Only idiots would join Navy medicine

[navdoc47]

If you are thinking of staying in the military beyond your commitment, you are screwing yourself by choosing the Navy.

For the 0-5 promotion board, the Navy's in-zone selection rate for physicians was 57.9%

For the 0-5 Air Force promotion board, the in-zone selection rate for physicians was 96.1%

http://www.public.navy.mil/bupers-n...Documents/FY 13 USN STATS/FY13 AO5S STATS.pdf

http://www.afpc.af.mil/news/story.asp?id=123372439

I think the Army is as high as the Air Force, but I can't find the link.

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[Homunculus]

army has not been 96% over the past few years. i'll see if i can find the exact data but i'm sure it's better than the navy- just not as peachy as the air force. many otherwise deserving people have been left scratching their heads (to put it nicely) as to why things suddenly changed for them when previous years made it through with few issues.

--your friendly neighborhood box checking caveman

 

[Qurmish]

Low promotion rates often correlate with high retention rates. Is that the case with the Navy?

 

[idq1i]

IIRC, the army was in the 60s too last time around, with most non-selects related to CCC non-completion and no utilization tours/deployments. LOL at those staying.

 

[DrMetal]

My understanding of promotion to O-5 (the first "real" promotion) is this, an please correct me if I'm wrong: There's a strong preference for those who have been operational and/or in leadership positions during their O-4 years. For instance, if during your 5 years as a LCDR, you were the senior medical officer on a big deck, then you came back to one of the major hospitals and became head of some clinic, you'd likely promote on first look .....as opposed to the guy who's still training as an O-4 (might be my case). I suppose that's fair.

My question is this: if you don't make O-5 on the first look, and perhaps not on the second, is there such a thing as a third look? A fourth look? There's definitely no such thing in the line communities, where if you're passed over twice, you're done, you must retire as an O-4. I've heard rumors of some medical officers getting promoted on 3rd or 4th looks, true?

 

[HighPriest]

What Ido know for sure: I won't be here for the first look.

 

[pgg]

Timely thread.

The FY15 Navy O5 staff selection board convened ... today.

 

[Chonal Atresia]

The good ones leave and the incompetent ones stay (minus those with ridiculously long commitments).

 

[Gastrapathy]

When you factor in the folks who will get out, I don't think the numbers are that bad. A few folks just out of training may get passed over and promote the next time but there aren't a bunch of quality terminal O4s walking around. The promotion phasing crap also makes this less of a difference although it could push you back a year group. I can think of one cards and one nephron passed over b4 I left my mtf and both picked up the next year. I put it on and split a few months later.


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[jabreal00]

CCC is now becoming or is a prerequisite to promote to 05. I'll be in the zone to promote to 05 in 2016. I haven't and don't plan on doing CCC. I coincidentally get out in 2016.

 

[Perrotfish]

Low promotion rates often correlate with high retention rates. Is that the case with the Navy?

+1. If there's one branch that is losing so many physicians that they need to promote literally anyone that's left, I don't feel like an idiot for not joining it.

If you could show me that they had similar retention rates, of course, that would be a different story.

 

[Qurmish]

+1. If there's one branch that is losing so many physicians that they need to promote literally anyone that's left, I don't feel like an idiot for not joining it.

If you could show me that they had similar retention rates, of course, that would be a different story.

The cynical view, if the low promotion rates are indeed related to high retention, might be that the Navy traps people that would otherwise get out by forcing them to make a decision between taking a major pay cut or giving a few years of extra service after a GMO tour. There might be equal levels of unhappiness, but different retention mechanisms.

 

[Perrotfish]

The cynical view, if the low promotion rates are indeed related to high retention, might be that the Navy traps people that would otherwise get out by forcing them to make a decision between taking a major pay cut or giving a few years of extra service after a GMO tour. There might be equal levels of unhappiness, but different retention mechanisms.

Maybe, but the O-5 promotion board is 10-12 years into your career. You should have had more than enough time to do a GMO, do a residency, serve out your obligation, and still get out before it comes up. Unless you took an extremely long obligation you shouldn't be trapped long enough to hit O-5

 

[Qurmish]

Maybe, but the O-5 promotion board is 10-12 years into your career. You should have had more than enough time to do a GMO, do a residency, serve out your obligation, and still get out before it comes up. Unless you took an extremely long obligation you shouldn't be trapped long enough to hit O-5

That's true; however, there might be a small but relevant population that gets to that number of years with a combination of extra CSC, ROTC commitments, prior commissioned service time, and longer residencies when you tack on GMO accrued years.

The bigger factor is that some people will invariably stick around past when they would otherwise choose to get out because their USUHS/HPSP + GMO + Residency commitments brought them to the tipping point where it made the most financial sense to stay until retirement. The financial implications of walking away from an all-or-nothing retirement plan will definitely sway some to stay even if they have extremely low job satisfaction.

No doubt that retention and promotion across branches reflect a multitude of different causal factors, but I would gamble that the heavy use of GMOs would cause higher retention in the O-4 to O-5 range.

 

[pgg]

I don't know what the retention figures are for Army vs Navy O5s and senior O4s, but I'd MUCH rather be a Navy O5 than an Army O5. The Navy doesn't abuse post-residency O5s with brigade surgeon (GMO) tours ...

 

[DrMetal]

but I'd MUCH rather be a Navy O5 than an Army O5. The Navy doesn't abuse post-residency O5s with brigade surgeon (GMO) tours ...

Amen. I know plenty of Navy O-5s/O-6s that still practice very regularly in their specialty, and they only take on the collateral duties that they want. Nobody has to go to a "Captains Career course" in order to make O-4 or O-5 . . . hell most haven't done their Navy NKO GMT bullsht courses in years, and nobody has called them out on it, because (of course) nobody is really tracking. The Navy kinda screws your when you're junior (per not enough GME spots, making you do a GMO tour), but seems to be more lenient in the BS as a senior officer.

Of course, all things are specialty dependent. The O-5 surgeon who hasn't done an ex lap in 4 years and has to moonlight in order to keep up his skills, might be a little pissed off, and understandably so....as compared to the pediatrician who stills sees a decent diversity/amount of cases in his practice.

 

[bobbyseal]

The real difficulty now is going from O5 to O6. Admiral Chin did a command visit a while back and gave his typical state of the MC powerpoint. There should be a nice downward slope on the number of O3 to O4 to O5 to O6. Currently, there's a dip of O4 due to poor manning during the beginning of the Iraq/Afghanistan Wars, but there's a bulge in the number of O6's. So, currently, it's hard to get promoted to captain. He discussed how this will be an issue for Navy medicine as this group of O4s move on through their careers. There will be fewer O5's and O6's to take the roles in upper level leadership. So, I guess to me that means more hospital CO's coming out of Nurse Corps or MSC. Y'all have fun with that!

< 3 months...

 

[USNR_Medicine]

Love of serving your country is about the only reason (and of course not a bad one) I can see for anyone to stay in the service as a doctor past your initial commitment.

There are several charts around that show the pay for docs in the service is better than civilians until about year 6, then civilian docs obviously start earning exponentially more.

 

[pgg]

There are several charts around that show the pay for docs in the service is better than civilians until about year 6, then civilian docs obviously start earning exponentially more.

That's an overbroad statement. There's tremendous specialty variability.

Financially it may make sense for peds or FM to stay in with 12+ years to go until retirement, while a spine surgeon may come out ahead by leaving just 4 or 5 years from retirement.

Do the numbers yourself, with an objective eye. Everyone publishing a chart has an agenda.

 

[USNR_Medicine]

Agree for the most part, but I'm specifically speaking of those between 0-6 years experience. Once someone is past that point, then of course there are way too many variables to consider. But it's tough to sell, from a financial perspective, the benefit of staying in the service vs. getting out. The financial aspects of leaving after an initial commitment are almost always weighed towards separating. There are of course many other reasons to stay in besides finances.

 

[Homunculus]

There are several charts around that show the pay for docs in the service is better than civilians until about year 6, then civilian docs obviously start earning exponentially more.

just as devil's advocate-- can you post a few of these charts? exponential? maybe for a select few, but the majority this is not the case. and most people have 4 year scholarships- which is 7 years service by the time they can escape if they do a "normal" residency.

you also have to remember that we may not be paid as much, but our patient volumes pale in comparison to some of our civilian counterparts. sure, the more work = more pay doesn't apply (which sucks) but less work does not equal less pay (which is nice). your pay charts would be best if they took this into account. 25 patients is about the norm for an active duty pediatrician. this would barely cover the overhead in some civilian practices.

between transferring the GI bill (earlier on but not at the first chance to get out) and the retirement package, there's some nice cheese at the end of the line for those that stick it out and can put up with the headaches. and at age 46 you have plenty of time to fulfill that civilian fantasy with a decent safety net, lol.

--your friendly neighborhood show me the money (charts) caveman

 

[USNR_Medicine]

First I should preface that I've been in the military (not a doc) for nearly 20 years, so I'm definitely pro-military. Couldn't find the actual chart in a quick search, and I guess the below kinda rebukes my argument although does show civilian wealth accumulated begin to surpass military around year 11.

Some problems with the above: I can't say I know anyone in the military that makes $116K for being in just 10 years, and certainly not in salary alone. I'm an O4 (Major equilivent) with nearly 20 years in and still don't make that much, so those numbers are flawed unless I'm missing something. They also don't take into account the ability to save for retirement during residency while in the military. That 6-8 year headstart is substantial in the long run and most new docs likely won't take it into account. It also doesn't take into account the military retirement if one decides to stay 20 years.

Anyway, this is likely a bad example for my statement, but I would still hold the opinion that in general (perhaps too general) civilian docs make substantially more after about year 8 than military docs.

 

[Qurmish]

I believe that chart was prepared by our very own Deuist for a blog he maintained during medical school. There is a more detailed explanation of the numbers on the blog (http://halfmd.wordpress.com/2007/03...f-the-health-professions-scholarship-program/). The military salary must include all of the special pays for medical officers. These numbers reflect the situation in 2007 and do not account for a lot of factors like the changes to HPSP and rise in cost of most medical schools.

I think pgg is spot on with his comment that everyone really needs to compute the numbers for themselves. There are so many variable factors to consider (med school cost, speciality, prior service years, extra ADSO, accumulated debt, interest rates, etc.) Even the most traditional HPSP student will have variables that can significantly tip the balance.

 

[twinning]

First I should preface that I've been in the military (not a doc) for nearly 20 years, so I'm definitely pro-military. Couldn't find the actual chart in a quick search, and I guess the below kinda rebukes my argument although does show civilian wealth accumulated begin to surpass military around year 11.

Some problems with the above: I can't say I know anyone in the military that makes $116K for being in just 10 years, and certainly not in salary alone. I'm an O4 (Major equilivent) with nearly 20 years in and still don't make that much, so those numbers are flawed unless I'm missing something. They also don't take into account the ability to save for retirement during residency while in the military. That 6-8 year headstart is substantial in the long run and most new docs likely won't take it into account. It also doesn't take into account the military retirement if one decides to stay 20 years.

Anyway, this is likely a bad example for my statement, but I would still hold the opinion that in general (perhaps too general) civilian docs make substantially more after about year 8 than military docs.

Excuse my French since I am only going to be entering USUHS this fall but this chart doesn't take into account that loans accrue interest and 163k in loans is a bit low for these days when the average school tuition is 50k and including cost of living and books you are looking at at least an extra 20k which makes your loan come out shy of 300k. When you take into account that the loans accrue interest throughout school and residency, although they may be offset slightly if you decide to contribute some of your paltry resident pay towards your loans, the red number should be much bigger.

Also, I don't know if the chart takes into account the benefit of BAH which can contribute 24k a year in some places. Note that this is post tax money so would actually add to the military pay chart by at least 30k per year.

I wish someone would do a calculation for salaries after tax because that is what really matters.


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[Ryank327]

Excuse my French since I am only going to be entering USUHS this fall but this chart doesn't take into account that loans accrue interest and 163k in loans is a bit low for these days when the average school tuition is 50k and including cost of living and books you are looking at at least an extra 20k which makes your loan come out shy of 300k. When you take into account that the loans accrue interest throughout school and residency, although they may be offset slightly if you decide to contribute some of your paltry resident pay towards your loans, the red number should be much bigger.

Also, I don't know if the chart takes into account the benefit of BAH which can contribute 24k a year in some places. Note that this is post tax money so would actually add to the military pay chart by at least 30k per year.

I wish someone would do a calculation for salaries after tax because that is what really matters.


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I think they included BAH but not VSP and the bonus. I just made a new, up to date chart real quick to show all the options, USUHS, prior service etc.

If anyone has info on better promotion rates, especially for the prior service I'll update it and maybe take it out to 20 years and include a retirement pay estimate.

 

[deuist]

I can't say I know anyone in the military that makes $116K for being in just 10 years, and certainly not in salary alone. I'm an O4 (Major equilivent) with nearly 20 years in and still don't make that much, so those numbers are flawed unless I'm missing something.

Yep, you're missing a lot. Docs get bonus pay which boosts the salary. Those numbers may be outdated since the chart was put together 7 years ago. As others have mentioned, each person should make a chart for himself based on a list of factors that affect pay such as USUHS vs HPSP, which medical school you attended, civilian vs military residency, number of years of service, specialty, and pay based on home station location and deployments, family separation, hazard duty pay and so on. You also need to factor in the cost of your spouse's job (or lack thereof from all of the PCS'ing). For me and many others, the numbers just don't work out. Also, there are certain intangibles. Do you really want to spend one day every week doing paperwork and computer-based training when you could be seeing patients instead?

 

[Mirror Form]

You also need to factor in the cost of your spouse's job (or lack thereof from all of the PCS'ing). For me and many others, the numbers just don't work out. Also, there are certain intangibles. Do you really want to spend one day every week doing paperwork and computer-based training when you could be seeing patients instead?

And these types of costs that people don't take into account are often the most crucial. When the military forced me to move around the country my wife's career took a significant hit. That cost alone blows away any other calculation in the chart. Then there is the loss of money associated with moving around a lot. You can either repeatedly buy and sell homes, or throw money away in rent.

Then there are significant financial disadvantages if you want to buy into a private practice in your career after you leave the military.

 

[idq1i]

I am surprised by the number of all these HPSP financial threads. Here is something for your to factor in: 4 years in some hole, no fellowship, no sick patients to admit, fighting for lap choles every other week, no advanced imaging, nurse-led risk management. How about 1-4 years as a doc-in-a-box, forced to treat patients with 1 year of military internship training under your belt? What's the cost of these situations? Should it be a set $ amount? How about a % reduction in compensation/year? How about a catastrophic deduction - "fort polk factor" for the unlucky ones? What about an Afghanistan "IED" reduction? GMOed factor for someone wanting to do surgery?

Southside Chicago and Detroit have awesomely cheap real estate. Does this mean you should move there? You can't separate the $ and the environment.

 

[HighPriest]

Agreed. Looking at $ alone is a bad idea. And,mas mentioned, you need to look at these numbers on an individual basis. The chart above, for example, doesn't apply for my specialty.

 

[Monty Python]

For you Army folks ... I occasionally hear Fort Polk mentioned generically in reference to anything undesirable. What is it about Polk? I had Navy friends rotate through JRTC when prepping for deployment, but they never stepped foot in the base hospital.

 

[colbgw02]

I don't think that the hospital there is appreciably different than any other Army MTF of similar size and acuity. It's more the location. I don't know if you've ever spent much time in rural southwestern Louisiana, but it pretty much sucks. I am not exaggerating when I say that the main attraction in Leesville is the Wal-Mart. There has been a rumor for years that they will be putting either an Applebee's or Chili's on post, which gets people super-excited, because that's just how awesome it is to live there. At best the nearest 'city' is 45 minutes away, and by that I mean either Alexandria or Lake Charles, neither of which are beacons of cosmopolitan life. It's pretty much the quintessential Ft. Elsewhere.

 

[idq1i]

It's like when you take NMC San Diego, remove all the intelligent people and relocate the base to north korea. That and Leonard wood - little hellholes in the the middle of toothless, shoeless, hillbilly knuckledragging paradise

 

[Kilgoretrout 65]

I'm going to Lackland Air Force Base! I'm going to Ft Leonard Wood!

Reminds me of an old National Lampoon skit:

 

[AbcJuly]

Reading the chart above from RyanK there is no specialty pay for the first three years? Not even for in demand specialties?

 

[Ryank327]

Reading the chart above from RyanK there is no specialty pay for the first three years? Not even for in demand specialties?

You can't get specialty pay if you haven't finished your residency...

 

[mpwb]

Hello, I'm a doctoral student in psychology and I'm very interested in becoming a psychologist in the military (I'll be applying this summer/fall). I'm very open to any of the branches right now. In trying to decide between branches I'm considering a lot of different factors, but one is promotion/retention rates. I know I may change my mind about wanting a 20 to 30 year career in the military, but I'd like to have that option. I have spoken to a few psychologists in the AF and one in the army. They said that for psychologists as long as you are competent there shouldn't be an issue with being able to stay in until retirement because there aren't enough of us in. I have searched for documents listing the numbers. The very first post in this forum had a working link for general AF numbers (not psychology specific) but the Navy's link did not work. Additionally, although the Army psychologist I spoke with said it wasn't an issue for psychologists, the information for one of the army's psychology internship sites (our version of MD's residency) said "psychologists compete with other officers with about 60-70% of the "best qualified" officers selected for promotion. In this respect, a career in the Army is not entirely elective, but must be earned by sustained superior performance." Do these numbers include people who choose not to stay or just those who want to promote? Any additional information on how it works/branch differences would be great. From what I've read it seems like for MDs, or maybe military medicine in general, the promotion rates go AF > Army > Navy. If anyone knows about promotion rates for psychologists in any of the branches or how they compare I would love to know more.

 

[VolatileNavyDoc]

That's an overbroad statement. There's tremendous specialty variability.

Financially it may make sense for peds or FM to stay in with 12+ years to go until retirement, while a spine surgeon may come out ahead by leaving just 4 or 5 years from retirement.

Do the numbers yourself, with an objective eye. Everyone publishing a chart has an agenda.

Agreed. There are TONS of things to consider. I know there are quite a few anesthesiologists in the SoCal area with 12-14 years in who are deciding to stay in based on financial / quality of life reasons. The pay for an O-5 anesthesiologist in the Navy is very similar to a private practice gig here, once you figure in the taxes. Also, there is military housing on the beach (within walking distance to great surfing) in a location that no anesthesiologist could afford on their salary alone down here. There are lots of moonlighting opportunities here and a command climate that does not discourage it. It's really a combination of factors, and they all should be taken into consideration.

There are a few hoops to jump through to pick up O5 these days in the Navy. I don't think I would switch to the Air Force though, even if I was almost guaranteed promotion. Intuitively, I just think there has to be a reason we are overmanned and they are not. Now, if you want to work 70 hours a week, make $400,000 a year, and be guaranteed to raise your kids in your location of choice, then the Navy is definitely a bad idea. I considered getting out at 15 years for these very reasons. The best resource I have found is talking to folks who got out, and just asking how they liked it... how their life changed... Some are very happy. Some have moved jobs twice in three years. Almost all say they have less free time on their hands.

 

[Chonal Atresia]

Agreed. There are TONS of things to consider. I know there are quite a few anesthesiologists in the SoCal area with 12-14 years in who are deciding to stay in based on financial / quality of life reasons. The pay for an O-5 anesthesiologist in the Navy is very similar to a private practice gig here, once you figure in the taxes. Also, there is military housing on the beach (within walking distance to great surfing) in a location that no anesthesiologist could afford on their salary alone down here. There are lots of moonlighting opportunities here and a command climate that does not discourage it. It's really a combination of factors, and they all should be taken into consideration.

There are a few hoops to jump through to pick up O5 these days in the Navy. I don't think I would switch to the Air Force though, even if I was almost guaranteed promotion. Intuitively, I just think there has to be a reason we are overmanned and they are not. Now, if you want to work 70 hours a week, make $400,000 a year, and be guaranteed to raise your kids in your location of choice, then the Navy is definitely a bad idea. I considered getting out at 15 years for these very reasons. The best resource I have found is talking to folks who got out, and just asking how they liked it... how their life changed... Some are very happy. Some have moved jobs twice in three years. Almost all say they have less free time on their hands.

Very well said. Yes, you will work harder in private practice but you are rewarded for it. The harder/more you work, the more you earn (also the more taxes you will pay) but at least you are rewarded for your effort. There is absolutely no incentive in the military to work other than the absolute minimum other than personal pride. You are compensated based on rank/time in service and not productivity/patient satisfaction/complication rates (for surgeons). For instance, the former "chief" of my department did not operate or see clinic but made 100k more than me per year for sending out emails/attending meetings. I brought in 700k+ in revenue for the hospital last year while he brought in next to nothing. This situation would never happen in private practice or even a hospital-employed position. That guy would be fired so fast it would make your head spin.

I am under no illusion that private practice is some sort of utopia but at least it allows those people who are willing to "move the meat" a chance to be financially rewarded commensurate their ability/work ethic. Moonlighting can more closely even the playing field, but this is very specialty/location/command dependent. You also miss out on ancillary services in the military such as ownership in an ASC as well as hearing aid sales, allergy treatment and in-office CT scanning (at least in my specialty). Throw in the risk of a "brigade surgeon tour" and a nurse as the "surgeon general" and it is too much for me to take.

 

[dynamicalan]

IIRC, the army was in the 60s too last time around, with most non-selects related to CCC non-completion and no utilization tours/deployments. LOL at those staying.

What is CCC? What I thought it was doesn't seem seem to be relevant for today.