New Medical Corps Special Pay Guidance?

[militaryPHYS]

I am 100% convinced that the MC leadership wants and argues for them to adjust the special pay (I’m pretty sure George H W. Bush was president the last time they did so). The reality is that it’s never going to happen. The line benefits when MTF’s appear dysfunctional due to understaffing. Why would they stop cutting? They get more warm bodies when they shut down MTFs. Give me 15 minutes with any med student, and I will show them how HPSP no longer makes financial sense and makes less sense every year. I’m not sure why someone would sign up for it now especially given the massive cuts projected in the future. USUHS makes sense for active duty with families, but HPSP makes sense for almost no one at this point.

I think the writing is on the wall. This ship isn’t stopping until it’s on the ocean floor. Give it another 10 years.

Massive cuts to billets or massive cuts to funding?

Financially it is a stable, conservative way to limit debt and moderately build wealth if living like a resident for 8+ years. It protects against unknowns of market shifts, med school failures, no matching, etc. These are unlikely issues but I think something many worry about and how the recruiters hook people. USUHS much more financially beneficial but comes with extra 3 years of service so if end up in high income specialty it is much less effective.

I think it could still make financial sense but this is obviously not a reason to join. The first place we typically see "adjustments" in pay is with HPSP incentives because this is recruitment driven. It is how the military ropes in new accessions before that person understands the undervalued, underpaid, no autonomy truths about MilMed. It's how they keep the HPSP pipeline full like @pgg mentioned. This decreases likelihood that those of us on active duty will be able to advocate for pay adjustments. Keeping the outflow of older, more expensive physicians open wider than the inflow of eager HPSP/USUHS applicants.

Anecdotally I can say we are now really seeing effects of manning cuts/changes but more focussed on support staff, contractors, etc. We are almost to bare minimum in terms of clinical support staff to run a clinic. This upcoming PCS season I think will be a make or break time.

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[Trefoil]

Massive cuts to billets or massive cuts to funding?

Financially it is a stable, conservative way to limit debt and moderately build wealth if living like a resident for 8+ years. It protects against unknowns of market shifts, med school failures, no matching, etc. These are unlikely issues but I think something many worry about and how the recruiters hook people. USUHS much more financially beneficial but comes with extra 3 years of service so if end up in high income specialty it is much less effective.

I think it could still make financial sense but this is obviously not a reason to join. The first place we typically see "adjustments" in pay is with HPSP incentives because this is recruitment driven. It is how the military ropes in new accessions before that person understands the undervalued, underpaid, no autonomy truths about MilMed. It's how they keep the HPSP pipeline full like @pgg mentioned. This decreases likelihood that those of us on active duty will be able to advocate for pay adjustments. Keeping the outflow of older, more expensive physicians open wider than the inflow of eager HPSP/USUHS applicants.

Anecdotally I can say we are now really seeing effects of manning cuts/changes but more focussed on support staff, contractors, etc. We are almost to bare minimum in terms of clinical support staff to run a clinic. This upcoming PCS season I think will be a make or break time.

Cuts to billets. I don’t see it as financially smart to take HPSP at this point with caveats. If you don’t owe time or have time in already, you are really looking at a substantial decrease in your long term earning potential if you take HPSP. In the short term, yes it’s great, but in the long term, someone who is financially savvy can do very well if they manage their student loans wisely. A thrifty person can pay off their student loans in 1-3 years while their pay continues to increase with experience. If you take HPSP, you are starting practice 4 years junior to the guy who took the loan. You got started later and you got paid half as much for that same period. There is no financial argument there. I could have paid off the theoretic loan amount in 1-2 years. Some people make arguments about well what about family docs, but even they make a lot more in private practice than military. Thrifty living and that extra 80-100k could pay off the loans in 3-4 years. In that period of time you are accruing a patient population that will sustain your income. Come out of HPSP and you are starting the practice from scratch. Time matters. Looking down the line, yes I will be able to retire easily assuming I can work until my 60s. I probably could have retired comfortably in my 40’s if I were private practice and not military. Time matters more than money. You can make an argument that you have more free time as an active duty doc, but that also is highly dependent on your practice situation, and I would argue that being far from family is definitely valuable time lost.

No, I don’t think HPSP is a smart financial decision today with inflation going up and no plans to increase pay. I’m doing fine, and I’m happy with my situation, but I would not recommend this to anyone for financial reasons. Our salaries could be worth nothing tomorrow and they wouldn’t increase our pay.