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Sorting truths from HPSP recruiters and Web sites (Army)

Discussion in 'Military Medicine' started by painmd87, Dec 15, 2008.

  1. painmd87

    painmd87 Not a pain doctor
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    I'm looking for some honest advice from HPSP students. Any help is greatly appreciated.

    I've been in touch with a recruiter for the past month or so. I'm trying to figure what he says is true and what may be wrong. I'm not calling him a liar, but I want to match up what he says with what you've all experienced. I'll be graduating undergrad in May and entering med school in the fall.

    1) Deployment: He said I'm not eligible to be deployed until 2019 at the soonest, or longer if I pick a long residency. Deployments are 90-180 days. True? Seems from people on here that deployments are usually 12-15 months. 2019 figure seems a bit off, too. I'll be class of 2013... done residency in 3-5 years...

    2) Commitment: If I do a residency that lasts four or fewer years, I owe four years of active Army duty and four years as Inactive Ready Reserve. Nothing more. Nothing less. I feel like I'd owe more, for some reason.

    3) Benefits: Paid healthcare for myself and my dependents. He's gone back and forth between saying it's paid during school and just during residency.


    I've asked him this question a few times but haven't gotten an answer yet: What are the benefits of HPSP, other than financial? What are the downsides of the program? (His answer to the last was "none.")

    Thanks for everyone's help.
     
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  3. IgD

    IgD The Lorax
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    That's absolutely false. You would have to apply for a PGY2 position during your internship and there is a reasonable chance you could get deployed as a "general medical officer" before you are permitted to complete a residency. You could get deployed the day after you graduate your residency as happened to many Navy physicians I know. Army deployments tend to be a minimum of 12 months.
     
  4. psychbender

    psychbender Cynical Member
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    Not entirely accurate. Most Army residencies are categorical, meaning you go straight from internship to residency without having to reapply for your PGY-2 position. General Surgery still operates this way (I believe), but it is one of the very few in the Army. Also, Army deployments vary depending on specialty from 6 months for things such as Anesthesiology and Critical Care to 12+ months for FM, EM, IM (and subspecialties), and others. This information is from some attendings I worked with who deployed recently. I think some physicians only deploy for 3 months, but I don't know who, as the only example I know of was a department head.

    Back to number 1...If you graduate in 2013, you are eligible for deployment in 2014. If you fail to match a specialty as an MS4 (just matched internship), then you will likely face deployment as a GMO prior to being allowed to continue residency training. If, however, you matched into an actual residency program, and were able to pass your PT, then you should remain a resident and not deploy until completion of your training.

    2) Your HPSP contract is initially for 8 years. It can increase with longer GME programs or fellowships. Your obligation after residency is calculated as years of residency - 1 (internship), or length of HPSP scholarship, whichever is greater. So, a 4-year HPSP recipient doing most residencies would still only owe 4 years active duty. If, however, you did something that totalled over 5 years (remember to subtract 1 for internship), then you would owe the length of time you were in residency. I have previously posted many examples of calculating payback and total time in service; I suggest searching for those posts for more examples. Also, its not Inactive Ready Reserve...its Individual Ready Reserve. They can call you back.

    3) You do not get Tricare when you are in school (just 45 day ADT). However, they will reimburse you for your (doubt family's) health insurance for the rest of the year.
     
  5. DeepCowboy

    DeepCowboy You never heard me coming
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    I am Army HPSP, graduating 2009.

    1: Deployment: You would only be deployed in residency under a full mobilization of assets. To my knowledge, no residents have deployed during the current wars. On the other hand, one of the reasons the military conducts residencies is to have a reserve of physicians that can be mobilized. If the world was in a situation where we were deploying military residents, the interruption in your training would be the least of your concerns. In terms of deploying after residency, my impression is that they are deploying residency graduates pretty quickly after graduation (not Top Gun style where they get orders at the ceremony, but within months). This is reasonable and should be expected. Length of deployment is somewhat specialty based, I think. For reasons I don't know (and this may not be true) I think the surgery specialties deploy for shorter periods. I think length also has to do with whether or not you take command/high position in the unit (commanders/higher ups stay longer while other docs rotate through, is my understanding).

    2. Commitment: Sounds right. Don't feel like you need to owe more, they will be getting their pound of flesh. You also need to know that you are not guaranteed a residency in your specialty of choice. Any recruiter that tells you that is full of it. My understanding is that the military is only going to offer civilian deferments after it fills its slots in all specialties. Also, there is the possibility of doing an internship, then doing a tour as a General Medical Officer, then going back to residency. Most people don't like this idea (understatement).

    3. Benefits: Continuous 4yrs of healthcare for dependents: A lie, or ignorance on his part. I am married with two kids. You do get coverage for them through Tricare only during your annual 45-day ADT, and you have to jump through hoops. I can't complain too much, my second kid was born during one of my ADT's, and Tricare picked up most of it, but that was total luck. In other words, you have to maintain separate health insurance for them and even continue it during your ADTs. This is expensive. If your wife doesn't work and get insurance through that, you will probably have to take out loans for it. The insurance offered through most schools totally sucks, wouldn't even pay for my kids vaccinations. My wife doesn't work, so I ended up putting my kids on Medicaid (didn't think of that until end of MS3 year, wish I had done earlier) and paying for private insurance for my wife.

    4. Benefits other than financial: If you do a military residency (most HPSP do, but not guaranteed) you will have better benefits (especially health coverage) and higher pay during residency compared to civilian. Of course, this stops after residency, but was an important consideration for me since I have a family. In terms of getting a military residency, my conclusion was that if you want it you can get it, the people that do civilian are the ones who didn't want a military residency (usually because they think they will get better training in a civilian program, this is mostly surgical people I think). Also, the military match process is easier (you can phone interview at the places you don't rotate at) and there are only </= 6 programs in each specialty, and you find out in December. This makes MS4 year nice. I didn't even register for the NRMP or send any applications to civilian programs.

    5. Downsides of HPSP: Read pretty much any other post on this site on HPSP, milmed gets a lot of poo-poo here, most of it centering around a haze of concerns regarding loss of freedom and poor quality (seen a lot of that in the civilian world of medicine so far, too, so sounds like a lot of "grass is greener" arguments to me).

    6. Also look at HSCP and FAP. Read other posts here.

    7. Another financial benefit not directly related to HPSP is that military service qualifies for the Dept. of Education Public Service Loan Forgiveness Program for Stafford Loans. I still had to take out a bunch of loans and I will be using this. Basically, you pay every month for 10 yrs, but the payment is based on your income level, not your loan principal. Whatever is left at the end of 10yrs, is forgiven. It just disappears. Does not conflict with HPSP obligation because it is Dept. of Education, not DOD. Can use during residency. Have to be in a public service job for 10 yrs, which could be either military, or possibly faculty at a med school after you got out, since they are non-profit.
     
  6. DeepCowboy

    DeepCowboy You never heard me coming
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    Army General Surgery is not categorical. Both programs I rotated at (BAMC and EAMC) both had more prelim interns that PGY-2 spots.

    HPSP does not reimburse family health insurance premiums. They just pay for yours, and will only pay the cost of what the standard one is for your school. You can take the standard one, or if you get private insurance outside the school (undoubtedly more expensive) HPSP will only reimburse you what it would have cost if you had taken the school insurance.
     
  7. Mirror Form

    Mirror Form Thyroid Storm
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    You seem to be getting some conflicting information on this one so I'll try and sort things out for you.

    How soon you will be deployable depends on two things: If you match into a residency and, if so, how long it is. If you do not match into residency (not that uncommon for competitive specialties) you will be sent out as a GMO after your internship. In that case you'd be deployable as soon as 2014. If you match into a residency then you won't be deployable until after you finish it (3 to 6 years after graduating med school).

    Depending on your specialty, the deployments will vary in length from 6 to 15 months.

    .

    Assuming you do a residency that is four or fewer years (*not including internship), you'll owe only four years active duty after medical school. This is because your inactive time will be chewed up during residency. The reason for that is because during residency you're actually simultaneously paying off and accruing more commitment.

    However, the army is going to actually own you for your time in medical school and you'll be active duty during residency as well. So even though it's a four year commitment, you're really signing away much more of your life.

    Hmm, no clue on that one.
     
  8. Mirror Form

    Mirror Form Thyroid Storm
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    Actually it is far from reasonable. You're going to learn far more information at far faster a rate during residency then you ever did before in your life. You need to have at least a year of practicing medicine after residency to consolidate your knowledge and study for your medical boards.

    Deploying people less than a year after finishing residency is awful and will likely lead to erosion of the skills they learned since they won't be using 90% of that knowledge in Iraq. Fortunately many specialties give their personel at least a year after finishing residency to be deployed.
     
  9. psychbender

    psychbender Cynical Member
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    Yeah, poor choice of words on my part. I did not mean to imply that GS is categorical, rather that it is one of the few that is not categorical.

    Are you sure about that? Some schools do not offer their own insurance, forcing their students to get private insurance, and the Army will reimburse this. Technically, per the HPSP manual, they will only reimburse up to $960 each year for insurance (read it 3 years ago, may have changed since). However, I don't think the people in Finance always read the HPSP manual, as I know several people who have been reimbursed greater than this amount for years, and have thus far not been "asked" to give the money back.
     
  10. painmd87

    painmd87 Not a pain doctor
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    Thanks for all the replies.

    Which residencies are most competitive now? I know it changes year-to-year, and it's tough to extrapolate what it'll be like in 4+ years, but which ones are consistently competitive?

    Also, the HPSP recruiter has said that part of agreeing to go through the program means he'll assist with getting into schools -- i.e. he'll send a letter to the dean/adcom. Is this normal? Is it beneficial?

    You've all been a great help. I love this place.
     
  11. notdeadyet

    notdeadyet Still in California
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    From my limited experience helping my school out with interviews during the admissions process, I think I can speak with great confidence when I say that no medical school is going to give a $hit about a letter sent to the dean from a recruiter. I have no doubts about this.
     
  12. psychbender

    psychbender Cynical Member
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    Concur, that's some grade-A bull**** he's trying to feed you.

    As for competitiveness, there really is no good way to figure that out, since there is so much variation each year (example: ENT in 2007). Below is some information that the Army puts out on MODS. The number in parenthesis is supposedly the number of spots, and the following numbers are the applicant/spot ratios.

    SPECIALTY 2003 2004 2005 2006 2007 2008
    Emergency Medicine (26) 1 1.17 1.38 1.25 1.23 1.63
    Family Medicine (43) 0.98 0.81 1.05 1.09 0.80 0.58
    General Surgery (29) 1.04 1.44 1.35 1.29 1.10 0.92
    GS Neurosurgery (2) 1 1 1 0.5 1 1
    GS Urology (7) 1 1.67 1.67 1.57 1 1.17
    Internal Medicine (50) 0.96 0.9 0.76 0.84 1.06 0.75
    Neurology (5) 0.6 0.2 0.8 1.2 0.6 0.33
    Child Neurology (1) 1 0 2 0 0 0
    OB-GYN (15) 1.06 1 1.53 1.53 1.13 1.20
    Orthopaedics (19) 1.68 1 1.84 1.36 1.95 1.84
    Otolaryngology (6) 1.33 0.57 1.33 1.28 4 1.14
    Pathology (6) 2.8 1.71 1 1.16 0.5 1.17
    Pediatrics (26) 0.75 1.29 0.96 1.20 0.88 0.92
    Psychiatry (14) 0.57 1 1.5 0.83 1.07 0.64
    Psych/IM (2) 1 0.5 0.5 0.5 1.5 0.5
    Transitional (15) 0.16 0.06 0 0.27 0.06 0.2
    Prelim Aerospace (2) n/a 0.5 1 0.5 0.5 0
    Prelim Anesthesiology (12) 1.6 1.8 1.33 1.33 1.42 1.25
    Prelim Dermatology (7) 1.4 1.2 1.83 1.62 1.29 0.57
    Prelim Ophthalmology (7) 1.25 1.29 1.29 1.42 1.14 0.71
    Prelim PM&R (3) 2.33 3.5 4.5 1.66 2 3.33
    Prelim Preventive Med (3) 0.25 0.75 2 0.25 0.67 0.75
    Prelim Rad Onc (1) 2 2 2 2 0 2
    Prelim Radiology (15) 1.42 1.83 0.71 1.25 1 1.67

    Now, exactly what went in to figuring out these numbers, no one is exactly sure, as they are not terribly accurate. For one, the number of spots varies year-to-year. Additionally, this does not seem to include civilian deferrals (look at Neurosurgery) or re-applicants (GMOs or other Med Corps officers).


    Edit: Well damn, the table was less f-ed up when I typed it in there.
     
    #11 psychbender, Dec 15, 2008
    Last edited: Dec 15, 2008
  13. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD
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    He he he. This might be one to watch. Keep in mind that many of us who talk about green grass have actually been on both sides of the fence (and in many cases, are actually ON both sides of the fence currently.)
     
  14. The White Coat Investor

    The White Coat Investor AKA ActiveDutyMD
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    I got a year. The guy who came to my base this year didn't.
     
  15. edmadison

    edmadison 1K Member
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    For me, 88 Days from residency completion to boots on the ground in Sand Box. This is not even close to a record.

    Ed
     
  16. BigNavyPedsGuy

    BigNavyPedsGuy Junior Member
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    How much longer til you come home? I'm gessing you've been out around 6 months?
     
  17. painmd87

    painmd87 Not a pain doctor
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    Here's the latest on what he said re: deployments...

    Recruiter: The Army doesn't do GMO tours. At all. I have a 100% chance of getting the residency of my choice, and 50% participants go into a fellowship of their choice after residency.

    So, what say the people?
     
  18. psychbender

    psychbender Cynical Member
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    HAHAHAHAHAHA!!!

    Pure, unadulterated BS. Ask some folk like GMObound if the Army still uses them. Look at the unmatched rates for the past few years...those people have to go somewhere. Also, while some people might not be classified as GMOs, they may be deployed as such. All of the Pediatricians that I worked with last year had just returned from not practicing their specialty while deployed, instead functioning as Battalion Surgeons (GMOs). Though, to be fair, the patients are closer in age to the standard Peds pt than the standard IM pt.

    Also, it is physically impossible to give everyone the residency of their choice. The needs of the Army come first, and they are not going to train more physicians in a specialty than they need. If the Army thinks that they will need 26 Emergency Physicians, and 46 apply for training...then 20 are SOL.
     
  19. NavyFP

    NavyFP Senior Member
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    I think it is safe to say that anyone offering a 100% chance of anything that is remotely desireable is too good to be true.
     
  20. edmadison

    edmadison 1K Member
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    13+ months in theater, just got home. Thanks for asking. I'm looking forward to seeing kids again -- if I can remember how.

    Ed
     
  21. Sarg's kid

    Sarg's kid HPSP Butterbar
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    Bullpuckey. I talked to the GME coordinator at BAMC, who explained it thusly: If you don't match to the residency that you want, then you can do a transitional internship (and apply for the match again during), then do a year of GMO (if you don't match 2nd time 'round) and apply while on your GMO tour. Odds of not matching anywhere the third time around, with GMO experience... well you'd have to be shooting pretty high and sucking pretty hard to get in nowhere. As long as you're realistic, you would be fine.

    The "100%" residency choice thing is based on 97% matching into one of their top 3 choices. Classic double talk. Top 3, not top choice. Now, hopefully your recruiter is ignorant and not purposely misrepresenting facts.

    Also, in case you haven't heard, there's a $20K sign on bonus in effect right now. If you're doing it anyway, you might as well get everything they'll give you.
     
  22. VTHOKIE

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    The 'skill erosion' concept is a prominent issue, do you think as a HPSP ARMY is would be better to do GMO tours and pay off your years that way when you finish a specialized residency in the ARMY, you can go to the civilian world...

    Another question, is there a buy out option, can you do HPSP and then decide to leave due to various reasons and just pay back the military...just food for thought
     
    #21 VTHOKIE, Jan 16, 2009
    Last edited: Jan 16, 2009
  23. psychbender

    psychbender Cynical Member
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    First off, doing a GMO tour does not pay off your obligation if you then seek further training in the military. The specialty training incurs a further service obligation, such that you end up owing more years once you are done. If you owe 4 from HPSP, then pay back 2 from your GMO tour, you don't just owe 2 years after you complete your Neurosurgery residency (6 years after internship). Rather, you end up owing six years after you complete your residency. So, no, you are not better off "paying off" your service obligation as a GMO prior to residency training, as that just further delays training, and causes you to spend more time in military medicine.

    As for number 2...no, you cannot just pay back the military. They don't want your money, they want your blood and your soul. Know this, and you will be fine. Deny it, and you will hate life.
     
  24. notdeadyet

    notdeadyet Still in California
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    Psychbender is right. You'd end up owing more time.

    Another thought fall back folks use with HPSP + GMO tour is this: if I get a 2 year GMO tour and can't get my residency, can't I just finish out my commitment by doing four years of GMO tour?

    The answer is yes, but if you're planning this as an option, keep in mind that depending on specialty and luck, there is a chance you will have to repeat your internship year, essentially starting from scratch. You would not wish this on your worst enemy. So caveat emptor on that path.
     
  25. tweaked17

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    notdeadyet, I'll admit that has crossed my mind ("If I hate it that much, why not do back-to-back GMO tours and get out?"). Is the possibility of repeating internship because after a certain number of years have passed, programs will not consider your training up-to-date?

    Also, in regard to the "owing more" theme, what about doing one GMO tour, then doing a non-neurosurg (lol) residency (e.g. IM); upon completion, you could pay your remaining two years back, then hit the civilian world, right?

    As I understand it, if your residency -1yr is greater than your original ADSO, you will owe that instead.

    In regard to "paying them back if you have the money" - that's laughable. Read the contract!
     
  26. psychbender

    psychbender Cynical Member
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    Correct. If you did a 4-year HPSP, then paid back 2 years as a GMO, your new ADSO is 2 years. You then come back and complete an IM residency (2 years), incuring a 2-year training ADSO, which is served concurrently with your 2 years remaining from your initial HPSP obligation. Net result, you have spent 7 years active duty in the Army, and have now completed your service obligation (well, still have one year IRR left). In this instance, the total time in was the same as if you were allowed to train straight through.
     

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