Making the HPSP Decision

[PistolPete3]

Hi everyone. First of all I would like to say thank you to all of the individuals who have posted such useful and detailed information on this forum. This is my first post, but I have spent many hours poring through SDN.

I apologize for adding to the obscene number of posts on this topic, but I am looking for some help regarding the HPSP decision. I recently received my first acceptance and am excited to attend medical school next fall. Given that my total cost of attendance will likely exceed $250k, I am quite worried about the debt burden. I have been working happily as an engineer for the last two years, so it is a little terrifying to jump into such a negative income situation.

I have also always had interest in the military including applying to (and being admitted to) USUHS in a previous application cycle. As a result I am strongly considering HPSP and I have taken many steps to learn the ins and outs of becoming a military physician. I have shadowed military physicians, spoken at length to individuals involved with military medicine, and read just about everything I can find online (including the Half M.D. and White Coat Investor pages). I have also prepared a submission and am now undertaking the painful experience of getting a physical, etc.

I am looking not so much for anyone to make a decision for me, but more for strategies others have used to make the decision. It is really difficult to envision what the healthcare system will look like in ~10 years, much less the military medicine system, and even less my own personal desires, so making an informed decision seems really quite difficult.

The one thing I would like to add is that I have been working in the startup arena designing medical devices. I really would like to leverage my engineering background in the future as a practicing physician. As a military doctor, the opportunities to pursue things like a startup seem very limited. On the other hand I am a huge fan of aerospace medicine and I am really interested in the future of space medicine if the private spaceflight arena can get off the ground.

So does anyone have some good strategies for making the decision? Seems like a very big one and I am very much on the fence. Thank you in advance.

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[Cooperd0g]

For the purposes of this decision, forget about the whole medical thing. Do you actually want to be in the military? If yes, then take the scholarship. If no, then don't. It really is that simple.

 

[denali]

1. Skip the HPSP and maximize your options.

2. Pursue the specialty you are passionate about.

3. Once you've finished residency and/or fellowship, and if the military still makes sense, then join-up through the Financial Assistance Program (FAP).

 

[HighPriest]

I took an HPSP scholarship, completed medical school, matched into a surgical subspecialty within the Army system, and am now working off my ADSO. From that perspective, here's what I can tell you:

1. Do not worry about the cost of medical school. HPSP or not, you'll find a way to pay it off. When I first signed on the dotted line, that was a big part of my decision, and if I could tell my past self one thing, it would be to make the decision independent of the debt. Most physicians don't take a military scholarship, and they all pay it off. Sometimes it's hard, but it is doable. Sometimes (as in the case of many subspecialists) it isn't that hard to pay off at all, as long as you have some semblance of frugality.

2. It is hard to see 10 yeras in the future. Who knows where either military medicine or civilian healthcare will be, especially considering the political climate. My personal, anecdotal, opinion is that military medicine will go away over the next 10-20 years. Another massive wave of hospital consolidations are on the way. The Surgeon General's office is considering the viability of smaller (community) hospitals in the Army, and trying to determine whether it makes more sense to keep only a few large centers open (SAMC, MAMC, TAMC, NCC) and to allow the rest of the Army to go out to the community.

3. There is no opportunity for startups in the military. As far as I know, any device you develop while wearing the green suit (or other version) is US government property. I am not a JAG officer, and so I could be wrong about that, but I can tell you that is by far the most common sentiment in the Army when it comes to new ideas and property rights. I suppose if you came up with the idea completely on your own, without using any military time or resources, there could be a loophole in there, but Uncle Sam will do his best to muscle you out of your rights.

The reason you see so much discrepency between commentors concerning military medicine is that the experiences are very different for different people. Unfortunately, there is no way of predicting what kind of experience you're going to have. If you are able to match into the residency you want, then you're more likely to be happy. If not, then you may be unhappy. That is, of course, true on the civilian side. But in many cases your chances of matching are lower (or higher) in the military, and that is also difficult to predict because it changes every year. If you're stationed at a MEDCEN (large hospital), you're more likely to be happy. If you're stationed at Fort Polk in the middle of nowhere LA, you're more likely to be unhappy (unless you're from that area by chance). If you request, and are allowed to do fellowship training, you're more likely to be happy. But if you're denied fellowship training, then you're more likely to resent the military - especially if you would have been competative on the outside. Finally, I would say that you're more likely to by happy in primary care (Family Med, Pediatrics, Internal Med, etc.) than if you do a subspecialty. In those positions, you're likely to make as much or more than your civilian counterparts, and you will certainly work fewer hours. But I can tell you with certainty that almost no one knows for sure what kind of medicine they want to practice before starting med school. There are stations at which you will see the full breadth of your specialty, and there are stations where you will have to moonlight to keep your skills up to date. Anyone who says otherwise either has a narrow breadth of practice, or is at a MEDCEN, or is frankly lying to you. But you'll never know to which of those stations you'll be assigned.

The desire to serve your country and it's soldiers is a good reason to sign. I will say that, in the middle of my ADSO, I feel like I spend a large chunk of my time doing paperwork and training unrelated to my field (like annual hot weather training, or training in the prevention of human trafficking). That leaves a sour taste in my mouth, and from my perspective the Army is more concerned with crossing these t's and dotting these i's than they are with actual medical care. But that is just MY perspective. Most of my patient's are family members, which is important. But unless you're at NCC or SAMC, you probably aren't going to see a lot of acute injuries. You will take care of a lot of WTB patients, but often for PTSD and related conditions. It's not glamorous, but it is important.

Above all, keep in mind that the Army (can't speak for the other branches) doesn't care about you, your family, your profession, or your desires. All it cares about is that you are where you are supposed to be when you're supposed to be there, and that you're trained up. End of story. A med school classmate of mine told me that at our graduation, and I never considered it until I finished my residency and started my ADSO. It is very, very accurate. Some people thrive in that kind of environment, and others do not.

 

[idq1i]

The above post should be stickied. Great summary of milmed.

I would re-emphasize the "Army (can't speak for the other branches) doesn't care about you, your family, your profession, or your desires. All it cares about is that you are where you are supposed to be when you're supposed to be there, and that you're trained up." They don't necessarily care if you are doing your MOS where you are, as long as you are there.

The only thing that I would add is that you lose any and all autonomy over your own personal healthcare decisions. You may have a bit more pull than PVT Snuffy from Bumpkinville, KS, but you will still be forced to receive care from sometimes qualified, but occasionally frighteningly incompetent providers. Should you encounter any health issues, everyone in your post will know about it. It will be displayed in command meetings, your commander will know more about it than you do, etc. This is something that a lot of people don't consider when signing up for milmed.

 

[deuist]

The only accurate statement anyone can tell you on the forum is that you can't predict your happiness in the military. You might like your location; you may hate it. You might like your co-workers; you could hate them. You may enjoy the pathology and procedures, but you could hate them, too. The only difference between military and civilian work settings is that you have no say over where you go and what you do once you get there. And if you hate it, you can't quit and find a job elsewhere. Every bad thing HighPriest mentioned above happened to me, and be aware that you could get a bad lot, too.

If you are concerned about opportunities to pursue aerospace medicine as a civilian, there are currently 3 places that take civilians. If you are concerned about debt, depending on your specialty, you might pay it off in as little as 3 years. Every thing else you might be concerned about has been addressed on this forum before. The constant computer-based training and sexual harassment seminars get old quick.

 

[student til 30]

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[PistolPete3]

Thank you guys for all of the responses. HighPriest I particularly appreciated your detailed response. I decided to move forward without pursuing HPSP further. I found myself unambiguously deciding no if I pretend money is no object. Given all of the potential cons I want to trust the frequent advice on SDN to not take HPSP for the money. I am not sure if I was more than 51% against it, but in the end I figure 51% against was enough to make the decision. Thanks!

 

[pgg]

Nice post overall, but

1. Do not worry about the cost of medical school.

I have to disagree with. There are some really obnoxiously expensive med schools out there. Interest rates on loans are going up, and 3-5+ years of residency is a lot of compounding time. Stepping out of residency owing $400K or more as some people are doing (just look around the SDN forums) is a problem if you decide on a less-well-compensated specialty.

 

[notdeadyet]

There are some really obnoxiously expensive med schools out there. Interest rates on loans are going up, and 3-5+ years of residency is a lot of compounding time. Stepping out of residency owing $400K or more as some people are doing (just look around the SDN forums) is a problem if you decide on a less-well-compensated specialty.

Agree with this. Folks who have yet to pursue medicine almost always overvalue the importance of medical school quality and undervalue the importance of residency quality. Medical schools all cover roughly the same stuff and their utility is largely their ability to get you into the best residency for you, as residency is where you learn to be a doctor.

I would very much have cost enter the equation for choosing a medical school, as I would location, clinical exposure, facilities, etc. But residency is where the training happens and the HPSP decision should take into account the question of whether or not the handful of residency program options for a specific specialty is going to be the right quality and fit for a particular individual. For some folks, given their specialty and career goals, that'll be fine. For others it won't.

 

[pgg]

Amen.

If you're footing the bill with loans, and are fortunate enough to have choices, pick the cheapest allopathic medical school in a place you can tolerate living. It'll get you into any residency in the country, if you do your part.

 

[HighPriest]

Allow me to rephrase: do not make the cost of medical school the most important issue when deciding, specifically, to choose to join the military. Obviously the money is an issue, or you probably wouldn't be considering HPSP in the first place. I would encourage you to decide whether you would consider joining if the money wasn't an issue. If the answer is yes or a strong maybe, then it may be a good fit.
however, the cost of losing your freedom for 7+ years, being unable to chose where you live, or potentially what you do for a living, and the possibility of being deployed multiple times tends to outweigh the benefit of having your medical school bills paid.

Most of the truly miserable people that I know in military medicine are miserable because their primary reason for joining was for the money. I'll even grant you that for some lower paying fields you can make more money in the military, and likely work less. But you may be miserable. If that's worth it, then by all means join.

 

[HighPriest]

I cannot speak for any training but my own, but having spent roughly half of my residency training at a highly rated civilian university (for my field) and half in the military system, I feel that my training was at least as good as anyone who trained solely at the university.
But it is true that not all programs are that way, and there are fewer training programs relative to the outside, and so that is a valid thing to consider.