Hpsp Faq

[a1qwerty55]

I wasn’t going to jump on this thread, but on the recommendation of someone I now feel that this may be the proper place to point out a couple misconceptions about the Army HPSP. HPSP students selected for the scholarship have an average GPA of 3.54 and the average MCAT across the board for those currently in the program is 28.

There is a bare minimum for a packet to be forwarded to the HPSP Selection Board. The minimum acceptance criteria is actually 3.2 GPA and 24 MCAT with no less than eight in each of the three categories. The selection board is staffed with three Army physicians of which one is or was a Program Director. It is the board that ultimately decides who will be offered the scholarship. Those physicians who sit the board are to be commended for taking the time and being conscientious to ensure that they only select the best of what they see at the board. Conversely, for those who are less than satisfied with the board’s decision and want to change a part of it are welcome to volunteer to sit on the board.

And these minimum standards where raised from far lower standards last year because someone started realizing that we had a major problem. We have a problem don't act like there is some rigor in being selected for an HPSP scholarship.

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[a1qwerty55]

Talk about arrogance and ignorance incarnate.

I wonder if it is borne of insecurity or just plain stupidity?

No it is borne out of having your license hanging in the breeze when you have to rely on residents who don't have the intellectual skills to be safe. Trust me, I've taught residents for a long time and never had seen the knowledge gaps we see today.

 

[a1qwerty55]

We're all doctors sounds really nice but to suggest that there aren't differences in applicant quality between the average MD and DO applicant is to lie for the sake of political correctness. It also doesn't change the reality that our current crop of trainees is struggling to meet basic standards that were easily met 8-10 years ago.

If anyone doubts this, sit down with a program director from a residency that pulls from the bottom half (ie my residency) and ask about applicant quality.

One major driving force behind this quality drop is the acceptance of more DO students. DO students have a more variable quality of education and some of the newer DO schools really put the onus on the student to an alarming degree. There is just more variability in the product (yes, some just as good but others not so much).

This is not a personal attack or some deep-seated insecurity. Its what we face with our current housestaff every day. If you are a DO trainee and go to a school that lacks structure, you need to overcome that with your own diligence.

Now, is there an alternative to accepting marginal students? Not really. The reason marginal performers can get a scholarship is because the scholarships are tough to sell. I don't believe that DoD is interested in fixing this because that would require making the scholarship a good enough deal to attract quality people (which would require fixing the payback experience, physician pay, and a host of other issues).

We've decided that this is good enough. I can understand why people find that disappointing.

All that said, if I was a DO, I would seriously consider the .mil because we take DOs in every specialty and there really isn't a significant anti-DO bias.

100% on point.

It is like being an NFL team drafting players from Division II schools b/c they are football players after all, what's the difference? There are some absolutely great DO's (frankly if it weren't for DO's the MHS would be toast since there isn't anyway we are recruiting enough MD's) and I have said this before, the problem is the spread (top is good, middle and lower half not so much, and add to that the lack of academic medical center affiliations and DO students are just not coming out at the same place). As in sports, heart only gets you so far, you actually have to have the tools to succeed, be that physical or intellectual.

 

[DeadCactus]

A higher minimum might trick a few higher-caliber people into signing up for HPSP, but let's be realistic. People aren't gonna rush into line to eat a s--t hotdog even if they do have a 5 page application and interview process. You raise the minimum and you just end up with fewer people joining HPSP.

The military used to have great applicants because it had great training. Medical school students are gunners. Every single one of them, at least in relation to the general public. GMO tours? Deployments? Moving every two years? You'd have people begging to do all of that and more if you guaranteed them top-tier training in their specialty of choice in return...

 

[AF M4]

A higher minimum might trick a few higher-caliber people into signing up for HPSP, but let's be realistic. People aren't gonna rush into line to eat a s--t hotdog even if they do have a 5 page application and interview process. You raise the minimum and you just end up with fewer people joining HPSP.

The military used to have great applicants because it had great training. Medical school students are gunners. Every single one of them, at least in relation to the general public. GMO tours? Deployments? Moving every two years? You'd have people begging to do all of that and more if you guaranteed them top-tier training in their specialty of choice in return...

This is realistic. You have to start somewhere. To have a high-tier training program(s) you have to have high-tier attendings, particularly when it comes to specialty training. The military is not going to be luring high-tier attendings from the civilian world into military hospitals - there are just too many advantages that the civilian world offers to top-tier people.

So, you're going to have to home-grow them. You do this by raising the bar on your application standards, which selects for those with more potential to become top-tier physicians. This also raises your reputation in general, which may attract more higher-level people to your environment as well as make it more likely that high-level people would actually stay.

It's only a first step, not a panacea. It's much easier to gut a system than to build one up. There are a lot of other things that would have to be fixed with milmed as well.

With the drawdown in our various engagements overseas, the military will soon need fewer active duty physicians, so it can naturally be more selective. Plus, the economy and rising student loan costs (recent debt deal killed off the subsidized student loans - this raises the value of HPSP considerably), make the military option more attractive. There is space to do this.

Finally, I quite frankly had to work with some real turds during my time on active duty. I hated when they were in clinic because they screwed up so often that it meant extra time for me to clean up what they did. So there's an element of addition by subtraction in excluding lesser applicants.

 

[Charlie0318]

Back in the day, the 29 on the MCAT would probably have disqualified you, now it is such a rarity thanks to our osteopathic brethren that it constitutes an "automatic acceptance" into the HPSP. Your GPA is even less impressive.

I think it is fair to say a good chunk, if not majority, of MD grads in the military are from USUHS. And ironically enough the average MCAT score for USUHS class of 2008 was 29P. (http://www.medicalschoolsinusa.com/...ences_F_Edward_Hebert_School_of_Medicine.html) So are you saying that on average they should have been disqualified also?

No it is borne out of having your license hanging in the breeze when you have to rely on residents who don't have the intellectual skills to be safe. Trust me, I've taught residents for a long time and never had seen the knowledge gaps we see today.

There are shoddy medical schools of both the MD and DO variety and pretending like DO schools have a monopoly in that department is just plain ignorant. If you are having a problem with the residents you get at your program then why are they getting accepted? Watch trends with which schools these underpreformers are coming from and stop accepting from those schools, but don't try to slough off your woes of bad residents on DO students being vastly inferior. In reality, if you are in a low level residency, you are probably getting low level students, regardless whether they are DO or MD.

 

[a1qwerty55]

[QUOTE/]There are shoddy medical schools of both the MD and DO variety and pretending like DO schools have a monopoly in that department is just plain ignorant. If you are having a problem with the residents you get at your program then why are they getting accepted? Watch trends with which schools these underpreformers are coming from and stop accepting from those schools, but don't try to slough off your woes of bad residents on DO students being vastly inferior. In reality, if you are in a low level residency, you are probably getting low level students, regardless whether they are DO or MD.[/QUOTE]
Never said DO's have a monopoly on anything (if you would read my post in detail you would see I actually complemented DOs) the point was, and is that if you were to blindly recruit interns - you would probably be wiser to take ones from let's say, Georgetown or a state school than let's say LECOM - pick your campus.

As far as not accepting from crappy schools, remember that when the applicant to slot ratio is less than one, as it is with primary care in the military, you don't get an option to refuse people. As far as monitoring schools - its a done deal once they are on HPSP - we own them and the reality is recruiters have one focus, putting a warm body in the military. Quality doesn't even show up on their radar as they are judged by numbers alone.

 

[Mirror Form]

Well for starters I do think it is disappointing that few, if any Ivy league med school grads choose HPSP. These are the proverbial "cream of the crop" and it was not uncommon in the 80's and 90's to find them well represented in military medicine. Their absence is a loss, to be sure.

Also, "state U" allopathic schools are usually very competitive (California comes to mind) b/c of their low tuition compared to Tufts, for instance. Ironically, these students also seldom join the military b/c their debt load is comparatively light.

The absence of these demographic groups reflects very poorly upon military medicine. Essentially it tells us that the cream of the crop want to have nothing to do with a system fraught with difficulties, bureaucracy, poor pay, and uncertainty. For the "state U" folks as you call them it would seem to tell us that patriotism and sense of duty is not a large factor in considering HPSP anymore. It's the money, stupid. Of course this is borne out by the glut of D.O's who flock to mil med b/c of the exorbitant costs of their schools. They are also attracted by the lack of discrimination within the DOD with regards to residency availability. Conversely, this lack of discrimination turns some MD students off and so they do not apply for the "scholarship." Finally, the people who join the .Mil strictly for the money are the ones most likely to end up embittered and unhappy.

If everybody would stop being so damn PC for a second and consider the present situation, they'd be alarmed. What does it say about an organization that it is forced to rely on sub-par applicants to fill its quota? Are the ridiculous "minimum" standards for application (MCAT 21, GPA 3.2!!!!????) a good thing? Is it better to lower the bar, as military medicine has, while consistently advertising the monetary and residency benefits of the resulting indentured servitude? Qualified applicants, it would seem, are not fooled.

I think the military would do better to be honest and upfront. Tell the lemmings that there is a good chance they won't get their residency of choice. Be open about GMO tours. Do not skirt the fact that for many specialists, military medicine is a financial black hole, and a considerable sacrifice.

Emphasize the SACRIFICE. Emphasize duty to country and kin. Emphasize honor and courage. Military service of any type, at this juncture in our history, is ennobling. These are the things that make daily life in the military livable, and the stuff you can look back on with pride.

//end rant

I pretty much agree with everything you said. I was was just trying to make a point with the old state U comment in a sarcastic and smarmy way b/c there's really no reason to bust on DO's. While there are some bad DO schools, that are much much worse foreign medical schools.

 

[Mirror Form]

In fairness, the physicians in U.S. allopathic residency programs from foreign medical schools (India included) are some of the best I've come across. In some of the bottom-of-the-barrel malignant programs you have questionable-admission folks who can hardly speak English, but most of the ones I've come across are as good or better physicians than most U.S. med school grads I've met.

I'm not talking the folks who flee the U.S. to attend Sandy U out of fear of the D.O. degree. I'm talking the actual foreign medical school graduates. Most of these folks (India comes to mind quite prominently) have skills and intellectual abilities that put most U.S. allopathic grads to shame. If you think it's hard to get into a U.S. medical school, try being born in another country.

I've worked with a number of FMG civilian contractors during my time in military medicine. Some of them are so bad it literally defies belief. The fact that our tax dollars paid for them to train in US residencies, while we turned away US students, is an F'ing outrage.

I don't think HPSP losing a few Harvard Med grads is a sign of the apocalypse. But the fact that there are increasingly few graduates from (say) the better half of the allopathic medical schools should probably be viewed with some significance.

I was just joking with the ivy league comment. The overall drop in HPSP competitiveness is concerning. That's what happens when you screw people though. I think the internet has a lot to do with the drop in competitiveness. Before the internet, no applicant even knew what a GMO tour was.

 

[244913]

USUHS is a good school, but they matriculate some prior service folks with low numbers, which probably explains the 29 average. I've met some truly awesome USUHS folks. I pity their absurd 7 year commitment but I honor their choice and sacrifice, and honestly with prior service time factored in most are close to retirement by the time they finish their ADSO anyways. I won't trouble you with the nickname bestowed on USUHS by its detractors...

Orbitsurg, there is definite truth in your remarks. But as bitter as I am about some aspects of milmed and the GMO experience, I think it can be enriching in some ways. Does the .mil hang you out to dry? Absolutely. Will they back you up if you get in trouble in spite of your best efforts? Probably not.

But GMO tours can be rewarding. Serving in combat is an honor that few Physicians can claim. The men out on the front line are the best I've ever met. Their sacrifice, courage, and humility truly defies words, and surely cannot be redeemed by them.

Also, GMO applicants often find a decent glide path into civilian residency. We stand apart from 4th year med students and I really believe that having done four years as a GMO or Flight Surgeon opens up doors into civilian training that would have been otherwise inaccessible.

It is definitely not all black and white. I stand by what I said though, that the military needs to emphasize the sacrifice. There are a lot of med school hopefuls out there (mostly men) with a "military size hole in their chest." Most of us, if we are honest with ourselves, did not sign up just for the money. Just because your sacrifices are not honored or recognized by the bureaucracy at large does not mean they are without merit. I recall the idea of "noblesse oblige," which essentially boils down to the canard that to whom much is given much is expected in return. Our current culture and society despises aristocratic trappings, but this message probably resonates with some. I don't have any major regrets. Serving in combat sets you apart, and you can carry those experiences with you wherever you go, and draw strength from them.

 

[notdeadyet]

There are shoddy medical schools of both the MD and DO variety and pretending like DO schools have a monopoly in that department is just plain ignorant.

I would question this.

A bottom of the barrel MD school still has to comply with standards that DO schools do not have to face. I don't really know of any "bottom of the barrel" MD schools.

I looked long at hard at DO schools. The one thing I was shocked by was how many didn't even have hospitals. That to me was a deal-killer.

There are many DO schools I was very impressed with. But some had two years of classroom study followed by two years of a gypsy-like arranging of their clinical training, forever being a visitor in a foreign hospital. That sucks.

There are some shoddy graduates of MD schools and DO schools, without any doubt. But I'd be hard pressed to say that you could compare "bottom of the barrel" MD programs vs. DO programs. If you took the worst 10% of MD programs with the worst 10% of DO programs, you'd be looking at very different animals.

Again, I'm not slamming DOs. I've met many I've been very impressed with. But comparing quality control in the MD schools with DO schools is comparing apples and oranges.

 

[notdeadyet]

I've worked with a number of FMG civilian contractors during my time in military medicine. Some of them are so bad it literally defies belief. The fact that our tax dollars paid for them to train in US residencies, while we turned away US students, is an F'ing outrage.

The better question is what sort of people did these programs turn away to take these FMGs. A sharp DO with a quality education will beat an FMG with a quality education almost every time.

 

[Charlie0318]

To be fair this:

yep the "whole person" concept - 2 arms, 2 legs, hopefully a head, and an acceptance to on of the DO metastatic schools. Only the best for the DOD.

and this:

There are some shoddy graduates of MD schools and DO schools, without any doubt. But I'd be hard pressed to say that you could compare "bottom of the barrel" MD programs vs. DO programs. If you took the worst 10% of MD programs with the worst 10% of DO programs, you'd be looking at very different animals.

are WAY different statements.

 

[a1qwerty55]

Few argue that the quality of HPSP graduates has not declined. This on the surface seems like maybe... it is due the fact that the proportion of DO entrants now is approximately 50% and HPSP students from top tier medical schools are almost nonexistent. Maybe it is completely unrelated and maybe if I flap my arms hard enough I can fly.

I'm tired or 4th year DO medical students and interns who tell me that their performance stinks because the have learning disabilities, or because their school has crappy rotations or will not let them write in the chart etc. These are real comments. Even the lower tier MD school are affiliated with major universities. I remember one guy crying telling me I should pass him because his father was a coal miner and he was the first one his family to go to college

Quality matters in healthcare. Would your prefer your loved one on average getting care in a rural hospital staffed with FMG's or Mass General? My point is not that DO's are bad but that again on average their academic performance (a reflection of either intrinsic intellect or work ethic) is lower in general. Now medicine isn't just about being smart, common sense is a gigantic player, but you have at least a basic set of tools which I have seen several recent DO graduates lacking.

It bears repeating that I give everyone a fair shake and have been impressed with many DO graduates (several of the strongest residents I worked with were DO's)- it is just that the bad ones are not that uncommon and proportionally seem more prevalent that the MD graduates I have worked with. You can discount my experience all you want but it is based on years of experience. For the DO students out there - best way to win this argument is to prove the naysayers wrong, and excel.

 

[orbitsurgMD]

Few argue that the quality of HPSP graduates has not declined. This on the surface seems like maybe... it is due the fact that the proportion of DO entrants now is approximately 50% and HPSP students from top tier medical schools are almost nonexistent. Maybe it is completely unrelated and maybe if I flap my arms hard enough I can fly.
. . . .

This is a shame. About ten years ago, in the journal U.S. Medicine, the former Surgeon General of the Navy (a respectable one, not the guy with the fake degrees) observed and lamented that the Navy then was no longer drawing a pool of HPSP candidates that was representative of the pool of the nation's medical school graduates as a whole, that graduates of the top-tier schools were not well represented as they once had been and that overall the Navy had a disproportionate number of accessions from osteopathic schools, a group over-represented compared to the relative percentage of osteopathic students graduating among all graduating medical students in the country. While the NSG did not link this fact to issues of resident quality, he did say that the average accepted HPSP candidate had declined in quality to the point where they were at the minimum level for acceptance to allopathic programs in the country. That was, and I suppose still is a very telling observation. I am surprised that addressing that fairly stunning drop in applicant quality wasn't more of a concern to the Navy's senior medical leadership (I guess filling out all those applications for diploma-mill law degrees to pump up that flag promotion packet actually does take time after all . . . .)

 

[AF M4]

[..

 

[Mirror Form]

The better question is what sort of people did these programs turn away to take these FMGs. A sharp DO with a quality education will beat an FMG with a quality education almost every time.

Except when those FMG's applied for residency, there weren't many DO schools. So the US was still stuck hiring FMG's to fill all of our residency slots.

Allopathic schools always talk so much about access to care, but I guess training enough doctors to fill more than 2/3's of the US residencies isn't part of access to care?

 

[notdeadyet]

Allopathic schools always talk so much about access to care, but I guess training enough doctors to fill more than 2/3's of the US residencies isn't part of access to care?

Assuming allopath grads only fill 2/3rds of allopathic residency slots, this leaves 1/3rd for osteopaths and IMGs/FMGs, and those seats are (for the most part) happily eaten up. Not sure what your point is that I'm missing.

And allopathic med schools fight every year to increase enrollments. They're just not allowed meteoric growth like DO programs.

 

[Mirror Form]

Assuming allopath grads only fill 2/3rds of allopathic residency slots, this leaves 1/3rd for osteopaths and IMGs/FMGs, and those seats are (for the most part) happily eaten up. Not sure what your point is that I'm missing.

Previously they were eaten up by IMG's/FMG's b/c there weren't many DO schools. That's my point. Why did allopathic schools decide to turn away US students by the droves when so many resideny programs were having to hire IMG/FMG's?

And allopathic med schools fight every year to increase enrollments. They're just not allowed meteoric growth like DO programs.

And who's fault is that?

 

[AF M4]

Previously they were eaten up by IMG's/FMG's b/c there weren't many DO schools. That's my point. Why did allopathic schools decide to turn away US students by the droves when so many resideny programs were having to hire IMG/FMG's?



And who's fault is that?

http://www.nejmcareercenter.org/rpt/medical-schools-expand.aspx

Call your Congressman.

 

[notdeadyet]

http://www.nejmcareercenter.org/rpt/medical-schools-expand.aspx

Call your Congressman.

I'd be curious where this will head, with presumed budget cuts in the years ahead.

As long as you have already-trained foreign medical grads who want to settle down here or as long as you have domestic students willing to either emigrate to the Caribbean or to for-profit strip-mall expansion schools, politicians can make a pretty good argument for holding off expanding public funds for medical student education.

 

[AF M4]

I'd be curious where this will head, with presumed budget cuts in the years ahead.

As long as you have already-trained foreign medical grads who want to settle down here or as long as you have domestic students willing to either emigrate to the Caribbean or to for-profit strip-mall expansion schools, politicians can make a pretty good argument for holding off expanding public funds for medical student education.

Maaybe. It's a good question. There are many people who don't want to see a doctor from Strip Mall U, and there are certainly others who wouldn't care.

Then again, a politician could object to the above plan by saying that it is putting the health care of the United States in the hands of foreigners and for-profits. Maintaining a steady pipeline of venerable State U grads is a good counterweight.

 

[notdeadyet]

Then again, a politician could object to the above plan by saying that it is putting the health care of the United States in the hands of foreigners and for-profits. Maintaining a steady pipeline of venerable State U grads is a good counterweight.

And I would agree with that politician you describe.

I'd also agree with him as he argued that we need to invest in primary education, as our performance (particularly in the maths and sciences) is going to cost us a fortune financially in the long run and in lost opportunity. I'd also agree with him as he made pushes for public health and preventative medicine, since that's been shown to pay back in spades far more than treatment does.

Unfortunately, politicians like this who are willing to make short-term sacrifices for long-term gain are a rarity in Washington. A more popular choice will be to fill those slots with graduates of medical education systems over which the government has less control.

 

[notdeadyet]

Oh, and in the interest of accuracy, have folks read about this study?

It's a study of 244,000 hospitalizations and found that foreign nationals trained abroad and U.S. nationals trained domestically had comparable outcomes. U.S. nationals trained abroad had the highest.

This mirrors other studies I've seen and the results aren't that surprising. When folks have horror stories of incompetent doctors with accents, I think it may be a reflection of the accent registering whereas his lousy counterpart that sounds like he's from Topeka flies under the radar. I haven't noticed much of a difference and the data I've seen doesn't seem to find a problem with them.

 

[AF M4]

Oh, and in the interest of accuracy, have folks read about this study?

It's a study of 244,000 hospitalizations and found that foreign nationals trained abroad and U.S. nationals trained domestically had comparable outcomes. U.S. nationals trained abroad had the highest.

This mirrors other studies I've seen and the results aren't that surprising. When folks have horror stories of incompetent doctors with accents, I think it may be a reflection of the accent registering whereas his lousy counterpart that sounds like he's from Topeka flies under the radar. I haven't noticed much of a difference and the data I've seen doesn't seem to find a problem with them.

I don't know. My BS Detector shot up pretty fast when there's a hyperlink at the top of the page saying "Nurse Anesthetists Provide Safe Care Without Doctor Supervision". I've heard too many harrowing tales from Travis about patients who were intubated via the esophagus by unsupervised nurse anesthetists.

Glancing at the mag's About page makes me think that it wants to find evidence that health care can function on the cheap. The Potential Bias light is on.

They're also making a LOT of assumptions about the quality of care by the outcomes (death rate, discharge rate) they describe. There's a fallacy here, and I believe it has been demonstrated in interventional cardiology, though I'm having difficulty finding the specific article. It has to do with mistaking results for the quality of process in achieving them. Here is something close:

http://jama.ama-assn.org/content/293/10/1239.short

To summarize, hospitals started grading their cardiologists on the outcomes of their procedures. Deaths and discharges, like the studies above. What happened was that many cardiologists simply stopped taking complicated patients, because there was a higher risk of complications, which would hurt their numbers. Those high-risk patients fell to some very good cardiologists who would try to save their lives, but of course some of them died and some of them had long hospital stays.

So when the grade cards came out, those who cherry-picked the easy ones came out ahead while those who did the complicated ones were made to look bad, even though they were the ones who you would want operating on your mother.

So when I see a line in your study like, "Physician performance declined over time, with mortality rates and length-of-stays increasing with the number of years since graduation from medical school.", I get skeptical.

Now I can demonstrate that very phenomenon with a ward team at my hospital. The intern (1 year from med school) is put in charge of discharging the 30 y/o rule out chest pain from the night before (~1 day stay); the attending (5 years from med school) has to take care of the CHF exacerbation (~1 week stay) whilst the intubated HIV with the weird pneumonia and 4 antibiotics (~1 month or dead) is being managed by the fellowship trained intensivist (10 years).

By the metrics used in that study and the logic of the authors (quote: "In addition to patient death rates, the study looked at length-of-stay as a measure of quality of care."), I would have to conclude that the interns are the best doctors in the hospital, and the ICU docs are borderline ******ed.

Lies, damn lies, and statistics.

 

[notdeadyet]

Yeah, I'm sure there are better studies out there. Do you know of any?

 

[AF M4]

Yeah, I'm sure there are better studies out there. Do you know of any?

If I knew of a study that proved a point that argued against my interest as US grad, why would I post it?

 

[notdeadyet]

If I knew of a study that proved a point that argued against my interest as US grad, why would I post it?

What data would be against your "interest" as a US grad? That FMGs aren't incompetent? I'm not clear why that would make you feel threatened. Maybe I'm missing something...

 

[AF M4]

What data would be against your "interest" as a US grad? That FMGs aren't incompetent? I'm not clear why that would make you feel threatened. Maybe I'm missing something...

You are missing a very big thing. It's called commoditization, and it should keep you awake at night.

Ok, listen to this example. I like the show Breaking Bad on AMC. It is about a hard luck but highly skilled high school chemist who turns to crime by cooking meth for the Mexican cartel.

This chemist turns out to be very good at meth-cooking, and cooks the purest meth ever. His talents are very much in demand, and he is paid millions by the cartel.

The chemist is assisted by a high school dropout/meth addict. The dropout is about as smart initially as you'd expect a dropout meth addict to be, but the chemist got his start in the crime business by working with the dropout, so there is some loyalty there. They are partners, and the cartel pays them both.

Eventually though, the chemist starts acting up, and the cartel is looking for a way to replace him. Now the chemist was the one who came up with the ingenious recipe for the drug in the first place, but the dropout has worked with him enough that he has the recipe down cold. That is all the cartel wants.

The chemist's genius and years of knowledge were valuable in that it helped him create the recipe. For awhile, he was the only one who could do it, and so he was paid handsomely and the cartel went to great lengths to protect him.

Now though, the all-important part of his knowledge has been commoditized, and passed on to the dropout. So now, instead of being rewarded and protected, the chemist has to fear for his and his family's life.

So when you hear stories and studies of PAs and CRNAs and NPs and FMGs all doing as good as job as you with your $500,000 degree and higher salary can do, you need to think of what happens to high-priced people who are no longer thought of as essential. Hint from the TV series: it involves getting driven out to the desert with a bag over your head by guys with guns.

You don't have to say that others are incompetent. But your motto needs to be that no one does it better than you, and you need to repeat that over and over and over for as long as you live.

 

[studerman]

.

 

[juliegirl]

Okay, I have read different answers to this question. I am EXTREMELY interested in HPSP. I want to pursue family medicine which would be at least a 3 year residency with the military. If I do a military residency, do these years count toward my "pay back"?

 

[J-Rad]

Okay, I have read different answers to this question. I am EXTREMELY interested in HPSP. I want to pursue family medicine which would be at least a 3 year residency with the military. If I do a military residency, do these years count toward my "pay back"?

No. An active duty residency actually accrues more time debt, but it is a time debt that is paid off concurrently with your time-debt from medical school. So if you did HPSP for four years and a three year residency, then you would serve a 4-year Active Duty Service Obligation (ADSO) from med school with your 3-year ADSO from residency and serve a total of four years active duty after completion of training before being able to leave the service (You would also owe another year of time in the Individual Ready Reserve [IRR] in which you have to maintain accountability to the .mil but not do any service time as all initial commitments to the military are eight years in length)

 

[notdeadyet]

So if you did HPSP for four years and a three year residency, then you would serve a 4-year Active Duty Service Obligation (ADSO) from med school with your 3-year ADSO from residency and serve a total of four years active duty after completion of training before being able to leave the service

Doesn't intern year in a military residency neither accrue nor pay back time?

 

[J-Rad]

Doesn't intern year in a military residency neither accrue nor pay back time?

This gets a little outside of my scope of knowledge and would be best answered by those experienced in the 1y-->GMO route, but I believe that when intern year is followed by GMO, the intern year is neutral or may count as one year of payback. But when it goes internship-->residency, it all counts toward the concurrent payback commitment.

 

[orbitsurgMD]

Doesn't intern year in a military residency neither accrue nor pay back time?

True.

 

[J-Rad]

This gets a little outside of my scope of knowledge and would be best answered by those experienced in the 1y-->GMO route, but I believe that when intern year is followed by GMO, the intern year is neutral or may count as one year of payback. But when it goes internship-->residency, it all counts toward the concurrent payback commitment.

True.

Thanks orbitsurg. This is one area in which I frequently become confused and I believe what I said was incorrect. http://www.goarmy.com/content/dam/goarmy/downloaded_assets/pdfs/hpsp_fact_sheet.pdf
This is an Army factsheet, but I don't believe rules on ADSOs would be any different amongst the services, so it seems pertinent to all.

 

[carp56]

OBC before 1st year? has anyone on here been able to go to OBC for the Army before their first year? I just received an acceptance and I am currently active duty enlisted but I would prefer to do OBC before but my recruiter doesn't know if it is possible. And for anyone that was enlisted Army that started HPSP what is the time line for getting commissioned and has anyone used ETS move to move to school?
Thanks for the help

 

[USArmyHPSP]

This is a litte more complicated than it would seem. You are welcome to PM me.

 

[ajp529]

I have read the FAQ and done a bit of research but still have some questions. I know that ultimately the decision is mine and no one can tell me what to do, just looking for some opinions of people who have faced the same decision.

I am 23, married, and have a 6 month old son. I still have at least 1.5 yrs left before I apply, 2.5 yrs left until I am in med school. My wife and I want more kids and will probably have another one before I am done with undergrad, and another one or two in med school. I am planning on being in debt, in a lot of debt. I know that having a large (for medical school standards) family will force me to take on lots and lots of debt. My wife and I really dislike debt and would prefer to have less, if possible. If we were to do HPSP then we would have to take out less debt, less debt=less interest and less stress. I am curious about serving in the military, I am not worried about salary while in the military, but rather the added stress that taking out all of that debt will have on our lives, and then having to pay it back for a substantial portion of my life. Does the decrease stress of having less debt justify the added stress of the HPSP program? Why?

Thanks!

 

[Charlie0318]

I have read the FAQ and done a bit of research but still have some questions. I know that ultimately the decision is mine and no one can tell me what to do, just looking for some opinions of people who have faced the same decision.

I am 23, married, and have a 6 month old son. I still have at least 1.5 yrs left before I apply, 2.5 yrs left until I am in med school. My wife and I want more kids and will probably have another one before I am done with undergrad, and another one or two in med school. I am planning on being in debt, in a lot of debt. I know that having a large (for medical school standards) family will force me to take on lots and lots of debt. My wife and I really dislike debt and would prefer to have less, if possible. If we were to do HPSP then we would have to take out less debt, less debt=less interest and less stress. I am curious about serving in the military, I am not worried about salary while in the military, but rather the added stress that taking out all of that debt will have on our lives, and then having to pay it back for a substantial portion of my life. Does the decrease stress of having less debt justify the added stress of the HPSP program? Why?

Thanks!

To be fair, only you can answer that question because the answer will be different for every person.

If I was you my concerns would be this: Do you want your children moving around every 4 years? Changing schools, finding new friends, etc, because doing HPSP will mean you will be moving to med school, to residency, then to wherever you are stationed. My wife and I are planning our kids so by the time the oldest is getting close to middle school I will be done with my service obligation and we can decide what the best course of action is from there.

Another big thing to consider if you are only doing it because you are afraid of debt, is that there are TONs of programs, both established and being implemented, to help with loan repayment/forgiveness. If you really want to serve, and it is important to you, go for it. The HPSP program does provide some nice benefits while in training, mostly financial security, but if you don't have a real desire to serve you will be very unhappy in the long run.

Also as far as kids and wife, I know people at my school that have their wife and kids on medicaid and collecting food stamps to help with expenses. So there are lots of ways to keep costs down in school, and then pay back loans afterwards. Don't stress about that.

 

[beargunkarate]

Hi All,

Would anyone currently in medical school or in residency under the Air Force HPSP be willing to answer some questions for me? I'm particularly interested in how "easy" it is to defer to a civilian residency if you don't match for an Air Force one and whether it is "rare" for someone to have to do a tour/GMO unless they "want" to experience flight surgery (as I was told by the recruiter). I'm really interested in doing Air Force HPSP (I just was deemed medically qualified at MEPS today), but I'm also an older, non-traditional applicant (28...soon to be 29) and the thought of having to do a 2-3 year tour/GMO prior to residency is horrifying...

I REALLY appreciate any help/insight, particularly if you've gone through the residency match process recently. Feel free to private message me if you'd rather, too.

 

[notdeadyet]

I'm really interested in doing Air Force HPSP (I just was deemed medically qualified at MEPS today), but I'm also an older, non-traditional applicant (28...soon to be 29) and the thought of having to do a 2-3 year tour/GMO prior to residency is horrifying...

If the thought of doing a GMO tour is horrifying you probably shouldn't go military at all, as all service currently force GMO tours. It's more likely depending on the competitiveness of your specialty, though every year, it changes somewhat and can be a crapshoot.

If you're deadset on the military for some reason and really hate the idea of a GMO tour, you should consider the Army, where it's less likely (but still oh-so-possible).

Can't answer the chance of civilian deferment question, other than it's not guaranteed in any branch.

 

[futuredevpediat]

Can anyone shed some light on the options of HPSP versus FAP? I am a married mother of four, and I am interested in this program because it sounds like a "win" financially for our family's future as opposed to going into enormous amounts of debt. However, the thought of being separated from my children is not something I am comfortable with. Would my family be with me wherever I went? Or, would I potentially be sent away somewhere without them? Also, how does this work? Do I begin medical school and then apply to the FAP or HPSP? Or, is it the other way around? Thanks for your assistance!

 

[Mirror Form]

Can anyone shed some light on the options of HPSP versus FAP? I am a married mother of four, and I am interested in this program because it sounds like a "win" financially for our family's future as opposed to going into enormous amounts of debt. However, the thought of being separated from my children is not something I am comfortable with. Would my family be with me wherever I went? Or, would I potentially be sent away somewhere without them? Also, how does this work? Do I begin medical school and then apply to the FAP or HPSP? Or, is it the other way around? Thanks for your assistance!

Make sure you know what you're getting yourself into. If your husband has a decent job, then joining the Army would be detrimental to his career. This is because he would have to follow you around the country every few years when you are moved to another random location. Therefore HPSP could cost you quite a bit of money in the long run.

Most likely you will not be split up from your family, but the risk of being deployed for 6 to 12 months is ever present. Also, depending on the age of your kids, they might not love being moved away from their friends multiple times.

You would apply for HPSP before medical school, or during your first year. FAP you apply for afterward.

 

[torshi]

after med school with the hpsp scholarship do you jump to O-3 when in AD? I heard O-4 a few times, and how do you really rank up..skill, automatic, doing your job etc?

Is it better to do your AD before residency or personal preference, I'm assuming most people who don't end up matching or something, they end up doing intern then GMO AD?

 

[notdeadyet]

However, the thought of being separated from my children is not something I am comfortable with. Would my family be with me wherever I went? Or, would I potentially be sent away somewhere without them?

If you are deployed to Afghanistan (or whatever the flavor may be when you're done with residency), you will be deployed without family for 6-12 months. When not deployed, you're usually stationed in places where your family can come.

If you're not okay with being separated from your children for 6-12 months during time of war, the military is not a good idea.

 

[drewskies]

Hi everyone,

I recently got accepted to several osteopathic medical schools and am currently in the process of submitting my HPSP application (Go Navy!). Anyhow, I just have a question on which GPA to use. According to my undergraduate GPA, I have a 3.035 (I was a terrible student in my first couple years). I also took some community college courses (got a 4.0 in those). However, according to AACOMAS (with their policy on repeated courses), I have a 3.24 GPA.

1. Which GPA do I use for the HPSP Application?
2. Am I considered competitive for the Navy HPSP Program (I have an MCAT score of 28R)

Thanks for your help

 

[torshi]

Can anyone shed some light on the options of HPSP versus FAP? I am a married mother of four, and I am interested in this program because it sounds like a "win" financially for our family's future as opposed to going into enormous amounts of debt. However, the thought of being separated from my children is not something I am comfortable with. Would my family be with me wherever I went? Or, would I potentially be sent away somewhere without them? Also, how does this work? Do I begin medical school and then apply to the FAP or HPSP? Or, is it the other way around? Thanks for your assistance!

HPSP 4 year scholarship is a payback of 4 years of AD and 4 years inactive but if you do FAP for residency that's additional active duty time.
If I do the scholarship I'm thinking of doing the 4 or 3 year HPSP then after med school, do my internship year, and all my active duty time before residency, then get into a civilian residency so after that i will be in IRR for 4 years since the military service obligation is 8 years. 4 years active, and 4 years inactive meaning they can call you up anytime

 

[AntsMarching44]

Can anyone outline exactly what happens at MEPS? Is it common to be disqualified for not passing the physical??

 

[smooththrow]

Can anyone outline exactly what happens at MEPS? Is it common to be disqualified for not passing the physical??

I am also curious about the passing the physical. I applied to all three military academies out of high school, and actually received conditional acceptances from two. However, I could not pass the physical portion due to a back surgery I had during high school. I went through a very extensive medical waiver process that ultimately failed. I have now been accepted to several medical schools, still have a strong desire to serve, and could definitely benefit from the HPSP because the school I would like to go to is private and very expensive. Does anyone know if the medical process would be the same for HPSP as for the military academies? I'm inclined to believe it is, but I'm not sure. My actual physical fitness has always been above average, and is even better now. My back has never given me problems, although I don't think the military is much concerned with that as it is the fact that I had a problem in the past. Any input would be greatly appreciated!