Stipend

[Tooth]

As far as the Navy is concerned...

To answer "when" these changes might occur, I would just like to reiterate a quote from Vice Admiral Donald C. Arthur, the Navy surgeon general. This quote was provided by Tom Philpott, the reporter who broke the story on the HPSP revamp. Arthur is reported to have said, "the Navy would like to have all of the new authorities and would use most of them immediately."

http://www.military.com/features/0,15240,104359,00.html

---

Members don't see this ad.

 

[aau22]

Anyone have any news? I know it's going to take a while but just curious I know I'm struggling on my 1200 a month...

 

[|2idicu|ous]

I don't know whats going on either. I can't find any info about if or when the stipend will increase. I guess we will sit and wait and hope.

 

[Tooth]

I can't believe how dead this thread has become. Why is it that before, many people had many connections, and now zippo?

 

[DD214_DOC]

I can't believe how dead this thread has become. Why is it that before, many people had many connections, and now zippo?

Not much to do now but wait and worry about other things. Before it was a matter of if/what was going to happen, now that it's finalized the only question is when, and it is doubtful anyone really has a clue.

 

[NavyFP]

Not much to do now but wait and worry about other things. Before it was a matter of if/what was going to happen, now that it's finalized the only question is when, and it is doubtful anyone really has a clue.

It is up to Health Affairs now. No new money was allocated, but that does not mean HA can't increase it. We will see what they dictate from on high.

 

[HumptyDumptyMil]

It is up to Health Affairs now. No new money was allocated, but that does not mean HA can't increase it. We will see what they dictate from on high.

I thought the general consensus was that money WAS allocated along with the bill? I personally contaced Mr. Philpott, who first wrote the article on the possible stipend increase, and I believe I saw someone else confirm the allocation as well.

 

[kaikai128]

Anyone have any news? I know it's going to take a while but just curious I know I'm struggling on my 1200 a month...

Struggling, heck after taxes here 1200 would not even pay rent and electric. Forget about food, insurance, gas, water, trash, etc.

 

[DD214_DOC]

Struggling, heck after taxes here 1200 would not even pay rent and electric. Forget about food, insurance, gas, water, trash, etc.

My rent alone for a 1200 sqft apartment is almost $1000/mo. Thankfully the wife has a decent job.

 

[almostfamous]

My rent alone for a 1200 sqft apartment is almost $1000/mo. Thankfully the wife has a decent job.

only $1000?
i'm at 1800 for rent, which is paid with loans, and the 1200 barely pays utilities, gasoline, and groceries. screw this.

 

[BigNavyPedsGuy]

Below is a correspndence between myself and CAPT McLean, the HPSP director. It gives the definitive answer. Everyone could have saved lots o' time by simply sending an e-mail

Good afternoon, I am currently on an AT, and all of the other HPSP students are buzzing because they heard we got a substantial stipend increase. Can you please confirm or deny that? Also, I heard they were giving out signing bonuses to new enrollees now . . . nice, too bad I missed out on that one.





I will have to deny that rumor.

You are being given a hard lesson in authorization vs appropriation.

Authorization - I am allowed to give it.

Appropriation - I have the money to pay for it.

Even with the most creative budgeting I can come up with will not allow for an increase in stipend.

Sorry.

David B. McLean, MD

CDR MC USN

 

[MedicalCorpse]

I will have to deny that rumor.

You are being given a hard lesson in authorization vs appropriation.

Authorization - I am allowed to give it.

Appropriation - I have the money to pay for it.

Even with the most creative budgeting I can come up with will not allow for an increase in stipend.

Sorry.

David B. McLean, MD

CDR MC USN

Insert Kübler-Ross DABD Stages Below.

A is only for lobotomized O-6s and above.

--
R

 

[meadco]

So, if I may ask, what happens to the 2% pay increase that they already erased for this year? Are we double-screwed?

 

[HumptyDumptyMil]

So, if I may ask, what happens to the 2% pay increase that they already erased for this year? Are we double-screwed?

Ohhhh, that will piss me off to the extreme We are not going to receive raises anymore b/c all the money is going towards the war?

 

[NavyFP]

So, if I may ask, what happens to the 2% pay increase that they already erased for this year? Are we double-screwed?

You will get the 2.2% increase. Blame Congress for not earmarking the money.

 

[Tooth]

So basically NavyFP had it right the whole time. Nice work! I guess it's time to come back to reality. I hate to be pessimistic, but due to the changing of wording in the authorization act, couldn't the stipend be cut back to zero if they wanted to? You know to allocate the money for the war?

 

[NavyFP]

So basically NavyFP had it right the whole time. Nice work! I guess it's time to come back to reality. I hate to be pessimistic, but due to the changing of wording in the authorization act, couldn't the stipend be cut back to zero if they wanted to? You know to allocate the money for the war?

Yes, but it won't. Navy is having a hard enough time getting students.

 

[former military]

Yes, but it won't. Navy is having a hard enough time getting students.

This is the first of many military bitch slaps for new entries into military medicine. Probably ought to get a mouth guard because more are coming.... (in the best interest in the military)...

 

[BOHICA-FIGMO]

You know, is it too much to hope that the military would at least TRY to recruit top notch physicians? With all the loan repayment programs offered by hospitals and private groups, what incentive is HPSP anymore? Perhaps that is why the military is using so many RNP, PA, and FMGs rather than licensed MDs and DOs!!

 

[deuist]

You know, is it too much to hope that the military would at least TRY to recruit top notch physicians? With all the loan repayment programs offered by hospitals and private groups, what incentive is HPSP anymore? Perhaps that is why the military is using so many RNP, PA, and FMGs rather than licensed MDs and DOs!!

The financial incentive is no longer there---not to mention all of the administrative headaches that a military doc has to take on.

 

[BomberDoc]

The military will always go with the lowest bidder. Dollars matter more than quality.

'nuff said.

 

[jmspilka]

So back at start of Oct i got that extra bonus for BAH backpay or whatever. it was about 1500. I got a email about three weeks later from OH saying they had done an audit on my account and discovered that I had been paid that "bonus" in error. and now DFAS is withholding pay till the 1500 is paid back. Anyone else have that issue?

 

[MedicalCorpse]

So back at start of Oct i got that extra bonus for BAH backpay or whatever. it was about 1500. I got a email about three weeks later from OH saying they had done an audit on my account and discovered that I had been paid that "bonus" in error. and now DFAS is withholding pay till the 1500 is paid back. Anyone else have that issue?

Hate to say I told you so...O.K., no I don't:

http://forums.studentdoctor.net/showpost.php?p=4251340&postcount=14
http://forums.studentdoctor.net/showpost.php?p=4209037&postcount=148

Get used to it. If there is any way the military can hose you (money, assignments, respect), they will...even if the option of "not hosing you" seems to be equally easy. Now, imagine if you will the life of an E-1 whose pay was messed up by the military through no fault of her own, only to have a month's salary withheld due to sheer incompetence on the part of the finance *****s? Now you know one reason why all the young troops at Travis and Andrews were on Food Stamps-- more reliable than military pay.

So much for the military tie fanwan (iron rice bowl)...more like ice.

Sad, sad, sad.

--
R

 

[BOHICA-FIGMO]

So back at start of Oct i got that extra bonus for BAH backpay or whatever. it was about 1500. I got a email about three weeks later from OH saying they had done an audit on my account and discovered that I had been paid that "bonus" in error. and now DFAS is withholding pay till the 1500 is paid back. Anyone else have that issue?

Yep. Ditto here. I guess the DoD is quite possibly the only organization in the world that pays single people less than married people for equal work/hardship. The DoD's 1950's social model for reimbursement is archaic, unfair, and HAS TO GO!!!!

 

[Tooth]

Tom Philpott just came out with another update on the HPSP stipend increase.

http://www.military.com/opinion/0,15202,119115,00.html

The John Warner National Defense Authorization Act for Fiscal Year 2007 (HR 5122), which was signed into law Oct. 17, authorizes the secretary of defense to increase the HPSP stipend to a maximum of $30,000 per year. The current stipend is $1319 per month.

But Congress did not provide funds to cover such an increase. In recent weeks, after reviewing their budgets, the Army, Navy and Air Force medical departments determined they do not have enough money in their fiscal 2007 accounts to be able to raise the HPSP stipend, except for 2.2 percent cost-of-living increase next July. That modest increase already had been programmed into their budgets.

The office of the Assistant Secretary of Defense for health affairs continues to review the issue of more substantial stipend increases but, for now, they are shelved. – Tom Philpott

 

[Maldini]

Good info guys. Thanks for the updates.

One thing that I wish I knew before I signed up for the military scholarship is that it's really not designed for the typical person in their mid-20's. What I mean by that is the scholarship is GREAT for a person who comes into medical school without any outside debt. So if your parents take care of your car and insurance payments and credit cards then this is the scholarship for you because after paying rent you should have a few hundred left over a month to do with as you will, and you'll exit medical school with very little debt.

I'm not sure how the financial aid departments work at other medical schools, but at NYMC, they'll only let me take out around $2600 extra in Federal Stafford Subsidized loans over my scholarship. The reason being is that the financial aid department sets the same budget cap for all students and students cannot borrow any more than that. No matter how much I argued with them, they wouldn't let me take out more loans. You'd think that it shouldn't happen that way because it's your future and your debt, but apparently schools have to report how much it should cost to attend school at their respective institution and they can't allow students to borrow above this cap or else they end up getting in trouble.

In my situation, I'm a guy in my mid-20's who accrued some debt in my life. I like to consider my situation as an average one. My parents don't support me, I lived on my own and worked for 3 years before attending medical school, so it's only natural that I accrued debt. I have a car payment for about $320 a month and a personal loan for $215 a month that will mature in about another year which will be nice. The rent for the dorms at NYMC is $675 a month which I have to pay out of pocket because of the military scholarhsip. So doing the math $1279 - $675 - $320 - $215 = $69. That's how much I theoretically have left over each month after bill payments. Factor in insurance payments of $600 every 6 months and you can see how the current stipend is not enough to live on for me personally.

If I had known how the math works before signing up, I probably wouldn't have taken the scholarship to begin with. Like I said earlier, the scholarship is great if you're in a good financial situation, but if you're not you're better off just going with the financial aid route and taking the > $200,000 hit from Medical School.

I hope this helps people with their decision making.

Thanks for listening.

 

[cyclegirl]

I am not sure how your school is calculating things but at my school the max I could take out was around $21,000 in federal Stafford subsidized and unsubsidized loans for the year. You just mentioned subsidized loans so if things are a little tight for you then think about taking out federal unsubsidized loans. It might make things easier for you.

 

[BOHICA-FIGMO]

FWIW, my school has the same policy as Maldini's. I receive ~$2K/yr above and beyond what HPSP gives me.

I think the real issue is this: what incentive is HPSP if people are going to have to take out loans to pay for medical school anyway? Sure, tuition is free, but you are stuck making a MAXIMUM of anywhere from 1/4 (e.g., ortho) - 3/4 (e.g., FP) what a civilian doc who is board certified in the same specialty makes for as long as you are in the military. Any way you do the math, HPSP has ZERO long term financial benefit. The ONLY benefit is in the short term during med school and residency, and even that benefit is quickly deteriorating. Perhaps that is why HPSP recruitment is way down and HPSP retention beyond the four year payback is (anecdotally) so abysmal.

 

[Maldini]

I am not sure how your school is calculating things but at my school the max I could take out was around $21,000 in federal Stafford subsidized and unsubsidized loans for the year. You just mentioned subsidized loans so if things are a little tight for you then think about taking out federal unsubsidized loans. It might make things easier for you.

They factor in your stipend in your aid. So take that 1279 a month and multiply it by how many months you're in school. That's the reason why the amount of loans that I can take out on HPSP is severely limited, according to their warped logic.

 

[Maldini]

My tuition runs about 30k/yr, and I was able to take out an extra 20k in loans to pay for assorted expenses this year with no problem. Of course they were not all Subsidized Stafford loans, a big chunk were unsubsidized. In addition, you have the option of applying for MedLoans (ALP) if you need additional money.

Why wouldn't you just go that route?

All outside sources of money has to get approved by your school's financial aid office, and they already told me on numerous occasions that I cannot take out an more educational loans.

Now there's nothing stopping me from taking out personal loans, but you cannot defer non-educational loans and I'd have to start paying those back right away which really doesn't help my situation at all.


Tuition here is about $19 K a semester with all the associated fees taken care of by the military. So that's how much the military pays the school. So take that ~$38 K and tack on all the stipend money over the course of 10 months and that's why I'm so limited in the amount of money that I can take out in additional loans.

 

[orbitsurgMD]

FWIW, my school has the same policy as Maldini's. I receive ~$2K/yr above and beyond what HPSP gives me.

I think the real issue is this: what incentive is HPSP if people are going to have to take out loans to pay for medical school anyway? Sure, tuition is free, but you are stuck making a MAXIMUM of anywhere from 1/4 (e.g., ortho) - 3/4 (e.g., FP) what a civilian doc who is board certified in the same specialty makes for as long as you are in the military. Any way you do the math, HPSP has ZERO long term financial benefit. The ONLY benefit is in the short term during med school and residency, and even that benefit is quickly deteriorating. Perhaps that is why HPSP recruitment is way down and HPSP retention beyond the four year payback is (anecdotally) so abysmal.

Your story illustrates just how poorly the services have treated the whole of the HPSP program, and not just the post-HPSP accessions.

Imagine having to pay market rate for an apartment share in NYC or Washington, and not just $675/ month. Even as far back as my medical school time, I was authorized to borrow up to $7500/ year under the Pell loans, and that was when HPSP paid $600/month stipends. Go figure.
They ought to be doing more to make life better for the people they are trying to attract.

 

[Maldini]

FWIW, my school has the same policy as Maldini's. I receive ~$2K/yr above and beyond what HPSP gives me.

I think the real issue is this: what incentive is HPSP if people are going to have to take out loans to pay for medical school anyway? Sure, tuition is free, but you are stuck making a MAXIMUM of anywhere from 1/4 (e.g., ortho) - 3/4 (e.g., FP) what a civilian doc who is board certified in the same specialty makes for as long as you are in the military. Any way you do the math, HPSP has ZERO long term financial benefit. The ONLY benefit is in the short term during med school and residency, and even that benefit is quickly deteriorating. Perhaps that is why HPSP recruitment is way down and HPSP retention beyond the four year payback is (anecdotally) so abysmal.

Well, you get bonuses for being specialized and a bonus for having your MD. If you're a highly skilled surgeon, you're probably looking at 6 digits when you start working for the military. You also get bonus for signing on to work with them for more years. Also, doctors tend to climb the ranks rather quickly.

That being said, you have to factor in the fact that you don't have to pay malpractice insurance - which is a huge chunk of money for some specialties, you don't have to pay for office space, equipment, hired help, PA's, hospital time for surgeons, etc. and the actual money that you make it quite competitive. Top on that the fact that if you work 20 years in a government job you get a > 80% pension for the rest of your life and health benefits for the rest of your life. Then there's also the minimum loans that you have to pay back versus the mortgage like student loan payments that other students may have to pay.

I mean there are perks to being a military doctor. Being a military resident is nice because you're making Captains pay with the MD bonus. The last I heard it's about twice what the average resident makes.

But like I said above, it might not be for you if you have a lot of debt going in to med school.

 

[Maldini]

Your story illustrates just how poorly the services have treated the whole of the HPSP program, and not just the post-HPSP accessions.

Imagine having to pay market rate for an apartment share in NYC or Washington, and not just $675/ month. Even as far back as my medical school time, I was authorized to borrow up to $7500/ year under the Pell loans, and that was when HPSP paid $600/month stipends. Go figure.
They ought to be doing more to make life better for the people they are trying to attract.

That's because of your stipend amount. You multiply that by 10 and you get $6000 which counts as part of your scholarship money. That's much less than the > $12 K that we get now. That $6000 was added onto the tuition that the military paid and the difference between the maximum amount they allow you to borrow and your scholarship total is what extra money you're allowed to take out.

 

[orbitsurgMD]

. . . That being said, you have to factor in the fact that you don't have to pay malpractice insurance - which is a huge chunk of money for some specialties, you don't have to pay for office space, equipment, hired help, PA's, hospital time for surgeons, etc. and the actual money that you make it quite competitive. Top on that the fact that if you work 20 years in a government job you get a > 80% pension for the rest of your life and health benefits for the rest of your life. Then there's also the minimum loans that you have to pay back versus the mortgage like student loan payments that other students may have to pay.

You are making an apples/oranges comparison here. All those business expenses on the private side are paid out of gross collections not net income; comparing that to the obvious fact that an institutional (military, here) employed physician doesn't have those expenses sort of implies the contrary. Also not mentioned is that the private doctor spending his practice revenues gets significant say in who gets hired where he works and what kind of office and equipment he gets to work with.

In general, the net income of a private practitioner, especially many of those highly compensated specialists who have high malpractice premiums is significantly greater than the military counterpart.

 

[Maldini]

My school does not include the stipend money in aid calculations. They also do not include wages from my job. Did you report your stipend to them?

They already know how much I get. It's a matter of fact and documented. According to them the purpose of the stipend is for medical school expenses, and as far as any outside debt goes, I'm basically S.O.L.

Your school probably reports a higher budget to the government. If that's the case, then they'll let the students borrow more.

I also go to school in New York where the cost of living is high so it sucks. If I was down south somewhere or in the midwest, I could by a lot better on the current stipend.

 

[Maldini]

You are making an apples/oranges comparison here. All those business expenses on the private side are paid out of gross collections not net income; comparing that to the obvious fact that an institutional (military, here) employed physician doesn't have those expenses sort of implies the contrary. Also not mentioned is that the private doctor spending his practice revenues gets significant say in who gets hired where he works and what kind of office and equipment he gets to work with.

In general, the net income of a private practitioner, especially many of those highly compensated specialists who have high malpractice premiums is significantly greater than the military counterpart.

Well, you're making assumptions. You're assuming that someone is in a group practice. A doctor working on his own has to manage his own overhead. But the military isn't for everyone, if it was, everyone would do it. The pay is good. You get sub-specialty bonuses, licensure bonuses, degree bonuses, etc. There's a lot of money thrown out there to help cover the gap. You also have free housing if you want to go that route. And as always you get an awesome pension and free health care for life if you put your time in.

And again there's small Q.O.L. benefits for being in the military like discounts at many, many businesses, etc.

There's perks in both ways of life. Which one you ultimately do is up to the individual. Military doctors are very well compensated, and I personally have never met a poor one.

 

[basicscikills]

Well, you're making assumptions. You're assuming that someone is in a group practice. A doctor working on his own has to manage his own overhead. But the military isn't for everyone, if it was, everyone would do it. The pay is good. You get sub-specialty bonuses, licensure bonuses, degree bonuses, etc. There's a lot of money thrown out there to help cover the gap. You also have free housing if you want to go that route. And as always you get an awesome pension and free health care for life if you put your time in.

And again there's small Q.O.L. benefits for being in the military like discounts at many, many businesses, etc.

There's perks in both ways of life. Which one you ultimately do is up to the individual. Military doctors are very well compensated, and I personally have never met a poor one.

To start with, there's a big difference between being poor and being comparably compensated relative to a civilian practitioner. Most of us recognize that we aren't going to be destitute being military physicians, but what's most frustrating to me as an HPSP recipient are the following:

1. Not having enough money to meet basic living expenses during med school. The fact is that we don't expect to live like kings, but for those of us who do not rely on parents for support, the stipend barely covers rent and food. The fact that most schools don't allow much additional borrowing to help bridge the gap only makes things worse.

2. Having the stipend increase dangled in front of us by recruiters only to discover that it's a pipe dream. It's a fact that military recruiters often don't have the right information or misrepresent it, but it's very frustrating when you're told to expect one thing and then don't get it.

3. Finding out after I sign the papers that military practice makes it difficult to obtain civilian employment unless you've moonlighted.

To address your point regarding malpractice insurance, bonuses, etc., I've not seen many malpractice premiums that makes up the two hundred thousand or so dollar difference between civilian specialist pay and military, even in the best case scenario. If your premium is that high, you have the option of relocating to a lower premium state. Additionally, I don't see very many practicing civilian physicians going broke for lack of income (high debt, on the other hand, is another story).

As for the retirement, I don't see military retirement as such a great deal. For one thing, it's based, as far as I can tell, on your base pay, not on your bonus pay. The health care plan is decent, but comparable care is available in the civilian world, especially considering the difficulty of obtaining care under Tricare. If retirement was really that great a deal for doctors, perhaps more of them would be staying in?

The negatives that are reported on this board, furthermore, make any income gap that much larger. Not being able to choose your field in some cases, not being able to choose your area of practice, patient population, nursing staff, or support staff, and facing command by non-medical personnel all are worth thousands of dollars to most of us. I'd much rather be less compensated, but able to make responsible decisions in patient care, about my location, and concerning my field of practice. Since I will be equally (in your rosy scenario) or much less (in every other scenario I've seen) compensated relative to a civilian, it's not hard to understand why many docs aren't that enthused about sticking around for their twenty.

Anyway, I fail to see any validity in your arguments. Rather, please respect those of us who have made the commitment, plan to serve without complaint, but don't wish to stay beyond that. Unless the system is changed, I believe the situation will not improve.

 

[Jet915]

Sorry to say but if you signed up for HPSP because of the money you signed up for the wrong reasons. I live comfortably off my stipend but I live in Omaha where my rent is 300/month. I have classmates who are also on Navy HPSP, are single but still need to take out more loans so it depends on your lifestyle I guess.

 

[Ave21]

"Finding out after I sign the papers that military practice makes it difficult to obtain civilian employment unless you've moonlighted."

Im curious as to where you have heard this comment. Of all the negative comments Ive read in the forum, I have to say I can't remember ever reading that one. Surprising but I really haven't. Please expound on this statement.

 

[met19]

not everyone lives in omaha. some people live in NYC and the stipend doesn't even cover rent. The idea that the stipend pays your living expense is crap in some areas (Boston, NYC, DC, chicago, LA). And I didn't take it for the $$ but it would be nice if it covered my living expenses.

I plan on paying back my 4 years and getting the hell out. Not b/c I don't want to serve, but b/c all the BS I saw as a student rotating at Portsmouth.

 

[HumptyDumptyMil]

There was a thread about the whole financial calculations a couple months ago ( I think it was Desperado that posted). According to his calculations, you end up making more money taking the HPSP depending on what specialty (such as peds) you pursue.

As far as taking out educational loans, GA-PCOM allows their HPSP students to take out max $8500 subsidized and $35000 unsubsidized. This was fortunate for me because I'm planning to get married soon and I also have to help out my fiancee financially. I might not make as much in the future, but if I didnt have the little help from the monthly stipend, there was no way I could have afforded med school. It's a good thing I have some interest in peds too

Oh, and don't get me wrong, money was NOT the only reason I joined.

 

[jmspilka]

It was even better when HPSP accidentally gave us that bonus a few months ago and then withhold 2/3 of pay for 2.5 months to repay it. Now not only is rent barely payable, but I have credit card and loan payments that are 2 months overdude. So much for helping young officers with maintaining good financial standings. My credit is going right down the drain. Hope they reconsider a raise in stipend for next years fiscal year.

 

[orbitsurgMD]

Well, you're making assumptions. You're assuming that someone is in a group practice. A doctor working on his own has to manage his own overhead. But the military isn't for everyone, if it was, everyone would do it. The pay is good. You get sub-specialty bonuses, licensure bonuses, degree bonuses, etc. There's a lot of money thrown out there to help cover the gap. You also have free housing if you want to go that route. And as always you get an awesome pension and free health care for life if you put your time in.

And again there's small Q.O.L. benefits for being in the military like discounts at many, many businesses, etc.

There's perks in both ways of life. Which one you ultimately do is up to the individual. Military doctors are very well compensated, and I personally have never met a poor one.

I'm not making any specific assumptions. Group or solo, overhead is paid out of gross receipts. Who manages the overhead has no bearing on that fact. Implying that private practice doctors have to pay their malpractice insurance premiums out of their personal income and not as a component of their gross practice overhead expenses is deliberately misleading. After-expenses incomes--the figure we are talking about when we make the comparison to total military pays--are far better on the private side compared to military pay.

There really isn't "a lot of money thrown out there to cover that gap", as you wrote. That is the issue and the problem of pay non-competitiveness in the military. Military doctors are not "very well compensated", except for those that skate and don't do any work.

And no, you really don't get "free" housing, unless you at the same time believe that housing allowances shouldn't count in your totals of military pay. But you tout the value of those allowances, so which is it?

Awesome pension? That depends on how you expect to live in retirement. Free health care for life, if you put your time in? Not.

Small quality of life benefits? Discounts at many, many businesses? Maybe a few, if getting government rate at hotels means that much to you.

If you think that military pay is good, you beg the question: compared to what? There's more perks on the private side. A lot more. And that is the point.

 

[megadon]

The bottom line is how much money and autonomy do you want, and what patient base do you want, and how much crap can you put up with. Yeah, you can make a lot more money on that outside, and if that drives you, get out or stay out. Once you're in and certified, you'll make six figures. Not much over but six figures. How much money do you need? That's not a judgement, but something to ask yourself. How much autonomy do you want, by which I mean the military OWNS you. They can yell at you, can't do nothing, they can make stupid rules (which they do) can't do nothing. It's a huge beaucracy, and if you can live with that, you'll be ok. Upside is, you can tell what rank everyone is, so you know which jerk you can't mouth off to. Patient base is great, generally healthy, which is a downer for education. How much crap you can put up with, this basically refers to how well you can cope with knee jerk reactions to some incident. I have no first hand evidence in medicine, but in the miltary in general I can comment. Something stupid happens, so the knee jerk reaction is something outrageous to prevent it from happening again, which only causes more problems in getting your job done. If you can accept this, you'll be ok.

Pension for life, absolutely, one of the few remaining. Just realize it is based on a percentage of your BASE pay, which doesn't include all the bonuses that got you over six figures, and doesn't include housing and food. If you own your house, you can live on that. Plus, you'll retire by 50, which means you can still work. Go private, no pension, so I hope the stock market doesn't crash, cause you're responsible for providing your own pension. Hope I'm wrong, but not a single one of us will see a dime from social security as we get means tested out, and I'm fine with that. If you want to complain how low the pension is, than don't even go into how low social security is.

Free health care for life, pretty much. You have to shift to medicare, but yeah, it's there.

Basically, if you're not in it for the MONEY, the military is on balance a good deal. Do your time, get a pension. Put up with a lot of crap and frustration during that. Get out with no debt (massive bonus) which enables you to go into private practice, and go to town. Feel good about yourself for serving the country, upcheck. Get yelled at time and time again, downcheck. Asked to do more with nothing, downcheck. I already did seven years time in the Navy, and am not hesistating about doing another thirteen.

 

[basicscikills]

"Finding out after I sign the papers that military practice makes it difficult to obtain civilian employment unless you've moonlighted."

Im curious as to where you have heard this comment. Of all the negative comments Ive read in the forum, I have to say I can't remember ever reading that one. Surprising but I really haven't. Please expound on this statement.

The point has been made several times on the board. The main crux of it is that civilian employers are well aware that military medicine has gone from being a functioning unit to an operator of clinics. Because of this, they know that surgeons might not see enough cases to keep their skills sharp or that emergency medicine docs (my main concern since that's what I wish to practice) don't see the type of cases they will be experiencing on the civilian side. If you're an EM doc but have basically manned a clinic for four years, you're not going to be prepared to step into a big city ED and function effectively. If you've moonlighted, prospective employers know that you've at least been seeing some of those things.

 

[Omar-57]

Ok it makes sense that they would want to see that you have experience. How does that relate to someone who is upset with there mil med sit and is getting out after gmo to look for civilian res spot?

Also on the moon-lighting bit, what levels mil medical people would be able to to do it?

And for letting the civ hospitals know you have seen and done it by moon-lighting; I thought the moon-light spot would be only in civ clinics. Or could you do it in trauma 1 centers? And what responsibilities would they give you as a temp?

Thanks

 

[Ave21]

As I stated before I haven't heard that comment before in this forum and Im not too sure I agree with it. I would like to hear from one of the doc that regularly post here on this topic of not finding a job after military?

I would think that if you are going to be an EM doc and will be soon anyway, there is a good chance of being sent to Iraq where you would see things that no other civilian EM doc would ever see. That type of experience could go a long way, I would hope and think.

 

[Maldini]

The bottom line is how much money and autonomy do you want, and what patient base do you want, and how much crap can you put up with. Yeah, you can make a lot more money on that outside, and if that drives you, get out or stay out. Once you're in and certified, you'll make six figures. Not much over but six figures. How much money do you need? That's not a judgement, but something to ask yourself. How much autonomy do you want, by which I mean the military OWNS you. They can yell at you, can't do nothing, they can make stupid rules (which they do) can't do nothing. It's a huge beaucracy, and if you can live with that, you'll be ok. Upside is, you can tell what rank everyone is, so you know which jerk you can't mouth off to. Patient base is great, generally healthy, which is a downer for education. How much crap you can put up with, this basically refers to how well you can cope with knee jerk reactions to some incident. I have no first hand evidence in medicine, but in the miltary in general I can comment. Something stupid happens, so the knee jerk reaction is something outrageous to prevent it from happening again, which only causes more problems in getting your job done. If you can accept this, you'll be ok.

Pension for life, absolutely, one of the few remaining. Just realize it is based on a percentage of your BASE pay, which doesn't include all the bonuses that got you over six figures, and doesn't include housing and food. If you own your house, you can live on that. Plus, you'll retire by 50, which means you can still work. Go private, no pension, so I hope the stock market doesn't crash, cause you're responsible for providing your own pension. Hope I'm wrong, but not a single one of us will see a dime from social security as we get means tested out, and I'm fine with that. If you want to complain how low the pension is, than don't even go into how low social security is.

Free health care for life, pretty much. You have to shift to medicare, but yeah, it's there.

Basically, if you're not in it for the MONEY, the military is on balance a good deal. Do your time, get a pension. Put up with a lot of crap and frustration during that. Get out with no debt (massive bonus) which enables you to go into private practice, and go to town. Feel good about yourself for serving the country, upcheck. Get yelled at time and time again, downcheck. Asked to do more with nothing, downcheck. I already did seven years time in the Navy, and am not hesistating about doing another thirteen.

To sort of carry on from this, years in school under the HPSP scholarship, though it doesn't add to years for your pension, it does add to years of pay for your pension when they calculate out at your retirement. I think that applies to years in residency as well since you're not active service. So when you do finish your 20 years, you get 20 years worth of pension + the years of reserves which is nice.

On top of that, nothing is holding you back from putting into a 401K, IRA's etc. so your retirement package is going to be that much nicer.

To the latter discusison in this thread, I'm sure Trauma Surgeons or even Orthopods aren't lacking work in the Military now-a-days

 

[Maldini]

To start with, there's a big difference between being poor and being comparably compensated relative to a civilian practitioner. Most of us recognize that we aren't going to be destitute being military physicians, but what's most frustrating to me as an HPSP recipient are the following:

1. Not having enough money to meet basic living expenses during med school. The fact is that we don't expect to live like kings, but for those of us who do not rely on parents for support, the stipend barely covers rent and food. The fact that most schools don't allow much additional borrowing to help bridge the gap only makes things worse.

2. Having the stipend increase dangled in front of us by recruiters only to discover that it's a pipe dream. It's a fact that military recruiters often don't have the right information or misrepresent it, but it's very frustrating when you're told to expect one thing and then don't get it.

3. Finding out after I sign the papers that military practice makes it difficult to obtain civilian employment unless you've moonlighted.

I agree with you on the above points

To address your point regarding malpractice insurance, bonuses, etc., I've not seen many malpractice premiums that makes up the two hundred thousand or so dollar difference between civilian specialist pay and military, even in the best case scenario. If your premium is that high, you have the option of relocating to a lower premium state. Additionally, I don't see very many practicing civilian physicians going broke for lack of income (high debt, on the other hand, is another story).

After speaking with several surgeons including pediatric surgeons and ob/gyn, malpractice insurance can cost a HUGE chunk of change. In fact looking at this article (http://www.washingtonian.com/articles/health/2561.html) shows that they can be well over 100 K for surgical sub-specialties.

Sometimes moving isn't always an option for a lot of people depending on their situation.

As for the retirement, I don't see military retirement as such a great deal. For one thing, it's based, as far as I can tell, on your base pay, not on your bonus pay. The health care plan is decent, but comparable care is available in the civilian world, especially considering the difficulty of obtaining care under Tricare. If retirement was really that great a deal for doctors, perhaps more of them would be staying in?

Military pension is that much nicer when you add to it the same retirement options that private sector doctors invest in. Nothing is stopping the military doctor from investing in the same fashion. The only difference is that they'll have the pension on top of that.

Also after 20 years as a military doctor, you're looking at a rank of Lt. Col or Col if you're good. The last time I checked, Col pay can be up around 6 figures.

In fact on page 450 of the Army Officer's Guide, 50th edition, a army doctor at the rank of colonel and 20 years in the service makes $7,763.40/month x 12 = $93,160.80. If you tack on to that years in the reserves in Residency or as a student, it goes up.

The negatives that are reported on this board, furthermore, make any income gap that much larger. Not being able to choose your field in some cases, not being able to choose your area of practice, patient population, nursing staff, or support staff, and facing command by non-medical personnel all are worth thousands of dollars to most of us. I'd much rather be less compensated, but able to make responsible decisions in patient care, about my location, and concerning my field of practice. Since I will be equally (in your rosy scenario) or much less (in every other scenario I've seen) compensated relative to a civilian, it's not hard to understand why many docs aren't that enthused about sticking around for their twenty.

Anyway, I fail to see any validity in your arguments. Rather, please respect those of us who have made the commitment, plan to serve without complaint, but don't wish to stay beyond that. Unless the system is changed, I believe the situation will not improve.

I would hope that I respect those of you, because I'll more or less probably be one of those people too. I also planned on practicing back home in RI, and the only major military bases in the area is in Newport, RI and that's the Navy academy.

 

[orbitsurgMD]

Military pension is that much nicer when you add to it the same retirement options that private sector doctors invest in. Nothing is stopping the military doctor from investing in the same fashion. The only difference is that they'll have the pension on top of that.

Also after 20 years as a military doctor, you're looking at a rank of Lt. Col or Col if you're good. The last time I checked, Col pay can be up around 6 figures.

So what are we to assume other than that the pension alone is not enough for a retirement. Adding to that retirement by having to establish a second career is what is necessary. Nothing is stopping the military doctor from investing his savings except that he has less income from which to accrue those savings. Also, despite available TSP, the private doctor still has available more options to save money in a tax-deferred status, and of course more money with which to make those investments in the first place.

O-5 pay might make an adequate retirement income, but that isn't what you get. The maximum you can receive is 75% of the base pay for that rank, and that comes after 30 years service. In the post-DOPMA career world, you are fairly late-career to draw that. There wouldn't be much time for second careers with accrual of invested savings to speak of.

A military career will not equal the income or retirement savings potential of a private career in medicine.