Civilian or Military Neurology

[Dr.RickSanchez]

Hello NeurologySDN,

I am pretty dead set on Neurology as my career through medicine. I am going to be starting medical school this Fall semester, and I am weighing my options between military and civilian career paths (yes I know my time is very quickly running short). If anyone would be kind enough to help me with answering these questions I'd really appreciate it.

1. Military match vs. civilian match - obviously the military match is different every year based on their needs and I have heard that some years there are no spots at all for neurology. Can anyone shed some light on choosing between civ/mil regarding this?

2. Fellowships. It is my understanding that fellowships are pretty much a no go in the military, especially regarding neurology (outside of neurophysiology). I feel like a successful career in neurology would be very geared towards fellowships, is this correct?

3. Starting pay. The starting pay of a military physician regardless of specialty is ~$100,000. The starting pay of a civilian physician specialty unaccounted for is ~$190,000. Accounting for all interest over 8 years (4yr ms, 4 yr res), I will owe $370,000 to banks and have a yearly interest of 23k. All while living like a slave through the entire process, taking out about $15k a year for living expenses. Does this sound like a feasible amount to tackle as a neurologist within the first 5-10 years while living semi-reasonably?

4. Skill deterioration. I often hear physicians in the military complain that they are not placed in locations which are conducive to their skill-set. A doctor in family practice or other more rounded specialties may get by with this, but is neurology a bit too specialized to allow 4 years of not dealing with many neurology cases?

Let me also specify that I do not intend to be career military, if I did go military I would probably leave after my obligation.

I spent so much time calculating costs that I actually forgot the rest of my questions. Whoops! I'll think of more as we go!

Thanks everyone!

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[BlackFrancis33]

Military-specific answers:

1. There are always spots to train neurologists. 2 per year in the AF, 2-3 in the Navy, and 4 to 5 in the Army. The army and navy numbers fluctuate a little as the Walter Reed program can potentially take an extra army or navy person depending on the numbers. Expect to train in a military program, civilian deferral is very unlikely for residency.

2. Fellowships held by current active duty neurologists include: Neurophys, Epilepsy, Interventional Neurology, Neurocritical Care, Peds Neurology, Movement d/o, neuro-onc, neuromuscular, neuro-ophth, neuro-immuno, stroke, behavioral neuro. Army has the widest array of fellowship trained neurologists, in part because our numbers are the biggest, but also has the most fellowship offerings. Fellowships are not guaranteed, to anyone, and it is typical to do a 3 year utilization tour after residency. Utilization tour = working at military base such as Fort Bragg, Ft. Benning, or Ft. Bliss at the hospitals as a general neurologist. If working your entire career as a sub-specialist, going from residency to fellowship to subspecialty practice is what you need to be happy, the military is not your best option.

3. You get paid less, the tax breaks help, but it is less. All of my civilian colleagues make more money than I do, some of them make double. If finishing residency and immediately maximizing salary is important the military is a terrible option. I can't speak to your math, I don't have those debts. But again, I make less money and do not live the lifestyle of some of my residency classmates who graduated residency after me (and are now civilians). I didn't care as much 7 or 8 years ago as I do now. I definitely don't work less than my civilian colleagues.

4. If you are in a smaller military hospital, you may see mainly active duty patients in clinic. In this setting you are at risk of skill atrophy. Neurologists are mainly stationed at the bases with larger hospitals, this helps some. This is the idea of the utilization tour after residency, 3 years at a smaller place then moving up to a bigger MEDCEN or fellowship training. This is how it works for some, but not for all. The needs of the military service always come first. At the larger MEDCENs you will be in clinic and on call in the hospital, there is less skill atrophy in this type of position. The military population does not expose you to the drug-addicted, adult sickle cell patients, HIV patients etc. So if you want to be a neurohospitalist in an inner city hospital in a large metropolitan area someday, you may not see these types of patients until you finish your military career.

You will get deployed if we are at war, and this can be as a battalion surgeon, brigade surgeon, or as a neurologist. But options 1 and 2 are more likely. You won't get the assignment you want at least once, and you will move around every 3-4 years, especially early in your career. You may not get the fellowship training you want, or be in the practice setting you want for periods of years. It is a career, but it is also service. You and your family will make sacrifices.

Of the people I was in residency with, and including me, only 2 of us are still active duty. This is in large part due to longer commitments for various reasons for the two of us still active duty. As a completely unofficial observation, I think military neurologists are a bit happier than some of the other specialties. I would do it again, and I signed up for time beyond my initial service commitment. But as I told you I am in the minority of those I trained with in residency, and I take a lot of medication. That last part is a joke.