All Branch Topic (ABT) Positive HPSP Experiences

Discussion in 'Military Medicine' started by commhealth, 09.24.14.

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  1. commhealth

    commhealth

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    I am currently applying to medical school and hoping to be accepted into the AF HPSP. However, because I have a wife and 1.5 children, I'd like to be careful about making large decisions for the family, especially after hearing repeatedly that the military dictates your residency, location, etc. Since I hope to do primary care, going to medical school and supporting a family without a stipend and debt forgiveness seems nigh impossible.

    After reading about a thousand of the HPSP threads, I've realized that they tend to attract a level of cynicism and/or aggrieved military physicians. I am hoping to hear some unheard positive HPSP experiences here. Also, current helpful statistics/factoids (positive or negative) would be welcome.

    commhealth
     
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  3. HighPriest

    HighPriest insert "clever" statement 7+ Year Member

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    Generally, I am one of those aggrieved physicians. I can give you some positivity, although I think hunting for positivity might be misleading. It is possible that this thread is merely a platform for the cynics, or it is possible that there are just a lot of angry military docs. My experience has always been the latter.

    My residency training was fantastic. A lot of military docs don't feel that way, but I couldn't have asked for better training, in my opinion. I would put my knowledge and skillset up there with almost anyone at the same point in their career, with confidence. Unfortunately, people who actually shop around for that kind of thing are going to go with the ivy league grad 10/10 times before they go with the guy who trained at a military institution. I think that's unfortunate.

    Our training is a lot more hands on, from my experience, than civilian training. Obviously that is related to the liability associated with military care. The issue was always getting complex cases, for which we did have to rotate to outside institutions. Some see that as a downside, and if you're flying all over the country for that additional training, it might be. We were able to perform our training at a nearby University system, and my opinion is that this was a boon rather than a burden.

    The additional pay is nice. I've never been one of the guys who says that the pay (as a resident) isn't a big deal. The question has always been: is the pay worth the price? That's an extremely internal decision, and depends so much on circumstance that discussing it is really just opinion and experience. I was buying electronics, taking yearly vacations overseas, and paying a mortgage while my civilian counterparts were eating Ramen. That's a fact. Whether it was enough is up to you. My experience is, however, that there's nothing magical about military pay in terms of tax breaks and the like, and I had a salaried job before med school.

    After residency, you don't have to market yourself to get a patient base. You just show up somewhere, and patients come to you. If you're not a used car salesman, then that's a good thing. The downside is that case complexity is poor most places, and marketing yourself actually doesn't make a difference. Because of this, if you want to keep your advanced skillset, you have to moonlight - assuming that you're practicing somewhere that you can. If you're ok with complacancy and watching your skills fade, then that doesn't matter. That sounds like a criticism, but it's not. I had a partner who wasn't interested in doing complex cases because he had no real desire to do them once he left the military. For him the situation was an ideal place to prepare for his practice, and luckily he was able to find a group that didn't care that he hadn't done certain case types in over 4 years.

    If you don't like clinical practice, the military is one of the easier routes by which you can move to administrative positions. Especially at smaller hospitals, they seem to be looking for people to take operational spots all the time. The unfortunate truth is, both in and outside of the military: some people don't know how much they hate medicine until they're done with residency. I'm not one of those people, but if I was I would strongly consider staying in the military. I feel that our system is made for people who want to do operational stuff.

    If you're lucky enough to get stationed at a large MEDCEN, life can be pretty good. Your pay may not match up to your civilian counterparts (especially if you're not doing primary care), but the amount of work that you have to do DEFINITELY doesn't match your civilian counterparts - especially if you have residents. If you're a primary care doc with residents, you've got it made. There is really no great reason to get out of the military in that case. Of course, all of those benefits depend upon chance.
     
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  4. idq1i

    idq1i 10+ Year Member

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    Your HPSP experience will really depend on the above. If you get into a bethesda or a san antonio, you can stay there forever, at least in my specialty. Those people have no idea how crappy it is in a FLW, or a Polk, or a Sill.
     
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  5. Gastrapathy

    Gastrapathy no longer apathetic Lifetime Donor 7+ Year Member

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    Everything is awesome! Everything is cool...keep singing dammit.
     
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  6. tabascosauce

    tabascosauce my temper short but my money long 5+ Year Member

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    great movie!!!
     
  7. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

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    We tried having a pro thread once before. It kinda got derailed and eventually got de-stickied.

    http://forums.studentdoctor.net/threads/pros-of-military-medicine.256225/

    If you search the forums (or do a plan Google search adding site:studentdoctor.net to the search terms) you'll find more.


    I'm basically happy with my time in the Navy. Med school, internship, residency, staff tour out of residency, 2nd staff tour now (two whole months into it). My GMO time was a mix but more good than bad. I may or may not have an atypically high "this pisses me off" threshold. I have definitely been lucky in some ways. A handful of things that really upset me at the time (like getting passed over for O5 my first time up) have worked out OK in the end.


    The Air Force is a different world. There's a zeal for "rightsizing" in that quarter that's been going on for 15-20 years ago that the other services are only now starting to dip their toes into. At least since I've been around SDN, when it comes to angry doctors on this forum, the AF seems quite heavily overrepresented.

    It's kind of funny - it's very common for new people to show up on this forum aiming for an Air Force HPSP slot, often for (IMO) misguided reasons of perception, like the idea that the AF is the most non-military of the services or that planes are neat or that the bases are nicer. All three of those may be true, to varying degrees, but they have just about zero to do with practicing medicine in uniform. So, may I ask, why did you pick the Air Force?
     
  8. Kilgoretrout 65

    Kilgoretrout 65 2+ Year Member

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    I don't think people post on this forum because they came home early from work and had a great day, I think they post when they are pissed off or something incredibly stupid happens in their
    workplace. Selection bias.

    I have had a good career in the Air Force, but doesn't mean there are no problems. The end of my career will have me being essentially an Army employee so now I get to see another
    bureaucratic disaster every day. When your hospital logistics treats critical medical supplies like just another spark plug it gets aggravating.

    I think HPSP or USUHS is a valid way to train if you are broke, have a family, and are going into primary care. For some specialists it is half a days work for half a days pay. For primary care, as was mentioned,
    you see fewer patients than your civilian counterparts with pretty competitive pay. When you get out, you have experience and a network of former colleagues to ease transition into the real world.
     
  9. commhealth

    commhealth

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    Thanks for the thoughtful and honest responses. I have chosen the Air Force for some of those misguided reasons (but not all). From the current officers that I know in all branches, they have told me to join the Air Force, though only one of them is an AF doc. That's why I've turned to these forums to get a greater understanding from those with their boots on the ground. My hope is to deconstruct my idealisms about milmed life and know if it's all worth it for my family and me. My primary concern is my wife and children.

    At times, I am more excited about serving my country and military life than becoming a physician, but these threads have certainly deterred my decision-making. I think the crux of these discussions may be the fact that joining is such a great gamble, some get shafted and others don't. There's no way to foresee the political/military climate in 10 years or whether the military will choose your specialty for you.

    After the military, my goal is to work in underserved primary care, so I will definitely not be making much money (relative statement). Entering that field without debt seems wise.
     
  10. idq1i

    idq1i 10+ Year Member

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    This is why you should not join milmed. If your wife is not a part of the DoD, she may as well not exist as far as assignments and deployments go.
     
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  11. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    Point of clarification: the military will not choose a specialty for you. At worst, they will choose an internship for you.

    Apart from that, you've left out a part - there's no way to foresee how you will change in 10 years. Or how about just the next four - that is, during medical school.

    For one, the world is filled with idealistic pre-meds that want to be a family doctor in BFE, but very few actually do that. I'm not trying to impugn your motivations; I'm just saying that most people will change their mind about what kind of physician they want to be.

    Secondly, I believe that going through medical school and GME really changes how one self-identifies. Or, perhaps more accurately, it changed me. After 9 years of training, I am, and will always be, a physician first. No way I would have said that straight out of undergrad as a freshly ROTC-commissioned 2LT. So when you say that you're more excited about serving your country and military life, you need to think about how you're going to change as a result of the medical training that you're about to start.
     
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  12. HighPriest

    HighPriest insert "clever" statement 7+ Year Member

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    I think this is an important point. My experience has definitely been that those who feel like a soldier first, and a physician second, enjoy their time in the military. Obviously, not everyone who enjoys their time falls into this category, but those that do are generally happy. But as mentioned, you are going to be a different person by the time you're applying for residency than you are now. Maybe you'll still be happy with the idea of being a soldier/airman/fancy person in bellbottoms, but if that inertia to be a provider that you have comes to the forefront, it's a setup for trouble (in my opinion). There are some stations where you can be a provider first (usually larger instillations), which I think is one of the reasons people are happier at these places. I can tell you with certainty that my duty station places no value on your clinical utility.
    In any case, I also agree that people are more likely to post bad experiences than they are good experiences. I feel like I've repeatedly posted my good experiences, but as time goes on I have more and more bad experiences and fewer and fewer good ones. Believe it or not, 2-3 years ago I was strongly considering staying in the military. My usual response when asked about it was that I wasn't sure, but that the military had some strong benefits. I now believe that is because I lived a happy, sheltered life as a resideny at a large hospital in a great area of the country. I realized at that time that there were lots of problems with our system compared to the civilian hospitals I had worked, but they seemed manageable. My experience since that time has crushed those ideas like Conan the Barbaian crushes his enemies. So if I post mainly bad experiences, it really is because most of the experiences I have had since residency have been bad ones.

    I love practicing medicine, I love operating, and I love treating soldiers. I do not feel like I am giving anything particularly special back to my country, I do not feel like I am valued as a physician, I do not feel like I am valued as a soldier, and I quite frankly do not look forward to going to work on any given day. I have good things in my job (the operating, and what not), but the bad stuff outweighs the good stuff most days. You will note that I haven't even mentioned pay-related issues. There is a big discrepency in my field, but not being paid is honestly not the driving force in my unhappiness as a DoD surgeon.

    When it comes to wife/family: I think that is a very, very important thing to take into consideration. Your family is no more than an extra duffle bag to the military. I've said this before, and I'll say it again: when I graduated medical school, a good friend who was prior service, infantry officer, now-med-school-grad told me: "Always remember, Big Green doesn't give a $#!T about you, your family, or your career." He wasn't being an dingus, he was legitimately concerned. You may get lucky, and your family will love where you're stationed. You may not. My wife hates where we live. She hates that I get called at 3am every other week for a UA. She hates that my schedule is unpredictable - not for medical reasons, which she understands, but because I have new, sudden-onset-mandatory-military-training almost every week and almost always on off-duty hours. And I've been lucky enough not to have had a deployment. I am actually perfectly ok with deploying, but some of my colleagues have deployed 6 or 7 times in a relatively short period of time. Two months ago, I would have told you that situation was changing, but it appears that deployments will continue as we continue to fight amorphous, unidentifiable extremist groups for the foreseeable future.

    So yes, you need to take what is said on this threat with a grain of salt, but I encourage you not to dismiss it either. Good luck with your decision.
     
  13. Doctor Bob

    Doctor Bob EM/CC 7+ Year Member

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    Which half do you have... and what happened to the other half?
     
  14. BigNavyPedsGuy

    BigNavyPedsGuy Junior Member 10+ Year Member

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    These are the kind of jobs that have debt repayment programs. I work in one (I don't have debt b/c I served a 7 year sentence in the Navy, but my partners are getting their loans repaid
     
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  15. Chonal Atresia

    Chonal Atresia 7+ Year Member

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    Spot-on. At least u did not have 12 years of indentured servitude. Wish I could convince every prospective HPSP, USUHS, FAP, etc that it is not worth it.
     
  16. Gastrapathy

    Gastrapathy no longer apathetic Lifetime Donor 7+ Year Member

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    Do a post search for a1qwerty. Start 6+ years ago and work forward. Draw your own conclusions. I was quite lucky in my career but I couldn't be happier to be out.
     
  17. Homunculus

    Homunculus SDN Caveman Administrator SDN Moderator 10+ Year Member

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    i think the reason this forum (which doesn't really have anything else like it out there) tends to be the way you interpret it as is because of both selection bias and reality. yes, people tend to be more vocal when they are complaining. but the absence of positive rebuttals should tell you that 1) that no one with positive things to say has the courage or desire to post it on an anonymous forum (not likely but maybe i suppose) or 2) that the points being brought up don't really have a positive counter argument. just look at how many recruiters have come in and been chewed up/spit out and their bones ground up into bread. many of the negatives are a matter of personal opinion and viewpoint. what may be painful and miserable to one may be tolerable for the outcome for another. but the bottom line is most of the complaints/issues are fact.

    i don't want to rehash my entire career, but i am squarely in the "not sure wtf i am going to do" when i hit my first ADSO at 14 years. the mere fact that i am on the fence about it at 14 should give you pause, but i can explain a bit further.

    first, i am ROTC+HPSP. and i had to sub specialize so i wouldn't gouge my eyeballs out in primary care. hence my obligation. that being said, HPSP and high interest title loans are similar-- you sign up for the quick fix, and don't really think out the long term consequences. you can't sign up for something at 22 and really know what you will be wanting at 30. people mature, priorities change, spouses and kids come along, and you start to wonder why you were so scared of the same debt that people all around you took on without pause.

    moving doesn't sound like a big deal. until you've done it every 3 years, and start to see how much stress is involved in buying or renting, moving, and finding yourself not really wanting to put down roots anywhere since you'll just be moving again anyway. kid's school? spouses job? same deal.

    ok, so as long as you know that's the deal, that's doable, right? surely there's some predictability to this, you say? you would think. see, the line officers talk about "career maps" and "planning your 20 year career" but the fact of the matter is in the medical corps it's a total crapshoot. not only could they move you to a position not even in your medical field (flight surgery, brigade surgeon) you may also be told to move simply due to some admin guy deciding you've been someplace too long. so any "map" you may come up with will be worth about the paper you scribbled it down on. air force included.

    now, in exchange for this, yes-- "debt free" so to speak. if you are a primary care specialty you will see about half the patients for about the same pay. subspecialist or surgery you'll make less, but also see substantially less. patient volumes per provider in the military pale in comparison to civilians. so in a way i don't get too wrapped up around the axle about pay-- i get wrapped around the axle about the admin BS.

    for me personally, i am dual military which has it's own hurdles and issues which don't apply to you. but, i have been fortunate to be able to buy a property in DC that is appreciating beyond what we ever expected it would, and bought a home in our current duty station that will hopefully be a nice rental for the long term as well. i've transferred by GI bill (so has my spouse) so getting out at 14 would leave us with 2 nice properties we could sell or rent, a good chunk in our TSPs, transferred GI benefits, and a decent resumé when i get out to likely have a choice of several better compensated civilian jobs.

    the retirement cheese is nice. and to be honest, i would be totally fine retiring as an O-5 if i am left alone. but what has become increasingly painful is something that really hit home when i went to a retirement last spring. this individuals career was as a clinician, and they did well, retired, the typical thing. but then when they spoke they mentioned the sacrifices that their now college aged kids had to make during their childhood for the army. it occurred to me that when i signed up for HPSP i didn't realize that i would also be signing up my kids for HPSP-- and i don't think most people do. or if they do, i don't think it really hits home like it does when you are staring a deployment or operational tour or random PCS move in the face. or being on service and tied to the hospital unable to travel for months at a time because your department is understaffed. or any number of other things that are unique to military life.

    i can't and won't tell anyone to carte blanche sign up for HPSP. you need to go into it for "more than the money" and you need to have a full understanding of what it is like having no control over your career. if you can accept that, and that you are firmly established as "human capital" and essentially an employee like everyone else, you'll be fine. in fact, i think the 3 year HPSP may be the best deal. 75% debt free, but the kicker is that with only a 3 year commitment you are only looking at 1 duty station and you can GTFO. 4 years they can screw with you more. fellowships-- well, that's a whole other cost/benefit analysis.

    the best stories i've heard and the happiest people i've met have been the hpsp civilian medschool, civilian residency who show up somewhere, do their time, then get out. it's almost like a bad dream that way i imagine. i've even seen a civilian medschool/residency/fellowship who did her time at a MEDCEN as a sub specialist then leveraged her military pay and admin setup to get a sweet academic gig. so there's some hay to be made out there if you can find it. the key is being your own advocate and knowing what you're getting into. which this forum, for better or worse, eliminates the excuse that this information isn't out there. google military medicine and this forum is there. we didn't have this resource back in the "old days"-- no that for some it really would have mattered.

    at any rate, it's good you came to seek out advice, but the "positives" you are looking for may need to be asked more specifically. mainly it's money. "serving your country" is such a loaded term you don't really want me commenting on it. there are some good youtube videos of i think some privates sweeping and taking out garbage or something. yup, serving their country. lol. sounds noble but when you get behind the curtain the show loses some luster.

    good luck

    --your friendly neighborhood served my country keeping mandatory training up to date caveman
     
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  18. Ziehl-Nielsen

    Ziehl-Nielsen I'm perfectly calm, dude. 10+ Year Member

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    Heed the caveman.

    The fact that he is so close to the "F*ck You money" and is still unsure if he should see it through to 20 should speak volumes, yet he is very fair to the military in his assessment of using the military simply as a means to an end--if you have the right temperament and things break your way with regard to specialty choice and duty assignment, HPSP could be a good financial deal.

    What an eloquent description of the doubts and difficulties inherent in making one's way through a military medical career in this day and age.
     
    Last edited: 10.01.14
  19. commhealth

    commhealth

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    This has been the most informative HPSP thread I have ever read. Thanks to all. At this point, considering the wealth of experiences shared, I will not be going through with AF HPSP. Should I choose to commit, however, would you all recommend 3yr commitment/civilian medschool/civilian residency? Thanks again.
     
  20. Perrotfish

    Perrotfish Has an MD in Horribleness 7+ Year Member

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    1) I would recommend either a 3 or 4 year commitment. Do not obligate yourself to 7 years via USUHS, do not obligate yourself to any military commitment during undergraduate. The best way to figure out if the military is for you is by doing it, and when you've done it for a few years you then need the option to leave if you don't like it.

    2) You cannot opt for a civilian residency with any length of medical school commitment. When you sign the contract, you are committing to use the military match and the military residency system. They can decide to allow (or force) you to do a civilian residency, but it is not your choice.
     
  21. Homunculus

    Homunculus SDN Caveman Administrator SDN Moderator 10+ Year Member

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    civilian school, civilian residency, 3 year military payback?-- yes. this means a medical residency (as opposed to surgical) and your 3 year payback stint would be 1) be compensated pretty comparable with your civilian colleagues, 2) be a great resume builder and conversation topic should you apply for a subspecialty fellowship, 3) give you a PGY4-6 period (think of it as post-residency OJT), malpractice free, without having to see 50 patients a day, to solidify your craft/skills** and 4) leave with an honorable discharge and Post 9/11 GI bill you can use later in life should you choose.

    **deployments to wars, humanitarian crises and backfilling to less enjoyable areas of the world always possible

    -- your friendly neighborhood not begrudging the short termers caveman
     
  22. Homunculus

    Homunculus SDN Caveman Administrator SDN Moderator 10+ Year Member

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    this too

    --your friendly neighborhood simultaneously composing posts caveman
     
  23. Kilgoretrout 65

    Kilgoretrout 65 2+ Year Member

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    Positive post: I got paid yesterday on time in the right amount and my daughter at college got her (my deferred) GI Bill BAH payment as well. 974 days left.
     
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  24. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    Man, how far have the goal posts moved that getting paid on time is considered a positive? Those of us on the inside understand implicitly how that's a victory, but from the outside, nobody should get extra points for that. To paraphrase Chris Rock, "that's what they're supposed to do. what do they want, a cookie?"
     
  25. DrMetal

    DrMetal To shred or not shred? Lifetime Donor 7+ Year Member

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    "i aint't neva been to jail!"
     
  26. pgg

    pgg Laugh at me, will they? SDN Moderator 10+ Year Member

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    Hah, so true.

    / also got paid on time this year, hooray
     
  27. DrMetal

    DrMetal To shred or not shred? Lifetime Donor 7+ Year Member

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    $6 all day/all u can hit driving range, free 9 hole par 3 course, free active duty golf clinic...that aint too shabby either
     
  28. mdmed2012

    mdmed2012 7+ Year Member

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    I did a 3 year scholarship and I agree with Homunculus - it is a good way to go. I am in my 2nd year of payback as a GMO and so far I have been pretty pleased. I did a FM internship and elected to leave for a GMO tour. I had a lot of people question my decision, but I only regret it for about an hour every 3 months. With that being said, I already extended at my current duty station for an extra year and am set up to get out in July 2016.

    Here are a few of my thoughts on my brief tour with milmed and the three year scholarship

    1) There is a big difference between 4 years and 3 years of training. In fact, many of the civilian programs I have spoken to have a cutoff of 3 years away from hospital medicine before having to repeat internship.
    2) I will certainly have skill atrophy but much less than if I had completed a residency.
    3) I get paid pretty well for my level of training. I will take a pay cut when I return to civilian residency, but there is the GI bill waiting for me.
    4) I will get a solid deployment out of it.
    5) I have met some awesome people outside of medicine.
    6) Recently I was at a social event with several program directors in my specialty of interest - I had many give me business cards and tell me to give them a call when I apply. They have had former military residents in the past and say they are some of the best they have had. It was great to hear that the experience the military offers can be valued in the civilian world.
    7) I do not stress about fitreps or other nonsense to advance my career because I won't make O-4. I go to work and try to my best to take care of patients and my Corpsmen. I am more focused on actually doing a good job, not talking about the dollar amount of the equipment I'm responsible for. Delinquent on mandatory training? No photo in my officer record? I still sleep at night

    It is anything but all glamorous, however. I have been living as a geobachelor, away from my wife, which is by no means an unusual situation. I know many guys who are doing the same thing I am. I also spend a lot of time away from medicine, in meetings that will make your eyes bleed. There are many things I could complain about, but for me, it's all about what I make of it. I am confident I will look back fondly upon my time in the Navy.
     
    Kilgoretrout 65 likes this.
  29. kingcer0x

    kingcer0x Re-Member 10+ Year Member

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    Positive post: After 4 years as a GMO followed by separation, I was able to succeed as a civilian resident and am stable financially

    Caveat: Everything that happened as a GMO I will refer to a black box, and success on the outside involved intensive repair of my professional development and medical skill
     
  30. studocplsignore

    studocplsignore 2+ Year Member

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    Look into the Army National Guard, slightly dated but whitecoatinvestor.com/army-national-guard-physicians/

    Essentially, it boils down to, you do stuff while in school/residency, you get paid for it. The big money doesn't come now, it comes later (if the program is still around), but the nice thing is your contract will end before your non-deployable status as a student/resident does. So if you don't like what you're doing, you can resign your commission and leave. If you do; however, you can stay on, have a civilan career and work for the military. It's the best of both worlds in my opinion, and it was a lot better before, but still quite good now.
     
  31. vamedrnr

    vamedrnr

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    I have not done HPSP. But I did want to offer this my story as an endorsement of sorts for folks who think there are no good reasons to choose military medicine.

    I served for 6 years as an Army Infantry Officer. I have seen the good, the bad, and the very deepest ugly of the Army. I have had many friends over the years who were Army physicians, including an fellowship trained ophthalmologist who served as our BN "surgeon" in Afghanistan... I had a friend who loved Army medicine when it provided well for his 4 kids during residency and then was crushed when had to leave that same family for 13 months to go serve in Afghanistan (I would add that even though he was a sub specialist, he was proud to go and considered it his duty). I left as a disgruntled and cynical vet with the GI Bill covering my full tuition plus a very nice stipend that is almost as much as HPSP. I have a great pre-med resume, go to a top school, my money is completely covered and then some, I know the BS that comes with the military, and yet we are still choosing to go back for no reason other than that we want to. The system is far from perfect. My wife and I have made peace with the fact that we will be very frustrated at times, we will lack control, and that someday we may look back at this as a bad decision. But the same is true at times for civilian residency and medicine as a whole. Pick any forum on studentdoctor and you will find many folks who say the sky is falling. I had a long talk with a senior VP in the hospital system of my school and her issues were eerily similar to a friend of mine who is an admin at a major Army MTF. In the end, for us there were elements of teamwork, mission, and community that we found in the military that we have simply not seen in the civilian world, though I have seen many of the same bureaucratic struggles in the civilian hospital system. Again, I am under no illusion that the system is perfect, that everyone shoulders their fair load or even gives a damn about the mission. But there are still many that do. More importantly, there are hundreds of thousands of selfless Soldiers who consistently put their country and their fellow Soldiers above themselves but don't have much in terms possessions. I know how important good healthcare is to these brave men and women -its so absolutely critical to know that you and your family will be taken care of when the sacrifices are real and I want to be part of providing that.

    Some conclusions that my wife and I came to while rehashing this discussion time and again: 1) the Army gave of us the best friends and a "family" that we have not found before or since in the civilian world; 2) in our experience, for every crappy thing the Army does there is almost always some perk that you take for granted (or don't know about to use) that makes up for it; 3) the good situations have been truly great and the bad situations have been invaluable as they forced us to learn and grow (i.e., we spent 2.5 of the first 3 years of marriage apart, but has left us with a marriage that is strong and young further down the line); 4) you have more control in the military than you think, most folks are just passive, don't plan far enough out and aggressively pursue what they really want (in the Army Infantry, I truly was a piece of equipment and was still able to consistently get positions I wanted -I fail to see how the medical system is worse when my consultant will actually know my name and OER); 5) this one should be obvious by now: it gives you a sense of perspective that allows you to not worry as much about the little stuff and appreciate the little blessings of life that are all around us every day.

    Again, I have not done HPSP but if you follow the general logic of this forum (money, career control, ignorance of the bad, etc), I have every reason not to and am still choosing to go this route. The Army is many things, but most of all "the Army is what you make of it". If you are reading this and you have not signed a contract, I cannot encourage you strongly enough to research everything you can about military medicine, but more importantly about the branch that you would sign with. At the end of the day you are piece of military equipment owned by that branch -no more and no less. I have made peace with this and it is the right route for my family at this point. For many others, this is a really bad route. But if you are inspired, please do not be so short sighted as to think that all of the doom and gloom on this forum is the end-all-be-all of military medicine -these are very real and honest insights, but like everything with the military there are some understated positives. I have been an enlisted private in the Army with no rights or even the ability to ask why -AFTER I had graduated college and run a successful business because I believed it was my duty to fight during a time of war. It was horrible at the time but if I am honest it was one of the key moments of my life that forced me to grow into the man I am today, including personal and professional successes that I would have not dreamed of. There is more to life than money and the illusion of control...
     
    Last edited: 10.06.14
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  32. vamedrnr

    vamedrnr

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    as motivated as I sound above, I would like to also point out that I think this forum provides a critical service in enlightening would-be recruits to the negatives. I am not saying that all or any of those comments are not warranted, but rather that when considering them it may be beneficial to look at the intangibles -both positive and negative that are usually not considered. So honestly I am not trying to criticize, those who regularly give a quick dose of harsh reality I really think you are providing an important service. I just wanted to illuminate my thought process for those who are viewing this with no military experience and let it be known that someone can fully know and appreciate the negatives and still choose this route.
     
  33. HighPriest

    HighPriest insert "clever" statement 7+ Year Member

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    This is a very typical response from someone who is prior service. That is not a criticism, and I think these points of view are important to take into consieration. But just like my opinion, there is a grain of salt involved in terms of point-of-view. As I have said in the past, you will enjoy military medicine if you can accept the idea of being a soldier/officer first, and a caregiver second. Even then, the Army is a very different place as a medical officer, when compared with an line officer/soldier.

    I hear time and time again the scenaio where "my buddy knows a guy" who manages a civilian hospital and all the same issues are there, yada, yada. Maybe that's true, I can't say for sure because I don't have a first person perspective when it comes to hospital management. What I can say is that I have worked in both systems as a surgeon, both during and after residency, and when it comes to efficiency, patient care, skilled staffing, safety, and respect for your employees the Army is way, way behind. I have worked in civilian hospitals both larger and of equal size to the one I current staff in the Army, and I have seen them do fewer cases and see fewer patients than I do in my clinic, and yet they are turning a profit,and we are going bankrupt. That is mismanagement. Yes, it exists on the civilian side, but not to the same extent as evidenced by the command culture and state of Army medicine as a whole. I have pointed out specific circumstances (a drop in the pond, I'm sure) in which I know my services are being miscoded and ignored, and I have been met with stonewalling and in some cases frank disdain.
    In any case, the point is that yes: there are good things and bad things about each side of the fence. But to say that the problems are the same on each side is untrue, at least from the perspective of someone in my position. And I think the attrition rate and the long history of only very few seeking to come back to service speak for themselves. I typically do not use money as a top reason not to join.
     
  34. vamedrnr

    vamedrnr

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    I agree -I think I phrased this incorrectly (but the timing of the conversation and similarities were shocking). I absolutely expect that there are different problems in the military vs civilian, and I expect that the upper management is largely of a significantly lower quality in the military. My main point is that there are problems everywhere, there is no panacea as many folks in medicine are often looking for and that dealing with many of the problems I encountered in the military made me far more flexible and adaptable than my civilian counterparts who were leaders in private business. At this point in my life I again think the problems within the military will be outweighed by the benefits, and even if they aren't I can use them to my advantage if I learn to grow from them. That said, we plan on taking this one ADSO at a time and I don't see myself staying active duty until retirement...
     
    HighPriest likes this.
  35. bobbyseal

    bobbyseal Boat boy 10+ Year Member

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    First, I'm glad that I'm not the only one who uses GTFO. I said it in clinic the other day, and my nurse had no idea what I was talking about. It was a little difficult to explain the acronym.

    Second, I guess I'm one of the best stories. I did civilian med school, got deferred for residency, and did my 4 years. With that, though I had to move midway. Probably all the more reason to do a 3 year HPSP. Anyway, if I had to do it again, I probably wouldn't. But if your parents had shattered credit, and couldn't help you out on the student loan applications, one might have to do the HPSP like I did. So, with that in mind, I probably would have to do it again.
     
  36. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    We all like to pigeon-hole each other, on this site and otherwise. One of the ways in which pro-military people do that with the naysayers is by citing some anecdote about how things are just as bad in civilian medicine. For me, it was my former boss who used to repeatedly tell me about this one guy who wanted to come back into military medicine a year after leaving. I never wanted to engage him on the topic, so I just nodded and said "yes sir", but the whole time I'm thinking about the dozens of people who left military medicine, never looked back, and are happier for it. I have no illusions that civilian medicine will be wonderful, but I do expect it to be better.

    The converse is true, too. The sunshine pumpers tend to get pigeon-holed as mindless bureaucrats, hell bent on doing as little work as possible - outside of padding their OER, of course - up until the point they've been institutionalized by military medicine and have no choice but to stay. And, obviously, that's not universally true either. Some people really are making the right decision for themselves and their family to stay in, both financially and otherwise.
     
  37. Doctor Bob

    Doctor Bob EM/CC 7+ Year Member

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    My n=1 positive military experience is not indicative of what you can expect by going the military route. But with that said, just because people have positive civilian route experiences doesn't mean that everyone can have that outcome as well. So be it a military route or a civilian route, knowing how to navigate the waters will have a big effect on your experience.


    My experience
    I joined under the HPSP program just prior to starting med school. With the stipend I didn't have to take any big supplemental loans. And if I had been anywhere else in the country besides a very high cost-of-living town, or if my wife and I had decided on different living arrangements, I might not have needed to take out any loans. As it was, I left med school with ~50,000 in loans. A situation that we were both quite content with.
    The military didn't let me go directly into the field I wanted (EM). Instead I did an internship year first. They assigned me to a surgical program which at first I dreaded. But then it turned out that the program had just been restarted so there were only 1st and 2nd year surgical residents. So I got to be in the OR a few times a day, and my procedural skills got much sharper than they otherwise would have. The second time around, the military match let me out to do a civilian residency. At the end of that time, I came back to active duty. And here's where the military really helped me.
    I wanted to do academics. Fresh out of residency it can be tough to get a job at a big academic medical center in a central teaching role. The military, with it's higher turnover rate, put me right in to a position that became a real resume booster. I was also given the freedom to restructure my little domain however I wanted. So it quickly got me out of the "you can't get a job without experience but how do you get experience without a job" catch 22. I also got deployed which was something I had been looking forward to back when I joined. I wanted the opportunity to practice in that kind of environment and had a good time while I was there (except the missing family part).
    The GME office then let me out again for fellowship. And what was key for me was that both my residency and fellowship were civilian deferred, meaning I didn't incur any extra obligation by doing them.

    There is as much annoying burecratic bulls**t in the civilian world as in the military; it just comes in different forms. The civilian world gives you ways to avoid it (private practice, etc), but if your field is one where you will be constantly interfacing with a hospital regardless, the administrative machine will be brought to bear in both sectors. The military's ability to up and move you at a whim can be a downside, unless you have no geographic ties. We've actually liked being moved around the country. When it comes time to get out of the military (I have 2 years left on my obligation) it'll make it easier to pick a region to set down roots because we'll have lived in multiple different areas.

    It is as much about expectations as attitude. Things some people complain about don't bother other people. Military medicine is not a bad institution. It's not a great one either. It is what it is, and as long as you understand what it is, then you can make a decision on whether or not it will work for you.
     
  38. Doctor Bob

    Doctor Bob EM/CC 7+ Year Member

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    Well... I wouldn't say things are just as bad. I'd say they are frustrating but in different ways. The advantage that the civilian sector has, is that if at whatever institution you are at, if the particular frustrations are too onerous, you can pack it up and go elsewhere. You don't have that option in the military.
     
  39. HighPriest

    HighPriest insert "clever" statement 7+ Year Member

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    Which you cannot do without actually experiencing it, unfortunately.
     
  40. commhealth

    commhealth

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    My recruiter isn't replying to emails. How does the military match program work? How does it limit your choices? Would it limit my choices, even in primary care (e.g. FM, Peds, Internal)?
     
  41. AFSurgeon

    AFSurgeon 2+ Year Member

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    Commhealth,

    With HPSP, the military has the ultimate say, even with whether you are allowed to do a residency in the first place (they could have you first serve as a GMO/"flight surgeon"/etc.). If you want the freedom to choose to do residency directly after medical school, but are still interested in the military, I would strongly suggest looking into FAP. And who knows, in the 4 years you are waiting to sign up for FAP, you might decide military isn't for you anyway (asking 22 year olds to sign a contract that will affect them into their mid-30s (hpsp) is quite a risk I think.
     
    commhealth likes this.
  42. Perrotfish

    Perrotfish Has an MD in Horribleness 7+ Year Member

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    If you take the HPSP scholarship, you are obligated to participate in the military match. That means that you must apply for residency within the military's residency training system. You cannot choose to go to an outside civilian hospital. You can request outside residency training, and the military can allow to obtain civilian training, but they rarely allow you to defer. The military can also announce that they have too many applicants and force you to seek civilian training, however that is also rare.

    The match works mostly like the civilian match, except that its in December rather than March. You are judged based on your board scores, publications, grades, interviews, and audition rotations. While fellowships can be difficult to obtain in the military I believe all branches of the military offer every type of residency except for PM&R and dual residencies like IM/Peds. Just like the civilian match it is an application process, and it is possible not to match in the specialty you applied to if you are not a competitive candidate.

    What is different is your odds of matching. Some specialties are harder for an average student to match into compared to the civilian (Peds, ER). Some are easier (Dermatology, Rad/Onc). All specialties have more variation in their odds than the civilian world. As a civilian you can comfortably assume that if the average EM matriculant had a 220 on step1 to match into EM last year, they'll have about the same score this year. On the other hand the pool of military applicants is so small that when a a handful of talented people are interested in your specialty it can dramatically change your odds of matching.

    If you join the Navy, there is an added twist: you don't apply for residency, you only apply for an intern year. Then after Intern year you apply for the rest of residency. 70% of navy Interns will be denied the chance to continue straight through and will have to do a 2 year GMO tour (basic primary care taking care of Marines/sailors) before they are allowed to continue with their training. In the AF and Army you can also be assigned to a GMO tour if you do not match into a specialty and are only given a transition/prelim year. It happens very rarely in the Army and to about 30% of the AF.

    The military cannot force you to do a residency you do not want to do. They can force you to do an Intern year in something you don't want to do, but they cannot force you through a full residency unless you sign a contract for it. The worset case scenario is always that you do an Intern year, doa GMO tour, and then get out of the military.

    Hope that helps. Let me know if you have any further questions.
     
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  43. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    Not for the Army. Deferment cannot be requested by an Army applicant. The board may grant a deferment, but it is done without input from the applicant.
     
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  44. haujun

    haujun 10+ Year Member

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    I enjoyed my 2 years as BDE surgeon (met some great soldiers) but I hated working at MEDDAC for 3 years. I met some toxic medical leaders at MEDDAC. However during those 5 years I was stationed in a location where I enjoyed living. If you like to travel and wants to live in Germany, Korea, Japan etc for few years I think it is great.

    Right now I am working at MEDCEN and it is great working environment but I hate location where I am living.
     
  45. deuist

    deuist Stealthfully Sarcastic Lifetime Donor 10+ Year Member

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  46. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    For those that take a look, this was written when the blogger was still a resident. But Luke Ballard separated 15 months ago, so some of the information may be a little dated.
     

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