ROTC into HSPS?

Discussion in 'Military Medicine' started by Vuvoozela, 01.12.14.

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  1. Vuvoozela

    Vuvoozela 2+ Year Member

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    Hi SDN, I've been lurking this subforum for a while but this will be my first post. I found one answer to this question before, but it's from quite a number of years ago and, knowing the military, this have probably changed.

    So I'm currently an Army ROTC cadet about to graduate from undergrad. I've already gotten my medical school acceptances and my ed delay so all that is squared away. I'll probably be going to a private school like Northwestern University. I've already had my very expensive undergrad paid for by ROTC, but I'm wondering if I should accept the HPSP scholarship I recently got. Based on my experiences in ROTC (I know it's not really being in the military, but I got a taste of it), there are some things I love about it (the camaraderie, the personal development, and getting school paid for), and there are some things I do not like about it. The things I do not like are mostly related to the intense schedule it demanded while being a pre-med undergrad, like having field problems and PT tests every month. But then again, can I really expect that level of stress to be any different after undergrad? Probably not. Overall I can say I had a really good but pretty challenging time in ROTC.

    I can take loans out for medical school. Or I can take HPSP. I already owe the ROTC 4 years (+4 years reserve). Is HPSP financially worth it?

    *yes I misspelled HPSP in post title LOL
     
    Last edited: 01.13.14
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  3. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    I was faced with nearly the same choice as a college senior as well, and I chose not to pursue HPSP. At that time, if I were to accept HPSP and assuming the shortest and straightest path (3-year residency immediately after medical school), then the earliest I could separate would be the age of 37. I decided I wasn't ready to make a decision as a 21 year old that I would still be affecting me 16 years later. As it turns out, my chosen specialty would have pushed that age back to 39, so that real number was 18 years. I suggest you take a similar inward look, and consider just how different your life might be over those last 4 years of obligation (that HPSP would add) as compared to now. It may be helpful to consider accepting HPSP as a commitment to stay in the Army until retirement.

    In retrospect, I made the right choice. For one, my undergraduate education was substantially more expensive than my medical school, so if the Army were only going to pay for one, I got them to pay for the "right" one. However, not accepting HPSP also pushed me to my state school with its lower tuition. It wasn't that hard of a choice anyway, because the state school was better or as good as the private schools I was also considering. If your heart is set on Northwestern, then that changes the calculus. And, obviously, there are lots of other variables. Remember that if you decline HPSP but decide to stay, it will make you eligible for MSP sooner. Depending on your specialty and its bonus, the financial hit you take on loans might not be as bad as you think it is in the long run. Regardless of how the specific finances work out, just think of those student loan payments as an investment in flexibility.

    What's more important is how vastly different my life and priorities are now. Namely, having a home close to family so that my kids can grow up knowing their grandparents, which staying in the Army never would have allowed (at least it didn't for me). Not taking HPSP - along with innumerable other things found elsewhere on this forum - have made it an easy decision for me to separate from the Army and pursue those priorities. If I owed 4 more years (more likely 6 when factoring in fellowship), then I may have felt compelled to stay for retirement.
     
  4. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    I had a long answer that my computer ate, so here's the quick version:

    -I faced same choice as a 21-year old college senior.
    -I didn't pursue HPSP because it would have committed me to Army until I was at least 36 (in reality 38, given my residency choice).
    -Financial impact isn't as bad as you think, particularly because of MSP will offset it someone. Consider student loan payments as an investment in free agency.
    -I went to an in-state school, which was an easy choice. If your heart is set on Northwestern, or a similarly priced school, then that changes things.
    -Most important factor is how different my life is now and how my priorities have changed.
    -Without HPSP, I'm relatively free to pursue those priorities in ways not available to me if I had to stay in the Army.
     
  5. Vuvoozela

    Vuvoozela 2+ Year Member

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    Thank you so much for your detailed reply, this is exactly the kind of perspective I think is really helpful. I'm definitely leaning in the direction of your reasoning. I wonder if you or anyone else has information about the exact number game. How much worse off financially will I be, in the long run, if I decide to take out loans. Or will I be worse off at all? I read a post that says you might come out on top by taking loans just because of the greater civilian salary you'd make sooner by getting out sooner.
     
  6. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    The financial side is difficult to pin down. There are a lot of factors, and there's no way to predict things like amount of your loans, interest rate on those loans, what specialty you'll choose, how that specialty will reimburse (in the Army or otherwise), and what military bonuses will look like.

    There's a good chance you'll come out behind financially with loans. It's not as bad as it seems, though, because there's the possibility of higher civilian pay if you separate and more bonus money if you don't (assuming you forego HPSP). My point is that even if you do come out behind, that's not necessarily wasted money. View avoiding HPSP as an investment - one that requires sacrifice in the form of loans in order to recoup control over your life and time later. You can't put a number on if, but that type of investment can be incredibly valuable.
     
  7. Mirror Form

    Mirror Form Thyroid Storm 10+ Year Member

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    I'm also a former Army ROTC cadet who took an ed-delay for med school. If you take a HPSP scholarship you're practically locking yourself into a career in the military. I'm really glad I didn't take the HPSP scholarship! Given how much military medicine changes over time, you don't want to sign your entire career and life away just yet.

    EDIT: remember that if you decide to stay in past your obligation, there are pretty big bonuses for re-upping. Plus you'll have a higher number of years in your pay grade. So even if you stay in the Army 30 years, you still won't come out that far behind by taking an ed-delay instead of HPSP.
     
  8. twinning

    twinning 2+ Year Member

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    Correct me if I'm wrong but the bonuses for re-upping probably won't match the amount of money the OP will receive from HPSP. The interest on medical school loans alone accounts for more money than signing up for more years.


    Sent from my iPhone using Tapatalk
     
  9. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    The annual bonus in my specialty for a signing 4-year MSP + ISP is $102K. ISP alone is $36k. A quick of the math shows that to be $264K more than someone still serving their initial ADSO. As I mentioned above, there are many variables, to include tax brackets, specialty choice, cost of your medical school tuition, and the time value of money. It's not that I'm saying you'll come out ahead by foregoing HPSP, it's that the financial hit is not necessarily as bad as it looks. Or - more to the point - the financial hit is well worth the increased flexibility.
     
  10. Vuvoozela

    Vuvoozela 2+ Year Member

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    Thanks everyone for their continued interest on this topic.

    That argument is very seductive to me. I'm definitely now leaning away from HPSP thanks to the input here, your help is all appreciated.
     
  11. Mirror Form

    Mirror Form Thyroid Storm 10+ Year Member

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    But the difference between taking the HPSP scholarship versus 4yr MSP +ISP is not that big in the grand scheme of things. It's not even remotely big enough to justify practically locking yourself into a career in the military at the age of 21. IMHO you'd have to crazy to do that.

    Keep in mind that if you're worried about your immediate finances, the extra time toward your payscale that deferring HPSP gives you is very helpful during internship and residency.
     
  12. Vuvoozela

    Vuvoozela 2+ Year Member

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    This is an aside from the original question I asked, but for all the doctors who were Army ROTC cadets, can you talk about your experiences doing military match, doing a military residency, and then working for the Army for a few years before going back to a normal job? I'd love to hear your stories.
     
  13. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    I totally forgot about this little nugget. My base pay during internship was over $1000 per month greater than my non-prior service internship classmates. That difference has dwindled a little through the years and after promotion, but it'll till be ~$750 more per month. Let's call it an average of $800/month to be conservative. Compare my base pay over the same 13-year period that a ROTC + HPSP physician in my specialty would get, and I come out nearly $125K ahead. Add that into $264K figure I calculated earlier, and that's $389K. I'll guess a 25% tax rate, so that number is closer to $292K.

    My medical school loans were about 35% of that $292K, so even after you calculate in the time value of money (i.e. interest), I think it's safe to say that I would come out way ahead if I were to sign a 4-year MSP as opposed to have taken HPSP. Of course, I went to an in-state school and lived frugally as a medical student. If you attend a really expensive school and/or make it rain every Saturday night, then you're much more likely to come out ahead with HPSP. But, again, that's not really the point.
     
  14. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    During medical school, I was in the IRR and was only peripherally tracked by the Army HPSP office. I imagine it would be largely the same for you. I believe the HPSP office required me to submit my USMLE scores to them and I had to reapply for my education delay each year, but that was it. For the first 2+ years, this wasn't a problem, but it became a source of frustration once I tried set up rotations at MTFs and prepare for the match. Keep in mind that, for purposes of the match, you are indistinguishable from an HPSP applicant. Of course, no one ever formally told me I was expected to participate in the Army match or how it worked. I learned about it chiefly through my own research, using this website - of all places - as my primary resource. I was also told that, because I was not HPSP, funding did not exist for me to do an ADT. I later found out that this wasn't true, but when was the last time a federal employee was fired for becoming incompetent?

    Knowing that I needed to do at least one audition rotation, I was forced to go as a civilian. I was required to establish a memorandum of understanding between my medical school and the MTF, and I had to pay my own way. What's more, because so much leg work had to be done on the front end, I was forced to choose a specialty and an audition rotation location much sooner than even the already accelerated military match schedule requires. I think that I started the process around January of MS3 year. I was lucky in that I knew what I wanted to do, but imagine being undecided. A lot of students are undecided early into MS4 year, much less halfway through the previous year. I ended up ranking my rotation location relatively low, but I was fortunate to still get my #1, despite not having rotated there.

    From that point forward, my time in uniform has not been appreciably different from anyone else. After living as a civilian during medical school, it was no problem adjusting to the relatively lax military bearing of the medical corps. No one will know or care that you did ROTC unless you bring it up, and if they do know, then they'll just assume that you also did HPSP. Even now when discussing ETS protocol, I have to remind people that I did not do HPSP. I mean, I get to wear my parachutist's badge on my ACUs and I occasionally use some Army lingo that HPSPers don't understand or have never heard, but no one cares. Army medicine is replete with former line officers, so it's not like I walk around pretending to be a real soldier because I once was really good at writing an OPORD or knew FM 7-8 down cold.

    Again, after the military, you'll be essentially indistinguishable from an Army doc from any other commission source. I have my first post-military job lined up already, but it's just a fellowship. Overall, I'd say that my time in uniform was a net positive in getting the fellowship, and I expect (hope) to have the same experience in getting a job after fellowship.
     
  15. BigRedDeal

    BigRedDeal 5+ Year Member

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    Just to add to what colbgw02 wrote, since I agree with what was said. I was told by Tripler that I could not go there for an audition rotation as a "civilian". Had to go to a different MTF. Also, I asked for funding and was laughed at...something about sequestration haha. So I paid my own way.

    I dont know if my experience is/was unique, but I was lost in the system. When I popped back up to apply for residency, the GME office didnt know who I was. I never submitted the yearly Ed Delay paperwork because I had no idea about it. I had to send them my ROTC contract, Oath, and some other papers that Cadet Command had lost. And I also had to jump through hoops to get access to MODS. It was an annoying situation.
     
  16. Vuvoozela

    Vuvoozela 2+ Year Member

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    It sounds like the program isn't managed very well with regard to ROTC/non-HPSP people. Are there any tips you guys have to help me prevent/navigate around some of this mess when I go to med school this fall?
     
  17. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    BRD's experience sounds like it was considerably worse than mine. It's also a great example of how, in the Army, you are your best (often only) career manager. If it's like that for you, then I would just steer clear of the HPSP/GME office as much as possible for the first 2.5 years. When you graduate/commission, your ROTC battalion will probably give you a packet of documents. This is a packet that you'll need to maintain and add to for the rest of your career. I guarantee someone will lose some ridiculously important file on you at some point, and the only proof that you ever did something/were told to do something will be the copy that you maintain personally. As I recall, I was able to use my orders to get a military ID from the local reserve unit, which was helpful when it came time to buy new uniforms (the ACU didn't exist when I was commissioned).

    Actually, one of the more important things you might be able to do is get a BOLC slot. AMEDD BOLC is pretty useless for a medical corps or future medical corps officer with an ROTC background, but I think it would have been more palatable if I had done it during medical school. If you can't do it during medical school, then you might find yourself having to do it after - or even worse - during residency. Interrupting your GME training to go to BOLC is a distraction that you just don't need.

    After that, you'll have to contact Falls Church about access to MODS and at least the possibility of funding for away rotations. The best thing is to just plan ahead, and understand how your timeline no longer jives with that of your classmates. Many of your civilian classmates will still be deciding on their specialty in the June-August time frame of your last summer. Ideally for you, you need to have already decided on a specialty and asked your letter writers. You probably need to inquire about an away rotation that spring, so you can establish an MOU if needed. Also, figure out when you're required to submit step II scores. Unlike your classmates who score well on step I, you likely won't have the option of waiting until after the match to take step II. When you take it has implications for how you set up your MS4 schedule, which is in the spring of MS3 year.

    Otherwise, sit back and relax. If your ROTC experience is as time-intensive as mine was, then it's kind of nice just to be a student for awhile. Just be able to pass the APFT during your internship, which isn't that hard, and you should be go-to-go.
     
  18. Cooperd0g

    Cooperd0g 5+ Year Member

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    You say medical acceptances (plural). If you have been accepted at a cheaper school than Northwestern, like your state school, then NOT taking HPSP is kind of a no brainer like what colbgw02 did. Medical education is very standardized and the differences are pretty minor with most of the work being on your own shoulders. Going to a more "prestigious" school or a "better name" is a silly game played by the young and inexperienced. The more expensive the school the more favorable the scholarship becomes. But like others have said it is tough to put a price on flexibility.
     
  19. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    Excellent point, made even more relevant by your Army commitment. What do I mean? Well, ask yourself, why do people go to top medical schools? Sometimes it's to get a better education, but as Cooperd0g points out, among allopathic schools the quality of the education has little variance. A major reason you go to a top medical school is to get into a top residency, which lets you get a top fellowship and ultimately a good job.

    Well, the chances of you doing an Army residency approach 100%. Your first job after training will be in uniform too, so a major advantage of going to a top medical school - to get a top residency - just disappeared like fart in the wind. A truism of medicine in this country is that your last stop is always the most important. To wit, it doesn't matter if I went to Downtown Upstairs Hollywood Medical College if I do my fellowship at MGH. By the time you start looking for a job, no one will care where you went to medical school. They'll care what you've been doing since finishing training and - to a lesser extent - where you did your residency.
     
  20. CirocTheHouse

    CirocTheHouse 2+ Year Member

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    I'll give a couple points. I'm currently a third year medical student who did Army ROTC but did not take HPSP. I really struggled with that decision, but this site served as a really helpful resource for me.

    1. When I actually run the numbers, the pay difference between having that extra four years toward pay and not accumulates over residency and the active 4year duty commitment to ~70-100k depending on your promotion progression. That alone pays back ~50% of debt for many medical students, depending on financial aid. From the numbers that I have seen, the military pays its residents very well compared to civilians, but pays its attending physicians poorly compared to civilians (depending on specialty). This basically means that it's much more feasible to pay back loans in residency compared to your civilian classmates. What has also been said above about bonuses, differences in civilian physician pay and career flexibility also apply.

    2. There is a program from the federal gov't called the Public Service Loan Forgiveness Program (http://studentaid.ed.gov/repay-loans/forgiveness-cancellation/charts/public-service). If you made 10years of payments on your loans while in public service (military residency and service count), then the federal gov't forgives the rest of your loans. I'm personally looking at 5year residency + 4year active duty = 9years. One extra year in public service (military or otherwise) and my remaining loans are forgiven. I haven't seen this program mentioned before on SDN, and perhaps it deserves more attention as it could potentially save people a lot of money (including those with pre-existing undergraduate debt). I'd encourage those in Vuvoozela's position to bring up this program with medical school financial advisors.

    3. During my time in medical school, my only requirement has been the yearly document and my USMLE scores. I 100% agree with what has been said above. Scheduling these away rotations has been frustrating because the infrastructure is not set up for the few students in my position. My advice is to get the process started around September-October of third year. The Memorandum of Agreement (MOA) takes months to be filled out (apparently it's a lengthy legal contract). If I had assumed the same timeline as the rest of my civilian class in scheduling away rotations, I wouldn't have been approved in time for the very early military match. Apparently, these away rotations are critical for a successful match.

    4. On the subject of timelines, the military match is surprisingly early. The military match requires step 2ck scores and the residency application to be in by Oct 15, and I believe the board meets ~November 1 (can anyone confirm this?). My school is fortunately on a very early schedule and my fourth year starts mid-May, but that still leaves me 5months to take step2ck (1month off to study), do a required fourth year core rotation (1month), do my specialty sub-internship (1month), do 2-2.5 Army away rotations (2-2.5months). It's going to be an intense five months. In addition, I will still have to apply for the civilian match just in case I don't match into the military. A benefit to the early military match though is finding out much earlier than your classmates (Dec compared to March), potentially making the second half of your fourth year less stressful.

    5. On the OBLC side, they did not let me go. I pushed the HPSP and ROTC offices to send me to OBLC in the summer between first and second year so that I wouldn't have to deal with it later on, but they don't have the funding to send non-HPSP students. I have no idea when I'm going to OBLC, but it seems like it's going to be during residency.

    6. It's important to mention the possibility of incurring more active duty obligation time than the original four years from ROTC. Please read this forum for a more complete explanation: http://forums.studentdoctor.net/thr...ng-rotc-non-hpsp-please.861888/#post-11666345
     
    Last edited: 01.20.14
  21. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    Thanks for adding to the discussion, Ciroc. I think that loan forgiveness is not something that many of us have looked at because of how the rules changed relatively recently. I didn't start paying off my loans until after residency, but this is no longer possible, as I understand it. It may be well worth it to stay an extra year or two, if it means forgiveness of your loans. Be sure to pay off the minimum if that's the route you take. Also, be sure to look ahead regarding your GI Bill benefits. If you're going to stay for 10 years anyway, make sure you look into transferring those benefits to a dependent.
     
  22. Vuvoozela

    Vuvoozela 2+ Year Member

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    Wow, this is a lot to take in, but thanks all for the information so far. The things that are really concerning me from all the posts here is the fact that it is very hard to do away rotations, and that it is hard to schedule a BOLC date at a time that is not highly inconvenient. Those things seem like they can really harm a career early. But, even with that said, you guys still ignored HPSP and would do it again? That at least gives me confidence that it's the right way to go. Would you guys say that all those hassles meant that you had to settle for less desired residencies?
     
  23. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    For me, no. I got my first choice. While still deciding, I chose to a take a week long "site visit" at what eventually ended up being my program. I don't think it really altered my decision making, but I believe it demonstrated to the program that I was serious about going there. I also had to do a fair amount of explaining to PDs who didn't understand the concept of an Army-obligated, non-HPSP, non-USUHS applicant. It's a complication, obviously, but not a huge deal, particularly if you plan ahead.

    Maybe. If you weren't able to do an ADT because you weren't HPSP AND you believe that was the reason that prevented you from matching, then that would be harmful. Of course, you would never be able to know for sure that an ADT would have made the difference. Regarding BOLC, the only harm really is that it could potentially cause you to finish GME training off-cycle (which is actually quite common) and possibly keep you in uniform for a couple months longer should you desire to separate after your initial ADSO. Even then, there's a silver lining because you may decide to sign the ISP bonus in your final year that most of us forego. Also, many people who get sent to BOLC during residency choose to give up elective time and still graduate on time. Much of this will depend on your program and your specialty's consultant.

    Absolutely. And it's not close. Those extra 4 years of my life that I get to "take back" are invaluable. I won't rehash all of the details here, but I'll summarize by saying that up until about 18 months ago, the decision to separate would have been a difficult one for me. For family reasons, I probably would have come to the same decision, but the Army took a difficult decision and made it very easy. In light of those changes, I cannot put a dollar value on how much for 4 years mean to me.
     
  24. Mirror Form

    Mirror Form Thyroid Storm 10+ Year Member

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    Don't worry at all about BOLC. BOLC will not affect your career no matter when you do it. It's not necessarily a bad thing to put off BOLC and have that summer after your first year of med school off.

    I didn't really have any hassles doing ADT's. I was able to get funding and orders for one, and did another rotation on my own dime. Getting the letters of agreement b/w my med school and the ADT location was pretty easy since it's a common thing. I ended up matching at my first choice, but if I hadn't it wouldn't have been b/c I paid for the ADT myself. The people who really make the decisions are the program directors and they don't know (or care) who's HPSP and who's ROTC.
     
  25. Vuvoozela

    Vuvoozela 2+ Year Member

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    Hey, I'm reviving this old thread of mine just to ask one small question. Pretty much everyone who's in the position I'm about to enter has mentioned that years spent in education (that isn't paid by the Army) will go toward years on the payscale when you go back to the Army, as long as the education is necessary for whatever job you do. Does anyone know exactly what the name of this policy is or where I can find it? I just want to read up on it on some official documentation.
     
  26. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    The regulation can be found under the DoD Financial Management Regulation 7000.14-R. Specifically, look at volume 7A, chapter 1, 010101.E, entitled 'Constructive Service', and 010191.F, where they give examples.
     
  27. deuist

    deuist Stealthfully Sarcastic Lifetime Donor 10+ Year Member

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    The official who approves or denies your credit has wide latitude on interpreting these regulations. A few years ago SDN'ers were reporting that the Army was only approving MPH's. Be prepared for a "no" answer.
     
  28. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

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    We're talking about the MD or DO degree. These degrees have been universally accepted for constructive credit for medical corps officers, when appropriate. Considering that holding such a degree is a prerequisite for being commissioned into the medical corps, it's a safe bet that this universal acceptance will be continued.
     
  29. deuist

    deuist Stealthfully Sarcastic Lifetime Donor 10+ Year Member

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    Messages:
    4,300
    Location:
    Florida
    Status:
    Attending Physician
    Verified
    Physician
    Verified
    Air Force
    Ah yes, in that case, med school gives 4 years credit. Plus, you get to add residency and years of medical practice as an attending. The AF will commission some docs as high as Lt. Col.
     
  30. denali

    denali Senior Member 10+ Year Member

    Joined:
    01.26.03
    Messages:
    361
    Status:
    Attending Physician
    However, to be clear in answering the question, you may be commissioned at a certain grade/rank, but constructive credit from a degree/training will not grant Time-In-Service credit. In the example above, barring prior service, the Lt. Col. will still have <2 years TIS for pay purposes.
     
  31. colbgw02

    colbgw02 Delightfully Tacky 10+ Year Member

    Joined:
    12.09.04
    Messages:
    4,141
    Location:
    By the guy with the thing at the place
    Status:
    Attending Physician
    We're conflating circumstances. On one hand, a direct accession can be commissioned at a rank commensurate with his or her civilian career, and I don't know enough about the pay situation in that instance to comment either way. The situation the OP is describing is different, because he already holds a reserve commission, is doing medical school out-of-pocket, and will get credit for those years toward pay, but not rank or retirement. When he re-commissions into the RA as an O3, he will be paid as an O3 over 4, which is exactly how it worked for me and the handful of other ROTC-only physicians I know.
     

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