Monologue ahead

[Gunsmoke841]

Hello all,

I am a long-time reader of SDN but this is my first time posting, so I apologize ahead of time for overlooking any customs and/or if I have simply failed to find answers on my own. Thank you all for your continued addition to these discussions so that we hopeful students may learn from your experiences. I will try to strike a balance between brevity and completion as I describe where I’m coming from and where I want to go.

BLUF: I’ve been planning on attending USUHS for years but over time I have begun to question my path.

I am a married, 26-year-old Marine vet w/4 years AD ending in 2017. My wife and I met when we were teenagers and married in 2015, so she stuck it out with me through my maybe somewhat-impromptu decision to enlist a year after we met, and then through two deployments and now into my undergraduate education. We had our complaints about military life when I was enlisted—trust me—but there was also a lot of things we enjoyed about it, too. I was an infantryman, and a kid, so maybe some of the running around playing games seemed a little less frustrating at that time, but I proudly maintain that my service was a generally positive experience that played a large role in my development.
Additionally, my wife enjoyed not having to work while she could finish her education, and we discuss now how the early financial stability of a pipeline like USUHS would be very helpful to our goals of starting a family. (I’ll be 32 when graduating med school, so we want to bring kids into the picture sooner or later) I have seen thread after thread offering wisdom against choosing mil med for financial reason. So, I will also express that I have been so passionate about the idea of putting the uniform back on and giving back to the community that raised me as a young man—this cause has driven me. Because of this, I have been able to get passed a lot of the frustrations that I have read about on SDN (not all—some really horrible stories have been shared and I will not forget them). Perhaps another factor in my ability to rationalize these issues away is that I have experienced one or another form of many of these frustrations in the infantry; administrative overload, complete disconnect between higher command and ground level, mission requires inaccessible logistics, unforeseeable last-minute changes to your orders, etc. And, even though I have read on here about bigger and bad-er version of these issues, I have thus far stayed true to the course: attend USUHS and follow through to retirement (which would mean 5-6 years after ADSO).
But as time moves on and I approach my graduation (spring 2021), I have started to waiver in my commitment to this plan. What is the issue that has loosened my devotion? The time commitment.
Although I could see myself putting on a smile regardless of the issues around me (perhaps a character flaw on its own, but beside the point), I simply don’t know if I can commit to a path for nearly 2 decades (fulfilling ADSO would end in 2037, retirement in 2043). Doing the civ route, I would not have to lock myself to such a commitment, but it would also mean that my wife and I would have to go it alone and struggle for years to come, and having her be able to stay home with kids 4 years from now is something that is important to us—its one of the reasons we have been careful not to have had any children already. I understand it can be done, though, through intelligent barrowing and having a plan to pay student loans off as efficiently as possible. (PSLF is one option that comes to mind—in which I could still spend some time in the service)

Now, I somewhat apprehensively hand over my story and ask for any insight that might be helpful. Are the financial/healthcare/retirement benefits of the USUHS pipeline going to be as helpful in starting a family as we believe? Or is going the civilian route just as do-able? I will remain open to any criticism and advice. Thank you for taking the time to read my small autobiography!

As an aside, I am currently interested in primary care—something that is congruent with predictions about the future of mil med, but I am not foolish enough to deny that I may one day discover a passion for a less mil-friendly specialty.

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[deleted480308]

I’m a family guy too, nontraditional who went mdssp with the guard (don’t recommend it financially when compared to hpsp or uhsus)

Long term over life? The military probably costs you money and definitely costs you freedom/risk/flexibility

Short term in regards to feeding kids while in school/residency? The military helps a lot. But there are strings attached to the money up front

 

[CABG patch]

I’m also a non-trad who did hpsp and was prior enlisted. Usuhs may have a steady income but there’s a lot of downsides as well. You may be interested in primary care now but that will likely change during med school. I know many people who went in thinking they were going to be one kind of doctor and came out doing something completely different either because they decided the lifestyle wasn’t for them or fell in love with a specialty they were never exposed to. If you decide you want to do something very specialized, especially in a surgical field, you may be limited in your case volume or opportunities.

Milmed is in a huge amount of flux and there’s not a person on the planet who can tell you what it will look like in 5 years, much less 7-10 years once you finish residency. Anyone who tells you different is probably telling you a story. I can’t even tell you what my career field will look like in 5 years. Thousands of people with families go through med school as civilians and do just fine. It’s hard to judge this early in your career if this is a good call which is why undergrads are so heavily recruited vs people done with training. If you get done with med school and residency and still want to serve, the military will always be here needing physicians and willing to help with student loans.

Lastly, prior enlisted guys tend to underestimate the amount of bs you’ll deal with. It’s one thing to be treated like a cog in the war machine when you’re a trigger puller. It’s an entirely different thing to be treated like one after 12 years of training and are highly specialized to take care of a specific population and are put in a primary care spot taking care of very healthy people.

 

[Cooperd0g]

Do you still have your post 9/11 GI Bill? If so, you should be able to get in state tuition to any state school. What state are you a resident of?

You could also look at HSCP with the Navy. With 4 years enlisted, 4 for med school, 1 for internship, 4 for payback that is 13 years total towards retirement. You could get out and do a civilian residency at 13 years. Or you could do a Navy residency and be very near retirement by the time you are done with your payback.

 

[Gunsmoke841]

Thank you all for your valuable input! Many good points to consider here. Even though I spend quite a bit of my precious free time reading documents from Congress, DoD, etc. in an attempt to give myself the best shot at controlling my destiny(I try to be aware of current events in milmed), I have reconciled the fact that such control can not be established. Additionally, I agree that my 19 y/o self was more likely to shake off the usual bs than I will be after years of sacrifice and work.



I am an AZ resident. Unfortunately, I did not realize the benefits of conserving my GI Bill until I finished my first two years of undergrad. Had I been wised up earlier, I would have sought the cheapest undergrad study possible and saved the benefits. I think if I were to attend a civ school, I would rather do it on fed loans than HPSP/HSCP. HPSP was the first association to mil med that I learned about, so researching that was what led me to learn about USU.



Although it opposes my USU plan, a lot of what I am reading here reverbs off of my own concerns. I am thankful to know that they are not without reason. For a while now I have been without a plan B—to focused on A. Public Service Loan Forgiveness has been an idea that I have been exploring more and more. Never in my life have I had experience dealing with the amount of money that exchanges hands throughout the road to medicine. So it hasn’t been easy thinking of putting such a debt on me succeeding, but I think I have become confident enough to gamble on myself over uncle sam.


I could choose a med school with a good tuition/scholarship ratio, borrow money for med school and live wisely. Then, continue to live modestly and begin qualifying payments on my loans during residency, bringing me 4 years closer to PSLF. If after residency I still wish to serve, I could easily finish those my remaining 6 years of payments in the mil. This route is not nearly as well suited to retirement in mil and involves familial struggle early on. However, it also guarantees my ability to choose for myself where my family will go. Does anyone have an insight that I might be missing? Or a similar but better alternative? What is it like trying to bring up kids in med school on loans? I appreciate everything that has been offered thus far and will consider it thoroughly!

 

[vom-]

Wow you are eerily similar to me! I was in the Army infantry and got out in 2017. I’m married with 1 child. We want more kids sooner rather than later, and my wife also has high educational goals. The military isn’t the greatest, but I think it’s the best deal for me right now. Daycare is expensive, and the CDCs have amazing rates compared to civilian daycares in major cities($500-600 vs easily $1500+/mo). I could not bare making my wife be a stay at home mom for 4 years because we wouldn’t be able to afford daycare. My goal right now is HSCP, like Cooperd0g said, the med school years count toward your 20 unlike USUHS, and you get paid as an active duty E6 the entirety of med school. I already have 6 years, and I would retire at 42. The downside is it doesn’t pay for your school. But, being active duty, you could go to any state school and get their in-state tuition(I think) and not have to take out any COL loans. I wouldn’t be mad if I had to go to USUHS either. It would just suck having to retire 4 years later. I realize milmed is a huge risk, but I’d rather my family be happy and comfortable and allow my wife to also reach her goals. USUHS also has 2 slots for IHS every year. They just have specific residencies they allow. You also get to do a civilian residency for IHS I believe.

I am only doing this because I have a kid and want more in the near future. If it was just my wife and I, I would choose civilian 100%. I would much rather have the certainty of getting the specialty I want and the possibility of matching into a top-tier residency that could train me better than a military residency.

Edit: oops sorry almost forgot another huge factor: health insurance! Health insurance for a family with children is very expensive. Tricare is free.

 

[teacherman84]

Wow you are eerily similar to me! I was in the Army infantry and got out in 2017. I’m married with 1 child. We want more kids sooner rather than later, and my wife also has high educational goals. The military isn’t the greatest, but I think it’s the best deal for me right now. Daycare is expensive, and the CDCs have amazing rates compared to civilian daycares in major cities($500-600 vs easily $1500+/mo). I could not bare making my wife be a stay at home mom for 4 years because we wouldn’t be able to afford daycare. My goal right now is HSCP, like Cooperd0g said, the med school years count toward your 20 unlike USUHS, and you get paid as an active duty E6 the entirety of med school. I already have 6 years, and I would retire at 42. The downside is it doesn’t pay for your school. But, being active duty, you could go to any state school and get their in-state tuition(I think) and not have to take out any COL loans. I wouldn’t be mad if I had to go to USUHS either. It would just suck having to retire 4 years later. I realize milmed is a huge risk, but I’d rather my family be happy and comfortable and allow my wife to also reach her goals. USUHS also has 2 slots for IHS every year. They just have specific residencies they allow. You also get to do a civilian residency for IHS I believe.

I am only doing this because I have a kid and want more in the near future. If it was just my wife and I, I would choose civilian 100%. I would much rather have the certainty of getting the specialty I want and the possibility of matching into a top-tier residency that could train me better than a military residency.

Edit: oops sorry almost forgot another huge factor: health insurance! Health insurance for a family with children is very expensive. Tricare is free.

Not prior service, but I went into med school with one kid and a wife who genuinely loves being a stay away home mom and wanted to have a few kids while young.

I looked at USUHS or HSCP as the best options given the steady income and Tricare. Luckily I was wait listed at USUHS and my wife vetoed the Navy. I went HPSP and while it brings a lot of the headaches, it's a lot less of a commitment and med school really wasn't too uncomfortable.

School, books and fees are paid for...which for most schools these days is a huge sum. They paid for my health insurance...after paying for my family's health insurance for MS1 with student loans, I swallowed my pride and out my kids on Medicaid and bought my wife a disaster plan, and she had Medicaid when we had a second child during school.

The stipend wasn't enough to live on, so we took a small amount in federal student loans each year so we could live a normal life. Granted I intentionally went somewhere with a reasonable cost of living, which helped.
We left med school with minimal loans, 4 year commitment (which could be horrible, but this far has been good to me so far).
At this point in mil med, I'm seeing multiple people leave active duty at 15+ years, so I'm not too concerned about those 4 years not counting toward retirement. A reserve retirement is much more likely at this point and those HPSP years count.

I think the 3 year difference between HPSP is huge, whether you staying or get out.
Say you want a specialty the mil doesn't need...doing 4 years as a GMO and then getting out isn't ideal but much more palatable than 7.
Same thing with fellowships...doing 4 years as a generalist and then getting out for fellowship.
3 years closer to the freedom to choose. If getting out then run, if staying in, that's 3 years closer to a jump in income with retention bonuses, which depending on your specialty, will likely be more then the income difference of USUHS vs HPSP.

 

[DeadCactus]

The reality for the finances of medicine are that you would far better financially taking out loans like 90%+ of medical students (even the ones with kids), going to a cheap medical school in a low cost of living part of the country, match into a well-paying specialty in a low-cost part of the country, work in a high-paying part of the country for a few years after residency, and not get divorced. The military doesn't even come close to offering a real financial incentive until you start straying from that ideal. Want to go to go to a $60k/yr medical school in the northeast and then match into pediatrics? OK, maybe maybe one of the military routes makes that more viable.

You want to do it because you want to serve and you want you family to be more comfortable during training (rather than maximizing long-term financial gain), which is a totally fair an valid approach, so now it's damage control. To me, USUHS is for people with prior service who feel certain they want a full 20+ year career in the military, want military leadership roles, and have stay-at-home spouses or highly mobile careers. I would take HSCP over USUHS, the earlier retirement more than makes up for the slight decrease in pay during medical school and you have more flexibility with it. I would take HPSP over USUHS for the increased flexibility.

The Guard/Reserve are worth exploring but probably not a good fit if your main priority is an improved financial situation during medical school. Going the MDSSP route starting in medical school is too long of commitment in my view. But depending on the state you end up in medical school, the combination of traditional loans, state Guard benefits, TriCare, and a little bit of drill pay from joining without any incentives may be a reasonable compromise for you.