Would the HPSP or FAP prevent me from doing an ID fellowship?

[The_Great_Zamboni]

Here's a little background: I was recently accepted to 2 medical schools. One I enjoyed more than the other, is more prestigious and has a better location, but far more expensive. I put together a spreadsheet and found I would have to go significantly into debt in order to attend my preferred school (about $200K, and that's with my girlfriend working), while for the other school my debt would be really quite low. Since ID isn't the highest paying specialty, we were anxious about racking up so much debt only to go to 6 years of residency and fellowship, especially if we want to start a family at some point.

As we were talking about the options, I mentioned the HPSP program and she had me look more into it more. In terms of finances, it makes a lot of sense, especially because it seems that the pay gap between the military and private practice isn't as big for ID (I found numbers like $190K vs $130 for starting ID physicians, let me know if those are wrong!). I've also heard, anecdotally, that ID in the military (particularly the navy) can lead to some very interesting work, so I could enjoy working in the military more than the private sector, and that's actually one of the things that excites me (I could be totally off base about that, please let me know if I am!).

My main worry is that my options for residency/fellowship would be delayed or even blocked. I've always heard that if the military doesn't need your specialty, you'll either end up in another field, or having to delay a year or two in order to reapply. Since IM is a pretty big field and not super competitive, I figure I would be able to get into a residency without too much trouble (please let me know if I'm off about that!) but I can't find very much data about how competitive the infectious disease fellowships are for each branch. It seems like it should be a field which would have a pretty large and constant need in the military, and I found one article that mentioned offhand that "58 applicants applied to 52 spots for ID for the military."

I also found out about FAP, which has the advantage that I'd already be in a residency when I applied. However, the problem there was that I still don't know if I would be able to go to fellowship after that, or if my commitment would be required before I could start the fellowship. It seems again that it all hinges on whether or not they need ID at the time. Is ID pretty "in demand" in the military?

Obviously I don't know if I'm 100% set on ID since I'm not even in medical school yet, but I really do think that's the field I'll be headed into. I am keeping in mind that if end up wanting to do something else it could change pretty much everything that I just said.

Thanks for you help guys!

tl;dr:
1) Is IM competitive/in demand in the military (especially navy), and could I enter my residency without having to reapply?
2) Is ID competetive/in demand in the milirary (especially navy), and could I enter a fellowship immediately after residency?
3) Would FAP make it harder to get into an ID fellowship?
4) Is ID really even more interesting in the navy? Is it about the same? Not as interesting? Anybody with experience, I'd love to hear it!
5) And if you know, where do ID physicians in the military get posted? Is it usually just the big medical centers, or do most hospitals in the military have an ID physician?

Thanks again for your help!! Stay safe out there!!

---

Members don't see this ad.

 

[Gastrapathy]

ID is one of the few fields where if I was certain that was my future, I would still consider Navy HPSP. But there is so much change right now that I’m not sure that is good advice

 

[Perrotfish]

tl;dr:
1) Is IM competitive/in demand in the military (especially navy), and could I enter my residency without having to reapply?
2) Is ID competetive/in demand in the milirary (especially navy), and could I enter a fellowship immediately after residency?
3) Would FAP make it harder to get into an ID fellowship?
4) Is ID really even more interesting in the navy? Is it about the same? Not as interesting? Anybody with experience, I'd love to hear it!
5) And if you know, where do ID physicians in the military get posted? Is it usually just the big medical centers, or do most hospitals in the military have an ID physician?

1) IM is one of the less competitive specialties. Everyone in the Navy reapplies for their second year of residency after Intern year, though how difficult it is to actually get your residency varies by both year and specialty and is in flux right now in any event.
2) The competitiveness isn't something you can predict. When the fellowship is available there will likely be a single fellowship available, and anywhere between zero and a dozen people applying for it. In the Navy you are usually expected to do a 2 year tour (or a chief year) before applying to fellowship, though there are some exceptions.
3) Probably not, though it might make you less of a known quantity to the specialty leader making the decision.
4) This question might also be worth asking an actual ID doctor (there isn't one posting on here right now). If you called one of the big MTFs I am sure one of them would be happy to talk to you.
5) Only the big centers have ID physicians, but you will be consulting by phone to the smaller medical centers. I called back to the big MTF for ID probably more than any other specialty.

 

[deleted314957]

ANYTHING you want out of the military, you make damned sure you get it IN WRITING and have an atty review your contract BEFORE you join

 

[ruiner]

Here's a little background: I was recently accepted to 2 medical schools. One I enjoyed more than the other, is more prestigious and has a better location, but far more expensive. I put together a spreadsheet and found I would have to go significantly into debt in order to attend my preferred school (about $200K, and that's with my girlfriend working), while for the other school my debt would be really quite low. Since ID isn't the highest paying specialty, we were anxious about racking up so much debt only to go to 6 years of residency and fellowship, especially if we want to start a family at some point.

As we were talking about the options, I mentioned the HPSP program and she had me look more into it more. In terms of finances, it makes a lot of sense, especially because it seems that the pay gap between the military and private practice isn't as big for ID (I found numbers like $190K vs $130 for starting ID physicians, let me know if those are wrong!). I've also heard, anecdotally, that ID in the military (particularly the navy) can lead to some very interesting work, so I could enjoy working in the military more than the private sector, and that's actually one of the things that excites me (I could be totally off base about that, please let me know if I am!).

My main worry is that my options for residency/fellowship would be delayed or even blocked. I've always heard that if the military doesn't need your specialty, you'll either end up in another field, or having to delay a year or two in order to reapply. Since IM is a pretty big field and not super competitive, I figure I would be able to get into a residency without too much trouble (please let me know if I'm off about that!) but I can't find very much data about how competitive the infectious disease fellowships are for each branch. It seems like it should be a field which would have a pretty large and constant need in the military, and I found one article that mentioned offhand that "58 applicants applied to 52 spots for ID for the military."

I also found out about FAP, which has the advantage that I'd already be in a residency when I applied. However, the problem there was that I still don't know if I would be able to go to fellowship after that, or if my commitment would be required before I could start the fellowship. It seems again that it all hinges on whether or not they need ID at the time. Is ID pretty "in demand" in the military?

Obviously I don't know if I'm 100% set on ID since I'm not even in medical school yet, but I really do think that's the field I'll be headed into. I am keeping in mind that if end up wanting to do something else it could change pretty much everything that I just said.

Thanks for you help guys!

tl;dr:
1) Is IM competitive/in demand in the military (especially navy), and could I enter my residency without having to reapply?
2) Is ID competetive/in demand in the milirary (especially navy), and could I enter a fellowship immediately after residency?
3) Would FAP make it harder to get into an ID fellowship?
4) Is ID really even more interesting in the navy? Is it about the same? Not as interesting? Anybody with experience, I'd love to hear it!
5) And if you know, where do ID physicians in the military get posted? Is it usually just the big medical centers, or do most hospitals in the military have an ID physician?

Thanks again for your help!! Stay safe out there!!

I'll admit to not reading your whole post, but when I was an intern several years ago at Balboa the ID doctors all seemed very happy and supremely competent. I remember there was a talk from one of the new fellowship graduates who had been stationed in Africa in kind of a public health/research/clinic position. Echo what someone else said, I think it would be a very rewarding career in the Navy (that being said I did four years as a GMO and am now in residency for something completely different).

 

[Jaundice101]

Zamboni,

I finished a 4 year stint in the Air Force through HPSP (9 years total counting residency and training) about 2 years ago. Things can obviously change, may have already changed, and in general I would echo miksheree's general advice that if it ain't in writing it ain't guaranteed. As for your questions...:

1) Is IM competitive/in demand in the military (especially navy), and could I enter my residency without having to reapply?

Wasn't when I was a resident. That said, in most the branches there are literally only a handful of places you can do your residency at.

2) Is ID competitive/in demand in the military (especially navy), and could I enter a fellowship immediately after residency?

Impossible to predict. Each year's fellow spots are determined a year or two in advance based on the projected needs of the force which is itself dependent on a lot of factors, chiefly how many folks are staying in or getting out. Since each year's residency class is also not typically super large the amount of applicants to ID can vary from none to many. In the Air Force when I applied -- and I believe the Air Force is the smallest of the branches -- we had 3 applicants for 2 spots. Typically there were 1-2 spots each year.

As for going into fellowship immediately after residency, unless it's changed that's pretty much what everyone does in the Air Force and Army that wants to subspecialize. The Navy I'm not so sure.

3) Would FAP make it harder to get into an ID fellowship?

Unfortunately I don't know much about FAP.

4) Is ID really even more interesting in the navy? Is it about the same? Not as interesting? Anybody with experience, I'd love to hear it!

I knew a few ID folks in the Navy. Not well, but enough to get an appreciation some for their experience. For those who like the global health aspect of ID absolutely Navy is the way to experience it. Most the overseas research and surveillance billets are in the Navy. It is considerably more difficult to get a similar position in the Air Force and Army. That said there are opporunities with the other branches as well, especially if you are willing to stick around a few extra years as years of service is a driving factor with assignments.

5) And if you know, where do ID physicians in the military get posted? Is it usually just the big medical centers, or do most hospitals in the military have an ID physician?

Define big medical center. I was stationed at Travis AFB near Fairfield, CA. It's about 150 beds on a good day. There were about a half dozen other Air Force hospitals in the US that also had ID docs and two overseas in Germany. The ID fellowship was centered in San Antonio where there are probably as many ID docs there as everywhere else. I would suspect this is similar for the Army and Navy from what I gathered.

Only other word of advice I'd share is that if you have a pre-existing interest in military service the HPSP may be a good choice for you. If you don't, and are primarily considering it in order to go mercenary, I'd would really ask yourself how much that money is worth. Although you have a great deal more freedom than the average enlisted GI there are still a good number of restrictions particularly with regards to where you live and what you will do work-wise. Plus there are the deployments which are their own thing. A good number of my friends did it primarily for the money, and I would gamble most would say it wasn't worth it. That said, lot of folks complain in the thick of it then speak fondly of their "service" afterwards so....