Question regarding ISP and MSP for sub specialists

[xmsr3]

so I found this web site that gives ISP and MSP info:

http://www.militaryconnection.com/2009-pay-charts/2009-medical-dental-special-pay.asp

If someone could please answer the following questions for me I would greatly appreciate it.

1. For sub specialists, is the sub specialty pay on top of specialty pay or instead of it, for example, an internist gets $20K ISP and a gastroenterologist is listed as Sub specialty cat 4, $20K. Does this mean an gastroenterologist gets $40K (cumulative) or that there is no difference between general internist and gastroenterologist?

2. For those planning to go career, regarding MSP is that figure per year or per contract? For example IM is listed as $35K for a 4 year MSP, does this mean $35K additional money to enter into a 4 year contract of $35K/year to enter into an additional 4 year contract?

3. Again regarding MSP, for sub specialists is the sub speciality MSP pay, (whether annual pay or contract pay) in addition to the regular specialty pay or in lieu of it? As an example, an endocrinologist is also listed as sub specialty cat 4, which has 4 year MSP listed as $25K. Does this mean an endocrinologist who enters into the 4 year MSP contract gets $35K (internal med)+$25K (endocrinology) = $60K?

Thanks to anyone who can answer these questions.

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[a1qwerty55]

so I found this web site that gives ISP and MSP info:

http://www.militaryconnection.com/2009-pay-charts/2009-medical-dental-special-pay.asp

If someone could please answer the following questions for me I would greatly appreciate it.

1. For sub specialists, is the sub specialty pay on top of specialty pay or instead of it, for example, an internist gets $20K ISP and a gastroenterologist is listed as Sub specialty cat 4, $20K. Does this mean an gastroenterologist gets $40K (cumulative) or that there is no difference between general internist and gastroenterologist?

2. For those planning to go career, regarding MSP is that figure per year or per contract? For example IM is listed as $35K for a 4 year MSP, does this mean $35K additional money to enter into a 4 year contract of $35K/year to enter into an additional 4 year contract?

3. Again regarding MSP, for sub specialists is the sub speciality MSP pay, (whether annual pay or contract pay) in addition to the regular specialty pay or in lieu of it? As an example, an endocrinologist is also listed as sub specialty cat 4, which has 4 year MSP listed as $25K. Does this mean an endocrinologist who enters into the 4 year MSP contract gets $35K (internal med)+$25K (endocrinology) = $60K?

Thanks to anyone who can answer these questions.

The ISP is instead of, not additive.
ASP = 15K/yr - everyone not in training gets this
ISP depends on speciality - let's say 20K average
MSP - essentially a re-enlistment bonus - it is annual so if you sign a 4 year it is an additional lets say 40K/yr depending on your specialty - payable as soon as you commit yourself - so in your case, you could sign a 4 year after residency even though you still have a USUHS committment and get the pay up front while extending your service obligation 4 more years. Probably not the greatest decision unless you know 100% you were a lifer.

Net effect is most docs get about 40K in annual bonuses excluding MSP - certain specialties can be considerably higher, some a bit lower. All is taxed at 25% some of which you recoup when you file taxes.

Hope that helps.

 

[xmsr3]

Thank you for the info. Do you know if the MSP works the same as ISP in that's its also not cumulative?

For example an endocrinologist gets $25k/year under a 4 year MSP (class 4 sub specialty) vs $35K for general internal med doc? I would have thought that the sub specialist gets more than the regular IM doc, or is that because the Army figures they can use a regular internist more flexibly than someone specializing in a specific organ system, (needs of the service and all)?

Also, I don't know if this has come up before but how does the military pay those with dual specialties?

For example my service, (army) offers combination Psych/FM and Psych/IM residencies, and I believe they may have had a Psych/Peds program a few years back or perhaps that was AF or Navy.

If someone does a combo Psych/IM and ends up doing a fellowship in endocrinology then how does the military pay them? For ISP all 3 specialties/sub specialties get $20K but for MSP it ranges from $25K for endo to $43K for Psych.

Do they go with the highest paying specialty? The lowest? Ask you to choose? Or pay based on whatever they have you doing at the time?

 

[haujun]

The ISP is instead of, not additive.
ASP = 15K/yr - everyone not in training gets this
ISP depends on speciality - let's say 20K average
MSP - essentially a re-enlistment bonus - it is annual so if you sign a 4 year it is an additional lets say 40K/yr depending on your specialty - payable as soon as you commit yourself - so in your case, you could sign a 4 year after residency even though you still have a USUHS committment and get the pay up front while extending your service obligation 4 more years..

I believe that Multiyear Special Pay (MSP) gets paid after completion of any other active duty service commitment OR has a least 8 years of creditable service. Since USUHS grads incur 7 year obligation, if they did 3 year IM residency they need to do 5 years obligations before becoming eligible in applying for MSP. Conversely as for 4 year HPSPers they will be eligible for MSP after completing 4 years commmitment after 3 year IM residency. Please google: MC special pays 2010 for more info...

 

[Homunculus]

The ISP is instead of, not additive.

wow. learn something every day. this doesn't make a lot of sense to me if true-- a subspecialist's bonus is the same as the non-specialist?

in my world, for example, what is the incentive to do a fellowship if you make the same as a general pediatrician as a pediatric gastroenterologist? or, as in xmsr3's example, an endocrinologist making *less* than they did before tehy subspecialized? doesn't compute. seeing subspecialists in house saves TRICARE a lot of cash i would think and which is why i think they'd be offered more in the way of bonuses.

i may have to email some of my old attendings and get the scoop on this. i always assumed the subspecialty category whatever was added to the baseline specialty. . .


--your friendly neighborhood now reconsidering fellowship caveman

 

[Gastrapathy]

wow. learn something every day. this doesn't make a lot of sense to me if true-- a subspecialist's bonus is the same as the non-specialist?

in my world, for example, what is the incentive to do a fellowship if you make the same as a general pediatrician as a pediatric gastroenterologist? or, as in xmsr3's example, an endocrinologist making *less* than they did before tehy subspecialized? doesn't compute. seeing subspecialists in house saves TRICARE a lot of cash i would think and which is why i think they'd be offered more in the way of bonuses.

i may have to email some of my old attendings and get the scoop on this. i always assumed the subspecialty category whatever was added to the baseline specialty. . .


--your friendly neighborhood now reconsidering fellowship caveman

A1 is correct. You only get one ISP. As for endocrine making less than general medicine, this isn't so far off from the real world.

 

[Homunculus]

for endo, sure it makes sense (i guess). i would still think it is more cost effective to have subspecialists in house vs the local economy.

take yourself though-- i would be a bit peeved if as a GI doc i was making the same as an internist. i'm already into the application cycle for peds GI, and while this isn't a deal breaker, it definitely causes me to re-evaluate things a bit. it's not all about the money (honestly in the military it's more about the lifestyle-- general pediatricians are abused at the MEDDACs) but in the end it is a little about the money. the civilian side peds specialties make more, on average, than their generalist counterparts. i'm working my b@lls off as chief of peds here and don't have the power to change squat. at least as a subpecialist i can avoid some (some) of the abuse. plus, 6 month deployments instead of 12 . . .

i guess the pay during fellowship is better, but if i didn't already have an obligation (and therefore a reason to try to make my time in better via subspecializing) this would just add to the "reasons to leave" pile.

good info to know. thanks.

--your friendly neighborhood chief with no teeth caveman

 

[Homunculus]

looking at it some more-- why would they even go through the trouble of creating the subspecialty categories I-V and add in subpecialties that are already covered?

for instance, ob/gyn has an ISP, but then also has a subpecialty ISP. which one do they get? 😕 same with ENT and ophtho (and probably others) . . .

--your friendly neighborhood number crunching caveman

 

[J-Rad]

What he's trying to say is that your 1-yr ISP pay as a sub will not be (in your case) Gen Peds ISP ($20K in FY10)+Peds Gastro ($26K), but rather will be $26K (unless rates increase). From looking at the chart, there are not any subs who make less than their base residency ISP rate (minimum for everything is $20K), but there are some that make the same (category-4 supspecialists which endocrine would fall under)

And be happy, your ISP is the same as the adult GI guys and more than derm! 😉

(But not as much as deserved 🙁)

 

[Chonal Atresia]

I am a subspecialized ENT (Subspecialty Cat V) - my ISP is 36K. General ENT receives 30K for ISP. I don't even pretend to understand MSP/MISP as I have 3.5 years left with my ADSO and have no desire to sign on for additional time. I am able to moonlight 7-8 full weeks per year and the extra 90-100K from this far exceeds any "carrot" that the military tries to put out there with MSP/MISP. Even with all this moonlighting I am still making half what I'm worth in the "real" world. Sorry to hijack the thread.

 

[GeoLeoX]

...and if you think about it you could actually be making less as a subspecialist than as a generalist for a few years if you do your fellowship during your ADSO. that's because your cohort would be able to sign the multiyear bonus before you can because you extended your ADSO.

 

[a1qwerty55]

I believe that Multiyear Special Pay (MSP) gets paid after completion of any other active duty service commitment OR has a least 8 years of creditable service. Since USUHS grads incur 7 year obligation, if they did 3 year IM residency they need to do 5 years obligations before becoming eligible in applying for MSP. Conversely as for 4 year HPSPers they will be eligible for MSP after completing 4 years commmitment after 3 year IM residency. Please google: MC special pays 2010 for more info...

This is probably correct (the 8 year creditable service part). I'm no special pay expert but it is fairly amazing to me that you can still be working off your ADSO and collect a re-enlistment bonus. In my case it actually extended me beyond 20 years of service but in my circumstance I was going to stay till 22 anyway so free money.

 

[Gastrapathy]

This is probably correct (the 8 year creditable service part). I'm no special pay expert but it is fairly amazing to me that you can still be working off your ADSO and collect a re-enlistment bonus. In my case it actually extended me beyond 20 years of service but in my circumstance I was going to stay till 22 anyway so free money.

Its true but it adds to your obligation. You just have to do the MSP-less years at the other end. You get the money earlier but get paid less later and give up control. Bad idea, IMO.

 

[bobbyseal]

Sorry to hijack,

But, here's a what if situation. You have 8 years creditable service, but still have 1 year ADSO for HPSP. If you take the 4 year MSP and then go off and do a two year fellowship, what's your new service obligation?

Is it just 3 years after your fellowship that you owe? How does the MSP get taken into account. I know of the "gotcha" clause whereby if you take MSP during fellowship you accrue both MSP obligation + fellowship obligation.

 

[pgg]

for endo, sure it makes sense (i guess). i would still think it is more cost effective to have subspecialists in house vs the local economy.

None of it makes sense.

They pay spine fellowship trained orthopedic surgeons a whoppin' $16K/year more than FP.


Anti-retention is the explicitly declared objective. The military does not want physicians to stay in beyond their commitments. I'm not sure why they pay us ISP or ASP or BCP or VSP at all.

 

[haujun]

None of it makes sense.

They pay spine fellowship trained orthopedic surgeons a whoppin' $16K/year more than FP.


Anti-retention is the explicitly declared objective. The military does not want physicians to stay in beyond their commitments. I'm not sure why they pay us ISP or ASP or BCP or VSP at all.

I have no issue about receiving those payments during our commitment. ISP, ASP, BCP and VSP are not design to keep physicians to stay in the military as they are paid during our commitment. I agree that MSP should go up esp for certain physicians if military is serious about keeping physicians to stay.

 

[Yellowstone]

Sorry to hijack,

But, here's a what if situation. You have 8 years creditable service, but still have 1 year ADSO for HPSP. If you take the 4 year MSP and then go off and do a two year fellowship, what's your new service obligation?

Is it just 3 years after your fellowship that you owe? How does the MSP get taken into account. I know of the "gotcha" clause whereby if you take MSP during fellowship you accrue both MSP obligation + fellowship obligation.

Correct, three years after fellowship, as long as you sign the MSP before starting fellowship.

 

[Charlie0318]

So if a Family Medicine Doc has 4 years of HPSP and wants to do a sports med fellowship isn't there a program where you can get a % of your MSP early if you sign on for an extra year or something? But if that was done before the fellowship started the fellowship year would count for that extra year and you would not accrue any extra time?

This stuff is far enough away that it will probably change 10 times by the time i am there, but hypothetical situations are so much fun 🙂

 

[bobbyseal]

This is a fun game...

How about this one...

You do HPSP for 4 years. You get a deferment for residency that is 6 years long. You come back on active duty and serve 2 years. Now you hit the 8 year creditable service mark. Can you take the 2 year MSP and not accrue any more commitment time?

Thanks.

 

[haujun]

This is a fun game...

How about this one...

You do HPSP for 4 years. You get a deferment for residency that is 6 years long. You come back on active duty and serve 2 years. Now you hit the 8 year creditable service mark. Can you take the 2 year MSP and not accrue any more commitment time?

Thanks.

No. Two years will be added to your remaining obligation (2 yr) giving you a grand total of 4 years.

 

[Fabio001]

From looking at the chart, there are not any subs who make less than their base residency ISP rate (minimum for everything is $20K), but there are some that make the same (category-4 supspecialists which endocrine would fall under)

And be happy, your ISP is the same as the adult GI guys and more than derm! 😉

(But not as much as deserved 🙁)

What about neurology. With a 4 year contract they make significantly less than internal... How does this mirror the real world??
... or am I dumb, and incapable of reading the chart (a serious possibility)