Thinking about HPSP/USUHS? READ THIS.

[militaryPHYS]

Nobody is dictating anything, especially not me. I’ve been a moderator for about 2 minutes and still don’t even know what I’m doing.

When I say what I think about how this forum could be more high yield and stay out of the rabbit holes, that is purely as a fellow staff milmed physician. Not a forum moderator. My moderator job stops at dealing with foul language and blatant ignorance/hate.

You guys keep me entertained and offer valid points. I welcome the counter discussion up and to the point of constant revolving around same topic, personal jabs, etc.


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[militaryPHYS]

@militaryPHYS you have a 10 year badge. Who did you used to be?

I’m not trying to change anyone. I don’t have an agenda. I’m also not interested in being lectured and I will share my point of view as long as @Lee decides I’m welcome.

I dont even remember my old screen name. I was a premed drifter who came to SDN to learn about MilMed. Lee was able to find the account and merge it based on 1 or 2 email addresses I provided.

Very confused on why the regulars are so defensive now that there is a mod designator under my picture. SDN asked me to come on to help their new initiatives for the year which is to make the site overall less negative. I’ve changed nothing about the milmed forum, and like I just explained, my “lectures” on how we can improve are not instructions, just suggestions as a fellow military physician. I was saying the same lame stuff before I became a moderator. You don’t have to read them. Most of you make it clear you disagree with everything I say and don’t read my posts anyway, so who cares what I post?

 

[californiasushi]

Some of the numbers being thrown around (or at least rumored to be) seem quite drastic and it's hard to believe that attrition will get them where they need to be. Is there any chance they might release people from their commitment early?

It was mentioned that non-bucket 1 sub-specialists might become GMO's or go into admin positions, could surgical specialists (urology, ENT, ophtho) end up doing this as well?

 

[elderjack21]

It's honestly so discouraging to hear all of this because I am very interested in military medicine. I know that I must obtain certain scores to be competitive for EM or general surgery which I know I will obtain, but seeing as it seems that these specialties are probably more competitive than civilian it worries me a lot. I just don't think I am willing to go into the military with the mindset of "military first medicine second". I still have wishes and desires and those seem to reside in either EM or general surgery so I don't want to be confined in that aspect. It's so frustrating.

If you choose to sign up for military medicine after reading all the truth that is shared in these forms about military medicine....you deserve whatever the military has in store for your future. Don't sign up unless you are absolutely interested in being a military officer. Patriotism isn't even enough now.

 

[elderjack21]

Some of the numbers being thrown around (or at least rumored to be) seem quite drastic and it's hard to believe that attrition will get them where they need to be. Is there any chance they might release people from their commitment early?

It was mentioned that non-bucket 1 sub-specialists might become GMO's or go into admin positions, could surgical specialists (urology, ENT, ophtho) end up doing this as well?

The briefing I went to last week with a GO regarding the way forward was basically... here are all changes that are coming soon...but we don't have any answers on how any of this will play out. They are making it up as they go. Seriously. They are decreasing 5000 medical billets army wide (healthcare providers of all types from MTFs etc... not just physicians, medical service corps and admin command spots as well) and changing these army spots into combat arms and such to increase lethality. DHA will be left to hire civilians to make up the gaps and he said we will refer out many more patients to the network.

What will they do with you once your medical spot is taken away? No answer to that direct question when it was asked. GMO...fill a spot for DHA since they will be short people...golden ticket out of army?... opportunity to join hospital admin ranks? Take away bonuses for most specialties and make staying in so terrible that attrition takes care of you?

Maybe just as likely, someone has enough courage and rank to stand up and say, we haven't thought this through all the way and need to hit pause on the rapid changes we are proposing.

 

[DrMetal]

I will share my point of view as long as @Lee decides I’m welcome.[/USER]

And as long as you don't rag on Neurologists, you'll be fine here.

 

[notdeadyet]

You can always join the reserves or even AD after you do a .civ residency. I don't know why young applicants agonize so much about this. Most rational voices here are saying- don't commit yourself for a minimum of 5 years AD when you are a college senior. There are multiple paths to join...HPSP esp. in the current climate is the riskiest and probably the worst.

^^^ This.

One of the challenges new applicants are going to face is that a large percentage of current .mil physicians came via either HPSP or USUHS, so when applicants are looking into military service, they equate it with these two routes and the necessity of a military residency.

It's not HPSP or bust.

If applicants are concerned about what they read here, they can always go FAP during residency. This way they will get into the highest quality residency they can achieve without being limited by what the military residencies offer (an incredibly small n). Though with upcoming changes, it'll be interesting to see FAP phased out for many/most specialties?

They can also go Direct Accession. The bonus there for most specialties covers the average debt for most medical students. If the changes people are discussing goes through, I doubt very much Direct Accession will go away, as DA will be one of the final ways to cope with the presumed decrease in HPSP recruitment.

And what if DA or FAP is not offered for the specialty an applicant ultimately winds up in? Then you dodged a bullet, as you wouldn't have been able to practice in your specialty of choice. And for all the moaning about loan repayment (and by the way, in the army reserve component, you can pay off $240K through 6 years of reserve time), if you electively live with the same discipline and sacrifice for your early civilian years that you would have in your military career and/or do the same moonlighting as a civilian that your .mil counterparts do, you'll have your loans paid down mightily very quickly.

 

[Perrotfish]

^^^ This.

One of the challenges new applicants are going to face is that a large percentage of current .mil physicians came via either HPSP or USUHS, so when applicants are looking into military service, they equate it with these two routes and the necessity of a military residency.

It's not HPSP or bust.
.

It kinda is, though. I have never met any physician who joined via DA, HPLRP, or FAP. Seriously, not a single one. And there's a reason why: everything other than HPSP a financially stupid way to join the military. FAP offers 135,000 taxed dollars, during a 3 year residency, in exchange for a 4 year commitment. HPLRP offers 160K of taxed loan forgiveness after residency. I can't find the DA bonus list but I am willing to bet it is similarly bad. None of these programs would cover even half of the cost of attendance for a public school, let alone a private one. HPSP offers what is basically the FAP bonus during residency + all your tuition and living expenses during medical school. Its not even close.

 

[AvoidMilitaryMedicine]

wow wow wow, can you clarify on this. I know service is required so that's not a downside to me. Military family so I know how it works too. Now, if I know I want nothing to do with bucket II then what's the problem? Even if I simply don't match, I would have very little problem being a GMO for the entire 4 years. (<- this is predicated on the 4 years not having a significant negative impact on civilian residency chances, as I have gathered). SO, what's the issue for someone like me?

In my opinion, going GMO after 4 years of medical school + 1 year of internship is the definition of "hustling backwards."

All that time learning, training to be a glorified PA/NP many of whom can get their degrees online with a 100 hours of YouTube training (I'm only half joking) is not a smart move.

More importantly, as a GMO, it'll be difficult to sustain the momentum from all the medical training and education when the average acuity of the medical problems you face is so low and monotonous. That's not to say you won't get to do some 'cool,' Army stuff -- but is that why you went to medical school?

As physicians, we are hard-wired to some extent to be all about, 'delayed gratification,' i.e., put off family, friends, income, etc. because 'one day,' it will 'all pay off.' But for many doctors, it never does (i.e., highest divorce and suicide rates among all professions). In a lot of ways we stack the deck against ourselves, why make it even harder?

Generally speaking, why would anyone want to put off for another 3-7 years the culmination of all their hard work and training doing a job (GMO) created by a government bureaucrat to plug holes in a sinking ship. To me, sacrificing more years of development, professional fulfillment, income and TIME to be a GMO doesn't make sense to me when AT BEST, a mildly competent college graduate with 30 hours of YouTube training could handle that job just fine. I also think the military vastly misuses docs in division/brigade surgeon billets, but that's another story for another day.

I don't get a chance to check this thread often, but I'm happy that it's creating discussion. In my personal opinion, a lot of the recent developments in DHA and AMEDD were conducted in a less than transparent way and I wanted to warn the next generation of docs coming after me about what's in store for them.

If anyone has any burning questions, feel free to msg me -- I'll get back to you as soon as I can.

... back to work...

 

[HighPriest]

It kinda is, though. I have never met any physician who joined via DA, HPLRP, or FAP. Seriously, not a single one. And there's a reason why: everything other than HPSP a financially stupid way to join the military. FAP offers 135,000 taxed dollars, during a 3 year residency, in exchange for a 4 year commitment. HPLRP offers 160K of taxed loan forgiveness after residency. I can't find the DA bonus list but I am willing to bet it is similarly bad. None of these programs would cover even half of the cost of attendance for a public school, let alone a private one. HPSP offers what is basically the FAP bonus during residency + all your tuition and living expenses during medical school. Its not even close.

Good information.
From a purely financial standpoint, HPSP is better. I think the message is more accurate for the students writing to say "I really want to specialize in "X," and I don't know how the upcoming changes will effect that, but I also want to serve in the military. If you can't see yourself doing anything other than derm, or whatever, but you really want to serve then HPSP isn't the only option. In those cases, it would probably be better to wait. Yeah, you get a worse financial deal, but on the other hand you have a higher chance of getting your residency. Assuming your scores allow it. Then, if you feel like it makes financial sense, you can do FAP. Or even work in the private sector a while, pay down your loans with your boatload of cash, and then join. If it's really about joining and serving, then delaying it is an option for more traditional students. If it's mostly about financials, then it's a harder decision. But, clearly, there are other options because most people don't join the military to pay for medical school.

 

[AvoidMilitaryMedicine]

I'm a, "bucket 1", specialty, and I would NOT recommend HPSP/USUHS. Bucket 1 doesn't mean you get special treatment or more opportunities to be a doc. It means you won't be a hospital asset and will belong to a FORSCOM unit, which effectively makes you the ***** of some O3 commander who knows absolutely nothing about medicine or being a physician (Yes, even less than the MEDDAC people in charge). Surgical cases scheduled at the MTF that gets to, "borrow", you from the FORSCOM unit? Tough ****, your commander needs his surgeon to go with the unit on a FTX to do an endless amount of meaningless bull****.

Nobody knows how the next few years will play out. It may end up not being so bad. More likely, it'll be an epic cluster****. I wouldn't chance it.

I will tell you, I've been doing the initial mentoring for 3 docs who just arrived right out of residency or fellowship. I've been here for a few years and am on my way out of the Army. They've all been here less than 6 months and are completely miserable and already counting down the days of their ADSO. I do not envy them. Don't be them.

This sounds almost exactly like the conditions for the docs at my duty station -- and for many of my friends/peers/colleagues across Army MTFs.

 

[Gastrapathy]

The reality is that they can’t recruit doctors. They need to grab people before they are in a position to make an informed decision. So premed recruitment will remain the dominant strategy.

 

[HighPriest]

The reality is that they can’t recruit doctors. They need to grab people before they are in a position to make an informed decision. So premed recruitment will remain the dominant strategy.

No doubt. Just another addition to my list of points. If it really is all about serving your country, as so many students state, then they don't need to be recruited. They'll just finish residency and do FAP, etc.

It's not. They say it is, but it usually isn't. Or at least, it's not as important as they say it is (not compared to the benefits of freedom, pay, and self-determination.)

 

[Detective SnowBucket]

In my opinion, going GMO after 4 years of medical school + 1 year of internship is the definition of "hustling backwards."

All that time learning, training to be a glorified PA/NP many of whom can get their degrees online with a 100 hours of YouTube training (I'm only half joking) is not a smart move.

More importantly, as a GMO, it'll be difficult to sustain the momentum from all the medical training and education when the average acuity of the medical problems you face is so low and monotonous. That's not to say you won't get to do some 'cool,' Army stuff -- but is that why you went to medical school?

As physicians, we are hard-wired to some extent to be all about, 'delayed gratification,' i.e., put off family, friends, income, etc. because 'one day,' it will 'all pay off.' But for many doctors, it never does (i.e., highest divorce and suicide rates among all professions). In a lot of ways we stack the deck against ourselves, why make it even harder?

Generally speaking, why would anyone want to put off for another 3-7 years the culmination of all their hard work and training doing a job (GMO) created by a government bureaucrat to plug holes in a sinking ship. To me, sacrificing more years of development, professional fulfillment, income and TIME to be a GMO doesn't make sense to me when AT BEST, a mildly competent college graduate with 30 hours of YouTube training could handle that job just fine. I also think the military vastly misuses docs in division/brigade surgeon billets, but that's another story for another day.

I don't get a chance to check this thread often, but I'm happy that it's creating discussion. In my personal opinion, a lot of the recent developments in DHA and AMEDD were conducted in a less than transparent way and I wanted to warn the next generation of docs coming after me about what's in store for them.

If anyone has any burning questions, feel free to msg me -- I'll get back to you as soon as I can.

... back to work...

Thanks for the input. I'm obviously no physician, so the closest I've gotten to MilMed has been shadowing. I got to shadow a group of like 15 guys (and gals) in a bucket 1 team and....I didn't see any skill or talent 'waste' there. I was with them for 30-odd hours and they did nothing but operate for the entire time I was there. Sure there was some down time but not a wasteful amount. Was 30 hours not enough to give me an unbiased look, did I only see the good days somehow?
I'm basing my hopes as an aspiring Navy bucket 1'er based on them and I would be fine doing what they were.

 

[Cooperd0g]

It kinda is, though. I have never met any physician who joined via DA, HPLRP, or FAP. Seriously, not a single one. And there's a reason why: everything other than HPSP a financially stupid way to join the military. FAP offers 135,000 taxed dollars, during a 3 year residency, in exchange for a 4 year commitment. HPLRP offers 160K of taxed loan forgiveness after residency. I can't find the DA bonus list but I am willing to bet it is similarly bad. None of these programs would cover even half of the cost of attendance for a public school, let alone a private one. HPSP offers what is basically the FAP bonus during residency + all your tuition and living expenses during medical school. Its not even close.

I have met both DA and FAP, but it is far less common.

 

[Cooperd0g]

In my opinion, going GMO after 4 years of medical school + 1 year of internship is the definition of "hustling backwards."

All that time learning, training to be a glorified PA/NP many of whom can get their degrees online with a 100 hours of YouTube training (I'm only half joking) is not a smart move.

More importantly, as a GMO, it'll be difficult to sustain the momentum from all the medical training and education when the average acuity of the medical problems you face is so low and monotonous. That's not to say you won't get to do some 'cool,' Army stuff -- but is that why you went to medical school?

As physicians, we are hard-wired to some extent to be all about, 'delayed gratification,' i.e., put off family, friends, income, etc. because 'one day,' it will 'all pay off.' But for many doctors, it never does (i.e., highest divorce and suicide rates among all professions). In a lot of ways we stack the deck against ourselves, why make it even harder?

Generally speaking, why would anyone want to put off for another 3-7 years the culmination of all their hard work and training doing a job (GMO) created by a government bureaucrat to plug holes in a sinking ship. To me, sacrificing more years of development, professional fulfillment, income and TIME to be a GMO doesn't make sense to me when AT BEST, a mildly competent college graduate with 30 hours of YouTube training could handle that job just fine. I also think the military vastly misuses docs in division/brigade surgeon billets, but that's another story for another day.

I don't get a chance to check this thread often, but I'm happy that it's creating discussion. In my personal opinion, a lot of the recent developments in DHA and AMEDD were conducted in a less than transparent way and I wanted to warn the next generation of docs coming after me about what's in store for them.

If anyone has any burning questions, feel free to msg me -- I'll get back to you as soon as I can.

... back to work...

This opinion may be shared by a great many who have no interest in operational medicine and who likely only joined for financial reasons. However, there are some who join specifically to do something in the military that simply cannot be done as a civilian, such as being a flight surgeon with a tactical jet squadron or being a UMO with a SEAL team. Some people actually are okay with the delay to do something they may have always wanted to do. Or to get the extra time to think twice about their desired specialty. I know many, many physicians who are much happier in the specialty they ended up in after a GMO tour than they one they originally would have done.

 

[HighPriest]

Thanks for the input. I'm obviously no physician, so the closest I've gotten to MilMed has been shadowing. I got to shadow a group of like 15 guys (and gals) in a bucket 1 team and....I didn't see any skill or talent 'waste' there. I was with them for 30-odd hours and they did nothing but operate for the entire time I was there. Sure there was some down time but not a wasteful amount. Was 30 hours not enough to give me an unbiased look, did I only see the good days somehow?
I'm basing my hopes as an aspiring Navy bucket 1'er based on them and I would be fine doing what they were.

30 hours at one location doesn’t really tell you anything about skill rot. Could have been a good day. I had those too. Could be a good location. There are places that are better than others, but no guarantee you would be stationed there. Lastly, it depends upon what they were doing. My first station was very busy, but all I ever did was bread-and-butter cases on healthy patients. So I didn’t lose any skill there, but it took a while to get used to doing cancer on old guys again.

You also really need to compare numbers between the military physician, what his civilian counterparts are doing, and (if known) what the number of cases/year to maintain proficiency is.

And I don’t think the comment about wasted talent was about surgeons doing surgery as much as it was about a specialist being billeted in an operational position where they’re not practicing on their field.

 

[AvoidMilitaryMedicine]

This opinion may be shared by a great many who have no interest in operational medicine and who likely only joined for financial reasons. However, there are some who join specifically to do something in the military that simply cannot be done as a civilian, such as being a flight surgeon with a tactical jet squadron or being a UMO with a SEAL team. Some people actually are okay with the delay to do something they may have always wanted to do. Or to get the extra time to think twice about their desired specialty. I know many, many physicians who are much happier in the specialty they ended up in after a GMO tour than they one they originally would have done.

I agree that some people do find GMO experience rewarding on some level -- although, in my experience, many of my Navy and Army friends would've much rather preferred to go into residency and be staff.

Nevertheless, I don't think anyone should be forced into going GMO (as many of my Navy friends were) nor do I think it's the best use of licensed M.D. for either the individual or the military.

 

[militaryPHYS]

No doubt. Just another addition to my list of points. If it really is all about serving your country, as so many students state, then they don't need to be recruited. They'll just finish residency and do FAP, etc.

It's not. They say it is, but it usually isn't. Or at least, it's not as important as they say it is (not compared to the benefits of freedom, pay, and self-determination.)

I agree that it’s not as important as they say it is. Financial stability, etc likely plays a larger role than we all like to admit. It’s not a bad thing necessarily so long as we understand the negative aspects too.

Coming in later is an option but it’s pretty crazy in my opinion. Completely selfless since you’re taking huge steps back in career, autonomy, pay...but still crazy. As @PerrotFish said, the best financial decision is to do it early with the HPSP scholarship, but this then burdens you with some unknowns on your path. Military service also has the most utility for someone young, in training and/or in the very early years of practice as we learn about ourselves and responsibilities.

It’s easy to fault the military and say they are targeting the young and naive because, well, they are. But young motivated people is who the military needs to serve and to be honest, if you’re going to serve it is the best time to do it so long as you understand what you are getting yourself in to.

Obviously right now MilMed has too many unknowns so the above doesn’t imply I am endorsing signing up right now. I just never agreed with telling people to come in later if they want to serve. It’s just another way to say don’t serve at all because so few will ever DA or FAP as a physician. It serves the purpose of you preventing someone being miserable (having an unacceptable time in service) but you’re also dissuading someone who may have had a very acceptable time.



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[HighPriest]

Coming in later is an option but it’s pretty crazy in my opinion. Completely selfless since you’re taking huge steps back in career, autonomy, pay...but still crazy. As @ParrotFish said, the best financial decision is to do it early with the HPSP scholarship, but this then burdens you with some unknowns on your path. Military service also has the most utility for someone young, in training and/or in the very early years of practice as we learn about ourselves and responsibilities.

You're right. It is crazy. And I think a lot of people who are very worried that they're not going to be able to pay their loans, and that the military is their only option before med school would finish residency and never join and be just fine. That's really my point. There are other options. If they really want to join, they can wait and join later. Is it a smart decision? Well, that's for them to decide. If they really, really want to serve they can make the decision then, when they're not under pressure to do it. But we have a tendency to listen to students, who are always, 100% of the time going to say they just want to serve, and we tell them "well, there's a lot of risk and now you may be limited in the residencies you choose, but you want to serve so do it." But that's a bit of a disservice if they're joining for service more than finances. As you usually say, they need to be informed. So they need to know that it makes less financial sense to join after residency, but there are benefits to doing so and if the desire to serve is still there, then the option to join can be as well. My guess is, the desire to serve will dissolve pretty rapidly once you're making real money and have real freedom. But, if that's what happens, that was probably the best option for them.

Military medicine, frankly, doesn't care that much if you start before or after residency because you're in the available pool at the same time. You're either a resident in the military who can't deploy and then you start your ADSO, or you come in as a residency-trained physician. Same age.

I don't fault the military for preying on the desperate and naive. That's what military service has always done. That's why recruiters show up at your door once you hit 17. Because you don't know anything. I've always known that, and I'm not at all anti-military.

It serves the purpose of you preventing someone being miserable (having an unacceptable time in service) but you’re also dissuading someone who may have had a very acceptable time.

No, it serves the purpose of educating them that there are other options. Letting them know that HPSP isn't the only way. I'm not telling anyone to do FAP. I am saying it'll be there when you finish residency, and if the real reason you want to join is to serve your country, then you have an option other than HPSP.

 

[BlackFrancis33]

And as long as you don't rag on Neurologists, you'll be fine here.

That's right or it is back to Froopyland for both of us...

 

[AvoidMilitaryMedicine]

Thanks for the input. I'm obviously no physician, so the closest I've gotten to MilMed has been shadowing. I got to shadow a group of like 15 guys (and gals) in a bucket 1 team and....I didn't see any skill or talent 'waste' there. I was with them for 30-odd hours and they did nothing but operate for the entire time I was there. Sure there was some down time but not a wasteful amount. Was 30 hours not enough to give me an unbiased look, did I only see the good days somehow?
I'm basing my hopes as an aspiring Navy bucket 1'er based on them and I would be fine doing what they were.

Many of my friends and peers in GS and surgical sub-specialties are bemoaning their choices now -- how do I know? There is a private thread on FB where they provide voluntary and unfiltered feedback on what their current experience is like and what they see coming their way -- ALL of it was bad with many of them reported either having to or knowing peers who are deploying every 12 months or so, over and over again to areas with little to no caseload or work for them to do. How does any physician recover from that and continue to develop and refine their skills? I don't think it's possible -- not to mention, the family disruption, low pay, risk of serious injury or death. With Afghanistan and Iraq set to become this generation's Germany and Korea, I don't see us ever leaving either of those 2 countries and I think that this trend will continue.

Medicine requires a continued commitment to learning and in my opinion, anyone who wants to be a highly skilled physician and/or values family/friends/income/etc. should NOT do HPSP and especially not USU.

 

[deleted707454]

It was my impression upon signing the HPSP that in the event that I flunked out of school, I would just go be a Medical Service Corps officer and pay back the time, and not have the high amount of medical school loans to worry about. Still get a salary. This was one of the recruiter's biggest selling points, and honestly a big draw for me as an underdog applicant (though, I am not sure if this was just recruiter BS or not; I am too lazy to look up my own contract, nor do I even know how to access it). I do know other (civ) drop outs who are six figures deep. That sounds worse than any level of army clusterf**kery

 

[244913]

It was my impression upon signing the HPSP that in the event that I flunked out of school, I would just go be a Medical Service Corps officer and pay back the time, and not have the high amount of medical school loans to worry about. Still get a salary. This was one of the recruiter's biggest selling points, and honestly a big draw for me as an underdog applicant (though, I am not sure if this was just recruiter BS or not; I am too lazy to look up my own contract, nor do I even know how to access it). I do know other (civ) drop outs who are six figures deep. That sounds worse than any level of army clusterf**kery

Damn- time to wake up. Get your priorities straight. Marginal applicants who are marginal med students at marginal schools do civ deferred internship 4 yrs of gmo and then have to reapply again to .civ residency. Your step scores matter a lot more than your OERs in this mileu

Also more likely they just boot your ass out and make you repay the DO pound of flesh. They’re not exactly hard up for any officer right now esp MSC. It isn’t 2008 anymore

 

[Cooperd0g]

It was my impression upon signing the HPSP that in the event that I flunked out of school, I would just go be a Medical Service Corps officer and pay back the time, and not have the high amount of medical school loans to worry about. Still get a salary. This was one of the recruiter's biggest selling points, and honestly a big draw for me as an underdog applicant (though, I am not sure if this was just recruiter BS or not; I am too lazy to look up my own contract, nor do I even know how to access it). I do know other (civ) drop outs who are six figures deep. That sounds worse than any level of army clusterf**kery

If you have legitimate concerns about failure then your confidence level is such that you likely won’t succeed.

In the book Flyboys by James Bradley, he said that all the pilots who were openly worried, concerned, etc about being shot down were ALL shot down. Sure, others had concern and more were shot down, but not all of them. He attributed it to the persistent distraction that prevented them for applying complete and total focus on the mission. The point is, if you have the level of concern to the point where you find yourself talking about it, then it is likely a distraction that can lead to a self fulfilling prophecy.

 

[TheEarDoc]

I agree that it’s not as important as they say it is. Financial stability, etc likely plays a larger role than we all like to admit. It’s not a bad thing necessarily so long as we understand the negative aspects too.

Coming in later is an option but it’s pretty crazy in my opinion. Completely selfless since you’re taking huge steps back in career, autonomy, pay...but still crazy. As @PerrotFish said, the best financial decision is to do it early with the HPSP scholarship, but this then burdens you with some unknowns on your path. Military service also has the most utility for someone young, in training and/or in the very early years of practice as we learn about ourselves and responsibilities.

It’s easy to fault the military and say they are targeting the young and naive because, well, they are. But young motivated people is who the military needs to serve and to be honest, if you’re going to serve it is the best time to do it so long as you understand what you are getting yourself in to.

Obviously right now MilMed has too many unknowns so the above doesn’t imply I am endorsing signing up right now. I just never agreed with telling people to come in later if they want to serve. It’s just another way to say don’t serve at all because so few will ever DA or FAP as a physician. It serves the purpose of you preventing someone being miserable (having an unacceptable time in service) but you’re also dissuading someone who may have had a very acceptable time.



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I will disagree. I think signing up when you are a season professional is better for the service and for our soldiers and families. I think if we increased the reserve components and increased the carrot size for commissioning as an officer and signing up, we'd do well. I know personally I will be a much better officer and provider now after having several years in the field to hone my craft and mentoring countless students. I do agree though the financial hit would be tough for many specialists to be pulled away for deployments, but if we had a larger reserve size with more billets and we also increase the incentive to sign up, we would get highly motivated, highly efficient folks. With more people in reserves deployments could be shorter and more spread out.

Also I think a lot of people would like being able to do their specialty in civilian life and maybe branch out and do something else in the reserves. Just my thoughts.

 

[Perrotfish]

It was my impression upon signing the HPSP that in the event that I flunked out of school, I would just go be a Medical Service Corps officer and pay back the time, and not have the high amount of medical school loans to worry about. Still get a salary. This was one of the recruiter's biggest selling points, and honestly a big draw for me as an underdog applicant (though, I am not sure if this was just recruiter BS or not; I am too lazy to look up my own contract, nor do I even know how to access it). I do know other (civ) drop outs who are six figures deep. That sounds worse than any level of army clusterf**kery

If there is an actual written instruction for what they do if you either fail or develop a medical problem I have never been able to find it. I have seen it happen with medical discharges, both in real life and in a few threads on this board, and it seems like the military's response is different every time. I saw someone develop a medical issue that in no way affected her ability to continue residency and they let gave an honorable discharge with no expectation of repayment. We had someone post here who got cancer and they wanted their money back, with interest, within 90 days of her discharge. I haven't see failures but I am guessing it is equally all over the map

If there is a written instruction I don't know about I hope someone will share it.

 

[deleted707454]

Damn- time to wake up. Get your priorities straight. Marginal applicants who are marginal med students at marginal schools do civ deferred internship 4 yrs of gmo and then have to reapply again to .civ residency. Your step scores matter a lot more than your OERs in this mileu

Also more likely they just boot your ass out and make you repay the DO pound of flesh. They’re not exactly hard up for any officer right now esp MSC. It isn’t 2008 anymore

What priorities do you think I don't have straight? I'm just saying making sure the car had airbags just in case I crashed was a good selling point. In fact (whether real or not) the alleged "parachute" of MSC service to pay off flunked school debt probably makes my life a lot less stressful, and I'm doing fine in school.

If you have legitimate concerns about failure then your confidence level is such that you likely won’t succeed.

In the book Flyboys by James Bradley, he said that all the pilots who were openly worried, concerned, etc about being shot down were ALL shot down. Sure, others had concern and more were shot down, but not all of them. He attributed it to the persistent distraction that prevented them for applying complete and total focus on the mission. The point is, if you have the level of concern to the point where you find yourself talking about it, then it is likely a distraction that can lead to a self fulfilling prophecy.

I didn't go in planning to fail out of school. But two of my undergrad classmates (who didn't take any gap years) did fail out of their programs and have some pretty high debt. Call it contingency to think out all angles, in a worse case scenario. I'm no fighter, but my gen aviation training was all about worst case scenarios and how to prevent them or mitigate the outcome if one does happen.

 

[deleted707454]

If there is an actual written instruction for what they do if you either fail or develop a medical problem I have never been able to find it. I have seen it happen with medical discharges, both in real life and in a few threads on this board, and it seems like the military's response is different every time. I saw someone develop a medical issue that in no way affected her ability to continue residency and they let gave an honorable discharge with no expectation of repayment. We had someone post here who got cancer and they wanted their money back, with interest, within 90 days of her discharge. I haven't see failures but I am guessing it is equally all over the map

If there is a written instruction I don't know about I hope someone will share it.

I have not found anything like that either (and haven't needed to). I recall my recruiter mentioning this, and I've seen it on some old SDN threads. I want to say it was Army specific, and the other branches made you pay back money with no service option. Those I know at my program who have failed (but not dropped out) while in HPSP are actually still on the scholarship, but are just having to take out loans for the year they are repeating while their service contract remains the same.

 

[HighPriest]

I have not found anything like that either (and haven't needed to). I recall my recruiter mentioning this, and I've seen it on some old SDN threads. I want to say it was Army specific, and the other branches made you pay back money with no service option. Those I know at my program who have failed (but not dropped out) while in HPSP are actually still on the scholarship, but are just having to take out loans for the year they are repeating while their service contract remains the same.

I would be very distrustful of this advice unless you can find it in writing. Not everything your recruiter tells you will be 100% accurate. Or even 5% accurate. Sometimes it’s made up on the spot and other times it’s just a rumor floating around the office that everyone starts to believe.

 

[deleted707454]

I would be very distrustful of this advice unless you can find it in writing. Not everything your recruiter tells you will be 100% accurate. Or even 5% accurate. Sometimes it’s made up on the spot and other times it’s just a rumor floating around the office that everyone starts to believe.

That is very clear to me now. 2 and a half years ago, it was not.

 

[notdeadyet]

It kinda is, though. I have never met any physician who joined via DA, HPLRP, or FAP.

Yup. I don’t think that’s so much indicative of how great the program is (see the 157 posts above). I think it is more indicative of where the recruiter dollars are focused. Any medical student has seen dozens of emails, posters, and mailings about HPSP and very little about DA or FAP.

And with good reason. You can sign up 22 year olds who have no idea what medicine is and commit them for the next 11-15 years. That’s a lot more effective than trying to recruit residents (who have secured their residency of choice and know the practicalities of what post-residency looks like) or fully trained physicians.

It
everything other than HPSP a financially stupid way to join the military. FAP offers 135,000 taxed dollars, during a 3 year residency, in exchange for a 4 year commitment. HPLRP offers 160K of taxed loan forgiveness after residency. I can't find the DA bonus list but I am willing to bet it is similarly bad.

Not exactly.

FAP: Agree with FAP not being as good financially as HPSP, but at least it offers some incentive to take care of some or most of your loans. And it has two HUGE benefits over HPSP: 1) you don’t join until you’ve secured your residency of choice and will have direct and full training and 2) you can do any residency you’re qualified for. That’s worth not completely having the government pay off your loan burden for some or many.

HPLRP: I don’t know what it is for active duty, but take it as a PGY-4 resident in reserve component Army and you can payoff $250K while you decide if you like the military life. Then you can join active duty if you’re so inclined.

DA: It’s better than you think for the accession bonus. I’m not sure what it is for all specialties but it was $280K for psychiatrists, which aren’t exactly unicorns.

We’ll agree to disagree. But I avoid the “everything but HPSP is stupid” argument because it’s just not true and it invents naive students into signing into a program that may or may not be a huge mistake. There are other options. YMMV.
[/QUOTE]

 

[pgg]

In the book Flyboys by James Bradley, he said that all the pilots who were openly worried, concerned, etc about being shot down were ALL shot down. Sure, others had concern and more were shot down, but not all of them. He attributed it to the persistent distraction that prevented them for applying complete and total focus on the mission. The point is, if you have the level of concern to the point where you find yourself talking about it, then it is likely a distraction that can lead to a self fulfilling prophecy.

Or maybe those pilots who got shot down were rather insightful concerning their (lack of) ability?

We mock the people on the wrong side of the Dunning-Kruger curve who don't know they're incompetent and therefore have inappropriate confidence. But here we have pilots who were incompetent, who knew they were incompetent, and the book-writer's wisdom is that all they needed was confidence. That sort of amuses me for some reason.

Maybe the author was less competent an assessor of others' ability to assess themselves than he thinks ...

 

[Cooperd0g]

Or maybe those pilots who got shot down were rather insightful concerning their (lack of) ability?

We mock the people on the wrong side of the Dunning-Kruger curve who don't know they're incompetent and therefore have inappropriate confidence. But here we have pilots who were incompetent, who knew they were incompetent, and the book-writer's wisdom is that all they needed was confidence. That sort of amuses me for some reason.

Maybe the author was less competent an assessor of others' ability to assess themselves than he thinks ...

But there is something to be said for having a positive mental attitude, which leads to hard work, which leads to confidence and competence. Negative Nancys rarely perform as well ...

Anecdote maybe, but I have seen it in action for a few decades now.

 

[HighPriest]

But there is something to be said for having a positive mental attitude, which leads to hard work, which leads to confidence and competence. Negative Nancys rarely perform as well ...

Anecdote maybe, but I have seen it in action for a few decades now.

The Japanese can sense negativity. Like a bear senses fear.

 

[Perrotfish]

But there is something to be said for having a positive mental attitude, which leads to hard work, which leads to confidence and competence. Negative Nancys rarely perform as well ...

Anecdote maybe, but I have seen it in action for a few decades now.

Hasn't been my experience. YMMV I guess.

 

[Cooperd0g]

Hasn't been my experience. YMMV I guess.

Please correct me if I’m wrong, but I believe you have approximately six years of active duty, have worked at only two MTFs, have never done an operational tour, and by your own admission never met someone who was DA or FAP.

I’m not trying to discount your opinion, but try not to make it seem more than your relatively limited experience can amount to.

 

[Perrotfish]

Please correct me if I’m wrong, but I believe you have approximately six years of active duty, have worked at only two MTFs, have never done an operational tour, and by your own admission never met someone who was DA or FAP.

I’m not trying to discount your opinion, but try not to make it seem more than your relatively limited experience can amount to.

Aren't you a resident?

 

[HighPriest]

.

 

[Cooperd0g]

Aren't you a resident?

Yes, I am. I'm also not wrong, am I?

 

[Perrotfish]

Yes, I am. I'm also not wrong, am I?

You are correct. I am an attending at the very tail end of my military obligation. Its just kinda weird that that, as a resident, you looked at that and thought 'limited experience' and at the same time thought your own opinion was wisdom worth sharing.

Is this a second residency or something? FM to RAM after being a department head for awhile? Do you have some experience with what works in medicine? I would still say you were wrong but it would at least explain the attitude.

 

[DondeEstaElBano]

It was my impression upon signing the HPSP that in the event that I flunked out of school, I would just go be a Medical Service Corps officer and pay back the time, and not have the high amount of medical school loans to worry about. Still get a salary. This was one of the recruiter's biggest selling points, and honestly a big draw for me as an underdog applicant (though, I am not sure if this was just recruiter BS or not; I am too lazy to look up my own contract, nor do I even know how to access it). I do know other (civ) drop outs who are six figures deep. That sounds worse than any level of army clusterf**kery

You have to have a relevant degree to join the MSC as well. So unless you have at least an MHA or MBA, I can’t imagine this being true. Being a medical school dropout alone does not meet commissioning requirements for any specialty in the MSC that I know of (at least in the Navy).

Maybe one of those scientists specialities - but you’d have to have the relevant undergraduate degree there as well.

I say this as a Pharmacy Officer in the MSC, so I’m definitely not the decision maker for something like this. Just giving my insight based on being in the corps.

 

[Cooperd0g]

You are correct. I am an attending at the very tail end of my military obligation. Its just kinda weird that that, as a resident, you looked at that and thought 'limited experience' and at the same time thought your own opinion was wisdom worth sharing.

Is this a second residency or something? FM to RAM after being a department head for awhile? Do you have some experience with what works in medicine? I would still say you were wrong but it would at least explain the attitude.

I have been a physician for 2.5 years and in the medical corps for 6.5 since I went to USUHS. But nothing I said about success or failure in this thread was specific to medicine. You said you hadn’t met certain types of people or seen certain types of experience. Given that we have both been in the medical corps in the Navy for the same amount of time, but I have boarder exposure to various MTFs, and that my total military time is 4x yours, it isn’t suprising that you don’t have the same level of experience that I have regarding the military in general or the amount of people I have seen succeed and fail. And that is okay. There are still many people with more experience than me. Remember, medical experience isn’t the only kind of experience. Traits that help people succeed or fail are not unique to medicine.

You can choose to believe I have an attitude if you wish, but you shouldn’t get upset for having a relative lack of experience compared to another person. I am sorry if it came off in an offensive way.

You provide significant value to this forum and generally have a level headed stance on things. I think that is very good. But you also tend to speak authoritatively on things and are not always correct or don’t have the experience to back up the confidence in your statements. Despite what some surgery programs like to teach, being confidently wrong is actually a bad thing. I would likely never challenge you on anything pediatric related because you are vastly more experienced than I am in that field. I’m sure there are many other things where you are much more experienced than I am.

If you look back through my post history I tend to comment on overall big picture medical things, military in general and administrative things. And if someone corrects me, I am glad for it.

 

[colbgw02]

You have to have a relevant degree to join the MSC as well. So unless you have at least an MHA or MBA, I can’t imagine this being true. Being a medical school dropout alone does not meet commissioning requirements for any specialty in the MSC that I know of (at least in the Navy).

Maybe one of those scientists specialities - but you’d have to have the relevant undergraduate degree there as well.

I say this as a Pharmacy Officer in the MSC, so I’m definitely not the decision maker for something like this. Just giving my insight based on being in the corps.

Is this degree thing Navy only, because it definitely didn’t used to be true for the Army? Anybody can be a MSC ambulance PL in the Army, including English majors without a graduate degree.

 

[DondeEstaElBano]

Is this degree thing Navy only, because it definitely didn’t used to be true for the Army? Anybody can be a MSC ambulance PL in the Army, including English majors without a graduate degree.

I don’t know about the Army, but I just scrolled through the requirements for all of the MSC specialties in the Navy and they all require a masters degree - with some caveats for “highly qualified” personnel with bachelor’s degrees. But those are for specific fields - like and industrial hygiene bachelors, or medical laboratory technology.

Ambulance platoon leader is not a job in the Navy MSC. You have to meet minimum subspecialty qualifications to commission even as a healthcare administrator (I don’t mean that disparagingly, just that HCA is, arguably, the least specialized). After that, if they let you run an EMS program as a collateral, then that’s secondary. But only a few of those exist still that belong to the active component. I can only think of GTMO right now and that’s headed by the ER department head (nurse corps) and medical director.

 

[colbgw02]

I don’t know about the Army, but I just scrolled through the requirements for all of the MSC specialties in the Navy and they all require a masters degree - with some caveats for “highly qualified” personnel with bachelor’s degrees. But those are for specific fields - like and industrial hygiene bachelors, or medical laboratory technology.

Ambulance platoon leader is not a job in the Navy MSC. You have to meet minimum subspecialty qualifications to commission even as a healthcare administrator (I don’t mean that disparagingly, just that HCA is, arguably, the least specialized). After that, if they let you run an EMS program as a collateral, then that’s secondary. But only a few of those exist still that belong to the active component. I can only think of GTMO right now and that’s headed by the ER department head (nurse corps) and medical director.

Sure...just trying to point out that MSC is different for the different services, apparently. A former Army HPSPer could very well end up an MSC officer, irrespective of degree.

 

[TheEarDoc]

You have to have a relevant degree to join the MSC as well. So unless you have at least an MHA or MBA, I can’t imagine this being true. Being a medical school dropout alone does not meet commissioning requirements for any specialty in the MSC that I know of (at least in the Navy).

Maybe one of those scientists specialities - but you’d have to have the relevant undergraduate degree there as well.

I say this as a Pharmacy Officer in the MSC, so I’m definitely not the decision maker for something like this. Just giving my insight based on being in the corps.

He could probably reclassify as 70B General admin officer in medical service corps, but then he’s competing with all other enlisted who have a college degree in a possible medical field (psych bachelors, etc.) and if he flunked out of med school it’s likely he’d make the cut against some up and coming mustang.

 

[Perrotfish]

I have been a physician for 2.5 years and in the medical corps for 6.5 since I went to USUHS. But nothing I said about success or failure in this thread was specific to medicine. You said you hadn’t met certain types of people or seen certain types of experience. Given that we have both been in the medical corps in the Navy for the same amount of time, but I have boarder exposure to various MTFs, and that my total military time is 4x yours, it isn’t suprising that you don’t have the same level of experience that I have regarding the military in general or the amount of people I have seen succeed and fail. And that is okay. There are still many people with more experience than me. Remember, medical experience isn’t the only kind of experience. Traits that help people succeed or fail are not unique to medicine.

You can choose to believe I have an attitude if you wish, but you shouldn’t get upset for having a relative lack of experience compared to another person. I am sorry if it came off in an offensive way.

You provide significant value to this forum and generally have a level headed stance on things. I think that is very good. But you also tend to speak authoritatively on things and are not always correct or don’t have the experience to back up the confidence in your statements. Despite what some surgery programs like to teach, being confidently wrong is actually a bad thing. I would likely never challenge you on anything pediatric related because you are vastly more experienced than I am in that field. I’m sure there are many other things where you are much more experienced than I am.

If you look back through my post history I tend to comment on overall big picture medical things, military in general and administrative things. And if someone corrects me, I am glad for it.

Alright, so I am trying not to write a combative reply to this (actually I deleted one). But bullet points:

1) I think you overestimate how much experience carries over from one work environment to another. I don't think the same personality traits work in a line unit that work in the MC. I think this thread is, in fact, all about how dangerous it is when the line starts thinking that everything can be the line.

2) If I am reading you correctly you are counting your student time towards your total experience. I think that's misleading. At a minimum you should be very clear that when you say you have 24 years of 'experience' that you are counting 8 years of school. I also think you should make it clear how much time you were in the reserves. When you say you have 24 years of military experience and 'some' of that in the medical corps any student reading that would think you were a grizzled former XO who is now a neurosurgery R7, not a former mid career pilot who is now an R3.

3) I think you will see your opinions change as you stress test the military healthcare system. That is doubly true if, as I suspect, you are doing the RAM rather than FM or a residency at a large MTF. If you are dismissing opinions of more experienced MC officers here, I worry that you are doing the same in person. Because of the military's odd system of carrying rank over for career changers you are likely going to be put in a leadership position that is designed for a senior medical officer when you are fresh out of residency. My opinion is that it would be best to go into that with an open mind towards advice from more experienced physicians, rather than a dismissive attitude.

 

[DondeEstaElBano]

He could probably reclassify as 70B General admin officer in medical service corps, but then he’s competing with all other enlisted who have a college degree in a possible medical field (psych bachelors, etc.) and if he flunked out of med school it’s likely he’d make the cut against some up and coming mustang.

Yea, my comment was geared toward Navy. I didn’t realize the Army had this option for their MSC officers. It’s not something that the Navy MSC has - general admin options for any bachelors degree. An interesting difference that’s for sure!

 

[DD214_DOC]

Here’s a completely-unrelated story about Army and SDN I never shared, and can be enlightening to many.

I don’t know if they continue to do this or not, but Army GME absolutely monitors this forum, or at least were back in 2010-2012. This was the COL Powers era.

How do I know? Because he made reference in an email exchange to something I posted in a thread about the, “Chief dude laying the hammer down”. It isn’t difficult to piece together information from my posts to figure out who I am. It resulted in only a telephone call involving my residency PD, (who visibly was trying his best to not laugh after COL Powers quoting me in the discussion), COL Powers, a residency classmate who also did something involving Powers, and myself. COL Powers seemed oddly amused by the whole thing and it wasn’t really a negative experience, but I got the message that they were watching — which I think was the point. This is why there are things I simply won’t share or discuss until I’m out.

I’m going to try and find the thread now ...