Vent your feelings about milmed gme here

[pgg]

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i'm just struggling with the fact that, how does military medicine get ANYONE to join given the negative impact it could/does have. surely not everyone is going in as ignorant as I was

Fear of debt. Desire to serve one's country. The hopeful/naive/arrogant feeling that since you are gonna be at the top of your med school class, the small matching pool and unpredictable competitiveness of some specialties won't affect you. The earnest and surface-believable promise (delivered annually since at least 1997) that the military will have done away with GMO tours "by the time you get there" ...

There are unique advantages and rewards to serving, but they are very individual and personal. In my case the good has far outweighed the bad in the Navy. But if the ONLY thing that attracts you to the military is debt aversion ... think twice.

 

[orbitsurgMD]

i'm just struggling with the fact that, how does military medicine get ANYONE to join given the negative impact it could/does have. surely not everyone is going in as ignorant as I was

They definitely have a more difficult time attracting candidates from the schools they used to get people from very regularly.

 

[175961]

this has really killed all other activities in my life, haha. I've been just sitting here thinking and reading, thinking and reading and then some about all this. i was interested in the military before i decided to apply for the HPSP, it wasnt as issue of "doing the whole military thing would be fun!". i did want to serve, i wanted to put on that uniform and be a part of something big. then i got into medical school and thought that I would get great training and experience and i honestly saw the graduate-with-no-debt thing as a tacked on bonus (a big bonus, but still just an appendage to the deal), it was not the reason i was going to do it, rather the only reason.
if going through milmed will in anyway make me less of a doctor than i would be if i did it all as a civilian, then bring on the debt.

 

[CanuckianSatori]

Fair enough.

But seriously, how is a prospective HPSPer supposed to come here and see the rants about mil-med, see the people who don't understand the basics of their contract, and not connect the dots to conclude "Well, that doesn't apply to me. I know what I'm getting into and these guys are just whiners who thought they signed up for free money"? It may not be the reality (and most likely is far from it), but it's certainly the appearance.

More just an observation than me having any real point to make.

I guess the reason I still visit this site, to see if I can reach that conclusion or not before signing (possibly) this spring. I'm really not sure how well the personalities on this board represent all of military medicine though.

 

[countingthedays]

.

 

[DrMetal]

I signed up for Navy HPSP ....

I don't quite understand why you started off on this thread in such a cynical manner. To be honest, I think your attitude about HPSP (as conveyed in your last post) is right on. It sounds like you knew what you were getting into (you did your homework, you didn't jump in blindly), you want to serve, you seem to be optimistic about your upcoming GMO tour, and you have a decent plan (to do your time as a GMO and punch out, which is totally fine).

Dont worry so much about your 'friend' in the AF (assuming you really are talking about a friend and not yourself). Yeah it's a crappy situation for him; not sure what he could do, maybe moonlight like crazy to make up for whatever he thinks he's missing. Can you moonlight as an IM res (R2, R3)? I dunno . . .

How old a guy are you? You have your whole life to be an anes. Go do something fun and memorable. What coast are you on? Catch a cruise on one of the Navy's newest big decks (the Makin Island outta San Diego, or the Bush outta Norfolk). I hear they brew Starbucks now in the ships stores and have WiFi throughout.

 

[The White Coat Investor]

i'm just struggling with the fact that, how does military medicine get ANYONE to join given the negative impact it could/does have. surely not everyone is going in as ignorant as I was

No, I think the vast majority of people in my "generation" were just as ignorant as you. I read the entire contract, I just didn't understand how medical training worked both in and out of the military and neither did my recruiter. It's fine, it's worked out all right. Not great. Wouldn't do it again. But it was all right. Nothing really bad happened to me. Of course I had 99%ile board scores, good grades, and strong letters so I got what I wanted out of the match, and I did my first deployment just before they changed to 6 month deployments and somehow escaped my second one due to another assignment. So all I had to deal with was a crappy assignment, crappy leadership, and not having any sick patients to take care of. Nothing big compared to most who go into milmed.

Good luck. Hope it works out at least as well for you as for me.

 

[faith2]

I did read the contract, and I still wanted to join. I have always been patriotic, and I am not scared to serve as a Dr. I am asking these questions about placement because I was not 100% sure. My recruiter did explain to me that the best places goes to those with seniority, and as long I can take my daughter ( obviously except deployment) I did not care. I am just trying to answer the questions that a BF has so he can be well informed. I want to really be apart of the arm forces, eventhough there are flaws. Based on my previous lifestyle the military can be no worse for me. I am looking forward to meeting my fellow brothers and sisters and hopefully form lasting friendships. In addition, I want my brothers and sisters in the field to know that they have quality Dr's for them and their families because eventhough I am not on the frontline with them I am behind them doing my part. The military will also give me discipline that I do not experience in my everyday life. I hope to make it a lifelong career, but if I am not able to is still an experience that I will able to tell my kids.

Accepted 2014 UCF!!!!!!
GO ARMY!!!!!!!!!!!!

 

[pgg]

Can you moonlight as an IM res (R2, R3)? I dunno . . .

Moonlighting as a inservice resident at a military program is verboten across the board.

 

[exafdoc]

i'm just struggling with the fact that, how does military medicine get ANYONE to join given the negative impact it could/does have. surely not everyone is going in as ignorant as I was

I believe few pre-med students truly understand GME and the residency matching system--I certainly did not. Unfortunately, most pre-med students that sign-up for HPSP also do not understand how the military further complicates the above. Given the lack of knowledge, many pre-med students are easily "tricked" or "lied to" by recruiters--I was. For instance, the statistic regarding the percentage of GME applicants that are allowed to train in their "first choice" specialty is deceiving. I am amongst that group because I was allowed to train in my "first choice" of radiology. However, I really wanted to go into dermatology. The AF would not allow me to apply for dermatology so I went with what was really my second choice.

The shame is that even if my recruiter had been truthful and forthright, I would have signed up anyways. I felt honored to join the military. But, when your are lied to or deceived it is natural to feel negatively toward the dishonest institution. I make no secret about the fact that I hated my time in the AF and that I think AF medicine is a disgrace (not everywhere, just at most institutions and not because of the physicians but because of the institution and leadership that is AF medicine). However, I would like to have at least made an informed and dumb decision to join the AF.

 

[DrMetal]

Moonlighting as a inservice resident at a military program is verboten across the board.

I thought so. So what do you do if you feel you're not getting adequate training? Can you ask your PD to farm you out to a civilian program for a while (if that's not already part of your program)?

 

[DrMetal]

I want to really be apart of the arm forces,

It's Armed Forces , not 'arm'.

Wow, you're shot out of a cannon. You're enthusiasm is nice. But just as how I'd caution against staunch pessimism, I'd also caution against blind enthusiasm. Military life isn't always great all of the time. You'll meet some of the best of folks, but you'll also meet some of the worst and self-serving of folks, who really dont give two shts about serving their country. Not everyone's your 'brother' or 'sister'. It's not as endearing as you think. Seriously, it's why we have a JAG corp.

On the happiness/enthusiasm scale, I think it's best to be about a '6' or '7'. If you're a '10'--overzealously happy, enthusiastic, optimistic about everything--then you're just delusional. The danger in this is that you don't see the bullsht and you lose your sense of reality. Moreover, you become timid and reluctant to bend/break stupid rules (even for the sake of a good cause).

You don't wanna be a '2' either, always miserable, always complaining. You gotta try to find something positive to bank on, as least for the sake of your own sanity.

 

[pgg]

I thought so. So what do you do if you feel you're not getting adequate training? Can you ask your PD to farm you out to a civilian program for a while (if that's not already part of your program)?

It's possible but very unusual to set up your own out rotations. If it's not already a part of your program there are huge hurdles -
- finding a place that will take you
- getting authorization from the RRC (I think?) so that the time counts
- your program director has a ton of administrative work to do to make it happen
- funding
My PGY4 year my PD arranged a new out rotation for me. He spent the better part of a year working out the details. It is not a common thing to do.

 

[jabreal00]

---------------- Listening to: Eclipse - Take Me Down (6 Underground) via FoxyTunes

I have no significant regrets about joining milmed. My residency training was pretty good. I graduated feeling competent. I had an awful year at my first assignment. I am back in GME for fellowship. So far it's going okay. Along the way I've saved a ton of money. I have no debt. My car is paid off. Other friends in my level of training have a ton of debt and are getting maybe $50K as fellows. However, they are where they want to be and are getting top notch training. Once I am done, I'll do my time and get out.

Would I do it again? No. I think my path was a bit of luck. The year I joined I had a strong class. Many of the staff who trained us have since retired or left. Another classmate of mine with similar scores didn't get picked up for the same fellowship. He was deployed for 12months. He is stuck in a place he doesn't want to be. He's two plus years into a four year obligation. He likely will finish his obligation in the place he and his family hates. He'll get out with a sour taste. That scenario could have easily been me. I got lucky.

If I joined today, the trajectory is too unpredictable. I'd rather control my own destiny as a civilian. There's just less variable. Buyer beware. If one wants to serve, then I'd say join. If one does it just for the money, think twice. Too each their own.

 

[ieatpizza]

thank you very much for the responses thus far. As per the FP, thats what i've wanted to do since i can remember. it runs in the family, and my desk is pretty much waiting for me when I get done with training. I did explore other areas of medicine during my time as an undergrad (several IM specialists, EM docs, surgery as well as FP). I know that my depth of knowledge of those specialties is nowhere near what I'll get while in med school and thereafter, but I do know that FP is what I'll be going into, it IS what i want to do as a doctor.

Essentially 100% chance for straight through training in FP and IM in the Army. These Army programs never fill all their slots because of the large number of positions and relatively low applicant interest. Also, essentially a 0% chance of civilian deferment in FP or IM because of this. All other specialties in the Army vary year to year because of the smaller number of training positions and variable interest of a relatively small applicant pool.

I may be biased, but in the Army, I think average to below average medical students going to lower- to mid-tier M.D. schools or D.O. medical schools are not missing out on better training opportunites as compared to their civilian counterparts minus specialties like general surgery, anesthesia, and emergency (and let's be honest, this makes up the majority of Army HPSP students). Whereas, I think the top medical students at mid-tier medical schools and students at the top-tier medical schools are missing out on better training opportunities as compared to their civilian counterparts.

 

[haujun]

Disclaimer: I am pretty cynical about the mediocre GME programs in the military, as you can probably tell by the thread title. The current state of military GME is especially sad considering a generation ago Walter Reed, Bethesda, etc. really did have outstanding training programs. Then came TRICARE.

GME is not a reward, it is an essential part of becoming a physician, and far more important than even medical school. Here's how I look at it: would you prefer for your own surgeon to be someone with an MD from Harvard who did general surgery residency at a USAF hospital or would you prefer a FMG or a graduate of an average US allopathic school who did residency/fellowship at Mayo or MGH? This is a no brainer.

What kills me is how strong medical students and interns have their careers derailed by a system that offers a tiny fraction of the opportunities that their civilian counterparts have. Yes, in the civilian match some people don't get what they want. However, when that happens it is usually because the applicant was not strong enough for the field. Take a moderately competitive field like anesthesia -- 90% of US allopathic grads will get a spot. Now consider the USAF match where not even half of anesthesia applicants will get a spot. A solid but average student will probably not even match into AF anesthesia at all, when he/she would be fine at many civilian programs (maybe not MGH or Hopkins, but certainly a solid university program). The HPSP students who are strong enough to match into AF anesthesia have solid, at least above average credentials. These are the candidates who probably could get anesthesia interviews at Hopkins or MGH. Instead they hustle to get a spot at Wilford Hall or Travis where their most difficult cases are laparoscopic cholecystectomies. It doesn't matter if your step I was 247, you will not become an excellent anesthesiologist by training at "medical centers" where the SICU is empty except when the choles go bad and patients end up septic -- which apparantly is not unheard of in military hospitals.

In sum, Air Force HPSP is a serious often a terminal condition that ruins careers before they even leave the runway. The Army and Navy subtypes are not as deadly, but still approach them with caution. If you are stuck, do four and out (I'm Navy and am doing just that). Work hard as a GMO/FS/UMO, don't be complacent, READ, and take care of your people to the best of your ability; they deserve nothing less. Then get out. This system is only going to get worse.

Quality GME is worth waiting for. At some point you have to have enough respect for yourself to do your time and sever your ties to milmed.

What is quality GME? Residency filled with lots of opportunities and interesting cases? You may have to wait long time. Here are the facts.

Fact#1:Military recruits healthy young people and when they get super sick/retired the tricare has option to defer their care to civilian sector.

Fact#2: Military know that most of you will get out after obligation

Fact #2: Having all volunteer military system create impossible task of recruting civilian doctors to go to war.HPSP is created to send trained officer/doctor to the war and provide medical support.

Fact #3: You are soldier. Your pay is not based on productivity. It is based on rank and years of service with special pay given to all physician--competent or not.

When you comebine all those facts you get this present GME system which is not bad (may be best possible?) after considering all those facts. The way it conduct business will not change unless those facts change.

Bottom line: If you want to take control of your life and make a lot of money by practing good medicine and good business then stay out of the military.

 

[faith2]

Thanks for the correction I will not make that mistake again. I also appreciate your advice, and your scales make sense. Please just wish me luck and hope I come out of the Army with the same attitude I had going in. Well maybe even a better one.
Class of 2014 UCF
GO ARMY!!!!!!!!!!!

It's Armed Forces , not 'arm'.

Wow, you're shot out of a cannon. You're enthusiasm is nice. But just as how I'd caution against staunch pessimism, I'd also caution against blind enthusiasm. Military life isn't always great all of the time. You'll meet some of the best of folks, but you'll also meet some of the worst and self-serving of folks, who really dont give two shts about serving their country. Not everyone's your 'brother' or 'sister'. It's not as endearing as you think. Seriously, it's why we have a JAG corp.

On the happiness/enthusiasm scale, I think it's best to be about a '6' or '7'. If you're a '10'--overzealously happy, enthusiastic, optimistic about everything--then you're just delusional. The danger in this is that you don't see the bullsht and you lose your sense of reality. Moreover, you become timid and reluctant to bend/break stupid rules (even for the sake of a good cause).

You don't wanna be a '2' either, always miserable, always complaining. You gotta try to find something positive to bank on, as least for the sake of your own sanity.

 

[175961]

just out of curiosity....what "bonus", if any, do recruiters receive when they get people to sign on for the HPSP??

 

[a1qwerty55]

i'm just struggling with the fact that, how does military medicine get ANYONE to join given the negative impact it could/does have. surely not everyone is going in as ignorant as I was

Have you ever seen a thread on any topic on the internet which wasn't dominated by angry people?

If you desire FP, (understanding you could change your mind) and are going Army, there is zero chance you won't go straight through in your training. As most have acknowledged, Army and other military FP residencies are very strong. You also will come away with the financial benefits coming from the HPSP scholarship (most agree that the financial reward is better for those going into primary care), and experience your civilian partners will absolutely never experience. You will be doing something for your Country and its servicemen/women. You also will be a Veteran which often has benefits you may not realize.

Plenty of us join, are happy with the choice, and practice very high quality medicine. Most happy people don't cruise medical student websites bashing military medicine. That being said I'm glad for full disclosure that the info is out there, I just tend to believe it has a more negative slant than what is reality.

If you can't handle the idea you lose control over where you live, and will likely deploy for a year or possibly more, and will have to deal with some military specific annoyances - then please don't join. You after all are not joining the Peace Corps, this is the military and the priorities of the military come before yours - fortunately the priorities of the military and physician can be the same.

 

[Kramerica]

Have you ever seen a thread on any topic on the internet which wasn't dominated by angry people?

👍👍

Originally Posted by cuadrado
i'm just struggling with the fact that, how does military medicine get ANYONE to join given the negative impact it could/does have. surely not everyone is going in as ignorant as I was

Originally Posted by a1qwerty55
...and experience your civilian partners will absolutely never experience. You will be doing something for your Country and its servicemen/women.

Regardless of the negativity on this board I signed the Army HPSP contract and this is my motivation. First and foremost I've always wanted to serve my country and my goal is to eventually become a general surgeon on a FST (clearly being deployed isn't an issue for me). The money is an added incentive but is not a deal maker because my family and I would be able to take on the financial burden of medical school.

I have taken into consideration and am thankful for the opinions on this board because they give direct insight into life in the armed services. Though there are many deficits in pursuing military medicine I made my decision on what I felt was best for me and the future career path I want to pursue.

So that is why I choose to take the Army HPSP scholarship.

 

[AFDuck]

I signed up for Navy HPSP knowing that I probably would not go straight through. It didn't matter because I wanted to serve in the military for a few years. Despite my current cynicism about the system as a whole, I'm still glad that I signed up and would do it again. However, I am actually grateful that FS/UMO/GMO x4 years is an option, because I was suprised that military GME is not as good as I thought it would/should be. It is with respect to the quality of military GME that I was naive.

That is not a criticism of all military physicians. The average military resident is probably more professional than the average civilian resident. The problem is that the civilians have far more patients to take care of and learn from.

My beef with the USAF is what I have seen it do to the careers of others. A medical school classmate did USAF HPSP basically to pay for school. That was a stupid decision, but he is a very smart guy -- graduated AOA. Any internal medicine residency would have interviewed him. However, he got to choose from the USAF IM programs, and he is training at a med center that is basically a glorified clinic. Therefore, the trajectory of his career dramatically changed for the worse because of AF HPSP. Again, it doesn't matter if you are AOA or have a step one of 250 -- without taking care of lots of sick, complicated patients as a resident, you will not become as good of a physician as your civilian counterparts who trained at quality civilian programs. Period.

That's where I am coming from.

Ultimately, doing four and out doesn't have to be a bad experience. Again, I am very grateful to have the option of serving my country and then moving on to civilian training. I love my patients, and ultimately I think this experience -- coupled with a solid residency -- will make me a much better physician than I otherwise would have become. Taking a few years to serve your country after internship is not necessarily a terrible experience. It is far preferrable to getting stuck with several years of poor training. Consider Dr. Oglesby Paul, former dean of Harvard Medical School whose training was interrupted for four years:
http://alumnibulletin.med.harvard.edu/bulletin/spring2008/paul.php

In sum, Army or Navy HPSP may or may not be the right choice for you. Make an informed decision. However, for the reasons cited before, I cannot understand how any informed person could sign for AF HPSP.

It seems to me that your friend's anecdotal experience could be that of an IM resident in any of branches, so I would argue that your points about milmed apply fairly evenly to all 3 branches. For example, the biggest AF GME location (San Antonio) is now fully integrated with with the Army programs, so the residents in both services there are getting the exact same training. I'm guessing your friend would've been disappointed with any military IM program, and that fact he was AF was just by chance.

 

[BOHICA-FIGMO]

I stand by the assertion that Air Force GME is across the board inferior to the civilian setting.

Have to agree. I was a former USAF officer. I assure the USAF has nothing that compares to the Navy's "Big Three." Wilford-Hall used to be that good (and they had some deal worked out with San Antonio to take civilian trauma) but sadly, it is no more.

I did my internship at one of the Navy's big three. Pediatrics, dermatology, and orthopedics were standout programs, comparable to highly respected civilian university-based programs. Internal medicine, OBGYN, anesthesiology, and psychiatry were all fine -- some good faculty, but with limited pathology in the patient population (thank you TRICARE), the training is not as good as at most university-based programs.

Can't really speak for peds, derm, and psych. Ortho seems outstanding based on a month rotating. All the others I would probably disagree with. OB-GYN, are you kidding me? Have you seen the rate that sailors crank out babies?!? Anesthesiology seems pretty solid, you get everything except trauma and limited cardiology. IM could be better, but there is a LOT of variation in the civilian world.. Sure it's not Mass Gen, but I'd probably rank it in the middle of the pack relative to civilian IM programs I've seen.

However, in my opinion, Navy general surgery and EM are, ironically, crap programs because you just don't have the patient volume or pathology to appropriately train young doctors. These programs rely on away rotations (at CIVILIAN hospitals) and fudging ACGME requirements to stay accredited.

I can guess which med center you are at based on the surgery comment. I've got several friends who are surgery interns and I don't think it is like that everywhere. Again, the lack of trauma and thoracic cases is a hinderance. As for EM, I totally agree. Our ED hardly ever sees: CVA, STEMI, NSTEMI, pneumothorax, or trauma of any sort. And the funny thing is, we have every department in the hospital (esp. medicine and surgery) pushing to take more trauma and hyperacute cases, but THE ED is pushing back!!!

 

[countingthedays]

OB-GYN, are you kidding me? Have you seen the rate that sailors crank out babies?!? Anesthesiology seems pretty solid, you get everything except trauma and limited cardiology. IM could be better, but there is a LOT of variation in the civilian world.. Sure it's not Mass Gen, but I'd probably rank it in the middle of the pack relative to civilian IM programs I've seen.

Yes OBGYN at NNMC, NMCSD, or NMCP are excellent for routine OB training. Their complicated OB services are low volume (though the one active duty MFM Navy physician I met was excellent). There is very limited GYN-ONC training there. So it depends on what you want, but, ultimately, it does not compare with the elite civilian programs. It probably could if TRICARE didn't pawn off the complicated cases.

Anesthesia -- they are at best average programs compared to the civilian side. Again, the SICU at the MTF I trained at was often empty. You don't see many AAA's or extremely sick patients in a Naval Med Cen. However, these are the cases that you should see as much as possible as a resident. The objective of anesthesia residency is not to master bread and butter cases -- that's what student nurse anesthetists do.

Internal Medicine -- agree -- middle of the pack compared to civilian programs. So if you are an average to below average student, these programs are good matches. However, if you were an above average allopathic medical student, you probably could have gotten much better training civilian-side.

 

[faith2]

I am glad to see other HPSP that are happy with the decision that they made. I think we are going to be okay because MONEY was not our only incentive. I hope to meet you this summer.

👍👍

Regardless of the negativity on this board I signed the Army HPSP contract and this is my motivation. First and foremost I've always wanted to serve my country and my goal is to eventually become a general surgeon on a FST (clearly being deployed isn't an issue for me). The money is an added incentive but is not a deal maker because my family and I would be able to take on the financial burden of medical school.

I have taken into consideration and am thankful for the opinions on this board because they give direct insight into life in the armed services. Though there are many deficits in pursuing military medicine I made my decision on what I felt was best for me and the future career path I want to pursue.

So that is why I choose to take the Army HPSP scholarship.

 

[DeadCactus]

👍👍

Regardless of the negativity on this board I signed the Army HPSP contract and this is my motivation. First and foremost I've always wanted to serve my country and my goal is to eventually become a general surgeon on a FST (clearly being deployed isn't an issue for me). The money is an added incentive but is not a deal maker because my family and I would be able to take on the financial burden of medical school.

I have taken into consideration and am thankful for the opinions on this board because they give direct insight into life in the armed services. Though there are many deficits in pursuing military medicine I made my decision on what I felt was best for me and the future career path I want to pursue.

So that is why I choose to take the Army HPSP scholarship.

HPSP (and all of the other student programs) is not really about serving anyone. They're about getting a check while you're in school. The service comes later at a point where people who never took any such program can jump in and serve just as much as any HPSPer, but retain control of their training.

That's been the number one point I've seen among the anti-HPSP crowd...

 

[Perrotfish]

HPSP (and all of the other student programs) is not really about serving anyone. They're about getting a check while you're in school. The service comes later at a point where people who never took any such program can jump in and serve just as much as any HPSPer, but retain control of their training.

That's been the number one point I've seen among the anti-HPSP crowd...

HPSP is about giving you the financial ability to serve your country at a point in your life when it's still practical to do so. I basically couldn't join after residency, I would be drowning in a crazy debt that I could not pay even with FAP, and nearly my entire salary would have to go towards servicing that debt. Either I would need to wait until my early 40s to join or I need to go through HPSP

 

[faith2]

👍👍👍👍

HPSP is about giving you the financial ability to serve your country at a point in your life when it's still practical to do so. I basically couldn't join after residency, I would be drowning in a crazy debt that I could not pay even with FAP, and nearly my entire salary would have to go towards servicing that debt. Either I would need to wait until my early 40s to join or I need to go through HPSP

 

[usnavdoc]

All military residencies are the equivelant to decent civilian community hospital programs. They dont compare at all to University based programs.

 

[mac61]

HPSP (and all of the other student programs) is not really about serving anyone. They're about getting a check while you're in school. The service comes later at a point where people who never took any such program can jump in and serve just as much as any HPSPer, but retain control of their training.

That's been the number one point I've seen among the anti-HPSP crowd...

I realize you're paraphrasing your impression, but I assure you there are those of us out here that committed themselves to careers in the military because they truly enjoy the mililtary, NOT just because of the money.

It is argued that one can not know what they're really getting into at the pre-medical/undergraduate medical stage. I agree. The caveat is that some of us are willing to accept that the system is broken, and choose to serve anyway for reasons far removed from the monetary benefit. Does it matter that the world outside of the military is "better" ? Does it matter that training could be delayed? Does it matter that care is touted as sub-standard?

I say that these arguments are a matter of perspective. If one is of the mind-set "If I don't mind, it don't matter" AND works to be the best that they can, I say good on 'em. After all, success in adversity is always more noble than success in luxury.

I came to USUHS because I love the Army. I have/had no idea what Army medicine is like because I am very young in the field (but I did watch the entire series of MASH). Similarly, people who enlist/commission don't REALLY know what the military is like until they've been in for 8-10 years (because the first four years suck substantially more than the second; comes with being a private/LT), no matter how many movies they've watched, how many recruiters they've talked to, no matter how long they've been military brats.

ALL aspects of military service involve a SIGNIFICANT amount of sacrifice. Whether you take the scholarship, or the FAP route, it's going to be a sacrifice. There is merit to limiting the amount of sacrifice and waiting, but the fact remains that level of sacrifice varies between careers and individuals; there is no real way of appreciating the sacrifice until you've made it, no matter how much it is explained. This is why people say "Thank you for your service." If it were easy, everyone would do it. You're either going to take it in stride and overcome, or be crushed by wallowing sorrow, scholarship or not.

If you're swayed by these forums, then you likely weren't up for the challenge anyway.

 

[DeadCactus]

HPSP is not about service. Serving in the military is about service. The decision to take HPSP, FAP, go to USUHS, etc. is about economics and training. A rebuttal about how HPSP makes it more financially comfortable to serve in the military and some irrelevant rant about the glory of service don't do much to counter that point.

Mentioning service as a reason for taking HPSP or USUHS is particularly irrelevant. Service is a ubiquitous feature among all the military options. You might as well say you took HPSP because you like air and you get all the air you can breathe with HPSP.

You committed to the military (hopefully) because you wanted to serve. You took HPSP or went to USUHS because you wanted the economic incentives. The two are intertwined, but separate decisions.

That's the root of the anti-HPSP argument. While many of argue against HPSP based purely on the experience of being a physician in the military, the strongest argument against the issues related to graduate education.

I find it irritating that on a board that should help people make these important decisions, so many want to obscure the decision really being made. People are trying to make the HPSP decision come down to "Is the money worth the loss of control and chance to serve?" The real decision is "Is having this money now worth the loss of control in my training?"

You're not serving as a HPSP or USUHS student. You serve as a physician in the military. How you get to that point has no bearing on being able to serve and is thus only an issue of finances and training.

That's the reason so many are against HPSP. You're trading off your GME for a financial carrot. The idea of service is a distraction and something that can be achieved without giving up control of your GME.

There are a lot of arguments for taking HPSP. Service is not one of them. Service is something that should have been decided on before ever even looking at HPSP and becomes irrelevant the second you decide to serve in the military and move on to deciding what program to enter through...

 

[mac61]

HPSP is not about service. Serving in the military is about service...

Mentioning service as a reason for taking HPSP or USUHS is particularly irrelevant. ...

... You took HPSP or went to USUHS because you wanted the economic incentives. The two are intertwined, but separate decisions.

My point is that HPSP/USUHS are 100% about service. The mindset that taking these scholarships is a purely financial decision is the error that those who oppose the scholarship slip into.

The military uses financial compensation to make the sacrifices of services less daunting. Even the most altruistic of our society can be pushed to ask "What's in it for me?" This is the same reason for student loan repayment, reenlistment bonuses, reenlistment for choice of duty station, enlistment for training opportunities, etc. The military recognizes the sacrifice, and tries (not necessarily succeeding) to use financial compensation to push those close to making the sacrifice of service toward the decision.

The difficulty becomes the fact that the sacrifices that are made by those who accept scholarships, etc. are not/can not be fully appreciated so early in a career.

I truly believe that this forum has done a pretty good job at helping people understand that HPSP/USUHS should NOT be a financial decision. I did not come to USUHS for the financial incentive, I am here because I thought that it would be the closest thing to staying in the Army I could have while getting my degree.

So, to make my argument more relevant in a more obvious way: Military GME is broken in many various ways, as is MILMED. The fact that your training has a decent chance of being delayed is a MAJOR deal. The fact that practicing/training in potentially substandard conditions is a MAJOR deal. The monetary compensation alone is NOT intrinsically worth it. The service that has been labeled irrelevant is what makes the sacrifices "worth it."

If people look at taking the scholarship as a reward for committing to serve rather than being required to serve as a condition of receiving monies, the argument would become null. Unfortunately, financial stress drives people to make poor decisions without fully understanding them when opportunities are presented as "carrots". (There is no love lost here for the recruiters who make the presentation as such.) Many people who are not driven to serve accept the scholarships and THEN realize that they aren't really cut out for the sacrifices of service. Therein lies the dissension found here.

 

[DeadCactus]

You're trying to tie together the decision to join the military with the decision of which method to enter through. Service is an issue in deciding the former, it has nothing to do with the latter.

It makes no sense to talk about service as a reason to take any one specific route to entering the military. "I took HPSP because I wanted to serve" or "I went to USUHS because I wanted to serve" are nonsensical statements. It's like saying "I bought a Ford F150 because I wanted a truck". Sure, it explains why you didn't buy a Honda Civic, but it's not a reason for specifically buying an F150.

The point is, people get caught up spouting nonsensical reasons for taking HPSP. "I took Program X because I wanted to serve" only explains why you did not go the civilian route, it has nothing to do with why you chose whatever specific program.

I'd hope the majority of people can say at least partially "I decided to join the military because I wanted to serve. I specifically chose HPSP/USUHS/FAP/etc for reason X."

What X is will vary from person to person and each program has a large number of good reasons to sign up for it. In general X will involve economic and training issues. But the one thing X is not is service; that motive was already fulfilled by the decision to join the military. By the point of deciding between various programs, you're beyond "service" being a valid reason just as "I wanted a truck" is not a valid reason for choosing an F150 over a Tundra.

Why make such a big deal out of a seemingly trivial point? Because I fully believe that a person who cannot list and justify a solid reason X to themselves should not be signing up. I constantly see long drawn-out posts where the only reason a person can state for taking HPSP is to serve.

"I want to serve so I'm going to take HPSP" is terrible logic. "I want to serve and buy choosing HPSP over the alternatives I'm gaining the A and losing B. I find this to be a solid investment" is not...

 

[175961]

wow, i think one could write a thesis on "why i chose to accept the HPSP" I didnt know there were so many reasons, or ways to analyze, why


/sarcasm

 

[orbitsurgMD]

HPSP is not about service. Serving in the military is about service. The decision to take HPSP, FAP, go to USUHS, etc. is about economics and training. A rebuttal about how HPSP makes it more financially comfortable to serve in the military and some irrelevant rant about the glory of service don't do much to counter that point.

Mentioning service as a reason for taking HPSP or USUHS is particularly irrelevant. Service is a ubiquitous feature among all the military options. You might as well say you took HPSP because you like air and you get all the air you can breathe with HPSP.

You committed to the military (hopefully) because you wanted to serve. You took HPSP or went to USUHS because you wanted the economic incentives. The two are intertwined, but separate decisions.

That's the root of the anti-HPSP argument. While many of argue against HPSP based purely on the experience of being a physician in the military, the strongest argument against the issues related to graduate education.

I find it irritating that on a board that should help people make these important decisions, so many want to obscure the decision really being made. People are trying to make the HPSP decision come down to "Is the money worth the loss of control and chance to serve?" The real decision is "Is having this money now worth the loss of control in my training?"

You're not serving as a HPSP or USUHS student. You serve as a physician in the military. How you get to that point has no bearing on being able to serve and is thus only an issue of finances and training.

That's the reason so many are against HPSP. You're trading off your GME for a financial carrot. The idea of service is a distraction and something that can be achieved without giving up control of your GME.

There are a lot of arguments for taking HPSP. Service is not one of them. Service is something that should have been decided on before ever even looking at HPSP and becomes irrelevant the second you decide to serve in the military and move on to deciding what program to enter through...

One of the more incisive assessments of the topic. This should get a sticky.

 

[Kramerica]

"I want to serve so I'm going to take HPSP" is terrible logic. "I want to serve and buy choosing HPSP over the alternatives I'm gaining the A and losing B. I find this to be a solid investment" is not...

I think this hit the nail on the head, and unfortunately I'm one of the people who didn't clarify my opinion earlier. Serving the country is #1, but also having a solid financial backing while during Med School with a monthly stipend is a major plus. As is going to medical school on the Army's dime which saves me future loans and my family from paying for school. I don't know if I would take the HPSP if I didn't plan to make a career out of military medicine, but because that is my current goal its the best for my personal situation.

 

[notdeadyet]

This isn't directed at anyone, but I hear lots of non-prior service folks talk about wanting to do HPSP and work in milmed to retirement.

To be honest, that makes about as much sense to me as a senior in college saying when he graduates, he is planning on working for Google for the rest of his life.

 

[Kramerica]

To be honest, that makes about as much sense to me as a senior in college saying when he graduates, he is planning on working for Google for the rest of his life.

I think it's a little bit absurd to compare a private for-profit cooperation to a 235 year old organization whose goal is to serve and protect a nation.

 

[backrow]

I think it's a little bit absurd to compare a private for-profit cooperation to a 235 year old organization whose goal is to serve and protect a nation.

Don't get your panties in a wad

The comparison made was between a decision making process, not the organizations involved.

 

[Gastrapathy]

This is all very nice philosophy but it ignores some basic facts. HPSP is the largest commissioning source for milmed. FAP is specialty-specific and not always available. The uniform advice to "just wait for FAP" ignores that and further ignores the reality that most people would change their minds in the interim. The financial "benefit" of HPSP IS its primary draw for most applicants and all this other stuff is window-dressing. You can argue that this SHOULDN'T be true but the system survives in its current state because people join for the money.

 

[Kramerica]

Don't get your panties in a wad

The comparison made was between a decision making process, not the organizations involved.

I didn't really care about the comparison as much as I thought it was an illogical analogy.