HPSP For Competitive Specialities

[Topiary56]

Just to give some background, I'm currently a third year pre-med applying this cycle. I made a spreadsheet of potential expenses and tuition and compounding interest and now I'm terrified. Not doing this purely for the money, but more for the ease of mind that I can start maxing my 401k when residency starts rather than being 401k in debt (I'm sorry) and being able to have a family earlier and stuff without taking more loans. My parents and grandparents might be able to contribute to my med school tuition but I'd rather them get a nice car or something than pay for my education since they've already covered my undergrad.

I've honestly always been drawn towards the military and I don't think the culture or anything will be an issue. I was very seriously considering taking gap years to be a combat medic but ultimately decided not to because the 3 year time commitment was too much before med school.

Personally, I'm very interested in doing medicine to try to get into an underserved area. I don't like cities and want to get away from urban centers in the future and don't have much interest in research or academic medicine. I'm like 90% sure I want to go into primary care or general surgery, but also I'm very interested in ophthalmology. I don't want to go into it for lifestyle, but I would like to go into it to get more scrappy in the midwest or southeast or somewhere without many ophthalmologists even if my salary would cap much lower. Also, I hate hospitals.

I've been reading through a bunch of threads, but I'm wondering if anyone has any insight on what residency matching looks like through HPSP. If I end up doing primary care I doubt it would be a problem, but if I want to go into optho or general surgery or something would it be an issue? Also, I hear a lot about needing to be relocated during service. Does anyone have any experience with that especially if you have a family and stuff? Finally, I'm wondering how often it happens that doctors would get pulled and deployed as a flight surgeon or something. Personally I would love doing that if I'm a single guy, but I wouldn't want to be absent if I have a wife and family at that point.

Sorry for the long winded post, I appreciate any insight!

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[SirGecko]

You say you’ve read threads so it probably shouldn’t come as a surprise that the first thing anyone is going to tell you is that you shouldn’t do it for the money. Not going to reiterate those arguments here.

To answer your other questions:

Residency match: depends on the year and service. Competitiveness will vary depending on the demand signal of the service and what everyone in your cohort is trying for etc. Gen surg will always have spots though they might be competitive but Ophtho is likely tighter cause it’s a smaller specialty.

Relocating: generally speaking you move every three years. They can (and sometimes do) move you sooner. Having a family isn’t a reason for them not to move you.

Deployments: depends on the op tempo. Again having a family is not a reason they wouldn’t deploy you. Don’t join if you aren’t ok with having to move or potentially deploying.

 

[armytrainingsir]

The military moves you every three years.

The military sends you overseas on deployments when they need a body with your skills in a particular area.

While they may put on a bit of a show, the military doesn’t give a rat’s arse about your personal likes, commitments, or concerns. If your goals and the military’s need match, great. If not, .mil wins.

Those are absolute fundamentals of military service. If they are not palatable, please, look elsewhere.

Of course, if you look, you will find folks that avoided one of these absolutes or even all of them. Folks win in Vegas too. But betting against the house is a poor strategy.

 

[pgg]

"I don't like hospitals" is a sort of odd thing to hear from a pre-med who's going to spend the better part of a decade in hospitals before (maybe) finding a niche in a non-hospital practice.

What don't you like about hospitals? Have you ever worked in one?


Residents at military programs are nondeployable. (GMO tours between internship and residency are sort of a side discussion to that principle.)

Your family or lack thereof has zero bearing on what the military will tell you to do or where it will put you. Unless you have a dependent with significant special needs. If your spouse is active military there are some co-location considerations, but less than you'd like, and hardly any guarantee.


The last thing I'll add is that even though you're interested in primary care and general surgery and eyeballs now, it is highly likely that you won't end up doing any of those things. The simple truth is that most med students don't go into the field they thought they would when they started medical school. Most of what they "know" about different specialties as pre-meds is based on incomplete or faulty (media-driven) information, or outright imagined. You'll get real-world exposure to many different specialties starting a year or two into medical school, and that's when your brain will finally be able to mesh its hopes and dreams and ideas with the actual reality of working as a physician.

For this reason alone, HPSP and USUHS carry some risk to all medical students. They are committing themselves to the military match, which is limited in many was compared to the vastly larger civilian match, and the only eject mode if you don't like your residency options is the "GMO & out" path.

 

[Topiary56]

"I don't like hospitals" is a sort of odd thing to hear from a pre-med who's going to spend the better part of a decade in hospitals before (maybe) finding a niche in a non-hospital practice.

What don't you like about hospitals? Have you ever worked in one?


Residents at military programs are nondeployable. (GMO tours between internship and residency are sort of a side discussion to that principle.)

Your family or lack thereof has zero bearing on what the military will tell you to do or where it will put you. Unless you have a dependent with significant special needs. If your spouse is active military there are some co-location considerations, but less than you'd like, and hardly any guarantee.


The last thing I'll add is that even though you're interested in primary care and general surgery and eyeballs now, it is highly likely that you won't end up doing any of those things. The simple truth is that most med students don't go into the field they thought they would when they started medical school. Most of what they "know" about different specialties as pre-meds is based on incomplete or faulty (media-driven) information, or outright imagined. You'll get real-world exposure to many different specialties starting a year or two into medical school, and that's when your brain will finally be able to mesh its hopes and dreams and ideas with the actual reality of working as a physician.

For this reason alone, HPSP and USUHS carry some risk to all medical students. They are committing themselves to the military match, which is limited in many was compared to the vastly larger civilian match, and the only eject mode if you don't like your residency options is the "GMO & out" path.

I've been working as a CCT for like 6 months now. My personal experience has been crap since they barely trained me and kinda just threw me out there in the float pool to figure things out. Ofc it's a generalization and I don't have enough experience to really draw a conclusion but I don't like it. I don't exactly want to leave though because they are paying me like 5 dollars more than any other healthcare job and give flexibility to work double shifts and pick up patient monitoring shifts and I need the money. I've done some lurking on the residency and IM subreddits also and it feels like a race of hospitals extracting as much value as physically possible out of frontline providers and physicians brawling to get as much money compensation back out of the hospitals. Only way I could see myself in a hospital is to find a really undesirable location where I'm basically unreplaceable and then be an dingus towards everyone that isn't a frontline provider or patient but I'd imagine that's not the best mentality and wouldn't provide the best patient care.

So yea I have a lot of bad attitudes towards hospitals. I worked as a tech at an optho clinic also and insurance was a pain in the ass and reimbursements are dropping and stuff, but it was a really pleasant experience because the doctor who owned it was really good and treated her staff and patients really well and I'm hoping I could do that one day. Doesn't have to be eyes, but I've spoken to a lot of doctors about their specialties and I feel like outpatient is a lot more appealing to me and I like business as well. Maybe something else besides ophtho will catch my eye (pun intended) during rotations tho I'll keep an open mind for sure. My mentality is kinda set myself up for ophtho because it's the most competitive speciality I can see myself doing and if I don't like it I'll be in a good position for other stuff but we'll see what happens.

Anyways that rant is over.

How exactly does the GMO & out path work? I doubt being a GMO would help necessarily, but what does it look like if you don't go matched? Also, does that count towards the 4 years of service required?

Do you know how matching into civilian residencies works out of HPSP? They mentioned it is possible but I would imagine it is very limited and they probably don't want you to do it.

I appreciate the response.

 

[Topiary56]

You say you’ve read threads so it probably shouldn’t come as a surprise that the first thing anyone is going to tell you is that you shouldn’t do it for the money. Not going to reiterate those arguments here.

To answer your other questions:

Residency match: depends on the year and service. Competitiveness will vary depending on the demand signal of the service and what everyone in your cohort is trying for etc. Gen surg will always have spots though they might be competitive but Ophtho is likely tighter cause it’s a smaller specialty.

Relocating: generally speaking you move every three years. They can (and sometimes do) move you sooner. Having a family isn’t a reason for them not to move you.

Deployments: depends on the op tempo. Again having a family is not a reason they wouldn’t deploy you. Don’t join if you aren’t ok with having to move or potentially deploying.

Ig seems that you basically should just expect to have no freedom until your 4 years are up. Ofc they'll advertise it like it's better but I'm just gonna go in with that mentality if I do the program.

As for the relocating stuff, how often would they relocate over the 4 years in your experience? If it's just once or twice in four years that's fine but has anyone gotten run around multiple times from what you've seen?

I'm wondering if you have any comprehensive lists of residency slots? I've been looking into it, but it seems like this is all the optho slots which is only like 15. I don't doubt my ability to match into ophtho normally, but if it's only 15 slots that seems really competitive.

 

[psychmd2016]

I w5×#$

 

[SirGecko]

Ig seems that you basically should just expect to have no freedom until your 4 years are up. Ofc they'll advertise it like it's better but I'm just gonna go in with that mentality if I do the program.

As for the relocating stuff, how often would they relocate over the 4 years in your experience? If it's just once or twice in four years that's fine but has anyone gotten run around multiple times from what you've seen?

I'm wondering if you have any comprehensive lists of residency slots? I've been looking into it, but it seems like this is all the optho slots which is only like 15. I don't doubt my ability to match into ophtho normally, but if it's only 15 slots that seems really competitive.

Fours years is often not four years. So many ways for it to be longer. If you did get a civilian deferred spot and actually only did four years of payback they would usually want to move you once but maybe they would let you extend to hit your four. Assume not though.

The navy publishes the GME note every year that has the training spots for the year. It’s publicly available. This is last years note: https://www.med.navy.mil/Portals/62... 13 Jun 2023.pdf?ver=OvwR7htJVea3sCzsYOEjZw==

I don’t know specifically about army and Air Force but you can probably find those numbers as well. If you look at the note they had one Navy Ophtho spot last year. One. That might change year to year in the future but that’s the order of magnitude that you can deal with in the military match. You have to be as flexible as possible to thrive in military.

 

[Topiary56]

Fours years is often not four years. So many ways for it to be longer. If you did get a civilian deferred spot and actually only did four years of payback they would usually want to move you once but maybe they would let you extend to hit your four. Assume not though.

How exactly does getting a civilian deferred spot work? It would be optimal to do a normal residency in all honesty just because it's better training.

Being the only residency in your class must be an interesting experience for that one navy guy damn

 

[orbitsurgMD]

The Navy has progressively withdrawn from ophthalmology training support. At one point there was a solid accession of 11 PGY2 (first-year of ophtho) slots. In a single year, they closed one center and cut the number down to three new residents per year. With the loss of Bethesda Naval Hospital, they have only San Diego as a training center and it appears they are shutting that down. I wouldn't want to be a sole trainee in an ophtho class. Part of the experience is clinic volume which is how surgery numbers are developed.It seems that the Army may be running the program (no surprise.) When you have so few residents, everything gets reduced, including the volume needed to see unusual cases.

If they are down to those kinds of numbers, they owe it to the trainees to send their residents to civilian programs as deferments.

Civilian deferred spots are requested in the military match. You must list them first. They are scarce. Typically you are deferred for both internship and residency and report as an attending when you are finished. You will have to have your application ready and possibly underway before applying for a deferment.

 

[DrMetal]

Just to give some background, I'm currently a third year pre-med applying this cycle. I made a spreadsheet of potential expenses and tuition and compounding interest and now I'm terrified. Not doing this purely for the money, but more for the ease of mind that I can start maxing my 401k when residency starts rather than being 401k in debt (I'm sorry) and being able to have a family earlier and stuff without taking more loans. My parents and grandparents might be able to contribute to my med school tuition but I'd rather them get a nice car or something than pay for my education since they've already covered my undergrad.

Impressive that you've put that much thought and effort into this. Very astute. When I was a 3rd year pre-med, I was too busy (chasing tail and the next bottle) to think of such things.

How exactly does the GMO & out path work? I doubt being a GMO would help necessarily, but what does it look like if you don't go matched? Also, does that count towards the 4 years of service required?

Go to business school. You don't want to be a doctor nor be in the military. When your initial inquiry about joining the military is how to GTFO of it, that's a red flag. When your inquiry into medicine is about how to avoid hospitals, also a red flag.

 

[Topiary56]

Go to business school. You don't want to be a doctor nor be in the military. When your initial inquiry about joining the military is how to GTFO of it, that's a red flag. When your inquiry into medicine is about how to avoid hospitals, also a red flag.

I would make a hell of a lot more money doing business, but unfortunately I hate business.

The reason I hate hospitals is because I hate the way that they are run. Giving c-suite hospital execs 7 figure bonuses is messed up. They aren't getting those bonuses through providing better quality of care, but it's purely from increasing margins and bottom line through finding new ways to profit. The quickest way to more profit isn't sustainable growth, but through cutting staff and increasing expenses of patients who are either suffering or had an emergency. I'd be fine fine if hospitals made money growing organically and providing good care and establishing good rapport with their community, but the industry seems to be heading towards slash and burn PE and hospital conglomerates eating up competition. Maybe the government will intervene or something and start regulating, but I doubt it.

If someone wants to make millions of dollars selling phones or cars or something I have no issue because I as a consumer can choose which phone or car to buy which will drive prices down through competition. If someone suddenly collapses and gets transported to an ER, they have no choice and are basically writing a blank check for the hospital to charge whatever and it's on the patient who is dying or the family who is stressed to get a massive bill to argue about with insurance and with the hospital to get down to a normal level.

I'm not looking at private practice for the more cushioned lifestyle or whatever. I'm a volunteer EMT and have no issue taking care of patients at their lowest. I just don't like the business aspect of hospitals and PE butting into healthcare and would rather make less money providing a good quality service to people who can actually choose to go to me over other docs.

If I wanted to provide emergency healthcare I would honestly just find a way to volunteer and do it for free. I hate the idea of charging them for it. So yea that's my pessimistic rant on healthcare.

Also, I'm not trying to dodge the military (I know you can't dodge them) but they're pretty hush with that kind of info and I wouldn't trust what a recruiter says. I just want to have every option laid down just to see what is available before committing to something like this as a MS-0 matriculant.

Impressive that you've put that much thought and effort into this. Very astute. When I was a 3rd year pre-med, I was too busy (chasing tail and the next bottle) to think of such things.

I should be spending some more time boozing and chasing tail that doesn't seem like a bad idea at all.

 

[Helpful Troll]

Also, I'm not trying to dodge the military (I know you can't dodge them) but they're pretty hush with that kind of info and I wouldn't trust what a recruiter says. I just want to have every option laid down just to see what is available before committing to something like this as a MS-0 matriculant.

Not sure what you mean "I'm not trying to dodge the military... they're pretty hush with that kind of info...." You were provided the Navy BUMED Notice that lays it out in a given year. It changes every year. The other services are similar. You can't ".. have every option laid down to see what is available...". Don't choose military service in a physician training program unless you are flexible as to training options, assignment locations, and possibility of deployment. If you're frustrated with civilian hospital administration you will be even more frustrated in the military/DHA.

Key is the final step in the BUMED Notice (Selection Process) indicates the final placement decision is 'needs of the service'. You could be placed in any PGY-1 position. "PGY-1applicants not competitively selected for their first or second choice specialties will be considered for unfilled FTIS PGY-1 (1-year internship) positions in a similar specialty."

You can't fully control your 'choice' in the military. Don't commit to this. Take the loans and have some 'choice'.

 

[pgg]

How exactly does getting a civilian deferred spot work?

You can apply to the military for permission to apply for a civilian spot at the GME selection board. Odds of approval are specialty dependent, vary greatly year to year, and very broadly speaking it is unlikely to be approved.

Sometimes when you apply for an inservice residency, you can be listed as deferred, if they didn't want you as a select or alternate. That may be because you're simply non-competitive, or because the military has decided that year that their projected needs exceed their inservice training slots.

Key point - hard to predict, generally unlikely, and mostly out of your control.

It would be optimal to do a normal residency in all honesty just because it's better training.

If you think that - and it's not an entirely unreasonable conclusion depending on specialty and your career aspirations - then it sounds like you shouldn't join the military.

Being the only residency in your class must be an interesting experience for that one navy guy damn

Not really. A resident is a resident. Does it really matter that most residents are getting paid by the hospital, and one is getting paid by the military?

I did an FTOS fellowship. For that year, I was paid by the Navy but was essentially a civilian at a civilian program. Maybe 4 times that year I had an hour or two that I needed to do some military administrative task at the local ROTC office.

The only real concrete difference is that at some institutions, residents can earn (a little) extra money by in-house moonlighting, while moonlighting is prohibited for military outservice residents and fellows.

 

[comp1]

If you're really anxious about debt and aren't really focused on the military, maybe consider the VA HPSP. (FAQs - Veterans Affairs Scholarship Program). It's still not the greatest deal in the world, but less restrictive than the military's HPSP. They will place you out in the middle of absolute nowhere USA caring for essentially indigent people as requested, probably hundreds of miles from any hospital. And no c-suite execs! But seriously...just take on the debt (with or without parental help) and do PSLF or EDRP after graduation. It's relatively clear you aren't into the military first and foremost. As such, you should not join.

 

[Topiary56]

If you're really anxious about debt and aren't really focused on the military, maybe consider the VA HPSP. (FAQs - Veterans Affairs Scholarship Program). It's still not the greatest deal in the world, but less restrictive than the military's HPSP. They will place you out in the middle of absolute nowhere USA caring for essentially indigent people as requested, probably hundreds of miles from any hospital. And no c-suite execs! But seriously...just take on the debt (with or without parental help) and do PSLF or EDRP after graduation. It's relatively clear you aren't into the military first and foremost. As such, you should not join.

Honestly the VA HPSP sounds kinda exactly what I was looking for. I'm honestly looking to become a doctor in bum**** nowhere and serving veterans as well would be pretty cool. I remember one time when I was shadowing and a veteran with PTSD got really pissed off and started swinging at techs and stuff and they shuffled me out of the room. It wasn't exactly a moment where I realized "I need to serve veterans" but I felt really bad and really wanted to help support veterans after that.

I found this pay table here but the salary ranges are really big. I'm wondering what realistic salaries would look like if you know? Either way the low end salary is enough for me in all honesty.

I have looked into PSLF and honestly I just really hate being in debt and I would rather just blitz it rather than be paying for 10 years. I'll look into EDRP more closely as well, but I feel like VA HPSP makes more sense because then I don't have the debt over me in med school at least.

I feel like my military thing is more of an itch and definitely not a passion I would fully uproot my life for. If I could guarantee my specialty (or at least be as hard as normal matches) I would be fully down but that risk of going unmatched and GMO is pretty off putting.

 

[comp1]

VA pay tables got simpler in 2024 (https://www.va.gov/OHRM/Pay/2024/PhysicianDentist/PayTables.pdf), but they still don't tell you exactly what you'll be making. There is nowhere in the country that pays $145k and only a few places that pay a base salary of $300k (like the DC metro). This base salary also doesn't include things like performance pay or any of the federal employment benefits and it outpaces inflation with seniority pay. If you really wanted to get a firm idea, pick a random rural CBOC like Billings MT, email [email protected] and ask them. That said...you're at least 7 years, maybe more, from getting the salary regardless of what it is. The important thing is that, in general, it's the average for the area. It'll seem low because everyone advertises crazy high salaries, but VA pay is based on what salaried full time physicians are actually paid in an area. However, the crazily well paid specialties do bump up against $400k which is the max due to not being able to go above the President's salary.

 

[MedicalCorpse]

Personally, I'm very interested in doing medicine to try to get into an underserved area. I don't like cities and want to get away from urban centers in the future and don't have much interest in research or academic medicine. I'm like 90% sure I want to go into primary care or general surgery, but also I'm very interested in ophthalmology. I don't want to go into it for lifestyle, but I would like to go into it to get more scrappy in the midwest or southeast or somewhere without many ophthalmologists even if my salary would cap much lower. Also, I hate hospitals.

--Doesn't like cities even though 100% of military training sites are in/near cities.

--Not sure if they want primary care or general surgery or ophtho or plumbing.

--Hates hospitals.

Folks, I think we've found our Quad-Service Health Care Provider General for the year 2034.

Here's what you need:

AVOID MILITARY MEDICINE if possible

All Branch Topic (ABT) - 35 Reasons Not to Join Military Medicine

You can look back in 20 years and thank me.

 

[Barrel Proof]

In your case, joining the military for medical school is the equivalent of stepping up to a roulette table and putting your life savings (or for you, all of your hard work so far) on “black 17.” I highly encourage you to not do this. I see so many scenarios where somebody like you ends up miserable and only a small few where you end up happy. The odds are very stacked against you. It just may hit on 17, but it very likely will not. And the house will crush you.

Even for folks who enjoy working in hospitals, living in cities and do not join for the money, it still doesn’t always turn out for the best. But for flexible folks that are easy going, have a general passion to serve and are able to recognize that the needs of the INSERT SERVICE come before their own, this path can be very rewarding. I had a classmate in medical school who came from a wealthy family. His parents offered to pay for his medical school tuition. They had paid for his private, elite undergraduate education. But he turned them down and joined the military for his own reasons. He seems to be thriving, living life and absolutely loves the Navy.

I’ve also served alongside guys/gals that joined for the money. And some that didn’t land in their top choice of speciality. Folks that ended up doing the GMO and out thing. And some of these types tend to be the WORST to work alongside. Because some of them were in it for selfish reasons to begin with. They end up miserable in a billet they didn’t want, in a location they didn’t ask for with a deployment they were hoping to avoid. Now I’m not saying this is you. But it might be you. So consider this my selfish plug in asking you not join. But also realize that I truly don’t think this sounds like a good fit for you.

 

[pawprint]

Competitive specialties is different in the military match vs the civilian match.

For example, my intern year, navy pediatrics had a match rate of 30%, while in the civilian world peds programs are struggling to fill all their spots. Meanwhile, I had a friend who graduated from a DO school who barely passed step 1 and step 2 who matched Navy Derm. And ENT didn’t fill all their spots.

Each specialty is dependent on the year. Competitiveness can rapidly change depending on who all is applying. I think the roulette wheel comparison above is the most accurate description for how things can go…you may get lucky (I feel like I did pretty well), but you likely won’t.

 

[Topiary56]

Aight it seems I got the info I was looking for overall from this thread.

Congrats y'all talked me out of doing HPSP! Definitely seems like it isn't the best option. I'm willing to be flexible with my lifestyle and stuff, but it's the inflexibility with specialty and residency that is a problem. While I'd be fully down to relocate and be deployed I would only want that if it was related to my specific specialty and being a flight surgeon for 2 years sounds like purgatory for me.

I will consider the VA HPSP program. My goal is to get someone to pay for my med school and residency and then I'd pay it back for a few years later as an attending physician. Sounds exactly like a normal med school loan, but again I hate debt and I want to avoid it if at all possible and I don't mind being moved around and stuff in the future to an underserved area because that's what I'm planning on doing anyways.

When I actually have offers (more like if I have offers lol) I'll discuss finances more seriously with family and see if it make sense, but I'll keep this as an option on the table. Caring for veterans is definitely something I'd be interested in doing as a way to give back. Even if I pay for med school normally, maybe looking into this program has inspired me to do some charity for veterans as a future triple board certified doctor captain surgeon plumber. I appreciate any insight.

 

[Helpful Troll]

My goal is to get someone to pay for my med school and residency and then I'd pay it back for a few years later as an attending physician. Sounds exactly like a normal med school loan, but again I hate debt and I want to avoid it if at all possible and I don't mind being moved around and stuff in the future to an underserved area because that's what I'm planning on doing anyways.

Have you considered the NHSC? National Health Service Corps

 

[Topiary56]

Have you considered the NHSC? National Health Service Corps

I've considered it, but they are only looking for primary care. I was gonna contact them and ask, but it's just FM, IM, peds, and geriatrics from what I see online. I'll try to contact them to see if they allow other specialties though. I don't see why they wouldn't allow it since all specialties can be underserved. NHSC would be ideal for me though if there aren't any restrictions because you're free to choose location.

 

[DrMetal]

Aight it seems I got the info I was looking for overall from this thread.

Congrats y'all talked me out of doing HPSP!

Well, that was easy.