-cat skinflint.

Incidently, congress absolutely DOES have a Robin Hood mentality... and so does plenty of the general electorate. With the attitudes I see in my ER every single shift, I make no apologies for that characterization.

I don't think it's the Federal Government's job to tell me what I should be making as a private physician. If my care is good (and it is), and my patients are satisfied (and they are), then I should be eligible to receive whatever the market will bear. Unfortunately, since CMS (medicare and Medicaid) are about 40% of the healthcare dollar (and everybody else indexes their rates off of medicare rates), the federal government effectively has wage/price controls in place that artificially limit all physicians. Wage and price controls also increase demand, decrease supply, and negatively affect quality... but that's a discussion for another time.

Physician incomes have been flat to declining for over a decade now (despite everyone working harder, seeing more patients, grouping up for economies of scale, etc)... and while you may be OK with that ("Hey, I'm not as bad off as a doctor in Djibouti! Woohoo!"), I think it's worth a bit of discussion in the context of military physician salaries. How many years has the ASP gone unchanged? All while simple inflation dictates that you're losing 3% per year?

Nobody cares about your paycheck, of course... and you absolutely proved my point. Just as in the case of your military commanders and military leadership, the general public (and congress) absolutely do not care about your financial state, or how hard you work to get that check. Your military commanders don't care, because they own you, body and soul... and there's a slab of fresh HPSP meat coming down the conveyor belt right behind you. Congress doesn't care, because doctors are divided politically (and our ethics prevent us from striking, so we have zero leverage). The public doesn't care, because some resent your status and reputed wealth (all doctors are rich, doncha know), and others simply feel entitled to your labors (without paying a dime) whenever they get a sniffle.

We'll have to agree to disagree. Sorry if anything I said came acrossed as a personal attack. That really wasn't my intention. Clearly your upset and I wasn't just trying to be a rabblerouser (sp?)

 

[Ex-44E3A]

No offense taken, BNPG... just trying to figure out where you were coming from. We're all adults here, and open discussion requires a bit of thick skin on everyones part. If necessary, we can even agree to disagree.

No worries.