Military medicine

[adamMD]

I was talking to an air force recruiter who said if a joined now I'd only owe the air force three years post-residency. Apparently, the air force would pay for my remianing three years plus pay me $2,000 a month during school. Also, he said the air force does not force you into a particular residency. I would be able to choose like everyone else. Of course, getting in would be challenging since this route is competitive. My question is, is it worth competing for? There has to be some catch here. Yes, I've considered having to move somewhere I didn't like after graduation.

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[Droopy Snoopy]

I was talking to an air force recruiter who said if a joined now I'd only owe the air force three years post-residency. Apparently, the air force would pay for my remianing three years plus pay me $2,000 a month during school. Also, he said the air force does not force you into a particular residency. I would be able to choose like everyone else. Of course, getting in would be challenging since this route is competitive. My question is, is it worth competing for? There has to be some catch here. Yes, I've considered having to move somewhere I didn't like after graduation.

There is an active military medicine forum further down the main page with lots of answers.

 

[Mobius1985]

Also, he said the air force does not force you into a particular residency. I would be able to choose like everyone else.

But will he put it in your contract as a guarantee? I know a doc who was not permitted to complete a residency, as they had a need for primary care providers. She spent the rest of her obligation as a General Medical Officer with one year of internship training.

Of course, getting in would be challenging since this route is competitive. My question is, is it worth competing for? There has to be some catch here. Yes, I've considered having to move somewhere I didn't like after graduation.

I've not heard it's competitive (but that's a good spin to put on it to make it seem desirable). I'd thoroughly educate myself on the subject before going back to that recruiter. There are some very enlightening experiences detailed in SDN's military forum.

 

[Jolie South]

i think you should check out the military medicine forum if you want more info. I'm actually AF HPSP and recruiters have a tendency of misleading med students/pre-meds.

if i were you, i'd read the milmed forum and see if your recruiter will get you in touch with some actual AF docs and organize a base visit.

unless you have a strong desire to serve in the military, i would stay away.

 

[deleted77919]

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[DoctorPardi]

You know I wonder, with there being some significant benefits to a future doctor in joining the military is it really necessary for them to pull all this trickery?

Obviously they are somewhat famous for it in general, somewhat misleading young men then they get in and don't get to do what they thought they were going to do etc.

However with doctors, if they would just be straight with us, we could get medical school paid for and it would seem so many more would consider it as an option too. I have thought about it and I like the idea of serving the country and taking care of soldiers. Though I will almost certainly never do it because I am deathly afraid I will be forced to do something that I didn't believe I had to do before hand. I couldn't imagine graduating from medical school and either going into a different residency than I wanted or doing GMO work instead of starting residency.

Disclaimer: I don't mean to bash military medicine, some people are more than willing to go into it knowing these conditions and assuming they may be doing things they didn't initially sign up for. That's obviously wonderful because the military requires physicians. It is just my opinion that the military might be better served to take a different approach with doctors than they might take with other recruits.

 

[coldweatherblue]

I researched this a bit before taking out loans. My opinion: unless you want to practice military medicine, it's not worth it. If you want to have the best chance of getting your dream residency/training/career, taking stafford loans are a better option than the HPSP.

That said, if you know you want to do military medicine, it's an awesome deal.

 

[78222]

Unless you go to a private institution that charges you somethong outrageous, there really is no financial incentive to do military medicine. You will almost certainly, even accounting for interest on loans, end up making less in the end than if you'd just become a civilian doctor. If you want to do military med, do it because you want to be in the military and know what that entails. You should never sign on with the military for the money.

 

[DoctorPardi]

Let me offer a thought: When you go to buy a car, do you just listen to the salesman, or do you read the information he provides? Probably both, and if you're like most people, you probably also read Consumer Reports, google a few car review sites, talk to your friends, and take it for a test drive before you ultimately plunk down the cash and drive it away.

But when it comes to the military and medical school, this site is rife with posters who claim that they were "lied to" and "never knew" all the requirements of the HPSP. Did they not bother to read the contract? Maybe cruise the internet and ask a few questions? Talk to some milmed physiians, maybe spend a day or two in a military clinic? No, of course not. But you'll do it for a stupid car . . .

I'm just so tired of the incessant crying about how "the recruiter lied to me". Gosh, you mean a non-physician might have given you incorrect information about an exceedingly complex system of medical education and training (one that most pre-meds and half of med students don't really get)?

I have no sympathy for that argument any more. If you're committing many years of your life to the military in exchange for hundreds of thousands of dollars, it's your responsibility to understand the terms before you sign the contract.

Ok I get what you're saying, but the point I really mean to make is as follows: I, a person who has researched military medicine thoroughly, will almost never sign up for it because of the fear of being lied to even after getting all the information I can. Obviously I have never been a military physician, and while I've done some research I am certainly no expert. However I do have the fear that getting "screwed" is very possible and that will keep me from signing.

It seems to me the military if they wanted to could be very upfront about all of this and possibly do a better job in recruiting physicians. Maybe you get less GMOs but maybe you end up with more residency trained physicians because medical students aren't scared to sign on.

My guess is the military is in need of physicians, maybe they are better served in general with GMOs vs a dermatologists. I am not keen on the specifics of what "type" of physician would provide the most utility for the military. However if they do want more residency trained physicians it would seem to me that they would be better served being very upfront about what is involved instead of possibly deceiving/lying to recruits (if that is the case, I have not personally talked to a recruiter).

 

[mitchconnie]

Also, he said the air force does not force you into a particular residency. I would be able to choose like everyone else.

Recruiters will rarely outright lie, but the spin is such that that most recruits (and maybe even the recruiters themselves) don't understand the reality of the situation.

Take the above quote. Many recruits will take this to mean that they will be able to do whatever specialty they want right out of med. school, and some may even think that they can choose deferment to the civilian residency of their choice. But that's not the case.

All this quote means is that the AF will not force you to complete an entire residency in a specialty not of your choosing. What they can and will force you to do is stop your training after internship and be a GMO (the most basic primary care) for a couple years. 25-30% of students get forced down this path every match. For some specialties in some years it is virtually impossible for an MS IV to match, regardless of grades or USMLE scores. So technically, they won't force you into a specialty, but you may have to serve out your entire committment as a GMO before going on to do the civilian training you want.

The fact is that your residency options are severely constrained by the military. While your civilian counterparts can pick from literally hundreds of programs of all types in many geographic locations, the AF students are required to rank the AF programs, typically only 2-5 in most specialties. You may get really lucky and be allowed to go into the civilian match, and you may not. You may match into the specialty you want, and you may get forced into a GMO. It's really a total crapshoot from the perspective of an MS I who hasn't decided on a specialty yet.

So while the recruiter is trying to sell you on the idea that you have lots of options, the reality is way more complex. If you aren't OK with the idea of spending three years as a GMO, then you have the potential to be SEVERELY disappointed.

 

[The White Coat Investor]

3 years sounds great, until you realize it's a three year active duty commitment with an additional 5 tacked on the the individual ready reserve (IRR). People from the IRR (yes including physicians) have definitely been getting called up.

You know a doctor who was called up out of IRR during this war? When? What service and specialty?

 

[The White Coat Investor]

this site is rife with posters who claim that they were "lied to" and "never knew" all the requirements of the HPSP. Did they not bother to read the contract? Maybe cruise the internet and ask a few questions? Talk to some milmed physiians, maybe spend a day or two in a military clinic?

Are you aware there were no good search engines, not to mention any good mil-med sites on the internet in the 90s when said physicians were doing their research? Of course we read the contract, but we were also informed of what was likely to happen. Those probabilities changed dramatically over the next few years, especially after 9/11. Unfortunately the military docs I talked to didn't really know about a lot of the changes that took place in the 90s (one was already out, the other was not far out of training and excited to be making more than his civilian counterparts (he was a pediatrician) and only going on humanitarian deployments. He has since spent his year in the sand taking care of adults and is not nearly as gung-ho.

 

[Yellowstone]

I don't believe any physicians have been called up from IRR (not yet anyway!) I wouldn't hold your breath though. Military medicine is struggling with recruitment and retention for obvious reasons.

Another consideration is that when you sign up for the military, it sounds like a nice 3 or 4 year payback, but after medical school, internship, likely GMO, residency, additional payback, etc, you are more likely committing the next 10-12 years of your life. I 'signed up' for a 4-year scholarship 10 years ago last month, and I still owe a couple more years. Clearly the world, and my personal life, have changed a lot since 1998.

 

[orbitsurgMD]

Recruiters will rarely outright lie, but the spin is such that that most recruits (and maybe even the recruiters themselves) don't understand the reality of the situation.

Take the above quote. Many recruits will take this to mean that they will be able to do whatever specialty they want right out of med. school, and some may even think that they can choose deferment to the civilian residency of their choice. But that's not the case.

This needs to be understood by every student accepting the contract, before signing.

The possibility of being permitted deferment for full outservice training and the possibility of being accepted directly from internship to military residency without having to serve as a GMO needs to be understood as just that, a possibility. In most cases it it not the most likely outcome. In some services, like the Navy, it is the least likely outcome.

The time spent as a GMO is no small thing, whether you enjoy it or not. It can be as long as all of medical school for those seeking competitive residencies or those who have decided they want to go civilian as soon as possible. While you are working as a GMO (at public schoolteacher's pay, but no summers off) your medical school colleagues are finishing their residencies , taking their boards and moving on in life with at least some sense of control over their careers and some say as to where and for whom they will work. You will not be in the same place. Now it may seem like a trivial difference, and you may make the best of your circumstances as a GMO, and you may even find what you are asked to do both satisfying and reasonable. If so, that's great. But you shouldn't fool yourself into thinking that you are giving up nothing for the money paid under your "scholarship." You are actually giving up quite a bit for that supposed largesse, even if you can't properly value it from the vantage point of someone in their early 20s who thinks he or she can put up with anything for three or four years.

You are putting at risk your being able to get the best choice of your training in a timely way. That is a real risk and has real consequences, and being happy with your choices in the end does not mean that you didn't take that risk or that the risk was necessarily worthwhile.

 

[crazybrancato]

While you are working as a GMO (at public schoolteacher's pay.

How do you figure? I'd have 8 years prior service, making 0-3 pay. (I might be an 0-4 at the time). That salary is the equivalent of a $110-125K civilian salary (taking into account that BAH/BAS isn't taxed). Could be even higher if you're separated from family and/or deployed.

Most public school teachers I know make $40-60K, on the high end if they've been teaching forever.

Even if you're not prior service, you'd be making $60-80K civilian equivalent.

The money's not that bad, please don't exaggerate!

Been doing some research with my civi-doc friends regarding pay scales. Seems to be this misconception that civi docs out of training are making $500k/year. That doesn't seem to be the case anymore, not all the time at least.

Case in point: civi-radiologist friend of mine got offered a $475K job, but in Vegas (he and his family are deeply rooted in L.A.). He could not find an equivalent offer anywhere in greater L.A. (turns out radiology openings aren't exactly advertised on Craigs List). In the end, he ended up taking a job in L.A., but for $200K. He blames the economy and the lousy job market that's now starting to affect medicine . . .whatever.

Anyway, my point is that the pay delta between civi and milmed is not as great as you might think (especially with the rise in costs of running say a private practice, insurance etc). And those $500K/year rad or cardio jobs aren't as abundant as they used to be.

 

[orbitsurgMD]

How do you figure? I'd have 8 years prior service, making 0-3 pay. (I might be an 0-4 at the time). That salary is the equivalent of a $110-125K civilian salary (taking into account that BAH/BAS isn't taxed). Could be even higher if you're separated from family and/or deployed.

Most public school teachers I know make $40-60K, on the high end if they've been teaching forever.

Even if you're not prior service, you'd be making $60-80K civilian equivalent.

The money's not that bad, please don't exaggerate!

Been doing some research with my civi-doc friends regarding pay scales. Seems to be this misconception that civi docs out of training are making $500k/year. That doesn't seem to be the case anymore, not all the time at least.

Case in point: civi-radiologist friend of mine got offered a $475K job, but in Vegas (he and his family are deeply rooted in L.A.). He could not find an equivalent offer anywhere in greater L.A. (turns out radiology openings aren't exactly advertised on Craigs List). In the end, he ended up taking a job in L.A., but for $200K. He blames the economy and the lousy job market that's now starting to affect medicine . . .whatever.

Anyway, my point is that the pay delta between civi and milmed is not as great as you might think (especially with the rise in costs of running say a private practice, insurance etc). And those $500K/year rad or cardio jobs aren't as abundant as they used to be.

You may have 8 years in, but most HPSP candidates come in as O-3 with under 2 years (thanks to DOPMA). Big difference there.

The comparison is a fair one, even considering the bonuses and untaxed benefits of the military pay package. At least retirement vesting is earlier for teachers.

 

[crazybrancato]

You may have 8 years in, but most HPSP candidates come in as O-3 with under 2 years (thanks to DOPMA). Big difference there.

The comparison is a fair one, even considering the bonuses and untaxed benefits of the military pay package. At least retirement vesting is earlier for teachers.

I don't think the comparison (mil-doc vs public school teacher) is a fair one. It's unfortunate that the latter aren't paid more, but I'd bet on a mil doc always being better-compensated. the comparison mil vs civ doc is a better one (let's stick to apples and apples) . . . and it's hard to generalize who wins that contest all of the time, especially given the current economic climate in medicine . . . and as you pointed out, not all people have prior service . . or more generally, exactly which route is best for you depends on your personal mindset and circumstances.

besides, if we're so concerned about money and employment, we should all go become nurse practitioners, who seem to be more employable and better-compensated than general surgeons!!!

 

[The White Coat Investor]

How do you figure? I'd have 8 years prior service, making 0-3 pay. (I might be an 0-4 at the time). That salary is the equivalent of a $110-125K civilian salary (taking into account that BAH/BAS isn't taxed). Could be even higher if you're separated from family and/or deployed.

Most public school teachers I know make $40-60K, on the high end if they've been teaching forever.

Even if you're not prior service, you'd be making $60-80K civilian equivalent.

The money's not that bad, please don't exaggerate!

Been doing some research with my civi-doc friends regarding pay scales. Seems to be this misconception that civi docs out of training are making $500k/year. That doesn't seem to be the case anymore, not all the time at least.

Case in point: civi-radiologist friend of mine got offered a $475K job, but in Vegas (he and his family are deeply rooted in L.A.). He could not find an equivalent offer anywhere in greater L.A. (turns out radiology openings aren't exactly advertised on Craigs List). In the end, he ended up taking a job in L.A., but for $200K. He blames the economy and the lousy job market that's now starting to affect medicine . . .whatever.

Anyway, my point is that the pay delta between civi and milmed is not as great as you might think (especially with the rise in costs of running say a private practice, insurance etc). And those $500K/year rad or cardio jobs aren't as abundant as they used to be.

I don't know where you're getting your figures from. Here's some accurate ones for my specialty (EM.)

Military straight out of residency ~$120K depending on BAH/BAS. Add maybe $5K for tax benefits.

Average pay in the region of the country I want to live in for employees (not partners) per the most accurate salary survey in the specialty: $278K.

125/278*100= 45%. I'm working for 45% of what the typical emergency doc is working for. Since it is assumed I had 4 years of school paid for and that is part of my pay, let's add on that cost. The military got me for a pittance, so we'll assume a more expensive school. Let's say $30K/year + $1K/month stipend (more than I was getting, BTW.) So add on $42K to the $125K previously discussed. That's now 60% of what I would be making on the outside. Think my 42K figure is dumb? It is amazingly close to what I would get extra per year if I signed on for 4 years after my educational commitment ($44K.) If you want to make it look even better, add in the retirement for someone who stays for 20. Let's assume a retirement at 0-5 with 20 years. $7200/month is what he makes in base pay. $7200*12/2= $43,200/year. An inflation-indexed annuity that pays $43,200/year starting at age 51 (the age I would be at retirement if I stayed 20) would cost $930,000. To get to $930,000 in 20 years with a 9% return I'd need to put away an additional $18,000/year so we'll add that on. $120K+$5K+$42K+$18K=$185K/278K= 67%. I can keep going with this exercise. Let's say you did an active duty residency so you were paid more than a civilian. Let's say you get paid $60K to do a military residency and $40K to do a civilian. Now both of these figures are probably a bit higher, but it is the difference we're looking at which hasn't changed much. So we'll add on another $20K. Now we're up to $205K/278K= 74%. Hmmm...but what about the time value of money? You got all that med school money years ago and that has to be worth something. Well, I used 9% earlier for an investment return, so we'll stick with that. If you do a 3 year residency, there are 7 years between the time you receive the average dollar you got from the military in med school and the time you have paid back 1/2 of your payback. We used $42K before so we'll use that again. $42K*4=$164. $164 invested at 9% for 7 years= $300K. Subtract out the original $164 (already accounted for that) and divide by four. That is $34K. $239K/278K=86%.

It doesn't matter how you spin it. You're simply going to come out behind going the military route. Financially, you would have to go to a very expensive school, choose a practice that pays significantly less than average, and get a high rate on your loans to even come close. No wonder our retention rate is less than 5%.

Military medicine has a lot of problems that cannot be solved by money. But I also think it has a significant amount that can be. I wish they'd try. I enjoy serving my country, but the sacrifice is great when I look at what I can provide to my family financially and what I can provide to my family time-wise. Growing up with your dad in the Middle East for 6 of every 24 months can't be good for kids.

 

[The White Coat Investor]

I don't think the comparison (mil-doc vs public school teacher) is a fair one. It's unfortunate that the latter aren't paid more, but I'd bet on a mil doc always being better-compensated. the comparison mil vs civ doc is a better one (let's stick to apples and apples) . .

I think I took care of the mil vs civ doc one above, so let's look at the school teacher thing. A non-prior service intern living near Portsmouth NMC gets paid $3408/month or $40896/year. His BAS is $202.76. His BAH is $1425. Total annual compensation is $60429.12.

According to this, http://www.simplyhired.com/a/salary/search/q-Science+Teacher/l-Portsmouth,+VA

a biology teacher (our intern is probably qualified to do this) in Portsmouth makes $38,000/year. But wait...that is in only 9 months, so let's multiply that by 12/9=$50,667. But wait, that biology teacher only works 40 hours/week whereas the intern works closer to 80. So the per hour pay for the teacher is $38000/40*37= $25.68. The per hour pay for the intern is $60400/80*49= $15.41. Who's making bank now? I think the schoolteacher vs resident is a pretty good comparison when we're talking about pay.

 

[crazybrancato]

I think I took care of the mil vs civ doc one above, so let's look at the school teacher thing. A non-prior service intern living near Portsmouth NMC gets paid $3408/month or $40896/year. His BAS is $202.76. His BAH is $1425. Total annual compensation is $60429.12.

According to this, http://www.simplyhired.com/a/salary/search/q-Science+Teacher/l-Portsmouth,+VA

a biology teacher (our intern is probably qualified to do this) in Portsmouth makes $38,000/year. But wait...that is in only 9 months, so let's multiply that by 12/9=$50,667. But wait, that biology teacher only works 40 hours/week whereas the intern works closer to 80. So the per hour pay for the teacher is $38000/40*37= $25.68. The per hour pay for the intern is $60400/80*49= $15.41. Who's making bank now? I think the schoolteacher vs resident is a pretty good comparison when we're talking about pay.

okay okay let's all get out and become school teachers then . . . it's a noble profession too . . .man you're pissed . . . well thought-out though, thanks for the numbers.