Why All The Gloom & Doom Over HPSP?

[Detective SnowBucket]

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I've heard so many people say they would not recommend HPSP and I ask them why and they tend to blow me off. No one can give me a real answer why I shouldn't.

I want to go into medicine.
I want to go into the military.
I want to go into a critical wartime specialty.
If I don't go to medical school, I will spend 4 years in the military all the same.
I have no problem doing a military residency.
I have no problem deploying and not choosing where I serve my active duty time.

In this light, is there any reason not to do HPSP?

 

[militaryPHYS]

Are you ok if your specialty is not available when you apply and you end up doing 4 years as a general medical officer?

Are you OK training as some sort of surgeon and then having lower than normal volume/complexity during your payback?

I think if the answer is also yes to those additional questions then it sounds like you have done your homework. Make sure you shadow or at least verbally discuss your decision with a current MilMed doc

 

[HighPriest]

Do you want to be a military officer more than a doctor? If you had to sacrifice a part of all of the work you did to become a physician in lieu of being a military officer, would you be ok with it?

 

[pgg]

I've heard so many people say they would not recommend HPSP and I ask them why and they tend to blow me off. No one can give me a real answer why I shouldn't.

I want to go into medicine.
I want to go into the military.
I want to go into a critical wartime specialty.
If I don't go to medical school, I will spend 4 years in the military all the same.
I have no problem doing a military residency.
I have no problem deploying and not choosing where I serve my active duty time.

In this light, is there any reason not to do HPSP?

No, milmed sounds good for you, if those things are true. You're the kind of person we want to have as a future colleague.

However, some things to consider -

I've heard so many people say they would not recommend HPSP and I ask them why and they tend to blow me off. No one can give me a real answer why I shouldn't.

This is concerning. You've been here a while, and the cons that have been presented (even by very unhappy disgruntled people) are "real answers".

I want to go into a critical wartime specialty.

You think you do, today. Be aware that a majority of pre-meds who actually go to medical school end up in a specialty other than what they had planned. This is totally normal. No one gets meaningful exposure to different specialties, and the lives of physicians in those specialties, until they start their 3rd year clerkships (sometimes 2nd year, depending on the school).

I know, I know ... changing one's mind is what OTHER people do. Finishing in the bottom 1/4 of a medical school class is what OTHER people do. Not matching to one's desired specialty happens to OTHER people.

How do you know you won't fall in love with radiation oncology? Or pediatric cardiology? Maybe you're in the huge flock of pre-milmeds who are all excited about trauma and emergency medicine but then discover that 90% of an EM practice is treating people who aren't sick or injured, sniffles, chest pain that turns out to be GERD, sprains, needs-a-note-to-get-outta-work ... mostly on night and weekend shifts.

If I don't go to medical school, I will spend 4 years in the military all the same.

No, it's not all the same. 4 years in the military as a line officer is worlds different than the medical corps.

If it's "all the same" to you, and you want to serve in the military, be a line officer for a while. Do great things, hit O3, and if you still want to be a doctor, go to medical school on the GI Bill. This is an awesome debt-avoidance path and spending a few years serving your country will be valuable and rewarding.

I have no problem doing a military residency.

You're 5-10 years away from getting there. I have no idea what inservice GME will look like - even in war critical specialties - ten years from now. What makes you think you know what it'll be like?


To an extent, everything we do in life has a degree of uncertainty tied to it.

If you told us you understood all of this uncertainty, and that you accepted it, that would be one thing. What's concerning about your post is that you seem so certain your assumptions are correct. And once again, this line:

No one can give me a real answer why I shouldn't.

makes me worried that you're having an easier time seeing affirmation than information. I don't doubt your sincerity ... just ... there are cons to go with the pros, and they are real, and you don't seem to be seeing them.


When I was a GMO, I had a Marine who was getting adsep'd out for an adjustment disorder. As the story went, he liked to draw, and his recruiter told him he could draw cartoons for the Marine Corps Times or some crazy thing like that. I'm sure somewhere along the line someone told him that they'd probably give him a rifle and send him to an infantry battalion and that the Marines really didn't need anyone to sit around and doodle all day. And I bet at some point he dismissed those opinions as not being real answers ...

But good luck to you. We need good, motivated people to join. Those of us serving want colleagues who join for the right reasons and with sound expectations.

 

[Detective SnowBucket]

To an extent, everything we do in life has a degree of uncertainty tied to it.

If you told us you understood all of this uncertainty, and that you accepted it, that would be one thing. What's concerning about your post is that you seem so certain your assumptions are correct. And once again, this line:

Ah, I think I have just mis-expressed myself. When I said I am not worried about those things, I mean to say I am fine with the uncertainty of it all, the same kind of uncertainty as not being able to choose if I deploy, or where I serve. I know that uncertainty would be terror for some people but I am fine with not knowing that too. I understand the uncertainty of whether or not the specialty I want at the time may even be offered.

Thank you very much for this.

 

[Detective SnowBucket]

Are you ok if your specialty is not available when you apply and you end up doing 4 years as a general medical officer?

Are you OK training as some sort of surgeon and then having lower than normal volume/complexity during your payback?

I think if the answer is also yes to those additional questions then it sounds like you have done your homework. Make sure you shadow or at least verbally discuss your decision with a current MilMed doc

I like to think I've done my homework.
I am fine with not matching then going GMO (that's a little bit of a lie, I'd rather go straight through, but if I match eventually and pay half of my time back before residency and the rest after, it's all ok if I get the specialty I want when I'm at that bridge to cross, whatever it may be then).
I am also Ok with lower volume/complexity (I think?). I don't want to sound like a know it all on this one, but I did get to shadow a Navy orthopod and I really didn't see any less volume than what a civilian would expect, I cannot comment as to complexity, though I would imagine for ortho that kind of complexity can show up in any population. What do you think about all this?

 

[DocSurgeon]

I like to think I've done my homework.
I am fine with not matching then going GMO (that's a little bit of a lie, I'd rather go straight through, but if I match eventually and pay half of my time back before residency and the rest after, it's all ok if I get the specialty I want when I'm at that bridge to cross, whatever it may be then).

Except you're not going to do half your payback as GMO and half after. You're going to pay back time as GMO then accrue more time in residency and wind up back at your original payback time and more. Example... 4 HPSP years + 0 intern year (payback neutral) - 3 GMO years + 5 ortho years = 6 year payback as attending staff = 15 years active duty. This is fundamental that all students applying understand this concept.

 

[militaryPHYS]

What do you think about all this?

Sports, Hand and Basic Trauma maintain pretty good numbers most places (big or small MTF). The other subspecialties (Joints, Foot and Ankle, Pediatrics, Spine) you have to stay at a large MTF to maintain numbers. But, to answer your question, yes, ortho is one of the easier specialties to maintain decent numbers and complexity, but it still won't be what a civilian surgeon does.... (which is good or bad depending on the person).

Planning for ortho is tough. Don't even consider/plan for it until you see how you fall out after taking STEP I. Unfortunately it is a benchmark that automatically screens people out even if you are otherwise an awesome person/applicant. It isn't right, but it is a fact.

 

[pawprint]

Example... 4 HPSP years + 0 intern year (payback neutral) - 3 GMO years + 5 ortho years = 6 year payback as attending staff = 15 years active duty. This is fundamental that all students applying understand this concept.

I know this is unrelated but I want to clarify in case anybody reads this and gets confused. The total payback is 5 years following residency, not 6. HPSP and residency payback are paid back concurrently, not consecutively.

For example, I’m peds. I did 4 years HPSP + 0 years peds intern - 3 years as flight surgeon + 2 years peds residency = 2 years payback of being a peds attending.

One of my programs staff attendings made the mistake of thinking she owed 3 years (thinking Hpsp and residency run consecutively) and was surprised to find out she could have put her separation in a whole year earlier than she thought. Don’t make that mistake!

 

[Detective SnowBucket]

Except you're not going to do half your payback as GMO and half after. You're going to pay back time as GMO then accrue more time in residency and wind up back at your original payback time and more. Example... 4 HPSP years + 0 intern year (payback neutral) - 3 GMO years + 5 ortho years = 6 year payback as attending staff = 15 years active duty. This is fundamental that all students applying understand this concept.

How does that come out to 15 years active duty? Residency is neutral for payback so it's only 4 years of payback and can't you do that all as GMO, or none? Then there is some commitment as reserve but not 11 years.

 

[Detective SnowBucket]

I know this is unrelated but I want to clarify in case anybody reads this and gets confused. The total payback is 5 years following residency, not 6. HPSP and residency payback are paid back concurrently, not consecutively.

For example, I’m peds. I did 4 years HPSP + 0 years peds intern - 3 years as flight surgeon + 2 years peds residency = 2 years payback of being a peds attending.

One of my programs staff attendings made the mistake of thinking she owed 3 years (thinking Hpsp and residency run consecutively) and was surprised to find out she could have put her separation in a whole year earlier than she thought. Don’t make that mistake!

If you did 3 yrs Flight Surgeon then why did you have to pay back another 2 yrs? I thought it was 4 yrs payback unless you have a long residency which can extend it.

 

[pawprint]

If you did 3 yrs Flight Surgeon then why did you have to pay back another 2 yrs? I thought it was 4 yrs payback unless you have a long residency which can extend it.

Hpsp incurs 4 year payback (year for year). Residency incurs year for year payback (intern year neither incurs payback time or allows you to payback Hpsp time, so it’s a neutral year). But you pay them back concurrently. GMO/flight/dive time allows you to start paying back Hpsp time but once you go back to residency, you’ll start incuring residency payback obligations.

So for my example, I incurred 4 years payback from my Hpsp, didn’t gain/lose anything intern year, paid off 3 years Hpsp as a flight surgeon (have 1 year of Hpsp payback left when I start residency again), and then I will incur 2 years of residency payback. So leaving residency, I owe 1 year for my remaining Hpsp and 2 years for my pediatric residency. However, they are paid back concurrently (at the same time), so my first year as a staff attending I am paying off my last year of Hpsp and 1 year of residency. My second year as a staff attending I’ll be paying off my 2nd year of residency.

This is straight from BUMED.

 

[Detective SnowBucket]

Hpsp incurs 4 year payback (year for year). Residency incurs year for year payback (intern year neither incurs payback time or allows you to payback Hpsp time, so it’s a neutral year). But you pay them back concurrently. GMO/flight/dive time allows you to start paying back Hpsp time but once you go back to residency, you’ll start incuring residency payback obligations.

So for my example, I incurred 4 years payback from my Hpsp, didn’t gain/lose anything intern year, paid off 3 years Hpsp as a flight surgeon (have 1 year of Hpsp payback left when I start residency again), and then I will incur 2 years of residency payback. So leaving residency, I owe 1 year for my remaining Hpsp and 2 years for my pediatric residency. However, they are paid back concurrently (at the same time), so my first year as a staff attending I am paying off my last year of Hpsp and 1 year of residency. My second year as a staff attending I’ll be paying off my 2nd year of residency.

This is straight from BUMED.

Ok super thanks, I'd seen the term concurrent payback but I never knew what exactly it means.

Basically, you have to pay back at least 4 years of HPSP. If you do a residency longer than 4 years, you pay back the length of the residency. Not counting GMO years.

 

[pawprint]

Correct!

 

[DeadCactus]

Because it's likely a financial loss to the medical student, a loss of career and personal freedom, and there is a good chance that what someone wants now is not what you want 4, 7, or 11 years from now.

HPSP is for most applicants nothing but financial fear-mongering leading to making an unnecessarily early commitments with potentially major implications that many who accept the scholarship don't fully comprehend. The only one generally benefiting from HPSP is the military because they can now forecast their number of physicians an extra 4 years in advance. The problem with USUHS is similar. The other options for joining the military are just far better and less manipulative. The nuanced benefits of HPSP in comparison to the other programs are not applicable to many applicants apart from the psychological benefit.

Military medicine has its flaws and is a separate discussion from HPSP specifically.

I will fully admit that for all the drama around it, in the grand scheme of the world, HPSP is a pretty good life. Life is already going much better for you than > 99% of the rest of the world. You just happen to be lucky enough to choose an even better route.

 

[Serenity89]

they let you do peds prelim? I am about to finish 4 year gmo commitment as FS and doing ERAS for peds. I had to SoAP into gen surg prelim 4 yrs ago, because the GME people told me it had to be prelim IM, transitional or gen surg and when I asked about peds prelim they said “NO”. Granted I’d probably have to repeat intern year anyway since its been 4 years.... but I woulda rather done peds than gen surg....

I know this is unrelated but I want to clarify in case anybody reads this and gets confused. The total payback is 5 years following residency, not 6. HPSP and residency payback are paid back concurrently, not consecutively.

For example, I’m peds. I did 4 years HPSP + 0 years peds intern - 3 years as flight surgeon + 2 years peds residency = 2 years payback of being a peds attending.

One of my programs staff attendings made the mistake of thinking she owed 3 years (thinking Hpsp and residency run consecutively) and was surprised to find out she could have put her separation in a whole year earlier than she thought. Don’t make that mistake!

 

[pawprint]

they let you do peds prelim? I am about to finish 4 year gmo commitment as FS and doing ERAS for peds. I had to SoAP into gen surg prelim 4 yrs ago, because the GME people told me it had to be prelim IM, transitional or gen surg and when I asked about peds prelim they said “NO”. Granted I’d probably have to repeat intern year anyway since its been 4 years.... but I woulda rather done peds than gen surg....

The Navy doesn’t care what you do your internship in to use you as a GMO...as long as you have a valid unrestricted state medical license by the end of intern year, that’s all they care about.

For finishing peds residency in the military, however, you must have done your internship in peds. So if you were a TY intern, did a few years GMO, you would have to repeat intern year as a peds intern. You would match with 3 year orders to complete all of peds internship and residency together (no risk of having to go back out to gmo after your repeat peds intern year).

 

[DocSurgeon]

How does that come out to 15 years active duty? Residency is neutral for payback so it's only 4 years of payback and can't you do that all as GMO, or none? Then there is some commitment as reserve but not 11 years.

15 years total active duty time counting intern year, GMO, residency and staff payback. I guess it's 14 though based on that concurrent payback issue. See, even I didn't fully understand it. Lucky for me I went straight through. But add in a research year or fellowship to that equation and you're potentially looking at a real long haul if you go a surgical specialty route. Looks like primary care docs have a much better path with the GMO then residency route.

 

[Perrotfish]

Ok super thanks, I'd seen the term concurrent payback but I never knew what exactly it means.

Basically, you have to pay back at least 4 years of HPSP. If you do a residency longer than 4 years, you pay back the length of the residency. Not counting GMO years.

Still not exactly. The rule is that the length of time you owe coming out of residency is either the length of time you owed on the day you go into residency, or the length of residency, whichever is more. Also intern years don't count, only the rest of residency

If you have a 4 year HPSP obligation and do a 3 year straight through FM residency your obligation from HPSP (4 years) is greater than your obligation from residency (2 years) so you come out owing 4 years. 3 years training + 4 years payback = 7 total years in the military

If you have a 4 year HPSP obligation and do a 6 year general surgery residency (Intern year + research year + 4 residency years) then your obligation from residency (5 years) is greater than your obligation from HPSP (4 years) and youcome out of residency owing 5 years. 6 years residency + 5 years payback = 11 years in the military

If you have a 4 year HPSP obligation, do a general surgery intern year, and payback 3 years as a flight surgeon you now owe one year. Then if you go into a 5 year general surgery Residency (4 years training + 1 year research) your obligation from residency (5 years) is greater than what you owed when you started residency (1 year) so you will owe 5 years. When you get out you still owe 5 years at the end of residency, just like if you'd trained straight through. So now 1 Intern year + 3 years flight surgery + 5 years training + 5 years paybacck = 14 years in the military.

A GMO tour + a long residency can leave you stuck in the military for a very long time.

.

 

[haujun]

I've heard so many people say they would not recommend HPSP and I ask them why and they tend to blow me off. No one can give me a real answer why I shouldn't.

I want to go into medicine.
I want to go into the military.
I want to go into a critical wartime specialty.
If I don't go to medical school, I will spend 4 years in the military all the same.
I have no problem doing a military residency.
I have no problem deploying and not choosing where I serve my active duty time.

In this light, is there any reason not to do HPSP?

Lots of “I” in the paragraph . Are you 18 years old? Are you thinking about getting married someday? You will be paying back HPSP when you become different person with new environment and priorities. It will require sacrifice from others. It is not all about you. For example I remember deploying for 12 months and missing birth of my first child. Was this easy? No, it wasn’t and I did not enjoy this at all. It certainly was not “no problem at all.” I am sure my wife did not enjoy this at all. Remember it is service and requires sacrifice of whole military family. Not just you.

 

[Detective SnowBucket]

Lots of “I” in the paragraph . Are you 18 years old? Are you thinking about getting married someday? You will be paying back HPSP when you become different person with new environment and priorities. It will require sacrifice from others. It is not all about you. For example I remember deploying for 12 months and missing birth of my first child. Was this easy? No, it wasn’t and I did not enjoy this at all. It certainly was not “no problem at all.” I am sure my wife did not enjoy this at all. Remember it is service and requires sacrifice of whole military family. Not just you.

How the hell else am I supposed to decide what I want? You want me to make up an imaginary girlfriend, how the **** do I know what she'll want. You've been the only person to miss the point of this thread, to decide if I would be a good fit for HPSP. Please, give me any suggestions on how to decide if I'd be a good fit for it without thinking about all those I's. This thread is about HPSP, not about military. DO you have anything to contribute on that front? On the military side, sure, but that doesn't matter because medicine or not I'll go military so its a null point about missing birthdays and ****, that may happen either way. Now, enlighten me if you have anything to contribute to the actual point of this thread, do you know anything about HPSP or not?

 

[dwb8p]

Dude, you've lost it. Please don't join the military. Of course Haujun knows about HPSP - he's an active duty O5 or O6 and has been through the very process you're contemplating. He's trying to provide some perspective on the potential opportunity cost you will incur over the next decade for a voluntary decision you make today in going HPSP.

 

[militaryPHYS]

How the hell else am I supposed to decide what I want? You want me to make up an imaginary girlfriend, how the **** do I know what she'll want. You've been the only person to miss the point of this thread, to decide if I would be a good fit for HPSP. Please, give me any suggestions on how to decide if I'd be a good fit for it without thinking about all those I's. This thread is about HPSP, not about military. DO you have anything to contribute on that front? On the military side, sure, but that doesn't matter because medicine or not I'll go military so its a null point about missing birthdays and ****, that may happen either way. Now, enlighten me if you have anything to contribute to the actual point of this thread, do you know anything about HPSP or not?

His point is that those are often things we don’t consider when we are young and have no one else to worry about.

Keep it professional. Posts like this won’t be tolerated.

Nobody is going to make the decision for you. We provide opinions/advice based on our experience and you consider it all and make your own decisions.

 

[Gastrapathy]

You'd fit right in.

 

[Perrotfish]

How the hell else am I supposed to decide what I want? You want me to make up an imaginary girlfriend, how the **** do I know what she'll want.

There is an answer to this question, and the answer is to wait to join until you are ready to begin payback. You will have met the girlfriend (or not) and will know what profession you are in, and you will be able to join with a pretty good idea of what military medicine is going to look like during your payback.

In my post above I went over how a general surgeon can start their payback 13 years after they commit to the scholarship. That's a lot of time for things to change in your personal life, in your attitude towards politics and the military, and in the military itself. In 13 years GME could be gone. Deployments could be 4 years long. You could be caring for half a dozen medically complicated family members. You could be a radical libertarian. We could have surgeons working 80 hours a week at civilian trauma centers, or working full time as hospital admins because we closed all the ORs. No one knows what the world will look like then.

On the other hand if you join after residency you are only looking at 4 years of obligation. There is still some uncertainty there, but 4 years is much less time for things to change, and odds are you will spend at least the majority of that commitment working an environment a lot like the one you thought you would be working in and with the personal obligations that you thought you'd have. In any event you won't be facing any more uncertainty than the junior enlisted who are signing up at the same time. That's fair, if not ideal.

There are downsides to joining after residency as well. Financially you will probably loose quite a bit vs HPSP. You will lose your chance to be a GMO if that is something you want. You won't be able to do a military residency, and will be plunged into the maze of the military paperwork and culture without any mentorship or real training. However now that military medicine is in such enormous flux its hard to recommend you join before medical school, when we can't even tell you what you'd be joining.

 

[Per5everance]

If I don't go to medical school, I will spend 4 years in the military all the same.

In this light, is there any reason not to do HPSP?

Sounds like you should skip medical school and just join the military. Find out if you like the military. If you still want to go to medical school you can when you are done with your obligation. Then you can decide to return to the military via HPSP (or another route) or go civilian.

 

[absolutdokta]

Well this thread just heated up a bit and got interesting

 

[HighPriest]

Who could ha e predicted it would start turning in this direction? It’s unheard of. And now back to the show.

 

[Baron Samedi]

Pros:
- In HPSP I became debt free and was able to begin investing and build a portfolio much sooner than my peers
- I enjoyed a higher quality of life during training than my peers. I had a nicer apartment, was able to take nicer vacations, etc.
- There's some camaraderie in military medicine. We're all going through this together. When you PCS to another hospital, there's at least 1-2 people there you knew during training to help you out. My civilian physician wife works in a clinic where she is the youngest physician by two decades. She's found it to be a bit isolating -- in military medicine it's less of an issue.
- You get opportunities to do cool stuff. How many civilian docs will ever ride around on a Blackhawk?
- Leadership opportunities. I'm fresh out of fellowship and my own clinic chief and leading hospital committees. This can also be considered a bit of a con, as rather than entirely focusing on clinical care, I have to wear several hats.

Cons:
- The uncertainty. I signed up for HPSP over 10 years ago. Imagine how different the world was 10 years ago. Different wars, different politics, different military medicine. Everything was ramping up for war with massive amounts of resources being invested into healthcare. Now, DHA has promised to streamline military medicine which mainly comes in the form of downsizing non-essential specialties and civilianizing others. There's absolutely nothing stopping them from deciding that we don't need any active duty docs and going entirely to a civilian corps.
- Lack of GME opportunities. I chose the Army because they had the most specialties available and I knew there was a decent chance I'd change my mind throughout medical school. That's become less and less the case. They are cutting GME slots in many programs and denying further fellowship training. Guess what? The same amount of HPSP/USUHS grads are coming through. Less slots means less people getting what they want. Do you want to be a military physician more than you want to be an -ologist?
- A limited patient population and limited opportunities to practice your specialty. I'm a Pain Management specialist. In the civilian world, this means geriatric patients with severe pathology, cancer, etc with opportunity to improve their lives with advanced procedures. In military medicine, my patients are 22 years old and just want a no sit-up profile.
- Lack of experienced practitioners. If you go to any GME site, the residency program directors are mostly O-4s a couple years out of the same residency they are now leading. There's no grey hair in the room to provide insight with their many years of experienced. To put it in perspective -- I am the most experienced person in my specialty in the hospital. I am 31 years old and literally months out of training. You're on an island.

Overall my experience has had good and bad. Do I regret doing HPSP? No. Would I do it again if I could decide? No. Would I recommend it for others? Absolutely not.

Anyways, there's some things for you to chew on. There's numerous threads on this exact topic.

 

[armytrainingsir]

I was HPSP and trained in a military residency in a completely different era. Wouldn't trade it for anything.

A few years ago, I would still have said take the scholarship, mostly out of nostalgia and ignorance on what AD, both residency and staff time, is like these days.

Now? Today? Nope. Take out the loans. After you match into what you want, join the reserves during or after residency or AD after you finish your training if you still feel the need to join and want the cash/experience/job.

To answer your question specifically, there is no way to know if you will land in a critical wartime specialty this early in the game. Medical school experiences can drastically alter what you end up doing vs what you dreamed of doing.

Good luck with whatever you decide.

 

[Cooperd0g]

Pros:
- In HPSP I became debt free and was able to begin investing and build a portfolio much sooner than my peers
- I enjoyed a higher quality of life during training than my peers. I had a nicer apartment, was able to take nicer vacations, etc.
- There's some camaraderie in military medicine. We're all going through this together. When you PCS to another hospital, there's at least 1-2 people there you knew during training to help you out. My civilian physician wife works in a clinic where she is the youngest physician by two decades. She's found it to be a bit isolating -- in military medicine it's less of an issue.
- You get opportunities to do cool stuff. How many civilian docs will ever ride around on a Blackhawk?
- Leadership opportunities. I'm fresh out of fellowship and my own clinic chief and leading hospital committees. This can also be considered a bit of a con, as rather than entirely focusing on clinical care, I have to wear several hats.

Cons:
- The uncertainty. I signed up for HPSP over 10 years ago. Imagine how different the world was 10 years ago. Different wars, different politics, different military medicine. Everything was ramping up for war with massive amounts of resources being invested into healthcare. Now, DHA has promised to streamline military medicine which mainly comes in the form of downsizing non-essential specialties and civilianizing others. There's absolutely nothing stopping them from deciding that we don't need any active duty docs and going entirely to a civilian corps.
- Lack of GME opportunities. I chose the Army because they had the most specialties available and I knew there was a decent chance I'd change my mind throughout medical school. That's become less and less the case. They are cutting GME slots in many programs and denying further fellowship training. Guess what? The same amount of HPSP/USUHS grads are coming through. Less slots means less people getting what they want. Do you want to be a military physician more than you want to be an -ologist?
- A limited patient population and limited opportunities to practice your specialty. I'm a Pain Management specialist. In the civilian world, this means geriatric patients with severe pathology, cancer, etc with opportunity to improve their lives with advanced procedures. In military medicine, my patients are 22 years old and just want a no sit-up profile.
- Lack of experienced practitioners. If you go to any GME site, the residency program directors are mostly O-4s a couple years out of the same residency they are now leading. There's no grey hair in the room to provide insight with their many years of experienced. To put it in perspective -- I am the most experienced person in my specialty in the hospital. I am 31 years old and literally months out of training. You're on an island.

Overall my experience has had good and bad. Do I regret doing HPSP? No. Would I do it again if I could decide? No. Would I recommend it for others? Absolutely not.

Anyways, there's some things for you to chew on. There's numerous threads on this exact topic.

The only thing I can disagree with here is the comment on the experience of the program directors. But this may easily vary with service and year by year. The vast majority I have seen are senior O-5 or O-6 physicians. I have only seen 2 O-4 program directors in the Navy over the course of 7 years.

 

[Baron Samedi]

The only thing I can disagree with here is the comment on the experience of the program directors. But this may easily vary with service and year by year. The vast majority I have seen are senior O-5 or O-6 physicians. I have only seen 2 O-4 program directors in the Navy over the course of 7 years.

Eh, perhaps "most" is hyperbolic. But I've definitely met my fair share of 0-4 PDs and APDs in the Army. I imagine in the Navy the overall ranks may be a little bit further along, given the popularity of GMO tours.

 

[haujun]

I was HPSP and trained in a military residency in a completely different era. Wouldn't trade it for anything.

A few years ago, I would still have said take the scholarship, mostly out of nostalgia and ignorance on what AD, both residency and staff time, is like these days.

Now? Today? Nope. Take out the loans. After you match into what you want, join the reserves during or after residency or AD after you finish your training if you still feel the need to join and want the cash/experience/job.

To answer your question specifically, there is no way to know if you will land in a critical wartime specialty this early in the game. Medical school experiences can drastically alter what you end up doing vs what you dreamed of doing.

Good luck with whatever you decide.

It is funny. We tell others not to join because of our current uncertain situation with DHA and potential lack of available training opportunities. But who knows in few years new opportunities may open up and change for the better. Or not. My Awesome colleague O6 just retired and he would not recommend HPSP to others. I don’t recommend it as well. I don’t like the general direction we are heading.

To original OP: If you don’t care and flexible in the future plan....sign up. You seem like you made decision. I tell my residents don’t order a test if it will not change your medical decision.

 

[militaryPHYS]

To original OP: If you don’t care and flexible in the future plan....sign up.

I think this holds true across decades and despite current climate. It doesn't matter that we are restructuring. If someone really wants to serve and their medical profession is second tier then they might as well sign up. Hopefully that person is flexible, an ESTJ, likes following orders and is OK going along for the ride. It isn't always a bad thing. That is me in a nutshell and things are working out...so far.

We need consolidation, standardization and simplicity across services. Nobody likes to admit it, but there is huge waste going on, lack of accountability, scarce resources and poor systems due to complexity of the overall system.

If you are skeptical, stay away. If you want to serve and won't be miserable if your Plan A gets squashed, sign up.

 

[HighPriest]

Agree with that. I would say, when making the decision, assume you're not going to get the specialty you want. Assume you're going to be stuffed in a tiny MEDDAC in a terribly boring and isolated area of the world. Assume that you're going to deploy, and assume that you're going to have a really hard time maintaining your skill set. If you can really accept all of that (and not rationalize it by telling yourself it isn't likely), but you still want to join because of the service and experience - great. do it.

And don't try to tell yourself that "all of these things could happen if I don't join." That is perhaps somewhat true, although you can always pull a rip cord as a civilian and do something else, move somewhere else. Plus, weighing your decision with the converse assumption is irrelevant to the thought experiment. The idea is that if you can accept the worst possible scenario, then you'll be fine. None of the things I mentioned above are all that unusual, even grouped together.

 

[absolutdokta]

In military medicine, my patients are 22 years old and just want a no sit-up profile.

Literally made me lol cuz that’s like 1/4 my BN population.

 

[j4pac]

The best milmed applicants are those that would do it in spite of the scholarship. They are well informed and know that they will embrace the suck for the opportunity to serve.

 

[Ziehl-Neelsen]

The best milmed applicants are those that would do it in spite of the scholarship. They are well informed and know that they will embrace the suck for the opportunity to serve.

That assessment describes the best Bolsheviks too🤔

 

[Baron Samedi]

The #1 reason not to do HPSP/USUHS is that you can't quit if you don't like it.

If you're a civilian doc and your practice environment sucks, you cut your losses and move to the next job. You can even make a big show out of it, if you want, and flip a desk or two on your way out. In uniform, you are just stuck. You might PCS after 2-3 years, you might not, you might get moved to something worse.

 

[CaliArMD]

I've heard so many people say they would not recommend HPSP and I ask them why and they tend to blow me off. No one can give me a real answer why I shouldn't.

I want to go into medicine.
I want to go into the military.
I want to go into a critical wartime specialty.
If I don't go to medical school, I will spend 4 years in the military all the same.
I have no problem doing a military residency.
I have no problem deploying and not choosing where I serve my active duty time.

In this light, is there any reason not to do HPSP?

I'm a an active Army physician near the end of my ADSO and I genuinely feel sorry for any HPSP and especially USUHS student. Military medicine always had its difficulties but the DHA and MEDCOM have destroyed it.

Please talk to a military doctor before you make this decision.

HPSP is a predatory loan. Plain and simple. The military will pay approx. 50k a year for 4 years of your school and then pay you at least a 100k less per year for 4 years of your work as an attending. You will lose in almost every way you can imagine (and in many ways that no one can right now).

I couldn't in good conscience recommend HPSP or USUHS to anyone now or for the foreseeable future.

 

[Detective SnowBucket]

I'm a an active Army physician near the end of my ADSO and I genuinely feel sorry for any HPSP and especially USUHS student. Military medicine always had its difficulties but the DHA and MEDCOM have destroyed it.

Please talk to a military doctor before you make this decision.

HPSP is a predatory loan. Plain and simple. The military will pay approx. 50k a year for 4 years of your school and then pay you at least a 100k less per year for 4 years of your work as an attending. You will lose in almost every way you can imagine (and in many ways that no one can right now).

I couldn't in good conscience recommend HPSP or USUHS to anyone now or for the foreseeable future.

Thanks for that info. I'm actually moving away from HPSP because of people like you who take the time to explain rather than simply telling me not to. I even did get to shadow a navy surgeon and from what I saw, I would have had no problem with milmed. With your experience, would you recommend not joining after residency for the same/other reasons? I do want to serve in the military but I won't put anything in front of medicine. What's the commitment time like if you join as a physician, I can't find that on google.

 

[rockafella12]

Thanks for that info. I'm actually moving away from HPSP because of people like you who take the time to explain rather than simply telling me not to. I even did get to shadow a navy surgeon and from what I saw, I would have had no problem with milmed. With your experience, would you recommend not joining after residency for the same/other reasons? I do want to serve in the military but I won't put anything in front of medicine. What's the commitment time like if you join as a physician, I can't find that on google.

Navy GMO here. I'd say don't do HPSP. Do med school, get into Residency (of your choice), and then see if the "desire to serve" still tickles your loins. I just call BS on the whole "I don't care if I deploy, do GMO, etc". Listen to everyone here man, there is a reason there is a huge general discontent with how the DoD is handling medical education and GME, let alone actual medical practice.

If you join as a Physician, there are multiple paths. Look up the resident programs and direct accessions. Those are incredibly uncommon, I'm sure you can imagine why. Best of luck with your decision. I wish I had come to these boards before I signed up.

 

[Detective SnowBucket]

Navy GMO here. I'd say don't do HPSP. Do med school, get into Residency (of your choice), and then see if the "desire to serve" still tickles your loins. I just call BS on the whole "I don't care if I deploy, do GMO, etc". Listen to everyone here man, there is a reason there is a huge general discontent with how the DoD is handling medical education and GME, let alone actual medical practice.

If you join as a Physician, there are multiple paths. Look up the resident programs and direct accessions. Those are incredibly uncommon, I'm sure you can imagine why. Best of luck with your decision. I wish I had come to these boards before I signed up.

Thanks. Would you still say don't join as an attending?

 

[rockafella12]

Thanks. Would you still say don't join as an attending?

Actually, not necessarily. My advice is obviously biased toward the Navy side of things. It's just that when you sign up for HPSP and run the risk of being a GMO, I really don't think it's a good idea to divorce med school from residency training. The Navy has a HUGE need for GMO's, but honestly what the Navy is giving back to GMO's just isn't there. We get paid a fraction of what we'd make in the civilian sector and there is absolutely NO promise of continuing on into a solid residency program. Even if they could guarantee you a spot back in a Navy Residency (which PD's will assure you they can), the quality of DoD GME has suffered quite a bit.

As an attending, at least you have secured your training and you've assured yourself that you are a "whatever"-ologist. If the Army/Navy/AF can use you, and you really want to practice in the military, go for it. AF & Army have leaned away from GMO/Flight Surgery; to my knowledge it's very limited in the AF. Going back, I'd probably have signed up through AF if even the HPSP itself. I think it's just way smarter to get your training in, exactly where you want it, and realize your full potential before you sign it over to Uncle Sam.

 

[deuist]

Former Air Force HPSP emergency physician here. I would not do it over again.

Residency: Emergency medicine is ridiculously competitive in the AF with a match rate of about 50%. I did not get selected when I was in medical school and ended up scrambling into an internship that has in no way been beneficial to my career. I got a civilian deferment the second time I applied and enjoyed my program. I did not have to do a flight surgeon/GMO tour. As a bonus, my specialty consultant lied to me during residency and I was unable to do a fellowship despite promises that had been made earlier.

Practice environment: Despite working at an MTF, the bulk of my patients were 19-year-old malingerers who would come in with colds, stomach bugs, and minor wounds. They typically drive by 6 pharmacies on the way to the hospital. My second most common patient type were the toddlers with fevers. Some days I saw more kids than the pediatricians. I pulled the numbers from the electronic medical record to make the case that our peds clinics were not seeing enough patients. Despite all of the training I did in a high acuity residency program, my skills got to atrophy as I only performed one intubation and one central line a year.

Moonlighting: I worked 16 twelve-hour shifts a month on active duty---an unheard of amount in the civilian sector. Because the pay was so low and the skill atrophy was a serious problem, I had to get a second civilian job to make up these deficits. I ended up working >250 clinical hours a month. The average civilian emergency physician works 140-180 hours per month.

Pay: By my calculations, I lost $300,000 by joining HPSP. I would have made more money by taking out student loans and then landing a lucrative civilian job.

Extra duties: At least once a month I had to come in on an off day to be told not to rape my co-workers or not to commit suicide.

Shockingly bad leadership: I've never been inspired by any of my commanders in the medical corps. Not a one of them.

 

[deuist]

Part 2

Inexperienced clinical staff: Everyone from the doctors to the nurses to the techs are right out of school. With time comes promotion to non-clinical jobs, leaving only nurses who have never given a particular drug, never heard of a particular disorder, or never seen a particular procedure.

Patient killers: They are rare, get a lot more publicity than they should, and yet absolutely exist. In the civilian world, completely incompetent doctors and nurses get fired. The Air Force promotes them to non-clinical staff and eventually puts them in charge... which is how you get uninspiring leaders and high tunover among physicians.

Inequality of deployments: I got tasked for deployment within 3 months of coming onto active duty. My O-6 hospital commander had never been deployed. I cannot understand how anyone would be allowed to be promoted to such a high position without ever once leaving the United States. We had several other co-workers who not deploy because of PT failures, perpetual pregnancy, or mysterious illnesses that would pop up 2 weeks prior to leaving.


I will say that the least bad part of being in the military was deployment. I saw all of 6 patients in 6 months and spent the rest of my time reading, hitting the gym, and watch movies. The time spent abroad added to skill atrophy, but did come across as a kind of vacation.

 

[deuist]

Thanks. Would you still say don't join as an attending?

The reserves don't seem so bad. You get health insurance and decent pay if you can swing a sign on bonus. Many of the reservists are in non-deployable slots anyway. All it costs you is one weekend a month.

 

[Detective SnowBucket]

Former Air Force HPSP emergency physician here. I would not do it over again.

Residency: Emergency medicine is ridiculously competitive in the AF with a match rate of about 50%. I did not get selected when I was in medical school and ended up scrambling into an internship that has in no way been beneficial to my career. I got a civilian deferment the second time I applied and enjoyed my program. I did not have to do a flight surgeon/GMO tour. As a bonus, my specialty consultant lied to me during residency and I was unable to do a fellowship despite promises that had been made earlier.

Practice environment: Despite working at an MTF, the bulk of my patients were 19-year-old malingerers who would come in with colds, stomach bugs, and minor wounds. They typically drive by 6 pharmacies on the way to the hospital. My second most common patient type were the toddlers with fevers. Some days I saw more kids than the pediatricians. I pulled the numbers from the electronic medical record to make the case that our peds clinics were not seeing enough patients. Despite all of the training I did in a high acuity residency program, my skills got to atrophy as I only performed one intubation and one central line a year.

Moonlighting: I worked 16 twelve-hour shifts a month on active duty---an unheard of amount in the civilian sector. Because the pay was so low and the skill atrophy was a serious problem, I had to get a second civilian job to make up these deficits. I ended up working >250 clinical hours a month. The average civilian emergency physician works 140-180 hours per month.

Pay: By my calculations, I lost $300,000 by joining HPSP. I would have made more money by taking out student loans and then landing a lucrative civilian job.

Extra duties: At least once a month I had to come in on an off day to be told not to rape my co-workers or not to commit suicide.

Shockingly bad leadership: I've never been inspired by any of my commanders in the medical corps. Not a one of them.

Part 2

Inexperienced clinical staff: Everyone from the doctors to the nurses to the techs are right out of school. With time comes promotion to non-clinical jobs, leaving only nurses who have never given a particular drug, never heard of a particular disorder, or never seen a particular procedure.

Patient killers: They are rare, get a lot more publicity than they should, and yet absolutely exist. In the civilian world, completely incompetent doctors and nurses get fired. The Air Force promotes them to non-clinical staff and eventually puts them in charge... which is how you get uninspiring leaders and high tunover among physicians.

Inequality of deployments: I got tasked for deployment within 3 months of coming onto active duty. My O-6 hospital commander had never been deployed. I cannot understand how anyone would be allowed to be promoted to such a high position without ever once leaving the United States. We had several other co-workers who not deploy because of PT failures, perpetual pregnancy, or mysterious illnesses that would pop up 2 weeks prior to leaving.


I will say that the least bad part of being in the military was deployment. I saw all of 6 patients in 6 months and spent the rest of my time reading, hitting the gym, and watch movies. The time spent abroad added to skill atrophy, but did come across as a kind of vacation.

Thanks for all that! I was actually interested in USAF EM so this is all good to know. I'm really glad more and more people are getting on this thread with their experiences.
All of these reasons make a lot of sense so I have a follow up question based on it that I've been asking as much as I can. Would you have had a better time if you went to school on loans rather than HPSP then civ residency then came into the Air Force as an attending? Would the lower milmed pay put you too behind on loans without a significant signing bonus? What kind of contract length would you be looking at if you do this?

 

[deuist]

Thanks for all that! I was actually interested in USAF EM so this is all good to know. I'm really glad more and more people are getting on this thread with their experiences.
All of these reasons make a lot of sense so I have a follow up question based on it that I've been asking as much as I can. Would you have had a better time if you went to school on loans rather than HPSP then civ residency then came into the Air Force as an attending? Would the lower milmed pay put you too behind on loans without a significant signing bonus? What kind of contract length would you be looking at if you do this?

The only difference would have been going straight through residency. Otherwise, the experience would have been the same. I still would not have done it again. The sign on bonus typically requires a 2-4 year commitment. Even then, you will never come close financially with the military.

 

[CaliArMD]

Thanks for that info. I'm actually moving away from HPSP because of people like you who take the time to explain rather than simply telling me not to. I even did get to shadow a navy surgeon and from what I saw, I would have had no problem with milmed. With your experience, would you recommend not joining after residency for the same/other reasons? I do want to serve in the military but I won't put anything in front of medicine. What's the commitment time like if you join as a physician, I can't find that on google.

Sorry for the late reply. Personally, I absolutely would NOT recommend fully trained physicians to willingly sign up for active duty -- if you want to serve or scratch the military itch, join the reserves (although, I've heard that they have recently either limited/eliminated reserve physician bonuses).

Through residency, I've worked in every type of setting imaginable, inpatient, outpatient, community, state, federal, etc. etc. -- in my experience and that of many of my colleagues, the military is without question the worst. That is not say that it is all bad for everyone, but despite a massive budget, there are endemic problems with leadership, lack of support, underfunding, skill atrophy, etc., that are too significant to ignore.

It's pretty telling that in my specialty, in the last 5 years there have been ZERO direct accessions to our specialty (i.e., the Army could not find/entice/bribe even 1 fully trained physician to voluntarily come on active duty).

Many people have already mentioned this, but if you want to be a physician first, the military is not the right place for that. It bears worth repeating, if you absolutely want to join the military, at most, consider the reserves.