Retirement Pay for Docs

[DeadCactus]

If you do your 20 years, what part of your income factors in to the 50% you get at retirement? Just the base pay? Base pay and housing allowance? Or base pay, housing, and bonuses? I assume it's the first...

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[wvdoc]

It is based only on base pay.

 

[DeadCactus]

I may be stating the obvious, but just to make sure I didn't miss anything:

That's a pretty ****y retirement compared to what a private practice Doc could put together in 20 years, no?

 

[delicatefade]

Yes it is.

Although I've heard rumor of legislation aimed at improving military physician retirement (as in basing it off the total pay package, not just base pay). But you know what they say about rumors in the military.

 

[BomberDoc]

That is just another way that the military continues to treat its doctors like garbage. The retirement "Holy Grail" doesn't mean much when it is more like 25% of your pay. The only time you make more in the military is during residency, but the attending pay is a shadow of what a decent civilian doc makes. The opportunity cost is just outrageous. For those of us going into highly compensated specialties, each year in the military is a loss of $500k-$1M. Unacceptable. Do you think the retirement plan we can put together with that compares favorably to the military retirement?

Also, consider how often the physician bonuses have been increased to keep up with inflation. Every single year you stay in the military, you are earning LESS purchasing power. The only reason to stay, and you'll see this in the leadership, is if you are too incompetent or too lazy to make such a paltry sum on the outside.

 

[wvdoc]

The view from someone now on the other side of the fence:

Take what you think non-military physicians earn and cut it in 1/2. If you are a surgical specialist cut it in 1/4.

For a primary care physician as an O-6 you will earn more in the military than in private practice (latest salary survey I saw had 60% of family medicine physicians earning less than 140K.) For general surgeons and most medical specialties (i.e. not Cards or GI) it will be close.

The best article on the current state of physician salaries was published in April in the Bulletin of the American College of Surgeons by Robert DeGroote (April 2007, Vol 92, No 4, pp. 28-36.) In his general/vascular surgery group the salary is 200K a year. Here is his calculation of what physicians actually earn per hour (as in actual salary on the pay check) in New York City:

Family Practice $47.28
Internal Medicine $51.38
Neurology $63.00
Ob/gyn $79.58
General Surgery $83.74
Otolaryngology $84.99
Cardiology $96.31

He basically found that insurance reimbursement was higher for vets (as in cats and dogs) than it is for surgeons doing the same procedure.

For the more lucrative sub-specialties there has been a massive cut in salaries over the last ten years. To make matter worse, deep cuts in Medicare reimbursements are programmed for the next ten years, so salaries are only going to continue dropping.

Unless you are doing cash-only cosmetic procedures, there are no more than a handful of physicians making more than 500K a year in physician salary. (Owning an imaging or day surgery center is a different matter.) Talking with my colleagues, a good salary for a private practice neurosurgeon these days is 375K, in academics starting salaries are running around 170K, a non-chair attending may hit 250-300K, with a chair having 400K+ potential. Diagnostic radiology can approach those numbers but that means reading films 12 hours a day 50 weeks a year.

View material from a physician recruiter with the same skepticism that you would from a military recruiter.

As a postscript, it is pretty easy to determine what your salary would be:

1) Figure out how many office visits/procedures you will do per day/week/year. (And hope that your volume is actually determined by how many you want to do and not how many show up.)
2) Find the CPT code for each and determine the number of RVUs you will do per year.
3) Multiply that by the current Medicare conversion factor for your region. (You can bill more, but then you have to include the collection rate. The Medicare rate turns out to be a very good estimate in all cases.)
4) Divide by two to account for overhead (nurse/clerical salaries, malpractice, rent, supplies, etc.)
5) If you are in a group practice and are not a full partner, divide by two.
5) Take out medical, diability, life, dental insurance, taxes, social security, retirement, etc., etc.

 

[Heeed!]

If you do your 20 years, what part of your income factors in to the 50% you get at retirement? Just the base pay? Base pay and housing allowance? Or base pay, housing, and bonuses? I assume it's the first...

My attending pulled up the retirement pay scale on his iPhone last week. According to what he showed me...and since it was displayed on the iPhone, I believe it...retirement starts at 40% now vs. 50% base pay. Has anyone else heard that?

 

[Gastrapathy]

My attending pulled up the retirement pay scale on his iPhone last week. According to what he showed me...and since it was displayed on the iPhone, I believe it...retirement starts at 40% now vs. 50% base pay. Has anyone else heard that?

Thats not really true. You have a choice between a couple of programs (REDUX, High-3).
http://www.defenselink.mil/militarypay/retirement/ad/index.html

I disagree that the military retirement is such a bad deal for those that make it to 20 (the fact that you get nada for 13 years of service is frustrating). If you look at what an O6 over 20 would make, its worth about $1million in the bank in todays bucks. Plus, its a defined benefit, so there is no risk and its indexed to inflation. Its not enough to keep me in, but its actually a pretty good retirement.

 

[a1qwerty55]

Thats not really true. You have a choice between a couple of programs (REDUX, High-3).
http://www.defenselink.mil/militarypay/retirement/ad/index.html

I disagree that the military retirement is such a bad deal for those that make it to 20 (the fact that you get nada for 13 years of service is frustrating). If you look at what an O6 over 20 would make, its worth about $1million in the bank in todays bucks. Plus, its a defined benefit, so there is no risk and its indexed to inflation. Its not enough to keep me in, but its actually a pretty good retirement.

Several issues to remember,

First; most of us would retire from the military around 47yrs of age and should be an O-6, pulling about 5000/mo (inflation adjusted) - I cannot emphasize how big a deal that is especially if inflation goes to let's say 10%/yr. Remember this pay starts the day you retire, not at 62yrs of age.

Secondly, you presumably will still be working so that $5000, supplements your civilian salary. So you have the option of dramatically scaling back how hard you work or ramping up your earning potential and working fulltime.

Thirdly, you should have been maxing out your TSP and ROTH IRA (you actually qualify as much of your income is nontaxable). So by 59.5 or whenever you can start pulling money from TSP/ROTH, you should be loaded.

Add to that some taxable investments, and some realestate you are home free.

I think the retirement should include bonuses but this will NEVER happen as the line guys already hate the fact we even get the paltry bonuses we currently get, and you will never ever get the USN and USAF to go along. The Army has tried annually to increase the 15K bonus which has been the same since the dawn of time. My understanding is that the CNO kills the idea every year. As pay has to be the same accross all services if one service doesn't want to play all lose.

 

[wvdoc]

If you crunch the numbers, you would have to save somewhere between $30-40K per year to equal the same payout as military retirement pay. If you are an interventional cardiologist that might be a little low, if you are in primary care, that is not bad.

You have two options once you retire. You can chose a position that pays less (i.e. academics) with the retirement pay supplementing your income to make up the difference with private practice. Or, if you simply keep investing the retirement payout until you are ready to "retire" you will be in excellent financial shape.

 

[a1qwerty55]

If you crunch the numbers, you would have to save somewhere between $30-40K per year to equal the same payout as military retirement pay. If you are an interventional cardiologist that might be a little low, if you are in primary care, that is not bad.

You have two options once you retire. You can chose a position that pays less (i.e. academics) with the retirement pay supplementing your income to make up the difference with private practice. Or, if you simply keep investing the retirement payout until you are ready to "retire" you will be in excellent financial shape.

I ran the numbers based on the following assumptions,
-8% rate of return on investment,
-Investing 60K/yr, for 16 years (you won't be saving any money during your civilian residency) thus 16yrs vs 20. started pulling money out at 5000/month after the 16.
Inflation 4%/yr

You will exhaust the 2 million you accumulated during the 16 years in 21 years, i.e. by age 68.

There is a reasonable chance you could actually earn far less than 8%/yr (a common misleading tactic of financial planners is to quote an avg return on S+P 500 of 8% or so, but there are ten or more year stretches during which the market was actually flat historically), and few doctors are good savers and investors, so the reality is that for most doctors (with wives, who want the same living standard as your colleagues wives), will not save anywhere near enough to equal the military retirement. If inflation is more than 4% year I estimated, or if your return is less you will run out of money considerably sooner.

 

[tscottturner]

Just out of curiosity, anyone know how much a VA hospital doc makes, or if VA time can be added to military service time to boost one's retirement?

 

[wvdoc]

Good point with not saving money during residency. That makes a big difference in the end result.

Your point about physicians not saving money is also very true. If you are in a university environment, where this is taken out of your salary and the employer provides a match you can do OK, providing that you include a large enough personal contribution.

The big danger is if you are in a solo practice or in a small group where your salary is basically a share of the profits. I have seen in too many cases where these guys basically have no savings when they approach 60. That is one reason why you seem some guys still practicing when they are 75. (The more positive reason is some just love what they do.)

I don't want to moralize but I will do it anyway: a lot of guys on active duty have grandiose visions of what life and private practice income are. (I know I did.) But when you experience it yourself, and/or start to actually crunch the numbers, military medicine starts to look a whole lot better. If you are in primary care, 20-30 years out you will likely be in a better financial situation than your private practice counterparts. The more lucrative specialties are of course a different story. However, they have had massive cuts in income (cardiovascular surgery down 1/2) in the last ten years. Even more massive Medicare cuts are on the horizon.

Like I said, do not believe everything you see in the journal adds or the mailings you get from recruiters. If you do sign somewhere MAKE SURE you read the contract extremely carefully and have an attorney do the same. I have heard way too many horror stories.

 

[wvdoc]

This is my memory from about 7 years ago:

VA salary is roughly comparable to military salary - better if you are a more junior physician. I do not believe that time spent in the VA will count toward military retirement. However, it does count to its own civil service retirement.

 

[DeadCactus]

This is my memory from about 7 years ago:

VA salary is roughly comparable to military salary - better if you are a more junior physician. I do not believe that time spent in the VA will count toward military retirement. However, it does count to its own civil service retirement.

Does military time count toward the civil service retirement (I assume you need 20 years in CS to retire)?

 

[tscottturner]

Does military time count toward the civil service retirement (I assume you need 20 years in CS to retire)?

I'm pretty sure you can - just not sure how. My father recently retired from the federal gov't after ~6 years AD time (during Vietnam) and then about 18 years with a federal agency. I guess the appropriate question is how can military time count towards a civil service retirement, and is there any possibility that having time in both will be of greater benefit come retirement than retiring as a doc strictly from one or the other?

 

[R-Me-Doc]

a lot of guys on active duty have grandiose visions of what life and private practice income are. (I know I did.) But when you experience it yourself, and/or start to actually crunch the numbers, military medicine starts to look a whole lot better.

Sure, as long as you are willing to surrender 100% of your autonomy to the military. Hmmm, could there potentially be any downside to that? The key issue is that in private practice, it's YOUR practice. You can work as much or as little or in whatever way you choose as long as you are willing to accept the results. The military system is great for the financially risk-averse, but otherwise there doesn't seem to be much upside.

I have heard way too many horror stories.

So have I . . . regarding military medicine. Depends on your definition of "horror."

X-RMD

 

[wvdoc]

Sure, as long as you are willing to surrender 100% of your autonomy to the military. Hmmm, could there potentially be any downside to that? The key issue is that in private practice, it's YOUR practice. You can work as much or as little or in whatever way you choose as long as you are willing to accept the results. The military system is great for the financially risk-averse, but otherwise there doesn't seem to be much upside.

That is correct only if you are a primary care physician in a solo practice who doesn't admit to a hospital. If you have to deal with a hospital, then you have to deal with the politics of credentials committee/executive medical staff and practice decisions made by a hospital CEO who may only have an MBA who worked at Ford until last month (true story.) As the new guy in town, heaven help you if you end up taking patients from an established practitioner - especially if he has political influence in the hospital. Very weird things can start to happen then with respect to QA reviews, referrals from other practitioners, and if you are a surgeon, operating room assignments

The downside is that if you are in a solo practice the insurance companies will eat you alive when it comes to setting reimbursement rates. This is likely to remain the case until anti-trust laws are changed to permit practitioners to band together to negotiate rates.

If you are in a medical group, then you are at the completion mercy of those who have full partnership status until you gain likewise. Even then you are merely 1 vote among X.

Also remember that in virtually every case where you are guaranteed income, this guarantee is actually a loan that has to be repaid over time. If you leave the hospital or the group, that money becomes can become due immediately. So you may find yourself working for three-five years "paying back" that income guarantee just the same as you did in the military.

For survival in private practice, interpersonal political skills become paramount. Those who can navigate the military system well usually quickly adapt to the civilian one and succeed. The opposite is also holds true.

As for the more "interesting" aspects of medicine out in the "real world" check around some of the specialty boards on this site and talk to some physicians who are actually in private practice.

 

[gastrodoc]

Or, you could get out then go back to work as a civilian contractor for uncle sugar. No call, better pay, no deployments.
Is the retirement/health care/ dental really that expensive that it's cheaper to pay a civilian 2-3x what I make to work 40 hr/week and take no call? Plus add in the 20-30% cut the contracting company (Spectrum or whoever). Really? REALLY?
And then pleade poverty on indexing the bonuses for inflation? Or, GASP, matching what the private sector pays?

I'm tracking on what you're saying about the grass not always being greener. But there's no grass where I'm at, so any grass is looking good to me

 

[The White Coat Investor]

The view from someone now on the other side of the fence:

Take what you think non-military physicians earn and cut it in 1/2. If you are a surgical specialist cut it in 1/4.
Family Practice $47.28
Internal Medicine $51.38
Neurology $63.00
Ob/gyn $79.58
General Surgery $83.74
Otolaryngology $84.99
Cardiology $96.31
.

While the grass is always greener on the other side, you're just smoking crack with these numbers. Most of my friends in emergency medicine make between $110-175/hour. The personal moonlighting opportunity available to me is $150/hour. I made $80/hour as a third year resident. I know my wife's OB/GYN's contract states $116/hour, $126/hour for hours over 8/day. Are you suggesting EPs make almost twice as much as invasive cardiologists and ENTs? I find that difficult to believe, although I have suspected that EPs make more per hour worked than almost all other specialties. I suspect that is because they work fewer, but more intense hours, have relatively high procedure rates, take almost no breaks while on shift, and are at high medicolegal risk.

$150/hour x 12 hours x 15 shifts/month x 12 months/year= $324,000. $110/hour x 9 hours x 12 shifts/month x 11 months per year (1 month of pure vacation in addition to 18 days off/month) = $130680. I currently make $120,000 in the military, $94,000 if I don't take the ISP my last year. When I make major next summer it'll go up about $6K. Even being in Iraq all year long would only give me another $6k/year plus another $6-8K in tax breaks. Seems to me the grass truly is greener, even without being a partner.

 

[pgg]

Here is his calculation of what physicians actually earn per hour (as in actual salary on the pay check) in New York City:

I'm not convinced that a set of numbers reflecting the pay of doctors working in one of the most job-competitive, desirable (to some), and expensive bits of real estate in North America is particularly useful ... unless one plans to live and work there.

And if you want to live in a big city that's not Washington DC, you really can't do it while in the military anyway.

If you're not in primary care, or you aren't already close to 20 (owing to prior service), it's hard to justify remaining in the military for financial reasons.

 

[wvdoc]

These are not "my numbers", they were published in the Bulletin of the ACS.

I agree that the numbers from New York City are not representative of the nation as a whole. That is why I specifically mentioned the location. However, these are published numbers from the April 2007 issue of the Bulletin of the American College of Surgeons. Since accurate physician salary figures are incredibly difficult to find - this is the closest to reality that I have seen. I believe the article is on-line and I would encourage everyone to read it, and more importantly to pay special attention to his methodology and general conclusions. If you do this type of analysis before you take your first civilian job, you will save yourself a ton of trouble (and more importantly money.)

The other point I would make is that you have to be very careful using moonlighting/locum tenens pay rates as an actual benchmark of salary. In virtually every situation, you end up paying more in these situations than you actually bring in from revenue. If the opposite was true, I would simply hire a locum tenens guy every week and profit the difference in cash.

The point of this discussion is not to exalt military medicine or suggest that the practice of medicine in the non-military world is a horrible thing. Unless you retire as AF/SG, you are going to practice in this environment. There are tremendous advantages to it, but there are also tremendous risks. It is important to know what you are walking into.

What I have found in my going on 10 years of private practice after my time in the military is that many (but not all) of the things I complained about in the AF medical service are not unique to military medicine. The specific details may be different, but the basic frustrations are the same.

The other thing I have found is that if you can manage navigating the military medical system with a bit of humor and perspective, you will enjoy your civilian medical practice. On the other hand, the guys I knew in the AF who were constantly complaining about the AF medical service, are the same ones who are constantly complaining about their practices today. Some things never change.

 

[BomberDoc]

Agree that it is difficult to find accurate numbers on physician income because we tend to be pretty guarded with that kind of info. However, if you do not intend on practicing in a totally saturated market like NYC, Boston, LA, other major metro areas, you can command a much higher salary. Just do a job search for rural Texas, for example. Compared to Manhattan, you will have a higher salary and tremendously lower cost of living. I'm not arguing one is better than the other, just illustrating a few differences.

Yes, when you leave the military you are basically trading one set of stupid pains in the a$$ for another. Dealing with hospital politics and insurance companies is going to suck. Roger, got it. Personally, though, I will be happy to be able to live where I want, wear what I want, never put on MOPP gear again, never be overruled clinically by a PA or nurse who outranks me, never have computer opsec-infosec-trafficking in persons-CBRNE-homosexual for managers-antiterrorism-etc useless training, said annual training will never "fall out of the system" and have to be reaccomplished every 4-6 months, no more deployments, no more extensions to deployments, no more mandatory PT that causes my clinic to run with 1 doc and 1 tech (we aren't allowed to close because access will suffer and numbers are more important than patient care), no more stupid PT test, no more OPRs & EPRs, no more taking vacation days to go away for the weekend, no more pointless exercises where everything is "simulated" and we all stand around for hours while no useful training occurs, ... I could go on and on, but hopefully you get the point. The military maddeningly wastes an enormous amount of physician time and effort and then continues to demand that we do more with less. The official word from my management is that 50% is the new 100%. Positions that are 50% manned are considered "full" and no further personnel will be needed.

Of course there are problems with civilian medicine, but there are TOO MANY problems with military medicine.

 

[R-Me-Doc]

Personally, though, I will be happy to be able to live where I want, wear what I want, never put on MOPP gear again, never be overruled clinically by a PA or nurse who outranks me, never have computer opsec-infosec-trafficking in persons-CBRNE-homosexual for managers-antiterrorism-etc useless training, said annual training will never "fall out of the system" and have to be reaccomplished every 4-6 months, no more deployments, no more extensions to deployments, no more mandatory PT that causes my clinic to run with 1 doc and 1 tech (we aren't allowed to close because access will suffer and numbers are more important than patient care), no more stupid PT test, no more OPRs & EPRs, no more taking vacation days to go away for the weekend, no more pointless exercises where everything is "simulated" and we all stand around for hours while no useful training occurs, ... I could go on and on, but hopefully you get the point. The military maddeningly wastes an enormous amount of physician time and effort and then continues to demand that we do more with less.

Obviously you are a commie pinko terrorist b@st@rd who derives no patriotic satisfaction from self-sacrifice!



Well put. I think your list pretty much sums it all up!


X-RMD

 

[IgD]

What I have found in my going on 10 years of private practice after my time in the military is that many (but not all) of the things I complained about in the AF medical service are not unique to military medicine. The specific details may be different, but the basic frustrations are the same.

I appreciated your remarks. Physicians I look up to who are senior to me told me military medicine is not the same place it was before. Before the war there was a new focus on productivity/RVUs, use of contractors and decreasing staffing of uniformed providers. The formulary was also tightened to reduce costs. At the same time AHLTA was implemented. AHLTA is nice because it is a global electronic medical record but adds more work. We are fighting a long war.

I would say the basic frustrations are similar but they aren't the same. Your family doesn't have to worry about being disrupted because of a deployment. It is easier for your spouse to pursue a career or education. You work hard and get paid well but have more autonomy and control over what you do. You aren't accountable for the military disposition of your patients. Most likely you have support staff.

What advice for young physicians would you give for those who finished their initial obligations and are at the decision point?

 

[mitchconnie]

What I have found in my going on 10 years of private practice after my time in the military is that many (but not all) of the things I complained about in the AF medical service are not unique to military medicine. The specific details may be different, but the basic frustrations are the same

I think it's great to get some perspective from a physician who has done both civilian and military medicine. However, I would question the relevance of observations from someone who got out ten years ago. Things are exponentially more frustrating today then when I started out in 1996. Sure, some of the baseline irritants are the same but a lot has changed. Take a look at what is new since 1997 when wvdoc left the military: massive downsizing, staffing cutbacks, an oppressive deployment schedule, AHLTA implementation, Tricare implementation...and on...and on...and on. Honestly, when I look back at some of the petty things that guys were complaining about in 1997, it is just laughable.

Personally, I would ignore advice from anyone who got out prior to the start of OIF. Military medicine is a completely different world today.

 

[BomberDoc]

Obviously you are a commie pinko terrorist b@st@rd who derives no patriotic satisfaction from self-sacrifice!

I've been accused of that crime many times on this board by cheerleaders and by my real-life command. I appreciate your sarcasm, however. Can't wait to be X-BD. 150-ish days to sweet sweet freedom.

 

[daveyjwin]

Just a quick note on Salaries in the Civilian world, I've found a couple sites with reliable looking stats for different specialties:

http://www.allied-physicians.com/salary_surveys/physician-salaries.htm
and
http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

The short of it is that those number quotes above are pretty low. Like, really low.

 

[met19]

Just a quick note on Salaries in the Civilian world, I've found a couple sites with reliable looking stats for different specialties:

http://www.allied-physicians.com/salary_surveys/physician-salaries.htm
and
http://www.cejkasearch.com/compensation/amga_physician_compensation_survey.htm

The short of it is that those number quotes above are pretty low. Like, really low.

I dont know how accurate those numbers are for my field-EM. It depends on what type of job, location, your status (IC vs employee in group, vs hosp, etc), and other such as benefits. Its hard to compare straight salary. But even so, much higher in the civ world than mil world.

 

[Coastie]

Your salary numbers are way way way off for the civi world.

FP guys routinely make 180-200k, and far greater if they are decent businessmen.

Anesthesia guys routinely make 400k, and I know a few EM buddies who are fresh civies with starting of 280k out of residency with a light schedule.

Military medicine doesn't cut it economically. They need to ramp up the $ spent for mil med, or just privatize the whole dang thing. It's tough to watch something that was once so great die so slowly.

The view from someone now on the other side of the fence:

Take what you think non-military physicians earn and cut it in 1/2. If you are a surgical specialist cut it in 1/4.

For a primary care physician as an O-6 you will earn more in the military than in private practice (latest salary survey I saw had 60% of family medicine physicians earning less than 140K.) For general surgeons and most medical specialties (i.e. not Cards or GI) it will be close.

The best article on the current state of physician salaries was published in April in the Bulletin of the American College of Surgeons by Robert DeGroote (April 2007, Vol 92, No 4, pp. 28-36.) In his general/vascular surgery group the salary is 200K a year. Here is his calculation of what physicians actually earn per hour (as in actual salary on the pay check) in New York City:

Family Practice $47.28
Internal Medicine $51.38
Neurology $63.00
Ob/gyn $79.58
General Surgery $83.74
Otolaryngology $84.99
Cardiology $96.31

He basically found that insurance reimbursement was higher for vets (as in cats and dogs) than it is for surgeons doing the same procedure.

For the more lucrative sub-specialties there has been a massive cut in salaries over the last ten years. To make matter worse, deep cuts in Medicare reimbursements are programmed for the next ten years, so salaries are only going to continue dropping.

Unless you are doing cash-only cosmetic procedures, there are no more than a handful of physicians making more than 500K a year in physician salary. (Owning an imaging or day surgery center is a different matter.) Talking with my colleagues, a good salary for a private practice neurosurgeon these days is 375K, in academics starting salaries are running around 170K, a non-chair attending may hit 250-300K, with a chair having 400K+ potential. Diagnostic radiology can approach those numbers but that means reading films 12 hours a day 50 weeks a year.

View material from a physician recruiter with the same skepticism that you would from a military recruiter.

As a postscript, it is pretty easy to determine what your salary would be:

1) Figure out how many office visits/procedures you will do per day/week/year. (And hope that your volume is actually determined by how many you want to do and not how many show up.)
2) Find the CPT code for each and determine the number of RVUs you will do per year.
3) Multiply that by the current Medicare conversion factor for your region. (You can bill more, but then you have to include the collection rate. The Medicare rate turns out to be a very good estimate in all cases.)
4) Divide by two to account for overhead (nurse/clerical salaries, malpractice, rent, supplies, etc.)
5) If you are in a group practice and are not a full partner, divide by two.
5) Take out medical, diability, life, dental insurance, taxes, social security, retirement, etc., etc.

 

[BomberDoc]

Your salary numbers are way way way off for the civi world.

FP guys routinely make 180-200k, and far greater if they are decent businessmen.

Anesthesia guys routinely make 400k, and I know a few EM buddies who are fresh civies with starting of 280k out of residency with a light schedule.

Military medicine doesn't cut it economically. They need to ramp up the $ spent for mil med, or just privatize the whole dang thing. It's tough to watch something that was once so great die so slowly.

Nice thread resurrection. Yes, military medicine makes absolutely zero sense economically. Either 10x the budget, pay us what we're worth, and redevelop the infrastructure or let the civilian hospitals take the whole damn thing over. Oh, and everybody who is O-5 or above and never sees patients should be fired and thrown on the street with no retirement. They are the dead weight that keeps milmed fat and inefficient.