quitting hpsp

[grayce79]

OK, so I've asked before about quitting hpsp. It seems that the consensus is that you can quit if you are willing to pay back all of the money with interest. However, does anyone actually know of anyone who has done this? I could only find one person using a google search who got court martialed and had to serve 5 days in military jail for being a conscientious objector. (Even though he offered to pay all of the money back.)
If I wanted to quit, could I end up in jail too? (I'm not a conscientious objector.)

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[kaikai128]

I have no clue where you are in the scholarship--but my best advice would be to just ask someone who would know (If you are AF, this would be Major Frisco). This is the only way you are going to be 1. taken seriously and 2. get the answers you are looking for.

...If I were you, I would pull out my contract and read it carefully before contacting anyone--it was covered quite extensively in mine.

 

[Neuronix]

On the Army contract side of things, the procedure is one of those "ask and see what happens" type deals. You can read the contract till you're blue in the face, but the conclusion I came to is: you can file and based their panel they can decide to punish you, to deny you, or to let you go (with payback? Without? They "may" ask you). Like everything else in HPSP, the procedure is very ambigious.

Word of mouth is that years ago (i.e. before Iraq) they used to let people out all the time. The idea was "if you don't want to serve, we don't want you to serve". It doesn't seem that way anymore. The insiders are planning to have people for operations in the Middle East for 15 years from now, and that means YOU (and anyone else in or thinking about HPSP). Nobody knows anyone who has left past OBC now, and asking anyone with any rank just gets you threats of court marshalls. We all know that this war that just drags on is hurting military recruitment. My guess is that they aren't letting anyone out--especially someone who is so far advanced (from your other posts I gather you're a fourth year?).

Edit: Looking back at some of your other posts, you are AF. Hopefully this post will be useful to someone

 

[grayce79]

...If I were you, I would pull out my contract and read it carefully before contacting anyone--it was covered quite extensively in mine.

OK, so I pulled out my contract and there it was...

"I will not be relieved of my active duty obligation solely because I am willing and able to reimburse the Government for the total cost of advanced education."

Well, that answers my question. Man, the AF is so smart! They have all of their bases covered! All right, this is my official turning point. Now that I know there is no way out, I'm just going to resolve to love the AF and serve my time with enthusiasm and honor.

For those of you who haven't signed on yet, don't do it until you have gotten a chance to at least shadow some active duty physicians. Most of them have told me how miserable they are and how the military is shifting gears to eventually contract most of the work out to civilian providers. Just remember that the recruiters benefit financially from getting you to sign on and mine was willing to lie and pressure me to get me to sign on. (Which I only blame myself for just believing him and giving into the pressure.)

For those of us who are stuck, let's try and improve things as much as we can. And on another note, from what I've seen so far, patient care is actually really great.

Go AF!

 

[island doc]

OK, so I've asked before about quitting hpsp. It seems that the consensus is that you can quit if you are willing to pay back all of the money with interest. However, does anyone actually know of anyone who has done this? I could only find one person using a google search who got court martialed and had to serve 5 days in military jail for being a conscientious objector. (Even though he offered to pay all of the money back.)
If I wanted to quit, could I end up in jail too? (I'm not a conscientious objector.)

Back when I was in we looked into this also. It is not about money, or paying back the money in cash with interest. The problem you face is this: they need and are counting on having your warm, breathing body at a certain point in the future. They don't want (or need) your money, but rather they want and need you as an endentured servant. They will get their pound (actually ton) of flesh out of you, but in terms of hard labor under difficult conditions, not cash. Sorry.

 

[island doc]

OK, so I pulled out my contract and there it was...

"I will not be relieved of my active duty obligation solely because I am willing and able to reimburse the Government for the total cost of advanced education."

Well, that answers my question. Man, the AF is so smart! They have all of their bases covered! All right, this is my official turning point. Now that I know there is no way out, I'm just going to resolve to love the AF and serve my time with enthusiasm and honor.

For those of you who haven't signed on yet, don't do it until you have gotten a chance to at least shadow some active duty physicians. Most of them have told me how miserable they are and how the military is shifting gears to eventually contract most of the work out to civilian providers. Just remember that the recruiters benefit financially from getting you to sign on and mine was willing to lie and pressure me to get me to sign on. (Which I only blame myself for just believing him and giving into the pressure.)

For those of us who are stuck, let's try and improve things as much as we can. And on another note, from what I've seen so far, patient care is actually really great.

Go AF!

Really great patient care????? As a medical student you are not yet in the position to determine what consitutes "really great" care. When you are an attending with full responsibility working in a fundamentally flawed system without the necessary resources to do your job effectively, your perspective will definitely change. Thinking you can change things is a good and idealistic notion, although unrealistic. Many before you have come in with the same motivation, only to quickly become disillusioned. As one Colonel (an MD) once said to me, "you are just only one small, insignificant cog in a giant machine ". I am sorry to say, but you will have no voice in how things are run.

 

[IgD]

grayce79, take what you read in this forum with a grain of salt. Some of the posters here perceive that the cause of all their problems is military medicine and have made it their life's crusade to talk smack about it. If you have a positive attitude about things and a good work ethic chances are you will enjoy your experience in the military.

If you only read what the bottom 2% (the people in this forum) claim you will get a distorted view of reality. Keep an open mind and try to find the other people that are happy. I've found days I wanted to get out but most of the time I'm pretty happy.

Good luck.

 

[island doc]

grayce79, take what you read in this forum with a grain of salt. Some of the posters here perceive that the cause of all their problems is military medicine and have made it their life's crusade to talk smack about it. If you have a positive attitude about things and a good work ethic chances are you will enjoy your experience in the military.

If you only read what the bottom 2% (the people in this forum) claim you will get a distorted view of reality. Keep an open mind and try to find the other people that are happy. I've found days I wanted to get out but most of the time I'm pretty happy.

Good luck.

You still have not indicated how much actual personal experience you have working in USAF medicine, unlike the "bottom 2%" of us who have and thus possess a "distorted view of reality". Unless you have that personal experience, you are not in a position to accurately describe the type of experience someone else can expect in it. Navy experience does not translate to Air Force experience any more than swimming does to flying.

 

[USAFdoc]

Your continued disregard of the experiences of physicians that have actually been through the USAF primary care system makes YOU the actual DISTORTER of reality.

You still have not answered the question of what your USAF primary care experience is yet you seem quite certain that our experience is off base.

You also seem comfortable with labeling “us” as pessimistic docs” who would be unhappy wherever we are. Well, I am extremely happy where I am now as a physician. I was happy with my USNAVY enlisted career, my residency, and other jobs. I was a resident teacher of the year, and a USNAVY supervisor of the quarter and instructor. I had never had a job that I felt I needed to voice concerns about UNTIL my USAF primary care career started.

You IgD are DOING A DISERVICE to those considering USAF primary care as a career. I speak to that which I know 1st hand, why don’t you do the same. Anyone that has worked USAF primary care can realize that you have no experience on this issue, otherwise your opinions would not be so absurd.

 

[IgD]

# of primary care physicians in the air force = 400 ?
# of disgruntled former air force primary care physicians in this forum = 2 ?
% = 0.5

Would it really make a difference what branch of service and type of specialty I was in?

What if the original poster wanted to be a specialist and not work in primary care? Would the same opinion hold up?

 

[USAFdoc]

1. how many primary USAF docs even know about this site? I found it by accident a few months ago.
2. how many USAF primary care docs have great things to say........ZERO.
3. How many USAF primary care docs have I spoken personally with during the last 4 years.....15.......how many share my concerns......100%
4. Read the last few issues of USAFP, the mil FP journal online......read the letters to the editor or even the president's editorial........the will echo similar concerns that I have voiced here.
5. Still waiting for your experience with what you are continuing to speak on.
6. Yes it would make a difference what is your specialy and service. You do not see me talking about radiology in the ARMY or surgery in the NAVY; I am speaking to that what I know. Is that such a hard concept for you IgD?
7. If the original poster did not want to be in USAF primary care, then my comments need to be put in that context. I would be most concerned for those going into USAF primary care, less so for other services Primary care, and even less so in other specialties........however, as stated in other threads, I am concerned that some of the same market forces that have adversely affected some civilian medical jobs are now running rampant in some military venues, and unlike the civilian markets, the doctor truly is owned and has few options when the line of safety and reasonable work loads are crossed.

 

[militarymd]

As a member of the bottom 2% in the Navy with 11 years.....I must concur with the other disgruntled physicians.

1) System is broke
2) Those who want to fix it can't
3) Those who can fix it won't
4) You are just a cog
5) Find a hobby...I recommend vodka
6) Serve your time...then be happy
7) Read my posts in the anesthesia forum....I'm a happy guy....now
8) I guess it means I'm in the top 2% now.

 

[island doc]

# of primary care physicians in the air force = 400 ?
# of disgruntled former air force primary care physicians in this forum = 2 ?
% = 0.5

Would it really make a difference what branch of service and type of specialty I was in?

What if the original poster wanted to be a specialist and not work in primary care? Would the same opinion hold up?

You still won't give us a simple straight answer as to how much, if any, personal experience you have working as an attending physician in a USAF primary care clinic. You are not going to give us an exact answer, because we all know that your answer would simply be: none. And this answer from you would undermine your credibility on this issue. But, alas, you have already shown that you have no credibility on this, despite not providing a straightforward answer.

I already answered how it makes a difference what branch of service and specialty you were in. But since it hasn't sunk in yet, I will explain again: Can one accurately compare being the White House Physician to the President (an Air Force Family Physician) to that of an oncologist in the Army at BAMC in San Antonio, a navy neurosurgeon in San Diego, or to an FP at Robins AFB for that matter...Of course not. So obviously it does matter.

 

[Heeed!]

# of primary care physicians in the air force = 400 ?
# of disgruntled former air force primary care physicians in this forum = 2 ?
% = 0.5

Would it really make a difference what branch of service and type of specialty I was in?

What if the original poster wanted to be a specialist and not work in primary care? Would the same opinion hold up?

IgD, you really need to answer the question which has been asked many times in order for your opinion to carry any weight. What USAF primary care experience do you have?

 

[kjayquen]

I worked in the medical field for the Army and it was not a good experience as far as the few admin dealings with which I was involved. I am glad that there is a place to gripe about all of this. However, as a former soldier I can tell you that the attitude of the physicians in the military may not be able to change their own lot in life but military doctors that really cared about people and showed an interest in the grunts and peons that they are helping really make a big difference in the day to day lives of the enlisted members. I say to the op that a change of attitude will not only make his payback time an easier pill to swallow but will also improve the experiences of many of the underlings who feel that they matter even less in the big military picture. Thank you to those of you that were in terrible situations as physicians who still were able to find a positive attitude with which to pass on to your military patients.

 

[UncleRico]

I am in residency training at an AF medical center with many specialists. I can assure you that 80% of docs across ALL specialties that I have come in contact with are miserable in military medicine and are anxiously awaiting the day that they can leave. The issues that have been brought up by Milmd, USAFdoc, island doc, and others are REAL and current problems facing military medicine today, and they are experienced by both primary care and specialist physicians.

The system is broken. The military should get out of GME as soon as possible. The military should outsource care dependent and retiree care and focus on the troops.

Docs are leaving in droves, and this is creating a major scarcity of experienced physicians to mentor and train med students and new residents. This constant turnover is horrible for morale among physicians, terrible for patient care continuity, and creates a major void in GME training.

So, for all of you pre-med students reading these posts, please understand that these problems are real and are generally accurately described by the current and prior active duty physicians in this forum. If you had my perspective, these docs are not being negative; they are being truthful and sharing of their experiences to help better educate others about what military medicine is really like.

I invite any of you to buy a plane ticket and go to the military training center of your choice and talk with active duty docs in several different specialties. I can guarantee you that you will hear the same types of frustrations and disallusionment that you are reading on this forum from the vast majority of them. Unless you actually make the effort to do this, you will not be making and informed decision and you may end up with a lot of heartache and regret down the road.

 

[mitchconnie]

.

The system is broken. The military should get out of GME as soon as possible. The military should outsource care dependent and retiree care and focus on the troops.

Docs are leaving in droves, and this is creating a major scarcity of experienced physicians to mentor and train med students and new residents. This constant turnover is horrible for morale among physicians, terrible for patient care continuity, and creates a major void in GME training.
.

I agree 100% that the USAF should totally get out of GME. The BRAC should be the last straw in a 7-8 year deterioration in the teaching environment which has made GME increasingly untenable. At one base “hospital” where I work, there are a grand total of 16 medical beds, and yet they try to maintain a free-standing FP residency program. How absurd. What other 16 bed hospital in the developed world maintains a residency program?!

If the leadership had any class at all, they would stop interviewing new candidates for residency at all the hospitals which are to be closed, and plan to finish only the residents already in the program. Unfortunately, as far as I know,the program directors are still selecting trainees for programs which will not exist by the time they are ready to graduate. Instead of facing the fact that their teaching centers have collapsed, the USAF continues to prop up innumerable teaching programs of marginal quality.

The scary thing for HPSP students in the USAF, is that you could be forced to do residency at a hospital in it’s death throes by a backroom deal at the selection board. I spoke with a participant in the selection board two years ago who told me that the USAF surgery program directors distribute the top applicants evenly among all the programs regardless of what they put on their rank order list--frightening.

Good training opportunities may still exist, but they are becoming increasingly scarce in the USAF.

 

[island doc]

I agree 100% that the USAF should totally get out of GME. The BRAC should be the last straw in a 7-8 year deterioration in the teaching environment which has made GME increasingly untenable. At one base “hospital” where I work, there are a grand total of 16 medical beds, and yet they try to maintain a free-standing FP residency program. How absurd. What other 16 bed hospital in the developed world maintains a residency program?!

If the leadership had any class at all, they would stop interviewing new candidates for residency at all the hospitals which are to be closed, and plan to finish only the residents already in the program. Unfortunately, as far as I know,the program directors are still selecting trainees for programs which will not exist by the time they are ready to graduate. Instead of facing the fact that their teaching centers have collapsed, the USAF continues to prop up innumerable teaching programs of marginal quality.

The scary thing for HPSP students in the USAF, is that you could be forced to do residency at a hospital in it’s death throes by a backroom deal at the selection board. I spoke with a participant in the selection board two years ago who told me that the USAF surgery program directors distribute the top applicants evenly among all the programs regardless of what they put on their rank order list--frightening.

Good training opportunities may still exist, but they are becoming increasingly scarce in the USAF.

I don't see how such weak programs can maintain ACGME accreditation. What happens when those programs are inspected by the ACGME? The inspectors usually interview residents during the course of an inspection of the program, and that is a perfect opportunity for residents to express their concerns.

 

[grayce79]

Really great patient care????? As a medical student you are not yet in the position to determine what consitutes "really great" care. When you are an attending with full responsibility working in a fundamentally flawed system without the necessary resources to do your job effectively, your perspective will definitely change. Thinking you can change things is a good and idealistic notion, although unrealistic. Many before you have come in with the same motivation, only to quickly become disillusioned. As one Colonel (an MD) once said to me, "you are just only one small, insignificant cog in a giant machine ". I am sorry to say, but you will have no voice in how things are run.

I can't believe how condescending you are. You don't have to write to me like I'm in the first grade. Look, even in the civilian world there are all types of problems now. Medicine is changing everywhere. Doctors are having to work a lot harder with less staff for a lot less.
What would you like me to do island doc? Jump on the bandwagon and whine like the rest of you? I obviously take your advice and experiences seriously since I was even considering quitting HPSP. But, as I mentioned before, I'm stuck. And so all I can do is make the best of it. I'm not saying that I can single handedly change military medicine, but I'm also not going to sit around and complain my life away. As bad as your job can be, you are still luckier than 75% of working people out there.

 

[militarymd]

What is condescending about point what a fact? Medical students do not know what good patient care is.....

You just don't know enough about medicine. Hell, half of the junior staff out there who just finished residency are learning the ropes on what is good care or not.

 

[USAFdoc]

I can't believe how condescending you are. You don't have to write to me like I'm in the first grade. Look, even in the civilian world there are all types of problems now. Medicine is changing everywhere. Doctors are having to work a lot harder with less staff for a lot less.
What would you like me to do island doc? Jump on the bandwagon and whine like the rest of you? I obviously take your advice and experiences seriously since I was even considering quitting HPSP. But, as I mentioned before, I'm stuck. And so all I can do is make the best of it. I'm not saying that I can single handedly change military medicine, but I'm also not going to sit around and complain my life away. As bad as your job can be, you are still luckier than 75% of working people out there.

grayce79;

my advice (since you are stuck,like I was), is to do the best you can, think of the glass as half full, but don't ignore the fact that it is really probably more than half empty). You are right, we are all way better off than most people in the world, but that is no excuse for the military to continue to put forward such as flawed health care system (I am speaking about USAF primary care....I cannot directly speak to other areas).
The tougher question is will you just put in the time and do the best you can and get out, or will you fight with admin (it would be nice for them to work with you on this, but expect the worse) and with the senior USAF admin to tell them that thier plan is failing and demand better for you and your patients and staff? (and if they do not fix it, then you get out). To fight comes with risks. Island doc was threatened by staff as was I at my base (threats to attempt to ruin your credentials etc). I went through my chain of command over 2 years which eventually included the IG and Congress. Everyone agreed with me (behind closed doors, but there was NO ONE willing to continue to fight for change). After 2 years of fighting and being threatened (although my commanders appologized later), things were worse than ever clinically for staff and patients. The only good that may have come from it was I am seeing more senior leadership in Wash DC vocalize my same concerns, but still no change.