National Public Health Service Corps vs. Military Healthcare Scholarship

[RummyMD]

Hey everybody I'm currently a sophomore undergrad and I've been trying to figure out which of those two programs to use to help me pay to get through medical school. I know that the NPHSC pretty much pays back your med school tuition if you agree to work in an underserved area located in various places around the country. After your term is served, then you are free to practice where you please. As for the military healthcare scholarship, they pay for all of your med school and residency costs up front, while paying you a stipend as a military officer throughout your schooling. And once your schooling is finished, you pay back the military by serving for the number of years you were in residency/sub-specialty. And again when you finish your repayment you can remain in the military or be discharged and work wherever you like.

So my question to all of you is which of these programs would be the best to pursue to pay for and help me through medical school? I like the service corps because I actually discovered that there are areas in need right around where I'd hopefully like to set up my eventual practice in the Buffalo/Niagara area of NY. So after my time is spent serving the service corps, I could simply try and carryover my patients throughout that time into my own practice when I'm on my own then. With the military scholarship, they pay for everything and take care of all the overhead and insurance information business that I don't quite have a grasp on at the moment but would know about by the time I'm through medical school. The upside to that is that I simply don't have to worry as much about it because it'd all be taken care of by the military. And I know that you are usually placed on or near a base, especially if you're going into primary care like me (hopefully family practice), but you get a top 3 choice list of where you'd prefer to be placed which is nice. And I wouldn't be solely interested in the military simply because they pay for everything, I've actually considered enlisting quite a few times before now, but the situation at those times never really ended up calling for me to need to go through with it.

So if any of you have had any experience with either of these programs, please feel free to add any input about these two choices, and possibly correct any misinformation I may have or misconceptions most people have if they sign up for either of these. Just trying to figure out what my different options are as I get closer to medical school is all

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[Deekle]

A few points of view on this:

1) HPSP is primary care only. If you're even possibly considering any path that is outside of primary care then you may be wasting your time even considering HPSP.

2) HPSP is a scholarship. Especially in a bad economy there are plenty of people who apply and don't get accepted. (Just saying that even if you go primary care, there are no guarantees)

3) There are also loan payback programs through DHHS that pay down med school debt in exchange for serving in underserved areas.

4) If you remember one thing about the united states military (I'm a vet), remember that they will always, always, 100% of the time do what is best for the military and not what is best for you. They will pay for your med school, but you are not guaranteed a residency. If they want to send you to Afganistan to treat people with the sniffles so the real docs can go plugging holes, that's what they're going to do. Once you sign on the dotted line you have effectively no say in your future. If you're flexible by nature and young, this could still be a good option for you.

All of this is not to discourage you, but to inform you. I've looked into these programs myself and come to the conclusion that they are not necessarilly a golden ticket through medical school, but are still good ways of getting through if you are willing to pay the piper.

 

[dr zaius]

A few points of view on this:

1) HPSP is primary care only. If you're even possibly considering any path that is outside of primary care then you may be wasting your time even considering HPSP.

2) HPSP is a scholarship. Especially in a bad economy there are plenty of people who apply and don't get accepted. (Just saying that even if you go primary care, there are no guarantees)

3) There are also loan payback programs through DHHS that pay down med school debt in exchange for serving in underserved areas.

4) If you remember one thing about the united states military (I'm a vet), remember that they will always, always, 100% of the time do what is best for the military and not what is best for you. They will pay for your med school, but you are not guaranteed a residency. If they want to send you to Afganistan to treat people with the sniffles so the real docs can go plugging holes, that's what they're going to do. Once you sign on the dotted line you have effectively no say in your future. If you're flexible by nature and young, this could still be a good option for you.

All of this is not to discourage you, but to inform you. I've looked into these programs myself and come to the conclusion that they are not necessarilly a golden ticket through medical school, but are still good ways of getting through if you are willing to pay the piper.

1) False. The military has most residencies (aside from combined like straight through vasc surgery, plastics). I can send you the military match stats for this year if you don't believe me.

4) Pretty much true. If you're stuck doing a GMO, FS tour, etc you will be plugging holes. This is less likely in the Army as they have more straight through training (internship and residency are usually not split by a GMO tour).

OP, go check out the military medicine forums on SDN. They are a wealth of knowledge.

 

[notbobtrustme]

Most of those programs are a negative investment because you lose out on time you would be actually earning money/specializing. Even with loan forgiveness in the case of the NIH, you would still be better off specializing than doing primary care in an underserved area. However, if your goal is primary care, then go for it.

The HSPS is very competitive (only a few hundred spots vs thousands of applicants) plus you effectively sign away decision making regarding your career as the other poster above said. There's a forum here dedicated to military medicine and it might be worth checking it out for further clarifications.

 

[Barcu]

If your goal is primarily to get med school paid for, neither of the programs is worth it.

A few points of view on this:

1) HPSP is primary care only. If you're even possibly considering any path that is outside of primary care then you may be wasting your time even considering HPSP.

Actually, National Health Service is primary care only. You have to serve your payback years before you can subspecialize.

As Dr. Zaius mentioned, you can do any residency you want in the military and you cannot be forced into a residency. You can, however, be forced to do a GMO/FS tour or live anywhere the military sees fit. OP, if you're interested in this, do A LOT more research.

Again, if the primary motivation is money, don't do either.

 

[Brachyury]

You're probably worried about the cost of medical school, which is common and understandable, but know that the majority of students take out loans to cover their education.

Unlike the HPSP, the NHSC scholarship is very competitive: less than 15% of applicants are awarded the scholarship, so it's not something to consider a 'sure-thing.' You're chances of being awarded a NHSC scholarship increase if you are from an urban or rural area that is medically underserved

 

[NickNaylor]

Many people (and dr zaius alluded to this) have encouraged people thinking about doing HPSP to do it only if they want to be in the military. In other words, it shouldn't be viewed strictly as a way to get your education paid for; it should be thought of as a convenient way to get some benefits out of something you were already seriously considering. Remember that in return for having your education paid for you're signing up for a military commitment. That's not something you should decide lightly.

I agree with Barcu in that doing either of these programs strictly for money isn't the best way to go. There's a good chance you could end up regretting your decision.

 

[dr zaius]

HPSP is only competitive in the sense that many people apply for it. The average GPA and MCAT of HPSP applicants is lower than the average for accepted allopathic students. If you have a solid GPA and MCAT as well as a sound reason for wanting to join the military you have a pretty decent shot. The reasons for this are deployment (you will be deployed away from your family and friends), the commitment, the fact that the military serves its own interests and not yours, and on and on. If you have a desire to join the military and be a military physician (read: you will NOT be knocking doors down and you will likely NOT work with special forces) HPSP is a great way to go.

It is not fiscally responsible compared to taking out loans. If you're thinking of doing it just to pay for school you will likely hate your life.

The idea that HPSP "is for primary care" is absolutely false. As if the military wouldn't need a full spectrum of care. There's everything from rad/onc to pediatric neurology.

Again, I implore you to search through the milmed forum here. You'll learn all there is to know about HPSP.

Edit: sorry for the seemingly pressured speech. Pathology final was today.

 

[Deekle]

Yeah, I was getting my terms mixed up. When I referred to HPSP being primary care only I was meaning the NIH scholarship.

 

[Brachyury]

Yeah, I was getting my terms mixed up. When I referred to HPSP being primary care only I was meaning the NIH scholarship.

You messed it up again: the NHSC scholarship is from the Department of Health & Human Services, not the NIH.

I am not an NHSC scholar, but I suggest you (the OP) read more about it. The NHSC can change the score required for scholars anytime they want. For instance, when you enter, the score for a scholar could be 13, but when it comes time to serve, they might decide to bump the number to 17 (thereby limiting where you can go and pushing you into the less desiarable locations). Much like HPSP, if you genuinely want to do primary care, OB/GYN, or psych in an underserved area, then the scholarship is a great fit, but if not, you're likely to be miserable (especially if you get married and have a kid in med school/residency, and your spouse cannot find a job in their field in rural Kansas and the quality of schools are not as good as you would like for your child). You can also read horror stories of OB/GYN scholars on old SDN threads (due to fewer scholar OB/GYN spots, they seem to get screwed more than the other scholars)

 

[smq123]

For instance, when you enter, the score for a scholar could be 13, but when it comes time to serve, they might decide to bump the number to 17 (thereby limiting where you can go and pushing you into the less desiarable locations).

Current HPSA score is 16; it actually went DOWN from when I was a med student (used to be 17). But it was 14 back when I was in college, so yes, it does fluctuate quite a bit.

I know that the NPHSC pretty much pays back your med school tuition if you agree to work in an underserved area located in various places around the country.

It doesn't "pay back" med school tuition, it flat out pays for tuition. The NHSC writes a check out to your med school.

I like the service corps because I actually discovered that there are areas in need right around where I'd hopefully like to set up my eventual practice in the Buffalo/Niagara area of NY. So after my time is spent serving the service corps, I could simply try and carryover my patients throughout that time into my own practice when I'm on my own then.

This is a little optimistic.

For a LOT of practices, once you leave, you agree not to practice in the nearby vicinity for X number of years after you leave. This is known as a "restrictive covenant" and is very common for physician contracts. The most lenient I've seen is a 5 mile radius for 5 years; some of the really bad ones (often in rural areas) say a 50 mile radius for 10 years. This is designed to DISCOURAGE what you've proposed - practices don't want to lose patients, even to physicians that used to work for them.

So I wouldn't bank on taking your patients with you when you set up your eventual practice.

I like the service corps because I actually discovered that there are areas in need right around where I'd hopefully like to set up my eventual practice in the Buffalo/Niagara area of NY.

Keep in mind that some rural hospitals/practices will invest a significant amount of money into you, if you are willing to commit to work for them once you finish residency. Some rural hospitals will even offer to pay you a stipend during your last year of residency. So, it's not like NHSC and the military are your ONLY options.

 

[Deekle]

You messed it up again: the NHSC scholarship is from the Department of Health & Human Services, not the NIH.

Par for the course this week. I think I'll go retire into obscurity.

 

[RummyMD]

Well thanks you guys for clearing up a few things for me and even showing me some new info I hadn't known before. So from what I can tell, a big deciding factor for both programs is whether or not I want to pursue primary care, which I do hence wanting to go family practice, so I have that going for me so far. And as for what was said about the military scholarship and the repayment plan, I would most likely be choosing the Army, where I understand that your residency remains uninterrupted, although you do go through officer training sometime during medical school. And although there is always the possibility I would be stationed somewhere other than my top 3 choices they'd allow me to pick, I don't think I would be too upset if placed elsewhere, as I have always wanted to be able to see new places and have experiences in new areas or even new countries as well. I will definitely make a note of checking out the military medicine forum soon to find more clarification on anything I need to know though.

While I certainly am worried about paying for medical school, it's not the main reason why I would consider either of these programs. I simply saw how that both of these would allow me to compound my desire to practice family medicine, be able to effectively pay off all or a majority of loans I would have to cover, and to be able to help those in need whether they be families or friends of those in the military or people living in rural or urban underserved areas.

And smq123, thanks for letting me know about the "restrictive covenant" that happen with practices associated with the NHSC payback. And I know I can be a too little optimistic about carrying over patients after I finish my term of service, but I think I simply meant along the lines of becoming more well-known amongst patients in a certain area. This would certainly help me in setting up a local practice when the time comes for me to set out on my own. And for all I know, I may not even decide to serve my term where I would eventually have my own practice, but it's a nice thought to have as a naive premed undergrad wouldn't you think?

With the main focus of my post being on either the NHSC or HPSP programs, I'm not entirely forgetting about other possible options, it's simply that these are the biggest ones I've encountered up to this point. In the future I may come across other ways to get through med school and residency that may in fact be a better choice for me, but for now I'm still searching. For now as a lowly hopeful undergrad I'm content with researching the different options I have available to me and being able to find the best choice that fits me.

 

[smq123]

And smq123, thanks for letting me know about the "restrictive covenant" that happen with practices associated with the NHSC payback. And I know I can be a too little optimistic about carrying over patients after I finish my term of service, but I think I simply meant along the lines of becoming more well-known amongst patients in a certain area.

Sorry, I did not mean to sound dismissive. I think it'd be great if you could go back and serve your community, but there were a lot of things about the "business part" of medicine that I didn't know when I was in your shoes....but wish I had known.

And to clarify, the restrictive covenant happens with many physician practices, not just NHSC practices. All physician practices want to keep their patients for themselves and will take measure to protect that.

Speaking as an NHSC scholar, I don't know if I would do it again. When I first took the scholarship, I was single and sure that I'd do either peds or Family Med. By the end of 3rd year, I had started dating someone, and I was very sad that I didn't have the chance to pursue a career in surgery. It didn't help that the person I had started dating was also a med student who wanted to pursue a very competitive specialty (radiology). Not really having that freedom to investigate other specialties, or feel like I had more control over where I ended up, job-wise, was very difficult. It caused a tremendous amount of strain in the relationship, since neither of us knew where we were going to end up.

Don't get me wrong - not having debt is great, and it certainly does free you up to take a job in a setting that might, otherwise, be financially untenable. But it does come with a lot of disadvantages that might, potentially, make the scholarship (military or NHSC) not worth it in the end.

 

[Bacchus]

I'm just going to offer an opinion, but defer to a lot of smq's postings in this thread because she is an active NHSC scholar.

You don't know where you stand when you start medical school. You try planning your future but as time progresses things change, dramatically. Where I saw myself after starting college and even at the completion of the degree (2009) are so vastly different than my intentions now as a 3rd year medical student who will be interviewing later this year. Your life changes, your intentions change, and nothing goes as planned.

The thought of primary care made me laugh. I wasn't going to do that. No way, no how. Now I'm going to either pursue family medicine or OB/GYN (both of which are NHSC approved specialties). I don't see myself living in a city anymore. In fact, I would say my dislike for the city is almost borderline hatred. I want to return, relatively, to where I grew up. My aspirations more so reflect what I said in interviews. Maybe my nerves brought out the truth.

I'm saddled with debt and considering one of the lowest paying specialties. I wish I had applied for the NHSC scholarship in my first year, but of course I had no intentions of being where I am currently. I had a friend who did so and received it, getting 3 years of medical school paid for. It's a huge relief to know you can pursue primary care without worrying about the creditors lurking behind you. If you want to be a primary care physician and KNOW IT WON'T CHANGE, I suggest applying for the program, but that might be the gnawing fear of my loans talking.