USUHS vs Civilian Medical School

[Gas_Seal]

Greetings,
I am seeking advice on deciding whether to attend medical school at USUHS or a civilian medical school. fortunately, I have been accepted at USUHS, as well as at multiple civilian programs this cycle, my top civilian choice is the University of Michigan Medical School. I will list the pros and cons I have identified for each. for background, I am an O3 AD officer with 4 years of service and have been selected by the Air Force at USUHS. I have a wife, 1 child, and 1 on the way.

USUHS
Pros:​

• continue my uniformed career and accrue additional time towards retirement, leading to retirement at 51 with 24 years of service (adding the 4 years that are only tacked on at retirement from USUHS).
  • if I make O6 I will have a pension of approximately $110K at this age (in future dollars) for the rest of my life not counting TSP.
• Maintain a good income as a O3 with 5 years of service my income will be approximately $130k (before taxes)
• Continue to pursue my passion of uniformed service and care delivery to service members.
• I am interested in potentially doing Anesthesiology and could do CCATT with the AF.

Cons:​

• During clerkships, I will likely have to be away from my family for a large part of the 2 years of clerkships (I spoke with a student who is dealing with being away from family for a majority of rotations despite asking for rotations in the DMV)
• I will have a much lower take-home income than my counterparts in the civilian sector especially if I pursue a surgical specialty, potentially as high as $500k yearly?
• I am considering a surgical subspecialty such as Urology, and the AF only has 4 Urology spots (according to the 2020 HPERB). They do have 25 Ortho surgery spots, but most are deferred spots, which I would prefer to avoid as the time doesn't count toward retirement.
• I have done a lot of research on this forum and Reddit and it seems a lot of AD physicians are not very pleased with the state and projected future of AD military medicine, and this concerns me.

University of Michigan
Pros:​

• A highly regarded medical program that would likely open many doors in my career as a physician
  • #3 ranked urology residency in the country
• The GI bill will cover all of my tuition, and give me a stipend of $2200/month, I would also sign up for the Army MDSSP which would give me a monthly stipend of $3100 - $3500 (If I get to keep my rank). I also plan to do 1 telemedicine shift per week (I am PA) which would give me another $2,400 monthly in the best-case scenario. This would leave me with a pre-tax income of approximately $90k/year.
  • this plan would allow me to graduate debt-free and hopefully maintain a reasonable lifestyle.
  • the MDSPP will allow me to have Tricare reserve for my family
• I will still be involved with the uniformed services in some capacity (it is very meaningful to me to serve my country)
• I will have the freedom to pursue whatever specialty I want without having to worry about the slots designated by the military.
• I will not have to worry about being away from my family for a large portion of my clerkships
  • I will not have to worry about PCSing every 4 years.
• My wife wants me to go with this option

Cons:

• I will be giving up on my AD military pension at 51. To be able to have a $110k/year pension from a civilian fund at that age I would need to have approximately 2.8 million in a retirement account (but to my knowledge, I can't even begin to withdraw until my 60s) withdrawn at 4% per year.
• I will be giving up the uniformed service lifestyle and the other benefits and assurances of being AD which I greatly appreciate
• I will not have the option to pursue CCATT

thanks for any and all advice, I look forward to reading your replies.

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[militaryPHYS]

I think the question you are really trying to answer is whether you want to stay active duty or not. It's a big shift but it will be OK. You served your country and should be proud. You have given yourself an awesome opportunity to go to a great medical school for free because of that service and that is likely what most will recommend that you do. I would agree based on the unknowns of MilMed right now, acceptance and planned pathway at your civilian school and a relatively debt free career available to you.

Some day (if you decide to stay in the reserves for a career or even go back active duty one day) you may end up questioning your decision to go civilian. Don't do that. You had a great opportunity in 2024 and took it. You have to make a decision now based on what is going on with you and your family. No way to predict the future.

You can't draw from your retirement accounts until 59.5 years old but most people that retire early have other money saved in a taxable account, CD ladder or other non-retirement vehicle to cover your years between 51 and 59.5 With debt-free medical school and a stipend from MDSSP during residency plus a civilian doc salary...if you want to retire before 59.5 you will be able to without a pension just by saving.

Now, if you absolutely LOVE the active duty life and end up realizing that you want to do 20 years and retire at 51 to move on to other things then definitely go to USUHS. But don't be upset if your training is delayed, urology not available and/or WWIII breaks out.

Good luck in your decision!

 

[ObsequiousAplomb]

I agree with your wife.

 

[pgg]

Congratulations on all of your acceptances - really a tremendous accomplishment. Whatever way you go, you'll do well.


You touch on but really don't note the full depth of the military residency risk on the USUHS con list:

I am considering a surgical subspecialty such as Urology, and the AF only has 4 Urology spots (according to the 2020 HPERB). They do have 25 Ortho surgery spots, but most are deferred spots, which I would prefer to avoid as the time doesn't count toward retirement.

In my opinion the real risk/con here is not so much the number of urology slots the AF has that's worrisome, though that adds some uncertainty to your ability to get one. It's the fact that by going to USUHS this year, you'll graduate and (probably) enter internship/residency in 2028, finishing your GME training sometime in the early 2030s. If you do any GMO time (less likely in the AF than it is in the Navy, but still a nonzero possibility) it may well be the mid 2030s before you exit residency. As a USUHS grad with a longer obligation, you don't have the easier HPSP exit option of GMO-and-out after 4 years.

There's a lot changing in military medicine now. Few of us would confidently say what we think inservice GME will look like in 5 years. By going to USUHS today, you're committing yourself to residency ~8-10 years from now in a system with a lot of questions hanging over what military GME is going to look like.

You don't have a strong financial reason to go to USUHS. With your GI Bill and some modest loans, you can certainly live well, even with a young family.

You can always rejoin afterwards if you really want to be in the military. This option is attractive because you can defer your decision until after your training is done, and you know what the state of military healthcare is at that moment.

I'm a 2002 USUHS grad and a cardiac anesthesiologist. I don't know much about urology, but when I retired from the Navy in 2022, I was increasingly anxious about the current and future caseload at Navy hospitals, even the large one I where I was stationed. I was heavily dependent upon off-duty moonlighting to meet minimum case numbers for my subspecialty. We had no cardiac surgery program at that time. Even the generalists had very light and not-especially-complex case loads. I was largely happy with my time and experience in the Navy but the trajectory of the case load and type was worrisome.


Your wife wants you to be a civilian. That alone might trump all other considerations. You're in the enviable position of having an acceptance to a quality public allopathic school, and the GI bill to pay for it. I think you should take that win. You can always rejoin afterwards.

 

[TheGoose]

Go Blue. (Not into the wild blue)
-usuhs grad surgical subspecialist

To expand briefly: embrace the gi bill and being debt free, wide breadth of residency choices not limited by military numbers and post residency atrophy. Can join the reserves or national guard if you really want to. Keep wife and family happy.

 

[DMBandFan86]

I’d recommend making complex decisions that span decades by considering the input from your spouse. That’s probably the best advise I can give you if you want a successful home life.

If you take MDSSP, you really won’t do anything with the military until you start your payback (minus any trainings). As someone who did MDSSP, it was a fine program at the time. But, now a days, the payback is so delayed and most go on to take STRAP. So just realize your contract / payback will easily span over a decade. The money is always nice up front, but on the back end isn’t so great compared to your civilian salary. I did get reserve retirement years during school and residency, which is nice. But, you’d want to calculate what your retirement would be if you stayed 20 years to see if really worth it.

Also the reserves functions quite differently than AD. If you thought AD could be jacked up, the reserves are 10x worse and everything is very slow for the most part.

As an alternative option, if a defined benefit pension plan is important to you, you could always plan to go academic medicine. Your salary will be more than AD and your pension will also be bigger, albeit start around 65.

 

[Barrel Proof]

First of all, congrats. You are in a great spot and at the end of the day this is a win-win. You asked about medical school so I’ll answer that first. USUHS is a fantastic medical school. It will prepare you very well for residency in whatever field you choose. You will graduate a clinically competent doctor. Michigan certainly is more of a brand name with a fantastic reputation and that’s about all that I can speak to. I graduated from USUHS so I am very biased. But I would put a newly minted USUHS intern up against any intern in the country. The product is very solid.

But that’s where any possible advantage ends for military medicine. Because the reality is that military GME is not in a good place right now. And this problem just continues as you move on to be staff in those same hospitals. In general, patients are healthy, volumes are low and complex pathology is lacking. I do know of Army USUHS graduates that are training at civilian academic centers in Urology. The Navy also has civilian training opportunities in Urology. I am not sure about the Air Force. Every speciality is different. And then also different by branch. So it is possible that you could go USUHS and train civilian for residency but this is unlikely. If you choose USUHS, you should accept that you will train via military GME. You *may* have civilian training as an option but it would *likely* come at a price of increasing your ADSO.

Having trained in both military GME and also civilian GME at a big academic center, I can tell you first hand there is a significant difference. And at the end of the day, residency is where you will build your every day skills that you will use as an attending. Advantage Michigan after residency, for sure.

Now you are staff. At an MTF, you will be much less busy. Which might not be a bad thing right out of residency while you learn how to settle in on your own. But you will risk skill atrophy as you won’t be seeing the volumes or complexity that you otherwise would. True, you can moonlight to supplement. This varies by specialty. Your work life balance in the military will be better. But your paycheck will be WAY less.

If your focus is on being the best urologist you can be, choose Michigan. It’s the safest bet.

The equation may change slightly towards the military if you are more concerned with work-life balance, less financial stress during training (you will be a very well paid medical student and resident), working with a unique population etc.

Good luck! I think you’ll be fine either way. Congrats again

 

[Gas_Seal]

I think the question you are really trying to answer is whether you want to stay active duty or not. It's a big shift but it will be OK. You served your country and should be proud. You have given yourself an awesome opportunity to go to a great medical school for free because of that service and that is likely what most will recommend that you do. I would agree based on the unknowns of MilMed right now, acceptance and planned pathway at your civilian school and a relatively debt free career available to you.

Some day (if you decide to stay in the reserves for a career or even go back active duty one day) you may end up questioning your decision to go civilian. Don't do that. You had a great opportunity in 2024 and took it. You have to make a decision now based on what is going on with you and your family. No way to predict the future.

You can't draw from your retirement accounts until 59.5 years old but most people that retire early have other money saved in a taxable account, CD ladder or other non-retirement vehicle to cover your years between 51 and 59.5 With debt-free medical school and a stipend from MDSSP during residency plus a civilian doc salary...if you want to retire before 59.5 you will be able to without a pension just by saving.

Now, if you absolutely LOVE the active duty life and end up realizing that you want to do 20 years and retire at 51 to move on to other things then definitely go to USUHS. But don't be upset if your training is delayed, urology not available and/or WWIII breaks out.

Good luck in your decision!

thank you for your advice, and the insight on early retirement.

 

[Gas_Seal]

Congratulations on all of your acceptances - really a tremendous accomplishment. Whatever way you go, you'll do well.


You touch on but really don't note the full depth of the military residency risk on the USUHS con list:



In my opinion the real risk/con here is not so much the number of urology slots the AF has that's worrisome, though that adds some uncertainty to your ability to get one. It's the fact that by going to USUHS this year, you'll graduate and (probably) enter internship/residency in 2028, finishing your GME training sometime in the early 2030s. If you do any GMO time (less likely in the AF than it is in the Navy, but still a nonzero possibility) it may well be the mid 2030s before you exit residency. As a USUHS grad with a longer obligation, you don't have the easier HPSP exit option of GMO-and-out after 4 years.

There's a lot changing in military medicine now. Few of us would confidently say what we think inservice GME will look like in 5 years. By going to USUHS today, you're committing yourself to residency ~8-10 years from now in a system with a lot of questions hanging over what military GME is going to look like.

You don't have a strong financial reason to go to USUHS. With your GI Bill and some modest loans, you can certainly live well, even with a young family.

You can always rejoin afterwards if you really want to be in the military. This option is attractive because you can defer your decision until after your training is done, and you know what the state of military healthcare is at that moment.

I'm a 2002 USUHS grad and a cardiac anesthesiologist. I don't know much about urology, but when I retired from the Navy in 2022, I was increasingly anxious about the current and future caseload at Navy hospitals, even the large one I where I was stationed. I was heavily dependent upon off-duty moonlighting to meet minimum case numbers for my subspecialty. We had no cardiac surgery program at that time. Even the generalists had very light and not-especially-complex case loads. I was largely happy with my time and experience in the Navy but the trajectory of the case load and type was worrisome.


Your wife wants you to be a civilian. That alone might trump all other considerations. You're in the enviable position of having an acceptance to a quality public allopathic school, and the GI bill to pay for it. I think you should take that win. You can always rejoin afterwards.

thank you for sharing your insight on the state of military GME. I think going civilian and staying in the reserve through MDSSP, I will have the opportunity to experience the complex pathology of the private/academic sector and be able to contribute in critical moments if I am needed.

 

[Gas_Seal]

I’d recommend making complex decisions that span decades by considering the input from your spouse. That’s probably the best advise I can give you if you want a successful home life.

If you take MDSSP, you really won’t do anything with the military until you start your payback (minus any trainings). As someone who did MDSSP, it was a fine program at the time. But, now a days, the payback is so delayed and most go on to take STRAP. So just realize your contract / payback will easily span over a decade. The money is always nice up front, but on the back end isn’t so great compared to your civilian salary. I did get reserve retirement years during school and residency, which is nice. But, you’d want to calculate what your retirement would be if you stayed 20 years to see if really worth it.

Also the reserves functions quite differently than AD. If you thought AD could be jacked up, the reserves are 10x worse and everything is very slow for the most part.

As an alternative option, if a defined benefit pension plan is important to you, you could always plan to go academic medicine. Your salary will be more than AD and your pension will also be bigger, albeit start around 65.

thanks for your advice on MDSSP. I have looked into the reserve pension and though it wouldn't be something I could live off of, I do appreciate the other benefits it provides like Tricare, base access, life insurance, etc. If I were to go MDSSP I would shoot for a reserve retirement. I have heard there can be negative aspects to the reserve, and mind-numbing admin work, but I feel this would be much more tolerable if I am only doing if a few days a month, and spend most of my time in other endeavors. regarding the pension plan, I have thought that if I go civilian and don't enjoy the private sector, I could find a VA job. I have shadowed anesthesia and Urology at the VA and they seemed to have a great work-life balance.

 

[Gas_Seal]

First of all, congrats. You are in a great spot and at the end of the day this is a win-win. You asked about medical school so I’ll answer that first. USUHS is a fantastic medical school. It will prepare you very well for residency in whatever field you choose. You will graduate a clinically competent doctor. Michigan certainly is more of a brand name with a fantastic reputation and that’s about all that I can speak to. I graduated from USUHS so I am very biased. But I would put a newly minted USUHS intern up against any intern in the country. The product is very solid.

But that’s where any possible advantage ends for military medicine. Because the reality is that military GME is not in a good place right now. And this problem just continues as you move on to be staff in those same hospitals. In general, patients are healthy, volumes are low and complex pathology is lacking. I do know of Army USUHS graduates that are training at civilian academic centers in Urology. The Navy also has civilian training opportunities in Urology. I am not sure about the Air Force. Every speciality is different. And then also different by branch. So it is possible that you could go USUHS and train civilian for residency but this is unlikely. If you choose USUHS, you should accept that you will train via military GME. You *may* have civilian training as an option but it would *likely* come at a price of increasing your ADSO.

Having trained in both military GME and also civilian GME at a big academic center, I can tell you first hand there is a significant difference. And at the end of the day, residency is where you will build your every day skills that you will use as an attending. Advantage Michigan after residency, for sure.

Now you are staff. At an MTF, you will be much less busy. Which might not be a bad thing right out of residency while you learn how to settle in on your own. But you will risk skill atrophy as you won’t be seeing the volumes or complexity that you otherwise would. True, you can moonlight to supplement. This varies by specialty. Your work life balance in the military will be better. But your paycheck will be WAY less.

If your focus is on being the best urologist you can be, choose Michigan. It’s the safest bet.

The equation may change slightly towards the military if you are more concerned with work-life balance, less financial stress during training (you will be a very well paid medical student and resident), working with a unique population etc.

Good luck! I think you’ll be fine either way. Congrats again

thank you for your honest answer. I have visited USUHS, and I think it offers a fantastic and unique education that no other school in the country can compare to in terms of the development of military-physician-leaders. I think the summer experiences and Operation Bushmaster beats the extra-curricular activities of any other school. However, as you mentioned, something that is weighing heavily is my future after graduation. I will consider your insight as I make my final decision in the next month.

 

[DOlor]

Just want to chime in here. I was in a similar position. Decided to separate after a long service period. The pros just don't outweigh the cons. Although USUHS grads are prioritized for the military match over HPSP grads, many still don't match, or some have ended up being forced to go primary care if they wanted to match. (Worked with many USUHS grads and HPSP grads during my time. Civilian deffered residencies are extremely rare.) Additionally, you could look into buying back your time for retirement. If you wanted to still serve a military population, you can work for the V.A. and they will credit your service towards a government retirement with them. I have calculated this for myself, and I could retire at 57. Sometimes, the larger military hospitals (that are left) will hire civilian docs to fill specialized positions. (Saw this at SAMMC in San Antonio a lot). Finally,
I think the earning potential over your lifetime as a civilian could pay you more in retirement than the military pension. I also gave this up when I separated. But $110k per year over the lifetime you have left once retired if you live 30 years after that is about $3.3mil. If you can get partner in private practice like a friend I know, you could be making $600-$800k annual. Investing wisely through your own vanguard retirement could likely net you much more than that 3.3mil when it is time to retire. Also, as far as benefits like healthcare, the downside is yes, you won't have the free tricare. But I receive care from the VA, completely free from visits to medications, and I have CHAMPVA for my kid, which is max $3k yearly out of pocket, no monthly premiums so its worth applying after separating. There are lots of other options. Like someone else mentioned, you could also go reserve to get time in the military environment without the loss of pay and full commitment.

 

[comp1]

Definitely second working for the VA post residency. You can still keep your early retirement dreams alive AND leave active duty.

 

[ProwlerturnGas]

Working for the VA is like a slow agonizing torture while your eyes are pecked out by petulant unionized nurses.

 

[DOlor]

Working for the VA is like a slow agonizing torture while your eyes are pecked out by petulant unionized nurses.

I won't disagree with this completely but you have to research which institution. There are some really good VA hospitals and some really crap VA hospitals. Unfortunately the more common experience for folks is at a crap one.

 

[militaryPHYS]

I won't disagree with this completely but you have to research which institution. There are some really good VA hospitals and some really crap VA hospitals. Unfortunately the more common experience for folks is at a crap one.

Agree. Highly variable but also research what you're getting in to and make sure it coincides with your expectations. There is a place for everyone based on their desires and points of their career that they find themselves in.

 

[Tmoo374]

Gas_Seal, what did you decide? Going through a similar process myself - 8 years in and accepted to USUHS, but my top choice civilian programs (Emory and Brown) are private, so GI Bill (only 90%, so no yellow ribbon) will only cover about half of tuition.

 

[Gas_Seal]

Gas_Seal, what did you decide? Going through a similar process myself - 8 years in and accepted to USUHS, but my top choice civilian programs (Emory and Brown) are private, so GI Bill (only 90%, so no yellow ribbon) will only cover about half of tuition.

Congratulations those are top notch programs! I decided to go to Michigan. they are public, so GI bill will cover the tuition, and they kindly offered me a full tuition scholarship if the GI bill runs out early. I am also going before the Army Commissioning board this month to hopefully secure the MDSSP scholarship. if you are set on going to Emory/Brown you could take out loans to cover the remaining tuition and then do the Loan Repayment Program (LRP) with the army, or go to the VA for a few years, they also have a loan repayment around 50k/year that some of my friends are using. USUHS is a fantastic choice, depending on what specialty you want to pursue, it could be the best choice. if you already have 8 years in so if you do a 4 year residency you would only have 1 year left to retire with 24 after you finish your payback!

 

[pgg]

Gas_Seal, what did you decide? Going through a similar process myself - 8 years in and accepted to USUHS, but my top choice civilian programs (Emory and Brown) are private, so GI Bill (only 90%, so no yellow ribbon) will only cover about half of tuition.

If you have GI Bill benefits the obvious choice is to go to Emory or Brown. The loans won't be large.

If you still want to serve later and pick up the remaining 12 years of service for the retirement benefits, you can always join via FAP or direct accession, either of which would cover most or all of the loan amounts.

Strongly recommend that you defer the join decision as long as possible. It's just impossible to know, with certainty, what your life situation or goals will be in 4-5 years, or what military GME options will exist in 5-10 years.

 

[Tmoo374]

If you have GI Bill benefits the obvious choice is to go to Emory or Brown. The loans won't be large.

If you still want to serve later and pick up the remaining 12 years of service for the retirement benefits, you can always join via FAP or direct accession, either of which would cover most or all of the loan amounts.

Strongly recommend that you defer the join decision as long as possible. It's just impossible to know, with certainty, what your life situation or goals will be in 4-5 years, or what military GME options will exist in 5-10 years.

Thanks for the input, I have sort of come to the same conclusion. Too much uncertainty with the military match and I'd personally rather do a civilian residency. Where I get hung up is that Navy HSCP would put me at 12 years upon graduation, 15-17 on finishing residency, and 19-21 years on finishing the payback so I'd essentially be able to retire right away. I think I'm losing the perspective of how long those years may be though.