Married Medical Students Navy HPSP?

[Chemicols]

Hello. I am quite new as to an actual sign on, but I have frequented SDN for some time now; hence, I do know there is a good mix of resources/opinions available, especially in the military medicine forums. So here's my situation:

I will be starting medical school in August 2007 along with my wife (classmate). We are strongly considering a military HPSP scholarship, specifically the Navy. Yet, we would like to both gain some insight into the advantages and disadvantages of joining (specific to a married couple). Our biggest challenge is to guarentee that we could both be together for the majority of the situation.

1) Have any of you seasoned Navy medical officers seen this occur in the Navy GMO tours?

2) Situation #2: What if I did some competitive specialty, such as Derm or Rad, and my wife went into FP? Do you think we could still be remotely close together.

Please feel free to comment on any type of advantages or disadvantages that we may face by walking this path.

Thanks,
-Chemicols

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[g293]

Could it happen, maybe. Do you really want to risk it?? Not only may you not be together, you may not get the specialty you want. What about deployments at different times??

If being the in Navy is more important than your marriage, your specialty and location of your training and initial practice, then go for it.

 

[megadon]

Per the detailing handbook, they are supposed to try and colocate you. Otherwise, they owe you 150 extra a month for non voluntary seperation by orders. Even if you are interservice, they are supposed to try, although that is much more difficult. My wife was a Marine and I was submarines, the Navy played ball but the Marine corps didn't. Thus for the first four years of our marriage, I was in Norfolk, and she was in Camp Lejeune. It will be easier for you guys because you same branch, and both doctors.
As far as specialties, they only conflict I can see is I can't recall if they FP at Bethesda, Portsmouth, and San Diego, I bet they do. However, for FP you also can go to Camp Lejeune, Bremerton, and maybe Pendleton (which is pretty much colocation with San Diego). Hope that helps.

 

[BigNavyPedsGuy]

I wouldn't risk it. Marriage is too important for it. I know a Navy couple that both wanted the same competitive specialty and one got while the other is stuck in a transitional year. I don't know how they're going to sort out their GMO years. ALL of the FP sites are different than the major training hospitals that have every other residency. There's one that's ~1.5 hrs away (San Diego and Camp Pendleton) but that's it.

I think if you don't sign up, you'll look back four years from now and no regrets about choosing not to.

 

[The White Coat Investor]

Our biggest challenge is to guarentee that we could both be together for the majority of the situation.

There are no guarantees, no matter what anyone tells you. And $150 a month will be chump change by the time you are apart. Only join if you both have a burning desire to be in the Navy. If you do it for any other reason you will be unhappy.

 

[Chemicols]

Thanks for the insight. Now if I may change the scenario slightly, bear with me.

Let's say, I changed my mind from a competitive speciality to a similar field that my wife is doing, say I go into FP with her.

1) Do you think that we could be together in this case?

2) How do you predict our GMO tours? Do you think we'd be separated in this case or manageably together?
A) What GMO tours, do you know of, allow couples to be together. My concern is that we could not be on the same ship together???

Thanks
-chemicols

 

[megadon]

you can't be on the same ship together. You can be in the same battlegroup or ARG or MEU, but not the same ship.

 

[Gastrapathy]

Thanks for the insight. Now if I may change the scenario slightly, bear with me.

Let's say, I changed my mind from a competitive speciality to a similar field that my wife is doing, say I go into FP with her.

1) Do you think that we could be together in this case?

2) How do you predict our GMO tours? Do you think we'd be separated in this case or manageably together?
A) What GMO tours, do you know of, allow couples to be together. My concern is that we could not be on the same ship together???

Thanks
-chemicols

Its actually quite likely that you could be placed together in the San Diego area for internship, you at Balboa and her at NHCP. But...and this is the huge problem...after that all bets are off, especially if you want a competitive specialty. You may find that "colocated" includes locations that are 4+ hours apart and during your inevitable GMO tours, you are likely to be off cycle from each other, so that not only will you not be on the same ship (lol), you'd deploy and when you got back, she'd deploy. Then this cycle could repeat. The Navy works reasonably hard to colocate people within their definition of colocation but no couple should join thinking they won't both deploy and do so separately and at different times.

As for highly competitive residencies/fellowships, I disagree with the general sentiment here. Most people think getting derm, etc, is harder in the Navy. I tend to think there is more year by year variation and, for marginal candidates, therefore a better chance of getting a competitive residency over time if you are willing to wait. The Navy gives you credit for paying your dues. Some people will never get selected but others wait it out and get a residency they couldn't get on the outside. BTW, I think this is particularly true for the competitive IM fellowships. That being said, if you decide you want to be a radiation oncologist or something else that the Navy isn't training...there is no chance to do that in the Navy.

 

[IgD]

Unless you are prepared to face the possibility you could spend 2 years apart I would not take the scholarships jointly. Remember you will also have to live in fear that you could be apart...

 

[swampthing]

As for highly competitive residencies/fellowships, I disagree with the general sentiment here. Most people think getting derm, etc, is harder in the Navy. I tend to think there is more year by year variation and, for marginal candidates, therefore a better chance of getting a competitive residency over time if you are willing to wait. The Navy gives you credit for paying your dues. Some people will never get selected but others wait it out and get a residency they couldn't get on the outside.

I am from a Navy Derm Program. I somewhat disagree with this statement.

Derm is the most competitive residency specialty in the Navy PERIOD. This has been true for many years. Navy Derm residents have done well academically in med school (AOA, Honors, etc), have high board scores, and/or published multiple times. For the Navy (I cannot speak for Army or Air Force), we take the best of the best...we do NOT take mediocre or border-line applicants who "wait out" the process by doing multiple GMO tours...although, that may have been true in the past (before the 1990's). Our current Navy GME point system only allows up to so many points for GMO tours (you max out after 1 or 2 tours). Therefore, if you have done 2 or more Navy GMO/FS/UMO tours and applied to Derm residency multiple times and still have not gotten in, then you pretty much have NO CHANCE of getting in.

Traditionally, all Navy Derm residents have done AT LEAST a 2-year GMO tour, 3-year Flight Surgeon (FS) tour, or 3-year Undersea Medical Officer (UMO) tour. The FS and UMO tours are longer because you go to flight or dive school first out of internship (typically 6 months) and then get assigned a 2-year billet. The Navy does NOT select from the 4th year med student pool. The Navy will only give you Derm AFTER you have served the fleet. Operational tours (ie, deployable billets with Marines or Navy) get more points than non-operational billets (ie, non-deployable clinic). So if you want the best chance to get into Derm, then you will deploy...most likely to Iraq or Afghanistan...maybe Iran soon too . In regards to the OP, deployments can be very difficult to any marriage.

Currently applying to Navy Derm is just as competitive as civilian programs. Although this may change in 4 or more years when those Navy HPSP classes that were undermanned the last few years start applying for residency. These HPSP classes will have less people and therefore less competition. But they'll still likely have to do a GMO/FS/UMO tour to be considered for Derm.

 

[swampthing]

Isn't that simply because, in order to match to Derm, you have to complete a Transitional Internship first, which by Navy mandate is followed by a GMO tour? You kind of make it sound like Derm is so selective that they will only take those with operational experience. My understanding was that this is true of most Navy specialties, and not a sign of the competitiveness of Derm.

For Derm residency in the Navy, you can do ANY TYPE of internship: Transitional, IM, Surg, FP, OB/GYN, and/or Peds. That being said, NO ONE in the Navy has gone straight through internship to Derm residency in the past 20 years (maybe even longer). Everyone has done a GMO/FS/UMO tour. The ONLY exception is "Deferment", but these are rarely given to 4th year Navy HPSP med students. However, in the Army, they are allowing people to go straight from internship to Derm residency. I don't know about the Air Force.

As for operational vs. non-operational (claimancy 18 billet) GMO/FS/UMO tours, you are correct in stating the operational (deployable) billets will generally give you more GME points. This applies to all the GME specialties (IM, Peds, Surg, etc). But this is especially true in the competitive specialties, such as Derm, Ophthal, Rads, etc. Believe me when I say "1 point" in your total Navy GME score can make the difference between you getting into competitive Navy specialty or not. Sometimes the applicant scores are just so darn close, but yet they can only pick a limited number of residents.

 

[IgD]

Currently applying to Navy Derm is just as competitive as civilian programs.

How does Navy derm compare to civilian programs? When I was in medical school it seemed like civilian dermatology was completely different than military derm. Civilian derm seemed to have a much larger focus on cosmetics. It seems like a radically different focus in the military.

 

[Galo]

Has your wife read throught this forum yet?? After all the negative information that exists about military medicine, I still find it intriguing that people go into it, seemingly without really understanding all that could happen. Are you or your wife willing to place a hold on your education at bay for years as a GMO, only to end up in a substandard residency that may not even be the one of your choice? Practice in a location where you do not want to be, apart for possibly years?? All these events are highly possible. Why not try and go the civilian route, get trained, and then see what the military climate is? Yes the possibility of not matching in the same city exists, but I doubt its any higher than in the military. I think you give up way to many choices and rights in the military especially when it comes to your training, and ability to practice medicine.

You are in a tough position, and if you are just starting med school, you've got a long way to go to really know what you are going to want to do. I'd recommend staying away from military medicine at this time. Have your wife read this forum THOROUGHLY, and see what she thinks.

 

[The White Coat Investor]

1) Do you think that we could be together in this case?

Yes, you could be, could being the important word there.

2) How do you predict our GMO tours?

You do not PREDICT anything in the military. You willingly give up your freedom in order to serve.

Do you think we'd be separated in this case or manageably together?

A) What GMO tours, do you know of, allow couples to be together. My concern is that we could not be on the same ship together???

I think it would be very odd if you WERE on the same ship together. As far as "manageably" together, I think the odds are relatively high (but not 100%) that you would both be stationed in either San Diego or Portsmouth, but relatively low that you would actually work at the same place.

 

[Gastrapathy]

I am from a Navy Derm Program. I somewhat disagree with this statement.

Derm is the most competitive residency specialty in the Navy PERIOD. quote]

I'm sure thats true. I probably shouldnt have used the word "marginal" or at least used it in the context of being marginal for something competitive. My point, and I think it holds, is that Navy GME does value things other than just grades, boards scores, research and connections, which are how you get matched in the civilian world. So, maybe Derm is a poor example because so many people seem to want that job but I think its true that, in general, there are people who are able to wait out the system. On the dental side, a friend of mine was passed over for orthodontics because "the person ranked below her had applied 3 times already." She really was told that, got out, applied as a civilian and matched her first choice, while the Navy applicant couldn't find a program willing to take her. In my IM sub, there are 300+ applicants for 3 spots at the program up the road and other programs are similarly competitive. In the Navy, just about everyone gets to do it eventually if they are willing to wait around.

 

[Gastrapathy]

Interesting info, thanks. Makes me grateful I'm in a field with a categorical internship.

So it is truly a point system then? We (students) kick around this question a lot. We are officially told that selection to internship/residency is strictly a numerical calculation. But a lot of the info we get from PDs can be contradictory. In my own case, of my three interviews, one PD told me it was a straight point system, one didn't want to discuss the selection process, and the last PD told me that he had wide latitude to select the students he wanted (implying, at least in my mind, that the point system was simply a guideline).

It was, at least for the first half of this year, mildly frustrating.

There truly is a point system, it is rigorously applied...however...the purpose is to select people, not to determine where they go (so you can't could on points to get you to the west coast...bastards). Also, one of the categories is something like "potential as a career blah blah blah" which is plenty subjective.

So, if that PD was in a field that isn't that competitive or picks a large number of housestaff, then that was true. In fact, I think they have to share the wealth between the programs.

 

[Ex-44E3A]

Are you out of your mind? Don't do it.

I have married physician friends in the AF, and they did manage to get stationed at the same installation.... then came their deployment cycles; back to back.

They went 8-9 months without seeing one another. When one got back from their AEF cycle, the other was going out...

Yeah. Unless that sounds hunky-dory-swell to you, I'd pick another option.

 

[ishii123]

Are you out of your mind? Don't do it.

I have married physician friends in the AF, and they did manage to get stationed at the same installation.... then came their deployment cycles; back to back.

They went 8-9 months without seeing one another. When one got back from their AEF cycle, the other was going out...

Yeah. Unless that sounds hunky-dory-swell to you, I'd pick another option.

I agree with this statement above by "Ex-44E3A". I've seen it a few times already with my active duty colleagues married to other active duty spouses. If you are assigned to different units on the same homeport duty station, that does not guarantee that you'll both be at homeport at the same time. As one comes home from a long deployment, the other can be departing for deployment. Makes life kinda lonely. This can be very difficult on any marriage.

If you truly have your mind set on joining the military, then I think it would be best if only 1 of you joined the military (you or your spouse). I do not think it is a good idea for both of you and your spouse to join because that means they would control both of your lives. Personally, I would rather the military control 1 life than 2 lives.

 

[Chemicols]

Thanks to all for the information. If more opinions come to mind please post.

 

[AF Anesthesia]

I'm one of the lucky ones. I got a deferrment to do a civillian residency of my choice in Anesthesia. I love anesthesia and can't imagine doing any other specialty or having to wait to do it. I didn't discover anesthesia until the last minute - I had my plans all worked out to do something else. I'm also lucky that my first assignment is coming up and it's in a decent place (Lakenheath - England). However, I signed those HPSP 8 years ago and regret it!! I'm also married. Life changes so much during med school and residency and now we have no choice or options. We have kids now which we never even imagined we would have 8 years ago. The bit of money they give you for school and stipend doesn't seem like such a big deal down the road, and is now going to cost me plenty. Med school and residency are hard enough on a marriage, you can't anticipate how time changes you and your marriage. Things that don't seem a big deal become a big deal and the things you think are so important - you may realize don't matter at all. I'm in favor of holding onto as much control over your lives as you can for as long as you can.

 

[Chemicols]

Great words of wisdom. From reading all of your views, let me manipulate my original question to the following.

Say I went NAVY HPSP, and my wife did not (hence, she entered a civilian residency of her choice/placement). What do you all think about the separation factor in this case? Could we still work in the same general area, even if it was outside the U.S.?

 

[Gastrapathy]

Great words of wisdom. From reading all of your views, let me manipulate my original question to the following.

Say I went NAVY HPSP, and my wife did not (hence, she entered a civilian residency of her choice/placement). What do you all think about the separation factor in this case? Could we still work in the same general area, even if it was outside the U.S.?

Actually this will be HARDER. The Navy makes no effort to account for a nonmilitary professional spouse. Trust me.

 

[BOHICA-FIGMO]

Actually this will be HARDER. The Navy makes no effort to account for a nonmilitary professional spouse. Trust me.

Ditto. The military promotion and assignment system is based on a 1940's-1950's social model where the man is the bread winner and woman stays at home. Unfortunately, we can't let progress get in the way of tradition , so there are absolutely NO programs (at least as of 2 years ago) to help your spouse get any sort of employment other than the BX or O-Club/E-club. If your spouse is a professional (e.g., doctor, lawyer, etc.) you are SOL.

So, the military cares absolutely NOTHING about your civilian spouses career or their happiness, but they will make damn sure the alimony check is taken out of your pay each month after the divorce.

 

[West Side]

Ditto. The military promotion and assignment system is based on a 1940's-1950's social model where the man is the bread winner and woman stays at home. Unfortunately, we can't let progress get in the way of tradition , so there are absolutely NO programs (at least as of 2 years ago) to help your spouse get any sort of employment other than the BX or O-Club/E-club. If your spouse is a professional (e.g., doctor, lawyer, etc.) you are SOL.

So, the military cares absolutely NOTHING about your civilian spouses career or their happiness, but they will make damn sure the alimony check is taken out of your pay each month after the divorce.

If anyone's qualified to speak to this, it's me. You're setting yourself up for a lot of pain down the road by considering this.

You're making big presumptions on your wife's (or your) estimated performance in medical school, and where you're going to be in 4 years, professionally. Trying to project that far in advance, or to ask the chances of matching before you've even started med school, is folly.

Out of interest, with all of the negative opinion on this board (which I'm sure you've read exhuastively), and the almost certainty of a really difficult personal life for 7 years after med school, why is the HPSP part of your consideration set? I'm intrigued to know what the allure is beyond the money...

 

[Ex-44E3A]

why is the HPSP part of your consideration set? I'm intrigued to know what the allure is beyond the money...

I'd like to know this as well.

You've clearly read all the cautions and warning from actual AD and veteran military docs that frequent this forum... why are you persisting in this course of action and/or risking your career/marriage? Have we not been strenuous enough in our admonitions?

I'd hate to think we're wasting our time attempting to change a dead-set mind. Throw us a bone; what on earth is motivating you to continue considering this?

 

[Chemicols]

why is the HPSP part of your consideration set? I'm intrigued to know what the allure is beyond the money...

Okay to answer your question about this:

My wife and I were looking mainly at the money factor. From reading other's posts in the past about the hardships they endured, I became skeptical. Hence, I had to ask the inevitable question to you all so that I could get a good range of ideas about the situation we were thinking about facing. We have not totally dismissed the option, but it is trending that way. It was just too good to be true....all that scholarship money and our idea of not being separated...hmm...no way...too good to be true in our minds.

 

[Galo]

why is the HPSP part of your consideration set? I'm intrigued to know what the allure is beyond the money...

Okay to answer your question about this:

My wife and I were looking mainly at the money factor. From reading other's posts in the past about the hardships they endured, I became skeptical. Hence, I had to ask the inevitable question to you all so that I could get a good range of ideas about the situation we were thinking about facing. We have not totally dismissed the option, but it is trending that way. It was just too good to be true....all that scholarship money and our idea of not being separated...hmm...no way...too good to be true in our minds.

Do yourself a favor, and read this forum more thoroughly. It has been stated a million times, (yeah, I counted them!), NEVER JOIN FOR MONEY!!

You give up too many freedoms. In the end, there is no money amount that will make up for the potential hardships you and your family will inevitably endure.

 

[AF Anesthesia]

Money? You really need to reconsider that. I am going to lose HUNDREDS of THOUSANDS of dollars in income over what my stipend and tuition payments consisted of through HPSP. HPSP may keep you from having debt up front, but in the long run it is a financial loss. You guys who are further long - is there anyone who has not ended up ultimately losing money by being in the military????

 

[Gastrapathy]

Money? You really need to reconsider that. I am going to lose HUNDREDS of THOUSANDS of dollars in income over what my stipend and tuition payments consisted of through HPSP. HPSP may keep you from having debt up front, but in the long run it is a financial loss. You guys who are further long - is there anyone who has not ended up ultimately losing money by being in the military????

Sure, there are lots of people but they are not anesthesiologists. A staff FP in the military makes $130k, about the same as on the outside. Couple that with a retirement worth about $1 million, and the primary care guy can do ok in comparison. But, for procedure-based, lucrative specialties...no chance. The only thing good that being in the Navy did for me financially was let me buy a house earlier and since the market appreciated, I suppose that equity is a result of my Navy pay.

 

[Croooz]

My wife and I were looking mainly at the money factor.

You are not looking long term. Look past the immediate dollar signs because if not you will be extremely miserable when you speak to your civilian colleagues. This is not a gift horse. If you look in the mouth you will see some very sharp teeth. As always, do not make a decision today based on chump change that will affect you AND your wife for at least the next 10 years.

 

[delicatefade]

why is the HPSP part of your consideration set? I'm intrigued to know what the allure is beyond the money...

Okay to answer your question about this:

My wife and I were looking mainly at the money factor. From reading other's posts in the past about the hardships they endured, I became skeptical. Hence, I had to ask the inevitable question to you all so that I could get a good range of ideas about the situation we were thinking about facing. We have not totally dismissed the option, but it is trending that way. It was just too good to be true....all that scholarship money and our idea of not being separated...hmm...no way...too good to be true in our minds.

Do a search for a post by Desperado. He ran the numbers comparing HPSP and civilian/student loans in terms of financial outcome years down the road. If I'm not mistaken, for most specialties outside of primary care, HPSP participants without prior service will come out BEHIND every single time. It's hard to believe when you're looking at enormous student loans, but it is true.
My school costs over 40K a year and I wish I had taken the loans.

 

[West Side]

why is the HPSP part of your consideration set? I'm intrigued to know what the allure is beyond the money...

Okay to answer your question about this:

My wife and I were looking mainly at the money factor. From reading other's posts in the past about the hardships they endured, I became skeptical. Hence, I had to ask the inevitable question to you all so that I could get a good range of ideas about the situation we were thinking about facing. We have not totally dismissed the option, but it is trending that way. It was just too good to be true....all that scholarship money and our idea of not being separated...hmm...no way...too good to be true in our minds.

Stop. Just...stop.

Here's what most 21 year olds aren't equipped to consider, and this is really no failing on your part. You do not have the capacity to put a dollar value on a) your time (because up until now, it's been pretty much worthless or worth slightly more than minimum wage) and b) your quality of life.

Look at it this way, and even set aside the fact that you and your wife have what sounds to be an exceptionally high chance of being seperated geographically: you'll have spent a total of 19 years in school preparing to be a resident. That's going to be somewhere in the range of 80% of your life up until then. Wouldn't you want to maximize that investment by having the flexibility to pursue whatever you want, wherever you want? All those nights in studying in high school while others partied, being on the sidelines for four years of income and work while your college buddies hauled in giant investment banking bonuses and created wonderfully creative ad campaigns, and you probably haven't pulled a meaningful paycheck in all that time...I'd be damned sure to give myself every opportunity to "catch up" and make all that sacrifice worth it.

Do you really want to let a lousy $180,000, more than half of which you can finance at the lowest interest rates you'll see in your life, get in the way of that?

 

[Chemicols]

Very good points. Thanks to all who represented their thoughts in this post.

In our ideal minds, we were both hoping that we could basically map our own path and be together throughout the entire process. This would allow us to save money up front, travel the world together working in low income areas treating all kinds of people, and give us the opportunity to prepare ourselves for when we entered a private, civilian practice. But imaginations do run wild; and as a result, that is why, prior to getting serious about signing on the dotted line, I posted my questions. Maybe it could possibly occur, but the positive chances seem greatly outweighed by unknowns. Again, thanks for all of support.

 

[IgD]

If you want to succeed in the military you have to accept that you have no control over your life and job. I've seen some people do it but it is hard.

 

[Galo]

Very good points. Thanks to all who represented their thoughts in this post.

In our ideal minds, we were both hoping that we could basically map our own path and be together throughout the entire process. This would allow us to save money up front, travel the world together working in low income areas treating all kinds of people, and give us the opportunity to prepare ourselves for when we entered a private, civilian practice. But imaginations do run wild; and as a result, that is why, prior to getting serious about signing on the dotted line, I posted my questions. Maybe it could possibly occur, but the positive chances seem greatly outweighed by unknowns. Again, thanks for all of support.

This sounds more like the Peace Corps, or some established medical missions. That is something you can do, but first get good training, and some experience. In the military, what you described as what you want or though you could get, is the farthest from what you will get. You will regret it every second you are separated from your wife doing something you both had no idea that you would end up doing.

 

[The White Coat Investor]

But imaginations do run wild; and as a result, that is why, prior to getting serious about signing on the dotted line, I posted my questions. Maybe it could possibly occur, but the positive chances seem greatly outweighed by unknowns.

Sorry to lose you. We need good people. But we also need people who know what they're getting into.

 

[Founder]

Sorry if this is off topic, but you all seem to know a lot about Navy HPSP...

I have heard rumors that because the applicants for the 2011 graduating class are so few (only like 40% filled) that the HPSP has increased the stipend to O-1 pay with a possible $10-15,000 sign bonus?

 

[megadon]

Whole other thread devoted to topic of stipend and all the rumors. Bottom line, yes, the bonus thing is possible, but I think only the Army has funded it (they put little flyers in our boxes), and its not for the four year guys. Also, the stipend is authorized to be a higher level, just no one is funding it at DOD.