Military Ophthalmology

[Free Radicle]

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Does anybody have good info/links/hearsay on life as a military ophthalmologist? I am interested

 

[Andrew_Doan]

Depends on what service, but in general, it's a great life and the pay is competitive. Now with the FAP, you can complete your civilian residency program and receive an extra ~$60K/year over your residency pay.

 

[orbitsurgMD]

Does anybody have good info/links/hearsay on life as a military ophthalmologist? I am interested

Depends on which service.
Depends on your duty station.
Depends on luck.

Some branches have more hospitals with specialty surgery than do others. Army>Navy>Air Force.

Because of the general trend toward releasing retirees to civilian care under Tricare, the availability of a patient population for surgery--important if you want to keep your skills--can vary significantly. Most AD are under 30, nearly all except senior Es and Os, under 40. Not much cataract or retinal disease there.

In the sandbox, ocular, orbital and facial trauma, but that is declining.

Availability of subspecialty fellowship training opportunities can be extremely unpredictable. They will not send someone for fellowship just because they want to go; there has to be a projected need for a subspecialist, usually a vacancy somewhere from retirement or EAOS.

The persons selected for training in military ophtho are generally of the highest caliber, higher on average than in most civilian programs. That makes for a good practice environment. Most military residents have good things to say about about their training. I have found the Army programs,
especially the faculty at BAMC, to be extremely good. They make me wish I had signed Army rather than Navy.

Military programs are very selective. I recall 40+ eligible applicants for three spots in an entering class of ophthalmologists. There were very good applicants leaving for civilian programs because of the poor odds.

 

[Jokestr]

I actually looked stronly into the Air Force last year. As Dr. Doan stated, they will now pay~70k per year while you are in residency on top of your current resident salary. You then owe however many years you take money plus one (ie if you take money for all 3 years of residency then you owe 4 years of service). Keep in mind you have to pay taxes on this 70k and if you are single without kids like myself I would have only seen about 45-50k of this money. You can use this money against school loans, but it would still be taxed prior to using it in your loans. In the Air force you can only be sent overseas for 4 months out of every 36. I spoke with multiple current docs in the AF and they all stated that they got PLENTY of good surgical numbers including ~10 refractive/wk, 4-10 cataracts/wk, and as much or as little plastic procedures as you want. The pay scale is not what you would make in private but you start out at ~115 after meal/housing payments etc. It seemed like a pretty good gig and got me very interested. Good luck!

 

[Free Radicle]

I have been speaking with an Army recruiter as well as with some Army ophtho's from the San Antonio base. I have liked everything about it except the deployment aspect. I chose ophtho for many reasons and one of them was the ability to spend time with my family which I value over everything else in life. I guess 4-6 months of deployment is a small sacrafice, but I was talking with a friend (a generalist in the Air Force) who sees a lot of depression/anxiety from wives before, during an after deployment. I realize that I am not going to the front lines or anything but I have no wish to stress the wife. I appreciate all of your feedback, if anything else comes to mind good or bad, please post it. Thanks

 

[Andrew_Doan]

The pay scale is not what you would make in private but you start out at ~115 after meal/housing payments etc. It seemed like a pretty good gig and got me very interested. Good luck!

Military pay is confusing and is based on rank, years of service, medical specialty, and board certification. Also, you need to consider your take home pay and the equivalent civilian pay needed to bring home the same amount.

Also, military members who have a home of record that do not collect state taxes (e.g. Oregon, Texas, Florida, Washington, and several others), your entire pay is state tax free, which saves you an additional ~8% on your entire pay.

Only your monthly pay for an officer is taxed SS/FICA.

The following pays are not subjected to SS/FICA taxes (an additional 8% savings):

1) Variable Special Pay: varies from $5000-$12,000/year depending on your years of service
2) Board Certification Pay: varies from $2400-$6000/year depending on your years of service
3) Incentive Special Pay: $28,000/year for ophthalmologists
4) Additional Special Pay: $15,000/year for all physicians

Once pay back is done and you sign a 4-year extension on contract:
5) Multi-year retention bonus: $25,000/year

Also, your BAH/BAS are completely tax free and based on your location. In Southern California, a physician with the rank of O-4 gets:
Without dependents: $2081/month or $24,972/year in BAH
With dependents: $2457/month or $29,484
BAS for officers is $2433.12/year

If you're single, you are receiving in Southern California tax free/SS-FICA tax free BAH/BAS of $27405.12, which is equivalent to a before tax income of $45,675.2.

If you're married or have kids, you are receiving in Southern California tax free/SS-FICA tax free BAH/BAS of $31917.12, which is equivalent to a before tax income of $53,195.20.

It's confusing with all these pays, but let's take an example of an ophthalmologist who went through medical school on HPSP (who is now debt free) and completed his/her ophthalmology residency through the military.

This new ophthalmologist (assuming board certification too) has a rank of O-4 with 6 years of service. Their pay in Southern California is:

Single: $61,563.6/year in base pay + $57,400/year in special pays + $27405.12 in BAH/BAS = $145,968.72

Married or /w kids: $61,563.6/year in base pay + $57,400/year in special pays + $31917.12 in BAH/BAS = $150,880.72

These pays are what you receive on paper, but remember that your tax burden is low. You're receiving 1/5 of your pay completely tax free (BAH/BAS is not reported on your W-2 and tax returns) and more than one-half of your pay is free from the ~8% FICA/SS tax. If you have a home of record that gives you state tax exemption, then you're also saving an additional ~8%. If not, then you need to reduce the following calculations by about 8% depending on your state tax rate.

For a married officer, this means payment of $150,880.72/year with a before tax equivalent income of ~$188,445.49 (i.e., a civilian physician needs to make this amount to bring home after taxes the same amount a military physician makes). Your family receives health care too, so that's worth an additional $10,000/year in premiums.

As the military ophthalmologist achieves the rank of 0-5 (usually after 6 years of practice) and can sign on for his/her MSP bonus, the military ophthalmologist receives:
military pay income of: $192,197.12/year with a before tax equivalent income of ~$237,097.40/year.

Military ophthalmologists will max out after achieving O-6 and 20 years of service with an additional ~$30,000/year in pay.

Therefore, income-wise, for general ophthalmologists and lower paying sub-specialties in ophthalmology, the military is better because military physicians make two times more during residency, have no school debt, and have take home salaries that are equivalent to average civilian ophthalmologists.

Here's the biggest financial bonus of being a military ophthalmologist. After 20 years of service, the ophthalmologists can retire from the military and collect retirement pay that is about 1/2 of his/her most recent base pay. Payment starts on day 1 after retirement. The above military doctor can quit the military and work in a civilian or university practice AND collect that retirement pay. Many military physicians retire at the age of 45-50, and then work elsewhere. This retirement pay is adjusted to the cost of living (increases about 3.5%/year), so it works out to be worth about $2 million in the bank as the retired officer draws from this for the rest of his/her life and receives health benefits through Tricare. To have the same financial benefit as a civilian ophthalmologist, one would have to save and invest over 20 years a next egg that is worth ~$2 million (i.e. $50,000/year savings in a tax deferred account - likely a SEP-IRA which has a max contribution of $46,000/year and have this account grow at ~7%/year).

Financially, there are upsides to both military and civilian practices, but I think they are equivalent in regards to income if the physician is a general ophthalmologist. If you're a neuro-ophthalmologist or lower-income sub-specialist in ophthalmology; however, you'll make more in the military with better retirement income.

On the other hand, military retirement can be adjusted based on decisions from Congress, as we have seen for Medicare Cuts. Nothing is set in stone.

Also, you need to enjoy the military lifestyle and be willing to move and go on deployments. The good thing is that there is a large pool of ophthalmologists to draw from for deployments and going overseas. Thus, one ophthalmologist will NOT be deployed often. Often there are many volunteers who want to go. One cool thing is the opportunity to go on humanitarian missions. In the last 2 years, we've seen 5 humanitarian missions to Africa, Asia, and South America where military ophthalmologists were asked to do sight saving ECCE and ocular surgeries. Read this article:
http://www.boston.com/news/nation/articles/2008/07/28/pentagon_flexes_its_altruism_muscle/

One last perk of being in the military is that if you get lucky and get selected for fellowship, the military sends you to fellowship with the above pay rates. As a fellow, you will make more than many junior attendings. 🙂

In regard to Free Radicle's concern about time with family, military physicians have good hours, receive time-off for meetings/CME, given 30-days/year of vacation/leave, and receive holidays that other people have to go to work and that only the US Mail and federal workers have off. If you're deployed, you can always take time off before and after your deployment.

References:
BAH Tables: http://usmilitary.about.com/od/housingallowance/a/08bah.htm
Military Pay Scale: http://www.militaryfactory.com/military_pay_scale.asp
Physician Bonus:
Special Pay for Medical Officers: http://www.military.com/benefits/military-pay/special-pay/special-military-pay-for-medical-officers

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DISCLAIMER
The views expressed here are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the United States Government.

 

[Andrew_Doan]

New recruiting video from the US Navy:
http://www.navyhealthcare.com/

 

[orbitsurgMD]

New recruiting video from the US Navy:
http://www.navyhealthcare.com/

The services, Navy included, have tens if not hundreds of millions of dollars to spend on advertising their "opportunities." I suggest anyone considering the military for medical training treat this advertising no differently than any other, and attempt to secure other less-biased information about practice in the military. It is nice that they can get an inspiring lieutenant from Harvard to act as a video spokesperson for Navy Medicine (still can't figure the recreational scuba angle, sure didn't have time for that in my Navy internship), but his story isn't the only one you should hear.

One place to start is the now-extensive board right here where many current and former Navy physicians have posted their experiences. Read well, then decide.

Caveat emptor.

 

[tammy01]

how does it work for civilians. are we allowed to apply if we already have PGY-1. is it a separate matching system????????????
what commitment is reqiured in terms of army service???????

 

[Andrew_Doan]

how does it work for civilians. are we allowed to apply if we already have PGY-1. is it a separate matching system????????????
what commitment is reqiured in terms of army service???????

As a civilian you cannot apply for the military match. What you can do, however, is consider the FAP through the Army, Air Force, or Navy. For the FAP you will need to match into a civilian program first, and then be commissioned into the military as an officer. Through the FAP, you will receive about $60K/year in addition to your residency salary. You will owe one year plus every year the military supports you. For a 3 year residency, you will owe 4 years of services.