Surgery through HPSP

[ducom]

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Hi,

I'm planning to join HPSP this year, either through the Navy or Air Force. These are the two branches that have contacted me so far, I haven't really considered the Army. I am still unsure as to whether I want to do general surgery or a subspecialty (my top two are thoracic and neurosurgery), but I want to have options when I apply to residency. I hope that I will have a better idea after meeting with some more surgeons and doing my clerkship in surgery. For those of you military surgeons or otherwise:

Is one branch better than the other in terms of surgical options?

I don't see thoracic surgery listed anywhere for the Navy - is that just temporary? Is it offered as a fellowship?

Are there more spots usually open in one of the branches?

I really would like to be near the coast, so I'm leaning toward the Navy. However, I'd like to have career options open and not limited to a decision I make now, so I want to choose wisely. This is of course assuming I get both scholarships. Thanks for the help in advance.

 

[IgD]

AFAIK, there are hardly any neuro or CT surgeons in the Navy. I think all the training is done out service. Your best bet would probably be to come in through the FAP program or just join after you graduate.

 

[ducom]

I really want to get involved earlier on, and the benefit of HPSP during med school will let me focus more than if with FAP. Is there a reason for one branch to have CT and neuro and the other not to?

 

[colbgw02]

First, you need to understand the training system. CT surgery is a sub-specialty that will require a residency in general surgery followed by a fellowship. Neurosurgery is its own residency. That may explain why you're not seeing any CT surgery "slots".

IIRC, there is a single military residency slot for neurosurgery. That's for all services, but people do get deferred into the civilian match for training. I've met 6 Army neurosurgeons since coming on active duty, so there are at least that many out there. For cardiothoracic surgery, you'd be applying for general surgery slots, of which there are quite a few in the Army. I have zero information about the availability or competitiveness of a CT fellowship.

I'm not a surgeon, but there seems to be significant concerns about case load and skill maintenance. Those concerns seem to be voiced more loudly by Air Force and Navy surgeons. At my medcen, the Army neurosurgeons and CT surgeons have plenty of work, but I can't speak to how representative that is across military medicine or even across Army medicine.

 

[ducom]

That's much clearer now, thanks. I'm still trying to get a list of residencies from the Air Force, because I could have sworn that it had Thoracic listed. Either way, does a fellowship count toward time served back (payback time)? I would not mind doing a two year fellowship in CT and then working as a CT attending for two years. Otherwise, how reasonable is it to do general surgery in residency, work as a military attending for 4 years (commitment time) and then do a civilian fellowship? What is the pay for a civilian CT fellow, for example (or other subspecialty fellow)? Is it about that of a general surgery attending?

 

[Galo]

That's much clearer now, thanks. I'm still trying to get a list of residencies from the Air Force, because I could have sworn that it had Thoracic listed. Either way, does a fellowship count toward time served back (payback time)? I would not mind doing a two year fellowship in CT and then working as a CT attending for two years. Otherwise, how reasonable is it to do general surgery in residency, work as a military attending for 4 years (commitment time) and then do a civilian fellowship? What is the pay for a civilian CT fellow, for example (or other subspecialty fellow)? Is it about that of a general surgery attending?

I shudder after reading your questions because you have some clear misconceptions that you really need to know well before you continue down a path that will lead you to misery, if your goal if to be a surgeon.

I would start out by suggesting that you spend more than a few hours looking through the stickies, especially the GME one, and then PM me for more clarification. Its a good idea to talk to current active duty people, but watch for the spin, especially from senior personnel.

I would STRONGLY recommend you DO NOT sign up for HPSP till you really know what can happen to you, and what is happening now in military medicine. My experience comes from 6 yrs active duty as a general surgeon in the AF.

 

[The White Coat Investor]

I shudder after reading your questions because you have some clear misconceptions that you really need to know well before you continue down a path that will lead you to misery, if your goal if to be a surgeon.

I laughed after reading the OP. Then I read it to my wife. She laughed and said I hope that guy isn't signing up if that is all he knows about HPSP.

She also says if your goal is to "have options" the military isn't the way you should do it.

Here's my two cents:

1) No reason to consider the Navy and AF and not the Army. Your life is awfully similar in all of them for all intensive purposes.

2) There is a really good chance you won't be interested in surgery, much less neuro or CT by the time you've been through med school. Bear that in mind.

3) The military is a HORRIBLE financial deal for a surgical subspecialist.

4) If having options is important to you, don't join the military. Seriously.

5) You won't be more involved earlier on by doing HPSP instead of FAP. You'll go to boot camp, do a "med school rotation" (med students aren't really very involved in true military medicine) and perhaps do a military residency, where you WOULD be more involved than doing a civilian residency, at the expense of having a low caseload (very important for a surgeon) and the military hassle on top of 80+ hour work weeks. This involvement isn't necessarily a good thing.

6) Thoracic surgery fellowship may not be offered the year you want it. You may not be allowed to do a fellowship (probably won't) without doing a tour as a general surgeon (and maybe even a battalion surgeon AKA GMO) first

7) The scholarships are in no way, shape, or form competitive. Navy didn't even fill all theirs last year.

8) If you care about where you live, don't join the military. I find I care now a lot more than I did as a pre-med, and I'm stuck living somewhere I don't want to (it IS near a coast though.)

9) If you don't want to be limited by a decision you make now, wait for FAP or even a direct accession. You'll get better training and better know how to evaluate the military option. There is a reason very few people come into the military through direct accessions.

 

[ducom]

ADMD, thanks for your reply. I'm not jumping into anything just yet - just getting my paperwork through so I have the scholarship option if I wish to take it, as I learn as much as possible in the meantime.

I have run the numbers for general surgery and with the current numbers and considering my school's cost, a reasonable rate of return on investments, etc., I will come out on top (IF I do general surgery). If I decide to do a surgical subspecialty, I understand that I'll be making far less as a military surgeon. However, I'd much rather do something interesting and serve my country since I'll be making enough money to live well later on as a civilian surgeon.

I've considered FAP, and what I mean by getting involved earlier on is also partially based on the peace of mind I get by taking the scholarship - not having to worry about being stingy in med school (I know there have been complaints that the stipend is not enough, but I have calculated a comfortable living expense under that). Essentially what I want is a military residency with some flexibility - which isn't realistic. While I hope to have some freedom and choice in terms of subspecializing and such, I really want to do something different and live and visit places that I'll never otherwise go.

I came to Philadelphia for a BS/MD program, knowing that I could have gone to a better school but not had the guaranteed spot in medical school; I have enjoyed myself and I'm glad I left California and did something different. Being a military doctor, I'm hoping, will give me a unique set of experiences that I would otherwise not have. I'm sure that it will be frustrating and that paperwork will be annoying, etc, but the previous considerations outweigh it for me.

What I am concerned with is case load. I have heard this before, but I'd like to know some more about it. How bad is skill atrophy as a result of low case load? What are case loads for military surgeons like (numbers)?

If you could, please answer my question about civilian fellowships after active duty payback? Is this a feasible option? What are the numbers like?

I appreciate the critique, because it helps put the brakes on for me so I don't make a quick decision. Thanks!

 

[IgD]

In the Navy you would:
Do a 2-3 year GMO tour
Complete a general surgery residency
Do a multi-year "utilization tour"
Complete a CT surgery fellowship
Do a fellowship "utilization tour"

Then retire because it will take you 20 years to get all that done🙂

 

[IgD]

What I am concerned with is case load. I have heard this before, but I'd like to know some more about it. How bad is skill atrophy as a result of low case load? What are case loads for military surgeons like (numbers)?

Can you ask the RRC about the case load information? I suspect military residents have to track their case numbers on the RRC website.

 

[Perrotfish]

Since no one has mentioned it, are you aware of how commitments work in the military? It's not as simple as 'how long you went to medical school', though the recruiter will make you think that it is. If you want neurosurgery in the Navy, and actually get it, your timeline would probably be:

1 year internship
2 year GMO
7 year post-GMO residency (I got 7 years because I'm not sure that many neurosurgery programs would give you credit for your military Intern year which you did 2 years ago, so you would may need to repeat that).

and now, 10 years later, you have a 7 year commitement to the military, because your obligation from the residency is equal to the time you spent in residency.

Just an FYI.

 

[ducom]

Perrotfish,

Thanks for that tip. There seems to be a lot of conflicting evidence over extra commitment time for longer residencies. Neurosurgery is a 6 year residency after FYGME (internship). GMO billets will be converted by then so the two years in the middle should not be an issue. Are there any official military documents stating how you accumulate extra years with the longer residency? I've been searching but I can't find it, even though it's been referred to in SDN discussions.

How about the possibility for a civilian residency deferment? How common are they for surgery? This would take care of the case load to some extent, right?

That certainly changes things though!

 

[psychbender]

GMO billets will be converted by then so the two years in the middle should not be an issue.

I just have to laugh a bit at this statement. GMO billets are not going anywhere. When you have a closed medical system like the military, you have to have someplace to send people who can't be trained in their desired specialty. If the Navy/Army/Air Force thinks that it only needs X people for a given specialty, and X+5 people apply...then 5 people will simply not train in that specialty, and have to do something else. For those that will not accept any other training, there will always be the 'out' of GMO for the duration of their payback, or until they accrue enough points in the GME system to get one of those coveted spots. Even in the Army, which "got rid of GMOs" nearly a decade ago, there are a startling number of internship-only trained physicians in service.

Are there any official military documents stating how you accumulate extra years with the longer residency? I've been searching but I can't find it, even though it's been referred to in SDN discussions.

How about the possibility for a civilian residency deferment? How common are they for surgery? This would take care of the case load to some extent, right?

That certainly changes things though!

Ok, here's the basic rundown for you. Your initial payback for HPSP is equal to the length of your scholarship. So, your basic 4-year scholarship incurs 4 years of Active Duty Service Obligation (and 4 years of IRR, but I'll get to that later). You also incur a service obligation based on the length of your residency, minus internship (PGY-1). These two service obligations are paid back concurrently, such that your total ADSO is equal to the greater of the two numbers (either GME years-1, or med school scholarship years). Note, these examples and discussions here all assume you do a military residency, not civilian deferred (or sponsored). Also, I'm going to stay consistent with my choice of residency and fellowship for the examples, so the differences of the various paths are more readily evident.

Example 1: You take a 4-year scholarship, incuring a 4 year ADSO. Let's say that you match to Internal Medicine, which has 2 years of GME after PGY-1. Since 4 > 2, you have a total of 4 years of ADSO after residency. You will have spent 7 years in the military (1 + 2 + 4).

Example 2: You take a 4-year scholarship, incuring a 4 year ADSO. You match to Neurosurgery in the military (6 years, post PGY-1). Since 6 > 4, your total ADSO after residency is 6 years. You will have spent 13 years in the military by the time you are finished with your pay-back (1 + 6 + 6).

Now for IRR:
Your contract, regardless of the number of years that you get school paid for, is 8 years (4 years Active Duty, 4 years Individual Ready Reserve). If you finish your ADSO, and have spent less than 8 years Active Duty in the military, then the remaining time in your contract is served IRR. So, in above Example 1, you would get out of the active duty military, and still have one final year of IRR before your contract was up. In Example 2, your total active duty time exceeded your 8-year contract, so you have no further IRR, and are done once you finish your ADSO.

Fellowships:
These, I think, are handled a little bit differently by the different services. In the Army, you incur an additional service obligation equal to the length of fellowship training, with a minimum of 2 years. So, if you decide to do a CCM fellowship after an Anesthesiology residency (1 year fellowship), you would incur a 2 year service obligation (1 < 2). However, if you decided to do a Pulm/CCM fellowship (3 years) after an IM residency, then you would incur a 3 year service obligation (3 > 2). Now we get to the tricky part. This service obligation is added to your previous training obligation, and compared to your scholarship obligation. If you are able to train straight through, then whichever is greater, is your total ADSO.

Example 3: You're on a 4-year scholarship, decide to do IM, then Pulm/CCM, and manage to go straight through, without having to do a utilization tour. Your ADSO from residency is 2 years, plus 3 years from Pulm/CCM, for a total ADSO from training of 5 years. Since 5 > 4, you owe 5 years after fellowship training, and will have spent a total of 11 years in the military (1 + 2 + 3 + 5).

However, if you have to do a utilization tour between residency and fellowship, it gets interesting. The training obligation incurred is compared to your remaining service obligation, and the greater of the two becomes your new obligation.

Example 4: Same 4-year scholarship, same IM residency, but you had to do a 2 year utlization tour, before being allowed to start your Pulm/CCM fellowship. You initially had a 4-year ADSO after residency, but managed to pay back 2 of it with your utilization tour, leaving just 2 years. Pulm/CCM is a 3 year fellowship, and 3 > 2, so your new ADSO is 3 years after completion of fellowship training. You will have spent 11 years in the military (1 + 2 + 2 + 3 + 3).

Now, for IGD's example:
You started with a 4-year HPSP scholarship, weren't sure of what you wanted to do, so did an internship, followed by a 2-year GMO tour before starting your IM residency. The GMO tour reduced your initial ADSO from 4 to 2 years. The additional 2 years from the IM residency did not incur anything extra, so your ADSO remains 2 years. For some reason, you are not allowed to go straight into fellowship training, and must complete a 2 year utilization tour. At the end of this tour, your obligation to the Army has been filled. However, you decide to stay in, as they have promised you a coveted fellowship spot. The fellowship is 3 years, so you incur another 3 year ADSO. After this is paid back, you will have been in the military for 13 years (1 + 2 + 2 + 2 + 3 + 3).

Ok...one last example, and this one is more relevant to what you want.

Example 5:
You take a 4-year HPSP scholarship, then do General Surgery. I think all the GS residencies in the military now have a mandatory research year, so they are 5 years in length, after internship. So, you incur a 5 year ADSO from residency. You then do a 2 year utilization tour before being allowed to pursue CT surgery training (let's assume its at NCC, rather than civilian deferred or sponsored). You then complete the fellowship, and still owe 3 years ADSO (five years ADSO - 2 year payback > 2 years from fellowship). You will have spent 13 years in the military after you finish all training and service obligations (1 + 5 + 2 + 2 + 3).




I'm going to leave the issues of civilian deferrment and payback for someone else...I need to get to bed.

 

[46&2]

As a military surgery resident, my big piece of advice is this: figure out if you'd rather be a surgeon or a military officer.

While they're not mutually exclusive, those two careers will collide.

1. Do not take HPSP unless you're prepared to be a GMO / Flight Surgeon. They're a lot of solid applicants to General Surgery who get shoved into 2-3 years of GMO. And no, if you take a military residency afterwards, it does not help with payback.

2. 'Case load'. Ironically, the more subspecialized you are, the more potential for your unique skills to be underutilized. Some subspecialty surgeons may do one case a week at some bases (and not utilizing their specialty training).
The problem with case load in the Air Force got so bad that the military programs had to combine with local civilian residencies. 60-90% of your time is spent civilian. Can't speak much for the other branches, but you're not going to find much Pediatric, Burn, Cardiothoracic, Transplant, etc in the military. Prior to combining, AF residents would do maybe 700-800 cases prior to graduation. That's at the bottom for civilian residencies (it's now 750 cases minimum).
Post residency, to give a concrete example, you may do 90 cases in a 7-9 month span at a domestic base. In Korea, maybe 200 or so a year, but that's counting everything including colonoscopies (if I recall collectly) and vasectomies (general surgeons learn to do other procedures). When you get deployed for 3-6 months, those numbers skyrocket.
Since not much is going on at domestic bases, that will impact your OR numbers when you do rotate on base. I did more cases on one 24 hr call over the weekend at a private hospital than in a week on base (and that includes 2-3 overnight calls). Many of the cases on base are hernias, lap choles, etc. Great cases for your first 2-3 years. But as time goes on, you're going to want to see/treat some bad necrotizing pancreatitis, be able to do a true ex-lap and do a sound oncologic hemicolectomy if need be, repair an SVC injury, etc. Those cases are hard to find in a young healthy populace with TriCare referrals sapping away the elders.
A few of the surgeons will work at civilian hospitals on their own time to keep their skills up. Remember that.

3. Don't go in expecting a fellowship much less a residency. There was an uptick this year in fellowship offerings, partly as a way to retain more general surgeons. If you want do Trauma/Critical Care, you should be able to do that. But everything else I would call a crapshoot, depending on random availability and competition. If you get a fellowship, there's a good chance it will have to be civilian, and yes, many times that will add to your commitment.

4. CT surgery is not something to take lightly. If you want to be a CT surgeon, your only choice is to be excellent. You want the best training possible, and you need to keep working.

5. Surgery can be the most thrilling and devastating experience you'll ever have. I can't think of being more 'involved' than having a 70 year old guy come in with an ascending aortic rupture in cardiogenic shock. And when you have to tell the family your bowel anastomosis leaked and now mom is dead, well, any medal, interesting experiences, or Powerpoint briefing, becomes bulls***.

6. You will not get involved earlier by doing HPSP. Being involved means being deployed. Maybe if you're Plastics or Ortho or something and stationed in San Antonio or the National Military Medical Center, you'll get to help on some transfers from overseas. But otherwise, the acute action is at Bagram and Balad (and then Landstuhl).

7. If you want flexibility, do FAP. If you want to have a surgery residency secured before joining the military, do FAP. If you want to get deployed, you can do FAP. If you want more time to find a honey to make you not want to get deployed, do FAP.

If you want to hunt terrorists, do that, become a doctor later. If you want to treat soldiers, you'll have to be patient either way.

 

[The White Coat Investor]

I have run the numbers for general surgery and with the current numbers and considering my school's cost, a reasonable rate of return on investments, etc., I will come out on top (IF I do general surgery). If I decide to do a surgical subspecialty, I understand that I'll be making far less as a military surgeon. However, I'd much rather do something interesting and serve my country since I'll be making enough money to live well later on as a civilian surgeon.
Being a military doctor, I'm hoping, will give me a unique set of experiences that I would otherwise not have. I'm sure that it will be frustrating and that paperwork will be annoying, etc, but the previous considerations outweigh it for me.

You sound a lot like me in 1998. I did the HPSP scholarship because I love my country, wanted to have an adventure, and thought it would be nice not to be so poor I had to donate plasma to eat anymore. I didn't donate plasma in med school. I haven't had much of an adventure. I still love my country. There are an awful lot of things I dislike about my job. I dislike where I live. I had to take a second job to keep up my skills. I double my monthly pay by working 4 days a month at this job. I'm considering passing up 1/4 of my pay my last year just to get out 3 months earlier.

Oh, one more thing, I just ran into future you on base. He said to pass along two messages to you: 1) Don't bet on the cubbies in 2013 and 2) Don't do HPSP.

Good luck with your decision.

 

[ducom]

Thanks so much for the last three posts. I really think those examples of how time accumulates should be a Sticky! As for the case load, I'm really close to thinking this may be a dealbreaker for me, even if it is on the rise. My primary goal is to be a surgeon, and a good one. I would love to be able to go on an adventure and serve my country on my path to this, but I don't want to sacrifice that goal. I'm flexible to some extent on time (I'm a year ahead already, and will graduate med school at 25), but not quality of training. It seems to me that this is a problem even with FAP? Agreed, it's a HUGE problem if you don't get enough cases in residencies, but it's still a problem when you're an attending.

I think now that subspecializing in the military system would be a bad move, but how about doing general surgery, working off my ADSO, and then going for a civilian fellowship to specialize? This has been partially addressed, but if any of you have some anecdotes on people who did this or faced this situation, that'd be great. Thanks again for all the guidance.

 

[edmadison]

GMO billets will be converted by then so the two years in the middle should not be an issue.

This is what they were saying before I went to medical school (I'm an attending now). I wouldn't count on this changing. I think that several issues brought up are so important, I will reiterate them based on my experiences

You will not get a deferment for general surgery. You might get one for neurosurgery, but that is unlikely. HPSP recruitment is down and there are residency slots that must be filled to keep the programs open. In such an environment deferments will be very rare

Surgical case load as a resident will be low. This is actually one of the factors that led me away from ortho in the Army. One of my ortho attendings told me that when he started fellowship (following an army ortho residency) he had 1/3 the number of cases as a resident that his co-fellow had.

Attending case load -- others can and have told you this is a huge factor. What I can tell you is this: The military doesn't care about your skill retention. You are a line on an excel spread sheet to them. I graduated from peds residency in 2007 and have yet to touch a child. There may be a 2 year gap before I get to do pediatrics again and that will likely be all clinic and nursery (no inpatient). Do you think my pediatric skills have deteriorated?

Control. This is my biggest issue. If you sign-up for HPSP you sign a large chunk of your life away. You loose the ability to walk away from a bad situation. In the military, if you have a terrible boss you can't leave. If they double your workload in the clinic you can't leave. I have a friend who is a pediatrician at an Army base that is staffed at 1/3 their normal level. The command's solution is for them to work longer hours. I've said this before, I'm not terribly dissatisfied, but I want to move on. I would gladly repay every penny of my HPSP scholarship for just 1 year off my service obligation. That's how much having control over my life means to me.

Ed

 

[Perrotfish]

Thanks so much for the last three posts. I really think those examples of how time accumulates should be a Sticky! As for the case load, I'm really close to thinking this may be a dealbreaker for me, even if it is on the rise. My primary goal is to be a surgeon, and a good one. I would love to be able to go on an adventure and serve my country on my path to this, but I don't want to sacrifice that goal. I'm flexible to some extent on time (I'm a year ahead already, and will graduate med school at 25), but not quality of training. It seems to me that this is a problem even with FAP? Agreed, it's a HUGE problem if you don't get enough cases in residencies, but it's still a problem when you're an attending.

Just a thought: keep in mind that your commitment to FAP is based on the length of time you accept FAP for, not your length of residency. Specificially length of FAP commitment = length of FAP benifits + 1 year. A 3 year commitment might be more manageable, in terms of skill atrophy, than a 7 year commitment. Also I understand that many commands allow attendings to moonlight, to prevent skill atrophy (though I know this is not something you can rely on)

Thought 2: If you do those 3 years I think you'll be eligible for GI bill benifits, which can translate to a rather large increase in your pay during fellowship. So one possible timeline is:

2 years FAP benifits during residency
3 years Active Duty service
Now you finish, do your CT fellowship as a civilian, and get a significant boost to your pay from the GI bill.

Keep in mind that this path involves you being in IRR for 5 years during fellowship. They haven't started calling up docs from the IRR yet, but if we keep making cross-border strikes into Syria that might change.

 

[ducom]

You will not get a deferment for general surgery. You might get one for neurosurgery, but that is unlikely. HPSP recruitment is down and there are residency slots that must be filled to keep the programs open. In such an environment deferments will be very rare

If it is rare to get a deferment for general surgery, does that also mean it's more likely I will go straight through?

Will a smaller number of residents increase case load per resident?

(I'm guessing the answer is no, but just checking).

 

[TraumaSurg2B]

Hi, I'm also looking into the military and HPSP program to get through medical school, but now that's not seeming like such a good idea after the forum posts I have read so far! I'm planning to go into Trauma/Critical Care Surgery, which requires both a residency and fellowship, and from what I've heard, fellowships are somewhat difficult to obtain if I'm in the HPSP program. But if Trauma Surgery is perhaps a field which would be useful to the military, what are the chances that I could get a fellowship before being deployed on active duty?

Another military/medical related question I have is about the Uniformed University of the Health Sciences. This seems to be the same sort of deal as the HPSP but at a military school. Does anyone know about that school, particularly residency and fellowship opportunities after graduation, and if they would recommend attending?

Thanks for any help, I appreciate it!

 

[psychbender]

If it is rare to get a deferment for general surgery, does that also mean it's more likely I will go straight

Not necessarily. It just means that if you are not picked up for one of the military residency spots, then you are unlikely to be trained as a General Surgeon, period. Remember, when it comes to specialty training, its the needs of the Army/Navy/Air Force first, your needs second. So, if they anticipate that 20 General Surgeons are needed, and they have the capacity to train 24, then there will be only 20 spots offered to PGY-1s (I think GS is one specialty where you still have to reapply during PGY-1 year...if not, then substitute MS4 for PGY-1).

If they anticipate that they will need 30, but only have the capability of training 24, then 24 will be trained in-house, and 6 will be granted civilian deferrments. Now, again, let's say that there are 36 people applying for General Surgery. In the first example, 16 are told to find something else (given GMO assignments, offered other residencies, etc). It may seem unfair, but why would the military train more people than they need in a given specialty?

Of course, their precognition may be way off, and they may end up needing far more than they initially anticipated...but that's what contractors or sudden retention bonuses (see Air Force) are apparently for.

I have a friend who is a pediatrician at an Army base that is staffed at 1/3 their normal level.

Hmmm, that sounds somewhat familiar. Your friend wouldn't happen to be at Womack, would he?

 

[psychbender]

Another military/medical related question I have is about the Uniformed University of the Health Sciences. This seems to be the same sort of deal as the HPSP but at a military school. Does anyone know about that school, particularly residency and fellowship opportunities after graduation, and if they would recommend attending?

Thanks for any help, I appreciate it!

I have several friends at USUHS, and many of my residents/interns/attendings went there. The deal they get is similar to HPSP, with a few major differences. First off, they are paid as active duty officers for the duration of medical school (rather than the stipend given to HPSP students). Second, the service obligation is increased from 4 (or 3, for three year HPSP) to 7 years, plus IRR (I think still 4 years, there). Additionally, those going to USUHS are obligated to do a military residency (cannot receive civilian deferrment). Now, since most HPSPers can't get deferrment right now, either, this part is probably not all that much of a difference.

Most of the reviews I have heard regarding the school have been positive, and it definitely seems to offer some extra connections in military medicine. If you are planning on making the military a career, or think you will do a long residency, then USUHS may be a good deal for you. If you just want to do your time and get out, then you might want to look at HPSP, instead (or, just not join in the first place). I'd suggest looking through the USUHS thread on this forum, and PMing some current and former students that still post here.

 

[mitchconnie]

As a military surgery resident, my big piece of advice is this: figure out if you'd rather be a surgeon or a military officer.

While they're not mutually exclusive, those two careers will collide.

46&2,

That was truly excellent advice for the budding surgeon. I wholeheartedly concur. Prospective HPSPers thinking about surgery should have that post tatooed on their forearm so they can read it again and again.

 

[Perrotfish]

So, if they anticipate that 20 General Surgeons are needed, and they have the capacity to train 24, then there will be only 20 spots offered to PGY-1s (I think GS is one specialty where you still have to reapply during PGY-1 year...if not, then substitute MS4 for PGY-1).

I disagree with this, at least from what I know of the process (which is admittedly second hand). My impression was that residencies that don't fill lose accreditation, therefore generally the priority of the services has been to keep their residencies filled even if they're not projecting a sufficent need. So you should be able to look at the number of residency slots offered in a specialty in a given year as a good estimate for the minimum number of HPSP/USUHS/post-GMO candidates that are going to get that specialty each year.

I remember this coming up before as a reason to choose Army and yet another reason to rule out the Air Force (Navy once again in the middle): AF has the lowest ratio of military residencies to total residencies and therefore has the biggest year to year swings in terms of competition for a given specialty.

Just a thought, correct me if I'm wrong.

 

[psychbender]

The number of spots a given program has can vary from year to year. From the way I understand it (may very well be wrong, as well), programs are accredited for up to a certain number of positions, but may choose to only fill some of them, based on projected need (or number of applicants).

Besides, there are plenty of residencies that don't fill to capacity in the civilian world, but they don't seem to be losing accreditation every year. Maybe a residency that was accredited for 10 spots and consistently only filled 5 might be re-accredited for fewer spots; I don't know.

I'm sure residencies do want to stay filled (more residents to do the work), but if there are not enough billets for board-certified physicians in that specialty to keep up with the increased supply, then the supply of fresh specialists would have to be decreased.