Why is HPSP called 'scholarship'?

[navdoc47]

shouldn't it be called, "HPSP Indentured Servitude Program"?

also, I wonder what will happen when the recipient class of 2005 has completed internship, unable to fill the typical GMO billets? (ie in 2010).

here's an interesting article:
http://www.usminstitute.org/content/HPSP.doc

"talk amongst yourselves"

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[BomberDoc]

It should be BMIEMP -- Biggest Mistake I've Ever Made Program.

I'm glad somebody is talking about this, but I feel he is oversimplifying the problems and missing a few big points. The author states that the Air Force has essentially eliminated GMOs. Wrong. The AF sends more and more One Year Wonders out into practice every year. GMOs far outnumber residency trained physicians at my facility.

Nobody is willing to admit it, but the money is important. Before going active duty, I worked at an urgent care center and made in 2 days what I make now in a month. For residency trained docs, the income disparity is obscene. Of course no amount of money would make all the BS worth it. Infosec, trafficking in persons, anti-terrorism, recalls, exercises, chem warfare training, deployments, having your paycheck held hostage by some finance ****** who barely finished high school, commander's call, squadron PT, the list goes on and on and on...

No, my friends, military medicine is dying. I hear agonal respiration and the end is near. I just hope I finish my prison term before the knuckleheads decide to stop-loss docs.

 

[jonb12997]

just to continue the conversation, for the reasons stated, do you (everyone) think that they'll move more toward using mid level providors in the "sand box" and using contract docs at the military hospitals in non combat areas?

 

[orbitsurgMD]

just to continue the conversation, for the reasons stated, do you (everyone) think that they'll move more toward using mid level providors in the "sand box" and using contract docs at the military hospitals in non combat areas?

They will bring back the draft first. The Congress of the United States would not hesitate for but a moment to bring back a draft to get doctors in support of the troops at war, and the public would support them. It hardly matters that they are the only drafted component in the military, they would do it anyway.

No one will cry unfair for the doctors. Your future labor is seen by many as theirs by right of entitlement.

 

[militarymd]

They call it a "scholarship" so that it can be used as a tool to sucker unsuspecting fools into signing up for the military...

I did...I was sooooo foolish.

 

[deuist]

shouldn't it be called, "HPSP Indentured Servitude Program"?

Yessa, master. I git rite on it.

 

[Monty Python]

....Of course no amount of money would make all the BS worth it. Infosec, trafficking in persons, anti-terrorism, recalls, exercises, chem warfare training, deployments, having your paycheck held hostage by some finance ****** who barely finished high school, commander's call, squadron PT, the list goes on and on and on...

.

Physicians aren't the only recepients of all these time-stealers. The attendance policies are DoD-wide regardless of MOS/AFSC/NOBC. Heaven forbid they make some of those classes mandatory only for the 17 year-old who truly needs it, while exempting those with more life experience and/or higher education, who've already been around the block a few times. No way. We can't discriminate (ie, employ common sense) like that - how politically incorrect.

If it's good enough for E-1 Jones, then it's good enough for O-5 Smith who by default must therefore also need it.

 

[BomberDoc]

If it's good enough for E-1 Jones, then it's good enough for O-5 Smith who by default must therefore also need it.

One person s#its their pants and we're all forced to wear diapers. How egalitarian.

 

[Mirror Form]

They will bring back the draft first. The Congress of the United States would not hesitate for but a moment to bring back a draft to get doctors in support of the troops at war, and the public would support them. It hardly matters that they are the only drafted component in the military, they would do it anyway.

No one will cry unfair for the doctors. Your future labor is seen by many as theirs by right of entitlement.

Although I agree with the last sentence of your post, the media would have a field day if we started drafting doctors. Even if the public was initially ambivilent, they'd be up in arms after every reporter jumped on the opportunity to criticize the war and the planning for it. Also, there is definitely a "slippery slope" argument. Once you start drafting doctors, could there be a general draft next? No, the public would not tolerate even the threat of such a thing.

 

[Croooz]

I agree that the media and the public wouldn't stand for a doctor draft. With all reports pointing to the lack of docs, the government then taking from a diminished supply wouldn't go over well.

 

[orbitsurgMD]

Why is HPSP called 'scholarship'?

Why is a punishment "awarded"?

 

[West Side]

They will bring back the draft first. The Congress of the United States would not hesitate for but a moment to bring back a draft to get doctors in support of the troops at war, and the public would support them. It hardly matters that they are the only drafted component in the military, they would do it anyway.

No one will cry unfair for the doctors. Your future labor is seen by many as theirs by right of entitlement.

This is a fantasy. Let's set aside the fact that over 60% of the general populace thinks any/all of the following:

• the war was not worth fighting in the first place
• we've completely bungled the war
• we can't win the war

There will be two whooshing sounds. One will be the flood of doctors headed to Canada (how ironic!). The second will be the sound of money flowing into doctor's lobbyist coffers, which is already well funded and influential.

You can cool your jets. With public sentiment the way it is, with the makeup of the Congress right now, the draft would be a political holocaust for all incumbants with elections in a year.

 

[West Side]

One person s#its their pants and we're all forced to wear diapers. How egalitarian.

Ha! You crack me up.

This is the case with any large organization, unfortunately. Private practice/entrepreneurism is the only respite, unfortunately!

 

[orbitsurgMD]

This is a fantasy. Let's set aside the fact that over 60% of the general populace thinks any/all of the following:

• the war was not worth fighting in the first place
• we've completely bungled the war
• we can't win the war

There will be two whooshing sounds. One will be the flood of doctors headed to Canada (how ironic!). The second will be the sound of money flowing into doctor's lobbyist coffers, which is already well funded and influential.

You can cool your jets. With public sentiment the way it is, with the makeup of the Congress right now, the draft would be a political holocaust for all incumbants with elections in a year.

Think again.

The American people will not abide the U.S. military sending their sons and daughters to war--never mind what they think of the reasons for the war or its success or failure--without the belief that there is sufficient medical support for them. If the present methods of recruitment are sufficient, that's fine. But if they are not, then other methods will be expected, even demanded. If that means huge money for bonuses, fine, but make no mistake, if that does not work well enough there will be a draft. The representatives of each party know how important that understanding is to their re-election.

It hardly matters what the public thinks of the war. The only thing that matters is what they want for the troops.

 

[West Side]

Think again.

The American people will not abide the U.S. military sending their sons and daughters to war--never mind what they think of the reasons for the war or its success or failure--without the belief that there is sufficient medical support for them. If the present methods of recruitment are sufficient, that's fine. But if they are not, then other methods will be expected, even demanded. If that means huge money for bonuses, fine, but make no mistake, if that does not work well enough there will be a draft. The representatives of each party know how important that understanding is to their re-election.

It hardly matters what the public thinks of the war. The only thing that matters is what they want for the troops.

That might have worked in the 70s. Hell, that might have worked with a straight red ticket in Congress and the White House in 2003. But with anti-war sentiment at an all-time high, with majorities in both houses in favor of ending the Iraq war, do you really think the American people would stand for an involuntary draft over scaling down forces due to lack of logistical support? Get real. You're being paranoid. Nothing wrong with that, but it's not a reality. The American people barely abide by their sons and daughters being sent over there in the first place, so any reason NOT to would be welcomed with open arms by the Democratic majorities, I'm sure. I'd say it's 60/40 that the White House has the political capital to even get high-priced medical contractors sent over there.

 

[Dr. Dukes]

Think again.

The American people will not abide the U.S. military sending their sons and daughters to war--never mind what they think of the reasons for the war or its success or failure--without the belief that there is sufficient medical support for them. If the present methods of recruitment are sufficient, that's fine. But if they are not, then other methods will be expected, even demanded. If that means huge money for bonuses, fine, but make no mistake, if that does not work well enough there will be a draft. The representatives of each party know how important that understanding is to their re-election.

It hardly matters what the public thinks of the war. The only thing that matters is what they want for the troops.

A doctor draft won't happen for a couple of reasons:

1) Every doctor drafted is a doctor who has to leave their private practice when they are drafted. This means that the public will lose their doctors (they're entitiled to medical care, remember?). When people realize this, they will be up in arms. This entire war has been fought with the premise that us stateside not sacrifice our standard of living like our parents/grandparents/great grandparents did during war time. When the first thing "we" are asked to sacrifice is healthcare, people will go rip-s_it.

2) If they can draft doctors they can draft grunts. People will realize that that they are drafting doctors because the Medical Corps is understaffed, and that the same argument applies to the combat arms which are dangerously close the being understaffed/stretched thin. If people don't mind losing their doctors they will mind losing themselves/their children.

3) Politicians aren't stupid. After all the allegations of draft-dodging with Vietnam-era politicians, they will realize that if even one senator/congressman's son/daughter somehow avoids getting drafted there will be politicial hell to pay. Politicians might not mind deploying their constituent's physicians/constituents/constituent's children, but they will mind deploying their own children.

 

[orbitsurgMD]

A doctor draft won't happen for a couple of reasons:

1) Every doctor drafted is a doctor who has to leave their private practice when they are drafted. This means that the public will lose their doctors (they're entitiled to medical care, remember?). When people realize this, they will be up in arms. This entire war has been fought with the premise that us stateside not sacrifice our standard of living like our parents/grandparents/great grandparents did during war time. When the first thing "we" are asked to sacrifice is healthcare, people will go rip-s_it.

2) If they can draft doctors they can draft grunts. People will realize that that they are drafting doctors because the Medical Corps is understaffed, and that the same argument applies to the combat arms which are dangerously close the being understaffed/stretched thin. If people don't mind losing their doctors they will mind losing themselves/their children.

3) Politicians aren't stupid. After all the allegations of draft-dodging with Vietnam-era politicians, they will realize that if even one senator/congressman's son/daughter somehow avoids getting drafted there will be politicial hell to pay. Politicians might not mind deploying their constituent's physicians/constituents/constituent's children, but they will mind deploying their own children.

1. They will preferentially draft younger physicians, physicians who have recently finished residency and if they need to, older retired military doctors. We have more than 600,000 doctors in the USA. Even with a draft they won't run out. A draft will happen once the supply from incentive offers and IRR callups is exhausted. Making people leave their jobs won't be the problem.

2. They can draft specific occupational groups and still not draft grunts. There is no global rationalization to be done that says that a draft has to include everyone. It is a slippery slope only if you make it one.

3. Politicians aren't stupid. They know that the public expects the government to use whatever resources are necessary to support American troops sent into combat. If medically-trained personnel are needed, they will expect them to be sent. They would prefer the doctors go willingly, but if that doesn't work, then unwillingly will have to do.

I'm not paranoid. I'm 4-alpha.

 

[megadon]

They will never draft Doctors. This is why I think that. Doctors are seondary high education, and if you draft them, that means the lawyers are prey. About the only time their PAC is aligned with us, cause if we're game, they are too.

The goal of a draft is to fill the ranks of the infantry. Draw a link to infantry and Doctors, it's difficult to make a direct corelation, because any Doc can become a primary care/emergency care doc in the militray. Before you flame throw, I don't say that they will be good at what they do, but everyone is up for GMO tour orders.

Now, to pubically admit that the military can't meet its ranks for doctors is a huge price to pay and exposes a lot of what everyone here compains about. It's gotta be pretty deperate times for the brass to admit it. They're already trying to cover their butts with the WR/Tricare debacle, how much more are they willing to show? Not gonna happen. If anything, involutary recall of fleet reserve.

 

[orbitsurgMD]

They will never draft Doctors. This is why I think that. Doctors are seondary high education, and if you draft them, that means the lawyers are prey. About the only time their PAC is aligned with us, cause if we're game, they are too.

The goal of a draft is to fill the ranks of the infantry. Draw a link to infantry and Doctors, it's difficult to make a direct corelation, because any Doc can become a primary care/emergency care doc in the militray. Before you flame throw, I don't say that they will be good at what they do, but everyone is up for GMO tour orders.

Now, to pubically admit that the military can't meet its ranks for doctors is a huge price to pay and exposes a lot of what everyone here compains about. It's gotta be pretty deperate times for the brass to admit it. They're already trying to cover their butts with the WR/Tricare debacle, how much more are they willing to show? Not gonna happen. If anything, involutary recall of fleet reserve.

The simple fact is they could easily draft doctors because they have done it before. During the Vietnam war and before, they did it routinely. The only question worth considering is whether their need for doctors will become dire enough that they would do so again.

All the talk about why they couldn't because it would mean they would have to draft some other group of professionals too (why?) is beside the point. If all the government needs or wants is more medical doctors, that is all they would have to draft. There won't be a "huge price to pay." Why would there be? When you are drafted, it isn't as if they lured you in promising one thing but giving you another. They just snatch you off the street.

There is more of an undercurrent of support for a draft than you think. And when liberal members of Congress publicly make a case for a draft, the idea isn't as unspeakable as you imagine.

The public's sympathy for the doctors isn't all that great. Don't expect an uproar if the draft ever comes. Quite a few people in this country really do believe they are entitled to claim your services solely on their terms just because you are a doctor. There are people who think that they should have a right to demand your services for free simply because you have a medical license. I know it is irrational, but it is real and prevalent all the same.

 

[Ex-44E3A]

Gotta say I'm with OrbitSurg on this one.

Then again, I'm an ER doc, so the bleeding edge of the growing entitlement culture is where I live.

In my opinion, hey'd never miss us. The public wouldn't blink an eye at a doctor draft.

 

[megadon]

The public's sympathy for the doctors isn't all that great. Don't expect an uproar if the draft ever comes. Quite a few people in this country really do believe they are entitled to claim your services solely on their terms just because you are a doctor. There are people who think that they should have a right to demand your services for free simply because you have a medical license. I know it is irrational, but it is real and prevalent all the same.

I cannot and will not argue that point. I love the idea that because I have spent so much of my own time and energy enhancing my skill set that I must be placed in servitude in those who haven't. Uhmm, communism didn't work, and wasn't that the underlying principle. How Ayn Rand. Who is John Galt? Please allow me my own little private fantasy that it won't happen, besides, I already signed up! No need for draft here, but I would like the bonuses.

 

[BomberDoc]

I say we draft all the FPs.

I say completely dismantle milmed and farm it all out to the civilian sector.

 

[The White Coat Investor]

I say completely dismantle milmed and farm it all out to the civilian sector.

How do you suggest we cover the operational mission? Your idea works fine for taking care of military personnel on their bases and for taking care of dependents and retirees, but who will deploy?

 

[jonb12997]

How do you suggest we cover the operational mission? Your idea works fine for taking care of military personnel on their bases and for taking care of dependents and retirees, but who will deploy?

Just an idea to fuel discussion, but what about making HPSP a LOT more lucrative so you can draw in more people, making everyone (Army, Navy, Air Force) HAVE to do a GMO as their payback, and using those docs for deployments.

That, and continue what the national guard does, sending docs overseas for 90 days at a time. You'd have to make that program more lucrative so more docs will sign up.

Combine these two programs with making mil med here in the states contractor based, and you've got more docs to go overseas.

 

[West Side]

How do you suggest we cover the operational mission? Your idea works fine for taking care of military personnel on their bases and for taking care of dependents and retirees, but who will deploy?

Probably the way we fight a war without the neccessary number of troops: poorly, and executed with contractors.

"I'm a Blackwater M.D. What seems to be the problem today?"

 

[The White Coat Investor]

"I'm a Blackwater M.D. What seems to be the problem today?"

It's the fact that all this blood keeps pouring out of this wound in my chest, and the tourniquet the GMO in the field put around my rib cage doesn't seem to be doing much.

 

[The White Coat Investor]

making everyone (Army, Navy, Air Force) HAVE to do a GMO as their payback, and using those docs for deployments.

Then you have underqualified physicians taking care of our troops. There may be a role for a GMO, but there is certainly also a role for residency trained physicians.

and you've got more docs to go overseas.

So now we have to find people who are willing to sign up to be deployed 90% of the time instead of 20%? That's a tough gig no matter how much you pay.

 

[jonb12997]

Then you have underqualified physicians taking care of our troops. There may be a role for a GMO, but there is certainly also a role for residency trained physicians.

So now we have to find people who are willing to sign up to be deployed 90% of the time instead of 20%? That's a tough gig no matter how much you pay.

2 very good points...

 

[Ex-44E3A]

Good, well-trained, forward-deployable medical care can't be done on the cheap. The military has pushed the medical corps as far as they can, cut back staff/services/support as much as possible, all while simultaneously adding to everyone's panel and mission.

It's asinine... and docs and students are fed up.

The military knows what it's doing... they're just unwilling to pay what is necessary to recruit/retain good people, and unwilling to make any changes in the way they do business. The leadership is not clueless... they're just procrastinating; kicking the can down the road... hoping the collapse will come some time after they retire. They will have to be forced to change... and the only way to do that is for docs to exercise the only option they have. In short, walk away... cut off their pipeline of signed-up-and-obligated-to-serve slave labor.

It'll come to a head, and it may come to a draft For my own part, I think they would do it and not think twice.

The military will fight tooth-and-nail against a general draft for enlisted folks. There are too many people in command positions today who remember what it was like during the Vietnam era... and their answer to a general draft will not only be a resounding "No"... it'll be "Hell no!!"

Physicians are different. We're a fairly motivated and well-educated group, and even if you draft, you're likely to get solid people, who aren't drug users, and at least know the job. We're also a small minority in the US, and the days of sky-high respect and deference to physicians are gone... we're seen as just another commodity.

Even worse, the public is sufficiently fed-up with medical care in general that they won't help us fight it. Plenty of problems in medicine are structural, but get blamed on the docs, including long waits in the ER, 15-minute appointment slots in their HMO, increasing co-pays and deductibles, and declining benefits. People don't see physicians driving yugos (they have no idea how much harder docs are working these days to maintain even the flat income growth we've had since the mid-90's), so they assume the docs are making it at their expense. That generates resentment, and along with the usual class-warfare crap, has largely depleted the reservior of goodwill that our profession once enjoyed (my opinion).

I think we're on our own on this one... I don't expect any significant help from the public.

 

[|2idicu|ous]

harumph?

 

[Ex-44E3A]

harumph?

intr.v. har·rumphed, har·rumph·ing, har·rumphs
1. To make a show of clearing one's throat.
2. To offer usually brief critical comments: harrumphed for a while over the proposal


Yes. Perfectly put... thank you.

 

[BigNavyPedsGuy]

Just an idea to fuel discussion, but what about making HPSP a LOT more lucrative so you can draw in more people, making everyone (Army, Navy, Air Force) HAVE to do a GMO as their payback, and using those docs for deployments.

That, and continue what the national guard does, sending docs overseas for 90 days at a time. You'd have to make that program more lucrative so more docs will sign up.

Combine these two programs with making mil med here in the states contractor based, and you've got more docs to go overseas.

Who in their right mind would sign up just to be a GMO and not get residency training?

Ex-44(however it goes) has some pretty good points. Unfortunately, it's terribly discouraging for someone who starts his Navy internship in about 50 days . . . .

I guess I'll just keep watching the political news about the next batch of elections. (No, I'm not trying to start that debate, I'm actually just looking for a shred of sunshine in this situation).

 

[BomberDoc]

they're just procrastinating; kicking the can down the road... hoping the collapse will come some time after they retire.

Exactly correct. This is classic military thinking. If I wait long enough, it will be someone else's problem.

Ultimately somebody is going to have to pay the price. I feel for the poor Navy and Army students who signed up in the years when HPSP didn't fill. Their year group is going to be suffering when they go active duty in a few years.

I would love to change the system but I am 100% unwilling to stay in, make rank, fight the inertia to change from the inside, etc... so I am voting with my feet and walking away at the earliest possible chance. Am I guilty of making it someone else's problem? Probably. Martyrdom just doesn't interest me.

As for the Doctor Draft, I'd like to see what kind of heat the AMA and other deep-pocketed organizations would bring to the congress. I know I'd be whipping out the checkbook for whichever PAC had the scariest lawyers. I just don't see it happening. It would be political suicide.

BigNavyPedsGuy, It is definitely discouraging and it sucks. At least you are going in a little more prepared than the average HPSP doc. All I can say is: keep your head down, do your time, take good care of your patients, and get the hell out as soon as you can.

 

[West Side]

Good, well-trained, forward-deployable medical care can't be done on the cheap. The military has pushed the medical corps as far as they can, cut back staff/services/support as much as possible, all while simultaneously adding to everyone's panel and mission.

It's asinine... and docs and students are fed up.

The military knows what it's doing... they're just unwilling to pay what is necessary to recruit/retain good people, and unwilling to make any changes in the way they do business. The leadership is not clueless... they're just procrastinating; kicking the can down the road... hoping the collapse will come some time after they retire. They will have to be forced to change... and the only way to do that is for docs to exercise the only option they have. In short, walk away... cut off their pipeline of signed-up-and-obligated-to-serve slave labor.

It'll come to a head, and it may come to a draft For my own part, I think they would do it and not think twice.

The military will fight tooth-and-nail against a general draft for enlisted folks. There are too many people in command positions today who remember what it was like during the Vietnam era... and their answer to a general draft will not only be a resounding "No"... it'll be "Hell no!!"

Physicians are different. We're a fairly motivated and well-educated group, and even if you draft, you're likely to get solid people, who aren't drug users, and at least know the job. We're also a small minority in the US, and the days of sky-high respect and deference to physicians are gone... we're seen as just another commodity.

Even worse, the public is sufficiently fed-up with medical care in general that they won't help us fight it. Plenty of problems in medicine are structural, but get blamed on the docs, including long waits in the ER, 15-minute appointment slots in their HMO, increasing co-pays and deductibles, and declining benefits. People don't see physicians driving yugos (they have no idea how much harder docs are working these days to maintain even the flat income growth we've had since the mid-90's), so they assume the docs are making it at their expense. That generates resentment, and along with the usual class-warfare crap, has largely depleted the reservior of goodwill that our profession once enjoyed (my opinion).

I think we're on our own on this one... I don't expect any significant help from the public.

Sorry, you've made the mistake of conflating public opinion with political influence. Oil companies, trial attorneys, and corporate executives: all probably smaller minorities than medical professionals (and given recent poll results, even less well regarded as professions), and they all have sway enough to prevent something far more damning to their livelihood than a draft: unfavorable legislation. Tort reform, executive compenation reform, ANWAR drilling: they've managed to pull the strings on all of these issues. Special interests (and yes, I'm including medical PACs and lobby groups) have a hell of a lot more influence than military families (who don't contribute to much). Sad but true state of affairs. However, the ability to set the rules is one hell of an incentive to be successful.

I mean, they've turned global climate change into a "theory".