Military Residency Pay

[zreagle]

Greetings everyone!

I will be starting med school next fall and am considering Army HPSP.

Quick question:

How much would I make as a military resident?

Also does the Army have any IM/EM combined residencies or if I were so motivated would they let me do a civ IM/EM residency?

thanks so much for any info.

-ZR

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[zreagle]

Well after asking the question about military residency pay, I then reviewed the post on specialty pay and found an answer to my question. Silly me.

I am still courious about combined residency in the military. I have found a number of web sites for military residency programs, but nothing about combined programs.

Any of you have any experience as HPSPers who wanted to or did do a combined residency?

 

[GeoLeoX]

Though not updated as much as it could be http://meded.amedd.army.mil/ is a good website to peruse. It has a lot of information about HPSP and residency. The only combined programs of which I am aware in the Army are IM/Psych and FP/Psych (both at Walter Reed).

I am a 4th year HPSP student on a 4 year Army scholarship. I have probably asked many of the questions that you will have, so please don't hesitate to post!

GeoLeoX

 

[texdrake]

I am still a little new to everything but in general you receive more pay, quite a bit actually and work less hours if you are in the military. Of course you also see less as you are working less hours.

I don't know the exact numbers but I believe it is just Captain's base pay plus Variable Special Pay $1200-12,000 based on service time and Board Certification Pay ($2,500 to 6,000 based on years).

So for a 1st year resident $40,000 + $1,200 + $2,500 = $44,000 + Housing Allowance at roughly $10,000 = 54,000.

Expect to get a slight raise each year and an additional 15-40,000
once you finish your residency.

You also get 30 days vacation annually, free to very cheap medical/dental health coverage for you and family.

 

[zreagle]

Originally posted by GeoLeoX
Though not updated as much as it could be http://meded.amedd.army.mil/ is a good website to peruse. It has a lot of information about HPSP and residency. The only combined programs of which I am aware in the Army are IM/Psych and FP/Psych (both at Walter Reed).

Thanks for the Web site.

I am a 4th year HPSP student on a 4 year Army scholarship. I have probably asked many of the questions that you will have, so please don't hesitate to post!
GeoLeoX

So you must be applying for residency now or getting ready to apply. How does it work in the Army? I know what the recruiters say, but do YOU think you will get your choice of residency? If the Army does not have an IM/EM combined program, do you think they would let me do a civ residency or would they make me pick one or assign me one or the other.

At this point are you happy you did the HPSP thing?

thanks for any info and I hope you get your pick of residency.
-ZR

 

[texdrake]

Again, I am sure he could answer better but from what I have heard, they now pretty much let you do what you want. You apply to specific residencies but you are only required to take the residency if it was your 1st choice. If not you could deny it, take a year of FYGME and a finish up your residency privately. I think you can even get out of FYGME as well if you don't take the residency.

 

[brats800]

i am pretty sure that you can defer your military service and take a civilian residency if you did HPSP. if you do USUHS, however, you MUST do a military residency. that's how i understand it. i can't tell you what your odds are at getting such and such a residency, but i wish you luck

 

[GeoLeoX]

I am in the process of applying for residencies in the Army right now. I am glad that I chose HPSP, but that is me. My career goals happen to jive well with military needs and the military training for my specialty (pathology) is excellent. I want to do a military residency and I get the feeling from interviews and rotations that I will be able to do so. That being said let's get to some questions:

It would be foolish for me to state definitively that one will or will not get their career choice. It is especially important to remember that you must take everyone's advice with a grain of salt. Every specialty is different. That means that the advice that you get from someone may not apply to you. There have been many posts on this subject in this forum and I have put my big nose into some of them. Search for them for more info. However, I will try to answer things in the broadest sense. The way the Army works for FYGME (First year graduate medical education) is the following: You must choose 5 Army programs for the Army match. This is done on the net. You must also specify your career goal (your specialty of choice. Path in my case). Say there are only 3 path programs (which there are). It is recommended that I choose transitional programs for the remaining two spots on my list. Historically, around 85% of Army grads get one of their top choices.

Your chances of being granted a deferment are based on a number of things.
1. The military decides that it needs more physicians in a particular field than it would be able to train in its' own training programs.
2. You are a sufficiently competitive student that you can get one of those cherished deferment spots.

Here's an example from my school (several years ago). A student decided that he wanted ENT. The military decided that they needed 10 (for example) ENTs, of which they had the capacity to train 4 in their programs. The military handed out residency spots to the 4 people that they wanted in their programs (and I should add, the 4 people who wanted to be (or had to be) in their programs). Then the military handed out 6 deferments for civilian residencies. He did not get one of the military or civilian residencies and ended up in medicine. This is an extreme example. There is also different kinds of non-military residencies (sponsored v. non-sponsored) that I don't feel qualified to address.

One of the most common misconceptions that comes up in this forum (and at my school amongst other HPSP students) is that one has a free option to pursue civilian training if for some reason the military does not seem appealing. This is simply not true. As you can see it is quite complicated and again the specialty that you choose makes a big difference. Most people get their first choice and you will see as you progress in medical school that to get what you want you have to know how to get it. I wanted pathology, so I went on two pathology rotations, made sure that I impresssed the people that I needed to impress, got a letter of recommendation from the chairman of the department, did extra reading, etc. It's the same in the military as it is in the civilian world. If you want to go somewhere you better be sure that you are what they want.

One thing that I wanted to clarify is in texdrake's post, I think that he omitted one thing. If you decide to do just your FYGME training with the military you still have to pay back your HPSP service obligation after FYGME. If you opt to go this route you must pay back your entire HPSP service obligation. If you do not pay back your entire HPSP service obligation and then go onto to military residency you will incur an additional service obligation. It is complicated and I am too tired right now to explain in detail. If you need more elaboration I can do so.

Anyhoo, I hope that I answered some of you guys' questions.

Geo

One other thing that I forgot that is germane to this discussion: The Army does NOT grant deferments for combined residency programs (even if they offer combined residencies in those specialties).

 

[bustbones26]

Okay you have to beware of what recruiters tell you. My recruiter told me that the army doesn't work their residents like a civilian program does. Thsis simply not true, you get your a$$ busted just as hard in the military programs.

Yes, you make more money as a resident than a civilian resident. But guess what, you do not make more money as an civilian attending.

The military does not just hand out deferments so easily. I think GeoLeoX explained that very well. No, they do not let you do whatever you want. ENT, ortho, rad/onc, etc are all competetive and difficult residencies to obtain civilian. This is the case for military as well. Of course, a recruiter will tell you different, I guaranteee they will!

HPSP is an obligation. There are catches. For example, if you do a residency greater than four years, then your payback time will be more than four years. And just to be cute, the army makes gen. surg, ortho, etc six year programs at some of their institutions.

If you want to be a specialist, most do not just jump from residency to fellowship. You are more likely to acheive this route in the civilian world.

Your recruiters are there now, getting all the wrong info for you, etc. But once you sign on the dotted line, they disapear and when you have a question, too bad, they don't help you! My experience with the army has been if you need something, you call somebody, they tell you to call comebody else who has no idea who you are or why somebody told you to call them, then they have you call somebody else, and the beat goes on. Its like pulling teeth.

Again, yeah great, so a military resident is pulling in over 50K while a civ. resident may make only like 35-40K. But guess what, in the army, whether your a family doc or a neurosurgeon, when you graduate from residency, both get captains pay! a civ. gen. surg for example probably gets offered a position for about 200K, you make much less as a gen. surg. attending in the army.

I am not trying to steer anybody from HPSP believe me I am not. There are frustrations to the program, but I am still glad I did it. Just be aware that a recruiter will make it sound that all that glitters is gold. YOU must realize that its an obligation and a hefty responsibility to take if you sign for HPSP.

My advice don't do it for the money. If you do it just for the money, you will hate it! YOu will regret it! There are other ways to get money for med school if you are just out looking for a way to get your tuition paid.

 

[GeoLeoX]

amen.

 

[texdrake]

something makes me think someone didn't think things through. Even my recruiter said if you aren't going into primary care there is no monetary advantage due to the extended committment to going into the military. Incidentally Surgeons wouldn't get Captains pay either.

By the time you finished your residency you would most likely be a major (50K) plus have 6 or more years of service. Plus surgery pays about max on all specialty payments. Not to mention housing allowance and food stipends. Total compensation for a Surgeon in the military would be closer to 140-160,000. Not as much but not nearly as bad as what you think. For an OB/GYN it is 120K starting after residency, upwards of 150 if you committ to more than the one extra year. needed for the residency......

So not as much but not bad....not to mention you don't have to pay medical malpractice which runs about 60-100K a year. The military pays just as well if not better.

 

[Mirror Form]

Originally posted by texdrake
So not as much but not bad....not to mention you don't have to pay medical malpractice which runs about 60-100K a year. The military pays just as well if not better.

Your numbers for military pay are a little high. Yes, military doc's will make six figures, but it's low six figures. And the 200k starting salary for a general surgeon in the civilian world is generally calculated after expenses (including malpractice). So you'll make a significant amount more in the civilian world if you're doing surgery. That said, you'll be living comfortably either way!

 

[texdrake]

My numbers are pretty close. I used an online calculator that a friend of mine found.

 

[bustbones26]

I am not saying that an army doc will starve. I mean, after getting your entire med school paid for and everything, yes the military is a great opportunity.

But what I am trying to say is that a captain gets captains pay, and a major gets majors pay, no matter what they do.

I am also warning against what recruiters say. when somebody starts a sentence with---"my recruiter said---" You have to be careful.

I also wanted to clear up the fallacies of military medicine. EVerybody thinks that military residents have it cushy and that anybody in HPSP gets whatever residency they want. That is certainly not true.

And again, I would not steer anybody away from HPSP. I love it. But that is me, before anybody does it, think long and hard about it. There's more to it than just getting a free ride through med school.

 

[Mirror Form]

Originally posted by texdrake
My numbers are pretty close. I used an online calculator that a friend of mine found.

Hmm, I'm not sure how the online calculator determines pay, but I've calculated it the old-fashion way from the army's website that goes over the pay rates for 2003. Maybe I'm just adding them up wrong, but I don't see how you can get some of those salaries you quoted. Depending on how many years of service you have, starting salary can actually be less then a 100,000 per year (not for surgery though). Of course that's not including all the benefits you get, which may be what the online calculator is taking into account.

 

[R-Me-Doc]

Let me hopefully put this to rest by providing some hard numbers. I was recently handed my "Personal Statement of Military Compensation" (an annual document that the Army hands out that summarizes your earnings for the year). I am a captain, done with residency, with 5 years active duty in one of the lower-paying specialties. In the past year I earned:

Basic pay (what every CPT in the Army with 5 years earns): 46K
BAH (housing allowance, varies by geographic location): 8K
BAS (some kind of food allowance that I've never really understood): 2K
Variable special pay (varies by time in service, to max of 12K): 5K
Board certification pay (varies with time in servcice, to max of 6K): 2.5K
Medical Additional Special Pay (what you get just for being a doc; every doc gets SAME amount): 15K
Incentive special pay (varies by specialty from 13-36K): 14K
TOTAL: 92.5K

Also, I had 7.5K in "indirect compensation" which is inusrance coverage, tax savings due to housing allowance not being taxable, etc.

Because I just know that someone will ask, the highest incentive pay rates are currently 36K and are for neurosurg, ortho, anesthesia, cardiology, CT surgery, colorectal surg, oncologic surgery, peds surgery, plastic surgery, vascular surg, trauma surg, transplant, and, although it irritates me to no end, radiology (max pay for looking at pictures! what a scam -- the most incredibly overpaid field in all of medicine, military as well as civilian. Just had to editorialize there for a minute)

General Surgeons get 29K; ophtho and urology 28K. ER, GI get 26K. OBGYN gets 31K, ENT gets 30K.

The lowest rate is 12K for peds. Not much better is 13K for aerospace med, Fam Prac, PM&R, and preventive med. Internal med, neuro and psych get 14K. Other medicine and peds subspecialties get either 14K or 23K depending on which one.

 

[ATPase]

R-Me-Doc, this may be a dumb question, but when you say you're done with residency and have five years active duty, do you mean five years active duty post-residency? Or are you counting from the time you finished med school?

 

[chillin]

One additional thought. Every dollar that goes towards repaying a student loan has been taxed. This means that if you take out 200,000 in loans you will be paying 300,000 in gross income just for the principal. Take into account the interest you pay on a student loan, and this will go up significantly. So you can tack on 75,000+ in loan savings to your salary! There's no question that the military is financially better if you go to a private school and are going into primary care.

 

[texdrake]

Post Residency.

R-Me-Doc. Thanks for the clarification. I looked up the numbers again and the reason mine was so high was the guy that was looking them up when I originally posted was factoring the fact that he was going to committ for four extra years which gives yoo something like 25,000 extra a year for those four.

Still even with your numbers a starting FP is going to get: 93K (I used 10K for housing as it is around 800-900 in most places, your figure was a little low). That isn't including the fact that you don't pay malpractice insurance (FP is around 10k I believe). So total compensation is around 105K. Plus you have no debt and were paid while in school. You factor that in and one is looking at compensation over 140K a year. (Just not paying the loan back saves you 15-20K a year, then factor in that they already paid you 16,000 a year in med school)

Likewise for a general Surgeon the numbers are:

Pay: Major (as it takes longer to finish residency) 52K
BAH: 10k
BAS: 2K
VSP: 6K
BCP: 4K
MASP: 15K
ISP: 29K
TOTAL: 118K

Factor in: 4 years of pay in medical school @ 16,000 and 4 years of medical tuition @ 26,000 p.us the interest earned from then till residency is finished (about 30,000). Now divide by years of commitment for general surgery (5) and you add that the total: 198,000/5 = $39,600 or 40K.

Also factor in average malpractice insurance for a general surgeon is 60K (or close to a couple different sites varied but were right around there...cheaper in the NE).

Total Pay + Tuition/Pay/Interest + Malpractice Savings = Total compensation for General Surgeon in US Army after residency

118K + 40k + 60K = 218K

Average Salary for a practicing general surgeon out of residency = 150K-200K and you still have to pay malpractice.

The difference is that by the time the commitment is up the army doc will be making around the same amount 220K, and the private surgeon will be making 200-250K.



So, do some research and look at the stats is what I say.

 

[texdrake]

I thought I would throw out what I have figured out for myself about my future pay using the same criteria above. I plan to practice in FP or Internal so I will use those numbers. I also took a three year scholarship so I will figure that as well.

Max Loan x 3 years: $115,500 + 35,000 (interest @ 5% over 10 years) = $150,500

Total Pay x 3 years: $48,000

Total Pay + Loan / commitment = $66K


Pay: Captain 46K
BAH: 10k
BAS: 2K
VSP: 5K
BCP: 2.5K
MASP: 15K
ISP: 13.5K

TOTAL: 94K

AVG Malpractice Saving for FP & IM = 12K

Total = $172K annually for 3 year commitment

Drops to around 105-110K if I stay in longer as loose loan advantage

Average starting salary for FP / IM - Malpractice = $125K - 12K = 113K.

Average salary in private sector after 3 years (when my commitment is up), minus malpractice = $128K

 

[zreagle]

Thank you R-Me-Doc, Texdrake, and others who have posted information here.

I think it is very difficult to make financial decisions about Med school, primarily because physician salaries are so different from location to location and specialty to specialty.

Excellent point about loan interest. Sometimes I forget that 200K in loans is really 275-300k that you will be paying back. It is also difficult to factor in insurance because none of us know what the malpractice rates will be in 3-7 years when we will be entering general practice.

More questions for R-Me-Doc since you are done with residency. Did you get the residency of your choice? Where did you get stationed after residency and did you get any say in that decision? Do you enjoy R-Me life?

 

[FliteSurgn]

As someone else has pointed out, the numbers that texdrake is quoting as average civilian salaries are above and beyond malpractice. Malpractice is usually paid by the practice before paying your salary. Therefore, texdrake's comparisons aren't accurate.

One other thing to remember, you'll only receive some of those incentive pay amounts if you sign a contract to stay on active duty longer. The longer time you are willing to stay, the larger the incentive. And some incentives aren't even available until AFTER you fulfill your HPSP committment.

I have over 6 years of prior service, have 7 years of creditable service, will be a major when I come back on active duty, and am a general surgeon. My pay will be about 120k/yr. That is a far cry from the 250k+ that my friends are getting for starting general surgery jobs. And once again, that is after overhead.

 

[pbp4]

i have read this whole post and although late to the discussion- i would still like to weigh in. DO NOT make this decision based on money- if you do you will regret it. in addition, you may think you know what you want to do as an MSI- but I can assure you many a first year FP have turned into a fourth year neurosurgeon. but as for the money there are so many variables that you cannot fathom as a starting med student- just one for thought.... you get out of the military and you get your first job with say three other surgeons- you are livin large and thank god no student loans to pay- then we need to invade some country that you have never heard of- guess what-you are called up because you are on ready reserve (the recruiters usaully forget this one) and suddenly the half mil you were making is gone- not to mention the debt you will owe your partners- money or personal. so if you want to serve your country- go for it but you are a fool if you do it mainly for the money. this is not even to mention the places you may need to serve.

 

[trauma_junky]

Thas why you put in your 20 years, retire with 80% of your salary, which you should be close to a Coln. by then.

 

[FliteSurgn]

Whoa, who told you that retirement is 80% of your salary? It is 50% and that is only taken from your base pay. That means that you get 50% of 50k. Retirement does NOT take into account any of your bonuses.

So, you'd retire with 20 years and be making 25k per year. Big whoop. Like others have said, don't do this for the money. It does not make any kind of financial sense to make lots less money for 20 years so that you can "retire" on 25k per year. Do it because you love it or because you have a sense of duty to serve this country, but never think that you're getting a good financial deal. The numbers just don't add up.

 

[entpa]

Sorry Flitesurgn, unless you entered the military prior to 1980 retirement can be significantly less than 50% at 20yrs. You do get 2.5% per yr after 20 though.

 

[pilotdoc]

They changed that 1980 rule back a few years ago - 20 years is 50% of base pay, with a 2.5% increase every year thereafter, i.e., at 30 years you would get 75% of your base pay. (USUHS grads get an additional 4 years of retirement pay %, when they retire, for time spent in the school.

If you are an O-5 (Lieutenant Colonel) right now retiring with 20 years, your retirement would be $36,000.

 

[pbp4]

again, if you make this decision based on money, you are a fool. many of us were fools also but no one told us the details. furthermore, when people talk about retirement, one has to remember that most civilian physcians own a large stake in their practice. some, like my uncle, even own the freakin' building- so he sold his practice for a large some of money and is still collecting rent from the doc that bought the practice. so again, there are so many variables when it come to compensation that you should forget it as a factor in this important decision.

you can of course make a excellent living in the military as a doc. but it will never match up to civilian pay for the vast majority of docs. anyone who tells you otherwise does not know many civilian docs (or at least not well enough to know what kind of money they make).

do it to serve your country and get paid to go all over the world and practice medicine in ways civilians are clueless about- if those things do not appeal to you- take out the loans and owe the bank.

-p

 

[ducom]

There's been some contention on the point of malpractice numbers and whether the usually quoted numbers include it or not. I found that the entering average pay for a general surgeon in 2008 is 239,000.

http://www.cna.org/documents/D0003361.A1.pdf

Does it seem that this includes malpractice? Considering a high malpractice rate in areas I would want to practice, this can amount to a large sum, so please weigh in!

There isn't a great disparity anymore if the malpractice is subtracted from that number, especially because ISP for general surgery has been raised now to $50,000 bringing total pay to around $130k. However, the gap widens if that 239 number is after malpractice/business costs. Thanks.

 

[The White Coat Investor]

There's been some contention on the point of malpractice numbers and whether the usually quoted numbers include it or not. I found that the entering average pay for a general surgeon in 2008 is 239,000.

http://www.cna.org/documents/D0003361.A1.pdf

Does it seem that this includes malpractice? Considering a high malpractice rate in areas I would want to practice, this can amount to a large sum, so please weigh in!

There isn't a great disparity anymore if the malpractice is subtracted from that number, especially because ISP for general surgery has been raised now to $50,000 bringing total pay to around $130k. However, the gap widens if that 239 number is after malpractice/business costs. Thanks.

Gen Surg ISP isn't $50K. The max ISP is $36K. I think Gen Surg last year was $29K. I don't think it was raised this year, but I don't recall exactly. Be sure to learn the difference between MISP and ISP. MISP only applies to those who have finished their educational commitment. This is where the military is throwing money at General surgeons. If you are a college senior, you are 14-17 years away from receiving MISP (varies depending on whether you do straight through training.) No one knows what MISP will be in 17 years.