USUHS Infectious Diseases Quality (MD/PhD)

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Gastrapathy said:
For an ID doc, the end of the initial ADSO is often most of the way to 20. So again, if that is the goal, just get out at the end of your obligation if you are unhappy is not that simple. Residency, utilization tour, fellowship, payback= ~11-13 years
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11-13 does not equal 20. You can get out, and you should if you are unhappy or concerned for the future. The blended retirement system makes this an even better option now.
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Yes and no. For a relatively poorly compensated specialty, there is a major financial loss to getting out at 13 years. They have to decide between being professionally unfulfilled for 7 years versus working an extra several years on the end of their career. Not so simple.
 
Yes and yes. I don't care how "poorly" a specialty pays, it is still vastly more than a significant portion of the population in this world. People get out at the 10-13 year mark all the time and it isn't just doctors. Yes, the pension is nice, but for a physician who can remotely manage their money it shouldn't be making or breaking their financial life. If a military physician has 11-13 years in, has mismanaged their money so bad, are miserable being in the military, but feel trapped into staying, then I have absolutely no sympathy for them. This is the utter essense of work the system, suck it up or GTFO.
 
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13 years certainly puts some weight on the scales, but I've definitely known people in lower paying specialties to get out at that time. It's a cost/benefit situation, and yeah, your mental health plays in to that. Or at least, it should.
 
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Cooperd0g said:
Yes and yes. I don't care how "poorly" a specialty pays, it is still vastly more than a significant portion of the population in this world. People get out at the 10-13 year mark all the time and it isn't just doctors. Yes, the pension is nice, but for a physician who can remotely manage their money it shouldn't be making or breaking their financial life. If a military physician has 11-13 years in, has mismanaged their money so bad, are miserable being in the military, but feel trapped into staying, then I have absolutely no sympathy for them. This is the utter essense of work the system, suck it up or GTFO.
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We shouldn't muddy the issue by thinking about starving kids in Africa, or slaves in Saudi Arabia, or villagers getting measles in Indonesia, or Canadians who have to put up with cold weather and ice hockey fans. Of course we first-world 1%'ers have it good. :) The question is whether a person can have it better by staying or going at completion of their ADSO.

Getting out at 12 years is a substantial financial hit to most specialties (generally excepting some of the higher paid surgical and IM subs), if the math is done correctly.

Unless you're in a specialty that can walk into a $500-600K or better job the day you exit active duty (and I readily acknowledge that these specialties exist), you've got to be truly miserable in the military, and/or staring down the barrel of unrecoverable skill atrophy, and/or bad at math to walk away from the pension at year ~12 or so.
 
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Or, if you were a four year HPSP, leave AD at 12, do 4 in the reserves, thus getting four good years toward retirement for HPSP, thus you get your 20 year letter at 16. Likely as an 05 with nothing more than CCC as far as .mil education.

Depending on specialty and doing just four years of reserve time; you could very well never deploy.

OR
work for VA after AD and 'buy back' your years in .mil for VA retirement.


A few ways to make you AD count toward retirement.
 
pgg said:
We shouldn't muddy the issue by thinking about starving kids in Africa, or slaves in Saudi Arabia, or villagers getting measles in Indonesia, or Canadians who have to put up with cold weather and ice hockey fans. Of course we first-world 1%'ers have it good. :) The question is whether a person can have it better by staying or going at completion of their ADSO.

Getting out at 12 years is a substantial financial hit to most specialties (generally excepting some of the higher paid surgical and IM subs), if the math is done correctly.

Unless you're in a specialty that can walk into a $500-600K or better job the day you exit active duty (and I readily acknowledge that these specialties exist), you've got to be truly miserable in the military, and/or staring down the barrel of unrecoverable skill atrophy, and/or bad at math to walk away from the pension at year ~12 or so.
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You know what I never allocated for in all of my ridiculous calculations for this stuff?! The 3 year difference between when HPSP can start taking a Retention Bonus compared to USUHS. :bang:

Also, food for thought: If you look at the eligible specialties for the new 6-year RB in FY-19 special pays guidance (Anethesiology, ER, FP, Gen Surg, Ortho, Psych, Pulm/CC) I'm sure you can imply what "Bucket" these specialties would fall in to.
 
I think you'll find the difference in RB for those 3 years is probably not astronomically different when you factor in the $65-70k for 4 years a USUHS student with no prior service gets as salary.
 
I'll add that the stay/go math has changed substantially with the new BRS, as the new pension is 20% less than the one we old high 3'ers get. The token TSP match introduced with BRS doesn't come close to bridging that gap.
 
Its not only on SDN that you will encounter the "logic" that being a military physician is better than many military jobs, ergo military docs should suck it up and deal. Its a little surprising to see a physician express that but its a very common view of the non-physician leadership to whom you are beholden.

As for the reserves, just be careful and expect to be activated if you join. The buyback for a civilian govie job (not just VA) is very important to understand, particularly if you are looking at academics. A combined uni/VA job can be much more attractive as a result.

WRT the new BRS, none of those folks are approaching stay/go yet, right? Its still high 3 for several more years?

Unrelated, I heard Bono is out. Will be interesting to see who is next for DHA.
 
It will be a little while still before the BRS cats exit. 2017 was the last time I knew people who were commissioned under the high 3 retirement model, so I think 2018 college grads had to commission into BRS. And literally everyone I know who could have opted out of high 3 and into BRS did the math and said it was crazy and it was better to see if they made it to 20. I’m at 10 and it’s definitely not worth opting into for me.
 
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pgg said:
I'll add that the stay/go math has changed substantially with the new BRS, as the new pension is 20% less than the one we old high 3'ers get. The token TSP match introduced with BRS doesn't come close to bridging that gap.
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I think we hashed this out about a year ago in a different thread. It's a mute point since the opt-in window for those eligible passed this past New Year. But regardless, I completely disagree. It doesn't bridge the gap, but it comes close enough for some when you consider all aspects of the decision. The big difference touches back on the mental health piece. Especially for Military Physicians.

What BRS provided is a subtraction from the golden handcuffs. With percentage of physicians staying to 20 years at likely 20% or less, the odds are not in favor of even the most well-intentioned career MilMed doc. I will be at 15 years towards 20 when I am done payback. Even being so close to 20 I still wanted the option to cut and run given the upcoming changes we knew about last year. Plus I am in the $500k+ expected civilian salary group.

What I have given myself is an extra $4500 bucks a year in tax-advantaged accounts for the next 9 years, plus my one-time continuation pay which I am eligible for this summer ($19k). That'll be an extra $60k in my pocket if/when I decide to leave at the end of obligated service (not even counting growth). Sure, worst case scenario is I end up staying for 20 and have a 20% decrease in my pension, but that 20% is a small fraction of what my TOTAL income will be at that period in my life (pension, rental income, withdrawals from taxable accts, etc) that it won't make a difference. Even with taking a 20% pension cut I'm still on track to be financially independent at my eligible retirement date. That's without working as an ortho surgeon or physician in general another day in my life. Add in the potential for part-time civilian physician pay via locums, consulting or even insurance reviews and that 20% pension cut is a very small fraction of total income for a physician. If I retire and roll in to a practice?! Now that 20% difference is pennies (all things being relative).

Anyway. I think military physicians leaving before 20 years is not "crazy", so BRS should never have been labeled a crazy option for MilMed docs. You had to have looked at the individual person's financial situation, chances of staying for 20 and show them the anticipated % TOTAL pay cut at the time they are hitting 20 years.

Just my two cents. :thinking:
 
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militaryPHYS said:
I think we hashed this out about a year ago in a different thread. It's a mute point since the opt-in window for those eligible passed this past New Year.
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Just FYI the phrase is moot point. (It’s a pretty common misheard phrase, kind of like “all intensive purposes” instead of “all intents and purposes”.
 
militaryPHYS said:
I think we hashed this out about a year ago in a different thread. It's a mute point since the opt-in window for those eligible passed this past New Year. But regardless, I completely disagree. It doesn't bridge the gap, but it comes close enough for some when you consider all aspects of the decision. The big difference touches back on the mental health piece. Especially for Military Physicians.

What BRS provided is a subtraction from the golden handcuffs. With percentage of physicians staying to 20 years at likely 20% or less, the odds are not in favor of even the most well-intentioned career MilMed doc. I will be at 15 years towards 20 when I am done payback. Even being so close to 20 I still wanted the option to cut and run given the upcoming changes we knew about last year. Plus I am in the $500k+ expected civilian salary group.

What I have given myself is an extra $4500 bucks a year in tax-advantaged accounts for the next 9 years, plus my one-time continuation pay which I am eligible for this summer ($19k). That'll be an extra $60k in my pocket if/when I decide to leave at the end of obligated service (not even counting growth). Sure, worst case scenario is I end up staying for 20 and have a 20% decrease in my pension, but that 20% is a small fraction of what my TOTAL income will be at that period in my life (pension, rental income, withdrawals from taxable accts, etc) that it won't make a difference. Even with taking a 20% pension cut I'm still on track to be financially independent at my eligible retirement date. That's without working as an ortho surgeon or physician in general another day in my life. Add in the potential for part-time civilian physician pay via locums, consulting or even insurance reviews and that 20% pension cut is a very small fraction of total income for a physician. If I retire and roll in to a practice?! Now that 20% difference is pennies (all things being relative).

Anyway. I think military physicians leaving before 20 years is not "crazy", so BRS should never have been labeled a crazy option for MilMed docs. You had to have looked at the individual person's financial situation, chances of staying for 20 and show them the anticipated % TOTAL pay cut at the time they are hitting 20 years.

Just my two cents. :thinking:
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I see what you’re saying. I should have caveated my statement that until now, almost all of the people I know who are commissioned are line officers like I currently am. For a line officer with 7-10 years to opt into BRS, I’m not sure there’s a way to make it worthwhile money wise (hence “crazy”). In my case, I’m going to be past 20 between prior service, USUHS, residency and ADSO.

BRS does definitely sound like a financial incentive for ‘typical’ military physicians to leave before 20. I understand your logic for what you decided to do. Did your wife do the same?
 
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BunsenBeaker said:
I see what you’re saying. I should have caveated my statement that until now, almost all of the people I know who are commissioned are line officers like I currently am. For a line officer with 7-10 years to opt into BRS, I’m not sure there’s a way to make it worthwhile money wise (hence “crazy”). In my case, I’m going to be past 20 between prior service, USUHS, residency and ADSO.

BRS does definitely sound like a financial incentive for ‘typical’ military physicians to leave before 20. I understand your logic for what you decided to do. Did your wife do the same?
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Yes. We both did BRS. She will be at 10 yrs when her payback is done so chances are higher that she won’t make it to 20. But who knows. She wants to stay if things stay positive.

For you it makes total sense to stay High-3. Not many eligible people were guaranteed to make it to 20 during opt-in period. And yes, I agree with you regarding non-physicians who have a higher likelihood of making it to 20 with a lower expected total income at time of retirement.
 
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I did an internal med internship at Walter Reed, albeit many years ago. I don’t remember PhD/MD ID physicians. There are physicians who are involved in research at WR, including some who are pretty well plugged in to NIH across the street. But I go to a world-renowned academic institution currently and I can say with good confidence that the docs at my current institution have a big advantage in regards to opportunity.

The military works pretty well if there is a predictable plan in place. You want to be an MD then go IM? No problem there. You want to do a fellowship after IM? Achievable but much more challenging (some fellowships are scarcely available and unbelievably competitive). You want to do MD/PHD? Again, this is not a typical military route, so there is more risk. Perhaps the military will see you as an asset, but there is also the risk that your not doing academics based on the needs of the military.

I love the military, but you have to be aware of the risks. Like @militaryPHYS recommended, I’d reach out to physicians at Walter Reed. They know better than we would know about the situation, and I’d try to talk to multiple people
 
SirGecko said:
Just FYI the phrase is moot point. (It’s a pretty common misheard phrase, kind of like “all intensive purposes” instead of “all intents and purposes”.
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I’m sorry, but you are wrong as well. It is a “moo point. You know, like a cow’s opinion. It doesn’t matter.”
 
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There is one MD/PhD ID doc I am aware of. Functionally, an ID physician from what I know.

I was not aware V Admiral Bono was out.
 
Its not on target for this thread, but I am interested to hear more about Admiral Bono leaving. That would raise huge questions about the direction DHA is going. MG Clark is getting out in a few months after serving in a DHA leadership role, and now Admiral Bono may be leaving/out at DHA. It seems being a flag officer at DHA may not be such an appealing gig. Standing up an organization to run an international health organization, national GME program, with planned 20% (or more) cuts to the workforce isn't so easy.
 
BlackFrancis33 said:
Its not on target for this thread, but I am interested to hear more about Admiral Bono leaving. That would raise huge questions about the direction DHA is going. MG Clark is getting out in a few months after serving in a DHA leadership role, and now Admiral Bono may be leaving/out at DHA. It seems being a flag officer at DHA may not be such an appealing gig. Standing up an organization to run an international health organization, national GME program, with planned 20% (or more) cuts to the workforce isn't so easy.
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Not sure why everyone would be surprised to see VADM Bono departing (if true). This would be about the normal rotation timing for a Flag Officer.
 
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Well, I heard she is retiring from what I think is a highly credible source. For all I know, she’ll civilianize her role and stay in it. I heard the best guess for the next DHA is also Navy, which was a little surprising. Time will tell. I certainly have zero first hand knowledge
 
Gastrapathy said:
Well, I heard she is retiring from what I think is a highly credible source. For all I know, she’ll civilianize her role and stay in it. I heard the best guess for the next DHA is also Navy, which was a little surprising. Time will tell. I certainly have zero first hand knowledge
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WRNMMC keeps going with Navy as well. Maybe someone is trying to make amends for changing Bethesda Naval to Walter Reed.
 
onepunchdoc said:
Care to elaborate?
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Currently it is a draft memorandum. Right now you will have to ask your local General Surgeon department head or Ortho department head for eyes on. It was included in a recent Tasker.

It really only addresses Trauma partnerships as it relates to surgical trauma care. I am not sure if there are drafts in progress for the other non-surgical specialties as it relates to partnerships for higher acuity patients (i.e. ICU, medical sub-specialties, etc.). I imagine such a memorandum would come second.

Additionally there were some new FAQs and Talking Points related to MHS transition that came through my inbox last week. Not marked as FOUO but I cannot see original distribution so I am confirming whether or not they can be shared.
 
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Gastrapathy said:
Well, I heard she is retiring from what I think is a highly credible source. For all I know, she’ll civilianize her role and stay in it. I heard the best guess for the next DHA is also Navy, which was a little surprising. Time will tell. I certainly have zero first hand knowledge
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Well, Bono is out and DHA went Army. So, the rumor mill was half right.
 
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