Several Questions about ROTC/HSPS

[Phead128]

Hi

I was wondering, right now, I am a non contracted member of ROTC and I plan to get an ROTC scholarship to pay for my four years, then graduate and commission, then apply for an educational delay, attend medical school on a HSPS scholarship, then become an army physician. I hope that these scholarships would alleviate my debt load as well as give me experience as an army physician before heading out in the civilian world practicing medicine. I love ROTC and I love the military.

So right after when I graduate from medical school, what happens there? When does residency fit into this? If I want to apply for specialty say cardiology, what time do I do this? What factors are weighed when they determine who get what slots that are available for say cardiology? I've read elsewhere in the forum that it is pretty selective process.

Pretty much, I want to know they take into account when matching you with the specialty you want. Do they take a look at undergrad GPA, med school GPA, MCAT score, OML rankings, or what? Is it better to risk getting a scholarship than to not get a specialty you really want?

Also, Can someone please explain GMO tours? I don't really understand what it is still after searching the forums. Say, if I do ROTC +HSPS = about 8 years of obligated active duty service, does doing a GMO tour prolong the amount of time I have to do active duty service? I'm really confused. srry.

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[Mirror Form]

as well as give me experience as an army physician before heading out in the civilian world practicing medicine.

You seem to be thinking about being in the military for a few years just to pay for school and gain experience. I don't think you understand the magnitude of your commitment.

First of all, if you do ROTC and HPSP, we're not talking about just a few years in the military before heading out to the civilian world. You won't even start paying off your 8 year commitment until somewhere b/w 11-16 years after signing up for ROTC. By the time you finish your commitment to the military, you'll likely already have about 12 years active duty, which might make you want to stay in for 20 so you can get your retirement. Furthermore, the military will have complete control over your training. So don't sign up unless you're doing it b/c you want to be in the military. This is your career we're talking about here.

 

[colbgw02]

Well, at least you're going into this with your eyes open, so you've got that going for you.

First of all, you won't apply for your educational delay after you get commissioned. Well, at least you won't if you plan on going to medical school right out of college. You will apply for the ED concurrently with your accessions packet.

Secondly, cardiology isn't a specialty; it's a subspecialty. If you plan on being a cardiologist as well as doing ROTC and HPSP, then you will likely spend - at a minimum - 17 years in the Army. That's 3 years residency, 3 years fellowship, 4 years ROTC obligation, 4 years HPSP obligation, and 3 years fellowship obligation.

To echo what Mirror Form has already said, you need to think long and hard about this decision. He and I are two of the few people out there that did Army ROTC but did not go to medical school on an HPSP scholarship, and I think we both came to the same conclusion as senior ROTC cadets. Namely, that we didn't want to commit ourselves to a career in Army medicine as college seniors.

Assuming that you're the typical age for a college student (21 or 22 as a senior), if you go into medicine, your ROTC obligation alone will commit you to the Army at least until you are about 34 years old. With the route that you've proposed, you will be 43 before you can even consider separating from the military. Are you really prepared to commit yourself for that length of time? I know I wasn't.

 

[alphagojo]

To colbgw, mirror form, and others who would know,

Well, I am pretty much in the same boat as Phead (except that I am contracted). I am currently an MSII and love ROTC (but don't necessarily know if I love the army obviously). I am definitely thinking about going something more specialized like cardiology or oncology.

Could you please explain this break down for me:

Secondly, cardiology isn't a specialty; it's a subspecialty. If you plan on being a cardiologist as well as doing ROTC and HPSP, then you will likely spend - at a minimum - 17 years in the Army. That's 3 years residency, 3 years fellowship, 4 years ROTC obligation, 4 years HPSP obligation, and 3 years fellowship obligation.

What is the fellowship and what is the fellowship obligation? Also, my naive understanding (I am just trying to get as much information as possible) was that paying off the AD years started while in residency. Am I wrong?

I have looked over quite a few of the military medicine forums, but wanted to hear about the HPSP specifically from Army ROTC cadets. Any info much appreciated.

 

[MonkeyRalph]

Alphagojo:

To become an adult cardiologist or oncologist, you must do a 3 year residency in Internal Medicine, and if the army lets you, then you can apply to do a 3 year fellowship in Cardiology or Hematology/Oncology, which begins after the completion of your Internal Medicine residency. Thus, you will need to do 6 years of post graduate training to subspecialize in one of those fields.
It is true that if you do your training in a military program, then you begin to pay back your AD obligation. However, every year of military training incurs an additional year of active duty obligation. Therefore, if you are a non-scholarship contracted cadet and you do HPSP, you will owe 7 years of AD (if you are a scholarship cadet, you will owe 8 years). You will pay off 6 of those years of obligation during your residency and fellowship training, but will gain another 6 years of obligation. So, as colbgw02 stated, you will spend 16-17 years in the army.

 

[colbgw02]

The above is essentially correct. The payback system is unnecessarily complicated and is a relic of the days when everyone in the Army did a GMO tour. Nowadays, for most people, take the number of years you have incurred and add it to the number of years you are in post-graduate training. That should equal the number of years you'll spend on active duty. If you do a GMO or otherwise have an interruption in training, then you'll want to spend more time figuring out the rules.

The fellowship obligation is a little trickly. The regulation says that it's 6-months for 6-months with a minimum of 2 years. If you're doing a fellowship that is 2 years or longer, then that works out to 1:1. If your specialty's fellowships are typically 1 year, like mine, then you'll spend 2 years extra in the Army for that one extra year of training.

 

[SF49ers Fan]

To colbgw, mirror form, and others who would know,

Well, I am pretty much in the same boat as Phead (except that I am contracted). I am currently an MSII and love ROTC (but don't necessarily know if I love the army obviously). I am definitely thinking about going something more specialized like cardiology or oncology.

Could you please explain this break down for me:



What is the fellowship and what is the fellowship obligation? Also, my naive understanding (I am just trying to get as much information as possible) was that paying off the AD years started while in residency. Am I wrong?

I have looked over quite a few of the military medicine forums, but wanted to hear about the HPSP specifically from Army ROTC cadets. Any info much appreciated.

There is also a good possibility that you may not get the fellowship right out of residency either. Which means that you could have to do an operational tour between residency and your fellowship. I don't have any numbers for you. Maybe some of the guys that are in fellowships can give you an idea on how competative they can be.

 

[MaximusD]

You could always do the fellowship as a civilian... odds would be stacked against you though as programs tend to take their own.

 

[alphagojo]

Ok, thanks for the info guys. So would it be essentially correct to say 14 year commitment if I did HPSP (4 from ROTC, 4 from HPSP, 6 for residency and fellowship). How does the internship fit in?

So another random couple of questions.
After all that, what about the reserve time I would owe from ROTC?
So the time in residency/fellowship counts towards retirement?
Lastly, it may be a dumb question, but what exactly is a GMO?

Thanks again.

 

[MonkeyRalph]

Ok, thanks for the info guys. So would it be essentially correct to say 14 year commitment if I did HPSP (4 from ROTC, 4 from HPSP, 6 for residency and fellowship). How does the internship fit in?

So another random couple of questions.
After all that, what about the reserve time I would owe from ROTC?
So the time in residency/fellowship counts towards retirement?
Lastly, it may be a dumb question, but what exactly is a GMO?

Thanks again.

Yes that seems right, unless you were non-scholarship, then subtract a year.
Internship is your first year of your internal medicine residency (unless you just do a stand-alone transitional year and become a GMO).
You may be able to serve your reserve time in the IRR, which means no drills. This is served after you end your active duty service, I think.
Yes, the time in training is AD service, so it counts toward retirement.
GMO is a General Medical Officer. It's like being a General Practitioner from back in the day, except you only do one year of training (internship aka transitional year) before starting to treat patients on your own. But you won't get paid any of the bonuses like specialty board certification pay, etc.

 

[colbgw02]

I don't believe that you would be required to spend any time in the reserves. If you serve at least 8 years on active duty, regardless of your obligation, then you should be able to separate completely from the military once you come off of active duty. Someone please correct me if I'm wrong, but that is my understanding of things.

 

[Gastrapathy]

Ok, thanks for the info guys. So would it be essentially correct to say 14 year commitment if I did HPSP (4 from ROTC, 4 from HPSP, 6 for residency and fellowship). How does the internship fit in?

So another random couple of questions.
After all that, what about the reserve time I would owe from ROTC?
So the time in residency/fellowship counts towards retirement?
Lastly, it may be a dumb question, but what exactly is a GMO?

Thanks again.

Its a 14 year committment if you include residency and fellowship as part of your committment. These are periods when you are paid quite well and nondeployable. Also, for IM subs, the training is at least comparable to most civilian programs. Really, you would have 6 years of GME and 8 years of payback. This all assumes the military will let you apply for medical school after ROTC, something that is also not guaranteed.

Time in GME does count towards retirement.

GMO tours are primary care operational tours (General Medical Officer) that are typically performed in between internship and residency.

Predicting whether a fellowship would be available right after residency is hard but the chances are 50/50 at best.

 

[alphagojo]

Its a 14 year committment if you include residency and fellowship as part of your committment. These are periods when you are paid quite well and nondeployable.

Significant point.

Thanks for the info. I am going to talk to my PMS at our ROTC Battalion some more about it, but the info is appreciated.

 

[Mirror Form]

Really, you would have 6 years of GME and 8 years of payback.

that's an underestimation b/c fellowship can incur additional obligation.

-4 yr's payback for ROTC
-4 yr's payback for HPSP
-3 to 4 years spent in military residency. You might be non-deployable during this time, but you're still not free, and still NOT paying off your commitment. Furthermore, you'll have VERY LITTLE CONTROLL OVER LOCATION. Really, this is active duty time that the military completely owns you. So this still counts as part of the obligation in my book. For example, while my friends were having great social lives in NYC (well, as great as it can be in residency) I get stuck in the deep south. Losing control over location is part of being in the military, but it's annoying when you're not even paying off your commitment.
-2 to 4 years for fellowship (once again, still not free, still have the military controlling your career and your life).
-2 to 4 years additional payback for fellowship training (depends on what type you do).

By the time you finish all of that, you'll be very close to hitting your 20 year mark. So you're basically signing yourself up for a career with the military.

 

[Gastrapathy]

that's an underestimation b/c fellowship can incur additional obligation.

-4 yr's payback for ROTC
-4 yr's payback for HPSP
-3 to 4 years spent in military residency. You might be non-deployable during this time, but you're still not free, and still NOT paying off your commitment. Furthermore, you'll have VERY LITTLE CONTROLL OVER LOCATION. Really, this is active duty time that the military completely owns you. So this still counts as part of the obligation in my book. For example, while my friends were having great social lives in NYC (well, as great as it can be in residency) I get stuck in the deep south. Losing control over location is part of being in the military, but it's annoying when you're not even paying off your commitment.
-2 to 4 years for fellowship (once again, still not free, still have the military controlling your career and your life).
-2 to 4 years additional payback for fellowship training (depends on what type you do).

By the time you finish all of that, you'll be very close to hitting your 20 year mark. So you're basically signing yourself up for a career with the military.

This is not accurate in this case. Because his pre-GME obligation would be 8 years, he would be unlikely to add obligation for fellowship. The only way he would add to his obligation is if he did more than 8 years of GME total or delayed his fellowship until he owed less than 2 or 3. Say, for example, he does an IM residency straight through, then a 3 year utilization tour, then a 3 year fellowship. He would finish fellowship owing the 5 years he owed to start. Even if you throw in a 2 year GMO, he would start fellowship owing 3 years and finish owing 3. Remember, obligation accrued for GME training is served concurrently with obligation accrued prior to GME.

In a sense, by starting off owing 8 years, he's free to choose any path he wants because he won't increase his obligation beyond that.

Still 6 years of GME plus an 8 year payback is 14 years.

 

[Mirror Form]

This is not accurate in this case. Because his pre-GME obligation would be 8 years, he would be unlikely to add obligation for fellowship. The only way he would add to his obligation is if he did more than 8 years of GME total or delayed his fellowship until he owed less than 2 or 3.

That may be correct for fellowships done within military hospitals (I'm not 100% sure how they work), but in my field the army sends the majority of people out to do fellowships at civilian institutions. In those situations, regardless of how much time you owe, you still incur an additional obligation. It's 1 year for 1 year, with a minimum of 2 years.

So for example, if you did an interventional cardiology fellowship (in which you'd typically be sent out to a civilian program), you'd incur an additional two years of obligation for the one year fellowship.

Regardless, if anybody does ROTC, HPSP, and a fellowship, then chances are they're going to finish their obligation close enough to 20 years that they'll end up staying in for 20 (unless they're super miserable).

 

[alphagojo]

That may be correct for fellowships done within military hospitals (I'm not 100% sure how they work), but in my field the army sends the majority of people out to do fellowships at civilian institutions. In those situations, regardless of how much time you owe, you still incur an additional obligation. It's 1 year for 1 year, with a minimum of 2 years.

So for example, if you did an interventional cardiology fellowship (in which you'd typically be sent out to a civilian program), you'd incur an additional two years of obligation for the one year fellowship.

Regardless, if anybody does ROTC, HPSP, and a fellowship, then chances are they're going to finish their obligation close enough to 20 years that they'll end up staying in for 20 (unless they're super miserable).

Not to be picky, but do you know where I could find this information in writing? I have read the HPSP portion of the AR 601-141 front to back and did not see this type of civilian fellowship obligation in there (maybe I missed it, but I just went back and looked again and still didn't see anything about that). My understanding is what Gastrapathy had stated (14 years).

Thanks.

 

[Mirror Form]

Not to be picky, but do you know where I could find this information in writing? I have read the HPSP portion of the AR 601-141 front to back and did not see this type of civilian fellowship obligation in there (maybe I missed it, but I just went back and looked again and still didn't see anything about that). My understanding is what Gastrapathy had stated (14 years).

Thanks.

It's in the contract of everybody who gets sent out to do a civilian fellowship, which is everybody in my specialty (and many other specialties) who do a fellowship. I'm sure there's some official policy for it written down somewhere but I really don't feel like searching for it (try google).

Why would you expect such a policy to be included in the HPSP portion of AR 601-141? Sending people out to civlian fellowships is completely separate program.

 

[alphagojo]

Ok, thanks. I was able to find some info about the fellowship payback.

 

[alphagojo]

Ok, so if in a civilian fellowship, you incur 1 year of ADO for each year in the fellowship (min 2 years), does your time in the civilian fellowship count towards time towards retirement? Are you paid by the army or the civilian fellowship program?

Also, do civilian residencies incur additional ADO years in a similar manner to civilian fellowships? For example, if you were placed into a 3 year civilian residency (if you were not selected for a military residency), do you incur an additional 3 year ADO on top of the 8 year ADO (from ROTC and HPSP)....cause that would suck.

Thanks for all the help here. Just trying to learn as much as I try to plan my whole freakin' life .

 

[FutureNavyFP]

Ok, so if in a civilian fellowship, you incur 1 year of ADO for each year in the fellowship (min 2 years), does your time in the civilian fellowship count towards time towards retirement? Are you paid by the army or the civilian fellowship program?

Also, do civilian residencies incur additional ADO years in a similar manner to civilian fellowships? For example, if you were placed into a 3 year civilian residency (if you were not selected for a military residency), do you incur an additional 3 year ADO on top of the 8 year ADO (from ROTC and HPSP)....cause that would suck.

Thanks for all the help here. Just trying to learn as much as I try to plan my whole freakin' life .

For residency: If you get a full deferment there is no additional obligation. You will essentially be just like your civilian peers during residency (getting paid just like them). When you are through, you will come back into the military.

Of course, getting the deferment is the trick.

 

[Mirror Form]

Ok, so if in a civilian fellowship, you incur 1 year of ADO for each year in the fellowship (min 2 years), does your time in the civilian fellowship count towards time towards retirement? Are you paid by the army or the civilian fellowship program?

Typically you'll remain active duty while in the civilian fellowship. So you're paid active duty attending physician board certified pay by the army. I *assume* that this time would count toward retirement.