Questions for current/prior military physicians

[Kay_Em_Jay]

Hello all. I am currently unconditionally accepted to USUHS. While I am very excited about the opportunity, I would like a little more clarification from folks as I make my decision going forward. I do have 6 years of prior military service as a submarine nuclear electronics technician, so I have a good idea of what enlisted military life was like, but this is likely a bit different than a commission physician. With that said, here are my questions:

• While I was enlisted, a significant aspect of our lifestyle was our sea/shore duty rotations. We would spend an average of four years at a seagoing command where we were expected to go underway for weeks/months or be deployed (typically 6+ months). During a shore tour, we would be attached to a command for an average of three years, with no expectation of going out to sea or being deployed. These were typically training roles and were seen as the easier portion of your service time. As a physician, is there a similar command rotation?

• How often have you seen the physicians rotate commands?

• As an enlisted person, I had little to no control of what my next command was. This depended on the individual (extenuating life circumstances, time in service, qualifications). On a scale of 1 to 10 (1 being no control and 10 being complete control,) I would say the average person fell around 2-3 on where they were stationed next. Of course, this is military service, and it always boils down to the needs of the Navy, and I expect that. With that said, I was curious if you felt, as a physician, what level of control you had over where you were stationed and what factors impacted that.

• I have seen a number of discussions regarding ODE, and I wondered if you agree with my takeaways. Also, could you expand on any of them to provide more context or specific examples?
  • Keep ODE earnings to yourself. (Of course, go through the proper chain of command requirements to request it, but don't brag).
  • It is dependent on the current chain of command if it is possible.
  • Most seem to agree it is necessary to avoid skill degradation.
  • Opportunities for ODE also depend heavily on your specialty. At this stage, I am interested in Psychiatry, Neurology, and Anesthesiology (keeping a very open mind, though, since I have no doubt rotations will impact this decision heavily) and wondered if you have seen anyone in these specialties having trouble getting ODE opportunities.

• Is there anything that you could share about your time in service that improved your capabilities as a physician that you otherwise would not have gotten had you not served?

• My last question is a bit more personal, and I wondered if you could share what you felt was the best/most rewarding aspect of being a military physician and, subsequently, what you felt was the part you disliked the most.

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[afteranesthesia]

Hello all. I am currently unconditionally accepting of USUHS. While I am very excited about the opportunity, I would like a little more clarification from folks as I make my decision going forward. I do have 6 years of prior military service as a submarine nuclear electronics technician, so I have a good idea of what enlisted military life was like, but this is likely a bit different than a commission physician. With that said, here are my questions:

• While I was enlisted, a significant aspect of our lifestyle was our sea/shore duty rotations. We would spend an average of four years at a seagoing command where we were expected to go underway for weeks/months or be deployed (typically 6+ months). During a shore tour, we would be attached to a command for an average of three years, with no expectation of going out to sea or being deployed. These were typically training roles and were seen as the easier portion of your service time. As a physician, is there a similar command rotation?

• How often have you seen the physicians rotate commands?

• As an enlisted person, I had little to no control of what my next command was. This depended on the individual (extenuating a person's life circumstances, time in service, qualifications). On a scale of 1 to 10 (1 being no control and 10 being complete control,) I would say the average person fell around 2-3 on where they were stationed next. Of course, this is military service, and it always boils down to the needs of the Navy, and I expect that. With that said, I was curious if you felt, as a physician, what level of control you had over where you were stationed and what factors impacted that.

• I have seen a number of discussions regarding ODE, and I wondered if you agree with my takeaways. Also, could you expand on any of them to provide more context or specific examples?
  • Keep ODE to yourself.
  • It is dependent on the current chain of command if it is possible.
  • Most seem to agree it is necessary to avoid skill degradation.
  • Opportunities for ODE also depend heavily on your specialty. At this stage, I am interested in Psychiatry and Neurology (keeping a very open mind, though, since I have no doubt rotations will impact this decision heavily) and wondered if you have seen anyone in these specialties having trouble getting ODE opportunities.

• My last question is a bit more personal, and I wondered if you could share what you felt was the best/most rewarding aspect of being a military physician and, subsequently, what you felt was the part you disliked the most.

1). Schedule can change with no notice. You can be deployed at will. People say there are bands, but there aren't for many physicians depending on what you practice. You can try to homestead, but this doesn't always work. There are no guarantees in the military. They want to change what they are doing with you - they will. You have no control.

2). You can request to move. You may not be allowed to. You may be forced to move, although I saw that less. See homestead comment.

3). Depends completely on your specialty and where they need you. This varies too widely per specialty to offer a blanket answer.

4). You cannot keep ODE to yourself if you want to avoid a LOC or LOA. Currently, physicians at one particular base I am thinking of are finding this out the hard way. Heads are rolling so to speak. It is 100 percent dependent on the command. Depending on the specialty, you may not even be allowed to practice your subspecialty. Command may grant then take back, grant then take back over and over again ODE privileges. You may or may not be credentiable when you come out because of this. Your volume may not be large enough where you are to feel competent when you get out either. But needs of the military and command dependent on ODE and definitely whether or not you are credentiable as a physician when you get out is not anything they are concerned about. It's not even worth addressing whether or not you can find ODE in Psychiatry and Neurology bc not only do you not know if you'll practice those, that's not a possible question to answer since basically you are asking - out of all the bases in all of America, are there opportunities to practice Neurology and Psychiatry on the side? What a weird question, because yes of course. But no one knows where you'll be or who your command will be or even if you'll be allowed to do it...so no way of knowing.

5). Best thing - My DD214 and the day I got out. Worst thing - Everything.

 

[afteranesthesia]

Hello all. I am currently unconditionally accepting of USUHS. While I am very excited about the opportunity, I would like a little more clarification from folks as I make my decision going forward. I do have 6 years of prior military service as a submarine nuclear electronics technician, so I have a good idea of what enlisted military life was like, but this is likely a bit different than a commission physician. With that said, here are my questions:

• While I was enlisted, a significant aspect of our lifestyle was our sea/shore duty rotations. We would spend an average of four years at a seagoing command where we were expected to go underway for weeks/months or be deployed (typically 6+ months). During a shore tour, we would be attached to a command for an average of three years, with no expectation of going out to sea or being deployed. These were typically training roles and were seen as the easier portion of your service time. As a physician, is there a similar command rotation?

• How often have you seen the physicians rotate commands?

• As an enlisted person, I had little to no control of what my next command was. This depended on the individual (extenuating a person's life circumstances, time in service, qualifications). On a scale of 1 to 10 (1 being no control and 10 being complete control,) I would say the average person fell around 2-3 on where they were stationed next. Of course, this is military service, and it always boils down to the needs of the Navy, and I expect that. With that said, I was curious if you felt, as a physician, what level of control you had over where you were stationed and what factors impacted that.

• I have seen a number of discussions regarding ODE, and I wondered if you agree with my takeaways. Also, could you expand on any of them to provide more context or specific examples?
  • Keep ODE to yourself.
  • It is dependent on the current chain of command if it is possible.
  • Most seem to agree it is necessary to avoid skill degradation.
  • Opportunities for ODE also depend heavily on your specialty. At this stage, I am interested in Psychiatry and Neurology (keeping a very open mind, though, since I have no doubt rotations will impact this decision heavily) and wondered if you have seen anyone in these specialties having trouble getting ODE opportunities.

• My last question is a bit more personal, and I wondered if you could share what you felt was the best/most rewarding aspect of being a military physician and, subsequently, what you felt was the part you disliked the most.

More importantly, have you considered other ways to pay for medical school that don't involve this? There are numerous.

 

[Kay_Em_Jay]

1). Schedule can change with no notice. You can be deployed at will. People say there are bands, but there aren't for many physicians depending on what you practice. You can try to homestead, but this doesn't always work. There are no guarantees in the military. They want to change what they are doing with you - they will. You have no control.

This sounds like military life in general, to be honest😅—loss of control, unpredictability, etc. No surprises there, especially with mottos like "expect the worst, hope for the best," and "embrace the suck," being a few I clearly remember from my time serving. I guess I'll throw in the follow-up question to help remove the generalization you offered: what is the average number of deployments a physician should expect in a 10-year period?

2). You can request to move. You may not be allowed to. You may be forced to move, although I saw that less. See homestead comment.

I'm not familiar with what homesteading is. Could you clarify that?

3). Depends completely on your specialty and where they need you. This varies too widely per specialty to offer a blanket answer.

Well, I suppose let's go based on your experience (assuming you were an anesthesiologist). On that scale of 1-10, how much control would you say you had?

4). You cannot keep ODE to yourself if you want to avoid a LOC or LOA. Currently, physicians at one particular base I am thinking of are finding this out the hard way. Heads are rolling so to speak. It is 100 percent dependent on the command. Depending on the specialty, you may not even be allowed to practice your subspecialty. Command may grant then take back, grant then take back over and over again ODE privileges. You may or may not be credentiable when you come out because of this. Your volume may not be large enough where you are to feel competent when you get out either. But needs of the military and command dependent on ODE and definitely whether or not you are credentiable as a physician when you get out is not anything they are concerned about. It's not even worth addressing whether or not you can find ODE in Psychiatry and Neurology bc not only do you not know if you'll practice those, that's not a possible question to answer since basically you are asking - out of all the bases in all of America, are there opportunities to practice Neurology and Psychiatry on the side? What a weird question, because yes of course. But no one knows where you'll be or who your command will be or even if you'll be allowed to do it...so no way of knowing.

Perhaps I worded that poorly. When I said, "Keep ODE to yourself," I didn't mean go rogue and don't tell anyone at the command or get permission to do so. I totally understand there are proper channels to go through to get approved for ODE by the command. I meant don't go around telling people how much money you made or rub it in people's faces. Have some tact, if you will.

As for the weirdness of my question, that comes from some items I have read here. Getting ODE opportunities seems to be easier for specialties that do not offer continuous care and can take on shift work. So, I wanted to ask those who specialize in or know those who specialize in neurology and psychiatry specifically if they experience trouble finding ODE opportunities in general. This certainly would matter based on a variety of factors, but I am looking for what others have experienced and expect various answers.

5). Best thing - My DD214 and the day I got out. Worst thing - Everything.

This is an excellent answer, even if meant to be partially a joke. It is in line with my past experience. I knew some of my fellow nuclear submariners in the past who literally made a chart with boxes counting down the number of days until they got out (counting into 1000+ days), and they would take great pleasure in crossing boxes off and watching that number go down each day. On the opposite side of the spectrum, I had others performing the same job but perhaps had a different personal life experience or were part of a different command, and they had an incredible experience and could not wait to re-enlist. I was somewhere in between. Reading through this forum has resurfaced some memories I have that I didn't realize I suppressed of things I hated, but there are equally as many experiences I had that I hold on to fondly and formed life-long friendships. I ask this question to get a feel for how being a commissioned physician was for folks as compared to my life as an enlisted submariner. Make no mistake, working in an engine room in a metal tube under the ocean for 190+ days on deployment, being isolated from loved ones, only to go back into port to continue the workup on a vessel to repeat that process endlessly felt horrible at times. Add in being forced to stay on board while in port every 3 days (sometimes every other day, depending on how many people were qualified to do what I did) for 24 hours, and not being allowed to leave was one of my least favorite items.

With that said, could you share a specific item you recall disliking? Also, let me know if there is anything you ever felt slightly good about (or even a neutral feeling) so that I can get a better feel for things.

More importantly, have you considered other ways to pay for medical school that don't involve this? There are numerous.

Of course. I am not someone who takes steps in a direction without considering options. I have narrowed things down to a few options at this stage, and USUHS is one of those paths.

 

[pgg]

When I said, "Keep ODE to yourself," I didn't mean go rogue and don't tell anyone at the command or get permission to do so. I totally understand there are proper channels to go through to get approved for ODE by the command. I meant don't go around telling people how much money you made or rub it in people's faces. Have some tact, if you will.

This is good life advice for anyone, anywhere - not just in the military.

Wherever you are, you'll earn more than some people and less than others. There's really never a time or place when it's OK to brag or show off, unless you're a tool. 🙂

 

[afteranesthesia]

This sounds like military life in general, to be honest😅—loss of control, unpredictability, etc. No surprises there, especially with mottos like "expect the worst, hope for the best," and "embrace the suck," being a few I clearly remember from my time serving. I guess I'll throw in the follow-up question to help remove the generalization you offered: what is the average number of deployments a physician should expect in a 10-year period?

I'm not familiar with what homesteading is. Could you clarify that?

Well, I suppose let's go based on your experience (assuming you were an anesthesiologist). On that scale of 1-10, how much control would you say you had?

Perhaps I worded that poorly. When I said, "Keep ODE to yourself," I didn't mean go rogue and don't tell anyone at the command or get permission to do so. I totally understand there are proper channels to go through to get approved for ODE by the command. I meant don't go around telling people how much money you made or rub it in people's faces. Have some tact, if you will.

As for the weirdness of my question, that comes from some items I have read here. Getting ODE opportunities seems to be easier for specialties that do not offer continuous care and can take on shift work. So, I wanted to ask those who specialize in or know those who specialize in neurology and psychiatry specifically if they experience trouble finding ODE opportunities in general. This certainly would matter based on a variety of factors, but I am looking for what others have experienced and expect various answers.

This is an excellent answer, even if meant to be partially a joke. It is in line with my past experience. I knew some of my fellow nuclear submariners in the past who literally made a chart with boxes counting down the number of days until they got out (counting into 1000+ days), and they would take great pleasure in crossing boxes off and watching that number go down each day. On the opposite side of the spectrum, I had others performing the same job but perhaps had a different personal life experience or were part of a different command, and they had an incredible experience and could not wait to re-enlist. I was somewhere in between. Reading through this forum has resurfaced some memories I have that I didn't realize I suppressed of things I hated, but there are equally as many experiences I had that I hold on to fondly and formed life-long friendships. I ask this question to get a feel for how being a commissioned physician was for folks as compared to my life as an enlisted submariner. Make no mistake, working in an engine room in a metal tube under the ocean for 190+ days on deployment, being isolated from loved ones, only to go back into port to continue the workup on a vessel to repeat that process endlessly felt horrible at times. Add in being forced to stay on board while in port every 3 days (sometimes every other day, depending on how many people were qualified to do what I did) for 24 hours, and not being allowed to leave was one of my least favorite items.

With that said, could you share a specific item you recall disliking? Also, let me know if there is anything you ever felt slightly good about (or even a neutral feeling) so that I can get a better feel for things.

Of course. I am not someone who takes steps in a direction without considering options. I have narrowed things down to a few options at this stage, and USUHS is one of those paths.

I felt good about nothing. I had zero good experiences in the military. I hated everything.

 

[afteranesthesia]

This sounds like military life in general, to be honest😅—loss of control, unpredictability, etc. No surprises there, especially with mottos like "expect the worst, hope for the best," and "embrace the suck," being a few I clearly remember from my time serving. I guess I'll throw in the follow-up question to help remove the generalization you offered: what is the average number of deployments a physician should expect in a 10-year period?

I'm not familiar with what homesteading is. Could you clarify that?

Well, I suppose let's go based on your experience (assuming you were an anesthesiologist). On that scale of 1-10, how much control would you say you had?

Perhaps I worded that poorly. When I said, "Keep ODE to yourself," I didn't mean go rogue and don't tell anyone at the command or get permission to do so. I totally understand there are proper channels to go through to get approved for ODE by the command. I meant don't go around telling people how much money you made or rub it in people's faces. Have some tact, if you will.

As for the weirdness of my question, that comes from some items I have read here. Getting ODE opportunities seems to be easier for specialties that do not offer continuous care and can take on shift work. So, I wanted to ask those who specialize in or know those who specialize in neurology and psychiatry specifically if they experience trouble finding ODE opportunities in general. This certainly would matter based on a variety of factors, but I am looking for what others have experienced and expect various answers.

This is an excellent answer, even if meant to be partially a joke. It is in line with my past experience. I knew some of my fellow nuclear submariners in the past who literally made a chart with boxes counting down the number of days until they got out (counting into 1000+ days), and they would take great pleasure in crossing boxes off and watching that number go down each day. On the opposite side of the spectrum, I had others performing the same job but perhaps had a different personal life experience or were part of a different command, and they had an incredible experience and could not wait to re-enlist. I was somewhere in between. Reading through this forum has resurfaced some memories I have that I didn't realize I suppressed of things I hated, but there are equally as many experiences I had that I hold on to fondly and formed life-long friendships. I ask this question to get a feel for how being a commissioned physician was for folks as compared to my life as an enlisted submariner. Make no mistake, working in an engine room in a metal tube under the ocean for 190+ days on deployment, being isolated from loved ones, only to go back into port to continue the workup on a vessel to repeat that process endlessly felt horrible at times. Add in being forced to stay on board while in port every 3 days (sometimes every other day, depending on how many people were qualified to do what I did) for 24 hours, and not being allowed to leave was one of my least favorite items.

With that said, could you share a specific item you recall disliking? Also, let me know if there is anything you ever felt slightly good about (or even a neutral feeling) so that I can get a better feel for things.

Of course. I am not someone who takes steps in a direction without considering options. I have narrowed things down to a few options at this stage, and USUHS is one of those paths.

Honestly, I don't know why I bother. You guys are going to continue to sign up, but I guess on the bright side, you will then replace me replying to clueless posters here trying to get them to not sign up. Listen, you want medical school paid for? Take the loans. Then take a job after you get to do the training and residency you want that pays everything off. Or go into the military then and as an attending, they will give you a sign on bonus that will pay your loans off, but you won't have sacrificed your training or sanity. You'll still then lament the lack of control and watch your skills dance out the door, though, while the military doesn't care one bit about it, but at least you got to train well etc. There are so many options these days. The military is the least great one. It's like people picking between sweet potatoes, baked potatoes, and a rotten potato. People keep posting here asking about picking the rotten potato, yet, I do not understand why. I can't answer your questions anymore, because it is exhausting.

 

[afteranesthesia]

This is good life advice for anyone, anywhere - not just in the military.

Wherever you are, you'll earn more than some people and less than others. There's really never a time or place when it's OK to brag or show off, unless you're a tool. 🙂

 

[afteranesthesia]

PGG - one of the only sane voices here.

 

[Kay_Em_Jay]

Honestly, I don't know why I bother. You guys are going to continue to sign up, but I guess on the bright side, you will then replace me replying to clueless posters here trying to get them to not sign up. Listen, you want medical school paid for? Take the loans. Then take a job after you get to do the training and residency you want that pays everything off. Or go into the military then and as an attending, they will give you a sign on bonus that will pay your loans off, but you won't have sacrificed your training or sanity. You'll still then lament the lack of control and watch your skills dance out the door, though, while the military doesn't care one bit about it, but at least you got to train well etc. There are so many options these days. The military is the least great one. It's like people picking between sweet potatoes, baked potatoes, and a rotten potato. People keep posting here asking about picking the rotten potato, yet, I do not understand why. I can't answer your questions anymore, because it is exhausting.

I understand you didn't have a good time in the military. It also makes sense that you would want to share this with others to ensure they don't go through the same thing you did. I've experienced the military for myself as well. I know there is a lot that is unpleasant about it, but my current life circumstances offer me limited options for pursuing medical school, and going to USUHS is one of them. I was trying to get productive answers other than "Don't do it; it sucks."

PGG - one of the only sane voices here.

I've also spoken at length with them and have gotten great information from them.

 

[afteranesthesia]

I understand you didn't have a good time in the military. It also makes sense that you would want to share this with others to ensure they don't go through the same thing you did. I've experienced the military for myself as well. I know there is a lot that is unpleasant about it, but my current life circumstances offer me limited options for pursuing medical school, and going to USUHS is one of them. I was trying to get productive answers other than "Don't do it; it sucks."


I've also spoken at length with them and have gotten great information from them.

That is a productive answer, but like all the other pre-meds, you won't accept it or recognize how productive it is. Best of luck.

 

[Kay_Em_Jay]

That is a productive answer, but like all the other pre-meds, you won't accept it or recognize how productive it is. Best of luck.

Thank you.

 

[pgg]

I understand you didn't have a good time in the military. It also makes sense that you would want to share this with others to ensure they don't go through the same thing you did. I've experienced the military for myself as well. I know there is a lot that is unpleasant about it, but my current life circumstances offer me limited options for pursuing medical school, and going to USUHS is one of them. I was trying to get productive answers other than "Don't do it; it sucks."

I understand.

It's common for premeds coming through this forum to think that the "don't do it; it sucks" posts are coming from people who just didn't like the military, the way some people just don't like mint ice cream.

At this point in history, I think people with prior service are about the only ones who might sometimes be a good fit and have a good experience with military medicine. The financial calculus is different, since you're so much closer to the military retirement, sometimes reaching retirement eligibility when the medical ADSO is fulfilled. The years of service improve your pay, and (if prior service was as an officer) you might enjoy an earlier promotion to O4. And, they have at least some real exposure to the loss of control that comes with serving in the military.

But be careful extrapolating your experiences serving in a line community with the nature of future service as a physician. The things that are important to enlisted servicemembers, line officers, and military physicians are all very different. The leadership is different. Their needs and priorities are different. The stage of life they are in are different.


A lot of people will talk about how military physicians are officers first and doctors second. This is hit pretty heavily during the medical corps indoctrination courses. It was also a theme at USUHS when I was there. Premeds with prior military service hear this, nod, and think "hey I lived the ups and downs of being in the military (as a ______), so I can accept the ups and downs of being in the military some more (but as a physician)" ... it's not the same.

"Officer first, doctor second" is a load of crap. Good doctors are always doctors first. Good military doctors are doctors who happen to be in the military - they do all the things they're supposed to as officers, they follow the rules, but their first duty is being a good doctor and taking good care of their patients. It can sometimes be hard to do that in the DOD system which (rightly) values warfighting over everything else, and is led by people who aren't doctors.

There are a number of necessary preconditions that must be met to become, and to continue to be, a "good doctor" - but case load and case complexity are among the highest on that list. Case load and complexity for active duty military physicians in many (if not most) specialties is very poor by civilian standards. It's hard to really explain this to premeds. (It can be hard to explain this to active duty doctors who don't moonlight and only know the military system!) They all understand the concept on an intellectual level, but they don't have the experience to judge the severity of the issue or its likely impact on them.

Importantly - premeds don't know what specialty they'll end up in. Most of them think they do, but the truth is that most of them don't. Since one's experience in the military is heavily dependent upon specialty, it's very hard to predict where anyone will wind up on the spectrum of "a pretty good experience" to "absolute professional catastrophe" ...


In very broad terms, it doesn't take a lot to keep a military pilot happy, competent, and improving: time in the air flying. Military surgeons need much the same thing: time in the OR operating. Both will endure the necessary side tasks the job requires, but the point of their existence is the flying and the operating.

The military is generally quite good about understanding that pilots need a lot of time in the air. Not to be merely competent, but to hone their skills and become exceptional. The line implicitly understands that more experienced pilots with lots of time in the air have a tactical edge and are more lethal combatants. They value seniority. They worry about retention of senior pilots, even if the ROTC and Academy training pipeline is full of newbies with wide eyes who dream about flying jets.

However, the line doesn't connect the dots in the same way when it comes to surgeons operating. If cornered, they'll all agree that yeah surgeons need to operate all the time. They'll move their lips and make concerned noises. But they don't have the capacity or genuine concern to understand the subtleties of case load, case complexity, and the supporting staff/clinic characteristics they need. They see a billet and they see that it's filled with a doctor, and they think it's all good. They see 98%+ survival rates when casualties reach a role 2+ facility in a combat theater, and they think it's all good. (And they have a point.) But they don't value seniority. They don't worry about retention, because the training pipeline is full of newbies with wide eyes dreaming about operating (and nightmares about student loan debt).

It's hard to really explain to anyone who isn't a doctor all of the little things the military gets terribly, terribly wrong when it comes to cultivating and retaining talented physicians.


All that said. The Navy at least has made some progress in the last couple years addressing case load and complexity. I'm 2 1/2 years out at this point and my first-hand knowledge of the practice conditions gets older every day. I hear that my last duty station is now getting some civilian trauma through the gates, and that progress has been made on setting up agreements with civilian hospitals to rotate staff through for more cases.

caveat emptor

 

[Apollyon]

I just remember our instructor for ship systems, when he said, "staff pukes exist to keep the war machine rolling".

 

[afteranesthesia]

I understand.

It's common for premeds coming through this forum to think that the "don't do it; it sucks" posts are coming from people who just didn't like the military, the way some people just don't like mint ice cream.

At this point in history, I think people with prior service are about the only ones who might sometimes be a good fit and have a good experience with military medicine. The financial calculus is different, since you're so much closer to the military retirement, sometimes reaching retirement eligibility when the medical ADSO is fulfilled. The years of service improve your pay, and (if prior service was as an officer) you might enjoy an earlier promotion to O4. And, they have at least some real exposure to the loss of control that comes with serving in the military.

But be careful extrapolating your experiences serving in a line community with the nature of future service as a physician. The things that are important to enlisted servicemembers, line officers, and military physicians are all very different. The leadership is different. Their needs and priorities are different. The stage of life they are in are different.


A lot of people will talk about how military physicians are officers first and doctors second. This is hit pretty heavily during the medical corps indoctrination courses. It was also a theme at USUHS when I was there. Premeds with prior military service hear this, nod, and think "hey I lived the ups and downs of being in the military (as a ______), so I can accept the ups and downs of being in the military some more (but as a physician)" ... it's not the same.

"Officer first, doctor second" is a load of crap. Good doctors are always doctors first. Good military doctors are doctors who happen to be in the military - they do all the things they're supposed to as officers, they follow the rules, but their first duty is being a good doctor and taking good care of their patients. It can sometimes be hard to do that in the DOD system which (rightly) values warfighting over everything else, and is led by people who aren't doctors.

There are a number of necessary preconditions that must be met to become, and to continue to be, a "good doctor" - but case load and case complexity are among the highest on that list. Case load and complexity for active duty military physicians in many (if not most) specialties is very poor by civilian standards. It's hard to really explain this to premeds. (It can be hard to explain this to active duty doctors who don't moonlight and only know the military system!) They all understand the concept on an intellectual level, but they don't have the experience to judge the severity of the issue or its likely impact on them.

Importantly - premeds don't know what specialty they'll end up in. Most of them think they do, but the truth is that most of them don't. Since one's experience in the military is heavily dependent upon specialty, it's very hard to predict where anyone will wind up on the spectrum of "a pretty good experience" to "absolute professional catastrophe" ...


In very broad terms, it doesn't take a lot to keep a military pilot happy, competent, and improving: time in the air flying. Military surgeons need much the same thing: time in the OR operating. Both will endure the necessary side tasks the job requires, but the point of their existence is the flying and the operating.

The military is generally quite good about understanding that pilots need a lot of time in the air. Not to be merely competent, but to hone their skills and become exceptional. The line implicitly understands that more experienced pilots with lots of time in the air have a tactical edge and are more lethal combatants. They value seniority. They worry about retention of senior pilots, even if the ROTC and Academy training pipeline is full of newbies with wide eyes who dream about flying jets.

However, the line doesn't connect the dots in the same way when it comes to surgeons operating. If cornered, they'll all agree that yeah surgeons need to operate all the time. They'll move their lips and make concerned noises. But they don't have the capacity or genuine concern to understand the subtleties of case load, case complexity, and the supporting staff/clinic characteristics they need. They see a billet and they see that it's filled with a doctor, and they think it's all good. They see 98%+ survival rates when casualties reach a role 2+ facility in a combat theater, and they think it's all good. (And they have a point.) But they don't value seniority. They don't worry about retention, because the training pipeline is full of newbies with wide eyes dreaming about operating (and nightmares about student loan debt).

It's hard to really explain to anyone who isn't a doctor all of the little things the military gets terribly, terribly wrong when it comes to cultivating and retaining talented physicians.


All that said. The Navy at least has made some progress in the last couple years addressing case load and complexity. I'm 2 1/2 years out at this point and my first-hand knowledge of the practice conditions gets older every day. I hear that my last duty station is now getting some civilian trauma through the gates, and that progress has been made on setting up agreements with civilian hospitals to rotate staff through for more cases.

caveat emptor

Once again, a very wise voice here that will go unheeded by pre-meds who think they get it, but they don't. I appreciate pgg's attempts at trying, and it's worth listening to him all you pre-meds out there. We are only shouting into the abyss, because we are hoping you will listen and not have the experience many of us very normal humans who went into this with bright eyes and good attitudes had.

 

[Kay_Em_Jay]

It's common for premeds coming through this forum to think that the "don't do it; it sucks" posts are coming from people who just didn't like the military, the way some people just don't like mint ice cream.

I was probably getting a bit frustrated when I typed this after re-reading it today. It was an oversimplification, but at the same time, I was genuinely seeking a good explanation as to why it sucks, which I did not feel I was getting from afteranesthesia. My point was that having someone say, "Don't do it because I said so," is not a productive answer and does not help me decide with the very limited options I have in front of me at this stage in my life.

But be careful extrapolating your experiences serving in a line community with the nature of future service as a physician. The things that are important to enlisted servicemembers, line officers, and military physicians are all very different. The leadership is different. Their needs and priorities are different. The stage of life they are in are different.

Absolutely! In fact, I made sure to state this exact point in my original post. I do not know what it's like to be a physician, much less a physician in the military. That is my entire motivation for making a post to ask questions to those who have this experience to make this much more clear to me. Despite what I have read and understand to be true about this path, I was trying to maintain a positive tone.

However, the line doesn't connect the dots in the same way when it comes to surgeons operating. If cornered, they'll all agree that yeah surgeons need to operate all the time. They'll move their lips and make concerned noises. But they don't have the capacity or genuine concern to understand the subtleties of case load, case complexity, and the supporting staff/clinic characteristics they need. They see a billet and they see that it's filled with a doctor, and they think it's all good. They see 98%+ survival rates when casualties reach a role 2+ facility in a combat theater, and they think it's all good. (And they have a point.) But they don't value seniority. They don't worry about retention, because the training pipeline is full of newbies with wide eyes dreaming about operating (and nightmares about student loan debt).

It's hard to really explain to anyone who isn't a doctor all of the little things the military gets terribly, terribly wrong when it comes to cultivating and retaining talented physicians.


All that said. The Navy at least has made some progress in the last couple years addressing case load and complexity. I'm 2 1/2 years out at this point and my first-hand knowledge of the practice conditions gets older every day. I hear that my last duty station is now getting some civilian trauma through the gates, and that progress has been made on setting up agreements with civilian hospitals to rotate staff through for more cases.

I could have quoted your entire response at this stage to thank you again for your thorough response. You have given me a massive amount of information between here and our previous discussions, and I can't thank you enough for answering them to the level you have. This is what I was referring to, explaining why it sucks. This helps me and others make a more informed decision. The lack of caseload has been a recurring trend I have seen several people state, and it is my primary concern as well.

As for specialty, everyone who has asked me up to this point, "What do you plan to specialize in?" I give the same answer. I have interests in a few areas (Psychiatry, Neurology, and Anesthesiology, as previously stated). Still, I really don't know, and I am keeping an open mind based on what I experience going forward. I ask about those in my original question not because I have this fantastical drive to specialize in one of those areas but simply because those are my interests at this stage (knowing they will likely change), and it makes sense to ask about them. I do not know what I do not know.

Again, this information from you (and others) does help tremendously. I have a career as a nuclear engineer right now that I have been at for 8 years, and I could certainly be fine (financially) staying there, but it is not the career I wanted. I have been working towards becoming a physician for the past 5 years, weighing everything out and having countless discussions with my spouse as we have reached this point. Even with all that planning, I am selecting schools with a few unknowns in my future as I wait to hear back from waitlists from 2 other schools. I have a strong preference for one of those other schools. If I am rejected from both, I will be faced with going to USUHS, putting off medical school another year with the hope that I will get accepted to a different school, or not becoming a physician at all. That makes this decision very challenging, especially putting off medical school for another year when I am accepted into USUHS. Denying that acceptance and gambling on another round is a terrifying prospect.

 

[Andrew_Doan]

First off, congratulations on your unconditional acceptance to USUHS! That’s a significant achievement, and your prior experience as a submarine nuclear electronics technician will serve you well in navigating the unique structure and culture of military medicine.

1. Command Rotation for Military Physicians

While there is no direct equivalent to sea/shore duty rotations in military medicine, physicians do have operational (deployable) and non-operational (hospital/clinic-based) assignments. As a medical officer on a ship, you will get close to a sea/shore duty based on the maintenance cycle of your ship. These assignments depend on your specialty and career track. I completed residencies in ophthalmology and aerospace medicine. When I pick ophthalmology assignments, I am mainly at the MTF and may be asked to cover on the hospital ships. If I pick aerospace medicine assignments, then I am assigned to operational billets, e.g. I was the Senior Medical Officer on a carrier for the strike group. I am also a flight surgeon, so I get asked to consider TAD assignments when flight surgeons are needed.

• Operational Tours: These can include assignments to fleet surgical teams, Marine Corps units, or overseas bases where deployment is more likely.
• Non-Operational Tours: These are typically at military treatment facilities (MTFs) such as Walter Reed, Portsmouth, or San Diego, where your primary role is patient care, education, and research. You may be attached to a platform such as one of the hospital ships.

2. How Often Do Physicians Rotate Commands?

The typical PCS (Permanent Change of Station) cycle is every 3-4 years, though this can vary based on mission needs, specialty, and personal circumstances. Some physicians, especially those in high-demand specialties, may stay longer at a duty station. I have seen specialists stay in one MTF for 10+ years. As an eye pathologist (one of one in the Navy), I had the option of staying in San Diego for my entire 20-year career. This is rare, so don't plan on homesteading. Others may rotate more frequently if they pursue leadership or operational roles.

3. Control Over Duty Stations

Compared to your enlisted experience, as a physician, you have significantly more influence over where you are stationed, but it’s still subject to the needs of the service. Here’s a general breakdown:

• Residency and Fellowship: Your options will be limited to military training hospitals with some FTOS (full-time out service) civilian residency training programs.

• After Training: You submit a “dream sheet” ranking your preferred assignments. While preferences are considered, the needs of the service take precedence.

• Specialty Matters: Some fields (e.g., family medicine, emergency medicine, surgery) have more assignment options, while others (e.g., cardiology, ophthalmology, neurology) may have fewer billet options because there are fewer of these specialists.

I’d estimate a 5-6 out of 10—you have input, but ultimate placement depends on service requirements. Also, when you climb rank (O5/O6), you'll be likely to get what you desire.

4. ODE (off-duty employment)

• Do NOT keep ODE to yourself. You'll stay out of trouble. It's no big deal to fill out the paperwork.
• ODE is dependent on your chain of command, but all commands I've worked for encourage it.
• The ODE instruction specifically states that ODE is necessary to avoid skill degradation, and most COs support it.
• Opportunities for ODE depend on where you live and the demand for your specialty.

If you’re looking for a career with purpose, leadership, and unique challenges, military medicine is an outstanding choice. Your prior enlisted service means you already understand the sacrifices and rewards of military life, and that experience will make you a stronger officer and physician. Best of luck at USUHS—you’re on an exciting path! I've enjoyed being a military physician, and I am entering my 20th year of service!

 

[Kay_Em_Jay]

First off, congratulations on your unconditional acceptance to USUHS! That’s a significant achievement, and your prior experience as a submarine nuclear electronics technician will serve you well in navigating the unique structure and culture of military medicine.

1. Command Rotation for Military Physicians

While there is no direct equivalent to sea/shore duty rotations in military medicine, physicians do have operational (deployable) and non-operational (hospital/clinic-based) assignments. As a medical officer on a ship, you will get close to a sea/shore duty based on the maintenance cycle of your ship. These assignments depend on your specialty and career track. I completed residencies in ophthalmology and aerospace medicine. When I pick ophthalmology assignments, I am mainly at the MTF and may be asked to cover on the hospital ships. If I pick aerospace medicine assignments, then I am assigned to operational billets, e.g. I was the Senior Medical Officer on a carrier for the strike group. I am also a flight surgeon, so I get asked to consider TAD assignments when flight surgeons are needed.

• Operational Tours: These can include assignments to fleet surgical teams, Marine Corps units, or overseas bases where deployment is more likely.
• Non-Operational Tours: These are typically at military treatment facilities (MTFs) such as Walter Reed, Portsmouth, or San Diego, where your primary role is patient care, education, and research. You may be attached to a platform such as one of the hospital ships.

2. How Often Do Physicians Rotate Commands?

The typical PCS (Permanent Change of Station) cycle is every 3-4 years, though this can vary based on mission needs, specialty, and personal circumstances. Some physicians, especially those in high-demand specialties, may stay longer at a duty station. I have seen specialists stay in one MTF for 10+ years. As an eye pathologist (one of one in the Navy), I had the option of staying in San Diego for my entire 20-year career. This is rare, so don't plan on homesteading. Others may rotate more frequently if they pursue leadership or operational roles.

3. Control Over Duty Stations

Compared to your enlisted experience, as a physician, you have significantly more influence over where you are stationed, but it’s still subject to the needs of the service. Here’s a general breakdown:

• Residency and Fellowship: Your options will be limited to military training hospitals with some FTOS (full-time out service) civilian residency training programs.

• After Training: You submit a “dream sheet” ranking your preferred assignments. While preferences are considered, the needs of the service take precedence.

• Specialty Matters: Some fields (e.g., family medicine, emergency medicine, surgery) have more assignment options, while others (e.g., cardiology, ophthalmology, neurology) may have fewer billet options because there are fewer of these specialists.

I’d estimate a 5-6 out of 10—you have input, but ultimate placement depends on service requirements. Also, when you climb rank (O5/O6), you'll be likely to get what you desire.

4. ODE (off-duty employment)

• Do NOT keep ODE to yourself. You'll stay out of trouble. It's no big deal to fill out the paperwork.
• ODE is dependent on your chain of command, but all commands I've worked for encourage it.
• The ODE instruction specifically states that ODE is necessary to avoid skill degradation, and most COs support it.
• Opportunities for ODE depend on where you live and the demand for your specialty.

If you’re looking for a career with purpose, leadership, and unique challenges, military medicine is an outstanding choice. Your prior enlisted service means you already understand the sacrifices and rewards of military life, and that experience will make you a stronger officer and physician. Best of luck at USUHS—you’re on an exciting path! I've enjoyed being a military physician, and I am entering my 20th year of service!

Thank you very much for this thorough response and kind words Dr. Doan. I really appreciate it. I had a few follow-up questions/clarifications, if you do not mind.

1. Is it common to see physicians rotate a PCS from an operational tour and then go to a non-operational tour following and continue this cycle, or do you see a lot of folks do back-to-back PCS operational/non-operational tours?

2. Regarding control of your destiny at higher ranks (O-5, O-6), do you have any resources that lay out requirements for promotion paths for a physician? For example, if I was motivated to make O-6, what sort of qualifications or commands should I be requesting to make myself more promotable?

3. One significant item I was unaware of before my enlistment was duty days. These were days when you were required to remain on site (station or the vessel itself) for 24 hours on a rotating watch schedule. This was easily my least favorite aspect of being enlisted, especially if there were limited individuals qualified, meaning I could be on board the ship for 24 hours while in port every other day. Officers also had duty days with us, although their rotation wasn't quite as demanding as hours. How often (if at all) do you see physicians perform these sorts of activities, and what do they entail if so?

4. I just clarified my original post since I did not type it clearly regarding ODE (specifically keeping it to yourself). I did not mean this to imply going rogue and getting employed without permission from your chain of command. I just meant don't be a jerk and go around bragging about how much money you're making with ODE to others. Be tactful and have some common sense/courtesy, if you will.

 

[SirGecko]

Thank you very much for this thorough response and kind words Dr. Doan. I really appreciate it. I had a few follow-up questions/clarifications, if you do not mind.

1. Is it common to see physicians rotate a PCS from an operational tour and then go to a non-operational tour following and continue this cycle, or do you see a lot of folks do back-to-back PCS operational/non-operational tours?

2. Regarding control of your destiny at higher ranks (O-5, O-6), do you have any resources that lay out requirements for promotion paths for a physician? For example, if I was motivated to make O-6, what sort of qualifications or commands should I be requesting to make myself more promotable?

3. One significant item I was unaware of before my enlistment was duty days. These were days when you were required to remain on site (station or the vessel itself) for 24 hours on a rotating watch schedule. This was easily my least favorite aspect of being enlisted, especially if there were limited individuals qualified, meaning I could be on board the ship for 24 hours while in port every other day. Officers also had duty days with us, although their rotation wasn't quite as demanding as hours. How often (if at all) do you see physicians perform these sorts of activities, and what do they entail if so?

4. I just clarified my original post since I did not type it clearly regarding ODE (specifically keeping it to yourself). I did not mean this to imply going rogue and getting employed without permission from your chain of command. I just meant don't be a jerk and go around bragging about how much money you're making with ODE to others. Be tactful and have some common sense/courtesy, if you will.

A lot of the answers to your questions are going to vary depending on the specialty. Some people bounce between operational and MTF commands but being at an mtf isn’t exactly like the sea shore rotations. You can deploy from either and one can argue the MTF job is actually more of your “real” job but even that will depend on the command. I’d just be aware that it isn’t really ever “fair”. Some people will magically seem to stay around certain locations while others wind up going overseas several times. For a lot of specialties you are dealing with a lot less people so it’s harder for there to be a “default”.

If you want to see what the military has lately been saying they want your career progression to look like check out Capt Schaefer’s blog. Joel Schofer's Career Planning Blog. They published a flowchart type thing with suggestions. The New Medical Corps Career Progression Slide – What Does It Mean to You?

Duty days could include officer of the day type assignments but it’s more typically a call schedule type thing. That could vary from at home call to in hospital call depending on the command. Some call might have a radius that you have to live around the command if it’s at home. It could potentially be very frequent depending on your job.

 

[Andrew_Doan]

Thank you very much for this thorough response and kind words Dr. Doan. I really appreciate it. I had a few follow-up questions/clarifications, if you do not mind.

1. Is it common to see physicians rotate a PCS from an operational tour and then go to a non-operational tour following and continue this cycle, or do you see a lot of folks do back-to-back PCS operational/non-operational tours?

2. Regarding control of your destiny at higher ranks (O-5, O-6), do you have any resources that lay out requirements for promotion paths for a physician? For example, if I was motivated to make O-6, what sort of qualifications or commands should I be requesting to make myself more promotable?

3. One significant item I was unaware of before my enlistment was duty days. These were days when you were required to remain on site (station or the vessel itself) for 24 hours on a rotating watch schedule. This was easily my least favorite aspect of being enlisted, especially if there were limited individuals qualified, meaning I could be on board the ship for 24 hours while in port every other day. Officers also had duty days with us, although their rotation wasn't quite as demanding as hours. How often (if at all) do you see physicians perform these sorts of activities, and what do they entail if so?

4. I just clarified my original post since I did not type it clearly regarding ODE (specifically keeping it to yourself). I did not mean this to imply going rogue and getting employed without permission from your chain of command. I just meant don't be a jerk and go around bragging about how much money you're making with ODE to others. Be tactful and have some common sense/courtesy, if you will.

I'll add to SirGecko above.

1. When people go on operational tours, the detailers and specialty leaders tend to give these individuals their preference after the tour, operational or non-operational.

2. The best guide for career progression is CAPT Joel Schofer's Career Planning Blog. The New Medical Corps Career Progression Slide – What Does It Mean to You?

3. In regards to being on call, for some specialties, it's in-house, but for many, it's home-call. The corpsmen take the overnight watch in the hospital and ship. If you're on a ship, you may be the only physician. Corpsmen will take duty and help with sick call 24/7.

 

[DOswag]

That is a productive answer, but like all the other pre-meds, you won't accept it or recognize how productive it is. Best of luck.

I signed up in 2010 after reading on this forum as well (I didn't officially create an account for a few more years but had started reading back in like 2007-2008). I was one of those who did not heed the warning and now I'm one of the ones on here trying to give a glimpse of what I went through so others won't do it as well. I separated in 2023 and am now living the good life on the civ side. I recognize there are things I wouldn't have ever done if I was not in the military and great people I would've never met, lived in a very cool location for 3 years which I otherwise would not have. I'm not sure I would have the job I have now if not for the military as my residency is what brought me to the city I live in currently and we were looking at returning here after separation so I can't say it was all for naught. But the work itself in the military was just awful. Extra duties that the military places on you that seem extremely asinine and take away from patient care are common place, the norm and expected, and trying to get out of those and work more on patient care can get you on the command's poop list pretty quick. And most of those that are up there in rank and position are sucking from the military teet and only see patient's for a 1-2 week period per year to meet the quota or standard of the military to "keep up with advances in medicine" lol, it's a joke for sure how far removed they are from patient care but they can dictate and rule your life. I just knew for me it was not sustainable for my health, my marriage/family as I was miserable especially the last year I was in.

 

[Andrew_Doan]

I just knew for me it was not sustainable for my health, my marriage/family as I was miserable especially the last year I was in.

Military medicine is not for everyone. Thank you for your service and your honesty. I am glad you're happy now!

Throughout my career, I’ve had the opportunity to do some incredible things. With a lighter patient load compared to my civilian counterparts, I didn’t mind taking on extra assignments—in fact, I enjoyed them. Life as an O6 definitely has its perks. My wife appreciates the stability of military life, and now that we’re empty nesters, I have no hesitation about moving overseas or taking odd assignments.

 

[militaryPHYS]

OP, congratulations on the acceptance! USUHS is a very special place and a great opportunity for the right person.

Don’t get too frustrated by the “never MilMed” folks. Their comments and experiences are valuable to hear and consider, especially for those high on the fence of joining. They just still can’t believe that some people want to join no matter what and also can’t fathom that some of us have a net positive experience in MilMed. Thankfully, they ensure that this forum provides a well informed consent for premeds who read it thoroughly.

Keep the specific questions coming. General ones are covered thoroughly in other threads.

 

[pgg]

Much of this really depends on what you want out of your time in the military, and how you want to be positioned for your time after the military.

Some people join for the financial support during medical school, do their payback tour(s), and get out. That's OK. Honestly that's what the majority of people do, and it's what the military wants the majority of people to do. There's ample room here to become an excellent physician, do some interesting work unique to the military, serve your country, and then move on to the next (and usually longer) phase of your career as a physician.

Others wish to advance to O6 or beyond and do operational leadership work. That is also OK, and it's what the career blog and the "career progression slide" are really all about. This is not a great path for the person who wants to primarily be a doctor, even if he has some tolerance or mild interest in administrative work. The non-clinical administrative burden of the billets that are required to take this path are enormous, and crowd out clinical time. It is common for doctors in these roles to do zero or almost zero clinical work for a year or more at a time.

When you consider that the volume of clinical work for a physician in the military is generally somewhere between 1/4 and 1/2 of what a civilian does (admittedly my estimate here is very specialty-dependent), a military physician who's in one of these leadership positions is doing a small fraction of what their civilian counterparts are doing. It's tough to practice at that pace for a full military career and then step into a practice that sees normal civilian volume and acuity. We talk often here about physicians being "institutionalized" by their military service - the risk is real.

I spent about a year as the director of surgical services the year before I selected to O5, and I was about 90% non-clinical. It got me promoted, but the Navy didn't let me be a doctor that year. For better or worse, I was burning the candle at both ends that year and moonlighting like crazy, so I emerged none the worse for wear, clinically speaking.

My glimpse of life with the leadership was a formative moment for me however, and as soon as I pinned on O5 I embraced the "terminal commander" rank - I wanted nothing more to do with that world. I just declined to do any more leadership work. For the remaining years of my Navy career, I got P fitreps and had no hope (or desire) to make O6. (During my last deployment, I did grudgingly agree to serve as the OIC of a FRSS, but it's not like I was going to be doing any clinical work during that period anyway.)


The problem with this "career development" paradigm, focused as it is on administrative work, is that it doesn't leave any room for senior physicians to be clinical all or most of the time. I think one of the most harmful things medical corps leadership has done to the medical corps over the last few decades is make no institutional effort to create and retain gray-haired clinician specialists that are such a key part of civilian academic and non-academic practices.

Rewarding administrators with promotion, and excluding clinicians from promotion, has also had negative unintended consequences - a significant percentage of the military physicians who take this administrative pathway and embrace the "career development" path involving JPME and HRO and LeanSigmaSixBlackBeltNinja, are doing so as an escape from clinical medicine. Don't get me wrong, escape is OK. Nobody should be forced to practice medicine if they hate it - but the concomitant neglect / non-promotion of senior clinically-focused physicians has resulted in a medical corps that is led at just about every level by physicians who don't practice medicine, and don't want to. (And sometimes, to be less charitable, by physicians who quit clinical work because they were bad physicians.)

The "career development" advice has a lot of emphasis on things of zero value to clinical work, and of dubious value to administrators who haven't drunk the Kool Aid of corporate cubicle-land. Getting an MBA (which will be garbage online degree work for anyone on active duty), attending the JPME courses, or sitting in seminars about "high reliability organizations" are helpful to get promoted to O5, and probably necessary to get promoted past O5.

My bias is probably obvious. Just take it as one more data point. Decide what you think you want out of your career as a physician, and consider whether or not military service will help you or hinder you in getting there.

 

[Kay_Em_Jay]

I signed up in 2010 after reading on this forum as well (I didn't officially create an account for a few more years but had started reading back in like 2007-2008). I was one of those who did not heed the warning and now I'm one of the ones on here trying to give a glimpse of what I went through so others won't do it as well. I separated in 2023 and am now living the good life on the civ side. I recognize there are things I wouldn't have ever done if I was not in the military and great people I would've never met, lived in a very cool location for 3 years which I otherwise would not have. I'm not sure I would have the job I have now if not for the military as my residency is what brought me to the city I live in currently and we were looking at returning here after separation so I can't say it was all for naught. But the work itself in the military was just awful. Extra duties that the military places on you that seem extremely asinine and take away from patient care are common place, the norm and expected, and trying to get out of those and work more on patient care can get you on the command's poop list pretty quick. And most of those that are up there in rank and position are sucking from the military teet and only see patient's for a 1-2 week period per year to meet the quota or standard of the military to "keep up with advances in medicine" lol, it's a joke for sure how far removed they are from patient care but they can dictate and rule your life. I just knew for me it was not sustainable for my health, my marriage/family as I was miserable especially the last year I was in.

Thank you for this perspective as well. My problem with what afteranesthesia said was not that they had a bad time and were vocal about it but more so that they failed to explain why they had a bad time adequately. Instead, they implied I was just another stupid premed and essentially said, "Don't do it because I said so." (paraphrasing). They can absolutely be valid concerns, but the very limited context they offered isn't helpful to me or anyone making these decisions in the future.

That said, you just offered me something tangible and understandable as to why you chose to get out, and I think they are valid warnings to pass on to anyone considering this path.

The only follow-up question I have for you right now is:

• I understand you are a Psychiatrist. Do you have any examples of how practicing Psychiatry in MilMed helped make you a better physician that you otherwise would not have gotten as a civilian?

 

[militaryPHYS]

Much of this really depends on what you want out of your time in the military, and how you want to be positioned for your time after the military.

Some people join for the financial support during medical school, do their payback tour(s), and get out. That's OK. Honestly that's what the majority of people do, and it's what the military wants the majority of people to do. There's ample room here to become an excellent physician, do some interesting work unique to the military, serve your country, and then move on to the next (and usually longer) phase of your career as a physician.

Others wish to advance to O6 or beyond and do operational leadership work. That is also OK, and it's what the career blog and the "career progression slide" are really all about. This is not a great path for the person who wants to primarily be a doctor, even if he has some tolerance or mild interest in administrative work. The non-clinical administrative burden of the billets that are required to take this path are enormous, and crowd out clinical time. It is common for doctors in these roles to do zero or almost zero clinical work for a year or more at a time.

When you consider that the volume of clinical work for a physician in the military is generally somewhere between 1/4 and 1/2 of what a civilian does (admittedly my estimate here is very specialty-dependent), a military physician who's in one of these leadership positions is doing a small fraction of what their civilian counterparts are doing. It's tough to practice at that pace for a full military career and then step into a practice that sees normal civilian volume and acuity. We talk often here about physicians being "institutionalized" by their military service - the risk is real.

I spent about a year as the director of surgical services the year before I selected to O5, and I was about 90% non-clinical. It got me promoted, but the Navy didn't let me be a doctor that year. For better or worse, I was burning the candle at both ends that year and moonlighting like crazy, so I emerged none the worse for wear, clinically speaking.

My glimpse of life with the leadership was a formative moment for me however, and as soon as I pinned on O5 I embraced the "terminal commander" rank - I wanted nothing more to do with that world. I just declined to do any more leadership work. For the remaining years of my Navy career, I got P fitreps and had no hope (or desire) to make O6. (During my last deployment, I did grudgingly agree to serve as the OIC of a FRSS, but it's not like I was going to be doing any clinical work during that period anyway.)


The problem with this "career development" paradigm, focused as it is on administrative work, is that it doesn't leave any room for senior physicians to be clinical all or most of the time. I think one of the most harmful things medical corps leadership has done to the medical corps over the last few decades is make no institutional effort to create and retain gray-haired clinician specialists that are such a key part of civilian academic and non-academic practices.

Rewarding administrators with promotion, and excluding clinicians from promotion, has also had negative unintended consequences - a significant percentage of the military physicians who take this administrative pathway and embrace the "career development" path involving JPME and HRO and LeanSigmaSixBlackBeltNinja, are doing so as an escape from clinical medicine. Don't get me wrong, escape is OK. Nobody should be forced to practice medicine if they hate it - but the concomitant neglect / non-promotion of senior clinically-focused physicians has resulted in a medical corps that is led at just about every level by physicians who don't practice medicine, and don't want to. (And sometimes, to be less charitable, by physicians who quit clinical work because they were bad physicians.)

The "career development" advice has a lot of emphasis on things of zero value to clinical work, and of dubious value to administrators who haven't drunk the Kool Aid of corporate cubicle-land. Getting an MBA (which will be garbage online degree work for anyone on active duty), attending the JPME courses, or sitting in seminars about "high reliability organizations" are helpful to get promoted to O5, and probably necessary to get promoted past O5.

My bias is probably obvious. Just take it as one more data point. Decide what you think you want out of your career as a physician, and consider whether or not military service will help you or hinder you in getting there.

I think we over complicate the discussion for premeds. Question is, do you want to do your training through the military and then spend 4 or 7 years paying back your free med school?? Biggest risks are deployments delaying your pathway and skill atrophy if stuck at a duty station with lower volume/complexity.

Most aren’t planning on staying past that time. Anyone who does sign on for more has time to make the decision to drink the Kool Aid or not during their extra years.

 

[Andrew_Doan]

I think we over complicate the discussion for premeds. Question is, do you want to do your training through the military and then spend 4 or 7 years paying back your free med school?? Biggest risks are deployments delaying your pathway and skill atrophy if stuck at a duty station with lower volume/complexity.

Most aren’t planning on staying past that time. Anyone who does sign on for more has time to make the decision to drink the Kool Aid or not during their extra years.

I agree!!! I was MSTP MD/PhD trained so I had no med school debt. I joined through the FAP. I owed the Navy 5 years. I had 5 years to decide if I wanted to drink the Kool Aid or not. I drank some for a 4-year IP/RB bonus. I kept drinking the Kool Aid to now 19 years. I didn't have to decide on staying to 20 before entering the Navy. I had many opportunities to exit during my career.

This is perfectly stated: “Question is, do you want to do your training through the military and then spend 4 or 7 years paying back your free med school?”

 

[pgg]

I agree!!! I was MSTP MD/PhD trained so I had no med school debt. I joined through the FAP. I owed the Navy 5 years. I had 5 years to decide if I wanted to drink the Kool Aid or not. I drank some for a 4-year IP/RB bonus. I kept drinking the Kool Aid to now 19 years. I didn't have to decide on staying to 20 before entering the Navy. I had many opportunities to exit during my career.

This is perfectly stated: “Question is, do you want to do your training through the military and then spend 4 or 7 years paying back your free med school?”

Except that's a misleading question, because nobody who enters via HPSP or USUHS spends 4-7 years on active duty.

The OP asked great and very specific questions pertaining to multiple aspects of service as a military physician, and you yourself referenced the career progression slide.

I didn't have to decide on staying to 20 before entering the Navy.

Well, you entered via FAP, which is an entirely different proposition than 98% of the medical corps.

FAP'ers are almost unicorn rare. I met one in my specialty when I was a resident. I don't think I ever met another.


For those who enter via HPSP or USUHS, you're still right - it's not 20. More like 15.

A plausible path for a USUHS matriculant is
- 4 years in the tender womb of USUHS
- 1 year inservice internship
- 2 year GMO
- 4 year inservice residency
- 5 year payback

A plausible path for a HPSP matriculant is
- 4 years in the tender womb of [civvie med school]
- 1 year inservice internship
- 2 year GMO
- 4 year inservice residency
- 4 year payback

The point is that if this future surgeon decides to go to USUHS today, he is committing to the next 16 years of his life on active duty, and an HPSP'er would be committing to the next 15 years of his life in the military.

If you redo the numbers with a 2-year FP residency, it works out to 14 and 11, respectively.

Yes, technically not 20. But also not 4-7.

I think we over complicate the discussion for premeds.

Disagree. I think you guys oversimplify the discussion, and I think you do it to avoid acknowledging some significant issues.

You can get on me for splitting hairs, but many important details aren't obvious to premeds.

To wit - ADSO calculations once you factor in GMO time and the non-intuitive way med school and GME ADSOs interact.

How many premeds weighing HPSP vs USUHS are aware of the fact that an HPSP'ers actual payback ADSO is often if not usually within a year or two of a USUHS grad's, due to the miracle of involuntary GMO time and the way residency training incurs additional obligated service?

"GMO & out" may be an escape hatch for HPSP grads but let's not pretend that it's a good career path we should be selling to them. And it certainly isn't an acceptable eject plan for a USUHS grad!

We could also talk about the declining quality of inservice GME, and the uncertainty regarding inservice training in non-war-critical specialties in the future. USUHS matriculants especially are committing to inservice training that likely won't even finish until a decade or more after their first day of medical school. HPSP'ers are making the same commitment, albeit with the dubious "GMO & out" option to cut their losses after 4 years.

The administrative burdens of being a military physician, issues surrounding ODE, and the promotion process are absolutely critical things for premeds to know before they sign up.


It would be a disservice to distill these and other issues down to a glib "would you like to do 4-7 years of payback in return for 'free' medical school" even if that question didn't have factual inaccuracies built into it.

 

[Andrew_Doan]

Except that's a misleading question, because nobody who enters via HPSP or USUHS spends 4-7 years on active duty.

The OP asked great and very specific questions pertaining to multiple aspects of service as a military physician, and you yourself referenced the career progression slide.



Well, you entered via FAP, which is an entirely different proposition than 98% of the medical corps.

FAP'ers are almost unicorn rare. I met one in my specialty when I was a resident. I don't think I ever met another.


For those who enter via HPSP or USUHS, you're still right - it's not 20. More like 15.

A plausible path for a USUHS matriculant is
- 4 years in the tender womb of USUHS
- 1 year inservice internship
- 2 year GMO
- 4 year inservice residency
- 5 year payback

A plausible path for a HPSP matriculant is
- 4 years in the tender womb of [civvie med school]
- 1 year inservice internship
- 2 year GMO
- 4 year inservice residency
- 4 year payback

The point is that if this future surgeon decides to go to USUHS today, he is committing to the next 16 years of his life on active duty, and an HPSP'er would be committing to the next 15 years of his life in the military.

If you redo the numbers with a 2-year FP residency, it works out to 14 and 11, respectively.

Yes, technically not 20. But also not 4-7.



Disagree. I think you guys oversimplify the discussion, and I think you do it to avoid acknowledging some significant issues.

You can get on me for splitting hairs, but many important details aren't obvious to premeds.

To wit - ADSO calculations once you factor in GMO time and the non-intuitive way med school and GME ADSOs interact.

How many premeds weighing HPSP vs USUHS are aware of the fact that an HPSP'ers actual payback ADSO is often if not usually within a year or two of a USUHS grad's, due to the miracle of involuntary GMO time and the way residency training incurs additional obligated service?

"GMO & out" may be an escape hatch for HPSP grads but let's not pretend that it's a good career path we should be selling to them. And it certainly isn't an acceptable eject plan for a USUHS grad!

We could also talk about the declining quality of inservice GME, and the uncertainty regarding inservice training in non-war-critical specialties in the future. USUHS matriculants especially are committing to inservice training that likely won't even finish until a decade or more after their first day of medical school. HPSP'ers are making the same commitment, albeit with the dubious "GMO & out" option to cut their losses after 4 years.

The administrative burdens of being a military physician, issues surrounding ODE, and the promotion process are absolutely critical things for premeds to know before they sign up.


It would be a disservice to distill these and other issues down to a glib "would you like to do 4-7 years of payback in return for 'free' medical school" even if that question didn't have factual inaccuracies built into it.

I have seen shorter pathways than you listed above for HPSP.

- HPSP payback is 4 years for a 4 yr scholarship.

-Ophtho residency is 4 years if you go straight through (ophthalmology is selecting residents to go directly from med school into Navy Ophtho training program.)

During times in graduate medical education you do not payback any Med school commitment. The commitment for the first residency is paid back concurrently with the HPSP commitment.

Therefore HPSP doc would owe a total of 4 years after ophtho residency if someone went straight through, which would end up being 8 years of service total.

It is possible to serve 8 years (do not count civvie med school) to get free medical AND a well-paid residency.

 

[Kay_Em_Jay]

For those who enter via HPSP or USUHS, you're still right - it's not 20. More like 15.

A plausible path for a USUHS matriculant is
- 4 years in the tender womb of USUHS
- 1 year inservice internship
- 2 year GMO
- 4 year inservice residency
- 5 year payback

A plausible path for a HPSP matriculant is
- 4 years in the tender womb of [civvie med school]
- 1 year inservice internship
- 2 year GMO
- 4 year inservice residency
- 4 year payback

The point is that if this future surgeon decides to go to USUHS today, he is committing to the next 16 years of his life on active duty, and an HPSP'er would be committing to the next 15 years of his life in the military.

If you redo the numbers with a 2-year FP residency, it works out to 14 and 11, respectively.

Yes, technically not 20. But also not 4-7.

I'd definitely like to highlight this. The actual versus advertised payback time is something I'm well aware of, but I know there are many who are not. Because I have 6 years of prior service, I will be very close to retirement once my ADSO is complete. I have already decided that if I choose to go to USUHS, I will push to retirement from the military, assuming no extenuating circumstances prevent me from doing so. I want to be absolutely sure and crystal clear on what this means for me and my family. The individuals who have been so kind to respond to my questions here have not disappointed. In fact, I have gotten much more out of this exercise than I expected.

 

[Chonal Atresia]

I have seen shorter pathways than you listed above for HPSP.

- HPSP payback is 4 years for a 4 yr scholarship.

-Ophtho residency is 4 years if you go straight through (ophthalmology is selecting residents to go directly from med school into Navy Ophtho training program.)

During times in graduate medical education you do not payback any Med school commitment. The commitment for the first residency is paid back concurrently with the HPSP commitment.

Therefore HPSP doc would owe a total of 4 years after ophtho residency if someone went straight through, which would end up being 8 years of service total.

It is possible to serve 8 years (do not count civvie med school) to get free medical AND a well-paid residency.

You neglected to mention the "payback neutral" internship year so the minimum payback (for 5-year residency) is 9 years. Also as pgg mentioned (at least in the Navy), many frequently get screwed with GMO time which lengthens payback an additional 2-3 years if he/she decides to pursue an in-service residency.

Also, please don't say "free medical" because it definitely is not free. Potential (likely) for deployments as well as significantly less pay (3-4 times with surgical specialties) make it a financial loss for the vast majority of physicians.....

HPSP, USUHS, etc are traps for unsuspecting students worried about debt. Other than allopathic USUIHS students, the only kids taking these "scholarships" in today's medical corps are those attending puppy-mill DO schools costing upwards of $100K/year.

As stated before ad nauseam (if you really want to serve), join as a direct accession after residency where you have complete control over job location, job type and loan payback, If the military doesn't offer you a good enough deal, tell them to go fly a kite.

 

[pgg]

I have seen shorter pathways than you listed above for HPSP.

- HPSP payback is 4 years for a 4 yr scholarship.

-Ophtho residency is 4 years if you go straight through (ophthalmology is selecting residents to go directly from med school into Navy Ophtho training program.)

During times in graduate medical education you do not payback any Med school commitment. The commitment for the first residency is paid back concurrently with the HPSP commitment.

Therefore HPSP doc would owe a total of 4 years after ophtho residency if someone went straight through, which would end up being 8 years of service total.

It is possible to serve 8 years (do not count civvie med school) to get free medical AND a well-paid residency.

It can certainly work out that way.

However, GMO tours are still common for many specialties, particularly in the Navy, and when they occur they're often (usually!) involuntary. So I counsel premeds to evaluate the whole package as if they're going to be a GMO for at least two years.

I count the medical school years in the math because (1) they're technically in the military and (2) it postpones the day they're eligible to get out by four years. Intern year is a dead year in terms of ADSO incurment or payback, but it's still a year of time that passes. It's a lot to ask a 22 yo college almost-grad and premed hopeful to commit to being anywhere and doing anything 10+ years into the future. Particularly under the cloud of debt and loans. Yet that's what HPSP demands.


Again, I'm a USUHS grad - had a great experience. Did a GMO tour with the Marines and enjoyed it so much I extended for a 3rd year and 2nd deployment with them. Did an inservice residency and got terrific training. Stayed on past my USUHS ADSO, and did a FTOS fellowship at a top 3 civilian institution - a door that was cracked open by the strength of my application, but kicked open the rest of the way by the Navy money that gave them an extra free body for the year. I retired 20 years and 13 days after I graduated from USUHS. I had a pretty good experience overall so I'm not completely negative on the concept.

I do feel the deal has substantially changed for the worse since I signed up way back on the 90s.

 

[pgg]

Because I have 6 years of prior service, I will be very close to retirement once my ADSO is complete.

Did you join before Jan 2018, or are you on the new blended retirement plan?

 

[Andrew_Doan]

You neglected to mention the "payback neutral" internship year so the minimum payback (for 5-year residency) is 9 years. Also as pgg mentioned (at least in the Navy), many frequently get screwed with GMO time which lengthens payback an additional 2-3 years if he/she decides to pursue an in-service residency.

Also, please don't say "free medical" because it definitely is not free. Potential (likely) for deployments as well as significantly less pay (3-4 times with surgical specialties) make it a financial loss for the vast majority of physicians.....

HPSP, USUHS, etc are traps for unsuspecting students worried about debt. Other than allopathic USUIHS students, the only kids taking these "scholarships" in today's medical corps are those attending puppy-mill DO schools costing upwards of $100K/year.

As stated before ad nauseam (if you really want to serve), join as a direct accession after residency where you have complete control over job location, job type and loan payback, If the military doesn't offer you a good enough deal, tell them to go fly a kite.

Ophtho is 1 year internship + 3 years residency. Minimum payback is 8 years as I stated above.

People who do a GMO tour can leave the military for a civilian residency after 5 years. That's a good deal for someone else paying for medical school.

You say “lost” income. I say cash advance.

Let's say it's only about the money. Do HPSP, internship, and 4 years of FS/UMO/GMO.

Private Medical School Tuition & Fees (Per Year)
Average tuition & fees: $65,000 - $75,000
Top-tier private schools: Can exceed $80,000 per year

Total Cost Over 4 Years
Tuition & fees: $260,000 - $320,000
HPSP Annual Stipend: ~$31,200 ($2,600 per month, as of 2024)
Total HPSP Stipend Over 4 Years: ~$124,800

Total Tuition, Fees, and Stipend Over 4 Years: $384,800 - $444,800

Pre-tax Dollar Equivalent for a Doctor Earning $250,000 per Year (money needed to payback loan). Assuming an effective tax rate of ~30% for a doctor earning $250,000 per year.

To cover $384,800 - $444,800 in post-tax costs, the pre-tax income required would be:

Equivalent Pre-tax Income Needed Per Year Over 5 Years (4 year HPSP + 1 internship)

$550,000 /5 = $110,000 per year
$635,000 /5 = $127,000 per year

Add this to the GMO Pay.

Total Estimated Pay for a Navy O-3 GMO (2 Years of Service, 2024)

Pay Component​	Monthly​	Annual​
Base Pay (~2 years in)	~$5,816	~$69,792
BAH (average, with dependents)	~$2,500	~$30,000
BAS	~$316	~$3,792
GMO Special Pays (Variable Special Pay, etc)	~$417	~$5,000
Total Compensation	~$9,049	~$108,584

Therefore, while paying back for 5 years, GMO income is really $218,584/year to $235,584/year
because the individual received a “cash advance” that paid for school.

Flight surgeons do some really fun stuff and spend a lot of time flying for this level of pay.

I am providing these calculations to help students make informed decisions.

 

[Kay_Em_Jay]

Did you join before Jan 2018, or are you on the new blended retirement plan?

I was in from 2011 to 2017 so I would be on the old system from my understanding.

 

[pgg]

I was in from 2011 to 2017 so I would be on the old system from my understanding.

That's a strong point in favor of you going to USUHS. The new BRE plan takes some of the shine off the golden handcuffs. 🙂

 

[Kay_Em_Jay]

That's a strong point in favor of you going to USUHS. The new BRE plan takes some of the shine off the golden handcuffs. 🙂

Exactly! By the time I am done with ADSO (assuming 4 year residency and 7 year pay back from USUHS) I will be 3 years from retirement. It really would make sense at that point to stay on for 1 more tour to get that 24 year retirement pay for life and move on to civilian life.

I guess a question that comes to mind with that said:

• Given 10 years of service post residency (assuming good evals, meeting expectations of the career progression slides, etc.) what rank would one expect to achieve in that time frame?

 

[pgg]

People who do a GMO tour can leave the military for a civilian residency after 5 years. That's a good deal for someone else paying for medical school.

It's at best an OK deal financially, considering most physicians in most specialties can easily pay off their student loans within 5 years of finishing residency. There are perhaps a handful of lower paid specialties for which the military path might come out ahead.

In any case, financial reasons are the worst reasons to join the military, and (anecdotally at least) I think most of us would agree the least happy people on AD are the ones who joined for the tuition checks and not primarily from a desire to serve in uniform.


Your "good deal" also rests on the assumption that GMO tours are themselves an acceptable phenomenon. We've discussed this in other threads at length, so I'll just repeat the highlights of my position:

GMO tours are dangerous to patients and neglectful if not abusive of young physicians. That they still exist in any branch of the military is a travesty.

A growing number of states will not even license a physician with less than two years of GME, but the military persists in its 1900s-era policy of taking internship grads and sending them out to practice independently. They offer excuses that range from tradition to the claim that the patient population is healthy and low risk.

Interrupting and delaying residency training is a Very Bad Thing. There is no way to defend the practice, and you won't find anyone outside the military looking in to agree that it's OK.


Again - I was a GMO 2003-2006 and had a good time. I'm pretty sure I didn't hurt anybody. It was only in retrospect, years later, as a fully trained physician, that I understood the magnitude of the risk and neglect that was inflicted on me and other GMOs.

 

[HighPriest]

Ophtho is 1 year internship + 3 years residency. Minimum payback is 8 years as I stated above.

People who do a GMO tour can leave the military for a civilian residency after 5 years. That's a good deal for someone else paying for medical school.

You say “lost” income. I say cash advance.

Let's say it's only about the money. Do HPSP, internship, and 4 years of FS/UMO/GMO.

Private Medical School Tuition & Fees (Per Year)
Average tuition & fees: $65,000 - $75,000
Top-tier private schools: Can exceed $80,000 per year

Total Cost Over 4 Years
Tuition & fees: $260,000 - $320,000
HPSP Annual Stipend: ~$31,200 ($2,600 per month, as of 2024)
Total HPSP Stipend Over 4 Years: ~$124,800

Total Tuition, Fees, and Stipend Over 4 Years: $384,800 - $444,800

Pre-tax Dollar Equivalent for a Doctor Earning $250,000 per Year (money needed to payback loan). Assuming an effective tax rate of ~30% for a doctor earning $250,000 per year.

To cover $384,800 - $444,800 in post-tax costs, the pre-tax income required would be:

Equivalent Pre-tax Income Needed Per Year Over 5 Years (4 year HPSP + 1 internship)

$550,000 /5 = $110,000 per year
$635,000 /5 = $127,000 per year

Add this to the GMO Pay.

Total Estimated Pay for a Navy O-3 GMO (2 Years of Service, 2024)

Pay Component​	Monthly​	Annual​
Base Pay (~2 years in)	~$5,816	~$69,792
BAH (average, with dependents)	~$2,500	~$30,000
BAS	~$316	~$3,792
GMO Special Pays (Variable Special Pay, etc)	~$417	~$5,000
Total Compensation	~$9,049	~$108,584

Therefore, while paying back for 5 years, GMO income is really $218,584/year to $235,584/year
because the individual received a “cash advance” that paid for school.

Flight surgeons do some really fun stuff and spend a lot of time flying for this level of pay.

I am providing these calculations to help students make informed decisions.

We have been through these numbers a million times on the forum.

And just like before: this all depends upon what specialty you go in to and what kind of job you land afterwards.

If you do FM, it’s a good financial deal.

If you do some subspecs and go academic medicine, it might be a good deal financially (but not the best deal for your career as military research by and large isn’t great and not everyone gets stationed somewhere they can do it).

If you do many specialities the numbers you’ve posted, when including the debt and income, would be a money loser. And that’s not even considering compounding interest.

If you’re a spine surgeon it’s a terrible deal financially.

But of course there are non-military loan forgiveness options as well. They pay less, but they pay your loans.

But finances aren’t the only thing to consider, of course.

If you’re thinking about most surgical fields, you really should decide:

1-do you want to make military medicine a full career, retire, and then depending upon your age and how long you were in, just don’t work afterwards, it’s fine. It’s ok to want to be a military doctor, transition to some non clinical leadership position, serve your country, and just take the goods with the bads. Just realize that being a physician is just an ancillary job you do for a while, and it’s very frustrating to be a doctor in the military (because of the distinct lack of focus on medicine over “being a soldier.”) and if you go this kind of route you really won’t be able to safely practice medicine in the end (as you’ll be out of practice as an administrator, or just suffer progressive skill rot for years as a surgeon). You can make a little nest out of the cases you do see, but be wary not to do $#!t that you haven’t done regularly and shouldn’t be doing because that happens all of the time. If you’re, say, an ortho knee guy, you’ll be fine. If you’re a transplant surgeon, you’ll be in trouble.


2 - do your time, get out asap, and realize that there is a very real possibility that you have to retrain yourself to do a lot of the basic things that others in your specialty see as “normal.” And with the pressure of being productive and having more legal liability in to boot. It’s hard, and the longer you’re in post-residency the harder it is.

I would ask myself “what is my goal when I do get out of the military?”

If the answer is to be totally retired, it’s easy. Do it.

If the answer is to be a productive, high volume surgeon with a good, developed skill set, you’re putting an obstacle in your way that you don’t necessarily need.

If you’re doing clinical family medicine - that’s a different story.

 

[pgg]

Exactly! By the time I am done with ADSO (assuming 4 year residency and 7 year pay back from USUHS) I will be 3 years from retirement. It really would make sense at that point to stay on for 1 more tour to get that 24 year retirement pay for life and move on to civilian life.

I guess a question that comes to mind with that said:

• Given 10 years of service post residency (assuming good evals, meeting expectations of the career progression slides, etc.) what rank would one expect to achieve in that time frame?

Was your prior service enlisted or commissioned?

If enlisted and you graduate as an O3E you could expect to hit O4 about 6 years later. Four more wouldn't be enough to get you to O5.

If prior commissioned with some time as an O3, you may put on O4 early enough that you could hit O5 by retirement. (I'm not familiar with exactly how that time is credited but I don't think it's 1:1?) in any case, retirement pay is based on your final 36 months and most of that would be based on the O4 payscale.

50% of (O4>16 + O4>18 + O4>18)/3 is a reasonable guess of where you'd end up on the retirement pay scale.

If you select for O5 in the last couple years, you might be required to remain on AD for a couple more years to put it on. The lifetime difference in retpay between retiring at 22 years vs retiring at 20 is probably NOT more than the additional pay you'd earn as a civilian during those two years.


As a retiree, nobody knows or cares that I was an O5. 🙂

 

[Kay_Em_Jay]

Was your prior service enlisted or commissioned?

If enlisted and you graduate as an O3E you could expect to hit O4 about 6 years later. Four more wouldn't be enough to get you to O5.

If prior commissioned with some time as an O3, you may put on O4 early enough that you could hit O5 by retirement. (I'm not familiar with exactly how that time is credited but I don't think it's 1:1?) in any case, retirement pay is based on your final 36 months and most of that would be based on the O4 payscale.

50% of (O4>16 + O4>18 + O4>18)/3 is a reasonable guess of where you'd end up on the reitement pay scale.

If you select for O5 in the last couple years, you might be required to remain on AD for a couple more years to put it on. The lifetime difference in retpay between retiring at 22 years vs retiring at 20 is probably NOT more than the additional pay you'd earn as a civilian during those two years.


As a retiree, nobody knows or cares that I was an O5. 🙂

I was previously enlisted, so the first scenario would apply to me, but I would have more than four years to hit O5. O3E would be after graduating from USUHS, meaning I would expect to hit O4 about 2 years after residency (assuming a 4-year residency), giving me about 8 more years in the service before I could retire.

 

[militaryPHYS]

I was previously enlisted, so the first scenario would apply to me, but I would have more than four years to hit O5. O3E would be after graduating from USUHS, meaning I would expect to hit O4 about 2 years after residency (assuming a 4-year residency), giving me about 8 more years in the service before I could retire.

Assuming no DUI's or other similarly destructive issues you will hit O5 no problem.

I was also prior enlisted. Did USUHS. I selected LCDR BZ 4 years after graduating USUHS. Most select 5th year post-USUHS which should give you enough time to pin O5 but maybe not maintain high-3 O5 pay.

 

[militaryPHYS]

It would be a disservice to distill these and other issues down to a glib "would you like to do 4-7 years of payback in return for 'free' medical school" even if that question didn't have factual inaccuracies built into it.

I am simplifying here based on the understanding that hundreds of threads with thousands of posts exist on this forum that have covered the nuances we constantly repeat and over complicate. Someone who is making a 10+ year commitment better have done their homework or have the self-discipline to go do it before signing up.

Remember, civilians have a PGY-1 year too. They also have residency years just the same as us. Only difference is we get paid more during those years, oh and a GMO tour could be thrown in there if you're Navy. Let's say 2 year assumption as @pgg uses, which I agree with. Thankfully, the % going out for them is steadily decreasing and for someone signing up to be a military physician and not a civilian in military clothes for a while it better be palatable.

So again...the real question is, do you want to spend your first 4 to 7 years in practice as a military physician with lower pay, possible deployments and skill atrophy or do you want to spend it as a civilian living like a resident to pay down loans in that same amount of time, usually changing jobs and also meeting RVU minimums? This for me is the cross road I get applicants to, then we go in to the more detailed discussion on each side. Helps group most in to binary buckets that my monkey ortho brain can handle. If someone is making this big decision based on ODE, online training or promotion theoreticals they probably fall in to the civilian considering playing military for a few years and probably shouldn't join anyway.

NOBODY talks about the negative sides of the first 4-7 years of civilian practice on here...at least not even close to the amount we talk about the first 4-7 years of military practice. Probably because none of us did it but we all know friends/colleagues who have and at least from my friends it isn't all sunshine and rainbows...so let's not pretend like it is.

 

[pgg]

NOBODY talks about the negative sides of the first 4-7 years of civilian practice on here...at least not even close to the amount we talk about the first 4-7 years of military practice. Probably because none of us did it but we all know friends/colleagues who have and at least from my friends it isn't all sunshine and rainbows...so let's not pretend like it is.

This is a fair point, though it is quite specialty (and location) dependent.

We have a couple of new grads joining our group this year. They'll probably clear $450-500K pretax in cash compensation their first year out (plus full benefits), perhaps a bit more of they don't take the full 12 weeks of vacation and choose to work extra. Young/hungry/indebted people often don't. Figure $300-350K or so post tax. They're going to have their loans paid off in a lot less than 4-7 years, and they won't have to live like residents to do it.

Even historically underpaid primary care people are commanding much better salaries now. Most FP and internists aren't languishing below $200K these days. The 1990s days of an anesthesiologist or pediatrician making $175K are ancient history.

Fear of medical school debt is very much overblown, unless perhaps the student is attending one of the ungodly expensive DO schools, and/or somehow already owes 6 figures from a loan-funded private undergrad degree, and is staring down the barrel off $400K+ in loans/interest when all is said and done.

There's a reason why the distribution of HPSP recipients has been extremely tilted toward DO students the last 20 years. Most traditional allopathic and less expensive DO students have done the math and understand that the debt (even if it tops $100K) isn't a big deal in the grand scheme of things. Financial aid in the form of grants to many allopathic schools is a thing too - it's a rare student who pays full price with loans.

So again...the real question is, do you want to spend your first 4 to 7 years in practice as a military physician with lower pay, possible deployments and skill atrophy or do you want to spend it as a civilian living like a resident to pay down loans in that same amount of time, usually changing jobs and also meeting RVU minimums?

I just don't agree that this is the "real question" because that's an unreasonably pessimistic view of civilian practice for new grads.

Again though - specialty and location dependent.

 

[pgg]

Assuming no DUI's or other similarly destructive issues you will hit O5 no problem.

I was also prior enlisted. Did USUHS. I selected LCDR BZ 4 years after graduating USUHS. Most select 5th year post-USUHS which should give you enough time to pin O5 but maybe not maintain high-3 O5 pay.

Agree, you're correct.

My math upthread was mistaken as I was only considering his 10 years post residency. Of course the residency and intern years count toward time in O3.

Agree he'll have the time to make O5 no problem.

 

[HighPriest]

I am simplifying here based on the understanding that hundreds of threads with thousands of posts exist on this forum that have covered the nuances we constantly repeat and over complicate. Someone who is making a 10+ year commitment better have done their homework or have the self-discipline to go do it before signing up.

Remember, civilians have a PGY-1 year too. They also have residency years just the same as us. Only difference is we get paid more during those years, oh and a GMO tour could be thrown in there if you're Navy. Let's say 2 year assumption as @pgg uses, which I agree with. Thankfully, the % going out for them is steadily decreasing and for someone signing up to be a military physician and not a civilian in military clothes for a while it better be palatable.

So again...the real question is, do you want to spend your first 4 to 7 years in practice as a military physician with lower pay, possible deployments and skill atrophy or do you want to spend it as a civilian living like a resident to pay down loans in that same amount of time, usually changing jobs and also meeting RVU minimums? This for me is the cross road I get applicants to, then we go in to the more detailed discussion on each side. Helps group most in to binary buckets that my monkey ortho brain can handle. If someone is making this big decision based on ODE, online training or promotion theoreticals they probably fall in to the civilian considering playing military for a few years and probably shouldn't join anyway.

NOBODY talks about the negative sides of the first 4-7 years of civilian practice on here...at least not even close to the amount we talk about the first 4-7 years of military practice. Probably because none of us did it but we all know friends/colleagues who have and at least from my friends it isn't all sunshine and rainbows...so let's not pretend like it is.

Highly specialty dependent.
I have two new partners, right out of residency, who are able to pay their loans, buy a house and live quite comfortably. And they’re not killing themselves at work, they’re usually out of the office by 4:30. And they’ll be ahead of where I was financially in the long run. But, again, they’re not pediatricians or family med docs either.

And I don’t think that even those guys are “living like a resident.” I know quite a few of them. They definitely have to budget, so if you mean you can’t get out of school and spend cash on speed boats and blow like it’s 1999, then yes. But they’re all working far less than they did in residency and they all have spare cash to take vacations and buy houses and cars and crap they don’t need. They’re also not working more than 40 hours a week or spending their nights reading and losing sleep. The point being that the QoL isn’t “like a resident.”

They also don’t have to ask permission to go on vacation, nor do they get a random UA call at 0300 once a month, nor does anyone suggest that they cancel clinic to go to a rifle range, nor do they get told at the last minute they’re going to backfill in Alaska over Christmas nor do they sit and worry about whether they’re going to be able to practice their full scope of medicine in a few years because they’re not seeing any pathology. All of which happened to in the first four years out of residency. So while that is definitely not living like a resident, it certainly balances the scales compared to learning to budget. And I realize we cover all of that here. But I don’t think most people are blind to the concept that if you have debts you need to pay them back. Except the federal government, who is clearly blind to that issue.

I can say that I don’t know any hospitalists who are struggling to make ends meet in their first 5 years of practice. But, I don’t know them all.

 

[Chonal Atresia]

I am simplifying here based on the understanding that hundreds of threads with thousands of posts exist on this forum that have covered the nuances we constantly repeat and over complicate. Someone who is making a 10+ year commitment better have done their homework or have the self-discipline to go do it before signing up.

Remember, civilians have a PGY-1 year too. They also have residency years just the same as us. Only difference is we get paid more during those years, oh and a GMO tour could be thrown in there if you're Navy. Let's say 2 year assumption as @pgg uses, which I agree with. Thankfully, the % going out for them is steadily decreasing and for someone signing up to be a military physician and not a civilian in military clothes for a while it better be palatable.

So again...the real question is, do you want to spend your first 4 to 7 years in practice as a military physician with lower pay, possible deployments and skill atrophy or do you want to spend it as a civilian living like a resident to pay down loans in that same amount of time, usually changing jobs and also meeting RVU minimums? This for me is the cross road I get applicants to, then we go in to the more detailed discussion on each side. Helps group most in to binary buckets that my monkey ortho brain can handle. If someone is making this big decision based on ODE, online training or promotion theoreticals they probably fall in to the civilian considering playing military for a few years and probably shouldn't join anyway.

NOBODY talks about the negative sides of the first 4-7 years of civilian practice on here...at least not even close to the amount we talk about the first 4-7 years of military practice. Probably because none of us did it but we all know friends/colleagues who have and at least from my friends it isn't all sunshine and rainbows...so let's not pretend like it is.

This is ridiculous. Civilian physicians do not live like residents their first 4-7 years. Do they live like physicians mid-career? No, they do not but to say they live like residents because of debt is complete nonsense. See High Priest's post....no reason to re-state the points he made. C'mon man!

 

[militaryPHYS]

There are “sacrifices” to family, quality of life, clinical practice and income on each side. What is defined as a sacrifice is different for each person and we are all free to decide what that means for ourselves.

 

[HighPriest]

Yeah but we all know what living like a resident was like.

 

[militaryPHYS]

With PSLF there is also one other decent option for people when they are figuring out what to do for student loans. Doesn’t change that there will always be people who join MilMed despite all of the other really good options. This forum couldn’t talk me out of it back in 2007 and we won’t be able to in 2027. The cycle continues…