Military docs who served a total of 3 years - what kept you from staying in longer than that?

[Beneath the marquee]

Also why didn't you opt for the minimum service length of 2 years?

Just out of curiosity. Thank you in advance!

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[pgg]

Also why didn't you opt for the minimum service length of 2 years?

Just out of curiosity. Thank you in advance!

Are you asking about direct accessions (residency trained physicians who are done with training, who decide to join directly)?

There aren't many of them. Direct accessions of residency-trained physicians who only serve a couple years are a vanishingly rare species. Almost nobody does it. I met exactly one in my 20+ years of service.

The vast, vast majority of military physicians join via HPSP or USUHS, which carries a minimum of a 3-year post-training obligation (for 3 years of HPSP financial support while in medical school) and usually it's usually 4 years (or 7 for USUHS grads). Moreover, this is post-training time, so all of the ones who do inservice residencies (i.e. most of them) end up serving 7-8 years minimum. USUHS grads will spend an absolute minimum of 12 years on active duty and if they do a residency it'll be 14+.

 

[militaryPHYS]

I owed 7 for USUHS. I signed on for 3 more to go do fellowship. I enjoyed my MilMed journey and now plan to stick around for a long time so long as the Navy keeps working for me and my family. I still enjoy my time and see a future in it because my subspecialty keeps me very clinically busy with high case complexity even in our young active duty patients. Typically this isn't the case.

 

[DOswag]

I'm planning on separating this coming summer after a 4 year ADSC for HPSP. Most active duty docs either go HPSP, USUHS, or FAP. Typical service commitment is 3- 7 years.

Pretty certain absolutely nothing at this point would change my mind on that decision. The outlook appears bleak for my specialty from my perspective. DHA takeover is already causing problems. Increased demand on production/patient volume, with continued expectation of meeting ever increasing admin demands/meetings/documentation, decreasing staffing across the board, less pay compared to civilian counterparts in my specialty based on people I've talked to and things I've learned looking for civilian jobs. It's not a sustainable model in my opinion. Physician retention is not good in the military.

 

[Beneath the marquee]

Are you asking about direct accessions (residency trained physicians who are done with training, who decide to join directly)?

There aren't many of them. Direct accessions of residency-trained physicians who only serve a couple years are a vanishingly rare species. Almost nobody does it. I met exactly one in my 20+ years of service.

The vast, vast majority of military physicians join via HPSP or USUHS, which carries a minimum of a 3-year post-training obligation (for 3 years of HPSP financial support while in medical school) and usually it's usually 4 years (or 7 for USUHS grads). Moreover, this is post-training time, so all of the ones who do inservice residencies (i.e. most of them) end up serving 7-8 years minimum. USUHS grads will spend an absolute minimum of 12 years on active duty and if they do a residency it'll be 14+.

I've never heard it called direct accession but yes, that's exactly what I'm referring to. Basically an attending who enters service without having done any of the prior training their HPSP/USUHS peers have.

 

[starbuck2]

I'm planning on separating this coming summer after a 4 year ADSC for HPSP. Most active duty docs either go HPSP, USUHS, or FAP. Typical service commitment is 3- 7 years.

Pretty certain absolutely nothing at this point would change my mind on that decision. The outlook appears bleak for my specialty from my perspective. DHA takeover is already causing problems. Increased demand on production/patient volume, with continued expectation of meeting ever increasing admin demands/meetings/documentation, decreasing staffing across the board, less pay compared to civilian counterparts in my specialty based on people I've talked to and things I've learned looking for civilian jobs. It's not a sustainable model in my opinion. Physician retention is not good in the military.

Has your time been professionally satisfying at all? Have the other military experiences provided any sort of sense of excitement/adventure to make up for the bleak work environment and pay, or has it been a let down?

 

[pgg]

I've never heard it called direct accession but yes, that's exactly what I'm referring to. Basically an attending who enters service without having done any of the prior training their HPSP/USUHS peers have.

Gotcha

Physicians who don't have any education obligations to the military, like direct accessions or HPSP/USUHS grads who've repaid their initial obligation, sign multi-year contracts.

The annual bonus money depends on the length of those contracts, and the annual rate for a 2 year contract is substantially less than the annual rate for a 3/4/6 year contract. I'm going to guess that has something to do with why there aren't many 2-year people out there.

Also, DA joins are unusual, and sometimes the branches don't always offer DA contracts to all specialties in all years. They may not always offer 2-yr contracts. Associated "loan repayment" sweeteners, if offered, may only come with >2 year contracts. But I don't know - joining via the DA pathway is quite rare.

 

[DOswag]

Has your time been professionally satisfying at all? Have the other military experiences provided any sort of sense of excitement/adventure to make up for the bleak work environment and pay, or has it been a let down?

I've had some great experiences in the military and worked with some awesome coworkers. I've been stationed at a couple of places that have been pretty cool, one overseas base that location-wise was unbeatable and I love that I had that experience. Just the military work environment doesn't seem to be a great place for physicians (in my opinion). Some may disagree but it just seems the outlook is one of increased demand in patient care with decreased staffing projected, and continued expectation to perform the admin duties as well, with for the most part significantly decreased pay compared to the civ side. I know the civ side has issues as well, it's not all roses and sunshine, but I'm still looking forward to separation. I still keep in touch with other people I graduated residency with who are military and the sentiment is the same across the board in our group. Military needs to make some changes if they wish to keep more physicians past the initial commitment or retention is going to remain abysmal.

 

[pgg]

Military needs to make some changes if they wish to keep more physicians past the initial commitment or retention is going to remain abysmal.

Retention has always been abysmal. Retention is an anti-goal. The military wants 90% of its physicians to leave after their initial ADSO, because

• Senior physicians on multi-year retention bonus special pays cost a lot more than junior physicians who are paying back USUHS/HPSP time.
• Retirement costs are a massive burden for the military as a whole - a genuine threat to the services' ability to procure ships, planes, tanks, and other stuff the trigger pullers need or want.
• Docs are widgets; one widget is as good as another so long as a billet is filled. You and I may scoff at the idea that a general surgeon fresh out of residency is as good as a 15 year veteran, but the truth is that our extraordinary success when caring for the battlefield wounded over the last 30 years is compelling evidence that the fresh grad is good enough.
• The HPSP/USUHS pipeline is full and the system is built with the understanding that 90% leave after their initial ADSO.

They won't solve the "problem" of poor retention because they don't view it as a problem.

If you think I'm just being cynical I will offer the following evidence that they can and will promptly find money to fix problems, if they actually perceive a problem.

HPSP didn't fill for a couple years around 2006. This was an actual problem, because the pipeline to supply the military with junior widgets to fill billets was in peril. They immediately conjured up a whole bunch of money to increase the HPSP stipend and start giving out signup bonuses. Now ask yourself, if they could throw money at medical students at civilian schools, why haven't physician special pays increased at all[1] in the last three decades?

It's because they want us to leave, before we start getting expensive.


[1] OK so this is not entirely true - family medicine and internal medicine had their ISP increased from $12K to $20K about 10 years ago, and recently some war critical specialties have been offered modestly higher RP bonuses if they sign 6-year contracts. But these ridiculous drops in the bucket just prove the larger point, that physician pay hasn't increased in 30+ years.

 

[Volatile]

I left because I was offered over 4x my military salary w/ ~3x the vacation time. I’ve spent 0 hours doing CBT. I’m not asked to do anything non-clinical. I miss the people in the military and I would say my time in was a good experience, but not worth everything they ask you to give up, especially in my field.

 

[Trefoil]

I’ll be at 15 when I reach ADSO. I’ll 100% be getting out. That might seem crazy, but you aren’t really valued if you are a medical worker in the military. We are generally there when everyone else is getting an extra long weekend, and we are expected to be there when no one else is due to inclement weather, but don’t expect them to actual service the parking lot, so that there is parking for you. We are given the bare minimum of support and expected to make it up by being our own administrators.

In the civilian world you are actually treated like a valued member of a team.

I haven’t had a bad time, but at some point, I want to be treated with respect. I think being treated like crap by the military makes you a better team player later, but I don’t want to do this forever. Pension ain’t worth it.

 

[Beneath the marquee]

I left because I was offered over 4x my military salary w/ ~3x the vacation time. I’ve spent 0 hours doing CBT. I’m not asked to do anything non-clinical. I miss the people in the military and I would say my time in was a good experience, but not worth everything they ask you to give up, especially in my field.

If I may ask-

- what is your specialty/MOS?
- what was your military salary?
- what was your branch?
- how much vacation time did the military give you?

 

[Volatile]

If I may ask-

- what is your specialty/MOS?
- what was your military salary?
- what was your branch?
- how much vacation time did the military give you?

Anesthesiologist
~150
All paid the same
Everyone gets 30 days

I really did enjoy my time in the military but drastic changes need to occur to milMED and they do NOT value physicians, which I knew going in. Good luck to you, join to serve and youll have a good experience like I did. It’s just not a great long term profession as it’s currently structured.

 

[usnavdoc]

I served on AD for 5 years. Internship at NMCP and 4 years at 2nd Marine Division. After internship in the mil, I wanted a civ university MC residency program. I felt that was important with regards to training. But the biggest reason I left was family related. I saw no point in staying AD if I wasn't wanting to continue deploying. I had been pretty much continuously deployed from 2002-2006 and saw no positive future for a family with that tempo.

I very much enjoyed my time in, but it was time for a different chapter

 

[Beneath the marquee]

I served on AD for 5 years. Internship at NMCP and 4 years at 2nd Marine Division. After internship in the mil, I wanted a civ university MC residency program. I felt that was important with regards to training. But the biggest reason I left was family related. I saw no point in staying AD if I wasn't wanting to continue deploying. I had been pretty much continuously deployed from 2002-2006 and saw no positive future for a family with that tempo.

I very much enjoyed my time in, but it was time for a different chapter

Interesting. Few extra things I was wondering about docs with your experience!

- How did you get a job with a Marine Division? Was it difficult or was it simply a matter of applying?
- Were you of prior service? Enlisted, ROTC, HPSP, etc.
- What do you specialize in, both in the civilian life and during your time with the Marines?
- What was your salary as a physician working with a Marine division, and how does it compare to civilian life?
- How much family time were you able to get while in service in comparison to civilian life?

 

[DOswag]

If I may ask-

- what is your specialty/MOS?
- what was your military salary?
- what was your branch?
- how much vacation time did the military give you?

All docs are payed the same "military salary" (rank, time in service etc.) but depending on specialty you get a bonus. Some may get paid more based on other things, such as, I lived in a very expensive area for 3 years and my BAH was substantial. I lived on base so I didn't see a dime of it so my total pay looks like I got paid a lot more but it was automatically deducted from my pay check for rent. Also COLA pay for expensive area. I'm psychiatry, not necessarily the most lucrative specialty and I'm seeing offers that will increase my pay by quite a bit on the civ side, not as much as anesthesiologist, but still a big bump in pay. Also just in interviewing I already feel much more valued than what the military does to its docs. I feel respected by people I work with in the military, but not by the military itself and what it asks of me.

 

[militaryPHYS]

DoD does not need nor want to retain physicians. They will pay for your training, get some years out of you and then gladly watch as you move on to the civilian world. @pgg is right.

If you end up marrying someone who also has a solid income then you may stick around longer.
If your cost of living is super low based on your upbringing and lifestyle choices you may stick around longer.
If your self worth is derived equally between family, recreation and occupation you may stick around longer if #1 or #2 is met.
If your specialty is one of the few that has a high volume/complexity in the military you may stick around longer if #1-3 are met.
Plus there are about 4,251 other things to consider.

No problem either way whether people stay or go...just be honest with yourself so you don't make yourself and everyone around you miserable.

 

[pawprint]

I served on AD for 5 years. Internship at NMCP and 4 years at 2nd Marine Division. After internship in the mil, I wanted a civ university MC residency program. I felt that was important with regards to training. But the biggest reason I left was family related. I saw no point in staying AD if I wasn't wanting to continue deploying. I had been pretty much continuously deployed from 2002-2006 and saw no positive future for a family with that tempo.

I very much enjoyed my time in, but it was time for a different chapter

I had a similar experience. Completed pediatric internship at portsmouth and then went out as a flight surgeon with a marine air wing, deploying 4 times in 3 years (half of them being unplanned but extended deployements to overseas disaster areas). I spent more time deployed than I did at home. Quickly learned from my experience that the more qualified/experienced you make yourself, the more likely you will be called upon to deploy again. Leadership wants experienced people for the hard jobs in resource-limited areas.

I do not trust that if I completed my residency in the military, that they wouldn't deploy me again as soon as I finish. Deploying was great, don't get me wrong...I joined the military wanting to have that experience. The older I get, however, family is becoming more important and its frustrating that there isn't a group of new doctors coming in with the same deployment mentality. Our flight surgeon billets in the Navy are so gapped right now that they are pulling people left and right to go to undesirable locations/high op tempo areas. Those that are left are getting burnt out in order to get the mission done.

Its also frustrating to get emails from my old specialty leader begging attendings who have been in for 10-15 years and never deployed to 'sign up to go OCONUS' for a few months. I'm sure how these people managed to stay in for that long and never be operational. It seems to me that once you go operational, you get sucked in and will continually be asked to go where nobody else wants to since you have the experience.

 

[powwerz]

DoD does not need nor want to retain physicians. They will pay for your training, get some years out of you and then gladly watch as you move on to the civilian world. @pgg is right.

If you end up marrying someone who also has a solid income then you may stick around longer.
If your cost of living is super low based on your upbringing and lifestyle choices you may stick around longer.
If your self worth is derived equally between family, recreation and occupation you may stick around longer if #1 or #2 is met.
If your specialty is one of the few that has a high volume/complexity in the military you may stick around longer if #1-3 are met.
Plus there are about 4,251 other things to consider.

No problem either way whether people stay or go...just be honest with yourself so you don't make yourself and everyone around you miserable.

Off topic, but what are the specialties in the Navy that have high volume/complexity. (Particularly not surgical specialties)

 

[militaryPHYS]

Off topic, but what are the specialties in the Navy that have high volume/complexity. (Particularly not surgical specialties)

VERY few. Probably Primary care sports med...

Anybody else got any?

 

[militaryPHYS]

Off topic but new BAH rates are set for 2023. Pretty significant. 12% average. Still not a reason to join or to stick around unless it cuts pay gap enough for your personal financial situation.

Personally I'm seeing a 26% jump for O4 with dependents in my area. Pretty crazy, especially because we know BAH is rate protected so even if rates decline in coming years all are protected at highest rate so long as they don't PCS or change dependent status.

 

[pgg]

VERY few. Probably Primary care sports med...

Anybody else got any?

Young active duty families are good at making babies, so I'd argue OB/GYN at places like San Diego or Portsmouth is probably still good. Respectable volume, and both have capable NICUs and MFM specialists so there weren't a lot of network deferrals. Although my vague perception is the volume and complexity at the Portsmouth NICU declined over the last 10 years so maybe they're deferring more complicated pregnancies. Just guessing. Ped surgery there is certainly less busy than it was in the '00s.

Of course, OB/GYN has that "not a war critical specialty" Sword of Damocles hanging over it ...

For similar reasons, I think outpatient peds is pretty busy just about everywhere too.

 

[IlDestriero]

Money. And professional goals not attainable in the .mil

 

[armytrainingsir]

Leaving AD was easy. Simply put, the money. Not worth making 2/3 less than civilian counterparts.

OTOH, de reserbs been berry berry good to me.

YMMV

 

[CCM-MD]

Leaving AD was easy. Simply put, the money. Not worth making 2/3 less than civilian counterparts.

OTOH, de reserbs been berry berry good to me.

YMMV

I think having an understanding employer is probably a key factor for the reserves. One of those that cover the salary difference during deployments would be really nice.

 

[HighPriest]

I haven’t had to have a 22 year old with no background as a mechanic “sign off” on my car before I make a mandatorily reported road trip with my family in 5 1/2 years. And incidentally, I have also not had any issues with breakdowns without that valuable safety net.

No one has been required to watch me urinate, nor have I been asked to urinate under supervision, in 5 1/2 years.

I don’t have to ask for permission to go on vacation and I have to submit zero clearance packets to travel overseas.

I don’t have to take SERE training to visit my wife’s family.

I now exercise because I enjoy it, not because I’m required.

I’ve lived under one roof now for the longest time since I was 18 and I have some say in where that roof is.

I don’t see @&$king Tina from cyber security training in my nightmares anymore (that took some time)

No one pulls me out of clinic to have an all service meeting about how bad access to care is…

I make about 4x as much as I did, and my employer matches my contributions pretty well and if I didn’t like them I could leave. Which for a lot of people is just the illusion of freedom, but I actually have nothing tying me to the area, so I stay because I’m happy.

I can still tell people I served and not feel bad about not doing it for 20 years. I find no shame in that. No one should.

 

[SirGecko]

I don’t see @&$king Tina from cyber security training in my nightmares anymore (that took some time)

They actually changed the cyber security training and Tina is no longer part of it. Now it’s some guy time traveling from the future to teach you about cyber security. It’s not better but it is different.

 

[HighPriest]

They actually changed the cyber security training and Tina is no longer part of it. Now it’s some guy time traveling from the future to teach you about cyber security. It’s not better but it is different.

Tina:

“Hey, this is my friend Yuri Sovietski. I met him 10 minutes ago at the coffee shop. Do you think he could use your computer just to check his email?”

Honestly, that office was begging for a security breach just by not firing Tina. I always assumed she was a GS employee who had been laterally transferred nine times because no one can fire her.

 

[armytrainingsir]

 

[HighPriest]

They actually changed the cyber security training and Tina is no longer part of it. Now it’s some guy time traveling from the future to teach you about cyber security. It’s not better but it is different.

Did they at least try to make that entertaining? Like if you pick the wrong option he shows you how because you put the USB drive you found in a port-a-john in your work laptop, the world falls under North Korean control in 3 years? Like a choose your own adventure?

 

[HighPriest]

*%# you, Tina. Mind your own damned business can you not read body language? I don’t want to talk to you.

 

[pgg]

Did they at least try to make that entertaining? Like if you pick the wrong option he shows you how because you put the USB drive you found in a port-a-john in your work laptop, the world falls under North Korean control in 3 years? Like a choose your own adventure?

This one time, at band ca---when I was in the Navy, I tried to do the entire cybersecurity module and get everything wrong. You still get credit if you slog through the whole thing. They animated characters just give you disappointing feedback. It's harder than you might think. I wasn't able to get through with a 0% result. A couple questions or options were so badly written that I accidentally got them correct.

The operational risk management one was awful too. I vaguely recall that after shipmate A drunk drove from shipmate B's apartment where they used ladders improperly to help shipmate C move some furniture, I think shipmate D fed everyone day old chili and got everyone sick, and I was supposed to quantum teleport guide the cook to help him do his job measuring galley slop pot temperatures or something. I'm pretty sure that made me a better doctor.

 

[Correlate Clinically]

I mean, a better question is why stay longer than your commitment? I'm still in, but not by choice. I am the product of poor life choices in that regard. It seems like every week, something new comes down to see just how low moral can be driven. Even in a specialty with adequate volume, the entire system is so fundamentally broken it's mind boggling.

I'm counting down the days until I'm free. It's a depressing number, but at least it's decreasing.

 

[pgg]

I mean, a better question is why stay longer than your commitment?

For me it made financial sense to stay for 20 once I passed about ~12 years of creditable service, which is approximately when my ADSO from school and GME put me. The all-or-none pension is a very large incentive. I did the math at the eligible-to-get-out point, and the civilian job/hours/lifestyle I would've had to work just to break even over that ~8 year period was really painful.

Also ...

• My wife was happy with me being in the Navy. She didn't have a career of the sort where military moves every few years were catastrophic. She's a small town girl who was content being in places like Camp Lejeune and Lemoore when we had small children.
• I wasn't unhappy with being in the Navy. I generally got everything I wanted (eventually). My deployment tempo was reasonable and the actual deployments were generally good experiences. The hours are pretty good. People treated me well. The Navy doesn't seem to have a lot of the Big Green Weenie problems the Army does ... no E5 ever inspected my car before a road trip, I was never called in from home to pee in a cup, etc. 98% of the time, I woke up in the morning, drove to a hospital, put on scrubs, worked in the OR, went home before 5. Often well before 5.
• The patient population is is deserving and largely devoid of the kind of social drama that makes civilian work trying at times.
• I was able to do a FTOS fellowship while on a multiyear retention contract, enjoying the consecutive repayment loophole. Being a fellow at a civilian institution for 4-5x the paycheck of a civilian fellow, while accruing time for the military retirement is an exceptionally good deal. It was a nice parole from military life for a year. Also, although I was a strong applicant, the fact that I came with funding opened doors that might have been harder to get through, and I had multiple offers from top tier institutions. I ended up at a top-5 program without having to go through the match - start to finish, from the day the military GME selection board gave me the OK to go, it took about a month to apply, interview, and have a signed contract. Being in the military can open some doors.
• Post-fellowship, I had good odds for homesteading at one of the big 3. I spent my final 8 years on active duty at the same hospital, minus the one year of fellowship.
• Moonlighting in my specialty is pretty easy, as it's possible to pick up random shifts and significantly supplement income and improve case load. Most years my total income was over $350K, which took some of the sting away from earning substantially sub-market wages from the Navy.
• By the time I was eligible to get out after my initial ADSO, I was on the cusp of promoting to O5, and I had enough rank to be mostly immune to petty abuses.
• Last and possibly most important for those final years ... I decided enough rank (O5) was simply enough. I opted out of all the tasks and collaterals that I would've needed to make O6. I spent my last ~6 years as a terminal Commander, or Termander, happily accepting fitness reports that I knew would make me unpromotable. I took on projects, residency program tasks, and research that interested me. I declined to be considered for positions of responsibility in the department or command and I did as much clinical work as I could. I annoyed and upset a handful of people who thought I, as a senior officer, should be doing more admin work ... but I just didn't care. I think more people should do this, but I also think most people are conditioned to never take their foot off the gas.

And now I'm happily retired, in my late 40s, collecting a $6000 check (that'll be COLA'd every year until I die) from the government every month, working in a private practice group that recently saw fit to make me a partner. I'm glad to be out, but the Navy worked out well for me.

 

[Correlate Clinically]

I don't disagree with you, and in many respects my career has been very fortunate. The experience varies widely, even among my peer group.

I was a bit more caustic than I intended, after a full day of meetings about not fixing known problems and how my folks are going to get screwed more to do "the mission".

There are a few people who want very specific things for whom the military is still a good (or at least decent) option. But that's a shorter list than it once was. Physician-pilot? Operational Flt Med? Nothing but Dive medicine? Sure. Dermatologist, Radiologist, Surgeon, even EM... eh.... I don't know.

You do have a very good point about rank. Hitting O-5 and higher makes a big difference and lets me brush off a lot. The frustrating thing is that there is no amount of rank that will allow me to fix what's broken in our system. I could get stars and still not make a dent.

I routinely recalculate how much the pension is worth for each of the remaining years of my life to make 20. My wife laughs when I try to talk myself into staying. People don't consider the reserves enough. It's not purely a separate or retire decision. If you have 10 yrs or more, the reserves deserve a close look. Is the pension less? Yes. Is it nothing? Nope. And it lets you feel like you are still serving your country, without fully sacrificing your family and personal life to do it (yes, some people will still get hosed).

It is also key that the milmed/DoD/DHA situation is changing rapidly. The med corps when I commissioned is very much not what I work in today and I can feel the changes from DHA. What I deal with will be different for anyone in residency now. It's subjective, but I will say that the trajectory is not positive. I'd be hard pressed to find areas where the situation is substantially improved from 10 or 15 years ago. Some are incrementally worse, others are dropping off the deep end with nothing but magical thinking at the bottom.

Would I do it all over again? I dunno, the debt scared me and every generation of my family has been military since before the Continental Congress thought we should do something about those British dudes.

I'm still counting down though. It makes me feel better. Like an emotional support timer.

 

[TheEarDoc]

They actually changed the cyber security training and Tina is no longer part of it. Now it’s some guy time traveling from the future to teach you about cyber security. It’s not better but it is different.

F$%& Marty and his problems. From the future eh? Why not give us a heads up about COVID or the crappy promotion boards in the reserves you fat useless #$%^!

 

[TheEarDoc]

Tina:

“Hey, this is my friend Yuri Sovietski. I met him 10 minutes ago at the coffee shop. Do you think he could use your computer just to check his email?”

Honestly, that office was begging for a security breach just by not firing Tina. I always assumed she was a GS employee who had been laterally transferred nine times because no one can fire her.

Nah most likely a veteran employee and by veteran I mean she got separated during BCT for issues not related to service but got her high service connection so she got hired for the job over people who were actually qualified.

 

[TheEarDoc]

I don't disagree with you, and in many respects my career has been very fortunate. The experience varies widely, even among my peer group.

I was a bit more caustic than I intended, after a full day of meetings about not fixing known problems and how my folks are going to get screwed more to do "the mission".

There are a few people who want very specific things for whom the military is still a good (or at least decent) option. But that's a shorter list than it once was. Physician-pilot? Operational Flt Med? Nothing but Dive medicine? Sure. Dermatologist, Radiologist, Surgeon, even EM... eh.... I don't know.

You do have a very good point about rank. Hitting O-5 and higher makes a big difference and lets me brush off a lot. The frustrating thing is that there is no amount of rank that will allow me to fix what's broken in our system. I could get stars and still not make a dent.

I routinely recalculate how much the pension is worth for each of the remaining years of my life to make 20. My wife laughs when I try to talk myself into staying. People don't consider the reserves enough. It's not purely a separate or retire decision. If you have 10 yrs or more, the reserves deserve a close look. Is the pension less? Yes. Is it nothing? Nope. And it lets you feel like you are still serving your country, without fully sacrificing your family and personal life to do it (yes, some people will still get hosed).

It is also key that the milmed/DoD/DHA situation is changing rapidly. The med corps when I commissioned is very much not what I work in today and I can feel the changes from DHA. What I deal with will be different for anyone in residency now. It's subjective, but I will say that the trajectory is not positive. I'd be hard pressed to find areas where the situation is substantially improved from 10 or 15 years ago. Some are incrementally worse, others are dropping off the deep end with nothing but magical thinking at the bottom.

Would I do it all over again? I dunno, the debt scared me and every generation of my family has been military since before the Continental Congress thought we should do something about those British dudes.

I'm still counting down though. It makes me feel better. Like an emotional support timer.

Yep I wanted to be an 0-6 and retire. The longer I stay even doing part time the more I am starting to feel like 0-5 is going to be terminal for me. Hit 0-5 and then just enjoy myself. No collaterals. No hard assignments. Just go back to being a provider instead of taking teams meetings about why my joes can't get their PHA's and dental exams done because LHI can't get them scheduled in a timely manner or why specialist snuffy has again used his GTC at the liquor store. If it was a full time gig with all the bennies it would be more easily swallowed, but when it amounts to a 2nd full time job with less than part time pay plus my civilian career, it's a little more bitter going down. Especially now that promotions are crap in the reserves in medical service corps and nurse corps.

 

[texasteacher]

Is it possible to do Navy HPSP if I take a small dose of sertraline (zoloft) for anxiety.

 

[militaryPHYS]

Most years my total income was over $350K

This is the key for balancing the negatives. If your household income is enough to live a comfortable physician lifestyle then most people who aren't completely appalled by MilMed can stick around. Whether the extra comes from a spouse or moonlighting, if someone makes "enough" to meet their financial lifestyle demands, the military family lifestyle and non-salary benefits are quite good.

If you have 10 yrs or more, the reserves deserve a close look. Is the pension less? Yes. Is it nothing? Nope. And it lets you feel like you are still serving your country, without fully sacrificing your family and personal life to do it (yes, some people will still get hosed).

I think anyone who is in 10 years should feel satisfied with their service. You did your training, paid back some years and shouldn't feel bad for leaving if the military has stopped serving you and your family. Reserves are great if you really just want to keep serving but at the same time want to leave and get paid what you are worth to meet the lifestyle you or your family want. Otherwise just go and live the good life as a civilian and free up even more weekends and summer weeks with your family.

To me, I'd rather front load my service and reap the rewards as fast as possible. I don't want to wait until I am 60 to take uncle Sam's money he owes me. Sucking it up for a few more years will provide me with a COLA adjusted paycheck for the rest of my life. By that point the "small pension" will cover the majority (if not all) of our annual expenses at the age of 46. That frees up a lot of space to be a consultant, locums if I want...or go full time and really fat FIRE in < 5 years.

[waiting for next conflict to completely change gameplan]

 

[narcusprince]

I spent 10 years active duty. And honestly look back positively on my time. Met some real movers and shakers in my field and some fakers. Salary difference is huge. You have to feel making 3-4x your military pay to understand it. Life gets real interesting when you have 4x salary and 3x the time off. Im currently in the reserves and will say working with the line support team has been a monumental disaster they have no understanding or appreciation for physicians. Nothing during my active duty time compares to dealing with the line for support.

 

[haujun]

I don’t know if this is right place to post. I did 20 years and retired as 05. 4 years enlisted time before medical school helped a lot and reduced BS time spent after becoming fellowship trained physician. I also got 100% VA disability so that is so sweet!!!I make three times more outside and feels real nice! I feel appreciated and my team tries best to help me succeed.

 

[armytrainingsir]

Life gets real interesting when you have…… 3x the time off.

Wow. I will say the military had time off down pat. 30 days of leave, every fed holiday and all the ‘training holidays’.

I’ve never had as much time off in private practice as I did on AD.

 

[pawprint]

Wow. I will say the military had time off down pat. 30 days of leave, every fed holiday and all the ‘training holidays’.

I’ve never had as much time off in private practice as I did on AD.

Depends on what unit you are attached to. When I worked in the outpatient clinic, yeah, days off were fantastic. When I was attached to an operational unit, days off didn’t exist. No such thing as a federal holiday when you are preparing to deploy or deploying.

 

[armytrainingsir]

Depends on what unit you are attached to. When I worked in the outpatient clinic, yeah, days off were fantastic. When I was attached to an operational unit, days off didn’t exist. No such thing as a federal holiday when you are preparing to deploy or deploying.

Good point. My AD time was all MEDCEN.

 

[narcusprince]

Wow. I will say the military had time off down pat. 30 days of leave, every fed holiday and all the ‘training holidays’.

I’ve never had as much time off in private practice as I did on AD.

In my current gig I get 10 weeks vacation and 3X the pay I had. Also when I take leave I get to go where ever I want no chits and no ifs ands or buts. Politics are still there.

 

[Volatile]

In my current gig I get 10 weeks vacation and 3X the pay I had. Also when I take leave I get to go where ever I want no chits and no ifs ands or buts. Politics are still there.

I’ll add I haven’t had to sit through a useless meeting or spend a single minute on CBT since leaving the military! I can also live wherever I want and not worry about leaving my family for 6 months at a time. The military is just so far behind; less pay, less vacation, less freedom. I enjoyed my time in service but the sense of freedom I have now is irreplaceable.

 

[SeniorWrangler]

It was a long time ago but the Army wouldn’t tell me ANYTHING about my next tour and my wife was not willing to spend another four years in a crappy location restarting her career. If you’ve got a lot of years in but need to leave, get out and go to the VA, is my advice.

 

[epidural man]

Also why didn't you opt for the minimum service length of 2 years?

Just out of curiosity. Thank you in advance!

What keeps people from leaving?
Stockholm syndrome.

 

[epidural man]

IF you are in a critical war time specialty -

The reserves can make a LOT of sense.

Consider the math.

Most CWS bonuses are 70k (for a 3 year contract). Anesthesia (my specialty) will likely go to 70 this year - currently at 40K.

Anyway, if I get out at 12 years, and do the reserves - that is 70K plus all the extra money you make as a reservist. PLUS, my civilian job gives me extra money beyond what I would have made active duty.

That 70K is basically MORE than what you would make with your retirement check.

Of course, lots of other issues need to be factored - but it is certainly something to consider.

I suspect the HPSP 2:1 deal will return.