Navy HPSP - Thinking about doing it for the money

[JMC_MarineCorps]

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Hello all,

I have been scrolling through this military med forum for a few days now, and I thought I would put this out there.

I have been thinking about applying for the Navy HPSP this year (due to start class on Aug 4th), which apparently is still not too late as long as I get my stuff in fairly soon.

I served 4 in the Corps as an 0311, so my sense of duty,and service to my country, has long been fulfilled...my question is why does everyone say don't do it for the money? When I joined the Corps straight out of high school I needed to get on the right track, but more importantly, I felt that I needed a way to pay for college -- so I joined and it worked out. I rec'd the GI Bill, took out some additional student loans and I have developed into the man I am today in large part because of my military service.

Now, there are many aspects that I loved about my military experience and probably even more that I didn't like at all, but the payback is just 4 years after residency -- seems like a small price to pay for such a large monetary incentive. I am looking to take out 52K/year otherwise. Tuition is close to 35K and I'll need to borrow cash to subsidize cost of living expenses (I am married and have two kids so roomates are out of the question).

One final note -- I had a USUHS interview (later offered a post-bac rather than outright acceptance), but was severely turned off by the school...more so due to other factors that I didn't like, i.e. the DC area in the winter (I am from SoCal) and the fact that I got a speeding ticket on base the day of the interview and was subsequently treated like I posed a threat to national security (maybe I am just out of touch since my EAS was in '97 and a lot has changed in this post 9/11 climate).

I only bring that last part up so you vets out there know that I am well aware of the garbage one deals with in the military. If I were to apply and accept the HPSP it would be for two reasons: (1) free tuition and monthly stipend (2) the prospect of staying in CA for my residency and service (which I think I would be able to pull off if I volunteered for a Marine billet as I imagine these are not very popular among most Navy docs). Thinking EM or Ortho.

Anyway, terribly sorry for the longwinded post. I know many of you currently serving are very knowledgeable so I look forward to hearing from you.

Thanks in advance,

JMC

 

[militarymd]

If you are familiar with the military (prior service, etc...), then doing it for the money is OK, because you know what you are getting into.....but even then, many become disillusioned because the practice of medicine and the practice of military medicine are 2 different things.

For those who are not initiated into the military way of life....looking at the financial benefits only will lead to a very dissatifying career.

 

[polkadot]

I just finished my 7th year of active duty and now am applying to optometry school for admission in '05. I've decided against applying for a Navy scholarship because the incentives don't add up. I would agree that four years post-residency doesn't seem like a long time. However, think about it in these terms. At the earliest, my commitment to the military will be completed 9 years from now (I don't know what your residency requirements will be, so add those years on top). That only adds 4 years towards retirement, so I would have 11 years active duty. That leaves me at age 38, trying to start a private practice from scratch or still 9 years to go for military retirement. Granted, graduating debt-free is nice, but I'd rather break out on my own, suffer a few years paying off my school loans and be able to sleep in my own bed (that isn't made of steel and doesn't rock side to side) every night. Like you, I don't have a problem with the idea of service, but being close to my family is more of a priority for me now. And as you know, there are no guarantees for duty stations.

-polkadot.

 

[JMC_MarineCorps]

Thank you for both of your comments. I am still on the fence. Any others out there with an opinion on the matter?

 

[edmadison]

Thank you for both of your comments. I am still on the fence. Any others out there with an opinion on the matter?

I think it is a fantastic deal if you know what you are getting into. If you do your homework and are ok with it, I would sign up (that's what I did).

Things to be carefull of (you probably know some of these, but for others);

1) GMO
2) Deployment (both you once you are finished, but also the staff that trains you).
3) Increased obligation from long residencies
4) Limited patient volume and diversity in some specialties -- especially some surgery programs.
5) Crappy post residency billets (Please not Ft. Polk, Please not Ft. Polk)
6) Working for/with people who don't place quality patient care high on there objective list.
7) Being evaluated on non-medical issues (e.g. your ability to run 2 miles in many ways is more important than your ability to generate a good DDx)
8) Posiblle discrimination by those in the civilian word who think the only reason people become military docs is because they can't make it in the real world.
9) Overly high emphasis on the resident in-service exams.

Thats a good start to the list, other people may have some items to add.

Good luck and Hoo-ah

Ed

 

[EvoDevo]

I think that, given your prior service and age, you're looking at career service. Here's why:

- Let's posit an age of ~30.
- Four years of med school (doesn't count towards service obligation). -->34 y/o
- Three years residency (EM) or ~ seven for ortho ----> could be 37-41 y/o {range}
- Now you do your payback time = 4 years. --->41-45 y/o {range}

It is at this point that you would (theoretically) be eligible to complete your service and return to civvy life.

Of course, starting or joining a practice at this age isn't a problem, but from a financial standpoint, you've "lost" at least four years of possible earned income: I believe $150K for EM and ~$250-$300K for ortho (however, these numbers are rough and I'm too tired to looke them up tonight.)

Let's play with some numbers, shall we? I've been thinking the same as you, so this is instructional.

Here's after residency breakdown as I interpret it:

• Basic Pay (O-3E < 6 yrs): $4, 027.20 month / $48, 326.4
• BAH II (w/dep): $879 mo/$10,548 year
• BAS: $175.23 mo/$2,102.76 year
• Var Special Pay (non-Intern): $1,000 mo/$12,000 yr
• Board Cert Pay: $208.33 mo/$2,500 year
• Incentive Special Pay (lump sum??): <$26,000 EM> vs <$36,000 ortho>

Totals: ~$99,000 per year for EM versus ~$109,000 per year as an orthopod.

Multiply each 4X (service obligation) ===> (EM=$396,000) vs. (Ortho=$436,000)

Finally, let's put in the value of your educational support:

4x years@ COMP: $140,000 (tuition + COL) + ~$1,200 mo/$14,400 in stipend
**Educational support value: $140,000 +4($14,400) = $197,600.

**Educ. Support + Income during payback**

EM: $593,600 and Ortho: $633,600

+++ If you took out loans instead +++

52Kx4 = 208,000 debt.

Pay during residency: variable but not much.

In the four years after residency (150K/yr EM and 250K/yr ortho):

EM --> 600,000
Ortho --> 1,000,000

Now I'm confused...but it looks like it doesn't pay to go into the service....have I gotten this wrong?

To heck with it. It's late and I'm going to bed. Someone wanna help out? 😕

 

[EvoDevo]

Oh yeah: the source for some of my numbers.....

http://www.dfas.mil/money/milpay/pay/

 

[edmadison]

EvoDevo, one thing you need to factor into your figures is that borrowing money has expenses (you did put in a generous sum for expenses so this is offset somewhat). You need to amortize the funds over 20 years or so (not to bad at current interest rates), but the big issue is that you have to pay back your loans with after tax dollars. Thus you will need to earn $2 for every $1 you pay off.

That being said, your point is well taken. For high paying specialties, the money is likely no worth it. For lower paying specialties it is a great deal (financially) especially if you go to a private med school.

Ed

 

[JMC_MarineCorps]

Bravo Evo and thanks very much emad for your thoughts as well.

Since it is impossible for me to say what I will specialize in, I must make my decision based on the fact that I don't know, thus I don't think I can factor in my long-term ease of paying this debt off with a high-paying specialty (ortho).

I seem to get caught up in the here and now - The "put it on my tab...but wait, Uncle Sam has my tab, even better" train of thought. I do miss the programmed 'Gung Ho' attitude of Marines, but I know the military picture is not a perfect one.

Somebody said it in another thread that he is seeing patients, typing up his dictations, making copies, changing paper, etc. - seems that w/ every minute of scutwork you are missing opportunities to keep your DDx skills sharp. In military medicine, it seems the emphasis is NOT healthcare as much as it is a multitude of things, i.e. being an officer, running (which I like to do by the way), and just 'playing the game' in general. Now, at one point, I was very good at playing the game, but that's when I was 18-21. I have a feeling that once I am a 36 yo doctor I might not want to play the game as much -- you know?

Anyway, everyone's comments have been helpful, thank you all. Back to my fence I go.

 

[EvoDevo]

Yeah. I hear you. I think that, no matter what else, the question is this:

"Are you ready to allow someone else (Uncle Sugar) to be in charge of your life, telling you where to be, where to go, how much you can make........?????"

For me, honestly right now, that answer is no. But I haven't given up on the idea. I can still see over onto the other side.....


<Civvy side>............(Evo).|====|......(Be 'Gung ho' again!)...................<Gungy side>.....

 

[edmadison]

Bravo Evo and thanks very much emad for your thoughts as well.

Since it is impossible for me to say what I will specialize in, I must make my decision based on the fact that I don't know, thus I don't think I can factor in my long-term ease of paying this debt off with a high-paying specialty (ortho).

I seem to get caught up in the here and now - The "put it on my tab...but wait, Uncle Sam has my tab, even better" train of thought. I do miss the programmed 'Gung Ho' attitude of Marines, but I know the military picture is not a perfect one.

Somebody said it in another thread that he is seeing patients, typing up his dictations, making copies, changing paper, etc. - seems that w/ every minute of scutwork you are missing opportunities to keep your DDx skills sharp. In military medicine, it seems the emphasis is NOT healthcare as much as it is a multitude of things, i.e. being an officer, running (which I like to do by the way), and just 'playing the game' in general. Now, at one point, I was very good at playing the game, but that's when I was 18-21. I have a feeling that once I am a 36 yo doctor I might not want to play the game as much -- you know?

Anyway, everyone's comments have been helpful, thank you all. Back to my fence I go.

I was gung-ho ortho until the start of fourth year. At the last minute, I switched to a primary field and I'm so glad. I my personal opinion, the military surgeons get short-changed in case volume. If I were to do it again, KNOWING that I was going to do surgery, I'd not do HPSP and do FAP instead. However, knowing that I want to do Peds, I'd do it in a heart beat.

Ed

 

[JMC_MarineCorps]

😱

One night, I was on call for the hospital, and saw a kid with appendicitis in the ER. I took him to the operating room, and did a laparoscopic appendectomy. It was a case I've done two dozen times before in residency. This was not an easy case. I had not done any laparoscopy in close to a year, at this point. I ended up converting to an open appy when I was not confident with the quality of the stapled appendiceal stump closure. Anyway, the kid ended up blowing out his stump, getting septic, landed in the unit, and required 3 additional operations to manage his abdominal contamination. He also got a diverting ileostomy...bad problem. This could have been bad luck, but I am certain that my lack of OR time and lack of recent laparoscopy cases during the intervening 9 months directly contributed to this horrendous outcome...

To summarize: On a ship, or other operational environment, Navy docs are expected to see all varieties of patients. This, in of itself, is not a bad thing. However, the staunch refusal to allow a surgeon to maintain technical skills while attatched to the ship is ridiculous. The DOD directive on this issue clearly states that a specialist should be 'allowed' to work at the local MTF (hospital) to maintain his/her skills, when the ship is home-ported. This directive was ignored by my SMO. He scoffed at it. He wanted me around so he could blow out of town and see his family. He wanted me around so he only had to see every other runny nose, rather than every case. The Div-O was a passive aggressive and obstructionist bitch who knew nothing about what each and every doc has invested in training. Bottom line: the Navy does not give a **** who you are and what you are capable of, they just want you to 'move the meat', see the patients, and do the paperwork.

Stay tuned for year 2 of active duty!

Thank you for the reality smackdown - coming down from my perch on the fence. http://forums.studentdoctor.net/showthread.php?p=1700644#post1700644

Sometimes I forget about the rampant and painfully reckless stupidity that is 'business as usual' in the military.

I got exactly what I needed out of the military and you have helped me realize that there is little reason to go back.

JMC out