Military Medicine

[deleted992700]

Hi all,

after reading as much as possible on military medicine, I'll soon have to make the decision of joining the military as either an HPSP student or an MDSSP student only for the duration of med school. Clearly, I'm not doing for the money since I'm currently serving for 4 years of reserves already and I've seen the active side of military medicine. I need to find a program to replace my current contract since I won’t be in IRR by the time medical school starts. My understanding from SDN was surgeons tends to not have enough case volume, complexity, and skill atrophy compared to the civilian side ? I want to either practice GenSurg or ENT, having to work in Madigan (MAMC) for a year I've noticed that the volume of the cases was enough but the complexity wasn't.

Do you all think that military residency is better as an HPSP student for General surgery/ENT since civilian deferment is like a unicorn, or taking a MDSSP stipend for medical school and taking on the civilian residency is better for training? After all, I want to be a competent surgeon. could it really be that bad?

Can someone give me some genuine pros and cons? Thank you !

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[Medic741]

Which service?

 

[Angus Avagadro]

I probably know a dozen docs who did military medicine and the vast majority stayed for their 20 yrs and longer. I know only 2 surgeons, one left after his hitch was up and the other is Chief of surgery at a military hospital. Cases might be mundane in peace time, but can change in a heartbeat. Our military medical personnel are awesome. I saw a stat that if found alive on the battlefield, you had greater than 90% survival. I dont think our level 1 trauma centers can boast a better record. One good friend has over 30 yrs in the navy, invited to war college and was a White House Doc in a former administration. You get moved around a lot, dont acquire many possessions, or lifelong friends, but go to some great places. With the cost of med school, it's not a bad gig. Thank you for your service and Good Luck with whatever you decide

 

[deleted992700]

Which service?

The Army

 

[907914]

From talking with all of the docs in my unit way back when that was the route I wanted to go, MDSSP sucks. It is only a stipend and your reserves service obligation is 8 years which you are still likely to end up deployed every 2 or 3 years anyway. These are not my words, it is is from the mouth of an Army Reserves Urologist, EM, Peds IM, and Anesthesiologists all with concurring opinions.

Sure, you don’t have to do the active duty lifestyle with MDSSP, but I think I would much prefer 4 years of AD lifestyle where Army is life than 8 years where I set up my own practice or arrange a Cush CIVvie position and to have to leave it for 150 days every two or 3 years (reserves docs have 90 Mob max with a 30 day deployment readiness phase and a 30 day redeployment phase). The incongruity between reserves life and civilian life is why I got out of the reserves after first contract despite loving what I did. If you go this route, definitely recommend the active duty route.

 

[HighPriest]

So, generally speaking, most docs do not do 20 years. The vast majority do their payback stint and then get out. That's not my opinion, that's a fact. Additionally, cases don't ramp up during a war for the vast majority of people. For most military docs stationed in CONUS, the difference between war and not war is unnoticeable with regards to their day-to-day schedule. Maybe things get a little slower when a large unit deploys from your MTF region. How much you do when you're actually deployed varies -highly. Some guys are actually doing emergency ex-laps and the like, but there are plenty of people who deployed to Iraq and spent 3-6 months sitting on their hands. In fact, deployment tours were long touted as a source of skill rot. So while I appreciate Angus Avagadro's enthusiasm and support, most of that is not exactly accurate. It is true that battlefield mortality is the best it's ever been. Medical care and the physicians providing it are a part of that equation, but better armoring and better evacuation is probably a bigger part. The last data I looked at indicated that you were much less likely to die in a gunfght than you ever were before, but if you got hit in the head or neck (the un-armored areas), you were still pretty likely to have a bad outcome (relatively, at least).

Don't bank on deferment. That being said, i felt like my residency adequately prepared me for practice. Military residencies don't show you a lot of unusual/zebra cases, and you're utterly dependent upon outside rotations to see those. It will prepare you to be a very good community surgeon with a fairly wide comfort zone. I know residents from top 10 programs who knew WAY more than me about specific oddities, but who didn't feel comfortable doing basic cases, and since I've been out of the military I've found that my comfort zone is broader than most of the guys I've met. I think in large part thats because I had the opportunity to do the full breadth of my specialty at my duty stations, and I didn't have to turn something away if I didn't want to, and turning it away meant sending it a LONG way away in most cases, so I never gave up doing certain things like guys often do when they leave residency (well, there's an otologist 30 minutes from here, and this is "kind of" a challenging ear, and I -could- do it, but the subspecialist is right there, so.....) A few years of that, and you just don't do ears anymore.

Skill atrophy is a real thing. read around the military medicine thread a bit about it. You can make up for it to an extent by moonlighting. Complex cases are, as you have identified, the issue. I was busier than many civilian docs at my first duty station, but it was almost entirely bread-and-butter, and when I got to my second duty station I had to brush up on a lot. When I left the military, there was even more brushing up. I felt comfortable doing cases, but I hadn't seen enough of them to feel confident (two very different C words). I can't imagine what I would have done if I was in for 20 years instead of just 4.

Skill rot CAN be that bad. the problem is: you never know. You may end up at a MEDCEN with minimal skill rot and the ability to moonlight locally, or you may end up in BFE or in a brigade surgeon spot unable to operate at all. Both extremes, but on other sides of the spectrum. On average, I think people finish their residency, station somewhere middle-of-the-road, feel the skill rot burn, moonlight to make up for it, and then get out before there's any permanent damage.

All this being said, you are one of the better candidates for HPSP since you know what you're getting in to (as much or more than anyone else). Plus, if you'd be at 20 after your ADSO? That's a no brainer. I'd to HPSP, and that's saying a lot.

If you're at MAMC, you should talk with a gen surg or ENT staff. I know ENT staff there, and they would be happy to at least answer your questions. Keep in mind that, at least in ENT, most of them have ONLY worked at large MEDCENs. They don't really know what it's like being stationed in BFE for 4 years. (one of them did a year at Polk, but went to fellowship right after, which isn't the same).

 

[deleted992700]

So, generally speaking, most docs do not do 20 years. The vast majority do their payback stint and then get out. That's not my opinion, that's a fact. Additionally, cases don't ramp up during a war for the vast majority of people. For most military docs stationed in CONUS, the difference between war and not war is unnoticeable with regards to their day-to-day schedule. Maybe things get a little slower when a large unit deploys from your MTF region. How much you do when you're actually deployed varies -highly. Some guys are actually doing emergency ex-laps and the like, but there are plenty of people who deployed to Iraq and spent 3-6 months sitting on their hands. In fact, deployment tours were long touted as a source of skill rot. So while I appreciate Angus Avagadro's enthusiasm and support, most of that is not exactly accurate. It is true that battlefield mortality is the best it's ever been. Medical care and the physicians providing it are a part of that equation, but better armoring and better evacuation is probably a bigger part. The last data I looked at indicated that you were much less likely to die in a gunfght than you ever were before, but if you got hit in the head or neck (the un-armored areas), you were still pretty likely to have a bad outcome (relatively, at least).

Don't bank on deferment. That being said, i felt like my residency adequately prepared me for practice. Military residencies don't show you a lot of unusual/zebra cases, and you're utterly dependent upon outside rotations to see those. It will prepare you to be a very good community surgeon with a fairly wide comfort zone. I know residents from top 10 programs who knew WAY more than me about specific oddities, but who didn't feel comfortable doing basic cases, and since I've been out of the military I've found that my comfort zone is broader than most of the guys I've met. I think in large part thats because I had the opportunity to do the full breadth of my specialty at my duty stations, and I didn't have to turn something away if I didn't want to, and turning it away meant sending it a LONG way away in most cases, so I never gave up doing certain things like guys often do when they leave residency (well, there's an otologist 30 minutes from here, and this is "kind of" a challenging ear, and I -could- do it, but the subspecialist is right there, so.....) A few years of that, and you just don't do ears anymore.

Skill atrophy is a real thing. read around the military medicine thread a bit about it. You can make up for it to an extent by moonlighting. Complex cases are, as you have identified, the issue. I was busier than many civilian docs at my first duty station, but it was almost entirely bread-and-butter, and when I got to my second duty station I had to brush up on a lot. When I left the military, there was even more brushing up. I felt comfortable doing cases, but I hadn't seen enough of them to feel confident (two very different C words). I can't imagine what I would have done if I was in for 20 years instead of just 4.

Skill rot CAN be that bad. the problem is: you never know. You may end up at a MEDCEN with minimal skill rot and the ability to moonlight locally, or you may end up in BFE or in a brigade surgeon spot unable to operate at all. Both extremes, but on other sides of the spectrum. On average, I think people finish their residency, station somewhere middle-of-the-road, feel the skill rot burn, moonlight to make up for it, and then get out before there's any permanent damage.

All this being said, you are one of the better candidates for HPSP since you know what you're getting in to (as much or more than anyone else). Plus, if you'd be at 20 after your ADSO? That's a no brainer. I'd to HPSP, and that's saying a lot.

If you're at MAMC, you should talk with a gen surg or ENT staff. I know ENT staff there, and they would be happy to at least answer your questions. Keep in mind that, at least in ENT, most of them have ONLY worked at large MEDCENs. They don't really know what it's like being stationed in BFE for 4 years. (one of them did a year at Polk, but went to fellowship right after, which isn't the same).

Thank you !! I'll definitely consider HPSP, the obligation years is 5 years since ENT residency is longer. But yeah, working in ENT at MAMC, I didn't think the complexity was enough, they can literally just do tonsillectomies all day. I am going to read up on moonlighting, but would that get you in trouble? As an ENT, my chance of getting stationed at a small MTFs or getting deployed is minimum compared to General surgery. right ?

 

[IlDestriero]

There’s always a back and forth about Elite training institutions with higher than normal complexity but with competing fellows, etc. vs. a more average residency with more routine cases and potentially not losing some interesting cases to fellows, etc. vs. how much any of that matters if you read, actively engage in your education, and are out in the real world for a couple years.
There’s no right answer, but I have trained and/or worked at elite anesthesia programs, superstar laden quaternary hospital systems, and NMCSD (the pacific rim Navy referral hospital).
There are night and day differences in training, opportunities, volume, acuity, skill, etc. between these places. Excepting a few extraordinary cases, my hardest days at NMCSD wouldn’t even register on the Richter scale at the big referral center where I work now. I wouldn’t want to train at NMCSD, and I was there when there were 4 neurosurgeons, 3 cardiac surgeons, 2 vascular guys, 2 pediatric surgeons, etc. Last I heard, they don’t even have that somewhat limited acuity level anymore. Your mileage may vary, but I want the best training possible, to learn tips and tricks to manage train wrecks, etc. Any dunce hat wearing doofus can get through bread and butter cases and pick up speed, etc. on routine stuff. You only have one chance to get training and I wouldn’t want average. If I can manage actual disasters, I can manage routine emergencies.
Of course others argue that not everyone is superstar MGH, Stanford, etc. material and that is certainly true. Nor will most people be headed out to fancy academic ivory towers. However wherever you are, you will get stuck with some wrecks on call, mismanaged should have been transferred yesterday kinds of folks, etc. It’s hard to gauge your potential until you’re already committed, but you don’t want to sell yourself short.
Again, others might argue that a true superstar can fly very high from modest beginnings.
Also true.

 

[HighPriest]

Thank you !! I'll definitely consider HPSP, the obligation years is 5 years since ENT residency is longer. But yeah, working in ENT at MAMC, I didn't think the complexity was enough, they can literally just do tonsillectomies all day. I am going to read up on moonlighting, but would that get you in trouble? As an ENT, my chance of getting stationed at a small MTFs or getting deployed is minimum compared to General surgery. right ?

Your obligation with ENT would be 5 years of residency and 4 years ADSO with HPSP unless you have some other commitment.

They DO complex cases in ENT at MAMC, but just not enough of them.

You won't get in trouble moonlighting as long as you have command approval.

You are not at less risk being deployed to a small MTF as an ENT doc. I mean, I don't know the absolute numbers, but there are plenty of ENTs at small facilities.

 

[HighPriest]

I do agree with the point that you should try to get the best training possible. The Army/military is definitely not that. I'm not at all dissatisfied with my residency, and we got to do a lot of training at a very good civilian institution to augment the failures of military GME (of which there are many). But to say the military is the best? no. It's a good community program. And you should always shoot for the best training that you can, because, why else are we here?

That being said, if you can complete med school and residency with no debt and then finish a 4 year ADSO with a pension? ehh....that's hard to turn down...I think you can make up for the difference in training strength. Maybe you won't be THE guy at some academic center, but if you're really interested in being a happy, productive surgeon I think you'll be fine.

 

[deleted992700]

There’s always a back and forth about Elite training institutions with higher than normal complexity but with competing fellows, etc. vs. a more average residency with more routine cases and potentially not losing some interesting cases to fellows, etc. vs. how much any of that matters if you read, actively engage in your education, and are out in the real world for a couple years.
There’s no right answer, but I have trained and/or worked at elite anesthesia programs, superstar laden quaternary hospital systems, and NMCSD (the pacific rim Navy referral hospital).
There are night and day differences in training, opportunities, volume, acuity, skill, etc. between these places. Excepting a few extraordinary cases, my hardest days at NMCSD wouldn’t even register on the Richter scale at the big referral center where I work now. I wouldn’t want to train at NMCSD, and I was there when there were 4 neurosurgeons, 3 cardiac surgeons, 2 vascular guys, 2 pediatric surgeons, etc. Last I heard, they don’t even have that somewhat limited acuity level anymore. Your mileage may vary, but I want the best training possible, to learn tips and tricks to manage train wrecks, etc. Any dunce hat wearing doofus can get through bread and butter cases and pick up speed, etc. on routine stuff. You only have one chance to get training and I wouldn’t want average. If I can manage actual disasters, I can manage routine emergencies.
Of course others argue that not everyone is superstar MGH, Stanford, etc. material and that is certainly true. Nor will most people be headed out to fancy academic ivory towers. However wherever you are, you will get stuck with some wrecks on call, mismanaged should have been transferred yesterday kinds of folks, etc. It’s hard to gauge your potential until you’re already committed, but you don’t want to sell yourself short.
Again, others might argue that a true superstar can fly very high from modest beginnings.
Also true.

Thank you very much for your advice!

 

[deleted992700]

I do agree with the point that you should try to get the best training possible. The Army/military is definitely not that. I'm not at all dissatisfied with my residency, and we got to do a lot of training at a very good civilian institution to augment the failures of military GME (of which there are many). But to say the military is the best? no. It's a good community program. And you should always shoot for the best training that you can, because, why else are we here?

That being said, if you can complete med school and residency with no debt and then finish a 4 year ADSO with a pension? ehh....that's hard to turn down...I think you can make up for the difference in training strength. Maybe you won't be THE guy at some academic center, but if you're really interested in being a happy, productive surgeon I think you'll be fine.

Thank you, I guess 4 years of ADSO won't be very bad if I do moonlight and catch u/ brush up on stuff after I finish my ADSO

 

[HighPriest]

Thank you, I guess 4 years of ADSO won't be very bad if I do moonlight and catch u/ brush up on stuff after I finish my ADSO

it's the military. Assume it could be really bad and hope that it won't.

 

[John1513]

DHA is taking over military medicine. MOUs and relationships with civilian hospitals is how they plan on combating the skill atrophy of surgeons. I was surprised to read this. One thought was, “wow I guess the higher ups do read SDN.”

 

[TheEarDoc]

it's the military. Assume it could be really bad and hope that it won't.

Hope for the best, prepare for the worst.

 

[pgg]

DHA is taking over military medicine. MOUs and relationships with civilian hospitals is how they plan on combating the skill atrophy of surgeons. I was surprised to read this. One thought was, “wow I guess the higher ups do read SDN.”

We'll have to see how this plays out. I'm hopeful DHA will get it done, but have been disappointed in the execution of this plan when driven by individual commands for 7 or 8 years now. Even now, with DHA support, all I'm seeing are initiatives driven by individual commands. One notable success, slightly tarnished by the civilian institution's refusal to accept anesthesia personnel alongside the surgeons who'll go there.

I will continue to burn all of my leave moonlighting to stay current, and hope for a better solution led from the top down. This is really what we need. If anything can make it happen, it'll be DHA leading the effort.

I've been pretty fortunate the last year to have local subspecialty ODE available. But I live with the worry it could dry up at any moment when the civilian hospital finally recruits someone permanent.

 

[deleted992700]

We'll have to see how this plays out. I'm hopeful DHA will get it done, but have been disappointed in the execution of this plan when driven by individual commands for 7 or 8 years now. Even now, with DHA support, all I'm seeing are initiatives driven by individual commands. One notable success, slightly tarnished by the civilian institution's refusal to accept anesthesia personnel alongside the surgeons who'll go there.

I will continue to burn all of my leave moonlighting to stay current, and hope for a better solution led from the top down. This is really what we need. If anything can make it happen, it'll be DHA leading the effort.

I've been pretty fortunate the last year to have local subspecialty ODE available. But I live with the worry it could dry up at any moment when the civilian hospital finally recruits someone permanent.

that’s at least a little bit of hope for me

 

[deleted992700]

DHA is taking over military medicine. MOUs and relationships with civilian hospitals is how they plan on combating the skill atrophy of surgeons. I was surprised to read this. One thought was, “wow I guess the higher ups do read SDN.”

Hopefully it improves by the time i start but who knows. They somewhat always disappoint

 

[pgg]

If anyone is a good fit for milmed, it's you. If nothing else, the financial upside to being able to retire right after your ADSO is large.

Its just so hard to advise pre-meds. So many end up in completely different specialties than they think they will. There's a lot we don't know about the future but we do know that non war critical specialties are going to be heavily scrutinized, and it's unlikely those people will have the same opportunities (case load, FTOS fellowship slots) as they did 5 years ago or even today.

 

[TheEarDoc]

This is speaking from the VA side of things as an audiologist, but it seems every VA I've been employed at has had a difficult time getting ENT's and keeping them. Often times they are contract workers paid big bucks to come in. Lots of loan repayment and incentives to get them on board. You could always just go to the reserves side and not take any cash and direct commission if you want to keep up and get some retirement (yes you wouldn't draw it until you're in your 60's), but then you could do a civilian residency, have some more freedom in employment, get loans paid off by the VA, and still serve.

Just a thought.

 

[deleted992700]

This is speaking from the VA side of things as an audiologist, but it seems every VA I've been employed at has had a difficult time getting ENT's and keeping them. Often times they are contract workers paid big bucks to come in. Lots of loan repayment and incentives to get them on board. You could always just go to the reserves side and not take any cash and direct commission if you want to keep up and get some retirement (yes you wouldn't draw it until you're in your 60's), but then you could do a civilian residency, have some more freedom in employment, get loans paid off by the VA, and still serve.

Just a thought.

I did consider the reserves side of things like MDSSP, the reserves obligation is not bad, but to be honest, reservists hates their life.

 

[HighPriest]

I did consider the reserves side of things like MDSSP, the reserves obligation is not bad, but to be honest, reservists hates their life.

Read this forum a bit more. You may or may not be happy in active service. What you have going for you is prior time in service, and being near retirement. I am normally one of the guys telling students that HPSP is a bad option for them, but I'm not telling you that because of these reasons. Even if you're miserable - it's 4 years, and then you get a retirement check. The scales are weighted.

 

[Gastrapathy]

You need 10 years of commissioned service to retire as an O

 

[deleted992700]

You need 10 years of commissioned service to retire as an O

Well that's unfortunate. LOL.

 

[HighPriest]

still. No debt. Plus, if you do HPSP you have 5 years residency and 4 years ADSO. Gen surg would put you over 10 (longer residency). And believe me, I'm choking while writing this. I'm not a fan of milmed overall.

 

[Gastrapathy]

Yup, worst case is a 3 year residency (people do change their mind or find they aren’t competitive for various specialties) in which case it would add 3 years to get to 10

 

[notdeadyet]

I did consider the reserves side of things like MDSSP, the reserves obligation is not bad, but to be honest, reservists hates their life.

The reserve obligation for MDSSP is horrible. You end up owing 8 years of services POST-residency. So if you’re doing a 5 year residency, you’re looking at committing to 17 YEARS from the first day of medical school until you are done with your reserve commitment. All for the sake of $100K or so plus dollars in the monthly stipend?

I don’t hate my life. For Army RC, deployments are currently limited to 120 days (90 days in country), so even with a tempo of q 2-3 years, it’s very do-able if you’re comfortable with committing to a Kaiser/VA type large practice. Most reserve corps docs I know like their gig. The only exceptions are the ones that joined by taking huge commitments that bound them (such as MDSSP).

Better route is to take nothing and then take the $250K in student loan repayment ($40K per year, year to year obligation). If you don’t like it, you can pop smoke at any time. $250K will pay off much or all of medical school and you can make up the rest easily with your civilian day-time salary. You can always switch to active if you’re so inclined.

But MDSSP? 17 year commitment for $100K? Not a good deal by any stretch.

 

[deleted992700]

The reserve obligation for MDSSP is horrible. You end up owing 8 years of services POST-residency. So if you’re doing a 5 year residency, you’re looking at committing to 17 YEARS from the first day of medical school until you are done with your reserve commitment. All for the sake of $100K or so plus dollars in the monthly stipend?

I don’t hate my life. For Army RC, deployments are currently limited to 120 days (90 days in country), so even with a tempo of q 2-3 years, it’s very do-able if you’re comfortable with committing to a Kaiser/VA type large practice. Most reserve corps docs I know like their gig. The only exceptions are the ones that joined by taking huge commitments that bound them (such as MDSSP).

Better route is to take nothing and then take the $250K in student loan repayment ($40K per year, year to year obligation). If you don’t like it, you can pop smoke at any time. $250K will pay off much or all of medical school and you can make up the rest easily with your civilian day-time salary. You can always switch to active if you’re so inclined.

But MDSSP? 17 year commitment for $100K? Not a good deal by any stretch.

Doesn't HPLR kicks in after your residency if you take MDSSP for 4 years during medical school ?

 

[notdeadyet]

If you take MDSSP, you can start taking HPLRP after residency, but you can not take HPLRP in a year you are paying back MDSSP obligation.

In other words, after you finish residency and have 8 years of MDSSP to pay back, you can take HPLRP for 4 years (for $160K in loans, for instance), but you don’t start your MDSSP payback of 8 years until AFTER you’re done with HPLRP. Alternately, you can pay back your 8 years of MDSSP and THEN start taking HPLRP. But you can’t do both at the same time.

Which way makes sense depends on a couple of factors. If you have loans that will exceed about $200K by the time you pay them back (since ~$32K of your $40K for HPLRP will go towards loans, the rest is used for taxes), it makes sense to take HPLRP first so that they don’t accumulate interest. On the other hand, the benefit of doing MDSSP payback first is that you can finish your 8 year hitch and decide whether you want to stay in during HPLRP from year to year and not be obligated.

 

[notdeadyet]

Disclosure: I am Army RC and I didn’t do MDSSP or STRAP, with the theory that I preferred to just stay in for as long as I wanted, knowing that I could pull the plug at any time. In retrospect (since it’s 10 years later and I’m still in), it may have made more financial sense to have taken one of those programs.

Do I regret not taking one of them? Not on your life. I love my involvement with the Army but over the past decade I have felt a real sense of peace knowing that I’m serving at will. Whether HPSP, MDSSP, STRAP, or FAP, most folks would agree that it’s easier to tolerate the strains and irritations of the military when you know you can leave if you want. Even if you don’t.

 

[vom-]

A good thing to keep in mind if you are willing to switch branches: the Air Force has 3 general surgery residencies that are partnered with civilian programs. I imagine they may be super competitive, because I think most of them only take 2 military residents per year.

 

[militaryPHYS]

I'm confused on your progress to a pension because of your edits to the OP. Specifics related to a crossroad of prior service and a new career in medicine will weigh heavily on the information you get here and ultimately your final decision. Best to clarify if you want the best advice.

 

[deleted992700]

I'm confused on your progress to a pension because of your edits to the OP. Specifics related to a crossroad of prior service and a new career in medicine will weigh heavily on the information you get here and ultimately your final decision. Best to clarify if you want the best advice.

Sorry for the confusion. So I’ve been in for 6 years, my IRR doesn’t come up until 2022. Medical school starts 2021, so I don’t want the chance of getting mobilized (high chance). So i needed a another contract. Pension wise HPSP will give me 9 years, that makes it almost 20 years. but not enough. MDSSP will be 8 years post residency, if residency/med school count toward retirement, i guess i could get 20 years. ( still sorta confused what year counts toward retirement). I was leaning toward MDSSP even people say it’s horrible because i didn’t want a military residency

 

[militaryPHYS]

Right. So we need to clarify things for you.

Lets start with what we know, then we can provide you some potential pathways.

Clarify the "been in for 6 years". Active, reserve? IRR "coming up" in 2022 means what? That is when you are off active reserve and start IRR or that is when you are done with IRR?

 

[deleted992700]

Right. So we need to clarify things for you.

Lets start with what we know, then we can provide you some potential pathways.

Clarify the "been in for 6 years". Active, reserve? IRR "coming up" in 2022 means what? That is when you are off active reserve and start IRR or that is when you are done with IRR?

Start IRR 2022.

 

[militaryPHYS]

Ok thanks. Here is a good article on summary of POINTS and Reserve Time towards retirements. https://themilitarywallet.com/guard-reserve-points/

Long story short. You won't be anywhere close to an active duty pension after payback for HPSP/USUHS. You'll have 20+ "good years" for reserve purposes and pension will kick in at age 60, but no active duty pension starting right away. 9 years of reserve time at year 2022 + 4 good reserve years for HPSP + 5 years active residency + 4 years active payback = 9 years active + 13 reserve good years.

I just wanted to have a solid idea on your time in service and implications that has for overall finances and timeline.

Your main concern though is not military retirement. Your main concern is wanting to avoid a military residency and the classic pitfalls of Milmed. Your explanations of your current impression of MilMed is understandable and I cannot argue with your logic.

My impression is that you are NOT a good candidate for milmed. You would be eligible for reserve retirement at the end of it but you'd be obligating yourself to a lot longer in military medicine which you don't seem keen on anyway. If you are not 100% Milmed you should not obligate yourself to any more time than you need. You could continue to serve your time in the reserves for MS-1 year and then be done 2022 free and clear. Yes, you would have the potential for deployment but I imagine this would just delay your medical school by 1 year. If you sign up for a new contract and commit yourself to more time in the military later in life you can have many more potential risks of deployment or training delays when it matters more (Intern/Resident/staff), plus risk of not training in certain specialties, skill atrophy, etc. This would cause you significant misery and frustration because you are already someone who is a reluctant MilMed to begin with. You can always come in later after you are trained up if you so desire. Reserves in MILMED are great for a transition from active duty to the civilian world if you want to collect the reserve pension starting at 60. I think it is risky to play with MilMed reserves any other way due to my above comments. When it comes to MILMED you have to be ALL IN or ALL OUT unless you are already full trained or at the very end of your career.

Just my two cents.

 

[deleted992700]

Ok thanks. Here is a good article on summary of POINTS and Reserve Time towards retirements. https://themilitarywallet.com/guard-reserve-points/

Long story short. You won't be anywhere close to an active duty pension after payback for HPSP/USUHS. You'll have 20+ "good years" for reserve purposes and pension will kick in at age 60, but no active duty pension starting right away. 9 years of reserve time at year 2022 + 4 good reserve years for HPSP + 5 years active residency + 4 years active payback = 9 years active + 13 reserve good years.

I just wanted to have a solid idea on your time in service and implications that has for overall finances and timeline.

Your main concern though is not military retirement. Your main concern is wanting to avoid a military residency and the classic pitfalls of Milmed. Your explanations of your current impression of MilMed is understandable and I cannot argue with your logic.

My impression is that you are NOT a good candidate for milmed. You would be eligible for reserve retirement at the end of it but you'd be obligating yourself to a lot longer in military medicine which you don't seem keen on anyway. If you are not 100% Milmed you should not obligate yourself to any more time than you need. You could continue to serve your time in the reserves for MS-1 year and then be done 2022 free and clear. Yes, you would have the potential for deployment but I imagine this would just delay your medical school by 1 year. If you sign up for a new contract and commit yourself to more time in the military later in life you can have many more potential risks of deployment or training delays when it matters more (Intern/Resident/staff), plus risk of not training in certain specialties, skill atrophy, etc. This would cause you significant misery and frustration because you are already someone who is a reluctant MilMed to begin with. You can always come in later after you are trained up if you so desire. Reserves in MILMED are great for a transition from active duty to the civilian world if you want to collect the reserve pension starting at 60. I think it is risky to play with MilMed reserves any other way due to my above comments. When it comes to MILMED you have to be ALL IN or ALL OUT unless you are already full trained or at the very end of your career.

Just my two cents.

so you think 8 years of MDSSP is not worth it too ? Thanks for the advice !!

 

[militaryPHYS]

No way.

Hopefully @notdeadyet will weight back in now that we know your actual time in service, etc since he is much better than me at reserve details, but I think his recommendation would be the same. MDSSP not worth it. For someone with your mindset about MilMed, HPSP/USUHS would also be too risky that you would end up miserable and disappointed.

 

[deleted992700]

No way.

Hopefully @notdeadyet will weight back in now that we know your actual time in service, etc since he is much better than me at reserve details, but I think his recommendation would be the same. MDSSP not worth it. For someone with your mindset about MilMed, HPSP/USUHS would also be too risky that you would end up miserable and disappointed.

The reserve obligation for MDSSP is horrible. You end up owing 8 years of services POST-residency. So if you’re doing a 5 year residency, you’re looking at committing to 17 YEARS from the first day of medical school until you are done with your reserve commitment. All for the sake of $100K or so plus dollars in the monthly stipend?

I don’t hate my life. For Army RC, deployments are currently limited to 120 days (90 days in country), so even with a tempo of q 2-3 years, it’s very do-able if you’re comfortable with committing to a Kaiser/VA type large practice. Most reserve corps docs I know like their gig. The only exceptions are the ones that joined by taking huge commitments that bound them (such as MDSSP).

Better route is to take nothing and then take the $250K in student loan repayment ($40K per year, year to year obligation). If you don’t like it, you can pop smoke at any time. $250K will pay off much or all of medical school and you can make up the rest easily with your civilian day-time salary. You can always switch to active if you’re so inclined.

But MDSSP? 17 year commitment for $100K? Not a good deal by any stretch.

when we say take nothing does it mean i can reclassify into a medical student AOC ? how does medical student drilling works ? how does HPLR works if taken the AOC? Thanks

 

[notdeadyet]

Agree with the comments above. If you take MDSSP for four years, and do a five year residency, you’re looking at a 17 year commitment. That’s a long time even if you are incredibly hooah about serving, which you don’t seem to be.

If you didn’t want to take any obligation-incurring programs, you could join specifically in a medical student slot (it has a weird AOC number to it). You are no longer assigned/attached to your old MOS/AOC-occupying unit. Med students are considered without AOC and are not tagged for deployment. Could they break the glass with you since you presumably have a deployment-ready MOS/AOC? Yes, but you’ll be in a new unit and branched into Medical Services Corps. Folks who are deployed from med school tend to be folks who remain with their old units.

If you don’t take any obligation-incurring benefits, you can still take HPLRP, but only after you finish residency.

 

[deleted992700]

Agree with the comments above. If you take MDSSP for four years, and do a five year residency, you’re looking at a 17 year commitment. That’s a long time even if you are incredibly hooah about serving, which you don’t seem to be.

If you didn’t want to take any obligation-incurring programs, you could join specifically in a medical student slot (it has a weird AOC number to it). You are no longer assigned/attached to your old MOS/AOC-occupying unit. Med students are considered without AOC and are not tagged for deployment. Could they break the glass with you since you presumably have a deployment-ready MOS/AOC? Yes, but you’ll be in a new unit and branched into Medical Services Corps. Folks who are deployed from med school tend to be folks who remain with their old units.

If you don’t take any obligation-incurring benefits, you can still take HPLRP, but only after you finish residency.

So with a medical student AOC, do I still go to drill and did you say I can possibly deploy during medical school? What happens during residncy ?Sorry, just wanted to clear things up. I talked with an AMEDD recruiter today, he said he doesn't know how to AOC works, so I just wanted to have more in-depth information. Thanks !!

 

[notdeadyet]

So with a medical student AOC, do I still go to drill and did you say I can possibly deploy during medical school? What happens during residncy ?Sorry, just wanted to clear things up. I talked with an AMEDD recruiter today, he said he doesn't know how to AOC works, so I just wanted to have more in-depth information. Thanks !!

No worries.

After you have been accepted to medical school, you can re-class into a medical student slot and re-branch into Medical Services Corp. Medical student slots are not typically deployed (there is a policy memo about this, or there was). Your AOC should be changed to the Medical student one (unless it’s changed, it’s 00E67).

Your experience for drill varies on a number of factors. First is ARNG vs. Army Reserve. For many medical students, they were told that their primary job was to be medical students and they were on the roster but didn’t drill for the four years. For some places, they had to show up for drill but just studied for the weekend. For others (including mine), it was more a matter of showing up and looking busy.

After medical student graduation, you will be re-branched into Medical Corps into a slot tied to your specialty. As an intern, you are largely protected. Once you are licensed, the military treats you differently. Technically you are deplorable (and you hear stories) but this is EXTREMELY rare and I’ve never heard of any residents deploying other than those that volunteered. What you do for drill during residency changes in that you are treated as a provider. Your experiences will vary based on ARNG vs. AR, your unit, and your role.

 

[deleted992700]

No worries.

After you have been accepted to medical school, you can re-class into a medical student slot and re-branch into Medical Services Corp. Medical student slots are not typically deployed (there is a policy memo about this, or there was). Your AOC should be changed to the Medical student one (unless it’s changed, it’s 00E67).

Your experience for drill varies on a number of factors. First is ARNG vs. Army Reserve. For many medical students, they were told that their primary job was to be medical students and they were on the roster but didn’t drill for the four years. For some places, they had to show up for drill but just studied for the weekend. For others (including mine), it was more a matter of showing up and looking busy.

After medical student graduation, you will be re-branched into Medical Corps into a slot tied to your specialty. As an intern, you are largely protected. Once you are licensed, the military treats you differently. Technically you are deplorable (and you hear stories) but this is EXTREMELY rare and I’ve never heard of any residents deploying other than those that volunteered. What you do for drill during residency changes in that you are treated as a provider. Your experiences will vary based on ARNG vs. AR, your unit, and your role.

Thank you. So after medical school graduation, do I have to apply for educational delay ? or does the AR knows that I'm still a resident? Also, all those years as an 00E67, does it counts towards retirement? Should I do this through AMEDD recruiter, AR recruiter, or retention? Thank you.

 

[notdeadyet]

Thank you. So after medical school graduation, do I have to apply for educational delay ? or does the AR knows that I'm still a resident? Also, all those years as an 00E67, does it counts towards retirement? Should I do this through AMEDD recruiter, AR recruiter, or retention? Thank you.

I don’t know anything about educational delays. Isn’t that for ROTC folks? After you graduate from medical school, you will re-branch again to Medical Corps and you will receive an AOC based on your specialty.

Your years as an 00E67 count for retirement. You are in drill status. Keep in mind it’s just reserve point retirement. Also keep in mind that you need a minimum to have a “good year” for retirement. You can google that stuff.

I’d talk to an AMEDD recruiter. They handle direct accession as well as folks coming in from Active and the RC. What you’d be doing is incredibly specific, so I wouldn’t go with another kind of recruiter.

 

[militaryPHYS]

So this 00E67 and then subsequent re-branch back in to the medical corps after graduation is all non-obligation reserve time? So you get paid for your drill and AT days, plus earn points towards a reserve retirement but you aren't receiving a stipend or loan repayment? This is all good info and stuff I know very little about.

What is the point though? If your loans aren't getting paid and you aren't super Hooah/Oorah about MilMed...aren't they just subjecting themselves to headaches/pitfalls of drills during med school/residency and risk of possible deployments? Seems like this would be a good option only for people super duper Hooah who just want to be serving but don't want to be incurring payback and are OK with student loans. Maybe I'm missing something.

Thanks for your time and help with this @notdeadyet ; I think we are all learning something.

 

[Apollyon]

Technically you are deplorable

At least to Hillary Clinton.

 

[HighPriest]

At least to Hillary Clinton.

It's funny....or maybe not funny, I dunno....

I talked to an Army K-9 trainer once who was screening a site prior to Hillary Clinton coming to speak. Apparently when she showed up, the secret service told him he had to wait in a closet with his dog so that she didn't see him.

He's not the type of guy who would make that kind of thing up, and while I don't know her motivations, I think I can guess.

 

[Apollyon]

It's funny....or maybe not funny, I dunno....

I talked to an Army K-9 trainer once who was screening a site prior to Hillary Clinton coming to speak. Apparently when she showed up, the secret service told him he had to wait in a closet with his dog so that she didn't see him.

He's not the type of guy who would make that kind of thing up, and while I don't know her motivations, I think I can guess.

Competition, maybe??

 

[HighPriest]

Competition, maybe??

Probably just wanted to make sure the dog wasn't going to sniff her @$$

 

[Apollyon]

Probably just wanted to make sure the dog wasn't going to sniff her @$$

That's true...dogs do that to each other.