Staying in or Getting out?

[haujun]

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Here is a website that talks about financial aspect of getting out or staying in the military. I guess most HPSPer (no prior serve) who finished obligation have about 12 year left before retirement. This website says that you need to save $150,000 a year in civilian sector in order to come ahead separating from the military.

http://whitecoatinvestor.com/should...inancial-implications-of-military-separation/

 

[Perrotfish]

Here is a website that talks about financial aspect of getting out or staying in the military. I guess most HPSPer (no prior serve) who finished obligation have about 12 year left before retirement. This website says that you need to save $150,000 a year in civilian sector in order to come ahead separating from the military.

http://whitecoatinvestor.com/should...inancial-implications-of-military-separation/

Wow, interesting. I can't find any obvious flaws with the numbers either.

 

[NavyFP]

Wow, interesting. I can't find any obvious flaws with the numbers either.

His tax estimates are low on the military side. In a normal year (no CZ time), my rate is closer to 17%.

 

[bobbyseal]

I'll have only 4 years on active duty and need 16 years before retirement. No way that I'm staying in and dealing with this organization any longer than necessary.

 

[Chonal Atresia]

Only way it is anywhere close to financially advantageous to stay in and retire is if you are primary care. Someone in my specialty ran the numbers last year at our national academy meeting and determined that a surgeon in our specialty would still come out financially ahead if he/she left after 17 YEARS in! As I've said before, the military should be utterly embarrassed how they compensate their physicians, specifically medical and surgical specialists. Leave and leave as soon as you can!

 

[deuist]

Wow, interesting. I can't find any obvious flaws with the numbers either.

Unless you're an O-3 with less than 2 years like me (currently deferred for residency). When I go active this summer I'll be making...

Base - $46,020
BAH - $18,180
BAS - $2,868

...with no MSP nor BCP. (When do I get VSP, ISP, ASP anyway?)

When I leave four years from now I'll be O-4 with 4 years. Given that two of my classmates just signed contracts to make over 300K next year, I think that saving up for retirement is certainly possible on the civilian side.

 

[NavyFP]

When do I get VSP, ISP, ASP anyway?

VSP is monthly and should start in month #1, but will likely start in #2 with back pay.
ASP can be requested immediately and paid within 30-45 days.
ISP is usually paid in October or when the new NavAdmin is published.
BCP starts once you get your results and is backdated to the start of active service or test date whichever is later.

 

[numberwunn]

Only way it is anywhere close to financially advantageous to stay in and retire is if you are primary care. Someone in my specialty ran the numbers last year at our national academy meeting and determined that a surgeon in our specialty would still come out financially ahead if he/she left after 17 YEARS in! As I've said before, the military should be utterly embarrassed how they compensate their physicians, specifically medical and surgical specialists. Leave and leave as soon as you can!

Can you explain how you figured this? Unless you're planning on making a million dollars more per year, and saving all of it, I'd have a hard time buying that math. The retirement alone is worth a lot of money...

 

[Chonal Atresia]

I currently make around 165k/yr. I could walk down the street and easily make 500k (600k if I busted my hump). That is a difference of 335K/yr. Over 3 years that is over $1,000,000. Assume 40k/yr for 25-30 years military retirement and there you go. As I said, military compensation for docs is an embarrassment.

 

[dwb8p]

Can you explain how you figured this? Unless you're planning on making a million dollars more per year, and saving all of it, I'd have a hard time buying that math. The retirement alone is worth a lot of money...

He did not figure it (his colleague did, apparently), and he's incorrect. There is absolutely no way that an ENT or any other specialist can come out ahead financially getting out with so many years in, unless as you alluded to they are amassing greater than 1.5+ million in additional savings during those remaining years. That isn't even considering the value of having Tricare for life once you get out, which in a lot of ways is just as valuable as the pension itself. Go browse the early-retirement.org or bogleheads.org forums-- usually the biggest factor preventing otherwise wealthy folks from retiring before 65 is the lack of semi-affordable health insurance.

 

[dwb8p]

I currently make around 165k/yr. I could walk down the street and easily make 500k (600k if I busted my hump). That is a difference of 335K/yr. Over 3 years that is over $1,000,000. Assume 40k/yr for 25-30 years military retirement and there you go. As I said, military compensation for docs is an embarrassment.

That 335k/year difference ignores any moonlighting that you could do while still active duty, the increased taxes that you would pay on that increased pay, the inevitable lifestyle inflation most docs have when they start making that kind of money, and how much harder you would have to work to make that money in private practice as compared to working as a staff ENT at one of the sleepy low volume MTFs. Additionally, the pension for an O6 > 20 is to the tune of 55k/year not 40k, meaning you would need at least 1,375,000 for a 4% annual withdrawal rate. That is with the assumption that you think 4% is a sustainable rate for 30+ years, which a lot of people would not agree with, and would favor more of a 3% rate, which would further increase the starting principle required.

 

[Chonal Atresia]

I didn't include ancillary income (i.e. Selling hearing aids, allergy, ownership in ASCs). These are things almost all civilian ENTs are involved in which you cannot be a part of while on active duty. Are you serious with your argument of "lifestyle inflation?". Whether it's 17 years or 15 years, my point is specialists get screwed. There is no debate on that point.

 

[dwb8p]

I didn't include ancillary income (i.e. Selling hearing aids, allergy, ownership in ASCs). These are things almost all civilian ENTs are involved in which you cannot be a part of while on active duty. Are you serious with your argument of "lifestyle inflation?". Whether it's 17 years or 15 years, my point is specialists get screwed. There is no debate on that point.

I am 100% serious on my argument that lifestyle inflation will decrease your presumed savings rate as a civilian doc who is making ca$h money. The military retirement system is a forced savings program for the masses. Physicians as a group are terrible at managing their own budgets and finances. Why do you think there are so many highly paid sub-specialists still in practice today in their 60s and even 70s?

I agree that specialists and other physicians do get screwed, very frequently, in the military. Completely agree with you. There are a ton of good reasons to jump ship before you hit 20, but financial reasons are not valid ones for the majority of physicians in the military.

 

[244913]

and how much harder you would have to work to make that money in private practice as compared to working as a staff ENT at one of the sleepy low volume MTFs.

Good Physicians want to work hard. We want to hone and refine our skillset. We want to treat challenging patients and tackle tough cases. That is how we grow and learn. After you spend 3-4 years as a GMO treating foot fungus and chronic low back pain, you'll know what I mean. I feel so sorry for surgeons in the .Mil. Poor facilities, low surgical volume- their hard-earned skills end up dying on the vine.

The .Mil is inundated with Physicians who love doing 2-3 cases a week at those "sleepy" low volume MTF's. They are part of the problem. They refer to themselves as Colonel or Major and climb through the ranks through sheer attrition until their awful leadership and poor policy decisions are brought to bear on the rest of us just trying to escape from this nightmare. They are dangerous and you should watch out for them.

-61N

 

[dwb8p]

Good Physicians want to work hard. We want to hone and refine our skillset. We want to treat challenging patients and tackle tough cases. That is how we grow and learn. After you spend 3-4 years as a GMO treating foot fungus and chronic low back pain, you'll know what I mean. I feel so sorry for surgeons in the .Mil. Poor facilities, low surgical volume- their hard-earned skills end up dying on the vine.

The .Mil is inundated with Physicians who love doing 2-3 cases a week at those "sleepy" low volume MTF's. They are part of the problem. They refer to themselves as Colonel or Major and climb through the ranks through sheer attrition until their awful leadership and poor policy decisions are brought to bear on the rest of us just trying to escape from this nightmare. They are dangerous and you should watch out for them.

-61N

I agree completely-- even as a med student rotating at the big MTFs I have been able to appreciate what you are talking about. It's dangerous for physicians' careers, and it's dangerous for patients.

 

[Gastrapathy]

I also did the math before getting out at 13y as a gastroenterologist and it was basically a wash. Whether it made better sense financially to stay or go would change depending on rates of return, how much my expenses would increase with a rising salary, tax assumptions and income assumptions. The big unknown amongst many was the potential for endo center partnership. I also think MSPs could drop.

All told, I couldn't predict which would be better...and that made it an easy decision.

 

[colbgw02]

As someone in a relatively high paying specialty, I've run these numbers before with many different permutations. Others have alluded to this, but the trick is not to count on how much you'll be able to save in your civilian job. The question is how much you'll be able to save in your civilian job more than what you would have saved if you had stayed in. This accounts for differences not just in salary, but also in lifestyle and taxes.

If you try to conceptualize a military retirement paycheck as a principle amount that pays out a regular income based on return, I think it's an inviting carrot for many people. Over the time period in question (20 years minus active duty time), I think it is somewhat unlikely for someone to save more in civilian practice than what they would have in uniform in order to equal the principle required to ensure an annuity comparable to military retirement.

Psychology tells us that most people will ramp up their lifestyle to fit their salary, at least to a degree. If you're not one of those people, then the case for staying in becomes significantly less compelling.

Of course, that is a very quantitative analysis. There are myriad qualitative reasons for getting out that can easily outweight any budgetary analysis. If you want to live close to family, limit administrative hassles, or practice in a certain city, then these are concerns that carry no dollar amount.

ETA: Another consider is practice opportunities after 20+ years in versus after less than 10 years in. I have known people who have had doors closed to them in the civilian world because they've been "institutionalized", as opposed to someone who just served their initial ADSO.

 

[Slevin]

After this contract is up I'll have 11 years in. I'm debating on staying in an additional 9 years for retirement or getting out. If I decide to get out and then become a GS employee, can I convert my military retirement for a civilian retirement?

 

[pgg]

I'm staying for the retirement cheese. I had a longer obligation to start with though, not being HPSP. I need 8 past my educational obligation.

I did the math and for my specialty (anesthesia) even without counting moonlighting while on AD or lifetime health benefits, to break even financially I'd have to get out and find a job that guaranteed me $450-500K/year for those 8 years.

Moreover, depending on my motivation and how I wanted to spend leave and weekends, my first three years out of residency I easily supplemented my .mil pay by $100-200K/year. Now, that's not something I can count on if I PCS someplace with a less convenient moonlighting gig, but now we're talking about a civilian PP job that guarantees me $550-700K/year over that period.

Those jobs are certainly out there, but the employment landscape for anesthesia is changing and most of the anesthesiologists pulling in $500K+/year are working long hours and/or supervising CRNAs.


The Navy isn't all bad. 100% my own cases. I don't supervise or direct. Those syphilis-ridden CMS wankers never show their evil faces at MTFs. At some point in the next few years FTOS fellowship spots will open up and instead of making $70-90 as a civilian fellow, as a FTOS funded fellow I'll make my full MSP-augmented $250K+ while still accruing retirement credit.

Have kids? Agree to stay for 4 more years and you can transfer your Post-9/11 GI Bill. That's a 4 year full ride worth $100-200K, depending.

The people who 'do the math' and get out at 17 years are either EXTREMELY highly paid subspecialists - think spine surgeons and the like - or they're doing the math wrong. An O5/O6 with 20+ has a retirement benefit that is objectively worth at least $1.5 million in today's dollars. I just don't believe there are many people who can get out and increase their AFTER-TAX income by $500,000/year for those three years AND save ALL of that extra money.


Beyond finances - another tipping point for me was moonlighting a lot my first three years out of residency. 5 or 6 days per month dealing with meth heads, non-English speaking uninsured self/no-pay, prisoners out on day trip to get hernia repairs ... it made me appreciate having active duty people, family members, and retirees as patients.

It's fashionable to bash the O6 surgeon who couldn't cut it in PP and stayed on in a 90% admin job, only to make scary appearances in the OR with the other 10% of his time. But believe me, there are guys in PP who also can't cut it, and they take cases to the OR 100% of their time. I've seen some malpractice in the military; it pales to the kind of things I see in PP.

I also have a wife who loves the military, enjoys living near bases with a big line presence, doesn't mind moving.

Deployments suck, and they don't. The family separation is horrible. But some of the most rewarding times of my professional life were deploying with Marine infantry as a GMO. I'm currently deployed as an anesthesiologist and I can honestly say that when I walk into the Role 3, I think "this is why I joined the Navy" ...


The ultimate caveat is that physician experiences within the military seem to vary wildly. I have been lucky so far. To an extent we make our own luck (it wasn't luck that made me choose the Navy over the Air Force, for example), but luck plays a non-trivial role in how happy people in the military are. Not having the freedom to just walk away from a bad situation is a very real downside to military service.

Money isn't everything. For someone who's miserable in the military, getting away at 17 years might be the wrong financial decision, but the right life decision.


Anyway, take what you want in life, and pay for it.

 

[pgg]

I agree completely-- even as a med student rotating at the big MTFs I have been able to appreciate what you are talking about. It's dangerous for physicians' careers, and it's dangerous for patients.

Spend some time in rural America. MTFs have got nothing on community hospitals.

When your experience is limited to big academic institutions and their affiliated teaching sites, where "bad surgeon" usually just means "slow but competent surgeon" it's easy to think that really, really bad surgeons aren't out there. To paraphrase the 4th Ghostbuster, I have seen **** that will turn you white.

 

[bobbyseal]

After this contract is up I'll have 11 years in. I'm debating on staying in an additional 9 years for retirement or getting out. If I decide to get out and then become a GS employee, can I convert my military retirement for a civilian retirement?

I know at the VA you can convert your mil time into VA time, but you have to pony up some cash. Essentially, you have to pay in for 11 years of military time to accrue the similar longevity at the VA. I'm not sure about how other federal employment works.

 

[corpsman33]

I'm staying for the retirement cheese. I had a longer obligation to start with though, not being HPSP. I need 8 past my educational obligation.

I did the math and for my specialty (anesthesia) even without counting moonlighting while on AD or lifetime health benefits, to break even financially I'd have to get out and find a job that guaranteed me $450-500K/year for those 8 years.

Moreover, depending on my motivation and how I wanted to spend leave and weekends, my first three years out of residency I easily supplemented my .mil pay by $100-200K/year. Now, that's not something I can count on if I PCS someplace with a less convenient moonlighting gig, but now we're talking about a civilian PP job that guarantees me $550-700K/year over that period.

Those jobs are certainly out there, but the employment landscape for anesthesia is changing and most of the anesthesiologists pulling in $500K+/year are working long hours and/or supervising CRNAs.


The Navy isn't all bad. 100% my own cases. I don't supervise or direct. Those syphilis-ridden CMS wankers never show their evil faces at MTFs. At some point in the next few years FTOS fellowship spots will open up and instead of making $70-90 as a civilian fellow, as a FTOS funded fellow I'll make my full MSP-augmented $250K+ while still accruing retirement credit.

Have kids? Agree to stay for 4 more years and you can transfer your Post-9/11 GI Bill. That's a 4 year full ride worth $100-200K, depending.

The people who 'do the math' and get out at 17 years are either EXTREMELY highly paid subspecialists - think spine surgeons and the like - or they're doing the math wrong. An O5/O6 with 20+ has a retirement benefit that is objectively worth at least $1.5 million in today's dollars. I just don't believe there are many people who can get out and increase their AFTER-TAX income by $500,000/year for those three years AND save ALL of that extra money.


Beyond finances - another tipping point for me was moonlighting a lot my first three years out of residency. 5 or 6 days per month dealing with meth heads, non-English speaking uninsured self/no-pay, prisoners out on day trip to get hernia repairs ... it made me appreciate having active duty people, family members, and retirees as patients.

It's fashionable to bash the O6 surgeon who couldn't cut it in PP and stayed on in a 90% admin job, only to make scary appearances in the OR with the other 10% of his time. But believe me, there are guys in PP who also can't cut it, and they take cases to the OR 100% of their time. I've seen some malpractice in the military; it pales to the kind of things I see in PP.

I also have a wife who loves the military, enjoys living near bases with a big line presence, doesn't mind moving.

Deployments suck, and they don't. The family separation is horrible. But some of the most rewarding times of my professional life were deploying with Marine infantry as a GMO. I'm currently deployed as an anesthesiologist and I can honestly say that when I walk into the Role 3, I think "this is why I joined the Navy" ...


The ultimate caveat is that physician experiences within the military seem to vary wildly. I have been lucky so far. To an extent we make our own luck (it wasn't luck that made me choose the Navy over the Air Force, for example), but luck plays a non-trivial role in how happy people in the military are. Not having the freedom to just walk away from a bad situation is a very real downside to military service.

Money isn't everything. For someone who's miserable in the military, getting away at 17 years might be the wrong financial decision, but the right life decision.


Anyway, take what you want in life, and pay for it.

Very nicely explained.

 

[Chonal Atresia]

Your arguments are well laid out and I respect your opinion. I will say that counting on 100-200K from moonlighting is NOT realistic. I essentially used all my built up leave from residency to moonlight in addition to working the patented 4-day "training" holidays as well as my 1/2 day of admin per week and have only been able to average 75K/yr for the last 5 years. However, I am not in a specialty that lends itself to "shift work coverage" (i.e. ER, radiology, anesthesiology, etc). I am in a similar paying specialty such as yourself and have now exhausted all leave (I currently have 0.5 days on the books) one year prior to ETSing.

You point is well-taken about the patient population and I would rather operate on military folks hand-down. Those high-paying jobs are out there, believe me. They are just not in New York City, LA, San Francisco, etc. I have been in talks with several practices in the state that their higher-producing docs routinely make 500-600K and are not spine surgeons. In addition, most practices only have a one-year employed cause and minimal buy-in. You have all the ancillaries to consider also. If you don't like busting your hump and enjoy the socialized nature of military medicine, than private practice certainly would not be the right place for you.

 

[pgg]

I will say that counting on 100-200K from moonlighting is NOT realistic.

Oh, I know it's not a pattern that's likely to continue for much longer. I fell into the perfect situation with the perfect group that needed evening and weekend coverage that aligned with my command's moonlighting policy. It helps that I'm 1 of 1 where I'm at and there are no other .mil anesthesiologists competing for hours. (Actually there have been two others, who actually commute 100s of miles to cover weekends there or work vacation time - but they don't take too big a bite of my pie.)

The job could evaporate tomorrow if the group gets bought out or hires some new/reliable people ... I didn't count that $ for planning purposes.

You point is well-taken about the patient population and I would rather operate on military folks hand-down. Those high-paying jobs are out there, believe me. They are just not in New York City, LA, San Francisco, etc. I have been in talks with several practices in the state that their higher-producing docs routinely make 500-600K and are not spine surgeons. In addition, most practices only have a one-year employed cause and minimal buy-in. You have all the ancillaries to consider also. If you don't like busting your hump and enjoy the socialized nature of military medicine, than private practice certainly would not be the right place for you.

Lots of physicians make $500-600K/year, sure, but they're not saving and investing $500K of that. Which is what they'd have to do if they get out at 17 years to break even financially.

I like to work and do cases, it's the other 1/2 of the reason I moonlight so much. A third 1/2 of the reason 🙂 is that being at a small command, I have ongoing fears of skill atrophy, and the trainwrecks on call help hold that off.

The military's not perfect. I like the way the civilian hospital treats me - as a producer of income for the place and a valuable person. Ancillary staff exist to make my life easier and care more efficient. In the military, the line views us as expensive liabilities, and this basic view of physicians ($ producers vs $ drainers) can taint the way the military treats as a group. (E.g., collateral duty creep, ISP getting paid in December, etc.) That sucks, but so far it hasn't sucked enough for me to leave.

 

[colbgw02]

I'm thankful for my moonlighting opportunities and income, but I wouldn't count it as a positive for staying in. Many of us work in jobs that don't pay comparable to our civilian counterparts and too frequently don't provide adequate volume and pathology. Moonlighting helps to bridge those divides, but I find it a little circular to count it as a reason for staying in uniform when it's the military that compels us to moonlight in the first place. Accordingly, I don't consider moonlighting income in my calculus when running the numbers.

 

[BOHICA-FIGMO]

Spend some time in rural America. MTFs have got nothing on community hospitals.

When your experience is limited to big academic institutions and their affiliated teaching sites, where "bad surgeon" usually just means "slow but competent surgeon" it's easy to think that really, really bad surgeons aren't out there. To paraphrase the 4th Ghostbuster, I have seen **** that will turn you white.

Agreed. If you went to medical school in LA, San Francisco, Chicago, Boston, or New York, you may be used to a slightly higher standard than most of the rest of the country. But aside from the lack of big research machines and the sub, sub, specialties, you could do a lot worse than a big MTF. Some of the rural community hospitals are where incompetent or legally challenged physicians go to hide out.

 

[Homunculus]

I'm staying for the retirement cheese. I had a longer obligation to start with though, not being HPSP. I need 8 past my educational obligation.

I did the math and for my specialty (anesthesia) even without counting moonlighting while on AD or lifetime health benefits, to break even financially I'd have to get out and find a job that guaranteed me $450-500K/year for those 8 years.

Moreover, depending on my motivation and how I wanted to spend leave and weekends, my first three years out of residency I easily supplemented my .mil pay by $100-200K/year. Now, that's not something I can count on if I PCS someplace with a less convenient moonlighting gig, but now we're talking about a civilian PP job that guarantees me $550-700K/year over that period.

Those jobs are certainly out there, but the employment landscape for anesthesia is changing and most of the anesthesiologists pulling in $500K+/year are working long hours and/or supervising CRNAs.


The Navy isn't all bad. 100% my own cases. I don't supervise or direct. Those syphilis-ridden CMS wankers never show their evil faces at MTFs. At some point in the next few years FTOS fellowship spots will open up and instead of making $70-90 as a civilian fellow, as a FTOS funded fellow I'll make my full MSP-augmented $250K+ while still accruing retirement credit.

Have kids? Agree to stay for 4 more years and you can transfer your Post-9/11 GI Bill. That's a 4 year full ride worth $100-200K, depending.

The people who 'do the math' and get out at 17 years are either EXTREMELY highly paid subspecialists - think spine surgeons and the like - or they're doing the math wrong. An O5/O6 with 20+ has a retirement benefit that is objectively worth at least $1.5 million in today's dollars. I just don't believe there are many people who can get out and increase their AFTER-TAX income by $500,000/year for those three years AND save ALL of that extra money.


Beyond finances - another tipping point for me was moonlighting a lot my first three years out of residency. 5 or 6 days per month dealing with meth heads, non-English speaking uninsured self/no-pay, prisoners out on day trip to get hernia repairs ... it made me appreciate having active duty people, family members, and retirees as patients.

It's fashionable to bash the O6 surgeon who couldn't cut it in PP and stayed on in a 90% admin job, only to make scary appearances in the OR with the other 10% of his time. But believe me, there are guys in PP who also can't cut it, and they take cases to the OR 100% of their time. I've seen some malpractice in the military; it pales to the kind of things I see in PP.

I also have a wife who loves the military, enjoys living near bases with a big line presence, doesn't mind moving.

Deployments suck, and they don't. The family separation is horrible. But some of the most rewarding times of my professional life were deploying with Marine infantry as a GMO. I'm currently deployed as an anesthesiologist and I can honestly say that when I walk into the Role 3, I think "this is why I joined the Navy" ...


The ultimate caveat is that physician experiences within the military seem to vary wildly. I have been lucky so far. To an extent we make our own luck (it wasn't luck that made me choose the Navy over the Air Force, for example), but luck plays a non-trivial role in how happy people in the military are. Not having the freedom to just walk away from a bad situation is a very real downside to military service.

Money isn't everything. For someone who's miserable in the military, getting away at 17 years might be the wrong financial decision, but the right life decision.


Anyway, take what you want in life, and pay for it.

great post.

--your friendly neighborhood cheese dreaming caveman

 

[Homunculus]

to add something more substantive to the discussion, i think the retirement break point depends on your specialty and your personal life. there are some people out there that have some amazingly sweet gigs-- people at/near retirement who have managed to already start the transition to academia or respected groups while maintaining active clinical practice and research. on the other end are mid-career subspecialists being tasked out to brigade surgeon billets to rot for 2 years. it's difficult to give an answer without knowing all those details. the big things pushing me toward career-ing is the retirement, the GI-bill, and the long term health care. on the other end is not being able to really "put down roots" until i settle into a post-fellowship staff position-- and even then having the uncertainty that has become the norm now in the day to day existence in the army medical system. the bonus to the lower op tempo now though is there is a glut of never deployed junior staff as a buffer, lol.

i don't honestly know which way i will go. i may hit 14 and find the best civilian job in the world and get out. . . or i may decide it aint that bad and stick it out. . but trying to figure it out know is damn near impossible.

--your friendly neighborhood just here for the ride caveman

 

[TheGoose]

This is a great thread. Thanks for all of the input.

 

[bleeker10]

There has been comparisons between 1) staying in and getting the retirement after 20 years with Tricare for life and 2) separating and having to save X amount of money to equal or better the lifetime total calculated above. So, unless I missed something, staying in for 20 and having the benefits for life as calculated above does not include anything extra one would invest out of their .mil salary.

Just out of curiosity, what percentage of total salary do each of you invest (if you don't mind answering)? Does this influence your decision to stay in or separate?

 

[IlDestriero]

The real value of tricare for life is questionable of you believe that we are headed, nearly certainly, to some form of universal healthcare. (free, inexpensive, subsided, public/private, whatever) I'm not selling the mansion just yet, but change is coming in our lifetime. It is inevitable. When it comes, there will be no need for a separate military plan.
Something to consider anyway.
The GI bill for your kids certainly has value, but so do the faculty tuition benefits offered by many universities. Mine is worth ~$80-150k per child depending on where they go to school. (over 4 years) Obviously the more kids you have, the more valuable this benefit becomes. I'm sure some places cap the benefit at 4 or 5 kids. 🙄

 

[IlDestriero]

I'm putting away 15% of our combined gross income every year, excluding college savings. I should do more, but I don't.🙁 I do have other investments though, so I'm not a total deadbeat.😀
(no longer in the .mil)

 

[MTGas2B]

I put away 20% of gross (including me and the wife). I think if you go the .mil route you need to be putting a good chunk away while your med school buddies are cranking away at their loans, that's the big advantage we have. I plan on getting out but am weighing benefits of the reserves. GI bill transfer might make a few more years worth some reserve time, even if I don't do enough for retirement.

 

[375RGRRGT]

Spend some time in rural America. MTFs have got nothing on community hospitals.

When your experience is limited to big academic institutions and their affiliated teaching sites, where "bad surgeon" usually just means "slow but competent surgeon" it's easy to think that really, really bad surgeons aren't out there. To paraphrase the 4th Ghostbuster, I have seen **** that will turn you white.

Must be a matter of where in rural America. In my experience having seen both (geographically limited to my upbringing) I would not let a military surgeon touch me. But is your rural America different? Must be. Or my military is different.

 

[jabreal00]

I'll be eleven years in when I am up to get out. There is no doubt that I will get out. My first assignment after my fellowship is down right crappy. It's a terrible location and the MTF is dysfunctional. I am a subspecialist and I fear skill atrophy. A buddy of mine who's also a sub-specialist was just ordered to fill a brigade-surgeon spot for two years. This is two years of mostly administrative BS.

Military medicine is broken. I could careless about making $50K a month in pension through the military. I love what I do. I always envisioned in my mind working into my late 60s and early 70s. Between my wife and I (who is also a physician) we would have enough savings between to do okay in our old-age.

 

[375RGRRGT]

I'll be eleven years in when I am up to get out. There is no doubt that I will get out. My first assignment after my fellowship is down right crappy. It's a terrible location and the MTF is dysfunctional. I am a subspecialist and I fear skill atrophy. A buddy of mine who's also a sub-specialist was just ordered to fill a brigade-surgeon spot for two years. This is two years of mostly administrative BS.

Military medicine is broken. I could careless about making $50K a month in pension through the military. I love what I do. I always envisioned in my mind working into my late 60s and early 70s. Between my wife and I (who is also a physician) we would have enough savings between to do okay in our old-age.

Why I was heavily recommended the reserves at most for a commitment and this is after 12 years of prior service. Would you have reservations about that at all?

 

[Mirror Form]

Here is a website that talks about financial aspect of getting out or staying in the military. I guess most HPSPer (no prior serve) who finished obligation have about 12 year left before retirement. This website says that you need to save $150,000 a year in civilian sector in order to come ahead separating from the military.

http://whitecoatinvestor.com/should...inancial-implications-of-military-separation/

This is just garbage for several reasons:

1. It doesn't seem to take into account what happens after 20 years in service! The doctors who get out of the military after 8 years then have a 12 year head start in the civilian world. This allows them to use their time and energy while they're still somewhat young to become successful and well established in private practice or academia.

Whereas, depending on the specialty, the docs who stay in the military will then have to start all over when they retire at 20 years. These doctors will never be as successful in private practice as their counter parts who left earlier. Many just end up staying in the military until they hit 30 years and retiring. Compare that to the doctor's who left the army earlier are now senior partners in private practice, and making more money than they ever have.

2. It fails to take into account your spouse's salary. Staying the military requires moving around, which destroys your spouse's career. In this day and age that fact alone will likely costs you more than the stinking retirement pay is worth.

3. Am I the only one who remembers that memo about how retirement pay may be changed soon? Nobody knows who much of it will really be available in the future. Medicaire and social security are in deep trouble. There's no reason to think the military's retirement plan is sacred.

4. It compares the price you'd pay for actual good health insurance to "try to find care." No thanks, I'll pay for real health insurance where I can actually find a physician.

 

[pgg]

This is just garbage for several reasons:

1. It doesn't seem to take into account what happens after 20 years in service! The doctors who get out of the military after 8 years then have a 12 year head start in the civilian world. This allows them to use their time and energy while they're still somewhat young to become successful and well established in private practice or academia.

Whereas, depending on the specialty, the docs who stay in the military will then have to start all over when they retire at 20 years. These doctors will never be as successful in private practice as their counter parts who left earlier. Many just end up staying in the military until they hit 30 years and retiring. Compare that to the doctor's who left the army earlier are now senior partners in private practice, and making more money than they ever have.

As you say, depends on specialty. For some, 10 years extra in the civilian world translates to an established practice and far higher income, or quality of life, or both. For anesthesia - not so much ... partnership tracks in private practice have historically been relatively short ("really long" being 3 years) ... and with MD-only groups dwindling and hospital employment arrangements becoming more common, the value of attempting to put down community roots or an establish a group now is more questionable now than it's ever been.

Even for those on the civilian side who've never been in the military, mid-career moves from one practice to another are common. It's a rare anesthesiologist who exits residency and finds himself working in the same place with the same people for the next 20-30 years.

At the other end of the spectrum, if you're a plastic surgeon looking to set up a cash-only boutique surgicenter, a 10 year head start is worth something.

I imagine those 10 years would mean something to an ophthalmologist, too.

2. It fails to take into account your spouse's salary. Staying the military requires moving around, which destroys your spouse's career. In this day and age that fact alone will likely costs you more than the stinking retirement pay is worth.

Fair point. Although it's worth considering that many subspecialists only get orders to major military MTFs, and it's common for them to homestead at one for extended periods. We all know people who've been in one place for 10+ years. Again though, specialty dependent.

3. Am I the only one who remembers that memo about how retirement pay may be changed soon? Nobody knows who much of it will really be available in the future. Medicaire and social security are in deep trouble. There's no reason to think the military's retirement plan is sacred.

Predicting the future is hard. But I predict that Social Security will be cut sooner and more than military pensions, if either get cut at all. Cuts to 'poor old grandma' though politically unpalatable, are not the lightning rod cuts to 'guys who bled for their country' would be.

Most likely NO explicit cuts will be made, but debt will be addressed via currency devaluation / inflation. Which will have an equal (if not worse) effect upon retirement savings that aren't SS or .mil ... because at least SS and .mil retirements are indexed to inflation. Even if the official inflation # lags reality.

If the government starts making retroactive/non-grandfathered cuts to military retirees, then we're in Greek/Russian collapse territory and that civilian-practice-funded 401(k) or IRA won't hold off the pain.

4. It compares the price you'd pay for actual good health insurance to "try to find care." No thanks, I'll pay for real health insurance where I can actually find a physician.

Another fair point. I deliberately excluded the predicted 'value' of lifetime Tricare benefits for me and my wife from my calculations. Those benefits are worth something however.

 

[buchemist]

Predicting the future is hard. But I predict that Social Security will be cut sooner and more than military pensions, if either get cut at all. Cuts to 'poor old grandma' though politically unpalatable, are not the lightning rod cuts to 'guys who bled for their country' would be.

Most likely NO explicit cuts will be made, but debt will be addressed via currency devaluation / inflation. Which will have an equal (if not worse) effect upon retirement savings that aren't SS or .mil ... because at least SS and .mil retirements are indexed to inflation. Even if the official inflation # lags reality.

OK, so the plan on the table last year was basically a 401k, phased in if you have less than 15 years of AD service. No changes to current retirees or those with more than 15 years. Thank you for your prediction, but the classic pension is definitely on the chopping block.

 

[Cooperd0g]

OK, so the plan on the table last year was basically a 401k, phased in if you have less than 15 years of AD service. No changes to current retirees or those with more than 15 years. Thank you for your prediction, but the classic pension is definitely on the chopping block.

It may theoretically be on the chopping block, but after the last 10 years it is highly unlikely to be actually chopped in the near future.

 

[Gastrapathy]

OK, so the plan on the table last year was basically a 401k, phased in if you have less than 15 years of AD service. No changes to current retirees or those with more than 15 years. Thank you for your prediction, but the classic pension is definitely on the chopping block.

The "plan" was a think tank that has made the same suggestions for years. It got a lot more press last year than in the past. I agree with pgg that this is incredibly unlikely. A military pension is the most secure investment out there (said from the perspective of someone who passed it up).

 

[Slevin]

Question... has anyone ever heard of a doc homesteading at a place like West Point for IM? Is that even possible?

 

[Mirror Form]

As you say, depends on specialty. For some, 10 years extra in the civilian world translates to an established practice and far higher income, or quality of life, or both. For anesthesia - not so much ... partnership tracks in private practice have historically been relatively short ("really long" being 3 years) ... and with MD-only groups dwindling and hospital employment arrangements becoming more common, the value of attempting to put down community roots or an establish a group now is more questionable now than it's ever been.

It is indeed very specialty dependent. However, I don't think you realize what partnership track actually means. The "3 years" that you mentioned is only when you start to buying in. Depending on how much expensive the stake you're buying is, it may take you 5 - 7 more years to actually finish buying in. Do you really want to spend 3 years as an associate and then 7 more buying in if you're 50 when you finally exit the military?

Furthermore that piece of an ASC/private practice that the guys exiting the military earlier will buy can be worth quite a bit. When you eventually retire and hopefully get bought out by your partners, you could get quite a bit of money. Obviously nobody really knows what any private practices and ASC's will be worth in the future. But chances are that they'll still be worth something.

Even for those on the civilian side who've never been in the military, mid-career moves from one practice to another are common. It's a rare anesthesiologist who exits residency and finds himself working in the same place with the same people for the next 20-30 years.

That may be the case for doctors employed by hospitals or as employees in large groups. However, the majority of physicians are still in private practice. Major mid-career moves are rare for doctors in private practice.

At the other end of the spectrum, if you're a plastic surgeon looking to set up a cash-only boutique surgicenter, a 10 year head start is worth something.

I imagine those 10 years would mean something to an ophthalmologist, too.

Exactly right.

 

[Mirror Form]

Question... has anyone ever heard of a doc homesteading at a place like West Point for IM? Is that even possible?

It would probably take awhile to get a desirable assignment like West Point. And unless you had at least one deployment (or significant operational experience like doing a tour as a brigade surgeon) under your belt, you'd always have a target on your back.

 

[Cooperd0g]

Question... has anyone ever heard of a doc homesteading at a place like West Point for IM? Is that even possible?

People who "homestead" are still typically taking new orders. They are not typically extending their existing orders out 6-10 years in one position. The homesteading is typically due to being at one of the larger MTFs or in an area where there are several facilities (like DC where you have WRNMMC, USUHS, Fort Belvoir, etc). So they take new orders, but those orders are to a different department, to an administrative role where they still practice clinically, or to another facility that is still a reasonable commute from where they live.

I do know of a couple of people who just parked it in their job and were able to stay exactly in that job, but it is more rare.

 

[sonofva]

If one was to do an internship straight to an operational slot, without residency, would it decrease the potential for brigade surgeon assignments/deployments later?

 

[Kilgoretrout 65]

If one was to do an internship straight to an operational slot, without residency, would it decrease the potential for brigade surgeon assignments/deployments later?

No just the opposite. They would look at you as having had the experience, especially if you are a flight surgeon.

In regard to stay or go, the prior posts are well written and detailed. I am in a low paying specialty with few deployments, had a long commitment, and the GI Bill for my child pushed me to stay. Now her college bills are paid, I just have to hold my nose, grit my teeth and make it 4 more years. Also, in regards to academia paying college costs for your kids, I asked this during my civilian fellowship and the attendings burst out laughing and said hell no; school specific apparently.

 

[IlDestriero]

Also, in regards to academia paying college costs for your kids, I asked this during my civilian fellowship and the attendings burst out laughing and said hell no; school specific apparently.

I interviewed for several faculty positions all over the country, actual faculty of the School of Medicine, not some affiliated or adjunct faculty position. Tuition benefits (reimbursement or tuition waver) for your children are a standard faculty benefit offered by the University. They are very variable though, from being limited to the state system schools only (ie. Only UC or UT schools) to any accredited school anywhere in the country. They frequently also have (more limited) benefits for you and your spouse as well. It would be surprising to me that a University did not offer this benefit, because it's a significant recruitment and retention tool for the non clinical faculty that make a fraction of a physician's salary, and is commonly available elsewhere. I have many family and friends who are/were university faculty, and assure you that it is a standard benefit and has been for a long time.
I'm guessing that your fellowship faculty were either employed by the hospital or a PP group with an academic affiliation/title vs University Faculty employed by the University. Otherwise the university will find itself losing competitive faculty candidates (with families) to other universities. Even a partial tuition waver adds up to a lot of coin if you're looking at 2 or 3 kids. The well endowed private universities seem to offer the most generous programs.
Where I am currently working, there are few "faculty" that I am aware of that are not employees of the University and do not have faculty titles for various reasons. They have different benefits packages that likely do not have any tuition benefits.
YMMV.

 

[colbgw02]

If one was to do an internship straight to an operational slot, without residency, would it decrease the potential for brigade surgeon assignments/deployments later?

No just the opposite. They would look at you as having had the experience, especially if you are a flight surgeon.

I don't think it's as straightforward as this. It's considered a bad career move to do two of the same field surgeon assignments. So, if you happened to be assigned as a brigade surgeon as a GMO (rare, but it happens), then it looks bad on your ORB to do another tour later on. The Army won't want to mismanage your career in this manner, which is crazy considering they have no problem wasting a highly trained specialist in administrative purgatory. It's disturbing, perverse logic.

Of course, most GMOs are filling battalion surgeon, or equivalent, spots, so doing a brigade surgeon tour later on shows "progression". That's where your consultant - or whoever is making these personnel decisions - plays a huge role. My specialty's consultant seems to have sought out people with no prior operational time to fill the BDE surgeon quota, even if that operational time was outside of the medical corps. However, I'm sure the rules are different in specialties where field surgeon assignments are more commonplace.