Specialty/lifestyle outlooks (considering army hpsp)

[fd25]

Hi all,

I have recently been accepted to an MD program and am strongly considering army HPSP. I feel good that I would be able to contribute to some sense of stability for my partner and child while I am in school, with a (correct me if im wrong) seemingly better work/life balance during residency compared to the civilian side. I find that these values are worth something substantial despite making significantly less than my civilian counterparts during my payback years, especially considering that I will graduate debt-free.

My question - I am extremely interested in pursuing something surgical. I have been interested in neurosurgery for quite some time, but believe I could see myself going for general surgery as well if 1) I don’t end up enjoying neurosurgery as much or if 2) matching neurosurgery may not be feasible in the army during my M4 year.

What kind of work satisfaction do people have as neurosurgeons or general surgeons in the army. Do they have a good case load with lots of diversity? Do they feel they learn skills that will translate well into the civilian sector after service? I would likely plan to moonlight as an attending, but just wanted to know what kind of lifestyle and patient diversity I might expect to see if I pursue either of those specialties in the army.

Side question - I am a lesbian female and am wondering what kind of culture I might be met with by the army as a part of two somewhat minority groups (as far as military goes). Would I face disrespect as a woman? How is military culture as far as LGBTQ goes?

thank you for any input!

---

Members don't see this ad.

 

[DMBandFan86]

Making significantly less…lol NSGY can be a 800k+ per year salary. You’ll pay off your student loans in no time. You likely can find an employer who will pay back your student loans and give you a bonus. You can also likely find an employer who will pay you a stipend during residency if you sign early with them.

Sense of stability…sure when you’re a student you don’t hardly do anything. After residency you will deploy and move. Your future stability will be worse.

Satisfaction in the army medical profession…everyone is different, so can’t say if you will like it or not. The army wants neurosurgeons for deployments and wartime care. Do you think there is a giant and diverse load of soldiers with brain/spine cancers, bleeds, infections or complicated back surgeries? Those people are rare and mostly end up discharging. Also planning to moonlight just to keep your skills up takes away more from whatever stability you hope to get.

My advice, if you’re going neurosurgery, would be to join the reserves after you finish training. But certainly do not take an incentives contract for reserves with that long of a residency.

If you’re trying to just get an easier residency and less hours, I believe you are thinking about this the the wrong way. Maybe consider a different specialty. For instance the army wants occupational med providers. The pay differences and work load make much more sense joining for a specialty like that.

I’m sure there are a lot of lesbians in the army. I don’t ask people if they are a lesbian so I don’t know. The army is full of weird and crazy people whether they are hetero or homosexual.

 

[fd25]

Making significantly less…lol NSGY is a 800k+ per year salary. You’ll pay off your student loans in no time. You likely can find an employer who will pay back your student loans and give you a bonus. You can also likely find an employer who will pay you a stipend during residency if you sign early with them.

Sense of stability…sure when you’re a student you don’t hardly do anything. After residency you will deploy and move. Your future stability will be worse.

Satisfaction in the army medical profession…everyone is different, so can’t say if you will like it or not. The army wants neurosurgeons for deployments and wartime care. Do you think there is a giant and diverse load of soldiers with brain/spine cancers, bleeds, infections or complicated back surgeries? Those people are rare and mostly end up discharging. Also planning to moonlight just to keep your skills up takes away more from whatever stability you hope to get.

My advice, if you’re going neurosurgery, would be to join the reserves after you finish training. But certainly do not take an incentives contract for reserves with that long of a residency.

If you’re trying to just get an easier residency and less hours, I believe you are thinking about this the the wrong way. Maybe consider a different specialty. For instance the army wants occupational med providers. The pay differences and work load make much more sense joining for a specialty like that.

I’m sure there are a lot of lesbians in the army. I don’t ask people if they are a lesbian so I don’t know. The army is full of weird and crazy people whether they are hetero or homosexual.

Thank you for your input! What would be your thoughts as far as general surgery goes?

 

[DOswag]

Only do military if you absolutely want to be a military officer. DO NOT do HPSP just because they pay for your school. You will make enough money once you get out to pay loans back, especially if you end up going neuro surge, you’d literally be able to pay them back as fast as you want. Also there’s plenty of loan repayment options out there. You’ll have to move every few years and you’ll likely deploy at some point with army.

The military is a different animal than civ side. You’re kind of half doctor half officer and sometimes those two clash. Work life balance won’t necessarily be a difference except you for sure will make substantially less money after residency than your civ counterparts.

 

[DMBandFan86]

Thank you for your input! What would be your thoughts as far as general surgery goes?

Relatively the same. You will have a better case load I believe in the military as a general surgeon, but nothing like in the civilian world. The Army wants general surgeons to do trauma and wartime surgical care and to make sure soldiers are ready to train and fight. The problem is the experience in the army is so different for everyone and hard to predict what your career would look like.

If all you want to do is wear the uniform and take care of soldiers no matter what, then it is probably a good gig and you should be happy with your choice. If you’re comfortable dealing with some bad leadership, orders and bad communication then you will likely be happy as well.

Army medicine is changing and has been changing for the last few years. No one knows what it will look like when you get done with training in 9-10+ years.

 

[Mace1370]

I have recently been accepted to an MD program and am strongly considering army HPSP. I feel good that I would be able to contribute to some sense of stability for my partner and child while I am in school, with a (correct me if im wrong) seemingly better work/life balance during residency compared to the civilian side. I find that these values are worth something substantial despite making significantly less than my civilian counterparts during my payback years, especially considering that I will graduate debt-free.

Military residencies don't really have better work/life balance than civilian ones. It's ultimately program and site specific as to how much work a particular residency is. Surgery is surgery though and you're going to be working long hours anywhere. The only real benefit the military will offer you in residency is better pay for those few years of your professional career. If you have a child that could be a significant benefit as it would take some stress off of your financials for those few years.

My question - I am extremely interested in pursuing something surgical. I have been interested in neurosurgery for quite some time, but believe I could see myself going for general surgery as well if 1) I don’t end up enjoying neurosurgery as much or if 2) matching neurosurgery may not be feasible in the army during my M4 year.

Keep in mind that the vast majority of medical students change their mind about what residency program they want to do throughout their time in medical school. With that said, I think you would be absolutely crazy to join the military if your heart is set on surgery. The military medical landscape is constantly changing, but there have been several fairly stable trends over the past 10 years. Fewer cases at all major medical centers. Less support staff. More offsite rotations for residents so that they can get their cases in order to graduate. Once you finish your training there is a high likelihood you are placed in a location where you can't practice the full scope of your skills. That's death to a surgeon. There are a few specialties that I think have good practice environments within the military system (such as family medicine), but surgery is absolutely not one of them.

What kind of work satisfaction do people have as neurosurgeons or general surgeons in the army. Do they have a good case load with lots of diversity? Do they feel they learn skills that will translate well into the civilian sector after service? I would likely plan to moonlight as an attending, but just wanted to know what kind of lifestyle and patient diversity I might expect to see if I pursue either of those specialties in the army.

I am not a surgeon, but I have heard nothing but complaints from the ones I have worked with regarding practicing surgery in the military. Your practice of surgery in the states is no different than any civilian location, with the exception of way less case complexity and fewer patients. The ones who have deployed that I have spoken with said that often they don't operate at all while deployed, or if they do operate then they are very simple procedures that aren't within their typical scope of practice (like a Surgical Oncologist doing hernia repairs). I have also heard that the trauma stuff done during wartime is pretty different than civilian trauma, although I'm sure that experience is valuable. When we aren't at war, however, there probably isn't much trauma in a deployed setting.

Side question - I am a lesbian female and am wondering what kind of culture I might be met with by the army as a part of two somewhat minority groups (as far as military goes). Would I face disrespect as a woman? How is military culture as far as LGBTQ goes?

I haven't seen anyone treated poorly because of their gender, race, or sexual orientation in my 13+ years in the military. Other people may have different experiences, but the organization has supportive policies and unless you run into a bad apple (which could happen anywhere) then you won't have problems.

Edit: I forgot to mention. The main reason I would recommend someone do HPSP is if you want to serve and want to be in the military and just so happen to have received a medical school acceptance. If your main interest is having your loans paid off and having a little extra cash during residency, then I would suggest taking a long look around these forums and speaking to many different people before you sign the dotted line.

 

[Helpful Troll]

Hi all,

I have recently been accepted to an MD program and am strongly considering army HPSP. I feel good that I would be able to contribute to some sense of stability for my partner and child while I am in school, with a (correct me if im wrong) seemingly better work/life balance during residency compared to the civilian side. I find that these values are worth something substantial despite making significantly less than my civilian counterparts during my payback years, especially considering that I will graduate debt-free.

My question - I am extremely interested in pursuing something surgical. I have been interested in neurosurgery for quite some time, but believe I could see myself going for general surgery as well if 1) I don’t end up enjoying neurosurgery as much or if 2) matching neurosurgery may not be feasible in the army during my M4 year.

What kind of work satisfaction do people have as neurosurgeons or general surgeons in the army. Do they have a good case load with lots of diversity? Do they feel they learn skills that will translate well into the civilian sector after service? I would likely plan to moonlight as an attending, but just wanted to know what kind of lifestyle and patient diversity I might expect to see if I pursue either of those specialties in the army.

Side question - I am a lesbian female and am wondering what kind of culture I might be met with by the army as a part of two somewhat minority groups (as far as military goes). Would I face disrespect as a woman? How is military culture as far as LGBTQ goes?

thank you for any input!

There are so few Army Neurosurgery residents authorized to start training each year it's better to stay civilian if that's your specialty of choice. My opinion, Active Duty Gen Surg residency provides no better work/life balance. In some ways it's worse. Many of the Army residency locations have training rotations in eight locations so you'll have to learn the EMR systems and everything else that comes with each training location. You can see this on the ACGME website. You'll still have terrible work hours.

 

[Correlate Clinically]

I'd agree with all the other posts. The first, and most important point is - don't do HPSP (or USUHS or whatever) unless you actually want to be in the military.

If you are serious about surgery, I'd be cautious about the military. It's hard to stay current in any procedural specialty right now. For neurosurgery in particular, you probably have a better statistical chance outside the military. All three services train very few neurosurgeons. General surgery is better, but still has issues. That's not to say you can't do it and be happy. But a lot of the surgeons I know aren't particularly thrilled while on active duty.

Residency is residency. There's no real work life balance. It varies from program to program, mil or civ. Most good programs are busy, and that usually means your hours are going to be bad no matter what.

 

[fd25]

Thank you everybody for your honest and informative advice

 

[orbitsurgMD]

Hi all,

I have recently been accepted to an MD program and am strongly considering army HPSP. I feel good that I would be able to contribute to some sense of stability for my partner and child while I am in school, with a (correct me if im wrong) seemingly better work/life balance during residency compared to the civilian side. I find that these values are worth something substantial despite making significantly less than my civilian counterparts during my payback years, especially considering that I will graduate debt-free.

My question - I am extremely interested in pursuing something surgical. I have been interested in neurosurgery for quite some time, but believe I could see myself going for general surgery as well if 1) I don’t end up enjoying neurosurgery as much or if 2) matching neurosurgery may not be feasible in the army during my M4 year.

What kind of work satisfaction do people have as neurosurgeons or general surgeons in the army. Do they have a good case load with lots of diversity? Do they feel they learn skills that will translate well into the civilian sector after service? I would likely plan to moonlight as an attending, but just wanted to know what kind of lifestyle and patient diversity I might expect to see if I pursue either of those specialties in the army.

Side question - I am a lesbian female and am wondering what kind of culture I might be met with by the army as a part of two somewhat minority groups (as far as military goes). Would I face disrespect as a woman? How is military culture as far as LGBTQ goes?

thank you for any input!

You really should do something else other than take an HPSP contract. Your residency training opportunities will be far better in a civilian match. Sure, the military branches do sometimes offer deferments for civilian training, but getting what you want when you want it is a crapshoot you don't have to play at all if you aren't tied to a military contract. Whether you eventually go to neurosurgery (a difficult to match specialty, but consider ortho-spine and interventional neuroradiology for similar clinical activities) or something else, the military would have you on a long payback obligation from HPSP, especially if you add a long residency, and that may have a significant impact on what your partner can do and where your family will live. Possibly things would work out OK, but you really can't count on it. The importance of maximizing your opportunities for getting the residency of your choice cannot be overemphasized. Your obligations under HPSP could compromise that significantly.

The prospect of borrowing money for med school is intimidating. The people who run the HPSP know that and exploit those fears to their advantage. Remember this: doctors manage to pay off their loans and do just fine, and so would you.

There was a time when the HPSP didn't represent a risk to your getting timely training, but that time has passed.

 

[pgg]

I would advise against joining for the money.

The main reason is that if you were just accepted, you'll start med school in 2023, graduate in 2027, finish neurosurgical residency in 2032 or 33, and then pay back a ~6 year commitment to the Army. Eligible to get out around 2040.

(This is something many prospective HPSP'ers don't fully appreciate. The obligated service time is the shorter of the HPSP commitment or the residency training time - and the clock doesn't START until you're done with residency. That "four year" HPSP payback routinely becomes 10+ years of service.)

And that's assuming you even do neurosurgery. Almost all premeds change their mind at some point. You really don't know what you're getting yourself into now, and you won't get the first real taste until you rotate through different specialties.

Approximately seventeen years from now you'd be eligible to leave. It's hard to know what milmed will look like 17 months from now. 17 years? You want to commit yourself to working for an organization in constant flux for the next 17 years?

You should only do that if one of your primary career goals is to be a military physician.

Also, residency is a grind everywhere. Whether or not it's "easier" aka "better work-life balance" at military programs is debatable, but you should also consider the notion that "easier" residency is often synonymous with "weaker" residency. As a resident, you've got a few years to do as much as you can and see as much as you can while you have the tender shelter of an attending to guide you and bail you out of your mistakes. Work-life balance is great, yes. Avoid programs with wasted time or low-yield time, yes. Don't go looking for residency programs that are easy. Plan for those years of your life to be a grind and understand that life as an attending is much better.

 

[fd25]

I would advise against joining for the money.

The main reason is that if you were just accepted, you'll start med school in 2023, graduate in 2027, finish neurosurgical residency in 2032 or 33, and then pay back a ~6 year commitment to the Army. Eligible to get out around 2040.

(This is something many prospective HPSP'ers don't fully appreciate. The obligated service time is the shorter of the HPSP commitment or the residency training time - and the clock doesn't START until you're done with residency. That "four year" HPSP payback routinely becomes 10+ years of service.)

And that's assuming you even do neurosurgery. Almost all premeds change their mind at some point. You really don't know what you're getting yourself into now, and you won't get the first real taste until you rotate through different specialties.

Approximately seventeen years from now you'd be eligible to leave. It's hard to know what milmed will look like 17 months from now. 17 years? You want to commit yourself to working for an organization in constant flux for the next 17 years?

You should only do that if one of your primary career goals is to be a military physician.

Also, residency is a grind everywhere. Whether or not it's "easier" aka "better work-life balance" at military programs is debatable, but you should also consider the notion that "easier" residency is often synonymous with "weaker" residency. As a resident, you've got a few years to do as much as you can and see as much as you can while you have the tender shelter of an attending to guide you and bail you out of your mistakes. Work-life balance is great, yes. Avoid programs with wasted time or low-yield time, yes. Don't go looking for residency programs that are easy. Plan for those years of your life to be a grind and understand that life as an attending is much better.

This is great advice. I truly appreciate it.

 

[DrZogg]

I would advise against joining for the money.

The main reason is that if you were just accepted, you'll start med school in 2023, graduate in 2027, finish neurosurgical residency in 2032 or 33, and then pay back a ~6 year commitment to the Army. Eligible to get out around 2040.

(This is something many prospective HPSP'ers don't fully appreciate. The obligated service time is the shorter of the HPSP commitment or the residency training time - and the clock doesn't START until you're done with residency. That "four year" HPSP payback routinely becomes 10+ years of service.)

And that's assuming you even do neurosurgery. Almost all premeds change their mind at some point. You really don't know what you're getting yourself into now, and you won't get the first real taste until you rotate through different specialties.

Approximately seventeen years from now you'd be eligible to leave. It's hard to know what milmed will look like 17 months from now. 17 years? You want to commit yourself to working for an organization in constant flux for the next 17 years?

You should only do that if one of your primary career goals is to be a military physician.

Also, residency is a grind everywhere. Whether or not it's "easier" aka "better work-life balance" at military programs is debatable, but you should also consider the notion that "easier" residency is often synonymous with "weaker" residency. As a resident, you've got a few years to do as much as you can and see as much as you can while you have the tender shelter of an attending to guide you and bail you out of your mistakes. Work-life balance is great, yes. Avoid programs with wasted time or low-yield time, yes. Don't go looking for residency programs that are easy. Plan for those years of your life to be a grind and understand that life as an attending is much better.

In my mind residency through the Navy will be equally as good, more coastal and the pay will be better than civilian.

It seems that residency in the Navy is better than civilian, and I will have to go through residency no matter what so I don't count it in my mind as time of service. A 4 Year HSPS = 4 years of better residency and then 4 years of pay back which honestly sounds fun.

Is this a bad line of thinking?

 

[SirGecko]

In my mind residency through the Navy will be equally as good, more coastal and the pay will be better than civilian.

It seems that residency in the Navy is better than civilian, and I will have to go through residency no matter what so I don't count it in my mind as time of service. A 4 Year HSPS = 4 years of better residency and then 4 years of pay back which honestly sounds fun.

Is this a bad line of thinking?

Yeah it’s probably going to depend a little on what you are trying to do. Is residency equally as good or at least not significantly worse? Maybe? Is it “better”? Depends on your priorities and specialty. (And what you might have otherwise matched in) Tons of potential negatives for military residency. A lot of surgical types have to do a significant amount of time away from their home hospital which can be a drawback. Volumes and complexity can low and the military hospitals are kind of a bear to work with for support and just getting things done. Your mileage on that will vary a lot though.

As for the upside you mention: more coastal? You can match to a residency on a coast as a civilian if that’s your priority. Pay is better: yes. Though this doesn’t work in your favor in the long run when you make less money as an attending. (And actually a lot of civilian residencies will let you moonlight later in residency which could help a little with the pay issue, can’t moonlight as a navy resident)

As for the four years of payback being fun… again totally depends. For starters it might not be four years. Could do a gmo tour before residency, could do a longer residency. Will the payback be fun? What makes you think it would be more fun that doing your specialty as a civilian? It’s possible the thing you are thinking would be fun is a reasonable expectation but it’s also possible that you don’t get to do that thing. (Like you really want to go overseas but they send you to Lemore or something)

 

[DrZogg]

Thanks for the feedback. Super helpful.

I guess what I'm getting at is that most of the residency locations are in desirable locations to live, better pay and the training should be comparable since residencies are held to accreditation standards. It strikes me as inaccurate to count a naval residency as "time served" and make a 4 year HSPS into an 8 year commitment. There is always the chance you match into north dakota in a civilian residency for less pay; I'd rather be on the coast for more pay.

Granted you might GMO first, or you might go into a residency longer than your scholarship.

 

[pgg]

In my mind residency through the Navy will be equally as good, more coastal and the pay will be better than civilian.

It seems that residency in the Navy is better than civilian, and I will have to go through residency no matter what so I don't count it in my mind as time of service. A 4 Year HSPS = 4 years of better residency and then 4 years of pay back which honestly sounds fun.

Is this a bad line of thinking?

Better residency in the Navy?

That's like saying the food is better in [insert city] ...

Better than what? Better hours? Better case load? Better climate? Better pay? Better board pass rates? Better patient population? Better holiday weekend calls? Better research opportunities?

Better educational experience than a true top-10 university program? Unlikely - lots of military residency programs are excellent, but you're not going to find one that has more pathology or more field-leading attendings than the big name civilian programs. Research opportunities at military hospitals are, in general, rather poor for a number of reasons that are unlikely to change.

The resulting product of any residency program is largely dependent upon the individual, but there's no denying that case load matters. And case load is something that a lot of military programs have been struggling with the last 5-10 years, especially on the surgical side.

Pedigree and connections matter to some degree for those who intend to seek future fellowships or academic appointments.

Now - just because amazing top tier civilian programs exist doesn't mean that any given individual will actually be able to match there. There are definitely a lot of lower tier / terrible civilian programs out there that are markedly inferior to military programs in multiple respects. But I don't think anyone would really disagree that the ceiling is higher in the pool of civilian programs.

The funny thing is that nobody starts medical school thinking they'll be bringing up the rear of their class and thereby relegated to non-competitive specialties and programs. Everyone plans to be a superstar. Most aren't.

If you go to a military program, odds are very high you'll graduate safe and competent. I think the worst military program is probably worlds better than the worst civilian program.


But - and this gets back to my earlier post in this thread - joining the military via HPSP because of what you'll do or where you'll be during medical school and residency is IMO the wrong set of criteria. It's the junior attending payback years you should be thinking about. Not so much the pay difference. But rather that it's impossible to know what that practice environment will be like 10+ years from now when you're paying back your time.

Something that is rarely appreciated amongst pre-meds is that the first few years after residency are extremely important in terms of becoming an excellent physician. The learning curve is still steep at that point. You graduate safe but it takes time and case load to get good. Military residencies can and do compensate for poor case load by sending residents to civilian hospitals. The military won't[1] send new grad attendings to to work at civilian hospitals to compensate for that same poor case load.



[1] With few exceptions, generally the military won't - though there's been talk for 10+ years about expanding partnerships with civilian institutions to promote skill maintenance amongst active duty physicians. I held my breath for 10+ years waiting for it to happen and retired before it did. Caveat emptor.

 

[DrZogg]

Thanks Gecko and pgg, I always appreciate all the info on this forum. Sorry if I hijacked this thread a bit.

 

[Correlate Clinically]

In my mind residency through the Navy will be equally as good, more coastal and the pay will be better than civilian.

It seems that residency in the Navy is better than civilian, and I will have to go through residency no matter what so I don't count it in my mind as time of service. A 4 Year HSPS = 4 years of better residency and then 4 years of pay back which honestly sounds fun.

Is this a bad line of thinking?

It really depends on what you want.

An "easier" residency sounds good in theory. It's usually not. You don't want to go somewhere toxic, but that's another discussion. Residency is years of getting everything crammed in while under the supervision and license of someone else. It honestly sucks at the time, but you will be grateful for it later. Can an "easier" program still be good? Maybe, but it would be really tough. That holds true for all or almost all specialties.

4 years. Those 4 years might be great. They also might be terrible. You can't quit. In a variety of ways, the payback can also end up being much longer than 4 years. It doesn't always happen that way, but it can.

Trying to become a doctor in the military is a risk. You are taking several, sequential risks by accepting HPSP (or USUHS or whatever). It didn't used to be quite as big of a gamble, but everything is in flux and DHA is running what's left into the ground.

Think of it this way, you're in Vegas and in order to become a happy, healthy, military attending you have to win 100% while gambling all night.

First, you are gambling against the house on what kind of training you want to do. Maybe the dealer has a lot of cards with Surgery on them, maybe they all say flight med assigned to that squadron everyone hates. Blackjack or something. Who knows?

If you get lucky there, next you move to the casino table where you spin the wheel for programs. Is the AD program still viable? Has DHA cut so much it in danger of loosing accreditation? Is it going to be shut down halfway through and you scramble to go to the local university to finish (seriously, has happened)?

If that works out, awesome! Now you get to play poker for where you are assigned. The other guy can see your cards. Actually, you have no cards, and are going to Iraq.

At the end of all of that, you may have won. Or at least arrived at outcomes that are tolerable to you. But it's taking a large number of additional, discretionary risks with your life and career. If you are ok with that, and the returns or military service on their own are enough that you will be happy. Then go for it. But don't do it for the stipend or the pay.

Edit - just realized I missed a bunch of posts basically saying the same thing. I typed and wandered off for dinner before finishing my train of thought.

Edit 2 - the point about case load/experience as a junior staff is important. I'm still on AD, but I moonlight more than I really want to. I am lucky and my specialty works well for moonlighting. The time commitment to maintain your skills outside of the MTF may be really tough depending on the area, specialty, and your military duties. It's something most people don't think about. I encourage all my new guys to moonlight if they want to. It's up to them, of course, but it's the only way to get enough experience and the right mix of experience. Unless you are at one of the big, major Medical Centers (BAMC, NNMC, etc), you can not rely on the MTF alone.

 

[Mace1370]

I am at one of the major medical centers and I still need to moonlight to keep up my skills. DHA has gutted case volume across the entire hospital. It's really impressive.

 

[DrZogg]

I am lucky and my specialty works well for moonlighting

Does FM/IM/EM work well for moonlighting?

 

[DMBandFan86]

I am at one of the major medical centers and I still need to moonlight to keep up my skills. DHA has gutted case volume across the entire hospital. It's really impressive.

A good reason to not join as a surgeon.

The problem is people change jobs every 2 or so years in the Army and higher. So policy and direction also changes, but takes about a decade or so. Current direction is to gut military medicine. In 10+ years it might be the exact opposite. I suspect in a few years they are going to say they need to revamp army medicine since they flushed it down the toilet. But that is only speculation. The army is in a constant but slow ebb and flows.

But these are slow changes that take many years. If you’ve never worked in the government you may not realize that about 60% of the workforce does about absolutely nothing. So even if policy changes, it won’t come to effect for years after. In the civilian world things can get addressed and fixed much easier.

That’s a big reason why I think waiting until you are done with training and then consider the reserves if you still feel like joining at that time. If you want to retire at 20 years in the reserves and do a long residency, that’s they only time it makes sense to join now and take a reserve incentive. Otherwise the contract will be just too long.

 

[pgg]

Does FM/IM/EM work well for moonlighting?

I'm an anesthesiologist so I can't comment directly on those specialties.

However, general principles:

Any work that require continuty of care is harder to make work as a military moonlighter. You're mostly limited to working evenings, weekends, and while on vacation. There are work hour limits and rest requirements imposed by the military that can make weeknight work tough.

So - shift work specialties tend to be easier to fit into the irregular and intermittent open time an active duty physician might have. Anesthesia (my specialty) is easy - for better or worse I'm a cog in the surgical machine; I don't see patients ahead of time and I never see them later. ER is similar (plus there's plenty of weekend demand for ER services). Pediatrics? OB? IM/FP? Maybe to the extent that they can also do work as hospitalists, but since the core of those specialties is long term management of patients, moonlighting is trickier.

Moonlighting surgeons tend to cover call or vacation for other surgeons. So, they handle emergencies and semi-urgent stuff that comes in the door. A moonlighting general surgeon might do some appendectomies or gall bladders, maybe an ex lap for a bowel obstruction - but they probably won't be doing Whipples, colectomies for cancer, etc. Their scope of practice as a moonlighter is going to be different.

Last - local command policies can have a big effect on if, how, when, and how frequently one can moonlight. I served at very permissive commands, for the most part, but i knew others who had to fight to get out on the town.

 

[pgg]

the point about case load/experience as a junior staff is important. I'm still on AD, but I moonlight more than I really want to. I am lucky and my specialty works well for moonlighting. The time commitment to maintain your skills outside of the MTF may be really tough depending on the area, specialty, and your military duties

Quoted for emphasis.

I've told this story in other threads but the short version is that I'm a cardiac anesthesiologist and the Navy closed our cardiac surgery program less than a year after I returned from fellowship.

I was forced to moonlight to maintain and develop skills related to cardiac anesthesia. My department and command were permissive but the Navy didn't really make any effort to get me the cases I needed.

My last year on active duty I burned all of my accrued leave, to the tune of about a week per month, to work. Plus I worked every free weekend. And every post-call day. Most of those weeks of leave I flew to another city to work because there wasn't local demand for cardiac anesthesia locums.

It worked out well - in that I was able to step into my post-Navy job without a hitch and immediately, but that last year was a grind. Humans aren't meant to spend every free moment working a second job.

This thread started with a comment about work-life balance. Not everybody moonlights, not everybody wants to or feels they need to. But for those of us who do/did, it can lead to some burnout. The extra income sure was nice, but it wasn't a super fun year.

 

[armytrainingsir]

Considering joining the military for work/life balance?

😂😂😂😂

 

[DocSurgeon]

These threads are exhausting. OP listen to those that have done this before. You’re not going to land in ND for residency unless you apply there. What you want to do now and who you are as a person is not what you’ll be doing or who you’ll be be in medical school residency or after graduation. George W Bush was on my commissioning paperwork. Biden signed my discharge. I’m sure others have much more impressive examples. Everyone is gonna owe something… time or money. Take the monetary debt. You’ll never get the time back.

 

[HighPriest]

I joined when you could still be discharged just for being a never nude. Now there are dozens of us.

 

[sarturo]

I joined when you could still be discharged just for being a never nude. Now there are dozens of us.

Prove it, lets see your army awards

 

[Fluidity of Movement]

Sorry for hijacking but what is Psych like military? I too am primarily interested in Army as a prior service nasty girl.

 

[DOswag]

Sorry for hijacking but what is Psych like military? I too am primarily interested in Army as a prior service nasty girl.

I can only speak to Air Force. Basically though I'm EXTREMELY happy that I'm separating this summer and it can't come soon enough. I love seeing patients for psychiatry/med management. But there's so much more to it when it's someone in the military: profiles, treatment team meetings with leadership, always having to be aware of impact on the mission, high interest list meetings (and lots of other pointless military meetings), lots of personality disorders and secondary gain (people trying to get out of work, trying to get an MEB), admin burden is an absolute beast. And it does not look like it's going to improve with DHA taking over essentially demanding increased workload with continued amount of admin BS that seems to ever increase as well as well as abysmal manning across the board. I'd highly recommend taking a loooooong look at what you are specifically wanting out of psychiatry in the military. If you absolutely want to be an officer in the military then go for it. If it's for any other reason (i.e. finances or other "incentives" that the military is throwing at you) I'd be very hesitant to join.. I don't know where you are in training or career, but you have the opportunity to make quite a bit more money civilian, don't have to worry about moving every 3 years or deployments, and you'll have more opportunity to likely have much more autonomy over your practice than in military medicine. Speak to others though as I may just have a biased opinion on my time in the military but many others I've talked that have practiced at least in Air Force have similar sentiments.

 

[Fluidity of Movement]

f you absolutely want to be an officer in the military then go for it. If it's for any other reason (i.e. finances or other "incentives" that the military is throwing at you) I'd be very hesitant to join.. I don't know where you are in training or career, but you have the opportunity to make quite a bit more money civilian, don't have to worry about moving every 3 years or deployments, and you'll have more opportunity to likely have much more autonomy over your practice than in military medicine. Speak to others though as I may just have a biased opinion on my time in the military but many others I've talked that have practiced at least in Air Force have similar sentiments.

Honestly I just miss the military. I was discharged early for a since-cured medical issue but was never able to get back in. I feel like a piece of me has been missing for almost 8 years now. But I was enlisted, I honestly don't know what it's like on the other side of the table.

 

[HighPriest]

Honestly I just miss the military. I was discharged early for a since-cured medical issue but was never able to get back in. I feel like a piece of me has been missing for almost 8 years now. But I was enlisted, I honestly don't know what it's like on the other side of the table.

$#!tty.

But if you really love the military, and don care about pay, maybe you’d like it.

 

[Correlate Clinically]

Honestly I just miss the military. I was discharged early for a since-cured medical issue but was never able to get back in. I feel like a piece of me has been missing for almost 8 years now. But I was enlisted, I honestly don't know what it's like on the other side of the table.

I get where you are coming from. I've spent my entire adult life in uniform, in one capacity or another, and my family is/was military for as far back as anyone has bothered to research it. I'm both eager to get out as my time gets close, but there's also that "what if I miss X and can't find something like Y" in the back of my head. It's like Stockholm syndrome.

But military medicine is really screwed up right now and has been for awhile. Some of the guys I know working closer to the line/operational units claim its better, others that it's just as bad or a different kind of bad. It's probably luck of the draw.

My personal opinion (so take it all that's worth) is to avoid military medicine unless you have other, over-riding, and very compelling reasons to join the military. If that's the case, and you want to be a military officer first and foremost, being a doctor is basically a secondary objective - then yeah, sure. If you are hell bent on getting a commission then this is one way to do it.

To someone considering it - I would suggesting getting your MD and a residency first, then think about it some more. If you still want to join when you are about to graduate, look at the FAP program (unless they changed the name) and join as a full attending.

If someone's primary goal is to join the military, that's different. In that case, I'd just say that continuing to be a good physician and simultaneously a military physician can more challenging than you think going into it. My who-knows-how-accurate prognostication is that it will only become more challenging for a lot of specialties as the years go by. I'd like to be proven wrong, though.

It is impossible to say if things will be the same (maybe), worse (probably), or better (unlikely, but who really knows) in the 10 years it would take someone to get through med school and residency.

Things change; commanders, generals, administrations change and objectives whipsaw around. The gov't can't seem to see many projects through if they take longer than 2 years. MilMed has been on the downswing for at least a decade, and honestly longer. It is possible that another administration, SecDef, or whoever will change their mind and try to change the trajectory. The problem is, we are at the point where so much has been gutted that I'm not certain they can reasonably rebuild it. It's not that it is technically or functionally impossible, but it may be politically/bureaucratically impractical to the point of being impossible. Replacing and rebuilding military medicine is a multiyear project, really at least a decade given the delay from recruiting a med student to getting a functioning attending (let alone a program director, "master clinician", or just senior physician). I am skeptical that anyone will have the influence, authority, and motivation to force that through. Maybe an actual act of Congress?

 

[orbitsurgMD]

I get where you are coming from. I've spent my entire adult life in uniform, in one capacity or another, and my family is/was military for as far back as anyone has bothered to research it. I'm both eager to get out as my time gets close, but there's also that "what if I miss X and can't find something like Y" in the back of my head. It's like Stockholm syndrome.

But military medicine is really screwed up right now and has been for awhile. Some of the guys I know working closer to the line/operational units claim its better, others that it's just as bad or a different kind of bad. It's probably luck of the draw.

My personal opinion (so take it all that's worth) is to avoid military medicine unless you have other, over-riding, and very compelling reasons to join the military. If that's the case, and you want to be a military officer first and foremost, being a doctor is basically a secondary objective - then yeah, sure. If you are hell bent on getting a commission then this is one way to do it.

To someone considering it - I would suggesting getting your MD and a residency first, then think about it some more. If you still want to join when you are about to graduate, look at the FAP program (unless they changed the name) and join as a full attending.

If someone's primary goal is to join the military, that's different. In that case, I'd just say that continuing to be a good physician and simultaneously a military physician can more challenging than you think going into it. My who-knows-how-accurate prognostication is that it will only become more challenging for a lot of specialties as the years go by. I'd like to be proven wrong, though.

It is impossible to say if things will be the same (maybe), worse (probably), or better (unlikely, but who really knows) in the 10 years it would take someone to get through med school and residency.

Things change; commanders, generals, administrations change and objectives whipsaw around. The gov't can't seem to see many projects through if they take longer than 2 years. MilMed has been on the downswing for at least a decade, and honestly longer. It is possible that another administration, SecDef, or whoever will change their mind and try to change the trajectory. The problem is, we are at the point where so much has been gutted that I'm not certain they can reasonably rebuild it. It's not that it is technically or functionally impossible, but it may be politically/bureaucratically impractical to the point of being impossible. Replacing and rebuilding military medicine is a multiyear project, really at least a decade given the delay from recruiting a med student to getting a functioning attending (let alone a program director, "master clinician", or just senior physician). I am skeptical that anyone will have the influence, authority, and motivation to force that through. Maybe an actual act of Congress?

The more I hear how things have not changed, the more I think military medicine ought to be managed under a separate, independent federal commission. As it is, they are intentionally or unintentionally weathercocked by annual budget whims and other variables that keep programs that need long-term support, guidance and planning in a debilitating state of uncertainty. Similar efforts were accomplished within specific services--the Navy's nuclear power program seemed to have a long-term planning and management design (although it could have done with less of the cray-cray chair-leg-filing control by Adm. Hyman Rickover). I have to believe that the same could be done on a DOD level. One year budgets and two-year command tours really serve institutional medicine requirements poorly, where program building commitments need decade-long time spans.

 

[militaryPHYS]

I like military medicine. My practice is busy. Navy has been good to us so far. The transition will be long and painful. Long term benefits should be net positive. Some of the above may be true, maybe none of it will be true for you. Only you can decide to sign the voluntary dotted line

 

[Activated]

Glad I found this forum. So after reading several posts on not signing up for the scholarship if it’s purely financial has given me a lot of answers.

I am 36 yo father of 5 and start DO school in August. I have been in EM for all of my career as an EMT/paramedic/nurse. It’s all I know, but going into Med school with an open mind for all opportunities/specialties. That being said, when I was younger I had a strong desire to join the marines but didn’t based on my mom. Now that I’m older, I don’t have that strong desire anymore but the financial aspect/stipend I s certainly intriguing. This decision is purely a financial purpose and stipend would help support my wife and family during school. Seems like that idea is folly based on reading posts.

My other fear is leaving my wife and kids (all boys mind you) for deployment. I’ve been told that there are tours where your family can accompany you if it’s a non-combat which to me would be most favorable.

I appreciate all of the info y’all have provided and appreciate any further posts

 

[orbitsurgMD]

Glad I found this forum. So after reading several posts on not signing up for the scholarship if it’s purely financial has given me a lot of answers.

I am 36 yo father of 5 and start DO school in August. I have been in EM for all of my career as an EMT/paramedic/nurse. It’s all I know, but going into Med school with an open mind for all opportunities/specialties. That being said, when I was younger I had a strong desire to join the marines but didn’t based on my mom. Now that I’m older, I don’t have that strong desire anymore but the financial aspect/stipend I s certainly intriguing. This decision is purely a financial purpose and stipend would help support my wife and family during school. Seems like that idea is folly based on reading posts.

My other fear is leaving my wife and kids (all boys mind you) for deployment. I’ve been told that there are tours where your family can accompany you if it’s a non-combat which to me would be most favorable.

I appreciate all of the info y’all have provided and appreciate any further posts

Tours are permanent orders for assignment to an activity location. That could be a base somewhere, at a hospital, or with a command like a Navy vessel or squadron that may deploy as part of its usual cycle of activity, or in wartime, on an indefinite basis. Those can be accompanied (i.e., with your dependents) or unaccompanied (without dependents). Some tours are OCONUS, meaning AK, HI, Guam, or to a foreign country, and in some cases to remote locations that are foreign territories (Antarctica, Diego Garcia). The remote tours are typically unaccompanied and relatively scarce and usually limited to one year. Typically they don't have difficulty filling those billets as there is usually a spiff that you get to write your own follow-on orders (within reason).

A "deployment" can apply to anyone, and almost never (read: "never") is accompanied. Routine deployments are common in combat units and frequently occur on a cyclical basis and for a set length of time to some forward location. A carrier group may deploy for six months from its home base in San Diego to a forward operating location in the Persian Gulf. In that case, the doctor assigned to the carrier goes with the ship. In other cases, say with a submarine squadron, the doctor stays ashore in a clinic or aboard a tender vessel which may or may not move from the home base of operations. Typically there may be shorter detachments of multi-vessel or multi-aircraft units during the time between longer deployments. Those are also unaccompanied. Doctors sometimes accompany those missions and sometimes do not, depending on the nature of the detachment mission. When I was assigned as a flight surgeon to an anti-submarine aircraft squadron, I deployed with the whole unit to a forward operating base (Sigonella, Sicily, for example) and then detached further from there (Saudi Arabia, Israel) for shorter periods. All of that was unaccompanied. My squadron usually deployed for six months out of every eighteen months, but frequently sent detachments of less than the full unit in the year in-between.

Deployment is expected as a feature of operational medicine assignments. I realize some people who go into military medicine have had careers where they have never deployed, but you can't and shouldn't count on that happening for you. If you really are reluctant to have that kind of tasking, don't join.

 

[militaryPHYS]

In case people are wondering.

MGMA numbers with deduction for military practice in my specialty amounts to 21 patients per clinic if seeing clinic twice per week. In an OCONUS practice on average might be under that given the population there. A CONUS practice at one of the big 3 with a GME program that number is very easy to hit and stay well above.

Main limitation is efficiency of clinic and OR time given staffing shortages.

I don’t work for referral management or healthcare business so I can’t speak to matters on that side of the house.

Many patients prefer military medicine, many do not…similar to our active duty or prior military physicians. Just depends on your own personal experience.

 

[militaryPHYS]

Glad I found this forum. So after reading several posts on not signing up for the scholarship if it’s purely financial has given me a lot of answers.

I am 36 yo father of 5 and start DO school in August. I have been in EM for all of my career as an EMT/paramedic/nurse. It’s all I know, but going into Med school with an open mind for all opportunities/specialties. That being said, when I was younger I had a strong desire to join the marines but didn’t based on my mom. Now that I’m older, I don’t have that strong desire anymore but the financial aspect/stipend I s certainly intriguing. This decision is purely a financial purpose and stipend would help support my wife and family during school. Seems like that idea is folly based on reading posts.

My other fear is leaving my wife and kids (all boys mind you) for deployment. I’ve been told that there are tours where your family can accompany you if it’s a non-combat which to me would be most favorable.

I appreciate all of the info y’all have provided and appreciate any further posts

It is easy for current and prior military physicians to say don’t join if purely for financial reasons because for the most part it is true. However, most of the same people dishing that out would be lying if they said that financial and job security weren’t a large part of their decision back in the day.

There are countless “factors” that determine if MilMed is a good idea for you and your family and honestly require dedicated mentoring with multiple different types/personalities of military physicians but most of the time that is not possible. You have access to recruiters or physicians who work for recruiting and/or you have access to forums like this which have a negative bias. Both should be considered. I agree that understanding that pure financial gain is not a reason to join is true. Financial incentive and motivation doesn’t mean you’re joining for wrong reasons it just means you need to overcompensate by understanding the large uncertainties and negative sides to MilMed.

 

[orbitsurgMD]

It is easy for current and prior military physicians to say don’t join if purely for financial reasons because for the most part it is true. However, most of the same people dishing that out would be lying if they said that financial and job security weren’t a large part of their decision back in the day.

There are countless “factors” that determine if MilMed is a good idea for you and your family and honestly require dedicated mentoring with multiple different types/personalities of military physicians but most of the time that is not possible. You have access to recruiters or physicians who work for recruiting and/or you have access to forums like this which have a negative bias. Both should be considered. I agree that understanding that pure financial gain is not a reason to join is true. Financial incentive and motivation doesn’t mean you’re joining for wrong reasons it just means you need to overcompensate by understanding the large uncertainties and negative sides to MilMed.

You are corrrect. The money is the main reason for taking HPSP, and it probably should be. It is the one--the only-- thing that is guaranteed; training opportunity and practice opportunity are not on the table and one can only guess at the probability of having what you want of either, assuming you know exactly what you want and do not change your mind along the way. Whether you can estimate the relative advantage or disadvantage of the HPSP contract versus taking and repaying loans is a matter of modeling out your choices and estimating market conditions down the road, all subject to uncertainty.

 

[HighPriest]

I’m fairly certain that when people say “don’t do it for the money,” the implied second part of that statement is that there are a lot of other factors that, if not considered, will lead you to regret your decision. If there were no other issues with milmed (it was exactly like civilian practice otherwise), then financials would be the only thing to consider and everyone would have a better time, unless of course they enjoy the military aspects. Which is also why people on the forum often say if you want to be an officer more than a doctor it’s a better fit. Financials definitely have to be a -part- of the reason to choose HPSP, otherwise there are other, better ways to be a military doc if cash is no issue.

But as I’ve said before on the forum, you can’t take financials out of the equation entirely. This is a very vulnerable group of people the military is salivating over, primarily because of financial reasons. It’s like telling a starving man not to think about food when he picks a path.

And, for some specialties finances ends up being a much smaller long term problem compared with others, so it’s hard to tell a premed student that they’re going to be so well off financially that it won’t matter.

My speciality was absolutely hamstrung at any and every location of which I am aware if you wanted to do anything more than the most basic bread-and-butter cases. To meet average MGMA numbers you had to have an all-star office staff (well above average) and you had to have an all star OR team. Our specialty is mostly Office based, but the cases we do are often very rapid turnover. It was REALLY hard to be average, and it took constant nuturing and course correction to maintain it. And again, you could see an average number of patients. That’s doesn’t mean they presented with anything resembling the disease portfolio that a civilian practice sees. I can see 25 patients in either setting, but they’re 25 completely different patients when it comes to why they’re here and what we do for them, ultimately.

I’m not saying you can’t do head and neck cancer in the Army. I am saying you can’t do it with any volume approaching what is done in the private sector (and what is expected for basic proficiency).

But this is of course specialty dependent, because I imagine that if you want to do a lot of knee surgery, the military is probably flush. And if you don’t think you’ll every be a specialist for something like Ewing’s, then it doesn’t matter if you don’t see it with any frequency.

I still maintain that this forum is fairly representative with the opinions of the military docs I served with - mostly negative with a few cheerleaders, many of whom eventually end up also disliking milmed on a long enough time frame. I think milmed has a negative bias, not the forum.

 

[DMBandFan86]

I think I just assume that no one in the military would be there without pay or incentives. That goes on any level. The military also doesn’t retain most of its soldiers on any level.

But we aren’t talking about soldiers who join for 4 years and then go IRR. These medical stipend programs have longer lasting and larger implications over 10+ years. That’s why I use so much caution when people want to sign up. If it was just some college grad who wants to join the army to do a tour of service and then get out, I think it’s great. But there are differences for medical officers, and that makes me want to give them advice to not do it unless they understand the the pros and cons. And certainly there are quite a bit of cons.

 

[Correlate Clinically]

I'm not trying to be overly negative, but what I was trying to get across to anyone interested was to be very cautious.

Med school, medicine, and all sorts of things in life are big decisions. Military medicine may work out for some people. The balance of what you sacrifice versus what you gain will tip one way or the other depending on everyone's individual situation. The sacrifices are significant.

It's easy to look at the situation as a ROTC cadet, college student, or prospective USUHS/HPSP student and think that the commitment really isn't that bad or that how things were for the retired or senior O-5/O-6 guy you just talked to is an accurate estimate of how it will be for you. The debt is frightening and the payback is "later".

My personal opinion is that military medicine is now a poor choice for most physicians in a lot of specialties. It used to be better; not great in some areas, but better than what it is now. That's my opinion, everyone has one. Someone else may have a different take, or simply enjoy the modern, administrative military part of the job more than I do.

Choices about HPSP/USUHS/etc rigidly lock in 8, 11, or more years of someone's adult life. It's not one tour and then you're out with some good stories about that time you deployed as a 2LT to Germany.

Military medicine isn't absolutely all bad. But it isn't exactly good either.