Is there ANYONE here who's glad he went into Military Medicine?

[kevinellerton]

Hi!

I'm considering taking the HSPS to go to medical school. I've been reading through this forum for a few days now, and I see a lot of people bashing on military medicine in general. I also see a few people "defending" it.

I don't want to rehash all the details of pros and cons, and why the system is messed up. Please don't do that in this thread, it's been done enough all over this forum.

All I want to know is, very simply... are you happy that you did the HSPS / FAP? Or do you regret it? Was it a mistake? Or was it a good decision? OVERALL.

Please only answer if you're already into (or past) your "payback period."

Also, please don't just vote in the poll! Post your experience as well! Let me know what you chose on the poll, and what type of path you took.

Thanks.

---

Members don't see this ad.

 

[StarboardMD]

Still a few weeks from actually paying back my time, but here's my $.02. I want to be a surgeon, but Army gen surg suddenly got super competitive, so I get to do a GMO tour instead. If I had thought it was a real possibility five years ago that I would be putting off residency for 2-4 years, I would never have taken the scholarship. That said, I'm excited about getting to do flight surgery as a GMO, and I'm still up in the air as to whether I'll reappy for Army gen surg or do my four years and get out. I figure my GMO tour will decide me one way or the other. Good luck with the decision.

I've also been told that financially, it's basically a wash by the time you take an income hit as a military attending, so another option is to take out loans and later in life you can still pursue the military thing as an attending.

 

[halethsonofhama]

I've also been told that financially, it's basically a wash by the time you take an income hit as a military attending, so another option is to take out loans and later in life you can still pursue the military thing as an attending.

But then you'd be kicking yourself for not doing the HPSP or FAP if you were just gonna end up there anyways.

Starboard, How does a GMO tour fit into how your active duty is repaid?

Say I take a 3 year scholarship
I don't match the first year (is this considered GMO or transitional?)
I then match the following year into a 4 year residency
After the residency, how long would I serve?

 

[Perrotfish]

But then you'd be kicking yourself for not doing the HPSP or FAP if you were just gonna end up there anyways.

Starboard, How does a GMO tour fit into how your active duty is repaid?

Say I take a 3 year scholarship
I don't match the first year (is this considered GMO or transitional?)
I then match the following year into a 4 year residency
After the residency, how long would I serve?

In the Navy:

GMO tour pays back your obligation

Intern Year is obligation neutral.

Civilian residency is obligation neutral

Military residency (this is complicated) is 'concurrent payback', meaning every year of residency you gain a year obligation but lose a year off your previous obligation. For practical purposes that means at the end of your residency you owe either your obligation going into residency OR the length of your residency, whichever is more.

Examples: You're on a 4 year HPSP scholarship, you get straight through military neurosurgery training (6 years plus an Intern year). At the end of your training you owe 6 years

You owe 4 years, you get an intern year, now you do a 2 year GMO and only owe 2 years, you do a 2 year peds residency (you already did the intern year), at the end of residency you owe 2 years.

Same as above, except you diid a 3 year GMO tour. At the end of residency you still owe 2 years, even though you only owed 1 going in. In this scenario residency extended your obligation.

Same as above, except you did a 1 year GMO tour. At the end of residency you owe 3 years. Residency never makes your obligation shorter.

So in the scenario you stated above, at least in the Navy, you would owe 4 years at the end of residency.

That make sense?

BTW I have no idea how a research year counts towards your obligation. That's significant if you want Army GenSurg, because all their sites require a research year.

 

[IlDestriero]

I enjoyed my time, however there are a few caveats.
1. I did not join for the money. I had money. I joined for my family tradition of some form of Government service. Wanting to serve is a powerful motivator to remain positive when things get painful. Most join for the money and are often unhappy as things don't go their way.
2. I got very lucky with regard to training. I got what I wanted, where I wanted. Many do not.
3. I did not have to do a GMO in the Navy. Now nearly all in my field must.
4. I got very lucky with regard to my payback position. I got what I wanted. Many do not.
5. Through luck, good timing and strategic planning, I was not deployed overseas. It would have forced my wife to quit her job, or more likely, forced us to hire a live in nanny which we did not want. Nearly all of my colleagues deployed. Some experienced problems associated with the deployments. Some missed significant events. Births, deaths, etc. A few deployed to the worst places at the worst times. That takes a significant toll and can change a person.
6. I limited my risk and potential pain with a 3 year scholarship. Most take 4. Only having a 3 year commitment changes your options a bit, for the better IMHO.
7. I had strong colleagues and limited exposure to painful superiors trying to make bullet points for their promotion off my efforts. Many are plagued by problems with this.
8. I was respected as an expert in my field. Not always the case.
9. I have a generally positive attitude, flexibility and teamwork is not a problem, and I had a supportive and positive spouse. Many do not. This can make or break you.
10. I was fine with delaying my fellowship until after my payback was completed.
11. I got a tremendous amount of personal satisfaction offering the highest quality care to military members, their families, and retirees.

The combination of all of the above lead to a great time in the Nayy. No regrets. Most don't get that lucky. I know many that regretted their decision. If a couple of the above went the other way, I'd still be happy and positive. Unfortunately, some don't get any breaks. That's the way it goes.
Over all, I strongly believe that the FAP is the way to go. Look into it.
When making your decision, don't forget to consider changes to your life/family, etc. 8-12 years down the line. You'll still be in, and maybe deployed.
Good luck.

 

[IlDestriero]

One more thing.
Joining COST me at least $400,000, and that's after correcting for loan repayment, etc. (and I only had a 3 year scholarship) If I did a GMO it would have been much worse, though I would have gotten out. See #1 above about joining for the money. It wasn't a wash, I got killed. Surgical specialists probably lose >$1M.
However, life is an adventure. It's about the trip, not the destination, and I have no regrets joining the Navy. I also get my own holiday now.

 

[bobbyseal]

So far, so good, I'd say. I'm living in a part of the country that I otherwise wouldn't have experienced. I'm doing some interesting work that I didn't do much of in residency. At the same time, a lot of what I learned in residency, I haven't had to put to use. So, I'm sure some skills are getting rusty while maybe some others are getting honed. All in all, it's probably not a bad first job out of residency. One kind of figures out how s/he wants to practice in an environment free of lawsuits. Finally, I much more enjoy working with my ancillary staff now than I did as a resident. Most are young and pretty excited about being involved in patient care vs those who are burned out after 20-30 years working as a nurse.

But, as il desterio pointed out, I'm getting paid peanuts for what I do.

 

[AF M4]

I'm wiser from the experience. There are less exasperating and less expensive ways to acquire wisdom however. One of the most useful is learning from the mis-steps of others. Read the forum.

 

[colbgw02]

I'm okay with my choice. There's definitely some hubris in that statement though, meaning that I could easily think the same about my life sans the military. I think there's a tendency to avoid regretting your decisions, even if you might choose differently if given a second chance.

The biggest pros for me are 1. I got to live in an amazing place that I never otherwise would have lived, 2. I'm going to get to teach residents, which I never would have gotten to do as a civilian, and 3. I have the pride knowing that I contributed something meaningful to a cause I consider worthy. The cons have been 1. I've been shot down (at least initially) on my preferred fellowship training, 2. I can't choose my practice location, and 3. I'll make considerably less as an attending (about $500K less over my time) as compared to my civilian counterparts.

Ultimately, the reasons that someone joins (and appreciates) their time in uniform can't be quantified.

 

[kevinellerton]

Thanks, everyone, for your quick replies. The more the merrier.

Starboard & Perrotfish, am I to understand that I could do a 4yr GMO tour, and then go into a civilian internship, completely free of obligation to the Navy? That would solve a lot of problems for me.

My main worry is that I won't be able to start a family for another 8 years after graduating from med school (military contract is 8 years). If I graduate med school at 32 (yeah I'm starting late, switching careers), and did 4 years internship/residency + 4 years payback, I wouldn't be free from the possibility of deployment until age 40. To me, that's a little old to be starting a family. I know a lot of people have kids before or during their years of service, but I don't want to be the dad who's away in Iraq for two years while my kids are born/growing up.

If I am understanding correctly about GMO Tour, I could be free of obligation 4 years after med school (36yo), and then start a family while in residency. I might be really BUSY, but at least I'll be AROUND.

So, am I understanding this correctly? If so, is your contract completely finished after GMO Tour or do I just go into "reserves?"

Thanks again for all your help!

 

[IlDestriero]

After your 4 year GMO, you could get out and you would go into the inactive reserve for 4 years. You could get called up, but it would be very unlikely, and almost certainly involve another war. I'd come back for that. Many people follow this path.
You could than use the GI bill to give you extra money during your civilian residency for 36 months. It's an obligation free benefit for veterans.

 

[orbitsurgMD]

Thanks, everyone, for your quick replies. The more the merrier.

Starboard & Perrotfish, am I to understand that I could do a 4yr GMO tour, and then go into a civilian internship, completely free of obligation to the Navy? That would solve a lot of problems for me.

My main worry is that I won't be able to start a family for another 8 years after graduating from med school (military contract is 8 years). If I graduate med school at 32 (yeah I'm starting late, switching careers), and did 4 years internship/residency + 4 years payback, I wouldn't be free from the possibility of deployment until age 40. To me, that's a little old to be starting a family. I know a lot of people have kids before or during their years of service, but I don't want to be the dad who's away in Iraq for two years while my kids are born/growing up.

If I am understanding correctly about GMO Tour, I could be free of obligation 4 years after med school (36yo), and then start a family while in residency. I might be really BUSY, but at least I'll be AROUND.

So, am I understanding this correctly? If so, is your contract completely finished after GMO Tour or do I just go into "reserves?"

Thanks again for all your help!

You must complete an internship, either in or out of the military before you can be assigned as a GMO. Completing an internship is the minimum amount of postgraduate training needed to qualify for an unrestricted medical license (some states and DC require more) and having a license is required to work as a GMO.

You may have to repeat part or all of an internship if you return to certain residencies after a tour as a GMO as you would not be considered adequately prepared for PGY2 hospital work having been out of a training setting for that length of time as would be typical for a scholarship payback. This fact itself may render you less competitive as an applicant to programs that would require you repeat internship as HHS would not fund your training program fully for your year of training as they would some non-military candidate; they regard full funding as paying twice.

 

[Gastrapathy]

Your poll is a little simplistic. Most of us fall somewhere in the middle. BTW, clearly people aren't taking your advice and only answering if they are attendings. We only have half a dozen attendings who post on here with any frequency, yet you already have ~20 poll answers.

 

[Trajan]

I'm Navy HPSP, an internship plus four year GMO guy on route to civilian residency. What I say next may surprise you: signing the bottom line for Navy HPSP was one of the best decisions I have ever made.

I was a sometimes good but certainly not great medical student at an expensive allopathic school. Honestly, I had doubts that medicine was the right choice for me, especially in the preclinical years, which made it hard to put in the effort needed to truly stand out. During internship things got better, and I started to become more excited about my work and comfortable with my decision to become a physician. Next came GMO, and those years with operational forces brought responsibility to patients and line commanders that led to a great deal of professional growth. I had a ton of time to read, and found that I began to enjoy basic science and clinical texts for their own sake. This independent study brought a renewed intellectual curiosity and, coupled with reflection on my internship rotations, led me to a different field than I intended to pursue following medical school.

Applied via the match for one of the competitive specialties that begins PGY-2. A well written personal statement and excellent letters from internship and my GMO time got me enough interviews. Thankfully, I managed to honor medicine and surgery at an MS-III, which was the only thing the interviewers seemed to care about from my medical school transcript. By the way, interviews were a breeze having spent the last few years frequently briefing some intimidating line O-6's. Ultimately, I matched at a very prestigious program, one where I would have never matched when I was a non-AOA medical student.

In summary, military medicine has been a positive experience for me because:
1) My medical school classmates have $250k in debt and I have none.
2) My Navy internship training was solid -- not amazing, but solid.
3) GMO made me a better doctor -- many call it professional stagnation, but I benefitted tremendously from it, both from the clinical experience and the four years of reading. I've already read and outlined the main textbooks that residents typically read for the first time as PGY-2 and PGY-3.
4) My GMO experience only involves giving care to active duty sailors. I feel comfortable treating this population with my level of training. Sometimes we do see unusual pathology, which I can certainly identify, work up, disposition, and then refer out. I do not see dependents or retirees. Putting GMO's in those clinics essentially as FP's, which seemed to happen more in the past, is not appropriate IMHO.
5) I am now on track to go into a field about which I am sincerely passionate, something that I would not have otherwise done.
6) I will be a better resident than I probably would have otherwise been (more mature, more experienced, and much better base of knowledge).
7) It's not why I chose it, but as a bonus my residency happens to be in a specialty that pays about twice what I would have made in the specialty that I wanted when I graduated medical school -- so, yes, I will come out well ahead financially in the long run.
8) Met some great people from all corners of the country.
9) Am very proud of the work that I have done in support of the fleet. My patients and line commanders have been very appreciative and are a privilege/honor to treat and serve.
10) Saw and did things in the operational Navy that I would have never experienced had I not joined.
11) Was paid reasonably well for someone in his late 20's early 30's and have lived well these past few years.
12) I would always have been a little bit disappointed in myself if I hadn't been in the military for a time.

So why not stay for a career?

Bottom line, I don't want to move my family frequently, and even if I could homestead at one of the big three as a subspecialist, I'm not terribly interested in settling in suburban DC, Portsmouth, VA, or San Diego. Active reserves is a strong possibility, but I'll wait and see what my career goals are following residency/fellowship. However, I certainly hope that the USNR ultimately is a part of my career once board certified.

I realize that military medicine has flaws and that some have not had good experiences. I think that AHLTA is a train wreck and a disgrace. Military medicine is certainly not for everyone, and the advice that you shouldn't do it for the money is sound. Additionally, I must mention that I was lucky in getting stationed in nice locations -- that can make all the difference in the world. Had they sent me to 29 Palms or Diego Garcia, I probably wouldn't be as happy.

That said, in the final analysis, the USN Medical Corps has been an important five year block of my life and career. That doesn't mean it is right for anyone who happens to read this. I'm only saying that I have absolutely no regrets.

 

[Galo]

I have been on this forum a long time. I came in mad as hell, and got in alot of internet fights with a lot of people who seemed to be blind to what was the ovbious to me: That military medicine is broken beyond repair, and a pit where mediocrity is the standard, and reaching beyond that can make your life miserable.

I benefited some from my time, but it was at a constant struggle that I would not want to experience again.

You really have to take all of what people are telling you here, (including me), with a grain of salt. One of the very positive posts above has explanations that a large number of instances are not the norm. Some are from people that have not yet experienced the pain of loosing skills, or having a nurse in charge impact patient care.

There is no doubt in my mind the system as a whole is tragically a shadow of what it once was, and it is one of the worst systems in the US where to start your foundation for a good medical career.

Make many phone calls to active duty physicians of all branches, read the forum, and really try to comprehend why you would want to be part of that system. It is now a place where you should really expect to be an officer first, and a physician a distant second. Not the way most physicians would want to start their careers. Sure you may get to live somewhere cool, shoot a gun, or a machine gun, be around military jets and fly in one, but in the end, is it worth the risk that you waste 4 or more years being a physician with one year of training doing what many have argued a PA, or NP could do? Or training and being somewhere where you cannot use the nascent skills you just learned or to be able to build on them?

This forum should be a good part of your research, but you should do as much as you can to be sure if the military is something you want to involve in your developent as a physician.

Good luck

 

[NavyFP]

I will start by saying what a difference a month makes.

A month ago, I would have had a very different answer from two weeks ago and have modified that answer in the past week. (slightly)

I have been in 17 years and as a whole have had a very good career. Up until last summer, I have had interesting assignments that were generally in line with what I needed and wanted. I would easily have said I am satisfied with the Navy and highly recommend it to people with a strong desire to serve. I have always recognized and accepted that most will not make a career of the military, but I feel any length of service in honorable and am happy when people pay back there time and move on to other pastures.

Some of that changed last summer. I had recently returned from an 8 month deployment (home less than 6 months) and was informed by the detailer that my current orders were being terminated and I was being reassigned as a Regimental Surgeon to be deployed for one year to Afghanistan. Needless to say, I was displeased. Three others had been "unable" to execute orders to this assignment. (one legal, one fat, one medical) Rather than pack up my family and move to lovely Jacksonville, NC just to leave them for a year, I chose to become a geographical bachelor. My agreement with the detailer was that I was to return to where my family was living after completion of the deployment provided my Commanding Officer was willing to let me go. I had a specific job in mind and told my detailer of my intentions/desires. He gave no indication that would be a problem.

Last month upon contacting the detailer, I was told the job I wanted had already been given away 2 years prior and there was no way I would get it. He offered me roughly 35 options. Half were operational (Yea, deploy again) and only one was in my desired geographical region. We bickered a bit and I ended up in an admin job I can't say I had a huge desire to do. Last week I was offered a better job, so my situation has improved. I will accept partial responsibility for my situation. There were a couple of plum assignments in the initial list, but my desire for geography would not allow me to go there. That is my choice, so I can't be completely bitter. I still think I was owed a little more consideration for taking one for the team. I'll get over it.

I still believe the Navy can be a good place, but there are difficulties. Trying to make the Navy a career and stay in one place will cause you to accept jobs that might not be at the top of your list. Here is a list of questions you must be able to emphatically answer yes to in order to decide to go military:

1) Are you willing to deploy whenever and where ever needed? If there is a hint of no in this question stay away. We have too many who find a way to weasel out of their obligation on this front. The bottom line is that someone is going. If you don't, you are screwing another. Too many are fine with this since they probably don't know who got screwed. For our women viewers, consider kids. Getting pregnant to get out of a deployment does not endear you to your colleagues (especially your male colleagues). Once you have kids, it is hard to leave them.

2) Are you willing to move to where they send you? Look at the possibilities of where the service could send you. Are there any show stoppers? Don't join and expect to stay exactly where you plan for the next 20 years. Can it be done? Yes, but typically not without sacrifice. You may have to take jobs which are not in line with what you expected. You may not have jobs which will make you promotable to O5/O6. Can you live with that?

3) Are you willing to uproot at a moments notice? Although this is not common, it is also not rare. It has happened to me, so it can happen to you. There are jobs that absolutely must be filled. As long as you have an obligation to the military (either initial, training or MSP) you can be sent.

4) How big an issue is money to you? For many specialties the pay on the outside is far better. Can you live with making less while you pay back your obligation? This is a balance sheet. You make more (have less debt) early on, but pay for it later. Money is often an emotional issue and the security in the beginning is worth it for some. That is OK, but make the initial obligation purely for the early money.

Other issues which arise (and are complained about) are non-physicians in leadership postions, non-helpful nursing staffs, inadequate staffs, the electronic medical record and other minor issues. These are highly variable in the impact to individuals, so I won't make them absolutes. Know that the military is a bureaucracy and has all of the trappings associated.


If I knew then where I would be now would I do it again?

I will still say yes. The past year has been dispiriting, but I (naively, probably) have hope for the future. I do know that my retirement date is set, I have signed my last MSP and will be transferring to the USS Backyard in 2015.

Hope this answers your question.

 

[dwb8p]

NavyFP, does being FP-trained make you less in control over your military career in terms of locations and frequency of deployments? Would going into IM (w/ or w/o subspecialty), anesthesiology, radiology, neurology, etc provide any more predictability or stability to one's career?

 

[NavyFP]

NavyFP, does being FP-trained make you less in control over your military career in terms of locations and frequency of deployments? Would going into IM (w/ or w/o subspecialty), anesthesiology, radiology, neurology, etc provide any more predictability or stability to one's career?

No, I don't think it gives you any less control. Since it is such a large community, there are frequently a large number of options. With options comes some level of control, but the options may not be where you want them to be.

Do other specialties give you more predictability or stability?

Depends on what you expect of predictability. If you expect to move every three years. That is predictable. If you expect to deploy every 3-4 years, that too is predictable. Is a job I want going to be available when I want it and am available? Less predictable unless there are a large number doing that job. A clinic with 5-6+ providers will likely always have someone leaving, but how many want one of those spots.

Stability is based on the size of your community. If there are only 3-5 of you in the Navy and they are only located at the big 3, you will likely have stability. It does not make a lot of sense to move someone from Bethesda to San Diego just to move someone from San Diego to Bethesda. If everyone is happy where they are, staying put is a real option.

Another thing to consider is how many crap (at least perceived as such) positions does a specialty have. If you are a neurosurgeon, somebody has to go to Okinawa. If no one wants to, someone will be stuck going. It could be you.

Some of the specialties have fewer operational positions. Rads, Derm, Path, Nuc Med, PM&R don't have any operational billets per se. (such as Regimental/Division Surgeon, Senior Medical Officer of a ship, Fleet Surgical Team, etc. Can they fill these jobs? Yes, but they have to ask and are not typically sent. There are spots for them to deploy such as Kuwait, Kandahar, the hospital ships (Comfort/Mercy) or go with the Army but not a lot and not often.

 

[narcusprince]

Current Navy HPSP/FAPer
I am very happy with my decision to join the Navy. I was not a stellar applicant to medical school. I played college football during my first half of undergrad and did not earn good grades, then quit football and was top of the class. I got to train straight through from medical school to residency in anesthesia. I have met some great people in the Navy so far PGG being a big one. I cannot wait to come on AD and apply some of this excellent training I have recieved to help those that put themselves in harms way. I was and am very lucky, went to a very good medical school, went to a top anesthesia residency, and was chief resident at my residency.

 

[i want out]

I left active duty almost 4 years ago and still can't talk about my time in the Navy without getting mad about it.

Things like 6 DAYS notice for 6 month deployment.
CO with absolutely no regard for my safety or that of the crew.

If I spend much time talking about it I don't sleep.

Even though I left med school debt free I am at least a million behind financially when compared to my peers. (this is specialty specific and would not apply to primary care)

Perhaps one day the anger will fade but it hasn't yet.

 

[kevinellerton]

Thanks for all your answers guys. Every person's perspective gives me a more and more well-rounded picture of what I should expect going into the military.

I see there are many people who have extreme views, both positive and negative (mostly negative), with only a few who seem to be "in the middle." I guess that this could come from differing circumstances (getting lucky on location placements and "good assignments), but I have a feeling it has more to do with attitude, and the ways that people cope with having their life choices made by someone else. I'm not sure how I would cope with that, to be honest... especially if I ended up somewhere I really didn't want to be, like freakin' Siberia or something.

I appreciate all of your answers; if anyone else has experience in this regard, please feel free to post something. I do want to keep it on topic as much as possible, though, so maybe I'll rephrase my question to make it more specific:

If you could go back to the beginning, before you started medical school... would you do it through the military again, or would you have done it through the civilian path? Or maybe even not gone into medicine at all? As far as I understand, there are many docs in the private sector who are unhappy as well...

 

[Perrotfish]

Three others had been "unable" to execute orders to this assignment. (one legal, one fat, one medical) .

Being fat gets you out of a deployment? Really?

 

[IlDestriero]

Being fat gets you out of a deployment? Really?

Time to start eating...

 

[NavyFP]

Being fat gets you out of a deployment? Really?

Actually, it can. When I was doing the predeployment for Kuwait, body composition got a nurse kicked off the deployment. And the Grunts (Infantry) really don't like having fat (esp Navy) people around.

In some ways it incentivises being fat. I'll wait until after I pin on CAPT to go there.

 

[AF M4]

Actually, it can. When I was doing the predeployment for Kuwait, body composition got a nurse kicked off the deployment. And the Grunts (Infantry) really don't like having fat (esp Navy) people around.

In some ways it incentivises being fat. I'll wait until after I pin on CAPT to go there.

Pfft. There were a ton of guys and gals at my base who got pulled from deployments because they flunked their PT test. I told their commanders that this was ridiculous, because they would be much more likely to get into shape while they were deployed: less options for food, more time for exercise, etc. And it seemed really crappy to keep bumping up the in-shape guys to take their places on extra deployments. Seemed a ridiculous arrangement.

Finally one of my commanders told me that at most other bases my objection would be true. But we were stationed at such a crappy base that most people were begging to be deployed, so in fact this was a punishment.

It was right around this time I decided the Air Force wasn't for me.

 

[pgg]

I almost didn't post in this thread, because I think the basic question and assumption of the OP is flawed, and that a short answer wouldn't be helpful in the way the OP was hoping. But then I figured not saying anything wasn't helpful either. And then I ended up writing a lot ...


OP is asking current/former military attendings if we are (or were) happy with our decision to join the military, assuming that our experiences then will have some kind of parallel to what his experiences might be in the future. The problem is that the milmed I joined in the late 1990's for med school wasn't the same as the milmed of the 2000's when I graduated, interned, GMO'd, residency'd, and started payback ... and the milmed of the 2010's is also changing as we speak. All of the pre-meds who visit this forum to learn about HPSP/USUHS these days are looking at residencies and payback tours in the 2020's ...

Yes, there are trends, but I would caution any reader to assume milmed will be what it used to be - for good or ill.


I am satisfied with my time in the Navy. I will get out in 2014 when my ADSO is up (for reasons enumerated below). I can not recommend HPSP or USUHS to anyone without substantial prior service (which implies first-hand AD experience and changes the retirement/$ calculus).


I went to USUHS - excellent overall. Lived well, debt free. Got a solid education with solid clinicals. Not top tier stupendously superb, but solid.

I was a transitional intern at NNMC - OK experience. The relatively low volume and lack of sick patients made that year less than it could've been, but it was adequate.

I applied to go straight through to anesthesia residency, didn't get it. This was the norm for anesthesia, I expected it, it was still disappointing. It also cost me $36,000 per year of GMO time.

I was a GMO with the Marines. I asked for infantry and they were happy to give it to me. Very good experience on the whole, some of the most rewarding medicine I've practiced. Deployed twice - hard on family, hard on me, but still an experience I valued at the time and in retrospect. I'll be practicing anesthesia for the next 30 or so years. I have no regrets about my short period of pseudo-primary-care working closely with the line ... except looking back I realize there were a few instances where I was in over my head and just got lucky I didn't have any hurt patients or bad outcomes. There is risk in being a GMO, and I'm not talking about the tiny risk of getting shot or blown up in some foreign dirt hole.

After GMO time, I did an inservice anesthesia residency. Anesthesia training in the Navy is on the good side of solid. Not top tier, but quite good. In part because case load and acuity shortcomings are overcome with out rotations at other institutions. How do I really "know" my residency training was good? 1) During these out rotations, two of which were at arguably top tier institutions, I did not feel outclassed by any of the other residents. 2) Since graduating I've done quite a bit of moonlighting in the civilian world a couple places, and over the last two years I've realized that the civilian trained people really don't have anything on me.

I'm two years into my first staff tour at a small command. It has some small command issues, mainly stemming from not enough patients and too many people creating work to keep busy and rearranging work to create fitrep bullet points. I'm basically content. I'm underutilized, but small hospitals deserve good doctors too. I can moonlight enough to keep current and learn new things. I'm extending my tour here to finish off my ADSO.

I'm penciled in to deploy for ~6 months in 2012 and my specialty leader promised to send me someplace busy ... looking forward to it, despite the family separation. Serving the troops when they need us most was the primary reason I chose USUHS over other medical schools, and I expect that this deployment will be like my last two - a chance to practice some of the "purest" medicine of my career.


I'm getting out for a number of reasons
1) First and foremost, the Navy has no need for my desired fellowship. I won't have the opportunity to do that fellowship unless I get out. This trumps all else.

2) My family has followed me around the country for 14 years now. We're tired of moving. Also, the Navy doesn't have any hospitals in the mountains.

3) Every year, the weight of the administrative and collateral nonsense gets heavier. In truth I don't have too high a non-clinical burden. But still, too often I feel like I spend too much time doing work that doesn't matter, for people who don't matter, all so some metric comes up green on some powerpoint that'll be viewed by more people who don't matter.

4) The Navy can't be bothered to pay me on time. I know most military physicians are irritated by the annual ISP shenanigans. I've been told I'm being unreasonable by being upset by the delay, or the 'next fiscal year' bit that essentially screws physicians out of a year's ISP or back-door extends their ADSO by three months. But it offends me on a visceral level and I think this, more than anything else, is really the distilled essence of how the people who run the military view us physicians. And I don't want to work for those people.


As for the OP, and his basic fundamental question: do we "old-timers" who've been there and done that think he should take HPSP?

No, he shouldn't. Yes, on the whole, I have been very satisfied with the Navy. I have had excellent training, and extremely rewarding experiences. I will forever compare what I'm doing now with what I did when I was the doctor for a bunch of Marines in Iraq and Afghanistan. No real regrets.

But today, 2011, I would not enter the military via HPSP or USUHS, for a simple reason. I would not want to commit myself today to military residency training in an unknown specialty sometime around 2020.

1) Tricare and the outsourcing and downsizing it brought has been an unmitigated disaster for military GME. Military GME is less than it once was. There is no reason to believe this trend will reverse.

2) There's no way to know what residency opportunities the military will offer, or their overall quality, 10 years from now when you've finished med school, finished internship, finished 2-3 years of GMO time, and gone back to the GME world for PGY2+.

3) Pre-meds may think they know what specialty they'll choose, but they don't. Most of us changed our minds in medical school. I did ... a couple times. You shouldn't look at the state of military GME in [insert specialty] today and assume you'll be equally satisfied with the options you'll have in whatever specialty you actually choose.


The Navy worked out great for me, partly because I was lucky, partly because milmed was different when I joined. Be careful of assuming our experiences will be predictive of yours if you join.

I think FAP is a better way to join the military to be a doctor.

 

[NavyFP]

Pfft. There were a ton of guys and gals at my base who got pulled from deployments because they flunked their PT test. I told their commanders that this was ridiculous, because they would be much more likely to get into shape while they were deployed: less options for food, more time for exercise, etc. And it seemed really crappy to keep bumping up the in-shape guys to take their places on extra deployments. Seemed a ridiculous arrangement.

Finally one of my commanders told me that at most other bases my objection would be true. But we were stationed at such a crappy base that most people were begging to be deployed, so in fact this was a punishment.

It was right around this time I decided the Air Force wasn't for me.

Good people do tend to be punished in the military, while dirtbags get to stay behind in cushy spots. Repeated deployments are a form of punishment when others never have to go. If someone can't or won't deploy, I want them gone. Don't care if they are doing good things in the rear. It was once said, the only people immune from deployments were COs. They have punishment authority which cannot be delegated, so they have to stay. From XOs on down, they can go. Does not work that way, but it is supposed to.

 

[IgD]

My friend was a former line officer who went to medical school. He said things were different on the operational side. When the order comes down to deploy comes, you go and there is little or no discussion.

It seemed like in Navy medicine it was the opposite. The order or communication comes down and then everyone tries to rebut it or stick it on someone else. It's sort of like musical chairs whoever gets stuck standing gets the deployment. There is also a sense of short staffing that goes with it. There aren't enough people to send someone out and get the work done.

That kind of stuff really got under my skin!!!

 

[IgD]

What I think is interesting is looking at the poll there is a 50% dissatisfaction rate with the military medicine machine. There has to be a way to change that to make it more palatable!!

 

[Trajan]

-

 

[The White Coat Investor]

I will start by saying what a difference a month makes.

A month ago, I would have had a very different answer from two weeks ago and have modified that answer in the past week. (slightly)

I have been in 17 years and as a whole have had a very good career. Up until last summer, I have had interesting assignments that were generally in line with what I needed and wanted. I would easily have said I am satisfied with the Navy and highly recommend it to people with a strong desire to serve. I have always recognized and accepted that most will not make a career of the military, but I feel any length of service in honorable and am happy when people pay back there time and move on to other pastures.

Some of that changed last summer. I had recently returned from an 8 month deployment (home less than 6 months) and was informed by the detailer that my current orders were being terminated and I was being reassigned as a Regimental Surgeon to be deployed for one year to Afghanistan. Needless to say, I was displeased. Three others had been "unable" to execute orders to this assignment. (one legal, one fat, one medical) Rather than pack up my family and move to lovely Jacksonville, NC just to leave them for a year, I chose to become a geographical bachelor. My agreement with the detailer was that I was to return to where my family was living after completion of the deployment provided my Commanding Officer was willing to let me go. I had a specific job in mind and told my detailer of my intentions/desires. He gave no indication that would be a problem.

Last month upon contacting the detailer, I was told the job I wanted had already been given away 2 years prior and there was no way I would get it. He offered me roughly 35 options. Half were operational (Yea, deploy again) and only one was in my desired geographical region. We bickered a bit and I ended up in an admin job I can't say I had a huge desire to do. Last week I was offered a better job, so my situation has improved. I will accept partial responsibility for my situation. There were a couple of plum assignments in the initial list, but my desire for geography would not allow me to go there. That is my choice, so I can't be completely bitter. I still think I was owed a little more consideration for taking one for the team. I'll get over it.

I still believe the Navy can be a good place, but there are difficulties. Trying to make the Navy a career and stay in one place will cause you to accept jobs that might not be at the top of your list. Here is a list of questions you must be able to emphatically answer yes to in order to decide to go military:

1) Are you willing to deploy whenever and where ever needed? If there is a hint of no in this question stay away. We have too many who find a way to weasel out of their obligation on this front. The bottom line is that someone is going. If you don't, you are screwing another. Too many are fine with this since they probably don't know who got screwed. For our women viewers, consider kids. Getting pregnant to get out of a deployment does not endear you to your colleagues (especially your male colleagues). Once you have kids, it is hard to leave them.

2) Are you willing to move to where they send you? Look at the possibilities of where the service could send you. Are there any show stoppers? Don't join and expect to stay exactly where you plan for the next 20 years. Can it be done? Yes, but typically not without sacrifice. You may have to take jobs which are not in line with what you expected. You may not have jobs which will make you promotable to O5/O6. Can you live with that?

3) Are you willing to uproot at a moments notice? Although this is not common, it is also not rare. It has happened to me, so it can happen to you. There are jobs that absolutely must be filled. As long as you have an obligation to the military (either initial, training or MSP) you can be sent.

4) How big an issue is money to you? For many specialties the pay on the outside is far better. Can you live with making less while you pay back your obligation? This is a balance sheet. You make more (have less debt) early on, but pay for it later. Money is often an emotional issue and the security in the beginning is worth it for some. That is OK, but make the initial obligation purely for the early money.

Other issues which arise (and are complained about) are non-physicians in leadership postions, non-helpful nursing staffs, inadequate staffs, the electronic medical record and other minor issues. These are highly variable in the impact to individuals, so I won't make them absolutes. Know that the military is a bureaucracy and has all of the trappings associated.


If I knew then where I would be now would I do it again?

I will still say yes. The past year has been dispiriting, but I (naively, probably) have hope for the future. I do know that my retirement date is set, I have signed my last MSP and will be transferring to the USS Backyard in 2015.

Hope this answers your question.

The casual reader should be aware the NavyFP is the attending who over the years has been the MOST positive about the scholarship. It makes this statement all the more impressive/concerning.

 

[The White Coat Investor]

What I think is interesting is looking at the poll there is a 50% dissatisfaction rate with the military medicine machine. There has to be a way to change that to make it more palatable!!

I can't believe it is that high. My experience is the number should be far lower, perhaps 10-20%.

 

[infirmarydude]

Quick question...

Most of this doesn't apply to national guard right?

Which of this does apply?

 

[orbitsurgMD]

I can't believe it is that high. My experience is the number should be far lower, perhaps 10-20%.

Who knows? Nobody really studies this in a meaningful way. There is selection bias when you consider only those who remain beyond the minimum payback term, or for that matter, people who went mostly through USUHS as opposed to those who came through HPSP, or those selected for straight-through training, in or out of the service, as opposed to those who are forced to do GMO duty before residency.

I might agree 10-20% of those who are remaining beyond the payback term. If you add in all those who come in from all pathways, I think the numbers are really much higher. People don't leave a job with a steady paycheck and take a pay cut at the same time, which is the case with all those leaving after GMOs, unless they really believe they are getting something better if not immediately then in the reasonably near future.

The Navy and other services really don't give a second thought to the doctors who leave without residencies after doing GMO assignments. To the services, they are temporary and somewhat faceless accessions, having been useful when used to fill some billet, but really nothing more than that. Unfortunately, that is half of their accessions, and a colossal waste if seen in he light of what it costs to recruit and train them. This fact is no secret anymore, which has had predictable effects in recruitment among students at competitive universities.

 

[Mirror Form]

I can't believe it is that high. My experience is the number should be far lower, perhaps 10-20%.

Wow, I can't believe you think the dissatisfaction rate is that low! Seriously, you must have no clue. You'll be perfect for an upper level management slot in the Army.

 

[Trajan]

The Navy and other services really don't give a second thought to the doctors who leave without residencies after doing GMO assignments. To the services, they are temporary and somewhat faceless accessions, having been useful when used to fill some billet, but really nothing more than that. Unfortunately, that is half of their accessions, and a colossal waste if seen in he light of what it costs to recruit and train them. This fact is no secret anymore, which has had predictable effects in recruitment among students at competitive universities.

While I generally agree with your statement, it's important to point out that this situation is hardly unique to the medical corps. For instance, submarine JO's go through a very expensive nuclear training pipeline after the Navy paid for college or USNA, only for half of them to then punch out without ever becoming department heads or XO's. These guys are standing watches and qualifying, just as GMO's are seeing patients and deploying, and to a degree they are faceless accessions, but I wouldn't call them a colossal waste.

 

[Gastrapathy]

Wow, I can't believe you think the dissatisfaction rate is that low! Seriously, you must have no clue. You'll be perfect for an upper level management slot in the Army.

Dude, I think he meant the satisfaction rate was 10-20%.

 

[orbitsurgMD]

While I generally agree with your statement, it's important to point out that this situation is hardly unique to the medical corps. For instance, submarine JO's go through a very expensive nuclear training pipeline after the Navy paid for college or USNA, only for half of them to then punch out without ever becoming department heads or XO's. These guys are standing watches and qualifying, just as GMO's are seeing patients and deploying, and to a degree they are faceless accessions, but I wouldn't call them a colossal waste.

Apples to oranges. The Navy cannot get submarine JOs on the open market. They have to be trained intensively to work on the Navy's propulsion systems and to the Navy's standards of proficiency. No doubt it is expensive. But there are USNA grads, ROTC grads and people off the street with appropriate educational qualifications for OCS, any of whom could compete for sub training.

The loss of sub JOs occurs for many reasons, but getting complete training as a submariner is not one of them. Some want other careers, some don't like deployment, some see the handwriting on the wall and realize the numerical odds are heavily against getting 20 years in, never mind a command at-sea pin.

Medical is done to outside agency standards, those of the USMLE, of universities and of state licensing bodies and the ACGME. The Navy could hire at many points, before or after medical school, before or after internship, before or after completing residency. Unlike with its sub officers, the Navy deliberately withholds training from its doctors, and perversely from those whose residency preferences are the longest to complete, preferring to send them to billets that in most cases neither require nor adequately support medical doctors, leading, not surprisingly, to widespread disaffection with Navy medical practice and Navy medicine. They have done this kind of thing long enough, and to enough doctors, that they have created a pool of former Navy medical officers who do not have a particularly high opinion of Navy medicine and do not speak well of the Navy HPSP program as an opportunity worth considering. That is a colossal waste, and inexcusably stupid.

 

[Trajan]

Apples to oranges. The Navy cannot get submarine JOs on the open market. They have to be trained intensively to work on the Navy's propulsion systems and to the Navy's standards of proficiency. No doubt it is expensive. But there are USNA grads, ROTC grads and people off the street with appropriate educational qualifications for OCS, any of whom could compete for sub training.

The loss of sub JOs occurs for many reasons, but getting complete training as a submariner is not one of them. Some want other careers, some don't like deployment, some see the handwriting on the wall and realize the numerical odds are heavily against getting 20 years in, never mind a command at-sea pin.

Medical is done to outside agency standards, those of the USMLE, of universities and of state licensing bodies and the ACGME. The Navy could hire at many points, before or after medical school, before or after internship, before or after completing residency. Unlike with its sub officers, the Navy deliberately withholds training from its doctors, and perversely from those whose residency preferences are the longest to complete, preferring to send them to billets that in most cases neither require nor adequately support medical doctors, leading, not surprisingly, to widespread disaffection with Navy medical practice and Navy medicine. They have done this kind of thing long enough, and to enough doctors, that they have created a pool of former Navy medical officers who do not have a particularly high opinion of Navy medicine and do not speak well of the Navy HPSP program as an opportunity worth considering. That is a colossal waste, and inexcusably stupid.

Again, I generally agree with you. However, my point is that the military does not need, want, or expect to retain all of its junior officers for a career, line or staff corps. Perhaps that is why they choose to hire medical officers earlier rather than later, for better or worse. True, the Navy cannot buy fully trained submarine officers off the street, and you are also correct that those who leave are not leaving for better submarine officer training elsewhere. However, submarine JO's are fully trained and ready for real responsibility only at the end of their tours, which is when half of them punch out. Along the way they are just qualifying and standing watch, the latter being a necessary duty, and the Navy needs bodies to do it. To punch at that point, as half of them do, is not particularly cost-effective. However, it is the only way that the Navy fills the jobs that the sub force requires, just as half of HPSP provides the bodies for GMO/FS/UMO jobs. Not sure that this is a waste from the Navy's perspective, and, no, I am not convinced that the Navy could easily buy enough board certified physicians fresh out of civilian residencies to fill all of our billets.

The greater waste, in my opinion, is what the Navy does with many medical officers who choose to stay. I'm referring to the practice and expectation that CAPT/CDR MC officers do everything except practice medicine. This seems to happen more with primary care physicians but applies to many specialists as well. I know some career MC officers who are trying to set themselves up to make CAPT, and it doesn't involve seeing patients. When considering whether to make the Navy a career, I considered that reality to be a much greater drawback than the 2-3 year delay of residency. My conclusion was that for me better long-term options existed on the outside. That doesn't mean that I think the system is a complete train wreck or that I got a bad deal.

 

[Mirror Form]

Dude, I think he meant the satisfaction rate was 10-20%.

Oh okay, that makes a lot more sense.

 

[NavyFP]

The casual reader should be aware the NavyFP is the attending who over the years has been the MOST positive about the scholarship. It makes this statement all the more impressive/concerning.

Well I did say I was satisfied overall and in truth I would do it again. Part of my current mood is tainted by being midway through a year long deployment and a bloody fight with the detailer. In 12 months I am sure I will feel better

Navy Medicine is certainly different than when I started in the early 90s. You can see the strain of two wars, multiple repeated deployments (for some of us at least), TRICARE, and tightening of budgets.

Since all history is cyclical, we are back in the era of the mid 70s. The end of a long war, poor economic times, and federal budget issues. Over the next 10 years, I think things will improve, but getting there may not be half the fun.

 

[AF M4]

Since all history is cyclical, we are back in the era of the mid 70s. The end of a long war, poor economic times, and federal budget issues. Over the next 10 years, I think things will improve, but getting there may not be half the fun.

This reminds me of the time we read about the Weimar Republic in Germany during the 1920s.

 

[a1qwerty55]

I'm happy I joined. I think I would have had a tremendously less interesting life had I just gone civilian and joined the Medicare grind and the keeping up with the Jones's which is medicine in America. I have done far more professionally both technically and outside of medicine than I could have in a civilian practice. Deployments also were positive and a time for professional and personal growth. That being said, I've had been extremely fortunate. I had straight through training, matched a fellowship without a utilization tour and have had my choice of assignments and good coworkers and superiors. In my case it has been a very good decision, I however would agree my experience may not (is not) typical.

My coworkers all for the most part have had similarly positive experiences and all have signed multi-year contracts extending past their ADSO.

 

[NavyFP]

As far as the JO/GMO get out before 20 goes.

The Navy really is OK with all of this. Most of the manpower planning is done by nonmedical types. They are OK with GMOs. Catastrophic failures by GMOs have been minimal, there has been no significant bad press, and they are much cheaper than hiring specialty trained physicians. For the manpower guys, tell me the downside? We can talk about patient safety, inadequate training, blah, blah, blah until we are blue in the face and it won't change anything. Only recurrent bad outcomes with associated bad press will change it. Completely political and not medical. The end to GMOs will truly come when states refuse to license anyone without residency training. That may actually happen, many states have gone to 2 or 3 years of GME vice the old standard of one.

For the Navy, half of interns end up going straight through training and only 25% of GMOs complete their obligation and leave the service. So the bottom line is that only 13%(ish) of graduating medical students will leave without completing some residency.

 

[NavyFP]

This reminds me of the time we read about the Weimar Republic in Germany during the 1920s.

Yeah, and then things improved, they had a war.......

 

[Ex-44E3A]

Financially, it was a big loser.

The administrative "crazymakers" were a source of almost constant fury among myself and my colleagues... and nobody in the CoC gave a hoot what we thought.

And how hard is it to pay people on time? Or not hold up their paycheck because they didn't fill out some meaningless administrative paperwork? Or not screw up their pay EVERY. SINGLE. DEPLOYMENT.

 

[bobbyseal]

I'm wondering if those who are generaly happy/not disgusted with milmed are those who were able to train straight through and move on as an attending. I imagine if you got stuck in gmo land and then did residency and regained all of the commitment back again, one would be pretty pissed.

I trained straight through and I'm pretty much left alone to do what I need/want to do with my patients at my current command. I can't really complain.

Not that I'm going to stick aroun milmed once my committment is done . Like we used to say in residency once the day was done - time to gtfo.

 

[Gastrapathy]

For the Navy, half of interns end up going straight through training and only 25% of GMOs complete their obligation and leave the service. So the bottom line is that only 13%(ish) of graduating medical students will leave without completing some residency.

Really? Thats an amazing statistic. That means that the GMO system benefits the Navy twice over. 1. more bodies for operational billets, 2. these people tend to come back for residency and incur extra obligation.

Not much incentive to be rid of GMO tours.

My main complaint with MTF life is the constant uncertainty with deployment. At least line officers know when they are going. I don't even mind going...I just want to know when more than 4 weeks in advance next time.

 

[orbitsurgMD]

Really? Thats an amazing statistic. That means that the GMO system benefits the Navy twice over. 1. more bodies for operational billets, 2. these people tend to come back for residency and incur extra obligation.

Not much incentive to be rid of GMO tours.

My main complaint with MTF life is the constant uncertainty with deployment. At least line officers know when they are going. I don't even mind going...I just want to know when more than 4 weeks in advance next time.

So think of it this way: if you take the HPSP "scholarship" and have to repay it in term of service, there is a 50% chance you will have to repay twice, and you won't know ahead of time.

You would have to show me that 75% of those selected for GMO tours actually stay for a Navy residency after their tours. Either there are very few GMOs anymore (fewer, yes, but not that many fewer) or much bigger residency programs than in the past (really doubtful). The numbers were very much the reverse in the past, with a large majority of GMOs leaving for civilian residency at their EAOS.

 

[Perrotfish]

Really? Thats an amazing statistic. That means that the GMO system benefits the Navy twice over. 1. more bodies for operational billets, 2. these people tend to come back for residency and incur extra obligation.
.

Its really not that much extra obligation for most specialties. Only the surgeons really add a significant amount of time to their obligation by doing a residency after a 2 year GMO tour. If you're Medicine, Peds, EM, or FM you don't gain any obligation. Psych, Neuro, OB, and Gas only add a year.