Looking for advice on taking HPSP, my financial predicament, and where to go from here.

[mylittlethrowaway]

Thank you for taking the time to check out my post. I just want to start with a little bit about me and how I’ve ended up in my current situation. I’m 25. I grew up in a pretty dysfunctional home in the rural midwest. My father was an abusive drug addict and my mom was often absent working multiple jobs to keep our house afloat. When it came time for college, I tried to get as far away as possible and ended up choosing to go to an expensive out of state university. I didn’t care at the time because anything was better than home. I picked up a hefty amount of debt (150k) over four years and some post bacc work. I didn’t have much guidance during this period of my life and only began to realize the financial predicament I was in as I approached the end of undergrad. I don’t blame anyone but myself for this current situation that I’m in and am not looking for any sympathy. I just want to make the right decisions going forward so that I can set myself up for success in the future.



I understand that some will say walk away from medicine now because it’s not financially worth it at this point. I’m not willing to do that. I can’t see myself doing anything else and have fought to damn hard to get here. So here I am debating on what my next move will be. I’ve been fortunate enough to have been accepted to several DO schools and put my first deposit down a couple of days ago on the cheapest program with the best resources. It's still going to be around 70k a year including COL. I’m still waiting to hear back from my state MD program which is significantly cheaper (In the mid-30s). I interviewed a month or so ago and should hear back around Feb/March.



I've considered several avenues to address my predicament including strap, mdssp, fap, nhsc, etc. But I basically feel my decision has come down to two scenarios: Eat the loans or take HPSP. I’ve been pouring over this forum for the last three weeks trying to decide if military medicine is right for me given my current financial predicament. I wake up every day and flip back and forth between taking the scholarship or the loans. I’m hoping that some current mil med physicians can lend some advice on what they would do in this situation. The overall tone of the posts regarding hpsp on the sdn is negative, but I don’t see many entering school with the level of debt that I’m carrying. So what would you do if you were in my situation? Do you think HPSP would be worth it to someone like me? Or should I take the loans and not look back. I do have an interest in serving in the military but after reading other's experiences on here, I know that oftentimes this comes with a variety of unique issues. I feel like either choice is going to leave me feeling like I made a mistake, and it all comes down who I want to answer to…uncle sam or student loans.



I’ve created a pros and cons list below and would like to think I have done my research. Please feel free to comment and tell me what you would do in my situation. I appreciate any advice anyone can offer. Thanks again.



Taking out loans

Cons

1.) Massive debt around 500-600k after interest (assuming 4-year residency)

2.) A career in primary care is probably out of the question with a debt burden this high. This scares me because what if that's what I end up really enjoying or I'm not competitive for a lucrative specialty?

3.) I’m gambling a lot on my ability to perform well in medical school. I believe that I will do well in school, but the higher the loan amount gets the more nervous I am about matching into a lucrative specialty.



Neutral

1.) I will need to “follow the money” meaning that I’ll probably end up practicing in rural America.

2.) I’ll have to excessively work to pay down my loans and will need to supplement my income with moonlighting, urgent care shifts, etc..

1.) I don’t have a problem living on or under 30k a year if it means that I can be debt-free in 5-8 years. I’ve been living paycheck to paycheck my entire life, so not having money is nothing new. I figure you can’t really miss something you never had in the first place.



Pros

1.) I’ll have more control over my life than in the military.

2.) no delay in training for GMO tours

3.) no skill atrophy

4.) Can utilize existing loan repayment programs to decrease debt load and try to seek out jobs with large signing bonuses.

5.) At least I’ll be working in a field that I want (hopefully).

6.) I still have the option to join the military via the CSWSAB



HPSP



Pros

1.) No medical school debt, which immediately saves me about 300k (not accounting for interest).

2.) Monthly stipend to live on in medical school

3.) Since I’m splitting COL with my SO I can use the leftover money from the stipend to keep my interest from building on current loans. The COL is very low for the school I’m attending (probably can get by under 10k a year).

4.) A viable pathway to begin paying back current loans as a GMO or resident.

5.) Possibility to leave with little to no debt if I use my money wisely.

6.) Chance to give back to those in uniform.

7.) Chance to travel and have some experiences that I won’t get anywhere else.



Neutral

1.) I’m interested in several of the critical wartime specialties. (I know this could change).



Cons

1.) I can’t predict what's going to happen with the proposed budget cuts and how that will impact my training.

2.) Deployment and time apart from my SO and family.

3.) Possible Delay in training for GMO tours.

4.) Skill atrophy

5.) No control over where I live.

6.) I have no previous experience with the military so I can’t predict if I’ll enjoy serving or be miserable for 4 plus years.

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[rhodesfb17]

So one question I have for you after reading your post is would you still consider a career in military medicine if you didn’t have this level of debt. While yes you have a lot of debt, you could pay it off in most specialties within 10 years post residency. If you do end up taking HPSP for the money remember that you’ll be making significantly less meaning you will still be burdened by your current debt but with less money available to pay off your undergrad loans.

 

[mylittlethrowaway]

So one question I have for you after reading your post is would you still consider a career in military medicine if you didn’t have this level of debt. While yes you have a lot of debt, you could pay it off in most specialties within 10 years post residency. If you do end up taking HPSP for the money remember that you’ll be making significantly less meaning you will still be burdened by your current debt but with less money available to pay off your undergrad loans.

Honestly, I go back and forth. There are aspects of military medicine that I find appealing and others that make me very hesitant. I understand that I would be making less in the long run, but at the same time, it seems significantly less financially risky than taking on an additional 300k. At least with the income from the military during residency or as a GMO, I would be able to make a dent in my current student loans while not incurring double what I already owe.

 

[Cooperd0g]

That level of debt sucks. Especially on normal primary care type salary. However, you can’t assume you’ll do primary care. Additionally you could always choose a bit of geographic arbitrage the first few years out of residency and make bank on some “less than desirable location” while living in a nice one bedroom apartment or rent a small home. Or do the same thing via locum tenens. You would be able to crush that debt in just a few years.

 

[mylittlethrowaway]

That level of debt sucks. Especially on normal primary care type salary. However, you can’t assume you’ll do primary care. Additionally you could always choose a bit of geographic arbitrage the first few years out of residency and make bank on some “less than desirable location” while living in a nice one bedroom apartment or rent a small home. Or do the same thing via locum tenens. You would be able to crush that debt in just a few years.

Thanks for the reply. A big part of this is that it's hard for me to estimate the level of income I'll have since it's impossible to predict what specialties I'll be competitive for. If I knew that I would be making the money that gas does vs say a pediatrician, I wouldn't be sweating it so much. I think the locum tenens will be a good idea no matter what specialty I end up in if I decide to eat the loans. I'm totally willing to forgo the big house, fancy cars, and the city by the coast if it means I can aggressively pay down my loans and live more on my terms. Like I said in my original post, you can't really miss something you never had. It just seems like the military route would provide more financial security in the short run. For me, what it's basically coming down to is are the headaches of mil med worth 500-600k. Coming from both a non-military background and a lower income family its hard to gauge what the right choice is because I've never had any experience with the military and I don't know what it's like to make 250k plus a year. I appreciate your perspective and insight!

 

[mylittlethrowaway]

@The White Coat Investor I've spent a lot of time on your site lately and was wondering if you had any advice you could share?

 

[Cooperd0g]

Your analysis is flawed. You think it gives you short term financial security, but it doesn’t. It gives your brain a perception of less financial risk, but that doesn’t make it real. And it definitely doesn’t give you long term financial security. Long term financial stability is far more valuable. And in exchange for a perceived short term financial security you almost completely give up autonomy.

 

[militaryPHYS]

You need financial responsibility no matter what. Doesn't make a difference whether you are a pediatrician or an orthopedic surgeon. If you are financially responsible you can go civilian and still come out on top in the long run.

That being said, military service does give you short term financial security. But that does NOT mean it is a reason to join.

Financial security is maximizing the chances you will have and maintain an income necessary to cover your financial obligations. Financial obligations include debt as well as future financial obligations of you AND your spouse/children if they do not have employment.

Any scholarship increases your financial security by decreasing amount of debt. Obligated service to the military increases financial security by providing a guaranteed income (even if low) for a specified amount of time as well as benefits afforded to your family. Most civilian programs provide health/insurance benefit through the academic institution...but only if you stay employed there. If you fail out of civilian med school/residency then you're stuck with the debt and don't have a job. In the military you are usually kept on as a line or support officer (maintained low salary and benefits) until you repay time accrued. BUT AGAIN, THIS IS NOT A REASON TO JOIN. Also, risk of failure in med school / residency is only around 5-10%.

Like I have said before, military service minimizes your financial risk but maximizes your risk to personal autonomy as @Cooperd0g mentioned. You might be miserable in your job and have no way out until your time is up. You might love pediatric cardiology but can't train in it until you get out. You might be the best in your class and still have to do a GMO tour which could delay your residency training. ZERO personal autonomy.

Every person is different. Each personality places a different level of attention/anxiety on different areas. I personally have anxiety about debt. I also self-inflict fear of failure. Since I also wanted to be an officer in the military regardless of medicine it was a win-win for me. Definitely not the case for everyone.

To each their own.

 

[j4pac]

Here's my question...how much debt will you have if you do HPSP? Because I'm going to assume that you currently have about $200,000 in debt before med school. That debt isn't going away. HPSP is only going to prevent you from accruing more debt on top of your previously existing debt. So, honestly, unless all of your debt is from medical school, I wouldn't consider you much differently than any other medical student considering HPSP. HPSP is pretty much net neutral for debt accrued during MEDICAL SCHOOL. Now if all of that debt is from medical school...I'd consider a different medical school.

 

[mylittlethrowaway]

Here's my question...how much debt will you have if you do HPSP? Because I'm going to assume that you currently have about $200,000 in debt before med school. That debt isn't going away. HPSP is only going to prevent you from accruing more debt on top of your previously existing debt. So, honestly, unless all of your debt is from medical school, I wouldn't consider you much differently than any other medical student considering HPSP. HPSP is pretty much net neutral for debt accrued during MEDICAL SCHOOL. Now if all of that debt is from medical school...I'd consider a different medical school.

I owe 150k now. Med school will run me 300k. With interest over four years of medical school and assuming a four-year residency I should be in the 500-600k range when everything is said and done.

 

[j4pac]

I owe 150k now. Med school will run me 300k. With interest over four years of medical school and assuming a four-year residency I should be in the 500-600k range when everything is said and done.

Your decision to go HPSP has nothing to do with that $150k. You will owe that $150k either way. So just look at the $300-$400k from med school and let that be your guide to determine if it’s worth it financially.

 

[HighPriest]

I would let the $300-400k and your desire to actually be in the military guide you. If you can't imagine a scenario where you have no debt at all and where you don't expect any debt at all, and you still have an itch that only being an officer in the military can solve, then you have some fuel for the HPSP fire. If military service would otherwise not cross your radar, then you should find another route.

 

[TheEarDoc]

I will echo what most here have said. You current loan debt isn't going anywhere whether you put on the uniform or not, it merely means you won't take on additional debt if you do health scholarship and join up. So in short term yay you won't gain more debt for medical school, but in the long run you're going to lose money for most specialties if you are a doc in uniform vs. being in the private sector. Yeah that's a huge amount of debt to stare at and Mark Twain said it best that compounding interest is one of the most powerful forces in the universe, but with some savvy living and smart job choices you can whack that debt out and have some autonomy in about 10 years in the private sector.

If it were me I would hope you get into the state med school, but if not live as cheaply as you can in medical school. Pick a specialty that pays really well and you enjoy. Finish medical school. Take a job with a high sign on bonus or better yet one that has significant loan repayment programs attached to it. Think VA or rural hospitals. Then while working there you can pick up a temp job on the side for extra cash. You can live cheap for several years and pay down your debt some and let the loan repayment programs pay a lot of your debt down too.

If you really want to serve then you can do the VA and help veterans or you can even do DOD civilian and have some autonomy, but still serve.

Just for money is not a reason to sign up for military service. You most likely will end up just as broke and hating life and your job. I am just being blunt and honest.

 

[d2305]

You're young and can handle a few years in the military. I don't like debt either.

 

[Trefoil]

With 150k of debt already, I would recommend the civilian route. The main benefit of military service would be during residency when you are making 70-90k and your civilian counterparts are making 50-60k. The extra money would make it easier to make payments on your student loans. Your lifestyle during medical school will be similar regardless. Sure, I was able to save a little in HPSP, but long term, my classmates will blow me out of the water financially. We lived fairly similar lifestyles overall.

I would advise not to subject yourself to the uncertainty of military medicine at the moment. With the way things are moving, skill atrophy is likely to worsen, and why go into medicine if you aren’t planning on practicing medicine? You may end up in an administrative role or low volume clinical role in the military. Why go through medical school to be treated like crap? Just eat the loans. It will hurt in the short term, but it will be a far better career move in the long term. Trust me. You can pay back the loans. Meet with a financial planner, and they will show you how.

 

[militaryPHYS]

@mylittlethrowaway It sounds like your #1 priority over the last few years is pursuing medicine. It also sounds like the only thing that brought you to consider MilMed is expected large amount of debt. You do not necessarily have prior service or strong desire to serve which is totally fine. For this reason alone you are better off professionally and emotionally staying a civilian and being smart with your debt by sticking to @The White Coat Investor principles. Nobody should ever make a yes or no decision on MilMed based purely on money. It's a recipe for dissatisfaction in the military.

 

[Red Lobster Actual]

I'm going to be contrarian with most of the opinions for this case. For this poster. I say take Uncle Sam's money. Go Navy and GMO yourself out.

Why? Because he is poor. True poor. The kind of poor most of us do not understand because most of us here are from middle to upper class families.

Every time I talk to pre-meds I tell them to join the military if they are patriotic or poor. I then tell them it is best if they are patriotic and poor. And I really mean poor as opposed to debt averse.

Who is he going to call when he needs $500 when his car breaks down or when his tires blow out? Or when he needs that extra $20 for gas that he doesn't have? When he has to choose between food or heating? When someone he cares about needs that surgery? What is his safety net to make sure he can still pay for living expenses and study medicine? His drug addled dad? His mom that has to work multiple minimum wage jobs to keep food on the table and pay the mortgage?

Take out more loans? Seems like the solution everyone here is offering. That is not a solution for someone like OP. That is even more indentured servitude to the Department of Loan Sharks... I'm sorry Education. At least while I'm being pounded by the DoD they leave some money on the nightstand the morning after and give me healthcare. And when the litany of financial analysts tell me of the 3 million dollars lost in opportunity income, a) I'm in primary care, I'm not losing out on much and b) my life is still better than sleeping on the floor in a closet and being hungry.

It is never easy for someone to climb out of the pit of poverty. At least the military provides a ladder albeit covered in thorns. If I am reading the OP's situation correctly.

If not then I apologize for projecting and yadda yadda congrats on getting into med school, save money! Financial Independence Retire Early (FIRE!!!! **** YEAH!!) and don't join the military.

 

[militaryPHYS]

I more than most appreciate the monetary value milmed programs have to offer. But if someone has very little "patriotism" and little experience or understanding of the military then high chance of not being happy. That being said, most who don't come from privelage have less entitlement and are less likely to blame the system if they aren't happy after volunteering for something. That should help chances of staying happy or neutral during payback because they appreciate what the system provided for them (no matter how little it might be).

Regardless, anyone who joins just needs to fully understand what military service is like before signing. Imagine being happy as a line officer (non-medical). If they can't do that then better to eat the debt and buckle down on budgeting starting day one of med school and continuing for 10 years post residency.

 

[Perrotfish]

Thank you for taking the time to check out my post. I just want to start with a little bit about me and how I’ve ended up in my current situation. I’m 25. I grew up in a pretty dysfunctional home in the rural midwest. My father was an abusive drug addict and my mom was often absent working multiple jobs to keep our house afloat. When it came time for college, I tried to get as far away as possible and ended up choosing to go to an expensive out of state university. I didn’t care at the time because anything was better than home. I picked up a hefty amount of debt (150k) over four years and some post bacc work. I didn’t have much guidance during this period of my life and only began to realize the financial predicament I was in as I approached the end of undergrad. I don’t blame anyone but myself for this current situation that I’m in and am not looking for any sympathy. I just want to make the right decisions going forward so that I can set myself up for success in the future.



I understand that some will say walk away from medicine now because it’s not financially worth it at this point. I’m not willing to do that. I can’t see myself doing anything else and have fought to damn hard to get here. So here I am debating on what my next move will be. I’ve been fortunate enough to have been accepted to several DO schools and put my first deposit down a couple of days ago on the cheapest program with the best resources. It's still going to be around 70k a year including COL. I’m still waiting to hear back from my state MD program which is significantly cheaper (In the mid-30s). I interviewed a month or so ago and should hear back around Feb/March.



I've considered several avenues to address my predicament including strap, mdssp, fap, nhsc, etc. But I basically feel my decision has come down to two scenarios: Eat the loans or take HPSP. I’ve been pouring over this forum for the last three weeks trying to decide if military medicine is right for me given my current financial predicament. I wake up every day and flip back and forth between taking the scholarship or the loans. I’m hoping that some current mil med physicians can lend some advice on what they would do in this situation. The overall tone of the posts regarding hpsp on the sdn is negative, but I don’t see many entering school with the level of debt that I’m carrying. So what would you do if you were in my situation? Do you think HPSP would be worth it to someone like me? Or should I take the loans and not look back. I do have an interest in serving in the military but after reading other's experiences on here, I know that oftentimes this comes with a variety of unique issues. I feel like either choice is going to leave me feeling like I made a mistake, and it all comes down who I want to answer to…uncle sam or student loans.



I’ve created a pros and cons list below and would like to think I have done my research. Please feel free to comment and tell me what you would do in my situation. I appreciate any advice anyone can offer. Thanks again.



Taking out loans

Cons

1.) Massive debt around 500-600k after interest (assuming 4-year residency)

2.) A career in primary care is probably out of the question with a debt burden this high. This scares me because what if that's what I end up really enjoying or I'm not competitive for a lucrative specialty?

3.) I’m gambling a lot on my ability to perform well in medical school. I believe that I will do well in school, but the higher the loan amount gets the more nervous I am about matching into a lucrative specialty.



Neutral

1.) I will need to “follow the money” meaning that I’ll probably end up practicing in rural America.

2.) I’ll have to excessively work to pay down my loans and will need to supplement my income with moonlighting, urgent care shifts, etc..

1.) I don’t have a problem living on or under 30k a year if it means that I can be debt-free in 5-8 years. I’ve been living paycheck to paycheck my entire life, so not having money is nothing new. I figure you can’t really miss something you never had in the first place.



Pros

1.) I’ll have more control over my life than in the military.

2.) no delay in training for GMO tours

3.) no skill atrophy

4.) Can utilize existing loan repayment programs to decrease debt load and try to seek out jobs with large signing bonuses.

5.) At least I’ll be working in a field that I want (hopefully).

6.) I still have the option to join the military via the CSWSAB



HPSP



Pros

1.) No medical school debt, which immediately saves me about 300k (not accounting for interest).

2.) Monthly stipend to live on in medical school

3.) Since I’m splitting COL with my SO I can use the leftover money from the stipend to keep my interest from building on current loans. The COL is very low for the school I’m attending (probably can get by under 10k a year).

4.) A viable pathway to begin paying back current loans as a GMO or resident.

5.) Possibility to leave with little to no debt if I use my money wisely.

6.) Chance to give back to those in uniform.

7.) Chance to travel and have some experiences that I won’t get anywhere else.



Neutral

1.) I’m interested in several of the critical wartime specialties. (I know this could change).



Cons

1.) I can’t predict what's going to happen with the proposed budget cuts and how that will impact my training.

2.) Deployment and time apart from my SO and family.

3.) Possible Delay in training for GMO tours.

4.) Skill atrophy

5.) No control over where I live.

6.) I have no previous experience with the military so I can’t predict if I’ll enjoy serving or be miserable for 4 plus years.

Why did you rule out NHSC?

 

[DeadCactus]

You're going to have to do something undesirable to handle that debt. Maybe it's military service. Maybe it's work in rural America as a PCP for loan forgiveness. Maybe it's work community for a bit when you really wanted to do academics. Maybe you have to defer a fellowship. Maybe you have to work more hours than you wanted to. Maybe it's live in a small apartment and drive an old civic for a few years. Maybe it's a compromise between a few of these. The military, public health service, etc are only a tiny subset of the options available.

There is a reason the military is paying off hundreds of thousands of dollars in debt for physicians and it is not out of the kindness of their heart. There are plenty of other organizations with similar motivations especially once you are fully trained. Fear of debt is a terrible reason to sign any contractual obligation as a medical student. Finish medical school, try to do residency in a low cost of living area, and then make an informed sacrifice for the first few years out of training. There is no tangible benefit to committing early and the psychological risks outweigh the benefits for all but the most neurotic.

 

[deuist]

Depending on where you go to medical school, specialty choice, whether you get to complete residency/fellowship, and where you practice, you might find wide disparities between what you can make in the military versus civilian sector. In my case I lost $300,000 by going HPSP. Crazy enough, I would have made more money by taking on student loans.

 

[militaryPHYS]

Depending on where you go to medical school, specialty choice, whether you get to complete residency/fellowship, and where you practice, you might find wide disparities between what you can make in the military versus civilian sector. In my case I lost $300,000 by going HPSP. Crazy enough, I would have made more money by taking on student loans.

Did you calculate that by looking at time up until the end of your initial commitment? Did you stay on past your HPSP commitment?

I'm very interested in these numbers for people and would love to see the specifics if possible.

 

[deuist]

Did you calculate that by looking at time up until the end of your initial commitment? Did you stay on past your HPSP commitment?

I'm very interested in these numbers for people and would love to see the specifics if possible.

I used a net present value calculation that included the internship that I didn't want up until the end of my commitment. I also did a civilian residency. I left active duty the day the clock ran out on my ADSO.